Presentation on theme: "Bones and Muscles and regional anatomy of the upper limb part2"— Presentation transcript:
1Bones and Muscles and regional anatomy of the upper limb part2 Lecturer: Dr. M. SamsamUniversity of Central Florida, Orlando,Pictures from Platzer atlas and textbookof human anatomy and K. Moore anatomyand Netter atlas of human anatomy
2Damage to the Radial nerve Injury proximal to the origin of Triceps:*No extension of elbow (elbow is flexed)*No triceps reflex*Wrist drop (all extensor muscles and theSupinator are paralyzed), thumb is flexedand adductedSensory loss: dorsolateral lower brachialregion, posterior surface of forearm,dorsum of the hand and radial side ofproximal phalangesInjury of the nerve in radial groove:In fractures of humerusTriceps muscle is usually functioningWirst drop and sensory loss indorsolateral aspect of the forearm and handPlus all other problems mentioned aboveNerve injury in forearm:Here the deep radial nerve is injured (wrist drop)Extension of the thumb and metacarpal joints isdisturbed. Sensation is usually preserved
3(suicide or injury e.g.: hand out of car’s window) Median Nerve injury:Above the elbow:Muscles in the arm are not affectedForearm and hand muscles are affected1- All flexors of the wrist are paralyzedexcept:2- Flexor carpi ulnaris and ulnar part of Flexordigitorum profundus.3- Thumb flexors and abductor paralyzed but notAdductor (ulnar N.) (ape hand)4- Flexion at metacarpophalangeal joints possible(intact interossei MM, ulnar N.)6- 1st and 2nd Lumbricals lost function and all together,inability to fully flex index and middle finger(HAND OF PAPAL BENEDICTION)Pronation of forearm paralyzed and sensory loss overthe median N. areaInjury at wrist Joint:(suicide or injury e.g.: hand out of car’s window)Short muscles of the thumb paralyzed, not adductor.Thenar muscles atrophy (flattened, ape hand)Flexor pollicis longus functioningSensory loss over Medial N. area
4Ulnar nerve injury: At wrist Injury at elbow: 1- Fingers are hyperextended at metacarpophalangeal jointsand flexed at interphalangeal joints (paralysis of interosseiMM and 2 medial lumbricals (Claw hand)2- Tendon of flexor digitorum perfundus (2 medial ones)paralyzed, Therefore flexion of the ring and little fingeris not possible at distal phalangeal joints3- Small muscles of the little finger are paralyzed4- Abduction and Adduction of the fingers are impaired( paralysis of interossei MM, piano playing,writing.. Impaired)5- Sensory loss over ulnar innervating area.Injury at elbow:1- Paralysis of flexor carpi ulnaris and medial portion ofFlexor digitorum profundus2- Ulnar deviation of the wrist is weakened, hand is abductedand extendedPlus problem number 4 and 5 from above
5Atlas: only look at the items Regional AnatomyAtlas: only look at the itemsInfraclavicular region(Deltopectoral triangle)Borders: 1- Clavicle, 2- Deltoid,3- Pectoralis majorSkin innervation: medial, intermediate andLateral supraclavicular nerves (cervical plexus)On deltoid region: innervation by axillary nerve6- Pectoralis minor M.7- Clavipectoral fascia8-Cephalic vein9- Axillary vein10- Thoracoacromial artery (11-clavicular,12-acromial, 13-deltoid, 14-pectoral parts)15- Pectoral nerve16- Subclavius M.17- Axillary artery18- lateral cord19- Posterior cord20- Medial cord21- Suprascapular nerve and vessels
6Axillary region: (Pyramidal shape) Borders:Pectoralis Major, Latis dorsi, ribs andintercostal muscles, humerus andcoracobrachialisAtlas: only look at the items
10Lymph nodes of the Axillary region: Arranged in 5 groups: Pectoral, medial, apical,central and subscapularDrainage: subclavian lymphatictrunk to right lymphatic duct toright venous angle**Importance:Breast Cancers maygive metastasis to the axillarylymph node (75% of breast’slymphatics drain here).Removal of the lymph nodesmay be necessary.Mastectomy: removal of thebreast.*LymphangitisMoore
11Regional anatomy:Atlas: Only look at the itemsAnterior Brachial region:1- Brachial fascia2- Cephalic vein3- Basilic vein4- Basilic hiatus5- Medial antebrachial cutaneous N.6- the same nerve as 57- lymph nodes8- Medial brachial cutaneous N.9- Intercostobrachial N.
12Anterior Brachial region Medial bicipital groove:Between biceps and intermuscular septaContents:Median N, Brachial artery and veins andbasilic vein, medial cutaneous antebrachialnerve and ulnar N. medially.Deep in this region, proximally , the radialnerve takes a posterior direction.
13Axillary spaces: Quaderangular space Triangular Spaces 1- Teres Minor 2- Teres Major3- Humerus4- Long head of TricepsRadial nerve is found deep in theposterior brachial region in radialgroove of humerus accompaniedby deep brachial A and V.
14Regional anatomy:Atlas: Only look at the itemsCubital fossa: Superficial1- Basilic vein2- Antebrachial Basilic vein5- Cephalic and7- Median cubital vein4- Medial cutaneous antebrachial nerve6- lateral antebrachial cutaneous nerve(branch of musculocutaneous N.)
15Cubital fossa (deep):Atlas: Only look at the items1- Biceps Brachii M.2- Bicipital aponeurosis3- Brachialis M4- Pronator teres5- Brachioradialis6- Radial artery and veins7- recurrent radial A.8- Median N.9- Ulnar nerve10- Radial N.11- Superficial Radial N.12- Deep radial N.13- Supinator muscle
16Arteries of the forearm and hand: 1- brachial artery2- Radial artery3- Ulnar artery6- Deep palmar arch8- Principal artery of the thumb13- Superficial palmar arch14- the 3 common digital arteries15- the 2 common palmar digital arteries16- Dorsal carpal branch
17Anterior antebrachial region: Atlas: Only look at the items2 and 6- Anastomoses between cephalicand basilic antebrachial veins7- Medial cutaneous antebrachial N.11- Radial artery and veins14- Superficial Radial N.21- Ulnar N22 and 23- Ulnar artery and veins
19Palm of the hand:1- Superficial palmar arch18- Deep palmar arch11- median nerve9- ulnar nerve
20Dorsum of the Hand:Radial artery (9) enters the Snuffbox andgives a dorsal branch which produces thedorsal arterial arch of the hand.Then it gives the principal artery of the thumband then a main branch to join the deeppalmar arch.Snuffbox: borders:Tendon of extensor pollicis longus (superior)tendons of the ext. pollicis brevis andabductor pollicis longus (inferiorly).Contents of snuffbox:9- Radial artery8- Superficial radial N.