MUSCLES OF

THE SHOULDER
REGION

1
DELTOID
 Origin: Lateral third of
clavicle, acromion and
spine of scapula

 Insertion: Deltoid
tuberosity of humerus

 Innervation: Axillary nerve

 Action: Abducts, adducts,

flexes, extends and
rotates arm
 LATISSIMUS DORSI
 Origin: Spines of T7-T12,
thoracolumbar fascia, ribs
9-12

 Insertion: Floor of bicipital

groove of humerus

 Innervation:
Thoracodorsal

 Action: Adducts, extends,

and rotates arm medially
SUPRASPINATUS
 Origin: Supraspinous fossa
Insertion: Superior facet of
greater tubercle of humerus
 Innervation: Suprascapular
 Action: Abducts arm

INFRASPINATUS
 Origin: Infraspinous fossa
 Insertion: Middle facet of
greater tubercle of humerus
 Innervation: Suprascapular
 Action: Rotates arm laterally
SUBSCAPULARIS

 Origin: Subscapular
fossa

 Insertion: Lesser tubercle

of humerus

 Innervation: Upper and

lower subscapular nerves

 Action: Adducts and

rotates arm medially
TERES MAJOR
 Origin: Dorsal surface of inferior
angle of scapula
 Insertion: Medial lip of
intertubercular groove of humerus
 Innervation: Lower subscapular
 Action: Adducts and rotates arm
medially

TERES MINOR
 Origin: Upper portion of lateral
border of scapula
 Insertion: Lower facet of greater
tubercle of humerus
 Innervation: Axillary
 Action: Rotates arm laterally
MUSCLES OF
THE ARM

7
THE ARM
 The arm is divided into
anterior and posterior
compartments by
extension of deep fascia
which are called the
medial and lateral
intermuscular septa.

 Contains the
neurovascular
structures, the brachial
vessels being vastly
prominent.
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INTERMUSCULAR SEPTA

 Intermuscular septa
are fibrous septa
attached the
supracondylar ridge of
the humerus.

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INTERMUSCULAR SEPTA
 Medial intermuscular septum
gives origin to the most
medial fibres of brachialis and
the medial head of triceps.

10
ANTERIOR COMPARTMENT OF ARM

11
ANTERIOR COMPARTMENT OF ARM

12
 ANTERIOR COMPARTMENT OF ARM
 Three flexor muscles out
of the four major arm
muscles are in the anterior
(flexor) compartment.

These muscles are:

 Coracobrachialis
 Biceps brachii
 Brachialis

13
ANTERIOR COMPARTMENT OF ARM CONT’D

14
CORACOBRACHIALIS
 Origin: Apex of the
coracoids process.

 Insertion: Midway along

the medial border of the
humerus

 Nerve supply:
Musculocutaneous nerve
(C5,6).

 Action: Weak flexor and

adductor of the shoulder
joint.
15
CORACOBRACHIALIS

 It is an important
landmark for locating
other structures in the
arm.

16
ANATOMICAL LANDMARKS AT
THE INSERTION OF THE
CORACOBRACHIALIS
Bone: The circular humeral shaft becomes triangular below
this level.

Fascial septa: The medial and lateral intermuscular septa

becomes better defined from this level downwards.

Muscles
(i) Deltoid is inserted at this level (ii) Upper end of origin of
brachialis. (iii) Upper end of origin of the medial head of
triceps.

17
 ANATOMICAL LANDMARKS AT
THE INSERTION OF THE
CORACOBRACHIALIS
Arteries
(i) The brachial artery passes from the medial side of the arm to
its anterior aspect.
(ii) The profunda brachii artery runs in the spiral groove and
divides into its anterior and posterior descending branches.
(iii) The superior ulnar collateral artery originates from the
brachial artery, and pierces the medial intermuscular septum with
the ulnar nerve.
(iv) The nutrient artery of the humerus enters the bone.

Veins
(ii) The basilic vein pierces the deep fascia.
(ii) Two venae commitantes of the brachial artery may unite to
form one brachial vein.
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 ANATOMICAL LANDMARKS AT THE
INSERTION OF THE CORACOBRACHIALIS
Nerves
(i) The median nerve crosses over the brachial artery from
the lateral to the medial side.

(ii) The medial cutaneous nerve of the arm and forearm

pierces the deep fascia.

(iii) The ulnar nerve pierces the medial intermuscular septum

with the superior ulnar collateral artery and courses to the
posterior compartment.

(v) The radial nerve pierces the lateral intermuscular septum

with the anterior descending (radial collateral) branch of the
profunda brachii artery and passes from the posterior to the
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 Origin:
BICEPS  Long head: supraglenoid
tubercle and adjoining part of the
glenoid labrum of the scapula.
Short head: apex of the
coracoids process to the lateral
side of the coracobrachialis.
 Insertion: Radial Tuberosity

 Nerve supply:
Musculocutaneous nerve (C5,6),
one branch to each belly.

 Action: Powerful flexor of the

elbow and supinator of the
forearm.
20
BICEPS cont’d
 Based on its origin and
insertion, the muscle has
has no articular
attachment to the
humerus.

 The tendon has a broad

medial expansion called
the bicipital aponeurosis

21
BICEPS cont’d
 The muscle tendon is
surrounded by a sheath of
synovial membrane as it
descends in the
intertubercular sulcus of
the humerus

 The two bellies lie side by side

and are loosely connected
until just above the elbow joint
where they merge .

22
BICEPS CONT’D

23
BICEPS BRACHI TEST
 Test: The forearm is
supinated and the
elbow is flexed against
resistance.

 The contracted muscle

forms a prominent
bulge, and the tendon
and aponeurosis at the
elbow are easily
palpable.

24
BRACHIALIS  
 The brachialis is a
flattened fusiform muscle
that lies posterior (deep) to
the biceps.

 It covers the anterior part

of the elbow joint

 It is the main flexor of the

forearm

25
BRACHIALIS
  The muscle always
contracts when the elbow is
flexed and is primarily
responsible for sustaining
the flexed position.

 It is regarded as the
workhorse of the elbow
flexors because of its almost
constant role and
importance.

 It steadies movement by
slowly relaxing when the
forearm is extended slowly
 
26
BRACHIALIS
 Origin: Anterio-inferior aspect of
the humeral shaft & the medial
intermuscular septum.

 Insertion: Coronoid process

and Ulna tuberosity.

 Nerve supply:
Musculocutaneous nerve
(C5,6), with small lateral part of
the muscle innervated by a
branch of the radial nerve (C7).

 Acton: Flexor of the elbow joint.

27
BRACHIALIS
 
 Test: The forearm is
semipronated and flexed
against resistance, and
the contracted muscle
can be seen and
palpated if acting
normally.

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POSTERIOR COMPARTMENT OF THE ARM
 The posterior (extensor)
compartment of the arm is
occupied by the triceps muscle.

 The radial nerve and profunda

artery run through it, and the ulnar
nerve passes through the lower
part of this compartment.

Origin: The long head from the

infraglenoid tubercle of scapula.
The lateral head is linear, superior
to radial groove. The medial head
arises from the inferior 2/3rd of the
humerus.

29
TRICEPS  Insertion/attachment:
Attached to the proximal
(upper) end of olecranon
of ulna and fascia of
forearm. A few fibres are
inserted into the posterior
part of the capsule of the
elbow joint.

 Nerve supply: Radial

nerve (C6,7 and 8).

 Action: Chief extensor of

forearm, extensor of the
elbow joint.
30
TRICEPS
 The long head of triceps
crosses the glenohumeral joint,
and helps to stabilize the
adducted glenohumeral joint

 The lateral head of the triceps

has a linear origin from the
back of the humerus.

 The medial head is deep to

long and lateral head, forming
the deep lamina of the tendon. 

31
TRICEPS CONT’D

32
TRICEPS TEST

 Test: The muscle is seen

and felt when the flexed
forearm is extended
against resistance.

33
ANCONEUS

 A small, triangular muscle

 Origin: Posterior aspect of

the lateral epicondyle of the
humerus.

 Insertion: Olecranon of the ulna.

 Innervation: Motor branch of

the radial nerve 

 Action: Extension of Forearm at

elbow joint

34
CUBITAL FOSSA
 INTRODUCTION

o Anatomical Position: It is
located anterior to the elbow
joint.

o Anatomical Shape: The fossa is

a triangular hollow/depression

o The cubital fossa marks the

transition between the brachium
and the antebrachium.
 BORDERS
 Laterally: medial border of
brachioradialis muscle

 Medially: lateral border of pronator

teres muscle

 Base: An imaginary horizontal line

connecting the two epicondyle of the
humerus

 Apex: by the intersection of the

medial and lateral borders. Here the
brachioradialis overlaps the pronator
teres.
 BORDERS CONT’D
Roof: by the;
1. skin
2. superficial fascia which
contains (i) median cubital vein
joining the cephalic and basilic
veins. (ii) medial and lateral
antebrachial cutaneous nerves
3. Deep fascia, reinforced
by the bicipital aponeurosis

Floor: brachialis proximally

&
supinator muscle distally
Structures in the roof Floor of the cubital
of the cubital fossa fossa
CONTENTS IN THE CUBITAL FOSSA
From lateral to medial, they
include:

 Radial nerve: it is not always

strictly considered part of the
cubital fossa, but it is in the
vicinity, passing underneath the
brachioradialis muscle.

 Biceps tendon: it runs through

the cubital fossa, attaching to the
radial tuberosity, just distal to
the neck of the radial tuberosity.
CONTENTS IN THE CUBITAL FOSSA

 Brachial artery: It bifurcates

into the radial and ulnar
arteries at the apex of the
cubital fossa.

 Median nerve: it leaves the

cubital fossa between the two
(2) heads of the pronator
teres. It supplies the majority
of the flexor muscles in the
forearm.
 APPLIED ANATOMY
BRACHIAL PULSE AND
BLOOD PRESSURE
 During blood pressure
measurements, the
stethoscope is placed over
the brachial artery which
runs medial to the biceps
tendon in the cubital fossa.

 The brachial pulse may be

palpated in the cubital
fossa just medial to the
Blood pressure being taken
tendon.
 SUPRACONDYLAR FRACTURE
 A transverse fracture that spans
between the two epicondyle.

 It is a common fracture, especially

in the young and usually occurs by
falling onto a hyper-extended
elbow. It can also occur by falling
onto a flexed elbow.

 The fracture fragments may impinge

and cause interference to the blood
supply of the forearm from the
brachial artery. This can result to
Volkmann’s ischaemic contracture Post-fracture Volkmann’s
swelling ischaemic contracture
 VENIPUNCTURE
• The area just superficial to the
cubital fossa is often used for
venous access (phlebotomy).

• The superficial veins in the

cubital fossa are the common
sites for venipuncture.

• Median cubital vein connects

the basilic vein to the cephalic
vein and can be accessed for
venipuncture.
THE END