Introduction to limbs Sanjaya Adikari Department of Anatomy

Main topics covered • Skeleton • Superficial nerves/veins – only the important ones • Dermatomes • Muscle compartments – attachment & action of muscle groups and their innervation • Brachial plexus & lumbosacral plexus

Main topics…. • Special regions: axilla, cubital fossa, carpal tunnel, snuff box, femoral triangle, cubital fossa, gluteal region etc. • Joints with ligaments • Arterial anastomoses • Lymph drainage

Skeleton • Axial • Skull • Vertebral column & ribs • Appendicular • Limb girdles • Bones of the limbs

Upper limb

Skeleton Shoulder/pectoral girdle Arm (humerus) Fore arm (radius, ulna) Wrist (carpal bones) Hand (metacarpals, phalanges)

Superficial veins & nerves

Dermatomes

Muscles of the shoulder • Flexors • Extensors • Internal/medial rotators • External/ lateral rotators • Abductors • Adductors

Compartments of the right arm • Anterior Coracobrachialis Biceps brachii Brachialis N: musculocutaneous C 5, C 6 • Posterior Triceps N: Radial nerve C 7, C 8

Contents of the right arm compartments

Compartments of the right forearm Pronator teres………. Flexor digitorum superficialis Flexor pollicis longus Flexor digitorum profundus Pronator quadratus

Brachial plexus

Axilla Transverse section Anterior wall Posterior wall Medial wall Lateral wall Apex Floor

Cubital fossa

Anterior aspect of wrist • Median and ulnar nerves • Radial and ulnar arteries • Tendons of flexor muscles • Flexor retinaculum

Carpal tunnel Palmar branch of median nerve

Anatomical snuffbox

Hand • Dorsum • Palm

Joints with ligaments

Arterial anastomoses Anastomosis around the elbow Scapular anastomosis

Axillary lymph nodes To thoracic duct or right lymphatic duct supraclavicular apical central posterior anterior lateral

Lower limb

Skeleton Pelvic girdle Thigh (femur) Leg (tibia, fibula) Ankle (tarsal bones) Foot (metatarsals, phalanges)

Skeleton of the foot

Superficial veins & nerves

Posterior arch vein

Adductor canal perforator Below knee perforator Lateral perforator Upper medial perforator Middle medial perforator Level of medial malleolus Lower medial perforator

Dermatomes

Fascia Lata

Femoral sheath

Compartments of the right thigh Fascia lata

Innervation Anterior compartment Femoral nerve Medial compartment Obturator nerve Posterior compartment Sciatic nerve

Compartments of the right leg

Innervation Anterior compartment Deep peroneal nerve Lateral compartment Superficial peroneal nerve Posterior compartment Tibial nerve

Lumbosacral plexus

Femoral triangle

Gluteal region

Popliteal fossa Right Se. Mem Se. Tend Gastroc Biceps Popliteal surface of femur Gastroc Popliteus muscle

Foot • Dorsum • Sole

Arches of the foot Medial longitudinal arch Lateral longitudinal arch Transverse arch:

Joints with ligaments Ligaments at the knee joint Ligaments at the ankle

Trochanteric & Cruciate anastomoses

Inguinal lymph nodes • Deep inguinal nodes • Superficial inguinal nodes ‐ Vertical group ‐ Horizontal group