anatomy: the shoulder girdle shoulder spaces axilla the arm
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The Upper Limb:The Upper Limb:
Pectoral (Shoulder) GirdlePectoral (Shoulder) Girdle
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Upper Limb DivisionsUpper 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. Handcontain carpals, metacarpals
& phalanges
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Bones of the PectoralBones of the Pectoral
GirdleGirdle
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Importance of the clavicle:Importance of the clavicle:
Connects upper limb to axial skeleton (strut)
Transmits shocks from upper limb to axialskeleton
Protects neurovascular bundle that supply theupper limb
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Clinical:Clinical: Fractures of ClavicleFractures of Clavicle
Common
indirect impact to upper limb
Between middle & lateral thirds
Medial part / lateral
-Shoulder drop
-Medial rotation of humerus
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Scapula (shoulder blade)Scapula (shoulder blade)
Triangular flat boneTriangular flat bone
3 borders3 borders
3 angles3 angles
2 surfaces:2 surfaces:
Anterior (Anterior (costalcostal) surface) surface
22ndnd 77thth ribsribs
Posterior (Posterior (spinousspinous) surface) surface
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Left Scapula (Posterior Aspect)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
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Humerus (brachial bone)Humerus (brachial bone)
The arm bone
Articulates with:
Scapula (shoulder joint)
Radius & Ulna (elbow joint)
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Joints of Pectoral GirdleJoints of Pectoral Girdle
3 Joints:
Sterno-clavicular joint
Gleno-humeral joint
(Shouldar joint)
Acromio-clavicular joint
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SternoSterno--ClavicularJointClavicularJoint
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 absorberShock absorber
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GlenoHumeral (Shoulder) JointGlenoHumeral (Shoulder) Joint
Type: Synovial (ball & socket)
Articulations:
Head of humerus
Glenoid cavity of scapule
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Ligaments ofshoulder joint:
1. Fibrous Capsule
2. Gleno-humerallig.(3)
3. Coraco-humerallig.
4. Transversehumeral lig.
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Movements of shoulder joint:
CircumductionIncludes??
Characteristics:
The fibrous capsule is Weak inferiorly
due to:
1. penetrated inferiorly by tendon of longhead of triceps
2. Joint is surrounded (stabilized) by groupof muscles called: Rotator Cuff muscles
*except inferiorly
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Acromio-clavicular joint
Synovial plane
Articulation betweenacromion process andlateral end of clavicle
Reinforced by sup andinf acromio-clavicularligaments
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Muscles of The Shoulder Region:Muscles of The Shoulder Region:
ThoracoThoraco--appendicular Musclesappendicular Muscles
& Scapulo& Scapulo--humeral Muscleshumeral Muscles
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AnteriorAnterior ThoracoappendThoracoappend MusclesMuscles
Pectoralis Major
Pectoralis Minor
Serratus Anterior
Subclavius
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Pectoralis MajorPectoralis Major
Fan shape muscle
Origin:
Clavicular & sternocostal heads
Insertion:
Humerus
Innervation:
Medial & Lateral pectoral nerves
Action:
Adduction of humerus
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Pectoralis MinorPectoralis Minor
triangular shaped muscle
Origin:
3rd, 4th & 5th ribs
Insertion:
Coracoid process
Innervation:
Medial pectoral nerves
Action:
Depress scapula, elevate ribs
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Pectoralis Major & MinorPectoralis Major & Minor
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Serratus Anterior MuscleSerratus 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
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Clinical: Winged ScapulaClinical: Winged Scapula
Medial border of scapula hangsaway from thoracic wall
1. Damage to serratus anterior m.
2. Injury to long thoracic n.
During fights
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Winged Scapula
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SubclaviusSubclaviusSmall muscle that extends:
Middle 1/3 of clavicle
1st costal cartilage
Innervation:Nerve to subclavius
Action:
Depresses the clavicle
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PosteriorPosterior ThoracoappendicularThoracoappendicular MusclesMuscles
Only names to be able to distinguish them in the lab
Trapezius
Latissimus dorsi m.
Levator scapulae
Rhomboid major
Rhomboid minor
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ScapuloScapulo--humeral Muscleshumeral MusclesRead the table in your book for innervation, origin, insertion &Read the table in your book for innervation, origin, insertion &
main actionmain action
Deltoid
Teres Major
Teres Minor
Supraspinatus
Infraspinatus
subscapularis
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Rotator Cuff MusclesRotator Cuff Muscles
4 muscles that inserted around shoulder joint & form amusculotendinous cuff
Cover the joint from 3 directions:
Superior: supraspinatus
Anterior: subscapularis
Posterior: infraspinatus & teres minor
Fxn.
Stabilize shoulder joint
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Shoulder Intermuscular SpacesShoulder Intermuscular Spaces
&&
The AxillaThe Axilla
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Quadrangular SpaceQuadrangular Space
Lateral to triangular space
Boundaries:
Sup.:
Inf.:
Med.:
Lat.: surgical neck of humerus
Contents:
Axillary n. (which muscles??)Post. circumflex humeral vessels
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The AxillaThe Axilla
A pyramidal space between upper part of the arm & the side ofchest 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
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Anterior Wall:
Pect. Major
Pect. minor
Subclavius
Clavipectoral Fascia:
Deep fascial layer that extends
from clavicle & covers
pect. Minor & subclavius
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Posterior Wall:
Subscapularis
Teres major
Latissimus dorsi
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Medial Wall:
1st 4th ribs
& intercostal musclesinbetween
Overlying serratus ant. m.
Lateral Wall:
Intertubercular groove
of the humerus
Containing???
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Contents of The AxillaContents of The Axilla
Axillary artery
Axillary vein
Axillary lymph nodes
Brachial plexus
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Axillary ArteryAxillary 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. Minorinto 3 parts
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Axillary ArteryAxillary Artery
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1st part:
Outer border of 1st rib
Medial border of pect. Minor
One branch:
Sup. (highest) thoracic a.
2nd part:
Post. to pec. Minor
2 branches:Thoracoacromial a.
Lateral thoracic a.
3rd part:
Lat. border of pec. minor
lower border of teres major
3 branch:
Subscapular a.(largest branch of axillary)
Ant. circumflex humeral a.
(in front of surgical neck)
Post. circumflex humeral a.
(behind the surgical neck)
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Scapular AnastomosesScapular 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.
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Clinical Importance ofClinical Importance of
Scapular AnastomosesScapular 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.
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Axillary VeinAxillary Vein
Medial to axillary a.
Starts:
At lower border of teres major
By union of:
brachial veins + basilic vein
Ends:
Lat.B
order of 1
st
ribTo become subclavian v.
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Axillary Lymph NodesAxillary Lymph Nodes
5 groups:
Pectoral (ant.)Lat. Border of pec. Minor
Subscapular (post.)In front of subscap.
Humeral (lateral)Medial to axillary v.
CentralEmbedded in fat
Apical
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Apical L.N.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
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Clinical: Enlargement of Axillary L.N.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
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Brachial PlexusBrachial Plexus
Composed of:
Roots
(in post. triangle of theneck)
Trunks
(above the clavicle)
Divisions
(post. to the clavicle)
Cords (within the axilla)
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Roots
Dorsal scapular nerve (C5)
(supplies the rhomboids and
levator scapulae
Long thoracic nerve (C5, 6, and 7)
Upper trunk
Nerve to subclavius (C5 and 6)
Suprascapular nerve (supplies thesupraspinatus and infraspinatus
muscles)
Lateral cord
Lateral pectoral nerveMusculocutaneous nerve
Lateral root of median nerve
Medial cord
Medial pectoral nerve
Medial cutaneous nerve of
arm and medial cutaneousnerve of forearm
Ulnar nerve
Medial root of median nerve
Posterior cord
Upper and lower subscapularnerves
Thoracodorsal nerve
Axillary nerve
Radial nerve
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The ArmThe Arm
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Bone of Arm:Bone of Arm: HumerusHumerus
Long bone that articulates:
Sup.:
To scapula at shoulderjoint
Inf.:
To radius & ulna at elbowjoint
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Upper partUpper 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 way on lat. Aspect of humerus
- site for deltoid m. attachment
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1. Radial Fossa
2. Lateral Epicondyle
3. Capitulum
4. Trochlea
5. Medial Epicondyle
6. Coronoid Fossa
7. Olecranon Fossa
Right Humerus, Lower partRight Humerus, Lower part
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Humerus FracturesHumerus Fractures
1. Fracture of the surgical neck:1. Fracture of the surgical neck:
Common in elderly (osteoporosis)
due to falls down
injury to circumflex arteries
&/or axillary n.
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2. Transverse fracture of2. Transverse fracture of
humerus shaft:humerus shaft:
direct blow to the arm
injury to radial n.
displacement depends onrelation to deltoid insertion
below deltoid tuberosity:
upperJ laterally (deltoid)
lowerJ superiorly (biceps)
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3. Supracondylar fracture:3. Supracondylar fracture:
fractures of the distal part of humerus
injury to median n.
4. Fracture of medial epicondyle:4. Fracture of medial epicondyle:
pulls the epicondyle inferiorly
weakness in fingers/hand flexion
injury to ulnar n.
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Fascial Covering of The ArmFascial 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
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Muscles of The ArmMuscles of The Arm
Anterior:Biceps Brachii
Brachialis m.
Coracobrachialis
Posterior:
Triceps m.:
LongLat.
Med.
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Biceps Brachii MuscleBiceps Brachii Muscle
Origin (2 heads)Short: coracoid process
Long: supraglenoid tubercle of scapula
Insertion
Radial tuberosityBicipital aponeurosis (to deep fascia)
Innervation
Musculocutaneous n.
Action
Flexion of forearm,
Supination of forearm
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Brachialis MuscleBrachialis Muscle
Beneath biceps brachii m.
Origin
Ant. lower of humerus
InsertionCoronoid process & tuberosity of ulna
Innervation
Musculocutaneous n.
Action
Flexion of forearm (main)
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Coracobrachialis MuscleCoracobrachialis Muscle
OriginCoracoid process of scapula
Insertion
Medial aspect of humerus shaft
Innervation
Musculocutaneous n.
Action
Weak flexor & adductor of the arm
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Triceps MuscleTriceps Muscle
Origin (3 heads)Long: infraglenoid tubercle of scapula
Lat.: sup. of post. aspect of humerus shaft
Med.: inf. of post. aspect of humerus shaft
Insertion
Olecranon process of ulna
Innervation
Radial n.
Action
Extension of forearm
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Nerves of the ArmNerves of the Arm
4 main nerves:
Musculocutaneous n.
Median n.
Ulnar n.
Radial n.
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Musculocutaneous NerveMusculocutaneous Nerve
Pass throughcoracobrachialis m.
Goes inferolaterally
between biceps brachii
& brachialis m.
Innervates all 3 muscles
of ant. arm
Continue distally as:
Lateral cutaneous n. of
forearm
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Median NerveMedian Nerve
Formed by (whichcords?)
Runs in the bicipital
groove
Upper : lat. to
brachial a.
Lower : med. to
brachial a.
Enters cubital fossa
at elbow
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Bicipital GrooveBicipital Groove
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Ulnar NerveUlnar 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
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Radial NerveRadial 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
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Brachial ArteryBrachial Artery
Starts:At lower border of teres major m.
As a continuation of axillary a.
EndsIn cubital fossa, opposite to radialneck
By dividing into:
Radial & Ulnar a.
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Pass in bicipital groove
Upper 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
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Veins of The ArmVeins of The Arm
Superficial Veins:Cephalic v.
Basilic v.
Deep Veins:Brachial v.
(vena comitans: L, accompanying
vein)
pair of veins on the sides ofbrachial a.
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Cephalic VeinCephalic 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.
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Basilic VeinBasilic 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