UPPER LIMB

• What is a limb?
• Sensory to upper limb
• Making it move
– Bones and joints
– Muscles and nerves
• Vascular supply
• Surface anatomy
• (muscle study hint)

Frolich, Human Anatomy,UpprLimb

 What is a limb?
• Ventral somatic outgrowth of outer tube
– Bones (with bone, cartilage, marrow, NAV,
etc.)
– Joints
– Muscle
– Nerves
– Vascular supply
• No viscera--all innervation is somatic
(motor or sensory) from ventral ramus of
spinal nerve (except autonomics to blood
vessels)
Frolich, Human Anatomy,UpprLimb
Sensory from limb
(dermatomes/sensory skin
segments from spine)
• Dermatomes extend
over limbs
• Twisted orientation
reflects twisting of limb
during development
• Named nerves generally
innervate skin over
muscles that they
innervate

Frolich, Human Anatomy,UpprLimb

 Sensory territory of nerves

Brachial plexus serves to re-

direct spinal routes into
named nerves covering
certain territory

Cutaneous branches of medial

cord/ulnar nerve

Frolich, Human Anatomy,UpprLimb

 Upper Limb Skeleton (old hat?)

• Scapula
• Humerus
• Radius, ulna
• Carpals--proximal,
distal
• Digits
– Metacarpals
– Phalanges

Frolich, Human Anatomy,UpprLimb

 Joints
JOINT BETWEEN MOVEMENT TYPE

Frolich, Human Anatomy,UpprLimb

 • If INSERTION on scapula = Move
Muscles scapula
of Scapula – Rhomboids
– Trapezius
– Pectoralis Minor
– Serratus Ventralis
– Levator Scapulae
• If ORIGIN on scapula = Move Arm
– Subscapularis
– Supraspinatus Rotator
– Infraspinatus Cuff
– Teres Minor
– Teres Major
– Latissimus Dorsi (partial O on scap)
– Coracobrachialis
pg 299 Use location of Insertion to determine exact movement!!
Frolich, Human Anatomy,UpprLimb
 POSTERIOR AND ANTERIOR COMPARTMENTS

Frolich, Human Anatomy,UpprLimb

Brachial Plexus

• Posterior Compartment—posterior cord

M&M, Fig. 14.11 • Anterior compartment—medial, lateral cords
Frolich, Human Anatomy,UpprLimb
• Name of cord is relative to axillary artery
ANTERIOR MUSCLES
• M-C
– Biceps
– brachialis
POSTERIOR MUSCLES
• Median
– Forearm flexors • Muscles (radial nerve)
– Thumb intrinsics (1M$ nerve) – Triceps
– Anconeus
• Ulnar
– Brachioradialis
– Flexor carpi ulnaris
– Carpal, digit extensors
– Hand intrinsics

Frolich, Human Anatomy,UpprLimb

 Muscles and nerves by compartment
ANTERIOR POSTERIOR
NERVES M-C, ulnar, Radial
median
MOVEMENT Flexion Extension
MUSCLES Biceps, Triceps,
flexors extensors
TWIST Flexors from Extensors from
medial lateral
epicondyle epicondyle

Frolich, Human Anatomy,UpprLimb

 Posterior Compartment of Forearm

Lateral Epicondyle

Brachioradialis
Extensor digitorum
Ext Carpi Radialis Longus
Extensor carpi ulnaris

Posterior View
Frolich, Human Anatomy,UpprLimb
 Anterior Compartment Forearm
pg 302
Medial Epicondyle

Brachioradialis
Pronator Teres

Flexor Carpi Radialis

Flexor Carpi Ulnaris

Flexor Retinaculum

Flexor Digitorum Superficialis

Anterior View
Frolich, Human Anatomy,UpprLimb is deep to other flexors
 Routes of nerves (in human)
• M-C: between biceps brachii and brachialis
• Median: medial/posterior to biceps, branches into
forearm flexors at elbow then to hand through carpal
tunnel
– Recurrent median (1M$) superficial at wrist to thumb over
thenar emminence) deficit - ape’s hand
• Ulnar: medial in arm, posterior to medial epicondle of
humerus (funny bone) down medial forearm medial to
carpal tunnel into palm
• Radial: deep posterior arm around lateral epicondyle
of humerus to forearm (deep and superficial branches)
Frolich, Human Anatomy,UpprLimb
 Vascular supply
• Subclavianaxillary
radial (same street, new
street sign every block)
• Collateral circulation
– Posterior/anterior
circumflex humeral
– Deep brachial a.
• Radial a. (with median n.)
deep palmar arch
• Ulnar a. (with ulnar n.) 
superficial palmar arch

Frolich, Human Anatomy,UpprLimb

 Median Nerve
Ulnar Nerve
Brachial Artery
Musculocutaneous Nerve UlnarArtery

Where’s Radial Nerve?

Radial Artery

Median Nerve
Ulnar Nerve

Frolich, Human Anatomy,UpprLimb

 Axilla = Armpit
• Region between arm and chest
• Boundaries
– 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
Frolich, Human Anatomy,UpprLimb
 Surface Anatomy of Upper Limb
• Biceps + Triceps brachii
• Olecrenon Process
• Medial Epicondyle
• Cubital Fossa
– Anterior surface elbow
– Contents
• Median Cubital Vein
• Brachial Artery
• Median Nerve
– Boundaries
• Medial= Pronator teres
• Lateral= Brachioradialis
• Superior= Line between epicondyles
pg 786 + 784
Frolich, Human Anatomy,UpprLimb
 • Carpal Tunnel
Surface Anatomy – Carpals concave anteriorly
– Carpal ligament covers it
of Upper Limb – 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
pg 306, 788 (pulse)
Frolich, Human Anatomy,UpprLimb
 Suggestion: a muscle table
organized by
Joint crossed?
Nerve innervating?
Action?
Compartments?
All of the above?

MUSCLE ACTION ORIGIN INSERTION INNERVATI ON

(cord to nerve)
Biceps Flex, sup. Humerus, Radial Medial cord—M-C.
glenoid tuberosity

Frolich, Human Anatomy,UpprLimb