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Anatomy & Physiology
Module 5
Thorax & Upper Extremities
Thorax
Chapter 5
Bones
• Human rib cage
• Boney and cartilaginous
structure which surrounds the
thoracic cavity
• Consists of:
• 24 ribs
• Sternum
• Costal cartilages
• 12 thoracic vertebrae
Bones
• Sternum
• 3 regions
• Manubrium
• Jugular notch - notch located at
the superior border
• Articular surfaces for the clavicle
and first rib
• Body
• Sternal angle - the point where
the manubrium and body meet.
The second rib articulates with
the sternum at the sternal angle
• Xiphoid process
• Not always present
Bones
• Ribs
• Humans typically have 24 ribs (12
pairs)
• First seven sets of ribs are called
"true" ribs. They are directly
attached to the sternum through the
costal cartilage.
• The last five pairs are called "false"
ribs. Of those, the first three pairs
are connected to the sternum by
sharing a common cartilaginous
attachment. The last two pairs are
considered "floating" and have no
attachment to the sternum
Joints
• Thoracic vertebral Articulations
were discussed in module 2.
• Sternoclavicular joint
• Articulation between the
sternal end of the clavicle and
the manubrium of the sternum.
• Sternocostal joint
• Articulation between the costal
cartilage and the sternum
Posterior Thorax
Muscles
Origin
Insertion
Action
Serratus posterior
superior
Spinous processes of
C7-T3
Superior margin of
2nd-4th ribs
Elevates ribs
Serratus posterior
inferior
Spinous processes of
T11-L2
Inferior margin of
8th-12th ribs
Lowers ribs
The Shoulder Girdle
Chapter 13
Bones
• Scapula
• Vertebral border
• Axillary border
• Inferior angle
• Spine
• Acromion
• Supraspinous
fossa
• Infraspinous fossa
• Subscapular
fossa
• Glenoid cavity
• Coracoid process
Bones
• Clavicle - AKA collar bone
• Connects the upper limb
to the trunk
• Articulates with the
sternum at the manubrium
and the scapula at the
acromion
Left clavicle: from above (a) and below ( b)
Bones
• Humerus (proximal)
• Head - rounded convex surface that
articulates with the glenoid fossa
• Anatomical neck - the portion of
bone that separates the head from
the tubercles
• Greater tubercle - place of insertion
for 3 shoulder muscles:
supraspinatus, infraspinatus, and
teres minor
• Lesser tubercle - location of
attachment for the subscapularis
muscle
• Body - long shaft of the humerus
• Deltoid tuberosity - site of
attachment for the deltoid muscle
Joints
• Glenohumeral
• Articulation between the head of the
humerus and the glenoid cavity of the
scapula
• Acromioclavicular
• Articulation of the acromial end of the
clavicle and the acromion of the
scapula
• Sternoclavicular
• Between the sternal end of the
clavicle and the manubrium
• Scapulothoracic
• A physiologic joint formed between
the anterior surface of the scapula
and the posterior thoracic rib cage. It
has no joint capsule and is
musculotendinous in nature
Joints
• Glenohumeral
Connective Tissue
• Articular capsule
• Acromioclavicular ligament
• Coracoclavicular ligament
• Coracoacromial ligament
• Coracohumeral ligament
• Sternoclavicular ligament
• Costoclavicular ligament
Connective Tissue
• Bursae
• Subdeltoid
• Subacromial
• Subcoracoid
• Coracobrachialis
• Infraspinatus
Muscles connecting
the scapula to the
spine
Trapezius
Rhomboid major
Rhomboid minor
Levator scapula
Origin
Insertion
Descending: lateral 1/3
Descending: EOP,
of clavicle; transverse:
ligmentum nuchae, SP's
medial side of acromion
C2-C7; transverse: SP's
and spine of scapula;
T1-T4; ascending: SP's
ascending: spine of
T5-T12
scapula
Action
Retraction, superior
rotation, elevation and
depression of the
scapula
Median margin of the
scapula inferior to the
spine
Stabilizes, retracts,
elevates, and inferiorly
rotates the scapula
SP's of C7 and T1
Medial border of the
scapula at the spine
Stabilizes, retracts,
elevates, and inferiorly
rotates the scapula
TP's of C1-C4
Superior angle of the
medial border of the
scapula
Elevates scapula
medially, ipsilaterally
lateral flexes cervical
spine
SP's of T2-T5
Muscles connecting
the upper limbs to the
trunk
Origin
Insertion
Action
Pectoralis major
Medial 1/2 of clavicle,
manubrium, body of
sternum, costal
cartilages of ribs 1-6
Greater tubercle of
humerus
Adduction, internal
rotation, and flexion of
humerus
Ribs 3-5
Coracoid process
Pulls scapula forward,
medial, and downward
Assists in respiration
Rib 1
Acromial end of the
clavicle
Draws clavicle
downward and forward,
elevates first rib
Ribs 1-9
Medial margin of the
costal surface of the
scapula
Lowers raised arm,
elevates ribs, protracts
scapula
Pectoralis minor
Subclavius
Serratus anterior
Latissimus dorsi
Inferior angle of the
scapula, ribs 9-12, SP's Intertubercular groove of
T7-T12, thoracolumbar
humerus
fascia, iliac crest
Internal rotation,
Adduction, and
extension of humerus
Rotator cuff muscles
Origin
Insertion
Action
Supraspinatus
Supraspinous fossa of
scapula
Greater tubercle of
humerus
Abduction of arm
Infraspinatus
Infraspinous fossa of
scapula
Greater tubercle of
humerus
External rotation of arm
Teres minor
Upper 2/3 of lateral
margin of scapula
Greater tubercle of
humerus
External rotation and
Adduction of arm
Subscapularis
Subscapular fossa of
scapula
Lesser tubercle of
humerus
Internal rotation and
extension of arm
Muscles of the
shoulder joint
Origin
Insertion
Action
Deltoid
Acromion, crest of the
spine of the scapula,
lateral 1/3 of clavicle
Deltoid tuberosity of
humerus
Adduction of arm;
anterior: flexion, internal
rotation; posterior:
extension and external
rotation
Teres major
Dorsal surface of the
inferior angle of the
scapula
Lessor tubercle of
humerus
Internal rotation,
adduction, and
extension of arm
Coracobrachialis
Coracoid process of the
scapula
Upper 1/3 of anterior
humerus
Flexion, Adduction, and
internal rotation of arm
Biceps brachii, short
head
Coracoid process of the
scapula
Radial tuberosity
Flexes elbow, flexes
shoulder, supinates
forearm
Biceps brachii, long
head
Supraglenoid tubercle of
the scapula
Radial tuberosity and
bicipital aponeurosis
Flexes elbow, flexes
shoulder, supinates
forearm
Muscles of the
shoulder joint
Origin
Insertion
Action
Triceps brachii, long
head
Infraglenoid tubercle of
scapula
Olecranon process of
ulna
Extends shoulder,
extends elbow
Triceps brachii, Lateral head
Posterolateral aspect of
proximal humerus
Olecranon process
Extends elbow
Triceps brachii, medial Posteromedial aspect of
distal humerus
head
Olecranon process
Extends elbow
Kinesiology
• Scapulohumeral Rythm - describes the timing of movement at these joints during shoulder
elevation
• First 30 degrees of shoulder elevation involves a "setting phase":
• The movement is largely glenohumeral.
• Scapulothoracic movement is small and inconsistent.
• After the first 30 degrees of shoulder elevation:
• The glenohumeral and scapulothoracic joints move simultaneously.
• Overall 2:1 ratio of glenohumeral to scapulothoracic movement.
• Scapulohumeral rhythm serves at least two purposes.
• It preserves the length-tension relationships of the glenohumeral muscles; the muscles do
not shorten as much as they would without the scapula's upward rotation, and so can
sustain their force production through a larger portion of the range of motion.
• It prevents impingement between the humerus and the acromion. Because of the difference
in size between the glenoid fossa and the humeral head, subacromial impingement can
occur unless relative movement between the humerus and scapula is limited. Simultaneous
movement of the humerus and scapula during shoulder elevation limits relative
(arthrokinematic) movement between the two bones.
The Elbow Joint and
Forearm
Chapter 14
Bones
• The elbow joint consists of the:
• Distal humerus
• Proximal radius
• Proximal ulna
• The forearm consists of the:
• Radius
• Lateral aspect
• Ulna
• Medial aspect
Bones
• Humerus (distal)
• Condyles - two distinct rounded
medial and lateral structures that
articulate with radius
• Capitulum - lateral structure that
articulates with the medial head
of the radius
• Trochlea - medial structure that
articulates the ulna
• Lateral epicondyle
• Medial epicondyle
• Coronoid fossa
• Olecranon fossa
Bones
• Ulna
• Olecranon process
• Coronoid process
• Trochlear fossa
• Ulnar tuberosity
• Shaft
• Head of the ulna
• Styloid process
Bones
• Radius
• Head of the radius
• Neck of the radius
• Radial tuberosity
• Shaft
• Styloid process
Joints
• 3 separate joints
• Ulnar-humeral
• Hinge joint
• Radio-humeral
• Gliding joint
• Radio-ulnar
• Pivot joint
Connective Tissue
• Radial collateral ligament
• Ulnar collateral ligament
• Annular ligament
• Interosseous membrane
Nerves
• Median
• Musculocutaneous
• Ulnar
• Radial
Superficial flexor
muscles
Origin
Insertion
Action
Pronator teres
Medial epicondyle of
humerus, Coronoid
process of ulna,
common flexor tendon
Lateral radius
Pronates forearm and
weak elbow flexion
Flexor carpi radialis
Medial epicondyle of
humerus
Base of 2nd and 3rd
meracarpal
Flexes and abducts
wrist
Palmerus longus
Medial epicondyle of
humerus
Palmer aponeurosis
Tightens palmer
aponeurosis, flexes wrist
Flexor carpi ulnaris
Medial epicondyle of
humerus, posterior
aspect of the proximal
ulna, olecranon
Pisiform, hook of
hamate, base of 5th
metacarpal
Flexes and adducts
wrist
Flexor digitorum
superficialis
Medial epicondyle of
humerus, middle 1/3 of
radius
Flexion of MCP and PIP
Shafts of middle
joints of digits 2-5, flexes
phalanges of digits 2-5
wrist
Deep flexor muscles
Origin
Insertion
Action
Flexor digitorum
profundus
Posterior and medial
aspects of proximal
ulna, interosseous
membrane
Bases of the distal
phalanges digits 2-5
Flexes MCP, PIP, DIP of
digits 2-5, flexes wrist
Flexor pollicis longus
Anterior surface of
radius and interosseous
membrane
Distal phalanx of thumb
Flexion of CMC, MCP,
and IP of first digit
Pronator quadratus
Brachialis
Anterior surface of distal Anterior surface of distal
ulna
radius
Pronates forearm
Distal anterior surface of Coronoid process of the Flexion of the elbow joint
the humerus
ulna
to flex the forearm
Superficial extensor
muscles
Origin
Insertion
Action
Brachioradialis
Lateral supracondylar
ridge of distal humerus
Lateral stylus of radius
Flexes elbow
Extensor carpi radialis
longus
Lateral supracondylar
ridge of distal humerus
Dorsal base of 2nd
metacarpal bone
Weak flexion of elbow,
extends and abducts
wrist
Extensor carpi radialis
brevis
Lateral epicondyle of
humerus
Dorsal base of 3rd
metacarpal bone
Weak flexion of elbow,
extends wrist
Extensor digitorum
Lateral epicondyle of
humerus
Dorsal digital expansion
of digits 2-5
Extend wrist, extend
MCP, PIP, and DIP of
digits 2-5
Extensor digiti minimi
Lateral epicondyle of
humerus
Dorsal digital extension
of digit 5
Extend wrist, extend
MCP, PIP, and DIP of
digit 5
Extensor carpi ulnaris
Lateral epicondyle of
humerus
Base of 5th metacarpal
bone
Extends and adducts
wrist
Anconeus
Lateral epicondyle of
humerus
Lateral side of olecranon
and ulna
Extends elbow
Deep extensor
muscles
Origin
Insertion
Action
Supinator
Lateral epicondyle of
humerus, supinator crest
and fossa of ulna
Lateral 1/3 of proximal
radius
Supinates forearm
Abductor pollicis
longus
Middle 1/3 of posterior
radius, interosseous
membrane
Base of first metacarpal
Abducts thumb
Extensor pollicis
longus
Posterolateral surface of
Base of distal phalanx of
ulna, interosseous
first digit
membrane
Extends distal phalanx
of thumb
Extensor indicis
joins the extensor
Posterolateral surface of digitorum tendon to the
ulna, interosseous
second digit and insert
membrane
into the posterior digital
expansion
Extends the proximal
phalanx of second digit
The Wrist and Hand
Chapter 15
Bones
• Wrist
• Carpal bones
• 8 - scaphoid, lunate, triquetral,
pisiform, trapezium, trapezoid,
capitate, hamate
• Hand
• Metacarpals
• 5 - numbered from the thumb to
the fifth finger
• Digits
• Phalanges
• 14 - 3 per finger and 2 for the
thumb
Connective Tissue
• Retinaculum
• Flexor retinaculum
• Palmer carpal ligament
• Transverse carpal
ligament
• Extensor retinaculum
Nerves
• Median
• Carpal tunnel syndrome
• Ulnar
• Tunnel of Guyon
• Radial
Nerves
• Carpal tunnel syndrome
• Median nerve becomes
pressed or squeezed at the
wrist
• Symptoms - burning,
tingling, itching numbness
of the palm of the hand,
thumb and 2nd and 3rd
digit. Progression can
result in weakening and
atrophy of the thenar
muscles
Thenar muscles
Origin
Insertion
Action
Abductor pollicis
brevis
Scaphoid and tapezium,
flexor retinaculum
Base of proximal
phalanx of first digit
Abduction of CMC joint
of first digit
Opponens pollicis
Trapezium and flexor
retinaculum
Shaft of first metacarpal
Opposition at CMC joint
of first metacarpal
Thenar muscles
Flexor pollicis brevis
Origin
Insertion
Radius and interosseous
Base of the proximal
membrane
phalanx of the first digit
Posterior radius and
Extensor pollicis brevis
interosseous membrane
Action
Flexion at CMC and
MCP joints of the first
digit
Base of the proximal
phalanx of first digit
Abduction at the
radiocarpal joint,
extension at the CMC
and MCP of first digit
Adductor pollicis
oblique
Capitate and base of
second and third
metacarpals
Base of the proximal
phalanx of first digit
Adduction at CMC,
flexion at MCP of first
digit
Adductor pollicis
transverse
Palmer surface of third
metacarpal
Base of proximal
phalanx of first digit
Adduction at CMC,
flexion at MCP of first
digit
Hypothenar muscles
Palmeris brevis
Origin
Palmer aponeurosis
Insertion
Action
Tightens palmar
Skin of the Hypothenar
aponeurosis and pulls
eminence over the ulnar
skin of ulnar side of
border
hand to the center of the
palm
Abductor minimi digiti
Pisiform
Base of 5th proximal
phalanx on ulnar side,
dorsal digital expansion
of 5th digit
Flexion of MCP joint,
extension in PIP and
DIP, and abduction of
5th digit
Flexor brevis minimi
digiti
Hook of hamate and
flexor retinaculum
Base of the 5th proximal
phalanx
Flexion at CMC and
MCP joint of 5th digit
Opponens minimi digiti
Hook of hamate and
flexor retinaculum
Ulnar margin of 5th
metacarpal
Opposes 5th digit
Intermediate muscles
of the hand
Origin
Insertion
Action
Lumbricales
Flexor digitorum
profundus tendons
Extensor expansion of
extensor digitorum of
digits 2-5
Flexion at MCP joint,
extension at proximal
and distal IP joints
Interosseous
Two heads, adjacent to
dorsal and palmar
metacarpals
Sides of the proximal
phalanges to extensor
expansion of digits 2-5
Flexion at MCP joint,
extension and adduction
at proximal and distal
interphalangeal joints
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