Upper Limb

What makes up the shoulder girdle?

Clavicle, scapula, + their connection to the manubrium

Where can you find the only bone to bone contact in the shoulder girdle?

Clavicle and sternum

Pectoral girdle bones

Clavicle and scapula

Purposes of the clavicle

1. A strut that suspends the upper limb and allowing freedom of motion

2. Protects neurovascular bundle that supplies the upper limb

3. Transmits force from the arm to the axial skeleton.

What happens if the clavicle is fixed?

Enables elevation of ribs during active respiration

Clavicular fracture

Caused by indirect force to the clavicle due to impacts to the outstretched hand or falls directly on the shoulder.

How does a clavicular fracture present?

Lateral 1/3 and Mid 3rd of the clavicle is pulled up due to the SCM pulling it up

Clavicular fracture intervention

Surgical intervention = putting a plate on the split clavicle to attach the bone together and help with bone growth

Scapula

Has 3 fossae that provides muscular attachment

Angles, borders, and spine also provide multiple attachment points

Actions of the scapula

Elevation, depression, protraction, retraction, upward/lateral rotation, downward/medial rotation

What are the 3 components of the AC joint?

1. Superior acromioclavicular joint

2. Coracoclavicular ligament

3. Coracoacromial ligament

AC Joint separation

Caused by a direct blow to the shoulder or falling on outstretched hand. Lateral (acromial end) tents upward.

Name these 2 structures

1. Axillary fascia

2. Pectoral fascia

Name these structures found in the axillary fossa

1. Deep cervical fascia

2. Pectoral fascia

3. Suspensory ligament of axilla

Name these structures

1. Lateral intermuscular septum

2. Brachial fascia

3. Medial intermuscular septum

Superficial veins of the arm

Cephalic vein (lateral)

Basilic vein (medial)

The cephalic and basilic vein communicates via?

The median cubital vein

Where is the common site of venipuncture?

Median cubital vein

Name these structures

1. Clavipectoral (deltopectoral) triangle

2. Cephalic vein in deltopectoral groove

3. Median cubital vein

4. Basilic vein

What are the muscles in the Anterior Thoracoappendicular?

Pectoralis Major, Pectoralis Minor, Subclavius, Serratus Anterior

Origin: clavicle, sternum, and costal cartilages

Insertion: intertubercular groove

Action: Adduction, Humerus medial rotation, scapular protraction.

• Clavicle = flexes humerus

• Sternocostal = extends humerus from flexion

Innervation: Lateral pectoral nerve (clavicle) and medial pectoral nerve (sternocostal)

Pectoralis Major

What muscle is this?

Pectoralis Major

Origin: ribs 3-5

Insertion: coracoid process

Action: depresses shoulder girdle, protracts and stabilizes scapula, assists in forced inspiration

Innervation: Medial Pectoral Nerve

Pectoralis minor

Name this muscle

Pectoralis minor

Origin: costal cartilage (1st rib)

Insertion: clavicle

Action: Anchors and depresses clavicle

Innervation: subclavius nerve

Subclavius

Name this muscle

Subclavius

Origin: Ribs 1-8 (lateral aspect)

Insertion: scapula (medial border)

Action: protracts, lateral rotation, secures scapula against thoracic wall

Innervation: Long thoracic nerve

Serratus anterior

Name this muscle

Serratus anterior

When serratus anterior is paralyzed, what happens to the scapula?

Scapular winging since serratus anterior is no longer holding the scapula down.

Posterior thoracoappendicular muscles

Trapezus, Latissimus dorsi, Rhomboids, Levator Scapulae

Origin: Superior nuchal line, ligamentum nuchae, spinous processes (C7- T12)

Insertion: Clavicle, acromion process, scapular spine

Action: Elevation, retraction, scapular rotation, and neck extension

Innervation: Accessory nerve and Sensory nerve (C2, C3)

Trapezius

Name this muscle

Trapezius

Origin: spinous processes (T6-T12), Iliac crest, Inferior ribs

Insertion: humeral intertubercal groove

Action: Humeral extension, adduction, and medial rotation

Innervation: Thoracodorsal nerve

Latissimus dorsi

Name this muscle

Latissimus dorsi

Origin:

• Minor - nuchal ligament and spinous process

• Major - spinous processes T12-T5

Insertion: scapula (medial border)

Action: Retracts, medially rotates, and fixes scapula to thoracic wall

Innervation: Dorsal scapular nerve

Rhomboids

Name this muscle

Rhomboids

Origin: Transverse processes of C1-C4 Vertebrae

Insertion: scapula (superior angle)

Action: Scapular rotation and elevation

Insertion: Dorsal scapular nerve & cervical nerve

Levator scapulae

Name this muscle

Levator scapulae

Scapulohumeral muscles

Deltoid, Teres major, Rotator cuff muscles (SITS)

Origin: Clavicle, acromion, and spinous process

Insertion: deltoid tuberosity

Action: Shoulder flexion, extension, medial rotation, lateral rotation, abduction, and stabilizes shoulder

Innervation: Axillary nerve

Deltoid

Name these structures

Clavicle, deltoid, humerus

Origin: inferior angle of scapula

Insertion: intertubercular groove

Action: Arm adduction, medial rotation, and stabilizes GH joint during abduction

Innervation: Lower subscapular nerve

Teres Major

Rotator cuff muscles

Supraspinatus, Infraspinatus, Teres minor, Subscapularis

Origin: Supraspinous fossa of scapula

Insertion: Greater tubercle

Action: Initiates arm abduction, stabilizes glenohumeral joint

Innervation: subscapular nerve

Supraspinatus

Name this muscle

Supraspinatus

Origin: infraspinous fossa of scapula

Insertion: Greater tubercle

Action: Arm lateral rotation, stabilizes GH joint

Innervation: Suprascapular nerve

Infraspinatus

Rotator cuff injuries

• Caused by repetitive-type throwing activities

• First appears as Tendonitis but continuous activity leads to tear due to overuse and no healing time.

Name this muscle

Infraspinatus

Origin: Lateral border of scapula

Insertion: Greater tubercle

Action: Arm lateral rotation, stabilizes GH joint

Innervation: Axillary nerve

Teres minor

Name this muscle

Teres minor

Origin: subscapular fossa of scapula

Insertion: Lesser tubercle

Action: Arm medial rotation, stabilizes GH joint

Innervation: Subscapular nerve

Subscapularis

Name this muscle

Subscapularis

Rotator Cuff injuries

• Caused by repetitive-type throwing activities

• First appears as tendonitis but leads to tear from continuous activities due to overuse and no time for healing.

Axillary boundaries

Apex, Base, Ant. Wall, Post. Wall, Medial Wall, Lateral Wall

Apex contains…

1st rib & clavicle

Base contains…

Axillary fascia

Ant. Wall contains…

Pec major & fascia

Post. Wall contains…

Scapula, subscapularis, teres major, & lats.

Medial wall contains…

Thoracic wall, serratus anterior (ribs 1-4)

Lateral wall contains…

Intertubercular groove

Name these structures

1. Anterior wall

2. Medial wall

3. Intertubercular sulcus (lateral wall)

4. Posterior wall

Name these structures

1. Brachial plexus

2. Axillary artery and vein

Axilla contents

1. Axillary vein & branches

2. Axillary artery & branches

3. Lymph vessels & nodes

4. Brachial plexus

Axillary sheath

A dense sheath that encloses all the contents of the axilla

Name these structures

1. Pectoral nerve

2. Brachial plexus

3. Axillary artery

4. Axillary sheath

5. Axillary vein

6. Long Thoracic nerve

Name these structures

1. Cephalic vein

2. Thoracoacromial artery

3. Lateral pectoral nerve

Name all the axillary veins

1. Cephalic vein

2. Basilic vein

3. Brachial veins

4. Axillary vein

5. Clavicle

6. Subclavian vein

Name all these structures

1. Suprascapular artery

2. Thoracoacromial artery

3. Circumflex humeral artery

4. Subscapular artery

5. Inferior border of teres major

6. Circumflex scapular artery

7. Thoracodorsal artery

8. Lateral thoracic artery

9. Thyrocervical artery

• Starts from the 1st rib to medial border of pec minor

• Is found inferior, medial, posterior to axillary vein

  • Contains the superior thoracic artery (supplies 1st and 2nd costal spaces and serratus anterior)

Axillary 1

Superior thoracic artery

Found in Axillary 1

Supplies 1st and 2nd costal spaces and serratus anterior

Name this structure

Superior thoracic artery

• Found medial to and posterior to pec minor

• Inferior, medial, and posterior to axillary vein

• Contains the thoracoacromial artery and lateral thoracic artery

Axillary 2

Trunk/artery that has 4 branches: acromial, deltoid, pectoral, and clavicular

Thoracoacromial artery

Artery found along the lats

Border of pec minor

Supplies pec muscles, axillary lymph nodes and breast, & serratus anterior

Lateral thoracic artery

Name these structures

1. Thoracoacromial artery

2. Lateral thoracic artery

• Starts from the lateral border of pec minor to inferior border of teres major

• Contains the subscapular artery, which divides into circumflex scapular artery

• Also contains the thoracodorsal artery and anterior & posterior circumflex humeral arteries.

• Where you will find the quadrangular space

Axillary 3

Found in axillary 3, along the lateral border of subscapularis to posterior axillary wall

Subscapular artery

• Divides from the subscapular artery and passes posterior along lateral border of subscapularis.

• Supplies subscapularis, teres major

• Anastomosis with dorsal scapular & suprascapular arteries

Circumflex scapular artery

• Continuation of subscapular artery

• contributes of anastomosis around scapula

• Supplies lats (main job of this artery)

Thoracodorsal artery

• Branch lateral

• Anterior-deep to biceps brachii

• Posterior part of this artery is found posterior with axillary nerve in the Quadrangular space

• Supplies deltoid (mainly), teres major & minor, and triceps

Anterior and posterior circumflex humeral arteries

Name these structures

1. Suprascapular artery

2. Subscapular artery

3. Circumflex scapular artery

4. Thoracodorsal artery

5. Dorsal scapular artery

Name these structures

1. Suprascapular artery

2. Dorsal scapular artery

3. Circumflex scapular artery

4. Thoracodorsal artery

• Formed when the anterior rami of spinal nerves combine and then bifurcate to form nerve branches consisting of motor and sensory neurons from 2 or more spinal nerves

• Redistribution from an orderly array to apparent disarray

• Composed of: 1) mixed somatic motor, 2) somatic sensory, & 3) sympathetic nerve fibers

Name these structures

1. Subscapular artery

2. Circumflex scapular artery