The Upper Limb:

Pectoral (Shoulder) Girdle

 Upper 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. Hand
contain carpals, metacarpals
& phalanges
Bones of the Pectoral
Girdle
 Clavicle

“S” shaped bone (resilience)

medial 2/3 convex anteriorly , lateral 1/3 concave ant.
Sternal end (rounded)  manubrium & 1st rib
Acromial end (flat)  acromion
 Importance of the clavicle:
Connects upper limb to axial skeleton (strut)

Transmits shocks from upper limb to axial

skeleton

Protects neurovascular bundle that supply the

upper limb
Clinical: Fractures of Clavicle

Common
indirect impact to upper limb
Between middle & lateral thirds

Medial part  / lateral 

-Shoulder drop
-Medial rotation of humerus
 Scapula (shoulder blade)

Triangular flat bone

3 borders
3 angles
2 surfaces:

Anterior (costal) surface

2nd – 7th ribs

Posterior (spinous) surface

 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
 Humerus (brachial bone)
The arm bone

Articulates with:
Scapula (shoulder joint)

Radius & Ulna (elbow joint)
 Joints of Pectoral Girdle

3 Joints:
Sterno-clavicular joint

Gleno-humeral joint
(Shouldar joint)

Acromio-clavicular joint
 Joint Questions

1. What is the type of that joint?

2. What are the articular surfaces of that joint?

3. What are the supporting ligaments?

4. What kind of movement is available?

5. Any special characteristics of the joint?

 Sterno-Clavicular Joint
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 absorber
 GlenoHumeral (Shoulder) Joint
Type: Synovial (ball & socket)

Articulations:
Head of humerus
Glenoid cavity of scapule
Ligaments of
shoulder joint:
1. Fibrous Capsule
2. Gleno-humeral
lig.(3)
3. Coraco-humeral
lig.
4. Transverse
humeral lig.
Movements of shoulder joint:
Circumduction
Includes??

Characteristics:
The fibrous capsule is Weak inferiorly
due to:
1. penetrated inferiorly by tendon of long
head of triceps

2. Joint is surrounded (stabilized) by group

of muscles called: Rotator Cuff muscles
*except inferiorly
 Acromio-clavicular joint

• Synovial plane

• Articulation between
acromion process and
lateral end of clavicle

• Reinforced by sup and

inf acromio-clavicular
ligaments
Muscles of The Shoulder Region:

Thoraco-appendicular Muscles
& Scapulo-humeral Muscles
 Anterior Thoracoappend Muscles

Pectoralis Major

Pectoralis Minor

Serratus Anterior

Subclavius
 Pectoralis Major

Fan shape muscle

Origin:
Clavicular & sternocostal heads

Insertion:
Humerus

Innervation:
Medial & Lateral pectoral nerves

Action:
Adduction of humerus
 Pectoralis Minor

triangular shaped muscle

Origin:
3rd, 4th & 5th ribs

Insertion:
Coracoid process

Innervation:
Medial pectoral nerves

Action:
Depress scapula, elevate ribs
Pectoralis Major & Minor
 Serratus 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
 Clinical: Winged Scapula

Medial border of scapula hangs

away from thoracic wall

1. Damage to serratus anterior m.

2. Injury to long thoracic n.

During fights
Winged Scapula
 Subclavius
Small muscle that extends:
Middle 1/3 of clavicle

1st costal cartilage

Innervation:
Nerve to subclavius

Action:
Depresses the clavicle
 Posterior Thoracoappendicular Muscles
“Only names to be able to distinguish them in the lab”

Trapezius

Latissimus dorsi m.

Levator scapulae

Rhomboid major

Rhomboid minor
 Scapulo-humeral Muscles
“Read the table in your book for innervation, origin, insertion &
main action”

Deltoid

Teres Major

Teres Minor

Supraspinatus

Infraspinatus

subscapularis
 Rotator Cuff Muscles
4 muscles that inserted around shoulder joint & form a
musculotendinous cuff

Cover the joint from 3 directions:

Superior: supraspinatus
Anterior: subscapularis
Posterior: infraspinatus & teres minor

Fxn.
Stabilize shoulder joint
Anterior Superior

Posterior
Shoulder Intermuscular Spaces
&
The Axilla
 Triangular Space

Boundaries:
Sup.:
Inf.:
Lat.:

Contents:
Circumflex scapular artery
 Quadrangular Space

Lateral to triangular space

Boundaries:
Sup.:
Inf.:
Med.:
Lat.: surgical neck of humerus

Contents:
Axillary n. (which muscles??)
Post. circumflex humeral vessels
 The Axilla
A pyramidal space between upper part of the arm & the side of
chest 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
 Apex:
The entrance from the root of the
neck

Boundaries:
Ant.: clavicle
Post.: upper border of scapula
Med.: 1st rib

Base:
Formed by the skin concavity
extending from the arm to
thoracic wall
Anterior and posterior axillary
folds
 Anterior Wall:
Pect. Major

Pect. minor

Subclavius

Clavipectoral Fascia:
Deep fascial layer that extends
from clavicle & covers
pect. Minor & subclavius
 Posterior Wall:

Subscapularis

Teres major

Latissimus dorsi
 Medial Wall:
1st  4th ribs
& intercostal muscles
inbetween

Overlying serratus ant. m.

Lateral Wall:
Intertubercular groove
of the humerus

Containing???
 Contents of The Axilla

Axillary artery

Axillary vein

Axillary lymph nodes

Brachial plexus
 Axillary 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. Minor into 3 parts

Axillary Artery
1st part:
3rd part:
Outer border of 1st rib
Lat. border of pec. minor


Medial border of pect. Minor
lower border of teres major

One branch:
3 branch:
Sup. (highest) thoracic a.
Subscapular a.
(largest branch of axillary)
2nd part:
Post. to pec. Minor
Ant. circumflex humeral a.
(in front of surgical neck)
2 branches:
Thoracoacromial a.
Post. circumflex humeral a.
Lateral thoracic a.
(behind the surgical neck)
 Scapular 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.
 Clinical Importance of
Scapular 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.

 Axillary Vein

Medial to axillary a.

Starts:
At lower border of teres major
By union of:
brachial veins + basilic vein

Ends:
Lat. Border of 1st rib
To become subclavian v.
 Axillary Lymph Nodes

5 groups:

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

Subscapular (post.)
In front of subscap.

Humeral (lateral)
Medial to axillary v.

Central
Embedded in fat

Apical
 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
 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

 Brachial Plexus

Composed of:
Roots
(in post. triangle of the
neck)

Trunks
(above the clavicle)

Divisions
(post. to the clavicle)

Cords (within the axilla)

•Roots •Medial cord
Dorsal scapular nerve (C5) Medial pectoral nerve
(supplies the rhomboids and Medial cutaneous nerve of
levator scapulae arm and medial cutaneous
Long thoracic nerve (C5, 6, and 7) nerve of forearm
Ulnar nerve
Medial root of median nerve
•Upper trunk
Nerve to subclavius (C5 and 6) •Posterior cord
Suprascapular nerve (supplies the Upper and lower subscapular
supraspinatus and infraspinatus nerves
muscles) Thoracodorsal nerve
Axillary nerve
Radial nerve
•Lateral cord
Lateral pectoral nerve
Musculocutaneous nerve
Lateral root of median nerve
The Arm
 Bone of Arm: Humerus

Long bone that articulates:

Sup.:
To scapula at shoulder joint

Inf.:
To radius & ulna at elbow joint
 Upper 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 ½ way on lat. Aspect of humerus

- site for deltoid m. attachment

Right Humerus, Lower part

1. Radial Fossa
2. Lateral Epicondyle
3. Capitulum
4. Trochlea
5. Medial Epicondyle
6. Coronoid Fossa
7. Olecranon Fossa
 Humerus Fractures
1. Fracture of the surgical neck:
Common in elderly (osteoporosis)
due to falls down
injury to circumflex arteries
&/or axillary n.
2. Transverse fracture of
humerus shaft:
direct blow to the arm
injury to radial n.

displacement depends on
relation to deltoid insertion

below deltoid tuberosity:

upper  laterally (deltoid)

lower  superiorly (biceps)

3. Supracondylar fracture:
fractures of the distal part of humerus
injury to median n.

4. Fracture of medial epicondyle:

pulls the epicondyle inferiorly
weakness in fingers/hand flexion
injury to ulnar n.
 Fascial 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
 Muscles of The Arm
Anterior:
Biceps Brachii

Brachialis m.

Coracobrachialis

Posterior:
Triceps m.:
Long
Lat.
Med.
 Biceps Brachii Muscle
Origin (2 heads)
Short: coracoid process
Long: supraglenoid tubercle of scapula

Insertion
Radial tuberosity
Bicipital aponeurosis (to deep fascia)

Innervation
Musculocutaneous n.

Action
Flexion of forearm,
Supination of forearm
 Brachialis Muscle
Beneath biceps brachii m.

Origin
Ant. lower ½ of humerus

Insertion
Coronoid process & tuberosity of ulna

Innervation
Musculocutaneous n.

Action
Flexion of forearm (main)
 Coracobrachialis Muscle

Origin
Coracoid process of scapula

Insertion
Medial aspect of humerus shaft

Innervation
Musculocutaneous n.

Action
Weak flexor & adductor of the arm
 Triceps Muscle
Origin (3 heads)
Long: infraglenoid tubercle of scapula
Lat.: sup. ½ of post. aspect of humerus shaft
Med.: inf. ½ of post. aspect of humerus shaft

Insertion
Olecranon process of ulna

Innervation
Radial n.

Action
Extension of forearm
 Nerves of the Arm

4 main nerves:

Musculocutaneous n.

Median n.

Ulnar n.

Radial n.
 Musculocutaneous Nerve
Pass through coracobrachialis
m.

Goes inferolaterally between

biceps brachii & brachialis
m.

Innervates all 3 muscles of ant.

arm

Continue distally as:

Lateral cutaneous n. of forearm

 Median Nerve
Formed by (which
cords?)

Runs in the bicipital

groove

Upper ½ : lat. to
brachial a.

Lower ½: med. to
brachial a.

Enters cubital fossa

at elbow
Bicipital Groove
 Ulnar 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
 Radial 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
 Brachial Artery

Starts:
At lower border of teres major m.
As a continuation of axillary a.

Ends
In cubital fossa, opposite to radial
neck
By dividing into:
Radial & Ulnar a.
Pass in bicipital groove

Upper ½ 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
 Branches of Brachial Artery
Muscular branches
To muscles of ant. compartment

Profunda brachii (Deep a. of the arm)

Pass post.
Follows radial n. into spiral groove
Supply triceps m.

Nutrient a.
To humerus

Sup. & Inf. ulnar collateral a.

Contribute to elbow anastomoses
 Veins of The Arm

Superficial Veins:
Cephalic v.
Basilic v.

Deep Veins:
Brachial v.
(vena comitans: L, accompanying
vein)

pair of veins on the sides of

brachial a.
 Cephalic 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.
 Basilic 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