UPPER EXTREMITY
A. Bone of Pectoral girdle (상지 연결대 뼈)
1. Clavicle (쇄골 1×2개)
2. Scapula (견갑골 1×2개)
B. Free bones of upper limb (상지의 자유뼈)
1. Humerus (상완골 1×2개)
2. Forearm (전완골)
① Radius (요골 1×2개)
② Ulna (척골 1×2개)
3. Carpal bones (손목뼈 8×2개)
4. Metacarpal bones (손바닥 뼈 5×2개)
5. Phalanges (손가락 뼈 14×개)
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32×2 = 64개
I. SHOULDER GIRDLE
1. CLAVICLE
-shoulder girdle의 ventral part를 이루는 curved long bone.
-manubrium의 clavicular notch에서 acromion of the scapula까지 놓인다.
-med. 2/3 : ventral 쪽으로 convex. sternal end를 가짐.
-lat. 1/3 : ventral 쪽으로 concave, acromial end를 가짐.
1) Lateral 1/3
① sup. surface
☞ ventral-deltoideus m.(O)
☞ dorsal-trapezius m.(I)
muscle
proximal/medial attachment
distal/lateral attachment
innervation
main action
deltoid
lateral third of clavicle, acromion and spine of scapula
deltoid tuberosity of humerus
axillary n. (C5 and C6)
anterior part ; flexes and medialy rotates arm
middle part ; abducts arm
posterior part ; extends and laterally rotates arm
trapezius
medial third of superior nuchal line ; external occipital protuberance, ligamentum nuchae, spinous process of C7 to T12 vertebrae, and lumbar and sacral spinous processes lateral third of clavicle, acromion and spine of scapula
spinal root of accessory n. (CN ?) and cervical nn. (C3 and C4)
elevates, retractes, and rotates scapula ; superior fibers elevate, middle fibers retract, inferior fibers depress scapula ; superior and inferior fibers act together in superior rotation of scapula
② inf. surface
-conoid tubercle : dorsal border 쪽 중간에 돌출.
☞ conoid lig.가 부착.
conoid ligament : clavicle의 inf. surface (conoid tubercle)
∼ scapula의 coracoid process 저부
-trapezoid line(oblique line)
: conoid tubercle에서 ventral & lat. 하게 뻗음.
☞ trapezoid lig.
trapezoid ligament : clavicle의 trapezoid line
∼ scapula의 coracoid process 상면
** coracoclavicular lig. = conoid lig. + trapezoid lig.
: coracoid proc. of scapula와 clavicle을 연결시키는 lig.
: conoid lig.와 trapezoid lig.로 이루어짐.
③ dorsal border
-trapezius m.(I)
④ ventral border
-deltoideus m.(O)
⑤ acromial end
-관절 면이 flat and oval.
-acromioclavicular lig.부착.
☞ acromioclavicular ligament : acromion의 상면 ∼ clavicle의 acromion end
2) Medial 2/3
① sup. surface
-ventral border : pectoralis major m.(O)
-dorsal border : sternocleidomastoid m.(O)
muscle
proximal attachment
distal attachment
innervation
main actions
pectoralis major
clavicular head ; anterior surface of the medial half of clavicle
sternocostal head ; anterior surface of sternum, superior six costal cartilages, and aponeurosis of external oblique muscle
lateral lip of intertubercular groove of humerus
lateral and medial pectoral nerves ; clavicular head (C5 and C6)
sternocostal head (C7, C8, and T1)
adducts and medially rotates humerus
acting alone : clavicular head flexes humerus and sternocostal head extends it
sternocleidomastoid
lateral surface of the mastoid process of the temporal bone and lateral half of the superior nuchal line of the occipital bone
sternal head ; anterior surface of the manubrium, lateral to the jugular notch clavicular head ; superior surface of the medial third of the clavicle spinal root of the accessory n. (CN ?) and branches of the second and third cervical n. (C2 and C3)
acting alone : tilts the head to its own side by drawing the mastoid process inferiorly
acting together : flex the neck
② inf. surface
-costal tuberosity : sternal end 근처의 dorsal border에 있는 조면.
costoclavicular lig.부착(1st rib과 clavicle 연결)
☞ costoclavicular ligament : 제 1 늑연골 상연
∼ 쇄골 흉골단의 하면
-groove for subclavian m.(subclavian groove) : costal tuberosity의 lat.에 위치.
subclavian m. insertion
-costal tuberosity의 dorsal 쪽으로 sternohyoid m. origin.
muscle
proximal attachment
distal attachment
innervation
main actions
subclavian
junction of rib 1 and its costal cartilage
inferior surface of middle third of clavicle n. to clavius (C5 and C6)
draws clavicle medially
sternohyoid
manubrium of sternum and medial end of clavicle
body of hyoid bone
C1, C2 and C3 ansa cervicalis
depresses hyoid bone after it has been elevated during swallowing
③ sternal end
-manubrium의 clavicular notch와 관절. articular facet 존재.
2. SCAPULA
-flat, triangular bone. 2nd rib과 7th rib 사이에 걸쳐 위치.
-2 surfaces
3 processes
3 borders
3 angles
1) Surface
① costal surface
-subscapular fossa존재 : subscapular m.(O)
-med. border쪽 : serratus ant. m.(I)
muscle
proximal attachment
distal attachment
innervation
main action
subscapular
scapular fossa
lesser tubercle of humerus
upper and lower scapular nn. (C5, C6 and C7)
medially rotates arm and adducts it ; helps to hold humeral head in glenoid cavity
serratus anterior
external surface of lateral parts of ribs 1 to 8 anterior surface of medial border of scapular long thoracic nerve (C5, C6 and C7)
protects scapula and hold it against thoracic wall ; rotates scapula
② dorsal surface
-spine of scapula에 의해 2개의 fossa로 나뉜다.
i) supraspinatous fossa - supraspinatus m.(O)
ii) infraspinatous fossa - infraspinatus m.(O)
muscle
proximal attachment
distal attachment
innervation
main action
supraspinatus
supraspinous fossa of scapula
superior facet of on greater tubercle of humerus suprascapular n. (C4, C5 and C6)
helps deltoid to abduct arm and acts with rotator cuff muscles
infraspinatus
infraspinous fossa of scapula middle facet of on greater tubercle of humerus suprascapular n. (C5 and C6) laterally rotate arm ; help to hold humeral head in glenoid cavity of scapula
-lat. border 쪽의 sup. 2/3 - teres minor m.(O)
inf. 1/3 - teres major m.(O)
-inf. angle근처 - latissimus dorsi m.(O)
muscle
proximal attachment
distal attachment
innervation
main action
teres major
dorsal surface of inferior angle of scapula
medial lip of intertubercular groove of humerus lower scapular n. (C6 and C7)
adducts and medially rotates arm
teres minor
superior part of lateral border of scapula
inferior facet on greater tubercle of humerus axillary n. (C5 and C6)
laterally rotate arm ; help to hold humeral head in glenoid cavity of scapula
latissimus dorsi
spinous processes of the inferior six thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs floor of intertubercular groove of humerus
thoracodorsal n. (C6, C7 and C8)
extends, adducts and medialy rotates humerus ; raise body towards arms during climbing
2) Border
① sup. border
-sup. angle ∼ the base of coracoid proc.
-scapular notch : coracoid proc.의 base에 부분적으로 형성된 semicircular notch.
☞ suprascapular n., a., v. 통과.
☞ sup. transverse lig.에 의해 연결.
? foramen을 만드는 인대 ; coracoid의 저부 ∼ scapular notch
♬: vessel은 lig. 위쪽으로, n.는 foramen으로 통과.
-omohyoid m. origin: scapular notch의 med.
muscle
proximal attachment
distal attachment
innervation
main action
omohyoid
superior border of scapula near suprascapular noch inferior border of hyoid bone C1, C2 and C3 by a branch of ansa cervicalis depresses, retractes and steadies hyoid bone
② lat. border
-lower margin of the glenoid cavity ∼ inf. angle, downward & backward
-infraglenoid tubercle
☞ long head of triceps brachii m.(O)
cf) supraglenoid tubercle - long head of biceps brachii m.(O)
muscle
proximal attachment
distal attachment
innervation
main action
triceps brachii
long head : infraglenoid tubercle of scapula
lateral head : post. surface of humerus, superior to radial groove
medial head : posterior surface of humerus, inferior to radial groove
proximal end of oleclenon ulna and fascia of forearm
radial n.
(C6, C7 and C8)
extends the forearm ; it is chief extensor of forearm ; long head steadies head of abducted humerus
biceps brachii
short head : tip of coracoid process of scapula
long head : supraglenoid tubercle of scapula
tuberosity of radius and fascia of forearm via bicipital aponeurosis
musculocutaneous n.
(C5 and C6)
supinates forearm and, when it is supine, flexes forearm
③ med. border
-sup. angle ∼ inf. angle
-ant. lip: serratus ant. m.(I)
-post. lip: supraspinatus & infraspinatus m.(O)
** 두 lip 사이 - levator scapulae m.(upper)
rhomboid minor m.(middle)
rhomboid major m.(lower)
muscle
proximal attachment
distal attachment
innervation
main action
serratus anterior
external surface of lateral parts of ribs 1 to 8
anterior surface of medial border of scapular long thoracic nerve (C5, C6 and C7)
protects scapula and hold it against thoracic wall ; rotates scapula
supraspinatus
supraspinous fossa of scapula
superior facet of on greater tubercle of humerus suprascapular n. (C4, C5 and C6)
helps deltoid to abduct arm and acts with rotator cuff muscles
infraspinatus
infraspinous fossa of scapula middle facet of on greater tubercle of humerus suprascapular n. (C5 and C6)
laterally rotate arm ; help to hold humeral head in glenoid cavity of scapula
levator scapulae
posterior tubercle of transverse processes of C1 to C4 vertebrae
superior part of medial border of scapula
dorsal scapula (C5) and cervical (C3 and C4) nn.
elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
rhomboid minor
ligamentum nuchae and spinous processes of C7 and T1 vertebrae
medial border of scapula from level of spine to inferior angle
dorsal scapula n. (C4 and C5)
retracts scapula and rotates it to depress glenoid cavity ; fixes scapula to thoracic wall
rhomboid major
spinous processes of T2 to T5 vertebrae
3) Angle
① sup. angle
-junction of the sup. & med. border
-levator scapulae m.일부
muscle
proximal attachment
distal attachment
innervation
main action
levator scapulae
posterior tubercle of transverse processes of C1 to C4 vertebrae superior part of medial border of scapula dorsal scapula (C5) and cervical (C3 and C4) nn. elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
② inf. angle
-dorsal surface: ☞ latissimus dorsi m.(O)
-ventral surface: ☞ serratus ant. m.(I)
muscle
proximal attachment
distal attachment
innervation
main action
latissimus dorsi
spinous processes of the inferior six thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs floor of intertubercular groove of humerus
thoracodorsal n. (C6, C7 and C8)
extends, adducts and medialy rotates humerus ; raise body towards arms during climbing
serratus anterior
external surface of lateral parts of ribs 1 to 8 long thoracic nerve (C5, C6 and C7)
long thoracic nerve (C5, C6 and C7)
protects scapula and hold it against thoracic wall ; rotates scapula
③ lat. angle(head of scapula)
-head of humerus와 관절 하는 부위로 움푹패인 관절 면인 glenoid cavity를 형성.
-shoulder joint는 ball & socket joint.
-supraglenoid tubercle: ☞ long head of biceps brachii m.(O)
muscle
proximal attachment
distal attachment
innervation
main action
biceps brachii
short head : tip of coracoid process of scapula
long head : supraglenoid tubercle of scapula
tuberosity of radius and fascia of forearm via bicipital aponeurosis
musculocutaneous n.
(C5 and C6)
supinates forearm and, when it is supine, flexes forearm
4) Process
① spine of scapula
-dorsal surface에서 돌출하여 supra- & infraspinatus fossa를 구분.
-med. border에서 acromion까지.
i) sup. surface - supraspinatous fossa의 일부 형성.
ii) inf. surface - infraspinatous fossa의 일부 형성.
iii) ant. border - dorsal surface of scapula에 부착.
iv) dorsal border (crest of spine) - upper: trapezius m.(I)
lower: deltoideus m.(O)
v) lat. border - acromion과 연결.
muscle
proximal/medial attachment
distal/lateral attachment
innervation
main action
deltoid
lateral third of clavicle, acromion and spine of scapula
deltoid tuberosity of humerus
axillary n. (C5 and C6)
anterior part ; flexes and medialy rotates arm
middle part ; abducts arm
posterior part ; extends and laterally rotates arm
trapezius
medial third of superior nuchal line ; external occipital protuberance, ligamentum nuchae, spinous process of C7 to C12 vertebrae, and lumbar and sacral spinous processes lateral third of clavicle, acromion and spine of scapula
spinal root of accessory n. (CN ?) and cervical nn. (C3 and C4)
elevates, retractes, and rotates scapula ; superior fibers elevate, middle fibers retract, inferior fibers depress scapula ; superior and inferior fibers act together in superior rotation of scapula
** great scapular notch
-head와 lat. border of spine이 만나서 형성하는 notch.
-suprascapular a., v., n. 통과.
→ (supraspinatous fossa → great scapular notch → infraspinatous fossa)
② acromion
-spine에서 연장된 돌기.
-sup. surface and lat. border에 deltoideus m.(O)
-med. border는 clavicle의 acromial end와 관절.
-apex: ☞ coracoacromial lig. 부착.
muscle
proximal/medial attachment
distal/lateral attachment
innervation
main action
deltoid
lateral third of clavicle, acromion and spine of scapula
deltoid tuberosity of humerus
axillary n. (C5 and C6)
anterior part ; flexes and medialy rotates arm
middle part ; abducts arm
posterior part ; extends and laterally rotates arm
** acromion에 부착하는 구조물
deltoideus m.(O)
acromioclavicular lig.
coracoacromial lig.
trapezius m.(I)
③ coracoid process
-upper part of neck of the scapula에 위치.
** coracoid proc.에 부착하는 구조물
coracoacromial lig.
coracoclavicular lig.
(coracohumeral lig.)
pectoralis minor m.(I)
coracobrachialis m.(O)
short head of biceps brachii m.(O)
clavipectoral fascia
-subclavian groove의 margin에 부착.
-subclavian m.을 싸고 costoclavicular memb.이 되었다가 pectoralis
minor m.을 싼 후 axillary fascia에 연결.
muscle
proximal attachment
distal attachment
innervation
main action
pectoralis minor
ribs 3 to 5 near their costal cartilages
medial board and superior surface of coracoid process of scapula medial pectoral nerve
(C8 and T1)
stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
coracobrachialis
tip of coracoid process of scapula middle third of medial surface of humerus musculocutaneous n.
(C5, C6 and C7)
helps to flex and adduct arm
biceps brachii
short head : tip of coracoid process of scapula
long head : supraglenoid tubercle of scapula
tuberosity of radius and fascia of forearm via bicipital aponeurosis
musculocutaneous n.
(C5 and C6)
supinates forearm and, when it is supine, flexes forearm
subclavian
junction of rib 1 and its costal cartilage
inferior surface of middle third of clavicle n. to clavius (C5 and C6)
draws clavicle medially