Muscle and Fascia Compartments

BONY LANDMARKS of the Upper

(parts that can be palpated- all areas in green)
Limb Anterior
Dr. Adelia Matanguihan- Quijano M.D.

FASCIA (divisions)
– Superficial (Hypodermis, Subcutaneous Tissue)
– Deep
○ Derivatives
1. intermuscular septa
2. ligaments
3. tendons
4. aponeurosis
5. muscular and nervous investments
○ Receives different names according to
region
1. Pectoral Fascia – encloses pectoralis
major.
2. Clavipectoral Fascia – encloses
subclavius and pectoralis minor.
3. Axillary Fascia
4. Brachial Fascia – arm
5. Antebrachial Fascia – forearm
6. Palmar Fascia
7. Dorsal Fascia
8. Flexor and Extensor Retinacula
9. Digital Fibrous Flexor Sheaths
UPPER LIMB (divisions)
– Joints divide the superior appendicular skeleton
– Limb is divided into 4 main regions (bold) • Fyi- clavicle is the first long bone to ossify in fetus
○ Shoulder (pectoral)
○ Arm (brachium)
○ Elbow (cubitum)
○ Forearm (antebrachium)
○ Wrist (carpus)
○ Hand
BONES OF UPPER LIMB

Posterior

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Legend:
C- Scaphoid, D- Lunate, E- Triquetrum, F-Psiform, G- Trapezium, H-
Trapezoid, I-Capitate, J-Hamate, L- Radius, L1-Styloid process of the
Radius, M- Ulna,
M1- Styloid process of the Ulna

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MUSCLES OF THE PECTORAL REGION
1- Trunk to scapula or clavicle
a. Trapezius- assists in suspending the
pectoral girdle and elevates, retracts and
rotates the scapula
b. Levator scapulae- pulls up the scapula
c. Rhomboideus major/minor- adducts
scapula towards the midline
d. Pectoralis minor- stabilizes the scapula, for
flexion
e. Subclavius- stabilizes (anchors and
depresses) the clavicle
f. Serratus anterior- (serrated appearance);
keeps scapula close to trunk and rotates it
2- Trunk to humerus
a. Latissimus dorsi- widest back muscle
b. Pectoralis major
**extends, adducts and rotates the humerus medially
Winging of the scapula
- paralysis of serratus anterior / injury to long
thoracic nerve
- when the medial border of the scapula moves
laterally and posteriorly away from the thoracic wall
AXILLA
– The pyramidal space inferior to the glenohumeral
joint and is superior to the axillary fascia at the
junction of the arm and thorax
MUSCLES OF PECTORAL REGION
 Scapula to humerus
1. Deltoid- triangular muscle that forms the
rounded contour of the shoulder; middle area
is multipennate; functions as the principle
abductor of the arm (flexion of shoulder joint)
2. Rotator Cuff muscles (scapulohumeral
muscles- SITS)
a. Supraspinatus
b. Infraspinatus- lateral rotator
c. Teres minor
d. Subscapularis- medial rotator
• Initiate abduction for first 150 degrees; deltoid does
the rest; grasps and pulls the humerus head
against the glenoid cavity (reinforces anteriorly,
superiorly and posteriorly)
3. Teres major (+ Teres minor)- minor is more
superiorly located; both help in lateral rotation
SCAPULOHUMERAL DISSECTION
*teres minor- above, major- below
– Quadrangular space
○ Teres minor, teres major, triceps brachii
(medial), humerus(lateral)
 Enervated by Axillary nerve
 Post humeral circumflex artery
runs through it
– Triangular space
○ Teres minor, teres major and triceps
brachii
 Circumflex scapular artery from
subscapular artery runs through it
ARM: MUSCULAR COMPARTMENTS
– Anterior- flexors (3)
○ Enervated by musculocutaneous nerve
○ Bloody supply from brachial artery
○ Supinator
○ Biceps brachii coracobrachialis (passes
only shoulder joint) and brachialis muscles
○ Covered by superficial Antibrachial fascia
○ Presence of bicipetal aponeurosis which
forms a roof over cubital fossa and
protects underlying structures
– Posterior- extensors (2)
○ Enervated by radial nerve
○ Blood supply c/o brachial artery
○ Triceps brachii- long, lateral and medial
heads + Anconeus (muscle that assists the
triceps in extending the elbow joint)
FOREARM: MUSCULAR COMPARTMENTS
– Anterior- flexors (+pronators)
○ Enervated by Median nerve and/or ulnar
nerve (only 1 and a ½ exceptions are
supplied by latter)
○ 3 layers/groups
 1 superficial group- common flexor
tendon; origin- medial epicondyle
of humerus; made up of 4 muscles
• Pronator teres
• Wrist flexors (3)- flexor
carpi radialis, Palmaris
longus, and flexor carpi
ulnaris
 2 intermediate group
• Flexor digitorum
superficialis muscle-
flexes in fast action
 3 deep group- flexors of digits and
pronator (made up of 3 muscles)
• Flexor digitorum
profundus- flexes fingers
in slow action
• Flexor pollicis longus –
extends the thumb,
extrinsic muscle
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 • Pronator quadrates-
between the radius and
ulna
** FYI- biceps brachii serves supinator function
– Cubital Fossa- triangular area in elbow which
serves as an imaginary border; found by the
brachialis muscle; filled with a variable amount of
fat
○ 3 boundaries
 Superiorly: imaginary line
connecting the medial and lateral
epicondyle
 Medially- mass of forearm flexor
muscles (pronator teres) arising
from a common flexor attachment
on the medial epicondyle
 Laterally- mass of extensor
muscles (brachioradialis)
○ Contents of fossa
 Terminal end of the brachial artery-
and divisions of radial and ulnar
arteries
 Deep accompanying veins of the
arteries
 Biceps brachii tendon
 Median nerve
 Radial nerve
– Posterior- Extensors (+supinator and forearm
flexor)
○ Enervated by the radial nerve
○ Divided into 3 functional groups
 Extensor muscles of the wrist joint
 Extensor muscles of the fingers
 Thumb abductor and extensors
○ Blood supply is from both radial and ulnar
arteries
 Flexor of the elbow joint (forearm)-
brachioradialis which is slanted
and found in the humerus to the
radius
• Exception to the rule that
radial nerve supplies only
extensory muscles and
that all flexors are found
anteriorly (flexor
compartment)
 Extensors
• E. carpi radialis longus
and E. carpi radialis
brevis- extends and
abducts hand at wrist joint;
for clenching
• E. digitorum (communis)-
extends 4 medial fingers
• E. digiti minimi – extends
5th finger
• E. carpi ulnaris- extends
and adducts hand at wrist
joint; for clenching
 Supinator, Abductor and Extensor
• Abd, pol. Longus
• E. pol. Brevis
• E. pol. Longus
** extends and abducts
the thumb
• E. indicis – extends 2nd
finger (for independent
extension)
– Anatomical Snuffbox
○ (triangular hollow) depression between ext.
pol. Longus and brevis tendons
○ Formed by scaphoid and trapezium bones
FASCIA: WRIST AND HAND
– Deep fascia continues from antebrachial fascia
I. Retinacula (At wrist region)
a. Extensor retinaculum
b. Flexor retinaculum- forms carpal
tunnel as it bridges carpal bones
concavity; for passage of flexor
digitorum profundus and superficialis
and flexor pollicis longus
** in the carpal tunnel runs the median nerve
c. Palmar carpal ligament- fund
superficial to flexor retinaculum
II. Palmar Fascia
a. Thenar Fascia
b. Hypothenar Fascia
c. Palmar Aponeurosis
III. Dorsal fascia
IV. Fibrous Flexor Sheaths of Digits (covering
of Flexor Digitorum Tendons)
V. Vincula – attach superficial fascial and
deep flexor tendons to middle and distal
phalanges respectively; provide route for
blood supply to tendons.
FASCIAL SPACES (4)
– Carpal Tunnel
– Thenar Compartment
– Hypothenar Compartment
– Central compartment
○ Palmar Space
 Thenar Space
 Midpalmar Space
○ Synovial Flexor Sheaths (for support)
 Ulnar Bursa – Contains tendons of
Flexor Digitorum Superficialis and
Profundus
 Radial Bursa – Contains tendon of
Flexor Pollicis Longus
 Synovial Sheaths for second to
Fourth Digits
INTRINSIC MUSCLES OF THE HAND
– Nerve supply c/o ulnar nerve EXCEPT thenar
muscles and the 1st 2 lumbricals which are
supplied by the median nerve
– Thenar compartment (act on thumb)
○ Abductor Pollicis brevis
○ Flexor Pollicis brevis
○ Opponens Pollicis
– Hypothenar compartment (act on little finger)
○ Abductor digiti minimi
○ Flexor digiti minimi
○ Opponens digiti minimi
– 12 short muscles
○ Lumbricals – in central compartment; arise
from flexor digitorum profundus; flexes
metacarpophalangeal (MP) joint and
extends dorsal and palmar interphalangeal
(DIP and PIP) joints
 1 and 2 = unipennate
 3 and 4 = bipennate
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○ Muscles in Interossei- adductor
compartment
 3 palmar (adducts) and 4 dorsal
(abducts)
 1 Adductor pollicis (adducts the
thumb)

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