Clinical anatomy of upper limb
Reading File
“Clinical anatomy of the upper limb” is a large topic. It can be organized as:
- Osteology and surface landmarks
- Pectoral region, axilla, and brachial plexus
- Shoulder and scapular region
- Arm and cubital fossa
- Forearm compartments, wrist, and hand
- Arteries, veins, lymphatics, and dermatomes
- Nerve lesions, common entrapments, and clinical tests
- Joints, movements, and applied anatomy
At a high level, the upper limb is designed to position the hand in space. Its clinical anatomy centers on the brachial plexus, the axillary-brachial-radial/ulnar arterial pathway, compartmental muscle actions, and predictable nerve-injury patterns such as wrist drop, clawing, winged scapula, and median-nerve thenar weakness.
Asking for Preferences
Which section should I cover in detail first?
“Clinical anatomy of the upper limb” is a large topic. It can be organized as:
- Osteology and surface landmarks
- Pectoral region, axilla, and brachial plexus
- Shoulder and scapular region
- Arm and cubital fossa
- Forearm compartments, wrist, and hand
- Arteries, veins, lymphatics, and dermatomes
- Nerve lesions, common entrapments, and clinical tests
- Joints, movements, and applied anatomy
At a high level, the upper limb is designed to position the hand in space. Its clinical anatomy centers on the brachial plexus, the axillary-brachial-radial/ulnar arterial pathway, compartmental muscle actions, and predictable nerve-injury patterns such as wrist drop, clawing, winged scapula, and median-nerve thenar weakness.Which section would you like in detail?
- Brachial plexus
- Axilla and shoulder
- Arm and cubital fossa
- Forearm, wrist, and hand
- Nerve lesions and clinical tests
- Full exam-oriented revision map
Clincal anatomy of upper limb
This is a broad, exam-sized topic. A clinical approach links regional anatomy with common injuries, compression syndromes, examination findings, and procedures.
Asking for Preferences
Which part should I develop first?
“Clinical anatomy of the upper limb” is a large topic. It can be organized as:
- Osteology and surface landmarks
- Pectoral region, axilla, and brachial plexus
- Shoulder and scapular region
- Arm and cubital fossa
- Forearm compartments, wrist, and hand
- Arteries, veins, lymphatics, and dermatomes
- Nerve lesions, common entrapments, and clinical tests
- Joints, movements, and applied anatomy
At a high level, the upper limb is designed to position the hand in space. Its clinical anatomy centers on the brachial plexus, the axillary-brachial-radial/ulnar arterial pathway, compartmental muscle actions, and predictable nerve-injury patterns such as wrist drop, clawing, winged scapula, and median-nerve thenar weakness.Which section would you like in detail?
-
Brachial plexus
-
Axilla and shoulder
-
Arm and cubital fossa
-
Forearm, wrist, and hand
-
Nerve lesions and clinical tests
-
Full exam-oriented revision mapThis is a broad, exam-sized topic. A clinical approach links regional anatomy with common injuries, compression syndromes, examination findings, and procedures.## Clinical anatomy of the upper limb: topic map
-
Bones, joints, and surface anatomy
- Clavicle, scapula, humerus, radius, ulna, carpal bones
- Shoulder, elbow, wrist, and hand joints
- Palpable landmarks and common fractures/dislocations
-
Pectoral region and axilla
- Pectoral muscles and axillary walls
- Axillary artery and its branches
- Axillary vein and lymph nodes
- Relation to breast surgery and axillary nerve injury
-
Brachial plexus
- Roots, trunks, divisions, cords, terminal branches
- Erb palsy, Klumpke palsy, thoracic outlet compression
- Important branches: long thoracic, dorsal scapular, suprascapular nerves
-
Shoulder and scapular region
- Rotator cuff and movements of the shoulder
- Glenohumeral dislocation
- Axillary nerve injury, winged scapula, rotator-cuff tear
-
Arm and cubital fossa
- Anterior and posterior compartments
- Brachial artery, median nerve, radial nerve
- Biceps tendon, venepuncture, brachial pulse
- Supracondylar fracture and Volkmann ischemic contracture
-
Forearm, wrist, and hand
- Flexor and extensor compartments
- Radial and ulnar arteries
- Carpal tunnel, anatomical snuffbox, flexor retinaculum
- Palmar spaces and tendon sheaths
-
Peripheral nerve lesions
- Median nerve: carpal tunnel syndrome, thenar wasting, hand of benediction
- Ulnar nerve: claw hand, Froment sign
- Radial nerve: wrist drop
- Musculocutaneous and axillary nerve lesions
-
Vessels, veins, lymphatics, and dermatomes
- Axillary to brachial to radial/ulnar arterial pathway
- Superficial veins: cephalic, basilic, median cubital
- Lymphatic drainage to axillary nodes
- Dermatomes and cutaneous nerve territories
-
Applied anatomy and examination
- Motor and sensory testing of major nerves
- Peripheral pulses and Allen test
- Common fractures, dislocations, entrapment neuropathies, and compartment syndrome
Core clinical idea
The major examination framework is to identify the site of lesion from the pattern of weakness, sensory loss, vascular impairment, and deformity. For example:
- Surgical-neck humeral fracture or anterior shoulder dislocation can injure the axillary nerve.
- Midshaft humeral fracture can injure the radial nerve, causing wrist drop.
- Supracondylar humeral fracture can endanger the brachial artery and median nerve.
- Medial epicondyle injury or cubital tunnel compression can affect the ulnar nerve.
- Carpal tunnel syndrome compresses the median nerve at the wrist.
Reply with a number, such as 3 for brachial plexus or 7 for nerve lesions, and I will give a detailed exam-oriented note on that section.
Create a table of upper-limb nerve injuries
Reading File
Finding Sources
Searching PubMed
upper extremity nerve injury
Searching the Web
upper limb peripheral nerve injury examination median ulnar radial axillary clinical findings
Upper-limb nerve injuries: clinical table
| Nerve | Common site / cause of injury | Main motor deficit | Characteristic clinical sign | Key sensory loss | Useful examination test |
|---|---|---|---|---|---|
| Long thoracic nerve (C5-C7) | Axillary surgery, trauma to lateral thoracic wall, traction | Paralysis of serratus anterior | Winged scapula; difficulty elevating arm above horizontal because scapula cannot rotate upward properly | None | Ask patient to push against a wall. Medial border of scapula protrudes posteriorly. |
| Suprascapular nerve (C5-C6) | Suprascapular notch compression, traction, shoulder trauma | Weak initiation of abduction from 0-15 degrees due to supraspinatus; weak lateral rotation due to infraspinatus | Weak shoulder abduction and external rotation; possible supraspinatus/infraspinatus wasting | Usually none | Test initiation of abduction and resisted external rotation. |
| Axillary nerve (C5-C6) | Anterior shoulder dislocation; fracture at surgical neck of humerus; deltoid-splitting procedures | Deltoid and teres minor paralysis | Flattened shoulder contour; weak abduction from 15-90 degrees and weak external rotation | “Regimental badge” area: lateral upper arm over lower deltoid | Test deltoid contraction during resisted abduction; assess sensation over lateral shoulder. |
| Musculocutaneous nerve (C5-C7) | Rare isolated injury; upper brachial plexus trauma; penetrating arm injury | Weak elbow flexion and forearm supination due to biceps and brachialis weakness | Reduced biceps bulk and weak flexion, especially with forearm supinated | Lateral aspect of forearm via lateral cutaneous nerve of forearm | Test elbow flexion and supination against resistance; biceps reflex may be reduced. |
| Radial nerve, proximal lesion (C5-T1) | Axillary compression from crutches or prolonged pressure, “Saturday-night palsy” | Loss of elbow, wrist, finger, and thumb extension, depending on level | Wrist drop; impaired grip because wrist cannot be stabilized in extension | Posterior arm/forearm and dorsolateral hand, especially dorsal first web space | Ask patient to extend wrist and MCP joints. Test sensation in first dorsal web space. |
| Radial nerve in spiral groove | Midshaft humeral fracture | Wrist and finger extension weak or absent, but triceps often spared | Wrist drop with preserved or relatively spared elbow extension | Dorsal first web space, variable posterior forearm loss | Test wrist and finger extension; examine for associated humeral fracture. |
| Posterior interosseous nerve (deep radial branch) | Compression at supinator, radial-head injury, repetitive pronation-supination | Finger and thumb extension weak; wrist extension usually preserved but may deviate radially | Finger drop without objective sensory loss | None, because it is primarily motor | Ask patient to extend MCP joints and thumb. |
| Superficial radial nerve | Tight wristwear, distal forearm trauma, compression | No motor weakness | Painful paresthesia over dorsoradial hand | Dorsolateral hand, particularly dorsal first web space | Sensory examination only; motor extension is intact. |
| Median nerve, high lesion (at elbow/proximal forearm) | Supracondylar fracture, elbow dislocation, proximal forearm laceration, pronator teres compression | Weak pronation; loss of flexion of thumb, index and middle fingers; weak thumb opposition | On making a fist, index and middle fingers fail to flex: hand of benediction. Thenar wasting may occur. | Lateral palm and palmar lateral 3½ digits; dorsal tips of these digits | Ask patient to make a fist, oppose thumb to little finger, and pronate forearm. Test sensation at index-finger pulp. |
| Anterior interosseous nerve (median branch) | Entrapment or forearm trauma | Flexor pollicis longus, pronator quadratus, and lateral FDP weakness | Abnormal pinch/OK sign: pad-to-pad pinch instead of a round “O” | None | Ask patient to make an “OK” sign using thumb and index finger. |
| Median nerve at wrist | Carpal tunnel syndrome; wrist laceration | Thenar weakness, especially abductor pollicis brevis and opponens pollicis | Thenar wasting; weak opposition, impaired precision grip; “ape thumb” posture in severe chronic lesion | Palmar lateral 3½ digits. Thenar eminence sensation is usually spared in carpal tunnel syndrome. | Tinel sign at carpal tunnel; Phalen test; test thumb abduction/opposition. |
| Ulnar nerve, high lesion (at elbow) | Medial epicondyle fracture, cubital tunnel compression, elbow dislocation | Interossei, medial lumbricals, hypothenar muscles, adductor pollicis, FCU, and medial FDP weakness | Weak finger abduction/adduction, weak grip, impaired flexion of DIP joints of ring/little fingers; clawing is often less marked than in a wrist lesion | Medial 1½ digits and adjacent medial hand, palmar and dorsal surfaces | Ask patient to abduct/adduct fingers; test Froment sign by having them hold paper between thumb and index finger. |
| Ulnar nerve at wrist | Laceration near Guyon canal; cyclist’s palsy; hook of hamate injury | Intrinsic hand-muscle paralysis but FDP preserved | Ulnar claw is prominent: hyperextension at MCP and flexion at IP joints of ring and little fingers. Hypothenar/interosseous wasting. | Palmar medial 1½ digits; dorsal ulnar hand may be spared if dorsal cutaneous branch is intact | Test finger abduction/adduction and Froment sign. Compare clawing with high lesion: “ulnar paradox.” |
| Lower trunk brachial plexus (C8-T1) | Traction on an abducted arm, cervical rib or thoracic outlet pathology | Weak intrinsic hand muscles, often with median and ulnar distribution involvement | Klumpke palsy: intrinsic-hand weakness and clawed hand; may coexist with Horner syndrome if T1 sympathetic fibers involved | Medial forearm and hand | Examine intrinsic hand muscles, sensory loss in C8-T1 distribution, and look for ptosis/miosis if severe. |
| Upper trunk brachial plexus (C5-C6) | Birth injury, fall/traction separating head and shoulder | Weak shoulder abduction and lateral rotation; weak elbow flexion and supination | Erb palsy: “waiter’s tip” posture, with adducted and medially rotated arm, extended elbow, and pronated forearm | Lateral arm and forearm may be affected | Test deltoid, supraspinatus, biceps, and brachioradialis; biceps reflex may be reduced. |
High-yield sensory points
- Axillary nerve: skin over lower deltoid, “regimental badge” region.
- Median nerve: palmar tip of index finger.
- Ulnar nerve: tip of little finger.
- Radial nerve: dorsal first web space between thumb and index finger.
- Musculocutaneous nerve: lateral forearm.
High-yield fracture and nerve associations
| Injury | Nerve most at risk | Typical finding |
|---|---|---|
| Surgical-neck humeral fracture / anterior shoulder dislocation | Axillary nerve | Deltoid weakness and sensory loss over lateral shoulder |
| Midshaft humeral fracture | Radial nerve | Wrist drop |
| Supracondylar humeral fracture | Median nerve and brachial artery | Weak median-innervated muscles; possible forearm ischemia |
| Medial epicondyle fracture | Ulnar nerve | Interosseous weakness and ulnar sensory loss |
| Scaphoid fracture | Superficial radial nerve is not typically injured, but the radial artery is clinically relevant | Anatomical snuffbox tenderness |
| Hook of hamate fracture | Ulnar nerve in Guyon canal | Ulnar intrinsic-hand weakness/sensory symptoms |
The five terminal branches of the brachial plexus are musculocutaneous, axillary, radial, median, and ulnar nerves, as summarized in the THIEME Atlas of General Anatomy and Musculoskeletal System. For clinical sensory and motor patterns, see the NCBI overview of median nerve injury and the ulnar nerve clinical anatomy review.
This is a shared conversation. Sign in to Orris to start your own chat.