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The Upper Extremity Bones, Muscles, Vessels,. Bones 30 bones!!!! Appendicular skeleton Pectoral girdle  Scapula  Clavicle Allows for mobility  Ball.

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Presentation on theme: "The Upper Extremity Bones, Muscles, Vessels,. Bones 30 bones!!!! Appendicular skeleton Pectoral girdle  Scapula  Clavicle Allows for mobility  Ball."— Presentation transcript:

1 The Upper Extremity Bones, Muscles, Vessels,

2 Bones 30 bones!!!! Appendicular skeleton Pectoral girdle  Scapula  Clavicle Allows for mobility  Ball and socket attachments Upper extremity:  Arm humerus  Forearm Radius, ulna (interosseous membrane)  Hand Carpals, metacarpals, phalanges Review bones and landmarks studied in lab!!! Glenoid cavity

3 Joints of Upper Extremity Sternoclavicular  Synovial-saddle  Diarthrosis Acromioclavicular  Synovial-plane  Diarthrosis Glenohumeral joint  Synovial-ball&socket  Diarthrosis  Many ligaments  Muscle reinforcement  Great Mobility

4 Joints of the Upper Extremity Elbow Joint  Synovial – hinge  Diarthrosis Articulations  Humerus & Ulna  Humerus & Radius Many Ligaments

5 Joints of Upper Extremity Proximal Radioulnar joint  Synovial - pivot  Diarthrosis Distal Radioulnar joint  Synovial – pivot  Diarthrosis Allows pronation and supination of forearm

6 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

7 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

8 Scapula Muscles If the origin is on the scapula – moves the arm  Subscapularis  Supraspinatus  Infraspinatus  Teres Minor  Teres Major  Latissimus Dorsi (partial attachment)  Coracobrachialis Rotator Cuff

9 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!!

10 Scapula Innervation Origin on scapula  Subscapularis and teres major Subscapular  Supraspinatus and Infraspinatus Suprascapular  Teres Minor Axillary  Latissimus Dorsi Thoracodorsal  Coracobrachialis Musculocutaneous Insertion on scapula  Rhomboids and Levator Scapulae Dorsal scapular  Trapezius Accessory  Pectoralis Minor Medial and Lateral  Serratus Ventralis Long thoracic

11 Muscles of the Rotator Cuff All INSERT on the humerus MuscleOriginAction Subscapularis Subscapular fossa Medial rotator of the humerus infraspinatus Infraspinous fossa Lateral rotator of the humerus Teres minor Lateral border of scapula (upper 2/3) Lateral rotator of the humerus supraspinatus Supraspinous fossa Abducts the humerus

12 Muscles of the Scapula *All these muscles INSERT on the scapula MuscleOriginAction Trapezius Ligamentum nuchae and C7-T12 Elevates, adducts, rotates, and depresses the scapula Levator Scapulae ventralis C1-C4 Elevates the scapula, flexes neck laterally RhomboidsC7-T5 Adduct, elevate, and rotate the scapula Pectoralis minor Ribs 3-5 Depresses and rotates the scapula Serratus anterior Ribs 1-9 Protracts and rotates the scapula

13 Arm Muscles Cross elbow, move forearm 2 compartments  Anterior Flexors of forearm  Posterior Extensors of forearm

14 Arm Muscles Anterior compartment  Brachialis  Biceps brachii  Coracobrachialis  Brachioradialis

15 Arm Muscles Posterior compartment  Triceps brachii  Anconeus

16 Arm Muscle Innervation Anterior compartment  Radial nerve Bracioradialis  Musculocutaneous nerve Coracobrachialis Brachialis Biceps brachii Posterior compartment  Radial nerve Triceps brachii Anconeus

17 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

18 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

19 Anterior Compartment of Forearm MusclesNerves  Superficial Flexor digitorum superficialisMedian Flexor carpi radialisMedian Pronator teresMedian Palmaris longusMedian Flexor carpi ulnarisRadial  Deep Flexor pollicis longusMedian Flexor digitorum profundusUlnar (med 1/2) Median (lat 1/2)

20 Anterior Compartment Forearm

21 Posterior Compartment of Forearm Muscles Nerves  Superficial Extensor carpi radialis longus Radial Extensor digitorum Radial Extensor carpi ulnarisRadial  Deep SupinatorRadial Abductor pollicis longusRadial Extensor pollicis longus + brevis Radial Extensor indicusRadial

22 Posterior Compartment of Forearm

23 Hand Bones Carpus (8)  “True” wrist  Distal to radius/ulna Metacarpus (5)  Distal to carpus Phalanges (14)  Distal to metacarpus

24 Intrinsic Muscles of the Hand MuscleNerve Pinky (little finger)  All digiti minimiUlnar (Flexor, Abductor, Opponens) Thumb  Abductor pollicis brevisMedian  Flexor pollicis brevisMedian  Opponens pollicisMedian  Adductor pollicisUlnar Other Intrinsic Muscles  Palmar + Dorsal InterosseiUlnar  LumbricalsMedian, Ulnar

25 Muscles of the Upper Limb *All INSERT on the humerus (*)MuscleOriginAction Deltoid Lateral ½ of clavicle, acromion and spine of scapula Prime flexor, abducts and extends the humerus. Laterally and medially rotates arm. Pectoralis major Sternum and ribs 2-6 Adducts, flexes, and medially rotates humerus Latissimus dorsi Iliac crest, T7-T12 and lumbar fascia Extends, adducts, and medially rotates the humerus Teres major Lateral border of scapula (lower 1/3) Extends, adducts, and medially rotates the humerus Coracobrachialis Coracoid process Flexes and adducts the humerus.

26 Muscles Crossing the ElbowMuscleOriginInsertionAction Triceps Brachii (radial nerve) Infraglenoid tubuercle and shaft of humerus Olecranon process of ulna Forearm extensor Anconeus (radial nerve) Lateral epicondyle of humerus Lateral aspect of olecranon process of ulna Abducts ulna during forearm pronation Biceps Brachii (musculocutaneous nerve) Supraglenoid tubercle and coracoid process Radial tuberosity Flex forearm and supinate hand Brachialis (musculocutaneous nerve) Anterior surface of humerus Coronoid process of ulna and capsule of elbow Forearm flexor and hand supinator Brachioradialis (radial nerve)* Supracondylar ridge of the humerus Styloid process of radius Synergist in forearm flexion *Exception: radial nerve usually serves extensor muscles

27 Muscles of the Forearm MuscleOriginInsertionAction Pronator Teres (median nerve) Humerus Coronoid process of ulna Lateral raidus Pronate forearm Weak flexor of elbow Flexor Carpi Radialis (median nerve) Humerus-medial epicondyle Base of 2 nd and 3 rd metacarpals Flexor of wrist, abduct hand Palmaris Longus (median nerve) Humerus-medial epicondyle Palmar fascia Weak wrist flexor Flexor Carpi Ulnaris (ulnar nerve) Humerus-medial epicondyle Olecranon process Pisiform and hamate bones, base the 5 th metacarpal Powerful flexor of wrist, adductor of hand Flexor Digitorum Superficialis (median nerve) Humerus-medial epicondyle, coronoid process of ulna, shaft of radius Four tendons into middle phalange of fingers 2-5 Flexes wrist ANTERIOR Superficial Muscles

28 Muscles of the Forearm MuscleOriginInsertionAction Flexor Pollucis Longus (median nerve) Radius and interosseous membrane Distal phalanx of thumb Flexes distal phalanx of thumb Flexor Digitorum Profundus (ulnar and median nerves) Ulna and interosseous membrane Four tendons into distal phalanges of fingers 2-5 Flexor of the fingers Pronator Quadratus (median nerve) ulnaradus Forearm pronation ANTERIOR Deep Muscles

29 Muscles of the Forearm MuscleOriginInsertionAction Extensor Carpi Radialis Longus (radial nerve) Humerus-lateral epicondyle Base of 2 nd metacarpal Extends and abducts wrist Extensor Carpi Radialis Brevis (deep branch of radial nerve) Humerus-lateral epicondyle Base of 3 rd metacarpal Extends wrist Extensor Digitorum (radial nerve) humerus Four tendons into extensor expansions and distal phalanges of fingers 2-5 Prime mover of finger extension Extensor Carpi Ulnaris (posterior interosseous nerve) Humerus-lateral epicondyle and ulna Base of fifth metacarpal Extends wrist and adducts wrist POSTERIOR Superficial Muscles

30 Muscles That Move the Forearm MuscleOriginInsertionAction Supinator (post. Interosseous nerve) Humerus, ulna Radius proximal end Supinate forearm Abductor Pollucis Longus (post. Inter. Nerve) Post. Radius and ulna Base of 1 st metacarpal and trapezium Abducts and extends thumb Extensor Pollucis Brevis and longus (post. Inter. Nerve) Shaft of radius and ulna, interosseous membrane Base proximal phalanx (brevis) and distal phalanx (longus) of thumb Extends thumb Extensor Indicis (post. Inter. Nerve) Distal ulna, interosseous membrane Extensor expansion of index finger Extends index finger POSTERIOR Deep Muscles

31 deep_muscles.htm# Upper Arm

32 1.Clavodeltoid 2.Biceps Brachii 3. Triceps Medial Head 4.Epitrochlearis 5. Triceps Long Head Upper Arm –Medial View

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35 1.Acromiotrapezius 2. Levator Scapulae Ventralis 3.Teres Major 4. Triceps Lateral Head (Reflected) 5.Triceps Long Head 6. Triceps Medial Head 7.Brachialis 8.Clavodeltoid 9.Anconeus Upper Arm – Lateral View

36 1’Long Head of Triceps7. Extensor Digitorum Communis 2.Lateral Head of Triceps8. Extensor Digitorum Lateralis 3.Brachialis9.Extensor Carpi Ulnaris 4.Brachioradialis 1 0. Flexor Carpi Ulnaris 5. Extensor Carpi Radialis Longus 11. Anconeus 6. Extensor Carpi Radialis Brevis

37 1.Brachioradialis8.Clavodeltoid 2.Extensor Carpi Radialis Longus9.Biceps Brachii 3.Extensor Carpi Radialis Brevis10.Epitrochlearis 4.Pronator Teres11.Long Head of Triceps 5.Flexor Carpi Radialis12.Medial Head of Triceps 6.Palmaris Longus13.Flexor Digitorum Superficialis 7.Flexor Carpi Ulnaris

38 Intrinsic Muscles of the Hand Thenar Eminence MuscleOriginInsertionAction Abductor Pollucis Brevis (median nerve) Flexor retinaculum, Carpal bones Base of first proximal phalanx Abducts thumb Flexor Pollucis Brevis (median nerve) Same as above Flex thumb Opponens Pollucis (median nerve) Flexor retinaculum and trapezium Anterior side of first metacarpal Oppostion Adductor pollucis (ulnar nerve) Capitate bone and bases of metacarpals 2-4 Medial side of base of first proximal phalanx Adducts and opposes the thumb

39 Intrinsic Muscles of Hand Hypothenar Eminence MuscleOriginInsertionAction Abductor Digiti Minimi (ulnar nerve) pisiform Medial side of proximal phalanx of 5 th finger Abducts little finger at MPJ. Flexor digiti minimi brevis (ulnar nerve) Hamate and flexor retinaculum Same as above Flexes little finger Opponens digiti minimi (ulnar nerve) Same as above Medial side of metacarpal 5 opposition

40 Muscles of the Hand Midpalmar Muscles MuscleOriginInsertionAction Lumbricals (median and ulnar nerve) Lateral side of each tendon of the deep flexor Lateral edge of extensor expansion of fingers 2-5 Flex the MPJ Extend IPJ’s Palmar Interossei (ulnar nerve) Midaxial side of each metacarpal except of met. #3 Extensor expansion Adduction of fingers Dorsal interossei (ulnar nerve) Sides of metacarpals Extensor expansions Abduct fingers

41 Intrinsic Muscles of the Hand Interossei Muscles Lumbrical Muscles

42 Blood Supply - Veins Deep veins  Deep palmar venous arches  Radial - forearm  Ulnar - forearm  Brachial – arm/elbow  Subclavian - neck  Axillary – axilla Superficial Veins  Cephalic – arm/forearm  Basilic – arm/forearm  Median cubital – elbow Blood draws!!  Median - forearm  Superficial palmar venous arches  Digital

43 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

44 Axilla Between arms and chest Where axillary hair grow Boundaries  Ventral Pectoral muscles  Dorsal Latissimus dorsi, teres major, subscapularis  Medial Serratus ventralis  Lateral Intertubercular (Bicipital) groove of humerus Contents  Axillary lymph nodes, Axillary vessels, brachial Plexus

45 Surface Anatomy of Arm Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle

46 Surface Anatomy of Elbow Cephalic vein Cubital Fossa  Anterior surface elbow  Contents Median Cubital Vein Brachial Artery Median Nerve  Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles

47 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)

48 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 C 5 -C 8 and T 1  Small contributions from C 4 and T 2

49 Ventral Rami

50 Brachial Plexus R eally T ired? D rink C offee B uddy! R = RAMI (ventral) (5) T = TRUNKS (3) D = DIVISIONS (2) C = CORDS (3) B = BRANCHES (Many!!)

51 Rami join to form Trunks! (in neck) Ventral Rami Trunks C5Upper Trunk C6 C7Middle Trunk C8 T1Lower Trunk

52 Trunks Split to form Divisions! (in neck) Trunks Divisions UpperAnterior Posterior MiddleAnterior Posterior LowerAnterior Posterior

53 Divisions Join to form Cords! (in axilla) Trunks Division Cords UALateral P MAMedial P LAPosterior P

54 Cords Give off Branches!! (in axilla) Lateral Musculocutaneous Median MedialUlnar PosteriorRadial Axillary Thoracodorsal Subscapular

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56 1.Vagus Nerve 2.Brachial Plexus 3.Radial Nerve 4.Axillary Nerve 5.Median Nerve 6.Ulnar Nerve

57 Brachial Plexus – Cords and Branches Lateral  Musculocutaneous  Median Medial  Ulnar Posterior  Radial  Axillary  Thoracodorsal  Subscapular

58 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)

59 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)

60 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  Innervates: Anterior forearm (motor)  Most flexors, some intrinsics (thumb) 2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory)

61 Posterior Cords 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 E. carpi radialis L + B)

62 Posterior Cord 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: Subscaplaris, Teres major Thoracodorsal nerve  Course: Runs with thoracodorsal artery and nerve  Innervates: Latissimus dorsi

63 Cutaneous Innervation to Hand

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65 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

66 Carpal Tunnel Syndrome At A Glance Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.

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