1 Upper Limb
BY
Hamza G. Adamu
Anatomy Unit
Capital City University, Kano
2 Upper Limb
Its consists of the following
Divisions:
1. Shoulder/Pectoral Girdle
(Pectoral, Scapular, and
lateral Supra-clavicular
regions)
2. Arm (Brachium)
3. Forearm (Antebrachium)
4. Hand
3 Shoulder/Pectoral Girdle
Its also consists of three regions:
1. Pectoral region
2. Scapular region
3. Lateral Supra-clavicular region
4 Bones of the Pectoral Girdle
1. Clavicle
2. Scapula
3. Humerus (Proximal
and Distal)
5 Clavicle
Clavicle lies almost
horizontally and superficial
throughout its whole length.
It connects the upper limb to
the trunk
6 Clavicle
Its Medial (sternal) end: is enlarged and triangular where its
articulates with the manubrium of the sternum to form
sternoclavicular (SC) joint.
Its lateral (Acromial) end: is flattened and articulates with
the with the medial side of the acromion to
acromioclavicular (AC) joint
7 Clavicle
The medial two thirds of the
shaft of the clavicle are convex
anteriorly
The Lateral third is flattened and
concave anteriorly.
The superior surface of the
clavicle is smooth while the
inferior surface is rough.
8 Scapular
The scapula (shoulder blade) is a triangular flat bone that
lies on the posterolateral aspect of the thorax.
The convex posterior surface is unevenly divided by a thick
projecting ridge into a small supraspinous fossa and a much
larger infraspinous fossa.
The concave anterior (costal) surface of most of the scapula
forms a large subscapular fossa.
9
10 Scapular
Scapular comprises:
Three angles (inferior, lateral and superior angles)
Three borders (superior, medial and lateral)
Three processes (acromion, spine and coracoid process)
Two surfaces (Anterior/costal and posterior)
11
12 Humerus
The humerus, the longest
and largest bone in the upper
limb.
Its articulates with the
scapula at the glenohumeral
joint and the radius and ulna
at the elbow joint
13 Humerus
The humerus consists of three parts;
1. Proximal end of the humerus
2. Shaft
3. Distal end of the humerus
14 Proximal end of the humerus
The proximal end of the
humerus consists:
1. The head
2. The neck (surgical and
anatomical necks)
3. The Tubercles (the greater
and lesser tubercles).
15 Proximal end of the humerus
The greater and lesser tubercles indicates a junction between
shaft of the humerus and head and neck
The greater tubercle is at the lateral margin of the humerus
while the lesser tubercle projects anteriorly from the bone.
The intertuberous sulcus (bicipital groove) lies between the
tubercles and contains the long head tendon of biceps as
well as ascending branch from the anterior circumflex
humeral artery
16 The Shaft
The shaft (body) is the region
between proximal and distal
part of the humerus.
It has two prominent features;
1. The deltoid tuberosity
(laterally)
2. Oblique radial groove
(posteriorly)
17 The Shaft
Deltoid tuberosity provide
attachment for deltoid muscle.
The oblique radial groove
contains, the radial nerve and
deep artery of the arm.
The Shaft’s inferior end widens to
form medial and lateral
supraepicondylar ridges and
epicondyle respectively.
18 Distal end of the humerus
The distal end of the humerus,
including:
1. The trochlea
2. The capitulum
3. The olecranon, coronoid, and
radial fossae
Note: 1-3 makes up the condyle
of the humerus
19 Distal end of the humerus
The condyle has two articular
surfaces:
1. Lateral capitulum:-
articulation with the head of
the radius
2. Medial trochlea:-
articulation with the proximal
end (trochlear notch) of the
ulna
20 Pectoral Region
Compartments
Superficial
• Skin
• Superficial fascia
• Breast
Deep
• Muscles
• Pectoralis major
• Pectoralis minor
• Subclavius
21 Pectoralis Major
Pectoralis Major: - is the most
superficial and largest muscle in
the pectoral region.
Origin:- It has two heads of
attachments;
• The clavicular head: anterior
surface of medial half of
clavicle.
22 Pectoralis Major
• The Sternocostal head:
anterior surface of the
sternum and superior six
costal cartilages, aponeurosis
of external oblique muscle.
Insertion:- both two heads
attached onto lateral lip of
intertubercular groove of
humerus.
23 Pectoralis Major
Innervation:- Lateral and medial pectoral nerves.
Action: - Adduction, Medial rotation, and Flexion of
humerus at shoulder joint.
24 Pectoralis Minor
Pectoralis Minor:is triangular
in shape & lies underneath
pectoralis major.
Origin:- 3rd-5th ribs near their
costal cartilages.
Insertion:- coracoid process of
the scapula.
Innervation:- Medial pectoral
nerve
Action:- Stabilises the scapula
25 Subclavius
Subclavius:- small muscle lies
inferior to clavicle.
Origin:- Junction of 1st rib and
its costal cartilage.
Insertion:- Inferior surface of
middle third of clavicle.
Innervation:- Nerve to
subclavius.
Action:- Anchors and depresses
the clavicle.
26 Serratus Anterior
Serratus Anterior:- lies more
laterally in the chest wall and
forms the medial border of the
axilla. region.
Origin:- External surfaces of
lateral parts of 1st – 8th ribs.
Insertion:- Anterior surface of
medial border of scapula
27 Serratus Anterior
Innervation:-Long
thoracic nerve.
Action:- Protracts scapula
and holds it against
thoracic wall.
28 Female Breast
Rudimentary in men (lack
glandular system), well developed
in females at puberty
Location:
It lies within the superficial fascia.
Extent:
Vertically: extends from 2nd to 6th
ribs
Horizontally: extends from
lateral border of the sternum to the
midaxillary line laterally.
29 Breast Structure
The mammary glands are
modified sweat glands; hence,
they have no special capsule or
sheath.
Its consists of 15-20 lobes and
lobules which are embedded
within subcutaneous fatty tissue
of superficial fascia.
30 Breast Structure
It has fibrous strands (ligaments
of cooper) which connect the
skin with deep fascia of
pectoralis major.
It is separated from the deep
fascia covering the underlying
muscles by a layer of loose
areolar tissue which forms the
retromammary space.
31 Blood Supply
The arterial supply of the breast from:
1. Medial mammary perforating branches and anterior
intercostal branches of the internal thoracic artery (subclavian
artery).
2. Lateral thoracic and thoracoacromial arteries, branches of the
axillary artery (Axillary artery).
3. Posterior intercostal arteries (Thoracic aorta)
32 Blood Supply
33 Blood Supply
The breast venous drainages
to the corresponding arteries.
First Circular venous plexus
are form at the base of nipple.
Finally, veins of this plexus
drain into axillary & internal
thoracic veins.
34 Lymph Node Stations
1. Axillary Lymph Node:-
They are arranged into 5
groups which lie in axillary
fat;
i. Pectoral (Anterior) group
ii. Subscapular (Posterior)
group
iii. Brachial (Lateral) group
iv. Central group
v. Apical group.
35 Lymph Node Stations
2. Parasternal Lymph Node
3. Others: clavicular
(infraclavicular and
supraclavicular), posterior
intercostal, Deltopectoral
lymph nodes.
36 Lymphatic Drainage
The lymphatic drainage of the
breast is important because of
its role in the metastasis of
cancer cells.
Lymph passes from the nipple,
areola, and lobules of the
gland drains into subareolar
lymphatic plexus.
37 Lymphatic Drainage
38 Lymphatic Drainage
Lymph (85%) from subareolar lymphatic plexus drains into
axillary lymph nodes (especially lateral breast quadrants).
Remaining lymph (10%) drains to the parasternal lymph nodes
or to the opposite breast.
Lymph from the skin of the breast, except the nipple and areola,
drains into the ipsilateral axillary, inferior deep cervical, and
infraclavicular lymph nodes or the parasternal lymph nodes of
both sides.
