I UPPER LIMB BeCtruS I nt tfre lower border of teres major. EttOS I in the cubital fossa opposite the neck of radius by dividing into radial & ulnar arteries. Relerrorus: ' Lies on anterior aspect of Triceps, coracobrachialis & brachialis muscles. , Lies medial to biceps. , ln the cubitalfossa, it is crossed by the median cubital vein. . lt is crossed by the median nerve.

 

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I UPPER LIMB

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Mediallv: extensor pollicis longus.

Laterallv: abductor pollicis longus & extensor pollicis brevis.

Content: radial artery, cephalic vein, trapezium, scaphoid.

Surqical lmportance:

Fracture scaphoid (commonest frA$ure of carpal bone):

. Swelling & tenderness in {fie anatomical snuff box.

o Avascular necrosis & non-union are common complications.

UPPER

Stf g ) Thick band stretches distat to wrist joint.

ATTncHMENTS:

, Mediallv ) attached to pisiform bone & hook of hamate.

, Laterallv ) tubercle of scaphoid bone & crest of trapezium.

. Superiorlv )to the deep fascia of the forearm.

, lnferiorlv )central portion of palmar fascia.

SUPERFlCIALLYtredialto taterat) r{r,.'.

1. Ulnar nerve.

2. Ulnar vessels.

3. Palmar cutaneous branch of ulnar nerve.

4. Tendon of palmaris longus muscle.

5. Palmar cutaneous branch of median nerve.

N.B. Radial artery does not pass superficialto flexor retinaculum

Df gp TO lT The carpaltunnet containing:

1. Flexor digitorum superficialis tendons.

2. Flexor digitorum profundus tendons.

3. Ulnar bursa enclosing flexor digitorum superficialis. & profundus tendons

(tendons of superficialis are arranged in two starta).

4. Flexor pollicis longus tendon.

5. Radial bursa enclosing flexor pollicis longus tendon.

6. Median nerve.

7. Flexor carpi radialis tendon & its synovial sheath (SPECIAL CANAL).

UPPER LIMB T

Thickened part of deep fascia which covers the extensor tendons

proximal to the wrist joint

The space is divided by 5 septa into 6 compartments:

. 1"t comp: Abductor pollicis longus & Extensor

pollicis brevis.

. 2nd comp: Extensor carpi radialis longus &

Extensor carpi radialis brevis

, 3'd comp: Extensor pollicis longus.

. 4th comp: Extensor digitorum (4 tendons) &

Extensor indices (ant. interosseous A + post.

interosseous n are present).

sth comp: Extensor digiti minimi.

6th comp: Extensor carpi ulnaris.

Structures superficial to the retinaculum

o 2 Veins: cephalic vein (lateral) & basilic vein (medial).

o 2 Nerves: Superficial branch of radial nerve (lateral) & dorsal branch of

ulnar nerve (medial).

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I UPPER LIMB

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Exlensor rHinafllum

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U PPER

Pulp Space

It is the subcutaneous compartment which is related to the palmar

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surface of the distal phalanx,

It is closed proximally by a fibrous septum at the level of epiphyseal line

of terminal phalanx.

It is separated from the distal volar space by a deep fascia.

It contains:

- Fat.

- Fibrous tissue septa, which extends from the skin to periosteum.

- Digital artery which gives epiphyseal branch before it enters the space.

S.Ufgip.A.L.!mpg..tknge..: Pulp space infection may lead to osteomyelitis of

the terminal phalanx except epiphysis.

Brench ts base

of distal pftaltnx

Digital artery

Oistal pulp spacs

Brgnchs* to Ehaft

of distel ph#*nx

traversing the

pulp space

Web Space*

o Triangular region between the dorsum & ventral skin present at the bases

of the fingers.

o They contain: fat, digitalvessels & nerves, lumbricals & interossei.

o They communicate with mid-palmar & thenar spaces.

Thenar spac"*

o Anterior ) thenai muscle, radial bursa, and flexor pollicis longus.

o Posterior ) adductor pollicis & 2'd & 3'd metacarpals.

. Medial ) deep mid palmar space (separated from it by a fibrous septum

extending from palmar aponeurosis to 3'o metacarpal bone'

o Distal ) extends to the web of the thumb.

Superficial mid palmar spac"

*

Anterior ) middle part of palmar aponeurosis.

Posterior ) flexor tendons.

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It is a contracture of palmar aponeurosis.

It affects its medial part.

It leads to flexion of MP joint & sometimes

is not affected).

It is seen in patients with liver cirrhosis.

proximal lP joint (DlP joint

- Synovial sheath of the middle 3 fingers

Each finger of these has a separate synovial sheath.

Proximal end:

- At the level of metacarpo-phalangeal Joint.

- Dilated Cul-de sac.

Distal end ) at base of distal phalanges.

They enclose the flexor tendons.

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Deep mid palmar

Anterior) flexor tendon of the medial 3 fingers & ulnar bursa.

Posterior ) fascia covering the interossei & 3'0, 4tn & 5th metacarpals.

Lateral ) fibrous band from palmar aponeurosis to 3'd metacarpal.

Distally ) 3 lumbrical canals to the medial 3 webs.

Medially ) separated from hypothenar muscles by mediar parmar

septum.

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UPPER LIMB I

; Synovial sheath of the thumb &little fingers

. Proximally they continue with radial & ulnar bursae, respectively.

Larger

Distally connected with synovial

sheath of little finger

Proximally ) runs below the flexor retinaculum ) extends 1" in the forearm

Envelops the flexor tendons of - Envelops the tendon of flexor pollicis

the medial 4 fingers longus

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- Smaller

- Distally connected with synovial

sheath of the thumb

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I UPPER LIMB

BeOtruSl at the outer border of 1't rib as a

continuation of subclavian artery.

EttOSl at the lower border of the teres major

muscle as brachial artery.

Pectoralis minor divides axillarv arterv into 3 parts:

A- 1"t Part:

o Lies above the pectoralis minor muscle.

. Re!a.!!.q: (see diagram).

. !!rang@: superior thoracic artery.

B- 2"d Part:

. Lies behind pectoralis minor.

. &!gt!.S,: (see diagram).

. Branches:

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1- Thoraco-acromial artery (pierce clavi-pectoral fascia).

branches

2- Lateral thoracic artery (supplies ! breast).

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C- 3'd Part:

o Lies below pectoralis minor.

o Lies medial to the short head of biceps & coracobrachialis.

. Eelallon: (see diagram) .@i. Sub-scapular: give circumflex scapular (anastomosis around

scapula).

ii. Posterior circumflex humoral: around the surgical neck.

iii. Anterior circumflex humeral: around surgical neck and gives

branches to the shoulder joint.

Ant.

Post.

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UPPER L!MB I

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S unc rcAL I rvrponrANcE :

Exposure:

o The incision used to expose the subclavian artery in the neck can be

extended across the clavicle into the delto-pectoral groove.

. A sub-clavicular incision 1 cm below the clavicle (started at the junction of

the medial %wifh the outer Yo of lhe clavicle & extended for 6 cm laterally).

s

I UPPER LIMB

BeCtruS I nt tfre lower border of teres major.

EttOS I in the cubital fossa opposite the neck of radius by dividing into radial & ulnar

arteries.

Relerrorus:

' Lies on anterior aspect of Triceps, coracobrachialis & brachialis muscles.

, Lies medial to biceps.

, ln the cubitalfossa, it is crossed by the median cubital vein.

. lt is crossed by the median nerve.

Bnlncnes:

. Profunda brachii.

- Ascending branch ) shares in the anastomosis

surgucal neck of humerus.

- 2 descending branches )share in anastomosis

elbow.

. Nutrient artery to humerus.