1. The Upper Limb Viroj Mitranonda Department of Anatomy
Faculty of Science
Mahidol University

2. Shoulder or Scapular region Arm Forearm Hand
Parts of the upper limb
Shoulder or Scapular region
Arm
Forearm
Hand

3. Bones Shoulder : Scapula, Clavicle Arm : Humerus
Forearm : Radius, Ulna
Hand : 8 carpal bones,
: 5 metacarpal bones,
: 14 phalanges
carpal bones
: trapezium, trapezoid, capitate, hamate
: scaphoid, lunate, triquetrum, pisiform

7. Superficial structures of the upper limb
Cutaneous nerves
Superficial veins
Lymph vessels

8. Cutaneous nerves of the upper limb
Shoulder
: Lateral branches of the supraclavicular n.(c.3,4)
Arm
: Upper lateral cutaneous nerve of arm (axillary n.)
: Lower lateral cutaneous nerve of arm (radial n.)
: Medial cutaneous nerve of arm (medial cord)
: Posterior cutaneous nerve of arm (radial n.)
: Intercosto-brachial nerve (T.2)

9. Cutaneous nerves of the upper limb (continued)
Forearm
Lateral cutaneous nerve of forearm (from musculocutaneous n.)
Medial cutaneous nerve of forearm (from medial cord)
Posterior cutaneous nerve of forearm (from radial n.)

10. Cutaneous nerves of the upper limb (continued)
Hand
Lateral 3 1/2
of the palm : Cutaneous branches of the median n.
of the dorsum : Cutaneous branches of the radial n
Medial 1 1/2
of the palm : Cutaneous branches of the ulnar n.
of the dorsum : Cutaneous branches of the ulnar n.
Distal part of the dorsum of the lateral 3 1/2 fingers :
Cut. br. of the median n.

15. Superficial veins of the upper limb
Digital veins
Dorsal venous arch
Cephalic vein
Basilic vein
Median cubital vein
Median veins of forearm
(Median cephalic vein)
(Median basilic vein)

19. The lymph vessels Accompanied the superficial veins The medial side
drains to the lateral group of the axillary node
The lateral side
drains to the delto-pectoral node

21. Muscles found in the shoulder (scapular) region
Axillary nerve
Suprascapular nerve
Upper and Lower subscapular nerves
Lower subscapular nerve
Deltoideus muscle
Supraspinatus muscle
Infraspinatus muscle
Teres minor muscle
Subscapularis muscle
Teres major muscle

25. The rotator cuff muscles
Consists of :
Supraspinatus m.
Infraspinatus m.
Teres minor m.
Subscapularis m.

28. Deltoideus muscle Origin : Lateral 1/3 of clavicle,
: Acromion, Spine of scapula
insertion : Humerus, deltoid tuberosity
Action : Arm Flexion, medial rotation,
Abduction, extension, lateral rotation
nerve : Axillary nerve

30. Supraspinatus muscle Origin : Scapula, supraspinous fossa
Insertion : Upper facet of greater tuberosity of Humerus
Action : Abduction
Nerve : Suprascapular nerve

31. Infraspinatus muscle Origin : Scapula, infraspinous fossa
Insertion : Middle facet of greater tuberosity of the Humerus
Action : Lateral rotation
Nerve : Suprascapular nerve

32. Teres minor muscle Origin : Scapula, superior 2/3 Lateral margin
Insertion : Lower facet of greater tuberosity of the Humerus
Action : Lateral rotate
nerve : Axillary nerve

36. Subscapularis muscle Origin : Scapula, subscapular fossa
Insertion : Lesser tuberosity of the Humerus
Action : Medial rotation
Nerve : Upper and lower subscapular nerve

37. Teres major muscle Origin : Inf. 1/3 lat. margin of scapula
Insertion : Humerus, crest of lesser tubercle
Action : Adduction,medial rotate, extension
Nerve : Lower subscapular nerve

43. Flexor muscles of the arm
Musculocutaneous n.
Musculocutaneous & radial nn.
Coracobrachialis m.
Biceps brachii m.
Brachialis m.
Extensor muscle of the arm
Triceps brachii m.
Radial n.

50. Biceps brachii muscle Origin : Short head; Coracoid process
: Long head; Supraglenoid tubercle
Insertion : Radial tuberosity, bicipital aponeurosis
Action : Supination, flexes elbow
Nerve : Musculocutaneous nerve

52. Coracobrachialis muscle
Origin : Coracoid process
Insertion : Humerus, middle of body,medial
Action : Flexion (flexes shoulder)
Nerve : Musculocutaneous nerve

54. Brachialis muscle Origin : Humerus, ant. surface distal 1/2
Insertion : Ulna, coronoid process,
ulnar tuberosity
Action : Flexes elbow
Nerve : Musculocutaneuos n. & radial n.

56. Cubital fossa Boundaries
Base : Imaginary line between the condyles of the humerus
Laterally : Brachioradialis muscle
Medially : Pronator teres muscle
Apex : Brachioradialis m. overlapped Pronator teres m.
Roof : Skin, superficial fascia & veins, bicipital aponeurosis
Floor : Brachialis m.,Supinator m.
Contents : Tendon of Biceps brachii m. Brachial a. and its’
terminal branches(radial a. and ulnar a.) Median n., fat

62. Triceps brachii muscle
Origin : Long head;Scapula, infraglenoid tubercle
: Lateral head; Humerus, post. surface
above groove for radial nerve
: Medial head; below groove for radial n.
Insertion : Ulna,olecranon process
Action : Extends elbow
Nerve : Radial nerve

63. Flexor muscles of forearm
The forearm
Flexor muscles of forearm
Superficial layer
Pronator teres muscle
Flexor carpi radialis muscle
Palmaris longus muscle
Flexor carpi ulnaris muscle
Median nerve
Median nerve
Ulnar nerve

65. Flexor muscles of forearm (continued)
Intermediate layer
Flexor digitorum superficialis (sublimis) muscle
Median nerve
Deep layer
Flexor pollicis longus muscle
Flexor digitorum profundus muscle
Pronator quadratus muscle
Median nerve
Median&Ulnar nn.

68. Pronator teres muscle Origin : Medial epicondyle of humerus,
: Coronoid process of ulna
Insertion : Midlateral surface of radius
Action : Pronation
Nerve : Median nerve

69. Flexor carpi radialis muscle
Origin : Medial epicondyle of humerus
Insertion : Base of 2nd and 3rd metacarpal bones
Action : Flexes and abducts wrist (hand)
Nerve : Median nerve

70. Palmaris longus muscle
Origin : Medial epicondyle of humerus
Insertion : Palmar aponeurosis
Action : Flexes wrist
Nerve : Median nerve

71. Flexor carpi ulnaris muscle
Origin : Medial epicondyle of humerus,
Upper dorsal border of ulna
Insertion : Pisiform bone
(& base of 5th metacarpal bone)
Action : Flexes wrist, adduct wrist (hand)
Nerve : Ulnar nerve

73. Flexor digitorum superficialis muscle
Origin : Medial epicondyle of humerus,
Coronoid process of ulna,
Oblique line of radius
Insertion : Middle phalanges of medial four fingers
Action : Flexes middle phalanges of each finger,
Flexion of MP & PIP joints
Nerve : Median nerve

75. Flexor pollicis longus muscle
Origin : Radius, ant. surface middle 1/2
Insertion : Distal phalanx of thumb
Action : Flexes thumb
Nerve : median nerve

76. Flexor digitorum profundus muscle
Origin : Ulna, prox. 2/3 ant. and medial surfaces
Insertion : Bases of distal phalanges of medial four fingers
Action : Flexes distal phalanges of each finger (DIP joints)
Flexes MP & IP joints (PIP joints)
Nerve : Median and ulnar nerves
(lateral 1/2 : median nerve, medial 1/2 : ulnar nerve)

78. Pronator quadratus muscle
Origin : Ulna, ant. surface distal 1/4
Insertion : Radius, ant. surface distal 1/4
Action : Pronation. Holds radius to ulna
Nerve : Median nerve

85. THE HAND Viroj Mitranonda Department of Anatomy Faculty of Science
Mahidol University

86. Muscles of the hand 3 Thenar muscles : Abductor pollicis brevis m.
Flexor pollicis brevis m.
Opponens pollicis m.
Median n.
Adductor pollicis m.
Ulnar n.

87. Muscles of the hand (continued)
3 Hypothenar muscles :
Abductor digiti minimi m.
Flexor digiti minimi m.
Opponens digiti minimi m.
Ulnar n.
3 Palmar interossei mm.
4 Dorsal interossei mm.
4 Lumbricales mm.
Ulnar n.
1st and 2nd Median n.
3rd and 4th Ulnar n.
Palmaris brevis m.
Ulnar n.

111. Extensor muscles of forearm
Superficial group
Brachioradialis m.*
Extensor carpi radialis longus m. *
Extensor carpi radialis brevis m.**
Laterally
Posteriorly
Extensor digitorum m.**
Extensor digiti minimi m.**
Extensor carpi ulnaris m.**
Anconeus m.*
* = Radial nerve ** = deep branch of radial nerve

113. Extensor muscles of forearm (continued)
Deep group
Supinator m.
Abductor pollicis longus m.
Extensor pollicis brevis m.
Extensor pollicis longus m.
Extensor indicis m.
Nerve supply : Deep branch of radial nerve or posterior interosseous nerve

116. Brachioradialis muscle
Origin : Humerus, lateral supracondylar line
Insertion : Radius, base of styloid process
Action : Flexes elbow
Nerve : Radial nerve

118. Extensor carpi radialis longus muscle
Origin : Humerus, lateral supracondylar line
Insertion : Base of second metacarpal bone
Action : Extends wrist, abduct hand
Nerve : Radial nerve

119. Extensor carpi radialis brevis muscle
Origin : Humerus, lateral epicondyle
Insertion : Base of third metacarpal bone
Action : Extends wrist, abduct hand
Nerve : Deep branch of the radial nerve

120. Extensor carpi ulnaris muscle
Origin : Lateral epicondyle of humerus,
posterior border of ulna
Insertion : Base of fifth metacarpal bone
Action : Extends wrist, adduct hand
Nerve : Deep branch of radial nerve

122. Extensor digitorum muscle
Origin : Humerus, lateral epicondyle
Insertion : Middle and distal phalanges,
extensor expansion
Action : Extends phalanges
Nerve : Deep branch of radial nerve

124. Extensor digiti minimi muscle
Origin : Humerus, lateral epicondyle
Insertion : Extensor expansion of fifth digit
Action : Extends fifth digit
Nerve : Deep branch of radial nerve

126. Anconeus muscle Origin : Lateral epicondyle of humerus
Insertion : Proximal 1/3 lat. surface of ulna
Action : Holds ulna to radius, extends elbow
Nerve : Radial nerve

127. Supinator muscle Origin : Humerus, lateral epicondyle
: Ulna, supinator crest
Insertion : Proximal 1/3 of radius
Action : Supination
Nerve : Deep branch of radial nerve

130. Abductor pollicis longus muscle
Origin : Radius and ulna distal to supinator m.
Insertion : Base of first metacarpal bone
Action : Abducts thumb
Nerve : Deep branch of radial nerve
(Posterior interosseous nerve)

131. Extensor pollicis brevis muscle
Origin : Radius, posterior surface
Insertion : Base of proximal phalanx of thumb
Action : Extends thumb
Nerve : Deep branch of radial nerve
(Posterior interosseous nerve)

132. Extensor pollicis longus muscle
Origin : Middle 1/3 post. surface of ulna
Insertion : Distal phalanx of thumb
Action : Extends thumb
Nerve : Deep branch of radial nerve
(Posterior interosseous nerve)

133. Extensor indicis muscle
Origin : Ulna, posterior surface
Insertion : Extensor expansion
Action : Extends index
Nerve : Deep branch of radial nerve
(Posterior interosseous nerve)

134. : Bounded the anatomical snuff box
Out cropping muscles
Abductor pollicis longus m.
Extensor pollicis brevis m.
Extensor pollicis longus m.
: Bounded the anatomical snuff box

140. Tendon of the muscles in the fascial tunnels
2 = Abductor pollicis longus and extensor pollicis brevis
3 = Extensor carpi radialis longus and brevis
1 = Extensor pollicis longus
5 = Extensor digitorum and extensor indicis
6 = Extensor digiti minimi
4 = Extensor carpi ulnaris

142. Arthrology (Study of joint)
1. According to the movement
1.1 Immovable or synarthrosis
eg. suture

143. 1.2 Slightly movable or amphi(ar)throsis
Fibrous tissue lies between the bones (syndesmosis) eg. Intermediate radio-ulnar jt.
Cartilage joins the bones (synchondrosis) eg. Pubic symphysis, intervertebral disc, sterno-costal joint

144. 1.3 Freely movable (diarthrosis)
have joint cavity, joint capsule eg. Shoulder joint, elbow joint

145. 2.According to the structures found in the joint
2.1. Fibrous joint
there are fibrous tissue in the joint eg. Suture, radio-ulnar joint, tibio-fibular joint
2.2. Cartilagenous joint
there are cartilage in the joint eg. Pubic symphysis, sterno-costal joint

146. 2.3. Synovial joint General patterns of synovial joint
There are at least 2 bones
It’s articular surfaces lied with hyaline cartilage (articular cartilage)
It has articular or joint capsule
It has joint cavity
Inner surface of the joint capsule lied with synovial membrane which secrete the synovial fluid or synovia

148. Classification of the synovial joint
Classified into 7 types
1. The ball and socket type
For example : shoulder joint
Bones : humerus and scapula
Ball : the head of the humerus
Socket : primary socket is the glenoid cavity of the scapula : secondary socket is the coraco-acromial ligament

149. The ball and socket type (continue)
Movement : multiaxial - flex, extend, adduct,abduct and circumduct
Joint capsule : thin fibrous membrane
Ligaments : coraco-humeral, superior, middle and inferior gleno-humeral ligaments

160. 2. Hinge type For example : the elbow joint
Bones : humerus, ulna and radius
Movement : around horizontal axis; flex and extend
Joint capsule : thin at the anterior and posterior sides : thicken at medial and lateral sides
Ligaments : medial or ulnar collateral ligament : lateral or radial collateral ligament

166. 3. Pivot type For example : proximal radio-ulnar joint
Bones : radius and ulna
Movement : around the vertical axis ; medial and lateral rotation
Ligament : annular ligament

168. 4. Ellipsoidal type For example : wrist or radio-carpal joint
Bones : distal end of radius, scaphoid, lunate and triquetrum
Movement : modified hinge type; flex, extend, adduct and abduct
Ligaments : medial or ulnar collateral ligament : lateral or radial collateral ligament

171. 5. Plane or gliding type
For example : intercarpal joints
Bones : carpal bones
Movement : gliding
Ligaments : interosseous ligaments

172. 6. Saddle type
For example :1st carpometacarpal joint
Bones : 1st metacarpal bone and trapezium
Movement : flex, extend, adduct, abduct and circumduct

174. 7. Condyloid type
For example : metacarpophalangeal joint (MP) interphalangeal joint (IP)
Bones : metacarpal bone, phalanges
Movement : flex and extend, (adduct, abduct)
Ligaments : medial and lateral collateral ligaments

176. Joints of the upper limb
Sternno-clavicular joint
Coraco-acromial joint
Coraco-clavicular joint
Acromio-clavicular joint
Shoulder joint
Elbow joint

177. Joints of the upper limb (continue)
Radio-ulnar joints (prox.,middle and distal)
Wrist or radio-carpal joint
Intercarpal joints
Carpometacarpal joints
Intermetacarpal joints
Metacarpophalangeal joints (MP joint)
Interphalangeal joints (IP joint)

179. NERVE LESIONS OF UPPER LIMBSBY
VIROJ MITRANONDA
Department of Anatomy
Faculty of Science, Mahidol University