ANATOMY Subject : Lecturer : Maher Hadidi Done by: lecture # : 11 Date :
Median nerve Meaian nerve to Pronator teres Course: Enter cubital fossa. Pierce Pronat. teres Between to FDS, FOP Below and lateral to palmaris Longus. Deep to Fl. Retinae. Branches: Ant. interosseous N. Ant. to interosseous membrane Palmar branch C/ skin SUQQiy: All muscles in ant. compt. except (1& 1/2) by ulnar N. Skin of hand. Elbow, Wrist & distal radioulnar joints. Anterior interosseous nerve to Flexor pollicis longus to Flexor carpi radialis to Pronator quad to Palmaris longus to elbow joint Pronator teres to Flexor digitorurn superficial is to Flexor digitorurn profundus to 2nd, 3rd fingers Spring 2013 Dr. Maher T. Hadidi, University of Jordan 87 1
Ulnar N. Course: Behind medial epicond. Between 2 heads of FCU. Lat. to pisiform bone. Medial to ulnar A. Above flex. retinae. Branches: Palmar~to skin of Med. 1/3 of palm Dorsal~ to skin of med. 1/3 of hand. Suppl~ 1 & 1 h muscles Skin of hand Elbow joint. Spring 2.013 Dr. Maher T. Hadidi, University of Jordan lnar nerve Bet1ind n1edial epicondyle to Flexor carpi ulnaris Between 2 heads of flexor carpi u\naris Deep to flexor digitorum superlicialis to Flexor digitorum profundus of 4th, 5th fingers Dorsal branch 1 to skin Flexor carpi ulnaris Pass lateral to it almar branch (Sk1n) To all small muscles of the hand except 5 by median nerve. 88,.. L
A Distal phalanx, ' ~ ---~ : structures pass superficial to flexor retinaculum: - 4 ulnars - 2 palmars -++' - ---' Flexor digitorun"l t\ prof'undu:s r Radialis indicis A... Superficial is tendon --- - -Palrn<Jr digital artery Palrnar digital nerve Rad1al A, superficial b Median nerv=- -... -=,,~ Palmaris long RacHal arte Brachicnadialis """ ~Flexor carpi ulnaris 11' Flexor digitorum superficial is 3
Course: Anterior to lateral epicondyle. Between brachialis and brachioradialis. Branches: Superficial branch o Deep branch Supply from stem: Brachioradialis Ext. carpi radialis longus Elbow joint Radial nerve-1 Radial nerve to Brachioradialis "-.._~'ill : to Extensor carpi~ "-...,,::; l radialis longus ~ ' ~"'"~ To elbow joint-------- Deep branch/.----- Supinator Superficial branch Posterior interosseous A Interosseous membrane / Spring 2013 Dr. Maher T. Hadidi, University of Jordan 90 4
Superficial Radial branch Course: Within cubital fossa. Under brachioradialis Go to the back below brachioradialis tendon. Posterior to wrist. Supply: Skin of lateral 2/3 of posterior part of hand. Skin of proximal phalanges of the lateral 3 and 1/2 Fingers. Radial nerve----,! Superficial branch ~ Under brachioradialis Brachioradialis --- j Flex. carpi radialis Pass posterior -! below brachioradialis tendon. to skin of hand ~. --Median N Spring 2013 Dr. Maher T. Hadidi, University of Jordan 91 5
Deep Radial N Course: ~ Inside cubital fossa. ~ Pierce supinator M. ~ Wind around neck of radius. ~ Reach posterior compartment. ~ Pass between superficial and deep group of muscles. ~ Reach wrist joint. Branches: All posterior compartment except 2 muscles by the stem. Wrist joint. Extensor indicis interosseous artery ~Supinator ---Posterior interosseous nerve ' Postenor interosseous artery Posterior view Spring 2013 Or. Maher T. Hadidi, University of Jordan 92 6
2 Arteries 1. Ulnar artery Larger branch of brachial Course: Begin: At neck of radius Deep 'IT, Superficial.g Above Flex. Retinaculum 111 Branches: Common interosseous Ant. interosseous To ant. Compt. Posterior interosseousc=::c> To post compt. At wrist gives 2 branches Superficial Deep branch Spring 2013 Brachial artery_-r--+--=-»'.. ~-.//Ulnar nerve /. + Pronator teres Superficial radial N Post interosseous A Interosseous n1embrane-~ Perforating branches ~ --- or ant interosseous Al Brachioradialis Flexor carpi radialis Radius ldistal1/4)_ ------ Deep branch------------------- "--- Superficial branch--. ---Flexor carpi ulnaris Comrnon interosseous l1 -----Jiex. digit superticialis ---.,Ant. l()terosseous A Flex. digit profundus ---... Ulnar artery _ Pronator quadratus Flexor carpi ulnaris I p 'f ~ 1s1 orm,-------ulnar nerve _ Deep palmar arch \ _-r~- Superficial palmar ' <- -~- arch 93
2 Arteries Brachial artery_... Flexor carpi ulnaris 2. Radial artery Smaller branch. Superficial radial N. Course: Post. interosseous A. ',Flex. digit superticialis Within cubital fossa. "'-.Ant interosseous A Deep to brachioradialis Between 2 radialis ms. Perforating branches ~-- Flex. digit. profundus At wrist, give 2 ol ant interosseous A... Branches, Superficial branch==> Brachioradialis Deep branch==> Flexor carpi radialis. Radius {distal 114]~ -- ~ Radial oulse site: At distal V4 of anterior surface of radius, between 2 (radialis) tendons. Deep branch.. ~ Superficial branch~. Ulnar artery Pronator quadratus Flexor carpi ulnaris ~--- _Deep palmar arch \ '"\\ S,... f I,~ upe111cta pa mar ' '~,.,\" arch Spring 2013 Dr. Maher T. Hadidi, University of Jordan 94 8
Digital artery Palmar digital A. SuperFicial palrnar arch Deep branch. Superficial branch (main) : Deep pal m ar~-~...:..----+.. arch U In a r a rte ry_ - - --,.._.,~11:- Radial artery / Princips -,~- pollicis A Superficial "----7"------- branch Deep branch (Main) ~LATERAL 9
Palmar arches-1 Superficial arch Contributed by ulnar and radial arteries. Mainly from superficial branch of ulnar artery. Located at the level of the distal border of fully extended thu-mb. Digital artery ( \-: ~~-- ~--.. ~-,, '\ Superficial palmar arch-~'-... Mainly ulnar artery ----------------1 i " Deep branch,_" ------~~...-- Superficial branch (rnain) ---'~ Deep palmar--+ arch Ulnar artery_... ". ),. Radial artery_~ 1 J Princips \ polllcis A. 1''/ / / Superficial brancn. I -"---Deep branch (Malni :.-+LATERAL Spring 2013 Dr. Maher T. Hadidi, University of Jordan 96 10
Palmar arches-2 Deep arch Contributed by.. radial and ulnar ' arteries. m Mainly from deep branch of radial artery. Located at the level of the proximal border of fully extended - thumb. Palmar digital A., '-"--, Superficial palrr1ar arch~ -""'-... _ Deep branch //// Superficial branch ( rwin)_ / /. Superficial Deep palrnar----i""' ' branch arch Ulnar artery ------~- Radial artery -1~,_,.,,fi(fi --~-Deep branch (l\i1a1n) -...LATERAL Spring 2013 Dr. Maher T. Had1di, University of Jordan 97 11