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The Upper Limb
The Upper Limb
Latissimus dorsi
Levator scapulae
Rhomboideus
Deep group
Erector spinae
Splenius
Thoracolumbar fascia
The muscles of thorax
Extrinsic muscles
Pectoralis major
Pectoralis minor
Serratus anterior
Intrinsic muscles
Intercostales externi
Intercostales interni
Intercostales intimi
The Muscles of Upper Limb
Muscles of shoulder
Deltoid
supraspinatus
Infraspinatus
Teres minor
Teres major
subscapularis
Major muscles of upper limb
Deltoid
Origin: lateral third of
clavicle, acromion, and spine
of scapula
Insertion: deltoid tuberosity
of humerus
Action: abducts,flexes and
medically rotates, extends,
and laterally rotates arm
Teres major
Origin: dorsal surface
of inferior angle of
scapula
Insertion: crest of
lesser tubercle of
humerus
Action: medially
rotates and adducts
arm
Foramen axillare laterale et mediale
Arm Muscles That Move the Shoulder/Elbow
Joint
(Flexor) compartment
Posterior (extensor) compartment
Anterior compartment
primarily contains shoulder/elbow flexors
Posterior group –
triceps brachii
Biceps brachii
Origin: long head,
supraglenoid tubercle; short
head, coracoid process
Insertion: radical tuberosity
Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint
Pronator teres
Origin: medical epicondyle of
humerus and deep fascia of
forearm
Insertion: middle of lateral
surface of radius
Action: pronation of forearm
and flexion of elbow
Triceps brachii
Origin: long head,
infraglenoid tubercle; lateral
head, above groove for
radical n., medical head,
below groove for radical n.
Insertion: olecranon of ulna
Action: extends elbow joint),
long head can extend and
adduct shoulder joint
Posterior of the arm
Surface anatomy
M. triceps brachii
caput longum, medialis, lateralis
Surface elements
Skin thick and movable
Subcutaneous tissue well expressed
n. cutaneus brachii posterior
n. cutaneus brachii lateralis inferior
n. cutaneus antebrachii posterior
Deep structures
А. Fascia brachialis
- Thick, thins distally
B. Neurovascular bundles
1. Upper - in canalis humero-muscularis, between:
- sulcus n. radialis
- medial and lateral head of m. triceps brachii
1.1. n. radialis – lies on the humerus
- n. cutaneus brachii lateralis inerior
- n. cutaneus antebrachii posterior
- rr. musculres
1.2. a. profunda brachii
- a. collateralis media
- collateralis radialis
Lower neurovascular bundle
behind medial epicondyle
n. ulnaris
a. collateralis ulnaris inferior
Elbow region
Anterior elbow
Surface anatomy
Three eminences
Two grooves
Elements
Lateral groove - v. cephalica, n. cutaneus
antebrachii lateralis
Medial groove – v. basilica, n. cutaneus
antebrachii medialis
V. mediana cubiti
Deep structures
А. Muscles
Flexors of forearm – medial eminence
Extensors of forearm – lateral eminence
Brachial muscles, mm. biceps, brachialis –
middle eminence
Deep structures
B. Vessels and nerves
Medial bundle - between m. biceps brachii and pronator
teres
- a.v. brachialis, n. medianus
Lateral bundle - between m. brachialis and
brachioradialis
- n. radialis, a. collateralis radialis, a. recurrens radialis
C. Cubital fossa
Boundaries
- m. brachioradialis (lateral), m. pronator teres (medial)
Content
- tendo m. brachialis, m. biceps brachii, bursa bicipitoradialis
Layers of the elbow
Venous
1 v. cephalica
2 v. basilica
3 v. mediana cubiti
Apponeurotic
1 aponeurosis bicipis
2 tendo m. biceps brachii
Neurovascular
1 a. brachialis
2 n. medianus
Muscle
1 m. supinator
2 m. brachialis
3 tendo m. biceps brachii
Bone
1 humerus
2 radius
3 ulna
Anterior elbow
Arteries of upper limb
Axillary artery
Continuation of subclavian artery at
lateral border of first rib
Becomes brachial artery at lower
border of teres major
Divided into three parts by overlying
pectoralis minor
First portion, above muscle-gives rise
to thoracoacromial a.
Second portion, behind muscle-gives
rise to lateral thoracic a.
Third portion, below muscle-gives rise
to subscapular a.
divides into throcodorsal a.
and circumflex scapular a.
anterior and posterior humeral
circumflex a.;
Brachial artery
Continuation of axillary artery
Anterior interossous a.
Posterior interosseous a.
Deep palmar branch
Basilic vein
Arises from the medial side of the
dorsal venous rete of hand
Ascends on the ulnar side of forearm
to the elbow and then in the medial
bicepital brachii furrow to middle of
the arm where it pierces the deep
fascia and joins the brachial vein or
axillary vein
Median cubital vein
links cephalic vein and basilic vein in
the cubital fossa. It is a frequent site
for venipuncture to remove a sample
of blood or add fluid to the blood
The lymphatic drainage of upper limb
Lymphatic vessels
Superficial-follow the
superficial veins, drain into
supratrochlear and axillary
lymph nodes
Deep-accompany main vessels,
end in axillary lymph nodes
Lymph nodes
Cubital lymph node: lies above
medial epicondyle of humerus
Axillary lymph node-arranged
in five groups
Axillary lymph nodes
Arranged in five groups
Lateral lymph nodes lie around
the distal end of axillary vein ,
receiving drainage from the arm,
forearm, and hand
Pectoral lymph nodes lie along
lateral thoracic vessels, receive
afferents from anterior thoracic wall
including central and lateral portion of
mamma
Subscapular lymph node along
subscapular vessels, receive lymph
from nape and scapular region
Efferents above three groups pass to
central lymph node
Brachial plexus
Formation:
Five roots: anterior rami of C5-C8
and T1 spinal nerves, roots C5-
C7give rise to long thoracic n.
Three trunks
Upper trunk formed by the joining of
roots C4,C5,C6.
Middle trunk continuation of root C7.
Lower trunk formed by the joining of
roots C8 and T1.
Six divisions: above clavicle,
trunks form anterior and posterior
divisions
Three cords: below clavicle,
divisions form three cords that
surround the second portion of
axillary a.
Position:
passes through the scalene fissure to
posterosuperior of subclavian artery, then
enters the axilla to form lateral, medial and
posterior cords
Main branches
Lateral cord
Musculocutaneous n.
Medial cord
Medial root to median n.
Ulnar n.
Supplies:
Muscles -‘BBC nerve’
Biceps brachii,
Brachalis
Coracobrachialis;
forearm,
Brachioradialis;
Insertion:
Base of middle phalanges of 2nd to 5th fingers.
Action:
Flexes middle and proximal phalanges of 2nd
to 5th fingers, and the hand
Third layer
Flexor digitorum
profundus
Flexor pollicis longus
Fourth layer
Pronator quadratus
Action: flex radiocarpal
joint and fingers,
pronate forearm
Lateral compartment (3)
Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Common extensor origin,
(front of lateral epicondyle of
the humerus), EXCEPT, 2 (BR
& ECRL).
Cross the wrist EXCEPT
brachioradialis.
Supplied by deep branch of
radial nerve
Posterior compartment (8)
Superficial layer (3)
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Common extensor origin, (front of
lateral epicondyle of the humerus),
Cross the wrist.
Supplied by deep branch of radial
nerve
Deep layer (5)
Supinator
Extensor indicis
Action: extend
radiocapral joint and
fingers, and supinate
forearm
INSERTION
Anterior interossous a.
Posterior interosseous a.
Deep palmar branch
Superficial palmar arch
Formed by ulnar artery and
superficial palmar branch
of radial artery
Curve of arch lies across
the palm, level with the
distal border of fully
extended thumb
Gives rise to three common
palmar digital arteries each
then divides into two
proper palmar digital
arteries
Deep palmar arch
Formed by radial artery
and deep palmar branch of
ulnar artery
Curve of arch lies across
upper part of palmar at
level with proximal border
of extended thumb
Gives rise to three palmar
metacarpal arteries
Veins of the upper limb
Deep veins: accompany the arteries of
the same region and bear similar
names
Superficial veins
Cephalic vein
Arises from the lateral side of the
dorsal venous rete of hand
Ascends on radial side of the forearm
to the elbow and then in the lateral
side of biceps brachii furrow,
continues up the arm in the
deltopectoral groove and then to the
infraclavicular fossa, where it pierces
clavipectoral fascia to drain into
axillary vein