NP Upper Extremity Grays

8/10/2019 NP Upper Extremity Grays

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The Upper Extremity

Bones,

Muscles,

Vessels,


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Bones 30 bones!!!! Appendicular skeleton ectoral irdle

"lenoid ca#ity

Allo$s %or mobility Attachments

Upper extremity& Arm

humerus

'orearm (adius, ulna )interosseous

membrane*

+and arpals, metacarpals, phalanes

(e#ie$ bones and landmarksstudied in lab!!!


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-oints o% Upper Extremity

.ternocla#icular .yno#ial/saddle iarthrosis

Acromiocla#icular .yno#ial/plane iarthrosis

"lenohumeral 1oint

.yno#ial/ball2socket iarthrosis Many liaments Muscle rein%orcement

"reat Mobility


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-oints o% Upper Extremity

roximal (adioulnar 1oint .yno#ial / pi#ot

iarthrosis

istal (adioulnar 1oint .yno#ial pi#ot

iarthrosis Allo$s pronation and

supination o% %orearm


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(e#ie$ o% :amin;

:amin 'lexor carpi ulnaris 'lexor diitorum super%icialis 'lexor pollicis lonus

ronator ?uadratus Extensor carpi radialis bre#is


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.capula Muscles

5% the insertionis

on the scapula

mo#es the scapula (homboids

Trape8ius

ectoralis Minor

.erratus Ventralis 4e#ator .capulae

Use location of Insertion to determine movement


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.capula 5nner#ation

@riin on scapula .ubscapularis and

teres ma1or

.ubscapular .upraspinatus and5n%raspinatus .uprascapular

Teres Minor Axillary

4atissimus orsi Thoracodorsal

oracobrachialis Musculocutaneous

5nsertion on scapula (homboids and 4e#ator

.capulae

orsal scapular Trape8ius Accessory

ectoralis Minor Medial and 4ateral

.erratus Ventralis 4on thoracic


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Arm Muscles

ross elbo$, mo#e

%orearm

6 compartments Anterior

'lexors o% %orearm

osterior Extensors o% %orearm


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Arm Muscles

Anterior

compartment

Brachialis Biceps brachii

oracobrachialis

Bracioradialis


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Arm Muscles

osterior

compartment Triceps brachii

Anconeus


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Arm Muscle 5nner#ation

Anterior compartment (adial ner#e

Bracioradialis

Musculocutaneous ner#e oracobrachialis Brachialis Biceps brachii

osterior compartment (adial ner#e

Triceps brachii Anconeus


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'orearm Muscles

ross elbo$, $rist and%iner 1oints

Mo#ement o% hand and%iners ross =rist

%lex, extend, abduct,adduct hand

ross 'iners %lex, extend %iners

roximally are %leshy

istally ha#e lon tendons 'lexor and extensor

retinacula $ristbands Ceep tendons %rom

1umpin out$ards $hen

tensed


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'orearm Muscles

Anterior %lexor

compartment .uper%icial and eep

Most %lexors ha#e

common tendon on

medial epicondyle

ontains 6 pronators

osterior extensorcompartment .uper%icial and eep


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Anterior ompartment o% 'orearm

Muscles :er#es .uper%icial

'lexor diitorum super%icialis Median 'lexor carpi radialis Median ronator teres Median almaris lonus Median 'lexor carpi ulnaris (adial

eep 'lexor pollicis lonusMedian 'lexor diitorum pro%undus Ulnar )med 9D6*

Median )lat 9D6*


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Anterior ompartment

'orearm


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osterior ompartment o% 'orearm

Muscles :er#es .uper%icial

Extensor carpi radialis lonus (adial Extensor diitorum (adial

Extensor carpi ulnaris (adial

eep .upinator (adial

Abductor pollicis lonus (adial

Extensor pollicis lonus bre#is (adial

Extensor indicus (adial


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osterior ompartment o% 'orearm


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+and Bones

arpus )F* True $rist

istal to radiusDulna Metacarpus )7*

istal to carpus

halanes )9G* istal to

metacarpus


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5ntrinsic Muscles o% the +and

Muscle :er#e inky )little %iner*

All diiti minimi Ulnar

)'lexor, Abductor, @pponens* Thumb

Abductor pollicis bre#is Median 'lexor pollicis bre#is Median @pponens pollicis Median Adductor pollicis Ulnar

@ther 5ntrinsic Muscles almar orsal 5nterossei Ulnar 4umbricals Median, Ulnar


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5ntrinsic Muscles o% the +and

5nterossei Muscles 4umbrical Muscles


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Blood .upply / Veins

eep #eins eep palmar #enous arches (adial / %orearm Ulnar / %orearm Brachial armDelbo$ .ubcla#ian / neck Axillary axilla

.uper%icial Veins ephalic armD%orearm

Basilic armD%orearm Median cubital elbo$

Blood dra$s!! Median / %orearm .uper%icial palmar #enous

arches

iital


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Blood .upply / Arteries

.ubcla#ian )neck* Axillary )armpit*

.ubscapular ircum%lex humeral arteries

Brachial )arm* eep brachial

(adial )%orearm* Ulnar )%orearm*

ommon 5nterosseous

.uper%icial 2 eep almararches iital


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Axilla

Armpit!! =here axillary hairs ro$ Boundaries

Ventral ectoral muscles

orsal 4atissimus dorsi, teres ma1or,

subscapularis Medial

.erratus #entralis 4ateral

Bicipital roo#e o% humerus

ontents Axillary lymph nodes, Axillary

#essels, brachial lexus


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.ur%ace Anatomy o% Arm

Biceps brachii

Triceps brachii

@lecrenon rocess

Medial Epicondyle

4ateral Epicondyle


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.ur%ace Anatomy o% Elbo$

ephalic #ein ubital 'ossa

Anterior sur%ace elbo$

ontents Median ubital Vein Brachial Artery Median :er#e

Boundaries MedialH ronator teres 4ateralH Brachioradialis .uperiorH 4ine bet$een epicondyles


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.ur%ace Anatomy o% +and

arpal Tunnel arpals conca#e anteriorly arpal liament co#ers it

ontains& lon tendons, Medianner#e

5n%lammation o% tendons Hcompression o% Median ner#e

Anatomical .nu%%box

4ateral H E


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Brachial lexus

:er#e plexus :et$ork o% ner#es %ormed by

#entral rami

4ies partly in neck and partly

in axilla

"i#es rise to almost all

ner#es that supply upper limb

'ormed by intermixin o%

#entral rami o% spinal ner#es

7/F and T9 .mall contributions %rom G and

T6


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Ventral (ami


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Brachial lexus

Really Tired> Drink !o%%ee "uddy!

( H (AM5 )#entral* )7* T H T(U:C. )3* H 5V5.5@:. )6* H @(. )3* B H B(A:+E. )Many!!*


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(ami 1oin to %orm Trunks! )in neck*

#entral Rami Trun$s

7 Upper Trunk

I

J Middle Trunk

F T9 4o$er Trunk


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Trunks .plit to %orm i#isions! )in neck*

Trun$s Divisions

Upper Anteriorosterior

Middle Anteriorosterior

4o$er Anteriorosterior


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i#isions -oin to %orm ords! )in axilla*

Trun$s Division !ords

U A 4ateral

M A Medial

4 A osterior


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ords "i#e o%% Branches!! )in axilla*

4ateral Musculocutaneous

Median

Medial Ulnar

osterior (adialAxillary)thoracodorsal*)subscapular*


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ut it all toether;;


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Brachial lexus ords and Branches

4ateral Musculocutaneous Median

Medial Ulnar

osterior

(adial Axillary Thoracodorsal .ubscapular


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Both Medial and 4ateral ords

Median ner#e ourse&

Middle o% brachial plexus )%rom lateral and medial cords*

oes not branch in arm

istal to elbo$ pro#ides many branches to most %orearm %lexors

asses throuh carpal tunnel to hand to lateral palmar intrinsics

5nner#ates& Anterior %orearm )motor*

Most %lexors, some intrinsics )thumb*

6D3 4ateral palm )sensory*

orsum o% %iners 6 and 3 )sensory*


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osterior ords

(adial ner#e 4arest branch o% brachial plexus omes %rom posterior cord ourse&

Throuh arm Around humerus Around lateral epicondyle )then di#ides*

5nner#ates& osterior muscles o% arm and %orearm

Triceps brachii, anconeus, supinator, brachioradialis

i#ides in %orearm& .uper%icial

.kin o% arm and dorsolateral sur%ace o% hand eep

Extensor muscles o% %orearm )e E< carpi radialis 4 B*


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osterior ord

Axillary ner#e Branches o%% posterior cord ourse&

(uns posterior to humerus (uns $ith caudal humeral circum%lex artery

5nner#ates& eltoid and teres minor )motor* apsule o% shoulder, skin o% shoulder )sensory*

.ubscapular ner#e 5nner#ates&

.ubscaplaris, Teres ma1or

Thoracodorsal ner#e ourse&

(uns $ith thoracodorsal artery and ner#e 5nner#ates&

4atissimus dorsi


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NP Upper Extremity Grays

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