The muscles of the chest and

upper limb
The muscles of the chest and upper limb
• The chest muscles attached at the level of the
upper limb's shoulder girdle/humerus include:

1. The major pectoral muscle

2. The minor pectoral muscle
3. The subclavius muscle
4. The serratus anterior muscle

They are associated with the following fasciae:

1. Pectoral fascia
2. Clavipectoral fascia
3. Axillary fascia
4. Serratus anterior muscle fascia
Pectoralis major
Broad muscle that radiates from the trunk to the
upper limbs.

Origin:
• Clavicular bundle: originates from the medial
half of the anterior margin of the clavicle.
• Sterno-costal bundle: from the anterior
surface of the sternum and the costal
cartilages of the first rib. 1. Crest of the greater tubercle
• Abdominal bundle: from the sheath of the 2. Greater tubercle
rectus abdominis muscle. 3. Clavicular fascia
4. Sternocostal fascia
5. Abdominal fascia
Insertion: tendon on the greater tubercle of the
humerus.
Pectoralis major
Action:
• When it takes a fixed point on
the chest → adducts, flexes, and
internally rotates the arm.
• When it takes a fixed point on
the humerus → elevates the ribs
- it is an inspiratory muscle.
Pectoralis major
Common tendon
The crest of the greater tubercle of the
humerus

Relations
Anterior
• Pectoralis major fascia
• Connective tissue
• Platysma muscle
• Mammary gland
• Skin
Pectoralis major
Posterior
• Sternum Ribs + intercostal spaces
Lateral
+ minor pectoral muscle, it forms
the anterior wall of the axilla
Superolateral border
+ deltoid muscle → clavipectoral
triangle
Inferolateral border
• border of the axillary base
Pectoralis major
The medial border
• Clavicle
• Sternum
• Costal cartilages
• Abdominal muscles
 Pectoralis major
• Innervation - the medial and
lateral pectoral nerves.
Pectoralis minor
Origin
• 3 digits
• Anterolateral surfaces of ribs III,
IV, V

Insertion
• Common tendon -> coracoid
process
Pectoralis minor
Relations
• Anterior - pectoralis major
• Posterior - ribs, intercostal
spaces, serratus anterior muscle
• Lateral - organs contained in the
axilla
Pectoralis minor
INERVATION:
• Medial and lateral pectoral
nerves

ACTION:
• If it takes a fixed point on the
chest, it lowers ↓ the shoulder.
• If it takes a fixed point on the
scapula, it raises the ribs - it is an
inspiratory muscle.
Pectoralis minor
Serratus anterior muscle

ORIGIN: Outer surfaces of ribs 1-10

INSERTION: Medial border of the

scapula

1. Rib 1
2. Scapula
3. Rib 10
Serratus anterior muscle
INNERVATION:
• LONG THORACIC NERVE
A branch of the brachial plexus
C5, C6, C7
.
 Serratus anterior muscle
ACTION:

• Stabilizes the scapula on the chest

With a fixed point on the scapula ->
raises the ribs ->
• Inspiratory muscle for portion I and
III
• Expiratory for portion II
 Subclavicular muscle
It is a spindle-shaped muscle that
extends from the first rib to the
clavicle.
• Origin: Rib 1.
• Insertion: Clavicle.
• Action: Lowers the clavicle and
shoulder
 Pectoral fascia

• It wraps around the pectoralis major

muscle.
• It continues with the deltoid fascia
laterally.
• Inserts above the clavicle and
sternum.
Clavicoracoaxillary fascia

• It detaches from the subclavius fascia,

covering the clavipectoral space,
known as the clavipectoral fascia.
• It splits into the minor pectoral
muscle and the axillary suspensory
ligament.
Axillary fascia
It continues with:
• Clavipectoral fascia anteriorly
• Subclavius muscle fascia
posteriorly
• Brachial fascia laterally
• Serratus anterior fascia medially Axillary
Fascia
Shoulder muscles
From the scapular girdle to the
humerus
6 muscles
• Deltoid
• Supraspinatus
• Infraspinatus
• Teres minor
• Teres major
• Subscapularis
Deltoid muscle
Origin:
Tendinous, on:
• Inferior lip of the scapula
• Lateral third of the clavicle

• Muscular - lateral edge of the 1. Spinous fascia

acromion 2. Acromial fascia
3. Spine of the scapula
• Insertion: Deltoid tuberosity 4. Clavicle
5. Clavicular fascia
6. Deltoid tuberosity of the
humerus
Body of the deltoid muscle
3 bundles
• Clavicular
• Acromial
• Spinal

1. Spinous fascia
2. Acromial fascia
3. Spine of the scapula
4. Clavicle
5. Clavicular fascia
6. Deltoid tuberosity of the
humerus
Deltoid muscle
Innervation: Axillary nerve

Action:
• Extensor and external rotator of
the arm - spinal bundle
• Strong abductor of the arm -
acromial bundle
• Flexor and internal rotator of the 1. Clavicular
arm - clavicular bundle 2. Acromial
3. Spinal
Supraspinatus muscle
Origin:
• Two-thirds of the medial border of the
supraspinous fossa.

Insertion:
• Greater tubercle of the humerus.

Muscle Body: 1. M. romboid minor

2. M. romboid major
• Superior to the spine of the scapula. 3. M. supraspinatus
• The tendon is adherent to the capsule of 4. M. infraspinatus
5. M. teres minor
the scapulo-humeral joint. 6. M. teres major
Supraspinatus muscle
Innervation Suprascapular nerve

Action
Abductor of the arm

1. M. romboid minor
2. M. romboid major
3. M. supraspinatus
4. M. infraspinatus
5. M. teres minor
6. M. teres major
 Infraspinatus muscle
Origin:
Muscular - three-quarters of the
medial region of the infraspinous
area.
Insertion:
In the middle region - the posterior
surface of the greater tubercle. 1. M. romboid minor
2. M. romboid major
3. M. supraspinatus
4. M. infraspinatus
5. M. teres minor
6. M. teres major
Infraspinatus muscle

Muscular body:
Large - triangular in shape
Innervation - suprascapular nerve

1. M. romboid minor
Action - abductor and external 2. M. romboid major
rotator of the arm 3. M. supraspinatus
4. M. infraspinatus
5. M. teres minor
6. M. teres major
Teres minor

Origin:
Infraspinous fossa - along the upper
half of the lateral edge of the
scapula

Flattened and elongated 1. M. romboid minor

2. M. romboid major
3. M. supraspinatus
Insertion - tendon - on the lower 4. M. infraspinatus
surface of the greater tubercle 5. M. teres minor
6. M. teres major
 Teres minor

Innervation - axillary nerve

Action- external rotation and

accessory adduction
 Teres major

Origin:
Infraspinous fossa - along the lower half of
the lateral edge of the scapula

Separated from the teres minor muscle -

the scapulohumeral triangle
Insertion: 1. M. romboid minor
2. M. romboid major
Tendon - on the crest of the lesser 3. M. supraspinatus
tubercle, posterior to the insertion of the 4. M. infraspinatus
major dorsal muscle 5. M. teres minor
6. M. teres major
 Teres major

Innervation - subscapular nerve

Action : adduction and internal

rotation of the arm
Shoulder region
The junction between
• Thorax
• Free upper limb

2 regions:
• One visible - the deltoid region
• The other hidden - the axillary
region.
Deltoid region
Limits
Superior
• Clavicle and acromion
Inferior
• Insertion of the deltoid muscle
Anterior and posterior:
• The oblique edges, anterior and
posterior of the deltoid muscle.
Deltoid region
Skin
• Superficial fascia:
• Thin, often adheres to the deep fascia.
Contents:
Nervous branches:
• Supraclavicular
• Superior lateral cutaneous of the arm
Superficial vessels
• Cephalic vein - in the deltopectoral
groove
Deltoid region

Anterior and lateral:

• Coracoid process and acromion
• Coracoacromial ligament
Lesser tubercle
Intertubercular groove
• Tendon of the long head of the
biceps brachii muscle
Deltoid region
Posterior
• Insertion of muscles:
• Supraspinatus
• Infraspinatus
• Teres minor
• Teres major
• Latissimus dorsi
Axillary region

• Piriform Space
• Located at the junction of the arm
with the thorax
Located:
Inferior: at the glenohumeral joint
Superior: at the axillary fascia
• the distribution center for the
vascular and nervous structures of
the upper limb.
Axillary region
• With the arm in slight abduction,
it has a trapezoidal truncated
pyramid shape,
• with the base facing downward
• long axis inclined upward and
medially.
Axillary region
• 1 angle
• 1 base
• 4 walls
Axillary region
Axillary apex
• The cervico-axillary canal - the
passage between the neck and
the axilla
• Crossed by arteries, veins,
lymphatic vessels, and nerves
Axillary region
Axillary base
• Skin tissue, subcutaneous tissue,
and axillary fascia
• Delimited by:
• Anterior and posterior axillary
folds
• Chest wall
• Medial aspect of the arm"
Axillary region
Anterior wall:
• 2 layers:
• Large pectoral muscle + small
pectoral muscle
• Pectoral fascia + clavipectoral
fascia
• Anterior fold - the lowest part of
the anterior wall: large pectoral
muscle - the transition area to
the humerus + skin"
Axillary region
1. Skin
2. Fascia superficialis
3. Pectoral fascia
4. Pectoralis major muscle
5. Clavipectoral fascia
6. Subclavius muscle
7. Pectoralis minor muscle
Axillary region

Posterior wall:
• Scapula
• Subscapularis muscle
• Latissimus dorsi muscle
• Posterior fold: latissimus dorsi
muscle, teres major muscle, skin
Axillary region
Medial wall:
• Ribs 1-4
• Intercostal muscles
• Anterior serratus muscle
Axillary region
Lateral wall:
• Bony - formed by the
intertubercular groove of the
humerus
• Coracobrachialis muscle
• Short head of the biceps brachii
Contents of the axilla
AXILLARY VASCULO-NERVOUS
BUNDLES
• Axillary artery + branches
• Axillary vein + tributaries
• LOOSE CONNECTIVE TISSUE.
• DENSER around the vessels -
forms the axillary sheath.
• Numerous lymph nodes.
• Important nerves: bundles and
branches of the brachial plexus.
Axillary artery
It begins as a continuation of the
subclavian artery
• from the lateral border of rib 1 to
the lower border of the teres
major muscle.
• The main artery of the axillary
region
• Surrounded by the brachial plexus
• Medially accompanied by the
axillary vein
Axillary
artery
ORIGIN:
• It originates at the posterior
edge of the clavicle, as a
continuation from the subclavian
artery.

• It becomes the brachial artery

behind the lower border of the
pectoralis major muscle."
Axillary artery
• The first portion of the axillary
artery:
• Located: from the lateral edge of
rib 1 to the medial edge of the
pectoralis minor muscle.
Axillary artery
The second portion:
Located: behind the pectoralis
minor muscle
2 branches: the medial
thoracoacromial artery to the
muscle
the lateral thoracic artery - lateral
to the muscle
Axillary artery
The third portion of the axillary
artery:
Located: from the lateral edge of
the pectoralis minor muscle to the
lower edge of the teres major
muscle.
Axillary
artery
Axillary artery
Branches:

• A. SUPERIOR THORACIC - 14
• It originates superiorly from the
clavicle
• Trajectory medially to
vascularize:
• The pectoral muscles
• The infraclavicular region.
 Axillary artery
Thoracoacromial Artery - 3
• It originates above the pectoralis minor muscle.
• It crosses the clavipectoral fascia - 2 branches.
Acromial - 4:
• Distributes laterally
• Vascularizes:
• Deltoid muscle
• Shoulder joint
• Acromioclavicular joint
Thoracic - 15:
• Distributes medially
• Vascularizes:
• Pectoral muscles
• Breast region
 Axillary artery
Lateral Thoracic Artery - 17
• Originates posteriorly from the pectoralis minor
muscle.
Vascularizes:
• Anterior serratus muscle
• Pectoral muscles
• Intercostal muscles
• Breast gland

Subscapular Muscular Branches - 5

• Origin - Posterior to the pectoralis minor muscle
• Intended for the subscapular muscle.
 Axillary artery
• Near the lower margin of the subscapular muscle:
• Subscapular Artery - 18
• Descends medially
• A. Thoracodorsal - 19
• Descends together with the dorsal thoracic nerve
• Vascularizes:
• Anterior serratus muscle
• Latissimus dorsi muscle
• .
Axillary artery
• Anterior Humeral Circumflex Artery - 6
• Vascularizes:
• Shoulder joint
• Coracobrachialis muscle
• Brachial biceps muscle
• Deltoid muscle

• Anterior Humeral Circumflex Artery - 7

• Crosses the lateral axillary space accompanied by the
axillary nerve, encircling the posterior aspect of the
surgical neck of the humerus.
• Anastomoses with the Anterior Humeral Circumflex Artery
- 6.
Axillary Vein
• Medial to the axillary artery,
• The medial side corresponds to
the axillary lymph nodes (lateral,
central, and apical).

• The posterior side crosses the

collateral branches of the axillary
artery and the dorsal thoracic
nerve.
Axillary vein
• It ensures the venous drainage of
the upper limb.

• Origin
• It originates at the lower margin of
the pectoralis minor muscle by the
union of the two brachial veins.
• Sometimes by the joining of the
common brachial venous trunk
with the basilic vein.
Axillary vein
• Trajectory and relations

• Along the medial side of the

axillary artery.
• Its terminal portion is anterior
and inferior to the axillary artery.
Axillary vein
• 3 portions correspond to the 3
portions of the axillary artery.
• The initial distal end is the 3rd
portion.
• The proximal terminal end is the
1st portion, ending at the lateral
margin of the first rib, leading to
the subclavian vein.
Axillary vein
Tributaries:
• The circumflex veins,
subscapular veins, lateral
thoracic veins
Axillary limphnodes
• Lymph nodes pectoral – anterior
• Located anterior to the lower margin of the pectoralis
major muscle, along the lateral thoracic artery.
• Lymph nodes subscapular – posterior
• Situated along the subscapular artery.
• Interpectoral lymph nodes - variable
• Located between the pectoral muscles.
• Humerous lymph nodes - lateral
• Correspond to the medial and posterior borders of the
axillary vein.
• Central lymph nodes
• In the center of the axilla – in contact with the brachial
plexus.
• Apical lymph nodes
• At the level of the apex of the axillary region.
Brachial Plexus
• Located in the cervical and axillary regions.

• Dedicated to the innervation of the upper

limb.

• Formation
• The brachial plexus is formed by the joining
of the anterior branches of the spinal nerves
• Cervical (C3 to C8) and
• Thoracic (T1).

• They form the roots of the brachial plexus.

Plexus brachial
• Upper trunk - 1
• C5-C6

• Middle trunk - 2
• C7

• Lower trunk - 3
• C8-T1
Brachial Plexus
• Each trunk - 2 divisions: anterior and
posterior - by regrouping these => bundles.

• Lateral cord - 6
• Anterior division of the upper and middle
trunks.

• Medial cord - 5
• Anterior division of the lower trunk.

• Posterior cord - 4
• The posterior divisions of the three trunks.
Brachial plexus
• At the level of the apex, the
nerve trunks are situated
laterally.
Brachial plexus
Above the pectoralis minor muscle,
The medial bundle is located
posteriorly.
The lateral and posterior bundles are
situated laterally.

Retropectoral
The posterior bundle is located
posteriorly.
The lateral bundle is situated laterally.
The medial bundle is situated medially.
Lateral and medial pectoral
nerve
• Medial pectoral nerve (C8 and T1)
• Originates from the medial bundle
Innervates:
• Subclavius muscle
• Pectoralis minor muscle

• Lateral pectoral nerve (C5, C6, and C7)

• Originates from the lateral bundle
• Innervates the pectoralis major
muscle.
 Long thoracic nerve
• It descends vertically, posterior to the
brachial plexus, the axillary artery,
and vein.

• Posterior to the pectoralis minor

muscle, it moves away from the vein
and crosses the surface of the
anterior serratus muscle, which it
innervates.
Relations

• Supraclavicular portion (CERVICAL)

• Infraclavicular portion (AXILLARY)

• The brachial plexus, as well as the

axillary vessels, are surrounded by
a connective tissue envelope
called the axillary sheath.
Supraclavicular portion
(CERVICAL)

1. Cervical nerves C3-C8

• Anterior to the vertebral artery

and vein and with the vertebral
nerve.
Supraclavicular portion (CERVICAL)
• 2. Thoracic nerve T1

• In relation to the stellate

ganglion - retropleural fossa.
Infraclavicular portion
• AT THE LEVEL OF THE APEX OF THE AXILLA

• Medial bundle - between:

• Lateral bundle (anterior)
• Posterior bundle (posterior)

• Relationships
• Anterior - Clavicle and subclavius muscle
• Posterior - Upper edge of the scapula +
subscapular muscle
• Lateral - Coracoid process
• Medial - Subclavian artery, long thoracic nerve,
first digit of the serratus anterior muscle.
Branches of
supraclavicular portion
• Muscular branches
• Dorsal scapular nerve - 1
• Long thoracic nerve - 13
• Subclavian nerve (C5 - C6) - 2
• Suprascapular nerve (C5 - C6) - 3
Muscular branches
• C5-C8

• For the muscles:

• Scalene
• Longus colli (muscle of the neck)
The connections of the brachial plexus.
• The brachial plexus has
connections with:

• Cervical plexus
• C4 branch
• Cervical sympathetic ganglia
• Communicating branches.
• Phrenic nerve
• C5 branch
 Functions
Motor function
• Root C5 Innervates shoulder muscles (deltoid, teres minor, supraspinatus, and infraspinatus)
• Root C6 Innervates anterior compartment muscles of the arm, supinator muscle, and brachioradialis
• Root C7 Innervates posterior compartment muscles of the arm and forearm, and pronator teres muscle
• Root C8 Innervates anterior compartment muscles of the forearm and thenar muscles
• Root T1 Innervates hypothenar muscles and interossei muscles.

Sensory function

• Root C5-C8: Innervates the skin of various areas of the upper limb.