ANATOMY: SHOULDER REGION

Vittoria A. Parawan PT1A

D. Terminal Branches
TOPIC OUTLINE
VIII. Blood supply
A. Axillary artery
I. Bones
B. Arterial anastomosis
A. Clavicle
C. Blood supply
B. Scapula
D. Lymph Nodes
C. Humerus
II. Muscles
A. Upper limb to thoracic wall SHOULDER COMPLEX
1. Pectoralis major
2. Pectoralis minor ➔ Junction of the arm with the trunk
3. Subclavius ➔ Joints, Muscles, Arteries, Veins, and lymph
4. Serratus anterior
B. Upper limb to vertebral column nodes
1. Upper trapezius ➔ Glenohumeral (Shoulder joint),
2. Middle trapezius Acromioclavicular, Sternoclavicular
3. Lower trapezius
4. Latissimus dorsi
BONES
5. Levator scapulae
6. Rhomboid minor
7. Rhomboid major ➔ Clavicle
C. Scapula to humerus ◆ Long, slender bone
1. Deltoid (anterior fibers) ◆ Transmits from upper limb to axial
2. Deltoid (posterior fibers)
skeleton
3. Supraspinatus
4. Infraspinatus ◆ Concave laterally, convex medially
5. Teres major ◆ Medial: Sternum and 1st costal
6. Teres minor
cartilage
7. Subscapularis
III. Rotator cuff ◆ Lateral: Acromion Process
IV. Joints
A. Sternoclavicular
B. Acromioclavicular
C. Scapulothoracic
D. Glenohumeral
V. Movements at the Shoulder Joints
VI. The Axilla
A. Walls
B. Structures
C. Contents
VII. Brachial plexus
A. Roots
B. Divisions
C. Cords

1
➔ Scapula MUSCLES
◆ Flat, triangular bone
UPPER LIMB TO THORACIC WALL
◆ Inferior angle
◆ Anterior: Subscapular fossa Pectoralis Major
◆ Posterior: Spine, supraspinous
O Clavicle, sternum, upper 6 costal
and infraspinous fossa cartilage
◆ Lateral: Acromion process
I Lateral lip of bicipital groove
◆ Superolateral: Glenoid fossa
N Medial and lateral pectoral nerves

A Adduction, IR Clavicular fibers (flexion)

Pectoralis Minor

O 3rd, 4th, and 5th ribs

I Coracoid process of the scapula

N Medial pectoral nerve

A Depresses shoulder, elevates ribs

➔ Humerus
◆ Long bone Subclavius

◆ Head → Anatomic neck → Greater O 1st costal cartilage

and lesser tuberosities → Surgical
I Clavicle
neck → Deltoid tuberosity → Spiral
groove → Medial and lateral N Nerve to subclavius

epicondyles A Depresses clavicle

◆ Capitulum: Radius (Radial fossa)
Serratus Anterior
◆ Trochlea: Ulna (Coronoid fossa)
O Upper 8 ribs

I Medial border and inferior angle of the

scapula

N Long thoracic nerve

A Rotates the scapula

UPPER LIMB TO VERTEBRAL COLUMN

Upper Trapezius

2
O Occipital bone, ligamentum nuchae, Levator Scapulae
spine of 7th cervical and all thoracic
vertebrae O Transverse process of C1 - C4

I Lateral 3rd of clavicle I Medial border of the scapula

N Accessory nerve (CN XI), C3 & C4 N Median nerve (digital branches), C3, C4,
(sensory) dorsal scapular nerve

A Elevates scapula A Raises medial border of the scapula

Middle trapezius Rhomboid Minor

O Occipital bone, ligamentum nuchae, O Ligamentum nuchae and spine of C7 -

spine of 7th cervical and all thoracic T1
vertebrae
I Medial border of the scapula
I Acromion and spine of scapula
N Dorsal scapular nerve
N Accessory nerve (CN XI), C3 & C4
A Raises medial border of scapula
(sensory)
upward and medially
A Pulls scapula medially
Rhomboid Major
Lower Trapezius
O Spine of T2 - T5
O Occipital bone, ligamentum nuchae,
I Medial border of the scapula
spine of 7th cervical and all thoracic
vertebrae N Dorsal scapular nerve

I Acromion and spine of scapula A Raises medial border of scapula

upward and medially
N Accessory nerve (CN XI), C3 & C4
(sensory)

A Pulls the border of the scapula

SCAPULA TO HUMERUS
downward
Deltoid (Anterior Fibers)
Latissimus Dorsi
O Lateral 3rd of clavicle, acromion and
O Iliac crest, lumbar fascia, T6 - T12
spine of scapula
spine, 9 - 12 rib, inferior angle of
scapula I Middle of lateral surface of shaft of
humerus
I Floor of bicipital groove
N Axillary nerve
N Thoracodorsal nerve
A Abducts arm, flexion and IR
A Extends, adducts and IR the arm

Deltoid (Posterior Fibers)

3
O Lateral 3rd of clavicle, acromion and N Axillary nerve
spine of scapula
A ER and shoulder stabilizer
I Middle of lateral surface of shaft of
humerus Subscapularis
N Axillary nerve O Subscapular fossa

A Extend and ER I Lesser tuberosity

Supraspinatus N Upper and lower subscapular nerves

O Supraspinous fossa
A IR and shoulder stabilizer
I Greater tuberosity
ROTATOR CUFF
N Suprascapular nerve
➔ Tendons of Subscapularis, Infraspinatus,
A Abducts arm, shoulder stabilizer
Teres Minor, and Supraspinatus
Infraspinatus ➔ Fused to the shoulder capsule
➔ Holds the humeral head against the
O Infraspinous fossa
glenoid cavity
I Greater tuberosity ➔ Anterior, superior, and posterior

N Suprascapular nerve

A ER, shoulder stabilizer

Teres Major

O Lower third of lateral border of scapula

I Medial lip of bicipital groove

ARM MUSCLES
N Lower subscapular nerve

A IR and adduction, shoulder stabilizer

Teres Minor

O Upper ⅔ of the lateral border of

scapula

I Greater tuberosity

4
 JOINTS
Sternoclavicular

Articulation Sternal end of clavicle,

manubrium sterni, 1st costal
cartilage

Type Synovial double-plane joint,

saddle joint

Nerve Suprascapular and nerve

Supply subclavius
Acromioclavicular
Degrees of 3
Articulation Acromion of the scapula and
Freedom
lateral end of the clavicle
Ligaments Sternoclavicular
Type Synovial plane joint
Costoclavicular
Nerve Suprascapular nerve
Articular Divides joint into 2
Supply
Disc compartments
Degrees of 3
Clavicle Convex vertically, convex AP
Freedom
Sternum Concave vertically, convex AP
Ligaments Superior and inferior AC
Coracoclavicular

Acromion Medially, superiorly

Clavicle Laterally, inferiorly

5
 Coracoacromial

Synovial Subscapularis bursa

membrane

Glenoid Upwardly rotated

Head Posterior, medial, superior

Scapulothoracic

Type Not a true joint

Scapular 1. Elevation and

Movements depression
2. Protraction and
retraction
3. Upward and downward
rotation

Serratus Anterior braces the scapula against

the thoracic wall

Glenohumeral

Articulation Head of humerus, glenoid MOVEMENTS OF THE SHOULDER COMPLEX

cavity of scapula
➔ Arm abduction: Rotation of the scapula
Type Synovial ball-and-socket
➔ 3 deg of arm ABD
Nerve Axillary and suprascapular
◆ 2 dec occurs in GH joint
Supply nerve
◆ 1 deg occurs by scapula rotation
Degrees of 3
Freedom STERNOCLAVICULAR

Ligaments Glenohumeral Movement Plane Muscles

Transverse humeral
Forward Parallel to Serratus anterior
Coracohumeral
movement transverse

6
Backward Parallel to Trapezius, and Circumduction Combination of above
movement transverse rhomboids

Elevation Frontal Trapezius, SCM,

levator scapulae,
and rhomboid AXILLA
muscle

Depression Frontal Pectoralis minor

and subclavius
muscle

Rotation Medial- Tightening of AC

Lateral ligaments

GLENOHUMERAL

Movement Degrees Muscles

Flexion GH joint - Anterior deltoid,

90 deg pectoralis major, ➔ The walls of the Axilla
biceps,
◆ Anterior
coracobrachialis
● Pectoralis major,
Extension 45 deg Posterior
subclavius, pectoralis minor
deltoids,
latissimus dorsi, ◆ Posterior
and teres major ● Subscapularis, latissimus
dorsi, teres major
Abduction 180 deg Middle deltoid,
supraspinatus ◆ Medial
(beginning range) ● Upper 4 or 5 ribs (covered

Adduction 45 deg Pectoralis major, by Serratus Anterior)

(across latissimus dorsi, ◆ Lateral
chest) teres major, and ● Coracobrachialis, biceps
teres minor
➔ Contents of the Axilla
Lateral 45 deg Infraspinatus, ◆ Axillary artery and its branches
rotation teres minor,
◆ Axillary vein and tributaries
posterior
deltoids ◆ Lymph vessels and lymph nodes
◆ Brachial plexus
Medial 55 deg Subscapularis,
rotation latissimus dorsi,
teres major,
anterior deltoid

7
 ◆ Inferior
● Teres major
◆ Medial
● Long head of triceps
◆ Lateral
● Surgical neck of the
humerus
◆ Structures
● Posterior circumflex
humeral vessels, axillary
nerve

BRACHIAL PLEXUS

➔ Structures

➔ Roots
◆ C5, C6, C7, C8, T1
➔ Trunks
◆ Upper, middle, lower
➔ Divisions
◆ Anterior and posterior
➔ Terminal branches
◆ Musculocutaneous N.
◆ Median N.
◆ Ulnar nerve
◆ Axillary N.
◆ Radial N.
➔ Roots
◆ Dorsal scapular N. (C5)
◆ Long Thoracic N. (C5, C6, C7)
➔ The Quadrangular Space ➔ Upper trunk
◆ Above ◆ Nerve to subclavius (C5, C6)
● Subscapularis and capsule ◆ Suprascapular N.
of the SH joint

8
➔ Lateral CORD
◆ Lateral pectoral N. BLOOD SUPPLY OF THE UPPER LIMB
◆ Musculocutaneous N.
◆ Lateral root of median N.
➔ Medial CORD
◆ Medial pectoral N.
◆ Medial cutaneous N. of arm and
forearm
◆ Ulnar N.
◆ Medial root of median N.
➔ Posterior CORD
◆ Upper and lower subscapular N.
◆ Thoracodorsal N.
◆ Axillary N.
◆ Radial N.

NERVE SUPPLY OF THE UPPER LIMB

➔ Arterial Anastomosis
◆ Arteries
● Subclavian (suprascapular)
● Subclavian (superficial
cervical)
● Axillary A. (subscapular)
● Axillary A. (anterior
circumflex)
● Axillary A. (posterior
circumflex)

9
 BLOOD SUPPLY
REFERENCES
Arteries Tissues Supplied ➔ Snell’s Clinical Anatomy by Regions
➔ Netter, Atlas of Human Anatomy 6th ed.
Thyrocervical trunk of Inferior neck and
➔ Prof. Sarah Faye A. Ramos’ PPT
subclavian A. shoulder

Axillary A. Pectoral region and

(thoracoacromial) shoulder

Axillary A. (lateral Pectoral mm,

thoracic) mammary glands,
axilla

Axillary A. Scapular mm
(subscapular)

Brachial A. (deep) Arm and humerus

LYMPH NODES

Anterior pectoral Lateral quadrants of the

breast, superficial vessels
of abdomen

Posterior Superficial lymph from the

(subscapular) back

Lateral Upper limb

Central Anterior (pectoral),

posterior (subscapular),
lateral

Infraclavicular Lateral side of hand, FA

and arm

Apical Other axillary nodes

10