Upper Limb Anatomy: Humerus and Axilla
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Questions and Answers

Which statement accurately differentiates the anterior and posterior views of the humerus?

  • The anatomical neck is exclusively visible in the anterior view, whereas the surgical neck is prominent in the posterior view.
  • The olecranon fossa is present on the posterior side of the humerus, while the coronoid fossa is present on the anterior side. (correct)
  • The intertubercular groove is visible in the posterior view, while the deltoid tuberosity is only visible in the anterior view.
  • The lesser tuberosity is a prominent feature of the posterior view, while the greater tuberosity is only visible in the anterior view.

Which statement most precisely identifies the boundaries of the axilla?

  • The apex is defined by the cervico-axillary canal, while the base is formed by the axillary fascia and skin. (correct)
  • The anterior wall consists solely of the subscapularis muscle, while the posterior wall is defined by the pectoral muscles.
  • Is bounded anteriorly by the teres major and posteriorly by the latissimus dorsi.
  • The lateral wall is composed of the serratus anterior muscle, and the medial wall is formed by the intertubercular sulcus.

A surgeon needs to access the cervico-axillary canal during a procedure. Which anatomical landmark should they use to locate this passage?

  • The lateral border of the scapula.
  • The base of the axilla.
  • The apex of the axilla. (correct)
  • The intertubercular groove of the humerus.

Following a surgical procedure in the axilla, a patient exhibits weakness in adduction and internal rotation of their arm. Which muscle is most likely affected?

<p>Latissimus dorsi. (A)</p> Signup and view all the answers

During an axillary lymph node dissection, a surgeon inadvertently damages a nerve, leading to a 'winged scapula'. Which nerve was most likely injured?

<p>Long thoracic nerve. (C)</p> Signup and view all the answers

A patient presents with an inability to medially rotate their arm. Physical examination and imaging reveals damage to one of the posterior axillary wall muscles. which of the following muscles could be damaged?

<p>Subscapularis. (D)</p> Signup and view all the answers

Which structure forms the lateral border of the axilla?

<p>Intertubercular groove (bicipital groove). (A)</p> Signup and view all the answers

After a strenuous workout focusing on chest exercises, a patient reports pain and difficulty with adduction and medial rotation of the arm. Which muscle is most likely involved?

<p>Pectoralis Major. (C)</p> Signup and view all the answers

Which of the following is the correct origin and action of the Pectoralis Minor?

<p>Origin: 3-5 ribs; Action: Pulls shoulder down and forward. (C)</p> Signup and view all the answers

A patient is diagnosed with damage to the thoracodorsal nerve. Which movement of the arm will be most affected?

<p>Adduction. (C)</p> Signup and view all the answers

A patient is unable to internally rotate their arm. Which muscle is most likely affected?

<p>Subscapularis. (D)</p> Signup and view all the answers

A patient has undergone a procedure that has damaged the long thoracic nerve. Which describes the action lost by the damage of this nerve?

<p>Protracts the scapula (holds it against the thoracic wall). (C)</p> Signup and view all the answers

Which of the following structures is most lateral?

<p>Humeral Neck. (A)</p> Signup and view all the answers

How would you describe the origin, insertion, and action of the pectoralis major?

<p>Origin: medial 1/2 of clavicle; insertion: bicipital groove of humerus; action: adduction and internal rotation of shoulder. (A)</p> Signup and view all the answers

Which of the following lists all contents of the axilla?

<p>Axillary Artery, Axillary Vein, Brachial Plexus (C)</p> Signup and view all the answers

Which of the following accurately describes the contents of the anterior compartment of the arm?

<p>Brachialis, Biceps Brachii, Musculocutaneous Nerve. (D)</p> Signup and view all the answers

A patient is diagnosed with a rupture of the distal biceps tendon. Which action will be most affected?

<p>Forearm Supination. (B)</p> Signup and view all the answers

Which statement accurately describes the innervation of the brachialis muscle?

<p>Innervated by the musculocutaneous and radial nerves. (B)</p> Signup and view all the answers

What is the primary function of the Coracobrachialis?

<p>Shoulder flexion and adduction. (B)</p> Signup and view all the answers

A weightlifter strains their triceps brachii during a bench press. Which action would be most difficult for them immediately following the injury?

<p>Elbow extension. (D)</p> Signup and view all the answers

The profunda brachii artery is a branch of which major vessel?

<p>Brachial artery. (B)</p> Signup and view all the answers

A stab wound at the midshaft of the humerus, posteriorly, damages what nerve and artery?

<p>Radial nerve &amp; profunda brachii artery. (B)</p> Signup and view all the answers

Which nerve is most at risk with a mid-shaft fracture of the humerus?

<p>Radial nerve. (D)</p> Signup and view all the answers

In an anterior view of the elbow joint, which structure is most medial?

<p>Trochlea. (C)</p> Signup and view all the answers

Which of the following structures is located within the cubital fossa?

<p>Median nerve (A)</p> Signup and view all the answers

What structures are known as the borders to the cubital fossa?

<p>Brachioradialis, pronator teres, imaginary line between the epicondyles. (A)</p> Signup and view all the answers

A deep laceration on the anterior aspect of the elbow joint lateral to the biceps tendon. Which of the following structures is most likely to be injured?

<p>Radial nerve. (C)</p> Signup and view all the answers

A baseball player injures his elbow. Initial examination reveals the distal humerus was fractured. The doctor mentions a risk of injury to a nerve that passes posterior to the medial epicondyle of the humerus. What nerve is likely to be at risk?

<p>Ulnar nerve. (C)</p> Signup and view all the answers

After a motorcycle accident, a patient has reduced sensation on the lateral aspect of their forearm, along with muscle weakness. Which represents the most probable nerve that was damaged?

<p>Lateral antebrachial cutaneous branch of the musculocutaneous nerve. (B)</p> Signup and view all the answers

What part of the brachial plexus does the radial nerve directly originate from?

<p>Posterior Cord. (C)</p> Signup and view all the answers

What movements are lost if the musculocutaneous nerve is severed?

<p>Elbow flexion and forearm supination. (A)</p> Signup and view all the answers

Which of the following does not contribute to the axillary walls?

<p>Biceps Brachii. (B)</p> Signup and view all the answers

The conjoint tendon of the short head of biceps brachii and coracobrachialis shares an insertion point with which bone feature?

<p>Coracoid Process of Scapula (C)</p> Signup and view all the answers

Which of the following provides the MOST support to elbow flexion?

<p>Brachialis (C)</p> Signup and view all the answers

Which of the following blood vessels anastomoses with the radial collateral artery around the elbow joint?

<p>Profunda brachii artery. (D)</p> Signup and view all the answers

What is the origin of the Radial Artery?

<p>Brachial Artery (A)</p> Signup and view all the answers

During a surgical approach to the anterior humerus, a surgeon must consider the path of the musculocutaneous nerve. Which muscle does this nerve pierce?

<p>Coracobrachialis (D)</p> Signup and view all the answers

Which of the following muscles does not insert on the intertubercular groove of the humerus:

<p>Pectoralis Minor (D)</p> Signup and view all the answers

Which statement correctly describes the relationship between the latissimus dorsi muscle and the posterior wall of the axilla?

<p>The latissimus dorsi forms the inferior part of the posterior wall, and affects its inferior border (A)</p> Signup and view all the answers

A surgeon is performing a procedure that requires precise knowledge of the axillary borders. If the surgeon makes an incision along the lateral border of the scapula, which axillary wall is being directly accessed?

<p>Posterior wall (C)</p> Signup and view all the answers

A patient presents with damage to the structure that protracts the scapula against the thoracic wall. Which nerve and axillary wall is most likely affected?

<p>Long thoracic nerve; medial wall (A)</p> Signup and view all the answers

A bodybuilder is performing a dumbbell fly exercise, focusing mainly on the anterior wall of the axilla. Which nerve would the bodybuilder most likely be stimulating?

<p>Medial and lateral pectoral nerves (C)</p> Signup and view all the answers

If the medial pectoral nerve were selectively damaged, what specific action would remain unaffected?

<p>Adduction of the arm (B)</p> Signup and view all the answers

Considering its origin and insertion, how does the latissimus dorsi contribute to movements of the arm and shoulder?

<p>Extension, adduction, and internal rotation of the shoulder (B)</p> Signup and view all the answers

What is the primary function of the subscapularis muscle in relation to the glenohumeral joint?

<p>Internal rotation and adduction (C)</p> Signup and view all the answers

How does the location of the teres major relative to the teres minor affect its contribution to arm movement?

<p>Teres major assists in internal rotation and adduction, different from teres minor (D)</p> Signup and view all the answers

A patient has difficulty in reaching forward and rotating the arm. Which muscle(s) are least likely to be involved?

<p>Subclavius (B)</p> Signup and view all the answers

Which of the following best explains how the conjoint tendon contributes to the stability and function of the shoulder region?

<p>It enhances the strength of the glenohumeral joint during flexion (C)</p> Signup and view all the answers

What is the functional consequence of a distal biceps tendon rupture concerning movements at the elbow and forearm?

<p>Impaired elbow flexion and supination (C)</p> Signup and view all the answers

How does the location of the brachial artery influence the clinical approach to measuring blood pressure in the arm?

<p>Pressure is applied directly over the medial intermuscular septum (B)</p> Signup and view all the answers

How does damage to the musculocutaneous nerve impact the actions of muscles in the anterior compartment of the arm?

<p>Impaired flexion, supination, and adduction (D)</p> Signup and view all the answers

A patient presents with weakness in both elbow flexion and supination. Which single muscle is most likely affected?

<p>Biceps brachii (B)</p> Signup and view all the answers

How do the individual heads of the triceps brachii contribute differently to the function of the muscle as a whole?

<p>The long head spans the glenohumeral joint assisting in adduction and extension of the arm in addition to extension at the elbow, while the other heads only extend the elbow (C)</p> Signup and view all the answers

What is the functional significance of the triangular interval in the posterior arm?

<p>It allows passage of the radial nerve and profunda brachii artery (B)</p> Signup and view all the answers

Damage to anatomical neck of humerus. Which structures would most likely be damaged

<p>Axillary nerve and posterior humeral circumflex artery and vein (B)</p> Signup and view all the answers

A patient has a mid-shaft fracture that causes numbness to the posterior compartment of the forearm. Which nerve would most likely be affected considering what is damaged with this fracture?

<p>Radial Nerve (A)</p> Signup and view all the answers

What structural feature of the elbow joint primarily resists valgus stress and prevents excessive abduction of the ulna relative to the humerus?

<p>Ulnar collateral ligament (A)</p> Signup and view all the answers

When accessing the cubital fossa for intravenous catheter placement, what is a key consideration given the anatomical arrangement of its contents?

<p>The median cubital vein provides a superficial route across important neural structures (D)</p> Signup and view all the answers

How does the path of the radial nerve at the elbow contribute to its clinical relevance in injuries around the lateral epicondyle?

<p>It passes posterior to the lateral epicondyle and is therefore at risk during fractures or dislocations (A)</p> Signup and view all the answers

Why would knowledge of the boundaries of the cubital fossa be critical in managing trauma to the anterior elbow?

<p>The boundaries dictate where key neurovascular structures are most susceptible to injury (D)</p> Signup and view all the answers

How does the relationship between the lacertus fibrosus and the median nerve affect the potential for nerve compression in the cubital fossa?

<p>The lacertus fibrosus runs superficial to the median nerve, increasing the risk of compression with forceful muscle contraction (D)</p> Signup and view all the answers

A baseball player reports a sudden 'pop' followed by immediate pain and weakness in elbow extension. What is most likely affected?

<p>Distal triceps tendon rupture (C)</p> Signup and view all the answers

If a surgeon needs to access the brachial artery distal to the profunda brachii branch, which approach allows the most direct access while minimizing risk to nearby nerves?

<p>An anterior approach medial to the biceps brachii (B)</p> Signup and view all the answers

Flashcards

Intertubercular Groove

A groove in the humerus that separates the greater and lesser tubercles.

Humerus Head

Superior portion of the humerus that articulates with the glenoid cavity of the scapula.

Supracondylar Ridge

A ridge on the humerus for muscle attachment.

Coronoid Fossa

A depression in the humerus for the coronoid process of the ulna.

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Olecranon Fossa

A depression in the humerus for the olecranon process of the ulna.

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Axilla

A tunnel in the upper limb that allows passage for nerves, vessels, and muscles.

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Anterior Wall of Axilla

Anterior border of the axilla comprised of the Pectoralis Major and Minor muscles.

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Posterior Wall of Axilla

Posterior border of the axilla comprised of the subscapularis, teres major and latissimus dorsi muscles.

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Medial Wall of Axilla

Medial border of the axilla comprised of the Serratus Anterior.

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Lateral Wall of Axilla

Lateral border of the axilla by the humerus.

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Pectoralis Major

A muscle that adducts and internally rotates the arm, originating in the medial clavicle, sternum, and upper 6 costal cartilages; it inserts in the bicipital groove of humerus and is innervated by medial and lateral pectoral nerves.

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Pectoralis Minor

A muscle that pulls the shoulder down and forward; originating on ribs 3-5 and inserts on the medial border of the coracoid process of scapula; it is innervated by the medial pectoral nerve

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Latissimus Dorsi

A muscle that extends, adducts, and internally rotates the shoulder, originating from the thoraco-lumbar fascia, iliac crest and ribs; it inserts in the intertubercular groove of the humerus and is innervated by the thoracodorsal nerve.

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Subscapularis

Internal rotator of the shoulder, originating in the subscapular fossa and inserts on the lesser tuberosity of humerus. It is innervated by the upper and lower subscapular nerves.

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Teres Major

A muscle that adducts, extends and internally rotates the shoulder, originating from the lower 1/3 of the lateral border of the scapula and inserts on the bicipital groove of humerus, innervated by the Lower subscapular nerve

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Serratus Anterior

A muscle that protracts the scapula, located on the medial wall of the axilla, originating on Ribs 1-9, inserting on the medial border of the scapula, innervated by the long Thoracic Nerve (C5,6,7).

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Musculocutaneous Nerve

A nerve that supplies the anterior compartment of the arm.

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Axillary nerve

A nerve emerging from the posterior cord of the brachial plexus providing sensory innervation to the skin of the lateral arm

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Brachial Artery

The main artery of the arm extending from the lower border of teres major distally, used to measure blood pressure.

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Axillary Vein

The main venous drainage of the arm, often accessed for IV lines and blood draws

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Brachial Plexus

A network of nerves originating from the spinal cord that provides motor and sensory innervation to the upper limb

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Brachium

Shoulder to Elbow (upper arm)

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Arm Compartments

Anterior and Posterior

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Biceps Brachii

A muscle in the anterior compartment of the arm that flexes the elbow and supinates the forearm.

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Lacertus Fibrosis

A broad aponeurosis of the biceps brachii muscle that reinforces the cubital fossa.

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Brachialis

A muscle in the anterior compartment of the arm that flexes the elbow.

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Coracobrachialis

Flexor and adductor of the arm; resists dislocation of shoulder.

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Triceps Brachii

Extends forearm.

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Anconeus

Extends forearm and stabilizes elbow joint.

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Cubital Fossa

Anatomical region around the elbow joint on the anterior side.

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Cubital Fossa Boundaries

Borders: Medial and lateral epicondyles, pronator teres, and brachioradialis.

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Study Notes

Humerus

  • Key features of the humerus include the head, anatomic neck, lesser and greater tuberosities, intertubercular groove, surgical neck, deltoid tuberosity, shaft, medial and lateral supracondylar ridges, and the head.

Axilla

  • The axilla's boundaries consist of:
    • Apex: Where the cervico-axillary canal is.
    • Base.
    • Anterior wall.
    • Lateral wall.
    • Medial wall.
    • Posterior wall.

Borders of the Axilla

  • The borders of the axilla are delineated by specific muscles:
    • Anterior: Pectoralis major and pectoralis minor.
    • Posterior: Latissimus dorsi.
    • Medial: Serratus anterior.

Anterior Wall: Pectoralis Major

  • Originates from the medial half of the clavicle, sternum, and upper six costal cartilages; it inserts on the bicipital groove of the humerus.
  • It is innervated by the medial and lateral pectoral nerves, adducts and internally rotates the arm, and functions as an accessory respiratory muscle.

Anterior Wall: Pectoralis Minor

  • Originates from ribs 3-5 and inserts on the medial border of the coracoid process of the scapula.
  • It is innervated by the medial pectoral nerve, pulls the shoulder down and forward, and elevates the ribs of origin when the shoulder is fixed.

Posterior Wall: Latissimus Dorsi

  • Originates from the thoracolumbar fascia, iliac crest, lower 3-4 ribs, and spinous processes of T7-T12.
  • It inserts on the intertubercular groove of the humerus and is innervated by the thoracodorsal nerve.
  • Causes extension, adduction, and internal rotation of the shoulder.

Posterior Wall: Subscapularis

  • Originates from the subscapular fossa and inserts on the lesser tuberosity of the humerus.
  • It is innervated by the upper and lower subscapular nerves, responsible for internal rotation of the shoulder

Posterior Wall: Teres Major

  • Originates from the lower one-third of the lateral border of the scapula and inserts on the bicipital groove of the humerus.
  • Innervated by the lower subscapular nerve, it causes adduction, extension, and internal rotation of the shoulder.

Medial Wall: Serratus Anterior

  • Originates from ribs 1-9 and inserts on the medial border of the scapula.
  • The long thoracic nerve (C5,6,7) innervates it.
  • Protraction of the scapula against the thoracic wall, is its function.

Lateral Wall

  • The lateral wall of the axilla is characterized by the:
    • Humeral neck.
    • Biceps.
    • Coracobrachialis.

Axillary Contents

  • The axillary contents include the axillary artery and vein, long thoracic nerve, brachial plexus, subscapular nerve, and serratus anterior.

Axillary Contents: Brachial Plexus

  • The components of the brachial plexus are:
    • Roots (C5-T1).
    • Trunks.
    • Divisions.
    • Cords.
    • Branches.

Clinical Scenario: Axillary Stab Wound

  • In a case involving a 25-year-old male stabbed in the axilla:
    • Injuries include pulsatile bleeding, inability to extend the elbow, and numbness on the dorsal radial aspect of the hand.
    • Expected injuries: Radial nerve and axillary artery.
    • The radial nerve originates from the posterior cord of the brachial plexus.
    • The axillary artery originates from the subclavian artery.

Brachium (Arm)

  • The arm contains two compartments, anterior and posterior, divided by intermuscular septa.

Anterior Compartment

  • Anterior compartment muscles include the biceps brachii, coracobrachialis, and brachialis, all typically innervated by the musculocutaneous nerve.

Biceps Brachii

  • Has a long head originating from the supraglenoid tubercle of the scapula and a short head from the coracoid process.
  • Both heads insert on the radial tuberosity via the conjoint tendon.

Brachialis

  • Originates from the distal half of the anterior surface of the humerus and inserts on the coronoid process and tuberosity of the ulna.
  • The musculocutaneous nerve (C5, C6) and the radial nerve (C5, C7) innervate this.
  • Flexion of the forearm in all positions is its function.

Corocobrachialis

  • Originates from the tip of the coracoid process, inserts on the middle third of the medial surface of the humerus, helps flex and adduct the arm, and resists dislocation of the shoulder
  • Innervated by the musculocutaneous nerve.

Clinical Scenario: Biceps Tendon Rupture

  • A 40 year old man lifts a TV when someone drops their side resulting in pain in the antecubital fossa.
  • Indicating a ruptured distal biceps tendon.
  • Involves the musculocutaneous nerve.
  • The musculocutaneous nerve comes from the lateral cord.
  • The long head of the structure originates from the supraglenoid tubercle of the scapula, and the short head originates from the coracoid process of the scapula.

Posterior Compartment

  • Contains the triceps brachii which spans the entire posterior side of the arm.

Triceps Brachii

  • Has a long head originating from the infraglenoid tubercle of the scapula.
  • A lateral head originating from the upper half of the posterior surface of the humeral shaft above the spiral groove.
  • A medial head originating from the lower half of the posterior surface of the humeral shaft below the spiral groove.
  • The common tendon inserts onto the olecranon process of the ulna.

Triangular Interval

  • Key structures found here include the radial nerve and profunda brachial artery.

Anconeus

  • Originates from the lateral epicondyle of the humerus and inserts on the lateral surface of the olecranon and the superior part of the posterior surface of the ulna.
  • innervated by the radial nerve (C7, C8, T1).
  • it assists the triceps in extending the forearm and stabilizes the elbow joint.
  • Abduction of the ulna may occur during pronation.

Clinical Scenario: Distal Triceps Tendon Rupture

  • A 35-year-old weightlifter felt pain and swelling during elbow extension exercises
    • Likely suffering a ruptured distal triceps tendon.
    • The tendon inserts on the olecranon process of the ulna.
    • Innervation comes from the radial nerve.
    • The radial nerve originates from the posterior cord of the brachial plexus.

Vasculature of the Arm

  • The primary artery is the brachial artery, originating as a continuation of the axillary artery.

Branches of Brachial Artery

  • The brachial artery gives rise to:
    • The profunda brachii artery.
    • Superior and inferior ulnar collateral arteries.
    • Radial and ulnar arteries.

Elbow Bones

  • The elbow bones include the humerus, radius, and ulna.

Elbow Joint

  • The elbow joint consists of key features like the:
    • Humerus.
    • Coronoid fossa.
    • Trochlea.
    • Capitellum.
    • Radial head and neck.
    • Radial tuberosity.

Cubital Fossa

  • Boundaries of the cubital fossa are described by medial and lateral epicondyles, pronator teres, and brachioradialis.
  • It contains distal bicep tendon, brachial artery and branches, median nerve, radial nerve

Clinical Scenario: Antecubital Fossa Laceration

  • A 40-year-old female with a laceration in the antecubital fossa had:
    • Extensive bleeding and inability to dorsiflex her wrist or extend the metacarpophalangeal joints.
    • Structures injured: Radial nerve and brachial artery.
    • If the radial nerve is injured, it comes off the posterior cord of the brachial plexus.
    • An injured brachial artery, the structure directly comes after, where the axillary artery passes the distal border of the teres major muscle.

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Description

Overview of the humerus including key features such as the head and tuberosities. Boundaries and borders of the axilla, including the muscles that form its walls, like the pectoralis major and latissimus dorsi are also discussed. Details the origin, insertion, and innervation of the pectoralis major.

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