Posterior region of upper Posterior region of upper limblimb

Regional anatomy of upper limb

Ling ShucaiLing Shucai

Parts and regions Parts and regions

Scapular region Scapular region 肩胛区肩胛区Posterior region of the arm Posterior region of the arm 臂后区臂后区Posterior region of the elbow Posterior region of the elbow 肘后区肘后区Posterior region of the forearm Posterior region of the forearm 前臂后区前臂后区Dorsum of wrist and hand Dorsum of wrist and hand 腕背及手背腕背及手背

The Posterior Region of the Upper The Posterior Region of the Upper LimbLimb

1. Surface anatomy 1. Surface anatomy 表面解剖表面解剖2. The superficial structures 2. The superficial structures 浅层结构浅层结构

Superficial veins Superficial veins 浅淋巴管浅淋巴管Superficial lymph vessels Superficial lymph vessels 浅静脉浅静脉Cutaneous nerves Cutaneous nerves 皮神经皮神经

3. The deep structures 3. The deep structures 深层结构深层结构The deep fascia The deep fascia 深筋膜深筋膜The muscles The muscles 肌肉肌肉The vessels The vessels 血管血管The nerves The nerves 神经神经

4. Regional anatomy 4. Regional anatomy 局部解剖局部解剖Trilateral and quadrilateral foramina Trilateral and quadrilateral foramina 三边孔和四边孔三边孔和四边孔Humeromuscular tunnel Humeromuscular tunnel 肱骨肌管肱骨肌管

Surface anatomySurface anatomy

Trapezium

Deltoid

Triangle of ausculation

Latissimus dorsi

Thoracolumbar fascia

Levator scapular

Rhomboideus

B尺骨鹰嘴Olecranon

CA

BCA

B

A肱骨内上髁Medial epicondyle

C肱骨外上髁Lateral epicondyle

肱骨外上髁

桡骨头尺骨鹰嘴

肘肘外外侧侧三三角角

The superficial structures

Cutaneous n. Cutaneous n. andand

superificial v. superificial v.

The deep structures

The muscles of upper limbThe muscles of upper limb

Muscles of shoulderMuscles of shoulder

1.1. Deltoid Deltoid 三角肌三角肌

2.2. Supraspinatus Supraspinatus 冈上肌冈上肌

3.3. Infraspinatus Infraspinatus 冈下肌冈下肌

4.4. Teres minor Teres minor 小圆肌小圆肌

5.5. Teres major Teres major 大圆肌大圆肌

6.6. Subscapularis Subscapularis 肩胛下肌肩胛下肌

1

2

3

6 1

4

5

Myotendinous Myotendinous

CuffCuff

((Rotator cuff)Rotator cuff)

肌腱袖肌腱袖

Myotendinous Myotendinous

CuffCuff

((Rotator cuff)Rotator cuff)

肌腱袖肌腱袖

Triceps brachiiTriceps brachii肱三头肌肱三头肌

Muscles of arm（ posterior view)

Posterior group (10)Posterior group (10)Superficial layer (5)Superficial layer (5)

1.1. Extensor carpi radialis Extensor carpi radialis longus longus 桡侧腕长伸肌桡侧腕长伸肌

2.2. Extensor carpi radialis Extensor carpi radialis brevis brevis 桡侧腕短伸肌桡侧腕短伸肌

3.3. Extensor digitorum Extensor digitorum 指伸肌指伸肌

4.4. Extensor digiti minimi Extensor digiti minimi 小指伸肌小指伸肌

5.5. Extensor carpi ulnaris Extensor carpi ulnaris 尺侧腕伸肌尺侧腕伸肌

Muscles of forearm（ posterior view)

12

345

12

34

5

Deep layer (5)Deep layer (5)

1.1. SupinatorSupinator 旋后肌旋后肌2.2. Abductor pollicis Abductor pollicis

longuslongus 拇长展肌拇长展肌3.3. Extensor pollicis Extensor pollicis

brevis brevis 拇短伸肌拇短伸肌4.4. Extensor pollicis Extensor pollicis

longuslongus 拇长伸肌拇长伸肌5.5. Extensor indicis Extensor indicis

示指伸肌示指伸肌

1

2

3

45

2

3

4

5

Arteries of Arteries of the scapular the scapular

regionregion肩胛区的动脉肩胛区的动脉

Suprascapular Suprascapular

a. a. 肩胛上动脉肩胛上动脉Dorsal Dorsal

scapular a. scapular a.

肩胛背动脉肩胛背动脉Circumflex Circumflex

scapular a. scapular a.

旋肩胛动脉旋肩胛动脉

Posterior cord Posterior cord axillary n. axillary n. 腋神经 腋神经 radial n. radial n. 桡神经桡神经 thoracodorsal n. thoracodorsal n. 胸背神经胸背神经

Innervation 神经支配

Axillary nerve Axillary nerve 腋神经腋神经 Distribution:Distribution: Deltoid Deltoid

and teres minor and teres minor muscle; skin over muscle; skin over deltoid and upper deltoid and upper posterior aspect of armposterior aspect of arm

InjuryInjury:: result in deltoid result in deltoid and teres minor and teres minor paralysis (loss of paralysis (loss of shoulser abdution and shoulser abdution and weel external rotation) weel external rotation) with loss of sensation with loss of sensation over the deltoidover the deltoid

RadialRadial nervenerve 桡神经桡神经 Distribution:Distribution:

Extensor muscles of Extensor muscles of arm and forearm, arm and forearm, brachioradialis; skin on brachioradialis; skin on back of arm, forearm, back of arm, forearm, and radial side of and radial side of dorsum of hand and dorsum of hand and radial two and one-half radial two and one-half fingers fingers

InjuryInjury:: Wristdrop Wristdrop 垂腕垂腕

Radial nerve injury: Wristdrop 垂腕

Nerves of handNerves of hand Median n.Median n. －－ thenar except adductor pollicis, first two thenar except adductor pollicis, first two lumbricals; skin of thenar, central part of palm, palmar lumbricals; skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including aspect of radial three and one-half fingers, including middle and distal fingers on dorsum middle and distal fingers on dorsum Ulnar n.Ulnar n. －－ hypothenar muscles, interossei, 3rd and 4th hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingerspalmar surface of ulnar one and one-half fingers

Median n.Median n. Ulnar n.Ulnar n. Radial n.Radial n.

Radial n.Radial n. －－ skin of radial side of dorsum skin of radial side of dorsum of hand and radial two and one-half fingers of hand and radial two and one-half fingers

Median n.Median n. Ulnar n.Ulnar n. Radial n.Radial n.

Regional anatomy

Trilateral and Trilateral and quadrilateral foraminaquadrilateral foramina 三三边孔和四边孔边孔和四边孔

Between the subscapularis and teres Between the subscapularis and teres major, there is a long triangular major, there is a long triangular space whose lateral side is surgical space whose lateral side is surgical neck of humerus. The long head of neck of humerus. The long head of triceps brachii subdivides this space triceps brachii subdivides this space into a medial trilateral foramen and a into a medial trilateral foramen and a lateral quadrilateral foramen.lateral quadrilateral foramen.

The The posterior humeral circumflex posterior humeral circumflex a.a. and and axillary n.axillary n. pass through the pass through the quadrilateral foramenquadrilateral foramen. .

The The circumflex scapular a.circumflex scapular a. passes passes through through the the triangular spacetriangular space to to reach the dorsum of the scapula.reach the dorsum of the scapula.

Axillary n.

Posterio humeral circumflex a.

Deep brachial a.

Radial n.

Suprascapular n.& a.

Supraspinatus

Infraspinatus

Teres minor

Teres major

Trilateral and quadrilateral foramina

Radial n. Deep brachial a.

Humeromuscular tunnel 肱骨肌管

Posterior interosseous a.

Posterior interosseous n.

Dorsum of wrist and handDorsum of wrist and hand 腕背和手腕背和手背背

Fascia of the dorsal handFascia of the dorsal hand

The superficial fasciaThe superficial fascia

Deep fasciaDeep fascia －－ the dorsal the dorsal

fascia of handfascia of hand

Superficial layer (dorsal Superficial layer (dorsal

aponeurosis) aponeurosis) 手背腱膜手背腱膜 Deep layer (dorsal Deep layer (dorsal

interosseous fascia) interosseous fascia)

骨间背侧筋膜骨间背侧筋膜

Anatomical snuff box Anatomical snuff box

解剖鼻烟壶解剖鼻烟壶When the thumb is When the thumb is abducted and extended, a abducted and extended, a triangular hollow appears triangular hollow appears between the tendon of the between the tendon of the extensor pollicis longs extensor pollicis longs medially and the tendons of medially and the tendons of the extensor pollicis brevis the extensor pollicis brevis and abductor pollicis longus and abductor pollicis longus laterally. laterally.

The floor of the snuff box is The floor of the snuff box is the scaphoid and trapezium the scaphoid and trapezium bones and crossed by the bones and crossed by the radial a..radial a..

Extensor retinaculum Extensor retinaculum 伸肌支持带伸肌支持带Thickening of deep faxcia Thickening of deep faxcia of forearm a wristof forearm a wrist

Attached laterally to radius Attached laterally to radius and medially to styloid and medially to styloid process of ulna and process of ulna and triquetrumtriquetrum

Forms six fibrous Forms six fibrous compartments for extensor compartments for extensor tendons passing from tendons passing from forearm into hand:forearm into hand:

1. tendons of abductor pollicis longus and extensor pollicis brevis 1. tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths; and their synovial sheaths;

2. tendons of extensor carpi radialis longus and brevis and their 2. tendons of extensor carpi radialis longus and brevis and their synovial sheaths; synovial sheaths;

3. tendon of pollicis longus and its synovial sheath; 3. tendon of pollicis longus and its synovial sheath;

4. tendons of extensor digitorum, extensor indicis and their 4. tendons of extensor digitorum, extensor indicis and their synovial sheaths; synovial sheaths;

5. tendon of extensor digiti minimi and its synovial sheaths; 5. tendon of extensor digiti minimi and its synovial sheaths;

6. tendon of extensor carpi ulnaris and its synovial sheaths 6. tendon of extensor carpi ulnaris and its synovial sheaths

Ulna Ulna 尺尺骨骨

Radius Radius 桡骨桡骨

Skin Skin incisionsincisions

The muscles of backThe muscles of back

Superficial groupSuperficial group1.1. TrapeziusTrapezius 斜方肌斜方肌2.2. Latissimus dorsiLatissimus dorsi 背阔背阔

肌肌3.3. Levator scapulae Levator scapulae 肩胛肩胛

提肌提肌4.4. RhomboideusRhomboideus 菱形肌 菱形肌

Deep groupDeep group 5.5. Erector spinae Erector spinae 竖脊肌竖脊肌6.6. Splenius Splenius 夹肌夹肌7.7. Thoracolumbar fascia Thoracolumbar fascia

胸腰筋膜胸腰筋膜

11

22

3

44

55

66

77

Major muscles of the trunkMajor muscles of the trunkTrapezius Trapezius

Origin: superior nuchal line, external Origin: superior nuchal line, external occipital protuberance, ligamentum occipital protuberance, ligamentum nuchae and spinous processes of nuchae and spinous processes of seventh cervical and all thoracic seventh cervical and all thoracic vertebraevertebrae

Insertion: lateral third of clavicle, Insertion: lateral third of clavicle, acromion, and spine of scapularteryacromion, and spine of scapulartery

Acton: upper fibers elevate scapula, Acton: upper fibers elevate scapula, lower fibers depress scapula; if lower fibers depress scapula; if scapula is fixed, one side acting along, scapula is fixed, one side acting along, draws head toward the same side, and draws head toward the same side, and turn face to opposite side; both sides turn face to opposite side; both sides together, draw head directly backwardtogether, draw head directly backward

Latissimus dorsiLatissimus dorsi

Origin: spinous processes Origin: spinous processes

of lower six thoracic and of lower six thoracic and

all lumbar vertebrae, all lumbar vertebrae,

median sacral crest, and median sacral crest, and

posterior part of iliac posterior part of iliac

crest. crest.

Insertion: floor of Insertion: floor of

intertubercular groove of intertubercular groove of

humerus.humerus.

Action: trunk fixed, Action: trunk fixed,

extends, adducts and extends, adducts and

medially rotates arm ; medially rotates arm ;

arm fixed, elevates trunk.arm fixed, elevates trunk.