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Introduction To The Study of Upper Limb.

UWI, MONA.

Dr.Suj
Anatomy,
U.W.I. Mona.

 The upper limb is specialised in man for:

- Prehension
- precision.
Anatomical position of upper limb,
- Upper limb is by the side of the trunk,
- Elbow, wrist and digits are in extension,
- Palm facing forward,(in erect posture)
- Forearm is supinated.
Midline of upper limb: passes through 3rd digit.
Axial lines: differ in their extent.

Axial lines of the upper limb

Anterior axial line and Posterior axial line.

The study of upper limb is considered in regions,

Pectoral region,
Scapular region
Axilla
Shoulder region
Arm
Cubital fossa
Forearm
Wrist
Hand.

Pectoral region

Scapular region,

Axilla.

Shoulder region,

The arm.

Cubital fossa,

Forearm.

The Wrist and The Hand

Anatomical aspects to focus in various regions,

Surface land marks and surface anatomy
Axial lines
Skeleton
Compartments and disposition of the structures,
Muscles
Joints,
Nerves, myotomes & dermatomes
Arteries and veins,
Lymphatics and lymph nodes,
Tissue planes and fascial spaces
Development,
Functional and clinical aspects,

Surface land marks and surface anatomy.

Eg; in the pectoral region

Skeleton of the upper limb.

 Features of bones and to which side of the body

particular bone belongs (mainly long bones)
Structures attached and related to the bones
Ossification centers and growing ends
Clavicle develops by membranous ossification
Rest of the upper limb bones develop
by endochondral ossification.

Disposition of the structures in any region,

Eg. In the cubital fossa;

Focus on the following aspects of muscles.

Name
Type (histological and gross )
Attachments
Nerve supply and blood supply
Action
.
Test and functional integrity

Joints of the upper limb

Sternoclavicular.J
Acromioclavicular.J
Glenohumeral.J
Elbow.J
Radioulnar.Js
- Superior
- Inferior
Radiocarpal.J
Intercarpal.Js
Carpometacalpal.Js
Metacarpophalangial.Js
Interphalangial.Js

What you need to know about any joint?

Type of joint
Aurticular components
Capsule and synovial membrane
Ligaments
Topographycal relations
Movements and the muscles involved
Nerve supply and myotomes
Blood supply
Clinical aspect.

Nerves for the upper limb are provided

mainly by the brachial plexus.
Motor innervation
Sensory innervation
Cutaneous
Proprioceptive
Autonomic innervation
To the upper limb.
+ Intercostobrachial nerve.

Study of nerves of the upper limb.

Name and root value

What is it a branch of
Course and relations
Its branches and their distribution
Testing of the nerve function
Clinical manifestations of the functional deficit.

Myotomes
and
Dermatomes
Axial lines

The arteries of the upper limb..

Stem artery of upper limb-Subclavian artery
-Lt side, it is a branch of the arch of aorta,
-Rt side, it is a branch of brachiocephalic trunk.

Beginning,course & relations, branches &distribution of :

Subclavian artery
Axillary artery
Brachial artery
Radial and ulnar arteries
Palmar arches
- Superficial
- deep
Digital arteries.

Venous return from upper limb,

through,
Superficial and deep veins drain into:
Axillary vein,
Subclavian vein,
Brachiocephalic vein,
(on both sides)
Superior vena cava,
Right atrium of the heart.

Arterial anastamosis.
Actual anastamosis
Potential anastamosis

Lymph from the upper limb goes to--Epitrochlear and axillary lymph nodes

Fascial planes and fascial spaces

Upper limb develops through

a series of epithelial*-mesenchymal interactions
in the lateral body wall - lower cervical area.

*AER

End of 4th week

Upper limb buds.
Hand plates
Digital rays
Elbow and wrists regions
Notches
During 8th wk,
digits: short and webbed.
end of week 8, distinct
fingers.

Rotation of upper limbs

Upper limbs rotate externally through 90 degrees
on their long axis and maintain anatomical
position.

Clinical aspects
Congenital defects
Supernumerary digits

Syndactily
Amelia,
Cubitus valgus,
Meromelia
Cubitus varum,
Amniotic band,
Aberrant radial artery,
Lobster hand,
Absence of radius,
Acledia,
And more.
Manus varum,
Manus valgus,

Amelia complete absence of a limb.

Meromelia the partial absence of a limb.
Hemimelia the absence of half a limb.
Phocomelia a flipper-like appendage attached to
the trunk.
Acheiria a missing hand or foot.
Adactyly the absence of metacarpal or metatarsal
Aphalangia an absent digit, finger or toe

Supernumerary digits

Syndactyly

Syndactyly

Amniotic band,

Amelia,
Acheiria
a missing
hand or foot.

Meromelia

Clinical aspects, contd.

Acquired conditions
Injuries,
Infections,
Lymph node enlargement
Lymphatic obstruction,
Arterial insufficiency
Venous obstruction,Etc.

End of topic
Praise the Lord.
Amen.