UPPER LIMB

1. UPPER LIMB CHAPTER 6 p726 MOORE & DALLEY CLINICALLY ORIENTED ANATOMY 5TH EDN

2. UPPER LIMB SHOULDER JOINT P853 Also pp 848-852

3. Shoulder Joint • Ball and socket (synovial) jnt • Designed for mobility • Stability compromised – soft tissue support

4. Important: • Articulation • Joint capsule • Ligaments – glenohumeral, coracohumeral • Movements – F, E, MR, LR, C, Abd, Add • Muscles – axioappendicular, scapulohumeral • Bursae – suprascapular, subacromial • Blood supply – ant, post circumflex humeral aa • Innervation – suprascapular, axillary, lateral pec.

5. Muscles which attach the humerus to the axial skeleton • M deltoideus • M latissimus dorsi • M teres major • M coracobrachialis • M subscapularis • M supraspinatus • M infraspinatus • M teres minor

6. M deltoideus • Origin • Ant border, lateral aspect of clavicle • Lateral border-acromion • Inf lip of spine (scapula) • Insertion • Deltoid tuberosity • Action • Abduction • Flexion, medial rotation • Extension, lateral rotation • Nerve supply • Axillary

7. M latissimus dorsi • Origin • Lower 6 thoracic vertebrae (spines • L1-L5 (spines) • Iliac crest (posterior) • Lower 4 ribs • Insertion • Bicipital groove (humerus) • Action • Extension • Medial rotation • Nerve supply • Thoracodorsal nerve

8. M teres major • Origin • Dorsum of lateral border of scapula (close to inferior angle) • Insertion • Medial lip of bicipital groove • Action • Adduction • Medial rotation • Nerve supply • Inferior subscapular nerve

9. M coracobrachialis • Origin • Coracoid process (apex) of scapula • Insertion • Shaft of humerus (medial aspect) next to deltoid tuberosity • Action • Flexor (weak) • Adductor • Nerve supply • Musculo-cutaneous nerve

10. ROTATOR CUFF MUSCLES • Muscles which stabilize the shoulder joint • Supraspinatus • Infraspinatus • Teres minor • Subscapularis

11. M supraspinatus • Origin • Supraspinous fossa (lateral part) of scapula • Insertion • Superior facet-greater tubercle of humerus • Action • Abduction • Nerve supply • Suprascapular nerve

12. M infraspinatus • Origin • Infraspinous fossa (lateral part) of scapula • Insertion • Middle facet-greater tubercle of humerus • Action • Extension • Lateral rotation • Nerve supply • Suprascapular nerve

13. M teres minor • Origin • Lateral border of scapula • Insertion • Inferior facet-greater tubercle of humerus • Action • Adduction • Lateral rotation • Nerve supply • Axillary nerve

14. M subscapularis • Origin • Subscapular fossa • Insertion • Lesser tubercle of humerus • Action • Adduction • Medial rotation • Nerve supply • Superior subscapular nn • Inferior subscapular nn

15. Winging of the scapula

16. AXILLA

17. Definition of axilla: An irregular space above the armpit • Anterior wall • Pectoralis major • Pectoralis minor • Clavipectoral fascia • Pierced by bv’s & nn • Ends in skin of axilla • Posterior wall • Subscapularis • Latissimus dorsi • Teres major • Medial wall • Serratus anterior • Lateral wall • Bicipital groove

18. Base • Skin of armpit • Apex • Runs upwards • Clavicle (ant) • R1 (medially) • Scapula sup border (post) • Contents • Brachial plexus • Axillary artery • Axillary vein • Lymph nodes • fat

19. MUSCLES OF THE UPPER ARM

20. Compartments • Anterior compartment • M coracobrachialis • M biceps brachii • M brachialis • Posterior compartment • M triceps brachii • M anconeus

21. UPPER LIMB ELBOW JOINT P860

22. Elbow Joint • Hinge (synovial) jnt • Designed for mobility / function

23. Important: • Articulation • Joint capsule • Ligaments • Movements • Muscles • Bursae • Blood supply • Innervation

24. Cubital Fossa • Inverted triangle • In front of elbow Borders • Base - imaginary line - 2 epicondyles • Lateral border – m. brachioradialis • Medial border – m. pronator teres • Roof - fascia, skin, superficial nerves and blood vessels • Floor - brachialis, supinator • Contents - median n., brachialis a., biceps brachii tendon

25. Cubital Fossa

26. UPPER LIMB RADIOULNAR JOINT Proximal – p863 Distal – p866

27. Important: Proximal Joints(pivot – synovial jnt) • Articulation • Joint capsule • Ligaments – anular lig • Movements – supination, pronation • Muscles – see mvmnts above • Blood supply – radial, radial recurrent aa • Innervation – musculocut., radial, median

28. Important: Distal Joints(pivot – synovial jnt) • Articulation • Joint capsule • Ligaments – anterior & posterior ligs • Movements – supination, pronation • Muscles – see mvmnts above • Blood supply – ant, post interosseous aa • Innervation – ant, post interosseous nn

29. Forearm • Posterior extensor compartment • 12 muscle • Radial nerve

30. Forearm - Compartments

31. Posterior Extensor Compartment • 3 muscles run from deep to the thumb • m. abductor pollicis longus • m. extensor pollicis brevis • m. extensor pollicis longus • Originate from the shafts of radius and ulna as well as interosseous membrane

32. Posterior Extensor Compartment

33. Posterior Extensor Compartment • 3 muscles lie lateral to previous group • m. brachioradialis • m. extensor carpi radialis longus • m. extensor carpi radialis brevis

34. Posterior Extensor Compartment Posterior View Anterior View

35. Posterior Extensor Compartment • 3 muscles lie medial to previous group • m. extensor digitorum • m. extensor digiti mini • m. extensor carpi ulnaris

36. Posterior Extensor Compartment Posterior View

37. Posterior Extensor Compartment • 3 other muscles • m. anconeus • m. extensor indicis • m. supinator

38. Posterior Extensor Compartment

39. Posterior Extensor Compartment • Actions • Extension of wrist and fingers • m. anconeus – helps extension of elbow • m. supinatior – supinates forearm • m. brachioradialis – arm in neutral position it flexes the elbow joint, if hand is pronated or supinated it turns hand back to neutral position

40. Distal Radio-Ulnar Joints