Applied Anatomy:

Pulsating scapula

In cases of coarctation of the aorta distal to the origin of subclavian artery, blood will be diverted to the subclavian artery then get back to the descending aorta through the intercostal arteries in the scapula anastomosis.

In such a case, the anastomosis opens up markedly. The scapula may even pulsate with the heartbeat. Dilatation of the intercostal arteries may erode and even cause notching of the ribs, evident on chest x-rays.


Fractures of the scapula:

Usually result from severe trauma such as occurs in run-over accident victims or in occupants of automobiles involved in crashes.
Injuries are usually associated with rib fractures but the fractured scapula usually requires very little treatment because the sandwitching muscles adequately splint the fragments


Dropped shoulder and Winged scapula
  • The position of the scapula on the posterior chest wall is maintained by the muscles there attached. If the muscles are paralysed, there is an imbalance.

  • In paralysis of the trapezius, the scapula drops (dropped shoulder), while in paralysis of serratus anterior, the scapula sticks out of the chest wall especially when reaching out or pushing. This is called “winged” scapula.

Low back Pain  

Pain in the lumbar region

A common cause of disability

Common causes

  1. Prolapsed Intervertebral disc
  2. Osteoarthritis
  3. Ligamentous strains
  4. Muscle spasms

Prolapsed IVD

Occurs more commonly in the lumbar region due to weight

Commonest direction is posterolateral because

  • The annulus fibrosus is thinner posteriorly
  • Central part is strengthened by the posterior longitudinal ligament

This herniation compresses the spinal nerves leading to pain in the area of distribution of the nerve e.g. sciatica: Pain in the region of distribution of sciatic nerve

Severe prolapsed disc can narrow the vertebral canal (spinal stenosis) thus compressing the spinal cord

Ligamentous Strains

Overstretching of the vertebral ligaments can cause back pain

The posterior ones are usually more commonly involved

Muscle Spasms
Spasms of intrinsic muscles of the back e.g. multifidus, rotatores and transverso spinalis as well as the long erector spinae will cause back pain.

Abnormal Curvatures

Lordosis: Exaggerated lumbar curve

Scoliosis: Lateral curvature of spine associated with hemi-vertebrae, poor posture, over-weight

Kyphosis: Exaggerated thoracic curvature frequently seen in TB spine

Traumatic Back Disorders

Fracture- dislocation of vertebrae are more liekely to occur in the mobile segments e.g. lumbar and cervical

Congenital disorders

  • Hemi-vertebrae
  • Spina bifida

Back Stiffness

Can be caused by

  • Muscle spasms
  • Ligamentous destruction
  • Fascial tightening
  • Neurological disorders

Degenerative Back Disorders


  • Osteoarthritis
  • Ligamentous ossification

Back and Scapula Region