Upper Limb Topography

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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 ?. Fascia brachialis -
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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Deep structures ?. Muscles Flexors of
forearm medial eminence Extensors of
forearm lateral eminence Brachial muscles,
mm. biceps, brachialis middle eminence B.
Vessels and nerves 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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Anterior elbow
Surface anatomy Three eminences Two
grooves Elements Lateral groove - v. cephalica,
n. cutaneus antebrachii lateralis Medial groove
v. basilica, n. cutaneus antebrachii medialis
V. mediana cubiti
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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 1 a. brachialis 2 n. medianus
Muscle 1 m. supinator 2 m. brachialis 3
tendo m. biceps brachii Bone 1 humerus 2
radius 3 ulna
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Anterior elbow
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Deep structures ?. Muscles Flexors of
forearm medial eminence Extensors of
forearm lateral eminence Brachial muscles,
mm. biceps, brachialis middle eminence B.
Vessels and nerves 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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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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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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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 -
mm. flexores digitorum superficialis
profundus - mm. lumbricales - vagina synovialis
communis flexorum Two spaces ?. 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 ? mm. lumbricales II - IV.

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