Dr. Adelia Matanguihan-Quijano, M.D.

June 21, 2011

Skeleton
1. Axial skull + vertebral column + ribs)
-central supporting axis
2. Appendicular - limbs + bones to axial skeleton
*sternoclavicular joint - only joint that connects the
upper limbs
*all other attachments are muscular
Dense Connective Tissues:
1. Tendons muscle to bone
2. Ligaments bone to bone
3. Retinacular keeps tendons in place
4. Bursae fluid filled cavities
5. Synovial sheath
I. Bones of the UPPER LIMB
1. Pectoral Girdle (Shoulder) = clavicle + scapula
- connected to manubrium of sternum
a. Clavicle (collar bone)
- a movable crane-like strut from which the
scapula and free limb are suspended at a
distance from the trunk that enables
freedom of motion
- first long bone to ossify and last to be fully
formed
b. Scapula (shoulder blade)
- connects upper limb to trunk
- forms the mobile base from which the free
limb acts
- a triangular flat bone to conform to the
thoracic wall to provide large surface areas
and edges for attachment of muscles
2.

Brachium (Arm) = humerus

- longest segment of the limb
- connects shoulder and elbow
- mobile strut used to position the hand at a
height/level and distance from the trunk to
maximize efficiency

3.

Antebrachium (Forearm) = radius + ulna

- connects elbow and wrist
a. Radius
- lateral and shorter of the two forearm bones
b. Ulna
- stabilizing bone of the forearm
- medial and longer of the two forearm bones
- for articulation with the humerus

4.

Carpus (Wrist) = 8 carpal bones

Scaphoid
Kunate
Pisiform
Trapezium
Capitates
Hamate

5.

Manus (Hand) = 5 metacarpals (digits) + 14

phalanges (5 proximal, 4 middle/pollux
& 5 distal) = 32/side (total)
- supplied with sensory endings for touch,
pain, and temperature

Triquetrum
Trapezoid

*thumb is not considered a finger

be able to distinguish and name bones regardless of

orientation of hand i.e. supinated or pronated
thumb doesnt have a middle phalanx
32 bones upper limbs
Muscle Nomenclature
refer to their:
size (used singly or in combination) shape
location
origin
orientation
action
number of heads
insertion
Be able to locate origins and insertions. Understand
how they produce particular joint actions. Study
derivation of each name (muscle, bone).

II. Fascial Compartment of the UPPER LIMB

1. Superficial Fascia
- Fatty; thick dense connective tissue
(subcutaneous); intermuscular septum;
fascicles
2. Deep (Investing) Fascia
- Dense connective tissue; could extend
inward to attach to bones
- According to area found (derivatives):
a. Anterior
Pectoral fascia
Axillary fascia forms the floor of
the axilla (suspensory ligament)
b. Posterior
Deltoid
Brachial
*palmar aponeurosis: dense connective tissue in the
middle of the palm

ANATOMY 3rd Lecture

deltopectoral groove superficial vein: cephalic vein

clavipectoral fascia (covers pectoralis minor)
- at the deltopectoral groove
- costocoracoid membrane
- coracopectoral fascia / costocoracoid
membrane
- structures piercing membrane:
cephalic vein subclavian vein
thorocoacrominal artery
lateral pectoral vein (through the
coracopectoral fascia)

suspensory ligament pulls the axillary fascia

upward as you abduct forming the axillary fossa

- elevates and rotates scapula upward in

elevation of arms
- provides direct attachment of pectoral
girdle to the trunk
b. Latissimus dorsi
- extends, adducts and medially rotates
humerus
- widest of back; from lower back
- raises body toward arms during
climbing
triangle of ausculaation - bordered by lateral part of
trapezius, upper boarder of latissimus dorsi and
medial part of teres major; best area to auscultate the
lungs
intrinsic muscles origin is in the same area of action
extrinsic muscles origins is of different area from area
of action
*between major and minor muscles, the minor is smaller
and more superior

III. Muscles of the UPPER LIMB

A. Superficial Muscles of the THORAX
1. Anterior
i. Pectoral muscle (acts on the upper limbs)
ii. Pectoralis major
fan-shaped; 2 heads: clavicle & sternal
portion; helps in flexion (flexor)
- flexes, adducts and medially rotates
- covers the superior part of the thorax
iii. Pectoralis minor ribs 3 to 5; inserts into the
corocoid proc. of the scapula
- stabilizes the scapula and elevates ribs
- used when stretching the upper limb
forward to touch an object that is out of
reach (adductor)
iv. Serratus anterior pulls the scapula inward
towards the thoracic wall; holds the scapula
to the chest wall
v. Subclavius slender muscle; draws clavicle
inferiorly and anteriorly

Winging of scapula paralysis of the serratus

anterior/ injury to long thoracic nerve
major always sits inferiorly to the minor

c. Teres minor laterally rotates arm

d. Teres major extends, adducts and
medially rotates arm
e. Levator scapulae elevates scapula
f. Rhomboid major adduct and rotates
scapula; draw scapula towards midline
g. Rhomboid minor - adduct and rotates
scapula
h. Deltoid (main abductor of arm) triangle
multipennate : several actions
- clavicular (anterior) part: flexes and
medially rotates arm
- acromial (middle) part: abducts arm
beyond 15 degrees
- spinal (posterior) part: extends and
laterally rotates arm
*serratus anterior: for abduction beyond
90 degrees
i. Supraspinatus - initiates and assists deltoid
in abduction of arm (up to 15 degrees)
j. Infraspinatus - laterally rotates and
adducts arm
k. Subscapularis medially rotates arm
*glenohumeral joint not very stable due to
disproportion of the articulating surfaces of the head of the
humerus and the glenoid fossa (the head is bigger than the
receiving cuff); inferior portion is the least protected region of
the joint
*axilla: pyramidal space inferior to the glenohumeral
joint and superior to the axillary fascia at the junction of the
arm and thorax

2.

Posterior 2 layers:
i. Superficial
ii. Deeper for postural maintenance
a. Trapezius muscle (triangular; 11th cranial
nerve)
ANATOMY 3rd Lecture

Quadrangular Space
1. Teres minor (above)
2. Teres major (below)
3. Triceps brachii, long head (medial)
4. Humerus (lateral)
Contents: Axillary nerve and Posterior humeral
circumflex artery

(to what degree is the humerus abducted? 15

degrees)
rotator cuff muscles (SITS) - reinforce the joint
capsule; hold head of humerus in glenoid cavity of
scapula
S upraspinatus
I nfraspinatus
T eres minor
S ubscapularis
axillary nerve is affected when head of humerus is
damaged

Triangular Space
1. Teres minor (above)
2. Teres major (below)
3. Triceps brachii
Contents: Dorsal scapular artery (circumflex) from the
subscapular anastomosis
The circumflex subscapular artery, a branch of the
scapular artery passes through this space to form part of
the scapular anastomosis
Scapular anastomosis - used as a collateral circulation
when there is a block in the proximal part of the axillary
artery since it interconnects branches from the subclavian
artery and the third part of the axillary artery
B. Muscles of the ARM

1.

Anterior Compartment = 3 flexors + supinator

i. Muscles = Flexion of the arm
a. biceps brachii - flexion of the forearm at the
elbow and shoulder joints; supinator of
forearm
- long head & short head (origin at the
scapula and inserts at the radial tuberosity);
long head appears shorter while short head
appears longer
b. coracobrachialis - flexion at the shoulder joint,
adducts humerus
c. brachialis - major flexor at the elbow joint
*coracobrachialis + brachialis : penetrated by
musculocutaneous nerve
ii. Nerve supply = Musculocutaneous nerve
- muscular branches to the arm
- cutaneous branches to the forearm
iii. Blood supply = Brachial artery

2.

Posterior Compartment = 2 extensors; extension of

elbow joint
i. Muscles = Extension of the arm
a. triceps brachii (chief extensor of forearm)
- long head = extension of shoulder joint
ANATOMY 3rd Lecture

- lateral and medial head = extension of

elbow joint
- blood supply: profunda brachii which arises
from brachial artery
b. brachioradialis - relatively weak flexion of
forearm
c. anconeus - assists triceps in extending
forearm; stabilizes elbow joint; may abduct
ulna during pronation
ii. Nerve supply = Radial nerve
iii. Blood supply = Brachial artery
C. Muscles of the FOREARM
- interosseous membrane between the radius and
the ulna
- nerve supply: median nerve
- Extrinsic Muscles of the Hand
1. Anterior Compartment = flexors (elbow jt) +
pronators
i. Superficial flexor and pronator
- common tendinous origin: medial epicondyle
- insertion: wrist joint
- forearm pronators:
a. pronator teres (round) pronates and
flexes forearm (at elbow)
- wrist flexors:
a. flexor carpi radialis - flexes and abducts
hand at wrist
b. palmaris longus (tendinous) the only
tendon that will cross flexor
retinaculum; aka spare tendon
c. flexor carpi ulnaris
d. flexor digitorum superficialis tendons
insert to the middle phalanges of the 2nd
to the 5th

Nerve supply: median nerve (except for flexor carpi

ulnaris and medical half of flexor digitorum profundus
by ulnar nerve)

ii. Intermediate
iii. Deep insertion goes beyond the wrist joint; flexor
of digits and pronator
a. flexor digitorum profundus
b. flexor pollicis longus - flexes thumb (1st digit)
c. pronator quadratus - pronates forearm

2.

all muscles are supplied by median n. except 1 and

muscles (flexor carpi ulnaris and ulnar half of flexor
digitorum profundus) which are supplied by ulnar n.
blood supplied by the radial and ulnar a.
Posterior Compartment
- Nerve supply: radial nerve
- Blood supply: radial and ulnar artery

b. Extensor digitorum communis

c. Extensor digiti minimi
d. Extensor carpi ulnaris - adductor of hand at
wrist

ii. Supinator
a. Abductor pollicis longus
b. Extensor pollicis longus
c. Extensor pollicis brevis
d. Extensor indicis
*Anatomic snuffbox subfascial space bounded by extensor
pollicis brevis and longus tendons and abductor pollicis
longus; floor: scaphoid and trapezium; pulsations of the radial
artery can be felt here
IV. Fascia: Wrist and Hand
A. Fascial Spaces
1. Carpal tunnel
a. median nerve
b. flexor tendons of digitorum:
Superficialis
Profundus
pollicis longus
2. Thenar (thumb area) components:
a. A bductor pollicis brevis (most lateral)
b. F lexor pollicis brevis
c. O pponens pollicis
3. Hypothenar (medial side of thumb area)
a. A bductor digiti minimi
b. F lexor digiti minimi
c. O pponens digiti minimi
4. Central component:
a. Palmar space
Thenar
midpalmar
b. Synovial flexor sheaths
Ulnar bursa contains tendons of flexor
digitorum superficialis and profundus
Radial bursa contains tendon of flexor
pollicis longus
Synovial sheaths for 2nd to 4th digits
B. Palmar fascia
1. thenar fascia
2. hypothenar fascia
3. palmar aponeurosis : between thenar and
hypothenar fascia

*brachioradialis flexes elbow joint (exception)

i. Extensor (Superficial group)

a. Extensor carpi radialis longus and brevis abductor of hand at wrist

carpi = wrist
profundus = deep
quadratus = squar
tere = round
pollicis = thumb
radial pulse: between the brachioradialis and flexor
carpi radialis
anatomical snuffbox: extensor pollicis brevis and
longus tendons (by radial artery)

Dupuytrens contracture due to thickening and

contracture of palmar aponeurosis; ring and little
finger flexed into palm and 1st to 3rd digits extended
(papal benediction)
ANATOMY 3rd Lecture

C.

Retinacula
1. palmar carpal ligament - lies superficial to flexor
retinaculum
2. extensor retinaculum
3. flexor retinaculum

G. Interosseous - in between metacarpals; nerve supply:

ulnar nerve
1. 4 dorsal bipennate : abduction
2. 3 palmar unipennate : adduction
3. 1 adductor pollicis for thumb

D. Dorsal fascia
E. Fibrous flexor sheaths of digits - covering of flexor
digitorum tendons
F. Vincula - attach superficial and deep flexor tendons
to middle and distal phalanges
- provide route for blood supply to tendons

nerve supply: ulnar nerve (except: thenar

compartment muscles and 1st two lumbricals by
median nerve)
Lumbrical Muscles:
Nerve Supply:
1st and 2nd
median nerve
3rd and 4th
ulnar nerve
act on MP joints : externsion of PIP and DIP

Short Muscles:
1. Lumbricals in central compartment; worm-like
2. Interossei 3 palmar (adduction); 4 dorsal
(abduction); between bones
3. Adductor pollicis
*All intrinsic muscles by the hand will be supplied by ulnar
nerve except for the first 2 lumbricals (supplied by median
nerve.

ANATOMY 3rd Lecture