Joints and Ligaments of the Shoulder

1 Acromial end of clavicle

2 Acromioclavicular joint

3 Acromion

4 Tendon of supraspinatus muscle

(attached to the articular capsule)

5 Coraco-acromial ligament

6 Tendon of long head of biceps brachii muscle

7 Tendon of subscapularis muscle

(attached to the articular capsule)

8 Intertubercular sulcus

9 Articular capsule of shoulder joint

10 Humerus

11 Trapezoid ligament

12 Coracoid process

13 Glenoid labrum

14 Shoulder joint (joint cavity)

15 Scapula

16 Head of humerus

17 Epiphysial line

18 Supraspinatus muscle

19 Glenoid cavity

20 Trapezius muscle

21 Suprascapular artery, vein, and nerve

22 Teres major muscle

23 Circumflexa scapular artery and vein

24 Latissimus dorsi muscle

25 Deltoid muscle

26 Tendon of long head of triceps brachii muscle

Right shoulder joint. The anterior part of the articular capsule has

been removed and the head of the humerus has been slightly rotated

outward to show the cavity of the joint.

Coronal section of the right shoulder joint

(anterior aspect).

Coronal section of the right shoulder joint (MRI scan; from Heuck et al.,

MRT-Atlas, 2009).

379

1

7

8

19

10

11

9

5

20

6

Ligaments of the Elbow Joint

1 Humerus

2 Lateral epicondyle of humerus

3 Articular capsule

4 Anular ligament of proximal

radio-ulnar joint

5 Radius

6 Tendon of biceps brachii muscle

7 Medial epicondyle of humerus

8 Ulnar collateral ligament

9 Oblique chord

10 Ulna

11 Interosseous membrane

12 Radial fossa

13 Capitulum of humerus

14 Head of radius

15 Radial collateral ligament

16 Coronoid fossa

17 Trochlea of humerus

18 Coronoid process of ulna

19 Olecranon

20 Radial tuberosity

Ligaments of the elbow joint (anterior aspect).

Elbow joint with collateral ligaments (medial aspect).

Elbow joint with ligaments (anterior

aspect). Articular capsule has been

removed to show the anular ligament.

Coronal section of the elbow joint

(MRI scan, courtesy of Prof. Dr. A. Heuck, Munich).

380 Ligaments of the Hand and Wrist

1 Ulna

2 Exostosis (pathological)

3 Head of ulna

4 Ulnar carpal collateral ligament

5 Deep intercarpal ligaments

6 Dorsal carpometacarpal ligaments

7 Dorsal metacarpal ligaments

8 Interosseous membrane

9 Radius

10 Styloid process of radius

11 Dorsal radiocarpal ligament

12 Radial collateral ligament

13 Articular capsule and dorsal intercarpal ligaments

14 Palmar radiocarpal ligament

15 Tendon of flexor carpi radialis muscle (cut)

16 Radiating carpal ligament

17 Palmar carpometacarpal ligaments

18 First metacarpal bone

19 Palmar ulnocarpal ligament

20 Tendon of flexor carpi ulnaris muscle (cut)

21 Pisohamate ligament

22 Pisometacarpal ligament

23 Palmar metacarpal ligaments

24 Fifth metacarpal bone

25 Articular disc (ulnocarpal)

26 Lunate bone

27 Triquetral bone

28 Hamate bone

29 Scaphoid bone (navicular)

30 Capitate bone

31 Trapezoid bone

32 Second and third metacarpal bones

33 Dorsal interosseus muscles

Ligaments of hand and wrist (dorsal aspect).

Ligaments of hand and wrist (palmar aspect).

9

29

30

31

32

33

1

25

26

27

28

24

Coronal section of the hand and wrist (MRI scan;

from Heuck et al., MRT-Atlas, 2009). Note the location of

the wrist joint.

Ligaments of the Hand and Wrist 381

1 Radius

2 Styloid process of radius

3 Palmar radiocarpal ligament

4 Tendon of flexor carpi radialis muscle (cut)

5 Radiating carpal ligament

6 Articular capsule of carpometacarpal

joint of thumb

7 Articular capsule of metacarpophalangeal

joint of thumb

8 Palmar ligaments and articular capsule

of metacarpophalangeal joints

9 Palmar ligaments and articular capsule

of interphalangeal joints

10 Articular capsule

11 Interosseous membrane

12 Ulna

13 Distal radio-ulnar joint

14 Styloid process of ulna

15 Palmar ulnocarpal ligament

16 Pisiform bone with tendon of flexor

carpi ulnaris muscle

17 Pisometacarpal ligament

18 Pisohamate ligament

19 Metacarpal bone

20 Deep transverse metacarpal ligament

21 Tendons of extensor muscles and

articular capsule

22 Collateral ligament of interphalangeal joint

23 Collateral ligaments of

metacarpophalangeal joints

24 Second metacarpal bone

Ligaments of right forearm, hand, and fingers (palmar aspect).

The arrow indicates the location of the carpal tunnel.

Ligaments of fingers

(lateral aspect).

382 Muscles of the Shoulder and Arm: Dorsal Muscles

1 Descending fibers of trapezius muscle

2 Spinous processes of thoracic vertebrae

3 Ascending fibers of trapezius muscle

4 Rhomboid major muscle

5 Inferior angle of scapula

6 Latissimus dorsi muscle

7 Transverse fibers of trapezius muscle

8 Spine of scapula

9 Posterior fibers of deltoid muscle

10 Infraspinatus muscle and infraspinous fascia

11 Teres minor muscle and fascia

12 Long head of triceps brachii muscle

13 Teres major muscle

14 Lateral head of triceps brachii muscle

15 Medial head of triceps brachii muscle

16 Medial intermuscular septum

17 Ulnar nerve

18 Olecranon

1 Trapezius muscle (reflected)

2 Levator scapulae muscle

3 Supraspinatus muscle

4 Rhomboid minor muscle

5 Medial border of scapula

6 Rhomboid major muscle

7 Infraspinatus muscle

8 Teres major muscle

9 Inferior angle of scapula

10 Cut edge of trapezius muscle

11 Intrinsic muscles of back with fascia

12 Latissimus dorsi muscle

13 Acromion

14 Spine of scapula

15 Deltoid muscle

16 Teres minor muscle

17 Long head of triceps brachii muscle

18 Lateral head of triceps brachii muscle

19 Medial head of triceps brachii muscle

20 Medial intermuscular septum

21 Tendon of triceps brachii muscle

Muscles of shoulder and arm, superficial layer (right side, dorsal aspect).

Muscles of shoulder and arm, deeper layer

(right side, dorsal aspect). The trapezius

muscle has been cut near its origin at the

vertebral column and reflected upward.

Muscles of the Shoulder and Arm: Dorsal Muscles 383

1 Splenius capitis muscle

2 Sternocleidomastoid muscle

3 Trapezius muscle (reflected)

4 Lateral supraclavicular nerves

5 Clavicle

6 Levator scapulae muscle

7 Supraspinatus muscle

8 Spine of scapula

9 Deltoid muscle (reflected)

10 Rhomboid minor muscle

11 Rhomboid major muscle

12 Axillary nerve and posterior

circumflex humeral artery

13 Infraspinatus muscle

14 Teres minor muscle

15 Long head of triceps brachii muscle

16 Teres major muscle

17 Inferior angle of scapula

18 Triceps brachii muscle

19 Latissimus dorsi muscle

1 Rhomboid minor muscle (red)

2 Rhomboid major muscle (red)

3 Levator scapulae muscle (red)

4 Supraspinatus muscle (blue)

5 Deltoid muscle (red)

6 Infraspinatus muscle (blue)

7 Teres minor muscle (red)

8 Teres major muscle (red)

Muscles of shoulder and arm, deeper layer (right side, dorsal aspect).

The trapezius and deltoid muscles have been divided and reflected.

Shoulder muscles, schematic diagram illustrating the course of

the main muscles of the dorsal aspect of the shoulder.

▲

384

1

2

3

3

4

5

6

Muscles of the Shoulder and Arm: Pectoral Muscles

1 Trapezius muscle

2 Acromion

3 Deltopectoral triangle

4 Clavicular part of deltoid muscle

(anterior fibers)

5 Acromial part of deltoid muscle

(central fibers)

6 Clavicular part of pectoralis major muscle

7 Sternocostal part of pectoralis major muscle

8 Short head of biceps brachii muscle

9 Long head of biceps brachii muscle

10 Abdominal part of pectoralis major muscle

11 Brachialis muscle

12 Serratus anterior muscle

13 External abdominal oblique muscle

14 Sternocleidomastoid muscle

15 Infrahyoid muscles

16 Clavicle

17 Manubrium sterni

18 Body of sternum

19 Xiphoid process

20 Anterior layer of sheath of rectus

abdominis muscle

1 Subclavius muscle (blue)

2 Pectoralis minor muscle (blue)

3 Pectoralis major muscle (red)

4 Subscapularis muscle (red)

5 Coracobrachialis muscle (red)

6 Serratus anterior muscle (green)

Shoulder, arm, and pectoral muscles, superficial layer (ventral aspect).

Arrangement of pectoral and shoulder muscles (ventral aspect).

(Schematic drawing.)

385

16

17

18

19

20

24

22

23

22

21

2

Muscles of the Shoulder and Arm: Pectoral Muscles

Shoulder, arm, and pectoral muscles, deep layer (ventral aspect).

1 Acromion

2 Clavicular part of deltoid muscle

3 Pectoralis major muscle (reflected)

4 Coracobrachialis muscle

5 Short head of biceps brachii muscle

6 Deltoid muscle (insertion on humerus)

7 Long head of biceps brachii muscle

8 Brachialis muscle

9 Sternocleidomastoid muscle

10 Clavicle

11 Subclavius muscle

12 Pectoralis minor muscle

13 Sternum

14 Third rib

15 Pectoralis major muscle

16 Platysma muscle

17 Pectoralis major muscle forming the anterior axillary fold

18 Anterior cutaneous branches of intercostal nerves

19 Lateral cutaneous branches of intercostal nerves

20 Rectus abdominis muscle

21 Subscapularis muscle

22 Latissimus dorsi muscle forming the posterior axillary fold

23 Serratus anterior muscle forming the medial wall of the axilla

24 External abdominal oblique muscle

Axillary fossa and serratus anterior muscle

(left side, lateral aspect).

386 Muscles of the Arm

Muscles of the right arm (lateral aspect).

Position and course of flexors of arm (schematic drawing).

1 Subscapularis muscle (red)

2 Coracobrachialis muscle (blue)

3 Biceps brachii muscle (red)

4 Brachialis muscle (blue)

33

1

34

29

3

35

36

37

1

2

3

4

6

8

9

32

Sagittal section of the right arm (MRI scan;

from Heuck et al., MRT-Atlas, 2009).

Muscles of the Arm 387

Muscles of the right arm (ventral aspect). Part of the

biceps brachii muscle has been removed. Arrow: tendon

of long head of biceps brachii muscle.

Muscles of the right arm (ventral aspect). The arm with the scapula

and attached muscles has been removed from the trunk.

1 Acromial part of deltoid muscle (central fibers)

2 Scapular part of deltoid muscle (posterior fibers)

3 Triceps brachii muscle

4 Tendon of triceps brachii muscle

5 Olecranon

6 Clavicular part of deltoid muscle (anterior fibers)

7 Deltopectoral groove

8 Biceps brachii muscle

9 Brachialis muscle

10 Brachioradialis muscle

11 Extensor carpi radialis longus muscle

12 Clavicle (divided)

13 Pectoralis major muscle

14 Medial intermuscular septum with vessels and nerves

15 Lateral intermuscular septum

16 Tendon of biceps brachii muscle

17 Bicipital aponeurosis

18 Axillary artery

19 Rhomboid major muscle

20 Subscapularis muscle

21 Latissimus dorsi muscle (divided)

22 Medial intermuscular septum

23 Medial epicondyle of humerus

24 Brachial artery and median nerve

25 Pronator teres muscle

26 Tendon of short head of biceps

brachii muscle

27 Coracobrachialis muscle

28 Distal part of biceps brachii muscle

29 Teres major muscle

30 Long head of triceps brachii muscle

31 Medial head of triceps brachii muscle

32 Radius

33 Head of humerus

34 Axillary nerve

35 Humerus

36 Trochlea

37 Ulna

388 Muscles of the Forearm and Hand: Flexor Muscles

Flexor muscles of forearm and hand, superficial layer

(ventral aspect).

Flexor muscles of forearm and hand, superficial layer

(ventral aspect). The palmaris longus and flexor carpi ulnaris

muscles have been removed.

1 Biceps brachii muscle

2 Bicipital aponeurosis

3 Brachioradialis muscle

4 Flexor carpi radialis muscle

5 Radial artery

6 Flexor digitorum superficialis muscle

7 Median nerve

8 Antebrachial fascia and tendon of palmaris longus muscle

9 Tendon of abductor pollicis longus muscle

10 Tendon of extensor pollicis brevis muscle

11 Abductor pollicis brevis muscle

12 Palmar aponeurosis

13 Superficial head of flexor pollicis brevis muscle

14 Tendon of flexor pollicis longus muscle

15 Medial intermuscular septum

16 Medial epicondyle of humerus

17 Humeral head of pronator teres muscle

18 Palmaris longus muscle

19 Flexor carpi ulnaris muscle

20 Ulnar artery

21 Tendon of flexor carpi ulnaris muscle

22 Palmaris brevis muscle

389

1

Muscles of the Forearm and Hand: Flexor Muscles

Flexor muscles of forearm and hand, middle layer (ventral aspect).

The palmaris longus, flexor carpi radialis, and ulnaris muscles have

been removed. The flexor retinaculum has been divided.

Position of flexors of fingers and hand (schematic drawing).

A Deep layer B Superficial layer

1 Flexor pollicis

longus muscle (blue)

2 Flexor digitorum

profundus muscle (red)

23 Abductor digiti minimi muscle

24 Transverse fasciculi of palmar aponeurosis

25 Digital fibrous sheaths of tendons of flexor digitorum muscle

26 Brachialis muscle

27 Flexor pollicis longus muscle

28 Carpal tunnel (canalis carpi, probe)

29 Triceps brachii muscle

30 Flexor digitorum superficialis muscle

31 Pisiform bone

32 Opponens digiti minimi muscle

33 Flexor digiti minimi brevis muscle

34 Tendons of flexor digitorum superficialis muscle

35 Supinator muscle

36 Extensor carpi radialis brevis muscle

37 Flexor pollicis longus muscle

38 Tendon of flexor carpi radialis muscle

39 Pronator teres muscle (insertion of radius)

40 Flexor digitorum profundus muscle

41 Lumbrical muscles

42 Tendons of flexor digitorum profundus muscle

43 Tendons of flexor digitorum profundus muscle having passed

through the divided tendons of the flexor digitorum superficialis

muscle

44 Flexor retinaculum

3 Pronator teres muscle (red)

4 Flexor carpi radialis

muscle (red)

5 Flexor carpi ulnaris

muscle (red)

6 Flexor digitorum superficialis

muscle (blue)

390 Muscles of the Forearm and Hand: Flexor Muscles

1 Biceps brachii muscle

2 Brachialis muscle

3 Pronator teres muscle

4 Brachioradialis muscle

5 Radius

6 Tendon of flexor carpi radialis muscle

7 Tendon of abductor pollicis longus muscle

8 Opponens pollicis muscle

9 Adductor pollicis muscle

10 Tendon of flexor pollicis longus muscle

11 Triceps brachii muscle

12 Medial intermuscular septum

13 Medial epicondyle of humerus

14 Common flexor mass (divided)

15 Ulna

16 Interosseous membrane

17 Pronator quadratus muscle

18 Tendon of flexor carpi ulnaris muscle

19 Pisiform bone

20 Abductor digiti minimi muscle

21 Flexor digiti minimi brevis muscle

22 Tendons of flexor digitorum profundus muscle

23 Tendons of flexor digitorum superficialis muscle

24 Flexor retinaculum

25 Hypothenar muscles

26 Thenar muscles

27 Common synovial sheath of flexor tendons

28 Synovial sheath of tendon of flexor pollicis

longus muscle

29 Digital synovial sheaths of flexor tendons

Flexor muscles of forearm and hand, deep layer (ventral aspect).

All flexors have been removed to display the pronator quadratus

and pronator teres muscles together with the interosseous

membrane. Forearm in supination.

Synovial sheaths of flexor tendons (palmar aspect of

right hand, semischematic drawing).

Muscles of the Forearm and Hand: Flexor Muscles 391

Right supinator and elbow joint

(ventral aspect). Forearm in pronation.

Synovial sheaths of flexor tendons

(palmar aspect of right hand). Blue PVA

solution has been injected into the sheaths.

Diagram illustrating the two axes of the elbow joint.

1 Humerus

2 Lateral epicondyle of humerus

3 Articular capsule

4 Position of capitulum of humerus

5 Deep branch of radial nerve

6 Supinator muscle

7 Entrance of deep branch of radial nerve to extensor muscles

8 Radius and insertion of pronator teres muscle

9 Interosseous membrane

10 Median nerve

11 Triceps brachii muscle

12 Trochlea of humerus

13 Tendon of biceps brachii muscle

14 Brachial artery

15 Pronator teres muscle

16 Tendon of pronator teres muscle

17 Ulna

18 Pronator quadratus muscle

19 Tendon of flexor carpi radialis muscle

20 Thenar muscles

21 Synovial sheath of tendon of flexor pollicis longus muscle

22 Fibrous sheath of flexor tendons

23 Digital synovial sheath of flexor tendons

24 Flexor digitorum superficialis muscle

25 Tendon of flexor carpi ulnaris muscle

26 Common synovial sheath of flexor tendons

27 Position of pisiform bone

28 Flexor retinaculum

29 Hypothenar muscles

A = axis of flexion and extension

B = axis of rotation

Arrows:

S = supination

P = pronation

392 Muscles of the Forearm and Hand: Extensor Muscles

Synovial sheaths of extensor

tendons. The sheaths have been

injected with blue gelatin.

Synovial sheaths of extensor

tendons on the back of the

right wrist (indicated in blue).

Notice the six tunnels for the

passage of the extensor

tendons beneath the extensor

retinaculum (schematic

drawing).

Extensor muscles of forearm and hand, superficial layer

(dorsal aspect). Tunnels for extensor tendons indicated by

probes.

1 Lateral intermuscular septum

2 Tendon of triceps brachii muscle

3 Lateral epicondyle of humerus

4 Olecranon

5 Anconeus muscle

6 Extensor carpi ulnaris muscle

7 Extensor digitorum muscle

8 Extensor digiti minimi muscle

9 Extensor retinaculum

10 Tendons of extensor digiti minimi muscle

11 Tendons of extensor digitorum muscle

12 Intertendinous connections

13 Brachioradialis muscle

14 Extensor carpi radialis longus muscle

15 Extensor carpi radialis brevis muscle

16 Abductor pollicis longus muscle

17 Extensor pollicis brevis muscle

18 Tendon of extensor pollicis longus muscle

19 Tendons of both extensor carpi radialis longus

and extensor carpi radialis brevis muscles

20 Tendon of extensor indicis muscle

21 First tunnel: Abductor pollicis longus muscle,

extensor pollicis brevis muscle

22 Second tunnel: Extensor carpi radialis longus and brevis muscles

23 Third tunnel: Extensor pollicis longus muscle

24 Fourth tunnel: Extensor digitorum muscle,

extensor indicis muscle

25 Fifth tunnel: Extensor digiti minimi muscle

26 Sixth tunnel: Extensor carpi ulnaris muscle