Arteries and veins of the upper limb 1. Identify the Subclavian
Lecture 10 – Arteries and veins of the upper limb 1. Identify the Subclavian, axillary, brachial (deep and superficial), radial and ulnar arteries and superficial/deep palmar arches 2. Describe the major course and relations of these arteries • Originate at Subclavian (under clavicle from upper aorta) • Through neurovascular bundle at axilla Axillary • Circumflex wrap around humerus posteriorly and anteriorly • Down to Brachial (passes via cubital fossa) with superficial and profundal branches • Brachial division supplies interosseous and branches into Radial) and Ulnar • Radial and Ulnar join at palm to Superficial and Deep Arch 3. Identify the main pulse sites of the upper limb • Axillary • Brachial mid arm • Brachial at cubital fossa • Radial pulse at distal forearm • Radial pulse at anatomical snuffbox • Ulnar pulse at distal forearm 4. Identify superficial veins: Cephalic, basilic, median cubital, median 1. Dorsal venous arch 2. Cephalic – toward head along anterior border of deltoid 3. Basilic – deeper in brachium 4. Median cubital – runs along brachial artery and joins veins 2, 3 and 5 5. Median -‐ antebrachial 5. Describe the general location and arrangement of deep veins • Accompany artery and carry same name venae comitantes • Often several deep veins accompany one artery until vein gets larger and reduces to one • Thin walled and dispensable – rely on valves to prevent backwash 6. Describe the pattern of superficial and deep venous return • As veins become more proximal they increase in size • Deep veins accompany artery • Flow: Superficial -‐> deep -‐> heart
• •
Originate at distal, terminate at proximal Oppose arterial flow
7. Explain the hazards relating to applying an injection in the cubital fossa • Brachial artery can be punctured to cause bruising and pain • Median nerve can also be pinched and can cause nerve damage or pain
Lecture 11 – Nerves of the upper limb 1. Describe the location of the “brachial plexus” • Supplies the upper limb from the C5-‐T1 vertebrae (neck and axilla) 2. Name the spinal segments that make up the brachial plexus • C5, C6, C7, C8, T1 3. Describe the distribution of the 5 terminal braches of the brachial plexus (radial, ulnar, medial, axillary and musculocutaneous nerves) Axillary nerve • From C5 and C6 -‐> Deltoid and Teres major Radial nerve • From C5-‐T1 -‐> All posterior arm and forearm muscles RAP (Radial all posterior) Musculocutaneous nerve • C5-‐C7 -‐> Anterior arm – sensory to skin of anterior forearm Median nerve • C6-‐T1 -‐> Anterior forearm, 3 thenar, 2 lumbricles, sensory thumb/2.5 digits • Runs through carpal tunnel Ulnar nerve • C7-‐T1 -‐> FCU (A), FDP ((A) ulnar half) and intrinsic hand muscles – hypothenar, adductor pollicis, 2 medial lumbricles, interossei 4. Identify main segmental cutaneous sensory innervation (dermatomes) of the upper limb) • C3 and C4 = base of neck • C5 = lateral arm • C6 = lateral forearm and thumb • C7 = middle and 4th finger • C8 = little finger and medial forearm • T1 = medial forearm • T2 = skin of medial forearm and axilla 5. Describe the motor innervation (muscle compartments supplied) by the main nerves of the upper limb (myotomes) • Axillary = deltoid and teres major • Radial = all posterior muscles • Musculocutaneous = all anterior arm (brachialis, biceps brachii, Coracobrachialis) • Median = anterior forearm, 3 thenar, 2 lateral lumbricles and 2 digits • Ulnar = Flexor carpi ulnaris, flexor digitorum profundus, hypothenar, medial 2 lumbricles, interossei
6. Describe the sensory representation of the radial, ulnar and median nerve in the hand • Radial – Posterior lateral half (non mid or distal phalanges) 1-‐3 some 4 • Ulnar – Posterior and anterior palm/phalanges 4-‐5 • Median – palmar surface and 1-‐3 phalanges
7. Understand the consequences of damage to the main nerves of the upper limb • Ulnar damage = claw hand – atrophy of hypothenar and interossei with muscle imbalance • Median nerve in forearm – Pronators, FCR, FDS, ½ FDP • Median nerve at carpal tunnel – 3 thenar muscles ONLY • Radial nerve at proximal humerus – all extensors of arm, forearm, fingers and supinator • Axillary in axilla – deltoid, teres major Lecture 12 – The Pelvic Girdle 1. Identify the bony structure and joints of the pelvis • Structures o Ilium o Ischium o Pubis § Make Acetabulum o ASIS, AIIS o PSIS, PIIS o Ischial spine o Ischial tuberosity (site of hamstring attachment) o Gluteal/Iliac fossa o Iliac spine o Obturator foramen o Greater and lesser sciatic notch • Joints o Acetabulum o Pubis symphisis – cartilaginous between pubic bones o Sacroiliac (x2) – synovial plane joint, posterior fibrous joints § Sacrospinous ligament § Sacrotuberous ligament § Interosseous ligament o Lumbosacral – L5 and sacrum o Sacrococcygeal – “tail bone” 2. Describe functions provided by the pelvic girdle • Bears weight of trunk and head • Maintains posture and stability • Weight transfer from axial to appendicular skeleton • Muscle attachment site • Protects abdominopelvic structures 3. Define the terms: greater (false) and lesser (true) pelvis • False (greater) = abdominal organs • True (lesser) = pelvic structures – perineum and pelvic diaphragm
4. Describe main gender differences seen in the pelvis MALE • Pelvis is thick and heavy • Heart shaped narrow pelvic inlet • Small pelvic outlet • Larger acetabulum • Narrow pelvic arch/angle 80 degrees
5. Identify and name the muscles that make up the pelvic walls and pelvic floor (diaphragm) Pelvic walls • Piriformis • Obturator internus o Laterally rotate hip • Arise from sacrum and Obturator foramen Pelvic floor • Pubococcygeus o Pubovaginalis/puboprostalis o Puborectalis § Levator ani muscles • Iliococcygeus • Coccygeus • Lack of muscular tissue anteriorly = urogenital hiatus 6. Describe the location and boundaries of the perineum • Below pelvic diaphragm • Between ischial tuberosities, coccyx, pubis symphisis • Pubic arch and sacrotuberous ligaments form sides • Anterior urogenital triangle • Anal triangle 7. Describe the main functions provided by the perineum • Waste excretion • Sexual function
Lecture 13 – The Hip Joint 1. Identify and name the bones that comprise the hip joint • Ilium, ischium, pubis (pelvis) and femur 2. Describe the functional requirements of the lower limb and the most stable position of the hip joint • Locomotion
• • •
Weight bearing Maintain equilibrium Most stable in extension
3. Demonstrate and name the main movements of the hip joint • Flexion/extension • Abduction/adduction • Medial and lateral rotation 4. 5. 6. 7.
Identify in pelvic bone: Ilium, ischium, pubis and acetabulum Identify on ilium: iliac and gluteal fossae, ASIS, AIIS, PIIS, PSIS, iliac spine Identify on Ischium: ischial tuberosity, greater sciatic notch, Obturator foramen Identify on the pubis: rami, body, pubis symphisis
8. Identify in proximal femur: head, neck, trochanters, gluteal tuberosity, linea alba 9. Classify joint at • Ball
•
the type of synovial the hip and socket
Close-‐packed in extension
10. Identify main hip ligaments and the acetabular labrum • Iliofemoral ligament – anterior and strongest, resists hyperextension • Ischiofemoral ligament – posterior (aids corkscrew action)
• •
Pubofemoral ligaments – inferior and weakest (aids corkscrew) Acetabular labrum deepens the socket
11. Identify origins and main insertion points for hip muscles • Psoas major o O = T12-‐L5 o I = Lesser trochanter o A = Hip flexion • Iliacus o O = Iliac fossa o I = Lesser trochanter o A = Hip flexion • Gluteus Maximus o O = Iliac fossa o I = Gluteal tuberosity o A = Extension / lateral rotation • Gluteus medius o O = lilac spine o I = Greater trochanter o A = Abduction / medial rotation • Gluteus minimus o O = ASIS o I = Greater trochanter o A = Abduction / medial rotation
• •
Originate at distal, terminate at proximal Oppose arterial flow
7. Explain the hazards relating to applying an injection in the cubital fossa • Brachial artery can be punctured to cause bruising and pain • Median nerve can also be pinched and can cause nerve damage or pain
Lecture 11 – Nerves of the upper limb 1. Describe the location of the “brachial plexus” • Supplies the upper limb from the C5-‐T1 vertebrae (neck and axilla) 2. Name the spinal segments that make up the brachial plexus • C5, C6, C7, C8, T1 3. Describe the distribution of the 5 terminal braches of the brachial plexus (radial, ulnar, medial, axillary and musculocutaneous nerves) Axillary nerve • From C5 and C6 -‐> Deltoid and Teres major Radial nerve • From C5-‐T1 -‐> All posterior arm and forearm muscles RAP (Radial all posterior) Musculocutaneous nerve • C5-‐C7 -‐> Anterior arm – sensory to skin of anterior forearm Median nerve • C6-‐T1 -‐> Anterior forearm, 3 thenar, 2 lumbricles, sensory thumb/2.5 digits • Runs through carpal tunnel Ulnar nerve • C7-‐T1 -‐> FCU (A), FDP ((A) ulnar half) and intrinsic hand muscles – hypothenar, adductor pollicis, 2 medial lumbricles, interossei 4. Identify main segmental cutaneous sensory innervation (dermatomes) of the upper limb) • C3 and C4 = base of neck • C5 = lateral arm • C6 = lateral forearm and thumb • C7 = middle and 4th finger • C8 = little finger and medial forearm • T1 = medial forearm • T2 = skin of medial forearm and axilla 5. Describe the motor innervation (muscle compartments supplied) by the main nerves of the upper limb (myotomes) • Axillary = deltoid and teres major • Radial = all posterior muscles • Musculocutaneous = all anterior arm (brachialis, biceps brachii, Coracobrachialis) • Median = anterior forearm, 3 thenar, 2 lateral lumbricles and 2 digits • Ulnar = Flexor carpi ulnaris, flexor digitorum profundus, hypothenar, medial 2 lumbricles, interossei
6. Describe the sensory representation of the radial, ulnar and median nerve in the hand • Radial – Posterior lateral half (non mid or distal phalanges) 1-‐3 some 4 • Ulnar – Posterior and anterior palm/phalanges 4-‐5 • Median – palmar surface and 1-‐3 phalanges
7. Understand the consequences of damage to the main nerves of the upper limb • Ulnar damage = claw hand – atrophy of hypothenar and interossei with muscle imbalance • Median nerve in forearm – Pronators, FCR, FDS, ½ FDP • Median nerve at carpal tunnel – 3 thenar muscles ONLY • Radial nerve at proximal humerus – all extensors of arm, forearm, fingers and supinator • Axillary in axilla – deltoid, teres major Lecture 12 – The Pelvic Girdle 1. Identify the bony structure and joints of the pelvis • Structures o Ilium o Ischium o Pubis § Make Acetabulum o ASIS, AIIS o PSIS, PIIS o Ischial spine o Ischial tuberosity (site of hamstring attachment) o Gluteal/Iliac fossa o Iliac spine o Obturator foramen o Greater and lesser sciatic notch • Joints o Acetabulum o Pubis symphisis – cartilaginous between pubic bones o Sacroiliac (x2) – synovial plane joint, posterior fibrous joints § Sacrospinous ligament § Sacrotuberous ligament § Interosseous ligament o Lumbosacral – L5 and sacrum o Sacrococcygeal – “tail bone” 2. Describe functions provided by the pelvic girdle • Bears weight of trunk and head • Maintains posture and stability • Weight transfer from axial to appendicular skeleton • Muscle attachment site • Protects abdominopelvic structures 3. Define the terms: greater (false) and lesser (true) pelvis • False (greater) = abdominal organs • True (lesser) = pelvic structures – perineum and pelvic diaphragm
4. Describe main gender differences seen in the pelvis MALE • Pelvis is thick and heavy • Heart shaped narrow pelvic inlet • Small pelvic outlet • Larger acetabulum • Narrow pelvic arch/angle 80 degrees
5. Identify and name the muscles that make up the pelvic walls and pelvic floor (diaphragm) Pelvic walls • Piriformis • Obturator internus o Laterally rotate hip • Arise from sacrum and Obturator foramen Pelvic floor • Pubococcygeus o Pubovaginalis/puboprostalis o Puborectalis § Levator ani muscles • Iliococcygeus • Coccygeus • Lack of muscular tissue anteriorly = urogenital hiatus 6. Describe the location and boundaries of the perineum • Below pelvic diaphragm • Between ischial tuberosities, coccyx, pubis symphisis • Pubic arch and sacrotuberous ligaments form sides • Anterior urogenital triangle • Anal triangle 7. Describe the main functions provided by the perineum • Waste excretion • Sexual function
Lecture 13 – The Hip Joint 1. Identify and name the bones that comprise the hip joint • Ilium, ischium, pubis (pelvis) and femur 2. Describe the functional requirements of the lower limb and the most stable position of the hip joint • Locomotion
• • •
Weight bearing Maintain equilibrium Most stable in extension
3. Demonstrate and name the main movements of the hip joint • Flexion/extension • Abduction/adduction • Medial and lateral rotation 4. 5. 6. 7.
Identify in pelvic bone: Ilium, ischium, pubis and acetabulum Identify on ilium: iliac and gluteal fossae, ASIS, AIIS, PIIS, PSIS, iliac spine Identify on Ischium: ischial tuberosity, greater sciatic notch, Obturator foramen Identify on the pubis: rami, body, pubis symphisis
8. Identify in proximal femur: head, neck, trochanters, gluteal tuberosity, linea alba 9. Classify joint at • Ball
•
the type of synovial the hip and socket
Close-‐packed in extension
10. Identify main hip ligaments and the acetabular labrum • Iliofemoral ligament – anterior and strongest, resists hyperextension • Ischiofemoral ligament – posterior (aids corkscrew action)
• •
Pubofemoral ligaments – inferior and weakest (aids corkscrew) Acetabular labrum deepens the socket
11. Identify origins and main insertion points for hip muscles • Psoas major o O = T12-‐L5 o I = Lesser trochanter o A = Hip flexion • Iliacus o O = Iliac fossa o I = Lesser trochanter o A = Hip flexion • Gluteus Maximus o O = Iliac fossa o I = Gluteal tuberosity o A = Extension / lateral rotation • Gluteus medius o O = lilac spine o I = Greater trochanter o A = Abduction / medial rotation • Gluteus minimus o O = ASIS o I = Greater trochanter o A = Abduction / medial rotation
