Scapular region

The scapula, also known as the shoulder blade, is a flat triangular bone located at the back of the trunk and resides over the posterior surface of ribs two to seven. ... It also articulates with the humerus and clavicle, forming the glenohumeral (shoulder) joint and acromioclavicular joint respectively.

1. SCAPULAR REGION
By
Dr Ndayisaba Corneille
MBChB,DCM,BCSIT,CCNA

2. The Scapula
The scapula body forms a broad
triangle with many surface markings
-sites of attachment for muscles,
tendons, and ligament
3 sides of the scapular triangle are
called borders: Superior; Medial
(vertebral); and Lateral (axillary)
-muscles that position the scapula
attach along these edges
Corners or angles: Superior;
Inferior; and Lateral
-lateral angle, or scapula head
forms a broad process that supports the
glenoid cavity (fossa)
DR NDAYISABA CORNEILLE

3. Scapula Bone Markings
Coracoid(‘crow’s beak’) –smaller process projects
anteriorly and slightly laterally
-origin for short head of biceps brachii muscle
-insertion for Pectoralis minor
Acromion–larger process projects anteriorly
-insertion for part of the trapezius muscle
-origin for part of Deltoid muscle
-articulates with the clavicle at the
acromioclavicular joint
-both processes are attached to ligaments and
tendons associated with the shoulder joint
Surface markings represent attachment sites for
muscles that position the shoulder and arm
-supraglenoidand infraglenoidtubercle: biceps
brachii
-supraspinousandinfraspinousfossa: supra,
infraspinatus
DR NDAYISABA CORNEILLE

4. Fig 7.5a-e The Scapula
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5. Copyright © 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings
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8. Deltoid
Origin
•Lateral third of clavicle, acromion
process, spine of scapula
Insertion
•Middle of lateral surface of shaft
of humerus
Insertion: Deltoid tuberosity of the
humerus
NB: has 3 parts. Ant, middle, and
posterior fibers.
Middle fibers are multipennate
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
DR NDAYISABA CORNEILLE

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10. Structures under cover of Deltoid
BONE-Upper part humerus, coracoid process
,greater tubercle, lesser tubercle Intertuberculus sulcus
Bursa-Subdeltoid , subaccromial bursa
Muscles –attached around shoulder joint
vessel-Ant and Post circumflex humeral vessel
Nerves-Axillary
DR NDAYISABA CORNEILLE

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12. ROTATOR CUFF MUSCLES
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13. Supraspinatus
Origin
•medial 2/3 of Supraspinous
fossa of scapula
Insertion
•Greater tuberosity of humerus;
capsule of shoulder joint
Nerve supply
•Suprascapular nerve C 5, 6
Action
•Abducts arm and stabilizes
shoulder joint
•Initiation of abduction 0-15
degrees
DR NDAYISABA CORNEILLE

14. Infraspinatus
Origin
•Medial 2/3 Infraspinous fossa
of scapula
Insertion
•Greater tuberosity of
humerus; capsule of shoulder
joint
Nerve supply
•Suprascapular nerve C 5, 6
Action
•Laterally rotates arm and
stabilizes shoulder joint
DR NDAYISABA CORNEILLE

15. Teresminor
Origin
•Upper two thirds of
lateral border of scapula
Insertion
•Greater tuberosityof
humerus; capsule of
shoulder joint
Nerve supply
•Axillarynerve C5, 6
Action
•Laterally rotates arm and
stabilizes shoulder joint
DR NDAYISABA CORNEILLE

16. Teresmajor
Origin
•Lower third of lateral
border of scapula
Insertion
•Medial lip of bicipital
groove of humerus
Nerve supply
•Lower subscapularnerve
C6, 7
Action
•Medially rotates and
adducts arm and
stabilizes shoulder joint
DR NDAYISABA CORNEILLE

17. Subscapularis
Origin
•Medial 2/3 subscapular
fossa
Insertion
•Lesser tubercle of humerus
Nerve supply
•Upper and lower
subscapularnerves C5, 6, 7
Action
•Medially rotates arm and
stabilizes shoulder joint
DR NDAYISABA CORNEILLE

18. Rotator Cuff
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24. Arterial Anastomosis Around the
Shoulder Joint
•The extreme mobility of the
shoulder joint may result in
kinking of the axillary artery and
a temporary occlusion of its
lumen
•To compensate for this, an
important arterial anastomosis
exists between the branches of
the subclavian artery and the
axillary artery
•ensuring that an adequate blood
flow takes place into the upper
limb irrespective of the position
of the arm
DR NDAYISABA CORNEILLE

25. ARTERIES
•Anastomosis between the subclavianand axilla artery branches
From the subclavian
-dorsal scapular artery:from the transverse cervical a branch from the
thyrocervicaltrunk of the 1 part of the subclavian (can also branch
from the third part of the subclavian) Accompanies the dorsal scapular
nerve.
-suprascapular-from the thyrocervicaltrunk
-
DR NDAYISABA CORNEILLE

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27. •From the axilla artery
-subscapular artery-from third part of the axilla artery-Supplies the
supraspinatus and the infraspinatus:
circumflex scapular branch supplies the infraspinatus
Other arteries may include: the posterior circumflex artery
DR NDAYISABA CORNEILLE

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30. CLINICAL APPLICATIONS.
Fractures of the scapula.
•Are usually the result of severe
trauma e.g. run-over accident
victims, occupants of
automobiles involved in crashes.
•Are usually associated with
fractured ribs.
•Most require little treatment
because muscles on the anterior
and posterior surfaces
adequately splint the fragments.
Dropped Shoulder
•Occurs with paralysis of the
trapezius.
Winged Scapula.
•Is caused by paralysis of the
Serratus anterior due to damage to
the Long thoracic nerve.
•Medial border, and particularly the
inferior angle, of the scapula to
elevate away from the thoracic wall
on pushing forward with the arm.
Furthermore, normal elevation at
the arm is no longer possible.
DR NDAYISABA CORNEILLE

31. ROTATOR CUFF TENDINITIS
•Manifestations :
•Spasm associated with
pain in the middle range
of abduction.
•It is a common cause of
pain in the shoulder
region.
DR NDAYISABA CORNEILLE

32. ROTATOR CUFF TENDINITIS
•Cause :
•Excessive overhead activity of the
upper limb which can cause
degenerative changes in the
subacromial bursa.
•This is followed by degenerative
changes in the supraspinatus
tendon and extend to the other
tendons of the rotator cuff.
DR NDAYISABA CORNEILLE

33. •THANKS
DR NDAYISABA CORNEILLE