Gross anatomy of the upper limb

1. The upper limb

2. Muscles That Move the Pectoral Girdle
 Originate on the axial skeleton and insert on the clavicle and
scapula.
 Stabilize the scapula and move it to increase the arm’s angle of
movements.
 Some of the superficial muscles of the thorax are grouped together
according to the scapular movement they direct.
 elevation, depression, protraction, or retraction

3. The muscles of back
Superficial group
 Trapezius
 Latissimus dorsi
 Levator scapulae
 Rhomboideus
Deep group
 Erector spinae
 Splenius
 Thoracolumbar fascia

4. The muscles of thorax
Extrinsic muscles
 Pectoralis major
 Pectoralis minor
 Serratus anterior
Intrinsic muscles
 Intercostales externi
 Intercostales interni
 Intercostales intimi

5. The Muscles of Upper Limb
Muscles of shoulder
 Deltoid
 supraspinatus
 Infraspinatus
 Teres minor
 Teres major
 subscapularis

6. Major muscles of upper limb
Deltoid
 Origin: lateral third of
clavicle, acromion, and spine
of scapula
 Insertion: deltoid tuberosity
of humerus
 Action: abducts，flexes and
medically rotates, extends,
and laterally rotates arm

7. Teres major
 Origin: dorsal surface
of inferior angle of
scapula
 Insertion: crest of
lesser tubercle of
humerus
 Action: medially
rotates and adducts
arm

8. Foramen axillare laterale et mediale

9. Arm Muscles That Move the Shoulder/Elbow
Joint
 (Flexor) compartment
 Posterior (extensor) compartment
 Anterior compartment
 primarily contains shoulder/elbow flexors
 Posterior compartment contains elbow extensors
 the principal flexors
 biceps brachii, brachialis, and brachioradialis
 muscles that extend the elbow joint
 triceps brachii and the anconeus

11. Muscles of arm
 Antererior group
 Biceps brachii
 Coracobrachialis
 Brachialis
 Posterior group –
triceps brachii

12. Biceps brachii
 Origin: long head,
supraglenoid tubercle; short
head, coracoid process
 Insertion: radical tuberosity
 Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint
Pronator teres
 Origin: medical epicondyle of
humerus and deep fascia of
forearm
 Insertion: middle of lateral
surface of radius
 Action: pronation of forearm
and flexion of elbow

13. Triceps brachii
 Origin: long head,
infraglenoid tubercle; lateral
head, above groove for
radical n., medical head,
below groove for radical n.
 Insertion: olecranon of ulna
 Action: extends elbow joint),
long head can extend and
adduct shoulder joint

14. Surface anatomy
M. triceps brachii
caput longum, medialis, lateralis
Surface elements
Skin thick and movable
Subcutaneous tissue well expressed
n. cutaneus brachii posterior
n. cutaneus brachii lateralis inferior
n. cutaneus antebrachii posterior
Posterior of the arm

15. Deep structures
А. Fascia brachialis
- Thick, thins distally
B. Neurovascular bundles
1. Upper - in canalis humero-muscularis, between:
- sulcus n. radialis
- medial and lateral head of m. triceps brachii
1.1. n. radialis – lies on the humerus
- n. cutaneus brachii lateralis inerior
- n. cutaneus antebrachii posterior
- rr. musculres
1.2. a. profunda brachii
- a. collateralis media
- collateralis radialis

16. Lower neurovascular bundle
behind medial epicondyle
n. ulnaris
a. collateralis ulnaris inferior

18. Elbow region

19. Anterior elbow
Surface anatomy
Three eminences
Two grooves
Elements
Lateral groove - v. cephalica, n. cutaneus
antebrachii lateralis
Medial groove – v. basilica, n. cutaneus
antebrachii medialis
V. mediana cubiti

20. Deep structures
А. Muscles
Flexors of forearm – medial eminence
Extensors of forearm – lateral eminence
Brachial muscles, mm. biceps, brachialis –
middle eminence

21. Deep structures
B. Vessels and nerves
Medial bundle - between m. biceps brachii and pronator
teres
- a.v. brachialis, n. medianus
Lateral bundle - between m. brachialis and
brachioradialis
- n. radialis, a. collateralis radialis, a. recurrens radialis
C. Cubital fossa
Boundaries
- m. brachioradialis (lateral), m. pronator teres (medial)
Content
- tendo m. brachialis, m. biceps brachii, bursa bicipitoradialis

22. Layers of the elbow
Venous
1 v. cephalica
2 v. basilica
3 v. mediana cubiti
Apponeurotic
1 aponeurosis bicipis
2 tendo m. biceps brachii

23. Neurovascular
1 a. brachialis
2 n. medianus
Muscle
1 m. supinator
2 m. brachialis
3 tendo m. biceps brachii
Bone
1 humerus
2 radius
3 ulna

24. Anterior elbow

27. Arteries of upper limb
Axillary artery
 Continuation of subclavian artery at
lateral border of first rib
 Becomes brachial artery at lower
border of teres major
 Divided into three parts by overlying
pectoralis minor
 First portion, above muscle－gives rise
to thoracoacromial a.
 Second portion, behind muscle－gives
rise to lateral thoracic a.
 Third portion, below muscle－gives rise
to subscapular a.
 divides into throcodorsal a.
 and circumflex scapular a.
 anterior and posterior humeral
circumflex a.;

29. Brachial artery
 Continuation of axillary artery
 Divides into radial and ulnar
arteries at level of neck of radius
 Branches
 Deep brachial a. accompanies
radial nerve
 Superior ulnar collaeral a.
accompanies ulnar nerve
 Inferior ulnar collateral a.

30. Radial artery and branches
 Radial recurrent a.
 Superfical palmar branch
 Principal artery of thumb
Ulnar artery and branches
 Ulnar recurrent a.
 Common interosseous artery
 Anterior interossous a.
 Posterior interosseous a.
 Deep palmar branch

31.  Basilic vein
 Arises from the medial side of the
dorsal venous rete of hand
 Ascends on the ulnar side of forearm
to the elbow and then in the medial
bicepital brachii furrow to middle of
the arm where it pierces the deep
fascia and joins the brachial vein or
axillary vein
 Median cubital vein
links cephalic vein and basilic vein in
the cubital fossa. It is a frequent site
for venipuncture to remove a sample
of blood or add fluid to the blood

32. The lymphatic drainage of upper limb
Lymphatic vessels
 Superficial－follow the
superficial veins, drain into
supratrochlear and axillary
lymph nodes
 Deep－accompany main vessels,
end in axillary lymph nodes
Lymph nodes
 Cubital lymph node: lies above
medial epicondyle of humerus
 Axillary lymph node－arranged
in five groups

33. Axillary lymph nodes
Arranged in five groups
 Lateral lymph nodes lie around
the distal end of axillary vein ,
receiving drainage from the arm,
forearm, and hand
 Pectoral lymph nodes lie along
lateral thoracic vessels, receive
afferents from anterior thoracic wall
including central and lateral portion of
mamma
 Subscapular lymph node along
subscapular vessels, receive lymph
from nape and scapular region
 Efferents above three groups pass to
central lymph node

34. Brachial plexus
Formation:
 Five roots: anterior rami of C5-C8
and T1 spinal nerves, roots C5-
C7give rise to long thoracic n.
 Three trunks
 Upper trunk formed by the joining of
roots C4,C5,C6.
 Middle trunk continuation of root C7.
 Lower trunk formed by the joining of
roots C8 and T1.
 Six divisions: above clavicle,
trunks form anterior and posterior
divisions
 Three cords: below clavicle,
divisions form three cords that
surround the second portion of
axillary a.

35. Position:
passes through the scalene fissure to
posterosuperior of subclavian artery, then
enters the axilla to form lateral, medial and
posterior cords
Main branches
 Lateral cord
 Musculocutaneous n.
 Lateral root to median n.
 Medial cord
 Medial root to median n.
 Ulnar n.
 Medial brachial cutaneous n.
 Medial antebrachial cutaneous n.

36.  Posterior cord
 radial n.
 axillary n.
 thoracodorsal n.

37. Musculocutaneous nerve
Supplies:
Muscles -‘BBC nerve’
 Biceps brachii,
 Brachalis
 Coracobrachialis;
skin on the anterior aspect of
forearm

38. Median nerve
Supplies:
 Flexors of forearm except
brachioradialis,
 Flexor carpi ulnaris
 flexor digitorum profundus - ulnar half
 Thenar except adductor pollicis, two
lateral lumbricals;
 Skin of thenar, central part of palm,
palmar aspect of radial three and one-
half fingers, including middle and
distal fingers on dorsum
Injury: Ape hand
 produces sign of benediction,
the index and middle fingers cannot
be flexed and the thumb cannot be
opposed

39. Ulnar nerve
Supplies:
 flexor carpi ulnaris,
 ulnar half of flexor digitorum
profundus,
 hypothenar muscles, interossei,
 3rd and 4th lumbricals and adductor
pollicis;
 skin of hypothenar, palmar surface
of ulnar one and one-half fingers,
ulnar half of dorsum of hand,
posterior aspect of ulnar two and
one-half fingers
Injury: claw hand

40. Radial
Supplies:
 Extensor muscles of arm and
forearm,
 Brachioradialis;
 skin on back of arm, forearm,
and radial side of dorsum of
hand and radial two and one-
half fingers
Injury: Wrist drop

41. Axillary nerve
Supplies:
 Deltoid and teres
minor muscle;
 skin over deltoid and
upper posterior aspect
of arm
Injury:
 deltoid and teres minor
paralysis (loss of
shoulder abdution and
wheel external rotation)
 loss of sensation over
the deltoid

42. Forearm Muscles
Supinate and Pronate
 Supinator muscle supinates the forearm.
 Biceps brachii supinates the forearm.
 Pronator teres and pronator quadratus pronate the forearm.
Move the Wrist Joint, Hand, and Fingers
 Muscles in the forearm move the hand at the wrist and/or the fingers.
 Extrinsic muscles of the wrist and hand originate on the forearm, not
the wrist or hand.
 Tendons of forearm muscles typically are surrounded by tendon
(synovial) sheaths and held adjacent to the skeletal elements by strong
fascial structures.
 At the wrist, the deep fascia of the forearm forms thickened, fibrous
bands termed retinacula.

43.  The forearm extends
from elbow to wrist.
 It posses two bones
radius laterally & Ulna
medially.
 The two bones are
connected together
by the interosseous
membrane.
 This membrane
allows movement of
Pronation and
Supination while the
two bones are
connected together.
 Also it gives origin for the
deep muscles.

44. Sheath of deep fascia
attached to the posterior
border of the ulna .
The fascial sheath,
interosseous membrane &
fibrous intermuscular septa,
divide the forearm into 3
compartments, each
having its own muscles,
nerves, and blood supply.
Fascial Compartments of the Forearm

45. I-Superficial: 4
 Pronator teres
 Flexor carpi radialis
 Palmaris longus
 Flexor carpi ulnaris
II-Intermediate: 1
 Flexor digitorum superficialis
These muscles: 8
 Act on the elbow & wrist
joints and those of the
fingers.
 Form fleshy masses in the
proximal part and become
tendinous in the distal part
of the forearm.
•Arranged in three groups:
III- Deep: 3
 Flexor digitorum profundus
 Flexor pollicis longus
 Pronator quadratus
FLEXOR GROUP

46. Superficial Flexors:
 They arise - more or
less- from the
common flexor origin
(front of medial
epicondyle).
 All are supplied by
median nerve except
one, flexor carpi
ulnaris, FCU (ulnar).
 All cross the wrist
joint except one,
pronator teres, (PT).

47. Muscles of forearm
 Superficial layer
 Brachioradialis
 Pronator teres
 Flexor carpi radialis
 Palmaris longus
 Flexor carpi ulnaris
 common flexor origin (front of
medial epicondyle)
 supplied by median nerve except
flexor carpi ulnaris
 All cross the wrist joint except
pronator teres

48. Second layer
Flexor digitorum superficials
Origin:
 Common flexor origin,
 Coronoid process of ulna;
 Anterior surface of radius
Insertion:
 Base of middle phalanges of 2nd to 5th fingers.
Action:
 Flexes middle and proximal phalanges of 2nd
to 5th fingers, and the hand

49.  Third layer
 Flexor digitorum
profundus
 Flexor pollicis longus
 Fourth layer
 Pronator quadratus
Action: flex radiocarpal
joint and fingers,
pronate forearm

50. Lateral compartment (3)
 Brachioradialis
 Extensor carpi radialis longus
 Extensor carpi radialis brevis
 Common extensor origin,
(front of lateral epicondyle of
the humerus), EXCEPT, 2 (BR
& ECRL).
 Cross the wrist EXCEPT
brachioradialis.
 Supplied by deep branch of
radial nerve

51. Posterior compartment (8)
 Superficial layer (3)
 Extensor digitorum
 Extensor digiti minimi
 Extensor carpi ulnaris
 Common extensor origin, (front of
lateral epicondyle of the humerus),
 Cross the wrist.
 Supplied by deep branch of radial
nerve

52. Deep layer (5)
 Supinator
 Abductor pollicis longus
 Extensor pollicis brevis
 Extensor pollicis longus
 Extensor indicis
 Action: extend
radiocapral joint and
fingers, and supinate
forearm

53. Extensor carpi radialis brevis:
base of 3rd metacarpal bone.
Extensor digitorum:
Extensor expansion of the
medial 4 fingers.
Extensor digiti minimi:
Extensor expansion of the
little finger.
Extensor carpi ulnaris:
Base of the 5th metacarpal
bone.
INSERTION

54. Supination
and
pronation
It occurs in the superior
and inferior radioulnar
joints;
Muscles produce
supination
 Biceps brachii.
 Supinator.
Muscles produce
pronation
 Pronator teres.
 Pronator quadratus.
NB. Brachioradialis put
the forearm in midprone-
position.

55. Human hand – masterpiece of art

56. Muscles of hand (palm)
 Lateral group thenar (4)
 Abductor pollicis brevis
 Flexor pollicis brevis
 Opponens pollicis
 Adductor pollicis
 Action: flex, abduct, adduct and
oppose thumb
 Medial group hypothenar (3)
 Abductor digiti minimi
 Flexor digiti minimi brevis
 Opponens digiti minimi
 Action: flex, abduct , and oppose
little finger

57. Intermedial group
 Lumbricals (4) flex
fingers at MP joints;
extend fingers at IP
joints
 Palmar interossei (3)
adduct fingers towards
middle finger at MP
joints
 Dorsal interossei (3)
abduct fingers away
from middle finger at
MP joints

58. Arteries of upper limb
Axillary artery
 Continuation of subclavian artery at
lateral border of first rib
 Becomes brachial artery at lower
border of teres major
 Divided into three parts by overlying
pectoralis minor
 First portion, above muscle－gives rise
to thoracoacromial a.
 Second portion, behind muscle－gives
rise to lateral thoracic a.
 Third portion, below muscle－gives rise
to subscapular a.
 divides into throcodorsal a.
 and circumflex scapular a.
 anterior and posterior humeral
circumflex a.;

60. Brachial artery
 Continuation of axillary artery
 Divides into radial and ulnar
arteries at level of neck of radius
 Branches
 Deep brachial a. accompanies
radial nerve
 Superior ulnar collaeral a.
accompanies ulnar nerve
 Inferior ulnar collateral a.

61. Radial artery and branches
 Radial recurrent a.
 Superfical palmar branch
 Principal artery of thumb
Ulnar artery and branches
 Ulnar recurrent a.
 Common interosseous artery
 Anterior interossous a.
 Posterior interosseous a.
 Deep palmar branch

62. Superficial palmar arch
 Formed by ulnar artery and
superficial palmar branch
of radial artery
 Curve of arch lies across
the palm, level with the
distal border of fully
extended thumb
 Gives rise to three common
palmar digital arteries each
then divides into two
proper palmar digital
arteries

63. Deep palmar arch
 Formed by radial artery
and deep palmar branch of
ulnar artery
 Curve of arch lies across
upper part of palmar at
level with proximal border
of extended thumb
 Gives rise to three palmar
metacarpal arteries

64. Veins of the upper limb
Deep veins: accompany the arteries of
the same region and bear similar
names
Superficial veins
 Cephalic vein
 Arises from the lateral side of the
dorsal venous rete of hand
 Ascends on radial side of the forearm
to the elbow and then in the lateral
side of biceps brachii furrow,
continues up the arm in the
deltopectoral groove and then to the
infraclavicular fossa, where it pierces
clavipectoral fascia to drain into
axillary vein