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Surface Anatomy of Upper Limb
Learning objectives
By the end of the lecture the student should be able to know:
The surface markings for various arteries of upper limb
Axillary Artery
For the marking of Axillary Artery, hold the arm at right angles to the trunk
with the palm directed upwards. The artery is then marked as a straight
line by joining the following two points:
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1st point: Midpoint of clavicle
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2nd point: At the junction of ant 1/3rd post 2/3rd of lateral wall of axilla at
its lower limit.
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Join these two points.
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Brachial Artery
1st point: At the junction of ant 1/3rd post 2/3rd of lateral wall of axilla at
its lower limit.
2nd point: At the level of neck of radius medial to the tendon of biceps
brachii.
Join these two points.
Axillary nerve
It is marked as horizontal line on the deltoid muscle 2cm above the mid
point between the tip of acromion process and the insertion of deltoid.
I/M injections in the deltoid are given in the lower part of the muscle
nearer to its insertion to avoid injury to the nerve
Median nerve
In the arm:
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Mark the brachial artery.
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The nerve is then marked lateral to the artery in the upper half and
medial to the artery in the lower half of the arm. The nerve crosses the
artery anteriorly in the middle of the arm.
In the forearm:
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A point medial to the brachial artery at the bend of the elbow.
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A point in front of the wrist over the tendon of palmaris longus.
Radial nerve
In the arm:
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A point at the junction of anterior 1/3 and posterior 2/3 of the lateral
wall at its lower limits.
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2nd point is at the junction of upper 1/3 and lower 2/3 of a line joining
the lateral epicondyle with the insertion of deltoid.
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3rd point is on the front of the elbow at the level of lateral epicondyle 1
cm lateral to the tendon of biceps brachii.
Radial Artery
In the forearm:
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1st point: At the level of neck of radius medial to the tendon of biceps
brachii.
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2nd point: At the wrist between anterior border of radius laterally and
tendon of flexor carpi radialis medially.
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Join these two points with a curved line, convex to the lateral side.
In the Hand:
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A point at the wrist between the anterior border of the radius and the
tendon of the flexor carpi radialis.
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The second point is just below the tip of the styloid process of the
radius.
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The third point at the proximal end of the first inter-metacarpal space.
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Ulnar artery
Ulnar Artery can be marked by joining the three points
A point in front of elbow at the level of neck of radius medial to tendon
of biceps brachii.
A 2nd point at the junction of upper 1/3rd and lower 2/3 of the medial
border of forearm lateral to ulnar nerve.
3rd point is lateral to pisiform bone.
Ulnar artery continues in the palm as superficial palmer arch.
Ulnar nerve
In the arm:
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A point at the junction of the anterior 1/3 and posterior 2/3 of the lateral
wall of the axilla at its lower limit.
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2nd point at the middle of the medial border of the arm.
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3rd point is behind the base of medial epicondyle of the humerus.
Ulnar nerve
In the forearm:
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A point on the back of the base of medial epicondyle of the humerus.
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2nd point is at lateral to the pisiform bone
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In the lower 2/3 of forearm ulnar nerve lies medial to ulnar artery.
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Superficial Palmer Arch
1 point- just lateral and distal to pisiform bone.
2nd point- to hook of hamate bone.
3rd point- on the distal border of the thenar eminence in line with the
cleft between index and middle finger.
Join these points with convex line, the convexity is toward fingers.
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Deep Palmar Arch
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A horizontal line 4cm long, and 1.2cm distal to superficial arch.
Flexor Retinaculum
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1st point: pisiform bone.
2nd point: tubercle of scaphoid bone.
3rd point: hook of hamate bone:
4th point: Crest of trapezium
Upper border- By joining the 1st and 2nd point.
Lower border- By joining the third and fourth point.
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Extensor retinaculum
It is an oblique band 2 cm broad directed downwards and medially.
Lateral attachment to the lower part of the anterior border of radius.
Medial attachment to the medial side of the carpus (pisiform and
triquetral bones) and to the styloid process of ulna.
Cubital fossa
Anterior surface elbow
Boundaries
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Medial= Pronator teres
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Lateral= Brachioradialis
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Superior= Line between epicondyles
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CARPAL TUNNEL
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Carpals concave anteriorly
Carpal ligament covers it
Contains: long tendons, Median nerve
Inflammation of tendons = compression of Median nerve
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ANATOMICAL SNUFFBOX
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Lateral = E.pollicis brevis
Medial = E. pollicis longus
Floor = scaphoid, styloid of radius
Contains Radial Artery (pulse)
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References
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Clinically oriented anatomy
6th edition
KLM
Ch. 6 –Upper Limb