upper limb-um 2011
TRANSCRIPT
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UPPER LIMB
PROFESSOR DR FAUZIAH OTHMAN
DEPARTMENT OF HUMAN ANATOMY,
FACULTY OF MEDICINE AND HEALTH SCIENCE,
UNIVERSITI PUTRA MALAYSIA MALAYSIA
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UPPER LIMB What is a limb?
Skeleton Joints Shoulder/Scapula
muscles
Brachial plexusgetting spinal nervesout onto limb
Musclesanterior
and posteriorcompartments Sensory innervation Surface anatomy
From Royal Collection daVinci drawings
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What is a limb? Ventral somatic outgrowth of
outer tube Bones (made of bony tissue,
cartilage, and other tissues)
Joints
Muscles
Nerves (with motor neurons tomuscles, sensory neurons toskin, proprioceptors)
No viscera--all innervation issomatic (motor or sensory)from ventral ramus of spinalnerve (except autonomics to
blood vessels)
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Upper Limb Skeleton
Scapula
Humerus
Radius, ulna
Carpals--proximal, distal
Digits
Metacarpals Phalanges
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Muscle origins and insertions
Muscle crosses joint
Origin is usually proximaland insertion is usuallydistal
Origin is considered fixedin analyzing muscle action
Muscle action (concentric)is given by movement ofinsertion relative to originacross joint
Remember: Sometimes insertion might
be fixed
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Muscles of Scapula
If INSERTION onscapula, muscle movesscapula Trapezius
Rhomboids Pectoralis Minor
Serratus Ventralis
Levator Scapulae
If ORIGIN on scapula,muscle moves arm Teres Major
Latissimus Dorsi (partially
on scapula)
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Rotator Cuff
Muscles originate onfossae of scapula
Help support opensocket of shoulder
joint
Insert around ball of
humerus Medial and lateralrotation of upper limb
Typical baseballpitcher injury
Supraspinatus
Infraspinatus
Teres minor Subscapularis
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Axilla = Armpit
Region between arm and chest
Boundaries Ventral - pectoral muscles
Dorsal = latissimus dorsi, teres majorsubscapularis
Medial = serratus ventralis
Lateral = bicipital groove of humerus
Contents
Axillary nerves and blood vessels Axillary lymph nodes
And.theBrachial plexus
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B hi l Pl
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Posterior Compartmentposterior cord Anterior compartmentmedial, lateral cords Name of cord is relative to axillary artery
Brachial Plexus
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Brachial plexus organizes nerves out to
muscles of upper limb
One posterior nerve
Radial n.
Three anterior nerves Musculocutaneous n.
Median n.
Ulnar n.
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Muscles and nerves by compartment
ANTERIOR POSTERIOR
NERVES M-C, ulnar,
median
Radial
MOVEMENT Flexion Extension
MUSCLES Biceps,
flexors
Triceps,
extensors
TWIST Flexors frommedial
epicondyle
Extensors fromlateral
epicondyle
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POSTERIOR AND ANTERIOR COMPARTMENTS
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Bicepsanterior compartment, flexion (M-C n.)
Tricepsposterior compartment, extension (radial n.)
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Anterior Compartment Forearm--flexors
Flexor Carpi Radialis
Flexor Retinaculum
Medial Epicondyle
Flexor Digitorum Superficialis
is deep to other flexors
Flexor Carpi Ulnaris
Brachioradialis
Pronator Teres
Anterior View
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Posterior Compartment of Forearm--extensors
Extensor digitorum
Extensor carpi ulnarisExt Carpi Radialis Longus
Brachioradialis
Lateral Epicondyle
Posterior View
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ANTERIOR MUSCLES
M-C nerve
Biceps brachialis
Median nerve
Forearm flexors
Thumb intrinsics
Ulnar nerve
Flexor carpi ulnaris Hand intrinsics
POSTERIOR MUSCLES
Muscles (radial nerve)
Triceps Anconeus
Brachioradialis
Carpal, digit extensors
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Sensory from limb
(dermatomes/sensory skin
segments from spine) Dermatomes extend
over limbs
Twisted orientationreflects twisting oflimb duringdevelopment
Named nervesgenerally innervateskin over musclesthat they innervate
S i f
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Sensory territory of nerves
REMEMBER: Brachialplexus re-directs spinalroutes into named nervescovering certain territory
Cutaneous branches of
medial cord/ulnar nerve
R f (i h )
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Routes of nerves (in human)
M-C: between biceps brachii and brachialis Median: medial/posterior to biceps, branches
into forearm flexors at elbow then to handthrough carpal tunnel
Recurrent median superficial at wrist to thumb overthenar emminence) deficit - apes hand
Ulnar: medial in arm, posterior to medialepicondle of humerus (funny bone) down medialforearm medial to carpal tunnel into palm
Radial: deep posterior arm around lateralepicondyle of humerus to forearm (deep and
superficial branches)
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Ulnar Nerve
Brachial Artery
Median Nerve
UlnarNerve
Median Nerve
Radial Artery
Musculocutaneous Nerve UlnarArtery
Wheres Radial Nerve?
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SUPERFICIAL VEIN IN CUBITAL FOSSA
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Clinical aspects
During blood pressuremeasurements, the stethoscopeis placed over the brachial artery in the cubital fossa.
The brachial pulse may be palpated in the cubital fossa. The area just superficial to the cubital fossa is often used
for venous access (phlebotomy). A number of superficialveins can cross this region. It may also be used for theinsertion of a peripherally inserted central catheter.
Historically, when (venous) blood-letting was practiced,the bicipital aponeurosis (the ceiling of the cubital fossa)was known as the "grace of God" tendon because itprotected the more important contents of the fossa (i.e.
the brachial artery and the median nerve).
http://www.royalcollection.org.uk/eGallery/searchResults.asp?piclib=y&searchText=&makerName=leonardo+da+vincihttp://www.royalcollection.org.uk/eGallery/searchResults.asp?piclib=y&searchText=&makerName=leonardo+da+vincihttp://www.royalcollection.org.uk/eGallery/searchResults.asp?piclib=y&searchText=&makerName=leonardo+da+vincihttp://www.royalcollection.org.uk/eGallery/searchResults.asp?piclib=y&searchText=&makerName=leonardo+da+vincihttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Phlebotomyhttp://en.wikipedia.org/wiki/Peripherally_inserted_central_catheterhttp://en.wikipedia.org/wiki/Bicipital_aponeurosishttp://en.wikipedia.org/wiki/Bicipital_aponeurosishttp://en.wikipedia.org/wiki/Peripherally_inserted_central_catheterhttp://en.wikipedia.org/wiki/Phlebotomyhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressure -
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The cubital fossa is the triangular area onthe anterior view of the elbow of a human.
S f A f U Li b
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Surface Anatomy of Upper Limb Biceps + Triceps brachii
Olecranon Process Medial Epicondyle
Cubital Fossa
Anterior surface elbow
Contents
Brachial Artery
Median Nerve
Boundaries
Medial = Pronator teres
Lateral = Brachioradialis
Superior = Line between epicondyles
Carpal Tunnel
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Surface Anatomy
of Upper Limb
Carpal Tunnel
Carpals concaveanteriorly
Carpal ligament covers it Contains: long tendons,
Median nerve
Inflammation of tendons =
compression of Mediannerve
Anatomical Snuffbox
Lateral = E.pollicis brevis
Medial = E. pollicis longus Floor = scaphoid, styloid
of radius
Contains Radial Artery
(pulse)
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