Heather Riley Tonia and Jo Anterior axillary fold

Heather, Riley, Tonia, and Jo

Anterior axillary fold - The inferior border of the pectoralis major muscle forms the anterior axillary fold Clavicular head of pectoralis major - The clavicular head is the smaller top section of the bare-chested upper-torso Clavipectoral triangle - The clavipectoral triangle (deltopectoral triangle) is the depressed area just inferior to the lateral part of the clavicle, bounded by the clavicle superiorly, the deltoid laterally, and the clavicular head of the pectoralis major medially. Sternocostal head of pectoralis major - The sternalcostal head consists of more muscle mass. It originates at the sternum and six sternum costal cartilages

Surface Anatomy Clavicle - can be felt from end to end (subcutaneous) since they produce horizontal ridges visible at the junction of the neck to the thorax Manubrium – the upper segment of the sternum in which the clavicles and upper two ribs articulate

Parts of the Deltoid : • clavicular part ( or anterior): originates on the lateral third of the clavicle • acromial part (or middle): originates on the acromion process • spinal part (or posterior): originates on the scapular spine

Surface Anatomy Posterior Axillary Fold – formed by the latissimus dorsi winding around the lateral border of the teres major muscle Triangle of auscultation - The space bounded by the lower border of the trapezius, the latissimus dorsi, and the medial margin of the scapula, used to listen to (auscultate) the lungs because the stethoscope can be placed close to the thoracic wall at this location Three areas of the Trapezius Muscle : 1. Descending Part of Trapezius (the superior region or Upper fibers) - which functions to support the weight of the arm 2. Ascending Part of Trapezius (the inferior region or Lower Fibers) - which function to rotate and or lower the scapulae. 3. Middle Part of the Trapezius (the intermediate region or middle fibers) - which function to draw or pull the scapulae inwards closer to the spine

Made up of three bones: 1. Clavicle 2. Humerus 3. Scapula

1. Sternal end 2. Acromial end 3. Conoid tubercle

Greater Tubercle Lesser Tubercle Intertubercular Sulcus Head Anatomical Neck Surgical Neck Deltoid Tuberosity

• Angles (Superior and Inferior) • Subscapular Fossa • Acromion Process • Infraspinatous Fossa • Coracoid Process • Supraspinatous Fossa • Borders (superior, vertebral, and axillary • Spine • Glenoid Fossa (Cavity)

Shoulder Ligaments v Coracohumeral ligament v Transverse humeral ligament v Acromioclavicular ligament v Glenohumeral ligaments - superior - middle - inferior v Coracoclavicular ligament - Trapezoid ligament - Conoid ligament v Superior transverse scapular ligament

Shoulder Bursae A bursa is a sac between two moving surfaces that contains a small amount of lubricating fluid, and they reduce friction where two body parts are moving against one another and there is no joint.

Labrum: is a type of cartilage found in the shoulder, found only around the socket where it is attached. This cartilage is more fibrous and rigid Articulating Cartilage: white cartilage found on the ends of bones, which allows the bones to glide and move on each other. When this type of cartilage starts to wear out you get arthritis.

Synovial Membrane: Layer of connective tissue that lines the joints, tendon sheaths, and bursae and makes synovial fluid, which has a lubricating function.

• Group of muscles and tendons that surround the shoulder joint • Keep the head of your upper arm bone firmly within the shallow socket of the shoulder.

Supraspinatus Infraspinatous Teres Minor Subscapularis ROTATOR CUFF MUSCLES

ROTATOR CUFF INJURY SYMPTOMS: • Dull ache deep in the shoulder • Disturb sleep, particularly if you lie on the affected side • Difficult to comb your hair or reach behind your back • Arm weakness http: //link. brightcove. com/services/player/bcpid 1709592238001? bckey=AQ~~, AAAB jg 7 u 0 WE~, 1 M 0 n 70 -zc 746 ABCo. Bjqsb. GI_Egt. Rkuwu&bctid=2549400139001

ROTATOR CUFF INJURY TYPES: • Partial tear: damages the soft tissues but does not completely sever it • Full thickness tear or a complete tear: splits the soft tissue into two pieces. CAUSE: • Injury: Falling on an outstretched hand or lifting something too heavy are two common injuries associated with rotator cuff tears. • Degeneration: Repetitive stress, lack of blood supply, and bone spurs are factors that contribute to degeneration.

OTHER COMMON INJURIES TO THE SHOULDER Labrum Tear Instability- One shoulder joint moves or is forced out of its normal position. This condition can result in a dislocation of one of the joints in the shoulder. Impingement. Caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade (acromion)

Cervical Plexus Accessory (Spinal) Nerve

Brachial Plexus • Medial Cord • Lateral Cord • Posterior Cord Nerves • • • Lateral Pectoral Medial Pectoral Long Thoracic Dorsal Scapular Musculocutaneous Thoracodorsal Axillary Subscapular Suprascapular

Arteries • Subclavian • Axillary • Transverse Cevical • Dorsal Scapular • Lateral Thoracic • Posterior Circumflex • Deep Scapular • Suprascapular • Circumflex Scapular • Subscapular • Brachial

Origin: Superior line of the occipital bone, ligamentum nuchae, and cervical vertebrae � Insertion: Lateral 1/3 of clavicle and acromion process � Action: Scapular elevation and upward rotation � Innervation: Spinal Accessory nerve � Roots C 3 and C 4 � Synergists: -Elevation : Levator Scapulae -Upward Rotation: Upper and Lower Trapezius � Antagonists: -Adduction: Rhomboids Major and Minor, Middle Trapezius -Downward Rotation: Levator Scapula, Rhomboids Major and Minor. �

� Origin: Spinous Processes of C 7 to T 3 � Insertion: Scapular Spine � Action: Scapular Adduction (retraction) � Innervation: Spinal Accessory Nerve � Roots C 3 and C 4 � Synergists: Adduction: Rhomboids Major and Minor � Antagonists: Serratus Anterior, Pectoralis Minor

Origin: Spinous Processes of Middle and Lower Thoracic Vertebrae � Insertion: Base of the scapular Spine � Action: Scapular depression and upward rotation � Innervation: Spinal Accessory Nerve � Roots C 3 and C 4 � Synergists: -Depression: Pectoralis Minor -Upward Rotation: Upper Trapezius, Serratus Anterior � Antagonists: -Elevation: Levator Scapulae, Upper Trapezius, Rhomboids Major and Minor -Downward Rotation: Rhomboids Major and Minor, Levator Scapulae �

Origin: Transverse process of first four cervical vertebrae � Insertion: Vertebral border of scapula between the superior angle and the spine � Action: Scapular elevation and downward rotation (Inferior rotation of Glenoid Cavity) � Innervation: Dorsal Scapular and Cervical nerves and Dorsal scapular artery � Roots: Dorsal Scapular C 5 -Cervical C 3 and C 4 � Synergists: -Elevation: Upper Trapezius, Rhomboids Major and Minor -Inferior Rotation: Rhomboid Major and Minor, Pectoralis Major � Antagonists: -Depression: Lower Trapezius, Pectoralis Minor -Superior Rotation: Upper and Lower Trapezius, Serratus Anterior �

� � � � � Origin: Anterior Surface, third through fifth Ribs Insertion: Coracoid process of the scapula Action: Ribs Fixed: Draws scapula forward (abducts) and rotates scapula downward against the thoracic wall Scapula fixed: Elevates the rib cage. Innervation: Medial pectoral nerve, Axillary artery Synergists: Abduction: Serratus Anterior Respiration: Sternocleidomastoid, Scalenes Antagonists: Adduction: Rhomboids major and minor, Middle Trapezius Respiration: Rectus Abdominus

Origin: Lateral Surface of the Upper eight ribs � Insertion: Anterior surface of the vertebral border of the scapula � Action: Scapular protraction and Upward Rotation, holds scapula against thoracic wall � Innervation: Long thoracic nerve, Lateral thoracic artery � Roots C 5 -C 7 � Synergists: -Abduction: Pectoralis Minor -Upward Rotation: Upper and lower Trapezius � Antagonists: -Adduction: Rhomboids Major and Minor, Middle Trapezius -Downward Rotation: Levator Scapulae, Rhomboids Major and Minor �

� Origin: Spinous processes of T 2 - T 5 � Insertion: Vertebral border of the scapula between the spine and inferior angle � Action: Adducts (retracts) Scapula, Depresses Glenoid Cavity, Stabilizes scapula � Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery � Synergists: -Adduction: Middle Trapezius -Downward Rotation: Levator Scapulae, Pectoralis Minor � Antagonists: -Abduction: Serratus anterior, Pectoralis Minor -Upward Rotation: Upper and lower Trapezius, Serratus Anterior

Origin: Nuchal Ligament and spinous process of C 7 and T 1 � Insertion: Vertebral border of scapula superior to spine � Action: Adducts (retracts) Scapula, Depresses Glenoid Cavity, Stabilizes scapula � Innervation: Dorsal Scapular Nerve and Dorsal Scapular Artery � Synergists: -Adduction: Middle Trapezius -Downward Rotation: Levator Scapulae, Pectoralis Minor � Antagonists: -Abduction: Serratus anterior, Pectoralis Minor -Upward Rotation: Upper and lower Trapezius, Serratus Anterior �

� � � Anterior (Clavicular) Origin: Lateral 1/3 of Clavicle Action: Shoulder Abduction, Flexion, Medial rotation, Horizontal Adduction Middle (Acromial) Origin: Acromion process Action: Shoulder Abduction � � � Posterior (Spinal) Origin: Scapular Spine Action: Shoulder Abduction, Extension, Hyperextension, Lateral Rotation, Horizontal Adduction All 3 Deltoids Insert on the Deltoid Tuberosity and are Innervated by the Axillary Nerve with Roots C 5 -C 6 � All 3 Deltoids have the Supraspinatus as a Synergist when performing Abduction �

Origin: (clavicular head) Medial third of the clavicle, (sternal head) sternum, costal cartilage of first six ribs and the aponeurosis of the External Oblique � Insertion: Lateral lip of bicipital groove of humerus � Action: Shoulder Adduction, Medial Rotation, Draws Scapula anteriorly and inferiorly, Clavicular Head Flexes Humerus, Sternal Head Extends Humerus � Innervation: Lateral and Medial Pectoral Nerve � Roots: Clavicular C 5 -C 6, Sternocostal C 7 -C 8 � Synergists: -Adduction: Latisumus Dorsi, Teres Major -Medial Rotation: Latissumus Dorsi, Anterior Deltoid, Teres Major -Extension: Posterior Deltoid, Latissimus Dorsi, Teres Major � Antagonists: -Abduction: Deltoids, Supraspinatus -Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid -Flexion: Anterior Deltoid �

Origin: Spinous Processes of T 7 through L 5 (via dorsolumbar fascia), posterior surface of sacrum, iliac crest, and lower 3 ribs � Insertion: Medial lip of Intertubercular sulcus of humerus � Action: Shoulder extension, adduction, medial rotation, hyperextension � Innvervation: Thoracodorsal nerve � Roots: C 6 -C 8 � Synergists: -Extension: Posterior Deltoid, Teres Major, Pectoralis Major -Adduction: Teres Major, Pectoralis Major -Medial Rotation: Teres Major, Petoralis Major, Subscapularis, Anterior Deltoid � Antagonists: -Flexion: Anterior Deltoid, Pectoralis Major -Abduction: Deltoids, Supraspinatus -Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid �

� Origin: Supraspinous fossa of the scapula � Insertion: Greater Tubercle of the humerus � Action: Initiates and Assists the Deltoid Abduct the arm � Innervation: Suprascapular nerve Root: C 5 and C 6 � Synergist -Abduction: Deltoids � Antagonist -Adduction: Pectoralis Major, Teres Major and Latissimus Dorsi �

� Origin: Dorsal surface of inferior angle of the scapula Insertion: Medial lip of intertubercular groove of humerus � Action: Adducts and medially rotates � Innervation: Lower subscapular nerve � Root: C 6 and C 7 � Synergist -Adduction: Pectoralis Major, Teres Major, Latissimus Dorsi -Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, and Pectoralis Major � Antagonist: -Abduction: Deltoids and Supraspinatus -Lateral Rotation: Infranspinatus, Teres Minor, and Posterior Deltoid �

� � Origin: Subscapular fossa of the scapula Insertion: Lesser tubercle of the humerus Action: Shoulder Medial Rotation and adduction, also helps hold Humeral Head in Glenoid Cavity � Innervation: Subscapular nerve and Subscapular Artery � Roots: C 5 -C 7 � Synergists: -Adduction: Pectoralis Major, Teres Major, Latissumus dorsi -Medial Rotation: Latissimus dorsi, Teres Major, Pectoralis Major, Anterior Deltoid � Antagonists: -Abduction: Deltoid, Supraspinatus -Lateral Rotation: Teres Minor, Posterior Deltoid �

� � � Origin: Coracoid process of the scapula Insertion: Medial 1/3 of the humerus Action: Helps adduct the shoulder joint Innervation: Musculocutaneus nerve Roots: C 6 -C 7 Synergists: -Arm Flexion: Biceps Brachii, Anterior Deltoid -Adduction: Subscapularis, Teres major, Pecotalis Major � Antagonists: -Forearm extension: Triceps Brachii, Posterior Deltoid -Abduction: Deltoids, Supraspinatus �

Origin: Infraspinous fossa of the scapula � Insertion: Greater tubercle of the humerus � Action: External (lateral) Rotation � Innervation: Suprascapular nerve � Root: c 5 and c 6 � Synergist: -Lateral Rotation: Teres Minor and Posterior Deltoid � Antagonist: -Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, Pectoralis Major and Anterior Deltoid �

� � Origin: Superior lateral border of the scapula Insertion: Greater tubercle of the humerus Action: External Rotation, weak rotation � Innervation: Axillary nerve � Root: c 5 and c 6 � Synergist -Lateral Rotation: Infraspinatus and the Posterior Deltoid � Antagonist: -Medial Rotation: Latissimus Dorsi, Teres Major, Subscapularis, Pectoralis Major, and Anterior Deltoid �

References http: //teachmeanatomy. info/upper-limb/misc/surface-anatomy-of-the-axillaanterior-and-posterior-axillary-folds/ http: //uni-doctors. blogspot. com/search? q=clavipectoral+triangle https: //web. duke. edu/anatomy/Lab 10/Lab 11_pre. Lab. html http: //www. science-art. com/image/? id=2961#. VF 7 j. Xt. Et. DVI https: //web. duke. edu/anatomy/Lab 10/images/Grant's%20 Atlas%206. 30%20(1). jpg http: //www. musclesused. com/wp-content/uploads/2012/08/Trapezius-Muscle-3. jpg http: //med. uc. edu/labmanuals/ga/HEMATOLOGY%20 AND%20 CARDIOVASCULAR/ Clemente, Carmine D. Atlas, A regional Atlas of the Human Body. 6 th edition. 2011 https: //www. google. com/search? q=levator+scapulae&biw=1301&bih=641&source=lnms&tbm=i sch&sa=X&ei=k. D 9 h. VJy 7 Js. Tuo. ASNp 4 Co. Bg&sqi=2&ved=0 CAYQ_AUo. AQ#tbm=isch&q=pectoralis+ major+images&imgdii=_ BLEVINS, GARY THE OFFICIAL MUSCLE SHEET. 2014