Lecture 10 Arteries and veins of the upper limb

Transcription

1 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

2 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 4 th 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

3 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 L 5 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 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 <70 degrees FEMALE Pelvis is thin and light Oval, round pelvic inlet Large pelvic outlet Small acetabulum Wide 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

5 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 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)

6 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