Moore's - Chapter 3: Upper Limb

Superior appendicular skeleton

- pectoral girdle and bones of the free part of the upper limb for this structure, which articulates with the axial skeleton only at the sternoclavicular joint, allowing great mobility

Glenoid cavity

- articulates with the head of the humerus at the glenohumeral joints

- found at the lateral surface of the head of the scapula

Humerus

- largest bone in the upper limb

- articulates with scapula at glenohumerual joint and the radius an ulna at the elbow joint

Ulna

- stabilizing bone of the forearm

- medial and longer of the two forearm bones

Radius

- lateral and shorter forearm bone

Carpus

- wrist

- composed of eight carpal bones arranged in proximal and distal rows of four

What are the carpal bones?

- scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Lunate

- a moon-shaped bone that is border anteriorly than posteriorly

Scaphoid

- a bat-shaped bone that has a prominent scaphoid tubercle

Triquetrum

- a pyramidal bone on the medial aspect of the carpus

Pisiform

- a small, pea-shaped bone that lies on the palmar surface of the triquetrum

Trapezium

- a four-sided bone on the lateral side of the carpus

Trapezoid

- a wedge-shaped bone

Capitate

- the head-shaped bone that is the largest in the carpus

Hamate

- a wedge-shaped bone, which has a hooked process, the hook of hamate, that extends anteriorly

What are the bones in the proximal row of the carpals?

- scaphoid, lunate, triquetrum, pisiform

What are the bones in the distal row of the carpals?

- trapezium, trapezoid, capitate, hamate

Metacarpus

- forms the skeleton of the palm of the hand between the carpus and the phalanges

- composed of five bones

Pectoral fascia

- invests the pectoralis major and is continuous inferiorly with the fascia of the anterior abdominal wall

- leaves the lateral border of the pectoralis major and becomes the axillary fascia which forms the floor of the axilla

Clavipectoral fascia

- deep to the pectoral fascia and pec major

- descends from clavicle, enclosing the subclavius and then the pec minor, becoming continuous inferiorly with the axillary fascia

Costocorocoid membrane

- part pf the clavipectoral fascia between pec minor and subclavius

- pierced by lateral pectoral nerve, which primarily supplies the pec major

Suspensory ligament of axilla

- part of clavipectoral fascia inferior to pec major

- supports axillary fascia and pulls it and the skin inferior to it upward during abduction of the arm, forming the axillary fossa

Deltoid fascia

- invests the deltoid and is continuous with the pectoral fascia anteriorly and the dense infraspinous fascia psteriorly

Brachial fascia

- a sheath of deep fascia

- encloses arm like a snug sleeve

- continuous superiorly with the deltoid, pectoral, axillary and infraspinous fasciae

Superficial transverse metacarpal ligament

- forms the base of the palmar aponeurosis

Cephalic vein

- ascends in the subcutaneous tissue from the lateral aspect of the dorsal venous network, proceeding along the lateral border of the wrist and the anterolateral surface of the forearm and arm

Profunda brachii artery

- travels posterior to the humerus in the radial groove and helps form the peri-articular cubital anastomosis of the elbow region

Ulnar artery

- descends through the anterior compartment of the forearm

- pulsations of this structure can be palpated on the lateral side of the floor carpi ulnaris tendon

Radial artery

- courses through the forearm laterally deep to the brachioradialis

- pulsation of this structure is usually measured on the distal radius

Superficial lymphatic vessels

- arise from lymphatic plexuses in the skin of the fingers, palm, and dorsum of the hand and ascend mostly with superficial veins, such as the cephalic and basilica veins

Brachial plexus

- most cutaneous nerves of the upper limb are multisegmental peripheral nerves derived from this structure

- major nerve network formed by anterior rami of the C5-T1 spinal nerves

Cervical plexus

- cutaneous nerves of the shoulder are derived from this structure

- a nerve network consisting of a series of nerve loops formed between adjacent anterior rami of the first four cervical nerves

- lies deep to the SCM on the lateral aspect of the neck

Supraclavicular nerves

- pass anterior to the clavicle, immediately deep to the platysma

- supplies the skin over the clavicle and the superolateral aspect of the pectoralis major

Posterior cutaneous nerve of the arm

- a branch of the radial nerve

- supplies the skin on the posterior surface of the arm

Posterior cutaneous nerve of the forearm

- also a branch of the radial nerve

- supplies the skin on the posterior surface of the forearm

Superior lateral cutaneous nerve of the arm

- a terminal branch of the axillary nerve

- emerges from beneath the posterior margin of the deltoid to supply the skin over the lower part of this muscle and on the lateral side of the midarm

Inferior lateral cutaneous nerve of the arm

- a branch of the radial nerve

- supplies the skin over the inferolateral aspect of the arm

- it is frequently a branch of the posterior cutaneous nerve of the forearm

Lateral cutaneous nerve of the forearm

- the terminal branch of the musculocutaneous nerve

- supplies the skin on the lateral side of the forearm

Medial cutaneous nerve of the arm

- arises from the medial cord of the brachial plexus, often uniting in the axilla with the lateral cutaneous branch of the 2nd intercostal nerve

- supplies the skin on the medial side of the arm

Intercostobrachial nerve

- a lateral cutaneous branch of the 2nd intercostal nerve, also contributes to the innervation of the skin on the medial surface of the arm

Medial cutaneous nerve of the forearm

- arises from the medial cord of the brachial plexus and supplies the skin on the anterior and medial surfaces of the forearm

Axio-appendicular muscles

- attach the superior appendicular skeleton of the upper limb to the axial skeleton

- most act at the physiological scapulothoracic joint, moving the scapula on the chest wall

- scapulohumerual muscles attach the scapula to the humerus and act at the glenohumerual joint

What are the six scapulohumeral muscles?

- deltoid, theres major, supraspinatus, infraspinatus, subscapularis, teres minor

What are the four scapulohumeral / rotator cuff muscles?

- supraspinatus, infraspinatus, teres minor, subscapularis

- S.I.T.S.

Cervico-axillary canal

- apex of axilla

- the passageway between the neck and the axilla

- bounded by the first rib, clavicle, and superior edge of the scapula

Axilla

- pyramidal compartment inferior to the glenohumeral joint and superior to the skin and axillary fascia at the junction of the arm and thorax

Axillary fossa

- base of the axilla is formed by the concave skin, subcutaneous tissue, and axillary fascia extending from the arm to the thoracic wall forming this structure

Anterior axillary fossa

- inferiormost part of the anterior wall

Posterior axillary fossa

- inferiormost part of the posterior wall

Pectoral (anterior) nodes

- consist of three to five nodes that lie along the medial wall of the axilla, around the lateral thoracic vein and inferior border of the pec minor

- receives lymph mainly from the anterior thoracic wall, including most of the breast

Subscapular (posterior) nodes

- consist of six or seven nodes that lie along the posterior axillary fold and sub scapular blood vessels

- these nodes receive lymph from the posterior aspect of the thoracic wall and scapular region

Humeral (lateral) nodes

- consist of four to six nodes that lie along the lateral wall of the axilla, medial and posterior to the axillary vein

- receive nearly all the lymph from the upper limb, except that carried by lymphatic vessels accompanying the cephalic vein, which primarily drain to the apical axillary and infraclavicular nodes

Central nodes

- efferent lymphatic vessels from the pectoral, subscapular and humeral nodes pass to this structure

- consist of three or four large nodes situated deep to the pec minor near the base of the axilla, in association with the second part of the axillary artery

Apical nodes

- located at the apex of the axilla along the medial side of the axillary vein and the first part of the axillary artery

Superior trunk of brachial plexus

- from the union of C5 and C6 roots

Middle trunk of brachial plexus

- a continuation of the C7 root

Inferior trunk of brachial plexus

- from the union of the C8 and T1 roots

What are the three cords of the brachial plexus?

- lateral

- medial

- posterior

Bicipital aponeurosis

- triangular membranous band

- runs from the biceps tendon across the cubital fossa and merges with the ante brachial fascia covering the flexor muscles in the medial side of the forearm

Median nerve

- formed in the axilla by the union of medial and lateral roots from the medial and lateral cords of the brachial plexus, respecitvely

Ulnar nerve

- arises from the medial cord of the brachial plexus, conveying fibers mainly from the C8 and T1 nerves

- passes distally, anterior to the insertion of teres major and to the long head of triceps, on the medial side of the brachial artery

Musculocutaneous nerve

- arises from the lateral cord of the brachial plexus, pierces the coracobrachialis, and then continues distally between the brachial and the biceps

- after supplying all three muscles of the anterior compartment of the arm, the nerve emerges lateral to the biceps brachia as the lateral cutaneous nerve of the forearm

Radial nerve

- enters the arm posterior to the brachial artery, medial to the humerus, and anterior to the long head of the triceps

- descends inferolaterally with the profunda brachia artery and curves around the humeral shaft in the radial groove

Cubital fossa

- shallow triangular depression on the anterior surface of the elbow

What are the boundaries of the cubital fossa?

- superiorly, an imaginary line connecting the medial and lateral epicondyles

- medially, the pronator teres

- laterally, the brachioradialis

- floor formed by brachial and supinator muscles

- roof formed by the continuity of brachial and antebrachial fascia, reinforced by the bicipital aponeurosis, subcutaneous tissue, and skin

Palmar carpal ligament

- tendons of most flexor muscles pass across the anterior surface of the wrist and are held in place by this structure

Superficial layer of flexor muscles of forearm

- pronator teres

- flexor carpi radialis

- palmaris longus

- flexor carpi ulnaris

Intermediate layer of flexor muscles of forearm

- flexor digitorum superficialis

Deep layer of flexor muscles of forearm

- flexor digitorum

- flexor pollicis longus

- pronator quadratus

Retinacular ligament

- delicate fibrous band that runs from the proximal phalanx and fibrous digital sheath obliquely across the middle phalanx and two interphalangeal joints

Mneumoic for interosseous muscles of the hand

- dorsal abduct (DAB)

- palmar adduct (PAD)

Carpal tunnel

- passageway deep to the flexor retinaculum between the tubercles of the scaphoid and the trapezium bones on the lateral side and the pisiform and the hook of hamate on the medial side

Sternoclavicular joint

- synovial articulation between the sternal end of the clavicle and the manubrium of the sternum and the 1st costal cartilage

Joint capsule

- surrounds the SC joint, including epiphysis at the sternal end of the clavicle

Acromioclavicular (AC) joint

- a plane synovial articulation

- located 2-3 cm from the point of the shoulder formed by the lateral part of the acromion of the scapula

AC ligament

- fibrous band extending from the acromion to the clavicle, strengthens the AC joint superiorly

Collateral ligaments of the elbow joint

- strong triangular bands that are medial and lateral thickenings of the fibrous layer of the joint capsule

Proximal (superior) radio-ulnar joint

- pivot type of synovial joint that allows movement of the head of the radius of the unla