Upper Limb

Muscles:

Shoulder:

Extrinsic; originate from the torso, and attach to the bones of the shoulder
(clavicle, scapula or humerus).

The muscles are organised into two layers – a superficial layer and a deep layer.

Superficial

Trapezius

The trapezius is a broad, flat and triangular muscle. The muscles on each side form a trapezoid
shape. It is the most superficial of all the back muscles.

• Attachments: Originates from the skull, nuchal ligament and the spinous processes of C7-

T12. The fibres attach to the clavicle, acromion and the scapula spine.

• Innervation: Motor innervation is from the accessory nerve. It also receives proprioceptor
fibres from C3 and C4 spinal nerves.

• Actions: The upper fibres of the trapezius elevate the scapula and rotates it during
abduction of the arm. The middle fibres retract the scapula and the lower fibres pull the
scapula inferiorly.

Latissimus Dorsi

The latissimus dorsi originates from the lower

part of the back, where it covers a wide area.

• Attachments: Has a broad origin –

arising from the spinous processes of
T7-T12, iliac crest, thoracolumbar fascia
and the inferior three ribs. The fibres
converge into a tendon that attaches to
the intertubercular sulcus of the
humerus.

• Innervation: Thoracodorsal nerve.

• Actions: Extends, adducts and

medially rotates the upper limb.

Deep

Levator Scapulae

The levator scapulae is a small strap-like

muscle. It begins in the neck, and descends to
attach to the scapula.

• Attachments: Originates from the

transverse processes of the C1-C4
vertebrae and attaches to the medial
border of the scapula.

• Innervation: Dorsal scapular nerve.

• Actions: Elevates the scapula.

Rhomboids

There are two rhomboid muscles – major and minor. The rhomboid minor is situated superiorly to
the major.

Rhomboid Major

• Attachments: Originates from the spinous processes of T2-T5 vertebrae. Attaches to the
medial border of the scapula, between the scapula spine and inferior angle.

• Innervation: Dorsal scapular nerve.

• Actions: Retracts and rotates the scapula.

Rhomboid Minor

• Attachments: Originates from the spinous processes of C7-T1 vertebrae. Attaches to the
medial border of the scapula, at the level of the spine of scapula.

• Innervation: Dorsal scapular nerve.

• Actions: Retracts and rotates the scapula.

 Upper Limb
Intrinsic; originate from the scapula and/or clavicle, and attach to the humerus.

The intrinsic muscles (also known as the scapulohumeral group) originate from the scapula and/or
clavicle, and attach to the humerus.

There are six muscles in this group – the deltoid, teres major, and the four rotator cuff muscles
(supraspinatus, infraspinatus, subscapularis and teres minor).

Deltoid

The deltoid muscle is shaped like the Greek letter delta – Δ. It can be divided into an anterior,
middle and posterior part.

• Attachments: Originate from the lateral third of the clavicle, the acromion and the spine of
the scapula. It attaches to the deltoid tuberosity on the lateral aspect of the humerus.

• Innervation: Axillary nerve.

• Actions:

• Anterior fibres – flexion and medial rotation.

• Posterior fibres – extension and lateral rotation.

• Middle fibres – the major abductor of the arm (takes over from the supraspinatus,
which abducts the first 15 degrees).

Teres Major

The teres major forms the inferior border of the quadrangular space – the ‘gap’ that the axillary
nerve and posterior circumflex humeral artery pass through to reach the posterior scapula region.

• Attachments: Originates from the posterior surface of the inferior angle of the scapula. It
attaches to the medial lip of the intertubercular groove of the humerus.

• Innervation: Lower subscapular nerve.

• Actions: Adducts at the shoulder and medially rotates the arm.





Rotator Cuff Muscles

The rotator cuff muscles are a group of four muscles that originate from the scapula and attach to
the humeral head. Collectively, the resting tone of these muscles acts to ‘pull’ the humeral head
into the glenoid fossa. This gives the glenohumeral joint a lot of additional stability.

In addition to their collective function, the rotator cuff muscles also have their own individual
actions.

Supraspinatus

• Attachments: Originates from the supraspinous fossa of the scapula, attaches to the
greater tubercle of the humerus.

• Innervation: Suprascapular nerve.

• Actions: Abducts the arm 0-15o, and assists deltoid for 15-90o

Infraspinatus

• Attachments: Originates from the infraspinous fossa of the scapula, attaches to the
greater tubercle of the humerus.

• Innervation: Suprascapular nerve.

• Actions: Laterally rotates the arm.

Subscapularis

• Attachments: Originates from the subscapular fossa, on the costal surface of the scapula.
It attaches to the lesser tubercle of the humerus.

• Innervation: Upper and lower subscapular nerves.

• Actions: Medially rotates the arm.

Teres Minor

• Attachments: Originates from the posterior surface of the scapula, adjacent to its lateral
border. It attaches to the greater tubercle of the humerus.

• Innervation: Axillary nerve.

• Actions: Laterally rotates the arm.



 Upper Limb

Upper Arm
It contains four muscles – three in the anterior compartment (biceps brachii, brachialis,
coracobrachialis), and one in the posterior compartment (triceps brachii).

Anterior Compartment of Upper Arm

There are three muscles located in the anterior compartment of the upper arm – biceps brachii,
coracobrachialis and brachialis. They are all innervated by the musculocutaneous nerve. A good
memory aid for this is BBC – biceps, brachialis, coracobrachialis.

Arterial supply to the anterior compartment of the upper arm is via muscular branches of
the brachial artery.

Biceps Brachii

The biceps brachii is a two-headed muscle. Although the majority of the muscle mass is
located anteriorly to the humerus, it has no attachment to the bone itself.

As the tendon of biceps brachii enters the forearm, a connective tissue sheet is given off –
 the bicipital aponeurosis. This forms the roof of the cubital fossa and blends with the deep
fascia of the anterior forearm.

• Attachments: Long head originates from the supraglenoid tubercle of the scapula, and

the short head originates from the coracoid process of the scapula. Both heads insert
distally into the radial tuberosity and the fascia of the forearm via the bicipital aponeurosis.

• Function: Supination of the forearm. It also flexes the arm at the elbow and at the
shoulder.

• Innervation: Musculocutaneous nerve. The bicep tendon reflex tests spinal cord segment

C6.

Coracobrachialis

The coracobrachialis muscle lies deep to the biceps brachii in the arm.

• Attachments: Originates from the coracoid process of the scapula. The muscle passes
through the axilla, and attaches the medial side of the humeral shaft, at the level of the
deltoid tubercle.

• Function: Flexion of the arm at the shoulder, and weak adduction.

• Innervation: Musculocutaneous
nerve.

Brachialis

The brachialis muscle lies deep to the

biceps brachii, and is found more distally
than the other muscles of the arm. It
forms the floor of the cubital fossa.

• Attachments: Originates from the

medial and lateral surfaces of the
humeral shaft and inserts into
the ulna tuberosity, just distal to the
elbow joint.

• Function: Flexion at the elbow.

• Innervation: Musculocutaneous
nerve, with contributions from the
radial nerve.

 Upper Limb

Posterior Compartment of Upper Arm

The posterior compartment of the upper arm contains
the triceps brachii muscle, which has three heads. The medial
head lies deeper than the other two, which cover it.

Arterial supply to the posterior compartment of the upper arm is

via the profunda brachii artery.

Triceps Brachii

• Attachments: Long head –  originates from the

infraglenoid tubercle. Lateral head – originates from
the humerus, superior to the radial groove. Medial head –
originates from the humerus, inferior to the radial groove.
Distally, the heads converge onto one tendon and insert
into the olecranon of the ulna.

• Function: Extension of the arm at the elbow.

• Innervation: Radial nerve. A tap on the triceps tendon tests spinal segment C7.

• Note: In some individuals, the long head of the triceps brachii is innervated by the
axillary nerve.

Anterior Compartment of the Forearm

Muscles in the anterior compartment of the forearm perform flexion at the wrist and fingers, and
pronation.

Superficial Compartment
The superficial muscles in the anterior compartment are the flexor
carpi ulnaris, palmaris longus, flexor carpi radialis and pronator
teres. They all originate from a common tendon, which arises from
the medial epicondyle of the humerus.

Flexor Carpi Ulnaris

• Attachments:  Originates from the medial epicondyle with

the other superficial flexors. It also has a long origin from
the ulna. It passes into the wrist, and attaches to the
pisiform carpal bone.

• Actions: Flexion and adduction at the wrist.

• Innervation: Ulnar nerve.

Palmaris Longus

This muscle is absent in about 15% of the population.

Dissection Tip: Just distal to the wrist, if you reflect back the
palmaris longus, you will find the median nerve immediately
underneath it

• Attachments:  Originates from the medial epicondyle,

attaches to the flexor retinaculum of the wrist.

• Actions: Flexion at the wrist.

• Innervation: Median nerve.

Flexor Carpi Radialis

• Attachments: Originates from the medial epicondyle, attaches to the base of metacarpals

II and III.

• Actions: Flexion and abduction at the wrist.

• Innervation: Median nerve.

Pronator Teres

The lateral border of the pronator teres forms the medial border of the cubital fossa, an
anatomical triangle located over the elbow.

• Attachments: It has two origins, one from the medial epicondyle, and the other from the
coronoid process of the ulna. It attaches laterally to the mid-shaft of the radius.

• Actions: Pronation of the forearm.

• Innervation: Median nerve.

 Upper Limb

Intermediate Compartment
The flexor digitorum superficialis is the only muscle of the intermediate compartment. It can
sometimes be classed as a superficial muscle, but in most cadavers it lies between the deep and
superficial muscle layers.

The muscle is a good anatomical landmark in the forearm – the median nerve and ulnar

artery pass between its two heads, and then travel posteriorly.

• Attachments: It has two heads – one originates from the medial epicondyle of
the humerus, the other from the radius. The muscle splits into four tendons at the wrist,
which travel through the carpal tunnel, and attaches to the middle phalanges of the four
fingers.

• Actions: Flexes the metacarpophalangeal joints and proximal interphalangeal joints at the

4 fingers, and flexes at the wrist.

• Innervation: Median nerve.

Deep Compartment
There are three muscles in the deep anterior forearm; flexor digitorum profundus, flexor pollicis
longus, and pronator quadratus.

Flexor Digitorum Profundus

• Attachments: Originates from the ulna and associated interosseous membrane. At the

wrist, it splits into four tendons, that pass through the carpal tunnel and attach to the distal
phalanges of the four fingers.

• Actions: It is the only muscle that can flex the distal interphalangeal joints of the fingers. It
also flexes at metacarpophalangeal joints and at the wrist.

• Innervation: The medial half (acts on the little and ring fingers) is innervated by the ulnar
nerve. The lateral half (acts on the middle and index fingers) is innervated by the anterior
interosseous branch of the median nerve.

Flexor Pollicis Longus

This muscle lies laterally to the FDP.

• Attachments: Originates from the anterior surface of the radius, and surrounding

interosseous membrane. Attaches to the base of the distal phalanx of the thumb.

• Actions:  Flexes the interphalangeal joint and metacarpophalangeal joint of the thumb.

• Innervation: Median nerve (anterior interosseous branch).

Pronator Quadratus

A square shaped muscle, found deep to the tendons of the FDP and FPL.

• Attachments: Originates from the anterior surface of the ulna, and attaches to the anterior
surface of the radius.

• Actions: Pronates the forearm.

• Innervation: Median nerve (anterior interosseous branch).

 Upper Limb

Posterior Compartment of the Forearm

The muscles in the posterior compartment of the forearm are commonly known as the extensor
muscles. The general function of these muscles is to produce extension at the wrist and fingers.
They are all innervated by the radial nerve.

Superficial Muscles

The superficial layer of the posterior forearm

contains seven muscles. Four of these muscles
– extensor carpi radialis brevis, extensor
digitorum, extensor carpi ulnaris and extensor
digiti minimi share a common tendinous origin
at the lateral epicondyle.

Brachioradialis

The brachioradialis is a paradoxical muscle. Its

origin and innervation are characteristic of an
extensor muscle, but it is actually a flexor at
the elbow.

The muscle is most visible when the forearm is

half pronated, and flexing at the elbow against
resistance.

In the distal forearm, the radial artery and nerve

are sandwiched between the brachioradialis
and the deep flexor muscles.

• Attachments: Originates from the

proximal aspect of the lateral
supracondylar ridge of humerus, and
attaches to the distal end of the radius,
just before the radial styloid process.

• Actions: Flexes at the elbow.

• Innervation: Radial nerve.

Extensor Carpi Radialis Longus and Brevis

The extensor carpi radialis muscles are situated on the lateral aspect of the posterior forearm. Due
to their position, they are able to produce abduction as well as extension at the wrist.

• Attachments: The ECRL originates from the supracondylar ridge, while the ECRB
originates from the lateral epicondyle. Their tendons attach to metacarpal bones II and III.

• Actions: Extends and abducts the wrist.

• Innervation: Radial nerve.

Extensor Digitorum

The extensor digitorum is the main extensor of the fingers. To test the function of the muscle, the
forearm is pronated, and the fingers extended against resistance.

• Attachments: Originates from the lateral epicondyle. The tendon continues into in the
distal part of the forearm, where it splits into four, and inserts into the extensor hood of each
finger.

• Actions: Extends medial four fingers at the MCP and IP joints.

• Innervation: Radial nerve (deep branch).

 Upper Limb
Extensor Digiti Minimi

The extensor digiti minimi is thought to originate from the extensor digitorum muscle. In some
people, these two muscles are fused together. Anatomically, the extensor digiti minimi lies
medially to the extensor digitorum.

• Attachments: Originates from the lateral epicondyle of the humerus. It attaches, with the
extensor digitorum tendon, into the extensor hood of the little finger.

• Actions: Extends the little finger, and contributes to extension at the wrist.

• Innervation: Radial nerve (deep branch).

Extensor Carpi Ulnaris

The extensor carpi ulnaris is located on the medial aspect of the posterior forearm. Due to its
position, it is able to produce adduction as well as extension at the wrist.

• Attachments: Originates from the lateral epicondyle of the humerus, and attaches to the
base of metacarpal V.

• Actions: Extension and adduction of wrist.

• Innervation: Radial nerve (deep branch).

Anconeus

The anconeus is situated medially and superiorly in the extensor compartment of the forearm. It is
blended with the fibres of the triceps brachii, and the two muscles can be indistinguishable.

• Attachments: Originates from the lateral epicondyle, and attaches to the posterior and
lateral part of the olecranon.

• Actions: Extends and stablises the elbow joint. Abducts the ulna during pronation of the
forearm.

• Innervation: Radial nerve.

Deep Muscles

There are five muscles in the deep

compartment of the posterior forearm – the
supinator, abductor pollicis longus, extensor
pollicis brevis, extensor pollicis longus and
extensor indicis.

With the exception of the supinator, these

muscles act on the thumb and the index finger.

Supinator

The supinator lies in the floor of the cubital

fossa. It has two heads, which the deep branch
of the radial nerve passes between.

• Attachments: It has two heads of

origin. One originates from the lateral
epicondyle of the humerus, the other
from the posterior surface of the ulna.
They insert together into the posterior
surface of the radius.

• Actions: Supinates the forearm.

• Innervation: Radial nerve (deep

branch).

Abductor Pollicis Longus

The abductor pollicis longus is situated immediately distal to the supinator muscle. In the hand, its
tendon contributes to the lateral border of the anatomical snuffbox.

• Attachments: Originates from the interosseous membrane and the adjacent posterior
surfaces of the radius and ulna. It attaches to the lateral side of the base of metacarpal I.

• Actions: Abducts the thumb.

• Innervation: Radial nerve (posterior interosseous branch).

Extensor Pollicis Brevis

The extensor pollicis brevis can be found medially and deep to the abductor pollicis longus. In the
hand, its tendon contributes to the lateral border of the anatomical snuffbox.

• Attachments: Originates from the posterior surface of the radius and interosseous
membrane. It attaches to the base of the proximal phalanx of the thumb.

• Actions: Extends at the metacarpophalangeal and carpometacarpal joints of the thumb.

• Innervation: Radial nerve (posterior interosseous branch).

 Upper Limb
Extensor Pollicis Longus

The extensor pollicis longus muscle has a larger muscle belly than the EPB. Its tendon travels
medially to the dorsal tubercle at the wrist, using the tubercle as a ‘pulley’ to increase the force
exerted.

The tendon of the extensor pollicis longus forms the medial border of the anatomical snuffbox in
the hand.

• Attachments: Originates from the posterior surface of the ulna and interosseous
membrane. It attaches to the distal phalanx of the thumb.

• Actions: Extends all joints of the thumb: carpometacarpal, metacarpophalangeal and

interphalangeal.

• Innervation: Radial nerve (posterior interosseous branch).

Extensor Indicis Proprius

This muscle allows the index finger to be independent of the other fingers during extension.

• Attachments: Originates from the posterior surface of the ulna and interosseous
membrane, distal to the extensor pollicis longus. Attaches to the extensor hood of the index
finger.

• Actions: Extends the index finger.

• Innervation: Radial nerve (posterior interosseous branch).

Hand
Muscles acting on the hand can be divided into two groups: extrinsic and intrinsic muscles.

• The extrinsic muscles are located in the anterior and posterior compartments of the

forearm. They control crude movements and produce a forceful grip.

• The intrinsic muscles of the hand are located within the hand itself. They are responsible
for the fine motor functions of the hand.

Thenar Muscles

The thenar muscles are three short muscles located at

the base of the thumb. The muscle bellies produce a
bulge, known as the thenar eminence. They are
responsible for the fine movements of the thumb.

The median nerve innervates all the thenar muscles.

Opponens Pollicis

The opponens pollicis is the largest of the thenar

muscles, and lies underneath the other two.

• Attachments: Originates from the tubercle of

the trapezium, and the associated flexor
retinaculum. It inserts into the lateral margin of
the metacarpal of the thumb (i.e. the first
metacarpal).

• Actions: Opposes the thumb, by medially

rotating and flexing the metacarpal on the
trapezium.

• Innervation: Median nerve.

Abductor Pollicis Brevis

This muscle is found anteriorly to the opponens

pollicis and proximal to the flexor pollicis brevis.

• Attachments: Originates from the tubercles of

the scaphoid and trapezium, and from the associated flexor retinaculum. Attaches to lateral
side of proximal phalanx of the thumb.

• Actions: Abducts the thumb.

• Innervation: Median nerve.

Flexor Pollicis Brevis

The most distal of the thenar muscles.

• Attachments: Originates from the tubercle of the trapezium and from the associated flexor
retinaculum. Attaches to the base of the proximal phalanx of the thumb.

• Actions: Flexes the metacarpophalangeal (MCP) joint of the thumb.

• Innervation: Median nerve. The deep head is innervated by the deep branch of

the ulnar nerve.

 Upper Limb
Hypothenar Muscles

The hypothenar muscles produce the hypothenar eminence – a muscular protrusion on the

medial side of the palm, at the base of the little finger. These muscles are similar to the thenar
muscles in both name and organisation.

The ulnar nerve innervates the muscles of the hypothenar eminence.

Opponens Digiti Minimi

The opponens digit minimi lies deep to the other hypothenar muscles.

• Attachments: Originates from the hook of hamate and associated flexor retinaculum,
inserts into the medial margin of metacarpal V.

• Actions: It rotates the metacarpal of the little finger towards the palm, producing
opposition.

• Innervation: Ulnar nerve.

Abductor Digiti Minimi

The most superficial of the hypothenar muscles.

• Attachments: Originates from the pisiform and the tendon of the flexor carpi ulnaris. It
attaches to the base of the proximal phalanx of the little finger.

• Actions: Abducts the little finger.

• Innervation: Ulnar nerve.

Flexor Digiti Minimi Brevis

This muscles lies laterally to the abductor digiti minimi.

• Attachments: Originates from the hook of hamate and adjacent flexor retinaculum, and
inserts into the base of the proximal phalanx of the little finger.

• Actions: Flexes the MCP joint of the little finger.

• Innervation: Ulnar nerve.

Lumbricals

These are four lumbricals in the hand, each associated with a finger. They are very crucial to finger
movement, linking the extensor tendons to the flexor
tendons.

Denerveration of these muscles is the basis for

the ulnar claw and hand of benediction.

• Attachments: Each lumbrical originates from a

tendon of the flexor digitorum profundus. They
pass dorsally and laterally around each finger,
and inserts into the extensor hood.

• Actions: The flex at the MCP joint, and extend

at the interphalangeal (IP) joints of each finger.

• Innervation: The lateral two lumbricals (of the

index and middle fingers) are innervated by
the median nerve. The medial two lumbricals (of
the little and ring fingers) are innervated by
the ulnar nerve.

 Upper Limb
Interossei

The interossei muscles are located between

the metacarpals. They can be divided into
two groups: the dorsal and palmar
interossei.

In addition to their actions of abduction

(dorsal interossei) and adduction (palmar
interossei) of the fingers, the interossei also
assist the lumbricals in flexion and MCP
joints and extension at the IP joints.

Dorsal Interossei

The most superficial of all dorsal muscles,

these can be palpated on the dorsum of the
hand. There are four dorsal interossei
muscles.

• Attachments: Each interossei

originates from the lateral and medial
surfaces of the metacarpals. They
attach into the extensor hood and
proximal phalanx of each finger.

• Actions: Abduct the fingers at the MCP joint.

• Innervation: Ulnar nerve.

Palmar Interossei

These are located anteriorly on the hand. There are three palmar interossei muscles – although
some texts report a fourth muscle at the base of the proximal phalanx of the thumb.

• Attachments: Each interossei originates from a medial or lateral surface of a metacarpal,

and attaches into the extensor hood and proximal phalanx of same finger.

• Actions: Adducts the fingers at the MCP joint.

• Innervation: Ulnar nerve.

Other Muscles in the Palm

There are two other muscles in the palm that are not lumbricals or interossei and do not fit in the
hypothenar or thenar compartments:

Palmaris Brevis

This is a small, thin muscle, found very superficially in the subcutaneous tissue of the hypothenar
eminence.

• Attachments: Originates from the palmar aponeurosis and flexor retinaculum, attaches to
the dermis of the skin on the medial margin of the
hand.

• Actions: Wrinkles the skin of the hypothenar

eminence and deepens the curvature of the hand,
improving grip.

• Innervation: Ulnar nerve.

Adductor Pollicis

This is large triangular muscle with two heads. The radial

artery passes anteriorly through the space between the
two heads, forming the deep palmar arch.

• Attachments: One head originates from

metacarpal III. The other head originates from the
capitate and adjacent areas of metacarpals II and
III. Both attach into the base of the proximal
phalanx of the thumb.

• Actions: Adductor of the thumb.

• Innervation: Ulnar nerve.