St. Luke’s College of Medicine – William H.

Quasha Memorial
ANATOMY BLOCK 1

Lecture: 2 - Pectoral Region, Shoulder, Axilla, and Arm Date: 8/3/2015

Lecturer: Dr. Arturo Decano Trans Team: Dela Cruz, Dela Cruz, Dela Fuente, Diangkinay

Topic Outline B. Thorax

I. Learning Objectives  The thorax has a “square-like” shape because of the
II. Pectoral Girdle and Bony Thorax presence of the pectoral girdle
A. Pectoral Girdle  Lies between the neck and abdomen
B. Thorax  Encases the great vessels, heart, and lungs
C. Bones
 Provides a conduit for structures passing between the head
III. Review: Spinal Nerve
IV. Brachial Plexus and neck superiorly and the abdomen, pelvis, and lower
A. Formation of the Brachial Plexus limbs inferiorly
B. Organization of the Brachial Plexus
C. Other Branches of the Brachial Plexus C. Bones
V. Axio-appendicular and Scapulohumeral Muscles 1. Clavicle – elongated short bone; attached to the scapula
A. Rotator Cuff Muscles and also attached to the bony thorax via the
B. Posterior Muscular Attachments of the Scapula sternoclavicular joint (clavicle attached to the sternum)
C. Posterior Muscles Acting on the Shoulder 2. Scapula – flat triangular bone; attached to the thorax via
D. Anterolateral Muscular Attachments of the Scapula
muscular attachments; it can retract, protract, move
E. Anterior Thoracoappendicular (Pectoral Muscles)
F. Intrinsic and Extrinsic Muscles of the Shoulder upward and downward
G. Primary Movers of the Glenohumeral Joint 3. Humerus – long bone, elongated diaphysis; attached to
H. Shoulder Joint the scapula via the glenohumeral joint
I. Ligaments of the Shoulder Joint
VI. Axilla
A. Review: Heart Chamber and Vessels
B. Branches of Axillary Artery
C. Blood Supply of the Upper Extremity
D. Axillary Vein
E. Axillary Lymph Nodes
F. Arteries and Nerves around the Humerus
VII. Muscles of the Arm
A. Muscles and Nerves of the Anterior Compartment
of the Arm
Figure 1. Pectoral Girdle and Thorax

I. Learning Objectives
ADDITIONAL INFO: Fractures of Upper Limb Bones
 Illustrate or describe the brachial plexus, including its parts,
1. Fracture of Clavicle
the nerves arising from it, and their specific origins and areas
 Most frequent fractured bone; common in children
of distribution
o Incomplete fracture in children – greenstick fracture
 Identify prominent features of the pectoral girdle
 Weakest part of the clavicle – junction of middle and lateral
 Describe the shoulder joint.
thirds
 Review the shoulder muscles and associated rotator cuff
 Result: the shoulder drops because trapezius can’t hold up
muscles. Give their general functions and nerve supply.
the lateral fragment; lateral fragment is pulled medially by
 Recall the concept of the axilla as a space, its boundaries
the adductor arm muscles
and its contents.
2. Fracture of Scapula
 Predict the functional and cutaneous loss that might result in
 Caused by severe trauma
the back, posterior shoulder, pectoral region, or cutaneous
 Most fractures involve protruding subcutaneous acromion
upper limb, given an injury to a specific site in the brachial
3. Fracture of Humerus
plexus.
 Fracture of surgical neck is common in elderly (osteoporosis)
 Identify or describe the axillary artery and vein, their major
 Transverse fractures caused by direct blow to the arm; pull
branches, and their relationships to each other, the brachial
of the deltoid muscle carries the proximal fragment laterally
plexus, and the pectoralis minor muscle.
 Intercondylar fracture caused by severe fall on the flexed
 Identify the contents of each of the three compartments of
elbow; Spiral fracture of humeral shaft is caused indirectly
the arm and the functional significance of the included
from a fall on an outstretched hand
muscles.
 Avulsion fracture of greater tubercle is common in middle-
II. Pectoral Girdle and Bony Thorax aged and elderly; small part of the tubercle is torn away
 Superior Appendicular Skeleton - consists of the pectoral
girdle and bones of the free part of the upper limb III. REVIEW: Spinal Nerve
 Initially arise from the spinal cord as rootlets
A. Pectoral Girdle – connects the axial skeleton (cranium,  Rootlets converge to form two nerve roots:
vertebral column, and associated thoracic cage) to the 1. Anterior (ventral) – consists of motor (efferent) fibers
upper limbs 2. Posterior (dorsal) – consists of sensory afferent fibers from
o Consists of the scapulae and clavicles; connected to the cell bodies in the spinal sensory or posterior root ganglion
manubrium of the sternum  The two nerve roots unite to form a mixed (motor and
o Connected to the trunk only anteriorly via the sternum by sensory) spinal nerve which immediately divides into:
flexible joints with three degrees of freedom 1. Posterior (primary) rami
2. Anterior (primary) rami

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o Lateral cord (LC) – union of anterior divisions of

superior and middle trunks
IV. Brachial Plexus o Posterior cord (PC) – union of of posterior divisions of
 Network of nerves joining together to form nerves moving superior, middle, and inferior trunks
towards the upper extremity o Medial cord (MC) – continuation of anterior division of
 In relation to the cervical vertebra, the nerves will exit the inferior trunk
vertebral foramen to an intervertebral foramen to move  The cords branch out to 5 main Terminal branches
towards the body (peripheral nerves):
o Musculocutaneous – terminal branch of lateral cord
A. Formation of the Brachial Plexus o Axillary – terminal branch of posterior cord
 Large network that extends from the neck to the upper limb o Radial – larger terminal branch of posterior cord (largest
via the cervico-axillary canal branch of brachial plexus)
 Bound by the clavicle, first rib, and superior scapula o Median – union of lateral root of median nerve(LRMN)
 Provides innervation to the upper limb and the shoulder and medial root of median nerve (MRMN)
region o Ulnar – larger terminal branch of medial cord

C. Other Branches of the Brachial Plexus

 Dorsal scapular – innervates the rhomboid muscles
 Suprascapular – innervate the supraspinatus and
infraspinatus m.
 Lateral pectoral – supplies the pectoralis major m.
 Long thoracic nerve – innervate the serratus anterior m.
 Medial pectoral nerve – innervates the pectoralis minor m.
 Medial cutaneous nerves – innervates skin in medial side of
the arm
 Upper and lower subscapular nerves (to subscapularis,
teres major, latissimus dorsi) – innervates the superior and
inferior portion of subscapularis, respectively

Figure 2. Brachial Plexus Formation

B. Organization of the Brachial Plexus (Note: RTDCB)

 The brachial plexus is formed by the union of the anterior
(ventral) rami of the last four cervical (C5-C8) and the first
thoracic (T1) nerves which constitute the Roots of the
brachial plexus
o Roots: C5, C6, C7, C8, T1 nerves

Figure 4. Other Branches of the Brachial Plexus

NOTE: Relationship of the Brachial Plexus with the

Axillary Artery – If the arm is abducted, the lateral cord will
look like it is superior to the axillary artery. The medial cord will
appear inferior.

ADDITIONAL INFO: Injury to muscle and nerves

1. Absence of Pectoral Muscle

 Absence of sternocostal part – no disability; Anterior axillary
fold is absent on the affected side, nipple is more inferior
 Poland syndrome – pectoralis major and minor are absent;
Figure 3. Nerves of the Brachial Plexus causes breast hypoplasia and absence of 2-4 rib segments
2. Paralysis of Serratus Anterior
 The roots of the brachial plexus unite to form three Trunks:  Paralysis occurs due to injury of the long thoracic nerve
o Superior trunk (ST) – union of C5 and C6 roots  Medial border of scapula moves laterally and posteriorly
o Middle trunk (MT) – continuation of C7 roots away from the thoracic wall – “Winging of the Scapula”
o Inferior trunk (IT) – union of the C8 and T1 roots  Arm cannot be abducted because serratus anterior can’t
 Each trunk divides into anterior and posterior Divisions: rotate the glenoid cavity superiorly
o Anterior divisions (AD) – supply anterior (flexor) 3. Triangle of Auscultation
compartments of the upper limb  Superior horizontal border of latissimus dorsi, medial border
o Posterior divisions (PD) – supply posterior (extensor) of the scapula, and the inferolateral border of trapezius
compartments of the upper limb  Good place to examine posterior segments of the lungs
 The divisions of the trunks form three Cords of the brachial 4. Injury of Spinal Accessory Nerve
plexus

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 Spinal Accessory Nerve Palsy – ipsilateral weakness when

shoulders are elevated against resistance
5. Injury of Thoracodorsal Nerve
 Nerve is susceptible to injury in mastectomies, surgery in the
inferior part of the axilla and on scapular lymph nodes
 Paralysis of Latissimus dorsi – person is unable to raise the
trunk with the upper limbs (ex. Climbing)
6. Injury to Dorsal Scapular Nerve
 Affects the actions of the rhomboids
 If one side is paralyzed, the scapula on the affected side is
farther from the midline
7. Injury to Axillary Nerve
 Atrophy of the deltoid if C5 and C6 are severely damaged
o Rounded contour of the shoulder disappears; Flattened
appearance; Loss of sensation may occur in the lateral Figure 6. Disposition of Rotator Cuff Muscles
side of the proximal part of the arm
 Injured if the surgical neck of the humerus is fractured and B. Posterior Muscular Attachments of the Scapula
also damaged during dislocation of glenohumeral joint  Trapezius
8. Fracture-Dislocation of Proximal Humeral Epiphysis o Descending (superior) part – elevate the scapula
 Caused by a direct/indirect injury to the shoulder o Middle part – retract the scapula (pull it posteriorly)
 Shaft of the humerus is markedly displaced in severe cases o Ascending (inferior) part – depress the scapula
9. Rotator Cuff Injuries  Levator scapulae
 Injury or disease may damage the musculotendinous rotator o Muscle attaching the scapula towards the neck
cuff producing instability of the glenohumeral joint o Elevates scapula; rotates glenoid cavity inferiorly
 Most common: rupture/tear of the supraspinatus tendon  Rhomboid minor and rhomboid major
 Degenerative tendonitis of the rotator cuff – common in o Retract scapula and rotate its glenoid cavity inferiorly
elderly people o Fix scapula to thoracic wall

V. Axio-Appendicular And Scapulohumeral Muscles

A. Rotator Cuff Muscles

 Stabilizes the glenohumeral joint (a ball-and socket joint
formed between the humerus and the scapula)
o Glenohumeral joint – most unstable joint of the body
 Help with movement of the arm, particularly in its rotation
 Made up of four muscles
1. Supraspinatus - initiates abduction of arm (assists
deltoid)
Figure 7. Posterior muscular attachments of the Scapula
2. Subscapularis – medial rotation of arm
3. Infraspinatus – lateral rotation of arm
C. Posterior Muscles Acting on the Shoulder
4. Teres minor – lateral rotation of arm
 Superficial
o Trapezius
 Descending (superior) part – elevates the scapula
 Middle part – retracts the scapula (pull it posteriorly)
 Ascending (inferior) part – depresses the scapula
 Braces the shoulders by pulling scapula posteriorly and
superiorly
 Weakness of the trapezius causes drooping of
shoulders
o Deltoid
 Anterior (clavicular) part – flexes and medially rotates
arm
 Middle (acromial) – abducts arm
Figure 5. Rotator Cuff Muscles
 Posterior (spinal) – extends and laterally rotates arm
 Primary combined function of the four rotator cuff  Fixes scapula to thoracic wall
(mnemonic: SITS) muscles – “grasp” and pull the head of o Latissimus dorsi (superficial)
the humerus medially  Attaches the humerus to the thoracic wall and lumbar
 Reinforces the capsule of the shoulder joint on three sides - area
anteriorly, superiorly and posteriorly  Extends, adducts, and medially rotates humerus
 Raises body toward arms during climbing
 Deep
o Levator scapulae
 Elevates scapula; rotates glenoid cavity inferiorly
 Acting bilaterally, the levators extend the neck
 Lateral flexion of the neck (acting unilaterally)

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o Rhomboid minor and rhomboid major F. Intrinsic and Extrinsic Muscles of the Shoulder
 Retract scapula and rotate its glenoid cavity inferiorly
Table 1: Intrinsic Muscles of the Shoulder
 Fix scapula to thoracic wall
 Supraspinatus - initiates abduction of arm (assists deltoid) Muscle Action Innervation
 Subscapularis – medial rotation of arm Deltoid Abduct, flex and Axillary nerve
 Teres minor - lateral rotation of arm extends arms
 Teres major - adducts and medially rotates arm Teres Major Adducts and medially Lower
rotates arm subscapular nerve
Supraspinatus Initiates abduction of Suprascapular
arms nerve
Infraspinatus Laterally rotates arms Suprascapular
nerve
Teres Minor Laterally rotates arms Axillary nerve
Subscapularis Adducts and medially Upper and lower
rotates arm subscapular nerve

Table 2: Extrinsic Muscles of the Shoulder

Muscle Action Innervation
Trapezius* Retract, elevate, Spinal
depress, rotate accessory
Figure 8. Posterior Muscles Acting on the Shoulder
scapula nerve
Latissimus Extend, adduct, Thoracodorsal
D. Anterolateral Muscular Attachments of the Scapula Dorsi medially rotate arm nerve
 Pectoralis minor Levator Elevate, rotate Dorsal scapular
o Attached to the coracoid process Scapulae scapula nerve
o Stabilizes scapula by drawing it inferiorly and anteriorly Rhomboid Retract and rotate Dorsal scapular
against thoracic wall Major and Minor scapula nerve
 Serratus anterior
o Protracts scapula and holds it against thoracic wall Serratus Protract and rotate Long thoracic
o When the muscle contracts, it will move the medial part of anterior scapula nerve
the scapula anteriorly Pectoralis Major Adduct and medially Lateral and
rotate arm medial pectoral
nerve
Pectoralis Minor Stabilizes Scapula Medial pectoral
nerve
*The trapezius muscle is not innervated by a nerve coming
from the brachial plexus. Spinal accessory nerve is a cranial
nerve.
G. Primary Movers of the Glenohumeral (shoulder) Joint
 Chief flexor of the glenohumeral joint – pectoralis major
(clavicular part) and deltoid (anterior fibers), assisted by the
coracobrachialis and biceps brachii.
 Chief extensor of the glenohumeral joint – latissimus
Figure 9. Muscular Attachments of the Scapula
dorsi
E. Anterior Thoracoappendicular (Pectoral Muscles)  Chief abductor of the glenohumeral joint – deltoid,
 Subclavius – anchors and depresses clavicle especially the central fibers (following initiation of the
 Pectoralis major movement by the supraspinatus)
 Chief adductors of the glenohumeral joint – pectoralis
o Adducts and medially rotates humerus
o Clavicular head – flexes humerus major and latissimus dorsi; simultaneously contract
o Sternocostal head – extends it back  Chief medial rotator of the glenohumeral joint –
 Pectoralis minor - Used when stretching upper limb forward subscapularis
 Serratus anterior – Used when punching or reaching  Chief lateral rotator of the glenohumeral joint –
anteriorly infraspinatus

H. The Shoulder Joint

1. Sternoclavicular Joint – saddle type of synovial joint but
functions as a ball-and-socket joint
 Sternal end of the clavicle articulates with the
st
manubrium and the 1 costal cartilage
2. Acromioclavicular Joint – plane type of synovial joint
 Acromial end of the clavicle articulates with the
acromion of the scapula
3. Glenohumeral Joint – ball-and-socket type of synovial joint
that permits a wide range of movement; mobility makes
the joint unstable
Figure 10. Pectoral Muscles  Large humeral head articulates with the shallow glenoid
cavity of the scapula

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A. Review: Heart Chambers and Vessels

I. Ligaments of the Shoulder Joint
 Strengthen the joint, not part of it; stabilized through the
tendons of the rotator cuff muscles
 Most common dislocation – anterior part of the humeral head
1. Coracoclavicular – acromioclavicular joint; clavicle attaches
to coracoid process
2. Coracohumeral - glenohumeral joint; coracoid process
attaches to greater tubercle of humerus
3. Glenohumeral – glenohumeral joint; supraglenoid tubercle
attaches to lesser tubercle of humerus
4. Coracoacromial – glenohumeral joint; acromion attaches to
coracoid process

Figure 13. Chambers and Vessels of the Heart

 Pathway of the blood

o Body → Superior/Inferior Vena Cava → R Atrium →
Tricuspid → R Ventricle → Pulmonary Valve Pulmonary
Artery → Pulmonary Circuit → Pulmonary Vein → L
Atrium → Bicuspid Valve → L Ventricle → Aortic Valve →
Aorta → Back to Systemic Circuit
Figure 11. Ligaments of the Shoulder Joint  Three branches of the aorta (brachiocephalic artery, left
common carotid artery, left subclavian artery)
VI. Axilla  The subclavian will continue to become the axillary artery
 The space between the pectoral girdle and the bony thorax  One continuous vessel
 Pyramidal in shape, it has an apex, base, and four walls
(three of which are muscular) B. Branches of the Axillary Artery
o Apex: passageway for structures entering or leaving the
1. First Part – between lateral border of Rib 1 and medial
shoulder and arm
border of pectoralis minor
o Anterior wall: pectoralis major and minor muscles,
a. Superior Thoracic Artery – supplies 1st and 2nd intercostal
clavipectoral fascia
spaces and superior part of serratus anterior
o Posterior wall: subscapularis, teres major, latissimus dorsi,
2. Second Part – posterior to pectoralis minor
and a long head of the triceps muscle
a. Thoraco-acromial Artery
o Medial wall: upper rib cage, intercostal and serratus
b. Lateral Thoracic Artery – supplies pectoral, serratus
anterior muscles
anterior, and intercostal muscles; supplies axillary lymph
o Lateral wall: humerus (intertubercular sulcus)
nodes and lateral aspect of breast
 Provides a passageway (“distribution center”) for the
3. Third Part – from lateral border of pectoralis minor to inferior
neurovascular structures that serve the upper limb
border of teres major; encircle around the neck of the
 Almost disappears when the arm is fully abducted – a
humerus
position in which its contents are vulnerable]
a. Subscapular Artery (largest branch of axillary artery) –
 Contains axillary blood vessels, lymphatic vessels, and
descends lateral border of subscapularis
several groups of axillary lymph nodes; also contains large
b. Anterior Circumflex Humeral Artery – passes lateral to
nerves that make up the cords and branches of the brachial
humerus, deep to coracobrachialis and biceps brachii
plexus
c. Posterior Circumflex Humeral Artery – supplies
 Axillary Sheath – sleeve-like extension of the cervical fascia
glenohumeral joint and surrounding muscles
that enclose the neurovascular structures

Figure 12. Axilla Figure 13. Branches of Axillary Artery

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compress the trunks of the brachial plexus; causes pain

C. Blood Supply of the Upper Extremity and anesthesia
 Axillary Artery → Brachial Artery → Radial Artery and Ulnar 4. Injuries to Axillary Vein
Artery  Wounds in the axilla often involve the axillary vein due to its
large size and exposed position
D. Axillary Vein  Wound in proximal part is dangerous because of profuse
 Vein in axillary region, receiving all blood from upper limb bleeding and air emboli (air bubbles) in the blood
 Lies distally to on anteromedial side of axillary artery 5. Enlargement of Axillary Lymph Nodes
 Formed from brachial vein (accompanying veins of the  Infection in the upper limb can cause node enlargement;
brachial artery – venae comitantes) and basilic vein lymphangitis (inflammation of lymphatic vessels)
 Has 3 parts but has extensive venous anastomosis  Infections in the pectoral region and breast can also
st
o The first part ends at lateral border of 1 rib and becomes produce enlargement of the nodes, the most common site
the subclavian vein of the spread of cancer of the breast
6. Variations of Brachial Plexus
E. Axillary Lymph Nodes  In addition to C5-T1, small contributions may be made by
 Pectoral (Anterior) Nodes – 3-5 nodes along medial wall of the anterior rami of C4 or T2
axilla; receive lymph mainly from anterior thoracic wall o Prefixed brachial plexus - Superiormost root of the plexus
 Subscapular (Posterior) Nodes – 6 or 7 nodes that receive is C4 and inferiormost is C8
lymph from posterior thoracic wall and scapular region H o Postfixed brachial plexus – superior root is C6 and inferior
 Humeral (Lateral) Nodes – 4-6 nodes draining the upper limb root is T2
 Pectoral, Subscapular, and Humeral Nodes → Central  Variations also occur in the formation of the trunks,
Nodes (near base of axilla) → Apical Nodes (at apex of divisions, and cords
axilla) → Subclavian Lymphatic Trunk 7. Brachial Plexus Injuries
 Injuries affect movements and cutaneous sensations in the
upper limb
 Disease/stretching/wounds in the lateral cervical region or
in the axilla produces injuries
 Results in loss of muscular movement (paralysis) and loss
of cutaneous sensations (anesthesia)
o Complete paralysis (no detectable movement) vs.
incomplete paralysis (weaker movements)
 Injuries to superior part of the brachial plexus (C5-C6)
o Result from extensive increase in the angle bet. the neck
and shoulder
 Stretches/ruptures superior parts of the brachial plexus;
Tears the roots of the plexus from spinal cord
 Injury to the superior trunk is apparent by the
Figure 14. Axillary Lymph Nodes
characteristic position of the limb (waiter’s tip position);
limb hangs by the side in medial rotation
F. Arteries and Nerves Around Humerus o Result of Erb-Duchenne palsy – paralysis of the shoulder
 Brachial artery – provides main supply to arm; continuation and arm supplied by C5 and C6: upper limb with an
of axillary artery adducted shoulder, medially rotated arm, extended elbow
 Musculocutaneous nerve – supplies all 3 muscles of  Lateral aspect of the upper limb – loss of sensation
anterior compartment of arm o Chronic microtrauma produce motor and sensory deficits
 Radial nerve – supplies all muscles in posterior (ex. When carrying a heavy backpack)
compartment of arm and forearm o Backpacker’s palsy produce muscle spasms and severe
 Ulnar nerve – supplies articular branches to elbow joint; no disability in hikers
branches in arm o Acute brachial plexus neuritis – neurologic disorder
 Median nerve – supplies articular branches to elbow joint; characterized by the sudden onset of severe pain around
no branches in axilla or arm the shoulder (unknown cause)
 Followed by muscle weakness and muscular atrophy
ADDITIONAL INFO: Axilla  Inflammation of the brachial plexus is preceded by some
event
1. Arterial Anastomosis Around the Scapula  Compression of cords of the brachial plexus result from
 vessels join to form networks on anterior and posterior prolonged hyperabduction of the arm when doing manual
scapular surfaces: Dorsal scapular artery, suprascapular tasks over the head
artery, circumflex scapular, thoracodorsal artery o Cords are compressed bet. coracoid process and
 Implication: severing the first or second part of the axillary pectoralis minor tendon
artery won’t stop blood flow; blood can reach the upper  Injuries to inferior part of the brachial plexus – klumpke
extremity through these anastomosis paralysis (less common)
2. Compression of Axillary Artery o Occurs when the upper limb is suddenly pulled superiorly
 Compression of 3rd part of the artery against the humerus o Injure the inferior trunk of the plexus (C8 and T1) and may
– necessary when profuse bleeding occurs tear the roots of the spinal cord
 Compression at the origin can be done if compression is 8. Brachial Plexus Block
required at a more proximal site  Injection of an anesthetic solution into or immediately
3. Aneurysm of Axillary Artery surrounding the axillary sheath
 1st part of axillary artery may enlarge (aneurysm) and

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ADDITIONAL INFO: Arm

VII. Muscles of the Arm 1. Biceps Tendinitis

 Inflammation of the tendon
 Wear and tear causes shoulder pain, usually the result of
repetitive microtrauma involving throwing
2. Dislocation of Tendon of Long Head of Biceps
 Partial or complete dislocation from the intertubercular
sulcus in the humerus
 Occurs during traumatic separation of the proximal
epiphysis of the humerus
3. Rupture of Tendon of Long Head of Biceps
 Rupture usually results from wear and tear of an inflamed
tendon; the tendon is torn from its attachment to the
supraglenoid tubercle of the scapula
 Detached muscle belly forms a ball near the center of the
distal part of the anterior aspect of the arm
4. Fracture of Humeral Shaft
 Midhumeral fracture may injure the radial nerve
o Fracture is not likely to paralyze even if the nerve is
damaged
 Supra-epicondylar fracture – fracture of the distal part of the
humerus
Figure 15. Muscles of the Arm o Any of the nerves or branches of the brachial vessel may
be injured by a displaced bone fragment because the
 Biceps brachii – supinate forearm; flex elbow; anterior brachialis and triceps tend to pull the distal fragment over
compartment the proximal fragment
 Brachialis – flex elbow; anterior compartment, lateral side 5. Injury to Musculocutaneous Nerve
 Coracobrachialis – flex arm; adduct arm; anterior  Injury is usually inflicted by a weapon
compartment  Flexion of elbow and supination of the forearm are greatly
 Anconeus – assist in forearm extension; stabilize elbow; weakened
posterior compartment  Loss of sensation on the lateral surface of the forearm
 Triceps brachii – extend forearm; posterior compartment supplied by the lateral cutaneous nerve of the forearm
o Large, three-headed muscle of the upper arm 6. Injury to Radial Nerve in Arm
o Enables extension and retraction of the forearm  Injury to the radial nerve superior to the origin of its
o Serves to stabilize the shoulder joint branches to the triceps brachii results in paralysis of the
o Parts of the Triceps Brachii: triceps
 Long head - originates at the infraglenoid tubercle of  Loss of sensation occurs in the areas of skin supplied by
the scapula. this nerve
 Medial head – originates at the dorsal humerus distally  When the radial nerve is injured in the radial groove:
from the radial sulcus o Triceps = Weakened and not completely paralyzed
 Lateral head- strongest part because only the medial head is affected
o Muscles in the posterior compartment of the forearm =
paralyzed

References
 Moore, 7 Ed.
th

 Doctor Decano’s lecture and ppt

QUIZ

1. Choose the correct combination (muscle:action)

a. Biceps brachii: forearm pronation
b. Brachialis: forearm flexion
Figure 16. Triceps brachii c. Coracobrachialis: forearm extension
2. What are the two muscles the suprascapular innervates?
3. What are the chief adductors of the glenohumeral joint?
4. What causes the winging of the scapula?
5. The posterior cord will divide into _____ and _____.

Answers:

1. B
2. Supraspinatus and infraspinatus
3. Pectoralis major and latissimus dorsi
4. Injury to the long thoracic nerve
5. Axillary and Radial Nerve

Figure 17. Anterior Muscles and Nerves of the Arm

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