Upper Limb Overview (PDF)

Upper Limb UPPER LIMB August 24, 2024 2  Objectives: by the end of this lecture the student must understand the following knowledge: 1) Identify Upper Limb, regarding: UPPER LIMB...

Upper Limb UPPER LIMB August 24, 2024 2  Objectives: by the end of this lecture the student must understand the following knowledge: 1) Identify Upper Limb, regarding: UPPER LIMB A. Components. B. Regions. C. Compartments D. Bones. E. Joints. F. Communication. G. Function. 2) Brachial Plexus August 24, 2024 3  Objective # ( 1 ) - A Overview of Upper Limb - Components 1 Bones 32 Bones UPPER LIMB 2 Joints 26 Joints (not including Intercarpal Joints) 3 Muscles 60 Muscles (-/+) 4 Nerves (main) 17 Major nerves + Brachial Plexus (not including branches) 5 Arteries (main) 4 Major Arteries (not including branches) 6 Veins (main) 4 Major Veins (not including tributaries) August 24, 2024 4 UPPER LIMB August 24, 2024 5  Overview of 1. Pectoral region (+/-) Objective Upper Limb - #(1)-B 2. Shoulder Regions 3. Posterior Scapular UPPER LIMB 4. Axilla 5. Arm 6. Cubital Fossa 7. Forearm 8. Wrist 9. Hand August 24, 2024 6  Pectoral Region Shoulder Shoulder Posterior scapular Region UPPER LIMB Arm Arm Cubital Fossa Forearm Forearm Axilla Axilla Hand Hand Anterior View Posterior View Of Right Upper Limb Of Right Upper Limb August 24, 2024 7  Definitions: Pectoral Region Part of upper limb lies anterior to upper part of thoracic wall. Shoulder is the area of upper limb attachment to the trunk UPPER LIMB Posterior Scapular Area of upper limb lies on posterior aspect of scapula. The axilla is the gateway to the upper limb, providing an area of transition Axilla between the neck and the arm Arm is the part of the upper limb between the shoulder and the elbow joints Cubital Fossa transition between the arm and the forearm. Forearm is between elbow joint and the wrist joint Wrist (Wrist retinacula) is a transition between forearm and hand Hand is distal to the wrist joint August 24, 2024 8 UPPER LIMB August 24, 2024 9 UPPER LIMB August 24, 2024 10  Objective # ( 1 ) - C Overview of Upper Limb – Compartments  For descriptive purposes, Some regions are further subdivided into compartments. UPPER LIMB Region Compartments (1) Anterior (Flexor) Compartment (2) Posterior (Extensor) Compartment Arm Main Action: Flexion Main Action: Extension Nerve Supply: Musculocutaneous Nerve Nerve Supply: Radial Nerve (1) Anterior (Flexor) Compartment (2) Posterior (Extensor) Compartment Forearm Main Action: Flexion Main Action: Extension Nerve Supply: Median & Ulnar Nerves Nerve Supply: Deep Radial Nerve (1) Thenar Compartment (2) Central Compartment (3) Hypothenar Compartment Main Action: Movement of Main Action: Movement of Main Action: Movement of Hand thumb Fingers little finger (Digiti Minimi) Nerve Supply: Median Nerve Nerve Supply: Median & Nerve Supply: Ulnar Nerve Ulnar Nerves August 24, 2024 11 UPPER LIMB August 24, 2024 12  Objective # ( 1 ) - D Overview of Upper Limb – Bones Name of the segment Bones forming UPPER LIMB  Formed of: 1. Girdle Pectoral (Shoulder) Girdle 1) Anteriorly: Clavicle. 2) Posteriorly: Scapula. 2. Proximal Segment Arm Humerus  Formed of: 3. Middle Segment Forearm 1) Medially: Ulna. 2) Laterally: Radius  Formed of: 3 groups 1) 8 Carpal bones. 4. Distal Segment Hand 2) 5 Metacarpal bones 3) 14 Phalanges. August 24, 2024 13  Clavicle (3) Shoulder region Humerus Scapula (1) Pectoral UPPER LIMB region (5) Arm (6) Cubital fossa (2) Axilla Radius Ulna Skeleton of hand (8) Hand (4) Posterior scapular region August 24, 2024 14  Objective # ( 1 ) - E Overview of Upper Limb – Joints Joint Site Region moved Movements UPPER LIMB In upper part the pectoral 1) Elevation. 1. Shoulder (Pectoral) Girdle region Shoulder 2) Depression 1) Flexion & Extension. 2) Adduction & Abduction. 2. Shoulder Joint Proximal to the arm Arm 3) Rotation (medial & lateral) 4) Circumduction. Proximal to forearm 3. Elbow (distal to arm) Forearm Flexion & Extension. Proximal to forearm 4. Radioulnar Joints (distal to arm) Forearm Pronation & Supination 1) Flexion & Extension. Proximal to hand 5. Wrist Joint (distal to forearm) Hand 2) Adduction & Abduction. 3) Circumduction. 6. Metacarpophalangeal 1) Flexion & Extension. Distal to metacarpal bones Fingers Joints (MCPJ) 2) Adduction & Abduction. 7. Interphalangeal Joints (IPJ) Between phalanges Phalanges Flexion & Extension. August 24, 2024 15  (2) Shoulder (1) Shoulder (Pectoral) Girdle Joint (2) Site of Shoulder Joint UPPER LIMB (1) Site of Shoulder (Pectoral) Girdle (3) Site of Elbow (3) Elbow Joint Joint (4) Sites of Radio-ulnar (4) Radio-ulnar Joints Joints (5) Site of Wrist Joint (5) Wrist Joint (6) Site of Small Joints of (6) Small hand Joints of hand August 24, 2024 16  Objective # ( 1 ) - F Overview of Upper Limb – Communication (1) Neck (2) Back and thoracic wall UPPER LIMB The upper limb is directly related to the neck. Muscles that attach the bones of the shoulder Lying on each to the trunk are associated with the back and Lying on each side of the superior thoracic the thoracic wall. aperture at the base of the neck is an axillary Includes the trapezius, levator scapulae, inlet. rhomboid major, rhomboid minor, and Axillary inlet is the only way for vessels and latissimus dorsi. nerves to pass from neck to upper limb August 24, 2024 17 UPPER LIMB August 24, 2024 18  Objective # ( 1 ) - G Overview of Upper Limb – Function Grip UPPER LIMB  Gripping objects generally involves flexing the fingers against the thumb.  Depending on the type of grip, muscles in the hand can modify its shape. August 24, 2024 19  Objective # ( 2 ) Brachial Plexus UPPER LIMB  The brachial plexus is a somatic plexus formed by the anterior rami of C5 to C8, and most of the anterior ramus of Tl.  The plexus originates in the neck.  It passes laterally and inferiorly over and enters the axilla.  It forms the main nerve supply of the whole upper limb August 24, 2024 20  Stages of formation of Brachial Plexus: 1. Roots. UPPER LIMB 2. Trunks (3 trunks): A. Superior Trunk. B. Middle Trunk. C. Inferior Trunk. 3. Divisions. 4. Cords (3 cords): A. Lateral Cord. B. Posterior Cord. C. Medial Cord. 5. Branches. August 24, 2024 21  Objective # ( 2 ) Brachial Plexus - Branches (1) From Roots (2) From Trunk (3) From Cords 1) Long Thoracic 1) Suprascapular A. Lateral Cord B. Medial Cord C. Posterior Cord UPPER LIMB nerve. nerve M.L.L. 4M & U S.T.A.R. 2) Dorsal scapular 2) Subclavius nerve 1) Lateral Pectoral 1) Medial Pectoral 1) Subscapular nerve nerve nerve. nerve. (upper and lower). 2) Lateral Root of 2) Medial Root of 2) Thoracodorsal median nerve median nerve. nerve. 3) Musculocutaneous 3) Medial Cutaneous 3) Axillary nerve. nerve. nerve of arm. 4) Radial nerve. 4) Medial Cutaneous nerve of forearm. 5) Ulnar nerve. August 24, 2024 22 UPPER LIMB August 24, 2024 23  Clinical Correlation UPPER LIMB How to answer MCQ Case Scenario August 24, 2024 24  Case Scenario Stem UPPER LIMB A 40-year-old patient ……………………………………………………….. Leading Question? Distractors (Choices) A. ………………………. B. ………………………. C. ………………………. D. ………………………. August 24, 2024 25  A 49-year-old porter had history of recurrent severe pain in right shoulder. Stem Yesterday, in ER, he was complaining of severe pain interfering with initial abduction of his arm. UPPER LIMB Leading Which of the following tendons is commonly to be affected? Question A. Subclavius. B. Supraspinatus. Distractors C. Serratus anterior. D. Supinator. August 24, 2024 26  A 49-year-old porter had history of recurrent severe pain in right shoulder. Stem Yesterday, in ER, he was complaining of severe pain interfering with initial abduction of his arm. UPPER LIMB Leading Which of the following tendons is commonly to be affected? Question A. Subclavius. B. Supraspinatus. Distractors C. Serratus anterior. D. Supinator. August 24, 2024 27