The Upper Limb

The upper limb is characterized by its mobility and

ability to grasp, strike, and conduct fine motor skills
(manipulation).
• The upper limb is divided into four :
The Shoulder girdle :joining the arm to the trunk
The Arm : is the part between the shoulder
and the elbow and is centered around
the humerus.

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• The Forearm (antebrachium) - which is the
part between the elbow and the wrist and
contains the ulna and radius.

• Hand - the part below the lower cutaneous

fold of the wrist.
• The arm and forearm are joined at the
elbow (cubitus) and the forearm is joined to
the hand at the wrist (carpus)

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 Bones of the upper limb
• The upper limb contains the following
bones
1. Shoulder girdle - Clavicle and scapula
2. Arm - Humerus
3. Forearm - Radius and ulna
4. Hand - Carpals, metacarpals and
phalanges

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 Upper Limb Skeleton
• Scapula
• Clavicle
• Hummers
• Radius, ulna
• Carpals
-proximal
-distal
• Digits
– Metacarpals
– Phalanges

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 Shoulder girdle (Pectoral girdle)

• attaches the upper limb to the axial skeleton

• It forms no articulation with the vertebral column
• Each of the two shoulder girdles consists of two
bones, the clavicle (collar bone) and the Scapula
(Shoulder blade).
• The clavicle forms the anterior component of the
shoulder girdle and articulates with the sternum
and the scapula.
• The posterior component, the scapula, is freely
suspended from the thorax by complex muscular
attachments and articulates with the clavicle and
the humerus.
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 Functions of the clavicle and the scapula

• They join the upper limb to the trunk

• They increase the range or extent of joint

movement at the shoulder

• They serve as origin and insertion for the muscles

of the shoulder girdle.

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 Clavicle
• - a long slender bone with a double curvature
extends from the manubrium of the sternum laterally
to the acromion process of the scapula playing an
important role as outrigger in thrusting the
scapula away from the chest wall thereby
increasing the range of joint movement at
shoulder and arm.
• - The clavicle (collar bone) connects the upper limb to
the axial skeleton and the trunk.

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 Clavicle
acromial end sternal end

has two halves:

medial half which is convex anteriorly,
lateral half is concave anteriorly

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• The clavicle ossifies in a membrane and it is
the first bone to start ossification at around
the 5th week of development.

Parts of the clavicle

• 1. Sternal (medial) end - is enlarged and

triangular where it articulates with the
manubrium of the sternum at the
sternoclavicular (SC) joint.
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• 2. Acromial end :is flat where it articulates with
the acromion of the scapula at the
acromioclavicular (AC) joint
• It is a flattened part that articulates with the
acromion process of the scapula
 Nearer to the acromial end on the anterior
border of the clavicle there is a small
thickening called deltoid tubercle
3. Shaft - is the part between the two ends
having a double curvature in a horizontal
plane
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• The clavicle is the only long bone without a
medullary cavity

• The part of clavicle between its medial 2/3

(which is convex forward) and its lateral 1/3
(which concave forward) medial to the
coracoid process of the scapula is the
weakest part and is a frequent site of
fracture.

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 Fracture of Clavicle

• commonly fractured bone even in the body

caused by an indirect force transmitted from an

outstretched hand through the bones of the

forearm and arm to the shoulder during a fall.

•The weakest part of the clavicle is at the junction

of its middle
After fracture of the clavicle, the sternocleidomastoid

(SCM) muscle elevates the medial fragment of bone•

The trapezius muscle is unable to hold up the lateral

fragment owing to the weight of the upper limb, and

thus the shoulder drops

• A fracture of the clavicle is often incomplete in

younger children and it is a greenstick fracture.

• Muscles attached to the clavicle
1. Clavicular head of pectoralis major
2. Deltoid
3. Clavicular head of sternocleidomastoid
4. Lateral part of sternohyoid
5. Trapezius
6. Subclavius

• Other structures attached to the clavicle

1. Clavipectoral fascia
2. Anterior and posterior sternoclavicular
ligaments
3. Interclavicular ligament
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 The Scapula
• is a large triangular flat bone that lies on the
posterolateral aspect of the thorax, overlying
the 2nd - 7th ribs.

• It articulates with the humerus and the

clavicle

• It is separated from the ribs by muscles

gliding on the chest wall in what has been
termed Scapulothoracic joint
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 Has:
Two surfaces: costal (ventral) and dorsal
Three borders: lateral, medial and superior
borders
Three angles: inferior, superior and lateral angles
Three processes: spine, acromion and coracoid
processes
Three fossae: supraspnous [small]
infraspnous [large] [convex], and
subscapular fossae[ concave]
 acromion
process
coracoid process
glenoid
cavity
superior angle

Anterior Scapula
subscapular fossa inferior angle

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Posterior scapula
Posterior Scapula
acromion process

supraspinous fossa

infraspinous fossa spine

lateral border
medial border

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• The relatively smaller glenoid cavity is
enlarged by a fibrocartilaginous rim called
glenoidal labrum to accommodate the large
head of the humerus

• Above and below the glenoid cavity there

are supraglenoid and infraglenoid tubercles
that provide attachment sites for the long
heads of biceps and triceps muscles
respectively.

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 Structures attached to the scapula

• Muscles
1. Deltoid 4. Coracobrachialis

2. Trapezius 5. Long head of triceps

3. Long and short heads of biceps
• Ligament
1. Coracoclavicular ligament
2. Coracoacromial ligament
3.02/21/2025
Suprascapular ligament
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• HUMERUS
the longest and largest bone of
the upper extremity divisible into a shaft
and two ends( proximal and distal)
• Proximal end consists of a large rounded
head joined to the shaft by a constricted
portion called the neck, and two
eminences, the greater and lesser
tubercles.

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• The Head - nearly hemispherical in form and
directed upward.
The circumference of its articular surface is slightly
constricted and is termed the anatomical neck
• The line separating the upper end of the humerus from
the shaft is called the surgical neck.OR
• A constriction below the tubercles called the
surgical neck which is frequently the sit of fracture
• The surgical neck is related to axillary nerve,
anterior and posterior circumflex humeral vessels
• Fracture of the anatomical neck rarely occurs.
. Lesser tubercle is an elevation on the anterior
aspect of the upper end.
. Greater tubercle is an elevation that forms the
lateral part of the upper end; its posterior
aspect is marked by three impressions, upper,
middle and lower.
..

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 Anterior Humerus
lesser
medial epicondyle deltoid tubercle
trochlea tuberosity

coronoid fossa intertubercular

groove greater
capitulum tubercle
lateral epicondyle

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• .

6.
• Shaft
is rounded in the upper half and triangular in the lower
half
has three borders and three surfaces
 At about the middle on the lateral side there is a V-
shaped rough raised area called deltoid tuberosity
to which the deltoid muscle is inserted
Radial sulcus (radial groove, radial fossa or spiral
groove
• Through this sulcus runs the radial nerve.

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 Lower End
• Forms condyle which is expanded from side
to side & has articular & nonarticular parts.
• Articular part
1.Capitulum is a rounded projection which
articulates between head of radius

2. Trochlea is a pulley shapes surface . It

articulates with the trochlear notch of the
ulna.
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1.-Three nerves are directly related to the
humerus and are therefore liable to injury.
-axillary nerve at the surgical neck
- radial nerve at the radial groove
- ulnar nerve behind the medial epicondyle
• Clinical features
2 Common sites of fracture are the surgical
neck ,the shaft & supracondylar region
3 The head of humerus commonly dislocates
inferiorly.

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• The following parts of the humerus are in direct
contact with the indicated nerves:
- Surgical neck: axillary nerve.
- Radial groove: radial nerve.
- Distal end of humerus: median nerve.
- Medial epicondyle: ulnar nerve.
N.B. These nerves may be injured when the associated
part of the humerus is fractured
• Humeral fractures are often result in one fragment
being driven into the spongy bone of the other
fragment (impacted fracture).
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 BONES OF THE FOREARM
These are radius and ulna.
RADIUS
- is the lateral and shorter of the two forearm
bones & is homologous with the Tibia.
-thinner proximally & progressively thickens
distally.
• has three parts
- proximal
- shaft
- distal
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02/21/2025 10:27:10 PM
trochlear notch
Ulna
coronoid process head

radial notch
olecranon process styloid process

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 Radius
radial tuberosity

head styloid process

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• Proximal end
- consists of the head, neck & radial tuberosity
1 Head - is disc shaped & is covered with hyaline
cartilage.
- has superior concave surface which articulates with
capitulum on humerus at the elbow joint.
- has articular circumference that rotates in the
radial notch of the ulna, covered by hyaline
cartilage & surrounded by annular ligament.

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 ULNA
• Is the medial and longer bone of the forearm
and is homologous to fibula of lower limb.
• Its thickness decreases in a distal direction or
viceversa.
• Proximal /Upper End.
-Presents the olecranon and coronoid process,
and the trochlear and radial notches.

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• Clinical features(fracture) of raduis and
ulna
- Radius commonly fractures ~2cm above
its lower end (Colle’s fracture) distal
fragment is displaced upwards &
backwards ( if upwards & forwards it is
called Smith’s fracture ) , caused by a
fall on outstretched hand.
- A sudden powerful jerk on the hand of
a child may dislodge the head of the
radius from the grip of the annular
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ligament, this is known as subluxation
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 Fractures of the radius and ulna
Fracture of the distal end of the radius is a
common fracture in adults > 50 years of age
occurs more frequently in women because their
bones are more commonly weakened by
osteoporosis.
A complete transverse fracture of the distal 2
cm of
the radius, called a colles fracture, is the most
common fracture of the forearm
The distal fragment is displaced dorsally and is
often comminuted (broken into pieces).
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CARPAL BONES
The eight small bones of the wrist, called carpal
bones are referred to collectively as the carpus.
The carpus is made up of 8 carpal bones- arranged
in two rows.
1. Proximal row contains (from lateral to medial side)
• scaphoid
• lunate
• triquetral
• pisiform .
2. Distal row contains in the same order
- trapezium
- trapezoid
- capitate
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- hamate.
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Manus (Hand)

Carpals (8)

Metacarpals (5)
3
1 pollex

Digits (5)
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• IDENTIFICATION
1.Scaphoid , is boat shaped and has tubercle on
lateral side.
2. Lunate , half moon-shaped or crescentic.
3. Triquetal – is pyramidal in shape, has isolated
oval facet on the distal part of the palmar
surface.
4. Pisiform , is pea shaped and has only one oval
facet on the proximal part of its dorsal surface.

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5. Trapezium is quadrangular in shape, and has a
crest and a groove anteriorly. It has a
concavoconvex articular surface distally.
6. Trapezoid- resembles shoe of a baby.
7. Capitate- largest carpal bone with a rounded
head.
8. Hamate – is wedge shaped with a hook near
its base

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CLINICAL FEATURES
• Commonest injuries which occur in the carpus
are fracture of the scaphoid and dislocation of
the lunate.
• METACARPAL BONES :forms the skeleton of
the palm of the hand between the carpus and
the phalanges.
• These are 5 miniature long bones, which are
numbered from lateral to medial side.
• Each bone has a head (placed distally), a shaft
and a base (at the proximal end)

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 PHALANGES
• There are 14 phalanges in each hand, 3 for
each finger and 2 for the thumb.
• Each digit has three phalanges except for
the first (the thumb)
• Each phalanx has a base , a shaft and a head.
The proximal phalanges are the largest,
the middle ones are intermediate in size
the distal ones are the smallest.

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• SESAMOID BONES OF THE UPPER LIMB.
• Sesamoid bones are small rounded masses of
bone located in some tendons at points where
they are subjected to great pressure.
1. Pisiform is often regarded as sesamoid bone
lying with in flexor carpi ulnaris.
2. Two sesamoid bones are always found on the
palmar surface of the hand of 1st metacarpal
bone.

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3. One sesamoid bone is found in the capsule of
interphalangeal joint of the thumb, in 75% of
subjects.
4. One sesamoid bone is found on the ulnar side
of intercarpophalangeal joint of little finger~
75% of subjects.
5. Less frequently there is a sesamoid on lateral
side of the metacarpophalangeal joint of index
finger.
6. sometimes found on other metacarpophalangeal
joints.
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 Joints of Upper Limb

Movement of the pectoral girdle involves the

sternoclavicular, acromioclavicular, and
glenohumeral joints, usually all moving
simultaneously.
1.Sternoclavicular Joint-sternoclavicular (SC)
joint is a synovial articulation between the
sternal end of the clavicle and the manubrium of
the sternum and the 1st costal cartilage.
The SC joint is divided into two compartments

by an articular disc. The disc is firmly attached

to the anterior and posterior SC ligaments,

thickenings of the fibrous layer of the joint

capsule, as well as to the interclavicular

ligament.The great strength of the SC joint is a

consequence of these attachments.

• Thus, although the articular disc serves as a
shock absorber of forces transmitted along
the clavicle from the upper limb, dislocation
of the clavicle is rare, whereas fracture of the
clavicle is common.
Ligaments:
Anterior sternoclavicular ligaments -
reinforce the joint capsule anteriorly
• Posterior sternoclavicular ligaments -
reinforce the joint capsule posteriorly.
The interclavicular ligament strengthens the
capsule superiorly. It extends from the sternal
end of one clavicle to the sternal end of the
other clavicle; is also attached to the superior
border of the manubrium.
The costoclavicular ligament anchors the
inferior surface of the sternal end of the clavicle
to the 1st rib and its costal cartilage, limiting
elevation of the pectoral girdle.
• The SC joint is supplied by internal
thoracic and suprascapular arteries.
Branches of the medial supraclavicular
nerve and the nerve to the subclavius
supply the SC joint.
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 2. Acromioclavicular Joint

• Acromioclavicular (AC) joint is a plane

synovial articulation in whicn the acromial end
of the clavicle articulates with the acromion of
the scapula.
The articular surfaces, covered with
fibrocartilage, are separated by an incomplete
wedge-shaped articular disc.
• The AC ligament, a fibrous band extending
from the acromion to the clavicle, strengthens
the AC joint superiorly
• Most of its strength comes from
coracoclavicular ligament. It maintains its
integrity and prevents the acromion from
being driven under the clavicle even when
the AC joint is separated. The strong, extra-
articular coracoclavicular ligament
(subdivided into conoid and trapezoid
ligaments) is located several centimeters
from the AC joint, which anchors the
clavicle to the coracoid process of the
scapula.
• The apex of the vertical conoid ligament
is attached to the root of the coracoid
process.
• The nearly horizontal trapezoid ligament
is attached to the superior surface of the
coracoid process and extends laterally and
posteriorly to the trapezoid line on the
inferior surface of the clavicle.
• coracoclavicular ligament provides the
means by which the scapula and free limb
are (passively) suspended from the
clavicle.
•
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 3. Glenohumeral Joint-shoulder

The articulating surfaces are Glenoid cavity of

the scapula and head of the humerus.
The glenoid cavity can receive only 1/4 - 1/3 of
the head of the humerus
Both the articulating surfaces are covered by
hyaline cartilage.
. a ball and socket, synovial joint that permits
a wide range of movement; however, its
mobility makes the joint relatively unstable.
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 Ligaments of Glenohumeral Joint

• Coracohumeral lig. - extends from coracoid

process to greater and lesser tubercles. It
reinforces the superior part of the capsule
• Glenohumeral ligs. (Sup., middle and inf.)
• they extend between the glenoid labrum
and the anatomical neck of the humerus.
• Transverse humeral ligament -holds the long
head of biceps in the groove.
• Coracoacromial ligament - forms a fibrous
arch roofing the shoulder joint. It also
prevents
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 Ligaments of Glenohumeral Joint

• Coracohumeral lig. - extends from coracoid

process to greater and lesser tubercles. It
reinforces the superior part of the capsule
• Glenohumeral ligs. (Sup., middle and inf.)
• they extend between the glenoid labrum
and the anatomical neck of the humerus.
• Transverse humeral ligament -holds the long
head of biceps in the groove.
• Coracoacromial ligament - forms a fibrous
arch roofing the shoulder joint. It also
prevents
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humerus
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 ELBOW JOINT
The elbow joint, a hinge type of synovial
joint, is located 2-3 cm inferior to the
humeral epicondyles.
There are three joints in the elbow
region,
1, Humeroulnar joint
2, Humeroradial joint
3, Proximal radioulnar joint
The three joints have a common
capsule & they share a single synovial
cavity , due to this they are
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considered
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 Elbow Joint

Articulation and Joint Capsule of the

Elbow Joint
• The spool-shaped trochlea and spheroidal
capitulum of the humerus articulate with
the trochlear notch of the ulna and the
slightly concave superior aspect of the
head of radius, respectively; therefore,
there are humeroulnar and
humeroradial articulations.
• proximal radioulnar joint--) radioulnar joint is a
pivot type of synovial joint that allows
movement of the head of the radius on the ulna.
Ligaments of Elbow Joint

The lateral, fan-like radial collateral

ligament extends from the lateral
epicondyle of the humerus and blends
distally with the anular ligament of the
radius.
The medial, triangular ulnar collateral
ligament extends from the medial
epicondyle of the humerus to the coronoid
process and olecranon of the ulna
 Ligaments of the Proximal
Radioulnar Joint

• The anular ligament attaches to the ulna,

anterior and posterior to the radial notch,
which forms a collar that, with the radial
notch
Distal Radioulnar Joint
 Joints of Hand
The joints formed by the carpus include
1.The wrist (radiocarpal joint),
2.Intercarpal,
3.Carpometacarpal, and
4.Intermetacarpal joints
1. Radiocarpal Joint ( Proximal wrist joint )
Upper - inferior surface of the lower
end of the radius & articular disc of
the inferior radioulnar joint.
• Lower - the three proximal carpal bones;
-scaphoid - lunate
triquetrium
2. Intercarpal :Jiont b/n distal &
proximal row of carpal bones.
3.Carpometacarpal: Jiont b/n distal
carpal and metacarpal bones .
 4.Intermetacarpal joints
• The proximal phalanges articulate with
the metacarpal bones at the
metacarpophalangeal joints. The joint
between the proximal and the middle
phalanx is the proximal
interphalangeal joint and that between
the middle and the distal phalanx is
the distal interphalangeal joint. The
thumb has one interphalangeal joint
JOINTS OF THE FINGERS
-All the fingers except the thumb
contain the ff joints.
1. Metacarpophalangeal joint
between the metacarpal and
proximal phalanx.
2. Proximal interphalangeal joints
- between proximal and middle
phalanx.
3. Distal interphalangeal joints
- between the middle and distal
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 Muscles of the shoulder girdle
All muscles of the shoulder girdle are involved in
the movement and fixation of the shoulder joint
and all are innervated by branches of the
brachial plexus (except trapezius, which gets
additional innervation from the accessory
nerve).

Muscles of Pectoral Region

Four muscles

A. Pectoralis major B. Pectoralis minor

 Muscles of the shoulder girdle
A. Pectoralis major muscle

It has three parts - clavicular, sternocostal,

abdominal

Clavicular part - medial half of the clavicle

Sternocostal part - sternum and the related

costal cartilages

Abdominal part - anterior part of the rectus

sheath
B. Pectoralis minor
This is a small muscle under the pectoralis major.
O - outer surface of ribs 2 - 5 or 3 - 5 near their
costochondral junctions.
I - coracoid process of the scapula
C. Serratus anterior muscle
• It also has three parts - horizontal part,
divergent part and convergent part.
O- 1. Horizontal part - ribs 1 and 2
2. Divergent part - ribs 2 and 3
3. Convergent part - ribs 4 – 9
I - costal surface of the scapula alonge the
medial border (superior angle, medial border
and inferior angle)
D. Subclavius muscle
O - near the costochondral junction of 1st rib
I - groove for the subclavius muscle on the
lower surface of the clavicle
E. Teres Minor muscle
0-upper part of the dorsal aspect of the
axillary border of the scapula
I - lower impression of the greater tuberosity
and adjoining part of the shaft of humerus.
Its tendon runs laterally behind the long
head of triceps brachii muscle.
F. Teres major
O - back of the inferior angle and axillary
border of the scapula below the teres
minor.
I - front of the humerus on the crest of
the lesser tubercle (medial lip of the
biceptal groove or intertubercular
sulcus).
G. Deltoid muscle -triangular in shape
and is divided in to three parts
according to the origin of its fibres.
- clavicular part - lateral 1/3 of the
clavicle
III. Scapulohumeral (intrinsic shoulder) muscles

9. Deltoid
• it is shaped like the inverted Greek letter delta.

• it is divided in to 3 parts that can act separately or

as a whole .
I. anterior = flexes and medially rotates arm
II. posterior = extends & laterally rotates arm.
III. middle = abducts arm.

• the anterior and posterior parts are used to swing

the limbs during walking.
 9. Deltoid . . . .

• deltoid also helps stabilize the glenohumeral joint and

hold the head of the humerus in the glenoid cavity during
movements of upper limb.

• The deltoid fascia descends over the superficial surface of

the deltoid from the clavicle, acromion, and scapular spine
to enclose the deltoid muscle.

O= lateral 3rd of clavicle, acromion & spine of scapula.

I = deltoid tuberosity of humerus .
N = Axillary nerve
H. Supraspinatus muscle
I. Infraspinatus muscle
J. Subscapularis muscle
K. Trapezius
L.Latissimus dorsi
M. Rhomboid major
N. Rhomboid minor
 Muscles of Arm

• Of the four arm muscles, three flexors

(biceps brachii, brachialis, and
coracobrachialis) are in the anterior
(flexor) compartment and are supplied
by the musculocutaneous nerve, and
one extensor (triceps brachii) is in the
posterior compartment, supplied by the
radial nerve. A small triangular muscle
on the posterior aspect of the elbow, the
anconeus, covers the posterior aspect of
the ulna proximally.
 Flexor group of arm muscles
This group is composed of three
muscles,namely biceps
brachii,coracobrachialis and brachialis
muscles
• Biceps brachii
• O:Long head: supraglenoid tubercle and
the superior portion of the glenoid labrum.
• Short head: lateral aspect of the apex of
the coracoid process of the scapula.

• I:Radial tuberosity and the biceptal

aponeurosis.
 Action
1. Flexion of the forearm at the elbow
• Biceps brachii flexes the elbow with the forearm
supinated
2. Assists with flexion of the arm at the
shoulder
3. Assists with supination of the forearm
Coracobrachialis
O: apex of the coracoid process of the scapula.
I:Medial aspect of the mid shaft of the humerus
Action
1.Flexion of the arm at the shoulder
2.Assists with adduction of the arm at the shoulder
Brachialis
O:Lower half of the anterior aspect of
humerus
I:Tuberosity and coronoid process of the
ulna.
Action
Flexion of the forearm at the elbow
 Triceps brachii:

• The triceps is the main extensor of the elbow

• O:long head:Infraglenoid tubercle of the
scapula
• Lateral head:posterior surface of
humerus, superior to radial groove
• Medial head: Posterior surface of humerus
,inferior to radial groove
• I:Posterior surface of the olecranon
process of the ulna.
 Extensor Muscles of the Forearm
• The extensor muscles are in the posterior
(extensor supinator) compartment of the
forearm, and all are innervated by branches of
the radial nerve. These muscles may be
organized into three functional groups:
1. Muscles that extend and abduct or adduct the
hand at the wrist joint (extensor carpi radialis
longus, extensor carpi radialis brevis, and
extensor carpi ulnaris).
2. Muscles that extend the medial four digits
(extensor digitorum, extensor indicis, and
extensor digiti minimi).
3. Muscles that extend or abduct the thumb
(abductor pollicis longus [APL], extensor pollicis
brevis [EPB], and extensor pollicis longus [EPL]).
 EXTENSOR MUSCLES OF THE FORE
ARM
• in the posterior(extensor –supinator)
compartment.
• All are innervated by branches of
radial nerve
• Are organized in to 3 functional
groups
• 1. Muscles that extend and abduct or
adduct the hand at the wrist joint
extensor Carpi radialis longus
extensor Carpi radialis brevis
extensor Carpi ulnaris
2. Muscles. that extend the medial 4
digits(extensor digitorium,extensor
indicis, extensor digiti minimi
3.Muscles that extend or abduct the
thumb
abductor policis longus
extensor policis longus
extensor policis brevis
 Muscles of Hand
• The intrinsic muscles of the hand are located in five
compartments:
• Thenar muscles in the thenar compartment: abductor
pollicis brevis, flexor pollicis brevis, and opponens
pollicis.
• Hypothenar muscles in the hypothenar compartment:
abductor digiti minimi, flexor digiti minimi brevis, and
opponens digiti minimi.
• Adductor pollicis in the adductor compartment.
• The short muscles of the hand, the lumbricals, in the
central compartment with the long flexor tendons.
• The interossei in separate interosseous compartments
between the metacarpals.
 Short Muscles of the Hand
• The short hand muscles are the lumbricals
and interossei. The four slender lumbrical
muscles were named because of their worm-
like appearance (L. lumbricus, earthworm). The
lumbricals flex the fingers at the
metacarpophalangeal joints and extend the
interphalangeal joints. The four dorsal
interosseous muscles (dorsal interossei) are
located between the metacarpals; the three
palmar interosseous muscles (palmar
interossei) are on the palmar surfaces of the
2nd , 4th , and 5th metacarpals. The 1st dorsal
interosseous muscle is easy to palpate; oppose
the thumb firmly against the index finger and it
can be felt easily in the web between them
 Arteries and Veins of Arm

• The brachial artery provides the main

arterial supply to the arm and is the
continuation of the axillary artery.It begins
at the inferior border of the teres major
and ends in the cubital fossa opposite the
neck of the radius under cover of the
bicipital aponeurosis, where it divides into
the radial and ulnar arteries. The brachial
artery, relatively superficial and palpable
throughout its
 Arteries of Arm

• The main named branches of the brachial

artery that arise from its medial aspect are
the deep artery of arm (L. arteria
profunda brachii) and the superior and
inferior ulnar collateral arteries. The
latter vessels help form the periarticular
arterial anastomoses of the elbow
region
 Axillary Artery
• The axillary artery is continuous proximally with
the subclavian artery and distally with the brachial
artery.
• It begins at the outer /lateral border of the upper
surface of the first rib and ends at the lower border
of teres major muscle after which it becomes
brachial artery.
• It passes posterior to the pectoralis minor into the
arm and becomes the brachial artery when it
passes distal to the inferior border of the teres
Branches of the brachial artery

1. Profunda brachii artery (deep

brachial artery)
2. muscular branches to the flexors of
the arm
3. Superior ulnar collateral artery
4. Inferior ulnar collateral artery
 Deep br. a
Brachial
artery
Superior
collatera
art.

Inferior
ulnar
colateral
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a 122
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 Veins of the arm
• Two sets of veins of the arm, superficial and deep,
anastomose freely with each other. The two
main superficial veins of the arm, are
cephalic and basilic veins.
• Paired deep veins, collectively constituting the
brachial vein, accompany the brachial artery.
• The brachial vein begins at the elbow by union of
the accompanying veins of the ulnar and radial
arteries and ends by merging with the basilic vein
to form the axillary vein. Both superficial and deep
veins have valves, but the deep veins have more.
• The perforating veins form communications between the
superficial and deep veins
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 The Axillary Vein
 Formed from the union of the brachial veins and
the basilic vein at the inferior border of teres minor

 lies on medial side of axillary artery

 Ends at lateral border of 1st rib where it becomes

the subclavian vein

 The cephalic vein enters the axillary vein close to

its transition to subclavian vein
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 Axillary vein
• The axillary vein that lies anteromedial to the
axillary artery is formed by the fusion of the
two brachial veins and drains into the
subclavian vein.
• Below the clavicle its lumen is kept open by the
clavipectoral fascia, because of which its open
injury results in air embolism.
• Its tributaries correspond to the branches of
the axillary artery, which are venae
commitantes
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 Nerves of Arm
• Four main nerves pass through the arm:
median, ulnar, musculocutaneous,
and radial.
• The median nerve in the arm is formed
in the axilla by the union of medial and
lateral roots from the medial and lateral
cords of the brachial plexus, respectively.
• The radial nerve enters the arm
posterior to the brachial artery, medial
to the humerus, and anterior to the long
head of triceps
 Arteries and Veins of Forearm
• The brachial artery ends in the distal part
of the cubital fossa opposite the neck of the
radius by dividing into the ulnar and radial
arteries, the main arteries of the forearm.
• The ulnar artery descends through the
anterior (flexor pronator) compartment of
the forearm, deep to the pronator teres.
Pulsations of the ulnar artery be palpated
on the lateral side of the flexor carpi ulnaris
tendon (FCU), where it lies anterior to the
ulnar head.
• . The ulnar nerve is on the medial side of the
ulnar artery.
• The pulsations of the radial artery can be felt
throughout the forearm
• There are superficial and deep veins in the
forearm: superficial veins ascend in the
subcutaneous tissue; deep veins accompany
the deep arteries (e.g., radial and ulnar).
 Superficial Veins of the Forearm
The cephalic vein forms over the anatomical
snuffbox from the lateral side of the dorsal venous
network.
The basilic vein arises from the medial side of the
dorsal venous network.
The median antebrachial vein begins in the
superficial venous palamr arch and usually ends
in the basilic vein.
The perforating veins form communications
between the superficial and deep veins
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 Nerves of Forearm
• The major nerves of the forearm are the
median, ulnar, and radial.
• The median nerve is the principal nerve of
the anterior compartment of the forearm.
• The ulnar nerve passes posterior to the
medial epicondyle of the humerus and
enters the forearm by passing between the
heads of the flexor carpi ulnaris, giving
branches to them. It then passes inferiorly
between the flexor carpi ulnaris and the
FDP, supplying the ulnar (medial) part of
the muscle that sends tendons to digits 4
and 5.
 Arteries and Veins of Hand

The ulnar and radial arteries and their

branches provide all the blood to the hand
Nerveous of the the hand
The median, ulnar, and radial nerves
supply the hand
.
 APPLIED ANATOMY
• Measuring Blood Pressure
• A sphygmomanometer is used to measure arterial blood
pressure.
•A cuff is placed around the arm and inflated with air until it
compresses the brachial artery against the humerus and
occludes it.
• A stethoscope is placed over the artery in the cubital
fossa, the pressure in the cuff is gradually released, and
the examiner detects the sound of blood beginning to
spurt through the artery.
• The first audible spurt indicates systolic blood pressure.
• As the pressure is completely released, the point at which
the pulse can no longer can heard indicates diastolic blood
pressure.
• Occlusion of Laceration of Brachial Artery
• Although collateral pathways confer some protection
against gradual temporary and partial occlusion,
sudden complete occlusion or laceration of the brachial
artery creates a surgical emergency because paralysis
of muscles results from ischemia within a few hours.
• After this, fibrous scar tissue develops and causes the
involved muscles to shorten permanently, producing a
flexion deformity ischemic compartment syndrome
(Volkmann ischemic contracture).
• Contraction of the fingers and sometimes the wrist
results in loss of hand power
 Venipuncture
• Because of the prominence and accessibility
of the superficial veins, they are commonly
used for venipuncture (puncture of a vein to
draw blood or inject a solution).
• By applying a tourniquet to the arm, the
venous return is occluded and the veins
distend and usually are visible and/or
palpable.
• Once a vein is punctured, the tourniquet is
removed so that when the needle is removed
the vein will not bleed extensively.
• The median cubital vein is commonly used for
venipuncture.
• The veins forming the dorsal venous network
and the cephalic and basilic veins arising from
it are commonly used for long-term
introduction of fluids (intravenous feeding).
• The cubital veins are also a site for the
introduction of cardiac catheters to secure
blood samples from the great vessels and
chambers of the heart.
 Areas of palpation of arterial pulse on the upper limb
1. Brachial artery
a. In the medial biceptal sulcus
b. Supero-ventral to the medial epicondyle
at the elbow
c. In the elbow deep and medial to the
biceptal aponeurosis.
2. Radial
a. Proximal to the wrist between the tendons of
flexor carpi radialis and brachioradialis
b. In the anatomical snuff-box
3. Ulnar
- at or near the wrist lateral to the tendon of
 Lymphatic drainage
• The superficial vessels accompany the superficial
veins in the fore arm until the elbow, where they
enter lymph nodes (cubital or epitrochlear).
• From the elbow most of the vessels run with the
basilic vein to the superficial axillary lymph nodes.
• The deep vessels follow the arteries and they
similarly open in to the superficial axillary nodes.
• The lymph from the superficial axillary nodes is
drained to the deep axillary lymph nodes and then
to the subclavian trunk.

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 Axillary Lymph Nodes
 Five principal groups:
 pectoral (anterior):lies along the medial wall of
axilla. Receive lymph from the anterior thoracic wall.
 Subscapular (posterior):receive lymph from the
posterior thoracic wall and scapula.
 Humeral (lateral):receive lymph from u.limb
 Central: receive lymph vesseles from the above
three groups.
Apical: receive lymph from all groups and
lymph vesseles accompanying cephalic vein.
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Cutaneous Nerves of Upper Limb
 C3 and C4 innervate base of neck
 C5 supplies the arm laterally
 C6 supplies the forearm laterally and the
thumb
 C7 supplies the middle fingers and middle
posterior surface of limb
 C8 supplies little finger, medial side of hand
and forearm
 T1 supplies middle of forearm to axilla
 T2 supplies skin of axilla
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- Most cutaneous nerves of upper limb are
derived from the Brachial Plexus
- The nerves of the shoulder however are
derived from the cervical plexus

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 Cutaneous Nerves are:
The supraclavicular nerve (C3 and C4)
Posterior cutaneous nerve of arm(C5-8)
Posterior cutaneous nerve of forearm(C5-8)
Superior lateral cutaneous nerve of arm(C5,6)
Inferior lateral cutaneous nerve of arm(C5,6)
Lateral cutaneous nerve of forearm(C6,7)
Medial cutaneous nerve of arm(C8-T2)
Medial cutaneous nerve of forearm(C8,T1)
Intercostobrachial (T2)
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 Assignment
 Breast:
Anatomical structure
Blood supply
Nerve supply
Lymphatic drainage
Some clinical notes
 Axillary region
• In the axillary region two parts should be
distinguished.
1. Axillary fossa (arm pit)
2. Axillary cavity (Axilla)
• Axillary fossa - is the visible deepening or groove
between the arm and the lateral thoracic wall.

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• Boundaries
- Anterior - anterior axillary fold
- Posterior - posterior axillary fold
- Lateral - medial side of the upper part of the
arm.
- Medial - lateral wall of the thorax
• The anterior axillary fold is formed by pectoralis
major muscle while the posterior axillary fold is
formed by the latissimus dorsi and teres major
muscles

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• Axilla - is a pyramidal space .
. Its base is formed by the axillary fascia.
. Its apex open to the lateral neck region
through a triangular space between the first
rib, the clavicle and scapula. This space is
known as cervicoaxillary canal.
. The main function of the axilla is to
transmit and protect blood vessels and
nerves that run from the neck to the arm or
vice versa.

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• In the upper part of the axilla these vessels
and nerves are related to each other in such
a way that the axillary vein lies ventromedial
(ventral), the axillary artery at the middle
and the brachial plexus dorsolateral
(dorsal).
• Additionally the axilla gives a greater
possibility of movement to the shoulder
girdle.

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• Walls of the axilla:
. Anterior - pectoralis major and minor
muscles
. Medial - serratus anterior muscle
. Lateral - Coracobrachialis
- short head of biceps
- upper part of the humerus
(surgical neck)
. Posterior - subscapularis (upper part)
- latissimus dorsi and teres
major
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• The vessels and nerves give important
branches in the axilla. Some of these
branches run to the posterior aspect of the
shoulder by passing through two openings.
1. A medial triangular space or Medial
axillary hiatus (interval) - contains the
circumflex scapular artery and vein.
2. A quadrangular space or lateral axillary
hiatus - containing the axillary nerve and the
posterior circumflex humeral vessels (artery
and vein).
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• Related to these on the adjacent part of the
arm there is a lateral triangular space that
contains the profunda brachii artery and the
radial nerve.
• Contents of the axilla
1. Axillary vessels
2. Infraclavicular part of the brachial plexus
3. Lateral cutaneous branches of the
intercostal nerves
4. Axillary lymph nodes
5. Adipose
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 Axillary artery
• The axillary artery is continuous proximally
with the subclavian artery and distally with
the brachial artery.
• It begins at the outer border of the upper
surface of the first rib and ends at the lower
border of teres major muscle after which it
becomes brachial artery.

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• The pectoralis minor muscle crosses over
the artery and divides it into three parts.
1. First or proximal part - between the first
rib and the medial border of pectoralis
minor.
2. Second or posterior part - behind or
posterior to the muscle
3. Third or distal part - between the lateral
border of pectoralis minor and the lower
border of teres major.
• Each of these parts gives branch to one,
two and three arteries respectively.

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A. Branch from the first part:
• Superior thoracic artery - it supplies the
muscles and the wall of the thorax in the
upper part of the pectoral region. It forms
anastomosis with the intercostal and the
internal thoracic arteries.
• Sometimes the superior thoracic artery may
arise from the thoracoacromial artery.

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B. Branches from the second part:
1. Thoracoacromial artery - gives rise to the
following four branches.
a. Pectoral branch
b. Acromial branch
c. Clavicular branch
d. Deltoid branch
2. Lateral thoracic artery - descends to the
lateral thoracic wall along the lateral border
of the pectoralis minor muscle.
C. Branches from the third part:
1. Subscapular artery - descends along the
lateral border of the scapula and divides in
to thoracodorsal and circumflex scapular
arteries.
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• The thoracodorsal artery runs with the
thoracodorsal nerve to the latissimus dorsi muscle
• the circumflex scapular artery turns backwards
around the lateral border of the scapula and
passes through the medial triangular space to
form anastomosis with the suprascapular artery
and the deep and superficial branches of the
transverse cervical artery in the posterior part of
the scapula forming the so called scapular
anastomosis
• This anastomosis provides an adequate collateral
blood flow in either directions.

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2. Anterior circumflex humeral artery - a
small branch that runs dorsally anterior to
the surgical neck of the humerus.

3. Posterior circumflex humeral artery - it

courses posteriorly around the surgical
neck of the humerus with the axillary nerve
and passes through the quadrangular
space.

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 Axillary vein
• The axillary vein that lies anteromedial to
the axillary artery is formed by the fusion of
the two brachial veins and drains into the
subclavian vein.
• Below the clavicle its lumen is kept open by
the clavipectoral fascia, because of which
its open injury results in air embolism.
• Its tributaries correspond to the branches of
the axillary artery, which are venae
commitantes.
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 Brachial plexus

• The brachial plexus is mainly formed by the

ventral rami of the spinal nerves C5 - C8 and
Th1, but sometimes C4 and T2 may also
contribute.
• If the contribution of C4 is larger than that of
T2, then the plexus C4 - T1 is known as
prefixed and if the contribution of T2 is
larger than that of C4, the plexus thus
formed by C5 - T2 is called post-fixed.
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• The brachial plexus passes through the
scalen gap and enters the axilla through the
cervicoaxillary canal behind the clavicle.
Therefore supraclavicular and
Infraclavicular parts can be distinguished.
• In the supraclavicular part the three trunks
of the brachial plexus are formed.
1. Upper (superior) trunk - formed by roots
from C5 and C6
2. Middle trunk - formed by the root from C7
3. Lower (inferior) trunk - formed by roots
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from
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• After passing between the clavicle and the first rib
it becomes the infraclavicular part where the
trunks branch in to ventral and dorsal divisions
and the divisions of the three trunks fuse with
each other to form three cords or fasciculi

• The dorsal divisions of all the three trunks form

the posterior cord

• The ventral divisions of the upper and middle

trunks form the lateral cord whereas the ventral
division of the lower trunk forms the medial cord.
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• These three cords (posterior, lateral and
medial) give the following branches to the
shoulder girdle, the arm and forearm and
extend.
1. Posterior cord - axillary and radial nerves
2. Lateral cord - musculocutaneous nerve
and lateral root of median nerve.
3. Medial cord - ulnar nerve, medial root of
median nerve, medial cutaneous
nerve of the arm (medial brachial cutaneous
nerve) and the medial cutaneous nerve of
the forearm (medial antebrachial cutaneous
nerve).
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 Branches of the brachial plexus to the

shoulder girdle
• All the branches of the brachial plexus to
the shoulder girdle are motor nerves except
the axillary nerve that has both motor and
sensory components.
• To these nerves belong:
1. Dorsal scapular nerve (C4 & C5 mainly
from C5) - passes through the scalenus
medius muscle and innervates the levator
scapulae, and rhomboid major and minor.
. It runs in the direction of the scapula 178
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the rhomboid muscles.
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2. Long thoracic nerve (C5, C6 & C7) - It also
passes through the scalenus medius
muscle and descends dorsal to the
brachial plexus and the first part of the
axillary artery along the midaxillary line to
the serratus anterior muscle.
. In its paralysis the arm can not be
elevated in addition to the appearance of a
clinical condition known as winged
scapula or scapula alata (this is a
condition where the medial border of the
scapula protrudes away from the thoracic
wall).

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3. Nerve to subclavius or subclavius nerve
(C5) - innervates the subclavius muscle
and the sternoclavicular joint.
. Frequently it contributes fibres to the
phrenic nerve as accessory phrenic nerve.
4. Medial pectoral (C8 & Th1) and lateral
pectoral (C5 - C7) - innervate the pectoralis
major and minor muscles.
5. Suprascapular nerve (C5 & C6) - it is the
upper most branch of the trunk of the
brachial plexus running with the
suprascapular vessels to reach the supra-
and infraspinatus muscles.
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• In its paralysis the scapular spine
becomes prominent and the lateral
rotation of the shoulder joint is affected.
6. Subscapular nerves (C5 & C6) - they are
two in number
a. Upper (superior) subscapular - small
and enters the upper part of subscapularis
muscle and teres minor muscle.
b. Lower (inferior) subscapular -
innervates the lower part of subscapularis
muscle
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7. Thoracodorsal nerve (C6 - C8) - also
referred to as middle Subscapular nerve
for it arises from the posterior cord
between the upper and lower Subscapular
nerves.
. It runs with the thoracodorsal vessels to
the latissimus dorsi muscle.
8. Axillary or circumflex nerve (C5 & C6) - it
runs through the quadrangular space
being related to the surgical neck of the
humerus. Therefore it can be injured by
fracture of the surgical neck, subluxation
of the
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shoulder and by a crutch pressing
184
 . It gives a motor supply to the deltoid and
teres minor muscles.
. Its paralysis results in the atrophy of
these muscles and loss of sensation in the
lower half of the deltoid region.
. The paralysis and atrophy of the deltoid
muscle results in a prominent greater
tuberosity and impairment of abduction of
the arm.
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 Branches of the brachial plexus to the
arm
• The brachial plexus gives six branches to
the arm. Out of the six two of them are
cutaneous sensory nerves and four of them
are mixed nerves.
a. Cutaneous nerves as direct branches of the
brachial plexus
1. Medial cutaneous nerve of the arm or
medial brachial cutaneous nerve (C8 & Th1)
2. Medial cutaneous nerve of the fore187
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arm or Medial antebrachial cutaneous nerve

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b. Mixed branches
1. Musculocutaneous nerve (C5 - C7)
2. Median nerve (C6 - Th1)
3. Ulnar nerve (C7 - Th1)
4. Radial nerve (C5 - C8)

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 Classification of branches of the
brachial
plexus
• Branches of the brachial plexus can be
classified with reference to the clavicle as
branches from the supraclavicular part
and branches from the infraclavicular part
or on the basis of the different parts of the
brachial plexus as branches from the
roots, from the trunks and from the cords.
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1. Classification with reference to the clavicle
A. Branches from the supraclavicular part
1. Subclavius nerve
2. Dorsal scapular nerve
3. Suprascapular nerve
4. Long thoracic nerve
B. Branches from the infraclavicular part
1. Branches to the shoulder girdle
a. Medial and lateral pectoral
nerves
b. Subscapular nerves
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 2. Branches to the arm
a. Musculocutaneous nerve
b. Median nerve
c. Ulnar nerve
d. Medial brachial cutaneous nerve
e. Medial antebrachial cutaneous nerve
f. Radial nerve
g. Axillary nerve

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2. Classification on the basis of their origin
from the parts of the brachial plexus.
A. Branches from the roots
1. Dorsal scapular (C4 & 5)
2. Long thoracic (C5, 6, 7)
B. Branches from the trunks
1. Suprascapular nerve - upper
trunk
2. Subclavius nerve - upper trunk
• Sometimes medial pectoral from the lower
trunk and lateral pectoral nerve from the
anterior division of the upper and middle
trunk
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 C. Branches from the cords
1. From the lateral cord
a. Lateral pectoral
b. Musculacutaneous
c. Lateral root of median
2. From the posterior cord
a. Upper subscapular
b. Thoracodorsal (Middle subscapular)
c. Lower subscapular
d. Radial
e. Axillary
f. Articular
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 3. From the medial cord
a. Medial pectoral
b. Medial brachial cutaneous
c. Medial antebrachial cutaneous
d. Ulnar
e. Medial root of median

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 Muscles of the shoulder girdle
• All muscles of the shoulder girdle are
involved in the movement and fixation of the
shoulder joint and all are innervated by
branches of the brachial plexus (except
trapezius, which gets additional innervation
from the accessory nerve).
A. Pectoralis major muscle
• It has three parts - clavicular, sternocostal,
abdominal
• O –
. Clavicular part - medial half of the
clavicle
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195
• Sternocostal part - sternum and the related
costal cartilages
• Abdominal part - anterior part of the rectus
sheath
• I - the fibres of the three parts converge and
are inserted to the crest of the greater
tubercle (lateral lip of the intertubercular
sulcus or biceptal groove). Fibres of the
clavicular part and the upper part of the
sternocostal part are inserted distally while
those of the abdominal part and lower part
of the sternocostal part are inserted
proximally by crossing over each other
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• Action
1. Movement - adduction, flexion, medial
rotation and depression of the elevated
shoulder. When the arm is fixed it moves the
trunk, e.g. when climbing a tree and during
difficulty of breathing for inspiration.
2. Fixation of the shoulder joint
• N/S - medial pectoral nerve from the medial
cord of the brachial plexus and lateral
pectoral nerve from the lateral cord of the
brachial
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plexus. 198
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 B. Pectoralis minor
• This is a small muscle under the pectoralis
major.
• O - outer surface of ribs 2 - 5 or 3 - 5 near
their costochondral junctions.
• I - coracoid process of the scapula
• Action: 1. Movement - depression of the
elevated shoulder in a ventrocaudal
direction and elevation of the ribs. Therefore
it helps in inspiration.
2. Fixation of the shoulder joint
• N/S - Medial and lateral pectoral nerves. 199
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 C. Serratus anterior muscle
• It also has three parts - horizontal part,
divergent part and convergent part.
• O 1. Horizontal part - ribs 1 and 2
2. Divergent part - ribs 2 and 3
3. Convergent part - ribs 4 - 9
• I - costal surface of the scapula alonge the
medial border (superior angle, medial
border and inferior angle)
• Action
1. Movement - moves the scapula on the
thorax. The convergent part moves the
inferior angle of the scapula anterolaterally.
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• This time the glenoid cavity faces cranially
thereby the arm can be elevated above 900.
With the scapula fixed it elevates the ribs
and acts as accessory inspiratory muscle.
2. Fixation of the scapula
• N/S - long thoracic nerve (C5 – C7), the
paralysis of which leads to a condition
called winged scapula or scapula alata.

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 D. Subclavius muscle
• O - near the costochondral junction of 1st
rib
• I - groove for the subclavius muscle on the
lower surface of the clavicle
• Action - fixation of the sternoclavicular joint,
i.e. it prevents its upward dislocation.
• N/S - Nerve to subclavius

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 E. Teres Minor muscle
• O - upper part of the dorsal aspect of the
axillary border of the scapula
• I - lower impression of the greater
tuberosity and adjoining part of the shaft of
humerus. Its tendon runs laterally behind
the long head of triceps brachii muscle.
• Action - lateral rotation, adduction and
fixation of the shoulder.
• N/S - Axillary nerve

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 F. Teres major
• O - back of the inferior angle and axillary
border of the scapula below the teres minor.
• I - front of the humerus on the crest of the
lesser tubercle (medial lip of the biceptal
groove or intertubercular sulcus).
• Action - medial rotation, adduction and
extension of the shoulder.
• N/S- lower subscapular

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 G. Deltoid muscle
• It is triangular in shape and is divided in to
three parts according to the origin of its
fibres. The three parts are: Clavicular
(anterior fibres) , Acromial (middle fibres)
and Spinal parts (posterior fibres).
• O - clavicular part - lateral 1/3 of the clavicle
- acromial part - acromion process of the
scapula
- spinal part - spine of the scapula
• I - deltoid tuberosity on the outer surface of
the humerus

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• Action
. Clavicular part - adduction, flexion,
medial rotation and participates in the
pulling of the trunk towards a fixed arm,
e.g. during climbing.
. Acromial part - abduction of the arm up
to 900
. Spinal part - adduction, extension,
lateral rotation
.All the three parts are involved in the
fixation of the shoulder joint.
• N/S - Axillary nerve (C5 - C6)

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 H. Supraspinatus muscle
• O - supraspinous fossa of the scapula
• I - upper part of the greater tubercle of the
humerus (upper impression). Its tendon
crosses laterally over the shoulder joint.
• Action - abduction of the shoulder up to
900, helps in climbing and fixation of the
shoulder joint. It responsible for the first 20
of abduction (initiator of abduction) after
which it is assisted by deltoid.
• N/S - suprascapular nerve
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 I. Infraspinatus muscle
• O - infraspinous fossa of the scapula
• I - at the middle of the posterior part
(middle impression) of the greater tubercle
of the humerus.
• Action - adduction, extension, lateral
rotation and is involved in climbing and
fixation of the shoulder joint.
• N/S - suprascapular nerve

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 J. Subscapularis muscle
• O - subscapular fossa on the costal surface
of the scapula.
• I - lesser tubercle of the humerus
• Action - adduction, medial rotation and
slight extension; also involved in climbing
and fixation of the shoulder joint.
• N/S - upper and lower subscapular

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• The subscapularis, supraspinatus,
infraspinatus and teres minor form the
rotator cuff.
• This cuff of muscles reinforces the
capsule of the shoulder joint and helps to
keep the disproportionately large head of
the humerus in the shallow glenoid cavity
of the scapula during movement of the
shoulder joint.

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 Trapezius
Has three parts( acc. to the direction of its
fibres)
1. Descending or superior part
2. Transverse or middle part
3. Ascending or inferior part
O -External occipital protuberance
Medial part of the superior nucheal line
Ligamentum nachae
Spinous processes of all thoracivertebrae

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 I- Lateral 1/3 of the clavicle (desc. F.)
- Acromion process of the scapula (trans.
- Scapular spine (ascending fibres)
Movement:
Desc. F.- Elevation of the shoulder girdle.
Trans. F. -retraction of the scapula).
Asc. F.-depression of elevated fibers
All parts together retracts scapulla
Desc. and asc. Parts rotate glenoid
cavity superiorly
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 In. - Spinal part of the accessory nerve,
cervical plexus (C3 and C4).
Latissimus dorsi
Fan shaped muscle that covers the back
O- Inferior angle of the scapula
- Spinous processes of thoracic vertebrae 7 -
12,
- Spinous processes of all the lumbar
vertebrae, sacrum, thoracolumbar
fascia ,(9th) 10th - 12th ribs by fleshy fibres
- iliac crest
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In. - thoracodorsal (Middle scapular) nerve
from the posterior cord of the brachial
plexus.
Action - Medial rotation, adduction and
retroversion (extension) of the
shoulder
- Raises the body during climbing
-Forms the posterior boundary of
the lumbar triangle and the inferior angle
of the triangle of auscultation. It forms the
posterior axillary fold together with teres
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major .
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Lumbar triangle:boundaries –
Ant.- external oblique
Floor – internal oblique
Post.- latissimus dorsi Inf. - iliac crest
Triangle of auscultation: a small triangular gap
near the inferior angle of scapula where heart
and lung sounds hear more clearly.
Boundaries –
Medial - trapezius Lateral - scapula
Inferior - Latissimus Floor -rhomboides major

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Rhomboid major
O - spinous process of Th2 - Th5 and
supraspinal lig.
I - medial border of the scapula
below the spine.
In. - dorsal scapular nerve
Action
- Elevation of the scapula

- Retraction of the shoulder

- Fixation of the scapula to the trunk.
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- Downward rotation of the scapula 222
 Rhomboid minor
O - spinous process of C7
- lower part of ligamentum nuchae
- spinous process of the Th1
I - Medial border of the scapula below
spine but above the insertion of
rmboid major
Inn. And action - Similar to rhomboid
major
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 MUCLES OF THE UPPER LIMB
Muscles of the arm
• The muscles of the arm are divided
in to extensors ( the posterior
compartment) and flexors ( anterior
compartment.
• Muscles of the same compartment
are similar in:
Their actions on the elbow joint
Innervation and development
Have the same covering fascia
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224
Flexor group of arm muscles
This group is composed of three
muscles,
namely biceps
brachii,coracobrachialis and
brachialis muscles

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Biceps brachii
O:Long head: supraglenoid tubercle and the
superior portion of the glenoid labrum.
Short head: lateral aspect of the apex of the
coracoid process of the scapula.
I:Radial tuberosity and the biceptal
aponeurosis.
In: Musculocutaneous nerve (C5, 6).
B/s: Muscular branches from the brachial
artery.
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02/21/2025 227
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Action
1. Flexion of the forearm at the elbow
Biceps brachii flexes the elbow with the
forearm supinated
2. Assists with flexion of the arm at the
shoulder
3. Assists with supination of the
forearm
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Coracobrachialis
O: apex of the coracoid process of the scapula.
I:Medial aspect of the mid shaft of the
humerus
In: Musculocutaneous nerve (C5, 6, 7).
B/ s:Muscular branches from the brachial
artery.
Action
1.Flexion of the arm at the shoulder
2.Assists with adduction of the arm at the
shoulder
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02/21/2025 230
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Brachialis
O:Lower half of the anterior aspect of humerus
I:Tuberosity and coronoid process of the ulna.
In: Musculocutaneous nerve (C5, 6).
B/s:Muscular branches from brachial artery and
radial recurrent artery from the radial artery. Action
Flexion of the forearm at the elbow
Flexor carpi radialis will contract during flexion of
the elbow against a heavy resistance and pronator
teres may also assist.

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Triceps brachii:
O:long head:Infraglenoid tubercle of the
scapula
Lateral head:posterior surface of
humerus, superior to radial groove
Medial head: Posterior surface of
humerus ,inferior to radial groove
I:Posterior surface of the olecranon
process of the ulna.
In: Radial nerve (C6, 7,8)
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B/s:muscularbranches,superiorulnarcollate
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Lateral head of
tricepts

Long head of
triceptis

Middle
head
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Action
Chief extensor of the forearm
Long head resists dislocation of shoulder
important during abduction.

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Anconeus
O:Posterior surface of the lateral epicondyle of
the humerus.
I; Lateral aspect of the olecranon, extending to
the lateral part of the ulnar body.
In: Radial nerve (C7, 8).
B/ s:Profunda brachii artery from the brachial
artery.
Actions
Anconeus is a weak extensor of the elbow,
stabilizes elbow joint, may abduct ulna during
pronation
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Anconeus

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 MUSCLES OF THE FORE ARM
Flexor-pronator muscles
Superficial layer
pronator teres m. Palmaris longus m.
flexor radialis m. Flexor carpi ulnaris m.
Intermediate layer
flexor digitorum superficialis
Deep layer
flexor digitorum profundus m
flexor policis longus m.
pronator quadratus
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Flexor-pronator muscles
Superficial layer

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• Pronator teres
O:Humeral head: superior portion of the
medial epicondyle via the common
flexor tendon.
Ulnar head: coronoid process of the
ulna.
I:Lateral aspect of the mid shaft of the
radius.
In:Median nerve (C6, 7).
B/ s:Muscular branches from the ulnar
and radial arteries.
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239
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2. Assists with flexion of the forearm at the
elbow. Pronator teres as well as flexor
carpi radialis only assists with flexion of the
elbow against a heavy resistance.
Flexor carpi radialis
O:Medial epicondyle of the humerus via the
common flexor tendon.
I:Base of the second and, sths. the third
metacarpal.
In:Median nerve (C6, 7).
B/s:Muscular
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 Action
1. Flexion of the wrist
Flexor digitorum superficialis, flexor digitorum
profundus, and flexor pollicis longus assist
with flexion of the wrist.
2. Assists with radial deviation of the wrist
Extensor pollicis longus and abductor pollicis
longus assist with radial deviation of the
wrist.
3. Assists with flexion of the forearm at the
elbow
Pronator
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242
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Palmaris longus
Fusiform muscle, may be absent
O: medial epicondyle of humerus
I:distal ½ of f.retinaculum and apex of
palmar aponeurosis.
In.: Median nerve
Action
Flexes hand at wrist joint and tenses
palmar aponeurosis.
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Flexor carpi ulnaris
O;Humeral head: medial epicondyle via
the common flexor tendon.
Ulnar head: medial aspect of the
olecranon and the proximal three- fifths
of the dorsal ulnar shaft.
I:Pisiform and hamate bones
Base of the fifth metacarpal
In:Ulnar nerve (C8, T1).
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B/s:Muscular branches from the ulnar
artery.
Action
1. Flexion of the wrist
Flexor digitorum superficialis, flexor
digitorum profundus, and flexor pollicis
longus assist with flexion of the wrist.
2. Ulnar deviation of the wrist
3. Helps to stabilize the wrist in order
to permit powerful thumb motion.
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246
Flexor digitorum superficialis
O:Ulnar head: medial epicondyle of humerus
via the common flexor tendon, medial border
of the base of the coronoid process of the
ulna, and ulnar collateral ligament.
Radial head: oblique line of the radius along
its supero-anterior border.
I:shaft of each middle phalanx of the four
digits via a bifurcated tendon.
In:Median nerve (C7, 8, T1).
B/S:Muscular brs. from ulnar and radial
arteries.
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Action
1.Flexion of the digits at the proximal
interphalangeal joints
2. Assists with flexion of the digits at
the metacarpophalangeal joints
3. Assists with flexion of the wrist
Flexor pollicis longus and flexor
digitorum profundus assist with
flexion of the wrist.
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 Flexor digitorum profundus
O:Anteromedial surfaces of the superior three-
quarters of the ulna and adjacent
interosseous membrane.
I: bases of the distal phalanx of the four digits
(travels through a split in the tendon of flexor
digitorum superficialis).
In: Medial portion: ulnar nerve (C8, T1).
Lateral portion: anterior interosseous
branch of median nerve (C8, T1).
B/s:Muscular branches and the anterior
interosseous
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artery from the ulnar artery and
250
muscular branches from the radial artery.
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02/21/2025 251
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Actions
1. Flexion of the digits at the proximal
interphalangeal joints
2.Flexion of the digits at the distal
interphalangeal joints
3. Assists with flexion of the digits at
the metacarpophalangeal joints
4.Assists with flexion of the wrist
Flexor pollicis longus and flexor digitorum
superficialis also assist with flexion of
the wrist.
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Flexor policis longus
Long flexor of the thumb,lies lateral to FDP
O:anterior surface of radius and adjacent
interosseous membrane
I:base of distal phalanx of thumb
In: anterior interosseous nerve, from median
nerve
Action
Flexes the distal phalanx of the thumb
Flexes the proximal phalanx and the first
metacarpal bone
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Pronator quadratus
O:Distal one-fourth of the anteromedial
surface of the ulna.
I:Distal one-fourth of the anterolateral
surface of the radius.
In: Anterior interosseous branch of the
median nerve (C8, T1).
B/S:Muscular branches from the radial
artery and the anterior interosseous artery
from the ulnar artery.
Action
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1.
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Pronation of the forearm (Anim)
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EXTENSOR MUSCLES OF THE FORE
ARM
Are in the posterior(extensor –supinator)
compartment.
All are innervated by branches of radial nerve
Are organized in to 3 functional groups
1.Mm. that extend and abduct or adduct the hand at
the wrist joint
extensor Carpi radialis longus
extensor Carpi radialis brevis
extensor Carpi ulnaris
2.Mm. that extend the medial 4 digits(extensor
digitorium,extensor indicis, extensor digiti minimi
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3.Muscles that extend or abduct the
thumb
abductor policis longus
extensor policis longus
extensor policis brevis
The extensor tendons are held together
at the wrist by the extensor
retinaculum, which prevents bow
stringing of the tendons when the hand
is extended at the wrist joint.
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Extensor mm. are organized
anatomically in to:
Superficial extesnsors
ECRB Originated from
lateral
ED epicondyle by
common
EDM Extensor origin
ECU
Brachioradialis originate from lateral
supra
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Brachioradialis
O:Upper lateral supracondylar ridge of the
humerus (between triceps brachii and
brachialis).
I:Superior aspect of the styloid process and
the lateral side of the distal radius.
In: Radial nerve (C5, 6).
B/s:Radial recurrent artery from the radial
artery.
Action
1. Flexion of the forearm at the elbow
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Flexor Carpi radialis will contract during
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Flexor-pronator muscles
Superficial layer

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Extensor carpi radialis longus
O:Lower lateral supracondylar ridge (below
brachioradialis).
I:Dorsal surface of the base of the second
metacarpal.
In:Radial nerve (C5, 6).
B/ s;Radial recurrent artery from the radial
artery.
Actions
1. Extension of the wrist
2.
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Extensor Carpi radialis brevis
O:Lateral epicondyle of the humerus via
the common extensor tendon and the
radial collateral ligament of the elbow.
I:Dorsal surface of the base of the third
metacarpal.
In:Radial nerve (C6, 7).
B/s:Radial recurrent art. from the radial
artery
Actions
1. Extension of the wrist
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Extensor digitorum
O:Lateral epicondyle of the humerus via
the common extensor tendon.
I:Main attachment: dorsal aspect of the
base of the proximal phalanx of each of
the four digits.
Central slip: dorsal aspect of the base of
the middle phalanx of each of the four
digits.
Lateral bands: via two slips to the
dorsal aspect of the base of distal
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 Actions
1.Extension of the digits at the
metacarpophalangeal (mcp) joints
2.Extension of the digits at the proximal
interphalangeal joints when mcp joints
are flexed
3. Extension of the digits at the distal
interphalangeal joints when mcp joints are
flexed
4.Assists with extension of the wrist with
digits flexed at the metacarpophalangeal
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Extensor digiti minimi
O:Lateral epicondyle of the humerus via
the common extensor tendon and the
ulnar aspect of extensor digitorum.
Is: via two slips to the dorsal surface of
the base of the distal phalanx of the fifth
digit.
In:Radial nerve (C6, 7, 8).
B/s:Posterior interosseous artery from the
ulnar artery.
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Actions
1.Extension of the fifth digit at the proximal
interphalangeal joint
2.Extension of the fifth digit at the distal
interphalangeal joint
3.Assists with extension of fifth digit at the
metacarpophalangeal joint
4.Assists with abduction of the fifth digit at
the carpometacarpal joint
5.Assists with extension of the wrist
Extensor digitorum and extensor pollicis
longus also assist with extension of the
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Extensor carpi ulnaris
O:from the common extensor origin
I:Tubercles on the medial side of the base
of the fifth metacarpal.
In:Radial nerve (C6, 7, 8).
B/s:Posterior interosseous artery from the
ulnar artery.
Actions
1. Extension of the wrist
Extensor digitorum, extensor digiti
minimi, and extensor pollicis longus
assist with extension of the wrist.
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Supinator
O:Lateral epicondyle of the humerus, the
radial collateral ligament, the supinator
crest of the ulna, and annular
ligaments.
I:Proximal portion of the anterolateral
surface of the radius.
In:Radial nerve (C6, 7, 8).
B/s:Radial recurrent artery from the radial
artery.
Action
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02/21/2025 272
10:27:13 PM
EXTENSOR INDICIS
O:posterior surface of distal third of ulna
I:Extensor expantion of second finger
In:posterior interosseous
nerve(c7,c8),C0ntinuatin of deep
branch of radial nerve.
Action
Extends second finger, helps extend
hand at wrist

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Abductor pollicis longus
O:Posterior surfaces of the ulna and
the radius and the interosseous
membrane.
I:Lateral aspect of the base of the
first metacarpal.
In:Radial nerve (C6, 7, 8).
B/s:Posterior interosseous artery
from the ulnar artery.
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275
Actions
1. Radial abduction of the thumb at
the trapeziometacarpal joint
2. Extension of the thumb at the
carpometacarpal joint
3. Assists with extension of the thumb
at the metacarpophalangeal joint
4. Assists with radial deviation of the
wrist
Extensor pollicis brevis may also assist
with radial deviation of the wrist.
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Extensor pollicis longus
O:Post. surface of the ulna and the
i.osseous membrane.
I:Distal phalanx of the thumb.
In:Radial nerve (C6, 7, 8).
B/s:Post. interosseous art. from the ulnar
art.
Action
1.Extension of thumb at the
interphalangeal jt.
2. Assists with extension of the thumb
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Extensor pollicis brevis
O:Post. surface of distal third of the
radius and the i.oss. memb.
I:proximal phalanx of the thumb.
In:Radial nerve (C6, 7, 8).
B/s:Post. interosseous artery from the
ulnar art.
Actions

1. Extension of the thumb at the CMC

joint
2. Assists with extension of the thumb
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02/21/2025 280
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 THE HAND
The hand is the distal part of the
upper limb.
It is a sensory and motor instrument
capable of a very wide range of
activities
The activities of the hand can be
divided into 3:
1.Power grip
2.Precision handling
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3.Pinch
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02/21/2025 282
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 Power grip
Power grip is the forcible motion of
the fingers and the thumb acting
against the palm
The motion transmits force to an
object and, in contrast to free
motion, is static and isometric.
The hand conforms to the shape and
size of the object. To do this
phalangeal rotation abduction and
adduction may be required, e.g.
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• Precision handling:
• Involves a change in position of a
handled object either in space or about
its own axes.
• It is dynamic and isotonic and mostly
involves two basic modes of handling.
1.Precision rotation – involving the
thumb and other fingers that rotate an
object about one of its internal axes,
e.g. winding a watch.
2.Precision translation – the moving of an
object
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284
284
• pinch –
• Is compression of an object between
the thumb and index finger or
between the thumb and the two
adjacent fingers. it is primarily a
static and isometric activity. e.g.,
handling a tea cup, holding a coin...

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Muscles of the hand
Short mm. of the hand are divided in to
3 groups.
Thenar, hypothemar and Intrinsic
mm.
1. Thenar muscles
These form ball of the thumb which is a
fleshy mass on the lateral sides of the
palm.
To this belong:
1. Abduuctor pollicis brevis
2.
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pollicis brevis 286
286
 Opponens
pollicis

Abductor
pollicis
brevis
Flexor
policis
brevis

Adducto
r policis
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These four muscles are arranged in
3 layer.
Superficial layer
- Abductor pollicis brevis
- Superficial part of flexor
pollicis brevis
Middle layer - Opponens pollicis
Deep layer- Deep part of flexor
pollicis brevis
- Adductor pollicis
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These muscles arise from the carpal
bones and some of them
additionally from the flexor
retinuculum
Inserted to the base of the proximal
phalanx of the thumb with few
exceptions.
Their action corresponds to their
names
All of them are innervated by
median nerve except, those that
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form the deep layer (adductor
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2. Hypothenar muscles
(Antithenar)
They form the hypothenar
eminence or prominence, which is
a fleshy mass on the medial side of
the palm composed of 4 mm.
1. Palmaris brevis
2. Abductor digiti minimi
3. Flexor digiti minimi brevis
4. opponens digiti minimi
Their action corresponds to their
All of them are innervated by ulnar
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names
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 Abductor digiti minimi

Flexor digiti
minimi

Opponens
digiti minimi

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 3. Intrinsic muscles of the hand
This group consist of:
1. Lumbricales (4) 3. Dorsal
Interosssei (4)
2. Palmar Interossei (3)
Lumbricales
O- tendon of the FDP.
The radial two lumbricales arise
by one head from the radial side of
the lateral two tendons of F.D.P. The
ulnar two lumbricales arise by two
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292
292
1st and 2nd 3rd and 4th
lumbricales lumbricales(bi
penate)
(unipenate)

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I:Each to the radial surface of the
extensor apparatus of the same
digits as the tendons of origin.
In:First and second lumbricals:
median nerve (C8, T1).
Third and fourth lumbricals: ulnar
nerve (C8, T1).
B/ s:Deep palmar arch of the radial
artery

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Action
1. Flexion of the digits at the
metacarpophalangeal joints
2. Assists with extension of the digits
at the proximal interphalangeal joints
3. Assists with extension of the digits
at the distal interphalangeal joints

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Palmar interossei
O:Ulnar aspect of the palmar
surfaces of the second metacarpal
and radial aspect of the palmar
surface of 4th and 5th
metacarpals.
I:Ulnar aspect of the base of the
proximal phalanx and extensor
apparatus of the second digit and
the radial aspect of the base of the
proximal phalanx and extensor
apparatus of the fourth and fifth
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 Palmar
interosseous
(unipannate)

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 Action
1. Flexion of the digits at the
metacarpophalangeal joints
2. Assists with adduction of the
digits at the metacarpophalangeal
joints
3. Assists with extension of the
digits at the proximal
interphalangeal joints
4. Assists with extension of the
digits at the distal interphalangeal
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02/21/2025 299
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 02/21/2025

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Dorsal interossei (of hand)
O:Each by two heads, to the adjacent
sides of the metacarpals in each
interspace. The first lying between the
1st and 2nd , the 2nd between the 2nd
and 3rd , the 3rd between the 3rd and
the 4th, and the 4th between 4th and
5th metacarpals.
I:The base of the proximal phalanx . The
1st dorsal interosseous attaches to the
radial side of the thumb, the 2nd
attaches to the radial side of the 2nd
digit,
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the 3rd attaches to the ulnar side
301
301
Dorsal
interosseo
us(bipenna
te)

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In:ulnar nerve (C8, T1).
B/s:Deep palmar arch of the radial
artery.
Primary action
1. Flexion of the digits at the MCP
joints
2. Assists with abduction of the digits
at the MCP jts with axis of rotation
running through 3rd digit
Extensor digitorum may also assist with
abduction of the digits at the MCP
joints.
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3.
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Assists with extension of the digits
303
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 Joints of the shoulder
girdle
I. Sternoclavicular joint
A. Articulating surfaces
Clavicular notch of the sternum
Articular facet of the sternal end of the
clavicle
Articular disc (oval fibro cartilaginous disc)
B. Articular capsule - is wide and attached to the
margins of the articular
surface and
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C. Ligaments
1. Anterior and posterior
sternoclavicular ligaments –reinforce
the joint anteriorly and posteriorly.
2. Internoclavicular ligament –
strengthen the joint capsule
superiorly.
3. Costoclavicular ligament -helps to
prevent the upward displacement of
the clavicle and dislocation of the
sternoclavicular joint.
D. Axes
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- it is a multiaxial saddle joint
307
02/21/2025 308
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• E. Movements
• 1. On the sagittal axis - elevation of
the shoulder (600) and
depression (only 100) of the elevated
shoulder.
• 2. On vertical axis - Forward and
backward movement of the
shoulder(200 - 00 - 200).
• 3. On the longitudinal axis - rotation
of the clavicle, which is
associated with
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movement of the scapula on the
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 II. Acromioclavicular joint
Articulating surfaces(facets)
an incomplete articular disc is
usually found between the two
surfaces.
Articular capsule - is wide and
attached to the margins of the
articular surfaces.
Ligaments
Acromioclavicular ligament -It
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310
02/21/2025 311
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Coracoclavicular ligament: It has
two parts:
Conoid ligament - the medial
inverted shaped part of the
coracoclavicular ligament.
Trapezoid ligament - is the lateral
quadrilateral part of the
coracoclavicular ligament
The coracoclavicular ligament
prevents the upward displacement of
the clavicle and dislocation of the
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acromioclavicular joint.
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The Shoulder (Glenohumeral) joint
Articular surfaces
Glenoid cavity of the scapula and head of the
humerus.
Both the articulating surfaces are covered by
hyaline cartilage.
The glenoid cavity can receive only 1/4 - 1/3 of
the head of the humerus
The cavity is widened and slightly deepened
by a lip of fibrocartilage the glenoidal labrum.
.
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02/21/2025 314
10:27:15 PM
Articular capsule - is very wide
Attachment
superiorly : to outer part of the
glenoidal labrum,
Inferomedially :to surgical neck and
inferolaterally : to anatomical neck
of humerus.
It is reinforced only anteriorly by the
coracohumeral ligament.
In the intertubercular sulcus the capsule
covers the tendon of the long head of
biceps forming the intertubercular
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synovial
10:27:15 PM sheath.
• Ligaments
• Coracohumeral lig. - extends from
coracoid process to greater and lesser
tubercles. It reinforces the superior part
of the capsule
• Glenohumeral ligs. (Sup., middle and inf.)
• they extend between the glenoid labrum
and the anatomical neck of the humerus.
• Transverse humeral ligament -holds the
long head of biceps in the groove.
• Coracoacromial ligament - forms a fibrous
arch roofing the shoulder joint. It also
02/21/2025 316
prevents
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Bursae -
1. Communicating bursae
a. Subacromial bursa b. Subcoracoid bursa
c. Subtendinous bursa of subscapularis m.
2. Non-communicating bursae
a. Subdeltoid bursa
b. Subcutaneous acromial bursa
The subdeltoid bursa may sometimes
communicate with the synovial cavity through
the subacromial bursa.

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Axes –multiaxial(ball-and-socket)
Movements
On the sagittal axis
- Abduction - 00 - 900,
-Adduction-0-20
On the transverse axis
- Flexion (anteversion) - 00 - 1000
- Extension (Retroversion) - 00 - 300

3. On the longitudinal axis –

Medial rotation 00-700
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• The movements at the shoulder joint are usually
associated with movements of the clavicular

joints thereby increasing the range of

movement, that is:

• Abduction - Adduction : 1800 - 00 - 400

• Flexion - Extension : 1800 - 00 - 400
• Medial rotation - Lateral rotation :
• The stability of the shoulder joint is assisted by
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321
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10:27:15 PM
• The shoulder joint is one of the most common sites
of dislocation or subluxation in our body. When it

occurs the dislocation is usually in a distal

direction(inferiorly)..

• There are three factors that make the shoulder joint

the most common site of dislocation (subluxation).

• The small contact area between the articular

surfaces
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323
 ELBOW JOINT
A synovial joint of hinge variety
There are three joints in the
elbow region,
1, Humeroulnar joint
2, Humeroradial joint
3, Proximal radioulnar joint
The three joints have a common
capsule & they share a single
synovial cavity , due to this they
are considered together as a
single joint.
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• Articular Capsule
- covers the articulating parts
including the olecranon , coronoid
& radial fossa of the humerus. It
doesn’t cover the epicondyles.
- around the neck of the radius it
forms an outpocketing called
sacciform recess of elbow joint.

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02/21/2025 327
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- A transverse line passing 2-3cm
below the epicondyles indicates the
level of humeroulnar & humeroradial
joints.
Articular surfaces
1, Trochlea of humerus & trochlear
notch of ulna.
2, capitulum of humerus & articular
fovea of head of radius.
3, Articular circumference of the
head of the radius & radial notch
of the ulna.
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Humeroulnar Joint
main joint of the elbow which is
hinge in type. ( uniaxial )
formed b/n trochlea of the
humerus & trochlear notch of
the ulna.
Movement - flexion & extension.

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Humeroradial Joint
- with regard to the articulating
surfaces it is ball & socket type
of joint. But functionally it is
hinge in type.
- From an extended position
( called in orthopedics 0 or Zero
position ) a flexion of 140 * is
possible , Degree of flexion
depends on muscle volume of
the arm & forearm.
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- In the extended arm the tips of
olecranon & the two epicondyles
lie in a straight line ( Hueter’s
line ).
During flexion of the arm to 90º
they form an equilateral triangle.
Most often there is a
subcutaneous bursa on the
olecranon. This bursa may be
inflammed by repeated trauma
resulting in olecranon bursitis
( students elbow or miner’s
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– Relations of elbow joint
-Anteriorly - Brachialis , median
nerve , brachial aa , tendon of
biceps.
-Medially- ulnar nerve , flexor
carpi ulnaris , common flexor
origin.
-Posteriorly - triceps & anconeus
-Laterally - Supinator , extensor
carpi radialis brevis , & other
common extensors.
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 RADIOULNAR JOINTS
1, Proximal-(pivot joint)
- Articular surfaces
- articular circumference of
head of radius
- radial notch of ulna
Ligaments
-radial collateral -annular
-quadrate
Articular capsule -similar to elbow
joint
Movement
-pronation
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& supination 336
• 2, Distal radio ulnar
- Articular surfaces
- ulnar notch of radius
- articular circumference of
head of ulna.
• Articular Capsule
- Is wide & attached at the
boundary b/n the bones & their
articular cartilage above & to
the margins of the articular disc
below.
- part of the capsule extends
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02/21/2025 338
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02/21/2025 339
10:27:15 PM
• Ligament
- Interosseous membrane connects
the interosseous border of radius
& ulna.
- keeps pressure balance b/n
radius & ulna.
- prevents friction / rubbing b/n the
bones
- sometimes referred as middle
radioulnar joint
- In its upper 1/3 it is
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10:27:15 PM
 – Axis of movement
-Uniaxial pivot joint , axis runs
diagonally from the center of the
head of radius proximally to the
middle part of the head of the ulna
distally.
– Movements
-supination
-pronation
-The ‘O’ position during pronation &
supination movements is when the
transverse axis of the forearm lies
in sagittal plane.
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341
02/21/2025 342
10:27:15 PM
• Applied Anatomy
-In cases of forearm fracture POP
casts should be applied in a
supinated position.
3. RADIOCARPAL JOINT ( Proximal
wrist jt )
• synovial joint of the ellipsoid variety.
• Articular surfaces
• Upper - inferior surface of the lower
end of the radius & articular disc of
the inferior radioulnar joint.
• Lower - the three proximal carpal
bones;
-scaphoid
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• Articular capsule
- Surrounds the joint & is
attached above to the lower ends
of radius & ulna & below to the
proximal row of carpal bones.
- Is wide , thin & is strengthened by
ligaments in its palmar , dorsal &
lateral aspects.
• Ligaments
• Anterior ( palmar radiocarpal )
• Strong band directed to medially
& downwards from radius to
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lunate bone.
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 Posterior ( dorsal
radiocarpal )
Is weaker than the anterior
ligament, is directed downwards &
medially to lunate bone.
Lateral ( radial collateral )
-Extends from styloid process of the
radius to the lateral side of the
scaphoid bone.
- Medial ( ulnar collateral )
- Extends from styloid process of
the ulna to the triquetral & pisiform
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Relations - Anterior – long flexor
tendons with their synovial sheath
& median nerve.
- Posterior - extensor tendons of
the wrist & fingers with their
sheath.
- Lateral - radial artery.
Blood Supply
-Anterior & Posterior carpal arches
Nerve Supply
-Anterior & posterior interosseous
nerves
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• Movements
1, A transverse radioulnar axis passing
through lunate bone.
-Palmar & dorsal flexion both for 90*
from ‘O’ position
2, A sagittal dorsopalmar axis passing
through capitate bone.
-Abduction ( radial deviation ) for ~15*
-Adduction ( ulnar deviation ) for ~45*
from ‘O’ position.
flexion is usually combined with
adduction
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347
10:27:15 PM
MIDCARPAL ( Distal wrist ) JOINT
A jt b/n distal & proximal row of carpal
bones
Articular cavity is S- shaped , due to
the downward projection of scaphoid
from the proximal row & upward
projection of capitate from distal
row.
Articular capsule
attached at the transition b/n bones
& their articular cartilage.
Axes & movement
02/21/2025 348
- as in radiocarpal joint
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02/21/2025 349
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Movements
-Adduction, abduction, opposition,
reposition.
-Opposition is the combined
movement of abduction, flexion,
adduction which can be done with
in a range of 50-60º.
- It is most important joint in the
hand , the loss of the thumb carries
a function loss of ~25 % in the
hand.
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02/21/2025 351
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JOINTS OF THE FINGERS
-All the fingers except the thumb
contain the ff joints.
1. Metacarpophalangeal joint
between the metacarpal and
proximal phalanx.
2. Proximal interphalangeal joints
- between proximal and middle
phalanx.
3. Distal interphalangeal joints
- between the middle and distal
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352
02/21/2025 353
10:27:16 PM
 Brachial plexus

• The brachial plexus is mainly formed by the

ventral rami of the spinal nerves C5 - C8 and
Th1, but sometimes C4 and Th2 may also
contribute.
• If the contribution of C4 is larger than that of
Th2, then the plexus C4 - Th1 is known as
prefixed and if the contribution of Th2 is
larger than that of C4, the plexus thus
formed by C5 - Th2 is called post-fixed.
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10:27:16 PM
• The brachial plexus passes through the
scalene gap and enters the axilla through
the cervicoaxillary canal behind the clavicle.
Therefore supraclavicular and
Infraclavicular parts can be distinguished.
• In the supraclavicular part the three trunks
of the brachial plexus are formed.
1. Upper (superior) trunk - formed by roots
from C5 and C6
2. Middle trunk - formed by the root from C7
3. Lower (inferior) trunk - formed by roots
from C8 and Th1
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02/21/2025 356
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• After passing between the clavicle and the
first rib it becomes the infraclavicular part
where the trunks branch in to ventral and
dorsal divisions and the divisions of the
three trunks fuse with each other to form
three cords or fasciculi.
• The dorsal divisions of all the three trunks
form the posterior cord.
• The ventral divisions of the upper and
middle trunks form the lateral cord whereas
the ventral division of the lower trunk forms
the medial
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cord.
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10:27:16 PM
357
357
• These three cords (posterior, lateral and
medial) give the following branches to the
shoulder girdle, the arm and forearm and
extend.
1. Posterior cord - axillary and radial nerves
2. Lateral cord - musculocutaneous nerve
and lateral root of median nerve.
3. Medial cord - ulnar nerve, medial root of
median nerve, medial cutaneous nerve of
the arm (medial brachial cutaneous nerve) and
the medial cutaneous nerve of the forearm
(medial antebrachial cutaneous nerve).

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 Branches of the brachial plexus to the

shoulder girdle
• All the branches of the brachial plexus to
the shoulder girdle are motor nerves except
the axillary nerve that has both motor and
sensory components.
• To these nerves belong:
1. Dorsal scapular nerve (C4 & C5 mainly
from C5) - passes through the scalenus
medius muscle and innervates the levator
scapulae, and rhomboid major and minor.
. It runs in the direction of the scapula 359
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under the rhomboid muscles.
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02/21/2025 360
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2. Long thoracic nerve (C5, C6 & C7) - It also
passes through the scalenus medius
muscle and descends dorsal to the
brachial plexus and the first part of the
axillary artery along the midaxillary line to
the serratus anterior muscle.

. In its paralysis the arm can not be

elevated in addition to the appearance of a
clinical condition known as winged
scapula (this is a condition where the
medial border of the scapula protrudes
away from the thoracic wall).

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3. Nerve to subclavius or subclavius nerve (C5) -
innervates the subclavius muscle and the
sternoclavicular joint.
. Frequently it contributes fibres to the
phrenic nerve as accessory phrenic nerve.
4. Medial pectoral (C8 & Th1) and lateral pectoral
(C5 - C7) - innervate the pectoralis major and
minor muscles.
5. Suprascapular nerve (C5 & C6) - it is the upper
most branch of the trunk of the brachial
plexus running with the suprascapular
vessels to reach the supra- and infraspinatus
muscles.
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• In its paralysis the scapular spine
becomes prominent and the lateral
rotation of the shoulder joint is affected.
6. Subscapular nerves (C5 & C6) - they are
two in number
a. Upper (superior) subscapular - small
and enters the upper part of subscapularis
muscle and teres minor muscle.
b. Lower (inferior) subscapular -
innervates the lower part of subscapularis
muscle
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and teres major muscle. 363
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10:27:16 PM
7. Thoracodorsal nerve (C6 - C8) - also
referred to as middle Subscapular nerve
for it arises from the posterior cord
between the upper and lower Subscapular
nerves.
. It runs with the thoracodorsal vessels to
the latissimus dorsi muscle.
8. Axillary or circumflex nerve (C5 & C6) - it
runs through the quadrangular space
being related to the surgical neck of the
humerus. Therefore it can be injured by
fracture of the surgical neck, subluxation
of the
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shoulder
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10:27:16 PM
and by a crutch pressing
364
364
 . It gives a motor supply to the deltoid and
teres minor muscles.
. Its paralysis results in the atrophy of
these muscles and loss of sensation in the
lower half of the deltoid region.
. The paralysis and atrophy of the deltoid
muscle results in a prominent greater
tuberosity and impairment of abduction of
the arm.
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10:27:16 PM
 Branches of the brachial plexus to the arm
• The brachial plexus gives six branches to the
arm. Out of the six two of them are cutaneous
sensory nerves and four of them are mixed
nerves.
a. Cutaneous nerves as direct branches of the
brachial plexus
1. Medial cutaneous nerve of the arm or
medial brachial cutaneous nerve (C8 & Th1)
2. Medial cutaneous nerve of the fore arm
or Medial antebrachial cutaneous nerve (C8 &
Th1)
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b. Mixed branches
1. Musculocutaneous nerve (C5 - C7)
2. Median nerve (C6 - Th1)
3. Ulnar nerve (C7 - Th1)
4. Radial nerve (C5 - C8)

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 Classification of branches of the
brachial plexus
• Branches of the brachial plexus can be
classified with reference to the clavicle as
branches from the supraclavicular part
and branches from the infraclavicular part
or on the basis of the different parts of the
brachial plexus as branches from the
roots, from the trunks and from the cords.

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1. Classification with reference to the clavicle
A. Branches from the supraclavicular part
1. Subclavius nerve
2. Dorsal scapular nerve
3. Suprascapular nerve
4. Long thoracic nerve
B. Branches from the infraclavicular part
1. Branches to the shoulder girdle
a. Medial and lateral pectoral nerves
b. Subscapular nerves
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c. Thoracodorsal nerve 369
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10:27:16 PM
 2. Branches to the arm
a. Musculocutaneous nerve
b. Median nerve
c. Ulnar nerve
d. Medial brachial cutaneous nerve
e. Medial antebrachial cutaneous nerve
f. Radial nerve
g. Axillary nerve

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2. Classification on the basis of their origin
from the parts of the brachial plexus.
A. Branches from the roots
1. Dorsal scapular (C4 & 5)
2. Long thoracic (C5, 6, 7)
B. Branches from the trunks
1. Suprascapular nerve - upper
trunk
2. Subclavius nerve - upper trunk
• Sometimes medial pectoral from the lower
trunk and lateral pectoral nerve from the
anterior division of the upper and middle
trunk
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of the brachial
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10:27:16 PM plexus. 371
371
 C. Branches from the cords
1. From the lateral cord
a. Lateral pectoral
b. Musculacutaneous
c. Lateral root of median
2. From the posterior cord
a. Upper subscapular
b. Thoracodorsal (Middle subscapular)
c. Lower subscapular
d. Radial
e. Axillary
f. Articular
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 3. From the medial cord
a. Medial pectoral
b. Medial brachial cutaneous
c. Medial antebrachial cutaneous
d. Ulnar
e. Medial root of median

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Injuries to Brachial plexus
The brachial plexus becomes
completely paralysed only in severe
injuries but usually some parts of it are
injured. Its injury that frequently occurs
during delivery is called brachial birth
paralysis. Three types of such paralysis
are recognised
1. Whole arm paralysis
2 Erb’s palsy of the arm and
3 Klumpke's paralysis of forearm.
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 Erb’s Duchenne paralysis or
palsy
It is due to injury to nerves arising
from C5 and C6 (upper trunk).
Musculocutaneous n, axillary n
suprascapular n ,n to subclavius are
injured
Is the most common type of brachial
plexus injury. Characterised by
paralysis and atrophy of the deltoid,
flexor muscles and the long
supinator muscles of the arm, in
which case flexion and supination
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 The arm and hand then assume the
Waiter's tip position (a medial
rotated upper limb hanging by the
side), sensation is lost over the deltoid
and radial side of the forearm and
hand.
The injury is usually caused by traction
during delivery and in adults from
excessive separation of the head from
the neck.
Klumpke’s paralysis (Dejerine
klumpke’s syndrome) :
Injuries to the lower segments C8 and
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Manifested by:
paralysis of the small muscles of the
hand and flexors of the wrist (claw
hand) and loss of sensation on the skin
area innervated by ulnar n.
Causes: Birth trauma or cervical rib .
It causes atrophic paralysis of the
forearm muscles and small muscles of
the hand associated with paralysis of
cervical and arm sympathetic
innervation( results in oedema of the
skin, cyanosis and atrophic nail changes).
It02/21/2025
can be associated
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10:27:16 PM
with the injury of the
377
377
• Brachial plexus can also be injured by
compression e.g. crutch paralysis,
Saturday night palsy, etc.
If C7 (middle trunk) is involved it leads to
the paralysis of triceps, weakness of the
extensors of the wrist and fingers. This
weakness of the extensors of the wrist
and the fingers results in wrist drop of
radial nerve type.

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• Signs of single nerve involvement
Long thoracic (C5-7) - paralysis of
serratus anterior, which causes
“winging” of the scapula when the arm
is extended and pressed against a fixed
object in front of the patient and
difficulty of raising the arm above the
horizontal plane.
Suprascapular nerve (C5 &6) -
Paralysis of supra- and infraspinatus
muscle leading to subluxtion of
the shoulder joint. Patients with such
02/21/2025 379
paralysis
10:27:16 PM will have difficulty of lifting
02/21/2025 10:27:16 PM 379
 Dorsal scapular nerve (C5)
• Paralysis of the rhomoides. The scapula
becomes slightly winged and can not be
drawn close to the vertebral column.
• Thoracodorsal nerve (C7& 8) -
• Paralysis of the latissimus dorsi with
weakened adduction and medial rotations
of the arm
• Lateral (C5-C7) and medial (C8 & Th1)
pectoral nn. Injury results in paralysis of
the pectoralis mm. The force of
adduction
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in the arm is lost and the 380
patient is unable to touch the opposite
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10:27:16 PM
• Musculocutaneous nerve (C5 -C7) –
• Motor part - innervates flexors of the
arm such as coracobrachialis, biceps and
brachialis. After passing through the
corachbrachialis it runs between the
biceps and brachialis muscles to the
elbow where it terminates.
• Sonsory - it gives supply to the radial
side of the forearm up to the thenar
eminence, by a branch called lateral
cutaneous nerve of the forearm.
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Paralysis-paralysis of flexors of the arm
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10:27:16 PM 381
02/21/2025 382
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10:27:16 PM
 Median nerve (C6-Th1)
• Innervates all the flexors of the forearm
except FCU and the ulnar two heads of
FDP.It arises from the lateral cord of the
br. plexus by its lat. root and from
medial cords by its med. root .
• These two roots unite on the ventral
surface of the axillary artery to form the
median nerve.
• In the arm it lies lateral to the brachial
artery and in the elbow it lies medial to
the artery. By passing under the biceptal
aponeurosis it runs through the space
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02/21/2025 384
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.
By passing under the biceptal aponeurosis it
runs through the space between the two heads
of pronator teres m. with the ulnar artery to
enter the flexor compartment of the forearm.
Here it lies between FDS and FDP.
In the lower 1/3 of the forearm it runs on the
medial (ulnar) side of the tendon of FCR
muscle and in the wrist between the tendons of
FCR and palmaris longus then enters the palm
through the carpal tunnel.
In the palm it divides in to its three terminal
branches called the common palmar digital
nerves
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385
385
10:27:16 PM
02/21/2025 386
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10:27:16 PM
• The proper palmar digital nerves run on
both sides of the 1st - 3rd fingers and only
on the radial side of the 4th finger. In the
hand gives a motor Innervation to the 1st
and 2nd lumbricals and thenar muscles
with the exception of adductor pollicis
and deep head of flexor pollicis branches
• Branches of median nerve in the
forearm
• no branch in the arm.
articular branches - sensory supply to
elbow
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joint
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10:27:16 PM
387
387
 . Palmar branch - gives a sensory supply
to the thenar eminence and radial side of
the palm.
• Recurrent branch - arises in the carpal
tunnel and supplies the thenar muscles
(APB), opponens pollicis and superficial
part of FPB.
• Branches of the median nerve in the
hand
• Communicating branch - connects the
median nerve to the superficial branch of
the ulnar nerve.
• Common
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palmar digital
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10:27:16 PM nerves- 388
388
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02/21/2025 390
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• Applied Anatomy of the median
nerve
• Paralysis of the median nerve
(supracondylar fracture of the humerus)
results in :
• Restricted pronation and flexion of the
forearm.
• The proximal and distal interphalangeal
joint of 1st - 3rd fingers remain extended
(due to paralysis of FPL and radial parts
of the FDP).
• Due to the paralysis of the FDS the
flexion
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at the metacarpophalangeal
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10:27:16 PM and
391
391
 Abduction of the thumb is absent
due to paralysis of abductor
pollicis. With this defect when the
patient tries to make a fist the
radial three fingers remain
extended resembling an Ape like hand
or obstetrician’s examining hand.

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• Ulnar nerve
• Arises from the medial cord of the
brachial plexus and runs medial to the
brachial artery until half way down the
arm and then pierces the medial
intermuscular septum in order to pass to
the extensor side. Then it descends
through the ulnar sulcus of the humerus.

• Through the space between the two

heads of the flexor Carpi ulnaris it runs
back to the flexor side of the forearm.

• In this part it runs with ulnar artery under

02/21/2025 393

the cover of the FCU muscle to reach the

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10:27:16 PM
02/21/2025 394
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02/21/2025 395
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10:27:17 PM
• . In the palm it divides in to deep
and superficial branches.
• proximal to the wrist, it divides in to:
• Palmar cutaneous branch - for the
sensory supply of the ulnar side of
the palm and divides in to two
common palmar digital nerve which
give rise to 3 proper palmar digital
nerves. These supply the palmar side
of the 5th and a half of 4th fingers and
their dorsal sides distal to proximal
interphalangial joint.
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10:27:17 PM
• Dorsal branch- it runs on dorsal side
between the flexor Carpi ulnaris and the
ulna, where it divides in to dorsal digital
nerves, which give sensory supply to the
dorsal side of the ulnar 11/2 fingers up to
their proximal interphalangeal joints.

• Usually the dorsal branch of ulnar nerve

and the superficial radial nerve are
interconnected by means of a
communicating branch.
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10:27:17 PM
02/21/2025 398
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10:27:17 PM
02/21/2025 399
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10:27:17 PM
 Branch of ulnar nerve in the palm
Deep branch - it is a motor branch
innervating all the hypothenar muscles,
the palmar and dorsal interosseous
muscles, the 3rd and 4th lumbricales,
adductor pollicis and deep head of flexor
pollicis brevis muscles.
Superficial branch- is motor nerve to
Palmaris brevis. It runs under the palmar
aponeurosis and divides in to comon
palmar digital nerves which gives rise to
the proper palmar digital nerves for the
sensory
02/21/2025 supply of the fingers (to the 400
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5th
400
10:27:17 PM
th
02/21/2025 401
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10:27:17 PM
The ulnar nerve may be injured in the
ulnar sulcus of the humerus by
longstanding pressure or fracture of the
medial epicondyle. This manifests by the
paralysis of the interossei muscles.
Normally these muscles flex at the MCP
joints and extend the interphalangeal
joint. Their paralysis leads to the over
domination of the antagonistic muscles
resulting in extension at the metacarpo-
phalangeal joints and flexion of both
interphalangeal
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10:27:17 PM
. Medial cutaneous nerve of the
forearm (C8-Th1) Branches.
a. Anterior branch - gives a sensory
supply to the flexor side of the forearm
b. Ulnar branch - for sensory innervation
of the ulnar side of the forearm.
Medial cutaneous nerve of the arm
(C8 -Th2) - it is connected to the
intercostobrachial nerve that arises from
the 2nd and 3rd intercostal nerves.
It gives a sensory innervation
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10:27:17 PM
Axillary nerve (C5-C7)-
Innervates the deltoid and teres minor
mm and gives a sensory supply to the
skin on the dorsolateral aspect of the
arm.
It runs with the posterior circumflex
humeral artery and veins through
quadrilateral space and gives branch to
the superior lateral cutaneous nerve of
the arm.
It may be injured by fracture of the
surgical neck of humerus; leading to
paralysis
02/21/2025
of deltoid
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10:27:17 PM resulting in difficulty
404
404
. Radial nerve (C5 -Th1)-
Gives both motor and sensory
innervation to the arm and forearm. It
runs with the deep brachial artery
between the medial and lateral heads
of triceps laying in the spiral (radial)
sulcus of humerus.
Then it passes to the flexor side and
then descends between brachioradialis
and brachialis muscles. In the elbow, at
the level of the head of the radius, it
divides in to its deep and superficial
branches.
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10:27:17 PM
405
405
02/21/2025 406
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10:27:17 PM
Branches of radial nerve in the arm
1. Motor branches to triceps, anconeus,
brachioradialis and extensor carpi
radialis longus -the nerves to triceps
and anconeus arise above the radial
sulcus.
2. Posterior cutaneous nerve of the arm
- it branches from the radial nerve in
the axilla and gives sensory innervation
to the dorsal or extensor side of the
arm.
3. Inferior lateral cutaneous nerve of the
arm - is sensory to the lateral aspect407of
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10:27:17 PM
 Branches radial nerve in the
forearm
1. Posterior cutaneous nerve of the
forearm - for the sensory innervation of
extensor side of the forearm up to the
wrist joint. It arises in the radial sulcus.
2. Deep radial nerve -it passes through
the supinator muscle and runs spirally
around the neck of the radius to enter the
extensor side and becomes posterior
interosseous nerve.
It gives muscular branches to supinator,
ECUB,
02/21/2025 EDM, EPB
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10:27:17 PM
and extensor indicis. 408
408
02/21/2025 409
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10:27:17 PM
 Superficial radial nerve - it runs with the
radial art. as cutaneous branch of the radial
nerve on the flexor side deep on the ulnar
side of the brachioradilis . In the lower 1/3 of
the forearm it under crosses the tendon of
brchioradialis to pass to the dorsum of the
hand.
At the back of the hand it is joined to the
dorsal ramus of the ulnar nerve through the
communicating branch of ulnar nerve. Then
it terminates as the dorsal digital nerve that
receives sensory fibres from the radial side
of the
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dorsum of
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10:27:17 PM
the hand and radial 31/2
410
410
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10:27:17 PM
 Applied Anatomy of the radial nerve
Radial nerve is usually injured by the
fracture of the shaft of the humerus in the
region of the radial sulcus and by
fractures of the neck of radius. In this
case the extensors of the wrist and
fingers are paralysed leading to the
clinical condition called wrist drop

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10:27:17 PM
02/21/2025 413
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 Brachial artery -
The continuation of axillary art. that
begins at the lower border of teres
major m.
They lie medially in the upper arm
but turn anteriorly as they approach
the elbows.
Enters elbow by passing under the
biceptal aponeurosis where it divides
in to radial and ulnar arteries.
In its course brachial veins and
median n. accompany the brachial
art. In the proximal part the median
n. lies lateral to the artery, but in the
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414
414
 Deep br. a
Brachial
artery
Superior
collatera
art.

Inferior
ulnar
colateral
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a 415
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10:27:17 PM
 Branches of the brachial artery
1. Profunda brachii artery (deep brachial
artery)
2. muscular branches to the flexors of
the arm
3. Superior ulnar collateral artery
4. Inferior ulnar collateral artery
Profunda brachii artery
Arise in the medial biceptal sulcus and
run to the dorsal side with the radial
nerve, where they lie in a canal formed
by the
02/21/2025 radial sulcus
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10:27:17 PM
of humerus and 416
416
 Branches of profunda brachii
artery
1. Nutrient artery to the humerus-
that enters the bone through its
nutreint foramen.
2. Posterior descending or middle
collateral - descends behind the
lateral Intermuscular septum and
lateral epicondyle
3. Anterior descending or radial
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10:27:17 PM
 Rete articularis cubiti
This is a network of arteries around
the elbow joint. It is formed by the
anstomoses between:
1. The middle collateral branch of
profunda brachii
2.Superior and inferior ulnar collateral
branches of the brachial artey
3. Radial recurrent artery from radial
artery
4. Interosseous recurent artery from
common interosseous artery.
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10:27:17 PM
 Radial artery
Begins in the elbow as branch of
brachial a.
It descends medial to the superficial
radial nerve under the cover of the
brachioradialis m. by crossing over
the tendon of biceps.
In the lower 1/3 of the forearm
superficial branch of radial n.
accompanies it. Proximal to the wrist
joint it lies between tendons of flexor
carpi radialis and brachioradialis
opposite the broad distal end of
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02/21/2025 420
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• Enters the anatomical snuff-box and
passes to the dorsum of the hand after
giving some branches that form rete
carpi palmare.
• Then it runs between the two heads of
the 1st dorsal interoseous muscle
between 1st and 2nd metacarpal bones
to enter the palm of the hand where it
forms the deep palmar arch together
with a smaller deep palmar branch
from ulnar a.
• It also gives branches for the
formation of the rete (dorsal
network)
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carpi dorsalis
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421
421
Anatomical snuff-box
A triangular depression at the base of
thumb Boundries
Proximally by the styloid process of
radius,
Distally by the base of the 1st
metacarpal bone
Medially by the tendon of EPL
laterally by EPB and APL
This depression is clearly visible when
the thumb is fully extended. It contains
the cephalic
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superficial branch of 422
422
 Branches of the radial artery
1. Radial recurrent (in the elbow)
2.Superficial palmar branch (superficial
palmar branch of ulnar arch superficial
palmar.
3.Principes pollicis artery to the thumb
4.Radialis indicis artery to radial side of the
index finger
Deep palmar arch
found between the flexor tendons and
interossei muscles. It give branch to
palmar metacarpal arteries that form
anastomosis
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with the digital branches of
423
the
10:27:18superficial palmar arch directly and
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PM 423
02/21/2025 424
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Ulnar artery
Larger branch of brachial a.
In the elbow it runs under the
superficial flexors to the ulnar side of
the forearm then it descends along the
radial side of FCU to the wrist being
accompanied by the ulnar n.
In the wrist it gives branches that
contribute to the formation of the
palmar and dorsal arterial networks of
wrist. Then runs anterior to the flexor
retinaculum
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02/21/2025 426
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 At the hypothenar eminence it divids in to:
1.Deep palmar branch (smaller) - that forms
anastomosis with larger deep palmar branch of
radial artery to complete the deep palmar
arch.
2.Superficial palmar branch (larger)- forms
anastomosis with the smaller superficial palmar
branch of radial artery to form the superficial
palmar arch.
• The superficial palmar arch gives branch to 4
common palmar digital arteries each of which
re-branch to two proper palmar digital arteries
to supply
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427
427
 Important Branches of ulnar
artery
1.Recurrent ulnar artery to rete
articularis cubitis
2.Superficial and deep palmar
branches
3.. Common interosseous artery
(usually arises from ulnar but it can
also arise directly from brachial
artery).
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Common interosseous artery
It lies on the interosseous
membrane being covered by the
origins of the deep flexors. It divides
in to anterior and posterior
interosseous arteries
The posterior interosseous artery
pierces through the interosseous
membrane to pass to the extensor
side and descends between the
superficial and deep extensors to join
the dorsal carpal arterial network of
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• After passing through the
interosseous membrane it give
branch to the interosseous recurrent
a. that joins the articular arterial
network of the elbow .
• The anterior inerosseous a. descends
on the anterior surface of the
interosseous membrane and supplies
adjacent muscles proximal to the
pronator quadratus muscle.
• It then penetrates through the
interosseous mem. to pass to the
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02/21/2025 431
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 Supply areas in the hand
Radial artery
-Rete carpi palmare
- Rete carpi dorsale
- Dorsum of the hand
- Radial 11/2 finger
Ulnar artery
- Rete carpi palmare
- Rete carpi dorsale
- Ulnar 31/2 finger

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Areas of palpation of arterial
pulse on the upper limb
1. Brachial artery
a. In the medial biceptal sulcus
b. Supero-ventral to the medial
epicondyle at the elbow
c. In the elbow deep and medial to
the
biceptal aponeurosis
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2. Radial
a. Proximal to the wrist between the
tendons of flexor carpi radialis
and
brachioradialis
b. In the anatomical snuff-box
3. Ulnar
- at or near the wrist lateral to the
tendon of flexor carpi ulnaris.

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 • THANKS
THANKS

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