1. Regional Anatomy of Upper Limb
Pectoral & Shoulder Region
Dr. Kumar K.V
Associate Professor

2. Parts and regions Shoulder region: junction of arm and trunk
Arm: between shoulder and elbow
Elbow: bend of arm, joint between arm and forearm
Forearm: between elbow and hand
Hand

3. Pectoralis major
Origin: medial half of clavicle,sternum,1th-6th costal cartilages.
Insertion: crest of greater tubercle of humerus.
Action: flexes, adducts and rotates arm medially; arm fixed, elevates trunk; elevates ribs 1-6,helping in forced inspiration.

4. The muscles of thorax Extrinsic muscles Intrinsic muscles
Deltoid
Extrinsic muscles
Pectoralis major
Pectoralis minor
Serratus anterior
Intrinsic muscles
Intercostales externi
Intercostales interni
Intercostales intimi

5. Mammary Gland Position
Lie in superficial fascia over the pectorals major and pectoral fascia
Extend from 3rd to 7th ribs vertically, and from parasternal line to midaxillary line transversally

6. Structures contains skin, mammary glands and adipose tissue
Each breast has about lobes of mammary gland
Each lobe radiates out from the nipple and has a lactiferous duct, which opens separately on the summit of the nipple and possesses a dilated lactiferous sinuses just prior to its termination

7. Suspensory ligaments of breast(cooper’s ligaments):strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands
Suspensory ligaments

8. Axilla
The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity

9. Boundaries
The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle.
The base: skin and fascia of the axillary fossa

10. The broad medial wall: serratus anterior: intercostal muscles and upper four ribs
The narrow lateral wall: coracobrachialis, biceps brachii and intertubercular groove
Contents
Brachial plexus, axillary a. and principal branches, axillary v. and tributaries, axillary lymph nodes and loose connective tissue
Lateral View
Axilla as seen from above

11. The anterior wall
Pectoralis major, pectoralis minor and subclavius muscles
Clavipectoral fascia
The deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles
The structures pass through the clavipectoral faxcia
Cephalic v.
Thoracoacromial a.
Lateral pectoral n.

12. The posterior wall: teres major, latissimus dorsi, subscapularis and scapula
Trilateral and quadrilateral foramina
Between the subscapularis and teres major, there is a long triangular space whose lateral side is surgical neck of humerus. The long head of triceps brachii subdivides this space into a medial trilateral foramen and a lateral quadrilateral foramen.
The posterior humeral circumflex a. and axillary n. pass through the quadrilateral foramen.
The circumflex scapular a. passes through the triangular space to reach the dorsum of the scapula.

13. Brachial plexus Formation:
Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5～C7give rise to long thoracic n.
Three trunks
The 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 divisions
Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a.

14. Ventral Rami of Spinal Nerve
Dorsal Root
Dorsal Ramus of spinal nerve
Ventral Ramus of spinal nerve
spinal nerve
Ventral Root

15. Parts of Brachial Plexus
Really Tired? Drink Coffee Boys!
R = ROOTS (ventral rami)
T = TRUNKS
D = DIVISIONS
C = CORDS
B = BRANCHES

16. Axillary artery
Continuation of subclavian artery at lateral border of first rib
Becomes brachial artery at lower border of teres major
Divided into three parts by overlying pectoralis minor
First 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.

17. Veins SUPERFICIAL Cephalic (arm-forearm) Basilic (arm-forearm) DEEP
Median Cubital (elbow)
Median Vein
SF. Palmar Venous Arch
Digital
DEEP
Subclavian (neck)
Axillary (axilla)
Brachial (arm-elbow)
Radial (forearm)
Ulnar (forearm)
Deep Palmous Venous arch

18. Axillary lymph node－arranged in five groups
Lateral lymph nodes－lie around the distal end of axillary artery vein , receive afferent vessels from upper limb.
Pectoral lymph nodes－lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma
Subscapular lymph node－along subscapular vessels, receive lymph from nape and scapular region
Efferents above three groups pass to central lymph node
Central lymph node－lie in fat of axillary fossa, receive lymph from all the above nodes, efferents pass to apical lymph node
Apical lymph node－lie in the apex of the axilla, along the proximal end of axillary vessels, receive afferents chiefly from central lymph node , upper portion of mamma; efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct

19. Major muscles of the trunk
Trapezius
Origin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebrae
Insertion: lateral third of clavicle, acromion, and spine of scapula
Acton: upper fibers elevate scapula, lower fibers depress scapula; if scapula is fixed, one side acting along, draws head toward the same side, and turn face to opposite side; both sides together, draw head directly backward

20. Latissimus dorsi
Origin: spinous processes of lower six thoracic and all lumbar vertebrae, median sacral crest, and posterior part of iliac crest.
Insertion: floor of intertubercular groove of humerus.
Action: trunk fixed, extends, adducts and medially rotates arm ; arm fixed, elevates trunk.

21. The Muscles of Upper Limb
Muscles of shoulder
Deltoid
Supraspinatus
Infraspinatus
Teres minor
Teres major
Subscapularis

22. Muscles of arm Anterior group Posterior group – triceps brachii
Biceps brachii
Coracobrachialis
Brachialis
Posterior group
– triceps brachii

23. Teres major Origin: dorsal surface of inferior angle of scapula
Insertion: crest of lesser tubercle of humerus
Action: medially rotates and adducts arm