ANATOMY OF

UPPER LIMB

BY
Dr.TEJASWI DUSSA
PG IN MS (ORTHO)
GANDHI HOSPITAL
MUSCLES OF UPPER LIMB

 Attachments
 Nerve Suply
 Blood Supply
 Actions &
 Clinical Testing
ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON

 BONY CONNECTION -  MUSCULAR

CLAVICLE ATTACHMENTS
 Trapezius,
 Latissmus Dorsi,
 Levator Scapulae,
 Rhomboideus Major,
 Rhomboideus Minor
 TRAPEZIUS
 ORIGIN: External occipetal protuberance,
Superior nuchal line of occipetal bone,
Spinous processes of 7th cervical and All thoracic
vertebrae
 INSERTION: lateral 1/3 of clavicle, Medial margin of
acromion, spine of scapula
 ACTION: Elevates The Scapula , rotation of
scapula, retraction of shoulder, draw the scapula
downwards and Abduction Of Shoulder Beyond 90*
 N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)
TREPEZIUS
LATISSIMUS DORSI
 ORIGIN: posterior layer of
thoraco lumbar fascia,
Spinous processes of lower 6
thoracic vertebrae and
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)
LEVATOR SCAPULAE

 ORIGIN: transvers
processes of upper 4
cervical vertebrae.
 INSERTION: medial
border of the scapula
superior portion.
 ACTION: elevation of
sup.angle of scapula and
draws it medially.
 N.SUPPY: C3,C4,C5
Nerves
RHOMBOIDUS MINOR

 ORIGIN: ligamentum
nuchae,spinous process
of c7,t1 vertebrae
 INSERTION : medial
border of the scapula
 ACTION :
retracts, depress the
scapula and fix it to
thoracis wall
 N.SUPPLY :Dorsal
Scapular .N (C4,C5)
RHOMBOIDUS MAJOR
 ORIGIN: Spinous process
of t2-t5
 INSERTION: medial
border of the
scapula, inf.angle
 ACTION: retracts the
scapula, depress the
glenoid cavity and
fix the scapula to the
thoracis wall
 N.SUPPLY: Dorsal
Scapular .N (c4,c5)
RHOMBOIDS (c4,c5)
MUSCLES OF PECTORAL REGION

 PECTORALIS MAJOR
 PECTORALIS MINOR
 SUBCLAVIUS
PECTORALIS MAJOR
 ORIGIN:
sternal half of the clavicle,
Upper half of
sternum, aponeurosis of
ext.obl.muscle,
 INSERTION : lateral lip of
intertubercular sulcus
 ACTIONS:
adduction, medial rotation
and flexion of the
shoulder.
 N.SUPPLY: Med & Lat
Pectoral.N (C5-8,T1)
PECTORALIS MAJOR
PECTORALIS MINOR
 ORIGIN: costocondral
jn.of 3,4,5 ribs
 INSERTION: corocoid
process medial &upper
surface
 ACTIONS: draws the
scapula
forwards, depression of
the shoulder.
 N.SUPPLY: Med & Lat
Pectoral.N (C5-C8,T1)
SUBCLAVIUS

 ORIGIN: 1st rib at the

costochondral jn.
 INSERTION: subclavian
groove of the clavicle
 ACTION:steadies the
clavicle
 N.SUPPLY:
N.Subclavius from
upper trunk of B.P
(c5,c6)
SERRATUS ANTERIOR
 ORIGIN: outer and superior
surface of the 1-8 ribs
 INSERTION: superior
angle, medial border and
inferior angle of the scapula
 ACTION: rotates scapula
upwards,
abduction of shoulder
above 90*
 N.SUPPLY: Long Thoracis.N
(c5,c6,c7)
WINGING OF SCAPULA
MUSCLES OF SHOULDER GIRDLE

 Deltoid
 Rotator cuff muscles- Supra Spinatus
Infra Spinatus,
Subscapularis,
Teres Minor.
 Teres major
 DELTOID
 ORIGIN
Lateral 1/3
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)
DELTOID
SUPRASPINATUS

 ORIGIN: supraspinatous
fossa of the scapula
 INSERTION: superior
facet on the gr.tubercle
of the humerus
 ACTION: initiation of
abduction (15*) & lat.
Rotation
 N.SUPPLY:
Suprascapular.N From
B.P (C5,C6)
SUPRASPINATUS
 INFRASPINATUS
 ORIGIN: infraspinatous
fossa of the scapula
 INSERTION: middle facet
on the gr.tubercle of the
humerus
 ACTION:
lat.rotation of
shoulder, strengthen the
shoulder by bracing the
head of humerus.
 N.SUPPLY:
Suprascapular .N of B.P
(C5,c6)
INFRASPINATUS
TERES MINOR

 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)
SUBSCAPULARIS
 ORIGIN:
medial 2/3 subscapular
fossa, lat border of tha
scapula
 INSERTION: lesser tubercle of
the humerus
 ACTION:
stabilise the shoulder &
prevents anterior
displacement of the shoulder
(med. rotation, adduction of
arm)
 N.SUPPLY: Upper &Lower
Subscapular .N (c5,c6)
SUBSCAPULARIS
ROTATOR CUFF
TERES MAJOR
 ORIGIN: dorsal surface of
the inf.angle of the scapula
 INSERTION: med.lip of the
intetubercular groove of the
humerus
 ACTION:
extends the arm from
flexd.position & it
adducts, med.rotates the
arm
 N.SUPPLY: Lower
Subscapular (C6,C7)
 MOVEMENTS OF THE SHOULDER

 Flexion
 Extension
 Abduction
 Adduction
 Internal rotation,
 External rotation
 circumduction
FLEXION

 Pect.Mojor
 Anterior Fibers Of
Deltoid
 Coraco brachialis
EXTENSION

 Lattismus Dorsi
 Teres Major
 Posterior fibers Deltoid
 ABDUCTION

 Supraspinatous (15*)
 Deltoid (15-90*)
 Serratus Anterior
(>90*)
 Trapezius (>90*)
 ADDUCTION

 Lattismus Dorsi
 Pectoralis Major
 Subscapularis
 Teres Minor
 Teres Major
 CORACO BRACHIALIS
INTERNAL ROTATION

 Pectoralis Major
 Ant.Deltoid
 Subscapularis
 Teres Major
 Lattismus Dorsi
EXTERNAL ROTATION

 Deltoid
 Supraspinatus
 Infraspinatus
 Teres Minor
MUSCLES OF ARM

 FLEXOR COMPARTMENT:
 BICEPS BRACHII
 CORACO BRACHIALIS
 BRACHIALIS

 EXTENSOR COMPARTMENT
 TRICEPS
BICEPS BRACHII
 ORIGIN:
Long head: supra glenoid
tubercle of the scapula
Short head: apex of the coracoid
process
 INSERTION: Radial Tuberosity
 ACTION: flexor of supinated
forearm
Powerful Supinator Of Partially
Flexed Forearm
 N.SUPPLY: musculo cutaneous.N
(c5,c6)
BICEPS BRACHI
CORACO BRACHIALIS

 ORIGIN: coracoid
process of the scapula
 INSERTION: middle of
medial surface of the
humerus
 ACTION: flexes and
adducts the arm
 N.SUPPLY:
musculocutaneous .N
(c6,c7)
BRACHIALIS
 ORIGIN: distal half of the
anterior humerus
 INSERTION :coronoid
process, tuberosity of ulna
 ACTION: Powerful Flexor
Of Forearm
 N.SUPPLY:
Musculocutaneous .N
(C5,C6,C7)
MUSCULOCUTANEOUS NERVE
:C5,C6,c7

Biceps Brachii

Brachialis

coracobrachialis
TRICEPS
 ORIGIN:
Long head: infraglenoid
tubercle of the scapula
Lat.head: oblique ridge on
upper surface above the
radial groove
Medial head: posterior
surface of the humerus inf.to
the radial groove
INSERTION: proximal olecrenon
of the ulna
ACTION:extends the forearm
N.SUPPLY: Radial .N.(C7,c8)
TRICEPS
MOVEMENTS AT ELBOW

 FLEXION  EXTENSION
Brachialis Triceps
Biceps
MUSCLES OF FOREARM
 Anterior Compartment:
common flx.origin
 SUPERFICIAL 1.Pronator Teres
2.Flx Carpi Ulnaris
3.Palmaris Longus
4.Flx.Carpi Radialis
5.Flx.Digitorum Superficialis (sublimus)
 DEEP:
1.Flx.Digitorum Profundus
2.Flx.Pollicis Longus
3.Pronator Quadratus
 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.Carpi Ulnaris
 DEEP
1.Abductor Pollicis Longus
2.Ext.Pollicis Brevis
3.Ext.Pollicis Brevis
4.Ext.Indicis
5.Supinator
PRONATOR TERES

 Insertion: midway long

the lateral surface of the
radius
 Action: pronation,flexion
of forearm
 N.Supply:Median.N
(C6c7)
PRONATOR TERES
FLX.CARPI RADIALIS
 INSERTION:base of the
2nd mc bone and slip to
the bace of the 3rd MC
bone
 ACTION: flexion and
abduction of wrist
 N.SUPPLY: Median.N
(c6,c7)
PALMARIS LONGUS
 INSERTION: anterior
aspect of the distal
flx.retinaculum and
palmar aponeurosis
 ACTION: flx.the
wrist, and tightens the
palmar.aponeurosis
 N.SUPPLY: Median. N
(c6,c7)
FLX CARPI ULNARIS

 ORIGIN:
humoral head: med epicondyle
Ulnar head:med.margin of the
olecrenon,posterior border of
the ulna
 INSERTION: pisiform,
hook of hamate, base of the 5th
MC & flx.retinaculum
 ACTION:flexes and adducts
the hand
 N.SUPPLY: Ulnar.N (C7,C8)
FLX.CARPI ULNARIS
FLX.DIGITORUM SUPERFICIALIS
 ORIGIN:
humeroulnar head:
med.epicondyle of the
humerus, coronoid process
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)
 FLX.DIGITORUM PROFUNDUS
 ORIGIN:prox.3/4 of the medial
and anterior aspect of the ulna
and from interosseous memb.
 INSERTION:base of The Diatal
phalanges of the medial 4 digits
 ACTION: flx.DIP,,PIP,MP, wrist
 N.SUPPLY:
Medial-ulnar.N (C8,t1)
Lateral-AIN Of Median.N
(C8,t1)
FLX.DIGITORUM PROFUNDUS
FLX.POLLICIS LONGUS
 ORIGIN: upper 3/4 of
anterior surface of radius
 INSERTION: base of distal
phalanx of the thumb
 ACTION: flexion of
proximal & distal phalnx of
the thumb
 N.SUPPLY:AIN (C7,C8,T1)
FLX.POLLICIS LONGUS
PRONATOR QUADRATUS
 ORIGIN: lower 1/4th of
anterior surface of ulna
 INSERTION: lower 1/4th of
anterior surface of radius
 ACTION :pronation
 N.SUPPLY:AIN (C8,T1)
POSTERIOR COMPARTMENT OF FOREARM

SUPERFICIAL
1.anconeus
2.Brachioradialis
3.Ext.Carpi Radialis Longus
4.Ext.Carpi Radialis Brevis
5.Ext.Digitorum
6.Ext.Digiti Minimi
7.Ext.Carpi Ulnaris
DEEP
1.Abductor Pollicis Longus
2.Ext.Pollicis longus
3.Ext.Pollicis brevis
4.Ext.Indicis
5.supinator
ANCONEUS
 ORIGIN: posterior surface
of the lat.epicondyle
 INSERTION:lateral surface
of olecranon,body of ulna
 ACTION: extension of
forearm
 N.SUPPLY: radial.n
BRACHIORADIALIS
 ORIGIN: prox.2/3rd of
lat.supracondylar ridge of
humerus, lateral intermuscular
septum
 INSERTION: lat.aspect of distal
radius just prox.to the styloid
process
 ACTION: acc.flexor of elbow
 N.SUPPLY: Radial.N (C5,C6)
BRACHIORADIALIS
EXT.CARPI RADIALIS LONGUS
 ORIGIN: lat.supracondylar
ridge of humerus
 INSERTION: base of the 2nd
MC bone
 ACTION: extends and
abducts the hand
 N.SUPPLY: Radial .N
(C6,C7)
EXTENSOR CARPI RADIALIS BREVIS
 ORIGIN: lat.epicondyle of
the humerus
 INSERTION: base of the 3rd
MC bone
 ACTION: extends and
abducts the wrist
 N.SUPPLY: deep br.of
radial .N(c7c8)
EXTENSOR DIGITORUM
 ORIGIN: lat epicondyle of
the humerus
 INSERTION: Extensor
Expansions Of The Medial 4
digits
 ACTION: extension at
MCP, IP joints, ext of wrist
when the fingers are
extended
 N.SUPPLY: PIN (c7,c8)
EXTENSOR DIGITI MINIMI
 ORIGIN:lat epicondyle of the humerus
 INSERTION:extensor expansion of the 5th
digit
 ACTION: ext.of 5th digit at MC, PIP ,
ext of wrist when little finger in extension
 N.SUPPLY:PIN (c7,c8)
EXT.CARPI ULNARIS
 ORIGIN:2 heads
lat epicondyle of humerus,
Posterior border of ulna
 INSERTION:medial side of
the base of the 5th MC
 ACTION: extends and
adducts the hand
 N.SUPPLY:PIN (c7c8)
SUPINATOR
 ORIGIN:
lat epicondyle of
humerus, radial collateral lig.,
annular lig.,supinator
fossa, crest of ulna
 INSERTION:
lateral,posterior,anterior
surface of prox 1/ 3rd 0f radius
 ACTION:supination
 N.Supply: deep Br.Of
Radial.N (C5,c6)
SUPINATOR
ABDUCTOR POLLICIS LONGUS

 ORIGIN:upper parts of the

posterior surface of the
radius & ulna and
interosseous mem.
 INSERTION:base of the 1st
MC bone
 ACTION:
abducts,extends, lat.rotat
es the thumb at
carpometacarpal joint, &
abducts the wrist.
 N.SUPPLY:PIN (c7,c8)
EXTENSOR POLLICIS BREVIS
 ORIGIN:posterior surface of
the radius below the origin
ofAbductor Pollicis longusand
from interosseous mem.
 INSERTION:base of the
prox.phalanx of the thumb
 ACTION:extends pox.phalanx
of the thumb at MC
joint, ext.at 1st
carpometacarpal joint
 N.SUPPLY:PIN (c7,c8)
EXT.POLLICIS LONGUS
 ORIGIN: posterior surface of
middle 1/3rd of ulna
And interrosseous mem.
 INSERTION:base of the diastal
phalanx of the thumb
 ACTION:extends distal phalanx
of the thumb at MP joint,IP
joint.and it can contribute
abduction of the thumb
 N.SUPPLY:PIN (c7,c8).
EXTENSOR INDICIS
 Origin:posterior surface of
ulna m/3rd below the EPL
 Insertion:extensor
expansion of the 2nd finger
 Action: ext of index finger
and wrist.
 N.supply:PIN (c7,c8)
 EXM.MOVEMENTS OF FOREARM
MUSCLES
 Flexion
 Extension
 Adduction
 Abduction

AT RADIO ULNAR JOINT

 Supination
 pronation
FLEXION

pronator teres
Flx.carpi radialis
Flx.carpi ulnaris
Flx.digitorum superficialis
Flx. Digitorum profundus
Palmaris longus
brachioradialis
 EXTENSION

 Anconeus
 Ext.Carpi Radialis
Longus
 Ext.Carpi Radialis Brevis
 Ext.Digitorum
 Ext.Indisis
 Ext.Carpi Ulnaris
 Ext. Digiti Minimi
 Abductor Pollicis Longus
 ADDUCTION  ABDUCTION
flexor carpi ulnaris flx.carpi radialis
extensor carpi ulnaris ext.carpi radialis longus
Ext.carpi radialis brevis
Abductor pollicis longus
 PRONATION
pronator teres
Pronator quadratus

 SUPINATION
biceps
supinator
INTRINSIC MUSCLES OF THE HAND
 Thenar muscles abductor pollicis brevis
flx.pollicis brevis
opponens pollicis
Adductor pollicis
 Hypothenar muscles- palmaris brevis
abductor digiti minimi
flx.digiti minimi
opponens digiti minimi
 Lumbricals -4
 Palmar interossei-4
 Dorsal interosei-4
THENAR MUSCLES
ABDUCTOR POLLICIS BREVIS
 ORIGIN:
flx.retinaculum, tubercle
of scaphoid, trapezium
 INSERTION: lat.side of
the base of the
prox.phalax of the
thumb
 ACTION: abduction at
carpometacarpal,MP
joints
 N.SUPPLY: recurrent
br.of median.n (c8t1)
ABDUCTOR POLLICIS BREVIS
 FLX.POLLICIS BREVIS
 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 base of the prox phalanx
 ACTION: flexes the prox.phalanx of the thumb at
MCP and med.rotation at carpometacarpal joint
 N.SUPPLY:
SEPERFICIAL HEAD: median.n (c8,t1)
DEEP HEAD: Deep Br.Of Ulnar Nerve
FLX.POLLICIS BREVIS
OPPONENS POLLICIS
 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 and med.rotation
 N:SUPPLY: Media.N (C8,t1)
ADDUCTOR POLLICIS
 ORIGIN: 2heads
oblique head : bases of 2nd 3rd
metacarpals and capitate bone
Transverse head: anterior surface
of 3rd metacarpal bone
 INSERTION: base of
prox.phalanx of the thumb
 ACTIONS: adducts tha
prox.phalanx of the thumb
 N.SUPPLY:
DEEP BR.OF ULNAR NERVE
(C8, T1)
ADDUCTOR POLLICIS
HYPOTHENAR MUSCLES
PALMARIS BREVIS

 ORIGIN:
flx.retinaculum,palmar
aponeurosis
 INSERTION: skin along
the medial border of the
hand
 ACTION:helps in
gripping by wrinkling of
skin over it
 N.SUPPLY:Ulnar.N
Suf.Br.
ABDUCTOR DIGITI MINIMI

 ORIGIN: pisiform
bone,the tendon of the
flx.carpi ulnaris
 INSERTION :medial side
of the base of the
prox.phalanx of the 5th
digit
 ACTION:abducts th 5th
digit
 N.SUPPY: Deep Br.Of
Ulnar .N (C8,t1)
ABDUCTOR DIGITI MINIMI
FLX.DIGITI MINIMI

 ORIGIN : hook of
hamate,flx.retinaculum
 INSERTION :medial
aspect of the base of the
prox.phalanx of little
finger
 ACTION: flex theprox
phalanx of 5th digit at
MCP joint
 N.SUPPLY: Deep Br. Of
Ulnar.N (C8,T1)
OPPONENS DIGITI MINIMI

 ORIGIN:hook of
hamate, flx.retinaculum
 INSERTION:body of the 5th
metacarpal.
 ACTION:
abducts, flexion,lat.rotates
the 5th metacarpal
 N.SUPPLY: deep br.of
ulnar.N (C8,T1)
LUMBRICALS
 ORIGIN:
1&2 lumbrical arise from the 2 lateral 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&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)
PALMAR INTEROSSEI
 ORIGIN: palmar interossei
arises from palmar surface
of the metacarpal bones of
2,4,5 digits
 INSERTION: extensor
expansion of the digit and
bases of the prox.phalanx of
the 2,4,5 digits
 ACTION:
Adduts The Fingers At
MCP, assists flexion at
MCP, extension at IP
 N.SUPPLY: deep br. Of
unlar .n (C8,T1)
PALMAR INTEROSSEI
Dorsal interossei

 ORIGIN: adjacent sides

of the metacarpal bones
 INSERTION: base of the
prox.phalanx and in to
the aponeurosis that
forms ext.expansion
 ACTION: abducts the
fingers,flex the MCP
 N.SUPPLY: Deep Br.Of
Ulnar .N (C8,t1)
Dorsal interossei
Dorsal interossei
Parts of Brachial Plexus

 Really Tired? Drink Coffee Buddy!

 R = ROOTS (ventral rami)

 T = TRUNKS
 D = DIVISIONS
 C = CORDS
 B = BRANCHES
 Roots join to form Trunks!
(in neck)
• Ventral Rami Trunks

• C5 Upper Trunk
• C6
• C7 Middle Trunk
• C8
• T1 Lower Trunk
Trunks Split to form Divisions :
(in• neck)
Trunks Divisions

• Upper Anterior
Posterior

• Middle Anterior
Posterior

• Lower Anterior
Posterior
Divisions Join to form Cords! (in
axilla)
Trunks Divisions
Cords

U A LATERAL CORD
P
M A
P
MEDIAL CORD

L A
P POSTERIOR CORD
 Cords Give off Branches!! (in
axilla)
 Lateral Musculocutaneous

Median

 Medial Ulnar

 Posterior Radial
Axillary
(thoracodorsal)
(subscapular)
Injury of the brachial
plexus
THANK YOU