Anatomy 1C Joshua Montelibano

NECK, AXILLA, ARM & BACK

POSTERIOR TRIANGLE OF THE NECK

Anterior: Posterior border of the sternocleidomastoid muscle
Posterior: Anterior border of the trapezius
Inferior: Clavicle
Covered by the Investing layer of the deep cervical fascia
Floor is formed by the prevertebral layer of the deep cervical fascia
Subdivided by the inferior belly of the omohyoid into:
Occipital triangle
Inferior: Inferior belly of the omohyoid
Supraclavicular triangle
Superior: Inferior belly of the omohyoid
Inferior: clavicle
Both triangles:
Anterior: Posterior border of the sternocleidomastoid muscle
Posterior: Anterior border of the trapezius
Floor: Splenius capitis, Levator scapula, Scalenus medius, Scalenus anterior

OCCIPITAL

Contents of the triangles

SUPRACLAVICULAR

Supraclavicular nerve
Spinal Accessory Nerve (XI)
Superior end of the sympathetic trunk
(Superior, Middle, Inferior cervical
sympathetic ganglion)
Cervical plexus
Semispinalis capitis muscle
Levator scapula muscle
Scalenus posterior muscle
Scalenus medius muscle

rd

3 part of the sublacian artrey

Subclavian vein
Apex of the lung
Roots of the brachial plexua
Deep cervical lymph nodes

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Anatomy 1C Joshua Montelibano

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Muscles of the Posterior Triangle

Origin

Insertion

Innervation

Splenius capitis

Ligamentum nuchae
Upper 4 thoracic spines

Superior nuchal line of occipital bone

Mastoid process of temporal bone

Dorsal primary rami of spinal

nerve

Levator Scapula

Transverse processes of C1-C4

Medial border of the scapula

Ventral primary rami (C3, C4)

Dorsal Scapular Nerve

Posterior

Transverse processes of C4-C6

2 rib

Medius

Transverse processes of C1-C6

Anterior

Transverse processes of C3-C6

Scalenus

nd

Anterior rami of cervical nerves

st

1 rib

C4-C6

Action
Bends neck laterally
Elevates medial border of the
scapula
Raises medial border of scapula
Bends neck laterally
nd
Elevates 2 rib, laterally flexes
and rotates cervical part of
vertebral column
Elevates 1st rib, laterally flexes
and rotates cervical part of
vertebral column

Scalenus Anterior muscles

1.
2.

3.

Key muscle in understanding the root of the neck and its relation to many neurovascular structures identified in the posterior triangle
Important relations:
Anteriorly related to carotid arteries, vagus nerve, IJV, and deep cervical lymph nodes
nd
Posteriorly related to the pleura, origin of the brachial plexus, and 2 part of the subclavian artery
Medially related to the vertebral artery and vein, sympathetic trunk, and thoracic duct (on the left side)
rd
Laterally - related to the emerging branches of the cervical plexus, roots of the brachial plexus, and the 3 part of the subclavian artery
Divides the subclavian artery into 3 parts

Fibers
1.

2.
Course
3.
4.

Areas of distribution

Phrenic Nerve

Spinal Accessory Nerve (XI)

Motor, Sensory

Motor
CRANIAL ROOT
1. Emerges from anterior surface of the medulla oblongata
2. Nerve runs laterally in the posterior cranial fossa and joins the spinal root
SPINAL ROOT
1. Emerges from nerve cells in the anterior gray horn of the upper 5 segments of the cervical part of
the spinal cord
2. Nerve ascends alongside the spinal cord and enters the skull through the foramen magnum
turns lateral to join cranial root

rd

th

Arises in the neck from the 3 , 4 ,

th
and 5 cervical nerves of the cervical
plexus (C3-C5)
Runs vertically downward across the
front of the scalenus anterior muscle
Enters the thorax by passing in front
of the subclavian artery
Further courses in the thorax
terminating at the diaphragm
Diaphragm

Cranial and Spinal root leave the skull through the jugular foramen and eventually separate:
Cranial root joins vagus nerve; distributed to soft palate, pharynx, and larynx muscles
Spinal root runs downward and laterally and enters SCM and over to the trapezius
Soft palate, pharynx, larynx, sternocleidomastoid, trapezius muscles

Anatomy 1C Joshua Montelibano

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Subclavian arteries
Origin
Commencement
Course
Termination

Left Subclavian
Right Subclavian
Arch of the aorta
Brachiocephalic artery
Behind manubrium sterni
Behind right sternoclavicular joint
Ascends to the root of the neck
Arches upward and laterally over the pleura between the scalenus
anterior and medius muscles
st
Outer border of the 1 rib

Scalenus anterior divides the subclavian artery into 3 parts

Vertebral artery

Basilar artery

Inferior thyroid artery

Posterior
cerebral artery

First Part of Subclavian Artery

Extends from the origin of the subclavian artery to the medial border of scalenus anterior

1st

Thyrocervical
trunk

Superficial cervical
artery

Suprascapular artery

Internal thoracic
artery

Subclavian artery

Superior epigastric
artery

Musculophrenic artery

2nd

Costocervical
trunk

Superior intercostal
artery
Deep cervical artery

3rd

Vertebral artery - ascends in the neck through foramina in the transverse processes of the
upper 6 cervical vertebrae ,ascends into the skull through the foramen magnum;
Forms the basilar artery at the anterior surface of the medulla oblongata at the level of the
lower border of the pons
Basilar artery - gives branches to the pons, cerebellum, and internal ear; contributes
to the formation of the Circle of Willis
Posterior cerebral artery - curves laterally and backward around the midbrain
Thyrocervical trunk
Inferior thyroid artery - closely related to recurrent laryngeal nerve; gives branches
to thyroid and inferior parathyroid glands
Superficial cervical artery - crosses the brachial plexus
Suprascapular artery - follows the suprascapular nerve onto the back of the scapula
st
Internal thoracic artery descends into the thorax behind the 1 costal cartilage and in front
of the pleura
Superior epigastric artery - supplies anterior abdomen
th th
Musculophrenic artery - supplies 7 -9 intercostal spaces and diaphragm

Anatomy 1C Joshua Montelibano

Second Part of Subclavian Artery
Lies behind the scalenus anterior

Costocervical trunk - runs backward over the dome of the pleura

st
nd
Superior intercostal artery supplies 1 and 2 intercostal spaces
Deep cervical artery - supplies deep muscles of the neck

Third Part of Subclavian Artery

Extends from the lateral border of the scalenus anterior across the posterior
st
triangle to the lateral border of the 1 rib
Continues to the axillary artery
No branches

Subclavian Vein
st

Commencement: Outer border of the 1 rib

From the axillary vein
Joins internal jugular vein to form the brachiocephalic vein
Receives the external jugular vein
Receives thoracic duct (left side) and right lymphatic duct (right side)
Relations:
Anterior: Clavicle
Posterior: Scalenus anterior and phrenic nerve
st
Inferior: upper surface of the 1 rib

Lymph Drainage

Superficial Cervical Lymph Nodes

Situated along the course of the External
Jugular Vein
Receive lymph from:
1. The skin over the angle of the jaw
2. Skin over the apex of the parotid gland
3. Lobe of the ear
Efferent lymph vessels drain into the deep
cervical lymph nodes

Deep Cervical Lymph Nodes

Form a vertical chain along the course of the Internal Jugular Vein
within the carotid sheath
Receive lymph from regional nodes:
1. Jugulodigastric node located below the angle of the jaw
Drainage of the tonsil and tongue
2. Jugulo-omohyoid node close to the omohyoid muscle
Drainage of the tongue
Efferent lymph vessels join to form jugular trunk drains into
thoracic duct (right lymph duct)

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CERVICAL PLEXUS
st

Formed by the anterior rami of 1 4 cervical nerves

Joined by connecting branches form loops that lie in front of the
origins of the levator scapulae and scalenus medius
Covered in front by the prevertebral layer of deep cervical fascia
Related to the Internal Jugular Vein in the carotid sheath
Supplies the skin and muscles of the head, neck, and shoulders

Branches of the Cervical Plexus

Branches
Nerve Root
CUTANEOUS BRANCHES
Lesser Occipital nerve
C2
Greater auricular
nerve
Transverse cervical
nerve

C2, 3

Supraclavicular nerve

C3, 4

Distribution
Back of the scalp and
auricle
Skin over the angle of the
mandible
Skin over the front of the
neck

Skin over the shoulder

region
MUSCULAR BRANCHES TO THE NECK MUSCLES
Proprioceptive, C2, 3
Prevertebral muscles, SCM
C3, 4
Levator scapulae
Proprioceptive C3, 4
Trapezius
Branch of C1 joins with hypoglossal nerve
Some C1 fibers leave as a descending branch unites with
descending cervical nerve (C2, 3)
C1 descending branch + descending cervical nerve = ansa cervicalis
Ansa cervicalis innervates Sternohyoid, Omohyoid, Sternothyroid
MUSCULAR BRANCH TO THE DIAPHRAGM
Phrenic nerve
C3, 4, 5
Diaphragm

CERVICAL PART OF THE SYMPATHETIC TRUNK

st

Extends upward to the base of the skull below the neck of the 1 rib
Directly behind the internal and common carotid arteries, embedded in deep fascia

Three Ganglia of the Sympathetic Trunk and its Branches

Superior
Cervical
Ganglion
Middle
Cervical
Ganglion
Inferior
Cervical
Ganglion

Internal carotid nerve

Gray rami communicantes
Arterial branches
Cranial nerve brances
Phrayngeal branches
Superior cardiac branch
Gray rami communicantes
Thyroid branches
Middle cardiac branch
Stellate ganglion
Gray rami communicantes
Arterial branches
Inferior Cardiac branch

Postganglionic fibers; accompanies ICA

To the upper 4 anterior rami of cervical nerves
To the common and external carotid arteries
th
th
th
Join the 9 , 10 , and 12 cranial nerves
Unite with glossopharyngeal and vagus nerves
Descends in the neck; ends in cardiac plexus
th
To the anterior rami of 5 and 6th cervical nerves
Pass along inferior thyroid artery; to thyroid gland
Descends in the neck; ends in cardiac plexus
st
Fused inferior cervical with 1 thoracic ganglion
th
th
To the anterior rami of the 7 and 8 cervical nerve
To the subclavian and vertebral arteries
Descends to join the cardiac plexus

Anatomy 1C Joshua Montelibano

AXILLA, PECTORAL REGION, and MAMMARY GLAND

BREAST (Mammary gland)
Specialized accessory glands of the skin that secrete milk
Present in both sexes (similar structures in males and immature females)
nd

Superior: 2 rib
th
Inferior: 6 rib
Medial: Lateral margin of the sternum
Anterior: Skin
Posterior: Deep pectoral fascia
th

Nipples (at level of 4 intercostal space) are small and surrounded by a colored area of
the skin areola
Areolar glands produces tiny tubercles in the areola
Darkening of areola increased deposits of melanin in the epidermis
Axillary tail of Spence
Extension upward and laterally piercing the deep fascia at lower border of
pectoralis major
Enters the axilla
Each breast consist of 15-20 lobes radiate out from the nipple
Main duct of each lobe opens separately on the summit of the nipple each
possess a dilated ampulla (before termination)
Lobes are separated by fibrous septa serves as
suspensory ligaments of Cooper
Retromammary space - space behind the breast filled by loose connective tissue
Perforating branches of internal thoracic artery,
intercostal arteries
Axillary artery via
Lateral
lateral thoracic and thoracoacromial arteries
(correspond to arteries)
Medial
Into the internal thoracic group of nodes
Lateral
Into the anterior axillary or pectoral group of nodes
Posterior Into the posterior intercostal nodes
th th
4 -6 intercostal nerves
Medial
Arterial supply
Venous supply
Lymph
drainage
Innervation

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Muscles of the Pectoral Region

Origin

Insertion

Pectoralis major

Clavicle
Sternum
Upper 6 costal cartilages

Pectoralis minor

3 , 4 , and 5 ribs

Subclavius

1 costal cartilage

Clavicle

Serratus anterior

Upper 8 ribs

Medial border and inferior

border of scapula

rd

th

st

th

Lateral lip of bicipital

groove of humerus
Coracoid process of
scapula

Innervation
Medial and lateral pectoral
nerves from brachial
plexus
Medial pectoral nerve
from brachial plexus
Nerve to subclavius from
upper trunk of brachial
plexus
Long thoracic nerve

Nerve Roots
C5, 6, 7, 8, T1
C6, 7, 8
C5, 6

C5, 6, 7

Action
Adducts arm and rotates it medially
Clavicular fibers also flex arm
Depresses point of shoulder
if fixed scapula elevates ribs of origin
Depresses clavicle and steadies this
bone during movements of the
shoulder girdle
Draws the forward anterior around the
thoracic wall
Rotates the scapula

The Axilla
Axilla (armpit)

Pyramid-shaped space between the upper part of the arm and side of the
chest
Forms an important passage for nerves, blood, and lymph vessels as they
travel from root of the neck to the upper limb

Apex upper end of the axilla

Directed into the root of the neck
Bounded in front by the clavicle, behind by the upper border of the scapula,
st
and medially by the outer border of the 1 rib
Base lower end of the axilla
Bounded in front by anterior axillary fold (lower border of pectoralis major),
behind by posterior axillary fold (tendon of latissimus dorsi and teres
major), medially by the chest wall
Contents:
Axillary artery and its branches supply blood to upper limb
Axillary vein and tributaries drains blood from upper limb
Lymph vessels and lymph nodes - drain lymph from upper limb and breast
Brachial plexus innervates the upper limb

Anatomy 1C Joshua Montelibano

Walls of the Axilla
Anterior Wall: Pectoralis major
Subclavius
Pectoralis minor
Posterior Wall: Subscapularis
Latissimus dorsi
Teres major
Medial Wall: Upper 4 or 5 ribs
Intercostal spaces covered by serratus anterior
Lateral Wall: Coracobrachialis
biceps in the bicipital groove of the humerus
Base is formed by the skin stretching between anterior and posterior walls
Axilla contains principal vessels and nerves to upper limb and lymph nodes

Key Muscle in Axilla

Pectoralis minor

Crosses axillary artery and

brachial plexus of nerves
Used in describing the axillary
artery to divide into 3 parts

BRACHIAL PLEXUS
Complicated plexus allowing nerve fibers from different segments of the spinal cord to be arranged and distributed
efficiently in nerve trunks to the various parts of the upper limbs
th
th
st
Formed in the posterior triangle of the neck union of anterior rami of the 5 to 8 cervical and 1 thoracic spinal nerves
Important functions:
1. Sensory innervation to the skin and deep structures
2. Motor innervation to the muscles
3. Influence over the diameters of the blood vessels by the sympathetic vasomotor nerves
4. Sympathetic secretomotor supply to the sweat glands
Divided into roots, trunks, divisions, and cords
Roots, trunks, divisions reside in lower part of posterior triangle of the neck
Cords and its branches arranged around the axillary artery in the axilla; enclosed in axillary sheath
Lateral cord Upper (C5, 6) + middle (C7)
Posterior cord Upper (C5, 6) + middle (C7) + lower (C8, T1)
Medial cord Lower (C8, T1)

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Anatomy 1C Joshua Montelibano

Branches of the Brachial Plexus

Branches
ROOTS
Dorsal Scapular nerve
Long Thoracic nerve
UPPER (SUPERIOR) TRUNK
Suprascapular nerve
Nerve to subclavius
(Accessory phrenic nerve)
LATERAL CORD
Lateral Pectroal nerve
Musculocutaneous nerve
POSTERIOR CORD
Upper subscapular nerve
Lower subscapular nerve
Axillary nerve
Thoracodorsal nerve
Radial nerve
MEDIAL CORD
Medial pectoral nerve
Medial cutaneous nerve
Medial cutaneous nerve of
forearm
Ulnar nerve
LATERAL + MEDIAL CORD
Lateral root of median nerve
Medial root of median nerve

Roots
C5
C5, 6, 7

C5, 6

C5, 6, 7

C5,6
C6, 7, 8
C5, 6, 7,
8, T1

C8, T1

Distribution
Rhomboid minor, Rhomboid major,
Levator scapulae muscles
Serratus anterior
Supraspinatus and infraspinatus
Subclavius
*Gives contribution to phrenic nerve
Pectoralis major
Coracobrachialis, biceps brachii, brachialis
Subscapularis
Subscapularis and teres major
Deltoid and teres mainor
Latissimus dorsi
Triceps, anconeus, part of brachialis,
forearm and hand and finger muscles
Pectoralis major and minor
Skin of medial side of arm
Skin of medial side of forearm
Hand and finger muscles

C5, 6, 7
C5, 6, 7,
8, T1

Forearm, hand and finger muscles

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AXILLARY ARTERY and VEIN

AXILLARY ARTERY
Origin: Subclavian artery
st
Commencement: Lateral border of the 1 rib
Termination: Lower border of the teres major
Closely related to brachial plexus and their branches and with the axillary sheath
Pectoralis minor muscle divides axillary artery into 3 parts
st
1. First Part extends from lateral border of 1 rib to upper border of pectoralis minor
2. Second part behind the pectoralis minor
3. Third part extends from lower border of pectoralis minor to lower border of teres major

Axillary artery
st

1 part

Branch
Highest thoracic
artery

Thoracoacromial
artery
nd

2 part
Lateral thoracic
artery

Subscapular artery
rd

3 part

Anterior circumflex
humeral artery
Posterior circumflex
humeral artery

Relation
Anterior: Pectoralis major and skin
Posterior: Long thoracic nerve
Lateral: 3 cords of the brachial plexus
Medial: axillary vein
Anterior: Pectoralis minor, pectoralis major and the
skin
Posterior: Posterior cord of the brachial plexus,
subscapularis, shoulder joint
Lateral: Lateral cord of the brachial plexus
Medial: Medial cord of the brachial plexus and
axillary vein
Anterior: Pectoralis major, crossed by medial root
of median nerve
Posterior: Subscapularis, latissimus dorsi, teres
major, axillary and radial nerves
Lateral: Coracobrachialis, biceps, humerus, lateral
root of median and musculocutaneous nerve
Medial: Ulnar nerve, axillary vein, medial
cutaneous nerve of the arm

AXILLARY VEIN
Commencement: Lower border of the teres major
st
Termination: Lateral border of the 1 rib
Drains into subclavian vein
Formed from union of:
venae comitantes of the brachial artery and basilic vein
Vein receives tributaries corresponding to branches of the axillary artery

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ARM and CUBITAL FOSSA

Skin
Superficial Sensory Nerves
Cutaneous nerves on lateral surface
1. Supraclavicular nerves (C3, 4)
Nerve supply to skin over the point of the shoulder halfway down the deltoid
2. Upper lateral cutaneous nerve of the arm (branch of axillary nerve C5, 6)
Nerve supply to skin over the lower half of the deltoid
3. Lower lateral cutaneous nerve of the arm (branch of radial nerve C5, 6)
Nerve supply to skin over lateral surface of arm below the deltoid
Cutaneous nerves on medial surface
1. Medial Cutaneous nerve of the arm (T1)
Nerve supply of skin of the armpit and medial side of the arm
2. Intercostobrachial nerves (T2)
3. Posterior cutaneous nerve of the arm (branch of radial nerve C8)
Nerve supply of skin of the back of the arm
Veins of upper limb
Deep veins
Comprises the venae comitantes accompany
large arteries and the axillary vein
Superficial veins
Lie in the superficial fascia

Cephalic vein

Termination

Subcutaneous tissue from the lateral aspect

of the dorsum of the hand (lateral of the
wrist)
Deltopectoral groove

Drainage

Axillary vein

Commencement

Basilic vein
Medial border of the wrist
Lower border of teres major
Joins venae comitantes of brachial artery
into the axillary vein

Medial cubital vein and Median vein of the forearm - Communicating veins (links cephalic and basilica veins)

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MUSCLES OF THE ARM

Origin

Insertion

Innervation

Nerve Roots

Action

ANTERIOR COMPARTMENT
Biceps
brachii

Long head

Short head
Coracobrachialis
Brachialis

Supraglenoid tubercle of
scapula
Coracoid process of
scapula
Front of lower half of
humerus

POSTERIOR COMPARTMENT
Long head
Infraglenoid tubercle of
scapula
Lateral head
Upper half of posterior
Triceps
surface of humerus shaft
Medial head
Lower half of posterior
surface of humerus shaft
Lateral epicondyle of the
Anconeus
humerus

Tuberosity of radius
bicipital aponeurosis
Medial shaft of humerus

C5, 6
Musculocutaneous nerve

Coronoid process of ulna

C5, 6, 7
C5, 6

Supinator of forearm
flexor of elbow
Weak flexor of shoulder joint
Flexes arm, weak adductor
Flexor of elbow joint

Extensor of elbow joint

Olecranon process of ulna

Radial nerve

C6, 7, 8

Help stabilize elbow joint

Fascial Compartments of the Upper Arm

Intermuscular septa Divides the arm into anterior and posterior compartment
Bicipital Aponeurosis reinforces antecubital area within the cubital fossa
Contents of the Fascial Compartment of the Upper Arm
Anterior
Posterior
Biceps brachii
Muscles
Coracobrachialis
3 heads of triceps
Brachialis
Blood supply
Brachial artery
Profunda brachii
Muscular Innervation
Musculocutaneous nerve
Radial nerve
Musculocutaneous
Median nerve
Ulnar nerve
Structures passing
Radial nerve
Brachial artery
through the compartment
Ulnar nerve
Basilica vein
Radial nerve (Present In Lower Part)

Anatomy 1C Joshua Montelibano

ANTERIOR FASCIAL COMPARTMENT
BRACHIAL ARTERY
Origin: Axillary artery
Commencement: Lower border of the teres major
Termination: Neck of the Radius
Divides into Radial and Ulnar arteries
Branches
Muscular branches to the anterior compartment of the upper arm
Nutrient artery to the humerus
Profunda artery - arises near beginning of the brachial artery; follows radial nerve into the spiral
groove of the humerus
Superior ulnar collateral artery - arises near the middle of the upper arm; follows the ulnar nerve
Inferior ulnar collateral artery - arises near the termination of the artery; takes part in the
anastomosis around the elbow joint
MUSCULOCUTANEOUS NERVE
From the lateral cord of the brachial plexus (C5,6, 7)
Pierces the coracobrachialis and passes between the biceps and brachialis
Appears at lateral margin of biceps tendon and pierces deep fascia above the elbow
Continues to the lateral aspect of the forearm as the lateral cutaneous nerve
Branches
Muscular branches to the biceps, coracobrachialis, and brachialis
Cutaneous branches - lateral cutaneous nerve of the forearm
Articular branches to the elbow joint

Median Nerve

Ulnar Nerve
Radial Nerve

From the lateral and medial cords of the brachial plexus

Runs downward on the lateral of the brachial artery
Halfway down the arm crosses brachial artery
At elbow crossed by bicipital aponeurosis
From medial cord of the brachial plexus
Runs downward on medial side of brachial artery up to middle of the arm
At coracobrachialis insertion pierces medial fascial septum and enters posterior
compartment of the arm; passes behind medial epicondyle of the humerus
Immediately enters posterior compartment of the arm

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Anatomy 1C Joshua Montelibano

POSTERIOR FASCIAL COMPARTMENT
From posterior cord of the brachial plexus
Nerve winds around back of the arm in the spiral groove on back of the
humerus between head of triceps
Pierces lateral fascial septum above elbow and continues into cubital fossa
In spiral groove nerve is accompanied by profunda vessels

Radial Nerve

Ulnar Nerve

Profunda brachii Artery

Superior and Inferior
Ulnar Collateral
Arteries

Branches
In axilla -Posterior cutaneous nerve of the arm; branches given to
the long and medial heads of triceps
In spiral groove branches given lateral and medial heads of
triceps and anconeus
Lower lateral cutaneous nerve of the arm
Posterior cutaneous nerve of the forearm
In anterior compartment of the arm gives branches to brachialis,
brachioradialis, extensor carpo radialis longus muscles
Articular branches to elbow joint
Descends behind the septum, covered posteriorly by the medial head
Accompanied by superior ulnar collateral vessels
At elbow lies behind medial epicondyle of the humerus on the medial
ligament of the elbow joint
Enters the forearm between 2 heads of origin of flexor carpi ulnaris
No articular branch to elbow joint
Origin: Brachial artery
Accompanies radial nerve through the spiral groove
Supplies triceps muscle, takes part in anastomosis around elbow joint
Origin: brachial artery
Take part in anastomosis around elbow joint

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Anatomy 1C Joshua Montelibano

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Cubital Fossa
Triangle depression in front of the elbow
Roof: skin and fascia reinforced by the bicipital aponeurosis
Floor: Brachialis
Base of the triangle: Imaginary line between the humeral
Lateral: brachioradialis
Medial: Pronator teres
Contents (medial to lateral):
Median nerve
Bifurcation of the brachial artery
Tendon of the biceps
Radial nerve and its deep branch

ELBOW JOINT
Articulation: between trochlea and capitulum of the humerus and the trochlear notch of the ulna and head of the radius
articular surfaces covered with hyaline cartilage
Type: Synovial hinge joint
Capsule: Anterior: attached above to the humerus along upper margins of coronoid and radial fossae
to the front of the medial and lateral epicondyles and below to the margin of the coronoid process of the ulna and to the annular ligament
Posterior: attached above to margins of olecranon fossa of the humerus and below to the upper margin and sides of the olecranon process
Ligaments: Lateral ligament triangular; attached by its apex to lateral epicondyle of humerus
Medial ligament triangile; with 3 strong bands: anterior band, posterior band, transverse band
Synovial membrane : lines the capsule and covers fatty pads in the floors of the coronoid, radial, and olecranon fossae
Nerve supply: Branches from median, ulnar, musculocutaneous, and radial nerves

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BACK, SHOULDER, & SCAPULAR MUSCLES

Bony Prominences

External occipital protuberance lies at junction of head and neck

th
Seventh (7 ) cervical vertebrae (vertebra prominens) most prominent
spinous process that can be felt in the neck
st
First (1 ) thoracic vertebra
Scapula
rd
Crest of the spine can be palpated at level of 3 thoracic spine
Medial border
st
Superior angle can be palpated opposite the 1 thoracic spine
th
Inferior angle can be palpated opposite the 7 thoracic spine
th
Iliac crest lie at the level of 4 lumbar spine

Superficial part of the back

Posterior rami of spinal nerves
Sensory nerve
st
th
(1 and 8 cervical nerves does not supply the skin)
supply
Arterial supply
Venous supply

Posterior branches of the:

posterior intercostal arteries and the lumbar arteries
Posterior intercostal vein and the lumbar vein
drain into azygos veins and the inferior vena cava

Deep Fascia of the back (Thoracolumbar Fascia)

Situated in the interval between the iliac crest and the 12th rib
Forms a strong aponeurosis
Gives origin to middle fibers of the transversus and the upper fibers of the

oblique muscle
Medially, splits into 3 lamellae
1. Posterior lamella covers deep muscles of the back;
attached to lumbar spines
2. Middle lamella attached to tips of transverse processes of the lumbar
vertebrae; lies anterior to deep muscles of the back and posterior to
the quadratus lumborum
3. Anterior lamella attached to anterior surface of the transverse
process of the lumbar vertebrae; anterior to quadratus lumborum

Muscles acting on the

vertebral column

Muscles acting on the

humerus

Erector spinae
Spinalis
Longissimus
Iliocostalis
Transversospinalis
Rotatores
Multifidus
Semispinalis
Interspinales
Intertrasnversarii

Deltoid
Supraspinatus
Infraspinatus
Teres major
Teres minor
Subscapularis

Anatomy 1C Joshua Montelibano

1st shift 2015-2016

MUSCLES OF THE BACK

Origin

Insertion

Innervation

Nerve Roots

Action

SUPERFICIAL MUSCLES

Trapezius

Latissimus dorsi

Occipital bone
Ligamentum nuchae
th
Spine of 7 cervical vertebra
Spines of all thoracic vertebra

Iliac crest
Lumbar fascia
Spines of lower 6 thoracic
vertebrae
Lower 3-4 ribs
Inferior angle of the scapula

Upper fibers into lateral

third of clavicle
Middle and lower fibers
into acromion and spine
of scapula

Floor of bicipital groove of

humerus

Spinal part of
accessory nerve
(motor)
C3, C4 (sensory)

XI cranial nerve
(spinal part)

Upper fibers: elevate

the scapula
Middle fibers: pull
scapula medially
Lower fibers: pull
medial border of
scapula downward

Thoracodorsal nerve

C6, 7, 8

Extends, Adducts, and

medially rotates the arm

C3 and C4
Dorsal scapular nerve

C3, 4, 5

Raises medial border of

scapula

Dorsal Scapular nerve

C4, 5

INTERMEDIATE MUSCLES
st

Levator Scapula
Rhomboid Minor
Rhomboid major
Serratus Posterior
Superior
Serratus Posterior
Inferior
DEEP MUSCLES
Splenius capitis
Splenius cervicis

Transverse processes of 1 four

cervical vertebrae
Ligamentum nuchae
th
st
Spines of 7 cervical and 1
thoracic vertebrae
nd
th
2 5 thoracic spines
Lower cervical and upper thoracic
spines

Medial Border of scapula

Upper ribs
Intercostal Nerves

Upper lumber and lower thoracic

spines

Lower ribs

Lower part of ligamentum nuchae

Upper 4 thoracic spines

Superior nuchal line of occipital

bone and mastoid process of
temporal bone
Transverse process of upper
cervical vertebrae

Erector spinae, Transversospinalis, Interspinales, Intertransversarii

Posterior rami of spinal

nerves

Raises medial border of

scapula upward and medially
Raises ribs
Inspiratory muscle
Depresses ribs
Expiratory muscle
Bends neck laterally
Elevates medial border of the
scapula

Anatomy 1C Joshua Montelibano

1st shift 2015-2016

Anatomy 1C Joshua Montelibano

1st shift 2015-2016

SHOULDER and SCAPULAR MUSCLES

Origin
Deltoid

Supraspinatus
Infraspinatus
Teres minor
Teres major
Subscapularis

Lateral third of the clavicle

Acromion
Spine of the scapula

Insertion
Middle lateral surface of shaft
of humerus

Supraspinous fossa of scapula

Infraspinous fossa of scapula
Upper two thirds of the
lateral border of scapula
Lower third of
lateral border of scapula
Subscapular fossa

Greater tuberosity of humerus

Capsule of shoulder joint

Innervation

Axillary nerve

Suprascapular nerve
Axillary nerve

Medial lip of bicipital groove of

humerus
Lesser tuberosity of humerus

Lower subscapular
nerve
Upper and lower
subscapular nerves

Nerve Roots

C5, 6

C4,5, 6
(C4), 5, 6
C6, 7
C5, 6, 7

Action
Abducts the arm
Anterior fibers: flex and
medially rotate arm
Posterior fibers: extend
and laterally rotate arm
Abducts arm and stabilizes
shoulder joint
Laterally rotates arm and
stabilizes shoulder joint
Medially rotates arm
Adducts arm
Stabilizes shoulder joint

Rotator Cuff Muscles:

SITS muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Stabilizes shoulder joint
Acts in coordination to hold the head of the
humerus in the glenoid fossa

Anatomy 1C Joshua Montelibano

1st shift 2015-2016

Triangle of Auscultation
Site on the back where breath sounds may be most easily heard with a microscope
Inferior: Superior border of the latissimus dorsi
Medial: Inferior fibers of the trapezius
Lateral: Medial border of the scapula

Lumbar Triangle
Site where pus may emerge from the abdominal wall (pus accumulation may
occur)
Inferior: Iliac crest
Medial: Inferior border of latissimus dorsi
Lateral: posterior border of the external oblique of the abdomen

Suboccipital Triangle
Medial: Rectus capitis posterior major
Lateral: Oblique capitis superior
Oblique capitis inferior

Triangular space
Superior: Teres minor
Inferior: Teres major
Lateral: Long head of triceps brachii
Contains circumflex scapular artery

Quadrangular space
Superior: Subscapularis
Inferior: Teres major
Medial: Long head of triceps brachii
Lateral: surgical neck of humerus
Contains Axillary nerve and Posterior circumflex humeral artery

Anatomy 1C Joshua Montelibano

1st shift 2015-2016

Arterial anastomosis around the shoulder joint

Anastomosis between the branches of the subclavian artery and axillary artery
Ensures adequate blood flow in upper limb irrespective of arm positioning

Branches from Subclavian artery

Suprascapular artery - distributed to the supraspinous and infraspinous
fossae of the scapula
Superficial cervical artery - gives off a deep branch running down the
medial border of the scapula
Branches from Axillar artery
Subscapular artery and its circumflex scapular branch - supply the subscapular and
infraspinous fossae of the scapula respectively
Anterior circmflex humeral artery
Posterior circumflex humeral artery
Both Circumflex arteries form an anastomosing circle around the surgical neck of the humerus

SHOULDER JOINT
Articulation: between rounded head of the humerus and shallow, pear-shaped glenoid cavity of the scapula
articular surfaces covered by hyaline cartilage; glenoid cavity deepened by glenoid labrum (fibrocartilaginous rim)
Type: Synovial ball-and-socket joint
Capsule: surrounds the joint and attached medially to the margin of the glenoid cavity outside the labrum
Thin and lax allows movement; strengthened by fibrous slips from the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor
Ligaments: Glenohumeral ligaments 3 weak bands of fibrous tissue, strengthen front of the capsule
Transverse humeral ligament strengthens the capsule and bridges the gap between 2 tuberosities
Coracohumeral ligament strengthens capsule above and stretches from the root of the coracoid process to the greater tuberosity of the humerus
Synovial membrane : lines the capsule and attached to margins of the cartilage covering the articular surfaces
extends through anterior wall of the capsule forms subscapularis bursa beneath subscapularis
Nerve supply: Axillar and suprascapular nerves

Anatomy 1C Joshua Montelibano

TOPOGRAPHIC ANATOMY

1st shift 2015-2016

Anatomy 1C Joshua Montelibano

MUSCLE ATTACHMENT and INSERTION

1st shift 2015-2016

Anatomy 1C Joshua Montelibano

CLAVICLE, SCAPULA and HUMERUS

1st shift 2015-2016