Suprascapular Nerve • The suprascapular nerve arises from the upper trunk of the brachial plexus (C5 a nd 6) in the posterior
triangle in the neck. • It runs downward and laterally and passes beneath the suprascapular ligament, wh ich bridges the suprascapular notch, to reach the supraspinous fossa • It supplies the supraspinatus and infraspinatus muscles and the shoulder joint. Axillary Nerve • The axillary nerve arises from the posterior cord of the brachial plexus (C5 and 6) in the axilla • It passes backward and enters the quadrangular space with the posterior circumfl ex humeral artery. • As the nerve passes through the space, it comes into close relationship with the inferior aspect of the capsule of the shoulderjoint and with the medial side of the surgical neck of the humerus. • It terminates by dividing into anterior and posterior branches. Branches The axillary nerve has the following branches: ■ An articular branch to the shoulder joint ■ An anterior terminal branch, which winds around the surgical neck of the humerus beneath the deltoid muscle; it supplies the deltoid and the skin that covers it s lower part. ■ A posterior terminal branch, which gives off a branch tothe teres minor muscle a nd a few branches to the deltoid, then emerges from the posterior border of the deltoid as the upper lateral cutaneous nerve of the arm Musculocutaneous Nerve • The origin of the musculocutaneous nerve from the lateral cord of the brachial p lexus (C5, 6, and 7) in the axilla. • It runs downward and laterally, pierces the coracobrachialis muscle and then passes downward between the biceps and brachialis muscles . • It appears at the lateral margin of the biceps tendon • pierces the deep fascia just above the elbow. • It runs down the lateral aspect of the forearm as the lateral cutaneous nerve of the forearm Branches ■ Muscular branches to the biceps, coracobrachialis, and brachialis ■ Cutaneous branches; the lateral cutaneous nerve of the forearm supplies the skin of the front and lateral aspects of the forearm down as far as the root of the thumb. ■ Articular branches to the elbow joint
Median Nerve ( IN ARM ) • It originate from the medial and lateral cords of the brachial plexus in the ax illa • It runs downward on the lateral side of the brachial artery • Halfway down the upper arm, it crosses the brachial artery and continues downwar d on its medial side. • The nerve, like the artery, is therefore superficial, but at the elbow, it is cr ossed by the bicipital aponeurosis. • The median nerve has no branches in the upper arm except for a small vasomotor n erve to the brachial artery. IN FOREARM • The median nerve leaves the cubital fossa by passing between the two heads of th e pronator teres • It continues downward behind the flexor digitorum superficialis and rests poster iorly on the flexor digitorum profundus. • At the wrist, the median nerve emerges from the lateral border of the flexor dig
It also gives articular branches to the elbow joint.46). th e flexor pollicis brevis. ■ In the spiral groove (Fig. • The cutaneous branches supply the palmar aspect of the lateral three and a half fingers and the distal half of the dorsal aspect of each finger. • It immediately divides into lateral and medial branches. 9. a nd the posterior cutaneous nerve of the arm is given off. One of these br anches also supplies the second lumbrical muscle. and it li es directly in contact with the shaft of the humerus Branches ■ In the axilla. branches are given to the lateral and medial h eads of the triceps and to the anconeus. originate bet ween two heads of pronator teres . after the nerve has pierced the lateral fascial septum. the flexor carpi r adialis. and th e extensor carpi radialis longus muscles . Branches ■ Muscular branches in the cubital fossa to the pronator teres. ■ In the anterior compartment of the arm. The posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the wrist.itorum superficialis muscle • lies behind the tendon of the palmaris longus • It enters the palm by passing behind the flexor retinaculum. the brachioradialis. the palmaris longus. This arises in the lower part of the forearm and is dis tributed to the skin over the lateral part of the palm (IN PALM) • The median nerve enters the palm by passing behind the flexor retinaculum and th rough the carpal tunnel. The lower lateral cutaneous nerve of th e arm supplies the skin over the lateral and anterior aspects of the lower part of the arm. and the flexor digitorum superficialis ■ Articular branches to the elbow joint ■ Anterior interosseous nerve : Largest branch of the median nerve. passing down with interosseous artery and ine vates muscles of deep layer ( Flexor Pollicis longus. and the opponens pollicis) and the 1st lumbrical muscl e. branches are given to the long and medial heads of the triceps. • The muscular branch takes a recurrent course around the lower border of the flex or retinaculum and lies about one fingerbreadth distal to the tubercle of the sc aphoid • It supplies the muscles of the thenar eminence (the abductor pollicis brevis. LATERAL COMPARTMENT OF THE FOREARM
. ■ Palmar cutaneous branch. it gives branches to the brachialis. • The palmar cutaneous branch of the median nerve given off in the front of the fo rearm crosses anterior to the flexor retinaculum and supplies the skin over the lateral part of the palm Radial Nerve (IN THE POSTERIROR COMPARTMENT OF ARM ) • It originate from the posterior cord of the brachial plexus in the axilla • The nerve winds around the back of the arm in the spiral groove on the back of t he humerus between the heads of the triceps • It pierces the lateral fascial septum above the elbow and continues downward int o the cubital fossa in front of the elbow. • In the spiral groove. Lateral half of Flexor dig itorum profundus & Pronator Quadratus).the nerve is accompanied by the profunda vessels. between the brachialis and brachiorad ialis muscles.
It reaches the dorsum of hand after winding around the lateral side of the radius. Branches ■ Muscular branches to the extensor carpi radialis brevis and the supinator. the a bductor pollicis longus. EI) ■ Articular branches to the wrist and carpal joints IN THE DORSUM OF HAND Radial Nerve in the hand is the continuation of the superficial branch of the ra dial nerve. S. • The area of skin supplied by the nerve on the dorsum of the hand is variable. EPL & EPB . the extensor digiti minimi. (IN THE POSTERIOR COMPARTMENT) Deep Branch of the Radial Nerve • The deep branch arises from the radial nerve in front of the lateral epicondyle of the humerus in the cubital fossa . it divides into superficial and deep bra nches Branches ■ Muscular branches to the brachioradialis. where it divides into terminal br anches that supply the skin on the lateral two thirds of the posterior surface o f the hand . ECU. • It reaches the posterior surface of the wrist. • In the distal part of the forearm. lying between the brachialis on the medial side and the brachioradialis and extensor carpi radialis longus on the lateral side • At the level of the lateral epicondyle. and a small branch to the lateral part of the brachialis muscle ■ Articular branches to the elbow joint ■ Deep branch of the radial nerve. • The nerve descends in the interval between the superficial and deep groups of mu scles .• The radial nerve pierces the lateral intermuscular septum in the lower part of the arm • passes forward into the cubital fossa . 1. ED. Lateral side of Index Finger 4. EDM. And divides into 4 dorsal digital branches which supply the skin of the digits as follows. it leaves the artery and passes backward unde r the tendon of the brachioradialis . Contiguous sides of index and middle finger 5. withi n the supinator muscle and enters the posterior compartment of the forearm ■Superficial Branch of the Radial Nerve • The superficial branch of the radial nerve is the direct continuation of the ner ve after its main stem has given off its deep branch in front of the lateral epi condyle of the humerus . Contiguous sides of index and ring finger Ulnar Nerve ANTERIOR COMPARTMENT OF ARM • Originate from the medial cord of the brachial plexus in the axilla is describe
. the extensor carpi ulnaris. Medial Side of the Thumb 3. the extensor pollicis brevis. the e xtensor digitorum. Lateral Side of the Thumb 2. APL. This winds around the neck of the radius.and the posterior surface over the proximal phalanges of the lateral three and a half fingers. the extensor pollicis lon gus. • It runs down under cover of the brachioradialis muscle on the lateral side of th e radial artery. • It then passes downward in front of the lateral epicondyle of the humerus. to the extensor carpi radialis longus. .It eventually reaches the posterior surface of the wrist joint. • It pierces the supinator and winds around the lateral aspect of the neck of the radius in the substance of the muscle to reach the posterior compartment of the forearm. and the extensor indicis (ECRB.
and enters the posterior compartment of the arm. the ulnar nerve becomes superficial and lies between the tendons o f the flexor carpi ulnaris and flexor digitorum superficialis muscles . the nerve passes behind the medial epicondyle of the humerus. the ulnar artery lies on the lateral si de of the ulnar nerve • At the wrist. at the insertion of the coracobrachialis. • The ulnar nerve has no branches in the anterior compartment of the upper arm (POSTERIOR COMPARTMENT OF ARM ) • Having pierced the medial fascial septum halfway down the upper arm. It passes medially between the tendon of the flexor carpi ulnaris and the ulna and is distributed on the posterior surface of the hand an d fingers. it lies behind the medial epicondyle of the humerus on the medial ligament of the elbow joint. here.d • It runs downward on the medial side of the brachial artery as far as the middle of the arm • Here. • The ulnar nerve enters the palm of the hand by passing in front of the flexor re tinaculum and lateral to the pisiform bone. it divides into a superficial and a deep terminal branch. crosses the medial ligament of the elbow joint • Enters the front of the forearm by passing between the two heads of the flexor c arpi ulnaris. it has the ulnar artery latera l to it Branches ■ Muscular branches to the flexor carpi ulnaris and to the medial half of the flex or digitorum profundus ■ Articular branches to the elbow joint ■The palmar cutaneous branch is a small branch that arises in the middle of the fo rearm and supplies the skin over the hypothenar eminence. • At the elbow. lying in the s ubcutaneous tissue between the pisiform bone and the hook of the hamate .
IN HAND (PALM) • The ulnar nerve enters the palm anterior to the flexor retinaculum alongside the lateral border of the pisiform bone. the ulnar n erve descends • behind the septum. • As it crosses the retinaculum. • It then runs down the forearm between the flexor carpi ulnaris and the flexor di gitorum profundus muscles. • In the distal two thirds of the forearm. • It continues downward to enter the forearm between the two heads of origin of th e flexorcarpi ulnaris Branches The ulnar nerve has an articular branch to the elbow joint IN FOREARM • The ulnar nerve passes from behind the medial epicondyle of the humerus. the nerve pierces the medial fas cial septum. accompanied by the superior ulnar collateral artery. Superficial Branch of the Ulnar Nerve • The superficial branch of the ulnar nerve descends into the palm.The uln
. covered posteriorly by the medial head of the triceps. ■The dorsal posterior cutaneous branch is a large branch that arises in the distal third of the forearm. • The nerve is accompanied by the superior ulnar collateral vessels.
the tunnel of Guyon. Deep Branch of the Ulnar Nerve • The deep branch of the ulnar nerve runs backward between the abductor digiti min imi and the flexor digiti minimi It pierces the opponens digiti minimi. The nerve gives off the fo llowing branches: a muscular branch to the palmaris brevis and cutaneous branche s to the palmar aspect of the medial side of the little finger and the adjacent sides of the little and ring fingers . The nerve lies behind the long flexor tendon s and in front of the metacarpal bones and interosseous muscles. created by fibrous tissue derived from • the superficial part of the flexor retinaculum. 9. the flexor digiti minimi. namely. Here.54) and supplies the ski n over the medial part of the palm
. and passes laterally within the concavity of the deep palmar arch. and the opponens digiti minimi. and both heads of the adductor pollicis muscle. winds ar ound the lower border of the hook of the hamate. • The palmar cutaneous branch of the ulnar nerve given off in the front of the for earm crosses anterior to the flexor retinaculum (Fig. the 3rd and 4th lumbrical muscl es. the nerve and artery may lie in a fibroosseous tunnel. giving rise to clinical signs and symptoms. the abd uctor digiti minimi.ar artery is on its lateral side. I t supplies all the palmar and dorsal interossei. The nerve may be compressed at t his site.It also supplies the distal half of the do rsal aspect of each finger. It gives off mu scular branches to the three muscles of the hypothenar eminence.