Upper Limb

Djoko Prakosa Dept. Anatomy, Embryologi & Anthropology

Upper Limb
- It is divided into: shoulder (junction of the arm and the trunk) arm (brachium) elbow forearm (antebrachium) wrist (carpus) hand (manus)

Bones of the upper limb

Clavicula & Scapula Humerus Radius & ulna Carpal bones: - proximal row: scaphoid (navicular), lunate, triquetrum, pisiform - distal row: trapezium, trapezoid, capitate, hamate Metacarpal bones (5) Phalanges

Shoulders Bones
Demonstrates the main anatomical landmarks of the clavicle, scapula, humerus, radius and ulna. A: greater tubercle B: head of humerus C: coracoid process D: acromion E: lesser tubercle of humerus

Carpals, metacarpals & phalanges

Identify the bones of the wrist, metacarpals and phalanges on suitable radiographs A: scaphoid B: lunate C: triquetrum & pisiform D. Trapezium E. Trapezoid F. Capitate G. Hamate H. Hook of hamate

Joints of the Upper Limb

Sternoclavicular joint Acromioclavicular joint Glenohumeral joint Elbow joint Radioulnar joint proximal & distal Wrist joint (radiocarpal joint) Intercarpal joints Carpometacarpal joints Metacarpophalangeal joints Interphalageal joints

Joints
Describe the anatomy of the glenohumeral joint Name and explain the movements at the joint,

Joints
Name the muscles responsible for its movement and list their main attachments.

Elbow joint
Describe the anatomy of the elbow joint Name and explain the movements at the joint,

Joint Stability

Describe the factors that are responsible for stability at the joint and explain the functional and possible pathological consequences of dislocation of the joint.

Factors affecting joint stability

The stabilizing subsystem of the joint control subsystem neural

passive subsystem

active subsystem

Muscles
Describe the major muscles groups in their fascial compartments, and explain the functional importance of those muscle groups.
Describe how muscle groups work in synergy to facilitate action

Muscles
I. Connecting the upper limb to vertebral column: - trapezius - levator scapulae - rhomboideus - latissimus dorsi II. Connecting the UL to Ant & Lat Thoracic wall: - pectoralis major & minor - subclavius - serratus anterior

Muscles
III. Muscles of the shoulder - deltoid - subscapularis - supraspinatus - infraspinatus - teres minor - teres major IV. Muscles of the arm anterior compartment: - coracobrachialis - brachialis posterior compartment: - triceps brachii

- biceps brachii

Muscles
V. Muscles of the forearm: a. Anterior compartment: Superficial: - pronator teres - flexor carpi radialis - palmaris longus - flexor carpi ulnaris - flexor digitorum superficialis Deep: - flexor digitorum profundus - flexor pollicis longus - pronator quadratus

Muscles
V. b. Posterior compartment: Superficial: - brachioradialis - extens carpi radialis long - extensor digit - extens carpi rad brevis - anconeus - extens digiti minimi - extensor carpi ulnaris Deep: - supinator - abductor pollicis longus - extens poll brev - extens pollicis longus - extensor indicis

Fascial compartment arm & forearm

Muscles
VI. Muscles of the hand a. Thenar muscles - abductor pollicis brevis - opponens pollicis - flexor pollicis brevis - adductor pollicis b. Hypothenar muscles - palmaris brevis - abductor digiti minimi - flexor dig min brev - opponens digit minimi c. Intermediate muscles - lumbricales - Interossei

Retinacula & Tendon sheaths

Describe the function of retinacula, tendon sheaths, specifically the flexor retinaculum of the wrist, to be able to explain the carpal tunnel syndrome, spread of infection in tendon sheaths and tenosynovitis.

Blood Vessels
Describe the origin, course and functions of the subclavian, axillary, brachial, radial and ulnar arteries and explain the importance of anastomoses between branches of these arteries.

Blood Vessels

Vessels
Describe the course of the main superficial veins (cephalic, basilic, median cubital) and recognized the common sites of venous access.

Nerves
Describe the origin, course and function of the axillary, musculocutaneus, radial, median and ulnar nerves in the arm, forearm, wrist and hand and name the main muscles and muscle groups that these nerves supply as well as their sensory distribution.

Nerves

Nerves

Pathology
Describe the close relations of the bones and joints e.g. bursae, blood vessels, nerves which may be injured in fracture and dislocation Understand why and where the axillary, musculocutaneus, radial, median and ulnar are commonly injured and describe the functional consequences of those injuries.

Pathology
Explain the loss of function resulting from injuries to the different parts of the brachial plexus in contrast to the injuries that may be incurred to the various nerves that arise from it, at various points along their course in the upper limb.

Brachial plexus injuries

Upper lesions = Erb-Duchene Palsy (Waiters tip) Cause: excessive displacement of the head to opposite side and depression of the shoulder at the same site traction of C5 and C6 Muscles affected: - supra & infraspinatus - subclavius - biceps brachii - brachialis - deltoid limb hang limply, medially rotated arm, pronation + loss sensation lateral side of arm

Brachial plexus injuries

Lower lesions: Klumpke Palsy Cause: excessive abduction of the arm Th1 torn muscles affected: all small muscles of the hand clawed appearance of the hand + loss sensation on the medial side of the arm

Nerve injuries
-Long thoracic nerve blows or pressure on the posterior triangle of the neck winged scapula - Axillary nerve: crutch pressing upward in the armpit; inferior displacement of humeral head; fracture of humeral surgical neck paralysis of deltoid & teres minor + loss of skin sensation over lower half of deltoid muscle

Nerve injuries
Radial nerve: In the axilla: pressure of crutch; fracture & dislocation of proximal end of humerus 1. motor: triceps, anconeus & long extensor of wrist paralyzed unable to extend elbow, wrist & fingers wrist drop 2. sensory: posterior & lower part of arm & back of forearm, lateral part of dorsum of hand In the spiral groove:

Nerve injuries
Median nerve: 1. at elbow - in supracondylar fracture, stab wound: motor: forearm in supine position; wrist flexion weak, no flexion on metacarpophalangeal joints of index & middle fingers preacher hand. Thenar muscles paralyzed and wasted simian hand = ape like hand sensory lateral half of palmar hand + finger 2. at wrist: carpal tunnel syndrome

Nerve injuries
Ulnar nerve: Injuries at elbow or wrist Motor: Claw hand Froments sign +

Examination

Describe how to test for motor and sensory nerve function and dysfunction and understand the anatomical basis of tendon jerk testing of biceps and triceps