7843166 topographic anatomy superior limbs

8/14/2019 7843166 Topographic Anatomy Superior Limbs

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Frolich Human Anatom U rLimb

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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Frolich Human Anatom U rLimb

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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Regional anatomy of upper limb


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Parts and regions

Shoulder regionjunction of arm

and trunk

Armbetween should and elbow

Elbowbend of arm, joint

between arm and forearm Forearmbetween elbow and

hand

Hand


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Anatomical snuff box

When the thumb is abducted

and extended, a triangularhollow appears between the

tendon of the extensor pollicis

longs medially and the tendons

of the extensor pollicis brevis

and abductor pollicis longuslaterally.

The floor of the snuff box is

the scaphoid and trapezium

bones and crossed by the radial

a..


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1650 1700

Carring angle


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Mamma

Position

Lie in superficial fascia

over the pectorals major

and pectoral fascia

Extend from 3rd to 7th

ribs vertically, and from

parasternal line to

midaxillary line

transversally


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Structures contains skin,mammary glands and adipose

tissue

Each brest has about 15 20

lobes of mammary gland

Each lobe radiates out from

the nipple and has a

lactiferous duct which opensseparately on the summit of

the nipple and possesses a

dilated lactiferous sinuses

just prior to its termination


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Suspensory ligaments ofSuspensory ligaments of

breastbreast (coopers

ligaments ) strands ofconnective tissue runs

between skin and deep

fascia and serve to

support the mammaryglands


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Axillary fossa

The axillary fossa is a

pyramid-shaped space

through which major

neurovascular structurespass between the thorax and

upper extremity


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Boundaries

The apex is a triangular

space limited by the firstrib, the scapula, and the

middle third of clavicle.

The base skin and

fascia of the axillary fossa


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The anterior wall Pectoralis major, pectoralis minor and subclavius muscles

Clavipectoral fascia The deep faxcia which extends between subclavius, coracoid process and

pectoralis minor muscles The structures pass through the clavipectoral faxcia

Cephalic v.

Thoracoacromial a.

Lateral pectoral n.


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The posterior wall teres major,latissimus dorsi, subscapularis and

scapula Trilateral and quadrilateral foramina

Between the subscapularis and teres major,

there is a long triangular space whose

lateral side is surgical neck of humerus.

The long head of triceps brachii

subdivides this space into a medial

trilateral foramen and a lateral

quadrilateral foramen.

The posterior humeral circumflex a.

and axillary n. pass through the

quadrilateral foramen. The circumflex scapular a. passes

through the triangular space to reach the

dorsum of the scapula.


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The broad medial wall serratus anterior intercostal musclesand upper four ribs

The narrow lateral wall coracobrachialis, biceps brachii andintertubercular groove

ContentsBrachial plexus, axillary a. and principal branches, axillary v. andtributaries, axillary lymph nodes and loose connective tissue


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Brachial plexusFormationFormation:

Five roots: formed by anterior rami of C5-C8and T1 spinal nerves, roots C5 C7give riseto long thoracic n.

Three trunks The upper trunk is formed by the joining of root

C4,C5,C6.

The middle trunk is the continuation of root C7. The lower trunk is formed by the joining of root

C8 and T1.

Six divisions: above clavicle, trunks formanterior and posterior divisions

Three cords: below clavicle, divisions formthree cords that surround the second portion ofaxillary a.


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PositionPosition:

passes through the scalene fissure to

posterosuperior of subclavian artery, thenenters the axilla to form lateral, medial and

posterior cords

Main branchesMain branches

Lateral cord

Musculocutaneous n.

Lateral root to median n.

Medial cord

Medial root to median n.

Ulnar n.

Medial brachial cutaneous n.

Medial antebrachial cutaneous n.


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Posterior cord

radial n.

axillary n. thoracodorsal n.


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Axillary sheath extension of deep cervical

fascia of the neck,forming a tubular sheath

that surrounds axillary a.

and v., and brachial

plexus


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Axillary artery Continuation of subclavian artery at lateral

border of first rib Becomes brachial artery at lower border of

teres major

Divided into three parts by overlying

pectoralis minor

First portion, above muscle gives rise tothoracoacromial a.

Second portion, behind muscle gives rise

to lateral thoracic a.

Third portion, below muscle gives rise to

subscapular a. anterior and posteriorhumeral circumflex a.; the former then

divides into throcodorsal a. and circumflex

scapular a.


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Cubiral fossaBoundaries

Base line drawn throughepicondyles of humerus

Apexbrachioradialis

laterally and pronator teres

medially Roof skin, superficial

faxcia, deep faxcia and

aponeurosis of biceps

Floorbrachialis, supinator

and capsule of elbow joint


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Carpal tunnelFlexor retinaculum

Thickening of deep fascia inthe hand

Attached laterally to scaphoidand trapeziun and medially to

pisiform and hamate

Form an osseofibrous tunnel(carpal tunnel) with carpalgroove transmits median n.,flexor digitorum supericialis,flexor digitorum profundus,and flexor pollicus longusfrom forearm into hand


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Common

flexor sheath

ninous sheath of flexor pollicis longus


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Clavipectoral fascia

The deep faxcia which

extends betweensubclavius, coracoidprocess and pectoralisminor muscles

The structures pass

through theclavipectoral faxcia Cephalic v.

Thoracoacromial a.

Lateral pectoral n.


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Axillary a.

Thoracoacromial a.

Musculocutaneous n.

Median n.

Medial antebrachial

cutaneous n.

Ulnar n.

edial brachial cutaneous n.

Intercostobrachial n.Thoracodorsal n. & a.

ong thoracic n. & lateral thoracic a.

Lateral pectoral

n.


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Posterior humeral circumflex a.

& axillary n.

Radial n.

Circumflex scapular a.


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Musculocutaneou

s n.Median n.

Medial brachial

cutaneous n.

Ulnar n.

Medial antebrachial

cutaneous n.

Superior ulnar coleteral a.

Deep brachial a.


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Median

cubital v.

Lateral anterachial

cutaneous n. & cephelic v. Medial interracial

cutaneous n. & basiic v.


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Radial

recurrent a.

Radial a.

Radial n.

Median n.

Ulnar n.

Ulnar a.

Ulnar recurrent a.

Ulnar n.

Brachial a.


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Muscolocutaneous n.

Brachial a.

Radial n.

Radial recurrent a.

Radial a.

Median n.

Ulnar recurrent a.

Common interosseous a.

Ulnar a., v. & n.


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Palmar aponeurosis


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Superficial palmar a.

recurrent n.

Ulnar a.


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Posterior region of upper limb


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Skin incisions


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Cutaneous n. and

superificial v.


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Trapezium

Deltoid

Triangle of ausculation

Latissimus dorsi

Thoracolumbar fascia

Levator scapular

Rhomboideus


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Axillary n.

Posterio

humeral

circumflex a.Deep brachial a.

Radial n.

Suprascapular n.& a.

Supraspinatus

Infraspinatus

Teres minor

Teres

major


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Radial n. Deep

brachiala.


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Posterior interosseousa.

Posterior interosseous n.


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Hand


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Palm of hand

Flexor retinaculum

Thickening of deep fascia in the hand Attached laterally to scaphoid and

trapeziun and medially to pisiform andhamate

Carpal tunnelCarpal tunnel

Formed by flexor retinaculumandcarpal groove

Transmits Median n.

Flexor digitorum superficialis andflexor digitorum profundus enclosed bycommon flexor sheath

Flexor pollicus longus enclosed bytendinous sheath of flexor pollicuslongus


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Common

flexor sheath

ndinous sheath of flexor pollicis longus


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Deep palmar fascia

Superficial layer

Thenar fascia

Hypothenar fascia

Palmar aponeurosis thicktriangular membrane

Deep layer palmar interosseousfascia


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Osseofascial compartments of palm

Lateral compartment

Medial compartment

Intermediate compartment

Laeral intermuscular

septum

Medialintermuscular

septum Palmar

aponeurosis

Palmar interosseous fascia

Adductor pollicis

ypothenar fascia Thenar fascia


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Intermediate compartment Formedbypalmar aponeurosis, Laeral and medial intermuscular

septum, palmar interosseous fascia Contents: superficial palmar arch, a., v.,n., tendons of flexor

digitorum superficialis and profundus, lumbricales, common flexorsheath


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Fascia spaces Thenar space

Midpalmar space

Midpalmar space

Thenar space

Midplmar septum


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Dorsum of hand

Extensor retinaculumThickening of deep faxcia of

forearm a wrist

Attached laterally to radius and

medially to styloid process of ulna

and triquetrum

Forms six fibrous compartments for

extensor tendons passing from

forearm into hand:


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tendons of abductor pollicis longus and extensor pollicis

brevis and their synovial sheaths;

tendons of extensor carpi radialis longus and brevis and their

synovial sheaths;

tendon of pollicis longus and its synovial sheath;

tendons of extensor digitorum, extensor indicis and their

synovial sheaths;

tendon of extensor digiti minimi and its synovial sheaths;

tendon of extensor carpi ulnaris and its synovial sheaths


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Fascia of the dorsal hand

The superficial fascia

Deep fascia the dorsalfascia of hand

Superficial layer (dorsal

aponeurosis)

Deep layer (dorsalinterosseous fascia)


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Two spaces The dorsal subcutaneous space

The dorsal subaponeurotic space

Superficial fascia

Dorsal

aponeurosisDorsal interosseous fascia

Dorsal subcutaneous

space

Dorsalsubaponeurotic

space

f


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Nerves of hand Median n. thenar except adductor pollicis, first two lumbricals; skin

of thenar, central part of palm, palmar aspect of radial three and one-halffingers, including middle and distal fingers on dorsum

Ulnar n. hypothenar muscles, interossei, 3rd and 4th lumbricals andadductor pollicis; skin of hypothenar, palmar surface of ulnar one andone-half fingers


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Radial n. skin of radial side of dorsum of hand and

radial two and one-half fingers


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Fingers Pulp space

On the palmar side of the tips of the fingers and

thumb. They contain fatty tissue that is divided into

numerous compartments by fibrous septa that pass

between the distal phalanx and the skin. The pulp

space is limited proximally by the firm adherence of

skin and the distal flexion crease to the underlying

tissue; this prevents pulp infection from spreading

proximally along the finger.


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vessels : Nerves

7843166 topographic anatomy superior limbs

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