Upper Limb

Muscular System 1
Dr. Osman Mohammed Ibrahim MBBS, M.Sc

,
Upper Limb
Bones of the upper limb
 1. Clavicle:
 - form the pectoral girdle with
scapula .
 - the first bone to being
ossification during the fetal life , but it is
the last one to complete ossification (21
y ).
 - is the only long bone to be
ossified intramembranously .
 2. Scapula :
- scapular notch : is bridged by

superior transverse scapular ligament ,
converted into a foramen that transmits
the suprascapular nerve .
 3. Humerus :
 Surgical neck :
a common site of fracture
 Bicapital groove :
 lie between greater and lesser
tubercal
 ocupied by long head of biceps muscle
 Spiral groove :
 contain the radial nerve and brofanda
brachii artery
Radius
 is shoorter than ulnar and situated
laterally to the ulnar
Ulna
Bones of the hand
1) Carpal bones
 are arranged in 2 row of 4 bones
i.proximal row [lateral to medial ]

[scaphoid- lunate -triquetrum -pisiform ]
ii. distal row :
[trapezium-trapizoid-capitate-hamate]
2) Metacarpals
3) Phalanges
Bones of the hand
Shoulder joint
 Ball and socket synovial joint btw glenoid cavity
of the scapula and head of the humerus .
 both articular surface are coverd by hyline

cartilage .
 joint stability is privided by tendons of rotator

cuff muscle ,genohumeral ligament and
coracohumeral ligament
 the joint is inervated by axillary , suprascapular
and lateral pectoral nerve
Shoulder joint
Shoulder joint
Blood Supply of shoulder
joint
Movement at the shoulder
joint
Muscles of shoulder
Muscles of pectoral region and axilla
Axilla
 Is a pyramid shaped space between the
upper thoracic wall and the arm .
 Boundaries :
 1. Medial wall: upper ribs and their
intrcostal muscles , and saratus anterior
muscle.
 2. Lateral wall: intertubercular
groove of the humerus .
 3. Posterior wall: subscapularis ,
teres major and latissimus dorsi muscles
.
Axilla
 4. Anterior wall: pectoralis major and
minor muscles and clavipectoral fascia .
 5. Base : axillary fascia and skin
 6. Apex : interval between the clavicle

, first rib , and upper border of scapula .
Axilla
 Contents of the axilla :
 1. brachial plexus and its branches .
 2. axillary artery
 3. axillary vein
 4. axillary tail of the breast .
 5. axillary lymph nodes .
Brachial plexus
 Formed by venteral primary rami of lower four
cervical nerves and the first thoracic nerve ( C5 -
T1).
 Originates in the neck , passes lateraly and

inferiorly over the first rib and inter the axilla .
 Has roots that pass between the scalenous

anterior and medius muscles .
Brachial plexus
 Is englosed ( with axillary artery and vein ) in
axillary sheath , which is formed by prolongation
of the prevertebral fascia .
 Has the following parts:
 1. Roots : are anterior rami of C1 to C8 and
T1.
 2. Trunk :
 i. superior trunk by union of C5 & C6
root.
 ii. middle trunk , continoution of C7.
 iii. inferior trunk by union of C8 & T1.
Brachial plexus
 3. Divisions : each trunk divided into anterior
and posterior division .
 4. Cords : originate from the divisions , and
related to the second part of the axillary artery .

 i. lateral cord : formed by unioin of anterior divisions of upper and

medile trunk .
 ii. medial cord ‘; formed by continuation of anterior division of inferior

trunk .
 iii . posterior cord : unioin of all 3 posterior divisions

Brachial plexus
Branches of brachial pluxes
 1)branchs from the root
 i. dorsal scapular nerve
[c5]
 ii. long thoracic nerve [c5
-c7]: which supply sarratus
anterior muscle .
 2) branchs from the upper trunk :
 i.suprascapular nerve [c5-c6]:
 pass through scapular notch under the
superior transvers scapular ligament
where as, the supra scapular artery pass
over the ligament supply supra and infra
supinatus muscles
 ii nerve to subclavius c5
 3) branches from the lateral cord:
 i. lateral pectoral nerve c 5-7.
 ii. musculcutanios nerve c5-7.
 iii.twig to the median nerve .

 4) branchs from medial cord
 i. medial pectoral nerve [c8-t1]
 ii. medial cutanius nerve of the arm [c8-t1]:
inervate skin of the medial site of the arm ,
comunicate with the intercostoprachial nerve
which arrive as lateral branch of 2end
intercosatal nerve [ carry the refered pain in MI
]
 iii. medial cutanious nerve of the forarm [c8-t1]
 iv. ulnar nerve [c7 -t1]
 v. twig to the median nerve
 5) branches from the posterior cord:
 i.upper subscapular nerve [c5-6]
 ii. lower subscapular nerve [c5-6]
 iii. thoraco dorsal nerve[ c7-8]
 iv. axillary nerve [c5-6]
 v. radial nerve [c5-t1]: the largest branch
of the brachial pluxes
Rotator cuff muscle
 formed by tendons of
 : 1.supraspinatos,
 2 infraspinatous
3 teres minor and
4. subscapularis [SITS]
 Keep the head of the humerus in the glenoid

fossa durring movement ,and stabilize the
shoulder joint
Muscles of the Arm
 1) Anterior compartment :
 - Coracobrachialis
 - Biceps
 - Bracialis
Muscles of the Arm
 2)posterior compartment:
 - Tricips
 - Anconeus
Muscles of the Arm
Quadrangular space
 Baoundries:
 -superiorly: teres minor and sub
scapularis muscle
 -inferiorly : teres major
 -medialy : long head of triceps muscle
 -latreally : surgical neck of the humerus

Quadrangular space
 Content:
 axillary nerve and posterior
humeral cercumflex artery
Triangular interval
Baoundries
 superioly : teres major
 medially : long head of triceps
 laterally : medial head of triceps .
 Contents :
 radial nerve and brofunda brachiie
artery
Muscles of the forearm
 1) Anterior comparment :
Anterior comparment of the forearm :
Anterior comparment of the forearm
Muscles of the forearm
 2) posterior comparment :
posterior comparment of the forearm
posterior comparment of the forearm
Elbow Joint
 synovial hint joint , complex joint involving 3
seperate articulation [humero-radial ,humero-
ulnar and proximal radio- ulnar joint ] which
sheare a common synovial cavity .
 inervated by musculocutanious median ,

radial and ulnar nerve .
 stabilised by anular ligament ,radial collateral

ligament and ulanr collateral ligament
Elbow Joint
Elbow Joint
Elbow Joint
Cupital Fossa
 V shaped interval on the anterior aspect of
the elbow .
 Boundries :
 laterally : brachioradialis muscle
 medially : pronator teres
 superiorly: imaginary line conecting the

epicondyles of the humerus
Cupital Fossa
 the floor formed by brachialis and
supinator muscle
 the roof by bicapital apunurosis
 content [from lateral to medial ]

radial nerve, biceps tendon ,brachial
artery, and median nerve .
Cupital Fossa
wrist joint
 synovial condylar joint .
 between the distal radius and proximal

row of the carpal bones .
wrist joint
wrist joint
Anatomical Snuffbox
 Is a triangular depression formed on the
posteriolateral side of the wrist .
 Bounderies :
 - Medially : by the tendon of extensor
pollicis longus.
 - laterally : by the tendons of extensor
pollicis brevis and abductor pollicis longus
 - floor formed by scaphoid bone .
 Contain radial artery .
Anatomical Snuffbox
Blood supply of the upper
limb
 Arterial Supply
Blood supply of the upper
limb
 Venous

Clinical correlations
Summary
 Interactive
Referance
 R.M.H.McMinn, LAST‘S anatomy regional and applied, 9th Ed. Churchill livingstone; 1997
 Richard L.Drake, Wayne Vogl,Adam W.M.Mitchell, GRAYS anatomy for students, Elsevier Inc. 2007
 Harold Ellis, Clinical Anatomy,Applied anatomy for students and junior doctors, 11th Ed,
Blackwell
 Publishing Ltd, 2006
 Richard S.Snell, Clinical Anatomy by Regions, 8th Ed. Lippincott Williams & Wilkins.
 Moore, Keith L.; Dalley, Arthur F, Clinically Oriented Anatomy, 5th Ed. Lippincott Williams &
Wilkins; 2006.
 Agur, Anne M.R.; Dalley, Arthur F. Grant’s Atlas of Human Anatomy. 12th Ed.
Lippincott Williams & Wilkins; 2009.
 Elaine N. Marieb, R.N.; Patricia Brady Wilhelm ; Jon Mallatt. Human anatomy. 6th edition,
Pearson
 Education, Inc. ; 2012
 Johannes W.Rohen; Chihiro Yokochi; Elke Lütjen-Drecoll. Color atlas of anatomy. 7th edition.
Lippincott Williams & Wilkins 2011
 Torsten B. Moeller; Emil Reif. Pocket Atlas of Sectional Anatomy. 3rd edition. Germany by Appl
 Aprinta Druck, Wemding; 2005
 Acland's video Atlas of Human Anatomy, Robert D.Acland M.D , FRCS.
 Abraham's et al , McMinn clinical atlas.
THANK YOU

Upper Limb

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Muscular System 1

Dr. Osman Mohammed Ibrahim MBBS, M.Sc

- scapular notch : is bridged by

i.proximal row [lateral to medial ]

 both articular surface are coverd by hyline

 joint stability is privided by tendons of rotator

 5. Base : axillary fascia and skin

 6. Apex : interval between the clavicle

 Originates in the neck , passes lateraly and

 Has roots that pass between the scalenous

 i. lateral cord : formed by unioin of anterior divisions of upper and

 ii. medial cord ‘; formed by continuation of anterior division of inferior

 iii . posterior cord : unioin of all 3 posterior divisions

 ii. musculcutanios nerve c5-7.

 iii.twig to the median nerve .

 Keep the head of the humerus in the glenoid

 -inferiorly : teres major

 -medialy : long head of triceps muscle

 -latreally : surgical neck of the humerus

 inervated by musculocutanious median ,

 stabilised by anular ligament ,radial collateral

 laterally : brachioradialis muscle

 medially : pronator teres

 superiorly: imaginary line conecting the

 content [from lateral to medial ]

 between the distal radius and proximal

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