INTRODUCTION TO
UPPER LIMB ANATOMY
Dr Linus A. Enye
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GENERAL DESCRIPTION
• The upper limb is associated with the lateral
aspect of the lower portion of the neck.
• It is suspended from the trunk by muscles and
a small skeletal articulation between the
clavicle and the sternum-the sternoclavicular
joint.
• Based on the position of its major joints and
component bones, the upper limb is divided
into shoulder, arm, forearm, and hand.
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• The shoulder is the area of upper limb
attachment to the trunk .
• The arm is the part of the upper limb
between the shoulder and the elbow
joint;
• The forearm is between the elbow joint
and the wrist joint;
• While the hand is distal to the wrist joint.
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• The axilla, cubital fossa, and carpal
tunnel are significant areas of transition
between the different parts of the limb.
• Important structures pass through, or are
related to, each of these areas.
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Regional anatomy of the upper limb
SHOULDER;
• The shoulder is the region of upper limb’s
attachment to the trunk and neck.
• The bony framework of the shoulder consists
of:
the clavicle and scapula, which form the
pectoral girdle (shoulder girdle); and
the proximal end of the humerus.
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• The superficial muscles of the shoulder consist
of the trapezius and deltoid muscles, which
together form the smooth muscular contour
over the lateral part of the shoulder.
• These muscles connect the scapula and
clavicle to the trunk and to the arm,
respectively.
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Bones of the shoulder girdle
• Clavicle;
• The clavicle is the only bony attachment
between the trunk and the upper limb.
• It is palpable along its entire length and has a
gentle elongated S-shaped contour.
• Its sternal (medial) end is enlarged and
triangular where it articulates with the
manubrium of the sternum to form the
sternoclavicular (SC) joint.
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• Its acromial (lateral) end is flat where it
articulates with the acromion to form the
acromioclavicular (AC) joint.
• The medial two-thirds of the body (shaft) of
the clavicle are convex anteriorly, whereas the
lateral third is flattened and concave
anteriorly.
• These curvatures increases the resilience of
the clavicle and give it the appearance of an
elongated capital "S."
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• Although designated as a long bone, the
clavicle has no medullary (marrow) cavity.
• It consists of spongy (cancellous) bone with a
shell of compact bone.
• The clavicle has 2 surfaces; a smooth superior
surface lying just deep to the skin and the
platysma muscle.
• The inferior surface of the clavicle is rough
because strong ligaments bind it to the 1st rib
near its sternal end and suspend the scapula
from its acromial end.
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Applied Anatomy
Variations of the Clavicle;
• The clavicle varies in shape more than most
other long bones.
• It is thicker and more curved in manual workers,
and the sites of muscular attachments are more
marked.
• The right clavicle is thicker and stronger than
the left and is usually shorter.
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Fracture of the Clavicle;
• The clavicle is commonly fractured, often by
an indirect force resulting from violent
impacts to the outstretched hand during a fall
transmitted through the bones of the hand,
forearm and arm to the shoulder- or by falls
directly onto the shoulder itself.
• The weakest part of the clavicle is the junction
of its middle and lateral thirds which makes
this point more susceptible to fracture
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Ossification of the Clavicle;
• The clavicle is the first long bone to begin to
develop, during the 5th and 6th embryonic
weeks in condensed mescnchyme.
• A secondary ossification centre begins to
appear around the sternal end and begin to
fuse with the body around 18-25 years of age.
• It completely ossifies by 25th to 31st years of
life making it the last of the epiphyses of long
bones to fuse.
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SCAPULA
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• The scapula or shoulder blade is a triangular flat
bone that lies at the posteriolateral aspect of the
thorax where it covers from the 2nd-7th ribs.
• It comprises of:
three angles (lateral, superior, and inferior);
three borders (superior, lateral, and medial);
three processes (acromion, spine, and coracoid
process) and
two surfaces (costal/anterior and posterior);
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• The convex posterior surface is evenly divided
into two by the spine of the scapula into a
smaller supraspinous fossa and a much larger
infraspinous fossa.
• These three fossae gives attachments to some
fleshy muscles of the upper limb.
• A thick projecting ridge of bone called the
spine of the scapula continues laterally as the
flat expanded acromion which articulates with
acromial end of the clavicle forming the
acromioclavicular joint.
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Supraspinous fossa
Coracoid Acromion
process
Coastal surface
urface
rio rs
ste
Po
Infraspinous fossa
Spine of scapula
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• Superiorlaterally, the scapula forms the
shallow glenoid cavity which articulates
with the head of the humerus to form the
glenohumeral/shoulder joint.
• Projecting anterolaterally to this cavity is
a structure that resembles a bending
finger pointing to the shoulder.
• This structure is called coracoid process.
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Supraspinous fossa
Coracoid Acromion
process
Coastal surface
urface
rio rs
ste
Po
Glenoid
cavity Infraspinous fossa
Spine of scapula
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Angles and borders of scapulae
• The scapula has three borders namely
median, lateral and superior.
• Also has three angles namely; superior, lateral
and inferior angles.
• In its anatomical position the thin median
border of the scapula runs parallel to and
approximately 5cm lateral to the spinous
process of the thoracic vertebrae.
• Hence, the median border is usually referred
to as the VERTEBRAE BORDER.
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• From the inferior angle. The lateral
border runs superiolaterally towards the
apex of the axilla, hence sometimes
called the AXILLA BORDER.
• The lateral border terminates in the
truncated lateral angle of the scapula,
where the thick glenoid cavity is located.
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• The broad process adjacent to the cavity is the
head of the glenoid cavity while the
constricted part between the head and the
body is the NECK.
• The superior border is marked by the
suprascapular notch near the junction of the
medial 2/3rd and the lateral 1/3rd.
• It is the thinnest and shortest of the three
borders.
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• The glenoid cavity is a shallow concave, oval
fossa of approximately 4cm long and 2-3cm
wide; for the reception of the head of the
humerus bone.
• the cavity faces anterolateraly and slightly
superiorly.
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• Fracture of the scapula;
• In most cases the scapulae are well protected
by muscles and its associated thoracic wall,
therefore, most fractures of the scapulae
involves the protruding subcutaneous
acromion.
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HUMERUS
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• The humerus (arm bone), the largest bone in
the upper limb, articulates with the scapula at
the scapulohumeral (shoulder) joint and the
radius and ulna at the elbow joint.
• Is composed of two extremities; proximal and
distal.
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HUMERUS
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Proximal humerus
• The proximal end of the humerus consists of
the head, the anatomical neck, the greater
and lesser tubercles, the surgical neck, and
the superior half of the shaft of humerus.
• The head is half-spherical in shape and
projects medially and somewhat superiorly to
articulate with the much smaller glenoid
cavity of the scapula.
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• The anatomical neck is very short and is
formed by a narrow constriction immediately
distal to the head.
• It lies between the head and the greater and
lesser tubercles laterally, and between the
head and the shaft more medially.
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Greater and lesser tubercles;
• The greater and lesser tubercles are
prominent landmarks on the proximal
end of the humerus and serve as
attachment sites for the four rotator cuff
muscles of the glenohumeral joint.
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• The greater tubercle is lateral in position.
• Its superior surface and posterior surface are
marked by three large smooth facets for
muscle tendon attachment:
the superior facet is for attachment of the
supraspinatus muscle;
the middle facet is for attachment of
infraspinatus;
the inferior facet is for attachment of teres
minor.
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• The lesser tubercle is anterior in position and
its surface is marked by a large smooth
impression for attachment of the
subscapularis muscle.
• A deep intertubercular sulcus (bicipital
groove) separates the lesser and greater
tubercles and continues inferiorly onto the
proximal shaft of the humerus .
• The tendon of the long head of the biceps
brachii passes through this sulcus.
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• Roughenings on the lateral and medial lips and on
the floor of the intertubercular sulcus mark sites
for the attachment of the pectoralis major, teres
major, and latissimus dorsi muscles, respectively.
• The lateral lip of the intertubercular sulcus is
continuous inferiorly with a large V-shaped
deltoid tuberosity on the lateral surface of the
humerus midway along its length, which is where
the deltoid muscle inserts onto the humerus.
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Surgical neck
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Surgical neck
• One of the most important features of the proximal end of
the humerus is the surgical neck.
• This region is oriented in the horizontal plane between the
expanded proximal part of the humerus (head, anatomical
neck, and tubercles) and the narrower shaft.
• The axillary nerve and the posterior circumflex humeral
artery, which pass into the deltoid region from the axilla, do
so immediately posterior to the surgical neck.
• Because the surgical neck is weaker than more proximal
regions of the bone, it is one of the sites where the humerus
commonly fractures. The associated nerve (axillary) and
artery (posterior circumflex humeral) can be damaged by
fractures in this region.
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Shaft and distal end of the humerus
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• The body/shaft of the humerus has two
prominent features:
• the deltoid tuberosity, laterally, for
attachment of the deltoid muscle, and the
oblique radial groove, posteriorly, in which the
radial nerve and deep artery of the arm
(Profunda brachii) lie as they pass between
the medial and the long and then the lateral
heads of the triceps brachii muscle.
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• Distally, the bone becomes flattened, and
these borders expand as the lateral
supraepicondylar ridge (lateral supracondylar
ridge) and the medial supraepicondylar ridge
(medial supracondylar ridge).
• The lateral supraepicondylar ridge is more
pronounced than the medial and is roughened
for the attachment of muscles found in the
posterior compartment of the forearm.
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The condyle
• The two articular parts of the condyle, the
capitulum and the trochlea, articulate with the
two bones of the forearm.
• The capitulum articulates with the radius of the
forearm.
• The trochlea articulates with the ulna of the
forearm.
• It is pulley shaped and lies medial to the capitulum.
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The two epicondyles
• The medial epicondyle, a large bony protuberance, is the
major palpable landmark on the medial side of the elbow, and
projects medially from the distal end of the humerus.
• On its surface, it bears a large oval impression for the
attachment of muscles in the anterior compartment of the
forearm.
• The ulnar nerve passes from the arm into the forearm around
the posterior surface of the medial epicondyle and can be
palpated against the bone in this location.
• The lateral epicondyle is much less pronounced than the
medial epicondyle.
• It is lateral to the capitulum and has a large irregular
impression for the attachment of muscles in the posterior
compartment of the forearm.
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• The three fossae
• Three fossae occur superior to the trochlea and
capitulum on the distal end of the humerus.
• The radial fossa is the least distinct of the fossae and
occurs immediately superior to the capitulum on the
anterior surface of the humerus.
• The coronoid fossa is adjacent to the radial fossa and is
superior to the trochlea.
• The largest of the fossae, the olecranon fossa, occurs
immediately superior to the trochlea on the posterior
surface of the distal end of the humerus.
• These three fossae accommodate projections from the
bones in the forearm during movements of the elbow
joint.
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MUSCULAR SYSTEM
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• Myology is the branch of anatomy that
studies or describes the function and
structures of the muscle.
• Muscles generally belongs to a group of
structures referred to as the effectors-
which are group of structures that
responds to stimulus either directly or
indirectly.
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• More than 600 skeletal muscles make up
the muscular system, and technically each
one is an organ.
• Collectively, the skeletal muscles account
for approximately 40% of the body weight.
• Muscles perform three principal functions:
(1) movement,
• (2) heat production, and (3) body support
and maintenance of posture.
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Movements;
• The most obvious function performed by
muscles is to move the body or parts of the
body, as in walking, running, writing,
chewing, and swallowing.
• Even the eyeball and the auditory ossicles
have associated muscles that are responsible
for their various movements.
• The contraction of skeletal muscle is equally
important in breathing and in moving internal
body fluids.
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Heat production;
• Body temperature is held remarkably
constant.
• Metabolism within the cells releases heat as
an end product. Because muscles constitute
approximately 40% of body weight and are
in a continuous state of fiber activity, they
are the primary source of body heat.
• The rate of heat production increases greatly
during strenuous exercise.
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Posture and body support;
• The muscular system provides a framework
for the body, but skeletal muscles maintain
posture, stabilize the flexible joints, and
support the viscera.
• Some postural muscles are working even
when you think you are relaxed.
• For example, as you are sitting, the weight
of your head is balanced at the atlanto-
occipital joint through the efforts of the
muscles located at the back of the neck. 59
Types of muscle
• There are three types of muscles according to
their locations in the body.
• Although these three types differ in structure
and function.
• The following basic properties characterize
all muscle tissue:
1. Irritability; Muscle tissue is sensitive to
stimuli from nerve impulses.
2. Contractility; Muscle tissue responds to
stimuli by contracting lengthwise, or
shortening. 60
3. Extensibility, once a stimulus has subsided
and the fibers within muscle tissue are relaxed,
they may be stretched even beyond their resting
length by the contraction of an opposing muscle.
The fibers are then prepared for another
contraction.
4. Elasticity, muscle fibers, after being stretched,
have a tendency to recoil to their original
resting length.
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The three basic muscles types are;
• Skeletal/Straited/Voluntary.
• Visceral/Smooth/Involuntary.
• Cardiac muscle.
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Skeletal/Straited/Voluntary
• This type of muscle is innervated by the
voluntary part of the nervous system and
therefore called the voluntary muscle.
• Because of this it is often under the control of
man.
• When viewed under the microscope it
contains stripes, therefore, it could also be
called straited or striped muscle.
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• Most skeletal muscles are attached directly or
indirectly through tendons to bones,
cartilages, ligaments, fascial or a combination
of more than one of these.
• Some are also attached to organs like muscles
of the eye, some to the skin like the facial
muscle while some are to the mucous
membranes like the intrinsic muscles of the
tongue.
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• Attachments of muscles are commonly
described as origin and insertion.
• The origin is usually the proximal end of
the muscle that remains fixed during
muscular contraction, and the insertion is
usually the distal end of the muscle that is
movable.
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Visceral/Smooth/Involuntary
• This type of muscle are found lining the
various cavities and organs of the body.
• They are innervated by the autonomic part of
the nervous system, therefore they are called
involuntary muscles.
• When viewed under a microscope they do not
possess stripes, they are therefore referred to
as smooth muscles.
• They control most involuntary actions of the
body.
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• Examples includes;
• Middle coat or layer of the walls of blood
vessels.
• Muscular part of the walls of digestive
tract.
• Also found in the skin.
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Cardiac muscle
• This muscle forms the muscular wall of the
heart called the myocardium.
• Some form of cardiac muscle could be found
in the walls of the aorta, pulmonary vein and
superior vena cava.
• Cardiac muscles contractions are not under
voluntary control but are regulated
intrinsically by a peacemaker composed of
special cardiac muscle fibres.
• Is also a striated muscle because it contains
striations under the microscope. 68
MUSCLES OF THE SHOULDER REGION
(THORACOAPPENDICULAR AND
SCAPULOHUMERAL REGION)
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`
• Muscles of the pectoral region are divided
into anterior and posterior muscles.
• Four anterior thoracoappendicular (pectoral)
muscles move the pectoral girdle:
Pectoralis major, pectoralis minor, subclavius,
and serratus anterior.
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Clavicular Lateral and Adducts and
head: anterior medial medially
surface of pectoral rotates
medial half of nerves; humerus;
clavicle . clavicular draws
Sternocostal Lateral lip of head (C5 and scapula
Pectoralis head: anterior intertubercular C6), anteriorly and
surface of groove of sternocostal inferiorly
major sternum, humerus head (C7, Acting alone:
superior C8, and T1) clavicular
six costal head flexes
cartilages, and humerus and
aponeurosis of stemocostal
external head
oblique muscle extends it .
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Pectoralis major muscle
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Medial border Medial pectoral Stabilizes
and superior nerve scapula by
surface of (C8 and T1) drawing it
Pectoralis Costal cartilages coracoid process inferiorly and
of 3rd to 5th of scapula anteriorly
minor ribs against thoracic
wall
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P. minor
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Junction of 1st Inferior surface Nerve to Anchors and
rib and of middle subclavius depresses
its costal third of clavicle (C5 and C6) clavicle
cartilage
Subclavius
External Anterior surface Long thoracic Protracts
surfaces of of medial nerve scapula and
Serratus lateral border of (C5, 66, and 07) holds
anterior parts of 1st to scapula it against
8th ribs thoracic wall;
rotates
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Serratus anterior and subclavius
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POSTERIOR THORACOAPPENDICULAR
(Muscles Connecting the Upper Limb
to the Vertebral Column)
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The two most superficial muscles of the
shoulder are the trapezius and latissimus dorsi
muscles.
trapezius attaches the scapula and clavicle to
the trunk;
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Trapezius
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• Deep to trapezius, the scapula is attached to
the vertebral column by three muscles-levator
scapulae, rhomboid minor and rhomboid
major.
• These three muscles work with trapezius (and
with muscles found anteriorly) to position the
scapula on the trunk.
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
1. Superior 1. Powerful
nuchal line, 2. elevator of the
external 1. Superior Motor spinal scapula; 2.
occipital edge of the part of rotates the
protuberance, crest of the accessory scapula during
Trapezius 3. medial spine of the nerve (CN XI). abduction of
margin of the scapula, 2. Sensory humerus above
ligamentum acromion, 3. (proprioception horizontal; 3.
nuchae, posterior ) anterior rami middle fibers
4. spinous border of of C3 and C4 retract scapula;
processes of lateral one- 4. lower fibers
CVII to TXII and third of clavicle depress
5. the related scapula
supraspinous
ligaments
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Superior nuchal line
Nuchal ligament
Descending part
of trapezius (right
side)
Middle part
of trapezius
Ascending part
of trapezius
Descending part
T12 Vertebra of trapezius (right
side)
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Iliac crest, lumbar
fascia, spines of Floor of bicipital Extends,
lower six thoracic groove of Thoracodorsal adducts, and
vertebrae, lower humerus nerve (C6, 7, 8) medially
three or four ribs, rotates the arm
Latissimus dorsi and inferior angle
of scapula
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Attachment of latissimus
dorsi to floor of
intertubercular groove of
humerus
Latissimus
dorsi
Thoracolumbar
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• Deep to trapezius the scapula is attached to
the vertebral column by three muscles-levator
scapulae, rhomboid minor and rhomboid
major.
• These three muscles work with trapezius (and
with muscles found anteriorly) to position the
scapula on the trunk.
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Transverse Posterior Branches Elevates the
processes of CI surface of directly from scapula
and CII medial border anterior rami of
vertebrae and of scapula from C3 and C4
Levator posterior superior angle spinal nerves
tubercles of to root of spine and by
scapulae transverse of the scapula branches [C5]
processes of from the dorsal
CIII and CIV scapular nerve
vertebrae
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Transverse
processes,
C1–C4
Levator scapulae
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Lower end of Posterior
ligamentum surface of Dorsal
Rhomboi nuchae and medial border scapular Elevates and
spinous of scapula at nerve [C4,C5] retracts the
d minor processes of the root of scapula
CVII and TI the spine of
vertebrae the scapula
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Posterior
Spinous surface of Elevates and
processes of TII- medial border Dorsal scapular retracts the
Rhomboid TV vertebrae of scapula from nerve [C4,C5] scapula
major and intervening the root of the
supraspinous spine of the
ligaments scapula to the
inferior angle
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Rhomboid minor
Rhomboid major
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MUSCLES OF THE
POSTERIOR SCAPULAR
REGION( SCAPULOHUMER
AL REGION)
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• The posterior scapular region occupies the
posterior aspect of the scapula and is located
deep to the trapezius and deltoid muscle.
• It contains six muscles, which pass between
the scapula and proximal end of the
humerus:
• the deltoid, supraspinatus, infraspinatus,
teres minor, teres major and subscapularis
muscles.
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• These muscles, along with other muscles of
the region and the humerus, participates in
forming a number of spaces through which
nerves and vessels enter and leave the region.
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• The supraspinatus, infraspinatus, and teres
minor muscles are components of the rotator
cuff, which stabilizes the glenohumeral joint.
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Major abductor
of arm
1. Inferior edge (abducts arm
Deltoid of the crest of
the spine of Deltoid
beyond initial
15° done by
the scapula, 2. tuberosity of Axillary nerve supraspinatus);
lateral margin humerus [C5,C6] clavicular fibers
of the assist in flexing
acromion, 3. the arm;
anterior border posterior fibers
of lateral one- assist in
third of clavicle extending the
arm
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Rotator cuff
Medial two- Most superior muscle;
Supraspinatus thirds of the facet on the Suprascapular initiation of
supra-spinous greater tubercle nerve [C5,C6] abduction of
fossa of the of the humerus arm to 15° at
scapula and the gleno-humeral
deep fascia that joint
covers the
muscle
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SUPRASPINATUS
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Medial two- Middle facet on Suprascapular Rotator cuff
thirds of the posterior nerve [C5,C6] muscle; lateral
infra-spinous surface of the rotation of arm
fossa of the greater tubercle at the
Infraspinatus scapula and the of the humerus glenohumeral
deep fascia that joint
covers the
muscle
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infraspinatus
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Upper two- Rotator cuff
thirds of a muscle; lateral
flattened strip of Inferior facet on rotation of arm
bone on the the posterior at the
Teres minor posterior surface of the Axillary nerve glenohumeral
surface of the greater tubercle [C5,6] joint
scapula of the humerus
immediately
adjacent to the
lateral border of
the scapula
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MUSCLE ORIGIN INSERTION INNERVATION ACTION
Elongate oval Medial lip of the
area on the intertubercular Inferior Medial rotation
posterior sulcus on the subscapular and extension of
Teres major surface of the anterior surface nerve [C5 to C7] the arm at the
inferior angle of of the humerus glenohumeral
the scapula joint
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