上肢解剖课件PPT文档资料.ppt

The muscles of back,Superficial groupTrapezius 斜方肌Latissimus dorsi 背阔肌Levator scapulae 肩胛提肌Rhomboideus菱形肌 Deep group Erector spinae 竖脊肌Splenius 夹肌Thoracolumbar fascia 胸腰筋膜,The muscles of thorax,Extrinsic musclesPectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前锯肌Intrinsic musclesIntercostales externi 肋间外肌Intercostales interni 肋间内肌Intercostales intimi 肋间最内肌,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: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 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.Insertion: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 spine 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 rotates arm medially;arm fixed,elevates trunk;elevates ribs 1-6,aidding in forced inspiration.,The Muscles of Upper Limb,Muscles of shoulderDeltoidsupraspinatusInfraspinatusTeres minorTeres majorsubscapularis,Muscles of armAntererior groupBiceps brachii 肱二头肌Coracobrachialis喙肱肌Brachialis 肱肌Posterior group triceps brachii肱三头肌,Muscles of forearm,Superficial layerBrachioradialis 肱桡肌Pronator teres 旋前圆肌Flexor carpi radialis 桡侧腕屈肌Palmaris longus 掌长肌Flexor carpi ulnaris 尺侧腕屈肌,Third layerFlexor digitorum profundus 指深屈肌Flexor pollicis longus 拇长屈肌Fourth layer pronator quadratus 旋前方肌Action:flex radiocarpal joint and fingers,pronate forearm,Second layer flexor digitorum superficials 指浅屈肌,Posterior group(10)Superficial layer(5)Extensor carpi radialis longus 桡侧腕长伸肌Extensor carpi radialis brevis 桡侧腕短伸肌Extensor digitorum 指伸肌Extensor digiti minimi 小指伸肌Extensor carpi ulnaris 尺侧腕屈肌,Deep layer(5)Supinator旋后肌Abductor pollicis longus拇长展肌Extensor pollicis brevis拇短伸肌Extensor pollicis longus拇长伸肌Extensor indicis 示指伸肌Action:extend radiocapral joint and fingers,and supinate forearm,Muscles of handLateral groupthenar 鱼际(4)Abductor pollicis brevis拇短展肌Flexor pollicis brevis 拇短屈肌Opponens pollicis 拇对掌肌Adductor pollicis 拇收肌Action:flex,abduct,adduct and oppose thumbMedial grouphypothenar(3)Abductor digiti minimi 小指展肌Flexor digiti minimi brevis小指短屈肌Opponens digiti minimi小指对掌肌Action:flex,abduct,and oppose little finger,Intermedial groupLumbricales 蚓状肌(4)flex fingers at MP joints;extend fingers at IP jointsPalmar interossei 骨间掌侧肌(3)adduct fingers towards middle finger at MP jointsDorsal interossei 骨间背侧肌(3)abduct fingers away from middle 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,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,supraglenoid 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 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.,medical 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 lateral 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 brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion,above musclegives rise to thoracoacromial a.胸肩峰动脉Second portion,behind musclegives rise to lateral thoracic a.胸外侧动脉Third portion,below musclegives rise to subscapular a.肩胛下动脉,anterior and posterior humeral circumflex a.旋肱前、后动脉;the former then divides into throcodorsal a.胸背动脉 and circumflex scapular a.旋肩胛动脉,Brachial arteryContinuation of axillary arteryDivides into radial and ulnar arteries at level of neck of radiusBranches Deep brachial a.肱深动脉accompanies with radial nerveSuperior ulnar collaeral a.尺侧上副动脉accompanies with ulnar nerveInferior ulnar collateral a.尺侧下副动脉,Radial artery and branches Radial recurrent a.桡侧返动脉Superfical palmar branch 掌浅支Principal artery of thumb 拇主要动脉Ulnar artery and branchesUlnar recurrent a.尺侧返动脉Common interosseous artery 骨间总动脉Anterior interossous a.骨间前动脉Posterior interosseous a.骨间后动脉Deep palmar branch 掌深支,Superficial palmar arch 掌浅弓Formed by ulnar artery and superficial palmar branch of radial 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 palmar 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,Veins of the upper limb,Deep veins:accompany the arteries of the same region and bear similar names Superficial veinsCephalic vein 头静脉 Arises from the lateral side of the dorsal venous rete of hand Ascends 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 vein,Basilic vein 贵要静脉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 arm where it pierces the deep fascia and joins the brachial vein or axillary veinMedian cubital vein 肘正中静脉 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 blood,The lymphatic drainage of upper limb,Lymphatic vesselsSuperficialfollow the superficial veins,drain into supratrochlear and axillary lymph nodesDeepaccompany main vessels,end in axillary lymph nodes lymph nodesCubital lymph node:lies above medial epicondyle of humerusAxillary lymph nodearranged in five groups,Axillary lymph nodes腋淋巴结arranged in five groupsLateral lymph nodes 外侧淋巴结 lie around the distal end of axillary vein,receiving drainage from the arm,forearm,and handPectoral lymph nodes 胸肌淋巴结lie along lateral thoracic vessels,receive afferents from anterior thoracic wall including central and lateral portion of mammaSubscapular lymph node 肩胛下淋巴结along subscapular vessels,receive lymph from nape and scapular regionEfferents above three groups pass to central lymph node,Central lymph node中央淋巴结lie in fat of axillary fossa,receive drainage from all the above nodes,efferents pass to apical lymph node Apical lymph node 尖淋巴结Lie in the apex of the axilla,along the proximal end of axillary vesselsReceive 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 plexus 臂丛,Formation:Five roots:formed by anterior rami of C5-C8 and T1 spinal nerves,roots C5C7give rise to long thoracic n.胸长神经Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk is 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 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 cordsMain branchesLateral cord Musculocutaneous n.肌皮神经Lateral root to median n.正中神经外侧根Medial cord Medial root to median n.正中神经内侧根Ulnar n.尺神经Medial brachial cutaneous n.臂内侧皮神经Medial antebrachial cutaneous n.前臂内侧皮神经,Posterior cord radial n.桡神经axillary n.腋神经thoracodorsal n.胸背神经,Musculocutaneous 肌皮神经 Distribution:Biceps brachii,brachalis and coracobrachialis BBC nerve;skin on anterior aspect of forearm,Median 正中神经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,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 cannot 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 surface of ulnar one and one-half fingers,ulnar half of dorsum of hand,posterior aspect of ulnar two and one-half fingersInjury:clawhand,Radial 桡神经Distribution: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 Injury:Wristdrop,Axillary 腋神经 Distribution:Deltoid and teres minor muscle;skin over deltoid and upper posterior 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,山东大学医学院 解剖教研室李振华,Parts and regions,Shoulder regionjunction of arm and trunk Armbetween should and elbowElbowbend of arm,joint between arm and forearmForearmbetween elbow and handHand,Surface anatomy,Shoulder region:acromion,spine of scapula,coracoid process,greater tubercle,anterior and posterior axillary folds Armmedial and lateral biceps brachii furrow,deltoid tuberosity Elbowmedial and lateral epicondyles,head of radius,olecranon,tendon of biceps brachiiForearmbetween elbow and handHandstyloid process,dorsal tubercle,Anatomical snuff box 鼻烟壶When 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.The floor of the snuff box is the scaphoid and trapezium bones and crossed by the radial a.,16501700,Carring angle 提携角,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,Structurescontains skin,mammary glands and adipose tissueEach brest has about 1520 lobes of mammary glandEach lobe radiates out from the nipple and has a lactiferous duct输乳管 which opens separately on the summit of the nipple and possesses a dilated lactiferous sinuses输乳管窦 just prior to its termination,Suspensory ligaments of breast乳房悬韧带(coopers ligaments)strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands,Axillary fossa 腋窝,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 limited by the first rib,the scapula,and the middle third of clavicle.The baseskin and fascia of the axillary fossa,The anterior wallPectoralis major,pectoralis minor and subclavius musclesClavipectoral fascia 锁胸筋膜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 wallteres major,latissimus dorsi,subscapularis and scapula Trilateral and quadrilateral foramina 三边孔和四边孔Between 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.The posterior humeral circumflex a.and axillary n.pass through the quadrilateral foramen.The circumflex scapular a.passes through the triangular space to reach the dorsum of the scapula.,The broad medial wallserratus anterior，intercostal muscles and upper four ribs The 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,Brachial plexus 臂丛,Formation:Five roots:formed by anterior rami of C5-C8 and T1 spinal nerves,roots C5C7give rise to long thoracic n.胸长神经Three trunksThe upper trunk is formed by the joining of root C4,C5,C6.The middle trunk is 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 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 cordsMain branchesLateral cord Musculocutaneous n.肌皮神经Lateral root to median n.正中神经外侧根Medial cord Medial root to median n.正中神经内侧根Ulnar n.尺神经Medial brachial cutaneous n.臂内侧皮神经Medial antebrachial cutaneous n.前臂内侧皮神经,Posterior cord radial n.桡神经axillary n.腋神经thoracodorsal n.胸背神经,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,Axillary 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 musclegives rise to thoracoacromial a.胸肩峰动脉Second portion,behind musclegives rise to lateral thoracic a.胸外侧动脉Third portion,below musclegives rise to subscapular a.肩胛下动脉,anterior and posterior humeral circumflex a.旋肱前、后动脉;the former then divides into throcodorsal a.胸背动脉 and circumflex scapular a.旋肩胛动脉,Axillary lymph nodearranged in five groupsLateral lymph nodeslie around the distal end of axillary artery vein,receive afferent vessels from upper limb.Pectoral lymph nodeslie along lateral thoracic vessels,receive afferents from anterior thoracic wall including central and lateral portion of mammaS