upper limb topography. fossa axillaris n between arm and chest n boundaries –anteriorly – mm....
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Upper Limb TopographyUpper Limb Topography
Fossa axillarisFossa axillaris
Between arm and chestBetween arm and chest BoundariesBoundaries
– Anteriorly – mm. pectoralesAnteriorly – mm. pectorales– Dorsally = latissimus dorsi, teres Dorsally = latissimus dorsi, teres
major, subscapularismajor, subscapularis– Medially = serratus anteriorMedially = serratus anterior– Laterally = sulcus bicipitisLaterally = sulcus bicipitis
ContentContent– Lymph nodes, vessels, pl. Lymph nodes, vessels, pl.
brachialisbrachialis
Foramen axillare laterale et medialeForamen axillare laterale et mediale
Surface anatomySurface anatomy
MM. triceps brachii. triceps brachii
caput longum, medialis, lateraliscaput longum, medialis, lateralis
Surface elementsSurface elements
SkinSkin thick and movablethick and movable
Subcutaneous tissueSubcutaneous tissue well expressedwell expressed
n. cutaneus brachii posteriorn. cutaneus brachii posterior
n. cutaneus brachii lateralis inferiorn. cutaneus brachii lateralis inferior
n. cutaneus antebrachii posteriorn. cutaneus antebrachii posterior
Posterior of the armPosterior of the arm
Deep structuresDeep structures
А. А. Fascia brachialis Fascia brachialis
- - Thick, thins distallyThick, thins distally
BB. . Neurovascular bundles Neurovascular bundles 1. 1. UpperUpper - in - in canalis humero-musculariscanalis humero-muscularis, , betweenbetween::
-- sulcus n. radialis sulcus n. radialis
- - medial and lateral head ofmedial and lateral head of m. triceps brachiim. triceps brachii
11.1..1. n. radialis – n. radialis – lieslies on the humeruson the humerus
-- n. cutaneus brachii lateralis inerior n. cutaneus brachii lateralis inerior
- n. cutaneus antebrachii posterior- n. cutaneus antebrachii posterior
- rr. musculres- rr. musculres
11.2. a. profunda brachii.2. a. profunda brachii
- a. collateralis media- a. collateralis media
- collateralis radialis- collateralis radialis
LowerLower neurovascular bundle neurovascular bundle behind medial epicondylebehind medial epicondyle
n. ulnarisn. ulnaris
a. collateralis ulnaris inferiora. collateralis ulnaris inferior
Elbow regionElbow region
Anterior elbowAnterior elbow
Surface anatomySurface anatomy
Three eminencesThree eminences
Two groovesTwo grooves
ElementsElements
Lateral grooveLateral groove - - v. cephalica, n. cutaneus v. cephalica, n. cutaneus
antebrachii lateralisantebrachii lateralis
Medial groove Medial groove – – v. basilica, n. cutaneus v. basilica, n. cutaneus
antebrachii medialisantebrachii medialis
V. mediana cubitiV. mediana cubiti
Deep structuresDeep structures
А. А. MusclesMuscles Flexors of forearmFlexors of forearm – – medial eminencemedial eminence
ExtensorsExtensors of forearmof forearm – – lateral eminencelateral eminence
Brachial muscles,Brachial muscles, mm. mm. bibiceps, brachialisceps, brachialis – – middle eminencemiddle eminence
Deep structuresDeep structures
BB. . Vessels and nervesVessels and nervesMedial bundleMedial bundle - - betweenbetween m. biceps brachii andm. biceps brachii and pronator pronator
teresteres
- a- a.v. brachialis, n. medianus.v. brachialis, n. medianus
Lateral bundleLateral bundle - - betweenbetween m. brachialis andm. brachialis and brachioradialisbrachioradialis
- - n. radialis, a. collateralis radialis, a. recurrens radialisn. radialis, a. collateralis radialis, a. recurrens radialis
CC. . Cubital fossaCubital fossa BoundariesBoundaries
-- m. brachioradialism. brachioradialis ( (laterallateral), ), m. pronator teres m. pronator teres ((medialmedial))
ContentContent- t- tendoendo m. brachialis,m. brachialis, m. biceps brachii, bursa bicipitoradialism. biceps brachii, bursa bicipitoradialis
Layers of the elbowLayers of the elbow
VenousVenous
1 1 v. v. cephaliccephalicaa
2 2 v. v. basilicbasilicaa
3 3 v. v. medianmedianaa cubit cubitii
ApponeuroticApponeurotic
1 aponeurosis bicipi1 aponeurosis bicipiss
2 tendo2 tendo m. m. bicepsbiceps brachii brachii
Neurovascular Neurovascular 1 1 a. a. brachialbrachialisis
2 2 n. n. medianmedianusus
MuscleMuscle 1 1 m. m. supinator supinator
2 2 m. m. brachialis brachialis
3 tendo3 tendo m. m. biceps biceps brachiibrachii
BoneBone 1 humerus 1 humerus
2 radius 2 radius
3 ulna3 ulna
The palmThe palm
Surface Anatomy of Upper Surface Anatomy of Upper LimbLimb
Carpal TunnelCarpal Tunnel– Carpals concave anteriorlyCarpals concave anteriorly– Carpal ligament covers itCarpal ligament covers it– Contains: long tendons, Contains: long tendons,
Median nerveMedian nerve– Inflammation of tendons = Inflammation of tendons =
compression of Median nervecompression of Median nerve
Anatomical SnuffboxAnatomical Snuffbox– Lateral = E.pollicis brevisLateral = E.pollicis brevis– Medial = E. pollicis longusMedial = E. pollicis longus– Floor = scaphoid, styloid of Floor = scaphoid, styloid of
radiusradius– Contains Radial Artery (pulse)Contains Radial Artery (pulse)
pg 306, 788
Muscles of the WristMuscles of the Wrist
Extensor musclesExtensor muscles– Extensor RetinaculumExtensor Retinaculum
What’s its function?What’s its function?
– Muscles innervated by Muscles innervated by radial nerveradial nerve
– There are 8 There are 8 Name them…Name them…
Flexor MusclesFlexor Muscles Flexor retinaculum Flexor retinaculum
(transverse carpal (transverse carpal ligament)ligament)
Two compartmentsTwo compartments– Superficial – 4 Superficial – 4 – Deep – 3Deep – 3– Name them…Name them…
Innervated by median and Innervated by median and ulnar nerveulnar nerve
Muscles of the WristMuscles of the Wrist
Wrist and Hand AnatomyWrist and Hand Anatomy
Nerves/VesselsNerves/Vessels– Radial & ulnar artery and veinsRadial & ulnar artery and veins– Radial, ulnar, & median nervesRadial, ulnar, & median nerves
Carpal TunnelCarpal Tunnel– Flexor Tendons - 9Flexor Tendons - 9– Median NerveMedian Nerve
Surface anatomySurface anatomy - - Medial and lateral eminenceMedial and lateral eminence and middle depressionand middle depression
- - Flexion groovesFlexion grooves - - Commissural padsCommissural pads
Surface elementsSurface elements
SkinSkin- thick- thick, , hairlesshairless
- - Attached to palmar aponeurosisAttached to palmar aponeurosis – – in the middlein the middle
- - Loose connective tissue in the eminencesLoose connective tissue in the eminences
- - r. palmaris (n. medianus)r. palmaris (n. medianus), , r. cutaneus palmaris r. cutaneus palmaris (ulnaris)(ulnaris)
- small veins- small veins
Aponeurosis palmarisAponeurosis palmaris – – thick fibrous tissuethick fibrous tissue
- - superficial layersuperficial layer – – tendinous fibers oftendinous fibers of m. palmaris m. palmaris longuslongus, ,
- - deep layerdeep layer – – transverse fiberstransverse fibers, , lig. metacarpeum lig. metacarpeum transversum superficialetransversum superficiale
- - commissural openingscommissural openings
Deep compartmentsDeep compartments
Intermuscular septaeIntermuscular septae andand
Palmar interosseous fasciaPalmar interosseous fascia formform
- - Three fascial compartmentsThree fascial compartments
LateralLateral ( (thenarthenar) ) compartmentcompartment
MuscleMuscle - - 4 4 layerslayers
- - M. abductor pollicis brevisM. abductor pollicis brevis
- M- M. opponens pollicis, m. flexor pollicis brevis (caput superfic.). opponens pollicis, m. flexor pollicis brevis (caput superfic.)
- - M. flexor pollicis brevis (caput profundus)M. flexor pollicis brevis (caput profundus)
- - MM. adductor pollicis. adductor pollicis
NervesNerves - - rr. muscularis n. medianus. muscularis n. medianus
VesselsVessels - - r. palmaris superficialis a. radialisr. palmaris superficialis a. radialis
Two connective tissue spacesTwo connective tissue spaces – – above and belowabove and below mm. adductor . adductor
pollicispollicis
MedialMedial ( (hypothenarhypothenar) ) compartmentcompartment
MusclesMuscles - - 2 2 layerslayers
- - SuperficialSuperficial - - m. abductor digiti minimi,m. abductor digiti minimi,
m. flexor digiti minimim. flexor digiti minimi
- - DeepDeep - - mm. opponens digiti minimi. opponens digiti minimi
NervesNerves – – superficial and deep branches ofsuperficial and deep branches of n. ulnarisn. ulnaris
VesselsVessels - - superficial and deep branches ofsuperficial and deep branches of aa. . ulnarisulnaris
MM. palmaris brevis. palmaris brevis - - proximalproximal
Middle compartmentMiddle compartment
Muscular tendinous layerMuscular tendinous layer::
- - mm. flexores digitorum superficialis & profundusmm. flexores digitorum superficialis & profundus
- mm. lumbricales- mm. lumbricales
- vagina synovialis communis flexorum- vagina synovialis communis flexorum
Two spacesTwo spaces
а. а. SuperficialSuperficial – – below palmar aponeurosisbelow palmar aponeurosis
- - aarcus palmaris superficialisrcus palmaris superficialis -- aa. digitales palmares communesaa. digitales palmares communes
-- n. medianusn. medianus - nn. digitales palmares communis- nn. digitales palmares communis
- - r. palmaris n. ulnarisr. palmaris n. ulnaris - - n. digitalis palmaris communis IV &n. digitalis palmaris communis IV & n. digitalis n. digitalis
palmaris proprius Vpalmaris proprius V
Interfascial canalsInterfascial canals - - distaldistal
- - mm. lumbricales, a.n. palmares digitales comm. et propriaemm. lumbricales, a.n. palmares digitales comm. et propriae
Middle compartmentMiddle compartment
bb. . Deep spaceDeep space - - belowbelow palmar interosseous fascia palmar interosseous fascia
- - communicationscommunications::
forearmforearm - - troughtrough carpalcarpal canalcanal
superficial spacesuperficial space – – interfascial canalsinterfascial canals
- - aarcus palmaris profundusrcus palmaris profundus -- a. radialis + r. profundus a. ulnarisa. radialis + r. profundus a. ulnaris
- - aa. metacarpales palmaresaa. metacarpales palmares - aa. digitales palmares communes - aa. digitales palmares communes
- - deep branchdeep branch ofof r. palmaris n. ulnarisr. palmaris n. ulnaris supplyingsupplying - -
- - mm. hypothenari, mm. interossei, m. adductor pollicis mm. hypothenari, mm. interossei, m. adductor pollicis и и mm. mm.
lumbricales II - IV.lumbricales II - IV.