Anatomy (Upper Limbs Muscle and Fascia)

ANATOMY 1st Semester

UPPER LIMBS: MUSCLE & FASCIA
SY 2013-2014
DR. QUIJANO
JUNE 20, 2013

OUTLINE C. Arm (Brachium)
I. Bones of the Upper Limbs • Humerus – longest bone of the upper limb
A. General Information • Most important parts: Greater and Lesser Tubercle, which provides
B. Shoulder (Pectoral Girdle) attachment and leverage to some scapulohumeral muscles
C. Arm (Brachium) • 2 Epicondyles: which are the protruding part of the distal end of the
D. Forearm (Antebrachium) humerus; common origin of group of muscles
E. Wrist (Carpus) o Lateral Epicondyle – common origin of extensor muscles
F. Hand (Manus)
o Medial Epicondyle – common origin of flexor muscles
II. Fascial Compartments of the Upper Limbs
A. Types D. Forearm (Antebrachium)
B. Fascial Spaces and Compartments • Composed of:
C. Two potential Spaces o Radius (lateral and shorter)
III. Muscle of the Upper Limbs o Ulna (medial and longer; stabilizing bone of the forearm)
A. Pectoral and Scapular Region • Elbow joint
B. Arm Region • Humeroradial joint
C. Forearm Region • Humeroulnar joint
D. Wrist and Hand Region
• Radioulnar joint – responsible for pronation and supination à pivot joint
III. Appendix

• Radiocarpal joint
OBJECTIVES E. Wrist (Carpus)
At the end of the lecture, the student should be able to: • Distally located
1. Enumerate the bones and joints of the upper limbs and be able to classify • Composed of 8 carpal bones: Scaphoid, Lunate, Triquetrum, Pisiform,
them; Trapezoid, Trapezium, Capitate, and Hamate (Mnemonics: Some Lovers Try
2. Describe the disposition of the deep fascia and subsequent functional Positions That They Cannot Handle)
compartmentalization of the muscle groups in the upper limb;
3. Describe the fascial spaces: axilla, cubital fossa, and those in the hand and
F. Hand (Manus)
enumerating their contents; • 5 metacarpals: # of digits/fingers: 4 fingers and a thumb
4. Describe the bursae at shoulder, elbow, wrist, and hands; • 14 phalanges: 5 proximal, 4 intermediate, 5 distal (because a thumb has no
5. Describe the muscles of the pectoral girdle conceived as anatomical group/ intermediate phalanges)
functional group and state their functions; • Metacarpal phalangeal joint (MP) joint: located between the metacarpal
6. Identify the main muscles of the UL conceived as functional groups in each and phalanges
region with the principal joint movements rather than as individual muscles; • Proximal interphalangeal joint (PIP): located between the proximal and
7. Identify the principal attachments of the muscle groups and the joints upon intermediate phalanges
which they act. • Distal interphalangeal joint (DIP): between intermediate and distal

phalanges
I. BONES OF THE UPPER LIMBS • Carpometacarpal joints
A. General Information
• There are a total of 32 bones per side of the upper limbs.
• Two Main Regions of the Skeleton
1. Axial – bones comprise the central supporting axis: midline, axis of the
body, attachment of the limbs
a. Exoskeleton consists of the skull, skull bone, vertebral column,
thoracic cage, hyoid bone = 80 bones
2. Appendicular – limbs + bones to the axial skeleton: pectoral
(upper)/pelvic girdles (lower) à connector
– the sternoclavicular joint (SC joint) is the only point
of bony union between the trunk and the upper limb, all other
attachments are muscular à gliding joint – no flexion or extension;
sternal end (enlarged and triangular) + manubrium of the sternum
– 126 bones in total
B. Shoulder (Pectoral Girdle)
• Two parts:
st
o Clavicle (collar bone) – 1 bone to classify in embryology; attached to
the manubrium of the sternum (SC joint); first long bone to ossify and
last to be fully formed; has curvatures that increase its resiliency à
gives its S shape
nd th
o Scapula (shoulder blade) – triangular flat bone that overlies the 2 -‐7
rib; has thicker borders with thin and translucent triangular body; the
Figure 1: Bony Landmarks of the Upper Limb
spine and the acromion serve as levers for the attached muscle à
trapezius II. FASCIAL COMPARTMENTS OF THE UPPER LIMBS
• Acromioclavicular joint – acromial end of clavicle (flat end) + acromion of • Continuous with antebrachial fascia and fascia of the dorsum of the hand
scapula • Types:
• Scapulothoracic joint – the base from which the upper limb operates 1. Palmar Fascia
• Glenohumoral Joint (shoulder joint): classified as one the triaxial joints (# a. Thenar à lateral side; found at the bottom of the thumb
of axis), ball and socket joint (morphology) and a synovial joint (type b. Hypothenar à medial side; found at the bottom of the pinky
on intervening tissue)
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08. Payte, E., Pecho III, N., Peddy, K., Penaceradda, B., Peralta, M., Pineda, A., Pineda, R., Pinos, H., Pira, A., & Pobre, D. MEDICINE CLASS 2017
ANATOMY Lec 3

c. Palmar Aponeurosis àcovers the soft tissues and overlies the long -‐They are found between the flexor tendons and the fascia covering
flexor tendons the deep palmar muscles
-‐The spaces are bounded by fibrous septa passing from the edges of
the palmar aponeurosis to the metacarpals

Figure 2:Types of Palmar Fascia Figure 4: Thenar and Midpalmar Spaces of the Hand
• Fascial Spaces and Compartments
1. Hypothenar Compartment III. MUSCLE OF THE UPPER LIMBS
a. Medial to the medial fibrous septum (which extends deeply from the A. Pectoral and Scapular Region
th
medial border of the palmar aponeurosis to the 5 metacarpal) • Divided into 3 muscle compartments:
b. Hypothenar muscles 1. Anterior Axioappendicular Muscles
c. Bounded anteriorly by hypothenar fascia
2. Posterior Axioappendicular Muscles
2. Thenar Compartment
a. Lateral to the lateral fibrous septum (which extends deeply from the
rd
lateral border of the palmar aponeurosis to the 3 metacarpal)
b. Thenar muscles
c. Bounded anteriorly by thenar fascia
3. Central Compartment
a. Found between the hypothenar and the thenar compartments
b. Bounded anteriorly by the palmar aponeurosis
c. Contains the ff:
i. Flexor tendons and sheaths
ii. Lumbricals
iii. Superficial palmar arterial arch
iv. Digital vessels and nerves
4. Adductor Compartment
a. Deepest muscular plane of the palm
5. Interosseous Compartment
a. Found between metacarpals
Figure 5: Muscles of the posterior axioappendicular region

• Divided into the following groups:
1. Superficial posterior axioappendicular muscles (extrinsic shoulder):
trapezius and latissimus dorsi.
2. Deep posterior axioappendicular muscles (extrinsic shoulder):
levator scapulae and rhomboids.
3. Scapulohumeral muscles (intrinsic shoulder): deltoid, teres major,
and the four rotator cuff muscles (supraspinatus, infraspinatus, teres
minor, and subscapularis).
3. Scapulohumeral Muscles (Intrinsic Shoulder Muscles)
• INTRINSIC – muscle found in specific regions and will be acting on the
SAME area)
B. Arm Region
• Scapulohumeral (Intrinsic Shoulder) Muscles

Figure 3:Fascial Spaces and Compartments of the Hand -‐ Acts on the Glenohumeral Joint
• Two potential spaces: • Deltoid
1. Thenar Space -‐ Divided into unipennate anterior & posterior & miltipennate middle part
2. Midpalmar space -‐ Becomes fully effective as an abductor after the initial 15 degrees of
abduction
ANATOMY Lec 3

-‐ How to test the deltoid: arm is abducted starting from approx. 15 • TYPES OF GRIPS
degrees, against resistance. If normally acting, the deltoid can easily be Power grip (“palm grip”)
palpated -‐Digits act against the palm
• Teres Major -‐Fingers (including the thumb) are wrapped around an object with
-‐ Adducts and medially rotates at the arm counterpressure from thumb
-‐ Stabilizer of the humeral head in the glenoid cavity -‐Involves the ff:
1. Long flexor muscles to the digits acting at the interphalangeal joints
-‐ How to test the teres major: an abducted arm is adducted against
2. Intrinsic muscles in the palm acting at the metacarpophalangeal
resistance. If acting normally, the muscle can easily be seen and
joints
palpated
3. Extensors of the wrist acting at the radiocarpal and midcarpal joints
• Rotator Cuff Muscles (Supraspinatus, Infraspinatus, Teres minor and -‐Example: grasping cylindrical figures
Subscapularis) SITS muscles
• Supraspinatus
• Hook grip
-‐Consumes less energy
-‐ Initiates & assist the deltoid in the first 15 degrees of abduction of the
-‐Involves: flexing of digits
arm
-‐Example: Carrying a briefcase
-‐ How to test the supraspinatus, abduction of the arm is attempted from
the fully adducted position against resistance, while the muscle is • Precision handling grip
palpated superior to the spine of the scapula -‐Used when fine control is required
-‐Involves the long flexor and extensor muscles. These hold the wrist and
• Infraspinatous
digits firmly so intrinsic muscles can perform precise movements.
-‐ Lateral rotator of the humerus
-‐Examples: Holding a pencil, treading a needle
-‐ How to test the Infraspinatus, the arm is laterally rotated against
resistance. If acting normally, the muscle can be palpated inferior the • Pinching
scapula -‐Involves compressing something between thumb and index finger.
• Teres Minor -‐Example: holding a coin on its edges
Position of rest
-‐ Rotate the lateral arm laterally and assist in its adduction
-‐Inactive hand
• Subscapularis -‐Necessary position when stabilize a fracture
-‐ Primary medial rotator of the arm
-‐ Helps in holding the head of the humerus in the glenoid cavity during
movement

TABLE 1: ATTACHMENTS OF THE MUSCLES OF THE ARMS

Muscle Proximal Attachment Distal Attachment
rd
Deltoid Lateral 3 of the clavicle; Deltoid tuberosity of
acromion and spine of Humerus

scapula
Supraspinatus Suprapinous fossa of scapula Superior facet of the greater
tubercle of humerus
Infraspinatus Infraspinous fossa of scapula Middle facet of the greater
tubercle of humerus
Teres minor Middle part of the lateral Inferior facet of the greater
border of scapula tubercle of humerus
Teres major Posterior surface of the Medial lip of intertubercular
inferior angle of scapula sulcus of humerus

Subscapularis Subscapular fossa Lesser tubercle of humerus

C. Forearm Region

Figure 6: Muscles of the Forearm

D. Hand and Wrist Region

ANATOMY Lec 3

APPENDIX

Figure 4. Bones of the Upper Limb

TABLE 2: ANTERIOR AXIOAPPENDICULAR MUSCLES

Muscle Origin Insertion Innervation Function Special Notes
Pectoralis Clavicular head: anterior Lateral lip of Lateral and medial Adducts and medially -‐ Large and fan shaped
major surface of medial half of intertubercular sulcus pectoral nerves; rotates humerus; draws -‐ Inferior border of muscle forms
clavicle of humerus clavicular head (C5, C6), scapula anteriorly and the anterior axillary fold
Sternocostal head (larger): sternocostal head (C7, inferiorly -‐ Pectoral major + adjacent deltoid
anterior surface of sternum, C8, T1) Acting alone, clavicular muscle = deltopectoral groove –
superior six costal cartilages, head flexes humerus and where the cephalic vein runs
aponeurosis of external sternocostal head extends -‐ Pectoral major, deltoid, and
oblique muscle it from the flexed position clavicle forms the clavipectoral
(deltopectoral) triangle
Pectoralis 3rd-‐5th ribs near their costal Medial border and Medial Pectoral nerve Stabilizes scapula by -‐ Lies in the anterior wall of the
minor cartilages superior surface of (C8, T1) drawing it inferiorly and axilla
coracoid process of anteriorly against thoracic -‐ Triangular in shape
scapula wall -‐ Surgical landmark for structures in
-‐Assists in elevating ribs for the axilla
deep inspiration when -‐Forms a bridge with the coracoid
pectoral girdle is process where vessels and nerves
fixed/elevated pass to the arm
Subclavius Junction of 1st rib and its Inferior surface of Nerve to subclavius Anchors and depresses -‐ Horizontally disposed on the
costal cartilage middle third of clavicle (C5, C6) clavicle length of the clavicle
-‐ Protects subclavian vessels and
superior trunk of brachial plexus
-‐ Resists the tendency for the
clavicle to dislocate
Serratus External surfaces of lateral Anterior surface of Long thoracic nerve Protracts scapula and holds -‐ Saw-‐toothed appearance
anterior parts of 1st-‐8th ribs medial border of (C5, C6, C7) it against thoracic wall; -‐ Overlies lateral part of thorax
scapula rotates scapula -‐ Winging of Scapula can occur due
Anchors scapula against to the paralysis of this muscle
thoracic wall

ANATOMY Lec 3

Figure 5: Muscles of the anterior axioappendicular region

TABLE 3: POSTERIOR AXIOAPPENDICULAR MUSCLES

Superficial posterior axioappendicular (extrinsic shoulder) muscles
rd
Trapezius Medial 3 of superior nuchal Lateral third of CNXI-‐ Spinal Descending part elevates; ascending -‐ Provides direct attachment
• Superior line, nuchal ligament, external clavicle; acromion Accessory part depresses; and middle part (or all to the pectoral girdle to
Fibers occipital protuberance, spinous and spine of scapula parts together) retracts scapula; the trunk
• Middle process of C7-‐T12 verterbrae descending and ascending parts act
Fibers together to rotate glenoid cavity
• Inferior superiorly
Fibers
Latissimus Spinous processes of inferior 6 Floor of Thoracodorsal Extends, adducts, and medially rotates -‐Large, fan shaped
dorsi thoracic vertebrae, intertubercular nerve C6,C7,C8 humerus; raises body toward arms
thoracolumbar fascia, iliac sulcus of humerus during climbing
crest, and inferior 3 or 4 ribs

Deep posterior axioappendicular (extrinsic shoulder) muscles
Levator scapulae Posterior tubercles of Medial border of scapula Nerve to Elevates scapula -‐ It rotates the scapula with
transverse processes of C1-‐C4 superior to root of scapular subclavius and tilts its glenoid the rhomboids and
vertebrae spine (C5, C6) cavity inferiorly by pectoralis minor
rotating scapula

Rhomboid Dorsal Retract scapula and -‐ They are not always clearly
• Minor • nuchal ligament; • smooth triangular scapular rotate it to depress separated from each other
• Major spinous processes of area at medial end nerve C4,C5 glenoid cavity; fix -‐ Rhomboid minor is superior
C7 and T1 vertebrae of scapular spine scapula to thoracic to the major
• spinous processes of • medial border of wall
T2-‐T5 vertebrae scapula from level of
spine to inferior
angle

TABLE 4: MUSCLES OF THE ARM

Muscle Proximal Attachment Distal Attachment Innervation Muscle Action Special Notes

ANATOMY Lec 3

Biceps Short head: tip of coracoid Tuberosity of radius and -‐ Supinates forearm -‐ Short head appears
brachii process of scapula fascia of forearm via -‐ Flexes forearm in supine longer than longhead
bicipital aponeurosis -‐ Short head resists dislocation
of shoulder
Long head: supraglenoid tubercle
of scapula Musculocutaneous
nerve (C5, C6, C7)
Coraco-‐ Tip of coracoid process of scapula Middle ⅓ of medial -‐ Helps flex arm -‐ Landmark b/c of
brachialis surface of humerus -‐ Helps adduct arm musculocutaneous
-‐ Resists dislocation of nerve
shoulder
Brachialis Distal half of anterior surface of Coronoid process & Musculocutaneous -‐ Flex forearm in all positions
humerus tuberosity of ulna nerve (C5, C6)

Radial nerve (C5, C7)
Triceps Long head: infraglenoid tubercle Proximal end of Radial nerve (C6, C7, C8) -‐ Chief extensor of forearm
brachii of scapula olecranon of ulna & -‐ Long head resists dislocation
fascia of forearm of humerus (esp. during
Lateral head: posterior surface of adduction)
humerus,superior to radial grove

Medial head: posterior surface of
humerus, inferior to radial groove
Aconeus Lateral epicondyle of humerus Lateral surface of Radial nerve (C7, C8, T1) -‐ Assists triceps in extending
olecranon & superior forearm
part of posterior surface -‐ Stabilizes elbow joint
of ulna -‐May abduct ulna during
pronations

Figure 6: Muscles of the Arm

TABLE 5: INTRINSIC MUSCLES OF THE HAND

Thenar Compartments
Muscle Origin Insertion Function
Abductor pollicis Brevis Scaphoid, trapezium, flexor retinaculum Abduction of thumb
(most lateral)

Base of proximal phalanx of thumb

ANATOMY Lec 3

Flexor pollicis Brevis Flexes metacarpophalangeal joint of thumb

Flexor retinaculum
Opponens pollicis Shaft of metacarpal bone of thumb Pulls thumb medially and forward across palm

Hypothenar Compartments (medial side of the thumb)
Abductor digiti minimi Pisiform bone Base of proximal phalanx of little finger Abducts little finger
Flexor digiti minimi Flexes little finger

Flexor retinaculum th
Opponens digiti minimi Medial border fifth metacarpal bone Pulls 5 metacarpal forward as in cupping the palm

Middle Compartments (12 short muscles)
Lumbricals: 4 (central compartment) Tendons of flexor digitorium Extensor expansion of medial four Flex metacarpophalangeal joints and
protundus fingers extend interphalangeal joints of fingers
except thumb
nd rd
Adductor Pollicis Oblique head;2 and 3 metacarpal Base of proximal phalanx of thumb Adduction of thumb
rd
bones; transvers head;3 metacarpal
bone
Interossei: (between bones)
• Palmar (3) • Base of first metacarpal • Adduction
• Dorsal (4) • Sides of shafts of • Abduction
metacarpal bones



Anatomy (Upper Limbs Muscle and Fascia)

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ANATOMY 1st Semester

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Figure 5: Muscles of the posterior axioappendicular region

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Flexor pollicis Brevis Flexes metacarpophalangeal joint of thumb

Flexor digiti minimi Flexes little finger

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