You are on page 1of 4

Anatomy of the Upper Limb

The bones of the upper limb include that of the shoulder girdle (clavicle, sternum and the
scapula), and the humerus, ulna, radius, and the carpal and hand bones.

The anterior pectoral (thoracoappendicular) muscles include pectoralis major, pectoralis minor,
subclavius and serratus anterior.

The posterior pectoral muscles include trapezius, latissimus dorsi, levator scapulae, rhomboid
minor and major, deltoid and teres major.

The rotator cuff muscles include supraspinatus, infraspinatus, teres minor and subscapularis.

Movement (flexion/extension and pronation/supination), and between the arm and forearm
occur at the elbow. The flexors of the arm are the muscles of the anterior compartment
(biceps brachii, brachialis and coracobrachialis), and the extensor is the posterior
compartment (triceps brachii). The flexor-pronators of the forearm are in the anterior
compartment of the forearm (superficial group [crosses elbow]: pronator teres, palmaris
longus, flexor carpi ulnaris and flexor digitorum superficialis; deep group: flexor digitorum
profundus, flexor pollicis longus and pronator quadratus). The extensor-supinators of the
forearm are in the posterior compartment of the forearm. Those that extend the hand at the
wrist joint are extensor carpi radialis longus and brevis, and extensor carpi ulnaris. Those
that extend the medial four digits are extensor digitorum, extensor indicis and extensor digiti
minimi. Those that extend the thumb are abductor pollicis longus, extensor pollicis brevis
and longus. The prime mover between the arm and forearm is the supinator muscle.

The intrinsic muscles of the hand are as follows:


1) Thenar muscles (abductor pollicis brevis, flexor pollicis brevis and opponens pollicis)
2) Adductor pollicis
3) Hypothenar muscles (abductor digiti minimi, flexor digiti minimi brevis and opponens
digiti minimi)
4) Short muscles (lumbricals, palmar (adductors) and dorsal (abductors) interossei)

Cubital fossa
The boundaries of the cubital fossa are:
1) Superiorly – medial and lateral epicondyle
2) Medially – pronator teres
3) Laterally – brachioradialis
4) Floor – brachialis and supinator
5) Roof – deep fascia

The contents of the cubital fossa include:


1) Brachial artery
2) Biceps tendon
3) Medial nerve
4) Median cubital vein (superficial)

Arterial Supply of the Upper Limb


The arterial supply to the upper limb begins with the axillary artery (a continuation of the
subclavian artery) at the distal border of the first rib. The axillary artery becomes the
brachial artery at the distal border of teres major, and can be divided into three parts:
1) highest thoracic
2) thoracoacromial (acromiothoracic), lateral thoracic
3) subscapular, anterior and posterior circumflex humoral

The brachial artery passes distally in the anterior compartment of the arm, and divides into
the radial and ulnar arteries at the neck of the radius. It also gives off profunda brachii
branch which supplies the posterior compartment of the arm.

Ulnar artery
This passes medially and inferiorly into the anterior compartment of the forearm and
terminates as the superficial palmar arch in the hand.

Radial artery
The radial artery passes distally under brachioradialis, and is only palpable on the lateral
wrist. It enters the palm and terminates as the deep palmar arch.

Nerves of the Upper Limb


Nerves from the brachial plexus supply the upper limb.
1) The brachial plexus begins from the anterior primary rami of C5, 6, 7, 8 and T1
2) These then merge to form the upper (C5, 6), middle (C7) and lower trunks (C8 and T1)
3) Each trunk then divides into an anterior and posterior trunk
4) These then merge to form the lateral (anterior upper and anterior middle), medial (anterior
lower) and posterior (all posterior trunks) cords
5) The cords then form the musculocutaneous nerve (lateral cord), ulnar nerve (medial cord),
median nerve (lateral and medial cords), radial nerve (posterior cord) and axillary nerve
(posterior cord)

Axillary Nerve (C5, C6)


Arising from the posterior cord of the brachial plexus, the axillary nerve passes distally
round the surgical neck of the humerus, and supplies the deltoid and teres minor. It also has
a cutaneous supply to the area of skin over the deltoid.

Radial Nerve (C5, C6, C7, C8, T1)


The radial nerve supplies the extensor muscles of the arm and forearm, and the cutaneous
supply for the posterior aspect of the arm and hand. Arising from the posterior cord of the
brachial plexus, the radial nerve passes between the long and medial heads of the triceps,
and becomes intimately related to the spiral groove on the posterior aspect of the humerus. It
then enters the anterior compartment of the arm between brachialis and brachioradialis by
piercing through the intermuscular septum, and continues as the superficial radial nerve.

Musculocutaneous Nerve (C5, C6, C7)


The musculocutaneous nerve supplies the flexor muscles of the arm. Arising from the lateral
cord of the brachial plexus, the musculocutaneous nerve pierces coracobrachialis to run
between biceps and brachialis. It also supplies the sensation of the lateral forearm.

Ulnar Nerve (C7, C8 and T1)


The ulnar nerve supplies flexor carpi ulnaris, the hypothenar and intrinsic muscles of the
hand and lumbricals 3 and 4. It also supplies the skin of the dorsal aspect of the little finger
and half of the ring finger. Arising from the medial cord, the ulnar nerve passes distally
posterior to the medial epicondyle (‘funny bone’), into the forearm and running lateral to
flexor carpi ulnaris. It then passes over the flexor retinaculum and terminates as a superficial
branch.

Median Nerve (C6, C7, C8 and T1)


The median nerve supplies the flexor muscles of the forearm (except for flexor carpi
ulnaris), and the thenar muscles of the hand, and the radial two lumbricals. It also supplies
the skin of the mid palm (radial aspect), and the skin of the dorsal thumb, index, middle and
half of the ring finger. Arising from the lateral cord, the median nerve passes lateral to the
brachial artery before crossing it to lie on the medial aspect of the humerus, and passes into
the forearm between the muscles of pronator teres. The median nerve then passes deep to the
flexor retinaculum and terminates in the hand.

pictures

You might also like