2Muscles That Move the Pectoral Girdle Originate on the axial skeleton and insert on the clavicle and scapula.Stabilize the scapula and move it to increase the arm’s angle of movements.Some of the superficial muscles of the thorax are grouped together according to the scapular movement they direct.elevation, depression, protraction, or retraction
3The muscles of back Superficial group Deep group Trapezius Latissimus dorsiLevator scapulaeRhomboideusDeep groupErector spinaeSpleniusThoracolumbar fascia
7The Muscles of Upper Limb Muscles of shoulderDeltoidSupraspinatusInfraspinatusTeres minorTeres majorSubscapularis
8Major muscles of shoulder DeltoidOrigin: lateral third of clavicle, acromion, and spine of scapulaInsertion: deltoid tuberosity of humerusAction: abduction, flexion and extension, medial and lateral rotation of arm
9Major muscles of shoulder Teres majorOrigin: dorsal surface of inferior angle of scapulaInsertion: crest of lesser tubercle of humerusAction: medially rotates and adducts arm
10Arm and Forearm Muscles That Move the Elbow Joint/Forearm Anterior (flexor) compartmentPosterior (extensor) compartmentAnterior compartmentprimarily contains elbow flexorsPosterior compartment contains elbow extensorsthe principal flexorsbiceps brachii, brachialis, and brachioradialismuscles that extend the elbow jointtriceps brachii and anconeus
12Muscles of arm Antererior group Posterior group Biceps brachii CoracobrachialisBrachialisPosterior grouptriceps brachiianconeus
13Muscles of arm Biceps brachii Origin: long head, supraglenoid tubercle; short head, coracoid processInsertion: radial tuberosityAction: supinator of forearm, flexor of elbow joint, weak flexor of should joint
14Muscles of arm Triceps brachii Origin: Insertion: olecranon of ulna long head, infraglenoid tuberclelateral head, above groove for radial nervemedical head, below groove for radial nerveInsertion: olecranon of ulnaAction: extends elbow joint, long head extends and adducts shoulder joint
16Forearm Muscles Supinate and Pronate Supinator muscle supinates the forearm.Biceps brachii supinates the forearm.Pronator teres and pronator quadratus pronate the forearm.Move the Wrist Joint, Hand, and FingersMuscles in the forearm move the hand at the wrist and/or the fingers.Extrinsic muscles of the wrist and hand originate on the forearm, not the wrist or hand.Tendons of forearm muscles typically are surrounded by tendon (synovial) sheaths and held adjacent to the skeletal elements by strong fascial structures.At the wrist, the deep fascia of the forearm forms thickened, fibrous bands termed retinacula.
23Posterior group (8) Superficial layer (3) Extensor digitorum Extensor digiti minimiExtensor carpi ulnarisAction: extension at wrist joint
24Posterior group (8) Deep layer (5) Supinator Abductor pollicis longus Extensor pollicis brevisExtensor pollicis longusExtensor indicisAction: extend at wrist joint and fingers, and supinate forearm
25Muscles of hand Lateral group thenar (4) Abductor pollicis brevisFlexor pollicis brevisOpponens pollicisAdductor pollicisAction: flex, abduct, adduct and oppose thumbMedial group hypothenar (3)Abductor digiti minimiFlexor digiti minimi brevisOpponens digiti minimiAction: flex, abduct , and oppose little finger
26Muscles of hand Intermedial group Lumbricales (4) flex fingers at MP joints; extend fingers at IP jointsPalmar interossei (3) adduct fingers towards middle finger at MP jointsDorsal interossei (3) abduct fingers away from middle finger at MP joints
27Arteries of upper limb Axillary artery Continuation of subclavian artery at lateral border of first ribBecomes brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above muscle－gives rise to thoracoacromial a.Second portion, behind muscle－gives rise to lateral thoracic a.Third portion, below muscle－gives rise to subscapular a., anterior and posterior humeral circumflex a.; the former then divides into throcodorsal a. and circumflex scapular a.
29Arteries of upper limb Brachial artery Continuation of axillary artery Divides into radial and ulnar arteries at level of neck of radiusBranchesDeep brachial a. accompanies with radial nerveSuperior ulnar collaeral a. accompanies with ulnar nerveInferior ulnar collateral a.
30Arteries of upper limb Radial artery and branches Radial recurrent a. Superfical palmar branchPrincipal artery of thumbUlnar artery and branchesUlnar recurrent a.Common interosseous arteryAnterior interossous a.Posterior interosseous a.Deep palmar branch
31Arteries of upper limb Superficial palmar arch Formed by ulnar artery and superficial palmar branch of radial arteryCurve of arch lies across the palm, level with the distal border of fully extended thumbGives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries
32Arteries of upper limb Deep palmar arch Formed by radial artery and deep palmar branch of ulnar arteryCurve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries
33Veins of the upper limbDeep veins: accompany the arteries of the same region and bear similar namesSuperficial veinsCephalic veinArises from the lateral side of the dorsal venous rete of handAscends on radial side of the forearm to the elbow and then in the lateral side of biceps brachii furrow, continues up the arm in the deltopectoral groove and then to the infraclavicular fossa, where it pierces clavipectoral fascia to drain into axillary vein
34Basilic vein Median cubital vein Arises from the medial side of the dorsal venous rete of handAscends on the ulnar side of forearm to the elbow and then in the medial bicepital brachii furrow to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary veinMedian cubital veinlinks cephalic vein and basilic vein in the cubital fossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood
35The lymphatic drainage of upper limb Lymphatic vesselsSuperficial－follow the superficial veins, drain into supratrochlear and axillary lymph nodesDeep－accompany main vessels, end in axillary lymph nodeslymph nodesCubital lymph node: lies above medial epicondyle of humerusAxillary lymph node－arranged in five groups
36Axillary lymph nodes Arranged in five groups Lateral lymph nodes lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and handPectoral lymph nodes lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mammaSubscapular lymph node along subscapular vessels, receive lymph from nape and scapular regionEfferents above three groups pass to central lymph node
37Central lymph node Apical lymph node lie in fat of axillary fossa, receive drainage from all the above nodes, efferents pass to apical lymph nodeApical lymph nodeLie in the apex of the axilla, along the proximal end of axillary vesselsReceive drainage chiefly from central lymph node , upper portion of mammaEfferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct
38Brachial plexus Formation: Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5-C7give rise to long thoracic n.Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk is the continuation of root C7.The lower trunk is formed by the joining of root C8 and T1.Six divisions: above clavicle, trunks form anterior and posterior divisionsThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a.
39Position: Main branches passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cordsMain branchesLateral cordMusculocutaneous n.Lateral root to median n.Medial cordMedial root to median n.Ulnar n.Medial brachial cutaneous n.Medial antebrachial cutaneous n.
40Posterior cordradial n.axillary n.thoracodorsal n.
41MusculocutaneousDistribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm
42Median nerveDistribution: Flexors of forearm except brachioradialis, flexor carpi ulnaris and ulnar half of flexor digitorum profundus, thenar except adductor pollicis, first two lumbricals; skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum.Injury: Apehandproduces sign of benediction, in which the index and middle fingers cannot be flexed and the thumb cannot be opposed
43Ulnar nerveDistribution: Flexor carpi ulnaris, ulnar half of flexor digitorum profundus, hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingersInjury: clawhand
44Radial nerveDistribution: Extensor muscles of arm and forearm, brachioradialis; skin on back of arm, forearm, and radial side of dorsum of hand and radial two and one-half fingersInjury: Wristdrop
45AxillaryDistribution: Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of armInjury: results in deltoid and teres minor paralysis (loss of shoulder abdution and weel external rotation) with loss of sensation over the deltoid