Download MBBS Anatomy PPT 11 Ul Intro Notes

Learning objectives

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At end of this session, students should be able to:

DESCRIBE

Contents of ant & post compartment of arm ,

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Brachial plexus

Nerves ,blood vessels & their anatomical Relations with

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clinical importance

2

Week 7

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Week 5

RULE -
Limbs are outgrowths of

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the ventral body wall that
undergo distal growth and
differentiation...5th Week

3

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and rotation...7th week

Anterior

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Upper Limb

Humerus

Muscle

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Arm

Compartments

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Posterior

Anterior

Radius

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Forearm

Ulnar

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S
t
e
r
n

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E
sse

Posterior

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n
t
a
i

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l
o
f

G

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Anterior

r
o

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ss
A

Hand

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n
a
t
o
m

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y

5th metacarpal

4

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Anterior

Humerus

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Arm

Posterior

Few muscles of

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posterior
compartment are
present in

Anterior

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anterolateral

*

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aspect of forearm

Radius

Forearm

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(*brachioradialis,

Ulnar

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S supinator)

t
e
r

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n
E
sse

Posterior

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n
t
a
i

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l
o
f

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G

Anterior

r

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o
ss

No posterior compartment in

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A

Hand

n

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a

the hand

t

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o
m
y

5th metacarpal

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5

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Anterior

Musculocutaneous n.

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Motor innervation

Muscle Compartments

Humerus

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Radial n.

Posterior

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Anterior

Median n. & Ulnar n.

Radius

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Ulna

S
t

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e
r
n

Radial n.

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E

Posterior

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sse
n
t
a
i

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l
o
f

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G

Ulnar n. & Median n.

r

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o
ss

Anterior

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A
n
a
t
o

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m

5th metacarpal

y

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Posterior

RULE : Ventral vs. dorsal limb mm.

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Developmental y-dorsal muscles:
? Lie posterior to the long bones in
anatomical position (* exceptions)

S

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t
e

*

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r
n

E
sse

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n

Developmentally-ventral muscles:

t

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a
i

l
o

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f


? Lie anterior to the long bones in

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G
r
o
ss

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anatomical position

A
n
a

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t
o
m
y

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7

Brachial Plexus

"Roots of BP"

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(=ventral rami)

(right side; simplified)

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C5
C6

Trunks

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C7

U

Divisions

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C8

M

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Cord

Terminal

Lat

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L

T1

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Branches

Post

S

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Med

t
e

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r
n
E
sse
n

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t
a
i

l

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o
f

G
r

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o
ss
A
n

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Anterior (ventral) division

a
t
o

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m

8

y

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Posterior (dorsal) division

Brachial Plexus

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"Roots of BP"

(=ventral rami)

(right side; simplified)

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C5
C6

Trunks

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C7

U

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Divisions

C8

M

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Cord

Terminal

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Lat

L

T1

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Branches

Post

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Musculocutaneous n.

S

Med

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t
e
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n

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E
sse

Median n.

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n
t
a
i

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l
o

Radial n.

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f

G
r
o

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ss
A
n

Ulnar n.

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Anterior (ventral) division

a
t

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o
m

9

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y

Posterior (dorsal) division

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Brachial plexus - cords

Lateral cord ? LML ? Lateral Pectoral n,

Musculocutaneous n, lateral root of Median n

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Medial cord ? MMMMU ? Medial pectoral n, Medial

cutaneous n of forearm, Medial cutaneous n of arm ,
Ulnar n & Medial root of median n.

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Posterior cord ? LUNAR ? Lower subscapular n, Upper

subscapular n , Nerve to latissimus dorsi, Axillary n
& Radial n.

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10

Brachial plexus ? supraclavicular branches
- roots & trunks

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Branch to Phrenic nerve ?C5 ?anterior to sclaneus

anterior

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Dorsal scapular n ? C5 ? pierces sclaneus medius,

supplies rhomboids & levator scapulae

Long thoracic n ? C5C6C7 ? (C7 ? may be absent) upper

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two roots C5C6 pierce sclaneus medius , runs b/w
sclaneus ant & medius ? Supply - serratus anterior.

TRUNKS ? Upper

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Nerve to subclavius ? Erb's Point - C5 C6 ?subclavius (

gives - accessory phrenic nerve ?C5)

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Suprascapular n- C5C6 ? supra & infraspinatus , articular

11

? shoulder, acromioclavicular,

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Brachial plexus-

Lateral pectoral n- C5C6C7 ? LC -larger, pierces

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clavipectoral fascia ,ant to axillary art- pectoralis
major & minor.

Medial pectoral n- C8T1-MC- , pierces pectoralis

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minor & supplies both pectoralis major & minor.

Upper sub scapular n- smaller ? frequently

double.

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Lower sub scapular n- subscapularis & teres

major.

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Axillary n- ant branch ?deltoid & post branch- has

pseudoganglion supplies teres minor ,cutaneous ?
as- upper lateral cutaneous nerve of a12rm .

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Brachial Plexus
(branches)

C5

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C6

supraspinatus

suprascapular n.

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C7

& infraspinatus

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*

mm.

C8

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T1

S
t

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e
r
n
E
sse

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n
t

**

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a
i

l
o

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f

upper subscapular n.

subscapularis m.

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G
r
o

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ss

axillary n. thoracodorsal n.

latissimus dorsi m.

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A
n
a

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lower subscapular n.

t

subscapularis &

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o
m
y

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teres major mm.

deltoid & teres minor mm.

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Brachial Plexus rhomboid mm.

dorsal
scapular n.

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(branches)

C5

C6

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suprascapular n.

C7

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*

C8

pectoralis mm.

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lateral pectoral n.

serratus

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T1 anterior m.

musculoskeletal
n.

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long

S

thoracic n.

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t
e
r
n

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E

medial n.

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sse

medial pectoral n.

pectoralis mm. nt

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**

a
i

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l
o
f

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upper subscapular n.


G
r

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o
ss

axillary n.

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thoracodorsal n.

A
n
a

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lower subscapular n.

t
o

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ulnar n.

m
y

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14

radial n.

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Dorsal

Brachial Plexus

scapular n.

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C5

(all branches)

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C6

Suprascapular n.

C7

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*

C8

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Lateral pectoral n.

T1

Musculoskeletal n.

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Long

S

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thoracic n.

t
e
r

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n
E

Medial n.

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sse

Medial pectoral n.

n

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**

t
a

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i

l
o
f

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Upper & lower subscapular nn.


G

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r
o
ss
A

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Axillary n.

Thoracodorsal n.

n

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a
t
o

Ulnar n.

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m
y

* Nerve to subclavius

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15

Radial n.

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** Medial brachial & antebrachial cutaneous nn.

Brachial plexus - cords

Lateral cord ? LML ? Lateral Pectoral n,

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Musculocutaneous n, lateral root of Median n

Medial cord ? MMMMU ? Medial pectoral n, Medial

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cutaneous n of forearm, Medial cutaneous n of arm ,
Ulnar n & Medial root of median n.

Posterior cord ? LUNAR ? Lower subscapular n, Upper

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subscapular n , Nerve to latissimus dorsi, Axillary n
& Radial n.

16

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Nerve supply of Scapula Muscles

Origin on Scapula:

Latissimus dorsi = Thoracodorsal nerve

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Subscapularis, Teres Major = Subscapular nerves

Supraspinatus, Infraspinatus = Suprascapular nerves

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Teres Minor = Axillary nerve

Insertion on Scapula

Levator Scapular, Rhomboids = Dorsal Scapular nerve

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Pectoralis Minor = Pectoral n.

Serratus anterior = Long Thoracic n.

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Trapezius = Accessory n.


Branches of the Posterior Cord (continued)

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Axillary Nerve ( w . Circumflex vs..)

Supplies:

Deltoid and Teres minor (motor supply )

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Capsule of shoulder

skin of lower part covering deltoid (sensory

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supply)

Subscapular Nerves {branches of C5 + C6 rami}

Innervates: Subscapularis, Teres major

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Thoracodorsal Nerve (runs w. thoracodorsal vs)

supplies: Latissimus dorsi

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Muscles of Arm: Cross elbow, Move forearm

Two compartments 1. Anterior: Flexors of forearm &

2. Posterior: Extensors of forearm

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Anterior Compartment ? MCN +AA & BA

Biceps brachii = MC nerve

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Brachialis =

MC nerve

Coracobrachialis = MC nerve &

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Brachioradialis = Radial nerve

Posterior Compartment ? RN + PBA

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Triceps brachii =

Radial nerve

Anconeus =

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Radial nerve


? If ORIGIN on scapula =

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Muscles of

?

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Move Arm

? Subscapularis

Scapula

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? Supraspinatus

Rotator

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? Infraspinatus

Cuff

? Teres Minor

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? Teres Major

? Latissimus Dorsi (partial O on

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scapula)

? Coracobrachialis

? If INSERTION on scapula =

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? Move scapula

? Rhomboids

? Trapezius

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? Pectoralis Minor

? Serratus Ventralis

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? Levator Scapulae

Compartments of the forearm :

Flexor Compartment : Anterior

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(Superficial + Deep layers)

Most of superficial flexors originate by a
common origin from medial epicondyle

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Contains 2 pronators, are supplied by

Median, AIN and Ulnar nerves

2.Posterior Extensor Compartment : Posterior

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(Superficial + Deep layers)

Are supplied by Radial and Posterior
interosseous nerve.

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Anterior Compartment of Forearm

Muscle

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Nerve

Superficial Muscles

Flexor digitorum superficialis

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Median

Flexor carpi radialis

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Median

Pronator teres

Median

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Palmaris longus

Median

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Flexor carpi ulnaris

Ulnar

Deep Muscles

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Pronator quadratus

Ant.int N - Median

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Flexor pollicis longus

Ant.int.N - Median

Flexor digitorum profundus

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Ulnar (med 1/2)

Flexor digitorum profundus Ant.int.N - Median (lat 1/2)

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Anterior Compartment Forearm

Medial Epicondyle

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Brachioradialis

Pronator Teres

Flexor Carpi Radialis

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Flexor Carpi Ulnaris

Flexor Retinaculum

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Flexor Digitorum Superficialis
is deep to other flexors

Anterior View

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Posterior Compartment of Forearm

Muscle

Nerve

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Superficial

Extensor carpi radialis Longus & Brevis

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RN

Extensor digitorum (communis) RN

Extensor digiti minimi

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RN

Extensor carpi ulnaris

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RN

Deep (post gp) - PIN

Supinator

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Radial n + PIN

Abductor pollicis longus

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PIN

Extensor pollicis longus + brevis PIN

Extensor indicis

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PIN

Posterior Compartment of Forearm

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Lateral Epicondyle

Brachioradialis

Extensor digitorum

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Extensor carpi ulnaris

Ext Carpi Radialis Longus

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Posterior View


Muscles of Hand

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Muscle

Nerve

Pinky (little finger)

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All digiti minimi

Ulnar

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(Flexor, Abductor, Opponens)

Thumb

Abductor pollicis brevis

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Median

Flexor pollicis brevis

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Median

Opponens pollicis

Median

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Adductor pollicis

Ulnar- deep br

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Other Intrinsic Muscles

Palmar & Dorsal Interossei

Ulnar

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4 Lumbricals

Median, Ulnar

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Muscles of Hand

Palmar

Dorsal

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Lumbricals

Interossei

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Interossei

3rd

ABduction

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ADDuction

2nd

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4th

1st

Interossei help the lumbricals to extend I P joints and flex MC-P joints

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The Axilla

Axilla = Armpit

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Region between arm and chest

Boundaries

Anterior - pectoral muscles

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Posterior = latissimus dorsi, teres major&

subscapularis

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Medial = upper 4 ICS & serratus ant

Lateral = bicipital groove of humerus

Contents

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Axillary lymph nodes, Axillary vessels ,Brachial

Plexus

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Upper Limb

Upper Limb
Cubital Fossa

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Contents

Median Cubital Vein

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Brachial Artery

Median Nerve

Boundaries

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Medial= Pronator teres

Lateral= Brachioradialis

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Superior= Line between epicondyles

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Surface Anatomy

Anatomical Snuffbox

of Upper Limb

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Lateral = APL & E

pol brevis

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Medial = E. pollicis

longus

Floor = scaphoid,

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styloid of radius

Contains Radial

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Artery (pulse)

Test for Peripheral Nerve

Sensory Function:

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M

U

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R

Ulnar n. ? Tip of 5th digit (little finger)

Median n. ? Tip of 2nd digit (index finger)

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Radial n. ? Webbing b/w thumb & index finger (dorsum)

M

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C7

U

C8

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C6

R

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40

Stretch Reflex

u

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d
e
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o

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t
n
cra
s
c.

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i
m
e
d
ca

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a

Bicipital reflex (C6 cord level)

Triceps reflex (C7 cord level)

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UPPER LIMB RADICULAR SYNDROMES

IVD

Root

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Sensory Loss

Motor Weakness

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C4-C5 C5

Shoulder

Shoulder weakness

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Cranial

Proximal

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C5-C6 C6

Anterior upper arm,

Forearm flexion

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Lateral forearm, thumb Biceps reflex

C6-C7 C7

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3rd digits

Forearm extension
Triceps reflex
Wrist extension

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Hand grip

C7-C8 C8

5th digits

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Wrist flexion

Caudal

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Medial forearm

Intrinsic hand mm.

Distal

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Source: Devinsky et al. Neurologic Pearls