Muscle Nerve supply Action

Anterior pectoral girdle

Pectoralis major Lateral pectoral nerve Sternocostal head: Adduction
Medial pectoral nerve Medial rotation of humerus
Clavicular head: assists in
flexion of shoulder
Pectoralis minor Lateral pectoral nerve Assists SA in protraction
Medial pectoral nerve
Subclavius Nerve to subclavius Stabilizes clavicle
Serratus anterior Long thoracic nerve Protracts scapula
Assists trapezius in abduction
above level of shoulder
Posterior pectoral girdle
Trapezius Spinal part of accessory nerve Retraction
And C3, C4 Elevation
Depression
Abduction above level of
shoulder
Lateral flexion of neck
Extension of neck
Latissimus dorsi Thoracodorsal nerve Extension
Medial rotation
Adduction
Rhomboids Dorsal scapular nerve Retraction
Levator scapulae C3, C4 Elevation
Dorsal scapular nerve Lateral flexion
Shoulder
Subscapularis Upper subscapular nerve Medial rotation
Lower subscapular nerve
Supraspinatus Suprascapular nerve Abduction first 15 degrees
Infraspinatus Suprascapular nerve Lateral rotation
Teres minor Post. branch of axillary nerve Lateral rotation
Weak adduction
Teres major Lower subscapular nerve Adduction
Medial rotation
Helps to extend flexed arm
Deltoid Axillary nerve Ant: flexion, medial rotation
Lat: abduction
Post: extension, lateral rotation
Arm
Biceps brachii Musculocutaneous nerve Flexion at elbow
Supination at forearm
Weak flexor of shoulder
Coracobrachialis Musculocutaneous nerve Weak flexor of shoulder
Weak adductor of shoulder
Brachialis Musculocutaneous nerve Flexion at elbow
Radial nerve
Triceps brachii Radial nerve Extension at elbow
Anconeus Radial nerve Assists triceps in extension
Anterior Forearm
Pronator teres Median nerve Pronation
Weak flexion at elbow
Flexor carpi radialis Median nerve Flexes wrist
Abducts hand
Flexor digitorum superficialis Median nerve Flexor of the proximal IP joint
Secondary flexor of MCP joint
Flexor of wrist joint
Flexion of elbow
Palmaris longus Median nerve Weak flexor of wrist
Flexor carpi ulnaris Ulnar nerve Flexion at wrist
Adduction at wrist
Flexor digitorum profundus Anterior interosseus branch of Flexes distal IP joint
median nerve Rolling fingers
Ulnar nerve Flexion of wrist
Flexor pollicis longus Anterior interosseus branch of Flexion at IP joint of thumb
median nerve Flexion at MCP joint of thumb
Flexion at CMC joint of thumb
Pronator quadratus Anterior interosseous branch of Pronates the forearm
median nerve
Posterior Forearm
Brachioradialis Radial nerve Flexion at elbow when semi
pronated
Extensor carpi radialis longus Radial nerve Extensor of wrist
(Can graft to flexor digitorum Abductor of wrist
profundus) Making a fist
Flexion of elbow
Extensor carpi radialis brevis Posterior interosseous nerve Extension of wrist
(CEO) Making a fist
Extensor digitorum (CEO) Posterior interosseous nerve Extension at wrist
Extension at MCP joint
Extension at IP joint
Extensor digiti minimi (CEO) Posterior interosseous nerve Extension of little finger
Extension of wrist
Extensor carpi ulnaris (CEO) Posterior interosseous nerve Extensor of wrist
Adductor of wrist
Making a fist
Anconeus Radial nerve Small amount of pronation
Supinator Posterior interosseous nerve Fixes arm in supination
Supinates fully extended
forearm
Abductor pollicis longus Posterior interosseous nerve Extends thumb at CMC joint
Assists in abduction of wrist
Assists in flexion of wrist
 Extensor pollicis brevis Posterior interosseous nerve Extends CMC joint of thumb
(during pinching, does not allow Extends MCP joint of thumb
flexion of MCP)
Extensor pollicis longus Posterior interosseous nerve Extends terminal phalanx
(after colles fracture, this is Draws thumb back from
damaged leading to hammer opposition
thumb) Assists in extension of wrist
Assists in abduction of wrist
Extensor indicis Posterior interosseous nerve Extends index finger (pointing)
Hand Muscles
Abductor pollicis brevis Median nerve muscular branch Abduction of thumb
Assist in extension of thumb
Flexor pollicis brevis Median nerve muscular branch Flexes proximal phalanx
Sometimes ulnar
Opponens pollicis Median nerve muscular branch Opposes metacarpal
Deep branch of ulnar nerve
Abductor digiti minimi Deep branch of ulnar nerve Cup the palm
Grip large object
Flexor digiti minimi brevis Deep branch of ulnar nerve Cup the palm
Grip large object
Opponens digiti minimi Deep branch of ulnar nerve Cup the palm
Grip large object
Lumbricals Medial 2: ulnar nerve
Lateral 2: median nerve
Adductor pollicis till 3rd Deep branch of ulnar nerve Approximate thumb to index
metacarpal
Interossei PAD and DAB Deep branch of ulnar nerve
MEAT LOAF

Median nerve: lateral two lumbricals, opp, abd, flex.

 Movements of scapula Muscles
Elevation Trapezius descending part
Levator scapulae
Rhomboids
Depression Gravity
Trapezius ascending part
Latissimus dorsi
Serratus anterior
Pectoralis major
Pectoralis minor
Protraction Serratus anterior
Pec major
Pec minor
Retraction Trapezius middle part
Rhomboids
Latissimus dorsi
Upward rotation Trapezius both parts
Serratus anterior
Downward rotation Gravity
Latissimus dorsi
Rhomboids
Levator scapulae
Pec major
Pec minor

Joint Type Ligaments Blood supply Nerve supply

Sternocla  Saddle type of  Ant & post.  Internal thoracic artery  Medial supraclavicular
vicular synovial sternoclavicular  Suprascapular artery nerves C3, C4
joint  Has an articular ligaments
disk  Interclavicular ligament
 Costoclavicular ligament
Acromiocl  Plane type of  Acromioclavicular  Thoracoacromial artery  Suprascapular nerve C5,
avicular synovial joint ligament  Suprascapular artery C6
joint  Coracoclavicular
ligament (conoid +
trapezoid)
Glenohu  Ball and socket  Glenohumeral ligament  Anterior & posterior  Axillary nerve
meral type of synovial (3 bands) circumflex humeral  Musculocutaneous
joint joint  Coracohumeral ligament arteries nerve
 Transverse humeral  Suprascapular artery  Suprascapular nerve
ligament
 Coracoacromial ligament

Elbow  Hinge type of  Ulnar collateral ligament  Elbow anastomosis  Musculocutaneous

joint synovial joint (3 bands, anterior nerve
strongest)  Median nerve
 Radial collateral  Ulnar nerve
ligament  Radial nerve
 Annular ligament
Wrist  Ellipsoid type of  Palmar radiocarpal  Dorsal and palmar  Posterior interosseous
joint synovial joint ligaments carpal arches nerve
 Has an articular  Dorsal radiocarpal  Anterior interosseous
disk ligaments nerve
 Ulnar collateral ligament
 Radial collateral
ligament

Wall of Axilla Structures

Anterior  Pectoralis major
 Pectoralis minor
 Subclavius
 Clavipectoral fascia
Posterior  Subscapularis
 Teres major
 Tendon of latissimus dorsi
Medial  Upper part of serratus anterior
 Till level of 4th rib
Lateral  Intertubercular groove of humerus
 Corachobrachialis
 Tendon of long and short biceps
Apex  Bounded by clavicle
 Upper border of scapula
 Outer border of 1st rib
Base  Axillary fascia from ant. and post. Folds
 Skin
Contents - Axillary artery
- Axillary vein
- Lymph vessels and nodes
- Brachial plexus
Lymph Nodes Drainage
Anterior/pectoral Upper half of trunk anteriorly
Breast major part
Posterior/subscapular Upper half of trunk posteriorly
Axillary tail of breast
Lateral Upper limb
Central From the above groups (APL)
Apical From the groups above (APLC)
Drains into subclavian lymph trunk > thoracic duct
Infraclavicular group Superficial tissues of thumb and lateral forearm
Cephalic vein
Drains into apical
Supratrochlear group Superficial tissues of medial forearm and hand
Basilic
Drains into lateral group

Relations of axillary artery Contents

st
1 part: superior thoracic artery
Anterior Pec major
Clavipectoral fascia
Lateral pectoral nerve
Cephalic vein
Thoraco-acromial veins
Posterior First intercostal space
Serratus anterior first and second digitations
Long thoracic nerve
Medial pectoral nerve
Medial cord of brachial plexus
Lateral Posterior cord of brachial plexus
Medial Axillary vein
2nd part: lateral thoracic and thoracoacromial artery
Anterior Pec major
Pec minor
Posterior Posterior cord of brachial plexus
Subscapularis
Lateral Lateral cord
Medial Medial cord
Medial pectoral nerve
Axillary vein
rd
3 part anterior and posterior circumflex humeral and subscapular artery
Anterior Pec major
Skin and fascia
Posterior Lower part of subscapularis
Lat dorsi tendon
 Teres major tendon
Lateral Coracobrachialis
Medial Axillary vein

Wall of Quadrangular space Structure

Above Subscapularis
Below Teres major
Medially Long head of triceps
Laterally Surgical neck of humerus
Contents Axillary nerve
Posterior circumflex humeral artery

Wall of Triangular interval: Structure

Superior Teres major
Medial Long head of triceps
Lateral Shaft of humerus
Contents Radial nerve
Profunda brachii

Wall of cubital fossa Structure

Medial Pronator teres
Lateral Brachioradialis
Superior Line joining humeral epicondyles
Roof Deep fascia of forearm
Floor Brachialis
Supinator
Contents Median nerve
Brachial artery
Biceps tendon
Radial nerve
Posterior interosseous nerve

Wall of Anatomical Snuffbox Structure

Ulnar side Extensor pollicis longus
Radial side Extensor pollicis brevis & abductor pollicis longus
Contents Cutaneous radial nerve
Cephalic vein
Radial artery
Radial styloid, scaphoid, trapezium, base of first metacarpal
Triangle of auscultation:

Supero-medially: Trapezius

Inferiorly: Latissimus dorsi

Laterally: Medial border of scapula

Musculocutaneous nerve (C5, C6, C7):

 Pierces coracobrachialis
 Lies between biceps and brachialis
 At lateral margin of biceps pierces deep fascia and continues as lateral cutaneous nerve of
forearm

Axillary nerve (C5, C6):

 Runs backwards through quadrangular space

 Emerges below teres minor
 Divides into anterior and posterior branches
 Anterior branch: winds behind humerus, supplies deltoid and skin
 Posterior branch: supplies teres minor, deltoid and then winds around posterior border of
humerus
o Becomes upper lateral cutaneous nerve of arm

Radial nerve (C5, C6, C7, C8, T1):

 Crosses lower border of posterior wall of axilla

 Gives:
o branch to triceps long and medial head in axilla
o Posterior cutaneous nerve of arm
 Passes through triangular interval with profunda brachii artery
 Pierces lateral intermuscular septum to enter anterior arm
  Gives:
o lower lateral cutaneous nerve of the arm which pierces lateral head of triceps
o posterior cutaneous nerve of the forearm runs straight down behind elbow
 At level of lateral epicondyle of humerus divides into deep and superficial
o Gives posterior interosseous nerve which runs behind elbow and passes through
supinator muscle
o Continues as superficial radial nerve that passes through snuff box
 Supplies radial 2.5 or 3.5 digits except nail beds and middle phalanges

Median Nerve (C5, C6, C7, C8, T1):

 Lateral and medial roots converge over brachial artery, lies lateral to BA
 In the middle of the arm, it crosses to medial side of brachial artery
 Gives vascular branches to brachial artery
 Enters cubital fossa
 Passes through two heads of pronator teres
 Deep to flexor digitorum superficialis gives off anterior interosseous branch
 Gives palmar cutaneous branch above flexor retinaculum
 Enters carpal tunnel and gives:
o Muscular recurrent branch
o Medial branch
o Lateral branch

Ulnar nerve (C7, C8, T1):

 Lies medial to axillary artery

 In middle of arm, pierces medial intermuscular septum
 Lies in groove behind medial epicondyle of humerus
 Passes between two heads of flexor carpi ulnaris
 Crosses flexor retinaculum
 Gives off palmar cutaneous branch which pierces deep fascia above FR to supply skin over
hypothenar muscles
 Gives dorsal cutaneous branch supplies one and a half digits
Back:

Dermatome: C2 – C5, T2 – L3, S2 – S4

Spinous process of thoracic:

 From T1 – T7 slope increasingly downwards

 from T8 – T12 increasingly level
 T12 is horizontal

Vertebra Superior facet Inferior facet

Cervical Obliquely up and backwards Down and forward
Thoracic Laterally and backwards Medially and forward
Lumbar Medially and upwards Laterally and down