e104
SECTION 6 Upper Limb Study Guide
CLINICAL POINTS
WINGED SCAPULA
Normally the scapula is held closely against the posterior
thoracic wall. Damage to the long thoracic nerve to serratus
anterior (which courses superficially over the muscle) causes
winging of the scapula as its medial border lifts away from
the thorax when the arm is raised. This is accentuated when
the individual leans on the hand or pushes the upper limb
against a wall. Most importantly, the arm cannot be abducted
above the horizontal plane because glenoid cavity cannot
be rotated upward without the action of the serratus
anterior.
6.2 SHOULDER AND AXILLA
Study Aims
At the end of your study, you should be able to:
Identify the different parts and surface markings of the
clavicle and scapula
Describe the sternoclavicular, acromioclavicular, and gleno-
humeral joints, their movements, and supporting
ligaments
Understand the organization of the scapular muscles
Know the origins, insertions, and actions of the intrinsic
scapular muscles
Identify the boundaries of the axilla and describe its
contents
Describe the organization of the deep fascia
GUIDE
BONES
Clavicle: sternal and acromial ends
Double-curved long bone
Sternal end articulates with manubrium of sternum
Acromial end articulates with acromion
Osteological features
Deltoid tubercle for attachment of deltoid muscle
Conoid tubercle for attachment of conoid ligament
Subclavian groove for attachment of subclavius
muscle
Trapezoid line where trapezoid ligament attaches
Serves as a strut suspending scapula and limb with
maximum freedom
Scapula: lying against posterolateral thorax
Triangular, flat bone
Lies posterolateral on 2nd through 7th ribs
Osteological features
Concave costal surface = subscapular fossa
Posterior surface divided by spine = transverse ridge
of bone
Supraspinous fossa
Infraspinous fossa
Acromion = flattened lateral end of spine
Coracoid process = anterior projection above glenoid
cavity
Glenoid cavity = socket for head of humerus
Suprascapular notch (scapular notch) = notch found
on superior border, two thirds of way along
laterally
Capable of considerable movement over thoracic wall
JOINTS
Sternoclavicular joint
Saddle-type, synovial joint
Divided into two compartments by an articular disc
Movements
Elevation with posterior rotation
Protraction
Depression
Articulation between concave facet of manubrium and
concave facet of clavicle
Strengthened by anterior and posterior sternoclavicu-
lar, costoclavicular, and interclavicular ligaments
Blood supply: branches of suprascapular and internal
thoracic arteries
Nerve supply: branches of supraclavicular nerve and
nerve to subclavius
Acromioclavicular joint
Plane-type, synovial joint
No demonstrable movement; muscles moving scapula
cause acromion to move on clavicle
Articulation between concave facet of acromion and
convex facet of clavicle
Strengthened by acromioclavicular and coracoclavicu-
lar (conoid and trapezoid) ligaments
Coracoclavicular
Unites coracoid process and clavicle
Two component ligaments: conoid: vertical, in shape
of inverted pyramid; trapezoid: horizontal, extends
laterally to inferior surface of clavicle
Blood supply: branches of suprascapular and thoraco-
acromial arteries
Nerve supply: branches of supraclavicular, lateral pec-
toral, and axillary nerves
Shoulder (glenohumeral) joint
Multiaxial, synovial ball-and-socket joint
Movements
Flexion/extension
Abduction/adduction
Internal/external (medial/lateral) rotation
Circumduction
Articulation of head of humerus with shallow glenoid
cavity of scapula
Joint socket deepened by glenoid labrum (fibrocarti-
laginous ring) and supported by the rotator cuff
muscles (see below)
Loose fibrous capsule encloses and contains two
apertures
Between tubercles of humerus for passage of long
head of biceps brachii, which attaches to supragle-
noid tubercle within joint
Anterior opening, inferior to coracoid process, for
communication between subscapular bursa and
synovial cavity of joint
Blood supply: branches of anterior and posterior cir-
cumflex humeral arteries from axillary and suprascapu-
lar artery from subclavian