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triangle in the neck. • It runs downward and laterally and passes beneath the suprascapular ligament, wh ich bridges the suprascapular notch, to reach the supraspinous fossa • It supplies the supraspinatus and infraspinatus muscles and the shoulder joint. Axillary Nerve • The axillary nerve arises from the posterior cord of the brachial plexus (C5 and 6) in the axilla • It passes backward and enters the quadrangular space with the posterior circumfl ex humeral artery. • As the nerve passes through the space, it comes into close relationship with the inferior aspect of the capsule of the shoulderjoint and with the medial side of the surgical neck of the humerus. • It terminates by dividing into anterior and posterior branches. Branches The axillary nerve has the following branches: ■ An articular branch to the shoulder joint ■ An anterior terminal branch, which winds around the surgical neck of the humerus beneath the deltoid muscle; it supplies the deltoid and the skin that covers it s lower part. ■ A posterior terminal branch, which gives off a branch tothe teres minor muscle a nd a few branches to the deltoid, then emerges from the posterior border of the deltoid as the upper lateral cutaneous nerve of the arm Musculocutaneous Nerve • The origin of the musculocutaneous nerve from the lateral cord of the brachial p lexus (C5, 6, and 7) in the axilla. • It runs downward and laterally, pierces the coracobrachialis muscle and then passes downward between the biceps and brachialis muscles . • It appears at the lateral margin of the biceps tendon • pierces the deep fascia just above the elbow. • It runs down the lateral aspect of the forearm as the lateral cutaneous nerve of the forearm Branches ■ Muscular branches to the biceps, coracobrachialis, and brachialis ■ Cutaneous branches; the lateral cutaneous nerve of the forearm supplies the skin of the front and lateral aspects of the forearm down as far as the root of the thumb. ■ Articular branches to the elbow joint
Median Nerve ( IN ARM ) • It originate from the medial and lateral cords of the brachial plexus in the ax illa • It runs downward on the lateral side of the brachial artery • Halfway down the upper arm, it crosses the brachial artery and continues downwar d on its medial side. • The nerve, like the artery, is therefore superficial, but at the elbow, it is cr ossed by the bicipital aponeurosis. • The median nerve has no branches in the upper arm except for a small vasomotor n erve to the brachial artery. IN FOREARM • The median nerve leaves the cubital fossa by passing between the two heads of th e pronator teres • It continues downward behind the flexor digitorum superficialis and rests poster iorly on the flexor digitorum profundus. • At the wrist, the median nerve emerges from the lateral border of the flexor dig
One of these br anches also supplies the second lumbrical muscle. Branches ■ Muscular branches in the cubital fossa to the pronator teres. th e flexor pollicis brevis. ■ In the anterior compartment of the arm. and the flexor digitorum superficialis ■ Articular branches to the elbow joint ■ Anterior interosseous nerve : Largest branch of the median nerve. branches are given to the long and medial heads of the triceps. it gives branches to the brachialis. LATERAL COMPARTMENT OF THE FOREARM . after the nerve has pierced the lateral fascial septum. It also gives articular branches to the elbow joint.46). branches are given to the lateral and medial h eads of the triceps and to the anconeus. • The palmar cutaneous branch of the median nerve given off in the front of the fo rearm crosses anterior to the flexor retinaculum and supplies the skin over the lateral part of the palm Radial Nerve (IN THE POSTERIROR COMPARTMENT OF ARM ) • It originate from the posterior cord of the brachial plexus in the axilla • The nerve winds around the back of the arm in the spiral groove on the back of t he humerus between the heads of the triceps • It pierces the lateral fascial septum above the elbow and continues downward int o the cubital fossa in front of the elbow. Lateral half of Flexor dig itorum profundus & Pronator Quadratus). • It immediately divides into lateral and medial branches. • The muscular branch takes a recurrent course around the lower border of the flex or retinaculum and lies about one fingerbreadth distal to the tubercle of the sc aphoid • It supplies the muscles of the thenar eminence (the abductor pollicis brevis. • The cutaneous branches supply the palmar aspect of the lateral three and a half fingers and the distal half of the dorsal aspect of each finger. The lower lateral cutaneous nerve of th e arm supplies the skin over the lateral and anterior aspects of the lower part of the arm.itorum superficialis muscle • lies behind the tendon of the palmaris longus • It enters the palm by passing behind the flexor retinaculum. a nd the posterior cutaneous nerve of the arm is given off. and th e extensor carpi radialis longus muscles . originate bet ween two heads of pronator teres . and the opponens pollicis) and the 1st lumbrical muscl e. between the brachialis and brachiorad ialis muscles. 9. the flexor carpi r adialis. the brachioradialis. and it li es directly in contact with the shaft of the humerus Branches ■ In the axilla. passing down with interosseous artery and ine vates muscles of deep layer ( Flexor Pollicis longus. • In the spiral groove.the nerve is accompanied by the profunda vessels. ■ In the spiral groove (Fig. This arises in the lower part of the forearm and is dis tributed to the skin over the lateral part of the palm (IN PALM) • The median nerve enters the palm by passing behind the flexor retinaculum and th rough the carpal tunnel. ■ Palmar cutaneous branch. The posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the wrist. the palmaris longus.
• It pierces the supinator and winds around the lateral aspect of the neck of the radius in the substance of the muscle to reach the posterior compartment of the forearm. EPL & EPB .It eventually reaches the posterior surface of the wrist joint. Medial Side of the Thumb 3. APL. to the extensor carpi radialis longus. . the extensor pollicis lon gus. the extensor pollicis brevis. where it divides into terminal br anches that supply the skin on the lateral two thirds of the posterior surface o f the hand . (IN THE POSTERIOR COMPARTMENT) Deep Branch of the Radial Nerve • The deep branch arises from the radial nerve in front of the lateral epicondyle of the humerus in the cubital fossa . Lateral side of Index Finger 4. • The nerve descends in the interval between the superficial and deep groups of mu scles . S. • It reaches the posterior surface of the wrist. Contiguous sides of index and middle finger 5. withi n the supinator muscle and enters the posterior compartment of the forearm ■Superficial Branch of the Radial Nerve • The superficial branch of the radial nerve is the direct continuation of the ner ve after its main stem has given off its deep branch in front of the lateral epi condyle of the humerus . • In the distal part of the forearm. • It then passes downward in front of the lateral epicondyle of the humerus. • The area of skin supplied by the nerve on the dorsum of the hand is variable. the a bductor pollicis longus. • It runs down under cover of the brachioradialis muscle on the lateral side of th e radial artery. Contiguous sides of index and ring finger Ulnar Nerve ANTERIOR COMPARTMENT OF ARM • Originate from the medial cord of the brachial plexus in the axilla is describe . the extensor digiti minimi. It reaches the dorsum of hand after winding around the lateral side of the radius. This winds around the neck of the radius. Branches ■ Muscular branches to the extensor carpi radialis brevis and the supinator.and the posterior surface over the proximal phalanges of the lateral three and a half fingers. it divides into superficial and deep bra nches Branches ■ Muscular branches to the brachioradialis. ECU. it leaves the artery and passes backward unde r the tendon of the brachioradialis . Lateral Side of the Thumb 2. and a small branch to the lateral part of the brachialis muscle ■ Articular branches to the elbow joint ■ Deep branch of the radial nerve. lying between the brachialis on the medial side and the brachioradialis and extensor carpi radialis longus on the lateral side • At the level of the lateral epicondyle. 1. the e xtensor digitorum. EDM. ED. EI) ■ Articular branches to the wrist and carpal joints IN THE DORSUM OF HAND Radial Nerve in the hand is the continuation of the superficial branch of the ra dial nerve.• The radial nerve pierces the lateral intermuscular septum in the lower part of the arm • passes forward into the cubital fossa . and the extensor indicis (ECRB. And divides into 4 dorsal digital branches which supply the skin of the digits as follows. the extensor carpi ulnaris.
the nerve pierces the medial fas cial septum. • At the elbow. the ulnar artery lies on the lateral si de of the ulnar nerve • At the wrist. the ulnar nerve becomes superficial and lies between the tendons o f the flexor carpi ulnaris and flexor digitorum superficialis muscles . crosses the medial ligament of the elbow joint • Enters the front of the forearm by passing between the two heads of the flexor c arpi ulnaris.d • It runs downward on the medial side of the brachial artery as far as the middle of the arm • Here. • The nerve is accompanied by the superior ulnar collateral vessels. Superficial Branch of the Ulnar Nerve • The superficial branch of the ulnar nerve descends into the palm. • In the distal two thirds of the forearm. the ulnar n erve descends • behind the septum. here. it has the ulnar artery latera l to it Branches ■ Muscular branches to the flexor carpi ulnaris and to the medial half of the flex or digitorum profundus ■ Articular branches to the elbow joint ■The palmar cutaneous branch is a small branch that arises in the middle of the fo rearm and supplies the skin over the hypothenar eminence. ■The dorsal posterior cutaneous branch is a large branch that arises in the distal third of the forearm. lying in the s ubcutaneous tissue between the pisiform bone and the hook of the hamate . covered posteriorly by the medial head of the triceps. • It continues downward to enter the forearm between the two heads of origin of th e flexorcarpi ulnaris Branches The ulnar nerve has an articular branch to the elbow joint IN FOREARM • The ulnar nerve passes from behind the medial epicondyle of the humerus. IN HAND (PALM) • The ulnar nerve enters the palm anterior to the flexor retinaculum alongside the lateral border of the pisiform bone. accompanied by the superior ulnar collateral artery. the nerve passes behind the medial epicondyle of the humerus. • The ulnar nerve has no branches in the anterior compartment of the upper arm (POSTERIOR COMPARTMENT OF ARM ) • Having pierced the medial fascial septum halfway down the upper arm. and enters the posterior compartment of the arm. It passes medially between the tendon of the flexor carpi ulnaris and the ulna and is distributed on the posterior surface of the hand an d fingers. it lies behind the medial epicondyle of the humerus on the medial ligament of the elbow joint. • The ulnar nerve enters the palm of the hand by passing in front of the flexor re tinaculum and lateral to the pisiform bone.The uln . • As it crosses the retinaculum. • It then runs down the forearm between the flexor carpi ulnaris and the flexor di gitorum profundus muscles. it divides into a superficial and a deep terminal branch. at the insertion of the coracobrachialis.
and the opponens digiti minimi. Here. and passes laterally within the concavity of the deep palmar arch. the 3rd and 4th lumbrical muscl es. created by fibrous tissue derived from • the superficial part of the flexor retinaculum. It gives off mu scular branches to the three muscles of the hypothenar eminence. • The palmar cutaneous branch of the ulnar nerve given off in the front of the for earm crosses anterior to the flexor retinaculum (Fig. the flexor digiti minimi.ar artery is on its lateral side. giving rise to clinical signs and symptoms.It also supplies the distal half of the do rsal aspect of each finger. winds ar ound the lower border of the hook of the hamate. 9. namely. The nerve gives off the fo llowing branches: a muscular branch to the palmaris brevis and cutaneous branche s to the palmar aspect of the medial side of the little finger and the adjacent sides of the little and ring fingers . the tunnel of Guyon. Deep Branch of the Ulnar Nerve • The deep branch of the ulnar nerve runs backward between the abductor digiti min imi and the flexor digiti minimi It pierces the opponens digiti minimi. The nerve may be compressed at t his site. The nerve lies behind the long flexor tendon s and in front of the metacarpal bones and interosseous muscles.54) and supplies the ski n over the medial part of the palm . I t supplies all the palmar and dorsal interossei. the abd uctor digiti minimi. the nerve and artery may lie in a fibroosseous tunnel. and both heads of the adductor pollicis muscle.
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