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Axillary and Median Nerve

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Axillary and Median Nerve Musculoskeletal block - Anatomy - lecture 6 Editing file Color guide : Only in boys slides in Blue Objectives Only in girls slides in Purple important in Red By the end of the lecture, students should be able to: Doctor note in Green Extra information in Grey ✓ Describe the origin, course, relations, branches and distribution of the axillary & median nerves ✓ Describe the common causes and effects of injury to the axillary and median nerves Brachial plexus Remember To Drink Cold Beer Axillary Nerve Origin Course Branches (C 5 & 6) - It passes inferiorly and Posterior cord of laterally along the brachial plexus. posterior wall of the axilla to exit. أي ﻋﺻب ﻧﺎﺧذه ﻻزم ﻧﻌرف ﻣن أي ﻗطﻊ ﻣن اﻟﺳﺑﺎﯾﻧل ﻛورد ﺟﺎء ، ﻷن أي ﺿرر ﯾﺻﯾر ﻓﯾﮭم ھو أﯾﺿﺎً راح ﯾﺗﺄﺛر. -Then, it passes posteriorly (Motor) (Sensory) around the surgical neck of to the deltoid and superior lateral cutaneous the humerus. teres minor nerve of arm that loops muscles. around the posterior -It is accompanied by the margin of the deltoid posterior muscle to innervate skin in circumflex humeral artery. that region. Axillary Nerve Lesions affects The axillary nerve is usually injured due to: ● Fracture of surgical neck of the humerus Motor: Sensory: ● Downward 1- Impaired abduction of the shoulder (15-90˚) Loss of dislocation of the Note: the patient CANNOT raise his arm over 30˚. sensation shoulder joint 2- Paralysis of the deltoid and teres minor over the lateral muscles side of the (The paralyzed deltoid wastes rapidly proximal part As the deltoid atrophies, the rounded contour of the of the arm. ● Compression from shoulder is flattened compared to the uninjured the incorrect use side). of crutches Median Nerve Origin (C5,6,7, 8, T1) The median nerve is formed anterior to the third part of the axillary artery by the union of lateral and medial roots • The lateral root (C5,6&7), arises from the lateral cord of the brachial plexus. • The medial root (C8 & T1), arises from the medial cord of the brachial plexus. originating from the lateral and medial cords of the brachial plexus. Note: Axillary artery is named Brachial artery when it reaches the arm Median Nerve In the arm Note that It enters the arm from the axilla at the ● The median nerve has NO inferior margin of the teres major major branches in the arm muscle. or axilla, but a branch to It passes vertically down the medial Brachial artery side of the arm in the anterior one of the muscles of the compartment and is related to the forearms, the (Pronator brachial artery throughout its course: Teres), this branch may ● In proximal regions (In upper 1⁄2 of the originate from the nerve arm), it lies immediately lateral to the immediately proximal to brachial artery. the elbow joint. ● In more distal regions (In the middle of the arm), it crosses the medial side of the brachial artery. ● In the lower 1⁄2 it descends on the medial side of the brachial artery. ● It descends anterior to the elbow joint. Note: Flexor retinaculum is a fibrous tissue: Retinaculum = Deep fascia flexor = in the middle Median Nerve In the forearm In the hand Median nerve passes into the The median nerve continues into the forearm anterior to the elbow hand by passing deep to the flexor joint(between the 2 heads of retinaculum. It innervates: pronator teres) where it branches innervates most ● Three thenar eminence muscles of the muscles in the anterior associated with the thumb. compartment of the forearm (6.5 ● Lateral two lumbrical muscles muscles) Except the: associated with movement of ● Flexor Carpi Ulnaris the index and middle finger. ● the medial half of the Flexor ● Skin over the palmar surface of Digitorum Profundus the lateral three and one- half (which are innervated by the digits and over the lateral side ulnar nerve). of the palm and middle of the wrist. (The lateral 2/3rd of the palm of the hand.) Median Nerve Lesions Injury of the median nerve at different levels causes different syndromes - In the arm and forearm the median nerve is usually not injured by trauma, why ? Because of its relatively deep position. Sites of damage Serious effects Loss of opposition of the Loss of sensation: thumb: from the thumb and lateral 3½ In the carpal tunnel (deep The delicate pincer- like action fingers & lateral ⅔ of the palm. in the flexor retinaculum) is not possible. اﺧﻄﺮ ﺷﻲ ﻻن ﻣﺎ ﻓﻲ ﻋﻀﻠﺔ ﺛﺎﻧﯿﺔ ﺗﺴﻮي ﻧﻔﺲ اﻟﺤﺮﻛﺔ أو ﻋﺼﺐ ﺛﺎﻧﻲ ﯾﻌﻮض At the wrist above the flexor retinaculum In the elbow region (supracondylar fracture of the humerus) Lesion About Motor Sensory and tropic ● Loss of pronation. Sensory: ● Hand is kept in supine position. Loss of sensation from: ● Wrist shows weak flexion, and ● The radial side ⅔ of the ulnar deviation. (cause there is no muscle to antagonise the action of the ulnaris) palm. ● Loss of flexion on the ● Palmar aspect of the interphalangeal joints of the lateral 3½ fingers. Damaged in supracondylar fracture of index and middle fingers. ● Distal part of the dorsal Median humerus ● Weak flexion of ring and little surface of the lateral 3½ Nerve Muscles affected are: fingers. ● Thumb is adducted (cause the fingers. adductor muscle is not supplied by the median Lesion in ● Pronator muscles of the forearm (they nerve) and laterally rotated, with the Elbow will always be supinated) ● All long flexors of the wrist and loss of flexion of terminal Region phalanx and loss of opposition. fingers except flexor carpi ulnaris ● Wasting of thenar eminence. and medial half of flexor ● Hand looks flattened and “apelike”,and presents an Trophic Changes: digitorum profundus inability to flex the three most ● radial digits when asked to Dry and scaly skin make a fist. ● Easily cracking nails Supinator ● Atrophy of the pulp of The index and Flex.Dig. Pronator teres Superficialis middle fingers are the fingers extended because of Wasting of Flex.carpi the antagonist radialis thenar eminence muscle Extra Flex.pol.long us Flex.carpi ulnaris Lesion About Motor Sensory Often injured by penetrating wounds (stab Thenar muscles are Sensory: wounds or broken glass) of the forearm. Loss of sensation from: paralyzed and atrophy (ﻟﻤﺎ اﻟﺸﺨﺺ ﯾﺤﺎول ﯾﻨﺘﺤﺮ) Median Nerve happens with time so that ● The radial side of the palm. the thenar eminence ● Palmar aspect of the lateral Lesion at the NOTE: You have to know each deformity and becomes flattened. 3½ fingers. Wrist the muscles/nerves involved. ● Distal part of the dorsal Opposition and abduction surface of the lateral 3½ of thumb are lost, and fingers. thumb and lateral two fingers are arrested in Trophic Changes: adduction and hyperextension position. ● Dry and scaly skin ● Easily cracking nails “Apelike hand” ● Atrophy of the pulp of the fingers are the same as in the elbow region injuries. Median Nerve The most common neurological problem Weak motor function of Burning pain or ‘pins Lesion associated with the median nerve is the thumb, index & middle and needles’ along the distribution of median nerve to deep in flexor compression beneath the flexor retinaculum fingers. lateral 3½ fingers. retinaculum at the wrist. “Carpal Tunnel The symptoms first appear as sensory but Syndrome” No sensory changes over the palm when it progresses further the motor as the palmar cutaneous branch is symptoms appear. given before the median nerve enters the carpal tunnel. most common in postmenopausal women SUMMARY MCQs Question 1: The median nerve continues into the hand by passing deep to the? Question 5: Loss of pronation is a motor effect of: A. Flexor retinaculum A. Median nerve injury in elbow B. Brachialis B. Median nerve injury at the wrist C. Coracobrachialis C. Axillary nerve injury D. Extensor digitorum longus D. Median nerve injury in the carpal tunnel Question 2: The median nerve originate from: Question 6: A patient complaining of pins and needles sensation along the medial side of A. Lateral cord the upper limb and the 3 lateral fingers, that would indicate: B. Medial cord A.Median Nerve Lesion in the Elbow Region C. Both B & A B. Carpal tunnel syndrome D. Posterior cord C. Surgical neck fracture Question 3: Which one of the following is a sensory supply of the median nerve? D.Median Nerve Lesion at the wrist A. 3 thenar Muscles B. 3 hypothenar Muscles SAQ C. Palmer lateral 3 and a half digit D. Palmer medial 1 and a half digit Question 1: One of the trophic changes in Median Nerve Lesion in the Elbow Question 4: A physician examined an X ray and saw that the patient had a Region? fracture in the surgical neck, which nerve will he be worried about? Dry and scaly skin A. brachial B. Radial Question 2: Where are the axillary motor branches located? C. Musculocutaneous In the deltoid and teres minor muscles. D. Axillary Answers: Q1.A- Q2.C -Q3.C -Q4.D- Q5.A- Q6.B Team members Girls team : Boys team: ● Ajeed Al Rashoud ● Khalid AL-Dossari ● Taif Alotaibi ● Naif Al-Dossari ● Noura Al Turki ● Faisal Alqifari ● Amirah Al-Zahrani ● Salman Alagla ● Alhanouf Al-haluli Special thank for ● Ziyad Al-jofan ● Sara Al-Abdulkarem ● Suhail Basuhail ● Rawan Al Zayed Anatomy team 436 ● Ali Aldawood ● Reema Al Masoud ● Khalid Nagshabandi ● Renad Al Haqbani ● Mohammed Al-huqbani ● Nouf Al Humaidhi ● Jehad Alorainy ● Fay Al Buqami ● Khalid AlKhani ● Jude Al Khalifah ● Omar Alammari ● Nouf Al Hussaini ● Alwateen Al Balawi ● Rahaf Al Shabri ● Danah Al Halees Team leaders ● Haifa Al Waily ● Rema Al Mutawa ● Abdulrahman Shadid ● Amirah Al Dakhilallah Good luck ● Ateen Almutairi ● Maha Al Nahdi ● Renad Al Mutawa Give us your feedback: ● Ghaida Al Braithen ● Reham Yousef =This lecture done by.
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  • The Muscles That Act on the Upper Limb Fall Into Four Groups

    The Muscles That Act on the Upper Limb Fall Into Four Groups

    MUSCLES OF THE APPENDICULAR SKELETON UPPER LIMB The muscles that act on the upper limb fall into four groups: those that stabilize the pectoral girdle, those that move the arm, those that move the forearm, and those that move the wrist, hand, and fingers. Muscles Stabilizing Pectoral Girdle (Marieb / Hoehn – Chapter 10; Pgs. 346 – 349; Figure 1) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: ANTERIOR THORAX: anterior surface coracoid process protracts & depresses Pectoralis minor* pectoral nerves of ribs 3 – 5 of scapula scapula medial border rotates scapula Serratus anterior* ribs 1 – 8 long thoracic nerve of scapula laterally inferior surface stabilizes / depresses Subclavius* rib 1 --------------- of clavicle pectoral girdle POSTERIOR THORAX: occipital bone / acromion / spine of stabilizes / elevates / accessory nerve Trapezius* spinous processes scapula; lateral third retracts / rotates (cranial nerve XI) of C7 – T12 of clavicle scapula transverse processes upper medial border elevates / adducts Levator scapulae* dorsal scapular nerve of C1 – C4 of scapula scapula Rhomboids* spinous processes medial border adducts / rotates dorsal scapular nerve (major / minor) of C7 – T5 of scapula scapula * Need to be familiar with on both ADAM and the human cadaver Figure 1: Muscles stabilizing pectoral girdle, posterior and anterior views 2 BI 334 – Advanced Human Anatomy and Physiology Western Oregon University Muscles Moving Arm (Marieb / Hoehn – Chapter 10; Pgs. 350 – 352; Figure 2) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: intertubercular