The Upper Extremity

Bones, Muscles, Vessels,

pg 650

Bones 30 bones!!!! Appendicular skeleton Pectoral girdle

Glenoid cavity Allows for mobility

Attachments Upper extremity:

Arm humerus

Forearm Radius, ulna (interosseous membrane)

Hand Carpals, metacarpals, phalanges

Review bones and landmarks studied in lab!!!

pg 654

Joints of Upper Extremity

Sternoclavicular Synovial-saddle Diarthrosis

Acromioclavicular Synovial-plane Diarthrosis

Glenohumeral joint Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility

pg 668

pg 669

Joints of the Upper Extremity

Elbow Joint Synovial – hinge Diarthrosis

Articulations Humerus & Ulna Humerus & Radius

Many Ligaments

pg 726pg 725

Joints of Upper Extremity

Proximal Radioulnar joint Synovial - pivot Diarthrosis

Distal Radioulnar joint Synovial – pivot Diarthrosis

Allows pronation and supination of forearm

pg 735

Radiocarpal joint Synovial-condyloid Distal radius with proximal row of carpals

Intercarpal joints Synovial-plane

Carpal-metacarpal (2-5) Synovial-plane

Trapezium-metacarpal 1 Synovial-saddle

Metacarpal-phalangeal Synovial-condyloid

Interphalangeal Synovial-hinge

ALL DIARTHROSES

Joints of the Upper Extremity

Review of Naming…..

What do the following names TELL you about the muscle? Naming

Flexor carpi ulnaris Flexor digitorum superficialis Flexor pollicis longus Pronator quadratus Extensor carpi radialis brevis

Scapula Muscles If the origin is on the scapula – moves the

arm Subscapularis Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial attachment) Coracobrachialis

RotatorCuff

pg 656

Scapula Muscles

If the insertion is on the scapula – moves the scapula Rhomboids Trapezius Pectoralis Minor Serratus Ventralis Levator Scapulae

Use location of Insertion to determine movement!!pg 656

Innervation of Muscles Moving Arm

Muscle Innervation

SubscapularisTeres Major

Subscapular N.

InfraspinatusSupraspinatus

Suprascapular N.

Teres Minor Axillary N.

Coracobrachialis Musculocutaneous N.

Arm Muscles

Arm Compartments Anterior Compartment (3 muscles)

Flexors of forearm and arm Posterior Compartment (1 muscle)

Extensor of forearm and arm

pg 667

Remember: If you cross the shoulder, you move the arm; if you cross the elbow, you move the forearm

Arm Muscles

Anterior compartment Brachialis Coracobrachialis Biceps brachii

Long head Short head

pg 718 pg 715

Arm Muscles

Posterior compartment Triceps brachii

Long head Medial head Lateral head

pg 717

Muscles of ArmMuscle Origin Insertion Action Innerv

Anterior Brachialis Ant shaft , distal humerus Coronoid process

/ulnar tuberosity

(ulna)

Flex forearm

Musculo-cutaneous

Biceps Brachii Long: supraglenoid tubercle (scapula)

Short: coracoid proc (scapula)

Radial Tuberosity (radius)

Flex forearm, Supination

Musculo-cutaneous

Coracobrachialis Coracoid proc (scapula) Medial surface midshaft (humerus)

Flex arm, Adduct arm

Musculo-cutaneous

PosteriorTriceps Brachii Long: Infraglenoid tubercle

(scapula)

Medial: Posterior Shaft

(middle humerus)

Lateral: Posterior Shaft

(proximal humerus)

Common tendon to olecranon (ulna)

Extend forearm

Radial

Forearm Muscles

Cross elbow, wrist and finger joints Movement of hand and fingers Proximally are fleshy Distally have long tendons Flexor and extensor retinacula

“wristbands” Keep tendons from jumping outwards when tensed

pg 738

Forearm Muscles Anterior compartment

Superficial and Deep layers Flexors of hand and fingers Most flexors have common origin on medial epicondyle Contains 2 pronator muscles

Posterior compartment Superficial and Deep layers Extensors of hand and fingers Most extensors have common origin on lateral epicondyle Contains a supinator muscle

pg 732

Anterior Compartment of Forearm

Muscles Nerves Superficial

Flexor digitorum superficialis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Ulnar

Deep Pronator quadratus Median Flexor pollicis longus Median Flexor digitorum profundus Ulnar (med 1/2)

Median (lat 1/2)pg 738, 740

Posterior Compartment of Forearm Muscles Nerves

Superficial Brachioradialis Radial Anconeus Radial Extensor carpi radialis longus & brevis Radial Extensor digitorum Radial Extensor carpi ulnaris Radial Extensor digiti minimi Radial

Deep Supinator Radial Abductor pollicis longus Radial Extensor pollicis longus + brevis Radial Extensor indicus Radial

pg 746

Hand Bones

Carpus (8) “True” wrist Distal to radius/ulna

Metacarpus (5) Distal to carpus

Phalanges (14) Distal to metacarpus

pg 753

Intrinsic Muscles of the Hand

Muscle Nerve Pinky = Hypothenar muscles

All digiti minimi Ulnar(Flexor, Abductor, Opponens)

Thumb = Thenar muscles Abductor pollicis brevis Median Flexor pollicis brevis Median Opponens pollicis Median Adductor pollicis Ulnar

Other Intrinsic Muscles Palmar + Dorsal Interossei Ulnar Lumbricals Median, Ulnar

Blood Supply - Arteries Subclavian (neck) Axillary (armpit)

Subscapular Circumflex humeral arteries

Brachial (arm) Deep brachial

Radial (forearm) Ulnar (forearm)

Common Interosseous Superficial & Deep Palmar arches

Digital

pg 719

Blood Supply - Veins Deep veins

Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Axillary – axilla Subclavian - neck

Superficial Veins Digital Superficial palmar venous arches Median – forearm Median cubital – elbow

Blood draws!! Cephalic – arm/forearm Basilic – arm/forearm

pg 664

Axilla Armpit!! Boundaries

Ventral Pectoral muscles

Dorsal Latissimus dorsi, teres major, subscapularis

Medial Serratus ventralis

Lateral Intertubercular (Bicipital) groove of humerus

Contents axillary lymph nodes, axillary vessels, brachial plexus

pg 651

Surface Anatomy of Arm

Cephalic Vein Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle

pg 651

Surface Anatomy of Elbow

Cubital Fossa Anterior surface elbow Contents

Median Cubital Vein Brachial Artery Median Nerve

Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles pg 730

Surface Anatomy of Hand 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 759

Brachial Plexus

Nerve plexus Lies partly in neck and partly in axilla Gives rise to almost all nerves that supply upper

limb Formed by intermixing of ventral rami of spinal

nerves C5-C8 and T1

pg 700

Brachial Plexus

Really Tired? Drink Coffee Buddy!

R = RAMI (ventral) (5) T = TRUNKS (3) D = DIVISIONS (2) C = CORDS (3) B = BRANCHES (Many!!)

Rami join to form Trunks! (in neck)

Ventral Rami Trunks

C5 Upper Trunk C6

C7 Middle Trunk

C8 T1 Lower Trunk

Trunks Split to form Divisions! (in neck)

Trunks Divisions

Upper AnteriorPosterior

Middle AnteriorPosterior

Lower Anterior Posterior

Divisions Join to form Cords! (in axilla)

Trunks Division Cords

U A LateralP

M A MedialP

L A PosteriorP

Cords Give off Branches!! (in axilla) Lateral Musculocutaneous

Median

Medial Ulnar

Posterior RadialAxillary

Thoracodorsal

Subscapulars

Lateral Cord

Musculocutaneous nerve Off lateral cord Course:

Anterior arm Becomes cutaneous and gives skin sensation to lateral forearm

Innervates: Corocobrachialis (motor) Biceps brachii (motor) Brachialis (motor) Skin distal to the elbow (sensory)

Medial Cord Ulnar nerve

Course: Comes off medial cord Descends along medial side of arm Passes posterior to medial epicondyle Follows the ulna Superficial to carpal tunnel into hand Branches to supply intrinsics and skin

Innervates: Flexor carpi ulnaris (motor) Flexor digitorum profundus (motor) Most intrinsic hand muscles (motor) Dorsal branch supplies skin of medial 2/3 of hand (sensory)

Both Medial and Lateral Cords

Median nerve Course:

Middle of brachial plexus (from lateral and medial cords) Does not branch in arm Distal to elbow provides many branches to most forearm flexors Passes through carpal tunnel to hand to lateral palmar intrinsics

Innervates: Anterior forearm (motor)

Most flexors, some intrinsics (thumb)

2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory)

Posterior Cord Radial nerve

Largest branch of brachial plexus Comes from posterior cord Course:

Through arm Around humerus Around lateral epicondyle (then divides)

Innervates: Posterior muscles of arm and forearm

Triceps brachii, anconeus, brachioradialis Divides in forearm:

Superficial Skin of arm and dorsolateral surface of hand

Deep Supinator & Extensor muscles of forearm (eg ext. carpi radialis L + B)

Posterior Cord (continued) Axillary nerve

Branches off posterior cord Course:

Runs posterior to humerus Runs with caudal humeral circumflex artery

Innervates: Deltoid and teres minor (motor) Capsule of shoulder, skin of shoulder (sensory)

Subscapular nerve Innervates:

Subscapularis, Teres major Thoracodorsal nerve

Course: Runs with thoracodorsal artery and vein

Innervates: Latissimus dorsi

Nerve Damage Ulnar nerve

“Claw hand” Inability to extend fingers at interphalangeal joints, results in

permanent flexion of hand = claw

Median nerve “Ape hand”

Inability to oppose thumb

Radial nerve “Wrist drop” Inability to extend the hand, inability to fully extend forearm

pg 783

pg 782