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    Reham Que
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    Upper limb

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    4 views20 pages

    Upper Limb

    Uploaded by

    Reham Que

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    TABLE 3.1. Dermatomes of Upper Limb ca Region at base of neck, extending laterally over shoulder g Lateral aspect of arm (.e., superior aspect of abducted arm) Lateral forearm and thumb Midale and ring fingers (or middle three fingers) and center of posterior aspect of forearm: Litt finger, medial side of hand and forearm (Le., inferior aspect of abducted arm) Medial aspect of forearm and inferior arm #/a/e}sie}e Medial aspect of superior arm and skin of axilla TABLE 3.2. Cutaneous Nerves of Upper Limb ‘Supractavicular nerves | C3, C4 Corvical planus ass anterior toclaviclo, immediately deep to platysma, and ‘upp ve cel an superar pect of pecrte major ‘Superior lateral cutaneous | C5, C6 Terminal branch of axilary | Emerges trom beneath posterior margin of deltoid and supplies ‘nerve of arm nerve ‘kin ovor lower part ofthis muscle and on lateral side of midarm Inferior lateral cutaneous | C5, C6 Radial nerve (or posterior | Perforates lateral head o triceps, passing close to cephalic vein to ‘nerve of arm Cutaneous nerve of arm) | supply skin over inferoateral aspect of arm Posterior cutaneous nerve | C5-C8 Racial nerve (in xia) ‘Crosses posterior to and communicates with intorcostobrachial cof arm ‘nerve and supplies skin on posterior arm as far as olecranon Posterior cutaneous nerve | C5-C8 ‘Racial nerve (with inferior of forearm lateral cutaneous nerve of arm) Lateral cutaneous nerve | C6-C7 Musculocutansous nerve | Emerges lateral to biceps tendon deep to cephalic vein, supplying of forearm (lorminal branch) ‘kin of antoolateal forearm to wrist ‘Medial cutaneous nerve of | C8,71 ‘Medial cord of brachial ‘Descends medial to brachial artery, pierces deep fascia with forearm Plexus (in axilla) ‘basic vain in midarm, dividing into anterior and posterior ‘branches that enter forearm and supply skin of anteromedial aspect to wrist Medial cutaneous nerve | C8-T2 “Medial cord of brachial ‘Communicates with ntercostobrachial nerve, continuing to supply of arm plexus (in axilla) ‘skin of medial aspect of distal arm Intercostobrachial nerve | T2 ‘Second intercostal nerve (as.| Extends laterally, communicating with posterior and medial is lateral cutaneous branch) ‘cutaneous nerves of arm, supplying skin of axilla and medial aspect of proximal arm Pectoralls major | Clavicular hoad: anterior surface | Lateral lip of intortubercular | Lataral and medial | Adduots and medially rotates ‘of medial half of clavicle ‘sulcus of humerus pectoral nerves; humerus; draws scapula anteriorly orssosaal ea sto Glaveular head (C5, | andinterory ‘surface of sternum, superior six C8), and sternocostal | Acting alone, clavicular head flexes: costal cartilages, and aponeuro- head (C7, C8, T1) humerus and sternocostal head 8s of extamal oblique muscle ‘@xands it from the flexed postion Pectoralis minor | Sr¢-sth ibs neartheircostal | Medial border and superior | Medial pectoral nerve | Stabilzes scapula by drawing it cartiages surace of coracoid process. | (C8, 1) inferiorly and anterior against of scapula thoracic wall Subelavius Junction of 1s bandits costal | Inferior surface of midsle | Nerve to subclavius | Anchors and depresses clavicle cartiage third of eavile (8.68) Sorratus anterior | External surfaces oflatral parts | Anterior surface of medial | Long thoracicnerve | Protacts scapula and holds it of fet-8h ibs border of scapula (5,08, c7) against horace wal oles scapula TABLE 3.3 ANTERIOR AXIO-APPENDICULAR MUSCLES TABLE 3.4. Posterior Axio-Appendicular Muscles ‘Superficial posterior axlo-appendicular (extrinsic shoulder) musclos ‘Trapezius Medial third of superior Latral third of clavicle; Spinal accessory Descending ‘uchal line; external occipital | acromion and spine of scapula | nerve (CN XI) (motor | ascending part depresses; and protuberance; nuchal liga fibers) and C3,C4 | middle part (or all parts together) ment; spinous processes of spinal nerves (pain | retracts scapula; descending and C7-T12 vertabrae ‘and proprioceptive | ascending parts act together to fibers) rotate glenoid cavity superiorly Latiesimus dors! | Spinous processes of inferior | Floor of intertubercular sulcus | Thoracodorsal nerve | Extends, adducts, and medially G thoracle vertebrae, thoraco- | of humerus (€8, 67,8) rotates humerus; raises body lumbar fascia, flac crest, and toward arms during climbing Inferior 3 oF 4 ribs Deep posterior axio-appendicular (extrinsic shoulder) muscles Levator ecapulae | Posterior ubercies of rans- | Medial border of scapula supe- | Dorsal scapular Elevates scapula and rotates its verse processes of C1-C4 | ior to rootof scapular spine | (C4, C5) andcervical_| glonoid cavity inferiorly by rotat- vertebrae (C3, C4) nerves ing scapula Rhombold minor | Minor: nuchal ligament; Minor: smooth tiangular area at | Dorsal scapular nerve | Retract scapula and rotate and major ‘spinous processes of G7 and | medial end of scapular spine | (C4, C5) its glenoid cavity inferior; ix Ti vertebrae Major: medial border of scapula scapula to thoracic wal Major: spinous processes of trom lvel of spine to inferior T2-TS veriobrae angle TABLE 3.5. Movements of Scapula Movement of Scapula Elevation Trapezius, descending part (1) Seatac Levatorscapulae 2) hombeids (9) scenes Depression Gravity (12) Pectorale major, inferior sternccostalhead (4) | Pactra nerves to-12em Latisimus dorsi (6) Thorecodorsal “Trapezius, ascencing part (8) Spinal accessory (CN Xi) Serra anterior, infor part 7) Long thoracic Pectoral minor (8) Medial pectoral Protraction ‘Serratus anterior (9) Long thoracic Pectoral major (10) Pectoral nerves Pctoralis minor (8) Medial pectoral 40-48%; 156m Retraction Trapezius, middle part (11) Spinal accessory CNX!) Rhomboids (3) Dorsal scapular Latisimus dorsi (5) Thorecodorsal Upward otaion” | Trapezius, descending part (1) ] Spt eczasory (ON) “Trapezius, ascending part (6) Serratus anterior, inferior part (7) Long thoracic Downward rotation’ | Gravity (12) 1 60": elerir angle: 10-12 em; Levatorscapulae (2) | Dorsal scapuar superio ange: 5-6em FRhombeids (2) Latiseimus dorsi 6) Thoracodorsal Pectorais minor (8) Medial pectoral Pecorais major, iefeviorsternocostal head (4) | Medial and lateral pectoral nerves TABLE 3.6. Scapulohumeral (Intrinsic Shoulder) Muscles Dettotd Lateral third of clavicle; | Dattoid tuberosity of | Axillary nerve | Clavicular(antario part exes and mecaly rotates arm sacromion and spine of | humerus (cs,cs) ‘Acrorial (mide) part: abducts arm om ‘Spina (postr) part extends and lateral rotates arm Supraspinatue® | Supraspinous fossa ot | Superior tacet of eater | Suprascapular | initates and assists dltoid in abduction of arm and scapula tuberce of humerus | nerve (C4, 3, C6) | acts with rotator cut muscoe! Infraspinatus® | Inraspinous fossa ot | Middle facet of greater | Suprascapular | Latoralyrolats arm; and acs with rotator cut scapula Uuberle ofhumerus | nerve (Cs,C6) | musces® ‘ores minor | Middle partofiatoral | Inferior facet of reator | Alla nerve | Lateral olates arm; and acts with rotator cut border of scapula | tuberle ofhumerus | (C5, C6) muscles” “Tres major Medial ip of tertuber- | Lower subscapular | Adévets and medialy rotates arm cular suleus of humerus | nerve (5,8) Subscapularis? | Subscapularfossa | Lesser tubercle of | Upperandiower | Medally rotates arm a par of rotator cuf,elps hold (resto anterior sur | humerus subscapular nerves | head of humerus in glancd cay {ace of scapula) (cs.en.cn TABLE 3.7. Arteries of Proximal Upper Limb (Shoulder Region and Arm) im ice dita crags fog Ros ocr pk ‘Strange tua parang barchen aan toa ‘Ratuepes ana tipetaropgeae wate, ‘Ascend shor ut wane, gig ie ur ances: ‘proncapia canting coves nee yi arin end ‘heconacoaoe rk “Tiyeenieal nk ores ret arch ot Rane ‘Paani cong ar ee mac, re stave ater abalone ey pase ‘ertrdombel eves pst penses oer tenors eter {Seen mgs baer ec eee ‘Stemi etspnou xen ponarrntace ape ‘Siperor once ‘er orc (Grerorae pmanon spa a oy rane Secon pa tbat eondcen ‘aan ariry ‘secant Pisa ern ‘id par apet ann Sayan ne snacresaly ang sper Doce of pect minor IRerpuses troean ens pctrea efeeerec a hops ‘Sip ttand anor epee aspen pe eras (Cte wend sapere te petra rer perce oso ‘Scecac merwron enya nea ese no er are ‘com, dots co ra ic Desens dog nity bordel petra rn alow eno ‘foc wl ug esol obra, sees mpc human entering Wit en het ‘Steer pn’ unc avons ana sac ‘Gree seapulr ‘Cues wou il bref can ona ee, “retoncara mth ural ay ‘ries cure of ibaa artery. escending wih Perce ‘Slane omer spartans (coopeneryotam) ‘Superga Weert ot Super ora | sam. | ‘Accompany ng atl poe of rin ay see cornet am cna praca ‘Azonpanes ua ane ptr ape ow anasres ‘Niveau nar mccoy ge aera ein ara ane TABLE 3.8. Brachial Plexus and Nerves of Upper Limb ee [ee a == Dorsal scapular Posterior aspect of anterior ramus Pierces middle scalene; descends deep to | Rhomboids; occasionally supplies as [oa eee 2a mma — Seana me ee enrmeceements mame — aa eee ERERIEEES iermmcee = | pereeaeamree | earmneacras, ‘to brachial plexus; then through scapular joint, eee rere Zee eas SE omen ES ee ee a ee (Fig. 3.29); often giving an accessory root diaphragm) ‘noe ofan ‘Sa acres tmacaicos, | modal seat nary andrachalvers; | me medal peony a era Imeewogiontumce ict | Sonmmesie win imecostomenal™ | sndaecanon una Wal etaeoue ‘ry re wth dro wn | Si meal ae tea a rar ttre Stoeacmnademensnaens | ‘en awctg to aera ones ‘ner Urgent arch tract | Descends mel wm pees ‘crn ed dra hat oh (ord cavngtomrtomce.T1, | lemedal eon tmenarten | Rear Sooner Gasser tar epact steam rand_| oar reece one som (Foeace nda ‘ind medelw seal Sot ‘Upper etacapaar | Sie ranch posi ict, —_—| Passes pono. onmrng ubcapdars | Super pron of candae ‘meow torte C8 Srey ‘wer edecapder | Se ranch pear cnt | Passe ity. nope tacanun’ | Hirrporon eden ant ‘nconog tow am Severe Seema ‘Tomcodonal | Se banchotpaamrercort | Arse between wpe ander ib, | Laem ot ‘meow toe ram 8,67 ‘arenas ene oe Sater aon 7 Terma arch of poner sant | Ext mary on ‘enorme hou tig owiarciawce | fun esengue ect wospotwe | Swern’ ms eae mace Scrat rer 30; owe | (Pa Seeb) on deemed ‘etnperer owe oh ‘Serio parte rove mens wens ge eat ‘Rien op wom 00) raat Langererirlareh of poreor Ea tary basa postr mlary | Al mann ot portico ‘tages ancna] pas” Sry: pasos poser haar marae ‘neonng orem OFT ‘aaa! prove wn Geoptacnaoran, | (Rg 2460) ponr wt Cftwesr en endrega noeascl” | flr a pone rea, Seow pwtoawe orsnwrrcuar | rset herd tl TABLE 3.9. Muscles of Arm Bicaps brachit | Shorthoad:tipofcoracold | Tuberosiyof radius and ‘Supinats forearm and, when process of scapula fascia of ear va Hie supine, toce forearm Lang ieee aires) Bical sponouosis eculoctaneous none | sertteed Tei lotion fora beet sues Mpadonae otenouder CCoracobrachiais | Tip of coacoid process of Midd tird of medal Help flex and aut arm seapula Surface of moras Teast dsocaton of shoulder Brachiaie Dita half of anterior surace of | Coronid process and | Musculocutaneous nerve? | Flaxes forearm in all posione humerus beret une (C5. Ce) and ada neve (C5, C7) ‘Triceps brachii | Long head: intraglenoid tubercle | Proximalendot olecra- | Radial nerve (C8,C7,C8) | Cel extensor of forearm: of scapula ‘non of ulna and fascia of long head resists dislocation Lateral head: posterior surace | forearm ‘of humerus; especially impor. ‘of humerus, superior to radial tant during adduction groove ‘Medial head: posterior surface ‘of humerus, inferior to racial groove ‘Anconeus Lateral epicondyle of humerus | Lateral surface of olecra- | Radial nerve (C7,C8,T1) | Assists triceps in extending Ron and superior part of posterior surface of ulna Ion may abduct una cutng ronal Ser rr artes wee serrmey eee eT oar seer FoR) od Pane ad ai ‘Pair tonoe at ee estar tw a ene Mea eco er eserves mans Roaciorenttom ‘Sw woven eonmentecorge) | rare sorasean | OH oct are FO ramen rot | Unaerae rhe ‘acorn antpeooreor | Remit smsacwns | (rE ee ara wd Sera we oecn ‘named tonto ot dgerum ser ier ‘aneourertest | Madu pein common saree ramon ‘SSrowmenteocoe” | owmcimae | uesannane | Gunurpamrgnajne dae Poot Bamgeciraae | Haren | Gragg me ae om ae ecaeeraunga esp ie eer ‘esr gran prota OP) Medal pet Poamaltwee caren! | Sueeal ae pain. | Unurare | Heme dtl palargee dandSat reaowaenoncraracse | pecctanngstape | (10 Sos rmepnaanged ne Tineardinwonene | — ‘rp mnoare ‘se op. ‘re de panes 230 Seger ees Seaman ene on ‘mcr potcelongun | Armrarece main | Ease ctanatpnaur | seca om | Fema none apE 5 cies mocsonce | Strum ‘esarnare | (ue) sete en Prnator quadrats | Detlqurarotani | Ot qari Pepa ma copter rd Port sores cur fn onsun ore ‘TABLE 3.10 MUSCLES OF ANTERIOR COMPARTMENT OF FOREARM SS Ea Sachonate [Pain oniine | Liwatnracn tat | Rastcae Favs cn ra preteen ine | sabcradeepeons | tench peven octet erm recs ronan cowpea emma cap mca | unl npn-pcrnoyar | Onna ecattoen | Reale 8 CP) ‘Saunt | sap haer hancacane rer nc nogainang ste element some oarg ena car ce pa oat toa cowacecna) Satan eemr dgtanen | Sar graene nee pad 9 rae cocotyest | Sie ga Seemed =a Sayer emer oot net Eperereneraene | Setnarctmdtl eae n ot pracy ae om bars ropa ear ‘Sensual Semrsor cant anate | tawatopciare | Domne Cree ng acer ca eerste bau | Saracen Sexoetao ee gt wanoese Sg Soar rd 7 Lama wcang ome rs | apd mds | Supa war med Sepmeadecam | wieminrecsec | tone Cree ikarewen enone Botwartomne™ | pmaltrc arene weet Aeacorooncn ug | Fnwrrnscns, | Sano ineacaps ‘eae pune acer oe Eoin Siramancaa ar caorsatca ou | Pnmtormre trade | Comalepactenn | nizriomman | cewcs aul eaine ol hae a Tecumacime: | @amupana” | Tere TOR cet | Megane esr es Soren fare (etomtped eras soe ‘arsersetca be | nmr asin gas | Oommen be ‘aren aa net e ro Redadwcninoee | Spememauee Smeoaltgaline Saeneowe "| Rie sDscmmesoene ‘TABLE 3.11 MUSCLES OF POSTERIOR COMPARTMENT OF FOREARM TABLE 3.12. Arteries of Forearm and Wrist ‘As larger teinal branch of bra Chat arery cual ost ‘Anterior ulnar | Ulnar aor jst dal to ebow | Passes sper between brachinis and pronaoteres, uspyng bo hen anastomoses ‘current artery | Joint eh nlror una! clara arr antral econ (Fi. 387 pana vw) Posterior una | Unnar artery tal anieor nar | Passes superior, posarioro mada @picondyle and deep tendon of xo carp ‘ecurent artery nan hen recreate anastomoses with superar una coat artery ‘ar artery in cuba fossa, tal to orcaton of Brac tery ‘As wera tranches af common irtrossoou artery. between radi angina Posterior introsseous airy. between actus and una (nar artery tater Fe ars art aspect of wis doop oad ct fexo igtoram profs. _anastoroe wh fe pala cara branch oe rae airy. mig pala carpal ach (nar arery proximal piste Passes across dora sure of wns, deep extensor andons, 6 anastomose wih

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