The Upper Extremity
Bones,
Muscles,
Vessels,
pg 650
Bones



30 bones!!!!
Appendicular skeleton
Pectoral girdle


Glenoid cavity
Allows for mobility


Attachments
Upper extremity:

Arm



humerus
Forearm

Radius, ulna (interosseous membrane)
Hand


pg 654
Carpals, metacarpals, phalanges
Review bones and landmarks studied in lab!!!
pg 668
Joints of Upper Extremity

Sternoclavicular



Acromioclavicular



Synovial-saddle
Diarthrosis
Synovial-plane
Diarthrosis
Glenohumeral joint





Synovial-ball&socket
Diarthrosis
Many ligaments
Muscle reinforcement
Great Mobility
pg 669
Joints of the Upper Extremity
pg 725

Elbow Joint



Articulations



Synovial – hinge
Diarthrosis
Humerus & Ulna
Humerus & Radius
Many Ligaments
pg 726
Joints of Upper Extremity

Proximal Radioulnar joint



Distal Radioulnar joint



Synovial - pivot
Diarthrosis
Synovial – pivot
Diarthrosis
Allows pronation and supination of forearm
pg 735
Joints of the Upper Extremity







pg 755
Radiocarpal joint

Synovial-condyloid

Distal radius with proximal row of carpals
Intercarpal joints

Synovial-plane
Carpal-metacarpal (2-5)

Synovial-plane
Trapezium-metacarpal 1

Synovial-saddle
Metacarpal-phalangeal

Synovial-condyloid
Interphalangeal

Synovial-hinge
ALL DIARTHROSES
Review of Naming…..

What do the following names TELL
you about the muscle?

Naming





Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis brevis
Scapula Muscles

If the origin is on the scapula – moves
the arm







pg 656
Subscapularis
Supraspinatus
Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial attachment)
Coracobrachialis
Rotator
Cuff
Scapula Muscles

If the insertion is on the scapula –
moves the scapula





Rhomboids
Trapezius
Pectoralis Minor
Serratus Ventralis
Levator Scapulae
pg 656
Use location of Insertion to determine movement!!
Innervation of Muscles Moving Arm
Muscle
Innervation
Subscapularis
Teres Major
Subscapular N.
Infraspinatus
Supraspinatus
Suprascapular N.
Teres Minor
Axillary N.
Coracobrachialis
Musculocutaneous N.
Arm Muscles


Cross elbow, move forearm
2 compartments

Anterior


Posterior

pg 657
Flexors of forearm
Extensors of forearm
Arm Muscles

pg 718
Anterior
compartment



pg 715

Brachialis
Biceps brachii
Coracobrachialis
Brachioradialis
Arm Muscles

Posterior
compartment


pg 717
Triceps brachii
Anconeus
Muscles of Arm
Muscle
Origin
Insertion
Action
Brachialis
Ant shaft , distal humerus
Coronoid proc/tuberosity
(ulna)
Flex forearm
Biceps Brachii
Long: supraglenoid tubercle
(scapula)
Short: coracoid proc (scapula)
Radial Tuberosity (radius)
Flex forearm,
Supination
Brachioradialis
Lateral supra-epicondylar ridge
(humerus)
Styloid process (radius)
Flex forearm
Coracobrachialis
Coracoid proc (scapula)
Medial surface midshaft
(humerus)
Flex arm
Triceps Brachii
Long: Infraglenoid tubercle
Short: Post. shaft (humerus)
Lateral: Post. Shaft (humerus)
Common tendon to
olecranon (ulna)
Extend
forearm
Anconeus
Lateral epicondyle (humerus)
Olecranon (ulna)
Extend
forearm,
Abduction of
ulna
Anterior
Posterior
Arm Muscle Innervation

Anterior compartment

Radial nerve


Musculocutaneous nerve




Brachioradialis
Coracobrachialis
Brachialis
Biceps brachii
Posterior compartment

Radial nerve


Triceps brachii
Anconeus
Forearm Muscles


Cross elbow, wrist and finger joints
Movement of hand and fingers

Cross Wrist




flex, extend, abduct, adduct hand
Cross Fingers


pg 738
flex, extend fingers
Proximally are fleshy
Distally have long tendons
Flexor and extensor retinacula


“wristbands”
Keep tendons from jumping outwards when tensed
Forearm Muscles

Anterior flexor compartment




Posterior extensor compartment


pg 732
Superficial and Deep
Most flexors have common tendon on medial
epicondyle
Contains 2 pronators
Superficial and Deep
Most extensors in superficial layer have
common origin on lateral epicondyle
Anterior Compartment of Forearm
Muscles

Superficial






Nerves
Flexor digitorum superficialis
Flexor carpi radialis
Pronator teres
Palmaris longus
Flexor carpi ulnaris
Median
Median
Median
Median
Ulnar
Deep



pg 738, 740
Pronator quadratus
Flexor pollicis longus
Flexor digitorum profundus
Median
Median
Ulnar (med 1/2)
Median (lat 1/2)
Posterior Compartment of Forearm
Muscles

Superficial




Extensor carpi radialis longus
Extensor digitorum
Extensor carpi ulnaris
Radial
Radial
Radial
Deep




pg 746
Nerves
Supinator
Abductor pollicis longus
Extensor pollicis longus + brevis
Extensor indicus
Radial
Radial
Radial
Radial
Hand Bones

Carpus (8)



Metacarpus (5)


“True” wrist
Distal to radius/ulna
Distal to carpus
Phalanges (14)

Distal to metacarpus
pg 753
Intrinsic Muscles of the Hand

Muscle
Pinky (little finger)


Ulnar
Thumb





All digiti minimi
(Flexor, Abductor, Opponens)
Nerve
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
Median
Median
Median
Ulnar
Other Intrinsic Muscles


Palmar + Dorsal Interossei
Lumbricals
pg 762
pg 767
Ulnar
Median, Ulnar
Blood Supply - Veins

Deep veins







Deep palmar venous arches
Radial - forearm
Ulnar - forearm
Brachial – arm/elbow
Axillary – axilla
Subclavian - neck
Superficial Veins




Digital
Superficial palmar venous arches
Median – forearm
Median cubital – elbow



Blood draws!!
Cephalic – arm/forearm
Basilic – arm/forearm
pg 664
Blood Supply - Arteries


Subclavian (neck)
Axillary (armpit)



Brachial (arm)



Deep brachial
Radial (forearm)
Ulnar (forearm)


Subscapular
Circumflex humeral arteries
Common Interosseous
Superficial & Deep Palmar arches

Digital
pg 719
pg 651
Axilla



Armpit!!
Where axillary hairs grow
Boundaries

Ventral


Dorsal


Serratus ventralis
Lateral


Latissimus dorsi, teres major, subscapularis
Medial


Pectoral muscles
Inetrtubercular (Bicipital) groove of humerus
Contents

axillary lymph nodes, axillary vessels, brachial plexus
Surface Anatomy of Arm






Cephalic Vein
Biceps brachii
Triceps brachii
Olecrenon Process
Medial Epicondyle
Lateral Epicondyle
pg 651
Surface Anatomy of Elbow

Cubital Fossa


Anterior surface elbow
Contents




Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries



Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles
pg 730
Surface Anatomy of Hand

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 759
Brachial Plexus

Nerve plexus




Lies partly in neck and partly in axilla
Gives rise to almost all nerves that supply upper
limb
Formed by intermixing of ventral rami of spinal
nerves C5-C8 and T1

pg 700
Network of nerves formed by ventral rami
Small contributions from C4 and T2
Brachial Plexus

Really Tired? Drink Coffee Buddy!

R = RAMI (ventral) (5)
T = TRUNKS (3)
D = DIVISIONS (2)
C = CORDS (3)
B = BRANCHES (Many!!)




pg 704
Rami join to form Trunks! (in neck)
Ventral Rami
Trunks
Upper Trunk

C5
C6

C7
Middle Trunk

C8
T1
Lower Trunk


Trunks Split to form Divisions! (in neck)
Trunks
Divisions

Upper
Anterior
Posterior

Middle
Anterior
Posterior

Lower
Anterior
Posterior
Divisions Join to form Cords! (in axilla)
Trunks
U
M
L
Division
A
P
A
P
A
P
Cords
Lateral
Medial
Posterior
Cords Give off Branches!! (in axilla)

Lateral
Musculocutaneous
Median

Medial
Ulnar

Posterior
Radial
Axillary
(thoracodorsal)
(subscapular)
Brachial Plexus – Cords and Branches

Lateral



Medial


Musculocutaneous n.
Median n.
Ulnar n.
Posterior




Radial n.
Axillary n.
Thoracodorsal n.
Subscapular n.
Lateral Cord

Musculocutaneous nerve


Off lateral cord
Course:



Innervates:





Anterior arm
Becomes cutaneous and gives skin sensation to lateral forearm
Corocobrachialis (motor)
Biceps brachii (motor)
Brachialis (motor)
Skin distal to the elbow (sensory)
Suprascapular (not part of lateral cord)


Runs with suprascapular artery and vein {C5, C6}
Innervates


Supraspinatus
Infraspinatus
Medial Cord

Ulnar nerve

Course:







Comes off medial cord
Descends along medial side of arm
Passes posterior to medial epicondyle
Follows the ulna
Superficial to carpal tunnel into hand
Branches to supply intrinsics and skin
Innervates:




Flexor carpi ulnaris (motor)
Flexor digitorum profundus (motor)
Most intrinsic hand muscles (motor)
Dorsal branch supplies skin of medial 2/3 of hand (sensory)
Both Medial and Lateral Cords

Median nerve

Course:





Middle of brachial plexus (from lateral and medial cords)
Does not branch in arm
Distal to elbow provides many branches to most forearm flexors
Passes through carpal tunnel to hand to lateral palmar intrinsics
Innervates:

Anterior forearm (motor)



Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory)
Dorsum of fingers 2 and 3 (sensory)
Posterior Cord

Radial nerve



Largest branch of brachial plexus
Comes from posterior cord
Course:




Through arm
Around humerus
Around lateral epicondyle (then divides)
Innervates:

Posterior muscles of arm and forearm


Triceps brachii, anconeus, supinator, brachioradialis
Divides in forearm:

Superficial


Skin of arm and dorsolateral surface of hand
Deep

Extensor muscles of forearm (eg ext. carpi radialis L + B)
Posterior Cord (continued)

Axillary nerve


Branches off posterior cord
Course:



Innervates:



Deltoid and teres minor (motor)
Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve

Innervates:


Runs posterior to humerus
Runs with caudal humeral circumflex artery
Subscapularis, Teres major
Thoracodorsal nerve

Course:


Runs with thoracodorsal artery and nerve
Innervates:

Latissimus dorsi
pg 782-3
Nerve Damage

Ulnar nerve

“Claw hand”


Median nerve

“Ape hand”


Inability to extend fingers at interphalangeal joints, results in
permanent flexion = claw
Inability to oppose thumb
Radial nerve

“Wrist drop”

Inability to extend the hand, inability to fully extend forearm