Upper Limbs

  • amelia – absence of limb
  • hemimelia – absence of distal part of limb
  • phocomelia – absence proximal part with distal attached to trunk


  • costal and dorsal surfaces
  • superior and inferior (lower border 7thrib) angles
  • superior, medial and lateral borders
  • body = blade
  • neck
  • infraglenoid and supraglenoid tubercles
  • glenoid cavity
  • coracoid process (ant)
  • spinoglenoid notch – posterior glenoid neck, connecting supraspinous and infraspinous fossae
  • suprascapular fossa/notch – superior glenoid neck, containing suprascapular n&a&v supplying supraspinatus and infraspinatus.
  • supraspinous fossa
  • spine –> acromion process (post)
  • infraspinous fossa
  • 2° ossification in coracoid (appear 1y fuses 15y), acromion (appear puberty, fuse 15y), glenoid fossa (2), medial border and inferior pole (appear 15y, fuse 25y)
  • os acromiale (V2-3%, bilateral in 60%) – failed fusion of acromial ossification centres, coronal linear defect in acromium. Associated with rotator cuff impingement.
  • scapular foramen (V) – circumscribed central body defect
  • scapulothoracic joint (muscular)


  • medial end (over posterior 4thrib)
  • rhomboid fossa (V5%) is irregular groove inferior medial above 1st costal cartilage for ligament
  • conoid tubercle (med inf) and trapezoid line (lat ant)
  • acromioclavicular facet and joint
  • first bone to ossify, in a membrane
  • 2° oss in lateral (appear 20/40, fuse 20y) and medial (appear 15y, fuse 20y) ends

Sternoclavicular joint

  • small fibrocartilage disc
  • articular surfaces: med-inf clavicle, clavicular notch sup-lat manubrium, upper surface 1stcostal cartilage
  • anterior and posterior sternoclavicular ligaments
  • rhomboid/costoclavicular ligament (inferomedial clavicle –> 1stcostal cartilage; acts as a falcrum)
  • interclavicular ligament (along upper manubrium)

Acromioclavicular Joint

  • incomplete fibrocartilaginous disc, tightly invested in connective tissue, limited mobility
  • acromioclavicular ligament (sleeve/capsule)
  • coracoclavicular ligament = conoid (med) and trapezoid (lat) ligs (inf –> base coracoid; second falcrum)
  • coracoacromial arch – contour of acromion tip and coracoacromial ligament undersurface as seen on sag oblique MR or outlet XR. Bigliani type 1 flat, type 2 concave (no focal subacromial space narrowing), type 3 anterior hook (acute narrowing of space), type 4 convex. Type 2-3 associated with supraspinatus impingement.
  • I = supraspinatus


  • apex (junction of posterior triangle neck and arm; scapula, lateral 1/3 clavicle, outer 1strib)
  • anterior wall – pectoralis major and minor, subclavius (sup 1st costochondral junction –> between conoid and trapezoid), clavipectoral fascia
  • posterior wall – subscapularis, latissimus dorsi, teres major
  • medial wall – serratus anterior, intercostal muscles
  • lateral wall – bicipital groove, biceps tendon, insertions of pectoralis major, latissimus dorsi and pectoralis minor
  • base – axillary fascia, subcutaneous tissues and skin
  • contents – axillary a+v, brachial plexus, coracobrachialis, biceps brachii, lymphatics, fat
  • axillary sheath – plexus, axillary a+v; < prevertebral fascia
  • superficial lymphatics follow vv; deep follow aa
  • pectoral, lateral (<UL), subscapular, central and apical groups of lymph nodes

Shoulder/Glenohumeral Joint

  • bony glenoid is oval (sup-inf), flat with shallow central depression. Articular surface humeral head 4x area of glenoid. Articular cartilage thinnest centrally.
  • bicipitolabral complex (sup labrum) – type 1 (biceps –> bone above labrum), type 2 (-> sup labral surface), type 3 (-> labrum with meniscoid-type insertion, predisposed to superior labral tears)
  • quadrilateral/quadrangular space – bound by teres minor (sup), teres major (inf), humerus (lat) and triceps (med). Contains axillary nerve and posteriro circumflex humeral artery.

Capsule and Ligaments

Glenohumeral joint capsule attaches to glenoid labrum and periosteum, bounded by rotator cuff. Anterior capsule attachment type 1 to labrum; type 2 <10mm medial to labrum; type 3 >10mm medial. Type 2 and 3 ?increased risk of anterior instability, may be normal variant or previous anterior dislocation. Amount of laxity is variable, excessive redundancy may predispose to instability, rotator cuff degeneration/tears, labral tears.

Glenohumeral ligaments (GHLs) are thickenings of anterior capsule, glenoid -> lesser tuberosity and inferior head. SGHL and MGHL variable in size and course, may be absent.

  • superior (SGHL) – from superior anterior labrum, MGHL or biceps tendon to superior lesser tuberosity. Anterior to biceps tendon .
  • middle (MGHL) – superior anterior labrum or glenoid neck to base of lesser tuberosity with subscapularis. Absent in 1/4, variable thickness, occasionally duplicated, may have Buford complex.
  • inferior (IGHL) – strongest, anterior usually > posterior bands, with axillary pouch between. Sling from inferior labrum to proximal humeral shaft. Lax and redundant when adducted (with axillary pouch), tight with abduction.

coracohumeral ligament (inf-lat coracoid > lesser tubercle, intertubercular lig; sup to GHLs)

intertubercular/transverse humeral ligament (over long head biceps tendon)

Glenoid Labrum

Fibrocartilage, adding ~3mm depth, large number of variants. Usually triangular, posterior labrum often has rounded lateral contour. May have small articular surface irregularities/clefts. Variable fixation with peripheral margin fixed to glenoid periosteum, joint capsule and glenoid articular cartilage. Comon variants:

  • Sublabral foramen (20%) – absent fixation at 1-3 o’clock.
  • Sublabral recess/sulcus (70%) – cleft between superior labrum and glenoid, pointing towards glenoid (cf SLAP tear extending ant->post, esp posterior to biceps tendon).
  • Buford complex (0.5%) – deficiency sup-ant labrum with thickened cord-like middle glenohumeral ligament

Synovium and Bursae

synovial membrane – labrum > anatomical neck; along long head biceps (tendon is intracapsular but extrasynovial)

Normal recesses/pouches continuous with joint cavity:

  • axillary pouch/recess – inf, between anterior and posterior bands of IGHL
  • subscapularis/subcoracoid bursa/recess – between capsule and subscapularis tendon, between superior and middle glenohumeral ligaments

Bursa not contious with joint cavity (unless supraspinatus tear), but may intercommunicate:

  • subacromial bursa – between supraspinatus and coracoacromial arch, deltoid. No communication with joint unless supraspinatus tear.
  • subdeltoid bursa – between capsule and deltoid muscle


  • latissimus dorsi – spinous processes T7-12, thoracolumbar fascia, iliac crest, lower 3-4 ribs, inferior angle scapula -> lesser tubercle crest
  • teres major – post-inf angle scapula -> medial humerus
  • deltoid – clavicle, acromion, spine scapula -> deltoid tuberosity
  • pectoralis major – clavicular head, sternocostal head, abdominal part -> greater tubercle crest
  • pectoralis minor – 3rd-5thribs -> coracoid process
  • coracobrachialis – coracoid process -> medial humerus

Rotator cuff

  • subscapularis – costal surface scapula -> lesser tubercle, with some fibers crossing intertubercular groove to greater tuberosity = transverse humeral ligament
  • supraspinatus – supraspinous fossa -> superior facet of greater tubercle
  • infraspinatus – infraspinatus fossa -> middle facet of greater tubercle
  • teres minor – lat border -> inferior facet of greater tubercle



  • head
  • anatomical neck
  • greater tubercle (lat; sup, mid and inferior facets)
  • intertubercular groove
  • lesser tubercle (ant-lat)
  • surgical neck
  • body
  • radial/spiral groove (post > inf-lat; radial n, profunda brachialis, fibrous attatchment)
  • deltoid tuberosity (lat)
  • medial and lateral supracondylar ridges (med/lat edges)
  • med and lateral epicondyles
  • capitulum (lat)
  • trochea (med)
  • olecranon fossa (post)
  • radial fossa (ant-lat)
  • coranoid fossa (ant med)
  • 2° oss in head (appear 1y), greater (3y) causing inverted V shape; and lesser (5y) tuberosities; fuse with each other 6y and with shaft 20y


  • notches on medial proximal and distal humers (10-15y, irregular metaphyseal growth)
  • olecranon/supratrochlear foramen (5%, fenestrated fossa)
  • supracondylar spur/process (1%; ant-med 5cm proximal to medial epicondyle; coracobrachialis insertion)
  • ligament of Struthers (spur > medial epicondyle; median n and brachial a below)


  • compartments separated by medial and lateral intermuscular septa
  • median n, brachial a and basilic v superficial in medial intermuscular septum
  • radial n and profunda brachii deep adjacent to humerus
  • anterior compartment
    • coracobrachialis (coracoid > medial humerus)
    • biceps brachii (long head origin supraglenoid tubercle and superior glenoid labrum at 1 o’clock via biceps groove, short head origin coracoid process; -> bicipital tuberosity radius + deep fascia and bicipital aponeurosis)
      • bicipital aponeurosis/lacertus fibrosis (betw superficial medial cubital v and brachial a)
  • brachialis (ant humerus > coronoid process; medial to biceps)
  • posterior compartment
  • triceps brachii (> superior olecranon)
    • long head (<infraglenoid tubercle, between teres major&minor)
    • medial head (<prox post-lat humerus)
    • lateral head (<dist post-med humerus)


  • humeroulnar, humeroradial and superior radioulnar joints in one cavity
  • capsule (sup olecranon, coranoid, radial fossae, olecranon and coranoid processes, superior annular lig; lax anterior and post)
  • anterior/coranoid fossa and posterior/olecranon fossa fat pads (betw synovial membrane and capsular lig)
  • cubital tunnel (post to medial epicondyle; ulnar n)
  • 2° oss in elbow appear CRITOE (Capitulum 1y, Radial head 4y, Internal epicondyle 4y, Trochlea 8y, Olecranon 9y, External epicondyle 10y), fuse 15y; 1-2y earlier in girls


  • prominent anterior fat pad (15%)
  • asymptomatic subluxation of ulnar n (absent arcuate lig)
  • anconeus epitrochlearis (accessory m fixing ulnar n in cubital tunnel
  • os suptratrochlare (post joint space)


  • lateral collateral ligaments
    • radial/lateral collateral ligament – thickening capsule from lateral epicondyle -> annular lig
    • lateral ulnar collateral ligament – lateral epicondyle -> posterior to radial head -> post-lat ulnar
    • annular/orbicular ligament (ulnar radial notch > around head radius, radial collateral lig)
    • accesssory annular ligaments
  • ulnar/medial collateral ligament. posterior and oblique bands form floor or cubital tunnel
    • anterior bundle/band – cord-like, medial epicondyle -> coronoid process, flexor digitorum superficialis
    • posterior bundle/band – medial epicondyle -> fan-like -> proximal ulna
    • oblique/transverse bundle/band – medial proximal olecranon -> coronoid process



  • radial head and neck
  • radial/bicipital tuberosity (med)
  • anterior, posterior and interosseous (= medial ridge) borders
  • radial styloid process
  • dorsal tubercle (post distal radius)
  • articular surface (scaphoid and lunate, with ulnar notch)
  • 2° oss distal radius (appears 1y, fuses 20y)


  • olecranon
  • trochlear notch/fossa (ant)
  • coronoid process
  • radial notch (lat)
  • carrying angle (lateral angulation of ulnar; male 5-10°, female 10-25°)
  • interosseous/lateral border/ridge
  • ulna head
  • ulnar styloid process (post-med head; narrower and more proximal than radial)
  • 2° oss distal ulnar (appears 5y, fuses 20y)
  • proximal/superior radioulnar joint
  • interosseous membrane


  • compartments separated by interosseous membrane
  • 3 mvt groups: radius/ulnar, carpus, fingers+thumb
  • radial vessels ant-lat to radius
  • ulnar vessels ant-med to ulnar
  • median n between flexor digitorum superficialis and profundus
  • anterior compartment
    • brachioradialis (lateral supracondylar ridge > radial styloid process)
    • pronator teres (medial epicondyle, proximal medial ulnar > lateral mid radius)
    • pronator quadratus (med distal ulnar > lateral distal radius)
    • common flexor tendon (CFT) < medial epicondyle
    • flexor carpi ulnaris (CFT>pisiform, hook of hamate, base 5th MC)
    • palmaris longus (CFT>palmar aponeurosis)
    • flexor capi radialis (CFT>base 2nd&3rd MC)
    • flexor digitorum superficialis (CFT, anterior mid radius>split> base 2nd-5th mid phalanges)
    • flexor digitorum profundus (ant ulna, membrane > 2nd-5th distal phalanges)
    • flexor pollicis longus (ant radius, membrane > 1st distal phalynx)
  • posterior compartment
    • anconeus (lateral epicondyle > lateral olecranon)
    • supinator (lat epicondyle, lateral collat lig, supinator crest [lat proximal ulnar], annular lig > lateral proximal radius)
    • common extensor tendon (CET) < lateral epicondyle
    • extensor carpi radialis longus (lateral supracondylar ridge >2nd MC)
    • extensor carpi radialis brevis (CET>3rd MC)
    • extensor digitorum (CET >2nd-5th mid [central] and distal [lat bands] phalanges)
    • extensor digiti mimini (CET > 5th mid&dist phalanx)
    • extensor capi ulnaris (CET > 5th MC)
    • abductor pollicis longus (post ulnar, membrane, radius > 1st MC)
    • extensor pollicis brevis (post membrane, radius > 1st proximal phalanx)
    • extensor pollicis longus (post ulna, membrane > 1st distal phalanx)
    • extensor indicis (post ulna, membrane > 2nd mid&dist phalanges)


Distal Radioulnar Joint (DRUJ)

  • Cylindrical distal ulnar with concave sigmoid notch in distal radius. Capacity of ~1mL. Bound distally by TFCC
  • capsule -> recessus sacciformis between radius and ulnar anterior to interosseus membrane; no communication with carpus
  • Triangular fibrocartilage comples (TFCC) = triangular fibrocartilage (TFC) articular disc (apex at ulnar notch, base at ulnar styloid), blending into dorsal and volar radioulnar ligaments, extensor carpi ulnaris tendon sheat and volar medial portion of wrist capsular ligaments, ulnotriquetral and ulnolunate ligaments. Meniscal homologue – wedge-shaped fibrofatty thickening of medial joint capsule distal to TFC.

Radiocarpal Joint

  • Betw TFCC, distal radius (scaphoid and lunate facets), scaphoid, lunate, triquetrum. Capacity 3-5mL. Separated by midcarpal joints by scapholunate and lunotriquetral interosseous ligaments.
  • Distal radius normal tilted towards ulnar by 20-25deg, palmar by 11deg. Contains scaphoid and lunate fossae/facets.
  • palmar radial recess of joint space
  • palmar and dorsal radiocarpal ligaments
  • palmar ulnocarpal ligaments (ulnolunate and ulnotriquetral, part of TFCC)
  • ulnar and radial collateral ligaments


Proximal and distal carpal rows in smooth carpal/Gilula’s arcs with radiocarpal and midcarpal joints between. “So Long To Pinkie, Here Comes The Thumb”. Approx 50% of wirst flexion and extesion occurs at radiocarpal joint, 50% at midcarpal joint; ulnar/radial deviation cuses carpal pivot around proximal capitate with scapoid and lunate tilting dorsally in ulnar deviation (and vice versa).

  • scaphoid (sole blood supply from nutrient aa distal->prox in 15%; tubercle; volar angulation)
  • lunate (convex proximal and concave distal surfaces; dorsal angulation)
  • triquetral
  • pisiform
  • hamate (with hook of hamate)
  • capitate
  • trapezoid
  • trapezium (groove from flexor carpi radialis tendon, tubercle/ridge)

Interosseous/intrinsic ligaments separate wrist into 3 compartments. The thicker stronger dorsal and palmar components of the ligaments bled into extrinsic ligaments of the joint capsule; thinner central portions

  • scapholunate ligament (SL) – between proximal bonesbalances opposing forces from volar scaphoid and dorsal lunate angulations
  • lunotriquetral ligament (LT) – between proximal bones

Extrinsic/capsular ligaments are stronger and more important at palmar/volar aspect.

  • Palmar ligaments:
    • Distal arc – radioscaphocapitate and capitotriquetral
    • Proximal arc – radiolunotriquetral (long radiolunate) and ulnotriquetral
    • Ulnar carpal complex – ulnar collateral ligament
  • Dorsal ligaments:
    • Radioscaphoid
    • Dorsal radiocarpal/radiolunotriquetral
    • Dorsal intercarpal (transverse) ligament(s) – variable between triquetrum over capitate to scaphoid and trapezoid

midcarpal joint (betw proximal and distal rows)

communication between compartments (V, radioulnar-radiocarpal 30%, radiocarpal-midcarpal 50%, radioulnar-pisiform bursa 50%)

1° oss capitate and hamate 2m; triquetral 3y, lunate 4y; scaphoid, trapezium and trapezoid 5y; pisiform 12y


  • os centrale (between scaphoid, trapezoid and capitate; non-fused tubercle of scaphoid)
  • os radiale externum (lateral scaphoid distal to styloid)
  • lunotriquetral coalition


flexor retinaculum (hook hamate, pisiform, scaphoid tubercle, trapezium ridge/tubercle)

carpal tunnel (median n, flexor pollicis longus, flexor digitorum superficialis and profundus, flexor carpi radialis [in sep compartment]; NOT flexor carpi ulnaris or palmaris longus)

Guyon’s canal (betw deep fascia, pisiform, flexor retinaculum; ulnar n lateral to a&v)

extensor retinaculum (pisiform, tiquetral, radius). 6 fibro-osseous tunnels for extensor tendons, from lat/radial->med/ulnar:

  • I – abductor pollicis longus (APL) + extensor pollicis brevis (EPB)
  • II – extensor carpi radialis longus (ECRL) + extensor carpi radialis brevis (ECRB)
  • III – extensor pollicis longus (EPL). crosses lateral over compartment II at wrist.
  • (lister’s tubercle on dorsal radius)
  • IV – extensor indicis (EI) + extensor digitorum (ED)
  • V – extensor digiti minimi (EDM)
  • VI – extensor carpi ulnaris (ECU) in groove in distal ulnar

Carpometacarpal Joints (CMCJs)

  • carpometacarpal joint of thumb (CMC1)
  • carpometacarpal joints of fingers (CMC2-5) – single synovial cavity cont with intermetacarpal joints, freqluently comm with midcarpal joint.

Metacarpals and Phalanges

  • base (prox), head (dist)
  • terminal tuft (terminal phalanges)
  • styloid proess on 3rdMC dorsal base
  • collateral ligaments (thickened capsule)
  • volar plate (thickening of volar capsule at PIPJs and MCPJs for passive resistance of hyperextension)
  • MC articulate with each other (apart from thumb) and trapezium (thumb &index), trapezoid (index), capitate (middle), hamate (ring and little)
  • 2 sesamoid bones at anterior 1stMCPJ
  • single sesamoid bone 5th MCPJ (83%) and 1stIPJ (73%)
  • 5th metatarsal apophysis (V22%, additional 2° oss appear 10y, fuse 13y; physis line sagittal)
  • 2° oss distal MC fingers (appear 2y, fuse 20y), proximal 1st MC&Ps (appear 2y, fuse 20y)


  • thenar eminence/mm (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, adductor pollicis)
  • hypothenar eminence (abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi)
  • interossei (dorsal bipennate abduction; palmar unipennate adduction)
  • lumbricals (<flexor digitorum profundus tendons; 1st&2nd [unipennate] > 2nd&3rd proximal phalanges; 3rd&4th [bipennate] > 4th&5th proximal phalanges)


Subclavian Artery

  • sternoclavicular joint > grooves superior 1st rib, >outer border 1strib > axillary a
  • scalenus anterior (transverse process upper C-spine > inner border 1strib)
  • R SCA origin above/below sternoclavicular joint (V), from aorta (V), aberrant RSCA (V)
  • L SCA origin from L innominate a (V)

1st part SCA (med to scalenus ant)

  • A = vagus, phrenic nn, vertebral and brachiocephalic vv, thoracic duct
  • P = 1st and 2nd posterior ribs
  • I = R recurrent laryngeal n, lung apices
  • med = CCA, trachea, oesophagus, R&L recurrent laryngeal n
  • vertebral artery (or < aorta [V])
  • internal thoracic/mammary a (inf SCA > lateral sternal border > superior epigastric and musculophrenic aa at 6th intercostal space; > anterior chest wall, sternum, anterior pericardium, anterior mediastinum, diaphragm)
  • thyrocervical trunk
    • inferior thyroid a (>inf pole thyroid; >pharynx, larynx, oesophagus, trachea, thyroid, segmental spinal; > ascending cervical a)
    • transverse cervical a (>superficial cervical)
    • suprascapular a = transverse scapular a (>shoulder girdle mm; origin from SCA [V])

2nd part SCA (post to scalenus ant)

  • A = scalenus ant
  • P = scalenus medius
  • costocervical trunk (or < 1st part SCA [V])
    • deep cervical a (>post vertebral mm, C7/T1 segmental spinal)
    • supreme/highest/superior intercostal a; > 1st and 2nd posterior intercostal aa)

3rd part SCA (lat to scalenus anterior > lateral border 1st rib)

  • A/I = SCV
  • P = brachial plexus
  • I = 1st rib
  • dorsal/descending scapular artey (>mm to medial border scapula, scapular anastamoses; origin from transverse cervical a [V])

Axillary Artery

  • lat 1st rib > lower teres major > brachial a
  • branches “S-AL-SA”


  • A = pectoralis minor
  • P = serratus ant, long thoracic nerve of Bell, posterior cord
  • med = axillary v, medial cord
  • lat = lateral cord

1st part (med to pectoralis minor)

  • superior thoracic artery (>chest wall)

2nd part (post to pectoralis minor)

  • acromiothoracic artery (>ant chest wall, deltoid, pectoralis major/minor, acromioclavicular joint)
  • lateral thoracic artery (>chest wall, scapular anastomosis)

3rd part (lat to pectoralis minor)

  • subscapular artery (>inf angle, scapular anastomosis)
  • anterior and posterior circumflex humeral arteries (around surgical neck of humerus to anastamose with each other and branches from suprascapular and acromiothoracic aa; >shoulder joint)
  • alar thoracic artery (V, common trunk for subscapular, circumflex humeral and profunda brachii)

Scapular anastamosis

  • around scapular to bypass joint regardless of position
  • < transverse cervical, suprascapular, descending scapular, lateral thoracic, subscapular branches, intercostal aa, IMA

Brachial Artery

  • lower teres major > neck of radius > radial and ulnar aa
  • A = skin, bicipital aponeurosis
  • med = median n
  • lat = biceps tendon
  • profunda brachii (high origin [V])
    • branch to shoulder
    • radial collateral a (>radial recurrent a)
    • middle collateral a (post to elbow; >recurrent interosseous a)
  • sup ulnar collat a (>ant ulnar recurrent a)
  • inf ulnar collat a (>post ulnar recurrent a)
  • nutrient arteries to humerus
  • muscular branches
  • bifurcation at radial head

Radial Artery

  • P = biceps brachii tendon, brachioradialis
  • high takeoff (V, from brachial a)
  • recurrent radial a (ant-lat elbow)
  • muscular branches
  • superficial palmar branch (>superficial palmar arch)
  • >anatomical snuffbox, between 1st&2nd MCs > palm
  • deep palmar arch

Ulnar Artery

  • A = pronator teres
  • anterior ulnar recurrent a
  • posterior ulnar recurrent a
  • common interosseous artery
    • anterior interosseous a (>deep mm, posterior compartment via perforating branches, anterior carpal branch; >dorsum of wrist)
    • posterior interosseous a (>recurrent interosseous a; anast with anterior interosseous, radial and ulnar aa in the wrist)
  • muscular branches
  • deep palmar branch (>deep palmar arch)
  • superficial palmar arch

Hand Arteries

  • superficial palmar arch (<ulnar dominant, may < medial a)
  • deep palmar arch (more proximal; <palmar carpal arteries from ulnar and radial [dominant], may <interosseus a)
  • arches > deep and superficial metacarpal = common dorsal and palmar digital aa (2nd-4th interosseous spaces) > dorsal and palmar digital aa (either side of digits)


  • incomplete arch (25%)
  • median artery contributing to arch
  • multiple other variants


Superficial Veins

  • dorsal venous plexus of the hand
  • cephalic v (lat wrist > ant-lat elbow > lateral to biceps > deltopectoral groove > pieces clavipectoral fascia [slowing passage of contrast/radionuclide]> axillary v)
  • median cubital v (cephalic > basilic v at elbow)
  • median vein of the forearm (palm >median cubital v)
  • basilic vein (med wrist > ant-med elbow > medial to biceps > pierces deep/investing fascia > joins brachial v to form axillary vein at lower teres major)

Deep Veins

  • paired venae comitantes accompanying aa
  • axillary vein (usually double; <brachial and basilic vv; >med to axillary a >lower 1st rib > subclavian v; <circumflex humeral, subscapular and lateral thoracic vv)
  • subclavian vein (<external jugular vein, anterior jugular, cephalic, dorsal scapula vv; >brachiocephalic v with internal jugular v)
    • A = clavicle
    • P/S= scalenus ant, subclavian a, phrenic nerve
  • brachiocephalic/innominate v (forms posterior to sternoclavicular joint; L anterior to trachea and great vessels)

Structure of Veins

  • tunica intima (endothelium)
  • tunica media (muscular)
  • tunica adventitia (connective tissue)
  • valves (semilunar cusps, intima)
  • venae comitantes (paired vv with an a)


  • superficial lymphatic vessels (follow cephalic and basilic vv > lateral nodes of the axilla, supratrochlear nodes [from medial hand], infraclavicular nodes [via cephalic v]; dorsal > ant
  • infraclavicular nodes (betw deltoid and pectoralis major)
  • deep lymphatics (follow main vessels > lateral axillary nodes; scapula > posterior axillary nodes)
  • axillary nodes > apical group > right lymphatic duct and thoracic duct > jugulosubclavian junctions

Brachial Plexus

From anterior rami of C5-T1 (or C4-T2 [V]). Lies between anterior and middle scalene muscles; posterior to clavicle, pectoralis minor and axillary vein.

  • Roots (5) – of C5-T1
  • Trunks (3) – upper (C5-6), middle (C7) and lower (C8-T1)
  • Divisions (2) – anterior and posterior
  • Cords (3) – lateral (ant sup&mid divisions), medial (ant inferior division) and posterior (post divisions). Separated by axillary artery.
  • Branches (6) > nerves (5)
  • Nerves
    • Musculocutaneous nerve (< lateral cord)
    • Median nerve (<lat and medial cords) – lateral to brachial a, mid humerus crosses anterior > cubital fossa > deep to flexor digitorum superficialis > carpal tunnel; >most mm flexor compartment forearm, thenar eminience, 2 radial lumbricals)
      • anterior interosseous nerve (<median n @ cubital fossa)
      • ulnar nerve (<med cord) – anterior comp > medial intermuscular septum > posterior comp >behind medial epicondyle > between heads then deep to flexor carpi ulnaris; >flexor carpi ulnaris, ulnar ½ flexor digitorum profundus> Guyon’s canal > most small muscles of hand
    • (circumflex) axillary nerve (<post cord) – posterior surgical neck > deltoid, mid-lateral skin of arm
    • radial nerve (<post cord) – posterior humerus > spiral groove >betw medial and lateral heads triceps in posterior comparment > lateral intermuscular septum > anterior compartment > branches
      • superficial branch (>brachioradialis, skin dorsum of hand)
      • deep branch (>post interosseous n distal to supernator; > mm posterior compartment forearm)


  • Ant – anterior scalene, clavicle, pectoralis minor, axillary vein
  • Post – middle scalene
  • Inf – subclavian artery