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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
coracobrachialis
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
THANK YOU