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. UPPER LIMB
Scapulohumeral Region

9. Muscles Attach the scapula to the
humerus
1. Deltoid
2. Supasinatus
3. Infraspinatus
4. Teres minor
5. Teres major
6. Subscabularis
7. ?? Triceps

10. Scapula
• Fractures of the Scapula
• Dropped Shoulder and Winged Scapula

11. • 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

14. 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

16. 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

17. ROTATOR CUFF
SITS

18. 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

19. 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

20. 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.???????

21. 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

22. 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

23. 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

25. 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

26. The axillary artery and its branches.

29. Source
Thyrocervical
trunk
Vein suprascapular vein
Supplies supraspinatus muscle, (sternocleidomastoid), (subclavius)

30. • 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

31. • 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

32. Suprascapular nerve
Innervates supraspinatus, infraspinatus
From C5–C6 of brachial plexus

33. • 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

34. Acromio-clavicular joint

35. 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.

36. 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.

37. 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.

38. 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.

40. 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.

41. 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.

42. 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.

43. 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.

44. 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

45. 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.

47. 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