1. Bones and Muscles and regional anatomy of the upper limb part2
Lecturer: Dr. M. Samsam
University of Central Florida, Orlando,
Pictures from Platzer atlas and textbook
of human anatomy and K. Moore anatomy
and Netter atlas of human anatomy

2. Damage to the Radial nerve
Injury proximal to the origin of Triceps:
*No extension of elbow (elbow is flexed)
*No triceps reflex
*Wrist drop (all extensor muscles and the
Supinator are paralyzed), thumb is flexed
and adducted
Sensory loss: dorsolateral lower brachial
region, posterior surface of forearm,
dorsum of the hand and radial side of
proximal phalanges
Injury of the nerve in radial groove:
In fractures of humerus
Triceps muscle is usually functioning
Wirst drop and sensory loss in
dorsolateral aspect of the forearm and hand
Plus all other problems mentioned above
Nerve injury in forearm:
Here the deep radial nerve is injured (wrist drop)
Extension of the thumb and metacarpal joints is
disturbed. Sensation is usually preserved

3. (suicide or injury e.g.: hand out of car’s window)
Median Nerve injury:
Above the elbow:
Muscles in the arm are not affected
Forearm and hand muscles are affected
1- All flexors of the wrist are paralyzed
except:
2- Flexor carpi ulnaris and ulnar part of Flexor
digitorum profundus.
3- Thumb flexors and abductor paralyzed but not
Adductor (ulnar N.) (ape hand)
4- Flexion at metacarpophalangeal joints possible
(intact interossei MM, ulnar N.)
6- 1st and 2nd Lumbricals lost function and all together,
inability to fully flex index and middle finger
(HAND OF PAPAL BENEDICTION)
Pronation of forearm paralyzed and sensory loss over
the median N. area
Injury at wrist Joint:
(suicide or injury e.g.: hand out of car’s window)
Short muscles of the thumb paralyzed, not adductor.
Thenar muscles atrophy (flattened, ape hand)
Flexor pollicis longus functioning
Sensory loss over Medial N. area

4. Ulnar nerve injury: At wrist Injury at elbow:
1- Fingers are hyperextended at metacarpophalangeal joints
and flexed at interphalangeal joints (paralysis of interossei
MM and 2 medial lumbricals (Claw hand)
2- Tendon of flexor digitorum perfundus (2 medial ones)
paralyzed, Therefore flexion of the ring and little finger
is not possible at distal phalangeal joints
3- Small muscles of the little finger are paralyzed
4- Abduction and Adduction of the fingers are impaired
( paralysis of interossei MM, piano playing,
writing.. Impaired)
5- Sensory loss over ulnar innervating area.
Injury at elbow:
1- Paralysis of flexor carpi ulnaris and medial portion of
Flexor digitorum profundus
2- Ulnar deviation of the wrist is weakened, hand is abducted
and extended
Plus problem number 4 and 5 from above

5. Atlas: only look at the items
Regional Anatomy
Atlas: only look at the items
Infraclavicular region
(Deltopectoral triangle)
Borders: 1- Clavicle, 2- Deltoid,
3- Pectoralis major
Skin innervation: medial, intermediate and
Lateral supraclavicular nerves (cervical plexus)
On deltoid region: innervation by axillary nerve
6- Pectoralis minor M.
7- Clavipectoral fascia
8-Cephalic vein
9- Axillary vein
10- Thoracoacromial artery (11-clavicular,
12-acromial, 13-deltoid, 14-pectoral parts)
15- Pectoral nerve
16- Subclavius M.
17- Axillary artery
18- lateral cord
19- Posterior cord
20- Medial cord
21- Suprascapular nerve and vessels

6. Axillary region: (Pyramidal shape)
Borders:
Pectoralis Major, Latis dorsi, ribs and
intercostal muscles, humerus and
coracobrachialis
Atlas: only look at the items

7. Brachial Plexus

8. Arteries of the shoulder and Upper arm:
**Arterial Blood pressure
Measurements using a sphygmometer
*Brachial artery occlusion/Laceration:
Deep flexor paralysis,
*Volkmann’s ischemic contracture

9. Veins of the shoulder
And upper arm:
Moore

10. Lymph nodes of the Axillary region: Arranged in 5 groups:
Pectoral, medial, apical,
central and subscapular
Drainage: subclavian lymphatic
trunk to right lymphatic duct to
right venous angle
**Importance:
Breast Cancers may
give metastasis to the axillary
lymph node (75% of breast’s
lymphatics drain here).
Removal of the lymph nodes
may be necessary.
Mastectomy: removal of the
breast.
*Lymphangitis
Moore

11. Regional anatomy:
Atlas: Only look at the items
Anterior Brachial region:
1- Brachial fascia
2- Cephalic vein
3- Basilic vein
4- Basilic hiatus
5- Medial antebrachial cutaneous N.
6- the same nerve as 5
7- lymph nodes
8- Medial brachial cutaneous N.
9- Intercostobrachial N.

12. Anterior Brachial region
Medial bicipital groove:
Between biceps and intermuscular septa
Contents:
Median N, Brachial artery and veins and
basilic vein, medial cutaneous antebrachial
nerve and ulnar N. medially.
Deep in this region, proximally , the radial
nerve takes a posterior direction.

13. Axillary spaces: Quaderangular space Triangular Spaces 1- Teres Minor
2- Teres Major
3- Humerus
4- Long head of Triceps
Radial nerve is found deep in the
posterior brachial region in radial
groove of humerus accompanied
by deep brachial A and V.

14. Regional anatomy:
Atlas: Only look at the items
Cubital fossa: Superficial
1- Basilic vein
2- Antebrachial Basilic vein
5- Cephalic and
7- Median cubital vein
4- Medial cutaneous antebrachial nerve
6- lateral antebrachial cutaneous nerve
(branch of musculocutaneous N.)

15. Cubital fossa (deep):
Atlas: Only look at the items
1- Biceps Brachii M.
2- Bicipital aponeurosis
3- Brachialis M
4- Pronator teres
5- Brachioradialis
6- Radial artery and veins
7- recurrent radial A.
8- Median N.
9- Ulnar nerve
10- Radial N.
11- Superficial Radial N.
12- Deep radial N.
13- Supinator muscle

16. Arteries of the forearm and hand:
1- brachial artery
2- Radial artery
3- Ulnar artery
6- Deep palmar arch
8- Principal artery of the thumb
13- Superficial palmar arch
14- the 3 common digital arteries
15- the 2 common palmar digital arteries
16- Dorsal carpal branch

17. Anterior antebrachial region:
Atlas: Only look at the items
2 and 6- Anastomoses between cephalic
and basilic antebrachial veins
7- Medial cutaneous antebrachial N.
11- Radial artery and veins
14- Superficial Radial N.
21- Ulnar N
22 and 23- Ulnar artery and veins

18. Anterior carpal region:
1- Antebrachial fascia, 2- Deep layer
3- tendon of palmaris longus
4- Pronator quadratus
5- Radial A.
6- Flexor carpi radialis
9- Median N.
10- Ulnar artery
11- Ulnar nerve
12- Flexor carpi ulnaris
13- Palmar aponeurosis

19. Palm of the hand:
1- Superficial palmar arch
18- Deep palmar arch
11- median nerve
9- ulnar nerve

20. Dorsum of the Hand:
Radial artery (9) enters the Snuffbox and
gives a dorsal branch which produces the
dorsal arterial arch of the hand.
Then it gives the principal artery of the thumb
and then a main branch to join the deep
palmar arch.
Snuffbox: borders:
Tendon of extensor pollicis longus (superior)
tendons of the ext. pollicis brevis and
abductor pollicis longus (inferiorly).
Contents of snuffbox:
9- Radial artery
8- Superficial radial N.