UPPER LIMB (PART 1): Dr.
Pecson scapula, then it goes downward to form the biceps brachii
Clavicle… Smooth superior, pointing medial
Medial 2/3 convex anteriorly
Lateral 1/3 concave anteriorly so this is the right clavicle
Clavicle serves as the attachment of muscles,
holds the arm away from the trunk and
serves to transmit forces from the upper limb to the trunk
SHOULDER BLADE/ SCAPULA
Take note of the clavicle attaching to the acromion to form the
acromioclavicular joint
and here’s your acromion
Lateralize: triangular, apex is facing down, clinoid fossa
pointing lateral, smooth subscapular fossa articulates with
thoracic cage, so this is the right scapyla
Huge wall called the subscapular fossa-origin of subscapularis
muscle which is a part of your rotator cuff
Inferior angle
medeial border
Superior angle
suprascapular notch: what passes: suprascapular artery
then this huge process in front: top of the glenoid…
coronoid process which serves as origin of the insertion
muscles then at the back is the
scapular spine that divides the scapula 1/3, 2/3…
upper 1/3 is the supraspinous fossa while the
lower 2/3 is the infraspinous fossa—origin of infraspinatus
muscle, while the suprascapular fossa will serve as the origin
of the supraspinatus muscle. These 2 muscles are part of the
rotator cuff muscles.
glenoid fossa, scapular spine which extends forward to become
the acromion
lateral border
medial border
inferior angle
superior angle
shallow glenoid fossa articulating with the huge humeral head
last bone of the shoulder girdle: Humerus
lateralize: right humerus, head articulates with the glenoid, so
it has to point medial, so what’s the clue: olecranon fossa—
always posterior---it accommodates the olecranon fossa to
have full elbow extension, kung walang butas, no extension, it
accommodates the trochlea of the humerus, the ulna articulates
with the trochlea, while the radius articulates with the
capitulum.
in the humerus, you have the
head,
greater tubercle,
lesser tubercle, and in between that is the
bicipital groove/ intertubercular sulcus—
what passes through: long head of the biceps brachii
tendon as it originates from the supraglenoid tubercle of the
muscle
short head of the biceps originates from the coracoid process,
and it will form one big muscle.
2 necks of the humerus:
Anatomic and surgical neck. Why 2?
Why is there a surgical neck? part of the humerus that is easily
fractured, hence, it is the common site of surgery
when you fall on your shoulder, you can easily fracture the
surgical neck—humeral neck fracture—common in
osteoporotic women. Once it displaces, you have to put it
back—ORIF. If it is undisplaced, treat it conservatively with a
shoulder splint.
shaft of the humerus
deltoid tuberosity—insertion of deltoid muscle
medial epicondyle
lateral epicondyle
capitum-articulates with radial head
trochlea—which articulates with the trochlear notch of ulna
the medial epicondyle is easily palpable, just underneath it,
what do you feel? they call that the funny bone…but are you
stimulating the bone? No. It is the ulnar nerve because as you
look down here you have the groove for the ulnar nerve where
it passes, that is underneath the medial epicondyle.
olecranon fossa
shaft - middle 3rd—diagonal chalk at the posterior side—spiral
groove or radial groove—what passes: radial nerve
AXILLA- where the important neurovascular structures pass
to supply the upper extremities
- highway for all the important neurovascular
structures
Boundaries:
anterior – chest muscle called the pectoralis major m., and the
pectoralis minor muscle as it originates from the 3rd, 4th, and
5th ribs, subclavius muscle
posterior- 3 muscles: subscapularis m., latissimus dorsi, teres
major m.
medial – upper 4 or 5 ribs and the intercostal spaces
lateral – 2 muscles: coracobrachialis m., and biceps brachii m.
contents:
axillary artery and its branches
axillary vein and its branches
brachial plexus
lymph vessels and lymph nodes
SEE TABLE OF MUSCLES
Pectoralis major- originates from the clavicle, sternum, and
upper 5th costal cartilage, and inserts into the lateral lip of the
bicipital groove
Pectoralis minor- 3rd-5th ribs, inserts into coracoid process
of the scapula
Nerves:
Lateral pectoral nerve
medial pectoral nerve- innervates the pectoralis minor
subclavius muscle
1st rib, and inserts into the clavicle
action:
pec major- abducts 180
adduction -0
flexion extension hyperextension- 40
lateral rotate 90
medial rotate 70
internal rotation reaching bra
combination: circumduction
serratus anterior-from upper 8th ribs, medial border and
inferior angle of scapula, long thoracic nerve
action: to draw the scapula forward
clavi-pectoral fascia: encloses the subclavius m., and is
attached to the clavicle then it goes down to enclose the
pectoralis minor
- then it goes down to terminate as the suspensory ligament of
the axilla, at the same time it fills in the interval between the
clavicle and the pectoralis minor and it also serves to protect
the contents of the axilla
pierced by 3 structures:
thoraco-acromial a.
cephalic v.
lateral pectoral n. that innervates the pectoralis major m.
fascia- dense, strong sheath of connective tissue
Contents:
axillary artery- continuation of the subclavian a. which comes
from the:
right- brachiocephalic trunk
left- aorta
branches of the _______________:
common carotid a.
brachiocephalic trunk
left subclavian a. – once it hits the lower border of
the 1st rib , it becomes the axillary a.
Axillary artery continues downward and once it hits the
lateral border of the teres major muscle, it becomes the brachial
artery—continues downward into the cubital fossa where it
divides into radial and ulnar artery. It is the brachial artery
that you palpate when you take the blood pressure.
Axillary artery is now divided into 3 parts:
1. From the lateral border of the 1st rib to the upper
border of pectoralis minor m.
2. Lies directly behind the pectoralis minor m.
3. Starts from the lower border of the pectoralis minor
up to lower border of the teres major m.
Branches of the axillary artery:
1st part- 1 branch
2nd part- 2 branches
3rd part- 3 branches
1st part: highest/ supreme thoracic artery
2nd part:
1. thoraco-acromial a.
2. lateral thoracic a.
3rd part:
1. subscapular a. – as it goes down and gives off a
branch called the circumflex scapular a.
2. anterior circumflex humeral artery – winds around
the humeral neck
3. posterior circumflex humeral artery
Axillary vein- continuation of the basilic vein, once it hits the
lower border of the 1st rib, it becomes the subclavian vein
-formed by the basilic vein and the union of the
venae comitantes of the brachial artery
Venae comitantes: are paired veins that usually accompany
medium-sized artery in order to drain the adjacent tissue or
muscles and artery, and unoxygenated blood ; it is not specific
to the brachial a. only
Brachial Plexus
-3rd component of the axilla, formed by the anterior rami of
the posterior triangle
-it is found in the posterior triangle of the neck where the fusion
of the anterior rami of C5,6,7,8,T1 is found—cervical nerve
roots
C5-C6 join together to form the upper trunk
C7- middle trunk
C8-T1 - inferior or lower trunk
from each trunk, there will be 2 divisions: anterior and
posterior divisions
3 anterior
3 posterior
Upper trunk- all 3 posterior divisions coming from the upper
trunk, middle trunk, and lower trunk will coalesce forming the
posterior cord
Anterior division of the upper trunk will continue to form the
lateral cord
While the lower trunk (anterior division) will continue to from
the middle trunk
Terminal branches:
Lateral cord or medial cord will give off a tributary to form the
median nerve, while the medial cord will continue to form the
ulnar nerve. These 2 nerves play a more important role in the
forearm, arm, and wrist.
The posterior cord will give off 2 branches: radial nerve and
axillary nerve (PAR)

Lateral cord gives off the musculocutaneous nerve
Brachial plexus is made up of roots, trunks, divisions, cords &
branches. (Reach To Drink Cold Beer)
Last content: Lymph Nodes
Lymph Node – swellings of the lymphatic system, wherein the
lymph drains into it and it filters the lymph fluid, it filters
bacteria, cancer cells. That’s why if you have infection of your
upper extremity or breast cancer, you have swelling of the
axillary nodes. It has an important role in your immune system.
Anterior groove/ pectoral groove: receives lymph vessels from
the lateral part of the breast and antero-lateral abdominal wall
& chest
Posterior groove/ subscapular groove- receives superficial
lymph vessels from the back as far down the level of iliac crest,
drains the posterior axillary wall, chest, and breast
Lateral groove/ humeral groove – receives most of the lymph
vessels from the upper extremity
Central groove – receives lymph vessels from the 3 previous
grooves
Infraclavicular groove/ deltopectoral groove- receives
superficial lymph vessels from lateral sides of the hand,
forearm, & arm
Apical groove- receives efferent lymph vessels from all the
other axillary nodes –from there the lymph will now travel in
the subclavian lymph trunk---
left side will drain to left thoracic duct, while
right subclavian will drain to right lymphatic trunk,
right lymphatic trunk is located in the junction
between the right subclavian vein and internal
jugular v.
Trapezius muscle – made up of 3 parts: upper fiber, middle
fiber, and lower fibers
-coming from the occipital bone and ligamentum nuchae—
thickening of supraspinous ligament in the cervical region,
inserts into the lateral 3rd part of the clavicle (?), acromion and
scapular spine, middle fibers draw the scapula medially, lower
fibers draw the scapula downward and medially
Latissimus dorsi- main adductor
Levator scapulae m. – elevate the scapula
Rhomboid minor m.- attached to the medial border, raise the
medial border upward
Rhomboid major m.
Deltoid m. – huge shoulder muscle;
originates from lateral 3rd of the clavicle, acromion,
& scapular spine, inserts into deltoid tuberosity of the humerus
anterior fiber contracts and flexes, at the side, it
shortens. adducts (?)
at the back, shortens or contracts, extends the
shoulders, innervated by the axillary nerve which
comes from the posterior cord of the brachial plexus
Rotator cuff muscles:
Subscapularis m.
origin: subscapula
Supraspinatus m. –origin: supraspinous fossa, inserts to the
greater tubercle; abducts (purely)
Infraspinatous m.- origin: infraspinous fossa, inserts to the
greater tuberosity; shortens- externally rotate
Teres minor m.- origin: upper 2/3 of lateral border of the
spine, inserts to the lowermost border of the greater tuberosity;
contract- externally rotate
As it inserts from anterior to posterior, you have the
subscapularis, and inserts to the lesser tuberosity of the
humerus
subscapularis fossa- inserts to the lesser tubercle (front) as
you go up, supraspinatus muscle in 12 o clock position inserts
in the greater tuberosity; shortens/ contracts- rotates
Rotator cuff muscles, which is easily torn: Supraspinatous m.
Teres major m. – originates from the lower 1/3 of the lateral
border of the scapula, inserts into the medial lip of the bicipital
groove
Lateral lip of the bicipital groove inserts the pectoralis major
m.
In the lab., basta may butas, what structure passes through.
There are (actually) 3 spaces in the bac, but only 2 are in your
book:
Quadrilateral space- 4 boundaries:
above- subscupalaris in front, teres minor in front
inferior- teres major
medial- long head of the triceps
lateral- surgical neck of the humerus
what passes:
axillary nerve coming from the posterior cord, and what
muscle innervates: deltoid & teres minor m.
posterior circumflex humeral artery- branch of the 3rd part of
the axillary artery
Triangular space- 3 boundaries:
upper- teres minor
lower- teres major
lateral- long head of the triceps-- what passes: circumflex
scapular artery which is a branch of thesubscapular artery
which is a branch of the 3rd part of the axillary v.
triangular interval bounded by the 2 heads: long head and
the shaft of the humerus, and the teres major, and the 2
structures that pass through are: profunda brachii artery which
is a branch of your brachial a., & radial n.
MAIN NERVE SUPPLY OF THE SHOULDER GIRDLE
Axillary n.- comes from the posterior cord (C5-6),
branches- gives off branches to the shoulder joint:
anterior terminal branch- winds around the surgical neck &
supplies the deltoid & the skin that covers it
posterior terminal branch- gives off branches to the teres
minor, few branches to the deltoid m., and becomes the
superior lateral cutaneous nerves of the arm, so the lateral part
of the arm is sub-served by your superior lateral cutaneous
nerves of the arm.

Arterial Anastomoses around the Shoulder Joint

- assures continuity of the circulation despite
thrombus or injury
- formed by the subclavian artery and the 3rd part of
the axillary artery
- arteries that participate in the subclavian a.-
suprascapular a., superficial cervical a.
- axillary a.- circumflex scapular a. (branch of the
subscapular a.), anterior & posterior circumflex
humeral arteries

Suprascapular artery joins with the circumflex scapular artery,

and the posterior circumflex humeral artery. ---EXTENSIVE
ANASTOMOSES

***FIDR 2021***