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8/8/2019 Upper Limb 2
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Frolich, Human Anatomy,UpprLimb
UPPER LIMB What is a limb? Skeleton Joints Shoulder/Scapula
muscles
Brachial plexus²getting spinal nervesout onto limb
Muscles²anterior
and posterior compartments Sensory innervation Surface anatomy
From Royal Collection daVinci drawings
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Frolich, Human Anatomy,UpprLimb
What is a limb?
Ventral somatic outgrowth of outer tube ± Bones (made of bony tissue,
cartilage, and other tissues)
± Joints
± Muscles
± Nerves (with motor neurons tomuscles, sensory neurons toskin, proprioceptors)
No viscera--all innervation issomatic (motor or sensory)from ventral ramus of spinalnerve (except autonomics to
blood vessels)
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Frolich, Human Anatomy,UpprLimb
Upper Limb Skeleton
Scapula
Humerus
Radius, ulna
Carpals--proximal, distal
Digits
± Metacarpals ± Phalanges
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Frolich, Human Anatomy,UpprLimb
JointsJOINT BETWEEN MOVEMENT TYPE
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Frolich, Human Anatomy,UpprLimb
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Frolich, Human Anatomy,UpprLimb
Muscle origins and insertions
Muscle crosses joint Origin is usually proximal andinsertion is usually distal
Origin is considered fixed inanalyzing muscle action
Muscle action (concentric) isgiven by movement of insertion relative to originacross joint
Remember: ± Sometimes insertion might be
fixed
± Muscle may be activeisometrically and concentricallygiving different real functionduring real activity
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Frolich, Human Anatomy,UpprLimb
Muscles of Scapula
If INSERTION onscapula, muscle movesscapula ± Trapezius
± Rhomboids ± Pectoralis Minor
± Serratus Ventralis
± Levator Scapulae
If ORIGIN on scapula,muscle moves arm ± Teres Major
± Latissimus Dorsi (partially
on scapula)
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Frolich, Human Anatomy,UpprLimb
Rotator Cuff
Muscles originate onfossae of scapula
Help support ³opensocket´ of shoulder joint
Insert around ball of
femur Medial and lateral
rotation of upper limb
Typical baseballpitcher injury
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
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Frolich, Human Anatomy,UpprLimb
Axilla = Armpit Region between arm and chest
Boundaries
± Ventral - pectoral muscles
± Dorsal = latissimus dorsi, teres major subscapularis
± Medial = serratus ventralis
± Lateral = bicipital groove of humerus
Contents
± Axillary nerves and blood vessels ± Axillary lymph nodes
± And«.the««Brachial plexus
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Frolich, Human Anatomy,UpprLimb
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Frolich, Human Anatomy,UpprLimb
Posterior Compartment²posterior cord Anterior compartment²medial, lateral cords Name of cord is relative to axillary artery
Brachial Plexus
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Frolich, Human Anatomy,UpprLimb
Brachial plexus organizes nerves out tomuscles of upper limb
One posterior nerve
± Radial n.
Three anterior nerves ± Musculocutaneous n.
± Median n.
± Ulnar n.
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Frolich, Human Anatomy,UpprLimb
Muscles and nerves by compartment
A TERI R P STERI R
ER ES M-C, ulnar,
median
Radial
M EME T Flexion Extension
MUSCLES Biceps,
flexors
Triceps,
extensors
T IST Flexors frommedial
epicondyle
Extensors fromlateral
epicondyle
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Frolich, Human Anatomy,UpprLimb
POSTERIOR AND ANTERIOR COMPARTMENTS
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Frolich, Human Anatomy,UpprLimb
Biceps²anterior compartment, flexion (M-C n.)
Triceps²posterior compartment, extension (radial n.)
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Frolich, Human Anatomy,UpprLimb
Anterior Compartment Forearm--flexors
Flexor Carpi Radialis
Flexor Retinaculum
edial Epicondyle
Flexor Digitorum Superficialis
is deep to other flexors
Flexor Carpi Ulnaris
Brachioradialis
Pronator Teres
Anterior View
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Frolich, Human Anatomy,UpprLimb
Posterior Compartment of Forearm--extensors
Extensor digitorum
Extensor carpi ulnarisExt Carpi Radialis Longus
Brachioradialis
Lateral Epicondyle
Posterior View
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Frolich, Human Anatomy,UpprLimb
ANTERIOR MUSCLES
M-C nerve
± Biceps
± brachialis
Median nerve
± Forearm flexors
± Thumb intrinsics (1M$nerve)
Ulnar nerve
± Flexor carpi ulnaris ± Hand intrinsics
POSTERIOR MUSCLES
Muscles (radial nerve)
± Triceps
± Anconeus
± Brachioradialis
± Carpal, digit extensors
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Frolich, Human Anatomy,UpprLimb
Sensory from limb(dermatomes/sensory skin
segments from spine)
Dermatomes extendover limbs
Twisted orientationreflects twisting of limb duringdevelopment
Named nervesgenerally innervateskin over musclesthat they innervate
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Frolich, Human Anatomy,UpprLimb
Sensory territory of nerves
REMEMBER: Brachialplexus re-directs spinalroutes into named nervescovering certain territory
Cutaneous branches of
medial cord/ulnar nerve
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Frolich, Human Anatomy,UpprLimb
Routes of nerves (in human)
M-C: between biceps brachii and brachialis Median: medial/posterior to biceps, branches
into forearm flexors at elbow then to handthrough carpal tunnel
± Recurrent median (1M$) superficial at wrist to thumbover thenar emminence) deficit - ape¶s hand
Ulnar: medial in arm, posterior to medialepicondle of humerus (funny bone) down medialforearm medial to carpal tunnel into palm
Radial: deep posterior arm around lateralepicondyle of humerus to forearm (deep and
superficial branches)
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Frolich, Human Anatomy,UpprLimb
Ulnar Nerve
Brachial Artery
Median Nerve
Ulnar NerveMedian Nerve
Radial Artery
Musculocutaneous Nerve UlnarArtery
Where¶s Radial Nerve?
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Frolich, Human Anatomy,UpprLimb
Surface Anatomy of Upper Limb Biceps + Triceps brachii
Olecranon Process Medial Epicondyle
Cubital Fossa
± Anterior surface elbow
± Contents Brachial Artery
Median Nerve
± Boundaries Medial = Pronator teres
Lateral = Brachioradialis
Superior = Line between epicondyles
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Frolich, Human Anatomy,UpprLimb
Surface Anatomyof Upper Limb
Carpal Tunnel
± Carpals concaveanteriorly
± Carpal ligament covers it
± Contains: long tendons,Median nerve
± Inflammation of tendons =
compression of Mediannerve
Anatomical Snuffbox
± Lateral = E.pollicis brevis
± Medial = E. pollicis longus
± Floor = scaphoid, styloidof radius
± Contains Radial Artery
(pulse)
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Frolich, Human Anatomy,UpprLimb
Suggestion: a muscle tableorganized by
Joint crossed?
Nerve innervating? Action?Compartments? All of the above?
MUSCLE ACTIO O IGI I SER TIO I ERVATIO
(cord to nerve)
iceps lex, sup. Humerus,
glenoid
R adial
tuberosity
Medial cord² M-C.
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Frolich, Human Anatomy,UpprLimb