Download MBBS 1st Year Anatomy Upper Limp Notes

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UPPER LIMB

Wrist and Hand:

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1. Bones of the hand ? 8 Carpal Bones

   • Proximal Row (From lateral to Medial)
     Scaphoid, Lunate, Triquetrum, Pisiform
   • Distal Row (From lateral to Medial)
     Trapezium, Trapezoid, Capitate, Hamate

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2. Commonly Fractured Carpal Bone ? Scaphoid

   Commonly dislocated Carpal Bone ? Lunate

3. 5 Meta Carpal Bones.

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   First metacarpal bone of the thumb is The Shortest and most Mobile

4. 14 Phalanges ? three phalanges for each of the fingers but only two for The Thumb

   • Proximal phalanges
   • Middle phalanges

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   • Distal phalanges
   • Proximal phalanges and Distal phalanges in The Thumb

5. Small Muscles of The Hand

   • Four lumbrical Muscles ? Nerve Supply
     

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     1st n 2nd / lateral two ? Median Nerve
     3rd n 4th ? Ulnar Nerve

• 8 Interossi Muscles
• 4 Palmar Muscles

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• 4 Dorsal Muscles ? Ulnar Nerve
• Palmaris Brevis ? Improve Grip of palm ? Ulnar Nerve
• Short Muscles of Thumb / Thenar Eminence:
  • Abductor Pollicis Brevis
  • Flexor pollicis Brevis
  • Opponens pollicis ? Median Nerve

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  • Adductor pollicis ? Ulnar Nerve
• Short Muscles of little Finger / Hypolhenar Eminence :
  • Abductor Digiti Minimi
  • Flexor Digiti Minimi
  • Opponens Digiti Minimi ? Ulnar Nerve

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All Small Muscles of The Hand Supplied by Ulnar Nerve Except 1st n 2nd Lumbrical and 3 thenar Eminence Muscles Supplied by Median Nerve

OR

Muscles of the hand Supplied by the Median Nerve Can be remembered using The mnemonic LOAF:

Lumbricals 1 & 2

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Opponens pollicis

Abductor pollicis Brevis

Flexor pollicis Brevis

6. Cutaneous Innervation of Hand

   Median Nerve ? Ulnar Nerve ? Palmar Branch

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   Median Nerve innervates lateral/3rd Part of palm, Skin of palmar Side of thumb, Index, Middle, half ring finger And Nail' beds of These fingers dorsally. Palmar digital Branches

   Ulnar Nerve innervates Medial 1/3rd part of palm, half ring finger, little Finger And dorsum of hand 1/3rd. Palmar digital Branches

   Anterior/ Palmar View

   Dorsal Branch and Dorsal digital Branches

   Proper Palmar digital Branches

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   Posterior / Dorsal View

7. Carpal Tunnel ? Carpal Bones and flexor Retinaculum form the Carpal tunnel at WRist!

   Ulnar Nerve ? Ulnar Artery ? Palmar Cutaneous branch of ulnar Nerve ? Tendon of Palmaris longus ? Palmar Cutaneous branch of Median Nerve * Flexor Pollicis longus tendon ? Median Nerve

   Capitate trapezoid ? Trepezium

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   Medially Laterally

   * Contents of Carpal Tunnel *

   Flexor Retinaculum ? Thickening of deep fascia.

8. Carpal Tunnel Syndrome ?

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   Causes:

   • Pregnancy
   • Amyloidosis
   • Endocrine disorders
   • Hypothyroidism

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   • Gigantism
   • Acromegaly
   • Frequent Use of Wrist during typing and cooking

   Features: Due to Compression of The Median Nerve Within The tunnel

   • Burning pain / pins and Needle's on palmar aspect of lateral three & a half fingers

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   • Weakness And Atrophy of The Thenas Muscles
   • Worse Features During Sleep
   • Apelike Hand.

   Condition Relieved by: Decompressing the tunnel by Making a longitudinal Incision through Flexor retinaculum.

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9. Palmar Aponeurosis ?

   Triangular in Shape

   Modified deep fascia in palm.

Fore Arm: /Ante Brachium

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10. Bones of Forearm ? Radius & ulna
11. Muscle's of Forearm ?

• Muscles Of Anterior / Flexor Compartment
  • Superficial Group:
    • pronator teres Median Nerve
    • Flexor Carpi Radialis Median Nerve
    • Palmasis longus Median Nerve

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    • Flexor Carpi ulnaris Ulnar Nerve
  • Intermediate Group:
    • Flexor Digitorum Superficialis Median Nerve
  • Deep Group:
    • Flexor pollicis longus Median Nerve

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    • Flexor Digitorum Profundus Ulnar (Medial half) Median (lateral half)
    • Pronator Quadratus Median Nerve

All Muscles Supplied by Median Nerve Except Flexor Carpi Ulnaris & Medial hall of Flexor Digitorum profundus which are Supplied by Ulnar Nerve...

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• Muscles Of Posterior/Extensor Compartment
  • Brachioradialis Radial Nerve
  • Anconeus "
  • Supinator "

Extensors of Wrist :

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• Extensor Carpi Radialis longus "
• Extensor Carpi Radialis Brevis "
• Extensor Carpi Ulnaris "

Extensors of Digits (except thumb) :

• Extensor digitorum "

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• Extensor digiti Minimi "
• Extensor Indicis "

Extensors of thumbs

• Abductor pollicis longus "
• Extensor pollicis Brevis "

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• Extensor pollicis longus "

All Muscles Supplied by Radial Nerve...

ARM/Brachium:

12. Bones of Arm ? Humerus
13. Muscles of Arm.

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• Muscles Of Anterior/Flexor Compartment
  • Biceps Brachii Musculocutaneous Nerve
  • Coracobrachialis Musculocutaneous Nerve
  • Brachialis Musculocutaneous Nerve

Biceps Brachii is a

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Powerful Supinator of Forearm

Powerful flexor of Elbow Joint

Weakan flexor of Shoulder Joint

• Muscles Of Posterior/Extensor Compartment
• Triceps Brachii Radial Nerve

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Shoulder Girdle :

14. Shoulder Girdle Consists of Clavicle and Scapula which articulate Wiln one another at acromioclavicular Joint
15. Most commonly Fractured Bone in The body Clavicle
16. Scapula Flat triangular Bone That lies on posterior Chest wall b/w and and 7in Ribs
17. Muscles Connecting The Scapula to The Humerus
    • Deltoid Axillary Nerve

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    • Supraspinatus Supra Scapular Nerve
    • Infraspinatus "
    • Teres Minor Axillary Nerve
    • Teres Major Lower Subscapular Nerve
    • Subscapularis upper and lower Subscapular

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Deltoid Muscle is the chief Flexor and Chief Extensor at Shoulder Joint...

18. Rotator Cuff ? Name given To The tendons of the

    • Subscapularis
    • Supraspinatus

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    • Infraspinatus
    • Teres Minor Muscles

    which are Fused to the underlying Capsule of The Shoulder Joint.

    Rotator cuff plays a very imp role in Stabilizing The Shoulder Joint ... Tone of these Muscles assists in holding The head of humerus in Glenoid Cavity of Scapula during movements at Shoulder Joint

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AXILLA:

19. Axilla OR Armpit ? pyramid-Shaped Space b/w upper part of arm and Side of Chest

    • Walls of Axilla
    • Anterior Walls Formed by Pectoralis Major, Pectoralis Minor, Subclavius
    • Posterios Wall : Formed by Subscapularis, Latissimus dorsi, teres Major from above down

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Medial Wall:

formed by upper 4/5 ribs and Inter-Costal Spaces Covered by Serratus Anterid Muscle

Lateral Wall:

Formed by Biceps and Coracobrachialis Muscles

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Base:

Skin Stretching b/w Ant and post Walls

Apex: / Cerricoaxillary Canal triangular in Shape, directed into The root of the Neck

• Contents of Axilla
  • Axillary Artery
  • Axillary Vein

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  • Axillary Group of Lymph Nodes
  • Nerve plexus/ Brachial plexus
  • Axillary pad of Fat
  • Axillary Sheath Connective tissue Sheath enclosed Axillary Artery And Cood's of Brachial plexus

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• Key Muscles in The Axilla Pectoralis Minor divide Axillary Artery into Three parts When crosses in front of Axillary Artery.

Cubital Fossa :

20. Cubital Fossa Triangular depression That dies in front of elbow

    Boundaries

    Laterally: Brachioradialis

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    Medially: pronator Teres

    R007 Skin And Fascia

    Floor Supinator laterally Brachialis Medially

    Base Imaginary line b/w two epicondyles of Humerus.

    Contents Medial to Lateral Side

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    • Median Nerve
    • Bifurcation of Brachial Artery into Ulnar and Radial Arteries
    • Tendon of Biceps Muscle
    • Radial Nerve and its deep branch
    • And Supratrochlear Lymph Node

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Blood Supply Of Upper Limbs

21. Arterial Supply:

    • Subclavian Artery : Origin R+ from Brachiocephalic trunk ott From Arch of aarta

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Termination Outer Bordes of 1st Rib

Parts ? parts formed by Anterior Scalene Muscle

Branches

1st Post

Vertebral Artery

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Internal Thoracic Artery

Thyro Cervical Trunk

2nd Past

Costo Cervical Trunk

3rd part

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Dorsal Scapular Artery

• Axillary Artery:

Location Axilla

Origin Outer Border of 1st Rib

Termination lower Border of teres Major

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Paots Pectoralis Minor Will divide into 3 posts

Branches

1st Part

Superior Thoracic Artery.

2nd Part

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Acromial Thoracic Artery

Lateral Thoracic Artery

3rd Part

Subscapular Artery

Anterior Circumflex humeral Astay

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Posterior Circumflex humeral Artery

• Brachial Artery

Origin Continution of Axillary Artery at lower Border of Teres Major Muscle

Termination In Cubital 7ossa & gires 2 terminal Branches Radial & Ulnar Arteries

Location Medial aspect of Anterior Compartment of arm

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Branches

• Profunda Brachii
• Superios Ulnar Collateral
• Inferior Ulnar Collateral
• Radial Artery

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• Vinar Artery
• Nutrient Artery of humerus

Anastomoses Around Elbow

22. Venous Drainage:

    Dorsal Venous Network

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    NetWork of Superficial Veins on the dorsum of the hand. Network drains upward, Into lateral Cephalic Vein and Media) Basilic Vein

Median Cubital Vein links The Cephalic and Basilic veins in The Cubital Fossa. Only Superficial Vein which is fixed.

Lymph Vessels And Nodes Of Upper Limb:

Lymphatics

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• Superficial Runs along Superficial Veins
• Deep Run's along Deep Vein's

Lymph Nodes

• Superficial Deltopectoral Group of LN
• Deep Axillary Group of LN in Axilla Superficial Lymphatics of thumb and 1st Web drains into Deltopectoral Group of Lymph Nodes...

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Axillary Lymph Nodes:

Drain Lymph vessels from the lateral Quadrants of Breast, Superficial lymph vessels From thoraco abdominal Walls above level of Umbilicus, Vessels From upper limb....

Six Groups:

Anterior/Pectoral Group

Receive Lymph Vessels from

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• lateral Quadrants of Breast
• Anterolateral Abdominal Walls above level of Umbilicus/Superficial. Vessels

Posterior/Subscapular Group

Receive Superficial Lymph Vessels From back

iliac Crests

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Lateral Group

From Upper Limb except thumb and 1st Web

Central Group

From

• Anterior group

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• Posterior group
• Lateral group

Infraclavicular / Deltopectoral group

Apical Group

Receive Lymph From

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• Central group

23. Nerve Plexus Of Upper Limb:

    Brachial Plexus:

Branches:

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Roots:

1. Long thoracic Nerve (C5,6,7) Serratus Anterior Muscle
2. Dorsal Scapular Nerve (C5) Rhomboid Minor, Major and levator Scapulae

Trunks:

3. Supra Scapular Nerve (C5,6) Supraspinatus & Infraspinatus

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4. Subclavius Nerve (C5,6) Subclavius Muscle

Lateral Cord:

5. Lateral pectoral Nerve (C5,6,7) Pectoralis Major
6. Musculocutaneous Nerve (C5,6,7) Muscles of Ant. Compartment of Arm
7. Lateral Root of Median Nerve (C5,6,7)

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Posterior Corde

8. upper Subscapular Nerve Subscapularis
9. Middle Subscapular Nerve / Thoracodorsal Latissimus Dorsi Muscle
10. Lower Subscapular Nerve Subscapularis And Teres Major
11. Axillary Nerve (C5,6) Deltoid, Teres Minor

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12. Radial Nerve (C5,6,7,8, Ti) Muscles of post. Compartment of Arm and forearm

Medial Cords

13. Medial pectoral Nerve Pectoralis Major, Minor
14. Medial brachial Cutaneous Nerve Skin of medial Side of Arm
15. Medial Antebrachial Cutaneous Nerve Skin of Medial Side of forearm

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16. Ulnar Nerve (C8, T1)
17. Medial Root of Medion Nerve

25. Brachial Plexus Injuries:
    • Upper Trunk Injury Erb-Duchenne Palsy (Waiter's tip)
    • Lower Trunk Injury Klumpke Palsy

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