Upper Limb - First Year MBBS Anatomy Syllabus

1. Osteology (Bones)

• Clavicle
• Scapula
• Humerus
• Radius and Ulna
• Carpal bones (8 bones - proximal and distal rows)
• Metacarpals and Phalanges

2. Pectoral Region & Axilla

• Pectoral muscles: Pectoralis major, Pectoralis minor, Serratus anterior
• Clavipectoral fascia
• Axilla: boundaries, contents, axillary artery and its branches, axillary vein, brachial plexus (formation, roots, trunks, divisions, cords, terminal branches)
• Axillary lymph nodes (groups and clinical importance)

3. Shoulder Region (Arm)

• Deltoid muscle, rotator cuff muscles (SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis)
• Cutaneous nerves of the arm
• Quadrangular and triangular spaces - contents and clinical significance
• Muscles of the front of the arm: Biceps brachii, Brachialis, Coracobrachialis
• Muscles of the back of the arm: Triceps brachii
• Cubital fossa - boundaries and contents

4. Forearm

• Anterior (flexor) compartment: Superficial, intermediate, and deep groups
  • Pronator teres, FCR, Palmaris longus, FCU, FDS, FDP, FPL, Pronator quadratus
• Posterior (extensor) compartment: Superficial and deep groups
  • ECRL, ECRB, ED, EDM, ECU; Supinator, APL, EPB, EPL, EI
• Brachioradialis (special: flexor in forearm, but supplied by radial nerve)

5. Hand

• Thenar muscles (Abductor pollicis brevis, Flexor pollicis brevis, Opponens pollicis, Adductor pollicis)
• Hypothenar muscles
• Lumbricals (1-4) and Interossei (palmar and dorsal)
• Palmar aponeurosis
• Fibrous flexor sheaths, Radial bursa, Ulnar bursa, Digital synovial sheaths
• Extensor expansion (dorsal digital expansion)

6. Nerves of the Upper Limb

• Brachial Plexus: formation (C5-T1), roots, trunks, divisions, cords, terminal branches
• Musculocutaneous nerve (C5, C6)
• Median nerve (C6-T1) - course, branches, applied anatomy
• Ulnar nerve (C8, T1) - course, branches, applied anatomy
• Radial nerve (C5-C8, T1) - course, branches, applied anatomy
• Axillary nerve (C5, C6)
• Long thoracic nerve (C5, C6, C7) - serratus anterior

7. Arteries of the Upper Limb

• Subclavian artery and branches
• Axillary artery (3 parts, 6 branches - "SIT A SA" mnemonic)
• Brachial artery - course, relations, profunda brachii
• Radial artery - course, anatomical snuff box, deep palmar arch
• Ulnar artery - course, superficial palmar arch
• Palmar arches: Superficial (mainly ulnar) and Deep (mainly radial)

8. Veins and Lymphatics

• Superficial veins: Cephalic vein, Basilic vein, Median cubital vein (clinical - IV access, venepuncture)
• Deep veins
• Lymphatic drainage: Axillary lymph nodes (5 groups), clinical importance in breast cancer

9. Joints of the Upper Limb

• Shoulder girdle joints: Sternoclavicular joint, Acromioclavicular joint
• Shoulder (Glenohumeral) joint: type, articular surfaces, capsule, ligaments, movements, rotator cuff
• Elbow joint: humeroulnar + humeroradial + proximal radioulnar joints
• Distal radioulnar joint
• Wrist (radiocarpal) joint
• 1st carpometacarpal joint (saddle joint - most mobile)

10. Fasciae, Retinacula & Spaces

• Deep fascia of arm and forearm
• Flexor retinaculum (carpal tunnel) - contents and carpal tunnel syndrome
• Extensor retinaculum - 6 compartments of extensor tendons
• Palmar spaces: thenar space, midpalmar space (for spread of infection)

11. Surface Anatomy & Living Anatomy

• Bony landmarks: acromion, coracoid process, medial epicondyle, lateral epicondyle, radial styloid, ulnar styloid, pisiform, tubercle of scaphoid
• Pulse points: brachial artery, radial artery, ulnar artery
• Nerve palpation: ulnar nerve at medial epicondyle
• Testing key muscles: deltoid, biceps, triceps, thenar, hypothenar, interossei
• Testing movements at each joint

12. Radiological Anatomy

• X-rays of shoulder, elbow, wrist, and hand joints
• Identifying bony landmarks and joint spaces

13. Applied / Clinical Anatomy (High-yield for exams)

• Carpal tunnel syndrome (median nerve compression)
• Claw hand (ulnar nerve palsy)
• Wrist drop (radial nerve palsy at spiral groove)
• Ape hand (median nerve palsy)
• Dupuytren's contracture (palmar fascia fibrosis)
• Tennis elbow (lateral epicondylitis - common extensor origin)
• Anatomical snuff box - contents, scaphoid fracture risk
• Erb's palsy (C5, C6 injury - "waiter's tip" position)
• Klumpke's palsy (C8, T1 injury - claw hand)
• Axillary nerve injury in shoulder dislocation

14. Histology (Related to Upper Limb)

• Histology of skeletal muscle, cartilage (hyaline, fibrocartilage), bone (compact and spongy), synovial joint, tendons, and nerves

15. Embryology (Related)

• Development of upper limb bud (4th week)
• Limb rotation and muscle differentiation
• Common congenital anomalies: polydactyly, syndactyly, amelia, phocomelia, club hand

Study Priority Guide

10-Day Upper Limb Anatomy Study Plan

📅 Day 1 — Osteology (Bones)

• Clavicle, Scapula, Humerus
• Radius, Ulna, Carpal bones, Metacarpals, Phalanges
• For each bone: surfaces, borders, angles, ossification centers, fracture sites
• Draw and label each bone from memory

Tip: Hold/touch the actual bone model while studying. It sticks much better.

📅 Day 2 — Pectoral Region + Axilla

• Pectoral muscles, clavipectoral fascia
• Axilla: walls, contents
• Axillary artery (3 parts, 6 branches)
• Axillary lymph nodes (5 groups)
• Brachial plexus - formation only today (roots → trunks → divisions → cords)

This is a heavy day. Focus on the brachial plexus diagram - draw it at least 3 times.

📅 Day 3 — Brachial Plexus + Nerves (Deep Dive)

• All terminal branches of brachial plexus
• Musculocutaneous, Median, Ulnar, Radial, Axillary nerves
  • Course, branches, area supplied
• Long thoracic nerve, Medial and lateral pectoral nerves
• All nerve injury clinical correlates (wrist drop, claw hand, ape hand, etc.)
• Erb's palsy and Klumpke's palsy

Most exam questions come from this day's content. Spend extra time here.

📅 Day 4 — Shoulder Region + Arm

• Deltoid, Rotator cuff (SITS muscles)
• Quadrangular and triangular spaces - contents
• Front of arm: Biceps brachii, Brachialis, Coracobrachialis
• Back of arm: Triceps brachii
• Cubital fossa - boundaries and contents
• Shoulder joint and elbow joint (brief intro, detail on Day 8)

📅 Day 5 — Forearm

• Anterior compartment: all 8 muscles (superficial, intermediate, deep groups)
• Posterior compartment: all 12 muscles (superficial and deep groups)
• Brachioradialis (the "rebel" muscle)
• Pronation and supination mechanisms
• Radial and ulnar arteries in forearm

Make a table of all forearm muscles: origin, insertion, nerve supply, action.

📅 Day 6 — Hand

• Thenar and hypothenar muscles
• Lumbricals and interossei (palmar 3, dorsal 4)
• All intrinsic hand muscles with nerve supply
• Palmar aponeurosis, fibrous flexor sheaths
• Radial bursa, ulnar bursa, digital synovial sheaths
• Extensor expansion
• Palmar spaces (thenar + midpalmar)
• Carpal tunnel - boundaries, contents, carpal tunnel syndrome

📅 Day 7 — Arteries + Veins + Lymphatics

• Subclavian → Axillary → Brachial → Radial/Ulnar
• Superficial and deep palmar arches
• Superficial veins: Cephalic, Basilic, Median cubital
• Lymphatic drainage of upper limb
• Anastomoses around the elbow and shoulder

📅 Day 8 — All Joints

• Sternoclavicular and Acromioclavicular joints
• Shoulder (glenohumeral) joint - full detail
• Elbow joint - full detail
• Superior and inferior radioulnar joints
• Wrist (radiocarpal) joint
• 1st carpometacarpal joint
• For each: type, surfaces, capsule, ligaments, movements, nerve/blood supply

📅 Day 9 — Histology + Embryology + Radiology

• Histology: skeletal muscle, bone (compact + spongy), cartilage types, synovial joint, tendon, nerve
• Embryology: limb bud development, rotation, congenital anomalies (polydactyly, syndactyly, Erb's palsy)
• Radiology: X-rays of shoulder, elbow, wrist - identify landmarks
• Surface anatomy and living anatomy landmarks

📅 Day 10 — Full Revision + Applied Anatomy

• Revise all nerve injuries and clinical conditions
• Carpal tunnel syndrome, Dupuytren's contracture, Tennis elbow
• Anatomical snuff box, scaphoid fractures
• Wrist drop, claw hand, ape hand, winged scapula

• Go through all diagrams you drew (brachial plexus, muscles, arteries)
• Do previous year exam questions
• Rapid-fire self-testing on nerve supplies and muscle actions

Daily Schedule Template

Key Tips for 10-Day Success

1. Draw every diagram yourself - brachial plexus, cubital fossa, carpal tunnel, palmar arches. Drawing is 3x more effective than just reading.
2. Use mnemonics - "My Aunt Fanny Regularly Pays Peanuts For Dates, Dimes, Nickels, Coins" for forearm flexors, etc.
3. Active recall over passive reading - after every topic, close the book and write what you remember.
4. Focus on nerve supplies - almost every exam question traces back to "which nerve supplies what."
5. Do not skip applied anatomy - clinical correlates are easy marks.
6. Attend dissection - seeing it on the cadaver makes the anatomy click instantly.
7. Previous year questions - solve them on Day 10. Upper limb questions are often repeated.