Upper limb lecture for Rehab residents

1. Anatomy Revision Session 1
slides are available online at
Slideshare.net/muradalshehry
After this session
The Upper Limb

2. Anatomy Revision Session 1
Objectives of this session
• To be able to Identify the muscles of the upper limb.
• Know relations of muscles to important nerves.
• There will be a few pop Quiz…. Stay focused ☺

3. Orientation and Movement REVISION
adduction
abduction
flexionextension
circumduction
rotation

4. elevation
depression
supination
pronation
protraction
retraction
Orientation and Movement REVISION

5. Pectoral girdle and shoulder joint
shoulder bones?
• Humerus
• Scapula
• Clavicle
The glenohumeral joint is a ball-and-socket
joint
• Flexible
• vulnerable

6. Pectoralis major
• Clavicle, costal cartilage ribs 1-6 and sternum to outer lip of
bicipital groove of the humerus
• Flexion and adduction of the arm, medial rotation of the
humerus
• Medial (C8-T1) and lateral (C5-7) pectoral nerves from the
medial and lateral cords of the brachial plexus

7. Pectoralis minor
• 3rd, 4th, 5th ribs to coracoid process of scapula
• Pulls shoulder anterior and inferior, or can elevate ribs if shoulder is fixed
• Medial pectoral nerve (C8,T1) from medial cord of brachial plexus

8. Serratus anterior
• Outer surface upper 8 ribs to medial border of the scapula
• Protraction of the scapula
• Long thoracic nerve (C5, 6, 7) of the brachial plexus

9. spine of
scapula
nuchal
ligament
A
B
C
Superior nuchal line, nuchal ligament, spinous processes of C7-T12 to lateral third of
clavicle, acromion and spine of scapula
Innervation = spinal accessory nerve (CN XI, motor), cervical plexus C3,C4 (pain)
A ascending part =
depress scapula
B
transverse part =
retracts scapula
C
descending part =
elevate scapula,
rotate glenoid
cavity
superior nuchal line
T12
Trapezius

10. Levator scapulae
• Transverse processes of atlas and axis,
3rd and 4th C vertebrae to medial
scapular border between superior
angle and medial end of scapular
spine
• Help control scapular position, elevate
shoulder (with trapezius), shoulder
fixed can laterally flex neck to the
same side
• Direct C3, 4 and C4 & C5 via dorsal
scapular nerve

11. Latissimus dorsi
• Ilium, thoracolumbar fascia, spinous process of lower 6 thoracic
vertebrae to floor of bicipital groove of humerus
• Extension, medial rotation and adduction of arm
• Climbing, chin-ups
• Thoracodorsal nerve, post. cord brachial plexus, C6-8
trapezius
LD

12. Levator scapulae
• Transverse processes of atlas and axis,
3rd and 4th C vertebrae to medial
scapular border between superior
angle and medial end of scapular
spine
• Help control scapular position, elevate
shoulder (with trapezius), shoulder
fixed can laterally flex neck to the
same side
• Direct C3, 4 and C4 & C5 via dorsal
scapular nerve

13. Rhomboideus major and minor
• Major from 2-5 thoracic spines to medial border of
scapula (spine to inferior angle)
• Minor from nuchal ligament and C7 to T1 thoracic spines
to medial end of spine of scapula
• Retraction of the scapula
• Dorsal scapular nerve C4-5
R

14. Deltoid
• Lateral 1/3rd clavicle, acromion, spine of scapula to deltoid
tuberosity of humerus
1. Abduction of the arm from 10o to 110o mostly middle fibres
2. Extension and lateral rotation of arm from posterior fibres
3. flexion and medial rotation of arm from anterior fibres
• Axillary nerve (C5,6) from posterior cord of brachial plexus
deltoid
POST

15. Teres major
• Lateral border of scapula (lower 1/3rd, posterior) to medial lip of
bicipital groove of humerus
• Adduction and medial rotation of the arm
• Subscapular branch of posterior cord of brachial plexus (lower C5-6)

16. Subclavius
• Sternal end of 1st rib to middle third of
underside of clavicle
• Draws down and slightly forwards
during abduction
• Nerve to subclavius C5,6
pectoralis
minor
Subclavius

17. Rotator cuff Muscles
 Group of four muscles that help to keep the head of the humerus
in the glenoid cavity of the scapula
 Prevent dislocation from very shallow joint with few other
supporting structures
T.I.S.S

18. Rotator cuff –
subscapularis
• Subscapular fossa (anterior scapula) to lesser tubercle of humerus
•Medially rotate arm
•Upper and lower subscapular nerves (C5,6,7) from posterior cord of
brachial plexus

19. Rotator cuff –
supraspinatus
• Supraspinous fossa of scapula to greater tubercle of humerus (upper facet)
• Abducts arm first 10-150
• Suprascapular nerve (C5,6) from superior trunk of brachial plexus

20. Rotator cuff –
infraspinatus
• Infraspinous fossa of scapula to greater tubercle of humerus (middle facet)
• Lateral rotation of arm
• Suprascapular nerve (C5,6) from superior trunk of brachial plexus

21. Rotator cuff –
teres minor
• Upper 2/3rds lateral border of scapula to greater tubercle of humerus
(lower facet)
• Lateral rotation of arm
• Axillary nerve (C5,6) branch of posterior cord of the brachial plexus

22. Quiz.1 you have 1 minute
Name the upper arm Abductor muscles, and which muscle abducts
more?

24. Anterior compartment of the arm
• Flexors of arm and elbow
• Musculocutaneous nerve
• Biceps brachii
• Coracobrachialis
• Brachialis

25. brachial fascia
medial intermuscular
septum
lateral intermuscular
septum
radial nerve
ulnar nerve
median nerve
musculocutaneous nerve

26. Biceps brachii • Long head from supraglenoid
tubercle of scapula
• Short head from coracoid process
• Insert into radial tuberosity
• Supination and flexion of elbow
(when supine)
• Long head prevent head of humerus
moving superiorly, short head resists
dislocation
• Weak flexion of arm
• Musculocutaneous nerve (C5-7)
long
head
short
head
bicipital aponeurosis

27. Coracobrachialis
• From coracoid process
of scapula
• Insert medial mid-
shaft humerus
• Flexion of arm (also
adduction)
• Pierced and supplied
by the
musculocutaneous
nerve (C5-7)

28. Brachialis
• Distal half of anterior surface
of the humerus
• Inserts on ulnar tuberosity
and coronoid process
• Under biceps brachii
• Flexion of the elbow
• Musculocutaneous (C5,6)
nerve (small component of
lateral fibres from radial
nerve (C7)

29. Posterior compartment of the arm –
Triceps
• Triceps brachii
• Long head from infraglenoid
tubercle of the scapula
• Medial head from posterior
surface of shaft of humerus
(inf. to radial groove)
• Lateral head from humerus
superior to radial groove
• Insert olecranon of ulna
• Extends elbow joint
• Long head resists dislocation
(especially during adduction)
• Radial nerve (C6-8)
long
head lateral head
(medial head
underneath)

30. Forearm

31. Anterior compartment of the forearm
• Flexion of the wrist, digits
• Pronation
• Common flexor origin = medial epicondyle
of the humerus
• Median nerve dominated except flexor
carpi ulnaris and the ring/little finger side
of flexor digitorum profundus (ulnar nerve)
medial
epicondyle

32. Palmaris longus
• Most superficial
• From medial epicondyle
to palmar fascia
(aponeurosis)
• Tighten aponeurosis and
aids with wrist flexion
• Not present in everyone
• Median nerve (C7,8)

33. Pronator teres
• Medial epicondyle of humerus and
coronoid process of the ulna to
lateral surface of radius
• Pronation (assists elbow flexion)
• Median nerve (C6,7)
biceps
humeral
head
ulnar
head
median nerve

34. Flexor carpi ulnaris and radialis
• Both from medial epicondyle and
both flex the wrist
• Ulnaris = base pisiform, hamate,
5th metacarpel
• Adduction of wrist
• Ulnar nerve (C7-C8)
• Radialis = base 2nd metacarpal
• Abduction of wrist
• Median nerve (C6,7)
flexor
carpi
ulnaris
flexor
carpi
radialis