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The Upper limb
Learning Objectives
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1. Define the region of upper limb (C1)
2. List the bone and joint of upper limb (C1)
3. Describe the blood supply of upper limb (C2).
4. Describe the structure of brachial plexus and
distribution of their branches (C2)
5. Describe the organization and function of muscle
of upper limb (C2)
6. Identify the structure in the cross sectional of
each region of the upper limb (C1)
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Shoulder
Hand
Forearm
Arm
Region of upper limb
Anterior view
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Posterior view
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Scapula
anterior : fossa subscapularis, incissura scapulae,
coracoid
posterior: fossa supra & infra spinata
spina scapulae, acromion
Lateral : glenoid cavity, supra & infra glenoid
tuberosity
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Clavicula
sternal extremity and acromial extremity
body : medial-convex anteriorly, lateral-concave
anteriorly
The Humerus
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Caput : tuberculum mayor,
minor, sulcus
intertubercularis
Neck : anatomical, surgical
Body : deltoid tuberosity,
sulcus N. radialis
Epicondyle : lateral and
medial
Fossa trochlearis
Capitulum
Bones and joints of Forearm
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Radius and Ulna
Radioulnare proximal joint
Radioulnare distal joint
Wrist jont
Membrana interossea

Elbow joint : flexi-extensi
Radioulnare joint : pronasi-supinasi
Wrist joint : flexi-extensi, adduksi-abduksi

Shoulder joints
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Acromioclaviculare
Sternoclaviculare
Glenohumerale
Acromioclavicular joint
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Articulation : plane synovial joint
Acromial extremity os
clavicula
Processus acromion os
scapula

Movements
Rotasi scapula

Ligaments
Acromioclavicularis
Coracoclavicularis
Sternoclavicular joint
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Articulation: syndesmosis
Facies articularis clavicularis of
manubrium sterni
Facies articularis sternalis of
clavicula
Movements
Elevasi and depresi clavicula
Protraction and retraction
clavicula
Ligaments
Sternoclavicular anterior
posterior
Costoclavicular (costa 1 and
clavicula)
Glenohumerale joint
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Articulation : a synovial joint
Caput humeri
Cavitas glenoidalis
Movements
Flexion/Extension; Rotation
Abduction/Adduction
Ligaments
Tendo m. biceps brachii
caput longum
Lig. coracohumeralis
Lig. coracoacromialis
Lig. Glenohumerale superior,
middle, inferior
Elbow joint
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Humeroradialis joint
Flexi/extensi dan Pronasi/supinasi
Capitulum humeri fovea radialis

Humeroulnaris joint
Flexi/extensi
Trochlea humeri incissura trochlearis
Fossa olecranii olecranon
Fossa coronoidea processus
coronoidea

Radioulnaris proximalis
Pronasi/supinasi
Lig collateralis ulnaris
Lig collateralis radialis
Lig annulare
Axilla
Boundaries of axilla:
lateral: humerus
anterior: m. pectoralis
Medial: costa
Posterior: scapula
Content:
- A. axillaris
- N. axillaris

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VASCULARIZATION OF UPPER LIMB
A. subclavia A. axillaris A.
brachialis A. ulnaris and A. radialis
Axillary artery
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Part I
A. thoracica superior
Part II
A. thoracoacromialis pectoral, acromial,
clavicular, deltoid branches
A. thoracalis lateralis
Part III
A. subscapularis
A. circumflexa scapula
A. thoracodorsalis
A. circumflexa humeri anterior
A. circumflexa humeri posterior
Vascularization of the arm
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A. circumflexa humeri
anterior
A. circumflexa humeri
posterior
A. brachialis
A. profunda brachii
A. collateralis radialis
A. collateralis ulnaris
superior
A. collateralis ulnaris
inferior
Vascularization of the forearm
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A. radialis
A. recurrent radialis
A. palmaris superficialis
A. ulnaris
A. recurrent ulnaris anterior
A. recurrent ulnaris
posterior
A. interosseus communis
A. interosseus anterior
A. interosseud posterior
A. palmaris profundus
Superficial veins
V. cephalica
V. basilica
V. mediana cubiti
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V. Cephalica V. axillaris
V. Basilica V. brachialis

innervation of upper limb
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Cells of the nerve
Neuron
Cell body / perikaryon / soma
Nucleus / karyon
Dendrite / afferent fiber
Receive signal at synapse
Axon / efferent fiber
Conduct impuls
Neuroglia
Astrocytes, oligodendrites, microglia
Axon Dendrites
Transmit impulse between neurons
Synaptic transmission: cleft, chemical /neurotransmitter
Chemical synapse
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Peripheral Nervous System
Cranial nerves
Attach to the brain
Spinal Nerves
Attach to the spinal cord
Autonomic Nerves
Run through cranial or
spinal nerves
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Peripheral nerve system: Spinal nerve
anterior and posterior
nerve roots transmit
sensoric and motoric
Length 1cm
Emerging from foramen
branches ventral and
dorsal rami
Forms Plexes cervicalis,
brachialis, lumbosacralis
and intercostal nerves

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Somatic
General somatic efferent (GSE) and General somatic afferent (GSA)
Visceral
General visceral efferent (GVE) and General visceral afferent (GVA)
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Somatic efferent
One-neuron pathway
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Patellar reflex m. quadriceps
contraction, m. hamstring relaxation
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Plexus brachialis
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C5, C6 Upper trunk
Divisi anterior
Divisi posterior
C7 Middle trunk
Divisi anterior
Divisi posterior
C8, T1 Lower trunk
Divisi anterior
Divisi posterior
Rami
C5 N. scapular dorsalis
C5, 6, 7 N. thoracicus longus
Truncus : N. for M. subclavius, N.
suprascapularis


Lateral fasciculus
N. musculocutaneus
N. thoracicus lateralis
N. medianus
Medial fasciculus
N. medianus
N. ulnaris
N. cut antebrachii medialis
N. cutaneus brachii medialis
N. pectoralis medialis
Posterior fasciculus
N. radialis
N. axillaris
N. subscapularis superior & inferior
N. thoracodorsalis
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terminal branches of brachial plexus
The shoulder muscles
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Anterior shoulder mm
Posterior shoulder mm
Scapulohumeralis mm
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M. pectoralis major

M. pectoralis minor

M. subclavius

M. serratus anterior

Anterior shoulder
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Posterior shoulder mm
Superficial
M. Trapezius
M. latissimus dorsi


Profundus
M. levator scapulae
M. rhomboideus mayor
M. rhomboideus minor
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M. deltoideus M. supraspinatus
M. infraspinatus
M. Teres minor
M. Teres mayor
M. subscapularis
Scapulohumeralis muscles
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Anterior mm
M. biceps brachii
M. coracobrachialis
M. brachialis


Posterior mm
M. tricep brachii
M. anconeus
Muscles of the arm
Muscles of the forearm
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Extensores
Superficial and Deep
Flexores
Superficial and Deep
Rotatores
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Brachioradialis
Extensor carpi radialis lo
Extensor carpi radialis bre
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Superficial extensor
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Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis

Deep extensor
Extensores muscles
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Of wrist
Extensor carpi radialis lo & bre
Extensor carpi ulnaris
Of digits
Extensor digitorum
Extensor digiti minimi
Extensor indicis
Of thumb
Abductor pollicis longus
Extensor pollicis lo & bre
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Rotators mm
Pronator teres
Pronator quadratus
Supinator
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Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Superficial
flexores mm
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Intermediate
flexores mm
Flexor digitorum
superficialis m
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Deep flexores mm
Flexor digitorum
profundus m
Flexor pollicis
longus m
Pronator
quadratus m
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Flexors of wrist
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
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Flexors of digits
Flexor digitorum
superficialis
Flexor digitorum
profundus
Flexor pollicis
longus
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N. musculocutaneus
N. axillaris N. radialis
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N. medianus
N. ulnaris
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N. Radialis extensors mm
wrist drop
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N. medianus: flexores digit 1-3
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N. ulnaris: flexores of digits 2-5
Claw hand
Assignment
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1. Draw the vascularization of the upper limb
2. Draw the brachial plexus and list the target of each
branch
3. Draw the cross sectional the middle of arm and
forearm and identify each structure