the upper extremity bones, muscles, vessels, pg 608
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The Upper Extremity
Bones, Muscles, Vessels,
pg 608
Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
Glenoid cavity Allows for mobility
Attachments Upper extremity:
Arm humerus
Forearm Radius, ulna (interosseous
membrane) Hand
Carpals, metacarpals, phalanges Review bones and landmarks
studied in lab!!!
pg 612
Joints of Upper Extremity
Sternoclavicular Synovial-saddle Diarthrosis
Acromioclavicular Synovial-plane Diarthrosis
Glenohumeral joint Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility
pg 626-7
Joints of the Upper Extremity
Elbow Joint Synovial – hinge Diarthrosis
Articulations Humerus & Ulna Humerus & Radius
Many Ligaments
pg 681-2
Joints of Upper Extremity
Proximal Radioulnar joint Synovial - pivot Diarthrosis
Distal Radioulnar joint Synovial – pivot Diarthrosis
Allows pronation and supination of forearm
pg 691
Radiocarpal joint Synovial-condyloid Distal radius with proximal row of
carpals Intercarpal joints
Synovial-plane Carpal-metacarpal (2-5)
Synovial-plane Trapezium-metacarpal 1
Synovial-saddle Metacarpal-phalangeal
Synovial-condyloid Interphalangeal
Synovial-hinge ALL DIARTHROSES
Joints of the Upper Extremity Pg 711
Review of Naming…..
What do the following names TELL you about the muscle? Naming
Flexor carpi ulnaris Flexor digitorum superficialis Flexor pollicis longus Pronator quadratus Extensor carpi radialis brevis
Scapula Muscles
If the origin is on the scapula – moves the arm Subscapularis Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial
attachment) Coracobrachialis
RotatorCuff
pg 614
Scapula Muscles If the insertion is
on the scapula – moves the scapula Rhomboids Trapezius Pectoralis Minor Serratus Ventralis Levator Scapulae
Use location of Insertion to determine movement!!
pg 614
Innervation of Muscles Moving Arm
Muscle Innervation
SubscapularisTeres Major
Subscapular N.
InfraspinatusSupraspinatus
Suprascapular N.
Teres Minor Axillary N.
Coracobrachialis Musculocutaneous N.
Arm Muscles
Cross elbow, move forearm 2 compartments
Anterior Flexors of forearm
Posterior Extensors of forearm
pg 667
Arm Muscles
Anterior compartment Brachialis Biceps brachii Coracobrachialis
pg 651
pg 671
Arm Muscles Posterior compartment
Triceps brachii
pg 636
Muscles of ArmMuscle Origin Insertion ActionAnterior
Brachialis Ant shaft , distal humerus Coronoid proc/tuberosity
(ulna)
Flex forearm
Biceps Brachii Long: supraglenoid tubercle (scapula)
Short: coracoid proc (scapula)
Radial Tuberosity (radius)
Flex forearm, Supination
Coracobrachialis Coracoid proc (scapula) Medial surface midshaft (humerus)
Flex arm
PosteriorTriceps Brachii Long: Infraglenoid tubercle
Short: Posterior shaft
(middle humerus)
Lateral: Posterior Shaft
(proximal humerus)
Common tendon to olecranon (ulna)
Extend forearm
Arm Muscle Innervation
Anterior compartment Musculocutaneous nerve
Coracobrachialis Brachialis Biceps brachii
Posterior compartment Radial nerve
Triceps brachii
Forearm Muscles Cross elbow, wrist and finger
joints Movement of hand and fingers
Cross Wrist flex, extend, abduct, adduct
hand Cross Fingers
flex, extend fingers Proximally are fleshy Distally have long tendons Flexor and extensor retinacula
“wristbands” Keep tendons from jumping
outwards when tensed
pg 694
Forearm Muscles Anterior flexor compartment
Superficial and Deep Most flexors have common tendon on medial epicondyle Contains 2 pronators
Posterior extensor compartment Superficial and Deep Most extensors in superficial layer have common origin on
lateral epicondyle
pg 688
Anterior Compartment of Forearm
Muscles Nerves Superficial
Flexor digitorum superficialis & brevis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Ulnar
Deep Pronator quadratus Median Flexor pollicis longus Median Flexor digitorum profundus Ulnar (med 1/2)
Median (lat 1/2)
pg 696
Posterior Compartment of Forearm
Muscles Nerves Superficial
Brachioradialis Radial Anconeus Radial Extensor carpi radialis longus & brevis Radial Extensor digitorum Radial Extensor carpi ulnaris Radial Extensor digiti minimi Radial
Deep Supinator Radial Abductor pollicis longus Radial Extensor pollicis longus + brevis Radial Extensor indicus Radial
pg 702
Hand Bones
Carpus (8) “True” wrist Distal to radius/ulna
Metacarpus (5) Distal to carpus
Phalanges (14) Distal to metacarpus
pg 711
Intrinsic Muscles of the Hand
Muscle Nerve Pinky (little finger)
All digiti minimi Ulnar(Flexor, Abductor, Opponens)
Thumb Abductor pollicis brevis Median Flexor pollicis brevis Median Opponens pollicis Median Adductor pollicis Ulnar
Other Intrinsic Muscles Palmar + Dorsal Interossei Ulnar Lumbricals Median, Ulnar
Intrinsic Muscles of the Hand
Interossei Muscles
Lumbrical Muscles
pg 718pg 723
Dorsal Palmar
Blood Supply - Veins Deep veins
Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Axillary – axilla Subclavian - neck
Superficial Veins Digital Superficial palmar venous
arches Median – forearm Median cubital – elbow
Blood draws!! Cephalic – arm/forearm Basilic – arm/forearm
pg 677
Blood Supply - Arteries Subclavian (neck) Axillary (armpit)
Subscapular Circumflex humeral arteries
Brachial (arm) Deep brachial
Radial (forearm) Ulnar (forearm)
Common Interosseous Superficial & Deep Palmar
arches Digital
pg 675
Axilla Armpit!! Where axillary hairs grow Boundaries
Ventral Pectoral muscles
Dorsal Latissimus dorsi, teres major,
subscapularis Medial
Serratus ventralis Lateral
Inetrtubercular (Bicipital) groove of humerus
Contents axillary lymph nodes, axillary
vessels, brachial plexus
pg 688
Surface Anatomy of Arm
Cephalic Vein Biceps brachii Triceps brachii Olecrenon
Process Medial Epicondyle Lateral Epicondyle
pg 688
Surface Anatomy of Elbow
Cubital Fossa Anterior surface elbow Contents
Median Cubital Vein Brachial Artery Median Nerve
Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles
pg 686
Surface Anatomy of Hand
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 715
Brachial Plexus
Nerve plexus Network of nerves formed by
ventral rami
Lies partly in neck and partly in axilla
Gives rise to almost all nerves that supply upper limb
Formed by intermixing of ventral rami of spinal nerves C5-C8 and T1
Small contributions from C4 and T2
pg 618
pg 21
Brachial Plexus
Really Tired? Drink Coffee Buddy!
R = RAMI (ventral) (5) T = TRUNKS (3) D = DIVISIONS (2) C = CORDS (3) B = BRANCHES (Many!!)
pg 660
Rami join to form Trunks! (in neck)
Ventral Rami Trunks
C5 Upper Trunk C6
C7 Middle Trunk
C8 T1 Lower Trunk
Trunks Split to form Divisions! (in neck)
Trunks Divisions
Upper AnteriorPosterior
Middle AnteriorPosterior
Lower Anterior Posterior
Divisions Join to form Cords! (in axilla)
Trunks Division Cords
U A LateralP
M A MedialP
L A PosteriorP
Cords Give off Branches!! (in axilla) Lateral Musculocutaneous
Median
Medial Ulnar
Posterior RadialAxillary
(thoracodorsal)
(subscapular)
Brachial Plexus – Cords and Branches
Lateral Musculocutaneous n. Median n.
Medial Ulnar n.
Posterior Radial n. Axillary n. Thoracodorsal n. Subscapular n.
Lateral Cord Musculocutaneous nerve
Off lateral cord Course:
Anterior arm Becomes cutaneous and gives skin sensation to lateral forearm
Innervates: Corocobrachialis (motor) Biceps brachii (motor) Brachialis (motor) Skin distal to the elbow (sensory)
Suprascapular (not part of lateral cord) Runs with suprascapular artery and vein {C5, C6} Innervates
Supraspinatus Infraspinatus
Medial Cord Ulnar nerve
Course: Comes off medial cord Descends along medial side of arm Passes posterior to medial epicondyle Follows the ulna Superficial to carpal tunnel into hand Branches to supply intrinsics and skin
Innervates: Flexor carpi ulnaris (motor) Flexor digitorum profundus (motor) Most intrinsic hand muscles (motor) Dorsal branch supplies skin of medial 2/3 of hand (sensory)
Both Medial and Lateral Cords
Median nerve Course:
Middle of brachial plexus (from lateral and medial cords) Does not branch in arm Distal to elbow provides many branches to most forearm flexors Passes through carpal tunnel to hand to lateral palmar intrinsics
Innervates: Anterior forearm (motor)
Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory)
Posterior Cord Radial nerve
Largest branch of brachial plexus Comes from posterior cord Course:
Through arm Around humerus Around lateral epicondyle (then divides)
Innervates: Posterior muscles of arm and forearm
Triceps brachii, anconeus, supinator, brachioradialis Divides in forearm:
Superficial Skin of arm and dorsolateral surface of hand
Deep Extensor muscles of forearm (eg ext. carpi radialis L + B)
Posterior Cord (continued) Axillary nerve
Branches off posterior cord Course:
Runs posterior to humerus Runs with caudal humeral circumflex artery
Innervates: Deltoid and teres minor (motor) Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve Innervates:
Subscapularis, Teres major Thoracodorsal nerve
Course: Runs with thoracodorsal artery and nerve
Innervates: Latissimus dorsi
Cutaneous Innervation to Hand
pg 620, 727, 729
Nerve Damage Ulnar nerve
“Claw hand” Inability to extend fingers at
interphalangeal joints, results in permanent flexion = claw
Median nerve “Ape hand”
Inability to oppose thumb
Radial nerve “Wrist drop” Inability to extend the hand,
inability to fully extend forearm
pg 737-8