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Okay. Uh, so high. A very good evening to everyone. All the viewers that are present today. Uh, first and foremost, welcome to the, uh, first of the seven part lecture series from the Q B or two society. Uh, my name is Danny. I am the fourth year, uh, representative for QB orto society and with me today with our to, uh uh, two speakers, Uh, Marcus Graham, fifth year medical student. And him, um, Owen Raj for few medical student who is gonna take us through this lecture today. So without further ado, do I think I can pass it to markers to crack on Perfect. Thank you so much, Danny. So we're going to do things a little bit, Um, the wrong way round schools this evening in that I'm going to talk about the pathologies of the opera limb first, and then him a is going to talk about the anatomy and and structural constitution of the upper limb. That is because I have an unexpected personal equipment, so I can only apologize for that. And so I will have to slip off after talking about this. But I have my email address up on the screen now. So if you've any questions about anything that I am speak about, please feel free to send me an email, and I'll do my best to answer it in the best way possible. So without further a do, we'll just get started. So in terms of the upper limb, we're not talking about the shoulder or the rest in the hand. And tonight, as those will be represented in another lecture, So I'm going to start sort of from and approximate and work my way distantly. So if we start with the humerus, some of these slides are quite hefty, and I appreciate that, but I'm trying to hopefully use them as revision tools and for you guys as well for the future. So for anyone that's done their fractures in fourth year, you know, HUMERAL fractures are quite a large part of that module, and they actually came up on our office keys last year. So forth year off skis. We had a radiology and fracture station, which was a proximal commuted humeral fracture. So in terms of what these fractures actually look like approximal fracture, obviously being the fractures that are highest up the arm if you want to think of it that way? And are those fractures, which are often like a fish, fractures those fractures that we talked about the fall on the outstretched hand, and there's a number of those that you'll see as we go through talking about the upper limb. And if you imagine, particularly an elderly people possibly trip on the carpet or there and only even pavement and put their arm out to save themselves. That's a fall on the outstretched hand. So things you always need to think about with fractures in particular are the neurovascular and problems that they can cause. So in terms of the proximal humeral fracture, you're thinking of axillary nerve damage and possible avascular necrosis to the joint as well, in terms of your axillary nerve damage in the way they remember that, that's your regimental badge area of sensitivity and Hemel Go on again and talk about the different and nerve structures later on. As with all things fractures, one view is too few, and therefore you need at least two different views and of these fractures. So you want an AP view and either an axle Oravail PPO X ray in order to assess the fracture from both sides. If it's an undisplaced fracture, a simple fracture you'd see someone with, uh, elevation sling for 5 to 6 weeks. The typical healing time for the upper limb fractures is about six weeks, and but if it's a displaced fracture and you'd be looking to do an or if so, an open reduction and internal fixation, or possibly hemiarthroplasty plasty if it was completely and it just well, although those would be significantly more rare, working our way down you're talking again about is a fish fracture of the shaft, and you'd be looking then at damage to the radial nerve and with a possible wrist-drop presentation in these patient's. So the kind of the flopping of the risk that you would expect to see. Um, with those you want a pa and lateral X ray views and an undisplaced humeral shaft fracture, you might want to apply a back slab for 1 to 2 weeks and then a brace for sort of up to 8 to 12 weeks. It's a more complex and fracture with more difficulty in healing. If it's a displaced fracture, it's an or if again, or and quite often these can be pathological fractures, so fracture student underlying disease process such as, uh, cancer. And in that case, you might put an intramedullary nail in place in order to stabilize that fracture. It's important to say that you never fix a primary bone cancer at this point, So if the bone cancer itself was in the Humeral shop, you wouldn't fix it with an intramedullary nail. But if it was a metastatic spread or a consequence of the cancer, you would in terms of in your distal fractures. And again, it's a fish fracture. There's possible nerve damage, particularly radial and interior interosseous, which only has, um, sensory issues and a pa and lateral and elbow. X rays are often the best way of seeing if it's accommodated fracture. Due to the complexity of that joint, you might need to get a CT scan. If it's an undisplaced fracture, you would have a long arm cast then, by that I mean wrist up to shoulder the kind of traditional 90 degree angle and long arm cast. All of those are very cumbersome and difficult for patients to manage, and and if it's a displaced fracture, it could be an or if again, or a total elbow replacement, and that's if it's an irreducible fracture. You'll see that a common thing here with all these fractures is that they're often fixed with the production internal fixation. If there is displacement and that goes for most most fractures, so working our way down to the elbow joint itself and there's a number of different problems that we can experience. And with the elbow there's three main ones that I think are important for, you know, for exams. And I've highlighted the bottom to their medial and lateral epicondyle itis because they're probably the most common ones. And we'll come on to talk about those in a moment, and a little graphic in the top right hand corner just highlights a couple of the other ones that I think are worth bearing in mind. So electron, um, bursitis and you'll not miss Electron um, bursitis. I've seen a couple of cases of it, and it literally looks like somebody's got a golf ball under the skin. It's just this, like big, hard to swallow and sorry, Not hard but big, firm, almost swollen, lump under and the elbow in terms of radial head dislocations or subluxations, and you're thinking there is like the child swinging or just that picture, and then any lacerations. The cut off also can obviously cause some nerve damage and arterial damage as well. But the three, I think, are most important to think about in terms of the elbow. And these do come up in past papers and in exams. Super combative fractures in kids particularly. Okay. So if it's an undisplaced fracture, that can be three weeks in a long arm, backstab with weekly X rays to check progress. If it's a displaced, um, fracture, you'd need to have an an urgent M. U S manipulation under anesthetic and K wiring to support the structure. And that's because if you mentioned that the brachial artery and nerve are very vulnerable, um, that that space in the elbow, particularly in Children and so you really risk, um, your vascular compromise at that point in terms of your medial and lateral epicondyle itis, and you just have to get these into your head as as to which one is which. But medial is golfer elbows and and that's cause causes pain and tenderness, which is localized to the medial epicondyle and that's team, which is worse on flexion against resistance. So medial is golfers is flexion lateral epicondyle itis is tennis elbow. You might have heard it called, and it's caused by and that's p and Intel tenderness localized to the lateral epicondyle. And that pain is worse on risk extension against resistance with the elbow extended or super nation of the Forum with the elbow extended. So that's kind of like you're emptying the contest if you can see my arm but emptying your contest and that's Super Nation so you can have an issue there as well. In terms of that acute pain, it can be like sort of 6 to 12 weeks, so quite long standing to be a lot of these presenting in general practice, and it can be if they're unaccustomed to an activity. So someone that paint their whole house and would normally partake in that kind of activity or plays tennis for the first time in a long time can experience this kind of pain. So medial is golfers reflection. Lateral is tennis is extension and whatever way you can kind of think to remember those by I sometimes think of it as let. So you got to let in tennis an l for lateral e for extension t for tennis. So sometimes that can help me to remember that after the elbow, we obviously then reach in the forum. Okay? And there's two major fractures that you need to remember when you're learning about in the forearm and their your Mantega and your gal IATSE fractures. And the way that I remember. This is actually when I found this, um, this that all in graphic and it's mugger. So it's in the Monte Jay a fracture. It's an ulnar fracture with dislocation of the radial head. So if you imagine that you're remembering EMU because it's Mantega is ulnar and that's where the fracture is cited. And as you can see here again, I'm not sure if you can see my mouse, but you can see there. That's the ulnar fracture, and that's the destination of the radial head. Okay, and another one another. One thing you can remember is that Mantega ends in an A and A is proximal, so the bones affected our proximal. So as you can see there, that joint in terms of gal IATSE fractures, and it's a radius fracture. So that's your sugar part of your mugger. And it's your dislocation of the distal radioulnar joint. So the issue is going to be at the wrist here, so Galaxies got seeds in it. Z is far away, down the alphabet. The bones are affected distantly. Okay, those come up all the time as X rays and questions MCQ. So it seems to be a bit obsessed with Mantega and Galbiati. But it's one of those things that's easy to test on, and it's easy to get into your head. Just remember, mugger. That's kind of the easiest way to think of it. So then talking about, um, going down to the rest. And there's three major fractures in the rest, and these are kind of the most common fractures of the upper limb. They're usually low energy. Fish fractures have talked about earlier, particularly in elderly or osteo product patient's. And it's important remembering that not all patient's your elderly are osteo product, and not all osteo product patient's are elderly. There are other reasons, and that you can have osteo protests, too, not just always to to assume in terms of how you would assess these fractures. And so you're looking at your history. You're talking about how they did it, which hand they use what they do for work, what they do for pleasure. And those are all really important in order for you to assess how you're gonna manage this and how important it is and how sort of em high intensity your intervention is going to be. Particularly if your patient is more elderly. Then you want to do a neuro Vassar assessment of your medial medium sorry radial and ulnar nerves with capillary refill and pulses bilaterally and as well to compare, I'll talk a little bit about how you do a very quick and your vascular assessment in a second and then, in terms of imaging, want to use too few. So you want an AP and lateral wrist X rays. So the three main fractures and colleagues is your first fracture. Unfortunately, um, orthopedics and radiology are full of all these eponymous names. So these all these like colleagues Spartans, that doesn't make it very easy to remember what things are, but you just kind of have to get into your head and remember them so a colleague fracture is an extra articular distal fracture, which is within 2.5 centimeters of the wrist joint. And it's quite often, as it says there a fragility fractures to someone that has a process underlying like osteo process. And it's a particularly low energy injury but just causes them to have quite a significant break. So when you think of these fractures, you think of the old lady that trips on the pavement because of our osteo process in something that maybe would have just bruised your I can cause a significant fracture. It's all the DS I think of with colleagues, so it's dorsal angulations and displacement with radio angulations displacement as well. But it's dorsal and a dinner fork deformity, So the picture you can see there in the bottom left kind of shows that dinner for deformity and it's just the shape of the fracture. Okay, so dinner for poor deformities are present most commonly with that dorsal ambulation kind of colleagues, fracture impaction is often present, and that's also where the bone is pushed closer together, and that's commonly seen with them. Those kind of more fragile or stoop product bones in terms of a Smith's fracture. That's also an extra articular fracture with, but this time it's Palmer displacement. It's being displaced in the other direction. So if you imagine the doors will displacement interest being displaced upwards and power means downwards just to be sort of more simplistic about it. And it's a volar angulations, so it's the opposite of a colleagues fracture. It involves someone falling on the back of their hand, so less common. But these are very unstable fractures, and the way I remember that they're very unstable is that they're very uncommon in comparison to colleagues, so much less likely much more important to get them resolved and because they often require surgical and management with an or if and then a Barton's fracture, which is a partial articular fracture subluxation, which basically means that part of the articular shaft surface sorry is still attached to the shaft. It's not a full dislocation, it's a subluxation and the corpus subluxed with the broken fragment due to sort of like the strong ligament, this attachment. So the ligaments, keeping it in place there and and that's why it's never really fully in displace, and it's usually displaced volar like so again. Downwards. Okay, so colleagues, Smith's and Barton's or the three, I think, most important fractures to be mindful of when it comes to, um, the disarray be is on the rest in terms of performing a neurovascular assessment. And I know this talks about pediatric fracture, but I just think this is quite a good way of remembering how to how to kind of do this assessment. So if you think of your median nerve and it provides finger flexion and that this is an over simplified version of this doesn't give all the correct people. But I just think in terms of all skis, and this is a really good way of remembering things. So it's kind of the like rock paper, scissors. Okay, so median nerve finger flexion is your rock in radial nerve. It's extension of the wrist, and your MCP joints are kind of put in the hand out flat, older nerve. It's in small muscles of the hands, the finger in abduction adduction. So that's your your scissors, and then your interior interosseous nerve is your okay, all right. And then when you go into your sensory assessment ways, in which you're doing this, you can see there the median. Um, the median nerve. I kind of think the And the best way to do this is if you take the palm of the hand so you can work your way, drawing so radio median ulnar. And you've touched all the main and sensory modalities just as long as you do touch all three. And and you're again. You're checking that to see if you're getting bilateral response to that, because you want to see that this is something that is acute and due to the fracture and not like a longstanding peripheral and you're up with the they might have. And then until you're interested, which I think I I think I said earlier by mistake, it only had a sensory component. But, I mean, it doesn't have a significant sensory component. It's just a motor component. So that's important for you to remember as well. So those are the major and ways of assessing in the neurological status in upper limb injuries. So I can take any questions and by email is probably best. Those are what I think are the most poignant things to remember when it comes to looking at upper limb and pathologies that are present. So it will be another session on the shoulder and the hand, and those will outline some of the conditions that I haven't touched on today. But in terms of what I think are the most important for exams, those are what I would be focusing your attention into. Right. Thank you very much, Marcus, for that comprehensive, uh, first part of the lecture. Um, So next can we have, uh, to, uh, conclude the second, the second part of the lecture? Yeah, I'm just, um, uploading the slides, so I think it should share soon. Okay. Yeah, almost there. 26. Meanwhile, for everyone else who has any questions, uh, towards, uh, Marcus again. His email is in the chat, so please feel free. If you have anything to ask, you can email it to it. Okay. Can you see that? Yep. OK, perfect. Okay. Um, so I'm basically just gonna talk about the anatomy of the upper limb. Um, And what I'll be covering, um, is just first the osteology. So the bones that make up the upper limb, um, the pectoral region, the axilla the shoulder, um form in hand, and the blood and municipal I of the upper limb. Um, so just for starting with the bones, um, so looking at the entire upper limb, um, the bony structures that are there are the clavicle, the scapula, the humerus, radius ulna, carpal bones, metacarpal bones and phalanges. And this is, um, from most distal to most proximal. Um, so, firstly, looking at the clavicle, So the clavicle is just your collarbone. Um, it basically extends from the manubrium of the sternum, um, to the acromion of the scapula, and it forms to joints. So the sternoclavicular a and the acromioclavicular joints, Um and so just some bony landmarks of the clavicle. Um, and that would be the corner typical. And the traffic sideline, where the corner ligament and the trapezoid ligament, um, both attached to, um, moving on. We have the scapula. Now, I say this is quite, um, an important bone to know. It's, um, quite, like, tested quite often, um, and just overall, the scapula basically, um, has two surfaces. Um, which is the dorsal and the, um Casal services. Costless anterior. Dorsal is posterior. It has three borders, and it has two processes And what it does is it basically, um, kind of helps to connect the upper limb, um, to the trunk of the body. Um, by articulating with the clavicle at the acromioclavicular joint and with the humerus at the glenohumeral joint. Um, and so the two services, um, costal and docile. And so the costal surface, Um, there is the big fossil, which is called the sub scapula fossa. Um, which is where the muscle subscapularis can be found. Um, and then the dorsal surface, um, is a site of origin of many rotator cuff muscles, which I'll cover in a bit. Um, and the rotator cuff muscles are very quite important when it comes to the anatomy of the upper limb. Um, and it is marked by at the dorsal surface. You have the spine of the scapula. You have the acromion, infraspinatus and supraspinatus fossa. And it is important to kind of know the, um, bony landmarks of the, um scapula. Because when performing, um, see the shoulder examination in your skis, Um, you would be expected to kind of, um, palpate all these, um, bony landmarks and regions. So it is quite important to know, um and just because I mentioned the borders and the processes. So the three borders are the, um, superior border medial border and lateral border. And the to process the three processes are the spinous process acromion and coracoid process. So moving to the next bone, which is the humerus. And this is the longest bone, um, of the upper limp. And it articulates proximately with the glenoid fossa forming the glenohumeral joint. Um, and this elite arctic articulates with the head of the radius, um, forming the elbow joint, um, so approximately, um, the tumor and sorry. The humerus is marked by the head, the head of the humerus. And with this, you have the they're they're two next as well. So the anatomical neck and the surgical neck And this is, um, will be quite important in the fractures and what Marcus was talking about earlier. Um, and then there's also the lesser tuberosity and inter tubular cell cas or groove. Um, the delta tuberosity is where the deltoid muscle attaches. And this can be found, um, on the shaft of the humerus. And we also have the radial groove. Um, where the radial artery is runs basically and distally um, this is where the elbow joint is formed. Um, there is the lateral and medial epicondyle. And so with the medial epicondyle, that's where you're on all the nerve runs quite superficially. Um, and that's why you it's called the Funny bone. If it if you hit it like knock it and the chocolate is located immediately and extends onto the posture aspect of the bone, and then we also have the capitulum and that articulates with the radius. And there's also the coronoid radio and olecranon Fosse, which accommodate for on bones when you need to flex or extend your elbow, Um, and moving on to the forum. So there are two bones that are, um, located in the forum and these other radius and the ulna. And so the radius, um, forms for joints. And that will be the elbow joint, Um, the proximal radioulnar joint. This is already on the joint as well as the wrist joint and kind of important bony prominences of the radius is the head of radius neck and the radial tuberosity distally. Um, on the radius, you can find, um, the styloid process and the, uh, the notch and the distal surface is where the radius will, um, articulate with the carpal bones of your hand from, um, the restaurant, Um, and then the alarm bone, um, is medial to the radius, and it lies parallel. So they just lie side by side next to each other. Um, and approximately, it also articulates with humorous to form the elbow joint. And this silly it articulates with the radius for the distal radio on the joint. Um, and so important landmarks for the ulna bone would be the Elocon in, um, coronoid process. Chocolate notch radio notch and ulna tuberosity. Um, and the distal head has a projection known as the styloid process. So next, I'm just going to talk about the bones in the hand. So hand does have a lot of bones. Um, So firstly, we're going to talk about the carpal bones, which are the ones that are colored right here. Um, and this can be sometimes quite if you remember. And that's why the pneumonic is quite helpful and help helping you remember this? Bones, uh, the bones. So some levels try positions that they can't handle. Um, it's what I used. It was really helpful. Um, so Basically the bones are scale Froilan, triquetrum, pisiform, trapezium, trapezoid, capitate and hammock. And these are just ate irregularly shaped bones. And in terms of the acronym, it covers the first floor, Um, which is located approximately from lateral medial and then goes to the second line, the second line, also from lateral to media. Um And so then, um, this is where with the carpal bones the restaurant is form, um, with the scaphoid and lunate, which articulate with the radius. And that's how there is dryness form. Um, and then the meta couples, which are these long bones right here, of which there are five. Um, and these are numbered 125. So, metacarpal number one, which is the thumb, and number five, which is the finger and the rest just go accordingly in order. Um, and these meta couples articulate proximately with the carpals and distally with a proximal phalanges. Um, and then the phalanges are the smaller bones just up here. Um, in this in the second smaller diagram. Um, and basically, all fingers have three phalanges, except for the thumb where there is just to, um and so the three phalanges in the rest of the fingers would be the proximal, middle and distal phalanges. So, um, moving on from osteology I'm just now going to cover the muscles of the petrol region. Um, and so petrol region is basically just the anterior chest wall, and it contains four muscles, mainly that exert a force on the upper limb. And these muscles pectoralis major petrol is minor subclavius and cirrhotics anteria. Um, I wouldn't really So I've written the origin and insertion in the notes. Um, but we won't really talk about that today. Um, I'm just gonna give you a brief overview. So basically, um, petrol is major. It's, um, What it helps in doing is kind of adduction and medial rotation of the upper limb, and it's innovated by the lateral and medial pectoral nerves. Um, pectoral is minor. Helps been stabilizing the scapula, and it's innovated by the media. Pectoral nerve. The subclavius is a really small muscle that you can see right here. And it's, um, kind of under, um, both, um, sorry. It's kind of under the muscles. And, um uh, it, um kind of originates from the first junction of the of the first and inserts into the clavicle, and it helps to anchor and depress depress the clavicle. And it's innovated by the nerve of, um, nerve to subclavius. And then we have Stratus anterior, which kind of comes from the ribs, and it's kind of like to the side as well. And it's from the lateral aspect of rib 1 to 8, and it attaches the costal surface of the scapula. And what Stratus anterior helps with its abduction of the arm, um, over 90 degrees, and it's innovated by the long thoracic nerve. So now moving on to the axilla, um, and this is a pyramidal space that lies underneath the gleno glenohumeral joint. And it's a passageway, um, by which we have neurovascular and muscular structures, and these structures can enter or leave the upper limb. And so it kind of resembles like a four sided pyramid. So it has an apex. It has a base and has four walls, anterior posture, medial and lateral. And so the contents of the axilla include the eggs, Ilary artery and its branches. Exactly vein, and its tributaries brachial plexus and its branches exhilarate the lymph nodes. The biceps break I, which is the muscle. Um, the short head of it and coracobrachialis, which is another muscle. And there are three main routes by which, um, structures leave the axilla. So the main route of exit, um, is immediately inferior early and laterally, which goes into the upper limb. And so the majority of the contents, um, leave by this method, however, another pathway is via the quadrangular space, which I'll talk about next. Um, and this is a gap in the posterior wall of the axilla allowing access to the posture. Um, and the shoulder area and the last passage way is that clearly pictorial triangle, which is an opening in the anterior wall of the axilla. Um, so now I'm just going to talk a little bit about the quadrangle space, which is kind of just an anatomical space. Um, and it has its borders. And, um, remember your own anatomy were quizzed about kind of what? What borders? Um what what muscles or form? Or an anatomical structures from the different borders. So superior Lee. It's the inferior aspect of terrace minor, inferior Lee. It's a superior aspect of terrorist major laterals. The surgical neck of the humerus and medial is the long head of, um, Tristesse Break I and anterior. Um and really, it's the subscapularis. So moving on then is the brachial plexus, and this is quite an important, um, anatomical structure to know both clinically and just for anatomy as well. Um, so this demonic right here read that damn cadaver book is just to talk about the roots, the trunks, the divisions, the cords, um, and the branches following that, um and so how? It's the brittle. Texas is basically this network of nerve fibers, and it supplies the skin and the musculature of the upper limb. So this plexus is formed by these routes here. C 52, t one. And these roots are basically the anti arrhythmia of cervical, the cervical spine, and loves C 52 t one. Um, and from that, the regular taxes can be divided into five parts. The roots, trunks, divisions, cords and branches. Um and so we're gonna start with after the after the roots, we're going to start with the trunk. So there are three different trunks, and that would be the superior trunk, which is formed by C five and C six, the middle trunk, which is just a continuation of C seven and the inferior trunk, which is formed by C eight and T one. Then each trunk has two divisions, which is anterior and posterior, and they combined together to form the cords. And there are three chords. The lateral cord, the posterior cord and the medial cord. And so it's important to know what kind of forms one chord. So the lateral cord is basically formed by you can see in the diagram, the anterior division of the superior trunk and the anterior division of the medial trunk. Um, the posture cord is formed by the posture divisions of, um, all three trunks and the medial cord is, um, just formed by the anti division of C eight and T one. So, um, moving on. And then, of course, after the cords, um, the branches are here on the diagram. So there's many, many different branches that, um, the brachial plexus gives off, and it's just quite important to know that. So moving on, I'm just gonna talk a little bit about the eggs Ilary artery, cause I remember this was also something that was quite important in year one. Um, and so there are, uh, there's this pneumonic that they used to kind of help. Remember which is Screw the lawyer and save the patient. Um, so the egg celery artery. It basically lies deep to the petrol pectoral pectoral list. Minor muscle and it's enclosed in an auxiliary sheet. Um, and it can be divided into three parts relative to how the petrol is Minor muscle kind of cuts it up, Um, and so the first part is proximal to petrol is minor. The second part is posterior to petrol is minor, and the third part is distilled. Petrol is minor. So the main branches of the auxiliary artery include the first part, which is the superior thoracic artery. Um, the second part, um then has two arteries, which is the thoraco acromial artery and the lateral thoracic artery. And the third part has three arteries, which is the sub scapular artery anterior and posterior circumplex arteries. So moving on, um, we now have the extrinsic muscles of the shoulder, and this is actually, um, also known as the superficial, um, back muscles. And these are situated kind of just under the skin and superficial fascia, and they originate from the vertebral column and attached the bones of this shoulder. So even though they're technically classes as back muscles, they kind of are very helpful in movement of the upper limb. Um, And so, these month, the muscles in this group are the trapezius legitimate Dorsey levator scapula and the rhomboids rhomboid Major and rhomboid minor. Um, so when you in dissection the trapezius and the latissimus dorsi site, like most superficially, um, with the trapezius covering the rhomboids and the Levitra scapula it So, um, I won't really talk so much about the origin and insertion as well. Um, but that's just basically the superficial muscles of the back. So, um, moving on, we now have the intrinsic muscles of the shoulder. Um, and so this is the deltoid, the terrace major. And then we have the rotator cuff muscles. Um, and so the delta delta muscle, um, you can divide it into kind of a few parts, which is the anterior middle and posterior parts of the deltoid. Um, and then the terrace major is, um, another muscle, which is an interesting part of the shoulder and then moving on, I'm just gonna talk a little bit about the rotator cuff muscles because this is quite important. So, um, we have super Spinatus infraspinatus and subscapularis and terrace minor. Um, and so supraspinatus it originates from the super spinous fossa of the scapula and patches to the greater typical of the humerus. Um, it's actually abduct the arm from 0 to 15 degrees, and it assists the deltoid in abduction of the, um from 15 to 90 degree, and it's in a rated by the super scapular nerve. We next have the infraspinatus, um, and this urge in. It's from the infraspinous fossa, as its name suggests, and attaches to the greater typical of the humerus. Um, it's Axion is to help laterally rotate the arm, and it's innovated by the super spectacular nerve. We next have the scapula wrist, and this originates from the subscapular fossa on the costal surface of the anterior surface of the scapula, and it attaches to the lesser typical of the humerus, and its action is to immediately rotate the arm, and it's innovation is upper and lower subscapular nerves. And then we have Terrace Minor, which originates from the posture surface of the scapula adjacent to its lateral border. It attaches to the greater typical of the humerus and its actions to laterally rotate the arm and it's innovated by the eggs. Ilary nerve. So moving on to the actual arm now, um, So the arm, um, has, um, many muscles, both anteriorly and posteriorly. So remember the muscles anteriorly. Um, B B C is in the morning. That's quite often used, and that's basically to say biceps break. I BRACHIALIS and Karaca break Alice and Posteriorly. We have the triceps break, right? So, um, basically the biceps breaker. It has two heads. It has a long head and a short head. And, um, the biceps breaker, as well as the tendon of it enters the forum. A connective sheet is given off, and this is called the bicipital up of neurosis. And this helps to form the roof of the cubital fossa, which is another, uh, kind of anatomical space that is important to know. Um, and then moving on. We have, um, the cubital fossa. And it's quite important to know what forms this space as well as the structures that run in it. Um and so it's basically just right here in your elbow. Um, it's a triangular shaped depression over the anterior aspect of the elbow joint, and it represents an area of transition of the arm and the forearm and conveys many important structures. So it's kind of triangular in shape, and it consists of three borders on the roof and a flaw. So the lateral border is the medial border of the brachioradialis muscle. The medial border is the lateral border of the prenatal terrace muscle. The superior border is the horizontal line that is joined from the that is drawn from the epicondyles of the humerus. The roof, as I mentioned earlier earlier, is the bicipital apple neurosis and fascia fat and skin. And the flow is ridiculous. Proximately and the supinator distally and in terms of what it contains, it contains the radial nerve, the biceps tendon, the brachial artery and the median nerve. And so, um, here is another kind of pneumonic to help remember, um, what it contains, which is really need radial nerve beer to biceps tendon be at regular artery. My nicest median nerve. Um, and these are just little things that just help to remember help you remember things so moving on we to the forum now. So the forum is, um, divided into the anterior four. Um, and then the posture form, which is the back of the forum. Um, so anteriorly there are three, um, layers of muscles, and that's the super superficial muscle flexor carpi ulnaris palmar is longest flex a copy radial list and pronator terrorists. Um, And then we have the intermediate muscle, which is the flexor digitorum super superficialis and deep muscle, which is the flexor pollicis longest flexor digitorum profundus and pronator quadratus. Um, and then moving on to the posterior forum. Um, this is too lazy as well. Um, and so there's a superficial layer, which is the breaker radialis, extensor, carpi, radialis longest and brothers extensor digitorum extensive digital Minami extensive cop by Al Norris and the Anconeus muscle. And deep to that is the supinator abducted policies longest extensive policies, brothers, extensive policies, longest and extensive indices, Um, and then moving on. Now we have the intrinsic muscles of the hand. And so, um, this is basically, um it can be quite complex because there are many muscles that make up the hand. Basically, um, and so these can be kind of divided into smaller groups. Um, and this would be, um, Latina muscles and which is the opponents? Policies, abducted policies brevis and flexor pollicis brevis. And then we have the high patina muscles, which are opponents digitally Minami, abductor digital, um, enemy and flexibility Mini me. And these are just in the palm of your hand, like right here. And then we have the lumbrical, the inter Russia and then other muscles, which is Palmyra's brevis and adducted policies and then moving on. We not next have the carpal tunnel. And so, um, the carpal tunnel is quite, um, important anatomically as well, because, um, this is where you hear carpal tunnel syndrome quite often. Um, and, um, when it gets inflamed, the median nerve. Basically, um, you will get the you get some problems with it. So then the borders of the carpal tunnel is the deep couple arch, as well as the Flexeril tenaculum. And, um, its contents is basically the median nerve, um, as well as, um, nine tendons of the muscles. Um and so yep, that's that. And then moving on, we're just moving on to the blood supply of the upper limb. Um, and so, in terms of, um, how the blood is supplied, you start with the subclavian artery, Um, which then transitions into the auxiliary artery, the brachial artery. And then we have the radio artery and ulnar artery, which is which is split into two. And then these two joined together and form the pommel tree branches or the digital arteries. And lastly, we have the venous drainage of the upper limb. And so this is, um it starts with the from the top. Um, it's the Catholic vein, which will, which will then go and drain into heart. So, basically, um, if you're going from down to up, it will be the on the vein, the radio vein, brachial vein, the basilic vein and the Catholic vein. Um, and then what joins? Um, both the basilic and Basilic. And, um, Catholic vein is the median cubital vein. And this is, um, the vein that you would use for venipuncture. Um, because it's quite superficial. Um, and so, yeah, I think that is, um, all in terms of an adding of the upper limb. Um, if you have any questions, please feel free to, um, sorry. Yeah, please feel free to email me. Um, I didn't see the comments that, but yeah, yeah, um, so thank you very much again, Uh, Emma, for concluding the second part of the lecture. Before we wrap this up. Are there any questions from the viewers? Anything that you want to go through again? Uh, anything that, uh, that. You know, Um, sorry. Anything that needs to, uh, to be gone through again. We I believe we're still good on time, so Yes, please. If you have any questions, please, uh, write it down in the chat, and, uh, um, a will be more than happy to answer that. Well, um, in any case, um, you can always email to, uh, email on the chat right now. If anyone has any questions, just feel free to email me, All right? And, uh, that being said, thank you very much again for attending the first of the seven part lecture series. Uh, next week, we'll be having a lecture series. Another Sorry. Another lecture. See, uh, another session of the lecture series. And it will be, uh, strictly regarding the anatomy and clinical anatomy of the and so, please, uh, do join us, then next week as well. And, uh, yeah, again. Thank you very much, Emma, If that is all that's all from us. Thank you very much. Thank you.