Axial vs Appendicular
Axial:
- Cranium
- Vertebral Column
- Ribs and Sternum
Appendicular:
- Clavicles
- Scapulae
- Pelvis
- Limbs
Osteology of Scapular Region
* HUMERUS is NOT part of the PECTORAL GIRDLE!!!!**
Joints of the Shoulder Region
1) Glenoid Cavity containing Synovial Fluid
2) Fibrous Articular Capsule
- Relatively thin and weak in the shoulder joint. Rotator cuss muscles helps stabilize this
3) Hyaline Cartilage
4) Synovial Sheath of Biceps Tendon
5) Subacromial Burse
** Synovial Fluid midigates friction of motion!!!!!
** Bursa allow frictionless smooth movement of Long tendons and bones between joints!!!
Joints of Shoulder Region: Reinforced by Ligaments
1) Coracoclavicular
A) Trapezoid
B) Conoid
2) Coracoacromial
3) Super Glenohumeral
4) Middle Glenohumeral
5) Inferior Glenohumeral
** The complex of ligaments and Boney Process are important when thinking about movement and potential of Injury!!!!!!
Muscles of Scapular Region (Scapulohumeral Musculature)
***** These muscles attach the SCAPULA to the HUMERUS. The move the HUMERUS at the SHOULDER JOINT and contribute to the Stabilization of this joint. THEY ARE ALL INNERVATED BY THE BRACHIAL PLEXUS!!!!!!!!!!!!!!
Scapulohumeral Muscles:
1) Deltoid
2) Teres Major
3) Serratus Anterior
Rotator Cuff Muscles:
1) Subscapularis
2) Supraspinatus (Most commonly hurt for Rotator Cuff)
3) Infraspinatus
4) Teres Minor
* * These attach at the GREATER TUBERCLE of HUMERUS**
Anterior Part of Humerus:
1) SUBSCAPULARIS!!!!!!!
- Attaches at Lesser Tubercle!!!!!!!
SLIDE 23 of SCAP&DELTOID LECTURE!!!!!!
Deltoid
Prox Attach:
- Lateral 1/3 of Clavicle, Acromion and Spine of Scapula
Dist Attach:
- DELTOID Tuberosity of Humerus
Actions:
- FLEXES, MEDIALLY Rotates, ABDUCTS, Extends, and LATERALLY Rotates Humerus
Blood Supply:
- Deltoid Branch of THORACOACROMIAL Aterial Trunk
Innervation:
- AXILLARY NERVE (C5, C6) —> ** Of POSTERIOR CORD!!!!!!!**
- Wraps around Posterior edge of Surgical Neck of Humerus!!!!!!!!!
Parts:
1) Clavicular Part (Anterior)
2) Middle Part
3) Spinal Part (Posterior)
Teres Major
Prox Attach:
- Posterior surface of Inferior angle of scapula
Dist Attach:
- Medial Lip of INTERTUBERCULAR (Bicipital) GROOVE of Humerus
Actions:
- ADDUCTS and MEDIALLY Rotates Humerus
Blood Supply:
- CIRCUMFLEX SCAPULAR Artery
Innervation:
- LOWER SCAPULAR NERVE (C5, C6)!!!!!!
Serratus Anterior
Prox Attach:
- External surfaces of Lateral Parts of RIBS 1-9!!!
Dist Attach:
- ANTERIOR Surface of MEDIAL border of scapula!!!!!
Actions:
- PROTRACTS SCAPULA and holds it against THORACIC WALL; ROTATES SCAPULA
Innervation:
- LONG THORACIC NERVE (C5, C6, C7)
- ** “RAISE YOUR ARMS TO HEAVEN”****
Supraspinatus
Prox Attach:
- SUPRASPINOUS Fossa of Scapula
Dist Attach:
- Superior facet of GREATER TUBERCLE of Humerus
Actions:
- Works with Deltoid in ABDUCTION of Humerus, acts with other rotator cuff muscles in STABILIZING SHOULDER JOINT
Blood Supply:
- SUPRASCAPULAR Artery
Innervation:
- SUPRASCAPULAR NERVE (C4, C5, C6)
Impingement Syndrome
*** SUPRASPINATUS TENDON!!!!!!
- Can involve SUBACROMIAL (Bursitis)
- Inflammation of the Bursa can lead to Irritaion of the Supraspintus Tendon.
- Some individuals have a unique morphology where they have a huge Acromion which makes them prone to this type of irritation
Rotator Cuff Injury
*** GREATER THAN 90 DEGREE angle of Humerus creates a COMPRESSION point for the Tendon of SUPRASPINATUS!!!!!!!!!!!!
- The Supraspinatus can also tear, which is a common Injury in the elderly
Repetitive Overhead Activities
- Tennis
- Swimming
- Pitching
- Stacking boxes or stocking shelves
- Painting
- Construction work
* THESE CAN ALL CAUSE ROTATOR CUFF INJURIES!!!!!!!!!!!!***
Other Causes:
- Bone spurs, Anatomical variation of the Acromion (Odd-shaped Acromion that limits the space within the roof of the Glenoid fossa)
Subscapularis
Prox Attach:
- SUBSCAPULAR FOSSA (Anterior surface of Scapula)
Dist Attach:
- Lesser tubercle of Humerus
Actions:
- MEDIALLY ROTATES and ADDUCTS Humerus, Helps hold Humeral head in place
Blood Supply:
- SUBSCAPULAR ARTERY
Innervation:
- UPPER and LOWER SUBSCAPULAR NERVES (C5, C6, C7)
- Lower Subscapular Nerve = Teres Major!!!!
Note regarding Nerve Roots
- A single nerve root is comprised of many, many axons that will diverge and contribute to multiple nerve pathways
- Usually each named nerve will have a certain nerve root that is it’s primary source of Innervation
For example:
- The Dorsal Scapular nerve receives contribution from the C4 and C5 nerve roots. C5 is it’s PRIMARY SOURCE (And you may see this indicated in your textbook as boldfaced type)
- However, the C4 Nerve root also contributes to the SUPRASCAPULAR Nerve, and the nerve to SUBCLAVIUS
- The C5 nerve root also contributes to the long thoracic nerve, the lateral Pectoral nerve, the Suprscapular nerve, the Musculocutaneous nerve, the Nerve to Subclavius, and others
Subscapularis Cont
- LARGEST and STRONGEST of all the ROTATOR SUCC MUSCLES!!!!!
- Isolated Subscapularis tears are RARE!!!!!
- Faily common SPORTS INJURY in PITCHERS (Powerful throwing motion), Rotator Cuff Tendonitis
- SUBSCAPULARIS Injuries can also lead to Bicipital Tendon INSTABILITY and Biceps Tendonitis
Rotator Cuff Tears
- Usually happens to the SUPRASPINATUS TENDON!!!!!!!
- Can happen to the Subscapularis Tendon though
Transverse Ligament of Humerus
- The Transverse Ligament of the Humerus holds the Long Tendon of the BICEPS BRACHII in the INTERTUBERCULAR GROOVE!!!!!!!!!!
Infraspinatus
Prox Attach:
- Infraspinous Fossa of Scapula
Dist Attach:
- Middle Facet of GREATER TUBERCLE of Humerus
Actions:
- LATERALLY ROTATES Humerus, Helps hold Humeral Head in place
Blood Supply:
- SUPRASCAPULAR Artery!!!!!!!!!!!!
Innervation:
- SUPRASCAPULAR NERVE (C5, C6)
Teres Minor
Prox Attach:
- Middle part of the Lateral Border of Scapula
Dist Attach:
- Inferior facet of GREATER TUBERCLE of Humerus
Actions:
- LATERALLY ROTATES Humerus, Helps Hold Humeral Head in place
Blood Supply:
- CIRCUMFLEX SCAPULAR ARTERY
Innervation:
- AXILLARY NERVE (C5 and C6)
- This nerve also Innervates the DELTOIDS!!!!!
Subclavian Artery
Origin:
- RIGHT: BRACIOCEPHALIC Trunk
- Left: AORTIC ARCH
- Arises Poertioer to Sternoclavicular Joint
- Usually has 3 “divisions”
3 Parts (In relation to Anterior Scalene Muscle):
1) Medial
2) Posterior
3) Lateral
SUBCLAVIAN TURNS INTO AXILLARY ARTERY!!!*****
-
THORACOCERVICAL TRUNK IS VERY IMPORTANT!!!!!***
- Off of some of these parts of the Axillary Artery, you have branches that connect with the THYROCERVICAL TRUNK!!!!
Subclavian Artery (Medial Portion)
1) Internal Thoracis (Internal Mammary) Artery
2) Vertebral Artery!!!!!!!
3) Thyrocervical Arterial Trunk
Subcalvian Artery (Thyrocervical Arterial Trunk)
1) Transverse Cervical Artery
- Superficial Branch
- Deep Branch (Dorsal Scapular Artery)
*** NOTE: The Superficial and Deep branches of the T.C.A. may arise Independently. When they do form an Aterial trunk, this structure is referred to as the CERVICODORSAL TRUNK!!!!
2) Inferior Thyroid Artery
3) Ascending Cervical Artery
4) Suprascapular Artery
Subclavian Artery (Posterior Portion)
Costocervical Arterial Trunk
1) Supreme Intercostal Artery
2) Deep Cervical Artery
Subclavian Artery (Lateral Part)
- The lateral part (3) of the subclavian artery typically has no branches, however, the DORSAL SCAPULAR ARTERY may arise independently fro this part of the Subclavian Artery
*** LATERAL Border of First rib is the point at which the SUBCLAVIAN Artery becomes the AXILLARY Artery!!!!!!!!
Scapular Anastamosis
1) Suprascaluar Artery (From Subclavian Artery)
- Involved with Lateral Border
2) Dorsal Scapular Artery ( Deep Branch of Transverse Cervical Artery)
- Runs medially or Vertebral!!!!
3) Posterior Intercostal Arteries (From Thoracic Aorta)
4) Circumflex Scapular Artery (Division of Subscapular Artery from Axillary Artery)
- Originates form the Axillary artery via the SUBSCAPULAR Artery (One of the Largest and most important parts of the Axillary Artery!!!!)
5) Thoracodorsal Artery (Division of Subscapualr Artery from Axillary Artery)
- Supplies Lats and give off branches to Inferior Border
SLIDE 48 of SCAP& DELT LECTURE!!!!!!
Scapular Anastamosis
- In certain cases of Injury to, or Ligation or Occlusion of the AXILLARY Artery SUPERIOR to the Subscapular Artery, direction of blood flow in the Subscapular artery is REVERSED, allowing blood to flow to the DISTAL PORTION of the AXILLARY Artery and the rest of the Arm, Forearm, and Hand.
Slide 49 and 50 of SCAP & DELT LECTURE!!!!!!1
Note Regarding the Dorsal Scapular Artery
*** The Dorsal Scapular Artery can arise from either some part of the SUBCLAVIAN ARTERY (Usually the 3rd) or from the TRANSVERSE CERVICAL ARTERY (about 30% of the time, and in this case it is called the “DEEP BRANCH OF THE TRANSVERSE CERVICAL ARTERY”
- Either way, the artery that runs along the VERTEBRAL BORDER of the SCAPULA is always referred to as the DORSAL SCAPULAR Artery!!!!!!!!!!
Venous Drainage
Slide 52 of SCAP & DELT LECTURE!!!!!!
Superficial and Deep Veins of Upper Limb
Superficial:
- Cephalic Vein
- Basilic Vein
Deep:
- Subclavian Vein
- Axillary Vein
Relationships and Spaces
- Within the Superficial back and Scapular regions there are named spaces and Triangles that illustrate relationships among muscles, vessels, and nerves:
1) TRIANGLE of ASCULATION!!!!
- Between Teres Major and Teres Minor and Lateral is the Long Head of the Triceps Muscle
- The CIRCUMFLEX SCAPULAR Artery goes into it!
2) Quadrangular Space
- The AXILLARY NERVE and the POSTERIOR CIRCUMFLEX HUMORAL Artery can be viewed!!!!
3) Triangular Space
- Can see the CIRCUMFLEX SCAPULAR ARTERY deep in Space!!!!!
4) Triangular Interval
- Can see the RADIAL NERVE and the DEEP BRACHIAL ARTERY!!!!!!
Interval: Inferior
Space: Superior
SLIDE 55, 56, and 57 of SCAP& DELT LECTURE!!!!
Pectoral Region Osteology
- Clavicles
- Sternum
- Manubrium
- Body
- Xiphoid
- Ribs
- Scapula
Pectoral Region (Ribs)
- Thoracic region ONLY
- Articulate with Sternum and Vertebrae
- Ribs 1,2,11 and 12 “ATYPICAL”
- Ribs 1-7 “True” ribs (Vertebrocostal)
- Have own costal attachments to some part of the sternum
- Ribs 8-10 “False” ribs (Vertebrochondral)
- Have a CONVERGENCE onto the cartilage of rib 7
- Ribs 11 and 12 “Floating”
** Tubercle of rib articulates with Facet of Transverse process on the Thoracic Vertebra!!!!!
Pectoral Region (Sternum)
- Manubrium
- Body
- Xiphoid
- STERNOCLAVICULAR JOINT: One of the Strongest joints in the body! More likely to fracture the Clavicle before undoing this joint!
The Breast
- In humans, the beats are BILATERAL GLANDULAR structures found in both Males and Females. In Females the breast is much more developed and is capable of producing Nourishment for young. The MAMMARY Glands are modified SWEAT Glands!!!!
The Breast Cont
- Cutaneous Structure
- Modified Sweat Gland
- Rests on PECTORAL FASCIA (Above Pect Major)
- Retromammary space is potential space between Breast and Pectoral Fascia
- INNERVATES by INTERCOSTAL NERVES (4th-6th)
The Breast Cont
- Attaches to DERMIS of overlying skin vis SUSPENSORY LIGAMENTS (Cooper’s Ligament)!!!!!!!
- Mammary gland lobules converge on the NIPPLE!!!!!
- 15-20 LACTIFEROUS Ducts open at Nipple, which is surrounded by pigmented areola!!!
Blood Supple and Drainage of Breast Tissue (Arterial Supply)
Arterial Supply:
- Mammary Branches from:
1) ANTERIOR Intercostal
2) LATERAL Thoracic (Axillary Artery)
3) INTERNAL Thoracic Ateries (Subclavian Artery)
Blood Supply and Drainage of Breast Tissue (Venous Drainage)
Venous Drainage
- Mainly to AXILLARY VEIN via LATERAL THORACIC veins and Medial Mammary Veins!!!!!!!!!
- Some drainage to Internal Thoracic vein via Anterior Intercostal Veins!!!!!!!!!!
Lymphatic Drainage of Breast Tissue
1) Nipple, Areola, Lactiferous Lobules
- SUBAREOLAR LYMPH NODES
2) Greater than 75% of Lymph from Breast
- AXILLARY LYMPH NODES (Pectoral, Central, Apical)!!!!!!!
3) Remaining Lymph
- Parasternal and Abdominal Lymph Nodes
Slides 12 and 13 of PC&AXILLARY LECTURE!!!!!
Innervation of Breast Tissue
- Mainly from the ANTERIOR and LATERAL Branches of the 4th-6th Intercostal Nerves
- May also receive some Innervation from SUPRACLAVICULAR NERVE Branches as well as Branches of other INTERCOSTAL NERVES!!!!!!!
Polymastia and Polythelia
( Supernumerary Breasts or Nipples)
- Accessory Breasts and Nipples run down the Mammary ridge (Very prominent in dogs)
Slide 15 of PC & AXILLARY LECTURE!!!!
The Pectoral Region (Fascia)
Fascia of the Pectoral Region
- The fascia of the Pectoral Region consists of superficial and Deep Layers that define Border, Invest Muscles, and Create Potential Spaces
-
DELTOPECTORAL TRIANGLE!!!!***
- This is where the CEPHALIC VEIN sumps into the SUBCLAVIAN and AXILLARY VEIN!!!!!!!
The Pectoral Region (Superficial Fascia)
Superficial Fascia
- Platysma
- Supraclavicular Nerves
- Anterior and Lateral Branches of Intercostal Nerves
SLIDE 17 of PC&AXILLARY LECTURE!!!!
The Pectoral Region (Deltopectoral [Clavipectoral] Triangle)
Deltopectoral (clavipectoral) Triangel:
- Deltoid, Pectorals Major, Middle 1/3 of Clavicle make up borders
- Cephalic Vein
- Deltopectoral Lymph Nodes
- Deltoid Branch of THORACOACROMIAL Artery (From Axillary)
The Pectoral Region (Clavipectoral Fascia)
Clavipectoral Fascia:
- Invests SUBCLAVIUS and PECTORALIS MINOR
- Attaches to Clavicle and Anterior Thoracic Wall
- Cephalic Vein, Thoracoacromial Artery, and Lateral Pectoral Nerve PIERCING IT!!!!!!
- Becomes SUSPENSORY LIGAMENT of AXILLA!!!!!
The Pectoral Region (Muslces of the Pectoral Region)
- These Muscles are INNERVATED by the VENTRAL RAMI of SPINAL NERVES via branches of the BRACHIAL PLEXUS!!!!!!!!
Pectoralis Major
Prox Attach:
- Clavicular and Sternocostal Attachments
- Ant Surface of Medial 1/2 of Clavicle
- Ant Surface of Sternum and Superior 6 Costal Cartilages
Dist Attach:
- Lateral Lip of INTERTUBERCULAR SULUC (Bicipital Groove)
Actions:
- ADDUCTS and MEDIAL ROTATES HUMERUS
- Draws SCAPULAR ANTERIORLY and INFERIORLY (Via Clavicle)
- Clavicular portion FLEXES HUMERUS
- Sternal portion can EXTEND HUMERUS while it is in this FLEXED POSITION
Blood Supply:
- PECTORAL BRANCHES of THORACOACROMIAL Arterial Trunk
Innervation:
- LATERAL and MEDIAL Pectoral Nerves (C5, C6 Clavicular portion, C7, C8, T1 Sternocostal portion)
Note about Medial and Lateral Pectoral Nerves
-
** The MEDIAL and LATERAL Pectoral nerves are NOT NAMED for their position on the ANTERIOR THORAX
- Rather they are named for the PART OF THE BRACHIAL PLEXUS (BP) THYE COME FROM!!!!!!!!!
-
** The MEDIAL Pectoral Nerve arises from the MEDIAL CORD of the BP
- Lateral and Inferior - ***** The LATERAL Pectoral Nerve arises from the LATERAL CORD of the BP
- Medial and Superior
Pectoral Minor
Prox Atttach:
- 3rd - 5th Ribs, Near Costal Cartilage
Dist Attach:
- CORACOID process of Scapula
Actions:
- Stabilizes Scapula by pulling it ANTERIORLY and INFERIORLY against Posterior Thoracic Wall
Blood Supply:
- Pectoral Branch(es) of THORACOACROMIAL Arterial Trunk
Innervation:
- MEDIAL PECTORAL NERVE (C8, T1) is is usually PIERCED by this Nerve!!!!!!
Subclavius
Prox Attach:
- Junction of 1st rib and its costal cartilage
Dist Attach:
- Inferior surface of middle 1/3 of Clavicle
Actions:
- ANCHORS and DEPRESSES clavicle
Blood Supply:
- Clavicular Branch(es) of THORACOACROMIAL Arterial Trunk!!!!!!
Innervation:
- “NERVES to SUBCLAVIUS” (C5,C6)!!!!!!!!!
Slide 25 of PC&AXILL LECTURE!!!!!!!!!
Serratus Anterior
Prox Attach:
- External Surface of Lateral Parts of ribs 1-9
Dist Attach:
- Anterior surface of Medial Border of Scapula
Actions:
- PROTRACTS Scapula, ROTATES Scapula, HOLDS Scapula against THORAX
Blood Supply:
- LATERAL THORACIC Artery
Innervation:
- LONG THORACIC NERVE (C5,C6,C7)
The Pectoral Region (Blood Supply)
- The pectoral region is supplies by the AXILLARY Artery (continuation of SUBCLAVIAN Artery) and its Branches!!!!!
Axillary Artery
Part 1 (Proximal/ Medial to Pect Minor) - SUPERIOR THORACIC Artery
Part 2 (at of behind Pect Minor)
- THORACOACROMIAL TRUNK
- Pectoral Branch
- Deltoid Branch
- Acromial Branch
- Clavicular Branch
Part 3 (distal/ lateral to Pect Minor)
- Subscapular Artery
- Circumflex Scapular
- Thoracodorsal - Anterior Circumflex Humeral
- Posterior Circumflex Humeral
Scapular Anastamosis
- Arterial Branches arising from the SUBCLAVIAN and AXILLARY Arteries (with some contribution from Branches arising directly from thoracic aorta) from an ANASTAMOSIS around the scapula, allowing collateral circulation to the Upper Limb!!!!!!!!
SLIDE 31 of PC & AXILLARY LECTURE!!!!!!
The Pectoral Region (Venous Drainage)
- The Pectoral region is drained by the AXILLARY VEIN. It generally follows the course of the Axillary Artery. This vein receives blood from Superficial and Deep Veins of the arm and forearm
1) DEEP BRACHIAL VEINS (Greater than 1)
2) SUPERFICIAL VEINS of Arm an Forearm:
- BASILIC Veins (Continues as the AXILLARY Vein)
- MEDIAL
- CEPHALIC Vein (drains into AXILLARY before it becomes SUBCLAVIAN Vein) - LATERAL
SLIDE 32 and 33 of PC & AXILLARY LECTURE!!!!
Boundaries of the Axilla
1) a Pyramid Shaped Space
2) APEX
3) Base (A&P Axillary Fold)
4) Anterior Wall
5) Posterior Wall
6) Medial Wall
7) Lateral Wall
SLIDE 34 of PC & AXILLARY LECTURE!!!!
Boundaries of Axilla (Apex)
APEX:
- Clavicle
- Scapula
- 1st Rib
Boundaries of Axilla (Base)
BASE:
- Skin and Superficial Fascia
- ANTERIOR Axillary Fold
- Pectoralis Major
- POSTEIOR Axillary Fold
- Latissimus Dorsi
- Teres Major
- Chest Wall
- SERRATUS Anterior
SLIDE 36 and 37 of PC& AXILLARY LECTURE!!!!!
Boundaries of the AXILLA (Anterior Wall)
Anterior Wall:
- (Clavicle)
- (Subclavius)
- Pectoralis Major
- Pectoralis Minor
Boundaries of AXILLA (Posterior Wall)
Posterior Wall:
- Scapula
- Subscapuaris
- Latissimus Dorsi
- Teres Major
Boundaries of AXILLA (Lateral Structures)
Lateral Structures:
- INTERTUBERCULAR SULCUS (Bicipital Groove)
- Tendon og LONG HEAD of BICEPS
- CORACOBRACHIALIS Tendon
Contents of Axilla
1) Axillary Sheath
a) Axillary Vein
b) Axillary Artery
c) Brachial Plexus
- Lateral
- Posterior
- Medial
2) Pectoral Major and Minor
3) Subscapularis
4) Teres Major and Latissimus Dorsi
5) Axilarry Lymph Nodes
a) Central
b) Pectoral
SLIDE 42 and 43 of PC & AXILLARY LECTURE!!!!!
Contents of Axilla (Vasculature)
- AXILLARY VEIN!!!!
The Brachial Plexus
- Arises in the Axialla and emerges from the Neck.
- C5 through T1
- It has to travel from the neck (Behind Anterior Scalene) and go underneath the Clavicle and travels under the Axillary Artery and Vein in a bundle called the AXILLARY SHEATH
Brachial Plexus Cont
- There is an Anterior Flexor part of the upper limb and a Posterior Extensor
The Brachial Plexus Cont
- The brachial plexus is made up of the VENTRAL RAMI of Cervical and Thoracic Spinal Nerves (C5-T1)
Dorsal Rami: Tiny, Smaller, and goes to the Intrinsic Back muscles
Ventral Rami: Much larger and makes up the large Plexuses in the Neck. Have Intercostal nerves and nerves in the Lateral Abdominal region that are from the Ventral Rami
Brachial Plexus Cont
- The Median and Ulnar Nerves bypass the ARM and Innervate the MUSCLES in the HANDS!!!!!
- ALL INTRINSIC Muscles are either Median or Ulnar Nerves!!!!
1) Roots
2) Trunks
3) Divisions
- Anterior (Flexion)
- Posterior (Extension)
4) Cords
5) Branches
The Brachial Plexus
LOOK AT DIAGRAM!!!!!!!!!!!!!!
SLIDES 7,8,9, and 10 in BRACHILA PLEXUS LECTURE!!!!!!!!!!!!!
- The Spinal NERVE ROOTS and TRUNKS are SUPRACLAVICULAR!!!!!!!
- Roots (Rami)
- Trunks - The start of the Division becomes the INFRASCAPULAR NERVE Branches!!!!!
- Divisions
- Cords
- Branches (Nerves)
Innervation of the Upper Limb Follows a Compartmentalized Pattern: ARM
For Example:
- For the arm (Brachium), the Medial and Lateral Intermuscular Septa divide the ANTERIOR and POSTERIOR COMPARTMENTS!!!
ARM (BRACHIUM) COMPARMENTS:
1) Anterior Compartment:
- MUSCULOCUTANEOUS Nerve (FLEXORS of the Elbow Joint)
2) Posterior Compartment:
- RADIAL Nerve (EXTENSORS of the Elbow Joint)
SLIDE 18 of BRACHIAL PLEXUS LECTURE!!!!!!!
Innervation of the Upper Limb Follows a Compartmentalized Pattern: FOREARM
FOREARM (ANTEBRACHIUM) and HAND:
1) Anterior Compartment
- ULNAR and MEDIAN Nerves
2) Posterior Compartment
- RADIAL Nerve
Injuries to Brachial Plexus:
INJURIES TO SUPERIOR TRUNK (C5 & C6)
- Upper/ Superior Trunk Lesion: ERB’S PALSEY!!!!!!
- Results from excessive, forceful increase in angle between neck and shoulder
- Most common obstetric Brachial Plexopathy
- Can also occur in adults from a fall onto the Shoulder
CLINICAL PRESENTATION:
1) At the SHOULDER:
- Arm will be ADDUCTED
- Arm will be INTERNALLY (Medially) ROTATED
2) At the ELBOW:
- There will be PRONATION
- There will be EXTENSION
** This describes the “WAITER’S TIP” position of the affected Upper Limb
NERVE DEFICITS and AFFECTED MUSCLES:
1) C5 Spinal Nerve Root:
- AXILLARY Nerve (Weakness in DELTOID and TERES MINOR)
- SUPRASCAPULAR Nerve (Weakness in SUPRASPINATUS and INFRASPINATUS)
- MUSCULOCUTANEOUS Nerve (Weakness in BICEPS)
2) C6 Spinal Nerve Root
- RADIAL NERVE (Weakness in BRACHIORADIALIS and SUPINATOR)
SLIDE 20, 21, and 22 of BRACHIAL PLEXUS LECTURE!!!!!
Injuries of Brachial Plexus:
INJURIES TO INFERIOR TRUNK (C8 and T1)
- Inferior/ Lower Trunk Lesion: KLUMPKE’s PALSEY!!!!!!
- An AVULSION INJURY that usually results from Excessive, Forceful ABDUCTION of the arm
- Relatively RARE OBSTETRIC Injury
- Often associated with HORNER’s SYNDROME (T1 involvement may cause PREGANGLIONIC INTERRUPTION of SYMPATHETIC Pathways)!!!!!!!!!!!!!!!!!!
CLINICAL PRESENTATION: MEDIAN and RADIAL NERVES AFFECTED!!!!!!!!
1) Wrist
- Will be held in an Extremely EXTENDED Posture (wrist flexors are unopposed)
2) Hand and Fingers
- All INTRINSIC Muscles of the Hands are Affected
- Joints between HAND BONES and FINGER BONES will be HYPEREXTENDED
- Joints between FINGER SEGMENTS will be FLEXED
- This is the “CLAW HAND” posture associated with this injury
SLIDE 23 and 24 of BRACHIAL PLEXUS LECTURE!!!!!
Injuries to Nerves of the Brachial Plexus
INJURIES TO THE RADIAL NERVE (C5-T1)
(Axillary)
AXILLARY REGION (Nerve is injured before it supplies Triceps)!!!!!!!! - Improper use of Crutches can COMPRESS and Injure the nerve of the Axilla
CLINICAL PRESENTATION:
- Weakness when trying to push something AWAY with Arm
- Difficulty EXTENDING the Wrist
- Difficulty EXTENDING the Fingers and OPENING the HAND
** “WRIST DROP” Posture!!!!!!!!!!
Injuries to Nerves of the Brachial Plexus
INJURIES TO THE RADIAL NERVE (C5-T1)
(Spinal Groove of Humerus)
INJURY AT SPINAL GROOVE OF HUMERUS
- Compression of the Radial Nerve along the MIDSHAFT of the Humerus in certain positions (“SLEEP PALSY”, “SATURDAY NIGHT PALSY”)
- HUMERAL FRACTURE at MIDSHAFT (Spinal Groove Fracture)
CLINICAL PRESENTATION:
- Difficulty EXTENDING the Wrist
- Difficulty EXTENDING or STRAIGHTENING the Fingers and Opening the Hand
- TRICEPS retains STRENGTH because nerve fibers entering this muscle branch off Proximal to the Mid Shaft of the Humerus
- Also causes “WRIST DROP” Posture
Injuries to Nerves of the Brachial Plexus
INJURIES TO THE AXILLARY NERVE (C5, C6)
CAUSES:
- FRACTURE to Surgical Neck of Humerus
- Anterior Dislocation of GLENOHUMERAL JOINT
- ROTATOR CUFF REPAIR SURGERY!!!!!!
CLINICAL PRESENTATION:
- Numbness in POSTERIOR DELTOID REGION
- Difficulty ABDUCTING ARM
- Diminished LATERAL ROTATION of Arm
- DELTOID MUSCLE WASTING (Prolonged Injury)
Injuries to Nerves of the Brachial Plexus
INJURIES TO THE LONG THORACIC NERVE (C5, C6, C7)
(Innervation to the SERRATUS ANTERIOR Muscles)
CAUSES:
- PENETRATING wound to the AXILLARY Region
- SURGICAL Removal of AXILLARY LYMPH Nodes
CLINICAL PRESENTATION:
- Cannot raise arms ABOVE 90 DEGREES!!!!!!!
- “WINGED SCAPULA”
Injuries to Nerves of the Brachial Plexus
INJURIES TO THE ULNAR NERVE (C8, T1, and often C7)
CAUSES:
- FRACTURE to MEDIAL EPICONDYLE of Humerus
- ENTRAPMENT of Nerve in CUBITAL TUNNEL!!!!!
**DAMAGE will Involve FLEXORS of Wrist, Digits, and Intrinsic Hand Muscles****
CLINICAL PRESENTATION:
- NUMBNESS/ TINGLING in 4th and 5th Fingers (May be worse when Elbow Bent)!!!!!!!!!!!!!!!!!
- Weakening of GRIP with some LOSS of FLEXION of FINGERS
- Loss of ABDUCTION and ADDUCTION of FINGERS
Injuries to Nerves of the Brachial Plexus
INJUREIS TO THE MEDIAN NERVE (C6-T1)
CAUSES:
- FRACTURE of the Humerus above the CONDYLES
- INTRAPMENT of Nerve by PRONATOR TERES
- Inflammation or Irritation in the CARPAL TUNNEL (CARPAL TUNNEL SYNDROME)
*****DAMAGE will affect FLEXORS of WRIST and DIGITS AFFECTED, also INTRINSIC Hand Muscles, Particularly those that move DIGIT 1 (THUMB)!!!!!!!!!!!!
CLINICAL PRESENTATION:
- PAIN and TENDERNESS in Anterior-Proximal
- Decreased SENSATION along course of MEDIAN NERVE
- NUMBNESS/ TINGLING and pain along MEDIAN Nerve Course
- INABILITY to FLEX DISTAL INTERPHALANGEAL Joint of DIGIT 1
- “HAND OF BENEDICTION” (When making a fist, Unable to FLEX SECOND AND THIRD DIGITS!!!!!!!!!!!!!)
- “APE HAND” (THENAR EMINENCE ATROPHY and loss of THENAR OPPOSITION)
- Loss of ABDUCTION and ADDUCTION of Fingers!!!!!!
Diagram of Hand Innervations
1) Ulnar Nerve:
- 4th and 5th Digits
2) Radial Nerve:
- Back of Hand
3) Median Nerve:
- Palm of hand from 1st Digit to 3rd Digit
ULNAR CLAW
Nerve Involved:
- Lesion of ULNAR NERVE at the WRIST
Typical Presentation:
- Appears in LONG STANDING CASES
Digits Affected:
- LITTLE and RING (4th and 5th)
Muscles Paralyzed:
- MEDIAL TWO LUMBRICALS
Movements Involved:
- Unopposed EXTENSION at the MCP JOINTS
- Unopposed FLEXION at the IP Joints
HAND of BENEDICTION
Nerve Involved:
- Lesion of the MEDIAN NERVE at the ELBOW or at the Wrist
Typical Presentation:
- Appears when PATIENT attempts to make a FIST
Digits Affected:
- MIDDLE and INDEX
Muscles Paralyzed:
- LATERAL TWO LUMBRICALS
- LATERAL HALD of FDP
Movements Involved:
- INABILITY: to FLEX at the MCP and IP Joints of the middle and INDEX FINGERS!!!!!!!!!!
- VOLUNTARY: FLEXION at the MCP and IP Joints of the RING and LITTLE FINGERS!!!!!!!!!!!
Arm
Brachium = Arm
Antebrachium = Forearm
Arm Osteology
- Humerus
- Radius (Only one that comes into contact with wrist bones aka Carpals)
- Ulna
Cutaneous Nerves and Veins of the Arm and Forearm
- Cephalic Vein (more Cephalad)
- Basilic Vein (towards the Base)
- Supraclavicular Nerve
- Medial Cutaneous Nerve of Arm (Medial Brachail Cutaenous)
- Median Cubital Vein (Cubital Fossa)
- Lateral Cutaneous Nerve of Forearm (Lateral Antebrachial Cutaneous Nerve)
- RADIL NERVE:
- Posterior Cutaneous Nerve of Arm
- Posterior Cutaneous Nerve of Forearm
- Intercostobrachial Nerve (T2)
- Superior Lateral Cutaneous Nerve of Arm
SLIDE 8 of ARM & CUBITAL LECTURE!!!
Dermatomes of Brachial Plexus
- C5
- C6
- C7
- C8
- T1
Slide 10 of ARM & CUBITAL LECTURE!!!
Dermatome and Myotome
Dermatome: The area of skin Supplied with AFFERENT Nerve fibers by a Single Posterior Spinal Root
Myotome: All the muscles that are innervated by a single EFFERENT Anterior root. Most muscles are composed of more than one MYOTOME
Fascial Compartments of Arm
- MEDIAL Intermuscular Septa
- LATERAL Intermuscular Septa
Anterior Compartment: FLEXORS
Posterior Compartment: EXTENSORS
SLIDE 12 and 13 of ARM&CUBITAL LECTURE!!!
Vacillator of Shoulder and Arm
AXILLARY ARTERY
1) Part 1 (Proximal/ Medial to Pectoralis Minot)
- Superior Thoracic Artery
2) Part 2 (At or Behind Pectoralis Minor)
- THORACOACROMIAL TRUNK
- Pectoral Branch
- Deltoid Branch
- Acromial Branch
- (Clavicular Branch)
- LATERAL THORACIC ARTERY
3) Part 3 (Distal/ Lateral to Pectoralis Minor)
- SUBSCAPULAR ARTERY
- Circumflex Scapular
- Thoracodorsal
- Anterior Circumflex Humeral
- Posterior Circumflex Humeral
SLIDE 14 of ARM&CUBITAL LECTURE!!!!
Vasculature of Arm (ARTERIAL SUPPLY)
- AXILLARY ARTERY (Forms into the brachial at the inferior border of Teres Major Muscles)
- BRACHIAL ARTERY:
1) PROFUNDA Brachii (Deep Brachial Artery)
- Posterior Descending Branch (Middle Collateral)
- Anterior Descending Branch (Radial Collateral)2) SUPERIOR ULNAR COLLATERAL
3) INFERIOR ULNAR COLLATERAL
Musculature of Arm (Anterior [Flexor] Compartment)
MUSCULOCUTANEOUS NERVE!!!!!*
- Biceps Brachii
- Long Head
- Short Head
- Brachialis
- Coracobrachialis
Biceps Brachii
Prox Attach:
- LONG HEAD: Supraglenoid Tubercle of Scapula
- SHORT HEAD: Coracoid Process of Scapula
Dist Attach:
- Radial Tuberosity and fascia of forearm via BICIPITAL APONEUROSIS
Actions:
- SUPINATES Forearm, when SUPINE with FLEX FOREARM
- RESISTS Dislocation of Shoulder (Short Head)
Blood Supply:
- Brachial Artery
Innervation:
- MUSCULOCUTANEOUS NERVE (C5,C6)
Coracobrachialis
Prox Attach:
- CORACOID process of Scapula
Dist Attach:
- Middle 1/3 of Medial Humeral Surface
Actions:
- FLEXES and ADDUCTS Arm at Shoulder Joint
- REsists DISLOCATION of Shoulder Joint
Blood Supply:
- Brachial Artery
Innervation:
- MUSCULOCUTANEOUS NERVE (C5, C6)
Brachialis
Prox Attach:
- Distal 1/2 of Anterior Surface of Humerus
Dist Attach:
- CORONOID Process and Tuberosity of Ulna
Actions:
- FLEXES Forearm at Elbow Joint
Blood Supply:
- Brachial Artery
Innervation:
- MUSCULOCUTANEOUS (C5, C6)
- Lateral portion may receive RADIAL NERVE Contributions
Musculature of Arm (Posterior [EXTENSOR] Compartment)
- Triceps Brachii
- Long Head
- Lateral Head
- Medial Head
- Anconeus
-
RADIAL NERVE!!!!!!***
- Runs along the Radial Groove of the Humerus
SLIDE 22 and 23 of ARM&CUBITAL LECTURE!!!!!
Anconeus
Prox Attach:
- Lateral Epicondyle of Humerus
Dist Attach:
- Lateral Surface of OLECRANON, Superior part of surface of ULNA
Actions:
- Assists Triceps in EXTENSION of Forearm and Stabilizes ELBOW Joint; also ABDUCTS ULNA during PRONATION
Blood Supply:
- Deep BRACHIAL ARTERY
Innervation:
- RADIAL NERVE (C7, C8, T1)
Triceps Brachii
Prox Attach:
- Long: Infraglenoid Tubercle
- Lateral: Posterior Surface of Humerus
- Medial: Posterior Surface of Humerus, Inferior to Radial Groove (Spiral Groove)
Dist Attach:
- Proximal End of OLECRANON and FASCIA of FOREARM
Actions:
- EXTENDS Forearm at ELBOW JOINT (Main)
- Resists Dislocation of Shoulder Joint (Long Head)
Blood Supply:
- Deep Brachial Artery
Innervation:
- RADIAL NERVE (C6,C7, C8)
Activity at the Elbow
- Much of the activity at the ELBOW joint involves WOKING AGAINST STRONG FLEXION!!!!!!!!!!
- to keep from “FLEXING” yourself into the Wheelbarrow
- The TRICEPS are constantly acting as ANTAGONISTS to the Forearm FLEXORS!!!!!!!!
SLIDE 26 and 27 ARM&CUBITAL LECTURE!!!!!
Cubital Fossa: Junction between the arm and forearm Regions
- Cephalic Vein (Lateral)
- Basilic Vein (Medial)
- Median Cubital Vein
- Cubital Fossa
- Medina Antebrachial Vein
Cubital Fossa: Subcutaneous Structures
- Cephalic Vein
- Basilic Vein
- Medial Antebrachial Cutaneous Nerve
- Lateral Antebrachial Cutaneous Nerve
- Median Cubital Vein
SLIDE 29 of ARM&CUBITAL LECTURE!!!!!
Cubital Fossa: Superficial Structures
- BRACHIALIS
- Lateral Antebrachial Cutaneous Nerve (Musculocutaneous Nerve)
- Peeks out between the Biceps Branchii and Brachioradialis
SLIDE 30 of ARM&CUBITAL LECTURE!!!!
Cubital Fossa: Deep Structures
- Musculocutaneous Nerve
- Median Nerve
- Triceps Brachii
SLIDE 31 of ARM&CUBITAL LECTURE!!!!!
Boundaries of Cubital Fossa
Latera: BRACHIORADIALIS
Medial: PRONATOR TERES
Superior: An Imaginary Line between MEDIAL and LATERAL Epicondyles of Humerus
Roof: Skin, Superficial & Deep Fascia, BICIPITAL APONEUROSIS
Floor: SUPINATOR and BRACHIALIS
Contents of Cubital Fossa
1) MEDIAN NERVE
2) Bifurcation of Radial and Ulnar Arteries
3) Brachial Veins (Venae Comitantes)
4) Tendon of Biceps Brachii & Bicipital Aponeurosis
5) RADIAL NERVE
- Deep Radial Nerve
- Superficial Radial Nerve
Posterior to Cubital Region: ELBOW REGION
- Triceps and Olecranon Process
- Anconeus
- ULNAR NERVE runs posterior to Medial Epicondyle of Humerus (“Funny Bone”)
- POSTERIOR ULNAR RECURRENT ARTERY
Vasculature of Arm (Cubital Anastomosis)
Brachial Artery—> Ulnar Artery
- Superior ULNAR Collateral —-> Posterior ILNAR Recurrent
- Inferior ULNAR Collateral —-> Anterior ULNAR Recurrent
Deep Brachial Artery —> Radial and Interosseous Arteries
- RADIAL Collateral Artery —-> RADIAL Recurrent Artery
- MIDDLE Collateral Artery —-> INTEROSSEOUS Recurrent Artery
Forearm
Ulnar Side: MEDIAL
Radial (Thumb) Side = Lateral
** The MEDIAL EPICONDYLE of the Humerus is the “COMMON FLEXOR ORIGIN”!!!!!!!!***
- Only the RADIUS articulates at the WRIST Joint!!!!!
Pronation and Supination at Radio-Ulnar Joint
Supine: Radius Lateral
Prone: Radius Medial
Cutaneous Nerve of Forearm
ANTERIOR (Palmar) View:
- Lateral Antebrachial Cutaneous Nerve (Musculocutaneous N. )
- Anterior and Posterior Branches of Medial Antebrachial Cutaneous Nerve
POSTERIOR (Dorsal) View:
- Posterior Antebrachial Cutaneous Nerve (Radial)
- Posterior Branch of Lateral Antebrachial Cutaneous Nerve (Musculocutaneous Nerve)
Cutaneous Innervation of Arm, Forearm, and Hand
ANTERIOR/ VENTRAL
1) Ulnar Nerve
- 4th and 5th fingers
2) Musculocutaneous Nerve
- Anterior Medial Portion of Forearm
3) Median Nerve
- Palm of hand and from 1st to half of 4th Finger
SLIDE 9 of ANTERIOR FOREARM LECTURE!!!!!!
Cutaneous Innervation of Arm, Forearm, and Hand
POSTERIOR/ DORSAL
1) Axillary
- Deltoid Muscle
2) Radial
- Back of the Brachium, Antebrachium, and Hand!!!!!
Vasculature of Arm and Forearm
ARTERIAL SUPPLY
- Axillary Artery
- Brachial Artery
- Profunda Brachii (Deep Brachial Artery:
1) POSTERIOR Descending Branch (Midle Collateral)2) ANTERIOR Descending Branch (Radial Collateral) - Superior Ulnar Collateral
- Inferior Ulnar Collateral
Vasculature of Arm
CUBITAL ANASTOMOSIS
Brachial Artery —> Ulnar Artery
- Superior ULNAR Collateral —> Posterior ULNAR Recurrent
- Inferior ULNAR Collateral —> Anterior ULNAR Recurrent
Deep Brachial Artery —> Radial and Interosseous Arteries
- RADIAL Collateral Artery —> RADIAL Recurrent Artery
- MEDDLE Collateral Artery —> INTEROSSEOUS Recurrent Artery
Blood Supply to Forearm and Hand
Anterior Forearm:
- Ulnar Artery
- Anterior Interosseous Artery
Posterior Forearm:
- Radial Artery
- Recurrent Interosseous Artery
- Posterior Interosseous Artery
- Ulnar Artery
Blood Supply to Forearm and Hand
Anterior Hand
Superficial Palmar Arch:
- ULNAR Artery
Deep Palmar Arch:
- RADIAL Artery
Muscles of Anterior Forearm
Superficial:
1) Pronator Teres
2) Flexor Carpi Radialis
3) Palmaris Longus
4) Flexor Carpi Ulnaris
Intemediate:
1) Flexor Digitorum Superficialis, Radial Head
2) Flexor Digitorum Superficialis, Humeral-Ulnar Head
Deep:
1) Flexor Digitorum Profundus
2) Flexor Pollicis Longus
3) Pronator Quadratus
Pronator Teres
Prox Attach:
- Coronoid Process of Ulna
- Also to the MEDIAL EPICONDYLE of the Humerus (PRONATOR SYNDROME)
Dist Attach:
- Middle of Lateral Surface of Radius
Actions:
- PRONATES and FLEXES Forearm at Elbow
Blood Supply:
- Anterior Ulnar Recurrent Artery
Innervation:
- MEDIAN Nerve (C6, C7)
Flexor Carpi Radialis
Prox Attach:
- Medial Epicondyle of Humerus (“Common Flexor Origin”)
Dist Attach:
- Base of 2nd Metacarpal
Actions:
- FLEXES and ABDUCTS Hand at wrist
Blood Supply:
- Ulnar Artery
Innervation:
- MEDIAN Nerve (C6, C7)
Palmaris Longus
Prox Attach:
- Medial Epicondyle of Humerus
Dist Attach:
- Flexor Retinaculum; continuous with Palmar Aponeurosis
Actions:
- FLEXES hand at wrist, tenses Palmar Aponeurosis
Blood Supply:
- Ulnar Artery
Innervation:
- MEDIAN Nerve (C7, C8)
Flexor Carpi Ulnaris
Prox Attach:
- Medial Epicondyle of Humerus (Humeral Head)
- Olecranon and Posterior Border of Ulna (Ulnar Head)
Dist Attach:
- Pisiform, Hook of Hamate, 5th Metacarpal
Actions:
- FLEXES and ADDUCTS Hand at Wrist
Blood Supply:
- Ulnar Artery
Innervation:
- ULNAR Nerve (C7, C8)
Review: Flexor Carpu Ulnaris and Cubital Tunnel Syndrome
- Ulnar Nerve becomes compressed in the Tendonous arch formed by the Humeral and Ulnar heads of FLEXOR CARPI ULNARIS in the region of the elbow!!!
- Sings and Symptoms same as those of a Proximal Ulnar Nerve Lesion (Numbness and Tingling in Medial Part of Palm and Medial Digits)
Flexor Digitorum Superficialis
Prox Attach:
- Medial Epicondyle of Humerus, Superior 1/2 of Anterior border of Radius
Dist Attach:
- Shafts of middle phalanges of medial 4 Digits
Actions:
- FLEXES Middle Phalanges at Proximal Interphalangeal Joint
- FLEXES Proximal Phalanges at Metacarpophalangeal Joints
Blood Supply:
- Ulnar Artery
Innervation:
- MEDIAN Nerve (C7, C8, T1)
Flexor Digitorum Profundus
Prox Attach:
- Proximal 3/4 of Medial and Anterior surfaces of Ulna and Interosseous Membrane
Dist Attach:
- Bases of Distal Phalanges of 2nd - 5th Fingers
Actions:
- FLEXES Digital Phalanges at Interphalangeal joints (Power Grip)
Blood Supply:
- Anterior Interosseous Artery
Innervation:
- MEDAIN and ULNAR Nerves (C8, T1)!!!!!!!!!!!!!!!
Flexor Pollicis Longus
Prox Attach:
- Anterior Surface of Radius and Interosseous Membrane
Dist Attach:
- Base of Distal Phalanx of Thumb
Actions:
- FLEXES thumb
Blood Supply:
- Anterior Interosseous Artery
Innervation:
- MEDIAN NERVE via Anterior Interosseous Nerve (C8, T1)
Pronator Quadratus
Prox Attach:
- Distal 1/4 of Anterior Surface of Ulna
Dist Attach:
- Distal 1/4 of Anterior Surface of Radius
Actions:
- PRONATES forearm, Deep fibers bind Radius and Ulna together
Blood Supply:
- Anterior Interosseous Artery
Innervation:
- Median Nerva via Anterior Interosseous Nerve (C8, T1)
Anatomical Relationships
Lateral to Medial
1) Superficial Branch of the Radial Nerve
2) Radial Artery
3) Median Nerve
4) Ulnar Artery
5) Ulnar Nerve
Ulnar Nerve Realtionships
- Posterior to the MEDIAL EPICONDYLE
- Runs along the MEDIAL FOREARM under the Flexor Carpi Ulnaris
- Goes through GUYON’S CANAL Lateral to the PISIFORM Bone
- Enter the hand and Supplies most of the Intrinsic Muscles of the hand
Anatomical Realtionships
1) Ulnar Nerve and Ulnar Artery
- Run together, Nerve is MEDIAL!!!!
2) Ulnar Artery and Flexor Carpi Ulnaris
- Located under Flexor Carpi Ulnaris or just lateral to it
3) Ulnar Artery and Nerve to Pisiform Bone and Guyon’s Canal
- Lateral!!!!
Median nerve Relationships
1) Median Nerve to Pronator Teres
- Runs through it
2) Median Nerve to Flexor Digitorum Superifcialis
- Deep to it (Runs between Flexor Digitorum Superficialis and Flexor Digitorum Profundus)
3) Median Nerve to Flexor Retinaculum
- Deep to it (Through CARPAL Tunnel)
Anatomical Relationships
1) Ulnar Artery and Flexor Carpi Ulnaris
- Located under Flexor Carpi Ulnaris or just lateral to it
2) Ulnar Artery and nerve t Pisiform Bone and Guyon’s Canal
- Lateral
3) Radial Artery to the Superficial Branch of the Radial Nerve
- Artery is MEDIAL (Nerve Lateral)
4) Radial Artery to Brachioradialis
- Under BRACHIORADIALIS or just MEDAIL to it
Anatomical Relationships
Anatomical Interosseous Nerve and Artery to the Pronator Quadratus
- The nerve and artery run deep (Posterior) to the Muscle
Posterior Compartment Muscles of Forearm
- Superficial Group
- Deep Group
- Brahcioradialis
RADILA NERVE!!!!!!!!!!
***Biceps Brachii FLEX the Elbow Joint while Arm is SUPINATED!!!
*** BRACHIORADILIS FLEXES the Elbow Joint when Arm is PRONATED!!!!!
Sensory Territories and Innervations (Dorsal View)
1) Median Nerve: Digital Branches
2) Radial Nerve: Superificial Branch and Dorsal Digital Branches!!!!!
- Supplies the back of the hand at the 1st, 2nd, and half of 3rd Digits
3) Ulnar Nerve: Cutaneous Nerve
- Supplies the back of the hand at hola of 3rd, 4th, and 5th Digits
Muscles of Posterior Arm
Superficial Lateral Group (Radialis Group)
1) Brachioradialis
2) Extensor Carpi Radialis Longus
3) Extensor Carpi Radialis Brevis
Superficial Layer
1) Extensor Digitorum
2) Extensor Digiti Minimi
3) Extensor Carpi Ulnaris
Deep Layer:
1) Supinator
2) ABDUCTOR Pollicis Longus
3) Extensor Pollicis Longus
4) Extensor Indicis
5) Extensor Pollicis Brevis
Superficial Extensors
**Most attach to the Lateral Epicondyle of Humerus
1) Brachioradialis (FLEXES Elbow Joint)
2) Extensor Carpi Radialis Longus
3) Extensor Carpi Radialis Brevis
4) Extensor Digitorum
5) Extensor Digiti Minimi
6) Extensor Carpi Ulnaris
***** ALL MUSCLES of the Posterior forearm are Innervated by the RADIAL NERVE via the DEEP BRANCH OF THE RADIAL NERVE or the POSTERIOR INTEROSSEOUS NERVE!!!!!!
Radial Nerve Distributions
RADIAL NERVE (Before it Branches):
1) Brachioradialis
2) Extensor Carpi Radialis Longus
DEEP RADIAL NERVE
- Travels through the Supinator Muscles and becomes Posterior Interosseous Nerve 1) Extensor Carpi Radialis Brevis 2) Supinator
POSTERIOR INTEROSSEOUS NERVE
1) Extensor Carpi Ulnaris
2) Extensor Digitorum
3) Extensor Digiti Minimi
4) Extensor Indicis
5) ABDUCTOR Pollicis Longus
6) Extensor Pollicis Longus
7) Extensor Pollicis Brevis
SUPERFICIAL RADIAL NERVE
1) Sensation to Lateral Hald of DISTAL Wrist, Hand, and Thumb
SLIDE 7 of POSTERIOR FOREARM LECTURE!!!!!!
Brachioradialis
Prox Attach:
- Proximal 2/3 of Supraepicondylar Ridge of Humerus
Dist Attach:
- Distal Radius, Proximal to Styloid Process
Actions:
- FLEXES Forearm when it is PRONATED (About mid prone position)
Blood Supply:
- Radial Collateral, Recurrent Radial, and Radial Arteries
Innervation:
- RADIAL NERVE (C5, C6, C7)
Extensor Carpi Radialis Longus
Prox Attach:
- Lateral Supracondylar Ridge of Humerus
Dist Attach:
- Dorsal aspect of Base of 2nd Metacarpal
Actions:
- EXTEND and ABDUCT Hand at Wrist
Blood Supply:
- Radial Collateral Artery, Radial Recurrent Artery, Recurrent Interosseous Artery, and Posterior Interosseous Artery
Innervation:
- RADIAL NERVE (C6,C7)
Extensor Carpi Radialis Brevis
Prox Attach:
- Lateral Epicondyle of Humerus (COMMON EXTENSOR ORIGIN)
Dist Attach:
- Dorsal aspect of as of 3rd Metacarpal
Actions:
- EXTEND and ABDUCT Hand at wrist
Blood Supply:
- Radial Collateral, Lateral Recurrent, Recurrent Interosseous, and Posterior Interosseous Arteries
Innervation:
- DEEP BRANCH OF RADIAL NERVE (C7,C8)
***LATERAL EPICONDYLE = Common EXTENSOR Origin
****MEDIAL EPICONDYLE = Common FLEXOR Origin
Extensor Digitorum
Prox Attach:
- Lateral Epicondyle of Humerus (COMMON EXTENSOR ORIGIN)
Dist Attach:
- Extensor Expansions of Medial 4 Fingers
Actions:
- EXTENDS Medial 4 fingers at Metacarpophalangeal Joints and somewhat at Interphalangeal joints
Blood Supply:
- Posterior Interosseous Artery, Recurrent Interosseous, and Perforating Branch of the Anterior Interosseous Arteries
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
- Note that this Nerve is the Continuation of the Deep Branch of the Radial Nerve****
Extensor Digiti Minimi
Prox Attach:
- Lateral Epicondyle of Humerus (Common EXTENSOR Origin)
Dist Attach:
- Extensor Expansion of 5th Finger
Actions:
- Extends 5th Finger of Metacarophalangeal Joint and Secondarily at Interphalangeal Joints
Blood Supply:
- Posterior Interosseous, Recurrent Interosseous, and Perforating Branch of Anterior Interosseous Arteries
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
Extensor Expansion & Extensor Hood Mechanism
- As EXTENSOR DIGITORUM Contacts, it pulls on the EXTENSOR EXPANSION (Extensor Hood), which causes the Interphalangeal (IP) Joints to Extend.
- The LUMBRICALS also attach to this Expansion at the “HOOD” and are thus able to Extend the IP JOINTS!!!!!
Extensor Carpi Ulnaris
Prox Attach:
- Lateral Epicondyle of Humerus and Posterior border of Ulna
Dist Attach:
- Dorsal aspect of Base of 5th Metacarpal
Actions:
- EXTENDS and ADDUCTS Hand at Wrist (ULNAR DEVIATION)
Blood Supply:
- Radial Collateral, Radial Recurrent, Recurrent Interosseous, and Posterior Interosseous Arteries
Innervation:
- POSTERIRO INTEROSSEOUS NERVE (C7, C8)
- **DORSAL DIGITAL EXPANSION, INTERTENDINOUS CONNECTIONS!!!!!
- SLIDE 15 of POSTERIOR ARM LECTURE!!!!!
Deep Extensors
1) Supinator
2) Extensor Indicis
3) Abductor Pollicis Longus
- OUTCROPPING Muscle
4) Extensor Pollicis Longus
- OUTCROPPING Muscle
5) Extensor Pollicis Brevis
- OUTCROPPING Muscle
**** ALL are Innervated by the DEEP BRANCH OF THE RADIAL NERVE, or the POSTERIOR INTEROSSEOUS NERVE, which is the Continuation of this same Nerve
Supinator
Prox Attach:
- Lateral Epicondyle of Humerus, Radial Collateral & Anular Ligaments, Ulnar Crest
Dist Attach:
- Proximal 1/3 of Radius (Nearly all surfaces, as it wraps around the bone)
Actions:
- SUPINATES Forearm, bringing Radius back to Anatomical Position
Blood Supply:
- Radial Artery, Posterior Interosseous, Radial Recurrent, Recurrent Interosseous, and Middle Collateral Arteries
Innervation:
- DEEP BRANCH of RADIAL NERVE (C7, C8)
Extensor Indicis
Prox Attach:
- Posterior Surface of distal 1/3 of Ulnar and Interosseous Membrane
Dist Attach:
- Extensor Expansion of 2nd Finger
Actions:
- Independent EXTENSION of 2nd Finger, but also helps with EXTENSION of the Wrist
Blood Supply:
- Posterior Interosseous and Perforating Branch of Anterior Interosseous Arteries
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
- Remember that this Nerve is the Continuation of the Deep Branch of the Radial Nerve
Abductor Pollicis Longus
Prox Attach:
- Posterior Surface of Proximal 1/2 of Ulna and Radius, Interosseous Membrane
Dist Attach:
- Base of 1st Metacarpal
Actions:
- ABDUCTS Thumb and EXTENDS it at Carpometacarpal Joint
Blood Supply:
- Posterior Interosseous Artery
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
Extensor Pollicis Brevis
Prox Attach:
- Posterior surface of Distal 1/3 of Radius, Interosseous Membrane
Dist Attach:
- Dorsal aspect of Proximal Phalanx of Thumb
Actions:
- EXTENDS Proximal Phalanx of Thumb at its Metacarpophalangeal Joint, also EXTENDS Carpometacarpal Joint
Blood Supply:
- Posterior Interosseous and Perforating Branch of Anterior Interosseous Arteries
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
Extensor Pollicis Longus
Prox Attach:
- Posterior Surface of middle 1/3 of Ulna, Interosseous Membrane
Dist Attach:
- Dorsal aspect of base of Distal Phalanx of Thumb
Actions:
- EXTENDS Distal Phalanx of Thumb at its Interphalangeal Joint and EXTENDS the Metacarpophalangeal and Carpometacarpal Joint
Blood Supply:
- Posteriro Interosseous and Perforating Branch of Anterior Interosseous Arteries
Innervation:
- POSTERIOR INTEROSSEOUS NERVE (C7, C8)
Arterial Supply to Posterior Forearm and Hand
1) RADIAL ARTERY
- Via DEEP PALMAR ARCH (Hand)
- Via DORSAL CARPAL ARCH (Hand)
2) COMMON INTEROSSEOUS ARTERY
- Posterior Interosseous Artery
3) PERFORATING (Posterior) BRANCH of ANTERIOR INTEROSSEOUS ARTERY
Innervation of Posterior Forearm
RADIAL NERVE
- SUPERFICIAL Branch of Radial Nerve (Lateral, Runs Beneath Brachioradialis)
- DEEP BRANCH of Radial Nerve (Posterior, becomes Posterior Interosseous Nerve)
***** The DEEP BRANCH of RADIAL nerve continues as the POSTERIOR INTEROSSEOUS NERVE!!!!!
Radial Nerve Injury
- The RADIAL NERVE can be injured if a person sustains a Fracture to the Humeral Shaft due to its Relationship to the Spiral Groove
** “ WRIST DROP”!!!!!!!!!!!!
- PARALYSIS of the EXTENSORS of the Wrist and Fingers results in the Inability to EXTEND and thus the FLEXORS “take-over” and the Wrist assumes a Partially FLEXED Position while in a Relaxed Posture
***** BICEPS BRACHII is attached to the Radial Tuberosity, and can cause SUPINATION and FLEXION of the Arm!!!!!!
Anatomical Snuff Bod
-
** Lies between the Extensor Pollicis Longus and the Extensor Pollicis Brevis!!!!!!
- Houses the RADIAL ARTERY!!!!!
1) EXTENSOR POLLICIS LONGUS
- ULNAR Border-more MEDIAL
2) EXTENSOR POLLICIS BREVIS
- RADIAL Border
3) ABDUCTOR POLLICIS LONGUS
- Runs with the EXTENSOR POLLICIS BREVIS)
Borders:
1) Floor:
- SCAPHOID BONE
2) Roof:
- SUPERFICIAL RADIAL NERVE Branches
3) Arteries in Snuff Box:
- RADIAL ARTERY!!!!!!!
Structural Classifications of Joints
Solid:
1) FIBROUS
- Sutures
- Syndesmoses
- Gomphoses
2) CARTILAGENOUS
- Synchondroses
- SYmphyses
SYNOVAIL (Most Joints):
1) Joint Capsule
- Inner Synovial Membrane
- Outer Fibrous Capsule
2) Hyaline Cartilage
3) Some have Articular Disc
4) Typically Very Mobile
Functional Classifications of Joints
1) SYNARTHROSIS = No Movement
2) AMPHIARTHROSIS = Little Movement
3) DIARTHROSIS = A lot of Movement (Most Synovial Joints)
Functional Classification of Joints
Movements at Synovial joints:
1) NONAXIAL = No Axis of Movement
2) UNIAXIAL = Single Axis of Movement
3) BIAXIAL = 2 Axes of Movement
4) MULTIAXIAL = Greater than 2 Axes of Movement
Joints of the Upper Limb
1) ACRIOCLAVICULAR JOINT:
- ACROMION Process of Scapula and Clavicle
- Synovial; Plane
- DIARTHROTIC; Gliding and Rotation of Scapula on Clavicle
2) SHOULDER (HLENOHUMERAL)
- Scapula and Humerus
- Synovial; Ball and Socket
- DIARTHROTIC; Multiaxial; Flexion; Extension; Abduction; Adduction; Circumduction; Rotation of Humerus/ Arm
3) ELBOW
- Ulna (and Radius) with Humerus
- Synovial; Hinge
- DIARTHROTIC; Uniaxial; Flexion; Extension of Forearm
4) RADIOULNAR (Proximal)
- Radius and Ulna
- Synovial; Pivot
- DIARTHROTIC; Uniaxial; Rotation of Radius around Long Axis of Forearm to allow Pronation and Supination
5) RADIOULNAR (Distal)
- Radius and Ulna
- Synovial; Pivot (Contains Articular Disc)
- DIARTHROTIC; Uniaxial; Rotation (CONVEX Head of Ulna Rotates in ULNAR NOTCH of Radius
6) STERNOCLAVICULAR
- Sternum and Clavicle
- Synovial; Shallow Saddle with Articular Disc
- DIARTHROTIC; Multiaxial
SLIDE 6 of JOINTS of UPPER LIMB LECTURE!!!!!!!
Joints of the Upper Limb
- The PECTORAL GIRDLE (A.k.a. The Shoulder Girdle) = THE SCAPULA and CLAVICLE ONLY!!!!!!!
1) Sternoclavicular Joint
2) Acromioclavicular Joint
*****Scapulothoracic Articulation: Where the Front of Scapula (No Cartilage) and Ribs come into Contact Together (NOT A JOINT!!!!!!!!)
SLIDE 7 and 8 of JOINTS OF UPPER LIMB LECTURE!!!!!!
SternoCllavicular Joint
- SYNOVIAL Joint
- DOUBLE SADDLE (Also called a “Shallow Saddle”)
- 2 SEPARATE Synovial Cavities
-
****THE ONLY “TRUE” BONY ARTICULATION BETWEEN UPPER LIMB AND THORAX!!!!!!!!!!
- Some texts describe this joint as a “double saddle” or “double gliding” joint because of the Inner-articular disc. Another team for “saddle joint” is “STELLAR JOINT”!!!!!
***COSTOCLAVICULAR: Reinforce the Articulation of the Sternum and Clavicle along with the Ribs!!!
Sternoclavicular Joint
- ANTERIOR and POSTERIOR STERNOCLAVICULAR LIGAMENTS!!!!!!!!
- INTERCLAVICULAR LIGAMENTS!!!!!!!
- COSTOCLAVICULAR LIGAMENTS!!!!!!!
Sternoclavicular Joint
** A MULTIAXIAL JOINT:
- ELEVATION/ DEPRESSION (Clavicle and Disc)
- PROTRACTION/ RETRACTION (Clavicle and Sternum)
- ROTATION (Both)
Dislocation of the Sternocalvicular Joint
- RARELY OCCURS because this is such a Strong Joint
- Direction of Force Transmission through the Clavicle also PREVENTS FRACTURE
- Forces are usually transmitted along the Length of the Clavicle, such that the Clavicle may FRACTURE, but DISLOCATION of the SC Joint typically DOES NOT OCCUR!!!!!!!!
- Most SC Dislocations are the result of the Fractures through the Epiphyseal Plate at the Sternal End of the Clavicle in Individuals GREATER THAN 25 YEARS of AGE!!!!!
** Young People are more Likely to Shift one of the EPIPHYSEAL Plates in the Sternum that can case the DISLOCATION!!!!!!!
Ankylosis of the Sternoclavicular Joint
- Stiffening, Fixation, or Fusion of the SC Joint
- ATHRITIC CONDITOINS
- SAPHO Syndrome (An Inflammatory Disorder that may Include SYNOVITIS, ACNE, PUSTULOSIS, HYPERSTOSIS, and OSTEITIS
- Shoulder MOBILITY LIMITES
Acromioclavicular Joint
- SYNOVIAL Joint
- PLANE JOINT
- Supporting or Accessory Ligaments: CORACOCLAVICULAR LIGAMENTS!!!!!!
- Acromioclavicular Ligament has 2 Parts:
1) SUPERIOR Acromioclavicular Ligament
2) INFERIOR Acromioclavicular Ligament - Coracoclavicular Ligaments:
1) CONOID Ligament
2) TRAPEZOID Ligament
**ACROMIOCLAVICULAR JOINT DISLOCATION!!!!!!!!!!
SLIDE 13 to 16 of JOINTS OF UPPER LIMB LECTURE!!!!
Separated Shoulder
GRADE 1:
- Acromioclavicular Ligament SPRAIN
GRADE 2:
- Acromioclavicular Ligament TEAR
GRADE 3:
- BOTH Acromioclavicular and Coracoclavicular Ligaments are TORN
Glenohumeral Joint
**Has GREAT RANGE OF MOTION and a lot of MOBILITY
- MULTIAXIAL Synovial Joint
- Between Glenoid of Scapula and Proximal end of Humerus
- Shallow Joint (Although it is classified as a “Ball and Socket”)
- ACROMION and CORACOID limit Range of Motion
- Stability is Primarily maintained by the Muscles and Tendons that Cross this Joint!!!!!
Glenohumeral Joint (ARTICULAR SURFACES)
1) Head of Humerus
2) Glenoid Fossa (Glenoid Labrum is Cartilagenous rim that EXTENDS the Surface Area of the GLENOID)
Glenohumeral Joint (SYNOVIAL CAPSULE)
- WEAK but VERY MOBILE
- Reinforce by the TENDONS of the ROTATOR CUFF MUSCLES
- Long Tendon of BICEPS BRACHII pierces the Capsule (Supraglenoid Tubercle)
Glenohumeral Joint (LIGAMENTS)
- Glenohumeral Ligaments:
- Superior
- Middle
- Inferior
- Coracohumeral
- Transverse humeral
- Coracoacromial
Glenohumeral Joint (Rotator Cuff Muscles)
Rotator Cuff Miscles:
1) Supraspinatus
2) Subscapularis
3) Infrapsinatus
4) Teres Minor
*** Tendon of Long Head of Biceps Brachii
** 1,2, and 3 = Superior, Middle, and Inferior Glenohumeral Ligaments!!!!!!
SLIDE 23 of JOINTS OF UPPER LIMB LECTURE!!!!
Glenohumeral Joint (Bursa)
- Bursa are “Pillows” of Synovial Fluid
1) SUBSCAPULAR Bursa
2) SUBACROMIAL Burse (Subdeltoid Bursa)
3) SUBCORACOID Burse
4) SYNOVIAL SHEATH (Long Biceps Tendon)
Dislocation of the Glenohumeral Joint
- FREELY MOVABLE yet relatively UNSTABLE JOINT
- Commonly DISLOCATED
- Most DISLOCATIONS Occur in the DOWNWARD (INFERIOR) direction (BUT ARE DESCRIBED AS ANTERIOR!!!!!)
- The Coracoacuromial Structures and the Rotator Cuff tend to PREVENT UPWARD DISLOCATION
- POSTERIOR DISLOCATIONS are more RARE
- ANTERIOR Dislocations occur most often in Young Adults, Especially Athletes
- HYPEREXTENSION with LATERAL ROTATIO
- Humeral Head is Forced INFERO-ANTERIOR Direction
- FIBROUS LAYERS of Joint Capsule and Glenoid Labrum may TEAR
- ANTERIOR DISLOCATION from a Hard Low to the Humerus while FULLY ABDUCTED
- TILTS Humeral Head Inferiorly and push it through the weaker part of the Joint Capsule
- Joint Capsule may tear and such that the Humeral Head is positioned INFERIOR to the Glenoid Cavity and ANTERIOR to the INFRAGLENOID TUBERCLE!!!!!
Adhesive Capsulitis of Glenohumeral Joint
- CHRONIC Inflamamtion in the Glenohumeral Joint can lead to FIBROSIS between the Joint Capsule, Rotator Cuff Muscles and Synovial Bursa
- Also called “FROZEN SHOULDER”
- Seen in Individuals 40 - 60 years of age
- ABDUCTION AFFECTED; Compensatory Scapular Movement
- AROMIOCLAVICULAR Joint may become STRAINED
- May be Initiated by GLENOHUMERAL DISLOCATION, Supraspinatus Tendinitis, Bicipital Tendinitis and/ or Rotator Cuff Tears!!!!!!
Glenohumeral Joint (Rotator Cuff)
Rotator Cuff:
- Tendons reinforce and Strengthen the Glenohumeral Joint
- Injury to the Rotator Cuff Muscles can affect Glenohumeral JOINT STABILITY!!!!!!
Rotator Cuff Injuries
1) FORCEFULL and/ or ABRUPT Overhead Motion
2) REPETITIVE Overhead Motion with Humerus at a 90 DEGREE ANGLE!!!!!
3) PUSHING OFF with Arms (Compensatory)
4) FALLING on OUTSTRETCHED Arm/ Hand (FOOSH)
SLIDES 28, 29, and 30 JOINT of UPPER LIMB LECTURE!!!
The Elbow (Cubital) Joint
- The Elbow Joint consists of 3 SEPARATE ARTICULATIONS:
1) Humeroulnar Articulation
2) Humeroradial Articulation
3) Proximal Radioulnar Articulation
Arm Muscles
1) Triceps = EXTENSORS
2) Biceps, Brachialis, and Brachioradialis = EXTENSORS
** Axis of Movement for FLEXION- EXTENSION at Elbow!!!!!!!!!!
The Elbow Joint (HUMEROULNAR/ HUMERORADIAL ARTICULATIONS)
- Several Ligaments around the Elbow Joint Reinforce these Articulations
HUMEROULNAR/ HUMERORADIAL ARTICULATIONS:
1) MEDIAL (Ulnar) Collateral Ligaments
2) LATTERAL (Radial) Collateral Ligaments
- Attaches from Lateral Epicondyle of Humerus
The Elbow Joint (PROXIMAL RADIOULNAR ARTICULATION)
PROXIMAL RADIOULNAR ARTICULATION:
1) ANNULAR LIGAMENT
2) QUADRATE LIGAMENT (A Thickened band EXTENDING from the INFERIOR Border of the ANNULAR LIGAMENT below the RADIAL NOTCH of the ULNA to the NECK of the RADIUS)
***** ANNULAR LIGAMENT: Does right over the head of the RADIUS!!!!!
SLIDE 34 of JOINTS OF UPPER LIMB LECTURE!!!!!
Proximal Radioulnar Joint
- View of TOP of PROXIMAL Radioulnar Joint
- Good view of the Annular Ligament
SLIDE 35 of JOINTS OF UPPER LIMB LECUTER!!!!!
Pronation and Supination of the Arm
PRONATION:
1) PRONATOR TERES
2) PRONATOR QUADRATUS
SUPINATION:
1) BICEPS BRACHII
2) SUPINATOR
- ***Supination and Pronation occurs at BOTH the PROXIMAL and DISTAL Radioulnar Joints!!!!!!!!!
- Be sure to note the DIFFERENCE in BONE POSITION DISTALLY (Radius Crosses Over Ulna)
Distal Radioulnar Joint
- The Radius will Cross over the Ulna
*** The HEAD of the Ulna DOES NOT ARTICULATE with any of the CARPALS!!!!!!
** The STYLOID PROCESS of the Ulna is where the BRACHIORADIALIS Attaches
The Elbow Joint (DISTAL RADIOULNAR ARTICULATION)
DISTAL Radioulnar Ligaments:
1) PALMAR RADIOULNAR LIGAMENT
- From Styloid process of Ulna to VENTRAL Surface of Radius
2) DORSAL RADIOULNAR LIGAMENT
- From Styloid process of Ulna to DORSAL Surface of Radius
3) EXTENSOR CARPI ULNARIS TENDON
SLIDE 30 of JOINTS OF UPPER LIMB LECTURE!!!!!!
Subluxation and Dislocation of Radial Head
- “NURSEMAID’s ELBOW”
- Preschool age Children tend to be VULNERABLE
- Child is SUDDENLY LIFTED by their Upper Limb in a JERKING MOTION
- DISTAL ATTACHMENT of ANNULAR LIGAMENT becomes TORN and Radial head becomes DISLOCATED!!!!
1) Normal
2) Subclinical Subluxation
3) Subluxation
- Head of Radius still in RELATIVE articular POSTION
4) Dislocation
- Head of Radius COMPLETELY out of Position
SLIDE 39 of JOINTS OF UPPER LIMB LECTURE!!!
Lateral Epicondylitis
- “TENNIS ELBOW”
- Tendons of FOREARM EXTENSORS become INFLAMED and/ or TORN at their LATERAL EPICONDYLAR Attachment (In Particular the Tendon of EXTENSOR CARPI RADIALS BREVIS)
- REPETITIVE MOTION INJURY!!!!
***** Tendons Attachment at Lateral Epicondyle showing Tears
***** Forearm muscles (Extensors) attached to Lateral Epicondyle of Humerus
*** Pain and Tenderness on OUTER BONY PART of ELBOW
SLIDE 40 of JOINTS OF UPPER LIMB LECTURE!!!!!!!!