1. The Upper Extremity
Bones, Muscles, Vessels,

2. Bones 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
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

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

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

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!!

10. Scapula Innervation Origin on scapula Insertion on scapula
Subscapularis and teres major
Subscapular
Supraspinatus and Infraspinatus
Suprascapular
Teres Minor
Axillary
Latissimus Dorsi
Thoracodorsal
Coracobrachialis
Musculocutaneous
Insertion on scapula
Rhomboids and Levator Scapulae
Dorsal scapular
Trapezius
Accessory
Pectoralis Minor
Medial and Lateral
Serratus Ventralis
Long thoracic

11. Arm Muscles Cross elbow, move forearm 2 compartments Anterior
Flexors of forearm
Posterior
Extensors of forearm

12. Arm Muscles Anterior compartment Brachialis Biceps brachii
Coracobrachialis
Bracioradialis

13. Arm Muscles
Posterior compartment
Triceps brachii
Anconeus

14. Arm Muscle Innervation
Anterior compartment
Radial nerve
Bracioradialis
Musculocutaneous nerve
Coracobrachialis
Brachialis
Biceps brachii
Posterior compartment
Triceps brachii
Anconeus

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

16. Forearm Muscles Anterior flexor compartment
Superficial and Deep
Most flexors have common tendon on medial epicondyle
Contains 2 pronators
Posterior extensor compartment

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 Radial
Deep
Flexor pollicis longus Median
Flexor digitorum profundus Ulnar (med 1/2) Median (lat 1/2)

18. Anterior Compartment Forearm

19. Posterior Compartment of Forearm
Muscles Nerves
Superficial
Extensor carpi radialis longus Radial
Extensor digitorum Radial
Extensor carpi ulnaris Radial
Deep
Supinator Radial
Abductor pollicis longus Radial
Extensor pollicis longus + brevis Radial
Extensor indicus Radial

20. Posterior Compartment of Forearm

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

22. Intrinsic Muscles of the Hand
Muscle Nerve
Pinky (little finger)
All digiti minimi Ulnar (Flexor, Abductor, Opponens)
Thumb
Abductor pollicis brevis Median
Flexor pollicis brevis Median
Opponens pollicis Median
Adductor pollicis Ulnar
Other Intrinsic Muscles
Palmar + Dorsal Interossei Ulnar
Lumbricals Median, Ulnar

23. Intrinsic Muscles of the Hand
Lumbrical Muscles
Interossei Muscles

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

25. 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

26. Axilla Armpit!! Where axillary hairs grow Boundaries Contents Ventral
Pectoral muscles
Dorsal
Latissimus dorsi, teres major, subscapularis
Medial
Serratus ventralis
Lateral
Bicipital groove of humerus
Contents
Axillary lymph nodes, Axillary vessels, brachial Plexus

27. Surface Anatomy of Arm Biceps brachii Triceps brachii
Olecrenon Process
Medial Epicondyle
Lateral Epicondyle

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

29. 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)

30. Brachial Plexus Nerve plexus Lies partly in neck and partly in axilla
Network of nerves formed by ventral rami
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
Small contributions from C4 and T2

31. Ventral Rami

32. 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!!)

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

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

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

36. Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous
Median
Medial Ulnar
Posterior Radial Axillary (thoracodorsal) (subscapular)

37. Put it all together……..

38. Brachial Plexus – Cords and Branches
Lateral
Musculocutaneous
Median
Medial
Ulnar
Posterior
Radial
Axillary
Thoracodorsal
Subscapular

39. Lateral Cord Musculocutaneous nerve Suprascapular 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)
Suprascapular
Runs with suprascapular artery and vein {C5, C6}
Innervates
Supraspinatus
Infraspinatus

40. 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)

41. 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)

42. Posterior Cords 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, supinator, brachioradialis
Divides in forearm:
Superficial
Skin of arm and dorsolateral surface of hand
Deep
Extensor muscles of forearm (eg E. carpi radialis L + B)

43. Posterior Cord Axillary nerve Subscapular nerve Thoracodorsal 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
Subscaplaris, Teres major
Thoracodorsal nerve
Runs with thoracodorsal artery and nerve
Latissimus dorsi

44. Cutaneous Innervation to Hand

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