membrul-superior-mg.pptx

7/27/2019 membrul-superior-mg.pptx

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MEMBRUL SUPERIOR

U.M.F.Cluj-Napoca


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Osteologie


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Osteologie


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Osteologie


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Osteologie

Carpal Bones (4 proximal, lateral tomedial; 4 distal, lateral to medial)"Some Lions Try Positions That TheyCan't Handle":Scaphoid, Lunate, Triquetrum, Pisiform,Trapezoid, Trapezium, Capitate, Hamate.TrapeziUM at the thUMb"TrapeziOID is inSIDE"

Flexor carpi superficialis splits in two, topermit profundus to pass through


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Muschii membrului superior


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Anatomy Mnemonics

Muscles Inserting intoHumerus"A lady between twomajors"

Pectoralis majorattaches to lateral lip ofbicipital groove, theteres major attaches tomedial lip of bicipitalgroove, and thelatissimus dorsiattaches to the floor ofbicipitalgroove. The "lati" isbetween two "majors"

Rotator CuffMuscles (3 greatertubercle; 1 lesser

tubercle)SITS:Superspinatus,Infraspinatus, Teresminor, Subscapularis


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The arteries of the upper limb


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The axillary artery Course: the axillary arterycommences at the lateral borderof the 1strib as a continuation of thesubclavian artery (see Fig. 60.1)

and ends atthe inferior border of teres majorwhere it continues as the brachialartery. The axillary vein is a medialrelation throughout its course. It iscrossed anteriorly bypectoralisminor which subdivides it intothreeparts:

First part (medial to pectoralisminor). Second part (behind pectoralisminor)agives off the lateralthoracic artery (which helps tosupply the breast) and thethoracoacromialartery (p. 75). Third part (lateral to pectoralisminor)agives off thesubscapularartery which follows the lateralborder of the scapula and gives offthe circumflex scapular artery.


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Axillary Artery BranchesSave The Lions And ProtectSpecies: Supreme/Superior

Thoracic Artery,Thoracoacromial Artery,Lateral Thoracic, AnteriorCircumflex Humeral, PosteriorCircumflex Humeral,Subscapular (thoracodorsaland circumflex scapular

Thoracoacromial Artery

Branches"CAlifornia PoliceDepartment": Clavicular,Acromial, Pectoral, Deltoid


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The brachial artery Course: the brachial arterycommences at the inferior border ofteresmajor as a continuation of the axillaryartery and ends by bifurcating

into the radial and ulnar arteries at thelevel of the neck of the radius. Itlies immediately below the deep fasciathroughout its course. Thebrachial artery is crossed superficially bythe median nerve in the midarmfrom lateral to medial and hence liesbetween the median nerve(medial relation) and biceps tendon (lateralrelation) in the cubital fossa(see Fig. 36.3). Branches: Profunda brachiiaarises near theorigin of the brachial artery andwinds behind the humerus with the radialnerve in the spiral groovebefore taking part in the anastomosisaround the elbow joint. Other branchesainclude a nutrientartery to the humerus andsuperior and inferior ulnar collateralbranches which ultimatelytake part in the anastomosis around theelbow.


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The venous and lymphatic drainage of the upper limb


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Venous drainage of the upper limb

As in the lower limb the venous drainagecomprises interconnectedsuperficial and deep systems. The superficial system: comprises thecephal ic and basi l ic veins. The cephalic vein commences from thelateral end of the dorsalvenous network overlying the anatomicalsnuffbox. It ascends thelateral, then anterolateral, aspects of theforearm and arm andfinally courses in the deltopectoral grooveto pierce the clavipectoralfascia and drain into the axillary vein. The basilic vein commences from themedial end of the dorsalvenous network. It ascends along themedial then anteromedialaspects of the forearm and arm to piercethe deep fascia (in theregion of the mid-arm) to join with thevenae comitantes of thebrachial artery to form the axillary vein.The two superficial veins are usuallyconnected by a median cubitalvein in the cubital fossa. The deep veins: consist of venaecomitantes (veins which accompanyarteries).The superficial veins of the upper limb areof extreme clinical importancefor phlebotomy and peripheral venousaccess. The most commonlyused sites are the median cubital vein inthe antecubital fossa andthe cephalic vein in the forearm.


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Nerves of the upper limb

The brachial plexus (C5,6,7,8,T1)

The plexus arises as five roots.These are the anterior primary rami ofC5,6,7,8,T1. The roots lie betweenscalenus anterior and scalenusmedius. The three trunks (upper, middle andlower) lie in the posterior triangleof the neck. They pass over the 1st rib

to lie behind the clavicle. The divisions form behind the middlethird of the clavicle around theaxillary artery. The cords lie in the axilla and arerelated medially, laterally andposteriorlyto the second part of the axillaryartery.

Terminal nerves arise from the cordssurrounding the third part of theaxillary artery.


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Nerves of the upper limbPectoral Nerves"Lateral is less,medial is more"Lateral pectoralnerve goes

through pectoralismajor, while medialpectoral nervegoesthough bothpectoralis majorand minor.


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Brachial plexus


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The axillary nerve (C5,6)

Type: mixed sensory andmotor nerve. Origin: it arises from theposterior co rd of the brachialplexus. Course: it passes through thequadrangular space with theposteriorcircumflex humeral artery. Itprovides: a motor supply todeltoid andteres minor; a sensory supply tothe skin overlying deltoid; and anarticularbranch to the shoulder joint. Effect of injury: the axillarynerve is particularly prone toinjuryfrom the downward displacementof the humeral head duringshoulderdislocations. Motor deficitaloss of deltoidabduction with rapid wasting ofthismuscle. Loss of teres minor

function is not detectableclinically. Sensory deficitais limited to thebadge region overlying thelower half of deltoid.


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The radial nerve (C5,6,7,8,T1)

Type: mixed sensory and motor. Origin: it arises as a continuation ofthe posterior cord of the brachialplexus. Course and branches: it runs withthe profunda brachii artery

between the long and medial heads oftriceps into the posterior compartmentand down between the medial andlateral heads of triceps.At the midpoint of the arm it enters theanterior compartment by piercingthe lateral intermuscular septum. In theregion of the lateral epicondylethe radial nerve lies under the cover ofbrachioradialis and dividesinto the superficial radial and posteriorinterosseous nerves.The branches of the radial nerveinclude: branches to triceps,brachioradialisand brachialis as well as somecutaneous branches. It terminatesby dividing into two major nerves: Theposterior interosseousnerveapasses between the two headsof supinator at a point threefingerbreadths distal to the radialhead thus passing into the posteriorcompartment. It supplies theextensor muscles of the forearm. The superficial radial nerveadescendsthe forearm under the coverof brachioradialis with the radial arteryon its medial side.


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It terminate as cutaneous branchessupplying the skin of the back of thewrist and hand. Effect of injury (Fig. 31.2): e.g.humeral shaft fracture resulting in

damage to the radial nerve in thespiral groove. Motor deficitaloss of all forearmextensors: wristdrop. Sensory deficitausually small due tooverlap: sensory loss over theanatomical snuffbox is usuallyconstant.The musculocutaneous nerve(C5,6,7)

Type: mixed sensory and motor. Origin: it arises from the lateralcord of the brachial plexus. Course: it passes laterallythrough the two conjoined headsof coracobrachialisand then descends the arm betweenbrachialis and biceps,supplying all three of these musclesen route. It pierces the deep fascia

just below the elbow (and becomesthe lateral cutaneous nerve of theforearm).


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Practica clinica de zi cu zi-cele mai importante progrese:

Razboiul II Mondial

-Sterling Bunell - Surgery of the Hand 1944

Rolurile mainii


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Manipulare

Sensibilitate

Gesturi

Protectie

Manipulare:

-mentinere independenta

--igiena personala

--munca

Sensibilitate :

-Homunculus senzitiv

--Portiune imensa de neocortex

dedicata mainii.

Gesturi:

-- Socializare

Protectie:

-- reflexa sau nu.

Rolurile mainiiDublate de o importanta componenta psihologica.

Cuprinsul cursului


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Cuprinsul cursuluiAnatomia clinica a mainii

Anatomie topograficaRegiunile mainii

OsteologieImportanta clinica

Inervatia mainiiImportanta clinica

Vascularizatia mainiiimportanta clinica

Muschi- tendoane flexori - extensoriImportanta clinica

Mana


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ManaNotiuni de topografie

Doua portiuni :

1.Proximala:

-scheletul carpo-metacarpian.

2.Distala:

- cele 5 degete.

1. Regiune palmara

2. Regiune dorsala


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Mana


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ManaNotiuni de topografie

3 loje profunde ale palmei:

1.Loja laterala : tenara.

2.Loja mediala:hipotenara

3.Loja mijlocie:mezotenara

2 straturi : tendoane flexori. Teaca sinoviala digito-carpiana

Arcade vasculare

Nervii digitali comuni

Un strat muscular interosos.


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OSTEOLOGIE


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Mana contine :

14 falange

5 oase metacarpiene

8 oase carpiene

Carpul : 8 oase asezate

pe doua randuri

Canalul carpian

OSTEOLOGIEIn total 27 de oase.

OSTEOLOGIE


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Contine 8 oase pe 2 randuri:

Scafoid-Semilunar-Piramidal-

Pisiform

Trapez-Trapezoid-Capitat-

Osul cu carlig

OSTEOLOGIECarpul

OSTEOLOGIE


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Contine 8 oase pe 2 randuri:

Scafoid-Semilunar-Piramidal-

Pisiform

Trapez-Trapezoid-Capitat-

Osul cu carlig

OSTEOLOGIECarpul

Tunelul carpian


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Peretele radial:

scafoid,tuberculul osului

trapez

Peretele ulnar : pisiform,osul

cu carlig

Podeaua: semilunar,capitat

Tavanul: retinaculul flexorilor

Tunelul carpianPereti.


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Tunelul carpian


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Tunelul carpian

Muschi


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Muschii eminentei tenare

Muschii eminentei

hipotenare

Muschii regiunii palmare

mijlocii:

Lumbricali

Interososi palmari

Interososi dorsali

MuschiIn total 5 grupe19 muschi.

Muschi


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4 muschi in trei planuri :

Scurt abductor al policelui Opozant al policelui

Scurt flexor al policelui

Adductor al policelui

MuschiIn total 5 grupe.

Muschi


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Inervatie:

Abductorul,opozantul,flexorul :nervul median

Flexorul , adductorul: ulnar


Muschi


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Muschii eminentei

hipotenare

4 muschi asezati in 3 planuri

Palmar scurt

Flexor scurt al degetului mic

Abductor al degetului mic

Opozantul degetului mic


Muschi


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Muschii eminentei

hipotenare

Inervatie : nervul ulnar

Actiune: flexie falangaproximala ; abductie in raport

cu axul mainii ; palmarul

scurtmuschi atrofiat.


Muschi


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Muschii regiunii palmaremijlocii:

Lumbricali


-in numar de 4

-Atasati tendoanelor flexorului profund

a degetelor-Insertia distala pe tendoanele

extensorului

-Inervatie : median pt. cei 2 laterali ;

ulnar pt. cei 2 mediali.

-Actiune : flexori ai falangei proximale

extensori ai celorlalte doua

Muschi


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mijlocii:

Interososi palmari

In total 5 grupe.

Muschi


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mijlocii:

Interososi palmari

In total 5 grupe.

Muschi


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mijlocii:

Interososi dorsali

In total 5 grupe.

Muschi


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mijlocii:

Interososi dorsali

In total 5 grupe.

Tendoane flexori


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Tendonul flexorului

superficial

Tendonul flexorului

profund

Tunelul carpian


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p

Tendoane flexori


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Tendonul flexorului

superficial

Tendonul flexorului profund


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Tendoane extensori


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.

Tendoane extensori


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.

Inervatie mana


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Inervatie mana


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Fata palmara :

Nervul median

Nervul ulnar Nervul radial

Nerv median

Nerv radial

Nerv ulnar

Inervatie mana


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Fata dorsala :

Nervul median

Nervul ulnar Nervul radial

Nerv median

Nerv radial

Nerv ulnar


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Picture Page Layout


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Picture Page Layout

Anestezie nerv median.


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Picture Page Layout


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Picture Page Layout

Anestezie nerv ulnar.


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Picture Page Layout


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Picture Page Layout

Anestezie nerv radial.


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1.Nerv ulnar

2.Condil medial

humerus

3.Proces oleocranian


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1.Nerv ulnar

2.Condil medial

humerus

3.Proces oleocranian


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Anestezie nerv median.


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Sectiune transversala deget


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Bloc digital.

VascularizatieArtera radiala


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Mana contine :

Arcada palmara superficiala

Arcada palmara profunda Artere digitale

Artere metacarpiene

Artera radiala

Artera ulnara


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Vascularizatie


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Vascularizatie


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Sectiune transversala deget

ClinicExaminarea mainii traumatizate:


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1. Inspectie:

Pozitia degetelor normal usor flectate.

Un deget anormal de drept poate avea

afectat tendoanele flexorilor

Se cauta pozitii tipice ale mainii :

- Claw hand : afectare ulnar

Examinarea mainii traumatizate:



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1. Inspectie:


- Afectare nerv radial:




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1. Inspectie:


- afectare nerv median ( mana simianaape hand):




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2. Testare senzoriala inainte de anestezie

a. Intepatura ; discriminare in 2 puncte. b. testare toate teritoriile senzoriale

(median, ulnar, radial)

c. ambele margini ale degetelor

3. Motor

a. Profund blocare mana in extensie,sesolicita flectare varf deget

b. Superficial stabilizare degete in

extensie pt a neutraliza tendonul profund Se solicita flexia degetului.




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c. Ramurile motorii ale nervului median:

testare abductia palmara a policeluicontra rezistenta

d.Ramurile motorii ale ulnarului:

pacientul face extensie maxima degete

apoi le indeparteaza. e. Tendoanele extensorilor

testare extensie


ClinicTratamente posibile:


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Tenorafii

Neurorafii

Tratamente posibile:

ClinicTratamente posibile:


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Osteosinteze

Tratamente posibile:


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membrul-superior-mg.pptx

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