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Shoulder girdle and brachial plexus anatomy
- 1. Shoulder Girdle and Brachial Plexus Anatomy Presenter Dr Junaid Ahmad Post Graduate Registrar JB&RSC
- 2. • Surface Anatomy • Sensory Supply • Bones • Muscle Attachments
- 5. Lymphatics and Superficial Veins
- 6. Bones and Joint • Bones of Shoulder – Clavicle – Scapula – Humerus – Muscle also originate from skull, ribs, sternum and spines • Joint – Shoulder Joint – Acromio Clavicular Joint
- 7. Clavicle
- 8. Clavicle
- 9. Fractures of Clavicle Location Medial two third and lateral one third junction Complications Nerve entrapments supraclavicular nerve Mostly need little treatment
- 10. Non Fracture Conditions of Clavicle Compressions due to narrow space Brachial plexus Subclavian Artery and Vien
- 11. Humerus Scapula
- 12. Humerus Scapula
- 13. Humerus Scapula
- 14. Humerus Scapula
- 15. Fractures of Scapula Associated with high energy run overs Also fractured ribs mostly Mostly need little treatment
- 16. Non fracture conditions of Scapula Dropping Due to Trapezius paralysis Winging Due to serratus anterior paralysis
- 17. How to check
- 18. Common Fractures of Humerus • Humeral Head Fractures • Greater Tuberosity Fractures • Lesser Tuberosity Fractures • Surgical Neck Fractures • Fractures of the Shaft of the Humerus • Radial Nerve • Supracondylar fractures • VIC • The medial epicondyle
- 19. Common Fractures of Humerus
- 21. Axilla • Pyramidal in shape • Apex in neck • Four walls • Contains vessles, nerves and lymphatics
- 22. Walls of Axilla • Anterior wall • By the pectoralis major, subclavius, and pectoralis minor muscles • Posterior wall • By the subscapularis, latissimus dorsi, and teres major muscles from above down • Medial wall • By the upper four or five ribs and the intercostal spaces covered by the serratus anterior muscle • Lateral wall • By the coracobrachialis and biceps muscles in the bicipital groove of the humerus
- 23. Walls of Axilla
- 24. Pectoralis Major Muscle • Origin • Sternum, Upper 6 costal cartilages, Clavicle • Insertion • Lateral lip of bicipital groove of humerus • Nerve Supply • Medial and lateral pectoral nerves from brachial plexus (B.P) C6,7,8 • Function • Adduct and medially rotate the arm
- 26. Pectoralis Minor Muscle • Origin • 3rd 4th and 5th ribs • Insertion • Coracoid process of scapula • Nerve Supply • Medial pectoral nerve from B.P C7 • Function • Depress the shoulder / Elevate the ribs
- 28. Subclavius Muscle • Origin • 1st costal cartilage • Insertion • Clavicle • Nerve Supply • Nerve to subclavius from upper trunk of B.P C5 • Function • Depress the clavicle
- 29. Serratus Anterior Muscle • Origin • Upper 6 ribs • Insertion • Medial border and inferior angle of scapula • Nerve Supply • Nerve to serratus anterior from roots of B.P C6,7 • Function • Rotate scapula / Draw it forwards
- 31. Trapezius Muscle • Origin • Ligamentum nuchae of occipital bone, 7th spine and all thoracic vertebrae • Insertion • Lateral third of clavicle, acromion and spine of scapula • Nerve Supply • Spinal part of accesory nerver IX • Function • Upper fibers elevate scapula • Middle fibers pull the scapula medially • Lower fibers pull scapula downwards
- 32. Trapezius Muscle
- 33. Latismus Dorsi Muscle • Origin • Iliac crest, lumbar fascia, spines of lower six thoracic vertebrae, lower three or four ribs, and inferior angle of scapula • Insertion • Floor of bicipital groove of humerus • Nerve Supply • Thoracodorsal nerve C7 • Function • Extends, adducts, and medially rotates the arm
- 35. Rhomboid Major Muscle • Origin • 2nd to 5th thoracic spines • Insertion • Medial border of scapula • Nerve Supply • Dorsal scapular nerve • Function • Raises medial border of scapula upward and medially
- 36. Rhomboid Minor Muscle • Origin • Ligamentum nuchae and spines of seventh cervical and first thoracic vertebrae • Insertion • Medial border of scapula • Nerve Supply • Dorsal scapular nerve • Function • Raises medial border of scapula upward and medially
- 37. Rhomboid Muscles • Origin • Insertion • Nerve Supply • Function
- 38. Levator scapulae Muscle • Origin • Transverse processes of first four cervical vertebrae • Insertion • Medial border of scapula • Nerve Supply • dorsal scapular nerve • Function • Raises medial border of scapula
- 39. Deltoid Muscle • Origin • Lateral third of clavicle, acromion, spine of scapula (same as insertion of trapezius) • Insertion • Middle of lateral surface of shaft of humerus • Nerve Supply • Axillary nerve C5 • Function • Anterior fibers medially rotate and flex arm • Posterior fibers extend and laterally rotate arm • Middle fibers abducts the arm
- 40. Deltoid Muscle
- 41. Supraspinatus Muscle • Origin • Supraspinous fossa of scapula • Insertion • Greater tuberosity of humerus • Nerve Supply • Suprascapular nerve C5 • Function • Abducts arm and stabilizes the shoulder
- 42. Infraspinatus Muscle • Origin • Infraspinous fossa of scapula • Insertion • Greater tuberosity of humerus • Nerve Supply • Suprascapular nerve C5 • Function • Laterally rotates arm and stabilizes shoulder
- 43. Teres minor Muscle • Origin • Upper two thirds of lateral border of scapula • Insertion • Greater tuberosity of humerus • Nerve Supply • Axillary nerve • Function • Laterally rotates arm and stabilizes shoulder joint
- 44. • Origin • Insertion • Nerve Supply • Function
- 45. Teres Major Muscle • Origin • Lower third of lateral border of scapula • Insertion • Medial lip of bicipital groove of humerus • Nerve Supply • Lower subscapular nerve C6 • Function • Medially rotates and adducts arm and stabilizes shoulder joint
- 46. Teres Major Muscle • Origin • Insertion • Nerve Supply • Function
- 47. Subscapularis Muscle • Origin • Subscapular fossa • Insertion • Lesser tuberosity of humerus • Nerve Supply • Upper and lower subscapular nerves C6 • Function • Medially rotates arm and stabilizes shoulder joint
- 48. • Origin • Insertion • Nerve Supply • Function
- 51. First Part of the Axillary Artery • This extends from the lateral border of the first rib to the upper border of the pectoralis minor • Relations • Anteriorly: The pectoralis major and the skin. The cephalic vein crosses the artery • Posteriorly: The long thoracic nerve (nerve to the serratus anterior) • Laterally: The three cords of the brachial plexus • Medially: The axillary vein
- 52. Second Part of the Axillary Artery • This lies behind the pectoralis minor muscle • Relations • Anteriorly: The pectoralis minor, the pectoralis major, and the skin • Posteriorly: The posterior cord of the brachial plexus, the subscapularis muscle, and the shoulder joint • Laterally: The lateral cord of the brachial plexus • Medially: The medial cord of the brachial plexus and the axillary vein
- 53. Third Part of the Axillary Artery • This extends from the lower border of the pectoralis minor to the lower border of the teres major • Relations • Anteriorly: The pectoralis major for a short distance; lower down the artery it is crossed by the medial root of the median nerve • Posteriorly: The subscapularis, the latissimus dorsi, and the teres major. The axillary and radial nerves also lie behind the artery • Laterally: The coracobrachialis, the biceps, and the humerus. The lateral root of the median and the musculocutaneous nerves Medially: The ulnar nerve, the axillary vein, and the medial cutaneous nerve of the arm
- 56. Quadrangular Space • The quadrangular space is an intermuscular space, located immediately below the shoulder joint. • It is bounded above by the subscapularis and capsule of the shoulder joint • Below by the teres major muscle. • Medially by the long head of the triceps • Laterally by the surgical neck of the humerus. • The axillary nerve and the posterior circumflex humeral vessels pass backward through this space
- 58. Triangular Space • Teres minor above • Teres major below • Long head of tricepes laterally • Circumflex scapular atery pass through it
- 60. • Thank You