PowerPoint Department of Anatomy
Shoulder regionjunction of arm and trunk
Arm (brachium)between should and elbow
Elbowbend of arm, joint between arm and forearm
Forearm (antebrachium)between elbow and hand
Hand (manus)
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Shoulder region:
Arm
Deltoid tuberosity
Tendon of carpi ulnaris
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16501700
Carring angle
The carrying angle, which opens laterally, is seen when the elbow joint is extended and lies between the arm and forearm. The angel is 1700 in males and 1670 in females. The angle disappears when the elbow joint is flexed.
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Pectoral Region
Superficial structures
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Vena cephalica
Arises from the lateral side of the dorsal venous rete on the back of hand
Winds around the lateral border of the forearm; it then ascends into the cubital fossa and up the front of the arm on the lateral side of the biceps.
It continues up in the deltopectoral groove and then to the infraclavicular fossa, where it pierces clavipectoral fascia to drain into axillary vein.
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Vena basilica
Arises from the medial side of the dorsal venous rete of hand
Winds around the medial border of the forearm
Then ascends into the cubital fossa and up the front of the arm on the medial side of the biceps to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary vein
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Vena mediana cubiti
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
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Pectoral Region
Deep structures
Deep fascia
Superficial layer
The deep fascia which extends between subclavius, coracoid process and pectoralis minor muscles
The structures pass through the clavipectoral fascia
V.cephalica.
The posterior wall
M. latissimus dorsi
M. teres major
The a.circumflexus humeri posterior and n.axillaris pass through the quadrilateral foramen.
The a.circumflexus scapularis passes through the triangular space to reach the dorsum of the scapula.
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Axillary v. and tributaries
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Arteri axillaris
Begins at the at lateral border of first rib as a continuation of arteri subclavia
At the lower border of teres major it becomes the brachial artery.
Divided into three parts by overlying pectoralis minor
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Vena axillaris
Formed at the lower border of the teres major by the union the brachial vein and the basilic vein
Runs upward on the medial side of the axillary artery
Ends at the lateral border of the first rib by becoming the subclavian vein
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Plexus brachialis
Formation
Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves
Three truncus (upper, middle and lower)
Six divisions
Three fasciculus
Fasciculus lateralis
Fasciculus medialis
Fasciculus posterior
Rami anteriores nn.spinales C5-Th.1
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Plexus brachialis
Passes through the scalene fissure to posterosuperior of subclavian artery
Then enters the axilla to form lateral, medial and posterior cords
Supraclavicular part
N. thoraclis longus companies with the a. thoracalis lateralis., supplies M.serratus anterior
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Paralysis of the serratus anterior
When the serratus anterior paralyzed because of injury to the long thoracic nerve, the medial border of the scapula moves laterally and posteriorly away from the thoracic wall, giving the scapula the appearance of a wing.
Winged scapula
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1. Fasciculus lateralis
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N.axillaris
N.radialis
N.thoracodorsalis
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Nervus axillaris
Origin: Arises from the posterior cord of the brachial plexus in the axilla.
Course: Passes backward and enters the quadrangular space with the posterior circumflex humeral artery.
Distribution: Deltoid and teres minor muscle; shoulder joint; skin over deltoid and upper posterior aspect of arm
Injury: result in deltoid and teres minor paralysis (loss of shoulder abdcution and weak external rotation) with loss of sensation over the deltoid
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Muscles:
N.musculocutaneous
N.musculocutaneous
N.medianus
N.ulnaris
A.brachialis
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Arteri brachialis
Begins at the lower border of the teres major as a continuation of axillary artery
Terminates opposite the neck of radius by dividing into radial and ulnar arteries
Branches
a.brachialis profunda follows the radial nerve into the spinal groove of the humerus
a.collateralis ulnaris superior follows the ulnar nerve
a.collateralis ulnaris inferior takes part in the anastomosis around the elbow joint.
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Nervus musculocutaneus
M.Brachalis
M.Coracobrachialis
At the lateral margin of biceps tendon it pierces the deep fascia just above the elbow. It runs down the lateral aspect of the forearm as the n.cutaneus antebrachii lateralis which supply skin on anterior aspect of forearm.
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Nervus medianus
Origin: arises from the medial and lateral cord of the brachial plexus.
Course:
Descends on the lateral side of brachial artery.
Halfway down the arm, it crosses the brachial artery to reach its medial side.
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Nervus ulnaris
Origin: arises from the medial cord of the brachial plexus.
Course:
Descends on the medial side of brachial artery.
At the middle of the arm, it pierces the medial intermuscular septum and passes down behind the medial epicondyle of the humerus.
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Contents of the fossa cubiti
Medial to biceps brachii tendon
A.Brachialis divides into radial and ulnar a., usually at apex of fossa
N. Medianus
N.Radialis
Muscle (9)
Nerve supply to the muscles: median nerve and ulnar nerve
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Arteri radialis
Begins: in the cubital fossa at the neck of the radius.
Course: passes downward and laterally
Branches
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Arteri ulnaris
Begins in the cubital fossa at the neck of the radius.
Course: passes downward and medially
Branches
Arcus palmaris superficialis
Formed by ulnar artery and superficial palmar branch of radial artery
The curve 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
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Arcus palmaris profunda
Formed by radial artery and deep palmar branch of ulnar artery
The curve of arch lies across upper part of palmar at level with proximal border of extended thumb
Gives rise to three palmar metacarpal arteries
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Nervus medianus
It continues downward behind the flexor digitorum superficialis.
At the wrist, it enters the palm by passing behind the flexor retinaculum.
Distribution:
Flexor of forearm except brachioradialis, flexor carpi ulnaris and ulnar half of flexor digitorum profundus
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Nervus ulnaris
Course
Passes from behind the medial epicondyle of the humerus, and enters the front of the forearm by passing between the two heads of the flexor capi ulnaris.
In the distal two-third of the forearm, the ulnar artery lies on the lateral side of the ulnar nerve.
Enters the palm of the hand b passing in front of the flexor retinaculum and lateral to the pisiform bone.
Distribution: flexor carpi ulnaris and ulnar half of flexor digitorum profundus
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Runs down on the lateral side of the radial artery.
In the distal part of the forearm, it leaves the artery and passes backward, reaches the posterior surface of the wrist and hand.
Distribution: M. brachioradialis
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Skin incisions
Make the skin incisions indicated in figure and reflect the skin flaps.
Be careful not to cut too deep. As you remove the skin, look for the cephalic v., basilic v. and median cubital v.
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Cut and reflect the pectoralis major
Clean the pectoralis major m.. Indentify the deltopectoral groove and the cephalic vein, which drains blood into the axillary v.
The pectoralis major m. forms the anterior axillary fold.
Cut and partlly reflect the pectoralis majorm. Close to its attachment to the clavicle. Look for the lateral pectoral n. on its underside.
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Identify and clean the a.thoracoacromialis medial to the pectoralis minor.
Next, detach the pectoralis minor from the costal cartilages of ribs 3, 4, and 5, and reflect it toward the should.
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Axillary a.
Thoracoacromial a.
Musculocutaneous n.
Median n.
Radial n.
Pectoral region and Axilla
Medial cord
Ulnar n.
Posterior cord
Radial n.
Axillary n.
Thoracodorsal n.
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Superficial vv.
Cephalic v.
Basilic v.