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1. BONES OF UPPER LIMB

2. • Overview of Bones of Upper Limb
Bones of upper limb consists of:
- The pectoral girdle 2(scapula and clavicle)
- The free part (30 bones)-
- - In arm→1 humerus.
- - In forearm→ 1 radius+ 1 ulna.
- - In hand → 8 carpals.
- 5 metacarpal
- 14 phalanges.

12. Nerves related to the humerus
1- The circumflex (axillary) N. may be injured in fracture of
surgical neck.
2- The Radial N. (which lies in the spiral groove) may be injured
in fracture of the middle of the shaft.
3- The Ulnar N. may be injured in fracture of the lower end (the
medial epicondyle)

15. ULNA
- The medial bone of forearm.
Long bone, tubular.
Consists of: - Upper end (epiphysis),
- Body (shaft)
- -Lower end (epiphysis).
- Body (shaft): = Upper ¾: Triangular (in cross section):
- 3 surfces (anterior, posterior, medial). 3 borders (anterior,
posterior, interosseous)
- = Lower ¼: cylindrical.
- Upper end: presents; - 2 curved processes: olecranon and the
coronoid
- - 2 concave, articular cavities, the tochlear and radial notches.
- Lower end: Has: - Head - Styloid process.

17. RADIUS
- The Lateral bone of forearm, Long bone, tubular,
- Consists of: - Upper end - Body (shaft) - Lower end.
- Upper end: - Consists of: Head, Neck, Radial
tuberosity.
- Body (shaft): Triangular has - 3 surfces, anterior,
posterior, lateral. - 3 borders, anterior, posterior,
interosseous
- Lower end: Has 5 surfaces: 1- anterior surface. 2-
lateral surface. 3- posterior surface. 4- medial
surface. 5- inferior surface

18. The bones of the hand
They consist of: carpus, metacarpus & phalanges bones
THE CARPUS BONES - they are 8 short bones
arranged in 2 rows (proximal & distal).
From lateral to medial:
1- the proximal row: scaphoid, lunate, triquetral &
pisiform.
2- the distal row: trapezium, trapezoid, capitate &
hamate.

21. METACARPAL BONES - 5 long bones (one for
each finger) - Long bone, tubular. Each Consists of:
=A base (directed proximally).
= Body (shaft).
= A head (directed distally).
PHALANGES
- ALL fingers have 3 phalanges (proximal, middle,
and distal) EXCEPT thumb (has 2 ONLY;
proximal and distal)
- - Each phalanx (long bone) consists of: =A base
(directed proximally) 7 = Body (shaft). = A head
(directed distally).

22. Overview of Joints of Upper Limb
SHOULDER (GLENOHUMERAL) JOINT -
Type: multiaxial ball and socket synovial joint.
-Bone form it: A- glenoid fossa of the scapula: it is
shallow and contains the glenoid labrum which
deepens it and aids in its stability.
B- head of the humerus.
-due to the very limited interface of the humerus
and scapula, it is the most mobile joint of the
human body.
- Fibrous Capsule: - shoulder joint has a loose
capsule, which lax inferiorly( at risk of dislocation
inferiorly).

23. A number of bursae related to the capsule aid its
mobility, they are:
- Subdeltoid bursa (between the joint capsule and deltoid
muscle),
- Subcoracoid bursa: between joint capsule and coracoid
process.
- Coracobrachial bursa: between subscapularis muscle and
tendon of coracobrachialis muscle.
- Subacromial bursa: between joint capsule and acromion of
scapula.
- Subscapular bursa: between joint capsule and tendon of .
- Supraspinatus bursa: between joint capsule and tendon of
supraspinatus muscle
- infraspinatus bursa: between joint capsule and tendon of
infraspinatus muscle

25. The shoulder joint is a muscle dependent joint as it
lacks strong ligaments.
The primary stabilizers of the shoulder include the
biceps brachii and tendons of the rotator cuff.
1- Superior, middle and inferior glenohumeral
ligaments: thickened parts of fibrous capsule.
2- Coracohumeral ligament: from root of coracoids
to greater tuberosity of humerus.
3- Transverse humeral ligament: It bridges over
bicipital groove to hold biceps long head tendon.
4- Coraco-acromial ligament.

28. - Shoulder joint is unstable joint due to:
- A- little fitting between glenoid cavity and head of
the humerus.
- B-the capsule is lax and weak.
- C- inferior aspect is not supported by muscles.
- - intracapsular structures of shoulder joint are;
synovial membrane,
- labrum glenoidale
- and long tendon of biceps (intracapsular
extrasynovial).

29. ELBOW JOINT
The elbow complex is comprised of three distinct
articulations:
– The humeroulnar joint.
– The humeroradial joint.
– The proximal radioulnar
-Type: hinge uniaxial synovial joint.
-Bone form it: -Humeroulnar joint: trochlear notch of the
ulna with trochlea of humerus.
-Humeroradial joint: head of the radius with capitulum of
the humerus.
- Ligaments of the joint: - Ulnar collateral ligament:
triangular ligament on medial side of joint.
- - Radial collateral ligament: triangular ligament on
lateral side of joint.

31. - Movements and Muscles do it:
- 1-Flexion - The prime movers of flexion are biceps,
brachialis, and brachioradialis - pronator teres, flexor carpi
radialis, and flexor carpi ulnaris are considered as weak
flexors.
- 2- Extension (145 - 150°).: by Triceps and anconeus
- Carrying angle: When the arm is extended, the bones of
the upper arm (humerus) and forearm (radius and ulna) are
not perfectly aligned. The deviation from a straight line
occurs in the direction of the thumb, and is referred to as the
"carrying angle". The carrying angle permits the arm to be
swung without contacting the hips. women may necessitate
a more acute carrying angle (i.e., less angle than that in
male when measured from outside).

33. RADIO-ULNAR JOINTS
1-Superior Radioulnar joint.
2-Middle Radioulnar articulation.
3-Distal Radioulnar joint.

35. 1-Superior Radioulnar joint
-Type: pivot-joint
- Bone form it: between the circumference of the head of the
radius and the ring formed by the radial notch of the ulna
and the annular ligament.
- NB: cavity of superior radioulnar joint is continuous with
the cavity of elbow joint.
Ligaments of the joint
- 1- Annular ligament: -it is a strong band of fibers, which
encircles the head of the radius, and retains it in contact
with the radial notch of the ulna.
- 2- Quadrate ligament: a thickened band which extends
from the inferior border of the annular ligament below the
radial notch to the neck of the radius.
- - Movements and muscles do it: supination and
pronation.

36. 2-Middle Radioulnar articulation
- The shafts of the radius and ulna are connected by the
the Interosseous Membrane.
- The Interosseous Membrane: -it is a broad and thin
sheet of fibrous tissue connect the radius and ulna
together and considered as fibrous joint (syndesmosis).
- Direction: descending obliquely downward and
medially, from the interosseous crest of the radius to
that of the ulna. - it is tense in midprone position,
relaxed in complete pronation and slightly stretched in
complete supination. -Function: - connect ulna and
radius together. - increase the surface area for the
attachment of the deep muscles. - transmission of the
hand weight from radius to the ulna.

37. 3-Distal Radioulnar joint
-Type: it is a pivot synovial joint.
-Bone form it: head of the ulna and the ulnar notch on the
lower end of the radius and the triangular articular disc.
-Ligaments:
1- anterior radioulnar ligament
2- posterior radioulnar ligament
- Movements and muscles do it: supination and
pronation.
NB: -The Articular Disk: - triangular fibrocartilage placed
transversely below the head of the ulna, separates the ulnar
notch from the carpal articular surface.

38. Supination and Pronation Definition
It’s the rotatory movements that occur in radioulnar
joints
Joints at which movements occur:
the superior and inferior radio-ulnar joints.
Axis of Supination and pronation: from the center of the
head of radius above to the root of styloid process of
ulna below.

40. WRIST (RADIOCARPAL) JOINT Type
Condyloid (ellipsoidal) synovial joint.
Articular surfaces:
- distally (convex): Scaphoid, Lunate and Triquetral
bones.
- proximally(concave): distal end of the
radius+articular disc below head of ulna.
Ligaments: - Radial collateral ligament. - Ulnar
collateral ligament. - Dorsal radiocarpal ligament. -
Palmar radiocarpal ligament. - Strengthen capsule.

42. Joints of Hand and Fingers
MIDCARPAL JOINT Type: ellipsoid synovial joint.
Bone form it: between proximal and distal rows of carpals.
Movements: as wrist joint.
INTERCARPAL JOINTS Type: plane synovial
Bone form it: between the individual carpal bones of the proximal
row and the individual carpal bones of the distal row.
Movements: Allows for gliding movement
CARPOMETATCARPAL JOINT Type:
- At the thumb: saddle joint →flex/ ext , add/abd and rotation. -
Other 2-5 joints: plane synovial→ gliding – flex/ext. Ligaments:
dorsal and palmer ligaments.
14 METACARPOPHALAGEAL JOINTS Type: Condyloid synovial
joints (knuckles). Movements: Flex/ ext
INTERPHALANGEAL JOINTS (PIP AND DIP) Type: Hinge synovial
Joints. Bone form it: between the Phalanges. Movements: -Flexion
- Extension

44. Muscles of The Upper Limb Muscles
Act On Shoulder Girdle
muscles primarily involved in shoulder girdle movements. -
These muscles are: Trapezius, Rhomboids, Levator scapula,
Serratus anterior and Pectoralis minor.
- All originate on axial skeleton & insert on scapula and/or
clavicle. - they do not attach to humerus & do not cause
shoulder joint actions.
- Essential in providing dynamic stability of the scapula so it
can serve as a relative base of support for shoulder joint
activities such as throwing, batting, & blocking.

46. TRAPEZIUS
Origin: Medial ⅓ of superior nuchal line and external
occipital protuberance. Ligamentum nuchae. 7th
cervical spine. * Spines of all thoracic vertebrae.
Insertion: - Upper fibers: posterior aspect of lateral 1/3
of clavicle. - Middle fibers: medial border of the
acromion. - Lower fibers: tubercle of the spine of the
scapula.
Action: a- Elevates shoulder by upper fibers. b-
Retracts scapula by middle fibers c- Rotates scapula
upwards by lower fibers.
N. supply: - motor: by Spinal accessory (CN XI). -
sensory(proprioception): by branches from C3, C4.
NB: Trapezius muscle is the only muscle in UL which
don’t supplied from brachial plexus.

47. LEVATOR SCAPULAE
Origin: Transverse processes of upper 4 cervical
vertebrae.
Insertion: medial border of scapula from superior angle
to root of the spine.
N. Supply: nerve to Rhomboides (dorsal scapular n.).
Action: - elevates the scapula. - Rotates scapula
downwards.
RHOMBOID MINOR
Origin: Spine of 7th C and 1st Thoracic vertebrae.
Insertion: medial border of scapula opposite the root of
spine.
N. Supply: nerve to Rhomboides.
Action: - Retract scapula. -Rotates scapula downwards.

48. RHOMBOID MAJOR
Origin: Spine of 2nd , 3rd, 4th and 5th Thoracic
vertebrae.
Insertion: Back of medial border of scapula from root
of spine to inferior angle.
N. Supply: nerve to Rhomboides (Dorsal scapular n).
Action: - Retract scapula -Rotates scapula downwards.
SERRATUS ANTERIOR
Origin: Outer surface of upper 8 ribs anterolaterally.
Insertion: Ventral aspect of medial border of the
Scapula.
N. Supply: Long thoracic n. {n. to Serratus anterior}.
Action: a- entire muscle: protracts scapula and holds it
against ribs. b- Lower 5/8: rotates scapula upwards.

49. Muscles of Axilla and Shoulder Region
SUPRASPINATUS
Origin: Medial ⅔ of supraspinous fossa of scapula.
Insertion:Top of greater tuberosity of humerus.[S-I-T].
Nerve supply: Suprascapular nerve.
Action: - Shoulder abduction from 0- 15 degrees. -
Steady shoulder j.
INFRASPINATUS
Origin: medial ⅔ of infraspinous fossa.
Insertion: Middle of greater tuberosity of humerus.
Nerve supply: Suprascapular n.
Action: - adducts the arm and ratates it laterally. -
steady head of humerus in glenoid cavity.

51. TERES MINOR
Origin: Upper 2/3 of dorsal aspect of lateral border of
scapula.
Insertion: Lower part of greater tuberosity of the
humerus.
Nerve supply: Axillary n.
Action: -Adduction & lateral rotation of shoulder Joint. -
Stabilize Shoulder Joint.
TERES MAJOR
Origin: Lower 1/3 of dorsal aspect of the lateral border of
the scapula.
Insertion: Medial lip of bicipital groove.
Nerve supply: Lower subscapular nerve.
Action: Adduction and Medial rotation of shoulder Joint.

52. SUBSCAPULARIS MUSCLE
Origin: Medial ⅔ of subscapular fossa.
Insertion: Lesser tuberosity of the humerus.
Nerve supply: Upper and lower subscapular n.
Action:- adducts arm and rotates it medially
- steadies the head of humerus.
- LATISSMUS DORSI
- Origin: -lower 4 ribs. -lower 6 thoracic spines. -
thoraco-lumbar fascia. -back of inferior angle of
scapula. - outer lip of iliac crest.
- Insertion: Floor of bicipital groove of the humerus.
- Nerve supply: Thoracodorsal n. {n. to Latissmus
dorsi}.
- Action: Adducts, extends and medially rotates the arm.

53. DELTOID MUSCLE
Origin: -anterior fibers: anterior border of lateral ⅓
of clavicle. -middle fibers: lateral border of
acromion. - posterior fibers: lower lip of spine of
scapula.
Insertion: Deltoid tubersity of the humerus.
Nerve supply: Axillary n.
Action:- Anterior part: flexes and rotate the arm
medially. - Middle fibers: abducts the arm from 15-
90. - Posterior fibers: extends and rotates the arm
laterally.

54. Rotator cuff muscles: Supraspinatus, infraspinatus, teres
minor and subscapularis muscles are inserted very close to
shoulder joint and are blended with its capsule so they
steady head of the humerus in glenoid cavity during
movements of the shoulder joint.
1- Muscles connecting scapula to trunk. - Trapezius -
Rhomboid - Levator scapulae - Serratus anterior - pectoralis
minor.
2- Muscles connecting scapula to hunmerus.
- deltoid. - Infraspinatus. - supraspinatus. - subscapularis. -
Teres minor. - Teres major. - coracobrachialis.
3- Muscles connecting humerus to trunk: - pectoralis
major. - latissmus dorsi.

57. Muscles of The Arm
1- Muscles of the front of arm:
- biceps - coracobrachialis - brachialis.
2- Muscles of the back of arm: - triceps

58. BICEPS BRACHII
Origin: By 2 heads,
1- long: from supraglenoid tubercle.
2- short: from the tip of coracoid process. Insertion: By 2
insertions;
1- biceps tendon: into the rough posterior part of radial
tubersity.
2- bicipital apponeurosis: into deep fascia of medial side of
upper part of forearm.
Action: a- powerful flexor and supinator of forarm.
b- flexion of arm.
c- long head steadies head of hunmerus in the glenoid
cavity.
d- bicipital apponeurosis protect the underlying structures.

59. CORACO-BRACHIALIS
Origin:
from the tip of coracoid process of scapula.
Insertion: Middle of medial surface of humerus.
Action: Weak flexor and adductor of the arm.
BRACHIALIS
Origin: Lower ½ of front of humerus.
Insertion: Ulnar tubersity
Action: main flexor of elbow joint.
Nerve supply of Biceps, Coraco-brachialis and
Brachialis: by musculocutaneous n.

60. TRICEPS BRACHII
Origin: By 3 heads,
1- long: from infraglenoid tubercle of scapula.
2- medial: from posterior surface of humerus below the
spiral groove.
3-lateral: from posterior surface of humerus above the spiral
groove.
Insertion: Posterior part of upper surface of olecranon
process of ulna.
Action: - main extensor of elbow joint by the whole muscle.
- long head: weak extensor of shoulder joint.
Nerve supply: radial nerve.