ANATOMY: The Shoulder Girdle Shoulder Spaces Axilla the Arm

8/8/2019 ANATOMY: The Shoulder Girdle Shoulder Spaces Axilla the Arm

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The Upper Limb:The Upper Limb:

Pectoral (Shoulder) GirdlePectoral (Shoulder) Girdle


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Upper Limb DivisionsUpper Limb Divisions

1. Pectoral (Shouldar) Girdle

incomplete bony ring

formed by Scapula & Clavicle

2. Arm

between shoulder & elbow

contain the Humerus

3. Forearm

between elbow & wrist

contain Ulna & Radius

4. Handcontain carpals, metacarpals

& phalanges


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Bones of the PectoralBones of the Pectoral

GirdleGirdle


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Importance of the clavicle:Importance of the clavicle:

Connects upper limb to axial skeleton (strut)

Transmits shocks from upper limb to axialskeleton

Protects neurovascular bundle that supply theupper limb


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Clinical:Clinical: Fractures of ClavicleFractures of Clavicle

Common

indirect impact to upper limb

Between middle & lateral thirds

Medial part / lateral

-Shoulder drop

-Medial rotation of humerus


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Scapula (shoulder blade)Scapula (shoulder blade)

Triangular flat boneTriangular flat bone

3 borders3 borders

3 angles3 angles

2 surfaces:2 surfaces:

Anterior (Anterior (costalcostal) surface) surface

22ndnd 77thth ribsribs

Posterior (Posterior (spinousspinous) surface) surface


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Left Scapula (Posterior Aspect)Left Scapula (Posterior Aspect)

1.Coracoid Process

3. Superior border

4. Supraspinous Fossa

6. Scapular Spine

7.Medial border 8.Infraspinous Fossa

9.Inferior Angle

10.Lateral border

11.Glenoid Cavity Margin 12.Acromion Process


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Humerus (brachial bone)Humerus (brachial bone)

The arm bone

Articulates with:

Scapula (shoulder joint)

Radius & Ulna (elbow joint)


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Joints of Pectoral GirdleJoints of Pectoral Girdle

3 Joints:

Sterno-clavicular joint

Gleno-humeral joint

(Shouldar joint)

Acromio-clavicular joint


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SternoSterno--ClavicularJointClavicularJoint

Type: Synovial (saddle shaped, or double plane)

Surfaces: sternal end of clavicle

Manubrium & 1st costal cartilage

Movements:

ant., post., sup. & inf.

Characteristics:

Articular disc

Shock absorberShock absorber


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GlenoHumeral (Shoulder) JointGlenoHumeral (Shoulder) Joint

Type: Synovial (ball & socket)

Articulations:

Head of humerus

Glenoid cavity of scapule


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Ligaments ofshoulder joint:

1. Fibrous Capsule

2. Gleno-humerallig.(3)

3. Coraco-humerallig.

4. Transversehumeral lig.


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Movements of shoulder joint:

CircumductionIncludes??

Characteristics:

The fibrous capsule is Weak inferiorly

due to:

1. penetrated inferiorly by tendon of longhead of triceps

2. Joint is surrounded (stabilized) by groupof muscles called: Rotator Cuff muscles

*except inferiorly


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Acromio-clavicular joint

Synovial plane

Articulation betweenacromion process andlateral end of clavicle

Reinforced by sup andinf acromio-clavicularligaments


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Muscles of The Shoulder Region:Muscles of The Shoulder Region:

ThoracoThoraco--appendicular Musclesappendicular Muscles

& Scapulo& Scapulo--humeral Muscleshumeral Muscles


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AnteriorAnterior ThoracoappendThoracoappend MusclesMuscles

Pectoralis Major

Pectoralis Minor

Serratus Anterior

Subclavius


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Pectoralis MajorPectoralis Major

Fan shape muscle

Origin:

Clavicular & sternocostal heads

Insertion:

Humerus

Innervation:

Medial & Lateral pectoral nerves

Action:

Adduction of humerus


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Pectoralis MinorPectoralis Minor

triangular shaped muscle

Origin:

3rd, 4th & 5th ribs

Insertion:

Coracoid process

Innervation:

Medial pectoral nerves

Action:

Depress scapula, elevate ribs


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Pectoralis Major & MinorPectoralis Major & Minor


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Serratus Anterior MuscleSerratus Anterior Muscle

Serrated border

Origin:

Outer surfaces of upper 8 ribs

Insertion:

Medial border of scapula

Innervation:

Long thoracic n.

Action:Pulls scapula forward along the ribs

Keeps the scapula in contact to

thoracic cage


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Clinical: Winged ScapulaClinical: Winged Scapula

Medial border of scapula hangsaway from thoracic wall

1. Damage to serratus anterior m.

2. Injury to long thoracic n.

During fights


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Winged Scapula


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SubclaviusSubclaviusSmall muscle that extends:

Middle 1/3 of clavicle

1st costal cartilage

Innervation:Nerve to subclavius

Action:

Depresses the clavicle


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PosteriorPosterior ThoracoappendicularThoracoappendicular MusclesMuscles

Only names to be able to distinguish them in the lab

Trapezius

Latissimus dorsi m.

Levator scapulae

Rhomboid major

Rhomboid minor


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ScapuloScapulo--humeral Muscleshumeral MusclesRead the table in your book for innervation, origin, insertion &Read the table in your book for innervation, origin, insertion &

main actionmain action

Deltoid

Teres Major

Teres Minor

Supraspinatus

Infraspinatus

subscapularis


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Rotator Cuff MusclesRotator Cuff Muscles

4 muscles that inserted around shoulder joint & form amusculotendinous cuff

Cover the joint from 3 directions:

Superior: supraspinatus

Anterior: subscapularis

Posterior: infraspinatus & teres minor

Fxn.

Stabilize shoulder joint


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Shoulder Intermuscular SpacesShoulder Intermuscular Spaces

&&

The AxillaThe Axilla


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Quadrangular SpaceQuadrangular Space

Lateral to triangular space

Boundaries:

Sup.:

Inf.:

Med.:

Lat.: surgical neck of humerus

Contents:

Axillary n. (which muscles??)Post. circumflex humeral vessels


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The AxillaThe Axilla

A pyramidal space between upper part of the arm & the side ofchest wall, just inferior to shoulder joint

Importance:

1. Passageway for vessels &

nerves between the neck &upper limb

2. Contain a group of important

lymph nodes (axillary L.N.)

Its made up of:

Apex, base & 4 walls


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Anterior Wall:

Pect. Major

Pect. minor

Subclavius

Clavipectoral Fascia:

Deep fascial layer that extends

from clavicle & covers

pect. Minor & subclavius


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Posterior Wall:

Subscapularis

Teres major

Latissimus dorsi


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Medial Wall:

1st 4th ribs

& intercostal musclesinbetween

Overlying serratus ant. m.

Lateral Wall:

Intertubercular groove

of the humerus

Containing???


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Contents of The AxillaContents of The Axilla

Axillary artery

Axillary vein

Axillary lymph nodes

Brachial plexus


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Axillary ArteryAxillary Artery

Starts:

At outer border of 1st rib

As a continuation of subclavian a.

Ends:

At lower border of teres major m.

To become brachial a.

Divides by pect. Minorinto 3 parts


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Axillary ArteryAxillary Artery


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1st part:

Outer border of 1st rib

Medial border of pect. Minor

One branch:

Sup. (highest) thoracic a.

2nd part:

Post. to pec. Minor

2 branches:Thoracoacromial a.

Lateral thoracic a.

3rd part:

Lat. border of pec. minor

lower border of teres major

3 branch:

Subscapular a.(largest branch of axillary)

Ant. circumflex humeral a.

(in front of surgical neck)

Post. circumflex humeral a.

(behind the surgical neck)


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Scapular AnastomosesScapular Anastomoses

An arterial anastomoses

between branches of

Subclavian a. & 3rd part of

axillary a.

Branches of subclavian:

Suprascapular a.

Superficial cervical a.

Branches of axillary:

Subscapular a.

Circumflex scapular a.


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Clinical Importance ofClinical Importance of

Scapular AnastomosesScapular Anastomoses

If an occlusion is happened in axillary a. before the subscapular

branch (such as thrombus)

bld. Will flow back through subscapular a. from subclavian

branches to brachial a. as an alternative way.

Reversed bld. Flow in subscapular a.


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Axillary VeinAxillary Vein

Medial to axillary a.

Starts:

At lower border of teres major

By union of:

brachial veins + basilic vein

Ends:

Lat.B

order of 1

st

ribTo become subclavian v.


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Axillary Lymph NodesAxillary Lymph Nodes

5 groups:

Pectoral (ant.)Lat. Border of pec. Minor

Subscapular (post.)In front of subscap.

Humeral (lateral)Medial to axillary v.

CentralEmbedded in fat

Apical


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Apical L.N.Apical L.N.

At the apex of the axilla

Medial to axillary v.

Receive lymph from all other

Groups via central group

Efferent vessels form the:

Subclavian lymph trunk


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Clinical: Enlargement of Axillary L.N.Clinical: Enlargement of Axillary L.N.

Lymphangitis:

Inflammation of lymph nodes & vessels

Enlarged & tender L.N.

Due to:

1. Infections in the upper limb

2. Metastases (spread) of breast cancer


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Brachial PlexusBrachial Plexus

Composed of:

Roots

(in post. triangle of theneck)

Trunks

(above the clavicle)

Divisions

(post. to the clavicle)

Cords (within the axilla)


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Roots

Dorsal scapular nerve (C5)

(supplies the rhomboids and

levator scapulae

Long thoracic nerve (C5, 6, and 7)

Upper trunk

Nerve to subclavius (C5 and 6)

Suprascapular nerve (supplies thesupraspinatus and infraspinatus

muscles)

Lateral cord

Lateral pectoral nerveMusculocutaneous nerve

Lateral root of median nerve

Medial cord

Medial pectoral nerve

Medial cutaneous nerve of

arm and medial cutaneousnerve of forearm

Ulnar nerve

Medial root of median nerve

Posterior cord

Upper and lower subscapularnerves

Thoracodorsal nerve

Axillary nerve

Radial nerve


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The ArmThe Arm


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Bone of Arm:Bone of Arm: HumerusHumerus

Long bone that articulates:

Sup.:

To scapula at shoulderjoint

Inf.:

To radius & ulna at elbowjoint


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Upper partUpper part

1. Head (1/3 of sphere)

2. Anatomical Neck

3. Lesser Tubercle

4. Intertubercular Groove

5. Greater Tubercle

6. Surgical Neck

7. Deltoid Tuberosity:

- rough elevation way on lat. Aspect of humerus

- site for deltoid m. attachment


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1. Radial Fossa

2. Lateral Epicondyle

3. Capitulum

4. Trochlea

5. Medial Epicondyle

6. Coronoid Fossa

7. Olecranon Fossa

Right Humerus, Lower partRight Humerus, Lower part


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Humerus FracturesHumerus Fractures

1. Fracture of the surgical neck:1. Fracture of the surgical neck:

Common in elderly (osteoporosis)

due to falls down

injury to circumflex arteries

&/or axillary n.


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2. Transverse fracture of2. Transverse fracture of

humerus shaft:humerus shaft:

direct blow to the arm

injury to radial n.

displacement depends onrelation to deltoid insertion

below deltoid tuberosity:

upperJ laterally (deltoid)

lowerJ superiorly (biceps)


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3. Supracondylar fracture:3. Supracondylar fracture:

fractures of the distal part of humerus

injury to median n.

4. Fracture of medial epicondyle:4. Fracture of medial epicondyle:

pulls the epicondyle inferiorly

weakness in fingers/hand flexion

injury to ulnar n.


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Fascial Covering of The ArmFascial Covering of The Arm

Skin

Superficial fascia

(subcutaneous fat)

Deep fascia:

(Brachial fascia)

From brachial fascia:

Med. & Lat. intermuscular septa

shaft of humerus

Divide the arm into:

Ant. & Post. compartments


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Muscles of The ArmMuscles of The Arm

Anterior:Biceps Brachii

Brachialis m.

Coracobrachialis

Posterior:

Triceps m.:

LongLat.

Med.


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Biceps Brachii MuscleBiceps Brachii Muscle

Origin (2 heads)Short: coracoid process

Long: supraglenoid tubercle of scapula

Insertion

Radial tuberosityBicipital aponeurosis (to deep fascia)

Innervation

Musculocutaneous n.

Action

Flexion of forearm,

Supination of forearm


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Brachialis MuscleBrachialis Muscle

Beneath biceps brachii m.

Origin

Ant. lower of humerus

InsertionCoronoid process & tuberosity of ulna

Innervation

Musculocutaneous n.

Action

Flexion of forearm (main)


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Coracobrachialis MuscleCoracobrachialis Muscle

OriginCoracoid process of scapula

Insertion

Medial aspect of humerus shaft

Innervation

Musculocutaneous n.

Action

Weak flexor & adductor of the arm


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Triceps MuscleTriceps Muscle

Origin (3 heads)Long: infraglenoid tubercle of scapula

Lat.: sup. of post. aspect of humerus shaft

Med.: inf. of post. aspect of humerus shaft

Insertion

Olecranon process of ulna

Innervation

Radial n.

Action

Extension of forearm


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Nerves of the ArmNerves of the Arm

4 main nerves:

Musculocutaneous n.

Median n.

Ulnar n.

Radial n.


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Musculocutaneous NerveMusculocutaneous Nerve

Pass throughcoracobrachialis m.

Goes inferolaterally

between biceps brachii

& brachialis m.

Innervates all 3 muscles

of ant. arm

Continue distally as:

Lateral cutaneous n. of

forearm


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Median NerveMedian Nerve

Formed by (whichcords?)

Runs in the bicipital

groove

Upper : lat. to

brachial a.

Lower : med. to

brachial a.

Enters cubital fossa

at elbow


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Bicipital GrooveBicipital Groove


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Ulnar NerveUlnar Nerve

From medial cord of

B.P.(C8 & T1)

Runs in bicipital

groove (most

medial)

Medial to brachial a.

Pass post. to medial

humeral

epicondyle:

Funny Elbow


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Radial NerveRadial Nerve

Pass in post. compartment of

the arm

Winds around the back of the

humerus, in spiral groove

At elbow: Pass ant. to lat.Epicondyle

Branches in the arm:

Motor: to triceps muscle

Sensory:

Lower lat. cutaneous n. of the

arm

Post. cutaneous n. of the arm


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Brachial ArteryBrachial Artery

Starts:At lower border of teres major m.

As a continuation of axillary a.

EndsIn cubital fossa, opposite to radialneck

By dividing into:

Radial & Ulnar a.


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Pass in bicipital groove

Upper of arm:

Between median & ulnar n.

At middle of arm:

Crossed by madian n. from lat. to med. Side

At elbow:

Enters cubital fossa,

Medial to biceps tendon


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Veins of The ArmVeins of The Arm

Superficial Veins:Cephalic v.

Basilic v.

Deep Veins:Brachial v.

(vena comitans: L, accompanying

vein)

pair of veins on the sides ofbrachial a.


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Cephalic VeinCephalic Vein

From lat. Side of venous network on the back of the hand

Ascends in the anterolateral aspect of forearm

Lat. to biceps m. in the arm

At delto-pectoral triangle:

drains to axillary v.


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Basilic VeinBasilic Vein

From medial side of venous network on the back of the hand

Ascends in posteromedial aspect of forearm

Medial side of biceps m. in the arm

At middle of arm:

Pierces deep fascia & join brachial vein.

To form: axillary vein

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ANATOMY: The Shoulder Girdle Shoulder Spaces Axilla the Arm