1. Scapular Region
artmiller.medicalillustration.com
Dr. Nivin Sharaf(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.
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 spinatus ms
Artery above, nerve below
Army un over the bridge, navy sail under the bridge

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

16. - retract / inferior rotate scapula
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. Posterior scapula
Rhomboids retract, so injury to the dorsal scapular nerve will make the scapula further away from the midline on the affected side

18. References Clinically Oriented anatomy “Keith Moore” sixth edition

19. Thank you