teres major origin
inferior angle of scapula
teres major insertion
crest of lesser tuberosity of the humerus (anterior angle)
teres major innervation
lower subscapular nerves (C5-C7)
teres major action
internal rotation, adduction, extension
teres minor origin
lateral border of scapula
teres minor insertion
greater tuberosity of humerus
teres minor innervation
axillary nerve (C5-C6)
teres minor action
external rotation, weak adduction
supraspinatus origin
supraspinous fossa of scapula
supraspinatus insertion
greater tuberosity of humerus
supraspinatus innervation
suprascapular nerve (C4-C6)
supraspinatus action
abduction
infraspinatus origin
infraspinous fossa of scapula
infraspinatus insertion
greater tuberosity of humerus
infraspinatus innervation
suprascapular nerve (C4-C6)
infraspinatus action
external rotation
subscapularis origin
subscapular fossa of scapula
subscapularis insertion
lesser tuberosity of humerus
subscapularis innervation
lower and upper sub scapular nerves (C5-C6)
subscapularis action
internal rotation
trapezius origin (descending, transverse, ascending)
descending part- occipital bone, spinous process of C1-C7
transverse part- aponeurosis at T1-T4 spinous process
ascending part- spinous process of T5-T12
trapezius insertion (descending, transverse, ascending)
descending part- clavicle (lateral one third)
transverse part- acromion
ascending part- scapular spine
trapezius innervation
spinal accessory nerve (CN XI)
trapezius action (descending, transverse, ascending)
steadies scapula on thorax
descending part- draws scapula obliquely upward; rotates glenoid cavity superiorly; tilts head to same side and rotates it to opposite
transverse part- draws scapula medially
ascending part- draws scapula medially downward
levator scapulae origin
transverse process of C1-C4
lavator scapulae insertion
scapula (superior angle)
lavator scapulae innervation
dorsal scapular nerve (C4-C5)
lavator scapulae action
-draws scapula medially upward, while moving inferior angle medially
-inclines neck to same side
rhomboid minor origin
spinous process of C6, C7
rhomboid minor insertion
medial border of scapula above scapular spine
rhomboid minor innervation
dorsal scapular nerve (C4, C5)
rhomboid minor action
-steadies scapula
-draws scapula medially upward (retracts scapula and tilts glenoid cavity inferiorly)
rhomboid major origin
spinous process of T1-T4 vertebrae
rhomboid major insertion
medial border of scapula below scapular spine
rhomboid major innervation
dorsal scapular nerve (C4, C5)
rhomboid major action
-steadies scapula
-draws scapula medially upward (retracts scapula and tilts glenoid cavity inferiorly)
deltoid origin (clavicular, acromial, spinal)
clavicular part- lateral one third of clavicle
acromial part- acromion
spinal part- scapular spine
deltoid insertion
deltoid tuberosity of humerus
deltoid innervation
axillary nerve (C5-C6)
deltoid action (clavicular, acromial, spinal)
clavicular part- flection, internal rotation, adduction
acromial part- abduction
spinal part- extension, external rotation, adduction
latissimus dorsi origin (vertebral, scapular, costal, iliac)
vertebral part- spinous process of T7-T12 vertebrae; thoracolumbar fascia
scapular part- inferior angle of scapula
costal part- ribs 9-12
iliac part- iliac crest (posterior one third)
latissimus dorsi insertion
crest of lesser tuberosity of the humerus (anterior angle)
latissimus dorsi innervation
thoracocodorsal nerve (C6-C8)
latissimus dorsi action
-internal rotation
-adduction
-extension
-respiration (cough muscle)
pectoralis major origin (clavicular, sternocostal, abdominal)
clavicular part- clavicle (medial half)
sternocostal part- sternum and costal cartilage of ribs 1-6
abdominal part- rectus sheath (anterior layer)
pectorals major insertion
humerus (crest of greater tuberosity)
pectorals major innervation
medial and lateral pectoral nerves (C5-T1)
pectorals major action (clavicular, sternocostal)
shoulder adduction and internal rotation
clavicular and sternocostal parts- shoulder flexion, assist in respiration when shoulder is fixed
pectoralis minor origin
ribs 3-5 near costal cartilages
pectoralis minor insertion
scapula coracoid process
pectoralis minor innervation
medial pectoral nerve (C6-T1)
pectoralis minor action
-draws scapula downward, causing inferior angle to move posteromedially
-rotates glenoid cavity interiorly
-assists in respiration
subclavius origin
first rib
subclavius insertion
inferior surface of clavicle
subclavius innervation
nerve to subclavius (C5, C6)
subclavius action
steadies the clavicle in the sternoclavicular joint
serratus anterior origin
1st to 9th ribs
serratus anterior insertion
scapula (medial border)
serratus anterior innervation
long thoracic nerve (C5-C7)
serratus anterior action (entire muscle, superior, inferior)
entire muscle- protraction, elevates ribs when shoulder is fixed
superior- lowers raised arm
inferior- rotates scapula laterally
biceps brachii origin (short head, long head)
short head- coracoid process of scapula
long head- supraglenoid tubercle of scapula
biceps brachii insertion
radius - tuberosity
biceps brachii innervation
musculocutaneous nerve (C5-C6)
biceps brachii action
-elbow joint flexion
-supination shoulder joint flexion
-stabilization of humeral head during deltoid contraction
-abduction and internal rotation of humerus
brachialis origin
humerus (distal half of anterior surface)
brachialis insertion
ulnar tuberosity
brachialis innervation
musculocutaneous nerve (C5-C6)
radial nerve (C7, minor)
brachialis action
elbow flexion
coracobrachialis origin
coracoid process of scapula
coracobrachialis insertion
humerus (in line with crest of lesser tuberosity)
coracobrachalis innervation
musculocutaneous nerve (C6-C7)
coracobrachialis action
shoulder flexion, adduction, internal rotation
triceps brachii origin (long head, lateral head, medial head)
long head- infraglenoid tubercle of scapula
lateral head- posterior humerus, proximal to radial groove; lateral intermuscular septum
medial head- posterior humerus, distal to radial groove; medial intermuscular septum
triceps brachii insertion
olecranon of ulna
triceps brachii innervation
radial nerve (C6-C8)
triceps brachii action
-elbow extension
-long head- shoulder extension and adduction
anconeus origin
lateral epicondyle of humerus
anconeus insertion
olecranon of ulna
anconeus innervation
radial nerve (C7, C8, T1)
anconeus action
-assists triceps in elbow extension
-stabilizes elbow joint
-abducts ulna during forearm pronation
pronator teres origin (humeral head, ulnar head)
humeral head- medial epicondyle of humerus
ulnar head - coronoid process
pronator teres insertion
lateral radius (distal to supination insertion)
pronator teres innervation
median nerve (C6-C7)
pronator teres action
-forearm pronation
-weak elbow flexor
flexor carpi radialis origin
medial epicondyle of humerus
flexor carpi radialis insertion
base of 2nd metacarpal
flexor carpi radialis innervation
median nerve (C6, C7)
flexor carpi radialis action
wrist flexion and abduction (radial deviation) of hand
palmaris longus origin
medial epicondyle of humerus
palmaris longus insertion
palmar aponeurosis
palmaris longus innervation
median nerve (C7, C8)
palmaris longus action
-wrist flexion tightens palmar aponeurosis
-weak elbow flexion
flexor carpi ulnaris origin (humeral head, ulnar head)
humeral head: medial epicondyle
ulnar head: olecranon
flexor carpi ulnaris insertion
-pisiform
-hook of hamate
-base of 5th metacarpal
flexor carpi ulnaris innervation
ulnar nerve (C7-T1)
flexor carpi ulnaris action
wrist flexion and adduction (ulnar deviation) of hand
flexor digitorum superficialis origin (humeral, ulnar head)
humeral head- medial epicondyle
ulnar head- coronoid process
flexor digitorum superficialis insertion
sides of middle phalanges of 2nd to 5th digits
flexor digitorum superficialis innervation
median nerve (C8, T1)
flexor digitorum superficialis action
-flexion of wrist
-MCP, and PIP joints of 2nd to 5th digits
-weak elbow flexor
flexor digitorum profundus origin
ulna (two thirds of flexor surface) and interosseous membrane
flexor digitorum profundus insertion
distal phalanges of 2nd to 5th digits (palmar surface)
flexor digitorum profundus innervation
medial half by medial nerve (C8, T1)
ulnar half by ulnar nerve (C8-T1)
flexor digitorum profundus action
-flexion of wrist
-MCP, PIP, DIP of 2nd to 5th digits
flexor pollicis longus origin
origin: radius (midanterior surface) and adjacent interosseous membrane
flexor pollicis longus insertion
distal phalanx of thumb (palmar surface)
flexor pollicis longus innervation
median nerve (C7, C8)
flexor pollicis longus action
-wrist flexion and abduction (radial deviation) of hand
-carpometacarpal of thumb flexion, MCP and PIP flexion
pronator quadratus origin
distal quarter of ulna (anterior surface)
pronator quadratus insertion
distal quarter of radius (anterior surface)
pronator quadratus innervation
median nerve (C7,C8)
pronator quadratus action
-hand pronation
-distal radioulnar joint stabilization
brachioradialis origin
lateral supraepicondylar ridge of distal humerus, lateral intermuscular septum
brachioradialis insertion
styloid process of radius
brachioradialis innervation
radial nerve (C5, C6, C7)
brachioradialis action
-elbow flexion
-forearm semipronation
extensor carpi radialis longus origin
lateral supraepicondylar ridge of distal humerus, lateral intermuscular septum
extensor carpi radialis longus insertion
base of 2nd metacarpal
extensor carpi radialis longus innervation
radial nerve (C6, C7)
extensor carpi radialis longus action
-wrist extension and abduction (radial deviation)
-weak elbow flexion
extensor carpi radialis brevis origin
lateral epicondyle of humerus
extensor carpi radialis brevis insertion
base of 3rd metacarpal
extensor carpi radialis brevis innervation
radial nerve (C7, C8)
extensor carpi radialis brevis action
-wrist extension and abduction (radial deviation)
-weak elbow flexion
Extensor digitorum origin
lateral epicondyle
Extensor digitorum insertion
dorsal digital expansion of 2nd to 5th digits
Extensor digitorum innervation
radial nerve (C7, C8)
Extensor digitorum action
wrist extension, MCP, PIP, and DIP of 2nd to 5th digits extension/abduction of fingers
Extensor digiti minimi origin
lateral epicondyle of humerus
Extensor digiti minimi insertion
dorsal digital expansion of 5th digit
Extensor digiti minimi innervation
radial nerve (C7, C8)
Extensor digiti minimi action
wrist extension, ulnar addiction of hand, MCP, PIP, and DIP of 5th digit
extension and abduction
Extensor carpi ulnaris origin
lateral epicondyle of humerus, ulnar head (dorsal surface)
Extensor carpi ulnaris insertion
base of 5th metacarpal
Extensor carpi ulnaris innervation
radial nerve (C7, C8)
Extensor carpi ulnaris action
wrist extension and adduction (ulnar deviation) of hand
supinator origin
olecranon, lateral epicondyle of humerus, radial collateral ligament, anular ligament
supinator insertion
radius (between radial tuberosity and insertion of pronator teres)
supinator innervation
radial nerve (C6, C7)
supinator action
radioulnar joint supination
Abductor pollicis longus origin
radius and ulna (dorsal surfaces, interosseous membrane)
Abductor pollicis longus insertion
base of 1st metacarpal
Abductor pollicis longus innervation
interosseous nerve from deep branch of radial nerve (C7, C8)
Abductor pollicis longus action
-abduction of the hand at radoiocarpal joint
-carpometacarpal joint of thumb abduction
Extensor pollicis brevis origin
posterior surface of radius, interosseous membrane
Extensor pollicis brevis insertion
base of proximal phalanx of thumb
Extensor pollicis brevis innervation
radial nerve (C7, C8)
Extensor pollicis brevis action
-radiocarpal joint: abduction (radial deviation) of hand
-Carpometacarpal and MCP of thumb extension
Extensor pollicis longus origin
posterior surface of ulna, interosseous membrane
Extensor pollicis longus insertion
base of distal phalanx of thumb
Extensor pollicis longus innervation
radial nerve
Extensor pollicis longus action
wrist extension and abduction (radial deviation) of hand, thumb carpometacarpal joint adduction, MCP and IP joint of thumb extension
Extensor indicis origin
posterior surface of ulna, interosseous membrane
extensor indices insertion
posterior digital expansion of 2nd digit
extensor indices innervation
posterior interosseous nerve from deep branch of radial nerve (C7, C8)
extensor indices action
wrist extension, MCP, PIP, and DIP of 2nd digit extension
abductor pollicis brevis origin
scaphoid bone and trapezium, flexor retinaculum
abductor pollicis brevis insertion
thumb (base of proximal phalanx) via radial sesamoid
abductor pollicis brevis innervation
median nerve (C8, T1)
abductor pollicis brevis action
CMC joint of thumb abduction
flexor pollicis brevis origin
-Superficial head- flexor retinaculum
-Deep head- capitate bone, trapezium
flexor pollicis brevis insertion
thumb (base of proximal phalanx) via radial sesamoid
flexor pollicis brevis innervation
superficial head - median nerve (C8, T1)
flexor pollicis brevis action
CMC joint of thumb flexion
Opponens pollicis origin
trapezium
Opponents pollicis insertion
first metacarpal (radial border)
Opponens pollicis innervation
median nerve (C8, T1)
Opponens pollicis action
CMC joint of thumb opposition
adductor pollicis origin
-Transverse head- 3rd metacarpal (palmar surface)
-Oblique head- capitate bone, 2nd and 3rd metacarpal bases
adductor pollicis insertion
thumb (base of proximal phalanx) via ulnar sesamoid
adductor pollicis innervation
ulnar nerve (C8, T1)
adductor pollicis action
-CMC joint of thumb adduction
-MCP joint of thumb flexion
Abductor Digiti minimi origin
pisiform bone
Abductor Digiti minimi insertion
5th proximal phalynx (ulnar base) and dorsal digital expansion of 5th digit
Abductor Digiti minimi innervation
ulnar surface (C8, T1)
Abductor Digiti minimi action
-MCP joint of little finger flexion
-abduction of little finger
PIP and DIP joints of little finger extension
Flexor digiti minimi origin
hook of hamate, flexor retinaculum
Flexor digiti minimi insertion
5th proximal phalanx (base)
Flexor digiti minimi innervation
ulnar nerve (C8, T1)
Flexor digiti minimi action
MCP joint of little finger flexion
Opponens digiti minimi origin
hook of hamate, flexor retinaculum
Opponens digiti minimi insertion
5th metacarpal (ulnar border)
Opponens digiti minimi innervation
ulnar nerve (C8, T1)
Opponens digiti minimi action
draws metacarpal in palmar direction (opposition)
Dorsal Interossei origin
adjacent metacarpals 1-5
Dorsal Interossei insertion
dorsal digital expansion of digits 2,3,4 and proximal phalanges 2,3,4
Dorsal Interossei innervation
ulnar nerve (C8, T1)
Dorsal Interossei action
-2nd to 4th digit MCP joint flexion
-2nd to 4th digit PIP and DIP joint extension
-abduction from 3rd digit
Palmar interossei origin
2nd metacarpal, 4th metacarpal, 5th metacarpal
Palmar interossei insertion
dorsal digital expansion digits 2,4,5 and proximal phalanges 2,4,5
Palmar interossei innervation
ulnar nerve (C8, T1)
Palmar interossei action
-2nd, 4th, 5th digits MCP joints flexion
-2nd, 4th, 5th digits DIP and PIP joint extension
-Adduction toward 3rd digit
Lumbricals origin
tendons of flexor digitorum profundus
Lumbricals insertion
dorsal digital expansion digits 2,3,4,5
Lumbricals innervation
1st & 2nd - median nerve (C8, T1)
3rd & 4th - ulnar nerve (C8, T1)
Lumbricals action
2nd-5th digits MCP joint flexion
PIP and DIP joint extension
Synergists- scapula depression
Trapezius (lower fibers)
Serratus anterior (with origin fixed)
Pectoralis minor
Synergists- scapula elevation
Trapezius (upper fibers)
Rhomboid major
Rhomboid minor
Levator scapula
Synergists- scapula adduction
Trapezius (middle fibers)
Rhomboid major
Rhomboid minor
Synergists- scapula abduction
Serratus anterior (with origin fixed)
Pectoralis minor
Synergists- upward rotation of the scapula
Trapezius (upper and lower fibers)
Serratus anterior (with the origin fixed)
Synergists- downward rotation of the scapula
Rhomboid major
Rhomboid minor
Levator scapula
Pectoralis minor
Synergists- shoulder flexion ( antagonists on extension)
Deltoid (anterior fibers)
Pectoralis major (upper fibers)
Biceps brachii
Caracobrachialis
Synergists- shoulder extension (antagonists on flexion)
Deltoid (posterior fibers)
Latissimus Doris
Teres major
Pectoralis major (lower fibers)
Triceps brachii (long head)
Synergists- shoulder horizontal abduction
Deltoid (posterior fibers)
Synergists- shoulder horizontal adduction
Deltoid (anterior fibers)
Pectoralis major (upper fibers)
Synergists- shoulder abduction
Deltoid (all fibers)
Supraspinatus
Synergists- shoulder adduction
Latissimus Doris
Teres major
Infraspinatus
Teres minor
Pectoralis major (all fibers)
Triceps brachii (long head)
Coracobrachialis
Synergists- shoulder lateral (external) rotation
Deltoid (posterior fibers)
Infraspinatus
Teres major
Synergists- shoulder medial (internal) rotation
Deltoid (anterior fibers)
Latissimus Doris
Teres major
Subscapularis
Pectoralis major (all fibers)
Synergists- elbow flexion
Biceps brachii
Brachialis
Brachioradialis
Flexor carpi radialis (assists)
Flexor carpi ulnaris (assists)
Palmaris longus (assists)
Pronator teres (assists)
Extensor carpi radialis longus (assists)
Extensor carpi radialis brevis (assists)
Synergists- elbow extension
Triceps brachii (all heads)
Anconeus
Synergists- forearm supination
Biceps brachii
Supinator
Brachioradialis (assists)
Synergists- forearm pronation
Pronator teres
Pronator quadratus
Brachioradialis (assists)
Synergists- wrist extensions
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum (assists)
Extensor indicis (assists)
Synergists- wrist flexion
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus (assists)
Flexor pollicis longus (assists)
Synergists- wrist abduction (radial deviation)
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor pollicis longus
Extensor pollicis brevis
Flexor carpi radialis
Abductor pollicis longus
Synergists- wrist adduction (ulnar deviation)
Extensor carpi ulnaris
Flexor carpi ulnaris
Synergists- thumb flexion
Flexor pollicis longus
Flexor pollicis brevis
Adductor pollicis (assists)
Palmar interossei (1st assists)
Synergists- thumb extension
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
Palmar interossei (1st assists)
Synergists- thumb opposition
Oppenens pollicis
Flexor pollicis brevis (assists)
Abductor pollicis brevis (assists)
What are the four major segments of the upper limb?
Shoulder
Arm
Forearm
Hand
Regions of the shoulder
Pectoral
Scapular
Deltoid
Regions of the arm
Anterior and posterior arm
Regions of the forearm
Anterior and posterior forearm
Regions of the hand
Wrist
Palm
Dorsum
Digits
Osteology of the superficial back and scapular region
Clavicle
Scapula
Proximal end and body of humerus
Occipital bone
Vertebrae
Nuchal ligament
Ilium
Superficial posterior thoracoappendicular muscles
Trapezius
Latissimus Dorsi
Deep posterior thoracoappendicular muscles
Levator scapulae
Rhomboid minor
Rhomboid major
Scapulohumeral muscles
Deltoid
Teres major
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Rotator cuff muscles
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
What is located in the deep fascia of the superficial back?
Thoracolumbar fascia
What arteries are in the thyrocervical trunk?
Suprascapular
Transverse Cervical
Dorsal Scapular
What artery does the thyrocervical trunk come from?
Subclavian artery
What does the suprascapular artery supply?
Travels with suprascapular nerve found in scapular notch, supplies supraspinatus and infraspinatus
What does the transverse cervical artery supply?
Trapezius
What does the dorsal scapular artery supply?
Supplies rhomboids
What are the boundaries of the quadrangular space?
Superior - teres minor
Medial - long head of triceps
Inferior - teres major
Lateral - lateral head of triceps
What are the contents of the quadrangular space?
Axillary nerve
Posterior circumflex numeral artery
What are the boundaries of the triangular space?
Superior - teres minor
Inferior - teres major
Lateral - long head of triceps
What are the contents of the triangular space?
Circumflex scapular artery
What are the external features of the breast?
Areola
Nipple
Areola
Contains numerous sebaceous glands, which enlarge during pregnancy and secrete an oily substance that provides a protective lubricant
What does the breast consist of?
Glandular and supporting fibrous tissue embedded within a fatty matrix
Glandular tissue
Lactiferous ducts that give rise to buds that develop into 15-20 lobules of the mammary gland, which constitute the parenchyma of the mammary gland
Suspensory ligaments
Help support the lobes and lobules of the mammary gland
What bones make up the sternum?
Manubrium
Body
Xyphoid
What are the 3 articulation of the sternum?
Manubriosternal joint
Sternoclavicular joint
Sternocostal joints
Surfaces and landmarks of the sternum
Jugular notch
Sternal angle
Epigastric fossa
3 types of ribs
True ribs (1-7)
False ribs (8-10)
Floating ribs (11-12)
Muscles in the pectoral region
Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior
What is located in the deep fascia in the pectoral region?
Pectoral fascia
Clavipectoral fascia
pectoral fascia
invests the pectoralis major
is continuous inferiorly with the fascia of the anterior abdominal wall
clavipectoral fascia
deep to the pectoral fascia
descends from the clavicle, encloses the subclavius and pectoralis minor
continuous inferiorly with the axillary fascia
arteries in the pectoral region
axillary artery
veins in the pectoral region
cephalic vein
axillary vein
nerves in the pectoral region
supraclavicular
anterior cutaneous branches C5
intercostal nerves (T2-T12)
what are the boundaries of the deltopectoral triangle?
superior - clavicle
medial - pectoralis major
lateral - deltoid
what are the contents of the deltopectoral triangle?
cephalic vein
deltoid branch of the thoracoacromial trunk
ligaments of the sternoclavicular joint
anterior sternoclavicular ligament
posterior sternoclavicular ligament
interclavicular ligaments
costoclavicular ligament
sternoclavicular joint
acromial end of the clavicle articulates with the acromion of the scapula
only articulation between the upper limb and the axial skeleton
general characteristics of the sternoclavicular joint
saddle type of joint but functions as a ball and socket joint
extremely strong joint, dislocation is rare
typically, where does the sternoclavicular joint fracture?
the clavicle
what ligament stabilizes the sternoclavicular joint?
costoclavicular ligament
acromioclavicular joint
strong pair of bands that unite the coracoid process of the scapula to the clavicle, critical for maintaining the integrity of the AC joint
what are the ligaments of the acromioclavicular joint?
acromioclavicular ligament
coracoclavicular ligament
conoid ligament
trapezoid ligament
scapulothoracic joint
conceptual joint" involving the muscles
muscles involved in the scapulothoracic joint
subscapularis
serratus anterior
glenohumeral joint
ball and socket joint
mobility makes this joint relatively unstable
what is the most commonly dislocated joint in adults?
the glenohumeral joint
ligaments of the glenohumeral joint
glenohumeral ligament
coracohumeral ligmaent
transverse humeral ligament
coracoacromial ligament
bursae
flattened fibrous sac lined by a synovial membrane and filled with synovial fluid
what is the function of bursae?
the lubricate and reduce friction
where are bursae located?
where tendons rub against each other, bones, or ligaments
between muscle and bone
between skin and bone
subscapular bursae
located between the tendon of the subscapularis and neck of the scapula
subacromial bursae
superior - acromion, coraco-acromial ligament, and deltoid
inferior - suprispinatus tendon and joint capusule of the glenohumeral joint
what forms the axilla?
clavicle
scapula
upper thoracic wall
humerus
related muscles
axillary fascia
axillary sheath
clavipectoral fascia
boundaries of the axilla
apex - lateral margin of rib 1, clavicle, superior margin of subscapularis
base - skin of armpit, subcutaneous tissue, axillary fascia
anterior - pectoralis major and minor muscles
posterior - subscapularis, teres major, and latissimus dorsi
medial - uppe
contents of the axilla
lymph nodes
axillary artery
brachial plexus
lymph nodes in the axilla
humeral (lateral) nodes
pectoral (anterior) nodes
subscapularis (posterior) nodes
central nodes
apical nodes
humeral (lateral) nodes
drain the upper limb, posterior medial to the axillary vein
pectoral (anterior) nodes
drain the abdominal wall, chest, mammillary glands
subscapular (posterior) nodes
drains the posterior axillary wall, back, shoulder, neck
central nodes
drains from the humeral, pectoral, and subscapular nodes
apical nodes
drains all the lymph nodes found in the axilla
origin of the axillary artery
lateral margin of the 1st rib
origin" of the brachial artery
inferior margin of teres major
what separates the 3 sections of the axillary artery
pectoralis minor
branches of the axillary artery
superior thoracic artery
thoracoacromial artery
lateral thoracic artery
subscapular artery
anterior circumflex humeral artery
posterior circumflex humeral artery
what does the superior thoracic artery supply?
the superior intercostal space
the superior part of serratus anterior
what does the thoracoacromial artery supply?
pectoral
acromial
clavicular
deltoid
what are the branches of the subscapular artery?
circumflex scapular artery
thoracodorsal artery
brachial plexus
C5 (motor)
elbow flexors
C6 (motor)
wrist extensors
C7 (motor)
elbow extensors
C8 (motor)
finger flexors
T1 (motor)
finger abduction
C5 (sensory)
lateral epicondyle
C6 (sensory)
back of thumb
C7 (sensory)
back of middle digit
C8 (sensory)
in between ring finger and pinky
T1 (sensory)
medial epicondyle
brachial fascia
lateral intermuscular fascia
medial intermuscular fascia
compartments of the arm
anterior compartment
posterior compartment
bones in the arm
distal end of the humerus
ulna
radius
median nerve injury results in
hand of benediction
ulnar nerve injury results in
claw hands
clinical breaks of the arm
ulna & radius are usually broken together
- steel plate put where they are broken to hold them together
distal end of radius
muscles in the anterior compartment of the arm
biceps brachii
brachialis
coracobrachialis
innervation of the anterior compartment of the arm
musculocutaneous nerve
what action is the anterior compartment of the arm responsible for?
elbow flexion
what muscles are located in the posterior compartment?
triceps brachii
anconeus
what is the innervation of the posterior compartment of the arm?
radial nerve
what action is associated with the posterior compartment of the arm?
elbow extension
lateral branches of the brachial artery
unnamed muscular branches
humeral nutrient
medial branches of the brachial artery
profunda brachii
superior ulnar collateral
inferior ulnar collateral
what are the branches of the profunda brachii?
ascending branch
middle collateral
radial collateral
what compartment of the arm does the profunda brachii supply?
the posterior compartment of the arm
superficial veins of the arm
cephalic and basilic vein
deep vein of the arm
brachial vein
neural elements of the arm
intercostal brachial (T2)
musculocutaneous
median
ulnar
medial brachial cutaneous
medial antibrachial cutaneous
musculocutaneous nerve injury results in
loss of elbow flexion and supination
medial brachial and antibrachial cutaneous nerve injury results in
tingling/numbness over medial aspect of the forearm
axillary nerve injury results in
inability to lift arm up all the way
radial nerve injury results in
wrist drop
what are the boundaries of the triangular interval?
superior - teres major
lateral - lateral head of triceps brachii
medial - long head of triceps brachii
what are the contents of the triangular interval?
radial nerve
profunda brachii artery
what are the boundaries of the cubital fossa?
roof - skin, subcutaneous tissue, brachial fascia, bicipital aponeurosis
superior - imaginary line connecting medial and lateral epicondyles of humerus
medial - pronator teres
lateral - brachioradialis
floor - brachialis, supinator
what are the contents of the cubital fossa?
superficial - cephalic vein (laterally), basilic vein (medially), median cubital (connects the cephalic and basilic veins)
deep - biceps brachii tendon, brachial artery, median nerve
articulations of the elbow joint
- trochlear notch of the ulna and the trochlea of the humerus
- head of the radius and capitulum of the humerus
- head of the radius and the radial notch of the ulna
what articulations are involved with flexion and extension of the forearm?
- trochlear notch of the ulna and the trochlea of the humerus
- head of the radius and capitulum of the humerus
what articulations are involved with pronation and supination of the forearm?
head of the radius and the radial notch of the ulna
articular capsule
fibrous membrane of the joint capsule that overlies the synovial membrane
encloses the joint
attaches to the medial epicondyle and the margins of the olecranon, coranoid and radial fossa of the humerus
supports flexion and extension
ligaments of the elbow
radial collateral ligament
anular ligament of radius
ulnar collateral ligament
radial collateral ligament
extends from the lateral epicondyle of humerus
reduces movement laterally
anular ligament of radius
encircles and holds the head of the radius in the radial notch of the ulna
ulnar collateral ligament
extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna
anterior cord - strongest
posterior cord - weakest
slender oblique band - deepens socket for trochlea of the humerus
reduces movement medially
what are the flexors of the arm?
brachialis and biceps brachii
what are the extensors of the arm?
triceps brachii
what is the carrying angle?
~170 degree angle made with the long axis of the fully extended ulna and the long axis of the humerus
olecranon bursae
intratendinous olecranon bursae
subtendinous olecranon bursae
subcutaneous olecranon bursae
bicipitoradial bursae
separates the biceps tendon from the anterior part of the radial tuberosity
reduces abrasion
intratendinous olecranon bursae
sometimes present on the tendon of triceps brachii
subtendinous olecranon bursae
located between the olecranon and triceps tendon
proximal to the triceps tendon attachment on olecranon
subcutaneous olecranon bursae
located in the subcutaneous connective tissue over the olecranon
what are the actions for the anterior compartment of the forearm?
wrist flexors
wrist pronators
what are the actions of the posterior compartment of the forearm?
wrist extensors
wrist supinators
what are the deep fascia of the forearm?
antebrachial fascia
-extensor retinaculum
-palmar carpal ligament
-flexor retinaculum
interosseus membrane
extensor retinaculum
holds down the extensor tendons that go to the digits
posterior (dosum side)
palmar carpal ligament
holds down the flexor tendons that go to the digits
flexor retinaculum
closes the carpel tunnel
from book of hamate and pisiform to the scaphoid and trapezium
deep and distal to PCL
anterior (palmar side)
8 carpal bones
scaphoid, lunate, triquetrum, pisiform
trapezium, trapezoid, capitate, hamate
metacarpals
forms the skeleton of the palm
between the carpus and phalanges
consists of base, body, and head
articulations of the phalanges
metacarpophalangeal (MC joint)
proximal interphalangeal (PIP joint)
distal interphalangeal (DIP joint)
what are the superficial muscles of the anterior compartment of the forearm?
pronator teres
flexor carpi radialis
palmaris longus
flexor capri ulnaris
flexor digitorum superficialis
what nerves innervate the muscles in the anterior compartment of the forearm?
median nerve
except flexor carpi ulnaris and 1/2 of flexor digitorum profundus
what are the deep muscles of the anterior compartment of the forearm?
flexor digitorum profundus
flexor policis longus
pronator quadratus
what are the superficial muscles of the posterior compartment of the forearm?
brachioradialis
extensor carpi radialis longus
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
what nerve innervates the posterior compartment of the arM?
radial nerve
what are the deep muscles of the posterior compartment of the forearm?
supinator
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
extensor indicis
what are the arteries in the forearm?
ulnar artery
radial artery
what are the branches of the ulnar artery?
anterior ulnar recurrent
posterior ulnar recurrent
common interosseous (anterior and posterior interosseous)
what are the branches of the radial artery?
radial recurrent artery
what arteries make up the dorsal and palmar carpal arches?
ulnar artery
radial artery
(carpal arches)
what are the nerves located in the forearm?
medial antebrachial cutaneous
lateral antebrachial cutaneous
median
ulnar
radial
what structures pass superficially through the flexor retinaculum?
palmar longus tendon
ulnar artery
ulnar nerve
flexor carpi ulnaris tendon
what structures pass deep through the flexor retinaculum?
carpal tunnel
flexor carpi radialis tendon
what makes up the carpal tunnel?
flexor digitorum superficialis tendon
flexor digitorium profundus tendon
flexor pollicis longus tendon
median nerve
what structures pass under the extensor retinaculum?
abductor pollicis longus
extensor pollicis brevis
extensor carpi radialis longus
extensor carpi radialis brevis
extensor pollicis longus
extensor digitorium
extensor indicis
extensor digiti minimi
extensor carpi ulnaris
what causes carpal tunnel syndrome?
inflammation of any of the tendons
compression of the median nerve
what are the boundaries of the anatomical snuff box?
lateral - abductor pollicis longus and extensor pollicis brevis
medial - extensor pollicis longus
what are the contents of the anatomical snuff box?
radial artery
cephalic vein
lateral antebrachial cutaneous nerve
superficial branch of radial nerve
what are the joints of the forearm?
proximal radioulnar joint
distal radioulnar joint
the proximal radioulnar joint allows for what movement?
pronation and supination of the forearm
what are the ligaments in the wrist?
palmar radiocarpal ligament
dorsal radiocarpal ligament
ulnar collateral ligament
radial collateral ligament
what are the movements allowed for in the wrist?
flexion
extension
abduction (radial deviation)
adduction (ulnar deviation)
circumduction
intercarpal joint movements
flexion and extension of the hand
caropmetacarpal joint movements
flexion, extension, abduction, adduction, circumduction
metacarpophalangeal joint movement
flexion, extension, abduction, adduction
interphalangeal joint movement
flexion and extension
joints of the hand
intercarpal
caropmetacarpal
intermetacarpal
metacaropphalangeal
interphalangeal
superficial fascia of the palm
continuous with the antebrachial fascia and fascia of the dorsum of the hand
what are the different fascias in the deep fascia of the palm?
thenar fascia
hypthenar fascia
palmar aponerurosis
fibrous digital sheaths
adductor interosseous fascia
thenar fascia
covers the muscles that help control the thumb
hypothenar fascia
covers the muscles that help control the pinky
palmar aponeurosis
palmaris longus tendon pulls on this aponeurosis
fibrous digital sheaths
help hold down the long flexor tendon (flexor digitorum superficialis, flexor digitorum profundus)
adductor interosseous fascia
helps adduct the thumb
fascial spaces
thenar space
midpalmar space
fibrous digitial sheaths
- only found on the palmar side
- continuous with the palmar aponeurosis
- osseofibrous tunnel for synovial sheaths of tendons of finger flexor
extensor expansions
- triangular shaped aponeurosis that wraps around sides of metacarpal and proximal phalanx
- holds extensor tendon in middle of digit
- serves as an attachment for interossei and lumbricals
what is located in the central compartment of the hand?
flexor tendons
lumbricals
superficial palmar arch
median nerve
ulnar nerve
what is located in the thenar compartment of the hand?
tendon of flexor pollicis longus
thenar muscles (except adductor pollicis)
recurrent branch of median nerve
what is located in the hypothenar compartment of the hand?
hypothenar muscles
deep branch of ulnar nerve
what is located in the adductor interossei compartment of the hand?
adductor pollicis
interossei
what is located in the dorsum compartment of the hand?
tendons of
- extensor digitorum
- extensor indicis
- extensor digiti minimi
- extensor pollicis brevis
- extensor pollics longus
dorsal carpal arch
thenar muscles of the hand
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
adductor pollicis
hypothenar muscles of the hand
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
short muscles of the hand
dorsal interossei
palmar interossei
lumbricals
Dupuytren Contracture of Palmar Fascia
results in progressive shortening, thickening, and fibrosis of the palmar fascia and palmar aponeurosis
partial flexion at the MCP and PIP joint of the 4th and 5th digits
Trigger Finger
wrist drop
radial nerve injury
loss of sensory to the back of hand
nerves in the hand
sensory loss as result of musculocutaneous nerve injury
numb lateral forearm
motor loss as result of musculocutaneous nerve injury
weak elbow flexion
weak forearm supination
absent biceps reflex
motor loss as result of axillary nerve injury
weak shoulder abduction
weak shoulder flexion
weak shoulder extension
weak shoulder external rotation
sensory loss as result of radial nerve injury
numb posterior arm and forearm
numb radial distribution of hand
motor loss as result of radial nerve injury
weak elbow extension
absent triceps reflex
weak wrist extension
weak finger MCP extension
absent supinator reflex
deformity as result of radial nerve injury
wrist drop on attempted wrist extension
sensory loss as result of median nerve injury
numb thenar eminence
numb median distribution of hand
motor loss as result of median nerve injury
weak forearm pronation
weak wrist flexion
weak wrist abduction
weak finger flexion of digits 1-3
weak grip strength and opposition
deformity as result of median nerve injury
hand of benediction on attempted finger flexion
sensory loss as result of ulnar nerve injury
numb hypothenar eminence
numb ulnar distribution of hand
motor loss as result of ulnar nerve injury
weak wrist flexion
weak wrist adduction
weak flexion of digits 4-5
weak finger abduction, adduction, opposition
deformity as result of ulnar nerve injury
claw hand on attempted finger extension