Axillary, Ulnar, Radial nerves & Arteries of upper limb

This presentations describes some of the arteries & nerves of the upper limb in an illustrated way

Transcript

1. AXILLARY (CIRCUMFLEX) NERVE (C5,6) (Page 70)
2. Posterior cord Axillary n. Subscapularis m. Quadrangular space Dr. Sherif Fahmy
3. Axillary n. Posterior circumflex humeral art. Anterior division of axillary n. (Supplies middle & anterior fibers of deltoid and skin covering lower half of deltoid.) Posterior division of axillary n. supplies posterior fibers of deltoid snd teres minor muscles Upper lateral cutaneous nerve of arm Quadrangular space Course of Axillary n. Dr. Sherif Fahmy Ends behind surgical neck of humerus
4. Branches 1- Articular to shoulder joint, 2- Anterior division: which gives deltoid and skin over its lower half. 3- Posterior division: gives posterior fibers of deltoid, teres minor muscles and upper lateral cutaneous nerve of arm.
5. Injury of Axillary Nerve (Page 183)
6. Causes: 1- Dislocation of shoulder j. 2- Fracture of surgical neck of humerus. 3- Badly adjusted crutch to armpit. Results: Motor loss: -Paralysis of deltoid and teres minor muscles. Sensory loss: -At skin over lower ½ of deltoid muscle. Disability & deformity: -Unable to abduct arm from 15 – 90 Degrees. -Arm is adducted. Late wasting changes: Wasting of deltoid, flat shoulder and prominent acromion.
7. Ulnar & Radial Nerves
8. Ulnar Nerve (Page 112)
9. Course & Branches of Ulnar Nerve
10. Medial intermuscular septum superior ulnar collateral art. Ulnar nerve (C7,8 & T1) Medial epicondyle Medial Lateral Medial cord of brachial plexus Axillary artery Brachial artery Insertion of coracobrachialis m.
11. Flexor carpi ulnaris m. Ulnar nerve Medial epicondyle
12. Flexor carpi ulnaris m. Flexor digitorum profundus m. Ulnar nerve Ulnar artery Flexor retinaculum Medial Lateral
13. Ulnar nerve Flexor retinaculum Medial Lateral
14. Ulnar nerve Superficial terminal branch Deep terminal branch Palmaris brevis Pisiform bone Flexor retinaculum
15. Branches of Ulnar Nerve In the arm: No branches In the forearm: Articular: to elbow joint. Muscular: to flexor carpi ulnaris and medial ½ of flexor digitorum profundus m. Cutaneous: Palmar & dorsal cutaneous branches.
16. Branches of ulnar n. in the palm: Superficial branch: ➢Muscular supply to palmaris brevis muscle. ➢Palmar cutaneous branches to medial 1&1/2 fingers. Deep branch: ➢All muscles of the hand except thenar and 1st 2 lumbricals. ➢Articular to joints of the hand.
17. Ulnar nerve Palmar cutaneous br. of ulnar nerve Superficial terminal branch Deep terminal branch Palmaris brevis Digital branches of superficial division
18. Injury of Ulnar Nerve (Page 159)
19. Injury of Ulnar Nerve 1- At wrist. 2- At elbow
20. Injury at Wrist Cause of injury: Cut wrist.
21. Motor loss: -Paralysis of all muscles in the hand except thenar and lateral 2 lumbricals. Sensory loss: -Loss of sensation in the palmar surfaces of medial 1&1/2 fingers. Disability and deformity: -Unable to adduct fingers and can not grip a piece of paper between medial 4 fingers or between thumb and index. -Unable to abduct medial 4 fingers. -Unable to do writing position. -Partial claw hand. Extension of metacarpo-phalangeal joints. Flexion of interphalangeal joint of medial 4 fingers with lesser affection of index and middle fingers. Late wasting changes: -Wasting of hypothenar eminence. -Prominent metacarpal bones due to wasting of dorsal interossii muscles.
22. Injury at Elbow Causes: -Fracture of medial epicondyle. -Narrow cubital tunnel (space between 2 heads of flexor carpi ulnaris).
23. Motor loss: -Paralysis of flexor carpi ulnaris and medial ½ of flexor digitorum profundus. -Paralysis of all muscles in the hand except thenar and lateral 2 lumbricals. Sensory loss: -Loss of sensation in medial 1/3 of palm and dorsum of hand. -Loss of sensation in medial 1&1/2 fingers. Disability & Deformity: -As at wrist, loss of adduction of all fingers & loss of abduction of medial 4 fingers. -Weak flexion of wrist with radial deviation due to paralysis of flexor carpi ulnaris muscle. -As in injury at wrist (partial claw hand) but with lesser flexion in ring and little fingers due to paralysis of medial ½ of flexor digitorum profundus muscle (Ulnar paradox). Late wasting changes: -Wasting at the medial side of forearm. -Wasting in muscles of the hand as with injury at wrist.
24. Radial Nerve (Page 84)
25. Long head of triceps Radial nerve C5,6,7,8&T1) Medial head of triceps Profunda brachii art. Course of Radial Nerve axillary art. Posterior cord of brachial plexus Humerus Lower triangular space Subscapularis m. Lateral Medial Teres major m.
26. Lateral head of triceps Medial head of triceps Radial nerve Profunda brachii art. Lateral inter-muscular septum Lower triangualr space Medial Lateral
27. Lateral inter- muscular septum Radial n. End of radial n. by giving superficial & deep brs.
28. Brachialis m. Brachio-radialis m. Radial nerve (C5,6,7,8&T1) Superficial radial n. Deep radial n.
29. Supinator muscle Deep radial nerve (posterior interosseous)
30. Superficial fibers of supinator m. Deep fibers of supinator m. Posterior interosseous nerve Posterior interosseous artery Extensor pollicis longus m. Interosseous recurrent artery
31. Radial artery Superficial radial nerve Brachio-radialis m.(cut) Medial Lateral Superficial radial nerve
32. Terminal digital branches of superficial radial nerve. Anatomical snuff box Superficial radial nerve
33. Deep radial nerve (posterior interosseous): It supplies most of the muscles of the back of forearm (extensors of the hand and fingers) except brachioradialis, extensor carpi radialis longus and anconeus ms. Superficial radial nerve: It supplies the skin of -Lateral 2/3 of the dorsum of the hand. -Back of lateral 3 and half fingers except terminal parts (from median nerve).
34. Radial nerve injury (Page 163) Causes: A- In axilla: by badly adjusted crutch in armpit. B- in upper part of arm: Saturday night palsy. C- In spiral groove: by fracture shaft of humerus. D- At elbow: by supracondylar fracture of humerus. N.B. Main deformity of radial nerve injury is wrist & finger drop (bad hand grip)
35. Dr. Sherif Fahmy
36. Injury in axilla or upper part of arm: (*) Motor loss: Paralysis of triceps and muscles of the back of forearm. Sensory loss: Loss of sensation in skin of: Back of arm, lower lateral of arm, back of forearm and back of lateral 2/3 of dorsum of hand and lateral 3 and half fingers. Disability: Unable to extends forearm against resistance, extends hand against resistance, extends fingers against resistance and supinate extended forearm. Weak hand grip. Deformity: Flexed elbow with wrist and finger drop. Late wasting changes: Wasting of back of arm & forearm.
37. Injury in the spiral groove Motor loss: Paralysis of lateral and part of medial head and muscles of the back of forearm. Sensory loss: Loss of sensation in: lower lateral of arm, back of forearm and back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Disability: Weak extension of forearm. Unable to extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: • Flexed elbow with wrist and finger drop. Weak hand grip. Late wasting changes: • Partial wasting of back of arm and wasting of back of forearm.
38. Injury of Superficial Radial Nerve
39. Cause: -Stab wound. Result of injury: Sensory loss: -At triangular area between 1st and 2nd metacarpal bones and dorsum of lateral 3 & ½ fingers except distal parts. -Hypoesthesia (decreased sensation) at the rest of area supplied by the nerve due to overlap of surrounding nerves.
40. Injury of Posterior Interosseous Nerve
41. Causes: -Dislocation of superior radio-ulnar joint. -Fracture of neck of radius. Results of injury: Motor loss: -Paralysis of muscles of back of forearm except brachio-radialis, extensor carpi radialis longus and anconeus muscles. Disability & deformity: -Weak extension of wrist with abduction of the hand. -Unable to extends fingers. -Finger drop. -No wrist drop due to action of ext.carpi radialis longus. Late wasting changes: -Wasting of back of forearm with lesser affection to lateral side.
42. Axillary Artery It is the artery of axilla.
43. Course & Relations
44. Course •It begins …………………… •It passes ……………………. •It ends ……………………
45. Course of Axillary Artery 1st rib Beginning Teres major m. End Pectoralis minor m. Subclavian art. Brachial art. Lateral Medial
46. Surface Anatomy
47. Midclavicular point Lateral wall of axilla infront posterior axillary fold Dr. Sherif Fahmy
48. Branches of Axillary Artery
49. Superior thoracic art. Acromio-thoracic art. Acromial Deltoid Pectoral Clavicular Lateral thoracic a. Anterior circumflex humeral a. Posterior circumflex humeral a. Subscapular artery
50. Subscapular artery Circumflex scapular a. Artery to latissimus dorsi m. Dr. Sherif Fahmy
51. Brachial Artery It is the artery of arm.
52. Brachial art Beginning Teres major m. Neck of radius End Ulnar art. Radial art. Course of brachial art. Humerus Axillary art.
53. Surface Anatomy
54. On lateral wall of axilla just infront the posterior axillary fold 1 cm below line of elbow just medial to tendon of biceps m.
55. Branches of Brachial Artery 1- Profunda brachii art. 2- Nutrient art. 3- Muscular arteries. 4- Superior ulnar collateral. 5- Inferior ulnar collateral. 6- Ulnar artery. 7- Radial artery.
56. Profunda brachii art Superior ulnar collateral art Inferior ulnar collateral Ulnar artery Radial artery Branches of brachial artery
57. Course & Branches of Profunda Brachii Artery
58. Brachial artery Profunda brachii art. Branches of brachial art. Dr. Sherif Fahmy
59. Profunda brachii art Superior ulnar collateral art Inferior ulnar collateral Ulnar artery Radial artery Anastomosis around elbow Radial recurrent Anterior & posterior ulnar recurrent Anterior descending br. of profunda brachii
60. ARTERIES OF FOREARM (Radial & Ulnar)
61. Brachial artery Radial artery Ulnar artery Flexor retinaculum
62. Beginning of Arteries of Forearm
63. Brachial art Neck of radius Ulnar art. Radial art. Tendon of biceps brachii m Lateral Medial Cubital fossa
64. Course of The Arteries of Forearm
65. Brachial artery Radial artery Ulnar artery & nerve Tendon of biceps Lateral Medial
66. Branches of Radial and Ulnar Arteries
67. Radial Artery Ulnar Artery In the Forearm 1- Radial recurrent 1- Anterior & posterior ulnar recurrent 2- Anterior carpal 2- Anterior & posterior carpal 3- Muscular 3- Muscular 4- Superficial palmar 4- Common interosseous Dr. Sherif Fahmy
68. Branches of radial & ulnar arteries in forearm Radial recurrent br. Anterior carpal br. Superficial palmar br. Anterior & posterior ulnar recurrent brs. Anterior carpal br. Posterior carpal br. Common interosseous art. Radial Artery Ulnar artery Anterior interosseous art. Posterior interosseous art Interosseous membrane
69. Common Interosseous Artery
70. Course & branches of anterior interosseous artery Common interosseous art. Posterior interosseous artery Median artery Descending br. Anterior interosseous artery Anterior carpal arch Nutrient to radius Nutrient to ulna Ulnar artery Interosseous membrane Median nerve Lateral Medial Pierces interosseous membrane
71. Interosseous recurrent br. Posterior interosseous art. Course & branches of posterior interosseous artery Lateral epicondyle Posterior descending br. of profunda brachii Supinator m. Abductor pollicis longus Posterior interosseous nerve End of posterior interosseous artery Lateral
72. Arteries of the Hand
73. Ulnar artery Flexor retinaculum Superficial palmar arch Radial artery Ulnar nerve Median nerve
74. Arterial Arches in the Hand 1- Anterior carpal arch: gives articular blood supply to wrist joint. 2- Superficial palmar arch: gives 3 common palmar digital arteries. 3- Posterior carpal arch: gives 2nd, 3rd and 4th dorsal metacarpal arteries. 4- Deep palmar arch: gives 3 palmar metacarpal arteries.
75. Anterior carpal arch Posterior carpal arch Superficial palmar arch Deep palmar arch Site of arterial arches in the hand
76. Radial artery in the forearm Radial artery in anatomical snuff box Radial artery passes between 2 heads of 1st dorsal interosseous muscle Abductor pollicis longus tendon Extensor pollicis brevis tendon Extensor pollicis longus tendon
77. Radial artery 1st dorsal interosseous m
78. Transverse head of adductor pollicis m Oblique head of adductor pollicis Deep palmar arch Base of 5th metacarpal bone Deep branch of ulnar artery Radial artery in the palm Radial artery 1st dorsal interosseous m Deep branch of ulnar nerve