Chapter 1

Introduction to Upper Limb

Textbook of
Human Anatomy
Volume 1: Upper Limb
Author: Dr Yogesh Sontakke, JIPMER, Pondicherry

©CBS Publishers & Distributors Pvt Ltd, New Delhi

INTRODUCTION
Anatomy
• Essential to create a base for clinical exposure and patient care
• Alphabets (ABC) or nomenclature of human body and functioning mechanism
The best way to learn anatomy–
• Read the subject
• Dissect and observe cadaver
More you dissect and observe cadaver, more easily you understand and remember anatomy

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Human Anatomy is divided into following sections
1. Upper limb
2. Lower limb
3. Thoracic region
4. Abdomen and pelvis
5. Head, neck, and face
6. Brain

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Parts of Upper Limb

1. Shoulder
2. Arm or brachium
3. Forearm or
antebrachium
4. Hand or manus

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Parts of Upper Limb
Shoulder region
Includes
• Pectoral region
• Axilla
• – Scapular region
• – Shoulder girdle (pectoral girdle)
-Consists of two bones
-Clavicle
-Scapula
Arm (brachium)
• Extent: Extends from shoulder to elbow.
• Bones: Humerus

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Parts of Upper Limb
Forearm (antebrachium)
Extent
• Extends from elbow to wrist
Bones
• Radius
• Ulna

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Parts of Upper Limb
Hand
Includes
• Wrist: Formed by 8 carpal bones that are arranged – two
rows
• Hand proper: Consists of 5 metacarpals
• Digits: 5 digits from lateral to medial
• Thumb, index finger, middle finger, ring finger, and little
finger
• Each finger is supported by three phalanges, except
thumb – two phalanges

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Bones of Upper Limb
Each upper limb consists – 32 bones
- Pectoral girdle
• Scapula 1 bone
• Clavicle 1 bone

- Bone of arm
• Humerus 1 bone

- Bone of forearm
• Radius 1 bone
• Ulna 1 bone

- Carpals 8 bones
- Metacarpals 5 bones
- Phalanges 14 bones
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Bones of Upper Limb
Joints of Upper Limb
1. Sternoclavicular joint
2. Acromioclavicular joint
3. Shoulder joint
4. Elbow joint
5. Radioulnar joints (superior, middle, and inferior)
6. Wrist joint
7. Intercarpal joints
8. Carpometacarpal joints
9. Metacarpophalangeal joints
10. Interphalangeal joints (proximal, middle, and distal)

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Muscles of Upper Limb
• Includes

• Muscles attached to pectoral girdle

• Muscles of arm, forearm, and palm

• Arm and forearm are divided – anterior and posterior muscular compartments

• Hand – divided into palm and dorsum

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Vessels of Upper Limb
Arteries of upper limb
• Major arteries of upper limb –
• Axillary artery
• Brachial artery
• Radial artery
• Ulnar artery
• In palm, arterial network form superficial and deep palmar arches

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Vessels of Upper Limb
Veins of upper limb
• Veins of upper limb are grouped as
-Superficial veins
• Include dorsal venous arch, cephalic vein, basilic vein, and median cubital vein
-Deep veins
Include
• Venae commitments of major arteries of upper limb
• Brachial vein
• Axillary vein
- Superficial veins are commonly used for intravenous injections

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Innervation (Nerve Supply) of Upper Limb

• Upper limb – supplied by nerve plexus called brachial plexus.

• Major nerves of upper limb include

• Axillary nerve
• Musculocutaneous nerve
• Ulnar nerve
• Median nerve
• Radial nerve

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FUNCTIONAL ANATOMY OF UPPER
LIMB
• In human beings, upper limb – highly evolved
• Upper limb has its own peculiarities that makes it different from lower limb

Peculiarities of the Upper Limb

• The skillful activity performed by human beings are due to following peculiarities of upper limb:
1. Smaller and shorter upper limb than lower limb
2. Freely moveable shoulder joint
3. Long arm and forearm bones
4. Presence of a carrying angle (angle between long axis of arm and forearm)

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FUNCTIONAL ANATOMY OF UPPER LIMB

5. Supination and pronation movements as adaptability to pick food and to eat using upper
limb
6. Arrangements of carpal bones – two rows
7. Laterally placed thumb
8. Separated long slender digits
9. Nail and nail bed protecting terminal phalanx
10. Grasping and skill movements of hand
11. Opposition actions of thumb and little finger

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FUNCTIONAL ANATOMY OF UPPER LIMB
Homologous Parts of Upper and Lower Limb
• Developmentally limbs are derived from limb buds, but due to rotation and
functional differences both limbs are different from each other
• Still upper and lower limbs show homologous parts

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FUNCTIONAL ANATOMY OF UPPER
LIMB
Transmission of Force in Upper Limb
• Weight transmission – upper limb occurs in following manner
• Weight  hand  wrist joint  radius  interosseous membrane 
ulna  elbow joint  humerus  shoulder joint  scapula 
coracoclavicular ligament  clavicle  sternoclavicular joint and
costoclavicular rligament  axial skeleton

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Fig. 1.2: Transmission of force or weight in the
upper limb
(right, anterior view, red dotted lines are indicative
of
direction of weight transmission)

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ARE YOU READY FOR DISSECTION?
• Dissection – most important part – understand anatomy
• Gives experience of exploring structure of human body and relationship of various parts with other
Instructions for Dissection
• Health and safety rules
• Always put on your laboratory coat before entering dissection hall.
• Never eat or drink in dissection hall
• Cut your nails, and tie your hair properly
• Wash hands with soap after each dissection
• All above instructions will help to keep you healthy and away from infections

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ARE YOU READY FOR DISSECTION?
Cadaver and specimen handling instructions
Ethics
• Respect cadaver as it is most useful material for learning medical sciences
Preservation of cadaver
• Cadaver are preserved using formalin and glycerol along with other chemicals
• Formalin causes discoloration (darkening) of the skin.
• Formalin hardens body parts, hence passive movements of body parts become difficult and
require more pressure to cut body parts than that in living state

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ARE YOU READY FOR DISSECTION?

Preservation of dissected parts

Dissected parts become dry due to exposure to atmosphere, hence it is advised
• To keep it covered with dissected skin on completion of dissection.
• To moisturize dissected part with water or glycerin
• To cover dissected part with wet cloth or cotton
Always preserve dissected structures so that others can use – for further study

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ARE YOU READY FOR DISSECTION?
First aid and emergency
• Any accident during dissection should be immediately reported –concerned
in charge or teacher
• If feeling giddiness, glucose solution can be taken on advice of in charge or
teacher
• Videography and photography should be done only with permission from
concerned teacher

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Instruments Required for the Dissection
Set of instruments are required
for routine dissection that –

• Scalpel
• Forceps
• Scissors
• Hand lens and so on

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Instruments Required for the Dissection
Scalpel
• Has two components
1. Scalpel handle (Number 4)
2. Scalpel blade (Number 24 or 23)
• Fit blade carefully to handle
• Some scalpels have in-built blades

Use
• Used to cut skin.
• Used to cut connective tissue, fascia, muscles,
vessels, nerves, and other structures as and when
required
Care
• Use clean and new blade every time as formalin
(used for cadaver preservation)
• Causes rusting of scalpel blades Human Anatomy/Yogesh Sontakke 24
Instruments Required for the Dissection
Forceps
• For dissection use forceps of 6 inches
length
• With short length forceps such as 4
inches, handling of hard cadaveric
tissue will be difficult

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Instruments Required for the Dissection
Forceps
Use
• To hold, lift, or retract structures
• Also useful for blunt dissection

• Plane forceps
• Use: – hold delicate structures such as vessels,
nerves, and muscles.
• Tooth forceps
• Use: – hold skin and hard structures.

• Pointed forceps
• Use: To show dissected structures during discussion
and for fine dissection or to hold thin nerves

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Instruments Required for the Dissection
Artery forceps or hemostatic forceps
• Has catch or ratches that helps –catching,
clamping, and crushing tissue
Use
• For strong grasping, holding, and catching the
structures. For example, – hold and reflect
skin
• Do not use it for holding delicate structures as it
crushes structure

Human Anatomy/Yogesh Sontakke 27

Instruments Required for the Dissection
Scissors
• Use:
• To cut tissue such as fascia, ligaments, tendons, and
so on
• There are two types of scissors commonly used for
dissection:
1. Straight scissors: Use: For blunt dissection
2. Curved scissors: Use: For delicate dissection and
cutting less accessible structure and also for
trimming tissue and cutting the fascia

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Instruments Required for the Dissection
Other instruments

For specific purpose, other instruments are required

These are as follows

1. Saw:
• Cut bone
• Take section of body part

2. Bone cutter or bone nibbler

• Cut bone into small pieces

3. Chisel and hammer

• Cut strong bones

4. Hammer
• Hit chisel for cutting bones

5. Brain knife
• Take section of brain

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Instrument handling

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Structures Encountered in Dissection
How to differentiate artery, vein and nerve in cadaver?

Following structures are encountered during the dissection:

Skin
• harder and darker in cadaver than living state due to action of formalin

Superficial fascia
• contains various amount of fat (yellowish), superficial veins, and loose connective tissue (whitish).
• Blunt bisection is required to remove superficial fascia

Deep fascia
• tough sheet of connective tissue (whitish) that encloses deeper structures

Muscles
• They have muscle fibers (brown in color) and tendons (white in color). Some muscles do not have long slender tendons

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Structures Encountered in Dissection
Veins
• Thin walled than arteries
• Have irregular lumen
• Mostly contain blood – their lumen
• Deep veins usually follow major arteries
Nerves
• Pale-looking cord-like structures.
• Can be differentiated from arteries by rolling in fingers (arteries have lumen, nerves do not
have)
Other structures
• Other structures – bones, ligaments, bursae, joints, lymph nodes, organs (lung, heart,
liver, and so on)

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Thank you………….

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