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Overview of limbs
1. OVERVIEW OF LIMBS
BY
DR. ABDUL WAHEED ANSARI
CHAIRPERSON & PROFESSOR OF ANATOMY
RAK COLLEGE OF MEDICAL SCIENCES
RAKMHSU.
12/18/2014 1
2. Learning outcomes of the lecture
• Broad outline of osteology of upper and lower limbs, how they form
the major joints of limbs and associated ligaments.
• Regions and compartments of upper limb and lower limb, their nerve
supply and important actions.
• The main blood supply of upper limb and lower limb and collateral
anastomosis forming alternate routes in case of obstruction or injury.
• The lymphatic drainage of upper limb and lower limb areas.
• Imaging studies of upper and lower limbs.
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3. The skeleton of upper limb
• There are 32 bones in each upper limb. They
constitute the appendicular skeleton. The
clavicle is the only long bone that is placed
horizontally and connect with the axial skeleton.
• Scapula lies dorsally and along with clavicle and
humerus constitute the shoulder girdle or
pectoral girdle.
• The humerus is the longest bone in upper limb,
the lower end forming the elbow joint
articulating with the ulna.
• The radius and ulna form the bones of forearm,
distally radius articulates with the carpal bones
forming the wrist joint.
• There are 8 carpal bones arranged in two rows,
distally carpal bones articulates with five
metacarpals forming carpometacarpal joints.
• The phalanges are bones of digits, thumb having
only 2 phalanx where as medial four digits have
3 distal phalanges.
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4. The bones of lower limb
• There 31 bones in each lower limb. The
hip bone articulates with the femur and
sacrum forming hip joint and sacroiliac
joints.
• Femur is the largest bone in the whole
skeleton, distally it articulates with the
tibia and patella forming knee joint.
• Tibia and fibula are the bones of leg.
Distally articulating with the talus
forming ankle joint, talotibiofibular joint.
• There are 7 tarsal bones:- calcaneum,
talus, cuboid, navicular and 3 cuneiforms.
• Distally tarsal articulates with the
metatarsals forming tarsometatarsl joints.
• Great tow has 2 phalanx where as lateral
4 digits have each 3 phalanges.
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5. Regions and compartments of upper limb
• The pectoral region, shoulder region, scapular
region, arm , forearm and hand are the regions
of upper limb.
• The arm is between the shoulder joint and elbow
joint.
• The anterior region of arm is flexor
compartment. It is supplied by
musculocutaneous nerve.
The muscles in this compartment are :-
1) Coracobrachialis
2) Biceps brachii
3) Brachialis
Coracobrachialis brings flexion of shoulder joint;
biceps brings supination of forearm; brachialis
brings flexion of elbow joint.
• The forearm compartments are anterior and
posterior.
• The anterior compartment is flexor compartment
and posterior compartment is extensor
compartment.
• The nerve of anterior compartment of forearm is
median nerve and ulnar nerve.
• The nerve of posterior compartment of forearm
is the posterior interosseous nerve ( branch of
radial nerve).
• The flexor group of muscles are flexors of wrist
and digits and thumb.
• The extensor group of muscles are extensors of
wrist, thumb and digits.
• The hand has intrinsic muscles of thumb and
hypothenar region, lumbricals, and interossei.
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8. Lower limb regions and
compartments
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• The gluteal region, anterior thigh region,
posterior thigh region, and medial thigh
region or adductor region.
• The leg is below knee and above ankle
joint. It has three compartments,
anterior, posterior and lateral
compartments of leg. Each compartment
has their own nerve supply.
• Foot has sole and dorsum, intrinsic
muscles and extrinsic muscles tendons.
9. The blood supply of upper limb
• The right upper limb is supplied by right
subclavian artery that arises from
brachiocephalic trunk.
• The left subclavian is a direct branch fro
arch of aorta.
• At the outer border of first rib the
subclavian artery is renamed as axillary
artery, it becomes brachial artery at the
lower border of teres major.
• The brachial artery divides into terminal
radial and ulnar arteries at the neck of
radius.
• The radial and ulnar arteries are palpable
at the wrist joint
• The dorsal venous arch present on
the dorsum of hand continues as
basilica and cephalic veins draining
the hand and forearm.
• At cubital fossa, basilic and cephalic
veins joins to form median cubital
vein.
• Basilic vein joins the deep veins and
drains in to axillary vein.
• The cephalic vein pierces the
clavipectoral fascia and ends into
axillary vein.
• The axillary vein becomes subclavian
vein at the outer border of first rib.
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10. A 68-year-old female with acute right lower extremity pain and absent
popliteal and pedal pulses. There is an occlusion of the popliteal artery
caused by an embolus. occlusion of the popliteal artery caused by an
embolus.
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12. The blood supply of lower
limb• The external iliac artery continuous as femoral
artery as it passes below inguinal ligament.
• The femoral artery gives profunda femoris
branch, to supply to the thigh muscles.
• The popliteal artery is the continuation of
femoral artery from the hiatus magnus to the
lower border of popliteus.
• The popliteal artery gives two terminal branches,
anterior and posterior tibial arteries.
• The anterior tibial artery descends on dorsum of
foot and renamed as dorsalis pedis artery.
• The dorsal venous arch continues as great
saphenous and small saphenous veins.
• The deep veins continues as popliteal vein and
femoral vein and external iliac vein.
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13. The lymphatic drainage of upper limb. The axillary group of lymph
nodes drain the entire upper limb, including breast.
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14. The lymphatic drainage of
lower limb
• The inguinal group of lymph nodes drain
the entire lower limb, including the groin
region.
• The lower part of abdominal wall also is
drained in to the inguinal group of lymph
nodes.
• 1. Superomedial superficial inguinal
• 2. Superolateral superficial inguinal
• 3. Inferior superficial inguinal
• 4. Deep inguinal lymph nodes
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15. They receive as afferents lymphatic vessels from the
following:
• integument of the penis
• scrotum
• perineum
• buttock
• abdominal wall below the level of the umbilicus
• back below the level of the iliac crest
• vulva
• anus (below the pectinate line)
• the thigh and the medial side of the leg (the lateral leg drains to the
popliteal lymph nodes first).
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