ANATOMY

ANATO
MY

BY
DR. THAAER MOHAMMED DAHER
ALSAAD
M.B.CH.B.(MBBS)
F.I.B.M.S.
(PH.D.)
SPECIALIST IN GENERAL SURGERY
SENIOR
LECTURER
IMS
MSU

UPPER LIMB
Scapulohumeral Region

Scapular Region
Scapular Region

Muscles Attach the scapula to the

humerus
1.
2.
3.
4.
5.
6.
7.

Deltoid
Supasinatus
Infraspinatus
Teres minor
Teres major
Subscabularis
?? Triceps

Scapula
Fractures of the Scapula
Dropped Shoulder and Winged
Scapula

 If

INSERTION on scapula = Move

scapula

Rhomboids
Trapezius
Pectoralis Minor
Serratus anterior
Levator Scapulae

If ORIGIN on scapula = Move Arm

Subscapularis
Supraspinatus
Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial Origin on scapula)
Coracobrachialis

Deltoid muscle
Origin

the anterior border and

upper surface of the lateral
third of the clavicle,
acromion, spine of the
scapula

Insertio deltoid tuberosity of

n
humerus
Artery

primarily posterior
circumflex humeral artery

Nerve

Axillary nerve

Actions

shoulder abduction, flexion

and extension

Antago
nist

Latissimus dorsi

Muscles on the dorsum of

the scapula, and the
Triceps brachii muscle:
3 = Latissimus dorsi muscle
5 = Teres major muscle
6 = Teres minor muscle
7 = Supraspinatus muscle
8 = Infraspinatus muscle
13 = long head of Triceps
brachii muscle

SITS

ROTATOR CUFF

Muscles composing rotator cuf

muscle

Origin on
scapula

Attachment on
humerus

Function

Innervation

Supraspinatus
muscle

supraspinous
fossa

greater
tubercle

abducts the
arm

Suprascapular
nerve (C5)

Infraspinatus
muscle

infraspinous
fossa

greater tubercle

externally
rotates the arm

Suprascapular
nerve (C5-C6)

Teres minor
muscle

lateral border

greater
tubercle

externally
rotates the
arm

Axillary nerve
(C5)

Subscapularis
muscle

subscapular
fossa

lesser tubercle

internally
rotates the
humerus

Upper and Lower

subscapular
nerve (C5-C6)

nfraspinatus muscle

Origin

infraspinous fossa of the

scapula

Inserti
on

middle facet of greater

tubercle of the humerus

Artery

suprascapular and circumflex

scapular arteries

Nerve

suprascapular nerve

Action
s

Lateral rotation of arm and

stabilizes humerus

Supraspinatus muscle
Origin

supraspinous fossa of
scapula

Insertion superior facet of greater

tubercle of humerus

Artery

suprascapular artery

Nerve

suprascapular nerve

Actions

abduction of arm and

stabilizes humerus
controversy of
action.???????

b
u
S

p
a
c
s

s
i
r
a
l
u

e
l
c
s
u

Origin

subscapular fossa

Insertion

lesser tubercle of humerus

Artery

transverse cervical artery, subscapular artery

Nerve

upper subscapular nerve, lower subscapular nerve

(C5, C6)

Actions

rotates medially humerus; stabilizes shoulder

Te
re
sm
i no
rm
us
c le

Origin

lateral border of the scapula

Insertion

inferior facet of greater tubercle of the humerus

Artery

posterior circumflex humeral artery and the

circumflex scapular artery

Nerve

axillary nerve

Actions

laterally rotates the arm

eres major muscle

Origin

posterior aspect of the inferior angle of

the scapula

Insertio medial lip of the intertubercular sulcus

n
of the humerus
Artery
Nerve
Actions

Subscapular and circumflex scapular

arteries
Lower subscapular nerve (segmental
levels C5 and C6)
Internal rotation (medial rotation) of the
humerus

Muscles on the dorsum of the scapula, and the

Triceps brachii muscle:
3 is Latissimus dorsi muscle
5 is Teres major muscle
6 is Teres minor muscle
7 is Supraspinatus muscle
8 is Infraspinatus muscle
13 is long head of Triceps brachii muscle

The axillary artery and its branches.

scapula
r a nd c i
rcumfe
x arte

pra
sca
pu
la

ra
r te
r

Source

Thyrocervical
trunk

Vein

suprascapular
vein

Supplies supraspinatus muscle,

(sternocleidomastoid), (subclavius)

Suprascapular
artery
1/2

Subclavian artery gives off the thyrocervical trunk.

Thyrocervical trunk divides into transverse cervical and suprascapular arteries.
The suprascapular artery (or transverse scapular artery) is a branch of the
thyrocervical trunk.
At first, it passes downward and laterally across the scalenus anterior and phrenic
nerve, being covered by the sternocleidomastoid muscle;
it then crosses the subclavian artery and the brachial plexus, running
behind and parallel with the clavicle and subclavius muscle and beneath the
inferior belly of the omohyoid to the superior border of the scapula.
It passes OVER the superior transverse scapular ligament (unlike the suprascapular
nerve, which passes below the ligament).
The artery then enters the supraspinatous fossa of the scapula.
It travels close to the bone, running between the scapula and the supraspinatus
muscle, to which it supplies branches.
It then descends behind the neck of the scapula, through the great scapular
notch and under cover of the inferior transverse ligament, to reach the infraspinatous
fossa, where it anastomoses with the scapular circumflex artery and the descending
branch of the transverse cervical artery.

Suprascapular
artery
2/2

Besides distributing branches to the sternocleidomastoid ,

subclavius , and neighboring muscles,
It gives off a suprasternal branch, which crosses over the sternal
end of the clavicle to the skin of the upper part of the chest;
It gives off an acromial branch, which pierces the trapezius and
supplies the skin over the acromion.
Just as with supplying the subclavius muscle, it anastomoses with
the thoracoacromial artery in supplying skin areas.
As the artery passes over the superior transverse scapular
ligament, it sends a branch into the subscapular fossa, where it
ramifies beneath the subscapularis, and anastomoses with the
subscapular artery and with the dorsal scapular artery.
It also sends articular branches to the acromioclavicular joint and
the shoulder joint, and a nutrient artery to the clavicle.

Suprascapular nerve

Innervat
es

supraspinatus,
infraspinatus

From

C5C6 of brachial plexus

Suprascapular nerve
The suprascapular nerve arises from the trunk formed by the
union of the fifth and sixth cervical nerves.
It innervates the supraspinatus muscles and infraspinatus muscles.
It runs lateralward beneath the Trapezius and the Omohyoideus,
and enters the supraspinatous fossa through the suprascapular
notch, BELOW the superior transverse scapular ligament;
It then passes beneath the Supraspinatus, and curves around the
lateral border of the spine of the scapula to the infraspinatous
fossa.
In the supraspinatous fossa it gives off two branches to the
Supraspinatus muscle, and an articular filament to the shoulderjoint;
and in the infraspinatous fossa it gives off two branches to the
Infraspinatous muscle, besides some filaments to the shoulder-joint
and scapula.

Acromio-clavicular joint

Acromioclavicular joint
The acromioclavicular joint, or AC
joint, is a joint at the top of the
shoulder. It is the junction between
the acromion (part of the scapula
that forms the highest point of the
shoulder) and the clavicle.

Ligaments
The ACROMIOCLAVICULAR
LIGAMENT

The joint is stabilized by three ligaments:

1. The acromioclavicular ligament, which attaches the clavicle to the
acromion of the scapula.
. Superior Acromioclavicular Ligament This ligament is a quadrilateral
band, covering the superior part of the articulation, and extending
between the upper part of the lateral end of the clavicle and the
adjoining part of the upper surface of the acromion.
. It is composed of parallel fibers, which interlace with the aponeuroses
of the Trapezius and Deltoideus; below, it is in contact with the
articular disk when this is present.
. Inferior Acromioclavicular Ligament This ligament is somewhat thinner
than the preceding; it covers the under part of the articulation, and is
attached to the adjoining surfaces of the two bones.
. It is in relation, above, in rare cases with the articular disk; below, with
the tendon of the Supraspinatus.

The CORACOACROMIAL
LIGAMENT
2. The coracoacromial ligament, which runs from the coracoid process to the
acromion.
. The Coracoacromial Ligament is a strong triangular band, extending between
the coracoid process and the acromion.
. It is attached, by its apex, to the summit of the acromion just in front of the
articular surface for the clavicle; and by its broad base to the whole length of the
lateral border of the coracoid process.
. This ligament, together with the coracoid process and the acromion, forms a vault
for the protection of the head of the humerus.
. It is in relation, above, with the clavicle and under surface of the Deltoideus; below,
with the tendon of the Supraspinatus, a bursa being interposed.
. Its lateral border is continuous with a dense lamina that passes beneath the
Deltoideus upon the tendons of the Supraspinatus and Infraspinatus.
. The ligament is sometimes described as consisting of two marginal bands and a
thinner intervening portion, the two bands being attached respectively to the apex
and the base of the coracoid process, and joining together at the acromion.
. When the Pectoralis minor is inserted, as occasionally is the case, into the capsule
of the shoulder-joint instead of into the coracoid process, it passes between these
two bands, and the intervening portion of the ligament is then deficient.

The CORACOCLAVICULAR
LIGAMENT
3. The coracoclavicular ligament, which consists of two
ligaments, the conoid and the trapezoid ligaments.
. The Coracoclavicular Ligament serves to connect the
clavicle with the coracoid process of the scapula.
. It does not properly belong to the acromioclavicular joint
articulation, BUT is usually described with it, since it
forms a most efficient means of retaining the clavicle in
contact with the acromion.
. It consists of two fasciculi, called
trapezoid ligament
conoid ligament.
. These ligaments are in relation, in front, with the
Subclavius and Deltoideus; behind, with the Trapezius.

Topographic Anatomy of the

Scapular Region
QUADRANGULAR SPACE
the space bounded by
the teres minor m.
superiorly, the teres
major m. inferiorly, the
long head of the
triceps brachii m.
medially and the
humerus laterally.
the axillary n. and the
posterior circumflex
humeral a. pass through
this space.

TRIANGULAR INTERVAL

The interval between

the teres major m.
superiorly, long head
of the triceps brachii
m. medially and
humerus laterally.
The radial n. passes
through this interval
to get from the axilla
to the posterior
surface of the
humerus.

TRIANGULAR SPACE

The space bounded by

the teres minor m.
superiorly, the teres
major m. inferiorly and
the long head of the
triceps brachii m.
laterally.

The circumfex
scapular vessels are
located in this space
as they pass from the
axilla to the dorsum
of the scapula.

The circumfex scapular artery

(scapular circumfex artery,
dorsalis scapulae artery) is a
branch of the subscapular artery
and part of the scapular
anastomoses.

It curves around the

axillary border of the
scapula, travelling
through the anatomical
"Triangular space" made up
of the Subscapularis (Teres
minor) superiorally, the Teres
major inferiorally, and the long
head of the Triceps laterally.

It enters the
infraspinatous fossa under
cover of the Teres minor,
and anastomoses with the

Circumfex scapular arte

transverse scapular artery

(suprascapular) and the
descending branch of the

subscapular artery

Nerve
axillary n.

lower
subscapular
n.

middle
subscapular
n.

Nerves of the Scapular Region

Source
Branches
Motor
Sensory
posterior cord superior
deltoid, teres skin of the
of the
lateral
minor
upper lateral
brachial
brachial
arm
plexus
cutaneous
nerve
posterior cord unnamed
subscapularis no cutaneous
of the
muscular brs. m., teres
branches
brachial
major m.
plexus (C5,
C6)

posterior cord unnamed

of the
muscular brs.
brachial
plexus (C7,
C8)
suprascapular superior trunk no named
n.
of the
branches
brachial
plexus (C5C6)

latissimus
dorsi m.

Notes
axillary n. is
endangered
by surgical
neck
fractures
subscapularis
and teres
major are
synergists
(medial
rotation of
the humerus)
no cutaneous also called
branches
the
thoracodorsal
n.

supraspinatus no cutaneous
m.,
branches
infraspinatus
m.

thoracodorsal posterior cord unnamed

latissimus
n.
of the
muscular brs. dorsi m.

suprascapular
n. passes
through the
scapular
notch inferior
to the
superior
transverse
scapular
ligament
no cutaneous also called
branches
the middle

Arteries of the Scapular Region

Branches
Supply to
unnamed muscular
deltoid m.; arm muscles
branches
near the surgical neck of
the humerus

Artery
anterior circumflex
humeral

Source
axillary a., 3rd part

posterior circumflex
humeral

axillary a., 3rd part

unnamed muscular
branches

axillary

subclavian a. (axillary a.
is the continuation of the
subclavian lateral to the
1st rib)

circumflex scapular

subscapular a.

1st part: superior

thoracic a.; 2nd part:
thoracoacromial a.,
lateral thoracic a.; 3rd
part: anterior humeral
circumflex a., posterior
humeral circumflex a.,
subscapular a.
unnamed muscular
branches

dorsal scapular

subclavian a., 3rd part

unnamed muscular
branches

subscapular

axillary a., 3rd part

circumflex scapular a.,

thoracodorsal a.

suprascapular

thyrocervical trunk

muscular

Notes
anterior circumflex
humeral a. anastomoses
with the posterior
circumflex humeral a.
deltoid; arm muscles
posterior circumflex
near the surgical neck of humeral a. anastomoses
the humerus
with the anterior
circumflex humeral a.; it
passes through the
quadrangular space with
the axillary nerve
pectoral region, shoulder pectoralis minor m.
region and upper limb
crosses anterior to the
axillary artery and is used
to delineate the 3 parts
mentioned at left

teres major m., teres

minor m., infraspinatus
m.

circumflex scapular a.
anastomoses with the
suprascapular a. and the
dorsal scapular a. to form
the scapular anastomosis
levator scapulae m.,
dorsal scapular a.
rhomboideus major m., anastomoses with the
rhomboideus minor m.
suprascapular a. and the
subscapular a. to form
the scapular
anastomosis; dorsal
scapular a is a branch of
the transverse cervical a.
in ~30% of cases
subscapularis m., teres
the circumflex scapular
major m., teres minor m., branch of the
infraspinatus m.
subscapular
a.anastomoses with the
suprascapular a. and the
dorsal scapular a. in the
scapular anastomosis
supraspinatus &
anastomoses with the

Omohyoid muscle
Origin

Upper border of the

scapula

Inserti
on

Hyoid bone

Nerve

Ansa cervicalis (C1-C3)

Action
s

Depresses the larynx and

hyoid bone. Also carries
hyoid bone backward and
to the side.

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