Upper Limb Arm & Forearm Flashcards
Is associated with the lateral aspect of the lower portion of the neck and with the thoracic wall
Upper limb
What suspends the upper limbs from the trunk
Muscles & Sternoclavicular joint
What is the upper limb divided into?
Shoulder, arm, forearm and hand
Where is the scapula attached at
Acromioclavicular joint
Allows the arm to move around three axes with a wide ROM.
Glenohumeral joint
flexion, extension, abduction, adduction, medial rotation (internal rotation), lateral rotation (external rotation) and circumduction
Movement of the glenohumeral joint
major movements a the elbow = flexion & extension of the forearm
Elbow joint
flipping the lateral bone over the medial bone
Pronation
hand can be abducted, adducted, flexed, extended, circumducted.
Wrist joint
These movements combined with those of the shoulder, arm and forearm enable the hand to be placed in a very wide range of positions relative to the body.
Wrist joint
irregularly shaped pyramidal area formed by muscles and bones of the shoulder and the lateral surface of the thoracic wall.
Axilla
triangularly shaped depression formed by muscles anterior to the elbow joint the major artery: the brachial artery, passing from the arm to the forearm passes through the fossa as does the median n.
Cubital fossa
What passes through the cubital fossa
Brachial artery and median nerve
Gateway to the palm of the hand
Carpal tunnel
Its posterior, lateral, and medial walls form an arch, which is made up of small carpal bones in the proximal region of the hand.
Carpal tunnel
Where are cutaneous nerves located?
Superficial fascia
- not visible thru skin
- branches of brachial plexus deep to deep fascia
Cutaneous nerves
Where are superficial veins located?
Superficial fascia
- generally visible thru skin
- tributaries to deep vv. beneath deep fascia
Superficial veins
What innervated the upper limbs?
Brachial plexus
Formed by the anterior rami of the cervical spinal nn C5-C8 & T1
Brachial plexus
Innervated the arm, forearm and hand
Brachial plexus
Spinal chord levels associated with brachial plexus
C5-C8 & T1
Innervates the superior shoulder and anterior superior shoulder
C3-C4
Used for testing sensation based on the innervation pattern
Dermatomes of UL
How are the dermatomes of the upper limb
Fairly specific and reliable /reproducible
Upper later arm
C5
Palmar pad of thumb
C6
Pad of index
C7
Pad of little finger
C8
Skin of medial elbow
T1
Superficiacl veins of the UL
- Cephalic
- Basilic
- Median cubital
- Dorsal venous arch
Path of venous return
Distal to proximal
What does the cephalic vein drain?
Posterior/lateral aspect of UL
Runs in deltopectoral groove & pierces deep fascia
Cephalic vein
The cephalic vein is tributary to
Axillary vein
What does the basilic vein drain
Anterior/medial aspect of UL
What does the basilic vein pierce?
Fascia of arm
The basilic vein is tributary to
Axillary vein
What does the median cubital vein connect?
Cephalic & Basilic
Where is the median cubital vein located?
In the cubital fossa
“I.V. vein” for venipuncture
- -intravenous fluid injection
- -drawing blood
Median cubital vein
What does the dorsal venous arch of the hand drain
Superficial dorsal vein of hand
Where is the dorsal venous arch of hand located?
It arches across dorsal surface of hand
The dorsal venous arch of hand is tributary to
Cephalic and basilic vv.
The dorsal venous arch of the hand is sometimes used for
Venipuncture
Deep fascia of the arm
Brachial fascia
Connected to humerus by 2 fascial septa
Deep fascia of the arm
Divides arm into anterior & posterior compartments
Deep fascia of the arm
mm., nn., & aa., compartmentalized via
deep fascia
Clinically relevant to compartmental syndromes
Deep fascia of the arm
_____ pressure in compartment can affect circulation
Increased
Directly related to the neck
UL
formed by the lateral margin of Rib 1, posterior surface of the clavicle and the superior margin of the scapula & the medial surface of the coracoid process of the scapula.
Axillary inlet
- Rib 1
- Clavical
- Scapula
- Coracoid process
Axillary inlet
The major artery and vein of the UL pass between the thorax and the UL by passing …
Over Rib 1 and thru the axillary inlet
On either side of the humerus
-medial & lateral
Intermuscular septa
What is contained in the anterior compartment of the arm
- Biceps brachii
- Coracobrachialis
- Brachialis mm
Contains brachial vessels & 5 brachial plexus nn.
Anterior compartment of arm
3 Motor nerves and 2 cutaneous nerves
Brachial plexus
3 motor nerves in brachial plexus
- musculocutaneous
- median
- ulnar nn.
2 cutaneous nerves in brachial plexus
- Medial brachial
- Medial antibrachial cutaneous
Supply skin of medial arm & forearm
Cutaneous nerves in the brachial plexus
Flexor compartment
Anterior compartment of arm
Has 2 heads
Biceps brachii
‘coracoid process to arm’
Coracobrachialis m
‘Arm’
Brachialis m
flexes & supinates forearm (slight arm flexion)
Biceps brachii muscle
musculocutaneous n. & brachial vessels
Biceps brachii muscle
an accessory flexor of the arm at the glenohumeral joint.
Biceps brachii
Action of Coracobrachialis m.
Flexes arm
What innervates the coracobrachialis m
Musculocutaneous n. & brachial vessels
Action of brachialis m.
Flexes forearm
What innervates the brachialis
radial & musculocutaneous nn. & brachial vessels
Deep to the biceps brachii m.
Brachialis
Flexes the arm and the elbow joint – powerful.
Brachialis m
Extensors the elbow/forearm
Posterior compartment of arm
Where are the radial nerve and deep brachial artery located?
Posterior compartment of the arm
Initially located within triangular interval
Radial n and deep brachial a
Contains triceps brachii muscle
Posterior compartment of the arm
the lateral portion of the brachialis m. that would be receiving the contribution from
Radial nerve
Extensor compartment
Posterior compartment of Arm
Action of triceps brachii
Extends forearm
What innervates triceps brachii
radial n. & deep brachial vessels
Where are the origins of the triceps brachii
Deep to the deltoid muscle
How many heads does triceps brachii have
3
Profunda brachii =
Deep brachial artery
The joint of the humerus and the ulna and radius.
Elbow
the anterior depression of the elbow joint
Cubital fossa
What happens at the cubital fossa
Major neurovasculature passes from the arm to the forearm
Where does the ulna nerve pass?
posterior to the medial epicondyle of the humerus.
Depressed area anterior to elbow
Cubital fossa
What does the cubital fossa contain?
- Biceps brachii tendon
- Brachial a
- Median n.
Forearm flexors to the
Medial of the cubital fossa
Forearm extensors to the
Lateral of the cubital fossa
part of the UL between the elbow and the wrist joints.
Forearm
complex joint involving 3 separate articulation.
Elbow joint
articular surface of the head of the ulna, with the ulnar notch on the end of the radius and with a fibrous articular disc which separates the radio-ulnar joint from the wrist joint.
Distal Radio-ulnar joint
thin fibrous sheet that connects the medial and lateral borders of the radius and ulna respectively
Interosseous membrane
____ with the sheet pass predominantly inferiorly from the radius to the ulna.
Collagen fibers
Just inferior to the radial tuberosity and a small circular aperture in its distal 3rd.
Superior free margin
Connects the radius and ulna without restricting its movements: supination and pronation.
Interosseous membrane
Anatomincal position of the hand
Supination
Occur entirely in the forearm and involve rotation of the radius at the elbow and movement of the distal end of the radius over the ulna
Pronation and supination
Where is the cubital fossa located
Anterior to the elbow joint
Major structure that doesn’t pass through the cubital fossa
Ulnar nerve
Distally structures pass between the forearm and the hand through or anterior to the carpel tunnel except
Radial artery
Where does the radial artery pass
Dorsally around the rest and enters the hand posteriorly
3 layers of the anterior compartment of forerarm
- Superficial (4)
- Intermediate (1)
- Deep (3)
wrist movements, flexion of digits & thumb, and pronation
Functions of the Anterior Compartment of Forearm
The anterior forearm has no more contributions from
C5
What does contribute to the anterior forearm
C6-C8 and T1
Layers of the posterior compartment of the forearm
- Superficial (7)
- Deep (5)
movement of the wrist
extension of the fingers and thumb. supination
Functions of the posterior compartment of the forearm
Radial nerve
C5-C8
There are no contribution of ____ in the posterior forearm
T1
Where does the C5 component of the radial n come in
Where the brachioradialis m extends superiorly across the elbow joint to the lateral arm
Pierces coracobrachialis m. to supply it
Musculocuntaneous nerve
What does the musculocuntaneous nerve supple
All of biceps brachii and medial part of brachialis m, coracobrachialis m
- Emerges between these mm. as lateral antebrachial cutaneous m.
- Supplies skin of lateral forearm
Musculocuntaneous nerve
- Runs down medial aspect of arm lateral to brachial a.
- Crosses over to medial side of it & enters cubital fossa
- Runs between superficial & deep anterior forearm mm
Median N
What does the median nerve supply
Most muscles of anterior forearm
Continues under carpal tunnel to supply lateral hand – palmar br. (cutaneous)
Median nerve
originates from the median n. in the distal forearm immediately proximal to the flexor retinaculum, passes superficially to innervate the skin over the base and central palm.
Small palmer branch
Spared in carpal tunnel syndrome because it passes into the hand superficial to the flexor retinaculum of the wrist.
Palmar branch
- Travels posteriorly down medial aspect of arm
- Runs in cubital tunnel between medial epicondyle & olecranon
- -very superficial at this point (‘funny bone’)
- Dives deep into medial forearm (with ulnar a.) to supply it
Ulnar Nerve
Continues over carpal tunnel to supply medial hand & deepest mm. of hand
Ulnar nerve
- Runs with deep brachial a. in radial groove of humerus
- -between lateral & medial heads of triceps m.
- Continues between brachialis & brachioradialis mm.
Radial Nerve
What does the radial nerve supply
all of triceps brachii & lateral part of brachialis m.
Divides into superficial & deep branches
Radial Nerve
Continues to supply skin on the back of the hand
Superficial branch of radial nerve
Dives to supply muscles of posterior forearm
Deep branch of radial nerve
Direct continuation of Axillary A.
Brachial A.
What does the Brachial a. split into in the cubital fossa?
Radial a. and Ulnar a.
Runs from inferior border of teres major m. to its bifurcation
Brachial A.
- Sends off deep brachial a. & several muscular branches
- Sends off superior & inferior ulnar collateral aa.
Brachial Artery
Supplies entire UL
Brachial Artery
