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Anatomy for Health Care Professionals NUR469: Lecture 2 September 14, 2009 Curtis L. Whitehair, MD Georgetown University School of Nursing & Health Studies.

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Presentation on theme: "Anatomy for Health Care Professionals NUR469: Lecture 2 September 14, 2009 Curtis L. Whitehair, MD Georgetown University School of Nursing & Health Studies."— Presentation transcript:

1 Anatomy for Health Care Professionals NUR469: Lecture 2 September 14, 2009 Curtis L. Whitehair, MD Georgetown University School of Nursing & Health Studies Graduate Program

2 Upper Arterial Supply LAB

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4 Veins

5 Brachial Plexus Robert Taylor Drinks Cold Beer

6 Brachial Plexus

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9 Brachial Plexus Injuries Injuries to the brachial plexus affects movement and cutaneous sensations in the upper limb. Erb-Duchenne Palsy: Upper Trunk or C5,6 Roots – results in waiters tip.  Shoulder Adducted  Medially rotated arm  Extend Elbow

10 Brachial Plexus Injuries Compression of cords of the brachial plexus from prolonged hyperabduction of the arm. Results in pain radiating down the arm with hand weakness.

11 Brachial Plexus Injuries Klumpke Palsy: Less common, inferior brachial plexus injury(C8-T1), may be from trying to break a fall. Intrinsic muscle of the hand affected, develops claw hand.

12 Brachial Plexus Injuries Injuries to the brachial plexus affects movement and cutaneous sensations in the upper limb. Erb-Duchenne Palsy: Upper Trunk or C5,6 Roots – results in waiters tip. Compression of cords of the brachial plexus from prolonged hyperabduction of the arm. Results in pain radiating down the arm with hand weakness. Klumpke Palsy: Less common, inferior brachial plexus injury(C8-T1), may be from trying to break a fall. Intrinsic muscle of the hand affected, develops claw hand. Acute Brachial Plexus Neuritis (Parsonage Turner Syndrome): sudden on set of severe shoulder pain then is followed by weakness. Inflammation is often preceded by some event (URI, Vaccination or Non-specific Trauma)

13 Anterior muscles of the Arm

14 Biceps Brachii Musculocutaneous (C5,C6) (bi, two + L. caput, head) – 2 heads Short head Tip of coracoid process Long head Supraglenoid tubercle of scapula Single distal tendon attached to Radius with biceps tendon Bicipital aponeurosis runs from biceps tendon across the cubital fossa Protects structures of cubital fossa No attachment to Humerus “Three joint muscle” Glenohumeral joint Elbow joint Radioulnar joint When elbow is extended – flexor of elbow Elbow 90 o : Supinated – flexor Pronated – primary supinator of the arm Semiprone – active with resistance only

15 Bicipital Myotatic Reflex Deep Tendon Reflex / Muscle Stretch Reflex – C5 Biceps Tendonitis Wear and tear, usually long head of the biceps Speed’s test – flexion pain at insertion Yergason test – elbow 90o resisted supination

16 Rupture of the Tendon usually long head, rare distally.

17 Brachialis LAB Musculocutaneous C5, C6 Flexes forearm all positions – not effected by position MAIN flexor of the forearm

18 Coracobrachialis LAB Musculocutaneous C5, C6, C7 Flexes arm Helps arm adduction Stabilizes glenohumeral joint from inferior dislocation Carrying suitcase

19 Posterior muscles of the Arm

20 Triceps brachii LAB Radial nerve (C6,C7, C8) 3 heads Long head Crosses glenohumeral joint Helps Adduct and extend Arm Stabilizes inferior dislocation Medial head Workhorse of forearm extension Lateral head Strongest but is recruited against resistance

21 Anconeus Radial C7, C8, T1 Tenses the capsule of the elbow joint preventing its being pinched during extension.

22 Muscles of the forearm flexor The flexors are arranged in three layers Superficial layer 4 muscles Crosses elbow Intermediate layer 1 muscle Crosses elbow Deep layer 3 muscles Crosses wrist and phalanges

23 Superficial Layer – forearm LAB Pronator Teres Median nerve C6, C7 pronates forearm medial boarder cubital fossa

24 Superficial Layer – forearm LAB Flexor carpi radialis Median nerve C6, C7 Flexes wrist Helps abducts wrist

25 Superficial Layer – forearm LAB Palmaris Longus Median nerve Absent in 14% of people (usually left) Tendon passes superficial to the flexor retinaculum Attaches to palmar aponeurosis Median nerve runs lateral to tendon CTS Injection - medial

26 Superficial Layer – forearm LAB Flexor Carpi Ulnaris Most medial flexor Flexes and adducts the wrist if acting alone Ulnar C7, C8

27 Intermediate layer – forearm LAB Flexor digitorum superficialis Distal end four tendons go through carpal tunnel to middle phalanges Flexes four fingers PIP MCP – stronger Median C7, C8, T1 Test – one finger flexed PIP, others extended

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29 Deep Layer – forearm LAB Flexor Digitorum Profundus Only muscle that flex the DIP Medial part – Ulnar C8, T1 Lateral part - Median (anterior interosseous) C8, T1 Flexor Pollicis Longus Only muscle to flex the 1 st IP, MCP and CMC joints Median (anterior interosseous) C8, T1

30 Deep Layer – forearm LAB Pronator quadratus Deepest muscle of anterior forearm Sometimes considered fourth layer Median (anterior interosseous) C8, T1

31 Posterior muscle of the forearm  Superficial layer  Deep layer and Outcropping muscles of deep layer

32 Extensor muscle of the forearm Divided into 3 functional groups Extend, abduct, adduct the hand at the wrist Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extend the medial four fingers Extensor digitorum Extensor indicis Extensor digiti minimi Extend or abduct the thumb Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus

33 Superficial LAB Extensor carpi radialis longus Extensor carpi radialis brevis Extend and abduct wrist Radial nerve C6, C7

34 Superficial LAB Extensor digitorum Four tendons to extensor hood of 4 fingers Extensor digiti minimi 5 th finger Extensor carpi ulnaris Extend and adducts wrist joint Radial nerve C7, C8 (posterior interosseous nerve)

35 Deep Layer LAB Supinator Prime supinator with arm extended Radial (deep branch) Extensor indicis Independent extensor of 2 nd finger Radial C7, C8 – (PI)

36 Deep Layer - Outcropping LAB Abductor pollicis longus Base of 1 st metacarpal Extensor pollicis brevis Base of 1 st proximal phalanx De Quervain’s Tenosynovitis Extensor pollicis longus Base of 1 st distal phalanx Radial nerve C7, C8

37 Medial & Lateral Epicondylitis Medial – Common Flexor Tendon Pitcher’s (Little League) Elbow Lateral – Common Extensor Tendon Tennis Elbow Treatment Splint Physical Therapy NSAIDs Steroids Oral Steroid Injection at the common flex/ext tendon

38 Intrinsic muscle of the hand Thenar muscle Abductor pollicis brevis Median nerve C8, T1 Flexor pollicis brevis Superficial head – Median C8, T1 Deep head – Ulnar C8, T1

39 Intrinsic muscle of the hand Thenar muscle Opposes thumb Median nerve C8, T1 Adductor pollicis Ulnar nerve C8, T1

40 Intrinsic muscle of the hand Hypothenar muscle Abductor digiti minimi Flexor digiti minimi Opponens digiti minimi Ulnar nerve C8, T1

41 Intrinsic muscle of the hand Short Muscles Lumbricals – Ulnar Flex fingers at the MCP joint Extend fingers at IP joint Interossei Dorsal – Abduct from axial line Palmar – Adduct to axial line DAB with a PAD

42 Arteries of forearm and hand

43 Nerves of the hand

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45 Shoulder Joint

46 Rotator Cuff

47 Nursemaid’s Elbow Preschool children Particularly girls Transient subluxation Treatment consists of manipulating the child's arm so that the annular ligament and radial head return to their normal anatomic positions. Immobilize the elbow and palpate the region of the radial head with one hand. The other hand applies axial compression at the wrist while supinating the forearm and flexing the elbow. As the arm is manipulated, a click or snap can be felt at the radial head.

48 Next Week Must know Bones of the LE Fig 5.6, 5.7, 5.8 and 5.9 Dermatomes Fig 5.13 Fig 5.15 – Tensor fascia lata Sartorius Rectus Femoris Adductor longus Vastus medialis / lateralis Gracilis Fig 5.17 – Neurovascular structure Fig 2.3 – Gluteal Region Biceps femoris Semi-tendinosus Semi-mebranosus Gluteus Medius / Maximus Piriformis Popliteal fossa Tibial nerve Popliteal vein Popliteral artery Common fibular (peroneal) nerve Sural nerve Should know Fig 5.15 – Pectinues Adductor brevis Superior gemellus Obturator internus Inferior gemellus Obturator externus Great to know Table 5.1


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