Bones of Upper Limb

Skeletal System

Axial skeleton: Appendicular

skeleton:
- Skull
- Vertebral column - Upper Limb
- Thoracic cage - Lower Limb
-Pelvis

N.B: * Anterior axio-appendicular muscles.

* Posterior axio-appendicular muscles.
1 Bones of the shoulder girdle:
Scapula and clavicle together

2 The bone of the arm:

Humerus

3 Bones of the forearm:

Radius and Ulna

4 Bones of the hand:

Carpals, Metacarpals & Phalanges
Clavicle Costo-clavicular
ligament
= collarbone

Coraco-clavicular ligament
Scapula
 Humerus

Olecranon fossa
 Radius
Head
Neck
Radial tuberosity

Anterior
view

Ulnar notch
Styloid process
Ulna

Lateral view
Muscles of the Shoulder (Scapular) region
 6
Muscles

Deltoid Rotator cuff muscles Teres major

(1) Subscapularis
(2) Supraspinatus
(3) Infraspinatus Supraspinatus

(4) Teres minor Teres minor

Infraspinatus

Teres major

Subscapularis
 Origin: (External V shape) Deltoid

- Front of lateral 1/3 of the clavicle,

- Lateral border of acromion, and
- Lower lip of the spine of the scapula.

Insertion:
Deltoid tuberosity.
(on the middle of the lateral surface of the shaft of the humerus)
 Anterior fibers

Action:
•Anterior fibers: Flexion, medial (internal) rotation,
and horizontal flexion of the arm at the shoulder joint.
Posterior fibers

•Posterior fibers: Extension, Lateral (external) rotation,

and horizontal extension of the arm at the shoulder joint.

• Middle fibers or muscle as whole: abduction

of the arm at the shoulder joint (from 15° up to 90°)
Middle fibers

Nerve supply:

Axillary nerve (post. Cord of brachial plexus).

 Origin:
Medial 2/3 of subscapular fossa.

Insertion:
Lesser tuberosity of the humerus.

Action:
Adduction and medial rotation of the arm at the shoulder joint

Nerve supply:
Upper and lower subscapular nerve (post. Cord of brachial plexus)
 supraspinatus
Origin:
Medial 2/3 of supraspinous fossa of the scapula.

Insertion:
Greater tuberosity of the humerus (superior facet).

Action:
Initiates abduction of the arm at the shoulder joint (0°–15°)

Nerve supply:
Suprascapular nerve
(upper trunk of brachial plexus)
 Origin:
Medial 2/3 of infraspinous fossa of the scapula.

Insertion:
Greater tuberosity of the humerus (middle facet).

Action: Infraspinatus

Lateral rotation, and horizontal extension of the arm

at the shoulder joint.

Nerve supply:
Suprascapular nerve (upper trunk of brachial plexus)
 Origin:
upper 2/3 of posterior aspect of lateral border of the scapula.

Insertion:
Greater tuberosity of the humerus (inferior facet).
(SIT greater tuberosity muscles) Teres minor

Action:
Lateral rotation, and horizontal extension of the arm
at the shoulder joint.

Nerve supply:
• Axillary nerve (post. Cord of brachial plexus).
 Teres major
Origin:
Lower 1/3 of posterior aspect of lateral border of the scapula.

Insertion:
Medial lip pf bicipital groove of the humerus.
(PLT bicipital groove muscles)
Action: Teres major

Adduction, medial rotation, and extension of the arm

at the shoulder joint.

Nerve supply:
• Lower subscapular nerve (post. Cord of brachial plexus).
 Muscles of shoulder region ( 6 Muscles )

Infraspinatus Teres major

Supraspinatus Teres minor

All shoulder (scapular) region muscles act on shoulder joint.

 According to shoulder joint
• Any muscle lies in Front or Anterior to the shoulder joint it can flex the humerus.
(Ant. deltoid fibers – Pectoralis major – Biceps brachii - Coracobrachialis)
• Any muscle lies in Back or posterior to the shoulder joint it can extend the humerus.
(Post. Deltoid fibers – Latissimus dorsi – Teres major – Long head of triceps)
• Coming from medial to lateral adduction of the humerus.
(Pectoralis major – Latissimus dorsi)
• crossing above the shoulder joint abduction of the humerus.
(Middle deltoid fibers – Supraspinatus)
• Inserted in the back of humerus External (lateral) rotation.
(Infraspinatus – Teres minor – Post. Deltoid fibers)
• Inserted in the front of humerus Internal (medial) rotation.
(Subscapularis – Teres major – Pectoralis major – Latissimus dorsi – Ant. deltoid fibers)
Muscles of the Arm
 Intermuscular septa

Anterior compartment Posterior compartment

Lateral Medial
 4
Anterior compartment Muscles Posterior compartment

(1) Biceps brachii (short & long heads) (1) Triceps:

(2) coracobrachialis - Lateral head
- Long head
(3) brachialis
- Medial head

Long Lateral

Lateral Lateral
 Origin:
• Short head: tip of coracoid process of scapula Long Lateral

( with coracobrachialis muscle).

• Long head: supraglenoid tubercle of scapula.
Insertion:
- Radial tuberosity.
- The bicipital aponeurosis into the deep fascia overlying the elbow joint.
Action:
Flexion of the forearm, powerful supination, flexion of the arm (acts on shoulder
and elbow joints).
Nerve supply:
Musclo-cutaneous nerve (lateral cord of brachial plexus).
 Origin:
Apex of coracoid process of the scapula.
( with short head of biceps brachii).

Insertion:
Middle 1/3 of the medial border of the shaft
of the humerus.

Action:
Flexion, adduction, and horizontal flexion of the arm at the shoulder joint.

Nerve supply:
Musclo-cutaneous nerve which pierces it. (lateral cord of brachial plexus).
 Origin:
Lower half of the anterior surface of the humerus.

Insertion:
Ulnar tuberosity and coronoid process of ulna.

Action:
Flexion of the forearm at the elbow joint.

Nerve supply:
Major part by Musclo-cutaneous nerve + lateral fibers by radial nerve. The radial
nerve descends in the groove between the brachialis and brachioradialis muscles,
above the elbow.
 Origin:
Long head: infraglenoid tubercle of the scapula.
Lateral head: upper 1/3 of posterior surface of the humerus (above spiral groove).
Medial head: lower 2/3 of posterior surface of humerus (below spiral groove).

Insertion: Long head Lateral

Upper surface of the olecranon process of ulna. head

Action: - Main extensor of the forearm. Medial

- Its long head extends the arm. head
(acts on shoulder and elbow joints).
Medial
Nerve supply: head
Radial nerve.
 4
Anterior compartment Muscles Posterior compartment

• Any muscle in Front or Anterior to the joints (either shoulder or elbow) it can Flex it.
• Any muscle in Back or posterior to the joints ( either…or... ) it can Extend it.
Muscles of the Back
 5
Muscles
2 Superficial 3 Deep

Trapezius
(1) Levator scapulae
(1) Trapezius
(2) Rhomboid minor
(2) Latissimus dorsi
(3) Rhomboid major

Latissimus dorsi
 Origin:
nuchal ligament

Medial 1/3 of superior nuchal line,

Head
external occipital protuberance,
nuchal ligament, Neck

and spinous processes of all thoracic vertebrae. Thorax

Insertion: (internal V shape)

Back (posterior border) of lateral 1/3 of the clavicle,
medial border of acromion, and
Upper lip of the spine of scapula.
 Action:
- Upper fibers: elevation of scapula.
- Lower fibers: depression of scapula.
- Upper + Lower: upward rotation of scapula.
- Middle fibers or muscle as a whole: retraction of scapula.

Nerve supply:
Spinal accessory nerve (11th cranial nerve).
 Origin:
- Spinous processes of lower six thoracic vertebrae (T7 – T12 ),
- Thoracolumbar fascia,
- iliac crest,
- Lower 3 or 4 ribs, and
- Inferior (lower) angle of scapula.

Insertion:
Floor of the intertubercular (bicipital) groove of the humerus.
 Action:
-Extension, adduction, and internal (medial) rotation
of the humerus.
- Raises the body during climbing
- Assist in forced expiration.

Nerve supply:
Thoracodorsal nerve.
 Origin:
Transverse processes of C1 – C4 vertebrae.
Insertion:
Back(Posterior aspect) of the medial border of
scapula above the level of the spine.
Action:
- Elevation of the scapula (with upper trapezius fibers).
- Downward rotation of the scapula (with other muscles).
Nerve supply:
Cervical nerve (C3-C4) and dorsal scapular nerve (C5)
Origin: Origin:
Spinous processes of C7 and T1 Spinous processes of T2 –T5
vertebrae (last and first). vertebrae.
Insertion: Insertion:
Triangular area at the root of the Back of medial border of scapula
spine of the scapula. below the level of the spine.
Action:

Both rhomboids:
- Retract the scapula.
- Rotate the scapula Downwards.

Nerve supply:
Dorsal Scapular Nerve (nerve to rhomboids).
• All post. axio-appendicular muscles act on shoulder girdle except latissimus dorsi which act on
shoulder joint because it is inserted in the humerus.
• Elevation, depression, Protraction, retraction, rotation (up-down) shoulder girdle.
• Flexion, extension, abduction, adduction, rotation (int. – ext.) shoulder joint.
• Rotation of the scapula is named according to the direction of glenoid cavity.
 Muscles of Back Muscles of Pectoral region

• All ant. & post. axio-appendicular muscles act on shoulder girdle except pectoralis major &
latissimus dorsi which acts on shoulder joint because they are inserted in the humerus.
 Elevation Depression
Muscles coming from above and inserted in Muscles coming from below and inserted in
the scapula (from above to below) the scapula (from below to above)

Upper fibers of trapezius + levator scapulae Lower fibers of trapezius + pectoralis minor
 Protraction Retraction

Muscles coming from front and inserted in Muscles coming from medial and inserted
the scapula (from front to back) in the scapula (from medial to lateral)

Serratus anterior + Pectoralis minor Middle fibers of trapezius + Rhomboids

 upward (lateral) rotation downward (medial) rotation

Glenoid cavity go up Glenoid cavity go down

Upper and Lower fibers of trapezius Levator scapulae
+ + Rhomboids
Lower 5 digitations of serratus anterior + help of pectoralis minor
 comparison

Pectoralis major Latissimus dorsi

Ant. axio-appendicular muscle post. axio-appendicular muscle
Act on shoulder joint Act on shoulder joint
Add. + flexion + internal (medial) Add. + extension +internal (medial)
rotation rotation
Climbing + Pull up Climbing + Pull up
Assist with P.minor & serratus anterior Assist in forced expiration
in forced inspiration
 According to shoulder joint

• Any muscle lies in Front or Anterior to the shoulder joint it can flex the humerus.
• Any muscle lies in Back or posterior to the shoulder joint it can extend the humerus

• Coming from medial to lateral adduction of the humerus.

• Crossing above the shoulder joint abduction of the humerus.

• Inserted in the front of humerus Internal (medial) rotation.

• Inserted in the back of humerus External (lateral) rotation.
Muscles of the Pectoral region
 (1) Pectoralis major (2) Pectoralis minor (3) Subclavius (4)Serratus anterior

Pectoralis Subclavius 8
major digits
Pectoralis
minor
Serratus
anterior

N.B: Between these muscles

there is clavipectoral fascia
 Origin:
Clavicular head: anterior surface of medial half of clavicle.
Sternocostal head: anterior surface of sternum,
Upper six (6) costal cartilages (not ribs), and
Aponeurosis of external oblique muscle.

Insertion:
Lateral lip of intertubercular (bicipital) groove of humerus.
 Action:
• The muscle as a whole:
- Flexes, adducts, and internally (medially) rotates the humerus.
- Climbing + Pull up
• Clavicular head:
Flexes the arm at shoulder joint (adducts abducted arm at 60°).
• Sternoclavicular head:
Brings the flexed arm into the neutral position (adducts abducted arm at 120°).

Nerve supply:
Medial and lateral pectoral nerves.
Origin:
3rd to 5th ribs, (near but not attached to their costal cartilages).

Insertion:
Medial border and superior surface of coracoid process of the scapula.

Action:
Draws the scapula inferiorly and anteriorly
against the thoracic wall (depression + protraction).
( N.B: both pectoralis muscles assist in forced inspiration)

Nerve supply:
Medial pectoral nerve.
 Origin:
Junction of 1st rib and its costal cartilage
(1st costochondral junction).

Insertion:
Groove of subclavius in the inferior surface of the middle third of the clavicle.

Action:
It steadies the clavicle during movements of shoulder girdle.

Nerve supply:
Nerve to subclavius (subclavian nerve).
 Origin:
Outer surfaces of the upper 8 ribs at the side of the chest.
8
digits

Insertion:
Anterior aspect (front) of medial border of the scapula
• 1st digit: front of the superior angle of the scapula
• 2nd and 3rd digits: along the whole medial border.
• Lower 5 digits: at inferior angle of the scapula.
 Action: (boxer’s muscle)
• It protracts the scapula (draws the scapula forward)
•Lower 5 digits: assist trapezius muscle in raising the arm above the head
(upward rotation of the scapula).
(N.B: serratus anterior helps also in forced inspiration).

Nerve supply:
Long thoracic nerve (Nerve to serratus anterior).
Winging of the scapula:
In condition of long thoracic nerve injury, such as:
• Surgical operations in the axilla
• Stabbing of the lateral side of the chest

The serratus anterior muscle will

become paralyzed, so the medial
border of the scapula will be
prominent posteriorly because it is not
in contact with the thoracic wall. It is
more prominent on pressing forward
with outstretched arm.
• All ant. axio-appendicular muscles act on shoulder girdle except pectoralis major which
act on shoulder joint, because it is inserted in the humerus.

• Pectoralis major muscle:

- In front or Anterior to the shoulder joint so it can flex the humerus.
- coming from medial to lateral so it can adduct the humerus.
- Inserted in the front of humerus so it can rotate it medially (internally)
 Origin:
Upper 2/3 of the lateral supracondylar ridge of humerus.

Insertion:
Lateral side of the styloid process of radius,

Action:
Ant. view
Flexion of the forearm (specially in the mid-prone position).
Initiation of supination & pronation.
Nerve supply:
Radial nerve.
 2
Annular
ligament
2 bones
Origin: 2 ligaments Radial
collateral
Lateral epicondyle of humerus, radial collateral ligament

ligament, annular ligament, supinator crest of ulna.

Insertion:
Upper 1/3 of posterior, lateral, and anterior surfaces of radius.
Action:
Supination of the forearm.
Nerve supply:
Radial nerve (posterior interosseous nerve).