Forearm

Anatomy 1C Joshua Montelibano 2nd shift 2015-2016
FOREARM & HAND
FOREARM
SKIN
Sensory Nerve Supply

 Anterior and Posterior branches of the lateral cutaneous nerve of the forearm –
continuation of the musculocutaneous nerve
 Anterior and Posterior branches of the medial cutaneous nerve of the forearm
 Posterior cutaneous nerve of the forearm – supplies narrow strip of skin down the
middle of the posterior surface of the forearm
Superficial Veins
 Lies in the superficial fascia
 Cephalic vein, Median cubital
vein, Basilic vein
Cephalic Vein
 Arises from the lateral side of the dorsal venous arch (back of the hand)
 Winds around the lateral border of the forearm
 Ascends into the cubital fossa and up the front of the arm - on lateral side of the biceps
 Terminates in axillary vein in deltopectoral triangle
Median Cubital vein

 Branch of the cephalic vein in the cubital fossa
 Runs upward, medially joins the basilic vein
 In the cubital fossa – median cubital crosses in front of the brachial artery and median nerve;
separated from brachial artery and median nerve by the bicipital aponeurosis
Basilic vein
 Arises from medial side of the dorsal venous arch (back of the hand)
 Winds around the medial border of the forearm
 Ascends into cubital fossa and up the front of the arm – on medial side of the biceps
 Terminates – joins venae comitantes of the brachial artery – forms axillary vein
1
Fascial Compartments of the Forearm

Fascial Compartments of the Forearm
Forearm – enclosed in a sheath of deep fascia

 Attached to periosteum of the posterior subcutaneous border of the ulna
 Deep fascia + interosseous membrane + intermuscular septa – divides forearm into several compartments (each with own muscles, nerves, and blood supply)
Interosseous Membrane
 Strong membrane – unites the shaft of the radius and ulna
 Attached to interosseous borders of radius and ulna
 Fibers run obliquely downward and medially – enables force applied to lower end of radius is transmitted from the radius to the ulna and eventually to
humerus and scapula
 Provides attachment for neighboring muscles
Flexor and Extensor Retinacula

Strong bands of deep fascia – holds long and extensor tendons in position at the wrist
CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT
 Muscles:
Superficial group Intermediate group Deep group
1. Pronator teres 1. Flexor pollicis longus
2. Flexor carpi radialis Flexor digitorum 2. Flexor digitorum
3. Palmaris longus superficialis profundus
4. Flexor carpi ulnaris 3. Pronator quadratus
 Blood supply to the muscles: Ulnar and Radial arteries

 Nerve supply to the muscles: MEDIAN NERVE
(except for flexor carpi ulnaris and medial part of flexor digitorum profundus
– ULNAR NERVE)
2
Muscles of the Anterior Fascial Compartment of the Forearm

Origin Insertion Innervation Nerve Roots Action
Superficial group
Pronator Teres
Medial epicondyle of
 Humeral head
humerus Lateral aspect of shaft of Pronation and flexion of
Medial border of coronoid radius forearm
 Ulnar head C6, 7
process of ulna
nd rd Median nerve
Bases of 2 and 3 Flexes and abducts hand
Flexor Carpi radialis
Medial epicondyle of the metacarpal bones at wrist joint
humerus Flexor retinaculum and
Palmaris longus C7, 8 Flexes hands
palmar aponeurosis
Flexor carpi ulnaris
Medial epicondyle of the
 Humeral head  Pisiform bone
humerus
 Hook of the hamate Flexes and adducts hand
 Medial aspect of Ulnar nerve C8, T1

th
Base at 5 metacarpal at wrist joint
 Ulnar head olecranon process
bone
 Posterior border of ulna
Intermediate group
Flexor Digitorum Superficialis
 Medial epicondyle of  Flexes middle phalanx
 Humeroulnar humerus of fingers
head  Medial border of coronoid Middle phalanx of medial 4  Assists in flexing
Median nerve C7, 8, T1
process of ulna fingers proximal phalanx and
 Radial head Oblique line on anterior hand
surface of shaft of radius
Deep group
Anterior surface of radius Anterior interosseous Flexes digital phalanx of
Flexor policis longus Distal phalanx of thumb
shaft branch of median nerve thumb
 Flexes digital phalanx
Ulnar (medial half) and of fingers
Flexor digitorum Anteromedial surface of shaft Distal phalanges of medial 4
median (lateral half) C8, T1  Assists in flexion of
profundus of ulna fingers
nerves middle and proximal
phalanges and wrist
Anterios surface of shaft of Anterior surface of shaft of Anterior interosseous
Pronator quadratus Pronates forearm
ulna radius branch of median nerve
3
Superficial group Intermediate group
4
Deep group Arteries of the anterior forearm
5
Arteries of the Anterior Fascial Compartment of the Forearm

Radial artery Ulnar Artery
 Smaller of the terminal branches of the brachial artery  Larger of the 2 terminal branches of the brachial artery
Commencement: Cubital fossa at the level of the neck of the radius Commencement: Cubital fossa at level of the neck of the radius
Termination: leaves forearm by winding around the lateral aspect of the Termination: Palm in front of the flexor retinaculum in company with ulnar nerve
wrist to reach posterior hand surface
Course: Course:
1. Passes downward and laterally, beneath the brachioradialis 1. Descends through anterior compartment of the forearm
muscle and rest on deep muscles of the forearm 2. In upper part – lies deep in flexor muscles
rd 3. Below its course – becomes superficial – lies between tendons of flexor carpi
2. In middle 3 of the course – superficial branch lies on its lateral
side ulnaris and flexor digitorum superficalis
3. In distal part of the forearm 4. Enters palm in front of the flexor retinaculum with the ulnar nerve – lies
 Lies on anterior surface of the radius lateral to pisiform bone
(only covered by skin and fascia) (covered only by skin and fascia – site for taking ulnar pulse)
 Has the tendon of flexor carpi radialis on its medial side 5. Forms superficial palmar arch – anastomoses with superficial palmar branch
(site for taking radial pulse) of the radial artery
Branches in the Forearm: Branches

 Muscular branches – to neighboring muscles  Muscular branches – to neighboring muscles
 Recurrent branch – takes part in arterial anastomosis around elbow  Recurrent branches – take part in arterial anastomosis around elbow joint
joint  Branches that take part in arterial anastomoses around wrist joint
 Superficial palmar branch - arises above the wrist; enters palm of the  Common interosseous artery
hand and joins ulnar artery – forms superficial palmar arch  Arises from upper part of ulnar artery
 Divides into anterior and posterior – distributed to muscles in front and
behind interosseous membrane
 Provide nutrient arteries to radius and ulna
6
Nerves of Anterior Fascial Compartment of the Forearm

Median Nerve Ulnar Nerve
Course Course
1. Leaves cubital fossa – passes between 2 heads of 1. Passes behind the medial epicondyle of the
the pronator teres humerus , crosses medial ligament of the
2. Continues downward behind the flexor elbow joint
digitorum superficialis 2. Enters front of the forearm – passes
Rest posteriorly on flexor digitorum profundus between 2 heads of the flexor carpi ulnaris
3. At wrist – emerges from lateral border of the 3. Runs downward the forearm between
flexor digitorum superficialis muscles; lies behind flexor carpi ulnaris and flexor digitorum
tendon of palmaris longus profundus
4. Enters palm – passes behind flexor retinaculum 4. In distal 2/3 – ulnar artery lies on lateral
side of median nerve
Branches 5. At wrist – becomes superficial; lies
 Muscular branches – in cubital fossa to the between tendons of the flexor carpi ulnarus
pronator teres, flexor carpi radialis, palmaris and flexor digitorum superficialis
longus, flexor digitorum superficialis 6. Enters palm – passes in front of flexor
 Articular branches – to elbow joint retinaculum and lateral the pisiform bone
 Anterior Interosseous Nerve Branches
 Arises from median nerve  Muscular branches – to flexor carpi ulnaris
(emerge between 2 heads of the pronator teres) and medial half of flexor digitorum profundus
 Passes downward on anterior surface of  Articular branches – to elbow joint
interosseous membrane  Palmar cutaneous branch
(between flexor pollicis longus and flexor
 Arises in middle of the forearm
digitorum profundus)
 Supplies skin over hypothenar eminence
 Ends on anterior surface of the carpus
Branches:  Dorsal posterior cutaneous branch
 Muscular branches – to flexor pollicis longus,  Large branch, arises in distal 3rd of the
pronator quadratus, lateral half of flexor forearm
digitorum profundus  Passes medially between tendon of flexor
 Articular branches – to wrist and distal carpi ulnaris and ulna
radioulnar joints; also supply hand joints  Distributed on posterior surface of hand
 Palmar cutaneous branch and fingers
 Arises in lower part of forearm
 Distributed to skin over lateral part of the palm
7
CONTENTS OF THE LATERAL FASCIAL COMPARTMENT

Lateral fascia compartment – may be regarded as part of the posterior fascial compartment
Muscles of the Lateral Fascial Compartment of the Forearm

 Flexes forearm at elbow joint
Base of styloid process of
Brachioradialis C5, 6, 7  Rotates forearm to midprone
Lateral supracondylar radius
Radial Nerve position
ridge of humerus
Extensor carpi radialis Posterior surface of base
nd C6, 7 Extends and abducts hand at wrist joint
longus of 2 metacarpal bone
Arteries of the Lateral Fascial Compartment of the Forearm
 Derived from branches of the radial and brachial arteries
Nerve of Lateral Fascial Compartment of the Forearm
Radial Nerve Superficial Branch of the radial nerve
Course  Direct continuation of the nerve after main stem has given
1. Pierces lateral intermuscular septum in lower part of the arm off its deep branch in front of lateral epicondyle of the
Passes forward into cubital fossa humerus
2. Passes downward in front of lateral epicondyle of the humerus – lies between Course
brachialis (medial side) and extensor carpi radialis (lateral) 1. Runs down under cover of brachioradialis muscle on
3. At level of lateral epicondyle – divides into superficial and deep branches lateral of the radial artery
Branches 2. In distal part of the forearm – leaves the artery and passes
 Muscular branches – to brachioradialis, extensor carpi radialis longus, small branch to backward under the tendon of the brachioradialis
lateral part of brachialis 3. Reaches posterior surface of the wrist – divides into
 Articular branches - to elbow joint terminal branches supplying:
 Deep branch of the radial nerve  Skin on lateral 2/3 of the posterior surface of the
 Winds around neck of radius (within supinator muscle) hand
 Enters posterior compartment of the forearm  Posterior surface over the proximal phalanges of
 Superficial branch of the radial nerve the lateral 3 ½ fingers
8
CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT
 Muscles
Superficial group Deep group
1. Extensor carpi radialis brevis 1. Supinator
2. Extensor digitorum 2. Abductor pollicis longus
3. Extensor digiti minimi 3. Extensor pollicis brevis
4. Extensor carpi ulnaris 4. Extensor pollicis longus
5. Anconeus 5. Extensor indicis
 Blood supply: posterior and anterior interosseous arteries
 Nerve supply to muscles: deep branch of radial nerve
Arteries of the Posterior Fascial Compartment of the Forearm
Anterior and Posterior Interosseous arteries

 Arise from common interosseous artery – branch of the ulnar artery
 Pass downward on the anterior and posterior surface of the interosseous
Nerve of Posterior Fascial Compartment of the Forearm
Deep branch of the Radial Nerve

Course
1. Arises from radial nerve in front of the lateral epicondyle of the humerus
and cubital fossa
2. Pierces supinator and winds around alteral aspect of the neck of the
radius - reaches posterior compartment of the forearm
3. Descends in interval between superficial and deep groups of muscles
4. Reaches posterior surface of wrist joints
Branches
 Muscular branches – superficial and deep group except extensor carpi
ulnaris and anconeus
 Articular branches – to wrist and carpal joints
9
Muscles of the Posterior Fascial Compartment of the Forearm

Superficial group
Extensor carpi radialis Posterior surface of base of Extends and abducts hand at
rd
brevis 3 metacarpal bone wrist joint
Middle and distal phalanges
Extensor digitorum Extends fingers and hand
of medial 4 fingers Deep branch of radial
C7,8
Lateral epicondyle of Extensor expansion of little nerve Extends metacarpal phalangeal
Extensor digiti minimi
humerus finger joint of little finger
th Extends and adducts hand at
Extensor carpi ulnaris Base of 5 metacarpal bone
wrist joint
Lateral surface of olecranon
Anconeus Radial nerve C7, 8, T1 Extends elbow joints
process of ulna
Deep group
 Lateral epicondyle of
humerus
 Anular ligament of
Supinator Neck and shaft of radius C5, 6 Supination of forearm
proximal radioulnar
joint
 Ulna
Posterior surface of st Deep branch of radial
Abductor pollicis longus Base of 1 metacarpal bone Abducts and extends thumb
radius and ulna shafts nerve
Posterior surface of Extends metacarpophalangeal
Extensor pollicis brevis
radius shaft Base of proximal phalanx of joints of thumb
C7 , 8
thumb Extends distal phalanx of
Extensor pollicis longus
Posterior surface of ulna thumb
shaft Extensor expansion of index Extends metacarpophalangeal
Extensor indicis
finger joint of index finger
10
Superficial group Deep group
11
WRIST
Flexor Retinaculum Extensor Retinaculum
 Thickening of deep fascia  Thickening of deep fascia
 Holds long flexor tendons in position at the wrist  Holds long extensor tendons in position
 Stretches across front of the wrist and converts concave anterior surface of the  Stretches across back of the wrist; converts grooves on posterior
hand into an osteofascial tunnel – carpal tunnel surface of the distal ends of the radius and ulna into 6 separate
tunnels
Attachment:
 Medially - pisiform bone and hook of the hamate Attachment:
 Laterally – tubercle of the scaphoid and trapezium bones  Medially – pisiform bone and hook of the hamate
(attachment to trapezium bones - consist of superficial and deep parts – forms  Laterally – distal end of the radius
synovial lined tunnel for passage of the tendon of the flexor carpi radialis)
Borders: Upper and lower
Borders:  Continuous with deep fascia of forearm and hand respectively
 Upper border: distal transverse skin crease in front of the wrist (continuous
with deep fascia of the forearm) 6 separate tunnels
 Lower border: attached to palmar aponeurosis  Passage for long extensor tendons
Carpal tunnel Tunnels

Carpus – deeply concave on anterior surface (forms a bony gutter – converted into a  Lined with synovial sheath (extends above and below retinaculum
tunnel by the flexor retinaculum) on tendons)
 Formed by bones of the hand and flexor retinaculum  Separated from one another by fibrous septa – pass from deep
 For passage of median nerve and flexor tendons of the thumb and fingers surface of the retinaculum to the bones
 4 separate tendons of the flexor digitorum superficialis in anterior and
posterior rows (those to the middle and ring fingers)
 At lower border of the flexor retinaculum – 4 tendons diverge and become
arranged on the same plane - tendons of flexor digitorum profundus
(lie behind superficialis tendons)
 All 8 tendons of superficialis and profundus – invaginate a common
synovial sheath from the lateral side
 Tendon of the flexor pollicis longus – runs through lateral part of the
tunnel with own synovial sheath
Median nerve – lies in restricted space between tendons of:
 Flexor digitorum superficialis
 Flexor carpi radialis
12
REGION ON THE WRIST

Structures on the Anterior Aspect of the Wrist
Structures that pass superficial the flexor retinaculum (medial to lateral)
1. Flexor carpi ulnaris tendon – ends on pisiform bone
(does not really cross the flexor retinaculum)
2. Ulnar nerve – lateral to pisiform bone
3. Ulnar artery – lateral to ulnar nerve
4. Palmar cutaneous branch of the ulnar nerve
5. Palmaris longus tendon
6. Palmar cutaneous branch of the median nerve
Structures that pass beneath the flexor retinaculum (medial to lateral)

1. Flexor digitorum superficialis tendons
Flexor digitorum profundus tendons (posterior of flexor digitorum superficialis
tendons; both share common synovial sheath)
2. Median nerve
3. Flexor pollicis longus tendon – surrounded by synovial sheath
4. Flexor carpi radialis tendon –going through a split in flexor retinaculum;
surrounded by a synovial sheath
Structures on the Posterior Aspect of the Wrist
Structures that pass superficial the extensor retinaculum (medial to lateral)
1. Dorsal (posterior) cutaneous branch of the ulnar nerve
2. Basilic vein
3. Cephalic vein 6. Abductor pollicis longus and extensor pollicis brevis tendons –
4. Superficial branch of the radial nerve separate synovial sheaths; common compartment
Structures that pass beneath the extensor retinaculum (medial to lateral) Extensor retinaculum
1. Extensor carpi ulnaris tendon – grooves the posterior aspect of the ulna head  Beneath – fibrous septa pass to underlying radius and ulna –
2. Extensor digiti minimi tendon – posterior to the distal radioulnar joint forms 6 compartments containing extensor muscle tendons
3. Extensor digitorum and Extensor indicis tendons – share common synovial  Each compartment – with synovial sheath extending above and
sheath; situated on lateral part of the posterior surface of the radius below the retinaculum
4. Extensor pollicis longus tendon – winds around the medial side of the dorsal
tubercle of the radius Radial artery – reaches back of hand by passing between lateral
5. Extensor carpi radialis longus and brevis tendons – share common synovial collateral ligament of wrist joint and abductor pollicis
sheath; situated on lateral part of the posterior surface of the radius longus and extensor pollicis brevis tendons
13
PALM OF THE HAND

SKIN Sensory Nerve Supply
 Thick, hairless, many sweat glands  Palmar cutaneous branch of the median nerve
 Bound to underlying deep fascia by numerous fibrous bands  Crosses in front of the flexor retinaculum
 Shows many flexure creases at sites of movement  Supplies lateral part of the palm
(not necessarily placed at sites of joints)  Palmar cutaneous branch of the ulnar nerve
 Crosses in front of the flexor retinaculum
Palmaris Brevis  Supplies medial part of the palm
Origin: Flexor retinaculum and palmar aponeurosis  Lateral cutaneous nerve of the forearm or
Insertion: Skin of the palm Superficial branch of the radial nerve
Innervation: Superficial branch of the ulnar nerve  Supplies skin over the base of the thenar eminence
Function: Corrugate the skin at the base of the hypothenar eminence and
improve DEEP FASCIA
the grip of the palm in holding a rounded object  Deep fascia of wrist and palm – thickened to form flexor retinaculum and
palmar aponeurosis
14
PALMAR APONEUROSIS
 Triangular, occupies central area of the palm
 Function: gives firm attachment to overlying skin
and improve grip to protect underlying tendons
Apex of the palmar aponeurosis

 Attached to the distal border of the flexor
retinaculum
 Receives the insertion of the palmaris longus
tendon
Base of the aponeurosis – divides at the bases of the fingers

into 4 slips
 Each slip – divides into 2 bands
 1 band passes superficially to the skin
1 band passes deeply to the root of the finger
 Deep band divides into 2 – diverge around
the flexor tendons
 Finally fuse with the fibrous flexor sheath
and deep transverse ligaments
Medial and lateral borders of the palmar aponeurosis

 Continuous with the thinner deep fascia covering
the hypothenar and thenar muscles
 From each border – fibrous septa pass posteriorly
into the palm (takes part in palmar fascial spaces
formation)
15
Fibrous Flexor Sheaths Synovial Flexor Sheaths

Provides strong fibrous sheath attached to sides of the phalanges in anterior Tendons of the flexor digitorum superficialis and profundus muscles invaginate
surface of each finger (from head of metacarpal to base of distal phalanx) a common synovial sheath from the lateral side
 Proximal end of the sheath – open  Medial part extends distally without interruption on little finger tendons
 Distal end of the sheath – closed; attached to the base of the distal phalanx  Lateral part stops abruptly on middle of the palm
 Sheath + bones – form a blind tunnel where flexor tendons of the finger lie
 Thick over the phalanges; Thin and lax over joints Digital synovial sheaths
 Acquired by the distal ends of the long flexor tendons of the index, the
In the thumb middle, and the ring fingers
 Osteofibrous tunnel contains tendon of the flexor pollicis longus
In the 4 medial fingers Flexor pollicis longus tendon
 Tunnel is occupied by tendons of the flexor digitorum superficialis and  Has own synovial sheath that passes into the thumb – allow long
profundus tendons to move smoothly beneath the flexor retinaculum and fibrous
flexor sheath (provides minimum friction)
 Also known as radial bursa – communicated with common synovial
sheath (ulnar bursa) of the superficialis and profundus tendons
Vincula longa and Brevia

 Small vascular folds of synovial membrane
 Connects tendons to the anterior surface of the phalanges
 Resemble a mesentery; convey blood vessels to tendons
16
INSERTION OF THE LONG FLEXOR TENDONS

Each tendon of the flexor digitorum superficialis
 Enters fibrous flexor sheath
 Opposite the proximal phalanx – divides into 2 halves
(passes around the profundus tendon and meet on its
deep posterior surface)
 Unites again
Each tendon of the flexor digitorum profundus
 Have passed the superficialis tendon – continues
downward
 Inserted into the anterior surface of the base of the
distal phalanx
SMALL MUSCLES OF THE HAND

Small muscles of the hand include:
1. 4 lumbrical muscles
2. 8 interossei muscles (consists of 4 dorsal and 4 palmar
muscles)
3. Short muscles of the thumb (Thenar muscles)
4. Short muscles of the little finger (Hypothenar muscles)
st
Short muscles of the thumb (Thenar eminence – 1 three)
1. Abductor pollicis brevis
2. Flexor pollicis brevis
3. Opponens pollicis
4. Adductor pollicis
Short muscles of the little finger (Hypothenar muscles)

1. Abductor digiti minimi
2. Flexor digiti minimi brevis
3. Opponens digiti minimi
17
Small Muscles of the Hand

Origin Insertion Innervation Roots Action
Flexor retinaculum, palmar Superficial branch of ulnar Corrugates skin to improve
Palmaris brevis Skin of palm
aponeurosis nerve grip of palm
 1 & 2 median nerve
st nd
C8, T1 Flex metacarpophalangeal
Tendons of flexor digitorum Extensor expansion of medial 4
 3 and 4 deep
rd th
Lumbricals (4) joints; extend
profundus fingers
branch of ulnar nerve interphalangeal joints
Both - flexes
Interossei (8) metacarpophalangeal joints
Extends interphalangeal joint
 1 – from base of 1  Proximal phalanges of
st st
metacarpal thumb, index, ring, and

Adduct fingers toward center
 Palmar (4)  Remaining 3 – from little fingers rd
of 3 finger
anterior surface of shafts  Dorsal expansion of each
nd th th Deep branch of ulnar
2 , 4 , & 5 metacarpals finger C8, T1
nerve
 Proximal phalanges of
Abduct fingers from center
Contiguous sides of shafts of index, middle, and ring rd
 Dorsal (4) of 3 finger
metacarpal bones fingers
 Dorsal extensor expansion
Short Muscles of the Thumb
Abductor pollicis Scaphoid, trapezium, flexor
Abduction of thumb
brevis retinaculum Base of proximal phalanx of
Flexor pollicis thumb Flexes metacarpophalangeal
Median Nerve
brevis joint of thumb
Flexor retinaculum
Shaft of metacarpal bone of Pulls thumb medially and
Opponens pollicis C8, T1
thumb forward across the palm
nd rd
Oblique head; 2 & 3
metacarpal bones Base of proximal phalanx of Deep branch of ulnar
Adductor policis rd Adduction of thumb
transverse head; 3 thumb nerve
metacarpal bone
Short Muscles of the Little Finger
Abductor digiti
Pisiform bone Base of proximal phalanx of Abducts little finger
minimi
little finger Deep branch of ulnar
Flexor digiti minimi C8, T1 Flexes little finger
th nerve th
Opponens digiti Flexor retinaculum Medial border 5 metacarpal Pulls 5 metacarpal forward
minimi bone as in cupping the palm
18
Arteries of the Palm

Ulnar Artery Radial Artery
st
Enters the hand anterior to the flexor retinaculum on the lateral side of the Leaves dorsum of the hand by turning forward between proximal ends of the 1
nd st
ulnar nerve and pisiform bone – gives deep branch and then into a superficial and 2 metacarpal bones and the 2 heads of the 1 dorsal interosseous muscle
arch
On entering the palm – curves medially between oblique and transverse heads of
Superficial palmar arch adductor pollicis (continues as deep palmar arch)
 Direct continuation of the ulnar artery
 On entering the palm – curves laterally behind the palmar aponeurosus Deep palmar arch
and in front of the long flexor tendons  Direct continuation of the radial artery
 Arch is completed on lateral side by a radial artery branch  Curves medially beneath the long flexor tendons and front of metacarpal
 Curve – lies across the palm; level with the distal border of fully bones and interosseous muscles
extended thumb  Completed on medial side by the deep branch of the ulnar artery
 Curve – lies at level with proximal border of extended thumb
Digital arteries (4) – arise from convexity of the arch; passes to the fingers  Sends branches superiorly – takes part in anastomosis
Deep branch of the ulnar artery Branches:

 Commencement: in front of the flexor retinaculum  Arteria radialis indicis – supplies lateral side of the index finger
 Passes between abductor digiti minimi and flexor digiti minimi  Arteria princeps pollicis – divides into 2 – supplies lateral and medial
 Joins radial artery to complete deep palmar arch sides of the thumb
Lymph Drainage of the Palm

Lymph vessels of the fingers – pass along their borders to reach the webs
vessels ascend onto the dorsum of the hand
 Forms a plexus – drained by vessels ascending in front of the forearm or pass around
the medial and lateral borders to join vessels on dorsum of the hand
From the medial side

 Ascends in vessels accompanying the basilic vein
 Drain into the supratrochlear nodes – ascend eventually into the lateral axillary nodes
From the lateral side

 Ascends in vessels accompanying cephalic vein
 Drain into the infraclavicular nodes – eventually to lateral axillary nodes
19
Nerves of the Palm

Median Nerve Ulnar Nerve
 Enters palm by passing behind the flexor retinaculum and through the  Enters palm anterior to the flexor retinaculum alongside the lateral border of
carpal tunnel; divides into lateral and medial branches the pisiform bone; divides into superficial and deep terminal branches
Muscular branch Superficial branch of the Ulnar nerve

 Takes recurrent course around the lower border of the flexor  Descends into the palm; lies n subcutaneous tissue between pisiform and
retinaculum hook of hamate; Ulnar artery on its lateral side
 Lies about one fingerbreadth distal to the tubercle of the scaphoid  Ulnar nerve and artery may lie in tunnel of Guyton – fibro-osseous tunnel
 Supplies the muscles of the thenar eminence and 1 lumbrical
st
derived from superficial part of the flexor retinaculum
muscle  Branches: muscular branch (palmaris brevis), cutaneous branches, distal
half of the dorsal aspect of each finger
Cutaneous branches
 Supplies palmar aspect of the lateral 3 ½ fingers and distal half of Deep branch of the Ulnar nerve
the dorsal aspect of each finger  Runs backward between the abductor digiti minimi and flexor digiti minimi
 One of the branches supply the 2 lumbrical muscle  Pierces opponens digiti minimi, winds around lower border of the hook of
nd
hamate, passes lateral in concavity of deep palmar arch

Palmar cutaneous branch  Lies behind the long flexor tendons, front of metacarpal bones and
 Crosses anterior to the flexor retinaculum interosseous muscles
 Supplies the skin over the lateral part of the palm  Gives off muscular branches to hypothenar eminence, 3 and 4
rd th
lumbricals, palmar and dorsal interossei, heads of the adductor pollicis
Palmar cutaneous branch

 Given off in front of the forearm crosses anterior to the flexor retinaculum
 Supplies skin over the medial part of the palm
nd
Fascial Spaces of the Palm 2 septum divides palm into thenar space and midpalmar space
Thenar space
 Potential spaces filled with loose connective tissue  Lies lateral to the septum (does not contain thenar muscles), posterior
to long flexor tendons to the index finger; in front of adductor pollicis
 Boundaries are important – limit spread of palm infections
 Contains 1 lumbrical muscle
st
Triangular palmar aponeurosis – fans out from lower border of flexor retinaculum Midpalmar space
 From medial border – fibrous septum passes backward; attached to  Lies medial to the septum; posterior to long flexor tendons to the
rd th
th
anterior border of 5 metacarpal middle, ring, and little fingers; front of interossei and 3 , 4 & th
metacarpal
 From lateral border – 2 fibrous septum passes obliquely to anterior
nd
 Contains 2 , 3 , and 4 lumbrical muscles
nd rd th
rd
border of the 3 metacarpal
20
21
DORSUM OF THE HAND

SKIN
 Thin, hairy, freely mobile on underlying tendons and bones
Sensory Nerve Supply

 Superficial branch of the Radial Nerve
 Winds around the radius deep to the brachioradialis tendon;
descends over extensor retinaculum
 Supplies lateral 2/3 of dorsum of the hand
 Divides into several dorsal digital nerves – supply the thumb, index,
and middle fingers; lateral side of ring finger
 Dorsal digital nerve – branch supplying lateral side of the ring finger
 Posterior (dorsal) cutaneous branch of the ulnar nerve
 Winds around the ulna deep to the flexor carpi ulnaris tendon;
descends over the extensor reticulum
 Supplies medial third of the dorsum of the hand
 Divides into several dorsal digital nerves – supply medial side of the
ring and sides of the little fingers
INSERTION OF THE LONG FLEXOR TENDONS

4 tendons of the extensor digitorum emerge from under the extensor retinaculum
 Embedded in deep fascia - forms roof of a subfascial space
 Subfascial space – occupies whole width of the dorsum of the hand
 Strong oblique fibrous bands connect the tendons to the little, ring, and
middle fingers – proximal to heads of metacarpal bones
Extensor expansion
 Extensor tendon joins fascial expansion on posterior surface of each finger
 Splits into 3 near the proximal interphalangeal joint
1. Central part – inserted into base of the middle phalanx
2. 2 lateral parts – converge to be inserted into base of distal
phalanx
 Receives tendon of insertion of corresponding interosseous muscle on each
side; receives tendon of lumbricals on lateral side
22
Radial Artery on the Dorsum of the Hand

Course:
1. Winds around the lateral margin of the wrist joint beneath the tendons
of abductor pollicis longus and extensor pollicis brevis
2. Lies on lateral ligament of the joint
3. On reaching the dorsum – descends beneath the tendon of the
st
extensor pollicis longus to reach interval between 2 heads of the 1
dorsal interosseous muscle
Branches – take part in anastomosis around the wrist joint

Dorsal digital arteries - pass to the thumb and index finger
Dorsal Venous Arch
 Lies in subcutaneous tissue proximal to metacarpophalangeal joints
 Drains on lateral side into the cephalic vein
Drains on medial side into the basilic vein
 Greater part of the blood from whole hand drains into the arch –
receives digital veins
 Freely communicate with deep veins of the palm through interosseous
spaces
ANATOMIC SNUFFBOX
 Used to describe a triangular skin depression on lateral side of the wrist
 Boundaries:
Medial: tendon of the extensor pollicis longus
Lateral: tendons of abductor pollicis longus and extensor pollicis brevis
 Clinical importance: scaphoid bone can be easily palpated here and
pulsations of the radial artery can be felt in this area
23
24
THORACIC WALL
THORACIC WALL
Thorax
 Region between the neck and abdomen
 Thoracic cage – thorax wall framework
Function:
1. Protects the lungs and heart
2. Affords attachment for muscles of the thorax,
upper extremities, abdomen, and back
 Thorax cavity – can be divided into the mediastinum (median partition)
and laterally placed lungs and pleurae
 Pleura
 Visceral Pleura – covers the lungs
 Parietal Pleura – covers inner surface of the chest wall
THORACIC WALL BOUNDARIES

 Covered on the outside by skin and muscles attaching
the shoulder girdle to the trunk
 Lined with parietal pleura
Posterior: Thoracic part of the vertebral column

Anterior: Sternum and costal cartilages
Lateral: Ribs and intercostal spaces
Superior: Suprapleural membrane (communicates with the neck)
Inferior: Diaphragm (separates thoracic cavity from abdominal cavity)
BONES FORMING THE THORAX

1. Sternum
2. Ribs
 True ribs
 False ribs
 Floating ribs
Typical Ribs
Atypical Ribs
25
STERNUM
 Lies in midline of the anterior chest wall
 Flat bone divided into 3 parts:
manubrium sterni, body of the sternum, and xiphoid process
1. Manubrium
 Upper part of the sternum
 Lies opposite the 3 and 4 thoracic vertebrae (T3 & T4)
rd th
Articulates with:
 Body of the sternum – at manubriosternal joint
 Clavicles
 1 costal cartilage
st
 Upper part of the 2 costal cartilages on each side

nd
2. Body of the sternum

Articulates with:
 Above – manubrium – at manubriosternal joint
 Below – xiphoid process – at xiphisternal joint (lies opposite the body of
th
the 9 thoracic vertebra, T9)
 On each side – with 2 to 7 costal cartilages
nd th
3. Xiphoid process
 Thin plate of cartilage
 Becomes ossified at proximal end during adult life
 No ribs or costal cartilages attached to it
Sternal Angle (Angle of Louis)

 Formed by the articulation of the manubrium with body of the sternum
 Recognized by presence of transverse ridge on anterior aspect of the sternum
 Transverse ridge – lies at level of 2 costal cartilage
nd
 Angle lies opposite the intervertebral disc – between 4 and 5 thoracic

th th
vertebrae, T4 & T5)
26
RIBS
 12 pairs of ribs
 All attached posteriorly to the thoracic vertebrae
1. True ribs – upper 7 pairs attached anteriorly to the sternum via costal cartilages
th th th th
2. False ribs – 8 , 9 , 10 pairs attached anteriorly to each other to the 7 rib via
costal cartilages and small synovial joints
th th
3. Floating ribs - 11 and 12 pairs, no anterior attachment
TYPICAL RIB
 Long, twisted, flat bone with rounded smooth superior border
 Sharp, thin, inferior border – overhangs, forms costal groove
Costal groove – accommodates intercostal vessels and nerves
 Anterior end – attached to costal cartilage
Parts of a rib
 Head – has 2 facets for articulation with the numerically corresponding
vertebral body and that of the vertebra immediately above
 Neck – constricted portion between the head and tubercle
 Tubercle - prominence on outer surface of the rib at junction of the neck with
the shaft; has facet for articulation with transverse process
 Shaft – thin and flattened, twisted on its long axis;
inferior border has the costal groove
 Angle – where shaft of the rib bends sharply forward
ATYPICAL RIB
 1 rib
st
 Clinical importance – close relationship to lower nerves of the brachial plexus

and main vessels to the arm (Subclavian artery and vein)
 Small and flattened from above downward
 Scalenus anterior – attached to upper surface and inner border
 Anterior to scalenus anterior – subclavian vein crosses rib
 Posterior to muscle – subclavian artery and lower trunk of brachial plexus
crosses rib
27
COSTAL CARTILAGES
 Bars of cartilage connecting the upper 7 ribs to lateral edge of the sternum and the
th th
8 -10 ribs to the cartilage above
 Cartilages of 11 and 12 ribs – end in abdominal musculature
th th
 Contribute to elasticity and mobility of thoracic walls

 In old age – losses flexibility due to superficial calcification
Manubriosternal Cartilaginous joint between manubrium and body of

Joints of the joint the sternum
Sternum Cartilaginous joint between xiphoid process and
Xiphisternal joint
body of the sternum
 1 rib and 3 lowest ribs – single synovial joint
st
with corresponding vertebrae

 2 to 9 ribs – head articulates by synovial joint
nd th
Joints of the heads with corresponding vertebra and immediately

above it
 With strong intraarticular ligament – connects
head to intervertebral disc
 Articulates via synovial joint with the transverse
Joints of tubercles process of the corresponding vertebra
 Absent on 11 and 12 (floating) ribs
th th
Joints of the
Joints of ribs and  Cartilaginous
Ribs
costal cartilage  No movement possible
 1 costal cartilage – articulates with manubrium;
st
no movement
 2 to 7 costal cartilages – articulate with lateral
nd th
Joints of costal border of the sternum by synovial joints

 6 to 10 costal cartilage – articulate with one
th th
cartilage with the
sternum another along their borders by small synovial
joints
 11 and 12 ribs – embedded in abdominal
th th
musculature
28
STERNOCLAVICULAR JOINT

st
Articulation: Bbetween sternal end of clavicle, manubrium sterni, & 1 costal cartilage
 Type: Synovial double-plane joint
 Capsule: Surrounds joint and attached to margins of articular surfaces
 Ligaments: Sternoclavicular ligament
 Articular disc: Flat fibrocartilaginous disc lies within joint and divides joint’s interior into 2 compartments

st st
Accessory ligament: Costoclavicular ligament - from junction of 1 rib with the 1 costal cartilage to
inferior surface of sternal end of clavicle
 Synovial membrane: lines the capsule; attached to margins of the cartilage
 Nerve supply: Supraclavicular nerve and nerve to subclavius
 Movements: forward (serratus anterior) Relations:
 Backward (trapezius & rhomboid) Anterior- skin, SCM, pec major
 Movement of clavicle (medial) Posterior - sternohyoid, brachiocephalic artery
 Elevation (trapezius, SCM, levator, rhomboid) (right), left brachiocephalic vein, left common
 Depression (pectoralis minor & subclavius) (lateral) carotid artery
Surface Anatomy
 Superior margin of the manubrium sterni
Suprasternal notch  Felt between prominent medial ends of the clavicles in the midline
 Lies opposite the lower border of the body of 2 thoracic vertebrae (T2)
nd
Anterior Chest wall  Angle made between manubrium and body of the sternum
 Lies opposite the intervertebral disc between 4 and 5 thoracic vertebrae (T4, T5)
th th
Sternal angle (angle of
Louis)  Easily felt, seen as a transverse ridge
 Finger moved to right or left will pass 2 costal cartilage and rib – all ribs can be counted from this point
nd
 1st rib – lies deep to the clavicle; cannot be palpated

Ribs  Lateral surfaces of remaining ribs – can be felt by pressing fingers upward into the axilla
 12 rib – can be used to identify a particular rib by counting from below
th
th
Nipple In male – usually lies in 4 intercostal space about 4 inches from midline; In female – not constant position
Axillary folds Anterior fold – formed by the lower border of the pectoralis major; Posterior fold – formed by the tendon of the latissimus dorsi
Midaxillary line Runs vertically downward from a point situated midway between the anterior and posterior axillary folds
st th
Vertebra prominens 1 spinous process felt; 7 cervical vertebrae (C7)
rd
Spine of the scapula Lies on a level with the spine of 3 thoracic vertebra (T3)
Posterior Chest Wall
Inferior angle of the th
Lies on level with the spine of the 7 thoracic vertebra (T7)
scapula
29
Lines of Orientation
Midsternal line In median plane over the sternum
Line drawn between sternal border and
Parasternal line
midclavicular line
Runs vertically downward from the
Midclavicular line
midpoint of the clavicle
Anterior axillary Runs vertically downward from anterior
line axillary fold
Posterior axillary Runs vertically downward from posterior
line axillary fold
Runs vertically downward on posterior wall
Scapular line of the thorax; passes through the inferior
angle of the scapula
Paravertebral line Vertical line along transverse process
Muscles of the Thorax

Origin Insertion Innervation Action
Raise ribs during inspiration
External Intercostal muscles Superior border Increases anteroposterior and transverse
Inferior border of the rib
of rib below Intercostal nerves diameters of the thorax
Internal Intercostal muscles Lower ribs during expiration
Innermost intercostal muscle Adjacent ribs Adjacent ribs Assists external and internal intercostals
 Xiphoid process Muscle of inspiration
Diaphragm  Lower 6 costal cartilages Central tendon Phrenic nerve Increases vertical diameter of the thorax
 1 3 lumbar vertebrae
st
Assist in raising lower ribs
Tip of transverse process of C7 Posterior rami of thoracic
Levatores costarum Rib below
and T1-11 vertebrae spinal nerves Raises ribs
Lower cervical and upper Inspiratory muscle
Serratus posterior superior Upper ribs
thoracic spines
Intercostal nerves
Upper lumbar and lower Depresses ribs
Serratus posterior inferior Lower ribs
thoracic spines Expiratory muscle
 Endothoracic fascia – lines the innermost intercostal muscle; lined internally by the
INTERCOTAL SPACES parietal pleura
 Spaces between the ribs  Intercostal nerves and blood vessels – arranged in the following order from above
 Contains 3 muscles of respiration –external intercostal, internal downward: intercostal vein, artery, and nerve (VAN); run between the intermediate
intercostal, innermost intercostal muscle and deepest layers of muscles
30
INTERCOSTAL MUSCLES Action

 In INSPIRATION – 1 rib fixed by scaleni muscles; intercostal muscles raise 2 to
st nd
1. External Intercostal muscle
th st
 Most superficial layer 12 rib towards the 1 rib
 In EXPIRATION – 12 rib is fixed by quadratus lumborum and oblique muscles;
th
 Fibers directed downward and forward from subcostal groove
st th
of the rib above to the upper border of the rib below it intercostal muscles lowers 1 to 11 ribs
 Muscles extends to forward the costal cartilage – replaced by  Tone of intercostal muscles during different phases of respiration – strengthens
an aponeurosis – anterior (external) intercostal membrane tissues of the intercostal spaces – prevents sucking in or blowing out of tissues
2. Internal Intercostal muscle with intrathoracic pressure changes
 Intermediate layer
 Fibers directed downward and backward from the subcostal Intercostal Arteries
grove of the rib above to the upper border of the rib below POSTERIOR INTERCOSTAL ARTERIES ANTERIOR INTERCOSTAL ARTERIES
 Extends backward from the sternum in front to the angles of  First 2 spaces  First 6 spaces
the ribs Branches of the superior intercostal Branches of the internal thoracic
 Replaced behind by an aponeurosis – posterior (internal) artery – branch of the costocervical
st
artery (from 1 part of subclavian
intercostal membrane trunk of the subclavian artery artery)
3. Innermost intercostal muscle  Lower 6 spaces
 Deepest layer  Lower 9 spaces 1. Musculophrenic artery
 Corresponds to transversus abdominis muscle rd th
(3 to 12 intercostal spaces)
th th
7 to 9 intercostal space
 Incomplete muscle layer, crosses more than 1 intercostal Branches of the descending thoracic 2. Superior epigastric artery
th th
space aorta 10 to 12 intercostal space
 Related internally to endothoracic fascia and parietal pleura;
externally to intercostal nerves and vessels
31
Intercostal Veins
Posterior intercostal veins Anterior intercostal veins
Drain backward into azygos or Drain forward into the internal thoracic and
hemiazygos veins musculophrenic veins
 1 intercostal vein – drain into vertebral or  1 to 3 intercostal space – drain into
st st rd
brachiocephalic vein internal thoracic vein

 2 and 3 intercostal veins – unite to form  4 to 9 intercostal space – drain into
nd rd th th
superior intercostal vein (drains into azygos musculophrenic vein (joins with
and hemizygos veins) superior epigastric vein to drain into
rd
 Lower 4 to 11 intercostal veins at right
th th
internal thoracic at 3 intercostal
side – drain into azygos vein space)
 Left vein drain into inferior hemiazygos vein
Intercostal Nerves
Anterior rami of the first 11 thoracic spinal nerves Branches
th
Anterior ramus of 12 thoracic nerve (subcostal nerve) – lies in abdomen and  Rami communicantes – connects intercostal nerve to a ganglion of
runs forward in abdominal wall sympathetic trunk; gray ramus joins nerve medial at a point
 Collateral branch – runs forward inferiorly to main nerve on upper
3 kinds of fibers border of rib below
1. Motor fibers – innervates respiratory muscles  Lateral cutaneous branch – reaches skin on side of the chest; divides
2. Sensory fibers – from cutaneous areas and parietal pleura into anterior and posterior
3. Sympathetic fibers – for smooth muscles around blood vessels,  Anterior cutaneous branch – terminal portion of the main trunk,
secretory fibers to glands in the skin reaches skin near the midline; divides into medial and lateral branch
 Muscular branches – runs to intercostal muscles
 Each intercostal nerve – enters an intercostal space between parietal  Pleural sensory branches – go to pleural parietal
pleura and posterior intercostal membrane  Peritoneal sensory branches - 7 to 11 intercostal nerves only; run to
th th
 Runs forward inferiorly to intercostal vessels in subcostal groove between parietal peritoneum
innermost intercostal and internal intercostal muscles
First intercostal nerve
1. First 6 nerves – distributed in intercostal spaces  Joined to brachial plexus by a large branch equal to lateral cutaneous
th th
2. 7 to 9 nerves – leave the anterior ends of intercostal spaces by branch of typical intercostal nerves
passing deep to costal cartilages – enters anterior abdominal wall Second intercostal nerve
th th
3. 10 to 11 nerves – pass directly into abdominal wall  Joined to medial cutaneous nerve of the arm via intercostobrachial
(since corresponding ribs are floating ribs) nerve (equal to lateral cutaneous branch of other nerves)
 Supplies skin of the armpit and upper medial side of the arm
32
Muscles of Acting on the Thoracic Wall

Muscle of inspiration
 Xiphoid process
Increases vertical diameter of the thorax
Diaphragm  Lower 6 costal cartilages Central tendon Phrenic nerve
Assist in raising lower ribs
 1 3 lumbar vertebrae
st
Abdominal straining and for weight lifting
st Nerve to subclavius from Depresses clavicle and steadies this bone
Subclavius 1 costal cartilage Clavicle
upper trunk of brachial plexus during movements of the shoulder girdle
 Anterior surface of
Mastoid process of
manubrium Spinal part of accessory nerve
Sternoclediomastoid temporal and Extend head, flex neck, rotates head
 Superior surface of the and C2 and C3
occipital bone
clavicle
Anterior: C4-C6 st nd
Elevates 1 and 2 rib
Transverse processes of C1- st nd Medius and Posterior:
Scalene muscles 1 and 2 rib Laterally flexes and rotates cervical part of
C6 Anterior rami of cervical
vertebral column
nerves
 Lower cervical and
upper thoracic spines Upper and lower Raises and depresses ribs (Inspiration and
Serratus posterior muscles Intercostal nerves
 Upper lumbar and lower ribs expiration)
thoracic spines
 Lower 8 ribs
 Lumbar fascia Xiphoid process Lower 6 thoracic nerves Compresses abdominal contents
Abdominal wall muscles
 Iliac crest Linea alba iliohypogastric and iliolingual Assists in forced expiration, defecation,
(Anterior)
 Symphysis pubis symphysis pubis nerves parturition, and vomiting
 Pubic crest
33
RESPIRATORY TRACT
UPPER RESPIRATORY TRACT

THE NOSE
Consists of external nose and nasal cavity – both divided by nasal
septum
Cricoid Cartilage
 Divides respiratory tract into upper and lower respiratory tract
EXTERNAL NOSE
 Pyramidal shaped
 Composed of fibro-muscular and cartilaginous tissues
Nostrils
 2 elliptical orifices
 Separated from each other by the nasal septum
 Ala nasi – lateral margin, rounded and mobile
Bony framework
 Superior
 Nasal bones (2)
 Frontal processes of the maxillae
 Nasal part of the frontal bone
 Inferior
 Plates of hyaline cartilage
External Nose Arteries External Nose Nerves
External Nasal Cartilages (joined to a single septal cartilage)
Skin of the external nose Sensory innervation – Branches of the
 Minor Alar cartilages
 Ophthalmic artery (ICA) Trigeminal nerve
- Positioned on upper half of each nostril
 Dorsal Nasal Artery  Ophthalmic nerve
- Helps keep nostrils open – assists dilator nares
 Maxillary artery (ECA)  Infratrochlear branch
 Superior Nasal Cartilage
- At dorsum of the nose  External nasal branch
- Unites with nasal bone superiorly and inferior nasal Skin of the ala and  Maxillary nerve
cartilage below lower part of the septum  Infraorbital branch
 Inferior Nasal Cartilage  Facial artery (ECA)
- Continues to the anterior end of the nose  Lateral Nasal Artery
- Unites with septal cartilage between the anterior nares  Angular Artery
at dorsum of the nose
34
NASAL CAVITY
NASAL CAVITY
 Extends from the nostrils in front to the posterior nasal apertures
(choanae) - opens into the nasopharynx
Choanae – separates nasal cavity from nasopharynx
Nasal vestibule
 Area lying just inside the nostril (antero-inferior part)
 Lined with stratified squamous epithelium with sebaceous glands
 With course hair
 Limen nasi – boundary separating vestibule from nasal cavity
Kisselbach’s area (Little’s area)

 Anastomosis of 5 branches converging in the antero-inferior
quadrant of the nasal septum
 Receives blood supply from ICA and ECA
 Site where capillary breakdown frequently occur – common site of
epistaxis (nosebleed)
Nasal Septum
 Divides nasal cavity into left and right; rarely lies in midline
 Made up of:
1. Septal cartilage (Anterior)
2. Vertical (perpendicular) plate of the ethmoid (Superior)
3. Vomer (Inferior)
Walls of the Nasal Cavity

Roof – formed by:
 Anterior: Nasal and Frontal bones
 Middle: Cribriform plate of the ethmoid
(beneath the anterior cranial fossa)
 Posterior: Body of the Sphenoid bone
Floor - Hard palate
 Palatine process of the maxilla
 Horizontal plate of the palatine bone
Medial wall
 Nasal Septum (deviated to the right)
35
Lateral Wall
With 3 projections – Superior, Middle, Inferior nasal conchae
(conchae – no more mucosa; turbinate – with mucosa)
 Meatus – space below each concha
 Sphenoethmoidal Recess – small area above the
superior concha; receives the opening of the
sphenoid air sinus
Superior Meatus
 Below the superior concha
 Receives openings of the posterior ethmoid sinuses
Middle Meatus
 Below the middle concha
 Antrum of the Nose – widened area anterior to the middle
meatus
 With rounded swelling – Bulla ethmoidalis (Ethmoidal Bulla)
Bulla ethmoidalis – formed by the middle ethmoidal air sinus
(opens on its upper border); superior limit of hiatus semilunaris Nasal Cavity Arteries Nasal Cavity Nerves
 Hiatus semilunaris – curved opening below the bulla; receives External carotid artery  Olfactory nerves – ascend through
openings of anterior and middle ethmoidal cells  Maxillary artery the cribrifom plate of the ethmoid
Unciate process – anterior to the hiatus  Sphenopalatine artery – bone
Maxillary sinus opens into the middle meatus via the hiatus anastomoses with septal branch
 Infundibulum – funnel-shaped channel at anterior end of the of superior labial branch of the Sensory innervation – Trigeminal nerve
hiatus; continuous with the Frontal sinus facial artery in the vestibule  Ophthalmic nerve
 Drains: Maxillary, anterior and middle ethmoidal, frontal Minor blood supply:  Nasociliary branch
sinuses  Anterior and Posterior ethmoidal  Maxillary nerve
artery
Inferior Meatus  Greater palatine artery Autonomic innervation – Facial nerve
 Below inferior concha (parasympathetic) via pterygopalatine
 Receives opening of the lower end of the nasolacrimal duct ganglion
Hasner’s valve – mucosal of the inferior end of the duct Nasal Cavity Veins Nasal Cavity Lymph Drainage
protecting the upper part of the passage; prevents air from being Final venous drainage – Cavernous sinus  Lymph vessels draining the vestibule
blown from nose to lacrimal sac – ends in submandibular nodes
 Opthalmic vein + Pterygoid venous  Nasal cavity – drained by vessels
plexus  Cavernous sinus passing to upper deep cervical nodes
36
Mucous Membrane of the Nasal Cavity Frontal sinus (2)

 Olfactory area  Contained in frontal bone; separated by bony septum
- Superior, narrower  Triangular; extends upward above the medial end of the eyebrow and
- Olfactory mucous membrane lines area above the superior concha backward into medial part of the orbit roof
- Contains nerve endings projecting from cribriform plate –sensitive
to smell reception Sphenoidal sinus (2)
- Lined with delicate, yellowish mucosa  Lie in body of the sphenoid bone
 Respiratory area
- Lower part of nasal cavity Ethmoidal sinus
- Lined with respiratory mucous membrane  Anterior, middle, and posterior – contained in ethmoid bone between
- Large plexus of veins in submucous connective tissue is present nose and orbit; separated by a thin plate of bone (causes easy infection)
- Glandular and thick mucosa
Paranasal sinuses and site of drainage in the nose
PARANASAL SINUSES Sinus Drainage
 Cavities in the interior of the maxilla, frontal, sphenoid, and ethmoid bones Maxillary Middle meatus via hiatus semilunaris
 Lined with mucoperiosteum (pseudostratified columnar epithelium with Frontal Middle meatus via infundibulum
goblet cells); filled with air Sphenoidal Sphenoidal recess
 Communicate with nasal cavity through small apertures Ethmoidal
 Maxillary and sphenoidal sinuses – present rudimentarily at birth, fully  Anterior group  Infundibulum and into middle meatus
formed in adolescence  Middle group  Middle meatus on or above bulla ethmoidalis
 Functions:  Posterior group  Superior meatus
 Voice resonators, humidification
 Reduce weight of the skull
 Absorb shock
 Thermal insulation, increase olfactory membrane areas
Maxillary sinus
 Pyramidal
 Located within body of maxilla behind skin of the cheek
Roof: floor of the orbit
Floor: related to roots of the premolars and molar teeth
37
THE LARYNX
 Situated below the tongue and hyoid bone between great blood vessels of Epiglottis
the neck (ECA, IJV)  Leaf-shaped lamina of elastic cartilage
 Lies at level of C4-C6  Lies behind root of the tongue
 Opens above into laryngeal part of the pharynx  Stalk – attached to back of thyroid cartilage
Continuous below with the trachea  Sides – attached to arytenoid cartilages via aryepiglottic folds of mucous
 Covered anteriorly by infrahyoid strap muscles and membrane
laterally by the thyroid gland  Upper edge of the epiglottis – free
 Median glossoepiglottic fold –where covering of mucous membrane passes
Function: forward onto the posterior surface of the tongue
Provides protective sphincter at inlet of air passages  Vallecula – depression on each side of the fold
Responsible for voice production  Hypoepiglottic ligament – attaches epiglottis to hyoid bone
 Thyroepiglottic ligament – reinforces attachment of thin narrowed inferior
Cartilages of the Larynx end to the middle of the internal surface of the thyroid cartilage
Paired Unpaired
Arytenoid cartilage Thyroid cartilage Arytenoid cartilage
Corniculate cartilage Cricoid cartilage  2 arytenoid cartilages – small and pyramidal
Cuneiform cartilage Epiglottis  Located at back of larynx
 Articulate with upper border of the lamina of the cricoid cartilage
Thyroid cartilage  Apex – articulates with corniculate cartilage
 Largest of the laryngeal cartilages  Base – articulates with lamina of the cricoid cartilage
 With 2laminae of hyaline cartilage – meets in midline in the prominent  Vocal process – projects forward; gives attachment to vocal ligament
V angle (Adam’s apple)  Muscular process – projects laterally; gives attachment to posterior and
 Posterior border – extends upward into superior cornu, downward into lateral cricoarytenoid muscles
inferior cornu  Ary-epiglottic membrane – connects apices and sides of arytenoid cartilage
 On outer surface of each lamina – oblique line for muscle attachment to epiglottic and thyroid cartilages
Cricoid cartilage Corniculate cartilage

 Formed of hyaline cartilage  Conical-shaped
 Signet ring shape – broad plate behind and shallow arch in front  Articulate with arytenoid cartilages
 Lies below thyroid cartilage  Gives attachment to aryepiglottic folds
 Each side of the lateral surface – facet for articulation with inferior cornu
 Posterior – lamina on upper border with facet for articulation with Cuneiform cartilage
arytenoid cartilage  Rod-shaped
 Found in aryepiglottic folds –strengthen them
38
3. Quadrangular membrane
 Extends between epiglottis and arytenoid cartilages
 Thickened inferior margin – forms vestibular ligament
 Vestibular ligament – forms interior of vestibular folds
4. Cricothyroid ligament
MEMBRANES and LIGAMENTS of the larynx  Lower margin attached to upper border of the cricoid cartilage
 Superior margin – ascends on medial surface of thyroid cartilage
1. Thyrohyoid membrane  Upper free margin – composed of elastic tissue (conus elasticus) –
 Connects upper margin of thyroid cartilage to hyoid bone forms vocal ligament
 In midline – thickened to form median thyrohyoid ligament  Vocal ligament – forms interior of vocal folds;
 Median thyrohyoid ligament - pierced by superior laryngeal Anterior ends: attached to thyroid cartilage
vessels and internal laryngeal nerve Posterior ends: attached to vocal process of the arytenoid cartilage
2. Cricotracheal ligament
 Connects cricoid cartilage to 1 trachea ring
st
39
Laryngeal Folds
Vestibular fold (false vocal folds)
 Fixed fold on each side of the larynx
 Formed by mucouse membrane covering the
vestibular ligament
 Vascular – color pink
Vocal fold (True vocal fold)

 Mobile fold on each side of the larynx
 Concerned with voice production
 Formed by mucous membrane covering vocal
ligament – avascular, color white
 Moves with respiration
Rima glottidis (glottis)
 Gap between vocal folds
 Bounded anteriorly by vocal folds and posteriorly
by medial surface of the arytenoid cartilages
 Narrowest part of the larynx
Intrinsic Muscles of the Larynx

Muscles controlling the Laryngeal Inlet
Muscular process of arytenoid Apex of opposite arytenoid Narrows inlet – brings aryepiglottic
Oblique arytenoid
cartilage cartilage Recurrent laryngeal folds together
Lateral margin of epiglottis and nerve Widens inlet – pulls aryepiglottic
Thyroepiglottic Medial surface of thyroid cartilage
aryepiglottic fold folds apart
Muscles controlling the Movement of the Vocal Folds
External laryngeal
Cricothyroid Side of cricoid cartilage Lower border of inferior cornu Tenses vocal folds
nerve
Thyroarytenoid Inner surface of thyroid cartilage Arytenoid cartilage Relaxes vocal folds
Adducts vocal cords – rotates
Lateral cricoarytenoid Upper border of thyroid cartilage
Muscular process of arytenoid arytenoid cartilage
Recurrent laryngeal
cartilage Abducts vocal cords – rotates
Posterior cricoarytenoid Back of cricoid cartilage nerve
arytenoid cartilage
Back and medial surface of Back and medial surface of Closes posterior part of rima
Transverse arytenoid
arytenoid cartilage opposite arytenoid cartilage glottidis
40
41
MUSCLES of the larynx

Extrinsic Muscles
 Moves the larynx up and down during swallong
 Most muscles are attached to hyoid bone (attached to thyroid cartilage
via thyrohyoid membrane) – movement of hyoid is movement of larynx
Elevation
 Digastric, stylohyoid, mylohyoid, geniohyoid, stylopharyngeus,
salpingopharyngeus, palatopharyngeus muscles
Depression
 Sternothyroid, strenohyoid, omohyoid muscles
Intrinsic Muscles
2 muscles that modify laryngeal inlet
1. Oblique arytenoid muscle - narrows inlet
2. Thyroepiglottic muscle – widens inlet
5 muscles that move the vocal folds

1. Cricothroid muscle – tenses vocal folds
2. Thyroartenoid (vocalis) muscle – relaxes vocal folds
3. Lateral cricoarytenoid muscle – adducts vocal folds
4. Posterior cricoarytenoid muscle – abducts vocal folds
5. Transvers arytenoid muscle – approximates arytenoid cartilages
Movement of Vocal folds

Voice production
 Depends on arytenoid cartilage movement
 Intermittent release of expired air between adducted vocal folds – results
 Stretched by contraction of cricothyroid muscle
to vibration and sound production
 Slackened by contraction of vocalis
 Frequency or pitch – determined by changes in length and tension of
Rima glottidis
vocal ligaments
 Opens - contraction of posterior cricoarytenoid (rotates arytenoid
 Quality of voice – depends on resonators above the larynx; controlled by
cartilage, abducts vocal process; elastic tissue keeps arytenoid apart)
muscles of soft palate, tongue, floor of mouth, cheeks, lips, jaws
 Closes – contraction of lateral cricoarytenoid (rotates arytenoid
 Normal speech – depends on modification of sound into recognizable
cartilage, adducts vocal process)
consonants and vowels; intermittent release of expired air between
adducted volds
During quiet inspiration – vocal folds abducted, Rima glottidis - traingular
In expiration – vocal folds adducted  Singing – prolonged release of expired air between adducted vocal folds
In deep inhalation – Rima glottidis – diamond shaped (due to maximal rotation)
42
Larynx Arteries Larynx Veins

 Superior Laryngeal artery – upper half of the  Superior Laryngeal Vein – Drains into
larynx; branch of superior thyroid artery superior thyroid vein
 Inferior Laryngeal artery - lower half of the  Inferior Laryngeal vein - drains into
larynx; branch of the inferior thyroid artery inferior thyroid vein
Larynx Lymphatic Drainage

 Drain into the deep cervical group of nodes
Larynx Nerve Supply

Sensory nerves
 Internal laryngeal branch of the superior laryngeal branch of the vagus – above the vocal
cords
 Recurrent laryngeal nerve – below the level of the vocal cords
Motor nerves
 Recurrent laryngeal nerve – all intrinsic muscles
 External laryngeal nerve of the superior laryngeal branch of the vagus – cricothyroid muscle
43
LOWER RESPIRATORY TRACT

TRACHEA
Commencement: Lower border of the cricoid cartilage at level of C6
Termination: At carina – divides into right and left principal bronchus at level of sternal angle (opposite T4 and T5)
 Mobile cartilaginuous and membranous tube
 Fibroelastic tube, kept patent by U-shaped cartilaginous rings of (15-20) hyaline cartilages
 Posterior free ends - connected by trachealis muscle (smooth muscle)
 Mucous membrane – with pseudostratified ciliated columnar epithelium
with goblet cells and tubular mucous glands
 At root of the neck – may be palpated in midline in suprasternal notch
Length: 4 ½ inch (11.25 cm)

Diameter: 1 inch (2.5 cm)
Relations in the Neck

 Anterior: skin, fascia, isthmus of the thyroid gland (in 2 to 4 rings), inferior
nd th
thyroid vein, jugular arch, thyroidea ima artery, sternothyroid

and sternohyoid muscles
 Posterior: Right and Left recurrent laryngeal nerves, esophagus
 Lateral: Lobes of the thyroid gland, carotid sheath and contents
(vagus nerve, IJV, CCA, ICA)
Relations in superior mediastinum of the thorax

 Anterior: Sternum, thymus, left brachiocephalic vein, origins of the
brachiocephalic and left common carotid arteries, arch of the aorta
 Posterior: Esophagus, left recurrent laryngeal nerve
 Right side: Azygos vein, right vagus nerve, pleura
 Left side: Arch of the aorta, left common carotid, left subclavian artery, pleura
Nerve Supply Blood Supply Lymph Drainage

Sensory nerve supply  Inferior thyroid  Pretracheal and
 Vagus nerve artery - upper 2/3 paratracheal
 Recurrent laryngeal  Bronchial artery - lymphnodes
nerve lower third  Deep cervical nodes
Sympathetic nerves
44
PLEURA
Pleurae and lungs lie on either side of the mediastinum – with 2 parts: 4. Diaphragmatic pleura
1. Parietal layer  Covers thoracic surface of the diaphragm
 Lines thoracic wall; Covers thoracic surface of the diaphragm  In quiet respiration – costal and diaphragmatic pleura – side-by-side to
and lateral aspect of the mediastinum each other below lower border of the lung
 Extends into the root of the neck – lines undersurface of  In deep inspiration – margins of the base of the lung descend – costal
suprapleural membrane at thoracic outlet and diaphragmatic pleurae separate
2. Visceral layer 5. Mediastinal pleura
 Covers outer surfaces of the lungs  Covers and forms lateral boundary of the mediastinum
 Extends into depths of interlobar fissures  At lung hilum – reflected as a cuff around the vessels and bronchi;
becomes continuous with visceral pleura
2 layers become continuous with one via a cuff of pleura - surrounds  Lung lies free except at hilum – attached to blood vessels and
structures entering and leaving the lung at the hilum bronchi (constitutes lung root)
Pleural cavity (pleural space) Full inspiration – lungs expand and fill pleural cavity
 Separates visceral and parietal pleura Quiet inspiration – do not fully occupy pleural cavities at 4 sites:
 Contains small amount of tissue fluid – pleural fluid – covers surfaces Right and left costodiaphragmatic recess
of the pleura as a thin film; permits 2 layers to move on each other  Lower area of the pleural cavity into which lung expands on inspiration
with minimum friction  Slit-like spaces between costal and diaphragmatic parietal pleurae
 During inspiration – lower margins of the lungs descend into the recesses
PARIETAL PLEURA ACCORDING TO REGION  During expiration – lower margins of lungs ascend; costal and diaphragmatic
come together
1. Cervical pleura
 Extends up into the neck (covers lung apex) Right and left costomediastinal recess
 Lines under surface of the suprapleural membrane (Sibson’s Fascia)  Situated along anterior margins of the pleura
 Reaches 1 to 1.5 inches (2.5 to 4 cm) above the medial third of the  Slit-like spaces between costal and mediastinal parietal pleurae
clavicle  During inspiration and expiration – apex of the lung slides in and out of the
2. Costal pleura recess
 Lines inner surface of the ribs, costal cartilages, intercostal spaces,
sides of the vertebral bodies, and back of sternum Nerve Supply of the Pleura
th th th
3. Diaphragmatic pleura (lower border s – 8 , 10 , 12 ribs)
Parietal pleura – sensitive to pain, temperature, Visceral pleura – sensitive
 Covers thoracic surface of the diaphragm touch, and pressure to stretch; insensitive to
 In quiet respiration – costal and diaphragmatic pleura – side-by-side  Costal pleura – intercostal nerves other sensations
to each other below lower border of the lung  Autonomic supply
 Mediastinal pleura – phrenic nerve
 In deep inspiration – margins of the base of the lung descend – costal
 Diaphragmatic pleura – phrenic nerve (domes) from pulmonary plexus
and diaphragmatic pleurae separate
& lower 6 intercostal nerves (periphery)
45
BRONCHI LUNGS
Right and Left principal (primary) bronchi Gross Features
 From the bifurcation of the trachea behind the arch of the aorta  Soft and spongy very elastic
 Divided dichotomously – gives rise to terminal bronchioles terminating  Lies on each side of the mediastinum – separated from each other by the
to respiratory bronchioles heart and great vessels
 Respiratory bronchioles divide into 2 -11 alveolar ducts that enter  Covered with visceral pleural
alveolar sacs  Suspended free in pleural cavity – attached to mediastinum only by its root
RIGHT BRONCHUS LEFT BRONCHUS Lung surfaces

 Wider (1.3 cm)  Narrower (1.1 cm)  Blunt apex – projects upwards (1 inch; 2.5 cm) above the clavicle
 Shorter (1 inch; 2.5 cm)  Longer (2 inches, 5 cm)  Concave base – sits on diaphragm
 More vertical  More horizontal  Convex costal surface – due to concave chest wall
 With eparietal and hyparietal stem  With hyparietal stem only  Concave mediastinal surface - molded to the pericardium and
 Before entering right lung hilum  On entering left lung hilum – mediastinal structures
– gives of superior lobar bronchus divides into superior and  At middle lung surface – with hilum – depression in which bronchi,
 On entering hilum – divides into inferior lobar bronchus vessels, and nerves forming the root enter and leave the lung
middle and inferior lobar bronchus  Passes to left below arch of the
 Azygos vein arches over it aorta and in front of the Lung Borders
esophagus  Apex of the Lung
 Mapped out by drawing a convex upward from sternoclavicular joint
to point 1 inch (2.5cm) above junction of medial and intermediate
thirds of the clavicle
 Anterior border of the right lung
 Begins behind sternoclavicular joint
 Runs downward almost reaching midline behind sternal angle
 Continues downward until it reaches xiphisternal joint
 Anterior border of the left lung
 Similar course until 4 costal cartilage – deviates laterally forming the
th
cardiac notch (produced by the heart displacing the left lung)

 Lower border of the lung
 Crosses 6 rib in midclavicular line
th
 8 rib in midaxillary line

th
 10 rib adjacent to vertebral column posteriorly

 Posterior border of the lung
 Extends downwards from spinous process of C7 to T10
 Lies 1.5 inches (4cm) from the midline
46
47
RIGHT LUNG LEFT LUNG

 Slightly larger  Slightly smaller
 Divided into 3 lobes by: upper, middle,  Divided into 2 lobes: upper and
and lower lobes lower lobes
 With oblique and horizontal fissures  No horizontal fissures
OBLIQUE FISSURE HORIZONTAL FISSURE

 Found in both lungs  Only in RIGHT lung
 Runs from inferior border upward  Divides superior lobe producing
and backward across the medial and middle lobe
costal surfaces  Runs horizontally across costal
 Cuts posterior border about 2.5
th
surface at level of the 4 costal
inches (6.25 cm) below the apex cartilage – meets oblique fissure
 Can be indicated by drawing a line in midaxillary line
from root of spine of the scapula  Middle lobe – bounded by
obliquely downward, laterally, and horizontal and oblique fissures
th
anteriorly – follows course of 6 rib
Lung Blood Supply

Bronchial arteries Pulmonary arteries
 Branch of the descending aorta  Carries deoxygenated blood to
 Supplies connective tissue of the the alveoli
lung, visceral pleura, bronchi Pulmonary veins
 Drain into azygos (right) and  Carries oxygenated blood
hemiazygos (left) veins  Empties into left atrium
Lung Nerve Supply

At root of each lung – with pulmonary Sympathetic efferent fibers
plexus - composed of efferent and  Produces bronchodilation and
afferent autonomic fibers vasoconstriction
 From branches of sympathetic
trunk Parasympathetic efferent fibers
 Receives parasympathetic fibers  Produces bronchoconstriction,
from vagus nerve vasodilation, increased glandular
secretion
48
Lung Lymph Drainage

Originate in superficial and deep plexuses Deep plexus
Not present in alveolar walls  Travels along bronchi and pulmonary vessels toward the hilum
 Passes through pulmonary (intrapulmonary) nodes – located within lung substance
Superficial (subpleural) plexus  Lymph then enters bronchopulmonary nodes in lung hilum
 Lies beneath visceral pleura
 Drains over surface of the lung toward the hilum – lymph All lymph nodes drains into trancheobronchial nodes then to
vessels enter bronchopulmonary (hilar) nodes branchomediastinal lymph trunks then to subclavian vein
49
BRONCHOPULMONARY SEGMENT
Bronchopulmonary segments
 Anatomic, functional, surgical units of the lungs
 Each lobar (secondary) bronchus – gives off a segmental (tertiary) bronchi
 Each segmental bronchi – with functionally independent bronchopulmonary
segment surrounded by a connective tissue
Components of each segment

 Pulmonary artery
 Lymphatic vessels
 Autonomic nerve supply
 Respiratory bronchiole, alveolar ducts, alveolar sacs
*Pulmonary veins - run in the connective tissue between adjacent bronchopulmonary
segments (lies outside the segment)
Upon entering the bronchopulmonary segment

1. Segmental bronchus divides repeatedly
2. As bronchi becomes smaller – U-shaped cartilages gets replaced by irregular
plates (becomes smaller and fewer in number)
3. Smallest bronchi gives rise to bronchioles (<1mm wide) – possess no cartilage in
walls; lined with columnar ciliated epithelium
Submucosa – with circularly arranged smooth muscle fibers
4. Bronchioles divide into terminal bronchioles (respiratory bronchioles; 0.5 mm
wide) – with outpouchings from walls; gaseous exchange occur in outpouching
walls
5. Respiratory bronchioles branches into alveolar ducts – lead into tubular
passages with alveolar sacs
6. Alveolar sacs – with alveoli surrounded by blood capillaries for gas exchange
Main characteristics of the Bronchoplumonary segment ROOT OF THE LUNG

 Subdivsiion of a lung lobe  Formed of structures entering or leaving the lung
 Pyramid shaped, apex towards lung root  Made of bronchi, pulmonary artery and veins, lymph vessels,
 Surrounded by connective tissue bronchial vessels
 With segmental bronchus, segmental artery, lymph vessels, autonomic nerves  Surrounded by tubular sheath of pleura – joins mediastinal parietal
 Segmental vein lies in connective tissue pleura to visceral pleura
 Diseased segment can be removed surgically
50
51
Bronchopulmonary Segments
Right Lung
 Superior lobe
1
1. Apical (S )
2
2. Posterior (S )
3
3. Anterior (S )
 Middle lobe
4
1. Lateral (S )
5
2. Medial (S )
 Inferior lobe
6
1. Superior (S )
7
2. Medial basal (S )
8
3. Anterior basal (S )
9
4. Lateral basal (S )
10
5. Posterior basal (S )
Left Lung
 Superior lobe
1+2
1. Apico-Posterio(S )
3
2. Anterior (S )
4
3. Superior lingular (S )
5
4. Inferior lingular (S )
 Inferior lobe
6
1. Superior (S )
7
2. Medial basal (S )
8
3. Anterior basal (S )
9
4. Lateral basal (S )
10
5. Posterior basal (S )
52
53
BONES
54
55
56
57
58

Forearm

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Forearm

Uploaded by

Copyright:

Available Formats

Anatomy 1C Joshua Montelibano 2nd shift 2015-2016

FOREARM & HAND

Sensory Nerve Supply

Median Cubital vein

Fascial Compartments of the Forearm

Forearm – enclosed in a sheath of deep fascia

Flexor and Extensor Retinacula

CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT

 Blood supply to the muscles: Ulnar and Radial arteries

Muscles of the Anterior Fascial Compartment of the Forearm

Superficial group Intermediate group

Deep group Arteries of the anterior forearm

Arteries of the Anterior Fascial Compartment of the Forearm

Branches in the Forearm: Branches

Nerves of Anterior Fascial Compartment of the Forearm

CONTENTS OF THE LATERAL FASCIAL COMPARTMENT

Muscles of the Lateral Fascial Compartment of the Forearm

CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT

Arteries of the Posterior Fascial Compartment of the Forearm

Anterior and Posterior Interosseous arteries

Deep branch of the Radial Nerve

Muscles of the Posterior Fascial Compartment of the Forearm

Superficial group Deep group

Carpal tunnel Tunnels

REGION ON THE WRIST

Structures that pass beneath the flexor retinaculum (medial to lateral)

PALM OF THE HAND

Apex of the palmar aponeurosis

Base of the aponeurosis – divides at the bases of the fingers

Medial and lateral borders of the palmar aponeurosis

Fibrous Flexor Sheaths Synovial Flexor Sheaths

Vincula longa and Brevia

INSERTION OF THE LONG FLEXOR TENDONS

SMALL MUSCLES OF THE HAND

Short muscles of the little finger (Hypothenar muscles)

Small Muscles of the Hand

metacarpal thumb, index, ring, and

Arteries of the Palm

Deep branch of the ulnar artery Branches:

Lymph Drainage of the Palm

From the medial side

From the lateral side

Nerves of the Palm

Muscular branch Superficial branch of the Ulnar nerve

hamate, passes lateral in concavity of deep palmar arch

lumbricals, palmar and dorsal interossei, heads of the adductor pollicis

Palmar cutaneous branch

DORSUM OF THE HAND

Sensory Nerve Supply

INSERTION OF THE LONG FLEXOR TENDONS

Radial Artery on the Dorsum of the Hand

Branches – take part in anastomosis around the wrist joint

THORACIC WALL BOUNDARIES

Posterior: Thoracic part of the vertebral column

BONES FORMING THE THORAX

 Upper part of the 2 costal cartilages on each side

2. Body of the sternum

Sternal Angle (Angle of Louis)

 Angle lies opposite the intervertebral disc – between 4 and 5 thoracic

vertebrae, T4 & T5)

 Clinical importance – close relationship to lower nerves of the brachial plexus

 Contribute to elasticity and mobility of thoracic walls

Manubriosternal Cartilaginous joint between manubrium and body of