- Surqical exposure: by an incision along its subcutaneous post. border - The tip of the olecranon process forms an equidistant A with the 2 humeral epicondyles in the normal elbow & also i.fnffir"iorivrr'r" fracture. ln elbow dislocation, this A is no longer.qriJirirni

 

thyroid cartilage

Hyoid

bone

Mastoid

process

Ansa cervicalis

(Cr,z,s)

Depresses the hyoid bone in

the 2nd phase of deglutition

2 muscles: flexes the neck

1 muscle: bends the head to the

same side & turns the face to the

opposite side

Depresses the hyoid bone in the

2nd phase of deglutition

Sternal head:

Manubrium sterni

Clavicular head:

clavicle

Spinal

accessory n

Suroical imoortance

o Examination of cervical LNs.

. Determination of the relation of neck swellings

. Boundaries in anterior & posterior triangles of

to it.

yhe neck.

Anterior tubercles of

transverse processes of

c3,4,5,6

Scalene tubercle of

1

tt rib

Anterior 1ry rami

of C4,5,6

Flexion of neck

Elevation of

the 1't rib

. Anterior to scalenus anterior is: subclavian vein, phrenic nerve.

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A fnrrrtcvix

. Phrenic N. (under pre-vertebralfascia)

. Ascending cervical fascia.

. Transverse cervical/su pra-scapu lar artery

. Carotid sheath

. Vagus

. Thoracic duct

. Lower belly of omohyoid

. Deep cervical nodes

' Longus coli

. Carotid tubercle

. Pyramidal space

. Carotid sheath

. Stellate ganglion

. Vertebral artery

. Middle cervical artery

. lnferior thyroid artery

. 2st paft subclavian artery

. Ansa cervicalis

. Thyro cervical trunk

, Vertebralvein

. Trunk of brachial plexus

. 3'd part of subclavian artery

. 2"" part of subclavian artery

. Anterior rami C3-T1

. Costo-cervical trunk

. Superior intercostal and deep cervical arteries

, Scalenus medius

HEAD & NECK I

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The function ofthe upper limb

is to place the hand in position

to be effective as a grasping

tool. As such, the upper limb

has adapted into a body part

with great freedom of motion.

Muscles that control this

motion extend across the back

and thorax.

Features:

. 2 ends. 1- Sternal end (bulky).

. 2 surfaces: 1- Upper (smooth).

Surqical importance:

- The clavicle carries the weight of the upper limb & transmits it to the trunk

through its articulation with the sternum (sterno-clavicular joint).

- lt is one of the most commonlv fractured bones in the bodv:

. Cause: direct violence as falling on outstretched hand.

. re. the junction between the 2 curvatures.

o Effect: shoulder drop; the lateral fragment is displaced downwards by

Features: a flat bone having:

1, 2 surfaces: ventral (forming sub-scapular fossa) & dorsal (presenting the spine).

2. 3 borders: upper, medial & lateral.

3. 3 angles:

- Superior (level of 2nd rib).

- lnferior (level of 7th rib).

- Lateral (glenoid cavity).

4. 3 fossae: sub-scapular (ventrally), supra-spinous & infra-spinous (dorsally).

5. 3 processes: spine, acromion and coracoid process.

2- Acromial end (flattened).

2- Lower (shows subclavius groove).

the weight of the limb.

I UPPER LIMB

Attachments:

-

Features:

Upper end: consists of:

. Head: articulates with the glenoid cavity.

. 2 necks: anatomical neck & surgical neck.

t I tuberosities: greater (carrying 3 muscles facets) &lesser

muscular facet).

' Bicipital groove: having medial lip, lateral lip & floor.

Shaft: has:

' 3 borders: anterior, medial & lateral.

. 3surfaces. antero-medial, antero-lateral & posterior surfaces.

Lower end: consists of:

. Trochlea: for articulation with ulna.

. Capitulum: for articulation with radius.

. Medial epicondyle: more prominent.

. Lateral epicondyle: less prominent.

. 3 fossae: olecranon (posterior), radial & coronoid (anterior).

(carrying 1

UPPER LIMB T

o Lower %: incision algfg the medial or lateral intermuscular septg.r-n,

fraclgIgg are @mm96, at the following sites:

o At middle of the shaft: being weakened

groove.

o At the medial epigffiyle.

Axillary n.

Radial n.

Ulnar n.

Around the surgical neck

ln spiralgroove

Behind medial epicondyle

Surqical Exposure:

o Upper %: incision along delto-pectoralgroove.

o At surgiga! neek: being a weak point

upper end.

after the

by spiral

Nerues which may be injured with fractures of humerus

Flattened shoulder

Drop-hand or wrist

Claw hand

E.FuHorrhr

I UPPER LIMB

Features:

o Upper end: shows:-

. 2 processes (olecranon &coronoid). ' 2 notches (trochlear & radial). ' 2 muscurar impressions (urnar tuberosity &supinator fossa).

o shaft: has 3 surfaces (anterior, posterior & medial) separated by 3 borders. o Lower end:- presents a smail rounded head & a brunt styroid process.

Surqical importance:

- Surqical exposure: by an incision along its subcutaneous post. border

- The tip of the olecranon process forms an equidistant A with the 2 humeral epicondyles in the normal elbow & also i.fnffir"iorivrr'r" fracture. ln elbow dislocation, this A is no longer.qriJirirni

Features:

' Uppqr end: consists of (head, neck & radial tuberosity)

.

' Shaft: has 3 surfaces (anterior, posterior & lateraliseparated by 3 borders. Lower end: expanded'& presents.

styloid process laterally, ulnar notch medially & articular surface (below).

Surqical importance:

Surqical Exposure:

By an incision arong the ant. border of brachioradiaris.

N.B. ln Pronation & Supination

- Ulna is fixed.

- Lower end of radius crosses in front of ulna

Pronation by: pronator teres & pronator quadratus.

Supination by : biceps (with elbow flexed) & supinator (with elbow

extended)

Head

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Surqical importance:

Fracture of the scaphoid

. lt is the most frequently fractured carpal

bone.

. Presents clinically with tenderness over

the anatomical snuffbox. tu

. Has high incidence of avascular'

necrosis & non-union.

Caral bss

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I UPPFN LIMB

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UPPER

a

a

o

Both are responsible for movements of the shoulder girdle.

Tvpe: Synovial (ball & socket).

Bones: Head of the humerus & glenoid cavity of the scapula.

Stabilitv of shoulder ioint: maintained by:

- Coraco-acromialarch.

- Rotator cuff muscles (supra-spinatus, infra-spinatus,

teres minor).

lnstabilitv of shoulder ioint: due to:

- Shallow glenoid cavity & large head of humerus.

- Laxity of capsule.

- Wide range of movement.

Abduction at Shoulder Joint:

- First 90" ) movement occurs at shoulder joint:

sub-scapularis and

- From 90" - 180" ) no movement at shoulder joint (scapula is rotating by

lower 5 digits of serratus anterior & upper & lower fibers of trapezius.

Tvpe: Synovial (hinge).

Bones: Lower end of humerus & upper end of radius & ulna

N.B: Student's elbow due to: inflammation of subcutaneous olecranon bursa

. Type: Synovial (pivot).

. fJE: Synovial (ellipsoid).

o Bones: Lower end of radius & carpal bones (scaphoid, lunate & triquetrium).

UPPER LIMB I

DEVEIOPIITENT:

o lt arises from the milk line, which extends from the axilla to the inguinal region

(mid-inguinal point).

o The epithelium is ectoderm (parenchyma) while connective tissue is

mesenchyme (stroma).