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UPPER LIMBWhat is a limb?Sensory to upper limbMaking it moveBones and jointsMuscles and nervesVascular supplySurface anatomy(muscle study hint)
What is a limb?Ventral somatic outgrowth of outer tubeBones (with bone, cartilage, marrow, NAV, etc.)JointsMuscleNervesVascular supplyNo viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)
Sensory from limb (dermatomes/sensory skin segments from spine)Dermatomes extend over limbsTwisted orientation reflects twisting of limb during developmentNamed nerves generally innervate skin over muscles that they innervate
Sensory territory of nervesBrachial plexus serves to re-direct spinal routes into named nerves covering certain territoryCutaneous branches of medial cord/ulnar nerve
Upper Limb Skeleton (old hat?)ScapulaHumerusRadius, ulnaCarpals--proximal, distalDigitsMetacarpalsPhalanges
Joints
JOINT
BETWEEN
MOVEMENT
TYPE
Muscles of ScapulaIf INSERTION on scapula = Move scapulaRhomboidsTrapeziusPectoralis MinorSerratus VentralisLevator ScapulaeIf ORIGIN on scapula = Move ArmSubscapularisSupraspinatusInfraspinatusTeres MinorTeres MajorLatissimus Dorsi (partial O on scap)Coracobrachialispg 299Rotator CuffUse location of Insertion to determine exact movement!!
POSTERIOR AND ANTERIOR COMPARTMENTS
Brachial PlexusM&M, Fig. 14.11 Posterior Compartmentposterior cord Anterior compartmentmedial, lateral cords Name of cord is relative to axillary artery
ANTERIOR MUSCLESM-CBicepsbrachialisMedianForearm flexorsThumb intrinsics (1M$ nerve)UlnarFlexor carpi ulnarisHand intrinsicsPOSTERIOR MUSCLES
Muscles (radial nerve)TricepsAnconeusBrachioradialisCarpal, digit extensors
Muscles and nerves by compartment
ANTERIOR
POSTERIOR
NERVES
M-C, ulnar, median
Radial
MOVEMENT
Flexion
Extension
MUSCLES
Biceps, flexors
Triceps, extensors
TWIST
Flexors from medial epicondyle
Extensors from lateral epicondyle
Posterior Compartment of ForearmExtensor digitorumExtensor carpi ulnarisExt Carpi Radialis LongusBrachioradialisLateral EpicondylePosterior View
Anterior Compartment Forearm
Flexor Carpi RadialisFlexor RetinaculumMedial EpicondyleFlexor Digitorum Superficialis is deep to other flexorspg 302
Flexor Carpi UlnarisBrachioradialisPronator TeresAnterior View
Routes of nerves (in human)M-C: between biceps brachii and brachialisMedian: medial/posterior to biceps, branches into forearm flexors at elbow then to hand through carpal tunnelRecurrent median (1M$) superficial at wrist to thumb over thenar emminence) deficit - apes handUlnar: medial in arm, posterior to medial epicondle of humerus (funny bone) down medial forearm medial to carpal tunnel into palmRadial: deep posterior arm around lateral epicondyle of humerus to forearm (deep and superficial branches)
Vascular supplySubclavianaxillary radial (same street, new street sign every block)Collateral circulationPosterior/anterior circumflex humeralDeep brachial a.Radial a. (with median n.) deep palmar archUlnar a. (with ulnar n.) superficial palmar arch
Ulnar NerveBrachial ArteryMedian NerveUlnar NerveMedian NerveRadial ArteryMusculocutaneous NerveUlnarArteryWheres Radial Nerve?
Axilla = ArmpitRegion between arm and chestBoundariesVentral - pectoral musclesDorsal = latissimus dorsi, teres major subscapularisMedial = serratus ventralisLateral = bicipital groove of humerusContentsAxillary lymph nodes, Axillary vesselsBrachial Plexus
Surface Anatomy of Upper LimbBiceps + Triceps brachiiOlecrenon ProcessMedial EpicondyleCubital FossaAnterior surface elbowContentsMedian Cubital VeinBrachial ArteryMedian NerveBoundariesMedial= Pronator teresLateral= BrachioradialisSuperior= Line between epicondylespg 786 + 784
Surface Anatomy of Upper LimbCarpal TunnelCarpals concave anteriorlyCarpal ligament covers itContains: long tendons, Median nerveInflammation of tendons = compression of Median nerveAnatomical SnuffboxLateral = E.pollicis brevisMedial = E. pollicis longusFloor = scaphoid, styloid of radiusContains Radial Artery (pulse)pg 306, 788
Suggestion: a muscle table organized byJoint crossed?Nerve innervating?Action?Compartments?All of the above?
MUSCLE
ACTION
ORIGIN
INSERTION
INNERVATION
(cord to nerve)
Biceps
Flex, sup.
Humerus, glenoid
Radial tuberosity
Medial cordM-C.