Download Introduction of the nervous system

Regional anatomy of upper limb
The Anterior Region of
the Upper Limb
Ling Shucai
Parts and regions
Shoulder region－junction of
arm and trunk
Arm－between should and
elbow
Elbow－bend of arm, joint
between arm and forearm
Forearm－between elbow and
hand
Hand
The Anterior Region of the Upper Limb
1. Surface anatomy
表面解剖
2. The superficial structures
浅层结构
Superficial veins
浅淋巴管
Superficial lymph vessels
浅静脉
Cutaneous nerves
皮神经
3. The deep structures
深层结构
The deep fascia
深筋膜
The muscles
肌肉
The vessels
血管
The nerves
神经
4. Regional anatomy 局部解剖
Cubital fossa
肘窝
The carpal canal
腕管
The palmar fascial space
手掌筋膜间隙
1.Surface anatomy
Surface anatomy
Shoulder region: acromion, spine of 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, tendon of biceps brachii
Forearm－between elbow and hand
Hand－styloid process, dorsal tubercle
Carring angle 提携角
1650～1700
2.The superficial structures
The superficial structures
Superficial veins
Cephalic vein
Cephalic vein 头静脉
Basilic vein 贵要静脉
Median cubital vein 肘正中静脉
Basilic vein
Median cubital vein
The lymphatic drainage of upper limb
Lymphatic vessels
Superficial－follow the
superficial veins, drain into
supratrochlear(滑车上淋巴结）
and axillary lymph nodes（腋
淋巴结）
Deep－accompany main
vessels, end in axillary lymph
nodes
lymph nodes
Superficial cubital lymph node
(Supratrochlear lymph node):
肘浅淋巴结（滑车上淋巴结）
Axillary lymph node－
arranged in five groups
Cutaneous nerves
Lateral antebrachial cutaneous n.
& cephelic v.
前臂外侧皮神经和头静脉
Medial antebrachial cutaneous
n. & basiic v.
前臂内侧皮神经和贵要静脉
Median cubital v
肘正中静脉.
3. The deep structures
Ⅰ.The Muscles
Muscles of arm
Antererior group
 Biceps brachii
肱二头肌
 Coracobrachialis
喙肱肌
 Brachialis
肱肌
Posterior group –
triceps brachii
肱三头肌
Muscles of forearm
Superficial layer

Brachioradialis 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
Second layer
Flexor digitorum superficials
指浅屈肌
Third layer


Flexor digitorum
profundus
指深屈肌
Flexor pollicis longus
拇长屈肌
Fourth layer
Pronator quadratus
旋前方肌
Muscles of hand
Lateral group－thenar 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
Medial group－hypothenar (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
Intermedial group
 Lumbricales
蚓状肌(4)
 Palmar interossei
骨间掌侧肌(3)
 Dorsal interossei
骨间背侧肌(4)
Ⅱ. The vessels
Arteries
Brachial artery
Continuation of axillary artery
Divides into radial and ulnar arteries
at level of neck of radius
Branches

Deep brachial a. 肱深动脉
－

accompanies with radial nerve
Superior ulnar collaeral a. 尺侧上副动脉
－accompanies with ulnar nerve

Inferior 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 branches
Ulnar 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
Muscolocutaneous n.
Brachial a.
Radial n.
Radial recurrent a.
Radial a.
Ulnar recurrent a.
Common interosseous a.
Median n.
Ulnar a., v. & n.
Superficial palmar arch 掌浅弓
Formed by ulnar artery（尺动脉）
and superficial palmar branch of
radial artery（桡动脉）
Curve of arch lies across the
palm, level with the distal border
of fully extended thumb
Gives rise to three common
palmar digital arteries（指掌侧总
动脉） each then divides into two
proper palmar digital arteries
（指固有动脉）
Deep palmar arch 掌深弓
Formed by radial artery
and deep palmar branch
of ulnar artery
Curve of arch lies across
upper part of palmar at
level with proximal
border of extended
thumb
Gives rise to three palmar
metacarpal arteries
Deep veins
The deep veins of upper limb: accompany the
arteries of the same region and bear similar
names
Ⅲ. Nerves
Musculocutaneous
肌皮神经
Distribution: Biceps
brachii, brachalis and
coracobrachialis ‘BBC
nerve’; skin on anterior
aspect of forearm
Median nerve 正中神经

Distribution:

Injury: Apehand 猿掌
produces sign of
benediction, in which the
index and middle fingers
cannot be flexed and the
thumb cannot be opposed
Ulnar nerve
Distribution:
 Injury:
Clawhand 爪形手

Ulnar n.
Brachial a.
Radial a.
Radial recurrent a.
Radial n.
Median n.
Ulnar a.
Ulnar recurrent a.
Ulnar n.
Innervation of hand
 Median n.
 Ulnar n.
 Radial n.
 Median n.
 Ulnar n.
 Radial n.
4. Regional anatomy
Ⅰ. Medial bicepital brachii furrow
肱二头肌内侧沟
Musculocutaneous
n.
Median n.
Medial brachial
cutaneous n.
Deep brachial a.
Ulnar n.
Superior ulnar coleteral a.
Medial antebrachial
cutaneous n.
Musculocutaneous n.
Median n.
Axillary a.
Medial antebrachial
cutaneous n.
Medial brachial cutaneous n.
Brachial a.
Deep brachial a.
Superior ulnar coleteral a.
& Ulnar n.
Inferior ulnar coleteral a.
Ⅱ. Cubiral fossa 肘窝
Boundaries
Base－line drawn through
epicondylesof humerus （肱骨
上髁）
Apex－brachioradialis
laterally and pronator teres
medially
Roof－skin, superficial faxcia,
deep faxcia and aponeurosis
of biceps（肱二头肌腱膜）
Floor－brachialis, supinator
（旋后肌） and capsule of
elbow joint
aponeurosis of biceps
Contents－from lateral to
medial
Biceps brachii tendon
Brachial a.－divides into
radial and ulnar a.,usually at
apex of fossa
Median n.
Lateral to the biceps brachii
tendon－radial n. and
lateral antebrachial
cutaneous n.
Ⅲ. Carpal tunnel 腕管
Flexor retinaculum 屈肌支持带
Thickening of deep fascia in the
hand
Attached laterally to scaphoid and
trapeziun and medially to pisiform
and hamate
Carpal tunnel 腕管
Formed by flexor retinaculum and
carpal groove
Transmits

Median n.

Flexor digitorum superficialis
and flexor digitorum
profundus enclosed by common
flexor sheath

Flexor pollicus longus enclosed
by tendinous sheath of flexor
pollicus longus
Ⅳ. Teninous sheath 腱鞘
Teninous sheath of flexor pollicis longus
Common flexor
sheath
Ⅴ. The palmar fascial space
手掌筋膜间隙
Deep palmar fascia
掌部深筋膜
Superficial layer
Thenar fascia 鱼际筋膜
Hypothenar fascia 小鱼际筋膜
Palmar aponeurosis 掌腱膜
thick triangular membrane
Deep layer
palmar interosseous fascia
骨间掌侧筋膜
Osseofascial compartments of palm
手掌骨筋膜鞘
Lateral compartment 外侧鞘
Medial compartment 内侧鞘
Intermediate compartment 中间鞘
Intermediate compartment 中间鞘
Formed by palmar aponeurosis, Laeral and medial intermuscular
septum, palmar interosseous fascia and abductor policis fascia
Contents: superficial palmar arch, a., v.,n., tendons of flexor
digitorum superficialis and profundus, lumbricales, common flexor
sheath
Medial intermuscular septum
Laeral intermuscular septum
Palmar aponeurosis
Hypothenar fascia
Thenar fascia
Adductor pollicis
Palmar interosseous fascia
Fascia spaces 筋膜间隙
Thenar space 鱼际间隙
Midpalmar space掌中间隙
Thenar space
鱼际间隙
Midplmar septum
掌中隔
Midpalmar space
掌中间隙
Pulp space 指髓间隙
On the palmar side of the tips of the
fingers and thumb. They contain fatty
tissue that is divided into numerous
compartments by fibrous septa that pass
between the distal phalanx and the skin.
The pulp space is limited proximally by
the firm adherence of skin and the distal
flexion crease to the underlying tissue;
this prevents pulp infection from
spreading proximally along the finger.
Skin incisions
思考题
1. 试述肘窝的境界、内容及排列关系。
2. 试述腕管的境界及穿行结构。
3. 试述掌中间隙和鱼际间隙的境界及炎症蔓延途径。
4. 由浅入深叙述手掌的层次结构。
5. 试述手的神经支配情况（包括皮支和肌支）。
6. 名词解释：肱骨肌管、前臂屈肌后间隙、腕尺侧管、桡侧囊、
尺侧囊、指髓间隙。