NECK, AXILLA, ARM & BACK

POSTERIOR TRIANGLE OF THE NECK Anterior: Posterior border of the sternocleidomastoid

muscle Posterior: Anterior border of the trapezius Inferior: Clavicle
Covered by the Investing layer of the deep cervical fascia Floor is formed by the prevertebral layer of the
deep cervical fascia
Subdivided by the inferior belly of the omohyoid into:
• Occipital triangle
Inferior: Inferior belly of the omohyoid
• Supraclavicular triangle
Superior: Inferior belly of the omohyoid Inferior: clavicle
Both triangles: Anterior: Posterior border of the sternocleidomastoid muscle Posterior: Anterior border of the
trapezius Floor: Splenius capitis, Levator scapula, Scalenus medius, Scalenus anterior
Contents of the triangles OCCIPITAL
• Supraclavicular nerve
• Spinal Accessory Nerve (XI)
• Superior end of the sympathetic trunk (Superior, Middle, Inferior cervical sympathetic ganglion)
• Cervical plexus
• Semispinalis capitis muscle
• Levator scapula muscle
• Scalenus posterior muscle
• Scalenus medius muscle
SUPRACLAVICULAR
• 3rd part of the sublacian artrey
• Subclavian vein
• Apex of the lung
• Roots of the brachial plexua
• Deep cervical lymph nodes
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Muscles of the Posterior Triangle Origin Insertion Innervation Action
Ligamentum nuchae
Splenius capitis
Upper 4 thoracic spines
Superior nuchal line of occipital bone Bends Mastoid process of temporal bone
Dorsal primary rami of spinal nerve
neck laterally Elevates medial border of the scapula Levator Scapula Transverse processes of C1-C4
Ventral primary rami (C3, C4)
Medial border of the scapula
Dorsal Scapular Nerve
Raises medial border of scapula Bends neck laterally
Scalenus
Elevates 2nd rib, laterally flexes Posterior Transverse processes of C4-C6 2nd rib Anterior rami of cervical

nerves
and rotates cervical part of vertebral column Medius Transverse processes of C1-C6
1st rib
Elevates 1st rib, laterally flexes
Anterior Transverse processes of C3-C6 C4-C6
and rotates cervical part of vertebral column Scalenus Anterior muscles
1. Key muscle in understanding the root of the neck and its relation to many neurovascular structures identified
in the posterior triangle 2. Important relations:
• Anteriorly – related to carotid arteries, vagus nerve, IJV, and deep cervical lymph nodes
• Posteriorly – related to the pleura, origin of the brachial plexus, and 2 nd part of the subclavian artery
• Medially – related to the vertebral artery and vein, sympathetic trunk, and thoracic duct (on the left side)
• Laterally - related to the emerging branches of the cervical plexus, roots of the brachial plexus, and the 3 rd
part of the subclavian artery 3. Divides the subclavian artery into 3 parts
Phrenic Nerve Spinal Accessory Nerve (XI) Fibers Motor, Sensory Motor
Course
CRANIAL ROOT
1. Arises in the neck from the 3rd, 4th,
and 5th cervical nerves of the cervical plexus (C3-C5) 2. Runs vertically downward across the front of the
scalenus anterior muscle 3. Enters the thorax by passing in front
of the subclavian artery
1. Emerges from anterior surface of the medulla oblongata 2. Nerve runs laterally in the posterior cranial
fossa and joins the spinal root SPINAL ROOT
1. Emerges from nerve cells in the anterior gray horn of the upper 5 segments of the cervical part of
the spinal cord 2. Nerve ascends alongside the spinal cord and enters the skull through the foramen magnum
–
turns lateral to join cranial root
4. Further courses in the thorax
terminating at the diaphragm
Cranial and Spinal root leave the skull through the jugular foramen and eventually separate:
• Cranial root – joins vagus nerve; distributed to soft palate, pharynx, and larynx muscles
• Spinal root – runs downward and laterally and enters SCM and over to the trapezius Areas of distribution
Diaphragm Soft palate, pharynx, larynx, sternocleidomastoid, trapezius muscles
Subclavian arteries Left Subclavian Right Subclavian Origin Arch of the aorta Brachiocephalic artery
Commencement Behind manubrium sterni Behind right sternoclavicular joint
Course
Ascends to the root of the neck Arches upward and laterally over the pleura between the scalenus anterior and
medius muscles Termination Outer border of the 1st rib
Scalenus anterior divides the subclavian artery into 3 parts
Posterior
Vertebral artery Basilar artery cerebral artery
Inferior thyroid artery
First Part of Subclavian Artery Extends from the origin of the subclavian artery to the medial border of
scalenus anterior Thyrocervical
Superficial cervical 1st
trunk
artery
• Vertebral artery - ascends in the neck through foramina in the transverse processes of the upper 6 cervical
vertebrae ,ascends into the skull through the foramen magnum;
Suprascapular artery
Forms the basilar artery at the anterior surface of the medulla oblongata at the level of the lower border of the
pons
• Basilar artery - gives branches to the pons, cerebellum, and internal ear; contributes Superior epigastric
to the formation of the Circle of Willis
Internal thoracic
artery
artery
Musculophrenic artery
• Posterior cerebral artery - curves laterally and backward around the midbrain
Subclavian artery
• Thyrocervical trunk
• Inferior thyroid artery - closely related to recurrent laryngeal nerve; gives branches to thyroid and inferior
parathyroid glands
• Superficial cervical artery - crosses the brachial plexus
Costocervical
2nd
trunk
Superior intercostal artery
• Suprascapular artery - follows the suprascapular nerve onto the back of the scapula
• Internal thoracic artery – descends into the thorax behind the 1st costal cartilage and in front of the pleura

3rd
Deep cervical artery • Superior epigastric artery - supplies anterior abdomen
• Musculophrenic artery - supplies 7th-9th intercostal spaces and diaphragm
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Second Part of Subclavian Artery Lies behind the scalenus anterior

• Costocervical trunk - runs backward over the dome of the pleura

• Superior intercostal artery – supplies 1st and 2nd intercostal spaces
• Deep cervical artery - supplies deep muscles of the neck

Third Part of Subclavian Artery Extends from the lateral border of the scalenus anterior across the
posterior triangle to the lateral border of the 1st rib

• Continues to the axillary artery

• No branches
Subclavian Vein Commencement: Outer border of the 1st rib From the axillary vein Joins internal jugular
vein to form the brachiocephalic vein Receives the external jugular vein Receives thoracic duct (left side) and
right lymphatic duct (right side)

Relations: Anterior: Clavicle

Posterior: Scalenus anterior and phrenic nerve Inferior: upper surface of the 1st rib

Lymph Drainage Superficial Cervical Lymph Nodes Deep Cervical Lymph Nodes
• Situated along the course of the External
Jugular Vein
• Receive lymph from:
1. The skin over the angle of the jaw 2. Skin over
the apex of the parotid gland 3. Lobe of the ear
• Efferent lymph vessels drain into the deep
cervical lymph nodes
• Form a vertical chain along the course of the
Internal Jugular Vein within the carotid sheath
• Receive lymph from regional nodes:
1. Jugulodigastric node – located below the
angle of the jaw
• Drainage of the tonsil and tongue 2. Jugulo-
omohyoid node – close to the omohyoid muscle
• Drainage of the tongue
• Efferent lymph vessels join to form jugular trunk
– drains into thoracic duct (right lymph duct)
Anatomy 1C Joshua Montelibano 1st shift
2015-2016
CERVICAL PLEXUS
Formed by the anterior rami of 1st 4 cervical nerves Joined by connecting branches – form loops that lie in
front of the origins of the levator scapulae and scalenus medius
Covered in front by the prevertebral layer of deep cervical fascia Related to the Internal Jugular Vein in the
carotid sheath Supplies the skin and muscles of the head, neck, and shoulders
Branches of the Cervical Plexus Branches Nerve Root Distribution CUTANEOUS BRANCHES
Lesser Occipital nerve C2 Back of the scalp and
auricle Greater auricular nerve
C2, 3 Skin over the angle of the mandible Transverse cervical nerve
Skin over the front of the neck Supraclavicular nerve C3, 4 Skin over the shoulder
region MUSCULAR BRANCHES TO THE NECK MUSCLES Proprioceptive, C2, 3 Prevertebral muscles, SCM
C3, 4 Levator scapulae Proprioceptive C3, 4 Trapezius Branch of C1 joins with hypoglossal nerve Some C1
fibers leave as a descending branch – unites with descending cervical nerve (C2, 3) C1 descending branch +
descending cervical nerve = ansa cervicalis Ansa cervicalis – innervates Sternohyoid, Omohyoid,
Sternothyroid
MUSCULAR BRANCH TO THE DIAPHRAGM Phrenic nerve C3, 4, 5 Diaphragm
CERVICAL PART OF THE SYMPATHETIC TRUNK Extends upward to the base of the skull below
the neck of the 1st rib Directly behind the internal and common carotid arteries, embedded in deep fascia
Three Ganglia of the Sympathetic Trunk and its Branches
Superior Cervical Ganglion
Internal carotid nerve Postganglionic fibers; accompanies ICA Gray rami communicantes To the upper 4
anterior rami of cervical nerves Arterial branches To the common and external carotid arteries Cranial nerve
brances Join the 9th, 10th, and 12th cranial nerves Phrayngeal branches Unite with glossopharyngeal and vagus
nerves Superior cardiac branch Descends in the neck; ends in cardiac plexus Middle Cervical Ganglion
Gray rami communicantes To the anterior rami of 5 th and 6th cervical nerves Thyroid branches Pass along
inferior thyroid artery; to thyroid gland Middle cardiac branch Descends in the neck; ends in cardiac plexus
Inferior Cervical Ganglion
Stellate ganglion Fused inferior cervical with 1st thoracic ganglion Gray rami communicantes To the anterior
rami of the 7th and 8th cervical nerve Arterial branches To the subclavian and vertebral arteries Inferior Cardiac
branch Descends to join the cardiac plexus
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
AXILLA, PECTORAL REGION, and MAMMARY GLAND BREAST (Mammary gland)
Specialized accessory glands of the skin that secrete milk Present in both sexes (similar structures in males
and immature females)
Superior: 2nd rib Inferior: 6th rib Medial: Lateral margin of the sternum Anterior: Skin Posterior: Deep pectoral
fascia
Nipples (at level of 4th intercostal space) are small and surrounded by a colored area of the skin – areola
Areolar glands – produces tiny tubercles in the areola Darkening of areola – increased deposits of melanin in
the epidermis
Axillary tail of Spence
• Extension upward and laterally piercing the deep fascia at lower border of pectoralis major
• Enters the axilla
Each breast consist of 15-20 lobes – radiate out from the nipple
• Main duct of each lobe opens separately on the summit of the nipple – each possess a dilated ampulla
(before termination)
• Lobes are separated by fibrous septa – serves as suspensory ligaments of Cooper Retromammary space
- space behind the breast filled by loose connective tissue
Arterial supply
Perforating branches of internal thoracic artery,
Medial
 Axillary artery via
intercostal arteries Lateral
lateral thoracic and thoracoacromial arteries Venous supply (correspond to arteries)
Lymph drainage
Medial Into the internal thoracic group of nodes Lateral Into the anterior axillary or pectoral group of nodes
Posterior Into the posterior intercostal nodes Innervation 4th-6th intercostal nerves
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Muscles of the Pectoral Region Origin Insertion Innervation Nerve Roots Action
Pectoralis major
• Clavicle
• Sternum
• Upper 6 costal cartilages
Lateral lip of bicipital Medial groove of humerus
and lateral pectoral nerves from brachial plexus
Adducts arm and rotates it medially
C5, 6, 7, 8, T1
Clavicular fibers also flex arm
Coracoid process of
Pectoralis minor 3rd, 4th, and 5th ribs
scapula
C6, 7, 8 Depresses point of shoulder
Medial pectoral nerve from brachial plexus
if fixed scapula – elevates ribs of origin
Subclavius 1st costal cartilage Clavicle
Nerve to subclavius from upper trunk of brachial plexus
Depresses clavicle and steadies this C5, 6
bone during movements of the shoulder girdle
Medial border and inferior
Serratus anterior Upper 8 ribs
Long thoracic nerve C5, 6, 7
border of scapula
Draws the forward anterior around the thoracic wall Rotates the scapula
The Axilla Axilla (armpit)
• Pyramid-shaped space between the upper part of the arm and side of the chest
• Forms an important passage for nerves, blood, and lymph vessels as they travel from root of the neck to the
upper limb
Apex – upper end of the axilla
• Directed into the root of the neck
• Bounded in front by the clavicle, behind by the upper border of the scapula, and medially by the outer
border of the 1st rib Base – lower end of the axilla
• Bounded in front by anterior axillary fold (lower border of pectoralis major), behind by posterior axillary fold
(tendon of latissimus dorsi and teres major), medially by the chest wall
Contents:
• Axillary artery and its branches – supply blood to upper limb
• Axillary vein and tributaries – drains blood from upper limb
• Lymph vessels and lymph nodes - drain lymph from upper limb and breast
• Brachial plexus – innervates the upper limb
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Walls of the Axilla

Anterior Wall: Pectoralis major

Subclavius Pectoralis minor

Posterior Wall: Subscapularis

Latissimus dorsi Teres major

Medial Wall: Upper 4 or 5 ribs

Intercostal spaces covered by serratus anterior

Lateral Wall: Coracobrachialis

biceps in the bicipital groove of the humerus

Base is formed by the skin stretching between anterior and posterior walls Axilla contains principal vessels and
nerves to upper limb and lymph nodes
Key Muscle in Axilla Pectoralis minor
• Crosses axillary artery and brachial plexus of nerves
• Used in describing the axillary artery to divide into 3 parts

BRACHIAL PLEXUS Complicated plexus allowing nerve fibers from different segments of the spinal cord
to be arranged and distributed efficiently in nerve trunks to the various parts of the upper limbs Formed in the
posterior triangle of the neck – union of anterior rami of the 5th to 8th cervical and 1st thoracic spinal
nerves

Important functions:
1. Sensory innervation to the skin and deep structures 2. Motor innervation to the muscles 3. Influence over the
diameters of the blood vessels by the sympathetic vasomotor nerves 4. Sympathetic secretomotor supply to
the sweat glands

Divided into roots, trunks, divisions, and cords Roots, trunks, divisions – reside in lower part of posterior
triangle of the neck Cords and its branches – arranged around the axillary artery in the axilla; enclosed in
axillary sheath

Lateral cord – Upper (C5, 6) + middle (C7) Posterior cord – Upper (C5, 6) + middle (C7) + lower (C8, T1)
Medial cord – Lower (C8, T1)
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Branches of the Brachial Plexus Branches Roots Distribution ROOTS Dorsal Scapular nerve C5
Rhomboid minor, Rhomboid major,
Levator scapulae muscles Long Thoracic nerve C5, 6, 7 Serratus anterior UPPER (SUPERIOR) TRUNK
Suprascapular nerve
C5, 6
Supraspinatus and infraspinatus Nerve to subclavius (Accessory phrenic nerve)
Subclavius *Gives contribution to phrenic nerve LATERAL CORD Lateral Pectroal nerve Musculocutaneous

nerve C5, 6, 7 Pectoralis major

Coracobrachialis, biceps brachii, brachialis POSTERIOR CORD Upper subscapular nerve
C5,6
Subscapularis Lower subscapular nerve Subscapularis and teres major Axillary nerve Deltoid and teres mainor
C5, 6, 7,
Thoracodorsal nerve C6, 7, 8 Latissimus dorsi Radial nerve
8, T1
Triceps, anconeus, part of brachialis, forearm and hand and finger muscles MEDIAL CORD Medial pectoral
nerve
C8, T1
Pectoralis major and minor Medial cutaneous nerve Skin of medial side of arm Medial cutaneous nerve of
forearm
Skin of medial side of forearm
Ulnar nerve Hand and finger muscles LATERAL + MEDIAL CORD Lateral root of median nerve C5, 6, 7

Medial root of median nerve C5, 6, 7,

Forearm, hand and finger muscles 8, T1
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
AXILLARY ARTERY and VEIN AXILLARY ARTERY
Origin: Subclavian artery Commencement: Lateral border of the 1st rib Termination: Lower border of the teres
major
Closely related to brachial plexus and their branches and with the axillary sheath Pectoralis minor muscle
– divides axillary artery into 3 parts
1. First Part – extends from lateral border of 1st rib to upper border of pectoralis minor 2. Second part – behind
the pectoralis minor 3. Third part – extends from lower border of pectoralis minor to lower border of teres
major
Axillary artery Branch Relation
Highest thoracic
1st part
artery
Anterior: Pectoralis major and skin Posterior: Long thoracic nerve Lateral: 3 cords of the brachial plexus Medial:
axillary vein
2nd part
Anterior: Pectoralis minor, pectoralis major and the Thoracoacromial
skin artery
Posterior: Posterior cord of the brachial plexus,
subscapularis, shoulder joint Lateral: Lateral cord of the brachial plexus Lateral thoracic
Medial: Medial cord of the brachial plexus and artery
axillary vein
3rd part
AXILLARY VEIN
Anterior: Pectoralis major, crossed by
Commencement: Lower border of the teres major Subscapular artery
medial root

of median nerve
Termination: Lateral border of the 1st rib Drains into subclavian vein Posterior: Subscapularis, latissimus
dorsi, teres Anterior circumflex
major, axillary and radial nerves
Formed from union of: humeral artery
Lateral: Coracobrachialis, biceps, humerus, lateral
venae comitantes of the brachial artery and basilic vein
Posterior circumflex humeral artery
Vein receives tributaries corresponding to branches of the axillary artery root of median and musculocutaneous
nerve Medial: Ulnar nerve, axillary vein, medial
cutaneous nerve of the arm
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
ARM and CUBITAL FOSSA Skin Superficial Sensory Nerves
• Cutaneous nerves on lateral surface
1. Supraclavicular nerves (C3, 4)
• Nerve supply to skin over the point of the shoulder halfway down the deltoid 2. Upper lateral cutaneous
nerve of the arm (branch of axillary nerve C5, 6)
• Nerve supply to skin over the lower half of the deltoid 3. Lower lateral cutaneous nerve of the arm (branch
of radial nerve C5, 6)
• Nerve supply to skin over lateral surface of arm below the deltoid
• Cutaneous nerves on medial surface
1. Medial Cutaneous nerve of the arm (T1)
• Nerve supply of skin of the armpit and medial side of the arm 2. Intercostobrachial nerves (T2) 3. Posterior
cutaneous nerve of the arm (branch of radial nerve C8)
• Nerve supply of skin of the back of the arm
Veins of upper limb
Deep veins Comprises the venae comitantes – accompany large arteries and the axillary vein
Superficial veins Lie in the superficial fascia
Cephalic vein Basilic vein
Commencement
Subcutaneous tissue from the lateral aspect of the dorsum of the hand (lateral of the wrist)
Medial border of the wrist
Joins venae comitantes
Termination Deltopectoral groove Lower border of teres major Drainage Axillary vein
of brachial artery

into the axillary vein

Medial cubital vein and Median vein of the forearm - Communicating veins (links cephalic and basilica
veins)
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
MUSCLES OF THE ARM Origin Insertion Innervation Nerve Roots Action ANTERIOR
COMPARTMENT
Biceps brachii
Supraglenoid tubercle of
Long head scapula
Tuberosity of radius
bicipital aponeurosis
Musculocutaneous nerve
Supinator of forearm flexor of elbow Short head Coracoid process of Weak flexor of shoulder joint
Front of
Coracobrachialis scapula Medial shaft of humerus C5, 6, 7 Flexes arm, weak adductor Brachialis
lower half of

Coronoid process of ulna C5, 6 Flexor of elbow joint

humerus POSTERIOR COMPARTMENT
Triceps
C5, 6
Long head Infraglenoid tubercle of
Lateral head Upper half of posterior
scapula Medial head surface of humerus shaft
Lower half of posterior
Olecranon process of ulna Radial nerve Extensor of elbow joint C6, 7, 8
Lateral epicondyle of the
surface of humerus shaft Anconeus
 Help stabilize elbow joint
humerus
Fascial Compartments of the Upper Arm Intermuscular septa – Divides the arm into anterior
and posterior compartment Bicipital Aponeurosis – reinforces antecubital area within the cubital fossa
Contents of the Fascial Compartment of the Upper Arm
Anterior Posterior
Muscles
Biceps brachii Coracobrachialis Brachialis
3 heads of triceps
Blood supply Brachial artery Profunda brachii Muscular Innervation Musculocutaneous nerve Radial nerve
Structures passing through the compartment
Musculocutaneous Median nerve Ulnar nerve Brachial artery Basilica vein Radial nerve (Present In Lower Part)
Radial nerve Ulnar nerve
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
ANTERIOR FASCIAL COMPARTMENT
BRACHIAL ARTERY
Origin: Axillary artery Commencement: Lower border of the teres major Termination: Neck of the Radius
Divides into Radial and Ulnar arteries
Branches
• Muscular branches to the anterior compartment of the upper arm
• Nutrient artery to the humerus
• Profunda artery - arises near beginning of the brachial artery; follows radial nerve into the spiral groove of
the humerus
• Superior ulnar collateral artery - arises near the middle of the upper arm; follows the ulnar nerve
• Inferior ulnar collateral artery - arises near the termination of the artery; takes part in the anastomosis
around the elbow joint
MUSCULOCUTANEOUS NERVE From the lateral cord of the brachial plexus (C5,6, 7) Pierces the
coracobrachialis and passes between the biceps and brachialis Appears at lateral margin of biceps tendon
and pierces deep fascia above the elbow Continues to the lateral aspect of the forearm as the lateral
cutaneous nerve
Branches
• Muscular branches to the biceps, coracobrachialis, and brachialis
• Cutaneous branches - lateral cutaneous nerve of the forearm
• Articular branches to the elbow joint
Median Nerve
From the lateral and medial cords of the brachial plexus Runs downward on the lateral of the brachial artery
Halfway down the arm – crosses brachial artery At elbow – crossed by bicipital aponeurosis
Ulnar Nerve
From medial cord of the brachial plexus Runs downward on medial side of brachial artery up to middle of the
arm At coracobrachialis insertion – pierces medial fascial septum and enters posterior compartment of the arm;
passes behind medial epicondyle of the humerus Radial Nerve Immediately enters posterior compartment of
the arm
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
POSTERIOR FASCIAL COMPARTMENT
Radial Nerve
From posterior cord of the brachial plexus Nerve winds around back of the arm in the spiral groove on back of
the humerus between head of triceps Pierces lateral fascial septum above elbow and continues into cubital
fossa In spiral groove – nerve is accompanied by profunda vessels
Branches
• In axilla -Posterior cutaneous nerve of the arm; branches given to the long and medial heads of triceps
• In spiral groove – branches given lateral and medial heads of triceps and anconeus Lower lateral
cutaneous nerve of the arm Posterior cutaneous nerve of the forearm
• In anterior compartment of the arm – gives branches to brachialis, brachioradialis, extensor carpo radialis
longus muscles Articular branches to elbow joint
Ulnar Nerve
Descends behind the septum, covered posteriorly by the medial head Accompanied by superior ulnar
collateral vessels At elbow – lies behind medial epicondyle of the humerus on the medial ligament of the
elbow joint Enters the forearm between 2 heads of origin of flexor carpi ulnaris
No articular branch to elbow joint
Profunda brachii Artery
Origin: Brachial artery Accompanies radial nerve through the spiral groove Supplies triceps muscle, takes
part in anastomosis around elbow joint Superior and Inferior Ulnar Collateral Arteries
Origin: brachial artery Take part in anastomosis around elbow joint
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Cubital Fossa Triangle depression in front of the elbow

Roof: skin and fascia reinforced by the bicipital aponeurosis Floor: Brachialis Base of the triangle: Imaginary
line between the humeral Lateral: brachioradialis Medial: Pronator teres

Contents (medial to lateral):

• Median nerve
• Bifurcation of the brachial artery
• Tendon of the biceps
• Radial nerve and its deep branch

ELBOW JOINT

Articulation: between trochlea and capitulum of the humerus and the trochlear notch of the ulna and head of
the radius
articular surfaces covered with hyaline cartilage

Type: Synovial hinge joint

Capsule: Anterior: attached above to the humerus along upper margins of coronoid and radial fossae
to the front of the medial and lateral epicondyles and below to the margin of the coronoid process of the ulna
and to the annular ligament Posterior: attached above to margins of olecranon fossa of the humerus and below
to the upper margin and sides of the olecranon process

Ligaments: Lateral ligament – triangular; attached by its apex to lateral epicondyle of humerus
Medial ligament – triangile; with 3 strong bands: anterior band, posterior band, transverse band

Synovial membrane : lines the capsule and covers fatty pads in the floors of the coronoid, radial, and
olecranon fossae
Nerve supply: Branches from median, ulnar, musculocutaneous, and radial nerves
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
BACK, SHOULDER, & SCAPULAR MUSCLES Bony Prominences
• External occipital protuberance – lies at junction of head and neck
• Seventh (7th) cervical vertebrae (vertebra prominens) – most prominent spinous process that can be felt in
the neck
• First (1st) thoracic vertebra
• Scapula
Crest of the spine – can be palpated at level of 3rd thoracic spine Medial border Superior angle – can be
palpated opposite the 1st thoracic spine Inferior angle – can be palpated opposite the 7th thoracic spine
• Iliac crest – lie at the level of 4th lumbar spine
Superficial part of the back
Sensory nerve supply
Posterior rami of spinal nerves (1st and 8th cervical nerves does not supply the skin) Arterial supply
Posterior branches of the:

Posterior intercostal vein and the

posterior intercostal arteries and the lumbar arteries Venous supply
lumbar vein

drain into azygos veins and the inferior vena cava

Deep Fascia of the back (Thoracolumbar Fascia)
• Situated in the interval between the iliac crest and the 12th rib
• Forms a strong aponeurosis
• Gives origin to middle fibers of the transversus and the upper fibers of the oblique muscle
• Medially, splits into 3 lamellae
1. Posterior lamella – covers deep muscles of the back;
attached to lumbar spines 2. Middle lamella –attached to tips of transverse processes of the lumbar
vertebrae; lies anterior to deep muscles of the back and posterior to the quadratus lumborum 3. Anterior
lamella – attached to anterior surface of the transverse
process of the lumbar vertebrae; anterior to quadratus lumborum
Muscles acting on the vertebral column
Muscles acting on the humerus
• Erector spinae Spinalis Longissimus Iliocostalis
• Transversospinalis Rotatores Multifidus Semispinalis
• Interspinales
• Intertrasnversarii
• Deltoid
• Supraspinatus
• Infraspinatus
• Teres major
• Teres minor
• Subscapularis
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
MUSCLES OF THE BACK Origin Insertion Innervation Nerve Roots Action
SUPERFICIAL MUSCLES
Trapezius
• Upper fibers: elevate the scapula
• Middle fibers: pull scapula medially
• Lower fibers: pull medial border of scapula downward
Latissimus dorsi
• Occipital bone
• Ligamentum nuchae
• Spine of 7th cervical vertebra
• Spines of all thoracic vertebra
• Upper fibers into lateral third of clavicle
• Middle and lower fibers into acromion and spine of scapula
• Spinal part of accessory nerve (motor)
• C3, C4 (sensory)
XI cranial nerve (spinal part)
• Iliac crest
• Lumbar fascia
• Spines of lower 6 thoracic vertebrae
• Lower 3-4 ribs
• Inferior angle of the scapula
Floor of bicipital groove of
Thoracodorsal nerve C6, 7, 8 Extends, Adducts, and
humerus
medially rotates the arm
Transverse processes of 1st
INTERMEDIATE MUSCLES Levator Scapula four
cervical vertebrae
Medial Border of scapula
C3, 4, 5 Raises medial border of
C3 and C4 Dorsal scapular nerve
scapula
Rhomboid Minor
• Ligamentum nuchae
Dorsal Scapular nerve C4, 5 Raises medial border of
• Spines of 7th cervical and 1st thoracic vertebrae
scapula upward and medially Rhomboid major 2nd – 5th thoracic spines Serratus Posterior Superior
Lower spines cervical and upper thoracic
Upper ribs

Intercostal Nerves
Raises ribs Inspiratory muscle Serratus Posterior Inferior
Upper spines lumber and lower thoracic
Lower ribs Depresses ribs

Expiratory muscle DEEP MUSCLES Splenius capitis

Lower part of ligamentum nuchae Upper 4 thoracic spines
Superior nuchal line of occipital bone and mastoid process of temporal bone Posterior rami of spinal
nerves
Bends neck laterally Elevates medial border of the scapula Splenius cervicis Transverse process of upper
cervical vertebrae Erector spinae, Transversospinalis, Interspinales, Intertransversarii
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
SHOULDER and SCAPULAR MUSCLES Origin Insertion Innervation Nerve Roots
Action
Deltoid
Abducts the arm
• Lateral third of the clavicle
• Acromion
• Spine of the scapula
Axillary nerve
Middle lateral surface of shaft of humerus • Anterior fibers: flex and
C5, 6

medially rotate arm

• Posterior fibers: extend and laterally rotate arm
Supraspinatus Supraspinous fossa of scapula
Greater tuberosity of humerus Capsule of shoulder joint
C4,5, 6 Abducts arm and stabilizes
Suprascapular nerve
Upper two thirds of the
shoulder joint Infraspinatus Infraspinous fossa of scapula Teres minor
Axillary nerve
lateral border of scapula
Laterally rotates arm and Lower third of
(C4), 5, 6 stabilizes shoulder joint Teres major
lateral border of scapula
Medial lip of bicipital groove of humerus Subscapularis Subscapular fossa Lower subscapular
Upper and lower
nerve Lesser tuberosity of humerus
C6, 7 Medially rotates arm
subscapular nerves
C5, 6, 7
Adducts arm Stabilizes shoulder joint Rotator Cuff Muscles:
• SITS muscles
Supraspinatus Infraspinatus Teres minor Subscapularis
• Stabilizes shoulder joint
• Acts in coordination to hold the head of the humerus in the glenoid fossa
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Triangle of Auscultation Site on the back where breath sounds may be most easily heard with a
microscope
Inferior: Superior border of the latissimus dorsi Medial: Inferior fibers of the trapezius Lateral: Medial border of
the scapula

Lumbar Triangle Site where pus may emerge from the abdominal wall (pus accumulation may
occur)
Inferior: Iliac crest Medial: Inferior border of latissimus dorsi Lateral: posterior border of the external oblique of
the abdomen

Suboccipital Triangle
Medial: Rectus capitis posterior major Lateral: Oblique capitis superior
Oblique capitis inferior
Triangular space
Superior: Teres minor Inferior: Teres major Lateral: Long head of triceps brachii Contains circumflex
scapular artery

Quadrangular space
Superior: Subscapularis Inferior: Teres major Medial: Long head of triceps brachii Lateral: surgical neck of
humerus Contains Axillary nerve and Posterior circumflex humeral artery
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
Arterial anastomosis around the shoulder joint
• Anastomosis between the branches of the subclavian artery and axillary artery
• Ensures adequate blood flow in upper limb irrespective of arm positioning

Branches from Subclavian artery

• Suprascapular artery - distributed to the supraspinous and infraspinous fossae of the scapula
• Superficial cervical artery - gives off a deep branch running down the medial border of the scapula

Branches from Axillar artery

• Subscapular artery and its circumflex scapular branch - supply the subscapular and infraspinous fossae
of the scapula respectively
• Anterior circmflex humeral artery
• Posterior circumflex humeral artery Both Circumflex arteries form an anastomosing circle around the
surgical neck of the humerus

SHOULDER JOINT

Articulation: between rounded head of the humerus and shallow, pear-shaped glenoid cavity of the scapula
articular surfaces covered by hyaline cartilage; glenoid cavity deepened by glenoid labrum (fibrocartilaginous
rim) Type: Synovial ball-and-socket joint Capsule: surrounds the joint and attached medially to the margin of
the glenoid cavity outside the labrum
Thin and lax – allows movement; strengthened by fibrous slips from the tendons of the subscapularis,
supraspinatus, infraspinatus, and teres minor

Ligaments: Glenohumeral ligaments – 3 weak bands of fibrous tissue, strengthen front of the capsule
Transverse humeral ligament – strengthens the capsule and bridges the gap between 2 tuberosities
Coracohumeral ligament – strengthens capsule above and stretches from the root of the coracoid process to
the greater tuberosity of the humerus

Synovial membrane : lines the capsule and attached to margins of the cartilage covering the articular surfaces
extends through anterior wall of the capsule – forms subscapularis bursa beneath subscapularis Nerve supply:
Axillar and suprascapular nerves
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
TOPOGRAPHIC ANATOMY
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
MUSCLE ATTACHMENT and INSERTION
Anatomy 1C Joshua Montelibano 1st shift 2015-2016
CLAVICLE, SCAPULA and HUMERUS
Anatomy 1C Joshua Montelibano 1st shift 2015-2016