THEUPPERLIMBQiongyingDeng鄧瓊英Ph.D,Associateprofessor2016.3.9TheUpperLimbsSection1IntroductionⅠ.BoundariesandDivisionsBoundaries:Thelateral1/3oftheclavicle,thelateral1/3ofthelinefromacromiontothespineofthe7thcervicalvertebrae.Anteriorandposteriormarginofthedeltoid.Alinedrawfromthemiddlepointoftheanteriorandposterioraxillaryfolds.

Divisions:Shoulder,Arm,Elbow,Forearm,Wrist,Hand

ShoulderAcromionClavicleGreatertubercleCoracoidprocessdeltoidAnteriorandposterioraxillaryfolds1.SurfacelandmarksII.Surfaceanatomyofupperlimb肩胛岡Spineofscapula

肩胛下角InferiorangleofscapulaArmBicepsbrachiiMedialbicipitalgrooveLateralbicipitalgrooveForearmulnaradiusElbowMedialandlateralepicondylesofhumerusHeadofradiusTendonofbicepsbrachiiSulcusforulnarnerveOlecranonofulnaWristandhandStyloidprocessofradiusStyloidprocessoftheulnaTubercleoftrapeziumbonePisiformboneTubercleofscaphoidHeadofulnaStyloidprocessofradiusStyloidprocessofulnaMiddlewristcreaseProximalwristcreaseDistalwristcreaseTendonofpalmarislongusTendonofflexorcarpiulnarisTendonofflexorcarpiradialisTendonofflexordigitorumsuperficialisAnatomicalsnuffboxItisatriangulardeepeningontheradial,dorsalaspectofthehand.Theboundariesmedial:tendonoftheextensorpollicislongus.lateral:ximalborder:styloidprocessoftheradiusFloor:scaphoidandtrapeziumbones,crossedbytheradiala.2.對比關(guān)系PosteriorcubitaltriangleInflexion,thebonypointformtheboundariesofanequilateraltriangle(isoscelestriangle)Inextension,themedialandlateralepicondylesandthetopoftheolecranonprocessareinastraightlinePosteriorcubitalfossaLateralcubitaltriangle1650～170000100

001503.CarryingangleWhentheelbowjointisextended,thebonesofthehumerusandforearmarenotperfectlyaligned.Thedeviationfromastraightlineoccursinthedirectionofthethumb,andisreferredtoasthe“carryingangle”.itis100-150innormal.Womenusuallyhaveamorepronouncedcubitusvalgusthanmen.1650～170000100

00150Ifcarryingangleis00

～100,calledelbowextendedlessthan00,calledcubitusVarusgreaterthan150calledcubitusValgus3.Carryingangle1)上肢動脈干的體表投影2)上肢神經(jīng)干的體表投影正中神經(jīng)尺神經(jīng)橈神經(jīng)4.血管、神經(jīng)的體表投影Theprojectionsofthebloodvesselsandnervesmediannerveulnarnerveulnara.radialnerveradiala.brachiala.axillarya.PisiformbonestyloidprocessLowermarginoftheteresmajor1.Theprojectionsofthebrachiala.,radiala.andulnara.2.Theprojectionsofthe:mediann.,ulnarn.,radialn.Axillaryfossa

Section2

theaxillaryregionPosition:

inferiortotheshoulderjoint，betweentheupperpartofthechestwallandthemedialsiderofthearm.Whenabductstheshoulderjoittheskinisconvexupward,calledaxillaryfossa.

1.Apex:thefirstribs,thesuperiorborderofthescapulaandMiddle1/3ofclavicle.

2.Base

axillaryfascia，skin3.Anteriorwall

pactoralismajor,pactoralisminorclavipectoralfascia4.Medialwall

1-4ribs,IntercostalmusclesSerratusanterior5.Posteriorwall

Subscapularis,TeresmajorLatissimusdorsi6.LateralwallIntertubercularsulcusofthehumerus,bicepsandcoracobrachialis

I.TheboundariesoftheaxillaTrilateralandquadrilateralforaminaQuadrilateralforamen:

Theposteriorhumeralcircumflexa.andaxillaryn.passthrough.Trilateralforamen:

Thecircumflexscapulara.passthrough.1.Axillarya.anditsbranches2.Axillaryv.anditstributaries3.Brachialplexusanditsbranches4.Axillarylymphnodes5.LooseconnectivetissueII.ContentsAxillarysheathExtensionofdeepcervicalfasciaoftheneck,formingatubularsheaththatsurroundsaxillarya.andbrachialplexusAbrachialplexusnerveblockcanbeachievedbyinjectinganaestheticintothisarea.Theanteriorregionofthearmandforearm1.Skin2.SuperficialfasciaThesuperficialstructures(1)superficialveins

Cephalicv.

→axillaryveinBasilicv.

→axillaryvein

Mediancubitalv.origincourseendingclinicaluse(2)lymphaticvesselstransversn.ofnecksupraclavicularn.superiorlateralcutaneousn.ofarminferiorlateralcutaneousn.ofarmmedialcutaneousn.ofarmmedialcutaneousn.offorearmlateralcutaneousn.offorearmpalmarbranchofulnarn.palmarbranchofmediann.anteriorcutaneousbranchofintercostaln.lateralcutaneousbranchofintercostaln.C4C5C6C7C8T1T2(3)cutaneousnervesC5C6C7C8T1T2posteriorcutaneousbranchofintercostaln.supraclavicularn.superiorlateralcutaneousn.ofarmmedialcutaneousn.ofarmposteriorcutaneousn.ofarmposteriorcutaneousn.offorearmmedialcutaneousn.offorearmlateralcutaneousn.offorearmsuperficialbranchofradialn.dorsalbranchofulnarn.上肢皮神經(jīng)分布上肢皮神經(jīng)分布ThedeepstructuresMedialintermuscularseptumThedeepfasciaLateralintermuscularseptumposteriorosseofascialcompartments后骨筋膜鞘anteriorosseofascialcompartments前骨筋膜鞘1.ArmMusclesofthearmbicepsbrachiicoracobrachialisbrachialis血管神經(jīng)束Bloodvesselsbrachialartery

Continuationofaxillaryartery.DividesintoradialandulnararteriesatlevelofneckofradiusBranchesDeepbrachiala.--accompanieswithradialnerve--radialandmiddlecollaterala.Superiorulnarcollaterala.--accompanieswithulnarnerveInferiorulnarcollaterala.

正中神經(jīng)mediann.尺神經(jīng)ulnarn.橈神經(jīng)radialn.肌皮神經(jīng)musculocutaneousn.Nerve2.Anteriorcubitalregion

CubitalfossaBoundariesRoof:

skin,superficialfascia,deepfasciaandaponeurosisofbicepsBase:

animaginarylinedrawnbetweenthemedialandlateralepicondyles

Medialinferior:

pronatorteresLateralinferior:brachioradialisFloor:

brachialis,supinatorandcapsuleofelbowjointContentsofthecubitalfossaThecubitalfossacontainsthreemainverticalstructures(fromlateraltomedial):ThetendonofbicepsbrachiiThebrachiala.,v.--usuallybifurcatesintoradiala.,andulnara.

neartheapexofthefossaTheMediann.

Theradialnerveisinthevicinityofthecubitalfossa,locatedbetweenbrachioradialisandbrachialismuscles.Itisoftenbutnotalwaysconsideredpartofthecubitalfossa.大圓肌肱深動脈肱動脈尺側(cè)上副動脈尺側(cè)下副動脈橈側(cè)副動脈尺側(cè)返動脈前支尺側(cè)返動脈后支尺動脈橈動脈骨間總動脈橈側(cè)返動脈中副動脈骨間返動脈肘關(guān)節(jié)（動脈）網(wǎng)由尺側(cè)上、下副動脈，中副動脈、橈側(cè)副動脈，橈側(cè)返動脈、尺側(cè)返動脈，骨間返動脈等互相吻合而成。medialintermuscularseptumlateralintermuscularseptumposteriorosseofascialcompartmentsanteriorosseofascialcompartmentsinterosseousmembrane3.ForearmThedeepfasciathreelayers:superficial：

①brachioradialis

②pronatorteres③flexorcarpiradialis

④palmarislongus⑤flexorcarpiulnaris

intermediate：

⑥flexordigitorumsuperficialisdeep：

⑦flexordigitorumprofundus⑧flexorpollicislongus

⑨pronatorquadratus

①②③④⑤⑥⑥⑧⑧⑦②⑨Musclesofforearm前臂前區(qū)的4個血管神經(jīng)束（1）橈血管神經(jīng)束：橈血管、橈神經(jīng)淺支（2）尺血管神經(jīng)束：尺血管、尺神經(jīng)（3）正中神經(jīng)血管束：由正中神經(jīng)及伴行血管(骨間前動脈的分支)組成。（4）骨間前血管神經(jīng)束：骨間前血管、骨間前神經(jīng)BloodvesselsandnervesRadialarteryandbranches

Radialrecurrenta.SuperficalpalmarbranchPrincipalarteryofthumb

UlnararteryandbranchesUlnarrecurrenta.Commoninterosseousartery---Anteriorinterossousa.----Posteriorinterosseousa.DeeppalmarbranchMediannerveUlnarnerveRadialnerveMusculocutaneousn.Nerves（復習）ThehumerusfracturedandnervesinjuredFracturelocationnerveinjuredsignsurgicalneck→→axillaryN.→→

“flatshoulder”middlepartofhumerus→radialN.→“wristdrop”med.epicondyleofhumerus→ulnarN.→“claw-like”handlowerendofhumerus→medianN.→“ape-like”handYoushouldknowthefollowingstructures！Pectoralregionand