UPPER EXTREMITIES

Efficiency of hand function results in Parts:

large part from the ability to place it in the
a. Shaft
proper position by movements at the:
Medial half
1. Scapulothoracic o convex anteriorly (2/3)
2. Glenohumeral Lateral half
3. Elbow o concave anteriorly,
4. Radio-Ulnar flattened (1/3)
5. Wrist
b. Sternal end
FOUR MAJOR SEGMENTS: o Enlarged and triangular
1. Shoulder where it articulates with
2. Arm the manubrium of the
3. Forearm sternum at the
4. Hand sternoclavicular joint

BONES OF UPPER LIMB: c. Acromial end

o Flat where it articulates
1. Clavicle
with the acromion of the
o Connects upper limb to the trunk
scapula at the
o Serves as a moveable, crane-like
acromioclavicular joint
strut from which the scapula and
free limb are suspended, keeping
d. Superior surface
them away from the trunk so that
o Smooth and lies deep to
the limb has maximum freedom o
the skin and platysma
motion
muscle in the
o Transmits shocks from the upper
subcutaneous tissue
limb to the axial skeleton
o Allows the scapula at the thoracic
e. Inferior surface
wall at the scapulothoracic joint,
o Rough because strong
increasing the range of motion of
ligaments bind it to the 1st
the limb
rib near its sternal end
Scapulothoracic Joint and suspend the scapula
from its acromial end
A physiological “joint,” in
which movement occurs between Conoid Tubercle
musculoskeletal structures (between
Gives attachment
the scapula and associated muscles
to the conoid ligament
and the thoracic wall), rather an
anatomical joint, in which movement Trapezoid Line
occurs between directly articulating
skeletal elements. To which the
trapezoid ligament
It is where the scapular attaches
movements of elevation-depression,
protraction-retraction, and rotation f. Subclavian Groove
occur. Site of attachment
of the subclavius muscle

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g. Impression for the scapula; although its borders,

costoclavicular ligament especially the lateral one are
somewhat thicker
Rough, often
depressed, oval area that d. Acromion
gives attachment to the
o Flat and expanded
ligament binding the 1st rib
continuation of the spine
to the clavicle, limiting
laterally which forms the
elevation of the shoulder
subcutaneous point of the
shoulder and articulates with
the acromial end of the
clavicle
e. Deltoid tubercle
o The prominence of the
scapular spine indicating
the medial point of
attachment of the deltoid
2. Scapula f. Glenoid cavity
o Is a triangle flat bone that lies on
the posterolateral aspect of the o Receives and articulates
thorax, overlying the 2nd-7th ribs with the head of the
o Is capable of considerable humerus at the
movement on the thoracic wall at glenohumeral joint
the physiologic scapulothoracic o Orientation: Superior,
joint, providing the base from Anterior, Lateral
which the upper limb appears.
g. Coracoid process
Parts: o Beak like superior to the
a. Spine glenoid cavity and
o Thick projecting ridge that projects anterolaterally
unevenly divides the convex o Provides the inferior
posterior surface of the attachment for the
scapula into a small passively supporting
supraspinous fossa and a coracoclavicular ligament
much larger infraspinous
fossa h. Medial border / Vertebral
border
b. Subscapular fossa o Runs approximately 5 cm
lateral to the spinous
o Formed by the concave
process of the thoracic
coastal surface of most of the
vertebrae
scapula
c. Body i. Lateral border / Axillary
border
o Triangular thin superior and
inferior to the spine of the
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o Runs superolaterally
toward the apex of the
axilla
o Made up of a thick bar of
bone that prevents
buckling of this stress
bearing region of the
scapula

j. Lateral angle
o Where the lateral border
terminates
3. Humerus
o Thickest part of the scapula
o Largest bone in the upper limb,
k. Head articulates with the scapula at the
o Located in lateral angle gelnohumeral joint, and the
o Primary feature is the glenoid radius and ulna at the elbow joint
cavity Parts:

l. Neck a. Head
o Shallow constriction between o Articulates with the glenoid
the head and body cavity of the scapula
b. Anatomical neck
m. Superior border
o Marked near the junction of its o Formed by the groove
medial two thirds and lateral circumscribing the head and
third by the suprascapular separating it from the greater
notch and lesser tubercles
c. Surgical neck
n. Suprascapular notch
o Located where the superior o Common site of fracture,
border joins the base of the is the narrow part distal to
coracoid process the head and tubercles

o. Superior border d. Greater tubercle

o Thinnest and shortest of the o Found at the lateral
three borders margin of the humerus
e. Lesser tubercle
o Projects anteriorly from
the bone
f. Intertubercular sulcus /
Bicipital groove
o Separates the tubercles,
and provides protected

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 UPPER EXTREMITIES

passage for the slender o Accommodates the olecranon

tendon of the long head of of the ulna during the full
the biceps muscle extension of the elbow

g. Deltoid tuberosity f. Radial fossa

o Laterally, for attachment o Accommodates the edge of
of the deltoid muscle the head of radius when
forearm is fully flexed
h. Radial groove / Spiral groove
o Posteriorly, in which the
radial nerve and profunda
brachii artery lie as they
pass anterior to the long
head and between the
medial and the lateral
heads of the triceps
brachii muscle

Inferior end of the humeral shaft:

a. Medial and lateral 4. Ulna
supracondylar ridges o Stabilizing bone of the forearm
b. Medial and lateral and is the medial and longer of
epicondyles the two forearm bones

Distal end of the humerus: Prominent projections:

a. Condyle a. Olecranon
o Includes trochlea, o Projects proximally from its
capitulum, olecranon, posterior aspect, and serves as
coronoid, and radial fossae a short lever for extension of the
b. Capitulum elbow
o Lateral articular surface of
b. Coronoid process
condyle for articulation with
the head of the radius o Projects anteriorly
c. Trochlear notch
c. Trochlea
o Medial spool-shaped or o Walls are formed by
pulley-like for articulation with olecranon and coronoid
the proximal end (trochlear processes and “grips” the
notch) of the ulna trochlea of the humerus

d. Coronoid fossa d. Ulnar tuberosity

o Receives the coronoid o Inferior to the coronoid
process of ulna during full process that serves as
flexion of the elbow attachment of the

e. Olecranon fossa
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 UPPER EXTREMITIES

tendon of the brachialis o Articulates with the

muscle radial notch of ulna
e. Radial notch b. Neck
o Receives the head of o Constriction distal to the
the radius head
c. Radial tuberosity
f. Shaft
o Thick and cylindrical o Distal to the medial part
proximally, but it tapers, of the neck
diminishing in diameter
as it continues distally
d. Shaft
g. Head
o Small disc-like at the o Gradually enlarges as it
narrow distal end of ulna passes distally
together with the ulnar o Essentially four sided when
styloid process sectioned transversely
e. Ulnar notch
o Accommodates the head of
the ulna
f. Radial styloid process
o Ridge-like lateral aspect of
ulnar notch

g. Dorsal tubercle
o Dorsally, lies between
shallow grooves for the
passage of the tendons of
forearm muscles

5. Radius
o Lateral and shorter of the
two forearm bones

Proximal end:
a. Head
o Concave for articulation
with the capitulum of
humerus during flexion
and extension of the
elbow joint

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 UPPER EXTREMITIES

It passes through the

axillary artery dividing into three
2. Quadrangular space

Superior: subscapularis, teres

minor and shoulder joint capsule
Inferior: teres major muscle
Medial: long head of triceps
Lateral: surgical neck of the
humerus

Contents: axillary nerve and the

posterior circumflex humeral vessels

3. Triangular space
Upper triangular

SHOULDER, ELBOW, AND FOREARM Superior: subscapularis

1. Axilla (anteriorly), teres minor (posteriorly)
Borders Inferior: teres major
Lateral: long head of triceps
Apex: clavicle, superior border of
scapula, 1st rib Contents: circumflex scapular
Base: anterior axillary fold vessels

Walls Lower triangular

Anterior: pectoralis major and Superior: teres major

minor, subclavius Medial: long head of triceps
Posterior: subscapularis, Lateral: shaft of humerus
latissimus dorsi, teres major
Medial: upper 4-5 ribs and ICS, Contents: radial nerve, profunda
serratus anterior brachii vessels
Lateral: coracobrachialis, biceps
brachii, bicipital groove of humerus

Contents: axillary artery/vein, lymph

nodes

Clavipectoral fascia
From clavicle (splits to
enclose pectoralis minor, continues
as suspensory ligament) to fascial
floor of axilla

Pectoralis minor

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 UPPER EXTREMITIES

Intermediate
FDS
Deep
FDP
FPL
PQ – both origin and insertion
are in forearm
Posterior
Superficial
ECRB
ED
EDM
ECU
Anconeus – initiator of elbow
extension
Deep
Supinator – upper/proximal
4. Cubital fossa part
Borders APL

Medial: pronator teres EPB

Lateral: brachioradialis
EPL
Superior: imaginary line between
two epicondyles of humerus EIP – most medial in deep
Roof: supinator (lateral), brachialis compartment
(medial)
Lateral
Contents: median nerve, bifurcation
of the brachial artery into ulnar and Brachioradialis
radial arteries, tendon of the biceps ECRL
muscle, radial nerve and its deep
branch (Medial to lateral: Media at Anatomic snuffbox
Radio)
Medial: EPL
5. Muscles
Lateral: APL, EPB
Anterior
Floor: scaphoid
Superficial
FCU *Tenderness: Fx of scaphoid
PL
FCR
PT – 2 heads are pierced by Lister’s tubercle
median nerve It is where tendon of EPL passes

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 UPPER EXTREMITIES

Quadrate ligament (Stop Letting Those People Touch The

Cadaver’s Hand)
Stabilizes proximal radioulnar joint
Oblique ligament
It limits pulling; perpendicular to
interosseous membrane; runs inferiorly and
laterally
Interosseous membrane
It limits pushing or too much
movement of radius and ulna; runs inferiorly
2. Metacarpals
and medially
Parts: base, shaft, head
WRIST, HAND, AND FINGERS
1st metacarpal: thickest and shortest
1. Carpals metacarpal
Proximal row (lateral to medial) 3rd metacarpal: metacarpal with
a. Scaphoid (boat shaped) styloid process
- Most commonly fractured
ORDER OF OSSIFICATION
- Largest in proximal row
Capitate: at birth
b. Lunate (moon or crescent
shaped) Hamate: immediately after birth
- 2nd most commonly Triquetrum: 2 ½ y/o
fractured
Lunate: 3 ½ y/o
- Most commonly dislocated
Trapezium and trapezoid: 5-6 y/o
c. Triquetrum (triangular)
Scaphoid: 5-6 y/o
d. Pisiform (pea shaped)
Pisiform: 10-12 y/o
- Placed above triquetrum
CLINICAL CORRELATES
Distal row (lateral to medial)
Fracture of the Scaphoid
e. Trapezium
- Occurs after a fall on the
f. Trapezoid outstretched hand, shows a deep
tenderness in an anatomical
g. Capitate
snuffbox, and damages the radial
- Largest carpal bone artery and cause avascular
necrosis of the bone and
- Keystone of palmar arch degenerative joint disease of the
wrist

h. Hamate Preisser’s Disease

- Avascular necrosis of scaphoid

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 UPPER EXTREMITIES

Keinbock’s Disease Carpal Tunnel Syndrome

- Avascular necrosis of lunate - Caused by compression of the
median nerve due to the
Fracture of the Hamate
reduced size of the osseofibrous
- May injure the ulnar nerve and carpal tunnel, resulting from
artery because they are near inflammation of the flexor
hook of hamate retinaculum, arthritic changes in
the carpal bones, or
Bennett’s Fracture inflammation or thickening of the
- Fracture of the base of the synovial sheaths of the flexor
metacarpal of the thumb tendons

Boxer’s Fracture Guyon’s canal

- Fracture of the necks of the - Formed by the pisiform, hook of

second and third metacarpals, hamate and pisohamate
seen in professional boxers, and ligament, deep to the palmaris
typically of the fifth metacarpal in brevis and palmar carpal
unskilled boxers ligament and transmits the ulnar
nerve and artery
Flexor retinaculum
Guyon’s Canal Syndrome
- Thickening of deep fascia that
holds the long flexor tendons in - Entrapment of the ulnar nerve in
position at the wrist the Guyon’s canal, which causes
- Stretches across the front of the pain, numbness, and tingling in
wrist and converts the concave the ring and little fingers,
anterior surface of the hand into followed by loss of sensation
an osteofascial tunnel, the and motor weakness.
carpal tunnel. Extensor retinaculum
Attachments: - Thickening of deep fascia that
Medially: hook of hamate and stretches across the back of the
pisiform wrist and holds the long extensor
tendons in position
Laterally: scaphoid and
trapezium Tunnels:

Carpal tunnel 1 – APL, EPB

- Formed anteriorly by the flexor 2 – ECRL, ECRB

retinaculum and posteriorly by 3 – EPL
the carpal bones
- Transmits median nerve and 4 – ED, EI
tendons of FPL, FDP, FDS
5 – EDM
- Contains 10 tendons; 11
structure: 4 FDS, 4 FDP, FCR, 6 – ECU
FPL and median nerve
JOINTS OF THE WRIST AND HAND

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 UPPER EXTREMITIES

Radiocarpal joint: synovial-condyloid

Intercarpal joints: synovial-plane
Carpal-metacarpal (2-5): synovial-plane
Trapezium-metacarpal 1: synovial-saddle
Metacarpal-phalangeal: synovial-condyloid
Interphalangeal: synovial-hinge
ALL DIARTHROSES

SIGNIFICANT FUNCTIONAL ROLE

OF THE HANDS
Power grip
- Forcible motion of the digits
acting against the palm
- Involves the long flexor muscles
to the fingers (acting on the IP
joints)
- The intrinsic muscles in the palm
(acting on the MCP joints)
- Extensors of the wrist
(radiocarpal and midcarpal joints)
Hook grip
- Posture of the hand that is used
when carrying a briefcase
- Consumes less energy
- Involves mainly the long flexors of
the fingers
Precision handling grip
- Involves a change in the position
of a handled object
- Requires fine control of the
movements of the fingers and
thumb
Pinching
- Compression of something
between the thumb and the index
finger

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 UPPER EXTREMITIES

MUSCLES CONNECTING THE UPPER LIMB TO THE THORACIC WALL

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Pectoralis Major Sternal half of Lateral lip of Medial and Shoulder
clavicle, sternum bicipital groove lateral pectoral FADIR
and upper 6 nerve
costal cartilages
Pectoralis 3rd-5th ribs Coracoid Medial pectoral Depresses and
Minor process of nerve protracts
scapula scapula
Subclavius 1st costal Clavicle Nerve to Depresses
cartilage subclavius clavicle
Serratus Upper 8 ribs Medial border Long thoracic Protracts and
Anterior and inferior nerve rotates scapula
angle of and holds it
scapula against thoracic
wall

MUSCLES CONNECTING THE UPPER LIMB TO THE VERTEBRAL COLUMN

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Trapezius Occipital bone; Upper fibers: Spinal part of Upper fibers:
ligamentum Lateral 3rd of accessory Elevates
nuchae, spine of clavicle nerve and C3 scapula
7th cervical Middle fibers: and C4 nerves Middle fibers:
vertebra, spines Acromion of Retracts and
of all thoracic scapula rotates scapula
vertebrae Lower fibers: Lower fibers:
Spine of scapula Depresses
medial border
of scapula
Latissimus Iliac crest, Floor of bicipital Thoracodorsal Shoulder
Dorsi lumbar fascia, groove nerve EXADIR
spines of lower
6 thoracic
vertebrae,
lower 3 or 4
ribs and inferior
angle of
scapula
Levator Transverse Medial border C3 and C4 Elevates the
Scapulae process of C1- of scapula dorsal scapular medial border
C4 nerve of scapula
Rhomboid Ligamentum Medial border Dorsal scapular Retracts and
Minor nuchae, spines of scapula nerve downward

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 UPPER EXTREMITIES

of C7 and T1 rotates the

vertebrae scapula
Rhomboid Spinous Medial border Dorsal scapular Retracts and
Major process of T2- of scapula nerve downward
T5 vertebrae rotates the
scapula

MUSCLES CONNECTING THE SCAPULA TO THE HUMERUS

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Deltoid Anterior: Deltoid Axillary nerve Anterior:
Lateral 3rd of tuberosity of Shoulder FIR
clavicle humerus Middle:
Middle: Shoulder AB
Acromion of Posterior:
scapula Shoulder EXER
Posterior:
Spine of scapula
Supraspinatus Supraspinous Greater Suprascapular Shoulder AB
fossa of tubercle of nerve
scapula humerus
Infraspinatus Infraspinous Greater Suprascapular Shoulder ER
fossa of tubercle of nerve
scapula humerus
Teres Major Lower 3rd of Medial lip of Lower Shoulder ADIR
lateral border of bicipital groove subscapular
scapula nerve
Teres Minor Upper 2/3 of Greater Axillary nerve Shoulder ER
lateral border of tubercle of
scapula humerus
Subscapularis Subscapular Lesser tubercle Upper and Shoulder IR
fossa of humerus lower
subscapular
nerve

MUSCLES OF THE ANTERIOR COMPARTMENT OF ARM

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Biceps Brachii Long head: Radial Musculocutaneous Elbow F and
Supraglenoid tuberosity and nerve forearm
tubercle of fascia of supinator
scapula forearm via
Short head: bicipital
Coracoid aponeurosis
process of
scapula

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 UPPER EXTREMITIES

Coracobrachialis Coracoid Middle 3rd of Musculocutaneous Shoulder

process of medial surface nerve FAD
scapula of humerus
Brachialis Distal half of Coronoid Musculocutaneous Elbow F
anterior process of nerve
surface of ulna
humerus

MUSCLES OF THE POSTERIOR COMPARTMENT OF ARM

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Triceps Brachii Long head: Olecranon Musculocutaneous Elbow EX
Infraglenoid process of ulna nerve
tubercle of
scapula
Lateral head:
Upper half of
posterior
surface of
humerus
Medial head:
Lower half of
posterior
surface of
humerus

MUSCLES OF THE ANTERIOR FASCIAL COMPARTMENT OF THE FOREARM

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Pronator Teres Humeral head: Lateral aspect of Median nerve Forearm
Medial shaft of radius pronation and
epicondyle of elbow F
humerus
Ulnar head:
Medial border of
coronoid
process of ulna
Flexor Carpi Medial Base of 2nd and Median nerve Wrist FAB
Radialis epicondyle of 3rd metacarpals
humerus
Palmaris Medial Distal half of Median nerve Wrist F
Longus epicondyle of flexor
humerus retinaculum
and palmar
aponeurosis
Flexor Carpi Humeral head: Pisiform, hook Ulnar nerve Wrist FAD
Ulnaris of hamate and
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 UPPER EXTREMITIES

Medial base of 5th

epicondyle of metacarpal
humerus bone
Ulnar head:
Medial aspect
of olecranon
process and
posterior border
of ulna
Flexor Humeroulnar Middle phalanx Median nerve PIP F and wrist
Digitorum head: of medial 4 F
Superficialis Medial fingers
epicondyle of
humerus,
medial border
of coronoid
process of ulna
Radial head:
Oblique line on
the anterior
surface of the
shaft of radius
Flexor Pollicis Anterior surface Distal phalanx Anterior Flexion of distal
Longus of the shaft of of thumb interosseous phalanx of
radius branch of thumb
median nerve
Flexor Anteromedial Distal Medial part: DIP F and wrist
Digitorum surface of shaft phalanges of Ulnar nerve F
Profundus of ulna medial 4 Lateral part:
phalanges Median nerve
Pronator Distal fourth of Distal fourth of Anterior Forearm
Quadratus anterior surface anterior surface interosseous pronation
of shaft of ulna of shaft of branch of
radius median nerve

MUSCLES OF THE LATERAL FASCIAL COMPARTMENT OF THE FOREARM

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Brachioradialis Proximal 2/3 of Base of styloid Radial nerve Elbow F,
lateral process of rotates the
supracondylar radius forearm in mid-
ridge of humerus prone position
Extensor Carpi Distal third of Posterior Radial nerve Wrist EXAB
Radialis lateral surface of base
Longus supracondylar of 2nd
ridge of metacarpal
humerus bone

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 UPPER EXTREMITIES

MUSCLES OF THE POSTERIOR FASCIAL COMPARTMENT OF THE FOREARM

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Extensor Carpi Lateral Posterior Deep branch of Wrist EXAB
Radialis Brevis epicondyle of surface of 3rd radial nerve
humerus metacarpal bone
Extensor Lateral Middle and Deep branch of Finger EX
Digitorum epicondyle of distal radial nerve
humerus phalanges of
medial 4 fingers
Extensor Digiti Lateral Extensor Deep branch of Extension of
Minimi epicondyle of expansion of radial nerve MCP of little
humerus little finger finger
Extensor Carpi Lateral Base of the 5th Deep branch of Wrist EXAD
Ulnaris epicondyle of metacarpal radial nerve
humerus bone
Anconeus Lateral Lateral surface Radial nerve Elbow EX
epicondyle of of the
humerus olecranon
process of ulna
Supinator Lateral Neck and shaft Deep branch of Forearm
epicondyle of of radius radial nerve supination
humerus,
supinator crest
of ulna
Abductor Posterior Base of 1st Deep branch of Thumb EXAB
Pollicis Longus surface of metacarpal radial nerve
shafts of radius bone
and ulna
Extensor Posterior Dorsal base of Deep branch of Thumb MCP
Pollicis Brevis surface of proximal radial nerve EX
shafts of radius phalanx of
thumb
Extensor Posterior Dorsal base of Deep branch of Extension of
Pollicis Longus surface of shaft distal phalanx radial nerve distal phalanx
of ulna of thumb of thumb
Extensor Indicis Posterior Extensor Deep branch of Extension of
surface of shaft expansion of radial nerve MCP of little
of ulna little finger finger

SMALL MUSCLES OF THE HAND

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Palmaris Brevis Palmar Skin of medial Superficial Corrugates skin
aponeurosis and border of palm branch of ulnar to improve grip
flexor nerve of palm
retinaculum

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 UPPER EXTREMITIES

Lumbricals Tendons of Extensor 1st and 2nd: MCP flexion, IP

FDP expansion of Median nerve finger extension
medial 4 fingers 3rd and 4th:
Deep branch of
ulnar nerve
Palmar Sides of Bases of Deep branch of Adduct digits
Interossei metacarpals proximal ulnar nerve toward axial
2,4,5 phalanges and line of hand (3rd
extensor digit); flexes
expansion of digits at MCP
digits 2,4,5 joint and
extends IP
joints
Dorsal Contiguous Bases of Deep branch of Abducts digits
Interossei sides of shafts proximal ulnar nerve from axial line
of metacarpal phalanges, of hand (3rd
bones extensor digit); flexes
expansion of digits at MCP
digits 2-4 joint and extend
IP joint

SHORT MUSCLES OF THUMB

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY
Abductor Pollicis Scaphoid, Base of proximal Median nerve Thumb AB
Brevis trapezium, flexor phalanx of
retinaculum thumb
Flexor Pollicis Flexor Base of Median nerve MCP thumb
Brevis retinaculum proximal flexion
phalanx of
thumb
Opponens Flexor Shaft of the 1st Median nerve Thumb
Pollicis retinaculum metacarpal opposition
Adductor Oblique head: Base of Deep branch of Thumb
Pollicis 2nd and 3rd proximal ulnar nerve adduction
metacarpals phalanx of
Transverse thumb
head:
Anterior surface
of 3rd
metacarpal

SHORT MUSCLES OF LITTLE FINGER

MUSCLE ORIGIN INSERTION NERVE ACTION
SUPPLY

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 UPPER EXTREMITIES

Abductor Digiti Pisiform bone Base of proximal Deep branch of Abduction of

Minimi phalanx of little ulnar nerve little finger
finger
Flexor Digiti Flexor Base of Deep branch of Flexes little
Minimi retinaculum proximal ulnar nerve finger
phalanx of little
finger
Opponens Flexor Medial border Deep branch of Little finger
Digiti Minimi retinaculum of 5th ulnar nerve opposition
metacarpal
bone

BIANCA OLLER, PLM BSPT 1-4 17