. ln radical mastectomy we remove the sterno-costal head of pectoralis major but the clavicular head is preserved (to protect the cephalic v. & prevent the infra-clavicular hollowness). o In modified radical mastectomy the whole muscle is preserved & only pectoral fascia is removed (as it contains LNs).

 

About 5 cm above the wrist, the nerve winds**

around the lateral side of radius to reach the

back of the hand crossing over the anatomical snuff

box & superficial to the extensor retinaculum.

BnnrucHEs:

On the medial side of arm: (2 muscular & one cutaneous):

1. A branch to the long head of triceps: arises in the axilla.

2. A branch to the medial head of triceps.

3. Posterior cutaneous nerve of arm: to skin of the back of the arm.

ln the spiral qroove: (3 muscular & 2 cutaneous):

1. A branch to the lateral head of triceps.

2. A branch to the medial head of triceps (so the medial head has 2 branches).

3. A branch to anconeus.

4. Lower lateral cutaneous nerve of the arm.

5. Posterior cutaneous nerve of the forearm.

a

a

I UPPER LIMB

On the lateral side of the arm: (3 muscularl

1. A branch to brachioradialis.

2. A branch to extensor carpi radialis longus.

3. A branch to lateral part of brachialis.

ln the forearm & hand: {S 1. Posterior interosseous nerve.

2. Dorsal digital branches: to supply the skin of the lateral Ts of the dorsum of the

hand & dorsum of the lateral 3 fingers as far as the distal lP joints.

lnfraspinatus

Nerve to

teres minor

Teres minor

Radial rtervL)

Teres major

Long head

triceps Lateral head

trlceps

Lateral epicondyle

Anconeus

Supinator

Deep brarrch of

radial rrcrve

(posterior

intt:rosscous

norve)

Axillary ncrve

UPPER LIMB I

. lt descends under cover of the brachioradialis &

r#kpierces the supinator through which it winds around tilf,n. raterar sroe of tne raqrus.

. lt appears on the back of the forearm, a short

distance above the lower border of the supinator.

Branches:

- lt supplies 2 muscles before piercing the

{StT'lffil;., carpi radiaris brevis

2. Supinator.

- It supplies the other extensor muscles:

1. Extensor carpi ulnaris.

2. Extensor didtorum.

3. Extensor digitiminimi.

4. Extensor indices.

5. Abductor pollicis longus.

6. Extensor pollicis brevis.

7. Extensor pollicis longus.

Suncrcal IMpoRTANcE (F{AUAL Nenra luuunv):

ln the Axilla: (Saturday night paralysis)

o Motor:

{r Patient can not extend his elbow.

Patient cannot pronate his forearm.

Wrist drop & finger drop. ,r*,r*-*Tffi

o Sensory: sensory loss in limited area at the

base of the thumb.

ln the Spiral Groove: as above, but

patient can extend his arm.

Feshr$r uiilw

jft lniurv of posterior interosseous T nerve: only finger drop (No extension of lP

joints)

UPPER

{B ln the axilla & arm:

It arises in the axilla by 2 braches

from medial cord & Iateral cord of

brachial plexus (C5, C6, 7, 8 & T1).

It crosses in front of the brachial

artery from lateral to medial.

Brachial art€rv

It lies medial to biceps, anterior to

brachialis & triceps.

the forearm:

CouRsE & RemnoNS:

P,rceps I lqng head

flrrn,, I sno,, n.u,

Pecloral,s

,WMusc ulcc utan eous

fiim

ln

ulnar freru0

Superiorulnar

co{lateral ariery

lvledral cu1afr€ous

nerue ol lorearm

lnlerior Llnar

collaleral artery

o ln the cubital fossa, it passes:

1. Medial to the brachial artery.

2. ln front of insertion of brachialis.

*o lt leaves the cubital fossa by passing

{S between 2 heads of pronator teres.

-^? lt passes deep to flexor digitorum

riltl.rrrerficialis where it is adherent to its !F undersurface & runs in front of flexor

digitorum profundus.

o About 5 cm above the wrist: it lies in

the interval between flexor carpi

radialis (laterally) & palmaris longus

(medially).

ln the hand:

o The nerve enters the carpal tunnel

immediate ly under cover of the

flexor retinaculum.

o lt terminates Just distal to the flexor

retinaculum, by dividing into lateral &

medial divisions each of which gives

off palmar digital branches.

BnerucHES:

t moron

J tr.r rHE FoREARM:

1. Pronator teres.

2. Flexor carpi radialis.

3. Palmaris longus.

4. Flexor digitorum superficialis.

Redalnfr6

Dcep b.trlch

o, radiel nffi6

SuDinalor

-.

Supedicial branch *

ol radid nsrve

Prof,ator terGg

{cut}

Erechioradislls

tendoo (Fqi

Flerrs q6y'i

@7al$ ltff Jn

icull

-

Uhd fi€rrro

I

Llhar h€d o{

pr0n6tor ?erBs

AnlBrior

iilerqBseouc

ITG*A

Fle*or dbitoflm

profundus

Flei6r digrtoflrrn

$uFFr{[rBlis klrl]

Dorcd brerch

iol rrlrur qaruel

Flox€il ai{fli

ulnariE tErd$il

{cut}

Frlnar b.anch M lal t*rar rerve)

>Hrfrerilhead

,'W.*i

orlr*aler

'rV.

,lf:-:lffilii,T

UPPER LIMB I

} The anterior interosseus N. + 2Tzmuscles

1. Pronator quadrates.

2. Flexor pollicis longus.

3. Lateral Yz of flexor digitorum profundus.

J rw rHE HAND (5 MUScLES).

adductor pollicis.

I serusonv

retinaculum then passes in front of it to supply skin of the lateral Te of the

palm (but not the digits).

,tD)

illl

il I

t

I

I

i

l

I

Pahurub*,

Ooma{ vtar.

* SunctcAL lmponrANcE (MeotlN NERVE ltt.luRy):

At wrist:

. &!s,

-- Wasting of thenar eminence.

---+ Loss of opposition.

--- Weakness of abduction of the thumb.

I UPPER LIMB

Sensory: sensory loss over

-+ Lateral Ts of palmar surface of the hand.

-' Lateral 37, fingers (palmar surface).

Deformitv. Ape hand deformity

t glbOW: As above + ulnar deviation + positive clasping test.

NE! Carpal tunnel syndrome (see neurosurgery)

CounsE & RELATToNS:

ln the axilla & arm:

It arises as the termination of

medial cord of brachial plexus

between 3'd part of axillary artery

& axillary vein.

It descends medial to brachial

artery till the insertion of

coracobrachialis where it

deviates medially & downwards

to pierce the medial intermuscular septum, to reach the

posterior compartment of the

arm.

ln the forearm:

It enters the forearm by passing

behind the medial epicondyle.

It passes between the 2 heads of flexor carpi ulnaris, &

descends along the medial side

of forearm between flexor carpi

ulnaris & flexor digitorum

profundus.

tu*cilloillxrsqtl

Let$d qrt naouE

narv6oatolBrrn

. Continues downwards superficial to the

flexor retinaculum.

. Terminates just lateral to pisiform bone by

dividing into superficial & deep branches.

UPPER LIMB I

BnnrucHES: {S

ln the forearm:

o Motor: to supply flexor carpi ulnaris + medial

Tz of flexor digitorum profundus.

o Sensory:

- Medial Ts of the palm & medial Ts of the

back ofthe hand.

- Back of the medial l7zfingers.

o Motor:

- Adductor pollicis.

3 muscles of the hypothenar eminence.

Palmaris brevis muscle.

3rd & 4th lumbricals.

All interosseous muscles (palmar & do

3 thenar muscles +-i't & 2'd lumbricals.

o Sensory: to the palmar surface of the medial lTzfinger.

lltt aldtsrtmurol

a.DefiddHfid!oallls

oarvairl nfrl

Palnr brgtdr of uls *

nflvofunful€f,m

EltlErfril

Fhrcr dlgitsum rDrfturS$

except the

rDa

uIBts as

Uhr,Ed ol

pronab.G.BB

Flmrdolbru

Frcitndrs

Ee€e DramD

{oautEntrY.}

UharnsrYs

$prftidblrdt

(af ulnnngrtlel

tr0rtrllrtnfi otul,tr rr[fitr$rfiEtD

I--UPFEFLTMB

Uhffitsry

frlldyi6rv

Suncrcal lnapoRTANce (ULNAR NeRve luuunv):

At wrist:

. Uolq

-+ Wasting of hypothenar eminence.

* Partial claw hand.

+ rve Froment's test.

-+ +ve card test + loss of abduction.

-, Guttering between metacarpal bones.

. Sry, sensory loss over:

, Medial Ts ol the palm.

-, Medial l7zfingers.

At glbOW: As above + loss of ulnar deviation + ulnar paradox.

UPPER LIMB I

PecroRALrs Mluon

Clavicular head: Lateral lip of the Medial & lateral Flexion, adduction

medYz of front of bicipital groove of Pectoral nerves & rotates arm clavicle humerus medially

Sternocostal head.

anterior surface of

the sternum, upper 6

costo-chondral

junctions &

Ext. oblique

aponeurosis.

SunCICAL IMPORTANCE:

. ln radical mastectomy we remove the sterno-costal head of pectoralis

major but the clavicular head is preserved (to protect the cephalic v. &

prevent the infra-clavicular hollowness).

o In modified radical mastectomy the whole muscle is preserved & only pectoral

fascia is removed (as it contains LNs).

o lt forms the anterior wall of the axilla.

o lt is the underlying muscle of the breast.

claviptrtod ttingh

C.phalblrcan

PecToRALIS MINOR

Coracoid process

of scapula

Medial pectoral

nerve

Protraction (draws

scapula forwards)

, 4'n & 5"' ribs

SuncrcRro

a

a

lrurponrANcE:

It divides axillary artery into 3 parts.

It is removed in radical mastectomy to open the axiila (it is the

door of the axilla).

It is retracted or cut for clearance of axilla in MRM.

SuecLAVIus

1tt costo-chondral

junction

Lower surface of

the middle % of

clavicle

Nerve to

subclavius

Holds clavicle in

place

{F Sennarus ArureRroR

8 digitations from Medial border of Nerve to serratus

the outer surface of the scapula ant (N. of bell)

upper 8 ribs (ventral surface) {long thoracic n.}

SuncrcAL IMPoRTANcE:

. Nerve to serratus anterior should be preserved

during radical mastectomy.

. InjuU to n. of Serratus anterior leads to

winging of the scapula.

Protraction &

rotation of the