UPPER LIMB

FLASHCARDS:

Compiled by- misojike and Allan Matu

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking.

-Steve Jobs


CONTENTS:

1.


Outline the surface landmarks of the back: (1-5)

1. Scapula (shoulder blade)

2. Eighth rib

3. Twelfth rib

4. Iliac crest

5. Sacrum


Outline the surface landmarks of the back: (6-10)

6. Coccyx

7. Spines of vertebrae

8. External occipital protuberance and superior nuchal lines

9.Nuchal groove furrow

10. Ligamentum nuchae


MUSCLES OF THE BACK:

GET READY!!!

GET READY!!!

  1. ATTACHMENTS

Deuteronomy 31:6 ~ Be strong and courageous. Do not fear or be in dread of them, for it is the Lord your God who goes with you. He will not leave you or forsake you.”

  1. ATTACHMENTS
  1. TRAPEZIUS:

i. ORIGIN

ORIGIN:

(a) medial third of the superior nuchal line,

(b) external occipital protuberance,

(c) ligamentum nuchae,

(d) spine of 7th cervical vertebra, and

(e) spines of all thoracic vertebrae

  1. ATTACHMENTS
  1. TRAPEZIUS:

ii. INSERTION

INSERTION:

•Sup. fibres- runs downwards and laterally to be inserted on to lateral third of posterior border of clavicle

• middle fibres- proceed horizontally; I to on to the medial margin of the acromion and upper lip of the crest of the spine of the scapula

  • lower fibres- upward and laterally- I on to the deltoid tubercle at junction of medial and middle third of the spine of the scapula


  1. ATTACHMENTS

2. LATISSMUS DORSI:

I. ORIGIN

ORIGIN:

(a) spines of lower six thoracic vertebrae anterior to the trapezius, by tendinous fibres,

b) posterior lamina of thoraco-lumbar fascia (by which it is attached to the spines of lumbar and sacral vertebrae) by tendinous fibres,

(c) outer lip of the posterior part of the iliac crest by muscular slips,

(d) lower three or four ribs by fleshy slips,

(e) inferior angle of the scapula.



  1. ATTACHMENTS

2. LATISSMUS DORSI:

II. INSERTION

INSERTION:

  • ends as flattened tendon, which is inserted into the floor of intertubercular sulcus (bicipital groove) of the humerus

* From its extensive origin the fibres pass laterally with

different degrees of obliquity (the upper fibres are nearly

horizontal, the middle are oblique, and lower are almost

vertical) to form a sheet that overlaps the inferior angle of

the scapula. This sheet curves around the inferolateral border

of the teres major to gain its anterior surface.

  1. ATTACHMENTS

3. LEVATOR SCAPULAE

ORIGIN:

arises by tendinous slips from:

(a) transverse processes of atlas and axis vertebrae, and

(b) posterior tubercles of the transverse processes of the 3rd and 4th cervical vertebrae


INSERTION:

  • between the superior angle and base of the spine of scapula
  1. ATTACHMENTS

4. RHOMBOIDEUS MINOR

ORIGIN:

  • Lower part of Ligamentum nuchae
  • C7, T1 spines

INSERTION:

  • Base of triangular area at the ROOT of SPINE of SCAPULA
  1. ATTACHMENTS

5. RHOMBOIDEUS MAJOR

ORIGIN:

  • Spine of T2, T3, T4, T5 vertebrae and intervening SUPRASPINOUS LIGAMENTS

INSERTION:

  • Medial border of scapula between the root of spine and inferior angle of scapula
  1. ATTACHMENTS

SCAPULOHUMERAL MUSCLES:

  1. Deltoid:

I. ORIGIN

ORIGIN:

  • (a) Lateral 1/3rd of Clavicle
  • (b) Acromion process
  • (c) Crest of spine of scapula
  1. ATTACHMENTS
  1. Deltoid:

II. INSERTION

INSERTION:

  • Deltoid tuberosity (on lateral aspect of midshaft of humerus)
  1. ATTACHMENTS

2.SUPRASPINATUS

ORIGIN:

  • medial two-third of the supraspinous fossa of the scapula.

INSERTION:

  • superior facet on the greater tubercle of the humerus
  1. ATTACHMENTS

3. Infraspinatus

ORIGIN:

  • medial two-third of the fossa by tendinous fibres from ridges on its surface

INSERTION:

  • middle facet of the greater tubercle of the humerus.
  1. ATTACHMENTS

4. TERES MINOR

ORIGIN:

  • posterior aspect of the lateral border of the scapula, above origin for Teres major

INSERTION:

  • lower facet of the greater tubercle of the humerus.
  1. ATTACHMENTS

5. TERES MAJOR

ORIGIN:

  • oval area on the dorsal surface of the inferior angle and adjoining lateral border of the scapula.

INSERTION:

  • medial lip of the intertubercular sulcus of the humerus.
  1. ATTACHMENTS

6. SUBSCAPULARIS

ORIGIN:

(a) medial two-third of the costal surface of the scapula and

(b) tendinous intermuscular septa attached to the ridges on the bone.

INSERTION:

  • lesser tubercle of the humerus

2. NERVE SUPPLY AND ACTIONS

  1. TRAPEZIUS:

NERVE SUPPLY

• Spinal accessory (motor)

• C3, C4 spinal nerves (proprioceptive)

ACTIONS

• Upper fibres elevates the scapula

• Middle fibres retract the scapula

• Lower fibres depress the scapula

NAME THE PARTS

  1. TRAPEZIUS:

2. NERVE SUPPLY AND ACTIONS

2. LATISSMUS DORSI:

NERVE SUPPLY

• thoraco-dorsal nerve

(C6, C7, C8)

(from the posterior cord of the brachial plexus)

ACTIONS

(REAM)- mnemonic

• Adduction, • Extension and medial rotation of the arm • Raises body towards arm as in climbing


NAME THE PARTS

  1. LATISSMUS DORSI

2. NERVE SUPPLY AND ACTIONS

3. LEVATOR SCAPULAE

NERVE SUPPLY

• Dorsal scapular nerve (C5)

• C3 and C4 spinal nerves (proprioceptive)


ACTIONS

Elevation and medial rotation of the scapula and tilts its glenoid cavity inferiorly


2. NERVE SUPPLY AND ACTIONS

4. RHOMBOIDEUS MINOR

NERVE SUPPLY

• Dorsal scapular nerve (C5)



ACTIONS

Elevation and retraction of the scapula


2. NERVE SUPPLY AND ACTIONS

5. RHOMBOIDEUS MAJOR

NERVE SUPPLY

• Dorsal scapular nerve (C5)



ACTIONS

Elevation and retraction of the scapula + median rotation of scapula


2. NERVE SUPPLY AND ACTIONS

SCAPULOHUMERAL MUSCLES:

  1. Deltoid:


NERVE SUPPLY

• Axillary nerve (C5, C6)


ACTIONS

Forget MAMAPEM (mnemonic)

• Flexion and medial rotation by the anterior fibres

• Abduction (15°–90°) of the arm by middle fibres

• Extension and medial rotation of the arm by posterior fibres


NAME

THE

PARTS


DELTOID


2. NERVE SUPPLY AND ACTIONS

2.SUPRASPINATUS

NERVE SUPPLY

• Suprascapular nerve (C5, C6)


ACTIONS

Initiates abduction of the arm and carries it up to 15°

2. NERVE SUPPLY AND ACTIONS

3. Infraspinatus

NERVE SUPPLY

• Suprascapular nerve (C5, C6)


ACTIONS

Lateral rotation of the arm

2. NERVE SUPPLY AND ACTIONS

4. TERES MINOR

NERVE SUPPLY

• Axillary nerve (C5, C6)


ACTIONS

Lateral rotation of the arm

2. NERVE SUPPLY AND ACTIONS

5. TERES MAJOR

NERVE SUPPLY

• Lower subscapular nerve (C5, C6)

ACTIONS

  • Abduction and medial rotation of the arm

2. NERVE SUPPLY AND ACTIONS

6. SUBSCAPULARIS

NERVE SUPPLY

•Upper and lower subscapular nerves (C5, C6, C7)

ACTIONS

• Adduction and medial rotation of the arm

• Helps to hold the humeral head in glenoid cavity

15 SEC break...


In the end, it's not the years in your life that count. It's the life in your years


~Abraham Lincoln


MUSCLES OF THE PECTORAL REGION:

A. ATTACHMENTS

Proverbs 3:5-6 ~

Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.

  1. ATTACHMENTS
  1. PEC MAJOR:

i. ORIGIN

  1. ATTACHMENTS
  1. PEC MAJOR:

i. INSERTION

ORIGIN:

1. Small clavicular head.

  • medial half of the anterior aspect of the clavicle

2. Large sternocostal head.

(a) lateral half of the anterior surface of the sternum, up to 6th costal cartilage.

(b) medial parts of 2nd–6th costal cartilages, and

(c) aponeurosis of the external oblique muscle of the abdomen




INSERTION:

  • by a U-shaped (bilaminar) tendon on to the lateral lip of the bicipital groove


*The anterior

lamina of the tendon is formed by the clavicular fibres, while

posterior lamina is formed by sternocostal fibres. The two

laminae are continuous with each other inferiorly.

*The lower sternocostal and abdominal fibres in their

course to insertion are twisted in such a way that fibres,

which are lowest are inserted highest.

This twisting of fibres forms the rounded axillary fold.

  1. ATTACHMENTS

2. PEC MINOR:

I. ORIGIN

ORIGIN:

It arises from 3rd, 4th, and 5th ribs, near their costal cartilages



  1. ATTACHMENTS

2. PEC MINOR:

II. INSERTION

INSERTION:

  • It is inserted by a short thick tendon into the medial border and upper surface of the coracoid process of the scapula
  1. ATTACHMENTS

3. SUBCLAVIUS:

ORIGIN:

  • 1st rib at the Costo-chondral junction

INSERTION:

  • Inferior surface (middle third) of clavicle (at Sub-clavian groove!)
  1. ATTACHMENTS

3 (II): DIAGRAM

  1. ATTACHMENTS

4. SERRATUS ANTERIOR

(Strictly speaking, not a muscle of pectoral region)

ORIGIN:

  • arises by a series of 8 digitations from upper eight ribs

*. The first digitation arises from the 1st and 2nd ribs, whereas all other digitations arise from their corresponding ribs.

INSERTION:

  • costal surface of the scapula along its medial border

(The first 2 digitations are inserted into the superior angle, next 2 digitations into the medial border and the lower 4 or 5 digitations into the inferior angle of the scapula.)

MOVEMENTS OF THE SCAPULA

THE ADULT FEMALE BREAST! :

(A moment to reflect...)

ACTIONS:

• Chief extensor of the hip joint

• Assists in getting up from sitting position

NERVE SUPPLY:

  • • Inferior gluteal nerve (L5; S1, S2)
  1. LOCATION

THE ADULT FEMALE BREAST! :


  • The breast is located in the superficial fascia of the pectoral region
  • A small extension from its superolateral part (axillary tail of Spence) however pierces the deep fascia and extends into the axilla (in an arpreture known as foramen of Langer)

*The axillary tail is the site of high percentage of breast tumor

THE ADULT FEMALE BREAST! :


2. EXTENTS

1. Vertically, it extends from 2nd rib to 6th rib.

2. Horizontally, it extends from lateral border of the sternum to the midaxillary line.

3. PARTS

THE ADULT FEMALE BREAST! :


  1. Skin: Presents nipple and areola
  2. Stroma- contains connective tissues that condense to form suspensory ligaments of Cooper which maintain the protuberance of the breast
  3. Parenchyma/ Glandular tissue: secrete milk to feed the newborn baby; consists of about 15-20 lobes

THE ADULT FEMALE BREAST! :


3. Parts of Parenchyma

Lobe

Lobule: division of lobe; contain cluster of acini

Lactiferous duct: drains lobe

Lactiferous siunus: Serves as reservoir of milk during lactation


Name the parts

4. BLOOD SUPPLY:


NAME THE

PARTS

  1. Internal thoracic (mammary) artery
  2. Axillary artery
  3. Posterior intercostal arteries

4 II. VENOUS DRAINAGE OF THE BREAST:

  1. Internal thoracic vein
  2. Axillary vein
  3. Posterior intercostal veins

4. LYMPHATIC DRAINAGE


NAME THE

PARTS

+Supraclavicular nodes (Above clavicle)

A BIT MORE ON LYMPHATICS

THE ADULT FEMALE BREAST! :


CC:

BREAST CANCER

(carcinoma of the breast)

*Mastectomy

*Breast conservation

Muscles DEEP to the breast:

15 SEC BREAK!

THE ADULT FEMALE BREAST! :


5. AXILLA:

i. Boundaries:

5. AXILLA:

i. Boundaries:

(a): APEX

  • formed by lateral border of the first rib, superior border of scapula, and the posterior border of the clavicle.

5. AXILLA:

i. Boundaries:

(b): Lateral wall

  • intertubercular groove of the humerus.

5. AXILLA:

i. Boundaries:

(c): Medial wall

  • consists of the serratus anterior and the thoracic wall (ribs and intercostal muscles).

5. AXILLA:

i. Boundaries:

(d): Anterior wall

  • contains the pectoralis major and the underlying pectoralis minor and the subclavius muscles.

5. AXILLA:

i. Boundaries:

(e): Posterior wall

formed by the subscapularis, teres major and latissimus dorsi.

5. AXILLA:

i. Boundaries:

(f): Base

formed by the axillary fascia, pectoralis major(its lower border forming the anterior axillary fold), tetres major latissimus dorsi tendons (forming posterior axillary fold) and medially by lateral aspect of chest wall.

5. AXILLA:

i. Contents:

  1. Axillary artery (and branches)
  2. Axillary vein (and tributaries)
  3. Cords of brachial plexus
  4. Axillary lymph nodes
  5. Fibrofatty tissue
  6. Axillary tail of breast
  7. Long thoracic and intercostobrachial nerves
  8. Biceps brachii (short head) and coracobrachialis

6. (a)

The BRACHIAL PLEXUS!

Discuss...

No content here!

You’re in med school. Time for you to DIY!

6. (b)

CCs

I. Erb’s Paralysis

A.K.A (upper plexus injury)

caused by the excessive increase in the angle between the head and shoulder

involves upper trunk (C5 and C6 roots)

leads to a typical deformity of the limb called policeman’s tip hand/porter’s tip hand/waiter's tip hand.

6. (b)

CCs

II. Klumpke’s paralysis (lower plexus injury)

caused by the hyperabduction of the arm

C8 and T1 and sometimes C7 involved

clinical features:

  1. Claw hand
  2. Loss of sensations along the medial border of the for

earm and hand (T1).

Horner’s syndrome

Surgical approach to axilla:

Surgical approach to axilla:

The axilla is approached surgically through the skin of the floor of axilla for the excision of axillary lymph nodes to treat the cancer of the breast. The structures at risk during this procedure are (a) intercostobrachial nerve, (b) long thoracic nerve, (c) thoraco-dorsal nerve, and (d) thoraco-dorsal artery. Effort should be made to safeguard the above structures.

7.


dorsiflexors of the ankle

and

extensors of the toes

2. Lateral compartment

plantarflex

and

evert the foot

8: THE AXILLARY LYMPH NODEs !:

Group; no; location; Area/Part(s) drained.



Posterior compartment: DEEP


  1. Lateral
  2. Anterior (pectoral)
  3. Pos­terior (subscapular)
  4. Central
  5. Apical

flex the toes

and

plantarflex the ankle.

THE

SHOULDER

REGION:

BONY LANDMARKS

  • Clavicle.
  • Acromioclavicular joint.
  • Acromion
  • Coracoid process


THE SHOULDER REGION:


CUTANEOUS INNERVATION

THE

SHOULDER

REGION:

JOINTS:

Name the 4 basic articulations of the Shoulder Joint complex

1. Glenohumeral joint.

2. Acromioclavicular joint.

3. Sternoclavicular joint.

4. Scapulothoracic articulation/scapulothoracic linkage (functional linkage between the scapula and thorax).

1.

The

GLENOHUMERAL

JOINT

(a)FORMATION

by large round head of humerus with the relatively shallow glenoid cavity of the scapula. The glenoid cavity is deepened slightly but effectively by the fibrocartilaginous ring called glenoid labrum

1.

The

GLENOHUMERAL

JOINT

TYPE

ball-and-socket type of synovial joint

*The shoulder joint is the most movable joint of the body

and consequently one of the least stable. It is most common

joint to dislocate and to undergo recurrent dislocations.

Therefore, the students must study it very thoroughly

1.

The

GLENOHUMERAL

JOINT

STABILITY FACTORS:

  1. Rotator cuff muscles
  2. Coracoachromial arch
  3. Long head of biceps tendon
  4. Glenoid Labrum

1.

The

GLENOHUMERAL

JOINT

MOVEMENTS

1. Flexion and extension.

2. Abduction and adduction.

3. Medial and lateral rotation.

4. Circumduction.

1.

The

GLENOHUMERAL

JOINT

STABILITY FACTORS:

  1. Rotator cuff muscles
  2. Coracoachromial arch
  3. Long head of biceps tendon
  4. Glenoid Labrum

1.

The

GLENOHUMERAL

JOINT

CC:

• Dislocation of the shoulder joint:


  • mostly occurs inferiorly because the joint is least supported on this aspect
  • often injures the axillary nerve
  • usually caused by excessive extension and lateral rotation of the humerus

Clinically, it presents as:(a) Hollow in rounded contour of the shoulder (b) Prominence of shoulder tip

1.

The

GLENOHUMERAL

JOINT

CC:

  • Frozen shoulder (adhesive capsulitis):
  • characterized by pain and uniform limitation of all movements of the shoulder joint
  • occurs due to shrinkage of the joint capsule
  • condition is generally seen in individuals with 40–60 years of age.

1.

The

GLENOHUMERAL

JOINT

CC:

• Rotator cuff disorders:


  • The rotator cuff disorders include:

-calcific supraspinatus tendinitis

-subacromial bursitis


(Describe more...)

Proceeding onto: ACROMIOCLAVICULAR JOINT!

...Get Ready!!!

  • The rotator cuff disorders include:

-calcific supraspinatus tendinitis

-subacromial bursitis


2.

The

ACROMIOCLAVICULAR

JOINT

  • formed between the lateral end of the clavicle and acromion process of the scapula

2.

The

ACROMIOCLAVICULAR

JOINT

TYPE

  • plane type of the synovial joint

2.

The

ACROMIOCLAVICULAR

JOINT

ARTICULAR SURFACES

  • small facets present on the lateral end of clavicle and the medial margin of the acromion process of the scapula.

2.

The

ACROMIOCLAVICULAR

JOINT

STABILITY:

JOINT CAPSULE

  • thin, lax fibrous sac attached to the margins of articular surfaces

2.

The

ACROMIOCLAVICULAR

JOINT

LIGAMENTS:

  1. ACROMIOCLAVICULAR ligament
  2. COSTOCLAVICULAR ligament

2.

The

ACROMIOCLAVICULAR

JOINT

Describe the ACROMIOCLAVICULAR LIGAMENT:

  • fibrous band that extends from acromion to the clavicle. It strengthens the acromioclavicular joint superiorly

2.

The

ACROMIOCLAVICULAR

JOINT

LIGAMENTS:

  1. ACROMIOCLAVICULAR ligament
  2. COSTOCLAVICULAR ligament

2.

The

ACROMIOCLAVICULAR

JOINT

POINT to note on CORACOCLAVICULAR LIGAMENT

N.B. The coracoclavicular ligament is largely responsible

for suspending the weight of the scapula and upper limb

from clavicle.

The coracoclavicular ligament is the strongest ligament

of the upper limb

2.

The

ACROMIOCLAVICULAR

JOINT

Describe the ACROMIOCLAVICULAR LIGAMENT:

  • fibrous band that extends from acromion to the clavicle. It strengthens the acromioclavicular joint superiorly

2.

The

ACROMIOCLAVICULAR

JOINT

Describe the COSTOCLAVICULAR LIGAMENT:

  • consists of two parts:

(a) conoid and

(b) trapezoid,

which are united posteriorly and often separated by a bursa

2.

The

ACROMIOCLAVICULAR

JOINT

Describe the

conoid ligament

  • inverted cone-shaped fibrous band. The apex is attached to the root of the coracoid process just lateral to the scapular notch and base is attached to the conoid tubercle on the inferior surface of the clavicle.

2.

The

ACROMIOCLAVICULAR

JOINT

Describe the

trapezoid ligament

a horizontal fibrous band that stretches from upper surface of the coracoid process to the trapezoid line on the inferior surface of lateral end of the clavicle.

2.

The

ACROMIOCLAVICULAR

JOINT

MOVEMENTS

  • the acromioclavicular joint rotation of acromion of scapula at the acromial end of the clavicle

These movements are associated with movements of scapula

at the scapulothoracic joint/linkage.

2.

The

ACROMIOCLAVICULAR

JOINT

A moment to reflect...

a horizontal fibrous band that stretches from upper surface of the coracoid process to the trapezoid line on the inferior surface of lateral end of the clavicle.

3.

The

STERNOCLAVICULAR

JOINT

  • the acromioclavicular joint rotation of acromion of scapula at the acromial end of the clavicle

These movements are associated with movements of scapula

at the scapulothoracic joint/linkage.

3.

The

STERNOCLAVICULAR

JOINT

TYPE

saddle type of the synovial joint.

3.

The

STERNOCLAVICULAR

JOINT

Articular Surfaces

  • rounded sternal end of clavicle articulates with the shallow socket at the superolateral angle of the manubrium sterni and adjacent part of the 1st costal cartilage

3.

The

STERNOCLAVICULAR

JOINT

What prevents...

saddle type of the synovial joint.

3.

The

STERNOCLAVICULAR

JOINT

Articular Surfaces

  • rounded sternal end of clavicle articulates with the shallow socket at the superolateral angle of the manubrium sterni and adjacent part of the 1st costal cartilage

3.

The

STERNOCLAVICULAR

JOINT

What prevents the poorly fitting medial end of clavicle's displacement?

  • a strong thick articular disc of fibrocartilage attached superiorly to the clavicle and
  • 1st costal cartilage inferiorly

the medial end of clavicle rises higher than the manubrium, hence it poorly fits into its shallow socket.

3.

The

STERNOCLAVICULAR

JOINT

Articular Capsule

  • The joint capsule is attached to the margins of the articular surfaces including the periphery of the articular disc.
  • The synovial membrane lines the internal surface of the fibrous joint capsule, extending to the edges of the articular disc.

3.

The

STERNOCLAVICULAR

JOINT

LIGAMENTS:

  1. Anterior and posterior sternoclavicular ligaments
  2. Interclavicular ligament
  3. Costoclavicular ligament

3.

The

STERNOCLAVICULAR

JOINT

DESCRIBE THE:

Anterior and posterior sternoclavicular ligaments:

  • reinforce the joint capsule anteriorly and posteriorly.
  • The posterior ligament is weaker than the anterior ligament

3.

The

STERNOCLAVICULAR

JOINT

Interclavicular ligament:

  • It is T-shaped
  • connects the sternal ends of two clavicles
  • strengthens the joint capsule superiorly.
  • In between, it is attached to the superior border of the suprasternal notch.

3.

The

STERNOCLAVICULAR

JOINT

DESCRIBE THE:

Costoclavicular ligament:

  • anchors the inferior surface of the sternal end of clavicle to the first rib and adjoining part of its cartilage.

3.

The

STERNOCLAVICULAR

JOINT

MOVEMENTS

  • The sternoclavicular joint allows the movements of pectoral girdle.
  • critical to the movement of the clavicle.

3.

The

STERNOCLAVICULAR

JOINT

CC:

Dislocation of the sternoclavicular joint:

  • It is rare because the sternoclavicular (SC) joint is extremely strong. However, dislocation of this joint in people below 25 years of age may result from fractures through the epiphyseal plate because epiphysis at the sternal end of clavicle does not unite until 23–25 years of age. The medial end is usually dislocated anteriorly. Backward dislocation is prevented by the costoclavicular ligament.

3.

The

STERNOCLAVICULAR

JOINT

CC:

Transmission of weight of the upper limb:


  • The weight of the upper limb is transmitted from scapula to the clavicle through coracoclavicular ligament, and then from clavicle to sternum through sternoclavicular joint. Some of the weight is transmitted to the first rib through costoclavicular ligament (Fig. 1.4). When a person falls on the outstretched hand the force of blow is usually transmitted along the length of the clavicle, i.e., along its long axis. The clavicle may fracture at the junction of its middle and lateral third but it is rare for the SC joint to dislocate

3.

The

ACROMIOCLAVICULAR

JOINT

CC:

Dislocation of the acromioclavicular joint:

  • It may occur following a severe blow on the superolateral part of the shoulder. In severe form, both acromioclavicular and coracoclavicular ligaments are torn. Consequently the shoulder separates from the clavicle and falls because of the weight of the limb. The acromioclavicular joint dislocation is often termed shoulder separation.
Detailed Storybook Indian Festival Fireworks

CONGRATULATIONS!

We are making

PROGRESS!

1 Minute Break!!!

"The greatest glory in living lies not in never falling, but in rising every time we fall."


~Nelson Mandela

MUSCLES OF THE ARM:

GET READY!!!

GET READY!!!

  1. ATTACHMENTS

buttock

hip or hip region

  1. Biceps Brachii:

i. ORIGIN

ORIGIN:

1. Long head

arises from supraglenoid tubercle within the capsule of shoulder joint. Its tendon runs above the head of humerus and emerges from the joint through intertubercular sulcus.


2. Short head

arises along with coracobrachialis from the tip of the coracoid process

  1. Biceps Brachii:

ii. INSERTION

INSERTION:

  • (a) the posterior part of the radial tuberosity by its tendon. A bursa intervenes between the tendon and anterior part of the tuberosity, and
  • (b) the deep fascia on the medial aspect of forearm by its aponeurosis (bicipital aponeurosis). The aponeurosis protects the underlying brachial artery and median nerve


2. Coracobrachialis:

I. ORIGIN

ORIGIN:

From the tip of coracoid process of the scapula along with short head of the biceps brachii



2. Coracobrachialis:

II. INSERTION

INSERTION:

  • Into the middle of the medial border of the shaft of the humerus.

ANATOMICAL EVENTS THAT HAPPEN AT THE INSERTION OF CORACOBRACIALIS:

3. BRACHIALIS

ORIGIN:

  • From the anterior surface of the distal half of the shaft of humerus

INSERTION:

  • anterior surface of coronoid process
  • ulnar tuberosity

4. TRICEPS BRACHII

i. Origin

ORIGIN:

LONG HEAD: Infraglenoid tubercle of humerus

LATERAL HEAD: Oblique ridge above the spiral groove on upper posterior shaft of humerus

MEDIAL HEAD: Posterior surface of lower half of shaft of humerus BELOW the spiral groove

*Medial head is deep...

4. TRICEPS BRACHII

i. Insertion

INSERTION:

  • The common tendon is inserted into the posterior part of the superior surface of the olecranon process of ulna

INNERVATION OF MUSCLES OF THE ARM:

Anterior

All by Musculocutaneous nerve

INNERVATION OF MUSCLES OF THE ARM:


Posterior

Radial nerve

SPACE: THE CUBITAL FOSSA:

*Boundaries

  • Lateral: Medial border of brachioradialis muscle.
  • Medial: Lateral border of pronator teres muscle.
  • Base: An imaginary horizontal line, joining the front of two epicondyles of the humerus.
  • Apex: Meeting point of the lateral and medial boundaries. Here brachioradialis overlaps the pronator teres.

FLOOR

SPACE: THE CUBITAL FOSSA:

*Boundaries

Floor:

It is formed by two muscles:

-brachialis in the upper part and -supinator in the lower part


SPACE: THE CUBITAL FOSSA:

*Boundaries

  • Lateral: Medial border of brachioradialis muscle.
  • Medial: Lateral border of pronator teres muscle.
  • Base: An imaginary horizontal line, joining the front of two epicondyles of the humerus.
  • Apex: Meeting point of the lateral and medial boundaries. Here brachioradialis overlaps the pronator teres.

ROOF

SPACE: THE CUBITAL FOSSA:

*Boundaries

  • Skin
  • Suoerficial fascia containing:

(i) median cubital vein

(ii) med. and lat. cutaneous nerves of the forearm, and

  • Deep fascia, strengthened by BICIPITAL APONEUROSIS

SPACE: THE CUBITAL FOSSA:

*CONTENTS

From medial to lat.:

  1. Median nerve
  2. Brachial artery
  3. Biceps tendon
  4. Radial nerve

Mnemonic: MBBS

*CC:

Median Cubital Vein

Brachial Pulse

Fractures around elbow

SPACE: THE CUBITAL FOSSA:



  • Median Cubital Vein: vein of choice in this region for collecting blood samples and giving intravenous injections
  • Brachial Pulse- easily felt in this region, medial to BICEPS tendon, for recording the blood pressure.
  • Fractures around elbow: to deal with them, eg. Supracondylar fracture of the humerus-Contents of c fossa vulnerable (esp. median nerve and brachial artery)

CC:

This set contains X cards.

5 seconds should be spent per Flash card.

ENJOY!

CC:

 Gluteal region. 

Thigh or femoral region.

 Knee or knee region. 

Leg or leg region. 

Ankle or talocrural region. 

Foot or foot region.

CC:

This set contains X cards.

5 seconds should be spent per Flash card.

ENJOY!

CC:

 Gluteal region. 

Thigh or femoral region.

 Knee or knee region. 

Leg or leg region. 

Ankle or talocrural region. 

Foot or foot region.

CC:

This set contains X cards.

5 seconds should be spent per Flash card.

ENJOY!

CC:

 Gluteal region. 

Thigh or femoral region.

 Knee or knee region. 

Leg or leg region. 

Ankle or talocrural region. 

Foot or foot region.

MAJOR NERVES

1. FORMATION

2.COURSE

3.BRANCHES

4.DISTRIBUTION

(FoCus BaDo)- mnemonic

Oh, taste and see that the Lord is good! Blessed is the man who takes refuge in him!

DIAGRAM

AXILLARY NERVE:

1.FORMATION

AXILLARY NERVE:

(C5 to T1)

  • arises from posterior cord of brachial plexus (C5-T1).

2. COURSE 1

AXILLARY NERVE:

(C5 to T1)

  • emerges from the axilla at the level of the lower border of the subscapularis, by traversing the quadrangular space.

3.BRANCH 1

AXILLARY NERVE:

(C5 to T1)

At the quadrangular space, the axillary nerve supplies a branch to the shoulder joint.


NB*The posterior circumflex humeral artery and vein also run posterior to this nerve in this space.

4. COURSE: anterior branch and Distribution 2*

AXILLARY NERVE:

(C5 to T1)

  • winds around the surgical neck of the humerus, posteriorly, with the posterior circumflex humeral vessels and
  • supplies the anterior aspect of the deltoid muscle.

5. COURSE and BRANCH of: posterior branch:

AXILLARY NERVE:

(C5 to T1)

  • supplies the posterior aspect of the deltoid muscle as well as the teres minor
  • Following this, it passes around the lower border of the deltoid

and is then referred to as the superior/upper lateral cutaneous nerve of the arm.

6. DISTRIBUTION 4: of the Upper lateral Cutaneous nerve of the arm

AXILLARY NERVE:

(C5 to T1)

  • supplies the skin over the lower part of the deltoid

and

  • over the upper part of the long head of triceps

( both anteriorly and posteriorly).

7. DISTRIBUTION 5: Articular branch

AXILLARY NERVE:

(C5 to T1)

  • supplies the glenohumeral joint.

CC: INJURY OF NERVE

AXILLARY NERVE:

(C5 to T1)

can result in the following:

  • Paralysis of the deltoid and teres minor muscles
  • Weakness of arm abduction
  • Wasting of the deltoid muscle
  • Anaesthesia or loss in sensation of the area of the skin posterior to the deltoid muscle

Atrophy of deltoid muscle= flattened shoulder appearance.(Loss of normal rounded appearance)


CC: Palsy

AXILLARY NERVE:

(C5 to T1)

  • Damage to the 5th and 6th spinal cervical nerves during delivery of a neonate results in Erb’s palsy
  • Infant cannot abduct nor externally rotate the arm at the shoulder joint (since nerve arises from upper trunk of brachial plexus)

CC: quadrangular space Syndrome

AXILLARY NERVE:

(C5 to T1)

  • occurs when the muscles of the quadrangular space hypertrophy and thus impinge on the axillary nerve in this space.
  • more commonly results in atrophy of the teres minor muscle.

(can cause weakness of the deltoid muscle )

AXILLARY NERVE

NAME THE PARTS

AXILLARY NERVE

RATE PROGRESS out of 11 Flashcards:

SCORE: x/11

Date of trial

Accuracy (out of 11)

*Use more space if necessary

TRIAL 1:

TRIAL 2:

TRIAL 3:

TRIAL 4:

TRIAL 5:

TRIAL 6:

TRIAL 7:

TRIAL 8:



1.FORMATION

MUSCULOCUTANEOUS NERVE:


  • emerges as the terminal branch of the lateral cord of the brachial plexus, from the C5-C7 nerve roots.

2. COURSE 1,2 and

branches 1,2,3

MUSCULOCUTANEOUS NERVE:

(C5-C7)

  • Pierces choracobracialis; gives branches to the muscle before entering it.

3. BRANCHES 4,5 and COURSE 3,4

MUSCULOCUTANEOUS NERVE:


4. TERMINATION

MUSCULOCUTANEOUS NERVE:

(C5-C7)

  • The musculocutaneous nerve terminates as the lateral cutaneous nerve of the forearm that supplies the anterolateral skin of the forearm.

MUSCULOCUTANEOUS NERVE:

CC: STAB WOUNDS

  • commonest reason for nerve injury
  • Weakened elbow flexion(as Brachioradialis still in function)
  • Supination and flexion at the shoulder joint also weakened. (supinator and pec major still present)
  • Sensation to the lateral part of the forearm would also be affected.

NAME

THE

PARTS

MUSCULOCUTANEOUS NERVE:

MUSCULOCUTANEOUS NERVE:

WILD CARD:

MUSCULOCUTANEOUS NERVE:

RATE PROGRESS out of 6 Flashcards:

SCORE: x/6

Date of trial

Accuracy (out of 11)

*Use more space if necessary

TRIAL 1:

TRIAL 2:

TRIAL 3:

TRIAL 4:

TRIAL 5:

TRIAL 6:

TRIAL 7:

TRIAL 8:



1.FORMATION

RADIAL NERVE:

  • originates from the posterior cord along with the axillary nerve, carrying fibers from ventral roots of spinal nerves C5-C8 and T1.

2. arises in the ______, immediately posterior to the _________, between _______________ and ______________ muscles.

RADIAL NERVE:

COURSE

  • arises in the axilla, immediately posterior to the axillary artery, between coracobrachialis and teres major muscles.

COURSE

RADIAL NERVE:

3.descends obliquely through the posterior aspect of the arm, between the bellies of ________ and _________,

through the ____________.

  • descends obliquely downwards through the posterior aspect of the arm, between the bellies of medial and lateral head of triceps, through a shallow depression on the posterior surface of the humerus radial groove)

*accompanied by the profunda brachii.

4. In the distal part of the arm, the radial nerve____________ the distal humerus and courses ___________________, where it penetrates the____________ septum.

RADIAL NERVE:

COURSE

  • In the distal part of the arm, the radial nerve wraps around the distal humerus and courses anterior to the lateral condyle of humerus, where it penetrates the lateral intermuscular septum.

RADIAL NERVE:

TERMINATION

5. As it crosses the ____________, the radial nerve terminates by dividing into two terminal branches: __________ and ____________.

Upon crossing the cubital fossa, the radial nerve terminates by dividing into two terminal branches: superficial (sensory) and deep (motor).

RADIAL NERVE: BRANCHES

(ARM)

muscular branches (ARM region) :

two sensory branches:

  1. posterior cutaneous nerve of the arm

and

2. lateral inferior cutaneous nerve of the arm


RADIAL NERVE: BRANCHES

(FOREARM)

sensoory branch (Forearm) :

  • posterior cutaneous nerve of the forearm

one motor branch:

The DEEP BRANCH

  • penetrates the supinator muscle and emerges as the posterior interosseous nerve.

RADIAL NERVE: THE *SENSORY BRANCH*

  • The superficial branch
  • continues the course of the radial nerve and enters the hand from the radial side
  • primary role- to provide sensation to the thenar eminence and dorsal aspect of the radial(lateral) 3 and a half digits of the hand.

RADIAL NERVE: CC

RADIAL NERVE PALSY

  • most commonly injured nerve of the arm.
  • injuries usually occur due to fractures of the humerus.
  • can also be injured when it is "overused" (e.g. sports-related injuries) or compressed (e.g. improper use of crutches).
  • most well-known motor presentation of the radial nerve injury is the "wrist drop".
  • sensory loss- "Saturday night palsy"

RADIAL NERVE: CC

WRIST DROP

  • occurs due to the paralysis of the posterior forearm muscles and their inability to extend the wrist (unopposed flexion)

RADIAL NERVE: CC

"Saturday night palsy"

  • ORIGIN OF NAME: direct pressure on radial nerve by a drunkard falling asleep with his one arm over the back of the chair

WRIST DROP:

DIAGRAM

RADIAL NERVE: CC

RADIAL NERVE: CC

"Saturday night palsy":

DIAGRAM

RADIAL NERVE:

DIAGRAM

Bad Breath, Smell, Deep Breathing, Wind, Air Icon

RADIAL NERVE

5 MINUTE BREAK:

Catch your breath

In three words I can sum up everything I've learned about life: it goes on.

~Robert Frost


Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

~Isaiah 41:10

RATE PROGRESS out of 11 Flashcards:

SCORE: x/11

RADIAL NERVE:

Date of trial

Accuracy (out of 11)

TRIAL 1:

TRIAL 2:

TRIAL 3:

TRIAL 4:

TRIAL 5:

TRIAL 6:

TRIAL 7:

TRIAL 8:



1.FORMATION

ULNAR NERVE:


  • terminal branch of the medial cord of the brachial plexus (distal continuation of the medial cord)from the nerve roots of C8 and T1 (often carries fibers from C7 via a communicating branch from the lateral cord)

2. COURSE 1,2

ULNAR NERVE:

(C8, T1)


3. COURSE 3,4

ULNAR NERVE:

(C8, T1)


  • In the mid-portion of the arm, the nerve pierces the medial intermuscular septum to enter the posterior compartment.

and in 70-80% of people, this nerve passes under the arcade of Struthers. This is a thin, aponeurotic band, that extends from the medial head of triceps to the medial intermuscular septum.

4. COURSE 5

ULNAR NERVE:

(C8, T1)

The ulnar nerve then passes between the medial epicondyle and olecranon in the groove for ulnar nerve to enter the anterior compartment of the forearm.

*The ulna nerve typically has no branches in the arm.

5. COURSE 6,7: FOREARM

ULNAR NERVE:

(C8, T1)


  • From the arm, the ulnar nerve runs through the cubital tunnel**
  • Here, the nerve gives off articular branches to the elbow joint.
  • continues into the anterior compartment of the forearm by:

passing between the humeral and ulnar heads of the of flexor carpi ulnaris.

6. COURSE 8,9: FOREARM

ULNAR NERVE:

(C8, T1)

  • Close to the wrist, the nerve emerges lateral to flexor carpi ulnaris with the accompanying ulnar artery, which lies lateral to it.

7. COURSE 10,11: FOREARM

ULNAR NERVE:

(C8, T1)


  • Both structures(Ulnar nerve and ulnar artery lateral to it) run superficial to the flexor retinaculum (transverse carpal ligament) to enter the hand just lateral to the pisiform bone and are only covered by fascia and skin.

8. BRANCHES: FOREARM

I. MUSCULAR BRANCHES

ULNAR NERVE:

(C8, T1)

two muscular branches:

  • one to the flexor carpi ulnaris and
  • to the ulnar (medial) part of the flexor digitorum profundus

*the lateral half of the flexor digitorum profundus muscle and the remaining muscles of the anterior compartment of the forearm are supplied by the median nerve.

8. BRANCHES: FOREARM

I. SENSORY BRANCHES

ULNAR NERVE:

(C8, T1)

  • Both structures(Ulnar nerve and ulnar artery lateral to it) run superficial to the flexor retinaculum (transverse carpal ligament) to enter the hand just lateral to the pisiform bone and are only covered by fascia and skin.

8. BRANCHES: FOREARM

I. SENSORY BRANCHES

ULNAR NERVE:

(C8, T1)

two cutaneous branches:

  • palmar cutaneous nerve and
  • dorsal cutaneous nerve.

These nerves pass into the hand to provide sensory innervation.

DIAGRAM

ULNAR NERVE:

(C8, T1)


ULNAR NERVE:

RATE PROGRESS out of 11 Flashcards:

SCORE: x/11

Date of trial

Accuracy (out of 11)

TRIAL 1:

TRIAL 2:

TRIAL 3:

TRIAL 4:

TRIAL 5:

TRIAL 6:

TRIAL 7:

TRIAL 8:



1. FORMATION

MEDIAN NERVE

  • The median nerve arises in the axillary region
  • it is formed by the unification of the medial and lateral cords of the brachial plexus.
  • It contains fibres from roots of spinal nerves C6-T1, but in some individuals it can also contain fibers from C5.

2. COURSE 1,2: ARM

MEDIAN NERVE

(C6-T1) *C5

  • descends down the centre of the arm in a superficial course.
  • Initially it is lateral to the brachial artery but as it descends, it eventually becomes medial.

2. COURSE 3,4: ARM

MEDIAN NERVE

  • Just before it enters the forearm, the median nerve passes between the tendons of biceps brachii and brachialis.
  • At this point it again becomes lateral to the brachial artery.

3. COURSE 5,6: ARM- FOREARM

MEDIAN NERVE

(C6-T1) *C5

4. COURSE 7 AND TERMINATION

MEDIAN NERVE

  • The median nerve then passes through the carpal tunnel beneath the flexor retinaculum
  • terminates by dividing into two terminal branches, the common palmar digital nerves (2 in number)

5. MOTOR SUPPLY

MEDIAN NERVE

(C6-T1) *C5

  • In summary, the median nerve provides the motor supply to the flexor muscles in the forearm, except flexor carpi ulnaris and the ulnar head of flexor digitorum profundus (which is supplied by the ulnar nerve). It also supplies the thenar muscles as well as the radial (lateral) two lumbricals.

6. SENSORY SUPPLY

MEDIAN NERVE

  • The skin of the palmar and distal dorsal aspects of the lateral three-and-a-half digits and adjacent palm.


7. DIAGRAM

MEDIAN NERVE

(C6-T1) *C5

weeeeek 8

FLEXOR

FOREARM

MUSCLES

REEEAADDDYYY!!

5 superficial

1.pronator

teres

NB:median nerve passes btn 2 ​heads

1.origin

Humeral head-C.F.O

ulnar head-medial margin of Coronoid ​process

2.insertion

middle 1/3 of lateral surface of radius

Action:flexion,pronation of ​forearm

nerve supply:median nerve

2.flexor

carpi

radialis

1.origin

C.F.O

2.insertion

anterior aspect of base of2&3 ​metacarpal bones

Action:flexion & abduction of the ​hand

NS:median nerve

Have your students read each clue and find the matching farm animal.

3.palmaris

longus

NB: absent in some individuals.

used for grafts.

1.origin

C.F.O

2.insertion

palmar aponeurosis

action:It flexes the wrist and makes ​the palmar aponeuroses tense.

NS:median nerve



4.flexor ​carpi ​ulnaris

1.origin

humeral head-C.F.O

ulna head-medial margin of the olecranon

process,by an aponeurosis from the upper two-​third

of the posterior border of the ulna.

2.insertion

pisiform bone,hook of hamate &base of 5 ​metacarpal bone

action:flexion and adduction of hand

NS:ulnar nerve

NB:ulnar nerve passes between 2 heads

Have your students read each clue and find the matching farm animal.

5.flexor ​digitorum ​superficialis

1.origin

humeroulnar head-C.F.O, sublime tubercle on ​medial margin of coronoid process of ulna & ​ulna collateral ligament

radial head-anterior oblique line of radius

2.insertion

middle phalanx of medial 4 fingers

action:flexion of MP joint,proximal ​interphalangeal joint of digits

NS:median nerve


3 deep

Have your students read each clue and find the matching farm animal.

1.flexor ​pollicis ​longus

1.origin

From upper two-third of the anterior surface of the ​radius

below the anterior oblique line and adjoining part ​of the

interosseous membrane.


2.insertion

terminal phalanx of thumb


action:flexion of all joint of the thumb

NS:median nerve

2.flexor ​digitorum ​profundas

1.origin

1. upper three-fourth of the anterior and medial

surfaces of the shaft of ulna and adjacent medial half of

the interosseous membrane.

2. By an aponeurosis from upper three-fourth of the

posterior border of ulna

3. From the medial side of olecranon and coronoid process

of ulna.


2.insertion

terminal phalanx of medial 4 fingers

action:flexion of MP joint,proximal interphalangeal joint of medial 4 fingers


NS:lateral 1/2-anterior interosseous branch of median nerve

medial 1/2-ulnar nerve


Have your students read each clue and find the matching farm animal.

3.pronator ​quadratus

1.origin

oblique ridge on the lower one-fourth of the anterior

surface of the shaft of ulna and medial part of this surface.

2.insertion

1. The superficial fibres into the distal one-fourth of the

anterior border and anterior surface of the shaft of radius.

2. The deeper fibres into the triangular area above the

ulnar notch of the radius.

Nerve supply

By anterior interosseous nerve.

action

chief pronator of the forearm


EXTENSOR ​FOREARM ​MUSCLES

All from C.E.O except B.R , E.C.R.L& An

posterior interosseus branch innervs all except B.R , ​E.C.R.L & An (radial nerve)

AS​TRONOMICAL

7 superficial

1.Brachioradialis

1.origin

upper 2/3 of the lateral supracondylar ridge ​of humerus

2.insertion

Lateral surface of the distal

end of radius just above the

styloid process

3.action

-flexion of elbow

-initiation of pronation & supination



Have your students read each clue and find the matching farm animal.

2.Extensor carpi ​radialis longus

1.origin

lower 1/3 of the lateral supracondylar ​ridge of humerus


2.insertion

Lateral side of the dorsal

surface of base of 2nd metacarpal bone


3.action

abduction of the hand

3.Extensor ​carpi radialis ​brevis

1.origin

C.E.O

2.insertion

Lateral side of the dorsal

surface of base of the 3rd ​metacarpal bone

3.action

Abduction of the hand

Have your students read each clue and find the matching farm animal.

4.Extensor ​digitorum

1.origin

C.E.O

2.insertion

extensor expansion of medial 4 ​fingers

3.action

extensor of all joints of the medial ​4 fingers

5.Extensor ​digiti minimi

1.origin

C.E.O

2.insertion

extensor expansion of little finger

3.action

extension of all joints of the little ​finger & helps in extension of the ​wrist.

Have your students read each clue and find the matching farm animal.

6.Extensor ​carpi ​ulnaris

1.origin

-C.E.O

-by an aponeurosis

from the upper two-third

of the posterior border of

ulna along with flexor carpi

ulnaris and flexor

digitorum profundus

2.insertion

a tubercle on the

medial side of the dorsal

surface of the base of the 5th metacarpal bone

3.action

adduction of the wrist

7.Ancorneus

1.origin

Back of the lateral epiconyle of the ​humerus

2.insertion

-lateral side of the olecranon process

-upper one-

fourth of the posterior

surface of the ulna

3.action

extension of the elbow

5 deep

1.​supinator

NB:posterior interosseus nerve ​passses btn 2 heads

1.origin

superficial head- Lateral epicondyle, ​Lateral ligament of the

elbow joint& Annular ligament

deep head- Supinator crest of ulna and ​from the triangular area in front of it.

2.insertion

lateral surface of radius

3.action

supination of the extended elbow

Have your students read each clue and find the matching farm animal.

Abductor ​pollicis longus

1.origin

Lateral part of the posterior surface of ulna ​below the anconeus, Middle one-third of

the posterior surface of radius (below the ​posterior oblique line) and intervening ​posterior surface of interosseous membrane.

2.insertion

lateral side of base of 1st metacarpal bone

3.action

abduction of thumb

Extensor ​pollicis brevis

1.origin

posterior surface of radius below the origin of ​abductor pollicis longus and from adjoining ​interosseous membrane

2.insertion

dorsal surface of base of proximal phalanx of ​the thumb

3.action

extension of M.P joint of the thumb(thumbs ​up)

Have your students read each clue and find the matching farm animal.

Extensor ​pollicis ​longus

1.origin

lateral part of middle one-third of the ​posterior surface of ulna

and adjoining interosseous membrane

2.insertion

dorsal surface of base of the distal ​phalanx of thumb

3.action

extension of all joints of thumb

Extensor ​indicis

1.origin

posterior surface of radius below the ​origin of abductor pollicis longus and from ​adjoining interosseous membrane

2.insertion

Extensor expansion of index finger

3.action

Extension of all fingers of the index finger

Have your students read each clue and find the matching farm animal.

Abductors ​of the hand

EC​RL,ECRB,FCR

Adductors of ​the hand

EC​U,FCU

Have your students read each clue and find the matching farm animal.

Anatomy of ​the hand

Nerve supply of skin

dorsal/vomer

palmar

dorsal/vomer

palmar

Have your students read each clue and find the matching farm animal.

Flexor ​retinaculum

Attachments;

medially - pisiform and the hook of the hamate

laterally - tubercle of scaphoid and crest of

the trapezium.

function-acts as a strap, binding down the flexor ​tendons preventing them from springing away from ​bone during flexion of the wrist joint.


Structures passing superficial to ​flexor retinaculum

2U + 3P

(medial to lateral)

1.ulnar nerve (lateral to pisiform bone)

2.ulnar artery

3.palmar cutaneous branch of ulnar nerve

4.palmaris longus tendon

5.palmar cutaneous branch of median nerve


Muscles attached to flexor retinaculum

lateral part-origin of the 3 thenar ​muscles

medial part-origin of the 3 ​hypothenar muscles

origin of palmaris brevis

insertion of the deep fibres of ​the tendon of palmaris longus

Carpal ​tunnel

Definition:fibro-osseous canal infront of ​wrist transmitting the tendons of the flexor ​muscles from the forearm to the hand

Boundaries:

Posteriorly-bony groove formed by the ​carpal bones &their interosseous ligaments

anteriorly-closed by the flexor retinaculum ​of the wrist

STRUCTURES ​PASSING ​THROUGH CARPAL ​TUNNEL

  1. median nerve
  2. 4 tendons of flexor digitorum ​superficialis(covered by ulnar bursa)
  3. 4 tendons of flexor digitorum ​profundas(covered by ulnar bursa)
  4. tendon of flexor pollicis longus(covered ​byradial bursa)
  5. the recurrent branch of deep palmar arch

clinical importance:

carpal tunnel ​syndrome

definition:

condition whereby there is compression of median ​nerve as it passes through carpal tunnel leading to its ​injury

causes:

1.dislocation of one of the carpal bones inside the ​carpal tunnel.

2.thickening of the tendon passing(tenosynovitis & ​acromegaly)

3.myxoedema or tumour inside the carpal tunnel ​pressing on the median nerve

Have your students read each clue and find the matching farm animal.

THE SPACE OF ​PARONA(RETROFLEXOR SPACE)

definition:

fascial space deep to the flexor muscles of the front of the ​forearm

boundaries:

ant-F.D.S & F.D.P

post-interosseous membrane & pronator quadratus muscle

above-limited by the oblique line of origin of F.D.S

below-passes deep to flexor tendons & flexor retinaculum ​becoming continous with midpalmar space of hand.

clinical importance;

infection can spread from mid palmar space to reach ​forearm through the space

ANATOMICAL SNUFF BOX

boundaries:

anterolaterally-tendons of abd. pollicis longus ​& ext. pollicis brevis

posteromedially-tendon of ext. pollicis longus

roof:

1.skin

2.superficial fascia containing beginning of ​cephalic v. & digital branches of superficial ​radial n.

3.deep fascia

floor:

1.styloid process of radius

2.scaphoid bone

3.trapezium bone

contents:

1.tendons of E.C.R.L & E.C.R.B

2.radial art.

clinical importance:

pain & swelling in anatomical snuffbox occurs ​in fracture of scaphoid bone

EXTENSOR RETINACULUM

Attachments:

lat-sharp crest btn ant& lat surfaces of the lowe ​end of radius

med-styloid process of ulna,triqitral & pisiform ​bones

above-continuous with deep fascia of forearm

below-continuous with deep fascia of hand

function:

retains the extensor tendons in position ​preventing their springing away from the bones

Structures passing superficial ​to it

2V + 2N

  • terminal branches of superficial ​radial n.
  • beginning of basilic v.
  • beginning of cephalic vein
  • dorsal cut. branch of ulnar nerve

structures passing deep ​to it

1st compartment:

2 tendons-abductor pollicis longus & extensor pollicis brevis

2nd compartment:

2 tendons-E.C.R.L & E.C.R.B

3rd compartment:

1 tendon-extensor pollicis longus

4th compartment:

2 tendons-extensor digitorum & extensor indicis

anterior interosseus artery

posterior interosseus nerve

5th compartment:

1 tendon-extensor digiti minimi

6th compartment:

1 tendon-extensor carpi ulnaris

Polarized Rewind Video
Polarized Rewind Video

HAND MUSCLES

Muscles of the thumb:

1.Thenar muscles:

  • Flexor pollicis brevis
  • Abductor pollicis brevis
  • Opponens pollicis

are innerv. by median nerve

2.Adductor pollicis

innervated by ulnar nerve



Muscles of the thumb

muscles of the little finger

Hypothenar eminence

Hypothenar eminence:

  • Flexor digiti minimi
  • abductor digiti minimi
  • Opponens digiti ​minimi(deep)

Innervated by ulnar nerve

muscles of the little finger

M​uscles in the middle

1.Interossei muscles:

Palmar I.M

action-adduction of medial 4 fingers

Dorsal I.M

action-abduction of medial 4 fingers

innerv.-Ulnar nerve

(PAD,DAB)

2.Lumbricals:

origin-tendons of flexor digitorum superficialis

insertion-extensor expansion of medial 4 fingers

action-writing position(flexion of M.P joint & extension pf interphalangeal ​joint)

innerv.-lateral 2 by median nerve

medial 2 by ulnar nerve

writing position