Superficialstructuresoftheupperlimb(P287-293)

DepartmentofthehumananatomyattachedtotheSichuanUniversity

ChenDaobang

1.Cephalicvein:

originatesfromdorsalvenousarchascendsinthesuperficialfasciaalongthelateralborderofwristalongtheanterolateral

borderofforearmandarmrunsbetweenthedeltoidandpectoralismajorm.drainsintotheaxillary

v.or

subclavianv.

2.Basilicveinoriginatesfromthedorsalvenousarchrunsinthesuperficialfasciaonthemedialsideoftheforearmandlowerpartofarmdrainsintobrachialv.oraxillaryv.3.Mediancubitalveinisthecommunicationbetweenthebasilic

andcephalicveinsintheant.regionoftheelbow.4.Cutaneousnervesofthehand1)skinonthepalm:

ulnarn.distributestotheskinoftheoneandhalf

fingersontheulnarsideofthepalm.

mediann.2)skinonthedorsum:

ulnarn.onulnar2andhalffingers

radialn.onradial2andhalffingers

mediann.(1st,2ndand3rdfingers,distal)Axilla

(P.293)Wallsapex:isboundedby

1strib,clavicleandsuperioredgeofsubscapularism.2)Base:skinandfascia3)Medialwall:

*1stto4thribs,**intercostalm.,

***serratusanterior4)Lateralwall:*intertuberculargrooveofthehumerus*bicepsbrachii

肱二頭肌*coracobrachialis

喙肱肌前鋸肌5)Anteriorwall

*pectoralismajor

*pectoralisminor

*clavicopectoralfascia鎖胸筋膜

(*cephalicv.,**thoracoacromiala.andv.胸肩峰血管,and***lateralpectoraln.piercethefascia)*Subclavius

鎖骨下肌*Clavicle6)Posteriorwall*subscapularis*teresmajor

大圓肌

*latissimus

dorsi

背闊肌

triangularspace三邊孔

quadrangularspace四邊孔大圓肌小圓肌肱三頭肌2.Contentsinaxilla

1)axillaryartery(1)course:*beacontinuationofthesubclavian

a.attheouterborderof1strib*becomethebrachiala.atthelowerborderoftheteresmajor.(2)chiefbranches:

thoracoacromiala.胸肩峰a.

lateralthoracica.胸外側(cè)a.

subscapulara.—肩胛下a.circumflex

scapulara.

thoracodorsala.

Ant.Circumflexhumerala.

Post.Circumflexhumerala.

accompanywithaxillaryn.旋肩胛動(dòng)脈胸背動(dòng)脈Pothe3segments:1stgivesoff1branche2ndgivesoff2branches3rdgives

off3branches胸上動(dòng)脈2).Axillaryvein*isthecontinuationofthebasilicv.attheleveloflowerborderoftheteresmajor*medialtotheaxillarya.*iscontinuousassubclavianvein

brachialplexus

臂叢5根roots3干trunks6股divisions3束cordsFormedbytheventralramiofC5-8andpartsofVentralramusofT1Brachialplexus:threetrunks&divisions1.anteriorramusofC5andC6unitetoformtheupper(superior)trunk.2.anteriorramusofC7continuationasmiddletrunk.3.anteriorramusofC8andT1(most)unitetoformthelower(inferior)trunk.Eachofthemdivideintoanteriorandposteriordivisions.Threecordofbrachialplexus1.Thealloftheposteriordivisionsofthethreetrunkunitetoformtheposteriorcord.2.Theanteriordivisionsoftheupperandmiddletrunksunitetoformthelateralcord.3.anteriordivisionoflowertrunkiscontinuationasmedialcord.Branchesofthethreecord:5nervesLateralcord:

MusculocutaneousN&lateralheadofmedianNposteriorcord:

radialN&axillaryNMedialcord:

ulnarN&medialheadofmedianNThe“M”isveryimportanttoidentifythebrachialplexus.Othernerves1.thelongthoracicnerve2.lateralandmedial

thoracicnerves3.thoracodorsal

nerve…肌皮N正中N外側(cè)頭3）.Infraclavicularpartofbrachialplexus（1）

intheaxilla,thereare3cords

lateralcord:lateraltotheaxillarya.

medialcord:medialtotheaxillarya.

posteriorcord:posteriortotheaxillarya.（2）.MainbranchesMediann:arisesbytowrootsfrommedialandlaterialcordsofbrachialplexus,embracesorholdstheaxillarya.,andaccompanieswiththebrachiala..Then.isonthelateral,then

ant.andthenmedial

tothebrachiala..Anditrunsintotheant.regionofelbow(cubitalfossa),alongthetendonofbiceps.Ulnar

n:arisesfromthemedialcordofbrachialplexus,runsinferiorlybetweentheaxillarya,heant.regionofarm.Thenitentersposteriorregionofthearm,passesthroughthegrooveforulnarn.andoccurstheforearm.

Radialn:Pos.cordgivesoffit.Then.runslateroinferiorly,throughtheradialgroove,accompaningwithdeepbrachialblood

vessels.Then,itoccursbetweenthebrachialis

and

brachioradilis,atthesuperiortolateralepicondyle.Where,theradialn.isdividedintothesuperficialbr.anddeepbr.肱深血管Radialn:Distribute:*triceps*pos.skinofarm,*m.in

partmentofforearm,*pos.skinofforearm*skinofthetowandonehalffingersofradialsideofdorsumofhandMusculocutaneous

n:arisesfromlateralcord,piercescoracobrachialisandliesbetweenthebrachialisandbiceps.Laterosuperiortotheelbowjoint,then.occursinthesuperficialfasciaandbecomes

lateralantebrachial

cutaneousn.Distribute:

mscularbr:--3musclescutaneous

theskinoflateralsideofforearm

喙肱肌肱肌前臂外側(cè)皮神經(jīng)Axillary

n:Pos.cord

givesoffthen.,*accompanieswithposteriorcircumflexhumeralbloodvesselsand

*pierces

quadrangularl

space,

*

runsaroundtheposteriorsurfaceofsurgicalnecksupply:deltoidm,teresminor

skinofthedeltoidregion4）.AxillarylymphnodesPectorallymphnodesarrangealongthelateralthoracicbloodvessels

drain/receivelymphfrom

*anteriorandlateralwallsofthebodytrunkabovetheleveloftheumbilicus(臍)

*lateralpartofthemammaryglandsLaterallymphnodesliealongthedistalpartoftheaxillaryv.

drainthelymphfromtheupperlimbSubscapularlymphnodesarrangealongthesubscapularvessels.receivethelymphoftheshoulder,backandbackoftheneck(nape-項(xiàng)部).Centrallymphnodes:

deeptothepectoralisminordrainlymphfromtheabove3groupsApicallymphnodesaredeeptotheclavicopectoralfasciaandarrangealongtheproximalpartoftheaxillaryv..

receivethelymphofthecentrallymphnodesandsuperiorpartofthemammaryglandsTheefferents（輸出管）

ofthegroupunitetoformthesubclaviantrunk鎖骨下干axillarysheath腋鞘

Thedeepcervicalfasciaextendsintotheaxillaandenvelopstheaxillarya.,v.,andbrachialplexustoformaxillarysheath.MammaP351.position:anteriortothepectoralfasciaItssuperiorborderisthelevelof2ndrib.inferior---6thribmedialborderisparasternallinelateralborderisthemidaxillary

line.The

axillarytailextendsintoaxilla.2.structure

skin

fat

mammary

glands—15-20lobesofmammaryglandseachlobehasone

lactiferousduct.Theductsextendandcentertothenipple,andarrangeontheradiation-shaped.

cooperlig.