Scapular region

Dr. Fatema
Department of Anatomy
LNMC.
 Cutaneous
innervation
 Lateral supraclavicular nerve
=>upper half of deltoid
 Upper lateral cutaneous nerve of the arm
=> lower half of deltoid
 Dorsal rami of upper thoracic nerves
=> scapula

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 Introduction
The muscles of the shoulder
support and produce the
movements of the shoulder girdle.
They attach the appendicular
skeleton of the upper limb to the
axial skeleton of the trunk.

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 Posterior
Shoulder
Muscles

Extrinsic Intrinsic
muscles muscles

Superficial posterior Deep posterior Scapulohumeral

axioappendicular axioappendicular muscles
muscles muscles

Deltoid
Trapizeus Levator scapulae Teres major
Latissimus dorsi Rhomboids Teres minor
Subscapularis
Supraspinatous
Infraspinatous 4
Sample Footer Text 5
 Trapezius muscle
• Proximal attachment:
medial third of the superior nuchal line,
external occipital protuberance, spinous
processes of C7-T12 vertebrae, nuchal
ligament.
• Distal attachment:
lateral third of clavicle, acromion and spine
of scapula

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• Innervation:
• Motor fibers- spinal accessory nerve (CN
XI)
• Sensory fibers- C3-C4 spinal nerves
• Muscle action:
• Descending part elevates;
• Ascending part depresses;
• Middle part retracts scapula;
• Asc. & desc. Part act together to rotate
glenoid cavity superiorly.
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 Latissimus dorsi
Proximal attachment:
• spinous processes of inferior 6
thoracic vertebrae, thoracolumbar
fascia, iliac crest, and the inferior 3
or 4 ribs.
Distal attachment:
• floor of intertubercular sulcus of
humerus
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 Latissimus dorsi
Innervation:
• Thoracodorsal nerve (C6, C7, C8)
Muscle action:
• adduction, medial rotation and
extension of the arm;
• Raises the body towards arms during
climbing.

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Scapulohumeral
(Intrinsic Shoulder)
Muscles
1. Deltoid
2. Teres major
3. Teres minor
4. Subscapularis
5. Supraspinatous
6. Infraspinatous

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 Deltoid
• Origin:
Lateral third of clavicle, acromion, spine of scapula

• Insertion:
Middle of lateral surface of shaft of humerus

• Nerve supply:
Axillary nerve C5, 6

• Action:
• Middle fibers Abducts arm;
• anterior fibers flex and medially rotate arm;
• posterior fibers extend and laterally rotate arm
• Abduction from 15-90 degrees
SUB-ACROMIAL BURSA
• It is situated below coraco-acromial arch &
deltoid muscle.
• Below the bursa there is the tendon of
supraspinatus & greater tubercle of humerus.
 Rotator cuff muscles:
The rotator cuff is a group of four muscles that form
muscultendinous rotator cuff around glenohumeral joint.
“Rotator cuff SITS on the shoulder”
1. Supraspinatus
2. Infraspinatus
3. Teres minor
4. Subsc
5. apularis

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Rotator cuff muscles:
• All except the supraspinatous are rotators
of the humerus.
• The cuff is deficient inferiorly, and this is
a site of potential weakness.

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Sample Footer Text 20
 INTER-MUSCULAR
SPACES

Inter-muscular
spaces

Upper- Lower-
Quadrangular
triangular triangular
space
space space
 Quadrangular Space
It is bounded :
• Above by the subscapularis and capsule of
the shoulder joint
• Below by the teres major muscle
• Medially by the long head of triceps
• Laterally by the surgical neck of the
humerus.

The axillary nerve and the posterior

circumflex humeral vessels pass backward
through this space.
 UPPER – TRIANGULAR SPACE

MEDIAL : teres-minor
LATERAL : long head of triceps
INFERIOR: teres-major

CONTENTS :
circumflex scapular artery
 LOWER TRIANGULAR SPACE
• MEDIAL:
long-head of triceps
• LATERAL:
humerus
• SUPERIOR:
teres-major

• CONTENTS :
Radial nerve ,
Profunda-Brachii vessels
Blood supply:
Anastomoses around the scapula:
• Suprascapular artery
• Deep-branch of transverse
cervical artery
• Circumflex scapular artery

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Sample Footer Text 27
Axillary nerve C5-6
It’s a branch of post. Cord of
brachial plexus.
It supplies deltoid.
It passes out of quadrangular space
and winds around the surgerical
neck, accompanied by posterior
circumflex artery

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INTRAMUSCULAR
INJECTION
In lower ½ of deltoid to
avoid injury to axillary
nerve
 AXILLARY NERVE DAMAGED
• It may be damaged by dislocation of
shoulder, fracture of surgical neck
 EFFECTS
• Loss of abduction till 90 degrees.
• Rounded contour of shoulder lost.
• Sensory loss of lower ½ deltoid which is
supplied by the superior lateral cutaneous
nerve of the arm.
Thank you

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