Table 9-1 Muscles Connecting the Upper Limb to the Thoracic Wall Muscle Pectoralis major Pectoralis minor

Subclavius Origin Clavicle, sternum, and upper six costal cartilages Third, fourth, and fifth ribs First costal cartilage Insertion Lateral lip of bicipital groove of humerus Coracoid process of scapula Clavicle Nerve Nerve Supply Rootsa Medial and lateral pectoral C5, 6, 7, nerves from brachial plexus 8; T1 Medial pectoral nerve from C6, 7, 8 brachial plexus Nerve to subclavius from C5, 6 upper trunk of brachial plexus Long thoracic nerve C5, 6, 7 Action Adducts arm and rotates it medially; clavicular fibers also flex arm Depresses point of shoulder; if the scapula is fixed, it elevates the ribs of origin Depresses the clavicle and steadies this bone during movements of the shoulder girdle Draws the scapula forward around the thoracic wall; rotates scapula

Serratus anterior

Upper eight ribs

Medial border and inferior angle of scapula

Muscle Trapezius

Latissimus dorsi

Levator scapulae Rhomboid minor Rhomboid major

Table 9-2 Muscles Connecting the Upper Limb to the Vertebral Column Nerve Rootsa Origin Insertion Nerve Supply Action Occipital bone, ligamentum Upper fibers into lateral third Spinal part of accessory XI cranial Upper fibers elevate the scapula; nuchae, spine of seventh cervical of clavicle; middle and lower nerve (motor) and C3 nerve middle fibers pull scapula vertebra, spines of all thoracic fibers into acromion and and 4 (sensory) (spinal part) medially; lower fibers pull medial vertebrae spine of scapula border of scapula downward Iliac crest, lumbar fascia, spines of Floor of bicipital groove of Thoracodorsal nerve C6, 7, 8, Extends, adducts, and medially lower six thoracic vertebrae, lower humerus rotates the arm three or four ribs, and inferior angle of scapula Transverse processes of first four Medial border of scapula C3 and 4 and dorsal C3, 4, 5 Raises medial border of scapula cervical vertebrae scapular nerve Ligamentum nuchae and spines of Medial border of scapula Dorsal scapular nerve C4, 5 Raises medial border of scapula seventh cervical and first thoracic upward and medially vertebrae Second to fifth thoracic spines Medial border of scapula Dorsal scapular nerve C4, 5 Raises medial border of scapula upward and medially

Table 9-3 Muscles Connecting the Scapula to the Humerus Nerve Muscle Origin Insertion Nerve Supply Rootsa Action Lateral third of clavicle, Middle of lateral surface of Axillary nerve C5, 6 Abducts arm; anterior fibers flex and Deltoid acromion, spine of scapula shaft of humerus medially rotate arm; posterior fibers extend and laterally rotate arm Supraspinous fossa of Greater tuberosity of Suprascapular nerve C4, 5, 6 Abducts arm and stabilizes shoulder joint Suprascapula humerus; capsule of spinatus shoulder joint Infraspinous fossa of Greater tuberosity of Suprascapular nerve (C4), 5, 6 Laterally rotates arm and stabilizes shoulder Infraspinatus scapula humerus; capsule of joint shoulder joint Medial lip of bicipital Lower subscapular C6, 7 Medially rotates and adducts arm and Teres major Lower third of lateral border of scapula groove of humerus nerve stabilizes shoulder joint Axillary nerve (C4), C5, Laterally rotates arm and stabilizes shoulder Teres minor Upper two thirds of lateral Greater tuberosity of border of scapula humerus; capsule of 6 joint shoulder joint Lesser tuberosity of Upper and lower C5, 6, 7 Medially rotates arm and stabilizes shoulder Subscapularis Subscapular fossa humerus subscapular nerves joint
* Clavipectoral Fascia

The clavipectoral fascia is a strong sheet of connective tissue that is attached above to the clavicle. Below, it splits to enclose the pectoralis minor muscle and then continues downward as the suspensory ligament of the axilla and joins the fascial floor of the arm. Table 9-5 Muscles of the Arm Muscle Origin Anterior Compartment Biceps brachii Long head Supraglenoid tubercle of scapula Insertion Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm Nerve Supply Nerve Roots Action Supinator of forearm and flexor of elbow joint; weak flexor of shoulder joint

Musculocutaneous C5, 6 nerve

Short head Coracoid process of scapula CoracobrachialisCoracoid process of scapula Medial aspect of shaft of humerus Brachialis Front of lower half of humerus Coronoid process of ulna

Musculocutaneous C5, 6, 7 Flexes arm and alsoprocess of weak nerve adductor Musculocutaneous C5, 6 Flexor of elbow joint nerve

Posterior Compartment Triceps Long head Infraglenoid tubercle of scapula Lateral head Upper half of posterior Olecranon process of ulna surface of shaft of humerus Medial head Lower half of posterior surface of shaft of humerus * Fascial Compartments of the Upper Arm

Radial nerve

C6, 7, 8 Extensor of elbow joint

The upper arm is enclosed in a sheath of deep fascia. Two fascial septa, one on the medial side and one on the lateral side, extend from this sheath and are attached to the medial and lateral supracondylar ridges of the humerus, respectively. By this means, the upper arm is divided into an anterior and a posterior fascial compartment, each having its muscles, nerves, and arteries. Muscles: Biceps brachii, coracobrachialis, and brachialis. Contents of the Posterior Fascial Compartment of the Upper Arm Muscle: The three heads of the triceps muscle Table 9-6 Muscles of the Anterior Fascial Compartment of the Forearm Nerve Insertion Nerve Supply Rootsa Action C6, 7 Pronation and flexion of forearm

Muscle Pronator Teres Humeral head

Origin

Medial epicondyle of humerus Lateral aspect of shaft of Median nerve radius Medial border of coronoid process of ulna Ulnar head Medial epicondyle of humerus Bases of second and third Median nerve Flexor carpi metacarpal bones radialis Median nerve Palmaris longus Medial epicondyle of humerus Flexor retinaculum and palmar aponeurosis Flexor Carpi Ulnaris Medial epicondyle of humerus Pisiform bone, hook of the Ulnar nerve Humeral head hamate, base at fifth metacarpal bone Medial aspect of olecranon process and posterior border of ulna Ulnar head Flexor Digitorum Superficialis Medial epicondyle of humerus; Middle phalanx of medial Median nerve Humeroulnar medial border of coronoid four fingers head process of ulna Oblique line on anterior surface of shaft of radius Radial head

C6, 7 C7, 8

Flexes and abducts hand at wrist joint Flexes hand

C8; T1 Flexes and adducts hand at wrist joint

C7, 8; T1

Flexes middle phalanx of fingers and assists in flexing proximal phalanx and hand

Flexor pollicis longus Flexor digitorum profundus Pronator quadratus

Anterior surface of shaft of Distal phalanx of thumb radius Anteromedial surface of shaft Distal phalanges of medial of ulna four fingers Anterior surface of shaft of ulna

Anterior interosseous C8; T1 branch of median nerve Ulnar (medial half) and C8; T1 median (lateral half) nerves Anterior surface of shaft of Anterior interosseous C8; T1 radius branch of median nerve

Flexes distal phalanx of thumb Flexes distal phalanx of fingers; then assists in flexion of middle and proximal phalanges and wrist Pronates forearm

Muscle Brachioradialis Extensor carpi radialis longus

Table 9-7 Muscles of the Lateral Fascial Compartment of the Forearm Nerve Nerve Origin Insertion Supply Rootsa Action Lateral supracondylar Base of styloid process of Radial C5, 6, 7 Flexes forearm atridge of humerus elbow joint; ridge of humerus radius nerve rotates forearm to the midprone position Lateral supracondylar Posterior surface of base of Radial C6, 7 Extends and abducts hand at wrist joint ridge of humerus second metacarpal bone nerve

Table 9-8 Muscles of the Posterior Fascial Compartment of the Forearm Nerve Muscle Origin Insertion Nerve Supply Rootsa Action Lateral epicondyle of humerus Posterior surface of base of Deep branch of C7, 8 Extends and abducts hand at Extensor carpi third metacarpal bone radial nerve wrist joint radialis brevis Lateral epicondyle of humerus Middle and distal Deep branch of C7, 8 Extends fingers and hand (see Extensor phalanges of medial four radial nerve text for details) digitorum fingers Lateral epicondyle of humerus Extensor expansion of little Deep branch of C7, 8 Extends metacarpal phalangeal Extensor digiti finger radial nerve joint of little finger minimi Lateral epicondyle of humerus Base of fifth metacarpal Deep branch of C7, 8 Extends and adducts hand at Extensor carpi bone radial nerve wrist joint ulnaris Lateral epicondyle of humerus Lateral surface of Radial nerve C7, 8; T1 Extends elbow joint Anconeus olecranon process of ulna Lateral epicondyle of humerus, anular Neck and shaft of radius Deep branch of C5, 6 Supination of forearm Supinator ligament of proximal radioulnar joint, and radial nerve ulna Deep branch of C7, 8 Abducts and extends thumb Abductor pollicis Posterior surface of shafts of radius and Base of first metacarpal ulna bone radial nerve longus

Extensor pollicis Posterior surface of shaft of radius brevis Extensor pollicis Posterior surface of shaft of ulna longus Extensor indicis Posterior surface of shaft of ulna

Base of proximal phalanx of thumb Base of distal phalanx of thumb Extensor expansion of index finger

Deep branch of C7, 8 radial nerve Deep branch of C7, 8 radial nerve Deep branch of C7, 8 radial nerve

Extends metacarpophalangeal joints of thumb Extends distal phalanx of thumb Extends metacarpophalangeal joint of index finger

Table 9-9 Small Muscles of the Hand Muscle Palmaris brevis Lumbricals (4) Origin Flexor retinaculum, palmar aponeurosis Tendons of flexor digitorum profundus Insertion Skin of palm Extensor expansion of medial four fingers Nerve Supply Superficial branch of ulnar nerve First and second, (i.e., C8; T1 Flex metacarpophalangeal joints and extend lateral two) median interphalangeal joints of fingers except nerve; third and fourth thumb deep branch of ulnar nerve C8; T1 Palmar interossei adduct fingers toward center of third finger Nerve Rootsa Action C8; T1 Corrugates skin to improve grip of palm

Interossei (8) Deep branch of ulnar Palmar (4) First arises from base of first Proximal phalanges of metacarpal; remaining three thumb and index, ring, and nerve from anterior surface of shafts little fingers and dorsal of second, fourth, and fifth extensor expansion of each metacarpals finger (Fig. 9-69) Contiguous sides of shafts of Proximal phalanges of Deep branch of ulnar Dorsal (4) metacarpal bones index, middle, and ring nerve fingers and dorsal extensor expansion (Fig. 9-69) Short Muscles of Thumb Scaphoid, trapezium, flexor Base of proximal phalanx Median nerve Abductor retinaculum of thumb pollicis brevis Flexor retinaculum Base of proximal phalanx Median nerve Flexor of thumb pollicis brevis Shaft of metacarpal bone of Median nerve Opponens Flexor retinaculum thumb pollicis

C8; T1 Dorsal interossei abductshafts of metacarpal fingers from center of third finger; both palmar and dorsal flex metacarpophalangeal joints and extend interphalangeal joints C8; T1 Abduction of thumb

C8; T1 Flexes metacarpophalangeal joint of thumb

C8; T1 Pulls thumb medially and forward across palm

Oblique head; second and third metacarpal bones; transverse head; third metacarpal bone Short Muscles of Little Finger Pisiform bone Abductor digiti minimi Flexor digiti Flexor retinaculum minimi Opponens Flexor retinaculum digiti minimi Adductor pollicis

Base of proximal phalanx Deep branch of ulnar of thumb nerve

C8; T1 Adduction of thumb

Base of proximal phalanx of little finger Base of proximal phalanx of little finger Medial border fifth metacarpal bone

Deep branch of ulnar nerve Deep branch of ulnar nerve Deep branch of ulnar nerve

C8; T1 Abducts little finger C8; T1 Flexes little finger C8; T1 Pulls fifth metacarpal forward as in cupping the palm