Chapter VI - Human_Anatomy

Shoulder Girdle
The human upper arm, the shoulder joint is composed of three bones:the clavicle
(collarbone), the scapula (shoulder blade), and the humerus (upper arm
bone). Two joints facilitate shoulder movement. The acromioclavicular (AC) joint is located
between the acromion (part of the scapula that forms the highest point of the shoulder) and
the clavicle. The glenohumeral joint, to which the generic term "shoulder joint" usually
refers, is a ball-and-socket joint that allows the arm to rotate in a circular fashion or to
hinge out and up away from the body. (The "ball" is the top, rounded portion of the upper
arm bone or humerus; the "socket," or glenoid, is a dish-shaped part of the outer edge of
the scapula into which the ball fits.) Arm movement is further facilitated by the ability of the
scapula to slide both laterally and vertically along the rib cage. The capsule is a soft tissue
envelope that encircles the glenohumeral joint. It is lined by a thin, smooth synovial
membrane.
The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons
are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in
moving the shoulder. Ligaments attach shoulder bones to each other, providing stability. For
example, the front of the joint capsule is anchored by three glenohumeral ligaments.
The rotator cuff is a structure composed of tendons that, with associated muscles, holds the
ball at the top of the humerus in the glenoid socket and provides mobility and strength to
the shoulder joint.
Two filmy sac-like structures called bursae permit smooth gliding between bone, muscle,
and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.
RIBCAGE
The human rib cage. In anatomy, ribs (Latin costae) are the long curved bones, which form
the rib cage. Ribs surround the chest (Latin thorax) of land vertebrates, and protect the
lungs, heart, and other internal organs of the thoracic cavity.
Types of Ribs
The human skeleton has 24 ribs, 12 on each side. (A small proportion may have one pair
more or fewer.) They are attached behind the vertebral column. The first seven pairs are
connected to the sternum in front and are known as true ribs (costae verae, I-VII). The
eighth, ninth, and tenth are attached in front to the cartilaginous portion of the next rib
above and are known as false ribs (costae spuriae, VIII-X). The lower two, that is the
eleventh and twelfth, are not attached in front and are called floating ribs (costae fluitantes,
XI-XII). The spaces between the ribs are known as intercostal spaces; they contain the
intercostal muscles, nerves, and arteries. The rib cage allows for breathing due to its
elasticity. In some humans, the rib remnant of the 7th neck vertebra on one or both sides is
replaced by a free extra rib called a cervical rib, which can cause trouble for the nerves
going to the arm.
Rib Anatomy
Typical ribs
The third through ninth ribs are "typical ribs" since they share the same structure. They
each have a head that has two facets separated by a crest. One head articulates with the
rib's corresponding vertebra and one head articulates with the vertebra superior (above) to

it. They have a neck that connects the head with the shaft. The neck meets the shaft at a
tubercle. The shaft is thin, flat, and curved. The curve is most prominent at the costal angle.
The concave (inside) surface has a groove to protect the intercostal nerve and vessels.
Atypical ribs
The atypical ribs are the 1st, 2nd, and 10th to 12th.
The first rib has a shaft that is wide and nearly horizontal, and has the sharpest curve of the
seven true ribs. Its head has a single facet to articulate with the first thoracic vertebra (T1).
It also has two grooves for the subclavian vessels, which are separated by the scalene
tubercle.
The second rib is thinner, less curved, and longer than the first rib. It has two facets to
articulate with T2 and T1, and a tubercle for muscles to attach to.
The 10th to 12th ribs have only one facet on their head, and the 11th and 12th ribs are
short with no necks or tubercles.
Rib Fractures and Associated Injuries
The first rib is rarely fractured because of its protected position behind the clavicle
(collarbone). However, if it is broken serious damage can occur to the brachial plexus of
nerves and the subclavian vessels.
The middle ribs are the ones most commonly fractured. Fractures usually occur from direct
blows or from indirect crushing injuries. The weakest part of a rib is just anterior to its
angle, but a fracture can occur anywhere.
A lower rib fracture has the complication of potentially injuring the diaphragm, which could
result in a diaphragmatic hernia.
Rib fractures are painful because the ribs have to move for inspiration and expiration of air.
Rib pain may also be associated with metastasis of cancer, especially from the breast or
prostate.
Bifid rib, bifurcated rib
A Bifid rib or bifurcated rib is a congenital abnormality occurring in about 1% of the
population. The sternal end of the rib is cleaved into two. It is usually unilateral. Effects of
this neuroskeletal anomaly can include respiratory difficulties, neurological difficulties,
limitations, and limited energy from the stress of needing to compensate for the
neurophysiological difficulties.
Vertebral column
The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal
aspect of the abdomen. It houses the spinal cord in its spinal canal.
Curves
Viewed laterally the vertebral column presents several curves, which correspond to the
different regions of the column, and are calledcervical, thoracic, lumbar, and pelvic.
Cervical curve: The cervical curve, convex forward, begins at the apex of the odontoid
(tooth-like) process, and ends at the middle of the second thoracic vertebra; it is the least
marked of all the curves.

Thoracic curve: The thoracic curve, concave forward, begins at the middle of the second
and ends at the middle of the twelfth thoracic vertebra. Its most prominent point behind
corresponds to the spinous process of the seventh thoracic vertebra.
Lumbar curve: The lumbar curve is more marked in the female than in the male; it begins
at the middle of the last thoracic vertebra, and ends at the sacrovertebral angle. It is convex
anteriorly, the convexity of the lower three vertebrae being much greater than that of the
upper two.
Pelvic curve: The pelvic curve begins at the sacrovertebral articulation, and ends at the
point of the coccyx; its concavity is directed downward and forward. The thoracic and pelvic
curves are termed primary curves, because they alone are present during fetal life. In the
early embryo, the vertebral column is C-shaped, and the cervical and lumbar curvatures are
not yet present in a newborn infant.
The cervical and lumbar curves are compensatory or secondary, and are developed after
birth, the former when the child is able to hold up its head (at three or four months), and to
sit upright (at nine months), the latter at twelve or eighteen months, when the child begins
to walk.
The vertebral column also has a slight lateral curvature, the convexity of which is directed
toward the right side. This may be produced by muscular action, most persons using the
right arm in preference to the left, especially in making long-continued efforts, when the
body is curved to the right side. In support of this explanation it has been found that in one
or two individuals who were left-handed, the convexity was to the left side. This curvature is
regarded by others as being produced by the aortic arch and upper part of the descending
thoracic aorta a view which is supported by the fact that in cases where the viscera are
transposed and the aorta is on the right side, the convexity of the curve is directed to the
left side.
Surfaces
Anterior surface
When viewed from in front, the width of the bodies of the vertebrae is seen to increase from
the second cervical to the first thoracic; there is then a slight diminution in the next three
vertebrae; below this there is again a gradual and progressive increase in width as low as
the sacrovertebral angle. From this point there is a rapid diminution, to the apex of the
coccyx.
Posterior surface
The posterior surface of the vertebral column presents in the median line the spinous
processes. In the cervical region (with the exception of the second and seventh vertebrae)
these are short and horizontal, with bifid extremities. In the upper part of the thoracic
region they are directed obliquely downward; in the middle they are almost vertical, and in
the lower part they are nearly horizontal. In the lumbar region they are nearly horizontal.
The spinous processes are separated by considerable intervals in the lumbar region, by
narrower intervals in the neck, and are closely approximated in the middle of the thoracic
region. Occasionally one of these processes deviates a little from the median line a fact to
be remembered in practice, as irregularities of this sort are attendant also on fractures or
displacements of the vertebral column. On either side of the spinous processes is the
vertebral groove formed by the laminae in the cervical and lumbar regions, where it is
shallow, and by the laminae and transverse processes in the thoracic region, where it is

deep and broad; these grooves lodge the deep muscles of the back. Lateral to the vertebral
grooves are the articular processes, and still more laterally the transverse processes. In the
thoracic region, the transverse processes stand backward, on a plane considerably behind
that of the same processes in the cervical and lumbar regions. In the cervical region, the
transverse processes are placed in front of the articular processes, lateral to the pedicles
and between the intervertebral foramina. In the thoracic region they are posterior to the
pedicles, intervertebral foramina, and articular processes. In the lumbar region they are in
front of the articular processes, but behind the intervertebral foramina.
Lateral surfaces
The lateral surfaces are separated from the posterior surface by the articular processes in
the cervical and lumbar regions, and by the transverse processes in the thoracic region.
They present, in front, the sides of the bodies of the vertebrae, marked in the thoracic
region by the facets for articulation with the heads of the ribs. More posteriorly are the
intervertebral foramina, formed by the juxtaposition of the vertebral notches, oval in shape,
smallest in the cervical and upper part of the thoracic regions, and gradually increasing in
size to the last lumbar. They transmit the spinal nerves and are situated between the
transverse processes in the cervical region, and in front of them in the thoracic and lumbar
regions.
Vertebral canal
The vertebral canal follows the different curves of the column; it is large and triangular in
those parts of the column which enjoy the greatest freedom of movement, such as the
cervical and lumbar regions; and is small and rounded in the thoracic region, where motion
is more limited.
Abnormalities
Occasionally the coalescence of the laminae is not completed, and consequently a cleft is
left in the arches of the vertebrae, through which a protrusion of the spinal membranes
(dura mater and arachnoid), and generally of the spinal cord (medulla spinalis) itself, takes
place, constituting the malformation known as spina bifida. This condition is most common
in the lumbosacral region, but it may occur in the thoracic or cervical region, or the arches
throughout the whole length of the canal may remain incomplete.
The following abnormal curvatures may occur in some people:
Kyphosis is an exaggerated posterior curvature in the thoracic region. This produces the
so-called "humpback".
Lordosis is an exaggerated anterior curvature of the lumbar region, "swayback". Temporary
lordosis is common among pregnant women.
Scoliosis, lateral curvature, is the most common abnormal curvature, occurring in 0.5% of
the population. It is more common among females and may result from unequal growth of
the two sides of one or more vertebrae.
Arm
In anatomy, the arm is the upper limb of a bipedal mammal, specifically the segment
between the shoulder and the elbow. Arm can also refer to any analogous structure, such as
one of the paired forelimbs of a quadruped, or any muscular hydrostat similar to a tentacle,
as seen on some cephalopods, such as octopuses.

The term arm also refers to the entire upper limb in an organism. Anatomically, the
segment between the elbow and wrist is properly called the forearm.
In primates the arms are richly adapted for both climbing and for more skilled, manipulative
tasks. The ball and socket shoulder joint allows for movement of the arms in a wide circular
plane, while the presence of two forearm bones which can rotate around each other allows
for additional range of motion at this level.
Anatomy of the human arm
The human arm contains bones, joints, muscles, nerves and blood vessels. Many of these
muscles are used for everyday tasks. There are clinical uses for the arm, including
venepuncture and peripheral venous cannulation in the cubital fossa.
Bony structure and joints
The humerus is the (upper) arm bone. It articulates with the scapula above at the
glenohumeral joint (shoulder) and with the ulna and radius below as the elbow joint.
Shoulder joint
The shoulder is the ball-and-socket joint between the proximal end of the humerus and the
clavicle and scapula.
Elbow joint
The elbow joint is the hinge joint between the distal end of the humerus and the proximal
ends of the radius and ulna.
Osteofascial compartments
The arm is divided by a fascial layer (known as lateral and medical intermuscular septa)
separating the muscles into an anterior and posterior osteofascial compartments. The fascia
merges with the periosteum (outer bone layer) of the humerus. The compartments contain
muscles which are innervated by the same nerve and perform the same action.
The anterior compartment is known as the "flexor compartment" as flexion is its main
action. The muscles contained therein are:
Biceps brachii
Brachialis
Coracobrachialis
They are all supplied by the musculocutaneous nerve, which has nervous origins of C5, C6,
C7 (see brachial plexus).
The deltoid muscle is considered to have part of its body in the anterior compartment. This
huge muscle is the main adductor of the upper limb and extends over the shoulder.
The brachioradialis muscle originates in the arm but inserts into the forearm. This muscle is
responsible for supination.
The posterior compartment contains muscles, which are all supplied by the radial nerve.
This compartment is also known as the "extensor compartment", extension being its main
action. Muscles of this compartment are:
Triceps brachii, a huge muscle which contains three heads, the lateral, medial and middle.
Anconeus, a tiny muscle, which some embryologists suggest may be the fourth head of the

triceps brachii muscle. This muscle stabilizes the elbow joint during movements. As the
upper and lower limbs have similar embryological origins and the lower limb contains the
quadriceps femoris muscle (the lower limb equivalent of the triceps), which has four heads,
this would seem to make sense.
Cubital fossa
This important area is clinically important for venepuncture and for blood pressure
measurement. It is an imaginary triangle with borders being:
Laterally, the medial border of brachioradialis muscle.
Medially, the lateral border of pronator teres muscle.
Superiorly, the intercondylar line, an imaginary line between the two condyles of the
humerus
The floor is the brachialis muscle
The roof is the skin and fascia of the arm and forearm
The structures, which pass through the cubital fossa, are vital. The order from which they
pass into the forearm are as follows, from medial to lateral:
1. Median nerve, which starts to branch
2. Brachial artery
3. Tendon of the biceps brachii muscle
4. Radial nerve
5. Median cubital vein - this important vein is where venepuncture occurs. It connects the
basilic and cephalic veins.
6. Lymph nodes
Nervous supply
Important nerves related to arms:
1. Musculocutaneous nerve
2. Radial nerve
3. Median nerve
4. Ulnar nerve
Blood supply and venous drainage
The main artery in the arm is the brachial artery. This artery is a continuation of the axillary
artery. The point at which the axillary becomes the brachial is distal to the lower border of
teres major. The brachial artery gives off an important brach, the profunda brachii (deep
artery of the arm). This branching occurs just below the lower border of teres major.
The profunda brachii travels through the lower triangular space with the radial nerve. From
here onwards it has an intimate relationship with the radial nerve.
The veins of the arm carry blood from the extremities of the limb, as well as drain the arm
itself. The two main veins are the basilic and the cephalic veins. There is a connecting vein
between the two, the median cubital vein, which passes through the cubital fossa and is
clinically important for venepuncture (withdrawing blood). The basilic travels on the medial
side of the arm and terminates at the level of the 7th rib. The cephalic travels on the lateral
side of the arm and terminates as the axillary vein. It passes through the deltopectoral
triangle, a space between the deltoid and the pectoralis major muscles.