AVICLE

SHOULD
ER • ​Location: ​o ​It connects the
apula to the sternum
• ​The proximal segment of the limb that o ​It articulates with the sternum at
overlaps the parts of the trunk (thorax and the
back) and lower lateral neck
sternoclavicular joint ​o ​It
• ​It includes: ​o ​Pectoral, scapular, articulates with the scapula at the
and deltoid regions of the
acromioclavicular
upper limb ​o ​Lateral part (greater joint
supraclavicular fossa) of
the the lateral cervical
region
• ​Overlies half of the ​pectoral
(shoulder) girdle ​o ​a bony ring ​o
incomplete posteriorly, formed by scapulae,
clavicles and humerus ​o
completed anteriorly by the manubrium of
the sternum (part of the axial skeleton)

in individuals below middle age ​o ​occur

• ​Bones of the Pectoral Girdle: ​Clavicle,
Scapula and Humerus ​o ​Acromion ​o
Coracoid ​o ​Body of scapula ​o ​Scapular
notch ​o ​Subscapularis fossa ​o
Angles/margins of scapula
(sup,med,inf/sup,med, lat) ​o ​Glenoid ​o
Glenoid fossa
A.
during a fall unto an outstretched arm ​o ​the
middle 3​rd ​is the most fractured site,
resulting to an upward displacement
proximal fragments and downward
displacement of the distal fragments ​o ​can
produce nerve damage as well as severe,
even fatal, internal bleeding ​o ​Fragment
displacement dependent on pull
of muscles
 attached cage ​o ​It is a flat bone that is
shaped like an
B. inverted triangle with superior,
SCAPULA vertebral, and lateral borders and an
• ​Characteristics: ​o ​Lie against the inferior apex
posterior aspect of the rib
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD

• ​Ossification: ​o ​First bone to begin ossification, starting in

the fifth week of fetal development ​o
Last to complete ossification at about the
twenty-first year ​o ​The only long bone by intermembranous
ossificatio
n
• ​Clavicular Fracture: ​o ​One of the most commonly fractured bones
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• ​Parts: a. ▪ ​separates the head from the

Spinous process b. metaphysis
Acromion process c. ▪ ​marks the location of an
Coracoid process d. epiphyseal plate c. Lesser tuberosity
Glenoid fossa ▪ ​lies on the anterior surface of the
humerus, just distal to the anatomic neck
C. ▪ ​provides an attachment for
HUMERUS the subscapularis muscle d.
• ​Characteristics: ​o ​A long bong Greater tuberosity
with a proximal end consisting of head and ▪ ​lie on the lateral surface of the
two tuberosities separated by an humerus, just lateral to the anatomic
intertubercular groove neck
• ​Parts of ▪ ​provides attachments for the
the bone: a. Head supraspinatus, infraspinatus, and teres
▪ ​Covered by hyaline minor muscles e. Intertubercular groove
cartilage ▪ ​lies between the greater and
▪ ​Articulates with the scapula at lesser tuberosities
the glenohumeral joint b. Anatomic ▪ ​contains the tendon of the long head of
neck the biceps brachii muscle
ARTICULATION OF THE SHOULDER ligament b.
GIRDLE A. STERNOCLAVICULAR Costoclavicular ligament
JOINT
• ​Structure: ​o ​The clavicle articulates with
the manubrium
of the sternum, proximally ​o ​The joint
has a fibrocartilaginous articular disk that
divides the joint into synovial capsules
B. ACROMIOCLAVICULAR
• ​Movement: -two degrees of freedom JOINT
o ​Elevation/ depression of the shoulder
• ​Structure: ​o ​The clavicle articulates with
o ​Protraction/ retraction ​o
the acromion of
circumduction
the
• ​Support: ​o ​The fibrous joint capsule is
scapula
reinforced by a
• ​Movement: -a sliding one with two
strong ligament so that dislocation of
degrees of freedom ​o ​rotation of the
the sternoclavicular joint is uncommon
scapula ​o ​accomodation to motion that
a. Anterior/ posterior sternoclavicular
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD
JMMISSION | 2021 ​2
 occurs at the sternoclavicular
joint
• ​Support: ​o ​The articular capsule, thin and lax, is
reinforced by several strong ligaments a. Coracoclavicular ligament – for
superior/inferior stability b.
Acromioclavicular ligament – for
anterior/posterior
stability
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD
• ​Clinical Correlation: ​AC joint omboids, serratus anterior, trapezius, and
dislocation ​o ​“Shoulder separation” ​o ator scapula
Deformity when coraco-clavicular ligaments
ruptur
e

C. SCAPULOTHORACIC
JOINT
• ​Structure: ​o ​It lies between the
scapularis muscle and
serratus anterior muscle ​o ​No
articulation between the scapula and
thoracic cage. ​o ​It appears to GLENOHUMERAL JOINT
function as a joint, although cHJ)
two of the movement pairs actually • ​Structure: ​o ​The glenoid fossa is
occurs at the sternoclavicular joint e site of articulation
• ​Movement: -three degrees of freedom, with the head of the
which allow for considerable motion of the humerus
scapula on the posterolateral thoracic
cage ​o ​Protraction/retraction (SCJ) ​o
Elevation/ depression (SCJ) ​o ​Rotation o ​This shallow fossa is deepened slightly
(ACJ) by a lip of fibrocartilage, the glenoid
• ​Support: ​o ​This pseudojoint is labrum
supported by the clavicle ​o ​Reinforced by the • ​Movement: -As a ball and socket joint, it
muscle that insert on the scapula, such as the has three degrees of freedom ​o
Flexion/extension ​o ​Abduction/adduction ​o reinforced by muscle action
Rotation a. Rotator cuff
• ​Support: ​o ​Its lax fibrous capsule is ▪ ​acts as a dynamic ligament, keeping
reinforced by tough the head of the humerus pressed into
articular ligaments a. superior, middle, and the glenoid fossa b. tendon of the long
inferior glenohumeral head of the biceps
ligaments b. brachii
Coracohumeral ligament muscle
c. Coracoacromial
ligament ROTATOR CUFF MUSCLES
• ​Dynamic stability: ​o ​This rather (SSIT)
unstable joint is dynamically
• ​Tendons blend with the joint capsule to
form a cuff
• ​Stabilizes and protects the
joint
• ​Tonic contractions keep humeral head in
small shallow glenoid during arm movements
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A- ​SHOULDER
REGION AND POSTERIOR COMPARTMENT OF THE ARM ​NORMAN VALERA, MD
MUSCLES THAT MOVE THE SHOULDER ​A. Anterior thoraco-appendicular muscles
B. Posterior thoraco-appendicular muscles C. Scapulo-humeral muscles
A. ANTERIOR THORACO-APPENDICULAR
MUSCLES 1. ​Pectoralis major
o ​adducts, medially rotates the humerus ​2. ​Pectoralis minor
o ​stabilizes the scapula ​3. ​Serratus anterior
o ​stabilizes, rotates the scapula laterally
allowing shoulder abduction past 90 ​4. ​Subclavius
o ​stabilizes the clavicle, SC joint ​o ​protects neurovascular structures under the
clavicle
B. POSTERIOR THORACO-APPENDICULAR
MUSCLES
• ​Extrinsic shoulder muscles
• ​Originate from base of skull and spinous processes of vertebral column
• ​Attach the shoulder girdle to the trunk
• ​Except the ​Latissimus dorsi ​which attaches to the arm
• ​Mainly innervated by cervical roots 3 to 8 1. Trapezius 2. Latissumus dorsi 3.
 Rhomboids 4. Levator Scapulae NOTE: See table at the last pages
C. SCAPULO-HUMERAL MUSCLES
1. Deltoid 2. Teres major 3. Rotator cuff muscles
a. Supraspinatus
▪ ​inserts topmost
▪ ​initiates arm abduction
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b. Infraspinatus
▪ ​posteriorly, middle muscle
▪ ​strong external rotator of the shoulder c. Teres minor
▪ ​external rotator of shoulder d. Subscapularis
▪ ​in front, inserts on the lesser tubercle
▪ ​internally rotates the arm NOTE: See table at the last pages
QUADRANGULAR SPACE
• ​Boundaries: ​o ​Superior: Teres minor and Subcapularis
muscle ​o ​Inferior: Teres major muscle ​o ​Medial: Long head of the triceps ​o ​Lateral:
Surgical neck of the humerus
• ​Transmits the axillary nerve and the posterior humeral circumflex vessels
TRIANGULAR SPACE (UPPER)
• ​Boundaries: ​o ​Superior: Teres minor muscle ​o ​Inferior: Teres major muscle ​o
Lateral: Long head of the triceps
• ​Contains the circumflex scapular vessels
TRIANGULAR SPACE
(LOWER)
• ​Boundaries: ​o ​Superior:
Teres major muscle ​o ​Medial:
longhead of the triceps ​o ​Lateral:
medial head of the triceps
• ​Contains the radial nerve and the
profunda brachii (deep brachial) artery

RIANGLE OF
USCULTATION
• ​Boundaries: ​o ​Upper border of the
ssimus dorsi muscle,
 the lateral border of the trapezius muscle, REGION -​Branches of the
and the medial border of the scapula ​o Subclavian Artery ​1.
Floor is formed by the rhomboid major Suprascapular artery
muscl o ​branch of thyrocervical trunk ​o ​Passes
e over the superior transverse scapular
• ​The area at which breathing sounds are
heard most clearly
MUSCLE
ATTACHEMENTS

BLOOD SUPPLY OF THE

Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD
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 ligament ​o ​Anastomoses with the deep branch of the
transverse cervical artery (DORSAL
SCAPULAR ARTERY) and the circumflex
scapular artery around the scapula
providing collateral circulation ​o ​supplies
the supraspinatus and infraspinatus
muscle and the shoulder
and acromioclavicular
joint
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A- ​SHOULDER
REGION AND POSTERIOR COMPARTMENT OF THE ARM ​NORMAN VALERA, MD
2. Dorsal scapular or descending scapular artery
VENOUS DRAINAGE ​o ​arises from the subclavian artery but may be
• ​Radial and ulnar veins ​of the forearm join to a deep branch of the transverse
cervical
form usually two to three ​brachial veins(venae ​artery
commitantes brachiales)​, which anastomoses ​o ​accompanies the dorsal scapular
nerve
freely with about the brachial artery. These join ​o ​supplies the levator scapulae,
rhomboid, and
with the basilic vein in the region of the teres serratus anterior muscles
major muscle to form the ​axillary vein
POSTERIOR COMPARTMENT OF THE ARM
LYMPHATIC DRAINAGE
• ​Corresponds to primitively dorsal musculature
• ​Superficial lympathics ​drain along the
• ​Triceps brachii and Anconeus
superficial veins and would bypass most of the
• ​Innervated by radial nerve
• ​When forearm is fully supinated and nearly fully extended, the brachioradialis is
considered extensor muscle of the posterior arm
axillary nodes, entering instead ​subclavian nodes
• ​Deep lymphatics ​accompany brachial vein and drain through the ​axillary lymph
nodes
BLOOD SUPPLY
• ​Deep brachial (profunda brachii) artery ​o ​Together with the radial nerve, they passes
posteriorly to and then lies laterally to the humerus in the radial(musculospiral) groove ​o
A recurrent branch anastomoses with the
 posterior humeral circumflex artery ​o ​A lateral branch anastomoses with the radial
recurrent artery ​o ​A posterior branch anastomoses with the
recurrent interosseous artery
MUSCLE ORIGIN INSERTION ACTION INNERVATION ​Triceps brachii long head
JMMISSION | 2021 ​6 ​Infraglenoid tubercle
Olecranon process extends forearm
Radial nerve(C7-C8) of the scapula
at elbow joint lateral head Posterior surface of
same same same the humerus medial head same same same same Anconeus Posterior aspect
of
the lateral epicondyle
same same same
Brachioradialis Distal lateral surface
of the humerus
Styloid process of
Extensor muscle Radial the radius
when the

nerve( C5-C6) forearm

​ is fully supinated and nearly fully extended
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD
JMMISSION | 2021 ​7
Far Eastern University- Nicanor Reyes Medical Foundation GROSS A-
SHOULDER REGION AND POSTERIOR COMPARTMENT OF THE
ARM ​NORMAN VALERA, MD
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