Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Musculocutaneous System Surgical Society | Junior Anatomy Series Lecture 5 14/02/2023 Created By Alexandra Cardoso Pinto Modified and presented By Deniz KokuStructure of Bones and joints of the upper limb & hand 10 mins the session Upper limb muscle compartments & hand 15 mins 15 mins Nerves of the upper limb Practice Questions 15 mins Surgical Society Junior Anatomy SeriesStructure of the session Bones and joints of the upper limb & hand Upper limb muscle compartments & hand Nerves of the upper limb Practice Questions Surgical Society | Junior Anatomy SeriesScapula • Acromion (A) • Coracoid process (C) • Glenoid fossa (G) • Scapular spine (Sp) • Supraspinous fossa (S) • Infraspinous fossa (I) • Subscapular fossa (Sub.) Surgical Societyunior Anatomy SeriesClavicle B A C Surgical Societyr Anatomy SeriesHumerus A D B E F C G H I J K Proximal end Distal end Surgical Society| Junior Anatomy SeriesHumerus EXTRA MATERIAL Surgical Societyor Anatomy SeriesUlna Proximal end Surgical Society | Junior Anatomy SeriesRadius Proximal end Surgical Society | Junior Anatomy SeriesThe Wrist Surgical Society | Junior Anatomy Series Proximal Row (lateral to Distal Row (lateral to medial) medial) Carpal bones Scaphoid Trapezium Lunate Trapezoid Triquetrum Capitate Pisiform Hamate Transverse section through carpal tunnel Surgical Society Junior Anatomy SeriesCarpal bones MNEMONIC Proximal Row Distal Row (lateral (lateral to medial) to medial) Some Scaphoid Lovers Lunate Try Triquetrum Positions Pisiform Scaphoid Trapezium That Trapezium Lunate Trapezoid They Trapezoid Triquetrum Capitate Can’t Capitate Pisiform Hamate Handle Hamate Surgical Societynior Anatomy SeriesScapulo-thoracic joint Virtual joint Movement Muscles Elevation superior trapezius, levator scapulae, rhomboids Depression inferior trapezius, pectoralis minor, serratus anterior Protraction pectoralis minor,serratus anterior Retraction rhomboids, middle trapezius, latissimus dorsi Rotation-up superior trapezius, inferior trapezius,atus anterior Rotation down pectoralis minor, latissimus dorsi, rhomboids and levator scapulae Stabilised by: • Trapezius muscle • Serratus anterior muscle • Levator scapulae and rhomboid muscles Surgical Society | Junior Anatomy Series Ball and socket synovial joint Shoulder joint Stability: • Rotator cuff muscles • Glenoid labrum (fibrocartilaginous ridge surrounding the glenoid cavity) • Ligaments (reinforce the joint capsule) • (Biceps tendon) Movement Muscles Flexion pectoralis major (clavicular head), deltoid (anterior fibres) Extension deltoid (posterior fibres) Abduction supraspinatus initially and then central deltoid Adduction pectoralis major, latissimus dorsi Internal rotation subscapularis External rotation infraspinatus Circumduction mainly the joint itself Surgical Society | Junior Anatomy Series Movement Muscles Elbow joint Hinge-type synovial joint Flexion biceps, brachialis, brachioradialis (pronator teres) Extension triceps (and...?) anconeus Surgical Society | Junior Anatomy SeriesRadio-ulnar joint Movement Muscles Supination Supinator, Biceps, (EPL, ECRL) Pronation Pronator quadratus, Pronator teres, (FCR, PL, brachioradialis) Pivot joints pronation and supination of the forearm Two locations: • Proximal radioulnar joint • Distal radioulnar joint Surgical Society | Junior Anatomy SeriesWrist joint The ulna is not part of the wrist joint • Joint capsule • Ligaments Movement Muscles Supination Supinator, Biceps, (EPL, ECRL) Pronation Pronator quadratus, Pronator teres, (FCR, PL, brachioradialis) Surgical Society | Junior Anatomy SeriesStructure of the session Bones and joints of the upper limb & hand Upper limb muscle compartments & hand Nerves of the upper limb Practice Questions Surgical Society | Junior Anatomy SeriesMuscles of the upper limb Intrinsic muscles rirforarm of the perfiaante hand Su rirforarm Deepante shoulderic muscles terrarm An rm serorfrea r Deep po strirfora oram uperiilpo Poser S Surgical Society Junior Anatomy Series1. Pectoral girdle Trapezius Serratus Anterior Pectoralis Major Surgical SocietyJunior Anatomy Series1. Pectoral girdle Trapezius Latissimus dorsi Surgical Societyunior Anatomy Series1. Pectoral girdle Trapezius Pectoralis Major Serratus anterior Latissimus dorsi Proximal Medial 1/3 of Proximal Anterior medial Proximal External Proximal Spinous attachment superior nuchal attachment ½ clavicle attachment surfaces of attachment processes line, external lateral parts of inferior 6 ribs, st th occipital Anterior surface 1 -8 ribs thoracolumbar protuberance, of sternum, fascia, iliac crest, spinous process superior 6 costal inferior 3 or 4 C7-T12 cartilage ribs Distal Lateral 1/3 of Distal Lateral lip of Distal Anterior surface Distal Floor of attachment clavicle attachment intertubercular attachment medial border attachment intertubercular sulcus humerus of scapula sulcus humerus Function Many parts Function Adducts and Function Protraction and Function Extends, mainly move medially rotates upward rotation adducts. scapula humerus, draws of scapula Medially rotates scapula forward humerus Innervation Spinal accessory Innervation Lateral and Innervation Long thoracic Innervation Thoracodorsal nerve and C3, medial pectoral nerve (C5, C6, nerve (C6, C7, C4 spinal nerves nerves C7) C8) Surgical Society | Junior Anatomy Series2. Intrinsic shoulder muscles Surgical Society | Junior Anatomy Series2. Intrinsic shoulder muscles Deltoid Teres Major Proximal spine of scapula, Proximal inferior angle of attachment acromion and attachment scapula clavicle Distal attachment deltoid tuberosity Distal attachment intertubercular of humerus sulcus of humerus Function abducts arm Function adducts and medially rotates arm Innervation axillary nerve Innervation lower subscapular nerve Surgical Society Junior Anatomy Series2. Intrinsic shoulder muscles (rotator cuff muscles) Surgical SocietyAnatomy Series 2. Intrinsic shoulder muscles Supraspinatus Infraspinatus Subscapularis Teres minor Proximal Supraspinous Proximal Infraspinous Proximal Subscapular Proximal Posterior surface attachment fossa of the attachment fossa of the attachment fossa, on the attachment of the scapula, scapula scapula costal surface of adjacent to its the scapula lateral border Distal Greater tubercle Distal Greater tubercle Distal Lesser tubercle Distal Greater tubercle attachment of the humerus attachment of the humerus attachment of the humerus attachment of the humerus Function Abducts the arm Function Laterally rotatesFunction Medially rotates Function Laterally rotates 0-15* and the arm the arm the arm assists deltoid for 15-90* Innervation Suprascapular Innervation Suprascapular Innervation Upper and Innervation Axillary nerve nerve. nerve lower subscapular nerves Surgical Society | Junior Anatomy Series3. Anterior arm Surgical Society | Junior Anatomy Series3. Anterior arm Coracobrachialis Biceps brachii Brachialis Proximal coracoid process Proximal short head: Proximal shaft of humerus attachment of scapula attachment coracoid process; attachment long head: supraglenoid tubercle Distal attachment shaft of humerus Distal attachment radial tuberosity Distal attachment coronoid process (medial side) and biceps of ulna aponeurosis (which merges with fascia of region) Function arm flexion at Function flexion of arm at Function flexion at the shoulder, and weak elbow, supination elbow adduction of forearm Innervation musculocutaneous Innervation musculocutaneous Innervation musculocutaneous nerve nerve nerve note: mainly below biceps Surgical Society | Junior Anatomy Series4. Posterior arm Surgical Society | Junior Anatomy Series4. Posterior arm Triceps Brachii Anconeus Proximal attachment medial head: shaft of Proximal attachment lateral epicondyle of humerus; long head: the humerus infraglenoid tubercle Distal attachment olecranon process of Distal attachment olecranon of ulna ulna, via triceps tendon Function extension of the arm Function stabilise elbow joint at elbow movements, assists in forearm extension at the elbow joint Innervation radial nerve Innervation radial nerve Surgical Society | Junior Anatomy Series5a. Superficial anterior forearm muscles Surgical Society | Junior Anatomy Series5a. Superficial anterior forearm muscles Flexor carpi ulnaris Palmaris longus* Flexor carpi radialis Pronator teres** Flexor digitorum superficialis Proximal medial epicondyle Proximal medial epicondyle Proximal medial epicondyle Proximal It has two origins, one Proximal It has two heads – one attachment with the other attachment attachme attachmen from the medial attachmen originates from the superficial flexors; nt t epicondyle, and the t medial epicondyle of also has a long origin other from the coronoid the humerus, the other from the ulna process of the ulna. from the radius. Splits into 4 tendons, which travel through carpal tunnel. Distal pisiform carpal bone Distal flexor retinaculum of Distal base of metacarpals II Distal attaches laterally to the Distal middle phalanges of attachment attachment the wrist attachme and III attachmen mid-shaft of the radius attachmen the four fingers. nt t t Function Flexion and adduction Function Flexion at the wrist. Function Flexion and abduction Function Pronation of the Function Flexes the at the wrist at the wrist forearm metacarpophalangeal joints and proximal interphalangeal joints at the 4 fingers, and flexes at the wrist. Innervation Ulnar nerve Innervation Median nerve. Innervatio Median nerve Innervatio Median nerve. Innervatio Median nerve n n n Surgical Society | Junior Anatomy Series5b. Deep anterior forearm muscles Surgical Society | Junior Anatomy Series5b. Deep anterior forearm muscles Flexor digitorum profundus Flexor pollicis longus Pronator quadratus Proximal attachment ulna and associated Proximal attachment anterior surface of the Proximal attachment anterior surface of the interosseous membrane. radius, and surrounding ulna interosseous membrane Distal attachment distal phalanges of the Distal attachment base of the distal Distal attachment anterior surface of the four fingers. phalanx of the thumb. radius Function It is the only muscle that Function Flexes the Function Pronates the forearm can flex the distal interphalangeal joint interphalangeal joints of and the fingers. It also flexes metacarpophalangeal at metacarpophalangeal joint of the thumb. joints and at the wrist. Innervation The medial half (acts on Innervation Median nerve (anterior Innervation Median nerve (anterior the little and ring interosseous branch). interosseous branch) fingers) is innervated by the ulnar nerve . The lateral half (acts on the middle and index fingers) is innervated by the anterior interosseous branch of the median nerve. Surgical Society | Junior Anatomy Series6a. Superficial posterior forearm muscles Surgical Society | Junior Anatomy Series6a. Superficial posterior forearm muscles Extensor carpi radialis longus and Extensor digitorum Extensor digiti minimi* Extensor carpi ulnaris brevis Proximal The ECRL originates Proximal lateral epicondyle. Proximal lateral epicondyle of Proximal It lateral epicondyle of attachment from the attachment attachme the humerus attachmen the humerus supracondylar ridge, nt t while the ECRB originates from the lateral epicondyle. Distal tendons attach to Distal extensor hood of each Distal extensor hood of the Distal base of metacarpal V attachment metacarpal bones II attachment finger attachme little finger, via extensor attachmen and III. nt digitorum tendon t Function Extends and abducts Function Extends medial four Function Extends the little finger, Function Extension and the wrist. fingers at the MCP and contributes to adduction of wrist and IP joints extension at the wrist Innervation Radial nerve Innervation Radial nerve (deep Innervatio Radial nerve (deep Innervatio Radial nerve (deep branch) n branch) n branch) Surgical Society | Junior Anatomy Series6b. Deep posterior forearm muscles Surgical Societyatomy Series6b. Deep posterior forearm muscles Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis proprius* Proximal It has two heads of Proximal interosseous Proximal posterior surface of the Proximal posterior surface of the Proximal posterior surface of the attachment origin. One originates attachment membrane and the attachme radius and interosseous attachme ulna and interosseous attachme ulna and interosseous from the lateral adjacent posterior nt membrane nt membrane. nt membrane, distal to epicondyle of the surfaces of the radius . the extensor pollicis humerus, the other and ulna longus. from the posterior surface of the ulna. Distal both heads insert Distal lateral side of the Distal base of the proximal Distal distal phalanx of the Distal extensor hood of the attachment together into the attachment base of metacarpal I. attachme phalanx of the thumb. attachme thumb. attachme index finger posterior surface of nt nt nt the radius Function Supinates the Function Abducts the thumb. Function Extends at the Function Extends all joints of the Function Extends the index forearm metacarpophalangeal thumb: finger. and carpometacarpal carpometacarpal, joints of the thumb. metacarpophalangeal and interphalangeal. Innervation Radial nerve (deep Innervation Radial nerve Innervatio Radial nerve (posterior Innervatio Radial nerve (posterior Innervatio Radial nerve (posterior branch) (posterior n interosseous branch) n interosseous branch) n interosseous branch) interosseous branch) Surgical Society | Junior Anatomy Series7. Intrinsic muscles of the hand HYPOTHENAR THENAR What nerve innervates thenar muscles? Median nerve Surgical Society | Junior Anatomy Series7. Intrinsic muscles of the hand Surgical Society | Junior Anatomy Series7. Intrinsic muscles of the hand Lumbricals Palmaris brevis Proximal attachment tendon of flexor digitorum Proximal attachment palmar aponeurosis and flexor profundus, laterally retinaculum Distal attachment extensor hood Distal attachment dermis of the skin on the medial margin of the hand Function flex the MCP’s, extend the IPJs* Function wrinkles the skin of the hypothenar eminence and deepens the curvature of the hand, improving grip. Innervation - lateral 2 lumbricals (index and Innervation ulnar nerve middle fingers; unipennate): median nerve - medial 2 lumbricals (ring and little fingers; bipennate): ulnar nerve There are 4 lumbricals in each hand, one for each digit. Important for finger movement: link extensor and flexor tendons. Surgical Society | Junior Anatomy Series7. Intrinsic muscles of the hand Palmar Interossei Dorsal Interossei What nerve innervates these muscles? Ulnar nerve Surgical Society Junior Anatomy Series7. Intrinsic muscles of the hand Dorsal interossei (4) Palmar interossei (3) Proximal medial and lateral Proximal medial or lateral attachment surface of attachment surface of metacarpals metacarpals Distal attachment extensor hood of Distal attachment extensor hood of proximal phalange proximal phalange Function abduction at MCP Function adduction at MCP (DAB) (PAD) Innervation ulnar nerve Innervation ulnar nerve Surgical Societyunior Anatomy SeriesStructure of the session Bones and joints of the upper limb & hand Upper limb muscle compartments & hand Nerves of the upper limb Practice Questions Surgical Society | Junior Anatomy SeriesNerves (brachial plexus) Somatic plexus formed from the anterior rami of spinal nerve roots C5-T1 Responsible for the innervation of almost the entire upper limb Except for one muscle Trapezius Surgical Societynior Anatomy SeriesNerves (brachial plexus) Somatic plexus formed from the anterior rami ofspinal nerve roots C5-T1 VOLUNTARY Surgical Societyor Anatomy SeriesNerves (brachial plexus) Somatic plexus formed from the anterior rami of spinal nerve roots C5-T1 C5 VOLUNTARY C6 C7 C8 T1 Surgical SocietyJunior Anatomy SeriesNerves (brachial plexus) Nerve roots Musculocutaneous (C5-C7) Axillary nerve (C5-C6) Radial nerve (C5-T1) Median nerve (C6-T1) Ulnar nerve (C8-T1) Surgical Societyunior Anatomy Series MNEMONIC: Read hat Damn adaver ook Roots, runkivisions, ords, ranchesranches = terminal nerves) Surgical Society Anatomy SeriesNerves (brachial plexus) Surgical Society | Junior Anatomy SeriesNerves (brachial plexus) Axillary artery Lateral cord Medial cord Posterior cord not visible as it is posterior to the axillary artery Surgical Society | Junior Anatomy SeriesSurgical Society | Junior Anatomy Series Musculocutaneous nerve (C5-C7) Motor Anterior compartment of the arm Lateral cord (Coracobrachialis, Biceps brachii, Brachialis) Musculocutaneous nerve Sensory Continues as lateral cutaneous nerve to lateral forearm Damage Hard to damage because well protected by muscles Surgical SocietyJunior Anatomy Series Musculocutaneous nerve (C5-C7) Musculocutannerve Lateral cord The nerve seen in relation to other structures. Biceps muscle Coracobrachialis muscle Pierces coracobrachialis to reach biceps and brachialis muscles. Brachialis muscle Continues to cross the elbow joint to innervate Lateral cutaneous nerve of the the lateral arm forearm Cutaneous innervation Surgical Society | Junior Anatomy SeriesAxillary nerve (C5-C6) Motor Deltoidmuscle Teres minormuscle Sensory Regimental badge area Damage Shoulder dislocation / fracture of surgical neck of humerus Surgical Societyunior Anatomy SeriesRadial nerve (C5-T1) Motor Posterior cord nerveary Posterior compartment of the arm and forearm Branches to Sensory Radial posterior nerve arm muscles Posterior aspect of the arm and forearm Posterolateral aspect of the hand Branches to posterior forearm Damage muscles It lies on the humerus in the radial groove and can be damaged there by fractures Surgical Society| Junior Anatomy Series Radial nerve (C5-T1) nervel Radial nerve divides in the elbow region to give: branch (motor) Superficial (sensory) Superficial branch – cutaneous to the dorsolateral hand Deep branch – motor supply to the posterior muscles of the forearm Surgical Society | Junior Anatomy SeriesMedian nerve (C6-T1) Motor Lateral cord Most flexors of anterior forearm Thenar muscles of hand Musculocutaneous Medial Lateral two lumbricals of hand nerve cord Median Sensory nerve Lateral part of palm – via palmar cutaneous branch Lateral three and half fingers on the anterior (palmar) surface of Branches to hand - via digital cutaneous branch anterior forearm muscles Common Damage sites of damage Branches to intrinsic Carpal tunnel syndrome (main); supracondylar fracture of the hand muscles humerus; lacerations of the wrist proximal to flexor retinaculum Surgical Society Junior Anatomy SeriesMedian nerve (C6-T1) Motor Most flexors of anterior forearm Lateral cord Thenar muscles of hand Medial Lateral two lumbricals of hand cord Sensory Lateral part of palm – via palmar cutaneous branch Branches to Lateral three and half fingers on the anterior (palmar) surface of anterior forearm hand - via digital cutaneous branch muscles Cutaneous innervation Damage Carpal tunnel syndrome (main); supracondylar fracture of the Branches to humerus; lacerations of the wrist proximal to flexor retinaculum musclesic hand Surgical SocietyJunior Anatomy SeriesMedian nerve (C6-T1) Surgical Society | Junior Anatomy SeriesUlnar nerve (C8-T1) Motor Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals) Lateral Cord Two muscles in the forearm : flexor carpi ulnaris and medial half of flexor digitorum profundus. Ulnar Sensory nerve Anterior and posterior surfaces of the medial one and half Branches to fingers, and the associated palm area medial muscles Common Damage damagef intrinsicto (“funny hand bone”) Lies posterior to the medial epicondyle of humerus - can muscles be damaged in fractures or dislocations of the elbow Surgical Society Junior Anatomy SeriesUlnar nerve (C8-T1) Motor Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals) Two muscles in the forearm : flexor carpi ulnaris and medial half of flexor digitorum profundus. profundusexor digitorum Cutaneous muscle innervation Sensory Flexor carpi ulnaris Anterior and posterior surfaces of the medial one and half muscle fingers, and the associated palm area Branches to intrinsic Damage hand muscles Liesposterior to the medial epicondyle of humerus - can be damaged in fractures or dislocations of the elbow Surgical SocietyJunior Anatomy SeriesUlnar nerve (C8-T1) Surgical Society | Junior Anatomy SeriesUlnar Claw Paradox Surgical Society | Junior Anatomy SeriesSummary The brachial plexus is responsible for the innervation of the almost entire upper limb It is formed from the anterior rami of spinal nerve roots C5-T1 It gives rise to 5 terminal nerves: musculocutaneous, axillar, radial, median and ulnar nerve Surgical Societyor Anatomy SeriesStructure of the session Bones and joints of the upper limb & hand Upper limb muscle compartments & hand Nerves of the upper limb Practice Questions Surgical Society | Junior Anatomy Series [VSA Q] PRACTICE QUESTION Which nerve supplies structure 8? Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION What movement is performed by structure 11? Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION What type of joint is formed by structure 36? Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION Name structure 15. Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION What is the function of structure 4? Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION Name the distal attachment of structure 23. Surgical Societyr Anatomy Series [VSA Q] PRACTICE QUESTION Which nerve roots innervate structure 7? Surgical Societyr Anatomy SeriesSurgical Society | Junior Anatomy Series Deniz Koku Contact dk520@ic.ac.uk Feedback Please fill out the following feedback form in order to receive a copy of the slides via Medall, Form along with bonus SBAs to aid your revision! We hope you enjoyed this lecture! Keep an eye out for mock details!