The document provides an overview of the anatomy of the upper limb, detailing the major bones, muscles, and vascular structures. It covers the clavicle, scapula, humerus, radius, ulna, carpal bones, and various muscle groups, along with their origins, insertions, and functions. Additionally, it discusses common injuries, such as fractures and dislocations, along with the vascular supply from the brachial plexus and relevant clinical procedures.

1. INTRODUCTION TO
UPPER LIMB
Dr. Ela kinra
Department of anatomy

2. Boundaries of upperlimbs
 Superior clavical—acrimoin—
spinous process of C7
 Anterior anterior border of the
deltoid—anterior axillary fold
 Posterior posterior border of the
deltoid—posterior axillary fold

3. Bony structures of upperlimbs
 Clavical
 Scapula
 Humerus
 Radius
 Ulna
 Carpal bones
 Matacarpal bones
 Phalanges

4. Clavicle
 Only one bone that lie
horizontally ,subcutaneous through out ,
first bone to start ossify , 2 primary
center of ossification , membranous
ossification, S- shaped ,
 1 shaft and 2 end ,, medial part
articulates with sternum and lateral
part with acromian process of scapula …
 m/c fracture site - junction between
middle and outer -third .
 Most common fracture bone in body
 also called Collar bone or beauty bone ..

5. scapula
 2nd to 7th rib
 Flat and triangular
 Anterior surface(costal surface) & dorsal
or posterior surface(spine of scapula).
 Superior, medial and lateral border.
 Superior, inferior angle.
 Acromian articulates with clavicle .
 glenoid cavity articulates with head of
humerus.
 Coracoid process projects upward
provides attachment for muscles and
ligaments.

6. humerus
 Longest and largest bone of upper limb
 Body and two ends
 Head, greater and lesser tubercle/
intertubecular sulcus or bicipital
groove.
 Anatomical neck
 Surgical neck=head meets the shaft
 Lower end is flat and two articular
surfaces
 Capitulum for head of radius
 Trochlea for articulation with trochlear
notch of ulna.
 Lateral and medial epicondyles for
muscles and ligament attachment
 Radial fossa for radial head when elbow
is flexed
 Coronoid fossa for coronoid process of
ulna during same movement.
 Olecranon fossa posteriorly for
olecranon process of ulna during
extension.

7. Humerus fractures and nerve injury
 surgical neck fracture - axillary
nerve injury .
 shaft #- radial nerve injury
 supracondylar # - median nerve
injury
 .
Supracondylar fracture

8. Radius and ulna

9. Radius
 Fracture of the distal end
(Colle’s fracture):
 It is due to a fall on the
outstretched hand in patients
over (50) years.
 The distal fragment of the radius
is pulled posteriorly and
superiorly
 The distal articular surface is
directed posteriorly.
 The posterior displacement
produces a posterior bump.
 The deformity is referred to as,
‘dinner-fork deformity’ because
the forearm and wrist resemble
the shape of a dinner fork.
 Smith’s fracture is a reversed
Cole’s as the distal segment is
displaced anteriorly

10. Carpal bones
8 in numbers
 proximal row (lateral to medial )
Scaphoid ( boat shaped )
Lunate( half –moon )
Triquetrum ( three
cornered
Pisiform ( pea Shaped )
Distal row
Trapezium ( four sided )
Trapezoid ( babys shoes
shaped )
Capitate ( head ,,, biggest )
Hamate ( hook)
Scaphoid fracture is most common .

11. Fracture of the Scaphoid Bone
 Common in young adults
 Fracture line passes through the
narrowest part of the bone
 If the fragments will not unite
properly, there will be permanent
pain and weakness at the wrist
 Deep tenderness in the anatomical
snuff box after a fall on an
outstretched hand in a young adult is
an indication of fracture of scaphoid
bone

12. Elbow Joint
 Dislocations are common
and most are posterior. Are
more common in children,
due to a fall on outstretched
hand. The distal end of
humerus is pushed
anteriorly through weak
part of the capsule
 Pulled Elbow: occurs in
children, when the child is
lifted by the upper limb.
The radial head is pulled out
of the annular ligament

13. Tennis Elbow
 Caused by partial tear or
degeneration of the origin
of superficial extensor
muscles attached to the
lateral epicondyle
 It results due to excessive
use of these muscles as in
tennis, violinists and
housewives.
 Results in pain and
tenderness over the lateral
epicondyle that radiates to
the lateral side of the
forearm

14. Golfer’s Elbow (Medial Epicondylitis)
 Caused by partial tear
or degeneration of the
origin of superficial
flexor muscles
attached to the medial
epicondyle
 It results due to
excessive use of these
muscles as in playing
golf
 Results in pain and
tenderness over the
medial epicondyle
that radiates to the

15. Bones of Hand
 Carpal bones
 Metacarpals
 Phalanges
From lateral to medial:
1- the proximal row : scaphoid
,lunate , triquetral &
pisiform .
2- the distal row : trapezium ,
trapezoid , capitate &
hamate

16. Deltoid
origin – from lateral 1/3rd
of clavicle , acromion
process and spine of scapula.
insertion – into the deltoid tuberosity of humerus .
Action- act as main muscle for abduction of shoulder
joint . Its anterior part is flexor and medial
rotator of humerus while posterior part is extensior
and lateral roatatior of humerus.
supraspinatus- deep to
trapezius, arises from supraspinatus
fossa of scapula. Fibers crosses above
the shoulder joint and is inserted into
greater tubercle of humerus. Stabilizes
shoulder joint and abducts the
humerus.
Muscles that abduct the upper arm

17. Muscles origin Insertion Actions Nerve supply
Deltiod Scapula and
clavical
Humerus Abduct the
upper arm
Axillary
nerve
Supra
spinatous
Scapula Humerus Abduct the
upper arm
Suprascapul
arnerve

18. Muscles that adduct the upper arm
 1) pectoralis major
 2) lattissimus dorsi
 3) teres major
 4) subscapularis

20.  Latissimus dorsi: very
broad, flat and triangular muscle in
lower back. It is overlapped by lower
part of trapezius. It originates from
lumbar fascia, spines of lower six
thoracic vertebrae, lower three or
four ribs and inferior angle of
scapula. .

24. Muscles origin Insertion Actions Nerve supply
Pectoralis
major
Clavical and
sternum
Humerus Adduct the
upper arm
Medial and
lateral
pectoral
nerves from
brachial
plexus
Lattissimus
dorsi
Thoracic-
lumber
vertebrae
Humerus Adduct the
upper arm
Thoracodorsal
nerve
Teres major Scapula Humerus Adduct the
upper arm
Lower
subscapular
nerve
Subcapsularis scapula Humerus Rotate the
upper arm
medially
Upper and
lower
subscapular
nerves
Infraspinatus scapula Humerus Rotate the
upper arm
laterally
Suprascapula
r
nerve

25. Rotator cuff muscles
 The name given to the
tendons of the
subscapularis, the
supraspinatus, the
infraspinatus, and the teres
minor muscles, which are
fused to the underlying
capsule of the shoulder
joint.
 The cuff is important in
stabilizing the shoulder
joint.

26. Mucles that move forearm
 Anterior flexor muscles
 1) bicep brachii
 2)brachilais
 3) coracobrachialis

29. coracobrachialis
 elongated muscle in
superiomedial aspect of
arm. Originates from
coracoid process of
scapula and inserts into
medial aspect of shaft of
humerus. It flexes the arm
 musculocutaneous nerve.

30. Muscles origin Insertion Actions Nerve supply
Baicep
brachii
Scapula Radius Flexes the
forearm and
supinates the
hand
Musculocuta
neous
nerve
Coracobrachi
alis
scapula humerus Flex the
forearm
Musculocuta
neous
nerve
Barchialis Humerus Ulna Flex the
forearm
Musculocuta
neous
nerve

31. Posterior extenser muscle of arm
Triceps Brachii:
 Arises by three heads, from which it takes its
name.
 Origin of each of the three heads is
1. Long Head: originates from infraglenoid tubercle of scapula
2. Lateral Head: upper half of posterior surface of shaft of
humerus
3. Medial Head: Lower half of posterior surface of shaft of
humerus
 All the fibers inserts into olecranon process
of ulna.
 It is an extensor of elbow joint
 nerve supply - radial nerve

32. Muscles that move the hand
 Anterior flexor pronator group
1) Flexor carpi radialis (flexes and
abduct the hand )
2) Palmaris longus (flexes the
hand)
3) Flexor carpi ulnaris (flexes and
adduct the hand)
4) Proneter teres (pronates the
hand)
5) Brachioradialis
6) Flexor digitorium superficialis
7) Flexor pollicis longus
8) Pronator quadratus

36.  Posterior extensor group muscles :-
1) Extensor carpi radialis
- Extends and abduct the hand
2) Extensor carpi ulnaris
- Extends and adduct the hand
3) Extensor digitorium
- Extends the phalanges

41. Volkmann’s Ischaemic Contracture
 It is the contractures of
the muscles of the
forearm that follows
fractures of the distal
end of the humerus or
fractures of the radius
and ulna.
 Spasm of a localized
segment of the brachial
artery reduces the blood
flow to the flexors and
extensor muscles so that
they under go ischemic
necrosis.
 The flexor muscles are
mostly affected

42. Intrinsic muscles of the hand
 1) palmer flexors :- thernar group
 hypothernar
 intermidiate group
 2) dorsal extensor :-
 thenar extensor
 hypothernar extensor
 intermidiate extensor

43. Dupuytren’s Contracture
 It is a localized thickening and
contracture of the palmar
aponeurosis.
 It commonly starts near the root
of the ring finger pulling it to the
palm and flexing it at the
metacarpo-phalngeal joint. Later
the little finger is involved.
 Dupuytren's disease is familial,
and may be associated with
cigarette smoking, vascular
disease, epilepsy, and diabetes.

44. Pulp-Space Infection (Felon)
 This is the commonest hand
infection. Pus more often
gathers in the finger tips than
anywhere else in the hand.
 It is more common in the
thumb and index fingers.

45. ARTERIES OF THE UPPER LIMB:
THE AXILLARY ARTERY :It begins at the outer border
of the 1st
rib as a continuation of the Subclavian A.
& ends at the lower border of the teres major M. by
becoming the Brachial A.

46. ARTERIES OF THE UPPER LIMB:
The pectoralis minor M . divided it to 3 parts
The 1st
part : lies above the pectoralis minor & give one
branch (superior thoracic A.) . It lies very deeply with the
axillary vein on its medial side .

47. The 2nd
part : lies behind the pectoralis minor M. & gives 2 branches ( acromio thoracic
A.& lateral thoracic A. ).
The 3rd
part : lies below the pectoralis minor M. & gives 3 branches :( subscapular A.,
post. circumflex humeral A. & ant . Circumflex humeral A.).

48. Anastamosis around the scapula
The branches of the third part of axillary A.
* the sub scapular A. which go down along the lateral
border of the scapula.
*the circumflex scapular A. which arise from the sub
scapular A.& go to the infraspinous fossa.

49. THE BRACHIAL ARTERY :
It begins at the lower border of the Teres major M. as a
continuation of the Axillary A. & ends at the level of the
neck of the Radius by dividing to Radial & Ulnar Aa.
It is a superficial A. lies
immediately below the deep
fascia.
The basilic vein lies on its
medial side.

50. The branches of the brachial A.: It supplies all the Mm.
of the arm & gives 3 branches
1- the profunda brachii A.
2- the superior ulnar collateral A.
3- the inferior ulnar collateral A.

51. Anastamosis around The Elbow Joint :
It is a rich anastamosis between small
branches of brachial ,ulnar & radial Aa.:

52. Anastamosis around medial
epicondyle :
The two branches of the brachial A .
(the superior ulnar collateral A. & the
inferior ulnar collateral A.)
with the branches of ulnar A. (the ant. &
post. Ulnar recurrent Aa.) .i.e.
the brachial & the ulnar Aa. only .
Anastamosis around lateral
epicondyle :
The 2 terminal branches of the profuda
brachii a. with recurrent branches of
ulnar & radial Aa.

53. Radial artery
 Begins: in the cubital fossa at the neck of the radius.
 Course: passes downward and laterally end with deep
palmer arch
 Branches
 Radial recurrent a.
 Superfical and deep palmar branch
 Principal artery of thumb
At the lower end of the
radius , it leaves the
front of the forearm &
turns backward round
the lateral border of
the wrist , below the
styloid process of the
radius& enter the
anatomical snuff-box
where the pulsation
can be felt then pass
to the palm .

54. Ulnar artery
 Begins in the cubital fossa at the
opposite neck of the radius.
 Course: passes downward and
medially .
 Branches
 Ulnar recurrent a.
 Common interosseous
artery
 Anterior interossous a.
 Posterior interosseous a.
 Deep palmar branch

55. THE SUPERFICIAL PALMER ARCH :
It is superficial because it lies
immediately next to the
palmer aponeurosis.
It is formed mainly by the ulnar
A. with the superficial palmer
branch of the radial A.
It gives 4 digital Aa. to supply
the 4 medial fingers.

56. THE DEEP PALMER ARCH :
It is formed mainly by the
radial A. with the deep
palmer branch of the
ulnar A.
It gives 3 palmer –
metacarpal Aa. To pass to
the clefts of the fingers.

57. Review
 The subclavian artery becomes the axillary artery after crossing
the 1st rib
 The axillary artery becomes the brachial artery after crossing the
posterior axillary fold
 The brachial artery divides just distal to the elbow into the radial
and ulnar arteries.
 The ulnar artery gives rise to the common interosseous artery,
which divides into anterior and posterior interosseous arteries.
 The hand is supplied on the palmar aspect by variable
anastomoses between branches of the radial and ulnar arteries.

58. THE VEINS OF THE UPPER LIMB
There are superficial & deep veins in the upper limb
.
The deep veins are the veins which
accompany the main Aa. ( way & name ).
The superficial Vv. : start as superficial
venous network on the back of the hand. this
network drains in 2 directions
laterally into Cephalic V &
medially to the basilic V.

59. Blood vessels of upper limbs
Superficial veins
 Dorsal venous network
 Cephalic vein
 Basilic vein
 Axillary vein( basilic+ brachial
vein)
 Median cubital vein
 Median vein of forearm
Deep veins
 Named according to companian
arteries
 Radial vein
 Ulnar vein
 Brachial vein
 Axillary vein

60. Clinical importance of median cubital vein
 Often used for clinical
procedures
1. Blood sampling
2. Blood transfusion
3. Intravenous injection
4. Introduction of cardiac
catheters to secure
blood samples from
chambers of heart and
great vessels
5. Cardio-angiography

61. Brachial plexus

62. THE BRACHIAL PLEXUS
A plexus: it is a complex arrangement of the
anterior primary rami of certain spinal Nn.
Which gives branches to supply the Mm. & skin
of a certain part of a body.

63. It is formed by the anterior primary rami of C5,C6,C7,C8 &T1 Nn.
these are called ROOTS of the plexus.
It lies in the lower part of the neck behind the clavicle & in the
axilla & formed of 4 main parts : Roots , Trunks , Divisions &
cords.

64. The root of C7 alone form the middle trunk.
The roots of C8 & T1 unite to form the lower trunk.
Then each trunk divides into anterior & posterior division .
Then the 3 posterior divisions unite to form the posterior cord .
The anterior divisions of the upper & middle trunks form the lateral
cord.
The anterior division of the lower trunk alone forms the medial cord .
THE TRUNKS formed by
The roots of C5 & C6 unite to form the upper trunk

65. So we have :5 roots , 3 trunks , 6 division , 3 cords & 5
terminal branches .
No branches arise from the trunks nor from the
divisions ( except the suprascapular N. which come
from the erbs point=at beginning of the upper trunk). .
The brachial plexus gives 16 branches , 11 small
branches & 5 big branches : radial , ulnar , median ,
circumflex (axillary) & musclocutaneous Nn.

66. Each cord gives rise to 2 branches one is big & consider
the continuation of the cord & one is small SO
The posterior cord continues as the radial N.
The medial cord continues as the ulnar N.
The lateral cord continues as the median N.
The 3 cords named according to their position to 2nd
part
of the axillary A. (post. , medial & lateral.) while the
name of the main N. according to position in the
forearm( ulnar , median & radial ).

67. The 5 main Nn. Arise opposite the lower border
of the pectoralis minor M. near the coracoid
process .
1- The circumflex (axillary ) N. supplies the
deltoid & teres minor Mm. then become the
lateral cutaneous N. of the arm.
2- The musculocutaneous N. supplies the
biceps , coracobrachialis & brachialis Mm.
then become the lateral cutaneous N. of the
forearm .
3- The median N ( with its branch =ant.
Interosseous N.) supplies most of the Mm. of
front of the forearm with sensation of lateral 3
& ½ fingers anteriorly .

68. 4- The radial N.( with its branch=post.
Interosseous N.) supplies most of the mm. of the
back of the forearm. With sensation of lateral 3 & ½
fingers posteriorly.
5- The ulnar N. supplies Mm. on the medial side of
the forearm with sensation of medial 1 & ½ fingers
anteriorly & posteriorly .

70. Median nerve
Origin: arises from the medial
and lateral cord of the
brachial plexus.
Course:
 Descends on the lateral side
of brachial artery.
 Halfway down the arm, it
crosses the brachial artery to
reach its medial side.

71.  he median nerve travels through
a tunnel within the wrist called
the Carpal Tunnel. The median
nerve gives sensation to the
palm sides of the thumb, index
finger, long finger, and half of the
ring finger. It also sends a nerve
branch to control the thenar
muscles of the thumb. The
thenar muscles help move the
thumb and let you touch the pad
of the thumb to the tips each of
each finger on the same hand, a
motion called opposition.

72. Ulnar nerve
Origin: arises from the medial cord of the
brachial plexus.
Course:
 Descends on the medial side of brachial
artery.
 At the middle of the arm, it pierces the
medial intermuscular septum and
passes down behind the medial
epicondyle of the humerus.

75. THE DERMATOMES OF THE UPPER LIMB
It is the cutaneous sensation of the upper limb.
C4 supplies the skin over the tip of the shoulder .
C5 supplies the lateral side of the arm &the upper lateral part of the forearm .
C6 supplies the lateral side of the lower part of the forearm & the lateral aspect of
the hand
C7 supplies the middle aspect of the hand (ant.& post.) .
C8 supplies the medial side of the hand & the
medial lower part of the forearm.
T1 supplies the medial part of the upper part of
the forearm & the medial lower part of the
arm.
T2 supplies the medial side of the upper part of
the arm & the floor of the axilla.

76. Cubital fossa
Boundaries
Superior: an imaginary line
drawn between the two
epicondyles of the humerus.
Lateral: brachioradialis;
Medial: pronator teres;
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77. Cubital fossa
Contents:
The median N.
The brachial A., radial A., ulnar
A.
The superficial and deep
branches of the radial N.
Radial artery
Ulnar artery
Median nerve
Brachial
artery
Radial
nerve
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78. The blood pressure is
universally recorded by
auscultating the brachial artery
in medial side of the biceps’
tendon in the cubital fossa.
Applying
Cubital fossa
Brachial artery
Biceps
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81. Thank you !!!