UPPER EXTREMITY-2

DR VINIT K ASHOK ADJUNCT FACULTY

BLOOD SUPPLY
‡ ARTERIAL SUPPLY ‡ -SUBCLAVIAN ARTERY(NECK) ‡ - AXILLARY ARTERY( UPPER ARM;UPTO LOWER BORDER OF TERES MAJOR) ‡ BRACHIAL ARTERY(LOWER PART OF ARM) ‡ RADIAL ARTERY( LATERAL) ‡ ULNAR ARTERY( MEDIAL),COMMON INTEROSSEOUS ‡ PALMAR ARCHES ‡ DIGITAL

VEINS OF UPPER LIMB

‡ SUPERFICIAL VEINS DORSAL VENOUS NETWORK CEPHALIC VEIN BASILIC VEIN AXILLARY VEIN( BASILIC+ BRACHIAL VEIN) MEDIAN CUBITAL VEIN MEDIAN VEIN OF FOREARM DEEP VEINS NAMED ACCORDING TO COMPANIAN ARTERIES RADIAL VEIN ULNAR VEIN BRACHIAL VEIN AXILLARY VEIN

SURFACE ANATOMY
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ACROMION CLAVICLE DELTOID ( IM INJECTIONS) HUMERUS BICEPS MUSCLE BICIPTAL GROOVE BRACHILA PULSE( BLOOD PRESSURE) TRICEPS OLECRNON PROCESS( PT OF THE ELBOW) MEDIAL /LATERAL EPICONDYLES TRIANGLE ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ CUBITAL FOSSA MEDIAN CUBITAL VEIN- IV CEPHALIC VEIN ULNA RADIUS STYLOID PROCESS RADIAL ARTERY( PULSE) ULNAR ARTERY ANATOMICAL SNUFF BOX THENAR EMINENC HYPOTHENAR EMINENCE CARPAL TUNNEL

CUBITAL FOSSA

CUBITAL FOSSA

STYLOID PROCESS

ANATOMICAL SNUFF BOX

AXILLA( ARMPIT)
‡ PYRAMIDAL SPACE BETWEEN THE UPPER LATERAL CHEST AND THE INNERSIDE OF THE ARM ‡ BOUNDARIES -APEX ±( BETWEEN THE CLAVICLE,SCAPULA AND 1ST RIB) -BASE-(AXILLARY FASCIA) -ANTERIOR ( PECTORALIS MAJOR AND MINOR MUSCLES) -POSTERIOR( SUBSCAPULARIS,LATISSIMUS DORSI AND TERES MAJOR) MEDIAL- ( FIRST 4 RIBS AND SERRATUS ANTERIOR MUSCLE) LATERAL-( BICEPETAL GROOVE OF THE HUMERUS)

‡ CONTENTS -AXILLARY LYMPH NODES

-AXILLARY ARTERY /VEIN -BRACHIAL PLEXUS

BRACHIAL PLEXUS
‡ ‡ ‡ ‡ PLEXUS- IS A NETWORK OF NERVES BRACHIAL PLEXUSFOUND IN THE NECK AND AXILLA FORMED BY VENTRAL RAMI OF C5C8 AND T1 ( THERE MAY BE CONTRIBUTIONS FROM C4, T2) GIVES RISE TO NERVES THAT SUPPLY THE UPPER LIMB FORMATION ROOTS- C5-C8 AND TI( VENTRAL RAMI) TRUNKS-UPPER , MIDDLE, LOWER DIVISONS-ANTERIOR/POSTERIOR CORDSMEDIAL/LATERAL/POSTERIOR

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ROOTS C5 C6 C7 C8 T1

FORMATION OF TRUNKS UPPER MIDDLE LOWER FORMED IN THE NECK

DIVISIONS AND CORDS OF BRACHIAL PLEXUS

‡ TRUNKS DIVISIONS CORDS LATERAL CORD-ANTERIOR DIVISIONS OF UPPER AND MIDDLE TRUNK ‡ UPPER TRUNK

PINKANTERIOR DIVISION

MIDDLE TRUNK

POSTERIOR CORDPOSTERIOR DIVISIONS OF ALL TRUNKS

MEDIAL CORD-ANTERIOR DIVISION OF LOWER TRUNK ‡ LOWER TRUNK

BLUE POSTERIOR DIVISION

CORDS ARE NAMED ACCORDING TO THEIR RELATIVE POSITIONS TO THE AXILLARY ARTERY

BRACHIAL PLEXUS

NERVES ARISING FROM THE CORDS

‡ 1. 2. 3. 4. 5. ‡ 1. 2. 3. MEDIAL CORD MEDIAL CUTANEOUS NERVE OF ARM- CUTANEOUS SUPPLY TO SKIN MEDIAL CUTANEOUS NERVE OF FOREARM-CUTANEOUS SUPPLY TO THE SKIN MEDIAL ROOT OF MEDIAL NERVE- JOINS WITH LATERAL ROOT TO FORM MEDIAN NERVE ULNAR NERVE MEDIAL PECTORAL NERVE LATERAL CORD LATERAL ROOT OF MEDIAN NERVE MUSCULOCUTANEOUS NERVE LATERAL PECTORAL NERVE

NERVES FROM THE POSTERIOR CORD

‡ ‡ ‡ ‡ ‡ 1. UPPER SUBSCAPULAR NERVE 2.LOWER SUBSCAPULAR NERVE 3.THORACODORSAL NERVE 4. RADIAL NERVE 5. AXILLARY NERVE

IMPORTANT NERVES AND AREA OF SUPPLY

‡ ‡ ‡ ‡ ‡ ‡ 1. MEDIAN NERVE( FORMED FROM BOTH MEDIAL AND LATERAL CORD)A) SUPPLIES ALL THE FLEXORS OF THE FOREARM( EXCEPT FLEXOR CARPI ULNARIS AND MEDIAL HALF OF FDP) B) INTRINSIC MUSCLES IN THE LATERAL PALM INCLUDING THENAR EMINENCE) 2. ULNAR NERVE A) SUPPLIES THE MEDIAL HALF OF FDP AND THE FLEXOR CARPI ULNARIS B) SUPPLIES MOST OF THE INTRINSIC MUSCLES OF THE HAND INCLUDING THE HYPOTHENAR EMINENCE, AND SKIN ON THE MEDIAL SIDE OF THE HAND CLINICAL APPLICATION *INJURY TO MEDIAN NERVE-´ APE HAND´ INJURY TO ULNAR NERVE-´ CLAW HAND´

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INPORTANT NERVES AND THEIR AREA OF SUPPLY

‡ A) MUSCULOCUTANEOUS NERVE SUPPLIES THE BICEPS, CORACOBRACHIALIS AND BRACHIALIS

AXILLARY NERVE SUPPLIES THE DELTOID AND TERES MINOR MUSCLE SUPPLIES THE SHOULDER JOINT RADIAL NERVE SUPPLIES THE TRICEPS SUPPLIES THE BRACHIORADIALIS SUPPLIES MOST OF THE EXTENSORS OF THE FOREARM * INJURY RESULTS IN ³ WRIST DROP´

CARPAL TUNNEL
TUNNEL FORMED BETWEEN THE CONCAVITY OF THE CARPAL BONES AND A LIGAMENT THAT COVERS THIS( FLEXOR RETINACULAM) ‡ TENDONS OF THE FLEXORS PASS THROUGH ‡ MEDIAN NERVE ALSO PASSES THROUGH ‡ CROWDED TUNNEL CARPAL TUNNEL SYNDROME - CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL - CAUSES- 1. SWELLING OF THE TEDONS( OVERUSE) - 2. PREGNANCY( EDEMA) - 3. ARTHRITIS SYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND, WEAKNESS IN THUMB MOVEMENT TREATMENT- REST, SPLINTING,ANTI-INFLAMMATORY DRUGS, SURGERY ‡

CUBITAL FOSSA
TRIANGULAR DEPRESSION ON THE ANTERIOR ASPECT OF ELBOW BOUNDARIES -BASE- LINE DRAWN BETWEEN THE EPICONDYLES OF THE HUMERUS LATERAL BOUNDARYBRACHIORADIALIS MEDIAL BOUNDARY- PRONATOR TERES APEX- WHERE THE MEDIAL AND LATREAL BOUNDARY MEET CONTENTS 1. MEDIAL CUBITAL VEIN 2. BRACHIAL ARTERY 3. TENDON OF THE BICEPS ‡

CUTANEOUS INNERVATION OF HAND( ANTERIORLY) LATREAL 31/2 FINGERS AND LATERAL PALM ± MEDIAN NERVE MEDIAL 11/2 FINGERS AND MEDIAL PALM- ULNAR NERVE

CUTANEOUS NERVE SUPPLY HAND ( POSTERIORLY) MEDIAL 11/2 FINGERS AND HAND- ULNAR NERVE TIPS OF FINGERS LATERAL 31/2 FINGERS- MEDIAN NERVE

REST OF LATERAL 31/2 FINGERS AND HAND - RADIAL NERVE