上肢解剖课件

1The 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2The muscles of backSuperficial groupnTrapezius 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3The muscles of thoraxExtrinsic musclesnPectoralis major 胸大肌胸大肌 nPectoralis minor 胸小肌胸小肌 nSerratus anterior 前锯肌前锯肌Intrinsic musclesnIntercostales 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4Major muscles of the trunkTrapezius nOrigin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebraenInsertion: lateral third of clavicle, acromion, and spine of scapularterynActon: 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, draw head directly backward5Latissimus dorsinOrigin: 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 ; arm fixed, elevates trunk.6Erector spinaen Position: fills the vertebral groove on each side of the spinen Action: extends vertebral column (draw head backwar)7Pectoralis majornOrigin: medial half of clavicle,sternum,1th-6th costal cartilages.nInsertion: crest of greater tubercle of humerus.nAction: flexes, adducts and rotates arm medially; arm fixed, elevates trunk; elevates ribs 1-6,aidding in forced inspiration.8The Muscles of Upper LimbMuscles of shouldernDeltoidnsupraspinatusnInfraspinatusnTeres minornTeres majornsubscapularis9Muscles of armnAntererior groupqBiceps brachii 肱二头肌肱二头肌qCoracobrachialis喙肱肌喙肱肌qBrachialis 肱肌肱肌nPosterior group triceps brachii肱三头肌肱三头肌10Muscles of forearmnSuperficial layerqBrachioradialis 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11nThird layerqFlexor digitorum profundus 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 forearm12nSecond layer flexor digitorum superficials 指浅屈肌指浅屈肌13Posterior group (10)nSuperficial layer (5)qExtensor carpi radialis longus 桡侧腕长伸肌桡侧腕长伸肌qExtensor 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14Deep 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 示示指伸肌指伸肌nAction: extend radiocapral joint and fingers, and supinate forearm15Muscles of handnLateral 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 thumbnMedial grouphypothenar (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 finger16Intermedial groupnLumbricales 蚓状肌蚓状肌(4)flex fingers at MP joints; extend fingers at IP jointsnPalmar interossei 骨间掌骨间掌侧肌侧肌(3) adduct fingers towards middle finger at MP jointsnDorsal interossei 骨间背侧骨间背侧肌肌(3)abduct fingers away from middle finger at MP joints 17Major muscles of upper limbDeltoidnOrigin: lateral third of clavicle, acromion, and spine of scapulanInsertion: deltoid tuberosity of humerus nAction: abducts，flexes and medically rotates, extends, and laterally rotates arm18Teres majornOrigin: dorsal surface of inferior angle of scapulanInsertion: crest of lesser tubercle of humerusnAction: medially rotates and adducts arm19Biceps brachiinOrigin: long head, supraglenoid tubercle; short head, coracoid processnInsertion: radical tuberositynAction: supinator of forearm, flexor of elbow joint, weak flexor of should jointPronator teresnOrigin: medical epicondyle of humerus and deep fascia of forearmnInsertion: middle of lateral surface of radiusnAction: pronation of forearm and flexion of elbow20Triceps brachiinOrigin: long head, infraglenoid tubercle; lateral head, above groove for radical n., medical head, below groove for radical n.nInsertion: olecranon of ulnanAction: extends elbow joint), long head can extend and adduct shoulder joint21SupinatornOrigin: lateral epicondyle of humerus and upper part of lateral border of ulnanInsertion: upper third of anterior surface of radiusnAction: supination of forearm22Arteries of upper limbAxillary artery nContinuation of subclavian artery at lateral border of first ribnBecomes brachial artery at lower border of teres majornDivided into three parts by overlying pectoralis minorqFirst 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. 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2324Brachial arterynContinuation of axillary arterynDivides into radial and ulnar arteries at level of neck of radiusnBranches qDeep brachial a. 肱深动脉肱深动脉accompanies with radial nerveqSuperior ulnar collaeral a. 尺侧上副动脉尺侧上副动脉accompanies with ulnar nerveqInferior ulnar collateral a.尺侧下副动脉尺侧下副动脉25Radial 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 branchesnUlnar recurrent a. 尺侧返动脉尺侧返动脉nCommon 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26Superficial palmar arch 掌掌浅弓浅弓nFormed by ulnar artery and superficial palmar branch of radial arterynCurve of arch lies across the palm, level with the distal border of fully extended thumb nGives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries27Deep palmar arch 掌深弓掌深弓nFormed by radial artery and deep palmar branch of ulnar arterynCurve of arch lies across upper part of palmar at level with proximal border of extended thumbnGives rise to three palmar metacarpal arteries 28Veins of the upper limbDeep veins: accompany the arteries of the same region and bear similar names Superficial veinsnCephalic vein 头静脉头静脉 qArises from the lateral side of the dorsal venous rete of hand qAscends on radial 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 drain into axillary vein29nBasilic vein 贵要静脉贵要静脉qArises from the medial side of the dorsal venous 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 veinnMedian cubital vein 肘正中静肘正中静脉脉 links cephalic vein and basilic vein in the cubital fossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood30The lymphatic drainage of upper limbLymphatic vesselsnSuperficialfollow the superficial veins, drain into supratrochlear and axillary lymph nodesnDeepaccompany main vessels, end in axillary lymph nodes lymph nodesnCubital lymph node: lies above medial epicondyle of humerusnAxillary lymph nodearranged in five groups31Axillary lymph nodes腋淋巴结腋淋巴结arranged in five groupsnLateral 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 handnPectoral 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 mammanSubscapular lymph node 肩胛下淋肩胛下淋巴结巴结along subscapular vessels, receive lymph from nape and scapular regionnEfferents above three groups pass to central lymph node 32nCentral 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 vesselsqReceive drainage chiefly from central lymph node , upper portion of mammaqEfferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct33Brachial plexus 臂丛臂丛Formation:nFive roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5C7give rise to long thoracic n.胸长神经胸长神经nThree trunksqThe 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 divisionsnThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a.34Position: passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cordsMain branchesnLateral cord qMusculocutaneous 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35nPosterior cord qradial n. 桡神经桡神经qaxillary n. 腋神经腋神经qthoracodorsal n. 胸背胸背神经神经36nMusculocutaneous 肌皮神经肌皮神经 Distribution: Biceps brachii, brachalis and coracobrachialis BBC nerve; skin on anterior aspect of forearm37nMedian 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 adductor 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 opposed 38nUlnar 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 ulnar two and one-half fingersqInjury: clawhand 39nRadial 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 40nAxillary 腋神经腋神经 qDistribution: Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of armqInjury: result in deltoid andteres minor paralysis (loss of shoulser abdution and weel external rotation) with loss of sensation over the deltoid 41Regional 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42Parts and regions nShoulder regionjunction of arm and trunk nArmbetween should and elbownElbowbend of arm, joint between arm and forearmnForearmbetween elbow and handnHand 43Surface anatomynShoulder region: acromion, spine of scapula, coracoid process, greater tubercle, anterior and posterior axillary folds nArmmedial and lateral biceps brachii furrow, deltoid tuberosity nElbowmedial and lateral epicondyles, head of radius, olecranon, tendon of biceps brachiinForearmbetween elbow and handnHandstyloid process, dorsal tubercle44Anatomical snuff box 鼻烟壶鼻烟壶nWhen the thumb is abducted and extended, a triangular hollow 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.4516501700Carring angle 提携角提携角46 Mamma 乳房乳房PositionnLie 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 47Structurescontains skin, mammary glands and adipose tissuenEach brest has about 1520 lobes of mammary glandnEach lobe radiates 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 termination48nSuspensory ligaments of breast乳房悬韧带乳房悬韧带(coopers ligaments )strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands49Axillary fossa 腋窝腋窝nThe axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity50Boundaries nThe apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle. nThe baseskin and fascia of the axillary fossa 51nThe anterior wallqPectoralis major, pectoralis minor and subclavius musclesqClavipectoral fascia 锁胸筋膜锁胸筋膜nThe deep faxcia which extends between subclavius, coracoid process and pectoralis minor musclesnThe structures pass through the clavipectoral faxciaqCephalic v.qThoracoacromial a.qLateral pectoral n. 52nThe posterior wallteres major, latissimus dorsi, subscapularis and scapula Trilateral and quadrilateral foramina 三三边孔和四边孔边孔和四边孔nBetween the subscapularis and teres major, there is a long triangular space whose 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 through the triangular space to reach the dorsum of the scapula.53nThe broad medial wallserratus anterior，intercostal muscles and upper four ribs nThe narrow lateral wallcoracobrachialis, biceps brachii and intertubercular grooveContents Brachial plexus, axillary a. and principal branches, axillary v. and tributaries, axillary lymph nodes and loose connective tissue 54Brachial plexus 臂丛臂丛Formation:nFive roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5C7give rise to long thoracic n.胸长神经胸长神经nThree trunksqThe 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 divisionsnThree cords: below clavicle, divisions form three cords that surround the second portion of axillary a.55Position: passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cordsMain branchesnLateral 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56nPosterior 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57nAxillary sheath 腋鞘腋鞘extension of deep cervical fascia of the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus58Axillary artery nContinuation of subclavian artery at lateral border of first ribnBecomes brachial artery at lower border of teres majornDivided into three parts by overlying pectoralis minorqFirst 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. 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59Axillary lymph nodearranged in five groupsnLateral 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 mammanSubscapular lymph nodealong subscapular vessels, receive lymph from nape and scapular regionnEfferents 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 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 duct60Cubiral fossa 肘窝肘窝Boundaries nBaseline drawn through epicondyles of humerusnApexbrachioradialis laterally and pronator teres mediallynRoofskin, superficial faxcia, deep faxcia and aponeurosis of bicepsnFloorbrachialis, supinator and capsule of elbow joint61Contentsfrom lateral to medialnBiceps brachii tendonnBrachial a.divides into radial and ulnar a.,usually at apex of fossanMedian n.Lateral to the biceps brachii tendonradial n. and lateral antebrachial cutaneous n.62Carpal tunnel 腕管腕管Flexor retinaculum nThickening of deep fascia in the handnAttached laterally to scaphoid and trapeziun and medially to pisiform and hamatenForm an osseofibrous tunnel (carpal tunnel) with carpal groovetransmits median n., flexor digitorum supericialis, flexor digitorum profundus, and flexor pollicus longus from forearm into hand63Common flexor sheathTeninous sheath of flexor pollicis longus6465Skin incisions66Cephalic v.Lateral cutaneous branchAnterior cutaneous branchSuperficial fascia 67Clavipectoral fascia 锁胸筋膜锁胸筋膜nThe deep faxcia which extends between subclavius, coracoid process and pectoralis minor musclesnThe structures pass through the clavipectoral faxciaqCephalic v.qThoracoacromial a.qLateral pectoral n.68Axillary a. Thoracoacromial a. Musculocutaneous n.Median n.Medial antebrachial cutaneous n.Ulnar n.Medial brachial cutaneous n.Intercostobrachial n.Thoracodorsal n. & a.Long thoracic n. & lateral thoracic a.Lateral pectoral n.69Posterior humeral circumflex a. & axillary n.Radial n.Circumflex scapular a.70Musculocutaneous n.Median n.Medial brachial cutaneous n.Ulnar n.Medial antebrachial cutaneous n.Superior ulnar coleteral a.Deep brachial a.71Musculocutaneous n.Median n.Axillary a.Brachial a.Medial antebrachial cutaneous n.Medial brachial cutaneous n.Deep brachial a.Superior ulnar coleteral a.& Ulnar n.Inferior ulnar coleteral a.72Median cubital v.Lateral anterachial cutaneous n. & cephelic v.Medial interracial cutaneous n. & basiic v.73Radial recurrent a.Radial a.Radial n.Median n.Ulnar n.Ulnar a.Ulnar recurrent a.Ulnar n.Brachial a.74Muscolocutaneous n.Brachial a.Radial n.Radial recurrent a.Radial a.Median n.Ulnar recurrent a.Common interosseous a.Ulnar a., v. & n.75Palmar aponeurosis76Superficial palmar a.recurrent n. Ulnar a.77Posterior region 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78Skin incisions 79Cutaneous n. and superificial v.80Trapezium Deltoid Triangle of ausculationLatissimus dorsiThoracolumbar fasciaLevator scapularRhomboideus 81Axillary n.Posterio humeral circumflex a.Deep brachial a.Radial n.Suprascapular n.& a.Supraspinatus Infraspinatus Teres minorTeres major82Radial n.Deep brachial a.83Posterior interosseousa.Posterior interosseous n.8485Hand 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86Palm of hand 手掌手掌Flexor retinaculum 屈肌支持带屈肌支持带nThickening of deep fascia in the handnAttached laterally to scaphoid and trapeziun and medially to pisiform and hamateCarpal tunnel 腕管腕管nFormed by flexor retinaculum and carpal groovenTransmitsqMedian n.qFlexor digitorum superficialis and flexor digitorum profundus enclosed by common flexor sheathqFlexor pollicus longus enclosed by tendinous sheath of flexor pollicus longus 87Common flexor sheathTendinous sheath of flexor pollicis longus8889 Deep palmar fascia 掌部深筋膜掌部深筋膜Superficial layernThenar fascia 鱼际筋膜鱼际筋膜nHypothenar fascia 小鱼际筋膜小鱼际筋膜nPalmar apon