UPPER EXTREMITY:

Upper Arm, Forearm,

Wrist & Hand

AXEL LANGUIDO ELISES, MD, FPSGS, FPALES, FPCS, PATOS

Learning Objectives
Objectives
 To identify & differentiate the different
bones of the upper extremity
 To describe and trace the blood &
lymphatic supplies of the upper
extremity
 To describe & differentiate the different
joints of the upper extremity
 To describe the cutaneous nerves of the
upper extremity & relate it to its sensory
innervation Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Course Outline
 Bones of Upper  Joints
Extremity  Glenohumeral joint
 Upper arm  Elbow joint
 Humerus  Wrist joint
 Forearm  Hand joints
 Radius  Carpal
 Ulnar  Metacarpal

 Hand  Interphalanges

 Carpal
 Metacarpal

 Phalanges Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Course Outline
 Blood & Lymphatic  Cutaneous nerves
Supply of Upper of the Upper
Extremity Extremity
 Arterial
 Venous
 Lymphatics

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 Upper Limb
 Shoulder girdle
 Humerus
 Radius
 Ulna
 Carpal
 Metacarpal
 Phalanges

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
Upper Arm
1. Humerus
 longest, largest
 upper end:
A. Head
A. Greater Tuberosity
 superior, lateral projection
 SIT muscles, Pectoralis major
B. Lesser Tuberosity
 inferior, anterior projection
 Subscapularis, Teres major
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
C. Intertubercular groove/ sulcus
 Bicipital groove
 for long head of Bicep brachii
 latissimus dorsi attachment
B. Anatomical Neck
C. Surgical Neck
 Axillary nerve

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 shaft:
 3 borders, 2 surfaces
A. Deltoid Tuberosity
 lateral aspect, rough surface
 attachment for Deltoid muscles
B. Radial groove
 posterior aspect, spiral groove
 Radial nerve & Deep brachial
artery crosses
 Origin of lateral & medial triceps

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 distal end:
 Median nerve crosses anteriorly
A. Capitulum
 lateral, round knob-like process
B. Trochlea
 spool-shaped projection
 medial to the capitulum
C. Medial Epicondyle
 Ulnar nerve; “funny bone”
D. Lateral Epicondyle
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
E. Radial fossa
 lateral, anterior depression
F. Coronoid fossa
 medial, anterior depression
 receives the coronoid process of
the ulna during forearm flexion
G. Olecranon fossa
 posterior depression
 receives the olecranon process
of the ulna during forearm
extension
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
Forearm
1. Radius
 lateral
 proximal end:
A. Head
 articulates with capitulum of
humerus & radial notch of ulna
B. Neck

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
C. Radial Tuberosity
 medial & below to neck
 attachment for biceps brachii

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 shaft:
 3 surface (anterior, posterior, lateral)
 3 borders (anterior, posterior, medial)
A. Interosseous margin
 attachment of interosseous membrane

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 distal end:
 broader than the proximal end
 wide articulation with carpals
 5 surfaces:
 anterior (smooth)
 posterior (grooves), medial to lateral:
 Extensor digitorum & indicis
 Extensor pollicis longus
 Extensor carpi radialis longus &
brevis
 lateral, medial, inferior

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
A. Ulnar notch
 distal articulation with ulna
B. Styloid process
 large lateral distal projection

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
2. Ulna
 longer than radius
 proximal end:
A. Olecranon
 large, prominent end
 “tip of your elbow”
 attachment of Triceps
B. Coronoid Process
 anterior “lip” of proximal ulna

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
C. Ulnar tuberosity
 Brachialis muscle attachment
D. Trochlear notch
 deep fossa that receives the trochlea
of humerus during elbow flexion
E. Radial notch

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 shaft:
A. Interosseous margin
B. Supinator crest
 ridge on lateral surface,
 inferior to the radial notch
C. Supinator fossa
 between the coronoid process &
the crest

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
 distal end:
 tapers
 does not form part of the wrist joint
but articulates with articular disc
of wrist joint
A. Head
B. Styloid process

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
Hand & Wrist
1. Carpus (8)
 wrist
 proximal row (radial to ulnar):
A. Scaphoid
 Tubercle of scaphoid
B. Lunate
C. Triquetrum
D. Pisiform
 sesamoid boneProperty
in tendon of flexor carpi ulnaris
of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: BONES
 distal row (radial to ulnar):
A. Trapezium
 articulates with:
 1st & 2nd metacarpals
 scaphoid
 trapezoid
B. Trapezoid
 articulates with:
 2nd metacarpal
 trapezium
 capitate
 scaphoid bones
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: BONES
C. Capitate
 largest bone in the carpus
 articulates with:
 3rd metacarpal
 trapezoid
 scaphoid
 lunate
 hamate

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
D. Hamate
 Hook of hamate (Humulus)
 articulates with:
 4th & 5th metacarpal
 capitate
 triquetrum

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES
3. Metacarpals (5)

3. Phalanges (14)
 3 per digit, but only 2 for the thumb

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: BONES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: JOINTS
ARTICULATING STRUCTURAL FUNCTIONAL
JOINT BONES
MOVEMENT
TYPE TYPE

Multiaxial; Flexion-
Extension,
Glenoid
Abduction-
process, Synovial;
Glenohumeral Diarthrotic Adduction,
scapula to Ball & Socket
Circumduction,
humerus
Rotation of
humerus
Humerus, Ulna, Synovial; Uniaxial: Flexion-
Elbow joint Diarthrotic Extension
Radius Hinge
Uniaxial:
Radioulnar, Synovial;
Radius, Ulna Diarthrotic Pronation-
Proximal Pivot
Supination
Radius, Ulna Uniaxial: Rotation
Radioulnar, (head of ulna, Synovial;
Diarthrotic
Distal ulnar notch of Pivot
radius)
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: JOINTS
ARTICULATING STRUCTURAL FUNCTIONAL
JOINT BONES
MOVEMENT
TYPE TYPE

Biaxial:
Flexion-Extension,
Radius,
Synovial; Abduction-
Radiocarpal Proximal Diarthrotic
Condyloid Adduction,
Carpals
Circumduction, of
Hand
Synovial;
Intercarpal Carpals Diarthrotic Gliding
Plane
Biaxial:
Flexion-Extension,
Carpo-
Trapezium, 1st Synovial; Abduction-
metacarpal of 1st Diarthrotic
metacarpal Saddle Adduction,
digit
Circumduction,
Opposition

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: JOINTS
ARTICULATING STRUCTURAL FUNCTIONAL
JOINT BONES
MOVEMENT
TYPE TYPE

Carpo-
Carpals, Synovial; Gliding of
metacarpal of Diarthrotic
Metacarpal Plane metacarpal
2nd to 5th digit

Biaxial:
Metacarpo- Flexion-Extension,
phalangeal Adjacent Synovial; Abduction-
Diarthrotic
phalanges Condyloid Adduction,
(“Knuckle”) Circumduction of
Fingers

Uniaxial:
Synovial;
Interphalangeal Carpals Diarthrotic Flexion-Extension
Hinge
of fingers

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: JOINTS

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: JOINTS

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS
Arteries
1. Brachial artery
 continuation of Axillary artery
 from Teres major, ends at neck of
radius
 terminates as radial & ulnar
arteries, behind the bicipital
aponeurosis
 accompanies median nerve &
basilic vein, in most of its course
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: VESSELS
 branches:
 Deep artery of the arm
(“profunda brachii”)
 largest
 accompanies Radial nerve
 terminal branches:
 Middle collateral artery
 Radial collateral artery
 Superior ulnar collateral artery
 accompanies Ulnar nerve
 Inferior ulnar collateral artery
 Humeral nutrient artery
 Muscular branchesProperty of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: VESSELS
2. Ulnar artery
 continuation of Brachial artery
 branches:
 Anterior recurrent ulnar artery
 Posterior recurrent ulnar artery
 Common interosseous artery
 Anterior interosseous artery
 Posterior interosseous artery
 Recurrent interosseous artery
 Palmar carpal branch
 Dorsal carpal branch
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: VESSELS
3. Radial artery
 continuation of Brachial artery
 branches:
 Radial recurrent artery
 Palmar carpal branch
 Dorsal carpal branch

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS
3. Periarticular Anastomosis of
the Elbow
 Superior ulnar collateral artery –
Posterior ulnar recurrent artery
 Inferior ulnar collateral artery – Anterior
ulnar recurrent artery
 Middle collateral branch of Deep artery of
the arm – Recurrent Interosseous artery
 Radial collateral artery – Radial recurrent
artery

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS
Superficial Veins
1. Dorsal venous arch
 tributaries : digital veins
2. Superficial palmar venous
arch
3. Cephalic vein
4. Basilic vein
5. Median Cubital vein
Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: VESSELS
6. Median Antebrachial vein
 variable
 from the dorsal base of thumb 
lateral anterior aspect of forearm,
between cephalic & basilic vein
 drains to basilic vein via Median
Basilic vein
 drains to cephalic vein via Median
Cephalic vein

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS
Deep Veins
1. Deep Palmar venous arch
2. Radial veins
3. Ulnar veins
 Anterior interosseous veins
 Posterior interosseous veins

4. Brachial veins

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: VESSELS
Lymphatics
1. Cubital Lymph node
2. Humeral/ Lateral Axillary
Lymph node
3. Apical Axillary Lymph node

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: Cut. NERVES

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS

Upper Extremity: Cut. NERVES
Nerve
Supraclavicular Clavicular & supralateral area of
C3, C4
nerve Pectoralis major
Posterior cutaneous Radial nerve branch
C5 - C8
nerve of the arm Posterior surface of the arm
Posterior cutaneous Radial nerve branch
C5 - C8
nerve of the forearm Posterior surface of the forearm
Superior lateral
Terminal branch of Axillary nerve
cutaneous nerve of C5, C6
Deltoid area, Lateral side of midarm
the arm
Inferior lateral
Radial nerve branch
cutaneous nerve of C5, C6
Inferolateral aspect of the arm
the arm
Terminal cutaneous branch of
Lateral cutaneous
C6, C7 musculocutaneous nerve
nerve of the forearm
Lateral
Property of Axelside of forearm
L. Elises, MD, FPSGS, FPALES, FPCS, PATOS
Upper Extremity: Cut. NERVES
Nerve
Medial cutaneous Medial cord of Brachial Plexus
C8 – T2
nerve of arm Medial side of arm
Lateral cutaneous branch of 2nd
Intercostobrachial
T2 intercostal nerve
nerve
Medial surface of arm
Medial cutaneous Medial cord of Brachial Plexus
C8, T1
nerve of forearm Anterior & medial surfaces of forearm

Property of Axel L. Elises, MD, FPSGS, FPALES, FPCS, PATOS