UPPER LIMB

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UPPER LIMB

• CHAPTER 6 p726
• MOORE DALLEY
• CLINICALLY ORIENTED ANATOMY
• 5TH EDN

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UPPER LIMB

• SHOULDER JOINT
• P853
• Also pp 848-852

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Shoulder Joint

• Ball and socket (synovial) jnt
• Designed for mobility
• Stability compromised soft tissue support

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Important

• Articulation
• Joint capsule
• Ligaments glenohumeral, coracohumeral
• Movements F, E, MR, LR, C, Abd, Add
• Muscles axioappendicular, scapulohumeral
• Bursae suprascapular, subacromial
• Blood supply ant, post circumflex humeral aa
• Innervation suprascapular, axillary, lateral
  pec.

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Muscles which attach the humerus to the axial
skeleton

1. M deltoideus
2. M latissimus dorsi
3. M teres major
4. M coracobrachialis
5. M subscapularis
6. M supraspinatus
7. M infraspinatus
8. M teres minor

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M deltoideus

• Origin
• Ant border, lateral aspect of clavicle
• Lateral border-acromion
• Inf lip of spine (scapula)
• Insertion
• Deltoid tuberosity
• Action
• Abduction
• Flexion, medial rotation
• Extension, lateral rotation
• Nerve supply
• Axillary

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M latissimus dorsi

• Origin
• Lower 6 thoracic vertebrae (spines
• L1-L5 (spines)
• Iliac crest (posterior)
• Lower 4 ribs
• Insertion
• Bicipital groove (humerus)
• Action
• Extension
• Medial rotation
• Nerve supply
• Thoracodorsal nerve

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M teres major

• Origin
• Dorsum of lateral border of scapula (close to
  inferior angle)
• Insertion
• Medial lip of bicipital groove
• Action
• Adduction
• Medial rotation
• Nerve supply
• Inferior subscapular nerve

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M coracobrachialis

• Origin
• Coracoid process (apex) of scapula
• Insertion
• Shaft of humerus (medial aspect) next to deltoid
  tuberosity
• Action
• Flexor (weak)
• Adductor
• Nerve supply
• Musculo-cutaneous nerve

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ROTATOR CUFF MUSCLES

• Muscles which stabilize the shoulder joint
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

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M supraspinatus

• Origin
• Supraspinous fossa (lateral part) of scapula
• Insertion
• Superior facet-greater tubercle of humerus
• Action
• Abduction
• Nerve supply
• Suprascapular nerve

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M infraspinatus

• Origin
• Infraspinous fossa (lateral part) of scapula
• Insertion
• Middle facet-greater tubercle of humerus
• Action
• Extension
• Lateral rotation
• Nerve supply
• Suprascapular nerve

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M teres minor

• Origin
• Lateral border of scapula
• Insertion
• Inferior facet-greater tubercle of humerus
• Action
• Adduction
• Lateral rotation
• Nerve supply
• Axillary nerve

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M subscapularis

• Origin
• Subscapular fossa
• Insertion
• Lesser tubercle of humerus
• Action
• Adduction
• Medial rotation
• Nerve supply
• Superior subscapular nn
• Inferior subscapular nn

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Winging of the scapula
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AXILLA
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Definition of axilla An irregular space above
the armpit

• Anterior wall
• Pectoralis major
• Pectoralis minor
• Clavipectoral fascia
• Pierced by bvs nn
• Ends in skin of axilla
• Posterior wall
• Subscapularis
• Latissimus dorsi
• Teres major
• Medial wall
• Serratus anterior
• Lateral wall
• Bicipital groove

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• Base
• Skin of armpit
• Apex
• Runs upwards
• Clavicle (ant)
• R1 (medially)
• Scapula sup border (post)
• Contents
• Brachial plexus
• Axillary artery
• Axillary vein
• Lymph nodes
• fat

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MUSCLES OF THE UPPER ARM
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Compartments

• Anterior compartment
• M coracobrachialis
• M biceps brachii
• M brachialis
• Posterior compartment
• M triceps brachii
• M anconeus

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UPPER LIMB

• ELBOW JOINT
• P860

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Elbow Joint

• Hinge (synovial) jnt
• Designed for mobility / function

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Important

• Articulation
• Joint capsule
• Ligaments
• Movements
• Muscles
• Bursae
• Blood supply
• Innervation

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Cubital Fossa

• Inverted triangle
• In front of elbow
• Borders
• Base - imaginary line - 2 epicondyles
• Lateral border m. brachioradialis
• Medial border m. pronator teres
• Roof - fascia, skin, superficial nerves and blood
  vessels
• Floor - brachialis, supinator
• Contents - median n., brachialis a., biceps
  brachii tendon

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Cubital Fossa
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UPPER LIMB

• RADIOULNAR JOINT
• Proximal p863
• Distal p866

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Important Proximal Joints(pivot synovial jnt)

• Articulation
• Joint capsule
• Ligaments anular lig
• Movements supination, pronation
• Muscles see mvmnts above
• Blood supply radial, radial recurrent aa
• Innervation musculocut., radial, median

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Important Distal Joints(pivot synovial jnt)

• Articulation
• Joint capsule
• Ligaments anterior posterior ligs
• Movements supination, pronation
• Muscles see mvmnts above
• Blood supply ant, post interosseous aa
• Innervation ant, post interosseous nn

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Forearm

• Posterior extensor compartment
• 12 muscle
• Radial nerve

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Forearm - Compartments
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Posterior Extensor Compartment

• 3 muscles run from deep to the thumb
• m. abductor pollicis longus
• m. extensor pollicis brevis
• m. extensor pollicis longus
• Originate from the shafts of radius and ulna
• as well as interosseous membrane

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Posterior Extensor Compartment
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Posterior Extensor Compartment

• 3 muscles lie lateral to previous group
• m. brachioradialis
• m. extensor carpi radialis longus
• m. extensor carpi radialis brevis

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Posterior Extensor Compartment
Anterior View
Posterior View
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Posterior Extensor Compartment

• 3 muscles lie medial to previous group
• m. extensor digitorum
• m. extensor digiti mini
• m. extensor carpi ulnaris

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Posterior Extensor Compartment
Posterior View
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Posterior Extensor Compartment

• 3 other muscles
• m. anconeus
• m. extensor indicis
• m. supinator

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Posterior Extensor Compartment
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Posterior Extensor Compartment

• Actions
• Extension of wrist and fingers
• m. anconeus helps extension of elbow
• m. supinatior supinates forearm
• m. brachioradialis arm in neutral position it
  flexes the elbow joint, if hand is pronated or
  supinated it turns hand back to neutral position

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Distal Radio-Ulnar Joints