Suboccipital and Scapular Region

b202107006 易廷辰
b202107026 趙守約
b202107035 劉詩宏
b202107038 許祐晟
Scapular Region
b202107035 劉詩宏
Skeleton
Scapula

A:superior border

B:medial border

C:lateral border

D:superior angle

E:inferior angle

F:lateral angle
Skeleton
Scapula
1:Acromion
2:Coracoid process
3:Scapular notch
4:Glenoid cavity
5:Infraglenoid tubercle
6:Supraspinous fossa
7:Spine
8:Infraspinous fossa
9:Articular facet for acromion
10:Neck
11:Supraglenoid tubercle
12:Costal(anterior) surface
13:Base of coracoid process
Skeleton
Scapula
1:Acromion
2:Coracoid process
4:Glenoid cavity
5:Infraglenoid tubercle
7:Spine
11:Supraglenoid tubercle
13:base of coracoid process
C:lateral border
D:superior angle
E:inferior angle
Muscles
1.Subscapularis 2.Supraspinatus
Origin: Subscapular fossa of scapula Origin: Supraspinous fossa of scapula
Insertion: Lesser tubercle of humerus Insertion: Greater tubercle of humerus
Muscles
3.Infraspinatus
Origin: Infraspinous fossa of scapula
Insertion: Greater tubercle of humerus
4.Teres minor
Origin: Posterior aspect of superior half of
lateral border of scapula
Insertion: Greater tubercle of humerus
大體圖譜
5:Clavicle

7:Supraspinatus muscle

8:Spine of scapula

13:Infraspinatus muscle

14:Teres minor muscle

16:Teres major muscle

Rotator cuff(4 muscles)
1.Subscapularis
2.Supraspinatus
3.Infraspinatus & Teres minor
Artery
1.Dorsal scapular artery
來源 :Subclavian artery→Thyrocervical
trunk→Transverse cervical artery
→Deep branch of Transverse
cervical artery→Dorsal scapular
artery
走向 : 通過 brachial plexus ，橫向往肩
胛骨的 superior angle 傾斜，沿著
肩胛骨的內側下降 ( 在 Rhomboid
m. 下方 )
Artery
1.Dorsal scapular artery
( 變異 大概 30 ％ )
來源 :Subclavian artery→
Dorsal scapular artery
Artery
2.Suprascapular artery
來源 :Thyrocervical trunk
→Suprascapular artery
走向 : 橫向平行於鎖骨，下跨肩胛骨
的 suprascapular notch ，走在
supraspinous fossa 的表面，深至
肩胛骨 inferior scapular notch
Artery
3.Circumflex scapular artery
來源 :Axillary artery→Subscapular artery
→Circumflex scapular artery
走向 : 沿肩胛骨外側邊界進入 infraspinous
fossa ，並走在 infraspinous fossa
的表面
Arterial anastomoses around scapula
occur between 3 groups of arteries:
1.suprascapular, dorsal scapular,
& circumflex scapular
2.posterior humeral circumflex
& acromial branch of
thoracoacromial artery
3.dorsal scapular
& posterior intercostal
Nerve
1.Dorsal scapular nerve
來源 :C5 臂神經叢
走向 : 沿肩胛骨內側邊界往下延伸
支配 : 運動神經
支配 levator scapulae
rhomboid minor/major
Nerve
2.Suprascapular nerve
來源 : 臂神經叢的 superior trunk
走向 : 橫向穿過 posterior triangle ，經過
suprascapular notch 到後肩胛骨區域
( 和同名的血管一起走 )
經過 inferior scapular notch
走在 supra/infraspinous fossa
支配 : 運動神經
支配 supraspinatus muscle
infraspinatus muscle
Posterior triangle of the neck
Anterior – posterior border
of the sternocleidomastoid
Posterior – anterior border
of the trapezius muscle
Inferior – middle 1/3
of the clavicle
大體圖譜
1.Clavicle
3.Suprascapular artery
4.Suprascapular nerve
6.Teres minor
9.Circumflex scapular artery
10.Teres major
18.Spine of scapula
19.Dorsal scapular artery
&dorsal scapular nerve
21.Infraspinatus muscle
&medial margin of scapula
大體圖譜
3.Suprascapular artery
4.Suprascapular nerve
5.Superior transverse
scapular ligament
6.Teres minor
9.Circumflex scapular artery
10.Teres major
18.Spine of scapula
19.Dorsal scapular artery
&dorsal scapular nerve
Dissection − Scapular Region
b202107006 易廷辰
四角空間 三角空間 棘上棘下區
1. 將大體老師呈俯臥姿勢，上肢外展
45 度。可用木枕墊在胸部下方及
腋下以利維持姿勢
2. 將斜方肌 (trapezius) 的起點處切斷，
向外側翻起
3. 整理三角肌 (deltoid) ( 整出邊界、
清理結締組織 )
4. 環切三角肌起點，向外側翻起
5. 觀察腋神經 (axillary n.) 、後旋肱
動脈 (posterior circumflex humeral
a.) 於四角空間
四角空間複習：

上邊界－小圓肌 (teres minor) 下緣

外邊界－肱骨 (humerus) 外科頸

內邊界－肱三頭肌 (long head of

triceps brachii) 長頭外側緣

下邊界－大圓肌 (teres major) 上緣

四角空間 三角空間 棘上棘下區
整理小圓肌 整理肱三頭肌長頭 整理大圓肌
1. 觀察旋肩胛動脈 (circumflex
scapular a.) ，從三角空間深層穿
出
三角空間複習：

上邊界－小圓肌下緣

外邊界－肱三頭肌長頭內側緣

下邊界－大圓肌上緣
四角空間 三角空間 棘上棘下區
1. 向外側翻起斜方肌，整理棘上肌
(supraspinatus)
2. 整理棘下肌 (infraspinatus)
1. 在棘上肌中央縱切開肌肉，斷緣向
外側翻起
2. 觀察肩胛上橫韌帶 (superior
transverse scapular ligament)
3. 觀察肩胛上神經 (suprascapular n.)
從韌帶下緣的孔洞內穿入
4. 觀察肩胛上動脈 (suprascapular a.)
從韌帶附近繞入
1. 在棘下肌中央縱切開肌肉，斷緣向
外側翻起
2. 觀察肩胛上動脈向外側繞過肩胛大
/ 下切跡 / 棘盂切跡 (greater/inferior
scapular notch)/(spinoglenoid notch)
至棘下窩 (infraspinous fossa)
3. 觀察各環繞肩胛的動脈形成的肩胛
動脈聯會網 (scapular anastomosis)
 Checklist
Bone Muscles Vessels Nerves

posterior circumflex
humerus trapezius axillary n.
humeral a.

circumflex scapular
scapula deltoid suprascapular n.
a.
teres minor suprascapular a.
long head of triceps
brachii
teres major
supraspinatus
infraspinatus
 Checklist
四角空間 三角空間 棘上棘下區
Bone humerus scapula
teres minor teres minor

long head of triceps long head of triceps supraspinatus

brachii brachii
Muscles

teres major teres major infraspinatus

posterior circumflex
Vessels circumflex scapular a. suprascapular a.
humeral a.
Nerves axillary n. suprascapular n.
Suboccipital Region
b202107038 許祐晟
Skeleton of the Suboccipital Region
• Occipital bone
Superior nuchal line
Inferior nuchal line
External occipital protuberance
Foramen magnum
Skeleton of the Suboccipital Region
• Atlas
Posterior tubercle
Posterior arch
Groove for the vertebral artery
Transverse process
Foramen transversarium
• Axis
Spinous process
Transverse process
Foramen transversarium
 Muscle of the Suboccipital Region
Splenius capitis
Semispinalis capitis
Muscle Origin Insertion

2 3
Superior articular surface Area between
1 Semispinalis of C4-C7 ; transverse superior and inferior
capitis process of T1-T6 nuchal line
4
nuchal ligament and Mastoid process of
Splenius capitis spinous processes of the temporal bone;
C7-T3 superior nuchal line

Longissimus capitis Transverse process of C4- Mastoid process of

Longissimus T4 temporal bone
capitis
 Muscle of the Suboccipital Region
Splenius capitis
Semispinalis capitis

2 3
1

Longissimus capitis
Suboccipital triangle-Suboccipital n.&Vertebral
a.
Suboccipital nerve
• Dorsal division of the first cervical
spinal nerve
• Innervates rectus capitis posterior
major , obliquus capitis superior,
obliquus capitis inferior and
rectus capitis posterior minor
• contains motor fibers but no
cutaneous sensory fibers
Vertebral artery
• The first branch of the subclavian
artery
• 4 parts: prevertebral part , vertebral
part , atlantal part , intracranial part
• 左右 vertebral artery 匯集形成
basilar artery
Other structure-Greater occipital nerve
• Medial branch of the dorsal primary
ramus of the second cervical nerve
• 與 occipital artery 伴行
• Penetrates the semispinalis capitis
muscle
• Supplies sensation to the skin in the
posterior skull, including the occiput
and temporal areas, and to the vertex
and ear
Other structure-occipital artery
• External carotid artery 的分支
• 與 greater occipital nerve 伴行
• Supply the muscle of neck , scalp region
, the meninges , and the mastoid region
of head
Dissection − Suboccipital Region
b202107026 趙守約
Dissection- Suboccipital Region
1. 把 Trapezius m. 向外翻開
2. Splenius Capitis m. 由內剪開向外翻， 翻
開後看到 Longissimus Capitis m.
3. 找出 Greater Occipital n. 以及 Occipital a.
4. 在 Semispinalis Capitis m. 靠近 Occipital
Bone 的部分剪開肌肉 並向下翻開
( 注意不要剪到穿過肌肉的 Greater Occipital n.)
Dissection- Suboccipital Region
Dissection- Suboccipital Region
5. 看到 Greater Occipital n. 是從 Obliquus
Capitis Inferior m. 下緣走出來
6. 清理並觀察組成 Suboccipital Triangle
的三條肌肉： Rectus
Capitis Posterior Major, Obliquus
Capitis Inferior, Obliquus Capitis
Superior
7. 清理 Rectus Capitis Posterior Minor m.
Dissection- Suboccipital Region
8. 清理並觀察 Suboccipital Triangle 中的神經血管： Suboccipital
nerve, Vertebral artery
 Dissection- Suboccipital Region
Greater occipital n.

Occipital a.
Obliquus Capitis Superior m.

Greater Occipital
n. Vertebral a.
Rectus Capitis Posterior Minor m.

Semispinalis Capitis m. Rectus Capitis Posterior Major

m.

Suboccipital n.

Obliquus Capitis Inferior

m.
Checklist- Suboccipital Region
Bone Muscles Vessels Nerves
Atlas Splenius Capitis m. Occipital a. Greater Occipital n.
Axis Semispinalis Capitis m. Vertebral a. Suboccipital n.
Occipital Bone Longissimus Capitis m.

External Occipital Rectus Capitis Posterior

Protuberance Minor m.

Rectus Capitis Posterior

Major m.

Obliquus Capitis Superior

m.

Obliquus Capitis Inferior

m.