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The upper limb. 山东大学医学院 解剖教研室 李振华. The muscles of back. Superficial group Trapezius 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 muscles

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the upper limb

The upper limb

山东大学医学院 解剖教研室

李振华

the muscles of back
The muscles of back

Superficial group

  • Trapezius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
The muscles of thorax

Extrinsic muscles

  • Pectoralis major胸大肌
  • Pectoralis minor胸小肌
  • Serratus anterior 前锯肌

Intrinsic muscles

  • Intercostales externi肋间外肌
  • Intercostales interni肋间内肌
  • Intercostales intimi 肋间最内肌
major muscles of the trunk
Major muscles of the trunk

Trapezius

  • Origin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebrae
  • Insertion: lateral third of clavicle, acromion, and spine of scapulartery
  • Acton: 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
slide5
Latissimus dorsi
  • Origin: 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.
slide6
Erector spinae
  • Position: fills the vertebral groove on each side of the spine
  • Action: extends vertebral column (draw head backwar)
slide7
Pectoralis major
  • Origin: 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
The Muscles of Upper Limb

Muscles of shoulder

  • Deltoid
  • supraspinatus
  • Infraspinatus
  • Teres minor
  • Teres major
  • subscapularis
slide9
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
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
slide11
Third layer
    • Flexor 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

slide13
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
slide14
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
slide15
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
  • Action: flex, abduct, adduct and oppose thumb
  • 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
  • Action: flex, abduct , and oppose little finger
slide16
Intermedial group
  • Lumbricales 蚓状肌(4)-flex fingers at MP joints; extend fingers at IP joints
  • Palmar interossei 骨间掌侧肌(3)- adduct fingers towards middle finger at MP joints
  • Dorsal interossei 骨间背侧肌(3)-abduct fingers away from middle finger at MP joints
major muscles of upper limb
Major muscles of upper limb

Deltoid

  • Origin: lateral third of clavicle, acromion, and spine of scapula
  • Insertion: deltoid tuberosity of humerus
  • Action: abducts,flexes and medically rotates, extends, and laterally rotates arm
slide18
Teres major
  • Origin: dorsal surface of inferior angle of scapula
  • Insertion: crest of lesser tubercle of humerus
  • Action: medially rotates and adducts arm
slide19
Biceps brachii
  • Origin: long head, supraglenoid tubercle; short head, coracoid process
  • Insertion: radical tuberosity
  • Action: supinator of forearm, flexor of elbow joint, weak flexor of should joint

Pronator teres

  • Origin: medical epicondyle of humerus and deep fascia of forearm
  • Insertion: middle of lateral surface of radius
  • Action: pronation of forearm and flexion of elbow
slide20
Triceps brachii
  • Origin: long head, infraglenoid tubercle; lateral head, above groove for radical n., medical head, below groove for radical n.
  • Insertion: olecranon of ulna
  • Action: extends elbow joint), long head can extend and adduct shoulder joint
slide21
Supinator
  • Origin: lateral epicondyle of humerus and upper part of lateral border of ulna
  • Insertion: upper third of anterior surface of radius
  • Action: supination of forearm
arteries of upper limb
Arteries of upper limb

Axillary artery

  • Continuation of subclavian artery at lateral border of first rib
  • Becomes brachial artery at lower border of teres major
  • Divided into three parts by overlying pectoralis minor
    • First portion, above muscle-gives rise to thoracoacromial a. 胸肩峰动脉
    • Second portion, behind muscle-gives rise to lateral thoracic a. 胸外侧动脉
    • Third portion, below muscle-gives 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
slide24
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
slide25
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
slide26
Superficial palmar arch 掌浅弓
  • Formed by ulnar artery and superficial palmar branch of radial artery
  • Curve 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
slide27
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
veins of the upper limb
Veins of the upper limb

Deep veins: accompany the arteries of the same region and bear similar names

Superficial veins

  • Cephalic 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
slide29
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 vein
  • Median 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
The lymphatic drainage of upper limb

Lymphatic vessels

  • Superficial-follow the superficial veins, drain into supratrochlear and axillary lymph nodes
  • Deep-accompany main vessels, end in axillary lymph nodes

lymph nodes

  • Cubital lymph node: lies above medial epicondyle of humerus
  • Axillary lymph node-arranged in five groups
slide31
Axillary lymph nodes腋淋巴结-arranged in five groups
  • Lateral lymph nodes 外侧淋巴结- lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and hand
  • Pectoral lymph nodes 胸肌淋巴结-lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma
  • Subscapular lymph node 肩胛下淋巴结-along subscapular vessels, receive lymph from nape and scapular region
  • Efferents above three groups pass to central lymph node
slide32
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 vessels
    • Receive drainage chiefly from central lymph node , upper portion of mamma
    • Efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct
brachial plexus
Brachial plexus 臂丛

Formation:

  • Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5~C7give rise to long thoracic n.胸长神经
  • Three trunks
    • The 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 divisions
  • Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a.
slide34
Position:

passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cords

Main branches

  • Lateral 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
slide35
Posterior cord
    • radial n. 桡神经
    • axillary n. 腋神经
    • thoracodorsal n. 胸背神经
slide36
Musculocutaneous肌皮神经

Distribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm

slide37
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

slide38
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 fingers
    • Injury: clawhand
slide39
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
slide40
Axillary 腋神经
    • Distribution: Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of arm
    • Injury: 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

Regional anatomy of upper limb

山东大学医学院 解剖教研室

李振华

parts and regions
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
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
slide44
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..
mamma
Mamma 乳房

Position

  • Lie 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
slide47
Structures-contains skin, mammary glands and adipose tissue
  • Each brest has about 15~20 lobes of mammary gland
  • Each 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
slide48
Suspensory ligaments of breast乳房悬韧带(cooper’s ligaments )-strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands
axillary fossa
Axillary fossa 腋窝
  • The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity
slide50
Boundaries
  • The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle.
  • The base-skin and fascia of the axillary fossa
slide51
The anterior wall
    • Pectoralis major, pectoralis minor and subclavius muscles
    • Clavipectoral fascia锁胸筋膜
      • The deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles
      • The structures pass through the clavipectoral faxcia
        • Cephalic v.
        • Thoracoacromial a.
        • Lateral pectoral n.
slide52
The posterior wall-teres 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.
slide53
The broad medial wall-serratus anterior,intercostal muscles and upper four ribs
  • The narrow lateral wall-coracobrachialis, biceps brachii and intertubercular groove

Contents

Brachial plexus, axillary a. and principal branches, axillary v. and tributaries, axillary lymph nodes and loose connective tissue

brachial plexus1
Brachial plexus 臂丛

Formation:

  • Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5~C7give rise to long thoracic n.胸长神经
  • Three trunks
    • The 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 divisions
  • Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a.
slide55
Position:

passes through the scalene fissure to posterosuperior of subclavian artery, then enters the axilla to form lateral, medial and posterior cords

Main branches

  • Lateral 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
slide56
Posterior cord
    • radial n. 桡神经
    • axillary n. 腋神经
    • thoracodorsal n. 胸背神经
slide57
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
slide58
Axillary artery
  • Continuation of subclavian artery at lateral border of first rib
  • Becomes brachial artery at lower border of teres major
  • Divided into three parts by overlying pectoralis minor
    • First portion, above muscle-gives rise to thoracoacromial a. 胸肩峰动脉
    • Second portion, behind muscle-gives rise to lateral thoracic a. 胸外侧动脉
    • Third portion, below muscle-gives 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
slide59
Axillary lymph node-arranged in five groups
  • Lateral lymph nodes-lie around the distal end of axillary artery vein , receive afferent vessels from upper limb.
  • Pectoral lymph nodes-lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma
  • Subscapular lymph node-along subscapular vessels, receive lymph from nape and scapular region
  • Efferents above three groups pass to central lymph node
  • Central lymph node-lie in fat of axillary fossa, receive lymph from all the above nodes, efferents pass to apical lymph node
  • Apical lymph node-lie in the apex of the axilla, along the proximal end of axillary vessels, receive afferents chiefly from central lymph node , upper portion of mamma; efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct
cubiral fossa
Cubiral fossa 肘窝

Boundaries

  • Base-line drawn through epicondyles of humerus
  • Apex-brachioradialis laterally and pronator teres medially
  • Roof-skin, superficial faxcia, deep faxcia and aponeurosis of biceps
  • Floor-brachialis, supinator and capsule of elbow joint
slide61
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.

carpal tunnel
Carpal tunnel腕管

Flexor retinaculum

  • Thickening of deep fascia in the hand
  • Attached laterally to scaphoid and trapeziun and medially to pisiform and hamate
  • Form an osseofibrous tunnel (carpal tunnel) with carpal groove-transmits median n., flexor digitorum supericialis, flexor digitorum profundus, and flexor pollicus longus from forearm into hand
superficial fascia

Cephalic v.

Lateral cutaneous branch

Anterior cutaneous branch

Superficial fascia
slide67
Clavipectoral fascia锁胸筋膜
  • The deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles
  • The structures pass through the clavipectoral faxcia
    • Cephalic v.
    • Thoracoacromial a.
    • Lateral pectoral n.
slide68

Axillary a.

Thoracoacromial a.

Lateral pectoral n.

Musculocutaneous n.

Medial antebrachial cutaneous n.

Median n.

Ulnar n.

Medial brachial cutaneous n.

Intercostobrachial n.

Thoracodorsal n. & a.

Long thoracic n. & lateral thoracic a.

slide69

Posterior humeral circumflex a. & axillary n.

Circumflex scapular a.

Radial n.

slide70

Median n.

Medial brachial cutaneous n.

Deep brachial a.

Ulnar n.

Superior ulnar coleteral a.

Medial antebrachial cutaneous n.

Musculocutaneous n.

slide71

Musculocutaneous n.

Median n.

Medial antebrachial cutaneous n.

Axillary a.

Medial brachial cutaneous n.

Deep brachial a.

Brachial a.

Superior ulnar coleteral a.

& Ulnar n.

Inferior ulnar coleteral a.

slide72

Lateral anterachial cutaneous n. & cephelic v.

Medial interracial cutaneous n. & basiic v.

Median cubital v.

slide73

Ulnar n.

Brachial a.

Median n.

Radial a.

Radial recurrent a.

Ulnar a.

Radial n.

Ulnar recurrent a.

Ulnar n.

slide74

Brachial a.

Radial n.

Radial recurrent a.

Ulnar recurrent a.

Radial a.

Common interosseous a.

Median n.

Ulnar a., v. & n.

Muscolocutaneous n.

slide76

Superficial palmar a.

Ulnar a.

recurrent n.

posterior region of upper limb

Posterior region of upper limb

山东大学医学院 解剖教研室

李振华

slide80

Levator scapular

Trapezium

Deltoid

Rhomboideus

Triangle of ausculation

Latissimus dorsi

Thoracolumbar fascia

slide81

Suprascapular n.& a.

Supraspinatus

Teres minor

Axillary n.

Infraspinatus

Posterio humeral circumflex a.

Deep brachial a.

Radial n.

Teres major

slide82

Radial n.

Deep brachial a.

slide83

Posterior interosseousa.

Posterior interosseous n.

slide85

Hand

山东大学医学院 解剖教研室

李振华

palm of hand
Palm of hand 手掌

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 retinaculumand 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
deep palmar fascia
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

Palmar aponeurosis

Thenar fascia

Hypothenar fascia

Adductor pollicis

Palmar interosseous fascia

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

Laeral intermuscular septum

Medialintermuscular septum

slide91
Intermediate compartment 中间鞘
  • Formed bypalmar aponeurosis, Laeral and medial intermuscular septum, palmar interosseous fascia
  • Contents: superficial palmar arch, a., v.,n., tendons of flexor digitorum superficialis and profundus, lumbricales, common flexor sheath
fascia spaces
Fascia spaces 筋膜间隙
  • Thenar space 鱼际间隙
  • Midpalmar space掌中间隙

Midplmar septum

掌中隔

Thenar space

Midpalmar space

dorsum of hand
Dorsum of hand手背

Extensor retinaculum 伸肌支持带

  • Thickening of deep faxcia of forearm a wrist
  • Attached laterally to radius and medially to styloid process of ulna and triquetrum
  • Forms six fibrous compartments for extensor tendons passing from forearm into hand:
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① tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths;
  • ② tendons of extensor carpi radialis longus and brevis and their synovial sheaths;
  • ③ tendon of pollicis longus and its synovial sheath;
  • ④ tendons of extensor digitorum, extensor indicis and their synovial sheaths;
  • ⑤ tendon of extensor digiti minimi and its synovial sheaths;
  • ⑥ tendon of extensor carpi ulnaris and its synovial sheaths
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Fascia of the dorsal hand
  • The superficial fascia
  • Deep fascia-the dorsal fascia of hand
    • Superficial layer (dorsal aponeurosis) 手背腱膜
    • Deep layer (dorsal interosseous fascia) 骨间背侧筋膜
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Dorsal subaponeurotic space

Superficial fascia

Dorsal subcutaneous space

Dorsal aponeurosis

Dorsal interosseous fascia

Two spaces

  • The dorsal subcutaneous space 手背皮下间隙
  • The dorsal subaponeurotic space 手背腱膜下间隙
nerves of hand
Nerves of hand
  • Median n.-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
  • Ulnar n.-hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingers
fingers
Fingers 手指
  • 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.
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vessels :

有2条指掌侧固有动脉和2条指背动脉,分别走行于手指的两侧。

  • Nerves:

神经与同名动脉伴行。