1. Muscles of Upper Appendage (Shoulder, Arm, Forearm, & Hand)
Nestor T. Hilvano M.D., M.P.H.

2. Learning Objectives You should be able to:
Identify the principal muscles of the shoulder and upper limbs and indicate their origin, insertions, actions, and innervation.
Explain common anatomic and physiologic problems based on what you have learned on this topic.

3. Muscles on Pectoral Girdle
Originate on axial skeleton and insert onto clavicle or scapula:
Trapezius, Rhomboid major and minor, Levator scapulae, Serratus anterior, Subclavius, Pectoralis muscle
Scapular movements produced include
medial and lateral rotation
elevation and depression
protraction and retraction
___ What bone braces the shoulder and limits movement?
a. clavicle b. first rib c. sternum d. humerus

4. Muscles on Pectoral Girdle Anterior Scapular Muscles
Pectoralis Minor
- ribs 3-5 to coracoid process of scapula
- protracts and depresses
shoulder
Serratus Anterior
- ribs 1-9 to medial border of scapula
- protracts and rotates shoulder
- throwing muscle
Subclavius
- rib 1 to clavicle
- depresses and protracts clavicle

5. Muscles on Pectoral Girdle Posterior Scapular Muscles
Trapezius
- occipital bone, spinous processes of thoracic
vertebrae to clavicle and scapula
- action: rotate upward, retract, & depress scapula
Levator scapulae
- C1-C4 to superior angle of scapula
- action: elevate shoulder
Rhomboid m. = C7- T1 to medial border of scapula
- action: adduct scapula & downward rotation
___ What muscles are used in shrugging your shoulders?
a. trapezius b. rhnomboid c. levator scapulae d. teres minor

6. Muscles that Move the Arm
___ What is the major abductor of the arm?
a. deltoid b. teres major
c. teres minor d. coracobrachialis
Deltoid – scapula to deltoid tuberosity of humerus; prime mover; flexion, extension, abduction of humerus
Coracobrachialis- assists in flexion & adduction at shoulder joint
Teres major- assists in extension & medial rotation at shoulder joint

7. Muscles that Move the Arm
Pectoralis major
- from anterior chest to crest of greater tubercle of humerus
- flexion at shoulder
Latissimus dorsi
- from thoracic vertebrae to intertubercular groove of
humerus
- extension at shoulder

8. Rotator Cuff Muscles (SITS)
Extending from posterior scapula to humerus
- Supraspinatus (abducts)
Infraspinatus and Teres minor (lateral rotation at
shoulder)
Extending from anterior scapula to humerus
- subscapularis (medial rotation)
What muscles are used in throwing a baseball?

9. Muscles that move the Forearm
Principal flexors
biceps brachii
Origin on scapula, inserts on radius
brachialis
inserts on ulna
Synergistic flexor
brachioradialis
Prime extensor
triceps brachii
Origin on scapula,
inserts onto olecranon of ulna

10. Muscles of Anterior Forearm
Action: Flex wrist and fingers, adduct, &/or abduct wrist
Flexor carpi radialis, palmaris longus, & flexor carpi ulnaris
FCR, PL (median n.); FCU (ulnar n)
Flexor digitorum superficialis
Flexor pollicis longus, flexor digitorum profundus

11. Muscles of Posterior Forearm
Action: Extension of wrist and fingers, adduct &/or abduct wrist
Innervation - radial nerve
Extensor carpi radialis, extensor digitorum, extensor carpi ulnaris, anconeus (extend at elbow), supinator, abductor pollicis longus, extensor pollicis longus, extensor indicis
Tennis elbow- inflammation at origin of ___ (a. flexor; b. extensor) carpi muscles.

12. Muscles of Hand and Fingers
Extrinsic muscles – strength and crude control
Intrinsic muscles – fine control
- Thenar group = fleshy base of thumb muscles (abductor pollicis brevis,opponens pollicis, adductor pollicis
- Hypothenar group = base of little finger muscles (abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi)
- Midpalmar group = Interosseus m. and Lumbrical m.
Flexor retinaculum – tendon passes underneath except palmaris longus.

13. Carpal Tunnel Syndrome
Repetitive motions cause inflammation and pressure on _____ nerve which innervates the hand.
Impairment of pronation of forearm and weakens flexion of wrist (chronic pain)
a. Median nerve b. radial nerve c. ulnar nerve d. axillary nerve

14. Muscles that move the Forearm and Hand
Biceps brachii, brachialis, brachioradialis – flexes the _________________________
Triceps brachii – extends the __________
Flexor carpi ulnaris, flexor carpi radialis, and palmaris longus – flexion of ____________
Extensor carpi radialis and extensor carpi ulnaris – extension and abduction, and extension and adduction of _______________
Pronator teres and pronator quadratus
- pronate _______________________

15. Homework (Self Review)
Describe carpal tunnel syndrome.
What is flexor retinaculum and it’s importance?
Name the muscles involved in the following:
___ extends the shoulders a. subclavius
___ throwing a ball b. extnesor carpi radialis
___ shrugging the shoulders c. flexor carpi radialis
___ flexes the shoulders d.supraspinatus
___ extend the forearm/elbow e. biceps
___ major abductor of arm f. triceps
___ flexion of wrist g. deltoid
___ flexion of elbow/move forearm up h. pectoralis major
___ extension of wrist i. levator scapulae
___ depresses the clavicle j. latissimus dorsi