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Upper Limb 2, Anterior and posterior compartments in the arm are separated…
Upper Limb 2
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Describe the proximal and distal attachments, innervation and actions of front and back of arm muscles
Anterior compartment
Biceps brachii
- Proximal attachment:
- Long head: Supraglenoid tubercle of scapula
- Short head: Apex of coracoid process
- Distal attachment: Radial tuberosity
- Innervation: Musculocutaneous nerve
- Action:
- Long head: Flexes glenohumeral joint. Accessory flexor of the arm at shoulder joint
- Short head: flexor of the forearm at the elbow joint. Supinator of the forearm.
Musculocutaneous Nerve
- Branch of lateral cord of brachial plexus
- Pierces coracobrachialis muscle
Brachialis
- Proximal attachment: Middle of humerus anteriorly
- Distal attachment: Ulnar tuberosity, coronoid process
- Innervation: Musculocutaneous nerve
- Action: Flexes elbow. Flexor of forearm at elbow joint
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Coracobrachialis
- Proximal attachment: Coracoid process of scapula
- Distal attachment: Mid shaft of humerus
- Innervation: Musculocutaneous nerve
- Action: Flexes glenohumeral joint
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Posterior compartment
Triceps brachii
- Proximal attachment:
- Long head: Infraglenoid tubercle of scapula
- Medial head: posterior surface of tubercle
- Lateral head: posterior surface of tubercle
- Distal attachment: Olecranon process
- Innervation: Radial nerve
- Action: Extension of the forearm at the elbow joint. Long head - extend and adduct the arm at the shoulder joint
Radial Nerve
- Branch of posterior cord of brachial plexus
- Supplies muscles of back of arm and forearm
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Forearm
Elbow joint
- Capitulum connects to head of radius
- Trochlea connects to trochlea notch of ulna
- Radial notch of ulna receives radial head
- 3 Main ligaments
- Radial collateral ligament
- Ulnar collateral ligament
- Anular ligament of radius
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Nerve Supply
- Musculocutaneous nerve
- Radial nerve
- Ulnar nerve
- Median nerve
Describe the proximal and distal attachments, innervation and actions of front and back of forearm muscles
Actions
- Cross Wrist : flex, extend, abduct, adduct hand
- Cross Fingers : flex, extend fingers
Anterior Flexor Compartment (Superficial + Deep layers)
- Most flexors have common tendon on medial epicondyle
- Contains 2 pronators
- Innervated by *Median, Ulnar nerves
Pronator teres
- Proximal attachment: medial epicondyle of humerus. Coronoid process of the ulnar head
- Distal attachment: Mid forearm, radius
- Innervation: Median nerve
- Action: Pronate and flexes forearm
Flexor carpi radialis
- Proximal attachment:Medial epicondyle of humerus
- Distal attachment: Base of 2nd (and 3rd) metacarpal
- Innervation: Median nerve
- Action: Flex wrist, deviate radially
Palmaris Longus
- Proximal attachment: Medial epicondyle of humerus
- Distal attachment: Palmer aponeurosis of hand
- Innervation: Median nerve
- Action: Flexes wrist
Flexor carpi ulnaris
- Proximal attachment: Medial epicondyle of humerus. Ulnar head: olecranon and posterior border of ulna
- Distal attachment: Pisiform, hamate, base of 5th metacarpal
- Innervation: Ulnar nerve
- Action: Flex wrist. Ulnar deviation of hand
Flexor digitorum superficialis
- Proximal attachment: Medial epicondyle of humerus. Coronoid process of ulna. Head of radius
- Distal attachment: Palmer surfaces of 2-5 middle phalanges, lateral and medial sides.
- Innervation: Median nerve
- Action: Flexes proximal interphalangeal joint. Flexes metacarpophalangeal joint. Assists in flexing wrists
Flexor digitorum profundus
- Proximal attachment: ulna and interosseous membrane
- Distal attachment: Palmer surfaces of 2-5 distal phalanges
- Innervation: Lateral half by median nerve , medial half by ulnar nerve
- Action: Flexes distal interphangeal joints, metacarpophalengeal joints, and wrists.
Flexor pollicis longus
- Proximal attachment: anterior surfaces of radius and interosseous membrane
- Distal attachment: Palmer surfaces of 1st distal phalanx
- Innervation: Median
- Action: flexes interphalangeal joint and metacarpophalengeal joint of thumb
Pronator quadratus
- Proximal attachment: Distal anterior surface of ulna
- Distal attachment: Distal anterior surface of radius
- Innervation: median nerve
- Action: pronation of the radioulnar joint
Posterior Extensor Compartment (Superficial + Deep layers)
- Lateral epicondyle origin
- Innervated by Radial nerve
Brachioradialis
- Proximal attachment:Lateral supracondylar ridge of humerus
- Distal attachment:radial styloid
- Innervation:radial nerve
- Action:Flex elbow
Extensor carpi radialis longus
- Proximal attachment: Lateral supracondylar ridge
- Distal attachment:dorsal surface of base of 2nd metacarpal
- Innervation:radial nerve
- Action:extend wrist, deviate radially
Extensor carpi radialis brevis
- Proximal attachment: Lateral epicondyle of humerus
- Distal attachment:dorsal surface of base of
2nd and 3rd metacarpals
- Innervation: radial nerve
- Action:flex wrist
Extensor digitorum
- Proximal attachment: lateral epicondyle of the humerus
- Distal attachment:base of 2nd to 5th distal phalanges and dorsal expansion
- Innervation:radial nerve
- Action:Extends 2nd to 5th fingers, extends wrist
Extensor digiti minimi
- Proximal attachment:lateral epicondyle of the humerus
- Distal attachment: base of 5th proximal phalanx and dorsal expansion
- Innervation: radial nerve
- Action: extends 5th finger
Extensor carpi ulnaris
- Proximal attachment: Lateral epicondyle of humerus and ulna
- Distal attachment: base of 5th phalanx
- Innervation: radial nerve
- Action: extend 5th finger and ulnar deviation
Supinator
- Proximal attachment: lateral epicondyle of humerus, ulna
- Distal attachment: lateral surface of radius
- Innervation: radial nerve
- Action: supinate radioulnar joint
Extensor indicis
- Proximal attachment: ulna,
- Distal attachment: base of 2nd proximal phalanx and dorsal expansion
- Innervation: radial nerve
- Action: extend 2nd finger
Abductor pollicis longus
- Proximal attachment: posterior surface of radius and ulna
- Distal attachment: lateral side of base of 1st metacarpal
- Innervation: radial nerve
- Action: abduct carpometacarpal joint of thumb, extend thumb and abduct metacarpalphalangeal joint of thumb
Extensor pollicis brevis
- Proximal attachment: posterior surface of radius
- Distal attachment: base of 1st proximal phalanx
- Innervation: radial nerve
- Action: extends metacarpophalangeal joint and carpometacarpal joint of thumb
Extensor pollicis longus
- Proximal attachment: posterior surface of ulna
- Distal attachment: base of 1st distal phalanx
- Innervation: radial nerve
- Action: extend interphalangeal, metacarpophalangeal and carpometacarpal joint of thumb
Flexor pollicis brevis
- Proximal attachment: Flexor retinaculum, tubercle of scaphoid, tubercle of trapezium
- Distal attachment: - base of 1st proximal phalanx
- Innervation: median nerve
- Action: flexes metacarpophalangeal joint of thumb
Abductor pollicis brevis
- Proximal attachment: flexor retinaculum, tubercle of scaphoid, tubercle of trapezium
- Distal attachment: base of 1st proximal phalanx, extensor hood of thumb
- Innervation: median nerve
- Action: abducts metacarpophalangeal joint of thumb,
Abductor digiti minimi
- Proximal attachment: pisiform
- Distal attachment: base of 5th proximal phalanx
- Innervation: deep branch of ulnar nerve
- Action: abduct 5th finger at metacarpophalangeal joint
Flexor digiti minimi brevis
- Proximal attachment: flexor retinaculum, hamate
- Distal attachment: base of 5th proximal phalanx
- Innervation: deep ulnar nerve
- Action: flex 5th finger at metacarpophalangeal joint
Opponens pollicis
- Proximal attachment: flexor retinaculum
- Distal attachment: lateral aspect of 1st metacarpal
- Innervation: median nerve
- Action: medially rotates thumb
Opponens digiti minimi
- Proximal attachment: flexor retinaculum, hamate
- Distal attachment: medial aspect of base of 5th phalanx
- Innervation: deep ulnar nerve
- Action: laterally rotates 5th metacarpal
Flexor & Extensor Retinaculum
Collagenous bands at the wrist keep tendons from bowing
• Thick, deep fascia
Anatomy of elbow, wrist and radio ulnar joints
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Axillary artery
- Commences at the outer border of the first rib
- Continuation of the subclavian artery
- Divided into three parts by pectoralis minor
- Continue as Brachial artery from the lower border of teres major
Brachial artery
- Commences at the lower border of teres major
- Divided into radial and ulnar artery below the elbow joint
Flexors
- Biceps brachii
- Brachialis
- Brachioradialis
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Arteries
- Brachial artery
- Profunda brachii
- Radial and ulnar arteries
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Blood supply
- Via deep palmer artery
- half of index, 3, 4 and 5 are supplied by ulnar artery
- 1 and half of index by radial artery
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Carpal tunnel syndrome
- Carpal tunnel is a passageway where median nerves and flexor tendons pass through a narrow opening
- Repeitive motion inflames the tendons, and compressing the median nerve
- Results in numbness and weakness in the hand