Muscles Connecting the Upper Limb to the Thoracic Wall Nerve Muscle Origin Insertion Nerve Supply Rootsa

Action Pectoralis Clavicle, Lateral lip of Medial and C5, 6, Adducts arm and major sternum, and bicipital lateral pectoral 7, 8; T1 rotates it medially; upper six groove of nerves from clavicular fibers also costal humerus brachial plexus flex arm cartilages Pectoralis Third, fourth, Coracoid Medial pectoral C6, 7, 8 Depresses point of minor and fifth ribs process of nerve from shoulder; if the scapula brachial plexus scapula is fixed, it elevates the ribs of origin Subclavius First costal Clavicle Nerve to C5, 6 Depresses the clavicle cartilage subclavius from and steadies this bone upper trunk of during movements of brachial plexus the shoulder girdle Serratus Upper eight Medial border Long thoracic C5, 6, 7 Draws the scapula anterior ribs and inferior nerve forward around the angle of thoracic wall; rotates scapula scapula a The predominant nerve root supply is indicated by boldface type.

Muscles Connecting the Upper Limb to the Vertebral Column Nerve Muscle Origin Insertion Nerve Supply Rootsa Action Trapezius Occipital bone, Upper fibers Spinal part of XI Upper fibers ligamentum into lateral accessory nerve cranial elevate the nuchae, spine of third of (motor) and C3 nerve scapula; middle seventh cervical clavicle; and 4 (sensory) (spinal fibers pull vertebra, spines of middle and part) scapula medially; all thoracic lower fibers lower fibers pull vertebrae into acromion medial border of and spine of scapula scapula downward Latissimus Iliac crest, lumbar Floor of Thoracodorsal C6, 7, 8, Extends, adducts, dorsi fascia, spines of bicipital nerve and medially lower six thoracic groove of rotates the arm vertebrae, lower humerus three or four ribs, and inferior angle of scapula Levator Transverse Medial border C3 and 4 and C3, 4, 5 Raises medial scapulae processes of first of scapula dorsal scapular border of scapula four cervical nerve vertebrae Rhomboid Ligamentum Medial border Dorsal scapular C4, 5 Raises medial minor nuchae and spines of scapula nerve border of scapula of seventh cervical upward and and first thoracic medially vertebrae Rhomboid Second to fifth Medial border Dorsal scapular C4, 5 Raises medial major thoracic spines of scapula nerve border of scapula upward and medially a The predominant nerve root supply is indicated by boldface type.

Muscles Connecting the Scapula to the Humerus Nerve Muscle Origin Insertion Nerve Supply Rootsa Action Deltoid Lateral third of Middle of Axillary nerve C5, 6 Abducts arm; clavicle, lateral surface anterior fibers flex acromion, spine of shaft of and medially of scapula humerus rotate arm; posterior fibers extend and laterally rotate arm SupraspinatusSupraspinous Greater Suprascapular C4, 5, 6Abducts arm and fossa of scapula tuberosity of nerve stabilizes shoulder humerus; joint capsule of shoulder joint Infraspinatus Infraspinous Greater Suprascapular (C4), 5, Laterally rotates fossa of scapula tuberosity of nerve 6 arm and stabilizes humerus; shoulder joint capsule of shoulder joint Teres major Lower third of Medial lip of Lower C6, 7 Medially rotates lateral border of bicipital subscapular and adducts arm scapula groove of nerve and stabilizes humerus shoulder joint Teres minor Upper two thirds Greater Axillary nerve (C4), Laterally rotates of lateral border tuberosity of C5, 6 arm and stabilizes of scapula humerus; shoulder joint capsule of shoulder joint SubscapularisSubscapular Lesser Upper and C5, 6, 7Medially rotates fossa tuberosity of lower arm and stabilizes humerus subscapular shoulder joint nerves a The predominant nerve root supply is indicated by boldface type.

Summary of the Branches of the Brachial Plexus and Their Distribution Branches Distribution Roots Dorsal scapular nerve (C5) Rhomboid minor, rhomboid major, levator scapulae muscles Long thoracic nerve (C5, 6, 7)Serratus anterior muscle Upper Trunk Suprascapular nerve (C5, 6) Supraspinatus and infraspinatus muscles Nerve to subclavius (C5, 6) Subclavius Lateral Cord Lateral pectoral nerve (C5, 6, Pectoralis major muscle 7) Musculocutaneous nerve (C5, Coracobrachialis, biceps brachii, brachialis muscles; 6, 7) supplies skin along lateral border of forearm when it becomes the lateral cutaneous nerve of forearm Lateral root of median nerve See medial root of median nerve (C5, 6, 7) Posterior Cord Upper subscapular nerve (C5, Subscapularis muscle 6) Thoracodorsal nerve (C6, 7, Latissimus dorsi muscle 8) Lower subscapular nerve (C5, Subscapularis and teres major muscles 6) Axillary nerve (C5, 6) Deltoid and teres minor muscles; upper lateral cutaneous nerve of arm supplies skin over lower half of deltoid muscle Radial nerve (C5, 6, 7, 8; T1) Triceps, anconeus, part of brachialis, extensor carpi radialis longus; via deepradial nerve branch supplies extensor muscles of forearm: supinator, extensorcarpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor digitiminimi, extensor indicis, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis; skin, lower lateral cutaneous nerve of arm, posteriorcutaneous nerve of arm, and posterior cutaneous nerve of forearm; skin onlateral side of dorsum of hand and dorsal surface of lateral three and a halffingers; articular branches to elbow, wrist, and hand Medial Cord Medial pectoral nerve (C8; Pectoralis major and minor muscles T1) Medial cutaneous nerve of Skin of medial side of arm arm joined by intercostal brachial nerve from second intercostal nerve (C8; T1, 2)

Medial cutaneous nerve of forearm (C8; T1) Ulnar nerve (C8; T1)

Skin of medial side of forearm

Flexor carpi ulnaris and medial half of flexor digitorum profundus, flexor digitiminimi, opponens digiti minimi, abductor digiti minimi, adductor pollicis, third and fourth lumbricals, interossei, palmaris brevis, skin of medial half ofdorsum of hand and palm, skin of palmar and dorsal surfaces of medial oneand a half fingers Medial root of median nerve Pronator teres, flexor carpi radialis, palmaris longus, flexor (with lateral root) forms digitorum superficialis, abductor pollicis brevis, flexor median nerve (C5, 6, 7, 8; T1) pollicis brevis, opponens pollicis, first twolumbricals (by way of anterior interosseous branch), flexor pollicis longus, flexor digitorum profundus (lateral half), pronator quadratus; palmar cutaneousbranch to lateral half of palm and digital branches to palmar surface of lateralthree and a half fingers; articular branches to elbow, wrist, and carpal joints

Muscles of the Arm Muscle Origin Insertion Anterior Compartment Biceps brachii Long head Supraglenoid Tuberosity of tubercle of radius and scapula bicipital aponeurosis into deep fascia of forearm Short head Coracoid process of scapula CoracobrachialisCoracoid Medial aspect process of of shaft of scapula humerus Nerve Supply Nerve Rootsa Action

Musculocutaneous C5, 6 Supinator of nerve forearm and flexor of elbow joint; weak flexor of shoulder joint

Musculocutaneous C5, 6, Flexes arm nerve 7 and alsoprocess of weak adductor Brachialis Front of lower Coronoid Musculocutaneous C5, 6 Flexor of half of process of ulna nerve elbow joint humerus Posterior Compartment Triceps Long head Infraglenoid tubercle of scapula Lateral head Upper half of Olecranon Radial nerve C6, 7, Extensor of posterior process of ulna 8 elbow joint surface of shaft of humerus Medial head Lower half of posterior surface of shaft of humerus a The predominant nerve root supply is indicated by boldface type.

Muscles of the Anterior Fascial Compartment of the Forearm Nerve Muscle Origin Insertion Nerve Supply Rootsa Action Pronator Teres Humeral head Medial Lateral aspect Median nerve C6, 7 Pronation and epicondyle of of shaft of flexion of humerus radius forearm Ulnar head Medial border of coronoid process of ulna Flexor carpi Medial Bases of second Median nerve C6, 7 Flexes and radialis epicondyle of and third abducts hand at humerus metacarpal wrist joint bones Palmaris Medial Flexor Median nerve C7, 8 Flexes hand longus epicondyle of retinaculum and humerus palmar aponeurosis Flexor Carpi Ulnaris Humeral head Medial Pisiform bone, Ulnar nerve C8; T1 Flexes and epicondyle of hook of the adducts hand at humerus hamate, base at wrist joint fifth metacarpal bone Ulnar head Medial aspect of olecranon process and posterior border of ulna Flexor Digitorum Superficialis Humeroulnar Medial Middle phalanx Median nerve C7, 8; Flexes middle head epicondyle of of medial four T1 phalanx of humerus; medial fingers fingers and border of assists in flexing coronoid process proximal of ulna phalanx and hand Radial head Oblique line on anterior surface of shaft of radius Flexor Anterior surface Distal phalanx Anterior C8; T1 Flexes distal pollicis of shaft of radius of thumb interosseous phalanx of longus branch of thumb median nerve Flexor Anteromedial Distal Ulnar (medial C8; T1 Flexes distal digitorum surface of shaft of phalanges of half) and phalanx of profundus ulna medial four median (lateral fingers; then fingers half) nerves assists in flexion of middle and proximal phalanges and wrist Pronator Anterior surface Anterior Anterior C8; T1 Pronates forearm

quadratus

surface of shaft interosseous of radius branch of median nerve a The predominant nerve root supply is indicated by boldface type.

of shaft of ulna

Muscles of the Lateral Fascial Compartment of the Forearm Nerve Nerve Muscle Origin Insertion Supply Rootsa Action Brachioradialis Lateral Base of styloid Radial C5, 6, 7 Flexes forearm supracondylar process of nerve atridge of humerus ridge of humerus radius elbow joint; rotates forearm to the midprone position Extensor carpi Lateral Posterior surfaceRadial C6, 7 Extends and abducts radialis longus supracondylar of base of nerve hand at wrist joint ridge of humerus second metacarpal bone a The predominant nerve root supply is indicated by boldface type.

Muscles of the Posterior Fascial Compartment of the Forearm Nerve Nerve Muscle Origin Insertion Supply Rootsa Action Extensor Lateral epicondyle Posterior Deep C7, 8 Extends and abducts carpi of humerus surface of base branch of hand at wrist joint radialis of third radial brevis metacarpal nerve bone Extensor Lateral epicondyle Middle and Deep C7, 8 Extends fingers and digitorum of humerus distal branch of hand (see text for phalanges of radial details) medial four nerve fingers Extensor Lateral epicondyle Extensor Deep C7, 8 Extends metacarpal digiti of humerus expansion of branch of phalangeal joint of little minimi little finger radial finger nerve Extensor Lateral epicondyle Base of fifth Deep C7, 8 Extends and adducts carpi of humerus metacarpal branch of hand at wrist joint ulnaris bone radial nerve Anconeus Lateral epicondyle Lateral surface Radial C7, 8; Extends elbow joint of humerus of olecranon nerve T1 process of ulna Supinator Lateral epicondyle Neck and shaft Deep C5, 6 Supination of forearm of humerus, anular of radius branch of ligament of radial proximal nerve radioulnar joint, and ulna Abductor Posterior surface Base of first Deep C7, 8 Abducts and extends pollicis of shafts of radius metacarpal branch of thumb longus and ulna bone radial nerve Extensor Posterior surface Base of Deep C7, 8 Extends pollicis of shaft of radius proximal branch of metacarpophalangeal brevis phalanx of radial joints of thumb thumb nerve Extensor Posterior surface Base of distal Deep C7, 8 Extends distal phalanx pollicis of shaft of ulna phalanx of branch of of thumb longus thumb radial nerve Extensor Posterior surface Extensor Deep C7, 8 Extends indicis of shaft of ulna expansion of branch of metacarpophalangeal index finger radial joint of index finger

nerve The predominant nerve root supply is indicated by boldface type.

Muscle Palmaris brevis

Origin Flexor retinaculum, palmar aponeurosis Lumbricals Tendons of (4) flexor digitorum profundus

Small Muscles of the Hand Nerve Nerve Insertion Supply RootsaAction Skin of palm Superficial C8; T1 Corrugates skin to branch of improve grip of palm ulnar nerve Extensor expansion of medial four fingers First and C8; T1 Flex second, (i.e., metacarpophalangeal lateral two) joints and extend median interphalangeal joints of nerve; third fingers except thumb and fourth deep branch of ulnar nerve C8; T1 Palmar interossei adduct fingers toward center of third finger

Interossei (8) Palmar (4) First arises Proximal Deep branch from base of phalanges of of ulnar first metacarpal;thumb and nerve remaining three index, ring, from anterior and little surface of fingers and shafts of dorsal second, fourth, extensor and fifth expansion of metacarpals each finger (Fig. 9-69) Dorsal (4) Contiguous Proximal Deep branch sides of shafts phalanges of of ulnar of metacarpal index, middle, nerve bones and ring fingers and dorsal extensor expansion (Fig. 9-69) Short Muscles of Thumb Abductor Scaphoid, Base of Median pollicis trapezium, proximal nerve brevis flexor phalanx of retinaculum thumb Flexor Flexor Base of Median pollicis retinaculum proximal nerve brevis phalanx of

C8; T1 Dorsal interossei abductshafts of metacarpal fingers from center of third finger; both palmar and dorsal flex metacarpophalangeal joints and extend interphalangeal joints C8; T1 Abduction of thumb

C8; T1 Flexes metacarpophalangeal joint of thumb

thumb Opponens Flexor Shaft of Median C8; T1 Pulls thumb medially and pollicis retinaculum metacarpal nerve forward across palm bone of thumb Adductor Oblique head; Base of Deep branch C8; T1 Adduction of thumb pollicis second and proximal of ulnar third metacarpalphalanx of nerve bones; thumb transverse head; third metacarpal bone Short Muscles of Little Finger Abductor Pisiform bone Base of Deep branch C8; T1 Abducts little finger digiti proximal of ulnar minimi phalanx of nerve little finger Flexor Flexor Base of Deep branch C8; T1 Flexes little finger digiti retinaculum proximal of ulnar minimi phalanx of nerve little finger Opponens Flexor Medial border Deep branch C8; T1 Pulls fifth metacarpal digiti retinaculum fifth of ulnar forward as in cupping the minimi metacarpal nerve palm bone a The predominant nerve root supply is indicated by boldface type.