This document provides an overview of the anatomy of the arm and pectoral region. It describes the origins, insertions, innervations, and actions of muscles like the latissimus dorsi, pectoralis major and minor, serratus anterior, biceps brachii, triceps brachii, brachialis, and coracobrachialis. It also details the fascia, compartments, and structures of the arm, forearm, cubital fossa, and pectoral region including bones, muscles, vessels and nerves.

1. ANATOMY ANATOMY By Dr. THAAER MOHAMMED DAHER ALSAAD M.B.Ch.B.(MBBS) F.I.B.M.S.(Ph.D.) SPECIALIST IN GENERAL SURGERY SENIOR LECTURER IMS MSU

2. ARM AND HUMERUS Pectoral region

3. Pectoral regionTopographical Anatomy MIDAXILLARY LINE an imaginary vertical line passing through the middle of the axilla. used as a surface landmark for descriptive purposes. MIDCLAVICULAR LINE /(milk line) an imaginary vertical line passing through the midshaft of the clavicle used as a surface landmark for descriptive purposes.

4. DELTOPECTORAL/ clavipectoral fascia Is pierced by the following structures; Cephalic vein. Acromiothoracic artery. Lateral pectoral nerve.

5. DELTOPECTORAL TRIANGLE/ The clavipectoral triangle a triangle in the upper chest region that is bounded medially by the clavicle, superiorly by the deltoid muscle and inferiorly by the pectoralis major muscle this pierced by the cephalic vein on its course from the upper limb to join the axillary vein in the axilla. NIPPLE located superficial to the 4th intercostal space in the male and prepubertal female; areola is dark ring surrounding nipple, location of the left nipple may be used to help locate the apex of heart, which is approximately 8 cm from the midline in the left 5th intercostal space; a surface landmark used to place the stethoscope for auscultation of the bicuspid valve. SUPRASTERNAL NOTCH the notch located at the superior border of the manubrium of the sternum, between the sternal ends of the clavicles also known as: jugular notch. Topographical Anatomy

12. LATISSIMUS DORSI Origin; spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula. Insertion; floor of intertubercular groove of the humerus. Nerve; thoracodorsal nerve (C6 - C8). Actions; adducts, extends and internally rotates the arm. Antagonist deltoid, trapezius Artery; thoracodorsal branch of the subscapular artery

16. Poland's Syndrome /// is a congenital anomaly in which there is a malformation of the chest causing the pectoralis major on one side of the body to be absent. The latissimus dorsi and teres major also aid in adduction and medial rotation of the arm.

17. PECTORALIS MINOR ORIGIN; ribs 3-5 near their costal cartilages. INSERTION; medial border and superior surface of the coracoid process of the scapula.

18. PECTORALIS MINOR The Pectoralis minor is a thin, triangular muscle, situated at the upper part of the chest, beneath the Pectoralis major. Action It stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall. Nerve supply medial pectoral nerve (C8, T1). Arterial supply pectoral branch of the thoracoacromial trunk.

19. SERRATUS ANTERIOR ORIGIN; outer surface ribs 1-8 or 9 INSERTION; medial border of the scapula on its costal (deep) surface. Action it draws the scapula forward; the inferior fibers rotate the scapula superiorly. Nerve supply long thoracic nerve (from ventral rami C5-C7). Arterial supply lateral thoracic artery. Antagonist Rhomboid major, Rhomboid minor, Trapezius”

21. a lesion of long thoracic nerve will cause winging of the scapula (i.e., the medial border of the scapula falls away from the posterior chest wall and looks like an angel's wing) (Latin, serratus = to saw)The serratus anterior is occasionally called the "big swing muscle”

22. A patient with pronounced winging of the left scapula during active external rotation against resistance, typical of trapezius palsy Winging of the right scapula due to serratus anterior palsy, accentuated by active flexion of the arms

25. Subclavian groove On the medial part of the clavicle is a broad rough surface, the costal tuberosity (rhomboid impression), rather more than 2 cm. in length, for the attachment of the costoclavicular ligament. The rest of this surface is occupied by a groove, which gives attachment to the Subclavius; the coracoclavicular fascia, which splits to enclose the muscle, is attached to the margins of the groove. Not infrequently this groove is subdivided longitudinally by a line which gives attachment to the intermuscular septum of the Subclavius.

29. The brachial fascia ensheathes the arm and attaches inferiorly to the epicondyles and olecranon.

30. The medial and lateral intermuscular septa extend to the medial and lateral surface of the humerus.

31. This separates the arm into the anterior (flexor) and posterior (extensor) compartments.

39. ARM BRACHIUM Anterior and posterior compartments

40. ANTERIOR COMPARTMENTBBC BICEPS BRACHII. BRACHIALIS. CORACOBRACHIALIS.

42. Cross section of the upper arm just below the level of insertion of the deltoid muscle

43. Coracobrachialis muscle ORIGINCoracoid process of scapula with biceps brachii .

44. Coracobrachialis muscle INSERTIONUpper half medial border of humerus, between the origins of the Triceps brachii and Brachialis. ACTIONFlexes and weakly adducts arm NERVEMusculocutaneous nerve (C5, 6, 7) (from lateral cord)

48. BICEPS BRACHII The biceps is tri-articulate, meaning that it works across three joints. The most important of these functions are to supinate the forearm and flex the elbow. These joints and the associated actions are listed as follows in order of importance: Proximal radioulnar joint . Humeroulnar joint. Glenohumeral joint.

49. BICEPS BRACHII ORIGIN short head: coracoid process of the scapula. long head: supraglenoid tubercle. INSERTION; TENDONradial tuberosity. BICIPITTAL APONEUROSIS into deep fascia on medial part of forearm.

50. BICEPS BRACHII NERVE Musculocutaneous nerve (C5–C7). ACTIONS flexes elbow and supinates forearm. Antagonist Triceps brachii muscle.

51. STRUCTURES PASSING THROUGH THE ANTERIOR FASCIAL COMPARTMENT Brachial Artery. Musculocutaneous Nerve. Median Nerve. Ulnar Nerve. Radial Nerve

53. TRICEPS BRACHII - LATERAL HEAD

55. TRICEPS BRACHI NERVE SUPPLY Triceps is innervated by the radial nerve, C6, 7 and 8, with separate branches for each head (and axillary nerve (long head)). ACTION: extends forearm, caput longum adducts shoulder. Antagonist : Biceps brachii

56. STRUCTURES PASSING THROUGH THE POSTERIOR FASCIAL COMPARTMENT Radial Nerve. Ulnar Nerve. Profunda Brachii Artery. Superior and Inferior Ulnar Collateral Arteries.

57. Transverse section through the left arm at the junction of the proximal and middle thirds of the humerus: distal aspect

58. Transverse section through the left arm a little below the middle of the shaft of the humerus: distal aspect.

59. Transverse section through the left arm 2 cm above the medial epicondyle of the humerus: distal aspect.

61. Medially, pronator teres muscle

62. The base of the triangle, an imaginary line drawn between the medial and lateral epicondyles.

63. The floor of the fossa is formed by the supinator muscle laterally and the brachialis muscle medially.

65. artery-nerve layer 1 brachial artery 2 median nerve aponeurotic layer 1 bicipital aponeurosis 2 biceps tendon venous layer 1 cephalic vein 2 basilic vein 3 median cubital vein bony floor 1 humerus 2 radius 3 ulna muscular floor 1 supinator 2 brachialis 3 biceps tendon

66. CUBITAL FOSSA VENOUS LAYER Cephalic Vein Basilic Vein Median Cubital Vein

69. Median Nerve CUBITAL FOSSA

70. MUSCULAR FLOOR Supinator Brachialis Biceps Tendon CUBITAL FOSSA

71. BONY FLOOR Humerus Radius Ulna CUBITAL FOSSA

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