The Upper Extremity

1. The Upper Extremity Bones, Muscles, Vessels,

2. 30 bones!!!! Appendicular skeleton Pectoral girdle Scapula Clavicle Allows for mobility Ball and socket attachments Upper extremity: Arm humerus Forearm Radius, ulna (interosseous membrane) Hand Carpals, metacarpals, phalanges Review bones and landmarks studied in lab!!! Bones Glenoid cavity

3. Joints of Upper Extremity • Sternoclavicular • Synovial-saddle • Diarthrosis • Acromioclavicular • Synovial-plane • Diarthrosis • Glenohumeral joint • Synovial-ball&socket • Diarthrosis • Many ligaments • Muscle reinforcement • Great Mobility

4. Joints of the Upper Extremity • Elbow Joint • Synovial – hinge • Diarthrosis • Articulations • Humerus & Ulna • Humerus & Radius • Many Ligaments

5. Joints of Upper Extremity • Proximal Radioulnar joint • Synovial - pivot • Diarthrosis • Distal Radioulnar joint • Synovial – pivot • Diarthrosis • Allows pronation and supination of forearm

6. Joints of the Upper Extremity • Radiocarpal joint • Synovial-condyloid • Distal radius with proximal row of carpals • Intercarpal joints • Synovial-plane • Carpal-metacarpal (2-5) • Synovial-plane • Trapezium-metacarpal 1 • Synovial-saddle • Metacarpal-phalangeal • Synovial-condyloid • Interphalangeal • Synovial-hinge • ALL DIARTHROSES

7. Review of Naming….. • What do the following names TELL you about the muscle? • Naming • Flexor carpi ulnaris • Flexor digitorum superficialis • Flexor pollicis longus • Pronator quadratus • Extensor carpi radialis brevis

8. If the origin is on the scapula – moves the arm Subscapularis Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial attachment) Coracobrachialis Scapula Muscles Rotator Cuff

9. If the insertion is on the scapula – moves the scapula Rhomboids Trapezius Pectoralis Minor Serratus Ventralis Levator Scapulae Scapula Muscles Use location of Insertion to determine movement!!

10. Origin on scapula Subscapularis and teres major Subscapular Supraspinatus and Infraspinatus Suprascapular Teres Minor Axillary Latissimus Dorsi Thoracodorsal Coracobrachialis Musculocutaneous Insertion on scapula Rhomboids and Levator Scapulae Dorsal scapular Trapezius Accessory Pectoralis Minor Medial and Lateral Serratus Ventralis Long thoracic Scapula Innervation

11. Muscles of the Rotator CuffAll INSERT on the humerus

12. Muscles of the Scapula*All these muscles INSERT on the scapula

13. Cross elbow, move forearm 2 compartments Anterior Flexors of forearm Posterior Extensors of forearm Arm Muscles

14. Anterior compartment Brachialis Biceps brachii Coracobrachialis Brachioradialis Arm Muscles

15. Posterior compartment Triceps brachii Anconeus Arm Muscles

16. Arm Muscle Innervation • Anterior compartment • Radial nerve • Bracioradialis • Musculocutaneous nerve • Coracobrachialis • Brachialis • Biceps brachii • Posterior compartment • Radial nerve • Triceps brachii • Anconeus

17. Cross elbow, wrist and finger joints Movement of hand and fingers Cross Wrist flex, extend, abduct, adduct hand Cross Fingers flex, extend fingers Proximally are fleshy Distally have long tendons Flexor and extensor retinacula “wristbands” Keep tendons from jumping outwards when tensed Forearm Muscles

18. Anterior flexor compartment Superficial and Deep Most flexors have common tendon on medial epicondyle Contains 2 pronators Posterior extensor compartment Superficial and Deep Forearm Muscles

19. MusclesNerves Superficial Flexor digitorum superficialis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Radial Deep Flexor pollicis longus Median Flexor digitorum profundusUlnar (med 1/2) Median (lat 1/2) Anterior Compartment of Forearm

20. Anterior Compartment Forearm

21. Posterior Compartment of Forearm MusclesNerves • Superficial • Extensor carpi radialis longus Radial • Extensor digitorum Radial • Extensor carpi ulnaris Radial • Deep • Supinator Radial • Abductor pollicis longus Radial • Extensor pollicis longus + brevis Radial • Extensor indicus Radial

22. Posterior Compartment of Forearm

23. Carpus (8) “True” wrist Distal to radius/ulna Metacarpus (5) Distal to carpus Phalanges (14) Distal to metacarpus Hand Bones

24. Intrinsic Muscles of the Hand MuscleNerve • Pinky (little finger) • All digiti minimi Ulnar (Flexor, Abductor, Opponens) • Thumb • Abductor pollicis brevis Median • Flexor pollicis brevis Median • Opponens pollicis Median • Adductor pollicis Ulnar • Other Intrinsic Muscles • Palmar + Dorsal Interossei Ulnar • Lumbricals Median, Ulnar

25. Muscles of the Upper Limb*All INSERT on the humerus (*)

26. Muscles Crossing the Elbow *Exception: radial nerve usually serves extensor muscles

27. Muscles of the Forearm ANTERIOR Superficial Muscles

28. Muscles of the Forearm ANTERIOR Deep Muscles

29. Muscles of the Forearm POSTERIOR Superficial Muscles

30. Muscles That Move the Forearm POSTERIOR Deep Muscles

31. http://bio.bd.psu.edu/cat/Muscular_System/deep_muscles.htm# Upper Arm

32. Upper Arm –Medial View

35. Upper Arm – Lateral View

38. Intrinsic Muscles of the HandThenar Eminence

39. Intrinsic Muscles of HandHypothenar Eminence

40. Muscles of the HandMidpalmar Muscles

41. Intrinsic Muscles of the Hand Lumbrical Muscles Interossei Muscles

42. Deep veins Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Subclavian - neck Axillary – axilla Superficial Veins Cephalic – arm/forearm Basilic – arm/forearm Median cubital – elbow Blood draws!! Median - forearm Superficial palmar venous arches Digital Blood Supply - Veins

43. Subclavian (neck) Axillary (armpit) Subscapular Circumflex humeral arteries Brachial (arm) Deep brachial Radial (forearm) Ulnar (forearm) Common Interosseous Superficial & Deep Palmar arches Digital Blood Supply - Arteries

44. Between arms and chest Where axillary hair grow Boundaries Ventral Pectoral muscles Dorsal Latissimus dorsi, teres major, subscapularis Medial Serratus ventralis Lateral Intertubercular (Bicipital) groove of humerus Contents Axillary lymph nodes, Axillary vessels, brachial Plexus Axilla

45. Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle Surface Anatomy of Arm

46. Surface Anatomy of Elbow • Cephalic vein • Cubital Fossa • Anterior surface elbow • Contents • Median Cubital Vein • Brachial Artery • Median Nerve • Boundaries • Medial= Pronator teres • Lateral= Brachioradialis • Superior= Line between epicondyles

47. Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse) Surface Anatomy of Hand

48. Nerve plexus Network of nerves formed by ventral rami Lies partly in neck and partly in axilla Gives rise to almost all nerves that supply upper limb Formed by intermixing of ventral rami of spinal nerves C5-C8 and T1 Small contributions from C4 and T2 Brachial Plexus

49. Ventral Rami

50. Brachial Plexus • Really Tired? Drink Coffee Buddy! • R = RAMI (ventral) (5) • T = TRUNKS (3) • D = DIVISIONS (2) • C = CORDS (3) • B = BRANCHES (Many!!)