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
Acromion (of scapula
• Spine
Trapezius muscle
Infraspinatus
muscle
Teres minor
muscle
Triangle of
ascultation
Teres major
muscle
Anterior
Scapula.
-angles, borders
-glenoid cavity,
-acromion,
-coracoid process,
-Subscapular fossa
Humerus.
-Head,
-Surgical neck
-Anatomical neck
-Greater tubercle
-Lesser tubercle
-Intertubercular
(bicipital) groove
Posterior
Clavicle.
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 / adduction
Flexion / extension
Rotation
Circumduction
– internal (medial)
- external (lateral)
Movements of the scapula (Thoracoappendicular):
(increase range of movement of upper limb)
Protraction / Retraction
Elevation / Depression
Rotation:
Superior / Inferior
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= Triangle
Deltoid=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
SITS
Because the scapula is triangular deep bone, padded
with 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
Subscapularis
Winged Scapula:
(long thoracic nerve)
"big swing muscle" or "boxer's muscle”
Antagonist of Rhomboids
Accessory 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
Posterior scapula
Rhomboids retract, so injury to the
dorsal scapular nerve will make the
scapula further away from the
midline on the affected side
References
• Clinically Oriented anatomy “Keith Moore”
sixth edition
• http://www.meddean.luc.edu/lumen/meded/
grossanatomy/dissector/labs/ue/pect_scap/sc
ap1a.html
• www.medicalstudents.com