MHS1101:

LECTURE
7
UPPER
LIMB 2
 LEARNING OUTCOMES

By the end of this lecture you should be able to:

 Describe the origins, insertions & actions of the flexor muscles of the forearm
 Describe the origins, insertions & actions of the extensor muscles of the forearm
 Describe the nerve and blood supply to the upper limb
 THE AXILLA & ITS CONTENTS

 pyramidal shaped region between chest wall & arm

 contains several important structures:

 brachial plexus
 axillary artery & vein
 lymph nodes

Structure
 apex
 base
 four walls: medial, lateral, anterior & posterior
 THE AXILLA & ITS CONTENTS
Blood vessels
 axillary artery & vein [continuation of subclavian artery & vein]
 artery has 3 named parts, in relation to pectoralis minor
 lymph nodes – drainage of chest & breast
 THE AXILLA & ITS CONTENTS
Brachial plexus
 network of nerves that supply the muscles & skin of the upper limb
 supplies all muscles except those attaching axial skeleton to scapula, e.g.
trapezius & sternomastoid - accessory nerve [CN XI]
 nerves of the plexus are formed by ventral rami of C5, C6, C7, C8, T1
 We will cover the formation of nerves in more detail in future sessions
 BRACHIAL PLEXUS

Anatomically/descriptively the plexus comprises:

 Roots – ventral rami of C5, 6, 7, 8, & T1

 Trunks [upper, middle, lower]

 Divisions [anterior & posterior from each trunk]

 Cords [lateral, medial & posterior]

 Branches - named nerves [musculocutaneous, median, ulnar, axillary, radial]

BRACHIAL PLEXUS
BRACHIAL PLEXUS
BRACHIAL PLEXUS
BRACHIAL PLEXUS
 ACTIVITY / BREAK
Lab guide task 1
(muscles from previous weeks)
 ANTERIOR [FLEXOR] COMPARTMENT OF ARM

Biceps brachii
 origins:
 long head - supraglenoid tubercle of the scapula
 short head - coracoid process of the scapula www.rad.washington.edu

 insertion: radial tuberosity

 actions: flexion of arm & forearm & medial rotation of forearm
 nerve supply: musculocutaneous nerve
 ANTERIOR [FLEXOR] COMPARTMENT OF ARM

Brachialis
 origin: shaft of humerus
www.rad.washington.edu
 insertion: coronoid process of ulna
 actions: flexion of forearm

Coracobrachialis
 origin: coracoid process of scapula
 insertion: shaft of the humerus
 action: flexion & adduction of arm

 nerve supply: musculocutaneous nerve

 POSTERIOR [EXTENSOR] COMPARTMENT OF
ARM

Triceps: 3 heads of origin

 origins:
 long head – infraglenoid tubercle of scapula
 lateral head – humerus, above radial groove
 medial – humerus, below radial groove
www.dartmouth.edu
 insertion: olecronon process of ulna

 action: extends shoulder & forearm

 nerve supply: radial nerve

D
ACTIVITY / BREAK
Lab guide task 2
 FLEXOR COMPARTMENT OF THE FOREARM

 superficial & deep compartments [fascia]

 superficial muscles share a common origin - medial epicondyle of humerus [+]

 deep muscles arise from the radius & ulna & interosseous membrane (I-O)
 FLEXOR COMPARTMENT OF THE FOREARM

Superficial compartment

 palmaris longus

 pronator teres

 flexor carpi radialis

 flexor carpi ulnaris

 flexor digitorum superficialis

 FLEXOR COMPARTMENT OF THE FOREARM

Palmaris longus
 origin: medial epicondyle of humerus
 insertion: palmar aponeurosis [tendon degenerated]
 action: flexion of forearm (v. weak) & wrist; tendinous insertions to MPJ – weak
 nerve supply: median nerve

 ?flexion of proximal phalanges

 may assist with thumb flexion
 missing in +/- 13% - variable - population or sex differences
 present in orangs (?climbing), variable in chimps & gorillas
 tendon used in graft surgical repair
 FLEXOR COMPARTMENT OF THE FOREARM

Pronator teres
 origin: medial epicondyle of humerus, coronoid process of ulna
 insertion: radial shaft – lateral aspect
 action: flexion of elbow & forearm pronation
 nerve supply: median nerve
 FOREARM ROTATION

 proximal & distal radio-ulnar joints

 rotation of radius over ulna

 pronation & supination

 full supination – anatomical position

 adaptation to brachiation

(a) Supination (c) Pronation

FIG. 10.26

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

 FLEXOR COMPARTMENT OF THE FOREARM

Flexor carpi radialis

 origin: medial epicondyle of humerus
 insertion: bases of 2nd & 3rd metacarpals
 action: flexion forearm & wrist, & radial deviation (abduction) of wrist
 nerve supply: median nerve
 FLEXOR COMPARTMENT OF THE FOREARM

Flexor carpi ulnaris

 origin: medial epicondyle of humerus, upper posterior border of ulna
 insertion: pisiform, hook of hamate & base of 5th metacarpal
 action: flexion forearm & wrist, ulnar (medial) deviation/adduction of wrist
 nerve supply: ulnar nerve
 FLEXOR COMPARTMENT OF THE FOREARM

Flexor digitorum superficialis

 origin: medial epicondyle, radius
 insertion: split to insert on middle phalanges of 4 fingers
 actions: flexion of elbow, wrist, proximal I-P joints
 nerve supply: median nerve

 strongest when wrist extended

 extensors act as antagonists to reduce excess movement at wrist
 act as synergists in finger flexion
 FLEXOR COMPARTMENT OF THE FOREARM

Deep Compartment

 flexor digitorum profundus

 flexor pollicis longus

 pronator quadratus
 FLEXOR COMPARTMENT OF THE FOREARM

Flexor digitorum profundus

 origin: upper anterior & medial ulna & interosseous membrane

 insertion: distal phalanges of 4 fingers

 actions: flexion of elbow, wrist, distal I-P joints

 nerve supply: median & ulnar nerve

 bulkiest, essential for gripping, strongest when wrist extended

 FLEXOR COMPARTMENT OF THE FOREARM

Flexor pollicis longus

 origin: anterior radius & interosseous membrane
 insertion: distal phalanx of thumb
 actions: flexion of thumb (& wrist, when thumb fixed)
 nerve supply: median nerve
 FLEXOR COMPARTMENT OF THE FOREARM

Pronator quadratus
 origin: distal anterior ulna
 insertion: distal anterior radius
 actions: pronation of forearm
 nerve supply: median nerve
 NERVE SUPPLY TO THE FOREARM

 flexor compartment - median & ulnar nerves

 NERVE SUPPLY TO THE FOREARM

 median nerve: enters forearm through 2 heads of pronator teres

 ulnar nerve: grooves the medial epicondyle & passes into flexor carpi ulnaris
 radial nerve: pierces supinator

 sites of nerve compression

 NERVE SUPPLY TO THE FOREARM
median nerve:

all anterior compartment muscles except flexor carpi ulnaris & medial 1/2
flexor digitorum profundus

ulnar nerve:

medial 1/2 flexor digitorum profundus & flexor carpi ulnaris

 BLOOD SUPPLY TO THE FOREARM
o
 brachial artery – divides into radial & ulnar arteries [cubital fossa]
 anastomotic branches supply elbow joint
 BLOOD SUPPLY TO THE FOREARM
radial artery
 lateral side of forearm, covered by skin, superficial & deep fasciae
 at wrist, runs dorsally to enter anatomical snuff-box
 passes through 1st dorsal interosseous muscle to enter palm
 BLOOD SUPPLY TO THE FOREARM
ulnar artery
 larger; initially lies deep to superficial compartment muscles
 gives rise to common interosseous [I-O] artery just below radial tuberosity
 divides into anterior & posterior I-O arteries on either side of membrane
 crosses over flexor retinaculum – accompanied by ulnar nerve
 distally becomes more superficial – pulse palpated deep to flexor carpi ulnaris
ACTIVITY / BREAK
Lab guide task 3
EXTENSOR COMPARTMENT OF THE FOREARM
 EXTENSOR COMPARTMENT OF THE FOREARM

 superficial & deep compartments

 superficial: common extensor origin (lateral epicondyle of humerus)

 deep: radius & ulna

 EXTENSOR COMPARTMENT OF THE FOREARM

Superficial Group
 brachioradialis
 anconeus
 extensor carpi radialis longus
 extensor carpi radialis brevis
 extensor carpi ulnaris
 extensor digitorum communis
 extensor digiti minimi
 EXTENSOR COMPARTMENT OF THE FOREARM

Deep Group
 supinator
 extensor indicis
 extensor pollicis longus
 extensor pollicis brevis
 abductor pollicis longus
 EXTENSOR COMPARTMENT OF THE
FOREARM

Brachioradialis
 origin: lateral supracondylar line of humerus
 insertion: distal radius, above styloid process
 actions: flexion of forearm
 nerve supply: radial nerve
 EXTENSOR COMPARTMENT OF THE FOREARM

Anconeus
 origin: lateral epicondyle of humerus
 insertion: posterior ulna, olecronon process
 actions: extension of forearm
 nerve supply: radial nerve
 EXTENSOR COMPARTMENT OF THE FOREARM
Extensor carpi radialis longus
 origin: supracondylar line of humerus
 insertion: base of 2nd metacarpal
 actions: extension & abduction of wrist

Extensor carpi radialis brevis

 origin: lateral epicondyle of humerus
 insertion: base of 3rd metacarpal
 action: extension of wrist

Extensor carpi ulnaris

 origin: lateral epicondyle of humerus, posterior border ulna
 insertion: base of 5th metacarpal
 actions: extension & adduction of wrist

 nerve supply: radial nerve

 EXTENSOR COMPARTMENT OF THE
FOREARM

Extensor digitorum communis

 origin: lateral epicondyle of humerus
 insertion: middle & distal phalanges of medial 4 fingers
 actions: extension of digits & wrist
 nerve supply: radial nerve
 DORSAL EXTENSOR EXPANSIONS

 insertions of extensor digitorum

 tendons cross dorsum of hand
 spread over MCP joints - hood
 slips to proximal phalanges
 central slip passes to middle phalanges
 lateral slips to distal phalanges – tension extends DIPJ
 slips to adjacent fingers

www.home.comcast.net
 EXTENSOR COMPARTMENT OF THE FOREARM

Extensor digiti minimi

 origin: lateral epicondyle of humerus
 insertion: all phalanges of 5th digit
 actions: extension of 5th digit
 nerve supply: radial nerve
 EXTENSOR COMPARTMENT OF THE FOREARM

Supinator
 origin: lateral epicondyle of humerus, supinator crest of ulna
 insertion: lateral aspect of radius (mid region)
 actions: supination of forearm
 nerve supply: radial nerve

 unopposed supination – usually acts alone

 fast/forceful supination – works with biceps [lifting heavy objects – start in
pronated position – move to supination accompanied by flexion]
 EXTENSOR COMPARTMENT OF THE FOREARM

Extensor indicis
 origin: ulna & I-O membrane
 insertion: phalanges 2&3 of index finger
 actions: extension of index finger & wrist
 nerve supply: radial nerve
 EXTENSOR COMPARTMENT OF THE
FOREARM

Extensor pollicis longus

 origin: lateral, middle 1/3, posterior ulna & I-O membrane
 insertion: base of distal phalanx of thumb
 actions: extension distal phalanx of thumb
 nerve supply: radial nerve
 EXTENSOR COMPARTMENT OF THE
FOREARM
Extensor pollicis brevis
 origin: posterior radius & I-O membrane
 insertion: proximal phalanx of thumb
 actions: extension of thumb & abduction of wrist

Abductor pollicis longus

 origin: posterior ulna & I-O membrane
 insertion: base of 1st metacarpal lateral
 actions: abduction of thumb & wrist

 nerve supply: radial nerve

 ANATOMICAL SNUFF-BOX

 Formed by tendons of EPL, EPB & APL

 dorsal, radial side

 scaphoid & trapezium form floor

Contains:
 tendons of extensor carpi radialis long & brevis [cross floor of snuff-box]
 radial artery - radial pulse can be palpated in snuffbox [between radius & FCR]
 cephalic vein
 NERVE SUPPLY TO THE FOREARM

 posterior compartment - radial nerve

 radial nerve - pierces supinator

 site of nerve compression

ACTIVITY / BREAK
Lab guide task 4
 NEXT LECTURE:
UPPER LIMB 3 & LOWER LIMB 1