MUSCLES AND FASCIA OF THE UPPER EXTREMITIES

MUSCLES CONNECTING THE UPPER LIMB TO THE THORACIC WALL

MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Pectoralis Major Clavicle, sternum, and LATERAL LIP of bicipital Lateral and Medial C5, 6, 7, 8, T1 Adducts the arm and rotates it
upper 6 costal cartilages groove of the humerus pectoralis nerves from medially; arm flexion
brachial plexus

Pectoralis Minor Rib 3/4/5 CORACOID PROCESS of Medial pectoralis nerve C6,7,8 Depresses the point of shoulder
ulna from brachial plexus

Subclavius 1st Costal Cartilage CLAVICLE Nerve to subclavius from C5,6 Depresses the clavicle and
upper trunk of the brachial stabilizes this bone during
plexus movement of shoulder girdle

Serratus anterior Upper 8 (to 9th) ribs MEDIAL BORDER, Long thoracic nerve C5,6,7 Draws the forward anterior
INFERIOR ANGLE of
scapula

*winging (abn)
around the thoracic wall,
ROTATES THE SCAPULA

MUSCLES CONNECTING THE UPPER LIMB TO THE VERTEBRAL COLUMN
MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Trapezius External Occipital ("U" shaped line of CN XI (spinal accessory) CN XI Upper fibers eleveate the
Protuberance and superior attachment) lateral motor scapula
nuchal line; spans from C1
to T12, encompassing of
third of clavicle,
acromion, and spinous

Anterior Rami of C3 and C4

Middle fibers pull the scapula
the ligamentum nuchae process of scapula sensory medially,
(C1 to C7)
Lower fibers pull medial border
of scapula downward

Latissimus dorsi Iliac crest, Floor of bicipital groove of Thoracodorsal nerve C6,7,8 Extends, Adducts, and Medially
Lumbar fascia, the humerus rotates the arm
Spines of lower 6 vertebrae
Lower 3/4 ribs,
Inferior angle of scapula

Levator scapulae C1 to C4 (transverse Medial border of Scapula Dorsal Scapular Nerve, C3,4,5 Elevates medial border of the
processes) C3 and C4 scapula

Rhomboid minor Base of ligamentum Medial border of Scapula Dorsal Scapular Nerve C4,5 Raises medial border of the
nuchae (C7) to T1 scapula upward and medially

Rhomboid major T2 to T5 Medial border of Scapula Dorsal Scapular Nerve C4,5 Raises medial border of the
scapula upward and medially

source: CLINICAL ANATOMY BY REGIONS 9th Ed. tjia
 MUSCLES AND FASCIA OF THE UPPER EXTREMITIES

MUSCLES CONNECTING THE SCAPULA TO THE HUMERUS

MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Deltoid ANTLateral third of the Deltoid tuberosity of the Axillary Nerve (passing C5,6 ANTflexion and medial rotation
clavicle, humerus through the Quadrangular MIDabduction (15' by
MIDAcromion, Space) supraspinatus)
POSSpine of the scapula POS-extension and lateral
rotation

Supraspinatus* Supraspinous fossa of the Superior facet of Greater Suprascapular nerve C4,5,6 Abducts arm and stabilizes
scapula Tuberosity of humerus Glenohumeral Joint (GHJ)

Infraspinatus* Infraspinous fossa of Middle facet of the Greater Suprascapular nerve C4,5,6 Laterally rotate arm and
scapula tubercle of humerus stabilizes GHJ

Teres major Lower third of LATERAL Medial lip of bicipital Lower subscapular nerve C6,7 Medially rotate and adduct arm,
BORDER of scapula groove of humerus and stabilizes GHJ

Teres minor* Upper 2/3 of LATERAL Inferior aspect of the Axillary nerve C4,5,6 Laterally rotate arm and
BORDER of scapula Greater tuberosity of stabilizes GHJ
humerus

Subscapularis * Subscapular fossa LESSER TUBEROSITY of Upper and Lower C5,6,7 Medial rotation of arms, and
the humerus subscapular nerves stabilizes GHJ

*muscles that form the Rotator Cuff which are crucial for the stabilization of the shoulder at the GHJ.



MUSCLES OF THE ARM
MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

ANTERIOR COMPARTMENT
Biceps brachii

Tuberosity of the radius,

Musculocutaneous nerve

C5,6

Supinator of the forearm,
Long Head...................... Supraglenoid tubercle Bicipital aponeurosis into (from lateral cord of Flexor of the elbow
Short Head..................... Coracoid process deep fascia of forearm brachial plexus) (Weak) flexor of GHJ

Coracobrachialis Coracoid process of scapula MEDIAL ASPECT of shaft of Musculocutaneous nerve C5,6,7 Flexes arm,
the humerus (Weak) adductor

Brachialis Front of lower half of the CORONOID process of the Musculocutaneous nerve C5,6 Flexor of the elbow joint
humerus (lies inferior to ulna
the biceps brachii)

POSTERIOR COMPARTMENT
Triceps brachii

Olecranon process of the

Radial nerve (passing

C6,7,8

Extensor of elbow joint
Long Head...................... ...Infraglenoid tubercle ulna through the triangular
Lateral Head................... ...Upper half of posterior interval)
surface of shaft of humerus
Medial Head................... ...Lower half of posterior
surface of humerus

source: CLINICAL ANATOMY BY REGIONS 9th Ed. tjia
 MUSCLES AND FASCIA OF THE UPPER EXTREMITIES

MUSCLES OF THE ANTERIOR FASCIAL COMPARTMENT OF THE FOREARM

MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Pronator teres*
Humeral Head................ ...Medial epicondyle of

Lateral aspect of the shaft

Median Nerve (originates

C6,7

Pronation and flexion of the
humerus
Ulnar Head..................... ...Medial border of
of the radius from the medial and lateral
cords of the brachial
forearm

Note: the median nerve exits ulna
CORONOID PROCESS of plexus)

between the humeral and the

ulnar head

Flexor Carpi Radialis* Medial epicondyle of Base of 2nd & 3rd Median nerve C6,7 Flexes and abducts hand at wrist
humerus Metacarpal bone (mcb) joint

Palmaris longus* Medial epicondyle of Flexor retinaculum Median nerve C7,8 Flexes the hand
Note: spindle shaped muscle humerus Palmar aponeurosis
And is absent in 15% of pop.

Flexor carpi ulnaris*

Humeral Head................ ... Medial epicondyle of

Pisiform bone,

Ulnar Nerve

C8; T1

Flexes and adducts hand at wrist
humerus
Ulnar Head..................... ....Medial aspect of the
Hook of hamate,
Base of 5th mcb
joint

olecranon process &

posterior border of ulna

Flexor digitorum
superficialis**

Humeroulnar Head....... ... Medial epicondyle of Middle phalanx of medial Median nerve C7,8;T1 Flexes middle phalanx of fingers
humerus; Medial border of
coronoid process of ulna
four fingers and assists in flexing proximal
phalanx and hand (major flexor
Radial Head................... ...Oblique line on anterior of latter of the Flexor Digitorum
surface of shaft of radius Profundus)

Flexor pollicis longus Anterior surface of shaft of Distal phalanx of thumb Anterior interosseous C8;T1 Flexes the distal phalanx of the
RADIUS branch of median nerve thumb

Flexor digitorum Anteromedial surface of Distal phalanges of medial Ulnar Nerve (medial half) C8;T1 Flexes distal phalanx of fingers,
profundus the shaft of ULNA four fingers (compare with Median Nerve (lateral half) then assists in flexion of middle
insertion of the FDS at the and proximal phalanges of wrist.
medial phalanges)

Pronator Quadratus Anterior surface of shaft of Anterior surface of shaft of Anterior interosseous C8;T1 Pronates the forearm
ulna radius branch of median nerve
*Superficial Muscles
**Intermediate Muscles

MUSCLES OF THE LATERAL FASCIAL COMPARTMENT OF THE FOREARM
MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Brachioradialis Lateral supracondylar ridge Base of styloid process of Radial nerve C5,6,7 Flexes forearm at elbow joint,
of humerus ulna Rotates forearm to midprone
position

Extensor carpi radialis Lateral supracondylar ridge Posterior surface of 2nd Radial nerve C6,7 Extends and abducts hand at
longus of humerus mcb wrist joint

source: CLINICAL ANATOMY BY REGIONS 9th Ed. tjia
 MUSCLES AND FASCIA OF THE UPPER EXTREMITIES

MUSCLES OF THE FASCIAL COMPARTMENT OF THE FOREARM

MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Extensor carpi radialis Lateral epicondyle of the Posterior surface of vase of Deep branch of the radial C7,8 Extend and abduct hand at wrist
brevis humerus 3rd mcb nerve joint
* recall, the FCR inserts both
at 2nd and 3rd mcb

Extensor digitorum Lateral epicondyle of the Middle and distal Deep branch of the radial C7,8 Extends fingers and hands
humerus phalanges of medial four nerve
fingers

* recall, the FDS inserts at middle phalanx only while the FDP inserts at the distal Phalanx only

Extensor digiti minimi Lateral epicondyle of the Extensor expansion of Deep branch of the radial C7,8 Extends metacarpophalangeal
humerus small finger nerve joint of small finger

Extensor carpi ulnaris Lateral epicondyle of the Base of 5th mcb Deep branch of the radial C7,8 Extend and adduct hand at wrist
humerus nerve joint

Anconeus Lateral epicondyle of the Lateral surface of olecranon Radial nerve C7,8, T1 Extends elbow joint
humerus process of ulna

Supinator Lateral epicondyle of Radial neck and shaft Deep branch of the radial C5,6 Supination of forearm
humerus; anular ligament nerve
of proximal radioulnar
joint, and ulna

Abductor pollicis longus Posterior surface of radial Base of 1st mcb Deep branch of the radial C7,8 Abducts and extends the thumb
and ulnar shafts nerve

Extensor pollicis brevis Posterior surface of radial Base of proximal phalanx Deep branch of radial C7,8 Extend metacarpophalangeal
shaft nerve joint of thumb

Extensor pollicis longus Posterior surface of ulnar Base of distal phalanx Deep branch of the radial C7,8 Extend the distal phalanx of
shaft nerve thumb

Extensor indicis Posterior surface of ulnar Extensor expansion of Deep branch of the radial C7,8 Extend metacarpophalangeal
shaft index finger nerve joint of index finger

GATEWAYS TO THE POSTERIOR SCAPULAR REGION
GATEWAY CONTRIBUTING STRUCTURES SIGNIFICANCE

Suprascapular Foramen Suprascapular Notch Suprascapular nerve passes through it

Superior transverse suprascapular ligament Suprascapular artery and vein passes immediately superior to the superior
transverse suprascapular ligament

Quadrangular Space Inferior margin of teres minor Passageway for the AXILLARY NERVE and POSTERIOR CIRCUMFLEX ARTERY/ VEIN
Surgical neck of humerus
Superior margin of teres major

*Quadrangular Space Syndrome hypertrophy of the space muscles (or fibrosis)
Lateral margin of the long head of biceps beachii that leads to impingement of associated nerves and vessels. Typically affects the
teres minor, subsequently limiting range of motion of rotator cuff at GHJ

Triangular Space Inferior margin of teres minor Passageway for the circumflex scapular artery and vein
Superior margin of teres major
Medial head of the long neck of biceps brachii

Triangular interval Lateral margin of the long head of biceps brachii Passageway for radial nerve and profunda brachii artery and vein
Medial shaft of humerus
Inferior margin of teres major

source: CLINICAL ANATOMY BY REGIONS 9th Ed. tjia

 MUSCLES AND FASCIA OF THE UPPER EXTREMITIES

SMALL MUSCLES OF THE HAND
MUSCLE ORIGIN INSERTION NERVE SUPPLY NERVE ROOTS ACTION

Palmaris brevis Flexor Retinaculum, Skin of palm Superficial branch of ulnar C8, T1 Corrugates skin to improve grip
Palmar aponeurosis nerve of palm

Lumbricals (4) Tendons of flexor Extensor expansion of 1st and 2nd Median nerve, C8, T1 Flex metacarpophalangeal joints
digitorum profundus medial four fingers 3rd and 4th deep branch of & extend interphalangeal joints
ulnar nerve of fingers except thumb

Interossei (8)

Palmar (4) First arises from base of 1st Proximal phalanges of Deep branch of ulnar nerve C8;T1 Palmar interossei adduct fingers
metacarpal; remaining
three from anterior surface
thumb and index, ring, and
little fingers, and dorsal
toward center of third finger

of shafts of 2nd, 4th, and
5th metacarpals
extensor expansion of each
finger

Dorsal (4)q

Continguous sides of shafts Proximal phalanges of

Deep branch of ulnar nerve C8;T1
Dorsal interossei abduct fingers
of metacarpal bones index, middle, and ring from center of third finger, both
fingers and dorsal extensor palmar and dorsal flex
expansion metacarpophalangeal joints and
extend interphalangeal joints

SHORT MUSCLES OF THUMB

Abductor pollicis brevis Scaphoid, trapezium, flexor Base of proximal phalanx Median nerve C8, T1 Abduction of thumb
retinaculum of thumb

Flexor pollicis brevis Flexor retinaculum Base of proximal phalanx Median nerve C8, T1 Flexes metacarpophalangeal
of thumb joint of thumb

Opponens polllicis Flexor retinaculum Shaft of mcb of thumb Median nerve C8, T1 Pulls thumb medially and
forward across palm

Adductor pollicis Oblique head at 2nd & 3rd Base of proximal phalanx Median nerve C8, T1 Adduction of thumb
mcb of thumb
Transverse head at 3rd
mcb

SHORT MUSCLES OF THE

LITTLE FINGER


Abductor digiti minimi

Pisiform bone

Base of proximal phalanx

Deep branch of ulnar nerve C8, T1

Abducts the little finger
of little finger

Flexor digiti minimi Flexor retinaculum Base of proximal phalanx Deep branch of ulnar nerve C8, T1 Flexes the little finger
of little finger

Opponens digiti minimi Flexor retinaculum Medial border of 5th mcb Deep branch of ulnar nerve C8,T1 Pulls 5th metacarpal forward as
in cupping the palm
NOTES

> the axilla provides a gateway to the upper limb and a communication between nerves and vessels which originate from the neck down to the limb structure

>the pectoralis major is the largest and most superficial muscle of the anterior wall of the axilla

>the clavipectoral fascia is an important structure that passes between the subclavius and pec.minor muscle which involves the (1) cephalic vein, (2) thoraco-acromial artery, (3)

lateral pectoral muscle
>the axilla contains the (1) axillary artery and vein, (2) infraclavicular part of brachial plexus, (3) axillary group of lymph nodes and vessels, (4) intercostobrachial nerve and some
lateral branches, (5) adpose tse and areolar tse, (6) axillary tail of spence

source: CLINICAL ANATOMY BY REGIONS 9th Ed. tjia