Anatomy

By- Vibha Sunil Sastry

 Upper
-

Limb-

Pectoral Region
chapter :

Pectoralis
majorclavicular ORIGIN
-
:
NS
-

mad (small ↑
musch
largest
t
Ant
Surface of medial rudial
- Lat
.

num
ad
Sternocostal
Gy
half of claviche (25
-
(7) (c8 , T1)
pectoral
-
Actions : nurse

(Large)

i anand
· Adduction +

surface of sternum
medial rotation
o Congenital anomaly
-
Usually sternocostal
costal
cartilages part is absent at
Aponeurosis of

E IIIIIII
INSERTION :
4 EO birth
-
.
t up - "Poland

&
syndrome"

u
sulcus

Bilaminat -
&
Ant .

3
continuous
inferiorly
~ ~
Twisted around
inserted
lower border -
rounded
highst
-

Post lowest :

~
.

~ ant .

axillary fold

TI
Pectoralis minor- Middle 3rd Subclavius =
Subclavian ussels

small ,
F Y N clavide musch + Brachial plexus

&L
4
-

S-I
Protraction C

·IS7) 2
·

Paralysis of servatus
I sams ①
ant -
·
Depression
.

&
musch
·

Accessory (

resp. Stab
injury/removal
OIN
of
of breast
t umour
2

thoracic
INSERTION :
-
From
Injury to
long
↓
.
N

medial border Es

upper surface of Paralysis of serratus ant.

coracoid process d
Protraction of scapula weakened
winging
of scapula

dy Caripectoral fascia

fascia-Sadoses
two mus

·
Caripectoral
attached
us

costoclavicular
Pecm

to 1st rib , lig .

vein
/ Axillary
Medially bundswithextintercostamme ig -

I
costocoracoid ligament
nat
Laterally
-

brachial plexus
with dupconical
a
a
post Lamina cont
Vertically-upper
-

Lower >
- extends downwards as
suspensary ligament
suspensary ligament
axilla
(
of

↓ Pec m of axilla
(Gerdy's Ligament)
.
 ⑭
***

Mammary gland-

I i
modified apocrine sweat
gland :
superficial fascia
Location :
sitting atop pectoralis major
tail
Axillary
small extension
from superlat. part of spence &
-

e foramin of Lange
↑ turnout
pierces deep fascia &, extends into axilla

Chape
& extent :
Hemispherical bulge
↓
2nd-6th rib
Vertically
4
:
Horizontally : Lat . Sternum
↓

↓
M
-

Midaxillary use

·
Retromammary space more
:

↑
breast

-PM
- SA artery
Relations :
Pectoral fascia ,
3 muscles - EO

Perforating
,
branches
a

j
A
structure -
artery
:
-
-
Axillary A
① Skin-Nipple
-
(4th ICs) -
smooth muscle fibres ICS)
↓ lat - branches of
post Intercostal A.
sensitive innervated NE
most part richly by sensory
.

② modified a
glad
,sebaceous
Areda-Large
↓
no

Parker
E enlarged :

preggo
mouter o
y Secretion-lube

su
Montgomery's tuberchs Apical group
-
- everywhere except beneath ② of Lymph
mode
8 Stroma-CT -
+
fat supporting framework
-

·
Deltopectoral (N-
-

jo
↓ 17 suspensary lig , -⑧
->
>
⑧

-
condenses to fibrous strands/septa-g cooper

craps [ent
form ·

.
↓
8
maintain protuberance in radial
fashion axiuary
of breast
,
arranged & ·
&
2 ↑2
↓ >
-
connect dermis to ducts breast and pectoral fascia
u·m
of
75 %

7-
20 %
in old
Atrophy due
aging breast pendulous
------
to
age
-

LM
&
post. intercostal ⑨ :

It
④ feed baby
arenchyma-secretes milk to LN

Breast
5 subperitoneal
15-20 lobes
radially arranged robuls acini
o
>
- - -

cymph prexus
-

iI
reservoir of mith
during lactation = sinus duct
C
·
Cancer (SES) :

Faropian Breast
-
hard lump
· Painless
immobile
Breast-fixed ,

3
Venous
drainage 1 Int thoracic vein-sup
·
: . .
Skin
Retraction of
↓ Metastasis of breast cancer :
& ·

Retraction ripple
of
dup Intercostal
-

post
ovary
cells
+
vein cancer
appearance
·

Axillary
.

venous plexus 2 .

veins - vertebral venous plexus . peau d'orange

intercranial DVS-brain

inhairfollichs apra
-
>

Haller . intercostal vein

.
3 Post
Krukenberg's
tumour
 Chapter :
Axila

Pyramidal blu axillary folds-brachial plexus vessels

·
+
space + N

Boundaries and M 1.
Axillary artery & its branchs

vein
Post Axillary , its
E tributaries

·
.
2
grou
a
.
3 cords of brachial plexus
scapula
Teres
major
Latie
4
Axillary Lymph nodes

sims
.

anterior

&
⑳
tissue
.
5
Fibrofatty
.
i
..
C thoracic N .

)
tall of breast
:
-"
.
6
Axillary

i
Biopss
-S
~
-
-

thoracic and
,

Long
-

L 1 .

Coraco-
intercostobrachial none

/ canal

Axillary
/Apex cervicoaxillary
sheath
Axilla-Base/floor
&
& walls-ant , post .,
M
, L

Axillary

are
a
5M
=
A small branch
,
D subcarian
1
Sup
-
. Thoracic .

-very >
- (supplies)
artery

nam-cargest
artery
-

passes blu pec Mandm med axilla

- (*
. .

subclavius ,
coracoid

-
~

Y
Pectoral
process -

2
1
-

.
2 acoacromial A.
Nor
-

Aikange 2
numural
a
flex
- d---

i
--

Athoracic
tat .A
Decord tancura
.
-runs
along inf
-
bord-
↑ I

·
:

er of pec . m , supplies PM
,
SA ,
PM breast

branch of exian
circumflex
-

scapular intermuscular
scapular A .
, upper L
Brachial
artery
ascending branchdeltoid
-

circumflix A
Ant .
.

subscapular artery
-larger supplies should
a
A
most. circumflex
-

~ ,

subclavian
artery Axillary artery Brachial
·

artery
- -

·
- into 3
parts by pectoralis minor
·
Proximal ,
deep ,
distal parts
***
Relations of
axillary artery
-

Pec . M

Emusculocutaneous
Mudian neve

O same datama
i
I
Pec . M #11/11/ I

~
I #// -
Pec m N 6
Lat
&
.

.
.

=
/
/
pectoralS//// O ②
Medial
Lat
Axillary
rudial pectoral
g
-

wayD-axillary Saxillara
.

I
N
-

3rd
-
cord-o and V

rudial
.

Lat N O

1st v.
Post-o
word .
/ cord
Post . O Medial cord #11// /1- Subscapularis
Lord
LongHoracic subscapularis
·

-&
H1-Teres major
N -

1st
- part 2nd part 3rd part

A
-
Scapular anastomosis-
&
S
E
Deep branch Thynocervical

Fa
-

F
twek
of transverse-
subclavian
cerrical artery -
artery
Body C1st part)
suprascapular-

M
- Acromial
branch of
artery
(
X
&S
thoraco-acromial A
Subcarian
.

A
Eaxillary

-numeral Ant .
circumflex
artery

E N

suscapular
-post .

circumflex
numeral artery
-
Axillary artery
(3rd part)

Intercostal
arteries ot
L
artery
3 Body

scapular anastomosis takes place at two sites

-

① Around ②
body of scapula- Over acromion process-
as

Suprascapular A .
~Thyro
cerc Acromial branch of thoracoacromial . A

scapular
circumflex scapular A
. ~artery
~
Acromial branch of suprascapular .
A

Deep branch of transverse "Acromial branch & post .

circumflex
~Thyrocervical A
cervical A
.
trunk numeral .

of serratus ant -Paralysis

Pimmysis .

of SA following an
injury to
long
thoracic N .

by
a stab
injury or
during removal of breast tumo-

weakened
i) Protraction of scapula for punching is

ii) Winging of scapula-inf angle .

& medial border becomes
underly prominent
⑭
*
Brachial plexus-
supraclaricular

↓
Infractaricular Trunks Roots
Formed Fami
by ant 10

tiny·
.

of C5-C8 EsT = Divisions

C5

I
C44
/ \Variations
T24 was
[
-
+ 1x
Prefixed Post
fixed
-
-

15 +

-
-
-Branches
of brachial plexus-
- -
A . From
~
roots :

Musculocutaneous radian -ill- thoracic

1
N
(C5-(7)
- .

/ Nerve of Bell
Long thoracic N
l
1
per o

I/
.

Lat. root of -

(C5)
median N I rudial cutaneous N Of arm

I
scapular
.

Dorsal
.

2 N
I
.
.

Axillary N .
= - Medial cutaneous .
N

B
. Amenks :

(only from upper Radial N .

of foram
supraspin- all
Median N Midial root of median N
.
1
Suprascapular N (C5 and (6) > infraspinatus
Lunar
-

. .

.
2 N . to Subclavius (15 and (6) -

subclavius

suprascapular
N .

C . From cords :
-

1. From lat , cord - Ant

C5

Erb's

3
point
pectoral
-

Lat . nerve CG

C5 -
CT '
Lat root of median nerve Post . - -
Nerve to
subclavius

Musculocutaneous neve
3M
=

injury)
/

Erbs
.
2 From medial -
cord
P alsy- Cupper plexus C5EC6
-

from house

Mudial pectoral nums (CSETI) ↑ in L blu head a shoulder-ball -child

yanked
medial root of median nerve (CSET) leads to policeman's/waiter's tip hand
- (8571-(7

Medial cutaneous neme

of arm (C8ETI) Klumpke's paralysis -

(lower plexus injury&

hanging from tree

medial
Hyperabduction of
/
cutaneous were
o forearm arm child
yanked by arm

(C7 , 18 , T1) leads hand

rinar daw
of sensation
to
nure , loss
along
From . cord- Horner's
3 .

post medial border

of FAG hand , syndrome
subscapular (6) axilla-skin of
Upper neve (C5 E
,
surgical approach to
floor
Lower
subscapular (C53(6) thoracic N thoraco dorsal N . ,
nerve
Harm-long .,

Nerve to latissimus dors ; (C6-(8) thoracodorsal A

.

(C5E(G)
Axillary nere

Radial nerve (C5-(8ET)

M brachial plexus Musculocutaneous N . ,
o
-

Median nure ,
Unan nune
 Chapter : Back of Body +
Scapula
Post
.
axio-appendicular muscles (muschs correctio with VCI
g scapula
① muschs- ② Deep
Sup .

layer of layer of muschs-

a) Trapezius a) Levator scapula

-
M
b) Latissimus dorsi b) Rhomboideus -m

5
*
Trapezius -

O muscle on back ruck

of and thorax
6) ext occipital al
medial 3rdo t
.

protuberance Nerve
supply-

·
-

-motor supply
a) Spinal part of spinal accessory
nerve
>
- carry proprioceptive sensations
& Ligamentum
nuchar b) Ventral rami of C3EC4
Actions -

·
,
27 -

↓ LS

I
margin of acromion
Upper-shrugging
+ rhomboids
, lower-depress scapula

-
y , middle-bracing,
*
+ SA-abduct > 900

# Minical
testing-
medial end of
Palpate trap
. while shoulder is
shrugged-R
spine
and
5 umpernate
mid multipennate
D Deltoid
.

musch
-
sin one S
trick a
powerful
, curred I 3 parts unipernate
-

, , post .

Lat 1/3rd of
clavic Zant
1 .

Structures under deltoid

.

ant. cover
upper of

.
Latmarging mid . .
Bos-upper end o humerus cracoid proceson
up Joints &
Lower o timel post lig -Glenohumeral jt coracoacromial .
lig
·

.,
.

scapula Bursal around shoulder chap

jt Next
·
of
-

Insertions : PM&M , Teres M Latissimus dorsi ,

~
,
-

Muschs
·

subscapulans intraspinatus
I Agins
, supras , Teres m
head a
:
Long short head
of biceps ,
coracobrachialis lat head
longs
, ,

of triceps

vessels-ant post circumflix

·

. E
. humeral A . EV .

& V-shaped dutoid

Euberosity of humenis ·

Newves-Axillary
·

Spaces - T &X spaces

Nerve (C55(6)
supply- Axillary nerve

3
Actions -

Ant . (clavicular) -
flexors + medial rotators
3-in-1
Post .
(spinous) -
extensors + lat. rotators

Mid (acromial) abductors 150-goo

strong from
-
.
 I
Rotator cuff muscles- Upper
-
triangular space-

[
4 scapul humeral supraspinatus (sup )
.

Passing through
:
Circumflex scapular A .-

Infraspinatus
( (post) origin infraspinous fossa
muschs tm to reach
FUSE
interrupts of
↓ Teres minor Lower
triangular space
-

Musculotendinous
Subscapularis (ant .
) Lat -

-shaft of humens

head
10
grasp relatively large
-
func .

o
/
, hold it smatter , shallow
Axillary
Nene--
E
humerus
against At circomplex Numeral A

gunoid carity Axillary

-
· &S
artery

L"
Post ·
raise
- anoue
numeral A

j
-

neck of

- ~
humerus
N to
Th
&

&
.

⑪ -
cutaon
a
N to
.
.
post
-S

partofdelloidtraneous
audia cabum

a
Deltoid muscle
.
N of arm

·
spaces
-

shoulder
dislocation
Teres minor
deltoid ed surgical neck

Supplies commonly injur

~
-

+
of n. fracture

W
post
.
circum ter
a C5 , 26 +
post .
Lord of brachial
plexus
-

& lower border of

- small terminal branch

--
Axillary newe
-

& subscapularis in axilla - backwards on

-
-
-
- Teres major
subscapularis quadrangular space
- - +

Profunda
brachie A .
circumflex humeral A R
surgical
. -

post . .

Radial N
.
neck humenis capsule of shoulder
of inf. to

↓ Auricularanch
Quadrangular space-
-
Sup .
-
Subscapulans (ant I .
Post . Ant .
T

shoulder
post. detoid Deltoid
capsule of jt .
blu 2 muscles Tm ,

lat cutaneous
upper .

neck branches to skin

Lat
surgical of humens
-
.
were
of ar m
 Chapter Shoulder
:

joint

I
oudit a

cap
synovial sheath
Joint blu head of humens and

glenoid cavity
Most morable
jt
of
.
scapula
-
least stable
-endas a n

·
and socket
synovial type it
Iype-ball .

quenoid
surfaces
#Articular -

head of humerus with shallow

Large round
Guno-
glenoid cavity o scapula
-

depened
fibrocartilaginous ring :
"gunoid labrum"

Point
capsule - thin Acromion process
fibrous layer coracoid
coracohumeral

·
process
Annually margins of glenoid cavity
-

beyond gunoid Labrum attachment -

Transversa
lig .

extends
beyond sypraglenoid tubercle
?
encloses head of biops brachi
long
A -
anatomical neck of humerus (exc. ) .

↓
↓ 1 5cm towards neck
iry. part
:
surgical
.

capsule Lax Stable

gaments
mobility
+ :
·

coracoacromial arch - 20 socket head

for
of humans -+
strengthened by long head and
brachi -o
intrascapularly
runs
had
biceps humeral
Higament
of
conmera
over

↑
o

-Tynovial membrane-

Lines inner
jt Capsule & refects from it
articular

glenoid labrum of read

-
to & humenis margin
3 apertures jt
in .
Capsule -

Tendon Transverse
of
i) blu tubercles of Lig
Opening huments : 1
synovial
of BB
carity,
ii) Ant .

inf. to coracoid process : subscapular bursa Bicipital

groove
iii) Post :
Synovial carity
-

Infraspinatus
bursa
 I
ligaments
Enumeral 3
thickenings on Infraspinatus-blu tendon of
Infraspina
:

inner aspect of part of fibrous capsule us & postero-lateral jt Capsule

ant. . .
It capsule
to it Midan In
strengthen .
sup
↓
.

↓ ↓

r
visible int Add
:
only from .

jt . .

-
Ext.rt .
And

Ant . dislocation of shoulder-defecta

ligament strong
ohumeral :
band of
coracoid process
fibrous tissue ,
- ant
aspect
of greater tubercl
of humerus

. Broad fibr
humenment
immerse
3 :

band ,
bridges bicipital groove blu greater 3

lesser tubercles

Provides to tendon of head

passage long of
surrounded
biceps by synovial sheath .

+ Ant
.
+
Suprascapular

Accessory ligaments
>
- -
+
Subscapular

I acoacromial
ligament
:
blu coracoid
Factors
stability- providing
and Motator
acromion process .
Protects
sup .

It. 1 .

cuff .
3 LH
of biceps tendon
.
2 Tacochomial
_
arch :
CP + AP +
CAL .
2 Coracoacromial arch 4 .
Glenoid labrum

struc arch
Osseoligamentous protective for
-
-

head of humerus above , prevent ↑ disp

.

Supraspinatus passes under arch &

, lies deep
to deltoid :
tendon blends jt
with .
capsule

related to shoulder . -
ursal jt
① subscapular-blw tendon of subscapularis
Eant aspect of neck of scapula , protects
Communicates
~
Dislocation of shoulder Frigbal.
tendonfromfrxn against nwitht cyto object above hyperabduction
patient falls , sudden grasp on to

tendinitis
calcific supraspinatus
②
Subacromial-blu coracoacromial Rotator
cuff disorders
lig.
-
subacromial bursitis
.

,
E
>
- movement below CAL
acromion process above , E supraspinatus tendon

Acromioclavicular
E jt Capsule
.
below .
Cont . I below destoid
jt-plane synovial jt .
I Drain
Chapter : Ven ous
Cephalic Vein-
Cephalic U in
Preaxial vein
.

of upper lib

Begins : cont -

of lat . end of dorsal venous

arch-great saphenous .
V of lower Limb
crosses
through roof of anatomical snuff box
↑ radial border in front
on on
forearm , 4

border
elbow
of along lat .

of biceps pierces ,

in
deep fascia & lower border PM

i
runs
of ,

cleft blo deltoid &,PM up to

infra- uphalic and
clavicular Basilic veins
Jossa ,
where it purces clari

pectoral fascia trains Axiuary

n
is Median Cubital
↓ elbow X M
vein -z
End 2 5 cm + bend of elbow
Begins
2 5 cm :
communicate
.
:
Basilic -
.

· At elbow " blood aphalic -

medial
-

=
Cephalic Basilic vein
,
·
↑ 2 5. cm
veen- -

SHUNT
·
Cephalic V .
is accompanied by lat .

Cutan-epicondyle & humens

cous N of forearm + median cubital V
.
Sep· brachial A
.

by bicipital aponeurosis
·

· Accessory
Cephalic v .
from back of forearm
·
Accompanied
cutaneous N .
by med

of forearm
.
from .

in below elbow
(-) ends Cephalic V
communicates deep veins through perfor
.
·

w a
- anchor

Basilic vein- ator vein

,
which pierces bicipital aponeuros is
post-axial vein upper vib Receives median V
·

of
.

of forearm

pa ·
Begins cont of medial end & dorsal venous
: .

arch I back of med border

,
along .

of fore-
border hear elbow-ant
arm ,
.

fore-
cont " in elbow
arm
front of along
.

med Side of biceps brachi to middle Venepuncture in cubital fossa Median cubi-
up
-

.
supported
pierces deep fascia, brachial V tal V
intravenous inj
-
drawing blood I Most Sup
apo . , anchor
, well

slip
of arm ,
+ .

by -X

BrachialV.She
a b ail
E med. side G brachial A to MCV Cephalic V
along
-
-
runs .
+ .

axillary A & lower border of teres major Hemodialysis Uphalic

-

Median Vein of forearm- Cardiac Catherization- Basilic vein

Cubital
>
- Axillan
Begins
:
palmar network I midline & (V )4 it
I
from
venous as V-
,
.

fossa
in direct line with vein
on ant. forearm, end :

any
1
o 3 axillary

veineinfueboB M, absent
Basilic subclavian-brachio-
axillary
- -

Cephalic-SVc-RA o &
Chapter : Arm
*

I
MR . BBC MUN
-

Ant .

compartment of arm- @
Anatomical events insertions of CB-
-
#

Muschs :
Biceps brachi , Brachialis
, Coraco-B 1 .
O
Median N .
brachial A .

from lat. to med.

·
Nerve : Musculocutaneous N .
( +
MedRN) 2 .
Radial N .
pierces lat . intermuscular septum
↑

in
to pass . -
ant
:
post comp .
. comp
.
3 .
O
Median cutaneous N .

of AEFA-deep fascia
Relations -

4 . 8
Unar N .

pierces med . intermuscular septum

Proximal part to
pass ant comp- post .
·
: . . comp

PM

⑨ numeriss energes overlaps/ Del. - .

5

Nutrient A .

pierces humerus
jt
from through
.

intertubercular ·
Distal partlies .
6 Brachial A . mid .
I
lat side
of ant arm
B
&
extra
synorial
in front -MCN .
7 Basilic v .
-

deep fascia
·
Medial border s . Circular shaft of humerus -
* B : brachialis

Median N.
-MN
overlaps N V
.
.
Ant .
compartment
&
Brachial

&Brachialearachialis
bundle ~ MN

Detrid
Musculocutaneous . (C5 (7)
Nerve
supply N
- -

Lat . intermuscular midial intermuscular

septum septum

of forearm (EF)
Actions
Strong supinator
-

Radial N
(EE) compartment
.

Post
Powerful fuxor of arm
.

work
weak
fexor of shoulder
jt Brachialis-untiring strong Luxor norse
-
.

Clinical
testing-R(E) when arm
supinated 4 Dual innervation : Med . 213rd -
MCN

clinical correlation- Lat . 3rd -

RN
C (5 -
(6)

Biceps refux-Tap biceps brachi jerk Brachial

Artery Main
artery of arm
- -

Popeye's deformity-long head of biceps Begins Lower border of TM

· -

ruptures : attrition -

belly : ball-s haped

·
cont -

axillary A. I arm

ouchie swelling like cartoon Popeyes Enters cubital fossa his med. to Btundon
·
,

Coracobrachialis- ·
Terminates in front of elbow & level of

by -dial

~
coracoid
artersa
neck radius
BB of its whole course
>
- through
Short head of BB
Lies superficial susceptible to trauma
· -

Actions-
of medial
numeris

arm
of
 I
branch)
Smart (medial)
I Am
Pretty
Clinical correlation- American Residents Prefer India (lat )
.

Brachial pulse-cubital med to tendon Cubital - hollow in front of elbow

fossa Jossa
-

Base-Horizontal,directed a,
of biceps BP
Easily palpable of jex elbow a
-

Compression -

against shaft of humerus & are

m
level
of insertion of CB to
stop bleeding in

upper limb A distal to

compression of
-

any
.

brachial A .

(bleeding in
palmar arterial archis)
Volkmann's ischaemic contracture -

Sudden
cast
/ tight plaster
complete occlusion supracondylar frac. hum
: - laceration -

ischaemia
cause fibrosis of muscles of FA : -necrosis

within his
few
Muscle can tourate ischaemia up to 6hrs

·
necrosis fibrosis shortens muscle
-
-

Causes claw hand-flex wrist , ex .

MP ,
flex IP

Arterial anastomosis around elbow-

Takes place blu branches of brachial artery

those ends radial
from upper of
unar arteries
 I
contents Nerve supply-
-

extended in axilla
Narrow space
displayed- elbow LH-radial N
-
.

Dan
herve leaves
fossa by passing blu La M radial N in radial
:

groove
.
.

heads
2
of pronator teres MH- radial N . In radial groove
through .
N

②
rachial
artery terminates in fossa o : leve to anconeus

of neck g radius by warfosagapea

sup, Actions -

③ Biops tendon -* attack radial

to
tuberosity powerful extensor
of
etbow

④ Radial nerve-Brachialis (mid ), brachio .

1
supports head of humerus
during hyper-
Sup
radialis (lat.) , & level of lat
. -I in front of ar m under cover
.

epicondyle
of brachio radialis
abduction
o arm

deep-disappears in substance of supinator muscle Clinical correlation -

Clinical correlation-
Injury of RN in radial
groove
:
ex.
of abou
-
a) Venepuncture of cubital veins
triceps reflex is not
completely
lost: nerve

in axilla
Intravenous
injection/removal of blood for lab to LM arises
from
RN

flexed elbow-loose bicipital aponeurosis

b) BA-Korkoff sounds - BP Profunda brachi
artery-
arises
c) Supracondylar fractures
- contents of to
largest branch of BA
, from post . med.

aspect gBA just below TM

post. Accompanies radial radial

compartment of arm- .
N
through groove
Muscle. triceps brachi Nene Radial N

Brachia
:
.

Arteny :
Profunda brachie A
.

Di
brachi A
Triceps
-

Profunda .

-[

·
brachi , radial
E
-

A
Profunda
Deltoidranch
.
~

neme

branch
Nut

Muscular branches
of scapula

a bro

-CradialLateral
· (middle collateral A)
artery
Radial
recurrent -
Interosseous recurrent A
.
 I
Chapter : Forearm
Anterior compartment/front of forearm - Flexor
Digitorum Profundus-
i) Most
Muschs S muschs
arranged in two
groups powerful bulky muscle of FA
:

Arteries : 2 arteries -
radial 5 ulnar ii) Dual innervation Xar N

Nerves : 3 nerves radial ulnar medial iii) I

gripping power iv) Origin to lumbricals
-

,
↑ (FDS)
common synovial
- v) 4 tendons
E Hand shath-ulnar bursa

Superficial -
Deep vi) Forms most
of surface elevation med. to

Ironator policis border of ulna

longus palpable post
teres Flexor .

digitorum pronaa
exorcarpiradialis
Flexor
- vestigial
↓
-
Pronator
quadratuss Ant .
interosseous N E vessels ↓ . on interosse-

Elexor digitorum superficialis our mem .

blu FPLE FDP

ulnaris FPL is the

Flexor carpi only muscle which flexes
·

Pass Fail Pass Fail Fail

interphalangeal jt .

o thumb

ag
Pronator teres NS : Median N
. common
origin
-

flexor

i am m
Chureral) medial
epicondyle
Main pronator
-
FA sup
of flexion elbow
.

,
o
FCU-NS : ulnar .
N radialis
Flexor carpi
+ ECU adducts wrist FCR wrist
+
flexes Humnulhathead-medialepicondylesubea
agemulatea
, ,
a
middle
Rough impression on
musch
Layer medial collateral lig of elbow jt
.

3rd of lat. Surface of radius

Radial head-ant. Oblique lime of radius exten-
Flexor
digitoum ding radial
tuberosity - ins of pronator teres
EDS NS Median superficialis
:
-
:
.
N
Palmaris longus
ema
·
as Head-small ,frommediale.
/metacarpophalangeal 3
,

jt s
.
Flexor
carpi ulhar is umeral
flexes wrist most medial ulnar head medial
margin of octanon
-

process a by aponeurosis from upper 213

post .
border of ulna
Middle
splits opp . to
phalanges of medial 4 digits
proxima phasuptendon middutny
a
a pisiform bone

b) Hook of hamate s , base of 5th Mc bone

paresmad mada
* UN
enters

up
forearm
b/0 2
heads by passing
MN each of FCU -

connectedo
·

other
by tendinous

u attent
↑
UNEA is lat.

at
to FCU

MNA passbut
.
af wrist

in had e
Radial *u
·
a
n
tendan FS paa
nurs
 I
Unar

--T rigin
course & termination- ,
Artery
-
~
gin ion-
,
RadialArtery a
course
Larger terminal
branch of brachial
artery Smaller terminal branch
↓
& brachial
artery
Begins in cubital a neck radius cubital of neck of radius
&
in
Begins fossa level
:
of
fossa
:

his beneath BR
med
convexity
↓: ↓: wrist
forearm midway blu elbow a wrist with lat upper part deep muscles
:
. . -
on

Upper 3rd FA-course is

oblique (t E
medially) Lower pt. - blu tendons
&
PR and FCR

Lower-l3rd-vertical & wrist his ant. surface of radius lat. to tendon

:
on

distal to elbow crossed MN (med -lat ) Of FCRE is covered skin and fascia
it by only by
2 5 cm .
- -
.

his distal 2/3rds RN his lat. to middle 3rd

UN medial to
of artery sup of RA
↓ ↓ anatomical
around snuff box
& wrist enters palm by passing in
front of FR lat. Leaves FA
by winding Lat. Wrist I
: to UN

Quite entire

manPistor sup Palmar

.
* superficial during course in compari-

Terminates : sup palmar archit

branch of
to ulnar
attery
RA son

Relations
> Relations-
- >
-
-

(5 muscle of ant FA)

Corey by Skinsfascia)
.
Lower part covered
Ant -
PT , FCR PL FDS FCU Ant skin and fascia
Upper BR,
only
-
Lower
.

. : :
, , ,

Post. -
Only
a origin : brachialis ,
rest : Lies on FDP Post.
Labore
-
Biceps tendon FDS :3 bed

(tendon) ↓ P
Medial +
UN ,
FCU Lat .
- FDS
supinator Pronator teres

>
-

Branches- -
Branches-

Muscular branches muschs Mus cular branches-lat muscles FA

1
-neighbouring 1
of
.
.

arises in cubital fossa ,

takes

.
2 Ant .

E post . Unar recurrent A

. anastomosis part .
2 Radial recurrent A .
-
part in form of anastomosis
un short wrist , anastomoses
Upper G
course
Ant intersseous A arises nar
Supperward.-
.
3 Common interosseous A
.
of inter . mem .
-
post- interosseous A . .
3 Palmar carpal branch -w
palmar carpal branch of rA

4 .
Palmar dorsal ulnar carpal
branchessal 4 .

Sup palmat branch + arises

just above wrist -

mandup T deep palmaracsee

branches X
sup
.
Terminal VA-palmar arch
palm by passing in FR-
5 .

front of
+
sup .

Clinical correlation - Clinical correlation -

Aberrant ulnar 3% individuals B A- Interventional

artery into
radiology/Angiography
: -

terminal branches
high up
in arm ,: UA- arise
Angioplasty
high in arm & pass sup . to
flexor musches
of
FAS Sup -
.
ation
Exam
of radial pulse : radial A .
blu tendon
mistake for

Xaraw I damaged
blood as
*
a
Variat" and brachioradiatis
kept in mind -bluden
g of FCR
mediatly laterally
Irritating drug-fatal
 I
Rel of main nerves and arteries in front of Extensor Retinaculum -

mid-FA (about 7 .

5cm above crit) - Keep

fascia in back of wrist is thickened to

NNice :
Radial N .

L * Lat .

SidegFA form an
oblique fibrous band

Radial A ↓ Directed - ↓ broad I

A
Aunty and
medially zom
: .

so
t
N Never : Median N
. surgical Attachments-

A Allowed Ulnar A Med.

styloid processo ulna triquetral pisiform
: -
, ,
V

WNuisance Ular .
N M Lat Lower ant border radius
part of
-
: .
.

of

rocess
Rel wrist-
Structures
of on
front of
·

i
a

compartment
ECRB tinterossoa EP
El Ant interosseous

/
.

artery

·
Suicidal cuts results in laceration these ECRL EDM
of
Back of forearm -

1. Muschs of back of forearm

.
2 Post .
interosseous N .

.
3 Post ,
and ant. interosseous arteries Functions-
- Holds extensor tendon in place & back
of
Mobile rad
& Henry (5)
Superficial (7) X Keep Wrist & prevents their
powstringing when hand

longers)·
(3)
Brachioradiatis is extended a wrist
Supinator It
cat
carpi radiatis
.

Extensor Abductor policis longus

radialis brevis
Extensor carpi Extensor policis brevis * Palmar aponeurosis represents degenerated

minimi
Extensor
digitorum Extensor
policis longes tendons of palmaris longus
post
Extensor
digiti Extensor indice

Extensor carpi ulnaris

Anconeus
 Chapter : Hand Palmar cutaneous Palmar cutaneous

&
Tendon
of
ulnar N
.
branch of median N .

palman's longus branch of

Fascia
of palm Sup .
palmar branch Unar A
.

·
--I
Sp
Palmaris brevis : Flexor
Deep ama FDS

umar bursa
bursa
subcutaneous muscle, retinaculum
#
whar side of palm Palmaraponeurosis Palmar aponeurosis
-

transverse Fibrous Deep fascia thin

Sup .

flexor over
palm is over thenar E

metacarpal lig .: sheaths of

digits hypothenar eminences & thick in central pt
.

thickening of palm
-
"palmat aponeurosis"gdefined
*
retinaculum (transverse ) tendons patmararch
Flexor carpal lig Covers
long flexor +
sup
-

.
.

strong fibrous band formed by thickening - in shape made

congitudinal transver
·
+
,
of

deep fascia in front of carpus se

-

fibres
Bridges ant
concavity E converts it into Features
-
·
.

of
blends
tunnel")
FR
an
osscofibrous tunnel-"carpal 1. Apex :
with , sup -

fibres are

digits cont with tendon palmaris longes

-

passage of flexor tendons of .

of
(Rectan just proximal
a

Su orde
2
se
:
to head of metacarpals,

base 3achter
bundwor
a
On either side
" Y
slip long .
slips
cred cat
Sup Deep
.

Digital nerve and vessels and tendons of

·
attached to ·
attached to med .

bone lip of of
pisiform groove

j informa
Umbrical intervals blu 4
crest of
UNE vessSSe ·
trapezium
osseovibrous turn .
emerge through
of hamate
this slip el for tendon of
trapezium

longitudinal slips.
volar carpal lig . FCR

Relations- border:
Medial continuous with deep fascia

!
ulnar N .
, A
E .

covering hypothenar muschs , gives origin to

Palmar cutaneous branch of ulnar .

N palmaris brevis
sup
Palmar cutaneous branch median .
N border
Atat. continuous with deep fascia
of
:

Tendon of palmaris longes covering thenar muscles

to 5th MC
Palmar
Med .
- inward
from edge
Sup .
palmar branch of radial A FR -
Lat - inward
.

from edge to 1st MC

3
FDS Median N septum inter-
edge obliquely
.

inward from
FDP deep mediate" to 3rd MC

FDL Functions>
- - improves grip of hand by fixing skin
protects underlying T N v , ,
 Localised

&
medicine
palmar and Direct continuation

of sup .
branch of UA-curves lat .

deep to PA

in tendons.
front of long flexor
completed lat .

by anastomosing w
sup RA .

Relations -

Sup .
-
palmar aponeurosis
Deep -
Long flexor tendons of FDS &, FDP
,
lat Side
from .

lumbricals,
digital branchis MNEUN

Branches-
borus
3 common
digital arteries
interdigital clefts
-

Intrinsic (small) muschs

of hand .
2 I
proper digital artery
-

pinky
# I 3 . Cutaneous branches to palm-skin-fascia
Adductor Lumbricals arch-direct cont
Thema
Hypo- Inter- Deep palmar .

of deep RA-

muscles of thumb Ihenal ossei completed med A base of 5th MC UA

- L -m
.

by deep
Abductor
policis pres
Abductor digiti minimi RA enters
by passing blu 2 heads
of ist dorsal

brevis
Flexor policis Flext
digitiminimi interosseous muscle
immediately after - a

deep blo
[artenaprinces policeeas
-
the two - dup
-

Opponens policis opponens digiti minimi entering palm

Froment's adductor policis longus In
parm-passes bl heads of
sign AP-arch
* -

Lumbricals 152 unipennate Lat Side Deep UA-passes blu ADME FDM
from
+
,
,

of lat 2 tendons
of FDP Relations Sup tendons , Lumb
long juxor
- -
.
.

Lumbricals 354-bipennate ,
from adjacent Deep-prox shafts -

of MC ,
interosseous muscles

Sides of medial 3 tendons of FDP ranches

- -

palmar MC A
digital A

·
1 3 + common
-
.
. .

3
perforating A
through 2nd 3rd E
-
.
2 .

pass ,

4th IS - + dorsal MCA

.

.
3 Recurrent branches -
run prox .
in front &

Superficial palmar
carpus -
palmar carpal arch
arch
* laceration of palmar arterial arches :*

Control-compression of BA
against med Humans .

Ligation/camping 3
x work-arches