Upper limb

Arm & Cubital region

黃敏銓
1
 Arm
Lateral intermuscular septum
Anterior ((flexor)) compartment:
p stronger
g

Medial intermuscular septum

Posterior (extensor) compartment

2
Coracobrachialis
Origin:
coracoid
id process (apex)
( )
Insertion:
mid-shaft of humerus (medial side)
Function: Coracobrachialis
helps flex and adduct arm
stabilize glenohumeral joint
Innervation:
musculocutaneous nerve
Serve as a shunt muscle, when
carrying a heavy suitcase: deltoid,
deltoid
long head of the triceps, 3
coracobrachialis
 Biceps brachii Transverse humeral ligament

Three-joint muscle
Origin:
g
Long head
long head: supraglenoid tubercle Short head
short head: coracoid process (apex)
Insertion:
radial tuberosity
Function:
accessory flexor of arm
extended
t d d elbow:
lb simple
i l flexor
fl off forearm
f
90˚ elbow:
1 supinated forearm: flexor
1.
2. pronated forearm: primary supinator
Innervation: Bicipital aponeurosis
musculocutaneous nerve radial tuberosity 4
Brachialis
Origin:
distal half of humerus (anterior)
Insertion:
tuberosity of ulna
F
Function:
i
pure flexor of forearm, in all directions Brachialis
Innervation:
musculocutaneous nerve

tuberosity of ulna
5
 Triceps brachii
Oi i
Origin:
1. long head: infraglenoid tubercle
2. lateral head: superior to radial
groove (strongest)
3. medial head: inferior (workhorse)
Lateral head
Insertion: Olecranon R di l groove off humerus
Radial h

Function: Long head

extensor of forearm Medial head

long head: extend and adduct arm,

shunt
h t muscle
l
Innervation:
radial nerve
6
 Axillary artery

Profunda brachii artery

Medial bicipital groove

Brachial artery

Radial artery Bicipital aponeurosis

Ulnar artery
7
Periarticular arterial anastomoses

Profunda brachii artery

Humeral nutrient artery
Brachial artery

Radial collateral Superior ulnar collateral

Middle collateral
Inferior ulnar collateral
Interosseous recurrent
Radial recurrent Anterior ulnar recurrent
Radial artery Posterior ulnar recurrent artery
8
Ulnar artery
 A ill
Axillary vein
i

Basilic vein

Paired brachial veins

Cephalic vein

9
 Musculocutaneous nerve Median nerve

Ulnar nerve

Arcade of Struthers (AS)

Lateral cutaneous nerve

of forearm

10
Surgical Neurology 64 (2005) S1:17– S1:21
 Axillary nerve
Superior lateral cutaneous nerve of arm
Radial nerve

Lo La Inferior lateral cutaneous nerve of arm

Me
Posterior cutaneous nerve of forearm

Posterior cutaneous
Me
nerve of arm
green: branch at axilla
blue: branch at radial groove

Anconeus
11
 Cubital fossa

Brachialis
Cubital fossa
Lateral epicondyle Medial epicondyle

Pronator teres

Brachioradialis

12
 Brachial artery

Biceps brachii
Median nerve

TAN

Tendon (biceps brachii)

Bicipital aponeurosis
Radial artery

Ulnar artery

13
 Honeymoon palsy
(wrist drop)

Ulnar nerve
Medial cutaneous
nerve of forearm

Radial nerve
Pronator teres

Brachioradialis Lateral cutaneous Median

nerve of forearm cubital
vein
Deep branch

Median nerve
Supinator

Superficial branch Cephalic vein Basilic vein

14
Superficial back
S
Scapular
l region
i
黃敏銓

15
Shoulder:
upper limb →trunk and neck
Bone:
Clavicle
Scapula
Proximal end of humerus

16
 Movements of the scapula
( h i l i l scapulothoracic
(physiological l th i joint)
j i t)
Elevation Protraction Upward rotation

Depression Retraction Downward rotation

17
Movements of glenohumeral joint

18
Lateral posterior cutaneous branch Medial posterior cutaneous branch
19
Shoulder
Superficial
p muscles:
Trapezius
scapula and clavicle → trunk
(pectoral girdle)
Deltoid
scapula and clavicle → humerus

Deep to trapezius:
Levator scapulae
Rhomboid minor
Rhomboid major 20
 Trapezius
Origin:
Skull ligamentum nuchae,
Skull, nuchae vertebrae C7-T12
C7 T12
Insertion:
Spine of scapula acromion lateral 1/3 clavicle
scapula, acromion,
Function:
Upper
U fibers: elevate
fib l t scapulal
Middle fibers: retract scapula
L
Lower fib
fibers: depress
d scapula l
Upper fibers+Lower fibers: upward rotate scapula
I
Innervation:
i
Accessory nerve (CN XI): motor fibers
Anterior rami of C3 and C4
21
 Deltoid
Origin:
spine of scapula, acromion, lateral 1/3 clavicle
Insertion:
deltoid tuberosity of humerus
Function:
anterior part: flexes and medially rotates arm
middle part: abducts arm
posterior part: extends and laterally rotates arm
all:
ll abductor
bd t > 15°
15°; shunt
h t muscle
l
Innervation:
axillary nerve
22
 Levator scapulae

Origin:
g
transverse processes of C1 to C4
Insertion:
scapula: superior angle to root of spine
Function:
scapula: elevation and downward rotation
neck: extension and lateral flexion
Innervation:
dorsal scapular (C5) nerve
anterior rami of cervical ((C3 and C4)) nerves
23
 Rhomboid minor
Origin:
lower end of ligamentum nuchae
spinous processes of C7 and T1
Insertion:
scapula: smooth triangular area at root of spine
Function:
scapula:
p elevation, retraction, downward rotation
Innervation:
dorsal scapular nerve

24
 Rhomboid major

Origin:
g
spinous processes of T2 to T5

Insertion:
scapula: from insertion of rhomboid minor
to inferior angle
Function:
scapula: elevation, retraction, downward rotation
Innervation:
dorsal scapular
p nerve
25
 Latissimus dorsi
Origin:
p
Spinous processes of inferior 6 thoracic
p
vertebrae, thoracolumbar facia, iliac crest,
inferior 3 or 4 ribs
Insertion: Triangle of auscultation
floor of intertubucular g
groove of humerus
Function:
Humerus: adduction,, extension,, medial
rotation
Scapula: downward rotation, depression
Innervation:
Thoracodorsal nerve
26
Elevate ribs
2nd to 5th intercostal nerves

Serratus posterior Origin: nuchal ligament, C7-

superior T3 spinous processes

Insertion: superior
borders of 2nd to
4th ribs

T11-L2
Origin: T11 L2
spinous processes
Insertion: inferior
b d
borders off 8th tto Serratus posterior
12th ribs inferior
Depress ribs
D ib
T9-T12 thoracic nerves 27
 Posterior scapular region
Supraspinatus

Teres minor
Infraspinatus

Teres major

Long head of triceps brachii

28
Supraspinatus
p p
Origin:
Supraspinatus
supraspinous fossa
(medial 2/3)
Insertion:
greater tubercle
b l ((superior
i
facet)
Function:
abduction of am (<15°)
Innervation:
suprascapular nerve
29
Infraspinatus
p
Origin:
Infraspinous fossa
(medial 2/3) Infraspinatus
Insertion:
greater tubercle
b l ((middle
iddl
facet)
Function:
Powerful lateral rotator
of humerus
Innervation:
suprascapular nerve 30
 Teres minor
Origin:
lateral upper 2/3 of scapula
Insertion:
greater tubercle (inferior Teres minor

f
facet)
)
Function:
lateral rotation of arm
Innervation:
axillary nerve

31
 Teres major
j
Origin:
Inferior angle (posterior) of
scapula
Insertion:
M di l lilip off iintertubercular
Medial b l
sulcus of humerus
Function:
Medial rotation and adduction Teres major

help extension
Innervation:
Inferior subscapular nerve 32
Long head of triceps brachii

Origin:
Infraglenoid tubercle on
scapula
Insertion:
Olecranon process of ulna
Function: Long head of triceps brachii

Arm: adductor and extensor

Forearm: extensor
I
Innervation:
ti
Radial nerve

33
 Supraspinatus Rotator cuff
muscles
Teres minor
Infraspinatus

Subscapularis

34
Gateways to the posterior scapular region
Suprascapular nerve
Suprascapular artery Transverse scapular ligament

Axillaryy nerve
Posterior circumflex humeral artery

Profunda brachii artery

Circumflex scapular artery Radial nerve

35
 Arterial anastomoses around the shoulder

Suprascapular artery
Th
Thyrocervical
i l ttrunk
k

Anterior
A t i circumflex
i fl
humeral artery

Deep branch of Posterior circumflex

transverse cervical artery humeral artery
(dorsal scapular artery)
Circumflex scapular artery

Thoracodorsal artery

Profunda brachii artery

36