detailed anatomy of arm

2. Subject of the presentation:
Anatomy-of-the-Arm
Prepared by:Prepared by: Dr. RasekhDr. Rasekh
Ms ortho, senior consultantMs ortho, senior consultant
Date :13/12/2015

3. The Humerus
The humerus bone has two parts:
1-Upper part(All are insertion)
2-Lower part(All are origins)
Attachments on the Humerus

4. Upper part
1-Inter tubercular sulcus
2-Greater tubercle
3-Lesser tubercle
4:Deltoid tuberosity

7. A-Inter tubercular sulcus
1-pectoralis major(Lateral lip)
2-Latissimus dorsi(Floor)
3-Teres major(Medial lip)
Mnemonic:
( lady between two majors)

8. Mnemonic:
( Lady between two majors)

9. B:Greater tubercle:
1:Supraspinatus(in upper impression)
2:Infraspinatus(in middle impression)
3:Teres minor(in lower impression)
Mnemonic:
(Minor sit)

12. Mnemonic:
(Minor sit)

13. C:Lesser Tubercle:
1:Subscapularis

15. D:Deltoid tuberosity
Deltoid muscle

16. E:Medial aspect of shaft of humerus
Coracobrachialis muscle

18. Lower part(All are origins)
Medial
• A:Pronator teres (lower
1/3 of supracondylar
ridge)
• B:common flexor origin
• (Epicondyle)
Lateral
• A:brachioradialis(upper 2/3
Of supracondylar ridge)
B:extensor carpi radialis
longus(lower 1/3 of
supracondylar ridge)
C:Anconeus(posterior surface
of epicondyle)
D:common extensor origin
(epicondyle)

19. A:Pronator teres
(lower 1/3 of supracondylar ridge)

20. A:Pronator teres

21. Common flexor origin
(med.Epicondyle(5)
– 1:Pronator teres
– 2:Flexor carpi radialis
– 3:Palmaris longus
– 4:Flexor carpi ulnaris
• 5:flexor digitorum superficials

22. Lateral
A:brachioradialis(upper 2/3
Of supracondylar ridge)

24. Flexor Digitorum Superficialis
is deep to other flexors
pg 302
Brachioradialis
Anterior View

25. Extensor carpi radialis longus(lower 1/3
of supracondylar ridge)

26. Anconeus(posterior surface
of epicondyle)

29. – 1:Extensor carpi radialis longus
– 2:Extensor digitorum
– 3:Extensor carpi ulnaris
– 4:Supinator
– 5: Extensor carpi radialis brevis
6:Extensor digiti minimi
Common extensor origin
(lat.epicondyle(8)

30. Brachialis

31. Triceps muscle

34. Biceps

35. Fascial Septa
• Divide arm into anterior and posteriorDivide arm into anterior and posterior
compartments.compartments.

36. Medial Intermuscular Septum
• From subcutaneous sheath to humerus.
• Separates muscles of anterior arm from
medial side of triceps complex.

37. Lateral Intermuscular Septum
• From subcutaneous sheath to humerus.
• Separates muscles of anterior arm from
lateral side of triceps complex.

39. Arteries
• Subclavian
• Axillary
• Brachial
• Radial
• Ulnar
• Profundus Brachii
• Ant/Post Interosseus

41. Arch of the aorta
Ascending aorta
Descending aorta

42. Arch of the aorta
Left subclavian artery
Left common carotid artery
Brachiocephalic artery

47. Pectoralis minor

48. Subclavian

49. Internal thoracic artery
Thyrocervical trunk
Transverse cervical artery
Suprascapular artery
Vertebral artery
VIST Turkey
Mnemonic

52. Axilary artery
• Continuation of subclavian artery at lateral border
of first rib
• Becomes brachial artery at lower border of teres
major
• Divided into three parts by overlying pectoralis
minor
– A:First portion, above muscle － gives rise to
1:highest thoracic artery
– B:Second portion, behind muscle － gives rise to
– 1:thoraco acromial artery
– 2:lateral thoracic artery.
– C:Third portion, below muscle － gives rise to
1:subscapular artery
– 2: posterior and anterior humeral circumflex
artery
1:Hi 2:Tell Laila 3:Samad Passed Away!
Mnemonic

56. Brachial Artery
• Direct continuation of axillary artery.
• Begins at inferior border of teres major.
• Main branch is deep brachial artery.
• Other branches:
Superior ulnar collateral:
To posterior ulnar recurrent.
Inferior ulnar collateral:
To anterior ulnar collateral.

57. Brachial artery

58. Radial Nerve

60. Brachial artery
Pronator teres
Brachialis tendon

61. Bicepital apponeurosis

62. Radial artery

64. Cephalic Vein
• Lateral continuation of dorsal venous arch.
• Ascends in superficial fascia along lateral
aspect of forearm and arm.
• Passes through deltopectoral triangle.
• Empties into axillary vein.

65. Basilic Vein
Antecubital Vein

66. Basilic Vein
• Medial continuation of dorsal venous arch.
• Ascends in superficial fascia along medial
aspect of forearm and arm to middle of arm.
• Pierces deep fascia and ascends in upper
aspect of arm in deep fascia.
• Joins venae comitantes to form axillary
vein:
Usually near inferior border of teres major.

67. Vein
Cephalic Vein
Basilic Vein
Anti cubital Vein

68. Median Cubital Vein
• Connects cephalic and basilic vein.
• Extends diagonally across bicipital
aponeurosis.
• Receives blood from median antebrachial
vein.
• Drains blood from palmar hand.

69. Basilic Vein
Antecubital Vein

70. Venae Comitantes
• Veins that parallel arteries:
• Usually two per artery.

71. Deltoid
Pectoralis major

77. Right brachiocephalic Vein left brachiocephalic Vein
Superior vena cava
Subclavian Vein

85. Nerves
• Principle Nerves are
– Radial Nerve (C5-C8, T1)
– Median Nerve (C6-C8, T1)
– Ulnar Nerve (C7, C8, T1)
– Musculocutaneous Nerve (C5-C7)

86. Radial Nerve
Musculocutaneous
Median Nerve
Ulnar Nerve
Auxiliary artery
pectoralis minor

87. Below pectoralis minor muscle
Auxiliary artery

88. Musculocutaneous

89. Radial Nerve

90. Median Nerve Ulnar NerveAuxiliary artery

92. Musculocutaneous Nerve
• Pierces coracobrachialis in upper half or
third of brachium.
• Innervates muscles of anterior brachial
compartment.
• Pierces fascia lateral to biceps tendon:
Continues as lateral cutaneous nerve of the
forearm.
Supplies skin on lateral forearm as far as
wrist.

93. Musculcutaneous Nerve
Biceps Brachii
Brachialis
Corcobrachialis

94. Coracobrachialis muscle

95. Biceps

96. Biceps
Brachialis

97. Lateral cutaneous nerve of forearm

98. Radial Nerve
• .
• Descends posterior to the axillary artery:
Spirals around the posterior surface of the
humerus in the spiral (radial) groove.
Accompanied by deep brachial artery.

99. Radial Nerve
• Pierces lateral intermuscular septum distal
to deltoid insertion.
• Passes into forearm:
Between the brachialis medially and the
brachioradialis laterally.
• Divides into superficial and deep branches
near lateral epicondyle.

100. Radial Nerve
• Branches in the distal third of the arm:
Branch to brachioradialis.
Branch to extensor carpi radialis longus
(brevis?)
Articular branches to elbow joint.

104. Latissimus dorsi

105. Long head
Medial head

106. After removing the long head of
triceps
lateral head
Medial head
Bone

107. lateral head
Bone
Brachioradialis

108. lateral epicondyle
Brachioradialis
Deep branch(motor)
Superficial branch
(sensory)

110. Median Nerve
• Supplies flexor muscles on the radial side of
the forearm.
• Travels with the brachial artery:
Lateral to artery in upper half of brachium.
Medial to artery in lower half of brachium.
• Crosses cubital fossa superficially:
With brachial artery
Deep to bicipital aponeurosis

111. Median Nerve
Brachial Artery
Cubital Fossa

112. Radial
recurrent a.
Radial a.
Radial n.
Median n.
Ulnar n.
Ulnar a.
Ulnar recurrent a.
Ulnar n.
Brachial a.

113. Median Nerve
Ulnar Nerve
Brachial artery

114. Median Nerve
Ulnar Nerve
Brachial artery

115. Brachial artery
Pronator teres
Brachialis tendon

117. Ulnar Nerve
• Supplies flexor muscles on the ulnar side of
the forearm.
• Starts in anterior brachial compartment:
Medial to brachial artery
Runs with superior ulnar collateral artery.

118. Ulnar Nerve
• Pierces medial intermuscular septum:
Enters posterior compartment of the
brachium.
Passes around (superficial) medial
epicondyle.
Passes into forearm between two heads of
flexor carpi ulnaris muscle.

119. Ulnar nerve
Fibrous tunnelFlexor carpi ulnaris
Triceps

120. Musculocutaneou
s n.
Median n.
Ulnar n.
Medial antebrachial
cutaneous n.
Superior ulnar coleteral a.
Deep brachial a.

121. Median n.
Axillary a.
Brachial a.
Medial
antebrachial
cutaneous n.
Superior ulnar coleteral a.
& Ulnar n.
Inferior ulnar coleteral a.

123. Nerves in the Brachium
• Medial brachial cutaneous nerve:
Direct branch from medial cord.
• Medial antebrachial cutaneous nerve:
Direct branch from medial cord.

124. CUBITAL FOSSA

125. Cubital Fossa Boundaries
• Lateral:
Brachioradialis muscle
• Medial:
Pronator teres muscle
• Superior base:
Line between two humeral epicondyles
• Floor:
Supinator and brachialis muscles

126. Cubital Fossa Contents
• Lateral to medial:
Biceps TTendon
Brachial AArtery
Median NNerve
Mnemonic
TAN

128. Articulations: The site where 2 or more
bones meet.
Joints are the weakest part of the skeleton.
Classification
Functional: Amount of movement allowed
1). Synarthroses: Immovable joints
2). Amphiarthrosis: Slightly movable joint
3). Diarthroses: Fully movable joints

130. Fibula
Tibia
Ligament
(b) Syndesmosis
Joint held together by a ligament.
Fibrous tissue can vary in length, but
is longer than in sutures.
Classification
Structural: based on material binding the bone.
1). Fibrous: Bone ends united by collagenic fibers
a). Sutures
b). Syndesmoses
c). Gomphoses

131. Classification
2). Cartilaginous Joints
Bones are united by cartilage
a). Synchondrosis
b). Symphyses

132. Immovable Joints
(synarthrosis)
• Bones united by ligament
suturesuture

133. Immovable Joints
(synarthrosis)
• Bones united by ligament
(syndesmosis)

134. Immovable Joints
(synarthrosis)
• Bones united by ligament
Interosseous
membrane
(syndesmosis)

135. • Ligaments hold tooth in bony socket
• Immovable joint
enamel
dentin
gum
root of
tooth
pulp
Socket of
alveolar
process
Peridontal
ligament
(membrane)

136. Slightly Movable (ampharthrosis)
and Immovable (synarthrosis)
Joints
• Lacks a synovial cavity
• Bones connected by fibrocartilage or
hyaline cartilage
• 2 types
- synchondrosis
- symphyses

137. Immovable Joint
(synchondrosis)

138. Slightly Movable Joint
(ampharthrosis)
pubic symphysispubic symphysis
symphysis

139. femur
ligaments
pelvis
(Diarthrosis)- freely moveable

145. femur
hyaline
cartilage
synovial
cavity

146. Shoulder joint

150. Ankle Joint

152. • Planar Joint
• Hinge Joint
• Pivot Joint
• Saddle Joint
• Ball & Socket Joint
• Condyloid or Ellipsoid Joint

154. • Convex surface of bone fits in concave surface of
2nd
bone
• Unixlateral like a door hinge
• Examples:
- Knee, elbow, ankle, interphalangeal joints
• Movements produced:
- flexion
- extension
- hyperextension

155. • Bone surfaces are slightly curved
• Side to side movement only
• Rotation prevented by ligaments
• Examples:
- intercarpal to intertarsal joints
- sternoclavicular joint
- vertebrocostal joints

156. • Rounded surface of bone articulates with
the ring formed by the 2nd
bone & ligament
• Monoaxial since it only allows rotation
around longitudinal axis
• Examples:
- proximal radioulnar joint
- supination
- pronation
- atlanto-axial joint
- Turning head side to side “no”

157. • One bone saddle-shaped, other bone fits
like a person riding on the saddle
• Biaxial
- circumduction allows the tip of the
thumb to travel in a circle
- Opposition allows thumb to touch tip
of other fingers
• Examples:
- Trapezium of carpus and metacarple
of thumb

158. • Ball fitting into a cup-like depression
• Multiaxial
- flexion/extension
- abduction/adduction
- rotation
• Examples:
- shoulder joint
- hip joint

159. • Oval-shaped depression fits into oval depression
• Biaxial= flex/extend or adduct/abduct is possible
• Examples:
- Wrist and metacarpophelangeal joints for 2 to
5 digits

160. Figure 8.5a Movements allowed
by synovial joints.
Gliding
(a) Gliding movements at the wrist

161. Figure 8.5b Movements allowed
by synovial joints.
(b) Angular movements: flexion, extension, and
hyperextension of the neck
Hyperextension Extension
Flexion

162. Figure 8.5c Movements allowed
by synovial joints.
Hyperextension Flexion
Extension
(c) Angular movements: flexion, extension, and
hyperextension of the vertebral column

163. Figure 8.5d Movements allowed
by synovial joints.
Extension
Extension
Flexion
Flexion
(d) Angular movements: flexion and extension at the
shoulder and knee

164. Figure 8.5e Movements allowed
by synovial joints.
Abduction
Adduction
(e) Angular movements: abduction, adduction, and
circumduction of the upper limb at the shoulder
Circumduction

165. Figure 8.5f Movements allowed
by synovial joints.Lateral
rotation
Medial
rotation
Rotation
(f) Rotation of the head, neck, and lower limb

166. Figure 8.6a Special body
movements.
Supination
(radius and
ulna are
parallel)
(a) Pronation (P) and supination (S)
Pronation
(radius
rotates
over ulna)

167. Figure 8.6b Special body
movements.
Dorsiflexion
Plantar flexion
(b) Dorsiflexion and plantar flexion

168. Figure 8.6c Special body
movements.
EversionInversion
(c) Inversion and eversion

169. Figure 8.6f Special body
movements.
(f) Opposition
Opposition

170. Type of joint movement:
• Flexion- bent knee
• Extension- extend knee
• Hyperextension- bring leg back
• Dorsi flexion- heal
• Plantar flexion- toe
• Abduction- leg out
• Adduction-leg in
• Rotation- twisting
• Circumduction- circular motion
• Supination- palm up
• Pronation- palm down
• Eversion- foot out
• Inversion- foot in
• Protraction- chin forward
• Retraction- chin back
• Elevation- shoulders up
• Depression- shoulders down

171. Questions?

172. Thanks for your kind
attention