09 - Scapular Region

The Scapular Region
kiryowa Haruna
Outline of presentation
• Definition of scapular region
• Bones of the scapular region
• Muscles of the scapular region
• Nerves of the scapular region
• Vessels of the scapular region
Introduction
• The scapular region is located at the upper
and posterior aspect of the rib cage.
• The bone of the scapular region is the
scapular.
• This region contains a number of muscles,
most of which attach the upper limb to the
axial skeleton.
The scapular
• It is a flat triangular bone located on the
posterior aspect of the upper limb
it provides attachment for all muscles of the
scapular region.
• Has a spine, acromion and coracoid processes,
medial and lateral borders, an inferior angle
and a glenoid fossa.
Anterior view
• Anteriorly, the scapula has a subscapular fossa
for attachment of subscapularis muscle
• Laterally it has a glenoid fossa that articulates
with the head of the humerusto form the
shoulder joint
• Above the glenoid fossa is the supraglenoid
tubercle for attachment of the long head of
biceps
• Below the G,fossa is the infraglenoid fossa for
attachment of the long head of triceps
Above the glenoid fossa is the coracoid
process for attachment of three muscles
• Short head of biceps
• Coracobrachialis
• Pectoralis minor
Posterior view
• Has a supine that divides the posterior surface
into the supraspinous fossa and infraspinous
fossa
• The supraspinous fossa gives attachment to
the supraspinatus muscle
• The infraspinous fossa gives attachment to the
infraspinatus muscle.
• The spine gives attachment to the trapezius,
deltoid and sternocleidomastoid muscles
• The spine continues laterally as the acromion
process that gives attachment to the deltoid
muscle
• The medial border of the scapular gives
attachment to levator scapulae, rhomboids
minor and rhomboids major.
• The lateral border gives attachment to teres
minor and teres major.
• The inferior angle gives attachment to
lattismus dorsi.
Muscles of the scapular region
Divided into different groups namely
1) superficial posterior axioappendicular group
2) deep posterior axio
appendicular group
3) Scapulohumeral group
Superficial posterior axioappendicular
group
Composed of two muscles namely
1) Trapezius
2)Lattismus dorsi
The Scapular region
• Dr Kiryowa Haruna Muhmood

Trapezius
The muscle provides a direct attachment of the
pectoral girdle to the trunk. This large,
triangular muscle covers the posterior aspect
of the neck and the superior half of the trunk).
It was given its name because the muscles of
the two sides form a trapezium (G. irregular
four-sided figure).
Lattismus dorsi
The name latissimus dorsi (L. widest of the back)
was well chosen because the muscle covers a
wide area of the back. This large, fan-shaped
muscle passes from the trunk to the humerus
and acts directly on the glenohumeral joint
and indirectly on the pectoral girdle
(scapulothoracic joint). The latissimus dorsi
extends, retracts, and rotates the humerus
medially
Summary of superficial posterior
axioappendicular muscles
Action Nerve supply insertion origin Muscle
Descending part Accessory Lateral third of Medial third of Trapezius
elevates; nerve (CN XI) clavicle; superior nuchal
ascending part (motor fibers) acromion and line; external
depresses; and and C3, C4 spine of scapula occipital
middle part (or all spinal nerves protuberance;
parts together) (pain and nuchal ligament;
retracts scapula; proprioceptiv spinous processes
descending and e fibers) of C7 to T12
ascending parts vertebrae
act together to
rotate glenoid
cavity superiorly
Action Nerve supply insertion origin Muscle
Extends, Thoracodorsal Floor of Spinous Latissimus
adducts, and nerve (C6, C7, intertubercular processes of dorsi
medially C8) groove of inferior 6
rotates humerus thoracic
humerus; vertebrae,
raises body thoracolumbar
toward arms fascia, iliac
during climbing crest, and
inferior 3 or 4
ribs
Deep posterior axioappendicular
group
Composed of the following muscles
1) Levator scapulae
2) Rhomboids major
3) Rhomboids minor
Levator scapulae
The superior third of the strap-like levator
scapulae lies deep to the sternocleidomastoid;
the inferior third is deep to the trapezius.
From the transverse processes of the upper
cervical vertebrae, the fibers of this muscle
pass inferiorly to the superomedial border of
the scapula. True to its name, the levator
scapulae acts with the descending part of the
trapezius to elevate the scapula, or fix it
Rhomboids
The rhomboid major and rhomboid minor,
which are not always clearly separated from
each other, have a rhomboid appearance.
They lie deep to the trapezius and form broad
parallel bands that pass inferolaterally from
the vertebrae to the medial border of the
scapula. The thin, flat rhomboid major is
approximately two times wider than the
thicker rhomboid minor lying superior to it.
Action
The rhomboids retract and rotate the scapula,
depressing its glenoid cavity. They also assist
the serratus anterior in holding the scapula
against the thoracic wall and fixing the scapula
during movements of the upper limb. The
rhomboids are used when forcibly lowering
the raised upper limbs (e.g., when driving a
stake with a sledge hammer).
Summary of deep posterior
axioappendicular muscles
Action Nerve supply Insertion Origin Muscle
Elevates Dorsal scapular Medial border Posterior Levator
scapula and (C5) and of scapula tubercles of scapulae
tilts its glenoid cervical (C3, superior to transverse
cavity inferiorly C4) nerves root of spine processes of C1
by rotating to C4 vertebrae
scapula
Action Nerve supply Insertion Origin Muscle
Retract scapula Dorsal scapular Minor: smooth Minor: nuchal Rhomboid
and rotate it to nerve (C4, C5) triangular area ligament; minor and
depress at medial end spinous major
glenoid cavity; of scapular processes of C7
fix scapula to spine and T1
thoracic wall vertebrae
Major: medial Major: spinous
border of processes of T2
scapula from toT5 vertebrae
level of spine
to inferior
angle
MUSCLES OF THE SHOULDER GIRDLE
• The deltoid forms the
contour of the
shoulder.
• Deep to it are :
• Supraspinatus.
• Infraspinatus.
• Subscapularis.
• Teres minor.
• Teres major.
Scapulohumeral group
Composed of Deltoid, Teres major and the
rotator cuff muscles namely
1) Supraspiantus
2) infraspinatus
3) Subscapularis
4) Teres minor
DELTOID
• It is triangular in shape.
• It is functionally divided into:
anterior, middle and posterior
parts.
• Origin :
• Anterior fibers: lateral 1/3 of
the anterior border of the
clavicle.
DELTOID
• Middle fibers : lateral
border of the acromion.
• Posterior fibers: lower
border of the spine of the
scapula.
DELTOID
• Insertion :
• deltoid tuberosity (middle of
the lateral surface of the
humerus).
DELTOID
• Nerve supply :
• Axillar nerve.
DELTOID
• Action:
• 1. Middle fibers: abduction of
the arm (helped by
supraspinatus).
• 2. Anterior fibers: flexion and
medial rotation.
• 3. Posterior fibers : extension
and lateral rotation.
AXILLARY NERVE
• Origin :
• Posterior cord of the brachial
plexus (in the axilla).
AXILLARY NERVE
• Course :
• Passes through the
quadrangular space.
• It is closely related to
the inferior part of the
shoulder joint and the
surgical neck of the
humerus.
AXILLARY NERVE
• Branches :
• 1. Articular : to the shoulder joint.
• 2. Anterior branch :
• deltoid muscle and the skin covering its
lower half.
• 3. Posterior branch :
• Deltoid.
• Teres minor.
• Upper lateral cutaneous nerve of the
arm.
QUADRANGULAR SPACE
• It is an intermuscular
space.
• Boundaries :
• Superior
(posterior) :Teres minor.
• Superior (anterior):
• Subscapularis
• Inferior : Teres major.
QUADRANGULAR SPACE
• Medially : Long head of
triceps.
• Laterally : Surgical neck
of the humerus.
• Contents :
• Axillary nerve.
• Posterior circumflex
humeral vessels.
ROTATOR CUFF
• It is formed of (4) muscles
• Supraspinatus.
• Infraspinatus.
• Teres minor.
• Subscapularis.
• It lies on the superior,
posterior and anterior
aspects of the shoulder joint.
• It is deficient inferiorly.
ROTATOR CUFF
• Function :
• The tone of the muscles
holds the head of the
humerus in the glenoid
cavity.
• So they assist in
stabilization of the shoulder
joint.
SUPRASPINATUS
• Origin :
• Supraspinous fossa of the
scapula.
SUPRASPINATUS
• Insertion :
• Upper facet of the
greater tuberosity of
the humerus and
– The capsule of the
shoulder joint.
SUPRASPINATUS
• Action :
• 1. It initiates abduction
of the shoulder joint.
• 2. Rotator cuff.
INFRASPINATUS
• Origin :
• Infraspinous fossa.
INFRASPINATUS
• Insertion :
• Middle facet of the
the humerus.
INFRASPINATUS
• Action :
• 1.Lateral rotation.
• 2. R.C.
NERVE SUPPLY
• Suprascapular nerve.
SUPRASCAPULAR NERVE
• Origin :
• Upper trunk of the brachial
plexus in the posterior
triangle.
SUPRASCAPULAR NERVE
• Course :
• It descends behind the
suprascapular ligament in
company with the suprascapular
vessels.
• Branches : Supraspinatus,
Infraspinatus and Shoulder joint.
TERES MINOR
• Origin :
• Upper 2/3 of the lateral
border of the scapula.
TERES MINOR
• Insertion :
• Lower facet of the
the humerus.
TERES MINOR
• Nerve supply :
• Axillary nerve.
• Action :
• 1. Lateral rotation.
• 2. R.C.
SUBSCAPULARIS
• Origin :
• Subscapular fossa.
SUBSCAPULARIS
• Insertion :
• Lesser tubercle of the
humerus.
SUBSCAPULARIS
• Nerve supply :
• Upper & lower
subscapular
• Action :
• 1. Medial rotation.
• 2. R.C.
ROTATOR CUFF TENDINITIS
• Manifestations :
• Spasm associated with
pain in the middle
range of abduction.
• It is a common cause of
pain in the shoulder
region.
ROTATOR CUFF TENDINITIS
• Cause :
• Excessive overhead activity of the
upper limb which can cause
degenerative changes in the
subacromial bursa.
• This is followed by degenerative
changes in the supraspinatus
tendon and extend to the other
tendons of the rotator cuff.
TERES MAJOR
• Origin :
• Inferior angle and
lower third of lateral
border of the scapula.
TERES MAJOR
• Insertion :
• Medial lip of the
bicipital groove of the
humerus.
TERES MAJOR
• Nerve supply :
• Lower subscapular
• Action :
• 1. Adduction.
• 2. Medial rotation.
Cutaneous Nerve supply of the
scapular region
• Posterior rami of the spinal nerves
• C1 and C8 don’t supply skin
• Blood supply is the by posterior branches of
the posterior intercoastal arteries
• Veins correspond to arteries and drain into
the azygos veins
• Lymphatic drainage is to scapular group of
axillary lymphnodes.
THE END

09 - Scapular Region

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The Scapular Region

• Dr Kiryowa Haruna Muhmood

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