Bones and Muscles and regional anatomy of the upper limb part2 Lecturer Dr M Samsam University of Central Florida Orlando Source textbook of human anatomy by Platzer Clinically oriented anatomy by K Moore and Human anatomy by B Pansky Damage to the Radial nerve Injury proximal to the origin of Triceps No extension of elbow elbow is flexed No triceps reflex Wrist drop all extensor muscles and the Supinator are paralyzed thumb is flexed and adducted Sensory loss dorsolateral lower brachial region posterior surface of forearm dorsum of the hand and radial side of proximal phalanges Injury of the nerve in radial groove In fractures of humerus Triceps muscle is usually functioning Wirst drop and sensory loss in dorsolateral aspect of the forearm and hand Plus all other problems mentioned above Nerve injury in forearm Here the deep radial nerve is injured wrist drop Extension of the thumb and metacarpal joints is disturbed Sensation is usually preserved Median Nerve injury Above the elbow Muscles in the arm are not affected Forearm and hand muscles are affected 1 All flexors of the wrist are paralyzed except 2 Flexor carpi ulnaris and ulnar part of Flexor digitorum profundus 3 Thumb flexors and abductor paralyzed but not Adductor ulnar N ape hand 4 Flexion at metacarpophalangeal joints possible intact interossei MM ulnar N 6 1st and 2nd Lumbricals lost function and all together inability to fully flex index and middle finger HAND OF PAPAL BENEDICTION Pronation of forearm paralyzed and sensory loss over the median N area Injury at wrist Joint suicide or injury e g hand out of car s window Short muscles of the thumb paralyzed not adductor Thenar muscles atrophy flattened ape hand Flexor pollicis longus functioning Sensory loss over Medial N area Ulnar nerve injury At wrist 1 Fingers are hyperextended at metacarpophalangeal joints and flexed at interphalangeal joints paralysis of interossei MM and 2 medial lumbricals Claw hand 2 Tendon of flexor digitorum perfundus 2 medial ones paralyzed Therefore flexion of the ring and little finger is not possible at distal phalangeal joints 3 Small muscles of the little finger are paralyzed 4 Abduction and Adduction of the fingers are impaired paralysis of interossei MM piano playing writing Impaired 5 Sensory loss over ulnar innervating area Injury at elbow 1 Paralysis of flexor carpi ulnaris and medial portion of Flexor digitorum profundus 2 Ulnar deviation of the wrist is weakened hand is abducted and extended Plus problem number 4 and 5 from above Regional Anatomy Atlas Infraclavicular region Deltopectoral triangle Borders Clavicle Deltoid Pectoralis major Skin innervation medial intermediate and Lateral supraclavicular nerves cervical plexus On deltoid region innervation by axillary nerve Axillary region Pyramidal shape Borders Pectoralis Major Latis dorsi ribs and intercostal muscles humerus and coracobrachialis Atlas Brachial Plexus Arteries of the shoulder and Upper arm Arterial Blood pressure Measurements using a sphygmometer Brachial artery occlusion Laceration Deep flexor paralysis Volkmann s ischemic contracture Veins of the shoulder And upper arm Lymph nodes of the Axillary region Arranged in 5 groups Pectoral medial apical central and subscapular Drainage subclavian lymphatic trunk to right lymphatic duct to right venous angle Importance Breast Cancers may give metastasis to the axillary lymph node 75 of breast s lymphatics drain here Removal of the lymph nodes may be necessary Mastectomy removal of the breast Lymphangitis Regional anatomy Atlas Anterior Brachial region Brachial fascia Cephalic vein Basilic vein Basilic hiatus Medial antebrachial cutaneous N lymph nodes Medial brachial cutaneous N Intercostobrachial N Anterior Brachial region Medial bicipital groove Between biceps and intermuscular septa Contents Median N Brachial artery and veins and basilic vein medial cutaneous antebrachial nerve and ulnar N medially Deep in this region proximally the radial nerve takes a posterior direction Axillary spaces Quaderangular space Triangular Spaces Teres Minor Teres Major Humerus Long head of Triceps Radial nerve is found deep in the posterior brachial region in radial groove of humerus accompanied by deep brachial A and V Regional anatomy Atlas Cubital fossa Superficial Basilic vein Antebrachial Basilic vein Cephalic and Median cubital vein Medial cutaneous antebrachial nerve lateral antebrachial cutaneous nerve branch of musculocutaneous N Cubital fossa deep Atlas Biceps Brachii M Bicipital aponeurosis Brachialis M Pronator teres Brachioradialis Radial artery and veins recurrent radial A Median N Ulnar nerve Radial N Superficial Radial N Deep radial N Supinator muscle Arteries of the forearm and hand Radial artery Ulnar artery Deep palmar arch Principal artery of the thumb Superficial palmar arch common digital arteries common palmar digital arteries Dorsal carpal branch Anterior antebrachial region Atlas Anastomoses between cephalic and basilic antebrachial veins Medial cutaneous antebrachial N Radial artery and veins Superficial Radial N Ulnar N Ulnar artery and veins Anterior carpal region Antebrachial fascia tendon of palmaris longus Pronator quadratus Radial A Flexor carpi radialis Median N Ulnar artery Ulnar nerve Flexor carpi ulnaris Palmar aponeurosis Palm of the hand Superficial palmar arch Deep palmar arch median nerve ulnar nerve Dorsum of the Hand Radial artery enters the Snuffbox and gives a dorsal branch which produces the dorsal arterial arch of the hand Then it gives the principal artery of the thumb and then a main branch to join the deep palmar arch Snuffbox borders Tendon of extensor pollicis longus superior tendons of the ext pollicis brevis and abductor pollicis longus inferiorly Contents of snuffbox Radial artery Superficial radial N