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made with the belly of a scalpel, and subcutaneous fat is filleted or peeled to separate from skin and fascia. Fascia will then be carefully peeled away, making sure to note/preserve blood vessels and nerves. Superficial vessels and muscles can be fragile. The goal of the exercise is to expose the relevant anatomy of the upper extremity and then affix labels to them. No skin/muscle will be removed from the body, but the subcutaneous layer and fascia are removed and preserved alongside the body. Starting at the acromion of the shoulder, perform a circumferential cut anterior to posterior, going a little bit underneath the axilla. This should expose the heads of the shoulder muscles, once the subcutaneous layer and fascia have been removed. Observable anatomies of the shoulder and torso include: Muscles: -Pectoralis major / minor (ant) -Subclavius (ant) -Subscalpularis (ant above axilla) -Serratus anterior (ant in axilla) -Teres major / minor (post) -Supraspinatus (post) -Infraspinatus (post) -Latissimus dorsi (post) -Levator scapulae (post on neck) -Trapezius (post) -Rhomboid major/minor (post) Nerves: Branches of the brachial plexus are likely to be most observable. They are likely to be found with the blood vessels, although the roots and trunks will be buried deep in the neck area. These will continue down the brachium into the antebrachium, with the ulnar and median responsible for most of the hand. -Musculotaneous nerve -Axillary nerve -Median nerve -Radial nerve -Ulnar nerve Vessels: -Suprascapular artery (ant in neck, crossing subclavian artery and brachial plexus) -Subscapular artery (ant, from axillary artery and anastomoses with suprascapular artery) -Thoracoacromial artery (ant, from axillary artery) -Thoracodorsal artery (ant/lat, branch of subscapular artery) -Scapular circumflex artery (ant on scapula, branch of subscapular artery The next cut is proximal to distal from the starting circumferential on the shoulder. This cuts toward the lateral side and to the olecranon of the ulna. However, convenience may dictate cutting to the lateral epicondyle of the humerus instead. A next circumferential cut will be made 1-2cm above the cubital fossa to preserve the structures there. Skin is retracted and subcutaneous tissue and fascia peeled away to expose the muscles, vessels, and nerves. Observable anatomies of the brachium include: Muscles: -Deltoideus (lat/ant)
the thoracoacromial artery. basilica vein (med). The deep veins include the brachial vein on either side of the brachial artery. Continuing down it branches into the cephalic artery on the lateral side. under triceps) -Coracobrachialis (med superior near coracoids of scapula) Nerves: The brachial plexus is further explored as its branches continue down the brachium. cephalic vein (lat) should be on top or lateral of the aponeurosis. The axillary branches into the anterior/posterior circumflex humeral arteries. the axillary vein as its continuation. and the basilica artery on the medial side. The superficial upper extremity veins are the cephalic on the lateral and basilica on the medial. Retract/peel back the skin. remove the subcutaneous layer and fascia. Bisecting the aponeurosis will expose the brachial artery and cubital origins and insertions of the muscles of the arm. Continue dissecting a lateral cut past the olecranon / lateral epicondyle into the antebrachium and to the wrist.-Biceps brachii (ant with two heads) -Brachial (lat of biceps) -Triceps brachii (post/med) -Brachioradialis (inf of biceps. Vessels: The great vessels here follow a branching system. Observable anatomies of the antebrachium include: Anterior superficial muscles from lateral to medial: -Brachioradialis (lat/ant from brachium and cubital fossa) -Pronator teres (ant) -Flexor carpi radialis (ant from med epicondyle of humerus) -Palmaris longus (ant/med) -Flexor carpi ulnaris (med on ulna side) -Anconeus (lat/post) -Extensor carpi ulnaris (lat/post on ulna side) Posterior superficial muscles from lateral to medial: -Extensor digiti minimi (post) -Extensor digitorum (post) . It branches into the axillary artery and cephalic artery. They communicate through the vena mediana cubiti in the cubital fossa and then branches into accessory veins in the antebrachium. which becomes the subclavian vein at the sterna end of the clavicle where it unites with the internal jugular. being careful of superficial vessels. Then perform a circumferential cut at the wrist. This will reveal insertions of the biceps brachii and brachioradialis. The deep veins of the forearm are the venae comitantes of the radial and ulnar veins and arise from the deep and superficial volar venous arches in an anastomosis. The bicipital aponeurosis will be fibrous and cover transversely the origins of the antebrachium flexors. -Axillary artery/vein -Basilic vein -Cephalic vein -Brachial artery -Profunda brachii artery (deep branch of brachial artery) -Anterior circumflex humeral artery -Posterior circumflex humeral artery/vein -Median cubital vein At slightly above the cubital fossa. the circumferential cut is made and underlying subcutaneous layer and fascia removed. the brachial artery deep within brachium. slightly before the radioulnar articulation since this area is complex and continues into the hand. subscapular artery. The subclavian sources from the aortic arch on the left and brachiocephalic on the right side of the body. The median cubital vein.
The radial nerve descends between the brachialis and brachioradialis on top of the lateral epicondyle. The radial artery is the main blood vessel of the lateral forearm. giving branches to extensor muscles.-Extensor carpi radialis brevis/longus (med/post/proximal) Intermediate layer of muscle: Pronator teres and brachioradialis muscles are retracted to expose the middle layer of antebrachium. accompanied by the radial vein. -Flexor pollicis longus (ant/lat) -Flexor digitorum profundus (ant) -Pronator quadratus (ant/lat near wrist) The deep layer of the posterior forearm can be accessed after retracting/bisecting the extensor digitorum and extensor digiti minimi. The deep branch is larger and pierces the supinator. brachial artery) -Posterior interosseous nerve (continuation of radial nerve after the supinator) Vessels: The ulnar artery is the main blood vessel of the medial forearm. descending deep on flexor digitorum profundus. arising from the brachial artery bifurcation in the cubital fossa. closer to wrist) -Extensor pollicis brevis/longus (med/post/distal) -Supinator (post/med. curving around the lateral radius. They lay underneath the extensor carpi ulnaris and extensor carpi radialis brevis. called the carpal tunnel. It then passes posteriorly in the distal forearm deep to the tendon of brachioradalis. and accompanies the ulnar artery near the middle of the antebrachium. large) Retract the extensor digiti minimi and extensor digitorum on posterior of antebrachium to expose: -Abductor pollicis longus (post under extensor digitorum) Deep layer of muscle: The flexor digitorum superficialis is either retracted or bisected to reveal the deep layer of muscles. It then passes under the annular ligament. medial to axillary artery. medial and posterior cutaneous antebrachial nerves (from medial cord of brachial plexus. joining with the radial artery. The radial artery joins with the deep branch of the ulnar artery. deep to the tendon of plamaris longus. piercing the deep fascia before the wrist. -Deep radial nerve -Radial Nerve -Ulnar nerve -Laterial. The interosseous arteries arise below the tuberosity of the radius from the ulnar . arising from the brachial artery and terminates in the superficial palmar arch. -Extensor indicis (lat/post under extensor digiti minimi. to enter the palm of the hand. proximal and diagonally transverse) -Abductor pollicis longus (med/post/distal) Nerves: The median nerve at the cubital fossa lies internal to the brachial artery next to the biceps brachii tendon on the brachialis muscle. The superficial branch is the direct continuation of the radial nerve. The anterior interosseous nerve arises from the median nerve in the distal cubital fossa and passes deep to the pronator quadratus. between the tendons of flexor digitorum superficialis and flexor carpi ulnaris. anterior to pronator teres and under the cover of brachioradilias. It crosses the ulnar artery obliquely then passes downward between the superficial and deep layers of muscles. dividing into superficial and deep branches in the antebrachium. accompanied by the ulnar veins. The ulnar nerve passes posterior to the medial epicondyle of humerus and passes between the two heads of flexor carpi ulnaris into the forearm. The radial winds laterally around the wrist between the heads of the first dorsal interosseous muscle that occupy the space between the metacarpals. It becomes more superficial in the distal part of the antebrachium. The Palmaris longus and flexor carpi ulnaris are then retracted to expose: -Flexor digitorum superficialis (ant under flexor carpi ulnaris/radialis.
and the big pollicis muscles make up most of the lateral art of the hand. lateral to the ulnar nerve. radial. It ends by supplying adductor pollicis and deep head of flexor pollicis. Observable anatomies include: Muscles: -Abductor digiti minimi -Abductor pollicis brevis -Adductor pollicis -Flexor digiti minimi brevis -Flexor pollicis brevis/longus -Hypothenar muscle -Interosseous muscles -Lumbricals -Opponens digiti minimi -Opponens pollicis -Thenar muscle Nerves: Broken into cutaneous (superficial) and motor groups. supplying the skin and palmar brevis muscle. flexor digitorum profundus. There are muscles in between the metacarpals. It follows with the tendons of flexor digitorum superficialis. and flexor pollicis longus. going across the fingertips and into the valleys of each finger. The median nerve sends off a recurrent branch of the thenar compartment muscles. -Fibrous digital sheaths -Flexor retinaculum -Median nerve -Radial nerve -Recurrent branch of the median nerve -Tendons of flexor digitorum profundus and superficialis -Ulnar nerve Vessels: . The posterior cutaneous nerve of forearm arises from the radial nerve in the arm can identified over the metacarpals. The volar surface has superficial vessels. perforating opponens digiti minimi and follows the deep palmar arch. dividing into anterior and posterior interosseous branches at the border of the interosseous membrane between ulna and radius. Vessels continue from the wrist from the ulnar artery into the lateral and medial sides of the fingers. and the muscles and nerves are protected by layers of aponeurosis. There are 4 nerves coming into the general area of the hand: posterior antebrachial cutaneous. The skin is then peeled back very carefully to expose the very intricate anatomy of the hand. The median nerve follows under the carpal tunnel (flexor retinaculum). ulnar. The carpal tunnel ligament should be cut to reveal the deeper muscles and nerves of the hand. Nerves from the median and ulnar nerves innervate the finger muscles and also receive information from the skin of the hand. -Ulnar artery/vein -Radial artery/vein -Interosseous arteries (deep) -Median cubital vein (connects basilica and cephalic veins in cubital fossa) The dissection continues into the hand with a continuous cut from the wrist up the lateral side of the hand. and digital cutaneous branches to the fingers coronally into the fingers and across the fingertips. Tendons from flexor digitorum profundus and superficialis go into the hand. bisecting the skin of the hand in the coronal plane. The ulnar nerve’s deep branch passes between abductor digiti minimi and flexor digiti minimi brevis. supplying the hypothenar muscles.artery. and median. and the third and fourth lumbricals. all the interosseous muscles. The ulnar’s dorsal branch and radial nerves continue on their respective sides over the dorsum of the hand. The ulnar nerve’s superficial branch continues on the medial side but within the hand.
I to V lateral to medial. and five distals (thumb only has proximal and distal) . forming basilica and cephalic veins into forearm) Bones of the hand: Carpal. I being of the thumb Phalanges: Five proximals. deep) -Dorsal venous plexus of the hand (post/dorsal.-Ulnar artery (med. wrist: -Scaphoid -Lunate -Triquetrum -Pisiform -Trapezium -Trapezoid -Capitate -Hamate. hook of hamate Five metacarpals. four middles. deep) -Radial artery (lat.
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