Outline of this region

Introduction
Bones of the upper limb
Superficial structures of
UL
Muscles of UL
Blood supply of UL
Axilla
Brachial plexus
Arm
Cubital fossa
Forearm
Hand
Joints of UL
Clinical condition of UL
 THE UPPER LIMB
It is associated with the lateral aspect of the lower portion of the neck.
It is suspended from the trunk by muscles and a small skeletal articulation
b/n the clavicle and the sternum- at the sternoclavicular joint
is characterized by its
Multi-jointed lever
ability to grasp, strike, and
conduct fine motor skills (manipulation)
 cont

consists of 4 segments
Shoulder: pectoral girdle
Arm: (L. brachium)
Forearm (L. antebrachium):
Hand (L. manus):
 BONES OF UPPER LIMB

The UL contains the

following bones
1. Shoulder girdle - Clavicle
and scapula

2. Arm Humerus

3. Forearm - Radius and ulna

4. Hand - Carpals, metacarpals

and phalanges
 SHOULDER
Is the proximal segment of UL &
divide in to axillary, pectoral &
scapular regions,.
Its bone framework consists of
clavicle
scapula, and
the proximal end of the humerus.
 (collar bone)
It is a long slender bone with a double curvature.
It extends from the sternum laterally to the acromion
process of the scapula .
It has two ends

acromial end sternal end

7
 Cont
sternal end: is enlarged
and triangular articulates
with manubrium of the
sternum at the
sternoclavicular (SC) joint

acromial end: flat

articulates with acromion
of scapula at the
acromioclavicular (AC)
joint
 Cont
Function of clavicle
Connects the UL to the trunk
Attachment site for muscles of the
thorax and shoulder
Forms one of the bony boundaries of
the cervico-axillary canal and
Afford protection to the neurovascular
bundle supplying the upper limb
Transmits shocks (traumatic impacts)
from the UL to the axial skeleton
 Fracture of clavicle
The weakest part is at the junction of its
middle and lateral thirds
After fracture
Sternocleidomastoid muscle elevates
the medial fragment of bone
trapezius muscle is unable to hold up
the lateral fragment owing to the
weight of the upper limb
results the shoulder drops
 Is a large triangular flat bone
lies on the posterolateral
aspect of the thorax, overlying
the 2nd-7th ribs

It has;

Three borders

Three angles

Three processes

Two surfaces
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 Right scapula
3 angles (superior,
lateral, and inferior);
3 borders (superior,
lateral, and medial);
3 processes
(acromion, spine, and
coracoid process)
2 surfaces (costal and
posterior).
 The superior border is the thinnest and shortest of the
three borders which contain suprascapular notch.
Anterior (costal) surface
shallow, concave, oval fossa that forms subscapular fossa
has a glenoid cavity laterally
Posterior (Dorsal) surface
convex
divided by spine into supraspinous and infraspinous fossa
spine continues laterally as flat expanded acromion which
articulates with the acromial end of the clavicle and
humerus .
Anterior Surface of scapula
Posterior Surface of scapula Lateral view
 The free upper limb
Arm
Humerus

Forearm
Ulna
Radius
Hand
Wrist (8 carpal bones)
Palm (5 metacarpal bones)
Fingers (14 phalanges)
 Humerus (arm bone)
Is the largest bone in the UL
It articulates with the scapula at the glenohumeral joint
and with the radius and ulna at the elbow joint
Its proximal end has;
Head =ball-shaped articulate with the glenoid cavity of
the scapula
Greater and lesser tubercles =separated by
intertubercular groove (bicipital groove)
Anatomical neck =formed by the groove circumscribing
the head and separating it from the greater and lesser
tubercles
Surgical neck (narrow part just distal to the tubercles)
 Cont
Its Shaft (body) has two prominent features:

deltoid tuberosity laterally for attachment of deltoid

muscle

radial (spiral) groove posteriorly for radial nerve and

deep artery of the arm

Its distal end has two articular surfaces &three fossa

capitulum: for articulation with the head of the radius

trochlea: for articulation with the trochlear notch of the

ulna
 Fractures of Humerus
Most injuries of the proximal end of the humerus are
fractures of the surgical neck.

These injuries are especially common in elderly people

with osteoporosis or from a direct blow to the arm.

Results a transverse fracture of the shaft of the humerus.

The displacement of the fragments depends on the

relation of the site of fracture to the insertion of the
deltoid muscle.
 Cont
1. If the fracture line is proximal to the deltoid insertion:
The proximal fragment is adducted by the
pectoralis major, latissimus dorsi and teres major.
The distal fragment is pulled proximally by deltoid,
biceps & triceps.
2. If the fracture line is distal to the deltoid insertion:
The proximal fragment is abducted (pull laterally
by deltoid
The distal fragment is pulled proximally by the biceps
& triceps
The radial nerve can be injured.
 Cont
the fracture line is distal to the deltoid insertion
 Cont
The following parts of the humerus are in direct contact
with the indicated nerves:
Surgical neck: axillary nerve.
Radial groove: radial nerve.
Distal end of humerus: median nerve.
Medial epicondyle: ulnar nerve.

N.B These nerves may be injured when the associated part

of the humerus is fractured
 Bones of Forearm
1.Ulna
is the medial and longer of the
two forearm bones

Its proximal end is specialized for

articulation with the humerus and
has two processes

Olecranon process, which projects

posteriorly
The two process form the
coronoid process projects walls of the trochlear notch
anteriorly which articulates with the
trochlea of the humerus
 2.Radius
The lateral and shorter of the two
forearm bones
Its proximal end consists of head,
neck, and radial tuberosity (a
projection from the medial surface)

1. Head
superiorly articulate with
capitulum of humerus
medially articulate with radial
notch of ulna
 Cont
2. Neck

between head and radial

tuberosity

3. Shaft (body)

gradually enlarges distally and

Distal end

medially - ulnar notch for head

of ulna

laterally - radial styloid process

 Fracture of radius
Colles fracture
Is in the distal end of the
radius
The most common fracture
of the forearm
It is due to a fall on the
outstretched or from forced
dorsiflexion of the hand
The distal fragment of the
radius is pulled posteriorly
and superiorly
28
 Radius
The posterior displacement
produces a posterior bump.
The deformity is referred to as,
dinner-fork deformity because
the forearm and wrist resemble
the shape of a dinner fork.
Smiths fracture
is a reversed Colles as the distal
segment is displaced anteriorly &
inferiorly
 8 carpal bone in two rows

5 metacarpal bone

14 phalanges

Totally 27 bones are found in each hand

N.B metacarpals and phalanges are numbered from

thumb to little finger .
Each carpus is made up of 8 carpal bones- arranged in two
rows.

1. Proximal row contains (from lateral to medial side)

Scaphoid---lunate----triquetral---pisiform .

2. Distal row contains in the same order

Trapezium---trapezoid--- capitate---hamate.

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 proximal row of carpals

1. Scaphoid , is boat shaped

on the lateral side.

2. Lunate , half moon-shaped .

3. Triquetal is pyramidal in
shape.

4. Pisiform , is pea shaped

 Distal row of carpals
5. Trapezium is quadrangular in
shape

6. Trapezoid- resembles shoe of a

baby.

7. Capitate- largest carpal bone with

a rounded head.

8. Hamate is wedge shaped with a N.B, Commonest injuries which

hook near its base occur in the carpus are

fracture of the scaphoid and
dislocation of the lunate.
 Composed of five bones and forms the skeleton of the p

Each metacarpal consists of a base, shaft, and head

Their proximal bases are articulate with the carpal bones

The distal heads articulate with the proximal phalanges

and form the metacarpophalangeal joint
 Phalanges
14 bones; form the fingers

Each digit has three phalanges (proximal, middle,& distal)

except for the first (thumb), which has only two
(proximal and distal) phalanges.

Each phalanx has a base proximally, a shaft (body), and a

head distally

The distal phalanges are flattened and expanded at their

distal ends, which underlie the nail beds
35
 Fascia of Upper Limb
Deep to the skin

subcutaneous tissue (superficial fascia) containing fat,

and

deep fascia surrounding the muscles.

 Superficial Veins of the Upper Limb
The main superficial veins are cephalic and basilic veins
They originate in the subcutaneous tissue on the dorsum of
the hand from the dorsal venous network
1. Cephalic vein
Ascends from lateral part of dorsal venous network
Proceed along anterolateral surface of forearm and arm
Anterior to elbow communicate with median cubital vein
Superiorly passes between deltoid and pectoralis major
muscles and enters clavipectoral triangle and
It pierces clavipectoral fascia and joins axillary vein
 Cont
2.Basilic vein
Ascends from medial part of dorsal venous network

Proceed along medial side of forearm and arm

It pierces the brachial fascia and running superiorly

parallel to the brachial artery to form the axillary vein

Median antebrachial vein (median vein of forearm)

Ascends in the middle of anterior aspect of forearm

between cephalic and basilic veins
Cont
 Deep Veins of UL
lie internal to the
deep fascia, and in
contrast to the
superficial veins
usually occur as
paired

They have same

name as, the major
arteries of the limb
 Venipuncture
Puncture of a vein to draw
blood or inject a solution

The median cubital vein is

commonly used.

The dorsal venous network

commonly used for long-
term introduction of fluids
 PECTORAL AND SCAPULAR REGIONS
Axioappendicular Muscles
Attach the appendicular skeleton to the axial skeleton
divided in to two anterior and Posterior group of
muscles
1.Anterior Axioappendicular Muscles
(thoracoappendicular or pectoral muscles ) move the
pectoral girdle
Four muscles that move the pectoral girdle
Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior
 Pectoralis major
is a large and fan-shaped
Covers superior part of thorax
has clavicular and sternal
attachments
Origin
C.H: medial half of clavicle
SC.H: sternum, superior six
costal cartilages
Insertion
Action
lateral lip of Intertubercular
groove of humerus Adducts and medially rotates
Innervation humerus;
Lateral and medial pectoral
nerves
 Pectoralis minor
Triangular and covered by
p.major
Origin: 3rd to 5th ribs near
their costal cartilages
Insertion: coracoid process of
scapula
Innervation: Medial pectoral
nn
Action:
Stabilizes scapula by drawing
it inferiorly
Elevates ribs in forced
inspiration
is useful anatomical and
surgical land mark...WAY??
 The subclavius muscle

Lies horizontally 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 ;Resists dislocation of sternoclavicular joint

 Serratus anterior (saw like)
Overlies lateral part of thorax

Forms medial wall of axilla

Origin: External surfaces of lateral parts of

1st to 8th ribs

Insertion: medial border of scapula

Innervation: Long thoracic nerve( C5, C6,

C7)

Action: strong protractor of the scapula

(sometimes called the boxer's muscle).
 Paralysis of serratus anterior
Paralysis of this muscle is due
to Injury of long thoracic
nerve.
hence,
Medial border of the scapula
moves laterally and
posteriorly away from
thoracic wall
Arm cannot be abducted
above horizontal position
And results in a "winged
scapula":
 Posterior Axioappendicular Muscles
Attach the superior appendicular skeleton to the axial skeleton

Divided into three groups

1. Superficial (extrinsic shoulder) muscles : trapezius and

latissimus dorsi

2. Deep (extrinsic shoulder) muscles : levator scapulae and

rhomboids

3. Scapulohumeral (intrinsic shoulder) muscles: deltoid, teres

major, and the four rotator cuff muscles (supraspinatus,
infraspinatus, teres minor, and subscapularis)
Posterior Axioappendicular Muscles
 Superficial Muscles
1) Trapezius
Attach pectoral girdle to
cranium and vertebral column
Covers posterior part of neck
and superior half of trunk
Fibers are divided into 3 parts
Superior (descending) part Innervation: Accessory

Middle part nerve (CN XI) (motor fibers)

and C3, C4 spinal nerves (pain
Inferior ( ascending) part
and proprioceptive fibers)
Cont
 2. Latissimus dorsii (L.widest of back)
Fan-shaped and Covers wide
area of back

Passes from trunk to humerus

Raises the body toward arms

during climbing and swimming

Innervation: Thoracodorsal
nerve
Muscle Origin Insertion Innervation Action

Trapezius Medial third of Lateral third Spinal Descending

superior nuchal line; of clavicle; accessory part elevates;
external occipital acromion nerve (CN XI) ascending part
protuberance; nuchal and spine of (motor fibers) depresses; and
ligament; spinous scapula &C3, C4 spinal middle part (or
processes of C7-T12 nerves (pain all parts
vertebrae and together)
proprioceptive retracts
) scapula;
Latissimu Spinous processes Medial lip Thoracodors Extends,
s dorsi of inferior 6 of al nerve adducts, and
medially
thoracic intertuber rotates
vertebrae, cular humerus;
thoracolumbar sulcus of raises body
fascia, iliac crest, humerus toward arms
and inferior 3 or 4 during climbing
ribs
 Injury of Thoracodorsal Nerve
This nerve is vulnerable to injury during;
Surgery in the inferior part of the axilla b/c it passes
inferiorly along the posterior wall of the axilla
mastectomies when the axillary tail of the breast is
removed.
surgery on scapular lymph nodes because its terminal part
lies anterior to them.
with paralysis of the latissimus dorsi, the person is unable
to raise the trunk with the upper limbs, during climbing.
 Branches of p.cord of brachial plexus, including thoracodorsal nerve
 Deep Muscles
1. Levator scapulae

Lies deep to(sternocleidomastoid) and trapezius muscles

Innervation: Dorsal scapular (C5) and cervical (C3, C4)

nerves

2. Rhomboids (major and minor)

Are rhomboid appearance that form parallel bands that

pass inferolaterally from vertebrae to medial border of
the scapula

Innervation: Dorsal scapular nerve (C5)

Deep Muscles
 Muscle Origin Insertion Innervation Action
Levator Posterior Medial border of Dorsal Elevates
scapulae tubercles of scapula superior to scapular (C5) scapula and
transverse root of scapular and cervical tilts its glenoid
processes of C1- spine (C3, C4) nerves cavity inferiorly
C4 vertebrae by rotating
scapula

Rhomboi Minor: nuchal Minor: medial Dorsal Elevates&

d minor ligament; end of scapular retract
and spinous scapular spine nerve scapula and
major processes of Major: medial rotate it to
C7 and T1 border of depress
vertebrae scapula from glenoid
level of spine cavity;
Major: spinous to inferior
processes of angle
T2-T5
vertebrae
 Scapulohumeral Muscles (Intrinsic Shoulder)
Six muscles

Are short muscles that pass from scapula to humerus and

they act on glenohumeral joint
 Deltoid muscle (inverted delta like)
Forming the rounded
contour of the shoulder
Divided into;
Clavicular (anterior),
Acromial (middle), and
Spinal (posterior) parts
When all three parts contract
simultaneously, the arm is
abducted
Innervation: Axillary nerve
 Teres major
Rounded muscle that lies
on the inferolateral third of
the scapula

Innervation: Lower
subscapular nerve

Action: Adducts and

medially rotates arm
 Rotator cuff muscles
Four of the Scapulohumeral
muscles:(referred to as the SITS
muscles) supraspinatus,
infraspinatus, teres minor, and
subscapularis.

They are Called rotator cuff b/c they

form a musculotendinous cuff
around glenohumeral joint

All except the supraspinatus are

rotators of the humerus

The supraspinatus initiates and

assists the first 15 of abduction the
deltoid muscle
Cont
 Supra and Infraspinatus
Origin: Supraspinous fossa and
Infraspinous fossa of scapula
respectively
Insertion: both greater tubercle
of humerus
Innervation: both
Suprascapular nerve
Action:
Supra spinatus= Initiates and
assists deltoid in abduction of arm.
Infraspinatus= Laterally rotate
arm; help hold humeral head in
glenoid cavity of scapula.
 Teres minor(L. teres, round)
Not clearly delineated from the
infraspinatus
N.B, It works with the infraspinatus
to rotate the arm laterally and
assist in its adduction. But it
distinguished from the
infraspinatus by its nerve supply.
The teres minor is supplied by
the axillary nerve, whereas the
infraspinatus is supplied by the
suprascapular nerve
 Subscapularis
lies on the costal surface of the
scapula
It crosses the anterior aspect of
the Scapulohumeral joint
Origin: Subscapular fossa
Insertion: Lesser tubercle of
humerus
Innervation: Upper and lower
subscapular nerves
Action: Medially rotates and
adduct arm; helps hold humeral
head in glenoid cavity

 Scapulohumeral Muscles (Intrinsic Shoulder)
Muscle Origin Insertion Innervation Action

Deltoid Lateral third of Deltoid Axillary nerve Clavicular (anterior)

clavicle; acromion tuberosity of (C5, C6) part: flexes and
and spine of scapula humerus medially rotates arm
Acromial (middle)
part: abducts arm
Spinal (posterior)
part: extends and
laterally rotates arm

Supra- Supraspinous fossa Superior facet of Suprascapular Initiates and assists

of scapula greater tubercle nerve (C4, C5, deltoid in abduction
spinatus
of humerus C6) of arm

Infra- Infraspinous fossa of Middle facet of Suprascapular Laterally rotates arm;

scapula greater tubercle of nerve (C5, C6)
spinatus humerus
 Scapulohumeral Muscles (Intrinsic Shoulder)
Muscle Origin Insertion Innervation Action

Teres Infraspinous fossa Inferior facet of Axillary nerve Laterally rotates

minor of scapula greater tubercle arm
of humerus

Teres Posterior surface of Medial lip of Lower Adducts and

major inferior angle of intertubercular subscapular medially rotates
scapula sulcus of nerve (C5, C6) arm
humerus

Sub- Subscapular fossa Lesser tubercle of Upper and Medially rotates

scapulari (most of anterior humerus lower arm; helps hold
surface of scapula subscapular head of humerus
s nerves (C5, C6, in glenoid cavity
C7)
 Injury to axillary nerve
Occur when surgical neck of
humerus is fractured

Results;

in atrophy of deltoid and

loss of sensation may occur

over the lateral side of the
proximal part of the arm
 Rotator Cuff Injuries
Injury or disease may damage the
musculotendinous rotator cuff,
producing instability of the
glenohumeral joint.
Trauma may tear or rupture the
tendons of the SITS muscles.
The supraspinatus tendon is most
commonly ruptured .
 AXILLA
Is the pyramidal space inferior to the
glenohumeral joint at the junction
b/n superior arm and lateral thorax
It is a gateway, or distribution
center, neurovascular between the
neck and the arm
It protected by the adducted upper
limb
Walls of Axilla
 Cont
Content of axilla
The axillary artery and its branches, which supply blood to
the upper limb;
The axillary vein and its tributaries, which drain blood from
the upper limb; and
Axillary Lymph vessels and lymph nodes,
Cords and branches of the brachial plexus
N.B, These structures are embedded in fat.
 Brachial plexus
is a major network of nerves supplying the UL

It formed by the union of the anterior rami of the last

four cervical (C5-C8) and the 1st thoracic (T1) nerves,
which constitute the roots of brachial plexus

The roots of the plexus usually pass through the gap

between the anterior and middle scalene mm with the
subclavian aa
Cont
 Cont
In the inferior part of the neck, the roots of the brachial plexus unite to form
three trunks. The trunks are
1. Superior trunk, from the union of C5 and C6 roots.
2. Middle trunk, which is a continuation of the C7 root.
3. Inferior trunk, from the union of the C8 and T1 roots
Each trunk of the divides into anterior and posterior divisions as the plexus
passes posterior to the clavicle.
Anterior divisions of the trunks supply anterior (flexor) compartments of the
UL, and posterior divisions of the trunks supply posterior (extensor)
compartments
 Cont
The divisions of the trunks form three cords of the BP are;

Anterior divisions of the superior and middle trunks unite to form the
lateral cord.

Anterior division of the inferior trunk continues as the medial cord.

Posterior divisions of all three trunks unite to form the posterior cord.

The cords bear the relationship to the 2nd part of the axillary artery that
is indicated by their names
 From cords:
Lateral cord Posterior cord medial cord
Lateral pectoral Medialroot of the
Nfor pectoralis Axillary N median nerve
major for teres minor and Medial cutaneous nerves of
deltoid muscles arm
skin ofsuperolateralarm &forearm
For Skin of medial side of
Upper subscapular N arm &
Musculocutaneous N forearm respectively
Muscles of anterior for Superior portion of Medial pectoral N
compartment of arm subscapularis mm
for Pectoralis minor and
(coracobrachialis, biceps sternocostal part of
thoracodorsal N
brachii and brachialis) and pectoralis major
For Latissimus dorsi
skin of lateral aspect of
forearm Lower subscapular N
for Inferior portion of Ulnar N
subscapularis
& teres forFlexorcarpiulnarismm and
major muscles ulnar half of
Radial N flexordigitorumprofundus(forea
Laterlroot of For All muscles rm); most intrinsic muscles of
Median nerve & skin of hand; skin of hand medial to
posterior compartments axial line of digit 4
 Brachial Plexus Injuries
affect movements and cutaneous sensation ( paralysis
and anesthesia) in the UL.
Disease, stretching, and wounds in the lateral cervical
region or in the axilla may produce BP injuries.
Signs and symptoms depend on the part of the plexus
involved.
In complete paralysis, no movement is detectable.
In incomplete paralysis, not all muscles are paralyzed; but
the movements are weak compared with those on the
normal side.
 Injuries to superior parts of BP (C5,C6)
(Erb-Duchenne palsy)
From an excessive increase in the angle between the neck
and shoulder
When excessive stretching of the neck occurs in a newborn
during delivery
Can damage to nerves arising from C5& C6 (upper trunk).
These nerve are Musculocutaneous, axillary ,
suprascapular and subclavius nerves are injured
Results in paralysis of the muscles supplied by C5 & C6
(deltoid, biceps, brachialis, supra & Infraspinatus)
the characteristic position of the limb is "waiter's tip
position"
i.e an adducted shoulder, medially rotated arm, and
extended elbow
lateral aspect of the upper limb also loses sensation
Injuries to superior parts of BP (C5,C6) (Erb-Duchenne palsy)
 Injuries to inferior parts of brachial plexus C8,T1 (Klumpke paralysis)

It may occur when the UL is

suddenly pulled superiorly or Klumpke paralysis)
a baby's upper limb is pulled
excessively during delivery
These events injure the
inferior trunk of BP (Mainly
the ulnar nerve is involved)
and may avulse the roots of
the spinal nerves from the
spinal cord.
The short muscles of the hand
are affected, and a claw hand
results.
Cutaneous Innervation of UL
 ARM
Extends from the shoulder to
the elbow.

Two types of movement occur

between the arm and the
forearm at the elbow joint:

1. flexion and extension ,

2. pronation and supination.

 Cont
There are four major arm muscles, from those three are
in the anterior (flexor) compartment those are ;
- Biceps brachii,
- Coracobrachialis and
- Brachialis, supplied by musculocutaneous nerve,
And one in the posterior (extensor) compartment
(triceps brachii) supplied by the radial nerve

The flexor muscles are almost twice as strong as the

extensors in all positions; consequently, we are better
pullers than pushers.
 The three muscles that found in the anterior (flexor)
compartment ;
Muscle Origin Insertion Innervation Action
Biceps Short head: tip of Tuberosity of Musculocuta Supinates
brachii coracoid process of radius and neous nerve forearm and,
scapula fascia of (C5, C6, C7) when it is
Long head: forearm via supine. flexes
supraglenoid bicipital forearm;
tubercle of scapula aponeurosis short head
resists
dislocation of
shoulder

Coraco- Tip of coracoid process Middle third Musculocuta Flexor of the

of scapula of medial neous nerve arm at the
brachialis
surface of (C5, C6, C7) gleno-
humerus humeral joint

Brachialis Distal half of anterior Coronoid Musculocuta Powerful

surface of humerus process and neous nerve flexor of the
tuberosity ulna and radial forearm at
nerve (C5, the elbow
C7) joint
 Two muscle are found in the posterior compartment:
The triceps brachii & Anconeus
Muscle Origin Insertion Innervation Action
Triceps Long head: Proximal end of Radial nerve (C6, Chief extensor of
brachii infraglenoid olecranon of C7, C8) forearm; long
tubercle of ulna and fascia head resists
scapula of forearm dislocation of
Lateral head: humerus;
posterior surface especially
of humerus, important during
superior to adduction
radial groove
Medial head:
posterior surface
of humerus,
inferior to radial
groove
Anconeus Lateral Lateral surface Radial nerve Assists triceps
epicondyle of of olecranon of (C7, C8, T1) in extending
humerus ulna forearm;
stabilizes
elbow joint
The triceps brachii
 Nerves of arm
4 main nerves
Musculocutaneous
Radial
Median
Ulnar
 Injury to Musculocutaneous Nerve
Results in paralysis of the coracobrachialis, biceps, and
brachialis
Flexion of the elbow and supination of the forearm are
greatly weakened
Loss of sensation may occur on the lateral surface of
the forearm supplied by the lateral cutaneous nerve of
the forearm
 FOREARM
It extends from the elbow to the
wrist and contains two bones, the
radius and ulna, which are joined by
an interosseous membrane.

The interosseous membrane is a

strong membrane that unites the
shafts of the radius and the ulna
 Cont
The ulna is medial in the forearm, is large proximally
and small distally.

Proximal and distal joints between the radius and the

ulna allow the distal end of the radius to swing over the
adjacent end of the ulna, resulting in pronation and
supination of the hand
Cont
 Compartments of Forearm
As in the arm, the forearm is divided into anterior and posterior
compartments
The anterior (flexor-pronator) compartment of the forearm;
lie anteromedially &served mainly by the median nerve; the one and
a half exceptions are innervated by the ulnar nerve. and
The posterior (extensor-supinator) compartment
lies posterolaterally & served by the radial nerve (directly or by its deep
branch).
 Muscles of Forearm
There are 17 muscles crossing

the elbow joint, some of which

act on the elbow joint and

others act at the wrist and

fingers.
 FLEXOR-PRONATOR MUSCLES OF FOREARM
are in the anterior compartment of the forearm
The tendons of most flexor muscles pass across the
anterior surface of the wrist and are held in place by;
palmar carpal ligament and
flexor retinaculum (transverse carpal ligament)
 cont
Thy are arranged in -3-layers
1. A Superficial layer or group of four muscles
pronator teres,
flexor carpi radialis,
palmaris longus, and
flexor carpi ulnaris.

All are attached proximally to medial epicondyle of

humerus (common flexor origin)
2. Intermediate layer One muscle:
Flexor digitorum superficialis
 Cont
3. Deep layer ( group of three muscles )
flexor digitorum profundus,
flexor pollicis longus, and
pronator quadratus.
N.B, The five muscles which are the superficial and intermediate groups
cross the elbow joint; the three deep muscles do not.
Functionally, the brachioradialias is a flexor of forearm, but it is
located in posterior or extensor compartment and is thus supplied by
radial nerve
FLEXOR-PRONATOR MUSCLES OF FOREARM
 Cont
Nerve supply of the intermediate &deep layers of
flexor-pronator muscles of forearm
1. FDS = by Median nerve

2. FDP
medial half =by ulnar nerve
3. FPL Lateral half
4. PQ (Pronator quadratus ) by Anterior interosseous nerve,
from branch median nerve
Muscle Origin Insertion Innervation Action

Pronator teres Humeral head- lateral surface, median nerve Pronates and
(teres = round) medial mid-shaft, of flexes forearm
epicondyle radius (at elbow)
ulnar head-
medial side of
coronoid
process

Flexor carpi Medial Base of 2nd median nerve Flexes and

radialis epicondyle of metacarpal abducts hand
humerus (at wrist

Palmaris Medial Palmar median nerve Flexes hand (at

longus epicondyle of aponeurosis of wrist)
humerus hand
Muscle Origin Insertion Innervation Action

Flexor carpi Humeral head- Pisiform, hook ulnar nerve Flexes and
ulnaris medial of hamate, 5th adducts hand (at
epicondyle of metacarpal wrist)
humerus;
ulnar head-
olecranon and
posterior
border of ulna
Flexor Humero-ulnar Shafts of Median Flexes the
digitorum head-medial middle nerve medial four
superficialis epicondyle of phalanges of digits(2nd -5th ) at
(FDS) humerus medial four proximal IP joints
radial head- digits(2nd -5th ) ; can also flex
Superior half of MCP joints of the
radius same fingers
Muscle Origin Insertion Innervation Action

Flexor medial and Bases of distal Ulnar nerve for only muscle
digitorum anterior phalanges of Medial part that can flex
profundus surfaces of 2nd -5th digits the medial
(FDP) ulna & Anterior four
interosseous interosseous nerve, digits(2nd -
membrane from median nerve 5th at distal
for Lateral part IP joints

Flexor pollicis Anterior Base of distal Anterior Flexes IP

longus (FPL) surface of phalanx of interosseous nerve, joints of 1st
radius & thumb from median nerve digit
radial half of (thumb)
interosseous
membrane
Pronator Distal Distal anterior Anterior Initiate
quadratus anterior surface of interosseous nerve, Pronation
surface of radius from median nerve forearm
ulna
 Important points of in some flexor-pronator
muscles of forearm.
Flexor Carpi Radialis tendon is a good guide to the radial
artery, b/c this artery lies just lateral to this tendon .
Palmaris Longus Is absent on one side (usually the left)
or both sides in approximately 14% of people, but its
actions are not missed.
It has a short belly and a long, cord-like tendon that
passes superficial to the flexor retinaculum
Its tendon is a useful guide to the median nerve at the
wrist b/c it lies deep and slightly medial to this nerve
before it passes deep to the flexor retinaculum.
 Important
Flexor Carpi Ulnaris is the most medial of the superficial
flexor muscles &It has 2 heads of proximal attachment,
between which the ulnar nerve passes & enter the
forearm.
Flexor Digitorum Superficialis It has two heads;
humeroulnar and Radial heads.
The median nerve and ulnar artery enter the forearm by
passing between these heads.
It gives rise to four tendons, which pass deep to the flexor
retinaculum through the carpal tunnel to the fingers.
The four tendons of the flexor digitorum superficialis are
anterior to the tendons of the flexor digitorum
profundus muscle.
 Pronator Quadratus
is quadrangular and is the deepest
muscle in the anterior aspect of
the forearm

is the only muscle that attaches

only to the ulna at one end and
only to the radius at the other end

is the prime mover for pronation

i.e, it initiates pronation and
assisted by the pronator teres
when more speed are needed
 EXTENSOR MUSCLES OF FOREARM
Are in the posterior (extensor-supinator) compartment of the forearm
All are innervated by branches of radial nerve
These muscles can be organized;
Physiologically into three functional groups and
Anatomically into superficial and deep layers
The extensor tendons are held in place in the wrist region by the extensor
retinaculum
 The three functional groups are
A. Muscles that extend and abduct or adduct the hand at wrist joint
1. extensor carpi radialis longus (ECRL )
2. extensor carpi radialis brevis (ECRB)
3. extensor carpi ulnaris (ECU)
B.Muscles that extend the medial four digits
1. extensor digitorum (ED)
2. extensor indicis (EI)
3. extensor digiti minimi (EDM)
C. Muscles that extend or abduct the thumb

1. extensor pollicis brevis (EPB)

2. extensor pollicis longus(EPL)
3. abductor pollicis longus (APL)
 The anatomical groups are
6-on superficial group and -4-deep layers
A. Superficial extensors groups;
Two attached proximally to the lateral supraepicondylar
ridge
1. Brachioradialis
2. extensor carpi radialis longus
Four muscles attached proximally by a common extensor
tendon to lateral epicondyle ;
3. extensor carpi radialis brevis
4. extensor digitorum
5. extensor digiti minimi
6. extensor carpi ulnaris
 Cont
B. Deep extensors groups are;
Three act on the thumb.
They emerge ("crop out") from a furrow in the lateral part of
the forearm. Because of this characteristic, they are referred
to as outcropping muscles of the thumb.
1. Abductor pollicis longus
2. Extensor pollicis brevis
3. Extensor pollicis longus
One act on index finger
4. Extensor indicis
N.B supinator muscle also groups on extensor groups
 INNERVATION of extensor-supinator muscles of fore arm
1. Brachioradialis
2. ECRL Via direct branch of Radial nerve
3. ECRB
4. supinator muscle Deep branch of Radial nerve
5. Extensor digitorum
6. EDM
7. ECU
8. APL Posterior interosseous nerve
9. EPB i.e., continuation of deep
10. EPL branch of radial nerve
11. Extensor indicis

N.B ,Posterior interosseous nerve accompanies the posterior

interosseous artery
 Brachioradialis
lies superficially on the
anterolateral surface of the
forearm and It forms the lateral
border of the cubital fossa
O: Proximal two thirds of supra
epicondylar ridge of humerus
I: Lateral surface of distal end of
radius proximal to styloid process
Inn. Radial nerve (C5, C6, C7)
Act. Relatively week flexion of
forearm and maximal when
forearm is in midpronated position
 Supinator
it lies deep in the cubital fossa and, forms its
floor
The deep branch of the radial nerve passes
between its muscle fibers, separating them
into superficial and deep parts
O: lateral epicondyle of humerus, radial
collateral and annular ligaments, supinator
fossa and crest of ulna.
I: lateral, posterior, and anterior surfaces of
proximal third of radius.
Inn: deep branch of radial nerve.
Action: supinates the forearm and
hand
 Anatomical snuff box
A triangular shallow depression on the
lateral aspect of the wrist when the
thumb is extended fully
It is bounded by;
The tendons of APLand EPB laterally,
and
Tendon of EPL medially
Floor
Radial styloid
Scaphoid
Contents of anatomical snuff box
Trapezium Superficial branch of radial Nerve
Base of first metacarpal Cephalic vein
Radial artery
 Superior thoracic Thoracoacromial Subscapular
aa aa aa

Brachiocephalic Subclavian Axillary aa Axillary aa Axillary aa

trunk aa (1st part) ( 2nd part) (3rd part)

Lateral Ant. Circ. Post. Circ.

thoracic Humeral Humeral
Radial aa aa aa
recurrent aa

Sup. Ulnar
Deep palmar Collateral aa
arch Radial aa
Superficial
branch
Deep branch Brachial aa
Superficial
Ulnar aa
palmar arch

Post. Inf. Ulnar

interosseous Anterior & Collateral Profunda
Common Posterior Ulnar aa brachii aa
Ant. interosseous recurrent
interosseous aa arteries
Blood supply to the upper limb
 CUTANEOUS NERVES OF FOREARM
lateral cutaneous nerve of the forearm (lateral
antebrachial cutaneous nerve) is the continuation of
the musculocutaneous nerve
Medial cutaneous nerve of the forearm (medial
antebrachial cutaneous nerve) is an independent
branch of the medial cord of the brachial plexus.
Posterior cutaneous nerve of the forearm from the
radial nerve, each supplying the area of skin
indicated by its name, these three nerves provide all
the cutaneous innervation of the forearm.
N.B, There is no anterior cutaneous nerve of the
forearm.
 Injury to Radial Nerve
Injury to the radial nerve superior to the origin of its
branches to the triceps brachii results in
paralysis of triceps, brachioradialis, supinator, and
extensor muscles of the wrist and fingers
Loss of sensation occurs in areas of skin supplied by this
nerve
When the radial nerve is injured in radial groove
the triceps is weakened
the muscles in posterior compartment of the forearm
are paralyzed
The clinical sign of radial nerve injury is wrist drop
Injury to Radial Nerve result in wrist drop
 Median Nerve Injury
When the median nerve is severed in the elbow region,
The proximal and distal IP joint of 1st - 3rd fingers remain
extended (due to paralysis of FPL and radial parts of the FDP).
Flexion of the PIP joints of the 1st-3rd digits is lost
Flexion of the 4th and 5th digits is weakened.
Flexion of the distal IP joints of the 4th and 5th digits is not
affected because the medial part of the FDP, which produces
these movements, is supplied by the ulnar nerve.
Due to the paralysis of the FDS the flexion at the MCP joint and
the PIP joints is restricted.
Opponens pollicis will be paralysed apposition movements of the
thumb are restricted.
 Cont
Abduction of the thumb is
absent due to paralysis of
abductor pollicis.
With this defect when the
patient tries to make a fist
the radial three fingers
remain extended resembling
an Ape like hand or
obstetricians examining
hand.
 Anterior interosseous syndrome
When the anterior interosseous nerve is injured, result in paresis
(partial inability to move) of the FDP and FPL.
But thenar muscles are unaffected b/c they innervate by recurrent
branch of median nerve,
When the person attempts to make the okay sign, opposing the
tip of the thumb and index finger in a circle, a pinch posture of
the hand results . Due to absence of flexion of the IP joint of the
thumb and distal IP joint of the index finger
Anterior interosseous syndrome
 Pronator Syndrome
Is caused by compression of the
median nerve near the elbow.
The nerve may be compressed
between the heads of the
pronator teres as a result of
trauma, muscular hypertrophy.
Individuals with this syndrome
are seen clinically with pain and
tenderness in the proximal aspect
of the anterior forearm and
hypesthesia of palmar aspects of
the radial three and half digits.
 Injury of Ulnar Nerve
Usually occur in four places:
1. posterior to the medial epicondyle of
the humerus,
2. in the cubital tunnel formed by the
humeral and ulnar heads of the FCU,
3. at the wrist, and
4. in the hand.
The injury results when the medial
part of the elbow hits a hard surface,
fracturing the medial epicondyle
(funny bone) and result in
extensive motor and sensory loss to
the hand.
 Cont
After ulnar nerve injury, the person has difficulty making
a fist because, in the absence of opposition, the MCP
joints become hyper-extended, and he or she cannot flex
the 4th and 5th digits at the distal IPjoints when trying to
make a fist.
Furthermore, the person cannot extend the IPjoints when
trying to straighten the fingers. This characteristic
appearance of the hand, resulting from a distal lesion of
the ulnar nerve, is known as claw hand.
The deformity results from atrophy of the interosseous
muscles of the hand supplied by the ulnar nerve.
Cont
 THE HAND
is the manual part of the
upper limb distal to the
forearm.
The wrist is located at the
junction of the forearm and
hand
It is subdivided into three
parts:
the wrist;
the metacarpus; and
the digits (five fingers
including the thumb).
The hand has;
anterior surface (palm) and
dorsal surface (dorsum of
hand).
 Hand
The digits of hand are numbered
from one to five, beginning with
the thumb:

digit 1 is the thumb;

digit 2, the index finger;
digit 3, the middle finger;
digit 4, the ring finger; and
digit 5, the little finger.
Abduction and adduction
of the fingers are defined
with respect to the long
axis of the middle finger
 Fibrous digital sheaths

ligamentous tubes that

enclose the flexor tendons
and the synovial sheaths
that surround them as they
pass along the palmar
aspect of their respective
digit.
Movements of thumb
 Muscles of the hand
The intrinsic muscles of the hand are located in five
compartments
1. Thenar muscles in thenar compartment:
abductor pollicis brevis, flexor pollicis brevis, and
opponens pollicis
1. Hypothenar muscles in hypothenar compartment:
abductor digiti minimi, flexor digiti minimi brevis and
opponens digiti minimi
2. Adductor pollicis in adductor compartment
3. Lumbricals in central compartment with the long flexor
tendons
4. The interossei in the interosseous compartments
between the metacarpals
 Thenar muscles
Form thenar eminence on lateral surface of palm
Responsible for opposition of thumb
Three muscles
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
 Hypothenar muscles
1. Abductor digiti minimi
(the most superficial)
2. Flexor digiti minimi brevis
3. Opponens digiti minimi
All innervated by deep
branch of ulnar
nerve(c8,T1)
 Short muscles of the Hand
Palmar Dorsal
Interossei Interossei
Lumbricals
3rd

ADDuction ABduction
2nd

4th 1st

Interossei help the lumbricals to extend I P joints and flex MC-P joints
 cont
Interossei muscles
are 7 in number
Four in the dorsal
surface
Three in the palmar
surface
All innervated by
deep branch of ulnar
nerve
Testing interossei (ulnar nerve).
A. Dorsal interossei. B. Palmar interossei
 cont
1. Lumbricals (L. lumbricus, earthworm)
are four muscles worm-like form
o. 1st and 2nd Lateral two tendons of flexor
digitorum profundus (as unipennate
muscles)
3rd and 4thMedial three tendons of FDP
(as bipennate muscles)
I .Lateral sides of 2nd-5th digits
 cont
Innervation:
The lateral two (1st and 2nd): Median nerve
The medial two (3rd and 4th): Deep branch of ulnar
nerve
Action:
Flex MPjoints, and
extend IPjoints of 2nd - 5th fingers
Blood supply to the hand.
 cont
At the hypothenar eminence the ulnar artery divides in to:
1. Superficial palmar branch (larger)- forms anastomosis
with the smaller superficial palmar branch of radial
artery to form the superficial palmar arch.
This arch gives one palmar digital artery to the medial side
of the little finger; and three large, common palmar digital
arteries.
each common palmar digital arteries re-branch to two
proper palmar digital arteries to supply the fingers.
 Cont
2. Deep palmar branch (smaller) - that forms
anastomosis with larger deep palmar branch of radial
artery to complete the deep palmar arch. And this arch
gives rise to three palmar metacarpal arteries and the
princeps pollicis artery.
The radialis indicis artery passes along the lateral side of
the index finger.
It usually arises from the radial artery, but it may
originate from the princeps pollicis
 Nerves of Hand
The hand is supplied by the ulnar, median, and
radial nerves.
Median nerve
Enters the hand through carpal tunnel and supplies
Two and a half thenar muscles and
The 1st and 2nd lumbricals
skin on the lateral palmar surface, the sides of the
first three digits, the lateral half of the 4th digit, and
the dorsum of the distal halves of these digits
Median nerve
 Ulnar nerve
Pass deep to flexor carpi ulnaris
tendon to the wrist via the
ulnar canal

It gives off palmar and dorsal

cutaneous branch which
supplies;
skin on the medial side of the
hand palm and
skin on dorsum of the hand, the
5th finger, and
skin on medial half of the 4th
finger
 Ulnar
Ends at the flexor retinaculum
by dividing into 2 branches
1. superficial branch: supplies
anterior surface of medial
one and a half fingers
2. deep branch: supplies
hypothenar muscles,
medial two lumbricals,
adductor pollicis,
deep head of FPB and
all the interossei
 Radial nerve
Supplies no hand
muscles
Supply the skin and
fascia over the lateral
two thirds of the dorsum
of the hand, the thumb,
and the proximal parts of
the lateral two and a half
digits
 Carpal tunnel
Formed anteriorly at the wrist and formed by the carpal bones and
the flexor retinaculum .
The base of the carpal arch is formed
medially by the pisiform and hook of hamate
laterally by the tubercles of the scaphoid and trapezium.
Flexor retinaculum bridges the space between the medial and
lateral sides of the base of the arch and converts the carpal arch
into the carpal tunnel.
Structures which cross through it are;
Four tendons from flexor digitorum profundus,
Four tendons from flexor digitorum superficialis,
One tendon from flexor pollicis longus
Median nerve
 cont
N.B
All the tendons of the flexor digitorum profundus and flexor
digitorum superficialis are surrounded by a single synovial
sheath; where as a separate sheath surrounds the tendon of
the flexor pollicis longus.
The median nerve is anterior to the tendons in the carpal
tunnel.
The ulnar artery, ulnar nerve, and tendon of palmaris longus
pass into the hand anterior to the flexor retinaculum and
therefore do not pass through the carpal tunnel.
The tendon of palmaris longus is not surrounded by a synovial
sheath
Carpal tunnel
 CARPAL TUNNEL SYNDROME
caused by pressure on the median nerve within the carpal
tunnel.
commonly, increases the size of some of the nine
structures or their coverings that pass through it (e.g.,
inflammation of synovial sheaths). Infection, and
excessive exercise of the fingers may cause swelling of the
tendons or their synovial sheaths. And result in
Absence of sensation may occur in the lateral three and
half ring finger
loss of coordination and strength in the thumb due to
affected three thenar muscles.
Individuals with carpal tunnel syndrome are unable to
oppose the thumb
 Dupuytren Contracture of Palmar Fascia
is a disease of the palmar fascia
resulting in shortening, thickening,
of the palmar aponeurosis.
The longitudinal bands of the palmar
aponeurosis on the medial side of the
hand pulling it to the palm and flexing
the 4th and 5th fingers at the MCP
joint and proximal IP joints.
Their distal IPjoints are not involved
and they actually become extended

Dupuytren's disease is familial, and

may be associated with cigarette

smoking, vascular disease, epilepsy,

and diabetes.
 JOINTS OF UPPER LIMB

The sternoclavicular joint

The joints of the
girdle of upper limb
The acromioclavicular joint

The shoulder(glenohumeral) joint

The elbow joint
The joints of
The joints between ulna and radius
free upper limb
The joints of hand
 Sternoclavicular Joint
The only articulation b/n the UL
and the axial skeleton

occurs b/n the ;

Sternal end of the clavicle,

Manubrium sternum, and

First costal cartilage

is a saddle type of synovial

joint but functions as a ball-&-

socket joint.
 Cont
Is surrounded by a joint capsule and is reinforced by four
ligaments:

1. The anterior and posterior sternoclavicular ligaments

reinforce the joint capsule anteriorly and posteriorly.

2. An interclavicular ligament extends b/n the sternal ends

of both clavicles. Also attached to the superior border of
the manubrium.

It strengthens the capsule superiorly.

 Cont

3. The costoclavicular ligament anchors the inferior surface of the

sternal end of the clavicle to the 1st rib and its costal cartilage,
It helps to prevent the upward displacement of the clavicle and
dislocation of the SC joint
Nerve supply: medial supraclavicular nerve and the nerve to the
subclavius muscle
Arterial supply : from branches of internal thoracic &
suprascapular arteries
 cont
Occasionally dislocated because of
strong ligaments around
Anterior dislocation: medial end of
clavicle pulled forward and upward
Posterior dislocation: medial end of
clavicle pulled backward, which may
press trachea, esophagus & great
vessels in the root of the neck

Anterior
dislocation
 2. Acromioclavicular Joint (AC joint)

B/n the acromion of the scapula and the lateral end of

the clavicle.

is a plane type of synovial joint

It reinforced by:

1. Acromioclavicular ligament directly related to the joint.

&strengthens the AC joint superiorly. However, the
integrity of the joint is maintained by extrinsic ligaments.

2. Coracoclavicular ligament, i.e., not directly related to the

joint
 cont

Coracoclavicular ligament: It
has two parts
1. Conoid (cone),ligament -
the medial inverted
triangle shaped part.
2. Trapezoid ligament - is the
quadrilateral part
They prevents the upward
displacement of the
clavicle and dislocation of
the AC joint.

Blood supply; by the suprascapular and thoracoacromial arteries

and the lateral pectoral and axillary nerves supply the AC joint
 Acromioclavicular Joint
The stability of the
acromioclavicular joint depends
on the strong coracoclavicular
ligament
The joint may get injured by a
severe blow such as a hard fall
on the shoulder.
The acromian tearing the
coracoclavicular ligament.
This condition is called shoulder
separation, as the shoulder
separates from the clavicle
because of the weight of the
upper limb.
 The Shoulder (Glenohumeral) joint
B/n the head of the humerus and the
glenoid cavity of the scapula
is a synovial ball and socket type
that permits a wide range of
movement
Both articular surfaces are covered by
hyaline cartilage.
 Cont
N.B, The glenoid cavity accepts little
more than a third of the humeral head, which is held in the
cavity by the musculotendinous rotator cuff, or SITS, muscles
The inferior part of the joint capsule, the only part not
reinforced by the rotator cuff muscles, is its weakest area
 LIGAMENTS OF GLENOHUMERAL JOINT
1. Glenohumeral ligaments
three fibrous bands, that reinforce the anterior part of
the joint capsule.
2. Coracohumeral ligament ,that passes from the base of the
coracoid process to the anterior aspect of the greater
tubercle of the humerus
3. Transverse humeral ligament , runs from the greater to the
lesser tubercle of the humerus, bridging over the
intertubercular sulcus .
This ligament converts the groove into a canal, which
holds tendon of the biceps brachii in place.
Cont
 Cont
BLOOD SUPPLY OF GLENOHUMERAL JOINT
supplied by the anterior and posterior circumflex humeral
arteries
INNERVATION OF GLENOHUMERAL JOINT
Innervate by suprascapular, axillary, and lateral pectoral
nerves.
 Clinical conditions of Shoulder Joint
is the most commonly dislocated
large joint.

Dislocations happen when a force

overcomes the strength of the
rotator cuff muscles and the
ligaments of the shoulder.

Nearly all dislocations are anterior

inferior dislocations,

Only three percent of dislocations

are posterior dislocations,
 Cont
Anterior inferior dislocation
Sudden violence applied to
the humerus when the joint is
fully abducted.
The humeral head comes to lie
inferior to the glenoid fossa &
forwards by the strong flexors
and adductors muscles .

N.B ,The Radial nerve can be damaged

 Cont
Posterior displacement
It is due to direct violence to the
front of the joint.
The shoulder loses its rounded
appearance as the greater
tuberosity is no more bulging
laterally.
The axillary nerve can be damaged.
 Elbow Joint
Hinge type of synovial joint
The trochlea and capitulum of the humerus articulate with the
trochlear notch of the ulna and the superior aspect of the head
of the radius, respectively; therefore, there are humeroulnar
and humeroradial articulations.
The joint capsule is weak anteriorly and posteriorly but is
strengthened on each side by collateral ligaments.
 LIGAMENTS OF ELBOW JOINT
Are collateral ligaments that are medial and lateral thickenings
of the joint capsule.
1. Radial collateral ligament ,lateral extends from the lateral
epicondyle of the humerus and blends distally with the anular
ligament of the radius,
It encircles and holds the head of the radius in the radial notch
of the ulna, forming the proximal radio-ulnar joint and
permitting pronation and supination of the forearm
 Cont
2. The triangular ulnar collateral ligament is medial, extends from the
medial epicondyle of the humerus to the coronoid process and
olecranon of the ulna .It consists of three bands:
A. the anterior cord-like band is the strongest,
B. the posterior fan-like band is the weakest, and
C. the slender oblique band deepens the socket for the trochlea of the
humerus.
LIGAMENTS OF ELBOW JOINT
 Cont
BLOOD SUPPLY OF ELBOW JOINT
The arteries are derived from the anastomosis around the
elbow joint .
NERVE SUPPLY OF ELBOW JOINT
supplied by the musculocutaneous, radial, and ulnar
nerves
 Elbow Joint
Dislocations are common and
most are posterior.
Are more common in children,
due to a fall on outstretched
hand. The distal end of
humerus is pushed anteriorly
through weak part of the
capsule
Pulled Elbow: occurs in
children, when the child is
lifted by the upper limb. The
radial head is pulled out of the
annular ligament
 Thank you

Sunday, December 3, 2017