anatomy of upper limb
TRANSCRIPT
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ANATOMY OF UPPER LIMB
BYDr.TEJASWI DUSSAPG IN MS (ORTHO)GANDHI HOSPITAL
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MUSCLES OF UPPER LIMB
Attachments Nerve Suply Blood Supply Actions & Clinical Testing
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ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON
BONY CONNECTION -
CLAVICLE
MUSCULAR ATTACHMENTS
Trapezius, Latissmus Dorsi, Levator Scapulae, Rhomboideus
Major, Rhomboideus
Minor
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TRAPEZIUS
ORIGIN: External occipetal protuberance, Superior nuchal line of occipetal bone, Spinous processes of 7th cervical and All thoracic
vertebrae INSERTION: lateral 1/3 of clavicle, Medial margin
of acromion, spine of scapula ACTION: Elevates The Scapula , rotation of
scapula, retraction of shoulder, draw the scapula downwards and Abduction Of Shoulder Beyond 90*
N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)
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TREPEZIUS
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LATISSIMUS DORSI
ORIGIN: posterior layer of thoraco lumbar fascia,
Spinous processes of lower 6 thoracic vertebrae and
Caudal most 3-4 ribs, May attach to iliac crest. INSERTION:
Intertubercular groove of the humerus.
ACTION: extends, adducts and medial rotation of arm
N.SUPPLY: THORACO DORSAL .N (C6,C7,C8)
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LEVATOR SCAPULAE
ORIGIN: transvers processes of upper 4 cervical vertebrae.
INSERTION: medial border of the scapula superior portion.
ACTION: elevation of sup.angle of scapula and draws it medially.
N.SUPPY: C3,C4,C5 Nerves
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RHOMBOIDUS MINOR
ORIGIN: ligamentum nuchae,spinous process of c7,t1 vertebrae
INSERTION : medial border of the scapula
ACTION : retracts, depress the scapula and fix it to thoracis wall
N.SUPPLY :Dorsal Scapular .N (C4,C5)
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RHOMBOIDUS MAJOR
ORIGIN: Spinous process of t2-t5
INSERTION: medial border of the scapula, inf.angle
ACTION: retracts the scapula, depress the glenoid cavity and
fix the scapula to the thoracis wall
N.SUPPLY: Dorsal Scapular .N (c4,c5)
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RHOMBOIDS (c4,c5)
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MUSCLES OF PECTORAL REGION
PECTORALIS MAJOR PECTORALIS MINOR SUBCLAVIUS
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PECTORALIS MAJOR
ORIGIN: sternal half of the clavicle, Upper half of sternum,
aponeurosis of ext.obl.muscle,
INSERTION : lateral lip of intertubercular sulcus
ACTIONS: adduction, medial rotation and flexion of the shoulder.
N.SUPPLY: Med & Lat Pectoral.N (C5-8,T1)
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PECTORALIS MAJOR
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PECTORALIS MINOR
ORIGIN: costocondral jn.of 3,4,5 ribs
INSERTION: corocoid process medial &upper surface
ACTIONS: draws the scapula forwards, depression of the shoulder.
N.SUPPLY: Med & Lat Pectoral.N (C5-C8,T1)
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SUBCLAVIUS
ORIGIN: 1st rib at the costochondral jn.
INSERTION: subclavian groove of the clavicle
ACTION:steadies the clavicle
N.SUPPLY: N.Subclavius from upper trunk of B.P (c5,c6)
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SERRATUS ANTERIOR
ORIGIN: outer and superior surface of the 1-8 ribs
INSERTION: superior angle, medial border and inferior angle of the scapula
ACTION: rotates scapula upwards,
abduction of shoulder above 90*
N.SUPPLY: Long Thoracis.N (c5,c6,c7)
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WINGING OF SCAPULA
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MUSCLES OF SHOULDER GIRDLE
Deltoid Rotator cuff muscles- Supra Spinatus
Infra
Spinatus,
Subscapularis,
Teres Minor.
Teres major
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DELTOID
ORIGIN Lateral 1/3 clavicle,
sup.surface of acromion, spine of the scapula.
INSERTION: deltoid tuberosity. ACTION: abduction of arm, flx.&.ext of arm, med.& lat. rotation. N.SUPPLY: Axillary.N
(C5,c6)
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DELTOID
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SUPRASPINATUS
ORIGIN: supraspinatous fossa of the scapula
INSERTION: superior facet on the gr.tubercle of the humerus
ACTION: initiation of abduction (15*) & lat. Rotation
N.SUPPLY: Suprascapular.N From B.P (C5,C6)
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SUPRASPINATUS
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INFRASPINATUS ORIGIN: infraspinatous
fossa of the scapula INSERTION: middle
facet on the gr.tubercle of the humerus
ACTION: lat.rotation of
shoulder, strengthen the shoulder by bracing the head of humerus.
N.SUPPLY: Suprascapular .N of
B.P (C5,c6)
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INFRASPINATUS
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TERES MINOR
ORIGIN: lat.borderof the scapula
INSERTION: inf.facet on the gr.tubercle of the humerus
ACTION: ext.rotator & weak adductor
N.SUPPLY: Axillary .N.(C5,C6)
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SUBSCAPULARIS
ORIGIN: medial 2/3 subscapular fossa,
lat border of tha scapula INSERTION: lesser tubercle of
the humerus ACTION: stabilise the shoulder &
prevents anterior displacement of the shoulder (med. rotation, adduction of arm)
N.SUPPLY: Upper &Lower Subscapular .N (c5,c6)
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SUBSCAPULARIS
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ROTATOR CUFF
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TERES MAJOR
ORIGIN: dorsal surface of the inf.angle of the scapula
INSERTION: med.lip of the intetubercular groove of the humerus
ACTION: extends the arm from
flexd.position & it adducts, med.rotates the arm
N.SUPPLY: Lower Subscapular (C6,C7)
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MOVEMENTS OF THE SHOULDER Flexion Extension Abduction Adduction Internal rotation, External rotation circumduction
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FLEXION
Pect.Mojor Anterior Fibers Of
Deltoid Coraco brachialis
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EXTENSION
Lattismus Dorsi Teres Major Posterior fibers
Deltoid
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ABDUCTION
Supraspinatous (15*)
Deltoid (15-90*) Serratus Anterior
(>90*) Trapezius (>90*)
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ADDUCTION
Lattismus Dorsi Pectoralis Major Subscapularis Teres Minor Teres Major CORACO BRACHIALIS
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INTERNAL ROTATION
Pectoralis Major Ant.Deltoid Subscapularis Teres Major Lattismus Dorsi
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EXTERNAL ROTATION
Deltoid Supraspinatus Infraspinatus Teres Minor
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MUSCLES OF ARM
FLEXOR COMPARTMENT: BICEPS BRACHII
CORACO BRACHIALIS BRACHIALIS
EXTENSOR COMPARTMENT TRICEPS
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BICEPS BRACHII
ORIGIN: Long head: supra glenoid
tubercle of the scapula Short head: apex of the
coracoid process INSERTION: Radial Tuberosity ACTION: flexor of supinated
forearm Powerful Supinator Of
Partially Flexed Forearm N.SUPPLY: musculo
cutaneous.N (c5,c6)
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BICEPS BRACHI
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CORACO BRACHIALIS
ORIGIN: coracoid process of the scapula
INSERTION: middle of medial surface of the humerus
ACTION: flexes and adducts the arm
N.SUPPLY: musculocutaneous .N (c6,c7)
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BRACHIALIS
ORIGIN: distal half of the anterior humerus
INSERTION :coronoid process, tuberosity of ulna
ACTION: Powerful Flexor Of Forearm
N.SUPPLY: Musculocutaneous .N (C5,C6,C7)
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MUSCULOCUTANEOUS NERVE :C5,C6,c7
Biceps Brachii
Brachialis
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TRICEPS
ORIGIN: Long head: infraglenoid
tubercle of the scapula Lat.head: oblique ridge
on upper surface above the radial groove
Medial head: posterior surface of the humerus inf.to the radial groove
INSERTION: proximal olecrenon of the ulna
ACTION:extends the forearmN.SUPPLY: Radial .N.(C7,c8)
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TRICEPS
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MOVEMENTS AT ELBOW
FLEXION Brachialis Biceps
EXTENSION Triceps
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MUSCLES OF FOREARM
Anterior Compartment:
common flx.origin SUPERFICIAL 1.Pronator Teres 2.Flx Carpi Ulnaris 3.Palmaris Longus 4.Flx.Carpi Radialis 5.Flx.Digitorum Superficialis (sublimus) DEEP: 1.Flx.Digitorum Profundus 2.Flx.Pollicis Longus 3.Pronator Quadratus
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POSTERIOR COMPARTMENT
SUPERFICIAL: 1. Anconeus 2.Brachioradialis
3.Ext.Carpi Radialis Longus 4.Ext.Carpi Radialis Brevis
5.Ext.Digitorum 6.Ext.Digiti Minimi 7.Ext.Carpi Ulnaris DEEP 1.Abductor Pollicis Longus 2.Ext.Pollicis Brevis 3.Ext.Pollicis Brevis 4.Ext.Indicis 5.Supinator
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PRONATOR TERES
Insertion: midway long the lateral surface of the radius
Action: pronation,flexion of forearm
N.Supply:Median.N (C6c7)
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PRONATOR TERES
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FLX.CARPI RADIALIS
INSERTION:base of the 2nd mc bone and slip to the bace of the 3rd MC bone
ACTION: flexion and abduction of wrist
N.SUPPLY: Median.N (c6,c7)
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PALMARIS LONGUS
INSERTION: anterior aspect of the distal flx.retinaculum and palmar aponeurosis
ACTION: flx.the wrist, and tightens the palmar.aponeurosis
N.SUPPLY: Median. N (c6,c7)
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FLX CARPI ULNARIS
ORIGIN: humoral head: med
epicondyle Ulnar head:med.margin of
the olecrenon,posterior border of the ulna
INSERTION: pisiform, hook of hamate, base of the
5th MC & flx.retinaculum ACTION:flexes and adducts
the hand N.SUPPLY: Ulnar.N (C7,C8)
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FLX.CARPI ULNARIS
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FLX.DIGITORUM SUPERFICIALIS
ORIGIN: humeroulnar head:
med.epicondyle of the humerus, coronoid process
Radial head: sup.half of anterior aspect
of the radius INSERTION : bodies of the
Middle phalanges of the medial 4 digits
ACTION: flx.of all joints it crosses
N.SUPPLY :Median .N (C7,C8,T1)
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FLX.DIGITORUM PROFUNDUS
ORIGIN:prox.3/4 of the medial and anterior aspect of the ulna and from interosseous memb.
INSERTION:base of The Diatal phalanges of the medial 4 digits
ACTION: flx.DIP,,PIP,MP, wrist
N.SUPPLY: Medial-ulnar.N (C8,t1) Lateral-AIN Of Median.N
(C8,t1)
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FLX.DIGITORUM PROFUNDUS
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FLX.POLLICIS LONGUS
ORIGIN: upper 3/4 of anterior surface of radius
INSERTION: base of distal phalanx of the thumb
ACTION: flexion of proximal & distal phalnx of the thumb
N.SUPPLY:AIN (C7,C8,T1)
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FLX.POLLICIS LONGUS
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PRONATOR QUADRATUS
ORIGIN: lower 1/4th of anterior surface of ulna
INSERTION: lower 1/4th of anterior surface of radius
ACTION :pronation N.SUPPLY:AIN
(C8,T1)
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POSTERIOR COMPARTMENT OF FOREARM
SUPERFICIAL1.anconeus2.Brachioradialis3.Ext.Carpi Radialis
Longus4.Ext.Carpi Radialis
Brevis5.Ext.Digitorum6.Ext.Digiti Minimi7.Ext.Carpi Ulnaris
DEEP1.Abductor Pollicis
Longus2.Ext.Pollicis longus3.Ext.Pollicis brevis4.Ext.Indicis5.supinator
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ANCONEUS
ORIGIN: posterior surface of the lat.epicondyle
INSERTION:lateral surface of olecranon,body of ulna
ACTION: extension of forearm
N.SUPPLY: radial.n
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BRACHIORADIALIS
ORIGIN: prox.2/3rd of lat.supracondylar ridge of humerus, lateral intermuscular septum
INSERTION: lat.aspect of distal radius just prox.to the styloid process
ACTION: acc.flexor of elbow
N.SUPPLY: Radial.N (C5,C6)
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BRACHIORADIALIS
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EXT.CARPI RADIALIS LONGUS
ORIGIN: lat.supracondylar ridge of humerus
INSERTION: base of the 2nd MC bone
ACTION: extends and abducts the hand
N.SUPPLY: Radial .N (C6,C7)
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EXTENSOR CARPI RADIALIS BREVIS
ORIGIN: lat.epicondyle of the humerus
INSERTION: base of the 3rd MC bone
ACTION: extends and abducts the wrist
N.SUPPLY: deep br.of radial .N(c7c8)
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EXTENSOR DIGITORUM
ORIGIN: lat epicondyle of the humerus
INSERTION: Extensor Expansions Of The Medial 4 digits
ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended
N.SUPPLY: PIN (c7,c8)
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EXTENSOR DIGITI MINIMI
ORIGIN:lat epicondyle of the humerus
INSERTION:extensor expansion of the 5th digit
ACTION: ext.of 5th digit at MC, PIP , ext of wrist when little finger in
extension N.SUPPLY:PIN (c7,c8)
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EXT.CARPI ULNARIS
ORIGIN:2 heads lat epicondyle of
humerus, Posterior border of
ulna INSERTION:medial
side of the base of the 5th MC
ACTION: extends and adducts the hand
N.SUPPLY:PIN (c7c8)
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SUPINATOR
ORIGIN: lat epicondyle of humerus,
radial collateral lig., annular lig.,supinator
fossa, crest of ulna INSERTION:
lateral,posterior,anterior surface of prox 1/ 3rd 0f radius
ACTION:supination N.Supply: deep Br.Of
Radial.N (C5,c6)
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SUPINATOR
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ABDUCTOR POLLICIS LONGUS
ORIGIN:upper parts of the posterior surface of the radius & ulna and interosseous mem.
INSERTION:base of the 1st MC bone
ACTION: abducts,extends, lat.rotates the thumb at carpometacarpal joint, & abducts the wrist.
N.SUPPLY:PIN (c7,c8)
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EXTENSOR POLLICIS BREVIS
ORIGIN:posterior surface of the radius below the origin ofAbductor Pollicis longusand from interosseous mem.
INSERTION:base of the prox.phalanx of the thumb
ACTION:extends pox.phalanx of the thumb at MC joint, ext.at 1st carpometacarpal joint
N.SUPPLY:PIN (c7,c8)
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EXT.POLLICIS LONGUS
ORIGIN: posterior surface of middle 1/3rd of ulna
And interrosseous mem. INSERTION:base of the
diastal phalanx of the thumb ACTION:extends distal
phalanx of the thumb at MP joint,IP joint.and it can contribute abduction of the thumb
N.SUPPLY:PIN (c7,c8).
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EXTENSOR INDICIS
Origin:posterior surface of ulna m/3rd below the EPL
Insertion:extensor expansion of the 2nd finger
Action: ext of index finger and wrist.
N.supply:PIN (c7,c8)
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EXM.MOVEMENTS OF FOREARM MUSCLES
Flexion Extension Adduction Abduction
AT RADIO ULNAR JOINT Supination pronation
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FLEXION
pronator teresFlx.carpi radialisFlx.carpi ulnarisFlx.digitorum
superficialisFlx. Digitorum
profundusPalmaris longusbrachioradialis
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EXTENSION
Anconeus Ext.Carpi Radialis
Longus Ext.Carpi Radialis
Brevis Ext.Digitorum Ext.Indisis Ext.Carpi Ulnaris Ext. Digiti Minimi Abductor Pollicis
Longus
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ADDUCTION flexor carpi ulnaris extensor carpi
ulnaris
ABDUCTION flx.carpi radialis ext.carpi radialis
longus Ext.carpi radialis
brevis Abductor pollicis
longus
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PRONATION pronator teres Pronator
quadratus
SUPINATION biceps supinator
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INTRINSIC MUSCLES OF THE HAND
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Thenar muscles abductor pollicis brevis flx.pollicis brevis opponens pollicis Adductor
pollicis Hypothenar muscles- palmaris brevis abductor digiti
minimi flx.digiti minimi opponens digiti
minimi Lumbricals -4 Palmar interossei-4 Dorsal interosei-4
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THENAR MUSCLES
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ABDUCTOR POLLICIS BREVIS
ORIGIN: flx.retinaculum, tubercle of scaphoid, trapezium
INSERTION: lat.side of the base of the prox.phalax of the thumb
ACTION: abduction at carpometacarpal,MP joints
N.SUPPLY: recurrent br.of median.n (c8t1)
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ABDUCTOR POLLICIS BREVIS
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FLX.POLLICIS BREVIS
ORIGIN:2 heads suf.head: flx.retinaculum & trapezium bone Deep head: floor of carpal canal overlies the
trepezoid,capitate INSERTION: lateral side of the 1st metacarpal
bone and base of the prox phalanx ACTION: flexes the prox.phalanx of the thumb
at MCP and med.rotation at carpometacarpal joint
N.SUPPLY: SEPERFICIAL HEAD: median.n (c8,t1) DEEP HEAD: Deep Br.Of Ulnar Nerve
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FLX.POLLICIS BREVIS
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OPPONENS POLLICIS
ORIGIN: flex.retinaculum, trapezium bone
INSERTION :lat.half of the palmar surface of the 1st metacarpal bone
ACTION: oppositioin of te thumb in combination of flexion and med.rotation
N:SUPPLY: Media.N (C8,t1)
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ADDUCTOR POLLICIS
ORIGIN: 2heads oblique head : bases of 2nd 3rd
metacarpals and capitate bone Transverse head: anterior
surface of 3rd metacarpal bone INSERTION: base of
prox.phalanx of the thumb ACTIONS: adducts tha
prox.phalanx of the thumb N.SUPPLY: DEEP BR.OF ULNAR NERVE
(C8, T1)
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ADDUCTOR POLLICIS
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HYPOTHENAR MUSCLES
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PALMARIS BREVIS
ORIGIN: flx.retinaculum,palmar aponeurosis
INSERTION: skin along the medial border of the hand
ACTION:helps in gripping by wrinkling of skin over it
N.SUPPLY:Ulnar.N Suf.Br.
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ABDUCTOR DIGITI MINIMI
ORIGIN: pisiform bone,the tendon of the flx.carpi ulnaris
INSERTION :medial side of the base of the prox.phalanx of the 5th digit
ACTION:abducts th 5th digit
N.SUPPY: Deep Br.Of Ulnar .N (C8,t1)
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ABDUCTOR DIGITI MINIMI
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FLX.DIGITI MINIMI
ORIGIN : hook of hamate,flx.retinaculum
INSERTION :medial aspect of the base of the prox.phalanx of little finger
ACTION: flex theprox phalanx of 5th digit at MCP joint
N.SUPPLY: Deep Br. Of Ulnar.N (C8,T1)
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OPPONENS DIGITI MINIMI
ORIGIN:hook of hamate, flx.retinaculum
INSERTION:body of the 5th metacarpal.
ACTION: abducts, flexion,lat.rotates the 5th metacarpal
N.SUPPLY: deep br.of ulnar.N (C8,T1)
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LUMBRICALS
ORIGIN: 1&2 lumbrical arise from the 2 lateral tendon of th
flx.digitorum profundus. 2&4 arises from the medial tendons of the
flx.digitorum profundus
INSERTION : lateral side of the ext.expansion of medial 4 digits.
ACTION: flex the MCP, extends the IP N.SUPPLY: 1&2 lumbrical- Median .N (C8,t1) 3&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)
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PALMAR INTEROSSEI
ORIGIN: palmar interossei arises from palmar surface of the metacarpal bones of 2,4,5 digits
INSERTION: extensor expansion of the digit and bases of the prox.phalanx of the 2,4,5 digits
ACTION: Adduts The Fingers At
MCP, assists flexion at MCP, extension at IP
N.SUPPLY: deep br. Of unlar .n (C8,T1)
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PALMAR INTEROSSEI
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Dorsal interossei
ORIGIN: adjacent sides of the metacarpal bones
INSERTION: base of the prox.phalanx and in to the aponeurosis that forms ext.expansion
ACTION: abducts the fingers,flex the MCP
N.SUPPLY: Deep Br.Of Ulnar .N (C8,t1)
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Dorsal interossei
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Dorsal interossei
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Parts of Brachial Plexus
Really Tired? Drink Coffee
Buddy!
R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES
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Roots join to form Trunks! (in neck)
• Ventral Rami Trunks
• C5 Upper Trunk• C6• C7 Middle Trunk• C8• T1 Lower Trunk
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Trunks Split to form Divisions : (in neck)• Trunks Divisions
• Upper AnteriorPosterior
• Middle Anterior
Posterior
• Lower Anterior Posterior
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Divisions Join to form Cords! (in axilla)
U A P
M A P
L A P POSTERIOR
CORD
LATERAL CORD
MEDIAL CORD
Trunks DivisionsCords
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Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous
Median
Medial Ulnar
Posterior RadialAxillary
(thoracodorsal)(subscapular)
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Injury of the brachial plexus
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THANK YOU