Anatomy of the upper limb

Tesfayesus G. ab
Public health*2013

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Introduction
• Divided in to 4
segments:
– Shoulder
– Arm
– Forearm
– Hand

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 1. Shoulder - the most proximal part overlapping with
trunk and lower & lateral part of the neck
 Consist – pectoral, scapular & lateral regions

2. Arm (Brachium)- b/n shoulder and elbow

 The 1st free segment of upper limb & longest one
 More mobile independent of the trunk

3. Forearm (antebrachium)- b/n elbow and wrist

(carpus)
 Second longest segment

4. Hand (Manus)- the most distal segment composed

of wrist, palm and dorsum of the hand and the
fingers

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  The superior appendicular skeleton is composed of:
 Pectoral girdle
 Bones of the free part of the upper limb

Articulates with the axial skeleton only at the

sternoclavicular joint
 Less number of articulation allows great mobility

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 Pectoral (Shoulder) Girdle
 Consists of two bones:
clavicle and scapula

 Loosely attached to the

axial skeleton, held in
place largely by
musculature

 The loose attachment

frees the girdle to move
over the thorax

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 Clavicle (collar bone)
• Double curved bones (S-shaped) extending horizontally
along the root of the neck

• The medial 2/3rd of the shaft of the clavicle are convex

anteriorly, whereas the lateral third is flattened and
concave anteriorly
– curvatures increase the resilience of the clavicle

• Has two ends:

• Sternal end (medial end): larger and round,
articulates with manubrium of the sternum at the
sternoclavicular joint
• Acromial end (lateral end): flattened, articulates
with acromion of scapula at the acromioclavicular
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joint
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 Clavicle: function
 The only bone to connects the upper limb with the
trunk (axial skeleton) at sterno-clavicular joint
Transmits the weight and shocks (traumatic impacts)
from the upper limb to the axial skeleton

 Attachment site for some muscles of the thorax,

shoulder and neck

 Keeps scapula away from thorax so that the arm

(humerus) which is attached to scapula has maximum
freedom of motion
 Afford protection to the neurovascular bundles passing
below this bone to supply the upper limb
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 Fracture of clavicle
• Commonly caused by an indirect
force transmitted from an
outstretched hand during a fall
• The weakest part is at the junction
of its medial 2/3rd and lateral
thirds
• After fracture:
– sternocleidomastoid (SCM)
muscle elevates the medial
fragment of bone
– trapezius muscle is unable to hold
up the lateral fragment owing to
the weight of the upper limb
– thus the shoulder drops
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 Scapula (shoulder blade)
 Triangular flat bone lying on the posterolateral aspect of
the thorax
 Overlies the 2nd -7th ribs

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 Has 3-borders and 3-angles
Angles: superior, lateral, and inferior angle

Borders:
Lateral (axillary) border
 the thickest part, includes head of the scapula where the
glenoid cavity is located

 Glenoid cavity on the upper part:

shallow, concave, oval fossa
directed anterolaterally and slightly superiorly
articulates with the head of the humerus -
glenohumeral (shoulder) joint
• The cavity is considerably smaller than the head
of the humerus (loose fitting joint)
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 Scapula: lateral view

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Superior border
Bears suprascapular notch near the root of coracoid process

Medial (vertebral) border

b/n superior and inferior angle

Has 2-surfaces
Anterior surface
Smooth and a bit concave
Its shallow concavity forms subscapular fossa

Posterior surface
Slightly convex

divided by a thick palpable ridge, the spine, into the smaller

supraspinous fossa (above the spine) and larger infraspinous
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fossa
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Has two processes (projections)
Acromion- lateral extension of the spine, flat expanded
projection
 the acromion articulates with the acromial end of the clavicle at
acromioclavicular joint

• Coracoid process
– projects anterolaterally from the superior border of scapula just
lateral to suprascapular notch (resembles birds beak)

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Scapula: anterior & posterior view

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 Bones of the free upper limb
Arm
Humerus
Forearm
Ulna
Radius
Hand
Wrist (8 carpal bones)
Palm (5 metacarpal bones)
Fingers (14 phalanges)

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 Humerus
• The longest and largest bone of upper extremity

Features of the proximal end:

• Head
– ball-shaped proximal end
– articulate with the glenoid cavity of the scapula at
shoulder joint

• Has two tubercles:

– Lesser tubercle- directed anteriorly, smaller
Greater tubercle – laterally placed mass, larger
– intertubercular groove (bicipital groove) separates the two,
long head of biceps brachii runs in this groove

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Surgical neck
narrow part just distal to the tubercles

Shaft (body)
Has radial (spiral) groove- oblique groove on posterior
surface for radial nerve

Features of the distal end:

Condyles of the humerus

distal articular end of the humerus

 Has prominent projections:

the more prominent medial epicondyle and the smaller
lateral epicondyle
A groove posterior to the medial epicondyle where the
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tesfsh nerve obtains protection is the ulnar groove
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 Olecranon fossa
Depression on the posterior aspect of distal end
accommodates the olecranon of the ulna during
extension of the elbow
coronoid fossa
Depression on the Anterior aspect of distal end
receives the coronoid process of the ulna during full
flexion of the elbow.
radial fossa
Depression on the Anterior aspect of distal end
accommodates the edge of the head of the radius
when the forearm is fully flexed.

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 Fracture of the humerus
Fractures of the surgical neck of the humerus
common in elderly people
usually result from a fall on the hand
Associated with injury of axillary nerve which winds it

 Transverse fractures of the shaft of humerus

Associated with injury of radial nerve in radial groove

 Supracondylar fracture
Associated with injury of median nerve

 Medial epicondylar fracture – associated with ulnar

nerve injury in ulnar groove

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 Ulna
 The medial and longer of the two forearm bones

 Its proximal end is large (wretch shaped) and the distal

end is small and rounded, which is its head having conical
distal projection, ulnar styloid process
 has two prominent projections on proximal end:
olecranon process posteriorly
coronoid process anteriorly
 The notch b/n the two processes is the articular surface for
the distal end of humerus forming elbow joint
 Just distal to the coronoid process is ulnar tuberosity where
brachialis muscle is inserted

 The ulna does not reach carpal bones, and therefore

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tesfshnot participate in the wrist (radiocarpal) joint
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 Radius
 The lateral and shorter of the two forearm bones
 Large distally and small proximally
 The small rounded proximall end is its Head
 Neck- narrow part below the head

 Radial tuberosity- is roughened thickening on the medial

aspect of the shaft immediately below the neck, is the
insertion for biceps brachii tendon

 laterally the distal end has downward projection called- radial

styloid process
 Interosseous membrane – fibrous membrane connecting the
radius and ulna

• Medially articulate with ulna both on its proximal and distal

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end at proximal and distal radio-ulnal joint
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 Fracture of ulna and radius
 A direct injury usually produces transverse fractures at
the same level, often in the middle third of the bones
Colles fracture
A complete fracture of the distal end of the radius
The most common fracture of the forearm
Results from forced dorsiflexion of the hand
The distal fragment of the radius is displaced dorsally
and often broken into pieces
As a result the hand resembles fork, so it is also called
dinner fork deformity

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 Colles fracture

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 Carpals Bones
 8 bones, form the wrist (carpus)
 Arranged in two transverse rows of 4 bones
 Carpus is concave anteriorly

Proximal row
articulate with radius and articular disc of wrist joint

Proximal row from lateral to medial:

 Scaphoid: boat-shaped, forms the floor of anatomical snuff box
 Lunate: moon-shaped
 Triquetrum: pyramidal
 Pisiform: pea-shaped; lies on palmar surface of triquetrum

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 Distal row
Articulate with base of metacarpals distally

Distal row from lateral to medial:

 Trapezium: four sided
 Trapezoid: four sided but wedge-shaped
 Capitate: has two heads; largest
 Hamate: wedge-shaped, has hooked process (hook of hamate)

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 Metacarpals
 Forms the skeleton of the palm
 Composed of 5-metacarpal bones
 Numbered from lateral (in line with thumb) to medial (in
line with little finger) as MC-1, MC-2, MC-3, MC-4 & MC-
5

 Each metacarpal consists of a base, shaft, and head

 The proximal bases of the metacarpals articulate with

the carpal bones

 The distal heads of the metacarpals articulate with the

proximal phalanges and form the knuckles
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Phalanges
 14 bones; form the fingers

 Each digit has three phalanges (proximal, middle, and

distal phalanx) except for the pollex (thumb), which has
only two (proximal and distal)

 Each phalanx has a base proximally, a shaft (body), and

a head distally

 The distal phalanges are flattened and expanded at

their distal ends, which underlie the nail beds

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 The following structures are palpable
Acromion
Coracoid process of scapula
Spine of scapula
Greater tubercle of humerus
Medial and lateral epicondyles
Olecranon
Styloid processes of radius and ulna
Pisiform

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 Palpable parts of upper limb bones

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Superficial vessels of upper limb
Dorsal venous network
On dorsum of the hand
Give rise to cephalic and basilic veins

Cephalic vein
Ascends from lateral part of dorsal venous network
Proceed along anterolateral surface of forearm and
arm
Superiorly passes in the groove between deltoid and
pectoralis major muscles and enters deltopectoral
triangle b/n the two muscles and joins axillary vein

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Basilic vein
Ascends from medial part of dorsal venous network
Proceed along medial side of forearm and inferior part
of arm
Pierce the deep fascia of arm and merges with the
deep brachial veins (venae comitantes of the brachial
artery) to form the axillary vein in axilla
Median cubitan vein
Anterior to elbow (in cubitan fossa), communicate
basilic and cephalic vein

Median antebrachial vein (median vein of

forearm)
Ascends in the middle of anterior aspect of forearm
between cephalic and basilic veins
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Venipuncture
 Puncture of a vein to draw blood or inject a solution
 Because of the prominence and accessibility of the
superficial veins, they are commonly used for
venipuncture

 The median cubital vein is commonly used for

venipuncture

 The veins forming dorsal venous network and the

cephalic and basilic veins arising from it are commonly
used for long-term introduction of fluids

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 Cephalic vein

Median cubitan ven

Cephalic vein Basilic vein

Median antebrachial vein

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 Axioappendicular Muscles

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 Anterior Axioappendicular Muscles
(muscles of the pectoral region)
Four muscles that move the pectoral girdle
Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior

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 Pectoralis major
 Covers superior part of thorax

 Origin- has two heads:

Clavicular head: medial half of clavicle
Sternocostal head: sternum, superior six costal
cartilages

Insertion- proximal part of shaft of humerus

Innervation
Lateral and medial pectoral nerves
Action
Adducts and medially rotates humerus
Acting alone, clavicular head flexes humerus
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 Pectoralis minor
 Small triangular muscle
covered by pectoralis major
 Draws the scapula foreward
and downward

Subclavius
 Lies horizontally inferior to
clavicle
 Protect subclavian vessels
and brachial plexus passing
below it to the axilla

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 Serratus anterior
 broad muscle overlying lateral part of thorax
 Anchors scapula against back of thoracic wall, enabling
other muscles to use it as a fixed bone for movement of
humerus

Origin: External surfaces of lateral parts of 2nd to 8th

ribs and appears a saw

Insertion: Anterior aspect of medial border of scapula

Innervation: Long thoracic nerve

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Paralysis of serratus anterior
• Due to injury of
long thoracic nerve

• Medial border of
the scapula moves
laterally and
posteriorly away
from thoracic wall
– winged scapula

• Arm cannot be
abducted above
horizontal position
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Posterior Axioappendicular Muscles
 Attach the pectoral girdle to the axial skeleton

 Are superficial back muscles (extrinsic muscles) acting

up on the upper limb
 Include: trapezius, latissimus dorsi, levator scapulae and
rhomboids

Scapulohumeral muscles:
 Attach the scapula to the proximal part of humerus
 Include: deltoid, teres major, and the four rotator cuff
muscles (supraspinatus, infraspinatus, teres minor, and
subscapularis)
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Trapezius
 Provides direct attachment of pectoral girdle to trunk

 Covers posterior part of neck and superior half of trunk

 Attach pectoral girdle to cranium and vertebral column

Innervation:
 Accessory nerve (CN XI)

Actions:
descending part (superior fibers) elevates scapula
ascending part (inferior fibers) depresses scapula
middle part (or all parts together) retracts scapula medially
Supports the neck and head resisting flexion of neck when
the trunk is in flexed position (at this time it is more
prominent and appears bilateral band separated by median
groove on the back of the neck or nucha)
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Latissimus dorsi
• Fan-shaped muscle which covers wide area of lower back

Origin:
 Iliac crest of hip, spines of inferior 6 thoracic vertebrae
and thoracolumbar fascia

Insertion: intertubercular groove of humerus

Innervation: Thoracodorsal nerve

Actions:
• Extends and adducts arm when the limb is free
• raises body (trunk) toward arms when the limb is holding
on fixed thing as in climbing the tree or walking on crunch
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Rotator cuff muscles
 Rotator cuff are short muscles that pass from scapula to
humerus (supraspinatus, infraspinatus, teres minor, and
subscapularis)
 Called rotator cuff because they form a
musculotendinous cuff around glenohumeral joint
All except the supraspinatus (which is abductor of the
humerus) are rotators of the humerus
 The tendons of the rotator cuff muscles blend with the
joint capsule of the glenohumeral joint, which protects
the joint and gives it stability

 Tonic contraction of these muscles holds the relatively

large head of the humerus firmly against the small and
shallow glenoid cavity during arm movements
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Main actions of scapulohumeral muscles on the
arm (humerus):
Teres major and Subscapularis= rotate the arm
medially

Supraspinatus= initiate abduction of arm up to 25

degree from the trunk (weak abductor)

Infraspinatus and Teres minor= rotate the arm laterally

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 Deltoid muscle
 Thick powerful muscle forming the rounded contour
of the shoulder

 Divided into clavicular (anterior), acromial (lateral),

and spinal (posterior) parts that can act separately or
as a whole

 Origin: Lateral third of clavicle; acromion and spine of

scapula

 Insertion: Deltoid tuberosity of lateral side of shaft

of humerus

 Innervation: Axillary nerve

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Action:
 When all three parts contract simultaneously, the arm is
abducted= strong abductor of the arm

 Independently acting:
Anterior part: flexes the arm
Middle part: abducts arm
Posterior part: extends the arm

 resist inferior displacement of the head of the humerus

from the glenoid cavity

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 Injury to axillary nerve
• Occur when surgical neck
of humerus is fractured
• Results in atrophy of
deltoid
• Rounded contour of
shoulder disappears and
the shoulder become
pointed (apparent
acromion)
• To test deltoid (function
of axillary nerve) the
arm is abducted against
resistance
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 Surface anatomy
• Triangle of auscultation
– The area formed by the superior border of latissimus
dorsi, the medial border of the scapula, and the
inferolateral border of the trapezius

– This gap in the back musculature is a good place to

examine posterior segments of the lungs with a
stethoscope

– When the scapulae are drawn anteriorly by crossing

the arms across the thorax and the trunk is flexed,
the auscultatory triangle enlarges

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 Triangle of ausculation

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Deltopectoral triangle

 Is formed by the
pectoralis major, the
deltoid and the clavicle.

 transmits the cephalic

vein which pierces the
clavipectoral fascia to
join the axillary vein.

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 Axilla

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 Axillary region

• has two parts:

1. Axillary fossa
(armpit)
- is the visible Concave
depression b/n the arm
and the lateral
thoracic wall.
• Skin covered with
hair

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2. Axillary cavity (Axilla)
- is a pyramidal space
located at the junction of
the arm and thoracic wall

function of the axilla is to

transmit and protect blood
vessels and nerves that run
from the root of neck to
the arm or vice versa.

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Axilla: content
The axilla contains
axillary artery and its branches
axillary vein and its tributaries
brachial plexus of nerves (cords and branches)
Groups of axillary lymph nodes

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 Axillary Artery
 Begins at the lateral
border of 1st rib
as the continuation
of subclavian artery
on the root of neck

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 Brachial plexus
 Brachial plexus is a major network of nerves supplying
the upper limb

 It begins in the lateral region of the neck and extends

into the axilla

 Formed by the union of the anterior rami of C5 - T1

spinal nerves, which constitute the roots of brachial
plexus

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 Parts of the brachial plexus

1. Roots:
 Has five roots formed by ventral rami of C5-T1 nerves

2. Trunks:
The 5 ventral nerve rami (roots) unite into 3 trunks in the
neck:
superior trunk – the union of C5 and C6
middle trunk – a continuation of C7
inferior trunk – the union of C8 and T1

3. Divisions:
Each trunk divide in to two divisions: anterior and
posterior division

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 4. Cords
 3-cords are formed in axilla by the union of divisions

lateral cord: from the anterior divisions of the

superior and middle trunks

medial cord- continuation of the anterior division of

the inferior trunk

posterior cord- from the posterior divisions of all 3

trunks

5. Branches
Side branches- arise from roots and trunks
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Terminal branches-arise from the cords
 Roots join to form Trunks (in neck)

Roots Trunks

 C5 superior trunk
 C6
 C7 Middle Trunk
 C8
 T1 Lower Trunk
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Trunks Split to form Divisions
Trunks Divisions

 Superior Anterior
Posterior

 Middle Anterior
Posterior

 inferior Anterior
Posterior

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Cords Terminal branches
Lateral Musculocutaneous

Median

Medial Ulnar

Posterior Radial Axillary

thoracodorsal
2 subscapular

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 Damage to Radial Nerve = wrist drop
Inability to extend the hand, st inability to fully
extend forearm

Median Nerve Damage = “Ape” Hand

Inability to Oppose Thumb

Ulnar Nerve Damage: Claw hand

Inability to extend fingers at interphalangeal
joints, results in permanent flexion = claw

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 Muscles of the arm
Anterior compartment- contains 3-muscles (BBC)
1. Biceps brachii - flex the arm and also
forearm
2. Brachialis- flex the forearm only
3. Coracobrachialis- flex the arm only
All are innervated by musculocutaneous nerve

Posterior compartment- contains only 1-muscle:

.Triceps brachii – extends the arm and forearm
It is innervated by the radial nerve

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 Biceps brachii Brachialis coracobrachialis

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 The cubital fossa
Is a small triangular depression on the anterior aspect
of elbow:
Its important contents are:
brachial artery
median nerve
Median cubital vein

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 Anterior (flexor) compartment of forearm
Superficial group (origin at medial epicondyle)
Pronator teres and quadratus (pronates forearm)
Flexor carpi radialis (flexes and abducts wrist)
Flexor carpi ulnaris (flexes and adducts wrist)
Flexor digitorum superficialis (flexes 4-digits except the
thumb via its four tendons, particularly middle phalanx)
Flexor digitorum profundus (flexes 4-digits except the
thumb via its four tendons, particularly distal phalanx)
Flexor pollicis longus (flexes thumb)

Nerve supply: except flexor carpi ulnaris and half part of flexor
digitorum profundus which are innervated by ulnar nerve, all
others are are innervated by median nerve

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Posterior (extensor) compartment of forearm
Superficial group (origin at lateral epicondyle)
Brachioradialis (transitional muscle b/n anterior and
posterior compartment, flexes elbow at mid-prone
position)
Extensor carpi radialis (extend and abduct wrist)
Extensor digitorum (extends fingers)
Extensor digiti minimi (extends fifth digit)
Extensor carpi ulnaris (extends and adducts wrist)
Deep group (originate from shaft of radius & ulna)
Supinator (supinates forearm)
Extensor pollicis brevis and longus (extend thumb)
Extensor indicis (extend index finger)
Nerve
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supply – Radial nerve to all muscles 09/16/2023
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 Muscles of palm of the Hand
 Thenar compartment- 3-muscles which act up on the thumb
(pollex), form an elevation on lateral part of the palm called
thenar eminence. These are:
Abductor pollicis- abduct the pollex (thumb)
Flexor pollicis brevis- flex the thumb
Opponens pollicis- oppose the thumb as in holding the pen

 Hypothenar compartment- 3-muscles which act up on the little

finger (digiti minimi), form an elevation on medial part of the
palm called hypothenar eminence. These are:
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

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  Short muscles of palm of the hand
Interossei muscles – muscles which lie b/n adjacent metacarpal
bones. In each space b/n the metacarpal bones there are two
interossei muscles (dorsal & palmar)
Palmar interossei- adduct digits = PAD
Dorsal interossei- abduct digits = DAB

Lumbricals – 4 worm like muscles, are straight finger flexors

 Nerve supply: except thenar muscles which are innervated by
median nerve, all other muscles are innervated by ulnar nerve

 Note: there is no muscle on the dorsum of the hand where there

are long tendons of muscles of posterior (extensor) compartment
of forearm

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 Arteries of the arm, forearm and hand
Brachial artery:
Is the artery of the arm
a continuation of axillary artery in the axilla
Runs in the groove on the medial side of the arm where it can
be compressed aginst humerus to feel its pulse (brachial
pulse)
In the cubitan fossa divide in to to: radial and ulnar artery
 Radial and ulnar arteries:
Are the arteries of the forearm
Radial artery runs deeply on the radial (lateral) side of
anterior compartment of forearm. Radial pulse usually felt on
the distal part of forearm lateral to the tendon of flexor carpi
radiais
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  Ulnar artery: runs deeply on the ulnar (medial) side of the
anterior compartment of forearm

 Palmar arch of arteries: supply the hand

As the radial and ulnar arteries reach the wrist, each divide in to
superficial and deep branches
The superficial branches of each artery unite (anastamose) and
form superficial palmar arch (subcutaneous)
The deep branches of each artery unite and form deep palmar
arch (deep to palmar muscles)
Digital arteries arise from each arch to supply the each digits

 Note: deep veins of the upper limb accompany all the arteries
(venacommitantes) and have same name. remember the
superficial veins (cephalic and basilic veins) which are not
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accompanied by the arteries
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 Contents of the Anterior Fascial
Compartment of the Forearm
Muscles:
A superficial group: consisting of the pronator
teres, the flexor carpi radialis, the palmaris
longus, and the flexor carpi ulnaris
An intermediate group: consisting of the flexor
digitorum superficialis and
A deep group: consisting of the flexor pollicis
longus, the flexor digitorum profundus, and the
pronator quadratus
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 Contents of the Anterior Fascial
Compartment of the Forearm
Blood supply to the muscles: Ulnar and
Radial arteries
Nerve supply to the muscles: All the
muscles are supplied by the median nerve
and its branches, except the flexor carpi
ulnaris and the medial part of the flexor
digitorum profundus, which are supplied by
the ulnar nerve

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 Muscles of the Anterior Fascial
Compartment of the Forearm
Superficial Muscles:
 Have a common origin by common flexor
tendon from the medial epicondyle of the
humerus
 They are arranged from lateral to medial:
1. Pronator teres
2. Flexor Carpi radialis
3. Palmaris longus
4. Flexor Carpi ulnaris
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 Contents of the Lateral Fascial Compartment
of the Forearm
The lateral fascial compartment may be
regarded as part of the posterior fascial
compartment.
Muscles:
Brachioradialis and Extensor carpi radialis
longus
Blood supply:
Radial and brachial arteries
Nerve supply to the muscles:
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Radial nerve
 Muscles of the Lateral Fascial Compartment
of the Forearm
Muscles in the lateral fascial compartment
of the forearm are Brachioradialis and
Extensor carpi radialis longus

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 THE POSTERIOR
COMPARTMENT
OF THE FOREARM

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 Contents of the Posterior Fascial
Compartment of the Forearm

Muscles:
The superficial group: the extensor carpi
radialis brevis, extensor digitorum, extensor digiti
minimi, and extensor carpi ulnaris
The deep group: includes the supinator,
abductor pollicis longus, extensor pollicis brevis,
extensor pollicis longus, and extensor indicis

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 Contents of the Posterior Fascial
Compartment of the Forearm
Blood supply: Posterior and anterior
interosseous arteries
Nerve supply to the muscles: Deep branch
of the radial nerve

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 Muscles of the Posterior Fascial
Compartment of the Forearm
Also known as Extensor - Supinator Muscles of
the Forearm

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 Extensor Muscles of the Forearm
These muscles can be organized physiologically into:
Muscles that extend and abduct or adduct the hand at
the wrist joint (extensor carpi radialis longus, extensor
carpi radialis brevis, and extensor carpi ulnaris)
Muscles that extend the medial four fingers (extensor
digitorum, extensor indicis, and extensor digiti
minimi)
Muscles that extend or abduct the thumb (abductor
pollicis longus, extensor pollicis brevis, and extensor
pollicis longus)
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 Extensor Muscles of the Forearm
The extensor tendons are held in place in the
wrist region by the extensor retinaculum, which
prevents bowstringing of the tendons when the
hand is extended at the wrist joint
As the tendons pass over the dorsum of the wrist,
they are provided with synovial tendon sheaths
that reduce friction for the extensor tendons as
they traverse the osseofibrous tunnels formed by
the attachment of the extensor retinaculum to the
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distal radius and ulna
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 Extensor Muscles of the Forearm
The extensor muscles of the forearm are organized
anatomically into superficial and deep layers
Superficial extensors: extensor carpi radialis brevis,
extensor digitorum, extensor digiti minimi, and
extensor carpi ulnaris- are attached proximally by a
common extensor tendon to the lateral epicondyle
Deep extensors: Supinator, Extensor indicis,
Abductor pollicis longus (APL), Extensor pollicis
longus (EPL), Extensor pollicis brevis (EPB) - the
latter three are termed as Outcropping muscles of deep
layer
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 DEEP MUSCLES
The deep extensors of the forearm act on
the thumb or the index finger
Acting on the thumb are abductor pollicis
longus, extensor pollicis longus, and
extensor pollicis brevis and
Acting on the index finger is extensor
indicis

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 DEEP MUSCLES
The three muscles acting on the thumb are
deep to the superficial extensors and crop
out (emerge) from the furrow in the lateral
part of the forearm that divides the extensors
Because of this characteristic, they are
referred to as outcropping muscles

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 DEEP MUSCLES
Arranged from lateral to medial, the deep
muscles of the back of forearm are:
1. Supinator
2. Abductor pollicis longus
3. Extensor pollicis brevis
4. Extensor pollicis longus
5. Extensor indicis

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