ANATOMY OF THE UPPER LIMB

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ANATOMY OF THE UPPER LIMB

• DR.AHMAD K. SHAHWAN
• PH.D. GENERAL SURGERY

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ANATOMY OF THE UPPER LIMB

• 1- Bones of the upper limb.
• 2- Muscles of the upper limb.
• 3- Vesseles of the upper limb.
• 4- Nerves of the upper limb.
• 5- Joints of the upper limb.

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ANATOMY OF THE UPPER LIMB

• Surface anatomy of the upper limb.
• The upper limb divided to
• 1- The Shoulder
• 2- The arm
• 3- The forearm
• 4- The hand
• 5- The axilla the breast

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ANATOMY OF THE UPPER LIMB

• THE SHOULDER
• IT CONTAINS THE SCAPULA THE CLAVICLE which
  articulate with the sternum the humerus.

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THE SCAPULA

• It is a flat bone with 2 surfaces (ventral
  dorsal).3 angles (superior, lateral inferior).
  3 borders (medial ,lateral superior).
• It has a spine ,acromial process coracoid
  process.

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THE SCAPULA

• The ventral (costal) surface is concave forms
  the subscapular fossa.
• The dorsal surface is convex divided by the
  spine of the scapula to 2 fossae
• 1- a small supraspinous fossa.
• 2-a large infraspinous fossa.

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THE SCAPULA

• The spine of the scapula starts medially to
  extend laterally where be wider to form acromial
  process which articulate with the lateral end of
  the clavicle.
• At the lateral end of the superior border is the
  coracoid process.
• The superior angle lies opposite the second rib
  while the inferior angle lies opposite the
  seventh rib. The lateral angle forms the glenoid
  cavity.

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Articulation of the scapula

• There are 2 synovial 2 fibrous joints.
• 1-The synovial joints
• 1-1-The glenoid cavity with the head of the
  humerus to form the shoulder joint .
• 1-2-Acromio-clavicular joint
• 2- The fibrous joints
• 2-1- coraco- clavicular joint (strong joint
  covered with strong ligament)
• 2-2- coraco- acromial joint (strong joint covered
  with strong ligament)

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Anastamosis around the scapula

• It is an important anastamosis between branches
  of the first part of the subclavian A. the third
  part of axillary A.
• 1- branches of the first part of the subclavian A
• 1-1- the supra scapular A. which distributed to
  the supraspinous the infraspinous fossa.
• 1-2- deep branch of the transverse cervical A.
  which go down along the medial border of the
  scapula.

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Anastamosis around the scapula

• 2- The branches of the third part of axillary A.
• 2-1- the sub scapular A. which go down along the
  lateral border of the scapula.
• 2-2- the circumflex scapular A. which arise from
  the sub scapular A. go to the infraspinous fossa.

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THE CLAVICLE

• It lies horizontally in the root of the neck. It
  covers the flat 1st rib its medial 2/3 are
  curved forward to give room for the passage of
  the large vessels nerves which leave the neck
  pass behind below the clavicle on their way to
  upper limb.
• It has 2 important functions
• 1- To transmit forces from the upper limb to the
  bones of the axial skeleton (sternum)
• 2- To act as strut holding the arm free from the
  trunk.

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THE CLAVICLE

• It is along bone with a body 2 ends
• 1- the sternal end articulate with the manuberium
  of the sternum forming the sterno- clavicular
  joint.
• 2-The acromial end articulate with the acromial
  process of the scapula forming the acromio-
  clavicular joint.
• The body is convex in medial 2/3 concave in
  lateral 1/3.

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THE CLAVICLE

• Important relations of the clavicle
• 1-The subclavian A.V.the trunk of the
  brachial pluxes pass behind the middle
  1/3 of the clavicle.
• 2- The common carotid A. lies behind the left
  sternoclavicular joint .
• 3- the brachio-cephalic A. divided to its 2
  branches behind the right sternoclavicular
  joint.
• 4-The internal jugular vein lies a little
  laterally on either side.

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THE HUMERUS

• It is a tubular long bone composed of upper end ,
  body (shaft ) lower end.
• The upper end formed from
• 1- the head
• 2- the neck ( anatomical surgical )
• 3- the tubercles (greater lesser )
• .

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THE HUMERUS

• The head which is less than ½ sphere directed
  medially ,upward posteriorly .It is separated
  from the greater lesser tuberosities by a
  shallow groove called the anatomical neck .
• The greater tuberosity is a prominence which
  projects posteriorly in rest position.
• The lesser tuberosity is a small prominence which
  project anteriorly.
• The greater lesser tuberosities the head are
  separated from the shaft by the surgical neck.
• There is small groove below them called the
  bicipital groove .

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THE HUMERUS

• The body (shaft ) the upper ½ of the shaft is
  cylindrical while the lower ½ is like a prism.
• The lateral medial borders of the lower shaft
  are continued below to form the lateral medial
  supracondyler ridges (crests) which end with the
  lateral medial epicondyles.
• In the middle of the shaft there is deltoid
  tuberosity the spiral groove .

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THE HUMERUS

• The lower end formed from( from medial to lateral
  )
• 1- the anterior aspect medial epicondyle ,
  trochlea ,capitulum lateral epicondyle . With 2
  fossae (coronoid radial ) .
• 2- the posterior aspect medial epicondyle ,
  trochlea lateral epicondyle with one fossa
  (olecranon) .
• The medial epicondyle is larger , more prominent
  extend downward more than the lateral .It
  carries a shallow groove in the posterior surface
  for the ulner nerve .

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THE HUMERUS

• Ligaments attached to the humerus
• 1- The capsule of the shoulder joint is
  attached to the anatomical neck except
  inferiorly where it extends for about 1
  cm. to attach to the surgical neck.
• 2- The capsule of the elbow joint where
  attached to the upper margins of the
  fossae
• 3- The lateral medial supracondyler ridges
  give attachments to the lateral medial
  intermuscular septum .

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THE HUMERUS

• Nerves related to the humerus
• 1- The circumflex (axillary) N. may be
  injured in fracture of surgical neck .
• 2- The radial N. (which lies in the spiral
  groove ) may be injured in fracture of the
  middle of the shaft .
• 3- The ulnar N. may be injured in
  fracture of the lower end (the
  medial epicondyle)

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THE RADIUS

• It is along bone , consist of thin narrow upper
  end ,body thick expanded lower end .
• The upper end consist of
• 1- The head is disc like with 2 articular
  surfaces
• 1-1-the upper surface with the capitulum of the
  humerus.
• 1-2-the lateral surface with the radial notch of
  the ulna .
• 2-The neck constricted part below the head .
• 3-The radial tuberosity below the medial part of
  the neck .

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THE RADIUS

• The body of the radius which had 3 surfaces 3
  borders pronator tuberosity.
• The lower end which is the styloid process
  laterally ulnar notch medially .

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THE RADIUS

• The joints of the radius
• Above1- the upper surface of the head receives
  the capitulum of the humerus to form
  part of the elbow joint .
• 2- the circumference of the head
  articulates with radial notch of the ulna to form
  the superior radio-ulnar joint .
• Below 1- the ulnar notch receives the head of
  the ulna to form the inferior radio-ulnar joint .
• 2- the inferior surface of the lower
  end articulate with 2 carpal
  bones to form the wrist(
  radio-carpal )joint

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THE ULNA

• It is along bone with upper end , body (shaft )
  lower end.
• The upper end consist of
• 1- The olecranon process the upper part of
  the trochlear fossa .
• 2- The coronoid process the lower part of
  the trochlear fossa .
• 3- The ulnar tuberosity below the coronoid
  process on the anterior surface .
• .

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THE ULNA

• 4-The trochlear fossa is a large deeply
  concave articular surface which lies
  between the olecranon coronoid
  processes.
• 5- The radial notch is a concave surface
  in the upper part of the lateral side of
  the coronoid process. It articulates with the
  circumference of the head of the radius to
  form the superior radio-ulnar joint.

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THE ULNA

• The body (shaft) of the ulna is triangular in the
  upper ¾ cylindrical in the lower ¼ .
• The lower end consist of
• 1- the head small rounded articulating
  with the medial side of the lower end of
  the radius forming the inferior radio
  ulnar joint.
• 2- The styloid process projects medially
  below the head .

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The interosseous membrane

• In addition to the sup. inf. Radio ulnar joints
  ,The radius ulna are also joined by a fibrous
  membrane which stretches between the interosseous
  borders of the 2 bones..
• It Ff. run obliquely downwards medially from
  radius to ulna.
• It is pierced by the ant.interosseous Vv.
• Its function is
• 1- increase the area of origin of forearm Mm.
• 2- transmits forces received by the lower end of
  radius to ulna.

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The bones of the hand

• They consist of carpus , metacarpus
  phalanges bones
• The carpus bones they are 8 arrange in 2 rows
  ( proximal distal ).
• From lateral to medial
• 1- the proximal row scaphoid ,lunate ,
  triquetral pisiform .
• 2- the distal row trapezium ,
  trapezoid , capitate hamate .

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The bones of the hand

• The Metacarpal bones are 5 . One for each
  finger .
• Each metacarpal bone has base ,shaft head .
• The phalanges all the fingers have 3 phalanges
  ( proximal , middle distal ) except the thumb
  has only 2 (proximal distal ).
• Each phalanx has base , shaft head .

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The articulation of the carpal bones

• The proximal row is convex toward the lower end
  of radius ulna .
• 1- The scaphoid lunate articulate with the
  lower end of the radius .
• 2- the triquetral articulates with the lower end
  of the ulna .
• The bones of the proximal row articulate with the
  bones of the distal row in mid carpal
  (transverese carpal) joint.

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• The bones of the distal row articulate with the
  base of the metacarpals by
• 1- the trapezium articulate with the 1st
  metacarpal bone .
• 2- the trapazoid articulate with the 2nd
  metacarpal .
• 3- the capitate articulate with the 3rd
  metacarpal .
• 4- the hamate articulate with the 4th 5th
  metacarpals..

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THE MUSCLES OF THE UPPER LIMB

• In general they divided to
• 1- Mm attached the upper limb to axial
  skeleton .
• 2- Mm of the upper limb proper .

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Mm attached the upper limb to axial skeleton .

• 1-1-THE FRONT Mm.
• Pectoralis major , Pectoralis minor subclavius
  Mm.
• 1-2- AT SIDE M. serratus ant M.
• 1-3- THE BACK Mm.
• Latissmus dorsi , trapezius , levator scapulae ,
  rhomboideus minor rhomboideus major Mm.
• Only the pect. Major latissmus dorsi are
  inserted in the humerus while all the others are
  inserted in the shoulder girdle( scapula
  clavicle) .

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MOVEMENTS OF THE SHOULDER GIRDLE

• 1- ELEVATION by upper Ff of trapezius levator
  scapulae Mm.
• 2-DEPRETION by pect.major , pect.minor
  latissmus dorssi Mm.
• 3- RETRACTION by middle Ff. of trapezius,
  rhomboideus major minor Mm.
• 4- PROTRACTION by serratus ant. ,levator
  scapulae pect. Minor.
• 5- ROTATION UP by upper lower Ff of trapezius
  serratus anterior Mm.
• 6-ROTATION DOWN levator scapulae ,rhomboideus
  major rhom. minor Mm.

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MUSCLES OF THE SHOUlDER REGION

• They are 6 Mm. deltoid , teres major , teres
  minor ,supraspinatus , infraspinatus
  subscabularis Mm.
• The last 4 called The Rotator cuff Mm.
• All of them arise from the scapula ( all from the
  dorsal surface except subscapularis M. from the
  anterior surface ) all inserted in the
  tuberosities of humerus .They rotate the
  arm(medially or laterally) adduct the arm
  (except the deltoid supraspinatus Mm.) all
  suplied by C5, C6 Nn.

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MUSCLES OF THE FRONT OF THE ARM

• They are Biceps , Brachialis coraco
  -brachialis Mm. and all supplied by
  musculo-cutaneous N.
• The biceps act on the shoulder jt. as put the
  head of humerus in its place on elbow jt. as
  flexor supinator as it inserted in the post.
  part of tuberosity of the radius.
• The brachialis M. from the shaft of humerus to
  the tuberosity of ulna, act as flexor to the
  elbow.
• The coracobrachialis act as flexor adductor to
  the arm.

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MUSCLES OF THE BACK OF THE ARM.

• It is the Triceps M. the long ,medial lateral
  heads inserted in the upper post. Part of
  olecranon process supplied by the radial N. to
  act as extensor of the elbow stabilize the
  elbow jt.

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THE FOREARM MUSCLES

• They divided to 2 groups
• 1- The flexor- pronator gp.
• 2- The extensor- supinator gp.
• THE FLEXOR PRONATOR GROUP
• They flex the wrist ,fingers pronate the
  forearm.
• They divided to superficial deep groups.
• The superficial group arise from the front of
  medial epicondyle of humerus, pass in front
  of the forearm the wrist to inserted in
  bones of the hand .

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THE FLEXOR PRONATOR GROUP

• They are Pronator teres , Fl. Carpi-radialis ,
  Fl. Carpi-ulnaris ,Fl. Digitorum superficialis
  palmaris longus Mm .
• The deep group arise from the front of
  interosseous membrane radius ulna.
• They are Fl.digitorum profundus , Fl.pollicis
  longus pronator quadratus Mm.

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THE FLEXOR PRONATOR GROUP

• The pronators are Pronator teres Pronator
  quadratus Mm. where inserted in the
  radius pronate the forearm .
• The flexors of the wrist are Fl.carpi-radialis
  ,Fl. carpi-ulnaris Palmaris longus where
  inserted in the metacarpal bones .
• The flexor of the fingers are Fl. digitorum
  superficialis Fl. Digitorum profundus
  where inserted in the phalanges.
• The flexor of the thumb is Fl. Pollicis longus
  inserted in phalanges of the thumb .

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THE EXTENSOR - SUPINATOR GROUP.

• They extend the wrist the fingers
  supinate the forearm .
• They divided to superficial deep groups
• The superficial group arise from the back of the
  lateral epicondyle of humerus to pass on the back
  of the forearm inserted in the bones of the
  hand . The are 7 Brachio-radialis , extensor
  carpi radialis longus ext.calpi-radialis
  brevis ext.digitorum ext. digiti- minimi
  ext. carpi ulnaris anconeus Mm.

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THE EXTENSOR - SUPINATOR GROUP.

• The deep group is 5 Mm supinator abductor
  pollicis longus ext. pollicis brevis ext.
  pollicis longus ext. indicis Mm.

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THE EXTENSOR - SUPINATOR GROUP.

• The supinators are Supinator ,Brachio radialis
  the anconeus Mm. where inserted in the bones of
  the forearm.
• The extensor of the wrist are
  Ext.carpi-radialis longus , Ext. carpi-radialis
  brevis ext. carpi-ulnaris Mm. where inserted in
  the metacarpal bones extend the wrist.
• The extensors of the fingers are Ext. digitorum
  Ext. digiti- minimi Ext. indicis where
  inserted in the fingers extend the
  metacarpo-phalangeal joints .

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THE EXTENSOR - SUPINATOR GROUP.

• The muscles of the thumb are Abductor pollicis
  longus , Ext. pollicis brevis ext. pollicis
  longus Mm. where inserted in the thumb bones .

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THE FLEXOR RETINACULUM

• It is a thick band made of dense white fibrous
  tissue which stretch across the anterior surface
  of the carpus bones which are concave in shape (
  carpus arch ) changing the arch to carpus tunnel
  .
• In the tunnel pass the median nerve tendons of
  Mm.
• THE EXTENSOR RETINACULUM
• It is a thickening of deep fascia between the
  lower ends of radius ulna .

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THE MUSCLES OF THE HAND

• They divided to thenar hypothenar Mm.
• The thenar Mm Abductor pollicis brevis , flexor
  pollicis brevis opponens pollicis Mm.
• The hypothenar Mm abductor digiti minimi
  ,flexor digiti minimi opponens digiti minimi
  Mm.
• There are also 4 lumbrical Mm 7 Interosseous
  Mm. in the fingers .
• All these Mm responsible for fine movements of
  fingers.

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IMPOTANT REGIONS IN THE UPPER LIMBTHE
BREASTTHE AXILLA
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THE BREAST( THE MAMMARY GLAND)

• It lies in the superficial fascia . It is
  modified skin gland rudimentary in males .In
  female , the non-lactating mammary gland is
  formed of fat milk glands covered by a skin
  contain the nipple the areola.
• It extends from the 2nd rib to 6th rib from the
  edge of sternum to the mid-axillary line.
• Each gland is formed of 16-20 lobes each lobe
  divided to lobules.
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THE BREAST( THE MAMMARY GLAND)

• The lymphatic drainage of the lateral side of
  the breast go to axillary L.N. while the medial
  side of the breast go to the internal mammary
  chain of L.N.
• It is the pathway of breast cancer to
  matestasize in the body .

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THE LYMPH NODES OF THE AXILLA

• They divided to
• 1- The anterior ( pectoral) group .
• 2- The posterior (subscapular ) group.
• 3- The lateral group along the axillary
  vein
• 4- The central group in the base of the
  axilla .
• 5- The apical group in the apex of the
  axilla.

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ARTERIES OF THE UPPER LIMB

• THE AXILLARY ARTERY It begins at the outer
  border of the 1st rib as a continuation of the
  Subclavian A. ends at the lower border of the
  teres major M. by becoming the Brachial A.
• The pctoralis minor M . divided it to 3 parts

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ARTERIES OF THE UPPER LIMB

• The 1st part lies above the pectoralis minor
  give one branch (superior thoracic A.) . It lies
  very deeply with the axillary vein on its medial
  side .
• The 2nd part lies behind the pectoralis minor
  M. gives 2 branches ( acromio -thoracic A.
  lateral thoracic A. ).
• The 3rd part lies below the pectoralis minor M.
  gives 3 branches ( subscapular A., post.
  circumflex humeral A. ant . Circumflex humeral
  A.).

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Anastamosis around the scapula

• It is an important anastamosis between branches
  of the first part of the subclavian A. the third
  part of axillary A.
• 1- branches of the first part of the subclavian A
• 1-1- the supra scapular A. which distributed to
  the supraspinous the infraspinous fossa.
• 1-2- deep branch of the transverse cervical A.
  which go down along the medial border of the
  scapula.

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Anastamosis around the scapula

• 2- The branches of the third part of axillary A.
• 2-1- the sub scapular A. which go down along the
  lateral border of the scapula.
• 2-2- the circumflex scapular A. which arise from
  the sub scapular A. go to the infraspinous fossa.

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ARTERIES OF THE UPPER LIMB

• THE BRACHIAL ARTERY
• It begins at the lower border of the Teres major
  M. as a continuation of the Axillary A. ends at
  the level of the neck of the Radius by dividing
  to Radial Ulnar Aa.
• It is a superficial A. lies immediately below the
  deep fascia.
• The basilic vein lies on its medial side.
• In the upper part , the brachial A. lies to the
  medial side of the humerus while in the lower
  part lies anterior to it.

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THE BRACHIAL ARTERY

• The branches of the brachial A. It supplies all
  the Mm. of the arm gives 3 branches
• 1- the profunda brachii A.
• 2- the superior ulnar collateral A.
• 3- the inferior ulnar collateral A.
• The profunda brachii A. is the largest branch
  pass with the radial N. in the spiral groove of
  the humerus to end in 2 terminal branches above
  the elbow joint .

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Anastamosis around The Elbow Joint

• It is a rich anastamosis between small branches
  of brachial ,ulnar radial Aa.
• 1- anastamosis around medial epicondyle
• The two branches of the brachial A .(the
  superior ulnar collateral A. the inferior ulnar
  collateral A.) with the branches of ulnar A.
  (the ant. post. Ulnar recurrent Aa.) .i.e. the
  brachial the ulnar Aa. only .
• 2- anastamosis around lateral epicondyle
• The 2 terminal branches of the profuda brachii a.
  with recurrent branches of ulnar radial Aa.
  

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THE RADIAL ARTERY

• It begins in the cubital fossa at the level
  opposite to the neck of the radius ends in the
  palm by becoming the deep palmer arch .
• It is the smaller of the 2 terminal branches of
  the brachial artery descend in the lateral part
  of the front of the forearm .
• At the lower end of the radius , it leaves the
  front of the forearm turns backward round the
  lateral border of the wrist , below the styloid
  process of the radius enter the anatomical
  snuff-box where the pulsation can be felt then
  pass to the palm .

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THE RADIAL ARTERY

• It is deep in the upper part of the forearm to
  become superficial in the lower part of the
  forearm where we can feel the radial pulse.
• The radial N . runs along the lateral side of the
  A. in the middle 1/3 then leave it in the lower
  1/3 to go backward .
• the radial A. form the deep palmer arch of the
  hand after giving many branches in the forearm
  the hand .

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THE ULNAR ARTERY

• It begins in the cubital fossa at the level
  opposite to the neck of the radius ends in the
  palm by becoming theSUPERFICIAL PALMER ARCH.
• It is the larger branch of the brachial A. It
  runs obliquely-medially in the upper part
  vertically in the lower part of the forearm where
  be superficial gives the deep palmer branch (
  which helps in forming the deep palmer arch )
  then becomes the superficial palmer arch.

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THE ULNAR ARTERY

• The ulnar N. runs on medial side of the lower 2/3
  of the ulnar artery while the median N. lies in
  the medial side of the A. in the cubital fossa
  then pass the A. obliquely to be in the middle
  part of the lower 2/3 of the forearm.
• It gives the ant. post. Ulnar recurrent Aa
  which form anastamosis with the brachial A. in
  the elbow region. Also gives many branches in the
  forearm above the wrist.

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THE SUPERFICIAL PALMER ARCH

• It is superficial because it lies immediately
  next to the palmer aponeurosis.
• It is formed mainly by the ulnar A. with the
  superficial palmer branch of the radial A.
• It gives 4 digital Aa. to supply the 4 medial
  fingers.

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THE DEEP PALMER ARCH

• It is formed mainly by the radial A. with the
  deep palmer branch of the ulnar A.
• It gives 3 palmer metacarpal Aa. To pass to the
  clefts of the fingers.

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THE BRACHIAL PLEXUS

• A plexus it is a complex arrangement of the
  anterior primary rami of certain spinal Nn. Which
  gives branches to supply the Mm. skin of a
  certain part of a body.
• THE BRACHIAL PLEXUS
• It is formed by the anterior primary rami of
  C5,C6,C7,C8 T1 Nn. these are called ROOTS of
  the plexus.
• It lies in the lower part of the neck behind the
  clavicle in the axilla formed of 4 main parts
  Roots , Trunks , Divisions cords.

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THE BRACHIAL PLEXUS

• 1- The roots lie in the neck between the
  scaleneus ant. scaleneus medius Mm.
• 2- The trunks traverse the lower part of
  the posterior triangle of the neck .
• 3- The divisions lie behind the middle 1/3
  of the clavicle.
• 4- The cords lie in the axilla .
• THE TRUNKS formed by
• The roots of C5 C6 unite to form the
  upper trunk

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THE BRACHIAL PLEXUS

• The root of C7 alone form the middle trunk.
• The roots of C8 T1 unite to form the lower
  trunk.
• Then each trunk divides into anterior
  posterior division .
• Then the 3 posterior divisions unite to form the
  posterior cord .
• The anterior divisions of the upper middle
  trunks form the lateral cord.
• The anterior division of the lower trunk alone
  forms the medial cord .

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THE BRACHIAL PLEXUS

• So we have 5 roots , 3 trunks , 6 divisions
  , 3 cords 5 terminal branches .
• No branches arise from the trunks nor from the
  divisions ( except the suprascapular N. which
  come from the erbs pointat beginning of the
  upper trunk). .
• The brachial plexus gives 16 branches , 11 small
  branches 5 big branches radial , ulnar ,
  median , circumflex (axillary) musclocutaneous
  Nn.

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THE BRACHIAL PLEXUS

• THE BRANCHES OF THE CORDS
• They are 2 types main branches small branches.
• Each cord gives 2 main branches
• 1- the posterior cord radial n circumflex N
  (axillary N.).
• 2- the medial cord ulnar N. medial root of
  median n.
• 3- the lateral cord the lateral root of median
  N. musclocutaeous N.

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THE BRACHIAL PLEXUS

• The small branches of the cords are
• 1- from the posterior cord upper subscapular N.
• N. To
  latissmus dorsi (thoracodorsal N.).
• Lower
  subscapular N.
• 2- from the lateral cord lateral pectoral N.
• 3- from the medial cord medial pectoral N.
• Medial cutaneous N. of
  the arm Medial
  cutaneous N. of the
  forearm.

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THE BRACHIAL PLEXUS

• THE BRANCHES OF THE ROOTS
• There are 4 branches
• 1- from C5 N. to rhemboids Mm.(rh.major
  ,rh. Minor levator scapulae)
• 2- from C5,C6,C7 N. to serratus anterior
  (long thoracic N.).
• 3- from C6 N. to subclavius.
• 4- at the union of C5 C6 (erbs point)
  suprascapular N.( to supraspinatus
  infraspinatus).

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THE BRACHIAL PLEXUS

• Each cord gives rise to 2 branches one is big
  consider the continuation of the cord one is
  small SO
• The posterior cord continues as the radial N.
• The medial cord continues as the ulnar N.
• The lateral cord continues as the median N.
• The 3 cords named according to their position to
  2nd part of the axillary A. (post. , medial
  lateral.) while the name of the main N. according
  to position in the forearm( ulnar , median
  radial ).

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THE BRACHIAL PLEXUS

• The 5 main Nn. Arise opposite the lower border of
  the pectoralis minor M. near the coracoid process
  .
• 1- The circumflex (axillary ) N. supplies the
  deltoid teres minor Mm. then become
  the lateral cutaneousN. of the arm.
• 2- The musculocutaneous N. supplies the
  biceps , coracobrachialis brachialis Mm.
  then become the lateral cutaneous N. of
  the forearm .
• 3- The median N ( with its branch ant.
  Interosseous N.) supplies most of
  the Mm. of front of the forearm with
  sensation of lateral 3 ½ fingers
  anteriorly .

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THE BRACHIAL PLEXUS

• 4- The radial N.( with its branchpost.
  Interosseous N.) supplies most of the
  mm. of the back of the forearm. With
  sensation of lateral 3 ½ fingers
  posteriorly.
• 5- The ulnar N. supplies Mm. on the
  medial side of the forearm with
  sensation of medial 1 ½ fingers
  anteriorly posteriorly .

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THE DERMATOMES OF THE UPPER LIMB

• It is the cutaneous sensation of the upper limb.
• C4 supplies the skin over the tip of the shoulder
  .
• C5 supplies the lateral side of the arm the
  upper lateral part of the forearm .
• C6 supplies the lateral side of the lower part of
  the forearm the lateral aspect of the
  hand
• C7 supplies the middle aspect of the hand (ant.
  post.) .

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THE DERMATOMES OF THE UPPER LIMB

• C8 supplies the medial side of the hand
  the medial lower part of the forearm.
• T1 supplies the medial part of the upper
  part of the forearm the medial lower part
  of the arm.
• T2 supplies the medial side of the upper
  part of the arm the floor of the axilla.

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THE VEINS OF THE UPPER LIMB

• There are superficial deep veins in the upper
  limb .
• 1-the deep veins are the veins which accompany
  the main Aa. ( way name ).
• 2- The superficial Vv. start as superficial
  venous network on the back of the hand. this
  network drains in 2 directions laterally into
  Cephalic V medially to the basilic V.

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THE VEINS OF THE UPPER LIMB

• THE CEPHALIC VEIN
• It starts in the superficial fascia just behind
  the styloid process of the radius . Then it runs
  upward to the anterior surface of the forearm
  in the upper arm it lies in a groove along the
  lateral border of biceps M. then pierces the deep
  fascia in a groove between the deltoid
  pectoralis major Mm. to inter the axillary vein.

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THE VEINS OF THE UPPER LIMB

• THE BASILIC VEIN
• It ascends along the postero-medial surface of
  the forearm to go in the ant. surface just below
  the Elbow. It pierces the deep fascia in the
  middle of the arm .At the edge of the post. fold
  of the axilla its joined by the brachial Vv. to
  form the Axillary vein.

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THE VEINS OF THE UPPER LIMB

• THE MEDIAN CUBITAL VEIN
• It is the most prominent superficial vein in the
  body .
• It joins the cephalic the basilic Vv just
  distal to the front of the elbow joint.
• These superficial veins are more important than
  the deep Vv. Because they are larger in size
  used for intravenous injections.

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