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  <head>
    <title>076-02 Upper-limb osteology, joints, muscles, vessels, and nerves</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Upper limb anatomy">
      <outline text="Mobility over bony stability">
        <outline text="Reach, orientation, manipulation"/>
        <outline text="Mobile scapula and shallow shoulder socket"/>
        <outline text="Learn by compartments, actions, routes, injury sites"/>
      </outline>
      <outline text="Shoulder girdle and axial connection">
        <outline text="Clavicle: only bony link to trunk">
          <outline text="Curves hold shoulder away from thorax"/>
          <outline text="Fracture threatens vessels, plexus, lung"/>
        </outline>
        <outline text="Glenoid shallow, deepened by labrum"/>
        <outline text="Scapulothoracic motion made by muscles"/>
        <outline text="Coracoclavicular ligaments suspend the limb">
          <outline text="Disruption causes separation, altered mechanics"/>
        </outline>
        <outline text="Elevation combines glenohumeral and scapular motion">
          <outline text="Scapulohumeral rhythm is not a fixed ratio"/>
          <outline text="Weak serratus or trapezius disrupts upward rotation"/>
        </outline>
      </outline>
      <outline text="Dynamic shoulder stability">
        <outline text="Large humeral head on small glenoid"/>
        <outline text="Static: labrum, capsule, ligaments, negative pressure"/>
        <outline text="Dynamic: rotator-cuff compression, scapular muscles">
          <outline text="Supraspinatus initiates and supports abduction"/>
          <outline text="Infraspinatus, teres minor externally rotate"/>
          <outline text="Subscapularis internally rotates"/>
        </outline>
        <outline text="Anterior-inferior dislocation in abduction, external rotation">
          <outline text="Axillary nerve at risk near surgical neck"/>
          <outline text="Recurrence: labral detachment, head impaction"/>
        </outline>
        <outline text="Subacromial pain has several sources">
          <outline text="Acromial shape alone does not prove cause"/>
        </outline>
      </outline>
      <outline text="Arm and cubital fossa">
        <outline text="Septa divide flexor and extensor compartments"/>
        <outline text="Musculocutaneous nerve supplies anterior arm"/>
        <outline text="Radial nerve in radial groove with profunda brachii">
          <outline text="Vulnerable in humeral-shaft injury"/>
        </outline>
        <outline text="Brachial artery divides into radial and ulnar"/>
        <outline text="Cubital fossa contents lateral to medial">
          <outline text="Biceps tendon, brachial artery, median nerve"/>
          <outline text="Bicipital aponeurosis protects during venepuncture"/>
        </outline>
        <outline text="Elbow collateral ligaments resist valgus and varus">
          <outline text="Annular ligament holds the radial head"/>
        </outline>
      </outline>
      <outline text="Forearm rotation and compartments">
        <outline text="Radius crosses ulna in pronation"/>
        <outline text="Interosseous membrane transmits load, separates compartments"/>
        <outline text="Anterior flexors mostly median nerve">
          <outline text="Flexor carpi ulnaris, medial profundus ulnar"/>
          <outline text="Anterior interosseous: pollicis longus, pronator quadratus"/>
        </outline>
        <outline text="Posterior extensors and supinator by radial nerve">
          <outline text="Deep branch through supinator as posterior interosseous"/>
          <outline text="Compression: extension weakness, little sensory loss"/>
        </outline>
        <outline text="Palmar arches vary, assess collateral circulation"/>
      </outline>
      <outline text="Wrist and carpal tunnel">
        <outline text="Scaphoid bridges carpal rows">
          <outline text="Fall on extended hand"/>
          <outline text="Retrograde supply risks proximal-pole necrosis"/>
        </outline>
        <outline text="Carpal tunnel: median nerve and nine flexor tendons"/>
        <outline text="Ulnar nerve and artery in Guyon canal"/>
        <outline text="Median compression: lateral three and a half digits">
          <outline text="Thenar and lateral lumbrical weakness"/>
          <outline text="Palmar branch superficial, palm may be spared"/>
        </outline>
      </outline>
      <outline text="Hand mechanics and innervation">
        <outline text="Metacarpophalangeal collaterals tighten in flexion"/>
        <outline text="Lumbricals flex MCP, extend IP via expansions"/>
        <outline text="Dorsal interossei abduct, palmar adduct"/>
        <outline text="Median nerve provides precision"/>
        <outline text="Ulnar nerve supplies most intrinsics for power grip"/>
        <outline text="Radial nerve supplies no intrinsic hand muscles"/>
        <outline text="Superficialis to middle, profundus to distal phalanx">
          <outline text="Mallet, boutonniere, jersey at specific levels"/>
        </outline>
      </outline>
      <outline text="Brachial plexus">
        <outline text="C5 to T1 ventral rami">
          <outline text="Trunks between anterior and middle scalenes"/>
          <outline text="Divisions behind clavicle, cords around axillary artery"/>
        </outline>
        <outline text="Root lesion affects parts of several nerves"/>
        <outline text="Upper trunk: abduction, external rotation, elbow flexion"/>
        <outline text="Lower trunk: intrinsic hand, possible Horner syndrome"/>
        <outline text="Long thoracic: serratus weakness, medial winging"/>
      </outline>
      <outline text="Trauma and compression">
        <outline text="Surgical neck threatens axillary nerve"/>
        <outline text="Humeral shaft threatens radial nerve"/>
        <outline text="Medial epicondyle threatens ulnar nerve"/>
        <outline text="Supracondylar threatens brachial artery, median fibres"/>
        <outline text="Forearm compartment pressure threatens perfusion">
          <outline text="Repeat neurovascular examination"/>
        </outline>
        <outline text="Thoracic outlet: scalene, costoclavicular, pectoralis minor">
          <outline text="Provocative tests are nonspecific"/>
        </outline>
      </outline>
    </outline>
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