肩关节解剖课件

1、Shoulder Anatomy bones 骨骼: Sternum胸骨Costae肋骨Clavicle锁骨Scapula肩胛骨humerus 肱骨Shoulder Anatomy bones 骨骼: 肩关节解剖课件The ribThe ribThe sternum The sternum The humerusThe humerusPosterior view of the scapula 1.coracoid process喙突2.acromion肩峰3.glenoid关节窝4.infraspinal fossa冈上窝5.scapular spine肩胛冈6.supraspinal fos

2、sa冈下窝Posterior view of the scapula肩关节解剖课件Anterior view of the scapula 1. Acromion肩峰2.coracoid process喙突3.glenoid fossa关节窝4. subscapular fossa 肩胛下窝Anterior view of the scapula 肩关节解剖课件肩关节解剖课件 The clavicleTrapezoid line 斜方线Conoid tubercle 锥状结节Tuberosity for costoclavicular ligament肋锁韧带压迹 The clavicleTr

3、apezoid line 斜方Anatomy- joints Joints:1The glenohumeral joint ：盂肱关节2The acromioclavicular joint ：肩锁关节3The sternoclavicular joint ：胸锁关节4The subacromial joint ：肩峰下关节囊 subacromial gliding mechanism肩峰下滑动机制5The scapulothoracic gliding mechanism 肩胛胸廓关节6the Coracoclavicular joint 喙锁关节Anatomy- joints Joints

4、:肩关节解剖课件ligamentTransverse scapular ligament 肩胛横韧带Coracoclavicular ligament 喙锁韧带 （斜方韧带、锥状韧带）Coracoacromial ligament 喙肩韧带Acromioclavicular ligament 肩锁韧带Glenohumeral ligaments 盂肱韧带ligamentTransverse scapular liAnterior sternoclavicular ligament 胸锁韧带Costoclavicular ligament 肋锁韧带Anterior sternoclavicula

5、r liga盂肱关节glenohumeral joint由肩胛骨的关节盂与肱骨头连接而成的球窝关节肱骨头垂直直径比前后直径长3-4cm.肱骨头轴与肱骨干成135度，与冠状面呈30度。肱骨外展90度时，肩关节最稳当。盂肱关节glenohumeral joint由肩胛骨的关节盂肱关节glenohumeral joint盂肱韧带：盂肱上韧带、盂肱中韧带、盂肱下韧带肩外展：盂肱中韧带和盂肱下韧带紧张肩外旋：盂肱韧带3条拉紧喙肱韧带：前束止于肱骨小结节，后束止于肱骨大结节肩伸展：喙肱韧带前束拉紧肩屈曲：喙肱后束拉紧盂肱关节glenohumeral joint盂肱韧带：盂肱肩关节解剖课件肩峰下关节 sub

6、acromial joint 喙突肩峰弓与肩峰下滑液囊之间的机能关节。其构成有大结节、腱板、肩峰下滑液囊、肩峰、喙肩韧带、喙突。喙突肩峰弓有防止肱骨头向上方移动及滑轮作用。肩峰下滑液囊的机能是缓冲压力。肩峰下关节 subacromial joint 喙突肩峰弓肩胛胸廓关节 scapulothoracic gliding mechanism 假关节，没有关节软骨，由肩胛骨和胸廓肋骨两个平面组成。有2个滑动空间。肩胛胸廓关节 scapulothoracic glidin肩关节解剖课件肩锁关节 acromioclavicular joint由肩峰与锁骨远端部所构成的半关节，借关节囊、肩锁韧带、三角肌

7、、斜方肌腱附着部和喙锁韧带（锥状韧带及斜方韧带）等组织连接而成主要参与肩关节的屈伸运动肩锁关节 acromioclavicular joint由肩关节解剖课件喙锁机制 the Coracoclavicular joint也称为第2肩锁关节，支持肩锁关节。由喙锁骨韧带来保持肩锁关节，支撑肩胛骨，产生锁骨与肩胛骨间的运动传导。喙锁机制 the Coracoclavicular joi胸锁关节 sternoclavicular joint 胸骨与锁骨的近端部所构成的鞍状关节，关节内有关节盘。由锁骨内端、胸骨柄的锁骨切迹与第一肋骨间所形成，被关节囊及韧带围绕固定，其中包括胸锁前、后韧带以及与对侧锁骨相

8、连的锁骨内韧带，减少肩肱关节活动时对胸骨的震荡，制止锁骨向内滑脱和调节关节旋转活动的功能胸锁关节 sternoclavicular joint 胸肩关节解剖课件Shoulder muscles origins and insertionsShoulder muscles origins and i肱二头肌biceps始点：长头起于盂上结节 短头起于喙突止点：桡骨粗隆作用：屈肘协助曲臂，当前臂处于旋前位时，使前臂旋后神经支配：肌皮神经c5-7肱二头肌biceps始点：长头起于盂上结节肱三头肌Triceps始点：长头起于盂下结节 内侧头起于肱骨后表面 外侧头起于肱骨大结节后外侧止点：尺骨鹰嘴作用：

9、伸肘，助肩关节后伸及内收（长头）神经支配：桡神经C5-C7肱三头肌Triceps始点：长头起于盂下结节喙肱肌coracobrachialis始点：肩胛骨喙突止点：肱骨内侧中部作用：外展屈曲肱骨，防止 肩关节向下滑脱神经支配：肌皮神经C6-C7喙肱肌coracobrachialis始点：肩胛骨喙突三角肌Deltoid始点：前束至锁骨外侧1/3； 中束至肩峰外侧缘； 后束至肩胛冈下缘。止点：肱骨三角肌粗隆作用：外展、屈曲、伸展和旋转上臂。神经支配：腋神经c4-6三角肌Deltoid始点：前束至锁骨外侧1/3； 大圆肌teres major始点：肩胛骨下角和外侧缘1/3.止点：肱骨二头肌间沟内侧缘作

10、用：内收和伸展上臂并使上臂内旋神经支配：肩胛下神经c6-7大圆肌teres major始点：肩胛骨下角和外侧缘1/3背阔肌latissimus dorsi始点：下5-6个胸椎和腰椎的棘突，骶骨上嵴中间和髂嵴外缘。止点：肱骨二头肌间沟内侧缘作用：内收上臂并使上臂内旋并伸展神经支配：胸背神经c6-8背阔肌latissimus dorsi始点：下5-6个胸椎小菱形肌和大菱形肌Rhomboid minor and Rhomboid major小菱形肌始点：第6-7颈椎棘突止点：肩胛骨上方内侧缘大菱形肌始点：1-4颈椎棘突和棘上韧带止点：肩胛骨下方内侧缘作用：将肩胛骨拉向脊柱；小菱形肌也将肩胛骨稍向上拉

11、。神经支配：肩胛背神经c5小菱形肌和大菱形肌Rhomboid minor and R肩胛提肌Levator scapulae始点：1-4颈椎横突后结节止点：肩胛骨上角作用：提高肩胛骨神经支配：肩胛背神经c3-4肩胛提肌Levator scapulae始点：1-4颈椎横斜方肌trapezius上斜方肌始点：上项线、项韧带和C1-5棘突止点：锁骨外1/3中斜方肌始点：C6-T3棘突和棘上韧带止点：肩胛骨肩峰和肩胛冈上部下斜方肌始点：T4-T12棘突和棘上韧带止点：肩胛嵴内侧缘接近肩胛提肌下方作用：提高肩胛骨，向上方旋转；使肩胛骨回缩；压低肩胛骨；伸展头和颈部；转动头和颈部。神经支配：颈丛C3-C4

12、臂丛C5-T1胸神经T2-T12斜方肌trapezius上斜方肌锁骨下肌Subclavius始点：第一肋骨止点：锁骨肩峰端下表面作用：固定锁骨或抬高第一肋骨，帮助肩胛骨伸展，将肩部向下向前拉神经支配：锁骨下神经C5-C6锁骨下肌Subclavius始点：第一肋骨胸锁乳突肌sternocleidomastoid始点：乳突外侧面和枕骨上项线外1/2止点：胸骨部分至胸骨柄前表面锁骨部分至锁骨前表面的内1/3作用：稳固头和颈；防止颈部过度伸展和头向后运动，弯曲颈部，参与吞咽和呼吸。神经支配：颈丛神经C2-C3胸锁乳突肌sternocleidomastoid始点：胸小肌Coracoid process始

13、点：至第3-5肋肋骨与肋软骨连接处。止点：喙突顶部作用：旋转肩胛骨并将它上拉，上抬肋骨。神经支配:胸前神经C6-C8胸小肌Coracoid process始点：至第3-5肋肋胸大肌pectoralis major始点：锁骨内侧1/2,胸骨柄胸骨体；第一到第六肋软骨前表面，腹部至腹外斜肌腱膜止点：肱二头肌沟的外侧缘作用：内收、屈曲、内旋上臂神经支配：正中神经C8-T1，胸外侧神经C5-7，锁骨部C5-6，胸肋部C7-T1，胸大肌表面皮肤是T2-T6胸大肌pectoralis major始点：锁骨内侧1/2前锯肌serratus anterior始点：1-8/9肋骨侧面中心止点：肩胛骨上角和下角以

14、及结余其间的内侧缘作用：旋转肩胛骨并使其向前拉，抬高肋骨。神经支配：胸长神经C5-C7前锯肌serratus anterior始点：1-8/9肋冈上肌Supraspinatus始点：肩胛骨冈上窝止点：肱骨大结节作用：发动上臂外展神经支配：肩胛上神经C5-C6冈上肌Supraspinatus始点：肩胛骨冈上窝肩胛下肌Subscapularis始点：肩胛下窝止点：肱骨小结节作用：内旋上臂神经支配：肩胛下神经c5-7肩胛下肌Subscapularis始点：肩胛下窝冈下肌Infraspinatus始点：肩胛骨冈下窝止点：肱骨大结节作用：伸展上臂并使其向外旋转神经支配：肩胛上神经c5-6冈下肌Infra

15、spinatus始点：肩胛骨冈下窝小圆肌Teres minor始点：肩胛骨外侧缘上2/3止点：肱骨大结节作用：外展上臂并外旋神经支配：腋神经c5-6小圆肌Teres minor始点：肩胛骨外侧缘上2/3Nerve Root Supply to Muscles of the ShoulderMusclesNerve RootPectoralis major胸大肌Pectoralis minor胸小肌Deltoid三角肌Supraspinatus冈上肌Infraspinatus冈下肌Teres minor 小圆肌Subscapularis 肩胛下肌Trapezius XI斜方肌Serratus a

16、nterior前锯肌Latissimus dorsi背阔肌Teres major大圆肌Levator scapulae肩胛提肌Rhomboid major大菱形Rhomboid minor小菱形肌Coracobrachialis喙肱肌Biceps brachii肱二头肌Triceps brachii C肱三头肌C5, C6, C7, C8, T1C7, C8, T1C5, C6C5, C6C5, C6C5, C6C5，C6,C7C5, C6, C7C6, C7, C8C6, C7, C8C5, C6C3, C4 C5C5C5, C6, C7C5, C6C6, C7, C8Nerve Root

17、Supply to Muscles o 肩胛骨的运动与肌肉肩关节运动与肌肉上提：斜方肌上部、菱形肌、肩胛提肌下降：斜方肌下部、胸小肌、锁骨下肌(补充)背阔肌、胸大肌内收：菱形肌、斜方肌，肩胛 提肌外展：前锯肌、胸小肌(补充)胸大肌上方旋转：前锯肌、斜方肌上部下部下方旋转：菱形肌、胸小肌(补充)肩胛提肌。屈曲：三角肌前部、胸大肌锁骨部、(补)喙肱肌、肱二头肌短头(外旋位)伸展：三角肌后部、背阔肌、大圆肌、(补)肱三头肌长头(内旋位)外展：冈上肌、三角肌中部、(补)肱=头肌长头(外旋位)、脓三肌长头(内旋位内收：胸大肌、背阔肌、大圆肌、(补)三角肌后部外旋：冈下肌、小圆肌、(补)三角肌后部内旋：胸

18、大肌、肩胛下肌、大圆肌、背阔肌、(补)三角肌前部环转运动：屈伸、内收外展及内外旋的复合运动。 肩胛骨的运动与肌肉肩关节运动与肌肉上提：斜方肌上部、菱形肌Anterior view of the bursae of the shoulder:Subdeltoid bursadeltoid musclesubscapularis muscle4. Subcoracoid bursa.Anterior view of the bursae of肩关节解剖课件Impingement撞击综合征Supraspinatus冈上肌Long head of biceps肱二头肌长头Common activity

19、 1. competitive swimmer游泳选手 2. crutch-walking 拐杖行走 3. transfer转换体位（活动不便）Impingement撞击综合征Supraspinatus The anterior scapulohumeral region1. subclavian artery锁骨下动脉;suprascapular artery and nerve 肩胛骨上动脉和神经; 3. axillary nerve腋神经; 4. radial nerve桡神经;5. subscapularis nerve肩胛下神经6. pectoralis minor muscle胸小

20、肌7. subscapularis muscle;肩胛下肌8. teres major muscle大圆肌9. latissimus dorsi muscle背阔肌 The anterior scapulohumeral r肩关节解剖课件肩关节解剖课件肩关节解剖课件肩关节解剖课件四方形旋肱后动脉旋肩胛动脉肋间后动脉肩胛上动脉四方形旋肱后动脉旋肩胛动脉肋间后动脉肩胛上动脉四方形旋肱后动脉旋肩胛下血管肱深动脉四方形旋肱后动脉旋肩胛下血管肱深动脉肩胛带运动Shoulder girdle movementsSternoclavicular胸锁关节,acromioclavicular 肩锁关节and s

21、capulothoracic joints肩胛胸廓Elevation上提 60 肩锁Depression下抑 5 to 1012cm Protraction前伸 胸锁Retraction 回缩 totally 2512cm Upward rotation 上旋 Downward rotation 下旋 totally 60肩胛带运动Shoulder girdle movement肩关节解剖课件肩胛带运动肌群控制MovementRetraction回缩Protraction前伸Elevation上提Depression下抑Lateral rotation外旋Medial rotation内旋Mu

22、sclesRhomboid major and minor Trapezius 菱形肌和斜方肌Serratus anterior Pectoralis minor 前锯肌和胸小肌Trapezius (upper fibres) Levator scapulae 上斜方肌和肩胛提肌Pectoralis minor Trapezius (lower fibres) 胸小肌和下斜方肌Trapezius Serratus anterior 斜方肌、前锯肌Rhomboid major and minor Levator scapulae Pectoralis minor 菱形肌、肩胛提肌、胸小肌肩胛带运

23、动肌群控制MovementRetraction回缩M肩关节运动肩关节运动concavity compression the rotator cuff musclesand the biceps compress the humeral head into theglenoid fossa, locking it into position and providing asecure scapulohumeral link for upper extremity functionconcavity compression the rotaThe flexors of the shoulder肩部

24、屈曲Muscle Nerve Spinal nerve root Coracobrachialis 喙肱肌 Musculocutaneous 肌皮神经 C5, C6Pectoralis major胸大肌 Pectoral胸神经 C5C8Deltoid (anterior portion) 前三角肌 Axillary腋神经 C5 (C6)Subscapularis肩胛下肌 Subscapular 肩胛下神经 C5C8Biceps brachii肱二头肌 Musculocutaneous 肌皮神经 C5, C6The flexors of the shoulder肩部Muscles used in

25、 medial rotation内旋肌群1. subscapularis2. pectoralis major3. latissimus dorsi4. teres majorMuscles used in medial rotatioThe medial rotators内旋Muscle Nerve Spinal nerve rootSubscapularis肩胛下肌 Subscapular肩胛下神经 C5C8Pectoralis major胸大肌 Pectoral 胸神经 C5C8Latissimus dorsi背阔肌 Thoracodorsal 胸背神经 C7 (C6, C8)Teres

26、 major 大圆肌 Subscapular肩胛下神经 C5C8The medial rotators内旋Muscle Rotator cuff muscles旋转套1.Supraspinatus2. Infraspinatus3. teres minorRotator cuff muscles旋转套1.SuprThe lateral rotators外旋 Muscle Nerve Spinal nerve root Infraspinatus肩胛下肌 Suprascapular 肩胛上神经 C5 (C6) Teres minor小圆肌 Axillary腋神经 C5 (C6)The later

27、al rotators外旋 MusThe adductors内收Muscle Nerve Spinal nerve root Pectoralis major胸大肌 Pectoral 胸神经 C5C8Latissimus dorsi背阔肌 Thoracodorsal胸背神经 C7 (C6, C8)Teres major大圆肌 Subscapular肩胛下神经 C5C8Teres minor 小圆肌 Axillary腋神经 C5 (C6)The adductors内收Muscle The abductors外展Muscle Nerve Spinal nerve root Deltoid 三角肌

28、Axillary 腋神经 C5 (C6) Supraspinatus 冈上肌 Suprascapular 肩胛上神经 C5 (C6)The abductors外展Muscle The flexors of the elbow屈肘Muscle Nerve Spinal nerve root Biceps brachii 肱二头肌 Musculocutaneous 肌皮神经 C5, C6The flexors of the elbow屈肘MusThe extensors of the elbowMuscle Nerve Spinal nerve root Triceps Triceps肱三头肌 R

29、adial 桡神经 C7 (C6, C8)The extensors of the elbowMus盂肱关节运动机制肩关节周围肌群 横肌：使肱骨头压向关节盂纵肌：支撑上肢，防止手提重物时脱臼，将肱骨头拉向关节盂纵肌和横肌形成拮抗-协同作用纵肌对关节的对合起主导作用，长期作用会导致肱骨头和肩峰间起缓冲作用的肩袖劳损和撕裂，甚至引起肩袖肌肉撕裂，尤其是冈上肌，撞击肩峰下方和喙肩韧带，出现肩袖破裂综合征。盂肱关节运动机制肩关节周围肌群肩关节解剖课件肩关节外展3个阶段第一阶段：0-60度主要参与肌肉：三角肌、冈上肌由于肱骨大结节碰到关节盂上缘锁住，终止于90度，肱骨外旋和轻度屈曲使肱骨大结节后移延迟力学绞锁，结合屈曲30度。肩关节外展3个阶段第一阶段：0-60度肩关节外展第二阶段