Anatomy - UPPER LIMB - 3 Muscles, Innervation and Compartments of The Upper Limb

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Muscles, Innervation and the Compartments of the Upper Limb

Organized in an Unintentionally Difficult Manner
Fascia and compartments of the shoulder

PECTORALIS FASCIA
-
The only contents is Pectoralis Major;

Pectoralis fascia continue inferiorly as fascia of the anterior abdominal wall
It continues laterally-once it leaves the lateral edge of Pectoralis Major, it becomes AXILLARY FASCIA
AXILLARY FASCIA
-
Continuous with the CLAVIPECTORAL FASCIA

Forms the floor of the axilla
CLAVIPECTORAL FASCIA
-
Deep to the Pectoralis major muscle, the CLAVIPECTORAL FASCIA invests the subclavius muscle and pectoralis minor.
It forms the costocoracoid membrane above pectoralis minor, and the suspensory ligament of axilla below pectoralis
minor. The suspensory ligament drags the axillary fascia upwards when the arm is raised, forming the actual pit of the armpit
Pectoralis major, wrapped
up in pectoralis fascia
Clavicle
Subclavius
Lateral pectoral nerve
and Thoracoacromial artery
Costocoracoid membrane
Pectoralis minor
Suspensory ligament of axilla
Axillary fascia
Axillary fascia
Supraspinous, Infraspinous and Subscapular fascia

-
The supraspinatus, infraspinatus and subscapularis muscles are contained in their own little fascial compartments
Deltoid Fascia
-
The deltoid has its own fascia, continous with the pectoral fascia and infraspinatus fascia
It has numerous fascial septa which separate the fascicles of the deltoid
Supraspinatus
fascia
Spine of scapula
Clavicle
Deltoid fascia
Infraspinatus fascia
Pectoralis fascia
Infraspinatus fascia
Subscapularis
fascia
Fascial septa
Pectoralis fascia, infraspinatus fascia and deltoid fascia all continue down the arm to form the brachial fascia
This document was created by Alex Yartsev (dr.alex.yartsev@gmail.com); if I have used your data or images and forgot to reference you, please email me.
Anterior Axioappendicular Muscles of the Shoulder

There are 3 distinct groups of shoulder muscles:
ANTERIOR AXIOAPPENDICULAR MUSCLES 4 muscles which move the pectoral girdle
POSTERIOR AXIOAPPENDICULAR MUSCLES 4 muscles which attach the upper lumb to the skeleton of the trunk
SCAPULOHUMERAL MUSCLES 6 muscles which act on the glenohumeral joint
Pectoralis Minor
Anterior Axioappendicular muscles
Subclavius
All supplied by stupidly different nerves.
Pectoralis Major :
clavicular head
No pattern whatsoever.
Pectoralis Major
Two heads:
-
CLAVICULAR HEAD: lateral pectoral nerve

o
Pectoralis major:
sternocostal head
Originates from the medial half of the anterior

clavicle
STERNOCOSTAL HEAD: medial pectoral nerve
Originates from the anterior surface of the sternum,

and the first 6 costoclavicular cartilages
o
Also originates from the aponeurosis of the external
oblique muscle of the abdomen
INSERTS INTO THE LATERAL LIP OF THE INTERTUBERCULAR
GROOVE OF THE HUMERUS
o
Intertubercular groove
of the humerus
Its inferior border forms the anterior axillary fold

o Abducts and medially rotates the humerus
o Draws scapula anteriorly and inferiorly by
pulling on the humerus
The heads can act independently:

o Clavicular head alone acts to flex the humerus
o When flexed, the sternocostal head extends it
from its flexed position.
Pectoralis Minor medial pectoral nerve

-
Serratus Anterior
Innervation
Nerve to Subclavius:
Off the superior trunk
Subclavius
Originates at the 3rd, 4th and 5th ribs near the costal
cartilages
Inserts into the medial border and superior surface of the
coracoid process of scapula
Its job is to stabilize the scapula by pulling it anteriorly
and inferiorly against the chest wall
It also assists in elevating the ribs when breathing
All the vessels and nerves to the arm travel under the
pectoralis minor.
Subclavius nerve to subclavius

-
Lateral Pectoral nerve:

Branch of the lateral cord
clavicular head of
Pectoralis Major
Originates at the junction of the 1st rib and its costal cartilage
Inserts into the groove for subclavius on the inferior surface
of the middle third of the clavicle
Depresses and anchors the clavicle
Protects the subclavian vessels when the clavicle is fractured
Serratus anterior long thoracic nerve

-
Long Thoracic Nerve:

Off the roots of C5, 6 and 7
Serratus Anterior
Medial Pectoral nerve:
Branch of the medial cord
Pectoralis Minor; sternocostal head of Pectoralis Major
Originates from the lateral surfaces of the first 8 ribs

Inserts into the medial border of scapula
Protracts the scapula, holds it against the chest wall, and
rotates it superiorly (eg when reaching for something up high).
THE MAIN PROTRACTOR OF THE SCAPULA
One of the most powerful muscles in the pectoral girdle.
Its paralysis causes a winged scapula. Also, the arm cannot be
abducted past the horizontal position (the scapula doesnt
rotate upwards anymore)
If you insert your chest drain BELOW the mid-axillary line, you
will cause this sort of paralysis, which is embarrassing.
Posterior Axioappendicular Muscles of the Shoulder: the Extrinsic Group

There are 2 layers, the superficial and the deep.
Posterior Axioappendicular Extrinsic Muscles
The superficial group is trapezius and latissimus dorsi
The deep group is the levator scapulae and the rhomboids
Viewed from above
Also supplied by confusingly different nerves.
Trapezius spinal accessory nerve

-
Originates from
o
o
o
o
o
Superior part of
Trapesius
Inserts into :
o
o
o
Middle part of
Trapesius
The external occipital protuberance

Nuchal ligament
Medial third of superior nuchal line
Spinous processes of C spine and T-spine
he medial half of the anterior clavicle
Lateral third of the clavicle
Acromion of scapula
Spine of scapula
Has 3 distinct parts:
Floor of the intertubercular

groove, anteriorly on the
humerus
Middle part of
Trapesius
SUPERIOR (descending)part which elevates

the scapula
MIDDLE part which retracts the scapula
INFERIOR (ascending) part which
depresses the scapula
All the parts together act to rotate the scapula superiorly, so

the glenoid fossa faces up.
T7
Latissimus dorsi Thoracodorsal nerve
Latissimus dorsi
Originates from
o Inferior 6 thoracic vertebrae
o Thoracolumbar fascia
o Iliac crest
o Inferior 3 or 4 ribs
Inserts into the ANTERIOR surface of the humerus, at the floor

of the intertubrercular groove
Extends, adducts, medially rotates the humerus
Lifts the body up too the arms when climbing
Levator scapulae
Levator scapulae dorsal scapular and cervical nerves

-
Rhomboid Minor
Rhomboid Major
Innervation
Dorsal scapular nerve:

Off the roots of C5
Rhomboid major and minor

Levator scapulae
Originates at the posterior tubercles of the spinous processes

of the C1, 2, 3 and 4 vertebrae
Inserts into the medial border of scapula, superior to the spine
Elevates that corner of the scapula, rotating it so the glenoid
cavity faces down
Extends the neck (when acting bilaterally) or flexes it laterally
(when acting unilaterally)
Rhomboid Minor dorsal scapular nerve

-
Thoracodorsal Nerve:
Off the posterior cord
Latissimus dorsi
Originates from the nuchal ligament and the spinous processes

of C7 and T1
Inserts into the medial border of the scapula, at the root of the
scapular spine
Retracts the scapula
Rotates the scapula so the glenoid cavity faces down
Fixes the scapula to the thoracic wall
Rhomboid Major dorsal scapular nerve

-
Originates from the spinous processes of T2,3 4and 5

Inserts into the medial border of the scapula, from the root of
spine down.
Retracts the scapula
Rotates the scapula so the glenoid cavity faces down
Fixes the scapula to the thoracic wall
Posterior Axioappendicular Muscles of the Shoulder: the Intrinsic Group with Rotator Cuff muscles
These are the deltoid and teres major; and the 4 rotator cuff muscles (teres minor, supraspinatus, infraspinatus and subscapularis)
Deltoid
Posterior Axioappendicular Intrinsic muscles

Again, supplied by totally different nerves.
Deltoid axillary nerve

-
Supraspinatus
Originates from the lateral third of the clavicle, the

acromion, and the lateral spine of scapula.
Inserts into the deltoid tuberosity of humerus
THREE PARTS:
Anterior part flexes and medially rotates the

humerus
o Middle part abducts the humerus
o Posterior part extends and laterally rotates the
arm
o The middle part is multipennate; the others are
unipennate
It cannot initiate abduction on its own when the arm is fully
adducted- thus it needs supraspinatus to initiate the movement. It
becomes effective after about 15 degrees of abduction.
The deltoids anterior and posterior parts swing your arms while
walking.it also helps to keep the humeral head in the glenoid
fossa.
o
Infraspinatus
Subscapularis
Teres Major
Teres Minor
Iinsertion of deltoid, at the
Deltoid Tuberosity
Teres major lower subscapular nerve

Deltoid
Supraspinatus
Deltoid
Originates from the posterior surface of the inferior

angle of scapula
Inserts into the medial lip of the intertubercular groove
of humerus
Adducts and medially rotates the arm
Also keeps the head of humerus in the socket
Rotator Cuff Muscles
Whatever other actions they may have, they all help hold
the humeral head in the glenoid fossa
Supraspinatus suprascapular nerve
Infraspinatus
Subscapularis
Teres Major
Innervation
Upper Subscapular nerve
Axillary nerve:
Off the posterior cord
Lower Subscapular nerve
Teres Minor
Deltoid
Subscapularis
Subscapularis
Teres major
Teres Minor
Teres Major
Suprascapular nerve
Supraspinatus
Infraspinatus
Originates in the supraspinous fossa of the scapula

Inserts into the superior facet of the greater tubercle of
humerus
Initiates abduction, and assists the deltoid with abduction of
the arm; its the only one that doesn't rotate the arm.
Infraspinatus suprascapular nerve

-
Originates in the infraspinous fossa of the scapula

Inserts into the middle facet of the greater tubercle of
humerus
Laterally rotates the arm
Teres Minor axillary nerve

-
Originates from the middle of the lateral border of scapula

Inserts into the inferior facet of the greater tubercle of
humerus
Laterally rotates the arm
Subscapularis upper and lower subscapular nerves

-
Originates in the subscapular fossa

Inserts into the lesser tubercle of humerus
Medially rotates and abducts the arm
Muscles and Nerves involved in the movements of the shoulder joint
flexion:
pectoralis major (clavicular head) medial and lateral pectoral nerve
deltoid (anterior part) axillary nerve
coracobrachialis musculocutaneous nerve
biceps femoris musculocutaneous nerve
extension:
deltoid (posterior part) axillary nerve
teres major lower subscapular nerve
abduction:
deltoid (central part) axillary nerve

supraspinatus suprascapular nerve
adduction:
pectoralis major medial and lateral pectoral nerve
latissimus dorsi thoracodorsal nerve
subscapularis - upper and lower subscapular nerve
infraspinatus suprascapular nerve
teres minor axillary nerve
medial rotation:
subscapularis
pectoralis major medial and lateral pectoral nerve
deltoid (anterior part) axillary nerve
latissimus dorsi thoracodorsal nerve
lateral rotation:
infraspinatus suprascapular nerve

long head of triceps radial nerve
coracobrachialis musculocutaneous nerve
short head of biceps musculocutaneous nerve
Fascia and compartments of the proximal arm

Section at a level just short of half-way along the humeris
Brachial Fascia
-
Encloses the upper arm like a sleeve

Superiorly, it is continuous with the deltoid fascia,
infraspinatus fascia and pectoralis fascia
Inferiorly, it is attached to the epicondyles of the
humerus and the olecranon of ulna
It is continuous with the antebrachial fascia the
fascia of the forearm
o It contains two SEPTA: the MEDIAL and
LATERAL INTERMUSCULAR SEPTA.
o The septa are attached to the supracondylar
ridges and to the shaft of humerus
o They separate the arm into the
ANTERIOR COMPARTMENT and the
POSTERIOR COMPARTMENT
Anterior compartment
Medial intermuscular septum
Posterior compartment
Lateral intermuscular septum
Anterior Compartment: FLEXORS

- Biceps Brachii
Supplied by the
MUSCULOCUTANEOUS
- Brachialis
- Coracobrachialis NERVE
- Median nerve
- Musculocutaneous nerve
The medial cutaneous nerve of forearm is not inside
the fascial sheath, but is still important enough to warrant a

brief mention.
The Basilic vein and the Cephalic vein are

usually superficial to the fascial planes
Cephalic vein
- Triceps Brachii
- Anconeus
- Radial nerve
Supplied by the
RADIAL NERVE
Deep artery of the arm (profunda brachii)
Superior ulnar collateral artery
Ulnar nerve as depicted here is in the posterior
(A branch of the brachial artery)
compartment; it travels anteriorly to the medial intermuscular

septum, until it pierces it about half-way down the humerus,
together with the superior ulnar collateral artery
Radial nerve
Lateral intermuscular septum
Biceps brachii
Lateral
intermuscular
septum
Posterior Compartment: EXTENSORS
Deep artery of the arm
Musculocutaneous nerve
Ulnar nerve
Median nerve
Triceps brachii
Brachialis
Medial
intermuscular
septum
Deltoid:
Not actually a part of the anterior
compartment, as it has its own
fascial compartment.
Basilic vein
Brachial artery
Coracobrachialis
Medial cutaneous
nerve of forearm
Medial intermuscular septum

The innervation and mechanics of the flexor and extensor muscle compartments of the arm
Anterior Compartment: FLEXORS
All supplied by the MUSCULOCUTANEOUS NERVE
Biceps Brachii
Two heads:
-
SHORT HEAD:
o
o
Biceps Brachii
Supraglenoid tubercle
ligament
Brachialis
-
Transverse
humeral
ligament
LONG HEAD:
The lateral head.

Originates from the supraglenoid tubercle of the
glenoid fossa
The biceps inserts into the tuberosity of radius; and it also inserts
into the antebrachial fascia by virtue of the bicipital aponeurosis.
It does very different things depending on what position the
arm is in:
o
It supinates the forearm by pulling on the
aponeurosis, when the arm is pronated; it is the
MOST POWERFUL SUPINATOR of the forearm
o
when the forearm is supine if FLEXES the elbow joint
by pulling on the attachment to the radial tuberosity.
o
It is useless as a flexor when the forearm is pronated.
The short head resists dislocation of the shoulder
Coracobrachialis
-
Bicipital aponeurosis
Coronoid process and
the tuberosity of ulna
Tuberosity of radius
The medial head.

Originates from the tip of the coracoid process
o
o
Coracobrachialis
Tip of the coracoid
process
Some of the brachialis is

innervated by the radial nervethe half that is posterior to the
insertion of deltoid
Short head
Long head
Originates at the tip of the coracoid process of scapula

Inserts into the middle third of the medial humerus
Helps flex and adduct the arm
Resists dislocation of the shoulder: its a SHUNT muscle, it
resists the downward dislocation of the humeral head
Stabilizes the glenohumeral goint
A landmark it is pierced by the musculocutaneous nerve
Brachialis
-
Originates from the distal half of the anterior humerus

Inserts into the tuberosity of the ulna, and the coronoid process
Flexes the forearm in all positions its the PRIMARY FLEXOR
Posterior
Compartment: EXTENSORS
.
All
supplied by the RADIAL NERVE
Triceps Brachii
Infraglenoid tubercle
Lateral head
of triceps
Long head of triceps
LONG HEAD:
o
Originates from the infraglenoid tubercle
LATERAL HEAD:
o
Originates from the proximal humerus, more
proximal than the radial groove
MEDIAL HEAD:
o
Originates from the posterior surface of the humerus,
distal to the radial groove
The united triceps inserts into the olecranon of ulna
Medial head of triceps
It is the chief extensor of the arm.

The long head resists dislocation of the head of humerus,
especially during abduction
Anconeus
Anconeus
-
Originates from the posterior lateral epicondyle of humerus

Inserts into the lateral surface of olecranon
Assists the triceps in flexing the forearm, and stabilizes the
elbow joint. It also pulls the joint capsule out of the way of the
olecranon upon extension; otherwise it would get pinched in
the olecranon fossa . Many anatomists believe it to be a vestigial
and forgotten 4th head of the triceps.
Fascia and compartments of the distal arm

Section at the junction of distal third and proximal two thirds of the humerus
Biceps brachii
Musculocutaneous nerve
Coracobrachialis
Brachial artery
Cephalic vein
Lateral cutaneous nerve of

forearm which has just branched off
Median nerve
from the MUSCULOCUTANEOUS nerve
Brachialis
Posterior cutaneous nerve of
forearm which has just branched off
Basilic vein
from the RADIAL nerve
Medial cutaneous nerve

of forearm which arises
Deep artery of the arm
from the MEDIAL CORD of the

brachial plexus
Radial nerve
Lateral
head
Medial
head
Ulnar nerve
Long
head
Section at the level of the humeral epicondyles

Triceps brachii
Basilic vein
Cephalic vein
Brachial artery
Radial nerve which has pierced the

lateral intermuscular septum a little while
ago, and now travels between brachialis
and brachioradialis
Median nerve
Biceps brachii
Brachioradialis
Brachialis
PRONATOR TERES
which is important for

a number of reasons:
-
Forms the lateral border

of the cubital fossa
Innervated by the RADIAL NERVE
Flexes the forearm, unlike
the rest of the forearm extensor
compartment
Together with the Supinator, they
are the only extensor compartment
muscles which do not cross the wrist
and cause no movement there
Ulnar nerve
Anconeus
Triceps Brachii tendon
Which is unimportant, and arguably useless. In fact some anatomists believe it to a rudimentary 4th
triceps head. If it were missing, you would likely not notice.
Fascia and compartments around the cubital fossa and distal forearm
Section at the level of the neck of radius
Antebrachial Fascia
-
Median cubital vein
Basilic vein
Cephalic vein
Extension of the brachial fascia

Also envelops the forearm like a sleeve
There are no intermuscular septa per se; the
muscles are all invested in their own fascia;
however there are still two recogniseable
compartments: the FLEXOR compartment and
the EXTENSOR compartment.
In 20% of people, the basilic vein branches off into a

median basilic vein, and when it joins the median
cephalic vein they form a clear M.
THERE ARE 17 MUSCLES CROSSING THE ELBOW JOINT.
Basilic vein
Cephalic vein
Median antebrachial vein
The BICEPS TENDON: one part blends with the antebrachial fascia;
The other part dives deep to attach to the radial tuberosity
Highly variable tributaries

Brachial artery which bifurcates at the level
of the radial head in the cubital fossa
Brachialis
Brachioradialis
Pronator teres which originates proximally to

the medial epicondyle, and forms the medial border
of the cubital fossa
Which forms the lateral

border of the cubital fossa
The Flexors of the forearm which originate

at the Common Flexor origin, at the medial
epicondyle of the humerus
The branches of the Radial Nerve
BrR
ECRL, B
ED
Superficial branch of the

radial nerve which travels
under brachioradialis down the
arm, where it supplies sensation
to the dorsum of the hand
Deep branch of the Radial Nerve which

will pierce the Supinator, penetrate the
interosseous membrane and become the
Posterior Interosseous Nerve
Biceps tendon
Radial artery
Ulnar artery
Daughters of the recently

bifurcated Brachial Artery
Median nerve which travels between the heads of P. teres

Pronator Teres
Brachioradialis
Flexor Digitorum Superficialis

(humeral head)
Extensor Carpi Radialis

Longus and Brevis
Flexor Carpi Radialis
Brachialis
Palmaris Longus
Neck of
Radius
ULNA
Flexor Carpi Ulnaris which is fully

innervated by the ulnar nerve, unlike the
rest of the flexors
Extensor Digitorum
Ulnar nerve, which runs between the two

heads of flexor carpii ulnaris
Annular Ligament
Anconeus
Flexor Digitorum Profundis

Half of which is innervated by the ulnar nerve, unlike the rest
of the flexors (which are all supplied by the Median nerve)
COMPARTMENTS IN THIS SECTION are not clear-cut or sensible.

-
This is an intersection of several compartments. The EXTENSOR compartment of the forearm is anterolateral, represented by
brachioradialis, extensor carpi radialis longus and brevis, and extensor digitorum. The FLEXOR compartment is posteromedial and
represented by pronator teres, palmaris longus, flexor carpi ulnaris, and flexor digitorum profundus and superficialis. The ANTERIOR
compartment of the arm is represented by the biceps tendon, and by brachialis.
Anconeus is a lonely representative of the POSTERIOR compartment.
Fascia and compartments of the middle forearm

Section at the level of the mid-forearm
Boundaries of the compartments:
Lateral border: radial artery
Interosseous membrane
Medial border: subcutaneous ulna
The border between layers 1-2 and layers 3-4 is the primary
neurovascular plane of the anterior compartment: the
neurovascular bundles exclusive to this compartment travel within it
FLEXOR COMPARTMENT
Palmaris Longus
This is the beefier compartment; twice as fat as the extensor compartment
Flexor carpi ulnaris

(ulnar nerve)
Flexor carpi radialis

4 layers of muscles:
Median nerve
LAYER 1: pronator teres(not

shown, too proximal)

Palmaris longus
Flexor carpi ulnaris
LAYER 2: Flexor digitorum
superficialis
Flexor
digitorum
superficialis
Flexor Pollicis
Longus
LAYER 3:Flexor pollicis longus

Flexor digitorum
profundis
LAYER 4:Pronator Quadratus

(not shown, too distal)
Flexor
digitorum
profundus
Anterior
Interosseous
Artery
Anterior Interosseous Nerve
Half of the Flexor Digitorum Profundus which is
innervated by the ulnar nerve, unlike the rest of the
flexors (which are all supplied by the Median nerve
Ulnar Nerve
Ulnar Artery
Medial cutaneous nerve of forearm
EXTENSOR COMPARTMENT
Lateral cutaneous
nerve of the forearm
Brachioradialis
Radial artery
Extensor carpi
radialis longus
Superficial branch of the radial nerve

Supinator
Extensor pollicis Brevis
Abductor pollicis longus
Muscles of a similar purpose are

grouped together in compartments.
The EXTENSORS are posteromedial, and
the FLEXORS are anterolateral. They
spiral round the arm and eventually the
flexors become truly anterior and the
extensors become truly posterior.
Functionally, the forearm includes the

distal humerus because the muscles that
attach at the supracondylar ridges and
the epicondyles stretch along the
forearm to move the wrist and fingers.
BOUNDARIES OF THE COMPARTMENTS
Extensor carpi
radialis brevis
Extensor pollicis Longus

Extensor carpi ulnaris
POSTERIORLY (proximal forearm) and

MEDIALLY (distal forearm), the
subcutaneous border of the ulna

ANTERIORLY (proximal forearm) and
then LATERALLY (distal forearm),
Extensor digitorum
Posterior interosseous nerve
Posterior interosseous artery
Extensor indices
the radial artery

Because neither of these boundaries
is crossed by motor nerves they are
used for surgical incisions
The Flexor Compartment of the Forearm

Pronator teres
Humeral head
Ulnar head is
hidden, but it
originates from
the coronoid
process
COMMON FLEXOR ORIGIN:

Pronator teres, humeral head
Palmaris longus
Flexor carpi ulnaris, humeral head
Flexor digitorum superficialis,
humeral head
LAYER 1:
All of these, except the ulnar head of pronator quadratus, attach to the medial humeral epicondyle at the
COMMON FLEXOR ORIGIN
Flexor carpi Ulnaris

Two heads, one originating
from the humerus, the
other from the olecranon
Inserts into the

Pisiform
Hook of hamate
Base of the 5th metacarpal
Flexor digitorum superficialis

Humeroulnar head
(common flexor origin and the
coronoid process)
Radial head
PRONATOR TERES
Forms the medial border of the cubital fossa; its the most lateral of the first layer of muscles
Has an ulnar head and a humeral head
The humeral head originates from the COMMON FLEXOR ORIGIN
The ulnar head originates from the coronoid process
Median nerve: mainly Layers 1 and 2
Pronates and flexes the elbow
Pronator teres
FLEXOR CARPI RADIALIS
o
Originates from the COMMON FLEXOR ORIGIN
Palmaris longus
o
Inserts into the base of the 2nd metacarpal
Flexor digitorum superficialis
o
Flexes and abducts the wrist
Anterior Interosseous nerve: mainly layer 3
o
About half-way down the forearm, its belly is replaced
Flexor digitorum profundus, lateral half
by a flat tendon which becomes cord-like at the wrist
Flexor pollicis longus
o
It travels in the lateral carpal tunnel inside its own
Pronator quadratus
synovial sheath (it doesnt share)
Ulnar nerve:
o
The radial artery is just lateral to this tendon
flexor digitorum profundus, medial half
flexor carpi ulnaris
PALMARIS LONGUS
o
Originates from the COMMON FLEXOR ORIGIN
o
Inserts into the distal flexor retinaculum, and palmar aponeurosis.
o
Flexes and abducts the wrist, tenses the palmar aponeurosis
o
Its actually absent in 14% of people (usually on the left side). Those people dont miss it being gone.
o
The tendon of palmaris longus is a marker for where the median nerve is the tendon passes medially
to it, and then deep to it in the flexor retinaculum
o
o
o
o
o
Palmaris Longus
Flexor carpi
radialis
The belly is
replaced by
a flat tendon
which
becomes
cord- like at
the wrist
Median nerve
Lateral to the
palmaris
longus tendon
Radial
Artery
Lateral to the
flexor carpi
radialis
tendon
All supplied by the MEDIAN NERVE, except:
The flexor compartment Flexor Digitorum Profundis, ulnar half

has 4 discrete layers:
Flexor Carpi Ulnaris, whole
FLEXOR CARPI ULNARIS

o
o
o
o
o
Ulnar nerve
Has an ulnar and a humeral head

Humeral head originates from the COMMON FLEXOR ORIGIN; Ulnar head originates from the
olecranon, and posterior border of ulna
Inserts into the pisiform, hook of hamate and the 5th metacarpal.
Flexes and abducts the wrist; has its own synovial sheath
The tendon of flexor carpi ulnaris is a marker for the ulnar artery, which passes laterally to it at the wrist
LAYER 2
-
FLEXOR DIGITORUM SUPERFICIALIS

o
o
o
o
Flexor digitorum
profundus:
Supplied by
MEDIAN NERVE
ULNAR NERVE
Flexor pollicis longus
LAYER 3
-
FLEXOR DIGITORUM PROFUNDUS

o
o
o
o
o
o
o
The flexors digitorum profundus and

superficialis are WEAKER when the
wrist is flexed, the tendons arent tense
The fast flexor of the fingers. Has two heads: humeroulnar head and radial head
The humeroulnar head originates from BOTH the COMMON FLEXOR ORIGIN and the coronoid process
of ulna; the radial head originates the proximal half of the radius
It inserts into shafts of the middle phalanges
It flexes the metacarpophalangeal joints and the proximal interphalangeal joints; it can flex each joint
independently of the others.
Its tendons are enclosed in the COMMON FLEXOR SHEATH together with the tendons of flexor
digitorum profundus
The slow flexor of the fingers

Originates from the interosseous membrane, and from the proximal three quarters of the anterior surface
of the ulna. It has two parts: medial and lateral parts;
The medial part is innervated by the ulnar nerve
Ulnar nerve
The medial part flexes the distal interphalangeal joints of the 4th and 5th digits
nd
rd
The lateral part flexes the distal interphalangeal joints of the 2 and 3 digits
All parts can flex the wrist joint as well as the fingers
The lateral part is innervated by the ANTERIOR INTEROSSEOUS NERVE (a branch of the median
nerve).
The tendon to the index finger tends to separate early; its the only one which can operate independently.
Unlike the flexor digitorum superficialis, the profundus flexes all the DIPs together.
FLEXOR POLLICIS LONGUS

o
o
o
o
Pronator Quadratus
Originates from the anterior surface of the radius and the nearby interosseous membrane
Inserts into the base of the distal phalanx of thumb. It has its own synovial sheal in the carpal tunnel
Also innervated by the ANTERIOR INTEROSSEOUS NERVE
It flexes the phalanges of the thumb; mainly the distal interphalangeal joint (its the only muscle that
flexes the DIP of the thumb)
LAYER 4
-
PRONATOR QUADRATUS
o
o
o
It originates from the distal quarter of the ulna, and inserts into the distal quarter of the radius
It is innervated by the ANTERIOR INTEROSSEOUS NERVE
It pronates the forearm (its the PRIMARY PRONATOR of the forearm) and its fibers hold the radius and
ulna together. When speed is needed, it is assisted by the Pronator Teres.
Extensor Compartment of the Forearm: Superficial layer

SUPERFICIAL LAYER OF EXTENSORS
All extend the forearm, wrist or fingers
two originate from the supracondylar ridge as well as the adjacent
EXCEPT BRACHIORADIALIS
Brachioradialis is the solitary exception:
it is in the extensor compartment, but it flexes the forearm.
It is the only flexor innervated by the radial nerve.
All supplied by the RADIAL NERVE, or some branch thereof

two layers: the SUPERFICIAL and DEEP
intermuscular septum:
Brachioradialis
o
o
o
o
o
o
Brachioradialis
Common extensor origin
Extensor Carpi
Radialis Longus
radial nerve
Inserts at the lateral surface of the distal end of the radius
Flexes the forearm, in a feeble way, and mostly when the forearm
is pronated; it also acts as a shunt muscle to prevent subluxation
of the head of radius. its most active in quick movements, and in
movement against resistance.
Forms the lateral border of the cubital fossa
under it run the radial nerve and the radial artery
Distally, its tendon is covered by the tendons of Abductor Pollicis
Longus and Extensor Pollicis Brevis.
Extensor Carpi Radialis Longus

o
o
o
o
o
radial nerve
Inserts at the dorsum of the 2nd metacarpal, at the base
extends and abducts the hand at the wrist
probably more involved in abduction than the ECRB
it is crucial in the clenching of the closed fist.
Four originate from the common extensor origin, at the lateral

epicondyle of the humerus
Extensor Carpi Radialis Brevis

o
o
o
o
o
o
Extensor Digitorum
Extensor Carpi Ulnaris
Extensor Digiti Minimi
o
Extensor Carpi
Radialis Brevis which
lies under the Extensor
Carpi Radialis Longus
o
o
Extensor Digitorum
The fattest muscle here
Tendon sheaths:
Extensor carpi ulnaris
has its own; and so
does extensor digiti
minimi. The extensor
digitorum shares a
sheath with the tendon
of Extensor Indicis
Brachioradialis tendon
which lies under
the tendons of
Abductor Pollicis Longus
and
Extensor Pollicis Brevis
o
o
o
posterior interosseous nerve which is really the continuation of

the deep branch of the radial nerve
inserts at the extensor expansions of the fingers
THE EXTENSOR EXPANSIONS are triangular aponeuroses
which wrap around the metacarpal head, and the proximal
phalanx. They are united with the insertions of the lumbricals and
the interosseous muscles.
The tendons thus divide into a median band which passes to the
base of the middle phalanx, and two lateral bands which insert at
the base of the distal phalanx.
Extends the fingers, primarily at the metacarpophalangeal joint;
secondarily at the distal interphalangeal joint.
Occupies a lot of space in the extensor compartment
Shares an extensor tendon sheath with the Extensor Indicis
Just proximally to the metacarpophalangeal joints, the
tendons are linked by intertendinous connections which
prevent the fingers from being independently extended; thus
you can never fully extend a finger while the others remain
flexed. This is most true of the ring finger.

The common tendon
sheath of th extensors
carpi radialis: both travel
within the same sheath
o
o
o
o
o
The Tendon of Extensor

Digit Minimi divides into
two tendons; the lateral
one joins the extensor
digitorum tendon to the
little finger
deep branch of radial nerve

Inserts into the dorsum of the 3rd metacarpal at the base
extends and abducts the hand at the wrist
it is covered by the Extensor Carpi Radialis Longus
They also share the same extensor tendon sheath at the wrist
the brevis is more involved in extension than the longus
The Insertions of the Extensors

Carpi Radialis tendons:
Bases of the metacarpals
Longus inserts into the 2nd
Brevis inserts into the 3rd
Intertendinous connections which

unite the extensor digitorum
tendons and prevent the digits from
extending independently
posterior interosseous nerve

Divides into two tendons- the lateral one joins the pinky tendon of
the extensor digitorum, and then together with the medial one all
three insert into the extensor expansion of the pinky finger.
extends the pinky, primarily at the metacarpophalangeal joint;
secondarily at the distal interphalangeal joint.
this is really just a detached part of the extensor digitorum
However, it has its own tendon sheath

o
o
o
o
o
o
posterior interosseous nerve

yes it does originate at the common extensor origin; thats the
humeral head. There is also an ulnar head, which originates at the
ulnar border posteriorly, via an aponeurosis. This origin is also
shared with the Flexor Digitorum profundis and the Flexor Carpi
Ulnaris.
inserts at the dorsum of the base of 5th metacarpal
extends the hand at the wrist joint, and abducts it
It has its own tendinous sheath at the wrist
It is also crucial to the formation of the closed fist
Extensor Compartment of the Forearm: Deep layer

DEEP LAYER OF EXTENSORS
"true" deep layer
Supinator
o
o
Supinator
Attachments of the Supinator to the

Epicondyle of humerus
Radial collateral ligament
Annular ligament of radius
Ulnar Supinator crest and fossa
Ulnar posterior surface
Interosseous membrane
o
o
o
Extensor Indicis
o
o
Abductor pollicis longus
o
o
o
the Supinator wraps around the
radius to insert into the anterior
surface of it. Together with the
brachialis it forms the floor of
the cubital fossa
Extensor Pollicis Longus
these originate from the proximal, middle and distal thirds of the ulna (as a
generalization). They emerge in the surface in the furrow that forms in the
extensor compartment
o
o
Extensor Indices
Which shares an extensor
tendon sheath with the
Extensor Digitorum tendon

originates from the posterior surface of the distal third of
the ulna, and the interosseous membrane
inserts into the extensor expansion of the index finger
extends the index finger, enabling independent extension
helps extend the hand at the wrist
"outcropping" deep layer
o
o
deep branch of radial nerve which pierces it on its way

to transforming into the posterior interosseous nerve
originates from everywhere... the lateral humeral
epicondyle, the radial collateral ligament, the annular
ligament, the supinator fossa and the crest of ulna
inserts into the lateral posterior and anterior surfaces of
the proximal third of radius
it supinates the forearm, turning the arm to face anteriorly
and superiorly when the forearm is flexed. It is the
PRIME MOVER for slow unopposed suination
The supinator forms the floor of the cubital fossa together
with brachialis. It is a sheet-like muscle, and it envelops
the radius.

originates from the posterior surface of the proximal
radius and ulna, as well as the interosseous membrane
inserts into the base of the 1st metacarpal, and
occasionally also the trapezium.
abducts and extends the thumb at the carpometacarpal
joint
shares a common tendon sheath with the extensor
pollicis brevis at the wrist

Common sheath for the
tendons of the extensor
pollicis brevis and abductor
pollicis longus
o
o
o
o
o
o
o

originates from the posterior surface of the distal third of
the ulna, and the interosseous membrane
inserts into the dorsum of the base of the proximal
phalanx of the thumb
extends the proximal phalanx of the thumb at the
metacarpophalangeal joint; also extends the
carpometacarpal joints of the thumb.
partly covered by the abductor pollicis longus
its tendon is immediately medial to the APL
these two tendons form the anterior boundary of the
anatomical snuffbox.

o
o
o
Extensor digitorum tendon
Extensor expansion
Medial band attaches to the base of
the middle phalanx
o
o
Lateral bands attach to the

base of the distal phalanx
The hood which attaches to the palmar tendon

originates from the posterior surface of the middle third
of the ulna, and the interosseous membrane
inserts into the dorsum of the base of the distal phalanx
of the thumb
extends the distal phalanx of the thumb; also extends
the metacarpophalangeal and the carpometacarpal joints
of the thumb. It also rotates the thumb laterally.
It enjoys its own tendon sheath at the wrist; it passes
medially over the dorsal tubercle of radius, using it as a
pulley.
the EPL forms the posterior border of the anatomical
snuffbox
APL inserts into the base of 1st metacarpal

EPB inserts into the base of proximal phalanx
EPL inserts into the base of distal phalanx
Flexor and Extensor Tendons at the Wrist: level of the Distal Radioulnar Joint
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Palmaris Longus
Ready to merge with the
palmar aponeurosis
Flexor Pollicis Longus
Median Nerve
Ulnar Artery
Ulnar nerve
Radial Artery
Flexor Carpi Ulnaris can cover the ulnar
artery and obscure its pulsation
ULNA
RADIUS

Extensor Digitorum
Extensor Indices

The Extensor Retinaculum

-- attaches
Attaches to the lateral border of the radius
-
Does NOT attach to the border of the ulna, because the ulna moves too much.
Instead, attaches to the pisiform and the triquetrum
Also attaches to the ridges of the radius, thus forming osseofibrous tunnels for the above tendons to run
through
There are 6 tunnels in total:
1. One for abductor pollicis longus and extensor pollicis brevis
2. One for extensor carpi radialis longus and extensor carpi radialis brevis
3. One for extensor pollicis longus
4. One for extensor digitorum and extensor indices
5. One for extensor digiti minimi
6.
One for extensor carpi ulnaris
The Carpal Tunnel and its Contents

This is a narrow enclosed space. Needless to say, if anything in here swells, the median nerve will get
compressed. It is the most sensitive structure in the carpal tunnel.
The lateral three and a half digits will get diminished sensation
Sensation on the thenar eminence will be spared because the palmar cutaneous branch splits
from the median nerve long before the flexor retinaculum
The movement of the thenar muscles is controlled by a terminal motor branch of the median nerve,
and so the thenar muscles will atrophy in carpal tunnel syndrome
Ulnar Artery
Palmaris Longus
Ulnar Nerve
Hypothenar muscles
Thenar muscles
TRAPEZIUM

HAMATE
TRAPEZOID

CAPITATE
Radial Artery
Crossing over to the
dorsum of the hand
Extensor Digiti minimi

Extensor Indices
Extensor Digitorum
Tuberosity of
Trapezium
Hook of Hamate
Flexor retinaculum
Median Nerve
Tuberosity
of Scaphoid
Flexor Digitorum
Superficialis
Pisiform
Flexor Pollicis Longus

Flexor Digitorum Profundus
The Flexor retinaculum is stretched between four

bony posts:
1) Hook of hamate
2) Pisiform bone
3) Tuberosity of scaphoid
4) Tuberosity of trapezium
A Summary of the Innervation of the Extensors and Flexors of the Forearm
Flexors
Extensors
All innervated by branches of the RADIAL NERVE
Radial nerve itself: innervates muscles with attachments proximal to
the cubital fossa
- Brachioradialis
- Extensor Carpi Radialis Longus
- Both of these originate at the supracondylar ridge
Deep branch of the radial nerve: a branch which splits off from
the radial nerve at the level of the humeral condyle in the cubital fossa; it
pierces the supinator muscle, and becomes the posterior interosseous nerve
- Extensor Carpi Radialis Brevis

- Supinator
Posterior interosseous nerve: travels along the posterior aspect
of the interosseous membrane; innervates most of the extensor muscles
Extensor digitorum
Extensor Indicis
Extensor Digiti minimi
Innervated by either the ULNAR or the MEDIAN nerves
Median nerve itself:

- Pronator Teres
- Palmaris Longus
- Flexor carpi Radialis
- Flexor Digitorum Superficialis
Anterior interosseous nerve, a branch of the median nerve:
- Flexor Digitorum Profundus - lateral half
- Flexor Pollicis Longus
- Pronator Quadratus
Ulnar nerve:
- Flexor Digitorum profundus, only the medial half
- Flexor Carpi Ulnaris
Ulnar nerve :
Innervates the muscles
directly adjacent to it along
its course down the arm
Radial nerve is in red
Deep branch of
the radial nerve
is in pink
Median nerve:
Innervates mainly the 1st
and 2nd layer of flexors
Anterior Inerosseous
nerve: innervates the 3
deepest muscles
Posterior interosseous nerve is in green
Fascia, Septa, Tendon Sheaths and the Potential Spaces of the Hand
These fascial layers are continuous with
the fascial sleeve of the forearm.
Centrally the fascia of the palm thickens
in the centre, where the palmaris
longs tendon attaches to it, which is
also where it merges with the flexor
retinaculum. This whole thickened
area is called the palmar aponeurosis.
Distally, the palmar aponeurosis divides
into four bands which attach to the
bases of the proximal phalanges, and
there it becomes a part of the
digital sheaths
All merge into the

Palmar Aponeurosis
Palmaris Longus tendon

Antebrachial Fascia
Flexor retinaculum
The Thenar Space
Palmar Aponeurosis
so thick and tough that any infections
in the palmar spaces will actually
cause the weaker DORSAL fascia to
bulge out.
In Dupuytrens contracture, the
palmar aponeurosis becomes nodular,
fibrosed, and thickened
Thenar fascia
The Midpalmar Space

Palmar Aponeurosis
Hypothenar fascia
Lateral fibrous septum of the palm

which stretches from the palmar
aponeurosis to the 3rd metacarpal
Medial fibrous septum of

the palm which stretches from the palmar
aponeurosis to the 5th metacarpal
Unlike the thenar

space, this one is
continuous with the
anterior compartment
of the forearm- it
communicates with it
via the carpal tunnel.
Digital Synovial Sheaths
Of the two septa, the LATERAL is the strongest
The common flexor sheath continues to the

5th digit. The other digits have their own
Digital Synovial Sheaths
Synovial sheath for Flexor
Pollicis Longus
Common flexor sheath: FDS and FDP
Synovial sheath for Flexor
Carpi Radialis
Compartments of the palm and their contents

Thenar compartment
Contains the thenar muscles
Adductor compartment
Contains only Adductor Pollicis
Central compartment
Contains the flexor tendons and their
sheaths, the lumbricals, the superficial
arterial palmar arch, and the digital
vessels and nerves
Hypothenar compartment
Contains the hypothenar muscles
Interosseous compartments
Contains the interossei muscles
Thenar Compartment
Flexor Pollicis Brevis: Superficial head
which is innervated by the MEDIAN NERVE
Central
Compartment
Deep Head which is innervated by the

DEEP BRANCH OF THE ULNAR NERVE
1st and 2nd Lumbricals which are unipennate and which are
innervated by the MEDIAN NERVE
3rd and 4th Lumbricals which are bipennate and which are
innervated by the DEEP BRANCH OF THE ULNAR NERVE
Abductor Pollicis Brevis
Abductor Digiti Minimi
Opponens Pollicis
Hypothenar
Compartment
Adductor Pollicis
Opponens Digiti Minimi
Adductor compartment
Flexor Digiti Minimi Brevis
1st Dorsal Interoissei

3rd Palmar Interoissei
1st Palmar Interoissei
Interosseous compartment
2nd Dorsal Interoissei

2nd Palmar Interoissei
rd
3 Dorsal Interoissei
4th Dorsal Interoissei
Thenar and Hypothenar muscles

There are 3 Thenar muscles, 3 Hypothenar muscles, 1 Adductor muscle, 4 Lumbricals, 4 dorsal interossei and 3 palmar interossei
ADDUCTOR POLLICIS, which has
2 heads, between the origins of which the
RADIAL ARTERY emerges to form the
deep palmar arch
Transverse head of Adductor Pollicics,
which originates from the 3rd metacarpal
Oblique head of Adductor Pollicics,
which originates from the 3rd metacarpal
as well as from the 2nd metacarpal, the
capitate bone, and all adjacent carpal
bones

Which originates from the
flexor retinaculum and the
hook of hamate, and inserts
into the medial border of
the 5th metacarpal
Adductor pollicis inserts into the lateral

part of the 1st proximal phalanx
Flexor pollicis brevis with two heads: the
superficial and the deep. The deep head is
innervated by the deep branch of the ulnar
nerve

Which originates from the flexor
retinaculum and the hook of
hamate, and inserts into the
medial side of the base of the 5th
proximal phalanx
Abductor Digiti Minimi
Which originates at the
pisiform and inserts into the
medial side of the base of
base of 5th proximal phalanx
Abductor Pollicis Brevis

Both of these muscles originate from the
flexor retinaculum and the tubercles of
scaphoid and trapezium; they both insert
into the lateral aspect of the base of the
proximal phalanx of the thumb.
Flexor retinaculum
Opponens Pollicis
Also originates from the flexor

retinaculum and the tubercles of scaphoid and trapezium;
however it inserts into the lateral border of the 1st metacarpal.
Hypothenar Muscles
In the HYPOTHENAR compartment
o
o
o
o
o
deep branch of ULNAR NERVE

originates from hook of hamate and the flexor retinaculum
inserts into the medial border of the 5th metacarpal
pulls the 5th metacarpal anteriorly, and rotates the 5th digit so
it can participate in opposition with the thumb
acts exclusively at the MCP joint

o
o
o
o

originates from hook of hamate and the flexor retinaculum
inserts into the medial side of the base of the 5th proximal
phalanx
flexes the proximal phalanx of the 5th digit
Abductor digiti Minimi

o
o
o
o
o

originates from the pisiform
inserts into the medial surface of the bae of the 5th proximal
phalanx
Abducts the 5th digit and assists in its flexion
It is the most superficial of the three hypothenar muscles
Thenar Muscles
In the ADDUCTOR compartment
Both ofPollicis
these muscles originate from the flexor retinaculum
Adductor
-
and the tubercles of scaphoid and trapezium; they both insert

o
deep branch of the Ulnar nerve
into the lateral aspect of the base of the proximal phalanx of the
TRANSVERSE HEAD originates from the anterior surface of the 3rd
thumb.
metacarpal
OBLIQUE HEAD originates from the bases of the 2nd and 3rd
metacarpals, from the capitate bone, and from any carpals around the
capitate.
Inserts into the medial side of the base of proximal phalanx of thumb.
There tends to be a sesamoid bone at the site of insertion.
Adducts the thumb towards the lateral border of the palm (presses
it against the palm)
In the THENAR compartment

Flexor Pollicis Brevis
o
o
o
o
o
DEEP HEAD: deep branch of ULNAR NERVE

SUPERFICIAL HEAD: Recurrent branch of MEDIAN NERVE
originates from the flexor retinaculum and the tubercles of the
scaphoid and trapezium.
Inserts into the lateral aspect of the base of the proximal phalanx
of the thumb
Flexes the thumb: brings its tip towards the base of pinky
Abductor Pollicis Brevis: Recurrent branch of MEDIAN NERVE

There is also Palmaris Brevis; a useless little muscle which wrinkles
the skin of the palm; it originates at the flexor retinaculum and inserts
into the skin. The ulnar nerve innervates it.
IT IS NOT PART OF THE HYPOTHENAR COMPARTMENT
o
o
o

scaphoid and trapezium.
Inserts into the lateral aspect of the base of the proximal phalanx
of the thumb
Abducts and helps oppose the thumb
Opponens Pollicis Brevis: Recurrent b. of MEDIAN NERVE

o
o

scaphoid and trapezium; Inserts into the lateral side of the 1st
metacarpal.
Opposes the thumb: medially rotates and the pulls medially the
1st metacarpal. Acts exclusively at the MCP joint
Short muscles of the Hand

o there are 4 lumbricals, 4 dorsal interossei, and 3 palmar interossei; you count them starting at the THUMB
The LUMBRICALS
-
Originate from the tendons of the FLEXOR DIGITORUM PROFUNDIS

Sit in the central compartment of the palm
From the palm, cross over to the dorsum of the hand
Insert into the extensor expansions on the dorsum of the proximal
phalanges
The FIRST and SECOND lumbricals are innervated by the median
nerve. All other short muscles are innervated by the deep branch of the
ulnar nerve
The THIRD and FOURTH lumbricals are bipennate; the other two are
unipennate
FLEX the metacarpophalangeal joints
EXTEND the proximal interphalangeal joints
Together the short muscles all produce the Z movement of the fingers; the MCPs are
flexed, and the PIPs extended. This is the opposite of what happens in ulnar nerve palsy
(claw hand) when the MCPs are extended and the PIPs are flexed.
The DORSAL INTEROSSEI

-
Originate from the sides of two metacarpals (ALL of them are bipennate)
Sit in their own INTEROSSEOUS compartment of the hand
Insert into the bases of the proximal phalanges and into the extensor
expansions
ABDUCT the hand away from the axis of the middle finger (the axis as
shown)- hence DAB ( Dorsal Interosei ABduct)
Also help the lumbricals flex the MCPs and extend the PIPs
When the thumb is flexed, the first dorsal interossei can be seen as the
lump that appears on the dorsum of the hand.
The Interossei all live inside the INTEROSSEOUS compartment. The Palmar
interossei occupy the anterior (palmar )part of it, and the dorsal interossei are
more properly between the metacarpals.
The PALMAR INTEROSSEI

-
Originate from the palmar surfaces of the metacarpals

Sit in the anterior part of the INTEROSSEOUS compartment of the hand
Inset into the bases of the proximal phalanxes and into the extensor
expansions
ADDUCT the fingers towards the middle finger,
hence PAD- Palmar Interossei Adduct
There are only 3 palmar interossei; the deep part of the Flexor Pollicis
Brevis can be described as the 4th, because it does much the same
thing as the rest, and is innervated by the same nerve
References: Moores Clinically Oriented Anatomy 5th edition

Anatomy - UPPER LIMB - 3 Muscles, Innervation and Compartments of The Upper Limb

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Anatomy - UPPER LIMB - 3 Muscles, Innervation and Compartments of The Upper Limb

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Muscles, Innervation and the Compartments of the Upper Limb

Fascia and compartments of the shoulder

The only contents is Pectoralis Major;

Continuous with the CLAVIPECTORAL FASCIA

Supraspinous, Infraspinous and Subscapular fascia

Anterior Axioappendicular Muscles of the Shoulder

Anterior Axioappendicular muscles

All supplied by stupidly different nerves.

CLAVICULAR HEAD: lateral pectoral nerve

Originates from the medial half of the anterior

STERNOCOSTAL HEAD: medial pectoral nerve

Originates from the anterior surface of the sternum,

Its inferior border forms the anterior axillary fold

The heads can act independently:

from its flexed position.

Pectoralis Minor medial pectoral nerve

Subclavius nerve to subclavius

Lateral Pectoral nerve:

Serratus anterior long thoracic nerve

Long Thoracic Nerve:

Pectoralis Minor; sternocostal head of Pectoralis Major

Originates from the lateral surfaces of the first 8 ribs

Posterior Axioappendicular Muscles of the Shoulder: the Extrinsic Group

Also supplied by confusingly different nerves.

Trapezius spinal accessory nerve

The external occipital protuberance

Has 3 distinct parts:

Floor of the intertubercular

SUPERIOR (descending)part which elevates

All the parts together act to rotate the scapula superiorly, so

Latissimus dorsi Thoracodorsal nerve

Inserts into the ANTERIOR surface of the humerus, at the floor

Levator scapulae dorsal scapular and cervical nerves

Dorsal scapular nerve:

Rhomboid major and minor

Originates at the posterior tubercles of the spinous processes

Rhomboid Minor dorsal scapular nerve

Originates from the nuchal ligament and the spinous processes

Rhomboid Major dorsal scapular nerve

Originates from the spinous processes of T2,3 4and 5

Posterior Axioappendicular Intrinsic muscles

Deltoid axillary nerve

Originates from the lateral third of the clavicle, the

Anterior part flexes and medially rotates the

Teres major lower subscapular nerve

Originates from the posterior surface of the inferior

Rotator Cuff Muscles

Supraspinatus suprascapular nerve

Upper Subscapular nerve

Lower Subscapular nerve

Originates in the supraspinous fossa of the scapula

Infraspinatus suprascapular nerve

Originates in the infraspinous fossa of the scapula

Teres Minor axillary nerve

Originates from the middle of the lateral border of scapula

Subscapularis upper and lower subscapular nerves

Originates in the subscapular fossa

Muscles and Nerves involved in the movements of the shoulder joint

deltoid (central part) axillary nerve

infraspinatus suprascapular nerve

Fascia and compartments of the proximal arm

Encloses the upper arm like a sleeve