SHOULDER SCAPULAR REGION 75 



SHOULDER SCAPULAR REGION. 



In the dissection of this region the following parts must be 

 studied : 



1. Cutaneous nerves of the shoulder. 



2. Deep fascia. 



3. Deltoid muscle. 



4. Sub-acromial bursa. 



5. Anterior and posterior circumflex vessels of the humerus. 



6. Axillary (circumflex) nerve. 



7. Circumflex scapular artery. 



8. Subscapularis muscle. 



9. Supraspinatus, infraspinatus, teres minor, and teres major muscles. 



10. Bursse in connection with the shoulder -joint. 



11. Suprascapular nerve and transverse scapular artery. 



12. Acromio-clavicular joint, and the coraco-acromial arch. 



Nervi Cutanei (Cutaneous Nerves). The nerves which lie 

 in the superficial fascia of the shoulder region are derived 

 from two different sources. They are : 



1. Posterior supraclavicular nerves from the third and fourth cervical 



nerves. 



2. Cutaneous branches from the axillary nerve (circumflex). 



They have already been secured and cleaned. 



The posterior supraclavicular nerves cross the lateral third 

 of the clavicle and the insertion of the trapezius, under cover 

 of the platysma. They were divided when the limb was 

 removed, and the distal ends have been followed over the 

 proximal half of the deltoid. 



The cutaneous branches of the axillary nerve consist 

 (a) of a large branch, the lateral cutaneous nerve of the arm^ 

 which turns round the posterior border of the deltoid muscle, 

 and (ft) of several fine filaments which pierce the substance 

 of the deltoid muscle, and appear at irregular intervals on 

 its surface (Fig. 33). The latter are difficult to secure, but the 

 lateral brachial cutaneous nerve has already been found and 

 cleaned (see p. 69). It turns round the posterior border, 

 and is distributed over the distal part of the deltoid region. 



Deep Fascia. It has already been noted that the deep 

 fascia over the deltoid is fairly strong, and that as it passes 

 from the deltoid to the muscles which spring from the lower 

 part of the posterior aspect of the scapula, it becomes strong 

 and dense over the infraspinatus, the teres minor and the 

 teres major. In the lower scapular region it is firmly attached 

 to the limits of the infraspinous fossa in which the infra- 



