ASSIGNMENT NO.

4A
SHOULDER REGION

At the end of the course the students must be able to:

1. Describe the surface landmarks of the shoulder region and its adjoining
pectoral, scapular, and deltoid areas

2. Enumerate the structures in the superficial fascia of the pectoral region

3. Describe the male and female mammary glands

4. Discuss the clavipectoral fascia

5. Enumerate the structures in the clavipectoral fascia

6. Identify the dorsal scapular spaces

7. Give the boundaries and contents of the dorsal scapular spaces

8. Discuss the formation of scapular anastomosis. State its importance.

9. Enumerate the muscles of the pectoral, scapular and deltoid areas

10. Give the origin, insertion, nerve supply, and action of the muscles of
the pectoral, scapular, and deltoid areas

11. Describe the shoulder joint

12. Enumerate the ligaments of the shoulder joint

13. Enumerate the rotator cuff muscles

14. Give the muscles acting on the shoulder joint

15. Discuss clinical correlation pertaining to the shoulder joint

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 ASSIGNMENT NO. 4 A
SHOULDER REGION
LABORATORY PROCEDURES

1. Identify and feel for the following in your body and in the cadavers:
a. clavicle
b. manubrium with its jugular notch
c. body of sternum
d. coracoid process
e. acromion process
f. spine of scapula

2.In the anatomical model, identify the following muscles:

a. deltoid
b. supraspinatus
c. infrapinatus
d. teres minor
e. teres major
f. subscapularis
g. pectoralis major
h. pectoralis minor
i. subclavian
j. serratus anterior

3. DISSECTION:
Palpate the jugular notch. Palpate and count the ribs. Give the location of the nipple (among
male cadavers). Make skin incission along the upper border of the clavicle from the mid point of
jugular notch up to the acromion process. From the midpoint of jugular notch make a vertical skin
incision down to the level of 6th costal cartilage. Then make a curve linear incision during the lower
border of the 6th rib up to the anterior axillary fold. By blunt dissection separate the skin from the
underlying fascia as far laterally as possible and connect them medially at the midline. Reflect the skin
flaps laterally to expose the superficial fascia of the anterolateral chest wall

4.Identify the cutaneous nerves and blood.

5. Remove the superficial fascia. Identify the clavipectoral fascia. What are the structures passing
through the clavipectoral fascia?
- Structures passing through clavipectoral fascia are lateral pectoral nerve, thoraco-acromial
artery & cephalic vein.

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6.Identify the pectoralis major. Cut the muscle at the middle of its belly and reflect the
cut ends. What is the muscle located under the pectoralis major?
- Muscle located under: Pectoralis minor

Pectoralis major Clavipectoral fascia

7.Dissect the area inferior to the lateral third clavicle. What is the muscle attached to the clavicle
coming from the 1st rib?
- Subclavius

8. Identify the serratus anterior muscle.

What is the nerve descending superficial to the muscle? – Long thoracic nerve
Give the action of the serratus anterior.
- Draws the forward anterior around the thoracic wall; rotates scapula

SHOULDER JOINT
9.In the mounted skeleton, study the shoulder joint. What are the bones forming the shoulder joint?
- scapula, clavicle, humerus

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 10. In the scapula, identify the origins/insertions/actions of the rotator cuff muscles.

Name of muscle Origin Insertion Action

a. Supraspinatus Supraspinous fossa of Superior part of greater Abductor of the arm
scapula tubercle of humerus
b. Infraspinatus Infraspinous fossa of Greater tubercle of Rotates humerus
scapula humerus laterally
c. Subscapularis Subscapular fossa of Lesser tubercle of Chief medially rotator
scapula humerus of humerus
d. Teres minor Lateral border of dorsal Greater tubercle of Lateral rotator of
scapular surface humerus humerus

11. Label the anterior view of shoulder joint.

Supraspinatus

Infraspinatus

Teres minor

Teres major

12. Label the scapular arterial anastomosis. Label the blood vessels.

Transverse
Suprascapular cervical artery
artery

Axillary artery

Subscapular
artery

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 ASSIGNMENT NO. 4B
BACK

At the end of the course the students must be able to:

1. Describe the thoracolumbar fascia

2. Enumerate the blood vessels of the back

3. Give the nerve supply of the back

4. Describe the lymphatic drainage of the back.

5. Give the layers of muscles of the back

6. Name the origin, insertion, action and nerve supply of the different layer of the
muscles of the back

7. Describe the auscultation triangle

8. Describe the triangle of Petit

9. Identify the muscles of the back of the neck. Give their attachments and actions.

10. Name the muscles forming the boundaries of the suboccipital triangle.

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 ASSIGNMENT NO. 4 B
BACK
LABORATORY PROCEDURE

SURFACE ANATOMY

Palpate and identify the following in your own body and your classmate's:
a. external occipital protuberance
b. prominences of the vertebral spines
c. spinal sulcus (midline sulcus at the back)
d. ribs
e. acromion process of scapula
f. scapular spine

DISSECTION PROCEDURE
1. Make a longitudinal skin incision starting from the external occipital
protuberance down to the tip of the coccyx

2. From the external occipital protuberance, extend the incision laterally as far as
the mastoid process of the temporal bone.

3. From the mastoid process, make an incision downward along the lateral side of
the neck to the acromion process of the scapula

4. From the tip of the coccyx, make an oblique incision connecting it (coccyx)
with the highest point of the ilium (iliac crest) laterally.

5. On one side, separate the skin from the underlying structures and reflect it
laterally.

Identify the cutaneous vessels and nerves. What are these cutaneous nerve?
- Long thoracic nerve
- Lateral pectoral nerve
- Musculocutaneous nerve
- Lateral root of the median nerve
- Medial pectoral nerve
- Medial cutaneous nerve of the arm
- Medial cutaneous nerve of the forearm
- Ulnar nerve
- Medial root of the median nerve
- Thoracodorsal nerve
- Axillary nerve
- Radial nerve

➢ These are the nerves that supplies the upper limb muscles.

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Examine the deep fascia of the lower portion of the back. This deep fascia is divided into three layers,
such as the posterior, middle and anterior lamellae which are best demonstrated is a cross section of the
back. Identify the muscles in the superficial layer such as the trapezius and the latissimus dorsi. Give
the insertion and nerve supply of the trapezius.

Name the actions of the trapezius.

- Medial: it abducts & retracts scapula
- Superior: elevates scapula or synergist to head extension
- Inferior: depresses scapula & shoulder

Give the insertion and nerve supply of the latissimus dorsi.

- Insertion: intertubercular groove of humerus
- Nerve supply: Thoracodorsal

What is the chief action of the latissimus dorsi?

- Powerful arm adductor
- Medially rotates arm & shoulder
- Depresses scapula
- Pulls body upward & forward with arm fixed overhead
- Agonist of arm extension

Look for the triangle of auscultation. Identify and name its boundaries.
Medially – scapula

Laterally - trapezius

Inferiorly – latissimus dorsi

6. Cut the trapezius muscle near its origin. Reflect it laterally. Identify the
rhomboid major and rhomboid minor and the levator scapula along medial
border of the scapula

Give the nerve supply of rhomboid major, rhomboid minor and levator scapula
- Rhomboid major: Dorsal scapular nerve
- Rhomboid minor: Dorsal scapular nerve
- Levator scapula: Cervical spinal nerve & dorsal scapular nerve

Give the action of levator scapula

- elevates & adducts scapula
- tilts glenoid cavity down, flexes neck to same side

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7. To expose the next layer of the muscles, cut the rhomboids and the latissimus
dorsi near their origin. Then pull the scapula laterally. Identify the
following muscles: serratus posterior superior and serratus posterior inferior.
Take note of the direction of fibers.

Give the nerve supply and action of the serratus posterior muscles.
Serratus posterior superior
▪ Nerve supply: intercostal nerve
▪ Action: elevates the ribs (inspiratory)

Serratus posterior inferior

▪ Nerve supply: intercostal nerve (expiratory)
▪ Action: depresses the ribs

8. Expose the 3rd layer. Identify the following components of the erector spine
(sacrospinalis) and their subdivisions: iliocostalis, longissimus, and spinalis.
Follow the course of their fibers upward to their insertion.

Give the common action and nerve supply of the erector spine.
Iliocostalis
▪ Nerve supply: occipital, deep cervical and vertebral arteries
▪ Action: extends & laterally bends vertebral column and head

Longissimus
▪ Nerve supply: dorsal branches of posterior intercostal, subcostal and lumbar
arteries
▪ Action: extends & laterally bends vertebral column and head

Spinalis
▪ Nerve supply: dorsal branches of lateral sacral arteries
▪ Action: extends & laterally bends vertebral column and head

9. Expose and identify the following muscles at the back of neck: Splenius capitis and splenius
muscles.
Give the insertion of the splenius muscles
- transverse processes of the upper cervical vertebrae

10. Identify the semispinalis capitis. Cut it about 2 inches from its insertion, then
reflect upward. This will expose the suboccipital triangle.

11. Identify following muscle that form the boundaries of the triangle: rectus
capitis posterior major, rectus capitis posterior minor, obliquus capitis
superior and obliquus capitis inferior

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Label important muscles:

1. Show the superficial layer of the back. Label.

Trapezius

Teres major

Deltoid

Teres minor

Latissimus dorsi

Semispinalis capitis muscle

Splenius capitis muscle

Levator scapulae

Serratus posterior superior muscle

Subscapularis

Teres minor

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 Rhomboid minor

Rhomboid major

Erector spinae
Trapezius

Latissimus dorsi
Gluteus medius

Gluteus maximus

3. Label the 3rd layer of the back.

Rectus capitis posterior minor

Rectus capitis posterior major

Levatores costarum muscles

Semispinalis thoracis muscle

Rotatores thoracis muscle

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 4. Label the boundaries in suboccipital triangle.
Rectus capitis posterior
minor

Rectus capitis posterior

major
Semispinalis capitis
muscle

Semispinalis capitis
muscle

Obliquus capitis superior

Splenius capitis muscle

Splenius capitis muscle

Obliquus capitis inferior

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