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Anatomy_Gray_1900	Anatomy_Gray	The remaining digits and the medial side of the index finger are supplied mainly by the ulnar artery. The ulnar artery and ulnar nerve enter the hand on the medial side of the wrist (Fig. 7.110). The vessel lies between the palmaris brevis and the flexor retinaculum and is lateral to the ulnar nerve and the pisiform bone. Distally, the ulnar artery is medial to the hook of the hamate bone and then swings laterally across the palm, forming the superficial palmar arch, which is superficial to the long flexor tendons of the digits and just deep to the palmar aponeurosis. On the lateral side of the palm, the arch communicates with a palmar branch of the radial artery.	Anatomy_Gray. The remaining digits and the medial side of the index finger are supplied mainly by the ulnar artery. The ulnar artery and ulnar nerve enter the hand on the medial side of the wrist (Fig. 7.110). The vessel lies between the palmaris brevis and the flexor retinaculum and is lateral to the ulnar nerve and the pisiform bone. Distally, the ulnar artery is medial to the hook of the hamate bone and then swings laterally across the palm, forming the superficial palmar arch, which is superficial to the long flexor tendons of the digits and just deep to the palmar aponeurosis. On the lateral side of the palm, the arch communicates with a palmar branch of the radial artery.
Anatomy_Gray_1901	Anatomy_Gray	One branch of the ulnar artery in the hand is the deep palmar branch (Figs. 7.109 and 7.110), which arises from the medial aspect of the ulnar artery, just distal to the pisiform, and penetrates the origin of the hypothenar muscles. It curves medially around the hook of the hamate to access the deep plane of the palm and to anastomose with the deep palmar arch derived from the radial artery. Branches from the superficial palmar arch include: a palmar digital artery to the medial side of the little finger, and three large, common palmar digital arteries, which ultimately provide the principal blood supply to the lateral side of the little finger, both sides of the ring and middle fingers, and the medial side of the index finger (Fig. 7.110); they are joined by palmar metacarpal arteries from the deep palmar arch before bifurcating into the proper palmar digital arteries, which enter the fingers.	Anatomy_Gray. One branch of the ulnar artery in the hand is the deep palmar branch (Figs. 7.109 and 7.110), which arises from the medial aspect of the ulnar artery, just distal to the pisiform, and penetrates the origin of the hypothenar muscles. It curves medially around the hook of the hamate to access the deep plane of the palm and to anastomose with the deep palmar arch derived from the radial artery. Branches from the superficial palmar arch include: a palmar digital artery to the medial side of the little finger, and three large, common palmar digital arteries, which ultimately provide the principal blood supply to the lateral side of the little finger, both sides of the ring and middle fingers, and the medial side of the index finger (Fig. 7.110); they are joined by palmar metacarpal arteries from the deep palmar arch before bifurcating into the proper palmar digital arteries, which enter the fingers.
Anatomy_Gray_1902	Anatomy_Gray	The radial artery curves around the lateral side of the wrist and passes over the floor of the anatomical snuffbox and into the deep plane of the palm by penetrating anteriorly through the back of the hand (Figs. 7.109 and 7.111). It passes between the two heads of the first dorsal interosseous muscle and then between the two heads of the adductor pollicis to access the deep plane of the palm and form the deep palmar arch. The deep palmar arch passes medially through the palm between the metacarpal bones and the long flexor tendons of the digits. On the medial side of the palm, it communicates with the deep palmar branch of the ulnar artery (Figs. 7.109 and 7.111).	Anatomy_Gray. The radial artery curves around the lateral side of the wrist and passes over the floor of the anatomical snuffbox and into the deep plane of the palm by penetrating anteriorly through the back of the hand (Figs. 7.109 and 7.111). It passes between the two heads of the first dorsal interosseous muscle and then between the two heads of the adductor pollicis to access the deep plane of the palm and form the deep palmar arch. The deep palmar arch passes medially through the palm between the metacarpal bones and the long flexor tendons of the digits. On the medial side of the palm, it communicates with the deep palmar branch of the ulnar artery (Figs. 7.109 and 7.111).
Anatomy_Gray_1903	Anatomy_Gray	Before penetrating the back of the hand, the radial artery gives rise to two vessels: a dorsal carpal branch, which passes medially as the dorsal carpal arch, across the wrist and gives rise to three dorsal metacarpal arteries, which subsequently divide to become small dorsal digital arteries, which enter the fingers; and the first dorsal metacarpal artery, which supplies adjacent sides of the index finger and thumb. Two vessels, the princeps pollicis artery and the radialis indicis artery, arise from the radial artery in the plane between the first dorsal interosseous and adductor pollicis. The princeps pollicis artery is the major blood supply to the thumb, and the radialis indicis artery supplies the lateral side of the index finger.	Anatomy_Gray. Before penetrating the back of the hand, the radial artery gives rise to two vessels: a dorsal carpal branch, which passes medially as the dorsal carpal arch, across the wrist and gives rise to three dorsal metacarpal arteries, which subsequently divide to become small dorsal digital arteries, which enter the fingers; and the first dorsal metacarpal artery, which supplies adjacent sides of the index finger and thumb. Two vessels, the princeps pollicis artery and the radialis indicis artery, arise from the radial artery in the plane between the first dorsal interosseous and adductor pollicis. The princeps pollicis artery is the major blood supply to the thumb, and the radialis indicis artery supplies the lateral side of the index finger.
Anatomy_Gray_1904	Anatomy_Gray	The deep palmar arch gives rise to: three palmar metacarpal arteries, which join the common palmar digital arteries from the superficial palmar arch; and three perforating branches, which pass posteriorly between the heads of origin of the dorsal interossei to anastomose with the dorsal metacarpal arteries from the dorsal carpal arch. As generally found in the upper limb, the hand contains interconnected networks of deep and superficial veins. The deep veins follow the arteries; the superficial veins drain into a dorsal venous network on the back of the hand over the metacarpal bones (Fig. 7.112). The cephalic vein originates from the lateral side of the dorsal venous network and passes over the anatomical snuffbox into the forearm. The basilic vein originates from the medial side of the dorsal venous network and passes into the dorsomedial aspect of the forearm.	Anatomy_Gray. The deep palmar arch gives rise to: three palmar metacarpal arteries, which join the common palmar digital arteries from the superficial palmar arch; and three perforating branches, which pass posteriorly between the heads of origin of the dorsal interossei to anastomose with the dorsal metacarpal arteries from the dorsal carpal arch. As generally found in the upper limb, the hand contains interconnected networks of deep and superficial veins. The deep veins follow the arteries; the superficial veins drain into a dorsal venous network on the back of the hand over the metacarpal bones (Fig. 7.112). The cephalic vein originates from the lateral side of the dorsal venous network and passes over the anatomical snuffbox into the forearm. The basilic vein originates from the medial side of the dorsal venous network and passes into the dorsomedial aspect of the forearm.
Anatomy_Gray_1905	Anatomy_Gray	The basilic vein originates from the medial side of the dorsal venous network and passes into the dorsomedial aspect of the forearm. The hand is supplied by the ulnar, median, and radial nerves (Figs. 7.113 to 7.115). All three nerves contribute to cutaneous or general sensory innervation. The ulnar nerve innervates all intrinsic muscles of the hand except for the three thenar muscles and the two lateral lumbricals, which are innervated by the median nerve. The radial nerve only innervates skin on the dorsolateral side of the hand. The ulnar nerve enters the hand lateral to the pisiform and posteromedially to the ulnar artery (Fig. 7.113). Immediately distal to the pisiform, it divides into a deep branch, which is mainly motor, and a superficial branch, which is mainly sensory.	Anatomy_Gray. The basilic vein originates from the medial side of the dorsal venous network and passes into the dorsomedial aspect of the forearm. The hand is supplied by the ulnar, median, and radial nerves (Figs. 7.113 to 7.115). All three nerves contribute to cutaneous or general sensory innervation. The ulnar nerve innervates all intrinsic muscles of the hand except for the three thenar muscles and the two lateral lumbricals, which are innervated by the median nerve. The radial nerve only innervates skin on the dorsolateral side of the hand. The ulnar nerve enters the hand lateral to the pisiform and posteromedially to the ulnar artery (Fig. 7.113). Immediately distal to the pisiform, it divides into a deep branch, which is mainly motor, and a superficial branch, which is mainly sensory.
Anatomy_Gray_1906	Anatomy_Gray	The deep branch of the ulnar nerve passes with the deep branch of the ulnar artery (Fig. 7.113). It penetrates and supplies the hypothenar muscles to reach the deep aspect of the palm, arches laterally across the palm, deep to the long flexors of the digits, and supplies the interossei, the adductor pollicis, and the two medial lumbricals. In addition, the deep branch of the ulnar nerve contributes small articular branches to the wrist joint. As the deep branch of the ulnar nerve passes across the palm, it lies in a fibro-osseous tunnel (Guyon’s canal) between the hook of the hamate and the flexor tendons. Occasionally, small outpouchings of synovial membrane (ganglia) from the joints of the carpus compress the nerve within this canal, producing sensory and motor symptoms.	Anatomy_Gray. The deep branch of the ulnar nerve passes with the deep branch of the ulnar artery (Fig. 7.113). It penetrates and supplies the hypothenar muscles to reach the deep aspect of the palm, arches laterally across the palm, deep to the long flexors of the digits, and supplies the interossei, the adductor pollicis, and the two medial lumbricals. In addition, the deep branch of the ulnar nerve contributes small articular branches to the wrist joint. As the deep branch of the ulnar nerve passes across the palm, it lies in a fibro-osseous tunnel (Guyon’s canal) between the hook of the hamate and the flexor tendons. Occasionally, small outpouchings of synovial membrane (ganglia) from the joints of the carpus compress the nerve within this canal, producing sensory and motor symptoms.
Anatomy_Gray_1907	Anatomy_Gray	The superficial branch of the ulnar nerve innervates the palmaris brevis muscle and continues across the palm to supply skin on the palmar surface of the little finger and the medial half of the ring finger (Fig. 7.113). The median nerve is the most important sensory nerve in the hand because it innervates skin on the thumb, index and middle fingers, and lateral side of the ring finger (Fig. 7.115). The nervous system, using touch, gathers information about the environment from this area, particularly from the skin on the thumb and index finger. In addition, sensory information from the lateral three and one-half digits enables the fingers to be positioned with the appropriate amount of force when using precision grip. The median nerve also innervates the thenar muscles that are responsible for opposition of the thumb to the other digits.	Anatomy_Gray. The superficial branch of the ulnar nerve innervates the palmaris brevis muscle and continues across the palm to supply skin on the palmar surface of the little finger and the medial half of the ring finger (Fig. 7.113). The median nerve is the most important sensory nerve in the hand because it innervates skin on the thumb, index and middle fingers, and lateral side of the ring finger (Fig. 7.115). The nervous system, using touch, gathers information about the environment from this area, particularly from the skin on the thumb and index finger. In addition, sensory information from the lateral three and one-half digits enables the fingers to be positioned with the appropriate amount of force when using precision grip. The median nerve also innervates the thenar muscles that are responsible for opposition of the thumb to the other digits.
Anatomy_Gray_1908	Anatomy_Gray	The median nerve also innervates the thenar muscles that are responsible for opposition of the thumb to the other digits. The median nerve enters the hand by passing through the carpal tunnel and divides into a recurrent branch and palmar digital branches (Fig. 7.115). The recurrent branch of the median nerve innervates the three thenar muscles. Originating from the lateral side of the median nerve near the distal margin of the flexor retinaculum, it curves around the margin of the retinaculum and passes proximally over the flexor pollicis brevis muscle. The recurrent branch then passes between the flexor pollicis brevis and abductor pollicis brevis to end in the opponens pollicis.	Anatomy_Gray. The median nerve also innervates the thenar muscles that are responsible for opposition of the thumb to the other digits. The median nerve enters the hand by passing through the carpal tunnel and divides into a recurrent branch and palmar digital branches (Fig. 7.115). The recurrent branch of the median nerve innervates the three thenar muscles. Originating from the lateral side of the median nerve near the distal margin of the flexor retinaculum, it curves around the margin of the retinaculum and passes proximally over the flexor pollicis brevis muscle. The recurrent branch then passes between the flexor pollicis brevis and abductor pollicis brevis to end in the opponens pollicis.
Anatomy_Gray_1909	Anatomy_Gray	The palmar digital nerves cross the palm deep to the palmar aponeurosis and the superficial palmar arch and enter the digits. They innervate skin on the palmar surfaces of the lateral three and one-half digits and cutaneous regions over the dorsal aspects of the distal phalanges (nail beds) of the same digits. In addition to skin, the digital nerves supply the lateral two lumbrical muscles. Superficial branch of the radial nerve The only part of the radial nerve that enters the hand is the superficial branch (Fig. 7.116). It enters the hand by passing over the anatomical snuffbox on the dorsolateral side of the wrist. Terminal branches of the nerve can be palpated or “rolled” against the tendon of the extensor pollicis longus as they cross the anatomical snuffbox.	Anatomy_Gray. The palmar digital nerves cross the palm deep to the palmar aponeurosis and the superficial palmar arch and enter the digits. They innervate skin on the palmar surfaces of the lateral three and one-half digits and cutaneous regions over the dorsal aspects of the distal phalanges (nail beds) of the same digits. In addition to skin, the digital nerves supply the lateral two lumbrical muscles. Superficial branch of the radial nerve The only part of the radial nerve that enters the hand is the superficial branch (Fig. 7.116). It enters the hand by passing over the anatomical snuffbox on the dorsolateral side of the wrist. Terminal branches of the nerve can be palpated or “rolled” against the tendon of the extensor pollicis longus as they cross the anatomical snuffbox.
Anatomy_Gray_1910	Anatomy_Gray	The superficial branch of the radial nerve innervates skin over the dorsolateral aspect of the palm and the dorsal aspects of the lateral three and one-half digits distally to approximately the terminal interphalangeal joints. Tendons, muscles, and bony landmarks in the upper limb are used to locate major arteries, veins, and nerves. Asking patients to maneuver their upper limbs in specific ways is essential for performing neurological examinations. Tendons are used to test reflexes associated with specific spinal cord segments. Vessels are used clinically as points of entry into the vascular system (for collecting blood and administering pharmaceuticals and nutrients), and for taking blood pressure and pulses. Nerves can become entrapped or be damaged in regions where they are related to bone or pass through confined spaces. Bony landmarks and muscles of the posterior scapular region	Anatomy_Gray. The superficial branch of the radial nerve innervates skin over the dorsolateral aspect of the palm and the dorsal aspects of the lateral three and one-half digits distally to approximately the terminal interphalangeal joints. Tendons, muscles, and bony landmarks in the upper limb are used to locate major arteries, veins, and nerves. Asking patients to maneuver their upper limbs in specific ways is essential for performing neurological examinations. Tendons are used to test reflexes associated with specific spinal cord segments. Vessels are used clinically as points of entry into the vascular system (for collecting blood and administering pharmaceuticals and nutrients), and for taking blood pressure and pulses. Nerves can become entrapped or be damaged in regions where they are related to bone or pass through confined spaces. Bony landmarks and muscles of the posterior scapular region
Anatomy_Gray_1911	Anatomy_Gray	Nerves can become entrapped or be damaged in regions where they are related to bone or pass through confined spaces. Bony landmarks and muscles of the posterior scapular region The medial border, inferior angle, and part of the lateral border of the scapula can be palpated on a patient, as can the spine and acromion. The superior border and angle of the scapula are deep to soft tissue and are not readily palpable. The supraspinatus and infraspinatus muscles can be palpated above and below the spine, respectively (Fig. 7.117). The trapezius muscle is responsible for the smooth contour of the lateral side of the neck and over the superior aspect of the shoulder. The deltoid muscles form the muscular eminence inferior to the acromion and around the glenohumeral joint. The axillary nerve passes posteriorly around the surgical neck of the humerus deep to the deltoid muscle.	Anatomy_Gray. Nerves can become entrapped or be damaged in regions where they are related to bone or pass through confined spaces. Bony landmarks and muscles of the posterior scapular region The medial border, inferior angle, and part of the lateral border of the scapula can be palpated on a patient, as can the spine and acromion. The superior border and angle of the scapula are deep to soft tissue and are not readily palpable. The supraspinatus and infraspinatus muscles can be palpated above and below the spine, respectively (Fig. 7.117). The trapezius muscle is responsible for the smooth contour of the lateral side of the neck and over the superior aspect of the shoulder. The deltoid muscles form the muscular eminence inferior to the acromion and around the glenohumeral joint. The axillary nerve passes posteriorly around the surgical neck of the humerus deep to the deltoid muscle.
Anatomy_Gray_1912	Anatomy_Gray	The latissimus dorsi muscle forms much of the muscle mass underlying the posterior axillary skin fold extending obliquely upward from the trunk to the arm. The teres major muscle passes from the inferior angle of the scapula to the upper humerus and contributes to this posterior axillary skin fold laterally. Visualizing the axilla and locating contents and related structures The axillary inlet and outlet and walls of the axilla can be established using skin folds and palpable bony landmarks (Fig. 7.118). The anterior margin of the axillary inlet is the clavicle, which can be palpated along its entire length. The lateral limit of the axillary inlet is approximated by the tip of the coracoid process, which is palpable immediately below the lateral third of the clavicle and deep to the medial margin of the deltoid muscle. The inferior margin of the anterior axillary wall is the anterior axillary skin fold, which overlies the lower margin of the pectoralis major muscle.	Anatomy_Gray. The latissimus dorsi muscle forms much of the muscle mass underlying the posterior axillary skin fold extending obliquely upward from the trunk to the arm. The teres major muscle passes from the inferior angle of the scapula to the upper humerus and contributes to this posterior axillary skin fold laterally. Visualizing the axilla and locating contents and related structures The axillary inlet and outlet and walls of the axilla can be established using skin folds and palpable bony landmarks (Fig. 7.118). The anterior margin of the axillary inlet is the clavicle, which can be palpated along its entire length. The lateral limit of the axillary inlet is approximated by the tip of the coracoid process, which is palpable immediately below the lateral third of the clavicle and deep to the medial margin of the deltoid muscle. The inferior margin of the anterior axillary wall is the anterior axillary skin fold, which overlies the lower margin of the pectoralis major muscle.
Anatomy_Gray_1913	Anatomy_Gray	The inferior margin of the anterior axillary wall is the anterior axillary skin fold, which overlies the lower margin of the pectoralis major muscle. The inferior margin of the posterior axillary wall is the posterior axillary skin fold, which overlies the margins of the teres major muscle laterally and latissimus dorsi muscle medially. The medial wall of the axilla is the upper part of the serratus anterior muscle overlying the thoracic wall. The long thoracic nerve passes vertically out of the axilla and down the lateral surface of the serratus anterior muscle in a position just anterior to the posterior axillary skin fold. The lateral boundary of the axilla is the humerus. The floor of the axilla is the dome of skin between the posterior and anterior axillary skin folds. Major vessels, nerves, and lymphatics travel between the upper limb and the trunk by passing through the axilla.	Anatomy_Gray. The inferior margin of the anterior axillary wall is the anterior axillary skin fold, which overlies the lower margin of the pectoralis major muscle. The inferior margin of the posterior axillary wall is the posterior axillary skin fold, which overlies the margins of the teres major muscle laterally and latissimus dorsi muscle medially. The medial wall of the axilla is the upper part of the serratus anterior muscle overlying the thoracic wall. The long thoracic nerve passes vertically out of the axilla and down the lateral surface of the serratus anterior muscle in a position just anterior to the posterior axillary skin fold. The lateral boundary of the axilla is the humerus. The floor of the axilla is the dome of skin between the posterior and anterior axillary skin folds. Major vessels, nerves, and lymphatics travel between the upper limb and the trunk by passing through the axilla.
Anatomy_Gray_1914	Anatomy_Gray	Major vessels, nerves, and lymphatics travel between the upper limb and the trunk by passing through the axilla. The axillary artery, axillary vein, and components of the brachial plexus pass through the axilla and into the arm by traveling lateral to the dome of skin that forms the floor. This neurovascular bundle can be palpated by placing a hand into this dome of skin and pressing laterally against the humerus. The cephalic vein travels in superficial fascia in the cleft between the deltoid muscle and the pectoralis major muscle and penetrates deep fascia in the clavipectoral triangle to join with the axillary vein. Locating the brachial artery in the arm The brachial artery is on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles (Fig. 7.119). The median nerve courses with the brachial artery, whereas the ulnar nerve deviates posteriorly from the vessel in distal regions. The triceps brachii tendon and position of the radial nerve	Anatomy_Gray. Major vessels, nerves, and lymphatics travel between the upper limb and the trunk by passing through the axilla. The axillary artery, axillary vein, and components of the brachial plexus pass through the axilla and into the arm by traveling lateral to the dome of skin that forms the floor. This neurovascular bundle can be palpated by placing a hand into this dome of skin and pressing laterally against the humerus. The cephalic vein travels in superficial fascia in the cleft between the deltoid muscle and the pectoralis major muscle and penetrates deep fascia in the clavipectoral triangle to join with the axillary vein. Locating the brachial artery in the arm The brachial artery is on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles (Fig. 7.119). The median nerve courses with the brachial artery, whereas the ulnar nerve deviates posteriorly from the vessel in distal regions. The triceps brachii tendon and position of the radial nerve
Anatomy_Gray_1915	Anatomy_Gray	The triceps brachii tendon and position of the radial nerve The triceps brachii muscle forms the soft tissue mass posterior to the humerus, and the tendon inserts onto the olecranon of the ulna, which is readily palpable and forms the bony protuberance at the “tip” of the elbow (Fig. 7.120). The brachioradialis muscle is also visible as a muscular bulge on the lateral aspect of the arm. It is particularly prominent when the forearm is half pronated, flexed at the elbow against resistance, and viewed anteriorly. The radial nerve in the distal arm emerges from behind the humerus to lie deep to the brachioradialis muscle. The cubital fossa lies anterior to the elbow joint and contains the biceps brachii tendon, the brachial artery, and the median nerve (Fig. 7.121).	Anatomy_Gray. The triceps brachii tendon and position of the radial nerve The triceps brachii muscle forms the soft tissue mass posterior to the humerus, and the tendon inserts onto the olecranon of the ulna, which is readily palpable and forms the bony protuberance at the “tip” of the elbow (Fig. 7.120). The brachioradialis muscle is also visible as a muscular bulge on the lateral aspect of the arm. It is particularly prominent when the forearm is half pronated, flexed at the elbow against resistance, and viewed anteriorly. The radial nerve in the distal arm emerges from behind the humerus to lie deep to the brachioradialis muscle. The cubital fossa lies anterior to the elbow joint and contains the biceps brachii tendon, the brachial artery, and the median nerve (Fig. 7.121).
Anatomy_Gray_1916	Anatomy_Gray	The cubital fossa lies anterior to the elbow joint and contains the biceps brachii tendon, the brachial artery, and the median nerve (Fig. 7.121). The base of the cubital fossa is an imaginary line between the readily palpable medial and lateral epicondyles of the humerus. The lateral and medial borders are formed by the brachioradialis and pronator teres muscles, respectively. The margin of the brachioradialis can be found by asking a subject to flex the semipronated forearm against resistance. The margin of the pronator teres can be estimated by an oblique line extending between the medial epicondyle and the midpoint along the length of the lateral surface of the forearm. The approximate apex of the cubital fossa is where this line meets the margin of the brachioradialis muscle.	Anatomy_Gray. The cubital fossa lies anterior to the elbow joint and contains the biceps brachii tendon, the brachial artery, and the median nerve (Fig. 7.121). The base of the cubital fossa is an imaginary line between the readily palpable medial and lateral epicondyles of the humerus. The lateral and medial borders are formed by the brachioradialis and pronator teres muscles, respectively. The margin of the brachioradialis can be found by asking a subject to flex the semipronated forearm against resistance. The margin of the pronator teres can be estimated by an oblique line extending between the medial epicondyle and the midpoint along the length of the lateral surface of the forearm. The approximate apex of the cubital fossa is where this line meets the margin of the brachioradialis muscle.
Anatomy_Gray_1917	Anatomy_Gray	Contents of the cubital fossa, from lateral to medial, are the tendon of the biceps brachii, the brachial artery, and the median nerve. The tendon of the biceps brachii is easily palpable. Often the cephalic, basilic, and median cubital veins are visible in the subcutaneous fascia overlying the cubital fossa. The ulnar nerve passes behind the medial epicondyle of the humerus and can be “rolled” here against the bone. The radial nerve travels into the forearm deep to the margin of the brachioradialis muscle anterior to the elbow joint. Identifying tendons and locating major vessels and nerves in the distal forearm Tendons that pass from the forearm into the hand are readily visible in the distal forearm and can be used as landmarks to locate major vessels and nerves.	Anatomy_Gray. Contents of the cubital fossa, from lateral to medial, are the tendon of the biceps brachii, the brachial artery, and the median nerve. The tendon of the biceps brachii is easily palpable. Often the cephalic, basilic, and median cubital veins are visible in the subcutaneous fascia overlying the cubital fossa. The ulnar nerve passes behind the medial epicondyle of the humerus and can be “rolled” here against the bone. The radial nerve travels into the forearm deep to the margin of the brachioradialis muscle anterior to the elbow joint. Identifying tendons and locating major vessels and nerves in the distal forearm Tendons that pass from the forearm into the hand are readily visible in the distal forearm and can be used as landmarks to locate major vessels and nerves.
Anatomy_Gray_1918	Anatomy_Gray	Tendons that pass from the forearm into the hand are readily visible in the distal forearm and can be used as landmarks to locate major vessels and nerves. In the anterior aspect of the distal forearm, the tendons of the flexor carpi radialis, flexor carpi ulnaris, and palmaris longus muscles can be easily located either by palpating or by asking a patient to flex the wrist against resistance. The tendon of flexor carpi radialis is located approximately at the junction between the lateral and middle thirds of an imaginary line drawn transversely across the distal forearm. The radial artery is immediately lateral to this tendon and this site is used for taking a radial pulse (Fig. 7.122A).	Anatomy_Gray. Tendons that pass from the forearm into the hand are readily visible in the distal forearm and can be used as landmarks to locate major vessels and nerves. In the anterior aspect of the distal forearm, the tendons of the flexor carpi radialis, flexor carpi ulnaris, and palmaris longus muscles can be easily located either by palpating or by asking a patient to flex the wrist against resistance. The tendon of flexor carpi radialis is located approximately at the junction between the lateral and middle thirds of an imaginary line drawn transversely across the distal forearm. The radial artery is immediately lateral to this tendon and this site is used for taking a radial pulse (Fig. 7.122A).
Anatomy_Gray_1919	Anatomy_Gray	The tendon of the flexor carpi ulnaris is easily palpated along the medial margin of the forearm and inserts on the pisiform, which can also be palpated by following the tendon to the base of the hypothenar eminence of the hand. The ulnar artery and ulnar nerve travel through the distal forearm and into the hand under the lateral lip of the flexor carpi ulnaris tendon and lateral to the pisiform. The palmaris longus tendon may be absent, but when present, lies medial to the flexor carpi radialis tendon and is particularly prominent when the wrist is flexed against resistance. The median nerve is also medial to the flexor carpi radialis tendon and lies under the palmaris longus tendon. The long tendons of the digits of the hand are deep to the median nerve and between the long flexors of the wrist. Their position can be visualized by rapidly and repeatedly flexing and extending the fingers from medial to lateral.	Anatomy_Gray. The tendon of the flexor carpi ulnaris is easily palpated along the medial margin of the forearm and inserts on the pisiform, which can also be palpated by following the tendon to the base of the hypothenar eminence of the hand. The ulnar artery and ulnar nerve travel through the distal forearm and into the hand under the lateral lip of the flexor carpi ulnaris tendon and lateral to the pisiform. The palmaris longus tendon may be absent, but when present, lies medial to the flexor carpi radialis tendon and is particularly prominent when the wrist is flexed against resistance. The median nerve is also medial to the flexor carpi radialis tendon and lies under the palmaris longus tendon. The long tendons of the digits of the hand are deep to the median nerve and between the long flexors of the wrist. Their position can be visualized by rapidly and repeatedly flexing and extending the fingers from medial to lateral.
Anatomy_Gray_1920	Anatomy_Gray	In the posterior distal forearm and wrist, the tendons of the extensor digitorum (Fig. 7.122B) are in the midline and radiate into the index, middle, ring, and little fingers from the wrist. The distal ends of the tendons of the extensor carpi radialis longus and brevis muscles are on the lateral side of the wrist (Fig. 7.122C) and can be accentuated by making a tight fist and extending the wrist against resistance. The tendon of the extensor carpi ulnaris can be felt on the far medial side of the wrist between the distal end of the ulna and the wrist.	Anatomy_Gray. In the posterior distal forearm and wrist, the tendons of the extensor digitorum (Fig. 7.122B) are in the midline and radiate into the index, middle, ring, and little fingers from the wrist. The distal ends of the tendons of the extensor carpi radialis longus and brevis muscles are on the lateral side of the wrist (Fig. 7.122C) and can be accentuated by making a tight fist and extending the wrist against resistance. The tendon of the extensor carpi ulnaris can be felt on the far medial side of the wrist between the distal end of the ulna and the wrist.
Anatomy_Gray_1921	Anatomy_Gray	Hyperextension and abduction of the thumb reveals the anatomical snuffbox (Fig. 7.122D). The medial margin of this triangular area is the tendon of the extensor pollicis longus, which swings around the dorsal tubercle of the radius and then travels into the thumb. The lateral margin is formed by the tendons of the extensor pollicis brevis and abductor pollicis longus. The radial artery passes through the anatomical snuffbox when traveling laterally around the wrist to reach the back of the hand and penetrate the base of the first dorsal interosseous muscle to access the deep aspect of the palm of the hand. The pulse of the radial artery can be felt in the floor of the anatomical snuffbox in the relaxed wrist. The cephalic vein crosses the roof of the anatomical snuffbox, and cutaneous branches of the radial nerve can be felt by moving a finger back and forth along the tendon of the extensor pollicis longus muscle. Normal appearance of the hand	Anatomy_Gray. Hyperextension and abduction of the thumb reveals the anatomical snuffbox (Fig. 7.122D). The medial margin of this triangular area is the tendon of the extensor pollicis longus, which swings around the dorsal tubercle of the radius and then travels into the thumb. The lateral margin is formed by the tendons of the extensor pollicis brevis and abductor pollicis longus. The radial artery passes through the anatomical snuffbox when traveling laterally around the wrist to reach the back of the hand and penetrate the base of the first dorsal interosseous muscle to access the deep aspect of the palm of the hand. The pulse of the radial artery can be felt in the floor of the anatomical snuffbox in the relaxed wrist. The cephalic vein crosses the roof of the anatomical snuffbox, and cutaneous branches of the radial nerve can be felt by moving a finger back and forth along the tendon of the extensor pollicis longus muscle. Normal appearance of the hand
Anatomy_Gray_1922	Anatomy_Gray	Normal appearance of the hand In the resting position, the palm and digits of the hand have a characteristic appearance. The fingers form a flexed arcade, with the little finger flexed the most and the index finger flexed the least (Fig. 7.123A). The pad of the thumb is positioned at a 90° angle to the pads of the fingers. A thenar eminence occurs at the base of the thumb and is formed by the underlying thenar muscles. A similar hypothenar eminence occurs along the medial margin of the palm at the base of the little finger. The appearance of the thenar and hypothenar eminences, and the positions of the fingers change when the ulnar and median nerves are compromised. Major superficial veins of the upper limb begin in the hand from a dorsal venous network (Fig. 7.123B), which overlies the metacarpals. The basilic vein originates from the medial side of the network and the cephalic vein originates from the lateral side.	Anatomy_Gray. Normal appearance of the hand In the resting position, the palm and digits of the hand have a characteristic appearance. The fingers form a flexed arcade, with the little finger flexed the most and the index finger flexed the least (Fig. 7.123A). The pad of the thumb is positioned at a 90° angle to the pads of the fingers. A thenar eminence occurs at the base of the thumb and is formed by the underlying thenar muscles. A similar hypothenar eminence occurs along the medial margin of the palm at the base of the little finger. The appearance of the thenar and hypothenar eminences, and the positions of the fingers change when the ulnar and median nerves are compromised. Major superficial veins of the upper limb begin in the hand from a dorsal venous network (Fig. 7.123B), which overlies the metacarpals. The basilic vein originates from the medial side of the network and the cephalic vein originates from the lateral side.
Anatomy_Gray_1923	Anatomy_Gray	Position of the flexor retinaculum and the recurrent branch of the median nerve The proximal margin of the flexor retinaculum can be determined using two bony landmarks. The pisiform bone is readily palpable at the distal end of the flexor carpi ulnaris tendon. The tubercle of the scaphoid can be palpated at the distal end of the flexor carpi radialis tendon as it enters the wrist (Fig. 7.124). An imaginary line between these two points marks the proximal margin of the flexor retinaculum. The distal margin of the flexor retinaculum is approximately deep to the point where the anterior margin of the thenar eminence meets the hypothenar eminence near the base of the palm. The recurrent branch of the median nerve lies deep to the skin and deep fascia overlying the anterior margin of the thenar eminence near the midline of the palm. Motor function of the median and ulnar nerves in the hand	Anatomy_Gray. Position of the flexor retinaculum and the recurrent branch of the median nerve The proximal margin of the flexor retinaculum can be determined using two bony landmarks. The pisiform bone is readily palpable at the distal end of the flexor carpi ulnaris tendon. The tubercle of the scaphoid can be palpated at the distal end of the flexor carpi radialis tendon as it enters the wrist (Fig. 7.124). An imaginary line between these two points marks the proximal margin of the flexor retinaculum. The distal margin of the flexor retinaculum is approximately deep to the point where the anterior margin of the thenar eminence meets the hypothenar eminence near the base of the palm. The recurrent branch of the median nerve lies deep to the skin and deep fascia overlying the anterior margin of the thenar eminence near the midline of the palm. Motor function of the median and ulnar nerves in the hand
Anatomy_Gray_1924	Anatomy_Gray	Motor function of the median and ulnar nerves in the hand The ability to flex the metacarpophalangeal joints while at the same time extending the interphalangeal joints of the fingers is entirely dependent on the intrinsic muscles of the hand (Fig. 7.125A). These muscles are mainly innervated by the deep branch of the ulnar nerve, which carries fibers from spinal cord level (C8)T1. Adducting the fingers to grasp an object placed between them is caused by the palmar interossei muscles, which are innervated by the deep branch of the ulnar nerve carrying fibers from spinal cord level (C8)T1. The ability to grasp an object between the pad of the thumb and the pad of one of the fingers depends on normal functioning of the thenar muscles, which are innervated by the recurrent branch of the median nerve carrying fibers from spinal cord level C8(T1). Visualizing the positions of the superficial and deep palmar arches	Anatomy_Gray. Motor function of the median and ulnar nerves in the hand The ability to flex the metacarpophalangeal joints while at the same time extending the interphalangeal joints of the fingers is entirely dependent on the intrinsic muscles of the hand (Fig. 7.125A). These muscles are mainly innervated by the deep branch of the ulnar nerve, which carries fibers from spinal cord level (C8)T1. Adducting the fingers to grasp an object placed between them is caused by the palmar interossei muscles, which are innervated by the deep branch of the ulnar nerve carrying fibers from spinal cord level (C8)T1. The ability to grasp an object between the pad of the thumb and the pad of one of the fingers depends on normal functioning of the thenar muscles, which are innervated by the recurrent branch of the median nerve carrying fibers from spinal cord level C8(T1). Visualizing the positions of the superficial and deep palmar arches
Anatomy_Gray_1925	Anatomy_Gray	Visualizing the positions of the superficial and deep palmar arches The positions of the superficial and deep palmar arches in the hand can be visualized using bony landmarks, muscle eminences, and skin creases (Fig. 7.126). The superficial palmar arch begins as a continuation of the ulnar artery, which lies lateral to the pisiform bone at the wrist. The arch curves laterally across the palm anterior to the long flexor tendons in the hand. The arch reaches as high as the proximal transverse skin crease of the palm and terminates laterally by joining a vessel of variable size, which crosses the thenar eminence from the radial artery in the distal forearm.	Anatomy_Gray. Visualizing the positions of the superficial and deep palmar arches The positions of the superficial and deep palmar arches in the hand can be visualized using bony landmarks, muscle eminences, and skin creases (Fig. 7.126). The superficial palmar arch begins as a continuation of the ulnar artery, which lies lateral to the pisiform bone at the wrist. The arch curves laterally across the palm anterior to the long flexor tendons in the hand. The arch reaches as high as the proximal transverse skin crease of the palm and terminates laterally by joining a vessel of variable size, which crosses the thenar eminence from the radial artery in the distal forearm.
Anatomy_Gray_1926	Anatomy_Gray	The deep palmar arch originates on the lateral side of the palm deep to the long flexor tendons and between the proximal ends of metacarpals I and II. It arches medially across the palm and terminates by joining the deep branch of the ulnar artery, which passes through the base of the hypothenar muscles and between the pisiform and hook of the hamate. The deep palmar arch is more proximal in the hand than the superficial palmar arch and lies approximately one-half of the distance between the distal wrist crease and the proximal transverse skin crease of the palm. Peripheral pulses can be felt at six locations in the upper limb (Fig. 7.127). Axillary pulse: axillary artery in the axilla lateral to the apex of the dome of skin covering the floor of the axilla. Brachial pulse in midarm: brachial artery on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles. This is the position where a blood pressure cuff is placed.	Anatomy_Gray. The deep palmar arch originates on the lateral side of the palm deep to the long flexor tendons and between the proximal ends of metacarpals I and II. It arches medially across the palm and terminates by joining the deep branch of the ulnar artery, which passes through the base of the hypothenar muscles and between the pisiform and hook of the hamate. The deep palmar arch is more proximal in the hand than the superficial palmar arch and lies approximately one-half of the distance between the distal wrist crease and the proximal transverse skin crease of the palm. Peripheral pulses can be felt at six locations in the upper limb (Fig. 7.127). Axillary pulse: axillary artery in the axilla lateral to the apex of the dome of skin covering the floor of the axilla. Brachial pulse in midarm: brachial artery on the medial side of the arm in the cleft between the biceps brachii and triceps brachii muscles. This is the position where a blood pressure cuff is placed.
Anatomy_Gray_1927	Anatomy_Gray	Brachial pulse in the cubital fossa: brachial artery medial to the tendon of the biceps brachii muscle. This is the position where a stethoscope is placed to hear the pulse of the vessel when taking a blood pressure reading. Radial pulse in the distal forearm: radial artery immediately lateral to the tendon of the flexor carpi radialis muscle. This is the most common site for “taking a pulse.” Ulnar pulse in the distal forearm: ulnar artery immediately under the lateral margin of the flexor carpi ulnaris tendon and proximal to the pisiform. Radial pulse in the anatomical snuffbox: radial artery as it crosses the lateral side of the wrist between the tendon of the extensor pollicis longus muscle and the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. Fig. 7.1 Upper limb. A. Anterior view of the upper limb. B. Superior view of the shoulder.	Anatomy_Gray. Brachial pulse in the cubital fossa: brachial artery medial to the tendon of the biceps brachii muscle. This is the position where a stethoscope is placed to hear the pulse of the vessel when taking a blood pressure reading. Radial pulse in the distal forearm: radial artery immediately lateral to the tendon of the flexor carpi radialis muscle. This is the most common site for “taking a pulse.” Ulnar pulse in the distal forearm: ulnar artery immediately under the lateral margin of the flexor carpi ulnaris tendon and proximal to the pisiform. Radial pulse in the anatomical snuffbox: radial artery as it crosses the lateral side of the wrist between the tendon of the extensor pollicis longus muscle and the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. Fig. 7.1 Upper limb. A. Anterior view of the upper limb. B. Superior view of the shoulder.
Anatomy_Gray_1928	Anatomy_Gray	Fig. 7.1 Upper limb. A. Anterior view of the upper limb. B. Superior view of the shoulder. Spinous process of vertebra TINeckShoulderGlenohumeral jointArmElbow jointForearmWrist jointHandBAThoracic wallRib IRib IAxillaScapulaManubriumof sternumClavicle Fig. 7.2 Areas of transition in the upper limb. Fig. 7.3 Movements of the scapula. A. Rotation. B. Protraction and retraction. Fig. 7.4 Movements of the arm at the glenohumeral joint. Fig. 7.5 Movements of the forearm. A. Flexion and extension at the elbow joint. B. Pronation and supination. Fig. 7.6 Movements of the hand at the wrist joint. Fig. 7.7 Bones of the upper limb. Fig. 7.8 Movements of the metacarpophalangeal (A) and interphalangeal (B) joints. Fig. 7.9 Muscles of the shoulder. A. Posterior shoulder. B. Anterior shoulder. C. Rotator cuff muscles.	Anatomy_Gray. Fig. 7.1 Upper limb. A. Anterior view of the upper limb. B. Superior view of the shoulder. Spinous process of vertebra TINeckShoulderGlenohumeral jointArmElbow jointForearmWrist jointHandBAThoracic wallRib IRib IAxillaScapulaManubriumof sternumClavicle Fig. 7.2 Areas of transition in the upper limb. Fig. 7.3 Movements of the scapula. A. Rotation. B. Protraction and retraction. Fig. 7.4 Movements of the arm at the glenohumeral joint. Fig. 7.5 Movements of the forearm. A. Flexion and extension at the elbow joint. B. Pronation and supination. Fig. 7.6 Movements of the hand at the wrist joint. Fig. 7.7 Bones of the upper limb. Fig. 7.8 Movements of the metacarpophalangeal (A) and interphalangeal (B) joints. Fig. 7.9 Muscles of the shoulder. A. Posterior shoulder. B. Anterior shoulder. C. Rotator cuff muscles.
Anatomy_Gray_1929	Anatomy_Gray	Fig. 7.8 Movements of the metacarpophalangeal (A) and interphalangeal (B) joints. Fig. 7.9 Muscles of the shoulder. A. Posterior shoulder. B. Anterior shoulder. C. Rotator cuff muscles. SupraspinatusSubscapularisHumerusAcromionSpine of scapulaInfraspinatusTeres minorCoracoid processTrapeziusDeltoidPectoralis majorTeres majorLatissimus dorsiABCTrapeziusLatissimus dorsiLevator scapulaeRhomboid minorRhomboid major Fig. 7.10 Muscle components in the arm and forearm. Fig. 7.11 Relationship of the upper limb to the neck. Axillary arteryAxillary veinAxillaMedial margin ofcoracoid processHumerusAxillary inletSuperior margin of scapulaNerves to upper limbLateral margin of rib I Fig. 7.12 Muscles of the back and thoracic wall. Fig. 7.13 Breast. Fig. 7.14 Innervation of the upper limb. Anterior ramiNervesMusculocutaneous nerve(C5 to C7)Radial nerve(C5 to C8,T1)Median nerve(C6 to C8,T1)Ulnar nerve(C[7], C8, T1)C5C6C7C8T1Brachial plexus	Anatomy_Gray. Fig. 7.8 Movements of the metacarpophalangeal (A) and interphalangeal (B) joints. Fig. 7.9 Muscles of the shoulder. A. Posterior shoulder. B. Anterior shoulder. C. Rotator cuff muscles. SupraspinatusSubscapularisHumerusAcromionSpine of scapulaInfraspinatusTeres minorCoracoid processTrapeziusDeltoidPectoralis majorTeres majorLatissimus dorsiABCTrapeziusLatissimus dorsiLevator scapulaeRhomboid minorRhomboid major Fig. 7.10 Muscle components in the arm and forearm. Fig. 7.11 Relationship of the upper limb to the neck. Axillary arteryAxillary veinAxillaMedial margin ofcoracoid processHumerusAxillary inletSuperior margin of scapulaNerves to upper limbLateral margin of rib I Fig. 7.12 Muscles of the back and thoracic wall. Fig. 7.13 Breast. Fig. 7.14 Innervation of the upper limb. Anterior ramiNervesMusculocutaneous nerve(C5 to C7)Radial nerve(C5 to C8,T1)Median nerve(C6 to C8,T1)Ulnar nerve(C[7], C8, T1)C5C6C7C8T1Brachial plexus
Anatomy_Gray_1930	Anatomy_Gray	Fig. 7.14 Innervation of the upper limb. Anterior ramiNervesMusculocutaneous nerve(C5 to C7)Radial nerve(C5 to C8,T1)Median nerve(C6 to C8,T1)Ulnar nerve(C[7], C8, T1)C5C6C7C8T1Brachial plexus Fig. 7.15 Dermatomes and myotomes in the upper limb. A. Dermatomes. B. Movements produced by myotomes. T1T1T1T2T2C6C6C6C5C5C5C4C4C3C3C8C8C8C7C7C7AAbduction of armC5Flexion of elbowC(5)6Adduction and abduction of digitsT1Flexion of digitsC8BC(6)7(8) Fig. 7.16 Nerves of upper limb. A. Major nerves in the arm and forearm. B. Anterior and posterior areas of skin innervated by major peripheral nerves in the arm and forearm.	Anatomy_Gray. Fig. 7.14 Innervation of the upper limb. Anterior ramiNervesMusculocutaneous nerve(C5 to C7)Radial nerve(C5 to C8,T1)Median nerve(C6 to C8,T1)Ulnar nerve(C[7], C8, T1)C5C6C7C8T1Brachial plexus Fig. 7.15 Dermatomes and myotomes in the upper limb. A. Dermatomes. B. Movements produced by myotomes. T1T1T1T2T2C6C6C6C5C5C5C4C4C3C3C8C8C8C7C7C7AAbduction of armC5Flexion of elbowC(5)6Adduction and abduction of digitsT1Flexion of digitsC8BC(6)7(8) Fig. 7.16 Nerves of upper limb. A. Major nerves in the arm and forearm. B. Anterior and posterior areas of skin innervated by major peripheral nerves in the arm and forearm.
Anatomy_Gray_1931	Anatomy_Gray	Radial nerve • All muscles in posterior compartment of arm and forearmUlnar nerve• Most intrinsic muscles in hand• Flexor carpi ulnaris and medial half of flexor digitorum profundus in forearmMusculocutaneous nerve• All muscles in anterior compartment of armMedian nerve• Most flexors in forearm• Thenar muscles in handABUlnar nerveMedian nerveRadial nerve• Inferior lateral cutaneous nerve of arm• Posterior cutaneous nerve of arm• Posterior cutaneous nerve of forearmMusculocutaneous nerve• Lateral cutaneous nerve of forearmRadial nerve• Superficial branchPosteriorT1T2Ulnar nerveMedian nerveRadial nerve• Inferior lateral cutaneous nerve of armAxillary nerve• Superior lateral cutaneous nerve of armAxillary nerve• Superior lateral cutaneous nerve of armMusculocutaneous nerve• Lateral cutaneous nerve of forearmRadial nerve• Superficial branchAnteriorT1T2 Fig. 7.17 Nerves related to the humerus.	Anatomy_Gray. Radial nerve • All muscles in posterior compartment of arm and forearmUlnar nerve• Most intrinsic muscles in hand• Flexor carpi ulnaris and medial half of flexor digitorum profundus in forearmMusculocutaneous nerve• All muscles in anterior compartment of armMedian nerve• Most flexors in forearm• Thenar muscles in handABUlnar nerveMedian nerveRadial nerve• Inferior lateral cutaneous nerve of arm• Posterior cutaneous nerve of arm• Posterior cutaneous nerve of forearmMusculocutaneous nerve• Lateral cutaneous nerve of forearmRadial nerve• Superficial branchPosteriorT1T2Ulnar nerveMedian nerveRadial nerve• Inferior lateral cutaneous nerve of armAxillary nerve• Superior lateral cutaneous nerve of armAxillary nerve• Superior lateral cutaneous nerve of armMusculocutaneous nerve• Lateral cutaneous nerve of forearmRadial nerve• Superficial branchAnteriorT1T2 Fig. 7.17 Nerves related to the humerus.
Anatomy_Gray_1932	Anatomy_Gray	Fig. 7.17 Nerves related to the humerus. Radial nerveUlnar nerveAxillary nerveRadial groove of humerusSurgical neck of humerusMedial epicondyle Fig. 7.18 Veins in the superficial fascia of upper limb. The area of the cubital fossa is shown in yellow. Clavipectoral triangleClavicleCephalic veinBiceps brachiiAxillary veinCephalic veinPectoralis majorBasilic veinMedian cubital veinDorsal venous network of handBasilic veinCubital fossaDeltoid Fig. 7.19 A to C. Movements of the thumb. Fig. 7.20 Right clavicle. LateralMedialSuperior viewSurface for articulationwith acromionAnterior viewSurface for articulation with manubrium of sternum andfirst costal cartilageTrapezoid lineInferior viewConoid tubercleConoid tubercle Fig. 7.21 Scapula. A. Posterior view of right scapula. B. Anterior view of costal surface. C. Lateral view.	Anatomy_Gray. Fig. 7.17 Nerves related to the humerus. Radial nerveUlnar nerveAxillary nerveRadial groove of humerusSurgical neck of humerusMedial epicondyle Fig. 7.18 Veins in the superficial fascia of upper limb. The area of the cubital fossa is shown in yellow. Clavipectoral triangleClavicleCephalic veinBiceps brachiiAxillary veinCephalic veinPectoralis majorBasilic veinMedian cubital veinDorsal venous network of handBasilic veinCubital fossaDeltoid Fig. 7.19 A to C. Movements of the thumb. Fig. 7.20 Right clavicle. LateralMedialSuperior viewSurface for articulationwith acromionAnterior viewSurface for articulation with manubrium of sternum andfirst costal cartilageTrapezoid lineInferior viewConoid tubercleConoid tubercle Fig. 7.21 Scapula. A. Posterior view of right scapula. B. Anterior view of costal surface. C. Lateral view.
Anatomy_Gray_1933	Anatomy_Gray	Fig. 7.21 Scapula. A. Posterior view of right scapula. B. Anterior view of costal surface. C. Lateral view. Articular surface for clavicleCoracoidprocessSuperior borderAnterior view of scapulaSuperior angleMedial borderSubscapular fossaAcromionGlenoid cavityLateral borderInfraglenoid tubercleInferior angleAAcromionSupraglenoid tubercleSuperior angleCoracoid processGlenoid cavityInfraglenoid tubercleInferior angleLateral borderSpinous processLateral viewCMedial borderLateral borderSuperior borderSuperior angleInferior angleArticular surface for clavicleCoracoid processPosterior viewAcromionGlenoid cavityInfraglenoid tubercleSupraspinousfossaSuprascapular notchGreater scapular notch (or spinoglenoid notch)InfraspinousfossaSpine of scapulaB Fig. 7.22 Proximal end of right humerus.	Anatomy_Gray. Fig. 7.21 Scapula. A. Posterior view of right scapula. B. Anterior view of costal surface. C. Lateral view. Articular surface for clavicleCoracoidprocessSuperior borderAnterior view of scapulaSuperior angleMedial borderSubscapular fossaAcromionGlenoid cavityLateral borderInfraglenoid tubercleInferior angleAAcromionSupraglenoid tubercleSuperior angleCoracoid processGlenoid cavityInfraglenoid tubercleInferior angleLateral borderSpinous processLateral viewCMedial borderLateral borderSuperior borderSuperior angleInferior angleArticular surface for clavicleCoracoid processPosterior viewAcromionGlenoid cavityInfraglenoid tubercleSupraspinousfossaSuprascapular notchGreater scapular notch (or spinoglenoid notch)InfraspinousfossaSpine of scapulaB Fig. 7.22 Proximal end of right humerus.
Anatomy_Gray_1934	Anatomy_Gray	Fig. 7.22 Proximal end of right humerus. HeadSuperior facet on greater tubercle(supraspinatus)GreatertubercleIntertubercularsulcusIntertubercularsulcusLesser tubercle(subscapularis)Lateral lip, floor,and medial lip ofintertubercularsulcus (pectoralismajor, latissimusdorsi, and teresmajor, respectively)Deltoid tuberosity(deltoid)Deltoid tuberosity(deltoid)Anatomical neckSurgical neckLateral viewAnterior viewAttachmentfor pectoralis majorAttachment forcoracobrachialisGreatertubercleSuperior facet(supraspinatus)Middle facet(infraspinatus)Inferior facet(teres minor)Surgical neckAnatomicalneckPosterior view Fig. 7.23 Sternoclavicular joint. A. Bones and ligaments. B. Volume-rendered reconstruction using multidetector computed tomography.	Anatomy_Gray. Fig. 7.22 Proximal end of right humerus. HeadSuperior facet on greater tubercle(supraspinatus)GreatertubercleIntertubercularsulcusIntertubercularsulcusLesser tubercle(subscapularis)Lateral lip, floor,and medial lip ofintertubercularsulcus (pectoralismajor, latissimusdorsi, and teresmajor, respectively)Deltoid tuberosity(deltoid)Deltoid tuberosity(deltoid)Anatomical neckSurgical neckLateral viewAnterior viewAttachmentfor pectoralis majorAttachment forcoracobrachialisGreatertubercleSuperior facet(supraspinatus)Middle facet(infraspinatus)Inferior facet(teres minor)Surgical neckAnatomicalneckPosterior view Fig. 7.23 Sternoclavicular joint. A. Bones and ligaments. B. Volume-rendered reconstruction using multidetector computed tomography.
Anatomy_Gray_1935	Anatomy_Gray	Fig. 7.23 Sternoclavicular joint. A. Bones and ligaments. B. Volume-rendered reconstruction using multidetector computed tomography. CostoclavicularligamentInterclavicularligamentClavicular notchAnteriorsternoclavicularligamentManubrium ofsternumSternal angleArticular disc(capsule and ligamentsremoved anteriorlyto expose joint)Attachment sitefor rib IIFirst costalcartilageRib IVertebral body of TIILeft clavicleSternalangleRib IRib IIManubriumof sternumAB Fig. 7.24 Right acromioclavicular joint. Fig. 7.25 Glenohumeral joint. A. Articular surfaces of right glenohumeral joint. B. Radiograph of a normal glenohumeral joint. Tendon of longhead of bicepsbrachii muscleGlenoid cavityABGlenoid labrumTransverse humeral ligamentClavicleAcromionGlenoid cavityHead of humerusHead ofhumerus Fig. 7.26 Synovial membrane and joint capsule of right glenohumeral joint.	Anatomy_Gray. Fig. 7.23 Sternoclavicular joint. A. Bones and ligaments. B. Volume-rendered reconstruction using multidetector computed tomography. CostoclavicularligamentInterclavicularligamentClavicular notchAnteriorsternoclavicularligamentManubrium ofsternumSternal angleArticular disc(capsule and ligamentsremoved anteriorlyto expose joint)Attachment sitefor rib IIFirst costalcartilageRib IVertebral body of TIILeft clavicleSternalangleRib IRib IIManubriumof sternumAB Fig. 7.24 Right acromioclavicular joint. Fig. 7.25 Glenohumeral joint. A. Articular surfaces of right glenohumeral joint. B. Radiograph of a normal glenohumeral joint. Tendon of longhead of bicepsbrachii muscleGlenoid cavityABGlenoid labrumTransverse humeral ligamentClavicleAcromionGlenoid cavityHead of humerusHead ofhumerus Fig. 7.26 Synovial membrane and joint capsule of right glenohumeral joint.
Anatomy_Gray_1936	Anatomy_Gray	Fig. 7.26 Synovial membrane and joint capsule of right glenohumeral joint. Synovial sheathSynovial membraneRedundant synovial membrane in adductionSubtendinous bursa of subscapularisLong head of biceps brachii tendonCoracohumeralligamentLong head of biceps brachiitendonFibrous membrane of joint capsule Fig. 7.27 Capsule of right glenohumeral joint. Superior glenohumeral ligamentMiddle glenohumeral ligamentInferiorglenohumeralligamentCoracohumeral ligamentTransversehumeral ligamentSynovialsheathTendon oflong headof bicepsbrachiiRedundant capsuleAperture for subtendinousbursa of subscapularis Fig. 7.28 Lateral view of right glenohumeral joint and surrounding muscles with proximal end of humerus removed.	Anatomy_Gray. Fig. 7.26 Synovial membrane and joint capsule of right glenohumeral joint. Synovial sheathSynovial membraneRedundant synovial membrane in adductionSubtendinous bursa of subscapularisLong head of biceps brachii tendonCoracohumeralligamentLong head of biceps brachiitendonFibrous membrane of joint capsule Fig. 7.27 Capsule of right glenohumeral joint. Superior glenohumeral ligamentMiddle glenohumeral ligamentInferiorglenohumeralligamentCoracohumeral ligamentTransversehumeral ligamentSynovialsheathTendon oflong headof bicepsbrachiiRedundant capsuleAperture for subtendinousbursa of subscapularis Fig. 7.28 Lateral view of right glenohumeral joint and surrounding muscles with proximal end of humerus removed.
Anatomy_Gray_1937	Anatomy_Gray	Fig. 7.28 Lateral view of right glenohumeral joint and surrounding muscles with proximal end of humerus removed. SupraspinatusInfraspinatusTeres minorTeres majorSynovial membraneSubtendinous bursaof subscapularisLong head of biceps brachii tendonLong head of tricepsbrachiiShort head of biceps brachiiand coracobrachialisLatissimus dorsiPectoralis majorGlenoid labrum Fibrous membraneSubscapularisDeltoidAcromionCoracoid processCoraco-acromial ligamentGlenoid cavitySubacromial bursa (subdeltoid) Fig. 7.29 Magnetic resonance image (T1-weighted) of a normal glenohumeral joint in the sagittal plane. SupraspinatusInfraspinatusPosteriorAnteriorClavicleAcromionTeres minorHead of humerusCoracoid processSubscapularis Fig. 7.30 There is an oblique fracture of the middle third of the right clavicle. Fracture of clavicleAcromioclavicular joint	Anatomy_Gray. Fig. 7.28 Lateral view of right glenohumeral joint and surrounding muscles with proximal end of humerus removed. SupraspinatusInfraspinatusTeres minorTeres majorSynovial membraneSubtendinous bursaof subscapularisLong head of biceps brachii tendonLong head of tricepsbrachiiShort head of biceps brachiiand coracobrachialisLatissimus dorsiPectoralis majorGlenoid labrum Fibrous membraneSubscapularisDeltoidAcromionCoracoid processCoraco-acromial ligamentGlenoid cavitySubacromial bursa (subdeltoid) Fig. 7.29 Magnetic resonance image (T1-weighted) of a normal glenohumeral joint in the sagittal plane. SupraspinatusInfraspinatusPosteriorAnteriorClavicleAcromionTeres minorHead of humerusCoracoid processSubscapularis Fig. 7.30 There is an oblique fracture of the middle third of the right clavicle. Fracture of clavicleAcromioclavicular joint
Anatomy_Gray_1938	Anatomy_Gray	Fig. 7.30 There is an oblique fracture of the middle third of the right clavicle. Fracture of clavicleAcromioclavicular joint Fig. 7.31 Radiographs of acromioclavicular joints. A. Normal right acromioclavicular joint. B. Dislocated right acromioclavicular joint (shoulder separation). Acromioclavicular jointAcromionClavicle Head of humerusClavicleAcromionHumerusAB Fig. 7.32 Radiograph showing an anteroinferior dislocation of the shoulder joint. AcromionGlenoid cavityClavicleHead of humerus Fig. 7.33 Magnetic resonance image of a full-thickness tear of the supraspinatus tendon as it inserts onto the greater tubercle of the humerus. Fig. 7.34 Ultrasound of shoulder showing needle placement into the subdeltoid/subacromial bursa. DeltoidHead of humerusNeedleSubacromial-subdeltoid bursa Fig. 7.35 Lateral view of trapezius and deltoid muscles. AcromionSpine of thescapulaTrapeziusDeltoidDeltoid tuberosity of humerusClavicle	Anatomy_Gray. Fig. 7.30 There is an oblique fracture of the middle third of the right clavicle. Fracture of clavicleAcromioclavicular joint Fig. 7.31 Radiographs of acromioclavicular joints. A. Normal right acromioclavicular joint. B. Dislocated right acromioclavicular joint (shoulder separation). Acromioclavicular jointAcromionClavicle Head of humerusClavicleAcromionHumerusAB Fig. 7.32 Radiograph showing an anteroinferior dislocation of the shoulder joint. AcromionGlenoid cavityClavicleHead of humerus Fig. 7.33 Magnetic resonance image of a full-thickness tear of the supraspinatus tendon as it inserts onto the greater tubercle of the humerus. Fig. 7.34 Ultrasound of shoulder showing needle placement into the subdeltoid/subacromial bursa. DeltoidHead of humerusNeedleSubacromial-subdeltoid bursa Fig. 7.35 Lateral view of trapezius and deltoid muscles. AcromionSpine of thescapulaTrapeziusDeltoidDeltoid tuberosity of humerusClavicle
Anatomy_Gray_1939	Anatomy_Gray	DeltoidHead of humerusNeedleSubacromial-subdeltoid bursa Fig. 7.35 Lateral view of trapezius and deltoid muscles. AcromionSpine of thescapulaTrapeziusDeltoidDeltoid tuberosity of humerusClavicle Fig. 7.36 Attachments and neurovascular supply of the trapezius and deltoid muscles. AcromionSpine of scapulaTrapeziusDeltoidDeltoid tuberosity of humerusRhomboid minorRhomboid majorClavicleSuperior nuchal lineExternal occipitalprotuberanceMastoid processLigamentum nuchaeSpinous processes and interspinous ligaments to TXIIAccessory nerve (XI)Levator scapulaeAxillary nervePosterior circumflex humeral arteryLine of attachment of trapeziusLine of attachment of deltoid Fig. 7.37 Right posterior scapular region.	Anatomy_Gray. DeltoidHead of humerusNeedleSubacromial-subdeltoid bursa Fig. 7.35 Lateral view of trapezius and deltoid muscles. AcromionSpine of thescapulaTrapeziusDeltoidDeltoid tuberosity of humerusClavicle Fig. 7.36 Attachments and neurovascular supply of the trapezius and deltoid muscles. AcromionSpine of scapulaTrapeziusDeltoidDeltoid tuberosity of humerusRhomboid minorRhomboid majorClavicleSuperior nuchal lineExternal occipitalprotuberanceMastoid processLigamentum nuchaeSpinous processes and interspinous ligaments to TXIIAccessory nerve (XI)Levator scapulaeAxillary nervePosterior circumflex humeral arteryLine of attachment of trapeziusLine of attachment of deltoid Fig. 7.37 Right posterior scapular region.