The upper limb

Muscles That Move the Pectoral

Girdle
 Originate on the axial skeleton and insert on the clavicle and
scapula.
 Stabilize the scapula and move it to increase the arm’s angle of
movements.
 Some of the superficial muscles of the thorax are grouped
together according to the scapular movement they direct.
 elevation, depression, protraction, or retraction
The muscles of back
Superficial group
 Trapezius

 Latissimus dorsi

 Levator scapulae

 Rhomboideus

Deep group
 Erector spinae

 Splenius

 Thoracolumbar fascia
4
The muscles of thorax
Extrinsic muscles
 Pectoralis major

 Pectoralis minor

 Serratus anterior

Intrinsic muscles
 Intercostales externi

 Intercostales interni

 Intercostales intimi
6
 The Muscles of Upper Limb

Muscles of shoulder
 Deltoid

 Supraspinatus

 Infraspinatus

 Teres minor

 Teres major

 Subscapularis
Major muscles of shoulder

Deltoid
 Origin: lateral third of
clavicle, acromion, and
spine of scapula
 Insertion: deltoid tuberosity
of humerus
 Action: abduction, flexion
and extension, medial and
lateral rotation of arm
Major muscles of shoulder
Teres major
 Origin: dorsal surface
of inferior angle of
scapula
 Insertion: crest of
lesser tubercle of
humerus
 Action: medially rotates
and adducts arm
Arm and Forearm Muscles That Move the Elbow
Joint/Forearm
 Anterior (flexor) compartment
 Posterior (extensor) compartment
 Anterior compartment
 primarily contains elbow flexors

 Posterior compartment contains elbow extensors

 the principal flexors

 biceps brachii, brachialis, and brachioradialis

 muscles that extend the elbow joint
 triceps brachii and anconeus
Muscles of arm
 Antererior group
 Biceps brachii
 Coracobrachialis
 Brachialis

 Posterior group
 triceps brachii
 anconeus
Muscles of arm
Biceps brachii
 Origin: long head,
supraglenoid tubercle; short
head, coracoid process
 Insertion: radial tuberosity
 Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint
Muscles of arm
Triceps brachii
 Origin:
 long head, infraglenoid tubercle
 lateral head, above groove for
radial nerve
 medical head, below groove for
radial nerve
 Insertion: olecranon of ulna
 Action: extends elbow joint,
long head extends and adducts
shoulder joint
Triceps brachii
Forearm Muscles
Supinate and Pronate
 Supinator muscle supinates the forearm.
 Biceps brachii supinates the forearm.
 Pronator teres and pronator quadratus pronate the forearm.

Move the Wrist Joint, Hand, and Fingers

 Muscles in the forearm move the hand at the wrist and/or the fingers.
 Extrinsic muscles of the wrist and hand originate on the forearm, not
the wrist or hand.

 Tendons of forearm muscles typically are surrounded by tendon

(synovial) sheaths and held adjacent to the skeletal elements by strong
fascial structures.
 At the wrist, the deep fascia of the forearm forms thickened, fibrous
bands termed retinacula.
Muscles of forearm

 Superficial layer
 Pronator teres
 Flexor carpi radialis
 Palmaris longus
 Flexor carpi ulnaris
Muscles of forearm
Pronator teres
 Origin: medical epicondyle of
humerus and deep fascia of
forearm
 Insertion: middle of lateral
surface of radius
 Action: pronation of forearm
and flexion of elbow
 Second layer
Flexor digitorum superficials
 Third layer
 Flexor digitorum
profundus
 Flexor pollicis longus
 Fourth layer
 Pronator quadratus
Action: flex radiocarpal
joint and fingers,
pronate forearm
Lateral group (3)

 Brachioradialis
 Extensor carpi radialis
longus
 Extensor carpi radialis
brevis
Posterior group (8)
 Superficial layer (3)
 Extensor digitorum
Extensor digiti minimi
 Extensor carpi ulnaris
 Action: extension at
wrist joint
Posterior group (8)
Deep layer (5)
 Supinator

 Abductor pollicis longus

 Extensor pollicis brevis

 Extensor pollicis longus

 Extensor indicis

 Action: extend at wrist

joint and fingers, and
supinate forearm
Muscles of hand
 Lateral group thenar (4)
 Abductor pollicis brevis
 Flexor pollicis brevis
 Opponens pollicis
 Adductor pollicis
 Action: flex, abduct, adduct
and oppose thumb
 Medial group hypothenar (3)
 Abductor digiti minimi
 Flexor digiti minimi brevis
 Opponens digiti minimi
 Action: flex, abduct , and oppose
little finger
Muscles of hand
Intermedial group
 Lumbricales (4) flex

fingers at MP joints;
extend fingers at IP
joints
 Palmar interossei (3)

adduct fingers towards

middle finger at MP
joints
 Dorsal interossei (3)

abduct fingers away

from middle finger at
MP joints
Arteries of upper limb
Axillary artery
 Continuation of subclavian artery at
lateral border of first rib
 Becomes brachial artery at lower
border of teres major
 Divided into three parts by overlying
pectoralis minor
 First portion, above muscle － gives
rise to thoracoacromial a.
 Second portion, behind muscle －
gives rise to lateral thoracic a.
 Third portion, below muscle － gives
rise to subscapular a., anterior and
posterior humeral circumflex a.; the
former then divides into throcodorsal
a. and circumflex scapular a.
 Arteries of upper limb
Brachial artery
 Continuation of axillary
artery
 Divides into radial and
ulnar arteries at level of
neck of radius
 Branches
 Deep brachial a.
accompanies with radial
nerve
 Superior ulnar collaeral a.
accompanies with ulnar
nerve
 Inferior ulnar collateral a.
Arteries of upper limb
Radial artery and branches
 Radial recurrent a.

 Superfical palmar branch

 Principal artery of thumb

Ulnar artery and branches

 Ulnar recurrent a.

 Common interosseous artery

 Anterior interossous a.
 Posterior interosseous a.
 Deep palmar branch
Arteries of upper limb
Superficial palmar arch
 Formed by ulnar artery
and superficial palmar
branch of radial artery
 Curve of arch lies across
the palm, level with the
distal border of fully
extended thumb
 Gives rise to three
common palmar digital
arteries each then divides
into two proper palmar
digital arteries
Arteries of upper limb
Deep palmar arch
 Formed by radial artery

and deep palmar branch

of ulnar artery
 Curve of arch lies across

upper part of palmar at

level with proximal border
of extended thumb
 Gives rise to three palmar

metacarpal arteries
Veins of the upper limb
Deep veins: accompany the
arteries of the same region and
bear similar names
Superficial veins
 Cephalic vein
 Arises from the lateral side of
the dorsal venous rete of hand
 Ascends on radial side of the
forearm to the elbow and then
in the lateral side of biceps
brachii furrow, continues up the
arm in the deltopectoral groove
and then to the infraclavicular
fossa, where it pierces
clavipectoral fascia to drain into
axillary vein
 Basilic vein
 Arises from the medial side of
the dorsal venous rete of
hand
 Ascends on the ulnar side of
forearm to the elbow and then
in the medial bicepital brachii
furrow to middle of the arm
where it pierces the deep
fascia and joins the brachial
vein or axillary vein
 Median cubital vein
links cephalic vein and basilic
vein in the cubital fossa. It is a
frequent site for venipuncture
to remove a sample of blood
or add fluid to the blood
The lymphatic drainage of upper limb
Lymphatic vessels
 Superficial － follow the
superficial veins, drain into
supratrochlear and axillary
lymph nodes
 Deep － accompany main
vessels, end in axillary lymph
nodes
lymph nodes
 Cubital lymph node: lies above
medial epicondyle of humerus
 Axillary lymph node － arranged
in five groups
Axillary lymph nodes
Arranged in five groups
 Lateral lymph nodes lie around
the distal end of axillary vein ,
receiving drainage from the arm,
forearm, and hand
 Pectoral lymph nodes lie along
lateral thoracic vessels, receive
afferents from anterior thoracic wall
including central and lateral portion of
mamma
 Subscapular lymph node along
subscapular vessels, receive lymph
from nape and scapular region
 Efferents above three groups pass to
central lymph node
 Central lymph node
 lie in fat of axillary fossa,
receive drainage from all the
above nodes, efferents pass
to apical lymph node
 Apical lymph node
 Lie in the apex of the axilla,
along the proximal end of
axillary vessels
 Receive drainage chiefly
from central lymph node ,
upper portion of mamma
 Efferents form subclavian
trunk, the right subclavian
trunk joints the right
lymphatic duct; left usually
drains directly into thoracic
duct
Brachial plexus
Formation:
 Five roots: formed by anterior
rami of C5-C8 and T1 spinal
nerves, roots C5-C7give rise to
long thoracic n.
 Three trunks
 The upper trunk is formed by the
joining of root C4,C5,C6.
 The middle trunk is the
continuation of root C7.
 The lower trunk is formed by the
joining of root C8 and T1.
 Six divisions: above clavicle,
trunks form anterior and posterior
divisions
 Three cords: below clavicle,
divisions form three cords that
surround the second portion of
axillary a.
Position:
passes through the scalene fissure to
posterosuperior of subclavian artery, then
enters the axilla to form lateral, medial
and posterior cords
Main branches
 Lateral cord
 Musculocutaneous n.

 Lateral root to median n.

 Medial cord
 Medial root to median n.

 Ulnar n.

 Medial brachial cutaneous n.

 Medial antebrachial cutaneous n.

 Posterior cord
 radial n.
 axillary n.
 thoracodorsal n.
 Musculocutaneous
Distribution: Biceps
brachii, brachalis and
coracobrachialis ‘BBC
nerve’; skin on
anterior aspect of
forearm
 Median nerve
 Distribution: Flexors of
forearm except
brachioradialis, flexor carpi
ulnaris and ulnar half of flexor
digitorum profundus,
thenar except adductor
pollicis, first two lumbricals;
skin of thenar, central
part of palm, palmar aspect of
radial three and one-half
fingers, including middle and
distal fingers on dorsum.
 Injury: Apehand
produces sign of benediction,
in which the index and middle
fingers cannot be flexed and
the thumb cannot be opposed
 Ulnar nerve
 Distribution: Flexor carpi
ulnaris, ulnar half of flexor
digitorum profundus,
hypothenar muscles,
interossei, 3rd and 4th
lumbricals and adductor
pollicis; skin of hypothenar,
palmar surface of ulnar one
and one-half fingers, ulnar half
of dorsum of hand, posterior
aspect of ulnar two and one-
half fingers
 Injury: clawhand
 Radial nerve
 Distribution: Extensor
muscles of arm and
forearm,
brachioradialis; skin on
back of arm, forearm,
and radial side of
dorsum of hand and
radial two and one-half
fingers
 Injury: Wristdrop
 Axillary
 Distribution: Deltoid
and teres minor
muscle; skin over
deltoid and upper
posterior aspect of arm
 Injury: results in deltoid
and teres minor
paralysis (loss of
shoulder abdution and
weel external rotation)
with loss of sensation
over the deltoid