Skin, Bones, Joints, Muscles; Upper and Lower Extremities 014.

Anatomy: Axilla, Shoulder, Elbow Joints, Pectoral CMED

Region, Back, Shoulder, & Scapular Regions (Part 2) 114

Doctor Teody Flores Date 09/27/23

Transer: Malinay, Macuno
Editor: Caldo, Seguido
OUTLINE/OVERVIEW
I. Introduction
II. Anatomical Terms
III. Bones
i. Architecture of Bone (Osseous Tissue)
IV. Joints
A. Types of Joints
V. Human Muscles
A. Functions
i. Intrinsic and Extrinsic Muscle
VI. Bones and Joints of the Upper Extremities
A. Shoulder
i. Clavicle
ii. Glenohumeral joint (Shoulder Joint)
iii. Glenoid Labrum
iv. Acromioclavicular (AC) Joint
v. Joint Capsule
vi. Sternoclavicular (SC) Joint
vii. Scapulothoracic Joint
viii. Ligaments
ix. Bursa
x. Regions of Humerus Bone
VII. Clinical Correlations
i. Impingement
ii. Anterior Dislocation
iii. Posterior Dislocation
VIII. Surface Anatomy
A. Anterior Shoulder
i. Deltoid
ii. Pectoralis Major
iii. Pectoralis Minor
iv. Serratus Anterior
IX. Appendix
X. FREEDOM WALL

Must Know Book Prev Trans Lecturer

I. Introduction
Anatomy is important to know what you are looking for,
what you are trying to treat.

II. Anatomical Terms

Figures 1 & 2. Reference Planes & Anatomical Position

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- Coronal Plane
● Proximal
- a vertical plane situated at a right angle
- close to the torso or point of origin
to the median plane
● Medial
- separates anterior/ventral (front) and
- nearer to median plane
posterior/ dorsal (back) portions of the
● Distal
body
- farther from the trunk or point of origin
- Sagittal Plane The blood flows from proximal to distal.
- any plane parallel to the median plane that ● Superior (Cranial)
divides the body into unequal right and left
- above
portions
- toward the head
- Transverse Plane ● Inferior (Caudal)
- separates caudal segments from cranial - below
- also called “axial view”, a term used in - toward the feet
MRI ● Superficial
- Horizontal Plane - closer to the exterior body surface
- lies at the right angles to both the Ex. skin- first cut in dissection
median and the coronal planes ● Deep
- divides the body into upper and lower - structures closer to the interior center of the
parts body
Ex. bones are located deeper than the muscles
- Median Plane
- a vertical plane passing through the center of
the body, dividing it into equal right and left
halves.
- based on the middle most part of the
body
- Ex. placement of pinky finger (5th digit)
in anatomical position
- Lateral
- away from the midline; going out
- Ex. placement of thumb in anatomical
position
- Anterior (Ventral)
- front of the body
- hands: palmar surface
- feet: plantar surface
- Posterior (Dorsal)
- back of the1 body
- hands: dorsal surface/ dorsum
- feet: dorsal surface/ dorsum

Figure 4. Anatomical Terms

Figure 3. Directional References

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 III. Bones
i. Architecture of Bone (Osseous Tissue) ii. Bone Structure
Cortical (compact) bone
● exterior dense layer of the bone
● consists of hollow tubes called lamellae
(collagen fibers that are arranged in layers and
run in different directions)
● A series of lamellae form an osteon or
Haversian System (weight-bearing pillars)
● Provides strength for weight bearing & stiffness
in response to muscle tension

Cancellous (spongy) bone

● interior to cortical bone
● consists of flat bone pieces called trabeculae
(collagen runs along the axis of the trabeculae)
● provides energy absorption & stress distribution
in response to loads
● not as strong as cortical bone (risk of fracture in
the elderly)

Figure 6. Structure & Parts of Long Bones

● Periostium- covers the bones

● Endosteum
● Epiphysis
● Epiphyseal plate
● Metaphysis
● Diaphysis

Figure 5. Spongy Bone

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 ● Diaphysis
● Cortex- hardest part of the bone
● Distal epiphysis- made of cancellous bone

Figure 7. Parts of a Femur, Emphasis on the Epiphysis

Figure 9 & 10. Osteon

Osteon- anatomical/basic unit of the bone; makes the

bone strong
It is arranged like bamboo.

Figure 8. Epiphysis
● Epiphysis- where we grow longer
For Filipinos, the epiphyses matures/closes at the age
of 14 for females and 16 for males.
● Proximal epiphysis- made of cancellous bone

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 Figure 13. Balance in Bone Formation and Resorption

Resorbing- demineralize to prepare a new “pavement”

for bone formation.

Figure 11. Composition of Osteon

Composition: Blood vessels, lamella, collagen fibers

Most vascular parts of the bone:

● epiphyses
● metaphyses- just below epi

Bone remodeling:
● osteoblast
● osteoclast Figure 14. Trabeculae

Calcium- main composition of bone for osteoblast to

form bones

Trabeculae- found in the cancellous part

There is resorption—removing of dead tissues;
osteoblast covers with a new layer

Figure 12. Bone Remodeling

The amount of osteoblast and osteoclast needs a

balance because compromise leads to osteoporosis.

Figure 15. Types of Bones

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Sesamoid bone a. Types of Joints
Ex.: patella
Irregular bone
Ex.: spine
Flat bone
- consist of 2 layers of compact bone with spongy
bone in between
- protect internal structures and offer broad
surfaces for muscle attachments
Figure 17. Types of Joints
Ex.: ribs, ilium, sternum, scapula
Long bone
● Cartilagenous- amphiarthroidal, slightly
- consist of a shaft called diaphysis (made of
movable
compact bone), which broadens out into the
Ex.: fingers
epiphysis (made of spongy bone inside a thin
● Fibrous- synarthroidal, immovable (symphesis-
layer of compact bone)
only fibrous tissue joins the bones)
- offer support and leverage
Ex.: patella-tibial, ulna-radius
more spongy, little layer of cortical bone ● Synovial- diarthroidal (2 bones together), freely
Ex.: humerus, radius, ulna, femur, tibia, fibula, movable
metacarpals
- seen in shoulder joints, knees, hip
Short bone
- consist of spongy bone with a thin layer of - the knee has synovial fluid for
compact bone lubrication
- has an important role in shock absorption and - Degenerative arthritis- 2 dry
transmission of forces cartilages rubbing with each other due
Ex.: carpals of the hand, tarsals of the foot to dry synovial fluid
Synovial fluid is thick and slippery; it prevents friction.
It is a viscous, pale yellow, clear fluid (egg white). It is for
IV. JOINTS nourishing and lubricating the cartilage.It has no
fibrinogen hence, it does not clot. It is composed of a
dialysate of plasma, glycoprotein, hyaluronic acid,
albumin and globulin.

Has cartilage that degenerates as we age

Synovial fluid has to stay intact within the joint,

contained in a capsule.

Characteristics of Synovial Joints

● Articular end plate- a thin layer of compact
bone over the spongy bone (covering the ends
of the bones)
● Articular (hyaline) cartilage- for shock
absorption, stability, improved fit for the
surfaces, lubrication
● Joint capsule- a fibrous connective tissue that
surrounds the bony ends forming the joint
● Synovial membrane- loose, vascularized
connective tissue that secretes synovial fluid into
the joint cavity for lubrication

Figure 16. Synovial Joint

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 V. Human Muscles
A. Functions
Consists of 600 muscles
1. Movement
2. Stability- the spines
3. Communication
4. Control of body openings & passages- anal
sphincter, mouth
5. Heat production

Muscle Classification
Based on shapes:

Figure 18. Synovial membrane

● Additional support- Where additional support

is needed, the joint capsule is thickened to form
tough, non-elastic ligaments
● Stability- provided by the capsule, ligaments,
muscles & tendons spanning the joint, and the
congruency of bone surfaces

• Synchodroses- fibrocartilagenous joint that allows

very slight movement
• Syndesmosis- bones held together by strong
ligaments that allows minimal movement
● Plane (gliding) joint- consists of 2 flat surfaces that
glide over each other
Ex.: carpals & tunnels
● Hinge joint- allow movement in one plane (flexion/
extension)
Ex.: interphalangeal joints (hand), ulnohumeral joint
● Pivot joint- allows a rotational movement around a Figure 19. Muscle Shapes
long axis
Ex.: superior & inferior radioulnar joint ● Fusiform- spindle shaped w/ a round & thick
(pronation/supination), atlantoaxial joint at the base belly & tapered ends
of the skull (rotation) ● Parallel- have parallel fibers often w/
● Condyloid joint- allows movement in 2 planes aponeurosis
(flexion/extension and abduction/adduction) without ● Convergent- arise from a broad area &
rotation converge to form a single tendon
Ex.: metacarpophalangeal joints ● Circular (sphincter)- surround a body opening
● Ball-and-socket joint- allows movement in all 3 or orifice
planes (flexion/extension, abduction/adduction, & ● Deltoid- triangle
rotation) ● Pennate- feather like in the arrangement of their
Ex.: hip and shoulder joints fascicles
● Saddle joint- allows 2 planes of movement ● Multi-headed or multi-bellied- one head of
(flexion/extension, abduction/adduction) attachment or one contractile belly
Ex.: only found at the carpometacarpal joint of the
thumb

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General anatomy of skeletal muscles In elbow flexion, the biceps (flexors) act as agonist while
the triceps (extensors) is the antagonist. In elbow
extension, the triceps become the agonist while the
biceps become the antagonist. [notes]

i. Intrinsic and Extrinsic Muscle

Intrinsic- origin & insertion are in the same region

(hand muscles)
Usually origin is not moving, only the muscle contracts
Insertion- usually at the end of the muscle, mobile part

Extrinsic- acts upon a designated region; origin/

insertion is outside the region (forearm muscles acting
on the fingers)

Muscle Nomenclature
Size, shape, location, origin, insertion, number of heads,
orientation, action

Important to know where origin and insertion is.

Figure 20. General Anatomy of Skeletal Muscles
Coordinated Action of Muscle Group
● Prime mover (agonist)
● Synergist
● Antagonist
● Antagonist pair
● Fixator

ii. Movement

Figure 21. Movement

Movement
● Extension- backward
● Flexion- forward
Figure 21. Flexion and Extension ● Pronation
● Supination- starting position for dissection
● Neutral
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 ● Abduction
● Adduction

Figure 22. Upper Extremities Bones

A. Shoulder
● A synovial joint containing synovial fluid
● It is the most proximal part of the upper limb (arm).
● Connected to our torso through clavicle only
Most protruded parts of the bones are attachment for
muscles
● Synovial Fluid - A joint lubricant
Figure 22. a. Neutral ; b. Pronation ; c. Supination

VI. BONES and JOINTS of the

UPPER EXTREMITIES
Upper Extremities
● Also known as the upper limbs or simply the
arms
● Parts of the human body that extend from the
shoulders to the hands

Terms to Remember
● Proximal - shoulders
● Distal - fingers
● Supra - above
● Sub – below

Figure 23. Right shoulder bones - anterior and posterior

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 i. Clavicle
● connects the arm to the axial skeleton and helps
support stabilize the shoulder joint
● Fibrous tissue connects clavicle to collarbone
● Clavicle attached to scapula by fibrous tissue
(acromioclavicular joint)
● It has another lip around that prevents
dislocation
● Referred to as fibrous tissue in the glenoid
● Glenoid Cavity - a shallow, concave depression
located on the lateral aspect of the scapula
(shoulder blade)

Shoulder Joint
● Shoulder joint - Glenoid and humeral head -
where we can freely move
● Hole in a socket
Scapula
● Movable joint
● Glides to and fro (when reaching something)

ii. Glenohumeral joint (Shoulder Joint)

A ball and socket between the scapular and the

humerus
ball and socket joint - round end of one bone
fits into a cuplike depression of another bone
● Highly mobile and complex joint formed by the
articulation of the humerus and the glenoid cavity of
the scapula
● Composed of cartilage
○ Has an opposing cartilage
○ Cartilage to cartilage
Cartilage tends to degenerate when you age.
A Synovial joint ( freely movable, free motion)
Figure 25. Glenoid Labrum
iv. Acromioclavicular (AC) Joint
A joint at the top of the shoulder.
● Junction between the acromion and the
clavicle
● Plays a cruicial role in shoulder movement
and stability.
● Allows for various movements of the
shoulder blade and collarbone, especially
during activities that involve raising the arm
or moving it in different directions.

Figure 24. Glenohumeral Joint

Figure 26. Acromioclavicular (AC) Joint
iii. Glenoid Labrum
v. Joint Capsule
”Labrum” - lips
● Stabilizes the humeral head A tough fibrous membrane that protects the
● Acts as shock absorber exterior of the synovial membrane
● Enhances joint congruence Hyaluronic acid - maintains joint to be slippery
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Figure 27. Joint Capsule
vi. Sternoclavicular (SC) Joint
● A synovial joint located in the upper chest,
where the clavicle articulates with the sternum.
● One of the key articulations that connect the
upper limb to the axial skeleton
Figure 28. Sternoclavicular Joint
vii. Scapulothoracic Joint
Not a true anatomical joint but is rather
considered as a unit that gathers the
sternoclavicular and acromioclavicular (AC)
joints and the junction between the anterior
surface of the scapula and the thoracic cage
(scapulothoracic junction)
● Not a synovial joint; there is only gliding
[CMED114] Anatomy: Upper Extremities (Part 1) – Dr. Flores
Figure 29. Scapulothoracic Joint
viii. Ligaments
● Connect bones to bones
● Strong, fibrous connective tissues that serve to
stabilize and reinforce joints
● Crucial role in maintaining structural integrity
and stability of the musculoskeletal system
Figure 30. Ligaments
ix. Bursa
Bursae (plural) - small sacs of synovial
membrane between tendons and underlying
bones; they permit tendons to slide more easily
as the joint moved
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 VII. Clinical Correlations
i. Impingement

Figure 33. Impingement

Figure 31. Bursa
DEFINITION:
x. Regions of Humerus Bone ● Common condition that affects the shoulder joint
● Occurs when the tendons of the rotator cuff and
the subacromial bursa (a fluid-filled sac) become
pinched or compressed as they pass through a
narrow space between the head of the humerus
and the acromion process of the scapula.
Head of humerus impinging on the acromion
Impinge - “naiipit” in tagalog

CAUSES:
● Repeated overhead activities
● Muscle imbalances
● Structural Issues like bone spurs or anatomical
variations

Figure 32. Proximal humerus SYMPTOMS

● Shoulder pain
Anatomical Neck ● Painful range in motion
● Slightly constricted, cylindrical region of the ● Weakness
bone located just below the head of the humerus ● Inflammations
● Part of the bone that connects the rounded head
to the rest of the shaft ii. Frozen Shoulder (Adhesive Capsulitis)
● Serves as an important reference point in the
anatomy of the humerus, particularly in
distinguishing the head and the rest of the bone

Surgical Neck
● A narrower, more fragile region located just
below the greater and lesser tubercles of the
humerus
● It is so named because it is a common site for
fractures of the humerus, often requiring surgical
intervention.

Figure 34. Frozen Shoulder

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DEFINITION: ● Affected arm may appear externally rotated
● Can hardly move shoulder ● Individual may be unable to move
“Frozen” and you cannot move the shoulder
A painful and restrictive shoulder condition iv. Posterior Dislocation
characterized by the gradual loss of shoulder
joint mobility.

CAUSES:
● It can develop after an injury, surgery, or a
period of immobilization
● Certain medical conditions like diabetes, thyroid
disorders, and cardiovascular disease are
associated with higher risk of developing
adhesive capsulitis

SYMPTOMS:
● shoulder pain
● Progressive loss of range of motion
● Activities like reaching, lifting and even dressing Figure 35. Posterior Dislocation
can become challenging.
DEFINITION:
iii. Anterior Dislocation ● displacement of a bone from its normal position
in a rearward direction
● Affected bone moves out of the joint socket
toward the back of the body

CAUSES:
● traumatic events such as falls, car accidents, or
direct blows to the affected joint
● Involves a force that pushes the bone backward

SYMPTOMS:
● pain
● Deformity of joint
● Loss of normal joint function
● Affected joint may appear flattened
● Movement severely limited

Figure 34. Anterior Dislocation v. Bursitis

DEFINITION:
● refers to the displacement of a bone from its
normal position in an anterior direction within a
joint.

CAUSES:
● occur due to traumatic events, such as falls,
sport injuries, or accidents

SYMPTOMS
● intense pain
● Deformity of joint
● Loss of normal joint function Figure 36. Bursitis

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 • the place where one end of a
DEFINITION: muscle is attached to the
● a painful condition characterized by the freely moving bone of its joint
inflammation of a bursa • the more distal and mobile
attachment (from Snell)
CAUSES: Innervation • the distribution or supply of
● repetitive motions nerves to a part
● Overuse of joint Action • movement of a muscle, can be
● Trauma described relative to the joint
● Infection or the body part moved
● Arthritis Table 1. Terms to familiarize ourselves with

SYMPTOMS:
● pain
A. Anterior Shoulder
● Swelling
i. Deltoid
● Tenderness
● Limited motion range
● Typically localized pain around the inflamed
bursa

VIII. Surface Anatomy

Figure 38. Deltoid

DEFINITION: Acromion / Spine of the scapula / lateral

3rd of Clavicle
INSERTION: Coracoid process
INNERVATION: Axillary Nerve
ACTION: Abducts the arm

Figure 37. Surface Anatomy with labels ii. Pectoralis Major

TERMS TO FAMILIARIZE OURSELVES WITH

Term Definition
Origin • less movable end of the
muscle/tendon that is attached
to a bone
• The more stationary
attachment site of a muscle
to a bone, the opposite end
of its insertion
• More proximal, less mobile
attachment (from Snell)
Insertion • The more mobile attachment
site of a muscle to a bone; the
opposite end of its origin

Figure 39. Pectoralis Major

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DEFINITION: Sternum / Clavicle / Ribs 1-6
INSERTION: Intertubercular sulcus / greater
tubercle of Humerus
INNERVATION: Dorsal scapular nerve
ACTION: Flexes / medially rotates / adducts arm

iii. Pectoralis Minor

Figure 42. Muscles of the Shoulder

Figure 40. Pectoralis Minor

DEFINITION: Anterior surface of ribs 3-5

INSERTION: Coracoid process of scapula
INNERVATION: Pectoral nerve
ACTION: Protracts / Depresses the scapula /
elevates ribs

iv. Serratus Anterior

Figure 44. Muscles of the Anterior Shoulder

IX. Appendix
Figures 1 & 2. Reference Planes & Anatomical Position
Figure 3. Directional References
Figure 4. Anatomical Terms
Figure 5. Spongy Bone
Figure 6. Structure & Parts of Long Bones
Figure 7. Parts of a Femur, Emphasis on the Epiphysis
Figure 8. Epiphysis
Figure 9 & 10. Osteon
Figure 11. Composition of Osteon
Figure 12. Bone Remodeling
Figure 13. Balance in Bone Formation and Resorption
Figure 41. Serratus Anterior Figure 14. Trabeculae
Figure 15. Types of Bones
DEFINITION: Ribs 1-8 Figure 16. Synovial Joint
Figure 17. Types of Joints
INSERTION: Medial border of the Scapula Figure 18. Synovial membrane
INNERVATION: Long Thoracic Nerve Figure 19. Muscle Shapes
ACTION: Rotates Scapula laterally Figure 20. General Anatomy of Skeletal Muscles
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Figure 21. Flexion and Extension
Figure 21. Movement
Figure 22. a. Neutral; b. Pronation; c. Supination
Figure 22. Upper Extremities Bones
Figure 23. Right shoulder bones - anterior and posterior
Figure 24. Glenohumeral Joint
Figure 25. Glenoid Labrum
Figure 26. Acromioclavicular (AC) Joint
Figure 27. Joint Capsule
Figure 28. Sternoclavicular Joint
Figure 29. Scapulothoracic Joint
Figure 30. Ligaments
Figure 31. Bursa
Figure 32. Proximal humerus
Figure 33. Impingement
Figure 34. Frozen Shoulder
Figure 34. Anterior Dislocation
Figure 35. Posterior Dislocation
Figure 36. Bursitis
Figure 37. Surface Anatomy with labels
Figure 38. Deltoid
Figure 39. Pectoralis Major
Figure 40. Pectoralis Minor
Figure 41. Serratus Anterior
Figure 42. Muscles of the Shoulder
Figure 44. Muscles of the Anterior Shoulder

X. FREEDOM WALL

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