The upper limb

Muscles That Move the

Pectoral Girdle

Originate on the axial skeleton and insert on the clavicle and

scapula.
Stabilize the scapula and move it to increase the arms angle of
movements.
Some of the superficial muscles of the thorax are grouped
together according to the scapular movement they direct.
elevation, depression, protraction, or retraction

The muscles of back

Superficial group
Trapezius
Latissimus dorsi
Levator scapulae
Rhomboideus
Deep group
Erector spinae
Splenius
Thoracolumbar fascia

The muscles of thorax

Extrinsic muscles
Pectoralis major
Pectoralis minor
Serratus anterior
Intrinsic muscles
Intercostales externi
Intercostales interni
Intercostales intimi

The Muscles of Upper Limb

Muscles of shoulder
Deltoid
Supraspinatus
Infraspinatus
Teres minor
Teres major
Subscapularis

Major muscles of shoulder

Deltoid

Origin: lateral third of

clavicle, acromion, and
spine of scapula
Insertion: deltoid tuberosity
of humerus
Action: abduction, flexion
and extension, medial and
lateral rotation of arm

Major muscles of shoulder

Teres major

Origin: dorsal surface

of inferior angle of
scapula
Insertion: crest of
lesser tubercle of
humerus
Action: medially rotates
and adducts arm

Arm and Forearm Muscles That Move

the Elbow Joint/Forearm

Anterior (flexor) compartment

Posterior (extensor) compartment
Anterior compartment
primarily contains elbow flexors
Posterior compartment contains elbow extensors
the principal flexors

biceps brachii, brachialis, and brachioradialis

muscles that extend the elbow joint

triceps brachii and anconeus

Muscles of arm

Antererior group

Biceps brachii
Coracobrachialis
Brachialis

Posterior group

triceps brachii
anconeus

Muscles of arm
Biceps brachii
Origin: long head,
supraglenoid tubercle; short
head, coracoid process
Insertion: radial tuberosity
Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint

Muscles of arm
Triceps brachii

Origin:

long head, infraglenoid tubercle

lateral head, above groove for
radial nerve
medical head, below groove for
radial nerve

Insertion: olecranon of ulna

Action: extends elbow joint,
long head extends and adducts
shoulder joint

Triceps brachii

Forearm Muscles
Supinate and Pronate

Supinator muscle supinates the forearm.

Biceps brachii supinates the forearm.
Pronator teres and pronator quadratus pronate the forearm.

Move the Wrist Joint, Hand, and Fingers

Muscles in the forearm move the hand at the wrist and/or the fingers.
Extrinsic muscles of the wrist and hand originate on the forearm, not
the wrist or hand.
Tendons of forearm muscles typically are surrounded by tendon
(synovial) sheaths and held adjacent to the skeletal elements by strong
fascial structures.
At the wrist, the deep fascia of the forearm forms thickened, fibrous
bands termed retinacula.

Muscles of forearm

Superficial layer

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

Muscles of forearm
Pronator teres
Origin: medical epicondyle of
humerus and deep fascia of
forearm
Insertion: middle of lateral
surface of radius
Action: pronation of forearm
and flexion of elbow

Second layer
Flexor digitorum superficials

Third layer

Flexor digitorum
profundus
Flexor pollicis longus

Fourth layer

Pronator quadratus

Action: flex radiocarpal

joint and fingers,
pronate forearm

Lateral group (3)

Brachioradialis
Extensor carpi radialis
longus
Extensor carpi radialis
brevis

Posterior group (8)

Superficial layer (3)

Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Action: extension at
wrist joint

Posterior group (8)

Deep layer (5)
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Action: extend at wrist
joint and fingers, and
supinate forearm

Muscles of hand

Lateral group thenar (4)

Action: flex, abduct, adduct

and oppose thumb
Medial group hypothenar (3)

Abductor pollicis brevis

Flexor pollicis brevis
Opponens pollicis
Adductor pollicis

Abductor digiti minimi

Flexor digiti minimi brevis
Opponens digiti minimi

Action: flex, abduct , and oppose

little finger

Muscles of hand
Intermedial group
Lumbricales (4) flex
fingers at MP joints;
extend fingers at IP
joints
Palmar interossei (3)
adduct fingers towards
middle finger at MP
joints
Dorsal interossei (3)
abduct fingers away
from middle finger at
MP joints

Arteries of upper limb

Axillary artery

Continuation of subclavian artery at

lateral border of first rib
Becomes brachial artery at lower
border of teres major
Divided into three parts by overlying
pectoralis minor

First portion, above muscle gives

rise to thoracoacromial a.
Second portion, behind muscle
gives rise to lateral thoracic a.
Third portion, below muscle gives
rise to subscapular a., anterior and
posterior humeral circumflex a.; the
former then divides into throcodorsal
a. and circumflex scapular a.

Arteries of upper limb

Brachial artery
Continuation of axillary
artery
Divides into radial and
ulnar arteries at level of
neck of radius
Branches

Deep brachial a.
accompanies with radial
nerve
Superior ulnar collaeral a.
accompanies with ulnar
nerve
Inferior ulnar collateral a.

Arteries of upper limb

Radial artery and branches
Radial recurrent a.
Superfical palmar branch
Principal artery of thumb
Ulnar artery and branches
Ulnar recurrent a.
Common interosseous artery

Anterior interossous a.
Posterior interosseous a.

Deep palmar branch

Arteries of upper limb

Superficial palmar arch
Formed by ulnar artery
and superficial palmar
branch of radial artery
Curve of arch lies across
the palm, level with the
distal border of fully
extended thumb
Gives rise to three
common palmar digital
arteries each then divides
into two proper palmar
digital arteries

Arteries of upper limb

Deep palmar arch
Formed by radial artery
and deep palmar branch
of ulnar artery
Curve of arch lies across
upper part of palmar at
level with proximal border
of extended thumb
Gives rise to three palmar
metacarpal arteries

Veins of the upper limb

Deep veins: accompany the
arteries of the same region and
bear similar names
Superficial veins
Cephalic vein

Arises from the lateral side of

the dorsal venous rete of hand
Ascends on radial side of the
forearm to the elbow and then
in the lateral side of biceps
brachii furrow, continues up the
arm in the deltopectoral groove
and then to the infraclavicular
fossa, where it pierces
clavipectoral fascia to drain into
axillary vein

Basilic vein

Arises from the medial side of

the dorsal venous rete of
hand
Ascends on the ulnar side of
forearm to the elbow and then
in the medial bicepital brachii
furrow to middle of the arm
where it pierces the deep
fascia and joins the brachial
vein or axillary vein

Median cubital vein

links cephalic vein and basilic
vein in the cubital fossa. It is a
frequent site for venipuncture
to remove a sample of blood
or add fluid to the blood

The lymphatic drainage of

Lymphaticlimb
vessels
upper
Superficial follow the
superficial veins, drain into
supratrochlear and axillary
lymph nodes
Deep accompany main
vessels, end in axillary lymph
nodes
lymph nodes
Cubital lymph node: lies above
medial epicondyle of humerus
Axillary lymph node arranged
in five groups

Axillary lymph nodes

Arranged in five groups

Lateral lymph nodes

lie around
the distal end of axillary vein ,
receiving drainage from the arm,
forearm, and hand
Pectoral lymph nodes lie along
lateral thoracic vessels, receive
afferents from anterior thoracic wall
including central and lateral portion of
mamma
Subscapular lymph node along
subscapular vessels, receive lymph
from nape and scapular region
Efferents above three groups pass to
central lymph node

Central lymph node

lie in fat of axillary fossa,

receive drainage from all the
above nodes, efferents pass
to apical lymph node

Apical lymph node

Lie in the apex of the axilla,

along the proximal end of
axillary vessels
Receive drainage chiefly from
central lymph node , upper
portion of mamma
Efferents form subclavian
trunk, the right subclavian
trunk joints the right
lymphatic duct; left usually
drains directly into thoracic
duct

Brachial plexus
Formation:

Five roots: formed by anterior rami

of C5-C8 and T1 spinal nerves,
roots C5-C7give rise to long
thoracic n.
Three trunks

The upper trunk is formed by the

joining of root C4,C5,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.

Position:
passes through the scalene fissure to
posterosuperior of subclavian artery, then
enters the axilla to form lateral, medial and
posterior cords

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 cutaneous n.

Posterior cord

radial n.
axillary n.
thoracodorsal n.

Musculocutaneous
Distribution: Biceps
brachii, brachalis and
coracobrachialis BBC
nerve; skin on
anterior aspect of
forearm

Median nerve

Distribution: Flexors of
forearm except
brachioradialis, flexor carpi
ulnaris and ulnar half of flexor
digitorum profundus,
thenar 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: Apehand
produces sign of
benediction, in which the
index and middle fingers
cannot be flexed and the
thumb cannot be opposed

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 onehalf fingers
Injury: clawhand

Radial nerve

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: Wristdrop

Axillary

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
weel external rotation)
with loss of sensation
over the deltoid