Muscles of upper limb:

TABLE 1:
Muscles connect the pectoral region with upper limb

Muscle Nerve supply Roots Action

Pectoralis major Medial and lateral Adducts arm and
pectoral nerves from rotates it medially;
brachial plexus C5, 6, clavicular fibers also
7, 8; T1 flex arm
Pectoralis minor Medial pectoral nerve Depresses point of
from brachial plexus shoulder , protraction.
C6, 7, 8 if the scapula is fixed,
it elevates the ribs of
origin
Subclaviuss Nerve to subclavius Depresses the clavicle
from upper trunk of and steadies this bone
brachial plexus C5, during movements of
the shoulder girdle
Serratus anterior Long thoracic nerve -Draws the scapula
C5, 6, 7 forward anterior
NB: injury of this around the thoracic
nerve lead to paralysis wall
to this muscle results -rotates scapula
in winging of scapula. laterally upward with
trapezius

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TABLE .2- Muscles Connecting the Upper Limb to the
Vertebral Column

The muscle Nerve supply Action

Trapezius Spinal part of Upper fibers elevate
accessory nerve the scapula; middle
(motor) fibers pull scapula
and medially; lower
C3 and 4 (sensory) fibers pull medial
border of scapula
downward
Latissimus dorsi Thoracodorsal Extends, adducts,
nerve C6, 7, 8 and medially rotates
the arm
Levator scapulae C3 and 4 and dorsal Raises medial
scapular nerve C3, border of scapula
4, 5
Rhomboid minor Dorsal scapular Raises medial
nerve C4, 5 border of scapula
upward and
medially
Rhomboid major Dorsal scapular Raises medial
nerve C4, 5 border of scapula
upward and
medially.

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TABLE.3 Muscles Connecting the Scapula to the Humerus

Muscle Nerve supply Action

Deltoid Axillary nerve C5, 6 1- anterior fibers flex
and medially rotate
arm
2-middle fiber abduct
arm (15-90)
3- posterior fibers
extend and laterally
rotate arm
Supraspinatus Suprascapular nerve Initiate abduction of
C4, 5, 6 the arm(0-15) and
stabilizes shoulder
joint
Subscapularis Upper and lower Adduction,Medially
subscapular nerves C5, rotates arm and
6, 7 stabilizes shoulder
joint
Infraspinatus Suprascapular nerve Adduction, Laterally
(C4), 5, 6 rotates arm and
stabilizes shoulder
joint
Teres minor Axillary nerve (C4), Adduction, Laterally
C5, 6 rotates arm and
stabilizes shoulder
joint
Teres major Lower subscapular Medially rotates and
nerve C6, 7 adducts and extension
of the arm and
stabilizes shoulder
joint

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NB;
1-Each one of these muscles is part of the rotator cuff and
plays an important role in shoulder joint stability it is formed by
the flattened tendon of 4 muscles
Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
2- Arm abduction
Supraspinatous: 0-15
Middle fiber of deltoid: 15-90
Serratus anterior and trapezius more than: 90

Fig: showing muscles attached to scapula & arm muscle anterior

and posterior view.
4- Muscles of the Arm
Arm compartments and muscles
The arm is surrounded by a layer of deep fascia that encloses its
contents like a sleeve and sends septa between the muscle
groups to facilitate their gliding on each other. The medial and
lateral intermuscular septa pass to the medial and lateral
supracondylar ridges of the humerus dividing the arm into an
anterior ―flexor‖ compartment and a posterior ―extensor‖
compartment.
The muscles of the anterior compartment are the biceps brachii,
brachilais and coracobrachialis which are all supplied by the
musculocutaneous nerve. The muscle of the posterior compartment
is triceps brachii which is supplied by the radial nerve.

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22
TABLE.4 Muscles of the Arm

Muscle Nerve supply Action

Biceps brachii Musculocutaneous Powerful Supinator
nerve C5, 6 of forearm and
flexor of elbow
joint; weak flexor
of shoulder joint
Coracobrachialis Musculocutaneous Flexes arm and also
nerve C5, 6 weak adductor
Brachialis Musculocutaneous Flexor of elbow
nerve mainly, its joint
lateral fibers by (principal)
radial n.
Triceps brachii Radial n gives Main Extensor of
aseprate branch for elbow joint
each head

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5-The Forearm:
The forearm is enclosed in sheath of deep fascia of the forearm
(antebrachial fascia). It is attached to the posterior subcutaneous border
of the ulna. From the deep surface fascia, septa pass between the
muscles and some of these septa reach the bone. This deep fascia,
together with interosseous membrane and fibrous intermuscular septa
divide the forearm into anterior (flexor) and posterior (extensor)
compartments.
Anterior compartment of the forearm
(8)Muscles:
The muscles of the anterior compartment of the forearm are divided
into 3 layers:
• The superficial layer includes; from medial to lateral; flexor carpi
ulnaris, palmaris longus, flexor carpi radialis and pronator teres.
• The middle layer is represented by flexor digitorum superficialis.
• The deep layer includes flexor digitorum profundus medially, flexor
pollicis longus laterally and pronator quadratus inferiorly behind
them.

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 Important features of these muscles:
The muscles of the superficial and middle layers all arise by a
common flexor tendon, from the medial epicondyle of the humerus.
Therefore, they cross the elbow joint and assist in elbow flexion.
Palmaris longus is often absent. If present, its main action is to tense
the palmar aponeurosis and palmar skin to facilitate hand maneuvers.
It assists in wrist flexion.
Pronator teres & flexor carpi ulnaris each has two heads,one of
them is from the common flexor tendon.
Flexor digitorum superficialis and flexor digitorum profundus
each divide into 4 tendons before passing to the hand, the tendons
pass to the phalanges of the medial 4 fingers. The tendons of flexor
digitorum superficialis insert to the middle phalanges while the
tendons of flexor digitorum profundus insert to the distal phalanges.
All the muscles of the anterior compartment are supplied by the
median nerve except flexor carpi ulnaris and the medial half (medial
2 tendons) of flexor digitorum profundus which are supplied by the
ulnar nerve.
NB; flexor pollicis longus, lateral 1/2 of flexor digitorum profundus,
pronator quadratus by anterior interosseus branch of median n.;
But lateral 1/2 of flexor digitorum profundus supplied by ulnar nerve.
The actions of the muscles of the flexor compartment of the forearm
are summarized below.

Muscle Action
Flexor carpi ulnaris Flexes and adducts the wrist joint
Palmaris longus Flexes wrist joint; tenses the skin of the palm
Flexor carpi radialis Flexes & abducts wrist
Pronator teres Pronation of forearm
Flexion of elbow
Flexor digitorum Flexes PIP & MCP joints of the medial 4 fingers and the
superficialis wrist joint
Flexor digitorum Flexes DIP & MCP joints of the medial 4 fingers and the
profundus wrist joint
Flexor pollicis Flexes interphalangeal joint of the thumb; can also flex
longus MCP joint of the thumb

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Pronator quadratus Pronation

DIP= Distal Interphalangeal Joints .

PIP= Proximal Interphalangeal Joints.
MCP= Metacarpophalangeal Joints.
Posterior compartment of the forearm
These muscles lies posterolateral to the posterior border of the ulna and
are arranged in two layers:
• The superficial layer (7MUSCLES) consists of two groups: The
posterior group includes; from medial to lateral and from above
downwards: anconeus, extensor carpi ulnaris, extensor digiti
minimi & extensor digitorum. The lateral group includes extensor
carpi radialis brevis, extensor carpi radialis longus and
brachioradialis.
• The deep layer contains (5MUSCLES); above downwards:
supinator, abductor pollicis longus, extensor pollicis longus and
extensor indices.

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 The muscles of the superficial group all originate by the common
extensor tendon from the lateral epicondyle and the lateral
supracondylar line of the humerus. Since they cross the elbow they
assist in elbow flexion, except anconeus which extends it.
Supinator has two heads & the deep branch of the radial nerve
passes between them.
The long extensor tendons (digitorum, indices, pollicis, digiti
minimi) are inserted to the dorsal expansion of the corresponding
digits, extensor digitorum is distributed to the medial 4 digits.
NBAll the muscles of the posterior compartment are supplied by
the deep branch (posterior interosseous nerve) of the radial nerve
except anconeus, brachioradialis and extensor carpi radialis longus
which are supplied directly by the radial nerve before it divides into
superficial and deep branches.
The actions of the extensor compartment muscles are summarized
below
Muscle Action
Anconeus Accessory extensor of the elbow joint
Extensor carpi ulnaris Extends and adducts the wrist
Extensor digiti minimi Extends the little finger
Extensor digitorum Extends the index, middle, ring, and little fingers;
extends the wrist
Extensor carpi radialis brevis Extends and abducts the wrist
Extensor carpi radialis longus Extends and abducts the wrist
Brachioradialis Moves the forearm to mid-pronation
Accessory flexor of elbow joint when forearm is
mid-pronated
Extensor indicis Extends index finger
Extensor pollicis longus Extends interphalangeal joint of the thumb; can
also extend carpometacarpal and
metacarpophalangeal joints of the thumb
Extensor pollicis brevis Extends metacarpophalangeal joint of the thumb;
can also extend the carpometacarpal joint of the
thumb
Abductor pollicis longus Abducts carpometacarpal joint of thumb;
accessory extensor of the thumb
Supinator Supination

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The arteries of the compartment are the posterior interosseous
artery and the terminal branch of the anterior interosseous
artery. The posterior interosseous artery enters the posterior
compartment just distal to the lower border of supinator and
gives muscular branches and sends the recurrent interosseous
branch for anastomosis around the elbow joint. It eventually
reaches the dorsal carpal arch.

Retinacula around the wrist

The deep fascia of the forearm is thickened at the carpal bones
anteriorly and posteriorly to form the flexor and extensor retinacula of
the wrist, respectively. These retinacula hold the long flexor & extensor
tendons and prevent them from springing away during wrist flexion &
extension.

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The flexor retinaculum
This is a strong fibrous band that stretches across the curved bony gutter
of the carpal bones turning it into the osteofascial crapal tunnel. The
retinaculum is attached laterally to the tubercles of the trapezium and
scaphoid and medially to the pisifrom and hook of the hamate.
• Structures passing anterior (superficial) to the flexor retinaculum;
from medial to lateral: Ulnar nerveUlnar arteryPalmar
cutaneous branch of the ulnar nervePalmaris longus
tendonPalmar cutaneous branch of the median nerve
• Structures passing posterior (deep) to the flexor retinaculum; from
medial to lateral: The 8 tendons of flexor digitorum superficialis
(anteriorly) and flexor digitorum profundus (posterior four)Median
nerveFlexor pollicis longus tendonFlexor carpi radialis tendon (in
its own separate tunnel).

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arrangement of structures at the wrist retinacula (cross section at the level of the
distal raw of the carpal bones)

The extensor retinaculum of the wrist

This is a thickened strip of deep fascia that passes obliquely from the
distal end of the radius laterally to the pisiform and hamate medially. It
sends from its deep surface multiple fibrous septa to the grooves of the
distal radius and ulna separating these grooves into 6 tunnels for the
passage of the long extensor tendons.
• Structures passing posterior (superficial) to the extensor retinaculum;
from medial to lateral: Dorsal cutaneous branch of the ulnar
nerveBasilic veinCephalic vein Superficial branch of the
radial nerve.
• Structures passing anterior (deep) to the extensor retinaculum; from
medial to lateral: Extensor carpi ulnaris tendonExtensor digiti
minimi tendonExtensor digitorum and extensor indicis tendons (in a
common sheath)extensor pollicis longus tendonExtensor carpi
radialis longus and extensor carpi radialis brevis tendons (in a common
sheathTendons of abductor pollicis longus & extensor pollicis
brevis and the radial artery.

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THE ANATOMICAL SNUFFBOX
The anatomical snuffbox is a term given to the triangular
depression formed on the posterolateral side of the wrist and the
st
base of the 1 metacarpal bone by the extensor tendons passing
into the thumb. The base of the triangle is at the wrist and the
apex is directed towards the thumb. The depression is most
apparent when the thumb is extended and has 2 borders and a
floor.

Boundaries
• The lateral border is formed by the tendons of the abductor pollicis
longus and extensor pollicis brevis.
• The medial border is formed by the tendon of the extensor pollicis
longus.
• The floor is formed by the scaphoid and trapezium.
Contents
The radial artery passes obliquely through the anatomical snuffbox,
deep to the extensor tendons of the thumb and lies adjacent to the
scaphoid and trapezium against which it may be pressed for pulsation.
The terminal part of the superficial branch of the radial nerve
passes subcutaneously over the snuffbox, lateral to the cephalic vein.
The origin of the cephalic vein from the dorsal venous arch of the hand
also runs subcutaneously over the snuffbox.

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 6- Muscles of the hand
Master piece of art:
The human hand is made up of the wrist, palm, and fingers and
consists of 27 bones, 27 joints, 34 muscles, over 100 ligaments
and tendons, and many blood vessels and nerves.
The hands enable us to perform many of our daily activities
such as driving, writing and cooking. It is important to
understand the normal anatomy of the hand to learn more about
diseases and conditions that can affect our hands.

Muscles acting on the hand can be divided into two groups: extrinsic
and intrinsic muscles.

 The extrinsic muscles are located in

the anterior and posterior compartments of the forearm. They control
crude movements and produce a forceful grip.

The intrinsic muscles all originate and insert within the hand
region. The muscles of the hand are divided into 3 groups:
the thenar, metacarpal, and hypothenar muscles. The metacarpal
muscles, sometimes referred to as the intermediate muscles of
hand, can be further subdivided into the dorsal interossei,
palmar interossei and lumbrical muscles.

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33
Muscle Action Nerve supply
Palmaris brevis Corrugates skin to Superficial branch
improve grip of palm of ulnar nerve
as it is the most C8; T1
superficial muscle lies
in the superficial fascia

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Abductor pollicis Abduction Median nerve
brevis
(Thenar Eminence)

Flexor pollicis brevis Flexion Median n

(Thenar Eminence)
Oppenens pollicis Opposition Median n
(Thenar Eminence)
Adductor pollicis Adduction Deep branch of
(Thenar Eminence) Ulnar nerve
Abductor digiti minimi Abduction Deep branch of Ulnar
(Hypothenar
Eminence)
Flexor digiti minimi Flexion Deep branch of Ulnar
brevis
(Hypothenar
Eminence)
Opponens digiti Pulls the 5th Deep branch of Ulnar
minimi metacarpal
(Hypothenar forward (Cup the
Eminence) palm)
Lumbrical muscles Flex 1st & 2nd (Lateral
(4 MUSCLES) metacarpophalangeal two) : Median N.
joints and extend 3rd & 4th : Ulnar N
interphalangeal joints (Deep branch)
of
fingers except thumb
Palmar interossei Adduction of fingers Ulnar nerve
(4 MUSCLES) toward
center of the 3rd one
Dorsal interossei Abduction of fingers Ulnar nerve
(4 MUSCLES) away
from the 3rd one

NB; ALL INTRINSIC MUSCLES OF THE HAND SUPPLIED

BY DEEP BRANCH OF ULNAR NERVE EXCEPT
PALMARIS BREVIS FROM SUPERFICIAL BRANCH OF
ULNAR NERVE AND
ADDUCTOR POLLICIS BREVIS, FLEXOR POLICIS
BREVIS AND OPPONENS POLLICIS by median nerve .
ALL THENAR MUSCLES SUPPLIED BY MEDIAN
NERVE EXCEPT ADDUCTOR POLLICIS by deep branch
of ulnar nerve.

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