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UPPER LIMB

Dr. Junhel C. Dalanon

ATTACHMENTS OF UPPER LIMB TO THE AXIAL


SKELETON
BONY CONNECTION -

CLAVICLE
MUSCULAR
ATTACHMENTS
Trapezius,
Latissmus Dorsi,
Levator Scapulae,
Rhomboideus Major,
Rhomboideus Minor

TRAPEZIUS
ORIGIN: External occipetal protuberance,
Superior nuchal line of occipetal bone,
Spinous processes of 7th cervical and All thoracic
vertebrae
INSERTION: lateral 1/3 of clavicle, Medial margin
of acromion, spine of scapula
ACTION: Elevates The Scapula , rotation of
scapula, retraction of shoulder, draw the scapula
downwards and Abduction Of Shoulder Beyond
90*
N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)

TREPEZIUS

LATISSIMUS DORSI
ORIGIN: posterior layer of
thoraco lumbar fascia,
Spinous processes of lower
6 thoracic vertebrae and
Caudal most 3-4 ribs,
May attach to iliac crest.
INSERTION: Intertubercular
groove of the humerus.
ACTION: extends, adducts
and medial rotation of arm
N.SUPPLY: THORACO
DORSAL .N (C6,C7,C8)

LEVATOR SCAPULAE
ORIGIN: transvers
processes of upper 4
cervical vertebrae.
INSERTION: medial border
of the scapula superior
portion.
ACTION: elevation of
sup.angle of scapula and
draws it medially.
N.SUPPY: C3,C4,C5 Nerves

RHOMBOIDUS MINOR
ORIGIN: ligamentum
nuchae,spinous process of
c7,t1 vertebrae
INSERTION : medial
border of the scapula
ACTION : retracts,
depress the scapula and
fix it to thoracis wall
N.SUPPLY :Dorsal
Scapular .N (C4,C5)

RHOMBOIDUS MAJOR
ORIGIN: Spinous process of
t2-t5
INSERTION: medial border of
the scapula, inf.angle
ACTION: retracts the scapula,
depress the glenoid cavity
and

fix the scapula to the


thoracis wall
N.SUPPLY: Dorsal Scapular .N
(c4,c5)

MUSCLES OF PECTORAL
REGION
PECTORALIS MAJOR
PECTORALIS MINOR
SUBCLAVIUS

PECTORALIS MAJOR
ORIGIN:
sternal half of the clavicle,
Upper half of sternum,
aponeurosis of ext.obl.muscle,
INSERTION : lateral lip of
intertubercular sulcus
ACTIONS: adduction, medial
rotation and flexion of the
shoulder.
N.SUPPLY: Med & Lat
Pectoral.N (C5-8,T1)

PECTORALIS MINOR
ORIGIN: costocondral
jn.of 3,4,5 ribs
INSERTION: corocoid
process medial
&upper surface
ACTIONS: draws the
scapula forwards,
depression of the
shoulder.
N.SUPPLY: Med & Lat
Pectoral.N (C5-C8,T1)

SUBCLAVIUS
ORIGIN: 1st rib at the
costochondral jn.
INSERTION: subclavian
groove of the clavicle
ACTION:steadies the
clavicle
N.SUPPLY: N.Subclavius
from upper trunk of B.P
(c5,c6)

SERRATUS ANTERIOR
ORIGIN: outer and superior
surface of the 1-8 ribs
INSERTION: superior angle,
medial border and inferior
angle of the scapula
ACTION: rotates scapula
upwards,
abduction of shoulder
above 90*
N.SUPPLY: Long Thoracis.N
(c5,c6,c7)

MUSCLES OF SHOULDER
GIRDLE
Deltoid
Rotator cuff muscles- Supra Spinatus
Infra Spinatus,
Subscapularis,
Teres Minor.
Teres major

DELTOID
ORIGIN
Lateral 1/3 clavicle,
sup.surface of acromion,
spine of the scapula.
INSERTION:
deltoid tuberosity.
ACTION:
abduction of arm,
flx.&.ext of arm,
med.& lat. rotation.
N.SUPPLY: Axillary.N
(C5,c6)

SUPRASPINATUS
ORIGIN: supraspinatous
fossa of the scapula
INSERTION: superior facet
on the gr.tubercle of the
humerus
ACTION: initiation of
abduction (15*) & lat.
Rotation
N.SUPPLY: Suprascapular.N
From B.P (C5,C6)

INFRASPINATUS
ORIGIN: infraspinatous
fossa of the scapula
INSERTION: middle facet
on the gr.tubercle of the
humerus
ACTION:
lat.rotation of
shoulder, strengthen the
shoulder by bracing the
head of humerus.
N.SUPPLY:
Suprascapular .N of B.P
(C5,c6)

TERES MINOR
ORIGIN: lat.borderof the
scapula
INSERTION: inf.facet on
the gr.tubercle of the
humerus
ACTION: ext.rotator &
weak adductor
N.SUPPLY: Axillary .N.
(C5,C6)

SUBSCAPULARIS
ORIGIN:
medial 2/3 subscapular fossa,
lat border of tha scapula
INSERTION: lesser tubercle of
the humerus
ACTION:
stabilise the shoulder &
prevents anterior displacement
of the shoulder (med. rotation,
adduction of arm)
N.SUPPLY: Upper &Lower
Subscapular .N (c5,c6)

ROTATOR CUFF

TERES MAJOR
ORIGIN: dorsal surface of
the inf.angle of the scapula
INSERTION: med.lip of the
intetubercular groove of
the humerus
ACTION:
extends the arm from
flexd.position & it adducts,
med.rotates the arm
N.SUPPLY: Lower
Subscapular (C6,C7)

MOVEMENTS OF THE SHOULDER


Flexion
Extension
Abduction
Adduction
Internal rotation,
External rotation
circumduction

FLEXION
Pect.Mojor
Anterior Fibers Of Deltoid
Coraco brachialis

EXTENSION
Lattismus Dorsi
Teres Major
Posterior fibers Deltoid

ABDUCTION
Supraspinatous (15*)
Deltoid (15-90*)
Serratus Anterior (>90*)
Trapezius (>90*)

ADDUCTION
Lattismus Dorsi
Pectoralis Major
Subscapularis
Teres Minor
Teres Major
CORACO BRACHIALIS

INTERNAL ROTATION
Pectoralis Major
Ant.Deltoid
Subscapularis
Teres Major
Lattismus Dorsi

EXTERNAL ROTATION
Deltoid
Supraspinatus
Infraspinatus
Teres Minor

MUSCLES OF ARM
FLEXOR COMPARTMENT:
BICEPS BRACHII
CORACO BRACHIALIS
BRACHIALIS

EXTENSOR COMPARTMENT
TRICEPS

BICEPS BRACHII
ORIGIN:

Long head: supra glenoid


tubercle of the scapula
Short head: apex of the
coracoid process
INSERTION: Radial Tuberosity
ACTION: flexor of supinated
forearm
Powerful Supinator Of
Partially Flexed Forearm
N.SUPPLY: musculo
cutaneous.N (c5,c6)

CORACO BRACHIALIS
ORIGIN: coracoid process
of the scapula
INSERTION: middle of
medial surface of the
humerus
ACTION: flexes and
adducts the arm
N.SUPPLY:
musculocutaneous .N
(c6,c7)

BRACHIALIS
ORIGIN: distal half of
the anterior humerus
INSERTION :coronoid
process, tuberosity of
ulna
ACTION: Powerful
Flexor Of Forearm
N.SUPPLY:
Musculocutaneous .N
(C5,C6,C7)

TRICEPS
ORIGIN:
Long head: infraglenoid
tubercle of the scapula
Lat.head: oblique ridge on
upper surface above the
radial groove
Medial head: posterior
surface of the humerus inf.to
the radial groove
INSERTION: proximal olecrenon
of the ulna
ACTION:extends the forearm
N.SUPPLY: Radial .N.(C7,c8)

MOVEMENTS AT ELBOW
FLEXION
Brachialis
Biceps

EXTENSION
Triceps

MUSCLES OF FOREARM
Anterior Compartment:
common flx.origin
SUPERFICIAL 1.Pronator Teres
2.Flx Carpi Ulnaris
3.Palmaris Longus
4.Flx.Carpi Radialis
5.Flx.Digitorum Superficialis (sublimus)
DEEP:
1.Flx.Digitorum Profundus
2.Flx.Pollicis Longus
3.Pronator Quadratus

POSTERIOR COMPARTMENT
SUPERFICIAL:

1. Anconeus
2.Brachioradialis
3.Ext.Carpi Radialis Longus
4.Ext.Carpi Radialis Brevis
5.Ext.Digitorum
6.Ext.Digiti Minimi
7.Ext.Carpi Ulnaris

DEEP
1.Abductor Pollicis Longus
2.Ext.Pollicis Brevis
3.Ext.Pollicis Brevis
4.Ext.Indicis
5.Supinator

PRONATOR TERES
Insertion: midway
long the lateral
surface of the radius
Action:
pronation,flexion of
forearm
N.Supply:Median.N
(C6c7)

FLX.CARPI RADIALIS
INSERTION:base of
the 2nd mc bone and
slip to the bace of
the 3rd MC bone
ACTION: flexion and
abduction of wrist
N.SUPPLY: Median.N
(c6,c7)

PALMARIS LONGUS
INSERTION: anterior
aspect of the distal
flx.retinaculum and
palmar aponeurosis
ACTION: flx.the wrist,
and tightens the
palmar.aponeurosis
N.SUPPLY: Median. N
(c6,c7)

FLX CARPI ULNARIS


ORIGIN:
humoral head: med epicondyle
Ulnar head:med.margin of the
olecrenon,posterior border of the
ulna
INSERTION: pisiform,
hook of hamate, base of the
5th MC & flx.retinaculum
ACTION:flexes and adducts the
hand
N.SUPPLY: Ulnar.N (C7,C8)

FLX.DIGITORUM SUPERFICIALIS
ORIGIN:
humeroulnar head:
med.epicondyle of the humerus,
coronoid process
Radial head:
sup.half of anterior aspect of
the radius
INSERTION : bodies of the
Middle phalanges of the medial
4 digits
ACTION: flx.of all joints it
crosses
N.SUPPLY :Median .N
(C7,C8,T1)

FLX.DIGITORUM PROFUNDUS
ORIGIN:prox.3/4 of the
medial and anterior aspect
of the ulna and from
interosseous memb.
INSERTION:base of The
Diatal phalanges of the
medial 4 digits
ACTION: flx.DIP,,PIP,MP,
wrist
N.SUPPLY:

Medial-ulnar.N (C8,t1)
Lateral-AIN Of Median.N
(C8,t1)

FLX.POLLICIS LONGUS
ORIGIN: upper 3/4 of
anterior surface of
radius
INSERTION: base of
distal phalanx of the
thumb
ACTION: flexion of
proximal & distal
phalnx of the thumb
N.SUPPLY:AIN
(C7,C8,T1)

PRONATOR QUADRATUS
ORIGIN: lower 1/4th of
anterior surface of
ulna
INSERTION: lower
1/4th of anterior
surface of radius
ACTION :pronation
N.SUPPLY:AIN (C8,T1)

POSTERIOR COMPARTMENT OF
FOREARM
SUPERFICIAL
1.anconeus
2.Brachioradialis
3.Ext.Carpi Radialis
Longus
4.Ext.Carpi Radialis
Brevis
5.Ext.Digitorum
6.Ext.Digiti Minimi
7.Ext.Carpi Ulnaris

DEEP
1.Abductor Pollicis Longus
2.Ext.Pollicis longus
3.Ext.Pollicis brevis
4.Ext.Indicis
5.supinator

ANCONEUS
ORIGIN: posterior
surface of the
lat.epicondyle
INSERTION:lateral
surface of
olecranon,body of ulna
ACTION: extension of
forearm
N.SUPPLY: radial.n

BRACHIORADIALIS
ORIGIN: prox.2/3rd of
lat.supracondylar ridge of
humerus, lateral
intermuscular septum
INSERTION: lat.aspect of
distal radius just prox.to the
styloid process
ACTION: acc.flexor of
elbow
N.SUPPLY: Radial.N (C5,C6)

EXT.CARPI RADIALIS
LONGUS
ORIGIN:
lat.supracondylar ridge
of humerus
INSERTION: base of
the 2nd MC bone
ACTION: extends and
abducts the hand
N.SUPPLY: Radial .N
(C6,C7)

EXTENSOR CARPI RADIALIS


BREVIS
ORIGIN:

lat.epicondyle of the
humerus
INSERTION: base of
the 3rd MC bone
ACTION: extends and
abducts the wrist
N.SUPPLY: deep br.of
radial .N(c7c8)

EXTENSOR DIGITORUM
ORIGIN: lat epicondyle
of the humerus
INSERTION: Extensor
Expansions Of The
Medial 4 digits
ACTION: extension at
MCP, IP joints, ext of
wrist when the fingers
are extended
N.SUPPLY: PIN (c7,c8)

EXTENSOR DIGITI MINIMI


ORIGIN:lat epicondyle of the
humerus
INSERTION:extensor expansion of
the 5th digit
ACTION: ext.of 5th digit at MC, PIP ,
ext of wrist when little finger in
extension
N.SUPPLY:PIN (c7,c8)

EXT.CARPI ULNARIS
ORIGIN:2 heads
lat epicondyle of
humerus,
Posterior border of
ulna
INSERTION:medial side
of the base of the 5th MC
ACTION: extends and
adducts the hand
N.SUPPLY:PIN (c7c8)

SUPINATOR
ORIGIN:
lat epicondyle of humerus,
radial collateral lig.,
annular lig.,supinator
fossa, crest of ulna
INSERTION:
lateral,posterior,anterior
surface of prox 1/ 3rd 0f
radius
ACTION:supination
N.Supply: deep Br.Of
Radial.N (C5,c6)

ABDUCTOR POLLICIS LONGUS


ORIGIN:upper parts of
the posterior surface of
the radius & ulna and
interosseous mem.
INSERTION:base of the
1st MC bone
ACTION:
abducts,extends,
lat.rotates the thumb at
carpometacarpal joint, &
abducts the wrist.
N.SUPPLY:PIN (c7,c8)

EXTENSOR POLLICIS BREVIS


ORIGIN:posterior surface of
the radius below the origin
ofAbductor Pollicis
longusand from
interosseous mem.
INSERTION:base of the
prox.phalanx of the thumb
ACTION:extends
pox.phalanx of the thumb at
MC joint, ext.at 1st
carpometacarpal joint
N.SUPPLY:PIN (c7,c8)

EXT.POLLICIS LONGUS
ORIGIN: posterior surface of
middle 1/3rd of ulna

And interrosseous mem.


INSERTION:base of the
diastal phalanx of the thumb
ACTION:extends distal
phalanx of the thumb at MP
joint,IP joint.and it can
contribute abduction of the
thumb
N.SUPPLY:PIN (c7,c8).

EXTENSOR INDICIS
Origin:posterior

surface of ulna m/3rd


below the EPL

Insertion:extensor
expansion of the 2nd
finger

Action: ext of index


finger and wrist.

N.supply:PIN (c7,c8)

EXM.MOVEMENTS OF FOREARM MUSCLES


Flexion
Extension
Adduction
Abduction
AT RADIO ULNAR JOINT
Supination
pronation

FLEXION
pronator teres
Flx.carpi radialis
Flx.carpi ulnaris
Flx.digitorum superficialis
Flx. Digitorum profundus
Palmaris longus
brachioradialis

EXTENSION
Anconeus
Ext.Carpi Radialis Longus
Ext.Carpi Radialis Brevis
Ext.Digitorum
Ext.Indisis
Ext.Carpi Ulnaris
Ext. Digiti Minimi
Abductor Pollicis Longus

ADDUCTION
flexor carpi ulnaris
extensor carpi ulnaris

ABDUCTION
flx.carpi radialis
ext.carpi radialis longus
Ext.carpi radialis brevis
Abductor pollicis longus

PRONATION
pronator teres
Pronator quadratus

SUPINATION
biceps
supinator

INTRINSIC MUSCLES OF THE


HAND

Thenar muscles

abductor pollicis brevis


flx.pollicis brevis
opponens pollicis

Hypothenar muscles-

Adductor pollicis
palmaris brevis
abductor digiti

minimi
flx.digiti minimi
opponens digiti
minimi
Lumbricals -4
Palmar interossei-4
Dorsal interosei-4

THENAR MUSCLES

ABDUCTOR POLLICIS BREVIS


ORIGIN: flx.retinaculum,
tubercle of scaphoid,
trapezium
INSERTION: lat.side of
the base of the
prox.phalax of the thumb
ACTION: abduction at
carpometacarpal,MP joints
N.SUPPLY: recurrent br.of
median.n (c8t1)

FLX.POLLICIS BREVIS
ORIGIN:2 heads
suf.head: flx.retinaculum & trapezium bone
Deep head: floor of carpal canal overlies the
trepezoid,capitate
INSERTION: lateral side of the 1st metacarpal
bone and base of the prox phalanx
ACTION: flexes the prox.phalanx of the thumb at
MCP and med.rotation at carpometacarpal joint
N.SUPPLY:
SEPERFICIAL HEAD: median.n (c8,t1)
DEEP HEAD: Deep Br.Of Ulnar Nerve

FLX.POLLICIS BREVIS

OPPONENS POLLICIS
ORIGIN: flex.retinaculum,
trapezium bone
INSERTION :lat.half of the
palmar surface of the 1st
metacarpal bone
ACTION: oppositioin of te
thumb in combination of
flexion and med.rotation
N:SUPPLY: Media.N (C8,t1)

ADDUCTOR POLLICIS
ORIGIN: 2heads

oblique head : bases of 2nd 3rd


metacarpals and capitate bone
Transverse head: anterior
surface of 3rd metacarpal bone
INSERTION: base of prox.phalanx
of the thumb
ACTIONS: adducts tha
prox.phalanx of the thumb
N.SUPPLY:
DEEP BR.OF ULNAR NERVE
(C8, T1)

HYPOTHENAR MUSCLES

PALMARIS BREVIS
ORIGIN:
flx.retinaculum,palmar
aponeurosis
INSERTION: skin along
the medial border of the
hand
ACTION:helps in gripping
by wrinkling of skin over it
N.SUPPLY:Ulnar.N Suf.Br.

ABDUCTOR DIGITI MINIMI


ORIGIN: pisiform bone,the
tendon of the flx.carpi
ulnaris
INSERTION :medial side of
the base of the
prox.phalanx of the 5th digit
ACTION:abducts th 5th digit
N.SUPPY: Deep Br.Of Ulnar
.N (C8,t1)

ABDUCTOR DIGITI MINIMI

FLX.DIGITI MINIMI
ORIGIN : hook of
hamate,flx.retinaculum
INSERTION :medial
aspect of the base of the
prox.phalanx of little finger
ACTION: flex theprox
phalanx of 5th digit at MCP
joint
N.SUPPLY: Deep Br. Of
Ulnar.N (C8,T1)

OPPONENS DIGITI MINIMI


ORIGIN:hook of
hamate, flx.retinaculum
INSERTION:body of the
5th metacarpal.
ACTION: abducts,
flexion,lat.rotates the 5th
metacarpal
N.SUPPLY: deep br.of
ulnar.N (C8,T1)

LUMBRICALS
ORIGIN:
1&2 lumbrical arise from the 2 lateral tendon of th
flx.digitorum profundus.
2&4 arises from the medial tendons of the
flx.digitorum profundus
INSERTION : lateral side of the ext.expansion of medial
4 digits.
ACTION: flex the MCP, extends the IP
N.SUPPLY:
1&2 lumbrical- Median .N (C8,t1)
3&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)

PALMAR INTEROSSEI
ORIGIN: palmar interossei
arises from palmar surface
of the metacarpal bones of
2,4,5 digits
INSERTION: extensor
expansion of the digit and
bases of the prox.phalanx
of the 2,4,5 digits
ACTION:
Adduts The Fingers At
MCP, assists flexion at MCP,
extension at IP
N.SUPPLY: deep br. Of
unlar .n (C8,T1)

PALMAR INTEROSSEI

Dorsal interossei
ORIGIN: adjacent sides of
the metacarpal bones
INSERTION: base of the
prox.phalanx and in to the
aponeurosis that forms
ext.expansion
ACTION: abducts the
fingers,flex the MCP
N.SUPPLY: Deep Br.Of
Ulnar .N (C8,t1)

Dorsal interossei

Dorsal interossei

Parts of Brachial Plexus

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Buddy!

R = ROOTS (ventral rami)


T = TRUNKS
D = DIVISIONS
C = CORDS

Roots join to form Trunks!


(in neck)
Ventral Rami

C5
C6
C7
C8
T1

Trunks

Upper Trunk
Middle Trunk
Lower Trunk

Trunks Split to form


Divisions
: (in
neck)
Trunks
Divisions
Upper
Posterior
Middle
Posterior
Lower
Posterior

Anterior

Anterior

Anterior

Divisions Join to form Cords!


Trunks

Divisions

A
POSTERIOR CORD

(in axilla)

Cords

P
LATERAL
CORD
P
P
MEDIAL
CORD

Cords Give off Branches!!


Lateral

(in axilla)

Musculocutaneous
Median

Medial
Posterior
Axillary

Ulnar
Radial
(thoracodorsal)
(subscapular)

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