UPPER LIMB

PROFESSOR DR FAUZIAH OTHMAN DEPARTMENT OF HUMAN ANATOMY, FACULTY OF MEDICINE AND HEALTH SCIENCE, UNIVERSITI PUTRA MALAYSIA MALAYSIA

UPPER LIMB
What is a limb? Skeleton Joints Shoulder/Scapula muscles Brachial plexus getting spinal nerves out onto limb Musclesanterior and posterior compartments Sensory innervation Surface anatomy
From Royal Collection da Vinci drawings

What is a limb?
Ventral somatic outgrowth of outer tube
Bones (made of bony tissue, cartilage, and other tissues) Joints Muscles Nerves (with motor neurons to muscles, sensory neurons to skin, proprioceptors)

No viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)

Upper Limb Skeleton

Scapula Humerus Radius, ulna Carpals-proximal, distal Digits
Metacarpals Phalanges

Muscle origins and insertions

Muscle crosses joint Origin is usually proximal and insertion is usually distal Origin is considered fixed in analyzing muscle action Muscle action (concentric) is given by movement of insertion relative to origin across joint Remember:
Sometimes insertion might be fixed

Muscles of Scapula
If INSERTION on scapula, muscle moves scapula
Trapezius Rhomboids Pectoralis Minor Serratus Ventralis Levator Scapulae

If ORIGIN on scapula, muscle moves arm

Teres Major Latissimus Dorsi (partially on scapula)

Rotator Cuff
Supraspinatus Infraspinatus Teres minor Subscapularis

Muscles originate on fossae of scapula Help support open socket of shoulder joint Insert around ball of humerus Medial and lateral rotation of upper limb Typical baseball pitcher injury

Axilla = Armpit
Region between arm and chest Boundaries
Ventral - pectoral muscles Dorsal = latissimus dorsi, teres major subscapularis Medial = serratus ventralis Lateral = bicipital groove of humerus

Contents
Axillary nerves and blood vessels Axillary lymph nodes And.theBrachial plexus

Brachial Plexus

Posterior Compartmentposterior cord Anterior compartmentmedial, lateral cords Name of cord is relative to axillary artery

Brachial plexus organizes nerves out to muscles of upper limb

One posterior nerve
Radial n.

Three anterior nerves

Musculocutaneous n. Median n. Ulnar n.

Muscles and nerves by compartment

ANTERIOR POSTERIOR NERVES M-C, ulnar, median MOVEMENT Flexion MUSCLES TWIST Biceps, flexors Flexors from medial epicondyle Radial Extension Triceps, extensors Extensors from lateral epicondyle

POSTERIOR AND ANTERIOR COMPARTMENTS

 Bicepsanterior compartment, flexion (M-C n.) Tricepsposterior compartment, extension (radial n.)

Anterior Compartment Forearm--flexors

Medial Epicondyle

Brachioradialis
Pronator Teres Flexor Carpi Radialis Flexor Carpi Ulnaris Flexor Retinaculum

Anterior View

Flexor Digitorum Superficialis is deep to other flexors

Posterior Compartment of Forearm--extensors

Lateral Epicondyle Extensor digitorum Extensor carpi ulnaris Brachioradialis Ext Carpi Radialis Longus

Posterior View

ANTERIOR MUSCLES M-C nerve

Biceps brachialis

POSTERIOR MUSCLES Muscles (radial nerve)

Triceps Anconeus Brachioradialis Carpal, digit extensors

Median nerve
Forearm flexors Thumb intrinsics

Ulnar nerve
Flexor carpi ulnaris Hand intrinsics

Sensory from limb (dermatomes/sensory skin segments from spine)

Dermatomes extend over limbs Twisted orientation reflects twisting of limb during development Named nerves generally innervate skin over muscles that they innervate

Sensory territory of nerves

REMEMBER: Brachial plexus re-directs spinal routes into named nerves covering certain territory

Cutaneous branches of medial cord/ulnar nerve

Routes of nerves (in human)

M-C: between biceps brachii and brachialis Median: medial/posterior to biceps, branches into forearm flexors at elbow then to hand through carpal tunnel
Recurrent median superficial at wrist to thumb over thenar emminence) deficit - apes hand

Ulnar: medial in arm, posterior to medial epicondle of humerus (funny bone) down medial forearm medial to carpal tunnel into palm Radial: deep posterior arm around lateral epicondyle of humerus to forearm (deep and superficial branches)

Median Nerve
Brachial Artery

Ulnar Nerve UlnarArtery

Musculocutaneous Nerve

Wheres Radial Nerve?

Radial Artery Median Nerve

Ulnar Nerve

SUPERFICIAL VEIN IN CUBITAL FOSSA

 Clinical aspects During blood pressure measurements, the stethoscope is placed over the brachial artery in the cubital fossa. The brachial pulse may be palpated in the cubital fossa. The area just superficial to the cubital fossa is often used for venous access (phlebotomy). A number of superficial veins can cross this region. It may also be used for the insertion of a peripherally inserted central catheter. Historically, when (venous) blood-letting was practiced, the bicipital aponeurosis (the ceiling of the cubital fossa) was known as the "grace of God" tendon because it protected the more important contents of the fossa (i.e. the brachial artery and the median nerve).

 The cubital fossa is the triangular area on the anterior view of the elbow of a human.

Surface Anatomy of Upper Limb

Biceps + Triceps brachii Olecranon Process Medial Epicondyle Cubital Fossa
Anterior surface elbow Contents
Brachial Artery Median Nerve

Boundaries
Medial = Pronator teres Lateral = Brachioradialis Superior = Line between epicondyles

Surface Anatomy of Upper Limb

Carpal Tunnel
Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve

Anatomical Snuffbox
Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse)