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200
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Anatomy

Upper Limb

Question 81 of 239

A 23 year old woman is thrown off her horse during a show jumping competition, landing on her shoulder. Imaging shows a fracture of the lesser tubercle of the humerus. Which of the following movements would you most expect to be affected by this injury:

Answer:

The subscapularis inserts into the lesser tubercle of the humerus, and acts to produce medial rotation of the arm (together with the teres major). The supraspinatus (abduction), infraspinatus (lateral rotation) and teres minor (lateral rotation) all insert into the greater tubercle of the humerus.

Subscapularis Muscle

Anatomy / Upper Limb / Axilla

Last Updated: 8th April 2019

The subscapularis muscle forms the largest component of the posterior wall of the axilla. Together with three muscles of the posterior scapula region (the supraspinatus, infraspinatus and teres minor muscles) the subscapularis is a member of the rotator cuff muscle group, which stabilises the glenohumeral joint.

Table: Function and Innervation of the Subscapularis Muscle

Muscle Subscapularis
Origin Medial two-thirds of subscapular fossa
Insertion Lesser tubercle of humerus
Actions Medial rotation of arm at glenohumeral joint
Innervation Upper and lower subscapular nerves

Attachments

It originates from, and fills, the subscapular fossa on the anterior surface of the scapula and inserts into the lesser tubercle of the humerus. The tendon crosses immediately anterior to the joint capsule of the glenohumeral joint.

Function

The subscapularis acts to medially rotate the arm at the glenohumeral joint.

To isolate the subscapularis muscle in examination, place the dorsum of the patient's hand in full medial rotation on the lower back and ask them to push their hand off the back (the 'lift-off' test). Loss of power suggests a tear while pain on forced medial rotation suggests tendonitis.

Innervation

The subscapularis is innervated by the upper and lower subscapular nerves, branches of the brachial plexus.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Subscapularis Muscle. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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