Three synovial articulations between the pectoral girdle, axial skeleton and upper limb

GLENO-HUMERAL (GH) joint STERNO-CLAVICULAR (SC) joint ACROMIO-CLAVICULAR (AC) joint

4th FUNCTIONALARTICULATION
SCAPULOTHORACIC joint not a true anatomical joint

 Slides for anatomy review of upper extremities Prepared by Deepak ghimire Mham cm- 2012

Muscles Connecting the Upper Limb to the Thoracic Wall ANTERIOR GROUP
Pectoralis major= medial & lateral pectoral nerve both Pectoralis minor= medial pectoral nerve,
@ minor has less nerve supply ie only medial pectoral N.

Subclavius- Nerve to subclavis Serratus anterior- long thoracic nerve

Pectoralis major
O=Clavicle, sternum, and upper 6 costal cartilages I = Lateral lip of bicipital groove of humerus N= Medial and lateral pectoral nerves from brachial plexus C 5, 6, 7, 8; T1 Action =Adducts arm and rotates it medially; clavicular fibers also flex arm

Pectoralis minor
O= 3rd ,4th ,5th ribs I =Coracoid process of scapula N =Medial pectoral nerve from brachial plexusC 6, 7, 8 Action Depresses point of shoulder; if the scapula is fixed, it elevates the ribs of origin

 Subclavius
O = 1st costal cartilage I = Clavicle N = Nerve to subclavius from upper trunk of brachial plexus C5, 6 Action Depresses the clavicle steadies clavicle during movements of the shoulder girdle

Serratus anterior
O = Upper 8 ribs I = Medial border and inferior angle of scapula N = Long thoracic nerve C5, 6, 7 Action
Draws the scapula forward around the thoracic wall; rotates scapula

 Lateral rotators of the arm

Deltoid-posterior fibers (axillary nerve) Infra-spinatus muscle (suprascapular nerve) Teres minor ( axillary nerve)

 Medial pectoral nerve pectoralis major + lateral pectoral N. Pectoralis minor ;less= only medial pectoral N.

Lower Subscapular nerve teres minor ; minor= only lower Subscapular N. Subscapularis + upper subscapularis N.
axillary nerve Teres major & deltoid Dorsal scapular nerve Levetor scapulae Rhomboid major & minor

Muscles Connecting the Upper Limb to the Vertebral Column

1) Trapezius - accessary nerve 2) Latissimus dorsi lower
thoracodorsal nerve, climbing muscle, lati-wide, widest and strongest muscle of the back !v

3) Levator scapule-superior side 4) Rhombodus major & minor-medial side

Muscles Connecting the Upper Limb to the Vertebral Column

Trapezius
Origin ( midline of back upto T12)
Occipital bone, ligamentum nuchae, spine of 7th cervical vertebra, spines of all thoracic vertebrae

Insertion
Upper fibers =lateral third of clavicle; middle and lower fibers = acromion and spine of scapula

Nerve
= Spinal part of accessory nerve (motor) = and C3 and 4 (sensory)

Action : Upper fibers > elevate the scapula; middle fibers > pull scapula medially; lower fibers > pull medial border of scapula downward

Latissimus dorsi

Origin
Iliac crest, lumbar fascia, spines of lower 6 thoracic vertebrae, lower 3 0r 4 ribs, and inferior angle of scapula

Insertion
Floor of bicipital groove of humerus

Nerve
Thoracodorsal nerveC6, 7, 8,

Action
Extends, adducts, and medially rotates the arm @ ex a m

Levator scapulae
Origin
Transverse processes of first 4 cervical vertebrae C1 - c 4

Insertion
Medial border of scapula

Nerve
C3,c4 & c 5(dorsal scapular nerve)

Action
Raises medial border of scapula

Rhomboid major and minor

Rhomboid major and rhomboid minor
Origin of Rhomboid minor
Ligamentum nuchae and spines of c7 & T1

Origin of rhomboid major

T2- T5 spines

Insertion of both
Medial border of scapula

Nerve to both :
Dorsal scapular nerveC4, 5

Action of both
Raises medial border of scapula upward and medially

Triangle of auscultation
It has the following boundaries:
Above/superior
Trapezius

Below/inferior
Latissimus dorsi

Lateral
by the medial margin of the scapula

The floor
partly formed by the Rhomboideus major.

Muscles Connecting the pectoral girdle to the Humerus

Deltoid muscle- 3 fibers, ant,middle,post @ CAS Supraspinatus- abduct Infraspinatus- lateral rotator, supraspinatus N. Teres major- adduct, med rotate Teres minor- axillary nerve, lateral rotate Sub-scapularis- lower & upper subscapular N

Deltoid
3 origins: @ C-A-S Anterior head: Lateral third of clavicle, Middle head: Acromion, POSTERIOR HEAD Spine of scapula Insertion: Middle of lateral surface of shaft of humerus/deltoid tuberosity of the humerus Nerve: Axillary nerve c5, 6 Action: Anterior fibers flex and medially rotate arm; Middle fibers: Abducts arm Posterior fibers extend and laterally rotate arm @ heard FM-ABout EL Read as ant fiber flex-med rotate,med fiber abduct, post fiber extend and laterallly rotate

Supraspinatus & Infraspinatus

ORIGN:
Supraspinatus: Supraspinous fossa Infraspinatus: Infraspinous fossa

INSERION:
Greater tuberosity of humerus; capsule of shoulder joint

NERVE:
Suprascapular nerveC4, 5, 6

ACTION:
Supraspinatus-above-abduct Abducts arm and stabilizes shoulder joint Infraspinatus Laterally rotates arm and stabilizes shoulder joint

Teres major and minor

Teres major
Origin
Lower third of lateral border of scapula

Insertion:
Medial lip of bicipital groove of humerus

Nerve:
Lower subscapular nerveC6, 7

Action:
Medially rotates and adducts arm and stabilizes shoulder joint

Teres minor
Origin:
Upper two thirds of lateral border of scapula

Insertion:
Greater tuberosity of humerus; capsule of shoulder joint

Nerve:
Axillary nerve(C4), C5, 6

Action:
Laterally rotates arm and stabilizes shoulder joint

Subscapularis
Origjn: Subscapular fossa Insertion: Lesser tuberosity of humerus Nerve: Upper and lower subscapular nervesC5, 6, 7 Action : Medially rotates arm and stabilizes shoulder joint

Rotator cuff muscles

the rotator cuff (rotor cuff) is a group of muscles and their tendons that act to stabilize the shoulder. Along with the teres majorand the deltoid, the four muscles of the rotator cuff make up the six scapulohumeral (those that connect to the humerus and scapula and act on the glenohumeral joint) muscles of the human body.

Muscles composing rotator cuff

SITS muscles
Supraspinatus Infraspinatus Teres minor Subscapularis

Scapulo humeral muscles=6

SITS Teres major deltoid

THE AXILLA