The document provides an overview of the anatomy of the upper limb, including key structures like bones, muscles, nerves, blood vessels and lymph nodes. It discusses the pectoral region, axilla, mammary glands, bones of the shoulder girdle and arm, joints, muscles, neurovascular structures, and clinical considerations. The goal is to familiarize medical professionals with the anatomy of the upper limb so they can accurately diagnose and treat common clinical problems involving this region.

1. ANATOMY OF THE UPPER LIMB
Dr. Akram M. Asbeutah, Ph.D
Faculty of Allied Health Sciences
Kuwait University
Dr. Akram Asbeutah
8-1

2. OBJECTIVES
• You must be familiar with the nerves, bones, joints,
muscles, tendons, and blood & lymphatic vessels and
their anatomic relationships
• You must know the basic anatomy of the mammary
glands (breast)
• You must know the basic anatomy of the upper limb so
that as a practicing medical professional he or she will
be able to make an accurate diagnosis and initiate
prompt treatment
• You must be familiar with common clinical problems of
the upper limb
8-2

3. The pectoral Region & the Axilla
Mammary Glands (The Breasts)
8-3

4. Mammary Glands
• Modified sweat glands that produce milk (lactation)
– amount of adipose determines size of breast
– milk-secreting glands open by lactiferous ducts at the nipple
– areola is pigmented area around nipple
– suspensory ligaments suspend breast from deep fascia of pectoral
muscles (aging & Cooper’s droop)
Dr. Akram Asbeutah
8-4

5. 8-5

6. 8-6

7. Dr. Akram Asbeutah
8-7

8. 8-8

9. Histology of the mammary gland
Dr. Akram Asbeutah
8-9

10. Blood Supply & Lymph Drainage
• Arteries:
 Perforating branches of the internal thoracic
artery
 Lateral thoracic & thoracoacromial branches of
axillary artery
• Veins: correspond to arteries
• Lymph Drainge:
 Lateral quadrants: anterior or pectoral group of
nodes
 Medial Quadrants: internal thoracic group of
nodes
 Posterior intercostal nodes
 Some communicate with the opposite breast and
with those of the anterior abdominal wall
8-10

11. Bones of the Shoulder Girdle & Arm
8-11

12. Pectoral (Shoulder) Girdle
• Consists of scapula and clavicle
• Clavicle articulates with sternum
(sternoclavicular joint)
• Clavicle articulates with scapula
(acromioclavicular joint)
• Scapula held in place by muscle
only
• Upper limb attached to pectoral
girdle at shoulder (glenohumeral
joint)
Dr. Akram Asbeutah
8-12

13. Clavicle (collarbone)
• S-shaped bone with two curves
– medial curve convex anteriorly/lateral one concave anteriorly
• Extends from sternum to scapula above 1st rib
• Fracture site is junction of curves
• Ligaments attached to clavicle stabilize its position.
Dr. Akram Asbeutah
8-13

14. Anterior Surface of Scapula
• Subscapular fossa filled with muscle
• Coracoid process for muscle attachment
Dr. Akram Asbeutah
8-14

15. Posterior Surface of Scapula
• Triangular flat bone found in upper back region
• Scapular spine ends as acromion process
– a sharp ridge widening to a flat process
• Glenoid cavity forms shoulder joint with head of humerus
• Supraspinous & infraspinous fossa for muscular attachments
Dr. Akram Asbeutah
8-15

16. Upper Extremity
• Each upper limb = 30 bones
– humerus within the arm
– ulna & radius within the forearm
– carpal bones within the wrist
– metacarpal bones within the palm
– phalanges in the fingers
• Joints
– shoulder (glenohumeral), elbow,
wrist, metacarpophalangeal,
interphalangeal
Dr. Akram Asbeutah
8-16

17. Humerus --- Proximal End
• Part of shoulder joint
• Head & anatomical neck
• Greater & lesser tubercles for
muscle attachments
• Intertubercular sulcus or
bicipital groove
• Surgical neck is fracture site
• Deltoid tuberosity
• Shaft
Dr. Akram Asbeutah
8-17

18. Humerus --- Distal End
• Forms elbow joint with ulna
and radius
• Capitulum
– articulates with head of
radius
• Trochlea
– articulation with ulna
• Olecranon fossa
– posterior depression for
olecranon process of ulna
• Medial & lateral epicondyles
– attachment of forearm
muscles
Dr. Akram Asbeutah
8-18

19. The Axilla
• Armpit is a pyramidal-shaped space between the upper part of the arm
and the side of the chest
• It has an apex and base
• The apex is directed into the root of the neck and is bounded
 front by the clavicle,
 behind by the upper border of the scapula,
 medially by the outer border of the first rib
• The base is the lower border and is bounded
 front by the anterior axillary fold (formed by the lower border of pectoralis
major muscle)
 behind by the posterior axillary fold (formed by the tendon of latissimus dorsi
and teres major muscle
 medially by the chest wall
8-19

20. The Axillary Walls
Wall side Made up
Anterior Pectoralis major, subclavius,
& pectoralis minor muscles,
the clavipectoral fascia, &
suspensory ligamnet of the
axilla
Posterior Subscapularis, latissimus
dorsi, & teres minor muscles
Medial Upper four to five ribs & the
intercostal spaces covered by
serratus anterior muscle
Lateral Coracobrachialis & biceps
muscles
Clavicopectoral Fascia is a strong sheet of connective tissue
that is attached above to the clavicle. Below it splits to enclose
the pectoralis minor muscle and then continue downward as the
suspensory ligament of the axilla and joins the fascial floor of
the armpit
8-20

21. Inlet, Walls, & Outlet of Axilla
8-21

22. Muscles Connecting the Upper
Limb to the Thoracic Wall
8-22

23. Muscles Connecting the Upper
Limb to the Vertebral Column
8-23

24. Muscles Connecting the Scapula to
the Humerus
8-24

25. Stabilizing the Pectoral Girdle
• Anterior thoracic muscles
– Subclavius extends from 1st rib
to clavicle
– Pectoralis minor extends from
ribs to coracoid process
– Serratus anterior extends from
ribs to inner surface of scapula
• Posterior thoracic muscle
– Trapezius extends from skull &
vertebrae to clavicle & scapula
– Levator scapulae extends from
cervical vertebrae to scapula
– Rhomboideus extends from
thoracic vertebrae to vertebral
border of scapula
Dr. Akram Asbeutah
8-25

26. 8-26

27. Contents of the Axilla
Structure
Axillary Artery
Axillary Vein
Brachial Plexus
Lymph Nodes
8-27

28. Axillary Artery
• It begins at the lateral border of
first rib as a continuation of the
subclavian artery
• It ends at the lower border of the
teres major muscle and continue
as the brachial artery
• It is enclosed in the axillary sheath
together with the cords of the
brachial plexus
• It is divided into three parts by the
pectoralis minor muscle
8-28

29. First Part of the Axillary Artery
• It extends from the lateral border of the
1st rib to the upper border of the
pectoralis minor m
• Relations
 Anterior: pectoralis major & skin.
Cephalic vein crosses it
 Posterior: long thoracic nerve
 Lateral: three cords of the brachial
plexus
 Medial; axillary vein
• Branches:
 highest thoracic artery
8-29

30. Second Part of the Axillary Artery
• It lies behind the pectoralis minor
muscle
• Relations
 Anterior: pectoralis minor, Major &
skin
 Posterior: posterior cord of the
brachial plexus, subscapularis m, &
shoulder joint
 Lateral: lateral cord of the brachial
plexus
 Medial: axillary vein and the medial
cord of brachial plexus
• Branches
 Thoracoacromial artery
 Lateral thoracic artery
8-30

31. Third Part of the Axillary Artery
• It extends from the lower border of the
pectoralis minor m to the lower border of the
teres major m
• Relations
 Anterior: pectoralis major and medial root of
the median nerve
 Posterior: subscapularis, latissimus dorsi, &
teres major. The axillary & radial nerves
 Lateral: coracobrachialis, biceps, & humerus.
The lateral root of the median nerve &
musculocutaneous nerves
 Medial; ulnar nerve, axillary vein, & medial
cutaneous nerve of the arm
• Branches
 Subscapular artery
 Anterior & posterior circumflex humeral
arteries
8-31

32. Axillary Vein
• It is formed at the lower border of the
teres major muscle by union of the
venae comitantes of the brachial
artery and the basilic vein
• It runs upward on the medial side of
the axillary artery and ends at the
lateral border of the first rib by
becoming the subclavian vein
• It receives tributaries, which
correspond to the branches of the
axillary artery, and the cephalic vein
8-32

33. Brachial Plexus
• Sensory innervation to the
skin and deep structures
(joints)
• Motor innervation to the
muscles
• Influence over the diameters
of the blood vessels by the
sympathatic vasomotor
nerves
• Sympathatic secretomotor
supply to the sweat glands
8-33

34. Axillary Lymph Nodes
• 20-30 in number
• Drain lymph vessels from the lateral quadrants
of the breast, the superficial lymph vessels from
the thoracoabdominal walls above the level of
the umbilicus, and vessels from the upper limb
• The lymph nodes are arranged in six groups
 Anterior (pectora) group
 Posterior (subscapualr) group
 Lateral group
 Central group
 Infraclavicular (deltopectoral) group
 Apical group
• The apical nodes drain into the subclavian
lymph trunk. On the leftside, this trunk drains
into the thoracic duct; on the right side, it
drains into the right lymph trunk
8-34

35. The Superficial Part of the back & the Scapular
8-35

36. Skin
• The sensory nerve supply to the skin of the back is
from the posterior rami of the spinal nerves and the
posterior rami of the L1-L3 run down to supply the
skin over the buttock
• The blood supply to the skin is from the posterior
branches of the posterior intercostal arteries and the
lumbar arteries. The veins correspond to the arteries
and drains into the azygos veins and the inferior vena
cava
• The lymph drainage of the back above the level of the
iliac crests is upward into the posterior group of the
axillary lymp nodes
8-36

37. Bones of the back
8-37

38. Muscles
Muscles Connecting the Upper Limb to the
Thoracic Wall
Muscles Connecting the Upper Limb to
the Vertebral Column
Muscles Connecting the Scapula to
the Humerus
8-38

39. Rotator Cuff Muscles
• Tendons off
 Subscapularis
 Supraspinatus
 Infraspinatus
 Teres minor
• The cuff plays a very important role in
stabilizing the shoulder joint
• The tone of these muscles assists in holding the
head of the humerus in the glenoid cavity of the
scapula during movements at the shoulder joint
• The cuff lies on the anterior, superior, and
posterior aspect of the joint
• The cuff is deficient inferiorly
8-39

40. Rotator Cuff Muscles
• Attach humerus to scapula
• Encircle the joint supporting the capsule
• Hold head of humerus in socket
Dr. Akram Asbeutah
8-40

41. Quadrangular Space
• It is an intermuscualr space, located
immediately below the shoulder joint
• Boundaries
 Superior: subscapularis & capsule of
the shoulder joint
 Inferior: teres major m
 Medial: long head of the triceps m
 Lateral: surgical neck of the humerus
• Contents
 Axillary nerve
 Posterior circumflex humeral vessels
8-41

42. Suprascapular nerve
• It arises from the upper trunck
of brachial plexus (C5-C6) in
the posterior triangle of the
neck
• It passes beneath the
suprascapular ligament which
bridges the suprascapular
notch to reach supraspinous
fossa
• It supplies the supraspinatus
and infraspinatus muscles and
the shoulder joint
8-42

43. Axillary Nerve
• It arises from the posterior cord of the
brachial plexus (C5-C6) in the axilla
• It enters the quadrangular space with
the posterior circumflex humeral
vessels
• It is very close to the inferior aspect of
the capsule of the shoulder joint and
with the medial side of the surgical
neck of the humerus
• It terminates by dividing into anterior
and posterior branches
8-43

44. Arterial Anastomosis Around the Shoulder Joint
• Subclavian artery branches
 Suprascapular a
 Superficial cervical a
• Axillary artery branches
 Subscapular a
 Anterior circumflex a
 Posterior circumflex a
8-44

45. •
Sternoclavicular Joint
Articulation: It occurs between the sternal end of the clavicle, the
manubrium sterni, and the first costal cratilage
• Type: Synovial double-plane joint
• Capsule: It surrounds the joint and is attached to the margins of the
articular surfaces
• Ligaments: sternoclavicular ligaments
• Accessory ligaments: costoclavicular ligaments
• Articular disc: flat fibrocartilagenous disc that divides the joint into
two compartments
• Synovial membrane: lines the capsule & is attached to the cartilage
covering the articular surfaces
• Nerve supply: supraclavicular nerve and nerve to subclavius m
• Movements: forward & backward movement of the calvicle in the
medial compartment. Elevation & depression in the lateral
compartment
• Muscles producing movement
 Forwar: serratus anterior
 Backward: trapezius & rhomoid muscles
 Elevation: trapezius, sternocleidomastoid, levator scapulae, &
rhomboid muscles
 Depression; pectoralis minor & subclavius muscles
• Imporatnt relations: Anterior Skin & sternocleidomastod and
pectoralis major muscles. Posterior: Sternohyoid muscle. On the right,
the Bracheiocephalic artery; on the left, the left brachicephalic vein & 8-45
left common carotid artery

46. Acromioclavicular Joint
• Articulation: Acromion and the lateral end of the
clavicle
• Type: Synovial plane
• Capsule: It surrounds the joint and is attached to the
margins of the articular surfaces
• Ligaments: Superior & inferior acromiolavicular
ligaments
• Accessory ligaments: coracocalvicular ligaments
• Articular disc: flat fibrocartilagenous disc projects into
the cavity from above
• Synovial membrane: lines the capsule & is attached to
the cartilage covering the articular surfaces
• Nerve supply: suprascapular nerve
• Movements: A gliding movements takes place when the
scapula rotates or when the clavicle is elevated or
depressed
• Important relations;
 Anterior: deltoid m
 Posterior: trapezius m
 Superior: skin
8-46

47. Shoulder Joint
• Articulation: head of humerus and the
gelnoid cavity of scapula. The glenoid
cavity is deepened by the presence of
the fibrocartlagenous rim called the
gelnoid labrum
• Type: Synovial ball-and-socket joint
• Capsule: it surrounds the joint and is
attached medially to the margin of the
glenoid cavity outside the labrum;
laterally it is attached to the anatomic
neck of the humerus. It is thin and lax,
allowing a wide range of movement. It
is strengthened by fibrous slips from
the rotator cuff tendons
8-47

48. Shoulder Joint
• Head of humerus and glenoid cavity of scapula
• Ball and socket
• Articular capsule from glenoid cavity to anatomical neck
• Glenoid labrum deepens socket
• Many nearby bursa (subacromial) Dr. Akram Asbeutah
8-48

49. Shoulder Joint
• Ligaments:
 glenohumeral ligaments are three weak bands of
fibrous tissue that strengthen the front of the capsule.
 The transverse humeral ligament
 Coracohumeral ligament
• Accessory ligament: coracoacromial that protect the
superior aspect of the joint
• Synovial membrane: lines the capsule and is
attached to the margins of the articular cartilage
surfaces. It form tubular sheath around the long head
of biceps and extend through the anterior wall of the
capsule to form the subscapularis bursa beneath the
subscapularis muscle and subdeltoid (subacromial)
bursa beneath the deltoid muscle and supraspinatus
tendon
• Nerve supply: Axillary & Suprascapular nerves
8-49

50. Shoulder Joint
• Flexion: anterior deltoid fibers, pectoralis major,
biceps, and coracobrachialis muscles
• Extension: posterior deltoid fibers, latissimus dorsi,
and teres major muscles
• Abduction: middle deltoid fibers and assissted by
supraspinatus muscle
• Adduction: pectoralis major, latissimus dorsi, teres
major, and teres minor muscles
• Lateral rotation: infraspinatus, teres minor, and
posterior fibers of deltoid muscle
• Medial rotation: subscapularis, latissimus dorsi,
teres major, anterior fibers of deltoid muscle
• Circumduction: a combination of all of the above
movements 8-50

51. Shoulder Joint
• Important relations
 Anterior: subscapularis m, axillary vessels
& brachial plexus
 Posterior: infraspinatus and teres minor
muscles
 Superior: the supraspinatusmuscle,
subacromial bursa, coracoacromial
ligament, and deltoid muscle
 Inferior: lomg head of triceps muscle, the
axillary nerve, posterior circumflex
humeral vessels
• The tendon of the long head of biceps
muscle passes through the joint and
emerges beneath the transverse humeral
ligament (extrsynovial and
intracapsular structure)
8-51

52. The Upper Arm
8-52

53. Superficial Veins
• Deep & superfacial veins
• Deep veins comprise the venae comitantes, which
accompany all the large arteries, usually in pairs, and
the axillary vein
• Superficial veins of the arm lie in the superficial fascia
 Cephalic vein: Lateral side of the arm and drain into the
axillary vein by piercing the deltopectoral fascia
(infracalvicular fossa)
 Basilic vein: medial side of the arm, halfway pierces the
deep fascia and at the lower border of the teres major
joins the venae comitantes of the brachial artery to form
the axillary vein
8-53

54. Superficial Lymph Vessels
• Form the lateral side of the arm follow the cephalic vein to the
infraclavicular group of nodes
• From the medial side follow the basilic vein to the lateral group of
axillary nodes
• Deep lymphatic vessels draining the muscles and deep structures of the
arm drain into the lateral group of axillary lymph nodes
8-54

55. Facial Compartments of the Upper Arm
• The upper arm is enclosed in a
sheath of deep fascia, one on the
medial side and the other one on
the lateral side
• Extend from this sheath and are
attached to the medial and lateral
supracondylar ridges of the
humerus, respectively
• By this means, the upper arm is
dividied into an anterior and a
posterior fascial compartments,
each having its muscles, nerves, &
arteries
8-55

56. Facial Compartments of The Upper Arm
Anterior Compartment
• Muscles: Bicpes brachii, coracobrachialis, & brachialis
• Blood supply: Brachial artery
• Nerve supply to the muscles: Musculocutaneous nerve
• Structures passing through the compartment:
musculocutaneous, median, and ulnar nerves and (radial
nerve is present in the lower part); brachial artery and
basilic vein
8-56

57. Anterior Fascial Compartment
Brachial Artery
• It begins at the lower border of teres major muscle as a continuation of the
axillary artery
• It provides the main arterial supply to the arm
• It terminates opposite the neck of the radius by dividing into the radial and
ulnar arteries
8-57

58. Anterior Fascial Compartment- Brachial Artery Relations
• Anterior: It is superifical & is overlapped from
lateral side by the coracobrachialis & biceps. The
medial cutaneous nerve of the forearm lies in
front of the upper part; the median nerve crosses
its middle part; and the bicipital aponeurosis
crosses its lower part
• Posterior: It lies on the triceps, the
coracobrachialis insertion, & the brachialis
• Medial: ulnar nerve & basilic vein in the upper
part of the arm; in the lower part of the arm, the
median nerve lies on its medial side
• Lateral: median nerve, and the coracobrachialis
and biceps above; the tendon of biceps lies
laterally in the lower part of its course
8-58

59. Anterior Fascial Compartment- Brachial Artery Branches
• Muscular to the muscles
• Nutrient to the humerus
• Profunda artery: arises near the beginning
of the brachial artery and follows the radial
nerve into the spiral groove
• Superior ulnar collateral artery: arises
near the middle of the upper arm and
follows the ulnar nerve
• Inferior ulnar collateral artery: arises
near the termination of the artery and takes
part in the anastomosis around the elbow
joint
8-59

60. Facial Compartments of The Upper Arm
Posterior Compartment
• Muscle: The three heads of the triceps muscle
• Nerve supply to the muscle: radial nerve
• Blood Supply: Profunda brachii and ulnar
collateral arteries
• Structures passing the through the compartment:
radia nerve & ulnar nerve
8-60

61. Cross-Section Through Arm
Dr. Akram Asbeutah
8-61

62. Posterior Facial Compartments of The Upper Arm
Profunda Brachii Artery
• It arises from the brachial artery near
its origin
• It accompanies the radial nerve
through the spiral groove, supplies
the triceps, and takes part in the
anastomosis around the elbow joint
• Superior & inferior ulnar collateral
arteries arise from the brachial artery
and takes part in the anastomosis
around the elbow joint
8-62

63. The Cubital Fossa
• It is a triangular depression that lies in front of the elbow
• Boundaries: Lateral: the brachioradialis m; Medial: the pronator
teres m
• The base is formed by an imaginary line drawn between the two
epicondyles of the humerus. The floor is formed by the supinator
m laterally & the brachialis m medially. The roof is formed by the
skin and fascia and is reinforced by the bicipital aponeurosis8-63

64. The Cubital Fossa
• It contains the following structures from medial to lateral side:
 The median nerve
 The bifurcation of the brachial artery
 The tendon of the biceps m
 The radial nerve and its deep branches
• The supratrochlear ly mph nodes lies in the superficial fascia over the upper
part of the fossa, above the trochlea
• Afferent lymph vessels receives from 3-5 fingers; medial part of the hand; and
the medial side of the forarm. The efferentlymph vessels pass up the axilla and
enter the lateral group of nodes
8-64

65. The Forearm
8-65

66. Ulna & Radius --- Proximal End
• Ulna (on little finger side)
– trochlear notch articulates with
humerus & radial notch with
radius
– olecranon process forms point
of elbow
• Radius (on thumb side)
– head articulates with capitulum
of
humerus & radial notch of ulna
– tuberosity for muscle attachment
Dr. Akram Asbeutah
8-66

67. Ulna and Radius - Distal End
• Ulna --styloid process
– head separated from wrist joint by fibrocartilage disc
• Radius
– forms wrist joint with scaphoid, lunate & triquetrum
– forms distal radioulnar joint with head of ulna
Dr. Akram Asbeutah
8-67

68. 8 Carpal Bones (wrist)
• Proximal row - lat to med
– scaphoid - boat shaped
– lunate - moon shaped
– triquetrum - 3 corners
– pisiform - pea shaped
• Distal row - lateral to medial
– trapezium - four sided
– trapezoid - four sided
– capitate - large head
– hamate - hooked process
• Carpal tunnel--tunnel of bone
& flexor retinaculum
Dr. Akram Asbeutah
8-68

69. Metacarpals and Phalanges
• Metacarpals
– 5 total----#1 proximal to
thumb
– base, shaft, head
– knuckles
(metacarpophalangeal joints)
• Phalanges
– 14 total: each is called
phalanx
– proximal, middle, distal on
each finger, except thumb
– base, shaft, head
Dr. Akram Asbeutah
8-69

70. Forearm, Wrist, & Hand Bones

71. Superficial Veins
• Deep & superfacial veins
• Deep veins comprise the venae comitantes, which
accompany all the large arteries, usually in pairs, and
the axillary vein
• Superficial veins of the arm lie in the superficial fascia
 Cephalic vein: Lateral side of the arm and drain into the
axillary vein by piercing the deltopectoral fascia
(infracalvicular fossa). Median cubital vein joins the
basilic vein at cubital fossa
 Basilic vein: medial side of the arm, halfway pierces the
deep fascia and at the lower border of the teres major
joins the venae comitantes of the brachial artery to form
the axillary vein
8-71

72. Superficial Lymph Vessels
• Form the lateral side of the arm follow the cephalic vein to the
infraclavicular group of nodes
• From the medial side follow the basilic vein to the lateral group of
axillary nodes and drain into the supratrochlear lymph node
• Deep lymphatic vessels draining the muscles and deep structures of the
arm drain into the lateral group of axillary lymph nodes
8-72

73. Facial Compartments of the Forearm
• Deep fascia (fascial sheath), that is attached to the posterior
subcatneous border of the ulna, together with the interosseous
membrane and fibrous intermuscular septa, divides the forearm
into anterior, posterior, and lateral fascial compartments, each
having its own muscles, nerves, and blood supply
8-73

74. Interosseous Membrane
• It is a strong membrane that unites the
shafts of the radius and the ulna
• It is attached to their interosseous borders
• Its fibers run obliquely downward and
medially (transmit force from radius to
ulna to humerus to scapula)
• Its fibers are taut when the forearm is in
the midprone position
• It provides attachement for neighboring
muscles

75. Retinaculum
• Tough connective tissue band that helps hold tendons in place
• Extensor & Flexor retinaculum cross wrist region attaching from bone
to bone (carpal tunnel syndrome = painful compression of median
nerve due to narrowing passageway under flexor retinaculum
Dr. Akram Asbeutah
8-75

76. Flexor Retinaculum
• It is a thickening of deep fascia that holds the long flexor tendons in position
at the wrist
• It turns the concave anterior surface of the hand into an osteofascial tunnel
(carpal tunnel) for the passage of the median nerve and the flexor tendons of
the thumb and fingers
• It is attached medially to the pisiform bone & hook of hamate and laterally to
the scaphoid tubercle and the trapezium bones. The attachment to trapezium
consists of superfical and deep parts and forms a synovial-lined tunel for the
passage of the flexor carpi radialis tendon
• Its upper border corresponds to the distal transverse skin crease in front of the
wrist and is continuous with the deep fascia of the forearm. Its lower border is
attached to the palmar aponeurosis

77. Extensor Retinaculum
• It is thichening of deep fascia that stretches across the back of the wrist and
hold the long extensors tendons in position
• It converts the grooves on the posterior surface of the distal ends of the
radius and ulna into six separate tunnels for the passage of the long extensor
tendons. Each tunnel is lined with a synovial shaeth. The tunnels are
separated from one another by fibrous septa that pass from the deep surface
of the retinaculum to the bones
• It is attached medially to the pisiform and the hookof hamate and laterally to
the distal end of the radius
• The upper and lower border of the retinaculum are continuous with the deep
fascia of the forearm and hand

78. Facial Compartments of the Forearm
Anterior Compartment
• Muscles: A superficial group, pronator teres, flexor carpi
radialis, palmaris longus, and flexor carpi ulnaris; an
intermediate group: flexor digitorum superficialis; and deep
group: flexor pollicis longus, flexor digitorum profundus,
and the pronator quadratus
• Blood supply: ulnar & radial arteries
• Nerve supply to the muscles: all muscles are supplied by
the median nerve and its branches, EXCEPT the flexor
carpi ulnaris and the medial part of the flexor digitorum
profundus, which are supplied by the ulnar nerve
8-78

79. Arteries of the Anterior Fascial Compartment of the Forearm
Ulnar Artery
• It is the larger of the two terminal branches of
the brachial artery
• It begins in the cubital fossa at the level of the
neck of the radius
• It descends through the anterior compartment
of the forearm and enters the palm in front of
the flexor retinaculum in company with the
ulnar nerve
• It ends by forming the superficial palmar arch
by anastomosis with the superficial palmar
branch of the radial artery
• In the upper part of its course, it lies deep to
most of the flexor muscles, it become
superficial and lies between the tendons of
FCU & tendons of FDS. In front of the flexor
retinaculum, it lies lateral to pisiform bone and
ulnar nerve and is covered by skin and fascia
• Branches: muscular, recurrent (anastomosis
around the elbow joint), branches that take part
in the arterial anastomosis around the wrist,
common interosseous aretry (anterior &
psoterior interosseous arteries)

80. Arteries of the Anterior Fascial Compartment of the Forearm
Radial Artery
• It is smaller than the ulnar artery
• It begins at the level of radial neck in the cubital
fossa
• It psaases downward and laterally beneath the
brachioradialis mand resting on the deep
muscles of the forearm
• In the middle third of its course, the superficial
branch of the radial nerve lies on its lateral side
• In the distal part, it lies on the anterior surface
of the radius and is only cobvered by skin &
fascia. The artery has the tendon of
brachioradialis on its lateral side and FCR
tendon on its medial side
• It leveas the forearm by winding around the
lateral aspect of the wrist to reach the poterior
surface of the hand
• Branches; muscular, recurrent (anastomosis
around elbow joint), and superficial palamr
branch) which usually join ulnar artery to form
the superficial palmar arch

81. Facial Compartments of the
Forearm- Lateral Compartment
• It is regarded as part of the posterior fascial
compartment
• Muscles: Brachioradialis and extensor carpi
radialis longus
• Blood supply: radial & brachial arteries
• Nerve supply to the muscles: Radial nerve
8-81

82. Facial Compartments of the
Forearm- Posterior Compartment
• Muscles: Superficial group includes the extensor carpi radialis
brevis, extensor digitorum, extensor digiti minim, extensor carpi
ulnaris, and anconeus ( all posses a common tendon of origin from
lateral humeral epicondyle). The deep group includes the supinator,
abductor pollicis longus, extensor pollicis brevis, extensor pollicis
longus, and extensor indicis
• Blood supply: anterior & posterior interosseous arteries from the
common interosseous artery from the ulnar artery. The end by taking
part in the amastomosis around the wrist joint
• Nerve supply to the muscles: deep branch of the radial nerve
8-82

83. Arteries of the Posterior Facial Compartments of the Forearm
• Anterior & posterior interosseous
arteries from the common
interosseous artery from the ulnar
artery. The end by taking part in
the amastomosis around the wrist
joint

84. The Region of the Wrist
• Before learning the anatomy of the hand and the fingers, it is
essential that you should have a sound knowledge of the
arrangement of the tendons, arteries, and nerves in the region
of the wrist
• You should identify the structures from medial to lateral and
vis versa
• You should examine your own wrist and identify as many of
the structures as possible
• From a clinical standpoint, the wrist is a common site for
injury
8-84

85. Structures on the Anterior Aspect of the Wrist
• Structures passing superficial to the flexor
retinaculum from medial to lateral:
 Flexor carpi ulnaris tendon
 Ulnar nerve
 Ulnar artery
 Palmar cutaneous branch of the ulnar n
 Palmaris longus tendon
 Palmar cutaneous branch of the median nerve
• Structures passing beneath the flexor
retinaculum from medial to lateral:
 Flexor digitorum superficialis tendons
 Median nerve
 Flexor pollicis longus tendon
 Flexor carpi radialis tendon

86. Structures on the Posterior Aspect of the Wrist
• Structures passing superficial to the
extensor retinaculum from medial to lateral:
 Dorsal cutaneous branch of the ulnar nerve
 Basilic vein
 Cepalic vein
 Superficial branch of the radial nerve
• Structures passing beneath the extensor
retinaculum from medial to lateral:
 Extensor carpi ulnaris tendon
 Extensor didgiti minimi tendon
 Extensor digitorum and extensor indicis tendons
 Extensor pollicis longus tendon
 Extensor carpi radialis longus and brevis tendons
 Abductor pollicis longus and extensor pollicis brevis tendons

87. The Palm of the Hand

88. The Palm of the Hand
• It is thick & hairless
• It is bound down to the underlying deep
fascia by numerous fibrous bands
• The skin shows many flexure creases
• Sweat glands are presents in large numbers
• The palmaris brevis muscle arises from the
flexor retinaculum and palmar aponeurosis
and inserted into the skin of the palm. It is
innervated by the superficial barnch of the
ulanr nerve. Its funcation is to corrugate the
skin at the base of the hypothenar eminence
and improve the grip of the palm in holding
a rounded object
• The plamar cutaneous bracnch of the medial
nerve (lateral part) and palmar cutaneous
nerve of the ulnar nerve (medial part) supply
the skin of the palm.
• The superficial branch of the radial nerve or
the lateral nerve of the forearm supplies the
thenar eminence
8-88

89. •
The Palmar Aponeurosis
The deep fascia of the wrist & the palm is thickened
to from the flexor retinaculum & the palmar
aponeurosis
• The palmar aponeurosis is triangular and occupies
the central area of the palm
• The apex of it is attached to the distal border of the
flexor retinaculum and receives the insertion of the
palmaris longus tendon
• The base of it divides at the bases of the fingers into
four slips. Each slip divides into two bands, one
passing superficially to the skin and the other passing
deeply to the root of the finger. Each deep band
divides into two, which diverge around the flexor
tendons and finally fuse with the fibrous flexor
sheath and the deep transverse ligaments
• The medial & lateral borders of the palmar
aponeurosis are continuous with the thinner deep
fascia covering the hypothenar & thenar muscles.
From each of these borders, fibrous septa pass
posteriorly into the palm and take part in the
formation of the palmar sapces
• Its function is to give firm attachment to the
overlying skin and so improve the grip and to protect
the underlying tendons 8-89

90. The Carpal Tunnel
• It is an anterior deep concave osteofascial tunnel
• The long flexor tendons to the fingers and thumb
pass through the tunnel accompanied by the median
nerve
• The four separate tendons of the flexor digitorum
superficialis muscles are arranged in anterior
(Middle & ring fingers) and posterior (index and
little fingers). At the lower border of the flexor
retinaculum, the four tendons diverge and become
on the same plane
• The tendons of the flexor digitorum profundas are at
the same plane and lie behind the superficialis
tendons
• All eight tendons invaginate a common synovial
sheath from the lateral side (ulnar bursa) the tendon
of the flexor pollicis longus muscle runs through the
lateral part of the tunnel in its own synovial sheath
(radial bursa). These two bursae communicated at
the level of the wrist joint in about 50% of subjects
• The median nerve passes beneath the flexor
retinaculum in a restricted space between the FDS
and FCR tendons
8-90

91. Fibrous Flexor Sheaths
• The anterior surface of each finger, from the
head of the metacarpal to the base of the distal
phalanx, is provided with a strong fibrous
sheath that is attached to the sides of the
phalanges
• The proximal end of the fibrous sheath is
open, whereas the distal end of the sheath is
closed and is attached to the base of the distal
phalanx
• The sheath and the bones form a blind tunnel
in which the flexor tendons of the finger lie
• In the thumb, the tunnel contains the tendon
of FPL, and four medial fingers is occupied
by the tendons of the FDS & FDP
• The sheath is thick over the phalanges but
thin and lax over the joints
8-91

92. Synovial Flexor Sheaths
• The tendons of FDS & FDP invaginate a common
synovial sheath from the lateral side (ulnar bursa).
The medial part of this common sheath extends
distally without interruption on the tendons of the
little finger. The lateral part of the sheath stops on
the middle of the palm, and the dustal ends of the
long flexor tendons of the index, the middle, and the
ring fingers acquire digital synovial sheath as they
enter the fingers.
• The tendon of the flexor pollicis longus muscle runs
through the lateral part of the tunnel in its own
synovial sheath (radial bursa). These two bursae
communicated at the level of the wrist joint in about
50% of subjects
• The vincula longa & brevia are samll vascular folds
of synovial membrane that connect the tendons to
the anterior surface of the phalanges. They resemble
a mesentery and convey blood vessels to the tendons
8-92

93. Insertion of the long Flexor Tendons
• Each tendon of the FDS enters the
fibrous flexor sheath
• Opposite the proximal phalanx it
divides into two halves, which pass
around the FDP tendons and meet on its
deep or posterior surface, where partial
decussation of the fibers takes place
• FDS tendons having united again,
divides almost at once into two further
slips, which are attached to the borders
of the middle phalanx
• The tendon of FDP pass through and to
be inserted into the base of the distal
phalanx
8-93

94. Arteries of the Palm- Ulnar Artery
• It enters the hand anterior to the flexor retinaculum on the lateral side of the
ulnar nerve and the pisiform bone
• It gives off a deep branch then continue into the palm as the superficial palmar
arch
• The superficial palmar arch is a direct continuation of the ulnar artery. On
entering the palm, it curves laterally behind the aponeurosis and in front of the
long flexor tendons
• The arch is completed on the lateral side by joining the superfacial palmar
branch from the radial artery. Four digital arteries arises from the convesity of
the arch and pass to the fingers
• The deep branch of the ulnar artery arises in front of the flexor retinaculum,
passes between the abductor digiti minimi and the flexor digiti minimi, and
joins the radial artery to complete the deep palamr arch
8-94

95. Arteries of the Palm-Radial artery
• The radial artery leaves the dorsum of the hand by turning forward between the
proximal ends of the first and second metacarpal bones between the two head
of the first dorsal interosseous muscle
• On entering the palm, it curves medially between the oblique and transverse
heads of the adductor pollicis and continue as a deep palmar arch by joining the
deep branch of the ulnar artery deep to the long flexors tendon and in front of
the metacarpal bones
• The deep palmar arch sends branches superiorly, which take part in the
anastomosis around the wrist joint, and inferiorly, to join the digital arteries of
the superficial palmar arch
• It gives arteria radialis indicis (lateral side of the index finger) and arteria
priceps pollicis (lateral & medial side of the thumb)
8-95

96. Vessels of the Palm

97. Lymph Drainage of the Palm
• Form the lateral side of the arm follow
the cephalic vein to the infraclavicular
group of nodes
• From the medial side follow the basilic
vein to the lateral group of axillary
nodes
• Deep lymphatic vessels draining the
muscles and deep structures of the arm
drain into the lateral group of axillary
lymph nodes

98. • It is fascial spaces filled with loose connective tissue
• Their boundaries are important clinically because they may limit
the spread of infection in the palm
• Medial fibrous septum arise from the medial border of the
flexor retinaculum and is attached to the anterior border of the 5 th
metacarpal bone (medial to it the hypothenar compartment)
• From the lateral border of the flexor retinaculum arises another
septum (Oblique septum) usually between the middle and
index finger and is attached to anterior border of the 3 rd
metacarpal bone and this divides the palm into thenar (lateral to
septum)and mid-palmar space (medial to the septum)
• These spaces are closed proximally butcontinue distally with the
lumbrical canal
 The thenar space contains the first lumbrical muscle and
lies posterior to the long flexor tendons to the index finger
and in front of the adductor pollicis longus muscle
 The midpalamar space conatins 2-4 lumbrical muscles and
lies posterior to the long flexor tendons of 4-5 fingers. It lies Facial Spaces of the
in the front of interossei, and 3-5 metacarpal bones
Palm
 The lumbrical canal is a potential space surrounding the
tendon of each lumbrical muscle and is normally filled with
connective tissue. Proxinmally, it is continous with one of
the palmar spaces
8-98

99. Pulp Space of the Fingers
• The deep fascia of the pulp of each
finger fuses with the periosteum of
the terminal phalanx just distal to the
insertion of the long flexor tendons
and closes off a fascial compartment
known as the pulp space
• Each pulp space is subdivided by the
presence of numerous septa, which
pass from the deep fascia to the
periosteum
• Pulp is filled with fat, terminal
branche sof the digital artery that
supplies the diaphysis of the terminal
phalanx. Epiphysis receieves its
blood supply from more proximally
8-99

100. The Dorsum of the Hand

101. Dorsal Venous Arch
• Lateral side: cephalic vein
• Medial side: Basilic vein
• Freely receives digital veins
and communivates with the
deep veins of the palm
8-101

102. Insertion of the Long Extensor Tendons
• The four tendons of the extensor tendons emerge from under the
extensor retinaculum
• The tendons are embedded in the deep fascia, and together they form
the roof of a subfascial space
• Strong oblique fibrous bands connect the tendons to 3-5 fingers
proximal to the heads of the metacarpal bones
• The tendons to index finger is joined on its medial side by the tendon
of extensor indicis, and the tendon to the little finger is joined on its
medial side by the two tendons of the extensor digiti minimi
• On the posterior surface of each finger, the extensor tendon joins the
fascial expansion called extensor expansion. Near the proximal
interphalangeal joint, the extensor expansion splits into three parts: a
central part, which is inserted into the base of the middle phalanx, and
two lateral parts, which converge to be inserted into the base of the
distal phalanx
• The dorsal extensor expansion receives the tendon of the insertion of
the corresponding iterosseous muscle on each side and farther distally
receives the tendon of the lumbrical muscle on the lateral side
8-102

103. The Radial Artery on the Dorsum of the Hand
• It winds around the lateral margin of the
wrist joint, beneath the tendons of the
abductor pollicis longus and extensor
pollicis brevis, and lies on the lateral
ligament of the joint
• On reaching the dorsum of the hand, the
artery descends beneath the tendon of the
extensor pollicis longus to reach the
interval between the two heads of the first
interossei muscle; here the artery turns
forward to enter the palm of the hand
• Branches: anastomaosis around the wrist
joint and two other branches arteria radialis
indicis (index finger) and arteria picceps
pollicis (thumb)
8-103

104. Joints of the Upper Limb

105. • Articulation: It occurs between the torchlea & cpitulum
of the humerus and the trochlear notch of the ulna &
head of the radius. The articular surfaces are covered
•
with hyaline cartilage
Type: Synovial hinge joint Elbow Joint
• Capsule: Anterior & posterior coverage
• Ligaments: lateral & medial ligaments (anterior,
posterior & transverse bands)
• Synovial membrane: Lines the capsule and covers fatty
pads in the floors of the coronoid, radial, and
olecranonfossa. It is continuous below with the synovial
membrane of the proximal radioulnar joint
• Nerve supply: branches from the median, ulnar,
musculocutaneous, and radial nerves
• Movements: Flexion (arm flexors) & extension (arm
extensors). Carrying angle is 170° in male and 167° in
female. It disappear in full flexion
• Important relations:
 Anterior: brachialis, biceps tendon, median nerve,
& brachial artery
 Posterior: triceps m, & small bursa
 Medial: ulnar nerve
 Lateral: common extensor tendon & the supinator
8-105

106. Elbow Joint
• Articulation of humerus with ulna and radius
• Ulna articulates with trochlea of humerus
• Radius articulates with capitulum of humerus
• Interosseous membrane between ulna & radius provides
site for muscle attachment
Dr. Akram Asbeutah
8-106

107. Elbow Joint
• Hinge joint
– trochlea notch of ulna and trochlea of humerus
– flexion and extension of elbow
• Pivot joint
– head of radius and capitulum of humerus
– supination and pronation of forearm
Dr. Akram Asbeutah
8-107

108. Articular Capsule of the Elbow Joint
• Radial annular ligament hold head of radius in place
• Collateral ligaments maintain integrity of joint
Dr. Akram Asbeutah
8-108

109. Proximal (Superior) Radioulnar Joint
• Articulation: radial head and the annular ligament
and the radial notch of the ulna
• Type: synovial pivot joint
• Capsule: enclose the joint and continuous with the
elbow joint
• Ligaments: annular ligament. It is not attached to
radius
• Synovial membrane: continuous with the elbow
above and below is attached radius & ulna
• Nerve supply: branches from the median,
ulnar, musculocutaneous, and radial nerves
• Movements: pronation & supination of the forearm
• Important relations:
 Anterior: supinator muscle and radial nerve
 Posterior: supinator muscle & common extensor tendon
8-109

110. Distal (Inferior) Radioulnar Joint
• Articulation: ulnar head and ulnar notch on the
radius
• Type: synovial pivot
• Capsule: encloses the joint but deficient
superiorly
• Ligaments: weak anterior and strong posterior
• Synovial membrane: lines the capsule
• Nerve supply: anterior interosseous nerve and
deep branch of the radial nerve
• Movements: pronation & supination
• Important relations:
 Anterior: tendons of flexor digitorum profundus
 Posterior: tendon of the extensor digiti minimi
8-110

111. Wrist (Radiocarpal) Joint
• Articulation: distal end of the radius & articular disc
above and the scaphoid, lunate, & triquetrum bones below
• Type: synovial elliposoid joint
• Capsule: enclose the joint
• Ligaments: anterior, posterior, medial, & lateral
ligaments
• Synovial membrane: lines the capsule. The joint cavity
does not communicate with the dital radioulnar joint
• Nerve supply: anterior interosseous nerve and deep
branch of the radial nerve
• Movements: flexion, extension, adduction, abduction, &
circumduction but not rotation (supination & pronation)
• Important relations:
• Anterior: tendons of FDS, FDP, FPL, FCR, FCU, &
median & ulnar nerves
• Posterior: tendons of ECU, EDM, ED, EI, ECRL &B,
EPL & B, APL
• Medial: posterior cutaneous nerve of the ulnar nerve
• Lateral: radial artery
8-111

112. Intercarpal Joint
• Articulation: between individual bones of the
carpal in the proximal and distal rows and
midcarpal between the proximal row carpal
bones and distal row carpal bones
• Type: synovial plane joints
• Capsule: encloses each joint
• Ligaments: anterior, posterior, & interosseous
• Synovial membrane: lines the capsule
• Nerve supply: anterior interosseous nerve and
deep branch of the radial nerve & deep branch of
the ulnar nerve
• Movements: small amount of gliding type of
movement is possible
8-112

113. Carpometacarpal & Intermetacarpal Joints
• They are synovial plane joints possessing anterior, posterior, &
interosseous ligaments
• They have common joint cavity
• A small amount of gliding movement is possible
8-113

114. Carpometacarpal Joint of the Thumb
• Articulation: trapezium & first
metacarpal bone base
• Type: synovial saddle-shaped
joint
• Capsule: surrounds the joint
• Synovial membrane: lines the
capsule and forms a separate joint
cavity
• Movements: flexion, extension,
abduction, adduction, & rotation
(opposition)
8-114

115. Metacarpophalangeal Joints
• Articulation: heads of the
metacarpal bones and bases of the
proximal phalanges
• Type: synovial condyloid joints
• Capsule: surrounds the joint
• Ligaments: palamr deep transverse
metacarpal (joining 2-5 heads), &
collateral
• Synovial membrane: lines the
capsule
• Movements: flexion, extension,
abduction & adduction
8-115

116. Interphalangeal Joints
• They are synovial hinge joints that have a structure
similar to that of the MCP joints
8-116

117. The Hand as a Functional Unit
8-117

118. Position of the Hand
• The position of rest
• The position of function

119. Movements of the Thumb
• Flexion
• Extension
• Abduction
• Adduction
• opposition

120. Movements of the 2-5 Fingers
• Flexion • Cupping of the hand
• Extension • Making a fist
• Abduction
• Adduction

121. Surface Anatomy of the Upper Limb
8-121

122. Surface Anatomy of the Trunk/Back
• Scapulae
• Latissimus dorsi muscle
• erector spinae muscle
• infraspinatus muscle
• trapezius muscle
• teres major muscle
• posterior axillary fold
• triangle of auscutation
Dr. Akram Asbeutah
8-122

123. Surface Anatomy of the Back

124. Surface Features of the Chest
• Clavicle
• Suprasternal Notch of Sternum
• Manubrium of Sternum
• Sternal Angle of Sternum
• Body of Sternum
• Xiphoid Process of Sternum
• Costal Margin
• Serratus Anterior Angle
• Ribs
• Mammary Glands
• Nipples
• Anterior Axillary Fold
• Pectoralis Major Muscle
Dr. Akram Asbeutah
8-124

125. Surface Features of the Chest

126. 8-126

127. Surface Features of the Chest

128. Surface Anatomy of the Upper Limb
• Surface features of the Shoulder
– Acromioclavicular Joint
– Acromiun
– Humerus
• Greater Tubercle
– Deltoid Muscle
Dr. Akram Asbeutah
8-128

129. Surface Anatomy of the Upper Limb

130. Surface Anatomy of the Upper Limb
• Surface Features of the Armpit
– apex
– base
• axillary lymph nodes
– anterior wall
– posterior wall
– medial wall
– lateral wall
Dr. Akram Asbeutah
8-130

131. Surface Anatomy of the Upper Limb
• Surface Features of the
Arm & Elbow
– Humerus
– Biceps brachii muscle
– Triceps brachii muscle
– Medial epicondyle
– Lateral epicondyle
– Olecron
– Ulnar nerve
– Cubital fossa
– Median cubital vein
– Brachial Artery
Dr. Akram Asbeutah
– Bicipital aponeurosis
8-131

132. Surface Anatomy of the Upper Limb
• Surface Features of the
Forearm & Wrist
– Ulna
– Radius
– Muscles
– Radial Artery
– Pisiform Bone
– “Anatomical
Snuffbox”
– Wrist Creases
Dr. Akram Asbeutah
8-132

133. Surface Anatomy of the Upper Limb
• Surface features of the
hand
– Knuckles
– Dorsal Venus Arch
– Tendon of extensor
digitorum muscle
– Tendon of the extensor
pollicis brevis muscle
– Thenar eminence
– Hypothenar eminence
– Palmar flexion creases
Dr. Akram Asbeutah
– Digial flexion creases
8-133

134. Surface Anatomy of the Wrist region

135. Radiographic Appearances of the Upper Limb
8-135

136. Anterioposterior radiograph of the
shoulder joint in the adult

142. AP projection of the Elbow joint

147. Lateral Radiograph of the Elbow Joint

148. PA radiograph of the wrist & distal
forearm

152. PA radiograph of an adult hand & wrist

154. PA & Lateral radiographs of the Hand

157. Lateral Radiograph of the Hand

158. MRI of the upper Forearm

159. Shoulder MRI
8-159

160. Arm MRI
8-160

161. Elbow MRI
8-161

162. Forearm MRI
8-162

163. Wrist MRI
8-163

164. Hand MRI
8-164

176. Clinical Notes of the Upper Limb
8-176

177. Fibrocystic Disease of the Breasts
• Most common cause of breast lumps
• Cysts and thickenings of alveoli develop
• Cause
– hormonal imbalance
• excess of estrogen or deficiency of progesterone in
the postovulatory phase
– result is lumpy, swollen & tender breast a week
before menstruation begins
Dr. Akram Asbeutah
8-177

178. Bony Abnormalities
• Fracture clavicle, scapula, humerus, radius & ulna,
hand bones
• SCJ dislocation
• ACJ dislocation/sublaxation
• Shoulder joint dislocation
• Elbow joint dislocation
• Radioulnar joint diseases
• Wrist joint injuries
• Hand joints diseases & preservation of function

179. Rheumatoid
Arthritis
• Autoimmune disorder
• Cartilage attacked
• Inflammation, swelling &
pain
• Final step is fusion of joint
Dr. Akram Asbeutah
8-179

180. Osteoarthritis
• Degenerative joint disease
– aging, wear & tear
• Noninflammatory---no swelling
– only cartilage is affected not synovial membrane
• Deterioration of cartilage produces bone spurs
– restrict movement
• Pain upon awakening--disappears with
movement
Dr. Akram Asbeutah
8-180

181. Gouty Arthritis
• Urate crystals build up in joints---pain
– waste product of DNA & RNA metabolism
– builds up in blood
– deposited in cartilage causing inflammation &
swelling
• Bones fuse
• Middle-aged men with abnormal gene
Dr. Akram Asbeutah
8-181

182. Vascular Diseases
• Axillary vein thrombosis
• Axillary artery compression & role of collaterals
• Volkmann’s ischemia contracture (brachial artery)
• Arterial injuries
• Compression of the NV bundle
• Allen test for the patency of the radial & ulnar arteries
• Raynaud’s disease

183. Miscellaneous Diseases
• Retracted & supernumery nipples
• Carcinoma of the breast
• Axillary lymphadenopathy
• Fascial spaces of the palm infection
• Pulp-space infection