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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 and fingers
 Muscles That Position the Pectoral Girdle
 Trapezius



Superficial
Covers back and neck to base of skull
Inserts on clavicles and scapular spines
Rhomboid and levator scapulae
Deep to trapezius
Attach to cervical and thoracic vertebrae
Insert on scapular border
 Muscles That Position the Pectoral Girdle
 Serratus anterior

On the chest

Originates along ribs

Inserts on anterior scapular margin
 Muscles That Position
the Pectoral Girdle
 Subclavius

Originates on ribs

Inserts on clavicle
 Pectoralis minor

Attaches to scapula
Anterior thoracic Muscles
(Pictorials Muscle Dose not
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
(C5,C6)
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
(C5,c6)
INFRASPINATUS
TERES MINOR
 ORIGIN: lat.borderof the
scapula
 INSERTION: inf.facet on
the gr.tubercle of the
humerus
 ACTION: ext.rotator &
weak adductor
 N.SUPPLY: Axillary
.N.(C5,C6)
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 (c5,c6)
Sub-scapularis
Muscle
SUBSCAPULARIS
Appendicular Musculature
[INSERT FIG. 11.15a]
Muscles That Position the Pectoral Girdle.
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
(C6,C7)
Teres major
 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
[INSERT Table. 11.8 (top portion)]
[INSERT Table. 11.8 (middle portion)]
 Anterior Muscles of the Vertebral Column
 Spinal flexors
 Neck
 Longus capitis and longus colli
 Rotate and flex the neck
 Lumbar
 Quadratus lumborum muscles
 Flex 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.(C7,c8)
The ARM
 An aponeurotic sheet separating
various muscles of the upper limbs,
including lateral and medial
humeral septa.
 The
lateral
and
medial
intermuscular septa divide the
distal part of the arm into two
compartments:
 Anterior compartments
 also known
compartment
as
the
 Posterior compartments
flexor
 also known as the extensor
compartment
Lateral
Medial
intermuscul intermuscul
ar septum
ar septum
ski
n
Fasci
a
Humeru
s
Neurovascul
ar bundle
MUSCLES OF FOREARM
 Anterior Compartment:
common flxor origin
 SUPERFICIAL 1.Pronator Teres
2.Flx Carpi Ulnaris
3.Palmaris Longus
4.Flx.Carpi Radialis
5.Flx.Digitorum Superficialis (sublimus)
 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 (C6c7)
FLX.CARPI RADIALIS
 INSERTION:base of the 2nd mc
bone and slip to the bace of the
3rd MC bone
 ACTION: flexion and
abduction of wrist
 N.SUPPLY: Median.N (c6,c7)
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 (c6,c7)
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 5th MC
& flx.retinaculum
 ACTION:flexes and adducts the
hand
 N.SUPPLY: Ulnar.N (C7,C8)
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 (C7,C8,T1)
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 (C8,t1)
Lateral-AIN Of Median.N
(C8,t1)
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 (C7,C8,T1)
PRONATOR QUADRATUS
 ORIGIN: lower 1/4th of anterior
surface of ulna
 INSERTION: lower 1/4th of
anterior surface of radius
 ACTION :pronation
 N.SUPPLY:AIN (C8,T1)
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.2/3rd 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 (C5,C6)
EXT.CARPI RADIALIS LONGUS
 ORIGIN: lat.supracondylar ridge
of humerus
 INSERTION: base of the 2nd MC
bone
 ACTION: extends and abducts the
hand
 N.SUPPLY: Radial .N (C6,C7)
EXTENSOR CARPI RADIALIS BREVIS
 ORIGIN: lat.epicondyle of the
humerus
 INSERTION: base of the 3rd MC
bone
 ACTION: extends and abducts the
wrist
 N.SUPPLY: deep br.of radial
.N(c7c8)
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 (c7,c8)
EXTENSOR DIGITI MINIMI
 ORIGIN:lat epicondyle of the
humerus
 INSERTION:extensor expansion of
the 5th digit
 ACTION: ext.of 5th digit at MC, PIP ,
ext of wrist when little finger in
extension
 N.SUPPLY:PIN (c7,c8)
EXT.CARPI ULNARIS
 ORIGIN:2 heads
lat epicondyle of humerus,
Posterior border of ulna
 INSERTION:medial side of the base
of the 5th MC
 ACTION: extends and adducts the
hand
 N.SUPPLY:PIN (c7c8)
SUPINATOR
 ORIGIN:
lat epicondyle of humerus, radial
collateral lig.,
annular lig.,supinator fossa,
crest of ulna
 INSERTION:
lateral,posterior,anterior surface
of prox 1/ 3rd 0f radius
 ACTION:supination
 N.Supply: deep Br.Of Radial.N
(C5,c6)
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 1st MC
bone
 ACTION: abducts,extends,
lat.rotates the thumb at
carpometacarpal joint, & abducts
the wrist.
 N.SUPPLY:PIN (c7,c8)
EXTENSOR POLLICIS BREVIS
 ORIGIN:posterior surface of the
radius below the origin ofAbductor
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 1st
carpometacarpal joint
 N.SUPPLY:PIN (c7,c8)
EXT.POLLICIS LONGUS
 ORIGIN: posterior surface of
middle 1/3rd 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 (c7,c8).
EXTENSOR INDICIS
 Origin:posterior surface of ulna
m/3rd below the EPL
 Insertion:extensor expansion of
the 2nd finger
 Action: ext of index finger and
wrist.
 N.supply:PIN (c7,c8)
Forearm 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,UpprLimb
CARPAL TUNNEL
 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
Latissimus dorsi