T H E U P P E R L I M B.

T ABLE OF C ONTENTS
Anterior Wall. ........................................................................................................... 2
Posterior Wall. .......................................................................................................... 2
Medial Wall. .............................................................................................................. 3
Lateral Wall. .............................................................................................................. 3
Contents Of Axilla. .................................................................................................. 4
Brachial Plexus ......................................................................................................... 5
Superficial Muscles. ................................................................................................. 8
Deep Muscles. .......................................................................................................... 8
Rotator Cuff Muscles (extensile ligaments). ........................................................ 9
Scapular Muscles. ................................................................................................... 10
Posterior Spaces. .................................................................................................... 11
Muscles Of Anterior Compartment Of Arm. ................................................... 13
Cubital Fossa. ......................................................................................................... 13
Muscles of Posterior Compartment Of Arm. ................................................... 14
Superficial Muscles of Anterior Compartment of Forearm. ........................... 15

P REPARED

BY

M ICHAEL C. D AVID

Intermediate muscles of anterior compartment of forearm. .......................... 15

Deep Muscles Of Anterior Compartment Of Forearm. ................................. 16
Superficial Muscles of Posterior Compartment Of Forearm. ........................ 16
Deep Muscles of Posterior Compartment Of Forearm. ................................. 17
The Anatomical SnuffBox. ................................................................................... 19
Posterior Arterial Supply of Forearm. ................................................................ 19
Nerves of Posterior Compartment Of Forearm. .............................................. 20
A special note on Extensor Digitorum Muscle. ................................................ 20
Carpal TunneL & Palm. ........................................................................................ 21
Thenar Muscles. ..................................................................................................... 24
Hypothenar Muscles. ............................................................................................. 24
Intinisic Muscles of The Hand............................................................................. 25
20 Muscles of The Hand....................................................................................... 26
Arteries Of Hand. .................................................................................................. 27
Nerves Of The Hand. ........................................................................................... 28

ON

23/08/08.

P AGE 1

OF

28

A XILLA .
ANTERIOR WALL.

NAME.
Pectoralis Major.

ORIGIN.
Sternocostal Head = 1st six
costal cartilages.
Clavicular Head = medial half of
clavicle.

INSERTION
Lateral lip of bicipital groove.

INNERVATION
Lateral and Medial Pectoral
Nerve.
Clavicular Head = C5, C6
Sternocostal Head = C7, C8, T1

Pectoralis Minor.

Ribs 3, 4, 5.

Coracoid process.

Medial Pectoral Nerve (C8, T1)

Subclavius.
Clavipectoral Fascia

1st Rib.
Clavicle

Inferior surface of Clavicle.

Laterally = coracoid process
Medially = sternum.
Suspensory Ligaments hold it to
skin of armpit.

Nerve to Subclavius (C5, C6)

ACTION
1. Adduction & medial
rotation of Humerus.
2. Flexion (Clavicular) &
extension (sternocostal) of
shoulder joint.
Depresses (and brings forward)
Scapula.
Stabilises clavicle.
1. Protection.
2. Forms a sleeve around
Pectoralis Minor.
3. Suspensory ligaments make
armpit wall concave.

P O S T E R I OR W A L L .

NAME.
Subscapularis

ORIGIN.
Subscapular fossa.

INSERTION
Lesser tubercle of humerus.

Teres Major

Lateral border of Scapula

Medial lip of bicipital groove.

Latissimus Dorsi

From back

Ribbon-like tendon on floor of

bicipital groove

P REPARED

BY

M ICHAEL C. D AVID

INNERVATION
Upper & lower subscapular nerves.
(C5, C6)
Lower subscapular Nerve (C5, C6)
Thoraco dorsal nerve (C6, C7, C8)

ON

23/08/08.

ACTION
1. Adduction of arm.
2. Stabilises Glenohumoral joint.
1. Adduction of arm.
2. Medial rotation of arm.
Adduction of arm (climbers
muscle)

P AGE 2

OF

28

M E D I A L WA L L .

NAME.
Ribs 1-6
Serratus Anterior

ORIGIN.

INSERTION

INNERVATION

ACTION

Digitations from ribs 1-8.

Medial border of Scapula (lower

five digitations insert at inferior
angle)

Long Thoracic Nerve (C5, C6, C7)

1. Protraction of Scapula (holds it

in place).
2. Lower 5 digitations = superior
rotation of scapula.

L A T E R A L WA L L .

This is the bicipital groove. The skin and fascia form the base of the axilla.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 3

OF

28

C ON T E N T S OF A X I L L A .

Axillary artery,
Begins at outer border of 1st rib (superior to this = subclavian artery).
Ends at inferior border of Teres Major (inferior to this = brachial artery).
1st part above Pectoralis minor muscle.
Superior thoracic artery supplies 1st & 2nd intercostal spaces + superior serratus anterior muscle.
2nd part behind Pectoralis Major muscle.
Thoracoacromial artery supplies deltoid muscle, pectoral muscles, clavicle & acromion.
Lateral Thoracic artery runs along Pectoralis minor, and supplies lateral part of mammary area.
3rd part below Pectoralis minor muscle.
Subscapular Artery
Circumflex scapular artery to muscle on back of scapular, to form collateral circulation at infraspinous fossa.
Thoraco dorsal artery supplies Latissimus dorsi muscle.
Anterior Circumflex Humoral artery.
Posterior Circumflex Humoral artery winds around surgical neck of humerus to anastomose with Anterior Circumflex Humoral.
Axillary Vein.
Is the continuation of the basilic vein after it pierces the deep fascia at the inferior border of the teres major muscle.
Ends at outer border of 1st rib continues subclavian.
Cephalic vein joins it as it passes into deep fascia. (Other tributaries accompanying arterial branches, to empty out into axillary vein)
Lymphatic System.
Lateral group (associated with axillary artery), Posterior group, and Anterior/Pectoral group (drains 75% of lymph from breast) all three groups of nodes
drain into Central group.
Central group and Infraclavicular Node (drains lateral side of hand) Apical group.
Apical group drains:
On right subclavian lymph trunk.
On left thoracic duct.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 4

OF

28

BRACHIAL PLEXUS

NERVE.
Musculocutaneous nerve

ROOT.
C5, C6, C7

Lateral Root of Median nerve

C5, C6, C7

Radial nerve

C5, C6, C7, C8, T1

Axillary nerve

C5, C6

Ulnar nerve

C8, T1

Median nerve

C5, C6, C7, C8, T1

Dorsal Scapular nerve

C5

Long Thoracic nerve

C5, C6, C7

P REPARED

BY

SUPPLIES
1. Biceps brachii muscle
2. Brachialis muscle
3. Coracobrachialis muscle
1. Flexors of forearm
2. 5muscles in hand
1. Triceps muscle
2. Anconeous muscle
3. Brachioradialis muscle
4. Cutaneous sensation to skin around
extensors + hand.
1. Deltoid muscle
2. Teres Minor muscle

1. Hand
2. Little of forearm
1. Forearm flexors
2. Little of hand muscles of thumb.
1. Rhomboid Major & Minor muscle
2. Levator Scapulae muscle.
Serratus Anterior muscle.

M ICHAEL C. D AVID

ON

23/08/08.

NOTES.
1. Pierces coracobrachialis muscle.
2. On piercing clavipectoral fascia, it becomes
Lateral antebrachial cutaneous nerve.
1. Travels posteriorly, inferiorly and laterally
between long & medial heads of triceps
enters radial groove on posterior surface of
humerus.
2. Travels with Profunda brachii artery.
1. Passes through quadrilateral space, around
surgical neck of humerus.
2. Travels with posterior circumflex humoral
artery.
3. Becomes Upper lateral brachial cutaneous
nerve.
Medial to artery.
Travels with brachial artery.
Pierces Scalenus medius muscle.
1. Roots form C5 & C6 pierce Scalenus
medius muscle.
2. Root from C7 passes anterior to Scalenus
medius muscle.

P AGE 5

OF

28

Suprascapular nerve

C5, C6

Nerve to Subclavius
Lateral Pectoral nerve

C5, C6
C5, C6, C7

Medial Pectoral nerve

C8, T1

Medial Brachial Cutaneous nerve

C8, T1

Medial Antebrachial Cutaneous nerve

C8, T1

Upper Subscapular nerve

Thoraco dorsal nerve
Lower Subscapular nerve

C5, C6
C6, C7, C8
C5, C6

P REPARED

1. Supraspinatus muscle
2. Infraspinatus muscle
Subclavius muscle.
Pectoralis Major muscle.
1. Pectoralis Major muscle
2. Pectoralis Minor muscle
1. Medial skin of arm (sensory)
2. Skin of distal medial forearm
Sensory supplies to skin of medial forearm.

1. Passes through deltopectoral triangle, and

pierces clavipectoral fascia.
2. From Lateral cord.
1. Lies lateral to Lateral Pectoral nerve.
2. Originated from Medial Cord.
Communicates with Intercostobrachial nerve
supplies skin on floor of axilla.

Subscapularis muscle.
Latissimus dorsi muscle.
1. Subscapularis muscle
2. Teres Major muscle

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 6

OF

28

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 7

OF

28

B ACK & S CAPULAR R EGION.

SUPERFICIAL MUSCLES.

NAME.
Trapezius

ORIGIN.
1. External occipital
protuberance on skull.
2. Ligamentum nuchae.
3. Spinous processes of C7T12

Latissimus dorsi

1. Inferior 3 or 4 ribs
2. Spinous processes of T7T12
3. Thoracolumbar fascia
4. Iliac crest

INSERTION
1. Superior fibres @ lateral
third of clavicle.
2. Middle fibres @ spine of
scapula.
3. Inferior fibres @ base of
spine of scapula.
Floor of bicipital groove of
humerus.

INNERVATION
Spinal part of accessory
nerve (Cranial nerve XI)
Sensory: C3, C4

Thoraco dorsal nerve (C6, C7,

and C8).

ACTION
1. Superior elevate scapula.
2. Middle retract scapula.
3. Inferior depress scapula.
4. Superior & Inferior
superiorly rotate scapula.
5. Prevents drooping shoulders
1. Extends humerus at
shoulder joint.
2. Adduct humerus at shoulder
joint.
3. Medially rotates humerus.
4. Pulls trunk up to arms
(during chin-ups)

DEEP MUSCLES.

NAME.
Levator Scapulae

ORIGIN.
Posterior tubercles of transverse
processes of C1 C4.

INSERTION
Superior part of medial border
of scapula.

INNERVATION
1. Dorsal Scapular nerve (C5)
2. Cervical Nerve (C3, C4)

Rhomboid Major

Spinous processes of T2-T5

Medial border of scapula (from

Dorsal Scapular muscles (C5).

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

ACTION
1. Elevates scapula
2. Tilts glenoid cavity inferiorly
by rotating scapula
3. Retracts scapula
4. Flexes neck laterally
1. Retracts scapula

P AGE 8

OF

28

level of spine to inferior angle)

Rhomboid Minor

1. Ligamentum nuchae
2. Spinal processes of C7 & T1

Medial border of scapula

(around level of spine)

Dorsal Scapular muscles (C5).

2. Rotates scapula to depress

glenoid cavity
3. Fixes scapula to thoracic
wall.
1. Retracts scapula
2. Rotates scapula to depress
glenoid cavity
3. Fixes scapula to thoracic
wall.

ROTA T OR C U F F M U S C L E S ( E X T E N S I L E L I G A M E N T S ) .

NAME.
Subscapularis

ORIGIN.
Subscapular fossa.

INSERTION
Lesser tubercle of humerus.

INNERVATION
Upper and lower subscapular
nerves (C5, C6).

Supraspinatus

Supraspinous fossa of scapula.

Superior facet on greater

tubercle of humerus.

Suprascapular nerve (C5, C6).

Infraspinatus

Infraspinous fossa of scapula

Middle facet on greater tubercle

of humerus.

Suprascapular nerve (C5, C6).

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

ACTION
1. Medially rotates arm
2. Adducts arm
3. Holds head of humerus into
glenoid cavity stabilises
glenoid cavity during
shoulder movement.
1. Helps Deltoid m., abduct
arm. Initiates 1st 15 of
movement.
2. Holds head of humerus into
glenoid cavity stabilises
glenoid cavity during
shoulder movement.
1. Laterally rotates arm
2. Holds head of humerus into
glenoid cavity stabilises
glenoid cavity during

P AGE 9

OF

28

Teres Minor

Superior part of lateral border of

scapula.

Inferior facet on greater tubercle

of humerus.

Axillary nerve (C5, C6).

shoulder movement.
1. Laterally rotates arm
2. Assists adduction of arm
3. Holds head of humerus into
glenoid cavity stabilises
glenoid cavity during
shoulder movement.

SCAPULAR MUSCLES.

NAME.
Deltoid

ORIGIN.
1. Anterior fibres lateral
third of clavicle
2. Middle fibres acromion
(protected by subacromial
bursa)
3. Posterior fibres spine of
scapula.

INSERTION
Deltoid tuberosity of humerus.

INNERVATION
Axillary nerve (C5, C6)

ACTION
1. Anterior fibres strong
flexor (works with Pectoralis
major muscle &
Coracobrachialis muscle.
2. Middle fibres chief
abductor of arm (aided by
Supraspinatus muscle.)
3. Posterior fibres strong
extensor & laterally rotates
humerus.
4. Generally holds arm &
stabilises arm.

Teres Major

Dorsal surface of inferior angle

of Scapula.

Medial lip of bicipital groove of

humerus.

Lower Subscapular nerve (C5,

C6)

1.
2.
3.

(forms Posterior Axillary Fold,

with tendon of Latissimus dorsi
muscle)

P REPARED

4.

BY

M ICHAEL C. D AVID

ON

23/08/08.

Adducts arm
Medially rotates arm
Helps extend arm from flexed
position.
Helps stabilise head of humerus in
Glenoid cavity, during abduction
of arm.

P AGE 10

OF

28

P O S T E R I OR S PA C E S .

Quadrilateral Space.
Superior boundary = Teres minor muscle.
Inferior boundary = Teres major muscle.
Medial boundary = long head of Triceps muscle.
Lateral boundary = humerus.
Posterior circumflex humoral artery & axillary nerve pass through (in direct contact with surgical neck of humerus)
Upper Triangular Space.
Superior boundary = Teres minor muscle.
Inferior boundary = Teres major muscle.
Lateral boundary = long head of Triceps muscle.
Circumflex scapular artery passes through.
Lower Triangular Space.
Superior boundary = Teres major muscle.
Medial boundary = long head of Triceps muscle.
Lateral boundary = shaft of humerus.
Radial nerve and Profunda brachii artery passes through.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 11

OF

28

T HE S HOULDER J OI NTS .
JOINT
Sternoclavicular

INTRINSIC LIGAMENTS
1. Sternoclavicular ligaments
strong. Anteriorly and
posteriorly.
2. Interclavicular ligaments
weak superior support.

Acromioclavicular

Acromioclavicular ligaments
provides weak superior
support.

Glenohumoral

1. Glenohumoral ligaments
anterior support from
supraglenoid tubercle to
lesser tubercle of
humerus.
2. Transverse humoral ligaments
across bicipital groove.
3. Coracohumoral ligaments
from coracoid process,
across capsule, to the
anatomical neck of
humerus (adjacent to
greater tubercle.

EXTRINSIC LIGAMENTS
Costoclavicular ligaments from
costal cartilage of 1st rib, to
inferior margin of medial
clavicle. Provides lateral
support, and limits any
movement of clavicle except
inferior movement.
Coracoclavicular ligaments
from coracoid process to
clavicle. Strong support, and
provides axis for rotation of
Scapula. (conoid and
trapezoid)
Coracoacromial ligaments
forms Coracoacromial arch,
with coracoid process and
acromion. Prevents superior
dislocation.

P REPARED

BY

MOVEMENTS
Many directions like
a ball and socket
joint.

BLOOD SUPPLY
1. Branches of
internal thoracic
artery.
2. Branches of
suprascapular
artery.

1. Rotation of
acromion on
clavicle.
2. Anterior &
posterior
movement.
1. Flexionextension.
2. Abductionadduction.
3. Circumduction.
4. Rotation.

1. Branches of
Suprascapular
artery.
2. Branches of
Thoracoacromial
artery.
1. Branches of
anterior and
posterior
circumflex
humoral artery.
2. Branches of
Suprascapular
artery (from
Subclavian)

M ICHAEL C. D AVID

ON

23/08/08.

NERVE SUPPLY
1. Branches of
medial
supraclavicular
nerve.
2. Branches of
Nerve to
Subclavius.
1. Supraclavicular
nerve branches.
2. Lateral pectoral
nerve branches.
3. Axillary nerve
branches.
1. Suprascapular
nerve.
2. Axillary nerve.
3. Lateral pectoral
nerve.

NOTES.
Fibro-cartilaginous
articular disc.
Prevents medial
displacement of
clavicle, and acts as a
shock absorber.
An incomplete
articular disc is
present within
articular capsule.
1. Subacromial bursa
between
deltoid muscle
over fibrous
capsule &
supraspinatus
tendon.
2. Subscapular bursa
between
subscapularis &
neck of scapula.
3. Rotator cuff
muscles stabilise
joint.

P AGE 12

OF

28

A RM .
M U S C L E S OF A N T E R I O R C OM PA RT M E N T O F A R M .

NAME.
Biceps brachii

Brachialis
Coracobrachialis

ORIGIN.
1. Short head = coracoid
process.
2. Long head = supraglenoid
tubercle.
Distal half of anterior surface of
humerus.
Coracoid process.

INSERTION
1. Radial tuberosity on radius.
Protected by a bursa.
2. Bicipital aponeurosis.

INNERVATION
Musculocutaneous nerve (C5,
C6)

ACTION
1. Supinates arm.
2. Flexes arm.

Coranoid process.

Musculocutaneous nerve (C5,

C6)
Musculocutaneous nerve (C5,
C6)

Flexion of arm.

Halfway down medial side of

humerus.

1. Aids flexion of arm

2. Aids adduction of arm

C U B I TA L F OS S A .

Superior boundary = imaginary line between medial & lateral epicondyle of humerus.
Medial boundary = lateral edge of Pronator Teres muscle.
Lateral boundary = medial edge of Brachioradialis muscle.
Floor = Brachialis muscle (superiorly), and Supinator muscle (inferiorly).
Roof = Bicipital Aponeurosis. protects the contents from damage during venepuncture.
Contents (medial lateral):
Median nerve
Brachial artery
Biceps tendon
Radial nerve
Superior to bicipital aponeurosis, lies the Median Cubital Vein. This links the cephalic (lateral) and the basilic (medial) vein, and is the site for venepuncture.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 13

OF

28

M U S C L E S OF P OS T E R I OR C OM PA RT M E N T OF A R M .

NAME.
Triceps

Anconeus

ORIGIN.
1. Long head = infraglenoid
tubercle of scapula.
2. Lateral head = posterior
surface of humerus, superior
to radial groove.
3. Medial head = posterior
surface of humerus, inferior
to radial groove.
Lateral epicondyle of humerus.

P REPARED

BY

INSERTION
Olecranon process protected
by Olecranon bursa.

INNERVATION
Radial nerve (C6, C7, C8)

ACTION
1. Extends arm.
2. Long head steadies the head
of the abducted humerus.

Radial nerve (C7, C8, T1)

1. Assists triceps in extension

of arm.
2. Abducts ulna during
pronation.
3. Stabilises elbow joint.

Bursa lie between skin &

tendon, and tendon & bone.
Inflammation of bursa
Students Elbow.
1. Lateral surface of olecranon
process.
2. Posterior surface of superior
ulna.

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 14

OF

28

F OREARM .
S U P E R F I C I A L M U S C L E S O F A N T E R I O R C O M PA RT M E N T OF F O R E A R M .

NAME.
Pronator Teres

INSERTION
Middle of lateral surface of
radius.
Base of 2nd metacarpal

INNERVATION
Median nerve (C6, C7)

Flexor Carpi Radialis

ORIGIN.
Medial epicondyle of humerus &
coranoid process of ulna.
Medial epicondyle

Palmaris Longus

Medial epicondyle

Median nerve (C7, C8)

Flexor Carpi Ulnaris

1. Humoral head medial

epicondyle.
2. Ulnar head olecranon &
posterior border of Ulna

Distal half of Flexor

Retinaculum (forms palmar
aponeurosis)
1. Pisiform
2. Hook of Hamate
3. 5th Metacarpal

Median nerve (C6, C7)

Ulnar nerve (C7, C8)

ACTION
1. Pronates forearm
2. Flexes forearm
1. Pronates forearm
2. Flexes forearm
1. Flexes hand
2. Tightens palmar
aponeurosis.
1. Flexes hand
2. Adducts hand

I N T E R M E D I A T E M U S C L E S OF A N T E R I O R C O M PA RT M E N T OF F O R E A R M .

NAME.
Flexor Digitorum
Superficialis

ORIGIN.
Humero-ulnar head
1. Medial epicondyle.
2. Ulnar collateral
ligament
3. Coranoid process
Radial head superior half of
anterior border of radius.

P REPARED

INSERTION
Bodies of the middle phalanges
of medial 4 digits.

BY

M ICHAEL C. D AVID

ON

INNERVATION
Median nerve (C7, C8, T1)

23/08/08.

ACTION
1. Flexes middle phalanges of
medial 4 digits.
2. Acting more strongly
flexes proximal phalanges
and hand.

P AGE 15

OF

28

D E E P M U S C L E S O F A N T E R I OR C OM PA RT M E N T OF F O R E A R M .

NAME.
Flexor Digitorum
Profundus

ORIGIN.
Proximal 3/4 of medial and
anterior surfaces of Ulna &
Interosseous membrane.

INSERTION
Base of distal phalanges of
medial 4 digits.

INNERVATION
ACTION
Medial half Ulna nerve (C8, T1) Flexes distal phalanges of medial
Lateral half Median nerve (C8, 4 digits (fingers).
T1)

Flexor Pollicis
Longus

1. Anterior surface of Radius.

2. Adjacent Interosseous
membrane
Distal quarter of anterior surface
of Ulna.

Base of distal phalanx of thumb.

Anterior interosseous nerve

(from median nerve) C8, T1

Flexes phalanges of thumb (1st

digit)

Distal quarter of anterior surface

of Radius.

Anterior interosseous nerve

(from median nerve) C8, T1

1. Pronates forearm.
2. Deep fibres bind Ulna &
Radius together.

Pronator Quadratus

S U P E R F I C I A L M U S C L E S O F P O S T E R I O R C OM PA RT M E N T OF F O R E A R M .

LATERAL.

NAME.
Brachioradialis
Extensor Carpi
Radialis Longus
Extensor Carpi
Radialis Brevis

ORIGIN.
Proximal of Lateral
Supracondylar ridge of Humerus
Lateral Supracondylar ridge of
Humerus
Lateral Epicondyle of Humerus

P REPARED

BY

INSERTION
Lateral surface of distal end of
Radius
Base of 2nd Metacarpal

INNERVATION
Radial nerve (C5, C6, C7)

ACTION
Flexes forearm

Radial nerve (C5, C6)

Base of 3rd Metacarpal

Deep branch of Radial nerve

(C7,C8)

1.
2.
1.
2.

M ICHAEL C. D AVID

ON

23/08/08.

Extends hand at wrist.

Abducts hand at wrist
Extends hand at wrist.
Abducts hand at wrist

P AGE 16

OF

28

POSTERIOR.

NAME.
Extensor Digitorum

ORIGIN.
Lateral Epicondyle of Humerus

INSERTION
Extensor expansions of medial 4
digits

INNERVATION
Posterior Interosseous nerve
(C7,C8)

Extensor Digiti
Minimi

Lateral Epicondyle of Humerus

Extensor expansion of 5th digit

Posterior Interosseous nerve

(C7,C8)

Extensor Carpi
Radialis Ulnaris

1. Lateral Epicondyle of
Humerus
2. Posterior border of Ulna
Lateral Epicondyle of Humerus

Base of 5th Metacarpal

Posterior Interosseous nerve

(C7,C8)

1. Lateral surface of olecranon

2. Superior part of posterior
surface of Ulna

Radial nerve (C7, C8, T1)

Anconeus

ACTION
1. Extends medial 4 digits at
Metacarpal-phalangeal joint
2. Extends hand at wrist
Extends 5th digit at the
Metacarpal-phalangeal joint, and
the Interphalangeal joint
1. Extends hand at wrist
2. Adducts hand at wrist
1. Assists Triceps in extending
elbow joint
2. Stabilises elbow joint
3. Abducts Ulna during
pronation

D E E P M U S C L E S O F P O S T E R I O R C OM PA RT M E N T O F F O R E A R M .

NAME.
Abductor Pollicis
Longus
Extensor Pollicis
Brevis
Extensor Pollicis
Longus

ORIGIN.
1. Posterior surfaces of Ulna,
Radius
2. Interosseous membrane
1. Posterior surface of Radius
2. Interosseous membrane

INSERTION
Base of 1st Metacarpal

INNERVATION
Posterior Interosseous nerve
(C7, C8)

Base of proximal phalanx of

thumb

Posterior Interosseous nerve

(C7, C8)

1. Posterior surface of middle

third of Ulna
2. Interosseous membrane

Base of distal phalanx of thumb

Posterior Interosseous nerve

(C7, C8)

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

ACTION
1. Abducts thumb
2. Extends thumb at Carpalmetacarpal joint
Extends proximal phalanx of
thumb at Metacarpal-phalangeal
joint.
Extends distal phalanx of thumb
at Metacarpal-phalangeal joint,
and Interphalangeal joint.

P AGE 17

OF

28

Extensor Indicis
Extensor
Retinaculum

1. Posterior surface of Ulna

2. Interosseous membrane
Distal end of Radius

P REPARED

Extensor expansion of 2nd digit

Posterior Interosseous nerve

(C7, C8)

1. Styloid process of Ulna

2. Triquetrum
3. Pisiform

BY

M ICHAEL C. D AVID

ON

23/08/08.

1. Extends index finger

2. Helps extend hand
Prevents bow-stringing of the
long extensor tendons, when the
hand is hyper-extended at the
wrist joint.

P AGE 18

OF

28

T H E A N A TOM I C A L S N U F F B OX .

Lateral boundary = Abductor Pollicis Longus and Extensor Pollicis

Brevis.
Medial boundary = Extensor Pollicis Longus.
Contents of Anatomical Snuffbox are:
Cephalic vein superficial to tendons
Superficial branch of radial nerve superior to tendons
Radial artery deep to tendons, forming floor of snuffbox.
Pierces 1st Dorsal Interosseous to form Deep Palmer Arch,
Princeps Pollicis artery, and Radialis Indicis artery.
Scaphoid forms floor. It is narrow in the middle, and frequently fractured
Pain in snuffbox.
Blood supply enters distally, and leaves proximally through nutrient
foramen risk of Avascular Necrosis.
P O S T E R I O R A RT E R I A L S U P P LY O F F O R E A R M .

The posterior interosseous artery (arising from the common interosseous

artery branch of the ulnar artery) supplies all the muscles of the posterior
compartment of the forearm.
Posterior Interosseous passes posteriorly between the Radius and Ulna,
just proximal to the interosseous membrane.
It enters the posterior compartment, between Supinator muscle and
Abductor Pollicis Longus.
Terminates by anastomosis with Anterior Interosseous artery, and the
Dorsal Carpal Arch.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 19

OF

28

N E R V E S O F P O S T E R I O R C OM P A R T M E N T O F F O R E A R M .

Radial nerve supplies Extensor Carpi Radialis Longus before splitting into a superficial branch
and a deep branch, just superior to the elbow.
The deep branch supplies the Extensor Carpi Radialis Brevis, and the Supinator muscle. It
then pierces the Supinator, and enters the posterior compartment.
Henceforth, it is called the Posterior Interosseous nerve, and supplies the remaining forearm
extensors.
It lies on the interosseous membrane, with the Posterior Interosseous artery.
The superficial branch runs down the forearm with the Radial artery, to be the most lateral
structure at the wrist. It divides into digital branches, to give cutaneous supply to the lateral
3 digits, and the dorsal surface of the palm.
A S P E C I A L N OT E O N E X T E N S O R D I G I TOR U M M U S C L E .

At Metacarpal-phalangeal joint, there is a diamond shaped aponeurosis wrapped around the

joint = Dorsal Digital Expansion.
Extensor Digitorum passes through the Dorsal Digital Expansion, and partially attaches to
proximal phalanges.
The central band attaches to the middle phalanx.
The marginal bands (medial & lateral) go around the middle phalanx, and then merge and
attach to the distal phalanx.
To make a fist, the extensor tendons have to be longer than the flexor tendons.
When the Metacarpal-phalangeal joint is extended by Extensor Digitorum, there is too
much slack in the tendon to further extend the Interphalangeal joints.
The Lumbricals and Interossei attach onto the margins of the Dorsal Digital Expansions,
and contract to re-tension the Extensor Digitorum, by pulling on its hood.
Thus the Extensor Digitorum and its collateral reinforcements extend the interphalangeal
joints.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 20

OF

28

T HE H AND.
C A R PA L T U N N E L & PA L M .

Bones of wrist are Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate.
Roof of carpal tunnel is the Flexor Retinaculum.
Contents of the Carpal Tunnel are:
Median nerve
Flexor Digitorum Superficialis tendons (4)
Flexor Digitorum Profundus tendons (4)
Flexor Carpi Radialis tendon in its own sleeve
Flexor Pollicis Longus tendon.
Superficial to roof of Carpal Tunnel are:
Ulnar artery
Ulnar nerve
Palmar branch of ulnar nerve
Palmar branch of median nerve
Palmaris Longus tendon
Superficial branch of Radial artery.
Palmar Aponeurosis (= deep fascia) originates at border of Flexor Retinaculum, and attaches to base of proximal phalanges of fingers.
Where it attaches to skin, are visible skin creases.
It extends Palmaris Longus.
Medially attached to 5th Metacarpal.
Laterally attached to 1st Metacarpal.
Divides palm into:
Lateral (Thenar) compartment.
Central (Mid-palmar) compartment.
Further split by a Septa from lateral edge of aponeurosis to 3rd Metacarpal.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 21

OF

28

 Medial (Hypothenar) compartment.

Dupuytren's Contracture = a tight fibrous band developing in palm, that pulls digits into a flexed position.
Fibrous flexor sheaths bind down tendons of digits, and prevents them from bow-stringing, when digits are flexed.
Pass from metacarpals to the distal phalanges.
At Interphalangeal joints, they are composed of cruciate fibres, to allow flexion.
Attachments of Flexor Digitorum Superficialis and Flexor Digitorum Profundus.

Synovial sheaths lie deep to the fibrous sheaths over tendons. They have occasional vincula, for a blood supply.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 22

OF

28

 Each digit has a neurovascular bundle on either side of it. From posterior to anterior:
Digital vein
Digital artery
Digital nerve.

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 23

OF

28

THENAR MUSCLES.

NAME.
Abductor Pollicis
Brevis
Flexor Pollicis Brevis
Opponens Pollicis
Adductor Pollicis

ORIGIN.
1. Flexor Retinaculum
2. Scaphoid & trapezium
tubercles
1. Flexor Retinaculum
2. Trapezium tubercle
1. Flexor Retinaculum
3. Trapezium tubercle
1. Oblique head bases of 2nd &
3rd metacarpals + Capitate &
adjacent carpal bones.
2. Transverse head anterior
surface of body of 3rd
metacarpal

INSERTION
Lateral side of base of proximal
phalanx of thumb.

INNERVATION
Recurrent branch of Median
nerve (C8, T1)

ACTION
1. Abduction
2. Aids opposition

Lateral side of base of proximal

phalanx of thumb.
Lateral side of 1st Metacarpal.

Recurrent branch of Median

nerve (C8, T1)
Recurrent branch of Median
nerve (C8, T1)
Deep branch of Ulnar nerve.
(C8, T1)

1. Flexes thumb

Medial side of base of proximal

phalanx of thumb

1. Opposition of thumb.
2. Medial rotation
Adducts thumb towards middle
digit.

H Y P OT H E N A R M U S C L E S .

NAME.
Abductor Digiti
Minimi
Flexor Digit Minimi
Brevis
Opponens Digit
Minimi

ORIGIN.
Pisiform

INSERTION
Medial side of base of proximal
phalanx of 5th digit.
Medial side of base of proximal
phalanx of 5th digit.
Medial border of 5th metacarpal

Hook of Hamate and Flexor

Retinaculum.
Hook of Hamate and Flexor
Retinaculum.

P REPARED

BY

M ICHAEL C. D AVID

ON

INNERVATION
Deep branch of Ulnar nerve
(C8, T1)
Deep branch of Ulnar nerve
(C8, T1)
Deep branch of Ulnar nerve
(C8, T1)

23/08/08.

ACTION
Abduction.
Flexion.
Draws 5th metacarpal anteriorly,
and laterally rotates it, bringing
5th digit into opposition with
thumb.

P AGE 24

OF

28

INTINISIC MUSCLES OF THE HAND.

NAME.
1st & 2nd Lumbricals

3rd & 4th Lumbricals

Palmar Interossei
Dorsal Interossei

ORIGIN.
Each from one of the two lateral
tendons of Flexor Digitorum
Profundus.
Unipennate
Each from two of the three
medial tendons of Flexor
Digitorum Profundus.
Bipennate
Palmar surfaces of 1st, 2nd, 4th &
5th metacarpals.
Unipennate
Adjacent sides of metacarpal
bones.
Bipennate

P REPARED

BY

INSERTION

INNERVATION
Median nerve (C8, T1)

Lateral sides of extensor

expansions of 2nd to 5th digit.

Deep branch of Ulnar nerve

(C8, T1)
Extensor expansions, and bases
of proximal phalanges of 1st, 2nd,
4th & 5th digits.
Extensor expansion and bases of
proximal phalanges of 2nd, 3rd &
4th digits.

M ICHAEL C. D AVID

ON

ACTION
Flexes digits at Metacarpalphalangeal joints, and extends
Interphalangeal joints. (Salute
position)

Deep branch of Ulnar nerve

(C8, T1)

Adduction.

Deep branch of Ulnar nerve

(C8, T1)

Abduction.

23/08/08.

P AGE 25

OF

28

NAME.
Palmaris Brevis

ORIGIN.
Flexor Retinaculum & palmar
aponeurosis.

INSERTION
Skin on medial side of palm
(therefore lies in fascia, deep to
skin and hypothenar eminence)

INNERVATION
Superficial branch of Ulnar
nerve (C8, T1)

ACTION
1. Wrinkles skin on medial side
of palm.
2. Deepens hollow of palm, to
aid grip.

2 0 M U S C L E S O F T H E H A N D.

Palmaris Brevis
Thenar Muscles
Adductor Pollicis
Hypothenar Muscles
Lumbricals
Interossei

P REPARED

BY

M ICHAEL C. D AVID

ON

1
3
1
3
4
8
20

23/08/08.

P AGE 26

OF

28

A RT E R I E S OF H A N D.

Supplies medial side of little finger,

and web spaces of fingers. From the
web spaces, the arterial supply divides
to run along the medial and lateral
sides of the fingers, up to medial side
of index finger.
Main
branch

Superficial Palmar
Arch

Superficial Palmar
branch

Radial
artery

Metacarpal
branches

Ulnar
artery

Deep
branch

Main
branch

Deep Palmar Arch

Gives branches to the thumb

(Princeps Pollicis artery), and to the
lateral side of the index finger
(Radialis Indicis artery).

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 27

OF

28

N E RV E S O F T H E H A N D.

MEDIAN NERVE.

Lies at wrist, between Flexor Carpi Radialis & Flexor Digitorum Superficialis tendons.
Palmar branch originates proximal to Carpal tunnel, and supplies lateral skin of palm
sensation of palm is unaffected by Carpal Tunnel Syndrome.
Cutaneous supply to lateral 3 fingers, and nail beds.
Muscular supply to:
3 Thenar muscles (recurrent branch)
Lateral two Lumbricals.
ULNAR NERVE.

Lies at wrist in between Flexor Digitorum Superficialis & Flexor Carpi Ulnaris tendons.
Palmar branch originates proximal to Flexor Retinaculum, and supplies medial skin of
palm.
Main branch runs superficially to Flexor Retinaculum, and laterally to the Pisiform, and
Hook of Hamate.
Superficial branch gives a cutaneous supply to medial 1 fingers.
Deep branch give a muscular supply to:
3 Hypothenar muscles
Two medial Lumbricals
8 Interossei
Adductor Pollicis muscle.
RADIAL NERVE.

Supplies no muscles in hand.

Cutaneous supply to dorsal surface of hand

P REPARED

BY

M ICHAEL C. D AVID

ON

23/08/08.

P AGE 28

OF

28