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UPPER LIMB
CHAPTER 6 p726
MOORE & DALLEY
CLINICALLY ORIENTED ANATOMY
5TH EDN
UPPER LIMB
SHOULDER JOINT
P853
Also pp 848-852
Shoulder Joint
• Ball and socket (synovial) jnt
• Designed for mobility
• Stability compromised – soft tissue support
Important:
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Articulation
Joint capsule
Ligaments – glenohumeral, coracohumeral
Movements – F, E, MR, LR, C, Abd, Add
Muscles – axioappendicular, scapulohumeral
Bursae – suprascapular, subacromial
Blood supply – ant, post circumflex humeral aa
Innervation – suprascapular, axillary, lateral pec.
Muscles which attach the humerus to the
axial skeleton
1.
2.
3.
4.
5.
6.
7.
8.
M deltoideus
M latissimus dorsi
M teres major
M coracobrachialis
M subscapularis
M supraspinatus
M infraspinatus
M teres minor
M deltoideus
• Origin
– Ant border, lateral aspect of
clavicle
– Lateral border-acromion
– Inf lip of spine (scapula)
• Insertion
– Deltoid tuberosity
• Action
– Abduction
– Flexion, medial rotation
– Extension, lateral rotation
• Nerve supply
– Axillary
M latissimus dorsi
• Origin
– Lower 6 thoracic vertebrae
(spines
– L1-L5 (spines)
– Iliac crest (posterior)
– Lower 4 ribs
• Insertion
– Bicipital groove (humerus)
• Action
– Extension
– Medial rotation
• Nerve supply
– Thoracodorsal nerve
M teres major
• Origin
– Dorsum of lateral border of
scapula (close to inferior
angle)
• Insertion
– Medial lip of bicipital groove
• Action
– Adduction
– Medial rotation
• Nerve supply
– Inferior subscapular nerve
M coracobrachialis
• Origin
– Coracoid process (apex) of
scapula
• Insertion
– Shaft of humerus (medial
aspect) next to deltoid
tuberosity
• Action
– Flexor (weak)
– Adductor
• Nerve supply
– Musculo-cutaneous nerve
ROTATOR CUFF MUSCLES
• Muscles which stabilize the shoulder joint
– Supraspinatus
– Infraspinatus
– Teres minor
– Subscapularis
M supraspinatus
• Origin
– Supraspinous fossa
(lateral part) of scapula
• Insertion
– Superior facet-greater
tubercle of humerus
• Action
– Abduction
• Nerve supply
– Suprascapular nerve
M infraspinatus
• Origin
– Infraspinous fossa (lateral
part) of scapula
• Insertion
– Middle facet-greater tubercle
of humerus
• Action
– Extension
– Lateral rotation
• Nerve supply
– Suprascapular nerve
M teres minor
• Origin
– Lateral border of scapula
• Insertion
– Inferior facet-greater tubercle
of humerus
• Action
– Adduction
– Lateral rotation
• Nerve supply
– Axillary nerve
M subscapularis
• Origin
– Subscapular fossa
• Insertion
– Lesser tubercle of humerus
• Action
– Adduction
– Medial rotation
• Nerve supply
– Superior subscapular nn
– Inferior subscapular nn
Winging of the scapula
AXILLA
Definition of axilla: An irregular space
above the armpit
• Anterior wall
– Pectoralis major
– Pectoralis minor
– Clavipectoral fascia
• Pierced by bv’s & nn
• Ends in skin of axilla
• Posterior wall
– Subscapularis
– Latissimus dorsi
– Teres major
• Medial wall
– Serratus anterior
• Lateral wall
– Bicipital groove
• Base
– Skin of armpit
• Apex
– Runs upwards
– Clavicle (ant)
– R1 (medially)
– Scapula sup border (post)
• Contents
– Brachial plexus
– Axillary artery
– Axillary vein
– Lymph nodes
– fat
MUSCLES OF THE UPPER ARM
Compartments
• Anterior compartment
– M coracobrachialis
– M biceps brachii
– M brachialis
• Posterior compartment
– M triceps brachii
– M anconeus
UPPER LIMB
ELBOW JOINT
P860
Elbow Joint
• Hinge (synovial) jnt
• Designed for mobility / function
Important:
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Articulation
Joint capsule
Ligaments
Movements
Muscles
Bursae
Blood supply
Innervation
Cubital Fossa
• Inverted triangle
• In front of elbow
Borders
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Base - imaginary line - 2 epicondyles
Lateral border – m. brachioradialis
Medial border – m. pronator teres
Roof - fascia, skin, superficial nerves and blood vessels
Floor - brachialis, supinator
Contents - median n., brachialis a., biceps brachii tendon
Cubital Fossa
UPPER LIMB
RADIOULNAR JOINT
Proximal – p863
Distal – p866
Important: Proximal Joints
(pivot – synovial jnt)
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Articulation
Joint capsule
Ligaments – anular lig
Movements – supination, pronation
Muscles – see mvmnts above
Blood supply – radial, radial recurrent aa
Innervation – musculocut., radial, median
Important: Distal Joints
(pivot – synovial jnt)
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Articulation
Joint capsule
Ligaments – anterior & posterior ligs
Movements – supination, pronation
Muscles – see mvmnts above
Blood supply – ant, post interosseous aa
Innervation – ant, post interosseous nn
Forearm
• Posterior extensor compartment
 12 muscle
 Radial nerve
Forearm - Compartments
Posterior Extensor Compartment
• 3 muscles run from deep to the thumb
 m. abductor pollicis longus
 m. extensor pollicis brevis
 m. extensor pollicis longus
 Originate from the shafts of radius and ulna
as well as interosseous membrane
Posterior Extensor Compartment
Posterior Extensor Compartment
• 3 muscles lie lateral to previous group
 m. brachioradialis
 m. extensor carpi radialis longus
 m. extensor carpi radialis brevis
Posterior Extensor Compartment
Posterior View
Anterior View
Posterior Extensor Compartment
• 3 muscles lie medial to previous group
 m. extensor digitorum
 m. extensor digiti mini
 m. extensor carpi ulnaris
Posterior Extensor Compartment
Posterior View
Posterior Extensor Compartment
• 3 other muscles
 m. anconeus
 m. extensor indicis
 m. supinator
Posterior Extensor Compartment
Posterior Extensor Compartment
• Actions
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Extension of wrist and fingers
m. anconeus – helps extension of elbow
m. supinatior – supinates forearm
m. brachioradialis – arm in neutral position it
flexes the elbow joint, if hand is pronated or
supinated it turns hand back to neutral position
Distal Radio-Ulnar Joints