UPPER NILE UNIVERSITY

FACULTY OF MEDICINE
2nd
YEAR
ANATOMY

GROUP A PRESENTATION
TOPIC OF DISCUSSION : UPPER LIMB
SUB-TOPIC: PECTORAL GIRDLE AND INTRAMUSCULAR
SPACES
DATE:21ST/JUN./2025
Contents

 Introduction
 Bones of the pectoral girdle
 Joints
 Muscles
 Intramuscular spaces
 Lymphatic
 Pectoral fascia
 Clinical correlations
Introduction

 Pectoral girdle is a region or set of bones that join

the upper limb to the axial skeleton(trunk)
 It is made up of mainly two(2) bones and the rest
is a muscular connection
Functions of Pectoral girdle
 provides the structural support to the shoulder
region
 allow the wide range of movement
 connecting muscles necessary for shoulder and
arm
The Pectoral girdle
Bones of the pectoral girdle(Osteology)

The pectoral girdle is made up of two bones

 Clavicle
 Scapula
The clavicle

 The clavicle is the only bony attachment between

the trunk and the upper limb. It is palpable along
its entire length and has a gentle S-shaped
contour.
 It is convex medially and concave at its lateral
end.
 The lateral(Acromial) end is flat while the
medial(Sternal) end is robust and quadrangular
 The lateral(acromial) end has a small oval facet
for articulation with identical oval facet of the
scapula
 The sternal end has a much larger facet for articulation mainly
with the manubrium of the sternum, and to a lesser extent, with
the first costal cartilage.
 The inferior surface of the lateral third of the clavicle possesses a
distinct tuberosity consisting of a tubercle (the conoid tubercle)
and lateral roughening (the trapezoid line), for attachment of the
important coracoclavicular ligament.
The Clavicle
Functions of the Clavicle

 Acts as strut that hold the arm away from the

truck
 its transmit forces from the Upper Limb to the
axial skeleton and provides attachment for
muscles that connect it to the truck and the Upper
Limb
The Scapula

The scapula or the shoulder blade, is a large, flat

triangular bone with
o Three angles (lateral, superior and inferior)
o Three borders (superior, lateral and medial)
o Two surfaces (costal and posterior)
o Three processes (acromion, spine and coracoid )
Features of Lateral border

 Coma shaped fossa (Glenoid fossa) which

articulates with the head of the humerus
 Roughening on the inferior side of glenoid fossa
called Infraglenoid tubercle for attachment of long
head of triceps muscle
 A less distinct supraglenoid tubercle is located
superior to the glenoid cavity and is the site of
attachment for the long head of the biceps brachii
muscle.
Features of the surfaces

 A prominent spine subdivides the posterior

surface of the scapula into a small, superior
supraspinous fossa and a much larger, inferior
infraspinous fossa
 The acromion, which is an anterolateral projection
of the spine, arches over the glenohumeral joint
and articulates, via a small oval facet on its distal
end, with the clavicle.
 Costal surface is slightly concave forming
subscapular fossa which is filled by subscapularis
muscle
Features of superior border

 Consists of the coracoid process, a hook-like

structure that projects anterolaterally and inferior
to the clavicle
 Anterolateral projection, The coracoid process
 the small but distinct suprascapular notch, which
lies immediately medial to the root of the coracoid
process.
Posterior surface of scapula
Costal surface of the scapula
Joints of the pectoral girdle

The pectoral girdle comprises of 2 joints

 Sternoclavicular joint
 Acromioclavicular joint
Sternoclavicular joint

 This is a joint which occurs between the

proximal(medial) end of the clavicle and the
clavicular notch of the manubrium of the sternum
 It is a saddle-shaped synovial joint.
 The articulating bones are separated by an
articular disc
 Joint allows predominantly antero-posterior
movement of clavicle, Vertical plane and some
rotation
The joint is reinforced by
 anterior and posterior sternoclavicular ligaments.
 interclavicular ligament links the ends of the two clavicles.
 costoclavicular ligament: Links the clavicle to the first rib and
related cartilage.
The Acromioclavicular joint

 It’s a small synovial joint formed between oval

facet on the medial side of the acromiom of
scapula and the acromial end of the clavicle
 It allows movement in the anteroposterior and
vertical planes together with some axial rotation.
 The joint is surrounded by joint capsule and reinforced by
 acromioclavicular ligament
Accessory ligament
 Coracoacromial
Made up of two bands
1. Conoid ligament
2. Trapezoid ligament
Muscles of the Pectoral girdle

Muscles of the pectoral girdle are divided into three

groups
 Anterior Axo-appendicular muscles
(Pectoralis major & Minor, Serratus anterior,
Subclavius)
 Posterior Axo-appendicular muscles
(Rhomboid Major & Minor, Trapezius, Levator
scapulae, Latissimus dorsi)
 Scapulohumeral muscles
(Deltoid, Teres major, The rotator cuff muscles)
Pectoralis Major

 Origin: Clavicular head, From medial 3rd of

clavicle
Sternocostal head: Anterior surface of sternum,
superior 6 costal cartilages
Aponuerosis of external oblique muscle
 Insertion: Lateral lip of intertubecular sulcus
 Innervation: Medial and lateral pectoral nerves
 Action: Adducts and medially rotates the
humerus
Pectoralis minor

 Origin: 3rd to 5th rib near costal cartilages

 Insertion: Superior surface of coracoid process
 Innervation: Lateral pectoral nerve
 Action: Stabilizes the scapula
Subclavius

 Origin: Junction of first rib and its costal

cartilages
 Insertion: Inferior surface of medial third of
clavicle
 Innervation: Nerve to subclavius
 Movement: Unclear
Serratus anterior

 Origin: External surface of lateral part of 1st-8th

ribs
 Insertion: Anterior surface of medial border of
scapula
 Innervation: Long thoracic nerve
 Action: Protracts and rotates the scapula
Trapezius Superior Upper third of Accessory Upper fibres:
nucheal line, clavicle, nerve Elevation of
spinous Acromiom scapula,
processes C7 and spine of Middle fibres:
– T12, scapula Medial
Posterior rotation,
occipital Lower Fibres:
protuberance Protraction
Rhomboid Spines of T2 – Medial border Dorsal Elevation of
major T5 of scapula Scapula nerve scapula

Rhomboid Ligamentum Medial border Dorsal Elevation of

minor nucheal, of scapula Scapula nerve scapula
Spines of C7-
T1
Levator Transverse Medial border Dorsal Elevation of
scapulae processes C1 of scapula Scapula nerve scapula
– C4
Latissimus Iliac crest, Floor of Thoracodorsal Extension,
Dorsi Lumbar bicipital nerve adduction and
fascia, Spines groove medial
of T6 –T12, rotaion of the
lower 3 -4 shoulder joint
ribs, Inferior
Muscles Origin Insertion Innervation Action
Teres Major Lower 3rd of Medial lip of Lower Medial
lateral border bicipital subscapular rotation,
of scapula groove nerve adduction
Deltoid Lateral third Middle of Axillary nerve Abduction,
of clavicle, lateral Flexion,
acromiom, surface of the Medial
Spine of shaft of rotation,
scapula humerus Extension,
Lateral arm
rotation
Supraspinatus Supraspinous Greater Supscapular Abduction
fossa tuberosity of nerve
humerus
Infraspinatus Infraspinous Greater Supscapular Lateral
fossa tuberosity of nerve rotation of the
the humerus arm
Teres Minor Upper 2/3 of Greater Axillary nerve Lateral
lateral border tuberosity of rotation of the
of scapula the humerus arm

Subscapularis Subscapula Lesser Upper and Medial

Intramuscular spaces

There are 3 Intramuscular spaces

 Quadriangular space
 Upper Triangular space
 Lower triangular space (Interval
* Suprascapula foramen
 Quadrangular space
 is an intramuscular space, located immediately below the shoulder
joint.
Borders
 Superiorly: Lower border of Teres minor muscle
 Inferiorly: Upper border of Teres major muscle
 Medially: Lateral border of long head of triceps
 Laterally: Surgical neck of the humerus
Contents
 Axillary artery
 Posterior circumflex humeral artery
Upper triangular space

Borders
 Superiorly: Lower border of Teres minor muscle
 Inferiorly: Upper border of Teres major muscle
 Laterally: Medial border of long head of Triceps
muscle
Contents
 Circumflex scapula artery
Lower triangular space
(Interval)

Borders
Superiorly: Lower border of Teres major muscle
Medially: Lateral border of long head of triceps
muscle
Laterally: Medial border of the shaft of humerus
Contents
 Profunda brachii artery (Deep humeral artery)
 Radial nerve
Suprascapular foramen

Borders
Superiorly: Superior transverse ligament
Inferiorly: Suprascapular notch
Contents
Suprascapular nerve below the ligament and
Suprascapular artery above
Lymphatics

 Most lymph of the pectoral girdle drain into the

axillary lymph nodes
 Some drain into the parasternal lymph nodes
 At the root of the neck, the lymph drain into the
deep and superficial cervical lymph nodes
Fascia of the pectoral region

Pectoral region is covered by two layers of fascia

 Superficial fascia (Subcutaneous)
 Deep Fascia (Clavipectoral & Pectoral Fascia)
 Deep fascia
Made up of two sections
 Pectoral fascia covering the pectoralis major muscle.
 Clavicpectoral fascia that connects the clavicle to the floor of the axilla,
It encloses pectoralis minor muscles and the subclavius muscle
 Structures through this fascia to the anterior wall of the axilla either
between the two muscles or inferior to perctoralis minor
Structures that pass between
 cephalic vein, the thoraco-acromial artery, and the lateral pectoral nerve
Structures that pass below pectoralis minor
 lateral thoracic artery
 Medial perctoral nerve penetrates the pectoralis minor muscles
Applied Anatomy

 Fractures of the clavicle

The fracture usually occur as a result of a fall on the
shoulder or outstretched hand. The force is
transmitted along the clavicle which break at its
weakest point, the junction of it lateral one-third and
medial two-thirds.
Dislocation of
Sternoclavicular joint

 Sternoclavicular joint is usually dislocated

anteriorly
Dislocation of Acromioclavicular joint
Winged Scapula

 Caused by palsy of Long thoracic nerve leading to

loss in innervation of Serratus anterior muscle
Features
Medial border of scapula moves laterally and
posteriorly
Quadrangular space
syndrome

 Compression due to fracture at surgical neck of

humerus in quadrangular space
Features
 Atrophy of deltoid and Teres minor muscles
 Sergeant badge anesthesia
Triangular space syndrome

Caused by injury to the redial nerve in the triangular

space
Triangle of Auscultation

 Found near the inferior angle of the scapula

 Formed by medial border of scapula, Inferolateral
border of trapezius and superior horizontal border
of latissimus dorsi
Significance
* Examination of posterior segment of the lung by
stethoscope
Suprascapular foramen

 Calcification of transverse suprascapular ligament

leading to compression of the suprascapular
nerve
References

 Richard L. Drake, “Grays anatomy”

 Shummy S. Chinnatamba, “Lasts’ anatomy” 12th
edition
 Keith L. Moore, “Moore’s clinically oriented
anatomy” 7th edition
Group members

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