Muscles of Upper Limb

Dr Nurul Raudzah Adib Ridzuan

MBBS YR1 MSK Module
21st Dec 2011
Contents:
 Muscles of the back & scapular region: group
action, nerve supply & result of paralysis
 Muscles of pectoral region: group action, nerve
supply & result of paralysis
 Muscles of the arm: group action, nerve supply &
result of paralysis
 Muscles of the forearm: group action, nerve supply
& result of paralysis
 Muscles of the hand: group action, nerve supply &
result of paralysis
 Boundaries & contents of axilla
 Boundaries & contents of cubital fossa
Introduction
 Upper limb: associated with lower
portion of the neck
 Suspended from the trunk by
muscles & a small skeletal
articulation between clavicle &
sternum
 Divided into shoulder, arm,
forearm & hand
Introduction:
 Muscles connecting  Muscles connecting
upper limb with upper limb with
vertebral column thoracic wall
 Trapezius  Pectoralis Major
 Latissimus dorsi  Pectoralis Minor
 Rhomboideus major  Subclavius
 Rhomboideus minor  Serratus Anterior
 Levator scapulae
Introduction:
 Muscles of shoulder  Muscles of arm
 Deltoid  Biceps

 Supraspinatus  Brachialis

 Infraspinatus  Coracobrachialis

 Subscapularis  Triceps

 Teres minor
 Teres major
Introduction:
 Muscles of forearm &
hand
 Superficial muscles of
flexor compartment
 Deep muscles of
flexor compartment
 Extensor muscles of
forearm
 Muscles of the hand
 Muscles connecting upper limb with
vertebral column: [ Trapezius]
 Has an extensive origin from axial
skeleton (sites on skull & vertebrae,
from CI to TXII)
 Originated from superior nuchal
line, external occipital
protuberence, medial margin of
ligamentum nuchae, spinous
processes of CVII to TXII
 Inserts onto superior edge of crest
of the spine of scapula, acromion,
posterior border of lateral one-third
of clavicle
 Left & right trapezius muscles
form a diamond/trapezoid
shape
 Function: powerful elevator
of scapula, rotates the
scapula
 Innervated by accessory
nerve , anterior rami of
cervical nerves C3 & C4

Evaluation of accessory n: shrug

patients’ shoulders
 [Latissimus dorsi]
 Originates from spinous processes
of lower six thoracic vertebrae &
interspinous ligaments
 Inserts on floor of intertubercular
sulcus
 Adduction, medial rotation,
extension of arm at glenohumeral
joint
 Innervated by thoracodorsal n
[C6,C7]
[Rhomboid minor & Rhomboid
major]
 Rhomboid minor:
originates at lower end of
ligamentum nuchae &
spinous process of CVII
and TI vertebra
 Inserts at posterior surface
of medial border of
scapula
 Elevates & retracts the
scapula
 Innervated by dorsal
scapular n [C4,C5]
 Rhomboid major: originates
at spinous processes of TII-TV
& supraspinous ligaments
 Inserts at posterior surface of
medial border of scapula
 Elevates & retracts the
scapula
 Innervated by dorsal
scapular n [C4,C5]
[Levator scapulae]
 Originates from transverse
processes of CI to CIV vertebrae
 Inserts into posterior surface of
medial border of scapula
 Elevates the scapula
 Innervated by dorsal scapular n
& C3, C4 spinal nerves
Muscles connecting upper limb with
thoracic wall [pectoralis major]
 The largest, most superficial
muscle of anterior wall
 Has 2 heads:
 Clavicular head - clavicle
 Sternocostal head –
anterior surface of sternum
 Flexion, adduction, medial
rotation of arm
 Innervated by medial and
lateral pectoral n.
Muscles connecting upper limb with
thoracic wall [pectoralis minor]
 A small triangular shaped
muscle
 Lies deep to pectoralis major
 Originates as 3 muscular slips
from anterior surfaces of ribs III
to V
 Protracts the scapula, pulls tip
of shoulder down
Muscles connecting upper limb with
thoracic wall [subclavius]
 Originates at first rib at junction
between rib and costal
cartilage
 Act to pull the shoulder down
 Innervated by small branch
from brachial plexus
Muscles connecting upper limb with
thoracic wall [serratus anterior]
 Originates on lateral surfaces of
upper 8-9 ribs
 Protraction and rotation of
scapula
 Innervated by long thoracic n.
Muscles of shoulder: [Deltoid muscle]
 Most superficial muscle of
shoulder
 Large, triangular in shape
 Its base attached to scapula
& clavicle, its apex attached
to humerus
 Originates along a
continuous U-shaped line of
attachment to clavicle &
scapula, inserts to deltoid
tuberosity on the lateral
surface of the shaft of
humerus
 Major function: abduction
of the arm
 Innervated by axillary n.
(brachial plexus)
 Blood vessels: post.
circumflex humeral artery &
vein
Muscles of shoulder [Supraspinatus &
infraspinatus]
 Originate from two large fossae (1 above & 1
below the spine), on the posterior surface of
scapula
 Tendons insert on the greater tubercle of
humerus
 Supraspinatus: initiates
abduction of the arm at
glenohumeral joint
 Innervated by
suprascapular nerve
{C5, C6}

 Infraspinatus: laterally
rotates the humerus at
glenohumeral joint
 Innervated by
suprascapular nerve
{C5, C6}
Muscles of shoulder [Teres minor &
Teres major]
 Teres minor: a cord like
muscle
 Originated from upper 2/3
of flattened strip of bone
on posterior surface of
scapula
 Inserts on inferior facet of
greater tubercle of
humerus
 Rotates the humerus
 Innervated by axillary
nerve {C5, C6}
 Teres major: originates from a
large oval region on the
posterior surface of inferior
angle of scapula
 Ends as flat tendon at medial
lip of intertubercular sulcus on
anterior surface of humerus
 Medially rotates & extends the
humerus
 Innervated by inferior
subscapular nerve {C5-C7}
 Muscles of shoulder [Subscapularis]
 Forms the largest component of
posterior wall of axilla
 Originates from and fills the
subscapular fossa, inserts on lesser
tubercle of humerus
 Medial rotation of the arm
 Innervated by upper & lower
subscapular nerves [C5,C6]
Rotator cuff muscles:

Supraspinatus, infraspinatus, teres

minor, subscapularis
Muscles of arm: [Biceps]
 Originates as 2 heads:
 Short head: apex of coracoid
process of scapula
 Long head: supraglenoid tubercle
of scapula
 Insert as a single tendon into radial
tuberosity
 Function: powerful flexor of the
forearm at elbow joint , powerful
supinator in the forearm
 Innervated by musculocutaneous n.
{C5,C6}
Muscles of arm: [Brachialis]
 Originates from anterior aspect of
humerus,
 Lies beneath the biceps brachii m.
 Is flattened dorsoventrally,
converges to form a tendon,
attaches to tuberosity of ulna
 Function: powerful flexor of forearm
at the elbow joint
 Innervated by musculocutaneous n
[C5,C6]
 Muscles of arm: [Coracobrachialis]
 Together with short head of
biceps, originates from apex of
coracoid process
 Inserts on linear roughening on
mid-shaft of humerus on medial
side
 Flexes the arm at glenohumeral
joint
 Innervated by
musculocutaneous n [C5,C6,C7]
 Muscles of arm: [Triceps]
 The only muscle of posterior compartment of
the arm
 Has 3 heads:
 Long head: originates from infraglenoid tubercle of
scapula
 Medial head: posterior surface of humerus
 Lateral head: posterior surface of humerus
 3 heads converge to form a large tendon,
inserts on superior surface of olecranon of ulna
 Function: extends extends forearm at elbow
joint
 Innervated by radial n [C6,C7,C8]
Muscles of forearm & hand
 Anterior (flexor) compartment of forearm
 Associated with:
 Movements of wrist jt
 Flexion of fingers including the thumb
 Pronation
 Superficial muscles of flexor compartment
 4 muscles:
 Flexor carpi ulnaris [flexes & adducts wrist jt]
 Palmaris longus [flexes wrist jt]
 Flexor carpi radialis [flexes & abducts wrist jt]
 Pronator teres [pronation]
 All muscles are innervated by median nerve EXCEPT
flexor carpi ulnaris muscle (ulnar nerve)
Intermediate & deep layer
 Intermediate: flexor digitorum superficialis
(innervated by median n)

 Deep layer: 3 muscles

 Flexor digitorum profundus [flexes
interphalangeal jt of index, middle, ring, little
finger]
 Flexor pollicis longus [flexes interphalangeal jt of
thumb]
 Pronator quadratus [pronation]

 Innervated by median n.
Extensor muscles of forearm
 Posterior compartment of forearm
 Superficial & deep layer
 Associated with:
 Movement of wrist jt
 Extension of fingers and thumb
 Supination

• All muscles are innervated by radial n.

Superficial layer of muscles of posterior
compartment
 Brachioradialis
 Extensor carpi radialis longus
 Extensor carpi radialis brevis
 Extensor digitorum
 Extensor digiti minimi
 Extensor carpi ulnaris
 Anconeus
Deep layer of muscles on posterior
compartment
 Supinator
 Abductor pollicis longus
 Extensor pollicis brevis
 Extensor pollicis longus
 Extensor indicis

 All innervated by posterior interosseous n

Muscles of the hand
 Thenar muscles
 Hypothenar muscles
 Blood supply: radial & ulnar art, ulnar n.
Axilla
 The gateway to the upper limb
 Provides an area of transition between neck
& arm
 Formed by clavicle, scapula, upper thoracic
wall, humerus & related muscles
 Irregularly shaped pyramidal space with:
 Four sides
 An inlet
 A floor/base
Axillary inlet
 Oriented in horizontal place, triangular in
shape, apex directed laterally
 Margins of the inlet completely formed by
bone
 Medial margin: lateral border of rib I
 Anterior margin: posterior surface of clavicle
 Posterior margin: superior border of scapula
Contents of axilla:
 Major vessels and nerves:
 Subclavian artery (major b.v supplying the upper
limb)
 Axillary artery (from subclavian art, crosses lateral
margin of rib I, enters axilla)
 Axillary vein ---- subclavian vein (to enter the
neck)
 Inferior trunk of brachial plexus
 Axillary lymph nodes (5 groups) & associated
lymphatics
 Long thoracic & intercostobrachial n
 Axillary fat & areolar tissue
Cubital fossa
 An important area of transition
between arm & forearm
 Located anterior to elbow joint
 A triangular depression formed
between two forearm muscles
 Brachioradialis m: originating from lateral
supraepicondylar ridge of humerus
 Pronator teres m: originating from medial
epicondyle of humerus
Boundaries of cubital fossa:
 Laterally: medial border of brachioradialis
 Medially: lateral border of pronator teres
 Base: imaginary line – 2 epicondyles
 Apex: meeting point of lateral & medial
boundaries
 Base of triangle: imaginary
horizontal line between
medial & lateral
epicondyles
 Floor/bed of fossa: mainly
by brachialis m

 Major contents:
 Tendons of biceps
brachii m + bicipital
aponeurosis
 Brachial artery ----- radial
& ulnar arteries
 Median nerve
 Brachial art:
Bifurcates into radial & ulnar art in the apex of
fossa
[blood pressure reading: brachial art in cubital fossa]
 Median n.: medial to brachial art, passing ulnar and
humeral heads of pronator teres
 Roof of cubital fossa:
 Formed by superficial fascia & skin
 Important structure: median cubital vein,
connects the cephalic vein on lateral side &
basilic vein on medial side
 Other structures: cutaneous n.
THANK YOU FOR YOUR ATTENTION