Limbs

General Body wall Head and neck Limbs Thoracic cavity Abdominal Pelvic cavity
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REGIONAL ANATOMY
Department of the human anatomy, NJMU
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Upper limbs
Lower limbs
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Upper limbs General
introduction
Lower limbs Structures
Dissections
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General
Upper limbs introduction
Lower limbs Structures Surface anatomy
Dissections Superficial fascia
Deep fascia
Muscles blood
vessels nerves
Regional structures
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Upper limb
Boundaries
Superior clavicalacrimoin
spinous process of C7
Anterior anterior border of the

deltoidanterior axillary fold
Posterior posterior border of the

deltoidposterior axillary fold
Subarea
Shoulder Arm Forearm Hand

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Upper limb
Surface landmark
Clavical
Spine of the scapula
Acromoin process of the scapula
Deltoid
Medial and lateral epicondyles
Olecranon process of ulna
Styloid process of the radius and
the ulna
Pisiform bone
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Upper limb
Layers
Skin
Superficial fascia
Deep fascia
Muscles, blood vessels

and nerves
Bones and joints

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Superficial fascia
Superficial veins
Brachial v. Subclavian v.
Dorsal venous network
Axillary v.
Basilic v.
of hand
Median cubital v.
Cephalic v.
The median cubital vein is easy to identify

and frequently used for blood sampling,
transfusion,and intravenous injection.
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Superficial fascia
Cutaneous nerves
Medial brachial cutaneous n.
the medial cord of brachial plexus
Medial brachial
Medial antebrachial cutaneous n. cutaneous n.
the medial cord of brachial plexus Medial antebrachial
cutaneous n.
(accompany with basilic vein)
Lateral antebrachial
Lateral antebrachial cutaneous n. cutaneous n.
musculocutaneous n. ( accompany Superficial branch
with the cephalic vein) of radial n.
Superficial branch of radial n.

radial n.
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Superficial fascia psoterior cutaneous n. of

the arm
Cutaneous nerves
Upper lateral cutaneous n. of

the arm axillary n. Upper lateral cutaneous
n. of the arm
Lower lateral cutaneous
Posterior cutaneous n. of the n. of the arm
arm: radius n. Posterior cutaneous
n. of the forearm
Lower lateral cutaneous n. of

the arm radius n.
Posterior cutaneous n. of the Superficial branch of

radial n.
forearm: radius n.
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Deep fascia
Arm
Intermuscular septum
Forearm
Intermuscular septum Bicipital
aponeurosis
Biciptial aponeurosis Flexor
retinaculum Extensor retinaculum
Flexor retinaculum
Extensor retinaculum
Palmar
Palmar aponeurosis
Palmar aponeurosis
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Muscles of the shoulder
Supraspinatus
Triangular muscle
Triangular muscle
Teres minor
(deltoid) Infraspinatus
Teres major
Supraspinatus
Latissimus dorsi
Infraspinatus
Teres minor
Teres major
Subscapularis
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Muscles of the shoulder

The supraspinatus, infraspinatus,
Supraspinatus
teres minor, and subscapularis Triangular muscle
Teres minor
are commonly called the Infraspinatus
Teres major
musculotendinous cuff. Their
Latissimus dorsi
distal tendons blend with and
reinforce the fibrous capsule of
the shoulder joint.

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Muscles of the Arm
Anterior group
Short head of biceps brachii
Long head of biceps brachii

Biceps brachii Coracobrachialis
Brachialis
Biceps brachii
Coracobrachialis Brachialis
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Muscles of the Arm
Posterior group
Triceps brachii Long head of triceps brachii
Lateral head of triceps brachii
Medial head of triceps brachii
Olecranon of ulna
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Muscles of the forearm

The first layer of the anterior group
Brachioradialis
Pronator teres Pronator teres

Flexor carpi radialis
Palmaris longus
Flexor carpi radialis,
Brachioradialis
Palmaris longus Flexor carpi ulnaris
Flexor carpi ulnaris

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The second layer of the anterior group
Flexor digitorum superficialis
Flexor
digitorum
superficialis
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The third layer of the anterior group
Flexor disitorum profundus
Flexor pollicis longus Pronator teres

Flexor disitorum
profundus
Flexor pollicis
longus
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The third layer of the anterior group
Flexor disitorum profundus

Flexor disitorum
profundus
Flexor pollicis longus
Flexor pollicis
longus
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The fourth layer of the anterior group
Supinator
Pronator quadratus
Pronator quadratus
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The first layer of the posterior
group
Extensor carpi radialis longus
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi radialis brevis
Extensor digitorum
Extensor digitorum
Extensor carpi ulnaris
Extensor digiti minimi Extensor digiti minimi
Extensor carpi ulnaris

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The second layer of the posterior
group
Supinator
Supinator
Abductor pollicis longus
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis brevis
Extensor pollicis longus Extensor pollicis longus
Extensor indicis
Extensor indicis
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Regional structures
Axillary cavity
Deltopectoral groove
Medial bicipital sulcus
Trilateral and quadrilateral foramen

Humeromuscular tunnel(radial nerve tunnel)
Cubital fossa
Median sulcus of the forearm
Carpal canal
General Body wall Head and neck Limbs Thoracic cavity Abdominal cavity Pelvic cavity
introduction
Axillary cavity
Position: between the upper
part of the arm and the chest wall P40
Boundaries: It has an apex, a
base, four walls
Apex: the middle third of the

clavicle, the superior border of
the scapula, the lateral border of
the 1st rib;
Base: skin, superficial, and the

axillary fascia (griddle fascia).
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Axillary cavity
Boundaries
Anterior wall: pectoralis major,

pectoralis minor, subclavius, clavipectoral
fascia, suspensory ligament of the axilla.
Posterior wall: subscapularis, scapula,

teres major, and latissimus dorsi,
Lateral wall: upper part of the shaft of

the humerus, coracobrachialis, short head
of the biceps brachii.
Medial wall: upper four intercostals

spaces, upper part of the serratus anterior.
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Axillary cavity
Contents
Axillary sheath
Axillary artery
Axillary lymph nodes
Branchial plexus
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Axillary sheath
Axillary sheath is derived
from the prevertebral layer
of the deep cervical fascia.
It encloses the axillay artery,
vein and the brachial plexus.

introduction
Axillary artery
It can be divided into three parts by the pectoralis minor
The branch of the axillary

arterys first part
Superior thoracic a. :supplying

pectoral muscles and the 1st
intercostal space
Superior thoracic a.
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The branch of the axillary arterys second part
Thoracoacromial a.: pectoral

branch -- the pectoral muscles and Thoracoacromial a.
breast. clavicular branch -- the
sternoclavicular joint and the
subclavius. acromial branch
supplies the skin over the
acromion. deltoid branch nourishes
the anterior portion of the deltoid
muscle.
Lateral thoracic a.: the lateral

thoracic wall and the lateral part of Lateral thoracic a.
the mammary gland (in females).

introduction
The branch of the axillary arterys third part

Subscapular a.: circumflex
scapular artery passes through
triangular space to muscles of the Posterior humeral circumflex a.
infraspionous fossa of the scapula.
thoracodoasal artey supply the
latissimus dorsi.
Posterior humeral circumflex a.:

passes through the quadrangular
space accompanied by axillary
nerve,It nourishes the shoulder joint,
upper end of humerus and triceps Subscapular a.
muscle.
Anterior humeral circumflex a.:

introduction
Axillary lymph nodes
Upper limb Lateral LN

(lies along the
distal part of
Lateral and the axillary v.)
upper part of
the breast
Lateral part of Subclavian
the thoracic trunks
Pectoral LN
wall (lies along the
lateral thoracic a.) Central LN Apical LN
Upper part of (lies in the fat (lies along the
the abdominal of the axilla) proximal part of
wall (above the axillary v.)
the umbilicus)
Part of the
Posterior part upper area of
of the neck Subscapular LN
(lies along the the breast
Back subscapular a.)
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Brachial plexus
Anterior rami of four cervical
Form
nerves (C5-C8) and most of the
T1 ramus roots(5),
trunks(3), divisions(6), and

cords(3).
Branches Supraclavicular branches
Infraclavicular branches
introduction
Supraclavicular branches
Long thoracic nerve
It descends to reach the serratus

anterior and innervates this muscle.
Long thoracic n.
introduction
Infraclavicular branches
Musculocutaneous nerve
It arises from the lateral cord and pierces the coracobrachialis
Median nerve
It has two roots from the lateral and
medial cords, which embrace the axillary
a., uniting the trunk of the median n.,
down to the medial bicipital sulcus
Ulnar nerve
It arises from the medial
cord down to medial bicipital
sulcus
introduction
Axillary nerve
passes through quadrangular space
with the posterior humeral a. and then
winds around the surgical neck of the
Axillary n.
humerus to the deltoid.
Radial n.
Thoracodorsal nerve
It accompanies the subscapular a.
along the posterior axillary wall to Thoracodorsal n.
supply the latissimus dorsi.
Radial nerve
Arises from the posterior cord, go through the sulcus for radial
nerve with the deep brachial a.
introduction
Medial pectoral nerve Lateral pectoral n.
To arrange the pectoralis major and

pectoralis minor
Lateral pectoral nerve

To arrange the pectoralis major and
pectoralis minor
Medial pectoral n.
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Quadrangular space
Quadrangular
Boundaries space
Superior--subscapularis in front
and teres minor(1) behind; 1
?
Inferior--teres major(2) 1
3
2
Medial--long head of the triceps(3)
?
Lateral--surgical neck of the
humerus.
Contents axillary nerve and

posterior circumflex humeral vessels.
introduction
Triangular space
Triangular
space
Boundaries:
Superior subscapularis in front

1
1
and teres minor(1) behind;
2
Inferior teres major(2);
Lateral long head of the triceps.
Contents: circumflex scapular
artery.
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Deltopectoral groove
Position between the

Deltopectoral
anterior border of the groove
deltoid and the superior
border of the pectoralis
major
Contents cephalic vein

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Position
Medial side of the biceps brachii

Brachial a.
Contents
Brachial artery and vein Median
n.
Ulnar n.
Median N.
Ulnar N.
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Humeromuscular tunnel
(Radial nerve tunnel)
Position: among the medial

and lateral head of the triceps
and the sulcus for radial
Deep brachial
artery
nerve.
Radial N.
Contents: radial N.; deep

brachial artery and vein.
Communications:
superiorly:axillary cavity
inferiorly: cubital fossa.
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Cubital fossa
Median nerve
Boundaries Brachial artery
Superior: an imaginary line drawn Pronator teres
between the two epicondyles of Brachioradialis

the humerus.
Lateral: brachioradialis;
Medial: pronator teres;

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Cubital fossa
Contents: Median nerve

Brachial artery
Radial nerve
The median N.
Ulnar artery
The brachial A. and V., radial A.
Radial artery
and V., ulnar A. and V..
The superficial and deep branches
of the radial N.
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Cubital fossa
Biceps
Brachial artery
Applying
The blood pressure is universally
recorded by auscultating the
brachial artery in medial side of
the biceps tendon in the cubital
fossa.
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Cubital fossa
Communications

Radial N. tunnel
Cubital fossa
Radial groove of the forearm
Median groove of the forearm
Ulnar groove of the forearm

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Median groove of the forearm
Position
Upper part: between the flexor
Median n.
digitorum superficialis and flexor
disitorum profundus Ulnar n.
Ulnar a.
Lower part: among the flexor Radial a.
carpi radialis, palmaris longus and
the flexor digitorum superficialis
Content
Median N.
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Radial groove of the forearm
Position
Between the brachioradialis and
flexor carpi radialis. Median n.
Ulnar n.
Contents
Superficial branch of the Radial a.
radial N. and radial vessels
Applying
For feeling the pulse at the wrist

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Ulnar groove of the forearm
Position
Between the flexor carpi ulnaris Median n.

and flexor digitorum superficialis. Ulnar n.
Contents Radial a.
Ulnar N. and ulnar vessels

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Carpal tunnel
Position
Median nerve
between the concave anterior
surface of the carpal bones and the
flexor retinaculum
Contents
9 tendons 4 tendons of the flexor
digitorum superficialis; 4 tendons of
tendons of the flexor digitorum
the flexor digitorum profundus;1
&
tendon of the flexor pollicis
longus(&)
1nervemedian nerve.
Significance
Carpal tunnel syndrome
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Structures of the palmar

Palmar aponeurosis
It is continuous with the deep
fascia lying between the thenar
and hypothenar eminences in
triangle shape. Proximally it
attaches with the Palmaris
longus, distally it separates into
four slips, which are jointed by
the superficial transverse
metacarpal ligments.
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Superficial palmar arch

Radial a.
Position: between the palmar Ulnar a.
aponeurosis and the flexor tendons.
Superficial
Composing: it is composed of palmar arch
superficial parlmar branch of radial Palmar digital

arteries
artery and the termination of ulnar
artery. The convex border of the
arch is at the level of middle skin
crease of the palmar.
Branches: four palmar digital
arteries supply the medial three and
a half fingers.
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Deep palmar arch

Position: deeper to the tendons
Radial a.
of flex digitorum muscles.
Ulnar a.
Composing: it is composed of
Deep
deep palmar branch of ulnar palmar arch
artery and the termination of the Palmar
metacarpal a.
radial artery. The convex border
of the arch is at the level of
carpometacarpal joints.
Branches: 3 palmar metacarpal

arteries which have anastomosis
with the common digital ateries .
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Communications among the regional structures

of the upper limbs
Root of neck
Axilla Trilateral and quadrilateral space
Medial bicipital sulcus Radial nerve cannel
Cubital fossa
Radial sulcus Median sulcus Ulnar sulcus

of forearm of forearm of forearm
Carpal tunnel
Midpalmar space
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Dissection
Dissect the ventral superficial structures
1. Place the cadaver in the supine position.
Incise and reflect the skin according to red
line of the picture.
2. Define the following structures in the
superficial fascia:
Cephalic v. Basilic v. Medial cubital v.;
Median v. of the forearm;
Medial brachial cutaneous n.
Medial and Lateral antebrachial cutaneous n.
Superficial branch of radial n.
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Dissect the ventral deep structures
1.Reflect the deep fascia and define the muscles.

2. Examine the structures in the medial biciptial sulcus:
Brachial a. Median n. Ulnar n.
3. Examine the Musculocutaneous nerve deeper to the biceps
4. Examine the structures in the cubital fossa:
(medially to laterally)Brachial a. and its braches Ulnar a. and
Radial a.; Median n.; Tendon of the biceps; the superficial and
deep branches of the radial n.
5. Clean and examine the muscles of the forearm.
6. Reflect the skin of the palmar and define the palmar
aponeurosis. Carefully transect the distal part and reflect the
palmar aponeurosis and examine the superficial palmar arch.
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Dissect the dorsal structures
1. Place the cadaver in the prone position, Incise and reflect

the skin and superficial fascia according to red line of the
picture.
2. Reflect the deep fascia and define all the muscles.
3. Cut the posterior origin of the deltoid and reflect it to the

lateral side, examine the long head of the triceps, Trilateral
and Quadrilateral space and structures which passing these
two space.
4. Attention: you cannot cut any muscles you meet except for
the deltoid, only you can do about the muscles is pulling them
to medial or lateral side.

Limbs

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Limbs

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General Body wall Head and neck Limbs Thoracic cavity Abdominal Pelvic cavity

Dissections Superficial fascia

Anterior anterior border of the

Posterior posterior border of the

Shoulder Arm Forearm Hand

Muscles, blood vessels

Bones and joints

The median cubital vein is easy to identify

Superficial branch of radial n.

Superficial fascia psoterior cutaneous n. of

Upper lateral cutaneous n. of

Lower lateral cutaneous n. of

Posterior cutaneous n. of the Superficial branch of

Muscles of the shoulder

Muscles of the shoulder

reinforce the fibrous capsule of

the shoulder joint.

Muscles of the Arm

Long head of biceps brachii

Muscles of the Arm

Triceps brachii Long head of triceps brachii

Lateral head of triceps brachii

Medial head of triceps brachii

Muscles of the forearm

Pronator teres Pronator teres

Flexor carpi ulnaris

Muscles of the forearm

Flexor digitorum superficialis

Muscles of the forearm

Flexor disitorum profundus

Flexor pollicis longus Pronator teres

Muscles of the forearm

Flexor disitorum profundus

Muscles of the forearm

Muscles of the forearm

Extensor carpi ulnaris

Muscles of the forearm

Medial bicipital sulcus

Trilateral and quadrilateral foramen

Median sulcus of the forearm

Apex: the middle third of the

Base: skin, superficial, and the

Anterior wall: pectoralis major,

Posterior wall: subscapularis, scapula,

Lateral wall: upper part of the shaft of

Medial wall: upper four intercostals

Axillary lymph nodes

Axillary sheath is derived

from the prevertebral layer

of the deep cervical fascia.

It encloses the axillay artery,

vein and the brachial plexus.

It can be divided into three parts by the pectoralis minor

The branch of the axillary

Superior thoracic a. :supplying

The branch of the axillary arterys second part

Thoracoacromial a.: pectoral

Lateral thoracic a.: the lateral

the mammary gland (in females).

The branch of the axillary arterys third part

Posterior humeral circumflex a.:

Anterior humeral circumflex a.:

Axillary lymph nodes