the upper limb iii the brachial...
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The Upper Limb IV
Muscles
AnatomyRHS 241
Lecture 13Dr. Einas Al-Eisa
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Humerus
• Articulates with the glenoid surface of the scapula to form the “glenohumeral joint”
• Articulates with the radius & ulna to form the “elbow joint”
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Humerus
• Proximal end:
Head
Anatomical & surgical neck
Greater & lesser tubercles
Bicipital (intertubercular) groove
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Humerus
• Distal end:
Medial & lateral epicodyles
Capitulum (articulates with the proximal surface of the head of radius)
Trochlea (articulates with the trochlearnotch of the ulna)
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Muscles of the pectoral region
• Pectoralis major:large muscle covering most of the upper part of the thorax
forms the wall of the axilla as it extends across to attach to the humerus
at its insertion, it passes deep to the deltoid, but superficial to the coracobrachialis and the short head of biceps brachii
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Pectoralis major
• Origin:medial two-thirds of claviclesternum costal cartilage 1-6
• Insertion:lateral lip of intertubercular groove (crest of greater tubercle of humerus)
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Pectoralis major
• Action:adduction & medial rotationclavicular fibers (working alone): flexion such as touching the lobe of the opposite earsternocostal fibers (working alone): extension of arm if the arm is already flexed
• Innervation:medial & lateral pectoral nerves
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Pectoralis major
• All or most of this muscle is removed in radical mastectomy (removal of the breast & surrounding diseased tissue)
• The approximately normal movement of the arm in the absence of this muscle indicates the role of the coracobrachialis & anterior fibers of deltoid in substituting this muscle
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Pectoralis minor
• Origin:Ribs 3-5
• Insertion:Coracoid process of scapula
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Pectoralis minor
• Action:depression of shoulderdownward rotation of scapula
• Innervation:medial pectoral nerve
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Muscles of the shoulder proper
• Sternocleidomastoid:• Subclavius• Trapezius• Latissimus dorsi• Levator scapulae• Rhomboids• Serratus anterior• Deltoid• Rotator cuff
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Sternocleidomastoid
• Origin:Sternum (tendinous head)Medial third of clavicle (muscular head)
• Insertion:Mastoid process of skull
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Sternocleidomastoid
• Action:Unilateral (one side): flexion of neck toward the same side (bringing the ear to clavicle)Bilateral action: neck flexion (like in raising the head when in supine)
• Innervation:Accessory nerve (11th cranial nerve)
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Subclavius
• Origin:Rib 1
• Insertion:Undersurface of clavicle
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Subclavius
• Action:Possibly depress clavicleHelp rise the 1st ribMaintain the sternoclavicular joint
• Innervation:Tiny branch from the upper trunk of brachial plexus
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Trapezius• Origin:
External occipital protuberanceLigamentum nuchaeSpinous processes of C7 and all thoracic vertebrae
• Insertion:Spine of scapulaAcromionLateral third of clavicle
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Trapezius
• Action:Upper fibers: elevation of scapulaMiddle fibers: retraction of scapulaInferior fibers: depression of scapulaUpward rotation of scapula
• Innervation:Accessory nerveSensory: C3 & C4
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Latissimus dorsi
• Origin:Spinous processes of lower 6 thoracic vertebrae & all lumbar and sacral vertebraePosterior part of iliac crest
• Insertion:Medial lip (crest of lesser tubercle)Floor of intertubercular groove of humerus
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Latissimus dorsi
• Action:Extension of armAdductionMedial rotation
• Innervation:Thoracodorsal nerve
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Levator scapulae
• Origin:Transverse processes of upper 4 cervical vertebrae
• Insertion:Superior angle of scapula
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Levator scapulae
• Action:Elevation of scapula
• Innervation:C3 & C4(sometimes receives innervation from dorsal scapular nerve)
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Rhomboid minor
• Origin:Lower part of ligamentum nuchaeSpinous processes of C7 & T1
• Insertion:Medial boarder of scapula at the base of spine
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Rhomboid minor
• Action:elevation & retraction of scapuladownward rotation of glenoid cavity
• Innervation:dorsal scapular nerve (C5)
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Rhomboid major
• Origin:Spinous processes of 2nd to 5th thoracic vertebrae
• Insertion:Medial boarder of scapula below rhomboid minor
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Rhomboid major
• Action:elevation & retraction of scapuladownward rotation of glenoid cavity
• Innervation:dorsal scapular nerve (C5)
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Serratus anterior
• Origin:Ribs 1-8 on antero-lateral thoracic wall
• Insertion:Medial boarder of scapula Heaviest insertion on inferior angle
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Serratus anterior
• Action:protraction of scapulaupward rotation of glenoid cavityholds medial boarder of scapula against thoracic wall
• Innervation:Long thoracic nerve (C5)
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Deltoid
• Origin:Lateral third of clavicleAcromionSpine of scapula
• Insertion:Deltoid tuberosity on shaft of humerus
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Deltoid
• Action:Anterior fibers: flexion & medial rotationPosterior fibers: extension & lateral rotationMiddle fibers: abduction
• Innervation:Axillary nerve
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Supraspinatus
• Origin:Supraspinous fossa of scapula
• Insertion:Greater tubercle of humerus
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Supraspinatus
• Action:Abduction of arm
• Innervation:Suprascapular nerve
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Infraspinatus
• Origin:Infraspinous fossa of scapula
• Insertion:Greater tubercle of humerus below supraspinatus
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Infraspinatus
• Action:Lateral rotation of arm
• Innervation:Suprascapular nerve
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Teres minor
• Origin:Upper two-thirds of lateral boarder of scapula
• Insertion:Greater tubercle of humerus below infraspinatus
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Teres minor
• Action:Lateral rotation of arm
• Innervation:Axillary nerve
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Teres major
• Origin:Inferior angle of scapula
• Insertion:Medial lip of intertubercular groove of humerus
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Teres major
• Action:Adduction Extension & medial rotation of arm
• Innervation:Lower subscapular nerve
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Subscapularis
• Origin:Subscapular fossa of scapula
• Insertion:Lesser tubercle and crest of humerus
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Subscapularis
• Action:Medial rotation of arm
• Innervation:Upper & lower subscapular nerves
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Rotator (musculotendinous) cuff
• Supraspinatus• Infraspinatus• Teres minor• Subscapularis
• As the tendons of these muscles cross the shoulder joint, they are closely applied to the joint capsule
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Rotator (musculotendinous) cuff
• Aid in stabilizing the joint by holding the head of humerus in the glenoid cavity
• No tendons are present to support the inferior part of the joint (possible dislocation in that area)