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Nerve supply of muscles of upper limb
Ms. of front of armMs. of Back of arm & forearm Ms. of front of forearm
Musculocutaneous N.All the Ms. except medial
11/2 Ms Median Nerve
Ulnar N. Radial N.
Cutaneous innervation of upper limb
ThenareminenceHypothenar
eminence
The muscles of the hand are supplied by ulnar & median nerves
A- All thenar muscles are supplied by median
except “ adductor pollicis” by ulnar N .
B- All hypothenar muscles by ulnar N.
C. Lumbrical muscles :
1 -1st & 2nd by median nerve
2 -3rd & 4th by ulnar nerve
D. Palmar & Dorsal interossei by ulnar nerve
(Fig. 32 ) Lumbrical muscles
Palmar Interossei
(Adductors)
(Abductors)
Ulnar nerve
(Fig.37)Musculocutaneous, median & ulnar nerves in the axilla & arm
Ulnar nerve in forearm & hand
Deep branch of ulnar N. passes with deep palmar arch in front of interossei muscles
Deep branch of ulnar N. supplies the interossei muscles
Injury to the ulnar nerve Cause : a fracture of the medial epicondyle, or wound in the wrist . It results in a claw hand )Fig.43(.
The lesion above the elbow : ) partial claw hand (1 -The ring and little fingers : a- loss of flexion of terminal phalanges ) due
to paralysis of flexor digitorum profundus )
b- hyperextension of the metacarpo-phalangeal joints with flexion of the proximal interphalangeal joints due to paralysis of interossei & the 2 medial lumbrical muscles
2 -loss of abduction and adduction of the fingers .
3 -Wasted hypothenar eminence and loss of adduction of the thumb due to paralysis of the adductor pollicis muscle
The lesion at wrist : leads to paralysis of the muscles of hand
(complete claw)
**The lesion above the elbow leads to less or partial clawing due to paralysis of medial 1\2 of flexor digitorum profundus.
.
(Fig.79)Fracture of medial epicondyle
causing injury of ulnar nerve
Ulnar nerve lesion “ Claw hand”
Dorsal view Palmar view
Ulnar tunnel syndrome
Ulnar Nerve injury
Median nerve
axilla
arm
forearm
hand
(Fig.37)Musculocutaneous, median & ulnar nerves in the axilla & arm
Median nerve in forearm & hand
Ulnar & median nerves
Median nerve lesion“Ape hand “
Colles’fracture. Fracture of the distal end of the radius causing a
“silver fork” deformity.
Flexor retinaculum
Carpal tunnel syndrome
Release of carpal tunnel
Carpal tunnel syndrome ( neglected(
Radial Nerve
(Fig.40) Radial nerve in axilla & arm
In axillaIn posterior arm
N.B. Brachial artery ,Median nerve, radial & ulnar nerves
Radial nerve in axilla , spiral groove , ant. arm
1-In axilla : A- long H. of triceps B-Post. Cut. N. of arm
2-In spiral groove: A-Lat.& Med. Hs. of triceps & anconeusB-Lower lat. Cut. N. of arm
C-Post. Cut. N. of forearm3 -Lower lat. Of front of arm:
A- Lat. Part of brachialisB- Brachioradialis & Ext. carpi radialis longus
C-Articular branch to elbow joint. 4 -In front of lateral epicondyle:
superficial & deep terminal branches
Superficial muscles of posterior forearmThey are arranged from lateral to medial side : 7 Ms.
1 -Brachioradialis 2 -Extensor carpi radialis longus3 -Extensor carpi radialis brevis
1 , 2 & 3 lie in the lateral side of forearm4 -Extensor digitorum
5 -Extensor digiti minimi 6 -Extensor carpi ulnaris
7 -Anconeus All are supplied by radial nerve & its deep branch.
Deep muscles of posterior forearm
They are 5 muscles arranged from above downwards:
1 -Supinator
2 -Abductor pollicis longus
3 -Extensor pollicis brevis
4 -Extensor pollicis longus
5 -Extensor indicis
All are supplied by deep branch of radial nerve ) posterior interosseous nerve (.
Radial nerve in forearm & hand
Front of forearm
Back of forearm
In hand
Radial nerve lesion “ Wrist drop& fingers drop ”
Radial Nerve injury
Fracture of the
shaft of the
humerus may
damage nearby nerves.
Radial Nerve injury
•In the upper part of the arm.
( penetrating injury, stab wound, gun shot injury or traction injury(
•In the mid arm.
( fracture humerus, iatrogenic, stab w(… ,.
•At the elbow.
( fracture or dislocation of the head of the radius(
(Fig.43 )Lesion of ulnar, median & radial nerves
Ulnar nerve lesion“Claw hand“
Median nerve lesion “Ape hand“
Radial nerve lesion “Wrist & finger drop“
Axillary Nerve
Lesion of Axillary Nerve
Musculocutaneous Nerve
Upper trunk lesion “ Erb’s Palsy”
Nerve to serratus anterior Lesion“ Winged scapula“
Distributed by University Book Centre
Mr. Sayed Mahmoud