The upper limb

The upper limb
Muscles That Move the Pectoral Girdle
Originate on the axial skeleton and insert on the clavicle and
Stabilize the scapula and move it to increase the arm’s angle of
Some of the superficial muscles of the thorax are grouped
together according to the scapular movement they direct.
 elevation, depression, protraction, or retraction
The muscles of back
Superficial group
 Trapezius
 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 shoulder
Origin: lateral third of
clavicle, acromion, and
spine of scapula
Insertion: deltoid tuberosity
of humerus
Action: abduction, flexion
and extension, medial and
lateral rotation of arm
Major muscles of shoulder
Teres major
Origin: dorsal surface
of inferior angle of
Insertion: crest of
lesser tubercle of
Action: medially rotates
and adducts arm
Arm and Forearm Muscles That Move the Elbow
Anterior (flexor) compartment
Posterior (extensor) compartment
Anterior compartment
 primarily contains elbow flexors
Posterior compartment contains elbow extensors
 the principal flexors
biceps brachii, brachialis, and brachioradialis
muscles that extend the elbow joint
triceps brachii and anconeus
Muscles of arm
Antererior group
Biceps brachii
Posterior group
triceps brachii
Muscles of arm
Biceps brachii
 Origin: long head,
supraglenoid tubercle; short
head, coracoid process
 Insertion: radial tuberosity
 Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint
Muscles of arm
Triceps brachii
long head, infraglenoid tubercle
lateral head, above groove for
radial nerve
medical head, below groove for
radial nerve
Insertion: olecranon of ulna
Action: extends elbow joint,
long head extends and adducts
shoulder joint
Triceps brachii
Forearm Muscles
Supinate and Pronate
Supinator muscle supinates the forearm.
Biceps brachii supinates the forearm.
Pronator teres and pronator quadratus pronate the forearm.
Move the Wrist Joint, Hand, and Fingers
Muscles in the forearm move the hand at the wrist and/or the fingers.
Extrinsic muscles of the wrist and hand originate on the forearm, not
the wrist or hand.
Tendons of forearm muscles typically are surrounded by tendon
(synovial) sheaths and held adjacent to the skeletal elements by strong
fascial structures.
At the wrist, the deep fascia of the forearm forms thickened, fibrous
bands termed retinacula.
Muscles of forearm
Superficial layer
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Muscles of forearm
Pronator teres
 Origin: medical epicondyle of
humerus and deep fascia of
 Insertion: middle of lateral
surface of radius
 Action: pronation of forearm
and flexion of elbow
Second layer
Flexor digitorum superficials
Third layer
Flexor digitorum
Flexor pollicis longus
Fourth layer
Pronator quadratus
Action: flex radiocarpal
joint and fingers,
pronate forearm
Lateral group (3)
Extensor carpi radialis
Extensor carpi radialis
Posterior group (8)
Superficial layer (3)
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Action: extension at
wrist joint
Posterior group (8)
Deep layer (5)
 Supinator
 Abductor pollicis longus
 Extensor pollicis brevis
 Extensor pollicis longus
 Extensor indicis
 Action: extend at wrist
joint and fingers, and
supinate forearm
Muscles of hand
Lateral group thenar (4)
Action: flex, abduct, adduct
and oppose thumb
Medial group hypothenar (3)
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
Action: flex, abduct , and oppose
little finger
Muscles of hand
Intermedial group
 Lumbricales (4) flex
fingers at MP joints;
extend fingers at IP
 Palmar interossei (3)
adduct fingers towards
middle finger at MP
 Dorsal interossei (3)
abduct fingers away
from middle finger at
MP joints
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., anterior and
posterior humeral circumflex a.; the
former then divides into throcodorsal
a. and circumflex scapular a.
Arteries of upper limb
Brachial artery
 Continuation of axillary
 Divides into radial and
ulnar arteries at level of
neck of radius
 Branches
Deep brachial a.
accompanies with radial
Superior ulnar collaeral a.
accompanies with ulnar
Inferior ulnar collateral a.
Arteries of upper limb
Radial artery and branches
 Radial recurrent a.
 Superfical palmar branch
 Principal artery of thumb
Ulnar artery and branches
 Ulnar recurrent a.
 Common interosseous artery
Anterior interossous a.
Posterior interosseous a.
Deep palmar branch
Arteries of upper limb
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
Arteries of upper limb
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
Basilic vein
Arises from the medial side
of the dorsal venous rete of
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
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
Subscapular lymph node along
subscapular vessels, receive lymph
from nape and scapular region
Efferents above three groups pass to
central lymph node
Central lymph node
lie in fat of axillary fossa,
receive drainage from all the
above nodes, efferents pass
to apical lymph node
Apical lymph node
Lie in the apex of the axilla,
along the proximal end of
axillary vessels
Receive drainage chiefly
from central lymph node ,
upper portion of mamma
Efferents form subclavian
trunk, the right subclavian
trunk joints the right
lymphatic duct; left usually
drains directly into thoracic
Brachial plexus
Five roots: formed by anterior
rami of C5-C8 and T1 spinal
nerves, roots C5-C7give rise to
long thoracic n.
Three trunks
The upper trunk is formed by the
joining of root C4,C5,C6.
The middle trunk is the
continuation of root C7.
The lower trunk is formed by the
joining of root 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.
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.
 Lateral root to median n.
Medial cord
 Medial root to median n.
 Ulnar n.
 Medial brachial cutaneous n.
 Medial antebrachial cutaneous n.
Posterior cord
radial n.
axillary n.
thoracodorsal n.
Distribution: Biceps
brachii, brachalis and
coracobrachialis ‘BBC
nerve’; skin on
anterior aspect of
Median nerve
Distribution: Flexors of
forearm except
brachioradialis, flexor carpi
ulnaris and ulnar half of flexor
digitorum profundus,
thenar except adductor
pollicis, first two lumbricals;
skin of thenar, central part of
palm, palmar aspect of radial
three and one-half fingers,
including middle and distal
fingers on dorsum.
Injury: Apehand
produces sign of benediction,
in which the index and middle
fingers cannot be flexed and
the thumb cannot be
Ulnar nerve
Distribution: Flexor carpi
ulnaris, ulnar half of flexor
digitorum profundus,
hypothenar muscles, interossei,
3rd and 4th lumbricals and
adductor pollicis; skin of
hypothenar, palmar surface of
ulnar one and one-half fingers,
ulnar half of dorsum of hand,
posterior aspect of ulnar two
and one-half fingers
Injury: clawhand
Radial nerve
Distribution: Extensor
muscles of arm and
forearm, brachioradialis;
skin on back of arm,
forearm, and radial side
of dorsum of hand and
radial two and one-half
Injury: Wristdrop
Distribution: Deltoid
and teres minor
muscle; skin over
deltoid and upper
posterior aspect of arm
Injury: results in deltoid
and teres minor
paralysis (loss of
shoulder abdution and
weel external rotation)
with loss of sensation
over the deltoid

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