局解上肢

1、The upper limb,山東大學(xué)醫(yī)學(xué)院 解剖教研室李振華,The muscles of back,Superficial groupTrapezius 斜方肌Latissimus dorsi 背闊肌Levator scapulae 肩胛提肌Rhomboideus菱形肌 Deep group Erector spinae 豎脊肌Splenius 夾肌Thoracolumbar fascia 胸腰筋膜,Th

2、e muscles of thorax,Extrinsic musclesPectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前鋸肌Intrinsic musclesIntercostales externi 肋間外肌Intercostales interni 肋間內(nèi)肌Intercostales intimi

3、 肋間最內(nèi)肌,,Major muscles of the trunk,Trapezius Origin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebraeInsertion:

4、lateral third of clavicle, acromion, and spine of scapularteryActon: 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

5、 to opposite side; both sides together, draw head directly backward,,Latissimus dorsiOrigin: spinous processes of lower six thoracic and all lumbar vertebrae, median sacral crest, and posterior part of iliac crest.Inse

6、rtion: floor of intertubercular groove of humerus.Action: trunk fixed, extends, adducts and medially rotates arm ; arm fixed, elevates trunk.,,Erector spinae Position: fills the vertebral groove on each side of the spi

7、ne Action: extends vertebral column (draw head backwar),,Pectoralis majorOrigin: medial half of clavicle,sternum,1th-6th costal cartilages.Insertion: crest of greater tubercle of humerus.Action: flexes, adducts and r

8、otates arm medially; arm fixed, elevates trunk; elevates ribs 1-6,aidding in forced inspiration.,The Muscles of Upper Limb,Muscles of shoulderDeltoidsupraspinatusInfraspinatusTeres minorTeres majorsubscapularis,,,,

9、Muscles of armAntererior groupBiceps brachii 肱二頭肌Coracobrachialis喙肱肌Brachialis 肱肌Posterior group – triceps brachii肱三頭肌,,,,Muscles of forearm,Superficial layerBrachioradialis 肱橈肌Pronator teres 旋前圓肌Flex

10、or carpi radialis 橈側(cè)腕屈肌Palmaris longus 掌長肌Flexor carpi ulnaris 尺側(cè)腕屈肌,,Third layerFlexor digitorum profundus 指深屈肌Flexor pollicis longus 拇長屈肌Fourth layer－ pronator quadratus 旋前方肌Action: flex radiocarpal joint and fi

11、ngers, pronate forearm,,,,Second layer－ flexor digitorum superficials 指淺屈肌,,,Posterior group (10)Superficial layer (5)Extensor carpi radialis longus 橈側(cè)腕長伸肌Extensor carpi radialis brevis 橈側(cè)腕短伸肌Extensor digi

12、torum 指伸肌Extensor digiti minimi 小指伸肌Extensor carpi ulnaris 尺側(cè)腕屈肌,,,Deep layer (5)Supinator旋后肌Abductor pollicis longus拇長展肌Extensor pollicis brevis拇短伸肌Extensor pollicis longus拇長伸肌Extensor indicis 示指伸肌

13、Action: extend radiocapral joint and fingers, and supinate forearm,,,Muscles of handLateral group－thenar 魚際 (4)Abductor pollicis brevis拇短展肌Flexor pollicis brevis 拇短屈肌Opponens pollicis 拇對掌肌Adductor pollicis 拇收肌Acti

14、on: flex, abduct, adduct and oppose thumbMedial group－h(huán)ypothenar (3)Abductor digiti minimi 小指展肌Flexor digiti minimi brevis小指短屈肌Opponens digiti minimi小指對掌肌Action: flex, abduct , and oppose little finger,,Interme

15、dial groupLumbricales 蚓狀肌(4)－flex fingers at MP joints; extend fingers at IP jointsPalmar interossei 骨間掌側(cè)肌(3)－ adduct fingers towards middle finger at MP jointsDorsal interossei 骨間背側(cè)肌(3)－abduct fingers away from middl

16、e finger at MP joints,,Major muscles of upper limb,DeltoidOrigin: lateral third of clavicle, acromion, and spine of scapulaInsertion: deltoid tuberosity of humerus Action: abducts，flexes and medically rotates, extends

17、, and laterally rotates arm,,Teres majorOrigin: dorsal surface of inferior angle of scapulaInsertion: crest of lesser tubercle of humerusAction: medially rotates and adducts arm,,Biceps brachiiOrigin: long head, supr

18、aglenoid tubercle; short head, coracoid processInsertion: radical tuberosityAction: supinator of forearm, flexor of elbow joint, weak flexor of should jointPronator teresOrigin: medical epicondyle of humerus and deep

19、 fascia of forearmInsertion: middle of lateral surface of radiusAction: pronation of forearm and flexion of elbow,,,Triceps brachiiOrigin: long head, infraglenoid tubercle; lateral head, above groove for radical n., m

20、edical head, below groove for radical n.Insertion: olecranon of ulnaAction: extends elbow joint), long head can extend and adduct shoulder joint,,SupinatorOrigin: lateral epicondyle of humerus and upper part of later

21、al border of ulnaInsertion: upper third of anterior surface of radiusAction: supination of forearm,Arteries of upper limb,Axillary artery Continuation of subclavian artery at lateral border of first ribBecomes brachi

22、al artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above muscle－gives rise to thoracoacromial a. 胸肩峰動脈Second portion, behind muscle－gives rise to lateral thora

23、cic a. 胸外側(cè)動脈Third portion, below muscle－gives rise to subscapular a. 肩胛下動脈, anterior and posterior humeral circumflex a. 旋肱前、后動脈; the former then divides into throcodorsal a. 胸背動脈 and circumflex scapular a. 旋肩胛動脈,,Brach

24、ial arteryContinuation of axillary arteryDivides into radial and ulnar arteries at level of neck of radiusBranches Deep brachial a. 肱深動脈－accompanies with radial nerveSuperior ulnar collaeral a. 尺側(cè)上副動脈－accompanies wi

25、th ulnar nerveInferior ulnar collateral a.尺側(cè)下副動脈,,Radial artery and branches Radial recurrent a. 橈側(cè)返動脈Superfical palmar branch 掌淺支Principal artery of thumb 拇主要動脈Ulnar artery and branchesUlnar recurrent a. 尺側(cè)返動脈Com

26、mon interosseous artery 骨間總動脈Anterior interossous a. 骨間前動脈Posterior interosseous a. 骨間后動脈Deep palmar branch 掌深支,,Superficial palmar arch 掌淺弓Formed by ulnar artery and superficial palmar branch of r

27、adial arteryCurve of arch lies across the palm, level with the distal border of fully extended thumb Gives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries,,Deep pa

28、lmar arch 掌深弓Formed by radial artery and deep palmar branch of ulnar arteryCurve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries,V

29、eins of the upper limb,Deep veins: accompany the arteries of the same region and bear similar names Superficial veinsCephalic vein 頭靜脈 Arises from the lateral side of the dorsal venous rete of hand Ascends on radial

30、 side of the 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 dr

31、ain into axillary vein,,Basilic vein 貴要靜脈Arises from the medial side of the dorsal venous rete of hand Ascends on the ulnar side of forearm to the elbow and then in the medial bicepital brachii furrow to middle of the

32、arm where it pierces the deep fascia and joins the brachial vein or axillary veinMedian cubital vein 肘正中靜脈 links cephalic vein and basilic vein in the cubital fossa. It is a frequent site for venipuncture to remov

33、e a sample of blood or add fluid to the blood,The lymphatic drainage of upper limb,Lymphatic vesselsSuperficial－follow the superficial veins, drain into supratrochlear and axillary lymph nodesDeep－accompany main vessel

34、s, end in axillary lymph nodes lymph nodesCubital lymph node: lies above medial epicondyle of humerusAxillary lymph node－arranged in five groups,,Axillary lymph nodes腋淋巴結(jié)－arranged in five groupsLateral lymph nodes 外

35、側(cè)淋巴結(jié)－ lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and handPectoral lymph nodes 胸肌淋巴結(jié)－lie along lateral thoracic vessels, receive afferents from anterior thoracic wall includ

36、ing central and lateral portion of mammaSubscapular lymph node 肩胛下淋巴結(jié)－along subscapular vessels, receive lymph from nape and scapular regionEfferents above three groups pass to central lymph node,,Central lymph node中央淋

37、巴結(jié)－lie in fat of axillary fossa, receive drainage from all the above nodes, efferents pass to apical lymph node Apical lymph node 尖淋巴結(jié)Lie in the apex of the axilla, along the proximal end of axillary vesselsReceive

38、 drainage chiefly from central lymph node , upper portion of mammaEfferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct,Brachial ple

39、xus 臂叢,Formation:Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5～C7give rise to long thoracic n.胸長神經(jīng)Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk i

40、s the continuation of root C7.The lower trunk is formed by the joining of root C8 and T1.Six divisions: above clavicle, trunks form anterior and posterior divisionsThree cords: below clavicle, divisions form three cor

41、ds 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 cordsMain bran

42、chesLateral cord Musculocutaneous n. 肌皮神經(jīng)Lateral root to median n. 正中神經(jīng)外側(cè)根Medial cord Medial root to median n. 正中神經(jīng)內(nèi)側(cè)根Ulnar n. 尺神經(jīng)Medial brachial cutaneous n.臂內(nèi)側(cè)皮神經(jīng)Medial antebrachial cutaneous n. 前臂內(nèi)

43、側(cè)皮神經(jīng),,Posterior cord radial n. 橈神經(jīng)axillary n. 腋神經(jīng)thoracodorsal n. 胸背神經(jīng),,Musculocutaneous 肌皮神經(jīng) Distribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm,,Median

44、正中神經(jīng)Distribution: Flexor of forearm except brachioradialis, flexor carpi ulnaris and ulnar half of flexor digitorum profundus, thenar except adductor pollicis, first two lumbricals; skin of thenar, central part of palm,

45、 palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum Injury: Apehand 猿手produces sign of benediction, in which the index and middle fingers cannot be flexed and the thumb ca

46、nnot be opposed,,,Ulnar nerve Distribution: Flexor carpi ulnaris, ulnar half of flexor digitorum profundus, hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surfa

47、ce of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar two and one-half fingersInjury: clawhand,,Radial 橈神經(jīng)Distribution: Extensor muscles of arm and forearm, brachioradialis; skin

48、 on back of arm, forearm, and radial side of dorsum of hand and radial two and one-half fingers Injury: Wristdrop,,,,,Axillary 腋神經(jīng) Distribution: Deltoid and teres minor muscle; skin over deltoid and upper poste

49、rior aspect of armInjury: 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,山東大學(xué)醫(yī)學(xué)院 解剖教研室李振華,Parts

50、and regions,Shoulder region－junction of arm and trunk Arm－between should and elbowElbow－bend of arm, joint between arm and forearmForearm－between elbow and handHand,Surface anatomy,Shoulder region: acromion, spine of

51、 scapula, coracoid process, greater tubercle, anterior and posterior axillary folds Arm－medial and lateral biceps brachii furrow, deltoid tuberosity Elbow－medial and lateral epicondyles, head of radius, olecranon, ten

52、don of biceps brachiiForearm－between elbow and handHand－styloid process, dorsal tubercle,,Anatomical snuff box 鼻煙壺When the thumb is abducted and extended, a triangular hollow appears between the tendon of the exten

53、sor pollicis longs medially and the tendons of the extensor pollicis brevis and abductor pollicis longus laterally. The floor of the snuff box is the scaphoid and trapezium bones and crossed by the radial a..,,,,,1650～1

54、700,Carring angle 提攜角,Mamma 乳房,PositionLie in superficial fascia over the pectorals major and pectoral fascia Extend from 3rd to 7th ribs vertically, and from parasternal line to midaxillary line transversally,,Structu

55、res－contains skin, mammary glands and adipose tissueEach brest has about 15～20 lobes of mammary glandEach lobe radiates out from the nipple and has a lactiferous duct輸乳管 which opens separately on the summit of the nipp

56、le and possesses a dilated lactiferous sinuses輸乳管竇 just prior to its termination,,Suspensory ligaments of breast乳房懸韌帶(cooper’s ligaments )－strands of connective tissue runs between skin and deep fascia and serve to suppo

57、rt the mammary glands,Axillary fossa 腋窩,The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity,,Boundaries The apex is a triangular space li

58、mited by the first rib, the scapula, and the middle third of clavicle. The base－skin and fascia of the axillary fossa,,The anterior wallPectoralis major, pectoralis minor and subclavius musclesClavipectoral fascia 鎖胸

59、筋膜The deep faxcia which extends between subclavius, coracoid process and pectoralis minor musclesThe structures pass through the clavipectoral faxciaCephalic v.Thoracoacromial a.Lateral pectoral n.,,The posterior wa

60、ll－teres major, latissimus dorsi, subscapularis and scapula Trilateral and quadrilateral foramina 三邊孔和四邊孔Between the subscapularis and teres major, there is a long triangular space whose lateral side is surgical ne

61、ck of humerus. The long head of triceps brachii subdivides this space into a medial trilateral foramen and a lateral quadrilateral foramen.The posterior humeral circumflex a. and axillary n. pass through the quadrilate

62、ral foramen. The circumflex scapular a. passes through the triangular space to reach the dorsum of the scapula.,,The broad medial wall－serratus anterior，intercostal muscles and upper four ribs The narrow lateral wall－c

63、oracobrachialis, biceps brachii and intertubercular grooveContents Brachial plexus, axillary a. and principal branches, axillary v. and tributaries, axillary lymph nodes and loose connective tissue,Brachial plexus 臂

64、叢,Formation:Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5～C7give rise to long thoracic n.胸長神經(jīng)Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk is the

65、 continuation of root C7.The lower trunk is formed by the joining of root C8 and T1.Six divisions: above clavicle, trunks form anterior and posterior divisionsThree cords: below clavicle, divisions form three cords th

66、at 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 cordsMain branches

67、Lateral cord Musculocutaneous n. 肌皮神經(jīng)Lateral root to median n. 正中神經(jīng)外側(cè)根Medial cord Medial root to median n. 正中神經(jīng)內(nèi)側(cè)根Ulnar n. 尺神經(jīng)Medial brachial cutaneous n.臂內(nèi)側(cè)皮神經(jīng)Medial antebrachial cutaneous n. 前臂內(nèi)側(cè)皮神經(jīng),

68、,Posterior cord radial n. 橈神經(jīng)axillary n. 腋神經(jīng)thoracodorsal n. 胸背神經(jīng),,Axillary sheath 腋鞘－extension of deep cervical fascia of the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus,,Ax

69、illary artery Continuation of subclavian artery at lateral border of first ribBecomes brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above muscle－gi

70、ves rise to thoracoacromial a. 胸肩峰動脈Second portion, behind muscle－gives rise to lateral thoracic a. 胸外側(cè)動脈Third portion, below muscle－gives rise to subscapular a. 肩胛下動脈, anterior and posterior humeral circumflex a. 旋肱前、