Transcript 08-Arm.ppt

ARM
SENSORY
INNERVATION
• The sensory supply over the upper half of
the deltoid is from the supraclavicular
nerves (C3 and 4).
• Over the lower half of the deltoid is from
the upper lateral cutaneous nerve of the
arm, a branch of the axillary nerve (C5
and 6).
• Over the lateral surface of the arm below
the deltoid is from the lower lateral
cutaneous nerve of the arm, a branch of
the radial nerve (C5 and 6). (SAR)
• The armpit and the medial side of the arm
are from the medial cutaneous nerve of
the arm (T1) and the intercostobrachial
nerves (T2).
• The back of the arm is from the posterior
cutaneous nerve of the arm, a branch of
the radial nerve (C8).
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• The sensory supply over the upper half of
the deltoid is from the supraclavicular
nerves (C3 and 4).
• Over the lower half of the deltoid is from
the upper lateral cutaneous nerve of the
arm, a branch of the axillary nerve (C5
and 6).
• Over the lateral surface of the arm below
the deltoid is from the lower lateral
cutaneous nerve of the arm, a branch of
the radial nerve (C5 and 6). (SAR)
• The armpit and the medial side of the arm
are from the medial cutaneous nerve of
the arm (T1) and the intercostobrachial
nerves (T2).
• The back of the arm is from the posterior
cutaneous nerve of the arm, a branch of
the radial nerve (C8).
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SUPERFICIAL
VEINS
• The veins of the upper
limb can be divided into
two groups:
1. superficial and
2. deep.
• The deep veins comprise
the venae comitantes,
which accompany all the
large arteries, usually in
pairs, and the axillary
vein.
• The superficial veins of
the arm lie in the
superficial fascia.
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• Cephalic vein ascends in
the superficial fascia on the
lateral side of the biceps
and, on reaching the
infraclavicular fossa, drains
into the axillary vein.
• Basilic vein ascends in
the superficial fascia on the
medial side of the biceps.
• Halfway up the arm, it
pierces the deep fascia
and at the lower border of
the teres major joins the
venae comitantes of the
brachial artery to form the
axillary vein.
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SUPERFICIAL
LYMPH VESSELS
• The superficial lymph
vessels draining the
superficial tissues of the
upper arm .
• Those from the lateral side
of the arm follow the cephalic
vein to the infraclavicular
group of nodes;
• Those from the medial side
follow the basilic vein to the
lateral group of axillary
nodes.
• The deep lymphatic vessels
draining muscles and deep
structures drain into the
lateral group of axillary
nodes.
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FASCIAL
COMPARTMENTS
OF THE UPPER ARM
• The arm is enclosed in
a sheath of deep
fascia.
• Two septa, medial &
lateral, extend from
this sheath, to the
medial & lateral
supracondylar ridges
of the humerus.
• So the arm is divided
into ant. & post.
compartments, each
having its muscles,
nerves, and arteries.
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ANTERIOR
COMPARTMENT
Muscles:
1. Biceps brachii,
2. Brachialis, and
3. Coracobrachialis.
CONTENTS
Blood supply:
Brachial artery.
Nerve supply to the muscles:
Musculocutaneous nerve.
Why coracobrachialis is
not seen in this cut?
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• Structures passing through the
compartment:
1.
2.
3.
4.
5.
musculocutaneous,
median, and
ulnar nerves;
brachial artery and
basilic vein.
• The radial nerve is present in the
lower part of the compartment.
Why the cephalic
vein is not listed?
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MUSCLES OF THE
ANTERIOR
COMPARTMENT
BICEPS BRACHII
• Origin:
– The long head from the supraglenoid tubercle it
is itracapsular but extrasynovial
– the short head from the tip of the coracoid
process of the scapula.
– The tendon of the long head emerges from the
joint capsule surrounded by a synovial sheath
and lying in the bicipital groove of the humerus.
– It is joined in the middle of the upper arm by the
short head.
• Insertion: Into the posterior part of the
radial tuberosity and, by an aponeurotic
band called the bicipital aponeurosis,
into the deep fascia on the medial aspect
of the forearm.
• The aponeurosis protects underlying
structures present in the cubital fossa.
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• Nerve supply:
Musculocutaneous nerve.
• Action:
• The biceps is a powerful
flexor of the elbow joint
and a weak flexor of the
shoulder joint.
• The biceps is also a
strong supinator of the
flexed forearm.
• Corkscrews are designed
to make use of this
powerful supination action
in twisting & driving the
screws into wood with a
screwdriver.
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CORACOBRACHIALIS
• Origin: tip of the
coracoid process.
• Insertion: Into the
middle of the medial
side of the shaft of
the humerus.
• Nerve supply:
Musculocutaneous n.
• Action:
• It flexes the arm
• Weak adductor.
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CORACOBRACHIALIS
• Origin: tip of the
coracoid process.
• Insertion: Into the
middle of the medial
side of the shaft of
the humerus.
• Nerve supply:
Musculocutaneous n.
• Action:
• It flexes the arm
• Weak adductor.
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BRACHIALIS
• Origin: From the front
of the lower half of the
humerus.
• Insertion: Into the
anterior surface of the
coronoid process of the
ulna.
• Nerve supply:
Musculocutaneous
nerve. Its lateral half, is
supplied by the radial
nerve.
• Action: powerful
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flexion of the elbow
joint.
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BRACHIALIS
• Origin: From the front
of the lower half of the
humerus.
• Insertion: Into the
anterior surface of the
coronoid process of the
ulna.
• Nerve supply:
Musculocutaneous
nerve. Its lateral half, is
supplied by the radial
nerve.
• Action: powerful
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flexion of the elbow
joint.
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STRUCTURES PASSING THROUGH
THE ANTERIOR FASCIAL
COMPARTMENT OF THE UPPER ARM
BRACHIAL ARTERY
• It is the continuation of
the axillary artery, at the
lower border of teres
major.
• It provides the main
arterial supply to the arm.
• It terminates opposite the
neck of the radius by
dividing into the radial
and ulnar arteries.
• Find the wrong label in this
picture.
• Do not trust textbooks
blindly.
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RELATIONS
• Anteriorly:
• The vessel is superficial and
is overlapped from the lateral
side by the coracobrachialis
and biceps.
– The medial cutaneous
nerve of the arm lies in
front of the upper part;
– the median nerve crosses
its middle part; and
– the bicipital aponeurosis
crosses its lower part.
• Posteriorly: The artery lies
on the triceps, the
coracobrachialis insertion,
and the brachialis.
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• Medially:
• The ulnar nerve and
• the basilic vein in the upper
part of the arm;
• in the lower part of the arm,
the median nerve lies on its
medial side.
• Laterally:
• The median nerve and the
coracobrachialis and biceps
muscles above;
• the tendon of the biceps lies
lateral to the artery in the
lower part of its course.
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BRANCHES
• Muscular branches to the
anterior compartment of the
arm.
• The nutrient artery to the
humerus.
• The profunda brachii artery
arises near the beginning of
the brachial artery and follows
the radial nerve into the spiral
groove of the humerus.
• The superior ulnar collateral
artery arises near the middle
of the arm and follows the
ulnar nerve.
• The inferior ulnar collateral
artery arises near the
termination of the artery and
takes part in the anastomosis
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around the elbow Prof
joint.
MUSCULOCUTANEOUS NERVE
• Origin: from the lateral cord
of the brachial plexus (C5, 6
& 7)
• It runs downward and
laterally, pierces the
coracobrachialis m
• Then passes downward
between biceps & brachialis
m
• It appears at the lateral
margin of biceps tendon &
pierces the deep fascia just
above the elbow.
• It runs down the lateral
aspect of the forearm as the
lateral cutaneous nerve of
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the forearm.
BRANCHES
• Muscular to the:
1.Biceps,
2.Coracobrachialis,
3.Brachialis.
• Cutaneous ;lat.
cutaneous n. of the
forearm supplies the skin
of the front and lateral
aspects of the forearm
down as far as the root of
the thumb.
• Articular: to the elbow
joint.
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MEDIAN NERVE
• Origin: from the medial and
lateral cords of the brachial
plexus in the axilla.
• It runs downward on the lateral
side of the brachial artery.
• Halfway down the upper arm, it
crosses the brachial artery and
continues downward on its
medial side.
• The nerve, like the artery, is
therefore superficial; but at the
elbow, it is crossed by the
bicipital aponeurosis.
• The median nerve has no
branches in the upper arm,
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MEDIAN NERVE
• Origin: from the medial and
lateral cords of the brachial
plexus in the axilla.
• It runs downward on the lateral
side of the brachial artery.
• Halfway down the upper arm, it
crosses the brachial artery and
continues downward on its
medial side.
• The nerve, like the artery, is
therefore superficial; but at the
elbow, it is crossed by the
bicipital aponeurosis.
• The median nerve has no
branches in the upper arm,
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ULNAR NERVE
•
•
•
•
•
•
Origin: from the medial cord of
the brachial plexus in the axilla.
It runs downward on the medial
side of the brachial artery as far
as the middle of the arm.
At the insertion of the
coracobrachialis, it pierces the
medial fascial septum and,
accompanied by the superior
ulnar collateral artery, enters
the posterior compartment of
the arm;
the nerve passes behind the
medial epicondyle of the
humerus.
The ulnar nerve has no
branches in the anterior
compartment of the upper arm.
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ULNAR NERVE
•
•
•
•
•
•
Origin: from the medial cord of
the brachial plexus in the axilla.
It runs downward on the medial
side of the brachial artery as far
as the middle of the arm.
At the insertion of the
coracobrachialis, it pierces the
medial fascial septum and,
accompanied by the superior
ulnar collateral artery, enters
the posterior compartment of
the arm;
the nerve passes behind the
medial epicondyle of the
humerus.
The ulnar nerve has no
branches in the anterior
compartment of the upper arm.
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RADIAL NERVE
• On leaving the axilla,
the radial nerve
immediately enters
the posterior
compartment of the
arm.
• It re-enters the
anterior compartment
just above the lateral
epicondyle.
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RADIAL NERVE
• On leaving the axilla,
the radial nerve
immediately enters
the posterior
compartment of the
arm.
• It re-enters the
anterior compartment
just above the lateral
epicondyle.
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POSTERIOR
FASCIAL
COMPARTMENT OF
THE UPPER ARM
CONTENTS
Blood
supply:
Ulnar collateral
artery
Profunda brachii
Muscles:
•
The three heads of the
triceps muscle.
Nerve supply to the
muscles: Radial nerve.
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•
•
•
Structures passing through the
compartment:
Radial nerve and
ulnar nerve.
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TRICEPS
•
•
•
•
•
•
•
•
The triceps is a large muscle that forms
the greater part of the substance of the
back of the arm.
Origin:
Long head from the infraglenoid
tubercle of the scapula;
lateral head from the upper half of the
posterior surface of the shaft of the
humerus above the spiral groove;
medial head from the posterior surface
of the lower half of the shaft of the
humerus below the spiral groove.
Insertion: The common tendon is
inserted into the upper surface of the
olecranon process of the ulna.
Nerve supply: Radial nerve.
Action: This muscle is a strong extensor
of the elbow joint.
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TRICEPS
•
•
•
•
•
•
•
•
The triceps is a large muscle that forms
the greater part of the substance of the
back of the arm.
Origin:
Long head from the infraglenoid
tubercle of the scapula;
lateral head from the upper half of the
posterior surface of the shaft of the
humerus above the spiral groove;
medial head from the posterior surface
of the lower half of the shaft of the
humerus below the spiral groove.
Insertion: The common tendon is
inserted into the upper surface of the
olecranon process of the ulna.
Nerve supply: Radial nerve.
Action: This muscle is a strong extensor
of the elbow joint.
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OTHER STRUCTURES PASSING
THROUGH THE POSTERIOR
COMPARTMENT OF THE ARM
RADIAL NERVE
•
•
•
•
Origin: from the posterior cord
of the brachial plexus in the
axilla.
The nerve winds around the
back of the arm in the spiral
groove on the back of the
humerus between the heads of
the triceps.
In the spiral groove, the nerve
is accompanied by the
profunda vessels, and it lies
directly in contact with the shaft
of the humerus.
It pierces the lateral fascial
septum above the elbow and
continues downward into the
cubital fossa in front of the
elbow, between the brachialis
and the brachioradialis
muscles.
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RADIAL NERVE
•
•
•
•
Origin: from the posterior cord
of the brachial plexus in the
axilla.
The nerve winds around the
back of the arm in the spiral
groove on the back of the
humerus between the heads of
the triceps.
In the spiral groove, the nerve
is accompanied by the
profunda vessels, and it lies
directly in contact with the shaft
of the humerus.
It pierces the lateral fascial
septum above the elbow and
continues downward into the
cubital fossa in front of the
elbow, between the brachialis
and the brachioradialis
muscles.
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BRANCHES
In the anterior compartment of the arm, after the nerve
has pierced the lateral fascial septum, it gives branches to
the brachialis, the brachioradialis, and the extensor carpi
radialis longus muscles
The radial nerve also
gives articular branches
to the elbow joint.
•
•
In the axilla, branches are given to the long and medial heads of the triceps.
In the spiral groove, branches are given to the lateral and medial heads of
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the triceps and to the anconeus.
•
•
•
In the axilla, the radial nerve
gives off the posterior
cutaneous nerve of the
arm.
In the spiral groove, it gives
off the lower lateral
cutaneous nerve of the
arm. This nerve supplies
the skin over the lateral and
anterior aspects of the
lower part of the arm.
The posterior cutaneous
nerve of the forearm runs
down the middle of the back
of the forearm as far as the
wrist.
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•
•
•
In the axilla, the radial nerve
gives off the posterior
cutaneous nerve of the
arm.
In the spiral groove, it gives
off the lower lateral
cutaneous nerve of the
arm. This nerve supplies
the skin over the lateral and
anterior aspects of the
lower part of the arm.
The posterior cutaneous
nerve of the forearm runs
down the middle of the back
of the forearm as far as the
wrist.
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ULNAR NERVE
•
•
•
•
•
•
•
Having pierced the medial fascial
septum halfway down the upper
arm, the ulnar nerve descends
behind the septum, and infront of
the medial head of the triceps.
The nerve is accompanied by the
superior ulnar collateral vessels.
At the elbow, it lies behind the
medial epicondyle of the humerus
on the medial ligament of the
elbow joint.
It is continues downward to enter
the forearm between the two
heads of the flexor carpi ulnaris.
Branches
No branches in the arm.
But it gives an articular branch to
the elbow joint.
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ULNAR NERVE
•
•
•
•
•
•
•
Having pierced the medial fascial
septum halfway down the upper
arm, the ulnar nerve descends
behind the septum, and infront of
the medial head of the triceps.
The nerve is accompanied by the
superior ulnar collateral vessels.
At the elbow, it lies behind the
medial epicondyle of the humerus
on the medial ligament of the
elbow joint.
It is continues downward to enter
the forearm between the two
heads of the flexor carpi ulnaris.
Branches
No branches in the arm.
But it gives an articular branch to
the elbow joint.
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ULNAR NERVE
•
•
•
•
•
•
•
Having pierced the medial fascial
septum halfway down the upper
arm, the ulnar nerve descends
behind the septum, and infront of
the medial head of the triceps.
The nerve is accompanied by the
superior ulnar collateral vessels.
At the elbow, it lies behind the
medial epicondyle of the humerus
on the medial ligament of the
elbow joint.
It is continues downward to enter
the forearm between the two
heads of the flexor carpi ulnaris.
Branches
No branches in the arm.
But it gives an articular branch to
the elbow joint.
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PROFUNDA
BRACHII ARTERY
• The profunda brachii
artery arises from the
brachial artery near its
origin.
• It accompanies the
radial nerve through the
spiral groove,
• supplies the triceps
muscle, and
• takes part in the
anastomosis around the
elbow joint.
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PROFUNDA
BRACHII ARTERY
• The profunda brachii
artery arises from the
brachial artery near its
origin.
• It accompanies the
radial nerve through the
spiral groove,
• supplies the triceps
muscle, and
• takes part in the
anastomosis around the
elbow joint.
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SUPERIOR AND
INFERIOR ULNAR
COLLATERAL
ARTERIES
• The superior and
• inferior ulnar
collateral arteries
• arise from the
brachial artery and
• take part in the
anastomosis around
the elbow joint.
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1. Quadrangular
Space:
Upper triangular
Space
Lower triangular
Space
Intermuscular
spaces
There are 3
intermuscular
spaces in
relation to the
scapular
muscles:
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Superiorly:
Subscapularis
& teres minor
nerve
Inferiorly:
Teres
major
Laterally: Surgical
neck of
humerus
1. Medially: Long
head of triceps
Quadrangular Space
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Circumflex scapular
vessels
Laterally: Long
head of triceps
Inferiorly: Teres
Major
Superiorly:
Subscapularis
& teres minor
Upper triangular space
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Superiorly: Teres
Major
Medially :Long
head of triceps
Laterally: Shaft of
the humerus
Radial nerve &
Profunda
brachii
vessels
Lower triangular space
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