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3 Cards in this Set
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Neurovasculature of shoulder and arm region |
1. Veins: there are two major veins which run from the shoulder region to the length of the arm. They are:
* cephalic vein runs from the lateral side of the shoulder down the arm, it joins with basilic vein at the cubital fossa to form a median cubital vein.
* basilic vein runs from the median side of the arm(originates from the armpit) and runs down the entire length of the arm.
* medial antebrachial vein is formed from the joining of the cephalic and basilic vein. This vein can be seen on the inside of the forearm after the cubital fossa.
2. Nerves: the network of nerves in this region originates from the brachial plexus. The brachial plexus is a network of nerves from the fifth to the 8th cervical vertebrae and the first thoracic vertebrae, ths network is responsible for the nerve supply of the muscles of the arm and shoulder.
* musculocutaneous nerve originates from the superior trunk and the lateral cord. It leads straight into the upper aspect of the arm and terminates as the lateral antebrachial cutaneous nerve at the anterior region of the forearm, just past the elbow joint.
* axillary nerve is another major nerve which rus into the upper part of the arm (quadrangular space) , just next to the musculocutaneous nerve. It splits from the posterior cord along with the radial nerve. * axillary nerve branches to supply teres minor before going into the quadrangular space, it then branches into the superior lateral brachial cutaneous nerve after coming out of the space.
* median nerve runs through the middle of the arm. It originates from the lateral and medial cord. Next to it is the longest nerve that runs the length of the arm, it is called the medial cutaneous nerve of the forearm. Also medial antebrachial cutaneous nerve runs close by.
*ulnar nerve splits from the median cord thus it runs close to the medial nerve, it supplies the muscles in the ulnar aspect of the forearm.
* radial nerve splits from the posterior cord where the axillary nerve splits too. It supplies the muscles associated with the radius, it goes into the triangular space forearm I. E. It is a deep nerve.
* lower, middle and upper subscapular nerve originate from the posterior cord and the supply muscles in the scapular region.
*lateral antebrachial cutaneous nerve is a branch from the musculocutaneous nerve, it terminates on the brachioradialis muscle of the arm.
Note: medial cutaneous nerve, medial antebrachial cutaneous nerve and ulnar nerve all run next to each other.
3. Arteries: the network of arteries in the shoulder and arm region are highly essential as they transport oxygenated blood to the active muscle cells. All of the branches of arteries come from the brachial/axillary artery.
* major artery : this starts off as the subclavian artery and then becomes the axillary artery once its past the initial shoulder region. Once it's past the teres major muscle it becomes the brachial artery. It branches into the profunda brachii I. E. The deep brachial artery in order to supply inner and posterior muscle cells.
*anterior and posterior circumflex humeral artery (posterior has ascending and descending branches, ascending branch joins with acromio and acromial anastomosis while descending branch supplies the triceps muscles. )
*circumflex scapular artery is a branch of subscapularis artery branching from the axillary artery. thoracodorsal artery is the second branch of the subscapularis artery.
* the radial nerve and profunda brachii lead into the lateral intermuscular septum after exiting the triangular space in the posterior region of the arm. Before entering the septum, profunda brachii branches into middle collateral artery and the rest becomes radial collateral artery. Radial nerve also branches into the nerve supplying anconeus and medial head of triceps brachii and the posterior antebrachial cutaneous nerve as well as the inferior lateral brachial cutaneous nerve.
* brachial artery and median nerve go into the hiatus covered by bicipital aponeurosis whereby brachial artery splits into ulnar and radial artery.
*Branches of ulnar, middle and radial collateral arteries:
. the ulnar collateral artery has a superior and inferior bracnch, once past the medial epicondyle of the humerus, the inferior branch becomes the anterior ulnar recurrent artery an And the superior branch becomes the posterior ulnar recurrent artery.
. The middle collateral artery becomes the recurrent interosseous artery past the trochlea of the humerus and joins with the common interosseous artery at the interosseous membrane of the forearm.
. The radial collateral artery becomes the radial recurrent artery past the lateral epicondyle of the humerus.
*ulnar artery: the posterior and anterior recurrent ulnar arteries join into this major artery that runs through the ulnar aspect of the forearm.
* radial artery: the radial recurrent artery joins into this major artery that supplies the radial region of the forearm.
* deltoid, pectoral, acromial, clavicular branch of the thoraco-acromial branch of axillary artery.
* Common, posterior and anterior interosseous arteries which run through the interosseous membrane of the forearm.
* superior and lateral thoracic artery.
* supra scapular artery branches out of the vertebral artery and has a supraspinous branch supplying suprapinatus and infraspinous branch supplying infraspinatus.
NB! * quadrangular space is found on the posterior region of shoulder and arm. It is bordered by teres minor, long head of biceps brachii, teres major and the humerus. This space transmits axillary nerve from the posterior cord and posterior circumflex humeral artery to the posterior aspect of the arm.
* triangular space is bordered by teres major, long head and short head of biceps brachii. It transmits profunda brachii and radial nerve.
* the blood vessels are a trio I.e. They go together, artery nerve and vein are together.
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Muscles of the shoulder and arm region |
1. Posterior region of shoulder and back: posterior deltoideus, latissimus dorsi, minor and major rhomboid, levator scapulae, trapezius, suprapinatus, infraspinatus, teres major, teres minor.
2. Anterior region of shoulder and chest region: anterior deltoideus, trapezius, external oblique, serratus anterior, pectoralis major and minor, ege of latissimus dorsi muscle just next to serratus anterior muscles. Tendon and body of subscapularis (deep layer underneath pectoralis major)
3. Anterior region of muscles of the arm: long and short head of biceps brachii, coracobrachialis, pronator teres, brachialis, brachioradialis.
4. Posterior region of muscles of the arm: long and lateral head of triceps brachii, flexor carpi ulnaris, extensor digitorum and extensor carpi radialisd brevis muscle. |
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Origin (proximal attachment) and insertions (distal attachment) of the muscles of the upper body. |
1. Biceps brachii: ( medial and lateral region of arm) * origin of the long head is the supra glenoid tubercle of scapula. Origin of short head is the tip of the coracoid process of scapula. * insertion of this muscle is at the radial tuberosity, fascia of the forearm via the bicipital aponeurosis. * nerve supply is by musculotaneous nerve and radial nerve. * blood supply is radial recurrent artery, muscular branches of the brachial artery. * main movement is flexion.
2. Brachialis: (lateral edge of distal humerus) * origin is at the distal (end) half of the anterior surface of the humerus. * it inserts into the coronoid process and tuberosity of the ulna. * nerve supply is by musculotaneous nerve and radial nerve. * old supply is radial recurrent artery and muscular branches of brachial artery. * major movement is flexion.
3. Brachioradialis: (lateral edge of inferior arm) *origin is the two-third of the lateral supracondylar ridge of humerus. * insertion Is the lateral side of the distal end of radius * nerve supply by radial nerve * blood supply is radial recurrent artery * movement is weak flexion of forearm when forearm is midpronated.
4. Coracobrachialis: (medial edge of superior arm) * origin is the tip of the coracoid process of the scapula. * insertion is the the middle third of the medial surface of the humerus. * nerve supply is the musculotaneous nerve * blood supply is the muscular branches of the brachial artery. * movements are flexion and adduction of arm at shoulder.
5. Deltoid: (posterior/superior/lateral shoulder) * origin is the anterior clavicle, lateral acromion, inferior Edge of spine of scapula. *insertion is the deltoid tuberosity of the humerus. * nerve supply is axillary nerve * blood supply is posterior circumflex humeral artery, deltoid branch of thoraco-acromial artery. * movements are divided into three ; the clavicular part flexes and medially rotates the arm, the acromial part a ducts arm beyond initial 15° done by the suprapinatus, the spinal part extends and laterally rotates the arm.
6. Infraspinatus: (poster-inferior shoulder) * origin is the infraspinous fossa of the scapula and deep fascia. * insertion is the middle facet of the greater tubercle of the humerus. * nerve supply is the suprascapular nerve. * blood supply is by the suprascapular artery. * movement is lateral rotation of arm along with the help of teres minor.
7. Latissimus dorsi: (poster-inferior shoulder) * origin is the spinous processes T7- L5 vertebrae, thoracolumbar fascia, iliac crest, last 3 ribs. * insertion is the intertubular sulcus of humerus. * nerve supply is the thoracodorsal nerve. * blood supply is thoracodorsal artery, first three lumbar arteries. * movements are extension, adduction and medial rotation of humerus at shoulder.
8. Pectoralis major: (pectoral region/axilla) * origin is the sternal half of the clavicle, sternum to the 7th rib, cartilage of the true ribs, aponeurosis of external oblique muscles. * insertion is the lateral lip of intertubucular sulcus of humerus. * nerve supply is by the medial and lateral pectoral nerves. * blood supply is by the pectoral branch of the thoraco-acromial artery, perforating branches of internal thoracic artery. * movements are the flexion and adduction of the arm. It also rotates the arm medially.
9. Triceps brachii: (posterior and medial arm) * origin of long head is infraglenoid tubercle of scapula. Origin of lateral head is upper half of posterior humerus. Origin of medial head is distal two third of medial and posterior humerus. * insertion is the posterior surface of olecranon process of ulna * nerve supply is the radial nerve * blood supply is the branch of profunda brachii artery. * movements are extension of forearm at elbow, long head stabilises head of abducted humerus and extends and addicts arm at shoulder.
10. Teres major : (posterior shoulder) * origin is the posterior surface of inferior angle of scapula. * Insertion is the medial lip of intertubular sulcus of humerus. * nerve supply is lower subscapular nerve. * blood supply is circumflex scapular artery. * movements are adduction and medial rotation of arm.
11. Supraspinatus: (superior posterior shoulder) * origin is the supraspinous fossa of scapula and deep fascia. * insertion is the superior facet of greater tubercle of humerus. * nerve supply is the suprascapular nerve. * blood supply is suprascapular artery. * movements are the initiation of arm abduction. It acts with the rotator cuff muscles.
12. Serratus anterior: (inferior shoulder) * origin is lateral surface of upper 8-9 ribs. *insertion is the costal surface of medial border of scapula. *Nerve supply is the long thoracic nerve. * blood supply is lateral thoracic artery. *Movements: protracts and rotates scapula and holds it against the thoracic wall.
13. Subscapularis : (deep anterior shoulder) *origin is the subscapular fossa * insertion is the lesser tubercle of the humerus. * nerve supply is the upper and lower subscapular nerves * blood supply is the subscapular artery and lateral thoracic artery. * movements are it medially rotates the arm at the shoulder and addicts it. It so helps hold the humeral head in the glenoid cavity.
14. Teres minor: (posterior shoulder) * origin is the upper two third of the posterior surface of the lateral border of the scapula. * insertion is the inferior facet of the greater tubercle of the humerus. * nerve supply is the axillary nerve * blood supply is the circumflex scapular artery. * movements are the lateral rotation of the arm.
15. Supinator: (posterior forearm) * origin is the lateral epicondyle of the humerus and the supinator crest of the ulna. * insertion is the lateral, posterior and anterior surfaces of the proximal third of the radius. * nerve supply is the deep branch of the radial nerve. * blood supply is the radial recurrent artery and posterior interosseous arteries. * movement is supination of the forearm.
16. Anconeus: ( posterior superior forearm) * origin is the posterior surface of lateral epicondyle of humerus * insertion is the lateral surface of the olecranon and posterior proximal ulna. * nerve supply is the radial nerve * blood supply is the deep brachial artery. * movements are the assisting of the triceps in extending the elbow, a ducting the ulna in pronation.
17. Pectoralis minor: (pectoralis region /axilla) * origin is the outer surface of upper margin of ribs 3-5. * insertion is the coracoid process of scapula * nerve supply is the medial pectoral nerve. * blood supply is the pectoral branch of thoraco-acromial and intercostal lateral thoracic arteries. * movements are that it lowers the lateral angle of scapula and protracts scapula.
18. Levator scapulae: (superficial back superior) * origin is the posterior tubercles of the transverse processes of C1-C4. * insertion is the medial border of scapula above spine of scapula. * nerve supply is the ventral rami of c3-c4 and dorsal scapular nerve. * blood supply is the dorsal scapular artery, transverse cervical artery, ascending cervical artery. * movements are the elevation of the scapula medially and inferior rotation of glenoid cavity.
19. Rhomboid major: (superfi ial back inferior) * origin is the spinous processes of t2 - t5 vertebrae. * insertion is medial border of scapula below base of spine of scapula. * nerve supply is dorsal scapular nerve * blood supply is dorsal scapular artery or deep branch of transverse cervical artery, dorsal perforating branches of the upper five or six intercostal arteries. * movements are fixation of scapula to thoracic wall and retraction/rotation of scapula to depress glenoid cavity.
20. Rhomboid minor: ( superficial back inferior) * origin is ligamentum nuchae, spines of c7 and t1 vertebrae. * insertion is the medial border of scapula at spine of scapula. * nerve supply is dorsal scapular nerve. * blood supply is dorsal scapular artery or branch of transverse cervical artery, dorsal perforating branches of the upper five or six posterior intercostal arteries.
21. Trapezius: (superior superficial back) *origin is superior nuchal line, external occipital tuberance, nuchal ligament, spinous processes C7 - T12. * insertions are lateral third of clavicle, acromion and spine of scapula. * nerve supply is accessory nerve. * blood supply is transverse cervical artery, dorsal perforating branches of posterior intercostal arteries. * movements are elevation, retraction and rotation of scapula. The lower fibres of the trapezius depress the scapula.
22. Pronator teres: (forearm and distal end of humerus) * origin is at two heads; the medial epicondyle of humerus and coronoid process of ulna. * insertions are midway along lateral surface of radius. ( below supinator insertion, posterior view of forearm). * nerve supply is the median nerve * blood supply is the anterior ulnar recurrent artery. * movement is to probate forearm and assist with elbow flexion. |
