Muscle Pectoralis major

Proximal Attachment Clavicular head: anterior surface of medial half of clavicle Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle 3rd5th ribs near their costal cartilages

Distal Attachment Innervationa Lateral lip of Lateral and medial pectoral intertubercular groove of nerves; clavicular head (C5, humerus C6), sternocostal head (C7, C8, T1)

Pectoralis minor

Medial border and superior surface of coracoid process of scapula Subclavius Junction of 1st rib and its costal cartilage Inferior surface of middle third of clavicle Serratus External surfaces of lateral parts of 1st8th Anterior surface of anterior ribs medial border of scapula

Medial pectoral nerve (C8, T1)

Main Action Adducts and medially rotates humerus; draws scapula anteriorly and inferiorly Acting alone, clavicular head flexes humerus and sternocostal head extends it from the flexed position Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall

Nerve to sub-clavius (C5, Anchors and depresses C6) clavicle Long thoracic nerve (C5, C6, Protracts scapula and holds it C7) against thoracic wall; rotates scapula

Otot-otot Bahu Muscle Proximal Attachment Distal Attachment Innervationa Superficial posterior axioappendicular (extrinsic shoulder) muscles Trapezius Medial third of superior nuchal Lateral third of Accessory nerve (CN XI) line; external occipital clavicle; acromion and (motor fibers) and C3, C4 protuberance; nuchal ligament; spine of scapula spinal nerves (pain and spinous processes of C7C12 proprioceptive fibers) vertebrae Latissimus dorsi Spinous processes of inferior 6 Floor of intertubercular Thoracodorsal nerve (C6, Main Action Descending part elevates; ascending part depresses; and middle part (or all parts together) retracts scapula; descending and ascending parts act together to rotate glenoid cavity superiorly Extends, adducts, and medially rotates

thoracic vertebrae, groove of humerus C7, C8) thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs Deep posterior axioappendicular (extrinsic shoulder) muscles Levator scapulae Posterior tubercles of transverse Medial border of Dorsal scapular (C5) and processes of C1C4 vertebrae scapula superior to root cervical (C3, C4) nerves of spine Rhomboid Minor: nuchal ligament; spinous Minor: smooth Dorsal scapular nerve (C4, minor and major processes of C7 and T1 vertebrae triangular area at C5) Major: spinous processes of medial end of scapular T2T5 vertebrae spine Major: medial border of scapula from level of spine to inferior angle Scapulohumeral (intrinsic shoulder) muscles Deltoid Lateral third of clavicle; acromion and spine of scapula Deltoid tuberosity of humerus Axillary nerve (C5, C6)

humerus; raises body toward arms during climbing

Elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula Retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall

Supraspinatusb Supraspinous fossa of scapula Infraspinatusb Teres minor

b

Infraspinous fossa of scapula Middle part of lateral border of scapula

Superior facet of Suprascapular nerve (C4, greater tubercle of C5, C6) humerus Middle facet of greater Suprascapular nerve (C5, tubercle of humerus C6) Inferior facet of greater Axillary nerve (C5, C6) tubercle of humerus

Anterior part: flexes and medially rotates arm Middle part: abducts arm Posterior part: extends and laterally rotates arm Initiates and assists deltoid in abduction of arm and acts with rotator cuff musclesb Laterally rotate arm; help hold humeral head in glenoid cavity of scapula

Teres major Subscapularisb

Posterior surface of inferior angle Medial lip of of scapula intertubercular groove of humerus Subscapular fossa (most of Lesser tubercle of anterior surface of scapula) humerus

Lower subscapular nerve (C5, C6)

Adducts and medially rotates arm

Upper and lower Medially rotates and adduct arm; helps subscapular nerves (C5, C6, hold humeral head in glenoid cavity C7)

Otot Lengan Atas Muscle Biceps brachii Brachialis Coracobrachialis Triceps brachii Distal Attachment Innervationa Tuberosity of radius and fascia of forearm via bicipital Musculocutaneous aponeurosis nerveb (C5, C6) Coronoid process and tuberosity of ulna Middle third of medial surface Musculocutaneous of humerus nerve (C5, C6, C7) Long head: infra-glenoid tubercle of Proximal end of olecranon of Radial nerve (C6, C7, scapula ulna and fascia of forearm C8) Proximal Attachment Short head: tip of coracoid process of scapula Long head: supraglenoid tubercle of scapula Distal half of anterior surface of humerus Tip of coracoid process of scapula Lateral head: posterior surface of humerus, superior to radial groove Medial head: posterior surface of humerus, inferior to radial groove Lateral epicondyle of humerus Main Action Supinates forearm and, when it is supine, flexes forearm; short head resists dislocation of shoulder Flexes forearm in all positions Helps flex and adduct arm; resists dislocation of shoulder Chief extensor of forearm; long head resists dislocation of humerus; especially important during abduction

Anconeus

Lateral surface of olecranon Radial nerve (C7, C8, and superior part of posterior T1) surface of ulna

Assists triceps in extending forearm; stabilizes elbow joint; may abduct ulna during pronation

Muscle Proximal Attachment Superficial (first) layer Pronator teres Ulnar head Coronoid process

Distal Attachment

Innervationa

Main Action

Middle of convexity of Median nerve (C6, lateral surface of C7) radius

Pronates and flexes forearm (at elbow)

Humeral head Flexor carpi Base of 2nd radialis (FCR) metacarpal Medial epicondyle of Palmaris longus Distal half of flexor Median nerve (C7, humerus (common flexor retinaculum and apex C8) origin) Flexor carpi of palmar aponeurosis ulnaris (FCU) Humeral head Pisiform, hook of Ulnar nerve (C7, C8) Ulnar head Olecranon and posterior hamate, 5th metacarpal border (via aponeurosis) Intermediate (second) layer Flexor digitorum superficialis (FDS) Humeroulnar Medial epicondyle (common Shafts (bodies) of Median nerve (C7, head flexor origin and coronoid middle phalanges of C8, T1) process) medial four fingers Radial head Superior half of anterior border Deep (third) layer Flexor digitorum Proximal three quarters of Bases of distal Ulnar nerve (C8, T1) profundus (FDP) medial and anterior surfaces phalanges of 4th and

Flexes and abducts hand (at wrist) Flexes hand (at wrist) and tenses palmar aponeurosis Flexes and adducts hand (at wrist)

Flexes middle phalanges at proximal interphalangeal joints of middle four fingers; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints

Flexes distal phalanges 4 and 5 at distal interphalangeal joints

Medial part Lateral part Flexor pollicis longus (FPL) Pronator quadratus

of ulna and interosseous membrane Anterior surface of radius and adjacent interosseous membrane Distal quarter of anterior surface of ulna

5th fingers Flexes distal phalanges 2 and 3 at distal interphaAnterior interosseous langeal joints Base of distal phalanx nerve, from median Flexes phalanges of 1st digit (thumb) of thumb nerve (C8, T1) Distal quarter of anterior surface of radius Innervationa Pronates forearm; deep fibers bind radius and ulna together

Muscle Proximal Attachment Superficial layer Brachioradialis Proximal two thirds of supraepicondylar ridge of humerus Extensor carpi radialis longus (ECRL) Extensor carpi radialis brevis (ECRB) Extensor digitorum

Distal Attachment

Main Action

Lateral surface of Radial nerve (C5, C6, C7) Relatively week flexion of forearm, distal end of radius maximal when forearm is in proximal to styloid midpronated position process Lateral supraepicondylar ridge of Dorsal aspect of base Radial nerve (C6, C7) humerus of 2nd metacarpal Extend and abduct hand at the wrist Doral aspect of base of Deep branch of radial joint; ECRL active during fist clenching 3rd metacarpal nerve (C7, C8) Lateral epicondyle of humerus (common extensor origin) Extensor expansions of medial four fingers Extends medial four fingers primarily at metacarpophalangeal joints, secondarily at interphalangeal joints Extends 5th finger primarily at metacarpophalangeal joint, secondarily at interphalangeal joint Extends and adducts hand at wrist joint

Extensor digiti minimi (EDM) Extensor carpi Lateral epicondyle of humerus;

Posterior interosseous nerve (C7, C8), Extensor expansion of continuation of deep 5th finger branch of radial nerve Dorsal aspect of base

ulnaris (ECU) Deep layer Supinator

posterior border of ulna via a shared aponeurosis

of 5th metacarpal

(also active during fist clenching)

Extensor indicis

Lateral epicondyle of humerus; Lateral posterior, and radial collateral and anular anterior surfaces of ligaments; supinator fossa; crest proximal third of of ulna radius Posterior surface of distal third of Extensor expansion of ulna and interosseous membrane 2nd finger

Deep branch of radial nerve (C7, C8)

Supinates forearm; rotates radius to turn palm anteriorlyor superiorly (if elbow is flexed) Extends 2nd finger (enabling its independent extension); helps extend hand at wrist

Posterior interosseous nerve (C7, C8), continuation of deep branch of radial nerve

Outcropping muscles of deep layer Abductor pollicis Posterior surface of proximal longus (APL) halves of ulna, radius, and interosseous membrane Extensor pollicis Posterior surface of middle third longus (EPL) of ulna and interosseous membrane Extensor pollicis brevis (EPB)

Base of 1st metacarpal

Abducts thumb and extends it at carpometacarpal joint Extends distal phalanx of thumb at interphalangeal joint; extends metacarpophalangeal and carpometacarpal joints Extends proximal phalanx of thumb at metacarpophalangeal joint; extends carpometacarpal joint

Dorsal aspect of base Posterior interosseous of distal phalanx of nerve (C7, C8), thumb continuation of deep branch of radial nerve Posterior surface of distal third of Dorsal aspect of base radius and interosseous of proximal phalanx of membrane thumb Innervationa Recurrent branch of medial nerve (C8, T1)

Muscle Proximal Attachment Distal Attachment Thenar muscles Opponens Lateral side of 1st Flexor retinaculum and pollicis metacarpal tubercles of scaphoid and Abductor Lateral side of base of trapezium pollicis brevis proximal phalanx of

Main Action To oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially Abducts thumb; helps oppose it

Flexor pollicis thumb brevis Superficial head Deep head Adductor Bases of 2nd and 3rd pollicis metacarpals, capitate, Medial side of base of Oblique head adjacent carpals proximal phalanx of Transverse Anterior surface of shaft thumb head of 3rd metacarpal Hypothenar muscles Abductor digiti Pisiform Medial side of base of minimi proximal phalanx of 5th Flexor digiti finger minimi brevis Hook of hamate and Opponens flexor retinaculum Medial border of 5th digiti minimi metacarpal Short muscles Lumbricals Lateral two tendons of 1st and 2nd flexor digitorum profundus (as unipennate Lateral sides of extensor muscles) expansions of 2nd5th 3rd and 4th Medial three tendons of fingers flexor digitorum profundus (as bipennate muscles) Dorsal Adjacent sides of two Bases of proximal interossei, metacarpals (as bipennate phalanges; extensor 1st4th muscles) expansions of 2nd4th fingers

Flexes thumb

Deep branch of ulnar nerve (C8, T1)

Adducts thumb toward lateral border of palm

Deep branch of ulnar nerve (C8, T1)

Abducts 5th finger; assists in flexion of its proximal phalanx Flexes proximal phalanx of 5th finger Draws 5th metacarpal anterior and rotates it, bringing 5th finger into opposition with thumb

Median nerve (C8, Flex metacarpophalangeal joints; extend interphalangeal T1) joints of 2nd5th fingers

Deep branch of ulnar nerve (C8, T1)

Abduct 2nd4th fingers from axial line; act with lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints

Palmar interossei, 1st3rd

Palmar surfaces of 2nd, Bases of proximal 4th, and 5th metacarpals phalanges; extensor (as unipennate muscles) expansions of 2nd, 4th, and 5th fingers

Adduct 2nd, 4th, and 5th fingers toward axial line; assist lumbricals in flexing metacar-pophalangeal joints and extending interphalangeal joints; extensor expansions of 2nd4th fingers

Table 6.14 Movements of the Glenohumeral (Shoulder) Joint Movement (function) Prime Mover(s) (from Synergists Notes pendent position) Flexion Pectoralis major (clavicular Coracobrachialis (assisted From fully extended position to its own (coronal) plane, head); deltoid (anterior by biceps) sternocostal head of pectoralis major is major force part) Extension Deltoid (posterior part) Teres major Latissimus dorsi, sternocostal head of pectoralis major, and long head of triceps act from fully flexed position to their own (coronal) planes Abduction Deltoid (as a whole, but Supraspinatus Supraspinatus is particularly important in initiating especially central part) movement; also, upward rotation of scapula occurs throughout movement, making a significant contribution Adduction Pectoralis major; latissimus Subscapularis; infraspinatus; In upright position and in absence of resistance, gravity is dorsi teres minor prime mover Medial rotation Subscapularis Pectoralis major; deltoid (anterior fibers); latissimus With arm elevated, synergists become more dorsi important than prime movers Lateral rotation Infraspinatus Teres minor; deltoid (posterior fibers) Tensors of articular capsule Supscapularis; Supraspinatus; teres minor Rotator cuff (SITS) muscles acting together; when (to hold head of humerus infraspinatus resting, their tonus adequately maintains integrity of joint against glenoid cavity) (simultaneously) Resisting downward Deltoid (as a whole) Long head of triceps; Used especially when carrying heavy objects (suitcases, dislocation (shunt muscles) coracobrachialis; short head buckets)

of biceps