Surface marking upper limb

Surface anatomy of the upper limb

1. SURFACE ANATOMY OF UPPER LIMB Dr. Zaheer Amjad M.B.B.S, D.L.O

2. Surface Anatomy A branch of gross anatomy that examines shapes and markings on the surface of the body as they relate to deeper structures.

3. Surface Anatomy Four techniques are used : Visual inspection Palpation Percussion Auscultation

4. Surface Anatomy The axillary artery, axillary vein and components of the brachial plexus ( neurovascular bundle ) can be palpated by placing a hand into the floor of axilla and pressing laterally against the humerus The cephalic vein travels in superficial fascia in the cleft between the deltoid muscle and the pectoralis major

5. Surface Anatomy The brachial artery is on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles The median nerve courses with the brachial artery The ulnar nerve deviates posteriorly from the vessel in distal regions

6. Axillary Artery Arm at right angles to the trunk Straight line joining the Midpoint of the clavicle with junction of the anterior 1/3 and posterior 2/3 of the lateral wall of axilla

7. Axillary Artery Arm at right angles to the trunk Straight line joining the Midpoint of the clavicle with junction of the anterior 1/3 and posterior 2/3 of the lateral wall of axilla

8. Brachial Artery Join ( 1 ) a point at the junction of the anterior 1/3 and posterior 2/3 of the lateral wall of the axilla with ( 2 ) that at the level of the neck of the radius medial to the tendons of the biceps brachii

9. Brachial Artery Join ( 1 ) a point at the junction of the anterior 1/3 and posterior 2/3 of the lateral wall of the axilla with ( 2 ) that at the level of the neck of the radius medial to the tendons of the biceps brachii

10. Axillary pulse: axillary artery in the axilla lateral to the apex of the dome of skin covering the floor of the axilla. Brachial pulse in mid-arm: brachial artery on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles. This is the position where a blood pressure cuff is placed. Brachial pulse in the cubital fossa: brachial artery medial to the tendon of the biceps brachii muscle. This is the position where a stethoscope is placed to hear the pulse of the vessel when taking a blood pressure reading. Radial pulse in the distal forearm: radial artery immediately lateral to the tendon of the flexor carpi radialis muscle. This is the most common site for 'taking a pulse'. Ulnar pulse in the distal forearm: ulnar artery immediately under the lateral margin of the flexor carpi ulnaris tendon and proximal to the pisiform. Radial pulse in the anatomical snuffbox: radial artery as it crosses the lateral side of the wrist between the tendon of extensor pollicis longus muscle and the tendons of extensor pollicis brevis and abductor pollicis longus muscles.

11. Radial Artery In the Forearm 1 st point at neck of the radius medial to the tendons of the biceps brachii 2 nd point at the wrist between anterior border of the radius laterally and tendon of flexor carpi radialis medially

12. Radial Artery In the Hand 1 st point at wrist between the anterior border of radius and the tendon of flexor carpi radialis . 2 nd points just below the tip of styloid process of radius 3 rd point at the proximal end of the first intermetacarpal space.

13. Ulnar Artery 1 st point in front of elbow at level of neck of radius medial to the tendon of biceps brachii

14. Ulnar Artery 2 nd point at the junction of the upper 1/3 and lower 2/3 of the medial border of the forearm (lateral to the ulnar nerve)

15. Ulnar Artery 3 rd point lateral to the pisiform bone The ulnar nerve lies just medial to the ulnar artery in the lower 2/3 of its course

16. Superficial Palmar Arch 1 st point just lateral and distal to the pisiform bone 2 nd point on the hook of the hamate bone. 3 rd point on the distal border of the thenar eminence in line with the cleft between index and middle fingers

17. Superficial Palmar Arch 1 st point just lateral and distal to the pisiform bone 2 nd point on the hook of the hamate bone. 3 rd point on the distal border of the thenar eminence in line with the cleft between index and middle fingers

18. Deep Palmar Arch Slight convexity to the fingers Marked by a more or less horizontal line, 4 cm (1.5 ") long , just distal to the hook of hamate bone It lies 1.2 cm proximal to the superficial palmar arch

19. Deep Palmar Arch Slight convexity to the fingers Marked by a more or less horizontal line, 4 cm (1.5 ") long , just distal to the hook of hamate bone It lies 1.2 cm proximal to the superficial palmar arch

20. Axillary Nerve with its Divisions Marked by a horizontal line on deltoid muscle, 2 cm above midpoint between the tip of the acromion process and the insertion of the deltoid Intramuscular injections in the deltoid are given in the lower part of the

21. Axillary Nerve with its Divisions Marked by a horizontal line on deltoid muscle, 2 cm above midpoint between the tip of the acromion process and the insertion of the deltoid Intramuscular injections in the deltoid are given in the lower part of the

22. Musculocutaneous nerve 1st point lateral to the axillary artery 3 cm above its termination 2 nd point lateral to the tendon of the biceps brachii muscle 2 cm above the bend of the elbow

23. Median Nerve In the Arm Marked lateral to the brachial artery in the upper half , and medial to the artery in the lower half of the arm The nerve crosses the artery anteriorly in the middle of the arm

24. Median Nerve In the Arm Marked lateral to the brachial artery in the upper half , and medial to the artery in the lower half of the arm The nerve crosses the artery anteriorly in the middle of the arm

25. Median Nerve In the Forearm 1st point medial to the brachial artery at the bend of the elbow 2 nd point in front of the wrist , over the tendon of the palmaris longus or 1 cm medial to the tendon of the flexor carpi radialis

26. Front of right upper extremity, showing surface markings for bones, arteries, and nerves

27. Radial Nerve In the Arm 1 st point at the junction of the anterior 1/3 and posterior 2/3 of the lateral wall of the axilla at its lower limit 2 nd point at the junction of the upper 1/3 and lower 2/3 of a line joining the lateral epicondyle with the insertion of the deltoid 3 rd point on the front of the elbow at the level of the lateral epicondyle 1 cm lateral to the tendon of the biceps brachii

28. Radial Nerve In the Arm 1 st point at the junction of the anterior 1/3 and posterior 2/3 of the lateral wall of the axilla at its lower limit 2 nd point at the junction of the upper 1/3 and lower 2/3 of a line joining the lateral epicondyle with the insertion of the deltoid 3 rd point on the front of the elbow at the level of the lateral epicondyle 1 cm lateral to the tendon of the biceps brachii

29. Radial Nerve In the Forearm 1 st point 1 cm lateral to the biceps tendon at the level of the lateral epicondyle 2 nd point at the junction of the upper 2/3 and lower 1/3 of the lateral border of the forearm just lateral to the radial artery 3 rd point at the anatomical snuff box

30. Ulnar Nerve In the Arm 1 st point at junction of anterior 1/3 rd and posterior 2/3 rd of lateral wall of axilla at its lower limit. 2 nd point at the middle of the medial border of the arm. 3 rd point behind the medial epicondyle of the humerus.

31. Ulnar Nerve In the Forearm 1 st point o n the back of the base of medial epicondyle of humerus. 2 nd point lateral to pisiform bone.

32. Flexor Retinaculum Pisiform bone Tubercle of scaphoid Hook of hamate Crest of trapezium

33. Question 1

34. Thank You