393 CHAPTER 11 Upper Limb ORGANIZATIONAL PATTERN OF UPPER QUADRANGULAR SPACE LIMB MUSCULATURE AND OF THE MUSCULAR BRANCHES OF THE TRIANGULAR SPACE BRACHIAL PLEXUS THE SUPRASCAPULAR NERVE - A Branch of Evolution and Development of the Pectoral Limb the Brachial Plexus Given Off in the Posterior How to Identify a Muscle of the Upper Limb as Triangle of the Neck Being Either Developmentally Dorsal or Ventral CLINICAL CONSIDERATIONS Developmentally Dorsal Muscles Developmentally Ventral Muscles SUPERFICIAL VEINS OF THE UPPER LIMB Relevance of Dorsal/Ventral Dichotomy for Cephalic Vein Understanding the Brachial Plexus Basilic Vein Median Cubital Vein PECTORAL GIRDLE Median Antebrachial Vein Scapula Some Common Variations of Superficial Veins Clavicle AXILLA SCAPULOTHORACIC JOINT ARTERIAL AXIS OF THE UPPER LIMB STERNOCLAVICULAR JOINT Branches of the Subclavian Artery to the Upper Limb - Transverse Cervical and Suprascapular ACROMIOCLAVICULAR JOINT Arteries MUSCLES CONNECTING THE TRUNK TO TRANSVERSE CERVICAL AND SUPRASCAPULAR VEINS THE SCAPULA Axillary Artery Trapeziuz The One Named Branch of the First Part of the Rhomboideus Major and Rhomboideus Minor Axillary Artery - Highest (Supreme) Thoracic Levator Scapulae Artery The Two Named Branches of the Second Part of the Serratus Anterior CLINICAL CONSIDERATIONS REGARDING THE SERRATUS Axillary Artery--Thoraco-acromial and Lateral ANTERIOR Thoracic Arteries Subclavius The Three Named Branches of the Third Part of the Pectoralis Minor Axillary Artery--Subscapular, Posterior Humeral Circumflex, and Anterior Humeral Circumflex HUMERUS Arteries MUSCLES CONNECTING THE TRUNK TO Variations in Branching Pattern of the Axillary THE HUMERUS Artery Pectoralis Major Arterial Anastomoses Around the Scapula Latissimus Dorsi Acromial Anastomosis Supraspinous Anastomosis DEVELOPMENTALLY DORSAL SCAPULO- Infraspinous Anastomosis HUMERAL MUSCLES Subscapular Anastomosis Deltoid Miscellaneous Anastomoses DELTOPECTORAL TRIANGLE AND GROOVE SIGNIFICANCE OF ALL THESE ANASTOMOSES Teres Major ANASTOMOSES BETWEEN THE SUBCLAVIAN/AXILLARY Rotator Cuff - Supraspinatus, Infraspinatus, Teres AXIS AND THE POSTERIOR INTERCOSTAL ARTERIES Minor, and Subscapularis AXILLARY VEIN Functions of the Rotator Cuff Muscles NERVES IN THE AXILLA THE DORSAL DIVISION SCAPULO-ULNAR Medial and Lateral Pectoral Nerves MUSCLE THAT ACTS PRIMARILY ACROSS CLINICAL CONSIDERATIONS THE GLENOHUMERAL JOINT Medial Cutaneous Nerves of the Arm and Forearm Long Head of Triceps Brachii (in the Posterior (Medial Brachial Cutaneous and Medial Ante- Compartment of the Arm) brachial Cutaneous Nerves) 394 Subscapular Nerves Pronator Teres CLINICAL CONSIDERATIONS THE ROLE OF ELBOW FLEXORS IN PRODUCING FLEXION Axillary Nerve OF THE FOREARM CLINICAL CONSIDERATIONS Flexor Carpi Radialis Palmaris Longus MUSCLES OF THE (UPPER) ARM Flexor Carpi Ulnaris Biceps Brachii, Coracobrachialis, and Brachialis Flexor Digitorum Superficialis - The Develop- (Developmentally Ventral Limb Muscles in the mentally Ventral Muscle in the Intermediate Anterior Compartment of the Arm) Layer of the Anterior Antebrachial Biceps Brachii Compartment Brachialis Flexor Digitorum Profundus, Flexor Pollicis Coracobrachialis Longus, and Pronator Quadratus - The Triceps Brachii and Anconeus (Developmentally Developmentally Ventral Muscles in the Deep Dorsal Limb Muscles in the Posterior Layer of the Anterior Antebrachial Compartment of the Arm) Compartment Triceps Brachii Flexor Digitorum Profundus Anconeus Flexor Pollicis Longus CUBITAL FOSSA Pronator Quadratus BRACHIAL ARTERY BLOOD VESSELS IN THE ANTERIOR Named Branches of the Brachial Artery in the COMPARTMENT OF FOREARM (Upper) Arm Radial Artery Profunda Brachii Artery Branches of the Radial Artery in the Forearm THE ANASTOMOSIS BETWEEN THE PROFUNDA BRACHII Radial Recurrent Artery AND POSTERIOR HUMERAL CIRCUMFLEX ARTERIES Palmar Carpal Branch Superior Ulnar Collateral Artery Superficial Palmar Branch Inferior Ulnar Collateral Artery Ulnar Artery AN IMPORTANT VARIATION IN THE COURSE OF THE BRACHIAL VEINS ULNAR ARTERY NERVES IN THE (UPPER) ARM Branches of the Ulnar Artery In the Forearm Musculocutaneous Nerve Ulnar Recurrent Artery CLINICAL CONSIDERATIONS Common Interosseous Artery and Its Branches Median Nerve Anterior Carpal Branch Ulnar Nerve Arterial Anastomoses Around the Elbow Radial Nerve Muscular Branches of the Radial Nerve Given Off in NERVES IN THE ANTERIOR COMPARTMENT the Arm OF THE FOREARM Cutaneous Branches of the Radial Nerve Given Off Radial Nerve in the Forearm in the Arm Superficial (Branch of the) Radial Nerve Deep (Branch of the) Radial Nerve BONES OF THE FOREARM Ulnar Nerve in the Forearm Ulna Muscular Branches of the Ulnar Nerve in the Radius Forearm Oblique Cord of Forearm and the Interosseous Dorsal Cutaneous and Palmar Cutaneous Branches Membrane of the Ulnar Nerve MUSCLES SEEN ON THE ANTERIOR ASPECT Median Nerve in the Forearm OF THE FOREARM Muscular Branches of the Median Nerve in the Brachioradialis - a Developmentally Dorsal Muscle Forearm More Readily Seen in Anterior than Posterior Palmar Cutaneous Branch of the Median Nerve View Pronator Teres, Flexor Carpi Radialis, Palmaris BONES OF THE WRIST AND HAND Longus, Flexor Carpi Ulnaris - The Develop- Carpal Bones mentally Ventral Muscles in the Superficial Metacarpals Layer of the Anterior Antebrachial Phalanges Compartment 395 SPECIAL LIGAMENTS OF THE WRIST Dorsal Interossei - Abductors of Fingers, Flexors Pisohamate and Pisometacarpal Ligaments of Finger MP Joints, and Extensors of Finger IP Transverse Carpal Ligament and the Carpal Joints Tunnel DEEP ARTERIES OF THE PALM PALMAR APONEUROSIS DEEP NERVES OF THE PALM PALMARIS BREVIS - A Peculiar Intrinsic Hand Muscle Unrelated to Any Joint MUSCLES OF THE POSTERIOR COMPART- MENT OF THE FOREARM CARPOMETACARPAL (CM) AND INTER- Brachioradialis, Extensor Carpi Radialis Longus, METACARPAL JOINTS OF THE FINGERS Extensor Carpi Radialis Brevis, Extensor Digitorum (Communis), Extensor Digiti Minimi, METACARPOPHALANGEAL (MP) AND Extensor Carpi Ulnaris - The Developmentally INTERPHALANGEAL (IP) JOINTS OF THE Dorsal Muscles in the Superficial Layer of the FINGERS Posterior Antebrachial Compartment Metacarpophalangeal (MP) Joints Brachioradialis - a Flexor of the Forearm Interphalangeal (IP) Joints Extensor Carpi Radialis Longus - an Extensor and JOINTS OF THE THUMB Abductor of the Wrist Extensor Carpi Radialis Brevis - another Extensor THENAR EMINENCE MUSCLES - Abductor and Abductor of the Wrist Pollicis Brevis, Flexor Pollicis Brevis, and A VERY IMPORTANT ROLE OF WRIST EXTENSORS DURING Opponens Pollicis FLEXION OF THE FINGERS Extensor Digitorum (Communis) - Producing MP HYPOTHENAR EMINENCE MUSCLES - Extension and Contributing to IP Extension of Abductor Digiti Minimi, Flexor Digiti Minimi, Fingers and Opponens Digiti Minimi Extensor Digiti Minimi - Producing MP Extension and Contributing to IP Extension of the Little ACTION OF EXTRINSIC FINGER FLEXORS Finger ON CM JOINTS Extensor Carpi Ulnaris - an Adductor and Extensor ARTERIES OF THE PALM IMMEDIATELY of the Wrist BENEATH THE PALMAR APONEUROSIS Functional Interactions of the Wrist Muscles Superficial Palmar Branch of the Ulnar Artery Supinator, Abductor Pollicis Longus, Extensor Superficial Palmar Branch of the Radial Artery Pollicis Brevis, Extensor Pollicis Longus, Extensor Indicis - The Developmentally Dorsal NERVES OF THE PALM IMMEDIATELY Muscles in the Deep Layer of the Posterior BENEATH THE PALMAR APONEUROSIS Antebrachial Compartment Superficial Branch of the Ulnar Nerve Supinator Palmar Digital and Motor Recurrent Branches of Abductor Pollicis Longus the Median Nerve Extensor Pollicis Brevis FDP AND FDS TENDONS IN THE HAND Extensor Pollicis Longus ANATOMICAL SNUFF BOX Fibrous Digital Flexor Sheaths of the Fingers Extensor Indicis DUPUTREYN’S CONTRACTURE DETAILS OF THE FIBROUS DIGITAL SHEATH OF INTEREST THE EXTENSOR RETINACULUM TO FUTURE ORTHOPAEDISTS Bony Insertions of the FDP and FDS Tendons INTERACTION OF EXTRINSIC AND Synovial Sheaths of the Extrinsic Finger Flexors INTRINSIC MUSCLES IN FLEXION AND LUMBRICALS - Extensors of IP Joints of Fingers EXTENSION OF THE FINGERS Flexion of the Fingers DEEP MUSCLES OF THE PALM Extension of the Fingers Adductor Pollicis - An Intrinsic Flexor/Adductor The Oblique Retinacular Ligament and Its Role in of the Thumb Finger Flexion Palmar Interossei - Adductors of Fingers, Flexors An Interesting Side Effect of the Trifurcation of of Finger MP Joints, and Extensors of Finger IP the ED Tendon Into Central and Marginal Joints Bands 396 BLOOD VESSELS IN THE POSTERIOR Wrist Joint--Radiocarpal and Intercarpal Joints COMPARTMENT OF THE FOREARM AND IN THE DORSUM OF THE HAND LYMPHATICS OF THE UPPER LIMB Posterior Interosseous Artery Axillary Group of Lymph Nodes Radial Artery Outlying Groups of Deep Nodes Dorsal Carpal Branch of the Radial Artery Outlying Superficial Nodes Dorsal Digital Branches of the Radial Artery to the SURFACE ANATOMY Thumb and Radial Side of the Index Finger Soft-Tissue Landmarks Princeps Pollicis Artery Bicipital Sulci Radialis Indicis Artery Cubital Fossa Ulnar Artery - Posterior Carpal Branch Carpal Flexion Creases Dorsal Metacarpal Arteries from the Dorsal Flexor Carpi Radialis Tendon Carpal Arch Palmaris Longus Tendon Arterial Anastomoses in the Wrist and Hand Flexor Carpi Ulnaris Tendon Extensor Pollicis Brevis and Longus Tendons, NERVES IN THE POSTERIOR COMPART- Abductor Pollicis Longus Tendon MENT OF THE FOREARM AND IN THE Palmar and Digital Flexion Creases DORSUM OF THE HAND Bony Landmarks Scapula and