Upper Limb Anatomy Notes (PDF)

# Upper Limb ## Bones of Upper Limb - **Clavicle:** Lob 4, r 132 each side. - Only long bone ossify membranous - Long bone, Lie Horizental - Wt ossify bone: Sc - 2 ends: - Med: Round, Sternoclavicular Joint - Lat: Flat, Acromioclavicular Joint - 2 Surfaces: - Sup: Smooth...

# Upper Limb ## Bones of Upper Limb - **Clavicle:** Lob 4, r 132 each side. - Only long bone ossify membranous - Long bone, Lie Horizental - Wt ossify bone: Sc - 2 ends: - Med: Round, Sternoclavicular Joint - Lat: Flat, Acromioclavicular Joint - 2 Surfaces: - Sup: Smooth - Inf: Rough - Shaft 2 parts - Med 2/3 = Convex Ant - Lat 1/3 = Concave Ant - Nutrient foramen: At lat end of subclavian groove - Transmits branch of suprascapular A - 2 Ligaments: - Costoclavicular lig - Coracoclavicular lig - Co transmit wt of ul to clavicle - Commonest site of * is? ## Scapula - Flat, triangle, PM in thorax - Angles: - Sup angle: 2nd rib - Inf angle: 7th rib - Lat angle: Glenoid - Borders: - Sup or med os lat - Process: - Coracoid or spine w Acromion - Surface: - Ventral & Dorsal - Tubercle: - Supra or infraglenoid tubercle - Notches: - Suprascapular & spinoglenoid notch - Supra scapular? - SSA Pass above lig outside foramen - SSN Pass below lig inside foramen - Ms attach Coracoid? - Ms 11 med border? - Ms 11 lat 11? - Ms spine w Acromion? ## Humerus - Proximul? Shoulder - Distal? Elbow - Upper end: Common dislocate - Head: Round, glenohumeral, upward or backward of med - Anatomical Neck: Just below Head - Surgical Neck: Common, related to? - GT = lat as S. IT - LT = Ant subscapularis - Bicipital groove: Continuin, ascending branch of ACHA - Laddy between 2 man? - Shaft? - Deltoid tuberosity: V shape of Deltoid - Radial groove: Post surface or, related to ? - Lower end? - Med epicondyle: More projected or related to? - Lat epicondyle - Trochlea: Pulley or med? Articulate é - Capitulum: Round what? Articulate é - Rudial fossa: Above capitulum - Coronoid fossa: Above trochlea - Olecranon fossa: Post surfule ## Nerves and Arteries Liable to Damage in Fracture Humerus - Axillary Nerve: Flat shoulder, PCHA - RN: Wrist Drop, profunda - Brachial Artery: MN, Ape hand - Sup ulnar: UN collateral artery ## Pectoral Region - Cutaneous N Supply? Supraclavicular NC3C4, 2nd to 6th IC nerves (T2-T6) - Breast: - Conicul - Modified sweat gland - Lie in S.F except axillary tail? Pierce D.F. Langer foramen - Extension? - Sup: 2nd rib - Inf: 6th rib - Med sternum: Midaxillary line - Ms bed? - P major, SA, com - which main? - Retromammary Space: Loose areolar w give mobility - Nipple: at 4th IC space, most sensetive - Areola? Pigmented a montogomerys - Skin - Glund - Stroma: CT w fat - Parenchyma: 15 to 20 lobes - 15 to 20 lf duct, converge, open - lf sinuses - A.S of breast: - ITA: Perforating branches - IC arteries - Lat thoracic A: - Ant branch - Post branch - Thoruco Acromial A: - N.S of Breast: 4th to 6th IC nerves - Separately? - L.D of Breast? - 25% - 5% - Upper Quadrants?: Apicul axillary L.N - Lat Quadrants?: Ant 11 - Med Quadrants?: Paraskernal L.N - Inf Quadrants?: Abdominal L.N - Breast cancer = Commonest in female - 60% occur in uLQ, age 40-60 years - Painles, hard muss, fixed, retruation skind Nipple. - Open orange skin - Incision of brast radial? ## Ms of Pectoral Region - P. major - O: - Clavicular head: med 2/3 clavicle, ant surface - Sternocostal head: Ant surface + upper 6 c sternum - I: Inter tuberculer groove "lat lip - NS: med + lat pectoral N - A: Arm flexion "MR - P. minor - O: 3rd, 4th, 5th rib - I: Coracoid process - NS: Med pectoral N - A: Scapula "forward, downward - P. major or P. minor: only ms supply by all roots of BP ## Subclavius - O: 1st rib - I: subclavian groove "clavicle - NS: Nerve to subcluvius "C5, c6 - A: Depress cluvick ## SA - O: Upper 8 ribs, outer ribs - I: Scapula, medial border "ventruel - NS: Long thorulic N "C5, C6, C7 - A: Protruction & with type 2 abd shoulder 98-180° - Boxer ms injury? ## Deltopectoral Groove - Cephalic vien - Deltoid branch of thorues acromial A - Deltopectoral L.N ## Clavipectoral Fascia - Deep to P. major: enclose P. minor or subclavius - Attached to clavicle "sup" - Continuus é suspensory higament of Axila ## Structures Pierce - Cephalic vien - Thoralo acromial artery - Lat pectoral N - Lymphatic vessels ## Axilla - Pyramidal space - Ant: P. major - P. minor - Subcluvius - Clavipectord fascie - Post: - Subscapularis - T. major - L.D - Ribs tovu - Med: - SA - Lat: - Coracobrachiala - Bicps short head - Humerus - Main vs & N - Base: - Skin - Axilla fascia - Contents of Axilla: - Fat - Tail of Breast - Vessels - LN - Cords of B.P - Long thoracic N - inter costo brachid nerve? ## Brachial Plexus - Roots > trunks > Division > Cords > Branchs - Neck - Behind clavicle - Axilla - UL - C5 - C6 - C7 - C8 - T1 - Upper trunk: - Anterior Division - Posterior Division - Middle trunk: - Anterior Division - Posterior Division - Lower trunk: - Anterior Division - Posterior Division - Lateral cord - Posterior cord - Medial cord - Root? - VR: C5, C6, C7, C8, T1 - Contribution of C4 or T2 - Prefixed? - Postfixed? - Trunks? - Upper trunk: C5, C6 - Middle trunk: C7 - Lower trunk: C8, T1 - Cords? - L.C: Ant division of upper and mid trunk, C5, C6, C7 - M.C: Ant division of lower trunk, C8, T1 - P.C: All post division, C5, C6, C8 T1 - Branches? - From roots: - Dorsal Scupular N: C5 - Long thorulic Na: C5, C6, C7... SA - From upper trunk? - Nerve to Subclavius: C5, C6 - Suprascapular N: C5, C6 - From L.C? - Lat root of MN: - Lat pectoral N: - Musculocutaneous N: BBC - gives no branchs?! - Middle & lower trunks - Divisions - P. major - From M.C? - Medial root of MN: - Med pectoral N: - Med cutaneous N arm: - Med cutaneous N forearm: - Ulnar Nerve: - From P.C: - Upper Subscapular N: - Lower subscapular N: - Nerve to LD: - Axillury N: - Radial N: - Subscapularis Ms - Subscapularis - Tmajor - LD - Deltoid - Tminor - Triceps - Lat 1/2 brachialis - 2 nerves from all rootes? - MN - RN - M shape? - lat: Muscubcutaneous N - middle: Median nerve - medial: Ulnar nerve - Injuries of B.P - Erbs Paralysis - Injury = upper trunk, C5, C6 - Birth injury - Nerves: - Suprascapulur - N to subclavius - Musculo cutancos N - Axillary N - Affected: Muscul - Deformity? - Arm Add + MR - Forearm extended + pronated - Klumpki Paralysis - Injury = lower trunk, C8, T1 - Excessive abduction - Nerves? Nerve to all affected, small ms hand - Deformity?: - Extension of MPJ - Flexion of IPJ