Clinical Anat Upper and Lower Limb

7/31/2019 Clinical Anat Upper and Lower Limb

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Upper Limb

Djoko Prakosa

Dept. Anatomy, Embryologi & Anthropology


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Upper Limb

- It is divided into:

shoulder (junction of the arm and the trunk)

arm (brachium)

elbow

forearm (antebrachium)

wrist (carpus)

hand (manus)


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Bones of the upper limb

Clavicula & Scapula

Humerus

Radius & ulna

Carpal bones:

- proximal row: scaphoid (navicular), lunate,

triquetrum, pisiform

- distal row: trapezium, trapezoid, capitate,hamate

Metacarpal bones (5)

Phalanges


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Shoulders Bones

Demonstrates themain anatomicallandmarks of theclavicle, scapula,humerus, radius andulna.

A: greater tubercle

B: head of humerus

C: coracoid processD: acromion

E: lesser tubercle ofhumerus


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Carpals, metacarpals & phalanges

Identify the bones of the

wrist, metacarpals andphalanges on suitableradiographs

A: scaphoid

B: lunateC: triquetrum & pisiform

D. Trapezium

E. Trapezoid

F. Capitate

G. Hamate

H. Hook of hamate


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Joints

Describethe anatomy of the glenohumeral joint

Name and explain the movements at the joint,


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Joints

Name the musclesresponsible for itsmovement and list

their mainattachments.


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Elbow joint Describe the anatomy of the elbow joint

Name and explain the movements at the joint,


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Joint Stability

Describe the factors that are responsible for

stability at the joint and explain the functional andpossible pathological consequences ofdislocation of the joint.


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Factors affecting joint stability

The stabilizing subsystem of the joint

control subsystem

neural

passive active

subsystem subsystem


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Muscles

Describe the major muscles groups in their fascialcompartments, and explain the functional

importance of those muscle groups.

Describe how muscle groups work in synergy to

facilitate action


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Muscles

I. Connecting the upper limb to vertebral column:- trapezius - levator scapulae

- rhomboideus - latissimus dorsi

II. Connecting the UL to Ant & Lat Thoracic wall:

- pectoralis major & minor

- subclavius

- serratus anterior


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Muscles

III. Muscles of the shoulder

- deltoid - subscapularis

- supraspinatus - infraspinatus

- teres minor - teres major

IV. Muscles of the arm

anterior compartment:

- coracobrachialis - biceps brachii

- brachialis

posterior compartment:

- triceps brachii


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Muscles

V. Muscles of the forearm:

a. Anterior compartment:

Superficial:

- pronator teres - flexor carpi radialis- palmaris longus - flexor carpi ulnaris

- flexor digitorum superficialis

Deep:- flexor digitorum profundus

- flexor pollicis longus

- pronator quadratus


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Muscles

V.b. Posterior compartment:

Superficial:

- brachioradialis - extens carpi radialis long

- extensor digit - extens carpi rad brevis

- anconeus - extens digiti minimi

- extensor carpi ulnaris

Deep:

- supinator - abductor pollicis longus

- extens poll brev - extens pollicis longus

- extensor indicis


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Fascial compartment arm & forearm


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Muscles

VI. Muscles of the hand

a. Thenar muscles

- abductor pollicis brevis - opponens pollicis

- flexor pollicis brevis - adductor pollicis

b. Hypothenar muscles

- palmaris brevis - abductor digiti minimi

- flexor dig min brev - opponens digit minimi

c. Intermediate muscles

- lumbricales

- Interossei


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Retinacula & Tendon sheaths

Describe the function of retinacula, tendonsheaths, specifically the flexor retinaculum of the

wrist, to be able to explain the carpal tunnelsyndrome, spread of infection in tendon sheathsand tenosynovitis.


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Blood Vessels

Describe the origin,course and functionsof the subclavian,axillary, brachial,

radial and ulnararteries and explainthe importance ofanastomosesbetween branches ofthese arteries.


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Blood Vessels


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Vessels

Describe the course of the main superficial veins(cephalic, basilic, median cubital) and recognized

the common sites of venous access.


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Nerves

Describe the origin,course and function ofthe axillary,musculocutaneus,radial, median andulnar nerves in thearm, forearm, wristand hand and namethe main muscles and

muscle groups thatthese nerves supplyas well as theirsensory distribution.


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Nerves


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Nerves


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Pathology

Describe the close relations of the bones andjoints e.g. bursae, blood vessels, nerves which

may be injured in fracture and dislocation

Understand why and where the axillary, musculo-

cutaneus, radial, median and ulnar are commonlyinjured and describe the functional consequencesof those injuries.


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Pathology

Explain the loss of function resulting from injuriesto the different parts of the brachial plexus in

contrast to the injuries that may be incurred to thevarious nerves that arise from it, at various pointsalong their course in the upper limb.


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Brachial plexus injuries

Upper lesions = Erb-Duchene Palsy (Waiters tip)Cause: excessive displacement of the head to

opposite side and depression of the shoulder atthe same site

traction of C5 and C6

Muscles affected:

- supra & infraspinatus - subclavius

- biceps brachii - brachialis

- deltoid

limb hang limply, medially rotated arm,pronation + loss sensation lateral side of arm


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Brachial plexus injuries

Lower lesions: Klumpke Palsy

Cause: excessive abduction of the arm

Th1 torn

muscles affected:all small muscles of the hand

clawed appearance of the hand + loss

sensation on the medial side of the arm


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Nerve injuries

-Long thoracic nerve

blows or pressure on the posterior triangle of theneck

winged scapula

- Axillary nerve:

crutch pressing upward in the armpit; inferior

displacement of humeral head; fracture ofhumeral surgical neck

paralysis of deltoid & teres minor + loss of

skin sensation over lower half of deltoid muscle


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Nerve injuries

Radial nerve:

In the axilla: pressure of crutch; fracture &dislocation of proximal end of humerus

1. motor: triceps, anconeus & long extensor ofwrist paralyzed unable to extend elbow, wrist &fingers wrist drop

2. sensory: posterior & lower part of arm & backof forearm, lateral part of dorsum of hand

In the spiral groove:


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Nerve injuries

Median nerve:1. at elbow

- in supracondylar fracture, stab wound:

motor: forearm in supine position; wristflexion weak, no flexion on metacarpophalangeal

joints of index & middle fingerspreacherhand. Thenar muscles paralyzed and wastedsimian hand = ape like hand

sensory lateral half of palmar hand + finger

2. at wrist:

carpal tunnel syndrome


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Nerve injuries

Ulnar nerve:

Injuries at elbow or wrist

Motor:

Claw handFroments sign +


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Examination

Describe how to test for motor and sensory nerve

function and dysfunction and understand theanatomical basis of tendon jerk testing of bicepsand triceps

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Clinical Anat Upper and Lower Limb

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