1. ANATOMY OF THE UPPER LIMB
DR.AHMAD K. SHAHWAN
PH.D. GENERAL SURGERY

2. ANATOMY OF THE UPPER LIMB
1- Bones of the upper limb.
2- Muscles of the upper limb.
3- Vesseles of the upper limb.
4- Nerves of the upper limb.
5- Joints of the upper limb.

3. ANATOMY OF THE UPPER LIMB
Surface anatomy of the upper limb.
The upper limb divided to
1- The Shoulder
2- The arm
3- The forearm
4- The hand
5- The axilla & the breast

6. ANATOMY OF THE UPPER LIMB
THE SHOULDER
IT CONTAINS THE SCAPULA& THE CLAVICLE which articulate with the sternum & the humerus.

8. THE SCAPULA *It has a spine ,acromial process &coracoid process.
*It is a flat bone with 2 surfaces (ventral& dorsal).&3 angles (superior, lateral& inferior).& 3 borders (medial ,lateral & superior).
*It has a spine ,acromial process &coracoid process.

9. THE SCAPULA
The ventral (costal) surface is concave &forms the subscapular fossa.
The dorsal surface is convex &divided by the spine of the scapula to 2 fossae:
1- a small supraspinous fossa.
2-a large infraspinous fossa.

10. THE SCAPULA
The spine of the scapula starts medially to extend laterally where be wider to form acromial process which articulate with the lateral end of the clavicle.
At the lateral end of the superior border is the coracoid process.
The superior angle lies opposite the second rib while the inferior angle lies opposite the seventh rib. The lateral angle forms the glenoid cavity.

13. Articulation of the scapula
There are 2 synovial & 2 fibrous joints.
1-The synovial joints :
1-1-The glenoid cavity with the head of the humerus to form the shoulder joint .
1-2-Acromio-clavicular joint
2- The fibrous joints :
2-1- coraco- clavicular joint (strong joint covered with strong ligament)
2-2- coraco- acromial joint (strong joint covered with strong ligament)

14. Anastamosis around the scapula
It is an important anastamosis between branches of the first part of the subclavian A.& the third part of axillary A.
1- branches of the first part of the subclavian A
1-1- the supra scapular A. which distributed to the supraspinous & the infraspinous fossa.
1-2- deep branch of the transverse cervical A. which go down along the medial border of the scapula.

15. Anastamosis around the scapula
2- The branches of the third part of axillary A.
2-1- the sub scapular A. which go down along the lateral border of the scapula.
2-2- the circumflex scapular A. which arise from the sub scapular A.& go to the infraspinous fossa.

19. THE CLAVICLE
It lies horizontally in the root of the neck. It covers the flat 1st rib& its medial 2/3 are curved forward to give room for the passage of the large vessels & nerves which leave the neck & pass behind & below the clavicle on their way to upper limb.
It has 2 important functions:
1- To transmit forces from the upper limb to the bones of the axial skeleton (sternum)
2- To act as strut holding the arm free from the trunk.

21. THE CLAVICLE It is along bone with a body & 2 ends:
1- the sternal end articulate with the manuberium of the sternum forming the sterno- clavicular joint.
2-The acromial end articulate with the acromial process of the scapula forming the acromio- clavicular joint.
The body is convex in medial 2/3 concave in lateral 1/3.

22. THE CLAVICLE Important relations of the clavicle
1-The subclavian A.&V.&the trunk of the brachial pluxes pass behind the middle /3 of the clavicle.
2- The common carotid A. lies behind the left sternoclavicular joint .
3- the brachio-cephalic A. divided to its branches behind the right sternoclavicular joint.
4-The internal jugular vein lies a little laterally on either side.

26. THE HUMERUS
It is a tubular long bone composed of upper end , body (shaft ) & lower end.
The upper end formed from
1- the head
2- the neck ( anatomical &surgical )
3- the tubercles (greater & lesser ) .

27. THE HUMERUS
The head : which is less than ½ sphere directed medially ,upward &posteriorly .It is separated from the greater & lesser tuberosities by a shallow groove called the anatomical neck .
The greater tuberosity is a prominence which projects posteriorly in rest position.
The lesser tuberosity is a small prominence which project anteriorly.
The greater & lesser tuberosities & the head are separated from the shaft by the surgical neck.
There is small groove below them called the bicipital groove .

30. THE HUMERUS
The body (shaft ): the upper ½ of the shaft is cylindrical while the lower ½ is like a prism.
The lateral & medial borders of the lower shaft are continued below to form the lateral & medial supracondyler ridges (crests) which end with the lateral & medial epicondyles.
In the middle of the shaft there is deltoid tuberosity & the spiral groove .

31. THE HUMERUS The lower end formed from( from medial to lateral ) :
1- the anterior aspect :medial epicondyle , trochlea ,capitulum & lateral epicondyle . With 2 fossae (coronoid & radial ) .
2- the posterior aspect: medial epicondyle , trochlea & lateral epicondyle with one fossa (olecranon) .
The medial epicondyle is larger , more prominent & extend downward more than the lateral .It carries a shallow groove in the posterior surface for the ulner nerve .

33. 3 Snell\Upper limb\473.jpg

35. THE HUMERUS Ligaments attached to the humerus :
1- The capsule of the shoulder joint is attached to the anatomical neck except inferiorly where it extends for about cm. to attach to the surgical neck.
2- The capsule of the elbow joint where attached to the upper margins of the fossae
3- The lateral & medial supracondyler ridges give attachments to the lateral & medial intermuscular septum .

36. THE HUMERUS Nerves related to the humerus :
1- The circumflex (axillary) N. may be injured in fracture of surgical neck .
2- The radial N. (which lies in the spiral groove ) may be injured in fracture of the middle of the shaft .
3- The ulnar N. may be injured in fracture of the lower end (the medial epicondyle)

38. THE RADIUS
It is along bone , consist of thin narrow upper end ,body & thick expanded lower end .
The upper end consist of :
1- The head :is disc like with 2 articular surfaces :
1-1-the upper surface with the capitulum of the humerus.
1-2-the lateral surface with the radial notch of the ulna .
2-The neck :constricted part below the head .
3-The radial tuberosity :below the medial part of the neck .

41. THE RADIUS
The body of the radius which had 3 surfaces & 3 borders & pronator tuberosity.
The lower end which is the styloid process laterally & ulnar notch medially .

42. THE RADIUS The joints of the radius :
Above:1- the upper surface of the head receives the capitulum of the humerus to form part of the elbow joint .
2- the circumference of the head articulates with radial notch of the ulna to form the superior radio-ulnar joint .
Below: 1- the ulnar notch receives the head of the ulna to form the inferior radio-ulnar joint .
2- the inferior surface of the lower end articulate with 2 carpal bones to form the wrist( radio-carpal )joint

44. THE ULNA It is along bone with upper end , body (shaft ) & lower end.
The upper end consist of :
1- The olecranon process :the upper part of the trochlear fossa .
2- The coronoid process : the lower part of the trochlear fossa .
3- The ulnar tuberosity :below the coronoid process on the anterior surface . .

46. THE ULNA
4-The trochlear fossa : is a large deeply concave articular surface which lies between the olecranon & coronoid processes.
5- The radial notch is a concave surface in the upper part of the lateral side of the coronoid process. It articulates with the circumference of the head of the radius to form the superior radio-ulnar joint.

47. THE ULNA
The body (shaft) of the ulna is triangular in the upper ¾ & cylindrical in the lower ¼ .
The lower end consist of :
1- the head : small rounded articulating with the medial side of the lower end of the radius forming the inferior radio – ulnar joint.
2- The styloid process : projects medially & below the head .

48. The interosseous membrane :
In addition to the sup. & inf. Radio ulnar joints ,The radius & ulna are also joined by a fibrous membrane which stretches between the interosseous borders of the 2 bones..
It Ff. run obliquely downwards &medially from radius to ulna.
It is pierced by the ant.interosseous Vv.
Its function is
1- increase the area of origin of forearm Mm.
2- transmits forces received by the lower end of radius to ulna.

49. The bones of the hand
They consist of :carpus , metacarpus & phalanges bones
The carpus bones : they are 8 arrange in 2 rows ( proximal & distal ).
From lateral to medial:
1- the proximal row : scaphoid ,lunate , triquetral & pisiform .
2- the distal row : trapezium , trapezoid , capitate & hamate .

52. The bones of the hand
The Metacarpal bones : are 5 . One for each finger .
Each metacarpal bone has : base ,shaft & head .
The phalanges : all the fingers have 3 phalanges ( proximal , middle & distal ) except the thumb has only 2 (proximal & distal ).
Each phalanx has base , shaft & head .

53. The articulation of the carpal bones
The proximal row is convex toward the lower end of radius & ulna .
1- The scaphoid & lunate articulate with the lower end of the radius .
2- the triquetral articulates with the lower end of the ulna .
The bones of the proximal row articulate with the bones of the distal row in mid carpal (transverese carpal) joint.

54. The bones of the distal row articulate with the base of the metacarpals by
1- the trapezium articulate with the 1st metacarpal bone .
2- the trapazoid articulate with the 2nd metacarpal .
3- the capitate articulate with the 3rd metacarpal .
4- the hamate articulate with the 4th & th metacarpals..

55. THE MUSCLES OF THE UPPER LIMB
In general they divided to
1- Mm attached the upper limb to axial skeleton .
2- Mm of the upper limb proper .

56. Mm attached the upper limb to axial skeleton .
1-1-THE FRONT Mm.
Pectoralis major , Pectoralis minor & subclavius Mm.
1-2- AT SIDE M. : serratus ant M.
1-3- THE BACK Mm.
Latissmus dorsi , trapezius , levator scapulae , rhomboideus minor & rhomboideus major Mm.
Only the pect. Major & latissmus dorsi are inserted in the humerus while all the others are inserted in the shoulder girdle( scapula & clavicle) .

60. MOVEMENTS OF THE SHOULDER GIRDLE
1- ELEVATION: by upper Ff of trapezius & levator scapulae Mm.
2-DEPRETION: by pect.major , pect.minor &latissmus dorssi Mm.
3- RETRACTION: by middle Ff. of trapezius, rhomboideus major & minor Mm.
4- PROTRACTION: by serratus ant. ,levator scapulae & pect. Minor.
5- ROTATION UP : by upper &lower Ff of trapezius &serratus anterior Mm.
6-ROTATION DOWN : levator scapulae ,rhomboideus major & rhom. minor Mm.

61. MUSCLES OF THE SHOUlDER REGION
They are 6 Mm.: deltoid , teres major , teres minor ,supraspinatus , infraspinatus& subscabularis Mm.
The last 4 called The Rotator cuff Mm.
All of them arise from the scapula ( all from the dorsal surface except subscapularis M. from the anterior surface ) & all inserted in the tuberosities of humerus .They rotate the arm(medially or laterally) & adduct the arm (except the deltoid &supraspinatus Mm.) all suplied by C5, C6 Nn.

62. MUSCLES OF THE FRONT OF THE ARM
They are :Biceps , Brachialis & coraco -brachialis Mm. and all supplied by musculo-cutaneous N.
The biceps act on the shoulder jt. as put the head of humerus in its place & on elbow jt. as flexor &supinator as it inserted in the post. part of tuberosity of the radius.
The brachialis M. from the shaft of humerus to the tuberosity of ulna, act as flexor to the elbow.
The coracobrachialis act as flexor & adductor to the arm.

63. MUSCLES OF THE BACK OF THE ARM.:
It is the Triceps M.: the long ,medial & lateral heads inserted in the upper post. Part of olecranon process& supplied by the radial N. to act as extensor of the elbow & stabilize the elbow jt.

64. THE FOREARM MUSCLES THE FLEXOR –PRONATOR GROUP :
They divided to 2 groups:
1- The flexor- pronator gp.
2- The extensor- supinator gp.
THE FLEXOR –PRONATOR GROUP :
*They flex the wrist ,fingers & pronate the forearm.
*They divided to superficial & deep groups.
*The superficial group arise from the front of medial epicondyle of humerus, pass in front of the forearm& the wrist to inserted in bones of the hand .

65. THE FLEXOR –PRONATOR GROUP :
They are :Pronator teres , Fl. Carpi-radialis , Fl. Carpi-ulnaris ,Fl. Digitorum superficialis &palmaris longus Mm .
The deep group arise from the front of interosseous membrane & radius & ulna.
They are : Fl.digitorum profundus , Fl.pollicis longus & pronator quadratus Mm.

66. THE FLEXOR –PRONATOR GROUP :
The pronators are Pronator teres & Pronator quadratus Mm. where inserted in the radius & pronate the forearm .
The flexors of the wrist are Fl.carpi-radialis ,Fl. carpi-ulnaris & Palmaris longus where inserted in the metacarpal bones .
The flexor of the fingers are Fl. digitorum superficialis & Fl. Digitorum profundus where inserted in the phalanges.
The flexor of the thumb is Fl. Pollicis longus& inserted in phalanges of the thumb .

67. THE EXTENSOR - SUPINATOR GROUP.
*They extend the wrist & the fingers & supinate the forearm .
* They divided to superficial & deep groups:
The superficial group arise from the back of the lateral epicondyle of humerus to pass on the back of the forearm & inserted in the bones of the hand . The are 7 ; Brachio-radialis , extensor carpi – radialis longus ;ext.calpi-radialis brevis ;ext.digitorum ; ext. digiti- minimi ;ext. carpi –ulnaris & anconeus Mm.

68. THE EXTENSOR - SUPINATOR GROUP.
The deep group is 5 Mm : supinator ;abductor pollicis longus ; ext. pollicis brevis ; ext. pollicis longus & ext. indicis Mm.

69. THE EXTENSOR - SUPINATOR GROUP.
The supinators are :Supinator ,Brachio radialis & the anconeus Mm. where inserted in the bones of the forearm.
The extensor of the wrist are : Ext.carpi-radialis longus , Ext. carpi-radialis brevis & ext. carpi-ulnaris Mm. where inserted in the metacarpal bones& extend the wrist.
The extensors of the fingers are :Ext. digitorum ; Ext. digiti- minimi & Ext. indicis where inserted in the fingers & extend the metacarpo-phalangeal joints .

70. THE EXTENSOR - SUPINATOR GROUP.
The muscles of the thumb are : Abductor pollicis longus , Ext. pollicis brevis & ext. pollicis longus Mm. where inserted in the thumb bones .

71. THE FLEXOR RETINACULUM
It is a thick band made of dense white fibrous tissue which stretch across the anterior surface of the carpus bones which are concave in shape ( carpus arch ) changing the arch to carpus tunnel .
In the tunnel pass the median nerve & tendons of Mm.
THE EXTENSOR RETINACULUM
It is a thickening of deep fascia between the lower ends of radius & ulna .

73. THE MUSCLES OF THE HAND They divided to thenar & hypothenar Mm.
The thenar Mm: Abductor pollicis brevis , flexor pollicis brevis & opponens pollicis Mm.
The hypothenar Mm : abductor digiti minimi ,flexor digiti minimi & opponens digiti minimi Mm.
There are also 4 lumbrical Mm & 7 Interosseous Mm. in the fingers .
All these Mm responsible for fine movements of fingers.

76. IMPOTANT REGIONS IN THE UPPER LIMB THE BREAST THE AXILLA

77. THE BREAST( THE MAMMARY GLAND) :
It lies in the superficial fascia . It is modified skin gland & rudimentary in males .In female , the non-lactating mammary gland is formed of fat & milk glands& covered by a skin contain the nipple & the areola.
It extends from the 2nd rib to 6th rib & from the edge of sternum to the mid-axillary line.
Each gland is formed of lobes & each lobe divided to lobules.

79. THE BREAST( THE MAMMARY GLAND) :
The lymphatic drainage of the lateral side of the breast go to axillary L.N. while the medial side of the breast go to the internal mammary chain of L.N.
It is the pathway of breast cancer to matestasize in the body .

80. THE LYMPH NODES OF THE AXILLA
They divided to :
1- The anterior ( pectoral) group .
2- The posterior (subscapular ) group.
3- The lateral group: along the axillary vein
4- The central group : in the base of the axilla .
5- The apical group :in the apex of the axilla.

81. ARTERIES OF THE UPPER LIMB:
THE AXILLARY ARTERY :It begins at the outer border of the 1st rib as a continuation of the Subclavian A. & ends at the lower border of the teres major M. by becoming the Brachial A.
The pctoralis minor M . divided it to 3 parts:

82. ARTERIES OF THE UPPER LIMB:
The 1st part : lies above the pectoralis minor & give one branch (superior thoracic A.) . It lies very deeply with the axillary vein on its medial side .
The 2nd part : lies behind the pectoralis minor M. & gives 2 branches ( acromio -thoracic A.& lateral thoracic A. ).
The 3rd part : lies below the pectoralis minor M. & gives 3 branches :( subscapular A., post. circumflex humeral A. & ant . Circumflex humeral A.).

84. Anastamosis around the scapula
It is an important anastamosis between branches of the first part of the subclavian A.& the third part of axillary A.
1- branches of the first part of the subclavian A
1-1- the supra scapular A. which distributed to the supraspinous & the infraspinous fossa.
1-2- deep branch of the transverse cervical A. which go down along the medial border of the scapula.

85. Anastamosis around the scapula
2- The branches of the third part of axillary A.
2-1- the sub scapular A. which go down along the lateral border of the scapula.
2-2- the circumflex scapular A. which arise from the sub scapular A.& go to the infraspinous fossa.

87. ARTERIES OF THE UPPER LIMB:
THE BRACHIAL ARTERY :
It begins at the lower border of the Teres major M. as a continuation of the Axillary A. & ends at the level of the neck of the Radius by dividing to Radial & Ulnar Aa.
It is a superficial A. lies immediately below the deep fascia.
The basilic vein lies on its medial side.
In the upper part , the brachial A. lies to the medial side of the humerus while in the lower part lies anterior to it.

88. THE BRACHIAL ARTERY :
The branches of the brachial A.: It supplies all the Mm. of the arm & gives 3 branches
1- the profunda brachii A.
2- the superior ulnar collateral A.
3- the inferior ulnar collateral A.
The profunda brachii A. is the largest branch & pass with the radial N. in the spiral groove of the humerus to end in 2 terminal branches above the elbow joint .

90. Anastamosis around The Elbow Joint :
It is a rich anastamosis between small branches of brachial ,ulnar & radial Aa.:
1- anastamosis around medial epicondyle :
The two branches of the brachial A .(the superior ulnar collateral A. & the inferior ulnar collateral A.) with the branches of ulnar A. (the ant. & post. Ulnar recurrent Aa.) .i.e. the brachial & the ulnar Aa. only .
2- anastamosis around lateral epicondyle :
The 2 terminal branches of the profuda brachii a. with recurrent branches of ulnar & radial Aa.

92. THE RADIAL ARTERY:
It begins in the cubital fossa at the level opposite to the neck of the radius & ends in the palm by becoming the deep palmer arch .
It is the smaller of the 2 terminal branches of the brachial artery & descend in the lateral part of the front of the forearm .
At the lower end of the radius , it leaves the front of the forearm & turns backward round the lateral border of the wrist , below the styloid process of the radius& enter the anatomical snuff-box where the pulsation can be felt then pass to the palm .

94. THE RADIAL ARTERY:
It is deep in the upper part of the forearm to become superficial in the lower part of the forearm where we can feel the radial pulse.
The radial N . runs along the lateral side of the A. in the middle 1/3 then leave it in the lower 1/3 to go backward .
the radial A. form the deep palmer arch of the hand after giving many branches in the forearm & the hand .

95. THE ULNAR ARTERY :
It begins in the cubital fossa at the level opposite to the neck of the radius & ends in the palm by becoming theSUPERFICIAL PALMER ARCH.
It is the larger branch of the brachial A. It runs obliquely-medially in the upper part & vertically in the lower part of the forearm where be superficial & gives the deep palmer branch ( which helps in forming the deep palmer arch ) then becomes the superficial palmer arch.

97. THE ULNAR ARTERY :
The ulnar N. runs on medial side of the lower 2/3 of the ulnar artery while the median N. lies in the medial side of the A. in the cubital fossa then pass the A. obliquely to be in the middle part of the lower 2/3 of the forearm.
It gives the ant. & post. Ulnar recurrent Aa which form anastamosis with the brachial A. in the elbow region. Also gives many branches in the forearm &above the wrist.

99. THE SUPERFICIAL PALMER ARCH :
It is superficial because it lies immediately next to the palmer aponeurosis.
It is formed mainly by the ulnar A. with the superficial palmer branch of the radial A.
It gives 4 digital Aa. to supply the 4 medial fingers.

100. THE DEEP PALMER ARCH :
It is formed mainly by the radial A. with the deep palmer branch of the ulnar A.
It gives 3 palmer – metacarpal Aa. To pass to the clefts of the fingers.

102. THE BRACHIAL PLEXUS
A plexus: it is a complex arrangement of the anterior primary rami of certain spinal Nn. Which gives branches to supply the Mm. & skin of a certain part of a body.
THE BRACHIAL PLEXUS
It is formed by the anterior primary rami of C5,C6,C7,C8 &T1 Nn. these are called ROOTS of the plexus.
It lies in the lower part of the neck behind the clavicle & in the axilla & formed of 4 main parts : Roots , Trunks , Divisions & cords.

105. THE BRACHIAL PLEXUS
1- The roots: lie in the neck between the scaleneus ant. & scaleneus medius Mm.
2- The trunks : traverse the lower part of the posterior triangle of the neck .
3- The divisions : lie behind the middle 1/ of the clavicle.
4- The cords : lie in the axilla .
THE TRUNKS formed by :
The roots of C5 & C6 unite to form the upper trunk

106. THE BRACHIAL PLEXUS The root of C7 alone form the middle trunk.
The roots of C8 & T1 unite to form the lower trunk.
Then each trunk divides into anterior & posterior division .
Then the 3 posterior divisions unite to form the posterior cord .
The anterior divisions of the upper & middle trunks form the lateral cord.
The anterior division of the lower trunk alone forms the medial cord .

109. THE BRACHIAL PLEXUS
So we have ; 5 roots , 3 trunks , 6 divisions , 3 cords & 5 terminal branches .
No branches arise from the trunks nor from the divisions ( except the suprascapular N. which come from the erbs point=at beginning of the upper trunk). .
The brachial plexus gives 16 branches , 11 small branches & 5 big branches : radial , ulnar , median , circumflex (axillary) & musclocutaneous Nn.

110. THE BRACHIAL PLEXUS THE BRANCHES OF THE CORDS:
They are 2 types :main branches & small branches.
Each cord gives 2 main branches :
1- the posterior cord: radial n & circumflex N (axillary N.).
2- the medial cord : ulnar N. & medial root of median n.
3- the lateral cord : the lateral root of median N. & musclocutaeous N.

111. THE BRACHIAL PLEXUS The small branches of the cords are :
1- from the posterior cord :upper subscapular N.
N. To latissmus dorsi =(thoracodorsal N.).
Lower subscapular N.
2- from the lateral cord : lateral pectoral N.
3- from the medial cord : medial pectoral N.
Medial cutaneous N. of the arm Medial cutaneous N. of the forearm.

112. THE BRACHIAL PLEXUS THE BRANCHES OF THE ROOTS: There are 4 branches :
1- from C5 :N. to rhemboids Mm.(rh.major ,rh. Minor & levator scapulae)
2- from C5,C6,C7 :N. to serratus anterior (long thoracic N.).
3- from C6 : N. to subclavius.
4- at the union of C5 & C6 (erbs point): suprascapular N.( to supraspinatus & infraspinatus).

114. THE BRACHIAL PLEXUS
Each cord gives rise to 2 branches one is big & consider the continuation of the cord & one is small SO
The posterior cord continues as the radial N.
The medial cord continues as the ulnar N.
The lateral cord continues as the median N.
The 3 cords named according to their position to 2nd part of the axillary A. (post. , medial & lateral.) while the name of the main N. according to position in the forearm( ulnar , median & radial ).

116. THE BRACHIAL PLEXUS
The 5 main Nn. Arise opposite the lower border of the pectoralis minor M. near the coracoid process .
1- The circumflex (axillary ) N. supplies the deltoid & teres minor Mm. then become the lateral cutaneousN. of the arm.
2- The musculocutaneous N. supplies the biceps , coracobrachialis & brachialis Mm then become the lateral cutaneous N. of the forearm .
3- The median N ( with its branch =ant Interosseous N.) supplies most of the Mm. of front of the forearm with sensation of lateral 3 & ½ fingers anteriorly .

117. THE BRACHIAL PLEXUS
4- The radial N.( with its branch=post Interosseous N.) supplies most of the mm. of the back of the forearm With sensation of lateral 3 & ½ fingers posteriorly.
5- The ulnar N. supplies Mm. on the medial side of the forearm with sensation of medial 1 & ½ fingers anteriorly & posteriorly .

125. THE DERMATOMES OF THE UPPER LIMB
It is the cutaneous sensation of the upper limb.
C4 supplies the skin over the tip of the shoulder .
C5 supplies the lateral side of the arm &the upper lateral part of the forearm .
C6 supplies the lateral side of the lower part of the forearm & the lateral aspect of the hand
C7 supplies the middle aspect of the hand (ant.& post.) .

126. THE DERMATOMES OF THE UPPER LIMB
C8 supplies the medial side of the hand & the medial lower part of the forearm.
T1 supplies the medial part of the upper part of the forearm & the medial lower part of the arm.
T2 supplies the medial side of the upper part of the arm & the floor of the axilla.

129. THE VEINS OF THE UPPER LIMB
There are superficial & deep veins in the upper limb .
1-the deep veins are the veins which accompany the main Aa. ( way & name ).
2- The superficial Vv. : start as superficial venous network on the back of the hand. this network drains in 2 directions ;laterally into Cephalic V & medially to the basilic V.

130. THE VEINS OF THE UPPER LIMB
THE CEPHALIC VEIN :
It starts in the superficial fascia just behind the styloid process of the radius . Then it runs upward to the anterior surface of the forearm ; in the upper arm it lies in a groove along the lateral border of biceps M. then pierces the deep fascia in a groove between the deltoid & pectoralis major Mm. to inter the axillary vein.

131. THE VEINS OF THE UPPER LIMB
THE BASILIC VEIN:
It ascends along the postero-medial surface of the forearm; to go in the ant. surface just below the Elbow. It pierces the deep fascia in the middle of the arm .At the edge of the post. fold of the axilla its joined by the brachial Vv. to form the Axillary vein.

135. THE VEINS OF THE UPPER LIMB
THE MEDIAN CUBITAL VEIN :
It is the most prominent superficial vein in the body .
It joins the cephalic & the basilic Vv just distal to the front of the elbow joint.
These superficial veins are more important than the deep Vv. Because they are larger in size & used for intravenous injections.

136. ANY QUESTION
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