### Summarized Notes on Breast Anatomy
**1. External Structures:**
- **Nipple**: The central protruding part of the breast through which milk is expelled during lactation.
- **Areola**: The darker, circular area surrounding the nipple, containing Montgomery’s glands which
secrete oil to lubricate the nipple during breastfeeding.
**2. Internal Structures:**
- **Lobes**: Each breast contains 15-20 sections called lobes, arranged in a radial pattern around the
nipple.
- **Lobules**: Smaller subdivisions within the lobes, these contain the alveoli, the tiny sacs where milk
production occurs.
- **Alveoli**: Small clusters of cells within the lobules that produce milk in response to hormonal
signals.
- **Ducts**: Milk ducts form a network of tubes that carry milk from the alveoli to the nipple. The
ducts converge into larger ducts and eventually form the lactiferous sinuses where milk is stored before
release.
- **Lactiferous Sinuses**: Enlarged ducts located just below the nipple that serve as reservoirs for milk
during lactation.
**3. Supporting Structures:**
- **Cooper’s Ligaments**: Bands of fibrous tissue that provide structural support to the breast,
helping maintain its shape and position on the chest wall.
- **Adipose (Fat) Tissue**: Fatty tissue surrounding the lobules and ducts, influencing the size and
shape of the breast.
- **Fascia**: The breast sits on top of the pectoral muscle, and the deep pectoral fascia separates the
breast from the muscle beneath. The superficial fascia encases the breast tissue.
**4. Vascular Supply:**
- **Blood Vessels**: The breast receives its blood supply primarily from the internal thoracic
(mammary) artery, the lateral thoracic artery, and smaller branches from the intercostal arteries. This
blood supply provides essential nutrients and oxygen.
- **Lymphatic Vessels**: Lymphatic drainage is crucial for immune function and is connected to lymph
nodes in the axilla (armpit), around the collarbone, and within the chest. The lymphatic system also
plays a role in the spread of breast cancer.
**5. Nerves:**
- **Sensory Nerves**: The breast is innervated by branches of the 4th, 5th, and 6th intercostal nerves,
which provide sensation to the skin of the breast, nipple, and areola.
**6. Hormonal Influence:**
- **Estrogen and Progesterone**: These hormones regulate breast development during puberty, the
menstrual cycle, and pregnancy. Estrogen promotes ductal growth, while progesterone stimulates the
development of the milk-producing alveoli.
- **Prolactin and Oxytocin**: During lactation, prolactin stimulates milk production, and oxytocin
causes milk ejection (let-down reflex) from the alveoli through the ducts to the nipple.
**7. Developmental Stages:**
- **Embryonic Development**: Breast tissue begins to form in the embryo as a mammary ridge.
- **Puberty**: Under the influence of hormones, the breast tissue grows, ducts expand, and fat tissue
accumulates.
- **Pregnancy and Lactation**: The breast undergoes significant changes to prepare for milk
production and breastfeeding, with the lobules and alveoli enlarging.
- **Menopause**: Breast tissue often reduces in size and becomes less dense due to decreased
hormone levels.
These components work together to facilitate the breast's primary functions in lactation, as well as
contributing to the overall shape and sensitivity of the breast.
### Summarized Notes on the Axilla
**1. Location and Structure:**
- **Axilla**: Also known as the armpit, the axilla is the pyramidal space beneath the shoulder joint,
between the upper arm and the chest wall.
- **Boundaries**:
- **Apex**: Directed toward the neck, bordered by the clavicle, scapula, and first rib.
- **Base**: The skin and fascia of the armpit.
- **Anterior Wall**: Formed by the pectoralis major and minor muscles, and the clavipectoral fascia.
- **Posterior Wall**: Formed by the subscapularis, teres major, and latissimus dorsi muscles.
- **Medial Wall**: Formed by the serratus anterior muscle over the upper ribs.
- **Lateral Wall**: Narrow, formed by the intertubercular sulcus of the humerus.
**2. Contents of the Axilla:**
- **Axillary Artery**: A major blood vessel supplying blood to the upper limb. It is a continuation of
the subclavian artery and becomes the brachial artery past the lower border of the teres major muscle.
It has three parts:
- **First Part**: Proximal to the pectoralis minor, with one branch (superior thoracic artery).
- **Second Part**: Behind the pectoralis minor, with two branches (thoracoacromial artery and
lateral thoracic artery).
- **Third Part**: Distal to the pectoralis minor, with three branches (subscapular artery, anterior and
posterior circumflex humeral arteries).
- **Axillary Vein**: A large vein that runs alongside the axillary artery, draining blood from the upper
limb back to the heart. It receives blood from the cephalic vein, basilic vein, and smaller tributaries.
- **Brachial Plexus**: A network of nerves that originate from the spinal cord (C5-T1) and innervate
the muscles and skin of the shoulder, arm, and hand. It has roots, trunks, divisions, cords, and terminal
branches.
- **Roots**: C5-C8, T1.
- **Trunks**: Upper, middle, and lower trunks.
- **Divisions**: Anterior and posterior divisions of each trunk.
- **Cords**: Lateral, medial, and posterior cords named according to their position relative to the
axillary artery.
- **Terminal Branches**: Includes the musculocutaneous nerve, median nerve, ulnar nerve, radial
nerve, and axillary nerve.
- **Axillary Lymph Nodes**: A group of lymph nodes that play a critical role in the immune system and
in the spread of cancer, especially breast cancer. They are grouped into five levels:
- **Pectoral (Anterior) Nodes**: Near the lower border of the pectoralis minor, receive lymph from
the anterior thoracic wall and breast.
- **Subscapular (Posterior) Nodes**: Near the subscapularis muscle, receive lymph from the back
and shoulder.
- **Humeral (Lateral) Nodes**: Along the axillary vein, receive lymph from the upper limb.
- **Central Nodes**: Embedded in the fat of the axilla, receive lymph from the pectoral, subscapular,
and humeral nodes.
- **Apical Nodes**: At the apex of the axilla, near the first rib, receive lymph from all other axillary
nodes and drain into the subclavian lymph trunk.
- **Axillary Fat**: Fills the axillary space and provides padding around the vessels, nerves, and lymph
nodes.
**3. Functions of the Axilla:**
- **Pathway for Neurovascular Structures**: The axilla serves as a conduit for nerves and blood
vessels that supply the upper limb.
- **Lymphatic Drainage**: Axillary lymph nodes filter lymphatic fluid from the upper limb, chest wall,
and breast, playing a key role in immune defense and the spread of diseases like breast cancer.
- **Muscle Attachment**: Muscles surrounding the axilla, such as the pectoralis major and latissimus
dorsi, contribute to the movement of the shoulder and arm.
**4. Clinical Relevance:**
- **Lymph Node Biopsy**: Often performed in cases of breast cancer to assess the spread of the
disease.
- **Axillary Artery Injury**: Can lead to significant bleeding and require surgical intervention.
- **Brachial Plexus Injury**: Can result in loss of motor function or sensation in the upper limb.
The axilla is a vital region that contains key structures necessary for the function and movement of the
upper limb, as well as important components of the vascular and lymphatic systems.
### Summarized Notes on the Pectoral Region
**1. Location and Boundaries:**
- **Pectoral Region**: The area on the anterior (front) part of the thoracic (chest) wall.
- **Boundaries**:
- **Superior**: Clavicle (collarbone).
- **Inferior**: Rib cage (lower border of the pectoralis major muscle).
- **Medial**: Sternum (breastbone).
- **Lateral**: Axilla (armpit).
**2. Muscles of the Pectoral Region:**
- **Pectoralis Major**:
- **Origin**: Clavicular head (medial half of the clavicle) and sternocostal head (sternum, upper six
costal cartilages, and aponeurosis of the external oblique muscle).
- **Insertion**: Lateral lip of the intertubercular sulcus of the humerus.
- **Function**: Adducts and medially rotates the humerus; clavicular head flexes the humerus;
sternocostal head extends the humerus from a flexed position.
- **Innervation**: Medial and lateral pectoral nerves (C5-C7 for the clavicular head, C8-T1 for the
sternocostal head).
- **Blood Supply**: Branches of the thoracoacromial artery and lateral thoracic artery.
- **Pectoralis Minor**:
- **Origin**: 3rd to 5th ribs near their costal cartilages.
- **Insertion**: Coracoid process of the scapula.
- **Function**: Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall.
- **Innervation**: Medial pectoral nerve (C8, T1).
- **Blood Supply**: Thoracoacromial artery (pectoral branch).
- **Subclavius**:
- **Origin**: Junction of the 1st rib and its costal cartilage.
- **Insertion**: Inferior surface of the middle third of the clavicle.
- **Function**: Anchors and depresses the clavicle.
- **Innervation**: Nerve to subclavius (C5, C6).
- **Blood Supply**: Clavicular branch of the thoracoacromial artery.
- **Serratus Anterior**:
- **Origin**: External surfaces of the lateral parts of the 1st to 8th ribs.
- **Insertion**: Anterior surface of the medial border of the scapula.
- **Function**: Protracts the scapula and holds it against the thoracic wall; rotates the scapula
upward.
- **Innervation**: Long thoracic nerve (C5-C7).
- **Blood Supply**: Lateral thoracic artery.
**3. Fascia of the Pectoral Region:**
- **Pectoral Fascia**: Encloses the pectoralis major muscle and is continuous with the axillary fascia
laterally and the abdominal fascia inferiorly.
- **Clavipectoral Fascia**: Located deep to the pectoralis major, it encloses the pectoralis minor and
subclavius muscles, and extends from the clavicle to the axillary fascia. It also forms part of the
suspensory ligament of the axilla.
**4. Neurovascular Structures:**
- **Thoracoacromial Artery**: A branch of the axillary artery, it supplies the pectoral muscles, deltoid,
acromion, and clavicle. It has four branches: pectoral, deltoid, acromial, and clavicular.
- **Lateral Thoracic Artery**: Another branch of the axillary artery that supplies the serratus anterior,
pectoral muscles, and the breast.
- **Medial and Lateral Pectoral Nerves**: Innervate the pectoralis major (both nerves) and pectoralis
minor (medial nerve).
**5. Function of the Pectoral Region:**
- **Upper Limb Movement**: The pectoral muscles, particularly the pectoralis major, are involved in
movements of the shoulder joint, including adduction, medial rotation, and flexion of the arm.
- **Scapular Stabilization**: The pectoralis minor and serratus anterior stabilize the scapula during
arm movements.
- **Breast Support**: The pectoral region provides a structural foundation for the breast, with the
pectoral fascia serving as a support for breast tissue.
**6. Clinical Relevance:**
- **Pectoral Muscle Injury**: Common in athletes, especially during activities like weightlifting. A tear
in the pectoralis major can lead to loss of arm function and require surgical repair.
- **Winged Scapula**: A condition where the scapula protrudes outwards due to paralysis of the
serratus anterior, typically caused by injury to the long thoracic nerve.
- **Thoracic Outlet Syndrome**: Compression of neurovascular structures passing through the
pectoral region, leading to symptoms like pain, numbness, and weakness in the upper limb.
The pectoral region plays a critical role in the movement and function of the upper limb, as well as
providing structural support to the chest and breast. It contains vital muscles, nerves, and blood vessels
that are essential for both everyday activities and athletic performance.
### Summarized Notes on the Arm (Brachium)
**1. Location and Segmentation:**
- **Arm (Brachium)**: The region between the shoulder and the elbow joint.
- **Segments**:
- **Anterior (Flexor) Compartment**: Contains muscles primarily involved in flexion of the elbow.
- **Posterior (Extensor) Compartment**: Contains muscles primarily involved in extension of the
elbow.
**2. Bones:**
- **Humerus**: The only bone in the arm. It articulates proximally with the scapula at the shoulder
joint (glenohumeral joint) and distally with the radius and ulna at the elbow joint.
**3. Joints:**
- **Shoulder Joint (Glenohumeral Joint)**: A ball-and-socket joint formed between the humeral head
and the glenoid cavity of the scapula.
- **Elbow Joint**: A hinge joint formed by the humerus, radius, and ulna, allowing for flexion and
extension of the forearm.
**4. Muscles:**
**Anterior Compartment:**
- **Biceps Brachii**:
- **Origin**: Short head from the coracoid process of the scapula; long head from the supraglenoid
tubercle of the scapula.
- **Insertion**: Radial tuberosity and the fascia of the forearm via the bicipital aponeurosis.
- **Function**: Flexes the elbow and supinates the forearm; also assists in shoulder flexion.
- **Innervation**: Musculocutaneous nerve (C5-C6).
- **Blood Supply**: Brachial artery.
- **Brachialis**:
- **Origin**: Distal half of the anterior surface of the humerus.
- **Insertion**: Coronoid process and tuberosity of the ulna.
- **Function**: Primary flexor of the elbow.
- **Innervation**: Musculocutaneous nerve (C5-C6).
- **Blood Supply**: Brachial artery.
- **Coracobrachialis**:
- **Origin**: Coracoid process of the scapula.
- **Insertion**: Medial surface of the humerus.
- **Function**: Flexes and adducts the arm at the shoulder joint.
- **Innervation**: Musculocutaneous nerve (C5-C7).
- **Blood Supply**: Brachial artery.
**Posterior Compartment:**
- **Triceps Brachii**:
- **Origin**: Long head from the infraglenoid tubercle of the scapula; lateral head from the posterior
surface of the humerus above the radial groove; medial head from the posterior surface of the humerus
below the radial groove.
- **Insertion**: Olecranon of the ulna.
- **Function**: Primary extensor of the elbow; long head also assists in shoulder extension and
adduction.
- **Innervation**: Radial nerve (C6-C8).
- **Blood Supply**: Deep brachial artery (profunda brachii).
- **Anconeus**:
- **Origin**: Lateral epicondyle of the humerus.
- **Insertion**: Lateral aspect of the olecranon and superior part of the posterior ulna.
- **Function**: Assists in elbow extension and stabilizes the elbow joint.
- **Innervation**: Radial nerve (C7-T1).
- **Blood Supply**: Deep brachial artery.
**5. Neurovascular Structures:**
**Nerves:**
- **Musculocutaneous Nerve**: Innervates the anterior compartment muscles and provides sensation
to the lateral forearm.
- **Radial Nerve**: Innervates the posterior compartment muscles and provides sensation to the
posterior arm and forearm.
- **Median and Ulnar Nerves**: Pass through the arm but do not innervate any muscles there; they
continue into the forearm and hand.
**Arteries:**
- **Brachial Artery**: The main artery of the arm, a continuation of the axillary artery. It supplies the
arm and divides into the radial and ulnar arteries at the elbow.
- **Deep Brachial Artery (Profunda Brachii)**: A major branch that supplies the posterior
compartment and travels with the radial nerve in the radial groove.
- **Collateral Arteries**: Provide blood supply around the elbow joint.
**Veins:**
- **Basilic Vein**: A superficial vein that drains the medial aspect of the arm and joins the brachial
veins to form the axillary vein.
- **Cephalic Vein**: A superficial vein that drains the lateral aspect of the arm and empties into the
axillary vein.
- **Brachial Veins**: Deep veins accompanying the brachial artery, merging with the basilic vein to
form the axillary vein.
**6. Fascial Compartments:**
- **Brachial Fascia**: A deep fascia that surrounds the arm, separating it into anterior and posterior
compartments.
- **Medial and Lateral Intermuscular Septa**: Extensions of the brachial fascia that divide the arm
into its respective compartments.
**7. Clinical Relevance:**
- **Fractures**: Common in the humerus, especially at the surgical neck, midshaft, or supracondylar
regions, potentially affecting nearby nerves like the radial nerve.
- **Biceps Tendon Rupture**: Can occur, especially in older adults or athletes, leading to a "Popeye"
deformity.
- **Compartment Syndrome**: Increased pressure within the arm compartments can compromise
circulation and nerve function, requiring urgent intervention.
- **Nerve Injuries**: Radial nerve injury can lead to "wrist drop" due to loss of extensor function.
The arm is essential for upper limb mobility and function, containing critical muscles, nerves, and blood
vessels that facilitate a wide range of movements from shoulder to hand.
### Summarized Notes on the Forearm (Antebrachium)
**1. Location and Overview:**
- **Forearm (Antebrachium)**: The region between the elbow and wrist, consisting of two bones
(radius and ulna) and divided into two compartments—anterior (flexor) and posterior (extensor).
**2. Bones:**
- **Radius**: Located on the lateral (thumb) side of the forearm.
- **Proximal End**: Includes the head (articulates with the capitulum of the humerus), neck, and
radial tuberosity (insertion for biceps brachii).
- **Shaft**: Features the interosseous border, where the interosseous membrane attaches.
- **Distal End**: Includes the styloid process and ulnar notch (articulates with the ulna).
- **Ulna**: Located on the medial (pinky) side of the forearm.
- **Proximal End**: Includes the olecranon (forms the elbow), coronoid process, and trochlear notch
(articulates with the humerus).
- **Shaft**: Also features an interosseous border.
- **Distal End**: Includes the head and styloid process.
- **Interosseous Membrane**: A fibrous sheet connecting the radius and ulna, dividing the forearm
into anterior and posterior compartments and allowing for the transfer of forces between the two
bones.
**3. Joints:**
- **Proximal Radioulnar Joint**: Allows rotation of the radius around the ulna for supination and
pronation.
- **Distal Radioulnar Joint**: Also allows for rotation, with the radius crossing over the ulna during
pronation.
- **Radiocarpal Joint (Wrist Joint)**: Articulation between the distal radius and the carpal bones,
allowing for wrist movement.
**4. Muscles of the Forearm:**
**Anterior Compartment (Flexors and Pronators):**
- **Superficial Layer**:
- **Pronator Teres**:
- **Function**: Pronates the forearm and assists in elbow flexion.
- **Innervation**: Median nerve (C6-C7).
- **Flexor Carpi Radialis**:
- **Function**: Flexes and abducts the wrist.
- **Innervation**: Median nerve (C6-C7).
- **Palmaris Longus**:
- **Function**: Flexes the wrist and tenses the palmar aponeurosis.
- **Innervation**: Median nerve (C7-C8).
- **Flexor Carpi Ulnaris**:
- **Function**: Flexes and adducts the wrist.
- **Innervation**: Ulnar nerve (C7-C8).
- **Intermediate Layer**:
- **Flexor Digitorum Superficialis**:
- **Function**: Flexes the proximal interphalangeal joints of the fingers and assists in wrist flexion.
- **Innervation**: Median nerve (C7-T1).
- **Deep Layer**:
- **Flexor Digitorum Profundus**:
- **Function**: Flexes the distal interphalangeal joints of the fingers.
- **Innervation**: Lateral half by the median nerve (C8-T1) and medial half by the ulnar nerve (C8-
T1).
- **Flexor Pollicis Longus**:
- **Function**: Flexes the thumb.
- **Innervation**: Anterior interosseous nerve (branch of the median nerve, C8-T1).
- **Pronator Quadratus**:
- **Function**: Pronates the forearm.
- **Innervation**: Anterior interosseous nerve (C8-T1).
**Posterior Compartment (Extensors and Supinators):**
- **Superficial Layer**:
- **Brachioradialis**:
- **Function**: Flexes the elbow, especially when the forearm is in a mid-prone position.
- **Innervation**: Radial nerve (C5-C6).
- **Extensor Carpi Radialis Longus**:
- **Function**: Extends and abducts the wrist.
- **Innervation**: Radial nerve (C6-C7).
- **Extensor Carpi Radialis Brevis**:
- **Function**: Extends and abducts the wrist.
- **Innervation**: Radial nerve (C7-C8).
- **Extensor Digitorum**:
- **Function**: Extends the fingers.
- **Innervation**: Posterior interosseous nerve (branch of the radial nerve, C7-C8).
- **Extensor Digiti Minimi**:
- **Function**: Extends the little finger.
- **Innervation**: Posterior interosseous nerve (C7-C8).
- **Extensor Carpi Ulnaris**:
- **Function**: Extends and adducts the wrist.
- **Innervation**: Posterior interosseous nerve (C7-C8).
- **Deep Layer**:
- **Supinator**:
- **Function**: Supinates the forearm.
- **Innervation**: Radial nerve (C6-C7).
- **Abductor Pollicis Longus**:
- **Function**: Abducts the thumb.
- **Innervation**: Posterior interosseous nerve (C7-C8).
- **Extensor Pollicis Brevis**:
- **Function**: Extends the thumb at the metacarpophalangeal joint.
- **Innervation**: Posterior interosseous nerve (C7-C8).
- **Extensor Pollicis Longus**:
- **Function**: Extends the thumb at the interphalangeal joint.
- **Innervation**: Posterior interosseous nerve (C7-C8).
- **Extensor Indicis**:
- **Function**: Extends the index finger.
- **Innervation**: Posterior interosseous nerve (C7-C8).
**5. Neurovascular Structures:**
**Nerves:**
- **Median Nerve**: Innervates most of the flexor muscles in the anterior compartment and the
thenar muscles in the hand.
- **Ulnar Nerve**: Innervates the flexor carpi ulnaris and the medial half of the flexor digitorum
profundus, as well as most of the small muscles in the hand.
- **Radial Nerve**: Innervates all the muscles in the posterior compartment (extensors and
supinators).
**Arteries:**
- **Radial Artery**: Travels along the lateral aspect of the forearm and is commonly used for taking
the pulse. It supplies the lateral muscles of the forearm and contributes to the deep and superficial
palmar arches in the hand.
- **Ulnar Artery**: Travels along the medial aspect of the forearm and supplies the medial muscles. It
also contributes to the superficial and deep palmar arches.
- **Anterior and Posterior Interosseous Arteries**: Branches of the ulnar artery that supply the deep
muscles of the forearm.
**Veins:**
- **Superficial Veins**: Include the cephalic, basilic, and median cubital veins, which drain the forearm
and are often used for venipuncture.
- **Deep Veins**: Accompany the arteries and eventually drain into the brachial veins.
**6. Fascial Compartments:**
- **Antebrachial Fascia**: A deep fascia that encloses the forearm and helps form the intermuscular
septa, dividing the forearm into anterior and posterior compartments.
- **Flexor Retinaculum (Transverse Carpal Ligament)**: A thickening of the antebrachial fascia on the
anterior wrist, forming the roof of the carpal tunnel.
- **Extensor Retinaculum**: A thickening of the antebrachial fascia on the posterior wrist, holding the
extensor tendons in place.
**7. Functions:**
- **Flexion and Extension**: The primary movements of the wrist and fingers, with flexors located in
the anterior compartment and extensors in the posterior compartment.
- **Pronation and Supination**: Rotation of the forearm, achieved by pronators (pronator teres and
pronator quadratus) and supinators (supinator and biceps brachii).
**8. Clinical Relevance:**
- **Fractures**: Common in the radius and ulna, especially distal radius fractures ("Colles' fracture")
from falls.
- **Carpal Tunnel Syndrome**: Compression of the median nerve as it passes through the carpal
tunnel, leading to pain, numbness, and weakness in the hand.
- **Tennis Elbow (Lateral Epicondylitis)**: Inflammation of the tendons of the extensor muscles at
their origin on the lateral epicondyle, causing pain and tenderness.
- **Golfer's Elbow (Medial Epicondylitis)**: Inflammation of the tendons of the flexor muscles at their
origin on the medial epicondyle, causing pain and tenderness.
The forearm plays
### Summarized Notes on the Brachial Plexus
**1. Overview:**
- The **brachial plexus** is a network of nerves that originates from the spinal cord in the neck and
extends through the axilla (armpit) to innervate the upper limb (shoulder, arm, forearm, and hand).
- It is responsible for motor and sensory innervation of the upper limb.
**2. Formation:**
- The brachial plexus is formed by the **ventral rami of the C5, C6, C7, C8, and T1 spinal nerves**.
- It is typically divided into **Roots, Trunks, Divisions, Cords,** and **Branches** (mnemonic:
**"Randy Travis Drinks Cold Beer"**).
**3. Structure:**
**Roots:**
- **C5, C6, C7, C8, T1**: These roots emerge from the spinal cord and form the foundation of the
brachial plexus.
**Trunks:**
- **Upper Trunk**: Formed by the union of the C5 and C6 roots.
- **Middle Trunk**: Continuation of the C7 root.
- **Lower Trunk**: Formed by the union of the C8 and T1 roots.
**Divisions:**
- Each trunk splits into an **anterior** and **posterior** division:
- **Anterior Divisions**: Generally supply flexor muscles.
- **Posterior Divisions**: Generally supply extensor muscles.
**Cords:**
- Named according to their position relative to the axillary artery:
- **Lateral Cord**: Formed by the anterior divisions of the upper and middle trunks (C5-C7).
- **Medial Cord**: Continuation of the anterior division of the lower trunk (C8-T1).
- **Posterior Cord**: Formed by the union of all three posterior divisions (C5-T1).
**Branches:**
- The terminal branches of the brachial plexus, responsible for innervating the muscles and skin of the
upper limb, include:
- **Musculocutaneous Nerve** (C5-C7): Innervates the anterior arm muscles (biceps brachii,
brachialis, coracobrachialis).
- **Axillary Nerve** (C5-C6): Innervates the deltoid and teres minor muscles.
- **Radial Nerve** (C5-T1): Innervates the posterior arm and forearm muscles (extensors).
- **Median Nerve** (C5-T1): Innervates most of the flexor muscles in the forearm and the thenar
muscles in the hand.
- **Ulnar Nerve** (C8-T1): Innervates the flexor carpi ulnaris, the medial half of the flexor digitorum
profundus, and most small muscles in the hand.
**4. Supraclavicular Branches (from the Roots and Trunks):**
- **Dorsal Scapular Nerve** (C5): Innervates the rhomboids and levator scapulae.
- **Long Thoracic Nerve** (C5-C7): Innervates the serratus anterior.
- **Suprascapular Nerve** (C5-C6): Innervates the supraspinatus and infraspinatus.
- **Nerve to Subclavius** (C5-C6): Innervates the subclavius muscle.
**5. Infraclavicular Branches (from the Cords):**
- **Lateral Pectoral Nerve** (C5-C7): Innervates the pectoralis major.
- **Medial Pectoral Nerve** (C8-T1): Innervates the pectoralis major and minor.
- **Medial Cutaneous Nerve of Arm** (C8-T1): Provides sensory innervation to the medial arm.
- **Medial Cutaneous Nerve of Forearm** (C8-T1): Provides sensory innervation to the medial
forearm.
- **Upper Subscapular Nerve** (C5-C6): Innervates the subscapularis muscle.
- **Lower Subscapular Nerve** (C5-C6): Innervates the subscapularis and teres major muscles.
- **Thoracodorsal Nerve** (C6-C8): Innervates the latissimus dorsi.
**6. Clinical Relevance:**
- **Injuries to the Brachial Plexus** can result in weakness or paralysis of the upper limb, depending
on the location and severity of the injury:
- **Erb's Palsy**: Injury to the upper trunk (C5-C6), leading to weakness in the shoulder and upper
arm ("waiter's tip" position).
- **Klumpke's Palsy**: Injury to the lower trunk (C8-T1), leading to weakness in the hand and
forearm ("claw hand").
- **Thoracic Outlet Syndrome**: Compression of the brachial plexus as it passes through the thoracic
outlet, causing pain and neurological symptoms in the upper limb.
The brachial plexus is essential for the function and sensation of the upper limb, and its complex
structure provides robust and diverse innervation for a wide range of movements.
### Summarized Notes on the Hand
**1. Overview:**
- The hand is a highly specialized structure at the distal end of the forearm, consisting of bones,
muscles, tendons, nerves, and blood vessels. It is divided into three main regions: the wrist (carpus), the
palm (metacarpus), and the fingers (phalanges).
**2. Bones:**
- **Carpal Bones (Wrist)**: 8 small bones arranged in two rows:
- **Proximal Row (lateral to medial)**: Scaphoid, Lunate, Triquetrum, Pisiform.
- **Distal Row (lateral to medial)**: Trapezium, Trapezoid, Capitate, Hamate.
- **Metacarpal Bones**: 5 bones (I-V), one for each digit, forming the palm.
- **Phalanges**: 14 bones in total:
- **Proximal Phalanges**: 5 (one for each digit).
- **Middle Phalanges**: 4 (absent in the thumb).
- **Distal Phalanges**: 5 (one for each digit).
**3. Joints:**
- **Wrist Joint (Radiocarpal Joint)**: Articulation between the distal radius and the proximal carpal
bones (scaphoid, lunate, triquetrum), allowing flexion, extension, abduction, and adduction of the hand.
- **Intercarpal Joints**: Joints between the carpal bones, allowing limited gliding movements.
- **Carpometacarpal (CMC) Joints**: Joints between the distal carpal bones and the metacarpals; the
thumb CMC joint (between the trapezium and the first metacarpal) allows significant movement for
opposition.
- **Metacarpophalangeal (MCP) Joints**: Joints between the metacarpals and the proximal
phalanges, allowing flexion, extension, abduction, and adduction of the fingers.
- **Interphalangeal (IP) Joints**: Hinge joints between the phalanges, allowing flexion and extension.
- **Proximal IP (PIP) Joints**: Between the proximal and middle phalanges.
- **Distal IP (DIP) Joints**: Between the middle and distal phalanges.
**4. Muscles of the Hand:**
- **Intrinsic Muscles**: Muscles that originate and insert within the hand, providing fine motor
control.
- **Thenar Muscles (Thumb)**
- **Abductor Pollicis Brevis**: Abducts the thumb.
- **Flexor Pollicis Brevis**: Flexes the thumb.
- **Opponens Pollicis**: Opposes the thumb.
- **Innervation**: Median nerve.
- **Hypothenar Muscles (Little Finger)**
- **Abductor Digiti Minimi**: Abducts the little finger.
- **Flexor Digiti Minimi Brevis**: Flexes the little finger.
- **Opponens Digiti Minimi**: Opposes the little finger.
- **Innervation**: Ulnar nerve.
- **Lumbricals**: Flex the MCP joints and extend the IP joints.
- **Innervation**: Lateral two by the median nerve, medial two by the ulnar nerve.
- **Interossei**: Dorsal interossei abduct the fingers (DAB), palmar interossei adduct the fingers
(PAD).
- **Innervation**: Ulnar nerve.
- **Adductor Pollicis**: Adducts the thumb.
- **Innervation**: Ulnar nerve.
- **Extrinsic Muscles**: Muscles that originate in the forearm and insert in the hand, providing
strength and gross motor control.
- **Flexor Tendons**:
- **Flexor Digitorum Superficialis (FDS)**: Flexes the PIP joints.
- **Flexor Digitorum Profundus (FDP)**: Flexes the DIP joints.
- **Flexor Pollicis Longus**: Flexes the thumb.
- **Extensor Tendons**:
- **Extensor Digitorum**: Extends the MCP joints.
- **Extensor Indicis**: Extends the index finger.
- **Extensor Digiti Minimi**: Extends the little finger.
- **Extensor Pollicis Longus and Brevis**: Extend the thumb.
**5. Nerves:**
- **Median Nerve**: Innervates the thenar muscles and the lateral two lumbricals; provides sensation
to the palmar side of the thumb, index, middle, and lateral half of the ring finger.
- **Ulnar Nerve**: Innervates most of the intrinsic muscles (except thenar and lateral lumbricals);
provides sensation to the medial half of the ring finger and the little finger.
- **Radial Nerve**: Provides sensation to the dorsal hand and innervates the extensor muscles in the
forearm.
**6. Blood Supply:**
- **Radial Artery**: Supplies the lateral aspect of the hand, contributes to the deep palmar arch.
- **Ulnar Artery**: Supplies the medial aspect of the hand, contributes to the superficial palmar arch.
- **Palmar Arches**: Formed by the anastomosis of the radial and ulnar arteries, with branches that
supply the fingers (digital arteries).
**7. Fascial Structures:**
- **Palmar Aponeurosis**: A thickened, triangular fascia covering the central palm, protecting the
underlying structures.
- **Flexor Retinaculum (Transverse Carpal Ligament)**: Forms the roof of the carpal tunnel.
- **Extensor Retinaculum**: Holds the extensor tendons in place at the wrist.
**8. Function:**
- **Grip and Manipulation**: The hand is capable of power grip (using the entire hand) and precision
grip (using the fingers and thumb).
- **Opposition**: The thumb’s ability to oppose the fingers allows for complex movements and
manipulation of objects.
- **Sensation**: The hand has a rich sensory nerve supply, crucial for tactile feedback and fine motor
tasks.
**9. Clinical Relevance:**
- **Carpal Tunnel Syndrome**: Compression of the median nerve under the flexor retinaculum,
causing pain, numbness, and weakness in the hand.
- **Dupuytren's Contracture**: Thickening of the palmar aponeurosis, leading to flexion contractures
of the fingers.
- **Trigger Finger**: Inflammation of the flexor tendons, causing a finger to catch or lock in a bent
position.
- **Fractures**: Commonly involve the scaphoid (wrist), metacarpals, or phalanges.
The hand's complex anatomy allows for a wide range of movements and functions, from gross motor
tasks to delicate manipulations, making it one of the most versatile and essential structures in the
human body.
