GROSS ANATOMY OF THE UPPER LIMBS

(Abridged)

BY

Dr. Dayo R. OMOTOSO

Dept. of Human Anatomy, RUN

©2020
 OSTEOLOGY
 CLAVICLE
 SCAPULA
 HUMERUS
ULNA
RADIUS
CARPAL BONES
METACARPAL BONES
PHALANGEES
 CLAVICLE
SURFACES
Anterior
Posterior
 ENDS/FACETS
Sternal
Acromial
 SHAFT
Subclavian groove
Conoid tubercle
Trapezoid line
 SCAPULA
SURFACES
Anterior/Costal
Subscapular fossa
Posterior
Spine
(Supraspinous &
Infraspinous fossae)
Acromion
 ANGLES
Superior BORDERS
Inferior Superior
Lateral Suprascapular notch
Head Coracoid process
Neck Medial
Glenoid cavity Lateral
 HUMERUS
 General Description
Proximal Part
 Head
 Neck Anatomical
Surgical
 Tubercles Greater
Lesser
Middle Part/Shaft
 Deltoid tuberosity
 Radial groove
Distal Part
 Supracondylar ridge
(Medial & Lateral)
 Epicondyle (Medial & Lateral)
Condyle (Trochlea & Capitulum)
(Coronoid & Radial fossae)
(Olecranon fossa)
 ULNA RADIUS
 Medial & longer  Lateral & Shorter
Proximal Part Proximal Part
Olecranon Head
Coronoid process Neck
Trochlear notch Shaft (enlarges
Tuberosity distally)
Radial notch
Supinator crest Distal Part
Ulnar notch
Shaft (narrows Styloid process
distally)
Interosseous
Distal Part
Head Membrane – runs
Styloid process inferomedially to
connect radius to ulna
 CARPAL BONES
 Proximal row
Scaphoid, Lunate,
Triquetrium, Pisiform
 Distal row
Trapezium, Trapezoid,
Capitate, Hamate
METACARPAL BONES
 Five bones of palm
 Head, Shaft, Base
PHALANGES
 Three in each digit except first digit with only two
 Head, Shaft, Base
 Proximal phalanges are largest while distal are smallest
 FASCIA
 Subcutaneous Tissue (or
Superficial Fascia)
 Deep Fascia
Pectoral fascia
Clavipectoral
Axillary fascia
Deltoid fascia
Supraspinous fascia
Infraspinous fascia
Brachial fascia
Intermuscular septa (Medial & Lateral)
Fascial compartments (Flexor & Extensor)
Antebrachial fascia
Palmar fascia/aponeurosis
 MUSCULATURE OF UPPER LIMBS
Anterior Axioappendicular/Pectoral Muscles

 Pectoralis major  Subclavius

 Pectoralis minor  Serratus anterior
 MUSCULATURE OF UPPER LIMBS CONT’D
Posterior Axioappendicular Muscles

DEEP
SUPERFICIAL Levator scapulae
Trapezius Rhomboid major
 Latissimus dorsi Rhomboid minor
 MUSCULATURE OF UPPER LIMBS CONT’D
Scapulohumeral/Intrinsic Shoulder Muscles

 Deltoid
 Teres major
 Teres minor
 Supraspinatus
 Infraspinatus
Assignment 1 – Describe  Subscapularis
the rotator cuff muscles.
 AXILLA
 Shape/Size/Function
 Apex & Base
 Walls
Anterior wall
Posterior wall
Medial wall
Lateral wall
Contents (Axillary sheath)
Fat
Lymphatic vessels
Lymph nodes (Axillary group of lymph nodes)
Cords & branches of Brachial Plexus
Blood vessels Assignment 2 –
Axillary artery (1st, 2nd & 3rd Parts) Describe the branches
Axillary veins of axillary arteries
 ANASTOMOSIS
AROUND THE
SCAPULA

ASSIGNMENT 3 –
Describe arteries
that form
anastomosis around
the scapula and
structures they
supply.
BRACHIAL PLEXUS
 BRACHIAL PLEXUS CONT’D
 Roots (5: C5-T1)
 Trunks (3: SMI)
 Divisions (2: A&P)
 Cords (3: PLM)
 Terminal Branches
 Roots (2)
 Trunk (2)
 Cords (12)

Assignment 4 – Enumerate the motor branches derived from

the cords of Brachial plexus & muscles supplied?
 CUTANEOUS INNERVATION OF UPPER LIMB

Dermatome of Upper Limb

Segment Description
C3, C4 Base of neck
C5 Lateral arm
C6 Lateral forearm & thumb
C7 Middle & ring fingers
C8 Little finger, Medial hand
and foream
T1 Medial forearm & arm
T2 Medial arm & axilla
CUTANEOUS INNERVATION OF UPPER LIMB CONT’D
 Supraclavicular nerve
 Superior lateral cutaneous
nerve of arm
 Inferior lateral cutaneous
nerve of arm
 Posterior cutaneous nerve
of arm
 Posterior cutaneous nerve
of forearm
 Lateral cutaneous nerve of
forearm
 Medial cutaneous nerve of
forearm
 Medial cutaneous nerve of
arm
 Intercostobranchial nerve
MUSCULATURE OF ARM (Anterior/Flexor Compartment)

Biceps brachi Coracobrachialis Brachialis

MUSCULATURE OF ARM (Posterior/Extensor Compartment)

Triceps brachi Anconeus

 CUBITAL FOSSA
 Shape/Size/Function
 Apex & Base
 Boundaries
Superiorly
Medially
Laterally
 Floor
 Roof
 Contents
Terminal part of brachial artery
Deep veins
Biceps brachii tendon
Median nerve
Radial nerve
 MUSCLES OF FOREARM
(Anterior Compartment)
(or Flexor-Pronator)
Pronator teres
Palmaris longus
Flexor carpi ulnaris
Flexor carpi radialis

Flexor digitorum
superficialis

Pronator quadratus

Flexor digitorum superficialis

Flexor digitorum profundus
Flexor pollicis longus
 MUSCLES OF FOREARM
(Posterior Compartment)
(or Extensor-Supinator)
Brachioradialis
Extensor carpi radialis
longus
Extensor carpi radialis
brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris

Supinator Abductor pollicis longus

Extensor indicis Extensor pollicis longus
Extensor pollicis brevis
 VASCULATURE OF UPPER LIMBS
ARTERIAL SUPPLY
 Axillary artery
 1st part
 2nd part
 3rd part
 Brachial artery
 Humeral Nutrient artery
 Profunda brachii artery
 Ulnar collateral arteries
(superior & inferior)
 Radial collateral artery
 Ulnar recurrent artery
(Anterior & Posterior)
 Radial recurrent artery
 ARTERIAL SUPPLY CONT’D
Radial artery
Ulnar artery
Common interosseous artery
Ant. interosseous artery
Post. Interosseous artery
Recc. Interosseous artery
Palmar carpal arch
Deep palmar arch
Superficial palmar arch
Dorsal carpal arch

Assignment 5: Describe arteries that

form anastomosis around the elbow.
 VENOUS DRAINAGE
 Superficial Veins
Cephalic Vein (Lateral)
Basilic Vein (Medial)
Median Cubital Vein
Median Antebrachial Vein
 Dorsal Venous Network
 Perforating Veins
Deep Veins (or accompanying
veins of major arteries)
 LYMPHATIC DRAINAGE
Superficial lymphatic vessels
accompany superficial
veins mostly cephalic veins
more abundant
drain into apical axillary
nodes
Deep lymphatic vessels
accompany deep veins
drain into humeral axillary
nodes

Assignment 6 - Describe
axillary group of lymph nodes
 THE HAND
 Skeleton
 5 Metacarpals
 14 Phalanges
 Palm (anterior surface)
Thick skin
 Creases
 Thenar eminence
(lateral & larger)
Hypothenar eminence
(medial & smaller)
 Fascia
 Palmar fascia
(Themar & Hypothenar)
 Palmar aponeurosis
 Wrist Creases
 Proximal, Middle & Distal
Anatomical Snuff Box Palmar Creases
 Extensor pollicis longus  Transverse (Proximal & Distal)
 Abductor pollicis longus  Radial Longitudinal

 Extensor pollicis longus Digital Creases

 Proximal, Middle & Distal
 COMPARTMENTS/MUSCLES OF HAND
Thenar compartment/eminence
 Abductor pollicis brevis,
 Flexor pollicis brevis,
 Opponens pollicis
Adductor compartment
 Adductor pollicis
Hypothenar compartment
 Abductor digiti minimi
 Flexor digiti minimi brevis
 Opponens digiti minimi
Central compartment
 Lumbricals (1st-4th)
Interosseus compartment
 Interossei (Dorsal & Palmar)
 VASCULATURE OF THE HAND - ARTERIES

 Superfical palmar arc Princeps pollicis artery

 Deep palmar arch  Radialis indicis artery
 Dorsal carpal arch
 Palmar digital arteries (common & proper)
 VENOUS DRAINAGE OF THE HAND
 Superficial Venous palmar arch Dorsal digital veins
 Deep venous palmar arch  Dorsal venous network

INNERVATION OF THE HAND

PALM DORSUM
 Median nerve Ulnar nerve
 Medial branch  Dorsal branch
 Lateral branch  Dorsal digital branch
 Recurrent branch  Palmar cutaneous branch
 Palmar digital branches  Radial nerve
 Palmar cutaneous branch  Superficial branch
 Ulnar nerve  Dorsal digital branch
 Deep branch Assignment 7: Use relevant
 Superficial branch
diagram to illustrate the sensory
innervation of the hand.
 MOVEMENTS OF THE HAND

Assignment 8 – Describe the various movements and

functional positions of the hand and enumerate associated
muscles.
 THE BREAST
 Major Structure
 Glandular tissue
 Mammary glands
 Fibrous/Fatty tissue
Blood vessels
 Lymphatics
 Nerves
 Other features
 Nipple
 Areola (sebaceous glands)
 Axillary process (Tail of Spence)
 Suspensory ligaments (of Cooper)
Breast Quadrants
Female Breast
 Well-developed/functional
 Stretches from sternum to
midaxillary line transversely
& from 2nd – 6th ribs vertically.
 rests on bed formed by
pectoral fascia covering
pectoralis major
 Lactiferous sinus
 Lactiferous ducts
 Lobules
 Alveoli
 Retromammary Space: is a potential space between the
breast and pectoral fascia. It contains fat and allows some
movement of the breast on the fascia.
 Venous Drainage of
Arterial Supply of Breast Breast
 Internal thoracic artery  Accompanying veins
(Medial mammary of arteries drain mainly
branches, anterior into the Axillary vein
intercostal branches)
 Axillary artery (Lateral
thoracic & thoracoacromial
arteries)  Innervation of Breast
 Posterior intercostal  Anterior & Lateral
nd
arteries (2 -4th) cutaneous branches of
4th-6th intercosal nerves
 Lymphatic Drainage of Breast
Lymph from lateral quadrants of breast drains into:
 Axillary/deltopectoral/supraclaivular/inferior deep cervical
nodes then to Clavicular nodes and to Subclavian
lymphatic trunk.
Lymph from medial quadrants of breast drains into:
 Parasternal nodes (medial quadrants) then to
Bronchomedistinal trunks.
Lymph from inferior quadrants of breast drains into:
 Subdiaphragmatic/Inferior phrenic nodes
Lymph from skin of breast (except niple & areola) drains into:
 Ipsilateral Axillary/infraclavicular/inferior deep cervical
nodes & parasternal nodes of both sides.
Lymphatic trunks merge with each other and with jugular trunk
to form Right Lymphatic Trunk on the right side or drain into
Thoracic Duct on the left.
APPLIED ANATOMY/CLINICAL CORRELATES
 Greenstick fracture (of clavicle)
 Fracture of Scapula (acromion)
Fractures of Humerus occur @:
 Surgical neck
 Greater tubercle (Avulsion fracture)
 Shaft (Transverse fracture)
 Intercondyle
Fractures of Radius (distal end)
 Colles fracture
 Fractures of Ulna (styloid process)
 Dinner fork deformity
Fractures of Carpal bones (Scaphoid, Hamate)
Fractures of Metacarpals (Boxer’s fracture)
Fractures of phalanges (crushing injuries)
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
 Paralysis of Serratus anterior/Winged Scapula
 Triangle of Auscultation
 Injuries to nerves of Brachial Plexus
 Deltoid muscle is a common site of intra-muscular injection
 Compression/aneurysm of axillary artery
 Axillary vein injury/puncture
 Lymphagitis (of axillary nodes – mostly humeral group of
nodes).
 Lympedema

Variations of Brachial Plexus

Prefixed brachial plexus (C4-C8) & Post-fixed brachial plexus (C6-T2)
Variations may also occur in formation of trunks, divisions, cords
and origin of branches.
 APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
Injuries of Brachial Plexus
Causes paralysis & anaesthesia
 Level of injury determines degree of paralysis (complete or
incomplete)
 Erb-Duchenne Palsy (C5&C6) – injuries of superior part of
plexus
 Back-packer palsy
 Klumpke paralysis (C8&T1) - injuries of inferior part of plexus
 Brachial plexus neuritis/ neuropathy
 Brachial plexus block
 Biceps brachii –tendinitis, rupture & dislocation of tendon
 Popeye deformity
APPLIED ANATOMY/CLINICAL CORRELATES CONT’D
 Venipuncture in cubital fossa (median cubital vein)

 Mallet/Baseball finger
 Carpal Tunnel Syndrome/Release
 Dupuytren contracture
 Raynaud syndrome
 Quervain tenovaginitis stenosans
Carcinoma of Breast
 Polymastia/Polythelia
 Masectomy/Lumpectomy/Quadrantectomy
 Gynecomastia