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Upper Limb Topography
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Fossa axillaris Between arm and chest Boundaries
Anteriorly – mm. pectorales Dorsally = latissimus dorsi, teres major, subscapularis Medially = serratus anterior Laterally = sulcus bicipitis Content Lymph nodes, vessels, pl. brachialis
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Foramen axillare laterale et mediale
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Posterior of the arm Surface anatomy M. triceps brachii
caput longum, medialis, lateralis Surface elements Skin thick and movable Subcutaneous tissue well expressed n. cutaneus brachii posterior n. cutaneus brachii lateralis inferior n. cutaneus antebrachii posterior
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Deep structures А. Fascia brachialis B. Neurovascular bundles
- Thick, thins distally B. Neurovascular bundles 1. Upper - in canalis humero-muscularis, between: - sulcus n. radialis - medial and lateral head of m. triceps brachii 1.1. n. radialis – lies on the humerus - n. cutaneus brachii lateralis inerior - n. cutaneus antebrachii posterior - rr. musculres 1.2. a. profunda brachii - a. collateralis media - collateralis radialis
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Lower neurovascular bundle
behind medial epicondyle n. ulnaris a. collateralis ulnaris inferior
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Elbow region
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Anterior elbow Surface anatomy Elements Three eminences Two grooves
Lateral groove - v. cephalica, n. cutaneus antebrachii lateralis Medial groove – v. basilica, n. cutaneus antebrachii medialis V. mediana cubiti
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Deep structures А. Muscles Flexors of forearm – medial eminence
Extensors of forearm – lateral eminence Brachial muscles, mm. biceps, brachialis – middle eminence
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Deep structures B. Vessels and nerves C. Cubital fossa Boundaries
Medial bundle - between m. biceps brachii and pronator teres - a.v. brachialis, n. medianus Lateral bundle - between m. brachialis and brachioradialis - n. radialis, a. collateralis radialis, a. recurrens radialis C. Cubital fossa Boundaries - m. brachioradialis (lateral), m. pronator teres (medial) Content - tendo m. brachialis, m. biceps brachii, bursa bicipitoradialis
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Layers of the elbow Venous 1 v. cephalica 2 v. basilica
3 v. mediana cubiti Apponeurotic 1 aponeurosis bicipis 2 tendo m. biceps brachii
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Neurovascular Muscle Bone 1 a. brachialis 2 n. medianus 1 m. supinator
2 m. brachialis 3 tendo m. biceps brachii Bone 1 humerus 2 radius 3 ulna
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The palm
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Surface Anatomy of Upper Limb
Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse) pg 306, 788
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Muscles of the Wrist Extensor muscles Extensor Retinaculum
What’s its function? Muscles innervated by radial nerve There are 8 Name them…
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Muscles of the Wrist Flexor Muscles
Flexor retinaculum (transverse carpal ligament) Two compartments Superficial – 4 Deep – 3 Name them… Innervated by median and ulnar nerve
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Wrist and Hand Anatomy Nerves/Vessels Radial & ulnar artery and veins
Radial, ulnar, & median nerves Carpal Tunnel Flexor Tendons - 9 Median Nerve
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- Medial and lateral eminence and middle depression
Surface anatomy - Medial and lateral eminence and middle depression - Flexion grooves - Commissural pads Surface elements Skin- thick, hairless - Attached to palmar aponeurosis – in the middle - Loose connective tissue in the eminences - r. palmaris (n. medianus), r. cutaneus palmaris (ulnaris) - small veins Aponeurosis palmaris – thick fibrous tissue - superficial layer – tendinous fibers of m. palmaris longus, - deep layer – transverse fibers, lig. metacarpeum transversum superficiale - commissural openings
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Lateral (thenar) compartment
Deep compartments Intermuscular septae and Palmar interosseous fascia form - Three fascial compartments Lateral (thenar) compartment Muscle - 4 layers - M. abductor pollicis brevis - M. opponens pollicis, m. flexor pollicis brevis (caput superfic.) - M. flexor pollicis brevis (caput profundus) - M. adductor pollicis Nerves - r. muscularis n. medianus Vessels - r. palmaris superficialis a. radialis Two connective tissue spaces – above and below m. adductor pollicis
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Medial (hypothenar) compartment
Muscles - 2 layers - Superficial - m. abductor digiti minimi, m. flexor digiti minimi - Deep - m. opponens digiti minimi Nerves – superficial and deep branches of n. ulnaris Vessels - superficial and deep branches of a. ulnaris M. palmaris brevis - proximal
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Middle compartment Muscular tendinous layer: Two spaces
- mm. flexores digitorum superficialis & profundus - mm. lumbricales - vagina synovialis communis flexorum Two spaces а. Superficial – below palmar aponeurosis - arcus palmaris superficialis - aa. digitales palmares communes - n. medianus - nn. digitales palmares communis - r. palmaris n. ulnaris - n. digitalis palmaris communis IV & n. digitalis palmaris proprius V Interfascial canals - distal - mm. lumbricales, a.n. palmares digitales comm. et propriae
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Middle compartment b. Deep space - below palmar interosseous fascia
- communications: forearm - trough carpal canal superficial space – interfascial canals - arcus palmaris profundus - a. radialis + r. profundus a. ulnaris - aa. metacarpales palmares - aa. digitales palmares communes - deep branch of r. palmaris n. ulnaris supplying - - mm. hypothenari, mm. interossei, m. adductor pollicis и mm. lumbricales II - IV.
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