Upper Limb Muscles Flashcards
muscles of the pectoral
region?
Pectoralis major. Pectoralis minor. Subclavius. Serratus anterior.
Pectoralis Major
Origin ? Insertion? Nerve supply? Action?
• Nerve supply : • Medial & lateral pectoral nerves. • Action : • Adduction and medial rotation of the arm. • Clavicular head helps in flexion of arm (shoulder).
Pectoralis minor
Origin ? Insertion? Nerve supply? Action?
• Origin:
• from 3rd , 4th , and 5th ribs
close to their costal
cartilages. • Insertion: • coracoid process. • Nerve supply: • medial pectoral nerve. • Action:
• Depression of shoulder. • Draw the ribs upward and
outwards during deep
inspiration
Subclavius
Origin ? Insertion? Nerve supply? Action?
Origin: • From 1st rib at the junction
with its costal cartilage. • Insertion: • Subclavian groove at the
inferior surface of middle 1/3
of clavicle. • Nerve supply: • Nerve to subclavius from
upper trunk of brachial plexus. • Action: • Steadies the clavicle during
movement of the shoulder
joint.
Serratus anterior
Origin ? Insertion? Nerve supply? Action?
Origin: Upper eight ribs. Insertion: Ventral aspect of medial border and inferior angle of scapula. Nerve supply: Long thoracic nerve. Action: Draws the scapula forward (protraction, in boxing). Rotates scapula outwards in raising the arm above 90 degree.
It is a thickened
membrane of deep fascia between the subclavius and pectoralis minor.
?
Clavipectoral Fascia
Clavipectoral Fascia is It is pierced by ?
Lateral pectoral nerve.
Thoraco-acromial artery
Cephalic vein.
Few lymph vessels.
A pyramid-shaped space between the upper part of the arm and the side of the chest ?
Axilla
Axilla what passes?
• Through this major neurovascular structures(Axillary vessels & nerves) pass between neck & thorax and upper extremity.
apex of axilla is the? Bounded by?
cervicoaxillary canal: The passageway between
theneck and the axilla
It is bounded by the 1st rib,
clavicle, and superior edge
of the scapula.
APEX’s Base formed by? Bounded by? In front? Behind? Medially?
Formed by skin stretching between the anterior and
posterior walls.
bounded:
-In front: the anterior
axillary fold (formed by
the lower border of the
Pectoralis major muscle).
-behind by the posterior axillary fold (formed by the tendon of latissimus dorsi and the teres major muscle).
-medially by the ribs and
the chest wall.
Apex
Anterior wall? Posterior wall ?
Medial wall? Lateral wall?
- Anterior wall formed by the
• pectoralis major • pectoralis minor • clavicopectoral fascia
-Posterior wall:
• Subscapularis • Latissimus dorsi • Teres major muscles
-medial wall:
Serratus anterior Upper 4-5 ribs & Intercostal muscles
-lateral wall:
Coracobrachialis Intertubercular groove of humerus Biceps brachii
Contents of The Axilla
1. Cords and braches of brachial plexus. 2. Axillary artery and its branches. 3.Axillary vein and its tributaries. 4. Axillary lymph nodes. 5. Axillary fat. 6.Loose connective tissue.
The brachial
plexus is formed
by the ?
anterior
rami of C5
C6,C7,C8, and T1
The apex of the axilla region is an opening
between the clavicle, first rib and the scapula. • In this apex, the vessels and nerves may
become compressed between the bones – this
is called?
thoracic outlet syndrome.
The serratus anterior is
paralyzed owing to injury to
? What happens?
long thoracic nerve . When the arm is raised, the medial border and inferior angle of the scapula pull markedly away from the posterior thoracic wall, a deformation known as a winged scapula
Shoulder Muscles?
Deltoid, • Teres major, • The four rotator cuff muscles (supraspinatus,
infraspinatus, subscapularis and teres minor).
Rotator cuff muscles attachments, innervation, and actions?
- Supraspinatus:
Innervation: Suprascapular nerve.
• Actions: Abducts the arm 0-15o, and
assists deltoid for 15-90o - Infraspinatus
• Innervation: Suprascapular nerve. • Actions: Laterally rotates the arm. - Subscapularis:
Innervation: Upper and lower
subscapular nerves.
• Actions: Medially rotates the arm. - Teres Minor
• Innervation: Axillary nerve.
• Actions: Laterally rotates the arm.
Teres Major
Origin ? Insertion? Nerve supply? Action?
Originates from the posterior surface of the inferior angle of the scapula. • It attaches to the intertubercular groove of the humerus. • Innervation: Lower subscapular nerve. • Actions: Adducts at the shoulder and medially rotates the arm.
refers to inflammation
of the tendons of the rotator cuff muscles. ? muscle most commonly affected is the
? During which movement?
Rotator Cuff Tendonitis
supraspinatus
abduction, causes inflammation and
degenerative changes in the tendon itself.
thickened band of deep fascia in center of palm of the hand. ?
Palmar Aponeurosis
Attachment of the Palmar Aponeurosis
?
Apex: flexor retinaculum & receives palmaris longus insertion Base: 4 slips
Function of Palmar Aponeurosis
?
Function: improve the grip Protect underlying structures
progressive shortening,
thickening, and fibrosis of the
palmar aponeurosis
Is called? What does it do?
Dupuytren contracture
pulls the
4th and 5th fingers into partial
flexion.
It is a thickening of deep fascia that lies over the front of the carpal bones
?
FLEXOR RETINACULUM
FLEXOR RETINACULUM
RELATIONS Superficial: from lateral to medial:
?
Superficial palmar branch of radial artery 2. Palmar cutaneous branch of median
nerve
3. Tendon of palmaris longus
4. Palmar cutaneous branch of ulnar nerve
5. Ulnar vessels
6. Ulnar nerve
FLEXOR RETINACULUM
RELATIONS Deep: Structures passing through carpal
tunnel
?
Tendon of FPL & its synovial sheath (radial
bursa)
8. Tendons of FDS & FDP & their common
synovial sheath (Ulnar bursa)
9. Tendon of FCR & its synovial sheath ( in a
special compartment)
10. Median nerve
HAND muscles ?
- Thenar eminence ( 3 muscles : • Flexor pollicis brevis • Opponens pollicis • abductor pollicis ) ( N supply: median nerve)
- Hypothenar eminence ( 3 muscles : • Abductor digiti minimi • Flexor digiti minimi • Opponens digiti minimi )( N.Supply=ulnar)
Superficial :
3. Palmaris brevis
Intermediate group
- Lumbricals ( 4 muscles : • lateral 2 by median n • medial 2 by ulnar n )
- Interossei ( 8 muscles : Palmar interossei ( 3) Dorsal Interossei (4) ) ( by ulnar N)
Thenar eminence
Muscles and nerve supply?
Flexor pollicis brevis • Opponens pollicis • Adductor pollicis • The median nerve innervates all the thenar muscles.
Hypothenar Muscles and nerve supply?
Hypothenar group: eminence • Abductor digiti minimi • Flexor digiti minimi
• Opponens digiti minimi • The ulnar nerve innervates
the muscles of the
hypothenar eminence.
Lumbrical muscles
Nerve supply and action?
Nerve supply . • lateral 2 by median n • medial 2 by ulnar n Action: writing position • Flex metacarpophalangeal
joints • Extend interphalangeal
joints of medial 4 fingers
Palmar interossei
Location? Action? Innervation?
(3 )These are located anteriorly on the hand. There are three palmar interossei muscles • Actions: Adducts the fingers at the MCP joint. • Innervation: Ulnar nerve.
Dorsal Interossei
Location ? Action? Nerve supply?
These can be palpated
on the dorsum of the
hand. • There are four dorsal
interossei muscles. • Actions: Abduct the
fingers at the MCP joint. • Innervation: Ulnar
nerve
It is a thickening of deep fascia in front of the fingers? Function?
Synovial flexor sheath
They enable tendons to slide freely over each other during movements of the fingers
Common synovial sheath surround? Exception? .
Common synovial sheath: Surrounds FDS & FDP • 2- synovial sheath for FPL: FPL has its own synovial sheath that continues till its insertion
strong ligamentous tunnels containing the flexor tendons and their synovial sheaths.
fibrous digital sheaths:
Inflammation of the tendon and synovial sheath, the digit swells and movement becomes painful. ?
Explain spread
Tenosynovitis/ In 2nd, 3rd, and 4th fingers, the infection is usually confined to the infected finger. Tenosynovitis in (5) little finger may spread to the common sheath and thus through the palm and carpal tunnel to the anterior forearm.
Anterior (flexor) Compartment of the arm ?
Muscles: Coracobrachialis. Biceps brachii. Brachialis.
Anterior (flexor) Compartment
Coracobrachialis. Biceps brachii. Brachialis.
Origin ? Insertion? Nerve supply?
Coracobrachialis
Origin: Apex of coracoid process. Insertion: Medial side of the midshaft of the humerus.
Biceps Brachii
Origin: • The short head: coracoid process. • The long head: Supraglenoid tubercle within the shoulder
joint. Insertion:
• Radial tuberosity.
• As the tendon enters the forearm, a
flat sheet of connective tissue (the
bicipital aponeurosis) fans out from
the medial side of the tendon to blend
with deep fascia covering the anterior
compartment of the forearm.
Brachialis • Origin: Lower half of the ant. aspect of the humerus. • Insertion: Tuberosity of the ulna beneath the biceps brachii muscle
N suppply: Musculocutaneous N., except a small
component of the lateral part of brachilais is innervated by the radial nerve.
Musculocutaneous nerve
Route?
Pierces the coracobrachialis muscle. • Runs between the biceps and brachialis. • Reaches the lateral side of the biceps tendon. • Penetrates the deep fascia, ends as the lat. cutaneous nerve of the forearm.
Musculocutaneous Nerve (nerve of the flexor comp.) Motor and sensory?
Motor: all three muscle of the ant.
compartment. • Sensory: lateral skin of the forearm.
Posterior Compartment of the Arm ?
Origin? Insertion? Nerve supply? Action?
Origin: (Triceps)
Long head from infraglenoid tubercle of the scapula (extracapsular). Lateral head from an linear roughening superior to the radial groove of the humerus Medial head from the shaft of the humerus inferior to the radial groove.
• Insertion: Superior surface of the olecranon process.
• Nerve supply: radial nerve
• Action: Extensor of the elbow joint.
is an
important area of transition between
the arm and the forearm. It is the
triangular depression in the front of
the elbow.
?
Cubital Fossa
Cubital Fossa
Boundaries? Lateral? Medial? Base? Roof? Floor?
Lateral: brachioradialis
Medial: pronator teres.
Base: a line between the two humeral epicondyles.
Floor: brachialis.
Roof: Roof: Skin, superficial fascia, and deep fascia.
superficial: medial cubital vein/ cephalic vein / basilic vein/ medial and lateral cutaneous nerves of forearm
deep: bicipital aponrosis
Cubital Fossa
• Contents from medial to lateral ?
1. Median N.: is the most medial structure, leaves the fossa by passing between the two heads of the pronator teres muscle 2. Brachial A.: terminates at the apex by dividing into radial and ulnar arteries. 3. Tendon of biceps brachii.
Deltoid
Origin ? Insertion? Nerve supply? Action?
Origin: Ant. border of the lat. third of the clavicle. • Lat. border of acromion • Lower lip of the crest of the scapular spine. Insertion:
Deltoid tuberosity of the humerus.
Nerve supply:
Axillary nerve.
Action: • Ant. fibres, flexor and medial rotator of the arm . • Post. fibres, extensor and lateral rotator of the arm . • Middle fibres, abductor of the shoulder from 15°-90°
Gateways to the Posterior Scapular Region? Names? Boundaries?
The quadrangular space Boundaries • the teres minor, • the surgical neck of the humerus, • the teres major • the long head of the triceps brachii.
The triangular space Boundaries: • the long head of the triceps brachii. • the teres major. • the teres minor.
The triangular interval Boundaries • the long head of the triceps brachii, • the shaft of the humerus • the teres major.
Gateways to the Posterior Scapular Region
Structures that pass through them?
Qspace
Structures passing through: Axillary nerve Posterior circumflex humeral artery and vein.
Tspace
Structures passing through: The circumflex scapular artery and vein.
Tint
Structures passing through: Radial nerve Profunda brachii artery
the anterior compartment muscle of forearms :
A. Superficial
- Pronator teres ( median nerve lies between the heads )
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris ( supply ulnar nerve+ lies overseen the two heads of this muscle )
Nerve supply: median nerve except flexor carpi radialis ulnar nerve.
B. Intermediate
1. Flexor digitorum superficialis
Nerve supply : median nerve
C. Deep
- Flexor digitorum profundus ( Its lateral half: from the anterior interosseus nerve (branch of the median nerve) It medial half: from the ulnar nerve.)
- Pronator Quadratus ( anterior interoseous nerve of median nerve)
- Flexor pollicis longus (anterior interoseous nerve of median nerve)
Nerve supply: anterior interoseous nerve of median nerve except flexor digitorum profundus
Pronator Teres
Origin? Insertion? Nerve? Action?
Origin by two heads Superficial head: Medial epicondyle. Deep Head : Coronoid process of ulna Insertion: middle of shaft of radius. Innervated by median nerve. Action: Pronates and flexes forearm. Note : Median nerve lies between its two heads
Flexor Carpi Radialis
Origin? Insertion? Nerve? Action?
Flexor Carpi Radialis Origin: medial epicondyle of humerus. Insertion: Base of second and third metacarpals. Innervated by median nerve. Action: -Flexor -[radial] abductor of wrist. - Flexes the elbow.
Palmaris longus
Origin? Insertion? Nerve? Action?
Origin: Medial Epicondyle of humerus. Inserted into the flexor retinaculum and the palmar aponeurosis Innervated by median nerve. Action: Weak flexor of wrist. Degenerating muscle absent in 13% of arms.(cf. the plantaris in leg) The palmar aponeurosis represents the distal part of the tendon of Palmaris longus.
Flexor Carpi Ulnaris
Origin? Insertion? Nerve? Action?
Origin: Humeral head –(Medial Epicondyle humerus) Ulnar head (shaft ulna) Inserted into the pisiform and
the base of fifth metacarpal. Nerve Supply: Ulnar nerve Action:
Flexor and
adductor(ulnar) of wrist . Ulnar nerve passes
between two heads of this
muscle.
Flexor Digitorum Superficialis
Origin? Insertion? Nerve supply? Action?
Origin:
medial epicondyle of humerus,
And upper part of radius and ulna
Inserts into the middle phalanges of medial 4 fingers
Innervated by median nerve
Action: Flexor of proximal interphalangeal joints, metacarpophalangeal and wrist joints.
narrow passageway found on the anterior portion of the wrist. It serves as the entrance to the palm for several tendons and the median nerve.
?
carpal tunnel
Flexor Digitorum Profundus
Origin? Insertion? Nerve supply? Action?
Origin:
From shaft of the ulna and interosseus
membrane. Insertion:The muscle divides into 4 tendons
which are inserted into the bases of the distal phalanges of the medial 4 fingers.
Nerve Supply: Its lateral half: from the anterior interosseus nerve (branch of the median nerve)
It medial half: from the ulnar nerve.
Action:
1 Flexion of the distal interphalangeal joints (of the 2.
medial 4 fingers.) Helps in flexion of the proximal interphalangeal joints and 3.
metacarpophalangeal joints (of the medial 4 fingers). Helps of flexion of the wrist joint.
Flexor Digitorum Profundus unique features
?
- It has a dual nerve supply so it is a
composite or hybrid muscle
-The tendons give origin to the
lumbricals ms. in the palm.
-The tendons of flexor digitorum profundus passes within the tendons of flexor digitorum superficialis before insertion on the phalanges.
Pronator Quadratus
Origin? Insertion? Nerve supply? Action?
Arises from anterior surface of distal ulna. Inserted into anterior surface of distal radius. Innervated by anterior interosseous nerve (branch of the median nerve) Action: Pronates the forearm and helps to hold lower ends of radius and ulna together, especially when hand is weight bearing.
Flexor Pollicis Longus
Origin? Insertion? Nerve supply? Action?
Origin From the anterior surface of the
shaft of the radius and
interosseus membrane. Insertion: Into the base of the distal phalanx
of the thumb. Nerve Supply: From the anterior interosseus nerve
(branch of the median nerve).
Action:
Flexion of the thumb
Pressure on median nerve because of tightly packed flexor digitorum tendons ?
CARPAL TUNNEL SYNDROME
is a compression neuropathy of the median nerve at the elbow between the two sections of the pronator teres muscle in the forearm. ? Results in ?
PRONATOR TERES SYNDROME
Weak pronation
? develops when swelling or bleeding occurs within a compartment. ?
COMPARTMENT SYNDROME
develops when swelling or bleeding occurs within a compartment. / Blood supply is disrupted and nerve compression can lead to abnormal sensations, muscular weakness and loss.
?
COMPARTMENT SYNDROME
medial epicondylitis, is tendinosis of the medial epicondyle ? ,most common for?
Golfer’s elbow
It is the most common elbow injury for rock climbers, construction and plumbing, golfers etc.
Muscles of the Back of Forearm
Extensors of the forearm :
Extensor compartment :
A. superficial:
- Brachioradialis (radial N)
- Extensor carpi radialis longus (radial N)
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
- Anconeus ( Radial nerve )
Nerve supply: posterior interosseous nerve
Except ( Brachioradialis 2- ECRL 3- Anconeus= Radial N)
B. Deep:
- Supinator ( nerve lies between two heads )
- Abductor pollicis longus
- Extensor pollicis longus
- Extensor pollicis brevis
- Extensor indicis
Nerve supply : posterior interosseous nerve
Brachioradialis muscle
Origin? Insertion? Nerve supply? Action?
Origin: Lateral supracondylar ridge Insertion: Lower end of radius (lateral surface) N.S.: Radial nerve Action: • Flexion of elbow in mid-prone position • Initiation of supination & pronation
Extensor carpi radialis longus
Origin? Insertion? Nerve supply? Action?
Origin : Distal part of lateral supracondylar of humerus Insertion : base of 2nd metacarpal Nerve supply: Radial nerve Action: extension and abducts the wrist
Extensor carpi radialis brevis
Origin? Insertion? Nerve supply? Action?
Origin: later epicondyl of humerus
Insertion: base of 3rd metacarpal
Nerve supply: posterior interosseous
Action: Extends and abducts the wrist
Extensor digitorum muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Common extensor origin (Lateral epicondyle of humerus)
- Insertion: Divides into 4 tendons to medial 4 fingers Which insert via extensor expansion (hood) into Middle & distal phalanges
- N.S.: Posterior interosseous nerve
- Action: • Extension of elbow & wrist • Extension of all joints of medial 4 fingers
Is triangular-shaped connective tissue aponeurosis • Situated on the dorsum of Proximal phalanx of the medial 4 fingers (Thumb has no extensor expansion) ?
extensor expansion (hood)
Receives tendons of Extensors,
Lumbericals& Interossei of fingers ?
The extensor expansion (hood)
The extensor expansion (hood)
Splits into three parts?
Splits into three parts: A central part, which is inserted into the base of the middle phalanx Two lateral parts, which converge to be inserted into the base of the distal phalanx
Extensor digiti minimi muscle
Origin? Insertion? Nerve supply? Action?
Origin: Common extensor origin (Lateral epicondyle of humerus) Insertion: Extensor expansion of little finger N.S.: Posterior interosseous nerve Ex. Digiti minimi
Action: • Extension of elbow & wrist • Extension of all joints of
little finger
Extensor carpi ulnaris muscle
Origin? Insertion? Nerve supply? Action?
Origin: Common extensor origin + Posterior border of ulna Insertion: Base of 5th metacarpal bone N.S.: Posterior interosseous nerve Action: • Extension of elbow & wrist • Adduction (Ulnar deviation) of wrist
Anconeus muscle
Origin? Insertion? Nerve supply? Action?
Origin: Back of lateral epicondyle Insertion: Posterior surface of ulna N.S.: Radial nerve Action: Assist in extension of elbow
Supinator muscle
Origin? Insertion? Nerve supply? Action?
-Origin : 2 heads Humeral head and a deep ulnar head —Insertion: Upper 1/3 of Lateral surface of Humeralradius -N.S.: Posterior interosseous nerve -Action: Supination of forearm Posterior interosseous nerve lies between its two heads
Abductor pollicis longus muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Posterior surface of ulna Posterior surface of radius Interosseus memebrane
- Insertion: Base of 1st metacarpal bone.
- N.S.: Posterior interosseous nerve
- Action: Abduction of thumb
Extensor pollicis brevis muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Posterior surface of radius
- Insertion: Base of proximal phalanx of thumb
- N.S.: Posterior interosseous nerve
- Action: Extension of carpometacarpal & metacarpophalangeal joints of thumb
Extensor pollicis longus muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Posterior surface of ulna
- Insertion: Dorsal surface of base of distal phalanx of thumb Its Tendon passes medial to dorsal tubercle of radius
- N.S.: Posterior interosseous nerve
- Action: Extension of all joints of thumb
Extensor indicis muscle
Origin? Insertion? Nerve supply? Action?
- Origin: Posterior surface of ulna
- Insertion: Extensor expansion of index finger
- N.S.: Posterior interosseous nerve
- Action: Extension of all joints of index finger
Triangular depression on lateral Side of wrist joint. ?
Anatomical Snuff Box
Anatomical Snuff Box
Boundaries? Lateral medial floor and content?
Boundaries:
- Lateral: tendons of Abductor pollicis longus & Extensor pollicis brevis
- Medial: Tendon of Extensor pollicis longus
- Floor: Styloid process of radius Scaphoid, Trapezium -Contents: Radial artery
Thickening of deep fascia on dorsal surface of wrist ?
Extensor retinaculum
Extensor retinaculum
Structure superficial to it?
Deep to it?
- Structures superficial to it: Superficial branch of radial n. Cephalic v. Basilic v. Dorsal cut. Branch of ulnar n. •
-Structures deep to it: 6 compartments contain all long extensor tendons except Brachioradialis • It holds the long extensor
tendons in position
after fracture of the distal third of the radius. Roughening of the dorsal tubercle of the radius by the fracture line can cause excessive friction on the tendon, which can then rupture .
?
Rupture of the Extensor Pollicis Longus
caused by a partial tearing or degeneration of the origin of the superficial extensor muscles from the lateral epicondyle of the humerus. It is characterized by pain and tenderness over the lateral epicondyle of the humerus, with pain radiating down the lateral side of the forearm; it is common in?
Tennis Elbow
Sudden severe tension on a long extensor tendon may avulse
part of its attachment to the phalanx. • This deformity results from the distal interphalangeal joint
suddenly being forced into extreme flexion leading to avulsion
of extensor expansion tendon from base of the distal phalanx.
As a result, the person cannot ?
Condition?
Mallet or Baseball Finger
the person cannot extend the distal interphalangeal
joint.
