Scapular Region

1. Scapular Region Dr. NivinSharaf(MD)

2. Objectives • Know the landmarks of the bony structures of the shoulder/axillary regions • Know the rotator cuff muscles, external rotators, internal rotators • Be familiar with principal muscles of the scapular , scapulo-humeral region • Scapular rotation in relation with shoulder movements

3. Surface Anatomy • Spine Acromion (of scapula Trapezius muscle Infraspinatus muscle Triangle of ascultation Teres minor muscle Teres major muscle

4. Anterior Scapula. -angles, borders -glenoid cavity, -acromion, -coracoid process, -Subscapular fossa Humerus. -Head, -Surgical neck -Anatomical neck -Greater tubercle -Lesser tubercle -Intertubercular (bicipital) groove acromion anatomical neck coracoid process Lesser tubercule Greater tubercule surgical neck bicipital groove glenoid cavity

5. Posterior Clavicle. Acromioclavicular joint Scapula. - Spine - Acromion - Supraspinous fossa - Infraspinous fossa Humerus. - Head - Anatomical neck, - Surgical neck, - Deltoid tuberosity - Spiral (radial) groove. Acromioclavicular joint Supraspinous Fossa anatomical neck surgical neck Spine Deltoid Tuberosity Infraspinous Fossa Radial Groove

6. Scapular Fracture

7. Movements of the shoulder joint(Review): Abduction / adduction Flexion / extension Rotation – internal (medial) - external (lateral) Movements of the scapula (Thoracoappendicular): (increase range of movement of upper limb) Protraction / Retraction Elevation / Depression Rotation: Superior / Inferior Circumduction

8. Superior rotation of • Glenoid fossa: • Powerful muscles • pull on bony struts. Scapula rotates when we move our arms to allow more range of motion at the shoulder joint

9. Complete abduction at the shoulder joint requires superior rotation of the scapula so that the glenoid fossa faces superiorly. Glenoid fossa

10. Deltoid • Clavicular origin, acromial, and scapular origins, attach all to deltoid tuberosity • Anterior fibers flexes • Posterior fibers extends and laterally rotates • Middle fibers abducts the arm • Innervation C5,6 Axillary nerve Delta= Triangle Deltoid=triangular in shape Principal abductors= Deltoid, supra spinatus

11. Subdeltoid / Subacromial bursa. Deltoid Sub Acromial Bursa Subdeltoid Bursa Subscapularis Bursa: a closed sac or envelope, lined with synovium and containing fluid, usually in areas subject to friction.

12. Rotator cuff muscles stabilize the shoulder joint. Supraspinatus, Infraspinatus, Subscapularis, Teres minor Subscapularis Subscapularis Anterior view Supraspinatus Infraspinatus Superior view Teres Minor Posterior view

13. Rotator Cuff Muscles SITS Because the scapula is triangular deep bone, padded with thick muscles, injuries leading to scapular fractures Will be so severe , and most commonly we will have lots of multiple, or serious other fraactures

14. Transverse scapular ligament • Runs between Subscapular nerve (C5,6) and artery, which supply supra and infra spinatusms • Artery above, nerve below • Army un over the bridge, navy sail under the bridge

15. Serratus Anterior Subscapularis Winged Scapula: (long thoracic nerve) "big swing muscle" or "boxer's muscle” Antagonist of Rhomboids Accessory muscle of respiration

16. Posterior view: - Trapezius - Latissimus Dorsi - Deltoid Trapezius Rhomboids Deltoid Rhomboids: - minor and major - retract / inferior rotate scapula Teres Major Latissimus Dorsi Teres major: - inserts near latissimus dorsi - adduct / medially rotate arm

17. Rhomboids retract, so injury to the dorsal scapular nerve will make the scapula further away from the midline on the affected side Posterior scapula

18. References • Clinically Oriented anatomy “Keith Moore” sixth edition • http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/labs/ue/pect_scap/scap1a.html • www.medicalstudents.com

19. Thank you