Upper Limb Topography Fossa axillaris n n n

Upper Limb Topography

Fossa axillaris n n n Between arm and chest Boundaries – Anteriorly – mm. pectorales – Dorsally = latissimus dorsi, teres major, subscapularis – Medially = serratus anterior – Laterally = sulcus bicipitis Content – Lymph nodes, vessels, pl. brachialis

Foramen axillare laterale et mediale

Posterior of the arm Surface anatomy M. triceps brachii caput longum, medialis, lateralis Surface elements Skin thick and movable Subcutaneous tissue well expressed n. cutaneus brachii posterior n. cutaneus brachii lateralis inferior n. cutaneus antebrachii posterior

Deep structures А. Fascia brachialis - Thick, thins distally B. Neurovascular bundles 1. Upper - in canalis humero-muscularis, between: - sulcus n. radialis - medial and lateral head of m. triceps brachii 1. 1. n. radialis – lies on the humerus - n. cutaneus brachii lateralis inerior - n. cutaneus antebrachii posterior - rr. musculres 1. 2. a. profunda brachii - a. collateralis media - collateralis radialis

Lower neurovascular bundle behind medial epicondyle n. ulnaris a. collateralis ulnaris inferior

Elbow region

Anterior elbow Surface anatomy Three eminences Two grooves Elements Lateral groove - v. cephalica, n. cutaneus antebrachii lateralis Medial groove – v. basilica, n. cutaneus antebrachii medialis V. mediana cubiti

Deep structures А. Muscles Flexors of forearm – medial eminence Extensors of forearm – lateral eminence Brachial muscles, mm. biceps, brachialis – middle eminence

Deep structures B. Vessels and nerves Medial bundle - between m. biceps brachii and pronator teres - a. v. brachialis, n. medianus Lateral bundle - between m. brachialis and brachioradialis - n. radialis, a. collateralis radialis, a. recurrens radialis C. Cubital fossa Boundaries - m. brachioradialis (lateral), m. pronator teres (medial) Content - tendo m. brachialis, m. biceps brachii, bursa bicipitoradialis

Layers of the elbow Venous 1 v. cephalica 2 v. basilica 3 v. mediana cubiti Apponeurotic 1 aponeurosis bicipis 2 tendo m. biceps brachii

Neurovascular 1 a. brachialis 2 n. medianus Muscle 1 m. supinator 2 m. brachialis 3 tendo m. biceps brachii Bone 1 humerus 2 radius 3 ulna

The palm

Surface Anatomy of Upper Limb n Carpal Tunnel – – – Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve – Inflammation of tendons = compression of Median nerve n Anatomical Snuffbox – Lateral = E. pollicis brevis – Medial = E. pollicis longus – Floor = scaphoid, styloid of radius – Contains Radial Artery (pulse) pg 306, 788

Muscles of the Wrist n Extensor muscles – Extensor Retinaculum n What’s its function? – Muscles innervated by radial nerve – There are 8 n Name them…

Muscles of the Wrist Flexor Muscles n n Flexor retinaculum (transverse carpal ligament) Two compartments – Superficial – 4 – Deep – 3 – Name them… n Innervated by median and ulnar nerve

Wrist and Hand Anatomy n n Nerves/Vessels – Radial & ulnar artery and veins – Radial, ulnar, & median nerves Carpal Tunnel – Flexor Tendons - 9 – Median Nerve

Surface anatomy - Medial and lateral eminence and middle depression - Flexion grooves - Commissural pads Surface elements Skin- thick, hairless - Attached to palmar aponeurosis – in the middle - Loose connective tissue in the eminences - r. palmaris (n. medianus), r. cutaneus palmaris (ulnaris) - small veins Aponeurosis palmaris – thick fibrous tissue - superficial layer – tendinous fibers of m. palmaris longus, - deep layer – transverse fibers, lig. metacarpeum transversum superficiale

Deep compartments Intermuscular septae and Palmar interosseous fascia form - Three fascial compartments Lateral (thenar) compartment Muscle - 4 layers - M. abductor pollicis brevis - M. opponens pollicis, m. flexor pollicis brevis (caput superfic. ) - M. flexor pollicis brevis (caput profundus) - M. adductor pollicis Nerves - r. muscularis n. medianus Vessels - r. palmaris superficialis a. radialis Two connective tissue spaces – above and below m. adductor pollicis

Medial (hypothenar) compartment Muscles - 2 layers - Superficial - m. abductor digiti minimi, m. flexor digiti minimi - Deep - m. opponens digiti minimi Nerves – superficial and deep branches of n. ulnaris Vessels - superficial and deep branches of a. ulnaris M. palmaris brevis - proximal

Middle compartment Muscular tendinous layer: - mm. flexores digitorum superficialis & profundus - mm. lumbricales - vagina synovialis communis flexorum Two spaces а. Superficial – below palmar aponeurosis - arcus palmaris superficialis - aa. digitales palmares communes - n. medianus - nn. digitales palmares communis - r. palmaris n. ulnaris - n. digitalis palmaris communis IV & n. digitalis palmaris proprius V Interfascial canals - distal - mm. lumbricales, a. n. palmares digitales comm. et propriae

Middle compartment b. Deep space - below palmar interosseous fascia - communications: forearm - trough carpal canal superficial space – interfascial canals - arcus palmaris profundus - a. radialis + r. profundus a. ulnaris - aa. metacarpales palmares - aa. digitales palmares communes - deep branch of r. palmaris n. ulnaris supplying - mm. hypothenari, mm. interossei, m. adductor pollicis и mm. lumbricales II - IV.