Anatomy of Upper Limb-2

Humaryanto
 FASCIA EXTREMITAS SUPERIOR
Fascia Superficialis
jaringan ikat fibrosa tebal menghubungkan kulit
dengan aponeurosis palmaris pada palmar manus
menebal transversal di sekeliling phalangeslig.
metacarpale transversum superficialis
proximal hypothenar bergabung dengan m.
palmaris brevis dari kulit di perbatasan ulnaris dan
manus ke aponeurosis palmaris
 Fascia Profunda
menutupi m. pectoralis majorperiosteum clavicula dan
sternumdi atas fossa infraclavicularis dan sulcus
deltopectoralefascia m. deltoideus.
inferolaterale m. pectoralis majorfascia axillaris yang
meregang antara m. pectoralis major dan m. latissimus dorsi
fascia clavipectorale di dinding anterior axillam.
pectoralis majorclaviculafascia axillarismenutupi m.
pectoralis minor.
dorsalis scapula: tebal dari spina scapulafossa
infraspinosa menutupi m. infraspinatussuperolateral
menutupi m. deltoideusinferior mengelilingi m. teres
major dan minormargo lateralis scapula
brachium posteriormenutupi m. triceps brachii, sangat
kuat. Di bawah insertio m. deltoideusseptum
intermuscularemelekat pada crista supracondylaris
lateralis dan medialis.
 Fascia Profunda
cubitusmenebal kr gabungan fascia m. triceps dan biceps
brachii dan otot-otot antebrachium
aponeurosis bicipitalis dari tendo m. biceps brachiimedial
ke fascia profundasubcutaneus--fascia profunda di margo
posterior ulna
carpuspita tebal (retinaculum) fascia profunda.
retinaculum extensorumtendo-tendo mm. extensores di
posterior dan lateral
retinaculum flexorumtendo-tendo mm. flexores dan n.
medianus di anterior
retinaculum sebagai katrol
 Fascia profunda
palmar manuslapisan tipis di atas thenar dan
hypothenar, menebal diantara keduanya untuk
membentuk aponeurosis palmaris
aponeurosis palmaristiap-tiap jarikembali
membentuk tunnel berisi tendo-tendo flexores
phalanges longumlapisan fibrosa tebal phalanges
yaitu sarung fibrosa flexoresmelekat pada pinggir
lateral dan medial phalanges permukaan
palmarissaluran fibro-osseus untuk tendo-tendo
flexores longum yang menuju ke phalanges
 BRACHIUM & CUBITUS
Ruang Fasial Lengan Atas
fascia profundaseptum intermusculare
setinggi insertio m. deltoideus
crista supracondylaris lateralismedialis 2
regio/ruang: regio brachialis anterior dan regio
brachialis posterior
 ANTEBRACHIUM
Ruang Fasial Lengan Bawah
fascia profundaperiosteum margo posterior ulna
septa intermuscularis fibrosa dan membrana
interosseamembagi antebrachium menjadi ruang
anterior, posterior, dan lateral.
 BAHU DAN AXILLA
Otot-otot Regio Pectoralis
1. M. pectoralis major
2. M. pectoralis minor
3. M. subclavius
4. M. serratus anterior
 Otot-otot Superficialis
Punggung
1. M. latissimus dorsi
2. M. trapezius
3. M. levator scapulae
4. M. rhomboid minor
5. M. rhomboid major
 Major muscles of the trunk
Trapezius
Origin: superior nuchal line, external
occipital protuberance, ligamentum nuchae
and spinous processes of seventh cervical
and all thoracic vertebrae
Insertion: lateral third of clavicle, acromion,
and spine of scapulartery
Acton: upper fibers elevate scapula, lower
fibers depress scapula; if scapula is fixed,
one side acting along, draws head toward
the same side, and turn face to opposite
side; both sides together, draw head
directly backward
Latissimus dorsi
Origin: spinous processes of
lower six thoracic and all
lumbar vertebrae, median
sacral crest, and posterior part
of iliac crest.
Insertion: floor of
intertubercular groove of
humerus.
Action: trunk fixed, extends,
adducts and medially rotates
arm ; arm fixed, elevates
trunk.
The Muscles Connecting the
Upper Extremity to the
Vertebral Column

The muscles of this

group are:
Trapezius.
Rhomboideus major.
Latissimus dorsi.
Rhomboideus minor.
Levator scapul.
 Superficial Fascia.The superficial fascia of the anterior
thoracic region is continuous with that of the neck and upper
extremity above, and of the abdomen below. It encloses the
mamma and gives off numerous septa which pass into the gland,
supporting its various lobes. From the fascia over the front of
the mamma, fibrous processes pass forward to the integument
and papilla; these were called by Sir A. Cooper the ligamenta
suspensoria.
Pectoral Fascia.The pectoral fascia is a thin lamina, covering
the surface of the Pectoralis major, and sending numerous
prolongations between its fasciculi: it is attached, in the middle
line, to the front of the sternum; above, to the clavicle; laterally
and below it is continuous with the fascia of the shoulder, axilla,
and thorax. It is very thin over the upper part of the Pectoralis
major, but thicker
 The Muscles Connecting
the Upper Extremity to the
Anterior and Lateral
Thoracic Walls

Pectoralis major.
Subclavius.
Pectoralis minor.
Serratus anterior.
Pectoralis major
Origin: medial half of
clavicle,sternum,1th-6th costal
cartilages.
Insertion: crest of greater
tubercle of humerus.
Action: flexes, adducts and
rotates arm medially; arm
fixed, elevates trunk; elevates
ribs 1-6,aidding in forced
inspiration.
 Muscles If INSERTION on scapula = Move
scapula
of Scapula

Rhomboids
Trapezius
Pectoralis Minor
Serratus Ventralis
Levator Scapulae
If ORIGIN on scapula = Move Arm
Subscapularis
Supraspinatus Rotator
Infraspinatus Cuff
Teres Minor
Teres Major
Latissimus Dorsi (partial O on scap)
Coracobrachialis

pg 299
Use location of Insertion to determine exact movement!!
Frolich, Human
Anatomy,UpprLimb
 Shoulder Anatomy
Rotator cuff
subscapularis
infraspinatus
supraspinatus
teres minor
Primary source of
stability to the shoulder
 Otot-otot Bahu
1. M. deltoideus
2. M. supraspinatus
3. M. infraspinatus
4. M. teres minor
5. M. teres major
6. M. subscapularis
 Major muscles of upper limb
Deltoid
Origin: lateral third of clavicle,
acromion, and spine of scapula
Insertion: deltoid tuberosity of
humerus
Action: abductsflexes and
medically rotates, extends, and
laterally rotates arm
Teres major
Origin: dorsal surface of
inferior angle of scapula
Insertion: crest of lesser
tubercle of humerus
Action: medially rotates
and adducts arm
 Celah Anatomis:
1. Spatium quadrilateral
atas depan m. subscapularis
belakang m. teres minor
bawah m. teres major
medial caput longum m. triceps
Lateral oleh collum sirurgicum humeri.
2. Spatium triangular
atas m. teres minor
bawah m. teres major
lateral caput longum m. triceps
A. circumflexa scapulae, suatu cabang a. subscapularis
melewati spatiumke fossa infraspinata.
 Axilla = Armpit
Region between arm and chest
Boundaries
Ventral - pectoral muscles

Dorsal = latissimus dorsi, teres major

subscapularis
Medial = serratus ventralis

Lateral = bicipital groove of humerus

Contents
Axillary lymph nodes, Axillary vessels
Brachial Plexus

Frolich, Human
Anatomy,UpprLimb
 AXILLA
Pyramid antara brachium dan dinding thorax
Dasarnya: fascia axillaris antara inferolateral m. pectoralis major,
m. latissimus dorsi+m. teres major di posterior, dinding thorax di
medial
lipatan axilla anterior lipatan axilla posterior
Apex: posterior clavicula, superior scapula, dan costa I
dilalui pembuluh-pembuluh axillaris dan saraf-saraf dari leher
menuju extremitas superior.
Dinding-dinding axilla:
Dinding anterior : m. pectoralis major, m.pectoralis minor, m.
subclavius, fascia clavipectoralis, dan lig. suspensorium axilla.
Dinding posterior : m. subscapularis, m. latissimus dorsi, m. teres major.
Dinding medial : costa I - IV(V) dan spatium intercostalisnya, m.
serratus anterior.
Dinding lateral : m. coracobrachialis, m. biceps brachii.
 NODUS LYMPHATICUS AXILLARIS
Tersusun dalam 6 kelompok :
1. Kelompok anterior (pectoralis): di bawah m. pectoralis minorbelakang
m. pectoralis major. Menerima dari lateral mammae dan dinding
anterolateral abdomen di atas umbilicus
2. Kelompok posterior (subscapularis): di depan m. subscapularis, dekat
dengan av. subscapularis. Menerima dari superfisial punggung, sampai
sejauh crista iliaca
3. Kelompok lateral: sepanjang sisi medial v. axillaris. Menerima sebagian
besar extremitas superior (kecuali pembuluh limfe superfisial yang
mengalirkan cairan limfe sisi lateral)
4. Kelompok sentral. Di tengah axilla. Menerima dari ketiga kelompok di
atas
5. Kelompok infraclavicularis (deltoideopectoralis): menyertai v.
cephalica.di fascia clavipectoralis pada trigonum deltoideopectorale.
Menerima superfisial sisi lateral tangan, lengan bawah dan lengan atas
6. Kelompok apical. di apex axilla pada pinggir lateral iga 1. Menerima dari
semua kelenjar axilla lainnya
The Muscles and Fasci of the Arm
Coracobrachialis.
Brachialis.
Biceps brachii.
Triceps brachii
Biceps brachii
Origin: long head, supraglenoid
tubercle; short head, coracoid
process
Insertion: radical tuberosity
Action: supinator of forearm,
flexor of elbow joint, weak
flexor of should joint
Pronator teres
Origin: medical epicondyle of
humerus and deep fascia of
forearm
Insertion: middle of lateral
surface of radius
Action: pronation of forearm
and flexion of elbow
Triceps brachii
Origin: long head, infraglenoid
tubercle; lateral head, above
groove for radical n., medical
head, below groove for radical
n.
Insertion: olecranon of ulna
Action: extends elbow joint),
long head can extend and
adduct shoulder joint
POSTERIOR AND ANTERIOR COMPARTMENTS

Frolich, Human
Anatomy,UpprLimb
 lacertus fibrosus (bicipital fascia)
passes obliquely
downward and
medialward across
the brachial artery,
and is continuous
with the deep
fascia covering the
origins of the
Flexor muscles of
the forearm
 Cubital fossa
Boundariest
Baseline drawn through
epicondyles of humerus
Apexbrachioradialis
laterally and pronator teres
medially
Roofskin, superficial faxcia,
deep faxcia and aponeurosis
of biceps
Floorbrachialis, supinator
and capsule of elbow joint
Contentsfrom lateral to
medial
Biceps brachii tendon

Brachial a.divides into radial

and ulnar a.,usually at apex of
fossa
Median n.

Lateral to the biceps brachii

tendonradial n. and lateral
antebrachial cutaneous n.
 Otot-otot Antebrachium
Kriteria deskriptif:
2 kelompok extensor (posterior) dan flexor (anterior).
Otot-otot lapisan superficial: otot-otot panjang
Lapisan intermedia (tambahan) pada kelompok flexor: dari humerus,
radius, & ulnadigiti yaitu m. flexor digitorum superficialis
Otot-otot lapisan profunda: otot-otot dari radius-ulna menuju digiti
(beraksi pada art. radio-carpalis dan art. metacarpophalangealis).
dari humerusradius & ulna:
m. pronator teres
m. brachioradialis
m. anconeus
m. supinator.
antara humerusulna:
m. pronator quadratus
m. supinator.
 Otot-otot Kelompok Anterior (Flexor)
5 otot lapisan superficial (termasuk intermedia):
1. M. pronator teres
2. M. flexor carpi radialis
3. M. palmaris longus
4. M. flexor carpi ulnaris
5. M. flexor digitorum superficialis
3 otot profunda:
1. M. flexor digitorum profundus
2. M. flexor pollicis longus
3. M. pronator quadratus
 Otot-otot Kelompok Posterior (Extensor)
7 otot-otot lapisan superficial (termasuk
intermedia):
1. M. brachioradialis
2. M. extensor carpi radialis longus
3. M. extensor carpi radialis brevis
4. M. extensor digitorum (communis)
5. M. extensor digiti minimi
6. M. extensor carpi ulnaris
7. M. anconeus
 5 otot-otot profunda kelompok posterior:
1. M. supinator
2. M. abductor pollicis longus
3. M. extensor pollicis brevis
4. M. extensor pollicis longus
5. M. extensor indicis
Supinator
Origin: lateral epicondyle of
humerus and upper part of
lateral border of ulna
Insertion: upper third of
anterior surface of radius
Action: supination of
forearm
 The Volar
Antibrachial Muscles
The Superficial Group
Pronator teres.
Palmaris longus.
Flexor carpi radialis.
Flexor carpi ulnaris.
Flexor digitorum sublimis.
The Deep Group
Flexor digitorum profundus
Flexor pollicis longus.
Pronator quadratus
 Posterior Compartment of Forearm

Lateral Epicondyle

Brachioradialis
Extensor digitorum

Ext Carpi Radialis Longus

Extensor carpi ulnaris

Posterior View Frolich, Human

Anatomy,UpprLimb
 Anterior Compartment Forearm
pg 302
Medial Epicondyle

Brachioradialis
Pronator Teres

Flexor Carpi Radialis

Flexor Carpi Ulnaris

Flexor Retinaculum

Flexor Digitorum Superficialis is deep to

Frolich, Human
Anterior View other flexors Anatomy,UpprLimb
 The Dorsal Antibrachial Muscles
The Superficial Group
Brachioradialis.
Extensor digitorum communis.
Extensor carpi radialis longus.
Extensor digiti quinti proprius.
Extensor carpi radialis brevis.
Extensor carpi ulnaris.Anconus.
The Deep Group
Supinator.
Extensor pollicis brevis.
Abductor pollicis longus.
Extensor pollicis longus.
Extensor indicis proprius
 The muscles of hand
Thumb (thenar eminence)
Little finger (hypothenar eminence)
Middle palm & between metacarpal bones
 Volar carpal ligament (ligamentum carpi volare)
Transverse carpal ligament (ligamentum carpi
transversum, anterior annular ligament)
Carpal Tunnel
Carpal Tunnel
Muscles of thumb
 The Lateral Volar Muscles
Abductor pollicis brevis.
Flexor pollicis brevis.
Opponens pollicis.
Adductor pollicis (obliquus).
Adductor pollicis (transversus).
The Medial Volar Muscles
Palmaris brevis.
Flexor digiti quinti brevis.
Abductor digiti quinti.
Opponens digiti quinti
The Intermediate Muscles
Lumbricales.
Interossei (intervals between the metacarpal bones, and are
divided into two sets, a dorsal and a volar )