anatomy of upper limb

ANATOMY OF UPPER LIMB

BYDr.TEJASWI DUSSAPG IN MS (ORTHO)GANDHI HOSPITAL

MUSCLES OF UPPER LIMB

Attachments Nerve Suply Blood Supply Actions & Clinical Testing

ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON

BONY CONNECTION -

CLAVICLE

MUSCULAR ATTACHMENTS

Trapezius, Latissmus Dorsi, Levator Scapulae, Rhomboideus

Major, Rhomboideus

Minor

TRAPEZIUS

ORIGIN: External occipetal protuberance, Superior nuchal line of occipetal bone, Spinous processes of 7th cervical and All thoracic

vertebrae INSERTION: lateral 1/3 of clavicle, Medial margin

of acromion, spine of scapula ACTION: Elevates The Scapula , rotation of

scapula, retraction of shoulder, draw the scapula downwards and Abduction Of Shoulder Beyond 90*

N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)

TREPEZIUS

LATISSIMUS DORSI

ORIGIN: posterior layer of thoraco lumbar fascia,

Spinous processes of lower 6 thoracic vertebrae and

Caudal most 3-4 ribs, May attach to iliac crest. INSERTION:

Intertubercular groove of the humerus.

ACTION: extends, adducts and medial rotation of arm

N.SUPPLY: THORACO DORSAL .N (C6,C7,C8)

LEVATOR SCAPULAE

ORIGIN: transvers processes of upper 4 cervical vertebrae.

INSERTION: medial border of the scapula superior portion.

ACTION: elevation of sup.angle of scapula and draws it medially.

N.SUPPY: C3,C4,C5 Nerves

RHOMBOIDUS MINOR

ORIGIN: ligamentum nuchae,spinous process of c7,t1 vertebrae

INSERTION : medial border of the scapula

ACTION : retracts, depress the scapula and fix it to thoracis wall

N.SUPPLY :Dorsal Scapular .N (C4,C5)

RHOMBOIDUS MAJOR

ORIGIN: Spinous process of t2-t5

INSERTION: medial border of the scapula, inf.angle

ACTION: retracts the scapula, depress the glenoid cavity and

fix the scapula to the thoracis wall

N.SUPPLY: Dorsal Scapular .N (c4,c5)

RHOMBOIDS (c4,c5)

MUSCLES OF PECTORAL REGION

PECTORALIS MAJOR PECTORALIS MINOR SUBCLAVIUS

PECTORALIS MAJOR

ORIGIN: sternal half of the clavicle, Upper half of sternum,

aponeurosis of ext.obl.muscle,

INSERTION : lateral lip of intertubercular sulcus

ACTIONS: adduction, medial rotation and flexion of the shoulder.

N.SUPPLY: Med & Lat Pectoral.N (C5-8,T1)

PECTORALIS MAJOR

PECTORALIS MINOR

ORIGIN: costocondral jn.of 3,4,5 ribs

INSERTION: corocoid process medial &upper surface

ACTIONS: draws the scapula forwards, depression of the shoulder.

N.SUPPLY: Med & Lat Pectoral.N (C5-C8,T1)

SUBCLAVIUS

ORIGIN: 1st rib at the costochondral jn.

INSERTION: subclavian groove of the clavicle

ACTION:steadies the clavicle

N.SUPPLY: N.Subclavius from upper trunk of B.P (c5,c6)

SERRATUS ANTERIOR

ORIGIN: outer and superior surface of the 1-8 ribs

INSERTION: superior angle, medial border and inferior angle of the scapula

ACTION: rotates scapula upwards,

abduction of shoulder above 90*

N.SUPPLY: Long Thoracis.N (c5,c6,c7)

WINGING OF SCAPULA

MUSCLES OF SHOULDER GIRDLE

Deltoid Rotator cuff muscles- Supra Spinatus

Infra

Spinatus,

Subscapularis,

Teres Minor.

Teres major

DELTOID

ORIGIN Lateral 1/3 clavicle,

sup.surface of acromion, spine of the scapula.

INSERTION: deltoid tuberosity. ACTION: abduction of arm, flx.&.ext of arm, med.& lat. rotation. N.SUPPLY: Axillary.N

(C5,c6)

DELTOID

SUPRASPINATUS

ORIGIN: supraspinatous fossa of the scapula

INSERTION: superior facet on the gr.tubercle of the humerus

ACTION: initiation of abduction (15*) & lat. Rotation

N.SUPPLY: Suprascapular.N From B.P (C5,C6)

SUPRASPINATUS

INFRASPINATUS ORIGIN: infraspinatous

fossa of the scapula INSERTION: middle

facet on the gr.tubercle of the humerus

ACTION: lat.rotation of

shoulder, strengthen the shoulder by bracing the head of humerus.

N.SUPPLY: Suprascapular .N of

B.P (C5,c6)

INFRASPINATUS

TERES MINOR

ORIGIN: lat.borderof the scapula

INSERTION: inf.facet on the gr.tubercle of the humerus

ACTION: ext.rotator & weak adductor

N.SUPPLY: Axillary .N.(C5,C6)

SUBSCAPULARIS

ORIGIN: medial 2/3 subscapular fossa,

lat border of tha scapula INSERTION: lesser tubercle of

the humerus ACTION: stabilise the shoulder &

prevents anterior displacement of the shoulder (med. rotation, adduction of arm)

N.SUPPLY: Upper &Lower Subscapular .N (c5,c6)

SUBSCAPULARIS

ROTATOR CUFF

TERES MAJOR

ORIGIN: dorsal surface of the inf.angle of the scapula

INSERTION: med.lip of the intetubercular groove of the humerus

ACTION: extends the arm from

flexd.position & it adducts, med.rotates the arm

N.SUPPLY: Lower Subscapular (C6,C7)

MOVEMENTS OF THE SHOULDER Flexion Extension Abduction Adduction Internal rotation, External rotation circumduction

FLEXION

Pect.Mojor Anterior Fibers Of

Deltoid Coraco brachialis

EXTENSION

Lattismus Dorsi Teres Major Posterior fibers

Deltoid

ABDUCTION

Supraspinatous (15*)

Deltoid (15-90*) Serratus Anterior

(>90*) Trapezius (>90*)

ADDUCTION

Lattismus Dorsi Pectoralis Major Subscapularis Teres Minor Teres Major CORACO BRACHIALIS

INTERNAL ROTATION

Pectoralis Major Ant.Deltoid Subscapularis Teres Major Lattismus Dorsi

EXTERNAL ROTATION

Deltoid Supraspinatus Infraspinatus Teres Minor

MUSCLES OF ARM

FLEXOR COMPARTMENT: BICEPS BRACHII

CORACO BRACHIALIS BRACHIALIS

EXTENSOR COMPARTMENT TRICEPS

BICEPS BRACHII

ORIGIN: Long head: supra glenoid

tubercle of the scapula Short head: apex of the

coracoid process INSERTION: Radial Tuberosity ACTION: flexor of supinated

forearm Powerful Supinator Of

Partially Flexed Forearm N.SUPPLY: musculo

cutaneous.N (c5,c6)

BICEPS BRACHI

CORACO BRACHIALIS

ORIGIN: coracoid process of the scapula

INSERTION: middle of medial surface of the humerus

ACTION: flexes and adducts the arm

N.SUPPLY: musculocutaneous .N (c6,c7)

BRACHIALIS

ORIGIN: distal half of the anterior humerus

INSERTION :coronoid process, tuberosity of ulna

ACTION: Powerful Flexor Of Forearm

N.SUPPLY: Musculocutaneous .N (C5,C6,C7)

MUSCULOCUTANEOUS NERVE :C5,C6,c7

Biceps Brachii

Brachialis

TRICEPS

ORIGIN: Long head: infraglenoid

tubercle of the scapula Lat.head: oblique ridge

on upper surface above the radial groove

Medial head: posterior surface of the humerus inf.to the radial groove

INSERTION: proximal olecrenon of the ulna

ACTION:extends the forearmN.SUPPLY: Radial .N.(C7,c8)

TRICEPS

MOVEMENTS AT ELBOW

FLEXION Brachialis Biceps

EXTENSION Triceps

MUSCLES OF FOREARM

Anterior Compartment:

common flx.origin SUPERFICIAL 1.Pronator Teres 2.Flx Carpi Ulnaris 3.Palmaris Longus 4.Flx.Carpi Radialis 5.Flx.Digitorum Superficialis (sublimus) DEEP: 1.Flx.Digitorum Profundus 2.Flx.Pollicis Longus 3.Pronator Quadratus

POSTERIOR COMPARTMENT

SUPERFICIAL: 1. Anconeus 2.Brachioradialis

3.Ext.Carpi Radialis Longus 4.Ext.Carpi Radialis Brevis

5.Ext.Digitorum 6.Ext.Digiti Minimi 7.Ext.Carpi Ulnaris DEEP 1.Abductor Pollicis Longus 2.Ext.Pollicis Brevis 3.Ext.Pollicis Brevis 4.Ext.Indicis 5.Supinator

PRONATOR TERES

Insertion: midway long the lateral surface of the radius

Action: pronation,flexion of forearm

N.Supply:Median.N (C6c7)

PRONATOR TERES

FLX.CARPI RADIALIS

INSERTION:base of the 2nd mc bone and slip to the bace of the 3rd MC bone

ACTION: flexion and abduction of wrist

N.SUPPLY: Median.N (c6,c7)

PALMARIS LONGUS

INSERTION: anterior aspect of the distal flx.retinaculum and palmar aponeurosis

ACTION: flx.the wrist, and tightens the palmar.aponeurosis

N.SUPPLY: Median. N (c6,c7)

FLX CARPI ULNARIS

ORIGIN: humoral head: med

epicondyle Ulnar head:med.margin of

the olecrenon,posterior border of the ulna

INSERTION: pisiform, hook of hamate, base of the

5th MC & flx.retinaculum ACTION:flexes and adducts

the hand N.SUPPLY: Ulnar.N (C7,C8)

FLX.CARPI ULNARIS

FLX.DIGITORUM SUPERFICIALIS

ORIGIN: humeroulnar head:

med.epicondyle of the humerus, coronoid process

Radial head: sup.half of anterior aspect

of the radius INSERTION : bodies of the

Middle phalanges of the medial 4 digits

ACTION: flx.of all joints it crosses

N.SUPPLY :Median .N (C7,C8,T1)

FLX.DIGITORUM PROFUNDUS

ORIGIN:prox.3/4 of the medial and anterior aspect of the ulna and from interosseous memb.

INSERTION:base of The Diatal phalanges of the medial 4 digits

ACTION: flx.DIP,,PIP,MP, wrist

N.SUPPLY: Medial-ulnar.N (C8,t1) Lateral-AIN Of Median.N

(C8,t1)

FLX.DIGITORUM PROFUNDUS

FLX.POLLICIS LONGUS

ORIGIN: upper 3/4 of anterior surface of radius

INSERTION: base of distal phalanx of the thumb

ACTION: flexion of proximal & distal phalnx of the thumb

N.SUPPLY:AIN (C7,C8,T1)

FLX.POLLICIS LONGUS

PRONATOR QUADRATUS

ORIGIN: lower 1/4th of anterior surface of ulna

INSERTION: lower 1/4th of anterior surface of radius

ACTION :pronation N.SUPPLY:AIN

(C8,T1)

POSTERIOR COMPARTMENT OF FOREARM

SUPERFICIAL1.anconeus2.Brachioradialis3.Ext.Carpi Radialis

Longus4.Ext.Carpi Radialis

Brevis5.Ext.Digitorum6.Ext.Digiti Minimi7.Ext.Carpi Ulnaris

DEEP1.Abductor Pollicis

Longus2.Ext.Pollicis longus3.Ext.Pollicis brevis4.Ext.Indicis5.supinator

ANCONEUS

ORIGIN: posterior surface of the lat.epicondyle

INSERTION:lateral surface of olecranon,body of ulna

ACTION: extension of forearm

N.SUPPLY: radial.n

BRACHIORADIALIS

ORIGIN: prox.2/3rd of lat.supracondylar ridge of humerus, lateral intermuscular septum

INSERTION: lat.aspect of distal radius just prox.to the styloid process

ACTION: acc.flexor of elbow

N.SUPPLY: Radial.N (C5,C6)

BRACHIORADIALIS

EXT.CARPI RADIALIS LONGUS

ORIGIN: lat.supracondylar ridge of humerus

INSERTION: base of the 2nd MC bone

ACTION: extends and abducts the hand

N.SUPPLY: Radial .N (C6,C7)

EXTENSOR CARPI RADIALIS BREVIS

ORIGIN: lat.epicondyle of the humerus

INSERTION: base of the 3rd MC bone

ACTION: extends and abducts the wrist

N.SUPPLY: deep br.of radial .N(c7c8)

EXTENSOR DIGITORUM

ORIGIN: lat epicondyle of the humerus

INSERTION: Extensor Expansions Of The Medial 4 digits

ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended

N.SUPPLY: PIN (c7,c8)

EXTENSOR DIGITI MINIMI

ORIGIN:lat epicondyle of the humerus

INSERTION:extensor expansion of the 5th digit

ACTION: ext.of 5th digit at MC, PIP , ext of wrist when little finger in

extension N.SUPPLY:PIN (c7,c8)

EXT.CARPI ULNARIS

ORIGIN:2 heads lat epicondyle of

humerus, Posterior border of

ulna INSERTION:medial

side of the base of the 5th MC

ACTION: extends and adducts the hand

N.SUPPLY:PIN (c7c8)

SUPINATOR

ORIGIN: lat epicondyle of humerus,

radial collateral lig., annular lig.,supinator

fossa, crest of ulna INSERTION:

lateral,posterior,anterior surface of prox 1/ 3rd 0f radius

ACTION:supination N.Supply: deep Br.Of

Radial.N (C5,c6)

SUPINATOR

ABDUCTOR POLLICIS LONGUS

ORIGIN:upper parts of the posterior surface of the radius & ulna and interosseous mem.

INSERTION:base of the 1st MC bone

ACTION: abducts,extends, lat.rotates the thumb at carpometacarpal joint, & abducts the wrist.

N.SUPPLY:PIN (c7,c8)

EXTENSOR POLLICIS BREVIS

ORIGIN:posterior surface of the radius below the origin ofAbductor Pollicis longusand from interosseous mem.

INSERTION:base of the prox.phalanx of the thumb

ACTION:extends pox.phalanx of the thumb at MC joint, ext.at 1st carpometacarpal joint

N.SUPPLY:PIN (c7,c8)

EXT.POLLICIS LONGUS

ORIGIN: posterior surface of middle 1/3rd of ulna

And interrosseous mem. INSERTION:base of the

diastal phalanx of the thumb ACTION:extends distal

phalanx of the thumb at MP joint,IP joint.and it can contribute abduction of the thumb

N.SUPPLY:PIN (c7,c8).

EXTENSOR INDICIS

Origin:posterior surface of ulna m/3rd below the EPL

Insertion:extensor expansion of the 2nd finger

Action: ext of index finger and wrist.

N.supply:PIN (c7,c8)

EXM.MOVEMENTS OF FOREARM MUSCLES

Flexion Extension Adduction Abduction

AT RADIO ULNAR JOINT Supination pronation

FLEXION

pronator teresFlx.carpi radialisFlx.carpi ulnarisFlx.digitorum

superficialisFlx. Digitorum

profundusPalmaris longusbrachioradialis

EXTENSION

Anconeus Ext.Carpi Radialis

Longus Ext.Carpi Radialis

Brevis Ext.Digitorum Ext.Indisis Ext.Carpi Ulnaris Ext. Digiti Minimi Abductor Pollicis

Longus

ADDUCTION flexor carpi ulnaris extensor carpi

ulnaris

ABDUCTION flx.carpi radialis ext.carpi radialis

longus Ext.carpi radialis

brevis Abductor pollicis

longus

PRONATION pronator teres Pronator

quadratus

SUPINATION biceps supinator

INTRINSIC MUSCLES OF THE HAND

Thenar muscles abductor pollicis brevis flx.pollicis brevis opponens pollicis Adductor

pollicis Hypothenar muscles- palmaris brevis abductor digiti

minimi flx.digiti minimi opponens digiti

minimi Lumbricals -4 Palmar interossei-4 Dorsal interosei-4

THENAR MUSCLES

ABDUCTOR POLLICIS BREVIS

ORIGIN: flx.retinaculum, tubercle of scaphoid, trapezium

INSERTION: lat.side of the base of the prox.phalax of the thumb

ACTION: abduction at carpometacarpal,MP joints

N.SUPPLY: recurrent br.of median.n (c8t1)

ABDUCTOR POLLICIS BREVIS

FLX.POLLICIS BREVIS

ORIGIN:2 heads suf.head: flx.retinaculum & trapezium bone Deep head: floor of carpal canal overlies the

trepezoid,capitate INSERTION: lateral side of the 1st metacarpal

bone and base of the prox phalanx ACTION: flexes the prox.phalanx of the thumb

at MCP and med.rotation at carpometacarpal joint

N.SUPPLY: SEPERFICIAL HEAD: median.n (c8,t1) DEEP HEAD: Deep Br.Of Ulnar Nerve

FLX.POLLICIS BREVIS

OPPONENS POLLICIS

ORIGIN: flex.retinaculum, trapezium bone

INSERTION :lat.half of the palmar surface of the 1st metacarpal bone

ACTION: oppositioin of te thumb in combination of flexion and med.rotation

N:SUPPLY: Media.N (C8,t1)

ADDUCTOR POLLICIS

ORIGIN: 2heads oblique head : bases of 2nd 3rd

metacarpals and capitate bone Transverse head: anterior

surface of 3rd metacarpal bone INSERTION: base of

prox.phalanx of the thumb ACTIONS: adducts tha

prox.phalanx of the thumb N.SUPPLY: DEEP BR.OF ULNAR NERVE

(C8, T1)

ADDUCTOR POLLICIS

HYPOTHENAR MUSCLES

PALMARIS BREVIS

ORIGIN: flx.retinaculum,palmar aponeurosis

INSERTION: skin along the medial border of the hand

ACTION:helps in gripping by wrinkling of skin over it

N.SUPPLY:Ulnar.N Suf.Br.

ABDUCTOR DIGITI MINIMI

ORIGIN: pisiform bone,the tendon of the flx.carpi ulnaris

INSERTION :medial side of the base of the prox.phalanx of the 5th digit

ACTION:abducts th 5th digit

N.SUPPY: Deep Br.Of Ulnar .N (C8,t1)

ABDUCTOR DIGITI MINIMI

FLX.DIGITI MINIMI

ORIGIN : hook of hamate,flx.retinaculum

INSERTION :medial aspect of the base of the prox.phalanx of little finger

ACTION: flex theprox phalanx of 5th digit at MCP joint

N.SUPPLY: Deep Br. Of Ulnar.N (C8,T1)

OPPONENS DIGITI MINIMI

ORIGIN:hook of hamate, flx.retinaculum

INSERTION:body of the 5th metacarpal.

ACTION: abducts, flexion,lat.rotates the 5th metacarpal

N.SUPPLY: deep br.of ulnar.N (C8,T1)

LUMBRICALS

ORIGIN: 1&2 lumbrical arise from the 2 lateral tendon of th

flx.digitorum profundus. 2&4 arises from the medial tendons of the

flx.digitorum profundus

INSERTION : lateral side of the ext.expansion of medial 4 digits.

ACTION: flex the MCP, extends the IP N.SUPPLY: 1&2 lumbrical- Median .N (C8,t1) 3&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)

PALMAR INTEROSSEI

ORIGIN: palmar interossei arises from palmar surface of the metacarpal bones of 2,4,5 digits

INSERTION: extensor expansion of the digit and bases of the prox.phalanx of the 2,4,5 digits

ACTION: Adduts The Fingers At

MCP, assists flexion at MCP, extension at IP

N.SUPPLY: deep br. Of unlar .n (C8,T1)

PALMAR INTEROSSEI

Dorsal interossei

ORIGIN: adjacent sides of the metacarpal bones

INSERTION: base of the prox.phalanx and in to the aponeurosis that forms ext.expansion

ACTION: abducts the fingers,flex the MCP

N.SUPPLY: Deep Br.Of Ulnar .N (C8,t1)

Dorsal interossei

Dorsal interossei

Parts of Brachial Plexus

Really Tired? Drink Coffee

Buddy!

R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES

Roots join to form Trunks! (in neck)

• Ventral Rami Trunks

• C5 Upper Trunk• C6• C7 Middle Trunk• C8• T1 Lower Trunk

Trunks Split to form Divisions : (in neck)• Trunks Divisions

• Upper AnteriorPosterior

• Middle Anterior

Posterior

• Lower Anterior Posterior

Divisions Join to form Cords! (in axilla)

U A P

M A P

L A P POSTERIOR

CORD

LATERAL CORD

MEDIAL CORD

Trunks DivisionsCords

Cords Give off Branches!! (in axilla)

Lateral Musculocutaneous

Median

Medial Ulnar

Posterior RadialAxillary

(thoracodorsal)(subscapular)

Injury of the brachial plexus

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