Upper limb Anna L. Kiss Department of Anatomy, Histology and Embryology Semmelweis University Budapest 2017. Flexor and extensor muscles of the upper limb, blood supply and innervation of the upper limb

Flexors of the brachium coracobrachialis m. biceps brachii m. brachialis m

Flexors of the forearm I.: superficial layer palmaris longus spf. flexor digitorum pronator teres

Flexors of the forearm II.: deep layer pronator quadratus flexor pollicis longus flexor dif. profundus

Muscles of the hand Thenar: AbFlOAd Hypothenar: PAbFlO Mesothenar: lumbricalis mm. interosseus mm. palmaris: 3 PAd dorsalis: 4 DAb

Extensors of the upper limb triceps brachii anconeus m.

Extensors of the forearm I. Superficial layer: brachioradialis m. ext. carpi radialis longus et brevis mm. ext. digitorum et ext. digiti minimi ext. carpi ulnaris

Extensors of the forearm II. Deep layer: supinator abductor pollicis longus extensor pollicis extensor indicis

Tendon sheath of the flexor muscles

Tendon sheathes of the extensor muscles 6 compartments: 1.) abductor pollicis longus+extensor pollicis brevis mm. 2.) ext. carpi radialis longus and brevis 3.) ext. pollicis longus 4.) ext. digitorum+ext. indicis 5.) ext. digiti minimi 6.) ext. carpi ulnaris

BLOOD SUPPLY OF THE UPPER LIMB ARTERIES OF THE UPPER LIMB THE AXILLARY ARTERY: This vessel begins at the outer border of the first rib as a continuation of the subclavian artery and ends at the lower border of the teres major muscle, where it is passed into the arm as the brachial artery. The axilary artery supplies the integuments of the shoulder. THE BRACHIAL ARTERY: This artery provides the main arterial supply to the arm. It begins at the lower border of the teres major muscle as the continuation of the axillary artery. It runs downward and slightly laterally to the cubital fossa. Where it is divided into its two terminal branches, the radial and the ulnar artery. THE PULSE OF THE BRACHIAL ARTERY: Is palpable on the anterior aspect of the elbow. With the use of stetoscope and blood pressure cuff often used to measure the blood pressure.

RADIAL ARTERY: It begins in the cubital fossa. This artery passes along the radial side of the forearm to the wrist. The radial artery leaves the forearm by winding around the distal end of the radius and passing posteriorly, then it pierces the first interosseal space and reaches the palmar side of the hand to form a deep palmar branch with the deep branch of the ulnar artery. THE RADIAL PULSE The common place for taking the pulse is where the radial artery lies on the anterior surface of the distal end of the radius. In this region this artery is covered only by deep and superficial fasciae and skin. About two fingerbreadths of this artery can be compressed against the distal end of the radius.

ULNAR ARTERY: It is the larger of the two terminal branches of the brachial artery. It passes from the cubital fossa along the ulnar side of the forearm to the wrist. At the palmar side of the hand the ulnar artery forms a superficial palmar arch with the superficial little branch of the radial artery. The radial and the ulnar arteries supply the elbow joint, the forearm and the hand muscles as well as the joints of the hand. PALMAR ARCHES: It is formed by the radial and ulnar artery at the palmar side of the hand. They supply the superficial and the deep layers of the hand. THE DORSAL CARPAL ARCH: The dorsal carpal arch is an anatomical term for the anastomoses of the dorsal carpal branch of the radial and the ulnar artery near the back of the wrist. It anastomoses with the deep palmar arch

Palmar arches

VEINS OF THE UPPER LIMB The veins of the upper limb are divided into two sets: Superficial Deep. 1. THE SUPERFICIAL VEINS: Are principally situated on the dorsal surface of the hand. They form plexuses. The inner plexus is formed by the veins from the little finger, the outer plexus is formed by the veins from the thumb. These two plexuses communicate on the back of the hand forming a superficial arch of veins. The superficial veins of the palm of the hand form a plexus in front of the wrist. Basilic vein: formed by the ulnar veins, it passes upward along the inner side of the forearm and enters into the brachial vein. Cephalic vein: arises from the radial veins, ascending at the radial side of the upper limb and terminates into the axillary vein just below the clavicle. It communicates with the basilic vein via the median cubital vein at the elbow. The cephalic vein is often visible through the skin. Medial cubital vein: it is located in the cubital fossa and connects the basilic and cephalic veins. It is often used for venipuncture (taking blood),

Cephalic v Basilic v.

3. BRACHIAL VEINS: The radial and the ulnar vein unite to form these veins. At the inferior border of the teres major muscle the brachial veins join to the cephalic vein to form the axillary vein. 3. AXILLARY VEIN: It is a large venous blood vessel that conveys the blood from the thorax, armpit (axilla) and the upper limb toward the heart. It is a continuation of the brachial veins. There is only one axillary vein on each side of the body.

INNERVATION OF THE UPPER LIMB BRACHIAL PLEXUS (PLEXUS BRACHIALIS) The brachial plexus is formed by the union of the anterior divisions of the four lower cervical (C5-C8) and the first thoracal nerve (Th1). This network of nerves extends from the neck to the axilla, and supplies motoric, sensory nerve fibers to the upper limb. The C5-C6 unite to form an upper (superior) trunk The C7 continues as a middle trunk The C8- Th1 form the lower (inferior) trunk. The upper and middle trunks unite to form the lateral cord The lower trunk continues as the medial cord The three trunks form the posterior cord.

1. THE LATERAL CORD: Divides into the musculocutaneous nerve and the lateral root of the median nerve. THE MUSCULOCUTANEOUS NERVE: Supplying the muscles of the front of the arm The endbranch of the musculocutaneus nerve is called as the lateral cutaneous nerve of the forearm, which becames superficial and supplies the skin on the lateral aspects of the forearm. THE LATERAL ROOT OF THE MEDIAN NERVE: It is the continuation of the lateral cord. It is joined by the medial root of the median nerve to form the median nerve.

2. THE MEDIAL CORD: THE MEDIAN NERV: Is formed by a lateral and a medial root. This nerve passes inferiorly to supply primerly the flexor muscles of the forearm, the muscles and the skin of the hand. THE ULNAR NERVE: It is the terminal branch of the brachial plexus. It passes through the arm into the forearm and hand. In the forearm this nerve innervates the muscles laying at the medial side of the antebrachium. In the hand most muscles and some skin are supplied by the ulnar nerve.

3. THE POSTERIOR CORD THE AXILLARY NERVE: It is a large terminal branch of the posterior cord of the brachial plexus. It passes to the back of the arm and supplies the shoulder joint, some of the shoulder girdl muscles and the skin of the shoulder region. THE RADIAL NERVE: is the other terminal branch of the posterior cord. It provides the major nerve supply to the extensors of the upper limb and supplies the skin of the extensor region includung the back part of the hand. The radial nerve runs backward, laying between the medial and the long heads of the triceps muscle and than enters into the radial groove of the humerus. Than it runs downward to supply the forearm extensors.

Innervation of the upper limb

Innervation of the hand

Carpal tunnel

Carpal tunnel syndrome

BIBLIOGRAPHY Gray’s Anatomy Keith L. Moor: Clinically Oriented Anatomy R.M.H.McMinn: Last’s Anatomy Regional and Applied Sobotta Atlas of Human Anatomy, Vol. 2. Werner Platzer: Color Atlas of Human Anatomy, Vol. 1. Locomotor System http://wikipedia.com