Anatomy Tables - Superficial Limbs

Anatomy Tables - Superficial Limbs

Topographical Anatomy
Structure/Space	Description/Boundaries	Significance
quadrangular space	boundaries: medial - long head triceps tendon, lateral - humerus, superior - teres minor, inferior - teres major	significance: traversed by the axillary nerve & posterior humeral circumflex artery
subacromial/subdeltoid bursa	between the deltoid, the supraspinatus tendon and the glenohumeral joint	facilitates movement of the supraspinatus tendon and the deltoid
triangular space	boundaries: lateral - long head triceps tendon, superior - teres minor, inferior - teres major	significance: traversed by the circumflex scapular artery
cubital fossa	superior - line between humeral epicondyles, medial - pronator teres, lateral - brachioradialis	site for phlebotomy

Osteology
Bone	Structure	Description	Notes
clavicle		an "S" shaped bone located between the sternum and the scapula	it articulates medially with the manubrium of the sternum and laterally with the acromion process of the scapula; it forms a strut that supports the upper limb; it is frequently fractured; it is the first bone to begin ossification during development
	acromial extremity	the flattened lateral end of the clavicle	it is marked on its inferior surface at the junction of the medial 2/3 and the lateral 1/3 by a roughened area for attachment of the coracoclavicular ligament; it articulates with the coracoid process of the scapula through a syndesmosis; it articulates with the acromion process of the scapula through a synovial joint; due to the shape of the distal clavicle, the acromion process passes inferior to the clavicle in acromioclavicular dislocations (Latin, akron = tip + omos = shoulder, therefore the tip of the shoulder)
scapula		the bone of the shoulder	the scapula floats in a sea of muscles, so it is difficult to fracture; it articulates with the axial skeleton through only one bone - the clavicle at the coracoclavicular and acromioclavicular joints
	scapular notch	a notch on the superior border of the scapula located medial to the attachment of the coracoid process	it is bridged by the superior transverse scapular ligament; the suprascapular a. passes superior to the superior transverse scapular ligament and the suprascapular n. passes inferior to it (Army goes over the bridge, Navy goes under the bridge)
	acromion	a broad, flat process located at the lateral end of the scapular spine	it articulates with the clavicle through a synovial joint (acromioclavicular joint) (Latin, akron = tip + omos = shoulder, therefore the tip of the shoulder)
	supraspinous fossa	a broad depression located superior to the spine of the scapula	it is the site of origin of the supraspinatus m.
	infraspinous fossa	a broad depression located inferior to the spine of the scapula	it is the site of origin of the infraspinatus m.
humerus		the bone of the arm (brachium)	the humerus articulates proximally with the scapula at the glenoid fossa; it articulates distally with the radius and ulna at the elbow joint
	head	the smooth, rounded proximal end of the humerus	it articulates with the glenoid cavity of the scapula to form the shoulder joint
	anatomical neck	the constricted region located inferolateral to the head	it is located at the circumference of the smooth articular surface of the head
	surgical neck	the proximal part of the shaft of the humerus	it is located inferior to the greater and lesser tubercles; it is a site of frequent fracture; fractures of the surgical neck of the humerus endanger the axillary n. and the posterior circumflex humeral a.
	greater tubercle	the large projection located lateral to the head of the humerus	it is the attachment site of the supraspinatus, infraspinatus & teres minor mm.
	lesser tubercle	the projection located lateral to the head of the humerus on the anterior surface	it is the insertion site of the subscapularis m.
	intertubercular groove	the groove on the anterior surface of the humerus that is located between the crest of the greater tubercle and the crest of the lesser tubercle	it is occupied by the tendon of the long head of the biceps brachii m.; the transverse humeral ligament spans the intertubercular groove and holds the biceps tendon in place; it is the attachment site for the tendon of the pectoralis major (lateral lip), teres major (medial lip), and latissimus dorsi (floor)
	crest of the greater tubercle	the ridge of bone on the anterior surface of the humerus extending inferiorly from the greater tubercle	it forms the lateral lip of the intertubercular groove; it is the attachment site for the transverse humeral ligament and the pectoralis major m.
	crest of the lesser tubercle	the ridge of bone on the anterior surface of the humerus extending inferiorly from the lesser tubercle	it forms the medial lip of the intertubercular groove; it is the attachment site for the transverse humeral ligament and the teres major m.
	deltoid tuberosity	the roughened process on the lateral surface of the mid-shaft of the humerus	it is the insertion site of the deltoid m.
ilium		fan-shaped bone that forms the lateral prominence of the pelvis	one of three bones that form the os coxae: ilium, ischium, pubis
	anterior superior iliac spine	spine at the anterior end of the iliac crest	lateral attachment of the inguinal ligament
	iliac crest	arching superior edge the ilium that forms the rim of the "fan"	attachment for abdominal wall muscles
	iliac tubercle	roughened area along the outer edge of the iliac crest
	posterior superior iliac spine	spine at the posterior end of the iliac crest	position marked by a dimpling of the skin
tibia		the bone on the medial side of the leg	the tibia is the weight-bearing bone of the leg (Latin, tibia = the large shin bone)
	medial malleolus	the large bony prominence on the medial side of the ankle	the medial malleolus of the tibia forms the medial side of the ankle joint; it articulates with the medial surface of the talus (Latin, malleus = hammer)
fibula		the slender bone on the lateral side of the leg	the fibula is not a weight-bearing bone, it is a muscle attachment bone (Latin, fibula = that which fastens)
	lateral malleolus	the enlarged distal end of the fibula	the lateral malleolus of the fibula forms the lateral side of the ankle joint; it articulates with the lateral surface of the talus; forcible lateral displacement of the foot can cause the fibula to fracture superior to the lateral malleolus, a condition called a Pott's fracture (Latin, malleus = hammer)

Muscles
Muscle	Origin	Insertion	Action	Innervation	Notes
deltoid	lateral one-third of clavicle, acromion, lower lip of the crest of the spine of the scapula	deltoid tuberosity of the humerus	abducts arm; anterior fibers flex & medially rotate arm; posterior fibers extend & laterally rotate arm	axillary nerve (C5,6) from posterior cord of brachial plexus	deltoid is the principle abductor of the arm but due to poor mechanical advantage it cannot initiate this action; assisted by supraspinatus
teres major	dorsum of the inferior angle of scapula	crest of lesser tubercle of humerus	adducts arm, medially rotates arm, assists in arm extension	lower subscapular nerve (C5,6) from the posterior cord of the brachial plexus	teres major inserts beside the tendon of latissimus dorsi, and assists latissimus in its actions (Latin, teres = round)
rotator cuff
supraspinatus	supraspinatus fossa	greater tubercle of humerus (highest facet)	abduct arm (initiate abduction)	suprascapular nerve (C5,6) from superior trunk of brachial plexus	supraspinatus initiates abduction of the arm, then the deltoid muscle completes the action
infraspinatus	infraspinatus fossa	greater tubercle of humerus (middle facet)	laterally rotate arm	suprascapular nerve	infraspinatus, supraspinatus, teres minor and subscapularis are the rotator cuff muscles
teres minor	upper 2/3 of the lateral border of the scapula	greater tubercle of humerus (lowest facet)	laterally rotates arm	axillary	fixes head of humerus in glenoid fossa during abduction & flexion of arm

Joints and Ligaments
Joint	Description	Significance
inguinal ligament	the ligament that connects the anterior superior iliac spine with the pubic tubercle	the inguinal ligament is a specialization of the inferior border of the external abdominal oblique aponeurosis; it is the site of origin for a part of the internal abdominal oblique muscle and for a part of the transversus abdominis muscle; also known as: Poupart's ligament
pubic symphysis	symphysis	midline joint uniting the pubic bodies (Greek, symphysis = a growing together)

Veins
Vein	Tributaries	Drains Into	Regions Drained	Notes
cephalic v.	lateral side of the dorsal venous arch of the hand; superficial veins of the forearm	axillary vein	superficial parts of the lateral hand and lateral forearm	median cubital vein usually shunts some of the blood collected by the cephalic v. to the basilic v. (Latin/Greek, kephale = head)
basilic	dorsal veins of hand medially; superficial veins of forearm, median cubital vein	unites with brachial vein(s) to form the axillary vein	superficial parts of medial hand & medial forearm	connects with deep veins of the forearm via perforating veins
median cubital	cephalic	basilic	superficial parts of hand & forearm	a median antebrachial vein is possible and, when present, it may drain into the median cubital vein
dorsal venous network of hand	dorsal metacarpal veins	medially into basilic v. and laterally into cephalic v.	superficial, dorsal aspect of digits	unlike the foot, a distinct arch may be absent in the hand, replaced by a dorsal venous network of veins
dorsal venous arch of foot	dorsal digital vv. and dorsal metatarsal vv.	great saphenous v. medially, small saphenous v. laterally	dorsum of digits & superficial structures of dorsum of foot
saphenous, greater	medial end of dorsal venous arch of foot, perforating communications, superficial epigastric, superficial circumflex iliac, superficial external pudendal	femoral v.	superficial structures of medial lower limb; lower abdominal wall, perineal region	frequently used as graft material in coronary bypass surgery (Saphenous, arabic for "al safin" = hidden, for this vein does not show through the skin)
epigastric, superficial	none	greater saphenous v.	superficial fascia and skin of the lower abdominal wall	superficial epigastric v. communicates with paraumbilical vv. and may enlarge in portal hypertension, producing the sign called caput medusae
saphenous, lesser	lateral end of dorsal venous arch of foot	popliteal v.	superficial lateral foot & leg	(Saphenous, arabic for "al safin" = hidden, for this vein does not show through the skin)

Nerves
Nerve	Source	Branches	Motor	Sensory	Notes
antebrachial cutaneous, lateral	musculocutaneous n.	anterior and posterior branches	none	skin of the lateral side of the forearm	lateral antebrachial cutaneous n. emerges from the lateral intermuscular interval between biceps and brachialis; it is the continuation of the musculocutaneous n. (Latin, cutis = skin)
antebrachial cutaneous, medial	medial cord of the brachial plexus	no named branches	none	skin of the medial side of the forearm	medial antebrachial cutaneous nerve travels with the basilic vein for part of its course (Latin, cutis = skin)
antebrachial cutaneous, posterior	radial n.	inferior lateral brachial cutaneous n.	none	skin of the lateral distal arm and posterior forearm	posterior antebrachial cutaneous n. passes posterior to the lateral epicondyle of the humerus (Latin, cutis = skin)
superficial radial n.	radial n.	dorsal digital brs.	sympathetic motor for the skin	skin of the posterolateral wrist and hand; dorsum of the lateral 2 1/2 digits (excluding the skin over the distal phalanx/nail bed)	superficial radial n. is located deep to the brachioradialis muscle
dorsal branch of the ulnar n.	ulnar n.	dorsal digital	sympathetic motor innervation to skin	skin of the dorsal surface of the medial 2 1/2 digits; skin of the medial side of the back of the hand	dorsal branch of the ulnar n. emerges at the level of the ulnar styloid process (Latin, ulna = elbow)
femoral	lumbar plexus (ventral primary rami of L2-L4)	anterior femoral cutaneous brs., nn. to: sartorius, rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, pectineus	sartorius, rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, pectineus	skin of anterior thigh	passes under inguinal ligament lateral to femoral a.
femoral cutaneous, anterior	femoral			skin of anterior thigh	(Latin, cutis = skin)
femoral cutaneous, lateral	lumbar plexus (ventral primary rami of L2-L3)	anterior & posterior brs.		skin of lateral thigh	(Latin, cutis = skin)
saphenous	femoral	infrapatellar br.		skin of medial leg & foot	travels with great saphenous v.; does not pass through the adductor hiatus at the knee; passes anterior to the medial malleolus at the ankle (Saphenous, arabic for "al safin" = hidden, for this vein does not show through the skin)
superficial fibular n.	common fibular n.	medial dorsal cutaneous n. to the medial side of the foot; dorsal digital nn. to the lateral 3 toes	muscles of the lateral compartment of the leg (fibularis longus and brevis mm.)	distal 1/3 of the anterior surface of the leg; dorsum of the foot excluding the skin of the web between the great toe and the 2nd toe and the distal interphalangeal segments of all toes	nail beds are supplied by nerves from the plantar surface of the foot
deep fibular n.	common fibular n.	one proper digital br.	muscles of the anterior compartment of the leg (tibialis anterior m., extensor hallucis longus m., extensor digitorum longus m., fibularis tertius m.) and muscles of the dorsum of the foot (extensor digitorum brevis m.and extensor hallucis brevis m.)	skin of the web between the great toe and the 2nd toe	anterior compartment syndrome - trauma to the anterior side of the leg can result in pressure buildup in the anterior compartment (from swelling or bleeding) that can damage the deep fibular n., resulting in "foot drop"
femoral cutaneous, posterior	sacral plexus (ventral primary rami of S1-S3)	inferior cluneal nn.; perineal br.		skin of lower buttock & posterior thigh	(Latin, cutis = skin)
medial sural cutaneous	tibial n.	no named branches	none	skin of the posterior surface of the leg; skin of the lateral side of the foot	unites with fibular communicating br. to form the sural n. (Latin, cutis = skin)
lateral sural cutaneous	common fibular n.	fibular communicating br.	none	skin of the lateral side of the leg	contains postganglionic sympathetic axons for supply of sweat glands, arrector pili mm. and blood vessels, as do ALL cutaneous sensory nerves (Latin, cutis = skin)
sural n.	formed by the union of the fibular communicating br. of the lateral sural cutaneous n. and the medial sural cutaneous nn.	lateral calcaneal brs., lateral dorsal cutaneous n. of the foot	none	skin of the posterior surface of the lower leg; skin of the lateral side of the foot	sural n. courses posterior to the lateral malleolus at the ankle with the lesser saphenous v.(Latin, sura= the calf of the leg)
suprascapular	superior trunk of the brachial plexus (C5-C6)	no named branches	supraspinatus, infraspinatus	no cutaneous branches	passes through the suprascapular notch inferior to the superior transverse scapular ligament

Arteries
Artery	Source	Branches	Supply	Notes
suprascapular	thyrocervical trunk	muscular	supraspinatus & infraspinatus, shoulder joint	anastomoses with the circumflex scapular a. and the dorsal scapular a. to form the scapular anastomosis
posterior circumflex humeral	axillary, 3rd part	muscular	arm muscles near surgical neck of humerus	passes through quadrangular space with axillary nerve
circumflex scapular	subscapular	muscular	teres major & minor, infraspinatus	anastomoses with suprascapular & dorsal scapular branches (Latin, circum- = around + -flex = to bend)

Fascia
Organ/Part of Organ	Location/Description	Notes
brachial fascia	sheath of deep fascia enclosing the arm that is continuous superiorly with the pectoral and axillary layers of fascia	attached inferiorly to the epicondyles of the humerus and the olecranon of the ulna and is continuous with the antebrachial fascia
antebrachial fascia	anterior and posterior thickening forming the extensor retinaculum; immediately distal but deeper to the palmar carpal ligament it forms the flexor retinaculum	formation of the carpal tunnel through which the median n. and flexor tendons pass
fascia lata	deep fascia forming tubular investment of the thigh	thickened laterally as iliotibial tract/band; connected to femur by lateral & medial intermuscular septa; Scarpa's fascia attaches to it below inguinal ligament
iliotibial tract	extends from the iliac tubercle to a tubercle on the lateral condyle of the tibia	the conjoint aponeurosis of the tensor fasciae latae and gluteus maximus mm.
crural fascia	deep fascia forming a tubular investment of the leg	crural fascia is continuous with the fascia lata at the level of the knee; it is connected to the fibula by the anterior and posterior intermuscular septa; crural fascia is thickened near the ankle to form the extensor and flexor retinacula (Latin, crural = the legs)
deep dorsal fascia	dorsally continuous with the inferior extensor retinaculum
plantar fascia	deep fascia of the sole	forms plantar aponeurosis

Lymphatics
Structure	Location	Afferents from	Efferents to	Regions drained	Notes
superficial inguinal nodes	in superficial fascia parallel to inguinal ligament & along greater saphenous v.		deep inguinal nodes	external genitalia; superficial parts of lower limb

Clinical Terms
Term	Definition
venipuncture	puncture of a vein (usually in the arm) with a hollow bore needle for the purpose of obtaining a blood specimen; risks are localized pain, hematoma (accumulation of blood under the skin), bleeding, secondary infection (rare) and fainting (in susceptible individuals). A common upper extremity vein is the median cubital vein.
meralgia paresthetica	tingling, itching, and other forms of paresthesia in the lateral side of the thigh in the area of distribution of the lateral femoral cutaneous nerve (Greek, meros = thigh + algos = pain)
saphenous cutdown	great saphenous vein can always be located by making a skin incision anterior to the medial malleolus; this procedure is used to insert a cannula for prolonged administration of blood, plasma expanders, electrolytes, or drugs (Saphenous, arabic for "al safin" = hidden, for this vein does not show through the skin)
varicose veins	an abnormal swelling and tortuosity especially of the superficial veins of the lower limbs; caused by failure of the valves in the perforating veins connecting superficial veins to deep veins
thrombophlebitis	inflammation of a vein associated with thrombus formation

The material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest & Jaye Schlesinger
Published by ILOC, Inc., New York
Copyright © 1995, unauthorized use prohibited.

The excellent editorial assistance of
Dr. Pat Tank, UAMS
is gratefully acknowledged.

Anatomy Tables - Superficial Limbs

Topographical Anatomy

Osteology

Muscles

Joints and Ligaments

Veins

Nerves

Arteries

Fascia

Lymphatics

Clinical Terms