Gross Anatomy Exam 2 Flashcards
Upper Limb four major compartments
Shoulder - includes pectoral, scapular, and deltoid region and lateral part of cervical
Arm (brachium) - connects shoulder and elbow
Forearm (antebrachium) - connects elbow to wrist
Hand (manus) - formed around carpal, metacarpals and phalanges, consists of wrist, palm and dorsum of hand and digits
Clavicle
also know as collar bone, connects upper limb to trunk
functions: serve as a moveable strut that suspends scapula and free limb, one of the boundaries of the cervical-axillary canal, transmits shock to axial skeleton
Parts of the clavicle
shaft sternal end, acromial end superior surface inferior surface - conoid tubercle, trapezoid tubercle, subclavian groove, impression for costoclavicular ligament
Scapula
also know as the shoulder blade, triangular flat bone, lies posterior aspect of ribs 2-7, convex post. and concave ant surfaces
Parts of the scapula
spine - deltoid tubercle, acromion, spinoglenoid notch
supraspinous fossa, infraspinous fossa, subscapular fossa, body, glenoid fossa - supraglenoid fossa and infraglenoid fossa, coracoid process, superior border having the suprascapular notch, medial border, lateral border, superior angle and inferior angle
Humerus
largest bone in the upper limb, articulates with the glenoid fossa proximal and the radius and ulna distally
Parts of the humerus
head, anatomical neck, surgical neck, greater tubercle with 3 facets (superior, middle and inferior), lesser tubercle, intertubercular groove, shaft with deltoid tuberosity and radial groove, supracondylar ridges, medial and lateral edpicondyles
Condyles of the forearm are formed by
Capitulum - lateral articular surface that articulates with head of radius
Trochlea - medial articular surface that articulates with trochlear notch of ulna
Coronoid fossa - anterior hollow that receives the coronoid fossa of ulna during flexion
Radial fossa - anterior depression superior to capitulum and receives the head of the radius during flexion
Olecranon fossa - posterior hollow that receives the olecranon of ulna during extension
Ulna
stabalize bone of forearm, medial and longer than radius, massive proximal end specialized for articulation with humerus and radius laterally
DOES NOT PARTICIPATE IN WRIST JOINT
Parts of the Ulna
Olecranon, coronoid process, trochlear notch, tuberosity of ulna, radial notch, shaft and head with the ulnar styloid process
the head is the distal part of the bone
Radius
lateral forearm bone, crosses over ulna in pronation
PARTICIPATES IN WRIST JOINT
Parts of the radius
head, neck, radial tuberosity, shaft, ulnar notch, radial styloid process and dorsal tubercle of radius
Which styloid process is larger and why
The radial styloid process is bigger because it limits more radial deviation than the ulna does in ulnar deviation
Carpal bones
makes up the wrist, 8 bones total, give flexibility to wrist, convex from side to side and concave anteriorly
Proximal row of carpal bones (lateral to medial)
Scaphoid - boat shaped bone that articulates with radius
Lunate - moon shaped bone that articulates with the radius
Triquetrum - pyramidal bone on medial side of wrist
Pisiform - pea-shaped sesamoid bone on palmer surface of triquetrum
Distal row of carpal bones (lateral to medial
Trapezium - four sided bone lateral side of wrist articulating with 1st and 2nd metacarpals
Trapezoid - wedge-shaped bone articulating with the 2nd metacarpal
Capitate - head-shaped bone articulating with 3rd metacarpal
Hamate - wedge-shaped bone on medial side articulating with 4th and 5th metacarpals
Metacarpals
form skeleton for palm of hand, b/w carpals and phalanges, 5 metacarpals numbered from lateral to medial 1-5, 1st metacarpal is the thumb
Scapulohumeral Joint
Physiological (muscular) joint where there are no bone articulations, represents scapular movment on the thoracic wall b/w ant scapula and post ribs, provides base for which upper limb operates
Sternoclavicular Joint
only articulation b/w upper limb and axial skeleton, synovial joint
features: saddle type joint b/w manubrium and clavicle but functions as a ball and socket, divided into 2 compartments by disc, strong joint
Ligaments of the sternoclavicular joint
Costoclavicular ligament - anchors inferior surface of sternal end of clavicle to rib 1 and its costal cartilage
Anterior sternoclavicular ligmanet - reinforces capsule anteriorly
Posterior sternoclavicular ligament - reinforces capsule posteriorly
BOTH THESE LIGAMENTS ARTICULATE WITH DISC
interclavicular ligament - strengthens capsule superiorly, extends b/w sternal end of clavicle, attaches to superior border of manubrium
Acromioclavicular ligament
also know as AC joint, located 2-3cm from point of shoulder and is a synovial joint
features: plane joint b/w clavicle and acromion, separated by incomplete wedge shaped articular disc
Ligaments of AC Joint
Coracoclavicular ligament - from coracoid process to underside of clavicle, strong pair of bands, provides means by which scapula and free limb are passively suspended
composed of 2 ligaments: trapezoid l. - nearly horizontal
conoid l. - inverted traingle with base being at conoid tubercle
Acromoiclavicular ligmanet - from clavicle to acromion, strengthens the AC joint superiorly, integrity of joint mainly by extrinsic ligaments distal from the joint itself
Glenehumeral Joint
provides wide range of motion which makes the joint unstable, synovial joint
features: ball and socket joint b/w head of humerus and glenoid fossa, held in fossa by rotator cuff muscles, glenoid fossa deepens by glenoid labrum, joint capsule in 2 apertures: b/w tubercles to allow for tendon of long head of biceps brachii m. and anteriorly that allows communication b/w subscapular bur sae and synovial cavity, inferior part of joint is weak
Ligaments of Glenohumeral joint
Gloenhumeral ligaments Coracohumeral ligament Coracoacromial LigamentTransverse humeral ligament
Gloenhumeral ligaments
sup. middle and int. ligaments, strengthen the capsule ANTERIORLY, can only been seen from interior of capsule
Coracohumeral ligament
from coracoid process to greater tubercle of humerus, intrinsic, strengthens joint superiorly and supports the weight of hanging arm
Coracoacromial Ligament
from coracoid process to acromion, along with the inferior aspects of the acromion and coracoid process it forms the coracoacromial arch, prevents superior displacement of humeral head
Transverse humeral ligament
passes obliquely from lesser tubercle to greater tubercle of humerus, converts IT groove into a canal, holds synovial sheath and tendon of long head of biceps in the groove
Deep Fascia of the scapular region
Deltoid Fascia
Supraspinous fascia
Deltoid Fascia
covers deltoid from clavicle, acromion and scapular spine
inferiorly, fascia is continuous with pectoral fascia anteriorly and infraspinous fascia posteriorly
Supraspinous Fascia
overlie supraspinatus and infraspinatus muscles, very dense and must be removes to view muscles
Scapulhumeral Muscles
Also known as intrinsic shoulder muscles
Deltoid, Supraspinatus, Infraspinatus, Teres Minor, Teres Major, and Subscapularis
Muscular Spaces of the shoulder
Quadrangular space
Triangular space
Triangular interval
Quadrangular space
Borders: SUperiorly - teres minor muscle Inferiorly - teres major muscle Lateral - surgical neck of the humerus Medial - long head of triceps brachii Contains: axiallary nerve and the posterior humeral circumflex artery
Triangular space
Borders: Superiorly - teres minor muscle
Inferiorly - teres major muscle
Base - long head of triceps brachii muscle
Contains: circumflex scapular artery and no nerve
Triangular Interval
Borders: Base - teres major muscle
Lateral - lateral head of triceps brachii muscle
Medial - long head of triceps brachii muscle
Contains - radianl nerve and the profunda brachiallis artery
Deep Fascia of Pectoral region
- attaches to clavicle and sternum
- there is the pectoral fascia and the clavipectoral fascia
Pectoral Fascia
- invests pectoralis major muscle
- continuous inferiorly with anterior abdominal wall fascia and with brachial fascia
- leaves lateral border of pectoralis major muscle to become the axillary fascia
Clavipecotral Fascia
-deep to pectoral fascia and pectoralis major muscle
-descends from clavicle and encloses the subclavius muscle and pectoralis minor muscle
-continuous inferiorly with axillary fascia
-this fascia is divided into 2 parts:
costocoracoid membrane - part of clavipectoral fascia b/w pectoralis minor muscle and subclavis muscle, it is pierced by lateral pectornal nerve, cephallic vein and thoracoacromial trunk
suspensory ligament of the axilla - part of clavipectoral fascia inferior to pectoralis minor muscle, supports the axillary fascia and pulls the skin inferiorly when ABD creating the axillary fossa
Anterior Axioappendicular Muscles
-muscles that move the pectoral girdle
-also known as thoracoappendicular or pectoral muscles
Pectoralis Major muscle, Pectoralis minor muscle, Subclavius muscle and Serratus Anterior muscle
Injury to Long Thoracic Nerve (C5,C6,C7)
-nerve takes superfisclal course and lies superfiscial to serratus anterior muscle
-when limb is elevated it is at risk for injury (knife fight)
-may also be injured during a mastectomy or by weapon into thorax
-Effects are the medial border of the scapula moves laterally and posteriorly away from thoracic wall exspecially when hand is pressed against a wall
This is known as a winged scapula!
-Upper limb will now be able to ABD past 90 degrees b/c they cannot upward rotate scapula
-NO SENSORY LOSS WOULD BE NOTICED
Axilla
- pyramidal space b/w upper arm and the thoracic wall, superior to axillary fossa and juntion of arm
- provides a passageway for neurovascular structures of upper limb which are protected by adducted limb
- size and shape of axilla depend on the position of the arm
- it has an apex, base and 4 walls (3 are muscular)
Apex of axilla
cervico-axillary canal
bounded by the 1st rib, clavicle and superior border of scapula
Base of Axilla
- formed by concave skin, subcutaneous tissue and axillary fascia
- extends from arm to thoracic wall, forms the axiallry fossa
- bounded by anterior and posterior axillary folds, thoracic wall and medial aspect of arm
Anterior Wall of Axilla
- formed by pectoralis major muscle and minor muscle and the deep fascias
- anterior axillary fold is the interiormost part of anterior wall that can be grasped, formed by pectoralis major muscle and the overlying skin
Posterior Wall of Axilla
- formed by scapula, subscapularis, teres major and lattisimus dorsi muscle
- posterior axillary fold is the inferior most part of the posterior wall that may be grasped, extends further interior than anterior wall and is formed by the latissimus dorsi, teres major muscle and skin
Medial wall of Axilla
formed by the thoracic wall, 1st - 4th ribs and intercostal muscles and the serratus anterior muscle
Lateral Wall of Axilla
-formed by the IT groove of humerus and is a narrow wall
What doe this axilla area contain
axiallry blood vessels
lymphatic vessels and nodes
axillary fat
cords and braches of brachial plexus
Axillary sheath
sleeve like extension of the cervical fascia that covers proximal parts of neuromuscular structures
Axillary Artery
continuation of subclavian a.
begins at lateral border of 1st rib, is divided into 3 parts and becomes the brachial a. after teres major
1st part of Axillary A.
from lat border of 1st rib to the medial pec minor m.
encloses the axillary sheath and has 1 branch coming off of it: Superior Thoracic A.
2nd Part of Axillary A.
posterior to pectoralis minor m. and had 2 branches: Thoracoacromial Trunk and the Lateral Thoracic
3rd Part of Axillary A
from the lat border of pec minor m. to inferior border of trees major and has 3 branches:
Subscapular A.
Anterior Humeral Cicumflex A.
Posterior Humeral Circumflex A.
Scapular Anastomoses
Involves 3 arteries: Dorsal scapular, Suprascapular and Circumflex scapular.
important if ligation or a slow occlusion (stenosis) of subclavian or proximal axillary so it can still supply the upper limb
Circumflex scapular is the key player
Ligation b/w subscapular a. and profunda brachii will cut off supply to arm
Axillary Vein
lies on anteromedial aspect of axillary a.
formed by a union of the brachial vv. and the basilica v.
ends at 1st rib and becomes subclavian v.
receives the cephalic v.
Axillary Lymph Nodes
Arranged in 5 principle groups, are arranged in a manner that reflect pyramidal shape of axilla Pectoral (Anterior) Nodes Subscapular (Posterior) Nodes Humeral (Lateral) Nodes Central Nodes Apical Nodes
Pectoral Nodes
lie along the medial wall of axilla
receive lymph mainly from the anterior thoracic wall and breast
Subscapular Nodes
lie along the posterior axillary fold
receive lymph from the posterior thoracic wall and scapular region
Humeral Nodes
lie along the lateral wall of axilla
receives nearly all lymph from upper limb
Central Nodes
lie deep to pectorals minor
receives lymph from the pectoral, sub scapular and humeral lymph nodes
Apical Nodes
located at apex of axilla
receive lymph from all groups pf axillar nodes as well as those accompanying cephalic v.
vessels from here traverse to crevice-axillary canal, some nodes drain to clavicle nodes
Efferent vessels unite to form subclavian lymphatic trunk and these drin to right lymphatic duct or thoracic duct
Brachial Plexus
begins at neck and extends to axilla
formed by union of the VPR of C5-C8 and T1
often C4 an T2 will contribute
divided into supraclavicular and infraclavicular parts: Roots and trunks are in the neck, Divisions are deep to the clavicle and the Cord and Branches are in the axilla
Roots
pass thru gap b/w anterior and middle scalene mm. and found with subclavian a.
roots unite to form 3 trunks
Trunks
Superior Trunk - formed by union of C5,C6 and sometime C4
Middle trunk - continuation of C7 nerve
Inferior Trunk - formed by union of C8 and T1 and sometime T2
Each trunk is divide into a posterior and anterior division which is all done posterior to the clavicle
Divisions
Anterior Division - supply the flexor compartments of the upper limb
Posterior Division - supply extensor compartments of upper limb
Divisions of trunk unite to form 3 cords
Cords
Lateral Cord - forms by anterior divisions of superior and middle trunks
Medial Cord - formed by the anterior division of the inferior trunk
Posterior Cord - formed by the posterior divisions of all 3 trunks
Cords are named for their relationship to 2nd part of the axillary artery
Branches
most branch from cord
a few from roots and trunks
Roots - dorsal scapular and long thoracic
Trunks - Suprascapular and nerve to subclavian
Lateral Cord
Lateral Pectoral nerve
Musculocutaneous Nerve
Lateral root of median nerve
Medial Cord
Median root of median nerve Medial pectoral nerve Medial brachial cutaneous nerve Medial Antebrachial nerve Ulnar nerve
Posterior Cord
Radial Nerve Axillary Nerve Upper Subscapular nerve Thoracodorsal Nerve Lower Subscapular nerve
Brachial Plexus Lesions
can be cause by pathology, trauma or compression
can occur as far up as roots or trunks
complete lesion of all parts is rare, partial lesion are more common
lesion to upper part will affect proximal muscles
lesion to lower parts will affect more distal muscles
Injuries results in Complete paralysis, Incomplete paralysis or Ability to feel pain
Arm
extends from shoulder to elbow
two movements can occur at elbow joint: flex/ext and supination/pronation
muscles are broken into 2 compartments with most action happening at the elbow
Elbow Joint
located 2-3 cm inferior to epicondyles of humerus
weak anteriorly and posteriorly, strengthened by the collateral ll.
synovial joint
composed of 2 articulations: humeroulnar and humeroradial
Humeraoulnar joint
throclea of humerus contacts throchlear notch of ulna
Ligamements
Ulnar collateral - triangular tape of 3 parts
Anterior Band- cord like band from medial epicondyle to tubercle on coronoid process, strongest
Posterior band - fan like band from medial epicondyle and spanning trochlear notch, weakest
Inferior band - spans medial aspect of trochlear notch, deepens the socket of the joint
Humeroradial Joint
capitulum of humerus contacts the head of radius
limited ball and socket hinge type joint
Ligaments
Radial collateral l. - fan like band from the lateral epicondyle to annular l of radius
Anular lig encircles the radial head
Bursae around the elbow joint
Subtendinous olecranon bursa - b/w the olecranon and triceps tendon
Intratendinous olecranon bursa - sometimes present in triceps tendon
Subcutaneous olecranon bursa - in subcutaneous tissue over olecranon
Brahcial Fascia
encloses arm like a sleeve
continuous superiorly with deltoid, pectoral, axially and infraspinous fossa
attaches inferiorly to humeral epicondyle and olecranon of ulna
continuous inferiorly with ante brachial fascia
has a medial and lateral intermuscular septa that divides arm into ant. and post. compartments
Cubital Fossa
triangular shaped depression on anterior aspect of elbow
filled with variable amount of fat
Boundaries are: Lateral - bracioradialis m
Medial - pronator teres m.
Base (superior) - line connecting medial and lat epicondyles
Floor - supinator and brachioradialis
Roof - skin, fascia and bicipital aponeurosis
Contains: terminal part of brachial a.
deep accompanying vv.
biceps brachii tendon
median n and radial n
Overlying the fossa is the median cubital v. and the medial and lateral ante brachial cutaneous nerves
Forearm
extends from the wrist to the elbow
contains the radius and ulna that are united by the interosseous membrane
Proximal radio Ulanr Ligament
synovial joint
fibrous layer of joint capsule is continuous with that of the elbow joint
radius moves around the ulna
- features: head of radius contacts the radial notch of the ulna, it is a pivot joint
-Ligaments of this joint: anular ligament, oblique cord, and interosseous membrane
Anualr LIgament
encircles radial head
oblique cord
from the coronoid process to the radial shaft
limits rotation
also limits distal movement of radius (pulling)
Interosseous membrane
connects shaft of radius and ulnalimits proximal displacement of radius (pushing)
Distal-radio-ulnar joint
synovial joint
radius moves around fixed ulna
-features: head of ulna articulates with ulnar notch of distal radius, pivot joint doing supination and pronation, has an articular disc that is a fibrocartilage complex triangular shaped and bind the end of ulna and radius together and is why the ulna does not participate in the wrist joint
Antebrachial Fascia
continuous superiorly with brachial fascia
divides the forearm into anterior (flexor) and posterior (extensor) compartments
compartments are separated by interosseuous membrane
thinkens posteriorly over the distal ends of radius and ulna forming a transverse band known as the extensor retinaculum
also forms the anterior thickening that is continuous with the extensor retinaculum called the palmar carpal ligament
distal and deeper to this ligament is the flexor retinaculum (transverse ligament), this is the carpal tunnel
Muscles of the forearm
flexors and pronators are in the anterior compartment
served by the median nerve and branches
1 and a 1/2 exceptions innervated by the ulnar nerve
extensors and supinators are in the posterior compartment innervated by the radial n and its branches
Pronator Teres
most lateral superficial forearm flexor
median nerve passes thru the two heads of this muscle and is a common site of impingment
Flexor Carpi Radialis
medial to the pronator teres m.
tendon does not pass thru the carpal tunnel
radial artery lies just lateral to this tendon
Palmaris Longus
absent in one or both sides in 14%
passes superficial to flexor retinaculum
tendon lies deep and slightly medial to median nerve at the wrist
Flexor Carpi Ulnaris
most medial and superficial flexor
tendon is guide to ulnar nerve and artery on the lateral side of the wrist
this muscle has 2 heads as well which has the ulnar nerve passing thru them, this is the cubital tunnel and is a potential site for impingement
Flexor Digitorum Superficialis
median and ulnar nerveenter forearm by passing between it 2 heads
gives rise to 4 tendons at the wrist that pass thru the carpal tunnel
chares a common flexor sheath with the FDP
Flexor Digitum Profundus
only muscle that flexes the DIPs!
4 tendons pass thru the carpal tunnel in the common flexor sheath with the FDS
Flexor Pollicis Longus
lies lateral to the FDP
passes thru the carpal tunnel in its own sheath known as the radial bursa
it the most lateral flexor sheath
Pronator Quadratus
deepest muscle in the anterior forearm
cannot be palpated but only observed in dissection
covers distal radius, ulna and interosseous membrane
A.I.N and A.I.A. pass deep to this muscle so they are found just proximal to this muscle in dissection
Medial Epicondylitis
inflammation of common tendon “golfers elbow”
results from over use of flexors, activities that require using lots of gripping
pitchers, golfers and rock climbers
Superficial Extensor muscles
Bracioradialis Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Digitorum Extensor Digiti Minimi Extensor Carpi Ulnaris
Deep Extensor Muscles
Supinator
Extensor Indicis
Outcropping Extensor Muscles
Abductor Pollicis Longus
Extensor Pollicis Longus
Extensor Policis Brevis
Extensor Muscle
tendons are held in place at wrist by extensor retinaculum
passes thru tunnel in extensor retinaculum and these tendons are covered by synovial sheaths
Bracioradialis
lies on the anterolateral surface of forearm
forms lateral border of cubital fossa
functionally a flexor but is innervated by radial nerve
overlies the radial nerve and artery proximally
TENDON IS OVERLAPPED DISTALLY BY APL AND EPB
does not cross the wrist joint
expecially active during quick movements and in the presence of resistance
Extensor Carip Radialis Longus
partly overlapped by bracioradialis muscle
distal tendon is crossed voer by ApL and EPB
indispensable when clenching a fist
Extensor Carpi Radialis Brevis
shorter than the ECRL because it starts distally on the humerus condyle
acts as synergist to ECRL
Extensor Digitorum
principal extensor of medial 4 digits
tendons spread on dorsum of hand as the pass digits
linked proximally at the MPs by the intertendenous connections
at distal ends of the metacarpals tendons flatten forming the extensor expansion
Hood is formed by extensor expansion
Extensor Digiti Minimi
partially detached part of ED
tendon located medial to ED on dorsum of han
Extensor Carpi Ulnaris
located medial border of forearm
has a humeral head and an ulnar head
Supinator
part of deep extensor group
helops form the cubital fossa
deep branch of radial nerve passes b/w its fibers, as it exits this muscle and joins the posterior interosseous artey it become the PI Nerve
Extensor Indicis
part of the deep extensor group
lies medial and alongside the EPL
confers independance to the index finger to point at people
tendon lies deep and medial to ED tendon on the dorsum of the hand
Abductor Lollicis Longus
lies just distal to supinator
tendon and belly may be split into 2, part may attach to trapezium instead of usual insertion
forms one border of the anatomical snuffbox
Extensor Pollicis Brevis
lies distal to APL
tendon lies parallel and immediately medial to APL
forms one border of the anatomical snuffbox
Extensor Pollicis Longus
larger and longer tendon than that of EPB
tendon passes medial to dorsal tubercle of radius
Anatomical Snuffbox
borders: posteromedial - EPL tendon
Anterolateral - EPB and EPL tendons
Floor - scaphoid and trapezium
Contents: radial artery
-superficial branch of radial nerve runs over the roof
-tenderness over the snuffbox may indicate a scaphoid fracture
Ulnar Artery
larger terminal branch of brachial artery
has unnamed muscular branches
Give rise to the Anterior Unlar Recurrent Artery which anastamoses with the Inferior Ulnar Collateral
Gives rise to the Posterior Ulnar Reccurent Artery which anastomoses with the Superior Ulnar Colalteral
Gives rise to the Common interosseous Artery which gives rise to the Anterior and Posterior Interosseous Arteries and the Recurrent Interosseous Artery which anastomoses with the Middle Collateral Artery
Palmar Carpal branch, anastamoses with palmar carpal branch of radial artery
Dorsal Carpal Branch, anastamoses with dorsal carpal branch of radial artery
Radial Artery
smaller terminal branch of brachial artery
has unnamed muscular branches
Gives rise to the Radial Recurrent Artery which anastamoses with the Radial Collateral Artery
Gives rises to the Dorsal and Palmar carpal branches
Deep Veins
arise from the deep venous palmar arch
gives rise to paired radial veins accompanied by radial artery
also gives rise to paired radial veins accompany ulnar arteries
In the cubital fossa join the median cubital veins and form the brachial veins
Median Nerve at forearm
supplies all anterior compartment muscles except FCU and 1/2 FDP
formed by union of lateral root of lateral cord and medial root of medial cord
C6, C7, C8
enters cubital fossa medial to brachial artery
passes b/w heads of pronator trees muscle and turns into the anterior interosseous nerve
median nerve found in facial plane between FDS and FDP
gives rise to the Palmar cutaneous branch which arises at the distal forearm and proximal to the flexor retinaculum
Ulnar Nerve at the Forearm
supplies FCU and medial 1/2 FDP
terminal branches of medial cord of brachial plexus
C8, T1
Gives rise to the Palmar cutaneous branch which arises at mid forearm and supplies the skin medial to axis of 4th digit
Gives rise to Dorsal cutaneous branch which arise at distal forearm and supplies forum of hand medial to 4th digit
Radial Nerve at the Forearm
Supplies the posterior compartment of forearm
terminal branch of posterior cord of brachial plexus
C5,C6,C7,C8
Gives rise to the postior antebrachial branch supplies skin of posterior aspect of forearm to wrist
Gives rise to Deep branch which supplies ECRB, ED, EDM, ECU, and supinator, pieces that supinator muscle and becomes the P.I.N.
Gives rise to the P.I.N. and supplies the out grouping muscles
Superficial branch emerges lateral to tendon of bracioradialis and runs over the roof of anatomical snuffbox and supplies the skin on the dorsum of hand lateral to axis of 4th digit.
Lateral Antebrachial Cutaneous Nerve
direct communication of musculocutaneous nerve
supplies the lateral aspect of forearm
Medial Antebrachial cutaneous nerve
from the medial cord of brachial plexus
supplies medial aspect of forearm
Wrist and Hand
wrist is located at junction of forearm and hand
movements at the wrist adjust position of the hand
consists of carpals, metacarpals and phalanges
Palmer features separates into 2 eminences:
-Thenar Eminence, lateral larger and more prominent at base of thumb
-Hypothenar eminence, medial smaller proximal to 5th digit
Radio carpal Joint
also know as the wrist joint
synovial joint
position of joint indicated by: line joining ulnar and radial styloid processes and proximal wrist crease
ulnar does not participate in this joint
Features: articulation b/w distal end of radius, articular disc and proximal row of carpals
condyloid type joint
permits flex/ext, radial and ulnar dev. and circumduction
Ligaments: Ulnar collateral, radial collateral, Palmar radiocarpal, Palmer Ulnocarpal, Dorsal radiocarpal
Carpometacarpal Joint
promote hollowing of hand
1 digits is different than 2-5 digits
synovial joint
Features: distal row of carpals articulate with bases of MC
Plane type joint for 2-5 digits
Saddle type joint at thumb
Ligaments: Dorsal Carpometacarpal, Palmar carpometacarpal and Superficial and deep transverse metacarpal.
Metacarpophalangeal Joint
synovial joints
Features: heads of metacarpals articulate with bases f proximal phalanges
COndyloid joints
LIgaments: Medial Collateral and Lateral Collateral
Deep transverse metacarpal
Interphalangeal Joints
synovial joint have the PIP and the DIP FeaturesL artculation b/w heads of phalanges with bases of more distal phalanges Hinge type joint flex and ext Ligaments: Medial Collateral Lateral COllateral
Fascia of the Palm
continuous with ante brachial fascia and the fascia of dorsum of hand
thin over thenar and hypothenar eminences
thick centrally where it forms the fibrous palmar aponeurosis
Palamr Aponeurosis
cover soft tissues, overlies flexor tendons, proximal end is continuous with flexor retinaculum and palmaris longs.
distally formes 4 longitudinal bands that radiate from the apex and attach distally at bases of proximal phalanges, becomes continuous with fibrous digital sheaths
has 2 fibrous septa that extend deeply, medial fibrous septum that attaches to 5th MC and the lateral fibrous septum that attaches to the 2nd MC
Creates 2 potential spaces in the deep hand
Two potential Spaces created by Fibrous Septa
Thenar space - underlies thenar compartment, distally related to synovial tendon sheath of index finger
proximally related to common flexor sheath distal to carpal tunnel
Midpalmar space - underlies the central compartment, distally related to synovial tendon sheaths of digits 3-5 and proximally to common flexor sheath as it emerges from carpal tunnel
It is continuous with the anterior compartment of forearm via carpal tunnel
Carpal Tunnel
passageway from anterior forearm to hand
formed by the anterior concavity of carpals and the flexor retinaculum (transverse ligament)
Contains the tendons of FDS, FDP, and FPL and their associated sheaths, and the median nerve b/w the FDS and FPL tendons
Guyon Canal (Tunnel)
also known as ulnar canal
created by the depression between pisiform and hook of hamate, covered by pisohamate ligament and forms osseofibrous tunnel, contains the ulnar nerve and artery
