Dr.

Eman El Sawaf
Anatomy & Embr yology
Depar tment
Faculty Of Medicine, Helwan Univer sity
 Basic Medical
Science II Module

Anatomy

Upper Limb
Upper Limb Regions
Pectoral
Scapular
Axilla
Arm

For Arm

Hand
Bones Of The Upper Limb
Clavicle
Scapula
Humerus

Radius
Ulna
Hand
Scapular (Shoulder) Region
 Objectives
- By the end of this lecture student should be
able to:
- Discuss the anatomy of the scapular (shoulder) region
(muscles – blood vessels – nerves)
 Pages:
Contents 713 to 730
- Shoulder Muscles:
- Trapezius - Deltoid - Levator scapulae
- Rhomboid minor - Rhomboid major
- Scapular Muscles:
- Subscapularis -Supraspinatus - Infraspinatus
- Teres minor - Teres major
- Axillary Nerve:
(Origin – Course – Branches)
- Suprascapular Nerve:
(Origin – Course – Branches)
- Suprascapular Artery:
(Origin – Course – Branches)
- Anastomosis around the scapula:
(Formation – Function)
 Muscles of the
shoulder & scapular regions
- Trapezius
- Deltoid muscle
- Levator scapulae
- Rhomboid minor
- Rhomboid major
- Subscapularis muscle
- Supraspinatus muscle
- Infraspinatus muscle
- Teres minor muscle
- Teres major muscle
- Origin
- Insertion Shoulder muscles
- Nerve supply
- Muscle action Levator scapulae

Trapezius
Rhomboid minor

Rhomboid major

Deltoid
Deltoid muscle
 - Large - Origin

triangular in Deltoid muscle - Insertion

- Nerve supply
- Muscle action
shape
Origin: Deltoid muscle (Superior view)
- Clavicle
Origin Deltoid muscle

Anterior border
of lat.1/3
of the clavicle
Origin: Deltoid muscle (Posterior view)
- Scapula
Origin Deltoid muscle

Spine

- Inferior edge of the crest of

the spine of the scapula
- Lateral margin of the
acromion
Insertion: (Anterior view)
Deltoid muscle
- Humerus
Insertion Deltoid muscle

Deltoid tuberosity
Deltoid muscle - Origin
- Insertion

Anterior
border
of Lat.1/3
of the clavicle
Inferior edge
of the crest of
Lateral
the spine of
margin
the scapula
of the
acromion
Deltoid tuberosity
Nerve supply Deltoid muscle

- Axillary Nerve
- From the posterior
cord of the brachial
plexus (C5,6)
 Nerve supply Deltoid muscle

- Axillary Nerve
- From the
posterior cord
of the brachial
plexus (C5,6)
 Muscle action Deltoid muscle

- The anterior fibers:

Flex the arm

- The middle fibers:

Abduct the arm from
15 - 90 degree

- The posterior fibers:

Extend the arm
 Muscle action Deltoid muscle
- The anterior fibers: - The posterior fibers:
Flex the arm Extend the arm
Muscle action Deltoid muscle

- The anterior
- The posterior fibers:
fibers: Flex the arm
Extend the arm
 Muscle action Deltoid muscle
- The anterior fibers: - The posterior fibers:
Flex the arm Extend the arm
 Muscle action Deltoid muscle
- The middle fibers:
Abduct the arm from
15 - 90 degree
Muscle action Deltoid muscle

- The middle fibers:

Abduct the arm from
15 - 90 degree
 Deltoid muscle
Deltoid
Origin - Anterior border of the lat. 1/3 of the clavicle
- Lateral border of the acromion
- The inferior margin of the crest of the spine of
the scapula
Insertion - Deltoid tuberosity of the humerus
Nerve - Axillary Nerve
supply
Action Anterior fibers: Flex the arm
Middle fibers: Abduct the arm from 15 - 90 degree
Posterior fibers: Extend the arm
Site: Deltopectoral groove
Contents: (Clavipectoral triangle)
- Cephalic vein
- Deltoid branch of
thoracoacromial artery
- Deltopectoral lymph node
Deltoid

Pctoralis Major

Deltopectoral groove
- Origin
- Insertion Scapular muscles
- Nerve supply
- Muscle action

Supraspinatus

Infraspinatus

Teres minor

Teres major
Scapular muscles
Subscapularis muscle
Subscapularis muscle
- Origin
- Insertion Subscapularis muscle
- Nerve supply
- Muscle action

- It from
part of the
posterior
wall of he
axilla
Origin: Subscapularis muscle (Anterior view)
- Scapula
Origin Subscapularis muscle

From the med.2/3

of the subscapular fossa
Insertion: Anterior view
- Humerus
Subscapularis muscle
- Insertion Subscapularis muscle

Lesser tubercle
- Origin Subscapularis muscle
- Insertion

Lesser tubercle From the med.2/3

of the subscapular fossa
Nerve Supply Subscapularis muscle

Upper and lower

subscapular nerves
(From the posterior
cord of the brachial
Plexus (C5&6))
Muscle action Subscapularis muscle

- Medial rotation of the arm at the glenohumeral joint

Muscle action Subscapularis muscle
- Medial rotation of the arm at the glenohumeral joint
 - Stabilizes the head of the
humerus in the glenoid cavity Rotator Cuff Muscles
during the movement of the arm
 Subscapularis muscle
Origin - Medial 2/3 of subscapular fossa
Insertion - Lesser tubercle of the humerus
Nerve - Upper and lower subscapular nerves
supply
Action - Medial rotation of the arm at the shoulder
joint
- Stabilizes the head of the humerus in the
glenoid cavity during the movement of the
arm (Rotator Cuff Muscles)
Supraspinatus & Infraspinatus Muscles
- Origin
- Insertion Supraspinatus & Infraspinatus Muscles
- Nerve supply
- Muscle action
- Origin
- Insertion Supraspinatus & Infraspinatus Muscles
- Nerve supply
- Muscle action
 (Posterior view)
Origin: Supraspinatus & Infraspinatus Muscles
Scapula
 - Origin Supraspinatus & Infraspinatus Muscles

Medial 2/3 of
supraspinous fossa
and from the deep fascia
covers the muscle

Medial 2/3 of
infraspinous fossa
and from the deep fascia
covers the muscle
- Insertion: Supraspinatus & Infraspinatus Muscles (Posterior
Humerus view)
Insertion Supraspinatus & Infraspinatus Muscles

Most superior facet

on the greater tubercle

Middle facet
on the greater tubercle
Supraspinatus Muscle:
- Origin
- Insertion

Most superior facet on

the greater tubercle

Medial 2/3 of
supraspinous fossa
and from the deep fascia
covers the muscle
Infraspinatus Muscle:
- Origin
- Insertion

Middle facet on
the greater tubercle

Medial 2/3 of
infraspinous fossa
and from the deep fascia
covers the muscle
 Nerve Supply Supraspinatus & Infraspinatus Muscles

Suprascapular nerve
(From the upper trunk
of the brachial Plexus
(C5&6))
Muscle Action Supraspinatus & Infraspinatus Muscles

Rotator Cuff Muscles

 Muscle Action Supraspinatus muscle

- Abducts the arm

from zero to 15 degree
(Initiation of abduction)
at the glenohumeral joint
 Muscle Action Infraspinatus Muscle
- Lateral rotation of the arm
at the glenohumeral joint
- Lateral rotation of the arm Infraspinatus Muscle
at the glenohumeral joint Muscle Action
 Supraspinatus & Infraspinatus
Muscles
Supraspinatus Infraspinatus
Origin - Medial 2/3 of supraspinous - Medial 2/3 of infraspinous
fossa and from the deep fascia fossaand from the deep fascia
covers the muscle covers the muscle
Insertion - The most superior facet of the - The middle facet on the greater
greater tubercle on the tubercle of the humerus
humerus
Nerve - Suprascapular nerve - Suprascapular nerve
supply
Muscle - Abducts the arm from zero to - Lateral rotation of the arm
action 15 degree at the shoulder joint

- Stabilizes the head of the - Stabilizes the head of the

humerus in the glenoid cavity humerus in the glenoid cavity
(Rotator Cuff Muscle) (Rotator Cuff Muscle)
Teres Minor & Teres Major Muscles
- Origin
- Insertion Teres Minor & Teres Major Muscles
- Nerve supply
- Muscle action
- Origin
- Insertion Teres Minor & Teres Major Muscles
- Nerve supply
- Muscle action
Origin: Teres Minor & Teres Major Muscles (Posterior view)

Scapula
- Origin Teres Minor & Teres Major Muscles

The upper 2/3 of the

posterior surface of the
scapula, near to the
the lateral border

Oval area on the

posterior surface of the
inf. angle of scapula
Insertion: Teres Minor & Teres Major Muscles
Humerus

(Anterior
view) (Posterior
view)
- Insertion Teres Minor & Teres Major Muscles

- Teres major - Teres minor

Inferior facet on
the greater tubercle
The medial lip of
the bicipital groove
(intertubercular sulcus) of
the humerus
- Origin Teres Minor Muscle
- Insertion

Inferior facet on the

greater tubercle

The upper 2/3 of the posterior

surface of the scapula, near to
the lateral border
 - Origin Teres Major Muscle
- Insertion

The medial lip of

the bicipital groove
(intertubercular sulcus) of
the humerus

Oval area on the back

of the inf. angle
Nerve Supply Teres Minor & Teres Major Muscles

Teres minor:
- Axillary Nerve
- From the posterior cord
of the brachial plexus
- (C5,6)

Teres major:
Lower subscapular
nerve
(From the posterior
cord of the brachial
Plexus (C5&6))
Muscle Action Teres Minor Muscle

Rotator Cuff Muscles

 Muscle Action Teres Minor Muscle
- Rotates the arm laterally
at the glenohumeral joint
- Rotates the arm laterally
at the glenohumeral joint
Muscle Action Teres Major Muscle

- Medial rotation & extension of the arm

at the glenohumeral joint

Extension
Muscle Action Teres Major Muscle

- Medial rotation & extension of the arm

at the glenohumeral joint
 - Medial rotation & extension Teres Major Muscle
of the arm at the glenohumeral joint
Muscle Action
 Teres Minor & Teres Major Muscles
Teres minor Teres major
Origin - The upper 2/3 of flattened strip of - Oval area on the back of the
bone on the back of the scapula, inf. angle
adjacent to the lateral border
Insertion - Inferior facet on the greater - The medial lip of
tubercle the bicipital groove
(intertubercular sulcus) of the
humerus
Nerve - Axillary nerve - Lower subscapular nerve
supply
Muscle - Rotates the arm laterally at the - Medial rotation &extension
action glenohumeral joint of the arm at the glenohumeral
joint
- Stabilizes the head of the
humerus in the glenoid cavity
(Rotator Cuff Muscle)
- Origin Anterior aspect Axillary nerve
- Course
- Branches Posterior cord

Origin:
From the posterior
cord of the brachial
plexus (C5,6)
 - Origin Posterior aspect Axillary nerve
- Course
- Branches

Course:
- It leaves the axilla by
passing through the
quadrangular space to
enters the posterior
scapular region with
the posterior
circumflex humeral
artery and vein.
- It is directly related humeral artery

to the posterior
surface of the surgical
neck of the humerus.
Axillary nerve - Origin
- Course
- Branches
Branches:
- Muscular: to
deltoid and teres
minor muscles.
- Cutaneous branch:
the superior lateral Teres
cutaneous nerve of minor
Upper lateral
the arm, which
cutaneous
carries general nerve of the
sensation from the arm
arm
skin over the
inferior part of the
deltoid muscle.
- Origin
- Course Suprascapular nerve
- Branches
Suprascapular notch

Supraspinous fossa

Infraspinous fossa
Spinoglenoid notch
- Origin Suprascapular nerve
- Course
- Branches Suprascapular ligament

Supraspinous fossa

Suprascapular foramen

Infraspinous fossa Spinoglenoid notch

- Origin Suprascapular nerve
- Course
- Branches
- Origin Suprascapular nerve
- Course
- Branches
Origin:
From the upper trunk of
the brachial plexus
(C5,6)
- Origin
- Course
Suprascapular nerve
- Branches

Course:
- It passes through the
suprascapular foramen
to the posterior scapular
region
- It enters the supra
spinous fossa (deep to
supraspinatus muscle)
- It passes through the
spinoglenoid notch to the
infraspinous fossa

Branches:
- Muscular: supraspinatus
& infraspinatus
- Origin Suprascapular artery
- Course
- Branches Suprascapular notch

Supraspinous fossa

Infraspinous fossa
Spinoglenoid notch
- Origin Suprascapular artery
- Course
- Branches Suprascapular ligament

Supraspinous fossa

Suprascapular foramen

Spinoglenoid notch
Infraspinous fossa
- Origin Suprascapular artery
- Course
- Branches
Suprascapular artery Thyrocervical trunk
Suprascapular
artery
Subclavian artery

Origin:
From the thyrocervical
trunk
(1st part of subclavian
artery)
 Suprascapular artery
Course:
- It passes superior to the
suprascapular foramen
to the posterior scapular
region
- It enters the supra
spinous fossa (deep to
supraspinatus muscle)
- It passes through the
spinoglenoid notch to the
infraspinous fossa

Branches:
Muscular: to supraspinatus
and infraspinatus muscles
 Thyrocervical
trunk

Suprascapular
artery

Subclavian artery
 Anastomosis around the scapula
Anastomosis
Communication between
tubular structures
(blood vessels)

Function
The arterial anastomosis maintain the blood
circulation if one of these arteries is blocked
 Anastomosis around the scapula
Subclavian a.

Axillary a.
 Anastomosis around the scapula

Subclavian artery (1st part)

Suprascapular
Transverse cervical (deep branch)

Axillary artery (3rd part)

Subscapular (circumflex scapular)
Anastomosis around the scapula
Subclavian a.

Axillary a.
Anastomosis around the scapula
 Reference
Gray's Anatomy for Students, 3rd Ed.
with STUDENT CONSULT Online
Access Drake, Vogl & Mitchell 2014.
ISBN: 978-0-7020-5131-9
Thank You