Anatomy of upper limb_ Dr. Joy F2024.pdf

MSK-Anatomy of upper limb ANT.6: Understand the structural organization of the upper limb and the functional and clinical correlations. Dr. Teresa Joy Assistant Professor of Anatomy...

MSK-Anatomy of upper limb ANT.6: Understand the structural organization of the upper limb and the functional and clinical correlations. Dr. Teresa Joy Assistant Professor of Anatomy Office- Block C GC 22 Email: [email protected] [email protected] Study Materials  Learning Objectives ANT.6: Understand the structural organization of the upper limb and the functional and clinical correlations. Given a clinical scenario, image, or description, students should be able to: ANT.6.1. Identify key anatomical landmarks of the bones of the upper limb. ANT.6.2. Describe how weight is transmitted from the hand to the axial skeleton. ANT.6.3. Recognize the muscles of the pectoral, scapular, and shoulder regions, their innervation, and actions. ANT.6.4. Recognize the fascial compartments of the arm and forearm, delineating the muscles, their innervation, and actions. ANT.6.5. Recognize the muscles of the hand, their innervation, and actions. ANT.6.6. Recognize the joints of the upper limb, movements at these joints, and the main muscles acting on them. [email protected] ANT.6.1. Identify key anatomical landmarks of the bones of the upper limb. ANT.6.2. Describe how weight is transmitted from the hand to the axial skeleton.  The appendicular skeleton 2 pairs of limbs and 2 girdles 3 regions – arm, forearm, hand Bones of upper extremity (limb) Arm or Brachium – between shoulder and elbow - Humerus Forearm or Antebrachium – between elbow and wrist – Radius & Ulna Hand includes: Wrist (carpus) – 8 carpal bones Palm (metacarpus) – 5 metacarpal bones Fingers (phalanges) – thumb (pollex) has 2; fingers have 3: proximal, middle, distal).  Carpal bones : She Looks Too Pretty Try To Catch Her Proximal row (lateral to medial) Scaphoid Lunate Radius Ulna Triquetral Scaphoid Lunate Pisiform Triquetral Trapezium Pisiform Distal row (lateral to medial) Hamate Trapezoid Trapezium Capitate Trapezoid Capitate Hamate Metacarpal bones  Carpal bones : She Looks Too Pretty Try To Catch Her Proximal row (lateral to medial) Scaphoid Lunate Radius Ulna Triquetral Scaphoid Lunate Pisiform Triquetral Trapezium Pisiform Distal row (lateral to medial) Hamate Trapezoid Trapezium Capitate Trapezoid Capitate Hamate Metacarpal bones  Pectoral girdle (shoulder girdle) Clavicle – anterior; collar/beauty bone Sternal end articulates to manubrium medially Acromial end articulates with scapula laterally Scapula – posterior; shoulder blade  Anatomical landmarks of the bones of the upper limb Clavicle Scapula: coracoid process, acromion process, spine Greater & lesser tubercles of humerus Medial and lateral epicondyles of humerus Ulna: olecranon process, styloid process of ulna Radius: radial head, styloid process of radius Metacarpal heads and phalanges ANT.6.2. Describe how weight is transmitted from the hand to the axial skeleton. Forces of the upper limb are transmitted to the axial skeleton by clavicle via costoclavicular ligament and sternoclavicular joint. Fall On Outstretched Hand (FOOSH) ANT.6.3. Recognize the muscles of the pectoral, scapular, and shoulder regions, their innervation, and actions. Where do the nerves of upper limb originate from? Brachial plexus Color codes Artery Vein Nerve Muscle  Axio-appendicular/ thoraco-appendicular/pectoral muscles Moves the pectoral girdle Pectoralis major Pectoralis major Pectoralis minor Serratus anterior Serratus anterior Subclavius Pectoralis minor Subclavius Pectoralis major Pectoralis major Lateral pectoral nerve Large fan shaped muscles covers the superior part of thorax Medial pectoral nerve Forms the anterior axillary fold Nerve supply – medial n lateral pectoral nerve Action – adduction ‘n medial rotation of arm Pectoralis minor Pectoralis minor Minor muscle Nerve supply – medial pectoral nerve Action – stabilizes scapula Serratus Anterior “Boxer’s muscle”- pulls the scapula anteriorly, giving the boxer more reach & power to their fists Covers the lateral part of thorax Nerve supply – long thoracic nerve of Bell (Nerve to serratus Long thoracic anterior) nerve of Bell Action – stabilizes scapula Serratus anterior Responsible for the protraction of the scapula, a movement that occurs when throwing a punch SALT- Serratus Anterior supplied by Long Thoracic nerve Winging of scapula Muscle Nerve Actions supply(innervation) Lateral pectoral (C5-C7) & Flexes, adducts and medially Pectoralis major medial pectoral(C8- T1) rotates the arm at shoulder nerves Pectoralis minor Medial pectoral(C8- T1) Stabilizes scapula by drawing nerves inferiorly and anteriorly against thoracic wall Long thoracic nerve (C5, Protracts scapula and holds it Serratus anterior C6,C7) against thoracic wall; rotates scapula Subclavius Nerve to subclavius(C5- Depresses and anchors C6) clavicle Posterior Axioappendicular Muscle Trapezius Levator scapulae Rhomboid Latissimus dorsi minor & major Trapezius Levator scapulae Rhomboid major & minor Muscle Nerve supply Actions Trapezius Motor fibers- spinal accessory Descending (superior) nerve (CN XI) part elevates, ascending (inferior) Proprioceptive fibers- C3,C4 part depresses, and middle part (or all spinal nerves parts together) retracts scapula; descending and ascending parts act Latissimus dorsi together to rotate glenoid cavity superiorly. Latissimus dorsi Thoracodorsal nerve (C6, Extends, adducts, and medially rotates C7,C8) shoulder joint; raises body toward arms during climbing Levator Dorsal scapular (C5) and Elevates scapula and rotates scapulae cervical (C3, C4) spinal nerves glenoid cavity inferiorly Rhomboid minor Dorsal scapular nerve (C4, C5) Retracts scapula and rotates glenoid and major cavity inferiorly; fix scapula to thoracic wall  Muscles of Scapular & Shoulder region – innervation and actions SITS- Rotator cuff Deltoid Teres major Muscles of shoulder Supraspinatus Infraspinatus Teres minor Subscapularis Other muscles to the scapula Levator scapulae Rhomboideus minor Rhomboideus major Serratus anterior Latissimus dorsi  Supraspinatus: performs initial 15° Abduction of arm at shoulder joint Infraspinatus: lateral rotation of arm; pitching(bringing arm back) Nerve supply : Suprascapular nerve Teres minor: Adduction & lateral rotation of arm Nerve supply: Axillary nerve LaTI Lateral rotation – Teres minor + Infraspinatus Costal surface of scapula: Subscapularis Action : Adduction and medial rotation of arm Nerve supply: upper & lower subscapular nerve  Musculotendinous/Rotator cuff – SITS structures Supraspinatus, Infraspinatus, Teres minor & Subscapularis - Form a musculotendinous rotator cuff around the shoulder joint, keeping the head of the humerus firmly within the shallow socket of scapula. Posterior Anterior Lateral view Anterior view Deltoid muscle Anterior fibres – from clavicle Middle fibres – acromion process of scapula Posterior fibres – spine of scapula Nerve supply – Axillary nerve Actions – Anterior fibres- flexion and medial rotation of shoulder Middle fibres – abduction of shoulder from 15-90° Posterior fibres – extension and lateral rotation Note: Axillary nerve- supplies Deltoid and Teres minor  Nerve supply of pectoral & shoulder muscles https://www.bookwidgets.com/play/2hIKERio- iQAFAjPyFgAAA/HFTWBHG?teacher_id=5602236642623488 https://www.bookwidgets.com/play/CLA4RTMD-iQAEvViEFgAAA/2FTJT2A/actions- of-pect?teacher_id=5602236642623488 Let's identify Muscles Nerve supply Actions Supraspinatus Suprascapular nerve (C4, C5, C6) Initiates and assists deltoid in abduction of shoulder joint and acts with other rotator cuff muscles Infraspinatus Suprascapular nerve (C4, C5, C6) Laterally rotates shoulder joint and acts with other rotator cuff muscles Teres minor Axillary nerve (C5, C6) Teres major Lower subscapular nerve (C5, C6) Adducts and medially rotates shoulder joint Subscapularis Upper and lower subscapular nerves Medially rotates and adducts shoulder joint (C5, C6, C7) and acts with other rotator cuff muscles Deltoid Axillary nerve (C5, C6) Clavicular (anterior) part flexes and medially rotates shoulder joint; acromial (middle) part abducts shoulder joint; spinal (posterior) part extends and laterally rotates shoulder joint. ANT.6.4. Recognize the fascial compartments of the arm and forearm, delineating the muscles, their innervation, and actions.  Arm Fascial compartments of Forearm the upper limb Wrist Fascial compartment of arm with muscles, their innervation & action Anterior compartment Posterior compartment Muscles of anterior (flexor compartment) of ARM (brachium) Muscles Biceps brachii Brachialis Musculocutaneous nerve Short head of biceps Coracobrachialis Coracobrachialis Long head of biceps Nerve supply: Coracobrachialis Musculocutaneous Long head of biceps Musculocutaneous nerve nerve Short head of biceps Action: flexion of elbow joint Brachialis Muscles of posterior (extensor compartment) of ARM (brachium) Muscle Triceps brachii Nerve supply: radial nerve Lateral head of triceps Action: extension of elbow Radial nerve joint Long head of triceps Branch of Radial nerve Long head of biceps Branch Lateral head of of Radial triceps nerve Medial head of triceps ANT.6.5. Recognize the muscles of the hand, their innervation, and actions. Muscles of forearm (antebrachium) Compartment in the forearm  Let's learn the terminologies!! Digitorum – of the fingers Pollex (pollicis) – thumb Digiti minimi – little finger Indicis – index finger Carpi – wrist Radialis – relating to radius Ulnaris – relating to ulna Longus – long muscle Brevis – short muscle Muscles of front (Anterior/flexor compartment) of Forearm 5 superficial muscles 5 superficial muscles 3 deep muscles Intermediate layer Flexor digitorum 3 deep muscles Flexor carpi profundus Flexor radialis pollicis Nerve supply: Median Pronator teres longus nerve – laborer’s nerve Palmaris Pronator Partly by ulnar nerve longus quadratus Flexor Flexor carpi digitorum ulnaris superficialis Muscles of front (Anterior/flexor compartment) of Forearm 5 superficial muscles 5 superficial muscles 3 deep muscles Intermediate layer Flexor digitorum 3 deep muscles Flexor carpi profundus Flexor radialis pollicis Nerve supply: Median Pronator teres longus nerve – laborer’s nerve Palmaris Pronator Partly by ulnar nerve longus quadratus Flexor Flexor carpi digitorum ulnaris superficialis  Superficial layer Intermediate layer Deep layer Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor pollicis Flexor digitorum longus Flexor digitorum superficialis Pronator profundus quadratus Median nerve Anterior compartment supplied by Median nerve mainly Partly by ulnar nerve – medial 1/3rd of flexor digitorum profundus  Muscles of back (Posterior/extensor compartment) of Forearm 6 superficial muscles Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor carpi ulnaris Extensor digiti minimi Back of forearm – 5 deep muscles Nerve supply – radial nerve Supinator Actions – extension at the wrist joint Extensor pollicis longus Abductor pollicis longus Extensor indicis Extensor pollicis brevis  Intrinsic muscles of hand Lateral group 4 thenar muscles Medial group 3 hypothenar muscles Palmaris brevis Central group 4 lumbricals 3 palmar interossei 4 dorsal interossei  Thenar muscles Abductor pollicis brevis Thenar eminence – Hypothenar Flexor pollicis brevis supplied by eminence Opponens pollicis median nerve Adductor pollicis Hypothenar muscles Thenar eminence Adductor pollicis Abductor digiti minimi Flexor digiti minimi Opponens digit minimi Palmaris brevis Palmaris brevis  Abduction: Abductor Pollicis Longus & Brevis(APL, APB) Adduction: Adductor Pollicis (AD) Movements of the thumb/pollex Extension: Extensor Pollicis Longus & Brevis(EPL, EPB) Flexion: Flexor Pollicis Longus & Brevis (FPL, FPB) Opposition: Opponens Pollicis Red arrow – location of metacarpophalangeal joint Green arrow – location of carpometacarpal joint  LUMBRICALS Interossei 4 in number 3 palmar interossei, 4 dorsal interossei – supplied by deep branch of ulnar nerve Adduction Abduction 1st & 2nd lumbricals 3rd & 4th lumbricals 1 2 3 4 Nerve supply 1st & 2nd – median nerve 3rd & 4th - ulnar nerve (deep br) Adduction Abduction Action Action PAD: Palmar interossei: Flexion: metacarpophalangeal ADduction of fingers joint DAB : Dorsal interossei: Extension: interphalangeal joint ABduction of fingers Intrinsic muscles of hand Nerve supply: Ulnar nerve (mainly) : musician’s nerve Median nerve (partly) – thenar muscles + 1st & 2nd lumbricals https://www.bookwidgets.com/play/EtmljaHa-iQAFTgat5gAAA/6FTT26J/compartment- of?teacher_id=5602236642623488 https://www.bookwidgets.com/play/BQu9XG4u-iQAF8UzqFgAAA/MFT7NML/muscular- compar?teacher_id=5602236642623488 ANT.6.6. Recognize the joints of the upper limb, movements at these joints, and the main muscles acting on them. Shoulder (glenohumeral) joint Articular surfaces Glenoid cavity of Head of humerus scapula Type Synovial B Multi-axial A Ball & socket variety of synovial joint Articular surfaces Glenoid cavity: small & shallow Head of humerus: 4 times larger A – glenoid cavity B – head of humerus Joints has great mobility but less stability  Movements and muscles acting Movements Muscles Flexion Pectoralis major (clavicular head); deltoid (clavicular and anterior acromial parts) Extension Deltoid (spinal part) Teres major; latissimus dorsi; long head of triceps brachii Abduction Supraspinatus, Deltoid Adduction Pectoralis major, Latissimus dorsi, Teres major Medial rotation Subscapularis, Pectoralis major; deltoid (clavicular part); Latissimus dorsi; Teres major Lateral rotation Infraspinatus, Teres minor; Deltoid (spinal part)  Anterior Posterior Elbow joint Olecranon fossa Type Olecranon Hinge type of synovial joint Uniaxial Capitulum Trochlea Articular surfaces Head of radius Humero-ulnar joint: lower end of humerus has trochlea notch of ulna Humero-radial joint: lower end of humerus has capitulum with head of Lateral radius Movements : flexion & extension of forearm Trochlea notch Radioulnar joints Superior radioulnar joint Middle radioulnar joint Inferior radioulnar joint Middle radioulnar joint Movements- supination & pronation Wrist (radiocarpal)joint Type Condyloid type of synovial joint Articular surfaces Lower end of radius Scaphoid, lunate and articular disc Movements Flexion –extension Abduction- adduction Circumduction Ulna does not contribute to the formation of wrist joint  Flash cards to review https://www.bookwidgets.com/play/9lUMBnp C-iQAEn4DEFgAAA/NFUJWNW/flash-cards- upp?teacher_id=5602236642623488  Dr. Joy [email protected] Acknowledgment : Dr. Amith Ramos