~ ~ ~ BACK, SHOULDER, ARMS ~ ~ ~ Ann Nguyen -- NYUCD 2008

Dr. Cunningham D1 Anatomy Notes -- Spring '05

Functions of the back

- supports body weight
- transmits forces thru the pelvis to the lower limbs
- carry and position the head
- brace and maneuver the upper limb

Skeletal Elements
• 33 vertebrae
• posterior skull – area of muscle attachment
• ribs
• pelvic bones

Vertebrae
• body
• vertebral foramen (houses spinal chord)
• arch – 2 parts:
• pedicle
• lamina
3 processes for muscle attachment (act as levers)
• 2 transverse processes
• 1 spinous process

○ Tendon = fibrous CT that attaches muscle to bone

○ Aponeurosis = a large flat fibrous sheet of CT that attaches to muscle to bone (a huge tendon / fascia)

SUPERFICIAL BACK MUSCLES

Nerve supply comes from the VENTRAL primary rami of spinal nerves
not considered true back muscles bc they attach to the upper limb
fxns = moves the upper limb

INTERMEDIATE BACK MUSCLES

Nerve supply comes from the VENTRAL primary rami of spinal nerves
fxns = attached to the ribs for respiration
• Serratus Posterior Superior
• Serratus Posterior Inferior

DEEP BACK MUSCLES

these are the true back muscles
fxns = maintain posture, move vertebral column
bilaterally = extends the vertebral column
unilaterally = laterally bends the vertebral column
Erector Spinae Group (goes up vertically parallel to the vertebral column)
- all 3 originate at the sacral aponeurosis, iliac crest, spinous processes of lumbar and sacral vertebrae
• Iliocostalis = outer, inserts into angle of the ribs
• Longissimus = middle, inserts into transverse processes of vertebrae
• Spinalis = inner, inserts into spinous processes of vertebrae
Nerve supply comes from the DORSAL primary rami of spinal nerves
dorsal root (sensory info) and ventral root (motor info) connect to form the spinal nerve (mixed info)
branches into the dorsal ramus and ventral ramus
• dorsal ramus (smaller) innervates the true muscles of the back and the skin over it Compiled for you by:
• ventral ramus (larger) innervates the rest of the body + the muscles of respiration and upper limbs
 Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

Compiled for you by:

 SHOULDER Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

upper limb = shoulder + arm + forearm + hand

shoulder = clavicle + scapula + proximal humerus

arm = bt the shoulder and elbow joint

forearm = elbow to wrist
hand = below the wrist
“brachial” = arm
“antebrachial” = forearm

- upper arm is extremely mobile

- has sacrificed stability for mobility

Arm = humerus is the only bone of the arm

Forearm = radius & ulna
Wrist = carpals (8)
Hand = metacarpals (hand, 5) + phalanges (fingers, 5)

PECTORAL GIRDLE BONES

Clavicle
- acts as a brace
- connects upper limb to trunk
- frequently broken

Scapula
• prominent spine ends in the Acromion Process (articulates w/ clavicle)
• coracoid process (muscle attachment)
• supraspinous & infraspinous fossae (posterior view)
• subscapular fossae (anterior view)
• medial spinous border, lateral axillary border
• glenoid fossae (very shallow, lack of stability) = articulates w/ humerus head

Humerus
• rounded head articulates w/ glenoid fossae of scapulae
• greater tubercle, lesser tubercle = areas of muscle attachment
• intertubercular groove = tendon runs thru here for muscle attachment

PECTORAL MUSCLES
• Pectoralis Major
• Pectoralis Minor
• Serratus Anterior
• Subclavius
○ Cephalic Vein = located in the Deltopectoral Triangle

Compiled for you by:

 ARM MUSCLES Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

Anterior Compartment
- these muscles are flexors
- innervated by the Musculocutaneous Nerve
• Biceps
• Coracobrachiallis
• Brachialis

Posterior Compartment
- these muscles are extensors
- innervated by the Radial Nerve
• Triceps

Rotator Cuff Muscles

- add stability to shoulder joint
- fxns as ligaments
- enhances range of movement
- origin = scapula
- insertion = humerus tubercles
• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

Compiled for you by:

AXILLA Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- this is the region of your armpit where BV-N’s must pass underneath
the clavicles to pass from the head-neck region down to the arm

- axilla is ∆ shape, extending superiorly & medially

- base = skin and sub-q tissue

- anterior border = pectoralis major + pectoralis minor + clavicle

- posterior wall = scapula + subscapularis muscle + teres major muscle
- lateral wall = serratus anterior muscle

• Axillary Sheath wraps around the following vessels…

○ Brachial Plexus of nerves
○ Axillary Artery & Vein that supply the upper limb
○ Axillary Lymph Nodes to drain the upper limb & breast

Subclavian Artery  passes underneath clavicle  becomes AXILLARY ARTERY  crosses over Teres Major tendon  becomes Brachial Artery

AXILLARY ARTERY
divided into 3 parts
in relation to Pectoralis Minor

1 = proximal to pec minor

● Superior Thoracic Artery

2 = posterior to pec minor

● Thoracoacromial Artery
• Clavicular branch
• Acromial branch
• Deltoid branch
• Pectoral branch

● Lateral Thoracic Artery

Serratus Anterior + breasts

3 = distal to pec minor

● Subscapular Artery
• Circumflex branch
• Thoracodorsal branch

● Anterior Circumflex Humeral Artery

● Posterior Circumflex Humeral Artery

Cephalic Vein  drains into the Axillary Vein

● Cephalic Vein = lateral side of the arm, in the Deltopectoral Triangle

● Basilic Vein = medial side of the arm
● Median Cubital Vein = union of Cephalic + Basilic
- common site of venipuncture
- ie: blood testing / IV fluids

BREAST
- Pec Major underneath
- Pec Minor is part of the superficial fascia
- Cooper’s Ligaments suspends breast to fascia
- 15-20 glandular lobules
- divided into 4 quadrants = upper, lower, medial, lateral
- lateral upper quad is most common site for CA
- dimpled appearance w/ advanced stages of CA = “p’eau d’ orange”
- Axillary Lymph Nodes drain the breast
- some of the lymph may drain to the internal thoracic wall / anterior abdominal wall Compiled for you by:
- some of the lymph may even cross to the opposite breast
 BRACHIAL PLEXUS Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

VENTRAL primary rami of spinal nerves

C5 + C6 + C7 + C8 + T1 are considered the
5 roots of the brachial plexus

Superior Trunk = C5 + C6
Middle Trunk = C7
Inferior Trunk = C8 + T1

Anterior & Posterior Divisions

there are 6 divisions
named according to their relationship to Axillary Artery
anterior + posterior arising from each Trunk
reunite to form Cords

Lateral Cord = both anterior divisions from Superior Trunk + Middle Trunk
Posterior Cord = all posterior divisions from all 3 trunks: Superior + Middle + Inferior
Medial Cord = anterior division from only the Inferior Trunk

Lateral Cord has 2 terminal branches

● Musculocutaneous Nerve -- flexor muscles of the arm in the anterior compartment
● Median Nerve (lateral contribution) -- forearm & hand muscles
Posterior Cord has 2 terminal branches
● Radial Nerve -- extensor muscles of the arm in the posterior compartment
● Axillary Nerve -- Deltoid + Teres Minor
Medial Cord has 2 terminal branches
● Median Nerve (medial contribution) -- forearm & hand muscles
● Ulnar Nerve -- hand muscles

COLLATERAL BRANCHES OF THE BRACHIAL PLEXUS

● Long Thoracic Nerve = from C5 + C6 + C7 Roots Serratus Anterior

● Dorsal Scapular Nerve = from C5 Root Levator Scapuli + Rhomboids
● Suprascapular Nerve = from Superior Trunk Supraspinatus + Infraspinatus
● Lateral Pectoral Nerve = from Lateral Cord Pectoralis Major
● Medial Pectoral Nerve = from Medial Cord Pectoralis Major + Pectoralis Minor
● Brachial Cutaneous Nerve = from Medial Cord innervates the arm
● Antebrachial Cutaneous Nerve = from Medial Cord innervates the forearm
● Upper Subscapular Nerve = from Posterior Cord Subscapularis
● Middle Subscapular Nerve = from Posterior Cord Latissimus Dorsi – AKA: Thoracodorsal Nerve
Compiled for you by:
● Lower Subscapular Nerve = from Posterior Cord Subscapularis + Teres Major