UPPER LIMB MUSCLES OF THE SHOULDER AND ARM.

DESCRIPTION OF INDIVIDUAL STRUCTURES.

DESCRIPTION OF TOPOGRAPHICAL STRUCTURES.

CLASSIFICATION OF MUSCLES.

MUSCLES OF THE SHOULDER REGION.

MUSCLES OF THE ARM REGION.

TOPOGRAPHICAL REGIONS.

AXILLA.

QUADRANGULAR SPACE.

ARM CROSS SECTION.

CUBITAL FOSSA.

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UPPER LIMB MUSCLES OF THE SHOULDER AND ARM.

DESCRIPTION / DISCUSSION OF INDIVIDUAL ANATOMICAL STRUCTURES – SYSTEMS

APPROACH.

Systems Anatomy. Involves the study or description of the individual characteristics of structures. Tissue
systems (anatomy) eg bones, joints, muscles etc. Physiological systems eg cardiovascular, respiratory etc.

Muscles. General Function. Produce movement, control and limit movement, protection, produce heat, other
eg metabolic. Description. Classification, size, shape, attachments, action/function (movements, stabilization,
protection), innervation, key relationships, living and surface features.

Miscellaneous eg Connective Tissue, Membranes, Skin. The body is surrounded just beneath the skin by two
layers of connective tissue known as the membranous or superficial fascia and the deep fascia. The deep fascia
is sometimes attached to bone, it is deficient in the upper head and upper trunk and is at its thickest in the thigh
region. Skin in the limbs is of two sorts thin or hairy skin and located on the palms and ventral foot thick skin.
Thick skin is particularly adapted to grip.

CLASSIFICATION OF MUSCLES.

Histological, skeletal, smooth, cardiac. All limb and back muscles are skeletal.

Group, location eg shoulder, anterior arm, posterior arm, anterior forearm, posterior forearm, intrinsic hand
muscles.

MUSCLES OF THE SHOULDER REGION.

As a group the muscles of the shoulder region form a cone with an inferior defecit and the base medially placed
on the trunk. Most of the individual muscles are roughly triangular in shape with the apex lateral. When
flattened the cone forms a circle with the muscles now located as on a clock face. The muscles also form two
layers some deep some superficial. The position of the muscles on the clock face, their attachment to either the
humerus or scapula and their relationship to the shoulder joint are a reasonable guide to their action. There is no
clear pattern to their innervation, however most are innervated either by the axillary nerve or the smaller nerves
from the brachial plexus. Some of the muscles are important stabilizers. The cuff muscles and biceps for the
shoulder joint and trapezius and serratus anterior for the scapula.

Muscles attaching the Humerus to the Pectoral Girdle. Supraspinatus, infraspinatus, subscapularis, teres
minor ( the four tendinous cuff muscles), teres major, deltoid.

Muscles attaching the Humerus and Pectoral Girdle to the Trunk. Rhomboids, trapezius, levator scapulae,
subclavius, pectoralis major, pectoralis minor, serratus anterior, latissimus dorsi.

MUSCLES OF THE ARM REGION.

Anterior group. Coracobrachialis, biceps brachii, brachialis. All innervated by the musculocutaneous nerve.
Important flexors of the elbow joint, biceps also supinates the forearm.
Posterior group. Triceps. Innervated by the radial nerve. Important extender of the elbow joint.

DESCRIPTION / DISCUSSION OF THE RELATIONSHIPS OF ANATOMICAL STRUCTURES -

TOPOGRAPHICAL APPROACH.

Topographical Anatomy. Involves the study or description of regions and the relationships of the structures
within the region. The body in general has four major regions the head, neck, trunk and limbs. These regions
are further divided, these subdivision are often also called regions eg, the shoulder region, cubital fossa, the
hand. A particular form of topographical anatomy is cross sectional anatomy.

Approaches to Topographical Regions.

Spaces with boundaries, contents and relationships between contents eg axilla, cubital fossa.
Layered regions eg hand.
Long structures with key points in their course eg median nerve.
Cross sections eg arm.
Compound individual structures eg joints.
Combinations eg shoulder region.

Define the region or subregion.

Decide the approach(es) eg space, layers, long structures, cross sections, compound structures, combinations
etc.
Define the boundaries (particularly if a space), stating the provisos, limitations etc.
List the contents eg bones, joints, muscles, supply (NAVL), organs, miscellaneous (eg connective tissue),
Decide the level of detail, use groups of structures if relevant.
Figure out the relationships. Use landmark structures.

In discussing the function of a region consider at least two levels. The general or overall contribution of the
region to the overall function of say the limb or back. The role that individual or groups of structures within the
defined region play, the individual, particular or component functions.

TOPOGRAPHICAL REGIONS OF THE UPPER LIMB.

Axilla.

A space located below the shoulder joint, between the arm and the chest wall, pyramidal in shape.
Boundaries. Inlet clavicle, scapula, first rib. Floor skin. Medial wall ribs 1-5, serratus anterior. Lateral wall
bicipital groove. Posterior wall subscapularis, latissimus dorsi, teres major. Anterior wall pectoralis major,
pectoralis minor.
Contents include, coracobrachialis, biceps tendon, part of the brachial plexus and its branches, the axillary
artery and vein, the cephalic vein and the axillary lymph nodes.

Quadrangular Space.

A space formed superiorly by teres minor, inferiorly by teres major, medially by the long head of triceps and
laterally by the shaft of the humerus. The axillary nerve passes through it.

The Arm.

Taking a cross section of the mid arm. Humerus centrally, two septa and surrounding deep fascia. Two muscle
compartments. Posterior compartment triceps. Anterior compartment two layers deep brachialis, superficial
biceps brachii, also coracobrachialis at a more proximal level. The medial nerve, brachial artery and its
comitantes and the basilic vein between the two layers of the anterior compartment medially, the
musculocutaneous nerve laterally. Ulna nerve now in the posterior compartment. Radial nerve in the posterior
compartment against the shaft of the humerus, The cephalic vein outside the deep fascia laterally.
Using a single or several cross sections of a structure to portray an overall three dimensional picture of the
structure while useful has its provisos and limitations. It assumes that the structure is a uniform cylinder (for the
limbs) and that all structures are present at all levels, have the same dimensions and have the same
relationships. This is often not the case. It can be partly resolved by having multiple cross sections or
constructing a typical or compound cross section.

Cubital Fossa.

A space located anterior to the elbow joint. Boundaries, lateral medial side of brachioradialis, medial lateral
side of pronator teres, superior a line between the epicondyles of the humerus, roof skin, the floor brachialis and
supinator.
The major contents are, from lateral to medial, the radial nerve, biceps tendon, brachial artery, median nerve.
The roof contains median cubital vein.

REFERENCES.

Moore.K.L. and Dalley A.F. ‘06. “Clinically Orientated Anatomy” 5th edition.
Upper Limb chapter 6.

Drake.R.L. et al Eds.’05 “Anatomy for Students”

Upper Limb chapter 7.

Kapit. W. and Elson. L. M. ‘02. “The Anatomical Coloring Book”. 3rd edition.
P 54-57.

TABLE 1. MUSCLES ACTING ON THE SCAPULA AND SHOULDER JOINT.

Scapular-Chest Wall Shoulder Joint

Elevation Levator Scapulae,

Trapezius.

Depression Trapezius.

Protraction Serratus Anterior, Flexion Pectoralis Major, Deltoid,

Pectoralis Minor. Biceps, Coracobrachialis.

Retraction Trapezius , Rhomboids. Extension Latissimus Dorsi,

Deltoid, Teres Major,
Triceps.
Upward Serratus Anterior, Abduction Supraspinatus, Deltoid.
Rotation Trapezius.

Downward Levator Scapulae, Adduction Pectoralis Major,

Rotation Rhomboids. Latissimus Dorsi, Teres
Minor, Teres Major.
 Medial Latissimus Dorsi, Teres
Rotation Major, Pectoralis Major,
Subscapularis, Deltoid.
Lateral Infraspinatus,
Rotation Teres Minor, Deltoid.

Combined action = scapulohumeral rythmn.

TABLE 2. MUSCLES OF THE SHOULDER REGION.

Muscle. Subclassi Superficial Angle/ Joint Action. Innervation.

fication. /Deep. Position. Acted
Upon.
Deltoid. PG – H. S 12 SJ F, E, Ab. MR Axillary.
,LR.
Subscapularis. ,, D 3 SJ MR, Stab. Subscapular.

Teres Major. ,, S 7 SJ E, Ad, MR. Lower Subscapular.

Teres Minor. ,, D 7.30 SJ E, LR, Stab. Axillary.

Infraspinatus. ,, D 8 SJ LR, Stab. Suprascapular.

Supraspinatus ,, D 12 SJ Ab, Stab. Suprascapular.

.

Levator UL – B. D 12 Sc-CW Elev, DR. Dorsal

Scapulae. Scapular.
Subclavius. ,, D 2 Cl-CW Stab. N to
Subclavius.
Pectoralis ,, S 3 SJ F, Ad. Pectoral.
Major.
Pectoralis ,, D 3 Sc-CW Pro. Pectoral.
Minor.
Serratus ,, S/D 4.30 Sc-CW Pro, UR, Stab. Long
Anterior. Thoracic.
Latissimus ,, S 7 SJ Ext, Ad, MR. Thoracodorsal.
Dorsi.
Rhomboids. ,, D 9 Sc-CW Ret, DR. Dorsal
Scapular.
Trapezius. ,, S 7 - 11 Sc-CW Elev, Dep, Ret, Accessory.
 Stab.
PG-H pectoral girdle to humerus. UL-B upper limb to rest of body.
For right shoulder 12 = sup, 3 = ant, 6 = inf, 9 = post.
SJ shoulder joint, Sc-CW scapula-chest wall, Cl-CW clavicle-chest wall.

TABLE 3. MUSCLES OF THE ARM REGION.

Muscle Classificatio Attachments Action Innervation Other

n
Coracobrachialis Ant arm. Scapula, Flex SJ M/c. M/c n
. humerus pierces.
Brachialis Ant arm Humerus, Flex EJ M/c. Med floor
ulna. cub fossa.
Biceps brachii. Ant arm. Scapula, FlexSJ,flex M/c. Stabilise SJ.
radius. EJ, sup RUJ
Triceps. Post arm Scap/hum, Ext SJ, ext Radial. Rad n deep.
ulna. EJ.

DESCRIPTION OF MUSCLES.

CLASSIFICATION.

HISTOLOGICAL.

GROUP.

SIZE.

SHAPE.

ATTACHMENTS.
ACTION.

INNERVATION.

KEY RELATIONSHIPS.

LIVING AND SURFACE FEATURES.

DESCRIPTION OF THE RELATIONSHIPS OF ANATOMICAL

STRUCTURES - TOPOGRAPHICAL APPROACH.

TOPOGRAPHICAL – DESCRIPTION OF REGIONS.

GROUPS OF STRUCTURES.

RELATIONSHIPS.

SPACE WITH BOUNDARIES AND CONTENTS.

LAYERS.
LONG STRUCTURE.

CROSS SECTION.

COMPOUND INDIVIDUAL STRUCTURE.

COMBINATIONS OF THE ABOVE.