ANAT 112

• Regional anatomy (topographical anatomy) considers the

• organization of the human body as major parts or segments
• (Fig. I.1): a main body, consisting of the head, neck, and
trunk
• (subdivided into thorax, abdomen, back, and
pelvis/perineum),
• and paired upper limbs and lower limbs. All the major parts
• may be further subdivided into areas and regions. Regional
• anatomy is the method of studying the body’s structure by
• focusing attention on a specifific part (e.g., the head), area
• (the face), or region (the orbital or eye region); examining
• the arrangement and relationships of the various systemic
• structures (muscles, nerves, arteries, etc.) within it; and then
• usually continuing to study adjacent regions in an ordered
• sequence.
• Regional anatomy also recognizes the body’s organization
• by layers: skin, subcutaneous tissue, and deep fascia
covering
• the deeper structures of muscles, skeleton, and cavities,
which
• contain viscera (internal organs). Many of these deeper
struc
• tures are partially evident beneath the body’s outer
covering
• and may be studied and examined in living individuals via
• surface anatomy.
• Systemic anatomy is the
study of the body’s organ
systems
• that work together to carry
out complex functions. The
basic
• systems and the field of
study or treatment of each
(in paren
• theses) are:
• The integumentary system (dermatology) consists of the
• skin (L. integumentum, a covering) and its appendages—
• hair, nails, and sweat glands, for example—and the sub
• cutaneous tissue just beneath it. The skin, an extensive sen
• sory organ, forms the body’s outer, protective covering and
• container.
• • The skeletal system (osteology) consists of bones and
• cartilage; it provides our basic shape and support for the
• body and is what the muscular system acts on to produce
• movement. It also protects vital organs such as the heart,
• lungs, and pelvic organs.
• • The articular system (arthrology) consists of joints and
• their associated ligaments, connecting the bony parts of
• the skeletal system and providing the sites at which move
• ments occur.
• • The muscular system (myology) consists of skeletal mus
• cles that act (contract) to move or position parts of the
• body (e.g., the bones that articulate at joints), or smooth
• and cardiac muscle that propels, expels, or controls the
• flflow of flfluids and contained substance.
• • The nervous system (neurology) consists of the central
• nervous system (brain and spinal cord) and the periph
• eral nervous system (nerves and ganglia, together with
• their motor and sensory endings). The nervous system
• controls and coordinates the functions of the organ sys
• tems, enabling the body’s responses to and activities
within
• its environment. The sense organs, including the olfac
• tory organ (sense of smell), eye or visual system (ophthal
• mology), ear (sense of hearing and balance—otology), and
• gustatory organ (sense of taste), are often considered with
• the nervous system in systemic anatomy.
• • The circulatory system (angiology) consists of the cardio
• vascular and lymphatic systems, which function in parallel
• to transport the body’s flfluids.
• • The cardiovascular system (cardiology) consists of the
• heart and blood vessels that propel and conduct blood
• through the body, delivering oxygen, nutrients, and hor
• mones to cells and removing their waste products.
• • The lymphatic system is a network of lymphatic ves
• sels that withdraws excess tissue flfluid (lymph) from the
• body’s interstitial (intercellular) flfluid compartment,
• fifilters it through lymph nodes, and returns it to the
• bloodstream.
• The alimentary or digestive system (gastroenterology)
• consists of the digestive tract from the mouth to the anus,
• with all its associated organs and glands that function in
• ingestion, mastication (chewing), deglutition (swallowing),
• digestion, and absorption of food and the elimination of
the
• solid waste (feces) remaining after the nutrients have
been
• absorbed.
• • The respiratory system (pulmonology) consists of the air
• passages and lungs that supply oxygen to the blood for cel
• lular respiration and eliminate carbon dioxide from it. The
• diaphragm and larynx control the flflow of air through the
• system, which may also produce tone in the larynx that is
• further modifified by the tongue, teeth, and lips into
speech.
• The urinary system (urology) consists of the kidneys,
• ureters, urinary bladder, and urethra, which filter
blood
• and subsequently produce, transport, store, and
intermittently excrete urine (liquid waste).
• • The genital (reproductive) system (gynecology for
• females; andrology for males) consists of the gonads
• (ovaries and testes) that produce oocytes (eggs) and
• sperms, the ducts that transport them, and the
genitalia
• that enable their union. After conception, the
female
• reproductive tract nourishes and delivers the fetus.
GROSS ANATOMY OF
UPPER LIMB
• Anatomy is a descriptive science and
• requires names for the many structures and processes of the
• body. All anatomical descriptions are expressed in relation to one
• consistent position, ensuring that descriptions are not ambiguous
• The anatomical position refers to the body position
• as if the person were standing upright with the:
• • head, gaze (eyes), and toes directed anteriorly (forward),
• • arms adjacent to the sides with the palms facing anteriorly,
• And lower limbs close together with the feet parallel
• Anatomical Planes
• Anatomical descriptions are based on imaginary planes
• Sagittal planes
• Frontal (coronal) planes
• Transverse planes
• Terms of Relationship and
Comparison
• Various adjectives, arranged
as pairs of opposites,
describe
• Superior refers to a structure that is nearer the vertex
• Posterior (dorsal) denotes the back surface of the body or nearer to the back.
• Medial is used to indicate that a structure is nearer to the median plane of the
body.
• Proximal and distal are used when contrasting positions nearer to or farther
from the attachment of a limb or the central aspect of a linear structure,
• Superficial, intermediate, and deep describe the position of
structures relative to the surface of the body or the relationship of
one structure to another underlying or overlying structure.
 Terms of Movement
• Various terms describe movements of the limbs and other parts of the body
• Flexion indicates bending or decreasing the angle between the bones or parts of the body.
• Extension indicates straightening or increasing the angle between the bones or parts of the body.
• abduction means moving away from the median plane
• adduction means moving toward it.
• Protrusion is a movement anteriorly (forward) as in protruding
• the mandible (chin), lips, or tongue
• Retrusion
• is a movement posteriorly (backward), as in retruding the
• mandible, lips, or tongue.
• protraction and
• retraction are used most commonly for anterolateral and posteromedial
• movements of the scapula on the thoracic wall,
• Elevation raises or moves a part superiorly, as in elevating the shoulders when
shrugging,
• Depression lowers or moves a part inferiorly, as in depressing the shoulders when
standing at ease, the upper eyelid when closing the eye, or pulling the tongue
away from the palate.
 Crest: ridge of bone (e.g., the iliac crest).
Bone markings appear wherever tendons, • Epicondyle: eminence superior to a condyle
ligaments, and fascias are attached or (e.g., the lateral epicondyle of the humerus).
where arteries lie adjacent to or enter • Facet: smooth flat area, usually covered
bones. with cartilage, where a bone articulates with
Other formations occur in relation to the another bone (e.g., the superior costal
passage of a tendon (often to direct the facet on the body of a vertebra for
tendon or improve its leverage) or to articulation with a rib).
control the type of movement occurring at • Foramen: passage through a bone (e.g., the
a joint. obturator foramen).
Some of the various markings and features • Fossa: hollow or depressed area (e.g., the
of bones are (Fig. I.13): infraspinous fossa of the scapula).
• Capitulum: small, round, articular head • Groove: elongated depression or furrow
(e.g., the capitulum of the humerus). (e.g., the radial groove of the humerus).
• Condyle: rounded, knuckle-like articular • Head (L. caput): large, round articular end
area, often occurring in pairs (e.g., the (e.g., the head
lateral and medial femoral condyles). of the humerus).
Line: linear elevation (e.g., the soleal line of the
tibia).
• Malleolus: rounded process (e.g., the lateral Tubercle: small raised eminence (e.g.,
malleolus of the fibula). the greater tubercle of the humerus).
• Notch: indentation at the edge of a bone • Tuberosity: large rounded elevation
(e.g., the greater (e.g., the ischial tuberosity).
sciatic notch).
• Protuberance: projection of bone (e.g., the
external occipital protuberance).
• Spine: thorn-like process (e.g., the spine of
the scapula).
• Spinous process: projecting spine-like part
(e.g., the spinous process of a vertebra).
• Trochanter: large blunt elevation (e.g., the
greater trochanter of the femur).
• Trochlea: spool-like articular process or
process that acts as a pulley (e.g., the trochlea
of the humerus).
 UPPER LIMB
• The upper limb is characterized by its mobility and ability to grasp, strike, and conduct
fine motor skills (manipulation).
• These characteristics are especially marked in the hand when performing manual
activities such as buttoning a shirt.
• Parts (Regions) of the Upper Limb
• The upper limb may be described as consisting of the following major parts:
• Scapular and pectoral regions;
• Axilla;
• Arm (brachium);
• Elbow;
• Forearm (or antebrachium);
• Wrist; and
• Hand
• Scapular and Pectoral Regions of the Upper Limb
• Note the following points:
• The scapular region overlies the thorax posteriorly;
• The pectoral region overlies the thorax anteriorly,
• The pectoral girdle is the incomplete bony ring of the scapular/pectoral regions
that articulates with the bones of the arms (humerus).
• The Pectoral Girdle
• The following are the bones of the pectoral girdle:
• Paired scapulae, located in the scapular regions;
• Paired clavicles, located in the pectoral regions;
• Unpaired (median) manubrium sterni, which articulates with the clavicles at
the sternoclavicular joints.
• Scapula
• The Scapula
• Is a flat triangular bone located in the
superolateral part of the dorsal surface of the
thorax; it overlies the 2nd to 7th ribs (dorsally)
• Has two surfaces: posterior and costal
surfaces
• Has three borders: superior, medial and
lateral borders
• Has three angles: lateral, superior and
inferior angles;
• Has three bony projections: coracoid
process, acromial process and spinous
process
• Gives attachment to fifteen muscles. Thus, it
is largely non-palpable.
• Surfaces of the Scapula
• These include: Costal surface; and Dorsal surface
• The costal surface of the scapula
• Is the concave surface that overlies the 2nd – 7th ribs (dorsally);
• Is deepened by the presence of the subscapular fossa;
• The dorsal surface of scapula
• Has a spine that is placed obliquely across it, closer to its upper border than to
its lower end. This divides the dorsal surface into a smaller upper supraspinous
fossa and a larger lower infraspinous fossa
• Has a great scapular (spinoglenoid) notch between the spine and the posterior
surface of the ‘neck’ of the scapula. This notch transmits neurovascular
structures from supraspinous to the infraspinous fossa.
• There are 3 processes in the scapula:
• Spinous process, Acromial process, and Coracoid process
• Applied Anatomy of the Scapula
• Note the following points:
• The scapula is less frequently involved in fracture owing to the fact
that it is surrounded by muscles. However, the acromion, being
subcutaneous, is prone to fracture
• Clavicle
• Is roughly S-shaped. It is the bone that connects the upper limb to the trunk
(as it stretches between the manubrium sterni and the acromion)
• Helps to strut (support) the shoulder
• Has two ends: a sternal end, which articulates with the manubrium sterni at the
sternoclavicular joint, and an acromial end, which articulates with the acromion
at the acromioclavicular joint
• Has a sinuous shaft (body), which is convex anteriorly in its medial ⅔ and
concave anteriorly in its lateral ⅓. Thus, its S-shaped outline
• Is largely subcutaneous. Thus, its outline can be seen and readily palpated
Bears certain surface features that include the following: conoid tubercle,
subclavian groove, impression for costoclavicular ligament and trapezoid line
• Appears shorter, smoother, less curved and thinner in females, with the
acromial end being a little lower than its sternal end Is stronger and usually
shorter on the right than the left side
• The medial ⅔ of the clavicle
• Is convex forwards
• Bears an impression for the
costoclavicular ligament on the medial
part of its inferior surface. This gives
attachment to the costoclavicular
ligament
• Possesses a subclavian groove, just
lateral to the impression for the
costoclavicular ligament, on the inferior
surface of the clavicle. This gives
attachment to the to the subclavius
• Has a nutrient foramen, which is located
in the lateral part of the subclavian
groove, and the opening of which is
directed laterally
•
The lateral ⅓ of the clavicle
 Is concave forwards
 May bear a deltoid tubercle on its anterior border. This
gives attachment to the deltoid
 Bears a conoid tubercle on its inferior surface. This gives
attachment to the conoid ligament (medial part of the
strong coracoclavicular ligament)
 Also bears a trapezoid line, just lateral to the conoid
tubercle. This gives attachment to the trapezoid ligament
(lateral part of coracoclavicular ligament)

Applied Anatomy of the Clavicle

Note the following points:
 The clavicle is commonly involved in fracture; this
usually occurs at the junction of its lateral ⅓ and medial
⅔
 Drooping (sagging) of the affected upper limb occurs
following fracture of the clavicle
 Fracture of the clavicle occurs more frequently in
children than in adults. In the former, it is often
incomplete and of the greenstick type.
• Humerus
• The humerus
• Is the only bone of the arm
• Has a proximal end, a shaft, and a distal
end.
• The proximal end of the humerus consists
of:
• A hemispherical head (for glenohumeral
articulation)
• An anatomical neck (which circumscribes
and separates the head from the tubercles)
• Two tubercles: greater and lesser tubercles
(for muscular attachment)
• The distal end of the humerus
• Is the condyle of the humerus; it lies distal
to humeral shaft Is widened transversely,
such that it has anterior and posterior
surfaces
• Has an articular and a non-articular part.
The former consists of the capitulum and
trochlea; while the latter consists of the
medial and lateral epicondyles, olecranon
fossa, radial fossa and coronoid fossa
• Articulates with the ulna and radius at the
elbow joint, via its articular part (capitulum
and trochlea)
Applied Anatomy of the Humerus

 The surgical neck of the humerus is more frequently involved in

fracture, especially in the elderly, who suffer from osteoporosis
 In fracture of humeral surgical neck, the axillary nerve is at risk.
Injury to the axillary nerve will produce paralysis of deltoid and teres
minor, and anaesthesia of the skin over the lower part of deltoid
 In mid-shaft fracture of the humerus, the radial nerve is at risk.
Injury to this nerve will result in wrist drop (owing to paralysis of
extensor muscles of the forearm)
 The nerve to the long head of triceps is spared when the radial nerve
is injured in the arm. Thus, this head of triceps is not paralysed
 Fracture of the medial epicondyle of the humerus may injure the ulnar nerve (which lies
in a groove behind this epicondyle)
 Because the medial epicondyle fuses with humeral shaft at a later time than the lateral
epicondyle, radiological examination of the distal end of the humerus may result in a
wrong diagnosis of fracture of this bone
 The median nerve is also at risk in fracture of the distal part of the humerus
 During a fall on the point of the shoulder, avulsion fracture of the greater tubercle of the
humerus may occur, especially in the elderly
 Following amputation of the arm in young subjects, the proximal humeral stump continues
to grow because longitudinal growth of the humerus is largely a function of the proximal
growth cartilage.
• Bones of the Forearm
• Bones of the forearm include radius and ulna;
these lie parallel to one another when the
forearm is supinated, with the ulna being
medial to the radius.
• Radius
• Regarding the radius, note the following facts:
• The radius is the shorter of the forearm bones.
It lies lateral to the ulna, and has a proximal
end, a body and a distal end
• The proximal end of the radius consists of a
head, a neck and a radial tuberosity
• Ulna
• The ulna
• Is the longer of the two bones of the
forearm. It lies medial to the radius
• Is relatively fixed during supination-
pronation movement (when radius moves
across the ulna)
• Has a proximal end, a body and a distal
end (head)
• Anatomical features at the proximal end
of the ulna include:
• Olecranon, which gives attachment to the
tendon of triceps,
• Coronoid process, which gives attachment
to brachialis,
• Trochlea notch, which articulates with humeral
trochlea (at the humero-ulnar joint)
• Radial notch, which articulates with the circumference
of the head of radius (at the proximal radio-ulnar joint)
• Tuberosity of ulna; this gives attachment to the
tendon of insertion of brachialis;
• Supinator crest, for the attachment of supinator
• Supinator fossa, also for the attachment of supinator.
• A heavy blow on the forearm may result in fracture of
the intermediate portion of the radius and/or ulna.
The radio-ulnar joints may also be dislocated
• Colle’s fracture – fracture of the distal end of radius –
is the commonest fracture of the forearm, especially in
(female) subjects beyond 50 years of age (owing to
osteoporosis, etc)
• Healing of Colle’s fracture is usually satisfactory owing
to the rich blood supply of the radius.
• Hand (Manus)
• Regarding the hand, note the following:
• The forearm and the hand are joined at the wrist
(carpus)
• The hand has 27 bones; these are arranged as
follows:
• 8 bones in the carpus (wrist)
• 5 bones in the metacarpus (hand proper)
• 14 bones in the digits
• The carpus contains 8 carpal bones, flexor
retinaculum, extensor retinaculum, anatomical
snuff box and the carpal tunnel
• The hand proper consists of 5 metacarpal bones
and the compartments and spaces of the hand
• Each digit has three phalanges (bones), except the
first digit (thumb), which has two phalanges
• The hand is highly adapted for skilled and selective
• Axilla
• The axilla
• Is the pyramidal region between the upper
part of the lateral wall of the thorax and the
arm. It deepens when the arm is by the side
but almost disappears when the arm is
abducted
• Has an apex, a base, and four walls (anterior,
posterior, lateral and medial walls)
• Allows the passage of vessels and nerves
between the neck/thoracic cavity and the arm.
The axilla contains axillary vessels,
infraclavicular part of the brachial plexus (of
nerve), lymph nodes and adipose tissue
• Boundaries of the Axilla
• Anterior Wall of the Axilla
• The anterior wall of the axilla
• Extends from the clavicle above to the
• Is formed by pectorales major
and minor, subclavius and
clavipectoral fascia (see below).
• The clavipectoral fascia
• Is a fascial sheet that stretches
from the clavicle above to the
axillary fascia below, in the
anterior wall of the axilla.
Between these attachment sites,
it splits to enclose subclavius and
pectoralis minor
• Is pierced by thoraco-acromial
artery, cephalic vein and lymph
vessels, just above the medial
border of pectoralis minor
• Posterior Wall of the Axilla
• The posterior wall of the axilla
• Is formed above by subscapularis and
its fascia; and below by teres major
and latissimus dorsi. The latter winds
round the inferior border of teres
major, from posterior anteriorly, and
together they form the posterior
axillary fold.
• Medial Wall of the Axilla
• The medial wall of the axilla
• Is formed by the upper four ribs and
their associated intercostal muscles,
and the upper part of serratus anterior
• Is convex from anterior posteriorly.
• Lateral Wall
• The lateral ‘wall’ of the axilla
• Is formed by the intertubercular groove of
the humerus, and the coracobrachialis,
which overlies it
• Is extremely narrow (as anterior and
posterior axillary walls converge towards
it)
• Base of the Axilla
• The base of the axilla
• Is formed by skin, subcutaneous tissue and
axillary fascia. The latter stretches
between the inferior borders of pectoralis
major and latissimus dorsi;
• Has a convexity that faces the axilla, and a
concavity that corresponds to the armpit
• Is broadens towards the medial wall of the
• Apex of the Axilla
• Is truncated and directed superomedially,
towards the root of the neck
• Is bounded by the external border of the first
rib medially, upper border of subscapularis
(and scapula) posteriorly, and the clavicle
anteriorly
• Is linked to the root of the neck by the cervico-
axillary canal. This canal transmits
neurovascular structures between the axilla
and the neck
• Contents of the Axilla
• The axilla contains the following:
• Axillary artery and its branches
• Axillary vein and its tributaries
• Infraclavicular part of the brachial plexus
• Lymph vessels and five groups of lymph nodes
• Adipose Tissue (between the above structures)
• Contents of the Axilla
• The axilla contains the following:
• Axillary artery and its branches
• Axillary vein and its tributaries
• Infraclavicular part of the
brachial plexus
• Lymph vessels and five groups of
lymph nodes
• Adipose Tissue (between the
above structures)
• The axillary artery
• Is the direct continuation of the
subclavian artery. It commences at
the outer border of the 1st rib and
ends at the lower border of teres
major; here, it becomes the brachial
artery
• Lies close to the humerus; and is
related medially to the axillary vein
• Is described as consisting of three
parts (first, second and third parts), in
relation to pectoralis minor
• Is intimately related to the
infraclavicular part of brachial plexus
• Aneurysm of axillary artery may occur. This causes compression of
parts of the brachial plexus, with the resultant anaesthesia of the skin
supplied by such nerves
• To control bleeding in the upper limb, the axillary artery (especially its
3rd part) may be compressed against the humerus.
• In stenosis of the axillary artery, blood cannot reach the distal part of
this vessel except through collateral channels provided by the arterial
anastomoses around the scapula (see below)
• Accidental laceration of the axillary artery may occur, the frequency
being higher when the vessel is diseased
Brachial Plexus
The brachial plexus is
the network of nerves
that supplies the skin,
muscles and joints of the
upper limb. It extends
laterally and downwards
from the lower part of the
neck, passing behind the
clavicle, to enter the
axilla.
Brachial Plexus
The brachial plexus is the network of
nerves that supplies the skin, muscles and
joints of the upper limb. It extends laterally
and downwards from the lower part of the
neck, passing behind the clavicle, to enter
the axilla.
• The brachial plexus
• Is a network of nerves that innervates the upper
limb
• Has five roots commonly formed by ventral rami of
C5, C6, C7, C8 and T1 spinal nerves.
• Is defined as having a superomedial
supraclavicular part, which lies above the clavicle,
in the posterior triangle of the neck; and an
inferolateral infraclavicular part, which lies below
the clavicle, in the axilla
• Consists of the roots, trunks, divisions, cords and
branches, from medial laterally
• Supraclavicular part of the brachial plexus
• Is the part that lies above and medial to the
clavicle, in the lower part of the neck (posterior
triangle). It joins the infraclavicular part of the
plexus behind the clavicle
• Comprises the roots and trunks of the brachial
plexus
• Infraclavicular part of the
brachial plexus
• Is the part that lies below and
lateral to the clavicle, in the
axilla
• Consists of cords of the brachial
plexus and the branches that
arise from these cords (in the
axilla)
• Branches of the Roots of the
Brachial Plexus
• Nerves that arise from the roots
of the brachial plexus include:
• Dorsal scapular nerve (C5)
• Long thoracic nerve (C5, C6, C7)
• Cords of the Brachial Plexus (Fig. 82, 83)
• The cords of the brachial plexus
• Arise from the union of the divisions of
the brachial plexus. They are designated
as medial, lateral and posterior cords
• Are all located in the axilla, in close
relation to the axillary vessels
• Are arranged around the 2nd part of
axillary artery according to their names;
i.e., the lateral cord is lateral to axillary
artery (Fig. 83)
• Give rise to several branches. These
bear a similar relationship to the (3rd
part of) axillary artery as the cord from
which they arise (except the medial root
of median nerve) (Fig. 83). That is,
branches arising from the lateral cord lie
lateral to the axillary artery.
• Applied Anatomy of the
Brachial Plexus
• Note the following facts:
• In a postfixed type of
brachial plexus (see
above), the inferior trunk
may be compressed by the
first rib. This produces
certain neurological
deficits
• Brachial block
(anaesthesia of the larger
part of the upper limb) can
be effected by injecting an
anaesthetic into the angle
between the clavicle and
the posterior border of
sternocleidomastoid
• Erb-Duchenne palsy involves
injury to the C5/C6 nerve roots or
upper trunk of the plexus. In this
palsy, the arm hangs loosely at the
side, with the forearm pronated,
while the elbow is extended
(‘waiter’s tip position’). This is due
to paralysis of deltoid, biceps
brachii, brachialis and
brachioradialis; anaesthesia of
lateral aspect of the limb also
occurs
• In Klumpke’s palsy, the C8/T1
nerve roots (or lower trunk) of the
brachial plexus are injured. This
produces paralysis of the muscles
of the forearm and hand, resulting
in clawhand. Cervical sympathetic
nerves are also involved, resulting
in pupillary disturbances
• Erb-Duchenne palsy has a higher
• Muscles of the Pectoral Region
• (Anterior Thoraco-
Appendicular Muscles)
• Anterior thoraco-appendicular
muscles include the following:
• Pectorales major and minor
• Serratus anterior and
• Subclavius
• Muscles of the Pectoral Region
• (Anterior Thoraco-Appendicular
Muscles)
• Anterior thoraco-appendicular
muscles include the following:
• Pectorales major and minor
• Serratus anterior and
• Subclavius
• Posterior Thoracoappendicular Muscles
• The posterior thoracoappendicular muscles
• Are much more numerous than the anterior
thoracoappendicular muscles.
• Include some muscles of the back, which are
attached to the scapula and thorax
• May be divided into three groups:
• Superficial posterior thoracoappendicular muscles
• Deep posterior thoracoappendicular muscles , and
• Scapulohumeral muscles (Scapular muscles)
• Superficial Posterior Thoracoappendicular
Muscles
• These include:
• Trapezius and
• Latissimus dorsi
• Posterior Thoracoappendicular Muscles
• The posterior thoracoappendicular muscles
• Are much more numerous than the anterior
thoracoappendicular muscles.
• Include some muscles of the back, which are
attached to the scapula and thorax
• May be divided into three groups:
• Superficial posterior thoracoappendicular muscles
• Deep posterior thoracoappendicular muscles , and
• Scapulohumeral muscles (Scapular muscles)
• Superficial Posterior Thoracoappendicular
Muscles
• These include:
• Trapezius and
• Latissimus dorsi
• The deep thoracoappendicular muscles
• Lie deep to the superficial
thoracoappendicular muscles. They connect
the pectoral girdle (scapula) with the thoracic
wall
• Play major roles in the stability and rotation
of the scapula
• Include levator scapulae, rhomboid major
and rhomboid minorScapulohumeral muscles
• Connect the scapula to the humerus; they are
relatively short muscles
• Closely surround and act on the shoulder
joint
• Scapulohumeral muscles are six; they
include:
• Deltoid and subscapularis
• Teres major and teres minor
• Supraspinatus and infraspinatus.
• The deep thoracoappendicular muscles
• Lie deep to the superficial thoracoappendicular
muscles. They connect the pectoral girdle
(scapula) with the thoracic wall
• Play major roles in the stability and rotation of
the scapula
• Include levator scapulae, rhomboid major and
rhomboid minorScapulohumeral muscles
• Connect the scapula to the humerus; they are
relatively short muscles
• Closely surround and act on the shoulder joint
• Scapulohumeral muscles are six; they include:
• Deltoid and subscapularis
• Teres major and teres minor
• Supraspinatus and infraspinatus.
• The deep thoracoappendicular muscles
• Lie deep to the superficial thoracoappendicular
muscles. They connect the pectoral girdle
(scapula) with the thoracic wall
• Play major roles in the stability and rotation of
the scapula
• Include levator scapulae, rhomboid major and
rhomboid minorScapulohumeral muscles
• Connect the scapula to the humerus; they are
relatively short muscles
• Closely surround and act on the shoulder joint
• Scapulohumeral muscles are six; they include:
• Deltoid and subscapularis
• Teres major and teres minor
• Supraspinatus and infraspinatus.
• The anterior compartment of the arm
• Lies anterior to the humerus and the medial and lateral intermuscular septa.
These separate it from posterior compartment
• Contains three flexor muscles, blood vessels and nerves.
• Muscles of the Anterior Compartment of the Arm
• Muscles of the anterior compartment of the arm include:
• Biceps brachii
• Brachialis; and
• Coracobrachialis
• Posterior Compartment of the Arm
• This compartment contains:
• Triceps brachii; and
• Certain vessels and nerves, including profunda brachii vessels and radial nerve.
• The forearm
• Is the region of the upper limb between the
elbow proximally and the wrist distally
• Has two long bones: the ulna (medially) and
the radius (laterally)
• Is divided into a flexor compartment
(anteriorly) and an extensor compartment
(posteriorly)
• Contains several muscles, nerves (ulnar,
median and [branches of] radial nerves) and
blood vessels.
• The cubital fossa
• Is a triangular intermuscular depression located anterior to the elbow joint
• Contains large arteries and nerves, which enter the forearm from the arm.
• Boundaries of the Cubital Fossa
• The cubital fossa is bounded by the following:
• Medial border: lateral border of pronator teres
• Lateral border: medial border of brachioradialis
• Base: interepicondylar line (an imaginary line that joins the two humeral epicondyles)
• Floor: supinator and brachialis
• Roof: bicipital aponeurosis, deep and superficial fasciae, and skin.
• Contents of the Cubital Fossa
• The cubital fossa contains the following:
• A tendon: bicipital tendon
• Two nerves: median and radial nerves
• Three arteries: brachial, radial and ulnar arteries
• Contents of the Cubital Fossa
• The cubital fossa contains the following:
• A tendon: bicipital tendon
• nerve: median
• Three arteries: brachial, radial and ulnar arteries
• Three paired veins: brachial, radial and ulnar veins.
• In the cubital fossa, note that
• Only segments (parts) of the above structures are present
• The bicipital tendon is lateral while the median nerve is medial to the brachial artery. Thus,
the brachial artery is intermediate in position (between bicipital tendon laterally and
median nerve medially)
• The brachial artery divides (anteromedial to the neck of the radius) into radial and ulnar
arteries
• The radial nerve is concealed between supinator and brachioradialis (in the lateral aspect of
the fossa).
• Flexor (Anterior) Compartment of the Forearm
• The flexor compartment of the forearm
• Occupies the ventral aspect of the forearm. It contains the flexors and
pronators of the forearm. These muscles are arranged into two groups:
superficial and deep
• Is separated from the extensor compartment by ulna and radius and the
interosseous membrane between them
• Also contains nerves (ulna and median nerves) and the ulnar and radial
vessels.
• Muscles of the Flexor Compartment of the Forearm (Fig. 88, 89)
• Muscles of flexor compartment of forearm
• Largely arise from the medial epicondyle of the humerus; and some of
them extend into the hand
• Are arranged into superficial and deep groups. These muscles are
innervated by the ulnar and median nerves.
• Superficial Group of Forearm Flexor Muscles
• This group contains five muscles. They include:
• Pronator teres and flexor carpi radialis;
• Palmaris longus and flexor carpi ulnaris; and
• Flexor digitorum superficialis.
• Deep Group of Flexor Muscles of the Forearm
• Muscles of this group include:
• Flexor digitorum profundus
• Flexor pollicis longus; and
• Pronator quadratus.
• Superficial Group of the Extensor Compartment (Fig. 89)
• Muscles of the superficial group of the extensor compartment are seven;
they include:
• Brachioradialis
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor digiti minimi; and
• Anconeus.
• Deep Group of Extensor Compartment Muscles (Fig. 89)
• Muscles of the deep group of extensor compartment are five; they
include:
• Supinator
• Abductor pollicis longus
• Extensor pollicis longus
• Extensor pollicis brevis; and
• Extensor indicis
• Forearm
• The forearm
• Is the region of the upper limb between the elbow proximally and the
wrist distally
• Has two long bones: the ulna (medially) and the radius (laterally)
• Is divided into a flexor compartment (anteriorly) and an extensor
compartment (posteriorly)
• Contains several muscles, nerves (ulnar, median and [branches of]
radial nerves) and blood vessels.
• Flexor (Anterior) Compartment of the Forearm
• The flexor compartment of the forearm
• Occupies the ventral aspect of the forearm. It contains the flexors and
pronators of the forearm. These muscles are arranged into two groups:
superficial and deep
• Is separated from the extensor compartment by ulna and radius and the
interosseous membrane between them
• Also contains nerves (ulna and median nerves) and the ulnar and radial
vessels.
• Muscles of the Flexor Compartment of the Forearm
• Muscles of flexor compartment of forearm
• Largely arise from the medial epicondyle of the humerus; and some of
them extend into the hand
• Are arranged into superficial and deep groups. These muscles are
innervated by the ulnar and median nerves.
• Superficial Group of Forearm Flexor Muscles
• This group contains five muscles. They include:
• Pronator teres and flexor carpi radialis;
• Palmaris longus and flexor carpi ulnaris; and
• Flexor digitorum superficialis.
• Deep Group of Flexor Muscles of the Forearm
• Muscles of this group include:
• Flexor digitorum profundus
• Flexor pollicis longus; and
• Pronator quadratus.
• Extensor (Posterior) Compartment of the Forearm
• Muscles of the extensor compartment of the forearm
• Include those muscles that extend the wrist and digits; abduct the thumb; and supinate the
forearm. They are all innervated by the radial nerve
• Are also arranged into superficial and deep groups (as do those of the flexor
compartment)
• Superficial Group of the Extensor Compartment
• Muscles of the superficial group of the extensor compartment are seven; they include:
• Brachioradialis
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor digiti minimi; and
• Anconeus.
• Deep Group of Extensor Compartment Muscles
• Muscles of the deep group of extensor compartment are five; they
include:
• Supinator
• Abductor pollicis longus
• Extensor pollicis longus
• Extensor pollicis brevis; and
• Extensor indicis
• Shoulder (Glenohumeral) Joint
• The shoulder joint
• Is a multi-axial, ball-and-socket type of synovial joint
• Is formed between the hemispherical head of the humerus and the concave,
shallow glenoid cavity of the scapula
• Has a high degree of mobility. However, it is relatively unstable
• Is strengthened and stabilized by the rotator cuff muscles, which intimately
surround it
• Contains the long head of biceps within its joint cavity.
• Bony Articular Surfaces
• In the shoulder joint,
• Hyaline articular cartilage covers the
hemispherical surface of humeral head
and the concavity of glenoid cavity
• The shallow glenoid cavity is much
smaller than the humeral head. Thus, it
is deepened by a ring of fibrocartilage –
glenoid labrum – which is applied
around its margin.
• Fibrous Capsule of Shoulder Joint
• The fibrous capsule of shoulder joint
• Forms a loose external investment for the joint. Thus, it has a dependent, loose
fold, when the arm is by the side
• Is attached proximally to the margin of the glenoid cavity, external to glenoid
labrum (to which it is also partially attached). Distally, it is attached to the
anatomical neck of the humerus
• Is extremely weak in its inferior part, which is only supported by tendon of the
long head of triceps brachii
• Has two openings, one of which is located anteriorly and allows communication
between the cavity of shoulder joint and the subscapular bursa. The other is
located superiorly, at the upper end of the bicipital groove. It transmits the
tendon of the long head of biceps brachii
• The synovial membrane of the shoulder joint
• Lines the fibrous capsule of the joint, from which it is reflected onto the
anatomical neck of the humerus and the glenoid labrum
• Also invests the long head of biceps brachii as this traverses the bicipital groove
of the humerus to enter the joint cavity
• Communicates with the large subscapular bursa through the opening in the
fibrous capsule. it may also communicate with the bursa of infraspinatus
• Forms a pouch in its lower part when the arm is dependent
• Secretes synovial fluid for the lubrication of the joint.
• Ligaments of the Shoulder Joint
• Ligaments of the shoulder joint include:
• Superior, middle and inferior
glenohumeral ligaments;
• Coracohumeral ligament; and
• Transverse humeral ligaments
•
• Stability of the Shoulder Joint
• Owing to its high degree of mobility, the stability of the shoulder joint is compromised.
• The following contribute to the stability of the shoulder joint:
• The fibrous capsule of the joint.
• The ligaments of the joint. These include glenohumeral and coracohumeral ligaments
• Rotator cuff muscles. These include teres minor, subscapularis, supraspinatus and
infraspinatus.
• Bursae Associated with the Shoulder Joint
• The following bursae are associated with the shoulder joint:
• Subscapular bursa: Between tendon of subscapularis and the anterior aspect of the
fibrous capsule. This bursa usually communicates with the joint cavity.
• Bursa of infraspinatus: Between infraspinatus and the posterior aspect of the joint
capsule
• Subacromial bursa: Between the coracoacromial arch and deltoid above and the
tendon of supraspinatus and joint capsule below.
• A bursa between the coracoid process and the joint capsule
• Movements of the Shoulder Joint
• The wide range of movement obtainable at the shoulder joint is due to:
• The shallow depth of the glenoid cavity relative to the large size of humeral head
• The looseness of the fibrous capsule and paucity of ligaments around the joint.
• Movements occurring at the shoulder joint and the axes involved include:
• Flexion and extension – around a transverse axis
• Abduction and adduction – around an anteroposterior axis
• Medial and lateral rotation – around a vertical axis
• Circumduction – a combination of the above movements and their axes.
•
• Muscles associated with the Movements of the Shoulder Joint
• Movements of the shoulder joint and the muscles that produce them include:
• Flexion – Clavicular fibres of pectoralis major, anterior fibres of deltoid, biceps brachii and
coracobrachialis
• Extension – Posterior fibres of deltoid, latissimus dorsi and teres major (assisted by
sternocostal fibres of pectoralis major and long head of triceps brachii [especially when acting
from the flexed position of the joint])
• Abduction – Supraspinatus and middle fibres of deltoid;
• Adduction – Teres major, latissimus dorsi, pectoralis major, subscapularis, infraspinatus and
teres minor
• Lateral rotation – Infraspinatus, teres minor and posterior fibres of deltoid
• Medial rotation – Subscapularis, latissimus dorsi, teres major, anterior fibres of deltoid and
pectoralis major.
• Blood Supply of the Shoulder Joint
• The following vessels supply the glenohumeral joint:
• Suprascapular artery – a branch of thyrocervical trunk;
• Anterior circumflex humeral artery – a branch of the 3rd part of axillary artery
• Posterior circumflex humeral artery – a branch of the 3rd part of axillary artery.
• Innervation of the Shoulder Joint
• The following nerves give sensory fibres to the shoulder joint:
• Suprascapular nerve
• Axillary nerve; and
• Lateral pectoral nerve.
• Applied Anatomy of the Shoulder Joint
• Note the following points:
• Owing to its relative instability and the laxity of its fibrous capsule, the shoulder joint is
frequently involved in dislocation
• Superior dislocation of the shoulder joint is rare, owing to the presence of osseofibrous
coracoacromial arch
• Anterior dislocation of the shoulder joint is common. This is owing to the inadequate support
provided by the infraglenoid tubercle and the long head of triceps brachii. Thus, humeral
head is prone to inferior, then anterior displacement
• In anterior dislocation of the shoulder joint, humeral head is displaced anterior to the
infraglenoid tubercle and long head of triceps
• Posterior dislocation of the shoulder joint may also occur, but this is relatively rare
• Injury to the axillary nerve may occur in (anterior) dislocation of humeral head. This may
result in paralysis of deltoid and anaesthesia of the skin over the central part of this muscle
• Forceful subluxation of humeral head may produce a tear in the glenoid labrum, with the
associated pains, especially when throwing objects.
• Subacromial bursitis (inflammation of subacromial bursa) and supraspinatus tendinitis may