Anatomy, Shoulder and Upper Limb, Arm Structure and Function Stephen D. Forro; Akul Munjal; Jason B. Lowe. Author Information Last Update: August 10, 2020. Go to: Introduction The upper extremity or arm is a functional unit of the upper body. It consists of three sections, the upper arm, forearm, and hand. It extends from the shoulder joint to the fingers and contains 30 bones. It also consists of many nerves, blood vessels (arteries and veins), and muscles. The nerves of the arm are supplied by one of the two major nerve plexus of the human body, the brachial plexus. Go to: Structure and Function The upper extremity begins at the shoulder joint. This joint is commonly referred to as a ball-and-socket joint, although it is more correctly described as a ball-and-saucer joint. In contrast to the hip, the other ball-and-socket joint of the body, the socket is much shallower. This allows for less restriction of movement at the joint but compromises stability in the process. The elbow joint is referred to by many as a hinge joint. This is partially true but does not explain the ability to pronate and supinate the forearm at the elbow joint. The articulation of the radial head and the radial notch on the ulna allows for this motion. This creates what is called a "pivot" joint, allowing the movement of one bone on another. The wrist joint can be classified as an ellipsoidal or condyloid joint. There are also joints of the carpal bones, which are referred to as intercarpal joints. Even though they are synovial joints, they do not allow much movement. The interphalangeal joints are basic hinge joints.[1][2][3] Go to: Embryology During the third week of development, the trilaminar embryonic disc is formed. Three layers, the endoderm, mesoderm, and ectoderm, are differentiated. The notochord is formed from mesoderm, and the overlying ectoderm becomes the neural plate. During the fourth week, the upper and lower limb buds begin to form. Muscle, bone, blood vessels, and lymphatics are all formed from the mesoderm, while the peripheral nerves are differentiated neural crest cells. Thirty bones in total make up the structure of the upper extremity. They act as a framework for the muscle, blood vessels, nerves and lymphatics to work upon. There is one bone in the upper arm region, the humerus. The forearm contains two bones, the radius and the ulna. When picturing the upper extremity in a standard anatomical position with the palm of the hand facing forward, the radius is located laterally and the ulna medially. However, because the forearm allows rotation around a central axis, the terms radial and ulnar provide a better description when describing direction or location in the forearm, wrist, and hand. The wrist and hand contain 27 bones. There are eight carpal bones, organized into a proximal and distal row. The proximal bones, from radial (thumb side) to ulnar are the scaphoid (navicular), lunate, triquetrum, and pisiform. From radial to ulnar, the distal row consists of the trapezium, trapezoid, capitate, and hamate. There are five metacarpal bones, each associated with a group of phalanges. There are also 14 phalanx bones. Fingers two to five have a proximal, intermediate, and distal phalanx, while the thumb has only a proximal and distal phalanx. Although many bony injuries can result, the most clinically significant are injuries to the humerus and scaphoid bones. Injuries at the neck of the humerus can result in axillary nerve injury. Midshaft fractures will damage the radial nerve, and supracondylar fractures can damage the median nerve (a common mnemonic is "ARM"). Another common clinical pathology is an injury to the scaphoid. Not only is it the most commonly injured carpal bone, but it also is a common site of avascular necrosis due to its retrograde blood supply. This commonly occurs in fall on an outstretched hand (FOOSH) injuries. Go to: Blood Supply and Lymphatics The arterial supply of the upper extremity starts with the subclavian artery. The subclavian has a complicated course through the axilla, changing names twice before it gets to the upper arm. As it passes the one rib, it becomes the axillary artery. In the axilla, it passes deep to the pectoralis minor muscle toward the humerus. It gives off the anterior and posterior circumflex humeral arteries, before coursing posteriorly around the humeral head, giving rise to its largest branch, the subscapular artery. As it passes the teres minor, it becomes the brachial artery. At this point, it gives off the profundal brachii, which supplies the deep structures of the arm. It then travels along the humerus in the radial groove, along with the radial nerve. As it passes into the elbow, near the median nerve, it courses deep to the brachialis and splits into 2 branches, the radial (lateral branch) and ulnar (medial branch). The radial artery courses down the arm and supplies the deep palmar arch, while the ulnar artery supplies the superficial palmar a