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UPPERLIMB IS ALSO KNOWN AS UPPER EXTREMITY
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it became the prehensile organ used to
manipulate the environment for survival and existance by its primary function
of grasping mechanism .
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Arm & forearm increase the range of movement
of hand .
Functions of upperlimb
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Grasping
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Defence
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Tactile apparatus( feeling & holding
objects).
Parts of upperlimb
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1) attached
part of upperlimb—it is the region in relation to shoulder girdle with the
help of which upper limb proper is attached to the trunk.it consists of :
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A) shoulder
region-in relation to shoulder girdle
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B) pectoral
region- lies in front of the chest
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C) scapular
region—around shoulder joint & over the scapula on back of the body
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D) axilla or
armpit—pyramidal space b/w pectoral region & scapular region.
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2) UPPER LIMB PROPER
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ARM
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FOREARM
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HAND –WRIST
--HAND PROPER.
Pectoral region
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cutaneous nerves---
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medial ,intermediate & lateral
supraclavicular nerves.(C3,4)
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anterior & lateral cutaneous branches of 2nd to 6th
rib , supply the skin below the level of 2nd rib.(
intercostobrachial nerve supply skin of floor of axilla and upper ½ of medial side of arm.
The breast
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found in both sexes , but rudimentary in males , well
developed in females after puberty.
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its modified sweat gland ,important accessary organ of female reproductive system
& provides nutrition to newborn in form of milk.
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Lies in superficial fascia of pectoral region.,only
axillary tail pierces deep fascia & lies in axilla.
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Extent—
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vertically 2nd
to 6th rib
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from lateral border of sternum to mid axillary line.
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Deep relations-
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breast lies on pectoral fascia covering pectoralis
major.
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deeper are part of three muscles—pectoralis major,
serratus anterior, external oblique ms of abdomen.
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structure
of breast•
skin with nipple & aerola,
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parenchyma
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fibrofatty stroma.
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blood
supply---( extremly vascular)
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internal thoracic artery,
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Lateral thoracic, superior thoracic , acromiothoracic
branches of axillary artery.
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lateral branches of posterior intercostal arteries.
• nerve supply –
• anterior & lateral cutaneous branches of 4th to
6th intercostal nerves. i.e sensory fibers to skin, autonomic fibers
to smooth muscle & to blood vessels. Nerve do not control secretion of
milk.
Lymphatic drainage of breast
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axillary group of LN ---anterior, posterior , lateral
,central , apical group.
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internal mammary group of LN
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supraclavicular group of LN.
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lymphatics---
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superficial
–drain skin of breast except nipple & aerola.
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deep – drain
parenchyma of breast , nipple & aerola.
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75% of lymph from breast drains into axillary LN
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25% ----internal mammary LN
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5% ----into posterior intercostal LN.
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lymph from ant. & post. LN ---central
,lateral LN ----apical LN-----supraclavicular LN.
Applied
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breast is most common site of carcinoma,
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in abscess of breast radial incisions are given
to avoid cutting of lactiferous ducts.
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cancer cells can infilterate deeper & breast
then become fixed .
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infilteration of lactiferous duct causes fibross
& retraction of nipple.
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obstruction of lymphatics causes oedema of skin
,( peau d’orange ) appearance.
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due to communication of superficial lymphatics
across the midline , cancer can spread from one breast to other.
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due to communication with abdomen
lymphatics it can spread
to liver or in pelvis.
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veins draining breast communicate with vertebral
venous plexus of veins ---spread to vertebrae, brain.
Muscles of pectoral region
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Clavipectoral
fascia---fibrous sheet situated deep to pectoralis major muscle ,
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extent—clavicle above to axillary fascia below,
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Medially attached to 1st rib &
costo –clavicular ligament,, laterally
attached to coracoid process & blends with coracoclavicular
ligament.
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it splits above to enclose subclavius muscle,
& inferiorly enclose pectoralis minor .
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it is pierced by --• Lateral pectoral
nerve,
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cephalic vein,
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thoracoacromial vessels,
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Lymphatics.
Pectoralis major
• attachments---
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anterior surface of medial half of clavicle,
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½ breadth of sternum upto 6th costal
cartilage.
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2nd to 6th costal
cartilage
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apponeurosis of external oblique muscle.
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inserted as bilaminar tendon on lateral lip pf bicipital
groove.
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nerve supply---medial & lateral pectoral
nerves.
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action—as whole, adduction & medial
rotation of arm.
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clavicular fibers –flexion of arm.
pectoralis minor
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arises
from 3,4,5 ribs near costochondral junction
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inserted to coracoid process
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nerve
supply---medial & lateral pectoral nerves
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Action– depress point of shoulder,
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draws scapula
forward, helps in forced
inspiration.
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Subclavius ---steadies clavicle during shoulder
movement.
• serratus anterior
muscle
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Arise as 8 digitations from upper 8 ribs & fascia covering intercostal muscles.
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Insertion
---costal surface of scapula along medial border.
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nerve
supply ---nerve to serratus interior from brachial plexus.
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action—in pushing
& punching movements along with
pectoralis minor,
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---along with trepazius ,pulls acromion upwards &
backwards thus rotate scapula so that glenoid cavity is upwards.
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---steadies scapula during weight carrying,
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---- helps in forced inspiration.
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applied—winging
of scapula,when due to ms paralysis medial border of scapula becomes
unduely prominent.
Axilla
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armpit or axilla,
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pyramidal
in shape with apex , base 4 walls
, apex is directed upwards & medially.
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apex is
truncated ,trinagular interval bounded anteriorly by clavicle, posteriorly by
superior border of scapula, medially by outer border of 1st rib.( cervico-axillary canal ---axillary
artery, brachial plexus passes through it )
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base –skin , fascia
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ant wall
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posterior wall
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medial wall,
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Lateral
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Contents—axillary
artery with branches,
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axillary vein & its tribueteries • infraclavicular
part of brachial plexus
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axillary group of LN.
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Axillary fat
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long thoracic & intercostobrachial nerve.
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