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VETERINARY TOPOGRAPHIC ANATOMY

Professor G N Purohit

Chapter 2: Forelimb (Thoracic Limb)

Anatomy
This chapter describes the topographic and regional anatomy of the thoracic limb in domestic
animals, with emphasis on bones, joints, muscles, nerves, vessels, and surface landmarks
relevant to clinical examination, surgery, and regional anesthesia.

## I. General Overview

The thoracic limb is attached to the trunk by synsarcosis — a muscular sling rather than a
skeletal articulation (no true clavicle in domestic mammals, except for a vestigial clavicle in
some species like the dog and cat, and a complete one in fowl).

Functions include weight bearing, locomotion, and manipulation (in some species).

Anatomical divisions of the thoracic limb:

• Shoulder region
• Brachium (upper arm)
• Antebrachium (forearm)
• Manus (forepaw/hand): Carpus, metacarpus, digits

## II. Bones of the Thoracic Limb

1. Scapula

The scapula is a flat, triangular bone situated on the antero-lateral part of the thorax, directed
obliquely downward and forward. It has two surfaces (lateral/dorsum, costal/venter), three
borders (anterior, posterior, vertebral), and three angles (anterior/cervical, posterior/dorsal,
inferior/glenoid).

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The lateral surface is traversed by the scapular spine, which divides it into the anterior smaller
supraspinous fossa and the posterior larger infraspinous fossa. The free edge of the spine is in
great part subcutaneous. The costal surface presents a shallow subscapular fossa. The vertebral
border carries the scapular cartilage in life. The inferior or glenoid angle carries the glenoid
cavity for articulation with the humerus, and anterior to it is the tuber scapulae.

Species Notable Features of Scapula

Spine terminates in a prominent acromion process; small scapular cartilage. Glenoid
Dog/Cat
cavity extends to the inferior face of the tuber scapulae. Coracoid process is absent.
Acromion process is absent. Subscapular fossa is deeper. Large scapular cartilage.
Horse
Tuber scapulae is larger and placed further away from the glenoid cavity.
Acromion process for the deltoid is present. Thick scapular cartilage. Tuber scapulae
Ox
presents the coracoid process on its medial aspect.
Very wide scapula. Spine is triangular and very wide in its middle, curving backward
Pig and bearing a large scapular tuberosity. Scapular cartilage is less extensive. Glenoid
cavity is rounded, not notched.
Narrow, sabre-shaped, parallel to vertebral column. Anterior end has an acromion
Fowl
process that meets the clavicle and coracoid to form the foramen triosseum.

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2. Humerus

The humerus is a long bone of the brachium, placed obliquely downward and backward,
articulating with the scapula above and the radius/ulna below. It has a shaft and two extremities.
The shaft has a twisted appearance and features the musculospiral groove for the brachialis
muscle and the deltoid tuberosity for the deltoid muscle. The proximal extremity consists of a
head, neck, greater and lesser tuberosities, and the intertuberal (bicipital) groove. The distal
extremity presents condyles and fossae (coronoid and olecranon).

Species Unique Humerus Traits

Intertubercular groove is deep and divided by an intermediate ridge. Deltoid
Horse
tuberosity is more prominent. Coronoid and olecranon fossae are shallower.
Large greater tubercle with cranial and caudal parts. The medial condyle of the distal
Ox
extremity is larger.
Pronounced deltoid tuberosity. Supratrochlear foramen (unique) connects the
Dog
coronoid and olecranon fossae, allowing no soft structures to pass.
Cat Has a supracondylar foramen (notch for nerve/vessel passage).
"Italic 'f'" shape. Teres tubercle is absent. Olecranon fossa is very deep, sometimes
Pig
perforated.
Fowl Proximal extremity has an opening leading into an air cavity in its shaft.

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3. Radius and Ulna

The radius is the primary weight-bearing bone of the forearm. The ulna's development and fusion
with the radius vary significantly among species. They enclose an interosseous space.

Species Radius-Ulna Relation

Separate, relatively long, articulate at extremities, enclosing a narrow interosseous
Dog/Cat
space, allowing pronation/supination.
Ulna is reduced and almost completely fused to the radius in its proximal third; no
Horse
rotation. Only forms the proximal radio-ulnar arch.
Ulna is rigidly fused to and longer than the radius, situated postero-laterally. Forms
Ox
proximal and distal radio-ulnar arches.
Separate, massive, and much longer/heavier than the radius. Proximal extremity of
Pig
ulna is large and bent medially.
Radius is slender, ulna is thicker and longer. They articulate at their ends and enclose a
Fowl
wide interosseous space.

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4. Carpal Bones

The carpus (knee in horse) consists of a number of small bones called carpals, typically arranged
in two rows:

• Proximal row: Radial carpal (scaphoid), Intermediate carpal (lunar), Ulnar carpal
(cuneiform), and Accessory carpal (pisiform).
• Distal row: First carpal (trapezium), Second carpal (trapezoid), Third carpal (os
magnum), and Fourth carpal (unciform).

Number of Carpal
Species Key Modifications
Bones
Dog 7 Radial and intermediate carpals are fused.

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All separate. The first carpal (Trapezium) is inconstant. Ulnar

Horse 7 or 8
carpal is the smallest in the proximal row.
First carpal often missing; second and third carpals are fused (Os
Ox 6
magnum).
Pig 8 Four in the proximal and four in the distal row.
2 free bones (radial
Fowl Lower row fuses with metacarpals to form the carpometacarpus.
and ulnar)

5. Metacarpals

The metacarpal bones form the skeleton of the metacarpus, connecting the carpus to the digits.
Their number and development vary greatly among species.

Species Arrangement
MC III is the main weight-bearing bone; MC II and MC IV are rudimentary splint
Horse
bones, attached to MC III.
Fused MC III and IV (forming a single large bone); MC V is a vestigial lateral small
Ox
metacarpal.
5 Metacarpals (MC I–V). MC I is the shortest (dewclaw). MC III and IV are the
Dog
longest.
4 main metacarpals (MC II–V); MC I is rudimentary. Third and fourth are large and
Pig
carry chief digits.
Fowl Three bony elements fuse with lower carpal row to form a single carpometacarpus.

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6. Digits and Phalanges

Digits form the terminal parts of the limbs. Each fully developed digit typically consists of three
bones arranged serially called phalanges (Proximal Phalanx/P1, Middle Phalanx/P2, Distal
Phalanx/P3 or pedal bone). Sesamoid bones are small bones associated with joints, providing
leverage and reducing friction.

• Proximal Sesamoids: A pair for each main digit, situated behind the distal extremity of
the metacarpal/metatarsal bones. They increase leverage for digital flexors.
o Ox: A pair for each of the two chief digits. They articulate with the large
metacarpal and the first phalanx, and with each other.
o Horse: One pair for the single digit (III). Much larger and distinctly pyramidal,
articulating only with the large metacarpal.
o Pig: A pair for each digit, narrow and ridged behind.
o Dog: Nine proximal sesamoids (one for digit I, two for each of digits II-V).
o Fowl: Sesamoids are absent.
• Phalanges:
o First Phalanx (Os Suffraginis / P1): A long bone placed obliquely downward
and forward. Its proximal articular surface is divided by a sagittal groove.
▪ Ox: Four-sided shaft. Proximal extremity articulates with the large
metacarpal and proximal sesamoids.
▪ Horse: Volar face has a "V" shaped area for the distal sesamoidean
ligament.
▪ Dog: First phalanges of chief digits have four-sided shafts.
▪ Pig: Phalanges of chief digits similar to ox.
▪ Fowl: First and second digits have two phalanges each.

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o Second Phalanx (Os Coronae / P2): A short bone, often included within the hoof
in ungulates.
▪ Ox: Distal half included in the hoof. Proximal extremity has two glenoid
cavities.
▪ Horse: Short bone, wider than long.
▪ Dog: About two-thirds the length of the first phalanges.
▪ Pig: Phalanges of chief digits similar to ox.
▪ Fowl: First and second digits have two phalanges each.
o Third Phalanx (Os Pedis / P3 / Pedal Bone): The distalmost phalanx, entirely
enclosed in the hoof or claw.
▪ Ox: Short bone, entirely enclosed in the hoof. Superior face articulates
with P2 and the distal sesamoid. Has a distinct extensor process.
▪ Horse: Has three surfaces, three borders, and two angles. Superior
articular surface adapted to the distal sesamoid. Has a prominent extensor
process (pyramidal process).
▪ Dog: Corresponds to the shape of the claws. Proximal face (base) responds
to the second phalanx, encircled by a collar of bone.
▪ Pig: Phalanges of chief digits similar to ox.
▪ Fowl: Third digit has only one phalanx.

• Distal Sesamoid (Os Navicularis / Navicular Bone): A small, shuttle-shaped bone

placed behind the distal interphalangeal articulation. It provides a gliding surface for the
deep digital flexor tendon and is crucial in hoof mechanics.
o Ox: Placed behind the second interphalangeal articulation. Dorsal face articulates
with P2.
o Horse: Shuttle-shaped and longer with narrow extremities.
o Pig: Small.
o Dog: Distal sesamoids are cartilaginous.

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Appendages of the Thoracic Limb

• Hair: Extremely variable in color and size. Two kinds: ordinary (coat color) and special
(tactile hairs like vibrissae, eyelashes, long tail hairs).
• Hoof (Ungulates): A horny box enclosing sensitive structures.
o Horse Hoof: Consists of three parts: wall (visible part, covers front and sides,
reflected as bars posteriorly), sole (crescentic, covers ground surface), and frog
(wedge-shaped mass between bars). The wall has an external glossy layer
(stratum tectorium) and a deep layer of horny laminae. The corium (dermis)
provides nutrition. The plantar cushion is a wedge-shaped mass over the frog.
Lateral cartilages are attached to the angles of the third phalanx.
o Ox Hoof: Has three parts: periople, wall, and sole. The frog, lateral cartilages, and
plantar cushion are absent. The cloven foot aids in diffusing concussion. The
accessory digits (dew claws) have short, conical horny coverings.
• Horns: Enclose the frontal flints (horn cores). Vary greatly in size, form, and curvature.
The root is continuous with the epidermis, similar to the periople.
• Cutaneous Pouches (Sheep): Infraorbital (lacrimal) pouch and interdigital pouch.
• Ergot (Horse): A small piece of horn in the tuft of hair at the flexor face of the fetlock; a
vestige of the second and fourth digits.
• Chestnut (Horse): A mass of horn on the medial face of the forearm (above carpus) and
distal part of the medial face of the tarsus; a vestige of the first digit.

## III. Joints of the Thoracic Limb (Forelimb)

The thoracic limb includes several joints that play crucial roles in weight-bearing, movement,
and shock absorption. These joints are primarily synovial in nature and vary in their degree of
mobility depending on species and functional demands.

1. Shoulder Joint (Scapulohumeral Joint)

• Type: Simple synovial ball-and-socket joint (spheroidal).

• Articulating Surfaces: Glenoid cavity of scapula and head of humerus.
• Ligaments:
o Capsular ligament: Loose, protected by surrounding muscles.
o Medial and Lateral glenohumeral ligaments: Well developed in horse and dog;
poorly defined in ox.
• Movements: Extension and flexion are best marked. Limited adduction, abduction, and
circumduction.
• Species Differences:
o In horses and cattle, the joint is stabilized by muscle tone and tendon tension
rather than strong collateral ligaments, reducing luxation risk.
o Dog shows greater mobility.
• Clinical Note: Shoulder joint luxation is rare in large animals due to strong muscular
support. Supraspinatus or infraspinatus tendinitis may affect working horses.

2. Elbow Joint (Cubital Joint)

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• Type: Compound hinge joint, consisting of humero-radio-ulnar and radio-ulnar

articulations.
• Articulating Surfaces: Distal humerus (condyles) and proximal radius and ulna
(trochlear notch of ulna, concavities on radius).

• Ligaments:
o Capsular ligament: Forms a pouch over the olecranon fossa.
o Medial and lateral collateral ligaments: Strong bands preventing medial or
lateral deviation.
o Annular ligament: In small animals, wraps around the head of the radius.
• Movements: Primarily flexion and extension.
• Species Differences:
o In ruminants and horses, the radius and ulna are fused, restricting pronation
and supination.
o In dogs and pigs, these bones are separate, allowing limited rotation
(pronation/supination).
o Dog: Capsule strengthened by oblique bands.
• Clinical Note: Elbow dysplasia and ununited anconeal process are common orthopedic
issues in dogs. Fractures of the olecranon or lateral condyle may impair extension.

3. Carpal Joint (Knee Joint in Horse)

• Type: Composite synovial joint with multiple articulations.

• Articulating Rows:
o Antebrachiocarpal joint: Between radius/ulna and proximal carpal bones.
o Middle carpal joint: Between proximal and distal carpal bones.
o Carpometacarpal joint: Between distal carpal bones and metacarpals.
• Ligaments:

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o Common ligaments: Dorsal capsular, volar capsular (forms anterior wall of

carpal sheath), lateral and medial carpal ligaments.
o Special ligaments: Specific interosseous ligaments connect adjacent carpal
bones.
o Check ligaments (Horse): Superior (radial) check ligament and inferior
(subcarpal) check ligament, which reinforce the digital flexor tendons.
• Movements: Most flexion-extension occurs at the antebrachiocarpal and middle
carpal joints. Minimal motion at the carpometacarpal joint.
• Species Differences:
o In horses, 7 or 8 carpal bones are arranged in two rows; carpus is subject to high
impact during locomotion.
o In cattle, carpal bones may be fused (e.g., 2nd and 3rd carpal bones).
• Clinical Note: Carpal hygroma (fluid swelling over the carpus) is common in cattle due
to trauma. Carpal chip fractures seen in racehorses. The carpal sheath contains tendons of
flexor perforans (DDF), deep division of flexor perforatus (SDF), Median nerve, ulnar
artery and vein.

4. Intermetacarpal Articulation

• Ox: A diarthrosis (between proximal facets) and an amphiarthrosis (between shafts)

formed between the large and small metacarpal bones. Slight vertical gliding motion.
• Horse: Each small metacarpal is united through its length to the posterolateral aspect of
the large metacarpal by syndesmosis. Proximal extremities form synovial joints with the
large metacarpal.
• Pig: Chief metacarpal bones articulate at proximal ends by interosseous ligament.
• Dog: Interosseous ligaments connect the various metacarpal bones. Proximal ends of
second to fifth bones form synovial joints.

5. Metacarpophalangeal Joint (Fetlock Joint in Large Animals)

• Type: Hinge joint (ginglymus).

• Articulating Surfaces: Distal end of the metacarpal bone, proximal end of the first
phalanx, and proximal sesamoids.
• Ligaments:
o Capsular ligament: Encloses the joint.
o Collateral ligaments: Abaxial and axial ligaments.
o Sesamoidean ligaments: Proximal (suspensory ligament/interosseous muscle),
distal (straight and oblique), collateral, and intersesamoidean ligaments.
• Movements: Primarily flexion-extension; some hyperextension allowed during weight
bearing in horses.
• Species Differences:
o In horses, fetlock hyperextension acts as an energy-saving mechanism. The
suspensory ligament is highly developed and crucial.
o Dogs have greater joint flexibility. The suspensory ligament is replaced by
interosseous muscles.

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o Ox: Two metacarpophalangeal joints per limb. Suspensory ligament prevents

excessive dorsal and volar flexion.
o Pig: Four metacarpophalangeal joints. No suspensory ligaments.
• Clinical Note: Fetlock lameness, sesamoiditis, or desmitis in sport horses. Annular
ligament constriction in large animals.

6. Interphalangeal Articulations (Pastern and Coffin Joints)

A. Proximal Interphalangeal Joint (Pastern Joint)

• Type: Hinge joint (ginglymus).

• Articulations: Between the first (P1) and second (P2) phalanges. Has a glenoid
fibrocartilage behind.
• Ligaments: Capsular ligament, abaxial and axial collateral ligaments, volar abaxial and
volar axial ligaments.
• Function: Limited movement; contributes to weight-bearing.
• Species Differences:
o Ox: Two joints per limb. Strong proximal/superior interdigital ligament connects
the axial faces of the two first phalanges. Distal/inferior interdigital ligament
(cruciate) prevents excessive abduction.
o Horse: Only one such joint per limb.
o Dog: Has capsular, two collateral, and three interdigital ligaments (between
2nd&3rd, 4th&5th, 3rd&4th digits) which restrict spreading.
o Pig: Resembles the ox in chief digits.
• Clinical Note: Stable joint, but injuries can lead to lameness.

B. Distal Interphalangeal Joint (Coffin Joint)

• Type: Saddle or hinge joint (ginglymus).

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• Articulations: Between the second (P2) and third (P3) phalanges, and includes the distal
sesamoid (navicular bone).
• Ligaments:
o Capsular ligament.
o Dorsal (anterior) elastic ligament: (Absent in horse) Aids in claw retraction in
dogs.
o Collateral ligaments: Abaxial and axial collateral ligaments.
o Volar collateral (collateral sesamoidean) ligaments.
o Superior navicular ligament: Connects volar collateral ligaments to the
navicular bone.
o Distal navicular ligament (phalangeosesamoidean ligament): Extends from the
navicular bone to the flexor surface of P3.
• Movements: Extension and flexion.
• Species Differences:
o Horse: Only one joint per limb. Dorsal elastic ligament is absent. Has three
additional ligaments attaching lateral cartilages to phalanges.
o Dog: Each joint has a capsular and two lateral ligaments. An elastic ligament aids
in retracting the claw.
• Clinical Note: Navicular disease in horses affects this joint complex. Deep digital flexor
tendon and navicular bursa play key roles in hoof mechanics.

## IV. Blood Supply of the Thoracic Limb

The main arterial supply to the thoracic limb arises from the subclavian artery, which becomes
the axillary artery and continues as the brachial and then median artery.

Key Arteries (and Branches):

Region Major Artery Key Branches

External thoracic, Subscapular (with its branches: thoraco-dorsal,
Axilla Axillary a. posterior circumflex humeral, circumflex scapula), Anterior
circumflex humeral.
Deep brachial, (Proximal) Collateral ulnar, (Distal) Collateral
Arm Brachial a.
radial.
Long muscular branches, Common Interosseous (divides into
Forearm Median a.
dorsal interosseous), Radial a., Ulnar a.
Medial and lateral Important for pulse detection (e.g., medial digital artery in
Digit/Hoof
digital arteries horses). These form arterial circles within P3.

Horse-Specific Note: The medial palmar artery is the main artery to the digit. It is commonly
palpated in clinical exams.

Key Veins:

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• Cephalic Vein: Formed by the upward continuation of the medial metacarpal vein. It
passes up subcutaneously upward and forwards in an oblique manner on the medial face
of the forearm, then upward in the arm to about its middle and is connected with the
median vein by an anastomotic branch, the medial cubital vein. It then runs in the groove
between the brachiocephalicus and anterior superficial pectoral, turns inwards and
terminates by joining the external jugular vein. The accessory cephalic vein lies on the
dorsal surface of the carpus and is a tributary of the cephalic, formed by the dorsal
metacarpal vein.
• Digital Veins: Accompany the digital arteries.

## V. Nerve Supply of the Thoracic Limb

The brachial plexus (formed by ventral primary branches of C6–T2 spinal nerves) gives rise to
all motor and sensory nerves of the forelimb. Knowing their function is key to localizing limb
lameness.

Major Nerves of the Forelimb:

Origin (Plexus
Nerve Muscles Innervated Clinical Importance
Fibers)
C8, T1
Deep pectoral, cutaneous Supplies pectoral muscles
External Thoracic (common trunk
muscle and skin of abdominal wall.
with ulnar)
Minimal clinical
Thoraco-dorsal C8, T1 Latissimus dorsi
importance.
Injury can lead to "winged
C7, C8
Long Thoracic Serratus ventralis scapula" or "dropped
(sometimes C6)
shoulder".
Anterior plexus Adduction and limb
Pectoral Nerves Superficial and deep pectorals
(various) protraction.
Injury → "Sweeney"
Suprascapular C6–C7 Supraspinatus, Infraspinatus
(muscle atrophy in horse).
Subscapular C7–C8 Subscapularis Stabilizes shoulder joint.
Nerve to Teres Teres major, posterior Flexion and adduction of
C7–C8
Major subscapularis arm.
Loss of shoulder flexion
Teres major, Deltoideus, and abduction. Supplies
Axillary C8
Teres minor dorsal/anterior cutaneous
nerve of forearm.
Flexor carpi ulnaris,
T1 (from Important for digital nerve
Superficial digital flexor,
Ulnar common trunk blocks. Supplies skin on
Ulnar head of deep digital
with median) posterior forearm.
flexor

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Elbow flexion loss if

damaged. Forms a loop with
Musculocutaneous C7–C8 Biceps brachii, Brachialis
median nerve for brachial
artery.
Pronator teres, Flexor carpi
Important for digital nerve
radialis, Superficial digital
Median C8–T1 blocks. Supplies skin on
flexor, Humeral and radial
front/medial forearm.
heads of deep digital flexor
Extensors of elbow (triceps, Injury → "Dropped
anconeus), carpus (ECR), elbow" (inability to extend
Radial C7–T1
digits (CDE, LDE, Ulnaris elbow, carpus, digits).
lateralis) Largest nerve of plexus.

Ruminant Note: Median and ulnar nerves together supply most digital flexors and cutaneous
innervation of the distal limb.

VI. Lymphatic Drainage and Lymph Nodes of the Forelimb

Lymph nodes are crucial for immune surveillance and are strategically located to drain specific
regions.

Primary Lymph Nodes:

Afferents (Area
Lymph Node Location Efferents
Drained)
On the left, lymph
At the anterior border of the Skin, superficial
flows to the
Superficial supraspinatus, about 10-13 cm muscles of the neck,
thoracic duct; on
cervical above the shoulder joint, under proximal forelimb,
the right, to the
(Prescapular) cover of the omotransversarius and and cranial part of the
right lymphatic
brachiocephalicus muscles. thorax.
duct.
Deep structures of the
shoulder, arm,
On the medial face of the teres Lymph flows to the
forearm, latissimus
Axillary major muscle (medial to the posterior cervical
dorsi, and lymph from
shoulder joint). lymph glands.
the shoulder, elbow,
and carpal joints.
Located behind the biceps brachii
muscle, associated with the
Drains the forelimb Lymph flows to the
brachial vessels and median nerve,
Cubital (Horse) distal to the elbow axillary and
on the medial aspect of the elbow.
joint. prescapular glands.
(Occasionally present in other
species).

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Lymph flows to the

Accessory Primarily drains the
axillary lymph
axillary (Dog, Location is variable. pectoral region and
node or directly to
cat) lateral thorax.
the thoracic duct.

Clinical Relevance:

• Superficial cervical LN is often palpated and biopsied in cases of generalized

lymphadenopathy, as it is readily accessible.
• Axillary LN enlargement may indicate deep limb infection, tumors, or mammary gland
involvement, especially in female animals.

VII. Stay Apparatus of the Forelimb (Horse)

The stay apparatus is essential for equine passive standing without muscular fatigue. It supports
the limb, particularly the fetlock, diminishes concussion, and prevents excessive extension of the
fetlock, pastern, and coffin joints. It includes muscles, tendons, and ligaments. The ability of the
horse to stand while sleeping is largely due to this apparatus.

Components of the Stay Apparatus in the Forelimb:

Joint Structures Involved Function

Prevents shoulder flexion by
Shoulder Biceps brachii tendon with lacertus fibrosus
transmitting tension to ECR.
Tension in triceps brachii (supported by muscles
Elbow Locks the joint in extension.
and ligaments)
Fibrous check ligaments (superior/radial and Prevents carpal overextension
Carpus inferior/subcarpal) of superficial and deep digital and relieves tension on muscle
flexors bellies.
Suspensory ligament (interosseous muscle), Prevents hyperextension of
Fetlock & Proximal sesamoidean ligaments (straight, fetlock, supports distal limb,
Digit oblique, cruciate), Deep digital flexor tendon, locks fetlock joint when
Superficial digital flexor tendon weighted.

Clinical Relevance:

• Failure of the stay apparatus leads to buckling or collapse of the limb, resulting in
inability to bear weight passively.
• Disorders of the suspensory ligament or Deep Digital Flexor Tendon (DDFT) can
significantly compromise the stay function, leading to lameness.
• The reinforcing bands running from the suspensory ligament to extensor tendons combat
the tendency for pastern and coffin joints to flex when the flexor tendon is weighted. The
distal sesamoid (navicular bone) also acts similarly as part of the suspensory apparatus of
the fetlock, providing a smooth gliding surface for the DDFT.

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VIII. Regional Nerve Blocks of the Forelimb (Primarily

Equine)
Used to localize or treat lameness by desensitizing specific regions.

Common Forelimb Blocks in the Horse:

Block
Nerves Targeted Desensitized Area Site
Name
In the neurovascular bundle
Palmar Medial & lateral Caudal 1/3 of hoof (navicular at the level of the proximal
digital palmar digital area), sole, frog, and distal sesamoids, just above the
block nerves phalanx. collateral cartilages of the
hoof.
Palmar digital Entire hoof and pastern (P1, P2, At the abaxial aspect of the
Abaxial
nerves at the level P3, navicular bone, proximal proximal sesamoid bones,
sesamoid
of the proximal sesamoids, and all digital where the palmar digital
block
sesamoid bones. tendons). nerves are more superficial.
5 to 7 cm above the fetlock,
Medial & lateral
in the depression between
Low 4- palmar nerves, and Fetlock joint and all structures
the suspensory ligament and
point medial & lateral below it (including all digital
the deep digital flexor
block palmar metacarpal structures).
tendon, on both medial and
nerves.
lateral aspects.
Same nerves as the
low 4-point block, From the distal metacarpus
High 4- Just below the carpus,
but blocked more downward (including the
point proximal to the origin of the
proximally to the metacarpophalangeal joint and all
block suspensory ligament.
suspensory structures distal to it).
ligament.
Below the medial tuberosity
Medial aspect of the limb distal to
Median of the radius, at the groove
Median nerve in the the elbow, including all flexor
nerve between the caudal border
distal forearm. muscles and associated cutaneous
block of the radius and the flexor
innervation.
carpi radialis muscle.
At the lower one-third of
Lateral aspect of the limb distal to
the forearm, a few inches
Ulnar the elbow, including the flexor
Ulnar nerve in the above the accessory carpal
nerve carpi ulnaris, superficial digital
distal forearm. bone, between the flexor
block flexor, and the ulnar head of the
carpi ulnaris and ulnaris
deep digital flexor.
lateralis muscles.

Veterinary Topographic Anatomy Series Prof G N. Purohit GNP Sir Classes

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At the anterior aspect of the

Radial nerve
Radial Dorsal aspect of the limb distal to elbow, between the
(superficial
nerve the elbow, affecting primarily the brachialis muscle and the
branches) in the
block extensor muscles. extensor carpi radialis
forearm.
muscle.

Canine Note: The brachial plexus block is a common regional anesthesia technique used for
forelimb surgery in dogs, desensitizing the entire limb distal to the shoulder.

Clinical Case Note: A horse with chronic foot lameness localizes to the navicular region after
positive response to a palmar digital nerve block. Radiography reveals navicular bone
sclerosis, confirming the diagnosis.

IX. Muscles of the Thoracic Limb

The musculature of the thoracic limb is divided based on anatomical region and function.

1. Muscles Connecting the Limb to the Trunk (Extrinsic Muscles)

These muscles form the synsarcosis, suspending the thoracic limb from the trunk without a
skeletal joint.

Muscle Origin Insertion Function Species Relevance

Neck & thoracic Spine of Elevates and Two parts in horse:
Trapezius
spine scapula abducts limb cervical & thoracic
Nuchal & Dorsal Prominent in
Rhomboideus Elevates scapula
thoracic ligament scapula ruminants
Main
Cervical Medial
Serratus ventralis suspensory Essential in all species
vertebrae & ribs scapula
muscle
Draws limb
Thoracolumbar Strong in diggers like
Latissimus dorsi Humerus caudally, flexes
fascia dogs
shoulder
Protracts limb,
Brachiocephalicus Head and neck Humerus Wide in horses
flexes neck
Spine of Small in ox, blends
Omotransversarius Transverse atlas Protracts limb
scapula with brachiocephalicus
Pectorals (superficial Deep pectoral helps
Sternum Humerus Adduct limb
and deep) pull trunk cranially

Clinical Note: Serratus ventralis rupture can cause "dropped shoulder" (flying scapula)
in horses.

Veterinary Topographic Anatomy Series Prof G N. Purohit GNP Sir Classes

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2. Muscles of the Shoulder Region (Intrinsic Muscles)

These muscles lie between the scapula and the humerus and stabilize the shoulder joint.

Muscle Function Species Note

Supraspinatus Extends shoulder Important in stay apparatus in horse
Infraspinatus Abducts and rotates humerus Acts as lateral collateral muscle
Subscapularis Adducts and stabilizes humerus Medial stabilizer
Teres major Flexes shoulder Prominent in dogs
Deltoideus Flexes shoulder, abducts limb Dual-headed in dogs and horses

3. Muscles of the Brachium

Muscle Function Comment

Flexes elbow, extends Has lacertus fibrosus in horse that merges
Biceps brachii
shoulder with ECR
Brachialis Flexes elbow Spirals around humerus
3 heads in horse/ox, 4 in dog (has
Triceps brachii Extends elbow
accessory head)
Tensor fasciae
Tenses antebrachial fascia Assists triceps
antebrachii

4. Muscles of the Antebrachium (Forearm)

Divided into extensors (craniolateral) and flexors (caudomedial).

Extensors (Cranial)

Muscle Function Clinical Use

Extensor carpi radialis
Extends carpus Part of stay apparatus
(ECR)
Common digital extensor Multiple tendons in ox,
Extends digits
(CDE) pig
Lateral digital extensor Well-defined in
Extends lateral digits
(LDE) ruminants
Abnormal "flexor" that acts as extensor
Ulnaris lateralis Named incorrectly
in horse

Veterinary Topographic Anatomy Series Prof G N. Purohit GNP Sir Classes

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Flexors (Caudal)

Muscle Function Note

Flexor carpi radialis Flexes carpus Originates from medial humerus
Flexor carpi ulnaris Flexes carpus Has two heads: humeral and ulnar
Superficial digital flexor (SDF) Flexes digits and carpus Supports fetlock joint
Deep digital flexor (DDF) Flexes digits Inserts on distal phalanx

Clinical Tip: DDF and SDF tendons are involved in tenotomy procedures to treat club foot
in foals.

5. Muscles of the Manus

• Primarily tendinous; allow fine control of the digits.

• Sesamoid ligaments and interosseous/suspensory ligaments present in large animals for
fetlock support.

IX. Surface & Topographic Anatomy of the Thoracic

Limb
Important for clinical examination, regional anesthesia, injections, and surgical approach.

Topographic Regions

1. Shoulder – spine of scapula, acromion (dog/cat)

2. Elbow – olecranon (landmark for joint injections)
3. Carpus (Knee) – flexion point of forelimb
4. Metacarpus – dorsal surface for digital extensor tendons
5. Digits – location for digital nerve blocks

Palpable Landmarks in the Forelimb

Structure Location Clinical Use

Identifies
Spine of scapula Lateral scapula
supraspinatus/infraspinatus

Veterinary Topographic Anatomy Series Prof G N. Purohit GNP Sir Classes

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Structure Location Clinical Use

Greater tubercle
Cranial shoulder joint Shoulder injection
(humerus)
Landmark for elbow joint, flexion
Olecranon Caudal to elbow
test
Accessory carpal bone Caudolateral carpus Injection landmark for carpal sheath
Suspensory ligament Palmar fetlock (horse) Evaluation in lameness
Medial/lateral to flexor
Digital arteries Pulse point for laminitis
tendons

X. Clinical Relevance Summary

Condition Related Anatomy Involved
Sweeney (horse) Suprascapular nerve injury → infraspinatus/ supraspinatus atrophy
Dropped elbow Radial nerve paralysis
Club foot (foal) DDFT and SDFT shortening
Laminitis Increased pulse in digital arteries
Venipuncture (dog) Cephalic or accessory cephalic vein
Nerve blocks (horse) Median, ulnar, digital nerve blocks

Summary of Key Structures per Region

Region Key Bones Key Muscles Key Nerves Key Vessels

Supraspinatus,
Shoulder Scapula, Humerus Suprascapular, Axillary Axillary a/v
Deltoid
Musculocutaneous,
Brachium Humerus Biceps, Triceps Brachial a/v
Radial
Antebrachium Radius, Ulna Extensors, Flexors Median, Ulnar Median a/v
Carpals, Digital
Manus Digital tendons Digital nerves
Metacarpals arteries

Veterinary Topographic Anatomy Series Prof G N. Purohit GNP Sir Classes