Morph Plan UL 22-23 Final(1).pptx

Morphological Plan of the Upper Limb Dr Catherine Hennessy [email protected] Learning Outcomes • Describe the functional organisation of the upper limb and back • Describe the organisation of the skeleton of the upper limb • Describe the movements of the upper limb • Describe the muscle compar...

Morphological Plan of the Upper Limb Dr Catherine Hennessy [email protected] Learning Outcomes • Describe the functional organisation of the upper limb and back • Describe the organisation of the skeleton of the upper limb • Describe the movements of the upper limb • Describe the muscle compartments of the upper limb, including the extensor versus flexor surfaces • Describe the anatomy of the vertebral column and the muscles of the back. Structures of Interest in the Upper Limb • 32 bones • 57 muscles • Brachial plexus • Major vessels Arrangement of the Upper Limb Shoulder Course muscle groups Arm Elbow Forearm Wrist Hand Fine muscle groups Bones of the Upper Limb Pectoral girdle (scapula and clavicle) Humerus Radius Ulna Carpal bones(x8) Metacarpals (x5) Phalanges (x14) Scapula and Humerus Acromion Superior angle Lesser tubercle Spine Greater tubercle Lateral epicondyle Coracoid Intertubercular sulcus/bicipital groove Medial epicondyle Inferior angle Deltoid tuberosity Radius and Ulna Olecranon Head Coronoid process Radial tuberosity Interosseous membrane Styloid process of radius Styloid process of ulna Wrist and Hand Two rows of carpal bones (proximal and distal) Anterior R D1 U D5 Posterior U D5 R D1 Limb Movements • Flexion/Extension • Abduction/ Adduction • Lateral/Medial rotation • Pronation/ Supination • Circumduction • Opposition Joints of the Upper Limb Wrist (radiocarpal) Glenohumeral Saddle joint OPPOSABLE THUMB Elbow Midcarpal Carpometacarpal Metacarpophalangeal Interphalangeal Muscles of the Upper Limb • Some originate from the vertebral column and insert onto the upper limb e.g. Superficial back muscles Muscles of the Upper Limb • Some originate from the thoracic wall and insert onto the upper limb Pectoralis major and minor Serratus anterior Muscles of the Upper Limb • Some muscles originate from the scapula and insert onto the humerus Deltoid Rotator cuff muscles Teres major Muscles of the Upper Limb • Some muscles make up the anterior and posterior compartments of the arm Flexors Extensors Coracobrachialis Triceps brachii Biceps brachii Brachialis Anterior Posterior Brachii = arm Muscles of the Upper Limb • Some muscles make up the anterior and posterior compartments of the forearm Medial epicondyle Lateral epicondyle Flexors of wrist and digits Extensors of wrist and digits Anterior Posterior Muscles of the Upper Limb • Some muscles make up the Thenar and Hypothenar muscles of the hand Thenar muscles Hypothenar muscles Anatomy of the Back • Back pain and injuries very common • Vertebral column • Muscles Movements of the Vertebral Column • Flexion/extension • Lateral flexion/lateral extension • Rotation Curves of the Vertebral Column Centre of gravity 4 curvatures allow for: • Bipedal stance • Shock absorption • Flexibility Cervical Thoracic Secondary (childhood) - Crawling to walking Primary (fetal) Lordoses Lumbar Kyphoses Sacral Ligaments of the Vertebral Column • • Reinforce and stabilize joints Limit range of movement Anterior to body Posterior to body Posterior longitudinal ligament Resists hyperextension Anterior longitudinal ligament Resists hyperflexion Ligamentum flava Vertebral canal Clinical: Injury to anterior longitudinal ligament following whiplash Intervertebral Joints and Discs • • • • • • Intervertebral joints for weight bearing and strength Secondary cartilaginous joints Fibrocartilage – intervertebral discs, act as shock absorbers Disc thickness increases down the vertebral column Anulus fibrosus – outer strong layer Nucleus pulposus – central gel-like Clinical: Disc protrusion/NP herniation can impinge on nerves Facet (Zygapophysial) Joints • • • Joints between vertebral arches Synovial Movement depends on joint angle • Cervical – flexion, extension and rotation • Thoracic – rotation • Lumbar – flexion and extension Clinical: Degeneration of facet joints can cause back pain Muscles of the Back Divided into: Extrinsic muscles (superficial group) (move upper limbs/ribs) Intrinsic muscles (deep group) (postural/move vertebral column) Superficial Muscle Group Attach upper limb to trunk Latissimus Dorsi Origin Thoracolumbar fascia Insertio Floor of the bicipital groove of the n humerus Latissimus dorsi T12 Thoracolumbar fascia Action Adduction of the glenohumeral joint Extension of the glenohumeral joint Medial rotation of the glenohumeral joint Nerve Supply Thoracodorsal nerve Superficial Muscle Group Attach upper limb to trunk Up pe r Trapezius Middle Origin Low er Trapezius External occipital protuberance and spinous processes of C1 – T12 Insertion Lateral part of the clavicle, acromion process and spine of scapula Action Whole muscle - upward rotation of the scapula Upper fibres alone – elevate the scapula Middle fibres alone – retract the scapula Lower fibres alone – depress the scapula Nerve Supply Accessory nerve (CNXI) T12 Superficial Muscle Group Deep to Trapezius Levator Scapulae Levator scapulae C7 Origin Transversus processes of C1-4 Insertion Superior angle of the scapula Action Elevates the scapula Nerve Supply Dorsal Scapular nerve Romboids T5 Rhomboids (minor and major) Origin Minor: Spinous process of C7-T1 Major: Spinous process of T2-5 Insertion Minor: Medial border of scapula (root of spine) Major: Medial border of scapula (inferior to the root of spine) Action Retracts and elevates the scapula Nerve Supply Dorsal Scapular nerve Deep Muscle Group 3 Layers 1. Splenius – most superficial (in neck) 2. Erector Spinae – main group 3. Multifidus – very deep Erector spinae Multifidus Erector Spinae Muscle 1. Spinalis • 3 muscle blocks • Within groove between the spinous processes and angles of the ribs 2. Longissimus Erector Spinae 3. Iliocostalis Erector spinae aponeurosis Origi n Erector spinae aponeurosis Inser t. Spinalis: spinous processes Longissimus: transverse processes Iliocostalis: ribs Actio n Extends/laterally flexes/rotates the vertebral column Multifidus Multifidus Origin Transverse processes Insert Spinous process (of the vertebra . above ) Actio n Spinous processes Multifidus to Transverse processes Extends/rotates/stabilizes vertebral column Nerve Supply of the Back Muscles Anterior primary ramus Extrinsic muscles (mainly cervical rami – brachial plexus) Posterior primary ramus Intrinsic muscles