on E Fracture ofthe clavicle results fro GUTEE ESN or may be caused by the obstetric hi ‘ st the maternal pubic the distal fragment by the deltoid muscle and gravity \lower trunk), causing paresthesia (sensation of tingling, ‘skin supplied by medial brachial and antebrachial cutanec orrhage from the subclavian vein and is responsible fort pulmonary embolism. Sperone apenas nce erage oer Sein commnce Srocavo Ingenta Ineo sete oun Peagetewenee 1 Seaptarnaten Tone Oe superr wanes sap pment and convene i forme ‘Sates capers TEI cattoa he supaiwanrre ECIREMLEM pce nn epatecor rns the sipror torts seaplr ieare enPy Fracture of the greater tuberosity LUTISEUESE tractions of the supraspinatus m of the supraspinatus, infraspinatus, and teres minor rotator cuff. Fracture of the lesser tuberosity accompanies pos ‘the bone fragment has the insertion of the subscapular Fracture of the surgical neck may injure the axl artery as they pass through the quadrangular space. Te 5 Fracture ofthe shaft may ij PEM Cnarene nat mey lore ‘Supracondylar fracture is 2 fracture ofthe distal and occurs when the child fll onthe outstretched ha injure the median nerve. Fracture of the medial epicondyle may damage groove bobind Cre ; Colles’ fracture ofthe wrists distal LiViLISTESN montis cisplaced tited) posteriory, 2 dinner (silver) fork deformity because the forearm and ‘the distal fragment is displaced anteriorly, itis ‘This fracture may show styloi processes ofthe radius andA. Carpal Bones (See Figure 2-2) © Are arranged in two rows of four (lateral to medial): scaphoid, lunate, riquetrum, pist- orm, trapezium, trapezoid, capitate, and hamate (mnemonic device: Sandra Likes to Pat ‘Tom's Two Cold Hands). (Trapezium precedes trapezoid alphabetically) FIGURE 2:2. Bones of he forearm and hand.CUT TMII reacture of the szaphoi e soaphoid occurs after 8 fal LULISE USS deep tenderness in anatomical snuffoox, cause avascular necrosis ofthe bone and degenerative joint di hhamate may injure the ulnar nerve and artery because they aren Bennet fracture is a fracture ofthe base ofthe metacert ‘racture ofthe necks ofthe second and third metacerpals, see of the ith metacarpal in unskilled boxer ore = Guyor's canal syndrome ison entrapment ofthe ul ease pea at eta by loss of sensation and mator weakness. it can be treated by surgical d uyons canal (ulnar tune! is formed byte psform hock of the hamato, a deep othe palais brevis ane palmar carpal igamert and ans the Eas Dislocation ofthe acromiotavcua joint with the impact taken by the acromion or FIGURE 23. Shoulder ont with bursae and rotator cut. Atarir view. B: Coronal section.Cy = 5 acotion (subluxation) of the sh GUAT SEALESN direction because ofthe lack of s ‘damage the axilary nerve and the posterior humeral Referred pain tothe shoulder most probably indi: iaphragm). The supractavicuar nerve (C3-C4), which has the same orgin asthe phrenic nerve (C3-CS), whic CLINICAL Ces motion, chi ‘tendon by fiction among middle-aged persons may cause dk {degenerative tendonitis) of the rotator cuff, resulting ina p shoulder,[BRS Gross Anatomy (ransverse coli atery) |p ssubelvian artery AE ‘Suprascapular artery od ‘Aeromion OH —£ Be Clavicle = Vege Ttonmernnotny SE SE Sg ee Lateral thorale artery S ¥ Fist ri ene seneaee ima oe ee ‘Scapular circumtlex artery: aey aces sera et colatora) Palmar carpal arch ‘Anterior {nferor Linas collateral artery oa imerosseous (Gupratrtloar artery) artery Interossoous recurrent artery vorang DeePpalmar arch WAY Doreal carpal te ante Perforating Fadia current artry Common interosseous artery be Cf posterioruinar Palmar Dorsal igi i Cm Dorsal nscis FIGURE 2-8. Blood suppiy tothe upper limb.EI Upper Limb 3 ‘branch of profunda brachi artery Profunda bach artory ‘Thoracodorsal anery Brachial artory Inferior ulnar ‘collateral artry Brachial artery Radial recurrent ‘artery Racial artery ‘Ulnar recurrent Posterior artery interosseous ‘Common ‘anery intorosseous Anterior anecy intorosseous artary Ulnar artery Fadia artery Suportcial palmar branch Sfracal artery Deep palmar arch ‘Superia ppaimar arch Loe MAL Grants Alas of Anstomy, 116. Phileelphie: opine, Wiliams & Wikis, 198435, 473)‘A. Rotator (Musculotendinous) Cuff (See Figure 2-3) © 1s formed by the tendons of the SITS; fuses with the joint capsule; and provides mobility. = Keeps the head of the humerus in the glenold fossa during movements and thus stabilizes the shoulder joint. Inferior thyroid artery “Thyocervical. ‘rank ‘Supraccapular ‘Subetavian anery Transverse cervical - -Teres minor muscle ater oop brah) Dorsal scapular nerve — Lateral head of ticops brachii muscla FIGURE 22 Stuctures oftheEs Tennis bow (tra epicondyi ‘aon fhe origin fandon fhe ‘eral epicondyl ofthe humerus asa result of unusual ‘common in tennis players and violinist, Golfers elbow (medial epicondylitis) is 2 ‘mation or iitatin in te orgin ofthe flexor muscles o similar to tennis elbow, which affects the other side of ‘glucocorticoid into the inflamed area or avoidance of ‘order to not compress the ulnar nerve. 2 [BRS Gross Anatomy CITY CCubital tunnel syndrome results from co CaUiiTS"ESN cubital tunne! behind the medial epicon ‘and tingling in the ring and litle fingers. The tunnels formed by the med ‘eral igament, and two heads ofthe flexor carpi unas ‘superior ulnar collateral or posterior ulnar recurrent artery.IV. MUSCLES OF THE HAND i ee) (Figures 2-7 and 2-14; Table 2-6) ie Flexor digitorum protuncus Floxoe cit minim brevis — aacor dot Tig Fitnrtacaal wee a, a Fourth dorea ntorosseous Extensor cigtorum tendon FIGURE 2-16. Bones end muscles of the hand. A: Radogreph ofthe wrist and hand. B Transverse magnetic resonance Image ofthe palm of tne hand.rete Te a Dupuyer’ conractr isa proorssive CETETETUEM the pina fascia especialy the pa ity of fingers in which the fingers are pulled toward the ly the third and fourth fingers. ‘and sometimes ofthe wrist, resulting from ischemic necro by a pressure injury, such as compartment syndrome, ora tg fibrous tissue, which contracts, producing the deformity. 4 BRS Gross Anatomy “Tendon of flexor ‘Sgjtorum protundus muscle ~Lumbrcal muscles Opponens cit minim muscle Aoductor git isi ‘brovie muscio Flexor retinaculum FIGURE 218 Superfital muscies of he hand lami view.(EI Upper Limb 5 Dorsal interosseous. muscles ‘Adductor policis muscle FIGURE2-18, Deep musels ofthe had anterie vow). CTT Carpal tunnel syndrome is caused by com PEUEM the reduc ofthe flexor retinaculum, artrtic chang synavial sheaths of the f ress) in the hand in th muscles in cases of se2. Synovial Sheath fr Flexor Pollicis Longus (Radial Bursa) © Envelops the tendon of the flexor pollicis longus muscle ture injuries cause infection ofthe synovial sheaths. of the second, third, and fourth diits have separate synovial sheaths so fined tothe infected digit, but rupture ofthe proximal ends ofthese she ‘spread to the midpalmar space. The synovial sheath ofthe litle common synovial sheath (ulnar bursa), and thus, tenosynovitis and thus through the palm and carpal tunnel to the forearm. Lik ‘may spread through the synovial sheath ofthe flexor pollicis long ore os Tigger finger resuits from stenosing tenosynovitis or LEUGISTAUESH tendon develops # nodule or swelling tht interferes pully, causing an auibe clicking or snapping. Symptoms are pan a th ‘extending or lexin the joins, This condtion may be caused by ropeitve trauma, and wear and tear of aging ofthe tondon. tt ean splint an injection of corticosteroid int the fexor tendon she incision of th thickened area, ‘Mallat finger (Hammer or baseball fing) isa fingor with lanx due to an avlsion of the lateral bands ofthe extensor tendon {deformity is nger wth abnormal flexion ofthe midle phalanx and phalanx due to an avulsion of the central band of the extensor tendon tothe middle phalanx ar reu- ‘atoid arthritis Vineula bovis Dorsal (extensor) expansion Vinoula longue: Dorsal (extensor) expansion Extorsor hood Flexor digtorum ane Lumbrcal muscle superfceis muscle -Lumbrical muscle Interosseous, muscle Interosseous muscle Extensor digitorum tendon Extonsorcigitorum tondon: Flexor digitorum protundus muscle FIGURE 217 Dorsal (extensor) expansion ofthe mile Mhger.Cry a. Injury tothe long thoracic nerve is caused GUSIET ME mastectomy of thoracie surgery results ‘muscle and inability to elevte the arm above the horizontal. the vertebral (medial) border ofthe scapula protrudes away tro Cry i vier: 0: CELE hich renting n prey ofthe ay ele meh ply resus asi functon ofthe extensors ne om com ané hand ate 3. Lower Subscapular Nerve (C5-C6) Innervates the lower part of the subscapularis and teres major muscles. ‘= Runs downward behind the subscapular vessels to the teres major muscle 4. Axillary Nerve (C5-C8) ‘= Innervates the deltoid and teres minor muscles and gives rise to the lateral brachial ‘cutaneous nerve ‘= Passes posteriorly through the quadrangular space accompanied by the posterior cir- ‘cumflex humeral artery and winds around the surgical neck of the humerus (may be Injured when this part of the bone is fractured). Cry im 1e axillary nerve is caused CETTE Nineus or narerdtoston ofthe rotation and abduction of the arm the supraspinetus ea 5. Radial Nerve (C5-T1) |= Ts the largest branch of the brachial plexus and occupies the musculospiral groove on. the back of the humerus with the profunda brachil artery. Crs Injury athe radial noreis caused CETGETICEN ners tresuls nose offuncion nthe extensors a ‘metacarpals, and phalanges. It also resuts in loss of wrist extension, leading to wri produces a weakness of abduction and adduction ofthe: Il, NERVES OF THE ARM, FOREARM, AND HAND (Figures 2-18 and 2-19) |A. Musculocutaneous Nerve (C5-C7) "© Pierces the coracobrachialis muscle and descends between the biceps and brachialis muscles. ‘= Innervates all ofthe flexor muscles in the anterior compartment of the arm, such as the coracobrachialis, biceps, and brachialis muscles. "= Continues into the forearm asthe lateral antebrachial eutaneous new. rE Injury to the musculocutaneous ne LITE UE (biceps) and flexion (biceps and ‘the atoral side of forearm. a0 [BRS Gross Anatomy Musculocutaneous nerve A= & ‘Coracobrachialis: Median serve mine con saws a a en, see a tt ne : worn |) (a — ssc ween radalis Palmaris eum vnewrne ES pao, iol ou Fimccpetio ranch Dewsalbeaneh, Seoeeamse veo ae 5 rose, Ysa p 2nd tumbecal ~~ Hypothenar muscles: ‘emer Serie Poxor pois ole mo ‘conan eres dae Patna iieceaand Scaminesns a 8 IGURE 2-18 Distribution of the museuloestancous, modia, and unr nore.(EI Upper Limb 51 FIGURE 218, Distribution ofthe axilary andra nerves. = Annervates also the lateral two lumbricals, the skin ofthe lateral side of the palm, and the palmar side ofthe lateral three and one-half fingots and the dorsal side ofthe index finger, ‘middle finger, and one-half of the ring finger. Cr si z CEICEVLEM indore conpressan nie carp ‘opposition ofthe thumb, and flexion of the lateral two ‘medial two interphalangeal joints It also produces a charat rence, often referred to as the ape hand. na flexion ofthe metacarpoph paralysis ofthe palmar and dorsal interossei muscles and duces a wasted hypCTT EPI vover rk inary (20-Duchenne injury during a breech delivery or @ shoulder such as might result from a fall rom a moto flexion, and lateral rotation ofthe arm, producing a ‘medial rotation resulting from paralysis of lateral rotator’ ae 1 axillary artery is ga CTPA 0 axitary artery is igated borwoen th ‘scapular artery then the blood from arrives at the subscapular artery in which the blood flow is tal tothe ligature. The axillary artery may be compressed or fel ‘major or against the humerus in the lateral wall of th Cy Ifthe brachial artery i ted off GUISES | sufficient blood reaches the ulnar an ‘sos around the elbow. The brachial artery may be comy against the humerus but medial tothe biceps and its te pressur ‘Arterial blood pressure can be measured by the placed around the arm and inflated with air until ito ‘against the humerus. A stethoscope is placed over the ‘uff is gradually released, and the pulse is detected th cates systolic pressure. As the pressure inthe cuff is further ‘can no longer be heard isthe diastolic pressure,tothe flexor muscles, then when injecting, taken for a vein for certain drugs, resulting in disastrous gangrene loss ofthe hand, The ulnar artary may be compressed or felt forthe pul thetinor ein on he ntartde te pater ine. tee D, Palmar Carpal Branch ' Joins the palmar carpal branch of the radial artery to form the palmar carpal arch, E. Dorsal Carpal Branch "= Passos around the ulnar side of the wrist and joins the dorsal carpal rete. F. Supericial Palmar Arterial Arch ' Is the main termination of the ulnar artery, usually completed by anastomosis with the ‘superficial palmar branch of the radial artery. © Lies immediately under the palmar aponeurosis. © Gives rise to three common palmar digital arteries, cach of which bifurcates into proper palmar digital arteries, which run distally to supply the adjacent sides ofthe fingers. G. Deop Palmar Branch = Accompanies the deep branch of the ulnar nerve through the hypothenar muscles and ‘anastomoses with the radial artery, thereby completing the deep palmar arch, ® Gives rise to the palmar metacarpal arteries, which join the common palmar digital arteries. CALLIN alten tests test for occlusion ofthe radial or un LUISE LE uinar artery is ciitally compressed by the examiner forced out of he hand by making 2 ght fit failue ofthe blood to raturn ‘opening indicates thatthe uncompressed artery is occluded.VI. VEINS OF THE UPPER LIMB (See Figure 2-4) ‘A. Deep and Superficial Venous Arches "© Are formed by a pair of venae comitantes, which accompany each of the deep and super ‘ficial palmar arterial arches, B, Doop Veins of the Arm and Forearm "= Follow the course of the arteries, accompanying them as thelr venae comitantes. (The radial veins receive the dorsal metacarpal veins. The ulnar veins receive tibutaries from the deep palmar venous arches. The brachial veins are the vena comitantes ofthe brachial artery and are joined by the basilic vein to form the axillary vein.) lary Vein ‘= Is formed atthe lower border of the teres major muscle by the union of the brachial veins (venae comitantes of the brachial artery) and the basilic vein and ascends along the ‘medial side of the axillary artery. “© Continues as the subclavian vein at the inferior margin of the ist rib. ‘= Commonly receives the thoracoepigastzic veins ditectly or indirectly and thus provides a collateral circulation ifthe inferior vena cava becomes obstructed. ‘= Has tributaries that include the cephalic vein, brachial veins (venae comitantes of the ‘brachial artery that join the basilic vein to form the axillary vein), and veins that corre- spond to the branches of the axillary artery. [EDITED Upper timo Cre F . ‘Venipuncture ofthe upper limb is performed on veins by a CUULIEELESN to the arm, when the venous retu is occluded and the vei ‘and are visible and palpable. Venipuncture may be performed on the axillary vein to tra ne, onthe mecian cubital vein for érewing blood, and on the dorsal venous cephalic and basic veins at ther origin for long-term introduction of fis ori‘SUMMARY OF MUSCLE ACTIONS OF THE UPPER LIMB ‘Movement of the Seapula Elevation—trapezius (upper parb, levator seapulae Depression—trapezius (lower part, serratus anterior, pectorlis minor Protrusion (forward or lateral movernent; abduction) serratus anterior Rewaction (backward or medial movement; adduction)—tapezius, chomboids Anterior or inferior rotation ofthe glenoidfossa—rhomboid major Posterior or superior rotation ofthe glenoid fossa—serratus anterior, trapezius ‘Movement atthe Shoulder Joint (Ball-and-Socket Join) ‘Adduction—pectoralis major, atssimus dorsi, deltoid (posterior part) ‘Abduction deltoid, supraspinatus Flexion—pectoralis major (clavicular par), deltoid (anterior par), corecobrachialis, biceps [Extension—latissimus dorsi, deltoid (posterior part) Medial rotation—subscapularis, pectoralis major, deltoid (anterior par) latissimus dorsi, teres major Lateral rotation—infraspinatus, teres minor, deltoid (posterior part) ‘Movement atthe Elbow Joint (Hinge Join) Flexion —brachialis, biceps, brachioradiali, pronator teres Extension—iceps, anconeus ‘Movement at the Radioulnar Joints (Pivot Joints) Pronation—pronator quadratus, pronator teres Supination—supinator, biceps brach ‘Movement atthe Wrist (Radiocarpel) Join (Condylr or Ellipsoidal Joint) Adduction—flexor carpi ulnars, extensor carpi ulnaris Abduction—flexor carpi radials, extensor carpi radialis longus and brevis Flexlon—flexor carpi radialis, flexor carpi ulnasis, palmaris longus, abductor pollicis longus Extension—extensor carpi radialis longus and brevis, extensor carpi ulnaris, ‘Movement atthe Metacarpophalangeal Joint (Condyloid Join) ‘Addietion-—palmarinterosses ‘Abduction—dorsl interossel Flexion—lumbricals and intezossel Extension—extensor digitorum. ‘Movement atthe interphalangeal Joint (Hinge Joint) Flexion—flexor digitorum superticialis (proximal interphalangeal joind, flexor digitorum. rofundus (distal interphalangeal joint) Extension—lumbricals and interosset (when metacarpophalangeal joint is extended by extensor digitorum) [Extension—extensor digitorum (when metacarpophalangeal joint is flexed by lumbricals ‘and interosse) ‘SUMMARY OF MUSCLE INNERVATIONS OF THE UPPER LIMB ‘Muscles of the Anterior Compartment ofthe Arm: Musculocutaneous Nerve Biceps bracii Coracobrachialis Brachialis ‘Muscles of the Posterior Compartment of the Arm: Radial Nerve ‘Triceps AneoneusBRS Gross Anatomy ‘Muscles of the Posterior Compartment ofthe Forearm: Radial Nerve Superficial layer—brachoradialis, extensor carpi radials longus, extensor carpi redialis brevis, extensor carpi ulnavis, extensor digitorum communis, extensor digit minim Deep layer—supinator, abductor pollicis longus, extensor pollicis longus, extensor policis brevis, extensor indics ‘Muscles of the Anterior Compartment of the Forearm: Median Nerve ‘Superficial layer—pronator teres, flexor carpi radials, palmaris longus flexor carp ulnaris {ulnar nerve)™ Middle layer—flexor digitorum superficial, Deep layer—flexor digitorum profundus (median nerve and ulnar nerve)," flexor pollicis longus, pronator quadratus “Thonar Muscles: Median Nerve ‘Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis (median and ulnar nerves)* ‘AdductorPolicis Muscle: Uinar Nerve Hypothenar Muscles: Ulnar Nerve ‘Abductor digit minimi Opponens digit minimt Flexor digit minimi Interossel (Dorsal and Palmar) Muscles: Unar Nerve ‘Lumbrical Muscles (Medial Two): Ulnar Nerve Lumbrical Muscles (Lateral Two): Metian Nerve 1 Pectoral (shoulder) girdle—incomplete bony ring formed by the clavicle and seapul, attach: {ng the upper limb (appendicular skeleton) to the vertebral column and sternum (anal skel ton). The claviele isa commonly fractured bone, the frst one to begin ossification but the last bone to complete ossification, and the only long bone to be ossified intramembranously.0 [BRS Gross Anatomy 1 Rotator cuft—formed by the tendons ofthe supraspinatus, infraspinatus teres minor, and subscapularis ($18), The quadrangular space is bounced by the teres minor with subscapu- Iasi), teres major, triceps (ng head), and the humerus and transmits the axillary nerve zc the posterior humeral circumfiex vessels. The auseuttation rangle is bounded by the trape- mus dorsi, and scapula and is the most audible site for breathing sound. The ‘ubital fossa isa bounded by the brachioradialis, the pronator tees, and an imeginary line between the epicondyles of the humerus, wth facial oof and a floor formed by the bra- chialis and supinstor. It contains (from lateral to medial) the radial nerve, bieeps brachii tendon, brachial artery and median nerve. The anatomic snuffox isbounded medially by the ‘extensor pollicis tendon and laterally by the extensor pollicis brevis and abductor pollicis Jongus tendons. Is floor i formed by the scaphold and trapezium bones and crossed by the radial acery. The palmar apaneurosis is trangulr fibrous layer overying the tendons inthe palm. and protects the superficial palmar arterial arch and palmar digital nerves. The flexor ‘otinaculum forms the carpal tunnel through which the median nerve and tendons ofthe long flexor muscles are transmitted, The extensor expansion provides the insertion of the lambri- ‘al, interosseous, and extensor muscles of the hand and fingers reast—is supported by the suspensory ligaments of Cooper. nipple les at the level of she fourth intercostal space, and an areola isa rng of pigmented skin around the nipple. The ‘mammary gland, which les inthe superficial fascia, has 15 t0 20 lobes and has an axillary tall that extends superoleterally into the aula. Bach lobe opens by a lactferous duct onto the tip ‘ofthe nipple, and each duct enlarges to form a lacifrous sinus fr milk storage during act tion, The chief ymphatic drainage i to the ailary nodes, more specifically to the pectoral nodes. © Nerve supply—the radial, axillary, median, ulnar. and musculocutaneous nerves contain GSA and GVA nerve fibers with col Bodies located inthe dorsal root ganglia, GSE fibers with cel bodies in the anterior hor of the spinal cord, and GVE (sympathetic postganglionic) fibers ‘with cel bodies in the sympathetic chain ganglia However. sympathetic preganglionic GVE fibers are not present in the branches of the brachial or cervical plexus, but they are present in the ventral roots, spinal nerves, white rami communicantes, and splanchnic nerves with cal bodies located in the lateral horn of he spinal cord between TI and L2. Cutaneous nerves such as the medial brachial and antebrachial cutaneous nerves contain GSA, GVA, and sym- pathetic postganglionic GVE fibers but no GSE fibers. = Arterial supply ‘= Subclovian artery gives rise to (a) the internal thoracic artery, which divides into the supe- ror epigastric and musculophrenic artery: (b) the vertebral artery, which ascends through ‘the upper six transverse foramina ofthe cervical vertebra; (the thyrocervical trunk, which divides into the suprascapular, transverse cervical, and inferior thyroid arceries; and (4) the costacervcal trunk which gives of the deep cervical and superior intercostal arteries. ‘= Rallary artery gives ofthe superar thoracic thorecoacramial (which has pectoral, clevilar, deltoid, and acromial branches), lateral thoracic, subscapular (which has crcumilex scapu- larand thorecodorsl branches), and anterior and posterior humeral circumflex arteries. 1 Brachial artery has the following branches: the deep brachial artery runs along with the zacial nerve, and the superior ulna collateral artery runs alongwith the ulnar nerve. The radial artery gives off the racial recurrent branch, and the whar artery gives off the enterior ‘and posterior ulnar recurrent arteries and the common inteesseous artery, which divides into the anterior and posterior interosseous branches. The supericiel palmar erteral arch {s the continuation of the ulnar artery, usually completed by anastomosis withthe super- ficial palmer branch of the radial artery, whereas the deep palmar arch isthe continuation ofthe radial artery usually completed by anastomosis with the deep branch of the ulnar artery. © Lymph vessels from the radial side of the hand and forearm drain directly into the axillary nodes, whereas some lymph vessels from the ulnar side of the hand and forearm may dai {nto the cubital Iymph nodes and then into axillary nodes. The apical noces receive iymph {rom the axillary nodes and other groups and sometimes dizecly from the breast, and they are drained into the subclavian trunks, which join the right lymphatic or thoracic duct to center the jugular-subelavian venous confluence.® The flexor digitorum superfcialis tendon splits into two medial and lateral bands and inserts ‘on the base ofthe middle phalans, while the flexor digitorum profundus tencion inserts on the base of the distal phalanx as a single tendon. On the dorsum of the hand, a single central ‘band of the extensor digitorum tendon inserts on the base ofthe middle phalans, whereas two lateral bands of the extensor digitorum tendon join to form a single band to insert on the ‘base of the distal phalanx.ETE |. CUTANEOUS NERVES OF THE UPPER LIM (Figure 24) 1. Sapmctorcle Mere "Ares fom te ceric plows (3, Cand innervate the lds ee the upper petra Geta and oer eapenus ress 8. Madi! rch Cannons Neve (Slt om te el cord ofthe bacilli and nner the mle af the 22 BRS Gat sony Setetarrene een er 3 se Soe ea ‘Slaten esi ear eat eer ay we rare ‘ees ey) Meonsave “eee “oe'ss) Mail tabaci Ctness Mere Ses om the medi con of he rach plow nner he mesa side of he ‘orem, Ler! rch Catena Nerve Thebes fom thew nerve ad anes he eer ie of he es, om he meclctane nerve end nerve theater sie ofthe eam Pout Gracia and Abaca Catnace Neves ‘hrs tom the al neve and innervate the petro ede ofthe crm an forearm, tespecua. athe tera euaneousbranch fe second intercostal ere emerge secondsuisse upper mo ” (EIEN Moscoso he Pectora Rovion and ila Action Vasa atiy res nmin ese ra Capen aka) Ons sap es "ier nr) a ‘ene Merce tte Cees — Naa Re kp = co Secs en 2 ‘BRS Gross Anetomy Muscles ofthe Shoulder Detdd ——=—sLaeeltedefeaicle, etiduterstyet —Aalry edi, seus foes, ‘comin andaphewt here ‘ura re ra sue ‘mesa any Sipaipesns Siparpeeufotiot Sugeneruceat eur Supeseopr Abacus ‘oa ‘vise ress loro iaupreus ete Melo ceotganet Sipeeapulr Atte mary teberde oneness Subscapis Suecerfonte ——Lansvuborclew!—Upsrandlwer Addit andes arm ett ea Tes eax Drs secs warar Medal a tare tds nd ces an cu suelo Masel! en ‘mast fens Tere inar—Uperputen ster! Loner ‘etl estar fostosematey Toriortacopan” threesome Uasies asi SinesctTET? Rowe of tlre dics eared ‘Soselabaritei,“atrumoue ‘cue or mecly ITeccrn ris 942 PEEVE ED Muscles of the Arm Muse iain Insertion Nene Coracobrachialis Coracoid process Middle third of medial ‘Musculocutaneous ‘surface of humeus Biceps brachii Long head, supraglenoid Radial tuberosity of Musculocutaneous tubercle;shorthead, radius coraccid process Brachialis: Lower anterior surface of | Coronoid process of ulna Musculocutaneous humerus “end ulnar tberesity icons Long head, infraglenoid Posterior surfaceot ——_—Radial ‘ubercie;lateralhead, olecranon process of superiorto radial groove vlna of humerus; medial head, inferior to rasal groove Anconeus Lateral epicondyieof ——Olezranan and upper Rata jpostarior surface of una Floxes and edduets arm Flexes arm and forearm, supinates forearm Flexes forearm Extends forearm Extends forearmMuscles of the Anterior Forearm Muscle Origin Insertion Nerve ‘Action Pronatorteres Medial epicondyle and Middle of lateral side of Median Pronates and flexes ‘cofonoid process of ulna radius forearm Flexor carpi ‘Medial epicondy/le of. Bases of second and third Median Flexes forearm, flexes and radialis humerus metacarpals abducts hand Palmaris longus Mediel epicondyle of Flexor retinaculum, palmar Median Flexes forearm and hand humerus ‘aponeurasis Flexor carpi ‘Medial epicondyle (humeral Pisiform, hook of hamate, Ulnar Flexes forearm, flexes and ulnaris j;medial olecranon, and base of fifth meta- ‘adducts hand id posterior border of carpal ulna (ulnar head) Flexor cigitorum Medial epicondyle, coronoid Middle phelanges of finger Median Flexes proximal intor- superficialis process, oblique line of ‘halangeel joints flexes radius hand and forearm Flexor digitorum Anteromadial surface ot Bases distal phalanges Ulnarand——_—Flexes distal interphalan- profundus ulna, interosseous mem- af fingers: ‘median ‘geal joints and hand brane Flexor pollicis Anterior surface af radius, Base of distal phalanx of Median Flexes thumb longus interosseous membrane, thumb ‘and coronoid process Pronator Antarior surface of distal Anterior surface of distal Median Pronates forearm quadrats vlna radiusSELTEF H Muscles of the Posterior Forearm Muscle in Insertion Nowe Action Brechioradialis Lateral supracondyler ridge of Base of rail styloid process atial—‘Fexes forearm humerus Exensor carpi Lateral supracondylar ridge of | Dorsum of base of second Radial Extands and abducts radialis longus humerus metacarpal hand Exensor carpi Lateral epicondyie of humerus Posterior base of third Radial Extands and abducts radials brevis metacarpal hands Extensor digitorum Lateral epicondyle of humerus Extensor expansion, base of Radial Extends fingers end middle and digital phalanges hand Extensor digit Common extensor tendon and Extensor expansion, base of | Fedial- ‘Extends tte finger minim interosseous membrane mid le and distal phalanges Exensor carpi Lateral epicondyie and Base of fth metacarpal Radial Extends and adducts ulnaris posterior surface of ulna hand Supinetor Lateral epicondyie radial Lateral side of upper part Fedial —Supinates forearm collateral and annular of radius ligaments, supinetor fossa and crest of una Abductor pollicis _Interasseous membrane, Lateral surface ofbase offirst Radial © Abducts thumb and Tongus middle third of posterior metacarpal hand surfaces of radius and ulna Extensor pollicis _Interesseous mambrane and Base of cistal phalanx of thumb Radial Extends distal ph Tongus riddle third of posterior lanxofthumb and surface of una ‘abducts hand Extensor pollicis _Interesseous membrane and Base of proximel phalanx Radial Extends proximal brevis posterior surface of middle ofthumb phalanx of thumb ‘third of radius ‘and abducts hand Extensor indicis Posterior surface of ulna and Extensor expansion of index ‘Radial Extends index finger interasseous membranetable 2-6 By Muscle Origin Insertion Nowe Action Abductorpoll- Fexorrenaculum, scaphoid, Lateral side of base of Median Abducts thumb cisbrovis and repezium proxime phalanx of ‘thumb Frexorpolisis Floxorainaculum and Base of proximal Medien Foxes thumb brows ‘trapezium phalanx thumb Opponers Flexor ainaculum and Lateral sie offirst Malian (Opposes thumb to other pollicis trapezium metacarpal digits Adductor _—_Capitte and bases of second Medial sid ofbase of Uner Adducts thumb palicis and third metacarpels, proximal phalanx of (oblique head; palmar sur- the thumb face ofthird metacarpal (transverse head) Palmaris brevis Medial side ofoxorretinge- Skin of mail sido of Ulnar ‘Wrinkles skin on mel ulum,galmar aponeures's palm side of paim ‘Abductor digit Pisiform end tendon of fiexor Unar Abducts lite finger rani carpi unaris Flexor digit __Flexorrenaculum and hook ner Flexos proximal phalanx minimibrovis of hemate proximal phalanx of of itl finger li finger COpponens dati Flexor retnaculum and hook Uner (Opposes ite finger nim otherate Lumbricals(4) Lateral side of tendons of Lateral side of extensor Median(two _—_—Flexmetacarpophalan- flexor digitorum profundus expansion lateral and uiner geal ints and extend (two media interphalangeal joints Dorsalintros- Adjacentsidesofmetacarpal Lateral sidesof bases of Ulnar Abduct fingers fox soil) bones proximal phalanges; metacarpophalangeal (bipennate) ‘extensor expansion joins; extend inter- phalangeal joints Palmar Madial se of second Bases of proximal Ulnar Adduct fingers fox interossei(3) metacarpal: lateral sides —_phalangssin same metacarpophalangesl (unipennste) of four and fith sides as their origins; joints; extend metacerpels extensor expansion interphalangeal joints