Anatomy of the upper limp

1. Anatomy of Upper
Limb
Dr. Md. Galib Raihan
Resident (Phase-A),
Department of Physical Medicine And Rehabilitation
Dhaka Medical College

2. Upper Limb
➝ 1- Surface Anatomy of upper limb
➝ 2- Skeleton of the upper limb.
➝ 3- Joints of the upper limb.
➝ 4- Muscles of the upper limb.
➝ 5- Nerves of the upper limb.

3. Surface anatomy of the upper limb.
The upper limb divided to
• The Shoulder
• The Arm
• The Forearm
• The Hand
• The Axilla

4. Surface Anatomy of Upper Limb
➝ Medial Epicondyle
➝ Lateral Epicondyle
➝ Olecranon Process
➝ Cubital Fossa
⇾ Anterior surface elbow
⇾ Contents
￫ Brachial Artery
￫ Median Nerve
⇾ Boundaries
￫ Medial = Pronator teres
￫ Lateral = Brachioradialis
￫ Superior = Line between
epicondyles

5. Surface Anatomy of Upper Limb
Carpal Tunnel
⇾ Carpals concave anteriorly
⇾ Carpal ligament covers it
⇾ Contains: Median nerve ,long tendons
Anatomical Snuff box
⇾ Lateral = E.pollicis brevis
⇾ Medial = E. pollicis longus
⇾ Floor = scaphoid, styloid of radius
⇾ Contains Radial Artery (pulse)

6. • Clavicle
• Scapula
• Humerus
• Radius
• Ulna
• Carpals- Proximal
Distal
• Metacarpals
• Phalanges
Upper Limb Skeleton

7. Bones of Upper Limb
Scapula

8. Bones of Upper Limb
Clavicle

9. Bones of
Upper Limb
Humerus

10. Bones of
Upper Limb
Radius and Ulna

11. Bones of Hands

12. Clinical Anatomy of Related Bones:
 Clavicle
•Commonly fracture at junction between two curvature of bone by falling on outstretched hand.
•Cleidocranial dysostosis.
 Scapula
•Winging of scapula.
 Humerus
•Three nerves are related to it and liable to injury : axillary at surgical neck, radial at radial
groove, ulnar behind the medial epicondyle.
•Common site of fracture surgical neck, shaft, supra condylar region.
•Volkmann’s ischaemic contracture.
•Dislocation of head of Humerus.
•Medial Epicondylitis, Lateral Epicondylitis.
•Student’s elbow
 Radius
• Colles’ fracture, smith’s fracture.
 Ulna
• Fracture of olecranon.
• Dislocation of elbow.

13. Joints of the upper limb.
• Sternoclavicular joint
• Acromioclavicular joint
Shoulder
Girdle
• Upper end: Glenohumeral joint
• Lower end: see below
Arm
• Humeroradial joint
• Humeroulnar joint
• Proximal radioulnar joint
• Distal radioulnar joint
Forearm
• Intercarpal joint
• Carpometacarpal joint
• Metacarpophalangeal joint
• Interphalangeal joint
Wrist and
Hand

14. MUSCLES OF UPPER LIMB
In general they divided to
 Muscles attached the upper limb to axial skeleton
.
 Muscles of the upper limb proper

15. Anterior Muscles
• Pectoralis major
• Pectoralis minor
• Subclavius
Medial
• Serratus anterior
Muscles attached the upper limb to axial skeleton

16. 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
• flexion of the shoulder.
N.SUPPLY: Med & Lat Pectoral.N (C5-8,T1)
PECTORALIS MAJOR

17. PECTORALIS MAJOR

18. 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)

19. 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
brachial.plexus (c5,c6)

20. 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)

21. WINGING OF SCAPULA

22. Muscles of the Shoulder Region
 Deltoid
 Teres major
 Supraspinatus
 Infraspinatus
 Teres minor
 Subscapularis
The last 4 called Rotator cuff muscles

23. DELTOID
ORIGIN:
Lateral 1/3 clavicle, sup.surface of
acromion, spine of the scapula.
INSERTION:
deltoid tuberosity.
ACTION:
abduction of arm,
flexion.&.extension of arm,
med.& lat. rotation.
N.SUPPLY:
Axillary.N (C5,c6)

24. DELTOID

25. 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)

26. 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)

27. SUPRASPINATUS

28. 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)
INFRASPINATUS

29. INFRASPINATUS

30. TERES MINOR
ORIGIN:
lat. Border of the scapula
INSERTION:
inf.facet on the gr. tubercle of the humerus
ACTION:
ext. rotator & weak adductor
N.SUPPLY:
Axillary .N.(C5,C6)

31. SUBSCAPULARIS
ORIGIN:
medial 2/3 subscapular fossa, lat border of the
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)

33. ROTATOR
CUFF MUSCLES

34. MOVEMENTS OF THE SHOULDER
 Flexion
 Extension
 Abduction
 Adduction
 Internal rotation,
 External rotation
 Circumduction

35. FLEXION
• Pectoralis Major
• Anterior Fibers Of Deltoid
• Coraco brachialis

36. • Lattisimus Dorsi
• Teres Major
• Posterior fibers Deltoid
EXTENSION

37. ABDUCTION
• Supraspinatous (15*)
• Deltoid (15-90*)
• Serratus Anterior (>90*)
• Trapezius (>90*)

38. ADDUCTION
• Lattisimus Dorsi
• Pectoralis Major
• Subscapularis
• Teres Minor
• Teres Major
• Coracobrachialis

39. INTERNAL ROTATION
• Pectoralis Major
• Ant.Deltoid
• Subscapularis
• Teres Major
• Lattismus Dorsi

40. EXTERNAL ROTATION
• Deltoid
• Supraspinatus
• Infraspinatus
• Teres Minor

41. Muscles of arm
• Biceps brachii
• Coracobrachialis
• Brachialis
Anterior /
Flexor
group
• Triceps brachii
Posterior/
Extensor
group

42. 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)

43. 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)

44. 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)

45. 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:
extension of forearm
N.SUPPLY:
Radial .N.(C7,c8)

46. MOVEMENTS AT ELBOW
FLEXION
• Brachialis
• Biceps
EXTENSION
• Triceps

47. MUSCLES OF FOREARM
Anterior Compartment:
• 1.Pronator Teres
• 2.Flexor Carpi Ulnaris
• 3.Palmaris Longus
• 4.Flexor Carpi Radialis
• 5.Flexor Digitorum Superficialis
(sublimus)
SUPERFICIAL:
• 1.Flexor Digitorum Profundus
• 2.Flexor Pollicis Longus
• 3.Pronator Quadratus
DEEP:
Common Flexor Group: Superficial muscles
Origin: Medial epicondyle of humerus

48. MUSCLES OF FOREARM
POSTERIOR COMPARTMENT
• 1.Anconeus
• 2.Brachioradialis
• 3.Extensor Carpi Radialis Longus
• 4.Extensor Carpi Radialis Brevis
• 5.Extensor Digitorum
• 6.Extensor.Digiti Minimi
• 7.Extensor.Carpi Ulnaris
SUPERFICIAL:
• 1.Abductor Pollicis Longus
• 2.Extensor.Pollicis Brevis
• 3.Extensor.Pollicis Brevis
• 4.Extensor.Indicis
• 5.Supinator
DEEP:

49. PRONATOR TERES
Insertion:
midway long the lateral surface of
the radius
Action:
pronation,
flexion of forearm
N.Supply:
Median.N (C6,c7)

50. PRONATOR TERES

51. FLEXOR CARPI RADIALIS
Insertion:
base of the 2nd mc bone and slip to
the base of the 3rd MC bone
Action:
flexion and abduction of wrist
N.Supply:
Median.N (c6,c7)

52. PALMARIS LONGUS
INSERTION:
Anterior aspect of the distal flexor
retinaculum and palmar aponeurosis
ACTION:
Flexion of the wrist and
Tightens the palmar.Aponeurosis
N. SUPPLY:
Median. N (c6,c7)

53. FLEXOR 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 &
flexor retinaculum
ACTION:
flexes and adducts the hand
N.SUPPLY:
Ulnar.N (C7,C8)

54. FLEXOR CARPI ULNARIS

55. 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:
flexion.of all joints it crosses
N.SUPPLY :
Median .N (C7,C8,T1)

56. FLX. DIGITORUM PROFUNDUS
ORIGIN:
prox.3/4 of the medial and anterior aspect of
the ulna and from interosseous membrane.
INSERTION:
base of the distal phalanges of the medial 4
digits
ACTION:
Flexion of DIP,PIP,MP, wrist
N.SUPPLY:
Medial-ulnar.N (C8,t1)
Lateral-AIN Of Median.N (C8,t1)

57. FLX. DIGITORUM PROFUNDUS

58. FLEXOR POLLICIS LONGUS
ORIGIN:
upper 3/4 of anterior surface of radius
INSERTION:
base of distal phalanx of the thumb
ACTION:
flexion of proximal & distal phalanx of the thumb
N.SUPPLY:
AIN (C7,C8,T1)

59. FLEXOR POLLICIS LONGUS

60. 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)

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. 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. BRACHIORADIALIS

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. 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. 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. 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. 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. 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. SUPINATOR

71. MOVEMENTS OF FOREARM MUSCLES
• Flexion
• Extension
• Adduction
• Abduction
AT RADIO ULNAR JOINT
• Supination
• pronation

72. FLEXION
• Pronator teres
• Flx.carpi radialis
• Flx.carpi ulnaris
• Flx.digitorum superficialis
• Flx. Digitorum profundus
• Palmaris longus
• brachioradialis

73. EXTENSION
• Anconeus
• Ext.Carpi Radialis Longus
• Ext.Carpi Radialis Brevis
• Ext.Digitorum
• Ext.Indicis
• Ext.Carpi Ulnaris
• Ext. Digiti Minimi
• Abductor Pollicis Longus

74. ADDUCTION
• flexor carpi ulnaris
• extensor carpi ulnaris
ABDUCTION
• flx.carpi radialis
• ext.carpi radialis longus
• ext.carpi radialis brevis
• abductor pollicis longus
PRONATION
• pronator teres
• pronator quadratus
SUPINATION
• biceps
• supinator

75. Flexor retinalculum: thick band made
of dense white fibrous tissue which stretch
across the anterior surface of the carpal
bones.
Form a tunnel known as carpal tunnel.
Median nerve & tendons of muscles
Through the tunnel .
Extensor retinaculum: It is a thickening
of deep fascia between the lower ends of
radius & ulna .
RETINACULUM IN HAND

76. MUSCLES OF THE HAND
Thenar muscles: abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
Adductor pollicis
Hypothenar muscles-
palmaris brevis
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi
Lumbricals -4
Palmar interossei-4
Dorsal interossei-4
All these Muscles responsible for fine
movements of fingers.

77. Brachial Plexus

78. Formation:
Five roots:
formed by anterior rami of C5-C8 and T1 spinal nerves.
Three trunks:
• The upper trunk is formed by the joining of rootC5,C6.
• The middle trunk is the continuation of root C7.
• The lower trunk is formed by the joining of root 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.
Brachial Plexus

79. 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 cut. n.
Posterior cord:
• radial n.
• axillary n.
• thoracodorsal n.

80. Musculocutaneous N.
Distribution:
Biceps brachii
Brachalis
coracobrachialis
skin on anterior aspect of forearm

81. Distribution:
Flexors of forearm except
brachioradialis, flexor carpi ulnaris
and ulnar half of flexor digitorum
profundus,
Thenar except adductor pollicis,
first two 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
Median nerve

82. Ulnar Nerve
Distribution:
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

83. Distribution:
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
Radial Nerve

84. Distribution:
Deltoid and teres minor
muscle; skin over deltoid
and upper posterior aspect
of arm
Injury:
results in deltoid and teres
minor paralysis (loss of
shoulder abdution and
external rotation) with loss of
sensation over the deltoid
Axillary Nerve

86. Dermatomes Of Upper Limb