concepts

Inguinal canal

Anterior wall: aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally

Posterior wall: transversalis fascia

Roof: transversalis fascia, internal oblique and transversus abdominis

Floor: inguinal ligament (a rolled up portion of the external oblique aponeurosis, thickened medially by the lacunar ligament)

Muscle attached to coracoid process

Biceps brachii(short), the pectoralis minor and the coracobrachialis

Muscles attached to medial epicondyle of humerus

Pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris

Boundaries and contents of quadrangular space

Superior: Teres minor

Inferior: Teres major

Medial: long head of triceps brachii muscle

Lateral: surgical neck of the humerus (shaft of the humerus)

Contents: axillary nerve, posterior circumflex humeral artery, and accompanying vein

QSS (quadrangular space syndrome), QS is a common site for compression or damage to the axillary nerve and the posterior circumflex humeral artery, which cause pain, numbness and weakness in the shoulder and upper arm

Triangular space

Lateral border: long head of the triceps brachii

Superior: Teres minor

Inferior: Teres major

Contents: circumflex scapular artery and circumflex scapular vein

Space allow the vessel to travel from axilla to posterior scapular region

Triangular interval

Boundaries:

Superior: Teres major muscle

Medial: long head of the triceps brachii muscle

Lateral: lateral head of the triceps brachii muscle and the shaft of the humerus

Contents: profunda brachii artery (aka deep brachial artery), radial nerve

Borders of axilla

Overall 3D shape, slightly like a pyramid

Apex: aka axillary inlet, formed by lateral border of the first rib, superior border of scapula and the posterior border of the clavicle

Lateral wall:Intertubercular sulcus

Anterior border: Pectoralis major, minor and subclavius

Medial border: serratus anterior and thoracic wall (ribs and intercostal muscles)

Posterior border: Scapularis, Teres major, Latissimus dorsi

*Apex decreases in size most markedly when arm is fully abducted, contents most at risk of being compressed

Contents of axillary sheath

1. Axillary artery and its branches

   1. 1st part medial to the pectoralis minor

   2. 2nd part posterior to pectoralis minor

   3. 3rd part lateral to pectoralis minor

   4. Medial and posterior parts travel in the axilla

2. Axillary vein and its tributaries

   1. Two largest tributaries are the cephalic and basilic veins

3. Brachial plexus and its branches

4. Axillary lymph nodes

   1. Drains from upper limb and pectoral region

   2. Enlargement is a non-specific indicator of breast cancer

5. Biceps brachii (short head) and coracobrachalis

   1. tendons move through the axilla

   2. attach to the coracoid process of the scapula

Costocoracoid membrane

ผ่านเข้า: cephalic vein

ผ่านออก: thoracoacromial trunk and lateral pectoral nerve

Inguinal hernia

Indirect: peritoneal sac enters the inguinal canal through the deep inguinal ring

Direct: peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal (medial to the epigastric vessels and can enter the superficial inguinal ring)

Rectus sheath borders

Anterior wall: formed by the aponeurosis of the external oblique and of half of the internal oblique

Posterior wall: formed by the aponeuroses of half of the internal oblique and of the transversus abdominis

Rectus sheath contents

Encloses the rectus abdominis and pyramidalis muscles

Superior and inferior epigastric vessel, lymphatic vessels and the terminal ends of lower thoracic nerves (T7-T12)

Arcuate line (aka semicircular line of Douglas)

Approximately midway between the umbilicus and the pubic symphysis, all the aponeuroses move to the anterior wall of the rectus sheath. At this point, there is no posterior wall to the sheath; the rectus abdominis is in direct contact with the transversalis fascia (more susceptible to hernia, inferior epigastric artery and vein can pass across and enter the rectus sheath)

The demarcation point where the posterior layer of the rectus sheath ends is the arcuate line or 1/3 of the distance from the pubic crest to the umbilicus

Rotator cuff muscles

1. Supraspinatus (abduction) initiates and assist in lifting the arm away from the body

2. Infraspinatus (lateral rotation)

3. Teres minor (lateral rotation)

4. Subscapularis (medial rotation) lesser tubercle

Greater tubercle

Cubital (anticubital fossa)

Lateral border: medial border of the brachioradialis muscle

Medial border: lateral border of the pronator teres muscle

Superior border: horizontal line drawn between the epicondyle of the hemerus

Roof: bicipital aponeurosis, fascia, subcutaneous fat and skin

Floor: brachialis (proximally) and supinator (distally)

Contents of cubital fossa

Passageway for structures to pass between upper arm and forearm

T: Biceps tendon (which attaches to radial tuberosity> bicipital aponeurosis, the roof)

A: Brachial artery

N: median nerve (exiting by passing between the two heads of the pronator teres)

aponeurosis (4th content)

Muscles contraction during pronation and supination

To pronate: pronator teres and pronator quadratus contract

To supinate: supinator and biceps brachii contract

*biceps ทำให้ radius หงายขึ้น

4 primary branches from thoracoacromial trunk

1. Pectoral

2. Acromial

3. Clavicular

4. Deltoid

Passageways exiting the axilla

1. Inferiorly and laterally into the upper limb

2. Quadrangular space (posterior wall, access to posterior arm and shoulder area, axillary nerve and posterior circumflex humeral artery)

3. Clavipectoral triangle (anterior wall, bounded by pectoralis major, deltoid and clavicle, cephalic vein enters, medial and lateral pectoral nerves leave)

Scapula insertion

Acromion and Spine: Trapezius

Medial border (upper portion): Levator Scapulae

Medial border at spine of scapula: Rhomboid minor

Medial border between spine and inferior angle: Rhomboid major

Medial border (costal/anterior surface): Serratus anterior

Coracoid process: Pectoralis minor

Humerus insertion

Floor: Lat. Dor

Medial lip: Teres major

Lateral lip: Pectoralis major

Linear roughening on midshaft (medial side):Coracobrachialis

Deltoid tuberosity: Deltoid

Lesser tubercle: Subscapularis

Greater tubercle (most superior facet): Supraspinatus

Greater tubercle (middle facet): Infraspinatus

Greater tubercle (inferior facet): Teres minor

Iliac crest origin

Lat. Dor.

External (i) Interal Transversus (medial lip) (from most superficial)

Iliac crest insertion

Lateral lip: M.External oblique

Aponeurosis ending in linea alba, public crest and pectineal line (insertion)

Internal oblique and transversus abdominis

Aponeurosis: external oblique

Radius insertion

Radial tuberosity: Biceps brachii

Roughening on lateral surface midshaft: Pronator teres

Distal anterior surface: Pronator quadratus

Lateral surface of distal end: Brachioradialis

Lateral surface superior to anterior oblique line: Supinator

Ulna Insertion

Ulnar tuberosity: Brachialis

Proximal posterior surface: Anconeus

Superior nuchal line

Origin:

and external occipital protuberance: Trapezius

Insertion: Lateral ½ SCM (sternal head)

Scapula (origin)

Superior border (medial to suprascapular notch): Omohyoid

(Inferior edge of the) crest of the spine and (lateral margin of the) acromion: Deltoid

Medial 2/3 of supraspinous fossa: Supraspinatus

Medial 2/3 of infraspinous fossa: Infraspinatus

Medial 2/3 of subscapular fossa: Subscapularis

Upper 2/3 (of a flattened strip of bone on) posterior surface (immediately adjacent to the lateral border of the scapula): Teres minor

(Elongate oval area on the posterior surface of the) inferior angle of the scapula: Teres major

Supraglenoid tubercle: Long head of biceps brachii

Infraglenoid tubercle: Long head of triceps brachii

Apex of coracoid process: Short head of biceps brachii and coracobrachialis

Humerus origin

anterior aspect (medial and lateral): brachialis

posterior surface: medial and lateral head of triceps brachii

Clavicle (origin and insertion)

insertion:

lateral 1/3: trapezius

(groove on inferior surface of) middle 1/3: subclavius

origin:

medial 1/2: pectoralis major

(anterior border of) lateral 1/3: deltoid

(superior surface of) medial 1/3: SCM (clavicular head)

Spinous process (origin)

Ligamentum nuchae C7-T12: Trapezius

Lower portion of ligamentum nuchae C7-T1: Rhomboid minor

T2-T5: Rhomboid major

T7-L5: Lat.Dor.

Ribs (origin)

Ribs 10-12: Lat.Dor

Anterior surface of 3,4,5: Pectoralis Minor

Outer surfaces of 5-12: External oblique

Lateral surfaces of upper 8-9: Serratus anterior

Transverse processes

C1-C4: Levator Scapulae

Costal cartilages (origin)

1-7: Pectoralis Major

Junction between rib and costal cartilage (1): Subclavius

7-12: transversus abdominis

Sternum (origin)

Anterior surface: Pectoralis major

Upper part of anterior surface of manubrium: SCM (sternal head)

Thoracolumbar fascia (origin)

Internal oblique, transversus abdominis

Joints Upper limb

Shoulder joint: synovial, ball and socket

Elbow joint: semilunar notch, sigmoid notch

Radio-ulnar joint: pivot

middle: syndesmosis

Wrist (radiocarpal) joint: ellipsoidal

Intercarpal joint (distal/midcarpal/proximal): plane synovial (gliding)

CMC and IMC joint: plane synovial (gliding)

CMC of thumb: saddle

MCP:Condyloid

IP: Bicondyloid