Overview of limbs

BROAD REVIEW OF LIMBS HUMAN ANATOMY

1. OVERVIEW OF LIMBS BY DR. ABDUL WAHEED ANSARI CHAIRPERSON & PROFESSOR OF ANATOMY RAK COLLEGE OF MEDICAL SCIENCES RAKMHSU. 1/4/2015 1

2. Learning outcomes of the lecture Broad outline of osteology of upper and lower limbs, how they form the major joints of limbs and associated ligaments. Regions and compartments of upper limb and lower limb, their nerve supply and important actions. The main blood supply of upper limb and lower limb and collateral anastomosis forming alternate routes in case of obstruction or injury. The lymphatic drainage of upper limb and lower limb areas. Imaging studies of upper and lower limbs. 1/4/2015 2

3. The skeleton of upper limb There are 32 bones in each upper limb. They constitute the appendicular skeleton. The clavicle is the only long bone that is placed horizontally and connect with the axial skeleton. Scapula lies dorsally and along with clavicle and humerus constitute the shoulder girdle or pectoral girdle. The humerus is the longest bone in upper limb, the lower end forming the elbow joint articulating with the ulna. The radius and ulna form the bones of forearm, distally radius articulates with the carpal bones forming the wrist joint. There are 8 carpal bones arranged in two rows, distally carpal bones articulates with five metacarpals forming carpometacarpal joints. The phalanges are bones of digits, thumb having only 2 phalanx where as medial four digits have 3 distal phalanges. 1/4/2015 3

4. The bones of lower limb There 31 bones in each lower limb. The hip bone articulates with the femur and sacrum forming hip joint and sacroiliac joints. Femur is the largest bone in the whole skeleton, distally it articulates with the tibia and patella forming knee joint. Tibia and fibula are the bones of leg. Distally articulating with the talus forming ankle joint, talotibiofibular joint. There are 7 tarsal bones:- calcaneum, talus, cuboid, navicular and 3 cuneiforms. Distally tarsal articulates with the metatarsals forming tarsometatarsl joints. Great toe has 2 phalanx where as lateral 4 digits have each 3 phalanges. 1/4/2015 4

5. Regions and compartments of upper limb The pectoral region, shoulder region, scapular region, arm , forearm and hand are the regions of upper limb. The arm is between the shoulder joint and elbow joint. The anterior region of arm is flexor compartment. It is supplied by musculocutaneous nerve. The muscles in this compartment are :- Coracobrachialis Biceps brachii Brachialis Coracobrachialis brings flexion of shoulder joint; biceps brings supination of forearm; brachialis brings flexion of elbow joint. The forearm compartments are anterior and posterior. The anterior compartment is flexor compartment and posterior compartment is extensor compartment. The nerve of anterior compartment of forearm is median nerve and ulnar nerve. The nerve of posterior compartment of forearm is the posterior interosseous nerve ( branch of radial nerve). The flexor group of muscles are flexors of wrist and digits and thumb. The extensor group of muscles are extensors of wrist, thumb and digits. The hand has intrinsic muscles of thumb and hypothenar region, lumbricals , and interossei . 1/4/2015 5

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8. The blood supply of upper limb The right upper limb is supplied by right subclavian artery that arises from brachiocephalic trunk. The left subclavian is a direct branch fro arch of aorta. At the outer border of first rib the subclavian artery is renamed as axillary artery, it becomes brachial artery at the lower border of teres major. The brachial artery divides into terminal radial and ulnar arteries at the neck of radius. The radial and ulnar arteries are palpable at the wrist joint The dorsal venous arch present on the dorsum of hand continues as basilica and cephalic veins draining the hand and forearm. At cubital fossa, basilic and cephalic veins joins to form median cubital vein. Basilic vein joins the deep veins and drains in to axillary vein. The cephalic vein pierces the clavipectoral fascia and ends into axillary vein. The axillary vein becomes subclavian vein at the outer border of first rib. 1/4/2015 8

9. A 68-year-old female with acute right lower extremity pain and absent popliteal and pedal pulses. There is an occlusion of the popliteal artery caused by an embolus. occlusion of the popliteal artery caused by an embolus . 1/4/2015 9

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11. The lymphatic drainage of upper limb. The axillary group of lymph nodes drain the entire upper limb, including breast. 1/4/2015 11

12. Lower limb regions and compartments 1/4/2015 12 The gluteal region, anterior thigh region, posterior thigh region, and medial thigh region or adductor region. The leg is below knee and above ankle joint. It has three compartments, anterior, posterior and lateral compartments of leg. Each compartment has their own nerve supply. Foot has sole and dorsum, intrinsic muscles and extrinsic muscles tendons.

13. The blood supply of lower limb The external iliac artery continuous as femoral artery as it passes below inguinal ligament. The femoral artery gives profunda femoris branch, to supply to the thigh muscles. The popliteal artery is the continuation of femoral artery from the hiatus magnus to the lower border of popliteus . The popliteal artery gives two terminal branches, anterior and posterior tibial arteries. The anterior tibial artery descends on dorsum of foot and renamed as dorsalis pedis artery. The dorsal venous arch continues as great saphenous and small saphenous veins. The deep veins continues as popliteal vein and femoral vein and external iliac vein. 1/4/2015 13

14. The lymphatic drainage of lower limb The inguinal group of lymph nodes drain the entire lower limb, including the groin region. The lower part of abdominal wall also is drained in to the inguinal group of lymph nodes. 1. Superomedial superficial inguinal 2. Superolateral superficial inguinal 3. Inferior superficial inguinal 4. Deep inguinal lymph nodes 1/4/2015 14

15. They receive as afferents lymphatic vessels from the following: integument of the penis scrotum perineum buttock abdominal wall below the level of the umbilicus back below the level of the iliac crest vulva anus (below the pectinate line) the thigh and the medial side of the leg (the lateral leg drains to the popliteal lymph nodes first). 1/4/2015 15

16. Imaging studies of upper limb 1/4/2015 16

17. Imaging studies of lower limb 1/4/2015 17

18. References:- http:// dentistryandmedicine.blogspot.ae/2012/05/blood-supply-venous-drainage-surface.html http://www.authorstream.com/Presentation/drmklamba-683806-blood-supply-to-upper-limb / http:// www.scribd.com/doc/17367456/Upper-Limbs-Blood-Supply-and-Nerves http://www.dartmouth.edu/~humananatomy/part_3/chapter_13.html http://download.videohelp.com/vitualis/med/lowrart.htm http://quizlet.com/25002638/thoracic-wall-flash-cards/ http://www.cixip.com/index.php/page/content/id/1363 http://en.wikipedia.org/wiki/Superficial_inguinal_lymph_nodes # 1/4/2015 18