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Bones of Upper Limb

Appendicular Skeleton
Pectoral Girdle =
scapula,clavicle
Upperlimb
Arm: humerus
Forearm: radius, ulna
Interosseus membrane

Hand: carpals,
metacarpals, phalanges

Joints of Upper Extremity


Sternoclavicular
Synovial of saddle
Diarthrosis

Acromioclavicular
Synovialof plane
Diarthrosis

Shoulder joint
(Glenohumeral j )
Synovial of
ball&socket
Many ligaments
Muscle
reinforcement
Great Mobility !

Joints of the Upper Limb


Elbow Joint :
Synovial of
hinge

Articulations
Humerus
with Ulna &
Radius

Collateral
Ligaments

Joints of Upper
Limb
Sup.Radioulnar joint
Synovial of pivot

Inf. Radioulnar joint


Synovial pivot

Allows pronation
and supination of
forearm

Joints of the
Upper Limb

Radiocarpal joint
Synovial of
condyloid
Distal radius with
scaphoid and Lunate
Intercarpal joints
Synovial of plane
Carpometacarpal (2-5)
Synovial of plane
Trapezium-metacarpal
1
Synovial of saddle
Metacarpo-phalangeal
Synovial of
condyloid
Interphalangeal
Synovial of hinge

Review of Naming
What do the following names TELL you about the muscle?

Naming
Flexor carpi ulnaris
Flexor digitorum
superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis
brevis

Muscles
of
Scapula

If ORIGIN on scapula = Move


Arm
Subscapularis
Rotator
Supraspinatus
Cuff

Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial O on scap)
Coracobrachialis

If INSERTION on scapula =
Move

scapula

Rhomboids
Trapezius
Pectoralis Minor
Serratus Ventralis
Levator Scapulae

Nerve supply of Scapula


Muscles

Origin on Scapula:

Latissimus dorsi = Thoracodorsal nerve


Subscapularis, Teres Major = Subscapular
nerves
Supraspinatus, Infraspinatus = Suprascapular
nerves
Teres Minor = Axillary nerve

Insertion on Scapula
Levator Scapular, Rhomboids = Dorsal
Scapular nerve
Pectoralis Minor = Pectoral n.
Serratus Ventralis = Long Thoracic n.
Trapezius = Accessory n.

Muscles of Arm:

Cross elbow, Move


forearm
2 Compartments
Anterior: Flexors of forearm
Posterior: Extensors of forearm

Anterior Compartment
Biceps brachii =
Brachialis
=
Brachioradialis =

MC nerve
MC nerve
Radial nerve
Coracobrachialis = MC nerve
O = coracoid process of scapula
I = medial side humeral shaft
A = flex, adduct arm

Posterior Compartment
Triceps brachii =
Anconeus
=

Radial nerve
Radial nerve

N.B. MC = musclocutaneous nerve

Muscles of forearm:

Cross wrist

& finger
joints, flexes hand
& Cross
Wrist = flex, extend, abduct, adduct hand
fingers
Cross Fingers = flex, extend fingers
Most muscles fleshy proximally, long tendons
distally
Flexor + Extensor Retinacula :
The retinaculum is a thick band of deep fascia has
bony attachment ; it keeps tendons in position during
movements
Under the retinaculum, tendons are surrounded by
synovial sheathes

Compartments of the
forearm :
1.Anterior
Flexor Compartment :
(Superficial +
Deep layers)

Most of superficial flexors


originate by a common origin
from medial epicondyle
Contains 2 pronators, are
supplied by
Median and Ulnar

Anterior Compartment of
Forearm s
Muscle

Nerve

Superficial Muscles

Flexor digitorum superficialis


Flexor carpi radialis Median
Pronator teres Median
Palmaris longus Median
Flexor carpi ulnaris
Ulnar

Median

Deep Muscles
Pronator quadratus Median
Flexor pollicis longus Median
Flexor digitorum profundus
Ulnar (med
1/2)
Median (lat 1/2)

Anterior Compartment
Forearm
Medial Epicondyle
Brachioradialis
Pronator Teres
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Flexor Retinaculum

Anterior View

Flexor Digitorum Superficialis


is deep to other flexors

Posterior Compartment of
Forearm
Muscle

Nerve

Superficial
Extensor carpi radialis longus
Extensor digitorum
Radial
Extensor carpi ulnaris Radial

Radial

Deep
SupinatorRadial
Abductor pollicis longus
Radial
Extensor pollicis longus + brevis
Radial
Extensor indicus
Radial

Posterior Compartment of
Forearm

Lateral Epicondyle
Extensor digitorum
Extensor carpi ulnaris

Posterior View

Brachioradialis
Ext Carpi Radialis Longus

Muscles of Hand
Muscle

Nerve

Pinky (little finger)


All digiti minimi
Ulnar
Abductor, Opponens)

(Flexor,

Thumb
Abductor pollicis brevisMedian
Flexor pollicis brevis
Median
Opponens pollicis Median
Adductor pollicis Ulnar

Other Intrinsic Muscles


Palmar & Dorsal Interossei Ulnar
4 Lumbricals Median, Ulnar

Muscles of Hand
Palmar
Interossei

Dorsal
Interossei

ADDuction

ABduction

Lumbricals
3rd
2nd

4th

1st

Interossei help the lumbricals to extend I P joints and flex MC-P joints

Blood Supply of U.L: 1. The


Veins
SUPERFICIAL
Cephalic (arm-forearm)
Basilic (arm-forearm)
Median Cubital (elbow)
Median Vein
SF. Palmar Venous Arch
Digital

DEEP
Subclavian (neck)
Axillary (axilla)
Brachial (arm-elbow)
Radial (forearm)
Ulnar (forearm)
Deep Palmous Venous arch

Blood Supply of the U.L:


2.Arteries
Subclavian A
(neck)
Axillary A (armpit)
Subscapular A

Brachial A (arm)
Deep brachial

Radial A (forearm)
Ulnar A (forearm)
Common
Interosseous A

Superficial & Deep


Palmar arches

Axilla =
Armpit

Region between arm and chest


Boundaries
Ventral - pectoral muscles
Dorsal = latissimus dorsi, teres major
subscapularis
Medial = serratus ventralis
Lateral = bicipital groove of humerus

Contents
Axillary lymph nodes, Axillary vessels
Brachial Plexus

The Axilla

Surface Anatomy of Upper


Limb
Biceps + Triceps brachii

Olecrenon Process
Medial Epicondyle
Cubital Fossa

Anterior surface elbow


Contents
Median Cubital Vein
Brachial Artery
Median Nerve

Boundaries
Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles

Surface
Anatomy of
Upper Limb

Carpal Tunnel
Carpals concave
anteriorly
Carpal ligament covers it
Contains: long tendons,
Median nerve
Inflammation of tendons
= compression of Median
nerve

Anatomical Snuffbox
Lateral = E. pollicis brevis
Medial = E. pollicis
longus
Floor = scaphoid, styloid
of radius
Contains Radial Artery
(pulse)

Brachial
Plexus

Network of nerves
starts in in the neck,
then to the axilla
Is motor to muscles of
upper limb except
trapezius
Sensory to skin of U.L
except tip of shoulder
& upper part of skin
covers deltoid.
Root value :
C5,6,7,8,T1

Where Ventral Rami Come


From
Dorsal Root
Dorsal Ramus of
spinal nerve

Ventral Ramus
of spinal nerve
spinal nerve
Ventral Root

Structure of the Spinal


nerve

Parts of Brachial Plexus

Really Tired? Drink Coffee


Buddy!

R = ROOTS (ventral rami)


T = TRUNKS
D = DIVISIONS
C = CORDS
B = BRANCHES

Roots join to form Trunks!


(in neck)
Ventral Rami Trunks

C5
C6
C7
C8
T1

Upper Trunk
Middle Trunk
Lower Trunk

Trunks Split to form


Divisions
:
(in neck)
Trunks
Divisions

Upper

Middle

Lower

Anterior
Posterior
Anterior
Posterior
Anterior
Posterior

Divisions Join to form Cords!


Trunks

U
M

Divisions

A
P
A
P

A
P
CORD

(in

axilla)
Cords

LATERAL CORD

MEDIAL CORD

POSTERIOR

Cords Give off Branches!!


axilla)

Lateral Musculocutaneous
Median
Medial Ulnar
Posterior Radial Axillary
(thoracodorsal) (subscapular)

(in

Parts of the brachial


plexus..

Injury of the brachial


plexus

Branches of the Posterior


Cord

Radial Nerve :

( is the largest branch of the post. cord)


Course: Through arm, spiral groove of the humerus,
then in front of lat. epicondyle, then divides :

Divides in the forearm to give :


Superficial = skin of arm and dorsolateral surface of
hand
Deep ( post interosseus nerve ) = extensor muscles of
forearm
(eg E. carpi radialis
L , B., )

Innervates: posterior muscles of arm


Triceps brachii, anconeus, supinator,
brachioradialis
Sensory :, skin of back

The Radial nerve


1.from post. cord
2.artificai
triangular space
3.spiral groove
4.pireces lat.
I.M.S
5.in front of lat.
epicondyle, and
divides into :
..

Damage to Radial Nerve = wrist drop


Inability to extend the hand

Branches of the Posterior Cord


(continued)
Axillary Nerve ( w . Circumflex vs..)
Supplies:
Deltoid and Teres minor (motor supply )
Capsule of shoulder
skin of lower part covering deltoid (sensory
supply)

Subscapular Nerves

{branches of C5 + C6 rami}

Innervates: Subscapularis, Teres major

Thoracodorsal Nerve (runs w. thoracodorsal


vs)
supplies: Latissimus
dorsi

The brachial
plexus

The Lateral Cord gives :


.Lat. Root of median nerve
.Lat.pectoral nerve
Musculocutaneous :
Course: branches to arm, distal to
elbow becomes cutaneous
:sensory to skin of lateral side of
forearm .
Motor :
Biceps brachii, brachialis,
coracobrachialis

The Median nerve


The Median nerve : is formed by 2 roots :..
Course: middle of brachial plexus, distal to elbow
provides many branches to most forearm flexors, passes
through carpal tunnel to hand to lateral palmar intrinsics

Motor supply to: most muscles of anterior of the


forearm flexors
thenar eminence (thumb), lat.2
Lumbrichals

Sensory : skin of lateral 2/3 of palm ,lat. Three &


half fingers to back of middle phalanges
Nerve Damage = Ape Hand
Inability to Oppose Thumb

The median nerve

The median nerve : C5,6,7,8,T1


.Is formed by

2 roots

.Has 3 relations w.
brachial A
.Enters forearm by
piercing pronator
teres( supplies it 1st )
.Enters hand deep to
flexor
retinaculum
( Carpal
tunnel )
. In the it gives deep &
superficial branches

The median nerve

Branches of the Medial


Cord : 5

The Ulnar nerve :

Course: runs along medial side of arm, behind


medial epicondyle ( site of its injury )
Enters the hand :superficial to flexor retinaculum .

Supplies :
Motor :FCU and medial part of FDP (in forearm1
1/2)
Ms. Of hand except 5
Skin of medial 1/3 of hand Ant +Post + medial
one & half fingers
Nerve Damage: Partial Claw hand
Inability to extend fingers at interphalangeal
joints, results in permanent flexion = claw

The Ulnar nerve


C7,8,T1

Ulnar nerve injury : Partial


Claw hand

Dermatomal supply of
the hand