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medical notes for medical students

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medical notes for medical students

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GROSS ANATOMY
Lecture Syllabus 2008
Unit #4: Upper and Lower Limbs




ANAT 6010 - Gross Anatomy
Department of Neurobiology and Anatomy
University of Utah School of Medicine


G24- Upper Limb Overview, Shoulder, and Axilla
G25- Arm and Elbow
G26- Forearm and Wrist
G27- Hand
G28- Hip and Posterior Compartment of the Thigh
G29- Anterior and Medial Thigh
G30- Leg and Knee
G31- Foot and Ankle


1

,G24: Upper Limb Overview and Shoulder and Axilla

At the end of this lecture, students should be able to master the following:
1) Upper limb overview
a) Cutaneous innervation of the upper limb
• Compare and contrast the dermatomes and cutaneous fields of the upper limb
• Dermatome: area of skin supplied by a single spinal cord level
• Cutaneous field: area of skin supplies by a single peripheral nerve branch ( multilple spinal cord lev-
els)




Dermatomes Cutaneous fields




2

, b) Major vessels
i) Superficial veins
Describe the location and direction of flow through the major superficial veins of the upper limb
- Cephalic

- Basilic

- Median cubital

- Dorsal veins of the hands




ii) Arteries
Trace the pathway and distribution of the principle arteries through the upper limb
- Subclavian
- Axillary
- Brachial
- Radial and ulnar
- Superficial and deep palmar arches




2) Actions of the Upper Limb
a) Describe the structure/action(s) of the following:
• Pectoral girdle (scapula and clavicle)
• Scapula- protraction, retraction, elevation, depression, upward rotation, downward rotation
• Glenohumeral joint- flexion, extension, abduction, adduction, medial rotation, lateral rotation
• Humeroulnar (elbow) joint- flexion, extension
• Proximal and distal radioulnar joints- supnation, pronation
• Wrist joint- flexion, extension, abduction (radial deviation), adduction (ulnar deviation)




3

, 3) Fascia of the Upper Limb
a) Describe the fascial organization of the upper limb:
Between the skin and bone are two fascial layers in the upper limb termed the superficial and deep fascia:

- Superficial fascia: located deep to the skin and contains superficial veins (cephalic, median cubital, ba-
silic), cutaneous nerves, superficial lymphatics and fat.

- Deep fascia: located deep to the superficial fascia and contains muscles, nerves, vessels and deep lym-
phatics. The deep fascia is a continuation of the deep fascia covering the deltoid and pectoralis major
muscles. As the deep fascia extends distally, intermuscular septa extend to the bone dividing the arm and
forearm into anterior and posterior compartments in the arm and forearm. Each compartment contains
muscles that perform similar actions and have common innervation and attachments.


Arm Forearm
- Anterior: Flexors, musculocutaneus nerve - Anterior: Flexors, medial epicondyle, median
- Posterior: Extensors, radial nerve and ulnar nerves
- Posterior: Extensors, lateral epicondyle,
radial nerve




4) Skeletal muscle basics
Skeletal muscles in the limbs:
- attach to at least two separate bones (origin and insertion)
- act on the joint(s) that the muscle crosses between the attachments
- contract when a muscle fiber generates tension through the actin and myosin cross-bridging cycling

The term “contraction” implies a shortening or reduction, however, in reality contraction refers to the genera-
tion of tension by muscle fibers with the help of motor neurons.

While under tension, the muscle may shorten, remain the same or lengthen (muscle cells do not push)
- Concentric contraction: muscle shortens (biceps curl)
- Isometric contraction: no change in length of muscle (muscles of the hand and forearm while gripping
an object)
- Eccentric contraction: muscle lengthens while under pressure due to an opposing force being greater
than the force generated by the muscle (setting an object down gently)




4

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