UPPER LIMB

Dr. Junhel C. Dalanon

ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON

BONY CONNECTION - MUSCULAR ATTACHMENTS

CLAVICLE 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 EXTENSION
Brachialis Triceps
Biceps
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 ABDUCTION
flexor carpi ulnaris flx.carpi radialis
extensor carpi ulnaris 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
Adductor pollicis
Hypothenar muscles- 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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R = ROOTS (ventral rami)

T = TRUNKS
D = DIVISIONS
C = CORDS
B = BRANCHES
 Roots join to form Trunks! (in neck)

Ventral Rami Trunks

C5 Upper Trunk
C6
C7 Middle Trunk
C8
T1 Lower Trunk
Trunks Split to form Divisions : (in neck)
Trunks Divisions

Upper Anterior
Posterior

Middle Anterior
Posterior

Lower Anterior
Posterior
Divisions Join to form Cords! (in axilla)
Trunks Divisions
Cords

U A
LATERAL CORD
P
M A
P
MEDIAL CORD
L A
P POSTERIOR CORD
 Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous

Median

Medial Ulnar

Posterior Radial
Axillary
(thoracodorsal)
(subscapular)