Scapular Region

Dr. Nivin Sharaf(MD)

Objectives

• Know the landmarks of the bony structures of the shoulder/axillary regions

• Know the rotator cuff muscles, external rotators, internal rotators

• Be familiar with principal muscles of the scapular , scapulo-humeral region

• Scapular rotation in relation with shoulder movements

Surface Anatomy

• Spine

Acromion (of scapula

Teres minormuscle Teres major

muscle

Infraspinatusmuscle

Triangle ofascultation

Trapezius muscle

AnteriorScapula.-angles, borders-glenoid cavity, -acromion, -coracoid process, -Subscapular fossa

Humerus.-Head,-Surgical neck-Anatomical neck-Greater tubercle-Lesser tubercle-Intertubercular (bicipital) groove

PosteriorClavicle.Acromioclavicular joint

Scapula.- Spine - Acromion- Supraspinous fossa- Infraspinous fossa

Humerus. - Head - Anatomical neck, - Surgical neck, - Deltoid tuberosity- Spiral (radial) groove.

Scapular Fracture

Movements of the shoulder joint (Review):

Abduction / adductionFlexion / extension

Rotation – internal (medial)- external (lateral)

Movements of the scapula (Thoracoappendicular):(increase range of movement of upper limb)Protraction / RetractionElevation / DepressionRotation: Superior / Inferior

Circumduction

Superior rotation of Glenoid fossa:

- Powerful muscles pull on bony struts.

Scapula rotates when we move our arms to allow more range of motion at the shoulder joint

Complete abduction at the shoulder joint requires superior rotation of the scapula so that the glenoid fossa faces superiorly.

Glenoid fossa

Deltoid

• Clavicular origin, acromial, and scapular origins, attach all to deltoid tuberosity

• Anterior fibers flexes• Posterior fibers extends and

laterally rotates• Middle fibers abducts the arm• Innervation C5,6 Axillary nerve

Delta= TriangleDeltoid=triangular in shape Principal abductors= Deltoid, supra spinatus

Subdeltoid / Subacromial bursa.

Bursa: a closed sac or envelope, lined with synovium and containing fluid, usually in areas subject to friction.

Rotator cuff muscles stabilize the shoulder joint.Supraspinatus, Infraspinatus,Subscapularis, Teres minor

Rotator Cuff Muscles SITSBecause the scapula is triangular deep bone, paddedwith thick muscles, injuries leading to scapular fractures Will be so severe , and most commonly we will have lots of multiple, or serious other fraactures

Transverse scapular ligament

• Runs between Subscapular nerve (C5,6) and artery, which supply supra and infra spinatus ms• Artery above, nerve below• Army un over the bridge, navy sail under the bridge

Serratus Anterior

Winged Scapula: (long thoracic nerve)

Subscapularis

"big swing muscle" or "boxer's muscle”Antagonist of RhomboidsAccessory muscle of respiration

Posterior view:- Trapezius- Latissimus Dorsi- Deltoid

Rhomboids:- minor and major- retract / inferior rotate scapula

Teres major:- inserts near latissimus dorsi- adduct / medially rotate arm

Rhomboids retract, so injury to the dorsal scapular nerve will make the

scapula further away from the midline on the affected side

Posterior scapula

References

• Clinically Oriented anatomy “Keith Moore” sixth edition

• http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/labs/ue/pect_scap/scap1a.html

• www.medicalstudents.com

Thank you