Download MBBS Anatomy PPT 11 Ul Intro Notes

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Learning objectives

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

DESCRIBE

Contents of ant & post compartment of arm ,

Brachial plexus

Nerves ,blood vessels & their anatomical Relations with

clinical importance

2

Week 7

Week 5

RULE -
Limbs are outgrowths of
the ventral body wall that
undergo distal growth and
differentiation...5th Week

3

and rotation...7th week

Anterior

Upper Limb

Humerus

Muscle

Arm

Compartments

Posterior

Anterior

Radius

Forearm

Ulnar

S
t
e
r
n
E
sse

Posterior

n
t
a
i

l
o
f

G

Anterior

r
o
ss
A

Hand

n
a
t
o
m
y

5th metacarpal

4

Anterior

Humerus

Arm

Posterior

Few muscles of
posterior
compartment are
present in

Anterior

anterolateral

*

aspect of forearm

Radius

Forearm

(*brachioradialis,

Ulnar

S supinator)

t
e
r
n
E
sse

Posterior

n
t
a
i

l
o
f

G

Anterior

r
o
ss

No posterior compartment in

A

Hand

n
a

the hand

t
o
m
y

5th metacarpal

5




Anterior

Musculocutaneous n.

Motor innervation

Muscle Compartments

Humerus

Radial n.

Posterior

Anterior

Median n. & Ulnar n.

Radius

Ulna

S
t
e
r
n

Radial n.

E

Posterior

sse
n
t
a
i

l
o
f

G

Ulnar n. & Median n.

r
o
ss

Anterior

A
n
a
t
o
m

5th metacarpal

y

Posterior

RULE : Ventral vs. dorsal limb mm.

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

S
t
e

*

r
n

E
sse
n

Developmentally-ventral muscles:

t
a
i

l
o
f


? Lie anterior to the long bones in

G
r
o
ss

anatomical position

A
n
a
t
o
m
y

7

Brachial Plexus

"Roots of BP"

(=ventral rami)

(right side; simplified)

C5
C6

Trunks

C7

U

Divisions

C8

M

Cord

Terminal

Lat

L

T1

Branches

Post

S

Med

t
e
r
n
E
sse
n
t
a
i

l
o
f

G
r
o
ss
A
n

Anterior (ventral) division

a
t
o
m

8

y

Posterior (dorsal) division

Brachial Plexus

"Roots of BP"

(=ventral rami)

(right side; simplified)

C5
C6

Trunks

C7

U

Divisions

C8

M

Cord

Terminal

Lat

L

T1

Branches

Post

Musculocutaneous n.

S

Med

t
e
r
n
E
sse

Median n.

n
t
a
i

l
o

Radial n.

f

G
r
o
ss
A
n

Ulnar n.

Anterior (ventral) division

a
t
o
m

9

y

Posterior (dorsal) division


Brachial plexus - cords

Lateral cord ? LML ? Lateral Pectoral n,

Musculocutaneous n, lateral root of Median n

Medial cord ? MMMMU ? Medial pectoral n, Medial

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

Posterior cord ? LUNAR ? Lower subscapular n, Upper

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

10

Brachial plexus ? supraclavicular branches
- roots & trunks

Branch to Phrenic nerve ?C5 ?anterior to sclaneus

anterior

Dorsal scapular n ? C5 ? pierces sclaneus medius,

supplies rhomboids & levator scapulae

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

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

TRUNKS ? Upper

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

gives - accessory phrenic nerve ?C5)

Suprascapular n- C5C6 ? supra & infraspinatus , articular

11

? shoulder, acromioclavicular,

Brachial plexus-

Lateral pectoral n- C5C6C7 ? LC -larger, pierces

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

Medial pectoral n- C8T1-MC- , pierces pectoralis

minor & supplies both pectoralis major & minor.

Upper sub scapular n- smaller ? frequently

double.

Lower sub scapular n- subscapularis & teres

major.

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

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

Brachial Plexus
(branches)

C5

C6

supraspinatus

suprascapular n.

C7

& infraspinatus

*

mm.

C8

T1

S
t
e
r
n
E
sse
n
t

**

a
i

l
o
f

upper subscapular n.

subscapularis m.


G
r
o
ss

axillary n. thoracodorsal n.

latissimus dorsi m.

A
n
a

lower subscapular n.

t

subscapularis &

o
m
y

teres major mm.

deltoid & teres minor mm.


Brachial Plexus rhomboid mm.

dorsal
scapular n.

(branches)

C5

C6

suprascapular n.

C7

*

C8

pectoralis mm.

lateral pectoral n.

serratus

T1 anterior m.

musculoskeletal
n.

long

S

thoracic n.

t
e
r
n

E

medial n.

sse

medial pectoral n.

pectoralis mm. nt

**

a
i

l
o
f

upper subscapular n.


G
r
o
ss

axillary n.

thoracodorsal n.

A
n
a

lower subscapular n.

t
o

ulnar n.

m
y

14

radial n.

Dorsal

Brachial Plexus

scapular n.

C5

(all branches)

C6

Suprascapular n.

C7

*

C8

Lateral pectoral n.

T1

Musculoskeletal n.

Long

S

thoracic n.

t
e
r
n
E

Medial n.

sse

Medial pectoral n.

n

**

t
a
i

l
o
f

Upper & lower subscapular nn.


G
r
o
ss
A

Axillary n.

Thoracodorsal n.

n
a
t
o

Ulnar n.

m
y

* Nerve to subclavius

15

Radial n.

** Medial brachial & antebrachial cutaneous nn.

Brachial plexus - cords

Lateral cord ? LML ? Lateral Pectoral n,

Musculocutaneous n, lateral root of Median n

Medial cord ? MMMMU ? Medial pectoral n, Medial

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

Posterior cord ? LUNAR ? Lower subscapular n, Upper

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

16

Nerve supply of Scapula Muscles

Origin on Scapula:

Latissimus dorsi = Thoracodorsal nerve

Subscapularis, Teres Major = Subscapular nerves

Supraspinatus, Infraspinatus = Suprascapular nerves

Teres Minor = Axillary nerve

Insertion on Scapula

Levator Scapular, Rhomboids = Dorsal Scapular nerve

Pectoralis Minor = Pectoral n.

Serratus anterior = Long Thoracic n.

Trapezius = Accessory n.


Branches of the Posterior Cord (continued)

Axillary Nerve ( w . Circumflex vs..)

Supplies:

Deltoid and Teres minor (motor supply )

Capsule of shoulder

skin of lower part covering deltoid (sensory

supply)

Subscapular Nerves {branches of C5 + C6 rami}

Innervates: Subscapularis, Teres major

Thoracodorsal Nerve (runs w. thoracodorsal vs)

supplies: Latissimus dorsi

Muscles of Arm: Cross elbow, Move forearm

Two compartments 1. Anterior: Flexors of forearm &

2. Posterior: Extensors of forearm

Anterior Compartment ? MCN +AA & BA

Biceps brachii = MC nerve

Brachialis =

MC nerve

Coracobrachialis = MC nerve &

Brachioradialis = Radial nerve

Posterior Compartment ? RN + PBA

Triceps brachii =

Radial nerve

Anconeus =

Radial nerve


? If ORIGIN on scapula =

Muscles of

?

Move Arm

? Subscapularis

Scapula

? Supraspinatus

Rotator

? Infraspinatus

Cuff

? Teres Minor

? Teres Major

? Latissimus Dorsi (partial O on

scapula)

? Coracobrachialis

? If INSERTION on scapula =
? Move scapula

? Rhomboids

? Trapezius

? Pectoralis Minor

? Serratus Ventralis

? Levator Scapulae

Compartments of the forearm :

Flexor Compartment : Anterior

(Superficial + Deep layers)

Most of superficial flexors originate by a
common origin from medial epicondyle
Contains 2 pronators, are supplied by

Median, AIN and Ulnar nerves

2.Posterior Extensor Compartment : Posterior

(Superficial + Deep layers)

Are supplied by Radial and Posterior
interosseous nerve.

Anterior Compartment of Forearm

Muscle

Nerve

Superficial Muscles

Flexor digitorum superficialis

Median

Flexor carpi radialis

Median

Pronator teres

Median

Palmaris longus

Median

Flexor carpi ulnaris

Ulnar

Deep Muscles

Pronator quadratus

Ant.int N - Median

Flexor pollicis longus

Ant.int.N - Median

Flexor digitorum profundus

Ulnar (med 1/2)

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


Anterior Compartment Forearm

Medial Epicondyle

Brachioradialis

Pronator Teres

Flexor Carpi Radialis

Flexor Carpi Ulnaris

Flexor Retinaculum

Flexor Digitorum Superficialis
is deep to other flexors

Anterior View

Posterior Compartment of Forearm

Muscle

Nerve

Superficial

Extensor carpi radialis Longus & Brevis

RN

Extensor digitorum (communis) RN

Extensor digiti minimi

RN

Extensor carpi ulnaris

RN

Deep (post gp) - PIN

Supinator

Radial n + PIN

Abductor pollicis longus

PIN

Extensor pollicis longus + brevis PIN

Extensor indicis

PIN

Posterior Compartment of Forearm

Lateral Epicondyle

Brachioradialis

Extensor digitorum

Extensor carpi ulnaris

Ext Carpi Radialis Longus

Posterior View


Muscles of Hand

Muscle

Nerve

Pinky (little finger)

All digiti minimi

Ulnar

(Flexor, Abductor, Opponens)

Thumb

Abductor pollicis brevis

Median

Flexor pollicis brevis

Median

Opponens pollicis

Median

Adductor pollicis

Ulnar- deep br

Other Intrinsic Muscles

Palmar & Dorsal Interossei

Ulnar

4 Lumbricals

Median, Ulnar

Muscles of Hand

Palmar

Dorsal

Lumbricals

Interossei

Interossei

3rd

ABduction

ADDuction

2nd

4th

1st

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

The Axilla

Axilla = Armpit

Region between arm and chest

Boundaries

Anterior - pectoral muscles

Posterior = latissimus dorsi, teres major&

subscapularis

Medial = upper 4 ICS & serratus ant

Lateral = bicipital groove of humerus

Contents

Axillary lymph nodes, Axillary vessels ,Brachial

Plexus


Upper Limb

Upper Limb
Cubital Fossa

Contents

Median Cubital Vein

Brachial Artery

Median Nerve

Boundaries

Medial= Pronator teres

Lateral= Brachioradialis

Superior= Line between epicondyles




Surface Anatomy

Anatomical Snuffbox

of Upper Limb

Lateral = APL & E

pol brevis

Medial = E. pollicis

longus

Floor = scaphoid,

styloid of radius

Contains Radial

Artery (pulse)

Test for Peripheral Nerve

Sensory Function:

M

U

R

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

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

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

M

C7

U

C8

C6

R

40

Stretch Reflex

u
d
e
.
n
o
t
n
cra
s
c.
i
m
e
d
ca
a

Bicipital reflex (C6 cord level)

Triceps reflex (C7 cord level)
UPPER LIMB RADICULAR SYNDROMES

IVD

Root

Sensory Loss

Motor Weakness

C4-C5 C5

Shoulder

Shoulder weakness

Cranial

Proximal

C5-C6 C6

Anterior upper arm,

Forearm flexion

Lateral forearm, thumb Biceps reflex

C6-C7 C7

3rd digits

Forearm extension
Triceps reflex
Wrist extension
Hand grip

C7-C8 C8

5th digits

Wrist flexion

Caudal

Medial forearm

Intrinsic hand mm.

Distal

Source: Devinsky et al. Neurologic Pearls

This post was last modified on 05 April 2022