1. The Upper Extremity
Bones, Muscles, Vessels,
pg 608

2. Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
pg 612
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 626-7
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
pg 681-2
Joints of the Upper Extremity
Elbow Joint
Synovial – hinge
Diarthrosis
Articulations
Humerus & Ulna
Humerus & Radius
Many Ligaments

5. Joints of Upper Extremity
pg 691
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
Pg 711
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
pg 614
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
pg 614
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. Innervation of Muscles Moving Arm
Subscapularis
Teres Major
Subscapular N.
Infraspinatus
Supraspinatus
Suprascapular N.
Teres Minor
Axillary N.
Coracobrachialis
Musculocutaneous N.

11. Arm Muscles Cross elbow, move forearm 2 compartments Anterior
pg 667
Cross elbow, move forearm
2 compartments
Anterior
Flexors of forearm
Posterior
Extensors of forearm

12. Arm Muscles Anterior compartment Brachialis Biceps brachii
pg 651
pg 671
Anterior compartment
Brachialis
Biceps brachii
Coracobrachialis

13. Arm Muscles
pg 636
Posterior compartment
Triceps brachii

14. Muscles of Arm Muscle Origin Insertion Action Anterior Posterior
Brachialis
Ant shaft , distal humerus
Coronoid proc/tuberosity
(ulna)
Flex forearm
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
Posterior
Triceps Brachii
Long: Infraglenoid tubercle
Short: Posterior shaft
(middle humerus)
Lateral: Posterior Shaft
(proximal humerus)
Common tendon to olecranon (ulna)
Extend forearm

15. Arm Muscle Innervation
Anterior compartment
Musculocutaneous nerve
Coracobrachialis
Brachialis
Biceps brachii
Posterior compartment
Radial nerve
Triceps brachii

16. Forearm Muscles Cross elbow, wrist and finger joints
pg 694
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

17. Forearm Muscles Anterior flexor compartment
pg 688
Anterior flexor compartment
Superficial and Deep
Most flexors have common tendon on medial epicondyle
Contains 2 pronators
Posterior extensor compartment
Most extensors in superficial layer have common origin on lateral epicondyle

18. Anterior Compartment of Forearm
pg 696
Muscles Nerves
Superficial
Flexor digitorum superficialis & brevis 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)

19. Posterior Compartment of Forearm
pg 702
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

20. Hand Bones Carpus (8) Metacarpus (5) Phalanges (14) “True” wrist
pg 711
Carpus (8)
“True” wrist
Distal to radius/ulna
Metacarpus (5)
Distal to carpus
Phalanges (14)
Distal to metacarpus

21. 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

22. Intrinsic Muscles of the Hand
pg 718
pg 723
Dorsal
Palmar
Lumbrical Muscles
Interossei Muscles

23. Blood Supply - Veins Deep veins Superficial Veins pg 677
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

24. Blood Supply - Arteries
pg 675
Subclavian (neck)
Axillary (armpit)
Subscapular
Circumflex humeral arteries
Brachial (arm)
Deep brachial
Radial (forearm)
Ulnar (forearm)
Common Interosseous
Superficial & Deep Palmar arches
Digital

25. Axilla Armpit!! Where axillary hairs grow Boundaries Contents Ventral
pg 688
Armpit!!
Where axillary hairs grow
Boundaries
Ventral
Pectoral muscles
Dorsal
Latissimus dorsi, teres major, subscapularis
Medial
Serratus ventralis
Lateral
Inetrtubercular (Bicipital) groove of humerus
Contents
axillary lymph nodes, axillary vessels, brachial plexus

26. Surface Anatomy of Arm Cephalic Vein Biceps brachii Triceps brachii
pg 688
Cephalic Vein
Biceps brachii
Triceps brachii
Olecrenon Process
Medial Epicondyle
Lateral Epicondyle

27. Surface Anatomy of Elbow
pg 686
Cubital Fossa
Anterior surface elbow
Contents
Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries
Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles

28. Surface Anatomy of Hand
pg 715
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)

29. Brachial Plexus Nerve plexus Lies partly in neck and partly in axilla
pg 618
pg 21
Nerve plexus
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

30. Really Tired? Drink Coffee Buddy!
Brachial Plexus
pg 660
Really Tired? Drink Coffee Buddy!
R = RAMI (ventral) (5)
T = TRUNKS (3)
D = DIVISIONS (2)
C = CORDS (3)
B = BRANCHES (Many!!)

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

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

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

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

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

36. 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)
Suprascapular (not part of lateral cord)
Runs with suprascapular artery and vein {C5, C6}
Innervates
Supraspinatus
Infraspinatus

37. 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)

38. 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)

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

40. 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 nerve
Latissimus dorsi

41. Cutaneous Innervation to Hand
pg 620, 727, 729

42. Nerve Damage Ulnar nerve Median nerve Radial nerve “Claw hand”
pg 737-8
Ulnar 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