Anatomy of bones, joints and Muscles of Upper limb

3. Bones, Joints and Muscles
Dr.B.B.Gosai
Anatomy of Upper limb-Movement
Appratus

4. What we will learn today?
 Bones of Upper limb: Characteristics and their relation to each other.
 Joints of Upper limb-
 Glenohumral (shoulder), Elbow andWrist joints and overview of small joints
 Pectoral Girdle
 Coracoacromial arch and its function.
 Comparison of Pelvic and Pectoral girdle
 Sternoclavicular and Acromioclavicular joints
 Muscles of Upper limb- Muscles of pectoral girdle and arm
 References:
 Clinical Oriented Anatomy by Keith Moore : Ch 6
 Atlas of Anatomy by Gilroy: Ch 21

5. Parts of Upper limb
 Shoulder: Proximal part of the
limb that overlaps parts of the trunk
(thorax and back) and lower lateral
neck.
 Arm (L. brachium): Extends
between the shoulder and the
elbow .
 Forearm (L. antebrachium):
Extends between the elbow and the
wrist
 Hand (L. manus): Part of the
upper limb distal to the forearm
(Wrist) that is formed around the
carpus, metacarpus, and phalanges

6. Clavicle
Medial end
Larger and join
with Sternum
Lateral end flat
and join with
acromion
process of
scapula
Inferior surface:
Conoid tubercle
and Trapezoid
line for
coracoclavicular
ligament
Shaft:
Inferior surface:
subclavian groove for
subclavius muscle
Fracture-Clavicle

7. Scapula
Triangular flat bone
Subscapularis muscle
Supraspinous muscle
Infraspinous muscle.
Join with humerus
to form shoulder
joint
Acromion join with clavicle
to form acromioclavicular
joint
Coracoid process form with acromion process Coracoacromial
arch and give attachment to Short head of biceps
Divided into two parts by spine of scapula

8. Humerus: Long bone of arm
Anatomical
neck
Intertubercular
sulcus
Deltoid
tuberosity
Radial
groove
Surgical Neck
Fracture

9. Upper End Shaft Lower End
Head: join with Scapula to
form shoulder joint
Between upper and lower
end
Two condyles
Anatomical neck between
head and tubercles
Deltoid tuberosity:
laterally for deltoid
muscle
Trochlea: Pulley like join
with ulna (Elbow joint)
Greater and lesser
tubercles: attachment of
Rotator cuff muscles
Radial groove: related to
Radial nerve and above
and below attachment of
triceps muscle
Capitulum: little head like
joint with head of radius
Intertubercular sulcus:
between tubercles
Medial and lateral
supracondylar ridges
(Medial and lateral
border near lower end)
Posteriorly : Olecranon
fossa (Receive Olecranon
process of ulna in
extension of Elbow joint)
Surgical Neck: Below
head and tubercles,
common site of fracture
Humerus

10. Radius and Ulna

11. Radius Ulna
Position in
forearm
Lateral Medial
Upper End Head of Radius: articulate
with Ulna, It do not take
part in Elbow joint
Olecranon process and coronoid
process articulate with humerus
to form elbow joint by through
trochlear notch. (Olecranon
Process give attachment to
Triceps)
Shaft RadialTuberosity:
Attachment of Biceps
brachii muscle
cylindrical and narrow inferiorly
Lower End Expanded large
Styloid process of Radius
(Laterally)
(Radial artery is universally
palpated in front of lower
end of radius)
Head of ulna: articulate with
radius
Styloid Process (Medially)
Due to articular disc ulna do not
take part inWrist joint

12. Bones of Hand
Colle’s Fracture-Lower end of Radius

13. Bones of Hand
Carpals-small bones of
hand
Metacarpals and
phalanges
 Total 8 bones: two rows
 Proximal row from lateral
to medial:
 Scaphoid, Lunate,
Triquetral, Pisiform
 Distal row:
 Trapezium,Trapezoid,
Capitate and Hamate.
 She Looks Too Pretty
 Try To Catch Her
 5 metacarpals numbered
from lateral to medial (1 to
5)
 1st metacarpal is for thumb
is thickest.
 Rest 4 for fingers.
 5th metacarpal for little
finger has styloid process
 Phalanges (14 in number):
2 phalanges for thumb and
3 phalanges

14. Pectoral Girdle
Pelvic Girdle

15. Pectoral girdle (Upper limb) and Pelvic girdle (Lower limb)
Pectoral Girdle Pelvic girdle
Seen in Upper limb Lower limb
Bone forming Scapula, clavicle and Manubrium Two hip bones and Sacrum
Similarities
Possess flat bone (Scapula)
posteriorly to connect to trunk
Possess flat bone (Ilium of hip)
posteriorly to connect to trunk
Connected anteriory to its
counterpart
Connected anteriory to its
counterpart
Differences
Connected posteriorly to trunk by
flexible muscles
Connected posteriorly to trunk
by strong bony articulation
More mobile Less mobile
Less stable (stability by Rotator
cuff muscles and coracoacromial
arch)
More stable due to strong
articulation

16. Sternoclavicular joint Acromioclavicular joint
Type Saddle type of synovial joint Plane type of synovial joint
Bone
forming
Sternal end of clavicle and
Manubrium of sternum
Lateral end of clavicle with
acromion process of scapula
Ligaments Costoclavicular ligament between 1st
rib and clavicle
Coracoclavicular ligament –very
strong - between coracoid process
of scapula and clavicle.
Two parts- Conoid andTrapezoid
ligaments

17. (a) Elevation of limb: Clavicle
is raised to approximately
a 60° angle.
(b) Anterior or posterior
movement of a range of up
to 25-30°. (During
protraction and retraction
of scapula)
(c) Associated with rotation of
the clavicle around its
longitudinal axis.
Movements of Pectoral girdle
(Elevation, Depression, Protraction, Retraction and Rotation)
The acromion of the scapula rotates on the acromial end of the clavicle.
These movements are at muscular articulation between scapula and trunk.

18. Glenohumeral (Shoulder) Joint
 Type: Ball and socket type of synovial joint
 Triaxial (Multiaxial joint –Movement in three axes and hence 3
degrees of freedom -3 df)
 Bones forming joint (Joint partners): Glenoid cavity of scapula
(deepened by glenoidal labrum) and Head of humerus.

19.  Ligaments of shoulder joint:
 Fibrous capsule: attached to margin of
glenoidal labrum and anatomical neck of
humerus. Synovial membrame lines inner
aspect of capsule.
 Glenoidal labrum: fibrocartilaginous ring
deepens the glenoidal cavity to receive large
head of humerus.
 Coracohumeral ligament: from
coracoid process to greater tubercle of
humerus
 Glenohumeral ligament: from margin
of glenoid cavity to anatomical neck
 Transverse humeral ligament bridge
the gap of bicipital groove below this pass
tendon of biceps brachii.

20. The coraco-acromial
arch
 Formation: Acromion and the coracoid process of the scapula, with
the coracoacromial ligament between them.
 Function:This forms a protective arch that lies above the humeral
head and prevent its superior displacement from the glenoid cavity.
 Applied importance:The coraco-acromial arch is so strong that a
forceful superior thrust of the humerus will not fracture it but the
humeral shaft or clavicle fractures first.

21. Flexion and
Extension: against
Transverse axis in
Sagittal plane.
Abduction and
Adduction: against
Anteroposterior axis in
Frontal plane
Medial rotation and lateral
rotation: against Vertical
axis in the Transverse
plane.
Circumduction: combination of all
possible movements at this joint.
Movements at shoulder joint

22. Abduction of Arm:
Although the initial 30° of abduction
may occur without scapular motion.
In the overall movement of fully
elevating the arm, the movement
occurs in a 2:1 ratio Humerus to
Scapula ( 1:2 ratio Scapula to
Humerus)
For every 3° of elevation,
2° at the glenohumeral joint
(Shoulder joint)
1° at the physiological
scapulothoracic joint (Pectoral
girdle-movements of scapula)

23. Elbow joint (Humero-ulnar joint)
 Type: Hinge type of synovial joint
 Uniaxial joint –Movement in one axis
(Transverse axis) and hence 1 degrees
of freedom -1 df)
 Bones forming joint (Joint partners):
Lower end of humerus (Trochlea (a) and
Capitulum (b)) and upper end of ulna
(Trochlear notch) and head of radius.
Elbow joint is classically between
Humerus and Ulna and all movements
takes place at this joint.
 Ligaments of Elbow joint:
 Radial(Lateral) and Ulnar Collateral
ligaments located laterally and medially
respectively and strengthen capsule of joint.
(a)(b)

24.  Movements at Elbow joint:
 Flexion and Extension: against the transverse
axis in sagittal plane only.
Carrying Angle:
Angle of approximately 170° between long axis of arm
and forearm (10° in male and more than 15° in female).
More in acute in female to clear wider pelvis.
Disappear during pronation and full flexion.

25. Radio-ulnar joints

26. Proximal Radio-ulnar joint Distal Radio-ulnar joint
Type Pivot type of synovial joint
Axis and
Plane
Uni-axial joints –Movement in one axis and hence 1 degrees of freedom -
1 df)
Bone
forming
Head of Radius and Radial
notch of ulna.
Head of ulna and ulnar
notch of Radius
Ligaments Annular ligament: Surrounds
head of radius like collar.
A fibrocartilaginous,
triangular articular disc binds
the ends of the ulna and radius
together .
Due to this articular disc ulna
is not included inWrist joint.
Movements Supination turns the palm anteriorly, or superiorly when the
forearm is flexed
Pronation turns the palm posteriorly, or inferiorly when the
forearm is flexed.
The axis passes proximally through the center of the head of the
radius and distally to the head (styloid process) of ulna.

27. Movements at Radio-ulnar joints
 During pronation, the distal end of the radius
moves (rotates) anteriorly and medially, crossing
over the ulna anteriorly.
 During supination, the radius uncrosses from
the ulna, so the bones become parallel.
Kings Pronate and Beggars Supinate !!!
Supination Pronation

28. Wrist joint (Radio-carpal joint)
 Type: Condyloid (Ellipsoid) type of synovial joint
 Biaxial joint –Movement in two axis (Transverse axis
and anteroposterior) and hence 2 degrees of freedom -
2 df). Planes of movement are Sagittal and Frontal
planes.
 Bones forming joint (Joint partners): Lower end of
radius and proximal row carpals except Pisiform. Ulna
does not take part in the formation of wrist joint.
 The movements are flexion—extension, abduction—
adduction (radial deviation-ulnar deviation), and
circumduction.

29. Carpometacarpal joints
 All carpometacarpal joints are plane synovial joint EXCEPT 1st
Carpometacarpal joint forThumb.
 1st Carpometacarpal joint forThumb:
 Saddle type of synovial joint.
 Trapezium (carpal bone) and 1st metcarpal bone.
 Biaxial (Two axis- 2 degree of Freedom-2df)
 Planes of movement: Sagittal and Frontal
 Movement inTransverse, andAnteroposterior axis, Flexion-Extension,
Abduction-Adduction, Opposition and Circumduction

30.  The metacarpophalangeal joints
are the condyloid type of
synovial joint that permit
movement in two planes and two
axes hence 2 degree of freedom.
 Bones forming these joint: head
of metacarpal and base of proximal
phalanges
 Movements: flexion-extension
and adduction-abduction.
 The interphalangeal joints
between phalanges are the hinge
type of synovial joint that permit
flexion-extension only (1 df
only).
Flexion - Extension

31. Pectoralis Major
Trapezius

32. Muscle Origin Insertion Nerve
supply
Action
Pectoralis
Major
Muscle of
pectoral
region
Clavicular head:
Medial end of
clavicle
Sternocostal
head: Sternum and
upper 6 costal
cartilages
Lateral lip of
Intertubercular
sulcus
Lateral and
Medial
Pectoral
nerves
At shoulder joint:
Adduction and Medial
Rotation
Clavicular part alone: Flexion
Sternocostal part: Extension
from flexed position
Trapezius
Looks like
four sided
figure
Superior nuchal
line, external
occipital
protuberance,
nuchal ligament,
Spinous processes
of C7-T12
vertebrae
Lateral third of
clavicle,
acromion and
spine of scapula
Spinal
accessory
nerve
(Motor) and
C3, 4
(Sensory)
(At shoulder girdle-
Movements of scapula)
Upper fibers: Elevation of
scapula (like in shrugging)
Lower fibers: Depression of
scapula
Middle Fiber: Retraction
(sliding of scapula backwards)
Upper and lower fibers
together: Rotation scapula
for overhead abduction of
arm.

33. Muscle Origin Insertion Nerve
supply
Action
Deltoid
Triangular
(Delta shaped)
muscle covering
top of shoulder
and make round
contour of
shoulder.
Lateral third of
clavicle,
acromion and
spine of scapula
Deltoid
tuberosity
on shaft of
humerus
Axillary
nerve
(At shoulder joint)
Acromial Fibers (Middle Part):
Abduction (Most important and
powerful abductor of arm from 15 to
80 degrees)
Also help in flexion (Anterior fibers
clavicular part) and extension
(Posterior fibres –from spine of
scapula) like in swinging of arm
Intramuscular injections are
given in lower part of this
muscle to avoid injury to axillary
nerve lying deep to it.

34. Subscapularis
Infraspinatus and Teres Minor
Supraspinatus:
15° Abduction
of arm

35. Muscles forming rotator cuff (SITS)
Supraspinatus, Infraspinatus, Teres minor, and Subscapularis ( SITS muscles )
Origin
(Scapula)
Insertion
(Humerus)
Nerve supply Actions
(Shoulder
joint)
Supraspinatus Supraspinous
fossa
Superior facet
of Greater
tubercle
Suprascapular 15 degree
initial
abduction of
arm
Infraspinatus Infraspinous
fossa
Middle facet of
Greater
tubercle
Suprascapular Lateral rotation
of arm
Teres Minor Lateral border Inferior facet
of Greater
tubercle
Axillary Lateral rotation
of arm
Subscapularis Subscapular
fossa
Lesser tubercle Subscapular Medial
Rotation of arm
All these muscle form a musculotendinous rotator cuff around
the glenohumeral (shoulder joint) for its stability.

36. Biceps Triceps
Short head
Long head
Radial tuberosity
Long head
Lateral head
Medial Head
Olecranon process

37. Muscle Origin Insertion Nerve
supply
Action
Biceps
Brachii
Muscle of
anterior
aspect of
arm
Short head:
Coracoid process
Long head:
Supraglenoid
tubercle of scapula
(Just above glenoid
cavity)
Radial
tuberosity and
fascia of forearm
Musculo-
cutaneous
nerve
(At Radio-ulnar joint)
Supination of forearm
(Movement when palm is face
upwards in semiflexed elbow
like in screwing by right
handed person)
Just medial to the tendon
of biceps-brachial artery
is palpated and
auscultated for
measurement of blood
pressure.
Triceps
Brachii
Muscle of
posterior
aspect of
arm
Long head:
Infraglenoid
tubercle of scapula
(Just below glenoid
cavity)
Lateral head:
above rdaila groove
Medial Head:
below radial groove
Olecranon
process of ulna
Radial nerve (At Elbow joint)
Extension of arm.
Prevent dislocation of head of
humerus during abduction
Biceps Reflex
Supination

38. My Wish !!!!!