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Shoulder

Muscle Origin Insertion Innervation Actions


Latissimus Spinous processes of T7 to L5 and sacrum, Floor of intertubercular sulcus of Thoracodorsal nerve (C6 to C8) Extends, adducts, and medially rotates the humerus
Dorsi thoracolumbar fascia, iliac crest, ribs 10 to 12, and humerus
has a small slip of origin at the inferior angle
Teres Major Elongated oval area on the posterior surface of the Medial lip of intertubercular Inferior subscapular nerve (C5, Medial rotation and extension of the humerus at the glenohumeral
inferior angle (inferior aspect of the lateral border) of sulcus on the anterior surface of C6, & C7) joint
the scapula humerus
Deltoid Lateral 1/3 of anterior clavicle, lateral acromion, and Deltoid tuberosity Axillary nerve (C5 & C6) Abducts arm with supraspinatus till 15○ (MF), solo abduction till 90○
inferior edge of the crest of the scapular spine (MF), flexionand medial rotation of the arm (AF), and extension and
lateral of the arm (PF)
Subclavius Superior border of the 1st rib and its cartillage Inferior medial 1/3 surface of Nerve to subclavius (C5, C6) Pulls tip of shoulder (aromioclavicular joint) down, anchors and
clavicle drepressed the clavicle, and pulls clavicle medially to stabilize
sternoclavicular joint
Serratus Lateral surfaces of upper 8-10 ribs (T1 to T8/T9/T10) Costal (anterior) surfaces of the Long thoracic nerve (C5, C6, & Protraction and rotation of the scapula and keeps the medial border
Anterior and deep fascia overlying the related intercostal medial border of the scapula C7) and inferior angle of scapula opposed (attached) to the thoracic wall
spaces
Subscapularis Medial 2/3 of subscapular fossa Lesser tubercle of the humerus Superior and inferior subscapular RC muscle, medial rotation and adduction of the arm at the
nerves (C5, C6, & C7) glenohumeral joint
Supraspinatus Medial 2/3 of supraspinous fossa and the deep fascia Superior facet of greater tubercle Suprascapular nerve (C5 & C6) RC muscle and abduction of humerus to 15○ with deltoid (MF)
covering the muscle of humerus
Infraspinatus Medial 2/3 of infraspinous fossa and the deep fascia Middle facet on posterior surface Suprascapular nerve (C5 & C6) RC muscle and lateral rotation of the humerus at the glenohumeral
covering the muscle of the greater tubercle of joint
humerus
Teres Minor Middle 1/3 to upper 2/3 of posterior lateral border of Inferior facet on the posterior of Axillary nerve (C5 & C6) RC muscle and lateral rotation of the humerus at the glenohumeral
scapula greater tubercle of humerus joint

Superficial back

Muscle Origin Insertion Innervation Actions


Trapezius UF: Superior nuchal line, external occipital Superior aspect of the lateral 1/3 of Motor: CN XI (Accessory nerve) Elevation of scapula (UF), scapular rotation, abduction of
protuberance clavicle, acromion, and scapular spine Sensory: Ventral rami C3 & C4 humerus above 90○, retract scapula (MF), and depress scapula
MF: medial margin of the ligamentum nuchae (LF)
LF: C7 to T12 and the related supraspinous ligament
Rhomboid Inferior aspect of ligamentum nuchae and spinous Posterior medial border of scapula at the Dorsal Scapular nerve (C4 & C5) Elevates and retracts the scapula, fixes scapula to the thoracic
Minor processes of C7 & T1 root of scapular spine wall, and rotates the scapula to depress the glenoid cavity
Rhomboid Spinous processes of T2-T5 and intervening Posterior medial border of scapula from Dorsal Scapular nerve (C4 & C5) Elevates and retracts the scapula, fixes scapula to the thoracic
Major supraspinous ligaments root of scapular spine to inferior angle wall, and rotates the scapula to depress the glenoid cavity
Levator Transverse processes of C1 & C2 and posterior Posterior medial border of scapula from Ventral rami of C3, C4, and Elevates the scapula medially, and inferiorly rotates the
Scapulae tubercles of transverse processes of C3 & C4 superior angle to root of scapular spine dorsal scapular nerve (C5) glenoid cavity

Pectoral region/axilla

Muscle Origin Insertion Innervation Actions


Pectoralis Clavicular head: anterior medial half of clavicle Lateral lip of intertubercular Medial and lateral pectoral nerves; Flexion, adduction, and medial rotation of arm at
Major Sternocostal head: anterior surface of sternum, T1-T7 costal sulcus on the anterior surface of Clavicular head (C5, C6); glenohumeral joint; Clavicular head: flexion of extended
cartillages, sternal end of T6, and aponeurosis of external oblique humerus Sternocostal head (C6-T1) arm; Sternoclavicular head: extension of flexed arm
Pectoralis Outer anterior surfaces of the superior border T3-T5 and deep Medial border of coracoid Medial and lateral pectoral nerves Protract scapula and lowers the lateral angle of scapula
Minor fascia overlying the related intercostal spaces process (C5-T1)
Arm

Muscle Origin Insertion Innervation Actions


Biceps Brachii LH – supraglenoid tubercle of scapula (goes True tendon – Radial tuberosity Musculocutaneous nerve (C5 & C6) Powerful flexor of the forearm at the elbow joint (true
through the intertubercular sulcus and through Aponeurosis – Bicipital aponeurosis tendon) and powerful supinator (aponeurosis); accessory
the glenohumeral capsule) into deep fascia on medial part of flexor of the arm at the glenohumeral joint
SH – apex of coracoid process forearm
Coracobrachialis Apex of coracoid process Middle 1/3 of (linear roughening) Musculocutaneous nerve (C5, C6, & C7) Flexes and adducts the arm at the glenohumeral joint
midshaft of humerus on the medial side
Brachialis Anterior aspect of the humerus (distal 1/2 of Coronoid process and ulnar tuberosity Musculocutaneous nerve (C5 & C6) and Powerful flexor of the arm at the elbow joint
the humerus) small contribution from the radial nerve
(C7) to the lateral aspect
Triceps Brachii LH – infraglenoid tubercle on scapula Common tendon of insertion with Radial nerve (C6, C7, & C8) Extension of forearm at the elbow joint; long head also
MH – distal 2/3 of medial and posterior medial, lateral, and long heads on the stabilizes the head of abducted humerus while also
surface of the humerus posterior surface of olecranon process adducting and extending the arm at the glenohumeral joint
Lat.H – upper 1/2 on the posterior surface of of ulna
the humerus

Anterior forearm
Muscle Origin Insertion Innervation Actions
Pronator Teres Humeral head – medial epicondyle and lower part of the Roughening on the lateral surface, Median nerve (C6 & C7) Pronation of the forearm and weak flexor of the elbow
medial supracondylar ridge midshaft of radius (most prominent part
Ulnar head – medial side of the coronoid process of its outward convexity)
Flexor Carpi Medial epicondyle of the humerus Base of the metacarpals 2 and 3 Median nerve (C6 & C7) Flexes and abducts the wrist joint
Radialis
Palmaris Longus Medial epicondyle of the humerus Distal half of flexor retinaculum and Median nerve (C7, C8) Flexes the wrist joint and tenses the palmar aponeurosis
palmar aponeurosis of the hand
Flexor Carpi Humeral head – medial epicondyle of the humerus Pisiform bone, hook of the hamate (via Ulnar nerve (C7, C8, & T1) Flexes and adducts the wrist joint
Ulnaris Ulnar head – Olecranon and posterior border of ulna the pisohamate and pisometacarpal
ligaments), and base of metacarpal 5
Flexor Digitorum Humeroulnar head – medial epicondyle of humerus and Bodies of the middle phalanges of the Median nerve (C8 & T1) Flexes the proximal interphalangeal joints,
Superficialis medial margin of coronoid process of ulna index, middle, ring, and little fingers (4 metacarpophalangeal joints of the index, middle, ring,
Radial head – anterior proximal half (oblique line) of tendons) and little fingers, and the wrist joint
radius
Flexor Pollicis Anterior surface of the radius (below the anterior oblique Palmar surface of base of the distal Median nerve (anterior Flexes the interphalangeal and metacarpophalangeal
Longus line and above the insertion of pronator quadratus) and phalanx of the thumb interosseous nerve; C7 & C8) joints of the thumb
anterior lateral half of the interosseous membrane
Flexor Digitorum Anterior and medial surfaces of the proximal 3/4 of the Palmar base of distal phalanges of the Median (anterior interosseous Flexes the distal interphalangeal joints,
Profundus ulna and anterior medial half of interosseous membrane index, middle, ring, and little fingers (4 nerve – lateral half) and Ulnar metacarpophalangeal joints of the index, middle, ring,
tendons) nerves (medial half (C8 & T1) and little fingers, and the wrist joint
Pronator Linear ridge on distal 1/4 of the anterior surface of ulna Distal 1/4 of the anterior surface of the Median nerve (anterior Pronation of the forearm
Quadratus radius interosseous nerve; C7 & C8)

Posterior forearm
Muscle Origin Insertion Innervation Actions
Brachoradialis Proximal 2/3 of the lateral Base of the radial styloid process Radial nerve (branch arising from above Flex the elbow joint
supracondylar ridge of humerus the elbow joint prior to deep and
superficial cutaneous branching; C5 &
C6)
Anconeus Posterior surface of lateral epicondyle Lateral surface of olecranon and proximal posterior Radial nerve (C5-T1) via a branch to Abduction of ulna in pronation and assists triceps in
of humerus surface of ulna medial head of triceps brachii extension of elbow
Extensor Carpi Lateral epicondyle of the humerus and Base of metacarpal 5 Radial nerve (posterior interosseous Extends and adducts the wrist
Ulnaris the posterior border of the ulna nerve; C7 & C8)
Extensor Digiti Lateral epicondyle of the humerus Extensor hood (tendon turned into aponeurosis) of Radial nerve (posterior interosseous Extends the little finger
Minimi the little finger nerve; C7 & C8)
Extensor Lateral epicondyle of humerus Inserts into the dorsal aspects (via extensor hoods – Radial nerve (posterior interosseous Extensor of the interphalangeal, metacarpophalangeal,
Digitorum tendons that convert into aponeurosis) of the bases of nerve; C7 & C8) and the wrist joints
the middle and distal phalanges of the index, middle,
ring and little fingers (4 tendons)
Extensor Carpi Lateral epicondyle of the humerus Dorsal surface of the base of metacarpals 2 and 3 Radial nerve (posterior interosseous Extends and abducts the wrist joint
Radialis Brevis nerve; C7 & C8)
Extensor Carpi Distal 1/3 of the lateral supracondylar Dorsal surface of the base of metacarpal 2 Radial nerve (branch arising from above Extends and abducts the wrist joint
Radialis Longus ridge the elbow joint prior to deep and
superficial cutaneous branching; C6 &
C7)
Supinator Superficial part – lateral epicondyle of Lateral surface of the radius in between the anterior Radial nerve (posterior interosseous Fixes the forearm in supination; prime supinator only
the humerus, lateral collateral ligament and posterior oblique lines nerve; C6 & C7) when the elbow joint is fully extended
of the elbow, and the annular ligament
of the radius
Deep part – Supinator crest of the ulna
and the fossa in front of it
Extensor Indicis Posterior surface of ulna (distal to Extensor hood of the index finger Radial nerve (posterior interosseous Extends the index finger and helps extend the wrist
extensor pollicis longus) and adjacent nerve; C7 & C8) joint
interosseous membrane
Extensor Policis Posterior surface of the middle 1/3 of Dorsal base of the distal phalanx of the thumb Radial nerve (posterior interosseous Extends the interphalangeal and metacarpophalangeal
Longus ulna and adjacent interosseous nerve; C7 & C8) joints of the thumb, draws the thumb back from
membrane opposed position, and assists in extension and
abduction of the wrist
Extensor Policis Posterior surface of the radius and Dorsal base of the proximal phalanx of the thumb Radial nerve (posterior interosseous Extends the metacarpophalangeal and
Brevis adjacent interosseous membrane nerve; C7 & C8) carpometacarpal joints of the thumb
Abductor Policis Posterior surfaces of ulna, radius, and Lateral surface of metacarpal 1 Radial nerve (posterior interosseous Extends and abducts the carpometacarpal joints of the
Longus adjacent interosseous membrane nerve; C7 & C8) thumb

Joints
Sternoclavicular joint

1. Atypical (articular bony surface covered by fibrocartilage) double plane synovial; 3 degrees of freedom
2. Medial clavicle, manubrium and 1st costal cartilage
3. Capsular ligaments: Anterior and Posterior sternoclavicular ligaments surrounds the joints
4. Intracapsular structures: articular disc – fibrocartilage disc from clavicle to costal cartilage of 1st rib
5. Ligaments: extrinsic costaclavicular ligament from 1st rib and costal cartilage to inferior margin at the medial end of the clavicle
6. Movements - Horizontal flexion/extension between disc/manubrium; elevation/depression between clavicle and disc; medial clavicle pivots
on costoclavicular ligament in rotation of limb
7. Stability – inherently unstable due to lack on bony congruence however extrinsic ligaments provides stability to the joint
8. Relations: posteriorly – jugular vein, braciocephalic vein, subclavian vein and artery, carotid artery, and trachea
9. Blood supply: Internal thoracic artery and suprascapular artery; nerve supply: nerve to subclavius and medial supraclavicular nerve
10. Clinical: rarely dislocated; clavicular fractures are more commonly result from excessive force transmitted through it
Acromioclavicular joint

1. Type: Atypical plane synovial with 1 degree of freedom


2. Articulating Surfaces: 2 oval articular facets slope inferomedially (1 on clavicle and 1 on acromion); fibrocartilage lines articular surfaces
3. Capsule attached to articular margins of bones, strengthened superiorly by acromioclavicular ligament & fibres of trapezius
4. Intra-capsular structures: synovial membrane – lines fibrous capsule; articular disc – incomplete wedge shaped fibrocartilage disc that extends
from posterolateral edge
5. Ligaments: extrinsic – coracoclavicular ligament (conoid and trapezoid – stronger) anchors lateral clavicle to coracoid process of scapula
6. Movements: simple gliding movements & slight rotation with scapula & shoulder girdle
7. Stability: inherently unstable and stability dependent on extrinsic ligaments
8. Relations: trapezius deltoid insertions
9. Blood supply: Articular branches of suprascapular artery and thoracoacromial artery; nerve supply: lateral pectoral nerve, supraclavicular
nerve, and axillary nerve
10. Clinical: Acromioclavicular dislocation, subluxation (incomplete or partial dislocation) is very common (mechanism of injury: fall onto point
of the shoulder - generally not serious); coracoclavicular ligament rupture is serious which leads to a dropped shoulder and needs urgent
surgical repair

Glenohumeral joint

1. Typical synovial ball and socket with 3 degrees of freedom


2. Humeral head (large articular surface) is a 2/3 spherical structure which articulates with the shallow glenoid fossa (small articular surface);
hyaline cartilage on the articulating surface
3. Medial attachments: attached to the scapula, medial to the glenoid labrum and medial to the supralgenoid tubercle; lateral attachments: to the
anatomical neck of the humerus except medially where it extends down 1.5 cm down the surgical neck to allow for slack during abduction;
openings exist at the insertion of the long head of the biceps brachii superalaterally and where the joint cavity communicates with the bursa of
subscapularis anteriorly
4. Intracapsular structure: Synovial membrane, glenoid labrum, hyaline cartilage, and biceps brachii long head (extra-synovial); superior labrum
blends together with the biceps brachii long head tendon
5. Intrinsic ligaments: superior, middle, and inferior (2 bands) ligaments which strengthen the capsule anteriorly and coracohumeral ligament;
extrinsic ligaments: coracoacromial (prevents upwards movement) and acromioclavicular (stabilizes the scapula)
6. Prime movers: deltoid, latissimus dorsi, teres major, and pectoralis major; stabilizers: suprspinatus, infraspinatus, teres minor, and
subscpularis
7. Dynamic restraints: 40% rotator cuff, 40% primary movers; static restraints: 20% ligamentous capsule; minimal effect from the labrum
8. Associated musculature, vasculature passing to and from the upper limb and brachial plexus (especially the cords)
9. Blood supply: anterior and posterior circumflex humeral arteries (wraps around the surgical neck of the humerus to anastamose), suprscapular
artery, transverse cervical artery, and subscapular artery; nerve supply, posterior cord of the brachial plexus (capsule is supplied by axillary
nerve, suprascapular nerve, and lateral pectoral nerve)
10. Fractures, dislocation, impingement, rotator cuff tears, tendonitis, tendenosis, labral tears, bursitis etc.

Elbow joint

1. Typical synovial hinge joint with 1 degree of freedom


2. Articulating surfaces: Torchlea (medial side) and capitulum (lateral side) of the humerus articulates with the trochlear notch of the ulna and
the concave superior surface of the head of the radius respectively; the articular surfaces is covered by hyaline cartilage; the head of the radius
articulates with the radial notch of the ulna to make the proximal radioulnar joint
3. Articular capsule is attached to articular margins of each bone; the capsule projects upwards to enclose the radial and coronoid fossae
anteriorly and the olecranon fossa posteriorly; it also passes inferiorly onto the neck of the radius to enclose the proximal radio ulnar joint; the
capsule blends in with the annular ligament distally and does not attach to the radius; that capsule is weak anteriorly and posteriorly as this is
the direction of movement for hinge joints
4. Intra-capsular features are hyaline cartilage and synovium, fat pads of the olecranon, radial and coronoid fossa, and some include the annular
ligament; the fat pads are extra-synovial but intra-capsular and contain pressure sensitive mechanoreceptors that initiate reflex contraction to
prevent joint damage
5. Extrinsic ligaments: ulnar collateral ligament (medial – critical for valgus stability and is the primary elbow stabilizer) and radial collateral
ligament (lateral – debated as to whether it exists); annular ligament (wrops around the ulnar head from the anterior to the posterior radial
notch on the ulna); synovial membrane – lines the fibrous capsule and is continuous with the synovial membrane of the proximal radioulnar
joint (lines the olecranon, radial, coronoid fossa, and a sacciform process extends inferiorly from lower margins of the annular ligament)
6. 150○ from the extended position (limited by contact of flexor surfaces of the arm and forearm); the extension is limited by the fit of the
olecranon into its fossa and the associated fat pads; the contact surfaces in the trochlea change during flexion/extension and this can cause a
side-to-side wobble during movement
7. Look above
8. Brachialis, biceps brachii, muscles from the medial and lateral epicondyle, and muscles from the medial and lateral supracondylar ridge
9. Blood supply: anastomosis formed by 4 collateral branches from the brachial artery, and two recurrent branches each from ulnar and radial
arteries; nerve supply: mainly musculocutaneous and radial nerves (ulnar, median, and sometimes anterior interosseous nerve contribute)
10. Ulnar collateral ligament injury, students elbow (bursa bleeding), golfers elbow – medial epicondylitis (tendinosis), tennis elbow – lateral
epicondylitis (tendinosis) etc.

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