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Okay, so I think we'll just make a star. Um, How everyone looking to you? They finally, first year and out of me revision night. And so we're going through and upper limb. Think and but yeah, we're going to start with, are in and he's gonna talk by the lungs. So 100 with him. Yeah. So I think just the way the time it's worked good for the last revision, they don't think lungs wasn't covered. So we're just gonna do that quickly to start of this lecture. Are this revision eight and then we'll move on to the upper limb. So what? GM was originally supposed to cover this, but he's unable to make it tonight, so I'll just quickly run through it. So here you're learning that comes. Yeah, it's not moving for you. No, it's no. Yeah. Give me one second. Yeah, there we go. Eso Here's your learning. I'd come so we'll just be covering the basic anatomy and then we'll talk about we better by clinical applications and chest X rays, because that stuff that's very likely to come up in your first year exams and all skis. So, first of all the trachea then. So that's your windpipe. It's the tube of the securities. Are yeah into the actual lungs themselves. Ah, they're covered in C shaped card in the drinks which obviously keep the our way of Peten. Ah, the reason they're completely circular rings is because sort of the back quarter of the key is left open. I'm just covered by the tricky Alice, most of which helps on contract and a closing the airway slightly to help you to do things like cough and increased the pressure in your chest. So it begins at the level of see sex of the lower border of the cricoid cartilage lies on tier two, the esophagus s. So that's another reason way you don't have sleep rings a as bolus. Three bullets has moved on through the esophagus, the esophagus of widen. And so the treatment tricky Here, the back of it needs to be asleep, be able to a comedy it that expansion, then so lie the ball list of move through the esophagus. Ah, the length. I think he had a t for a and at this level you have something called the Carina, which is just a ridge of cartilage at the bottom of the trachea. Um, it'll split gland into the left and right Me and broke a So it's only president in the superior me this mediastinum if you remember your media side of monogamy from First Master Ah, a lot of things being helping a t for worse without transversus Rozic. Cleon, your aorta well are your trachea will buy for kit on basically your support, superior mediastinum becomes your middle mediastinum. Ah, to a trickier there's line by ciliated pseudostratified Columnar apathy Leo sales on goblet cells. So ciliated mean it has cellular little higher sales not be asleep. Helps move any debris and my crew does anything like that There a upwards to be spot. I'd basically the goblet cells and produce mucus. So again, if you're ever coughing up phlegm, not mucous originates from these carpets. Sales necessarily a will help move up this mucus through the turkey and capture any doctor microorganisms. It's gone sensor innovation from the recurrent laryngeal nerve which are these loops coming off of the vagus nerve on the arterial supply, then is through the inferior thyroid ordering the bronchitis. And so you have two of them, one for each alone. The primary bronchi are formed up the level a sternal angle that t four level. These will in further split into secondary bronchitis or little barber. Okay, eso There's three for the right lung and two for the left, and that's because each secondary bronchus will play one lobe. And as you know, then the rate look a long has three lobes on the left is to secondary, then split further into segmental bronch A on these to play bronchopulmonary segments. So the right longest 10 of these segments left lung. Is it usually on? Those, obviously are the smallest, a independent sag mints of the lungs, which can sort of exist on the room each of their own nurse, from a tertiary bronchus to each of their own blood supply from a tertiary bronchial O. R. A tertiary pulmonary artery on their own limb PSA plane. So say when there's a cancer in one set of these segments, that's sad. Man Convert, completely removed in an operation called a sag, went back to me on the rest of the loan will still be able to function because these units act independently. Essentially ah, seeing where obsesses to gallons of Paasschen a basically local, a single segments. And again, if that was out of fact in the entire lung. And so the right knee and bronchus. And this is important, that fact that always comes up. Um, well, the point. So you can see here it's slightly more whiter, slightly more vertical. Ah, um, the reason this is so important is when you aspirate anything. Were you or something, do you swallow goes into your trachea rather than your esophagus? So, for instance, you know, ah, piece of food, better stick, you know, whatever or in the hospital satin. If you get something called Aspiration pneumonia or say someone has been sick, but they're swallow, is that weaker there, so unconscious that that's sick basically use dying there when pipe. Then more than likely, Doctor Breer, well actor into the right lung and specifically the middle for the lower loop because, as you can see, your gravity will do the work and pull it down into one of these two onset without point. Then you'll get something called an aspiration pneumonia, which is really common in hospital, especially longer stairs and older patients. It's treated slightly differently than Ah, normal pneumonia. Your left, me and bronchus and is under your air is inferior to your aortic arch. The artist actually comes up, loops over it, and then it makes sense. And it lives on two years to the your third thoracic aorta. Because it's not Luke. Then becomes the ferocity order it runs doing behind that wrong and again, cartilage will and circle least help keep impudent. So stop them basically from collapsing. Ah, and then you have your low burn segmental bronch a have their craftsmanship. So weird shift car legends, Dad. So not quite three rings a boot for the most played baby. The vagus nerve on each side on also from the bronchial arteries and beings bronchioles and or your next stop in the trade. So these have no car legend know goblet sales it club sales, which produce surfactant, which basically stops the walls from sticking together. Because humanity, because of the movements quite small, the walls are quite close to gather, and you don't want them to be completely collapsing on one another. Um, well, not then. They're divided into sort of three parts. So there's conducting bronchioles. What's that split off in the multiple terminal bronchioles, which then each a split off and number of respiratory bronchioles. So essentially the conducting bronchioles only conductor were Where is your respiratory bronchiole is when you get, um, they also conductor to the alveoli, a continuing that job on what they also are involved in the actual gas exchange process. So where the auction will be exchanged into the Bloods. But I surrounding these bronchioles on carbon dioxide will be removed, then for expiration and the Elavil A. You probably heard before that believes of the tree. Then they're just little sacs the lane, the airways, and that's where the majority of gas exchange occurs. Uh, just about a clinical relevance. Stands for the bronchioles are what are mainly involved when you think of asthma. So there's a hypersensitivity, a condition where you just actually got bronchospasms. So that's smooth muscle that lying. The bronchioles begins the spasm like any other muscle junk. Um, on top of that, then you can get her way. Remodeling on that causes the smooth muscle becomes thicker, which obviously decrease in the size of the Lumen Eso. An asthma attack. Then it's a science. See when you get an acute exacerbation of the condition. So that's seriously, when you you're exercising or you breathe in the knowledge and or pollen or whatever it is to contribute it for you or dust or cold weather is, well, consum times do it that causes your body. Just actually overreacting this hypersensitivity reaction because a sudden inflammation on the muscle contracts then, as you can imagine when it's contracting, then it's more difficult for the artists and to get through that when paper them and that also, because you got turbulent airflow, then you'll know from your Marber's. If you don't anything like that and see SEC, turbulent flow can cause signs be produced. So in the heart and terms and talk blood flow in the heart, you'll get your murmurs and turbulent airflow. You'll get wheezy or other signs that God, and that's a GMC Also, just put in the treatment algorithm, which is one of the few ones you sort of Do you need to know when first year, So you'll probably have. Don't Saban la been on pharmacology, your cell beautiful and self matter old and all of those. So it's important even we learn in the first two or three steps of that could be really useful for exams as well structured alone. Lance, A buffer coating shipped point to the colon, the science of these here and packs. And it actually just goes above the clavicle. And first rib up into sort of your shoulder area. Uh, just above the clavicle, your B s plan on either side Sit on the respect of how my diet from on each arm it above lobes, which are split up by fissures. The right lung is a right oblique fisher on the horizontal Fisher, making three lobes and toe on the left, just has a left oblique Fisher. Should that split it into your You have three services on each to the short of name for the area that they're fees in to the mediastinal surfaces where they intersect. Office, which faces the mediastinum in the middle mediastinum diaphragm out of surfaces on the bottom, on sets on the actual diaphragm, and then the costal surfaces that curved service, which faces the ribs or you'll know the cost little mean ribs. Intercostal is between the ribs on. Then they have three borders as well. So the anterior posterior and then the inferior border. So the lobes And as I've said before, split by fishers here the right has this oblique one on the horizontal woman, a superior middle and in fear lobe the last. This is an oblique fissure which puts it into you surface. Since I was upset already, the Mediastinal service faces the middle mediastinum so essentially faces the heart set in that middle mediastinum. This is where the loan hilum occurs. This is just a special name for the little area where structures after and leave the long So your bronch your me and bronchias. You're here on your pulmonary arteries. Ah, together on their own together and something called the long route, which is just a collective name for all the structures running into the lung. The beast of the long run is just formed by the diaphragmatic surface on address. Does it say it on the dome with the dye from wasn't Conchita because it's obviously be impressed upon by the diet from on each side. This a concubine, He is deeper in the right lung because it as you'll see him that these later actually is, and you might already know the right hemidiaphragm sets up slightly higher than the left because of the presence of the liver. Right below job seeds, the largest internal organ that's gonna press up onto the right honey die from, whereas in the left side there isn't so much at better up down, a little bit surreal pressing on it, and the cost of service is smooth and come back. So it's just the curved area feast on the actual chest wall. Let's just separate a Band Bay and from the ribs by the pleura, which is just that membranous covering ah, almost like a bag that pulls the lungs and on the mediastinal surface. Then you also get impressions. He's actually are invisible and actual Evin people. But you'll see them on cadavers because of the involvement process. So you might get images of, you know, counter kind of our exaction be asked the label. So on the left lung thing always think arteries. So RJ, order thoracic aorta Simply be an artery natural heart except itself little making pressure on the right. Think V in So you're spc I D. C and yours Agosti and on each side. And then I'll see the heart itself gets because they're sort of central. Uh, well, sort of Give impressions and both sides. The degree, man, Just quickly the borders, your your aunt ear, ear posterior and then the inferior, which sets on the diet from. So that's your mediastinal service a year. The costal service will be around the back, that curved part, and then your diaphragmatic service. Um, as I said in the lung roots are just the collection structures that enter and leave the long at the HILUM and actually help suspend the long from the mediastinum, which contains a Broncos pulmonary artery to pulmonary vanspor, long on any bronchial arteries and beings. So the pulmonary arteries and viens air there to actually help along do its job, which is the oxygen it blood for the body. Where is the problem? Gill? Bronchial arteries are there to supply the lung tissue itself. So it seemed way like a renal artery will play the kidney provided with oxygen and nutrition, the bronchial arteries air keeping that long going so we can do its job, a oxygen in the blood coming in and the pulmonary vessels. And then you obviously have nerves and lymphatics like any organ. So the high Lama said that it's just that way. She had diarrhea, as you see in this image here where these structures under and leaves alone lung itself. And then this is just a bit more what? I was talking about it so we can get a bit confusing because it's a little blood supply. Dorgan, you have your pulmonary arteries, which are there almost like an assembly line bringing the blood ends. What could be option? It'd so it could be brought back in the pulmonary bands of the heart pump, trying the body. But like any tissue, the bronch a yearlong roots your visual pleura on any of the sort of connective tissue in the lung are going to need nutrition themselves. I won't. They won't just get from the pulmonary arteries. They need their own special to play, which is the bronchial arteries. The left alone gets to bronchial arteries. The right gets one. The left bronchial arteries come off of just the thoracic aorta. Where is the right comes off of one of your intercostal order is usually the third one. And then the bronchial viens and just dream the, um loans and they'll drain and euros. Agassi be in on the right, and you're how many's Agosti And on the left, which a Landry and into the Zags be in on end of the superior vena Cheever nerves and then vice I your state. I don't think you go into too much detail is really necessary. You just know that for each lung, there's something called a pulmonary taxes, which is made up of fibers from your vagus nerve on that side on your sympathetic trunk. Sympathetic trunk obviously gives the sympathetic fibers about your fight or flight response. Well, sort of widen your are ways, learning you to breathe more. So if you're Roman and she Espace, some things were anything like that there. Where is your parson? Big part Sympathetic intervention comes from the vagus nerve, so that's sort of contracts your smooth muscle, those bronchial muscles that would start him on asthma. But in this case, the control. And are they contract in a controlled manner to sort of thin the are ways. I don't think the Lumen I on then causes Visa dietician that of blood vessels around them. A swell then at. Like any organ, you also get your pee in impulses and not coming by the vagus nerve as well. Don't worry too much with the lymphatic supply. If you've got time, you could learn it. But it's not really something that I'll ask you in first year. Pulmonary embolism, then, is the next sort of clinical application to do with the blood supply the lung so P is any obstruction of a pulmonary artery by substances travels from somewhere else in the body. So the most common side thrombosis, which the blood clot that's responsible for most cases I would usually arises and distant being. So your DVT, or defeat and thrombosis is work. Flatter a form and one of your lower limbs and one of the deep fiends are, and then that could bring a piece of a clock and break off. Follow the venous system back up into the heart, not blood thinning in the heart, because the opens a quite way there. But once it hits one of the pulmonary arteries, it will call it a large there and cause produce profusion the end of the loan. So that's common for overweight people, people who are a move island hospital. For a long time, you know to get our amylase are so like following channel a shin were fought following a broken bone fracture. Say after doing CPR, not reduces, obviously loan profusion on. Was I going into too much detail? And because you really don't do this much more until third year, you'll need to treat around equalization usually. So that's the break up that club we were talking about. The blood test. You do something called a d dimer usually, which is just the breakdown product of clot formation. So if you have high levels that, you know, clots have been formed, broken dine, so it's more than likely it's wrong. Political nature die from that ends just your muscular sheet that sits in between the water acts in the optimum in your means sort of muscle of respiration. Um, but it also acts as a pathway for vessels that move from the thorax, the abdomen. So ah, you have your three openings. Really? The cavalry. It is soft geo hiatus. And they were like this a couple how it is in the, um suggest for the IV. See on the right. Phrenic nerve. You saw the jail. Hey, this is obviously for this offer. Guess the right and left vagus nerves on the esophageal branches of the left gastric artery. Then your aortic I. It is for the aorta. Thoracic doctors, Agassi and you probably heard this already, but there's a quick mama minimal nick, for it's actually memorizing the levels and which each of these opens are so ti it. There's ladders and vennochi ever. It's opening. It's a ti it soft. Guess is tan. It's opens a t 10 aortic a year. This is 12, and it's a T 12 again. The diet from perceived innervation from the phrenic nerve so fibers from C three, C four and FIFA see favor interviewed. It's Who Seat 345 keeps the diaphragm. Aleve is the way I remember, and that each half a diaphragm gets its own innervation solution. Phrenic nerve on each side. So if one's parlays, the other half of the diet from still move. Um, that's really all you need to know about the diaphragm, but you're ST age. I wouldn't worry too much about blood supply at this point, was was saying then of ah, fracture of dominance, whether it's through surgery or any, uh, trauma or any other means you'll get part oscal movements so that the diet from usually will move dying when you breathe in and revoked when you breathe out. But when you have a paralyzed down from having died from that isn't moving, you breathe in and the lungs expand the other half the diaphragm will move down and increased pressure in the abdomen. No force the power lies time he die from rather than darn. Then when you breathe back out, negative pressure, then it's actually we push the diet from the hum, he die from back during them. There's a few more slides here just about covering things in the mediastinum, which was already talked about the last anonymous vision. Right, So we're just gonna have a read it damage your own pain when they're sound. Don't. Um, But other than that, then James just left a couple of quick questions. Do you have chest X rays? So this office is in the chest, actually revision night, So we're not gonna go through it and d t o. But the main things to look out for is your M B c D. That you'll do and see. Second that you'll have to do in your old ski so way. Looking for a way is a deviated is constricted. Be breathing. Looking at the loans. Is there any obvious problems in the lung? But the both symmetrical. Are you missing any of those? We long feels a little white areas. See for cardiac for your heart than is it enlarged? Is it taking up more than half of the thorax? Can you see the borders? Clearly, I should mention is well, be a swell just looking at the hail as well. Well, there's any enlargement there. Do you then for diet from can you see the angles of the diaphragm? Okay, Is there fluid collar and darn here? Ah, And then we weren't taught a b c d to ease of those two days of the others disabilities or any broken bones, Fractured clavicle, broken ribs. Normally, if you follow the ribcage, dine should be smooth. There's a little step that can apply a broken rib there, that lab, um and then ease for extra equipment. So, looking for any sternal wires, any tubes going in on any chest leaves around. Hang that about So then there's a few slaves as Well, just they down to find the pathology will not run through the mall in detail. No, but when the slaves air sound out, the answers will be right there in the notes on each of the slides here. And you could do them on your own time then. So that is me Apostle. And then the Magan for the next person was great. Thanks. Aren't so then next week or we have a a rash like that and I think she is talking about the bones in the arm. No, she might not be here yet. You might have the skipper and go back. Um, I think she may be a spot. We can move on to the next person anyway. Right? Um, the next person and is caller. And he's been talking about this shoulder joint. Yeah, corner you have, Do you get? Um so we're just gonna go over? The muscles are right in the shoulder joint. The ones that are attached on just got rid of the humerus on to do with the shoulder movement. So here the basic living objectives that we're gonna be covering eso start off. We're just gonna talk about it on the pectoralis major muscle. Uh, you can see here it's got two different heads. So the origin off the clavicular head or the one that is most appear is from the anterior surface of the media. Half the clavicle on the sternal or the start of costal head is from the anterior surface of the sternum on Disappear six cost the car seat, but just it also has a connection to the, um, external oblique print. It looks just die near the Optima that these both insert in the same level over the lateral hip of the particular Celtics of the humerus on these air, innovated both by the lateral and medial collateral nerves. Now, the function off the pectoralis major muscle is to abduct the arm on to mid medially. Pretty It, um it also draws the scapula. Um, that is you just pushed. There aren't here under here and there on the club. Regular here is the one that that is involved in deflection off the upper. Um, no. Moving on to the a factor as my not it's not a sub carrier muscles. So the girls minor muscle. It originates from the anterior surface off the 3rd 4th and 5th ribs on it is inserted in the medial border of the superior surface of the corporate process of this. Now it is innervated by the medial picked. Wrong, uh, the lateral will bypass it terribly. I'm just innervates the, um, girls, major. Now, this one shouldn't is to stabilize the scapula by drawing it, um, entirely on. And I'm teary really towards the thoracic wall. Um, on number on to the psoriasis. Anterior muscle. The origin is the external surface is off the lateral. First to get ribs. Um, it's insertion is on the anterior surface of the media border of this cocktail. It is innervated by the long thoracic nerve on its function is to contract a scalpel on hold it tight towards the rast warm and also ts to scapula. Now, this is also called the boxes muscle Dutilleux and full extension of the arm. In throwing a straight punch, Discover never needs to move or protracted. So the Rituxan theory is the one that gives up the movement. So about a clinical context. If there is damage to the long thoracic nerve that they really do, um, process off the Stratus anterior. Um, so This will be Teo the Patrician off the scapular. So you can see here on the right. Deficits the patricians. Governor on the left. That's normal. Stop it. Giving the wings stop your appearance. That's concurrently be done in like high trauma injuries and the moving onto the deltoid muscle eso the deltoid is has its origin on the lateral third of the car as well as the Crimean and smiling scapula. Ah, the insertion point of this is the death for tremor oxydi on the lateral aspect off the humeral shaft. It is innovative by the Examiner. Um Now the function depends on which of the different heads so different has a strong here. So the clavicular part of the anterior head will flex immediately. Repeat the arm at the middle or the chromium part will, uh, duct the arm. But I will take over from the supraspinatus muscle after 15 degrees off abduction on the spinal spark which will expand and lateral, uh, continuing with the craziest leftism store. Say the wrong boy. Major minor on better scapula muscles. Eso The trapezius muscle itself has quite a wide abroad Origin eso it is from the media third of the superior natural line off the occipital bone. A. Z well as the example step. It'll prominence of what your parents at the natural ligament, which is what a continuation of one of the ligaments off the spine, up towards the little bone on the spinal. Processes off C 7 to 12 and the and inserts and the lateral third with clavicle as well as they grow in process on the spine that scapula on it is innervated by the spinal accessory nerve or the cranial nerve. 11. Now the function depends on different parts, so the the sending a fibrous parts are the anterior part. I will elevate the scapula. Uh, the A sending part, or the one that's most inferior will depress the scapula on the middle part will attract the scapula towards the thoracic cage. The A sending the send it back together to, um, look at the liver and company superior early when, uh, abduction is greater than 35 degrees. I believe on that the tissues door say muscle. So again, it's got a quite a broad origin point as well. So it's from the spine. Spox s is off. T 62 t 12 as well as the lumber fascia on the back, on the crest of the pew Boom. Um, Andi, Uh, the inferior 3 to 4 ribs. Now the insertion point is the floor of the interview. Regular self, Get something, Onda. It is innovated behind the threshold. Or so now it's function is that will extend on add stuff, swells! Media hit you up for them. Um, Andi, In times of climate, it will raise the body towards the arms night. A way to remember it's insertion is the leading between two majors. So you been seeing the floor? Um, from the hour. This is the floor of the interview. Particular silk. Us, um on you can see here, the dismiss door say is, um, insurgent Between the insertion points off the pectoralis major and Terry's major muscles. So it is a lady between two measures the wrong boy major and know by minor muscle. So starting with the major and this muscle, or originates from the Spanish processors off a tea tree, tea five on will insert in the medial part of the scapula on it will be more on fear than the one book Minor. Awesome. Be a lot sicker. So the minor originates higher up from the spinal processes off C seven t one as well as the ligament as well. I will insert in the smooth triangle area on the medial and stuff. So they're both innovated, uh, by the door. So stop your nerve. And they both have the same function to attract the Skokie. Uh, we'll hit the bladder cavity in fear. Really? Um, as well as defects. This car, your scapula to the thoracic wall. So the libido is computer, which is just superior to you. The room boys. Um, it's origin point Is the post here? Typical off the transfers processes of the C one to see for better. Right, um, on it will insert on the media border off the scapula. Uh, just appear to the start of the spine. Now it's got jewel interventions, and it generated by both the doctor stepping on C three c four a cervical nerves, um, on dysfunction is to elevate the scapula as well as to repeat that you haven't traveled e inferior. Really? That's, um so the rotator cuff muscles, starting with the super spinning, it's muscle. So it's origin is too super spinous sponsor on the posterior aspect of the scapular. Um, and even start the superior facet off the credit. Typical on it's innovation. Is this a prescription for nerve? So X function is to the doctor The I'm up to 15 degrees after that. It helps with the deltoid abduction and the interest in in this muscle. So it is originating from the infraspinous faucet on the posterior aspect of this Back to that, um, it inserts in the middle of 57 to trickle of humorous. Um, it is also supplied by the scapula. Um, on its function is total. Actually, with it, the arm. So Terry's minor. So it is originating. Just, um, I feel really to the ever spending this muscle on the medial part of the lateral border of the scapula. Uh um, its insertion is on the inferior facet. It's a great trip, and it is interviewed by the exhilarating earth that will run three the um, or drying to the space for the prepectoral faxes that we discussed now on its function is also to, uh, lottery ticket the arm. So the subscapularis is different from the other three do, too. It's a origin point being on the anterior aspect off the scapular being on the subscapular Foster on it will answer from the last trip a room where the other three are old and inserted into the greater triple. It's intervention is the upper and the worst substance you know, nerves on its function is to immediately would get the arm, uh, theater cuff muscles there or the sitz muscles. So the super Spinatus infraspinatus Terry's minor on the subscapularis will all hold the humeral head inside that I'm a cabinet to the right, um, movement of the arms. Uh, Terry's major muscle man. Um, still, Terry's major is originating from the post, their surface of the inferior on girls scapular uh, just inferior to, um the spine is muscle is well on. It will uncertainty the media lip of theater tripper Marisol just of the givers as to make up the lady between the two majors. Um uh, So peck, Major Terry's measure will go on either side off the insertion point over the Christmas door. So, muscle, I mean it is innervated by the lower scope you letter subset, there's no sir on its function is to add duct on medically with hit the arm. So just a few short questions here on just MCQ questions. And if anyone like the shot up? Yeah, it is, um, day long, thoracic nerve on. Then what muscle would be affected with? This is the case. Yeah, you go on. Finally. Last question. What muscle attaches to the media lip of the tuberculosis office of Humor of it. There's major there on. So that is the end of this. I would leave off. Um, you're going to the next thanks corner. And soon I we're gonna make on Teo the arm and four are on. Um hum, it's been attacks with that. Yeah. Uh, guys. Um so let's get this up on my foot. Er cool. Uh, can you see my partner and everything? Usually? Yep, Yes. Just, uh, get some will go through the anatomy off the arm and forearm s. So that's your dining outcomes. If you want to talk about the until your apartment of the arm, close your department of the arm scratch to keep it off. Also, one reason contents and go through the compartments before and apply a bit off the anatomy we learned to clinical case is s before we move on, I want to just clarify a couple of times so and not me what we refer to arm. We just mean from the shoulder to the elbow joint, Um, and then forearm reverse osteo would want to restaurant, and the whole thing is referred to us that so some I think that you know, our Ms just the whole thing. It's just from the shoulder to the elbow. Um, muscles are going to act on all the joints. First cross. And so I mean, joints were going to talk about it on a shoulder joint. Albert joint restraint cover metacarpal joints. Here. You got your metacarpal phalangeal trip here, and then your two inter phalangeal joints Don't remember it in your thumb because you only have to fill Auntie's. You have only one into financial drink. And so if the muscle cross is, for example, the corporate medical for joint on the medical profile and joint some of effect. But this is so keep that in mind. When we talk about muscles eso forceful in the arm, you have to, uh, compartments. You have the anterior compartment on the posterior compartment, so the interiors, like your flexors and then your post. Here's some of the your sensors. So here's your anterior compartment. So first of all, we look at the bus. That's pretty good. So the biceps a great guy has to heads has a long hand in the short head. The short hand comes from the court. Quick process on. Then the long head comes from the super better to people on scapular on it can take. Its tendon goes through the shoulder joint runs through the winter tuberculosis office or bicipital roof underneath. This transfers from a ligament on. Then fuse is with this. Your head they both insert. Find bicipital tendonitis on to the radiology Brasi Eso the way to differentiate these two, for example, the cadaver. It's just remember that long l is lateral l again, Just remember the l's. Also, I always think about it like the long head is kind of hard to treat it because it looks smaller, unless it's because most of its tendon this head in within the shoulder joint. Um, another thing is well, so as the, um, uh, tendon inserts into the real irritable see it yourself this bicipital up in your OSIs, which forms is kind of this protective covering over these major vessels or nerves, which we'll talk about on also kind of holds the household that the only place where your biceps supinate, which is one of the functions of the biceps. It Simponi PSA for, um, do this attachment on to the religious, and you can see it's crossing the elbow joint. So seeing with the flex, the other on Also it's crosses the shoulder joints to see more across to seriously with the flag. Social drugs are the other two muscles of the anterior compartment. You have the Carac a brick Ellis. So Crocker Brachialis, you're gonna find out something medium to the biceps, great guy again originating on the court court process on inserting onto the interior, humorous on it's quite easy and then find because the bus you cutaneous nerve, it pierces directly through the crack of Brachialis Thea. Other muscle is gonna be fine, just deep to the biceps. For a guy more distant. Reaching this still on the anterior humorous on the bulge is a bit large, really, it inserts on to the owner Cipro C, so the carotid brachialis because it's only crossing the shoulder joint. It can only do shoulder flexion on also because it's fibers kind of go obliquely. You can also do his shoulder at ductions a deduction brachialis only crosses the elbow joint so it can only do elbow flexion. Uh, this week, able just summarizing what I said, Uh, main thing here is note the innovation. The anterior compartment of the arm is innovated by the mostly Catania serve except breaking Alice has been innovation from the from the radial nerve. So, for example, if you get a, uh, nerve injury of the most retain ius nerve, um, you might have still a week of elbow flexion left because the brachialis is, uh, being in a bit of a radial nerve. Just remove it. Eso the clinical anomie. You have some bicipital tendonitis shoes. So this community proximal So this is where the long head off the biceps tendon cares off the super better to go on. The reason why that happens is because I'm off movement off the shoulder. The tendon in here in this bicipital groove can't get undergo a lot of friction. A lot of wear tear on. Then that information begins the pendant over tired, particularly older people. This can cause a rupture, and they present with something called pop like deformity. That's basically where the biceps muscle just Bunches in the middle of the humerus when you're flexing the elbow on, Um, it kind of looks like the cartoon character called Byetta and the metformin. A distant rupture is less common occurs due to excess for the central load. So what that means essentially, for example, if you're lifting a heavy object like, for example, someone's doing it dead lift on the have one of the arms supinated like this. The biceps is going to be stretched, but the same time the biceps go contracting to maintain its legs. I'm not forced can cause a rupture of the tendon. It's the weight is have enough so this would be diagnosed using a test. So in a slightly flexed out boats, you can took your finger underneath the biceps tendon. Uh, but it's tough. Tenderness ruptured off. There's nothing to pick under. So if this still tendon, but you should be really touched surgically proximal tendon rupture. Unless they're young, I think you're going to buy aesthetic function. You wouldn't go into the shoulder joint to readjust the tendon. You do. She just put it back on to the humerus. Or just leave it because you have other shoulder flexures to do the more for you moving on to the posterior apartment in the arm. You have two muscles, you have triceps, and you have antonius. So triceps try three s a street headed. Um, you have the long head, which, um, is coming from the infergen end of June Pickle. Um, it's, um eso it's crossing the shoulder joint with people, but you should be a shorter extension. You have the lateral head, so the lateral hair comes off the humerus on. What you should know is that the lateral head originates above where the really on there ever be. So above the spiral groove inspired roof is when the reading on that runs on down. The medial head of the triceps is gonna be originating on the humerus below the spiral group below the regular. So you see, this is the media head on. This new muscle fibers are above the really a nerve. Eastery heads for one tendon. In starting on, electron was that big only prominence. So it it does elbow extension I'm curious as well. Small we muscle assistant Reflection also prevents impingement of the Albu actually, the joint capsule and Philip section. So it kind of place is more of a supportive role again, That's another table summarizing what I said. No, the innovation, the Pristiq form of the arm is done. So anybody radial nerve. So over time, by about the cubital fossa, Why, it's important. Clinically, some cubital fall, so this means kind of fall. So in the elbow on the anterior surface off the albuterol, um, has somebody freeze which form a triangle? So the superior boundary is It's the monetary line between the epicondyles of the humerus. The lateral Bondra is formed by your recurrent Alice. Uh, media barn DRI is formed by your protein to Terry's. These two muscles, we're going to see what we talked about the forearm in a couple seconds. Onda the superior, this approximately the floor would be formed by brachialis, and in distantly, the floor is is for my super super nature muscle. And then the roof is just for him by the bicipital Up in your OSIs skating on fascia. Eso The contents of this you drove also is your bicipital tendonitis. Uh, break your artery and then median nerve on the way. You learn the relationships is gone. So from lateral to medial, you have the attending our tree nerves. Remember, Tom, if you feel in your own elbow, you feel your biceps tendon. If you're just medial to your be able to feel the break it artery and just medial lots of your median nerve. So it's important to know this well, you have your overlying this fall. So you have your meeting. Keep your beard on. That's a venous commonly used for being a puncture. So if you put in and prodding arrived within the needle, you're gonna wanna know where the meter structures are. So you don't want to know that the breaker artery and median nerve er media are medial to the Yes, a little tendon on also, because you have bicipital up in your OSIs covering this major structures. And usually if you're putting in the note to that by step it up a neuroses, you're failed lot of resistance. So when you start feeling of resistance, you should know that I've gone to deep deeper than this. I'm gonna hit some major structures. So I'm moving on to the four. Are you gonna have five compartments? Three anterior into post here. Uh, there's, like a million muscles in the forearm. So I'm not going to go through the origin specific origin and insertion is off. All of them. They some of them do share origin a shin points, which I'll mention. I was going to talk about where, What most small compartment they are for you, then find most is, um, their basic functions. Uh, so the first one's gonna be your superficial onto your compartment. Eso has four muscles, has pretty a terry's, which permeates the for your gonna have to palmaris longest, which helps, um, Flexeril on. Also, it inserts in fashion in the pounds, so it helps tense the fascia in Iran. Um, and then you have flexor carpi. Radialis affects your final Norris. When these two work together, they help the flexor issues. But when the really Alice works alone, it will pull your heart towards the radius. That's called abduction. A reduction or radio deviation. If the ulnar socks a low, it will abduct the hand or only deviate the hand. But then, when they work together they pulled the wrist on was about a good way to remember. These is if you put your thumb on the medial epicondyle. So all these muscles are originating from the medial epicondyle. Oh, that's called your common flexor origin on your first finger. You could first finger across here for unless your Prolia Terry's second finger across the forearm that's where your flexor carpi already else will be. Third finger is where your gallbladder is long. This will be the fourth finger is where your sex or propranolol would be. All these muscles except for the Effexor. Corporal Norris is innervated by the median nerve. Uh, the ulnar is's anything about the older nerve. Just remember all our older So this is that a good opportunity? Here's your media at the condyle called Effexor gyn First Muslim for me to Terry's second also is your flexor carpi radialis going towards the thumb? Uh, how long? This is the one in the middle of a strict on the middle. And then I lost one. Is your fax a copy of our on your pinky side on? Then you have your intermediate and deep compartment. So the intermediate compartment only counsel one. Um, muscle relaxer, Flexeril issue or superficial is no. I've rented Why I mentioned here. Is it Flex is up to the proximal i p drug, so it inserts onto the middle. Filante is so you see, it's spinning there on why I said up to you because I mentioned earlier muscles act on all the dress across across it is able to flex all the all the drugs previously is all, um And then you have to deep group, which has three muscles. Eso if you reflect your Flexil digitorum superficialis which is this big wise, mostly belly here you reflect thought you gonna find your flex a digital profound, this profound. This is means deep. You're flaccid is tore muscles. They're easily identified because they split off into into multiple tendons on. Then on the radio side, off accident stopped funding. You know, have your flexor pollicis longus which goes it, take you for some. And then when you take away these two muscles and go even deeper, the deepest muscle is your prune apricot. It's which is just, um, square shaped muscle bridging the radius in the on left or not those pronation before less so the way I kind of learned These is matching. You're gonna make a fist. So the first movement you'll do is kind of flexing that middle into fly into your joint on your side. A proximal inter phalangeal joint. That's your flex. Your digital specialist in that movement cannot flex a distal I PGE one. So the flexor did it. Or before this band works, Teo flexes this type of drug. And then to complete the face I need to bring in my son. That's the flexor pollicis longest, and then two pumps someone I need to prove it. My form. So that's pretty pretty obvious. So those four muscles going to help you make 50 and that's why I looked it, Um, and then all of these again are done by the media nerve except for the medial half off Effexor. Fax it itched or refund this specifically, the one's going to the 4th and 5th digits again. This is an adult over, so flexes it Storms officials has been reflected. Here's your refund. This spinoff of the multiple tendons there is your flexor pollicis longest on your on your radius. Go towards your thumb and then belief that is gonna be your chronic arthritis. And then you have your prostate department, which spend too Booster compartment is known kind more extensive. Department across the anterior is your flexors. But there's one expect exception to this or that drinker. Really? Ellis is fund in the posterior compartment of the form, but it is a flexor. Particularly good in pronation. So this is this position on your feel it if brachioradialis, I think told you most so many tests before are, um you have to corporate radios, muscles in the push your department extensive car property else along this and brothers um uh, these, like in the flexor is so when working alone, they will radially d v it. But I'm working together with extensive Corporal Norris will extend the wrist on Do have extensive digitorum and extensive the demon. To me, excessive digitorum goes all is able to extend all the way up to the dislike each joint on same with the digital mean to me. But just off the pinky finger, digital media means usually quite closely. So is here with extensive storms is slightly separate. So that your pinky finger How's it been? More maneuverable, maneuverable, itty you can move it alone and compared to the other fingers on, then you have access for carpal Norris, which acting alone will only really deviate acting with the copper videos with just risk stand, uh, brachioradialis on extensive carpal videos. Longest kind of get confusing in the cadaver. Just remember that brachioradialis is more on tier e er, um forms and lots of border off that cubital fossa. Um, slightly more above on old the muscles in the posterior compartment, Ardian or dump I radial nerve. So this is more a specimen plus the specimen. So here's your breakthrough videos. Let's see. All right, it's above a bit more on TV here to your extensors carp, I realize longest below it just there's extensive car radios private from the lateral epicondyle. Oh, which is your nose? Your common extensive or origin sensor, dissed or censor? Did it, um, enemy on extensive crop? I'll Maris also come from the lots of a condom on here. You just kind of see some your deep posterior compartment muscles Notice that like dropping muscles because they literally cramps, like from beneath the superficial muscles, which we're talking about. See how your deep department see how super meter, um, super nadir is the tree US name, says Supinate form. It's really easy to find because it comes with a lot of conduct and that you wraps around the radius you have. And then you have those four dropping muscles, which I mentioned. You have three policies, muscles and one indices muscle, so three muscles go into the some one going to the index finger, um, on then, so that's them here. So if you take away your sensor digitorum and your superficial post your muscles because he supernuclear on an abductor, pulses longest. Ah, excess repulsive brevis on longest. The way that's probably easiest to identify them is knowing way that where they go so extensive pulses long. This goes to the distal feelings, extensive pulses. Privacy goes to the proximal feelings, and the abductor pulses long. This goes the first metacarpal, so when you know where they go, you to follow the tendons back on, then find each muscle specifically. Another way to Tonto by them is extensive pulses brevis. It's some which between the other proposals longest on extensive pulses, longest and then extensive and desist. This is going to the index finger sticks be able to extend the second digit again. All these muscles are gonna be innovative by the radial nerve on news three policies muscles form the boundaries of the anatomical stuff Box eso again. This is an easy way to help you identify deuce muscles so it has to borders the anatomical stuff box. You have your video on your natural. No signs of it. Weird, because once a about once below. But remember everything in the not amused on topical position on this top side is slightly more video in this bottom side and why it's medium large. So the media was done by extensors policies longest. It's going all the way up here to the tip of your thumb. You know, your extensive, repulsive brevis which goes to the proximal feelings. And then you have your sensor Close it up, doctor pulses longest, which goes to your first metacarpal. Um, and if you follow these tendons back, you're gonna be able to find the muscles. Uh, this snuffbox is clinically important as well, because it contains a radio artery and also the skin foot boat. So if you press inside, the problem is stuff I want to be able to press all to the skin for bone on. You can use that The test for tenderness in a suspect to skip for fracture, a couple of absence uses to finish off six year old man presents the E. D for some onset shoulder appeared, which developed while he was lifting boxes to clear eyes. Carriage Nasoflex is Alba. Visible. Deformity can be observed in which the biceps Rick, I must little Bunches in the middle of the arm. There's no hospital history about the block. What tendon is most likely to be ruptured? I've been in show You like whatever. You're no long asleep. It's It's be, uh, biceps Long has that says for it. But, um, yes, I must be nice. Um, yeah. So that's your Publix deformity. Um, so and the long head is same rupture from Super Manager. Go on And last one fourth year medical student. Junior doctors ask you to take blood from patient. You decide to take blood from the veins, overlying issue before stuff which muscle forms of media border of this fall. So, yeah, it's a pretty, uh, Terry's. So remember here the media borders for the entire ease the borders, your brachioradialis this year to muscles that, uh, that is the end of my talk. We'll begin bore you all too much on, uh, thank you for this thing. I will come back over to the scrubs, people. Thanks very much for Hamad. And so, you know, I was just gonna move on, Tomo. And she's going to tell us a bit about the anatomy of the harm. Yeah. Okay, so in terms of the hunt here, you're done, it comes on down. They you have to eminences. So you have You're thinner. Evidence is which is not big spongy. Um, but on your palms surface of your hand, and then you have your high protein, our our moments, which is on the little finger side of your homes. Um, you're thinner. Evidence is made up of three muscles. So you have your opponent's policies. You're a doctor. Policies brevis on your flexor pollicis bravas. Um, the abductor policies bravas and the flexor pollicis brought us both originate from the flexor retinaculum, which is this. But let me see if I can show you, which is this bit here, um, on the opponent's policies. Brad, this originates from the metatarsal. So if you fail in your hand, you can figure Ah, bone right there. Um, I'm not sure. Metatarsal, um, are your metacarpal sorry? Um so it originates from there, so it doesn't actually originate from the flexor at knocking. Um, like the other two, Um, the opponent's If you think of trying to make an o with your little finger on your thumb, that's how I kind of think of it. So it, like, makes that oh shit on. So that's why it's opponents. So both the opponent's policies on Theopylline instead steam enemy they both act in Ah, an opponent's is, let me call it, which is just making that little shape with your no finger and thumb. The abductor of see brings the thumb through the hand on the flexor. And they said, if you think that the thumb has, ah digit turned 90 degrees So that's kind of if you flex your thumb, it's like doing that like that kind of helped me because it was a bit confusing reflection off the thumb. Um, and then in your Hypothenar Eminence, you have your flexor digitally. Many me bravas on your abductor digiti many be breakfast or you're just your doctor. Continue Minniti on they both original again from the flexor retinaculum. Um, event your number. Girls are, um, quite a complicated muscle just because they flex at the metacarpal carpal financial joints. So these your metacarpals easier following says so they they flex there because they're touching to, um they're going to come from the metatarsal, and they're going rhymes. So they're going moving from the Palmer aspect to the dorsal aspect of behind to attach to the extent, sir, Hoods. So when their contracts, um, they're bending here, but they're extending here. They're touching to that extent, sir hood, which is pulling and your other AM interval in jail joints in extension, so it can be quite hard to wrap your head around that you have. So you see your you're too lateral ones are bipennate, which just means that they have to. Bally's under two media ones are unique in it. So they have one valley, um, and then the other muscles of the hand. So we have the plumbers brevis, um, which is just a very superficial muscle, um, subcutaneous, um, in the high protein or eminence. And then we have the A doctor pollicis, which has two heads. The one head originates from the third metacarpal on the other. From the 2nd and 3rd metacarpal along with the cap. It'd I'm not just inserts that the base of the proximal followings of the thumb on its I'm gonna adopt some, then with our interruption muscles that we have pot and job, so pot. So you're adopting the fingers. You're bringing them together. You only have three. So hot stalk, just it's three on the pay for, um, the door. So you've got three on the palmar aspect of the hunt bringing the fingers together to your your middle finger. So there is no attachment onto your middle finger on your polymer. Uh, spect but on the dorsal aspect of your hand I pod on dob, so the fingers are moving away from each other. So, um, it doesn't touch the middle finger. You can see there, and you can also see in that picture that they did. Dorsal ones are Bipin it again to muscle bellies on the palm er ones. Or you need pennant. They're innervation. So unlike the forearm, the forearm was mostly innervated by medium except for the two muscles innovated by owner here. Everything's interviewed by owner except for one half off loaf. So the one half is the half of your lumber girls. So if we go back here to remember girls there so apart, your your median lumbrical, um are innovative by older eso That's technically these because of think behind and, um, on atomical position. This is the median us, but so these two are interviewed by older on these two are innovative by and medium Oh, so one half of lumbrical then we also have opponents policies, abductor policies, gravis in flexor policies gravis So they're old interview did buy the median nerve. Everything else in the hand is innervated by owner. So that's just an easy way to remember that in terms of your carpal tunnel, this side over here is your thumb. This side is your little finger. So, um, you can then work our so you have your trapezium. Trapezium is the side your thumb because the kind of rhyme So that's how you remember that's that's trapezium your skin void your carpet it and then your PC form in your home it and you can feed your home. It has a hook on it that you can see there. And you can feel that hook. If you see it right there in your hand, you can feel that hooks sticking up on. So that's kind of where you know, worker, your carpal tunnel sets. It's just right along there. You have the deep, carpal arch, which is just this line here. And then we have the superficial flexor about knocking on which is the grief. Together these form a tunnel on inside the tunnel. We have, um, four tendons off flexor digitorum superficialis four tendons of flexor digitorum for fun. This we have flexor pollicis longest on. Most importantly, we have the median nerve. So median nerve. If we got compression in this area, um, it can cause carpal tunnel syndrome on date of the causes. A carpal tunnel syndrome on this concludes muscle wasting off the office area here. So around your eye thing remnants so and a demon is just swelling. So if you've swelling for whatever reason, and it can call's compression in that total, and diabetes is where you get flu gal's deposits on the tendons. So again, compressing not a tunnel idiopathic means unknown cause, um, actually, is where the growth hormone a sacrum, a magnet just means you got too much growth hormone on. That just happens because you've got salt and water retention. So if you're holding on to too much salt water, you're going to get again. A Dema compressing the nerve neoplasm is cancer cancer can. If it's rose big enough, it can compress most things. Um, trauma. If you injured area, you're going to cut off your median nerve rheumatoid arthritis because it causes and inflammation of the tendons. So if you get inflammation of the tendons and that areas become more compact, amyloidosis is where you get deposits of amyloid on the tendons as well, compressing them on pregnancy because you get a demo with pregnancy. So, um, median truck. That's just a need. The way to remember it causes If you want to know, the cause is off carpal tunnel syndrome. Then over here, this is important. They do like to ask about the kidneys. Innovation of the harmed. So I would think of it is if you draw, you hear everything that my finger touch is is made up of older. So this is old owner and half of this finger's owner on both sides. Then your median nerve is the M on plus the the neo bads up they they dorsum of the hands. Then that means the rest of the hounds the bucket behind just this portion is made up of a radio. Um, and that's really important if you want to try and diagnosed carpal tunnel syndrome because these people will have very clear borders to their, um, tingling and numbness in the hunt. So it'll very much be on these three fingers if you're getting beast this side of the hand of fact it it's generally not carpal tunnel syndrome. Um, then the course of the older nerve. So the older nerve comes from C A T one. It travels between the accelerator order Ambien. It then travels in the older tunnel, which is just here. So behind the medial malleolus. And, um, if you hit your older nerve, you told about hitting your funny bone. So if you hit your elbow funny, it sends tingling the whole way up your arm. If you actually think about it, it sends it right up. These this finger and half of this finger. Um, it's not a very pleasant feeling. Uh, then Pierce is that you had the flexor carpi little nurse on it branches in the Forum to give a muscular brunch a polymer Q. Genius on the dorsal future. Nous um, the muscular branches going to supply the muscles of the Honda on the Palmer. The muscles in the forearm on the palmar cutaneous endorse a few genus they're doing. They started harms on the side of the hunt. Then it travels superficial to the flexor out inoculum on that flat flats around in ocular is the roof off the carpal tunnel. So it travels superficial to that in what we call the older canal. Or it can also call The guy owns, come out. And then the Honda gives off superficial and deep branches on those superficial, indeed branches, air going to supply the intrinsic muscles of the heart, Which is those muscles that we were just talking about, which give buying control of the harmed. Um, again, this is just what I was talking about again. They do like you to know the specific intervention off the hound. Um, so the older nerve supplies Doctor Carr Bile. Nice half flexor digitorum fungus, so they're the two muscles in forearm on. Then it supplies intrinsic muscles of the hand, except for one half of loaf. Which is the more the muscles we just talked about on the sensation to hound. So specifically, these regions, you probably don't need to know that this fits done by polymer and the spits dorsal. But if you know what, great. So these are just a few and see Q questions. So if you can just typing what you think the answer is, I'll be great. So which one of the following fingers is not a point of attachment for the polymer and you're all shy, Remember three on the pee. So does anyone know which one? It's the middle finger, because pods see your, um adopting. So you're bringing everything towards the middle finger so you don't need attachment to the middle finger. And then this is about a 16 year old boys on a dip. But the cinema drug film he is, he moves his arm over his front seat. When the film ends, he finds he cannot move his wrists very well. On examination, he cannot extend his wrist on his anatomical Snuffbox has reduced sensation. Which nerve is damaged at the cinema. So, like Mohammed will send, the anatomical snuffbox is right here. So in terms of em sensation to the dorsal aspect of the hand. Which nerve is a factor and calcium the answers anyway, So I'm just move on. So it's the radio nurse. So again, Rio does here this part of these three fingers of the hum, except for the meal beds on older, does this finger and half of this singer the patients that stands damaged the median nerve during the carpal tunnel release Which of the following muscles will be effective? So it's the abductor policies. Purpose. Um, so it's just about No. One, which muscles are innovative by the median nerve on which of the following is not an intrinsic muscle of the hand. And that's Palmer's longest. And because we spoke about all the recipes that former Kalmar as long this doesn't originate in the hum, then this is a 38 year old woman with a personal history of diabetes. She has tingling in her thumb index finger and middle finger on her right on, she mentions she has difficulty gripping objects the GP performs in their production test, thinking it's carpal tunnel center, which nervous, mostly affected. I'm not the median nerve. That's May. Thanks for listening. So it's like e m EMR. So our last talk tonight is from fine on, and he's gonna tell us what? Nerves? No, I was going. Oh, does that never would see that. Okay. Yep, we can see it. And so tonight I'm gonna talk about, but the nerves, the upper limb saying Philly, some of this one already been covered in other people's talks and probably recap on some of it's been you on. Just a disclaimer of the slaves, the pictures and Slade's flowers. Nothing to do with the presentation. I just This topics very stressful for me. So I just like that coming in the background. So I guess you're wondering. So the three things I'm talking about this evening are the regular plexus. I'm I'm talking about the rich trunks, divisions, cords and branches and then really the cutaneous innervation of the upper limb. And then, um, we'll do some nerve anonymous. So I'm going to do four of the five nerves and accept the older nerve because emergency did that so good break a plexus and the the end of most first years existences. So I've tried to break it up into the five parts. I was going to 31 intern and hopefully be breaking it up. It should be a bit more straightforward. So when it comes to the roots of the record plexus they raised from the lower cervical and then the first thoracic spinal nerves. So C five and C six on you'll see that they joined together. See, seven is on its own on See It and tea one. I'm joined together and following that you get drunk and they're just named basically top middle bottoms. To see it here, middle and inferior, you'll see in a second from a moron atomical and picture that at this point in the shoulder, there kind of horizontal. And that's where they're not rainy, um, top, middle bottom and as opposed to the cords, which we'll talk about in a second. The divisions then. So you've got three until your divisions and three posterior divisions on, but I always find whenever I was trying to draw this, it was a bit messiest, like were are things going So if you remember that you could three posterior divisions and they all have to go to the past year according just kind of in the middle of the three. Then you'll know that there's 12 and three going towards the center can like an oral. You've got three anterior reasons to one of the top one of the bottom. And then you just have to remember that this little fellow goes to he goes from the middle trunk up operate. So that's why I always members with three going to the middle, one of the top one at the bottom, and then the sweets Allergist can it was up towards threat and then the cords. So you've got three. A lot of lateral posterior middle medial on. These are named in relation to the exhilarate artery. So this court with the lateral, the exhilarate artery, that's my posture. And that's some of the medial and then our five man branches. So the thing you always say to look for and exams on spot test, whatever it is, is look for the M. So you're literally say in the nerves this kind of letter m ship. Um and that's the three first run from talking about some Most lieutenants median on on Earth to these rays from the anterior divisions, and so they will supply deflectors off the arm. And so most aggravating want to turn apart from the older but the most of your Penis comedian or all of it. Fractures of the arm on the forearm and then the exhilarate and the radio. They come off the posterior cord so they will supply the posterior muscles, mainly the radio, so all the other. Hopefully, it's not quite as daunting A Z and myself. Okay, it's not quite as daunting as Maybe if you want a tax, we can see it all together, is kind of broken through and different stages, and but the enforcing the best way to care of a zit. In my experience and from talking with people, you just can't have to sit down and draw it a few times. But yeah, on, then, just for completion. I have included this slave, so this one just talked through. The smaller branches of Break Your plaques is, and they supply the skin of the arm, which just these two or muscles in the that corner talked about kind of run the shoulder region, select your Testim store, say and trapezius on much of pieces. All those runners interior it's after, I don't think in first year it's very important to know exactly where all these branches come off. But I just include it for anyone who cares. So not a moron. Atomical picture. Now it's back to front. From what I've just been talking about, that you came to see how whenever it's trunks, they're kind of horizontal. So that's why it's top middle bottom. But by the time it gets to chords that kind of bent around and they're going into the shoulder, I'm going to be going down into the arms. So that's why it's not. All men are posterior on medial, so they exaggerate. Arteries can be really just along here. Eso yeah, so continuous nerves are next. So when it comes to getting is innovation off the names, there's two inmates. Look another. We've got the peripheral nerves, which are like the actual nerve you're going to study the names off, and then you've got dermatomes, which are just you're kind of spinal cord, the spinal nerve levels. So to do the prefilled numbers first and cutaneous nerves integrate the skin That's a teenage just literally mean skin. So the other race directly from the break your plaques is understood those and be in immediate, like second these two years, the medial cutaneous nerve, the arm on the medial, kittenish in over the forearm. So that was the only two that are raised directly from the plaques is herself. Them. The other ones are all branches of our five million nerves, so exhilarating muscle achiness radio median on her, and this picture is kind of just talked about the five GM branches. So here is the exhilarate up at the top. The radio nerve pretty much does all of the back of the arm and hand and median nerve dollars, the lateral part of the hand on the owner of dollars, the medial part of the hunt on. And then that's just if we talk about the actual specific branches. So just a couple to note the lateral, cutaneous nerve of the forearm is just the direct continuation off the muscle achiness nerve. But it's hard with that. In a second, the superficial brown to the radio comes off the radio they passed your cutaneous nerve of the arm and forearm. Both come off the radio on the knee. Um, is of the branches for the main owner. I didn't put it in because I don't think it's really not necessary first year. So then the dermatomes. So I talked about Dermatomes in my last presentation of anyone can Remember. But essentially, a dermatome is an area of skin innervated by a single Spangenberg. So in was in the trunk. The last time was nothing, actually kind of going like these names for his uncle Bonds in the limbs. That's slightly way bit more annoying because our limbs or twisted and I think everyone would walk around in the hands and knees, whatever they would look right. But we're not doing that. So essentially the dermatomes twisted and but they still follow some kind of a sequence. So up in the very top you could see for a C. For these, I would say, are more kind of into the neck when it comes to examine in the upper limits. For that, neuro exams never really tested, so they're there. But don't worry about them. It can. It gets important when we started seeing five. So this is the front of the arm and this is the back of the arm. They pretty much up to see him. I'm going from lateral. You could see five and then following around all the way. If it see 678 and t ones, they can't grind in this kid next kind of a sequence, and they don't match up with the picture. We just hard for the cutaneous perform nerves, and that's because the drama Tums makes it much and suspect the favors. Maximus. When everything one of the plaques is that's where they don't match exactly. So sometimes, if you're testing like a spinal cord lesion or a stroke or something, you may say Yes, dermatomes. Do you want to see Where is the spinal cord damage? But if it's a neuropathy of, it's like you think the radial nerves injured, then you go for the distribution of the really owner of itself, so you can have to know when you're going to use which one. But for use, it's drama Tums. So what have just put in here is whenever you're doing a neuro exam with the upper levels for sensation. You have to test the sensation in every dermatol. So I find it's helpful if you just go around fax feigned five landmarks that you're gonna say it's the five dermatomes on. Just keep using. It wasn't every patient rather than having to think through that picture and go, Where am I gonna put this? But often will order It is so I just start off at the lateral side of the elbow. It's five still miss Sex, middle finger, seven baby fingers, it medial said it all goes to the one and that way I just keep going every single time. That was the five classes I go down and I don't have to think about it. Um, I know what their middle man. It just goes 56781. And but I don't have to worry about where abouts um my testing that the CT wonder if we just go for the elbow and just go there every time. Although I don't know if you actually don't listen. C section. But if you haven't come back to this one of the health, okay, so then individual nerve anatomy and so for nerves. I'm gonna talk a bit on some of the shoot. Sound familiar? Because I was listening to every ask this presentation and they mentioned it. So the exhilarate, first of all, and so for each moment of Canada, is the rich world goes on. What interview? It's so in some ways I'm in a terrible afraid. Slides. We'll show you that after, but just for the eggs or a nerve on gets no great factor devising like such a life. So the exam a nerve comes off the posterior cord. Here it's this orange 10. It'll orange one, and it is ritzy. Five. T sex, but not really relevant in first year on. Then it just literally lips around the back of the humerus. So it's a very, very short nerve and only innovates two structures, which are the deltoid muscle on the Terry's minor muscle. The deltoid muscle. You would have seen just kind of sets over here, say the nerve. Terry's Meinert comes up and then right in the back of the humerus, beside the nerves. That's where those two muscles are available. Exhilarate on the area of skin, innovative with the exhilarating. Is that what we call the regimental biology area. Soldiers must wear badges or something, you know. But it's essentially in this part of the shoulder. And just with the nervous was pretty straightforward. And the only other landmarks talk about is in the back of the humerus. She has a quadrangular XPS. So the examining are on the posterior circumplex humor artery of both and SPS. Well, not no much else to know. So it's just a summary writ. One of them what muscles that interviewed somewhat skin of the nerve. It so very comical stuff then and exhilarate nerve injury comes up well, a tickly, you know, commonly in a secure a spot test or whatever. Two men mechanisms either a I'll go back. But either I showed her a dislocation. So if you can imagine the shoulder was the part right here and get cold in this nerve, which is really just like a string around the humerus, we'll get pulled down. Or if he had a surgical neck fracture on the Neulasta is going okay with us theology in a minute. But the surgical neck is just here, so if you cut the bone of the bone gets fractured here, you might cut the nerve. So what will happen? You don't have deltoid and, you know, to Terry's minor tears Minor is a lot of rotator, but so is a little muscle em. You have one of the allergy or cough muscles, so where lateral rotation won't be that way it affected. But it's the deltoids, the main one. So basically you won't be able to follow up Doctor arm. You get the first Taney that 15 degrees or so from super Spinatus. But after that, basically the arm will just be stopped here, and you'll also the sensation over the regiment, the body area on over time, if it's not treated to get what we call it deltoid opera face. Oh Artifi just means the breakdown a tissue in the deltoid muscle. So in a normal deltoid, you got this nice, curved Ryan appearance. If it's ah trifida, it's kind of thin and wasted, so it's just on the note. Comes up sometimes and antiquey so muscle achiness then. And as Mohammad said, the mosque your routine is nerve interview. It's the three muscles on the anterior part of the arm. So what Worries member? The BBC So ridiculous. Biceps on crack a regular and was your three. Flex is the arms just like mostly get in. It's nerve onto your muscles. They are in flexion of the elbow That's pretty much for the doors and starts off from the lateral corner. Brachial plexus travels until early in the arm interview. It's those three muscles pierces cracker brachial s. And then, at the very end, it comes out from between biceps and Regulus on becomes the ladder, looking tennis, more of the forearm. So it interview. It's the skin, not outside of the forearm. So extends the elbow, are plaques is a level and then skin on the lateral side of the forearm. They inject, some raised in the three muscles. BBC on the skin, over the lateral forearm. So last few nerves are bit of a doozy. They're they're big, long nerves, like the older nerves, have quite a few things. They pass through. Go across under, essentially. So the radial nerve. First of all, I just think the real nervous basically just does everything on the back of the arm. On the forearm, John was doing the back of the arm travels down the back. The forearm does the muscles in the back of the arm does the muscles in the back of the forearm. That's sensitive job all the extent that they all do the extent of the wrist. And so but to talk about, it's specific, another May, so it comes off. The posterior record goes behind the spiral grave of the radial groove on which Mohammed mentioned earlier. Because your triceps are in certain originating around here and goes with the performed A Break a artery in what we call the triangular interval and which is something that they ask about becomes anterior elbow and then goes, especially the three branches to professional, which goes down the forearm on interview. It's the skin of the hand on the deep branch, which goes back into the posterior part of the forearm, and of it's all the muscles on the back of the forearm, a new and so Mohamed talked about your muscles earlier, so this might look a bit daunting. But if you know your muscles on the back of the arm, that's a sensible with the radial nerve does. So you've got your trace of spread okay and corneas. I've just put it in your never really going to see a, um, undergrad. It's just a muscle that doesn't do us. And it's just beside triceps. Brachialis, if you remember, Mohammad said that although great year less is mostly muscular, routine ius, it does get innovation from the radio on, then all the muscles in the back of four. And so that's essentially it. The skin. And so there was that posturing. Cutaneous front of the arm posterior continuous fronts, the forearm both radio the natural dorsal aspect of the hand. So if we go way back Okay. So, uh, this is the dorsal part of the homes. This is the lateral saved. There's your reading owner of those, the lateral dorsal part of the Honda excluding the Neil meds. And they're doing better median nerve. And I have a note document which is, you know, mentioned. The explanation for that is in the notes document. Not way out of it for a guard. Um yep. And then the heart reading or injury, then So the classic thing that you'll hear about it or see is a thing called restaurant. So essentially, if you remember, you're really unnerved. Does the extensors off the rest? So these muscles right here if they're parlays, was really owners injured. You can't extend the rest of Basically the rest just kind of hangs flop to people, will carry it around with them and could be injured. Any point threats course could be injured in the forearm by a radial fracture. Like a colleagues fracture could be injured at the elbow and buy a fracture. Dislocation could be injured and humorous by Humeral fracture panel. More days, certain muscles will be effective, but the further up it is, the more is affected. If it's very proximal and you can dump, it's the Detroit the triceps one works. You will be able to extend the Albu, but that has to be pretty much up in the armpit. So it's it's less likely to happen. And so just basically a restaurant, something that I got for for really a nerve injury. Last one, then median nerve So median nerve comes off the lateral under medial cords. Off the break. Your plaques is comes down through the arm, doesn't do anything in the arm. It just kind of travels there. The trouble is lateral to the brachial artery for anyone who cares and name crosses over medial to it in the brachial plexus. They're not the greatest access to keep it off also, but in the arm doesn't do any motor innovation. Nusantara Innovation is just there at the forearm. It interview. It's the muscles of the anterior compartment. So that was the ones Mohammed self injector. Flexer. You are very radiologists and furniture, Terry's and all out it interview. It's all those muscles, except for Flexeril Capital Norris, which it remember, all Nora's is older nerve on. Then the medial half of Flexeril Digitorum performed us, which just lays here, and that's also the owner nerve. But everything else. Median nerve in the hand and innovates the skin over the lateral 3.5 digits on the nail beds again expand in the note section to worry too much about it. On it only innovates the loaf muscles, which you know nothing was ever talked about, so the lateral lumbar calls lateral to number close the under thinner muscles point roaming around the whole times, right. This is Laura, and this is a senior muscles, which is the opponent's policies. They have doctor Pollicis Brevis on the flexor pollicis practice, so they're all median nerve, and then the first few number close everything else on the nerve on just to note, the median nerve travels through the carpal tunnel. But you already said that on again it might look like a lot, but essentially muscles of the anterior compartment of the forearm, all of them pretty much thinner muscles on dilated laurel to number girls and in the skin of the home. As I said, So it may look like the transmits off that bad and carpal tunnel emergently talk about it. We'll just go through it quickly. Median nerve travels through. The carpal tunnel can get compressed. You lose motor function, and especially in the thumbs, you get this kind of atrophy or muscle wasting called theater muscle, wasting something to look at for common and women common in pregnancy and common in diabetes. That's those other causes. The name er nextly put it. But I just think of females. David. These pregnancy and unpopular of sensation is not affected because the problem cutaneous brunch comes off here and rest passes over the carpal tunnel is not affected. So a couple MCQ on, but I can't see the chart, so uh oh oh Yeah, so and you can put on your answer to the shot or just think about the mental and I'll give you the answer in 10 seconds. And so so at 42 year old meal injured work he received the last radiation midway along the anterior aspect was right arm that's average all tissue to the bone, sensually for the arm caught and following neurological examination by the F one and A, it's noted that the man it's severe weakness and elbow flexion on loss of sensation over the lateral aspect was for what nerve is most likely affected. So I'll give you, like, 20 seconds or shouldn't have. We think, Mm, nerve lesions can be a bit annoying. So if you don't have a clue, eh, that's fine. I wouldn't. Not if you're at the stage. Other. Okay, I'm Yeah. So they'll Bella Sorry I said that wrong yet, So you're absolutely right. Mostly, it's not Well, you're right. If it's let me tell you long. So it is mostly routine is nerve. So I understand there's a lot of information in the question when it comes in the religions and see what you kind of wanted it was roughly words the lesion on What can you know longer day? So weakness and L deflection. So if you think the muscles that flex the elbow are biceps and particularly and caracal Regulus, your PBC and so that's mostly continuous nerve, there's still some elbow flexion because of that real nerve. Break your list. Joe supplied worry about that, but the point is, he can barely flaxseed oil. Go on days lost. The sensation over the lateral aspect was forearm. So that's the natural kitchen. It's nerve in the forearm, and that is not the acceptable answer, because that nervous only century so he would as Alba a flexion would be fine. Median nerve doesn't do anything. The arm examiner. It doesn't do anything the arm until your interosseous nerve is just a brand to the media and doesn't have one in the arm. OKay, and so next one, then so 32 year with the meal presented the GP with peeing and heaviness and right huh? Left hand. Not that matters. She mentions that she's noticed herself dropping things around the house 26 weeks pregnant and has a past medical history of Exam A GP suspect Calcitonin syndrome. Which of the following muscles would not be affected by this condition. So again, just how we think and what nerve is affected in carpal tunnel syndrome on there for what muscle would not be damaged if not nervous and working and again, these are a bit hard, so don't panic if you want today. Okay, so it's gonna send these evolve thought about mentally, so the abductor policies longer. So this ones, we've been annoying. So if if this was the median nerve a sleeve ever said a Zeiss said she was meeting Nervous effect is what muscles are innovative in the median nerve. So in the hand, it's the little muscle. So first in several 1st and 2nd Lumbrical, which is the first of the lateral to number girls, then you're seen her muscles. So a doctor policies brevis, flexor pollicis bravas and opponents policies. And this one, when you're a vase or another may make more sense. But the doctor policies long. This is one of the muscles in the back of the forearm, so it's one of the long muscles. It goes into the hand, so if it's in the back of the forearm, it's the real nerve. So it's it's not affected. On the last question. This is the worst one of the three. So if anyone gets this, um, for a free T shirt of so 20 year old medical student presented to any for one night of heavy drinking on able to extend the rest and fear the alcohol, a concern the night before might have accelerated the onset of multiple sclerosis after a thorough examination, they have to use your is, um, that they have a very approximately little nerve policies. So not much to worry of it. Which of the following movements with the students still be able to perform in the affected limb despite the injury. And this was just a mean question for me. So if anything gets it, I'll, uh, I don't really like congratulations is that any of their speaker's when I have a lot of with that one has No, no. Okay, so yes. So this one is horrible. I apologize. So the answer is extension of the interfuron geo joints off the fingers. So And if we remember, the regal nerve does extension essentially off the elbow, on the wrist, on the fingers. So at first Lance, All of these answers might seem correct. This is really high level stuff, so don't panic if it didn't make any sense initially. But the extent of the elbow that is the radial nerve, not your triceps extension off the interval and deal joints off the thumb. That again is the real nerve. And that's your extensors policies. Longest and extension qualities brevis, which is the ones in your snuffbox. So they are really a nerve extension of the medical people. Financial joints of the fingers under thumb. That's your extension, digitorum and on extensive policies to again, that's radial nerve. This one is mean, so the and you're following your inter phalangeal joints of the fingers. There's two muscles that can extend the so it's after the extensor digitorum, which does the approximate ones. And but more importantly, it's the interosseous and the longer coast, which extend the interferon and your joints on their innovated by the ulnar nerve on a couple of the median nerve. So the interval Angela joints. If you remember that, do this so you are the longer because the Intrarosa do that so they flex the MCP joints, extend the AP joints. So if you don't majority inner of basically the only thing you can extend is there was little joints in the fingers because the longer it goes in, the anteroseptal do that. But that was another nice question. So I apologize. And so thanks for listening. Hope that wasn't horrendous. And I found out recently questions. My email is in the notes document, which was three things a bit more detail what I've talked about today, so thanks. Okay, thanks very much. And so that's all our talks for this evening, and I'm finished. And what we're gonna do is because you'll and registered with your email address, is we're just gonna email like the and that you on the slides and and also email like your feet, but for him. So if you've been mindful on that, I felt great. And thank you all for a tendon and thanks very much. First to your sleep. Hers for Children tonight. And, yeah, that's it. You'll handle. So you later. Good luck to exam.