UPPER EXTREMITY
tunnel.
General Description
• Upper limb is associated with the
lateral aspect of the lower portion of the
neck and with the thoracic wall.
• Is suspended from the trunk by muscles
and small skeletal articulation between
the clavicle and sternum – the
STERNOCLAVICULAR JOINT.
• Divided into shoulder, arm, forearm and
hand.
• Shoulder is the area of upper limb
attachment to the trunk.
• Arm is the part of the upper limb bet.
the shoulder and elbow joint.
• Forearm is bet. the elbow and the wrist
joint.
• Hand is distal to the wrist joint.
• Axilla, cubital fossa and carpal tunnel
are significant areas of transition bet.
the diff. parts of the limb.
• Axilla is an irregularly shaped pyramidal
area formed by muscles and bones of
the shoulder and the lateral surface of
the thoracic wall. Skin of armpit forms
the floor.
• All major structures that pass bet. the
neck and arm pass through the axilla.
• Cubital fossa is a triangularly shaped
depression formed by muscles anterior
to the elbow.
• Brachial artery passes from the arm to
the forearm passes through this fossa
with the median nerve.
• Carpal tunnel is the gateway to the
palm of the hand. Its posterior, lateral
and medial walls form an arch which is
made up of a small carpal bones in the
proximal region of the hand.
• Flexor reticulum, a thick band of CT
spans the distance bet. each side of the
arch and forms the anterior wall of the
• Median nerve and all long flexor
tendons pass through the carpal
tunnels.
FUNCTIONS
Positioning the hands
• Upper limb is highly mobile for
positioning the hand in space.
• Sliding and rotating the scapula on the
thoracic wall changes the position of the
glenohumeral joint(shoulder joint) and
extends the reach of the hand.
• Glenohumeral joint allows the arms to
move around the 3 axes with a wide
range of motion.
• Flexion, extension, abduction,
adduction, medial rotation, lateral
rotation and circumduction are movt. of
arms.
• Elbow joint major movt. includes flexion
and extension of forearm.
• The distal end of the lateral bone, the
radius, can be flipped over the adjacent
head of the medial bone (ulna).
• Pronation – crossing of the distal end of
the radius to the ulna. Occurs solely in
the forearm. Supination returns the hand
to its anatomical position.
• Wrist joint, hand can be abducted,
adducted, flexed, extended and
circumducted.
The hands as mechanical tool
• One of the major fxn of hands is to grip
and manipulate objects. Gripping
generally involves flexing the fingers
against the thumb. Depending on the
type of grip,muscles in the hand act to:
1. Modify the axn of long tendons that
emerge from the forearm and insert into
the digits of hand.
 2. Produce combination of joint movement
w/in digits that cannot be generated by
the long flexor and extensor tendons
along coming from the forearm.
The hans as a sensory tool
• Touch is the basis of discrimination.
• They contain a high density of somatic
sensory receptors.
COMPONENT PARTS
Bones and Joints
• Scapula, clavicle and proximal end of
the humerus consist the shoulder
bones.
• Clavicle articulates with the manubrium
of the sternum and laterally with the
acromion of the scapula, which arches
over the joint bet the glenoid cavity of
the scapula and the head of the
humerus.
• Humerus is the bone of the arm. Distal
end articulates with the bones of the
forearm and elbow joint, which is a
hinge joint that allows flexion and
extension of the forearm.
Forearm contains two bones:
1. Radius – lateral
2. Ulna – medial
• At elbow joint, the proximal ends of the
radius and ulna articulate w/ each other
as well as w/ the humerus.
• It also allows the radius to spin on the
humerus while sliding against the head
of the ulna during pronation and
supination of the hand.
• Distal portions of radius and unla also
articulates w/ each other. This joint
allows the end of the radius to flip from
the lateral side of the ulna during
pronation of the hand.
• Wrist joint is formed bet. radius and
carpal bones of the hand and bet. the
articular disc, distal to the ulna and
carpal bones.
• The bones of the hand consist of the
carpal bones, metacarpal and
phalanges.
• Joints bet. the 8 snakk carpal bones
allow only limited amount of movement;
as a result it works together as a unit.
• The 5 metacarpal bones, 1 for each digit
are the primary skeleton foundation of
the palm.
• Joint bet. the metacarpal bone of the
thumb (metacarpal 1) and one of the
carpal bones allow greater mobility.
• The heads of metacarpal II and V are
interconnected by strong ligaments.
Lack of this ligament connection
between the metacarpal bones of the
thumb and index finger together w/ the
biaxial saddle joint bet. the metacarpal
bone of the thumb and the carpus
provide the thumb w/ greater freedom
movt. than the other digits of the hand.
• Phalanges are bones of the digit.
Thumb has 2 and other has 3.
• Metacarpophalangeal joint are biaxial
condylar joint that allow abduction,
adducition, flexion, extension and
circumduction.
• The interphalangeal joint are primarily
hinge joints that allow flexion and
extension.
MUSCLES
• Trapezius, Levator, Scapulae and
Rhomboids connect the scapula and
clavicle to the trunk.
• Pectoralis major, minor, Lat. Dorsi, teres
major and deltoid connect the clavicle,
scapula and body wall to the proximal
end of the humerus.
• The most important are the 4 rotator cuff Relationship to other regions
muscles:
NECK
o Subscapularis
• Upper limb is directly related to it.
o Supraspinatus
• Lying on each side of the superior
o Infraspinatus thoracic aperture at the base of the neck
is an axillary inlet, which is formed by:
o Teres minor
1. Lateral margin of rib
All of which connect the scapula to the
humerus and provide support to the 2. Posterior surface of the clavicle
glenohumeral joint.
3. Superior margin of the scapula
• Muscle in the arm and forearm are
separated into anterior(flexor) and 4. Medial surface of the coracoid process
posterior(extensor) compartments by of the scapula.
layers of fascia, bones and ligaments.
• Major artery and vein of the upper limb
• The anterior compartment of the arm pass between the thorax and limb by
lies anteriorly in position and is passing over rib1 and through the
separated from muscle of the posterior axillary inlet.
compartment by the humerus and by
medial and lateral intermucular septa.

• The intermuscular septa are continuous

with the deep fascia enclosing the arm
and attach to the sides of the humerus.

• Forearm, the anterior and posterior

compartment are separated by a lateral
intermuscular septum, raidus, ulna and
interosseus membrane which joins the
adjacent sides of the radius and ulna.

• Arm muscles act mainly to move the

forearm at the elbow joint, while those in
the forearm function predominantly to
move the hand at the wrist joint and the
fingers and thumb.

• Hand muscles, the intrinsic muscles

generate delicate movement of the
digits of the hand and modify the forces
produced by tendons coming into the
fingers and thumb from the forearm.

• Thenar eminence – are soft tissue

mound which are included among the
intrinsic muscle. It allows thumb to move
freely relative to the fingers.