Upper Limb Muscles II Innervation, Blood Supply Miloš Grim Institute of Anatomy, First Faculty of Medicine, Charles University winter semester 2016/2017

Muscle compartments on the upper limb

Stingl, Grim, Druga: Regional Anatomy, Prague, 2012

Quadrangular space: axillary nerve, posterior circumflex humeral artery

Shoulder muscles Triangular space: circumflex scapular artery – anastomosis with suprascapular artery

Cross section of forearm, MRI

Muscles of forearm

Cross section of forearm

Anterior (flexor) compartment of forearm – superficial and deep part. Posterior (extensor) compartment - radial part

Radial artery Ulnar artery Interosseal artery Deep palmar arch Superficial palmar arch Palmar digital arteries

Veins of upper limb VS – subclavian vein VA – axillary vein VBR – brachial veins VC – cephalic vein VB – basilic vein VMC – median cubital vein VMA – median antebrachial vein VCA – cephalic antebrachial vein VBA – basilic antebrachial vein RVD – dorsal venous network

Grim M, Druga R et al.: Základy anatomie II. Kardiovaskulární systém, Galén, Praha 2015 (v tisku)

Subcutaneous veins: cephalic, basilic

Anterior muscles of the forearm 1st layer (common head): Pronator teres Flexor carpi radialis Palmaris longus, Flexor carpi ulnaris 2nd layer: Flexor digitorum superficialis

3rd layer: Flexor pollicis longus Flexor digitorum profundus 4th layer: Pronator quadratus

Anterior muscles of the forearm 1st layer: (common head) PT, FCR PL, FCU

Anterior muscles of the forearm 2nd

layer: FDS

3rd layer: FPL, FDP

Anterior muscles of the forearm 3rd layer: FPL, FDP

4th layer: PQ

chiasma tendinum

Fibrous and synovial sheath of fingers

Carpal tunnel, tendons of flexors

Carpal tunnel

Palmar carpal tendinous sheaths: Common flexor sheath Tendinous sheath of flexor carpi radialis Tendinous sheath of flexor pollicis longus

Carpal tunnel

Flexor retinaculum Palmar carpal tendinous sheaths:

Tendinous sheath of flexor pollicis longus Tendinous sheath of flxor carpi radialis Common flexor sheath Fibrous and synovial sheaths of digits

Nerves and vessels of the forearm

Dorsal group of forearm muscles Superficial layer: Extensor digitorum, Extensor digiti minimi, Extensor carpi ulnaris

Deep layer: Abductor pollicis longus, Extensor pollicis brevis, Extensor pollicis longus, Extensor digiti indicis

Dorsal group of forearm muscles. Superficial layer: ED, EDM, ECU Deep layer: ABPL, EPB, EPL, EDI Retinaculum musculorum extensorum

Dorsal group of forearm muscles. Superficial layer: ED, EDM, ECU Deep layer: ABPL, EPB, EPL, EDI

Radial group of forearm muscles: Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Supinator

Radial group BR, of forearm muscles ECRL, ECRB S

Radial n., median n. Radial n.

Extensor retinaculum Tendinous sheath of AbPL and EPB Tendinous sheath of ECRL + B Tendinous sheath of EPL Tendinous sheath of ED + EI Tendinous sheath of EDM Tendinous sheath of ECU Intertendinous connections fossa la tabatiere

Groups of hand muscles: Thenar group Abductor pollicis brevis, Opponens pollicis, Flexor pollicis brevis (superficial head, deep head), Adductor pollicis (oblique head, transverse head)

Hypothenar group Palmaris brevis Abductor digiri minimi, Flexor digiti minimi brevis, Opponens digiri minimi Mm. Interossei palmares (I.- III.), dorsales (I. – IV.) Mm. Lumbricales I. – IV.

Groups of hand muscles: thenar group (AbdPB, OP, FPB, AddP), hypothenar group (AbdDM, FDMB, OpDM), interossei (ID, IP), middle palmar space (L)

Cross section of hand Palmar aponeurosis, dorsal fascia of hand, thenar compartment, hypothenar compartment, middle palmar compartment, intermetacarpal compartments, dorsal compartment

Aponeurosuis plamaris, palmaris brevis

Thenar group (AbdPB, OP, FPB, AddP), Hypothenar group (AbdDM, FDMB, OpDM), flexor retinaculum synovial sheaths, lumbricals

Thenar group (AbdPB, OP, FPB, AddP), Hypothenar group (AbdDM, FDMB, OpDM),palmar interossei, lumbricals

Palmar interossei, dorsal interossei , innervation from ulnaris n.

Adductors of digits

Abductors of digits

Dorsal interossei, radial a., superficial radial n., dorsal branch of ulnar n.

Superficial and deep palmar arch, ulnar n. median n.

Vessels of hand, ventral view AU – ulnar artery, APS – superficial palmar rch, AaDPP – palmar digital aretries APP – princeps pollicis artery ArPP – deep palmar arch, AR – radial artery, AM – metacarpal arteries RPS(AR) – superficial palmar branch ARI – radialis indicis artery, ArPP (AU) – deep palmar branch

Grim M, Druga R et al.: Základy anatomie II. Kardiovaskulární systém, Galén, Praha 2015 (v tisku)

Superficial and deep palmar arch, ulnar n. median n

Common palmar digital aa., proper palmar digital aa., palmar metacarpal arteries

Vessels of hand, dorsal view AR – radialis a. RCD (AR) – dorsal carpal radial branch RCD (AU) – dorsal carpal ulnar branch AIP – posterior interosseous artery AaDD– dorsal digital arteries AaMD – dorsal metacarpal arteries

Grim M, Druga R et al.: Základy anatomie II. Kardiovaskulární systém, Galén, Praha 2015 (v tisku)

Distribution of cutaneous nerves of upper limb (areae nervinae)

Palsy of upper extremity nerves

Radial n.

Median n.

Ulnar n.

Sources of used illustrations: Gray´s Anatomy, Sobotta: Atlas of Human Anatomy, 15th Edition, 2011 Stingl, Grim, Druga: Regional Anatomy, 2012 Benninghoff, Drenckhahn: Anatomie I., II. 2003 or Netter: Atlas of Human Anatomy, Saunders 2010, 5th Edition Grim, Naňka, Helekal: Atlas of human anatomy, Grada 2014 Sadler: Langman´s Medical Embryology, 11th edit. 2009 Recommended Textbooks: Gilroy, MacPherson, Schuenke, Schulte, Schumacher: Atlas of Anatomy, Thieme, 3 ed. 2016 W. Platzer: Color Atlas of Human Anatomy, Vol. 1 Locomotor System. Thieme, 6th Edition, 2008 Kahle, Frotscher: Color Atlas of Human Anatomy – Vol.3 Nervous System and Sensory Organs, Thieme 2010, 6th Edition Stingl, Grim, Druga: Regional Anatomy, 2012 Snell: Clinical Anatomy by systems, Lippincott Williams and Wilkins 2007 or K. L. Moore, A.F.Dalley, A.M.R. Agur: Clinically oriented Anatomy, 6th Edition, Wolters Kluwer, Lippincot Williams & Wilkins 2006