Upper Limb

• Anterior: Abductor pollicis longus & Extensor Pollicis Brevis
• Posterior: Extensor Pollicis Longus
• Radial Artery courses thru the box & passes to the Dorsum of the Hand
• Superifcial branch of the Radial Nerve crosses the tendon of box and enters the Hand

• Flexion of the PP (proximal phalanges) @ MCP
• Extension of MP & DP ( middle & distal phalanges) @ IPs ( PIP & DIP)
• Muscles are:
• Lumbricals - small hand
• Dorsi Interossei
• Extensor digitorum

• is a strong CT structure that arches over the tendons flexing the digits
• there are 5 digital sheaths
• attach to the margins of the phalanges
• each form tunnels for 1 FDS tendon & 1 FDP tendon (except Thumb)
• function as Retinacula

• are Loose CT bursae located wherever tendon are retained by retinacula
• located btwn the tendons to the 5 digits & respective fibrous digital sheath
• located deep to the flexor & extensor retinacula

• content of the carpal canal
• 9 : 4 FDS tendons + 4 FDP tendons + 1 tendon of Flexor Pollicis Longus
• 2: Ulnar bursa (synovial sheath surround 8 tendons) + Radial Bursa ( synovial sheath surroud Flexor Pollicis Longus)
• 1: Median nerve

• tranverse fibrous structure anterior to the carpals
• Lateral attachment: Scaphoid & Trapezium
• Medial attachment: Pisoform, Triangular & Hook of Hamate

• transverse fibrous structure located on posterior surface of the distal FA (forearm)
• Lateral attachment: Radius
• Medial attachment: Ulna & triangular
• Deep aspect: septa is attached to ridges on posterior surface of the Radius & ulna - 6 compartments
• 1st - abductor pollicis longus & extensor pollicis brevis
• Radial nerve
• 3rd - extensor pollicis longus
• 2nd- extensor carpi radialis longus & extensor carpi radialis brevis
• 4th- extensor digitorum & extensor indicis
• 5th- extensor digiti minimi
• 6th- extensor carpi ulnaris

• expanded tendons of insertion of extensor digitorum
• located on the posterior surfance of the PP & MP of digits 2-5
• each tendon splits into 3 bands
• 1- central band : attaches to the posterior surface of base of MP
• 2- collateral bands: attach to the posterior surface of base of DP
• provides aponeurotic / tendinous fusion of digital extensors, lumbricals, & interossei muscles

• Superior: Teres Minor ( Subscapularis : anteriorly
• Inferior: Teres major
• Lateral: Long head of Tricep
• C: Circumflex scapular artery

• Boundaries
• Latissimus dorsi
• Trapezius
• Medial border of Scapula
• Floor
• Rhomboid major
• Chest wall

• Superior: Tere major
• Medial: Long head of Tricep
• Lateral: Lateral head of Tricep
• C: Radial Nerve Profunda brachial artery

• Superior: Teres minor ( subscapularis anteriorly )
• Lateral: Sugerical Neck of humerous
• Inferior: Teres major
• Medial: Long Head of Tricep
• C: Axillary Nerve Posterior circumflex humeral artery

• Trapezius
• Lat. Dorsi
• Levator Scapulae
• rhomboid major & minor

• Deltoid
• Supraspinatus
• infraspinatus
• teres major & minor
• subscapularis

• Pectoralis major & minor
• Subclavius
• Serratus Anterior

• clavicle
• scapula
• proximal humerus

• Deltoid
• LAS
• lateral 1/3 clavicle
• Acromion
• Spine of Scapula

• breast become less movable
• contraction of Pmajor breast will move superiorly

dimpling of the skin similar to appearance of an organe peel

route for spread of cancer cells from the breast to the vertebrae & then to the skull and brain

covers the brachial plexus

these vessels will anatomose across the midline so if cancer develop in one breast it can develop in the other

coraococlavicular ligament

• fibrous capsule attached at their periphery to the joint capsule
• separate two cavities

• costoclavicular ligament -type of fibrous joint
• it is the only attachment of the UL with the axial skeleton

• princeps pollicis a-principal thumb a.
• radialis idicis -lateral side of the index finger
• descends btwn 1st dorsal interosseous muscle & oblique head of the adductor p. near the base of the 1st phalanx
• supplies skin & subcut tissue of thumb
• Superficial palmar branch-from the rad a. prox wrist, thru thenar eminence which it supplies

• Recurrent branch of the median nerve -Thenar compartment
• Ulna nerve -hypothenar muscles except Palamis brevis supplied by superifical ulnar n.

special folds of CT of long flexor tendons in the phalangeal region supplied by blood vessels, which these tendons pass from the periosteum of the phalanges w/n

• defined as any area btwn fascial layers of a compartment
• may contain tissue fluid
• spaces are posterior to the radial & ulnar bursa & adductor pollicis muscle
• separated by oblique palmar septum - 3 MC to Palmar Ap
• Lat palmar space lat to oblique septum
• Med palmar space med to oblique septum
• infection to spaces can ONLY move proximally