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Learning objectives
At end of this session, students should be able to:
DESCRIBE
Contents of ant & post compartment of arm ,
Brachial plexus
Nerves ,blood vessels & their anatomical Relations with
clinical importance
2
Week 7
Week 5
RULE -
Limbs are outgrowths of
the ventral body wall that
undergo distal growth and
differentiation...5th Week
3
and rotation...7th week
Anterior
Upper Limb
Humerus
Muscle
Arm
Compartments
Posterior
Anterior
Radius
Forearm
Ulnar
S
t
e
r
n
E
sse
Posterior
n
t
a
i
l
o
f
G
Anterior
r
o
ss
A
Hand
n
a
t
o
m
y
5th metacarpal
4
Anterior
Humerus
Arm
Posterior
Few muscles of
posterior
compartment are
present in
Anterior
anterolateral
*
aspect of forearm
Radius
Forearm
(*brachioradialis,
Ulnar
S supinator)
t
e
r
n
E
sse
Posterior
n
t
a
i
l
o
f
G
Anterior
r
o
ss
No posterior compartment in
A
Hand
n
a
the hand
t
o
m
y
5th metacarpal
5
Anterior
Musculocutaneous n.
Motor innervation
Muscle Compartments
Humerus
Radial n.
Posterior
Anterior
Median n. & Ulnar n.
Radius
Ulna
S
t
e
r
n
Radial n.
E
Posterior
sse
n
t
a
i
l
o
f
G
Ulnar n. & Median n.
r
o
ss
Anterior
A
n
a
t
o
m
5th metacarpal
y
Posterior
RULE : Ventral vs. dorsal limb mm.
Developmental y-dorsal muscles:
? Lie posterior to the long bones in
anatomical position (* exceptions)
S
t
e
*
r
n
E
sse
n
Developmentally-ventral muscles:
t
a
i
l
o
f
? Lie anterior to the long bones in
G
r
o
ss
anatomical position
A
n
a
t
o
m
y
7
Brachial Plexus
"Roots of BP"
(=ventral rami)
(right side; simplified)
C5
C6
Trunks
C7
U
Divisions
C8
M
Cord
Terminal
Lat
L
T1
Branches
Post
S
Med
t
e
r
n
E
sse
n
t
a
i
l
o
f
G
r
o
ss
A
n
Anterior (ventral) division
a
t
o
m
8
y
Posterior (dorsal) division
Brachial Plexus
"Roots of BP"
(=ventral rami)
(right side; simplified)
C5
C6
Trunks
C7
U
Divisions
C8
M
Cord
Terminal
Lat
L
T1
Branches
Post
Musculocutaneous n.
S
Med
t
e
r
n
E
sse
Median n.
n
t
a
i
l
o
Radial n.
f
G
r
o
ss
A
n
Ulnar n.
Anterior (ventral) division
a
t
o
m
9
y
Posterior (dorsal) division
Brachial plexus - cords
Lateral cord ? LML ? Lateral Pectoral n,
Musculocutaneous n, lateral root of Median n
Medial cord ? MMMMU ? Medial pectoral n, Medial
cutaneous n of forearm, Medial cutaneous n of arm ,
Ulnar n & Medial root of median n.
Posterior cord ? LUNAR ? Lower subscapular n, Upper
subscapular n , Nerve to latissimus dorsi, Axillary n
& Radial n.
10
Brachial plexus ? supraclavicular branches
- roots & trunks
Branch to Phrenic nerve ?C5 ?anterior to sclaneus
anterior
Dorsal scapular n ? C5 ? pierces sclaneus medius,
supplies rhomboids & levator scapulae
Long thoracic n ? C5C6C7 ? (C7 ? may be absent) upper
two roots C5C6 pierce sclaneus medius , runs b/w
sclaneus ant & medius ? Supply - serratus anterior.
TRUNKS ? Upper
Nerve to subclavius ? Erb's Point - C5 C6 ?subclavius (
gives - accessory phrenic nerve ?C5)
Suprascapular n- C5C6 ? supra & infraspinatus , articular
11
? shoulder, acromioclavicular,
Brachial plexus-
Lateral pectoral n- C5C6C7 ? LC -larger, pierces
clavipectoral fascia ,ant to axillary art- pectoralis
major & minor.
Medial pectoral n- C8T1-MC- , pierces pectoralis
minor & supplies both pectoralis major & minor.
Upper sub scapular n- smaller ? frequently
double.
Lower sub scapular n- subscapularis & teres
major.
Axillary n- ant branch ?deltoid & post branch- has
pseudoganglion supplies teres minor ,cutaneous ?
as- upper lateral cutaneous nerve of a12rm .
Brachial Plexus
(branches)
C5
C6
supraspinatus
suprascapular n.
C7
& infraspinatus
*
mm.
C8
T1
S
t
e
r
n
E
sse
n
t
**
a
i
l
o
f
upper subscapular n.
subscapularis m.
G
r
o
ss
axillary n. thoracodorsal n.
latissimus dorsi m.
A
n
a
lower subscapular n.
t
subscapularis &
o
m
y
teres major mm.
deltoid & teres minor mm.
Brachial Plexus rhomboid mm.
dorsal
scapular n.
(branches)
C5
C6
suprascapular n.
C7
*
C8
pectoralis mm.
lateral pectoral n.
serratus
T1 anterior m.
musculoskeletal
n.
long
S
thoracic n.
t
e
r
n
E
medial n.
sse
medial pectoral n.
pectoralis mm. nt
**
a
i
l
o
f
upper subscapular n.
G
r
o
ss
axillary n.
thoracodorsal n.
A
n
a
lower subscapular n.
t
o
ulnar n.
m
y
14
radial n.
Dorsal
Brachial Plexus
scapular n.
C5
(all branches)
C6
Suprascapular n.
C7
*
C8
Lateral pectoral n.
T1
Musculoskeletal n.
Long
S
thoracic n.
t
e
r
n
E
Medial n.
sse
Medial pectoral n.
n
**
t
a
i
l
o
f
Upper & lower subscapular nn.
G
r
o
ss
A
Axillary n.
Thoracodorsal n.
n
a
t
o
Ulnar n.
m
y
* Nerve to subclavius
15
Radial n.
** Medial brachial & antebrachial cutaneous nn.
Brachial plexus - cords
Lateral cord ? LML ? Lateral Pectoral n,
Musculocutaneous n, lateral root of Median n
Medial cord ? MMMMU ? Medial pectoral n, Medial
cutaneous n of forearm, Medial cutaneous n of arm ,
Ulnar n & Medial root of median n.
Posterior cord ? LUNAR ? Lower subscapular n, Upper
subscapular n , Nerve to latissimus dorsi, Axillary n
& Radial n.
16
Nerve supply of Scapula Muscles
Origin on Scapula:
Latissimus dorsi = Thoracodorsal nerve
Subscapularis, Teres Major = Subscapular nerves
Supraspinatus, Infraspinatus = Suprascapular nerves
Teres Minor = Axillary nerve
Insertion on Scapula
Levator Scapular, Rhomboids = Dorsal Scapular nerve
Pectoralis Minor = Pectoral n.
Serratus anterior = Long Thoracic n.
Trapezius = Accessory n.
Branches of the Posterior Cord (continued)
Axillary Nerve ( w . Circumflex vs..)
Supplies:
Deltoid and Teres minor (motor supply )
Capsule of shoulder
skin of lower part covering deltoid (sensory
supply)
Subscapular Nerves {branches of C5 + C6 rami}
Innervates: Subscapularis, Teres major
Thoracodorsal Nerve (runs w. thoracodorsal vs)
supplies: Latissimus dorsi
Muscles of Arm: Cross elbow, Move forearm
Two compartments 1. Anterior: Flexors of forearm &
2. Posterior: Extensors of forearm
Anterior Compartment ? MCN +AA & BA
Biceps brachii = MC nerve
Brachialis =
MC nerve
Coracobrachialis = MC nerve &
Brachioradialis = Radial nerve
Posterior Compartment ? RN + PBA
Triceps brachii =
Radial nerve
Anconeus =
Radial nerve
? If ORIGIN on scapula =
Muscles of
?
Move Arm
? Subscapularis
Scapula
? Supraspinatus
Rotator
? Infraspinatus
Cuff
? Teres Minor
? Teres Major
? Latissimus Dorsi (partial O on
scapula)
? Coracobrachialis
? If INSERTION on scapula =
? Move scapula
? Rhomboids
? Trapezius
? Pectoralis Minor
? Serratus Ventralis
? Levator Scapulae
Compartments of the forearm :
Flexor Compartment : Anterior
(Superficial + Deep layers)
Most of superficial flexors originate by a
common origin from medial epicondyle
Contains 2 pronators, are supplied by
Median, AIN and Ulnar nerves
2.Posterior Extensor Compartment : Posterior
(Superficial + Deep layers)
Are supplied by Radial and Posterior
interosseous nerve.
Anterior Compartment of Forearm
Muscle
Nerve
Superficial Muscles
Flexor digitorum superficialis
Median
Flexor carpi radialis
Median
Pronator teres
Median
Palmaris longus
Median
Flexor carpi ulnaris
Ulnar
Deep Muscles
Pronator quadratus
Ant.int N - Median
Flexor pollicis longus
Ant.int.N - Median
Flexor digitorum profundus
Ulnar (med 1/2)
Flexor digitorum profundus Ant.int.N - Median (lat 1/2)
Anterior Compartment Forearm
Medial Epicondyle
Brachioradialis
Pronator Teres
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Flexor Retinaculum
Flexor Digitorum Superficialis
is deep to other flexors
Anterior View
Posterior Compartment of Forearm
Muscle
Nerve
Superficial
Extensor carpi radialis Longus & Brevis
RN
Extensor digitorum (communis) RN
Extensor digiti minimi
RN
Extensor carpi ulnaris
RN
Deep (post gp) - PIN
Supinator
Radial n + PIN
Abductor pollicis longus
PIN
Extensor pollicis longus + brevis PIN
Extensor indicis
PIN
Posterior Compartment of Forearm
Lateral Epicondyle
Brachioradialis
Extensor digitorum
Extensor carpi ulnaris
Ext Carpi Radialis Longus
Posterior View
Muscles of Hand
Muscle
Nerve
Pinky (little finger)
All digiti minimi
Ulnar
(Flexor, Abductor, Opponens)
Thumb
Abductor pollicis brevis
Median
Flexor pollicis brevis
Median
Opponens pollicis
Median
Adductor pollicis
Ulnar- deep br
Other Intrinsic Muscles
Palmar & Dorsal Interossei
Ulnar
4 Lumbricals
Median, Ulnar
Muscles of Hand
Palmar
Dorsal
Lumbricals
Interossei
Interossei
3rd
ABduction
ADDuction
2nd
4th
1st
Interossei help the lumbricals to extend I P joints and flex MC-P joints
The Axilla
Axilla = Armpit
Region between arm and chest
Boundaries
Anterior - pectoral muscles
Posterior = latissimus dorsi, teres major&
subscapularis
Medial = upper 4 ICS & serratus ant
Lateral = bicipital groove of humerus
Contents
Axillary lymph nodes, Axillary vessels ,Brachial
Plexus
Upper Limb
Upper Limb
Cubital Fossa
Contents
Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries
Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles
Surface Anatomy
Anatomical Snuffbox
of Upper Limb
Lateral = APL & E
pol brevis
Medial = E. pollicis
longus
Floor = scaphoid,
styloid of radius
Contains Radial
Artery (pulse)
Test for Peripheral Nerve
Sensory Function:
M
U
R
Ulnar n. ? Tip of 5th digit (little finger)
Median n. ? Tip of 2nd digit (index finger)
Radial n. ? Webbing b/w thumb & index finger (dorsum)
M
C7
U
C8
C6
R
40
Stretch Reflex
u
d
e
.
n
o
t
n
cra
s
c.
i
m
e
d
ca
a
Bicipital reflex (C6 cord level)
Triceps reflex (C7 cord level)
UPPER LIMB RADICULAR SYNDROMES
IVD
Root
Sensory Loss
Motor Weakness
C4-C5 C5
Shoulder
Shoulder weakness
Cranial
Proximal
C5-C6 C6
Anterior upper arm,
Forearm flexion
Lateral forearm, thumb Biceps reflex
C6-C7 C7
3rd digits
Forearm extension
Triceps reflex
Wrist extension
Hand grip
C7-C8 C8
5th digits
Wrist flexion
Caudal
Medial forearm
Intrinsic hand mm.
Distal
Source: Devinsky et al. Neurologic Pearls
This post was last modified on 05 April 2022