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UPPER LIMB. A point just lateral and distal to the pisiform bone
(Fig. 11.s).
o The second point medial to the hook of the hamate
bone.
. The third point on the distal border of the thenar
eminence in line with the cleftbetween the index and
middle fingers (see Fig.9.32).
The convexity of the arch is directed towards the
fingers, and its most distal point is situated at the level
of the distal border of the fully extended thumb.
Deep PolmorAtch
Deep palmar arch is formed as the direct continuation
of the radial artery. It has a slight convexity towards the
fingers. It is marked by a slightly convex line,^4 cm long,
just distal to the hook of the hamate bone (Fig. 11.3).
The deep palmar arch lies 1,.2 cm proximal to the
superficial palmar arch across the metacarpals,
immediately distal to their bases. The deep branch of
ulnar nerve lies in its concavity (see Fi9.9.22).illory Nerve with ils Divisions
Axillary nerve is marked as a horizontal line on the
deltoid muscle,^2 cm above the midpoint between the
tip of the acromion process and the insertion of the
deltoid (Fig. 11.4).
Intramuscular injections in the deltoid are given
below the middle part of the muscle to avoid injury to
the axillary nerve and its accompanying vessels.Musculoculoneous Nerve
Musculocutaneous nerve is marked by joining the
following two points.. A point lateral to the axillary artery 3 cm above its
termination (Fig. 11.1).
. A point lateral to the tendon of the biceps brachii
muscle^2 cm above the bend of the elbow. Here it
pierces the deep fascia and continues as the lateral
cutaneous nerve of the forearm (seeFig. A1.1).
Medion Nerve
fm ffue Arn:
Mark the brachial artery. The nerve is then marked
lateral to the artery in the upper half, and medial to the
artery in the lower half of the arm. The nerve crosses
the artery anteriorly in the middle of the arm (Fig.^11 .2).dm ffue Foreevrm
Median nerve is marked by joining the following two
points.. A point medial to the brachial artery at the bend
of the elbow (Fig. 11.Q).
. A point in front of the wrist, over the tendon of the
palmaris longus or 1cm medial to the tendon of
the flexor carpi radialis (Fig. 11.3).
fra ffte F$smd
Median nerve enters the palm by passing deep to flexor
retinaculum, immediately below which it divides
into lateral and medial branches. Lateral branch
supplies the three muscles of thenar eminence and gives
two branches to the thumb, and one to lateral side of
index finger. Medial branch gives branches for the
adjacent sides of index, middle and ring fingers. The
lateral three and a half nail beds are also supplied
(Figs 11.5, 11.6 and A1.4).RodiolNerve
fm ffue Anm
Radial nerve is marked by joining the following points.. The first point is at the lateral wall of the axilla at
its lower limit (Figs 11.1 and 11.4).
. The second point is at the junction of the uPper one-
third and lower two-thirds of a line joining the lateral
epicondyle with *re insertion of the deltoid (Fig.^11 .a).
. The third point is on the front of the elbow just below
the level of the lateral epicondyle^1 cm lateral to the
tendon of the biceps brachii (Fig. 11.3).
The first and second points are joined across the back
of the arm to mark the oblique course of the radial nerve
in the radial (spiral) groove (posterior compartment).
The second and third points are joined on the front of
the arm to mark the vertical course of the nerve in the
anterior compartment (see Fig. ,{1.3).
dr: ffte Fore
Superficial branch of radial nerve is marked by joining
e following three points.
A point 1 cm lateral to the biceps tendon just below
the level of the lateral epicondyle (Fig. 11.3).. The second point at the junction of the upper
two-thirds and lower one-third of the lateral border
of the forearm just lateral to the radial artery (Fig. 11.3).
. The third point at the anatomical snuff box (Fig. 11'4).
The nerve is vertical in its course between points one
and two. At the second point it inclines backwards to
reach the snuff box.
The nerve is closely related to the lateral side of the
radial artery only in the middle one-third of the forearm.
Posterior lnlerosseous Nerve/
Deep Bronch of Rodiol Nerve
It is marked by joining the following three points.. A point 1 cm lateral to the biceps brachii tendon just
below the level of the lateral epicondyle (Fig. 11.3).
. The second point at the junction of the uPPer one-
third and lower two-thirds of a line joining the