SCAPULAR REGION

Dr. Ahmed Alkhuzai

Assistant Professor
Orthopaedic Surgeon
 SCAPULAR REGION
The scapula is a
thin, flat triangular-
shaped bone placed
on the postero-
lateral aspect of the
thoracic cage. It has
2 surfaces, 3
borders, 3 angles
.and 4 processes
SCAPULAR REGION
Posteriorly; the scapula is .1 .1 Osteology

divided into a supraspinous

fossa and infraspinous fossa by
the scapular spine. Anteriorly,
on the costal surface, is the
shallow subscapular fossa
Laterally; is the glenoid fossa. .2 .2
3.Anteriorly; is the coracoid
process
Superiorly is the acromion .4 .3
that is continuous with the
scapular spine and arcs
anteriorly over the humeral
head. The suprascapular notch
lies immediately medial to the
base of the coracoid process.
The spinoglenoid notch lies
.posteriorly behind the neck
Three
superior,
medial. borders:
lateral
Scapula-Border-
The superiorand• Angle
border
shortest
thinnest is the
and
border of
the
The
a three.
medial
thin border border
and is
runs parallel
vertebral
and is column
therefore to the
often
The called
vertebral
lateral the
border.
border is
often
axillary
runs called
border the
superolaterally as it
towards
the axilla.
thickest the
and It apex
is the of
strongest
three
muscle bordersof the
attachment. for
It
thealso
socket has
glenoid
along cavity
this or
border,
fossa a
which
articulates shallow
with the
head
the of
humerus,
forming
the
.jointglenohumeral
There
Three
scapula. are
anglesalso
The to the•
superior
meets
border the
at border
lateral
the lateral
angle
medial
the and with
border
superior the
at
angle.
The
the
angle third
inferior
whereangle the is
medial and
.borders meet lateral
 •Surfaces
The
two scapula
surfaces; on •
has
the
is theanterior costal•
smoothaspect
surface,
concave which is •
and is in shape
majorly
by the taken
subscapularup •
fossa.
of At the
convex and is the
the scapula back
uneven posterior
surface which has a •
protruding
bone (spine ridge
of the of •
scapula)
unevenly
it into twothat
separates
divisions:
superior
us fossa and the
supraspino
the
much
inferior bigger,
.s fossa infraspinou
1/4
Synonyms: Transverse scapular artery,
Several arteries form an anastomosis to
supply blood to the posterior scapular
:region
Suprascapular artery- a branch of the .1
thyrocervical trunk, which in turn arises
from the subclavian artery. It runs along
the suprascapular nerve and mostly
supplies the supraspinatus and
.infraspinatus muscles
a - 2. Posterior circumflex humeral artery
branch of the axillary artery supplying
the glenohumeral joint
originating - 3. Circumflex scapular artery
from the subscapular artery, which in
turn is a branch of the axillary artery
Transverse cervical artery - a branch of .4
the thyrocervical trunk running along the
medial border of the scapula
Learn everything about the anatomy of
the scapula with our study unit below.
 Muscles of the shoulder region

Divided into:  •
A. Extrinsic Muscles (5 M) •
.Superficial Extrinsic Muscles (2 M) 2 .1 •

Deep Extrinsic Muscles.2 •

B. (3 M)  Intrinsic Muscles (6 M) •
Name the 17 muscles that attach to the scap
ula
Biceps brachii .1
Coracobrachialis .2
Deltoid .3
Infraspinatus .4
Latissimus dorsi .5
Levator scapulae .6
)inferior belly(Omohyoid .7
8. Pectoralis minor
9. Rhomboid major
10. Rhomboid minor
11. Serratus anterior
12. Subscapularis
13. Supraspinatus
14. Teres major
15. Teres minor
16. Trapezius
17. Triceps brachii (long head)
By surfaces, borders, and structures, these muscles •
:group and attach as follows

Rotator Cuff • Superior border: •

1. Supraspinatus 12. Omohyoid (inferior belly)
2. Infraspinatus Medial border:
13. Triceps brachii (long
3. Subscapularis head)
4. Teres minor
Scapular spine and acromion: External
• angle: •
5. Trapezius .14
Deltoid .6 Biceps brachii (long head
Anterior surface: • )
7. Subscapularis
Coracoid process: •
Serratus anterior .8
14.
Medial border: •
Biceps brachii (short head)
8. Serratus anterior
9. Rhomboid major 15. Coracobrachialis
10. Rhomboid minor 16. Pectoralis minor
Levator scapulae .11
Inferior angle:
it originates inferiorly along – Deltoid muscle 
the scapula spine to the acromion (and
lateral third of the clavicle). Its actions
include flexion and medial rotation (anterior
fibres), abduction (middle fibres), extension
and lateral rotation (posterior fibres) at the
shoulder joint. It is innervated by the
.axillary nerve
it originates – Supraspinatus muscle 
from supraspinous fossa. It is responsible for
abduction at the shoulder joint and it is
.innervated by the suprascapular nerve
it originates from – Infraspinatus muscle 
the infraspinous fossa. Its action involves
lateral rotation at the shoulder joint. The
muscle is also innervated by the
.suprascapular nerve
it originates from – Subscapularis muscle 
the subscapular fossa. It performs adduction
and medial rotation at the shoulder joint.
.The subscapular nerve innervates it

it originates from the – Teres minor muscle 

lateral border of the posterior surface. Its
 Scapular muscles
Scapular Origin 6----1/11
its origins are the posterior surface of – Teres major muscle 
the inferior angle and the lower part of the lateral border. Its
role is to perform adduction and medial rotation at the
.shoulder joint. It is innervated by the subscapular nerve
it originates from the inferior angle – Latissimus dorsi muscle 
(inconstant). It performs a variety of actions, such as
adduction, extension and medial rotation at the shoulder
.thoracodorsal nerve joint. It receives its innervation via the
its origin is the coracoid process. – Coracobrachialis muscle 
Its actions include adduction and flexion at the shoulder
.musculocutaneous nerve joint. It is innervated by the
the long head – Biceps brachii muscle (long and short head) 
originates from the supraglenoid tubercle, while the short
head from the coracoid process. This muscle is responsible
for elbow flexion. It is innervated by the musculocutaneous
.nerve
its origin is – Triceps brachii muscle (long head)
the infraglenoid tubercle found on the lateral border, inferior
to the glenoid cavity. It is responsible for elbow extension
.radial nerve and it is innervated by the
its origin is the superior border (adjacent – Omohyoid muscle •
to the suprascapular notch) and causes depression of
hyoid bone. It is innervated via the Ansa cervicalis (from
.cervical plexus)
spine, acromion process, and clavicle. Its actions
include elevation of the scapula and rotation of
scapula during abduction of humerus beyond 90
.accessory nerve degrees. It is innervated by the
they insert into the superior – Levator scapulae muscle 
angle and medial border (superior to the spine). Their
roles are to elevation the scapula. They are
.innervation by branches of C3-C5
its insertion is the medial – Rhomboid major muscle 
border (inferior to the spine). This muscle performs
elevation and retraction of scapula and it is innervated
.dorsal scapular nerve by the
it inserts above the scapular – Rhomboid minor muscle 
spine. It performs actions like elevation and retraction
of the scapula. It is supplied via the dorsal scapular
.nerve
its insertion is along the – Serratus anterior muscle 
medial border, from the superior angle to the inferior
angle. This muscle protracts and rotates the scapula.
.long thoracic nerve It is innervated by the
it inserts into the coracoid – Pectoralis minor muscle 
process. Its actions consist of protraction and
depression of the scapula. The muscle is innervated by
the medial pectoral nerve
Protraction - Pectoralis minor & serratus anterior 
homboid major mu 
cle
.
homboid minor mu  minor muscle
Pectoralis
cle
–
rratus anterior m 
cle

Rhomboid minor
muscle Rhomboid major
muscle

Serratus anterior
Pectoralis minor muscle
 Angles
Superior Angle is covered by .1
trapezius
Inferior angle is covered by .2
the latissimus dorsi. It moves
forwards round the chest,
when the arm is abducted.
Palpation of the inferior angle
provides a convenient method
for following the movement of
the scapula during arm
.motion
Lateral or Glenoid angle is .3
broad and bears the glenoid
cavity or fossa, which is
directed forward, laterally and
.slightly upwards
 Scapula
scapula,
the also blade,
shoulder knownis asa •
flat triangular
located at the bone
back of
the
over trunk
theof and
posteriorresides
surface
seven. The ribs two to
scapula,
along
and with
the the clavicle
manubrium of
the
the sternum, make up
pectoral
lewhich (shoulder)
connects thegird
upper limb of skeleton
appendicular the
The scapula
important is an
bone as each•
scapula
point of provides
attachment a for
a number
that make of
up muscles
the It
arm
also and shoulder.
articulates with
the humerus
clavicle, forming and the
ohumeral
ntand (shoulder
acromioclavicular
respectively. joint
However,
because
aspect ofthe
the medial
scapula to is
not
the directly
axial held attached
skeleton, but
is
andrather
connected in place
to the
thorax
vertebral and column by
muscles,
can the
move freely scapula
across
the
wall posterior
( thoracic
scapulothoracic
This allows the joint).
arm to
move with
providing the
a wide scapula,
range
of movement
mobility and
for theto upper
limb compared
.lower limb the
Borders Superior, lateral and medial
Angles Lateral, superior and inferior
Surfaces Anterior: subscapular fossa
Posterior: supraspinous fossa, spine,
infraspinous fossa

Processes Coracoid, acromion

Muscles Deltoid, supraspinatus, infraspinatus, triceps
that brachii (long head), teres minor, teres major,
latissimus dorsi, coracobrachialis, biceps
originate brachii, subscapularis, omohyoid muscles
from
scapula
Muscles Trapezius, levator scapulae, rhomboid major,
that insert rhomboid minor, serratus anterior, pectoralis
minor muscles
on the
scapula
Vasculariz Suprascapular, posterior circumflex humeral,
ation circumflex scapular, transverse cervical
arteries
Clinical Scapulothoracic dysfunction, scapulothoracic
relations instability, scapular dysplasia, snapping
scapula syndrome, fractures
Deltoid muscle: It is a triangular
(inverted delta) shaped muscle that
forms the rounded contour of the
shoulder. It is divided into three
.parts anterior, middle and posterior

:Origin

Anterior part: Anterior border of •

.lateral 1/3rd of clavicle

Middle (acromial) part: Lateral •

border of the acromion process of
.scapula

Posterior part : Lower lip of the •

crest of spine of scapula
Insertion: ‘V’ shaped deltoid
tuberosity on anterolateral surface
.of humerus
 Deltoid
Intramuscular injection •
Deltoid muscle is often used •
to administer intramuscular
injection. It should be given
in the lower half of the
muscle to avoid injury to
.axillary nerve
Paralysis of deltoid •
muscle
If deltoid is paralysed, •
rounded contour of the
shoulder is lost and there is
loss of power of abduction of
.arm from 15 to 90ο
 Scapular Spine
The crest of the spine of the
scapula can be palpated and traced
medially
to the medial border of the
scapula, which it joins at the level
of the third
.thoracic spine
The acromion of the scapula forms
the lateral extremity of the spine of
the scapula. It is subcutaneous and
easily located
 Part of scapula
”,Shoulder Bone“ •
shoulder blade”) is a large, flat,“ •
triangular bone that lies on the
posterior
chest wall between the second and •
seventh ribs. It articulates with the
acromial extremity of the clavicle and •
the head of the humerus. The major
defining features of the scapula are its •
,three borders (superior, medial
lateral), three angles (superior, inferior, •
,lateral), two surfaces (dorsal, costal)
and three large bony processes (spine, •
acromion, coracoid)
 suprascapular notch
The superior border is the short, thin, •

.superior edge of the scapula

A notch (the scapular notch) is located •
on the lateral aspect of the superior
,border
near the base of the coracoid process. •
The superior transverse scapular
ligament bridges the notch. Normally,
the suprascapular artery passes
superior to this ligament, whereas the • Schematic arrangements of
suprascapular nerve passes inferior to it structures passing around
remember: the Army goes over the( • .the suprascapular notch
;suprascapular nerve :1
bridge; the Navy goes under the ;suprascapular vein :2
.)bridge ;suprascapular artery :3
superior transverse scapular
.ligament (STSL)
 Scapula
The medial (vertebral) border is the •
,long, medial edge of the scapula
located closest to the vertebral •
column. The lateral (axillary) border is
the
thickened, lateral edge of the scapula, •
located closest to the axilla. The
junction of the superior and medial •
borders forms the superior angle of the
scapula. The junction of the medial •
and lateral borders forms the inferior
.angle
 Scapula

The inferior angle of the •

scapula can be palpated easily
in the living
subject and marks the level of •
the seventh rib and the spine
of the seventh
thoracic vertebra. The •
junction of the superior and
lateral borders forms the
.lateral angle •
 Scapula
The lateral angle of the scapula is the •

thickest and most complex part of

the scapula. It is composed mainly of a •
broadened process (the head of the
scapula) that is connected to the rest •
of the bone by a slight constriction (the
neck of the scapula). The lateral •
surface of the head forms a shallow
articular surface, the glenoid cavity or •
fossa (glen- is Greek for “pit” or
.socket”), for the head of the humerus “ •
A fibrocartilage ring (glenoid •
labrum) rims the margin of the •
glenoid cavity and serves to
broaden and
deepen the joint cavity. A small •
elevation (supraglenoid tubercle)
is located
at the apex of the glenoid cavity, •
near the base of the coracoid
process. A
roughened area (infraglenoid •
tubercle) is located immediately
inferior to the
.glenoid cavity •
,The spine is the large •
triangular ridge that runs •
laterally from the medial border
of the scapula to
merge into the acromion •
process. The lateral border of
the spine blends into
the neck of the scapula and •
forms a notch like passageway
(spinoglenoid, or
greater scapular, notch) that •
connects the supraspinous
fossa with the
.infraspinous fossa •
The acromion (acromi- is •
Greek for “point of the
shoulder”) is the broad, flat •
lateral extension of the
spine of the scapula. This
forms the easily palpable tip •
of the shoulder. It partly
roofs over the glenoid
cavity and provides an •
articulation with the clavicle
at the acromioclavicular
.joint •
The costal (ventral, anterior) surface of the •

scapula lies against the

posterior aspect of the rib cage. A large part •
of this surface forms a shallow
concavity, the subscapular fossa. The coracoid •
process (coraco- is Greek
for “like a crow’s beak”) is a thick, beaklike •
structure that projects
anterolaterally from the junction of the neck •
and lateral end of the superior
border of the scapula. It can be palpated via •
deep pressure through the
anterior part of the deltoid muscle, inferior to •
.the lateral end of the clavicle
Rotator cuff muscles
 Rotator Cuff

Supraspinatus Abduction of Suprascapular

arm - Initial 15 nerve
degrees

Infraspinatus Lateral Suprascapular

rotation of arm nerve

Teres minor Lateral Axillary nerve

rotation of arm

Subscapularis Medial rotation Upper & lower

of arm subscapular
nerves
The superficial extrinsic •
muscles join the axial
skeleton (chest wall
and rib cage) to the
appendicular skeleton
(bones of the upper
limb). The two muscles
in this group are the
trapezius and
latissimus dorsi. The
large, triangular
trapezius muscle
slightly
The deep extrinsic muscles (levator •
scapulae, rhomboid major, and
rhomboid minor) elevate and retract
strap-like levatorthe scapula. The
scapulae muscle is deep to the
sternocleidomastoid muscle and
trapezius
muscles and joins the upper medial •
border of the scapula to the
transverse processes of the upper
cervical vertebrae. The rhomboids
also originate on the medial border
of the scapula, with the rhomboid
minor being more superior than the
rhomboid major muscle. These
muscles attach to the spinous
processes of the upper thoracic
.vertebrae
The deep ‘intrinsic’ or true scapular •
muscles are the deltoid,
supraspinatus, infraspinatus, teres
subscapularisminor, teres major, and
.muscle
The deltoid muscle, which has three •
(clavicular, acromial, and spinal),parts
roundness ofis superior and forms the
the shoulder over the glenohumeral
.joint
deltoid are four scapularInferior to •
muscles – the supraspinatus,
infraspinatus, teres minor, and
subscapularis – which originate from
the scapula and insert laterally on the
humerus, forming a protective
covering (rotator cuff) over the
.glenohumeral joint
NERVES
The skin of the scapular region
receives sensory information
from the medial branches of the
posterior rami of cervical nerves
C4 to C8 and thoracic nerves T1
to T6 . The skin over the lateral
scapular area overlying the
deltoid muscle is innervated by
branches of the superior lateral
cutaneous nerve of arm, which
is a branch of the axillary nerve.
Motor innervation to the
muscles of the scapular region is
almost entirely by branches of
the brachial plexus
the dorsal scapular nerve (levator
and rhomboid muscles) is from the
;anterior ramus of C5
the suprascapular nerve
(supraspinatus and infraspinatus
muscles) is from the superior
;trunk
the four other nerves to this region
(the superior and inferior
subscapular, thoracodorsal, and
axillary) are branches of the
posterior cord and supply the
subscapularis, teres major,
latissimus dorsi, deltoid, and teres
minor muscles. Only the spinal
root of accessory nerve [XI], which
innervates trapezius, does not
originate from the brachial plexus
 ARTERIES

Blood is brought to the scapular region •

by a network of arteries, which form the
:scapular anastomosis
muscles medial and superior to the •
dorsalscapula receive blood from the
scapular, transverse cervical, and
suprascapular arteries, which are
branches of the subclavian artery, and
also from the acromial artery, which is a
;branch of the axillary artery
muscles anterior and lateral to the •
scapula are supplied by the subscapular,
circumflex scapular, and posterior
circumflex humeral arteries, which are
.derived from the axillary artery
 The extensive arterial •
anastomosis at the scapular
region provides a collateral
circulation, so if one vessel
is blocked or damaged,
many others can provide
blood to the region. This
anastomosis helps preserve
the upper limb during injury
VEINS AND LYMPHATICS
Venous drainage of the
scapular region is by
veins that correspond to
the arteries. Each of
these veins drains –
directly or indirectly –
into the axillary or
subclavian veins.
Lymphatic drainage of
the scapular region is to
the axillary and
supraclavicular lymph
nodes
ANATOMICAL SPACES
Three openings in the scapular
region – the triangular space,
the quadrangular space, and
the triangle of auscultation –
contain important
neurovascular structures or are
of clinical relevance
.
The three-sided triangular space
contains the
circumflex scapular artery and
is bordered laterally by the long
head of the triceps brachii,
inferiorly by the teres major,
and superiorly by the teres
minor muscle
Anastomosis
around scapula is
between branches
of first part of
subclavian
artery and branches
of third part of
axillary artery. It
provides collateral
circulation in case
distal part of
subclavian artery or
proximal part of
axillary artery is
 Quadrangular Space
The quadrangular space is an •
intermuscular space, located
immediately below the glenohumeral
. (shoulder) joint
It is bounded above by the •
subscapularis and teres minor muscles
and the capsule of the shoulder joint
and below by the teres major muscle. •
It is bounded medially by the long
head of the triceps and laterally by the
.surgical neck of the humerus
significance of the quadrangular space •
is that the axillary nerve and the
posterior circumflex humeral vessels
emerge through this space to reach
their terminal destinations in the
shoulder
Quadrangular space •
Boundaries •
Superiorly – Subscapularis, •
capsule of shoulder joint,
teres minor ( from front to
back)
Inferiorly – Teres major •
Laterally – surgical neck of •
humerus
Medially – long head of •
triceps
Contents •
Axillary nerve •
Posterior circumflex •
humeral vessels
 Upper triangular space

Upper triangular space •

Boundaries •

Laterally – Long head of •

triceps
Medially – Teres minor •

Inferiorly – Teres major •

Contents •

Circumflex scapular artery •

 Lower triangular space

Lower triangular space •

Boundaries •

Superiorly – Teres major •

Laterally – Shaft of humerus •

Medially – Long head of •
triceps
Contents •

Radial nerve and profunda •

brachii vessels
What are the boundaries of •
?”“Triangle of Auscultation
The “Triangle of Auscultation” is •
:bounded

Medially by lateral border of •

.trapezius muscle

Laterally by medial border of •

.scapula

Inferiorly by upper border of •

.latissimus dorsi muscle
Respiratory sounds of inferior lobe •
of lung are heard better (using
stethoscope) over triangle of
auscultation as no large muscle