UPPER LIMB

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UPPER LIMB

• What is a limb?
• Sensory to upper limb
• Making it move
• Bones and joints
• Muscles and nerves
• Vascular supply
• Surface anatomy
• (muscle study hint)

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What is a limb?

• Ventral somatic outgrowth of outer tube
• Bones (with bone, cartilage, marrow, NAV, etc.)
• Joints
• Muscle
• Nerves
• Vascular supply
• No viscera--all innervation is somatic (motor or
  sensory) from ventral ramus of spinal nerve
  (except autonomics to blood vessels)

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Sensory from limb (dermatomes/sensory skin
segments from spine)

• Dermatomes extend over limbs
• Twisted orientation reflects twisting of limb
  during development
• Named nerves generally innervate skin over
  muscles that they innervate

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Sensory territory of nerves
Brachial plexus serves to re-direct spinal routes
into named nerves covering certain territory
Cutaneous branches of medial cord/ulnar nerve
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Upper Limb Skeleton (old hat?)

• Scapula
• Humerus
• Radius, ulna
• Carpals--proximal, distal
• Digits
• Metacarpals
• Phalanges

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Shoulder region

• Rule if a muscle crosses over/spans a joint, it
  must MOVE that joint!
•     A. Muscles originating on Axial Skeleton
•         1. Pectoralis Major flexes and adducts
  arm/humerus
•         2. Latissimus Dorsi extends and adducts
  arm
•     B. Muscles originating on Scapula
•         1. Deltoid abducts, flexes and extends
  arm
• 2. Coracobrachialis flexes and adducts arm
•         3. Teres Major extends and adducts arm

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• If INSERTION on scapula Move scapula
• Rhomboids
• Trapezius
• Pectoralis Minor
• Serratus Ventralis
• Levator Scapulae
• If ORIGIN on scapula Move Arm
• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres Minor
• Teres Major
• Latissimus Dorsi (partial O on scap)
• Coracobrachialis

Muscles of Scapula
Rotator Cuff
Use location of Insertion to determine exact
movement!!
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• C. "Rotator Cuff" Muscles
• 1. Subscapularis medially rotates arm
• 2. Supraspinatus abducts arm
• 3. Infraspinatus laterally rotates arm
• 4. Teres Minor laterally rotates arm

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POSTERIOR AND ANTERIOR COMPARTMENTS
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Arm

• A. Anterior arm muscles are Flexors of
  forearm/elbow joint
• 1. Biceps brachii
• 2. Brachialis
• 3. Brachioradialis
• B. Posterior arm muscles are Extensors of the
  forearm / elbow joint
• 1. Triceps brachii
• 2. Anconeus

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Posterior Compartment of Forearm
Lateral Epicondyle
Brachioradialis
Extensor digitorum
Ext Carpi Radialis Longus
Extensor carpi ulnaris
Posterior View
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Anterior Compartment Forearm
pg 302
Medial Epicondyle


Brachioradialis
Pronator Teres
Flexor Carpi Radialis

Flexor Carpi Ulnaris
Flexor Retinaculum
Flexor Digitorum Superficialis is deep to other
flexors
Anterior View
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Forearm

• A. Anterior Forearm contains
• pronator and flexor muscles
• 1. Pronators of the forearm
• a. Pronator Teres
• b. Pronator Quadratus
•  2. Flexors
• -- flexor retinaculum
•  Superficial Group
• a. Flexor Carpi Radialis flexes wrist and
  abducts hand
• b. Palmaris Longus flexes wrist
• c. Flexor Carpi Ulnaris flexes wrist and adducts
  hand

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Forearm

• Intermediate Group
• d. Flexor Digitorum Superficialis flexes wrist
  and flexes digits 2 through 5 at the MP and PIP
  joints
•        MPmetacarpal-phalangeal    PIPproximal
  interphalangeal
• Deep Group
• e. Flexor Digitorum Profundus flexes wrist and
  digits 2-5 at the MP, PIP and DIP joints
•     DIPdistal interphalangeal  
• f. Flexor Pollicis Longus flexes wrist, MP
  joint, IP joint of thumb

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Forearm

• B. Posterior Forearm contains supinator and
  extensor muscles
• 1. Supinators of the forearm
• a. Supinator
• 2. Extensors
• -- extensor retinaculum
• Superficial Group
• a. Extensor Carpi Radialis Longus extends wrist
  and abducts hand
• b. Extensor Carpi Radialis Brevis extends wrist
  and abducts hand
• c. Extensor Digitorum extends wrist and extends
  digits 2-5 at MP, PIP, and DIP joints
• d. Extensor Carpi Ulnaris extends wrist and
  adducts hand

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Forearm

• Deep Group
• e. Extensor Pollicis Longus extends thumb
• f. Extensor Pollicis Brevis extends thumb
• g. Abductor Pollicis Longus abducts thumb

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Hand
A. Thenar muscles move the thumb B. Hypothenar
musclesmove little finger C. Midpalmar muscles
- move fingers 2-5 --  all of these muscles flex
the MP joints and extend the PIP/DIP joints 1.
Lumbricals (4) 2. Palmar Interossei (3) also
adduct fingers 3. Dorsal Interossei (4) also
abduct fingers
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Brachial Plexus

• Posterior Compartmentposterior cord
• Anterior compartmentmedial, lateral cords
• Name of cord is relative to axillary artery

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Muscles and nerves by compartment
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• ANTERIOR MUSCLES
• M-C
• Biceps
• brachialis
• Median
• Forearm flexors
• Thumb intrinsics (1M nerve)
• Ulnar
• Flexor carpi ulnaris
• Hand intrinsics

• POSTERIOR MUSCLES
• Muscles (radial nerve)
• Triceps
• Anconeus
• Brachioradialis
• Carpal, digit extensors

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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 hand
  through carpal tunnel
• Recurrent median (1M) superficial at wrist to
  thumb over thenar emminence) deficit - apes hand
• Ulnar medial in arm, posterior to medial
  epicondle of humerus (funny bone) down medial
  forearm medial to carpal tunnel into palm
• Radial deep posterior arm around lateral
  epicondyle of humerus to forearm (deep and
  superficial branches)

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Sensory from limb (dermatomes/sensory skin
segments from spine)

• Dermatomes extend over limbs
• Twisted orientation reflects twisting of limb
  during development
• Named nerves generally innervate skin over
  muscles that they innervate

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Sensory territory of nerves
Brachial plexus serves to re-direct spinal routes
into named nerves covering certain territory
Cutaneous branches of medial cord/ulnar nerve
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Vascular supply

• Subclavian?axillary ?radial (same street, new
  street sign every block)
• Collateral circulation
• Posterior/anterior circumflex humeral
• Deep brachial a.
• Radial a. (with median n.) ?deep palmar arch
• Ulnar a. (with ulnar n.) ? superficial palmar arch

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Median Nerve
Ulnar Nerve
Brachial Artery
Musculocutaneous Nerve
UlnarArtery
Wheres Radial Nerve?
Radial Artery
Median Nerve
Ulnar Nerve
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Axilla Armpit

• Region between arm and chest
• Boundaries
• Ventral - pectoral muscles
• Dorsal latissimus dorsi, teres major
  subscapularis
• Medial serratus ventralis
• Lateral bicipital groove of humerus
• Contents
• Axillary lymph nodes, Axillary vessels Brachial
  Plexus

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Surface Anatomy of Upper Limb

• Biceps Triceps brachii
• Olecrenon Process
• Medial Epicondyle
• Cubital Fossa
• Anterior surface elbow
• Contents
• Median Cubital Vein
• Brachial Artery
• Median Nerve
• Boundaries
• Medial Pronator teres
• Lateral Brachioradialis
• Superior Line between epicondyles

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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)

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Suggestion a muscle table organized by Joint
crossed? Nerve innervating? Action? Compartment
s? All of the above?