Movements of Upper Limb PDF

anatomy of upper limb Movements of Upper Limb By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study UPPER LIMB Left Deltoid Muscle Atrophy (Left Flat Shoulder)...

anatomy of upper limb Movements of Upper Limb By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study UPPER LIMB Left Deltoid Muscle Atrophy (Left Flat Shoulder) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 2  Case Study UPPER LIMB Rupture of biceps tendon Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 3  Case Study UPPER LIMB Radial Head Dislocation (Pulled Elbow) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 4  Objectives: by the end of this lecture the student must understand the following knowledge: UPPER LIMB  Mention the Movements of Upper Limb, regarding: 1. Movement 2. Muscle Producing 3. Nerve Supply 4. Effects of Nerve Injury. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 5  Movements of Shoulder Girdle ( Movement of the Shoulder ) Movements Muscles Nerve Supply Effect of Lesion (Deformity) Elevation of the scapula 1. Upper fibers of Trapezius Cranial Accessory (11th ) 1 UPPER LIMB --------------------------- (Elevation of Shoulder) 2. Levator scapulae Dorsal Scapular nerve Depression of the scapula 2 Pectoralis minor Medial Pectoral Nerve --------------------------- (Depression of Shoulder) 1. Upper fibers of Trapezius Upward rotation of the scapula Cranial Accessory (11th ) --------------------------- 3 (Abduction) 2. Lower fibers of Trapezius (Raising the arm above the head) 3. Lower digitations of serratus anterior Long Thoracic Nerve Winging of Scapula 1. Levator scapulae Dorsal Scapular nerve 4 Downward rotation of the scapula 2. Rhomboideus major and minor --------------------------- 3. Pectoralis minor Medial Pectoral Nerve 1. Serratus anterior Long Thoracic Nerve Winging of Scapula Protraction 5 (Movement the shoulder forward) 2. Pectoralis minor Medial Pectoral Nerve --------------------------- 1. Middle fibers of trapezius Cranial Accessory (11th ) --------------------------- Retraction 6 (Movement of the shoulder backward) 2. Rhomboideus major and minor Dorsal Scapular nerve --------------------------- Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 6  Actions of Trapezius UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 7  Actions of Levator Scapulae UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 8  Actions of Rhomboidei UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 9  Actions of Serratus Anterior UPPER LIMB Serratus anterior Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 10 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 11 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 12  Stages of Abduction of arm (raising the arm above the head) UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 13 UPPER LIMB Movements of Shoulder Joint ( Movement of the Shoulder ) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 14  Movements Muscles Nerve Supply Effect of Lesion (Deformity) 1. Pectoralis major (clavicular part) Medial & Lateral pectoral nerve --------------------------- 2. Deltoid (anterior fibers) Axillary nerve Flat Shoulder Flexion 3. Biceps brachii (short head) Musculocutaneous nerve --------------------------- 4. Coracobrachialis 5. Sternocostal head of pectoralis major Medial & Lateral pectoral nerve --------------------------- 1. Deltoid (posterior fibers) Axillary nerve Flat Shoulder UPPER LIMB 2. Latissimus dorsi Thoracodorsal nerve --------------------------- Extension 3. Teres major Lower Subscapular nerve --------------------------- 4. Long head of triceps Radial nerve Wrist Drop 1. Pectoralis major (sternocostal part) Medial & Lateral pectoral nerve --------------------------- 2. Latissimus dorsi Thoracodorsal nerve --------------------------- 3. Teres major Lower Subscapular nerve --------------------------- Adduction 4. Coracobrachialis Musculocutaneous nerve --------------------------- 5. Short head of biceps 6. Long head of triceps Radial nerve Wrist Drop 1. Deltoid (lateral fibers) Axillary nerve Flat Shoulder 2. Supraspinatus Suprascapular nerve --------------------------- Abduction 3. Serratus anterior Long thoracic nerve Winging of Scapula 4. Upper and lower fibers of trapezius Cranial accessory (11th cranial) --------------------------- 1. Subscapularis Upper and Lower Subscapular nerve --------------------------- 2. Pectoralis major Medial & Lateral pectoral nerve --------------------------- Medial rotation 3. Latissimus dorsi Thoracodorsal nerve --------------------------- 4. Deltoid (anterior fibers) Axillary nerve Flat Shoulder 5. Teres major Lower Subscapular nerve --------------------------- 1. Deltoid (posterior fibers) Axillary nerve Flat Shoulder Lateral rotation 2. Infraspinatus Suprascapular nerve --------------------------- 3. Teres minor Axillary Movements of Upper Limb nerve By Dr. Hassan Rezk September 14,Flat 2024Shoulder 15  Actions of Pectoralis Major UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 16  Actions of Subscapularis UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 17 UPPER LIMB Actions of Latissimus Dorsi Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 18 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 19  Actions of Deltoid Posterior cord UPPER LIMB Deltoid Middle fibers Posterior fibers Axillary nerve Scapula Teres minor Deltoid Tuberosity Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 20 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 21  Suprascapular nerve UPPER LIMB Deltoid Action of Supraspinatus Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 22  Suprascapular nerve Action of Infraspinatus UPPER LIMB Deltoid Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 23  Axillary nerve Action of Teres Minor UPPER LIMB Deltoid Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 24 UPPER LIMB Action of Teres Major Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 25 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 26  Movements of Elbow Joint (Movement of the Forearm) UPPER LIMB Movements Muscles Nerve Supply Effect of Lesion (Deformity) 1. Biceps brachii (Powerful) Musculocutaneous nerve --------------------------- 2. Brachialis (Powerful) Musculocutaneous nerve & Radial nerve --------------------------- Flexion 3. Brachioradialis Radial nerve Wrist Drop 4. Pronator teres Median nerve Ape Hand 1. Triceps Brachii Radial nerve Wrist Drop Extension 2. Anconeus Radial nerve Wrist Drop Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 27 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 28 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 29 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 30 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 31 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 32  Lateral Humerus Medial Humeral Head UPPER LIMB Pronator Ulnar Head tuberosity Ulna Radius Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 33  Movements of Radioulnar Joints (Movement of the Forearm) UPPER LIMB Movements Muscles Nerve Supply Effect of Lesion (Deformity) 1. Pronator teres Median nerve Ape hand Anterior Interosseous nerve Pronation 2. Pronator Quadratus. Ape hand branch from median nerve 3. Brachioradialis (mid-prone Radial nerve Wrist Drop position) 1. Biceps brachii: It is most effective as a supinator when the forearm is Musculocutaneous nerve flexed. 2. Supinator: It is most effective as Supination Posterior Interosseous nerve a supinator when the forearm is Wrist Drop branch from radial nerve extended 3. Brachioradialis (mid-supine Radial nerve Wrist Drop position) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 34 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 35  Movements of Wrist Joint ( Movement of the Hand ) Movements Muscle Assisted By UPPER LIMB  Flexor carpi radialis  Flexor digitorum superficialis Flexion  Flexor carpi ulnaris  Flexor digitorum profundus  Palmaris longus.  Flexor pollicis longus.  Extensor digitorum  Extensor carpi radialis longus.  Extensor indicis Extension  Extensor carpi radialis brevis.  Extensor digiti minimi  Extensor carpi ulnaris.  Extensor pollicis longus.  Flexor carpi ulnaris. Adduction  Extensor carpi ulnaris.  Flexor carpi radialis  Abductor pollicis longus Abduction  Extensor carpi radialis longus and  Extensor pollicis longus and brevis. brevis. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 36  Movements of 1 st Carpo - Metacarpal (CMJ) & Metacarpo - phalangeal (MCPJ) Joints UPPER LIMB ( Movement of the Thumb ) Movements Muscle  Flexor pollicis brevis and Longus Flexion (MCPJ)  Opponens pollicis  Extensor pollicis longus Extension (MCPJ)  Extensor pollicis brevis  Adductor pollicis Adduction (CMJ)  1st palmar interossoeus.  Abductor pollicis longus Abduction (CMJ)  Abductor pollicis brevis Opposition (medial rotation of thumb)  Opponens pollicis. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 37  Movements of Metacarpophalangeal & Interphalangeal Joints ( Movement of the medial four fingers and Phalanges ) UPPER LIMB Movements Muscle Assisted By  Lumbricals Flexion of Fingers and  Flexor digitorum superficialis  Palmar Interossei. Phalanges  Flexor digitorum profundus.  Dorsal Interossei.  Extensor digitorum Extension of Fingers  Extensor indicis, and Phalanges  Extensor digiti minim Adduction of Fingers  Palmar interossei. (PAD) Abduction of Fingers  Dorsal interossei. (DAB) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 38 Clinical Correlation  Testing of Biceps Brachii (Testing of Musculocutaneous Nerve) UPPER LIMB  The biceps brachii muscle is innervated by the musculocutaneous nerve (C6).  A tap on the tendon of the biceps brachii at the elbow is used to test predominantly spinal cord segment C6. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 40  Testing of Triceps Brachii (Testing of Radial Nerve) UPPER LIMB  Innervation of the triceps brachii is by branches of the radial nerve (C7).  A tap on the tendon of the triceps brachii tests predominantly spinal cord segment C7. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 41  Testing of Trapezius (Testing of Accessory Nerve) UPPER LIMB The accessory nerve can be evaluated by testing the function of the trapezius muscle. This is most easily done by asking patients to shrug their shoulders against resistance. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 42  Testing of Deltoid (Testing of Axillary Nerve) UPPER LIMB The axillary nerve can be evaluated by testing the function of the deltoid muscle. This is most easily done by asking patients to abduct the arm beyond 15 against resistance. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 43  Rupture of biceps tendon  The tendon that most commonly ruptures UPPER LIMB is the tendon of the long head of the biceps brachii muscle in intertubercular sulcus).  Characteristic deformity: “Popeye” sign”: on flexing the elbow, there is an extremely prominent bulge of the muscle belly. Biceps tendinopathy and biceps tendon rupture - AMBOSS Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 44  Serratus Anterior Muscle Atrophy (Injury of Long Thoracic Nerve) UPPER LIMB 1) Stab wound in mid-axillary line. Cause 2) Rib fracture. Commonest site in mid-axillary line. Winging of scapula (excessive prominence of the medial Deformity border of scapula). Muscles paralyzed Serratus anterior muscle. Motor loss Weakness in abduction from 90˚ - 180˚ Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 45  Injury of Ulnar Nerve At the level of elbow joint UPPER LIMB Commonest 1) Fracture medial epicondyle. Cause 2) Cubital tunnel syndrome: compression of ulnar nerve between two heads of flexor carpi ulnaris. Commonest site Behind the medial epicondyle (Cubital tunnel syndrome) (Funny bone) Deformity Claw’s hand Muscles All muscles of the forearm & hand that is supplied by ulnar nerve. Which are????? paralyzed 1) weakness of flexion & adduction of the wrist. Motor loss 2) weakness of flexion of the fingers. 3) Loss of adduction & abduction of the medial four fingers. Loss of the sensations from: Cutaneous loss Medial 1/3 of the palm & dorsum. Medial 1 & ½ fingers (palm & dorsum). Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 46 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 47  Injury of Median Nerve UPPER LIMB At the level of elbow joint Commonest Cause Pronator teres syndrome Commonest site Compression of the median nerve between two heads of pronator teres Deformity Ape hand Muscles paralyzed All muscles of the forearm & hand that is supplied by median nerve. Which are????? Motor loss 1) weakness of flexion of the wrist. 2) weakness of flexion of the fingers. Cutaneous loss Loss of the sensations from:  Lateral 2/3 of the palm.  Lateral 3 & ½ fingers (palm & dorsum of terminal phalanges).  Skin covers thenar eminence. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 48 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 49  Injury of Radial Nerve UPPER LIMB 1) Intramuscular injection in the triceps brachii Commonest Cause 2) Fracture mid-shaft of the humerus. Commonest site In spiral groove. Deformity Wrist drop Muscles paralyzed All the extensors of the forearm. Extension of the wrist and elbow. Motor loss Weakness in Adduction and abduction of the wrist joint. Cutaneous loss All areas supplied by radial nerve, which are? Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 50 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 51 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 52  Injury of Axillary Nerve UPPER LIMB Cause Fracture of surgical neck of the humerus. Commonest site Surgical neck of the humerus. Deformity Flat shoulder (loss of the rounded contour of the shoulder) Muscles 1. Deltoid muscle. paralyzed 2. Teres minor muscle. Motor loss Loss of abduction from 15˚- 90˚ Cutaneous loss Loss of sensation from upper lateral part of the skin of the arm. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 53 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 54  Rotator Cuff Tendinitis UPPER LIMB  It is a common cause of pain in the shoulder region.  It is age related.  Cause: Excessive overhead activity of the upper limb. (commonest)  Patho-physiology:  During abduction of the shoulder joint, the supraspinatus tendon is exposed to friction against the acromion in subacromial space.  Degenerative changes in the bursa are followed by degenerative changes in the underlying supraspinatus tendon.  It is characterized by the presence of a spasm of pain in the middle range of abduction. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 55 UPPER LIMB P A Parasagittal Section Through the Shoulder Joint Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 56 UPPER LIMB Subacromial space (relation of supraspinatus tendon to acromion process) Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 57  Rupture of the Supraspinatus Tendon UPPER LIMB  In advanced cases of rotator cuff tendinitis, the necrotic supraspinatus tendon can become calcified or ruptured.  Rupture of the tendon seriously interferes with the normal abduction movement of the shoulder joint.  The patient with a ruptured supraspinatus tendon is unable to initiate abduction of the arm.  However, if the arm is passively assisted for the first 15° of abduction, the deltoid can then take over and complete the movement to a right angle. Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 58 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 59  Case Scenario UPPER LIMB A 17-year-old boy comes to the physician because of a 3-month history of pain in his right shoulder. He reports that he has stopped playing for his high school football team because of persistent difficulty lifting his right arm. Physical examination shows impaired active abduction of the right arm from 0 to 15 degrees. After passive abduction of the right arm to 15 degrees, the patient is able to raise his arm above his head. The dysfunctional muscle in this patient is most likely to be innervated by which of the following nerves? A. Suprascapular nerve B. Long thoracic nerve C. Axillary nerve D. Upper subscapular nerve E. Accessory nerve Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 60  Reference UPPER LIMB  Gray's anatomy for students, 3rd edition.  ISBN: 978-0-7020-5131-9  Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc.  Chapter 7 Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 61 UPPER LIMB Movements of Upper Limb By Dr. Hassan Rezk September 14, 2024 62