M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

Muscles of the Upper Limb * Black font: Essential for Tutorial

(Compiled from Yunnan + Em’s) Red font: Notes for understanding

General Objectives
a) To understand how the major muscles, (by virtue of their attachments and relation to joints), produce the
important movements (required for prehensile functions) at the various joints of the upper limb.

Specific Objectives
1. Review the muscles responsible for movements of the scapula and at the glenohumeral joint.

Muscles involved in movements of the scapula

Movement Muscles Responsible
Elevation Trapezius (upper part)
Levator scapulae
Rhomboid major
Rhomboid minor
Depression Latissimus dorsi
Pectoralis major (sternal head)
Pectoraliis minor
Upward Rotation Serratus anterior
Trapezius
Downward Rotation Latissimus dorsi
Pectoralis major (sterna head)
Pectoralis minor
Levator scapulae
Protraction (abduction) Serratus anterior
Pectoralis major
Pectoralis minor
Retraction (adduction) Trapezius
Rhomboid major and minor

Muscles involved in movements at the glenohumeral joint

Movement Muscles Responsible
Flexion Deltoid (anterior fibres)
Pectoralis major
Biceps brachii
Coracobrachialis
Extension Deltoid (posterior fibres)
Latissimus dorsi
Teres major
Abduction Deltoid (middle fibres)
Supraspinatus
Adduction Latissimus dorsi
Pectoralis Major
Teres major
Teres minor
Medial Rotation Subscapularis
Latissimus dorsi
Lateral Rotation Infraspinatus
Teres minor
Deltoid (posterior fibres)
Circumduction Combination of above movements

Remarks:
1. Deltoid fibres end where the brachialis muscle starts.

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

2. The biceps and triceps brachii form the major flexor (e.g. in pull ups) and extensor (e.g. in push ups) muscle
groups respectively of the arm. Both muscles are used for eliciting tendon reflexes.
Review the attachments, actions and innervations of these two muscles with special mention of the course of
the long tendon (prone to rupture) of the biceps.

Attachments, actions, innervations and course of biceps brachii

Origin Insertion Actions Innervation
Biceps brachii
Long head Supraglenoid tubercle of Radial tuberosity; Supination of forearm
scapula Deep fascia of forearm via Flexion of elbow joint Musculocutaneous
Short head Coracoid process of bicipital aponeurosis Weak flexor of shoulder nerve
scapula joint
Course of long tendon:
- Crosses the head of humerus within the glenohumeral cavity
- Descends in the intertubercular groove of the humerus
- Attached to the supraglenoid tubercle
- Held in place by the transverse humeral ligament

Attachments, actions and innervations of triceps brachii

Origin Insertion Actions Innervation
Triceps brachii
Long head Infraglenoid tubercle of
scapula
Lateral head Posterior surface of Extension of elbow joint
humerus superior to Olecranon process of ulna; Radial nerve
radial groove fascia of forearm (Long head aids in
Medial head Posterior surface of adduction and extension of
humerus inferior to arm)
radial groove

Spinal Reflex
A spinal reflex is a rapid, involuntary response to a sensory stimulus. The nervous impulse passes through a
reflex arc, a neural pathway through the spinal cord bypassing the brain impulses. The components of a reflex
arc are the sensory receptor, afferent sensory neuron, efferent motor neuron and the effector. Skeletal
muscles receives segmental innervation by several spinal nerves and thus spinal segments, thus eliciting muscle
reflexes tests the respective spinal segments.

The degree of tension in a muscle, and hence a sensory stimulus, is detected by sensitive sensory endings
called muscle spindles and tendon spindles. The nervous impulses travel in sensory neurons that enter the
dorsal gray horn of the spinal cord via the dorsal root (sensory) ganglion where the cell bodies are located.
They synapse with motor neurons in the ventral grey horn where cell bodies of the motor neurons are located.
The motor neurons in turn send the impulses down their axons which end on muscle fibers at motor end-plates.
Consequently, a response is elicited from the effector muscles.

Biceps tendon jerk (Test for elbow flexors): C5, C6

Triceps tendon jerk (Test for elbow extensors): C6, C7 and C8

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

3. Review the basic organization and major attachments of the muscles of the forearm and relate the muscle
groups to the following movements: pronation/supination of the forearm; flexion, extension, abduction,
adduction, circumduction at the wrist joint; and flexion/extension at the digits.

Major attachments of muscles of the forearm

Anterior compartment (Superficial)
Muscle Origin Insertion Movement
Pronator teres Medial epicondyle of humerus Lateral aspect of radius Pronation and flexion of
-Humeral head Medial border of coronoid forearm
-Ulnar head process of ulna
Flexor carpi radialis Medial epicondyle of humerus Bases of 2nd and 3rd metacarpal Flexion and abduction of
bones hand
Palmaris longus Medial epicondyle of humerus Flexor retinaculum and palmar Flexion of hand
aponeurosis
Flexor digitorum superficialis Medial epicondyle of humerus Middle phalanx of medial 4 Flexion of middle phalanges
-Humeroulnar head Oblique line on anterior surface fingers Assists in flexion of proximal
-Radial head of shaft of radius phalanx and hand
Flexor carpi ulnaris Medial epicondyle of humerus Pisiform, hook of hamate and Flexion and adduction of
-Humeral head Medial aspect of olecranon base of fifth metacarpal bone hand
-Ulnar head process and posterior border of
ulna

Anterior compartment (Deep)

Muscle Origin Insertion Movement
Pronator quadratus Anterior surface of shaft of ulna Anterior surface of shaft of radius Pronation of forearm
Flexor pollicis longus Anterior surface of shaft or radius Distal phalanx of thumb Flexion of distal phalanx of
thumb
Flexor digitorum Anteromedial surface of shaft of Distal phalanges of medial 4 Flexion of distal phalanges
profundus ulna fingers Assists flexion of middle and
proximal phalanges and hand

Lateral compartment
Muscle Origin Insertion Movement
Brachioradialis Base of styloid process of radius Flexion of forearm; Rotation of
Lateral supracondylar ridge of forearm to midprone position
Extensor carpi radialis humerus Posterior surface of base of 2nd Extension and abduction of hand
longus metacarpal bone

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

Posterior compartment (Superficial)

Muscle Origin Insertion Movement
Extensor carpi radialis Posterior surface of base of 3rd Extension and abduction of hand
brevis metacarpal bone
Extensor digitorum Middle & distal phalanges of Extension of fingers and hand
Lateral epicondyle of humerus medial 4 fingers
Extensor digiti minimi Extensor expansion of little finger Extension of metacarpal
phalangeal joint of little finger
Extensor carpi ulnaris Base of 5th metacarpal bone Extension and adduction of hand

Posterior compartment (Deep)

Muscle Origin Insertion Movement
Abductor pollicis Posterior surface of shafts of radius Base of 1st metacarpal bone Abduction & extension of thumb
longus and ulna
Extensor pollicis Posterior surface of shaft of radius Base of proximal phalanx of Extension of metacarpo-
brevis thumb phalangeal joint of thumb
Extensor pollicis Base of distal phalanx of thumb Extension of interphalangeal joint
longus Posterior surface of shaft of ulna of thumb
Extensor indicis Extensor expansion of index Extension of metacarpo-
finger interphalangeal joint of index
finger
Anconeus Lateral epicondyle of humerus Lateral surface of olecranon Extension of forearm
process of ulna
Supinator Lateral epicondyle of humerus, Neck and shaft of radius Supination of forearm
annular ligament of proximal
radioulnar joint and ulna

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

4. Relate the muscles of the forearm and hand to movements of the thumb and fingers that aid gripping and
pinching.

Muscles of the forearm related to movements of thumb and fingers

Finger Movements Muscles responsible
distal phalanx – flexion Flexor pollicis longus
distal phalanx – extension Extensor pollicis longus
metacarpophalangeal joint – flexion Flexor pollicis brevis
Abductor pollicis longus
metacarpophalangeal joint – extension Extensor pollicis brevis
carpometacarpal joint – abduction Abductor pollicis longus
Thumb Abductor pollicis brevis
metcarpophalangeal joint – abduction Abductor pollicis brevis
carpometacarpal and metacarpophalangeal joints – adduction Adductor pollicis
Opposition Opponens pollicis
Circumduction
metacarpophalangeal joint – flexion Flexor digitorum superficialis
Flexor digitorum profundus
Flexor digiti minimi
Palmar and Dorsal interossei
metacarpophalangeal joint – extension Extensor digitorum
Digit Extensor indicis
Extensor digiti minimi
interphalangeal joints – extension Dorsal interossei
abduction (away from centre of 3rd finger) Dorsal interossei
adduction (towards centre of 3rd finger) Palmar interossei
abduction of little finger at metacarpophalangeal joint Abductor digiti minimi

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

5. Review the boundaries of the axilla, cubital fossa and carpal tunnel which are all clinically important sites,
especially with respect to nerves and vessels.

Boundaries of the axilla

- Upper end (a.k.a. apex)
o Anteriorly: clavicle
o Posteriorly: upper border of scapula
o Medially: outer border of first rib
- Lower end (a.k.a. base)
o Anteriorly: anterior axillary fold (formed by lower border of pectoralis major muscle)
o Posteriorly: posterior axillary fold (formed by tendon of latissimus dorsi and teres major)
o Medially: chest wall

Boundaries of the cubital fossa

- Base of triangle: imaginary line drawn between medial & lateral epicondyles of humerus
- Apex: crossing of pronator teres & brachioradialis
-
- Laterally: brachiocradialis muscle
- Medially: pronator teres muscle
- Floor: supinator muscle (lateral), brachialis muscle (medial)
- Roof: skin and fascia, reinforced by the bicipital aponeurosis

Boundaries of the carpal tunnel

- Floor: carpal bones
o Proximal row: scaphoid, lunate, triquetrum, pisiform
o Distal row: trapezium, trapezoid, capitates, hamate
- Roof: Flexor retinaculum
- Medial wall: hook of hamate, pisiform
- Lateral wall: scaphoid, trapezium

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

For self integration

a. Relate the microscopic features of skeletal muscles to function. How does a nerve impulse lead to muscle
contraction?

Microscopic arrangement of muscle fibres

- Muscle fibres surrounded by a layer of connective tissue called epimysium
- Muscle fibres grouped into fascicule; each is surrounded by a layer of perimysium
- Individual muscle fibre is surrounded by endomysium

Microscopic features of skeletal muscles and function

Feature
Muscles fibres are striated, showing broad light I bands and dark
Abands
Fine dark lines called Z bands bisect the light I bands
Nucleus at extreme periphery of the cell
Sarcolemma (i.e. muscle cell plasma membrane) extends
transversely into the muscle cell to surround each myofibril at the
region of the junction of A and I bands
Function
Sarcomere consist of two types of thick and thin filaments
- Thick filaments are composed mainly of protein myosin,
attached to M line
- Thin filaments are composed mainly of protein actin, attached
to Z line
Using energy released from ATP, the thick and thin filaments slide
over one another, thus shortening the sarcomere
Attachment of protein actin of thin filaments
Muscle fibres which are the result of regeneration after damage
have nuclei in the centre of the fibre rather than at the periphery
Permits the synchronous contraction of all sarcomeres in the
muscle fibre

How does nerve impulse lead to muscle contraction

1. Action potential in somatic motor neuron arrives at the axon terminal.
2+ 2+
2. Voltage-gated Ca channels open. Ca entry triggers exocytosis of ACh-containing synaptic vesicles.
3. ACh diffuses into synaptic cleft and binds with nicotinic channel-receptors on muscle motor end plate.
+
4. Net influx of Na through the ACh-gated channel depolarizes the muscle membrane, creating an end-plate
potential (EPP).
5. The EPP always creates a muscle action potential.
6. The action potential spreads from the neuromuscular junction along the fibre membrane and down the t-
tubules.
2+
7. Voltage-sensitive dihydropyridine receptors open Ca release channels in the sarcoplasmic reticulum.
2+
8. Ca diffuses into the cytosol and binds to troponin, pulling tropomyosin away from the myosin-binding site.
This action allows myosin to release inorganic phosphate from ATP hydrolysis and complete its power
stroke.
9. At the end of the power stroke, the myosin crossbridge releases ADP and remains tightly bound to actin.
Myosin must bind an ATP molecule in order to release from this rigor state.
2+ 2+ 2+
10. The muscle fibre relaxes when Ca is transported out of the cytosol by a Ca -ATPase. Ca removal from
troponin allows tropomyosin to again block the myosin-binding site of actin.
11. The ATPase activity of myosin hydrolyses ATP to ADP and inorganic phosphate. Both remain bound to
myosin. The myosin head swivels and binds to a new actin molecule, ready to execute its next power stroke.

b. Outline the microscopic features of a tendon as distinct from other connective tissue.

Microscopic features of a tendon

- Compact linear collagen fibres
- Compressed nuclei of inactive fibroblasts between the collagen bundles
- Poorly vascularised and heals slowly when damaged
- Contains tiny nerve fibres and tendon stretch receptors
- Some tendons have a thin outer layer of synovium

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 M1 Anatomy Tutorial: Bones, Joints and Proximal Muscles of the Upper Limb

c. Describe briefly how muscles develop in an embryo and acquire their nerve supply.

How muscles develop

- During embryological development, mesenchymal stem cells in each myotome differentiate into long,
mononuclear skeletal muscle precursors called myoblasts
- Myoblasts proliferate by mitosis
- Myoblasts fuse end to end forming elongated multinucleate cells called myotubes

How muscles acquire their nerve supply

Muscles acquire their nerve supply from the motor (efferent) fibres passing from nerve cell bodies in the
anterior horn of the spinal cord gray matter (in the ventral nerve root). As the muscles develop and migrate,
the spinal nerves migrate with the muscles/effector organs peripherally.

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