Anatomy and Physiology Week 6 - Upper Limb

Osteology of the Shoulder

Clavicle

Scapula

Humerus

Joints of the Shoulder

Sternoclavicular

Acromioclavicular

Scapulothoracic

Glenohumeral

Which shoulder joint is not a true shoulder joint?

Scapulothoracic- made of soft tissue articulation

Which shoulder joint is considered a “double joint”?

Sternoclavicular- due to the articular disc

What type of joint is the Sternoclavicular joint?

Saddle/Sellar joint

Movements of the Sternoclavicular joint

Elevation/Depression

Protraction/Retraction

Axial Rotation

Ligaments of the sternoclavicular joint

Anterior/Posterior SC ligaments

Interclavicular ligament

Costoclavicular ligament

What type of joint is the acromioclavicular joint?

Gliding joint

Ligaments of the acromioclavicular joint

AC ligament

Coracoclavicular ligament (conoid and trapezoid portions)

Intrinsic Ligaments of the Scapula

Coracoacromial ligament

Superior transverse ligament

Inferior transverse (Spinoglenoid) ligament

What ligament closes off the scapular notch?

Superior transverse ligament

What type of joint is the glenohumeral joint?

Ball & Socket (Polyaxial)

Movements of the glenohumeral joint

Flexion/Extension

Abduction/Adduction

Inward/Outward Rotation

Circumduction

Horizontal abduction/adduction

Scaption

Ligaments of the Glenohumeral joint

Superior/Middle/Inferior GH ligaments

Coracohumeral ligament

Transverse humeral ligament (intrinsic)

Scapulothoracic movements

Elevation/Depression

Protraction/Retraction (aka scapular abduction/adduction)

Upward/Downward Rotation

Where is the Brachial Plexus anatomically?

Lies in the clavicular region of the neck and extends from the scalenus anterior to axilla

What nerve comes off the C5 PPR?

Dorsal Scapular Nerve

What nerve extends from the C5 C6 & C7 Spinal Root?

Long thoracic Nerve

What nerve(s) derive from the Upper Trunk of the Brachial Plexus?

Suprascapular Nerve

Nerve to the Subclavius

What nerve(s) derive from the Lateral cord of the Brachial plexus?

Lateral Pectoral Nerve

What nerve(s) derive from the posterior cord of the brachial plexus?

Lower Subscapular Nerve

Axillary Nerve

Thoracodorsal Nerve

Upper Subscapular Nerve

What nerve(s) derive from the medial cord of the brachial plexus?

Medial Pectoral Nerve

Medial Antebrachial Nerve

Medial Brachial Nerve

What nerve(s) derive from the middle line of the brachial plexus after the cords?

Radial Nerve

What nerve(s) derive from the upper line of the brachial plexus after the cords?

Musculocutaneous Nerve

What nerve(s) derive from the lower line of the brachial plexus after the cords?

Ulnar nerve

What nerve(s) connect the upper and lower lines after the cords?

Median nerve

Description of Musculature

Trunk to Shoulder Girdle

Humerus to Scapula

Trunk to Humerus

Trunk to Shoulder Girdle muscles

Rhomboid(s)

Trapezius

Subclavius

Levator Scapulae

Serratus Anterior

Pectoralis Minor

Rhomboid(s) (major and minor)

P- Spinous processes of C7, T1-T5; supraspinous ligament; inferior aspect ligamentous nuchae
D- Medial border scapula; inferior angle to root of spine of scapula
N- Dorsal Scapular Nerve
S- C4, C5
A- Scapular Retraction, Elevation, Inward Rotation

Trapezius (Upper)

P- Ligamentous Nuchae; occipot; spinous process C7
D- Lateral 1/3 posterior aspect clavicle
N- CN XI (Spinal accessory) C3, C4
A- Scapular elevation, retraction, outward rotation

Trapezius (Middle)

P- Spinous process T1-T5; supraspinous ligament
D- Medial margin acromion process; superior aspect of spine of scapula to root
N- CN XI (Spinal Accessory) C3, C4
A- Scapular retraction, outward rotation

Trapezius (Lower)

P- Spinous Process T6-T12; supraspinous ligament
D- Inferior aspect of medial 2/3 spine of scapula
N- CN XI (Spinal accessory) C3, C4
A- Scapular depression, outward rotation, retraction

Subclavius

P- Superior aspect first rib
D- Inferior and lateral aspect clavicle
N- Nerve to Subclavius
S- C5, C6
A- Depress shoulder girdle, accessory muscle in respiration

Levator Scapulae

P- Transverse process C1-C4
D- Superior angle of scapula; medial border to root of spine of scapula
N- Dorsal Scapular Nerve; C3, C4 (cervical plexus)
S- C3, C4, C5
A- Scapular elevation, retraction, inward rotation

Serratus Anterior

P- Anterolateral aspect of ribs 1-8
D- Medial border of scapula
N- Long thoracic nerve
S- C5, C6, C7
A- Outward rotation, protraction of scapula

Pectoralis Minor

P- Anteromedial aspect of ribs 3,4,5
D- Coracoid process
N- Medial Pectoral Nerve
S- C8, T1
A- Scapular depression, protraction, downward rotation

Humerus to Scapula Muscles

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Deltoid

Teres Major

Coracobrachialis

Supraspinatus

P- Medial 2/3 of supraspinous fossa
D- Superior fascet of greater tubercle
N- Suprascapular nerve
S- C5, C6
A- Shoulder abduction, rotator cuff function

Infraspinatus

P- Medial 2/3 of infraspinous fossa
D- Middle fascet of greater tubercle
N- Suprascapular nerve
S- C5, C6
A- Shoulder ER, rotator cuff function

Teres Minor

P- Proximal 2/3 axillary border of scapula
D- Inferior fascet of greater tubercle
N- Axillary nerve
S- C5, C6
A- Shoulder ER, rotator cuff functions

Subscapularis

P- Medial 2/3 subscapularis fossa
D- Lesser tubercle
N- Upper/Lower subscapularis nerve
S- C5, C6, C7
A- Shoulder IR, rotator cuff functions

Rotator cuff function

Static stabilization of the humerus in the glenoid fossa with the arm at the side

Dynamic stabilization of the humerus in the glenoid fossa and force couple actions during shoulder flexion/abduction (convex-concave relatioships of joint movements)

Deltoid (Anterior)

P- Lateral 1/3 anterior superior clavicle
D- Deltoid tuberosity
N- Axillary nerve
S- C5, C6
A- Shoulder flexion, horizontal adduction

Deltoid (Middle)

P- Lateral margin of acromion
D- Deltoid Tuberosity
N- Axillary Nerve
S- C5, C6
A- Shoulder Abduction

Deltoid (Posterior)

P- Lateral 2/3 posterior inferior spine of scapula
D- Deltoid tuberosity
N- Axillary Nerve
S- C5, C6
A- Shoulder extension, abduction, horizontal abduction

Teres Major

P- Distal 1/3 axillary border of scapula; inferior angle
D- Crest of lesser tubercle of humerus
N- Lower subscapular nerve
S- C5, C6
A- Shoulder IR, extension

Coracobrachialis

P- Coracoid process
D- Anteromedial aspect humerus at mid-shaft
N- Musculocutaneous Nerve
S- C5, C6, C7
A- Shoulder flexion, adduction (Glenohumeral stabilizer)

Trunk to Humerus Muscles

Latissimus Dorsi

Pectoralis Major

Latissimus Dorsi

P- Spinous process T7-T12; lumbar vertabrae, sacrum, lower 4 ribs, thoracolumbar fascia
D- Intertubercular groove, crest of lesser tubercle, inferior scapular fascia
N- Thoracodorsal nerve
S- C6, C7, C8
A- Shoulder IR, Extension, depsression of girdle

Pectoralis Major (Sternal)

P- Lateral 1/3 anterior sternum and costal cartiladge
D- Crest of greater tubercle
N- Medial pectoral nerve
S- C7, C8, T1
A- Shoulder adduction, IR

Pectoralis Major (Clavicular)

P- Medial ½ anterior aspect clavicle
D- Crest of greater tubercle
N- Lateral pectoral nerve
S- C5, C6
A- Shoulder adduction, IR, flexion, horizontal adduction

Base Boundary of Axillary Fossa

Axillary Fascia

Anterior Boundary of Axillary fossa

Pectoralis Major and minor

Posterior boundary of axillary fossa

Latissimus dorsi, teres major, subscapularis

Lateral boundary of axillary fossa

Humerus

Medial boundary of axillary fossa

Serratus anterior, medial/lateral chest wall

Apex boundary of axillary fossa

Glenohumeral joint

Content of axillary fossa

Axillary sheath and axillary lymph nodes

Contents of axillary sheath

Axillary artery and vein, cords of brachial plexus

What kind of joint is the humeroulnar joint?

Hinge joint

What kind of joint is the humeroradial joint?

Plane joint

Anterior Compartment Muscles of the Arm

Biceps Brachii

Brachialis brachii

Posterior compartment muscles of the arm

Triceps brachii

Biceps Brachii

P- short: Coracoid process; long: supraglenoid tubercle and labrum
D- Tuberosity of radius; bicipital aponeurosis
N- Musculocutaneous nerve
S- C5, C6, C7
A- GH flexion, elbow flexion, forearm supination

Brachialis Brachii

P- Distal ½ anterior humerus
D- Tuberosity of ulna and coronoid process
N- Musculocutaneous nerve
S- C5, C6
A- Elbow flexion

Triceps Brachii

P- Long: infraglenoid tubercle; Lateral: Proximal 2/3 posterolateral humerus; Medial: Distal 1/3 posteromedial humerus
D- Posterior aspect of olecranon
N- Radial Nerve
S- C6, C7, C8
A- Elbow Extension, Shoulder Extension, Adduction