clinical anat upper and lower limb
TRANSCRIPT
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Upper Limb
Djoko Prakosa
Dept. Anatomy, Embryologi & Anthropology
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Upper Limb
- It is divided into:
shoulder (junction of the arm and the trunk)
arm (brachium)
elbow
forearm (antebrachium)
wrist (carpus)
hand (manus)
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Bones of the upper limb
Clavicula & Scapula
Humerus
Radius & ulna
Carpal bones:
- proximal row: scaphoid (navicular), lunate,
triquetrum, pisiform
- distal row: trapezium, trapezoid, capitate,hamate
Metacarpal bones (5)
Phalanges
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Shoulders Bones
Demonstrates themain anatomicallandmarks of theclavicle, scapula,humerus, radius andulna.
A: greater tubercle
B: head of humerus
C: coracoid processD: acromion
E: lesser tubercle ofhumerus
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Carpals, metacarpals & phalanges
Identify the bones of the
wrist, metacarpals andphalanges on suitableradiographs
A: scaphoid
B: lunateC: triquetrum & pisiform
D. Trapezium
E. Trapezoid
F. Capitate
G. Hamate
H. Hook of hamate
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Joints
Describethe anatomy of the glenohumeral joint
Name and explain the movements at the joint,
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Joints
Name the musclesresponsible for itsmovement and list
their mainattachments.
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Elbow joint Describe the anatomy of the elbow joint
Name and explain the movements at the joint,
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Joint Stability
Describe the factors that are responsible for
stability at the joint and explain the functional andpossible pathological consequences ofdislocation of the joint.
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Factors affecting joint stability
The stabilizing subsystem of the joint
control subsystem
neural
passive active
subsystem subsystem
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Muscles
Describe the major muscles groups in their fascialcompartments, and explain the functional
importance of those muscle groups.
Describe how muscle groups work in synergy to
facilitate action
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Muscles
I. Connecting the upper limb to vertebral column:- trapezius - levator scapulae
- rhomboideus - latissimus dorsi
II. Connecting the UL to Ant & Lat Thoracic wall:
- pectoralis major & minor
- subclavius
- serratus anterior
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Muscles
III. Muscles of the shoulder
- deltoid - subscapularis
- supraspinatus - infraspinatus
- teres minor - teres major
IV. Muscles of the arm
anterior compartment:
- coracobrachialis - biceps brachii
- brachialis
posterior compartment:
- triceps brachii
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Muscles
V. Muscles of the forearm:
a. Anterior compartment:
Superficial:
- pronator teres - flexor carpi radialis- palmaris longus - flexor carpi ulnaris
- flexor digitorum superficialis
Deep:- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus
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Muscles
V.b. Posterior compartment:
Superficial:
- brachioradialis - extens carpi radialis long
- extensor digit - extens carpi rad brevis
- anconeus - extens digiti minimi
- extensor carpi ulnaris
Deep:
- supinator - abductor pollicis longus
- extens poll brev - extens pollicis longus
- extensor indicis
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Fascial compartment arm & forearm
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Muscles
VI. Muscles of the hand
a. Thenar muscles
- abductor pollicis brevis - opponens pollicis
- flexor pollicis brevis - adductor pollicis
b. Hypothenar muscles
- palmaris brevis - abductor digiti minimi
- flexor dig min brev - opponens digit minimi
c. Intermediate muscles
- lumbricales
- Interossei
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Retinacula & Tendon sheaths
Describe the function of retinacula, tendonsheaths, specifically the flexor retinaculum of the
wrist, to be able to explain the carpal tunnelsyndrome, spread of infection in tendon sheathsand tenosynovitis.
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Blood Vessels
Describe the origin,course and functionsof the subclavian,axillary, brachial,
radial and ulnararteries and explainthe importance ofanastomosesbetween branches ofthese arteries.
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Blood Vessels
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Vessels
Describe the course of the main superficial veins(cephalic, basilic, median cubital) and recognized
the common sites of venous access.
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Nerves
Describe the origin,course and function ofthe axillary,musculocutaneus,radial, median andulnar nerves in thearm, forearm, wristand hand and namethe main muscles and
muscle groups thatthese nerves supplyas well as theirsensory distribution.
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Nerves
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Nerves
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Pathology
Describe the close relations of the bones andjoints e.g. bursae, blood vessels, nerves which
may be injured in fracture and dislocation
Understand why and where the axillary, musculo-
cutaneus, radial, median and ulnar are commonlyinjured and describe the functional consequencesof those injuries.
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Pathology
Explain the loss of function resulting from injuriesto the different parts of the brachial plexus in
contrast to the injuries that may be incurred to thevarious nerves that arise from it, at various pointsalong their course in the upper limb.
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Brachial plexus injuries
Upper lesions = Erb-Duchene Palsy (Waiters tip)Cause: excessive displacement of the head to
opposite side and depression of the shoulder atthe same site
traction of C5 and C6
Muscles affected:
- supra & infraspinatus - subclavius
- biceps brachii - brachialis
- deltoid
limb hang limply, medially rotated arm,pronation + loss sensation lateral side of arm
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Brachial plexus injuries
Lower lesions: Klumpke Palsy
Cause: excessive abduction of the arm
Th1 torn
muscles affected:all small muscles of the hand
clawed appearance of the hand + loss
sensation on the medial side of the arm
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Nerve injuries
-Long thoracic nerve
blows or pressure on the posterior triangle of theneck
winged scapula
- Axillary nerve:
crutch pressing upward in the armpit; inferior
displacement of humeral head; fracture ofhumeral surgical neck
paralysis of deltoid & teres minor + loss of
skin sensation over lower half of deltoid muscle
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Nerve injuries
Radial nerve:
In the axilla: pressure of crutch; fracture &dislocation of proximal end of humerus
1. motor: triceps, anconeus & long extensor ofwrist paralyzed unable to extend elbow, wrist &fingers wrist drop
2. sensory: posterior & lower part of arm & backof forearm, lateral part of dorsum of hand
In the spiral groove:
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Nerve injuries
Median nerve:1. at elbow
- in supracondylar fracture, stab wound:
motor: forearm in supine position; wristflexion weak, no flexion on metacarpophalangeal
joints of index & middle fingerspreacherhand. Thenar muscles paralyzed and wastedsimian hand = ape like hand
sensory lateral half of palmar hand + finger
2. at wrist:
carpal tunnel syndrome
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Nerve injuries
Ulnar nerve:
Injuries at elbow or wrist
Motor:
Claw handFroments sign +
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Examination
Describe how to test for motor and sensory nerve
function and dysfunction and understand theanatomical basis of tendon jerk testing of bicepsand triceps