GROSS ANATOMY

[Pages:31]GROSS ANATOMY

Lecture Syllabus 2008

Unit #4: Upper and Lower Limbs

ANAT 6010 - Gross Anatomy Department of Neurobiology and Anatomy

University of Utah School of Medicine

G24- Upper Limb Overview, Shoulder, and Axilla G25- Arm and Elbow G26- Forearm and Wrist G27- Hand G28- Hip and Posterior Compartment of the Thigh G29- Anterior and Medial Thigh G30- Leg and Knee G31- Foot and Ankle

1

G24: Upper Limb Overview and Shoulder and Axilla

At the end of this lecture, students should be able to master the following: 1) Upper limb overview a) Cutaneous innervation of the upper limb ? Compare and contrast the dermatomes and cutaneous fields of the upper limb ? Dermatome: area of skin supplied by a single spinal cord level ? Cutaneous field: area of skin supplies by a single peripheral nerve branch ( multilple spinal cord levels)

Dermatomes

Cutaneous fields 2

b) Major vessels i) Superficial veins Describe the location and direction of flow through the major superficial veins of the upper limb - Cephalic - Basilic - Median cubital - Dorsal veins of the hands

ii) Arteries Trace the pathway and distribution of the principle arteries through the upper limb - Subclavian - Axillary - Brachial - Radial and ulnar - Superficial and deep palmar arches

2) Actions of the Upper Limb a) Describe the structure/action(s) of the following:

? Pectoral girdle (scapula and clavicle) ? Scapula- protraction, retraction, elevation, depression, upward rotation, downward rotation ? Glenohumeral joint- flexion, extension, abduction, adduction, medial rotation, lateral rotation ? Humeroulnar (elbow) joint- flexion, extension ? Proximal and distal radioulnar joints- supnation, pronation ? Wrist joint- flexion, extension, abduction (radial deviation), adduction (ulnar deviation)

3

3) Fascia of the Upper Limb a) Describe the fascial organization of the upper limb:

Between the skin and bone are two fascial layers in the upper limb termed the superficial and deep fascia:

- Superficial fascia: located deep to the skin and contains superficial veins (cephalic, median cubital, basilic), cutaneous nerves, superficial lymphatics and fat.

- Deep fascia: located deep to the superficial fascia and contains muscles, nerves, vessels and deep lymphatics. The deep fascia is a continuation of the deep fascia covering the deltoid and pectoralis major muscles. As the deep fascia extends distally, intermuscular septa extend to the bone dividing the arm and forearm into anterior and posterior compartments in the arm and forearm. Each compartment contains muscles that perform similar actions and have common innervation and attachments.

Arm - Anterior: Flexors, musculocutaneus nerve - Posterior: Extensors, radial nerve

Forearm - Anterior: Flexors, medial epicondyle, median and ulnar nerves - Posterior: Extensors, lateral epicondyle, radial nerve

4) Skeletal muscle basics Skeletal muscles in the limbs: - attach to at least two separate bones (origin and insertion) - act on the joint(s) that the muscle crosses between the attachments - contract when a muscle fiber generates tension through the actin and myosin cross-bridging cycling

The term "contraction" implies a shortening or reduction, however, in reality contraction refers to the generation of tension by muscle fibers with the help of motor neurons.

While under tension, the muscle may shorten, remain the same or lengthen (muscle cells do not push) - Concentric contraction: muscle shortens (biceps curl) - Isometric contraction: no change in length of muscle (muscles of the hand and forearm while gripping an object) - Eccentric contraction: muscle lengthens while under pressure due to an opposing force being greater than the force generated by the muscle (setting an object down gently)

4

5) Axilla: Muscles of the shoulder girdle a) Describe the attachments, principle actions, and relations of the muscles of the shoulder girdle as grouped below

Muscle Scapular Muscles Subclavius

Table ? Muscles of the Shoulder Girdle

Proximal Attachment

Distal Attachment

Action

1st rib

Clavicle

Depresses the clavicle

Trapezius

Levator scapulae

Rhomboid minor Rhomboid major Serratus anterior

Occipital bone, nuchal ligament, C7-T12 vertebrae Transverse processes of C1?C4

C7?T1 vertebrae T2?T5 vertebrae

Ribs 1-8

Pectoralis minor Ribs 3-5

Intertuberular Groove Muscles

Pectoralis major

Clavicle, sternum and costal cartilage

Latissimus dorsi Teres major

T7?T12, sacrum, thoracolumbar fascia

Inferior angle of the scapula

Deltoid

Spine, acromion and

lateral clavicle

Rotator Cuff Muscles

Spine, acromion and lateral clavicle

Superior angle of the scapula

Medial margin of the scapula

Coracoid process of the scapula

Intertubercular groove of the humerus Intertubercular groove of the humerus Intertubercular groove of the humerus

Deltoid tuberosity of the humerus

Elevates, retracts, rotates and depresses the scapula

Elevates the scapula

Retracts the scapula

Protracts and rotates the scapula Protracts and depresses the scapula

Adducts, medial rotates, extends and flexes the humerus Adducts, extends and medial rotates the humerus Adducts, extends and medially rotates the humerus Flexes, extends and abducts the humerus

Innervation

Nerve to the subclavius (C5) Spinal accessory n. and C3 and C4 spinal nerves Dorsal scapular n. (C5) and C3 and C4 spinal nerves Dorsal scapular n. (C5)

Long thoracic n. (C5-C7) Medial pectoral n. (C8-T1)

Medial and lateral pectoral nn. (C5-T1)

Thoracodorsal n. (C6-C8) Lower subscapular n. (C6-C7) Axillary n. (C5-C6)

? Supraspinatus ? Infraspinatus

Supraspinous fossa Infraspinous fossa

? Teres minor ? Subscapularis

Lateral margin of the scapula Subscapular fossa

Greater tubercle of the humerus

Lesser tubercle of the humerus

Abduction of humerus (first 15?) Laterally rotates the humerus Medially rotates the humerus

Suprascapular n. (C4-C6) Suprascapular n. (C5-C6) Axillary n. (C5-C6)

Upper and lower subscapular nn.

5

6) Brachial Plexus- Shoulder a) Draw and label all parts of the brachial plexus; describe the topographical relations of the plexus as it passes through the neck, shoulder, and axilla; and describe the origin, course and distribution of the branches that supply the shoulder ? Roots (Randy) - 5 roots between anterior and middle scalene mm. ? Trunks (Travis) - 3 trunks lateral to the interscalene space and superior to the clavicle ? Divisions (Drinks) - 6 divisions deep to the clavicle (3 anterior and 3 posterior) ? Cords (Cold) - 3 cords in the axilla, deep to the pectoralis minor m. named according to their position to axillary a. ? Branches (Beer) - 5 branches to the upper limb (3 anterior division and 2 posterior division) (See tutorial on DIGANAT on drawing the brachial plexus)

i) Roots (C5-T1)- pass between the anterior and middle scalenes with the subclavian a. (subclavian vein courses anterior to the anterior scalene m.)

? Dorsal scapular nerve- (C5) pierces the middle scalene, descends deep to the levator scapulae, rhomboideus mm. along with the deep branch of the transverse cervical a. supplying both rhomboideus mm. and partially the levator scapulae

? Long thoracic nerve- (C5-C7) descends posterior to the roots of the plexus and the axillary a., descends along the lateral surface of the serratus anterior m. with the lateral thoracic a. while supplying the muscle

ii) Trunks (superior, middle, inferior)- emerge between anterior and middle scalenes and descend towards the clavicle ? Suprascapular nerve- (C5,C6) branches off the upper trunk, courses across the posterior triangle of neck, through the suprascapular foramen, inferior to the transverse scapular ligament, (suprascapular a. and v. pass superior to the transverse scapular ligament) to supply the supraspinatus m.; continues through the greater scapular notch to supply the infraspinatus m. ? Nerve to the subclavius- (C5, C6) branches off the upper trunk to the subclavius m. ? No branches arise from the middle and infeiror trunks

iii) Divisions (anterior, posterior)- anterior divisions innervate anterior compartments of the limb (flexor muscles); posterior divisions innervate posterior compartments of the limb (extensor muscles)

iv) Cords (medial, lateral, posterior)- medial and lateral cords arise from the anterior divisions and are named for their relation to the axillary a.; the posterior cord arises from the posterior division and runs posterior to the axillary a.

? Lateral pectoral nerve- (C5-C7) branches off the lateral cord, sends a branch to the medial pectoral n. anterior to the axillary a., passes proximal to the pectoralis minor to reach the pectoralis major m.

? Medial pectoral nerve- (C8, T1) branches off the medial cord, receives a contribution from the lateral pectoral n., pierces the pectoralis minor m., supplying it as it passes, continues deep to the pectoralis m.

? Medial brachial cutaneous nerve (C8-T1) ? Medial antebrachial cutaneous nerve (C8-T1) ? Upper subscapular nerve- (C5, C6) branches off posterior cord, enters anterior surface of the subscapularis m. ? Thoracodorsal nerve (middle subscapular)- (C6-C8) branches off the posterior cord, descends to the posteriolat-

eral thorax to supply the latissimus dorsi m. ? Lower subscapular nerve- (C5, C6) branches off the posterior cord, splits to send one branch to the anterior

surface of the subscapularis m. and one to the anterior surface of the teres major m.

v) Branches ? Musculocutaneous nerve (C5-C7) ? Median nerve (C5-T1) ? Ulnar nerve (C7-T1) ? Axillary nerve- (C5, C6) terminal branch of the posterior cord, courses through the quadrangular space then splits, sending one branch to the teres minor m.and the other to the deltoid m; also contributes to the lateral brachial cutaneous nerve, supplying the glenohumeral joint and the skin over the deltoid m. ? Radial nerve (C5-T1)

6

7

7) Brachial plexus lesions

1. Waiter's tip 2. Claw hand 3. Wrist drop 4. Winged scapula 5. Deltoid paralysis 6. Saturday night palsy (wrist drop) 7. Difficulty flexing elbow, variable sensory loss 8. Decreased thumb function; Sign of Benediction 9. Intrinsic muscles of hand; claw hand

8

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download