Fig. Muscles of the Scapular Region : Muscle. Stabilizes and supports the shoulder joint (rotator cuff muscle). A lesion may be caused by dislocation of the shoulder joint or a fracture of the surgical neck of the humerus and results in deltoid atrophy, in weakness in abduction from 15 degrees to 90 degrees, and in loss of cutaneous sensation over the lower half of the deltoid. The third through ninth ribs overlap the posterolateral aspect of the adjacent disc space. These muscles of accessory respiration are innervated by the anterior primary rami of segmental nerves (Fig. The dorsal scapular nerve traveled intertwined with the dorsal scapular artery in all specimens and was found along the anterior border of the rhomboid muscles. the shoulder joint is supported by the muscles of the rotator cuff group (supraspinatus, scapula into a supraspinatous fossa and an infraspinatous fossa, a notch on the superior border of the scapula located medial to the attachment it articulates with only one bone - the clavicle at the coracoclavicular and borders of the scapula, it articulates with the head of the humerus; it is deepened by a fibrocartilaginous 2743799. The dorsal scapular nerve arises from the C5 nerve root. Two divisions are described: Anterior division innervates anterior (flexor) muscles and posterior division innervates posterior (extensor) muscles. The nerves descending from the brachial plexus, along the scapulae and down the humerus include the suprascapular nerve, subscapular nerve, axillary nerve, musculocutaneous nerve, radial nerve, and the median nerve . it is the attachment site of the tendon o of the long head of the triceps - 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). However, the needling is very tricky because the lung is directly under this ARP and under both the rhomboid muscles. joint; it is frequently dislocated, the joint what connects the clavicle with the sternum, a synovial joint; its joint capsule is subdivided by a fibrous articular At lower volumes of local anesthestic, the supraclavicular block misses the dorsal scapular nerve, which arises from the root of C5, and also misses the superficial cervical plexus. 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. The quadrangular space is a gap in the muscles of the posterior scapular region. of the inferior 1/2 of the humerus, extends the forearm; the long head extends and adducts arm, long head of the triceps separates the triangular and quadrangular spaces 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. Action: Starts abduction of the arm (from 0° to 15°). This nerve innervated the rhomboid minor, rhomboid major, and levator scapulae in all specimens. Nerve supply: From a branch of axillary nerve C5 C6 this branch shows a small pseudo ganglion. Action: It is the lateral rotator of humerus also help in abduction at shoulder joint by fixing head of humerus. superior border of the scapula, it is the attachment site for the short head of the biceps brachii m., the It also receives proprioceptor fibres from C3 and C4 spinal nerves. rim called the glenoid labrum, a projection of bone located superior to the glenoid cavity. 5 Describe Subacromial bursa. from the greater tubercle. Stabilisation of shoulder joint. The dorsal scapular nerve originates in the fifth cervical nerve root. to slide inferior to the clavicle during dislocation (shoulder separation) 6 What are the Boundaries and Contents of Intermuscular Spaces in the Scapular Region. It begins in the neck, and attach to the scapula. The roots from C5 and C6 pierce through the medial scalene muscle to join the C7 nerve root. If this is difficult, the alternative method is to needle this point perpendicularly with four or five 1.5-cm-long needles. Attachments of the Levator Scapulae Muscle Origin: Transverse processes of the C1-C4 vertebrae Insertion: Medial border of the scapula Nerve supply of the Levator Scapulae Muscle Innervation: The dorsal scapular nerve. The wrist and fingers cannot be extended, and wristdrop occurs. We use cookies to help provide and enhance our service and tailor content and ads. It innervates three muscles: the rhomboids major and minor, and the levator scapulae. head, the proximal part of the shaft of the humerus. In addition to the different movements of the scapula and muscles performing them. (floor), the ridge of bone on the anterior surface of the humerus extending inferiorly It is felt just below the right shoulder blade, but acts as a phantom pain, as the muscle tissue injury is located elsewhere on the body. Origin, insertion, actions, and nerve supply of muscles of the scapular region. Learn more. Significant recovery after nerve grafting can take more than 18 months for functional improvement. joint, it connects the humerus to the scapula; a thickening of the anteroinferior It innervates the Supra spinatous muscle and infra spinatus muscles. 100. Start studying LECTURE 2: MUSCLES, NERVES, AND VESSELS OF THE SHOULDER REGION. However, the supraclavicular block misses the dorsal scapular nerve arising from the root of C5 and also misses the superficial cervical plexus. 2-6). of the coracoid process, it is bridged by the superior transverse scapular ligament; the suprascapular Paul Rea MBChB, MSc, PhD, MIMI, RMIP, FHEA, FRSA, in Essential Clinically Applied Anatomy of the Peripheral Nervous System in the Limbs, 2015. 2-4). There may also be pain present over the shoulder region. space, the interval between the teres major m. superiorly, long head of the triceps mechanical advantage it cannot initiate this action; it is assisted by the 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. surface. 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 Origin. By continuing you agree to the use of cookies. ligaments; the sternoclavicular joint has the range of movement, but not the B] Nerves that innervate intrinsic muscles of the scapular region: - suprascapular n. (to supraspinatus and infraspinatus mm.) 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 suprascapular a. and the dorsal scapular a. in the scapular anastomosis, supraspinatus & infraspinatus, shoulder joint, anastomoses with the circumflex scapular a. and the dorsal scapular a. to The blood supply to the thoracic spinal cord is less abundant than in the cervical or lumbar region. 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 American Journal of Sports Medicine. superior transverse scapular ligament, subscapularis is a strong medial rotator of the humerus, deltoid m.; arm muscles near the surgical neck of the humerus. As with interscalene block, supplemental blocks are required for elbow procedures (i.e., intercostobrachial). 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 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). Brian M. Kelly DO, James A. LeonardJr. 2-15). 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. DSN entrapment is a known, yet relatively uncommon, the cause of neck and/or shoulder pain. The dorsal scapular nerve (DSN) is a motor nerve arising from the ventral ramus of the C5 nerve root. No named minor nerves arise directly from the anterior or posterior divisions. The thoracic cavity contains the pleural cavities and the mediastinum. it is an important site of attachment for the teres major m. and teres 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. The two major nerves of the posterior scapular region are the suprascapular and axillary nerves (see Fig. Nerve supply: From a branch of axillary nerve C5 C6 this branch shows a small pseudo ganglion. Lesser tubercle of humerus. The brachial plexus (BP) forms from the ventral rami of C5-T1 and variably from minor branches of C4 or T2. a. to form the scapular anastomosis; dorsal scapular a is a branch of the transverse posterior surface of the humerus, the space bounded by the teres minor m. superiorly, the teres major m. inferiorly NERVES The skin of the scapular region receives sensory information from the medial branches of the posterior rami of cervical nerves C4 to C8and thoracic nerves T1 to T6(see Chapter 26). 2-2). It is found just proximal to the upper trunk of the brachial plexus. tendon; it provides support for the head of the humerus that prevents superior 3 Write Origin, Insertion, Action & Nerve Supply of Muscles of Scapular Region. We are pleased to provide you with the picture named Muscles Of Scapular Region And Posterior Region Of Arm Diagram.We hope this picture Muscles Of Scapular Region And Posterior Region Of Arm Diagram can help you study and research. it is the attachment site for the levator scapulae m. the portion of the scapula that runs inferomedially from the infraglenoid Pain management aims to help with participation in rehabilitation. Related Issues. The dorsal scapular nerve receives branches from C4 – T1 nerve roots. Attachments of the Levator Scapulae Muscle Origin: Transverse processes of the C1-C4 vertebrae Insertion: Medial border of the scapula Nerve supply of the Levator Scapulae Muscle Innervation: The dorsal scapular nerve. Deep layer: Consists of the intrinsic back muscles, which function in movement of the spinal column. The roots/rami originate directly from the spinal cord levels C5 to T1. Some recent studies have shown that the calculated volume of local anesthetic required for an ultrasound-guided supraclavicular block does not seem to differ from the conventionally recommended volume required for supraclavicular blocks performed with non–ultrasound-based nerve localization techniques.227 The minimum effective volume of 1.5% lidocaine with 5 µg/mL epinephrine was 32 mL.228 Multiple studies have confirmed that when UGRA is used, a single injection offers the same clinical profile and analgesic benefit as two injections.229,230, Vincent J. Devlin MD, Darren L. Bergey MD, in Spine Secrets Plus (Second Edition), 2012. 100. The long thoracic nerve is only a motor nerve and it innervates the Serratus Anterior muscle. The suprascapular nerve originates in the base of the neck from the superior trunk of the brachial plexus. Upper and lower subscapular nerves. On 19 sides, the dorsal scapular nerve originated solely from the C5 spinal nerve and on 1 side (left) it arose from the C5 and C6 spinal nerves. 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.; Scapular the biceps tendon in place; it is the attachment site for the tendon of the cervical a. in ~30% of cases. 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. Supraspinatus. Once branching from the brachial plexus, the DSN pierces the middle scalene muscle, coursing deep to levator scapulae and the rhomboid muscles. The suprascapular nerve is a nerve that branches from the upper trunk of the brachial plexus. mm. Nerve Supply: Long thoracic nerve (C 5,6,7). Figure 43.5. 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. The long thoracic nerve arises from the ventral rami of cervical nerves C5, C6, and C7.1 In some people, the root from C7 is absent, and in others, there is a small root of the nerve arising from C8. Acromion. it is the attachment site for the tendon of the long head of the biceps Despite some attractive advantages of this block, for example, rapidity of onset and broad upper extremity coverage, this block remains the least common brachial plexus block to be performed for postoperative analgesia, and recent literature on this approach is sparse. What is the passageway between the axilla and posterior scapular region? The cords branch to form several important named terminal peripheral nerve branches. scapular region is often associated with a cervical nerve root block. Mark A. Mahan, Robert J. Spinner, in Nerves and Nerve Injuries, 2015. British Journal of Sports Medicine. Brian A. Williams, ... Christopher L. Wu, in Raj's Practical Management of Pain (Fourth Edition), 2008. Positions that help avoid pain lend themselves to contracture development and prevention is paramount to optimal functional outcomes. angle, it is an important site of muscle attachments for the intermediate layer Stabilisation of shoulder joint. This alternative method is less effective but safer in dealing with thin patients. 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). The brachial plexus is a grouping of nerves where the last three cervical nerves nerves C-6, C-7, and C-8 and the first two thoracic nerves T-1 to T-2 descend ventrally. it is the attachment site of the supraspinatus, infraspinatus & teres minor Many orthotic braces exist to accommodate each unique plexus injury and reduction of pain appears to be the strongest motivator for brace compliance. 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. This block is associated with the greatest blockade of the brachial plexus with a single injection of the local anesthetic, primarily because the plexus is the most compact at this level. For scapular surgeries, important target nerves are suprascapular nerve (C5–C6), axillary nerve (C5–C6), musculocutaneous nerve (C5–C7), lateral pectoral nerve (C5–C7), subscapular nerves (C5–C6) along with supraclavicular nerve (C3–C4) and dorsal rami (C6–T5) which cover most of the dermatomes, myotomes, and osteotomes. SCAPULAR REGION This is the region that lies at the posterior thoracic wall. Important minor nerves arising directly from the trunks include the suprascapular nerve and nerve to subclavius muscle. The ends of these nerves reached the middle of the scapula, and the course of the medial branches of cervical nerve roots veered more to the caudal side than the traditional cervicothoracic line.14,15 It is possible that the skin in the scapular region was doubly innervated from another segment. and the long head of the triceps brachii m. laterally, the circumflex scapular vessels are located in this space as they pass from Subscapularis. for more anatomy content please follow us and visit our website: www.anatomynote.com. Nerves of the Scapular Region; Nerve Source Branches Motor Sensory Notes; axillary n. … However, this nerve may also receive some contributions from C4 to T1. minor m.; it has a groove for passage It is a pathway for neurovascular structures to move from the axilla anteriorly to the posterior shoulder and arm. 100. Subscapularis. Because these muscles are closely opposed, clinical and even electrodiagnostic ascertainment of preservation of the rhomboid muscle may be challenging. Brachial Plexus. The dorsal scapular nerve may share a common trunk with the long thoracic nerve. It begins in the neck, and attach to the scapula. disk; it is strengthened by the sternoclavicular, interclavicular and costoclavicular Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systemic review.