Nerves of upper limb

• Spinal Accessory Nerve(XI Cranial Nerve)

• Runs down in posterior triangle of the neck
• Accompanied by C3,C4
• trapezius muscle at the junction of its middle and lower thirds
 Nerves of Arm
• Musculocutaneous
• Axillary
• Radial nerve
 Musculocutaneous Nerve
The musculocutaneous nerve (C5 to 7) originates from the lateral cord of the
brachial plexus in the axilla.
It runs downward and laterally, pierces the coracobrachialis muscle and then
passes downward between the biceps and brachialis muscles .
It appears at the lateral margin of the biceps tendon, pierces the deep fascia just
above the elbow, and moves into a superficial position. It then runs down the
lateral aspect of the forearm as the lateral cutaneous nerve of the forearm.
Muscular branches: The musculocutaneous nerve is the motor nerve to
the anterior compartment of the arm (i.e., to the coracobrachialis, biceps
brachii, and brachialis muscles
Cutaneous branches: The lateral cutaneous nerve of the forearm
supplies the skin of the front and lateral aspects of the forearm down as
far as the root of the thumb.
Articular branches supply the elbow joint.
 Axillary Nerve

• The axillary nerve (C5 to 6) arises from the termination of the posterior cord
of the brachial plexus in the axilla curves deeply into the axilla and enters the
quadrangular space with the posterior circumflex humeral artery. As the nerve
passes through the space, it comes into close relationship with the inferior
aspect of the capsule of the shoulder joint and with the medial side of the
surgical neck of the humerus. It terminates by dividing into anterior and
posterior branches and
Branches:
• An articular branch supplies the shoulder joint.
• An anterior terminal branch winds around the surgical neck of the humerus
deep to the deltoid muscle; it supplies the deltoid and the skin that covers its
lower part.
• A posterior terminal branch gives off a branch to the teres minor muscle and
a few branches to the deltoid and then emerges from the posterior border of
the deltoid as the upper lateral cutaneous nerve of the arm
 Nerves of forearm and hand

• Median nerve
• Ulnar nerve
• Radial nerve
MEDIAN NERVE
 MEDIAN NERVE IN ARM
• originates from the medial and lateral cords of the brachial plexus
in the axilla

• runs along the median axis of the upper limb

• first runs on the lateral side of the brachial artery

• Halfway down the arm, it crosses the brachial artery and

continues downward on its medial side.
• No branch in the upper arm except for the vasomotor nerve to
brachial artery
 MEDIAN NERVE IN FOREARM
• It is covered anteriorly by bicipital aponeurosis at the
cubital fossa
• Leaves cubital fossa by passing between two heads of
pronator teres. Here it give anterior interosseous nerve
(ends on anterior surface of carpals).
• Lies between flexor digitorum superficial (anteriorly) and
flexor digitorum profundus (posteriorly) in the forearm
 FOREARM BRANCHES
• Muscular branches: The median nerve is the major motor nerve
to the anterior compartment of the forearm. It supplies all the
muscles therein, except for the flexor carpi ulnaris and the
medial half of the flexor digitorum profundus It gives off
muscular branches in the cubital fossa to the pronator teres, the
flexor carpi radialis, the palmaris longus, and the flexor
digitorum superficialis
• Articular branches supply the elbow joint.
• Anterior interosseous nerve.
• Palmar cutaneous branch arises in the lower part of the
forearm crosses the superficial side of the flexor retinaculum,
and distributes to the skin over the lateral part of the palm
 MEDIAN NERVE AT WRIST JOINT

• At wrist joint it emerges from the lateral

border of flexor digitorum superficialis muscle
and lies behind the tendon of Palmaris longus
• It enters the palm behind flexor retinaculum
through carpal tunnel
 MEDIAN NERVE IN PALM
• Recurrent branch curves back around the distal
border of the flexor retinaculum and supplies
muscles of thenar eminence (abductor pollicis
brevis, flexor pollicis brevis, opponens pollicis) and
first lumbrical
• Palmar digital branches supply the palmar aspect
of the lateral three and a half fingers and the distal
half of the dorsal aspect of each finger
• One of these branches also supplies the second
lumbrical muscle.
ULNAR NERVE
 ULNAR NERVE IN THE ARM
• originates from the medial cord of the brachial plexus in
the axilla
• Runs downward on the medial side of the brachial artery
• at the insertion of the coracobrachialis(in middle of arm),
the nerve pierces the medial intermuscular fascial septum
and enters the medial aspect of the posterior compartment
of the arm.
• descend behind the septum covered posteriorly by the
medial head of the triceps, and then pass behind the
medial epicondyle of the humerus
• Only Articular branches to elbow joint
 ULNAR NERVE IN FOREARM

• emerges from behind the medial epicondyle

of humerus
• Passes over medial collateral ligament
• enters the medial aspect of the anterior
compartment of the forearm by passing
between the two heads of the flexor carpi
ulnaris
 ULNAR NERVE IN FOREARM
• Runs down the forearm between flexor carpi
ulnaris and flexor digitorum profundus
• In distal third of forearm, the ulnar nerve lies
on the medial side of the ulnar artery
 Forearm branches
• Muscular branches: supply the flexor carpi ulnaris and the
medial (ulnar) half of the flexor digitorum profundus
• Articular branches supply the elbow joint.
• Palmar cutaneous branch: Arises in middle of forearm,
crosses superficial to flexor retinaculum and supplies the skin
over the medial part of the palm
• Posterior (dorsal) cutaneous branch: arises in the distal
third of the forearm, descends superficial to the extensor
retinaculum, and supplies the medial third of the dorsum of
the hand ,divides into several dorsal digital nerves that supply
the medial side of the ring and the sides of the little fingers.
 ULNAR NERVE AT WRIST JOINT
• At wrist joint ulnar nerve becomes superficial
between the tendons of flexor carpi ulnaris and flexor
digitorum superficialis
• Ulnar nerve enters the medial side of palm of hand
superficial to flexor retinaculum and lateral to
pisiform bone
• Divides into superficial and deep branches
 Hand branches
• Superficial branch:
• May lie in a fibro-osseous tunnel (the tunnel of Guyon).The
nerve may be compressed at this site, giving rise to clinical
signs and symptoms.
• Muscular branch supplies the palmaris brevis muscle.
• Common palmar digital and proper palmar digital nerves
supply the palmar aspect of the medial side of the little finger
and the adjacent sides of the little and ring fingers. They also
supply the distal half of the dorsal aspect of each finger.
• Deep Branch:
• Travels deep to intrinsic muscles of hand
• Muscular branches supply the three muscles of the
hypothenar eminence (abductor digiti minimi, flexor digiti
minimi, and opponens digiti minimi), all the palmar and dorsal
interossei, the third and fourth lumbrical muscles, and both
heads of the adductor pollicis.
RADIAL NERVE
 Radial nerve in arm
• originates from the posterior cord of the brachial plexus
in the axilla
• immediately enters the posterior compartment of the
arm
• winds around the back of the arm in the radial groove of
the humerus
• then it pierces the lateral intermuscular septum above
the lateral epicondyle of the humerus, enters the
anterior compartment of the arm between the brachialis
and brachioradialis muscles, and continues into the
cubital fossa
 Axillary Branches
• Muscular branches supply the long and
medial heads of the triceps
• Posterior cutaneous nerve of the arm
supplies the skin of the back of the arm
 Arm Branches
• Muscular branches: lateral and medial heads of
the triceps and the anconeus.
• Brachialis,brachioradialis, and extensor carpi radialis
longus muscles
• Lower lateral cutaneous nerve of the arm
• Posterior cutaneous nerve of the forearm
• Articular branches supply the elbow joint
 Radial nerve in forearm
• Radial nerve passes anterior to the lateral
epicondyle of humerus
• Lying between the brachialis (medially) and
brachioradialis & extensor carpi radialis
longus (laterally)
• divides into superficial and deep branches at
the level of the lateral epicondyle
 Cubital Fossa Branches
• Articular branches supply the elbow joint.
• Superficial branch of the radial nerve
• Deep branch of the radial nerve
SUPERFICIAL BRANCH OF RADIAL NERVE

• Direct continuation of main branch after it

gives deep branches in front of the lateral
epicondyle of the humerus
• It run down in the cover of brachioradialis
lateral to the radial artery
• In the lower third it leaves the artery and
moves backward under the tendon of
brachioradialis
SUPERFICIAL BRANCH OF RADIAL NERVE

• It reaches the posterior surface of the wrist

enters dorsum of hand superficial to extensor
retinaculum
• Terminal branches(dorsal digital branches)
supply the skin of lateral 2/3 of posterior
surface of hand and posterior surface of
lateral 3 and half of fingers till proximal
phalanx.
 DEEP BRANCH OF RADIAL NERVE
• pierces the supinator muscle and winds around the lateral
aspect of the neck of the radius
• reaches the posterior compartment of the forearm referred to
as the posterior interosseous nerve.
• Descends between the superficial and deep groups of muscles
and reaches the posterior surface of the wrist joint.
• Muscular branches supply the extensor carpi radialis brevis,
supinator, extensor digitorum, extensor digiti minimi, extensor
carpi ulnaris, abductor pollicis longus, extensor pollicis brevis,
extensor pollicis longus, and extensor indicis muscles.
• Articular branches supply the wrist and carpal joints.