Anatomy of the

Limbs
Session 2
The shoulder and arm

Anatomy of the Limbs

1 Overview of upper and lower limbs

2 Shoulder and Arm
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.

Standard Anatomy session format

Lectures
Dissecting Room prosections
Living Anatomy
Bones and joints
Surface anatomy
Clinical testing

Session Two
The bones of the pectoral girdle and arm
The muscular anatomy of the region
The joints of the pectoral girdle and upper
arm
The axilla
The blood vessels of the region
The lymphatic drainage of the region
The nerves of the region

The Bones of the Region

The Scapula
The Clavicle
The Humerus

The Scapula

The Clavicle

The Humerus

The surgical
neck is
more
commonly
damaged
than the
anatomical
neck.

Muscle attachments
Old fashioned terminology for muscle attachments
is:
origins and insertions. Now considered inaccurate.

For Limbs, the correct terminology is:

proximal attachment and distal attachment. The
proximal attachment is at, or closer to, the trunk.

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

The Anterior Pectoral Girdle Muscles

Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior*
*runs anterior and posterior

Pectoralis Major
Proximal attachments:
on the medial 1/3rd of
the clavicle, the
sternum and costal
cartilages.
Distal attachment:
lateral lip of the
intertubercular sulcus
(groove).
Adducts and medially
rotates the humerus.
Lesser actions on the
scapula.

Pectoralis Minor

Subclavius
Anchors the clavicle

Serratus anterior

Runs from lateral border of

scapula to the anterior
attachments on the ribs.
Supplied by the long thoracic
nerve

The Posterior Pectoral Girdle

Muscles
Trapezius, Latissimus dorsi, Levator scapulae, the Rhomboids

Trapezius
Trapezius

The motor supply is by the

spinal accessory nerve (CNXI).
(N.B. a muscle of the upper limb
is supplied by a cranial nerve.)
Major actions on the scapula.

Latissimus dorsi

Latissimus dorsi

Supplied by the thoracodorsal

nerve.

Extends, adducts and rotates the

humerus; pulls the body up to the
arms during climbing. Important in
rowing.

Rhomboids
Rhomboids

Supplied by the dorsal scapular

nerve.

Retracts, rotates and fixes the

scapula.

Levator scapulae
Levator
scapulae

Supplied by the dorsal scapular

nerve (+ C3,4).

Elevates and rotates the scapula.

Intrinsic Shoulder Muscles

Deltoid
Teres Major
The Rotator Cuff
Muscles

supraspinatus
infraspinatus
teres minor
subscapularis

Rotator Cuff
Deltoid

Teres major

Deltoid

Deltoid

Rotator Cuff

Teres major

Supplied by the axillary nerve.

Deltoid abducts arm.

Rotator cuff
group acts to fix
the head of
humerus in the
glenoid fossa.
Supraspinatus
important in
initiating
abduction of arm
for first 15, then
deltoid takes
over.
Teres major (not
rotator cuff)
adducts and
medially rotates
arm.

The Rotator Cuff

Teres major (not rotator cuff)

Innervated by lower subscapular nerve

Anterior Compartment of the Arm

Biceps, Brachialis, Coracobrachialis
All supplied by the musculocutaneous nerve.

Posterior Compartment of the Arm

Triceps, Anconeus; supplied by the radial nerve

The Joints of the Region

Sterno-clavicular joint
Acromio-clavicular joint
Gleno-Humeral joint (Shoulder joint)
Scapulo-thoracic joint (sometimes referred to
as a virtual joint)
Elbow joint

The pectoral girdle = SCJ + ACJ + GHJ +

STJ

Joints of the Pectoral Girdle

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)

The Rotator Cuff and the Shoulder Joint

Main function is to
hold the humeral
head within the
glenoid
The rotator cuff
depresses the
humeral head

Movements of the Shoulder Joint

Movements of the Scapulo-Thoracic Joint

Elevation / Depression of the scapula
Protraction / Retraction of the scapula
Rotation of the scapula

The Axilla
The gateway for nerves and blood vessels
to enter the upper limb
Shaped like a pyramid
Contains;
Arteries axillary artery and its branches
Veins axillary vein and its tributaries
Lymphatic vessels and lymph nodes
(important!)
Nerves the brachial plexus

The Axilla

Neurovascular
contents of
the axilla

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 arm profunda brachii
Divides as the level of the elbow into

Ulnar and Radial arteries

The Arteries of the Region

The Veins of the Region

Superficial and deep systems
Cephalic vein (superficial) runs up lateral border
of arm
Basilic vein (superficial) runs up the medial
border of arm
Basilic veins joins venae comitantes to form the
axillary vein in the arm
Cephalic vein joins axillary vein in the axilla
Axillary vein becomes the subclavian vein at the
level of the first rib

The Veins of the Region (superficial)

The Veins of the Region (deep)

The Lymphatic Drainage of the

Region

Superficial and deep systems, run with veins

Cubital lymph nodes
Delto-pectoral lymph nodes
Axillary lymph nodes important!
Subclavian lymph trunk
Long thoracic nerve and thoraco-dorsal
nerve!

The Lymphatic Drainage of the Arm

Axillary lymph nodes

also very important in
draining the breast;
removing axillary
lymph nodes in breast
cancer treatment can
lead to lymphedema
of the arm, forearm
and hand.

The Nerves of the Region

the Brachial Plexus

Brachial Plexus: supplying the upper limb

Largest Nerves of the brachial

plexus

Axillary nerve (C5)

Musculo-cutaneous nerve (C567)
Ulnar nerve (C8T1)
Median nerve (C678T1)
Radial nerve (C5678T1)

Nerves of the Upper Limb

Nerves of the Upper Limb

Common
sites of
damage

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

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