1. The upper limb

2. 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

3. The muscles of back Superficial group Deep group Trapezius
Latissimus dorsi
Levator scapulae
Rhomboideus
Deep group
Erector spinae
Splenius
Thoracolumbar fascia

5. The muscles of thorax Extrinsic muscles Intrinsic muscles
Pectoralis major
Pectoralis minor
Serratus anterior
Intrinsic muscles
Intercostales externi
Intercostales interni
Intercostales intimi

7. The Muscles of Upper Limb
Muscles of shoulder
Deltoid
Supraspinatus
Infraspinatus
Teres minor
Teres major
Subscapularis

8. 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

9. 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

10. 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

12. Muscles of arm Antererior group Posterior group Biceps brachii
Coracobrachialis
Brachialis
Posterior group
triceps brachii
anconeus

13. 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

14. Muscles of arm Triceps brachii Origin: Insertion: olecranon of ulna
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

15. Triceps brachii

16. 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.

18. Muscles of forearm Superficial layer Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

19. 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

20. Second layer Flexor digitorum superficials

21. Action: flex radiocarpal joint and fingers, pronate forearm
Third layer
Flexor digitorum profundus
Flexor pollicis longus
Fourth layer
Pronator quadratus
Action: flex radiocarpal joint and fingers, pronate forearm

22. Lateral group (3) Brachioradialis Extensor carpi radialis longus
Extensor carpi radialis brevis

23. Posterior group (8) Superficial layer (3)
Extensor digitorum Extensor digiti minimi
Extensor carpi ulnaris
Action: extension at wrist joint

24. 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

25. 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

26. 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

27. 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.

29. 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.

30. 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

31. 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

32. 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

33. 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

34. Basilic vein Median cubital 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

35. 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

36. 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

37. Central lymph node Apical 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

38. 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.

39. Position: Main branches
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.

40. Posterior cord
radial n.
axillary n.
thoracodorsal n.

41. Musculocutaneous
Distribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm

42. 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

43. 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

44. 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

45. 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