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Upper Limb

Upper Limb. Arm & Forearm. Arm Cross Section. The intermuscular septum and the humerus divide the arm into anterior and posterior compartments. Anterior Compartment: Flexor’s “3” muscles Musculocutaneous nerve Brachial artery. Posterior Compartment: Extensor’s “3” muscles

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Upper Limb

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  1. Upper Limb Arm & Forearm

  2. Arm Cross Section • The intermuscular septum and the humerus divide the arm into anterior and posterior compartments • Anterior Compartment: • Flexor’s • “3” muscles • Musculocutaneous nerve • Brachial artery • Posterior Compartment: • Extensor’s • “3” muscles • Radial nerve • Deep brachial artery

  3. Triceps brachii Posterior Compartment Lateral head Posterior surface of humerus – superior to radial grove Long head Infraglenoid tubercle Radial nerve Deep brachial a. All three heads have a common distal attachment on the olecranon Medial head Posterior surface of humerus – inferior to radial grove

  4. Muscles of the Arm - Posterior • Long head: Power assist for elbow extension • Medial head : primary extensor • Active throughout elbow extension • Triceps Brachii • Primary elbow extensor

  5. Anterior Compartment coracobrachialis Biceps brachii Corocoid process to mid way along the medial humerus Long head – supraglenoid tubercle Short head- corocoid process brachialis Common insertion: tuberosity of the radius Anterior surface of humerus to coronoid process and tuberosity of the ulna Brachial a Musculocutaneous n.

  6. Muscles of the Arm - Anterior • Biceps Brachii • Primary forearm supinator • Power assist for elbow flexion • Brachialis • Primary elbow flexor • Active throughout elbow flexion • Coracobrachialis • Action at the GH joint for flexion & adduction

  7. Elbow Joint- A “Hinge” Joint Humero-ulnar joint Humero-radial joint Enclosed in a single joint capsule (along with the superior radioulnar joint)

  8. Distal Humerus In full flexion, the rim of the radial head slides in the capitulotrochlear groove and enters the radial fossa Medial Lateral The trochlear ridge of the olecrenon rides in the trochlear groove (right) Lenangie 8-1

  9. The lower end of the humerus flairs out as epicondyles. These provide a mechanical advantage to the forearm muscle groups that attach at these sites. Bones of the Elbow Lateral lateral Medial Medial extensors flexors trochlea capitulum Attachment of the biceps Attachment of the brachialis Anterior view Posterior view

  10. Elbow Xray • O = olecranon • T = trochlea of the humerus • CP = coronoid process of the ulna • HR = head of the radius • C = capitulum

  11. Carrying Angle of the Elbow Formed by the vertical axis of the humerus and the vertical axis of the forearm The angulation is due to the configuration of the bony articulating surfaces Males = 5o Females = 10o - 15o

  12. Transverse Axis • Includes the humeroulnar and humeroradial joints • Flexion and extension Flexors: Biceps, brachialis, brachioradialis Extensors: Triceps, anconeus

  13. Elbow Flexors • In addition to the biceps and brachialis, the brachioradialis also functions as a flexor of the elbow • Each functions at differing degrees of supination and pronation of the forearm

  14. Increase stability and joint apposition Collateral Ligaments Annular ligament Ulnar collateral “MCL” medial • Fibers of the radial collateral ligament attach to the annular ligament Capitulum Radial head lateral Radial collateral “LCL” Annular ligament

  15. Annular ligament acts like a sling holding the radial head close to the ulna bone Annular Ligament • Annular ligament offers support but allows rotation (spin) as well as glide of the radial head during supination/ pronation Radial collateral Synovial fold

  16. Radioulnar Joint Motion supination pronation

  17. Radioulnar Joint • Complex joint with 2 articulations connected by the interosseous membrane • Superior (annular ligament) • Inferior – with capsule and disc

  18. Vertical Axis • Humeroradial and radioulnar joints • Forearm supination and pronation

  19. Muscles of Supination/Pronation Supinator & biceps brachii Pronator teres & pronator quadratus

  20. Forearm Cross Section • The interosseus membrane and radius and ulna divide the forearm in to anterior and posterior compartments

  21. Innervation rule • All muscles of the anterior compartment are supplied by the median nerve Or Ulnar nerve • All muscles of the posterior compartment are supplied by the radial nerve.

  22. Superficial Muscles of the Anterior Forearm • 5 superficial muscles • From the common flexor tendon arising from the medial condyle of the humerus • Cross the elbow but have minimum function at that joint

  23. Surface Anatomy - Anterior Forearm lateral medial Thumb = pronator teres 5th digit (tucked under) = flexor digitorum superficialis 2nd digit = flexor carpi radialis 3rd digit = palmaris longus 4th digit = flexor carpi ulnaris

  24. Deep Muscles of the Anterior Forearm • 3 Deep Muscles Thumb Fingers Wrist • Arise from the ulna (pronatorquadratus, flexor digitorum profundus) and radius (flexor pollicislongus)

  25. Superficial muscles of the posterior forearm • Extensor carpiulnaris • Extensor carpiradialisbrevis • Extensor carpiradialislongus • 3 Superficial Muscles

  26. Intermediate muscles of the posterior forearm • 2 IntMuscles • Extensor digitiminimi muscle • Extensor digitorum

  27. Deep muscles of the posterior forearm 5 muscles • Abductor pollicislongus • Extensor pollicisbrevis • Extensor pollicislongus • Supinator • Extensor indices

  28. Median Nerve • All forearm muscles are innervated by the MEDIAN nerve EXCEPT: 1 ½ muscles • flexor carpi ulnaris • ulnar side of the flexor digitorum profundus Plus: All thenar mm except adductor pollicis

  29. Brachial Artery in Situ • Posterior circumflex humeral a. runs with the axillary nerve • Deep brachial a. runs with radial nerve • Superior ulnar collateral a. runs with the ulnar nerve

  30. Brachial Artery Anastomoses

  31. Radial & Ulnar Arteries medial lateral Radial artery Ulnar artery Common interosseous • Anterior • Posterior Dorsal and palmer carpal branches Dorsal and palmer carpal branches Deep (superficial) palmar arches superficial (deep)palmar arches

  32. Injuries Cubital tunnel syndrome – contraction of the flexor carpi ulnaris causes nerve compression Stretch of the MCL during throwing Loss of IR & ER rotation of the shoulder may lead to excessive pronation of supination of the forearm and subsequent muscle strain

  33. Injuries Nursemaid’s elbow – radial head subluxed from the annular ligament in an unexpected pull Fall on the outstretched hand may lead to fracture of the elbow

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