Anatomy of upper limb

Gross anatomy of upper limb

1. Anatomy of Upper Limb Dr. Md. Galib Raihan Resident ( Phase-A), Department of Physical Medicine And Rehabilitation Dhaka Medical C ollege

2. Upper Limb 1- Surface Anatomy of upper limb 2- Skeleton of the upper limb . 3 - Joints of the upper limb . 4 - Muscles of the upper limb. 5 - Nerves of the upper limb.

3. Surface anatomy of the upper limb . The upper limb divided to • The Shoulder • The Arm • The Forearm • The Hand • The A xilla

4. Surface Anatomy of Upper Limb Medial Epicondyle Lateral Epicondyle Olecranon Process Cubital Fossa Anterior surface elbow Contents Brachial Artery Median Nerve Boundaries Medial = Pronator teres Lateral = Brachioradialis Superior = Line between epicondyles

5. Surface Anatomy of Upper Limb Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains : Median nerve ,long tendons Anatomical Snuff box Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse)

6. Clavicle Scapula Humerus Radius U lna Carpals- Proximal Distal Metacarpals Phalanges Upper Limb Skeleton

7. Bones of Upper Limb Scapula

8. Bones of Upper Limb Clavicle

9. Bones of Upper Limb Humerus

10. Bones of Upper Limb Radius and Ulna

11. Bones of Hands

12. Clinical Anatomy of Related Bones: Clavicle Commonly fracture at junction between two curvature of bone by falling on outstretched hand. Cleidocranial dysostosis. Scapula Winging of scapula. Humerus Three nerves are related to it and liable to injury : axillary at surgical neck, radial at radial groove, ulnar behind the medial epicondyle. Common site of fracture surgical neck , shaft, supra condylar region. Volkmann’s ischaemic contracture. Dislocation of head of Humerus . Medial Epicondylitis, Lateral Epicondylitis. Student’s elbow Radius Colles’ fracture , smith’s fracture. Ulna Fracture of olecranon. Dislocation of elbow .

13. Joints of the upper limb.

14. MUSCLES OF UPPER LIMB In general they divided to Muscles attached the upper limb to axial skeleton . Muscles of the upper limb proper

15. Anterior Muscles Pectoralis major Pectoralis minor S ubclavius  Medial Serratus anterior Muscles attached the upper limb to axial skeleton

16. ORIGIN: S ternal half of the clavicle, Upper half of sternum, A poneurosis of ext.obl.muscle , INSERTION : Lateral lip of intertubercular sulcus ACTIONS : adduction, medial rotation flexion of the shoulder. N.SUPPLY : Med & Lat Pectoral.N (C5-8,T1) PECTORALIS MAJOR

17. PECTORALIS MAJOR

18. ORIGIN : C ostocondral jn.of 3,4,5 ribs INSERTION : Corocoid process medial &upper surface ACTIONS : D raws the scapula forwards depression of the shoulder. N.SUPPLY : Med & Lat Pectoral.N (C5-C8,T1)

19. ORIGIN: 1 st rib at the costochondral jn. INSERTION: Subclavian groove of the clavicle ACTION : Steadies the clavicle N.SUPPLY: N. Subclavius from upper trunk of brachial.plexus (c5,c6)

20. ORIGIN: Outer and superior surface of the 1-8 ribs INSERTION: Superior angle, medial border and inferior angle of the scapula ACTION: rotates scapula upwards abduction of shoulder above 90* N.SUPPLY: Long Thoracis.N (c5,c6,c7)

21. WINGING OF SCAPULA

22. M uscles of the Shoulder R egion Deltoid Teres major Supraspinatus Infraspinatus Teres minor Subscapularis The last 4 called Rotator cuff muscles

23. ORIGIN: Lateral 1/3 clavicle, sup.surface of acromion, spine of the scapula. INSERTION: deltoid tuberosity. ACTION: abduction of arm, flexion.&.extension of arm, med.& lat. rotation. N.SUPPLY: Axillary.N (C5,c6)

24. DELTOID

25. ORIGIN: dorsal surface of the inf.angle of the scapula INSERTION: med.lip of the intetubercular groove of the humerus ACTION: extends the arm from flexd.position & it adducts, med.rotates the arm N.SUPPLY : Lower Subscapular (C6,C7)

26. ORIGIN: supraspinatous fossa of the scapula INSERTION: superior facet on the gr.tubercle of the humerus ACTION: initiation of abduction (15*) lat. Rotation N.SUPPLY: Suprascapular.N From B.P (C5,C6)

27. ORIGIN: infraspinatous fossa of the scapula INSERTION: middle facet on the gr.tubercle of the humerus ACTION: lat.rotation of shoulder strengthen the shoulder by bracing the head of humerus . N.SUPPLY: Suprascapular .N of B.P (C5,c6)

28. INFRASPINATUS

29. ORIGIN: lat. Border of the scapula INSERTION: inf.facet on the gr. tubercle of the humerus ACTION: ext. rotator & weak adductor N.SUPPLY: Axillary .N.(C5,C6)

30. ORIGIN: medial 2/3 subscapular fossa, lat border of the scapula INSERTION: lesser tubercle of the humerus ACTION: stabilise the shoulder & prevents anterior displacement of the shoulder (med. rotation, adduction of arm) N.SUPPLY: Upper &Lower Subscapular .N (c5,c6)

31. ROTATOR CUFF MUSCLES

32. MOVEMENTS OF THE SHOULDER Flexion Extension Abduction Adduction Internal rotation, External rotation C ircumduction

33. FLEXION Pectoralis Major Anterior Fibers Of Deltoid Coraco brachialis

34. Lattisimus Dorsi Teres Major Posterior fibers Deltoid EXTENSION

35. ABDUCTION Supraspinatous (15*) Deltoid (15-90*) Serratus Anterior (>90*) Trapezius (>90*)

36. ADDUCTION Lattisimus Dorsi Pectoralis Major Subscapularis Teres Minor Teres Major Coracobrachialis

37. INTERNAL ROTATION Pectoralis Major Ant.Deltoid Subscapularis Teres Major Lattismus Dorsi

38. EXTERNAL ROTATION Deltoid Supraspinatus Infraspinatus Teres Minor

39. Muscles of arm

40. ORIGIN: Long head: supra glenoid tubercle of the Scapula. Short head: apex of the coracoid process INSERTION: Radial Tuberosity ACTION: F lexor of supinated forearm Powerful Supinator Of Partially Flexed Forearm N.SUPPLY: musculo cutaneous.N (c5,c6)

41. ORIGIN: coracoid process of the scapula INSERTION: middle of medial surface of the humerus ACTION: flexes and adducts the arm N.SUPPLY: musculocutaneous .N (c6,c7)

42. ORIGIN: D istal half of the anterior humerus INSERTION : C oronoid process, tuberosity of ulna ACTION: Powerful Flexor Of Forearm N.SUPPLY: Musculocutaneous .N (C5,C6,C7)

43. ORIGIN: Long head : infraglenoid tubercle of the scapula Lat. head: oblique ridge on upper surface above the radial groove Medial head : posterior surface of the humerus inf.to the radial groove INSERTION: proximal olecrenon of the ulna ACTION: extension of forearm N.SUPPLY: Radial .N.(C7,c8)

44. MOVEMENTS AT ELBOW FLEXION Brachialis Biceps EXTENSION Triceps

45. Anterior Compartment: Common Flexor Group : Superficial muscles Origin: Medial epicondyle of humerus

46. MUSCLES OF FOREARM POSTERIOR COMPARTMENT

47. Insertion: midway long the lateral surface of the radius Action: pronation, flexion of forearm N.Supply : Median.N (C6,c7)

48. PRONATOR TERES

49. Insertion: base of the 2 nd mc bone and slip to the base of the 3 rd MC bone Action: flexion and abduction of wrist N.Supply : Median.N (c6,c7)

50. INSERTION: Anterior aspect of the distal flexor retinaculum and palmar aponeurosis ACTION : Flexion of the wrist and Tightens the palmar.Aponeurosis N. SUPPLY : Median. N (c6,c7)

51. ORIGIN: Humoral head: med epicondyle Ulnar head:med.margin of the olecrenon,posterior border of the ulna INSERTION: pisiform, hook of hamate, base of the 5 th MC & flexor retinaculum ACTION : flexes and adducts the hand N.SUPPLY: Ulnar.N (C7,C8)

52. ORIGIN : Humeroulnar head: med.epicondyle of the humerus , coronoid process Radial head: sup.half of anterior aspect of the radius INSERTION : bodies of the Middle phalanges of the medial 4 digits ACTION: flexion.of all joints it crosses N.SUPPLY : Median .N (C7,C8,T1)

53. ORIGIN : prox.3/4 of the medial and anterior aspect of the ulna and from interosseous membrane. INSERTION: base of t he d istal phalanges of the medial 4 digits ACTION : Flexion of DIP,PIP,MP, wrist N.SUPPLY : Medial- ulnar.N (C8,t1) Lateral-AIN Of Median.N (C8,t1 )

54. ORIGIN : upper 3/4 of anterior surface of radius INSERTION : base of distal phalanx of the thumb ACTION : flexion of proximal & distal phalanx of the thumb N.SUPPLY : AIN (C7,C8,T1)

55. ORIGIN : lower 1/4 th of anterior surface of ulna INSERTION : lower 1/4 th of anterior surface of radius ACTION : pronation N.SUPPLY : AIN (C8,T1)

56. ORIGIN: posterior surface of the lat.epicondyle INSERTION: lateral surface of olecranon,body of ulna ACTION: extension of forearm N.SUPPLY: radial.n

57. ORIGIN : prox.2/3 rd of lat.supracondylar ridge of humerus , lateral intermuscular septum INSERTION : lat.aspect of distal radius just prox.to the styloid process ACTION : acc. flexor of elbow N.SUPPLY : Radial.N (C5,C6)

58. ORIGIN : lat.supracondylar ridge of humerus INSERTION: base of the 2 nd MC bone ACTION: extends and abducts the hand N.SUPPLY : Radial .N (C6,C7)

59. ORIGIN: lat.epicondyle of the humerus INSERTION : base of the 3 rd MC bone ACTION : extends and abducts the wrist N.SUPPLY : deep br.of radial .N(c7c8)

60. ORIGIN: lat epicondyle of the humerus INSERTION: Extensor Expansions Of The Medial 4 digits ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended N.SUPPLY: PIN (c7,c8)

61. ORIGIN : lat epicondyle of the humerus INSERTION : extensor expansion of the 5 th digit ACTION : ext.of 5 th digit at MC, PIP, ext of wrist when little finger in extension N.SUPPLY : PIN (c7,c8)

62. ORIGIN : 2 heads: lat epicondyle of humerus , Posterior border of ulna INSERTION : medial side of the base of the 5 th MC ACTION: extends and adducts the hand N.SUPPLY : PIN (c7c8)

63. ORIGIN : lat epicondyle of humerus , radial collateral lig , annular lig , supinator fossa, crest of ulna INSERTION : lateral,posterior,anterior surface of prox 1/ 3 rd 0f radius ACTION : supination N.Supply : deep Br.Of Radial.N (C5,c6)

64. SUPINATOR

65. MOVEMENTS OF FOREARM MUSCLES Flexion Extension Adduction Abduction AT RADIO ULNAR JOINT Supination pronation

66. FLEXION P ronator teres Flx.carpi radialis Flx.carpi ulnaris Flx.digitorum superficialis Flx . Digitorum profundus Palmaris longus brachioradialis

67. EXTENSION Anconeus Ext.Carpi Radialis Longus Ext.Carpi Radialis Brevis Ext.Digitorum Ext.Indicis Ext.Carpi Ulnaris Ext. Digiti Minimi Abductor Pollicis Longus

68. ADDUCTION flexor carpi ulnaris extensor carpi ulnaris ABDUCTION flx.carpi radialis ext.carpi radialis longus e xt.carpi radialis brevis abductor pollicis longus PRONATION pronator teres pronator quadratus SUPINATION biceps supinator

69.  Flexor retinalculum : thick band made of dense white fibrous tissue which stretch across the anterior surface of the carpal bones .  Form a tunnel known as carpal tunnel.  M edian nerve & tendons of muscles Through the tunnel .  Extensor retinaculum: It is a thickening of deep fascia between the lower ends of radius & ulna .

70. MUSCLES OF THE HAND Thenar muscles: abductor pollicis brevis flexor pollicis brevis opponens pollicis Adductor pollicis Hypothenar muscles- palmaris brevis abductor digiti minimi flexor digiti minimi opponens digiti minimi Lumbricals -4 Palmar interossei-4 Dorsal interossei-4 All these Muscles responsible for fine movements of fingers .

71. Brachial Plexus

72. Formation: Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves. Three trunks: The upper trunk is formed by the joining of rootC5,C6. The middle trunk is the continuation of root C7. The lower trunk is formed by the joining of root C8 and T1. Six divisions: above clavicle, trunks form anterior and posterior divisions Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a. Brachial Plexus

73. Main branches Lateral cord: Musculocutaneous n. Lateral root to median n. Medial cord: Medial root to median n. Ulnar n. Medial brachial cutaneous n. Medial antebrachial cut. n. Posterior cord: radial n. axillary n. thoracodorsal n.

74. Musculocutaneous N. Distribution: Biceps brachii Brachalis coracobrachialis skin on anterior aspect of forearm

75. Distribution: Flexors of forearm except brachioradialis , flexor carpi ulnaris and ulnar half of flexor digitorum profundus , T henar except adductor pollicis , first two lumbricals ; skin of thenar , central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum. Injury : Ape hand Median nerve

76. Ulnar Nerve Distribution: Flexor carpi ulnaris , ulnar half of flexor digitorum profundus , hypothenar muscles, interossei , 3rd and 4th lumbricals and adductor pollicis ; skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingers. Injury : claw hand

77. Distribution: Extensor muscles of arm and forearm, brachioradialis ; skin on back of arm, forearm, and radial side of dorsum of hand and radial two and one-half fingers Injury : Wrist drop Radial Nerve

78. Distribution: Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of arm Injury : results in deltoid and teres minor paralysis (loss of shoulder abdution and external rotation) with loss of sensation over the deltoid Axillary Nerve

79. Dermatomes Of Upper Limb