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Muscle and Fascia Compartments Trans

Muscle and Fascia Compartments Trans

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Published by: marksterxxx on Jul 15, 2009
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FASCIA (divisions)
Superficial (Hypodermis, Subcutaneous Tissue)
Deep
Derivatives1.intermuscular septa2.ligaments3.tendons4.aponeurosis5.muscular and nervous investments
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)
Joints divide the superior appendicular skeleton
Limb is divided into 4 main regions (bold)
Shoulder (pectoral)
Arm (brachium)
Elbow (cubitum)
Forearm (antebrachium)
Wrist (carpus)
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)
 Anterior 
• 
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 majo
**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
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
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 rotatoc.Teres minod.Subscapularis- medial rotato
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
Quadrangular space
Teres minor, teres major, triceps brachii(medial), humerus(lateral)
Enervated by Axillary nerve
Post humeral circumflex arteryruns through it
Triangular space
Teres minor, teres major and tricepsbrachii
Circumflex scapular artery fromsubscapular artery runs through itARM: MUSCULAR COMPARTMENTS
Anterior- flexors (3)
Enervated by
musculocutaneous nerve
Bloody supply from
brachial artery 
Supinator 
Biceps brachii coracobrachialis (passesonly shoulder joint) and brachialis muscles
Covered by superficial Antibrachial fascia
Presence of bicipetal aponeurosis whichforms a roof over cubital fossa andprotects underlying structures
Posterior- extensors (2)
Enervated by
radial nerve
Blood supply c/o
brachial artery 
Triceps brachii- long, lateral and medialheads + Anconeus (muscle that assists thetriceps in extending the elbow joint)FOREARM: MUSCULAR COMPARTMENTS
Anterior- flexors (+pronators)
Enervated by Median nerve and/or ulnar nerve (only 1 and a ½ exceptions aresupplied by latter)
3 layers/groups
1 superficial group- common flexor tendon; origin- medial epicondyleof humerus; made up of 4 muscles
Pronator teres
Wrist flexors (3)- flexor carpi radialis, Palmarislongus, and flexor carpiulnaris
2 intermediate group
Flexor digitorumsuperficialis muscle-flexes in fast action
3 deep group- flexors of digits andpronator (made up of 3 muscles)
Flexor digitorumprofundus- flexes fingersin slow action
Flexor pollicis longus –extends the thumb,extrinsic muscle
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Pronator quadrates-between the radius andulna
** FYI- biceps brachii serves supinator function
Cubital Fossa- triangular area in elbow whichserves as an imaginary border; found by thebrachialis muscle; filled with a variable amount of fat
3 boundaries
Superiorly: imaginary lineconnecting the medial and lateralepicondyle
Medially- mass of forearm flexor muscles (pronator teres) arisingfrom a common flexor attachmenton the medial epicondyle
Laterally- mass of extensor muscles (brachioradialis)
Contents of fossa
Terminal end of the brachial artery-and divisions of radial and ulnar arteries
Deep accompanying veins of thearteries
Biceps brachii tendon
Median nerve
Radial nerve
Posterior- Extensors (+supinator and forearmflexor)
Enervated by the radial nerve
Divided into 3 functional groups
Extensor muscles of the wrist joint
Extensor muscles of the fingers
Thumb abductor and extensors
Blood supply is from both radial and ulnar arteries
Flexor of the elbow joint (forearm)-brachioradialis which is slantedand found in the humerus to theradius
Exception to the rule thatradial nerve supplies onlyextensory muscles andthat all flexors are foundanteriorly (flexor compartment)
Extensors
E. carpi radialis longusand E. carpi radialisbrevis- extends andabducts hand at wrist joint;for clenching
E. digitorum (communis)-extends 4 medial fingers
E. digiti minimi – extends5
th
finger 
E. carpi ulnaris- extendsand adducts hand at wrist joint; for clenching
Supinator, Abductor and Extensor 
Abd, pol. Longus
E. pol. Brevis
E. pol. Longus** extends and abductsthe thumb
E. indicis – extends 2
nd
finger (for independentextension)
Anatomical Snuffbox
(triangular hollow) depression between ext.pol. Longus and brevis tendons
Formed by scaphoid and trapezium bones
FASCIA: WRIST AND HAND
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)
Carpal Tunnel
Thenar Compartment
Hypothenar Compartment
Central compartment
Palmar Space
Thenar Space
Midpalmar Space
Synovial Flexor Sheaths (for support)
Ulnar Bursa – Contains tendons of Flexor Digitorum Superficialis andProfundus
Radial Bursa – Contains tendon of Flexor Pollicis Longus
Synovial Sheaths for second toFourth Digits
INTRINSIC MUSCLES OF THE HAND
Nerve supply c/o ulnar nerve EXCEPT thenar muscles and the 1
st
2 lumbricals which aresupplied by the median nerve
Thenar compartment (act on thumb)
A
bductor Pollicis brevis
F
lexor Pollicis brevis
O
pponens Pollicis
Hypothenar compartment (act on little finger)
A
bductor digiti minimi
F
lexor digiti minimi
O
pponens digiti minimi
12 short muscles
Lumbricals – in central compartment; arisefrom flexor digitorum profundus; flexesmetacarpophalangeal (MP) joint andextends dorsal and palmar interphalangeal(DIP and PIP) joints
1 and 2 = unipennate
3 and 4 = bipennate
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