The Upper Limb

The Upper Limb

1. Muscles

   • Pectoral and Shoulder Regions
     • Serratus Anterior
       • - rotates the scapula = allows arm to be raised above 90 degrees - long thoracic nerve = when damaged "winging of the scapula" (long thoracic nerve palsy) is produced as serratus anterior is paralysed  - thought to occur from traction injuries where upper limb is stretched violently 
     • Pectoralis Major
       • - adducts and medially rotates upper limb - draws scapula anteroinferiorly - lateral and medial pectoral nerves 
     • Pectoralis Minor
       • - stabilises the scapula by drawing it anteroinferiorly against the thoracic wall - medial pectoral nerve
     • Subclavius
       • - anchors and depresses the clavicle - nerve to subclavius 
     • Intrinsic
       • Subscapularis
         • - subscapular fossa - lesser tubercle  - upper and lower subscapular nerves - medially rotates the arm
         • Rotator Cuff
           • - gives glenohumeral joint a lot of additional stability - pull humeral head into glenoid fossa - repetitive use of shoulder joint --> rotator cuff tendonitis  - Swimmers shoulder = overuse of supraspinatus muscle  - causes inflammation and degenerative changes in the tendon itself
       • Supraspinatus
         • - supraspinatus fossa - greater tubercle of humerus - suprascapular nerve - abducts arm first 15 degrees - assists deltoid after that
       • Infraspinatus
         • - infraspinatous fossa - greater tubercle  - suprascapular nerve - laterally rotates arm
       • Teres Minor
         • - posterior surface of scapula - greater tubercle of humerus - axillary nerve - laterally rotates the arm
       • Deltoid
         • - originates from scapula and clavicle - attaches to deltoid tuberosity on the lateral surface of humerus - axillary nerve - anterior fibers flex arm at the shoulder  - posterior fibres extend arm at shoulder  - middle fibres major abductor of the arm  - takes over from supraspinatus 
       • Teres Major
         • - forms inferior border of quadrangular space - originates from posterior surface of the inferior angle of the scapula - attaches to intertubercular groove of the humerus - lower subscapular nerve - adducts at shoulder and medially rotates the arm
     • Extrinsic
       • - originate from torso and attach to bones of the shoulder 
       • Trapezius
         • - originates from skull - fibres attach to clavicle, acromion and scapula spine - accessory nerve - proprioceptor fibres from C3 and C4 spinal nerves - upper fibres elevate scapula and rotates it during abduction of the arm - middle fibres retract scapula - lower fibres full scapula inferiorly
       • Latissimus Dorsi
         • - thoracodorsal nerve - extends, adducts and medially rotates the upper limb
       • Rhomboid Major
         • - attaches to medial border of the scapula, between the scapula spine and inferior angle  - dorsal scapular nerve - retracts and rotates scapula
       • Rhomboid Minor
         • - attaches to medial border of scapula, at level of the spine of scapula - dorsal scapula nerve - retracts and rotates the scapula
       • Levator Scapulae
         • - attaches to medial border of the scapula - dorsal scapular nerve - elevates the scapula 
   • Arm
     • Anterior
       • Biceps brachii
         • - 2 headed - gives of the bicipital aponeurosis - supraglenoid tubercle of scapula = long head - coracoid process of scapula = short head - inserts into radial tuberosity and fascia of the forearm via bicipital aponeurosis - supination of the forearm - rupture of long head = popeye sign- flexes arm at elbow and at shoulder- musculocutaneous nerve 
       • Brachialis
         • - medial and lateral surfaces of humeral shaft  - inserts into ulna tuberosity - flexion at elbow - musculocutaneous nerve with contributions from radial nerve
       • Coracobrachialis
         • - coracoid process - flexion of arm at shoulder - weak adduction - musculocutaneous nerve
     • Posterior
       • Triceps brachii
         • - 3 headed - long head = infraglenoid tubercle - lateral head = humerus superior to radial groove  - medial head = inferior to radial groove - all insert into olecranon of ulna - extension of arm at elbow - radial nerve
   • Forearm
     • Posterior
       • Superficial
         • Brachioradialis
           • - flexes at elbow - radial nerve
         • Extensor Carpi Radialis Longus
           • - supracondylar ridge - extends and abducts wrist -radial nerve
         • Extensor Carpi Radialis Brevis
           • - lateral epicondyle - extends and abducts wrist - radial nerve
         • Extensor Digitorum
           • - lateral epicondyle - extends medial 4 fingers at the MCP and IP joints - radial nerve
         • Extensor Digiti Minimi
           • - lateral epicondyle - extends little fingers, contributes to extension at wrist - radial nerve (deep branch)
         • Extensor Carpi Ulnaris
           • - lateral epicondyle - extension and adduction of wrist - radial nerve (deep branch)
         • Aconeus
           • - lateral epicondyle - extends and stabilises elbow joint - abducts ulna during pronation of the forearm - radial nerve
       • Deep
         • Supinator
           • - lateral epicondyle and posterior surface of ulna - supinates forearm - radial nerve (deep branch)
         • Abductor Pollicis Longus
           • - interosseous membrane and adjacent posterior surfaces of radius and ulna - abducts thumb - radial nerve (posterior interosseous branch)
         • Extensor Pollicis Brevis
           • - posterior surface of ulna and interosseous membrane - extends at MCP and CM joints - radial nerve (posterior interosseous branch)
         • Extensor Pollicis Longus
           • - posterior surface of ulna and interosseous membrane - extends all joints of the thumb - radial nerve (posterior interosseous branch)
         • Extensor Indices
           • - posterior surface of ulna and interosseous membrane - extends index finger - radial nerve (posterior interosseous branch)
     • Anterior
       • Superficial
         • Flexor Carpi Radialis
           • - medial epicondyle - flexion and abduction at wrist - median nerve
         • Palmaris longus
           • - flexion and abduction of wrist - median nerve - medial epicondyle
         • Flexor carpi ulnaris
           • - ulnar nerve - flexion and adduction at wrist - medial epicondyle
         • Pronator Teres
           • - 2 attachments = medial epicondyle and coronoid process of ulna - pronation of forearm - median nerve
       • Intermediate
         • Flexor Digitorum Superficialis
           • - medial epicondyle and radius - flexes MCP joints and PIP joints  - flexes at wrist - median nerve
       • Deep
         • Flexor Digitorum Profundus
           • - ulna and associated interosseous membrane - only muscle that can flex DIP joints of fingers - also flexes MCP joiints and at wrist - medial half = ulnar nerve - lateral half = median nerve
         • Pronator Quadratus
           • - anterior surface of ulna - pronates forearm - median nerve (anterior interosseous branch)
         • Flexor Pollicis Longus
           • - lies laterally to FDP - anterior surface of radius and surrounding interosseous membrane - flexes IP joint and MCP join of thumb - median nerve (anterior interosseous branch)
   • Hand

2. Brachial Plexus

   • Median n.
   • Musculocutaneous n.
   • Ulnar n.
   • Radial n.
   • Axillary n.

3. Bones

   • Shoulder Area
     • Scapula
     • Clavicle
       • Function  - attaches upper limb to trunk - protects underlying neurovascular structures supplying - transmits force from upper limb to axial skeleton Bony landmarks- sternal ended has large facet for articulation with the manubrium of the sternum- costoclavicular ligament attaches to inferior surface of sternal end- conoid tubercle where the conoid ligament attaches- trapezoid line where the trapezoid ligament attaches Clinical RelevanceFracture: most common is junction of the medial 2/3 and lateral 1/3. Suprascapular nerves (medial, intermedial and lateral) can be damaged by upwards movement of the medial part of the the fracture = waiter's tip 
   • Arm
     • Humerus
   • Forearm
     • Ulna
     • Radius
   • Hand

4. Vasculature

5. Clinical Examination

   • Shoulder
   • Wrist
   • Hand
   • Systems Review

Imagens e arquivos do mapa