3. Introduction to upper limb
• Limbs are outgrowth of
anterior part of body wall
• Rotation occurs at 7th week
4. Introduction to upper limb
• Divided into
– Shoulder
• Pectoral
• Scapular
• Axilla
– Arm
– Forearm
– Hand
5. Arrangement of muscles
• Arranged in 2 groups
– Anterior compartment
– Posterior compartment
• A few muscles of
posterior compartment
occupy anterolateral
side in forearm
• No muscles in
posterior compartment
Hand
7. Pectoral region
• Surface landmarks
– Clavicle
– Jugular notch
– Sternal angle
– Epigastric fossa
– Midclavicular line
– Infraclavicular fossa
– Coracoid process
– Acromion process
– Nipple
– Midaxillary line
8. Skin
• Dermatome
– Area of skin supplied by
• An individual spinal nerve
– In trunk dermatome arranged
• Successive Horizontal strip
– Unusual in pectoral region
• In upper part of chest
– Upto sternal angle
• C3 & C4
– But below sternal angle
• T2
• Why this overlap
– Upper ;imb is developed from
C5-T1
13. Pectoral fascia
• Deep fascia of pectoral region
• Covers pectoralis major
• Attachment
– Medially
• Sternum
– Superorlaterally
• Deltoid fascia
– Inferiorly
• Merges with rectus sheath
– Laterally
• Axillary fascia
16. Pectoralis major
• Origin
– 2 heads
• Clavicular head
– From medial ½ of the front of the
clavicle.
• Sternocostal head
– Sternum
– Upper 6 costal cartilages.
• Aponeurosis of external oblique muscle
• Insertion
– Lateral lip of bicipital groove
• Upper fibres in lower part
• Lower fibres in upper part
17. Pectoralis major
• Deltopectoral groove
– Intermuscular groove
– Upper part of Pectoralis major is
near to Deltoid
– A gap between
• Deltoid & pectoralis major
• Structures traversing
– Cephalic vein
– Deltoid branch of
• Thoracoacromial artery
– Deltopectoral lymph node
• Drain lymph from
– Superficial tissue of upper limb along
cephalic vein (including thumb)
18. Pectoralis major
• Nerve supply
– Lateral pectoral
• Pierces clavipectoral fascia
– Medial pectoral nerve
• Pierces pectoralis major muscle
• Action
– Medial rotation & adduction of arm
19.
20. Pectoralis minor
• Origin
– 3rd, 4th & 5th ribs
• Close to their costal cartilages
• Insertion
– Coracoid process
• Nerve supply
– Medial pectoral nerve
• Action
– Depression of shoulder
• Draw the ribs upward and
outwards during deep
inspiration
21. Relations
• Anteriorly
– Pectoralis major
– Interpectoral nodes
• Posteriorly
– Axillary artery (2nd part)
– Axillary vein
– Cords of brachial plexus
• Lower border
– Lateral thoracic vessels
– Anterior group of axillary
lymph nodes
• Tail of breast
22. Subclavius
• Origin
– 1st rib
• At its junction with 1st costal cartilage
• Insertion
– Subclavian groove
• At middle 3rd of inferior surface of
clavicle
• Nerve supply
– Nerve to subclavius
• From upper trunk of brachial plexus
• Action
– Fixes the clavicle during
movement of shoulder joint
24. Clavipectoral fascia
• Location
– In anterior wall of axilla
• Deep to pectoralis major (clavicular
part)
• Vertical extent
– Above
• Clavicle
– Below
• Axillary fascia
• Suspensory ligament of axilla
– Clavipectoral fascia
• Below pectoralis minor
• Maintains concavity of axilla
• Encloses
– 2 muscles
• Subclavius
• Pectoralis minor
25.
26. Horizontal extent
• Medial
– Costoclavicular ligament
– First 2 external intercostal
membrane
• Lateral
– Coracoid process
– Coracoclavicular ligament
• Costocoracoid ligament
– Upper thickened part
– Extend
• First costochondral junction
• Coracoid process
27. Structures piercing
• Lateral pectoral nerve
– From lateral cord
• Thoraco- acromial artery
– Branch from 2nd part of axillary
• Cephalic vein
– Into axillary vein
• Few lymph vessels
– From
• Breast to apical group of axillary
lymph node
29. Serratus anterior
• Origin
– Upper eight ribs
• Insertion
– Medial border and inferior angle of
scapula
• Anterior aspect
• Nerve supply
– Long thoracic nerve
• Action
– Draws the scapula forward
(protrusion, in boxing)
8
6
4
2
30. Long thoracic nerve
• Otherwise
– Nerve of Bell
• Arises from
– Roots of brachial plexus
• Root value
– C5, C6 & C7
• Protected by
– Deep fascia
– Not injured during surgery at
axilla
31. Winging of scapula
• Paralysis of serratus anterior
• Medial margin of scapula
becomes prominent
• Why
– Protraction of scapula is by
serratus anterior
• In the absence of action of serratus
• Rhomboideus retract
• So medial margin prominent
43. Age changes
• Appearance of milk ridge – 7th week of IUL
• Nipple appears just before birth
• Lactiferous ducts without alveoli –till
puberty
• Deposition of fibrofatty tissue – puberty
• Proliferation of parenchyma –pregnancy
• Alveoli shrink – after lactation
• Atrophy of skin & fibrous tissue – old age
