Myology and ostrology of upper limb
- 2. ANATOMY OF THE UPPER LIMB 1-Bones of the upper limb. 2-Joints of the upper limb. 3- Muscles of the upper limb. 4- Vessels of the upper limb. 5- Nerves of the upper limb. .
- 3. ANATOMY OF THE UPPER LIMB Surface anatomy of the upper limb. The upper limb divided to 1- The Shoulder 2- The arm 3- The forearm 4- The hand 5- The axilla & the breast 6-Cubital fossa
- 5. Bones of the upper limb.
- 6. SHOULDER THE SHOULDER It contains THE SCAPULA & THE CLAVICLE which articulate with the sternum & humerus.
- 7. THE SCAPULA
- 8. THE SCAPULA It is a triangle flat bone with lies on the posterlateral aspect of the thorax. 2 surfaces (ventral& dorsal).& 3 angles (superior, lateral& inferior).& 3 borders (medial ,lateral & superior). It has a spine , acromial process & coracoid process.
- 9. THE SCAPULA • The scapula (shoulder blade) is a triangular flat bone that lies on the posterolateral aspest of the thorax, overlying the 2nd-7th ribs. • The spine of the scapula starts medially. • Extend laterally where be wider to form acromial process • Articulate with the lateral end of the clavicle. • At the lateral end of the superior border is the coracoid process. • The lateral angle forms the glenoid cavity.(SHOULDER JOINT)
- 10. Articulation of the scapula There are 2 synovial & 2 fibrous joints. The synovial joints The glenoid cavity with the head of the humerus to form the shoulder joint Acromio-clavicular joint The fibrous joints coraco- clavicular joint (strong joint covered with strong ligament) coraco- acromial joint (strong joint covered with strong ligament)
- 11. Anastamosis around the scapula It is an important anastamosis between branches of the first part of the subclavian artery.& the third part of axillary artery. Branches of the first part of the subclavian artery. The supra scapular artery. which distributed to the supraspinous & the infraspinous fossa. Deep branch of the transverse cervical artery. which go down along the medial border of the scapula.
- 12. Anastamosis around the scapula The branches of the third part of axillary artery. The sub scapular artery. which go down along the lateral border of the scapula The circumflex scapular artery. which arise from the sub scapular artery & go to the infraspinous fossa.
- 14. THE CLAVICLE
- 15. THE CLAVICLE It lies horizontally in the root of the neck. It covers the flat 1st rib its medial 2/3 are curved forward to give room for the passage of the large vessels & nerves which leave the neck & pass behind & below the clavicle on their way to upper limb. It has 2 important functions: To transmit forces from the upper limb to the bones of the axial skeleton (sternum) To act as support, holding the arm free from the trunk.
- 16. THE CLAVICLE It is along bone with 2 ends: The sternal end articulate with the manuberium of the sternum forming the Sterno- clavicular joint. The acromial end articulate with the acromial process of the scapula forming the Acromio- clavicular joint. The body is convex in medial 2/3 concave in lateral 1/3.
- 17. THE CLAVICLE Important relations of the clavicle The subclavian artery &vein &the trunk of the brachial pluxes pass behind the middle /3 of the clavicle. The common carotid artery lies behind the left sternoclavicular joint The brachio-cephalic artery. divided & its branches behind the right sternoclavicular joint. The internal jugular vein lies a little laterally on either side.
- 18. THE HUMERUS
- 19. THE HUMERUS It is a tubular long bone composed of upper end , body (shaft ) & lower end. The upper end formed. The head The neck ( anatomical &surgical ) The tubercles (greater & lesser )
- 20. THE HUMERUS The head : which is less than ½ ball directed medially ,upward & posteriorly . It is separated from the greater & lesser tuberosities by a shallow groove called the anatomical neck . The greater tuberosity is a importance which projects posteriorly in rest position. The lesser tuberosity is a small importance which project anteriorly. The greater & lesser tuberosities & head are separated from the shaft by the surgical neck. There is small groove below them called the bicipital groove .
- 21. THE HUMERUS The anterior aspect :medial epicondyle , trochlea ,capitulum & lateral epicondyle . 2 fossae (coronoid & radial ) . The posterior aspect: medial epicondyle , trochlea & lateral epicondyle with one fossa (olecranon) .The medial epicondyle is larger , more prominent & extend downward more than the lateral .It carries a shallow groove in the posterior surface for the ulner nerve .
- 22. THE HUMERUS • Nerves related to the humerus : • The circumflex (axillary) nerves may be injured in fracture of surgical neck • The radial nerves. (which lies in the spiral groove ) may be injured in fracture of the middle of the shaft . • The ulnar nerves may be injured in fracture of the lower end (the medial epicondyle)
- 23. Bone of forarm
- 24. Bone of forarm. • THE RADIUS The radius bone is the lateral and shorter bone. The lower end which is the styloid process laterally & ulnar notch medially • THE ULNA The ulna is the stabilizing bone of forearm and it is medial and longer bone of forearm.
- 25. THE RADIUS The radius is the lateral bone of the forarm ,and homologus with the tibiaof the lower limb. it has 2 end and shaft Above: Upper end is having disc-shaped head while lower end is styloid process. Shaft: 3borders,3 surface BORDERS SURFACES Anterior border anterior , Posterior border posterior, Medial or interosseous border lateral Below The lower end is the wides part of the bone. it has 5 surfaces Anterior surfaces. Posterior surfaces. Medial surfaces. Lateral surface Inferior surfaces
- 26. THE ULNA The ulna is the bone of forearm,its homologous with the fibula of the lower limb its thas 2 end and shaft. ABOVE: upper end is hook-like, upper end presented the olecranon and coronoid processes, and trochlear and radial notches. 5 surfaces.(olecranon processes) Anterior, Posterior, Medial, Lateral, Superior, 4 surface.(coronoid processes) Superior, Anterior, Lateral,medial Shaft 3 borders,3surfaces Borders surfaces Lateral Anterior Anterior Medial Posterior Posterior
- 27. THE ULNA BELOW lower end of ulna is made up of head and styloid process.. The head : small rounded articulating with the medial side of the lower end of the radius forming the inferior radio – ulnar joint. The styloid process : projects medially & below the head .
- 29. Ulna bone with border and surfaces
- 31. The interosseous membrane The radius & ulna are also joined by a fibrous membrane which stretches between the interosseous borders of the 2 bones.. It run obliquely downwards &medially from radius to ulna. It is pierce by the ant: Interosseous membrane . Its function is Increase the area of origin of forearm. transmits forces received by the lower end of radius to ulna.
- 34. BONES OF HAND
- 35. The bones of the hand
- 36. The bones of the hand They consist of :carpus , metacarpus & phalanges bones The carpus bones : they are 8 arrange in 2 rows ( proximal & distal ). From lateral to medial: The proximal row : scaphoid ,lunate , triquetral & pisiform The distal row : trapezium , trapezoid , capitate & hamate .
- 37. The bones of the hand • The Metacarpal bones : are 5 . One for each finger . • Each metacarpal bone has : base ,shaft & head . • The phalanges : all the fingers have 3 phalanges • ( proximal , middle & distal ) • Each phalanx has base , shaft & head • except the thumb has only 2 (proximal & distal ).
- 38. The articulation of the carpal bones The proximal row is convex toward the lower end of radius & ulna . The scaphoid & lunate articulate with the lower end of the radius The triquetral articulates with the lower end of the ulna . The bones of the proximal row articulate with the bones of the distal row in mid carpal (transverese carpal) joint.
- 39. The bones of the distal row articulate with the base of the metacarpals by The trapezium articulate with the1st metacarpal bone The trapazoid articulate with the 2nd metacarpal . The capitate articulate with the 3rd metacarpal . The hamate articulate with the 4th & 5th metacarpals..
- 42. MYOLOGY THE MUSCLES OF THE UPPER LIMB
- 43. THE MUSCLES OF THE UPPER LIMB In general they divided to Muscle attached the upper limb to axial skeleton . Muscles of the upper limb proper .
- 44. Muscle attached the upper limb to axial skeleton . THE FRONT Mm. Pectoralis major , Pectoralis minor & subclavius Muscles. AT SIDE Mm. serratus ant Muscles. THE BACK Mm. Latissmus dorsi , trapezius , levator scapulae , rhomboideus minor & rhomboideus major muscles. Only the pect: Major & latissmus dorsi are inserted in the humerus while all the others are inserted in the shoulder girdle( scapula & clavicle) .
- 45. MOVEMENTS OF THE SHOULDER GIRDLE 1- ELEVATION: by upper of trapezius & levator scapulae Mm .2-DEPRETION: by pect.major , pect.minor &latissmus dorssi Mm. 3- RETRACTION: by middle of trapezius, rhomboideus major & minor Mm .4- PROTRACTION: by serratus ant:,levator scapulae & pect. Minor. 5- ROTATION UP : by upper &lower of trapezius &serratus anterior Mm. 6-ROTATION DOWN :levator scapulae,rhomboideus major & rhom.minor Mm.
- 46. MUSCLES OF THE SHOUlDER REGION • They are 6 Mm.: deltoid , teres major , teres minor ,supraspinatus , infraspinatus& subscabularis Mm. • The Rotator cuff M. ,supraspinatus , infraspinatus& subscabularis. teres minor • Arise from the scapula ( all from the dorsal surface except subscapularis M. from the anterior surface ) • Inserted in the tuberosities of humerus .They rotate the arm(medially or laterally) & adduct the arm (except the deltoid &supraspinatus Mm.) all suplied by C5, C6 Nn.
- 47. MUSCLES OF THE BACK OF THE ARM.: Triceps Brachii: The triceps brachii muscle “three-headed muscle of the arm” is the large muscle on the Posterior Compartment of the upper limb. Triceps Brachii muscle is principally responsible for extension of the elbow joint. • Attachments of the triceps brachii muscle • Origin: • Long head – originates from the infraglenoid tubercle • Medial head – originates from the humerus, inferior to the radial groove • Lateral head – originates from the humerus, superior to the radial groove
- 48. • Insertion: Distally, the heads converge onto one tendon and insert into the olecranon of the ulna. • Actions of the triceps brachii muscle • Extension of the arm at the elbow
- 49. THE FOREARM MUSCLES THE FLEXOR –PRONATOR GROUP They divided to 2 groups: 1- The flexor- pronator group. 2- The extensor- supinator group. *They divided to superficial & deep groups. *The superficial group arise from the front of medial epicondyle of humerus, pass in front of the forearm& the wrist to inserted in bones of the hand .
- 50. THE FLEXOR –PRONATOR GROUP Anterior compartment of forearm They are :Pronator teres , Fl. Carpi- radialis , Fl. Carpi-ulnaris ,Fl. Digitorum superficialis &palmaris longus Mm . The deep group arise from the front of interosseous membrane of radius & ulna. They are : Fl.digitorum profundus , Fl.pollicis longus & pronator quadratus Mm.
- 51. THE FLEXOR –PRONATOR GROUP : • The pronators; are Pronator teres & Pronator quadratus Mm. where inserted in the radius & pronate the forearm . • The flexors of the wrist are ;Fl.carpi-radialis ,Fl. carpi-ulnaris & Palmaris longus where inserted in the metacarpal bones . • The flexor of the fingers; are Fl. digitorum superficialis & Fl. Digitorum profundus where inserted in the phalanges. • The flexor of the thumb; is Fl. Pollicis longus& inserted in phalanges of the thumb .
- 54. THE EXTENSOR - SUPINATOR GROUP. Posterior compartment of forearm • *They extend the wrist & fingers & supinate the forearm . • * They divided in to superficial & deep : • The superficial group arise from the back of the lateral epicondyle of humerus to pass on the back of the forearm • inserted in the bones of the hand . • There are 7 ; Brachio-radialis , extensor carpi – radialis longus ;ext.calpi- radialis brevis ;ext.digitorum ; ext. digiti- minimi ;ext. carpi –ulnaris & anconeus Mm.
- 55. THE EXTENSOR - SUPINATOR GROUP. Posterior compartment of forearm
- 56. THE EXTENSOR - SUPINATOR GROUP.
- 57. THE EXTENSOR - SUPINATOR GROUP Muscles of the thumb Muscles of the thumb are : Abductor pollicis longus , Ext. pollicis brevis Ext. pollicis longus Mm. Inserted in the thumb bones
- 58. RETINACULUM Two types of retinaculum Flexor retinaculum Extensor retinaculum
- 59. THE FLEXOR RETINACULUM They are the band of deep fascia of the wrist. Attachments Medially The pisiform bone & The hook of the hamate. Laterally The tubercle of the scaphoid The crest of the trapezium Function Hold the long flexor and extensor Tendons in positions at the wrist.
- 60. RELATIONS..
- 61. THE EXTENSOR RETINACULUM They are the band of deep fascia of the wrist. Attachments Medially Medially pisiform &triquterum Laterally Distal end of radius Function Hold the long flexor and extensor Tendons in positions at the wrist.
- 62. RELATIONS..
- 64. CARPAL TUNNEL SYNDROME • The Carpal Tunnel in your wrist. • It is made up of the carpal bones and the flexor retinaculum (transverse carpal ligament). Carpal Bones •
- 65. Carpal tunnel syndrome • Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. • The condition occurs when one of the major nerves compressed • The median nerve; is squeezed or compressed as it travels through the wrist.
- 68. HYPOTHENAR • The hypothenar eminence is a group of three muscles found at the base of the little finger, on the ulnar side of the palm. • Similarly to the thenar muscles with the thumb, these muscles control movement in the little finger. • This group consists of the following three muscles: • abductor digiti minimi, • the flexor digiti minimi brevis • opponens digiti minimi.
- 69. Thenar Thenar Eminence Group of three short muscles located at the base of the thumb. This group of muscles forms a “fleshy mass” on the lateral side of the palm which is responsible for the thumb’s fine movements. • This group consists of the following three muscles: • Opponens Pollicis. • Abductor Pollicis Brevis. • Flexor Pollicis Brevis.
- 71. REFERENCES B D CHURASIA’S HUMAN ANATOY. SNELL THANK YOU
Editor's Notes
- #69: The hypothenar Mm : abductor digiti minimi ,flexor digiti minimi & opponens digiti minimi Mm. There are also 4 lumbrical Mm & 7 Interosseous Mm