The upper limb

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The upper limb. Muscles That Move the Pectoral Girdle. Originate on the axial skeleton and insert on the clavicle and scapula. Stabilize the scapula and move it to increase the arm’s angle of movements. - PowerPoint PPT Presentation

Transcript of The upper limb

  • The upper limb

  • Muscles That Move the Pectoral GirdleOriginate on the axial skeleton and insert on the clavicle and scapula.Stabilize the scapula and move it to increase the arms angle of movements.Some of the superficial muscles of the thorax are grouped together according to the scapular movement they direct. elevation, depression, protraction, or retraction

  • The muscles of backSuperficial groupTrapeziusLatissimus dorsiLevator scapulaeRhomboideus

    Deep group Erector spinaeSpleniusThoracolumbar fascia

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  • The muscles of thoraxExtrinsic musclesPectoralis majorPectoralis minorSerratus anterior

    Intrinsic musclesIntercostales externiIntercostales interniIntercostales intimi

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  • The Muscles of Upper Limb

    Muscles of shoulderDeltoidSupraspinatusInfraspinatusTeres minorTeres majorSubscapularis

  • Major muscles of shoulderDeltoidOrigin: lateral third of clavicle, acromion, and spine of scapulaInsertion: deltoid tuberosity of humerus Action: abduction, flexion and extension, medial and lateral rotation of arm

  • Major muscles of shoulderTeres majorOrigin: dorsal surface of inferior angle of scapulaInsertion: crest of lesser tubercle of humerusAction: medially rotates and adducts arm

  • Arm and Forearm Muscles That Move the Elbow Joint/ForearmAnterior (flexor) compartment Posterior (extensor) compartmentAnterior compartment primarily contains elbow flexorsPosterior compartment contains elbow extensors the principal flexorsbiceps brachii, brachialis, and brachioradialismuscles that extend the elbow joint triceps brachii and anconeus

  • Muscles of arm

    Antererior groupBiceps brachiiCoracobrachialisBrachialis

    Posterior grouptriceps brachiianconeus

  • Muscles of armBiceps brachiiOrigin: long head, supraglenoid tubercle; short head, coracoid processInsertion: radial tuberosityAction: supinator of forearm, flexor of elbow joint, weak flexor of should joint

  • Muscles of armTriceps brachiiOrigin: long head, infraglenoid tubercle lateral head, above groove for radial nerve medical head, below groove for radial nerveInsertion: olecranon of ulnaAction: extends elbow joint, long head extends and adducts shoulder joint

  • Triceps brachii

  • Forearm Muscles Supinate and PronateSupinator muscle supinates the forearm.Biceps brachii supinates the forearm. Pronator teres and pronator quadratus pronate the forearm. Move the Wrist Joint, Hand, and Fingers Muscles in the forearm move the hand at the wrist and/or the fingers. Extrinsic muscles of the wrist and hand originate on the forearm, not the wrist or hand. Tendons of forearm muscles typically are surrounded by tendon (synovial) sheaths and held adjacent to the skeletal elements by strong fascial structures.At the wrist, the deep fascia of the forearm forms thickened, fibrous bands termed retinacula.

  • Muscles of forearm

    Superficial layerPronator teresFlexor carpi radialisPalmaris longusFlexor carpi ulnaris

  • Muscles of forearmPronator teresOrigin: medical epicondyle of humerus and deep fascia of forearmInsertion: middle of lateral surface of radiusAction: pronation of forearm and flexion of elbow

  • Second layer Flexor digitorum superficials

  • Third layerFlexor digitorum profundusFlexor pollicis longus Fourth layer Pronator quadratusAction: flex radiocarpal joint and fingers, pronate forearm

  • Lateral group (3)

    Brachioradialis Extensor carpi radialis longusExtensor carpi radialis brevis

  • Posterior group (8)

    Superficial layer (3)Extensor digitorum Extensor digiti minimiExtensor carpi ulnarisAction: extension at wrist joint

  • Deep layer (5)SupinatorAbductor pollicis longusExtensor pollicis brevis Extensor pollicis longus Extensor indicis Action: extend at wrist joint and fingers, and supinate forearm

    Posterior group (8)

  • Muscles of hand

    Lateral group thenar (4)Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis Action: flex, abduct, adduct and oppose thumbMedial group hypothenar (3)Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi Action: flex, abduct , and oppose little finger

  • Muscles of handIntermedial groupLumbricales (4) flex fingers at MP joints; extend fingers at IP jointsPalmar interossei (3) adduct fingers towards middle finger at MP jointsDorsal interossei (3) abduct fingers away from middle finger at MP joints

  • Arteries of upper limbAxillary artery Continuation of subclavian artery at lateral border of first ribBecomes brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above musclegives rise to thoracoacromial a. Second portion, behind musclegives rise to lateral thoracic a. Third portion, below musclegives rise to subscapular a., anterior and posterior humeral circumflex a.; the former then divides into throcodorsal a. and circumflex scapular a.

  • Brachial arteryContinuation of axillary arteryDivides into radial and ulnar arteries at level of neck of radiusBranches Deep brachial a. accompanies with radial nerveSuperior ulnar collaeral a. accompanies with ulnar nerveInferior ulnar collateral a.

    Arteries of upper limb

  • Radial artery and branches Radial recurrent a. Superfical palmar branch Principal artery of thumb Ulnar artery and branchesUlnar recurrent a. Common interosseous artery Anterior interossous a. Posterior interosseous a. Deep palmar branch

    Arteries of upper limb

  • Superficial palmar arch Formed by ulnar artery and superficial palmar branch of radial arteryCurve of arch lies across the palm, level with the distal border of fully extended thumb Gives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries

    Arteries of upper limb

  • Deep palmar arch Formed by radial artery and deep palmar branch of ulnar arteryCurve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries

    Arteries of upper limb

  • Veins of the upper limbDeep veins: accompany the arteries of the same region and bear similar names Superficial veinsCephalic vein Arises from the lateral side of the dorsal venous rete of hand Ascends on radial side of the forearm to the elbow and then in the lateral side of biceps brachii furrow, continues up the arm in the deltopectoral groove and then to the infraclavicular fossa, where it pierces clavipectoral fascia to drain into axillary vein

  • Basilic vein Arises from the medial side of the dorsal venous rete of hand Ascends on the ulnar side of forearm to the elbow and then in the medial bicepital brachii furrow to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary veinMedian cubital vein links cephalic vein and basilic vein in the cubital fossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood

  • The lymphatic drainage of upper limb

    Lymphatic vesselsSuperficialfollow the superficial veins, drain into supratrochlear and axillary lymph nodesDeepaccompany main vessels, end in axillary lymph nodes lymph nodesCubital lymph node: lies above medial epicondyle of humerusAxillary lymph nodearranged in five groups

  • Axillary lymph nodesArranged in five groupsLateral lymph nodes lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and handPectoral lymph nodes lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mammaSubscapular lymph node along subscapular vessels, receive lymph from nape and scapular regionEfferents above three groups pass to central lymph node

  • Central lymph node lie in fat of axillary fossa, receive drainage from all the above nodes, efferents pass to apical lymph node Apical lymph node Lie in the apex of the axilla, along the proximal end of axillary vesselsReceive drainage chiefly from central lymph node , upper portion of mammaEfferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct

  • Brachial plexus

    Formation:Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5-C7give rise to long thoracic n. Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk is the continuation of root C7.The lower trunk is formed by the joining of root C8 and T1.Six divisions: above clavicle, trunks form anterior and posterior divisionsThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a.

  • Position: passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cordsMain branchesLateral cord Musculocutaneous n. Lateral root to median n. Medial cord Medial root to median n. Ulnar n. Medial brachial cutaneous n. Medial antebrachial cutaneous n.

  • Posterior cord radial n. axillary n. thoracodorsal n.

  • Musculocutaneous Distribution: Biceps brachii, brachalis and coracobrachialis BBC nerve; skin on anterior aspect of forearm

  • Distribution: Flexors of forearm except brachioradialis, flexor carpi ulnaris and ulnar half of flexor digitorum profundus, thenar except adductor pollicis, first two lumbricals; skin of thenar, central part of palm, palmar