musculocutaneous nerve * supplies the bicep brachii, brachialis muscle, coracobrachialis ( from the lateral cord of the brachial plexus)

terminal branch  is lateral cutaneous nerve of forearm

a long head in the bicipital groove across shoulder joint to supraglenoid tubercle

short head to the coracoid prcess

biceps brachii

( important supinator of forearm when elbow is flexed )

triangular region anterior  and distal to elbow joint

*  location of nerves and blood vessels

median nerve and brachial artery

• biciptal aponeurosis protects the deeper structures

ulnar arteries gives off a common interosseos artery that divide into anterior and posterior interosseos arteries

• ** occasionally the radial an ulnar arteries aris more proximall and one of them superficial to biceps tendo n possible danger in blood drawing

• deep branches run through the supinator in the floor of the cubital fossa and become posterior interosseous nerve  supplied posterior comp.
• superficial is cutaneous and continues toward the hand under cover of the brachioradialis muscle ( supply the back of the hand)

• from lateral to medial
• pronator teres
• flexor carpi radialis
• palmaris longus
• flexor carpi ulnaris

• inserts on the radius and draws the radius medially over the ulna causes pronatio
• attached to the medial epicondyle of humerus and coronoid process of ulna

attaches to the pisiform and the hook of the hamate with an extension to the 5th metacarpal

supplied by the ulnar nerve

flexes the wrist with the flexor carpi radialis

flexor carpi radialis and ulnaris

pronator teres

palmaris longus

layer 2 of the anterior compartment of the forearm

attaches to the middle phalanx of digits 2-5 and flexes proximal interphalangeal joints  ( median nerves lies deep to this and supplies this )

flexor digitorum profundus

flexor pollicis longus

• from ulna and interosseous membrane
• inserts into distal phalanx and flexes  distal interphalangeal joint of digits 2-5
• ulnar 1/2 supplied by ulnar nerve
• radial 1/2  supplied by deep branch of the median nerve which is the anterior interosseous nerve

• from radius and interosseous membrane
• attached to the distal phalanx of the thumb and flexes the interphalangeal joint

2 phalanges

1 IP joint

pronator quadratus

supplied by the anterior interosseous nerve

• layer 4 of the ant comp. of the forearm
• square pronator
• attached to radius and ulnar at their distal ends ( deep to flexor digitorum profundus ) 

• radial artery run distally with superficial branch of the radial nerve ( under brachioradialis )
• ulnar -->  gives rise to common interosseous artery ( under flexor carpi ulnaris )

2 layers : superficial and deep

superficial : 3 lateal muscles, 3 medial muscle ,and 3 muscles that "crop out " betwen them

brachioradialis

2 wrist extensors ( extensor carpi radialis longus and extensor carpi radialis brevis )

this is an exception* , supplied by the radial nerve ,  but is on the anterior side of the forearm and is a flexor of the elbow.

• attached to the distal styloid of the radius and thus doesnt cross the wrist joint
• assists in supination and pronation to the "working position" of the forearm ( 1/2 pronated with elbow partially flexed )

1) extensor carpi longus ( superficial to brevis and supplied by the radial nerve b4 superficial and deep branches)

2) extensor carpi brevis

1) arises from the lateral epicondyle of the humerus and attaches to the base of the 2nd metacarpal (lateral)

2) arises from the common extensor origin and attaches to the base of the 3rd metacarpal (medial)

simultaneous contraction of the wrist extensor and flexors on one side bends the hand toward the side

• "power grip" - ulnar adduction combined with supination for twisting against resistance
• "precision grip"- thumb and index finger

extensors pollicis longus

extensor pollicis brevis

abductor pollicis longus

skin of the forearm is supplied by cutaneous nerve

lateral , medial , and posterior cutaneous nerve are branches from the cords of the brachial plexus

 the supinator is wrapped around the proximal end of the radius

• contractu causes supination ( has two heads  , assist ulnar head in supination )
• deep branch of radial nerve supplies this muscle

broken wrist

• Colles fracture - both radius and ulnar are fractured

flexor retinaculum

• attaches laterally to the scaphoid and medially to pisiform

flexor retinaculum and carpal bones

( tendons of the flexor muscles for the digits and the thumb and median nerve run through the tunnel )

abductor pollicis brevis

- assist in abdcut the thumb away from the palm ( attached to the proximal phalanx)

• abductor digiti minimi
• flexor digiti minimi brevis
• opponens digiti minimi

• medial to hypothenar ( ht)   -abducts little finger
• lateral to ht - flexor of MP joint of little finger
• deep to both attached to the 5th metacarpal

these muscles are supplied by the ulnar nerve

True ( the tendons of the profundus insert on the distal phalanz and flex the distal IP joint

superficialis insert at the mid phalanz and flex the proximal IP joint

lumbrical muscles

• flex the MP joint and extend the IP joint
• lumbricals of 2 and 3 digits are median nerve
• lumbricals of 4 nd 5  supplied by ulnar

palmar and dorsal interossei ( between the bones)

• located between the metacarpals and controls MP joint
• PAD palmar adducts  (3)  2,4, 5 digits -of middle finger
• DAB dorsal abducts (4)  for 2, 3,4  of middle finger

superficial - cutaneous to the little finger and medial side of the ring finger

deep - passes laterally between the pisiform bone and the hook of hamate in Guyon's canal ( where is may be compressed), continues laterally and supplies hypothenar eminence , interossei and adductor pollicis

above + ant - mandible

above  + lateral - mastoid and styloid process

above + post.- occiptal bone , external occiptal protuberance

below- sternum and clavicle

spinous process and transverse process of cervical vertebra

carotid arteries , jugular veins, vertebral arteries

thyroid and parathyroid

surrounds the carotid artery , jugular vein , and vagus nerve

*** vagus  and jugular vein leaves the skull via the jugular foramen

has no body, but lateral masses and anterior and posterior arches facts that articulate with axis( anterior arch)  , articulate with the occiptal condyles ( flexion-exension)

• movements of the head are controlled by subocciptal triangle 

posterior back muscles stabilize and extend the vertebral column

three columns  ( transverse and spinous process , angles of the ribs )

spinalis and semispinalis capitis attached to spinous process

longissimus - attached to transverse process iliocostalis - attached to rib angles

semispinal capitis insert on the occiput betweeen the sup and inf  nuchal lines

hyoid bone

• attached to thyroid cartilae  via the thyrohyoid ligament - controlled vertical postion of the thyroid cartilage ( pharynx and larynx)

• anterior triangle
• digastric triangle -submandibular gland
• submental triangle -ant jugular vein, lymph nodes
• carotid triangle- carotid artery
• muscular triangle -strap muscles, thyroid and parathyroid glands

sympathetic chain

- branches from sup. cervical ganglion regulate blood supply to face and brain.

other ganglia control blood supply in upper limb and upper thorax

lies in the prevertebral fascia, receives input from T1-T4  via rami communicantes ,

synapses in cervical ganglia and postganglionic fiber travels  blood vessels to regulate blood pressure

carries parasympathetic and sensory supply to thethorax and abdomen

carries somatic motor fiber ( given off as sup. and recurrent laryngeal nerves)  to pharynx and larynx

arise from the right brachiocephalic trunk or the left subclavian artey 

- supply cervical muscle and upper intercostal spaces

next branch is on verterbral artery ( supply post brain

- thyrocervical supply neck and thyroid gland

 divides into internal and external carotid ,

internal carotid - goes to carotid canal and supply brain

external carotid- sup. thyroid , lingual , facial

occiptal , ascending pharyngeal

external divide  into final branches maxillary and superficial temporal arteries

consists of two lobes connected by an isthmus across the midline

-supplied with blood by superior thyroid artery ( first branch of external carotid )  inferiorr thyroid artery  (from the thyrocervical trunk) 

- gland is drained by super. ,middle , and infer. thyroid veins

anterior to the trachea  below the thyroid cartilage

- lies in btw investing fascia ( enclose nech  and continuous with trapezius fascia and sternocleidomastoid)

- attached to hyoid and thyroid cartilage ( enclosed by pretracheal fascia

- posterior of pretracheal is buccopharyngeal fascia ( sep. by retropharyngeal space  which is pathway for infection into mediastinum of thorax)

thyrohyoid and geniohyoid

-innervated by branches of C1 that travel with CN XII( not part of ansa )

innervation of ( strapmuscles) C1 -C3  ansa cervicalis just lateral to the internal jugular vein

C1 - sup. limb of ansa travel with hypoglossal nerve (CN XII)

C2-C3   inferionr limb

SOS ( sternohyoid , omohyoid, sternothyroid )  supply these ( after ansa loop

digastric muscles

anterior and posterior bellies of digastric attached to hyoid by tendion of stylohyoidbone

posterior belly attaches to the digastric groove on the medial side of tue mastoid process , supplied by facial nerve

-anterior belly attaches to the genial tubercles on the insde of hte mandible - supplied by the trigeminal nerve ( MAST MATT - mylohyoid, anterior digastric, tensor tympani , tensor veli palatini

attached to mylohyoid line of the mandible and hyoid bone, innervated by the motor root of cranial nerve V3 ( trigeminal )

press th tongue upward with digastric muscles

glenoid fossa  is deepened by a lip of cartilage , glenoid labrum

attachment of long head biceps to supraglenoid tubercle ( inthe bicipital groove by transverse humeral ligament )  ; ( coracoacromial ligament -prevents upward movement of humeral head )

-subscapular burse deep to subscapularis

-synovial sheath for the biceps tendon

latissimus dorsi ( attach to the floor)  and teres major -attaches to scapula ( behind the chst wall  and medial to lat. dorsi )

SITS - supraspinatus  ( abductor)  lies sup. to joint ,infraspinatus, and teres major ( both are lateral rotators , lie posterior )

subscapularis - medial rotator

supraspinatus and infraspinatus - innervated by suprascapular nerve and artery

says that nerves supplying a join are bracnhes of nerves supplying muscles that act on the joint

nerves that supply the shoulder joit are braches of the suprascapular , axillary and lateral pectora nerves

pect. major- adductor and medial rotator

deltoid - abductor , flexor , extensor ( attaches to spine of scapular , acrommion , and lateral third of the clavicle )

triceps - an extensor via long head

biceps - flexor

teres major and l. dorsi -adductors

serratus anterior

serratus and trapezius - full abduction of upper limb ( both supplied by the spinal accessory nerve and long thoracic nerves)

sternoclavicular joint , acromioclavicular joint