NORMAL ANATOMICAL POSITION *coracoid process-curves below the clavicle

PERSON STANDING ERECT WITH THE FACE SCAPULA (Shoulder Blade)

DIRECTED FORWARD, UPPER LIMBS
HANGING ON THE SIDES AND THE PALMS Flattened triangular bone covering 2nd –7th
FACING FORWARD rib

BONES AND JOINTS Acromion process - “point of the scapula”

General Considerations: CLAVICLE

* 206- average no. of bones in adults * LONG BONE WITH SLIGHT s CURVE

* PAIRED (86)- upper and lower limbs * “COLLARBONE”

* UNPAIRED (34)- vertebral column * acromial or lateral end

AXIAL SKELETON * sternal or medial end

form the upright axis of the body:skull, * the pectoral girdle s only attachment to the
auditory ossicles, hyoid bone, vertebral axial skeleton is at the STERNUM
column, rib cage. CLAVICLE (Collar Bone)
APPENDICULAR SKELETON Extends from the manubrium sterni to the
upper and lower limbs plus the girdles acromion of the scapula 1st bone in the body
to OSSIFY (7th week intra utero)
APPENDICULAR SKELETON
Most common site of fractures in children
PECTORAL GIRDLE
HUMERUS
(shoulder girdle)- consist of (2) SCAPULAE
and (2) CLAVICLES HUMERAL HEAD –articulates withn the
glenoid cavity of the scapula
SCAPULA
ANATOMICAL NECK
Flat triangular bone
SURGICAL NECK
*glenoid cavity
GREATER TUBERCLE
*scapular spine
LESSSER TUBERCLE
*supraspinous fossa
INTERTUBERCULAR(BICIPITAL)groove
*infraspinous fossa
DELTOID TUBEROSITY
*subscapular fossa
CAPITULUM- radial head
*acromion process- “point” of the shoulder
TROCHLEA –ulna
MEDIAL AND LATERAL EPICONDYLES
HUMERUS (longest bone of the upper limb)
Surgical Neck - common site of fractures
Nerves in close contact:
– Axillary
TRIANGLE OF AUSCULTATION : On the
medial back, it is an area of little muscle and
hence a good place to listen to the lungs.
Medial Border: Trapezius muscle
Lateral Border: Teres Major, laterally and
deep.

– Radial Inferior Border (base): Latissimus Dorsi

– ulnarn -

-surgical neck ARM MOVEMENTS

-radial groove FLEXION

medical epicondyle EXTENSION

MUSCLES: GENERAL PRICIPLES ABDUCTION

ORIGIN (head)- fixed end- usually the most ADDUCTION

stationary end of a muscle ROTATION(INT./EXT)
INSERTION(mobile end)-usually the end CIRCUMDUTION
undergoing greatest movement
TRUNK MUSCLES MOVING THE ARM
TENDONS –muscles connect to bones thru
these cordlike structures PECTORALIS MAJOR

APONEUROSIS- broad sheetlike structures LATISSIMUS DORSI

also forming attachment to bones
SHOULDER MUSCLES MOVING THE ARM
* Muscles attaching scapula to the thorax
DELTOID
These muscles move the scapula, permitting
a wide range of movements of the upper TERES MAJOR
limb, or act as fixators to hold the scapula ROTATOR CUFF MUSCLES
firmly in position.
*supraspinatus
1.TRAPEZIUS
*infraspinatusprimary action:hold
2.Levator scapulae
*teres minorthe humeral head in
3.Rhomboideus major/minor
*subscapularisglenoid cavity
4.Serratus anterior
Deltoid Muscle
5.Pectoralis minor
* It inserts on the Deltoid Tuberosity of the
humerus and has multiple actions
*Anterior part flexes and medially rotates the
arm.
*Posterior part extends and laterally rotates
the arm.
*Lateral fibers abduct the arm.
MUSCLES OF THE ARM THAT MOVE THE
ARM
CORACOBRACHIALIS
BICEPS BRACHII
TRICEPS BRACHII
QUADRANGULAR SPACE : Just medial to the
surgical neck of the humerus on the posterior
side.
Superior border: Teres Minor (posteriorly)
Inferior border: Teres Major (anteriorly)
Lateral border: Lateral head of the Triceps
Medial border: Long head of the Triceps
CONTENTS: can be damaged with a fracture
of the neck of the humerus.
– Axillary Nerve
– Posterior Circumflex Humeral Artery
THE AXILLA
Borders of the Axilla
Anterior Border: The pectoralis major and
minor, and the subclavius, plus investing
fascia (Clavipectoral fascia).
Base of the Axilla: The skin of the armpit,
superficial fascia.
Apex of the Axilla: The root of the neck,
through which the brachial plexus of nerves
and vessels travels.
Medial Border: Serratus Anterior and
intercostal muscles.
Posterior Border: Subscapularis, Latissimus
Dorsi, and Teres Minor.
CONTENTS:
The axillary artery
The axillary vein
The Brachial Plexus
The Axillary group of lymph nodes
ARTERIAL CIRCULATION UPPER
EXTREMITY
AXILLARY ARTERY : Branches of the Axillary
Artery
1st Part of Axillary Artery: Above the
pectoralis minor. Has 1 branch. – Superior
Thoracic Artery
2nd Part of Axillary Artery: Directly deep to
the Pectoralis Minor. Has 2 branches.
– Thoracoacromial Artery (pierces
clavipectoral fascia)
Deltoid Branch of Thoracoacromial
Pectoralis Branch of Thoracoacromial.
– Lateral Thoracic Artery (aka External
Mammary Artery) -- important source of
blood for mammary glands.
3rd Part of Axillary Artery: Below the
pectoralis minor. Has 3 branches.
– Anterior Circumflex Humeral Artery FOREARM,WRIST,HAND

– Posterior Circumflex Humeral Artery -- RADIUS

passes through Quadrangular space along
with the axillary nerve. tuberosity

And anterior and posterior circumflex - lateral

humerals anastomose with each other around * radial head
the lateral neck of the humerus.
* radial or bicipital
The posterior circumflex also
anastomoses with the deep brachial artery. * styloid process

– Subscapular Artery -- largest branch which ULNA

supplies muscles of posterior wall (scapula)
Medial trochlear or semilunar notch
Circumflex Scapular Artery branches off
and proceeds posteriorly through the olecranon process
triangular space.
coronoid process
Thoracodorsal Artery travels along with radial notch
thoracodorsal nerve.
ulnar tuberosity
AXILLARY LYMPH NODES : The apical group
is the most crucial for spreading of breast ulnar styloid
cancer. If it has gotten to the axillary group,
you are in trouble. WRIST

Lateral Group: Drains the upper limb. REGION between the forearm and hand

Located near brachial artery. CARPAL BONES (8)

Subscapular Group: Drains the scapular Proximal Row: Scaphoid

region and posterior thoracic wall.
Lunate
Pectoral Group: Drains the anterior thorax
Triquetrum
and some of mammary glands.
Pisiform
Assoc. with lateral thoracic artery.
DISTAL ROW
CENTRAL GROUP: It receives the lymph from
the previous three groups. It forms the largest Trapezium
group and is often palpable upon examination
Trapezoid
APICAL GROUP: The only one above the
pectoralis minor. It receives lymph from the Capitate
central group as well as other locales, and
Hamate
dumps into the subclavian trunk.
HAND * extensor digitorum

Metacarpals (5) 2. DEEP group: Posterior:origin:radius/ulna

Phalanges (5) proximal middle distal * abductor pollicis longus

FOREARM MOVEMENTS * extensor indicis

FLEXION – brachialis, biceps, brachioradialis * extensor pollicis brevis

EXTENSION – triceps brachii * extensor pollicis longus

PRONATION - pronator teres, pronator EXTRINSIC MUSCLES - HAND

quadratus
SUPINATION- supinator, biceps brachii
WRIST, HAND,FINGER MOVEMENTS
ANTERIOR GROUP
1. Superficial:origin:medial epicondyle of
humerus * flexor carpi radialis
* flexor carpi ulnaris
* flexor digitorum superficialis
* palmaris longus
2. Deep Group: origin: medial epicondyle
* flexor digitorum profundus
* flexor pollicis longus
ACTION: ANTERIOR GROUP:FLEXION OF
WRIST AND FINGERS
POSTERIOR GROUP
1. Superficial: origin: lateral epicondyle of
humerus
Origin located outside the hand but controls
hand movement. Tendons are attached to the
fingers and hand
RETINACULUM- holds the tendons in place to
prevent ―bowstring‖ effect during muscle
contraction
INTRINSIC MUSCLES HAND
Origin and insertion located in the hand
1. Thenar Group- base of the thumb
*abductor pollicis brevis
*opponens pollicis
*flexor pollicis brevis
2.HYPOTHENAR GROUP
Abductor - Digiti Minimi
Flexor Digiti Minimi Brevis
Opponens Digiti Minimi
3.MIDPALMAR GROUP

* extensor carpi radialis longus INTEROSSEI ( 7 )

* extensor carpi radialis brevis 3 Palmar - Adductors

* extensor carpi ulnaris 4 Dorsal - Abductors

* extensor digiti minimi LUMBRICALS

Originate from the 4 tendons of the Flexor
Digitorum Profundus
( ACTION: flex the mcp joint / extend the
interphalangeal joint )
MAJOR ANATOMIC AND CLINICAL POINTS:
*The ―rotator cuff ― muscles which provide
strength and stability to the shoulder joint are
the SITS muscles

ARTERIES *The deltoid muscle functions on all

BRACHIAL– divides into RADIAL and
ULNAR
Radial- deep palmar arch
Ulnar - superficial palmar arch
Digital arteries- passes to both sides of each
digit
*Veins of the upper limb
2 Major superficial veins:
1. Basilic- arise from superficial veins of the
medial and posterior hand---- curves around
the forearm to the anterior of the
elbow(cubital fossa)---- axillary vein---
suclavian vein
movements of the shoulder joint
Intramuscular injections are placed on
*the fleshy portions of the shoulder joint
*Because of the strength of the fused tendons,
forming the rotator cuff, protection of the
acromion process, and laxity of the capsule
joint inferiorly, most shoulder dislocations
occur inferiorly.
*The lateral and medial intermuscular septae
divde the arm into anterior (flexor) and
posterior(extensor) compartments
*The RADIAL nerve supplies ALL extensor
muscles to the upper extremity distal to the
shoulder joint

2. Cephalic—arise from superficial veins of

the medial and posterior hand---curves
around the forearm to the anterior
elbow(cubital fossa)---- lateral to the arm---
axillary artery

MEDIAN CUBITAL VEIN – connects the

basilic and cephalic vein at the cubital fossa
*SITE FOR DRAWING BLOOD

Deep veins – follows the course of the

arteries:

DIGITAL VEIN-----deep/superficial palmar

arch----radial/ulnar veins---- brachial vein----
axillary vein