Upper Limb Topography
Fossa axillaris
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

Between arm and chest
Boundaries
– Anteriorly – mm. pectorales
– Dorsally = latissimus dorsi, teres
major, subscapularis
– Medially = serratus anterior
– Laterally = sulcus bicipitis
Content
– Lymph nodes, vessels, pl. brachialis
Foramen axillare laterale et mediale
Posterior of the arm
Surface anatomy
M. triceps brachii
caput longum, medialis, lateralis
Surface elements
Skin thick and movable
Subcutaneous tissue well expressed
n. cutaneus brachii posterior
n. cutaneus brachii lateralis inferior
n. cutaneus antebrachii posterior
Deep structures
А. Fascia brachialis
- Thick, thins distally
B. Neurovascular bundles
1. Upper - in canalis humero-muscularis, between:
- sulcus n. radialis
- medial and lateral head of m. triceps brachii
1.1. n. radialis – lies on the humerus
- n. cutaneus brachii lateralis inerior
- n. cutaneus antebrachii posterior
- rr. musculres
1.2. a. profunda brachii
- a. collateralis media
- collateralis radialis
Lower neurovascular bundle
behind medial epicondyle
n. ulnaris
a. collateralis ulnaris inferior
Elbow region
Anterior elbow
Surface anatomy
Three eminences
Two grooves
Elements
Lateral groove - v. cephalica, n. cutaneus
antebrachii lateralis
Medial groove – v. basilica, n. cutaneus
antebrachii medialis
V. mediana cubiti
Deep structures
А. Muscles
Flexors of forearm – medial eminence
Extensors of forearm – lateral eminence
Brachial muscles, mm. biceps, brachialis –
middle eminence
Deep structures
B. Vessels and nerves
Medial bundle - between m. biceps brachii and pronator
teres
- a.v. brachialis, n. medianus
Lateral bundle - between m. brachialis and
brachioradialis
- n. radialis, a. collateralis radialis, a. recurrens radialis
C. Cubital fossa
Boundaries
- m. brachioradialis (lateral), m. pronator teres (medial)
Content
- tendo m. brachialis, m. biceps brachii, bursa bicipitoradialis
Layers of the elbow
Venous
1 v. cephalica
2 v. basilica
3 v. mediana cubiti
Apponeurotic
1 aponeurosis bicipis
2 tendo m. biceps brachii
Neurovascular
1 a. brachialis
2 n. medianus
Muscle
1 m. supinator
2 m. brachialis
3 tendo m. biceps brachii
Bone
1 humerus
2 radius
3 ulna
The palm
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)
pg 306, 788
Muscles of the Wrist
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Extensor muscles
– Extensor Retinaculum

What’s its function?
– Muscles innervated by
radial nerve
– There are 8

Name them…
Muscles of the Wrist
Flexor Muscles


Flexor retinaculum
(transverse carpal
ligament)
Two compartments
– Superficial – 4
– Deep – 3
– Name them…

Innervated by median and
ulnar nerve
Wrist and Hand Anatomy


Nerves/Vessels
– Radial & ulnar artery and veins
– Radial, ulnar, & median nerves
Carpal Tunnel
– Flexor Tendons - 9
– Median Nerve
Surface anatomy
- Medial and lateral eminence and middle
depression
- Flexion grooves
- Commissural pads
Surface elements
Skin- thick, hairless
- Attached to palmar aponeurosis – in the middle
- Loose connective tissue in the eminences
- r. palmaris (n. medianus), r. cutaneus palmaris
(ulnaris)
- small veins
Aponeurosis palmaris – thick fibrous tissue
- superficial layer – tendinous fibers of m. palmaris
longus,
- deep layer – transverse fibers, lig. metacarpeum
transversum superficiale
- commissural openings
Deep compartments
Intermuscular septae and
Palmar interosseous fascia form
- Three fascial compartments
Lateral (thenar) compartment
Muscle - 4 layers
- M. abductor pollicis brevis
- M. opponens pollicis, m. flexor pollicis brevis (caput superfic.)
- M. flexor pollicis brevis (caput profundus)
- M. adductor pollicis
Nerves - r. muscularis n. medianus
Vessels - r. palmaris superficialis a. radialis
Two connective tissue spaces – above and below m. adductor
pollicis
Medial (hypothenar) compartment
Muscles - 2 layers
- Superficial - m. abductor digiti minimi,
m. flexor digiti minimi
- Deep - m. opponens digiti minimi
Nerves – superficial and deep branches of n. ulnaris
Vessels - superficial and deep branches of a. ulnaris
M. palmaris brevis - proximal
Middle compartment
Muscular tendinous layer:
- mm. flexores digitorum superficialis & profundus
- mm. lumbricales
- vagina synovialis communis flexorum
Two spaces
а. Superficial – below palmar aponeurosis
- arcus palmaris superficialis - aa. digitales palmares communes
- n. medianus - nn. digitales palmares communis
- r. palmaris n. ulnaris - n. digitalis palmaris communis IV & n. digitalis
palmaris proprius V
Interfascial canals - distal
- mm. lumbricales, a.n. palmares digitales comm. et propriae
Middle compartment
b. Deep space - below palmar interosseous fascia
- communications:
forearm - trough carpal canal
superficial space – interfascial canals
- arcus palmaris profundus - a. radialis + r. profundus a. ulnaris
- aa. metacarpales palmares - aa. digitales palmares communes
- deep branch of r. palmaris n. ulnaris supplying - mm. hypothenari, mm. interossei, m. adductor pollicis и mm.
lumbricales II - IV.