ARM

Dr. Al-Qaysi Department of Anatomy Faculty of Medicine

Muscles of upper limb

Specific objectives
At the end of this lecture, the student should be able to: Describe the general arrangement of layers of muscles in arm and forearm. Describe innervation and action of muscles in flexor and extensor compartment of arm and forearm. Describe brachial artery, its branches and clinical application. Explain importance of contents of intermuscular spaces.

Muscles of pectoral region

Four in number 1. Pectoralis major 2. Pectoralis minor 3. Subclavius 4. Serratus Anterior

Pectoralis Major muscle

Origin- From clavicle, sternum and upper costal cartilages. Insertion to lat. Lip of intertubercular groove of humerus. N. supply Lateral & medial pectoral Ns Main action adduction & medial rotation of humerus

Pectoralis minor

Origin from external surfaces of 2nd to 5th ribs Insertion into coracoid process of scapula Nerve supply medial pectoral nerve. Action depresses the shoulder

Subclavius

Origin from 1st rib with its costal cartilage Insertion into the groove on the lower surface of clavicle. Nerve supply Nerve to subclavius Action stabilizes sternoclavicular jt

Serratus Anterior

Origin from external surface of upper 8 ribs Insertion into costal surface of scapula along medial border. Nerve supply long thoracic n. Action rotates scapula & plays important role in abduction arm.

Muscles of shoulder
These group of muscles consists of

1. Deltoid 2. Supraspinatus 3. Infraspinatus 4. Teres minor 5. Teres major 6. Subscapularis

Deltoid

Origin from clavicle, acromion & spine. Insertion into deltoid tuberosity of humerus. Nerve supply axillary nerve. Action acromial fibres are powerful abductors, anterior fibres are flexors & med rotators, post fibres are extensors and lateral rotators.

Deltoid Actions

Anterior fibres assist Pect Major in drawing arm forwards and rotating medially. Posterior fibres act with L.Dorsi & T.Major to draw arm backwards and laterally. Multipennate acromial part is strong abductor. 15- 90 abduction.

Applied anatomy of Deltoid

Intramuscuular injections should always be given in lower half of muscle to avoid injury to the axillary nerve.

Clinical test Tested by asking the patient to abduct the arm against resistance.

Supraspinatus

Origin From medial 2/3 rd of Supraspinous fossa Insertion Into medial impression of greater tubercle of humerus, steadies the head of humerus. Nerve supply Suprascapular nerve. Action initiates and assists in abduction of the arm (upto 15 degrees).

Infraspinatus

Origin From Infraspinous fossa Insertion Into middle facet on greater tubercle of humerus. N. supply Suprascapular nerve. Action Lateral rotator of arm.

Teres Major

Origin From lower 1/3rd of dorsal surface of lateral border and inferior angle. Insertion To medial lip of bicipital groove. N. supply Lower subscapular nerve. Action Medial rotator and adductor of arm.

Teres Minor

Origin: Upper two third of dorsal surface of lateral border of the scapula Insertion: Lowest impression on the greater tubercle of humerus. Nerve supply: Axillary nerve (C5& 6) Action: Lateral rotator of arm

Subscapularis

Origin: Medial 2/3rd of Subscapular fossa Insertion: Lesser tubercle of humerus Nerve Supply: Upper and lower subscapular nerve ( C5,6) Action: Medial rotation and adduction.

Rotator Cuff

Tendons of four muscles, the Supraspinatus, Inraspinatus, Teres minor, and Subscapularis fuse with lateral part of capsule of shoulder joint forming Rotator Cuff. These muscles assist in holding humeral head in glenoid cavity.

Quadrangular space

Bounded

Medially- long head of tricep Above subscapularis Laterally surgical neck of humerus Below - Teres major muscle Axillary nerve & posterior circumflex humeral vessels pass through quadrangular space.

Triangular space

Boundaries: Superiorly by Teres minor muscle. Inferiorly by Teres major muscle. Laterally by long head of Triceps. Circumflex scapular vessels pass through it.

Anatomically, the term arm refers specifically to the segment between the shoulder and the elbow. The segment between the elbow and wrist is the forearm.

2.Fascial Compartments of arm bounded by lat.l & med. Intermuscular septi

Ant. Or Flexor C

Post. or Extensor C

Supplied by Musc.C. N

Supplied by Radial N

Flexor. c
MISeptum

M.C.N

LIS Extensor.c

R.N

Contents of the Anterior Fascial Compartment of the Upper Arm

Muscles

-Biceps brachii. -Coracobrachialis. -Brachialis. Blood Supply -Brachial artery. Nerve Supply -Musculocutaneous nerve.

Coracobrachialis

Origin- Tip of coracoid process of scapula Insertion -Middle third of medial surface of humerus Innervation Musculocutaneous nerve (C5,6,7)) Action Flexes the arm

Structures passing through the Compartment

Musculocutaneous N., Median N. and Ulnar N; brachial artery and basilic vein. The radial nerve is present in the lower part of the compartment.

Biceps Brachii

Brachialis

Origin - Distal half of anterior surface of humerus. Insertion -Coronoid process and tuberosity of ulna. InnervationMusculocutaneous nerve

Action -Flexes forearm in all positions.

Brachial artery

Begins at lower border of teres major muscle as a continuation of axillary art. It terminates opposite neck of radius by dividing into radial and ulnar arteries. Relations Anteriorly.

Vessel is superficial and is overlapped from lateral side by coracobrachialis and biceps.

Posteriorly

The artery lies on triceps, coracobrachialis insertion and brachialis. Ulnar nerve and basilic vein in upper part of arm.In lower part , median nerve lies on medial side. Median nerve , coracobrachialis and biceps M.

Medially

Laterally

Branches of brachial artery

1.Muscular branches. 2.Nutrient artery to humerus. 3.Profunda brachii artery arises near beginning of brachial art. Follow radial nerve into spiral groove of humerus. 4. Superior ulnar collateral art. Arises near middle of upper arm and follows ulnar nerve. 5. Inferior ulnar collateral art. Arises near termination of art. & takes part in anastomosis around elbow joint.

Musculocutaneous Nerve(C5,6,7)

Arises from lateral cord of brachial plexus in axilla. Pierces coracobrachialis muscle. Passes downrards between biceps and brachialis muscle. Descends as lateral cutaneous nerve of forearm.

Two intermuscular septa extend from the brachial fascia and are attached to the medial and lateral supracondylar ridges of the humerus. The septa divide the arm into anterior flexor and posterior extensor fascial compartments, each of which contains muscles, nerves, and blood vessels.

Contents of the Posterior Fascial Compartment of the Upper Arm

Muscle - The three heads of the triceps muscle. Nerve Supply - Radial nerve. Blood Supply - Profunda brachii and ulnar collateral arteries. Structures passing through the Compartment - Radial Nerve and Ulnar Nerve.

Triceps

Origin
- Long head - infraglenoid tubercle of scapula. - lateral head - posterior surface of humerus, above the radial groove. -medial head - posterior surface of humerus, below the radial groove.

Insertion -Long and lat head converge to insert into olecranon process. Med head into sup tendon and olecranon. Nerve Supply - Radial Nerve. Action - Extends the forearm; Powerful extension at elbow,

Radial nerve
Largest branch of posterior cord of brachial plexus. Relations: Anteriorly: Third part of axillary artery. Posteriorly: Subscapularis. Laterally: Axillary nerve and coracobrachialis. Medially: Axillary vein.

Relation in radial groove

In the radial (spiral) groove) the nerve runs downwards between lateral and medial head of triceps. At the lower end, 5 cm below the deltoid tuberosity, the nerve pierces the lateral inter-muscular septum and passes into anterior compartment of the arm. Branches Muscular: Before entering spiral groove, it supplies the long and medial head. In the spiral groove, it supplies lateral and medial head of triceps and the anconeus. Below the radial groove, it supplies brachioradialis and ext carpi radialis longus.

Cutaneous branches
Above radial groove, it gives off posterior interosseous nerve. In the radial groove, it gives off lower lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm.

Applied anatomy Commonly injured in radial groove due to intramuscular injections, Saturday night palsy( limb hanging by the side of chair), crutch palsy, fracture of shaft of humerus.

Thank You