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Upper Limb T utorial SUBTITLE By Srijan Curpad BSc (Hons) th 4 Year Medical Student University College London Saturday 20 April (time) @ BRITISHINDIANMEDICASSOCIATION @BINDIANMEDICS BRITISH INDIAN MEDICAL @BIMA ASSOCIATION BIMA Preclinical seriesWHO AM I Hi my name is Srijan I am currently a 4 year medical student at UCL. I have just completed my iBSc year where I did Oncology. I have an interest in Trauma and Orthopaedics and Neurology. Your pictureTOPICS COVERED I. Bones and articulations II. Muscles III. Innervation IV. Arterial and venous supply V. Lymphatics VI. SBA questionsI. Bones and articulations The Shoulder 2539 8868I. Bones and articulations The Shoulder • This is a ball-and-socket joint, it has a wide range of motion in multiple planes • It is inherently an unstable joint and very easily dislocated • head common dislocation is anterior dislocation of the humeral 2539 8868I. Bones and articulations The Elbow 2539 8868I. Bones and articulations The Elbow • This is an example of a hinge joint, made up of the • This joint is used in flexion and extension • Common conditions are: lateral epicondylitis (tennis elbow) and medial epicondylitis (golfers' elbow) 2539 8868I. Bones and articulations The Wrist 2539 8868I. Bones and articulations The Wrist • It is a condyloid joint is formed of the radius, ulnar and carpal • The joint allows for flexion, extension, abduction and adduction • So Long To Pinky, Here Comes The Thumb • Common conditions are: Scaphoid fractures and carpel tunnel syndrome 2539 8868I. Bones and articulations The Hand 2539 8868I. Bones and articulations The Hand • Used to grip and preform intricate movements • Carthritis (important to be aware this is not the only join in which they can occur) 2539 8868II. Muscles Proximal Muscles 2539 8868II. Muscles Proximal Muscles • Pectoralis major: adduction, internal rotation and flexion of the arm • Trapezius: Elevates (upper) retracts (middle) and depress (lower) the scapula • Latissimus dorsi: Adduction, internal rotation and extension of the arm • Rhomboid major: Retracts and rotates the scapula • Rhomboid minor: Retracts and rotates the scapula • Levator scapulae: Elevates the scapulard 2539 8868II. Muscles Rotator Cuff Muscles 2539 8868II. Muscles Rotator Cuff Muscles • Supraspinatus: used at the start of arm abduction up to 15 degrees • Infraspinatus: external rotation • Teres minor: external rotation 2539 8868II. Muscles Upper Arm Muscles 2539 8868II. Muscles Upper Arm Muscles • The Biceps brachii is made up of 2 heads long and short: Flexion at the elbow joint and • The Triceps brachii is made up of 3 heads long, short and lateral head: Extension at the elbow joint • Brachialis (this can be considered a forearm muscle also): Flexion at the elbow joint 2539 8868II. Muscles Forearm Muscles (Anterior) 2539 8868II. Muscles Forearm Muscles (Anterior) • Flexor carpi radialis: Wrist flexion with radial deviation • Flexor carpi ulnaris: Wrist flexion with ulnar deviation • Palmaris longus: Wrist flexion, absent in some people • Flexor digitorum superficialis: Finger flexion at PIP joints • Pronator teres: Forearm pronation • Brachioradialis: Flexion at elbow • Deep • Flexor digitorum profundus: Finger flexion at DIP joints • Pronator quadratus: Forearm pronation • Supinator: Supinates the arm 2539 8868II. Muscles Forearm Muscles (Posterior) 2539 8868II. Muscles Forearm Muscles (Posterior) • Superficial • Extensor carpi radialis longus and brevis: Extends and abducts the wrist • Extensor digitorum: Extends the medial 4 fingers at the MCP-IP joint • Extensor digiti minimi: Extends the little finger • Extensor carpi ulnaris: Extension and adduction of the wrist • Anconeus: Extends and stabilises elbow joint also abducts ulna during pronation • Deep • Supinator: Supination • Extensor digitorum: Finger extension at MCP joints • Extensor carpi ulnaris: Wrist extension with ulnar deviation • Extensor carpi radialis: Wrist extension with radial deviation 2539 8868II. Muscles Hand Muscles 2539 8868II. Muscles Hand Muscles • Thenar muscles: Abductor pollicis brevis, flexor pollicis brevis (abducts and flexes • Hypothenar muscles: Abductor digiti minimi, flexor digiti minimi (abducts and flexes pinky finger at MCP joint, respectively) • Lumbricals: Flexion at MCP joints, extension at PIP and DIP joints • Interossei muscles: Dorsal interossei, palmar interossei (abduct and adduct fingers, respectively) 2539 8868III. Innervation Brachial Plexus 2539 8868III. Innervation Dermatomes and Myotomes 2539 8868III. Innervation Main Nerves 2539 8868III. Innervation Musculocutaneous nerve (C5-C7) • Motor: Elbow flexion supplies biceps brachii • Sensory: Lateral part of the forearm 2539 8868III. Innervation Axillary nerve (C5-T6) • Motor: Shoulder abduction supplies deltoid muscle • Sensory: Inferior region of deltoid muscle known as the regimental badge area 2539 8868III. Innervation Median nerve (C6-T1) •flexor digitorum profundus. In addition, supplies the thenar muscles and the lateral 2 lumbricals.e • Sensory: Palmar aspect of the lateral 3.5 fingers 2539 8868III. Innervation Radial nerve (C5-T1) • Motor: Extension in the forearm, wrist, fingers ast thumnd • Sensory: Area between the dorsal aspect of the 1 and 2 metacarpals 2539 8868III. Innervation Ulnar nerve (C8-T1) •abductor pollis brevis and flexor pollis brevisept for lateral 2 lumbricals, opponens pollis, • Sensory: Medial 1.5 fingers 2539 8868III. Innervation Long Thoracic nerve (C5-C7) • Motor: Serratus anterior • Sensory: None 2539 8868III. Innervation Musculocutaneous nerve (C5-C7) • Innervates anterior upper arm muscles: biceps brachii, brachialis, coracobrachialis 2539 8868IV. Arterial and venous supply 2539 8868V. Lymphatic Supply A good mnemonic to remember the axillary lymph nodes is: APICAL Anterior Posterior Infraclavicular Central Apical Lateral 2539 8868VI. SBAs Which is not a muscle in the rotator cuff b) Supraspinatus c) Teres major d) Subscapularis e) Infraspinatus 2539 8868VI. SBAs Which is not a muscle in the rotator cuff b) Supraspinatus c) Teres major d) Subscapularis e) Infraspinatus 2539 8868VI. SBAs A 25-year-old man comes to the emergency department following a fall from his stepladder onto his left arm. He complains of pain in her elbow and reduced movement of his left hand. There is palpable tenderness over the left elbow with reduced flexion and adduction of the wrist. What nerve is involved in this patient's injury ? a) Axillary nerve b) Median nerve c) Musculocutaneous nerve d) Radial nerve e) Ulnar nerve 2539 8868VI. SBAs A 25-year-old man comes to the emergency department following a fall from his stepladder onto his left arm. He complains of pain in her elbow and reduced movement of his left hand. There is palpable tenderness over the left elbow with reduced flexion and adduction of the wrist. What nerve is involved in this patient's injury ? a) Axillary nerve b) Median nerve c) Musculocutaneous nerve d) Radial nerve e) Ulnar nerve 2539 8868VI. SBAs What muscle is used in the first 15 degree of abduction ? a) Teres minor b) Supraspinatus c) Deltoid e) Subclaviustus 2539 8868VI. SBAs What muscle is used in the first 15 degree of abduction ? a) Teres minor b) Supraspinatus c) Deltoid d) Infraspinatus e) Subclavius 2539 8868VI. SBAs How many movements can the elbow joint preform a) 1 b) 2 c) 3 d) 4 e) 5 2539 8868VI. SBAs How many movements can the elbow joint preform a) 1 b) 2 c) 3 d) 4 e) 5 2539 8868VI. SBAs A 74-year-old man is brought to the emergency department after a fall onto an outstretched arm. He has a past medical history of osteoporosis and his medications include calcium and vitamin D and alendronic acid. On examination, he is tender at the proximal humerus and is unable to abduct his shoulder. Examination of the elbow, wrist and hand is unremarkable. Plain radiography demonstrates a fracture of the proximal humerus. What nerve has been injured? a) Axillary nerve b) Long thoracic nerve c) Musculocutaneous nerve d) Radial nerve e) Ulnar nerve 2539 8868VI. SBAs A 74-year-old man is brought to the emergency department after a fall onto an outstretched arm. He has a past medical history of osteoporosis and his medications include calcium and vitamin D and alendronic acid. On examination, he is tender at the proximal humerus and is unable to abduct his shoulder. Examination of the elbow, wrist and hand is unremarkable. Plain radiography demonstrates a fracture of the proximal humerus. What nerve has been injured? a) Axillary nerve b) Long thoracic nerve c) Musculocutaneous nerve d) Radial nerve e) Ulnar nerve 2539 8868THANK YOU FOR LISTENING ANY QUESTIONS INSERT QR CODE FOR FEEDBACK FORM BIMA Preclinical series