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FASCIA (divisions)

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Superficial (Hypodermis, Subcutaneous Tissue)

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Deep

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Derivatives1.intermuscular septa2.ligaments3.tendons4.aponeurosis5.muscular and nervous investments

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Receives different names according toregion1.Pectoral Fascia – encloses pectoralismajor.2.Clavipectoral Fascia – enclosessubclavius and pectoralis minor.3.Axillary Fascia4.Brachial Fascia – arm5.Antebrachial Fascia – forearm6.Palmar Fascia7.Dorsal Fascia8.Flexor and Extensor Retinacula9.Digital Fibrous Flexor Sheaths

UPPER LIMB (divisions)

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Joints divide the superior appendicular skeleton

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Limb is divided into 4 main regions (bold)

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Shoulder (pectoral)

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Arm (brachium)

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Elbow (cubitum)

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Forearm (antebrachium)

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Wrist (carpus)

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HandBONES OF UPPER LIMB

Legend:C- Scaphoid, D- Lunate, E- Triquetrum, F-Psiform, G- Trapezium, H-Trapezoid, I-Capitate, J-Hamate, L- Radius, L1-Styloid process of theRadius, M- Ulna,M1- Styloid process of the Ulna

BONY LANDMARKS

(parts that can be palpated- all areas in green)

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Fyi- clavicle is the first long bone to ossify in fetusPosterior

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Muscle and Fascia

Compartments of the Upper

Dr. Adelia Matanguihan- Quijano M.D.1 July 2009

MUSCLES OF THE PECTORAL REGION

1-Trunk to scapula or claviclea.Trapezius- assists in suspending thepectoral girdle and elevates, retracts androtates the scapulab.Levator scapulae- pulls up the scapulac.Rhomboideus major/minor- adductsscapula towards the midlined.Pectoralis minor- stabilizes the scapula, for flexione.Subclavius- stabilizes (anchors anddepresses) the claviclef.Serratus anterior- (serrated appearance);keeps scapula close to trunk and rotates it2-Trunk to humerusa.Latissimus dorsi- widest back muscleb.Pectoralis major

**extends, adducts and rotates the humerus medially

Winging of the scapula-

paralysis of serratus anterior / injury to longthoracic nerve

when the medial border of the scapula moveslaterally and posteriorly away from the thoracic wall

AXILLA

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The pyramidal space inferior to the glenohumeral joint and is superior to the axillary fascia at the junction of the arm and thoraxMUSCLES OF PECTORAL REGION

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Scapula to humerus1.Deltoid- triangular muscle that forms therounded contour of the shoulder; middle areais multipennate; functions as the principleabductor of the arm (flexion of shoulder joint)2.Rotator Cuff muscles (scapulohumeralmuscles- SITS)a.Supraspinatusb.Infraspinatus- lateral rotator c.Teres minor d.Subscapularis- medial rotator

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Initiate abduction for first 150 degrees; deltoid doesthe rest; grasps and pulls the humerus headagainst the glenoid cavity (reinforces anteriorly,superiorly and posteriorly)3.Teres major (+ Teres minor)- minor is moresuperiorly located; both help in lateral rotationSCAPULOHUMERAL DISSECTION

*teres minor- above, major- below

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Quadrangular space

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Teres minor, teres major, triceps brachii(medial), humerus(lateral)

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Enervated by Axillary nerve

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Post humeral circumflex arteryruns through it

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Triangular space

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Teres minor, teres major and tricepsbrachii

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Circumflex scapular artery fromsubscapular artery runs through itARM: MUSCULAR COMPARTMENTS

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Anterior- flexors (3)

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Enervated by

musculocutaneous nerve

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Bloody supply from

brachial artery

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Supinator

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Biceps brachii coracobrachialis (passesonly shoulder joint) and brachialis muscles

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Covered by superficial Antibrachial fascia

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Presence of bicipetal aponeurosis whichforms a roof over cubital fossa andprotects underlying structures

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Posterior- extensors (2)

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Enervated by

radial nerve

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Blood supply c/o

brachial artery

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Triceps brachii- long, lateral and medialheads + Anconeus (muscle that assists thetriceps in extending the elbow joint)FOREARM: MUSCULAR COMPARTMENTS

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Anterior- flexors (+pronators)

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Enervated by Median nerve and/or ulnar nerve (only 1 and a ½ exceptions aresupplied by latter)

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3 layers/groups

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1 superficial group- common flexor tendon; origin- medial epicondyleof humerus; made up of 4 muscles

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Pronator teres

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Wrist flexors (3)- flexor carpi radialis, Palmarislongus, and flexor carpiulnaris

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2 intermediate group

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Flexor digitorumsuperficialis muscle-flexes in fast action

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3 deep group- flexors of digits andpronator (made up of 3 muscles)

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Flexor digitorumprofundus- flexes fingersin slow action

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Flexor pollicis longus –extends the thumb,extrinsic muscle

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Pronator quadrates-between the radius andulna

** FYI- biceps brachii serves supinator function

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Cubital Fossa- triangular area in elbow whichserves as an imaginary border; found by thebrachialis muscle; filled with a variable amount of fat

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3 boundaries

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Superiorly: imaginary lineconnecting the medial and lateralepicondyle

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Medially- mass of forearm flexor muscles (pronator teres) arisingfrom a common flexor attachmenton the medial epicondyle

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Laterally- mass of extensor muscles (brachioradialis)

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Contents of fossa

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Terminal end of the brachial artery-and divisions of radial and ulnar arteries

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Deep accompanying veins of thearteries

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Biceps brachii tendon

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Median nerve

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Radial nerve

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Posterior- Extensors (+supinator and forearmflexor)

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Enervated by the radial nerve

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Divided into 3 functional groups

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Extensor muscles of the wrist joint

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Extensor muscles of the fingers

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Thumb abductor and extensors

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Blood supply is from both radial and ulnar arteries

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Flexor of the elbow joint (forearm)-brachioradialis which is slantedand found in the humerus to theradius

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Exception to the rule thatradial nerve supplies onlyextensory muscles andthat all flexors are foundanteriorly (flexor compartment)

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Extensors

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E. carpi radialis longusand E. carpi radialisbrevis- extends andabducts hand at wrist joint;for clenching

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E. digitorum (communis)-extends 4 medial fingers

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E. digiti minimi – extends5

finger

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E. carpi ulnaris- extendsand adducts hand at wrist joint; for clenching

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Supinator, Abductor and Extensor

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Abd, pol. Longus

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E. pol. Brevis

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E. pol. Longus** extends and abductsthe thumb

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E. indicis – extends 2

finger (for independentextension)

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Anatomical Snuffbox

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(triangular hollow) depression between ext.pol. Longus and brevis tendons

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Formed by scaphoid and trapezium bones

FASCIA: WRIST AND HAND

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Deep fascia continues from antebrachial fasciaI.Retinacula (At wrist region)a.Extensor retinaculumb.Flexor retinaculum- forms carpaltunnel as it bridges carpal bonesconcavity; for passage of flexor digitorum profundus and superficialisand flexor pollicis longus

** in the carpal tunnel runs the median nerve

c.Palmar carpal ligament- fundsuperficial to flexor retinaculumII.Palmar Fasciaa.Thenar Fasciab.Hypothenar Fasciac.Palmar AponeurosisIII.Dorsal fasciaIV.Fibrous Flexor Sheaths of Digits (coveringof Flexor Digitorum Tendons)V.Vincula – attach superficial fascial anddeep flexor tendons to middle and distalphalanges respectively; provide route for blood supply to tendons.

FASCIAL SPACES (4)

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Carpal Tunnel

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Thenar Compartment

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Hypothenar Compartment

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Central compartment

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Palmar Space

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Thenar Space

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Midpalmar Space

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Synovial Flexor Sheaths (for support)

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Ulnar Bursa – Contains tendons of Flexor Digitorum Superficialis andProfundus

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Radial Bursa – Contains tendon of Flexor Pollicis Longus

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Synovial Sheaths for second toFourth Digits

INTRINSIC MUSCLES OF THE HAND

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Nerve supply c/o ulnar nerve EXCEPT thenar muscles and the 1

2 lumbricals which aresupplied by the median nerve

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Thenar compartment (act on thumb)

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bductor Pollicis brevis

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lexor Pollicis brevis

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pponens Pollicis

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Hypothenar compartment (act on little finger)

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bductor digiti minimi

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lexor digiti minimi

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pponens digiti minimi

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12 short muscles

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Lumbricals – in central compartment; arisefrom flexor digitorum profundus; flexesmetacarpophalangeal (MP) joint andextends dorsal and palmar interphalangeal(DIP and PIP) joints

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1 and 2 = unipennate

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3 and 4 = bipennate

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