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Upper extremity
Surface anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial Plexus
Brachial plexus formation…. ,[object Object],[object Object],[object Object]
Brachial plexus formation…. ,[object Object],[object Object],[object Object],[object Object]
Brachial plexus formation… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial plexus formation… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial plexus formation… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial plexus formation… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anesthesia of the Brachial Plexus ,[object Object]
Peripheral nerve blockade ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial plexus blockade  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Injuries ,[object Object],[object Object],[object Object]
The cardinal signs of brachial plexus avulsion are: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial Plexus and Nerves of Upper limb Supraclavicular nerve  Origin  Muscle distribution  Dorsal scapular Ventral rami of C4, C5 Rhomboids & Lev. scapulae Long thoracic Ventral rami of C4- C7 Serratus anterior Nerve to subclavius Superior trunk, C4- C6 Subclavius, sternoclavicular joint Suprascapular  Superior trunk, C4-C6 Supraspinatus, infraspinatus, glenohumeral (shldr) joint
Infraclavicular nerves Origin  Muscle distribution Lateral pectoral Lateral cord, C5-C7 Pectoralis major, pectoralis minor Musculocutaneous Lateral cord, C5-C7 Coracobrachialis, biceps brachii, brachialis,  Median Lateral cord, C6-C7 Flexor carpi ulnaris, flexor digitorum profundus Medial pectoral Medial cord, C8-T1 Pectoralis major/minor Medial brachial cutaneous Medial cord C8-T1 Skin on medial side of arm. Medial antebrachial cutaneous Medial cord, C8-T1 Skin over medial side of forearm
Infraclavicular nerve Origin Muscle distribution Ulnar Terminal of medial cord, C7, C8- T1 Half of flexor forearm muscles, small muscles of hand, skin on medial of hand to ring finger Upper subscapular Posterior cord, C5-C6 Superior subscapularis Thoracodorsal Posterior cord, C6-C8 Latissimus dorsi Lower subscapular Posterior cord, C5-C6 Inferior subscapularis and teres major Axillary Terminal posterior cord, C5- C6 Teres minor, deltoids, shoulder joints, skin over inferior deltoids. Radial Terminal posterior cord, C5- C6 Triceps brachii, anconeus, brachioradialis, extensor muscles of forearm, skin over post. Aspect of arm and forearm.
Muscle Origin Insertion Nerve Action  Biceps brachii Coracoid process, supraglenoid tubercle Radial tuberosity, biciptal aponeurosis Musculocutaneous C5 – C6 Supinates forearm, flexes forearm Brachialis  Anterior surface of distal humerus Coronoid process, ulna tuberosity Musculocutaneous C5 – C6 Flex and adducts arms Cracobrachialis Coronoid process of scapula Mid3rd medial surface humerus Musculocutaneous C5 – C7 Flex and adducts arm Triceps brachii LH:Infraglenoid tubercle Lat hd: post humerus sup. To radial groove Medial Hd: post. Humerus inf. To radial groove Olecranon of ulna and fascia of forearm Radial nerve C6 – C8 Extend forearm, long head steadies head of humerus Anconeus Lateral epicondyle Humerus Lat. Surface olecranon sup of ulna Radial nerve C7 – T1 Assist triceps to extend forearm, stabilize elbow, adducts ulna in pronation
Break
Axillary artery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial artery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Venous return ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lymphatic drainage ,[object Object],[object Object],[object Object],[object Object]
Ligaments of the Glenohumeral Joint. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ligaments of the Rotator Cuff ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Muscles of the shoulder ,[object Object],[object Object],[object Object],[object Object],[object Object]
Deep ( Intrinsic) muscles ,[object Object],[object Object],[object Object],[object Object]
Bursas of the Shoulder  ,[object Object],[object Object]
Muscles of the Back
Superficial muscles Muscle Origin Insertion Action  Nerve  Trapezius Occiput, nuchal line Clavicle, acromion, spine of scapula Rotator, adductor, lowers the scapula.  Spinal accessory nerve Latissimus dorsi Thoraco-Lumbar fascia,spines of lumbar & sacral, iliac crest, lower 4 ribs Intertubercular groove or bicipital groove. Extends, adducts, median rotator of shoulder Thoraco dorsal ( long subscapular)
Superficial, rhomboid layer… Muscle Origin Insertion Action  Nerve  Levator scapula Post, tubercle and transverse process  C1-4 Medial border scapula, higher Elevator and rotator of scapula Dorsal scapular nerve Rhomboid minor Nuchal lig. Spine C7-T1 Medial border scapula, lower Adduct scapula medially, depressor of scapula Dorsal scapular nerve Rhomboid major Spine T2 – T5,  supraspinous lig. Medial border lower Adduct scapula medially, depressor  Dorsal scapular nerve
Deep muscles of the back, transverse- costal group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Deep layer, Transverse-spinal group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suboccipital muscle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Actions, general…. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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  • 16. Brachial Plexus and Nerves of Upper limb Supraclavicular nerve Origin Muscle distribution Dorsal scapular Ventral rami of C4, C5 Rhomboids & Lev. scapulae Long thoracic Ventral rami of C4- C7 Serratus anterior Nerve to subclavius Superior trunk, C4- C6 Subclavius, sternoclavicular joint Suprascapular Superior trunk, C4-C6 Supraspinatus, infraspinatus, glenohumeral (shldr) joint
  • 17. Infraclavicular nerves Origin Muscle distribution Lateral pectoral Lateral cord, C5-C7 Pectoralis major, pectoralis minor Musculocutaneous Lateral cord, C5-C7 Coracobrachialis, biceps brachii, brachialis, Median Lateral cord, C6-C7 Flexor carpi ulnaris, flexor digitorum profundus Medial pectoral Medial cord, C8-T1 Pectoralis major/minor Medial brachial cutaneous Medial cord C8-T1 Skin on medial side of arm. Medial antebrachial cutaneous Medial cord, C8-T1 Skin over medial side of forearm
  • 18. Infraclavicular nerve Origin Muscle distribution Ulnar Terminal of medial cord, C7, C8- T1 Half of flexor forearm muscles, small muscles of hand, skin on medial of hand to ring finger Upper subscapular Posterior cord, C5-C6 Superior subscapularis Thoracodorsal Posterior cord, C6-C8 Latissimus dorsi Lower subscapular Posterior cord, C5-C6 Inferior subscapularis and teres major Axillary Terminal posterior cord, C5- C6 Teres minor, deltoids, shoulder joints, skin over inferior deltoids. Radial Terminal posterior cord, C5- C6 Triceps brachii, anconeus, brachioradialis, extensor muscles of forearm, skin over post. Aspect of arm and forearm.
  • 19. Muscle Origin Insertion Nerve Action Biceps brachii Coracoid process, supraglenoid tubercle Radial tuberosity, biciptal aponeurosis Musculocutaneous C5 – C6 Supinates forearm, flexes forearm Brachialis Anterior surface of distal humerus Coronoid process, ulna tuberosity Musculocutaneous C5 – C6 Flex and adducts arms Cracobrachialis Coronoid process of scapula Mid3rd medial surface humerus Musculocutaneous C5 – C7 Flex and adducts arm Triceps brachii LH:Infraglenoid tubercle Lat hd: post humerus sup. To radial groove Medial Hd: post. Humerus inf. To radial groove Olecranon of ulna and fascia of forearm Radial nerve C6 – C8 Extend forearm, long head steadies head of humerus Anconeus Lateral epicondyle Humerus Lat. Surface olecranon sup of ulna Radial nerve C7 – T1 Assist triceps to extend forearm, stabilize elbow, adducts ulna in pronation
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  • 31. Superficial muscles Muscle Origin Insertion Action Nerve Trapezius Occiput, nuchal line Clavicle, acromion, spine of scapula Rotator, adductor, lowers the scapula. Spinal accessory nerve Latissimus dorsi Thoraco-Lumbar fascia,spines of lumbar & sacral, iliac crest, lower 4 ribs Intertubercular groove or bicipital groove. Extends, adducts, median rotator of shoulder Thoraco dorsal ( long subscapular)
  • 32. Superficial, rhomboid layer… Muscle Origin Insertion Action Nerve Levator scapula Post, tubercle and transverse process C1-4 Medial border scapula, higher Elevator and rotator of scapula Dorsal scapular nerve Rhomboid minor Nuchal lig. Spine C7-T1 Medial border scapula, lower Adduct scapula medially, depressor of scapula Dorsal scapular nerve Rhomboid major Spine T2 – T5, supraspinous lig. Medial border lower Adduct scapula medially, depressor Dorsal scapular nerve
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