Gross Anatomy

21 October 2015
Arm
Dr. Romeo Abiog

Humerus
Proximal
o Head
o Anatomical neck - separate the head and
trochanter
o Surgical neck - below the constricted area,
most common site of fracture
o Greater tubercle S(upper) I(Middle) T(Lower)
o Lesser tubercle Subscapularis (IR)
o Intertubercular groove (bicipital groove)
contains the tendon of biceps long head,
transverse humeral ligament, the tendons
move instead of the groove
o Crests of the tubercles (lips of the groove)
Lateral lip (Cr of GT)
Medial lip (Cr of GT)
o SPACES
Quadrangular/Quadrilateral
space

contains the axillary nerve and posterior

humeral circumflex artery (Lat: surgical neck
of the humerus, Med: triceps brachii, Sup:
teres minor Inf: Teres major)
Sd Axillary nerve injury during anterior
dislocation of the glenohumeral joint
Triangular space contains the circumflex
scapular vessels, radial nerve, deep brachial
artery and brachial vein (Sup: teres minor
Inf: teres major Lat: triceps long head)
Triangular Interval contains the radial
nerve and deep brachial artery

Glenohumeral Joint
Formed by the ball shaped head of humerus and
shallow concave glenoid fossa

Most striking feature is marked discrepancy in the

shape of both
Stability is sacrificed for mobility of the joint
(movement along sagittal + movement along
transverse axis = rotation + lateral bending)
Head - angular value of 153
Glenoid fossa - 75(shallower, larger radius)
Stability of GH
o Negative atm pressure
o Upward direction of glenoid
o Static stabilizers:
Presence of glenoid labrum- makes
fossa deeper
Ligaments and capsules
o Dynamic Stabilizers:
Musculotendinous cuff muscles (SITS)

Shaft
o Borders
Lateral
Medial
o Surfaces
Anterolateral
Anteromedial
Posterior
o Radial sulcus (radial groove, humeromuscular
tunnel)
o Deltoid tuberosity insertion of the deltoid
muscle
Humeromuscular tunnel
Formed by 3 heads of triceps brachii and radial
sulcus of the humerus for the radial nerve
Extends downwards from the medial to the lateral
side of the back of middle part of humerus
Transmits the radial nerve and the deep brachial
vessels (profunda brachii artery) __________ vein

Distal

o
o
o
o
o
o
o

Lateral & Medial supracondylar ridges

Lateral: origin of muscle flexor brachioradialis
Lateral & Medial epicondyles
Lateral: extensor common origin
Radial fossa
Coronoid fossa
Capitulum (capitellum)
Trochlea
Olecranon fossa
Ulnar sulcus (groove) posterior aspect of the
medial epicondyle of the humerus, contains
the ulnar nerve
Cubital tunnel formed by the tendinous arch
joining the humeral and ulnar heads of
attachment of the FCU (ulnar nerve may be
compressed here)
Spiral groove fracture at this site would
injure the radial nerve causing wrist drop
Lateral head of triceps brachii
lateral to the sulcus
Medial head of triceps brachii
below and posterior to the
sulcus

Bicipital aponeurosis - (lacertus fibrosus)

superficial attachment of the biceps into the
forearm fascia
Musculocutaneous nevre becomes sensory
in function after innervating the anterior
compartment Lateral cutaneous forearm
nerve
Long head of the biceps can abduct during
external rotation cheating motion of the
biceps
POPEYE MUSCLE ruptured biceps brachii

Anterior Compartment
Coracobrachialis
Biceps brachii
Brachialis

Posterior Compartment
Triceps brachii
(+) Anconeus
because
of
its
action not based on
its anatomical class
(forearm)

Anterior Compartment

Posterior Compartment

BRACHIAL REGION
o Divided by the intermuscular septum into
anterior and posterior compartment

Answer: In supinated position, biceps

becomes a strong elbow flexor; further, the
biceps is aided by the brachialis that equally
gives a strong flexion force in that position
too. However, when the forearm is flexed in
pronation, the effectiveness of the biceps is
reduced by the vain attempt to supinate the
forearm as it tries to flex the elbow
Brachialis known as flexor par excellence or the
workhorse among the elbow flexors as it is
uninfluenced by the position of the forearm in its
strength of elbow flexion (bec it is the shortest)
Studies by Basmajian showed that brachialis is
always active as an elbow flexor with or without
a load and whether the motion is rapid or slow
Lateral part of the brachialis often receives a
branch from the radial nerve, though functional
significance is not clear (still innervated by the
musculocutaneous nerve motor)
This branch helps supply the elbow joint but
there is disagreement on whether it provides any
motor fibers to the brachialis
Harnessing the 2 joint mechanism can enhance
action of triceps or biceps long head tendon
portion.
The head tendon of triceps is elongated when
the shoulder is flexed. So elbow extension
combined with shoulder flexion enhances the
strength capability of triceps and is used to
advantage in pushing activity bec of its 2 joint
mechanism
The extension and flexion combination are used
alternately in the following activities: sanding,
polishing, pulling the beater of a loom, using a
carpet sweeper, sawing wood, throwing a ball
Biceps and triceps acting simultaneously as
synergists, though they are antagonistic with
each other.
This can be verified and felt when screwing with
screwdriver
Strongest head of triceps Medial, closest to
the elbow joint.
Medial winging Serratus anterior Long
thoracic nerve
Lateral winging trapezius CN 11

Peculiarities
Biceps is in a position to act on 3 joints i.e.
glenohumeral, humeroulnar and proximal
radioulnar joints
FLEXION (best muscle for flexion when forearm
is..)
o Supinated - biceps
o Pronated - brachioradialis
o Neutral position - brachialis
In the shoulder it can flex, or abduct; at the
humeroulnar it can flex the elbow and at the
prox. Radioulnar, it can supinate
That makes it polyarticular, multijointed muscle
When the forearm is in supination, the biceps
acts in flexion of the elbow both with or without a
load, in slow as well as in fast movements, and
regardless whether it acts in shortening
(concentric
contraction)
or
lengthening
(eccentric contraction) capacity
Biceps acts most effectively as a supinator when
the elbow is 90 degree flexed. At 90 degrees,
Fick calculated, the biceps is 4 times as effective
as the supinator muscle

Only twice that of the supinator on an extended

elbow. However, the effectiveness of supinator
muscle is not influenced by the elbow angle
What is the most effective position of the
forearm when doing chin-ups or pull-ups?