Shoulder Back Upper Extremities Muscles Dr Nabil Khouri

Shoulder, Back & Upper Extremities Muscles Dr. Nabil Khouri MD MSc Ph. D

Appendicular Musculature

Muscles of the Shoulders and Upper Limbs Position the pectoral girdle Move the arm Move the forearm and hand Move the hand fingers

Muscles That Position the Pectoral Girdle Trapezius Superficial Covers back and neck to base of skull Inserts onto clavicles and scapular spines Rhomboid and levator scapulae Deep to trapezius Attach to cervical and thoracic vertebrae Insert on scapular border Serratus anterior On the chest Originates along ribs Inserts on anterior scapular margin

Muscles That Position the Pectoral Girdle.

Latissimus dorsi

Antaerior Muscles That Position the Pectoral Girdle Subclavius Originates on ribs Inserts on clavicle

Anterior thoracic Muscles (Pictorials Muscle Dose not Crossing the Shoulder)

Musles crossing the shoulder

Deltoid muscle

Muscles Crossing the Shoulder Rotator cuff muscles – supraspinatus, infraspinatus, teres minor, and subscapularis Function mainly to reinforce the capsule of the shoulder Secondarily act as synergists and fixators The coracobrachialis and teres major: Act as synergists Do not contribute to reinforcement of the shoulder joint

Rotator calf muscles

SUPRASPINATUS ORIGIN: supraspinatous fossa of the scapula INSERTION: superior facet on the gr. tubercle of the humerus ACTION: initiation of abduction (15*) & lat. Rotation N. SUPPLY: Suprascapular. N From B. P (C 5, C 6)

SUPRASPINATUS

INFRASPINATUS ORIGIN: infraspinatous fossa of the scapula INSERTION: middle facet on the gr. tubercle of the humerus ACTION: lat. rotation of shoulder, strengthen the shoulder by bracing the head of humerus. N. SUPPLY: Suprascapular. N of B. P (C 5, c 6)

INFRASPINAT US

TERES MINOR ORIGIN: lat. borderof the scapula INSERTION: inf. facet on the grt. tubercle of the humerus ACTION: ext. rotator & weak adductor N. SUPPLY: Axillary. N. (C 5, C 6)

SUBSCAPULARIS ORIGIN: medial 2/3 subscapular fossa, lat border of tha scapula INSERTION: lesser tubercle of the humerus ACTION: stabilise the shoulder & prevents anterior displacement of the shoulder (med. rotation, adduction of arm) N. SUPPLY: Upper &Lower Subscapular. N (c 5, c 6)

Sub-scapularis Muscle

SUBSCAPULAR IS

TERES MAJOR ORIGIN: dorsal surface of the inf. angle of the scapula INSERTION: med. lip of the intetubercular groove of the humerus ACTION: extends the arm from flexd. position & it adducts, med. rotates the arm N. SUPPLY: Lower Subscapular (C 6, C 7)

Superficial Spinal Extensors Spinalis group Longissimus group Iliocostalis group Deep Spinal Extensors Semispinalis group Multifidus muscle Interspinalis muscles Intertransversarii muscles Rotatores muscles

Trunk Movements: Deep Back Muscles The prime mover of back extension is the erector spinae Erector spinae, or sacrospinalis, muscles consist of three columns on each side of the vertebrae – iliocostalis, longissimus, and spinalis Lateral bending of the back is accomplished by unilateral contraction of these muscles Other deep back extensors include the semispinalis muscles and the quadratus lumborum

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Anterior Muscles of the Vertebral Column Spinal flexors Neck Longus Rotate capitis and longus colli and flex the neck Lumbar Quadratus Flex lumborum muscles spine and depress ribs

Muscles of the upper extremities

coracobrachialis

Muscles Crossing the Elbow Forearm flexion Brachialis and biceps brachii are the chief forearm flexion The brachioradialis acts as a synergist and helps stabilize the elbow Forearm extension The triceps brachii is the prime mover of forearm extension The anconeus is a weak synergist

Biceps Brachi Muscle

Brachalis muscle

Triceps Brachi Muscle ORIGIN: Long head: infraglenoid tubercle of the scapula Lat. head: oblique ridge on upper surface above the radial groove Medial head: posterior surface of the humerus inf. to the radial groove INSERTION: proximal olecrenon of the ulna ACTION: extends the forearm N. SUPPLY: Radial. N. (C 7, c 8)

The ARM v An aponeurotic sheet separating various muscles of the upper limbs, including lateral and medial humeral septa. v The lateral and medial intermuscular septa divide the distal part of the arm into two compartments: Ø Anterior compartments also known compartment as the flexor Ø Posterior compartments also known as compartment the extensor Lateral Medial intermuscul ar septum ski n Fasci a Humeru s Neurovascul ar bundle

MUSCLES OF FOREARM Anterior Compartment: common flxor origin Ø SUPERFICIAL 1. Pronator Teres 2. Flx Carpi Ulnaris 3. Palmaris Longus 4. Flx. Carpi Radialis 5. Flx. Digitorum Superficialis (sublimus) Ø DEEP: 1. Flx. Digitorum Profundus 2. Flx. Pollicis Longus 3. Pronator Quadratus

Forearm Muscles Superficial Compartment Flexor Carpi Radialis Flexor Carpi Ulnaris Flexor Digitorum Superficialis - all Palmaris Longus Pronator Teres

Forearm Muscles Superficial Compartment Superficial layer These muscles are primarily flexors of the wrist and fingers

PRONATOR TERES Insertion: midway long the lateral surface of the radius Action: pronation, flexion of forearm N. Supply: Median. N (C 6 c 7)

FLX. CARPI RADIALIS INSERTION: base of the 2 nd mc bone and slip to the bace of the 3 rd MC bone ACTION: flexion and abduction of wrist N. SUPPLY: Median. N (c 6, c 7)

PALMARIS LONGUS INSERTION: anterior aspect of the distal flx. retinaculum and palmar aponeurosis ACTION: flx. the wrist, and tightens the palmar. aponeurosis N. SUPPLY: Median. N (c 6, c 7)

FLX CARPI ULNARIS ORIGIN: humoral head: med epicondyle Ulnar head: med. margin of the olecrenon, posterior border of the ulna INSERTION: pisiform, hook of hamate, base of the 5 th MC & flx. retinaculum ACTION: flexes and adducts the hand N. SUPPLY: Ulnar. N (C 7, C 8)

Forearm Muscles Deep Compartment Flexor Digitorum Profundus - all Flexor Pollicis Longus Pronator Quadratus

Muscles of the Forearm: Anterior Compartment Meddle and Deep Layers

FLX. DIGITORUM SUPERFICIALIS ORIGIN: humeroulnar head: med. epicondyle of the humerus, coronoid process Radial head: sup. half of anterior aspect of the radius INSERTION : bodies of the Middle phalanges of the medial 4 digits ACTION: flx. of all joints it crosses N. SUPPLY : Median. N

FLX. DIGITORUM PROFUNDUS ORIGIN: prox. 3/4 of the medial and anterior aspect of the ulna and from interosseous memb. INSERTION: base of The Diatal phalanges of the medial 4 digits ACTION: flx. DIP, , PIP, MP, wrist N. SUPPLY: Medial-ulnar. N (C 8, t 1) Lateral-AIN Of Median. N (C 8, t 1)

FLX. POLLICIS LONGUS ORIGIN: upper 3/4 of anterior surface of radius INSERTION: base of distal phalanx of the thumb ACTION: flexion of proximal & distal phalnx of the thumb N. SUPPLY: AIN (C 7, C 8, T 1)

PRONATOR QUADRATUS ORIGIN: lower 1/4 th of anterior surface of ulna INSERTION: lower 1/4 th of anterior surface of radius ACTION : pronation N. SUPPLY: AIN (C 8, T 1)

POSTERIOR COMPARTMENT OF FOREARM SUPERFICIAL 1. anconeus 2. Brachioradialis 3. Ext. Carpi Radialis Longus 4. Ext. Carpi Radialis Brevis 5. Ext. Digitorum 6. Ext. Digiti Minimi 7. Ext. Carpi Ulnaris DEEP 1. Abductor Pollicis Longus 2. Ext. Pollicis longus 3. Ext. Pollicis brevis 4. Ext. Indicis 5. supinator

Forearm Muscles superficial Posterior Compartment Anconeus Brachioradialis Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus Extensor Carpi Ulnaris Extensor Digiti Minimi Extensor Digitorum - All

Forearm Muscles Posterior Compartment These muscles are primarily extensors of the wrist and fingers

ANCONEUS ORIGIN: posterior surface of the lat. epicondyle INSERTION: lateral surface of olecranon, body of ulna ACTION: extension of forearm N. SUPPLY: radial. n

BRACHIORADIALIS ORIGIN: prox. 2/3 rd of lat. supracondylar ridge of humerus, lateral intermuscular septum INSERTION: lat. aspect of distal radius just prox. to the styloid process ACTION: acc. flexor of elbow N. SUPPLY: Radial. N (C 5, C 6)

EXT. CARPI RADIALIS LONGUS ORIGIN: lat. supracondylar ridge of humerus INSERTION: base of the 2 nd MC bone ACTION: extends and abducts the hand N. SUPPLY: Radial. N (C 6, C 7)

EXTENSOR CARPI RADIALIS BREVIS ORIGIN: lat. epicondyle of the humerus INSERTION: base of the 3 rd MC bone ACTION: extends and abducts the wrist N. SUPPLY: deep br. of radial. N(c 7 c 8)

EXTENSOR DIGITORUM ORIGIN: lat epicondyle of the humerus INSERTION: Extensor Expansions Of The Medial 4 digits ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended N. SUPPLY: PIN (c 7, c 8)

EXTENSOR DIGITI MINIMI ORIGIN: lat epicondyle of the humerus INSERTION: extensor expansion of the 5 th digit ACTION: ext. of 5 th digit at MC, PIP , ext of wrist when little finger in extension N. SUPPLY: PIN (c 7, c 8)

EXT. CARPI ULNARIS ORIGIN: 2 heads lat epicondyle of humerus, Posterior border of ulna INSERTION: medial side of the base of the 5 th MC ACTION: extends and adducts the hand N. SUPPLY: PIN (c 7 c 8)

SUPINATOR ORIGIN: lat epicondyle of humerus, radial collateral lig. , annular lig. , supinator fossa, crest of ulna INSERTION: lateral, posterior, anterior surface of prox 1/ 3 rd 0 f radius ACTION: supination N. Supply: deep Br. Of Radial. N (C 5, c 6)

Forearm Muscles Deep Posterior Compartment Abductor Pollicis Longus Extensor Indicis Extensor Pollicis Brevis Extensor Pollicis Longus Flexor Digitorum Profundus Supinator

ABDUCTOR POLLICIS LONGUS ORIGIN: upper parts of the posterior surface of the radius & ulna and interosseous mem. INSERTION: base of the 1 st MC bone ACTION: abducts, extends, lat. rotates the thumb at carpometacarpal joint, & abducts the wrist. N. SUPPLY: PIN (c 7, c 8)

EXTENSOR POLLICIS BREVIS ORIGIN: posterior surface of the radius below the origin of. Abductor Pollicis longusand from interosseous mem. INSERTION: base of the prox. phalanx of the thumb ACTION: extends pox. phalanx of the thumb at MC joint, ext. at 1 st carpometacarpal joint N. SUPPLY: PIN (c 7, c 8)

EXT. POLLICIS LONGUS ORIGIN: posterior surface of middle 1/3 rd of ulna And interrosseous mem. INSERTION: base of the diastal phalanx of the thumb ACTION: extends distal phalanx of the thumb at MP joint, IP joint. and it can contribute abduction of the thumb N. SUPPLY: PIN (c 7, c 8).

EXTENSOR INDICIS Origin: posterior surface of ulna m/3 rd below the EPL Insertion: extensor expansion of the 2 nd finger Action: ext of index finger and wrist. N. supply: PIN (c 7, c 8)

Muscles Posterior Compartment These muscles are primarily extensors of the wrist and fingers

Surface Anatomy of Upper Limb Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E. pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse) Frolich, Human Anatomy, Uppr. Limb

CARPAL TUNNEL FORMED BETWEEN THE CONCAVITY OF THE CARPAL BONES AND A LIGAMENT THAT COVERS THIS( FLEXOR RETINACULAM) TENDONS OF THE FLEXORS PASS THROUGH MEDIAN NERVE ALSO PASSES THROUGH CROWDED TUNNEL CARPAL TUNNEL SYNDROME - CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL - CAUSES- 1. SWELLING OF THE TEDONS( OVERUSE) - 2. PREGNANCY( EDEMA) - 3. ARTHRITIS SYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND, WEAKNESS IN THUMB MOVEMENT TREATMENT- REST, SPLINTING, ANTI-INFLAMMATORY DRUGS, SURGERY