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Scapular region OBJECTIVES … To list scapular muscles To describe axillary gateways To describe scapular anastomosis To follow main nerves in the region The scapula articulates: -By its glenoid with the humeral head -By its acromion with the clavicle Surface localization: -Scapula extends from T2-T7 vertebral level -Costal level is the same as the vertebral level -Scapular spine: T3 -Inferior scapular angle: T7 Scapular movements: Elevation Depression Protraction Retraction Medial rotation Lateral rotation Muscles connecting the scapula to the axial skeleton Muscle Origin • Trapezius • • Back of skull Insertion • spine of the scapula Ligamentum nuchae • Lateral 1/3 of Spines of C7-T12 clavicle Innervation Spinal Function • accessory n • Scapular elevator Lateral rotator Muscle Origin Insertion Innervation Function Levator Transverse processes of superior angle to root scapulae Rhomboid minor Rhomboid major C3-C6 vertebrae Elevator of scapula of spine of the scapula Medial border of Spines of C7 & T1 scapula at the spine Dorsal scapular root Medial border of Spines T2-T5 scapula below the spine root nerve • Scapular elevator • Retractor Muscles connecting the scapula to the humerus Muscle Origin • Deltoid • • Scapular spine Acromion Lateral 1/3 clavicle Insertion Deltoid tuberosity of humerus Innervation Function • Shoulder abductor Axillary nerve • Flexor (anterior F) • Extensor (post F) Muscle Origin Subscapularis Subscapular fossa Insertion Innervation Function Lesser tuberosity of Upper & lower • Medial rotator humerus subscapular n • Rotator cuff Muscle Origin Supraspinatus Supraspinous fossa Insertion Innervation Function Greater tuberosity • Initiates abduction (upper facet) • Rotator cuff Greater tuberosity • Lateral rotator (middle facet) • Rotator cuff Suprascapular n Infraspinatus Infraspinous fossa Muscle Teres minor Teres Major Origin Insertion Axillary border of Greater tuberosity scapula (lower facet) Oval area beside Medial lip of bicepital infraspinous fossa groove Innervation Axillary n Lower Function • Lateral rotator • Rotator cuff • Medial rotator subscapular n • Extensor Rotator cuff: These four muscles play important role in stabilizing the shoulder joint in position by: 1- Fusing with its capsule 2- Approximating surfaces the two articular Muscles connecting the trunk to the humerus Muscle Latissimus dorsi Origin • Spines of T7-12 • Iliac crest • Lower 4 ribs Insertion Intertubercular groove Innervation Thoracodorsal n Function • Shoulder adductor • Extensor • Medial rotator Communication with the axilla (axillary gateways): 1- Quadrangular space 2- Triangular space 3- Triangular interval Quadrangular space: Boundaries: 1- Teres major 2- Teres minor 3- Triceps long head 4- Humerus Structures: 1- Axillary nerve 2- Posterior CHA Triangular space: Boundaries: 1- Teres major 2- Teres minor 3- Triceps long head Structures: Circumflex scapular n Triangular interval: Boundaries: 1- Teres major 2- Humerus 3- Triceps long head Structures: 1- Radial n 2- Profundal brachii artery Nerves: 1- Suprascapular n (C5 & 6): - Branch of upper trunk of BP - Descends to the region to pass in the scapular notch underneath the transverse scapular ligament - Enters supraspinatus - Hooks around scapular spine & reaches the infraspinatus to supply it 2- Dorsal scapular n (C5): - Arises from BP roots - Descends deep to levator scapulae & rhomboids supplying them 3- Thoracodorsal n (C5, 6 &7): - Branch of posterior cord of BP - Descends on subscapularis accompanied by the subscapular artery - Enters latissimus dorsi near its insertion to supply it Arteries: 1- Suprascapular artery: - Branch of 1st part of subclavian a - Passes in the neck then descends with its accompanying nerve - Shares the same course of the nerve but it passes above the ligament - Shares in scapular anastomosis 2- Dorsal scapular artery: - Arises from subclavian artery or from its transverse cervical branch - Descends deep to levator scapulae & rhomboids supplying them - Shares in scapular anastomosis 3- Subscapular artery: - Branch of 3rd part of axillary artery - Descends on subscapularis accompanied by thoracodorsal nerve - Gives the circumflex scapular branch to the back muscles - Shares in scapular anastomosis Scapular anastomosis Connects the 1st part of subclavian to the 3rd part of axillary arteries