Anatomy Workshop Upper Extremity David Ebaugh, PT, PhD Workshop Leader. Lab Leaders: STATION I BRACHIAL PLEXUS

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1 Anatomy Workshop Upper Extremity David Ebaugh, PT, PhD Workshop Leader Lab Leaders: STATION I BRACHIAL PLEXUS A. Posterior cervical triangle and axilla B. Formation of plexus 1. Ventral rami C5-T1 2. Trunks i. superior ii. middle iii. inferior 3. Divisions of each trunk i. anterior ii. posterior 4. Cords relative to axillary artery i. lateral ii. medial iii. posterior C. Terminal nerves 1. Musculocutaneous 2. Median 3. Ulnar 4. Axillary 5. Radial D. Anatomic sites of potential entrapment 1. IVF 2. Superior thoracic aperture 3. Scalene triangle 4. Costoclavicular interval 5. Coracoid pectoralis minor loop E. Humeral head 1/23/2015 1

2 STATION II- GLENOHUMERAL JOINT A. Glenoid fossa and humeral head B. Glenoid Labrum C. Rotator cuff muscles - subscapularis, supraspinatus, infraspinatus, teres minor 1. Relationships with glenohumeral joint capsule 2. Roles in stabilizing glenohumeral joint D. Glenoid labrum E. Subacromial (suprahumeral) space 1. Boundaries 2. Contents a. Superior: acromion, coracoid process, coracoacromial ligament, acromioclavicular joint. b. Inferior: head of humerus. a. Subacromial (subdeltoid bursa) b. Supraspinatus tendon and/or muscle c. Superior aspect of glenohumeral joint capsule d. Tendon of long head of biceps brachii F. Suprascapular nerve 1. Suprascapular notch G. Axillary nerve 1. Quadrangular space 1/23/2015 2

3 STATION III - ARM, ELBOW AND FOREARM A. Osteology 1. Distal humerus 2. Proximal ulna 3. Proximal radius B. Soft tissue supports 1. Joint capsule 2. Medial (ulnar) collateral ligament 3. Lateral (radial) collateral ligament 4. Annular ligament C. Course and potential entrapment points for the radial, ulnar, and median nerves 1. Radial nerve a. Spiral groove b. Lateral intermuscular septum c. Radial tunnel, archade of frosche, supinator muscle i. deep radial nerve d. Antebrachial fascia i. superficial radial nerve 2. Ulnar nerve a. Archade of Struthers b. Cubital tunnel 3. Median nerve a. Supracondylar process/ligament of Struthers b. Bicipital aponeurosis c. Pronator teres d. Sublimus bridge 1/23/2015 3

4 STATION IV WRIST and CARPAL TUNNEL A. Osteology and articulations 1. Distal radius and ulna 2. Proximal and distal carpal bones 3. Distal radioulnar joint and TFCC B. Flexor retinacula 1. Superficial part of flexor retinaculum (volar carpal ligament) 2. Deep part of flexor retinaculum (transverse carpal ligament) 3. Palmar branch of median nerve C. Formation of carpal tunnel 1. Transverse carpal ligament and carpal bones i. pisiform and hook of hamate medially ii. tubercles of scaphoid and trapezium laterally iii. thickness and tautness of transverse carpal ligament iv. rigidity of canal 2. Proximal vs. distal carpal tunnel i. transverse dimension D. Contents of canal 1. Tendons of FDS, FDP, FPL 2. Median nerve 3. Radial and ulnar bursa 1/23/2015 4

5 STATION V HAND A. Ulnar Nerve 1. Superficial to carpal tunnel i. Guyon's canal ii. deep branch iii. superficial branch iv. common and Proper digital branches v. dorsal cutaneous branch B. Median nerve 1. Palmar branch 2. Through carpal tunnel 3. Recurrent (Thenar, Motor) branch 4. Common and Proper digital branches C. Superficial radial Nerve 1. Common and proper digital nerves D. Metacarpophalangeal joint 1. Shapes of articular surfaces 2. Attachments and eccentricity of collateral ligaments; tightness of ligaments from extension to flexion 3. Relationship of extensor digitorum tendon to capsule 4. Extensor hood and capsule; movement of extensor hood 5. Capsule and volar plate 6. Volar plate (palmar ligament) relationship to extensor hood and deep transverse metacarpal ligament E. Interphalangeal joints 1. Shapes of articular surfaces 1/23/2015 5

6 2. Attachments of collateral ligaments 3. Tightness of ligaments from extension to flexion 4. Proximal interphalangeal joint i. Relationship of central and lateral bands to capsule ii. Capsule and volar plate 5. Distal interphalangeal joint i. Relationship of lateral bands to capsule ii. Capsule and volar plate 6. Volar plates i. Proximal and distal attachments ii. Movement of volar plate from extension to flexion 1/23/2015 6