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PECTORALANDSCAPULARREGION MUSCLES AXILLA PECTORALANDSCAPULARREGION 4ANTERIORAXIO-APPENDICULARMUSCLES: movethepectoralgirdle • PECTORALISMAJOR • PECTORALISMINOR • SUBCLAVIUS • SERRATUSANTERIOR PECTORALANDSCAPULARREGION PECTORALISMAJOR: • • • • • largemusclecoverssuperiorpartofthethorax hasclavicularandsternocostalheads sternocostalheadislarger formstheanteriorwallofaxilla withdeltoidmuscleformthenarrow–deltopectoralgrooveforcephalicvein PECTORALISMAJOR: PROXIMALATTACHMENT: • clavicularhead:anteriorsurfaceofmedialhalfofclavicle • sternocostalhead:anteriorsurfaceofsternum,superiorsixcostalcarMlages DISTALATTACHMENT: • laterallipofintertubercularsulcusofhumerus FUNCTION: adductsandmediallyrotateshumerus thetwopartsofthepectorismajorcanactindependently: • theclavicularheadflexingthehumerus • thesternocostalheadextendingitbackfromtheflexedposiMon INNERVATION: lateralandmedialpectoralnerves: • clavicularhead:C5,C6 • sternocostalhead:C7,C8,T1 PECTORALANDSCAPULARREGION PECTORALISMINOR: • liesintheanteriorwalloftheaxilla • coveredbymuchlargerpectoralismajor • variaMonsinthecostalaYachmentsarecommon PECTORALISMINOR: PROXIMALATTACHMENT: • 3rdto5thribsneartheircostalcarMlages DISTALATTACHMENT: • medialborderandsuperiorsurfaceofcoracoidprocessofscapula INNERVATION: • medicalpectoralnerve(C8,T1) FUNCTION: • musclestabilizesthescapula PECTORALANDSCAPULARREGION TRAPEZIUSMUSCLE: • providesadirectaYachmentofthepectoralgirdletothetrunk • large,triangularmusclecoverssuperiorhalfofthetrunkandposterioraspectoftheneck • hastwosides,whichformatrapezium PARTSOFTHETRAPEZIUSMUSCLE: • descendingfiberselevatethescapula • middlefibersretractthescapula • ascendingfibersdepressthescapula TRAPEZIUSMUSCLE: PROXIMALATTACHMENT: • medialthirdofsuperiornuchalline • externaloccipitalprotruberance • nuchalligament • spinousprocessesofvertebraeC7-T12 DISTALATTACHMENT: • lateralthirdofclavicule • acromionandspineofscapula INNERVATION: • spinalaccessorynerveCNXI(motorfibres) • spinalnervesC3,C4(painfibres) PECTORALANDSCAPULARREGION LATISSIMUSDORSIMUSCLE: • • • • large,fan-shapedmuscle coversawideareaoftheback extends,retractsandrotatesthehumerusmedially incombinaMonwiththepectorismajor,isapowerfuladductorofthehumerus LATISSIMUSDORSIMUSCLE: PROXIMALATTACHMENT: • spinousprocessesofinferior6thoracicvertebrae • thoraco-lumbarfascia • iliaccrest • inferior3or4ribs DISTALATTACHMENT: • floorofintertubercularsulcusofhumerus INNERVATION: • thoracodorsalnerveC6,C7,C8 PECTORALANDSCAPULARREGION SUBCLAVIUSMUSCLE: • smallmusclelocatedinferiortotheclavicle • affordsprotecMontothesubclavianvessels,trunkofthebrachialplexusiftheclavicle fractures INNERVATION: • nervetosubclavius C5,C6 LEVATORSCAPULAEMUSCLE: • liesdeeptothesternocleidomastoidmuscle • actswiththetrapeziustoelevatethescapulaorfixit INNERVATION: • dorsalscapularC4,C5 andcervicalC3,C4nerves RHOMBOIDSMUSCLE: • therhomboids(majorandminor)arenotalwaysclearlyseparatedfromeachother • liedeeptothetrapezius • retractandrotatethescapula,fixscapulatothoracicwall INNERVATION: • dorsalscapularnerveC4,C5 PECTORALANDSCAPULARREGION 6SCAPULOHUMERALMUSCLES shortmusclesthatpassfromthescapulatothehumerus actontheglenohumeraljoint • DELTOIDMUSCLE • SUPRASPINATUSMUSCLE • INFRASPINATUSMUSCLE • TERESMINOR • TERESMAJOR • SUBSCAPULARISMUSCLE PECTORALANDSCAPULARREGION DELTOIDMUSCLE coverstheshoulderandformingitsroundedcontour 3partsofthedeltoid:anterior(clavicular),middle(acromial)andposterior(spinal) FUNCTION: • clavicular(anterior)part:flexesandmediallyrotatesarm • acromial(middle)part:abductsarm • spinal(posterior)part:extendsandlaterallyrotatesarm INNERVATION: • axillarynerveC5,C6 SUPRASPINATUSMUSCLE oneoftherotatorcuffmuscles occupiesthesupraspinatusfossaofthescapula iniMates(iniMal150)andassistsdeltoidinabducMonofarmandactswithrotatorcuffmuscles FUNCTION: • iniMatesandassistsdeltoidinabducMonofarm • actswithrotatorcuffmuscles INNERVATION: • suprascapularnerveC4,C5,C6 PECTORALANDSCAPULARREGION INFRASPINATUSMUSCLE • oneoftherotatorcuffmuscles • occupiespartoftheinfraspinatusfossaofthescapula • partlycoveredbydeltoidandtrapezius FUNCTION: • laterallyrotatesarm • actswithrotatorcuffmuscles INNERVATION: • suprascapularnerveC5,C6 TERESMINORMUSCLE • oneoftherotatorcuffmuscles • iscompletelyhiddenbydeltoid • oeennotclearlydelineatedfromtheinfraspinatusmuscle FUNCTION: • laterallyrotatesarm • actswithrotatorcuffmuscles INNERVATION: • axillarynerveC5,C6 PECTORALANDSCAPULARREGION TERESMAJORMUSCLE thickandroundedmuscle inferiorborderoftheteresmajormuscleformstheinferiorborderoflateralpartof theposteriorwalloftheaxilla FUNCTION: • adductsandmediallyrotatesarm INNERVATION: • lowersubscapularnerveC5,C6 SUBSCAPULARISMUSCLE thickandtriangularmuscle liesonthecostalsurfaceofthescapula formspartoftheposteriorwalloftheaxilla FUNCTION: • mediallyrotatesarm • actswithrotatorcuffmuscles • helpsholdtheheadofthehumerusintheglenoidcavity INNERVATION: • upperandlowersubscapularis nervesC5,C6,C7 PECTORALISMAJOR Totesttheclavicularheadofpectoralismajor,thearmisabducted90°;the individualthenmovesthearmanteriorlyagainstresistance. Totestthesternocostalheadofpectoralismajor,thearmisabducted60°andthen adductedagainstresistance. SERRATUSANTERIOR Totesttheserratusanterior(orthefuncMonofthelongthoracicnervethat suppliesit),thehandoftheoutstretchedlimbispushedagainstawall. TRAPEZIUS Totestthetrapezius(orthefuncMonofthespinalaccessorynerve[CNXI]that suppliesit),theshoulderisshruggedagainstresistance. LATISSIMUSDORSI TotestthelaMssimusdorsi(orthefuncMonofthethoracodorsalnervethat suppliesit),thearmisabducted90°andthenadductedagainstresistanceprovided bytheexaminer. DELTOIDMUSCLE Totestthedeltoid(orthefuncMonoftheaxillarynervethatsuppliesit),thearmis abducted,starMngfromapproximately15°,againstresistance. SUPRASPINATUSMUSCLE AbducMonofthearmisaYemptedfromthefullyadductedposiMonagainst resistance,whilethemuscleispalpatedsuperiortothespineofthescapula. INFRASPINATUSMUSCLE Thepersonflexestheelbowandadductsthearm. AXILLA AXILLA AXILLA • pyramidspaceinferiortotheglenohumeraljointandsuperiortotheaxillaryfascia atthejuncMonofthearmandthorax • theshapeoftheaxillavaries,dependingontheposiMonofthearm–disapears whenthearmisfullyabducted Theaxillahas: • APEX • BASE • 4WALLS(3ofthemaremuscular) AXILLA APEXOFAXILLA: • isthecervico-axillarycanal • isboundedbyclavicle,1strib,andsuperiorborderofscapula BASEOFAXILLA: • consistsofaxillaryfasciaandskinofaxillaryfossa(armpit) ANTERIORWALLOFAXILLA: • consistsofpectoralismajorandminormuscles POSTERIORWALLOFAXILLA: • isformedbythesubscapularis,teresmajor,andlaMssimusdorsimuscles MEDIALWALLOFAXILLA: • istheupperribcagecoveredbyserratusanteriormuscle LATERALWALLOFAXILLA: • isformedbytheintertuberculargrooveofhumerus AXILLA AXILLA THEAXILLACONTAINS: • axillarybloodvessels(axillaryarteryanditsbranches,axillaryveinandits tributaries, • lymphaMcvessels • axillarylymphnodes • cordsandbranchesofthebrachialplexus • axillarysheath,anextensionofprevertebrallayerofdeepcervicalfascia enclosingaxillaryvesselsandbrachialplexus • axillaryfat AXILLA THEAXILLARYARTERY • beginsatthelateralborderofthe1stribastheconMnuaMonofthesubclavianartery • endsattheinferiorborderoftheteresmajor • crossedbypectoralisminormuscle,whichdividesarteryintothreeparts THEAXILLARYARTERY THEFIRSTPARToftheaxillaryarteryhasonebranch: • thesuperiorthoracicartery,whichsuppliesareaoveruppertwointercostalspacesand pectoralmuscles THESECODNPARToftheaxillaryarteryhastwobranches: • Thoracoacromialartery-mulMplebranchespiercingclavipectoralfasciatosupplypectoral andshoulderregions • Lateralthoracicartery-descendsalonglateralchestwalltosupplyserratusanteriorand breast THETHIRDPARToftheaxillaryarteryhasthreebranches: • Subscapularartery-dividesintoscapularcircumflexarteryandthoracodorsalartery • Anteriorhumeralcircumflexartery • Posteriorhumeralcircumflexartery-passeswithaxillarynervethroughquadrangular space AXILLA THEAXILLARYVEIN conMnuouswithbasilicveinandreceivesbrachialandcephalicveinsbefore becomingsubclavianvein Aninjuredaxillaryveinmaybleedprofuselyandallowairembolitopasstothe rightsideoftheheart. AXILLA THEAXILLARYLYMPHNODES: • drainupperextremityanduppertrunkalongbranchesofaxillary vessels • receiveabout75%oflymphfrombreast • fivegroupsthatulMmatelydraintosubclavianlymphtrunk: • pectoral • subscapular(posterior) • humeral(lateral) • central • andapicalnodes AXILLA THEAXILLARYLYMPHNODES Theapicalnodesreceivelymphfromallothergroupsofaxillarynodes. ThelymphaMcvesselsunitetoformsubclavianlymphaMctrunk Ontheleeside,thesubclavianlymphaMctrunkcommonlyjoinsthethoracicduct Thepectoralnodesliealongthelateralthoracicvesselsanddrainthelateralquadrantsof thebreastandanteriorthoracicwall.Breastcancerthatmetastasizesfromthelateral quadrantsusuallyinvolvestheaxillarylymphnodesfirst. MUSCLESOFTHEANTERIOR(FLEXOR)COMPARTMENTOFTHEARM BICEPSBRACHII • Musculocutaneousnerve(C5,C6) • Flexesandsupinatestheforearm BRACHIALIS • Musculocutaneousnerve(C5,C6) • FlexesforearminallposiMons CORACOBRACHIALIS • Musculocutaneousnerve(C5,C6) • Flexesandadductsthearm MUSCLESOFTHEPOSTERIOR(EXTENSOR)COMPARTMENTOFTHEARM TRICEPSBRACHII • Radialnerve(C6,C7,C8) • Extendstheforearm ANCONEUS • Radialnerve(C7,C8,T1) • Extendstheforearm • Stabilizestheelbowjoint MUSCLESOFTHEANTERIOR(FLEXOR)COMPARTMENTOFTHEFOREARM PRONATORTERES • Mediannerve(C6,C7) • Flexesandpronatestheforearm FLEXORCARPIRADIALIS • Mediannerve(C6,C7) • Flexesandabductsthehand PALMARISLONGUS • Mediannerve(C7,C8) • Flexesthehand FLEXORCARPIULNARIS • Mediannerve(C7,C8) • Flexesandadductsthehand MUSCLESOFTHEANTERIOR(FLEXOR)COMPARTMENTOFTHEFOREARM FLEXORDIGITORUMSUPERFICIALIS • Mediannerve(C7,C8,T1) • Flexesproximalphalangesatmetacarpophalangealjoints • Flexesmiddlephalangesatproximalinterphalangealjoints FLEXORDIGITORUMPROFUNDUS Medialpart • Ulnarnerve(C8,T1) • Flexesdistalphalangesatdistalinterphalangealjoint FLEXORDIGITORUMPROFUNDUS Lateralpart • Anteriorinterosseousnerve(C8,T1) • Flexesdistalphalangesatdistalinterphalangealjoint FLEXORPOLLICISLONGUS • Anteriorinterosseousnerve(C8,T1) • Flexesphalangesofthethumb PRONATORQUADRATUS • Anteriorinterosseousnerve(C8,T1) • Pronatestheforearm MUSCLESOFTHEPOSTERIOR(EXTENSOR)COMPARTMENTOFTHEFOREARM BRACHIORADIALIS • Radialnerve(C5,C6,C7) • FlexestheforearmwheninmidpronatedposiMon EXTENSORCARPIRADIALISLONGUS • Radialnerve(C6,C7) • Extendsandabductsthehand EXTENSORCARPIRADIALISBREVIS • Deepbranchofradialnerve(C7,C8) • Extendsandabductsthehand EXTENSORDIGITORUM • Posteriorinterosseousnerve(C7,C8) • Extendsthefingersatthemetacarpophalangealjoints EXTENSORDIGITIMINIMI • Posteriorinterosseousnerve(C7,C8) • Extendsthefiehfingeratthemetacarpophalangealjoints MUSCLESOFTHEPOSTERIOR(EXTENSOR)COMPARTMENTOFTHEFOREARM EXTENSORCARPIULNARIS • Posteriorinterosseousnerve(C7,C8) • Extendsandadductsthehand SUPINATOR • Deepbranchofradialnerve(C7,C8) • Supinatestheforearm EXTENSORINDICIS • Posteriorinterosseousnerve(C7,C8) • Extendsthesecondfinger ABDUCTORPOLLICISLONGUS • Posteriorinterosseousnerve(C7,C8) • Abductsthethumb • Extendsthethumbatthecarpometacarpaljoint MUSCLESOFTHEPOSTERIOR(EXTENSOR)COMPARTMENTOFTHEFOREARM EXTENSORPOLLICISLONGUS • Posteriorinterosseousnerve(C7,C8) • Extendsthethumbatthecarpometacarpal,metacarpophalangeal,and interphalangealjoints EXTENSORPOLLICISBREVIS • Posteriorinterosseousnerve(C7,C8) • Extendsthethumbatthecarpometacarpalandmetacarpophalangealjoints ANATOMICSNUFFBOX Isatriangularintervalboundedmediallybythetendonoftheextensorpollicis longusmuscleandlaterallybythetendonsoftheextensorpollicisbrevisand abductorpollicislongusmuscles. Islimitedproximallybythestyloidprocessoftheradius. Hasafloorformedbythescaphoidandtrapeziumbonesandcrossedbythe radialartery.
