上肢局部解剖学Theupperlimb

1、The muscles of back Superficial group nTrapezius 斜方肌斜方肌 nLatissimus dorsi 背阔肌背阔肌 nLevator scapulae 肩胛提肌肩胛提肌 nRhomboideus菱形肌菱形肌 Deep group nErector spinae 竖脊肌竖脊肌 nSplenius 夹肌夹肌 nThoracolumbar fascia 胸腰胸腰 筋膜筋膜 The muscles of thorax Extrinsic muscles nPectoralis major 胸大肌胸大肌 nPectoralis minor 胸小肌胸小肌 nS

2、erratus anterior 前锯肌前锯肌 Intrinsic muscles nIntercostales externi 肋间外肌肋间外肌 nIntercostales interni 肋间内肌肋间内肌 nIntercostales intimi 肋间最内肌肋间最内肌 Major muscles of the trunk Trapezius nOrigin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical

3、and all thoracic vertebrae nInsertion: lateral third of clavicle, acromion, and spine of scapulartery nActon: upper fibers elevate scapula, lower fibers depress scapula; if scapula is fixed, one side acting along, draws head toward the same side, and turn face to opposite side; both sides together,

4、draw head directly backward Latissimus dorsi nOrigin: spinous processes of lower six thoracic and all lumbar vertebrae, median sacral crest, and posterior part of iliac crest. nInsertion: floor of intertubercular groove of humerus. nAction: trunk fixed, extends, adducts and medially rotates arm ; ar

5、m fixed, elevates trunk. Erector spinae n Position: fills the vertebral groove on each side of the spine n Action: extends vertebral column (draw head backwar) Pectoralis major nOrigin: medial half of clavicle,sternum,1th-6th costal cartilages. nInsertion: crest of greater tubercle of humerus. nActi

6、on: flexes, adducts and rotates arm medially; arm fixed, elevates trunk; elevates ribs 1-6,aidding in forced inspiration. The Muscles of Upper Limb Muscles of shoulder nDeltoid nsupraspinatus nInfraspinatus nTeres minor nTeres major nsubscapularis Muscles of arm nAntererior group qBiceps brachii 肱二头

7、肌肱二头肌 qCoracobrachialis 喙肱肌喙肱肌 qBrachialis 肱肌肱肌 nPosterior group triceps brachii 肱三头肌肱三头肌 Muscles of forearm nSuperficial layer qBrachioradialis 肱桡肌肱桡肌 qPronator teres 旋前圆肌旋前圆肌 qFlexor carpi radialis 桡侧腕屈肌桡侧腕屈肌 qPalmaris longus 掌长肌掌长肌 qFlexor carpi ulnaris 尺侧腕屈肌尺侧腕屈肌 nThird layer qFlexor digitorum p

8、rofundus 指深屈肌指深屈肌 qFlexor pollicis longus 拇拇 长屈肌长屈肌 nFourth layer pronator quadratus 旋前方肌旋前方肌 Action: flex radiocarpal joint and fingers, pronate forearm nSecond layer flexor digitorum superficials 指浅屈肌指浅屈肌 Posterior group (10) nSuperficial layer (5) qExtensor carpi radialis longus 桡侧腕长伸肌桡侧腕长伸肌 qExt

9、ensor carpi radialis brevis 桡侧腕短伸肌桡侧腕短伸肌 qExtensor digitorum 指指 伸肌伸肌 qExtensor digiti minimi 小指伸肌小指伸肌 qExtensor carpi ulnaris 尺侧腕屈肌尺侧腕屈肌 Deep layer (5) nSupinator旋后肌旋后肌 nAbductor pollicis longus 拇长展肌拇长展肌 nExtensor pollicis brevis拇拇 短伸肌短伸肌 nExtensor pollicis longus 拇长伸肌拇长伸肌 nExtensor indicis 示示 指伸肌指伸

10、肌 nAction: extend radiocapral joint and fingers, and supinate forearm Muscles of hand nLateral groupthenar 鱼际鱼际 (4) qAbductor pollicis brevis拇短展肌拇短展肌 qFlexor pollicis brevis 拇短屈肌拇短屈肌 qOpponens pollicis 拇对掌肌拇对掌肌 qAdductor pollicis 拇收肌拇收肌 nAction: flex, abduct, adduct and oppose thumb nMedial grouphyp

11、othenar (3) qAbductor digiti minimi 小指展肌小指展肌 qFlexor digiti minimi brevis小指短屈小指短屈 肌肌 qOpponens digiti minimi小指对掌肌小指对掌肌 nAction: flex, abduct , and oppose little finger Intermedial group nLumbricales 蚓状肌蚓状肌(4) flex fingers at MP joints; extend fingers at IP joints nPalmar interossei 骨间掌骨间掌 侧肌侧肌(3) ad

12、duct fingers towards middle finger at MP joints nDorsal interossei 骨间背侧骨间背侧 肌肌(3)abduct fingers away from middle finger at MP joints Major muscles of upper limb Deltoid nOrigin: lateral third of clavicle, acromion, and spine of scapula nInsertion: deltoid tuberosity of humerus nAction: abducts，flexe

13、s and medically rotates, extends, and laterally rotates arm Teres major nOrigin: dorsal surface of inferior angle of scapula nInsertion: crest of lesser tubercle of humerus nAction: medially rotates and adducts arm Biceps brachii nOrigin: long head, supraglenoid tubercle; short head, coracoid proces

14、s nInsertion: radical tuberosity nAction: supinator of forearm, flexor of elbow joint, weak flexor of should joint Pronator teres nOrigin: medical epicondyle of humerus and deep fascia of forearm nInsertion: middle of lateral surface of radius nAction: pronation of forearm and flexion of elbow Trice

15、ps brachii nOrigin: long head, infraglenoid tubercle; lateral head, above groove for radical n., medical head, below groove for radical n. nInsertion: olecranon of ulna nAction: extends elbow joint), long head can extend and adduct shoulder joint Supinator nOrigin: lateral epicondyle of humerus and

16、upper part of lateral border of ulna nInsertion: upper third of anterior surface of radius nAction: supination of forearm Arteries of upper limb Axillary artery nContinuation of subclavian artery at lateral border of first rib nBecomes brachial artery at lower border of teres major nDivided into thr

17、ee parts by overlying pectoralis minor qFirst portion, above musclegives rise to thoracoacromial a. 胸肩峰动脉胸肩峰动脉 qSecond portion, behind musclegives rise to lateral thoracic a. 胸外侧动脉胸外侧动脉 qThird portion, below musclegives rise to subscapular a. 肩胛下动脉肩胛下动脉, anterior and posterior humeral circumflex a.

18、旋肱前、后动脉旋肱前、后动脉; the former then divides into throcodorsal a. 胸背动脉胸背动脉 and circumflex scapular a. 旋肩胛动脉旋肩胛动脉 Brachial artery nContinuation of axillary artery nDivides into radial and ulnar arteries at level of neck of radius nBranches qDeep brachial a. 肱深动脉肱深动脉 accompanies with radial nerve qSuperior

19、 ulnar collaeral a. 尺侧上副动脉尺侧上副动脉 accompanies with ulnar nerve qInferior ulnar collateral a. 尺侧下副动脉尺侧下副动脉 Radial artery and branches nRadial recurrent a. 桡侧返动脉桡侧返动脉 nSuperfical palmar branch 掌浅支掌浅支 nPrincipal artery of thumb 拇主要动脉拇主要动脉 Ulnar artery and branches nUlnar recurrent a. 尺侧返动脉尺侧返动脉 nCommon

20、interosseous artery 骨间总动脉骨间总动脉 qAnterior interossous a. 骨间前动脉骨间前动脉 qPosterior interosseous a. 骨间后动脉骨间后动脉 nDeep palmar branch 掌深支掌深支 Superficial palmar arch 掌掌 浅弓浅弓 nFormed by ulnar artery and superficial palmar branch of radial artery nCurve of arch lies across the palm, level with the distal border

21、 of fully extended thumb nGives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries Deep palmar arch 掌深弓掌深弓 nFormed by radial artery and deep palmar branch of ulnar artery nCurve of arch lies across upper part of palmar at level with proximal border

22、 of extended thumb nGives rise to three palmar metacarpal arteries Veins of the upper limb Deep veins: accompany the arteries of the same region and bear similar names Superficial veins nCephalic vein 头静脉头静脉 qArises from the lateral side of the dorsal venous rete of hand qAscends on radial side of t

23、he forearm to the elbow and then in the lateral side of biceps brachii furrow, continues up the arm in the deltopectoral groove and then to the infraclavicular fossa, where it pierces clavipectoral fascia to drain into axillary vein nBasilic vein 贵要静脉贵要静脉 qArises from the medial side of the dorsal v

24、enous rete of hand qAscends on the ulnar side of forearm to the elbow and then in the medial bicepital brachii furrow to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary vein nMedian cubital vein 肘正中静肘正中静 脉脉 links cephalic vein and basilic vein in the cubita

25、l fossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood The lymphatic drainage of upper limb Lymphatic vessels nSuperficialfollow the superficial veins, drain into supratrochlear and axillary lymph nodes nDeepaccompany main vessels, end in axillary lymph

26、 nodes lymph nodes nCubital lymph node: lies above medial epicondyle of humerus nAxillary lymph nodearranged in five groups Axillary lymph nodes腋淋巴结腋淋巴结 arranged in five groups nLateral lymph nodes 外侧淋巴结外侧淋巴结 lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and

27、hand nPectoral lymph nodes 胸肌淋巴结胸肌淋巴结 lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma nSubscapular lymph node 肩胛下淋肩胛下淋 巴结巴结along subscapular vessels, receive lymph from nape and scapular region nEfferents above three gr

28、oups pass to central lymph node nCentral lymph node中央淋巴中央淋巴 结结lie in fat of axillary fossa, receive drainage from all the above nodes, efferents pass to apical lymph node nApical lymph node 尖淋巴结尖淋巴结 qLie in the apex of the axilla, along the proximal end of axillary vessels qReceive drainage chiefly

29、from central lymph node , upper portion of mamma qEfferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct Brachial plexus 臂丛臂丛 Formation: nFive roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5C

30、7give rise to long thoracic n.胸长神经胸长神经 nThree trunks qThe upper trunk is formed by the joining of root C4,C5,C6. qThe middle trunk is the continuation of root C7. qThe lower trunk is formed by the joining of root C8 and T1. nSix divisions: above clavicle, trunks form anterior and posterior divisions

31、 nThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a. Position: passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cords Main branches nLateral cord qMusculocutan

32、eous n. 肌皮神经肌皮神经 qLateral root to median n. 正中神经外侧正中神经外侧 根根 nMedial cord qMedial root to median n. 正中神经内侧根正中神经内侧根 qUlnar n. 尺神经尺神经 qMedial brachial cutaneous n.臂内侧皮臂内侧皮 神经神经 qMedial antebrachial cutaneous n. 前臂内侧皮神经前臂内侧皮神经 nPosterior cord qradial n. 桡神经桡神经 qaxillary n. 腋神经腋神经 qthoracodorsal n. 胸背胸背

33、神经神经 nMusculocutaneous 肌皮神经肌皮神经 Distribution: Biceps brachii, brachalis and coracobrachialis BBC nerve; skin on anterior aspect of forearm nMedian 正中神经正中神经 qDistribution: Flexor of forearm except brachioradialis, flexor carpi ulnaris and ulnar half of flexor digitorum profundus, thenar except adduct

34、or pollicis, first two lumbricals; skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum qInjury: Apehand 猿手 produces sign of benediction, in which the index and middle fingers cannot be flexed and the thumb cannot be

35、opposed nUlnar nerve qDistribution: Flexor carpi ulnaris, ulnar half of flexor digitorum profundus, hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ul

36、nar two and one-half fingers qInjury: clawhand nRadial 桡神经桡神经 qDistribution: Extensor muscles of arm and forearm, brachioradialis; skin on back of arm, forearm, and radial side of dorsum of hand and radial two and one-half fingers qInjury: Wristdrop nAxillary 腋神经腋神经 qDistribution: Deltoid and teres

37、minor muscle; skin over deltoid and upper posterior aspect of arm qInjury: result in deltoid andteres minor paralysis (loss of shoulser abdution and weel external rotation) with loss of sensation over the deltoid Regional anatomy of upper limb 山东大学医学院山东大学医学院 解剖教研室解剖教研室 李振华李振华 Parts and regions nShou

38、lder regionjunction of arm and trunk nArmbetween should and elbow nElbowbend of arm, joint between arm and forearm nForearmbetween elbow and hand nHand Surface anatomy nShoulder region: acromion, spine of scapula, coracoid process, greater tubercle, anterior and posterior axillary folds nArmmedial a

39、nd lateral biceps brachii furrow, deltoid tuberosity nElbowmedial and lateral epicondyles, head of radius, olecranon, tendon of biceps brachii nForearmbetween elbow and hand nHandstyloid process, dorsal tubercle Anatomical snuff box 鼻烟壶鼻烟壶 nWhen the thumb is abducted and extended, a triangular hollo

40、w appears between the tendon of the extensor pollicis longs medially and the tendons of the extensor pollicis brevis and abductor pollicis longus laterally. nThe floor of the snuff box is the scaphoid and trapezium bones and crossed by the radial a. 16501700 Carring angle 提携角提携角 Mamma 乳房乳房 Position

41、nLie in superficial fascia over the pectorals major and pectoral fascia nExtend from 3rd to 7th ribs vertically, and from parasternal line to midaxillary line transversally Structurescontains skin, mammary glands and adipose tissue nEach brest has about 15 20 lobes of mammary gland nEach lobe radiat

42、es out from the nipple and has a lactiferous duct输乳管输乳管 which opens separately on the summit of the nipple and possesses a dilated lactiferous sinuses输乳管输乳管 窦窦 just prior to its termination nSuspensory ligaments of breast乳房悬韧带乳房悬韧带 (coopers ligaments ) strands of connective tissue runs between skin

43、and deep fascia and serve to support the mammary glands Axillary fossa 腋窝腋窝 nThe axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity Boundaries nThe apex is a triangular space limited by the first rib, the scapula, and the

44、 middle third of clavicle. nThe baseskin and fascia of the axillary fossa nThe anterior wall qPectoralis major, pectoralis minor and subclavius muscles qClavipectoral fascia 锁胸筋膜锁胸筋膜 nThe deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles nThe structures pass

45、 through the clavipectoral faxcia qCephalic v. qThoracoacromial a. qLateral pectoral n. nThe posterior wallteres major, latissimus dorsi, subscapularis and scapula Trilateral and quadrilateral foramina 三边孔和四边孔三边孔和四边孔 nBetween the subscapularis and teres major, there is a long triangular space whose

46、lateral side is surgical neck of humerus. The long head of triceps brachii subdivides this space into a medial trilateral foramen and a lateral quadrilateral foramen. nThe posterior humeral circumflex a. and axillary n. pass through the quadrilateral foramen. nThe circumflex scapular a. passes throu

47、gh the triangular space to reach the dorsum of the scapula. nThe broad medial wallserratus anterior，intercostal muscles and upper four ribs nThe narrow lateral wallcoracobrachialis, biceps brachii and intertubercular groove Contents Brachial plexus, axillary a. and principal branches, axillary v. an

48、d tributaries, axillary lymph nodes and loose connective tissue Brachial plexus 臂丛臂丛 Formation: nFive roots: formed by anterior rami of C5- C8 and T1 spinal nerves, roots C5 C7give rise to long thoracic n.胸长神经胸长神经 nThree trunks qThe upper trunk is formed by the joining of root C4,C5,C6. qThe middle

49、trunk is the continuation of root C7. qThe lower trunk is formed by the joining of root C8 and T1. nSix divisions: above clavicle, trunks form anterior and posterior divisions nThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a. Position: passes th

50、rough the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cords Main branches nLateral cord qMusculocutaneous n. 肌皮神经肌皮神经 qLateral root to median n. 正中神经外侧根正中神经外侧根 nMedial cord qMedial root to median n. 正中神经内侧根正中神经内侧根 qUlnar n. 尺神

51、经尺神经 qMedial brachial cutaneous n.臂内侧皮神经臂内侧皮神经 qMedial antebrachial cutaneous n. 前臂内侧皮神经前臂内侧皮神经 nPosterior cord qradial n. 桡神经桡神经 qaxillary n. 腋神经腋神经 qthoracodorsal n. 胸背神经胸背神经 nAxillary sheath 腋鞘腋鞘 extension of deep cervical fascia of the neck, forming a tubular sheath that surrounds axillary a. an

52、d v., and brachial plexus Axillary artery nContinuation of subclavian artery at lateral border of first rib nBecomes brachial artery at lower border of teres major nDivided into three parts by overlying pectoralis minor qFirst portion, above musclegives rise to thoracoacromial a. 胸肩峰动脉胸肩峰动脉 qSecond

53、portion, behind musclegives rise to lateral thoracic a. 胸外侧动脉胸外侧动脉 qThird portion, below musclegives rise to subscapular a. 肩胛下动脉肩胛下动脉, anterior and posterior humeral circumflex a. 旋旋 肱前、后动脉肱前、后动脉; the former then divides into throcodorsal a.胸背动脉胸背动脉 and circumflex scapular a. 旋肩胛动脉旋肩胛动脉 Axillary ly

54、mph nodearranged in five groups nLateral lymph nodeslie around the distal end of axillary artery vein , receive afferent vessels from upper limb. nPectoral lymph nodeslie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma nSub

55、scapular lymph nodealong subscapular vessels, receive lymph from nape and scapular region nEfferents above three groups pass to central lymph node nCentral lymph nodelie in fat of axillary fossa, receive lymph from all the above nodes, efferents pass to apical lymph node nApical lymph nodelie in the

56、 apex of the axilla, along the proximal end of axillary vessels, receive afferents chiefly from central lymph node , upper portion of mamma; efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct Cubiral fossa 肘窝肘窝

57、 Boundaries nBaseline drawn through epicondyles of humerus nApexbrachioradialis laterally and pronator teres medially nRoofskin, superficial faxcia, deep faxcia and aponeurosis of biceps nFloorbrachialis, supinator and capsule of elbow joint Contentsfrom lateral to medial nBiceps brachii tendon nBra

58、chial a.divides into radial and ulnar a.,usually at apex of fossa nMedian n. Lateral to the biceps brachii tendonradial n. and lateral antebrachial cutaneous n. Carpal tunnel 腕管腕管 Flexor retinaculum nThickening of deep fascia in the hand nAttached laterally to scaphoid and trapeziun and medially to

59、pisiform and hamate nForm an osseofibrous tunnel (carpal tunnel) with carpal groovetransmits median n., flexor digitorum supericialis, flexor digitorum profundus, and flexor pollicus longus from forearm into hand Common flexor sheath Teninous sheath of flexor pollicis longus Skin incisions Cephalic

60、v. Lateral cutaneous branch Anterior cutaneous branch Superficial fascia Clavipectoral fascia 锁胸筋膜锁胸筋膜 nThe deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles nThe structures pass through the clavipectoral faxcia qCephalic v. qThoracoacromial a. qLateral pect