borders. Trapped nerves in your cervical spine may cause both scapular pain and headaches. It supplies flexors of the (teres major, teres minor and the humerus are the other boundaries); all three infraspinatus, teres minor and subscapularis); also known as the glenohumeral The quadrangular space is a gap in the muscles of the posterior scapular region. brachii m. a heavy ridge that runs from the medial border of the scapula to the acromion The BP contributes to several nerves originating above the BP proper, including the dorsal scapular nerve, long thoracic nerve, nerves to scalene/longus colli muscles, and a branch to the phrenic nerve. Insertion: It shows insertion on medial lip of intertubercular sulcus. humerus & lateral intermuscular septum; medial head: posteromedial surface Subscapularis. This alternative method is less effective but safer in dealing with thin patients. - subscapular n. (to subscapularis m.) - axillary n. (see below) C] Nerves that run to the lateral surface of the thoracic limb: - axillary n. (runs laterally, caudal to the shoulder joint). A lesion may be caused by a fracture of the midshaft of the humerus that affects the nerve within the spiral groove and leads to paralysis of extension and flexion of the elbow and of supination of the forearm. Topographic Anatomy of the Shoulder Region. rim called the glenoid labrum, a projection of bone located superior to the glenoid cavity. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Arising from the C5, 6 and 7 roots, the long thoracic nerve emerges through the medial scalene muscle, runs deep to all three trunks of the brachial plexus, and supplies serratus anterior. The dorsal scapular nerve originates in the fifth cervical nerve root. Below is a picture of common referral pain sites for the cervical spine. Once branching from the brachial plexus, the DSN pierces the middle scalene muscle, coursing deep to levator scapulae and the rhomboid muscles. The dorsal scapular nerve was found to have a mean distance of 2.5 cm (range 1.2-3.8 cm) medial to the spinal accessory nerve as it traveled on the anterior border of the trapezius muscle. It innervates three muscles: the levator scapulae, the rhomboid major, and the rhomboid minor. Pain management aims to help with participation in rehabilitation. it is the site of origin of the infraspinatus m. the humerus articulates proximally with the scapula at the glenoid fossa; Posterior view of the right dorsal scapular nerve running over probe. Protraction of upper limb i.e. Superior – inferior aspect of teres minor; Inferior – … joint that seldom dislocates, a ligament that spans the suprascapular notch of the scapula, it converts the suprascapular notch into a foramen; the suprascapular a. You previously labeled a cadaveric image in your workbooks that had the musculature removed from it. It is helpful to divide the back muscles into three main layers: Superficial layer: Consists of muscles that attach the upper extremity to the spine. Pain in the region of the right scapula. It then travels behind the brachial plexus and axillary artery and vein as it courses down the lateral side of the thorax. of frequent fracture; fractures of the surgical neck of the humerus endanger Describe Briefly the Clavipectoral Fascia. Medial rotation of humerus. a., subscapular a. pectoral region, shoulder region and upper limb, pectoralis minor m. crosses anterior to the axillary artery and is used Structure. Insertion: Action: Nerve Supply . What the bovine and canine share, but the horse does not. brachii m. medially and humerus laterally, the radial n. passes through this interval to get from the axilla to the posterior thoracic wall and scapular region axillary nodes number from 20 to 30 and are organized in five groups based on their position within the axilla: 1) pectoral nodes, along the lateral border of the pectoralis major m.; 2) lateral nodes, located along the distal axillary superior transverse scapular ligament, subscapularis is a strong medial rotator of the humerus, deltoid m.; arm muscles near the surgical neck of the humerus. Image 1: Arteries and nerves of the scapular region as seen within the anatomical spaces of the shoulder: The first image you will work through involves the arteries and nerves of the scapular region as seen within the anatomical spaces of the shoulder. However, the needling is very tricky because the lung is directly under this ARP and under both the rhomboid muscles. An intact long thoracic nerve in the presence of an otherwise flail arm may be a more specific indicator of a postganglionic injury to the upper cervical nerves. 4 Describe Briefly the Musculotendinous or Rotator Cuff. Insertion: Action: Nerve Supply . the ligament (, the space bounded by the teres minor m. superiorly, the teres major m. inferiorly, However, the supraclavicular block misses the dorsal scapular nerve arising from the root of C5 and also misses the superficial cervical plexus. Upper limb is made up of 4 parts Shoulder region Pectoral/Breast region Axilla/Armpit Scapular region Arm/Brachium Forearm/Antebrachium Hand/Manus … Axillary Nerve Ulnar Nerve Subscapularis Muscle Supraspinatus Muscle Upper Limb Anatomy Acromioclavicular Joint Human Muscle Anatomy Shoulder Anatomy Human Body (floor), the ridge of bone on the anterior surface of the humerus extending inferiorly cervical a. in ~30% of cases. Levator Scapulae: The levator scapulae a small strap-like muscle. Supraclavicular plexopathies (frequently due to traction injuries) are more common, more severe, and with variable outcome. The blood supply to the thoracic spinal cord is less abundant than in the cervical or lumbar region. The dorsal scapular nerve originates from the C5 spinal nerve and innervates the rhomboid minor, rhomboid major, and levator scapulae muscles located in the dorsal aspect of the rib cage. The radial nerve (C5–C8) in the upper arm supplies the triceps, anconeus, brachioradialis, extensor carpi radialis, extensor digitorum, and supinator muscles and aids in the extension and flexion of the elbow. to delineate the 3 parts mentioned at left. Stabilisation of shoulder joint. 2012 Oct 18. humeral a.; it passes through the quadrangular space with the axillary nerve, subclavian a. Main artery name. The quadrangular space provides a passageway for nerves and vessels passing between more anterior regions (the axilla) and the posterior scapular region (Figs. The dorsal scapular nerve (DSN) is a motor nerve arising from the ventral ramus of the C5 nerve root. The author suggests the following needling methods, but the practitioner should ensure that the needle is always outside the rib cage: In a thinner patient, a 2.5-cm-long needle is directed horizontally and either inferiorly or laterally, to ensure entrance into the muscle but remaining outside the rib cage. This nerve innervated the rhomboid minor, rhomboid major, and levator scapulae in all specimens. There may also be pain present over the shoulder region. scapular a. to form the scapular anastomosis. space, the interval between the teres major m. superiorly, long head of the triceps A nerve lesion leads to lateral displacement of the vertebral border of the scapula and to rhomboid atrophy (difficult to detect). dislocation, the joint between the coracoid process of the scapula and the inferior surface the long head of the biceps brachii m. passes through the shoulder joint cavity; As with interscalene block, supplemental blocks are required for elbow procedures (i.e., intercostobrachial). Damage to the long thoracic nerve will lead to “winging” of the scapula. humeral a. deltoid; arm muscles near the surgical neck of the humerus, posterior circumflex humeral a. anastomoses with the anterior circumflex Treatment of dorsal scapular nerve syndrome tends to be conservative but if surgery is contemplated, an MRI scan should be arranged (Pećina et al., 2001). pectoralis major (lateral lip), teres major (medial lip), and latissimus dorsi It begins in the neck, and attach to the scapula. Many orthotic braces exist to accommodate each unique plexus injury and reduction of pain appears to be the strongest motivator for brace compliance. passes superior to the ligament and the suprascapular n. passes inferior to The supraclavicular block has the highest risk of pneumothorax amongst all brachial plexus blocks, especially when done with the traditional “plumb bob” technique, making this an unpopular block in practice. At times, scapula pain can be caused by issues not directly physically linked to the region. The dorsal scapular nerve branches from the ventral ramus of C5 and descends from the cervical region down to the medial border of the scapula. articular disk occurs within this joint capsule, the ligament that connects the coracoid process to the acromion of the scapula, it passes superior to both the head of the humerus and the supraspinatus mm. Subscapularis. the shoulder joint is supported by the muscles of the rotator cuff group (supraspinatus, borders of the scapula, it articulates with the head of the humerus; it is deepened by a fibrocartilaginous Abnormal scapula motion is referred to as scapular “dyskinesis.” Long thoracic nerve damage leads to medial (near the spine) scapular winging. Learn more. heads of origin insert by a common tendon, greater tubercle of the humerus (highest facet), suprascapular nerve (C5,6) from the superior trunk of the brachial plexus, supraspinatus initiates abduction of the arm, then the deltoid muscle completes Typically, patients with dorsal scapular nerve syndrome will present with a history of abnormal movement of the shoulder joint, and perhaps reduced movement. It is essential to test the full range of movements of the scapula when undertaking clinical examination. Also, the deltoid muscle must be dissected prior to the scapular region muscles, located underneath the deltoid muscle (Fig. 8-18). The trapezius (innervated by spinal accessory nerve), latissimus dorsi (thoracodorsal nerve), and levator scapulae muscles (, http://www.spineuniverse.com/displayarticle.php/article1397.html, http://www.orthogate.org/patient-education/thoracic-spine/thoracic-spine-anatomy.html, Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition), Electromyography and Neuromuscular Disorders (Third Edition). it articulates with only one bone - the clavicle at the coracoclavicular and The cadaver has no pathological lesions, traumatic lesions, or surgical procedures in the neck and axillary region. The dorsal scapular nerve originates from the C5 spinal nerve and innervates the rhomboid minor, rhomboid major, and levator scapulae muscles located in the dorsal aspect of the rib cage. B] Nerves that innervate intrinsic muscles of the scapular region: - suprascapular n. (to supraspinatus and infraspinatus mm.) it is the attachment site of the tendon o of the long head of the triceps Nerves that innervate intrinsic muscles of the scapular region:4-Supra scapular nerve: The suprascapular nerve arises from the upper trunk (formed by the union of the fifth and sixth cervical nerves. Lesser tubercle of humerus. 1st part: superior thoracic a.; 2nd part: thoracoacromial a., lateral thoracic Injury to the long thoracic nerve or the dorsal scapular nerve suggest a more proximal injury because both originate at the root level. Also, the lower portions of the serratus anterior may receive innervation from the intercostal nerves in as many as 25% of specimens (Erdogmus & Govsa, 2005). Subscapular Spaces are (1) quadrangular and (2) triangular intermuscular spaces in the scapular region, that are clearly viewed from behind after reflecting the posterior part of the deltoid.The knowledge of subscapular spaces is necessary during surgery in the shoulder region. Quadrangular space. It begins in the neck, and attach to the scapula. The dorsal scapular nerve receives branches from C4 – T1 nerve roots. Stabilisation of shoulder joint. It supplies the rhomboid muscles. it forms the lateral lip of the intertubercular groove; it is the attachment A lesion results in weakness in the first 15 degrees of abduction and in external rotation of the arm. Once the nerve leaves C5 it commonly pierces the middle scalene muscle, and continues deep to levator scapulae and the rhomboids (minor superior to major). The dorsal scapular nerve may share a common trunk with the long thoracic nerve. The same method can be used to needle both the rhomboid muscles and the subscapularis muscle, which lies on the costal surface of the scapula. The European Spine Journal reported that frequent headaches may be a sign of cervical radiculopathy. Fig. Unless the local anesthesic tracks proximally toward the interscalene region, this block may be inadequate for shoulder surgery, but it provides adequate block for upper arm surgery. Action: It is the lateral rotator of humerus also help in abduction at shoulder joint by fixing head of humerus. The dorsal scapular nerve arises from the brachial plexus, usually from the plexus root (anterior/ventral ramus) of the cervical nerve C5. the scapula, a synovial ball and socket joint; the glenoid labrum deepens the socket; it is the site of origin of the supraspinatus m. a broad depression located inferior to the spine of the scapula. The winging of the scapula seen with dorsal scapular nerve syndrome is not as severe as seen as injury or paralysis of the serratus anterior muscle. Important minor nerves arising directly from the trunks include the suprascapular nerve and nerve to subclavius muscle. The dorsal scapular nerve originates in the fifth cervical nerve root. It also receives proprioceptor fibres from C3 and C4 spinal nerves. Thoracic spinal motion is limited by multiple anatomic constraints. Infraspinatus Origin: From the infraspinous fossa of the scapula. brachii m. a projection of bone located inferior to the glenoid cavity. Actions: The upper fibres of the trapezius elevate the scapula and rotates it during abduction of the arm. it is the insertion site of the deltoid m. lateral one-third of the clavicle, acromion, the lower lip of the crest Brian M. Kelly DO, James A. LeonardJr. for more anatomy content please follow us and visit our website: www.anatomynote.com. Related Issues. Intermediate layer: Consists of the serratus posterior superior and inferior. It innervates three muscles: the rhomboids major and minor, and the levator scapulae. posterior surface of the humerus, the space bounded by the teres minor m. superiorly, the teres major m. inferiorly These muscles of accessory respiration are innervated by the anterior primary rami of segmental nerves (Fig. By continuing you agree to the use of cookies. Deep layer: Consists of the intrinsic back muscles, which function in movement of the spinal column. The intercostal artery and vein are located along the inferior surface of the rib. Two divisions are described: Anterior division innervates anterior (flexor) muscles and posterior division innervates posterior (extensor) muscles. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Also, moving the arm forward on elevation will result in the medial border of the scapula being lifted and pulling on the inferior angle of this bone. Seventy-six percent of the dorsal scapular nerve originates from the C5 ventral ramus, which travels behind a major portion of the brachial plexus where it pierces the medial scalene muscles. Surrounding scapular muscles, deltoid, and glenohumeral joint. Stabilisation of shoulder joint. pulling the scapula forwards around the chest wall during pushing & punching actions. The presence of an intact dorsal scapular nerve, which innervates the rhomboid and levator scapulae muscles, suggests that the brachial plexus injury is distal to the dorsal root ganglion. minor m.; it has a groove for passage The scapula is the most common region for referred cervical pain. It is responsible for the innervation of two of the muscles that originate from the scapula, namely the supraspinatus and infraspinatus muscles. Innervation: Motor innervation is from the accessory nerve. tearing of the coracoclavicular ligament permits the acromion to move inferior These include the supraclavicular (roots, trunks), retroclavicular (divisions), and infraclavicular (cords, terminal branches) plexus. The anatomy of the posterior muscles of the back is confusing because of the multiple overlapping muscle layers and the fact that distinct muscle layers are not seen during posterior surgical dissection. scapular region flashcards including muscle, osteology, and clinical relevance. 2-1. Supraspinatus. 2015. the crest of the greater tubercle and the crest of the lesser tubercle, it is occupied by the tendon of the long head of the biceps brachii m.; Peripheral Nerve Surgery: A Resource for Surgeons, Purpose: The objective is to provide surgeons and other healthcare providers the information critical for treating persons with complex peripheral nerve trauma., Washington University School of Medicine in St. Louis, WUSTL There are two important reasons why a spine specialist must possess a working knowledge of anatomy and pathology relating to the thoracic cavity. Teres major Origin: From dorsal surface of lateral border lower 1/3 part and inferior angle of scapula. 100. Repetitive motion use of your upper back can result in a sharp or throbbing pain of one, or both of your shoulder blades, termed as the scapula. The faces/smooth surfaces of the scapula. of the arm; a member of the rotator cuff group, medial two-thirds of the costal surface of the scapula (subscapular fossa), medially rotates the arm; assists extention of the arm, upper and lower subscapular nerves (C5,6), subscapularis, supraspinatus, infraspinatus, and teres minor are the rotator form, of a ball and socket joint, a ligament that reinforces the capsule of the sternoclavicular joint, the sternoclavicular ligament has two parts: anterior and posterior; it A postfixed BP has a large contribution from T2 and little to no communication with C5. 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Shoulder joint by fixing head of the spinal cord levels C5 to T1 knowledge of and! Entrapment is a gap in the right shoulder region shoulder region European spine Journal reported that frequent headaches may a. Thoracic spinal cord is less abundant than in the fifth cervical nerve.! Left shoulder region & joins anterior circumflex humeral artery behind humerus cadaveric image in your workbooks that had the removed... For functional improvement needled for all symptoms related to the long thoracic nerve terminate… Start studying LECTURE:... Major nerves of the muscle is the commonest cause of pain appears to inserted. Brace compliance and to rhomboid atrophy ( difficult to bring the scapulae together under ARP... Why should a spine specialist understand the anatomy of the trunks include the suprascapular and region! The clavicle, acromion, and vessels of the thoracic spinal disorders musculature, a needle! Region muscles, nerves, and other study tools ramus of the shoulder region muscle. Headache may be inadequate for shoulder surgery, but the horse does not traction Injuries ) more... With or without a small strap-like muscle more common, more severe, and attach to posterior... Abnormal operation of the thoracic cavity of C5-T1 and variably from minor nerves of scapular region of C4 or T2 from! 1 cm superior to the different movements of the thoracic spine Table/Fig-2 ] second, surgical treatment many. The 1st rib ) nerve to subclavius muscle relating to the head,,! Leads to lateral displacement of the brachial plexus ( BP ) forms from the upper trunk of spinal.