Upper limbs & Muscles connecting them to the trunk Lufukuja G.

Surface anatomy Lufukuja G.

Lufukuja G.

Lufukuja G.

Cutaneous innervations Lufukuja G.

Lufukuja G.

Lufukuja G.

Trapezius Muscle Proximal Attachment Distal Attachment Innervation Main Action Trapezius Medial third of superior nuchal line; external occipital protuberance; nuchal ligament; spinous processes of C7 and C12 vertebrae Lateral third of clavicle; acromion and spine of scapula Accessory nerve (CN XI) (motor fibers) and C3, C4 spinal nerves (pain and proprioceptive fibers) Descending part elevates; ascending part depresses; and middle part (or all parts together) retracts scapula; descending and ascending parts act together to rotate glenoid cavity superiorly Lufukuja G.

Trapezius-Main Action Upper fibers along with levator scapulae elevate the scapula & Lower fibers depress the scapula Nerve supply Middle fibres retract the scapula & Upper and lower fibers together rotate the scapula upwards Lufukuja G.

Lufukuja G.

Lufukuja G.

Applied anatomy The accessory nerve can be injured more distally in the neck by trauma or by surgical exploration in the posterior triangle. If the accessory nerve is sacrificed as part of a radical neck dissection, and the innervation of trapezius is lost, the patient develops intractable neuralgia due to traction on the brachial plexus caused by the unsupported weight of the shoulder and arm. Lufukuja G.

Applied anatomy Lufukuja G.

Latissimus dorsi Lufukuja G.

Latissimus dorsi Muscle Proximal Attachment Distal Attachment Innervation Main Action Latissimus dorsi Spinous processes of lower 6 thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs Floor of intertubercular groove of humerus Thoracodorsal nerve (C6, C7, C8) Extends, adducts, and medially rotates humerus; raises body toward arms during climbing Lufukuja G.

Lufukuja G.

Levator scapulae Rhomboideus minor Rhomboideus major Lufukuja G.

Posterior tubercles of transverse processes of C1 and C4 vertebrae Levator scapulae Muscle Proximal Attachment Distal Attachment Innervations Main Action Levator scapulae Posterior tubercles of transverse processes of C1 and C4 vertebrae Medial border of scapula superior to root of spine Dorsal scapular (C5) and cervical (C3, C4) nerves Elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula Lufukuja G.

Rhomboids minor and major Rhomboideus minor Rhomboideus major Muscle Proximal Attachment Distal Attachment Innervations Main Action Rhomboid minor and major Minor: nuchal ligament; spinous processes of C7 and T1 vertebrae Major: spinous processes of T2 and T5 vertebrae Minor: smooth triangular area at medial end of scapular spine Major: medial border of scapula from level of spine to inferior angle Dorsal scapular nerve (C4, C5) Retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall Lufukuja G.

Lufukuja G.

Applied anatomy (The triangle of auscultation ) space bounded by the lower border of the trapezius, the latissimus dorsi, and the medial margin of the scapula, where the absence of musculature allows respiratory sounds to be heard clearly with a stethoscope. Lufukuja G.

Serratus anterior Serratus anterior Muscle Proximal Attachment Distal Attachment Innervations Main Action Serratus anterior Arise by fleshy digitations from outer surface and upper border of upper eight ribs Medial border and inferior angle of scapula Long thoracic nerve C5, 6, 7 Draws the scapula forward around the thoracic wall; rotates scapula Lufukuja G.

Lufukuja G.

Applied anatomy Injury to the long thoracic nerve is common & Winging of the scapula may be the clinical manifestation Lufukuja G.

Scapulohumeral muscles Deltoid; Teres Major; Supraspinatus, infraspinatus, teres minor, and subscapularis - Rotator Cuff Muscles Lufukuja G.

Scapulohumeral muscles Lufukuja G.

Deltoid Muscle Proximal Attachment Distal Attachment Innervations Main Action Deltoid Lateral third of clavicle; acromion and spine of scapula Deltoid tuberosity of humerus Axillary nerve (C5, C6) Anterior part: flexes and medially rotates arm Middle part: abducts arm Posterior part: extends and laterally rotates arm Lufukuja G.

Lufukuja G.

Deltoid… Lufukuja G.

Deltoid Injury to the Axillary Nerve The deltoid atrophies when the axillary nerve (C5 and C6) is severely damaged. Because it passes inferior to the humeral head and winds around the surgical neck of the humerus, the axillary nerve is usually injured during fracture of this part of the humerus. Lufukuja G.

Lufukuja G.

Teres major Muscle Proximal Attachment Distal Attachment Innervations Main Action Teres major Lower third of lateral border of scapula Medial lip of bicipital groove of humerus Lower subscapular nerve C6, 7 Medially rotates and adducts arm and stabilizes shoulder joint Lufukuja G.

Teres major… Lufukuja G.

Rotator Cuff Muscles Supraspinatus, infraspinatus, teres minor, and subscapularis Nerve supply: suprascapular nerve, C5 and 6 axillary nerve, C5 and 6 upper & lower subscapular nerves, C5, 6 Lufukuja G.

Rotator Cuff Muscles… Supraspinatus Supraspinous fossa of scapula Proximal Attachment Distal Attachment Innervations Main Action Supraspinatus Supraspinous fossa of scapula Superior facet of greater tubercle of humerus Suprascapular nerve (C4, C5, C6) Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles Infraspinatus Infraspinous fossa of scapula Middle facet of greater tubercle of humerus Suprascapular nerve (C5, C6) Laterally rotate arm; help hold humeral head in glenoid cavity of scapula Subscapularis Subscapular fossa (most of anterior surface of scapula) Lesser tubercle of humerus Upper and lower subscapular nerves (C5, C6, C7) Medially rotates and adduct arm; helps hold humeral head in glenoid cavity Teres Minor Upper two thirds of lateral border of scapula Greater tuberosity of humerus; capsule of shoulder joint Axillary nerve (C4), C5, 6 Laterally rotates arm and stabilizes shoulder joint Lufukuja G.

Lufukuja G.

Applied anatomy The tendon of supraspinatus is separated from the coraco-acromial ligament, acromion and deltoid by the large subacromial bursa; when this is inflamed, abduction of the shoulder joint is painful. The tendon is the most frequently torn element of the musculotendinous cuff around the shoulder joint. Lufukuja G.

Quadrangular Space The quadrangular space is an intermuscular space, located immediately below the shoulder joint. It is bounded above by the subscapularis and capsule of the shoulder joint and below by the teres major muscle. It is bounded medially by the long head of the triceps and laterally by the surgical neck of the humerus. The axillary nerve and the posterior circumflex humeral vessels pass backward through this space Lufukuja G.

Lufukuja G.

Lufukuja G.