‫بسم هللا الرحمن الرحيم‬

‫” و فى أنفسكم أفال تبصرون“‬

Bones of upper limb
Scapula
▪ The scapula is a flat triangular bone which lies on
the back of the upper part of the thoracic cage
on each side.
▪ It has 2 surfaces, 3 angles, 3 borders & 3
processes.

Dorsal surface Ventral surface

▪ Borders: 3
1. Superior border: The shortest & sharpest border. It
presents the suprascapular notch.
2. Medial (vertebral border): The longest border, extending
along the vertebral column from the superior to inferior
angles.
3. Lateral (axillary) border: Thick border which extends
from the lateral to inferior angles
Sup. Angle

Glenoid cavity

Neck

Inf. Angle
∙ Identification of side: (Right or left):
1. The glenoid cavity is directed laterally.
2. The superior border is the shortest & sharpest border.
3. The spine is attached to the posterior surface.
Coracoid
Spine

Glenoid
acromion
Dorsal surface Ventral surface
Pectoral Girdle & Extremities
Anterior Surface of Scapula
Acromion Superior angle
Superior border
Facet for clavicle
Suprascapular notch
Coracoid process
Glenoid cavity
Subscapular fossa

Lateral border Medial border

Inferior angle

7-6
Pectoral Girdle & Extremities

Posterior Surface of Scapula

Facet for clavicle
Superior angle Acromion
Superior border Coracoid process
Scapular notch
Supraspinous fossa Spine
Glenoid
cavity

Infraspinous fossa Infraglenoid tubercle

Body
Lateral border
Medial border

Inferior
angle
7-7
Clavicle
▪ The clavicle lies nearly horizontally at the
junction of the neck with the front of the thorax
on each side.
▪ It is a long bone; formed of medial end, shaft &
lateral end.

Lat.
Lat.

Med.
Med.
 Medial (Sternal) end: Large & quadrilateral. It ∙
articulates with the sternum & 1st costal cartilage
to form the sternoclavicular joint.
Lateral (Acromial) end: Flattened & articulates ∙
with the acromion process of scapula to form the
acromioclavicular joint.
Acromioclavicular
Sternoclavicular
 Groove for subclavius
Lateral

Medial

∙ Identification of side: (Right or left)

1. The medial end is bulky & quadrilateral.
2. The medial 2/3 of the shaft are convex
anteriorly.
3. The inferior surface is rough near both ends.
Humerus
▪ It is the bone of the arm.
▪ It is a long bone which is formed of an upper
end, shaft & a lower end.

Upper end Upper

Shaft
Shaft

Lower end Lower

 Upper end
Head
Greater T.
Anat.neck
Bicipital G.
∙ Identification of side: (Right or left):
1. The head is directed upwards.
2. The head is directed medially.
3. The lesser tuberosity is directed anteriorly.
The post. surface
It has Spiral groove
 Radiograph 1: Shoulder
girdle
5
6 3 1 - Name bone

8
2 - Name bone
& part
9

Name 7
bone
Pectoral Girdle & Extremities
Humerus
Greater tubercle
Head
Lesser tubercle
Intertubercular groove Anatomical Surgical neck
neck

Groove for radial nerve Nutrient foramen

Deltoid tuberosity Deltoid tuberosity
Nutrient foramen
Medial
supracondylar ridge

Coronoid fossa Olecranon fossa

Lateral supracondylar ridge
O.F.
Radial fossa Medial
epicondyle Lateral epicondyle
Capitulum
Trochlea
7-16
 Movements of the Shoulder
Girdle (scapula)
• Protraction
• Retraction
• Elevation
• Depression
• Upward rotation
• Downward rotation
 Elevation

Retraction Protraction

Depression
© McGraw-Hill Higher Education. All 4-
rights reserved. 18
Protraction
Retraction
Elevation
Depression
Upward Rotation
Downward Rotation
 Pectoral region
Pectoralis major:
Origin: has 2 heads : sternocostal and
clavicular heads

Insertion: lat lip of bicepital groove of

humerus

Nerve supply: Medial & lateral pectoral

nerves

Action (Joint): Flexion, adduction &

medial rotation of arm.
 Pectoral region
Pectoralis minor:
Origin: 3rd, 4th and 5th ribs

Insertion: coracoid process of scapula

Nerve supply: Medial & lateral pectoral

nerves

Action (Girdle): Depression and

protraction of scapula.
 Pectoral region
Subclavius:
Origin: 1st costal cartilage and 1st rib.

Insertion: groove on inferior surface of

clavicle

Nerve supply: Nerve to subclavius

Action: (Girdle)

Steadies clavicle during movements of

shoulder joint.
 Pectoral region
Clavipectoral fascia:
Definition: fibrous sheet of connective
tissue lies deep to pectoralis major
between clavicle & pectoralis minor &
enclosing subclavius.

Structures piercing it:

❑ Cephalic vein
❑ Thoracoacromial artery
❑ Lateral pectoral nerve
 Pectoral region
Serratus anterior:
Origin: Upper 8 ribs.

Insertion: front of medial border of scapula

Nerve supply: long thoracic nerve

Action: (Girdle)
1- Protraction of scapula (main)
2- Upward rotation of scapula (Move arm above
head) (= abduction > 90º) together with
trapezius

Paralysis of serratus ant due to injury of long

thoracic nerve (during mastectomy) lead to
Winging of Scapula
 Applied Anatomy
Injury of long 
thoracic nerve leads
to paralysis of
serratus anterior →
winging of the
scapula ( prominence
of medial border of
scapula i.e. it does
not become in
contact with the
thoracic wall )
 Muscles of the back
Latissimus dorsi:
Origin:
1. iliac crest.
2. Lumbar fascia.
3. Lower thoracic spines and ribs
4. inferior angle of scapula.

Insertion:
❑ Floor of bicepital groove of the humerus

Nerve supply:Thoracodorsal nerve.

(N. to Latissmus dorsi)

Action: extension, adduction and medial

rotation of the arm.
 Muscles of the back
Trapezius
Origin:
◼ Back of head and neck
◼ Spines of 7th cervical vertebra &

all thoracic vertebra.

Insertion:
◼ Upper fibers→ posterior border of
clavicle.
◼ Middle fibers→ acromion process
◼ Lower fibers→ upper border of spine of
scapula.
 Muscles of the back
Trapezius
Nerve supply:
◼ Spinal accessory nerve (motor)

Actions:
◼ Upper fibers → elevate
◼ Lower fibers → depress
◼ Middle fibers → retract
◼ Upper fibers + serratus anterior →
rotate the scapula upward (Abduction
more than 90º).
 Muscles of the back
Levator Scapulae
Origin:
 upper 4 cervical vertebrae.
Insertion:
 back of the medial border of scapula
Nerve supply:
 Dorsal scapular nerve.
Action:
 Elevation of the scapula
 Muscles of the back
Rhomboid Minor & Major
Origin: cervical & thoracic spines
Insertion: back of medial border of
scapula
Nerve supply: dorsal scapular nerve.
Action: retraction of the scapula.
 Scapular region
Subscapularis:
Origin: Subscapular fossa.

Insertion: Lesser tuberosity of the

humerus.

Nerve supply: Upper and lower

subscapular nerves.

Action:
Adduction and medial rotation of the arm.
 Scapular region
Supraspinatus
Origin:
 Supraspinous fossa
Insertion:
 Greater tuberosity of the humerus.
Nerve supply: Suprascapular nerve.
Action:
 Initiate abduction of arm (0 to 15°).
 Scapular region
Infraspinatus
Origin:
 Infraspinous fossa
Insertion:
 greater tuberosity of the humerus.
Nerve supply: Suprascapular nerve.
Action:
 Lateral rotation of the arm.
 Scapular region
Teres minor:
Origin: lateral border of scapula

Insertion: greater tuberosity of

humerus

Nerve supply: Axillary n.

Action: lateral rotation of arm

 Scapular region
Teres major:
Origin: lateral border of scapula

Insertion: Medial lip of bicipital

groove of the humerus

Nerve supply: Lower subscapular

nerve.

Action: Extension, adduction and

medial rotation of the arm.
 Scapular region
Deltoid
Origin:
 Anterior fibers → anterior border of clavicle.
 Middle fibers → acromion.
 Posterior fibers → spine of scapula.

Insertion: deltoid tubrosity of humerus.

Nerve supply: axillay nerve.

Action:
 Anterior fibers → flexion & medial rotation.
 Middle fibers → abdoction from 15 – 90º.
 Posterior fibers → extension & lateral rotation.

Paralysis of deltoid: (injury of axillary n. in

shoulder dislocation)

Flat shoulder & loss of abduction from 15 – 90º.

 Scapular region
Rotator cuff muscles
2

4
3
1

1. Subscapularis
2. Supraspinatus
3. Infraspinatus
4. Teres Minor
 Scapular region
Rotator cuff muscles
-The 4 muscles: supraspinatus,
infraspinatus, teres minor, and
subscapularis. (muscles attached
to greater & lesser tuberosities)

-The main support of shoulder joint

-The cuff is defecient inferiorly

which is thus a point of weakness
of the shoulder joint.
 Muscle Action Nerve Supply Special feature
Pectoralis major Flex, add & Med & lat Form ant axillary
med rot of pectoral fold
arm
Latissmus dorsi Ext, add & Thoraco-dorsal
med rot (n to lat dorsi) Both form
post axillary
Teres major Ext, add & Lower fold
med rot subscspular

Rotator Cuff Action Nerve

Muscles Supply
Supra-spinatus Abduction
(0-15) Both by
Suprascapular
Infra-spinatus Both are
lat rotators
Teres minor Axillary n
Of arm

Subscapularis Med Upper &

rotation lower
subscapular
 Muscle Action Nerve Supply Special feature
Pectoralis minor Protraction & Med & lat
Depression pectoral
* Upward rot of
As Pectoralis long thoracic n scapula (above
Serratus ant minor & * (C5,6,7) (n to 90=raise arm
serratus ant) above head)

3 fibers Spinal accessory

Trapezius + * (Only ms of UL not
supplied by brachial
plexus)

Levator scapulae elevation

All by
Dorsal scapular n
Rhomboidus Major Retraction
& minor

commonest nerve injured in mastectomy is long thoracic n Winging of scapula

 Axilla
Definition: Pyramidal space between
the upper part of the arm and
chest.

It has the following boundaries:

❑ Apex
❑ Base
❑ Anterior wall
❑ Posterior wall
❑ Lateral wall
❑ Medial wall
 Axilla

❑ Apex
(cervicoaxillary canal).

Apex
❑ Base:
Skin & fascia
 Axilla
Anterior wall of axilla:
1. Pectoralis major & minor.
2. Subclavius & clavipectoral
fascia

-Pectoralis major form ant

axillary fold
 Axilla

Posterior wall of axilla:

1. Subscapularis.
2. Teres major.
3. Latissimus dorsi.

-Latissimus dorsi + teres major

form post axillary fold
 Axilla

Medial wall of Axilla:

1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
 Axilla

Lateral wall of Axilla:

1. Upper part of the humerus.
2. Coracobrachialis and biceps
muscles.
 Axilla
Contents of Axilla:
1.Axillary Artery.
2.Axillary Vein.
3.Brachial Plexus (cords + branches).
4.Axillary Lymph nodes.
5.Axillary tail of Breast.
6.Axillary pad of fat
 Roots join to form Trunks
Ventral rami (in posterior triangle of neck)

C5
Upper trunk
C6

Middle trunk
C7

C8
Lower trunk
T1
Roots Trunks Divisions Cords

C5
Lateral cord
Upper trunk
C6

Middle trunk Posterior cord

C7

C8
Lower trunk
Medial cord
T1
 •Brachial plexus X Upper
only
1-2

From roots : 1- n to serratus (long thoracic)

2- n to rhomboids (Dorsal scapular)

From upper Trunk : 1- n to subclavius

2- Suprascapular n
 Brachial Plexus
Branches of Cords:
A. Lateral cord.
1.Lateral pectoral.
2.Lateral root of median.
3.Musculocutaneus.
B. Medial cord.
1.Medial pectoral.
2.Medial root of median.
3.Ulnar n.
4.Medial Cut. Nerve of arm
5.Medial cut. Nerve of forearm.
C. Posterior cord.
1.Upper subscapular.
2.Lower subscapular.
3.N.to Latiss dorsi.
4.Axillary.
5.Radial .
 •Injury: (due to 1- fracture clavicle
1- whole plx: 2- Shoulder traction)
paralysis of all ms except trapezius
+ sensory loss in whole limb except

2- Upper trunk injury (Erb’s palsy):(C5,6)

Policeman tip position

3- Lower trunk injury (Klumpke’s paralysis):(C8,T1)

Complete claw hand

 Axillary Artery
Beginning: at outer border of
first rib as continuation of the
subclavian artery.

Termination: at lower border of

teres major where it continues
as brachial artery.

Divisions: divided by pectoralis

minor into 3 parts
Axillary Artery
1st part

2nd part

3rd part
1

pectoralis minor
 Axillary Artery
Relations:
- Axillary vein is medial
allthrough the 3 parts
 Axillary Artery
Branches:
1st part: 1- Superior thoracic art

2nd part: 1- Lateral thoracic art

2- Thoraco-acromial art

3rd part: 1- Subscapular art (largest)

2- Ant circumflex humeral
3- Post circumflex humeral
 Branches of the axillary artery

Suprascapular artery

Dorsal scapular artery

Post. hum. circ. Artery 3

Supreme/highest thoracic artery 1

Ant. hum.circ artery 3

Thoraco-acromial trunk 2

Subscapular artery 3
Circumflex scapular artery
Thoaraco dorsal artery Lateral thoracic artery 2
 Axillary Lymph Nodes
-Anterior abdominal The back till From the whole upper
wall above the iliac crest limb except few
umbilicus. lymphatics accompany
-Lateral part of cephalic vein.
the breast

Posterior
Anterior Lateral
(pectoral)

Central
From lymphatic
accompany
cephalic vein
which ends in the
Subclavian lymph trunk
Apical
infraclavicular
Lymph nodes.
 Apical nodes pectoralis minor

Central nodes

Lateral nodes Parasternal nodes

(humeral)

Posterior nodes
(subscapular)

Anterior nodes
(pectoral)
 Axillary nerve
Origin: Posterior cord of the brachial plexus.

Course:
- In axilla, post to axillary artery
- Passes with post circumflex humeral art
through the quadrangular space
- Then curves around surgical neck of humerus

Branches:
Muscular: deltoid ms, teres minor ms
Cutaneous: upper lateral cutaneous nerve of
arm
Quadrangular space
1- Boundaries:
Superiorly; Teres minor.
Inferiorly; Teres major.
Medially; Long head of triceps.
Laterally; Surgical neck of the humerus.
2- Contents:
Axillary nerve.
Posterior circumflex humeral vessels.
 Axillary nerve
Applied anatomy:
Axillary n injury:
(as in fracture surgical neck of
humerus or shoulder dislocation)
leads to:
1. atrophy of the deltoid ( flat shoulder)
2. Loss of abduction of the arm from 15°-
90
Results of axillary nerve injury
deltoid &
Paralysis of 
teres minor →flat
shoulder & inability to
abduct arm to 90°

Loss of sensation over 

lower 1/2 of deltoid
1.Shoulder Girdle
1. Sternoclavicular Joint:
Type: saddle synovial
Articulating bone:
Important ligaments:
1.Ant. & post. Sternoclavicular lig.
2.Interclavicular ligament.
3.Costoclavicular lig.:
 1.Shoulder Girdle

1. Acromioclavicular
Joint:
Type: plane synovial
Articulating bone:
Important ligaments:
Coracoclavicular ligament
1.Shoulder Girdle
Movement
Elevation Depression Protraction Retraction

Levator scapulae Pectoralis minor Pectoralis minor Rhomboids

Trapezius (upper Serratus ant Serratus anterior Trapezius
fibers) Trapezius (lower (middle fibers)
fibers)

Upward rotation of scapula Downward rotation of scapula

Trapezius (upper & lower) Rhomboids

Serratus anterior Levator scapulae
 2.Shoulder joint
Type: Synovial ball & socket
Articulating bone:

Important ligaments:
 Coracohumeral ligament

 Glenohumeral ligaments.

 Transverse humeral ligament

Intracapsular structures
 Labrum glenoidale

 Tendon of long head of biceps

 2.Shoulder joint
Movement
Flexion Extension Adduction Abduction
Movement:

Pectoralis major Latissimus Pectoralis major Supra spinatus (0-

Deltoid dorsi Latissmus dorsi 15)
Coracobrachiali Teres major Teres major Deltoid (15 -90)
s Deltoid Subscapularis

Medial rotation Lateral rotation

Pectoralis major Infraspinatus
Latissmus dorsi Teres minor
Teres major
Deltoid
Subscapularis
Deltoid