Shoulder and Arm Session 2(1)

8/10/2019 Shoulder and Arm Session 2(1)

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Anatomy of theLimbs

Session 2

The shoulder and arm


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Anatomy of the Limbs

1 Overview of upper and lower limbs

2 Shou lder and A rm

3 Elbow, forearm and wrist

4 Hand

5 Brachial plexus. Review of nerves and vessels

6 Hip, buttock and thigh 7 Knee, leg, ankle and foot

8 Review of nerves and vessels.


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Standard Anatomy session format Lectures

Dissecting Roomprosections

Living Anatomy Bones and joints

Surface anatomy

Clinical testing


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Session Two

The bones of the pectoral girdle and arm

The muscular anatomy of the region

The joints of the pectoral girdle and upperarm

The axilla

The blood vessels of the region

The lymphatic drainage of the region

The nerves of the region


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The Bones of the Region The Scapula

The Clavicle

The Humerus


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The Scapula


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The Clavicle


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The Humerus

The surgicalneck is

morecommonlydamagedthan theanatomical

neck.
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Muscle attachments

Old fashioned terminology for muscle attachments

is:

originsand insertions. Now considered inaccurate.

For Limbs, the correct terminology is:

proximal attachmentand distal attachment. Theproximal attachment is at, or closer to, the trunk.


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The Muscular Anatomy of the

Region: the compartments

Anterior pectoral girdle muscles

Posterior pectoral girdle muscles Intrinsic shoulder muscles

Anterior compartment of the upper arm

Posterior compartment of the upper arm


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The Anterior Pectoral Girdle Muscles

Pectoralis major Pectoralis minor

Subclavius

Serratus anterior*

*runs anterior and posterior


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Pectoralis MajorProximal attachments:on the medial 1/3rdof

the clavicle, thesternum and costalcartilages.

Distal attachment:

lateral lip of theintertubercular sulcus(groove).

Adducts and medially

rotates the humerus.Lesser actions on thescapula.


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Pectoralis Minor


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SubclaviusAnchors the clavicle


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Serratus anterior

Runs from lateral border ofscapula to the anteriorattachments on the ribs.

Supplied by the long thoracicnerve


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The Posterior Pectoral Girdle

MusclesTrapezius, Latissimus dorsi, Levator scapulae, the Rhomboids


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Trapezius

Trapezius

The motor supply is by the

spinal accessory nerve (CNXI).

(N.B. a muscle of the upper limbis supplied by a cranial nerve.)

Major actions on the scapula.


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Latissimus dorsi

Latissimus dorsi

Supplied by the thoracodorsalnerve.

Extends, adducts and rotates thehumerus; pulls the body up to thearms during climbing. Important in

rowing.


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Rhomboids

Rhomboids

Supplied by the dorsal scapularnerve.

Retracts, rotates and fixes thescapula.


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Levator scapulae

Levator

scapulae

Supplied by the dorsal scapularnerve (+ C3,4).

Elevates and rotates the scapula.


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Intrinsic Shoulder Muscles

Deltoid

Teres Major

The Rotator CuffMuscles supraspinatus

infraspinatus teres minor

subscapularis

Rotator Cuff

Deltoid

Teres major


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Deltoid

Rotator Cuff

Supplied by the axillary nerve.

Deltoid abducts arm.

Deltoid

Teres major


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The Rotator CuffRotator cuffgroup acts to fixthe head ofhumerus in theglenoid fossa.

Supraspinatusimportant in

initiatingabduction of armfor first 15, thendeltoid takesover.

Teres major (notrotator cuff)adducts andmedially rotatesarm.


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Teres major(not rotator cuff)Innervated by lower subscapular nerve


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Anterior Compartment of the Arm

Biceps, Brachialis, Coracobrachialis

All supplied by the musculocutaneous nerve.


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Posterior Compartment of the ArmTriceps, Anconeus; supplied by the radial nerve


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The Joints of the Region

Sterno-clavicular joint

Acromio-clavicular joint

Gleno-Humeral joint (Shoulder joint)

Scapulo-thoracic joint (sometimes referred toas a virtual joint)

Elbow joint

Thepectoral girdle= SCJ + ACJ + GHJ +STJ


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Joints of the Pectoral Girdle


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Shoulder (gleno-humeral) Joint

Ball-and-socket synovial joint.

The glenoid fossa (the socket) is

shallow, but slightly deepened

by a cartilaginous labrum.

However, muscles required for

joint stability. (eg. Rotator cuff

group)


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The Rotator Cuff and the Shoulder Joint

Main function is to

hold the humeral

head within theglenoid

The rotator cuff

depressesthe

humeral head


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Movements of the Shoulder Joint


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Movements of the Scapulo-Thoracic Joint

Elevation / Depression of the scapula

Protraction / Retraction of the scapula Rotation of the scapula


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The Axilla

The gateway for nerves and blood vesselsto enter the upper limb

Shaped like a pyramid

Contains;Arteriesaxillary artery and its branches Veinsaxillary vein and its tributaries

Lymphatic vessels and lymph nodes

(important!) Nervesthe brachial plexus


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The Axilla


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Neurovascular

contents of

the axilla


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The Arteries of the Region

Subclavian artery

passes over the first rib to become

Axillary artery at the lower border of teres major becomes the

Brachial artery

Gives off a large branch in the armprofunda brachii

Divides as the level of the elbow into

Ulnar and Radial arteries


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The Arteries of the Region


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The Veins of the Region

Superficial and deep systems

Cephalic vein(superficial) runs up lateral borderof arm

Basilic vein(superficial) runs up the medialborder of arm

Basilic veins joins venae comitantes to form theaxillaryveinin the arm

Cephalic vein joins axillary vein in the axilla Axillary vein becomes the subclavian veinat the

level of the first rib


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The Veins of the Region (superficial)

f ( )


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The Veins of the Region (deep)


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The Lymphatic Drainage of the

Region

Superficial and deep systems, run with veins

Cubital lymph nodes

Delto-pectoral lymph nodes

Axillary lymph nodesimportant!

Subclavian lymph trunk

Long thoracic nerve and thoraco-dorsal

nerve!


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The Lymphatic Drainage of the Arm

Axillary lymph nodesalso very important indraining the breast;

removing axillarylymph nodes in breastcancer treatment canlead to lymphedemaof the arm, forearm

and hand.


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The Nerves of the Region

the Brachial Plexus

B hi l Pl l i th li b


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Brachial Plexus: supplying the upper limb

f


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Largest Nerves of the brachial

plexus

Axillary nerve (C5)

Musculo-cutaneous nerve (C567)

Ulnar nerve (C8T1)

Median nerve (C678T1)

Radial nerve (C5678T1)

N f th U Li b


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Nerves of the Upper Limb



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Common

sites ofdamage


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Dissecting Room Session

Prosections of the shoulder, axilla and arm

Prime movers of the shoulder girdle,

shoulder joint and elbow joint Axillary nerve

The axilla

The brachial plexus in the axilla (overview) The subclavian and axillary vessels


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Living Anatomy Session

Osteology of scapula, clavicle and

humerus

Surface anatomy of the shoulder girdle

and upper arm

Movements of the limbs in general

Movements of the shoulder girdle and

upper limb

Documents

Shoulder and Arm Session 2(1)