Anatomy of Upper Limbs

Lucky Prasetiowati, dr
Dept Anatomy & Histology
Faculty of Medicine
Universitas Airlangga
 Overview
Segments of upper limb
• Pectoral-scapular
• Arm (brachii)
• Forearm (antebrachii)
• Hand (manus)

Structures:
• Bones and joint
• Fascia
• Muscle
• Neurovascular

Moore, Clinically Oriented Anatomy. 2014

 Bones and joints
• Glenohumeral joint
• elbow joint
• proximal and distal radio-ulnar
joints
• wrist joint
• carpometacarpal joint
• metacarpophalangeal joints

Moore, Clinically Oriented Anatomy. 2014

 • (1) subcutaneous fat (superficial fascia)
Fascia • (2) deep fascia → investing the muscles, attached to bone.
 Superficial Veins Of Upper Limb

• Dorsal venous network

• Cephalic vein (lateral side)
• Basilic vein (medial side)
• Median cubital vein

Moore, Clinically Oriented Anatomy. 2014

 Lymphatic Drainage of Upper
Limb
• Superficial
– from lymphatic in the skin & ascend with the
cephalic and basilic veins
– Medial: lnn. Cubital → lnn. Humeri axillaris
– Lateral: lnn. Apical, some→ lnn. dectopectorall
• Deep
– drain from the joint capsules, periosteum, tendons,
nerves, and muscles
– ascend with the deep veins → lnn. Hum axill → lnn.
Central axill → lnn. Apical → subclavian lymphatic
trunk

Moore, Clinically Oriented Anatomy. 2014

 Cutaneous Innervation of Upper Limb
• Most cutaneous nerves are derived from the brachial plexus (C5–T1)
spinal nerves
• Shoulder: from the cervical plexus (C1-C4)

Dermatome proposed by Foerster, 1933)

Moore, Clinically Oriented Anatomy. 2014

 Cutaneous
nerve

Moore, Clinically Oriented Anatomy. 2014

 Muscles in each region
• Pectoral region
• Scapular region
• Arm region (regio brachii)
• Forearm region (regio antebrachii)
• Hand (regio manus)
 1. PECTORAL REGION
• SURFACE ANATOMY:
– ANTERIOR: Pectoralis major m.(male) & mammary gland (female)
– POSTERIOR: Scapula
• FASCIA:
– SUPERFICIAL: Fat >>, vessels&nerves (cephalic v.), mammary gland
– DEEP: → continue to abdominal region
• Pectoral fascia: clavicle to sternum, encloses pectoralis major m., continue to
latissimus dorsi→ form axillary fascia
• Axillary fascia: as the base of axillary fossa, form suspensory lig.of axilla→
clavipectoral fascia, continue to brachial fascia
• Clavipectoral fascia: encloses pectoralis minor m.&subclavius m.,
→ Costocoracoid membrane: pierces by cephalic vein, thoracoacromial a., lateral
pectoral n.
 Pectoral region
• M. pectoralis major
• M. pectoralis minor
• M. subclavius
• M. serratus anterior
 2. SCAPULAR REGION

• Muscles:
– Extrinsic superficial ➔ Trapezius & latissimus dorsi muscles
– Extrinsic profundus➔ levator scapulae, rhomboidei minor et
major muscles
– Intrinsic➔ mm. deltoideus, supraspinatus, infraspinatus,
subscapularis, teres minor et major muscles
 Muscles of Arm Region
 Septum intermusculare medial et lateral →
kompartmen (anterior dan posterior)

Fascia superficialis

Moore KL. Clinnically oriented anatomy. 6th. 2010

Muscle of the arm (anterior)

Netter. Atlas of human anatomy. 4th ed.2006

 Posterior compartment of arm
M. Triceps Brachii
– 3 head (longum, medial et lateral)
– lateral & medial head separated by radial groove (sulcus N. radialis)
• O : caput longum → tuberositas infraglenoidalis
caput lateral et medial → os humeri
• I : superior olecranon
• Inervation N. radialis
• Fs : extent artic. cubiti
long head → extent & adduct artic. Humeri
 Compartment of Forearm
• Deep fascia of forearm and interossea membrane → flexor &
extensor muscles
• Deep fascia thicken distally➔ retinacula flexorum et extensorum.

Grant’s atlas of anatomy. 12th ed.2009

 Muscle of the forearm
Anterior Flexor Compartment Muscle
Superficial
▪ Mm. pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris et
flexor digitorum superficialis
▪ O: medial epicondyl humeri
▪ Innervation: median nerve except. M. flex carp ulnar (ulnar nerve)

Deep
▪ Mm. flexor digitorum profundus, flexor policis longus, et pronator quadratus
▪ Inervation: ant interossea nerve (branch of median nerve) except medial part of M.
flex digit prof (ulnar nerve)

Action: flexion radiocarpal joint and fingers, pronate forearm

 Superficial muscle groups
Musculus O I Inervasi Aksi
Pronator teres lin supracond med & Fasciae lateralis radii. N. Medianus pronasi radioulnaris dan
epicond med hum flexi cubiti.
Flexor carpi Epicond med hum Metacarpal II-III N. Medianus Flexi & abduksi
radialis radiocarpal.
Palmaris longus Epicond med hum Aponeurosis palmaris N. Medianus Flexio cubiti &
radiocarpal.
Flexor carpi Epicond med hum Pisiforme & basis N. Ulnaris flexi & adduksi
ulnaris metacarpal V radiocarpal,
Flexor digitorum Epicond med hum & lateral & medial N. ulnaris Flexi interphalang.
superficialis margo ant radii phalang media digiti II-V

Deep muscles groups

Musculus O I Inervasi Aksi
Flexor digitorum Fac ant ulna & Phalanx distal digiti Med : N. Ulnaris, flexi interphalang
profundus membrana interossea II-V Lateral : N. Interossea
anterior
Flexor pollicis Fac ant radius & Phalanx distalis N. Interossea anterior Flexi interphalang
longus Membrana interossea pollicis
Pronator Fac ant Ulna Facies anterior N. Interossea anterior Pronasi antebrachii
quadratus radius
Netter. Atlas of human anatomy. 4th ed.2006
Grant’s atlas of anatomy. 12th ed.2009
 Muscle of the forearm
Posterior Extensor Compartment Muscle
▪ Innervation by radial nerve
▪ Most attach posterior aspect of the lateral epicondyle humeri

Superficial
▪ Mm. brachioradialis, extensor carpi radialis longus et brevis, extensor digitorum
communis, extensor digiti V, extensor carpi ulnaris dan anconeus.

Deep
▪ Mm. supinator, abductor pollicis longus, extensor pollicis brevis et longus, extensor
indicis propius
 Superficial muscle groups
Musculus O I Inervasi Aksi
Brachioradialis Linea Proc. Styloideus radius N. Radialis Flexi articulatio cubiti,
supracondylaris dan rotasi antebrachii
lateralis
Extensor carpi Linea Basis metacarpal II N. Radialis Extensi dan abduksi
radialis longus supracondylaris articulatio radiocarpeae
lateralis
Extensor carpi epicondylus lateralis Basis metacarpal III N. Interossea Extensi dan abduksi
radialis brevis humeri posterior articulatio radiocarpeae

Extensor digitorum epicondylus lateralis Phalanx media dan N. Interossea Extensi digiti II-V, &
communis humeri distal digiti II-V posterior articulatio radiocarpeae

Extensor digiti epicondylus lateralis Digiti V N. Interossea Extensi digiti V

minimi humeri posterior
Extensor carpi epicondylus lateralis Basis metacarpal V N. Interossea Extensi dan adduksi
ulnaris humeri posterior articulatio radiocarpeae

Anconeus Post epicondylus Proc. Olecranon dan N. Radialis Extensi dan stabilisasi
lateralis humeri corpus ulna articulatio cubiti
Netter. Atlas of human anatomy. 4th ed.2006
 Deep muscle groups
Musculus O I Inervasi Aksi
Supinator Epicondyl lat humeri Collum dan corpus N. Interossea posterior Supinasi antebrachii
& incisura radialis radius
ulna
Abductor pollicis Corpus radius dan Basis metacarpal I N. Interossea posterior Abduksi pollex
longus ulna, membrana
interossea
Extensor pollicis Corpus radius dan Basis phalanx N. Interossea posterior Extensi articulatio
brevis membrana interossea proximal pollex MCP pollex

Extensor pollicis Corpus ulna dan Basis phalanx N. Interossea posterior Extensi pollex
longus membrana interossea distalis pollex

Extensor indicis Corpus ulna dan Digiti II N. Interossea posterior Extensi digiti II
membrana interossea
 Fascia and compartment the Palm
• The fascia of the palm is continuous with the
antebrachial fascia and the fascia of the dorsum of
the hand.
• The palmar fascia is thin over the thenar and
hypothenar eminences but it is thick centrally ➔
palmar aponeurosis, and in the fingers ➔ digital
sheaths.
• The proximal end palmar aponeurosis is continuous
with the flexor retinaculum and the palmaris longus
tendon.
 Compartments of the hand
The intrinsic muscles of the hand are located in five
compartments:
1. Thenar muscles in the thenar compartment
➔abductor pollicis brevis, flexor pollicis brevis,
and opponens pollicis.
2. Adductor pollicis in the adductor compartment.
3. Hypothenar muscles in the hypothenar
compartment ➔ abductor digiti minimi, flexor
digiti minimi brevis, and opponens digiti minimi.
4. Short muscles of the hand, the lumbricals, in the
central compartment with the long flexor
tendons.
5. The interossei in separate interosseous
compartments between the metacarpals.
Thenar muscles
Hypothenar muscle
Short muscle of the hand
Arteries

• Subclavian A (neck)
• Axillary A (armpit)
– Subscapular A
• Brachial A (arm)
– Deep brachial
• Radial A (forearm)
• Ulnar A (forearm)
Common Interosseous A
• Superficial & Deep Palmar
arches
Special features:
Axillary fossa

Drake’s Basic Gray of Anatomy

Anatomy Lecturer Team-Faculty of Medicine-
36
Universitas Airlangga-2016
 axillary artery
• From subclavian artery (lateral A. Thoracica superior
costa I) A. thoracoacromialis

• Branch (M. pectoralis minor): A. subscapularis

▫ I ➔ A. thoracica superior
▫ II ➔ A. thoracoacromialis,
A. thoracalis lateralis
▫ III ➔ A. subscapularis
A. circumflexa anterior
A. circumflexa posterior
A. Circumflexa anterior

A. Circumflexa posterior
A. thoracalis lateralis
 Brachial artery
• A. profunda brachialis →
– A. collateralis radialis
– A. collateralis media
• A. collateralis ulnaris proksimal
• A. collateralis ulnaris distal

Netter. Atlas of human anatomy. 4th ed.2006

Ulnar artery
• Branch:
▫ Aa. rec ulnaris ant et post
▫ A. inter comm
▫ Rr. carpal palm et dors.

Radial artery
• Branch:
▫ A. recc radialis
▫ Rr carpal palm et dors
▫ Rr muscular

Moore KL. Clinnically oriented anatomy. 6th. 2010

 ULNAR ARTERY IN HAND
• ulnar artery enters the hand anterior to the
flexor retinaculum via the ulnar canal (Guyon
canal), lateral to the ulnar nerve ➔ the
superficial palmar arch and the deep palmar
branch
• The superficial palmar arch → gives rise to
common palmar digital arteries that
anastomose with the palmar metacarpal
arteries from the deep palmar arch.
• Each common palmar digital artery divides
into a pair of proper palmar digital arteries,
which run along the adjacent sides of the 2nd–
4th digits.
 RADIAL ARTERY IN HAND
• The radial artery curves dorsally and crosses the
floor of the anatomical snuff box →enters the
palm
• The radial artery ends by anastomosing with
the deep branch of the ulnar artery to form the
deep palmar arch.
• The deep palmar arch → gives rise to three
palmar metacarpal arteries and the princeps
pollicis artery.
• The radialis indicis artery passes along the
lateral side of the index finger.
 Veins
SUPERFICIAL

•Cephalic (arm-forearm)
•Basilic (arm-forearm) DEEP

•Subclavian (neck)
•Median Cubital vein (elbow) •Axillary (axilla)

•Brachial (arm-elbow)
•SF. Palmar Venous Arch
•Digital
•Radial (forearm)
•Ulnar (forearm)
•Deep Palmous Venous arch
 Pulses, palpation and arterial gases

• Brachial artery:
– along the medial side of t.m biceps brachii
– a useful site to pass an arterial catheter for coronary angiography or cardiac
catheterization.
• Radial artery:
– on the anterior aspect of the wrist, between T.m. flexor carpi radialis and lateral
aspect of the radius.
• Median cubital vein
– Blood sampling, blood transfusion and i.v →near the elbow
• Cephalic vein
– may be accessed where it lies superficial in the anatomical snuffbox
 Plexus Brachialis

Moore, Clinically Oriented Anatomy. 2014

 M. Supraspinatus
M. infraspinatus

M. rhomboid

M. Serratus anterior

M. subclavius

Moore, Clinically Oriented Anatomy. 2014

 Axillary a. N. dorsalis scapulae
N. suprascapularis
N. musculocutaneous

N. axillaris

Median n.

N. ulnaris
N. cut antebrachii med

N. cut brachii med

N. subscapularis inf

N. pectoralis lat
N. thoracodorsalis
N. subscapularis sup
N. pectoralis medial
N. thoracalis lat
Netter. Atlas of human anatomy. 4th ed.2006
N. ulnaris
 N. radialis

N. medianus
Special Features:
Gateways in posterior scapular region
• Triangular space/Hiatus axillaris medialis:
– m. teres minor, m. teres major and caput longum
m. triceps brachii
• Quadrangular space/Hiatus axillaris lateralis:
– m. teres minor, m. teres major, caput longum m.
triceps brachii and collum chirurgicum humeri
• Triangular interval:
– caput longum m. triceps brachii, caput laterale
m. triceps brachii and m. teres major
 Cubital Fossa
Boundaries:
• Sup →line between epicondyle humeri
• Apex→ M. Brachioradialis, M. pronator teres
• Roof →deep fascia and M. Biceps brachii
aponeurosis
• Floor → M. brachialis, M. supinator
• Superficial structure ➔ Vv. basilica, cephalica et
mediana cubiti dan Nn. cutaneus antebrachii
medialis et lateralis.

Content of cubital fossa N. medianus

(lat →med)
Tendon of M. biceps brachii
A. brachialis and branches of Aa. Radialis et ulnaris A. ulnaris
T.i.m. Biceps
N. medianus. brachii

Radial nerve → deep M. Brachioradalis → give A. radialis

branches: Rr superficial dan profundus.

Frolich, Human Anatomy, Lower
LImb