Anatomy of the upper extremity

1. ANATOMY OF
UPPER LIMB

2. MUSCLES OF UPPER LIMB
 Attachments
 NerveSuply
 BloodSupply
 Actions &
 ClinicalTesting

3. ATTACHMENTSOFUPPERLIMBTOTHEAXIALSKELETON
 BONY CONNECTION -
CLAVICLE
 MUSCULAR
ATTACHMENTS
 Trapezius,
 Latissmus Dorsi,
 LevatorScapulae,
 RhomboideusMajor,
 RhomboideusMinor

4. TRAPEZIUS
 ORIGIN:External occipetal protuberance,
Superior nuchal line of occipetal bone,
Spinous processesof 7th cervical andAll thoracic
vertebrae
 INSERTION:lateral 1/3of clavicle, Medial margin of
acromion, spine ofscapula
 ACTION: Elevates The Scapula , rotation of
scapula,retraction of shoulder, draw the scapula
downwards and AbductionOf Shoulder Beyond 90*
 N.SUPPY:XI cranial nerve (SPINALACCESSORY.N)

5. TRAPEZIUS

7. LATISSIMUSDORSI
 ORIGIN: posterior layer of
thoraco lumbarfascia,
Spinousprocessesof lower 6
thoracic vertebraeand
Caudal most 3-4 ribs,
May attach to iliac crest.
 INSERTION: Intertubercular
groove of the humerus.
 ACTION:extends, adducts and
medial rotation of arm
 N.SUPPLY:THORACO DORSAL
.N (C6,C7,C8)

8. LEVATORSCAPULAE
 ORIGIN: transvers
processes of upper4
cervical vertebrae.
 INSERTION: medial
border of the scapula
superior portion.
 ACTION: elevation of
sup.angle ofscapula and
draws it medially.
 N.SUPPY:C3,C4,C5
Nerves

9. RHOMBOIDUSMINOR
 ORIGIN: ligamentum
nuchae,spinous process
of c7,t1vertebrae
 INSERTION: medial
border of the scapula
 ACTION :
retracts, depressthe
scapula and fix it to
thoracis wall
 N.SUPPLY :Dorsal
Scapular .N(C4,C5)

10. RHOMBOIDUSMAJOR
 ORIGIN: Spinousprocess
of t2-t5
 INSERTION: medial
border of the
scapula,inf.angle
 ACTION: retractsthe
scapula, depress the
glenoid cavityand
fix the scapulato the
thoracis wall
 N.SUPPLY: Dorsal
Scapular .N(c4,c5)

11. RHOMBOIDS (c4,c5)

12. MUSCLES OF PECTORAL REGION
 PECTORALIS
MAJOR
 PECTORALIS
MINOR
 SUBCLAVIUS

13. PECTORALIS MAJOR
 ORIGIN:
sternal half of the clavicle,
Upper half of
sternum, aponeurosisof
ext.obl.muscle,
 INSERTION : lateral lip of
intertubercular sulcus
 ACTIONS:
adduction, medialrotation
and flexion of the
shoulder.
 N.SUPPLY: Med & Lat
Pectoral.N (C5-8,T1)

14. PECTORALIS MAJOR

15. PECTORALIS MINOR
 ORIGIN: costocondral
jn.of 3,4,5ribs
 INSERTION: corocoid
process medial&upper
surface
 ACTIONS: drawsthe
scapula
forwards, depressionof
the shoulder.
 N.SUPPLY: Med & Lat
Pectoral.N (C5-C8,T1)

16. SUBCLAVIUS
 ORIGIN: 1st rib at the
costochondral jn.
 INSERTION: subclavian
groove ofthe clavicle
 ACTION:steadies the
clavicle
 N.SUPPLY:
N.Subclaviusfrom
upper trunk ofB.P
(c5,c6)

17. SERRATUSANTERIOR
 ORIGIN: outer andsuperior
surfaceof the 1-8 ribs
 INSERTION: superior
angle, medial border and
inferior angle of the scapula
 ACTION: rotatesscapula
upwards,
abduction ofshoulder
above 90*
 N.SUPPLY:LongThoracis.N
(c5,c6,c7)

18. WINGING OF SCAPULA

19. MUSCLESOFSHOULDERGIRDLE
 Deltoid
 Rotator cuff muscles-SupraSpinatus
Infra Spinatus,
Subscapularis,
TeresMinor.
 Teresmajor

20. DELTOID
 ORIGIN
Lateral1/3
clavicle, sup.surface of
acromion, spine of the
scapula.
 INSERTION:
deltoid tuberosity.
 ACTION:
abduction of arm,
flx.&.ext of arm,
med.& lat.rotation.
 N.SUPPLY:Axillary.N
(C5,c6)

21. DELTOID

22. SUPRASPINATUS
 ORIGIN:supraspinatous
fossa of thescapula
 INSERTION:superior
facet on the gr.tubercle
of thehumerus
 ACTION: initiation of
abduction (15*) & lat.
Rotation
 N.SUPPLY:
Suprascapular.NFrom
B.P(C5,C6)

23. SUPRASPINATUS

24. INFRASPINATUS
 ORIGIN:infraspinatous
fossa of thescapula
 INSERTION:middlefacet
on the gr.tubercle of the
humerus
 ACTION:
lat.rotation of
shoulder, strengthenthe
shoulder by bracing the
head of humerus.
 N.SUPPLY:
Suprascapular .N ofB.P
(C5,c6)

25. INFRASPINATUS

26. TERESMINOR
 ORIGIN: lat.borderof
the scapula
 INSERTION: inf.facet
on the gr.tubercle of
the humerus
 ACTION: ext.rotator &
weak adductor
 N.SUPPLY:Axillary
.N.(C5,C6)

27. SUBSCAPULARIS
 ORIGIN:
medial 2/3 subscapular
fossa, lat border of tha
scapula
 INSERTION: lesser tubercleof
the humerus
 ACTION:
stabilise the shoulder &
prevents anterior
displacementof the shoulder
(med. rotation, adduction of
arm)
 N.SUPPLY:Upper&Lower
Subscapular .N(c5,c6)

28. SUBSCAPULARIS

29. ROTATOR CUFF

30. TERESMAJOR
 ORIGIN: dorsal surface of
the inf.angle of the scapula
 INSERTION: med.lip of the
intetubercular groove ofthe
humerus
 ACTION:
extends the arm from
flexd.position & it
adducts, med.rotatesthe
arm
 N.SUPPLY:Lower
Subscapular(C6,C7)

31. MOVEMENTS OF THE SHOULDER
 Flexion
 Extension
 Abduction
 Adduction
 Internal rotation,
 Externalrotation
 circumduction

32. FLEXION
 Pect.Mojor
 Anterior FibersOf
Deltoid
 Coraco brachialis

33. EXTENSION
 Lattismus Dorsi
 TeresMajor
 Posterior fibersDeltoid

34. ABDUCTION
 Supraspinatous(15*)
 Deltoid (15-90*)
 SerratusAnterior
(>90*)
 Trapezius (>90*)

35. ADDUCTION
 Lattismus Dorsi
 PectoralisMajor
 Subscapularis
 TeresMinor
 TeresMajor
 CORACOBRACHIALIS

36. INTERNAL ROTATION
 Pectoralis Major
 Ant.Deltoid
 Subscapularis
 TeresMajor
 Lattismus Dorsi

37. EXTERNAL ROTATION
 Deltoid
 Supraspinatus
 Infraspinatus
 TeresMinor

38. MUSCLES OFARM
 FLEXORCOMPARTMENT:
 BICEPSBRACHII
 CORACOBRACHIALIS
 BRACHIALIS
EXTENSOR COMPARTMENT
 TRICEPS

39. BICEPSBRACHII
 ORIGIN:
Long head: supraglenoid
tubercle of the scapula
Short head:apexof the coracoid
process
 INSERTION: RadialTuberosity
 ACTION: flexor ofsupinated
forearm
PowerfulSupinatorOf Partially
FlexedForearm
 N.SUPPLY:musculo cutaneous.N
(c5,c6)

40. BICEPS BRACHI

41. CORACOBRACHIALIS
 ORIGIN: coracoid
process of thescapula
 INSERTION: middle of
medial surface of the
humerus
 ACTION: flexesand
adducts thearm
 N.SUPPLY:
musculocutaneous .N
(c6,c7)

42. BRACHIALIS
 ORIGIN: distal half ofthe
anterior humerus
 INSERTION:coronoid
process, tuberosity ofulna
 ACTION: PowerfulFlexor
Of Forearm
 N.SUPPLY:
Musculocutaneous.N
(C5,C6,C7)

43. MUSCULOCUTANEOUS NERVE
:C5,C6,c7
BicepsBrachii
Brachialis
coracobrachialis

44. TRICEPS
 ORIGIN:
Long head:infraglenoid
tubercle ofthe scapula
Lat.head: oblique ridgeon
upper surface above the
radial groove
Medial head: posterior
surfaceof the humerus inf.to
the radialgroove
INSERTION: proximal olecrenon
of theulna
ACTION:extends theforearm
N.SUPPLY:Radial .N.(C7,c8)

45. TRICEPS

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

47. MUSCLESOFFOREARM
 AnteriorCompartment:
common flx.origin
 SUPERFICIAL 1.Pronator Teres
2.Flx CarpiUlnaris
3.Palmaris Longus
4.Flx.Carpi Radialis
5.Flx.Digitorum Superficialis(sublimus)
 DEEP:
1.Flx.Digitorum Profundus
2.Flx.Pollicis Longus
3.PronatorQuadratus

48. POSTERIOR COMPARTMENT
 SUPERFICIAL: 1.Anconeus
2.Brachioradialis
3.Ext.Carpi Radialis Longus
4.Ext.Carpi Radialis Brevis
5.Ext.Digitorum
6.Ext.Digiti Minimi
7.Ext.CarpiUlnaris
 DEEP
1.Abductor PollicisLongus
2.Ext.PollicisBrevis
3.Ext.PollicisBrevis
4.Ext.Indicis
5.Supinator

49. PRONATORTERES
 Insertion: midway long
the lateral surface of the
radius
 Action: pronation,flexion
of forearm
 N.Supply:Median.N
(C6c7)

50. PRONATOR TERES

51. FLX.CARPIRADIALIS
 INSERTION:base ofthe
2nd mc bone and slip to
the bace of the 3rd MC
bone
 ACTION: flexion and
abduction ofwrist
 N.SUPPLY: Median.N
(c6,c7)

52. PALMARISLONGUS
 INSERTION: anterior
aspect of the distal
flx.retinaculum and
palmar aponeurosis
 ACTION: flx.the
wrist, and tightensthe
palmar.aponeurosis
 N.SUPPLY: Median.N
(c6,c7)

53. FLXCARPIULNARIS
 ORIGIN:
humoral head: medepicondyle
Ulnar head:med.margin of the
olecrenon,posterior border of
the ulna
 INSERTION: pisiform,
hook of hamate, baseof the 5th
MC& flx.retinaculum
 ACTION:flexes andadducts
the hand
 N.SUPPLY: Ulnar.N(C7,C8)

54. FLX.CARPI ULNARIS

55. FLX.DIGITORUMSUPERFICIALIS
 ORIGIN:
humeroulnarhead:
med.epicondyle of the
humerus, coronoidprocess
Radial head:
sup.half of anterior aspect of the
radius
 INSERTION : bodies of the
Middle phalanges of the medial 4
digits
 ACTION: flx.of all joints it
crosses
 N.SUPPLY:Median .N (C7,C8,T1)

56. FLX.DIGITORUMPROFUNDUS
 ORIGIN:prox.3/4 of the medial
and anterior aspect of the ulna
and from interosseousmemb.
 INSERTION:base of TheDiatal
phalanges of the medial 4 digits
 ACTION: flx.DIP,,PIP,MP,wrist
 N.SUPPLY:
Medial-ulnar.N (C8,t1)
Lateral-AIN OfMedian.N
(C8,t1)

57. FLX.DIGITORUM PROFUNDUS

58. FLX.POLLICISLONGUS
 ORIGIN: upper 3/4 of
anterior surface ofradius
 INSERTION: base ofdistal
phalanx of thethumb
 ACTION: flexion of
proximal & distal phalnx of
the thumb
 N.SUPPLY:AIN (C7,C8,T1)

59. FLX.POLLICIS LONGUS

60. PRONATORQUADRATUS
 ORIGIN: lower 1/4th of
anterior surface ofulna
 INSERTION: lower1/4th of
anterior surface ofradius
 ACTION :pronation
 N.SUPPLY:AIN (C8,T1)

61. POSTERIORCOMPARTMENTOFFOREARM
SUPERFICIAL
1.anconeus
2.Brachioradialis
3.Ext.Carpi RadialisLongus
4.Ext.Carpi Radialis Brevis
5.Ext.Digitorum
6.Ext.Digiti Minimi
7.Ext.CarpiUlnaris
DEEP
1.Abductor PollicisLongus
2.Ext.Pollicis longus
3.Ext.Pollicis brevis
4.Ext.Indicis
5.supinator

62. ANCONEUS
 ORIGIN: posterior surface
of thelat.epicondyle
 INSERTION:lateral surface
of olecranon,body ofulna
 ACTION: extensionof
forearm
 N.SUPPLY:radial.n

63. BRACHIORADIALIS
 ORIGIN: prox.2/3rd of
lat.supracondylar ridge of
humerus, lateralintermuscular
septum
 INSERTION:lat.aspect of distal
radius just prox.to the styloid
process
 ACTION: acc.flexor ofelbow
 N.SUPPLY: Radial.N(C5,C6)

64. BRACHIORADIALIS

65. EXT.CARPIRADIALISLONGUS
 ORIGIN: lat.supracondylar
ridge ofhumerus
 INSERTION: baseof the 2nd
MCbone
 ACTION: extendsand
abducts thehand
 N.SUPPLY: Radial.N
(C6,C7)

66. EXTENSORCARPIRADIALISBREVIS
 ORIGIN: lat.epicondyle of
the humerus
 INSERTION: baseof the 3rd
MCbone
 ACTION: extendsand
abducts the wrist
 N.SUPPLY: deepbr.of
radial .N(c7c8)

67. EXTENSORDIGITORUM
 ORIGIN: lat epicondyle of
the humerus
 INSERTION: Extensor
ExpansionsOfThe Medial 4
digits
 ACTION: extension at
MCP
,IPjoints, ext ofwrist
when the fingers are
extended
 N.SUPPLY: PIN(c7,c8)

68. EXTENSORDIGITIMINIMI
 ORIGIN:lat epicondyle of the humerus
 INSERTION:extensor expansionof the 5th
digit
 ACTION: ext.of 5th digit at MC, PIP,
ext of wrist when little finger in extension
 N.SUPPLY:PIN (c7,c8)

69. EXT.CARPIULNARIS
 ORIGIN:2 heads
lat epicondyle of humerus,
Posterior border ofulna
 INSERTION:medial sideof
the base ofthe 5th MC
 ACTION: extendsand
adducts thehand
 N.SUPPLY:PIN (c7c8)

70. SUPINATOR
 ORIGIN:
lat epicondyleof
humerus, radial collaterallig.,
annular lig.,supinator
fossa, crest ofulna
 INSERTION:
lateral,posterior,anterior
surface of prox1/ 3rd 0f radius
 ACTION:supination
 N.Supply: deepBr.Of
Radial.N (C5,c6)

71. SUPINATOR

72. ABDUCTORPOLLICISLONGUS
 ORIGIN:upper parts ofthe
posterior surface of the
radius & ulna and
interosseous mem.
 INSERTION:base of the 1st
MCbone
 ACTION:
abducts,extends, lat.rotat
esthe thumb at
carpometacarpal joint, &
abducts the wrist.
 N.SUPPLY:PIN (c7,c8)

73. EXTENSORPOLLICISBREVIS
 ORIGIN:posterior surface of
the radius below the origin
ofAbductor Pollicislongusand
from interosseousmem.
 INSERTION:base of the
prox.phalanxof the thumb
 ACTION:extends pox.phalanx
of the thumb at MC
joint, ext.at 1st
carpometacarpaljoint
 N.SUPPLY:PIN (c7,c8)

74. EXT.POLLICISLONGUS
 ORIGIN:posterior surface of
middle 1/3rd of ulna
And interrosseousmem.
 INSERTION:base of the diastal
phalanx of thethumb
 ACTION:extends distalphalanx
of the thumb at MP joint,IP
joint.and it can contribute
abduction ofthe thumb
 N.SUPPLY:PIN (c7,c8).

75. EXTENSORINDICIS
 Origin:posterior surfaceof
ulna m/3rd below theEPL
 Insertion:extensor
expansion of the2nd finger
 Action: ext of index finger
and wrist.
 N.supply:PIN (c7,c8)

76. EXM.MOVEMENTS OF
FOREARM
MUSCLES
 Flexion
 Extension
 Adduction
 Abduction
ATRADIO ULNARJOINT
 Supination
 pronation

77. FLEXION
pronator teres
Flx.carpiradialis
Flx.carpiulnaris
Flx.digitorum superficialis
Flx. Digitorum profundus
Palmaris longus
brachioradialis

78. EXTENSION
 Anconeus
 Ext.CarpiRadialis
Longus
 Ext.Carpi RadialisBrevis
 Ext.Digitorum
 Ext.Indisis
 Ext.CarpiUlnaris
 Ext. DigitiMinimi
 Abductor PollicisLongus

79.  ADDUCTION
flexor carpi ulnaris
extensor carpiulnaris
ABDUCTION
flx.carpi radialis
ext.carpi radialis longus
Ext.carpi radialis brevis
Abductor pollicislongus

80.  PRONATION
pronator teres
Pronator quadratus
 SUPINATION
biceps
supinator

81. INTRINSICMUSCLESOFTHEHAND

82.  Thenar muscles abductor pollicisbrevis
flx.pollicis brevis
opponens pollicis
Adductor pollicis
 Hypothenar muscles- palmarisbrevis
abductor digitiminimi
flx.digiti minimi
opponens digiti minimi
 Lumbricals -4
 Palmar interossei-4
 Dorsal interosei-4

83. THENAR MUSCLES

84. ABDUCTORPOLLICISBREVIS
 ORIGIN:
flx.retinaculum, tubercle
of scaphoid,trapezium
 INSERTION: lat.sideof
the base of the
prox.phalax of the
thumb
 ACTION: abductionat
carpometacarpal,MP
joints
 N.SUPPLY: recurrent
br.of median.n(c8t1)

85. ABDUCTOR POLLICIS BREVIS

86. FLX.POLLICISBREVIS
 ORIGIN:2 heads
suf.head: flx.retinaculum & trapezium bone
Deep head: floor of carpal canal overlies the
trepezoid,capitate
 INSERTION: lateral side of the 1st metacarpal bone
and baseof the prox phalanx
 ACTION: flexes the prox.phalanx of the thumb at
MCPand med.rotation atcarpometacarpal joint
 N.SUPPLY:
SEPERFICIALHEAD: median.n(c8,t1)
DEEPHEAD: Deep Br.Of UlnarNerve

87. FLX.POLLICIS BREVIS

88. OPPONENSPOLLICIS
 ORIGIN:
flex.retinaculum,trapezium
bone
 INSERTION :lat.half of the
palmar surface of the 1st
metacarpal bone
 ACTION: oppositioin of te
thumb in combination of
flexion andmed.rotation
 N:SUPPLY: Media.N(C8,t1)

89. ADDUCTORPOLLICIS
 ORIGIN: 2heads
oblique head : basesof 2nd 3rd
metacarpals and capitatebone
Transverse head: anteriorsurface
of 3rd metacarpalbone
 INSERTION: base of
prox.phalanxof the thumb
 ACTIONS: adducts tha
prox.phalanx of the thumb
 N.SUPPLY:
DEEP BR.OFULNAR NERVE
(C8,T1)

90. ADDUCTOR POLLICIS

91. HYPOTHENAR MUSCLES

92. PALMARISBREVIS
 ORIGIN:
flx.retinaculum,palmar
aponeurosis
 INSERTION: skin along
the medial border of the
hand
 ACTION:helps in
gripping by wrinkling of
skin overit
 N.SUPPLY:Ulnar.N
Suf.Br.

93. ABDUCTORDIGITIMINIMI
 ORIGIN: pisiform
bone,the tendon of the
flx.carpi ulnaris
 INSERTION:medial side
of the baseof the
prox.phalanx of the 5th
digit
 ACTION:abducts th5th
digit
 N.SUPPY: DeepBr.Of
Ulnar .N(C8,t1)

94. ABDUCTOR DIGITI MINIMI

95. FLX.DIGITIMINIMI
 ORIGIN : hook of
hamate,flx.retinaculum
 INSERTION :medial
aspectof the baseof the
prox.phalanx of little
finger
 ACTION: flex theprox
phalanx of 5th digit at
MCPjoint
 N.SUPPLY: Deep Br. Of
Ulnar.N (C8,T1)

96. OPPONENSDIGITIMINIMI
 ORIGIN:hook of
hamate, flx.retinaculum
 INSERTION:body of the 5th
metacarpal.
 ACTION:
abducts,flexion,lat.rotates
the 5th metacarpal
 N.SUPPLY: deepbr.of
ulnar.N (C8,T1)

97. LUMBRICALS
 ORIGIN:
1&2lumbrical arise from the 2lateral tendon of th
flx.digitorum profundus.
2&4 arises from the medial tendons of the flx.digitorum
profundus
 INSERTION : lateral side of the ext.expansion of medial 4
digits.
 ACTION: flex the MCP
,extends the IP
 N.SUPPLY:
1&2 lumbrical- Median .N(C8,t1)
3&4lumbrical- Deep Br.OfUlnar .N(c8,t1)

99. PALMARINTEROSSEI
 ORIGIN: palmar interossei
arises from palmar surface
of the metacarpal bones of
2,4,5digits
 INSERTION: extensor
expansion of the digit and
basesof the prox.phalanx of
the 2,4,5digits
 ACTION:
AddutsTheFingersAt
MCP
, assists flexion at
MCP
,extension at IP
 N.SUPPLY: deepbr.Of
unlar .n(C8,T1)

100. PALMAR INTEROSSEI

101. Dorsalinterossei
 ORIGIN: adjacent sides
of the metacarpalbones
 INSERTION:baseof the
prox.phalanx and in to
the aponeurosis that
forms ext.expansion
 ACTION: abductsthe
fingers,flex theMCP
 N.SUPPLY: DeepBr.Of
Ulnar .N(C8,t1)

102. Dorsal interossei

103. Dorsal interossei

106. Parts of Brachial Plexus
 Really Tired? Drink Coffee Buddy!
 R =ROOTS (ventral rami)
 T =TRUNKS
 D = DIVISIONS
 C =CORDS
 B =BRANCHES

107. Roots join to form Trunks!
( i n neck)
• Ventral Rami Trunks
UpperTrunk
MiddleTrunk
• C5
• C6
• C7
• C8
• T1 LowerTrunk

108. Trunks Spl i t t o f orm Di vi si on:
(in• n
T
e
r
u
c
n
k
k
)
s Divisions
• Upper Anterior
Posterior
• Middle Anterior
Posterior
• Lower Anterior
Posterior

109. Di vi si ons Joi n t o f or m Cor ds! (in
U A
P
M A
P
L A
P POSTERIORCORD
LATERALCORD
MEDIALCORD
axiTrlulnkas) Divisions
Cords

110. Cords Give o f f Branches!! (in
axilla)
 Lateral Musculocutaneous
Median
 Medial Ulnar
 Posterior Radial
Axillary
(thoracodorsal)
(subscapular)

111. THANK YOU