Chapter 11 Scapular Region

Deltoid, Rotator cuff
muscles and serratus

Anterior
SCAPULAR REGION
INTRODUCTIO
N
• Includes muscles and structures surrounding scapula
• Region contains scapulohumeral muscles arise from scapula and
inserts – humerus
• Muscles of scapular region
• Deltoid
• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres minor
• Teres major 2
MUSCLES OF SCAPULAR REGION
Deltoid muscle
• Triangular muscle (delta = triangle, in
Greek)
• Bulky muscle that forms rounded
contour of shoulder
• Has three parts
• Anterior part – Unipennate
• Middle part – Multipennate
• Posterior part – Unipennate
3
Deltoid muscle
Origin
• Originates as follows
1.Anterior part – from anterior
border of lateral one-third of
clavicle
2.Middle part – from lateral
margin of acromion and from
four intermuscular septa
3.Posterior part – from lower lip of
crest of spine of scapula
4
Human Anatomy/Yogesh Sontakke 5
Deltoid muscle
Insertion
• All fibers converge inferiorly and insert onto V-
shaped deltoid tuberosity – lateral aspect of shaft
of humerus
Innervation
• Supplied by axillary nerve (C5, C6)
Actions
• Performs following actions
• Anterior fibers – Flexion and medial rotation of
arm
• Middle fibers – Abduction of arm from 15° to
90° 6
Some Interesting Facts
• Abduction of arm – performed

as follows
• Initiation of abduction (0° to
15°): Supraspinatus
• Middle part of abduction
(15° to 90°): Acromial fibers
of deltoid
8
• Overhead abduction (90° to 180°):
Upper and lower fibers of
trapezius and serratus anterior
• Axillary nerve and posterior
circumflex humeral artery are
related – upper part of muscle
(along surgical neck of
humerus)
9
Clinical
Integration
Intramuscular injection
• Deltoid – commonly
used for intramuscular
injections
• Should be given in
middle of muscle as
upper part of deltoid –
related – axillary nerve
12
Clinical
Integration
Paralysis of deltoid
• Damage – axillary nerve results
in paralysis of deltoid muscle
• Signs and symptoms
• Inability to abduct the arm
between 15° to 90°
• Inability in medial rotation of
arm
• Loss of rounded contour of
shoulder
• Sensory loss over the lower
half of deltoid called
regimental-badge anesthesia
13
Rotator Cuff Muscles
• Musculotendinous rotator cuff or dynamic

stabilizer of shoulder fibro tendinous
sheath surrounding capsule of shoulder
joint
• Flattened tendons of four muscle namely,
subscapularis, supraspinatus,
infraspinatus, and teres minor forms
rotator cuff
• All tendons blend with capsule of shoulder
joint and inserts –greater and lesser
tubercle of humerus
15
Subscapularis
Multipennate, triangular muscle covers
scapula anteriorly
Origin
• Medial two-thirds of subscapular fossa of
scapula
Direction of fibers
• Fibers converge laterally – form tendon
• Separated by bursa, which communicates
with cavity of shoulder joint
16
Subscapularis
Insertion
• Inserts –lesser tubercle of humerus
Innervation
• Upper and lower subcapsular nerves
(C5, C6)
Actions
• Acts medial rotator, adductor, and
extensor of arm
17
Supraspinatus
Small muscle occupies
supraspinous fossa of
scapula
Origin
• Originates from medial
2/3rd of supraspinous
fossa of scapula
including upper
surface of spine of 21
Supraspinatus
Directions of fibers
• Fibers run horizontally and laterally –
tendon is separated from
coracoacromial arch (coracoid
process – coracoacromial ligament –
acromion process) by subacromial
bursa
22
Supraspinatus
Insertion
• Inserts on upper impression of
greater tubercle of humerus
Innervation
• Suprascapular nerve (C5, C6)
Actions
• Initiates abduction (0°–15°) of arm
23
Clinical Integration
• Rupture of supraspinatus tendon

• Inability of initiation of abduction – present
• Subacromial bursitis
• Lies deep – coracoacromial arch and prevents
friction of supraspinatus tendon with coracoacromial
arch
• Inflammation of bursa is called subacromial bursitis
25
Clinical Integration
• Dawbarn’s sign
• Adducted arm, pressure over deltoid just below
acromion elicit the tenderness (pain) tenderness
disappears in abducted arm because subacromial
bursa moves under acromion
• Supraspinatus tendinitis
• Inflammation of tendon of supraspinatus muscle
26
Infraspinatus
Triangular muscle occupies infraspinous
fossa of scapula
Origin
• Originates from medial two-thirds of
infraspinous fossa including inferior
surface of spine of scapula
Direction of fibers
• Fibers converge laterally and cross
shoulder joint posteriorly
27
Infraspinatus
Insertion
• Inserts – middle impression of greater
tubercle of humerus
Innervation
• Suprascapular nerve (C5, C6)
Actions
• Acts as lateral rotator of arm
28
Teres Minor
Rounded muscle (teres = rounded,
in Latin)
Origin
• Originates from upper two-thirds
of
• Dorsal surface of lateral border
of scapula.
• Circumflex scapular artery
divides origin of teres
• Two parts (upper and lower)
Direction of fibers
• Fibers run obliquely upward
and laterally 29
Teres Minor
Insertion
• Inserts –lowest impression
– greater tubercle of
humerus
Innervation
• Axillary nerve (C5, C6)
Actions
• Acts as lateral rotator of
arm
30
Teres major muscle
One of scapulohumeral muscles
Origin
• Originates from lower one-third of dorsal
aspect of lateral border and inferior angle of
scapula
Direction of fibers
• Fibers run upward, forward, and laterally
• Crosses shoulder joint inferiorly along with
latissimus dorsi – reach anteriorly to
bicipital groove
31
Teres major muscle
Insertion
• Inserts on medial lip of bicipital groove
Innervation
• Lower subscapular nerve (C5,C6)NEXT
Actions
• Acts as medial rotator and adductor of arm
32
• Subscapularis – triangular muscle
covers anterior surface (subscapular
fossa) of scapula
• Forms major part of posterior wall of
axilla
• Supraspinatus – slender muscle covers
supraspinous fossa
• Lies under cover of trapezius
muscle
33
• Dissect fascia and fat cover
infraspinatus and teres minor –
visualize these muscles
• Differentiate teres minor from teres
major, trace both these muscles
laterally
• Teres minor inserts on lowest
impression of greater tubercle,
whereas teres major runs 34
35
SERRATUS ANTERIOR
MUSCLE
Q. Write a short note on
serratus anterior muscle.
Serrate = to saw, in Latin
• Other names: Boxer’s
muscle, swimmer’s
muscle.

SERRATUS ANTERIOR
MUSCLE
Origin
• 8 digitations (slips) from
upper eight ribs and fascia
intervening intercostal muscles
in the midaxillary plane
Direction
• Curve around thoracic wall to
reach the medial border of
scapula
SERRATUS ANTERIOR
MUSCLE
Insertions
• On costal surface of medial border
of scapula as follows:
– 1st digitation at the superior angle
– 2nd and 3rd digitations along the
entire medial border
– Remaining digitations on the
triangular area at the costal surface
of inferior angle of scapula

SERRATUS ANTERIOR
MUSCLE
Innervation (nerve
supply)
• Long thoracic nerve
(nerve to serratus
anterior)Viva, Spotters
• Arises from C5, C6, C7
roots of brachial plexus

SERRATUS ANTERIOR
MUSCLE
Actions
• Pushing and punching
action (Boxer’s muscle)
• Serratus anterior and
pectoralis minor together
pulls the scapula forward
around the chest wall for
pushing and punching
action.
SERRATUS ANTERIOR
MUSCLE
Actions
• Overhead abduction of
arm Serratus anterior
(lower 4–5 digitations) and
trapezius (lower part)
rotate the scapula and
thus help in overhead
abduction of arm Neet
• Keeps the scapula in
Thank you………….
43

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Chapter 11 Scapular Region

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Deltoid, Rotator cuff

muscles and serratus

• Abduction of arm – performed

• Musculotendinous rotator cuff or dynamic

• Rupture of supraspinatus tendon

Human Anatomy/Yogesh Sontakke 36

Human Anatomy/Yogesh Sontakke 38

Human Anatomy/Yogesh Sontakke 39

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