Superficial structures UE

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Superficial structures UE Axioappendicular
Muscles

• Dr. Ed Smith
• Office 2119
• Phone X1764

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Superficial structures

• Fascia a sheet of fibrous tissue that envelopes
  the body beneath the skin and/or encloses muscles
  and groups of muscles.
• Pectoral fascia invests the pectoral muscle and
  is continuous with abdominal wall fascia. It
  leaves the lateral border of the pectoralis to
  become
• Axillary fascia that forms the floor of the
  axilla.
• Clavipectoral fascia descends from the clavicle
  to surround the pectoralis minor.

Fig. 6.9 p743 Clinically Oriented Anatomy , 5th
ed. Moore Dalley
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Superficial structures

• 4. The lower clavipectoral fascia forms the
  suspensory ligament of the axilla which pulls the
  axillary fascia taught when the UE is abducted.
• 5. Scapular fascia invests each muscle
  originating from the surface of the scapula
  (supra, infra- spinatus subscapularis creating
  a tough fascial compartment. Muscle fibers
  originated from these fascial surfaces.

Fig. 6.9, p743
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Superficial structures

• The brachial fascia ensheathes the arm and
  attaches inferiorly to the epicondyles and
  olecranon.
• The medial and lateral intermuscular septa extend
  to the medial and lateral surface of the humerus.
  
• This separates the arm into the anterior (flexor)
  and posterior (extensor) compartments.
• The antebrachial fascia, interoseous membrane and
  the lateral intermuscular septa isolate an
  anterior and posterior compartment in the forearm

Fig. 6.10, p 744
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Compartment Syndromes

• Compartment syndrome can occur as a result of
• An injury or procedure which causes bleeding
  within the compartment and therefore swelling.
• A muscle tear which also causes bleeding.
• Over use injury which also causes swelling.
• Symptoms pain, weakness, swelling
• Intervention
• RICE
• Post traumatic/operative may require fasciotomy
  to avoid necrosis

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Cutaneous innervation of the UE

• Variability and overlap make specific
  correlations somewhat difficult however there are
  a few landmarks.
• Deltoid C5
• Thumb C6
• 3rd digit C7
• 5th digit C8

Fig. 6.11, p746
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Superficial Veins of the UE

• Superficial deep veins communicate via
  perforating veins.
• Veins begin in the dorsal venous plexus of the
  hand
• Cephalic vein forms on the lateral aspect of 2
  and course proximally on the lateral arm crossing
  the arm to the deltopectoral groove. Here it
  pierces the clavipectoral fascia to join the
  axillary vein.

Fig. 6.12, p 748
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Superficial Veins of the UE

• 4. Basilic vein begins on the medial aspect
  of 2 and course on the medial aspect of the
  forearm and arm piercing the brachial fascia to
  join run superiorly wit the brachial artery.
• 5. The median cubital vein crosses the
  antebrachial fossa to communicate between the
  cephalic basicilic veins.

Fig 6.12, p 748
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Lymphatics of the UE

• Cubital nodes
• Humeral nodes
• Subscapular nodes
• Axillary nodes
• UE lymphedema may result from metastatic
  involvement of proximal brachial nodes or sequela
  of its treatment.

Fig. 6.13, p 749
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• Causes
• Breast Cancer
• Work-up SLNB vs. ALD
• Treatment ALD, XRT
• Trauma
• Infection
• Decreased mobility

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Anterior Axioappendicular Muscles move the
pectoral girdle

• Pectoralis major
• Pectoralis minor
• Subclavius
• Serratus anterior

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Pectoralis major

• A large fan shaped muscle on the superior thorax
• Forms the anterior wall and inferior border of
  the axilla
• Forms the inferior border of the deltopectoral
  groove that contains the cephalic vein.
• Anterior to the clavipectoral fascia
• Origins
• Clavicular head
• Sternocostal head

Table 6.1 A

• Table 6.1 E

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Pectoralis major

• 6. Insertion Lateral lip of
  intertubercular groove humerus
• 7. Major adductor medial rotator of the
  humerus, draws scapula toward thorax
• 8. Has 2 heads
• Clavicular head which flexes the humerus (lateral
  medial pectoral nerves)
• Sternal head which extends the humerus from a
  flexed position (medial pectoral n)
• 9. Testing
• Clavicular head abduct arm 90, move arm
  anteriorly against resistance
• 2. Sternal head - abduct arm 90, adduct arm
  against resistance

• Table 6.1 A

• Table 6.1 E

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Pectoralis minor

• Table 6.1 B

• Forms anterior wall of the axilla beneath the
  pectoralis major
• Origin from the anterior ends of 3-5th ribs near
  the costal cartilage
• Insertion medial border superior surface of
  coracoid process of scapula
• Innervation Medial pectoral n.
• Stabilizes the scapula when stretching UE
  forward.
• Accessory muscle of inspiration by elevating ribs
• The key to organizing the axilla

• Table 6.1 E

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Subclavius

• Inferior surface of the clavicle to 1st rib
• Origin at the junction of 1st rib and costal
  cartilage
• Insertion Inferior surface of middle 1/3rd of
  the clavicle.
• Innervation ?
• Pads the BP and subclavian as they pass between
  clavicle an 1st rib
• Anchors and depresses scapula.
• Helps prevent dislocation at the sternoclavicular
  joint

• Table 6.1 C

• Table 6.1 E

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Serratus Anterior

• Lateral thorax, forms the medial wall of the
  axilla
• Origin External surface of lateral 1st-8th ribs
• Insertion Anterior surface of medial border of
  the scapula
• Innervation Long thoracic n.
• Attaches to the whole length of the medial
  scapula
• The most powerful muscle of the pectoral girdle
• Strong protractor of the scapula, the boxers
  muscle
• Inferior part rotates the scapula to elevate the
  glenoid fossa.

• Table 6.1 D

• Table 6.1 E

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Serratus Anterior

• 6. Stabilizes the scapula against the thoracic
  wall so other muscles can act on the UE
• 7. Test push against the wall, weakness
  results in winging of the scapula
• 8. Long thoracic nerve injury results in
  winging inability to raise the arm past
  horizontal due to inability to rotate the
  glenoid.

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Serratus Anterior

• Long thoracic nerve injury results in winging
  inability to raise the arm past horizontal due to
  inability to rotate the glenoid.
• Paralysis may be traumatic (sports, MVA ect..),
  atraumatic (post-infectious neuritits, allergic
  rxns), or iatrogenic (mastectomy, thoracotomy)
• In most cases, serratus paralysis will resolve
  over 6 months
• Paralysis of the trapezius may also cause winging
  of the scapula

• Fig. B6.5 p 753

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Superficial structures UE Axioappendicular
Muscles

• Netter 188,189,418,424,426,479,479-483

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Superficial structures UE Axioappendicular
Muscles