1. Upper limbs & Muscles connecting them to the trunk
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2. Surface anatomy
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5. Cutaneous innervations
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8. Trapezius Muscle Proximal Attachment Distal Attachment Innervation
Main Action
Trapezius
Medial third of superior nuchal line; external occipital protuberance; nuchal ligament; spinous processes of C7 and C12 vertebrae
Lateral third of clavicle; acromion and spine of scapula
Accessory nerve (CN XI) (motor fibers) and C3, C4 spinal nerves (pain and proprioceptive fibers)
Descending part elevates; ascending part depresses; and middle part (or all parts together) retracts scapula; descending and ascending parts act together to rotate glenoid cavity superiorly
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9. Trapezius-Main Action
Upper fibers along with levator scapulae elevate the scapula & Lower fibers depress the scapula
Nerve supply
Middle fibres retract the scapula & Upper and lower fibers together rotate the scapula upwards
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12. Applied anatomy
The accessory nerve can be injured more distally in the neck by trauma or by surgical exploration in the posterior triangle. If the accessory nerve is sacrificed as part of a radical neck dissection, and the innervation of trapezius is lost, the patient develops intractable neuralgia due to traction on the brachial plexus caused by the unsupported weight of the shoulder and arm.
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13. Applied anatomy
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14. Latissimus dorsi
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15. Latissimus dorsi Muscle Proximal Attachment Distal Attachment
Innervation
Main Action
Latissimus dorsi
Spinous processes of lower 6 thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs
Floor of intertubercular groove of humerus
Thoracodorsal nerve (C6, C7, C8)
Extends, adducts, and medially rotates humerus; raises body toward arms during climbing
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17. Levator scapulae
Rhomboideus minor
Rhomboideus major
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18. Posterior tubercles of transverse processes of C1 and C4 vertebrae
Levator scapulae
Muscle
Proximal Attachment
Distal Attachment
Innervations
Main Action
Levator scapulae
Posterior tubercles of transverse processes of C1 and C4 vertebrae
Medial border of scapula superior to root of spine
Dorsal scapular (C5) and cervical (C3, C4) nerves
Elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
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19. Rhomboids minor and major Rhomboideus minor Rhomboideus major
Muscle
Proximal Attachment
Distal Attachment
Innervations
Main Action
Rhomboid minor and major
Minor: nuchal ligament; spinous processes of C7 and T1 vertebrae Major: spinous processes of T2 and T5 vertebrae
Minor: smooth triangular area at medial end of scapular spine Major: medial border of scapula from level of spine to inferior angle
Dorsal scapular nerve (C4, C5)
Retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall
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21. Applied anatomy (The triangle of auscultation )
space bounded by the lower border of the trapezius, the latissimus dorsi, and the medial margin of the scapula, where the absence of musculature allows respiratory sounds to be heard clearly with a stethoscope.
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22. Serratus anterior Serratus anterior
Muscle
Proximal Attachment
Distal Attachment
Innervations
Main Action
Serratus anterior
Arise by fleshy digitations from outer surface and upper border of upper eight ribs
Medial border and inferior angle of scapula
Long thoracic nerve
C5, 6, 7
Draws the scapula forward around the thoracic wall; rotates scapula
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24. Applied anatomy
Injury to the long thoracic nerve is common & Winging of the scapula may be the clinical manifestation
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25. Scapulohumeral muscles
Deltoid; Teres Major; Supraspinatus, infraspinatus, teres minor, and subscapularis - Rotator Cuff Muscles
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26. Scapulohumeral muscles
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27. Deltoid
Muscle
Proximal Attachment
Distal Attachment
Innervations
Main Action
Deltoid
Lateral third of clavicle; acromion and spine of scapula
Deltoid tuberosity of humerus
Axillary nerve (C5, C6)
Anterior part: flexes and medially rotates arm Middle part: abducts arm Posterior part: extends and laterally rotates arm
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29. Deltoid…
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30. Deltoid Injury to the Axillary Nerve
The deltoid atrophies when the axillary nerve (C5 and C6) is severely damaged. Because it passes inferior to the humeral head and winds around the surgical neck of the humerus, the axillary nerve is usually injured during fracture of this part of the humerus.
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32. Teres major Muscle Proximal Attachment Distal Attachment Innervations
Main Action
Teres major
Lower third of lateral border of scapula
Medial lip of bicipital groove of humerus
Lower subscapular nerve
C6, 7
Medially rotates and adducts arm and stabilizes shoulder joint
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33. Teres major…
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34. Rotator Cuff Muscles
Supraspinatus, infraspinatus, teres minor, and subscapularis
Nerve supply:
suprascapular nerve, C5 and 6
axillary nerve, C5 and 6
upper & lower subscapular nerves, C5, 6
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35. Rotator Cuff Muscles… Supraspinatus Supraspinous fossa of scapula
Proximal Attachment
Distal Attachment
Innervations
Main Action
Supraspinatus
Supraspinous fossa of scapula
Superior facet of greater tubercle of humerus
Suprascapular nerve (C4, C5, C6)
Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles
Infraspinatus
Infraspinous fossa of scapula
Middle facet of greater tubercle of humerus
Suprascapular nerve (C5, C6)
Laterally rotate arm; help hold humeral head in glenoid cavity of scapula
Subscapularis
Subscapular fossa (most of anterior surface of scapula)
Lesser tubercle of humerus
Upper and lower subscapular nerves (C5, C6, C7)
Medially rotates and adduct arm; helps hold humeral head in glenoid cavity
Teres Minor
Upper two thirds of lateral border of scapula
Greater tuberosity of humerus; capsule of shoulder joint
Axillary nerve
(C4), C5, 6
Laterally rotates arm and stabilizes shoulder joint
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37. Applied anatomy
The tendon of supraspinatus is separated from the coraco-acromial ligament, acromion and deltoid by the large subacromial bursa; when this is inflamed, abduction of the shoulder joint is painful.
The tendon is the most frequently torn element of the musculotendinous cuff around the shoulder joint.
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38. Quadrangular Space
The quadrangular space is an intermuscular space, located immediately below the shoulder joint. It is bounded above by the subscapularis and capsule of the shoulder joint and below by the teres major muscle. It is bounded medially by the long head of the triceps and laterally by the surgical neck of the humerus.
The axillary nerve and the posterior circumflex humeral vessels pass backward through this space
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