SAN JUAN BAUTISTA PRIVATE UNIVERSITY ASSOCIATION

FACULTY OF HEALTH SCIENCES

PROFESSIONAL SCHOOL OF HUMAN MEDICINE

MONOGRAPH OF UPPER LIMB OF HUMAN BODY

SUBJECT

ENGLISH I

TEACHER

Valdez Arango, Ada

CYCLE

IV

Chincha - Per

2016- I
STUDENTS:

Canchari Violeta, Deivis

Cusipuma Garca, Mayra Melany
Garayar Julin, Mara Antonieta
Guilln Carbajal, David
Mendez Flores, Luca Jaqueline
Mendoza Bellido, Renan
Muoz Cceres, Ximena
Pando Marin, Jeffrey Ubaldo
Tasayco Melo, Pierina Mara
Vera Barrios, Leticia Medali
Guzmn Tercero, Carlos
Siguas Garca, Vctor

DEDICATION
Dedicate for our teachers of Faculty of health Sciences of
San Juan University, for your contribution and agreement
in our medical education.
.

INDEX

INTRODUCTION...................................................................... 6
CHAPTER I: SKELETON OF THE UPPER LIMB.......................................... 7
1.1.
1.2.
1.3.
1.4.
1.5.
1.6.
1.7.
1.8.

THE CLAVICLE......................................................................................7
THE SCAPULA......................................................................................7
THE HUMERUS....................................................................................8
THE RADIO.........................................................................................10
THE ULNA...........................................................................................11
CARPAL BONES.................................................................................12
METACARPAL BONES.......................................................................13
PHALANGES OF THE FINGERS.......................................................13

CHAPTER II: JOINTS OF THE UPPER LIMB............................................. 14

2.1 JOINTS OF SHOULDER............................14
2.2 ELBOW JOINTS........................................14
2.3 JOINT OF FOREARM.................................14
2.4 WRIST JOINT.............................................15
2.5 JOINT OF HAND........................................15
CHAPTER III: MUSCLES OF THE UPPER LIMB....................................

17

3.1. MUSCLES OF THE SHOULDER REGION.............................................17

3.2. MUSCLES OF THE ARM REGION.........................................................18
3.3. MUSCLES OF THE FOREARM REGION...............................................19
3.3.1. VENTRAL MUSCLES................................................................20
3.3.1.1. FIRST PLANE..............................................................20
3.3.1.2. SECOND PLANE.........................................................20
3.3.1.3. THIRD PLANE.............................................................21
3.3.1.4. FOURTH PLANE.........................................................21
3.3.2. DORSAL MUSCLES..................................................................21
3.3.3. LATERAL MUSCLES.................................................................22
3.4. MUSCLES OF THE HAND REGION......................................................22

CHAPTER IV: ARTERIES OF UPPER LIMB............................................

23

4.1. SUBCLAVIAN ARTERY...........................................................................23

4.2. AXILLARY ARTERY................................................................................24

4.3. BRACHIAL OR HUMERAL ARTERY.....................................................25
4.4. RADIAL ARTERY.....................................................................................25
4.5. ULNAR ARTERY.....................................................................................26

CHAPTER V: VEINS OF UPPER LIMB.....................................................

27

5.1. SUPERFICIAL VEINS OF FOREARM....................................................27

5.2. DEEP VEINS OF FOREARM..................................................................27

CHAPTER VI: LYMPH NODES OF UPPER LIMB....................................

29

6.1. AXILLARY NODES..................................................................................29

CHAPTER VII: NERVES OF THE UPPER LIMB.......................................... 31

7.1. THE BRACHIAL PLEXUS....................................................................... 31

CHAPTER VIII: CONCLUSIONS................................................................. 33

CHAPTER IX: BIBLIOGRAPHIC REFERENCES...................................... 34

CAPITULO X: ANNEXES..........................................................................

35

INTRODUCTION
The Human Medicine students of English I subject of San Juan Bautista Private
University Association performed the monograph of upper limb of Human body.

This monograph describes to superior limb, which is called limb thoracic too and
born of the chest portion super lateral.

This corresponds to an appendix of the body and one of the major regions in
which it is divided for study. It is cylindrical in shape with flattened end portion
from front to back. It consists of a central bony skeleton surrounded by soft
tissue. Its length varies with the height of the person, Normally it reaches the
middle of the thigh.
For a better description we started rewiewing the skeleton, then the joints,
muscles, vessels, nerves and finally lymph nodes in the upper limb of the
human body.

I. SKELETON OF THE UPPER LIMB

The upper limb bones include the clavicle, scapula, humerus, ulna,
radius, carpal bones and phalanges of the fingers. With exception of the
carpal bones, all the others correspond to long bones and presented for
study two ends or epiphysis and a middle portion called the body or
diaphysis.
1.1. THE CLAVICLE
It is a long bone ubicated in the superolateral and anterior chest
and transversely directed. The clavicle is S shaped, with convex
and concave curves. His epiphysis or medial end is bulkier and
the clavicle attaches to the manubrium of the sternum. Its
epiphysis or lateral ends is flattened from front to back and
articulates with the acromion process of the scapula. Its diaphysis
or body is cylindrical in the middle portion and flattened from top to
bottom on the side.
In the inferior aspect, the clavicule has a conoid tubercle, which
serves as a point of attachment for ligaments. Also on the inferior
surface is the costal tuberosity, which also serves as an
1.2.

attachment point for ligaments.

THE SCAPULA
The scapula has the shape of a broad triangle. As we have seen,
the two major processes are the acromion process and the
coracoid process. These projections can be felt through the skin.
Their ends meet to form a large concavity called the glenoid fossa.
This cavity can be seen particularly well in the lateral view of the
right scapula. A rim of cartilage is attached to the circumference of

the glenoid cavity, and the head of the humerus articulates with
the scapula at the cavity to form the shoulder joint.
The dorsal surface of the scapula is divided into two regions by
the spine of the scapula. The area above the spine is called the
supraspinous fossa. The area below is known as the infraspinous
fossa. These areas are seen in the lateral and posterior views.
With the subscapular fossa, they serve as sites of attachment for
numerous shoulder muscles. Each scapula has three borders and
two angles. The medial border, sometimes called the vertebral
border, is thin and lies close to the vertebral column. The lateral or
axillary border is thicker and lies closer to humerus. The superior
border is at the upper edge of the scapula. It contains a notch
called the scapular notch where nerves pass through the upper
border. Where the medial and lateral borders meet, the scapula
has an inferior angle. The superior angle lies where the medial
1.3.

border meets the superior border.

THE HUMERUS
It is a the largest and longest bone and its proximal ends it is
formed by the following parts: head, anatomic neck and two
tuberositys. It is a relatively thick bone with a large, smooth head
at the proximal end and a number of projections at the distal end.
The humerus is the main bone of the upper extremity. It articulates
with the scapula at the glenoid fossa. Another prominent bone in
this area is the clavicle. The nearby bones to the pectoral girdle
include the ribs, which articulate with the sternum. Distally, the
humerus articulates with the radius and the ulna.
Beginning at the proximal end, the humerus features a head that
articulates at the glenoid cavity of the scapula. The head is
8

prominent in the posterior view. On the lateral surface of the

epiphysis of the humerus is the greater tubercle. This is an
attachment point for shoulder joint ligaments and is the most
lateral point of the shoulder region that can be felt through the
skin. The lesser tubercle is also an attachment point for ligaments.
It lies on the anterior and medial surface of the humerus.
A groove called the intertubercular groove separates the greater
and lesser tubercles. The anatomical neck is the distal limit of the
articular capsule. It is the site of what once was the epiphyseal
plate.
The surgical neck is a constricted portion distal to the tubercles
and a common site of fractures.
The shaft of the humerus is rounded at the proximal end, but more
triangular at the distal end. An important process on the shaft is
the deltoid tuberosity. This is where the deltoid muscle attaches to
the humerus. The tuberosity is shaped like a V. At the distal end of
the bone is a depression called the radial fossa. The head of the
radius articulates here when the arm is flexed. The coronoid fossa
is the depression that receives the ulnas coronoid process during
flexion. The lateral epicondyle is an attachment site for muscles
that move the forearm. The medial epicondyle is a second
attachment side for these muscles. The capitulum is seen
prominently in the anterior view. It is a Little head that articulates
with the radius. The trochlea is a point of articulation with the ulna.
The posterior view of the humerus shows the olecranon fossa.
This is a depression that receives the olecranon process of the
ulna during extension of the forearm.
9

1.4.

THE RADIUS
It is a long bone and takes the side of the skeleton of the forearm.
It is shorter tan and lateral to the ulna. The proximal end
articulates with the humerus, the medial aspect with the ulna, and
the distal end with the carpus.
The proximal end consists of a head, neck and tuberosity. The
superior, concave surface of the head articulates with the
capitulum of the humerus. The head of the radius can be felt
immediately inferior to the lateral epicondyle, particularly during
rotation. The tuberosity of radius is situated on the anteromedial
aspect, immediately distal to the neck.
The shaft has anterior, posterior and lateral surfaces and anterior,
posterior, and interosseous borders. The interosseous border is
attached by the interosseous mmembrane to a corresponding
border on the ulna.
The distal end of the radius terminates in the styloid process
laterally. On its medial side, the distal end of the radius has an
ulnar notch, for articulation with the head of the ulna. At about the
middle of the convex dorsal aspect of the distal end of the radius,
a small prominence, the dorsal tubercle, may be felt.
The inferior surface of the distal end articulates with the lunate

1.5.

(medial) and the scaphoid (lateral).

THE ULNA
It is a long bone and formed the medial part of skeleton of
forearm. Its proximal end of the ulna articulates with the trochlea
of the humerus. To enable movement at the elbow joint, the ulna
has a specialized structure, with bony prominences for muscle
attachment.

10

Important landmarks of the proximal ulna are the olecranon,

coronoid process, trochlear notch, radial notch and the tuberosity
of ulna.
Olecranon is a large projection of bone that extends proximally,
forming part of trochlear notch.
The coronoid process forming part of the trochlear notch.
Trochlear notch formed by the olecranon and coronoid process. It
is wrench shaped and articulates with the trochlea of the humerus.
The radial notch located on the lateral surface of the trochlear
notch, this area articulates with the head of the radius.
The tuberosity of ulna, an roughening immediately distal of the
coronoid process.
The ulnar shaft is triangular in shape with three surfaces, anterior,
posterior and medial surfaces and three borders, posterior,
interosseous and anterior border.
The distal portion of the ulna is much smaller in diameter that the
proximal end. It is mostly unremarkable, terminating in a rounded
1.6.

head, with distal projection, the ulnar styloid process.

CARPALS BONES
The carpals consists of the proximal row of carpals and the distal
row. There are four carpal bones in each row.
The scaphoid bone is found on the lateral border of the wrist near
the styloid process of the radius. Proceeding from the lateral to the
medial side of the hand on the anterior surface, the next bone is
the lunate bone. This bone also articulates with the radius. Next
medial to the lunate bone is the triquetal bone. This bone is
somewhat triangular in shape. The triquetal bone articulates with
cartilage separating the ulna from the carpals. The most medial of
the carpal bones is the small pisiform bone. This bone is evident
from the outside body, because it projects posteriorly on the little
11

finger side as a small, rounded elevation. The lateral bone of the

distal row of carpals is the trapezium bone. Medial to the
trapezium bone is the trapezoid bone. This bone articulates with
the scaphoid bone, as does the trapezium. The trapezoid bone is
shaped like a wedge. The largest bone is the capitate bone, and
the medial carpal bone in the distal row is the hamate bone. This
bone has roughly the shape of a hook.

1.7.

METACARPAL BONES
The metacarpal bones form the palm of the hand. The bones are
long, and are not given names but are numered one to five,
beginning with the thumb and ending with the Little finger.
Each metacarpal has three distinctive areas: the base of the
metacarpal, followed by the long shaft of the metacarpal, and the
head of the metacarpal. The heads of the metacarpals are
prominent as the proximal knuckles of the hand. They articulate

1.8.

with the phalanges.

PHALANGES OF THE FINGERS
Also we have to the phalanges of the fingers. Each hand has
forteen phalanges. They are distinguished as proximal phalanges,
middle phalanges and distal phalanges. The thumb has no middle
phalanx. It has only a proximal phalanx and a distal phalanx. A
phalanx has three distinctive reas: base, the most proximal part
of the phalanx; the shaft and the head, the most distal portion of
the phalanx.

12

II. JOINTS OF THE UPPER LIMB

2.1.

JOINTS OF SHOULDER

a. The Sternoclavicular joint: It is the joint of sternum with the medial

third of the clavicle. It is synovial type, plane or arthrodial joint.
b. The Acromioclavicular joint: It is the joint of acromion of the
scapula with the lateral third of the clavicle. Belongs to the group
of synovial joints, planes or arthrodial.
c. The Scapulhumeral joint or shoulder joint: It is the joint of the
glenoid fossa of the scapula, located at the upper lateral angle of
this bone, with the proximal third of humerus. Belongs to the group
of spheroid synovial joints.
2.2.

ELBOW JOINT
a. The Humerus-ulna joints:It is a joint of type sinovial joint and
gender troclearthrosis.
b. The Humerus-radius: It is a joint of type sinovial joint and
gender condyloarthrosis.
c. The Radio-ulnar joint: Joint type sinovial of gender trocoid.

2.3.

JOINT OF FOREARM
a. Union of diaphysis ulna-radius: Witch is fibrous type, belonging to
gender syndesmosis.
b. Below Radius-ulnar: Joint of fibrous type, belonging to gender
syndesmosis.

13

2.4.

WRIST JOINT

a. The Radiocarpal joint: It is a condyloid sinovial joint between distal

radius and the proximal row of the carpal bones, scaphoid, lunate
and triquetal bones.
b. The Ulna-pyramidal joint: Joint of fibrous type, belonging to gender
syndesmosis.
2.5.

JOINT OF HAND

a. Middle carpal: It is of type sinovial of gender condylo-arthrodial.

b. The Intercarpals joints: Are the joints of the carpal bones together.
Son las articulaciones de los huesos del carpo entre s. Belongs to
the group of synovial joints, planes or arthrodial.
c. The carpal-metacarpal joints: Are joints of inferior border of carpal
bones with proximal end or base of metacarpals.
The joints of carpal and the three last metacarpals are type
sinovial of gender arthrodial.
The joint of trapezium bone with the first metacarpal is type
sinovial of gender saddle.
d. Intermetacarpals: Are the joints of the upper thirds of the
metacarpal together; except the first with the second not
articulated. Are types synovial of gender arthrodial.
e. The Metacarpalphalangeal joints: Are the joints of the inferior
thirds of the metacarpal or heads, with the upper third of the first
phalanges; this formed the knuckles. Are types synovial of gender
condyloid.
f. Interphalanges: Are the joints of phalanges of the fingers together.
Are joints of type sinovial and gender troclearthrosis.

14

III. MUSCLES OF THE UPPER LIMB

For a better description thereof, we divide the upper limb in regions such as,
shoulder region, arm region, forearm region and hand region.
3.1.

MUSCLES OF THE SHOULDER REGION

15

a. SUPRASPINATUS MSCLE: Muscle abducts of arms the first fifteen

grades and external rotator of arm. Originates in supraspinatous
fossa of scapula and insert in the greater tubercle of the humerus or
troquiter. It is innervated by suprascapular nerve.
b. INFRASPINATUS MUSCLE: Muscle external

rotator

of

arm,

originates in the infraspinous fossaof the scapula for then inserted in

the greater tubercle of humerus or troquiter. It is innervated by
suprascapular nerve.
c. TERES MINOR MUSCLE: Muscle external rotator of arm, originates
in external border of scapula by dorsal part for then insert in greater
tubercle of humerus. It is innervated by axillary nerve.
d. SUBSCAPULARIS MUSCLE: Medial two-thirds of the costal surface
of the scapula (subscapular fossa). It is medially rotates the arm.
Originates in subscapular fossa for then insert in lesser tubercle of
humerus or troquin. It is innervated by subscapular nerve.
e. DELTOID MUSCLE: This muscle has three portions, the clavicular
that is medially rotates, the acromion that does the movement of
abduction and spinal is external rotator. Originates in the clavicle, the
acromion and the spine of scapula for then insert in the deltoid v of
humerus. It is innervated by axillary nerve.
f. SUBCLAVIUS MUSCLE: Stabilizes the

joint

sternoclavicular.

Originates in the first rib and insert in the clavicle. It is innervated by

Subclavius Nerve.
g. RHOMBOIDEUS MAJOR AND MINOR MUSCLES: These muscles
retracts, elevates and rotates the scapula inferiorly. The rhomboideus
major muscle originates from first to fourth thoracic vertebrae and the
rhomboideus minor from sixth and seventh cervical vertebrae for

16

then insert in medial border of the scapula inferior to the spine to the
scapula. It is innervated by Dorsal scapular nerve.
H. LEVATOR SCAPULAE MUSCLE: As its name said, elevates the
scapula. Originated in transverse processes of C1-C4 vertebrae for
then insert in superior angle to the spine. It is innervated by dorsal
scapular nerves.
i. TRAPEZIUS MUSCLE: It is the most superficial shoulder and one of
the largest muscles in the body. It makes elevates and depresses the
scapula; rotates the scapula superiorly; retracts scapula. Originates
in medial third of the superior nuchal line, external occipital
protuberance, ligamentum nuchae, spinous processes of vertebrae
C7-T12. Then insert in the clavicle, the acromion and the spine of
scapula. It is innervated by spinal accessory nerve.
3.2.

MUSCLES OF THE ARM REGION

a. MSCULO BRAQUIAL: It is a muscle flexes the elbow.
Originated in the anterior surface of the lower one-half of the
humerus for then insert in coronoid process of the ulna. It is
innervated by musculocutaneous nerve.
b. CORACOBRACHIALIS MUSCLE: This muscle flexes the
elbow, assists in pronation and supination. Originated in
coracois process of the scapula for then insert in medial side of
the humerus at mid shaft. It is innervated by musculocutaneous
nerve.
c. BICEPS BRAQUII MUSCLE: This muscle flexes the forearm,
flexes arm and supinates. It is formed for two heads, a short
head that originated in tip of the coracoid process of the
scapula and a long head that originated in supraglenoid
17

tubercle of the scapula, for then insert in tuberosity of the

radius. It is innervated by musculocutaneous nerve.
d. TRICEPS BRAQUII MUSCLE: It is formed by three portions, a
long that originated in infraglenoid tubercle, the lateral portion
originated posterolateral humerus and lateral intermuscular
septum and medial head originated posteromedial surface of
the inferior middle of the humerus. Then insert it in olecranon
process of the ulna. It is innervated by radial nerve.
e. ANCNEOUS MUSCLE: Muscle extends the

forearm.

Originated in lateral epicondyle of the humerus by then insert in

lateral side of olecranon and the upper one-fourth of the ulna. It
is innervated by radial nerves.
3.3.

FOREARM REGION

Given the large number of muscles in this region, for better study the
muscles divide by ventral, dorsal and lateral and inside of this distinction the
plane occupying.
3.3.1. VENTRAL MUSCLES: They are divided into four muscular
planes from the outside in:
3.3.1.1. FIRST PLANE: It is the most superficial.
a. PRONATOR
TERES
MUSCLE:

Muscle

pronates the forearm. This muscle originates in

common flexor tendon and from medial side of
coronoid process of the ulna for then insert in
midpoint of the lateral side of the shaft of the
radius It is innervated by median nerve.
b. PALMARIS BREVIS MUSCLE: This muscle
draws the skin of the ulnar side of the hand
18

toward the center of the palm. Originated in

fascia overlying the hypothenar eminence and
insert inn the skin of the palm near the ulnar
border of the hand. It is innervated by
superficial br. Of the ulnar nerve.
c. PALMARIS LONGUS MUSCLE: Muscle flexes
the wrist. Originated in commom flexor tendon,
from the medial epicondyle of the humerus and
end palmar aponeurosis. It is innervated by

3.3.1.2.

median nerve.
d. ULNAR ANTERIOR MUSCLE
SECOND PLANE
a. FLEXOR
DIGITORUM
SUPERFICIALIS
MUSCLE:

Muscle

metacarpophalangeal

flexes
and

the
proximal

interphalangeal joints. Originates in the medial

epicondyle, coronoid process and the diaphysis
of radius and insert in the second phalange
from second to fifth finger. It is innervated by
3.3.1.3.

median nerve..
PLANE THIRD
a. FLEXOR LARGO DEL PULGAR MUSCLE:
Flexor muscle of first finger. Originated in radius
for then insert in the distal phalange of first
finger. It is innervated by the median nerve.
b. FLEXOR
DIGITORUM
PROFUNDUS
MUSCLE: Flexor muscle of the fingers that
originated in the ulna and the interosseous
membrane for then insert in base of the distal
19

phalanx of digits 2-5. It is innervated by median

3.3.1.4.

and ulnar nerves.

FOURTH PLANE: It is most deep.
a. PRONATOR QUADRATUS MUSCLE: Muscle
pronates the forearm, originated in the distal
part of ulnar and insert in the distal part of
radius. It is innervated by anterior interosseous

nerve.
3.3.2. DORSAL MUSCLES
a. SHORT SUPINATOR MUSCLE
b. LARGE ABDUCTOR OF THUMB MUSCLE
c. SHORT EXTENSOR OF THUMB MUSCLE
d. LARGE EXTENSOR OF THUMB MUSCLE
e. EXTENSOR OF INDEX FINGER MUSCLE
f. EXTENSOR OF THE FINGERS AND
EXTENSOR OF FIFTH FINGER MUSCLES
g. ULNAR EXTENSOR OF CARPAL MUSCLE
3.3.3. LATERAL MUSCLES
a. LARGE SUPINATOR MUSCLE
b. EXTERNAL RADIAL OR FIRST RADIAL MUSCLE
c. RADIAL OR SECOND RADIAL
d. SHORT SUPINATOR MUSCLE
3.4. MUSCLES OF THE HAND REGION
Are the muscles of the palm of the hand.
a. DORSAL INTEROSSEOUS MUSCLES (I-IV)
b. INTEROSSEOUS PALMARES MUSCLES (II, IV Y V)
c. LUMBRICALS MUSCLES
d. ADDUCTOR OF THUMB MUSCLES
e. OPONENT OF THUMB MUSCLE
f. SHORT FLEXOR OF THUMB MUSCLE
g. SHORT ABDUCTOR OF THUMB MUSCLE
h. ABDUCTOR OF FIFTH FINGER
i. SHORT FLEXOR OF FIFTH FINGER
j. OPONENT OF FIFTH FINGER MUSCLE

IV. ARTERIES OF UPPER LIMB

20

The arteries leaving the heart with oxygenated blood to the rest of the
body. The arteries leading to the upper limb lie Subclavian Artery leaving
the heart, it comes down by the upper limb and has numerous
ramifications vascularized the arm, forearm and the hand.
4.1. SUBCLAVIAN ARTERY
The right Subclavian artery has its origin from the brachiocephalic artery
and left in the aortic arch. Both are directed outward, passing by upward
of the first rib, between the scalenus anterior muscle and the middle, up
to the lower edge of the subclavian muscle where it is continuous with
the axillary artery.
It is divided into following collaterals branches:
a. ASCENDENTS BRANCHES
Vertebral artery
Inferior Thyroid Artery
b. DESCENDING BRANCHES
Internal Thoracic Artery
Superior Intercostal Artery
c. EXTERNAL BRANCHES
Superior scapular Artery
Posterior scapular Artery
Deep cervical Artery
4.2. AXILLARY ARTERY
This artery is a continuation of the Subclavian Artery, which passing by
inferior border of middle third of the clavicle change name and nominated
Axillary Artery until the border of pectoralis major muscle, in this tour
gives several branches.
4.2.1. BRANCHES OF THE AXILLARY ARTERY
a. Superior thoracic artery: It vascularized of first
intercostal space.
b. Trunk Thoracoacromial It has five branches.
Pectoralis minor artery
Pectoralis major artery
Deltoic artery
Acromial artery
Clavicular artery
c. Lateral thoracic artery
21

d. Trunk subscapular
Superior Subscapular Artery
Inferior Subscapular Artery
Circumflex of the Scapula Artery
Artery that go Teres major muscle
Artery that has two branches,one that go to
Latissimus dorsi muscle and other that go
anterior serrate muscle.
e. Anterior Circumflex humeral Artery
f. Posterior Circumflex humeral Artery
4.3. BRACHIAL OR HUMERAL ARTERY
It is Braquial Artery a continuation of Axillary Artery, begins at the lower
border of Teres Major Muscle, where it divided in its ends branches:
a. Muscular branches
b. Nutrient Artery to humerus
c. Deep Brachial Artery
d. Superior Ulnar Collaterals Artery
e. Inferior Ulnar Collaterals Artery
4.4. RADIAL ARTERY
Radial artery a smaller terminal branch of Brachial artery, arises in the
cubital fossa at the neck of radius. It passes downwards and laterally
beneath the Brachioradialis resting on the deep muscles of forearm.
In the middle third of its course, superficial branch of radial nerve lies on
its lateral side.
In the distal part of forearm, it lies on the anterior surface of radius,
covered by skin and fascia. The tendon of Brachioradialis lies on its
lateral side while the tendon on flexor carpi redialis lies on its medial
side.It leaves the forearm by winding around the lateral aspect of wrist to
reach the posterior surface of hand. It divided in:
Muscular branches
Nutrient Artery to radial
Anterior recurrent radial artery
Palmar branche of carpal
Dorsal branche of carpal
Superficial Palmar branche
Dorsal of thumb artery
4.5. ULNAR ARTERY

22

Ulnar artery, the larger of the two terminal branches of brachial artery,
begins in the cubital fossa at the level of neck of radius. In the anterior
compartment, it lies in front of the flexor retinaculum in company with yhe
ulnar nerve. It forms the superficial palmar arch and anastomosis with
the superficial palmar branch of radial artery. The branches are:
Muscular branches
Nutrient artery to cubital
Anterior recurrent cubital artery
Posterior recurrent cubital artery
Interosseous artery
o Posterior recurrent radial artery
o Anterior interosseous artery
o Posterior interosseous artery
Cubitodorsal artery
Anterior transversse of carpal artery
Cubitopalmar artery
Deep palmar artery
Red Peri scapular

V. VEINS OF UPPER LIMB

The venous system of the upper limb drains deoxygenated blood from the
arm, forearm and hand. It can anatomically be divided into the superficial
veins and the deep veins.
5.1. SUPERFICIAL VEINS OF FOREARM AND OF THE ELBOW FOSSA
Venous networks hand give rise to several main trunks, which become
collectors trunks forearm veins:
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a. CEPHALIC VEINS: Also called Superficial Radial Venous,

ascends by the lateral aspect of forearm and located in the
elbow fossa. At the shoulder it travels between the deltoid
and pectoralis major muscles and enters the axilla region.
b. BASILIC VEIN: Originates from the dorsal venous network
of the hand. It ascends the medial aspect of the upper limb.
At the border of the teres major, the vein moves deep into
the arm.
c. ACCESORY CEPHALIC VEINS
d. MEDIAN OF FOREMAN VEIN
5.2. DEEP VEINS OF FOREARM
The deep veins of the upper limb are situated underneath the deep fascia. They
are paired veins that accompany and lie either side of an artery. The brachial
veins are the largest in size, and are situated either side of the brachial artery.

Veins that are structured in this way are known as vein comitantes.
Perforating veins run between the deep and superficial veins of the upper limb,
connecting the two systems.

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VI. LYMPH NODES OF UPPER LIMB

Vessels follow the path of the Cephalic and Basilic veins from the hand.
They pass through the ulnar nodes or supraepithroclear. Then they ascend
the arm, bind to the deep nodes. Then enter the Axillary nodes.
6.1.

AXILLARY NODES: Here drain the lymphatic vessels of upper limb,

the major part of the breast and skin vessels trunk above the navel. They
can be divided anatomically in five groups.

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A. External nodes or humeral: Are 4-6 nodes, located in the lateral

wall of the axila, posterior to the axillary vein. They receive the
majority of lymph drained from the upper limb.
B. Anterior nodes or Pectoral: Are 3-5 nodes, located in the medial
wall of the axila. They receive lymph primarily from the anterior
thoracic wall, including most of the breast.
C. Posterior nodes or subscapular: Are 6-7 nodes, located along the
posterior axillary fold and subscapular blood vessels. They receive
lymph from the posterior thoracic wall and scapular region.
D. Central nodes: Are 3-4 large nodes, located near the base of the
axilla.They receive lymph via efferent vessels from the pectoral,
subscapular and humeral axillary lymph node groups.
E. Apical nodes: Located in the pex of the axilla, close to the axillary
vein and first part of the axillary artery. They receive lymph from
efferent vessels of the central axillary lymph nodes, therefore from
all axillary lymph node groups. The apical axillary nodes also
receive lymph from those lymphatic vessels accompanying the
cephalic vein.
Efferent vessels from the apical axillary nodes travel through the cervico-axillary
canal, before converging to form the Subclavian lymphatic trunk. The right
Subclavian trunk continues to form the right lymphatic duct, and enters the right
venous angle directly. The left subclavian trunk drains directly into the thoracic
duct.

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VII. NERVES OF THE UPPER LIMB

The manager of sensory, motor, vasomotor and propioceptive innervation of
the shoulder girdle and upper limb, is performed by the brachial plexus.
7.1. THE BRACHIAL PLEXUS
This is a structure where the nerves to the upper limb originate.
It is very extensive and is located in the neck and armpit.
It is formed by the union of the anterior branches of the last four cervical
nerves (C5, C6, C7 y C8) and the anterior branch of the first dorsal nerve
(D1).
The brachial plexus descends by the inferior part of posterior triangle of
neck. Here located by above clavicle and back and outside of ECM.
This is by up and back of the third portion of the Subclavian Artery and
is crossed by the lower belly homoioideo muscle. It descend by the

27

concavity of the inner two third of clavicle and accompanies the axillary
artery. Covered by the Pectoralis Major muscle.
The secondary trunks are located around the second portion of the
Axillary Artery, behind the Pectoralis Minor muscle.
The ends branches are given in the inferoexterno border of Pectoralis
Minor muscle and ahead of the Subscapular muscle.
Five parts of the Brachial Plexus are distinguished.
A. SPINAL NERVES OR ANTERIOR BRANCHES: They are
C5,C6,C7, C8 and D1. Sometimes C4 and D2. Its branches have:
Rhomboids nerve (escapular dorsal) of C5.
Serratus major nerve (long thoracic) of C5, C6 and C7.
B. PRIMARY TRUNKS:
Superior primary: Whose branches are Subclavian Nerve

and Suprascapular nerve.

Middle primary: Whose branche gives the Pectoralis mayor

nerve.
Inferior primary: Whose branche gives the Pectoralis minor

nerve.
C. DIVISIONS: Each primary trunk has an anterior divisin and other
posterior. In total its six and no give branch.
D. SECUNDARY TRUNKS: They are three.
Anteroexternal trunk: Hence are formed the Pectoral major,
musculocutaneous and external root of median nerves.

Also the Ulnar nerve.

Posterior trunk: Hence

are

formed

the

Superior

Subscapular, Latissimus dorsi, Inferior Subscapular, Radial,

Circumflex nerves and joint branches.

Anterointernal trunk: Hence are formed Minor pectoral,
internal brachi skyn , accesory of brachi skyn, cubital and

internal root of median nerves.

E. TERMINAL BRANCHES: The most important are the following:
Median nerve
Cubital nerve
Musculocutaneous nerve
Radial nerve
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Circumflex nerve

VIII. CONCLUSIONS

The upper limb formed part of apendicular skeleton and you can not
overemphasize the importance of the shoulder girdle whose function

is binding axial skeleton of the human body.

The very quality of the type of synovial joints that has the upper limb,

allows your movements are varied amplitude and addresses.

As well as the joint, the muscles that owns in that region, also causes
the upper limb is characterized by its ability to grab, hit or perform fine
skills thanks to the careful arrangement and complex functions of

these muscles.
The brachial plexus is the protagonist, who brings the sensory,
motors, vasomotor and propioceptive branches of the shoulder girdle
for its innervation.

IX. BIBLIOGRAPHIC REFERENCES

Michel Latarjet Alfredo Ruiz Liard. Anatoma Humana. Cuarta

edicin. Tomo I. Pg. 471-645.
29

Autor Jos C. Ruiz Vargas. Libro de Anatoma Topogrfica con uso

de nmina internacional. Quinta edicin. Pg. 43-56.

Johannes W. Rohen, Chihiro Yokochi, Elke Lutjen-Drecoll. Atlas de

Anatoma Humana. Quinta edicin. Pg. 356-416.

Netter. Atlas de Anatoma Humana. Quinta edicin. Lmina 397-452
Extremidad superior [citado el 15 de Junio del 2016]; Disponible
desde: www.edvillajunco.es>doc>5_extremidad_superior

Inervacin e irrigacin del miembro superior [citado el 15 de Junio del

2016];

Disponible

desde:

www.academia.edu/10558274/CLASE_DE_INERVACION_E_IRRIGA
CION_DEL_MIEMBRO_SUPERIOR

Arterias del miembro superior [citado el 15 de Junio del 2016];

Disponible

desde:

https://es.scribd.com/mobile/doc/62449692/Arterias-Del-MiembroSuperior

Miembro superior [citado el 15 de Junio del 2016]; Disponible desde:

https://escuela.med.puc.cl>LocomPaso2>Guia2

X. ANNEXES
ANEXO N 1

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ANEXO N02
31

ANEXO N03

32

ANEXO N 04

33

ANEXO N 05

34

ANEXO N 06

ANEXO N 07

35

36