Upper Extremity Flashcards
Origin: Trapezius
- Medial part of superior nuchal line
- Ligamentum nuchae (an expansion of the supraspinous ligament)
- Thoracic spinous processes
- Supraspinous ligament
Insertion: Trapezius
- Lateral part of the clavicle
- Acromion
- Spine of the scapula
Innervation: Trapezius
Motor from spinal portion of accessory nerve (CN XI)
Action: Trapezius
- Acting as a whole, trapezius rotates scapula upward
- Acting individually,
a. Upper trap: rotates scapula upward
b. Middle trap: retracts (adducts) scapula
c. Lower trap: depresses and upwardly rotates scapula
eg: cyclist extending neck over handlebars, holding phone between shoulder and ear, carrying bags on shoulder, pulling shoulders back
Notes: Trapezius
Most superficial layer of superficial back muscles
Nerve runs on deep side of muscle with superficial branch of transverse cervical artery
Origin: Latissimus Dorsi
- Spinous processes of T7-T12
- Lumbar aponeurosis (thoracolumbar fascia)
- Crest of ilium
- Lower 3 or 4 ribs
- Inferior angle of scapula
Insertion: Latissimus Dorsi
Floor of bicipital groove of humerus
Innervation: Latissimus Dorsi
Thoracodorsal nerve (from brachial plexus)
Action: Latissimus Dorsi
- Shoulder extension
- Shoulder internal rotation
- Shoulder adduction
- Can also contribute to scapular depression and retraction (adduction)
eg: paddling a kayak, walking with crutches, unzipping dress
Notes: Latissimus Dorsi
Most superficial layer of superficial back muscles
Origin: Levator Scapulae
Transverse processes of C1-C4
Insertion: Levator Scapulae
Vertebral border between the spine and the superior angle of scapula
Innervation: Levator Scapulae
Dorsal scapular nerve
Action: Levator Scapulae
- Elevation of scapula
- Downward rotation of scapula
eg: rotating head, holding phone between ear and shoulder
Notes: Levator Scapulae
Intermediate layer of superficial back muscles
Origin: Rhomboid Minor
Spinous processes of C7 and T1
Insertion: Rhomboid Minor
Vertebral border of scapula at base of spine
Innervation: Rhomboid Minor
Dorsal scapular nerve
Action: Rhomboid Minor
- Downward rotation of scapula
- Retraction (adduction) of scapula
- Elevation of scapula
Notes: Rhomboid Minor
Intermediate layer of superficial back muscles
Nerve lies on deep surface with deep branch of transverse cervical artery
Origin: Rhomboid Major
Spinous processes T2-T5
Insertion: Rhomboid Major
Vertebral border of scapula below rhomboid minor to the inferior angle
Innervation: Rhomboid Major
Dorsal scapular nerve
Action: Rhomboid Major
- Downward rotation of scapula
- Retraction (adduction) of scapula
- Elevation of scapula
Notes: Rhomboid Major
Intermediate layer of superficial back muscles
Origin: Serratus Posterior Superior
Spinous processes of C7-T2
Insertion: Serratus Posterior Superior
Upper ribs
Innervation: Serratus Posterior Superior
Intercostal nerves T2-T5 (ventral rami)
Action: Serratus Posterior Superior
Assists in lifting ribs in inspiration
Notes: Serratus Posterior Superior
Deepest layer of superficial back muscles
Origin: Serratus Posterior Inferior
Spinous processes T11-L2
Insertion: Serratus Posterior Inferior
Lower ribs
Innervation: Serratus Posterior Inferior
Intercostal nerves T9-T12 (ventral rami)
Action: Serratus Posterior Inferior
Unclear, may hold lower ribs down during inspiration
Notes: Serratus Posterior Inferior
Deepest layer of superficial back muscles
Origin: Serratus Anterior
Digitations from ribs 1-8
Insertion: Serratus Anterior
- Vertebral border on costal surface of scapula
2. Inferior angle of scapula
Innervation: Serratus Anterior
Long thoracic nerve
Action: Serratus Anterior
- Scapula protraction (abduction)
- Rotates scapula (glenoid) upward
eg: push up, throwing a punch, opening a swinging door
Notes: Serratus Anterior
Scapular winging if serratus anterior denervated
Important in scapulohumeral rhythm
Origin: Deltoid
- Lower margin of lateral 1/3 of clavicle
- Acromion
- Lower margin of scapular spine
Insertion: Deltoid
Deltoid tuberosity of humerus
Innervation: Deltoid
Axillary nerve
Action: Deltoid
- Acting as a whole, deltoid stabilizes glenohumeral (GH) joint
- Acting individually,
a. Anterior fibers: shoulder flexion and horizontal adduction
b. Middle fibers: shoulder abduction
c. Posterior fibers: shoulder extension and horizontal abduction
Origin: Subscapularis
Costal surface of scapula (subscapular fossa)
Insertion: Subscapularis
Lesser tubercle of humerus
Innervation: Subscapularis
Upper and lower subscapular nerves
Action: Subcapularis
- Stabilizes GH (glenohumeral) joint
- Shoulder internal rotation
eg: reaching hand around to scratch back; clutching a book to chest
Notes: Subscapularis
Rotator cuff muscle
Origin: Supraspinatus
Supraspinous fossa
Insertion: Supraspinatus
Superior facet of greater tubercle of humerus
Innervation: Supraspinatus
Suprascapular nerve
Action: Supraspinatus
- Stabilizes GH joint
- Shoulder abduction
- Depresses humeral head during abduction
eg: conducting an orchestra, installing ceiling tiles overhead
Notes: Supraspinatus
Rotator cuff muscle
Origin: Infraspinatus
Infraspinous fossa
Insertion: Infraspinatus
Middle facet of greater tubercle
Innervation: Infraspinatus
Suprascapular nerve
Action: Infraspinatous
- Stabilizes GH joint
- Shoulder external rotation
eg: starting a pull-cord lawn mower
Notes: Infraspinatus
Rotator cuff muscle
Origin: Teres Minor
Lateral border of scapula, above teres major
Insertion: Teres Minor
Lower facet of greater tubercle
Innervation: Teres Minor
Axillary nerve
Action: Teres Minor
- Stabilizes joint
- Shoulder external rotation
eg: starting a pull-cord lawn mower
Notes: Teres Minor
Rotator cuff muscle
Origin: Teres Major
Lower lateral border of scapula, as far as inferior angle
Insertion: Teres Major
Medial lip of bicipital groove
Innervation: Teres Major
Lower subscapular nerve
Action: Teres Major
- Shoulder internal rotation
- Shoulder adduction
- Shoulder extension
Origin: Coracobrachialis
Coracoid process
Insertion: Coracobrachialis
Middle shaft of humerus
Innervation: Coracobrachialis
Musculocutaneous nerve
Action: Coracobrachialis
- Shoulder flexion
- Shoulder adduction
eg: reaching around face to scratch opposite ear; doing a bench press
Notes: Coracobrachialis
Anterior compartment
Musculocutaneous nerve pierces coracobrachialis muscle belly
Origin: Biceps Brachii
- Short head: coracoid process
2. Long head: supraglenoid tubercle (blends with labrum, see notes)
Insertion: Biceps Brachii
Radial tuberosity (radius)
Innervation: Biceps Brachii
Musculocutaneous nerve
Action: Biceps Brachii
- Elbow flexion
- Forearm supination
- Shoulder flexion
eg: carrying infant in cradled arms, tightening a screw with right arm, holding heavy hymnal while singing
Notes: Biceps Brachii
- Anterior compartment
- Tendinous origin of long head runs in fibrous capsule of GH joint (enclosed in synovial membrane,) travels in bicipital groove, held down by transverse humeral ligament
- Two tendons fuse into one muscle belly
- Prior to insertion gives off bicipital aponeurosis medially, which fuses with deep fascia
- In 10% a third head can be found arising from the humerus
Origin: Brachialis
Lower, anterior humerus
Insertion: Brachialis
Coronoid process
Innervation: Brachialis
Musculocutaneous nerve
Action: Brachialis
Elbow flexor in both supination and pronation
eg: bringing food from plate to mouth; picking up heavy books; carrying baby car seat
Notes: Brachialis
Anterior compartment
Possibly dual innervation from radial nerve
Origin: Triceps Brachii
- Long head: infraglenoid tubercle
- Lateral head: posterior humerus above the spiral groove
- Medial head: posterior humerus below the spiral groove (deep)
Insertion: Triceps Brachii
Olecranon process
Innervation: Triceps Brachii
Radial nerve
Action: Triceps Brachii
- Elbow extension
- Long head can adduct and extend shoulder
eg: slamming trunk of car; push up; dribbling basketball
Notes: Triceps Brachii
Posterior compartment
Long head runs anterior to teres minor and posterior to teres major muscles
Long and lateral heads form the superficial part of the muscle
Origin: Anconeous
Lateral epicondyle of humerus
Insertion: Anconeous
- Lateral surface of olecranon
2. Lateral ulna
Innervation: Anconeous
Radial nerve
Action: Anconeous
Elbow extension
Notes: Anconeous
Posterior compartment
Origin: Pectoralis Major
- Clavicular head: medial 1/3 of clavicle
- Sternal head: sternum, upper 6 costal cartilages
- Aponeurosis of external oblique
Insertion: Pectoralis Major
Lateral lip of bicipital (intertubercular) groove of humerus
- Clavicular fibers insert lower part of groove
- Sternal fibers insert in higher part of groove
Innervation: Pectoralis Major
Medial and lateral pectoral nerves
Action: Pectoralis Major
- Shoulder adduction
- Shoulder flexion
- Shoulder internal rotation
eg: chin-up, swimming, sawing wood