UPPER LIMBWhat is a limb?Sensory to upper limbMaking it moveBones and jointsMuscles and nervesVascular supplySurface anatomy(muscle study hint)

What is a limb?Ventral somatic outgrowth of outer tubeBones (with bone, cartilage, marrow, NAV, etc.)JointsMuscleNervesVascular supplyNo viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)

Sensory from limb (dermatomes/sensory skin segments from spine)Dermatomes extend over limbsTwisted orientation reflects twisting of limb during developmentNamed nerves generally innervate skin over muscles that they innervate

Sensory territory of nervesBrachial plexus serves to re-direct spinal routes into named nerves covering certain territoryCutaneous branches of medial cord/ulnar nerve

Upper Limb Skeleton (old hat?)ScapulaHumerusRadius, ulnaCarpals--proximal, distalDigitsMetacarpalsPhalanges

Joints

JOINT

BETWEEN

MOVEMENT

TYPE

Muscles of ScapulaIf INSERTION on scapula = Move scapulaRhomboidsTrapeziusPectoralis MinorSerratus VentralisLevator ScapulaeIf ORIGIN on scapula = Move ArmSubscapularisSupraspinatusInfraspinatusTeres MinorTeres MajorLatissimus Dorsi (partial O on scap)Coracobrachialispg 299Rotator CuffUse location of Insertion to determine exact movement!!

POSTERIOR AND ANTERIOR COMPARTMENTS

Brachial PlexusM&M, Fig. 14.11 Posterior Compartmentposterior cord Anterior compartmentmedial, lateral cords Name of cord is relative to axillary artery

ANTERIOR MUSCLESM-CBicepsbrachialisMedianForearm flexorsThumb intrinsics (1M$ nerve)UlnarFlexor carpi ulnarisHand intrinsicsPOSTERIOR MUSCLES

Muscles (radial nerve)TricepsAnconeusBrachioradialisCarpal, digit extensors

Muscles and nerves by compartment

ANTERIOR

POSTERIOR

NERVES

M-C, ulnar, median

Radial

MOVEMENT

Flexion

Extension

MUSCLES

Biceps, flexors

Triceps, extensors

TWIST

Flexors from medial epicondyle

Extensors from lateral epicondyle

Posterior Compartment of ForearmExtensor digitorumExtensor carpi ulnarisExt Carpi Radialis LongusBrachioradialisLateral EpicondylePosterior View

Anterior Compartment Forearm

Flexor Carpi RadialisFlexor RetinaculumMedial EpicondyleFlexor Digitorum Superficialis is deep to other flexorspg 302

Flexor Carpi UlnarisBrachioradialisPronator TeresAnterior View

Routes of nerves (in human)M-C: between biceps brachii and brachialisMedian: medial/posterior to biceps, branches into forearm flexors at elbow then to hand through carpal tunnelRecurrent median (1M$) superficial at wrist to thumb over thenar emminence) deficit - apes handUlnar: medial in arm, posterior to medial epicondle of humerus (funny bone) down medial forearm medial to carpal tunnel into palmRadial: deep posterior arm around lateral epicondyle of humerus to forearm (deep and superficial branches)

Vascular supplySubclavianaxillary radial (same street, new street sign every block)Collateral circulationPosterior/anterior circumflex humeralDeep brachial a.Radial a. (with median n.) deep palmar archUlnar a. (with ulnar n.) superficial palmar arch

Ulnar NerveBrachial ArteryMedian NerveUlnar NerveMedian NerveRadial ArteryMusculocutaneous NerveUlnarArteryWheres Radial Nerve?

Axilla = ArmpitRegion between arm and chestBoundariesVentral - pectoral musclesDorsal = latissimus dorsi, teres major subscapularisMedial = serratus ventralisLateral = bicipital groove of humerusContentsAxillary lymph nodes, Axillary vesselsBrachial Plexus

Surface Anatomy of Upper LimbBiceps + Triceps brachiiOlecrenon ProcessMedial EpicondyleCubital FossaAnterior surface elbowContentsMedian Cubital VeinBrachial ArteryMedian NerveBoundariesMedial= Pronator teresLateral= BrachioradialisSuperior= Line between epicondylespg 786 + 784

Surface Anatomy of Upper LimbCarpal TunnelCarpals concave anteriorlyCarpal ligament covers itContains: long tendons, Median nerveInflammation of tendons = compression of Median nerveAnatomical SnuffboxLateral = E.pollicis brevisMedial = E. pollicis longusFloor = scaphoid, styloid of radiusContains Radial Artery (pulse)pg 306, 788

Suggestion: a muscle table organized byJoint crossed?Nerve innervating?Action?Compartments?All of the above?

MUSCLE

ACTION

ORIGIN

INSERTION

INNERVATION

(cord to nerve)

Biceps

Flex, sup.

Humerus, glenoid

Radial tuberosity

Medial cordM-C.