1. The Upper Extremity
Bones, Muscles, Vessels,
pg 650

2. Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
pg 654
30 bones!!!!
Appendicular skeleton
Pectoral girdle
Glenoid cavity
Allows for mobility
Attachments
Upper extremity:
Arm
humerus
Forearm
Radius, ulna (interosseous membrane)
Hand
Carpals, metacarpals, phalanges
Review bones and landmarks studied in lab!!!

3. Joints of Upper Extremity
pg 668
Joints of Upper Extremity
pg 669
Sternoclavicular
Synovial-saddle
Diarthrosis
Acromioclavicular
Synovial-plane
Glenohumeral joint
Synovial-ball&socket
Many ligaments
Muscle reinforcement
Great Mobility

4. Joints of the Upper Extremity
Elbow Joint
Synovial – hinge
Diarthrosis
Articulations
Humerus & Ulna
Humerus & Radius
Many Ligaments
pg 725
pg 726

5. Joints of Upper Extremity
Proximal Radioulnar joint
Synovial - pivot
Diarthrosis
Distal Radioulnar joint
Synovial – pivot
Allows pronation and supination of forearm
pg 735

6. Joints of the Upper Extremity
Radiocarpal joint
Synovial-condyloid
Distal radius with proximal row of carpals
Intercarpal joints
Synovial-plane
Carpal-metacarpal (2-5)
Trapezium-metacarpal 1
Synovial-saddle
Metacarpal-phalangeal
Interphalangeal
Synovial-hinge
ALL DIARTHROSES

7. Review of Naming…..
What do the following names TELL you about the muscle?
Naming
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis brevis

8. Scapula Muscles If the origin is on the scapula – moves the arm
Subscapularis
Supraspinatus
Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial attachment)
Coracobrachialis
Rotator
Cuff
pg 656

9. Scapula Muscles If the insertion is on the scapula – moves the scapula
Rhomboids
Trapezius
Pectoralis Minor
Serratus Ventralis
Levator Scapulae
Use location of Insertion to determine movement!!
pg 656

10. Innervation of Muscles Moving Arm
Subscapularis
Teres Major
Subscapular N.
Infraspinatus
Supraspinatus
Suprascapular N.
Teres Minor
Axillary N.
Coracobrachialis
Musculocutaneous N.

11. Arm Muscles Arm Compartments Anterior Compartment (3 muscles)
Flexors of forearm and arm
Posterior Compartment (1 muscle)
Extensor of forearm and arm
pg 667
Remember: If you cross the shoulder, you move the arm; if you cross the elbow, you move the forearm

12. Arm Muscles Anterior compartment Brachialis Coracobrachialis
Biceps brachii
Long head
Short head
pg 718
pg 715

13. Arm Muscles Posterior compartment Triceps brachii Long head
Medial head
Lateral head
pg 717

14. Muscles of Arm Muscle Origin Insertion Action Innerv Anterior
Brachialis
Ant shaft , distal humerus
Coronoid process /ulnar tuberosity
(ulna)
Flex forearm
Musculo-cutaneous
Biceps Brachii
Long: supraglenoid tubercle (scapula)
Short: coracoid proc (scapula)
Radial Tuberosity (radius)
Flex forearm, Supination
Coracobrachialis
Coracoid proc (scapula)
Medial surface midshaft (humerus)
Flex arm, Adduct arm
Posterior
Triceps Brachii
Long: Infraglenoid tubercle (scapula)
Medial: Posterior Shaft
(middle humerus)
Lateral: Posterior Shaft
(proximal humerus)
Common tendon to olecranon (ulna)
Extend forearm
Radial

15. Forearm Muscles Cross elbow, wrist and finger joints
Movement of hand and fingers
Proximally are fleshy
Distally have long tendons
Flexor and extensor retinacula
“wristbands”
Keep tendons from jumping outwards when tensed
pg 738

16. Forearm Muscles Anterior compartment Posterior compartment
Superficial and Deep layers
Flexors of hand and fingers
Most flexors have common origin on medial epicondyle
Contains 2 pronator muscles
Posterior compartment
Extensors of hand and fingers
Most extensors have common origin on lateral epicondyle
Contains a supinator muscle
pg 732

17. Anterior Compartment of Forearm
Muscles Nerves
Superficial
Flexor digitorum superficialis Median
Flexor carpi radialis Median
Pronator teres Median
Palmaris longus Median
Flexor carpi ulnaris Ulnar
Deep
Pronator quadratus Median
Flexor pollicis longus Median
Flexor digitorum profundus Ulnar (med 1/2) Median (lat 1/2)
pg 738, 740

18. Posterior Compartment of Forearm
pg 746
Muscles Nerves
Superficial
Brachioradialis Radial
Anconeus Radial
Extensor carpi radialis longus & brevis Radial
Extensor digitorum Radial
Extensor carpi ulnaris Radial
Extensor digiti minimi Radial
Deep
Supinator Radial
Abductor pollicis longus Radial
Extensor pollicis longus + brevis Radial
Extensor indicus Radial

19. Hand Bones Carpus (8) Metacarpus (5) Phalanges (14) “True” wrist
Distal to radius/ulna
Metacarpus (5)
Distal to carpus
Phalanges (14)
Distal to metacarpus
pg 753

20. Intrinsic Muscles of the Hand
Muscle Nerve
Pinky = Hypothenar muscles
All digiti minimi Ulnar (Flexor, Abductor, Opponens)
Thumb = Thenar muscles
Abductor pollicis brevis Median
Flexor pollicis brevis Median
Opponens pollicis Median
Adductor pollicis Ulnar
Other Intrinsic Muscles
Palmar + Dorsal Interossei Ulnar
Lumbricals Median, Ulnar

21. Blood Supply - Arteries
Subclavian (neck)
Axillary (armpit)
Subscapular
Circumflex humeral arteries
Brachial (arm)
Deep brachial
Radial (forearm)
Ulnar (forearm)
Common Interosseous
Superficial & Deep Palmar arches
Digital
pg 719

22. Blood Supply - Veins Deep veins Superficial Veins
Deep palmar venous arches
Radial - forearm
Ulnar - forearm
Brachial – arm/elbow
Axillary – axilla
Subclavian - neck
Superficial Veins
Digital
Superficial palmar venous arches
Median – forearm
Median cubital – elbow
Blood draws!!
Cephalic – arm/forearm
Basilic – arm/forearm
pg 664

23. Axilla Armpit!! Boundaries Contents Ventral Dorsal Medial Lateral
pg 651
Armpit!!
Boundaries
Ventral
Pectoral muscles
Dorsal
Latissimus dorsi, teres major, subscapularis
Medial
Serratus ventralis
Lateral
Intertubercular (Bicipital) groove of humerus
Contents
axillary lymph nodes, axillary vessels, brachial plexus

24. Surface Anatomy of Arm Cephalic Vein Biceps brachii Triceps brachii
Olecrenon Process
Medial Epicondyle
Lateral Epicondyle
pg 651

25. Surface Anatomy of Elbow
Cubital Fossa
Anterior surface elbow
Contents
Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries
Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles
pg 730

26. Surface Anatomy of Hand
Carpal Tunnel
Carpals concave anteriorly
Carpal ligament covers it
Contains: long tendons, Median nerve
Inflammation of tendons = compression of Median nerve
Anatomical Snuffbox
Lateral = E.pollicis brevis
Medial = E. pollicis longus
Floor = scaphoid, styloid of radius
Contains Radial Artery (pulse)
pg 759

27. Brachial Plexus Nerve plexus Lies partly in neck and partly in axilla
Gives rise to almost all nerves that supply upper limb
Formed by intermixing of ventral rami of spinal nerves C5-C8 and T1
pg 700

28. Really Tired? Drink Coffee Buddy!
Brachial Plexus
Really Tired? Drink Coffee Buddy!
R = RAMI (ventral) (5)
T = TRUNKS (3)
D = DIVISIONS (2)
C = CORDS (3)
B = BRANCHES (Many!!)

29. Rami join to form Trunks! (in neck)
Ventral Rami Trunks
C5 Upper Trunk C6
C7 Middle Trunk C8
T1 Lower Trunk

30. Trunks Split to form Divisions! (in neck)
Trunks Divisions
Upper Anterior Posterior
Middle Anterior Posterior
Lower Anterior Posterior

31. Divisions Join to form Cords! (in axilla)
Trunks Division Cords
U A Lateral P
M A Medial
L A Posterior

32. Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous
Median
Medial Ulnar
Posterior Radial Axillary Thoracodorsal Subscapulars

33. Lateral Cord Musculocutaneous nerve Off lateral cord Course:
Anterior arm
Becomes cutaneous and gives skin sensation to lateral forearm
Innervates:
Corocobrachialis (motor)
Biceps brachii (motor)
Brachialis (motor)
Skin distal to the elbow (sensory)

34. Medial Cord Ulnar nerve Course: Innervates: Comes off medial cord
Descends along medial side of arm
Passes posterior to medial epicondyle
Follows the ulna
Superficial to carpal tunnel into hand
Branches to supply intrinsics and skin
Innervates:
Flexor carpi ulnaris (motor)
Flexor digitorum profundus (motor)
Most intrinsic hand muscles (motor)
Dorsal branch supplies skin of medial 2/3 of hand (sensory)

35. Both Medial and Lateral Cords
Median nerve
Course:
Middle of brachial plexus (from lateral and medial cords)
Does not branch in arm
Distal to elbow provides many branches to most forearm flexors
Passes through carpal tunnel to hand to lateral palmar intrinsics
Innervates:
Anterior forearm (motor)
Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory)
Dorsum of fingers 2 and 3 (sensory)

36. Posterior Cord Radial nerve Largest branch of brachial plexus
Comes from posterior cord
Course:
Through arm
Around humerus
Around lateral epicondyle (then divides)
Innervates:
Posterior muscles of arm and forearm
Triceps brachii, anconeus, brachioradialis
Divides in forearm:
Superficial
Skin of arm and dorsolateral surface of hand
Deep
Supinator & Extensor muscles of forearm (eg ext. carpi radialis L + B)

37. Posterior Cord (continued)
Axillary nerve
Branches off posterior cord
Course:
Runs posterior to humerus
Runs with caudal humeral circumflex artery
Innervates:
Deltoid and teres minor (motor)
Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve
Subscapularis, Teres major
Thoracodorsal nerve
Runs with thoracodorsal artery and vein
Latissimus dorsi

38. Nerve Damage Ulnar nerve Median nerve Radial nerve “Claw hand”
pg 782
pg 783
Ulnar nerve
“Claw hand”
Inability to extend fingers at interphalangeal joints, results in permanent flexion of hand = claw
Median nerve
“Ape hand”
Inability to oppose thumb
Radial nerve
“Wrist drop”
Inability to extend the hand, inability to fully extend forearm