Anatomy upper limb scapulohumeral 24112010

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Anatomy upper limb scapulohumeral 24112010

  1. 1. ANATOMY 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
  2. 2. UPPER LIMB Scapulohumeral Region
  3. 3. Muscles Attach the scapula to the humerus 1. Deltoid 2. Supasinatus 3. Infraspinatus 4. Teres minor 5. Teres major 6. Subscabularis 7. ?? Triceps
  4. 4. Scapula • Fractures of the Scapula • Dropped Shoulder and Winged Scapula
  5. 5. • 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
  6. 6. Origin the anterior border and upper surface of the lateral third of the clavicle, acromion, spine of the scapula Insertion deltoid tuberosity of humerus Artery primarily posterior circumflex humeral artery Nerve Axillary nerve Actions shoulder abduction, flexion and extension Antagonist Latissimus dorsi Deltoid muscle
  7. 7. 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
  8. 8. ROTATOR CUFF SITS
  9. 9. 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) Muscles composing rotator cuff
  10. 10. Origin infraspinous fossa of the scapula Insertion middle facet of greater tubercle of the humerus Artery suprascapular and circumflex scapular arteries Nerve suprascapular nerve Actions Lateral rotation of arm and stabilizes humerus Infraspinatus muscle
  11. 11. 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.???????
  12. 12. 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
  13. 13. 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
  14. 14. Teres major muscle Origin posterior aspect of the inferior angle of the scapula Insertion medial lip of the intertubercular sulcus of the humerus Artery Subscapular and circumflex scapular arteries Nerve Lower subscapular nerve (segmental levels C5 and C6) Actions Internal rotation (medial rotation) of the humerus
  15. 15. 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
  16. 16. The axillary artery and its branches.
  17. 17. Source Thyrocervical trunk Vein suprascapular vein Supplies supraspinatus muscle, (sternocleidomastoid), (subclavius)
  18. 18. • 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 1/2
  19. 19. • 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 artery 2/2
  20. 20. Suprascapular nerve Innervates supraspinatus, infraspinatus From C5–C6 of brachial plexus
  21. 21. • 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 shoulder- joint; • and in the infraspinatous fossa it gives off two branches to the Infraspinatous muscle, besides some filaments to the shoulder-joint and scapula. Suprascapular nerve
  22. 22. Acromio-clavicular joint
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.
  26. 26. 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.
  27. 27. 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.
  28. 28. 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.
  29. 29. 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 circumflex scapular vessels are located in this space as they pass from the axilla to the dorsum of the scapula.
  30. 30. subscapular artery Circumflex scapular artery The circumflex scapular artery (scapular circumflex 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 transverse scapular artery (suprascapular) and the descending branch of the transverse cervical.
  31. 31. Nerves of the Scapular Region Nerve Source Branches Motor Sensory Notes axillary n. posterior cord of the brachial plexus superior lateral brachial cutaneous nerve deltoid, teres minor skin of the upper lateral arm axillary n. is endangered by surgical neck fractures lower subscapular n. posterior cord of the brachial plexus (C5, C6) unnamed muscular brs. subscapularis m., teres major m. no cutaneous branches subscapularis and teres major are synergists (medial rotation of the humerus) middle subscapular n. posterior cord of the brachial plexus (C7, C8) unnamed muscular brs. latissimus dorsi m. no cutaneous branches also called the thoracodorsal n. suprascapular n. superior trunk of the brachial plexus (C5-C6) no named branches supraspinatus m., infraspinatus m. no cutaneous branches suprascapular n. passes through the scapular notch inferior to the superior transverse scapular ligament thoracodorsal n. posterior cord of the brachial plexus (C7, C8) unnamed muscular brs. latissimus dorsi m. no cutaneous branches also called the middle subscapular n. upper subscapular n. posterior cord of the brachial plexus (C5, C6) unnamed muscular brs. subscapularis m. no cutaneous branches subscapularis is a strong medial rotator of the humerus
  32. 32. Arteries of the Scapular Region Artery Source Branches Supply to Notes anterior circumflex humeral axillary a., 3rd part unnamed muscular branches deltoid m.; arm muscles near the surgical neck of the humerus anterior circumflex humeral a. anastomoses with the posterior circumflex humeral a. posterior circumflex humeral axillary a., 3rd part unnamed muscular branches deltoid; arm muscles near the surgical neck of the humerus posterior circumflex humeral a. anastomoses with the anterior circumflex humeral a.; it passes through the quadrangular space with the axillary nerve axillary subclavian a. (axillary a. is the continuation of the subclavian lateral to the 1st rib) 1st part: superior thoracic a.; 2nd part: thoracoacromial a., lateral thoracic a.; 3rd part: anterior humeral circumflex a., posterior humeral circumflex a., subscapular a. pectoral region, shoulder region and upper limb pectoralis minor m. crosses anterior to the axillary artery and is used to delineate the 3 parts mentioned at left circumflex scapular subscapular a. unnamed muscular branches 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 dorsal scapular subclavian a., 3rd part unnamed muscular branches levator scapulae m., rhomboideus major m., rhomboideus minor m. dorsal scapular a. anastomoses with the 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 subscapular axillary a., 3rd part circumflex scapular a., thoracodorsal a. subscapularis m., teres major m., teres minor m., infraspinatus m. the circumflex scapular branch of the subscapular a.anastomoses with the suprascapular a. and the dorsal scapular a. in the scapular anastomosis suprascapular thyrocervical trunk muscular supraspinatus & infraspinatus, shoulder joint anastomoses with the circumflex scapular a. and the dorsal scapular a. to form the scapular anastomosis thoracodorsal subscapular a. unnamed muscular branches latissimus dorsi m. thoracodorsal a. accompanies the thoracodorsal n.
  33. 33. Origin Upper border of the scapula Insertion Hyoid bone Nerve Ansa cervicalis (C1-C3) Actions Depresses the larynx and hyoid bone. Also carries hyoid bone backward and to the side. Omohyoid muscle

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