anatomy of upper limb

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anatomy of upper limb

  1. 1. ANATOMY OF UPPER LIMB BY Dr.TEJASWI DUSSA PG IN MS (ORTHO) GANDHI HOSPITAL
  2. 2. MUSCLES OF UPPER LIMB  Attachments  Nerve Suply  Blood Supply  Actions &  Clinical Testing
  3. 3. ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON  BONY CONNECTION - CLAVICLE  MUSCULAR ATTACHMENTS  Trapezius,  Latissmus Dorsi,  Levator Scapulae,  Rhomboideus Major,  Rhomboideus Minor
  4. 4. TRAPEZIUS  ORIGIN: External occipetal protuberance, Superior nuchal line of occipetal bone, Spinous processes of 7th cervical and All thoracic vertebrae  INSERTION: lateral 1/3 of clavicle, Medial margin of acromion, spine of scapula  ACTION: Elevates The Scapula , rotation of scapula, retraction of shoulder, draw the scapula downwards and Abduction Of Shoulder Beyond 90*  N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)
  5. 5. TREPEZIUS
  6. 6. LATISSIMUS DORSI  ORIGIN: posterior layer of thoraco lumbar fascia, Spinous processes of lower 6 thoracic vertebrae and Caudal most 3-4 ribs, May attach to iliac crest.  INSERTION: Intertubercular groove of the humerus.  ACTION: extends, adducts and medial rotation of arm  N.SUPPLY: THORACO DORSAL .N (C6,C7,C8)
  7. 7. LEVATOR SCAPULAE  ORIGIN: transvers processes of upper 4 cervical vertebrae.  INSERTION: medial border of the scapula superior portion.  ACTION: elevation of sup.angle of scapula and draws it medially.  N.SUPPY: C3,C4,C5 Nerves
  8. 8. RHOMBOIDUS MINOR  ORIGIN: ligamentum nuchae,spinous process of c7,t1 vertebrae  INSERTION : medial border of the scapula  ACTION : retracts, depress the scapula and fix it to thoracis wall  N.SUPPLY :Dorsal Scapular .N (C4,C5)
  9. 9. RHOMBOIDUS MAJOR  ORIGIN: Spinous process of t2-t5  INSERTION: medial border of the scapula, inf.angle  ACTION: retracts the scapula, depress the glenoid cavity and fix the scapula to the thoracis wall  N.SUPPLY: Dorsal Scapular .N (c4,c5)
  10. 10. RHOMBOIDS (c4,c5)
  11. 11. MUSCLES OF PECTORAL REGION  PECTORALIS MAJOR  PECTORALIS MINOR  SUBCLAVIUS
  12. 12. PECTORALIS MAJOR  ORIGIN: sternal half of the clavicle, Upper half of sternum, aponeurosis of ext.obl.muscle,  INSERTION : lateral lip of intertubercular sulcus  ACTIONS: adduction, medial rotation and flexion of the shoulder.  N.SUPPLY: Med & Lat Pectoral.N (C5-8,T1)
  13. 13. PECTORALIS MAJOR
  14. 14. PECTORALIS MINOR  ORIGIN: costocondral jn.of 3,4,5 ribs  INSERTION: corocoid process medial &upper surface  ACTIONS: draws the scapula forwards, depression of the shoulder.  N.SUPPLY: Med & Lat Pectoral.N (C5-C8,T1)
  15. 15. SUBCLAVIUS  ORIGIN: 1st rib at the costochondral jn.  INSERTION: subclavian groove of the clavicle  ACTION:steadies the clavicle  N.SUPPLY: N.Subclavius from upper trunk of B.P (c5,c6)
  16. 16. SERRATUS ANTERIOR  ORIGIN: outer and superior surface of the 1-8 ribs  INSERTION: superior angle, medial border and inferior angle of the scapula  ACTION: rotates scapula upwards, abduction of shoulder above 90*  N.SUPPLY: Long Thoracis.N (c5,c6,c7)
  17. 17. WINGING OF SCAPULA
  18. 18. MUSCLES OF SHOULDER GIRDLE  Deltoid  Rotator cuff muscles- Supra Spinatus Infra Spinatus, Subscapularis, Teres Minor.  Teres major
  19. 19. DELTOID  ORIGIN Lateral 1/3 clavicle, sup.surface of acromion, spine of the scapula.  INSERTION: deltoid tuberosity.  ACTION: abduction of arm, flx.&.ext of arm, med.& lat. rotation.  N.SUPPLY: Axillary.N (C5,c6)
  20. 20. DELTOID
  21. 21. SUPRASPINATUS  ORIGIN: supraspinatous fossa of the scapula  INSERTION: superior facet on the gr.tubercle of the humerus  ACTION: initiation of abduction (15*) & lat. Rotation  N.SUPPLY: Suprascapular.N From B.P (C5,C6)
  22. 22. SUPRASPINATUS
  23. 23. INFRASPINATUS  ORIGIN: infraspinatous fossa of the scapula  INSERTION: middle facet on the gr.tubercle of the humerus  ACTION: lat.rotation of shoulder, strengthen the shoulder by bracing the head of humerus.  N.SUPPLY: Suprascapular .N of B.P (C5,c6)
  24. 24. INFRASPINATUS
  25. 25. TERES MINOR  ORIGIN: lat.borderof the scapula  INSERTION: inf.facet on the gr.tubercle of the humerus  ACTION: ext.rotator & weak adductor  N.SUPPLY: Axillary .N.(C5,C6)
  26. 26. SUBSCAPULARIS  ORIGIN: medial 2/3 subscapular fossa, lat border of tha scapula  INSERTION: lesser tubercle of the humerus  ACTION: stabilise the shoulder & prevents anterior displacement of the shoulder (med. rotation, adduction of arm)  N.SUPPLY: Upper &Lower Subscapular .N (c5,c6)
  27. 27. SUBSCAPULARIS
  28. 28. ROTATOR CUFF
  29. 29. TERES MAJOR  ORIGIN: dorsal surface of the inf.angle of the scapula  INSERTION: med.lip of the intetubercular groove of the humerus  ACTION: extends the arm from flexd.position & it adducts, med.rotates the arm  N.SUPPLY: Lower Subscapular (C6,C7)
  30. 30. MOVEMENTS OF THE SHOULDER  Flexion  Extension  Abduction  Adduction  Internal rotation,  External rotation  circumduction
  31. 31. FLEXION  Pect.Mojor  Anterior Fibers Of Deltoid  Coraco brachialis
  32. 32. EXTENSION  Lattismus Dorsi  Teres Major  Posterior fibers Deltoid
  33. 33. ABDUCTION  Supraspinatous (15*)  Deltoid (15-90*)  Serratus Anterior (>90*)  Trapezius (>90*)
  34. 34. ADDUCTION  Lattismus Dorsi  Pectoralis Major  Subscapularis  Teres Minor  Teres Major  CORACO BRACHIALIS
  35. 35. INTERNAL ROTATION  Pectoralis Major  Ant.Deltoid  Subscapularis  Teres Major  Lattismus Dorsi
  36. 36. EXTERNAL ROTATION  Deltoid  Supraspinatus  Infraspinatus  Teres Minor
  37. 37. MUSCLES OF ARM  FLEXOR COMPARTMENT:  BICEPS BRACHII  CORACO BRACHIALIS  BRACHIALIS  EXTENSOR COMPARTMENT  TRICEPS
  38. 38. BICEPS BRACHII  ORIGIN: Long head: supra glenoid tubercle of the scapula Short head: apex of the coracoid process  INSERTION: Radial Tuberosity  ACTION: flexor of supinated forearm Powerful Supinator Of Partially Flexed Forearm  N.SUPPLY: musculo cutaneous.N (c5,c6)
  39. 39. BICEPS BRACHI
  40. 40. CORACO BRACHIALIS  ORIGIN: coracoid process of the scapula  INSERTION: middle of medial surface of the humerus  ACTION: flexes and adducts the arm  N.SUPPLY: musculocutaneous .N (c6,c7)
  41. 41. BRACHIALIS  ORIGIN: distal half of the anterior humerus  INSERTION :coronoid process, tuberosity of ulna  ACTION: Powerful Flexor Of Forearm  N.SUPPLY: Musculocutaneous .N (C5,C6,C7)
  42. 42. MUSCULOCUTANEOUS NERVE :C5,C6,c7 Biceps Brachii Brachialis coracobrachialis
  43. 43. TRICEPS  ORIGIN: Long head: infraglenoid tubercle of the scapula Lat.head: oblique ridge on upper surface above the radial groove Medial head: posterior surface of the humerus inf.to the radial groove INSERTION: proximal olecrenon of the ulna ACTION:extends the forearm N.SUPPLY: Radial .N.(C7,c8)
  44. 44. TRICEPS
  45. 45. MOVEMENTS AT ELBOW  FLEXION Brachialis Biceps  EXTENSION Triceps
  46. 46. MUSCLES OF FOREARM  Anterior Compartment: common flx.origin  SUPERFICIAL 1.Pronator Teres 2.Flx Carpi Ulnaris 3.Palmaris Longus 4.Flx.Carpi Radialis 5.Flx.Digitorum Superficialis (sublimus)  DEEP: 1.Flx.Digitorum Profundus 2.Flx.Pollicis Longus 3.Pronator Quadratus
  47. 47. POSTERIOR COMPARTMENT  SUPERFICIAL: 1. Anconeus 2.Brachioradialis 3.Ext.Carpi Radialis Longus 4.Ext.Carpi Radialis Brevis 5.Ext.Digitorum 6.Ext.Digiti Minimi 7.Ext.Carpi Ulnaris  DEEP 1.Abductor Pollicis Longus 2.Ext.Pollicis Brevis 3.Ext.Pollicis Brevis 4.Ext.Indicis 5.Supinator
  48. 48. PRONATOR TERES  Insertion: midway long the lateral surface of the radius  Action: pronation,flexion of forearm  N.Supply:Median.N (C6c7)
  49. 49. PRONATOR TERES
  50. 50. FLX.CARPI RADIALIS  INSERTION:base of the 2nd mc bone and slip to the bace of the 3rd MC bone  ACTION: flexion and abduction of wrist  N.SUPPLY: Median.N (c6,c7)
  51. 51. PALMARIS LONGUS  INSERTION: anterior aspect of the distal flx.retinaculum and palmar aponeurosis  ACTION: flx.the wrist, and tightens the palmar.aponeurosis  N.SUPPLY: Median. N (c6,c7)
  52. 52. FLX CARPI ULNARIS  ORIGIN: humoral head: med epicondyle Ulnar head:med.margin of the olecrenon,posterior border of the ulna  INSERTION: pisiform, hook of hamate, base of the 5th MC & flx.retinaculum  ACTION:flexes and adducts the hand  N.SUPPLY: Ulnar.N (C7,C8)
  53. 53. FLX.CARPI ULNARIS
  54. 54. FLX.DIGITORUM SUPERFICIALIS  ORIGIN: humeroulnar head: med.epicondyle of the humerus, coronoid process Radial head: sup.half of anterior aspect of the radius  INSERTION : bodies of the Middle phalanges of the medial 4 digits  ACTION: flx.of all joints it crosses  N.SUPPLY :Median .N (C7,C8,T1)
  55. 55. FLX.DIGITORUM PROFUNDUS  ORIGIN:prox.3/4 of the medial and anterior aspect of the ulna and from interosseous memb.  INSERTION:base of The Diatal phalanges of the medial 4 digits  ACTION: flx.DIP,,PIP,MP, wrist  N.SUPPLY: Medial-ulnar.N (C8,t1) Lateral-AIN Of Median.N (C8,t1)
  56. 56. FLX.DIGITORUM PROFUNDUS
  57. 57. FLX.POLLICIS LONGUS  ORIGIN: upper 3/4 of anterior surface of radius  INSERTION: base of distal phalanx of the thumb  ACTION: flexion of proximal & distal phalnx of the thumb  N.SUPPLY:AIN (C7,C8,T1)
  58. 58. FLX.POLLICIS LONGUS
  59. 59. PRONATOR QUADRATUS  ORIGIN: lower 1/4th of anterior surface of ulna  INSERTION: lower 1/4th of anterior surface of radius  ACTION :pronation  N.SUPPLY:AIN (C8,T1)
  60. 60. POSTERIOR COMPARTMENT OF FOREARM SUPERFICIAL 1.anconeus 2.Brachioradialis 3.Ext.Carpi Radialis Longus 4.Ext.Carpi Radialis Brevis 5.Ext.Digitorum 6.Ext.Digiti Minimi 7.Ext.Carpi Ulnaris DEEP 1.Abductor Pollicis Longus 2.Ext.Pollicis longus 3.Ext.Pollicis brevis 4.Ext.Indicis 5.supinator
  61. 61. ANCONEUS  ORIGIN: posterior surface of the lat.epicondyle  INSERTION:lateral surface of olecranon,body of ulna  ACTION: extension of forearm  N.SUPPLY: radial.n
  62. 62. BRACHIORADIALIS  ORIGIN: prox.2/3rd of lat.supracondylar ridge of humerus, lateral intermuscular septum  INSERTION: lat.aspect of distal radius just prox.to the styloid process  ACTION: acc.flexor of elbow  N.SUPPLY: Radial.N (C5,C6)
  63. 63. BRACHIORADIALIS
  64. 64. EXT.CARPI RADIALIS LONGUS  ORIGIN: lat.supracondylar ridge of humerus  INSERTION: base of the 2nd MC bone  ACTION: extends and abducts the hand  N.SUPPLY: Radial .N (C6,C7)
  65. 65. EXTENSOR CARPI RADIALIS BREVIS  ORIGIN: lat.epicondyle of the humerus  INSERTION: base of the 3rd MC bone  ACTION: extends and abducts the wrist  N.SUPPLY: deep br.of radial .N(c7c8)
  66. 66. EXTENSOR DIGITORUM  ORIGIN: lat epicondyle of the humerus  INSERTION: Extensor Expansions Of The Medial 4 digits  ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended  N.SUPPLY: PIN (c7,c8)
  67. 67. EXTENSOR DIGITI MINIMI  ORIGIN:lat epicondyle of the humerus  INSERTION:extensor expansion of the 5th digit  ACTION: ext.of 5th digit at MC, PIP , ext of wrist when little finger in extension  N.SUPPLY:PIN (c7,c8)
  68. 68. EXT.CARPI ULNARIS  ORIGIN:2 heads lat epicondyle of humerus, Posterior border of ulna  INSERTION:medial side of the base of the 5th MC  ACTION: extends and adducts the hand  N.SUPPLY:PIN (c7c8)
  69. 69. SUPINATOR  ORIGIN: lat epicondyle of humerus, radial collateral lig., annular lig.,supinator fossa, crest of ulna  INSERTION: lateral,posterior,anterior surface of prox 1/ 3rd 0f radius  ACTION:supination  N.Supply: deep Br.Of Radial.N (C5,c6)
  70. 70. SUPINATOR
  71. 71. ABDUCTOR POLLICIS LONGUS  ORIGIN:upper parts of the posterior surface of the radius & ulna and interosseous mem.  INSERTION:base of the 1st MC bone  ACTION: abducts,extends, lat.rotat es the thumb at carpometacarpal joint, & abducts the wrist.  N.SUPPLY:PIN (c7,c8)
  72. 72. EXTENSOR POLLICIS BREVIS  ORIGIN:posterior surface of the radius below the origin ofAbductor Pollicis longusand from interosseous mem.  INSERTION:base of the prox.phalanx of the thumb  ACTION:extends pox.phalanx of the thumb at MC joint, ext.at 1st carpometacarpal joint  N.SUPPLY:PIN (c7,c8)
  73. 73. EXT.POLLICIS LONGUS  ORIGIN: posterior surface of middle 1/3rd of ulna And interrosseous mem.  INSERTION:base of the diastal phalanx of the thumb  ACTION:extends distal phalanx of the thumb at MP joint,IP joint.and it can contribute abduction of the thumb  N.SUPPLY:PIN (c7,c8).
  74. 74. EXTENSOR INDICIS  Origin:posterior surface of ulna m/3rd below the EPL  Insertion:extensor expansion of the 2nd finger  Action: ext of index finger and wrist.  N.supply:PIN (c7,c8)
  75. 75. EXM.MOVEMENTS OF FOREARM MUSCLES  Flexion  Extension  Adduction  Abduction AT RADIO ULNAR JOINT  Supination  pronation
  76. 76. FLEXION pronator teres Flx.carpi radialis Flx.carpi ulnaris Flx.digitorum superficialis Flx. Digitorum profundus Palmaris longus brachioradialis
  77. 77. EXTENSION  Anconeus  Ext.Carpi Radialis       Longus Ext.Carpi Radialis Brevis Ext.Digitorum Ext.Indisis Ext.Carpi Ulnaris Ext. Digiti Minimi Abductor Pollicis Longus
  78. 78.  ADDUCTION flexor carpi ulnaris extensor carpi ulnaris  ABDUCTION flx.carpi radialis ext.carpi radialis longus Ext.carpi radialis brevis Abductor pollicis longus
  79. 79.  PRONATION pronator teres Pronator quadratus  SUPINATION biceps supinator
  80. 80. INTRINSIC MUSCLES OF THE HAND
  81. 81.  Thenar muscles     abductor pollicis brevis flx.pollicis brevis opponens pollicis Adductor pollicis Hypothenar muscles- palmaris brevis abductor digiti minimi flx.digiti minimi opponens digiti minimi Lumbricals -4 Palmar interossei-4 Dorsal interosei-4
  82. 82. THENAR MUSCLES
  83. 83. ABDUCTOR POLLICIS BREVIS  ORIGIN: flx.retinaculum, tubercle of scaphoid, trapezium  INSERTION: lat.side of the base of the prox.phalax of the thumb  ACTION: abduction at carpometacarpal,MP joints  N.SUPPLY: recurrent br.of median.n (c8t1)
  84. 84. ABDUCTOR POLLICIS BREVIS
  85. 85. FLX.POLLICIS BREVIS  ORIGIN:2 heads suf.head: flx.retinaculum & trapezium bone Deep head: floor of carpal canal overlies the trepezoid,capitate  INSERTION: lateral side of the 1st metacarpal bone and base of the prox phalanx  ACTION: flexes the prox.phalanx of the thumb at MCP and med.rotation at carpometacarpal joint  N.SUPPLY: SEPERFICIAL HEAD: median.n (c8,t1) DEEP HEAD: Deep Br.Of Ulnar Nerve
  86. 86. FLX.POLLICIS BREVIS
  87. 87. OPPONENS POLLICIS  ORIGIN: flex.retinaculum, trapezium bone  INSERTION :lat.half of the palmar surface of the 1st metacarpal bone  ACTION: oppositioin of te thumb in combination of flexion and med.rotation  N:SUPPLY: Media.N (C8,t1)
  88. 88. ADDUCTOR POLLICIS  ORIGIN: 2heads oblique head : bases of 2nd 3rd metacarpals and capitate bone Transverse head: anterior surface of 3rd metacarpal bone  INSERTION: base of prox.phalanx of the thumb  ACTIONS: adducts tha prox.phalanx of the thumb  N.SUPPLY: DEEP BR.OF ULNAR NERVE (C8, T1)
  89. 89. ADDUCTOR POLLICIS
  90. 90. HYPOTHENAR MUSCLES
  91. 91. PALMARIS BREVIS  ORIGIN: flx.retinaculum,palmar aponeurosis  INSERTION: skin along the medial border of the hand  ACTION:helps in gripping by wrinkling of skin over it  N.SUPPLY:Ulnar.N Suf.Br.
  92. 92. ABDUCTOR DIGITI MINIMI  ORIGIN: pisiform bone,the tendon of the flx.carpi ulnaris  INSERTION :medial side of the base of the prox.phalanx of the 5th digit  ACTION:abducts th 5th digit  N.SUPPY: Deep Br.Of Ulnar .N (C8,t1)
  93. 93. ABDUCTOR DIGITI MINIMI
  94. 94. FLX.DIGITI MINIMI  ORIGIN : hook of hamate,flx.retinaculum  INSERTION :medial aspect of the base of the prox.phalanx of little finger  ACTION: flex theprox phalanx of 5th digit at MCP joint  N.SUPPLY: Deep Br. Of Ulnar.N (C8,T1)
  95. 95. OPPONENS DIGITI MINIMI  ORIGIN:hook of hamate, flx.retinaculum  INSERTION:body of the 5th metacarpal.  ACTION: abducts, flexion,lat.rotates the 5th metacarpal  N.SUPPLY: deep br.of ulnar.N (C8,T1)
  96. 96. LUMBRICALS  ORIGIN: 1&2 lumbrical arise from the 2 lateral tendon of th flx.digitorum profundus. 2&4 arises from the medial tendons of the flx.digitorum profundus  INSERTION : lateral side of the ext.expansion of medial 4 digits.  ACTION: flex the MCP, extends the IP  N.SUPPLY: 1&2 lumbrical- Median .N (C8,t1) 3&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)
  97. 97. PALMAR INTEROSSEI  ORIGIN: palmar interossei arises from palmar surface of the metacarpal bones of 2,4,5 digits  INSERTION: extensor expansion of the digit and bases of the prox.phalanx of the 2,4,5 digits  ACTION: Adduts The Fingers At MCP, assists flexion at MCP, extension at IP  N.SUPPLY: deep br. Of unlar .n (C8,T1)
  98. 98. PALMAR INTEROSSEI
  99. 99. Dorsal interossei  ORIGIN: adjacent sides of the metacarpal bones  INSERTION: base of the prox.phalanx and in to the aponeurosis that forms ext.expansion  ACTION: abducts the fingers,flex the MCP  N.SUPPLY: Deep Br.Of Ulnar .N (C8,t1)
  100. 100. Dorsal interossei
  101. 101. Dorsal interossei
  102. 102. Parts of Brachial Plexus  Really Tired? Drink Coffee Buddy!      R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES
  103. 103. Roots join to form Trunks! (in neck) • Ventral Rami Trunks • • • • • Upper Trunk C5 C6 C7 C8 T1 Middle Trunk Lower Trunk
  104. 104. Trunks Split to form Divisions (in neck) • Trunks • Upper • Middle • Lower Divisions Anterior Posterior Anterior Posterior Anterior Posterior :
  105. 105. Divisions Join to form Cords! (in axilla) Trunks U M L Divisions A P A P A P Cords LATERAL CORD MEDIAL CORD POSTERIOR CORD
  106. 106. Cords Give off Branches!! (in axilla)  Lateral Musculocutaneous Median  Medial  Posterior Ulnar Radial Axillary (thoracodorsal) (subscapular)
  107. 107. Injury of the brachial plexus
  108. 108. THANK YOU

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