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* INNERVATION OF THE SHOULDER REGION: Sensory information -Branch of the "axillary nerve" of the (braquial plexsus)This is a Superior lateral cutaneous nerve of the arm Skin over the deltoid Note: Axillary nerve (Deltoid) * Motor innervation is Almost entirely via the brachial plexus Brachial plexus : upper extremities The most extensive arterial anastomosis is at __ ______ _____ explain why? (the scapular region) provides a collateral circulation, so if one vessel is blocked or damaged, many others can provide blood to the region This anastomosis helps preserve the upper limb in the event of injury Blood is brought to the scapular region by a network of arteries which form the ________ ___________ scapular anastamosis (join together) The extensive arterial anastomosis at the scapular region provides a collateral circulation, so if one vessel is blocked or damaged, many others can provide blood to the region This anastomosis helps preserve the upper limb in the event of injury 3 Openings in the scapular region _Triangular space (Circumflex scapular artery _Quadrangular space _Triangle of auscultation (in the back there is no muscle and no bone) Contain important neurovascular structures Or are of clinical relevance Why scapular fracture or sternum fracture are highly significant injuries? What is between the scapula and the sternum? 1) Scapular fractures are not common An injury is significant because of the amount of force needed. If we break that area we have to worry about the heart, lungs and great vessels. The shoulder joint complex is composed of three joints. Name them 1) Acromioclavicular 2) Glenohumoral 3) Sternoclavicular The rotator cuff consists of four muscles, sometimes referred to as the SItS muscle.Rotate the humerus to enable actions such as throwing a baseball. Name them four muscles: Supraspinatous, infraspinatus, Tere major, and subscapularis. 1) The (supraspinatous) & infraspinatous insert on the greater tubercle of the humerus. 2) The teres major & subscapularis insert on the lesser tubercle of the humerus. 3) The rotator cuff muscles rotate the humerus to enable actions such as throwing a baseball. 4) The teres major, which is just inferior to the rotator cuff muscles, helps form the posterior axillary fold Upper limb is attached to the ____ ____ and articulates at the _____ ____ Upper limb is attached to the pectoral girdle (scapula + clavicle) Articulates at the acromioclavicular joint Only bony contact between the pectoral girdle & the upper extremity All other attachments are muscular sternoclavicular join Axilla contains: Brachial plexus Axillary artery Axillary vein (come from the arm) Lymph nodes (mastectomy) Note: Axilla is a fat filled pyramid shaped region between the chest wall and the upper extremity. This area is a viaduct for neurovascular structures to pass to and from the neck. UPPER EXTREMITY ( Musculoskeletal) What is at the anterior compartment? Primarily flexors muscles UPPER EXTREMITY (Musculoskeletal) What is at the posterior compartment? Primarily extensors muscle (triceps extensors) Function of Deep fascia Primarily provide support The nerve supply to the upper extremity is derived from the ___ ___ brachial plexus UPPER EXTREMITY: which is the main supply arteries in the brachial plexus? Axillary artery (main supply) Superior thoracic Upper chest & ribs Thoraco-acromial Shoulder & pectoral regions Lateral thoracic Breast & lateral chest Subscapular Scapular region What kind of injury can effect the axillary artery (most commun)? Shoulder dislocations Axillary vein becomes the ______ at the lateral border of rib 1 Becomes the subclavian at the lateral border of rib 1 Anterior circumflex humeral and Posterior circumflex humeral Injuries must commun Tend to be caused by a high energy impact/trauma Can occur at any area along the shaft of the humerus ANTERIOR CIRCUMFLEX HUMERAL: upper arm, shoulder and Glenohumeral Joint (damaged by a Fx in the proximal humerus) Main support of the arm Humerus Only osseous support Nerves of Forearm Anterior Region (MEDIAN NERVE C6-T1) main nerve to anterior forearm. It branches into the anterior interosseus nerve, which supply the 3 deep muscles. Median nerve goes through the carpal tunnel and supplies muscles and skin of the medial part of the hand. Carpal Tunnel is ENTRAPMENT of the median nerve. Anterior Region o (MEDIAN NERVE C6-T1) main nerve to anterior forearm. It branches into the anterior interosseus nerve, which supply the 3 deep muscles. Median nerve goes through the carpal tunnel and supplies muscles and skin of the medial part of the hand. Carpal Tunnel syndrome Carpal Tunnel is ENTRAPMENT of the median nerve.  Innervated Pronator teres, Flexor Carpi Radialis, and palmaris longus. MEDIAN EPICONDYLITIS (Golfer's Elbow) Inflammatory condition involving the medial epicondyle through its origin of attachment of the forearm flexors by the common flexor tendon LATERAL EPICONDYLITIS (Tennis Elbow) Inflammatory condition involving the common extensor tendon of the lateral elbow. The Treatment is RICE method (Rest, Ice, Compression, Elevation) Wrist 8 CARPAL bones are contained within a single joint Capsule. Has no lymph nodes and * (does not INNERVATE):  Anterior Interosseus nerve (Branch of media nerve)  Posterior Interosseus Nerve (Branch of radial nerve)  Dorsal & Deep Branches of Ulnar nerve _______ _______ Conveys sensation to Skin over medial dorsal region, but it DOES NOT innervate any hand muscles. It innervates al the muscles in the posterior forearm. o Its *(crucial to have a good neurovascular exam) when you have a hand injury. Radial nerve