Presentation on theme: "WINDSOR UNIVERSITY SCHOOL OF MEDICINE St.Kitts"— Presentation transcript:
1WINDSOR UNIVERSITY SCHOOL OF MEDICINE St.Kitts DEPARTMENT OF ANATOMYUPPER LIMBDr. SREEKANTH THOTA
2Upper LimbThe upper limb is divided into the shoulder (junction of the trunk with the arm), arm, elbow, forearm, wrist, and hand.
3How to study upper limb? 1. Bones of the Upper Limb 2. Brachial Plexus 3. Muscles of the Upper Limba. Shoulderb. Armc. Forearmd. Hand4. Blood vessels of upper limb5. Lymphatics of upper limb6. Joints of upper limb
4Bones of the Upper LimbBest way to learn bones of upper limb is during the anatomy lab, looking at Netter and follow your instructor.
5Brachial PlexusThe brachial plexus is a somatic plexus formed by the anterior rami of C5 to C8, and most of the anterior ramus of T1.It originates in the neck, passes laterally and inferiorly over rib I, and enters the axilla.
7Brachial PlexusAll major nerves that innervate the upper limb originate from the brachial plexus, mostly from the cords.The parts of the brachial plexus, from medial to lateral, are roots, trunks, divisions, and cords.
9Brachial Plexus Injuries Injuries to the brachial plexus affect movements and cutaneous sensations in the upper limb.Signs and symptoms depend on the part of the plexus involved.Injuries to the brachial plexus result in paralysis and anesthesia.
10Branches of the Brachial Plexus Roots: The roots of the brachial plexus are the anterior rami of C5 to C8, and most of T1.1. Dorsal scapular nerve (C5)2. Long thoracic nerve (C5, 6, and 7)
11TrunksIn the inferior part of the neck, the roots of the brachial plexus unite to form three trunks1. Superior trunk, from the union of the C5 and C6 roots.2. Middle trunk, which is a continuation of the C7 root.3. Inferior trunk, from the union of the C8 and T1 roots.The inferior trunk lies on rib I posterior to the subclavian artery; the middle and superior trunks are more superior in position.
12Branches of the trunksThe only branches from the trunks of the brachial plexus are two nerves that originate from the superior trunk (upper trunk):1.Suprascapular nerve (C5 and 6)2.Nerve to the subclavius muscle (C5 and 6)
13DivisionsEach of the three trunks of the brachial plexus divides into an anterior and a posterior division.No peripheral nerves originate directly from the divisions of the brachial plexus.
14CordsThe three cords of the brachial plexus originate from the divisions and are related to the second part of the axillary artery.The anterior divisions of the upper and middle trunks unite to form the lateral cord, the anterior division of the lower trunk continues as the medial cord, and the posterior divisions of all three trunks join to form the posterior cord.
20Branches of the medial cord 1.Medial pectoral nerve(C8; T1)2.Medial cutaneous nerve of arm (C8; T1)3.Medial cutaneous nerve of forearm(C8; T1)4.Ulnar nerve(C8; T1)5.Medial root of median nerve(C5, 6, 7, 8; T1)
317. Median nerve(C5, 6, 7, 8; T1)All muscles in the anterior compartment of the forearm (except flexor carpi ulnaris and medial half of flexor digitorum profundus), three thenar muscles of the thumb and two lateral lumbrical muscles
328. Medial pectoral nerve (C8; T1) Pectoralis major and minor muscles
339. Medial cutaneous nerve of arm(C8; T1) Skin of medial side of arm
3410. Medial cutaneous nerve of forearm (C8; T1) Skin of medial side of forearm
3511.Ulnar nerve (C8; T1)All intrinsic muscles of the hand (except three thenar muscles and two lateral lumbricals); also flexor carpi ulnaris and the medial half of flexor digitorum profundus in the forearm
44Injury to C5-6 at Erb’s point Muscles paralysed – Deltoid, Erb-Duchenne’s PalsyInjury to C5-6 at Erb’s pointMuscles paralysed – Deltoid,biceps, brachialis,barachioradialisPosture – waiter’s tip deformityMechanism of injury : fall on shoulder or excessive pulling of head of new born during delivery
49wrist-dropThe characteristic clinical sign of radial nerve injury is wrist-drop.
50Fracture of the Humeral Shaft A midhumeral fracture may injure the radial nerve in the radial groove in the humeral shaft.Fracture is not likely to paralyze the triceps because of the high origin of the nerves to two of its three heads.
51Main Effect: Radial Nerve Injury in Axilla: Mechanism: SATURDAY NIGHT PALSYRadial Nerve Injury in Axilla:Mechanism:Crutches pressing in axillaSaturday night palsy!Main Effect:WRIST DROP