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Anatomy

Subject:
(1.4) Upper Limbs Muscle and Fascia
Title:
Lecturer:
Dr. Adelia Quijano, MD
Transcribers: Bascara, Battad, Bautista, Bautista, Baybay, Bayona
Trans Subject Head: Jacinto, C. (09157536686/ccjacinto15@gmail.com)

I.
A.
B.
C.
D.
E.
F.

3.
4.
5.

6.

III.

Sem/ A.Y.:

1st/A.Y. 2014-2015

Thoracic cage = 25

Hyoid = 1
2. Appendicular Skeleton
Bones of extremities
Superior appendicular skeleton -comprised of the
pectoral girdle and bones of the free part of the upper
limb
Inferior appendicular skeleton comprised of the
pelvic girdle and bones of the free part of the lower limb
Composition:
o
Pectoral girdle = 4
o
Pelvic girdle = 2
o
Upper limbs = 60
o
Lower limbs = 60

OUTLINE

OBJECTIVES

Review the bones and joints of the upper limbs and be able to
classify them.
Describe the deep fascia of the UL and its subsequent
functional compartmentalization of the muscle groups.
Describe the fascial spaces: axilla, cubital fossa, and those in
the hand, and enumerate their contents.
Describe the muscles of the pectoral girdle conceived as
anatomical group/functional group and stating their functions.
Identify the main muscles of the UL conceived as functional
groups in each region with respect to the principal joint
movements rather than as individual muscles.
Identify the principal attachments of the muscle groups and the
joints upon which they act.

2.

June 23, 2014

Bones and joints of Upper Limb (UL)


Fascia of Upper Limb
Pectoral Girdle region
Arm
Forearm
Hand
II.

1.

Date:

*sternoclavicular joint joins upper appendicular bones to the axial


skeleton; allows great mobility; fibrous, gliding joint; only point of bony
union between trunk and upper limb
b.

- 32 bones per side


1.

BONES, MUSCLES, AND FASCIAE OF THE UPPER LIMB


A. BONES AND JOINTS OF THE UPPER LIMB

a.

OVERVIEW OF THE UPPER LIMB

4 Major Segments of the Upper Limb


Shoulder
includes the pectoral, scapular, and deltoid regions of the
upper limb, and the lateral part of the lateral cervical
region
overlies half of the pectoral girdle
*pectoral girdle formed by scapulae and clavicles,
incomplete posteriorly, completed anteriorly by the
manubrium of the sternum
2. Arm
First segment of the free upper limb
Longest segment of the limb
Consists of anterior and posterior regions of the arm,
centered around the humerus
3. Forearm
second longest segment of the limb
extends between and connects the elbow and the wrist
consists of anterior and posterior regions of the forearm,
overlies the radius and ulna
4. Hand
composed of the wrist, palm, dorsum of the hand, and
digits

1.

1.
-

Axial Skeleton
Bones along the axis of the body
Composed of the

Skull = 22+6

Vertebral column = 26

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Shoulder

Scapula (shoulder blade)


triangular flat bone on the posterolateral surface of the
thorax
overlies the 2nd to 7th ribs
Parts:
o
Acromion process
o
Coracoid process
o
Glenoid fossa
o
Spine

Descriptive Regions of the Human Skeleton

BONES OF THE UPPER LIMB

Clavicle (collar bone)


Long bone; with absence of medullary cavity
Connects upper limb to the trunk
First to ossify and last to be formed
Most commonly fractured bone in the body

JOINTS:

Glenohumeral joint between shoulder and humerus (ball


and socket joint)

Acromioclavicular joint between acromion of the scapula


and clavicle (plane joint)

Sternoclavicular joint between manubrium of the sternum


and clavicle
2.

Arm (Brachium)

Humerus
longest and largest of UL bones

JOINTS:

Radioulnar joint connecting the radius and ulna via an


interosseus membrane (syndesmosis joint)

Elbow between arm and forearm;


o
Humeroradial joint, Humeroulnar joint (uniaxial,
hinge joint; flexion and extension)
3.

Forearm (Antebrachium)

Radius (lateral)

Ulna (medial)

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ANATOMY 1.4 Upper Limbs Muscle and Fascia


JOINT:

4.

Covers the muscles


Made up of dense connective tissue
Named according to the area covered (i.e. deltoid fascia,
pectoral fascia)
Each muscle bundle will be covered by deep fascia and will
also extend as covering of tendons.
*In the forearm, fascial compartments are separated by an
interosseus ligament connecting the radius and ulna
Deeper layer of deep fascia
Will extend inward to the bone of a particular region to
divide that region into compartments (hence it is a boundary
for compartmentalization
Ex. In arm, the deeper layers of deep fascia will extend
inward to attach to the medial and lateral side of the
humerus
Ex. Arm divided into anterior and posterior compartment
*each compartment will have muscles of similar function and
will be innervated by a similar nerve

Proximal radioulnar joint (pivot joint; for


pronation/supination)

Wrist (Carpus)

Carpal bones (8) give flexibility to the wrist


4 Carpal Bones in Proximal Row of Wrist (from lateral to medial)
a. Scaphoid
b. Lunate
c. Triquetrum
d. Pisiform
4 Carpal Bones in Distal Row of Wrist (from lateral to medial)
a. Trapezium
b. Trapezoid
c. Capitate
d. Hamate

*Mnemonic: Some Lovers Try Positions That They Cannot Handle


(Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid,
Capitate, Hamate)
JOINT:

5.

Distal radioulnar joint (pivot joint)

Hand (Manus)

Metacarpals (5)

Phalanges (5 proximal, 4 middle, 5 distal)

***NOTE:
DIGITS NOT EQUAL TO FINGERS: 5 digits: 4 fingers and a thumb
(thumb has no middle phalanges)
JOINTS:

Intercarpal joints (plane or gliding joints)

Carpometacarpal joints (plane joints except the 1st which is


a saddle joint)

Intermetacarpal joints (plane joints)

Metacarpophalangeal joints (condylar joints)

Interphalangeal joints (hinge joints)

Figure 2. Cross-sectional view of superficial and deep fasciae (arm)


Extensor Retinaculum transverse band formed by the thickening of
the antebrachial fascia posteriorly over the distal ends of the radius
and ulna; forms an anterior thickening called the palmar carpal
ligament
Flexor Retinaculum located distal and at a deeper level to the palmar
carpal ligament; converts the anterior concavity of the carpus into a
carpal tunnel, through which the flexor tendons and median nerve pass
*The deep fascia of the upper limb continues beyond the extensor and
flexor retinacula as the palmar fascia
o
Palmar aponeurosis
thickening at central part of the palmar fascia
triangular area at concavity of hand
forms four distinct thickenings that radiate to the
bases of the fingers and become continuous with
the fibrous tendon sheaths of the digits
o
Thenar fascia at lateral portion of arm
o
Hypothenar fascia medial to thenar fascia, both thenar
and hypothenar are THINner than palmar aponeurosis
(thenar = thinner)
C. PECTORAL GIRDLE REGION
a.

ANTERIOR AXIOAPPENDICULAR MUSCLES


(UPPER LIMB TO THORAX)
1.

Figure 1. Bones of the Wrist and Hand (posterior view of the right
hand)
B. FASCIA OF THE UPPER LIMB
Fascia wrapping, packing & insulating materials of deep structures
1.

Superficial Fascia (subcutaneous tissue)


Made up of loose connective tissue with fat deposit
*In the clinics, superficial fascia = subcutaneous tissue

2.

Deep Fascia

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PECTORALIS MAJOR
convergent group of muscles, fan-shaped
a. Proximal attachment
Clavicular head: anterior surface of medial half of
clavicle
Sternocostal head: anterior surface of sternum,
superior six costal cartilages, aponeurosis of
external oblique muscle
b. Distal attachment
Lateral hip of intertubercular sulcus of humerus
c. Main action
Adducts and medially rotates humerus; draws
scapula anteriorally and inferiorly

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ANATOMY 1.4 Upper Limbs Muscle and Fascia


PECTORALIS MINOR
smaller; triangular; covers the brachial plexus in the axilla
a. Proximal attachment
3rd to 5th ribs near their costal cartilages
b. Distal attachment

coracoid process of scapula


c. Main action
Stabilizes scapula by drawing it inferiorly and
anteriorly against thoracic wall
3. SUBCLAVIUS
underneath the clavicle
a. Proximal attachment
Junction of 1st rib and its costal cartilage
b. Distal attachment
Inferior surface of middle third clavicle
c. Main action
Anchors and depresses clavicle
4. SERRATUS ANTERIOR
innervated by long thoracic nerve
a. Proximal attachment
External surfaces of lateral parts of 1st to 8th ribs
(Moore) 2nd to 8th or 9th ribs (Dr. Quijano)
b. Distal attachment
Anterior surface of medial border of scapula
c. Main action
Protracts scapula and keep it close to the
thoracic wall; rotates scapula
* WINGING OF SCAPULA
- paralysis of serratus anterior/injury to long thoracic nerve

Extends, adducts, and medially


rotates humerus; raises body toward arms during
climbing

2.

DEEP (EXTRINSIC SHOULDER) MUSCLES


1.
LEVATOR SCAPULAE
a. Proximal attachment
Posterior tubercles of transverse processes of C1
to C4 vertebrae
b. Distal attachment
Medial border of scapula superior to root of
scapular spine
c. Muscle action
Elevates scapula
2.
RHOMBOID MINOR AND MAJOR connect vertebral
column to medial border of scapula
a. Proximal attachment
Rhomboid minor Nuchal ligament; spinous
processes of C7 and T1 vertebrae
Rhomboid major - spinous processes of T2-T5
vertebrae
b. Distal attachment
Rhomboid minor Smooth triangular area at medial
end of scapular spine
Rhomboid major - medial border of scapula from
level of spine to inferior angle
c. Muscle action
Retract scapula and rotate it to depress glenoid
cavity; fix scapula

Figure 3. Anterior Axioappendicular muscles

b.

POSTERIOR AXIOAPPENDICULAR MUSCLES


(UPPER LIMB TO VERTEBRAL COLUMN)

SUPERFICIAL (EXTRINSIC SHOULDER) MUSCLES


1.

2.

TRAPEZIUS
a. Proximal attachment
Medial third of superior nuchal line; external
occipital protuberance; nuchal ligament; spinous
processes of C7 to T12 vertebrae
b. Distal attachment
Lateral third of clavicle; acromion and spine of
scapula
c. Muscle action
Descending part (lower fibers) elevates scapula
Ascending part (upper fibers) depresses scapula
Middle part (or all parts together) retracts
scapula
Both descending and ascending parts together
act together to rotate to glenoid cavity superiorly
LATISSIMUS DORSI
a. Proximal attachment
Spinous processes of inferior 6 thoracic
vertebrae, thoracic columbar fascia, iliac crest,
and inferior 3 or 4 ribs
b. Distal attachment
Floor of intertubercular sulcus of humerus,
bicipital groove
c. Muscle action

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Figure 4. Posterior Axioappendicular Muscles

c.

SCAPULOHUMERAL MUSCLES
(INTRINSIC SHOULDER MUSCLES)
-

Located in the scapula and inserted in the humerus


Extrinsic vs. intrinsic

Extrinsic muscles in a region that act on another


region
ex. muscles on the forearm that act on the hand

Intrinsic muscles in the same region that act on that


region
ex. muscles on the hand that act on the hand
1.

a.

DELTOID

triangular; multipennate; form the rounded contour of


the shoulder

base is on proximal end

origin: lateral third of clavicle, acromion process and


spine of scapula

has spinal head, clavicular head, acromial head

-will be inserted into deltoid tuberosity of humerus


Anterior deltoid flexion

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ANATOMY 1.4 Upper Limbs Muscle and Fascia


b.
c.
2.

3.

4.

5.

6.

Posterior deltoid extension


Middle portion of deltoid help in abduction
SUPRASPINATUS

Insertion: superior facet of greater tubercle of humerus

Action: Assists deltoid in abduction of arm


INFRASPINATUS

Insertion: greater tubercle of humerus, lower than the


insertion of supraspinatus

Action: Externally rotates the humerus


TERES MINOR

located in the upper part; below insertion of


supraspinatus muscle

holds the humeral head in the glenoid cavity of the


scapula

laterally rotates the arm

innervated by axillary nerve


TERES MAJOR

medial rotator and adductor of the humerus

assists the latissimus dorsi in extending the humerus


SUBSCAPULARIS

insert into lesser tubercle of humerus

covers anterior portion of shoulder joint (Infraspinatus,


Teres Minor, Supraspinatus covers posterior portion)

**Glenohumeral joint classified as triaxial joint, ball and socket joint


capable of flexion and extension, abduction, lateral rotation,
medial rotation circumduction
protected anteriorly, posteriorly and superiorly
inferior part: not protected
shallow cavity of glenohumeral fossa: frequent dislocation
towards the anterior part, common accident at basketball
Rotator Cuff Muscles
Reinforce the joint capsule, hold the humeral head in the
glenoid cavity
Remember SITS! (Supraspinatus, Infraspinatus, Teres
Minor, Subscapularis)

Figure 5. Scapulohumeral Muscles

d.

FASCIA OF THE PECTORAL REGION


1.

2.

Pectoral fascia

covers the pectoralis major

attached in the middle line, to the front of the sternum;


above, to the clavicle; laterally and below it is
continuous with the fascia of the shoulder, axilla, and
thorax
Clavipectoral fascia (clavicle + pectoral)

extends from the clavicle, covers the pectoralis minor


muscle and extends to join the axillary fascia

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3.

e.

suspensory ligament of axilla part of


clavipectoral fascia inferior to the pectoralis minor;
supports the axillary fascia
costacoracoid membrane- part of clavipectoral fascia
between the pectoralis minor and subclavius; pierced
by the cephalic vein, thoracoacromial artery and lateral
pectoral nerve supplying the pectoralis muscle

Axillary fascia

fascia between the pectoralis major and the latissimus


dorsi, forming the base of the axilla

AXILLA
-

pyramidal space inferior to the glenohumeral joint and superior


to the axillary fascia at the junction of the arm and thorax
provides a passageway, or distribution center, usually
protected by the adducted upper limb, for the neurovascular
structures that serve the upper limb
has an apex, a base, and four walls (three of which are
muscular)
Contents: brachial plexus, axillary artery & vein, lymph nodes,
axillary tail of breast for females (Tail of Spence)

Boundaries/Walls of the Axilla


1. Apex of axilla

the cervico-axillary canal

passageway between the neck and the axilla

bounded by the 1st rib, clavicle, and superior edge of


the scapula

arteries, veins, lymphatics, and nerves traverse this

superior opening of the axilla to pass to or from the arm


2.

Base of axilla

formed by the concave skin, subcutaneous tissue, and


axillary (deep) fascia extending from the arm to the thoracic
wall (approximately the 4th rib level), forming the axillary
fossa (armpit)

bounded by the anterior and posterior axillary folds,


thoracic wall, and the medial aspect of the arm

3.

Anterior wall of axilla

has two layers, formed by the pectoralis major and


pectoralis minor and the pectoral and clavicopectoral
fascia associated with them

anterior axillary fold is the inferiormost part of the anterior


wall that may be grasped between the fingers;

it is formed by the pectoralis major, as it bridges from


thoracic wall to humerus, and the overlying integument

4.

Posterior wall of axilla

formed chiefly by the scapula and subscapularis on its


anterior surface and inferiorly by the teres major and
latissimus dorsi

posterior axillary fold is the inferiormost part of theposterior


wall that may be grasped. It extends farther inferiorly than
the anterior wall and is formed by latissimus dorsi, teres
major, and overlying integument.

5.

Medial wall of axilla

formed by the thoracic wall (1st4th ribs and intercostal


muscles) and the overlying serratus anterior

6.

Lateral wall of axilla

narrow bony wall formed by the intertubercular groove in the


humerus

Subfascial Spaces
A. Quadrangular Space
teres minor (above), teres minor (below), triceps brachii, long
head (medial), humerus (lateral)
Contents: axillary nerve, post humeral circumflex artery
B. Triangular Space

teres minor (above), teres major (below), triceps brachii, long


head (lateral)

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ANATOMY 1.4 Upper Limbs Muscle and Fascia

contents: circumflex scapular artery from subscapular artery

*Triangle of Auscultation
formed by superomedial border of latissimus dorsi,
inferolateral border of trapezius, lower part of scapula
area where you apply your stethoscope to hear the sounds
of the posterior segments of lungs, lesser intervening
structures

b.

c.

D. ARM
-

a.

extends from the shoulder to the elbow


two types of movement between the arm and forearm at
elbow joint: flexionextension and pronationsupination

2.

ANTERIOR: FLEXOR MUSCLES

Nerve Supply: Musculocutaneous nerve


Blood supply: Brachial artery
1.

BICEPS BRACHII
2 heads: long head and short head

o
Origin: scapula (both heads)
o
Fuse distally into a single biceps tendon that attaches
to radius
o
Short head appears longer (grossly)
Action and effectiveness are affected by the position of the

elbow and forearm:


o
Flexes the forearm at the elbow joint when forearm is
in supination
o
Primary supinator of the forearm when forearm in is
pronation
No attachment to humerus
o

*Sample activities: right-handed people drive a screw into hard wood,


inserting a corkscrew, pulling the cork from a wine bottle
*bicipital aponeurosis: triangular membranous band that runs from
biceps tendon across the cubital fossa and merges with the
antebrachial (deep) fascia
2.

3.

CORACOBRACHIALIS
Elongated muscle in the supero- medial part of the arm

Flex and adduct the arm

Stabilizes the glenohumeral joint

Pierced by the musculocutaneous nerve

Shunt muscle (with deltoid and long head of triceps):

resisting downward dislocation of the head of the humerus


(e.g. carrying a heavy suitcase)
BRACHIALIS
Flattened fusiform muscle that lies posterior (deep) to the

biceps brachii
Workhorse of the elbow flexors (most powerful flexor of

the forearm)
Main flexor of the forearm: flexes the forearm in all

positions (pronation and supination), during both slow and


quick movements, and presence or absence of resistance
(the only pure flexor)

Crosses the glenohumeral joint


Serves as a shunt muscle (with deltoid and
coracobrachialis) resisting inferior displacement of
the head of the humerus
Medial head

Origin: humerus

Workhorse of forearm extension


Lateral head

Origin: humerus

Strongest among the three heads

ANCONEUS
Small triangular muscle on the posterolateral aspect of the

elbow
Assist triceps in extending forearm

Also stabilizes elbow joint

* cubital fossa- shallow triangular depression on the anterior surface


of the elbow. Boundaries are:

Superiorly: imaginary line connecting the medial and lateral


epicondyles

Medially: pronator teres


o Laterally: brachioradialis
o Floor: brachialis and supinator
o Roof: brachial and antebrachial fascia
*contents of the cubital fossa: Radial nerve
Biceps brachii tendon Brachial arteries and veins Median nerve
[RBBM Ron Beats Bad Men]
E. FOREARM
-

Extends from elbow to wrist


Radius and ulna joined by interosseus membrane (permits
pronation and supination; provides proximal attachment for
some deep forearm muscles)

a. ANTERIOR: FLEXOR/PRONATOR MUSCLES


Nerve supply median nerve; 1 by ulnar nerve
-

Anterior surface of wrist tendons held in place by palmar


carpal ligament + flexor retinaculum (thickenings of
antebrachial fascia)
Common flexor tendon/origin: medial epicondyle of humerus
Functionally, includes brachioradialis

Superficial Layer
Crosses elbow joint
Wrist joint action (except for pronator teres acts on radioulnar
joint)
Muscles involved:
1. PRONATOR TERES pronates and flexes
2. FLEXOR CARPI RADIALIS (FCR) flexes

+ extensor carpi radialis longus and brevis = abduct

Flex + abduct = Hand moves anterolaterally


3. PALMARIS LONGUS

flexes hand at wrist and tenses palmar aponeurosis


4. FLEXOR CARPI ULNARIS (FCU) flexes

+ Extensor carpi ulnaris = adduct

Most medial

*Sample activities: pick up and put down a teacup


b.

POSTERIOR: EXTENSOR MUSCLES

Nerve Supply: Radial nerve


Blood supply: Brachial artery
1. TRICEPS BRACHII
Large fusiform muscle in the posterior compartment of the

arm
Main extensor of the forearm

3 heads (long, lateral and medial heads)

Heads of triceps brachii:


a. Long head

Origin: scapula

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ANATOMY 1.4 Upper Limbs Muscle and Fascia


*Note: fingers can be independently
flexed at the proximal but NOT at distal interphalangeal
joint
2.

FLEXOR POLLICIS LONGUS (FLP)

long (longus) flexor of thumb (pollicis)

Flexes distal phalanx of the thumb ( interphalangeal


joint) and proximal phalanx and 1st metacarpal
(metacarpophalangeal and carpometacarpal joints)

Assist in flexion of wrist joint

Lateral to FDP

3.

PRONATOR QUADRATUS prime pronator of forearm

Deepest muscle

Attaches to ulna at one end and radius at the other


end

Figure 6. Flexors of the forearm (Superficial layer)

Figure 9. Flexors of the forearm (deep layer)


Figure 7. Superficial flexor muscles of the forearm (for easy recall)
Intermediate Layer
Crosses elbow
Muscle involved:
1. FLEXOR DIGITORUM SUPERFICIALIS (FDS)
- flexes middle phalanges at proximal interphalangeal
joints and proximal phalanges at
metacarpophalangeal joints and wrist joint
-Gives rise to four tendons which pass deep to flexor
retinaculum

Figure 8. Flexors of the forearm (Intermediate layer Flexor digitorum


superficialis)
Deep layer
1. FLEXOR DIGITORUM PROFUNDUS* (FDP)

flexes distal interphalangeal joints

flexes distal phalanges after FDS flexed middle


phalanges

Index finger independent contraction

Clothes anterior part of ulna

Profundus/profound deep

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*Cubital fossa bounded laterally by extensor-supinator group of


muscles attached to lateral epicondyle
Radial artery traverses up to the wrist; separating flexorpronator and extensor supinator compartments
b.

POSTERIOR: EXTENSOR/SUPINATOR MUSCLES


Held by extensor retinaculum (prevents bowstringing of
tendon)

Nerve supply: Radial nerve


Superficial layer
Originates in lateral epicondyle
1. BRACHIORADIALIS flexes forearm to the elbow

Incapable of acting at the wrist since brachioradialis


and supinator do not cross

Anterior of the arm

Active during quick movements or presence of


resistance during forearm flexion
2. EXTENSOR CARPI RADIALIS LONGUS indispensable
when clenching fist

Acts as synergist together with ECRB


3. EXTENSOR CARPI RADIALIS BREVIS(short) shorter than
ECRL

ECRL + ECRB = abduct hand as they extend

ECRL + ECRB + FCR = pure abduction

ECRL + ECRB (more involved than longus) + ECU =


extend hand

Synergistic action of ECRL (more involved) and ECRB


with ECU = clench fist
4. EXTENSOR DIGITORUM (COMMUNIS) principal extensor
of medial 4 digits

Extends proximal phalanges; middle and distal


phalanges as well

Helps extend hand at wrist joint


5. EXTENSOR DIGITI MINIMI extends little finger
6. EXTENSOR CARPI ULNARIS extends hand

ECU + ECRB + ERCL = extends

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ANATOMY 1.4 Upper Limbs Muscle and Fascia

ECU + FCU = Adducts


Indispensable when clenching fist

Deep layer
1. SUPINATOR prime mover for slow unopposed supination
esp when extended forearms
2. ABDUCTOR POLLICIS LONGUS Abducts thumb

+ APB = abducts thumb

+ EP muscles = Extends thumb


3. EXTENSOR POLLICIS BREVIS extends proximal phalanx of
thumb; helps extend 1st metacarpal + extend and abduct hand
4. EXTENSOR POLLICIS LONGUS extends distal phalanx of
thumb + adducts the extended thumb + rotates laterally
*Anatomical Snuffbox hollow, fascial space bet. Tendons of
EPL & EPB

Seen on radial aspect of wrist

Contains radial artery

Floor: scaphoid and trapezium


5. EXTENSOR INDICIS confers independence of index finger +
extend index finger (w/ E Digitorum) + extends hand

Figure 11. Palmar fascia


Dorsal Fascia posterior aspect of the hand
Digital fibrous flexor sheaths
covers the flexor digitorium tendon
b.

FASCIAL SPACES AND COMPARTMENTS OF THE PALM

Compartments
1. THENAR COMPARTMENT
space between the attachment of the palmar aponeurosis to
the 3rd metacarpal bone
contains thenar muscle
lateral to lateral fibrous septum
Figure 10 Posterior muscles of the forearm

2.

F. HAND
a.

DEEP FASCIA OF THE HAND

3.

Retinacula
1. FLEXOR RETINACULUM
- forms the carpal tunnel (palmar side of the wrist that
connects the forearm to the middle compartment of the
deep plane of the palm) where the ff. pass through:

flexor digitorum superficialis

flexor digitorum profundis

flexor pollicis lingus


**Carpal Tunnel Syndrome - numbness over lateral 3.5 digits with
weakness and atrophy of thenar muscles due to pressure on the
median nerve
2.

HYPOTHENAR COMPARTMENT
space between the attachment of the palmar aponeurosis to
the 5th metacarpal bone
medial to medial fibrous septum
-

4.

CENTRAL COMPARTMENT
between the thenar and hypothenar compartments
space occupied by:

flexor tendons

lumbricals

superficial palmar arterial arch

digital vessels

nerves

ADDUCTOR COMPARTMENT
Deepest muscular plane of the palm

INTEROSSEUS COMPARTMENT
Found between metacarpals

5.

EXTENSOR RETINACULUM holds the extensor tendons in


place

Palmar Fascia anterior aspect of the hand


1. PALMAR APONEUROSIS
between the two eminences (thenar and hypothenar)
overlies long flexor tendons
forms four longitudinal digital bonds from apex to distal
attached to proximal phalanges and continuous with
fibrous digital sheaths
2. THENAR base of the thumb
3. HYPOTHENAR proximal to the base of the 5th finger

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ANATOMY 1.4 Upper Limbs Muscle and Fascia

Figure 12. Compartments, spaces, and fascia of the palm


Figure 13. Synovial flexor sheaths
Palmar Spaces
1. Mid-palmar space extension and covering to the flexor
group of tendons
2. Thenar space extension and covering to the thumb

Figure 12. Palmar spaces


Synovial Flexor Sheaths
1. Ulnar bursa protects the flexor digitorium superficialis and
profundus
2. Radial bursa - protects the flexor pollicis longus

c.

INTRINSIC MUSCLES OF THE HAND

Thenar Compartment
1. ABDUCTOR POLLICIS BREVIS
abducts the thumB
assists the opponenspollicis during early stages of
opposition through rotating its proximal phalynx
2. FLEXOR POLLICIS BREVIS
short flexor of the thumb
has two heads (bellies): the larger superficial head is
innervated by the median nerve while the smaller deep
head is innervated by the ulnar nerve
3. OPPONENS POLLICIS
quadrangular muscle, opposes the thumb
flexes and rotates the first metacarpal medially at the
carpometacarpal joint during opposition
4. ADDUCTOR POLLICIS
With two heads of origin (oblique and transverse) which
are separated by the radial artery as it enters the palm
to form the deep palmar arch
Adducts the thumb
Hypothenar Compartment (act on little finger)
1.

2.

3.

4.

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ABDUCTOR DIGITI MINIMI


most superficial layeR
abducts the fifth finger
FLEXOR DIGITI MINIMI BREVIS
originates in the pisiform
flexes the proximal phalynx of the fifth finger at the
metacarpophalangeal joint
OPPONENS DIGITI MINIMI
draws the fifth metacarpal anteriorly and rotates it
laterally
PALMARIS BREVIS
not in the hypothenar compartment BUT it wrinkles the
skin of the hypothenar eminence and deepens the
hollow of the palm, to aid the palmar grip
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ANATOMY 1.4 Upper Limbs Muscle and Fascia

Figure 16. Palmar Interosseus muscles

Figure 14. Intrinsic Muscles of the Hand (anterior view)


Middle Compartments
1.
LUMBRICAL MUSCLES
flex the fingers at the metacarpophalangeal joints and
extend the interphalangeal joint
nerve supply: median nerve (1st and 2nd) and ulnar (3rd
and 4th)
2.

MUSCLES IN INTEROSSEI
**(Mnemonic: DABPAD)

Dorsal Interosseous Muscles (4) Dorsal Abuction


nerve supply: ulnar nerve

IV.
1.

It is a large fusiform muscle in the posterior compartment of the


arm.
a. triceps brachii
b. anconeus
c. biceps brachii
d. coracobrachialis

2.

A girl picks up and puts down her morning cup of tea. Which arm
muscle is primarily used?
a. triceps brachii
b. brachialis
c. biceps brachii
d. anconeus

3.

Damage to the coracobrachialis muscle and its nerve supply would


weaken which motion of the arm and forearm?
a. Extension
b. Rotation
c. Flexion
d. Supination
e. Abduction

4.

Nerve that supplies posterior extensor/supinator muscles


a. radial nerve
b. ulnar nerve
c. axillary nerve
d. median nerve

Figure 15. Dorsal interosseums muscles

GUIDE QUESTIONS

Palmar Interosseous Muscles (3) Palmar Adductionnerve supply: ulnar nerve

5. What muscle will be affected if there is injury to the long thoracic


nerve?
a. latissimus dorsi
b. serratus anterior
c. pectoralis minor
d. coracobrachialis
6.

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Transverse thickening of deep fascia anterior to the wrist area


a. flexor retinaculum
b. flexor pollicis brevis
c. extensor retinaculum

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ANATOMY 1.4 Upper Limbs Muscle and Fascia


d.

anatomical snuffbox

Answers: ABCABA
V. REFERENCES
1. Moore, K. et al. (2010). Clinically oriented anatomy. 8th ed.
Lippincott Williams & Wilkins: Baltimore, MD

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2. Netter, F. (2014). Atlas of Human Anatomy. 6th ed.


Saunders Elsevier: Philadelphia, USA.
3. Quijano, A. (2014). Lecture presentation. Upper Limbs Muscle
and Fascia. University of the East Ramon Magsaysay Memorial
Medical Center, Quezon City.

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