arm & cubital region

Upper limbArm & Cubital region

黃敏銓

1

ArmLateral intermuscular septum

Medial intermuscular septum

Anterior (flexor) compartment: stronger

Posterior (extensor) compartment

2

Coracobrachialis

3

Origin:coracoid process (apex)

Insertion:mid-shaft of humerus (medial side)

Function: helps flex and adduct armstabilize glenohumeral joint

Innervation: musculocutaneous nerve

Coracobrachialis

Serve as a shunt muscle, when carrying a heavy suitcase: deltoid, long head of the triceps, coracobrachialis

4

Biceps brachii

Origin:long head: supraglenoid tubercleshort head: coracoid process (apex)

Insertion:radial tuberosity

Function: powerful flexor of forearm accessory flexor of armsupinator of forearm

Innervation: musculocutaneous nerve

Long head of biceps brachii

Short head of biceps brachii

Bicipital aponeurosis

Brachialis

Origin:distal half of humerus (anterior)

Insertion:tuberosity of ulna

Function: pure flexor of forearm, in all directions

Innervation: musculocutaneous nerve

Brachialis

5

6

Triceps brachiiOrigin:1. long head: infraglenoid tubercle2. lateral head: humerus (posterior,

superior to radial groove)

3. medial head: humerus (posterior) Insertion: OlecranonFunction:

extensor of forearmlong head: extend and adduct arm

Innervation: radial nerve

Lateral head of triceps brachii

Medial head of triceps brachii

Long head of triceps brachii

Radial groove of humerus

Brachial artery

Radial artery

Ulnar artery

Axillary artery

Profunda brachii artery

Bicipital aponeurosis

7

Superior ulnar collateral

Posterior ulnar recurrent artery

Inferior ulnar collateral

Anterior ulnar recurrent

Radial collateral

Middle collateral

Interosseous recurrent

Profunda brachii arteryHumeral nutrient artery

Brachial artery

Radial artery

Radial recurrent

Ulnar artery8

Basilic vein

Cephalic vein

Paired brachial veins

Axillary vein

9

Musculocutaneous nerve

Lateral cutaneous nerve of forearm

Median nerve

Ulnar nerve

10

11

Inferior lateral cutaneous nerve of arm

Posterior cutaneous nerve of forearm

Radial nervePosterior cutaneousnerve of arm

Superior lateral cutaneous nerve of arm(from axillary nerve)

Cubital fossa

Lateral epicondyle Medial epicondyle

Brachioradialis

Pronator teres

BrachialisCubital fossa

12

13

Tendon (biceps brachii)

Brachial artery

Median nerveBiceps brachii

Radial artery

Ulnar artery

Bicipital aponeurosis

14

Radial nerve

Superficial branch

Deep branch

Median cubitalvein

Basilic veinCephalic vein

Lateral cutaneousnerve of forearm

Medial cutaneousnerve of forearm

Superficial back Scapular region

黃敏銓

15

16

Upper limb

Shoulder:upper limb →trunk and neck

Bone:ClavicleScapulaProximal end of humerus

Movements of the scapulaElevation Protraction Upward rotation

Depression Retraction Downward rotation

17

Medial posterior cutaneous branchLateral posterior cutaneous branch18

Shoulder

19

Superficial muscles:

Trapeziusscapula and clavicle → trunk

Deltoidscapula and clavicle → humerus

Deep to trapezius:

Levator scapulae

Rhomboid minor

Rhomboid major

TrapeziusOrigin:

Skull, vertebrae C1-T12Insertion:

Spine of scapula, acromion, clavicleFunction:

Elevator of scapulaAbduction of humerus above horizontalMiddle fibers: retract scapulaLower fibers: depress scapula

Innervation:Accessory nerve (CN XI)Anterior rami of C3 and C4

Accessory nerveSuperficial branch of transverse cervical artery

20

Deltoid

21

Origin:spine of scapula, acromion, clavicle

Insertion:deltoid tuberosity of humerus

Function: 1. major abductor of arm＞15°2. anterior part: flex and medially

rotate arm3. posterior fibers: extend and

laterally rotate armInnervation:

axillary nerve

Levator scapulae

Origin:transverse processes of C1 to C4

Insertion:scapula: superior angle to root of spine

Function: scapula: elevation and downward rotationneck: extension and lateral flexion

Innervation: dorsal scapular nerveanterior rami of cervical (C3 and C4) nerves

22

23

Rhomboid minor

Origin:lower end of ligamentum nuchaetransverse processes of C7 and T1

Insertion:scapula: smooth triangular area at root of spine

Function:scapula: elevation, retraction, downward rotation

Innervation:dorsal scapular nerve

Rhomboid major

Origin:transverse processes of T2 to T5

Insertion:scapula: from insertion of rhomboid minor

to inferior angleFunction:

scapula: elevation, retraction, downward rotationInnervation:

dorsal scapular nerve24

Elevate ribs2nd to 5th intercostal nerves

Origin: nuchal ligament, C7-T3 spinous processes

Origin: T11-L2 spinous processes

Insertion: superior borders of 2nd to 4th ribs

Insertion: inferior borders of 8th to 12th ribs

25

Depress ribsT9-T12 thoracic nerves

Serratus posterior superior

Serratus posterior inferior

Posterior scapular regionSupraspinatus

InfraspinatusTeres minor

Teres major

Long head of triceps brachii

26

Supraspinatus

SupraspinatusOrigin:

supraspinous fossa(medial 2/3)

Insertion:greater tubercle (superior facet)

Function:abduction of am (15°)

Innervation: suprascapular nerve

27

Infraspinatus

Infraspinatus

Origin:Infraspinous fossa(medial 2/3)

Insertion:greater tubercle (middle facet)

Function:Powerful lateral rotator of the humerus

Innervation: suprascapular nerve 28

Teres minor

Teres minor

Origin:lateral upper 2/3 of scapula

Insertion:greater tubercle (inferior facet)

Function:lateral rotation of arm

Innervation: axillary nerve

29

Teres major

30

Teres major

Origin:Inferior angle (posterior) of scapula

Insertion:Medial lip of intertubercularsulcus of humerus

Function:Medial rotation and adductionhelp extension

Innervation: Inferior subscapular nerve

Long head of triceps brachii

Long head of triceps brachii

Origin:Infraglenoid tubercle on scapula

Insertion:Olecranon process of ulna

Function:Arm: adductor and extensorForearm: extensor

Innervation: Radial nerve

31

32

Supraspinatus

InfraspinatusTeres minor

Rotator cuff muscles

Subscapularis

Gateways to the posterior scapular regionSuprascapular nerve

Suprascapular artery

Axillary nerve

Posterior circumflex humeral artery

Circumflex scapular artery

Profunda brachii artery

Radial nerve

Transverse scapular ligament

33

Arterial anastomoses around the shoulder

34

Thyrocervical trunk

Suprascapular artery

Deep branch of transverse cervical artery(dorsal scapular artery) Circumflex scapular artery

Profunda brachii artery

Anterior circumflex humeral artery

Posterior circumflex humeral artery

Thoracodorsal artery