Regionalanatomyofupperlimb

丁兆習山東大學醫學院人體解剖學教研室Office:1205dingzhaoxi@DissectionofthePectoralRegion

andAxillaPreparation:Reviewtheimportantlandmarkssuchasthejugularnotchofmanubrium

sterni,xiphoidprocess,

acromion,clavicle,anteriorandposterioraxillaryfolds.Step1

Skintheanteriorthoraxandaxillary

fossaStep2DissectthesuperficialfasciaCleantheupperendofthecephalicv.inthegroovebetweenthedeltoidandpectoralismajorFindonebranchesofsupraclaviclularn.andlat.cutaneous

br.ofintercostaln.dissectthebreastStep3Dissecttheanteriorwallofaxillary

fossaReflectpectoralismajorCleanandidentifytheclavipectoralfascia,trytofindcephalicv.,thoracoacromiala.andv.,lateralpectoraln.ReflectpectoralisminorStep4RemovetheaxillaryfasciaCarefullyremovetheaxillaryfasciaandareolartissue.TrytofindtheaxillarylymphnodesStep5Dissecttheaxillaryartery

andbranches

Cleantheaxillarya.v.andtracethebranchessuchassuperiorthoracica.,thoracoacromiala.,lateralthoracica.,subscapular

a.(thoracodorsala.,circumflexscapulara.),anteriorandposteriorhumeralcircumflexa.Step6DissectthebrachialplexusandbranchesIdentifythelateral/medial/posteriorcords.Tracethemediann,musculocutaneousn.,ulnarn.,axillaryn.,radialn.,thoracodorsaln.,medialbrachialandantebrachial

nerves

AxillarysheathStep7Dissecttheposteriorwallofaxillary

fossaTrytoidentifythe

teresmajor,latissimus

dorsiandsubscapularis

Identifythetrilateralforamenandtracethecircumflexscapulara.Identifythequadrilateralforamenandtracetheposteriorhumeralcircumflexa.,axillaryn.DissectionoftheArm

Step1

SkinthearmandforearmStep2

DissectthesuperficialfasciaTraceandcleanthesuperficialveins,suchascephalicveinonlateralside,basilicveinonmedialside,mediancubitalveinonelbowTraceandcleanthe

cutaneousnerves,

suchaslateralantebrachialnerve,medialantebrachialnerve,Step3DissectthebrachialfasciaStep4Dissecttheanteriorosseofascialcompartmentinthearm.Separatethemusclessuchasbicepsbrachii,coracobrachialisandbrachialisCleanthemusculocutaneousn.,mediann.,ulnarn.,medialantebrachial

cutaneousn.andradialnerveTracethebrachialartery,trytofindthedeepbrachialarteryStep1

Identifytheboundariesofthecubital

fossaStep2

Dissectthecontentsofcuital

fossaIdentifythetendonofbiceps

brachiiTracethebrachiala.toradiala.(alsotherecurrentradiala.)andulnara.(alsocommoninterosseusartery)andtheriraccompanyingveinsTracethemediann.Tracethesuperficialbranchofradialn.Dissectthecubital

fossaDissecttheflexorcompartmentintheforearmStep1

Cleanandidentifythe1stlayerof

muscles

Step2

Cleanandidentifythe2ndlayerof

muscles

Step3

Cleanandtracetheradialandulnar

artery,ulnarandmediannerve,superficialbranchofradialnerve.Step4

Cleanandseparatethepronator

terestovisualizethecommoninterosseusartery(branchingfromtheulnarartery),whichgiverisetotheanteriorandposteriorinterosseusarteriesthattravelwiththeanteriorandposteriorinterosseousnervesfrommediann.Step5

Identifythedeeplayerofmuscles(3rdand4thlayer)intheanteriorforearmDissectionofAnteriorRegionofwristandpalmStep1

Skinthewristandpalm

Step2RemovethesuperficialfasciaStep3DissectthedeepfasciaCleanthepalmarcarpallig.(volarcarpallig.)Cleanthesuperficialpalmar

br.ofmedianN.Cleantheflexorretinaculum

（transversecarpallig.）Step4IdentifythecarpalcanalandcontentsDissecttheulnarcarpalcanalandtracetheulnarAVNDissectthe

radialcarpalcanalandtracetheflexorcarpi

radialisCutofftheflexorretinaculum（transversecarpallig.）CleanandidentifythecontentsinCarpalcanalDissectionofAnteriorRegionofwristandpalmStep5DissectthesuperficialfasciaofpalmSearchforpalmar

cutaneous

brancheofulnarn.Searchforpalmar

cutaneous

brancheofmediann.Searchforsuperficialbranchofradialn.Step6DissectthePalmar

aponeurosisCutoffthedistalendsofpalmar

aponeurosisandreflectitproximallyOpentheosseofascialcompartmentsofpalmDissectionofAnteriorRegionofwristandpalmStep7dissectulnarn.anditsbranchesStep8dissectulnara.andsuperficialpalmararchTracetheulnara.todeeppalmarbranchofulnara.Tracethetrunkofulnara.tofindtheSuperficialpalmararchandbranches（commonpalmardigitala.）Step9dissectthe

mediann.

andbranches（commonpalmardigitaln.）Step12Cleanandidentifythe

tendons

offlexordigitorum

supericialisandprofundusStep13cleanandidentifythe

LumbricalesStep14probethe

midpalmarspaceandthenarspaceStep15tracethe

deeppalmarbranchofulnarn.

Step16tracethe

deeppalmararchandbranches

(palmarmetacarpalarteries)Step17cleanandidentifythelateralandmedial

osseofascialcompartmentsandtheircontents(thethenarandhypothenar)DissectionoftheDeltoid,scapularregionStep1

Skin

thebackandscapularregionStep2Identifythe

musclesofthebackStep3Reflectthe

trapezius

laterallyandtracetheunderlyingaccessoryn.andsuperficialcervicala.Step4

Reflecttherhomboideusandtracethedorsalscapulara.DissectionoftheDeltoid,ScapulaStep5Dissectthetrilateralandquadrilateralspacesandtheircontents

partiallyreflectthedeltoidtoexposethespaces.Step6Reflectthesupraspinatuslaterallyanddissectthesuprascapulara.andn.

DissecttheextensorcompartmentinthearmStep1skinthebackofarmStep2removethesuperficialfasciaDissecttheextensorcompartmentinthearmStep3

Dissectthetricepsbrachii

Cleanthelateralheadandlongheadofthetricepsbrachii.

Findandtracetheradialnerveonthemedialsurfaceofthearmandanteriorlybetweenthebrachialisandbrachioradialis.Theprofunda

brachiiarteryaccompanytheradialnerveStep4

Dissectthe

humeromusculartunnelCutthelateralheadofthetricepsbrachiitodemonstratehumeromusculartunnel

andtracetheradialnerveandprofunda

brachiiarterytraversingtheradialgroovesuperiortothemedialheadofthetriceps.Step5

Dissectthebranchesofradialnerve

TracetheradialnervetothelateralepicondyleofhumeruswhereitdividesintosuperficialanddeepbranchesDissecttheextensorcompartmentintheforearm.Step1CleanandIdentifythesuperficiallayerofthemusclesStep2Cleantheposteriorinterosseusnerve,whereitexitsthesupinatormuscle,andcleantheposteriorinterosseusartery,whichtravelswiththenerve.Step3IdentifythedeeperlayerofthemusclesoftheposteriorcompartmentoftheforearmDissecttheextensorcompartmentintheforearm.Youmustidentifyfollowstructures！PectoralregionandAxilla

MusclesPectoralismajorPectoralisminorSerratusanteriorArteriesandveinsAxillaryarterythoracoacromiala.lateralthoracica.subscapulara.Throcodorsala.Circumflexscapulara.Posteriorhumeralcircumflexa.AxillaryveinNervesLongthoracicn.Lateralcordmusculocutaneousn.lateralrootofmediann.MedialcordMedialrootofmediann.Ulnarn.PosteriorcordRadialn.Axillaryn.Thoracodorsaln.Youmustidentifyfollowstructures！Superficialvv.Cephalicv.Basilicv.Mediancubitalv.ArmBicepsbrachiiCoracobrachilis

BracialisMusculocutaneousn.Mediann.Ulnarn.Brachiala.Profunda

brachiia.ForearmBrachioradialis

Pronator

teresFlexorcarpi

radialisPalmarislongusFlexorcarpi

ulnarisFlexordigitorum

superficialisFlexordigitorum

profundusFlexorpollicis

longusPronator

quadratusUlnarn.Radialn.Mediann.Ulnara.Radiala.Youmustidentifyfollowstructures！MusclesTrapezius

斜方肌Levatorscapulae肩胛提肌Rhomboideus

菱形肌Latissimus

dorsi

背闊肌Thoracolumbarfascia胸腰筋膜Deltoid三角肌Supraspinatus

岡上肌Infraspinatus

岡下肌Teresminor小圓肌Teresmajor大圓肌Tricepsbrachii

肱三頭肌Extensorcarpi

radialis

longus

橈側腕長伸肌Extensorcarpi

radialis

brevis

橈側腕短伸肌Extensordigitorum

指伸肌Extensordigiti

minimi

小指伸肌Extensorcarpi

ulnaris

尺側腕伸肌Supinator

旋后肌Abductorpollicis

longus

拇長展肌Extensorpollicis

brevis

拇短伸肌Extensorpollicis

longus

拇長伸肌Extensorindicis

示指伸肌Youmustidentifyfollowstructures！VesselsSuprascapulara.Posteriorhumeralcircumflexa.Deepbrachiala.NervesAccessoryn.Suprascapularn.Axillaryn.Radialn.deepbranchoftheradialn.Review1.Describetheboundariesandcontentsofthe①axilla,②cubital

fossaand③carpaltunnel.2.Writeoutthebeginning,endingandbranchesof