Upper Limb

Upper Limb

1. Shoulder

   • Pectoral Girdle
     • Scapula
       • Superior Border
         • Coracoid Process
         • Suprascapular notch
       • Glenoid Cavity
       • Infraglenoid Tubercle
       • Supraglenoid Tubercle
       • Acromion
     • Clavicle
       • Joints
         • Sternoclavicular
           • Between Clavicular notch and manubrium of the sternum
           • Ligaments
             • Anterior & Posterior Sternoclavicular Ligaments
             • Interclavicular (between 2 clavicles & superior manubrium)
             • Costoclavicular (Proximal end of clavicle to 1st rib)
         • Acromioclavicular
           • Ligaments
             • Acromioclavicular: Superior to joint, between clavicle & Acromion
             • Coracoclavicular
               • Trapezoid: Trapezoid line of clavicle to coracoid process
               • Conoid: Coinoid tubercle of clavicle to coracoid process
   • Proximal Humerus
     • Head
       • Glenohumeral Joint
     • Anatomical Neck
     • Greater Tubercle
       • Facets
         • Inferior
           • Supraspinatus Muscle
         • Middle
           • Infraspinatus Muscle
         • Superior
           • Teres Minor Muscle
     • Lesser Tubercle
       • Subscapularis Muscle
       • Intertubercular sulcus (bicipital groove)
         • Lateral Lip
           • Pectoralis Major Muscle
         • Floor
           • Latissimus Dorsi Muscle
         • Medial Lip
           • Theres Major Muscle
     • Surgical Neck

2. Forearm

   • Radius
     • Proximal End
       • Head
         • Articulates with capitulum and distally with the radial notch of the ulna
       • Neck
         • Short and narrow
       • Radial Tuberosity
         • Large, blunt projection, inferior to the neck, attachment for biceps brachii
     • Triangular Cross Section
       • Anterior, Posterior & Interosseous borders
       • Anterior, Posterior & Lateral Surfaces
       • Flattened distally, has A, P, L & M surfaces
   • Ulna
     • Olecranon
       • Large projection, extending proximally, articulates with trochlea anterolaterally, superior edge is rough enabling triceps brachii attachment
     • Coronoid Process
       • Projects anteriorly, links with Olecranon
     • Trochlear Notch
       • Formed by Olecranon and Coronoid Process
     • Radial Notch
       • Articulates with the radius
     • Tuberosity of the ulna
       • Largest roughening on anterior surface or Coronoid Process: attachment for brachialis muscle
     • Triangular Cross Section
       • Anterior, Posterior & Interosseous borders
       • Anterior, Posterior & Medial Surfaces
       • Distal end is small, rounded and has 'ulnar Styloid Process'
   • Divided into compartments:
     • Lateral intermuscular septum, interosseous membrane, attachment of deep fascia
     • Anterior
       • 3 Muscle Layers
         • Superficial (4 Muscles)
           • Flexor Carpi Ulnaris
             • Has second origin at olecranon, attaches to the pisiform distally
           • Palmaris Longus
             • Attaches to deep fascia/palmar aponeurosis , flexor of wrist
           • Flexor Carpi Radialis
             • Attaches to anterior metacarpals II & III, flexor & abductor, lage tendon immediately medial to radial pulse
           • Pronator Teres
             • Also originates supraepicondylar ridge, attaches to lateral surface of mid-radius
           • All originate from medial epicondyle
         • Intermediate (1 Muscle)
           • Flexor digitorium superficialis
             • 2 heads:
               • Humero-ulnar head: from medial epicondyle and medial head of coronoid process
               • Radial Head: Anterior oblique line of radius
             • Forms 4 tendons: split and pass posteriorly around proximal phalanx and attach to middle phalanx, tendons for ring & middle finger are superficial to index & little finger
               • Flexion of MCPJ, IPJ & Wrist
         • Deep (3 Muscles)
           • Flexor digitorium profundus
             • Origin: Anterior & Medial surfaces ulna & adjacant interosseous membrane. Becomes 4 tendons inserting on bases of distal phalanges
             • Flexes MCPJ, PIPJ, DIPJ & Wrist
             • Lateral 1/2- anterior interosseous nerve, Medial 1/2- ulnar nerve
           • Flexor pollicis longus
             • Origin: Anterior surface of radius & adjacent interosseous membrane, single tendon attaching to distal phalanx of thumb
             • Anterior interosseous nerve
           • Pronator quadratus
             • Origin: Linear ridge on anterior surface of ulna, inserting on anterior surface of radius, moves distal end of radius to pronate
             • Anterior Interosseous nerve
     • Posterior
       • Superficial Layer (7 Muscles)
         • Brachioradialis
           • Origin: Proximal supraepicondylar ridge, inserts lateral distal radius, accessory flexor
         • Extensor carpi radialis longus
           • Origin: Distal supraepicondylar ridge & lateral epicondyle. Tendon to dorsal base of 2nd metacarpal. Extends & abducts the wrist.
         • Extensor carpi radialis brevis
           • Origin: Lateral epicondyle, tendon inserts base of metacarpals II & III, extends and abducts the wrist.
         • Extensor digitorium
           • Origin: Lateral epicondyle. Forms 4 tendons inserting into extensor hoods on middle/distal phalanges. Extensor of fingers.
         • Extensor digiti minimi
           • Accessory extensor of little finger.
         • Extensor carpi ulnaris
           • From Lateral epicondyle, tendon inserting into medial 5th metacarpal. Extends & adducts wrist.
         • Anconeus
           • From lateral Epicondyle to posterolateral surface of olecranon, abducts the ulna.
       • Deep Layer (5 Muscles)
         • Supinator
           • 2 heads: Superficial- lateral epicondyle and deep- supinator crest on posterolateral ulna. Inserts on proximal radius. Supinates forearm
         • Abductor pollicis longus
           • Origin: Proximal posterior surface of radius, ulna & interosseous membrane. Tendon inserts lateral side of 1st metacarpal, abducts thumb at proximal joint of MCP.
         • Extensor pollicis brevis
           • Origin: Posterior radius & interosseous membrane. Inserts into dorsal base of proximal phalanx of thumb. Extends MCPJ
         • Extensor pollicis longus
           • Origin: Posterior ulna/adjacent interosseous membrane, tendon inserts into distal phalanx of thumb, extends all thumb joints.
         • Extensor indicis
           • Origin: Posterior surface of ulnar & interosseous membrane (distal to extensor pollicis longus) passes into extensor hood of index finger. Accessory extensor of index finger.

3. Arm

   • Humerus
     • Triangular, 3 surfaces and 3 borders
       • Anterior, Lateral & Medial borders
         • Intermuscular septa attach to lateral & Medial Borders
       • Anterolateral, Anteromedial & Posterior surfaces
         • Posterior surface has attachment for lateral head of triceps brachii (inferior to Surgical Neck)
         • Radial Groove between posterior and anterolateral surfaces. Radial Nerve & Profunda brachii artery lie in this grove.
     • Distal End: condyle, 2 epicondyles & 3 fossae
       • Condyle has 2 articular parts:
         • Capitulum
           • Articulates with Radius
           • Lateral, anterior, not visible posteriorly
         • Trochlea
           • Articulates with Ulna
           • Medial, Extends posteriorly
       • Epicondyles
         • Lateral
           • Attachment for posterior compartment muscles
         • Medial
           • Large, palpable protuberance, attachment for anterior compartment muscles
       • Fossae (Superior to Condyle)
         • Radial
           • Least Distinct, immediately superior to capitulum
         • Coronoid
           • Adjacent to Radial Fossa, superior to trochlea
         • Olecranon
           • Largest, superior to trochlea on posterior surface
     • Muscle Compartments
       • Anterior
         • Corachobrachialis
           • Coracoid Process of Scapula to medial midshaft Humerus
             • Flexes Arm
         • Brachialis
           • Short-head from coracoid process, long-head from supraglenoid tubercle, attaches to radial tuberosity
             • Flexes arm and glenohumeral joint
         • Biceps Brachii
           • Originates from distal half of anterior humerus, underlying biceps brachii, attaches to tuberosity of ulna
         • Musculocutaneous innveration
       • Posterior
         • Triceps Brachi
           • 3 heads
             • Long-head from infraglenoid tubercle
             • Medial-head from inferior to radial groove
             • Lateral head from roughening superior to radial groove
           • Attaches to superior surface of olecranon
             • Extends forearm
           • Radial nerve innervation

4. Wrist

   • Carpal Bones
     • Proximal
       • Pisiform (pea shaped)
       • Triquetrum (three sided)
       • Lunate (crescent)
       • Scaphoid (boat shaped)
     • Distal
       • Hamate (Has a hook)
       • Capitate (Has a head)
       • Trapezoid (4 sided)
       • Trapezium (irreg. 4 sided)
     • Form carpal tunnel: Carpal arch (anterior facing) formed by carpal bones. Posterior (roof) formed by flexor retinaculum ligament,
       • Structures passing through tunnel:
         • 4 Tendons of Flexor Digitorum Profundus, 4 Tendons of Flexor Digitorum Superficialis (share a sheath)
         • Tendon of Flexor Pollicis Longus
         • Median nerve passes anterior to tendon
       • Ulnar Nerve, Ulnar artery & Palmaris longus tendon are anterior to carpal tunnel

5. Hand

   • 5 Metacarpals
   • Phalanges
     • Thumb: Distal, Proximal
     • 4 Fingers: Distal, Middle, Proximal
   • Intrinsic Muscles (Execute Precision Movements)
     • Palmar brevis
     • Interossei
     • Thenar
     • Hypothenar
     • Lumbrical
     • Median Nerve (T1/C8)