ThePectoralRegionandtheAxilla

LearningObjiective

1.Knowthesurfacelandmarksoftheupperlimb.

2.Mastertheboundariesandcontentsoftheaxilla.

3.Masterthebeginning,endingandbranchesoftheaxillaryartery.

4.Mastertheformation,positionandmainbranchesofthebrachialplexus.

5.Masterthelocation,maingroupsandareadrainageofaxillarylymphnodes.

6.Knowthelocationofthebreast.Masterthecompositionandgeneralstructureofthebreast.Masterthelymphdrainageofthebreast.

Keystone

1.Theboundariesandcontentsoftheaxillaryfossa.

2.Theformation,positionandmainbranchesofthebrachialplexus.

3.Thelocation,maingroupsandareadrainageofaxillarylymphnodes.

4.Thebeginning,endingandbranchesoftheaxillaryartery.

QuestionsRequiringShortAnswer

1.Describetheboundariesandcontentsoftheaxillaryfossa.

2.Writeoutthebeginning,endingandbranchesoftheaxillaryartery.

3.Describetheformation,positionandmainbranchesofthebrachialplexus.

4.Describethegroups,areaofdrainageoftheaxillarylymphnodes.

5.Describethelymphdrainageofthebreast.

6.Describethebeginnings,courseandendingsofcephalicandbasilicveins.

ReadingandComprehension

RegionsAnatomyofUpperLimb

Ⅰ.Partsandregionsofupperlimb

Ⅰ)Arm－betweenshouldandelbow

Ⅱ)Elbow－bendofarm,jointbetweenarmandforearm

Ⅲ)Forearm－betweenelbowandhand

Ⅳ)Hand

Ⅱ.Surfaceanatomyofupperlimb

Ⅰ)Shoulderregion:acromion,spineofscapula,coracoidprocess,greatertubercle,anteriorandposterioraxillaryfolds

Ⅱ)Arm:medialandlateralbicepsbrachiifurrow,deltoidtuberosity

Ⅲ)Elbow:medialandlateralepicondyles,headofradius,olecranon,tendonofbicepsbrachii

Ⅳ)Wristandhand:styloidprocess,headofulna,dorsaltubercle,proximalwristcrease,middlewristcrease,distalwristcrease,tendonofpalmaris,tendonofflexorcarpiulnaris,tendonofcarpiulnaris,radiallongitudinalcrease,proximalpalmarcrease,distalpalmarcrease

Ⅲ.Nomalrelationsofthebonypoints

Ⅰ)Theacromion,thegreatertubercleandcoracoidprocessformtheboundariesofanequilateraltriangle.

Ⅱ)whenexaminingtheelbowjoint,thephysicianmustrememberthenormalrelationsofthebonypoints.Inextension,themedialandlateralepicondylesandthetopoftheolecranonprocessareinastraightline;inflexion,thebonypointformtheboundariesofanequilateraltriangle.

Ⅳ.Carringangle

Thecarryingangle,whichopenslaterally,isseenwhentheelbowjointisextendedandliesbetweenthearmandforearm.Theangelis1700inmalesand1670infemales.Theangledisappearswhentheelbowjointisflexed.

ThePectoralRegionandtheAxilla

Ⅰ.Mamma

I)Position–lieinsuperficialfasciaoverthepectoralsmajorandpectoralfascia,extendingfrom3rdto7thribsvertically,andfromparasternallinetomidaxillarylinetransversally

II)Structures－containsskin,mammaryglandsandadiposetissue

1.Eachbreasthasabout15～20lobesofmammarygland

2.Eachloberadiatesoutfromthenippleandhasalactiferousductwhichopensseparatelyonthesummitofthenippleandpossessesadilatedlactiferoussinusjustpriortoitstermination

3.Suspensoryligamentsofbreast(cooper’sligaments)－strandsofconnectivetissuerunsbetweenskinanddeepfasciaandservetosupportthemammaryglands

Ⅱ.Superficialstructures

I)Superficialnn.

1.Supraclavicularn.

2.Anteriorcutaneousbranchesofintercostaln.

3.lateralcutaneousbranchesofintercostaln.

II)Superficialveinsoftheupperlimb

1.Basilicvein

(1)Arisesfromthemedialsideofthedorsalvenousreteofhand

(2)Ascendsontheulnarsideofforearmtotheelbowandtheninthemedialbicepitalbrachiifurrowtomiddleofthearmwhereitpiercesthedeepfasciaandjoinsthebrachialveinoraxillaryvein

2.Cephalicvein

(1)Arisesfromthelateralsideofthedorsalvenousreteofhand

(2)Windsaroundthelateralborderoftheforearm;itthenascendsintothecubitalfossaandupthefrontofthearmonthelateralsideofthebiceps.Itcontinuesupinthedeltopectoralgrooveandthentotheinfraclavicularfossa,whereitpiercesclavipectoralfasciatodrainintoaxillaryvein.

3.Mediancubitalveinlinkscephalicveinandbasilicveininthecubitalfossa.Itisafrequentsiteforvenipuncturetoremoveasampleofbloodoraddfluidtotheblood

Ⅲ.Deepstructures

I)Deepfascia

1.Superficiallayer

2.Deeplayer—clavipectoralfascia

II)MusclesofPectoralRegion

1.Pectoralismajor

2.Subclevius

3.Pectoralisminor

4.Serratusanterior

Ⅳ.Axillaryfossa

Axillaryfossaisapyramid-shapedspacebetweentheupperpartofthearmandthesideofthechest.Throughwhichmajorneurovascularstructurespassbetweenthethoraxandupperextremity.Axillahasanapex,abaseandfourwalls

I)Thewallsoftheaxillaryfossaaremadeupasfollows:

1.Apexisboundedbythemiddle1/3ofclavicle,lateralborderoffirstribandupperborderofthescapula.

2.Baseisformedbytheskinstretchingbetweentheanteriorandposteriorwalls

3.Anteriorwall:bythepectoralismajor,pectoralisminor,subclaviusmusclesandclavipectoralfascia.

(1)Clavipectoralfascia:deepfasciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormuscles

(2)Thestructurespassthroughtheclavipectoralfascia:cephalicv.,thoracoacromiala.andlateralpectoraln.

4.Theposteriorwallformedbylatissimusdorsi,teresmajor,subscapularisandscapula.

(1)Trilateralandquadrilateralforamina:betweenthesubscapularisandteresmajor,thereisalongtriangularspacewhoselateralsideissurgicalneckofhumerus.Thelongheadoftricepsbrachiisubdividesthisspaceintoamedialtrilateralforamenandalateralquadrilateralforamen.

(2)Theposteriorhumeralcircumflexa.andaxillaryn.passthroughthequadrilateralforamen.Thecircumflexscapulara.passesthroughthetriangularspacetoreachthedorsumofthescapula.

5.Themedialwall:byserratusanterior，upperfourribsandintercostalmuscles.

6.Thelateralwall:bycoracobrachialis,bicepsbrachiiandintertuberculargroove

II)Contentsofaxillaryfossa:brachialplexusandbranches,axillarya.andprincipalbranches,axillaryv.andtributaries,axillarylymphnodesandlooseconnectivetissue.

Ⅲ)Axillaryartery

1.Beginsattheatlateralborderoffirstribasacontinuationofsubclavianartery

2.Atthelowerborderofteresmajoritbecomesthebrachialartery.

3.Dividedintothreepartsbyoverlyingpectoralisminor

(1)Firstpartoftheaxillaryartery(abovemuscle)givesoffthoracoacromialartery

(2)Secondpartoftheaxillaryartery(behindmuscle)givesofflateralthoracicartery

(3)Thirdpartoftheaxillaryartery(belowmuscle)givesoffsubscapularartery,anteriorandposteriorhumeralcircumflexarteries;theformerthendividesintothrocodorsalandcircumflexscapulararteries

Ⅳ)Axillaryvein

1.Formedatthelowerborderoftheteresmajorbytheunionthebrachialveinandthebasilicvein

2.Runsupwardonthemedialsideoftheaxillaryartery

3.Endsatthelateralborderofthefirstribbybecomingthesubclavianvein.

Ⅴ)Brachialplexus

1.Formation:formedbyanteriorramiofC5-C8andT1spinalnerves

2.Position:passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformthreecords

3.Mainbranches

(1)Supraclavicularpart:longthoracicn.－companieswiththelateralthoracica.,suppliesserratusanterior.

Whentheserratusanteriorparalyzedbecauseofinjurytothelongthoracicnerve,themedialborderofthescapulamoveslaterallyandposteriorlyawayfromthethoracicwall,givingthescapulatheappearanceofawing.

(2)Infraclavicularpart:

1)Lateralcord:musculocutaneousn.,lateralrootofmediann.

2)Medialcord:medialrootofmediann.,ulnarn.,medialbrachialcutaneousn.,medialantebrachialcutaneousn.

3)Posteriorcord:radialn.,axillaryn.,thoracodorsaln.

4.axillaryn.

(1)Origin:Arisesfromtheposteriorcordofthebrachialplexusintheaxilla.

(2)Course:Passesbackwardandentersthequadrangularspacewiththeposteriorcircumflexhumeralartery.

(3)Distribution:deltoidandteresminormuscle;shoulderjoint;skinoverdeltoidandupperposterioraspectofarm

(4)Injury:resultindeltoidandteresminorparalysis(lossofshoulderabductionandweakexternalrotation)withlossofsensationoverthedeltoid

Ⅵ)Axillarylymphnodes:varyinsizefromapin-headtoalargebean.Theyarearrangedinfivegroups.

1.Laterallymphnodes

(1)Liearoundthedistalendofaxillaryarteryvein

(2)Receiveafferentvesselsfromupperlimb.

2.Pectorallymphnodes

(1)Liealonglateralthoracicvessels

(2)Receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmamma

3.Subscapularlymphnode

(1)Liealongsubscapularvessels

(2)Receivelymphfromnapeandscapularregion

(3)Efferentsabovethreegroupspasstocentrallymphnode

4.Centrallymphnode

(1)Lieinfatofaxillaryfossa,receivelymphfromalltheabovenodes

(2)Efferentspasstoapicallymphnode

5.Apicallymphnode

(1)Lieintheapexoftheaxilla,alongtheproximalendofaxillaryvessels

(2)Receiveafferentschieflyfromcentrallymphnode,upperportionofmamma.

(3)Efferentsformsubclaviantrunk,therightsubclaviantrunkjointstherightlymphaticduct;leftusuallydrainsdirectlyintothoracicduct

Ⅶ)Axillarysheath

Extensionofdeepcervicalfasciaoftheneck,formingatubularsheaththatsurroundsaxillarya.andv.,andbrachialplexus

Ⅴ.Myotendionouscuff(rotatorcuff):

Ⅰ)Thenamegiventothetendonsofthesubscapularis,thesupraspinatus,theinfraspinatus,andtheteresminormuscles,whicharefusedtotheunderlyingcapsuleoftheshoulderjoint.The

Ⅱ)Thecuffisimportantinstabilizingtheshoulderjoint.

TheAnteriorBrachialRegionandAnteriorAntebrachialRegion

LearningObjiective

1.Knowthecontentsofanteriorfascialcompartmentofthearm.

2.Masterthebeginning,endingandbranchesofthebrachialartery.

3.Masterthecourseanddistributionsofthemusculocutaneousandradialnerves.

4.Mastertheboundariesandcontentsofthecubitalfossa.

5.Knowtheflexorandextensorretinacula.

6.Knowcontentsofanteriorfascialcompartmentoftheforearm.

7.Masterthebeginning,endingandbranchesoftheradialandulnararteries.

8.Masterthedistributionsofthemedian,radialandulnarnervesinanteriorantebrachialregion.

Keystone

1.Theboundariesandcontentsofthecubitalfossa.

2.Thedistributionsofthemedian,radialandulnarnervesinanteriorantebrachialregion.

QuestionsRequiringShortAnswer

1.Describetheboundariesandcontentscubitalfossa

2.Writeoutthebeginning,endingandbranchesofthe①brachialartery,②radialartery,③ulnarartery.

3.Describethedistributionsofthe①median,②radialand③ulnarnervesinanteriorantebrachialregion.

ReadingandComprehension

TheAnteriorBrachialRegion

Ⅰ.Deepfascia

Ⅰ)Thedeepfasciawhichenclosesthearmsendsseptabetweenthevariousgroupsofmusclestoallowthemtoslideoneachotherandtogiveanincreasedareaoforiginfortheirfibres.

Ⅱ)Thelateralandmedialintermuscularseptadividethedistalpartofthearmintoanteriorandposteriorosseofascialcompartments.

Ⅲ)Contentsofanteriorosseofascialcompartmentofthearm

1.Muscles:

(1)Bicepsbrachii

1)Origin:longhead,supraglenoidtubercle;shorthead,coracoidprocess

2)Insertion:radicaltuberosity

3)Action:supinatorofforearm,flexorofelbowjoint,weakflexorofshouldjoint

4)Nervesupply:Musculocutaneousn.

(2)Coracobrachialis

(3)Brachialis

2.Bloodsupply:brachialartery

3.Nervesupplytothemuscles:musculocutaneousnerve

4.Structurespassingthroughthecompartment:

(1)Musculocutaneousnerve

(2)Mediannerve

(3)Ulnarnerve

(4)Brachialartery

(5)Medialantebrachialcutaneousnerve

Ⅱ.Brachialartery

Ⅰ)Beginsatthelowerborderoftheteresmajorasacontinuationofaxillaryartery

Ⅱ)Terminatesoppositetheneckofradiusbydividingintoradialandulnararteries

Ⅲ)Branches

1.Deepbrachialarteryfollowstheradialnerveintothespinalgrooveofthehumerus.

2.Superiorulnarcollaeralarteryfollowstheulnarnerve.

3.Inferiorulnarcollaterala.takespartintheanastomosisaroundtheelbowjoint.

Ⅲ.Musculocutaneousnerve

Ⅰ)Origin:arisesfromthelateralcordofthebrachialplexus.

Ⅱ)Course:piercesthecoracobrachialisandthendescendsbetweenthebicepsandthebrachialis.Atthelateralmarginofbicepstendonitpiercesthedeepfasciajustabovetheelbow.Itrunsdownthelateralaspectoftheforearmasthelateralantebrachialcutaneousnerve.

Ⅲ)Distribution:bicepsbrachii,brachialis,coracobrachialis

Ⅳ.Mediannerve

Ⅰ)Origin:arisesfromthemedialandlateralcordofthebrachialplexus.

Ⅱ)Course:descendsonthelateralsideofbrachialartery.Halfwaydownthearm,itcrossesthebrachialarterytoreachitsmedialside.Thenervethendescendsthroughtheforarmbetweenthetwoheadsofthepronatorteresandrunstheposteriorsurfaceoftheflexordigitorumsuperficialis.

Ⅴ.Ulnarnerve

Ⅰ)Origin:arisesfromthemedialcordofthebrachialplexus.

Ⅱ)Course:descendsonthemedialsideofbrachialartery.Atthemiddleofthearm,itpiercesthemedialintermuscularseptumandpassesdownbehindthemedialepicondyleofthehumerus.

CubitalFossa

Ⅰ.Boundaries

Ⅰ)Base:animaginarylinedrawnbetweenthetwoepicondylesofhumerus

Ⅱ)Laterally:brachioradialis

Ⅲ)Medially:pronatorteres

Ⅳ)Roof:formedbyskinandfasciaandisreinforcedbythebicipitalaponeurosis.

Ⅴ)Floor:brachialis,supinatorandcapsuleofelbowjoint

Ⅱ.Contentsofthecubitalfossa

Ⅰ)Medialtobicepsbrachiitendon:

1.Brachiala.－dividesintoradialandulnara.,usuallyatapexoffossa

2.Mediann.

Ⅱ)Lateraltothebicepsbrachiitendon

1.Radialn.

2.Lateralantebrachialcutaneousn.

AnteriorAntebrachialRegion

Ⅰ.Contentsofanteriorosseofascialcompartmentoftheforearm

Ⅰ)Muscle(9)

Ⅱ)Bloodsupplytothemuscles:ulnarandradialarteries.

Ⅲ)Nervesupplytothemuscles:mediannerveandulnarnerve

Ⅱ.Musclesofanteriorfascialcompartmentoftheforearm

Ⅰ)Superficiallayer

1.Brachioradialis

2.Pronatorteres

(1)Origin:medicalepicondyleofhumerusanddeepfasciaofforearm

(2)Insertion:middleoflateralsurfaceofradius

(3)Action:pronationofforearmandflexionofelbow

(4)Nervesupply:mediann.

3.Flexorcarpiradialis

4.Palmarislongus

5.Flexorcarpiulnaris

Ⅱ)Secondlayer:Flexordigitorumsuperficialis

Ⅲ)Thirdlayer

1.Flexordigitorumprofundus

2.Flexorpollicislongus

Ⅳ)Fourthlayer:Pronatorquadratus

Ⅴ)Action:flexradiocarpaljointandfingers,pronateforearm

Ⅲ.Radialartery

Ⅰ)Beginsinthecubitalfossaattheneckoftheradius.

Ⅱ)Course:passesdownwardandlaterally,beneaththebrachioradialisandrestingofthedeepmusclesoftheforearm.Inthemiddlethirdofitscourse,thesuperficialbranchoftheradialnerveliesonitslateralside.Leavestheforearmbywindingaroundthelateralaspectofthewristtoreachtheposteriorsurfaceofthehand.

Ⅲ)Branchesintheforearm:

1.Muscularbranchestoneighboringmuscles

2.Recurrentbranch,whichtakespartinthearterialanastomosisaroundtheelbowjoint.

3.Superficialpalmarbranch,whicharisesjustabovethewrist,entersthepalmofthehand,andfrequentlyjointstheulnararterytoformthesuperficialpalmararch.

Ⅳ.Ulnarartery

Ⅰ)Beginsinthecubitalfossaattheneckoftheradius.

Ⅱ)Course:descendsthroughtheanteriorcompartmentoftheforearmandentersthepalminfrontoftheflexorretinaculumincompanywiththeulnarnerve.

Ⅲ)Endsbyformingthesuperficialarch.

Ⅳ)Branchesintheforearm

1.Commoninterosseousartery:afterabriefcoursedividesintoanteriorandposteriorinterosseousarteries

2.Recurrentbranch,whichtakespartinthearterialanastomosisaroundtheelbowjoint.

Ⅵ.Mediannerve

Ⅰ)Course:Passesbetweenthetwoheadsofthepronatorteres.Itcontinuesdownwardbehindtheflexordigitorumsuperficialis.Atthewrist,itentersthepalmbypassingbehindtheflexorretinaculum.

Ⅱ)Distribution:Flexorofforearmexceptbrachioradialis,flexorcarpiulnarisandulnarhalfofflexordigitorumprofundus

Ⅶ.Ulnarnerve

Ⅰ)Course:

1.Passesfrombehindthemedialepicondyleofthehumerus,andentersthefrontoftheforearmbypassingbetweenthetwoheadsoftheflexorcapiulnaris.

2.Inthedistaltwo-thirdoftheforearm,theulnararteryliesonthelateralsideoftheulnarnerve.

3.Entersthepalmofthehandbpassinginfrontoftheflexorretinaculumandlateraltothepisiformbone.

Ⅱ)Distribution:flexorcarpiulnarisandulnarhalfofflexordigitorumprofundus

Ⅷ.Superficialbranchoftheradialnerve

Ⅰ)Course:

1.Runsdownonthelateralsideoftheradialartery.

2.Inthedistalpartoftheforearm,itleavesthearteryandpassesbackward,reachestheposteriorsurfaceofthewristandhand.

Ⅱ)Distribution:brachioradialis

DorsalSurfaceoftheUpperLimb

LearningObjiective

1.Knowthecontentsofposteriorfascialcompartmentofthearm.

2.MasterthecompositionandStructurespassingthroughthehumeromusculartunnel.

3.Knowthecontentsofposteriorfascialcompartmentoftheforearm.

4.Knowtheinnervationofthemusclesoftheposteriorgroupmusclesofforearm.

Keystone

1.Thecompositionandstructurespassingthroughthehumeromusculartunnel.

2.Thebeginnings,courseanddistributionoftheradialnerve.

QuestionsRequiringShortAnswer

1.Describetheboundariesandcontentsofthehumeromusculartunnel.

2.Describethebeginnings,courseanddistributionoftheradialnerve.

ReadingandComprehension

Ⅰ.Themusclesofback

Ⅰ)Superficialgroup

1.Trapezius

(1)Origin:superiornuchalline,externaloccipitalprotuberance,ligamentumnuchaeandspinousprocessesofseventhcervicalandallthoracicvertebrae

(2)Insertion:lateralthirdofclavicle,acromion,andspineofscapulartery

(3)Acton:upperfiberselevatescapula,lowerfibersdepressscapula;ifscapulaisfixed,onesideactingalong,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackward

(4)Nervesupply:accessorynerve(Ⅺcranialnerve)

2.Latissimusdorsi

(1)Origin:spinousprocessesoflowersixthoracicandalllumbarvertebrae,mediansacralcrest,andposteriorpartofiliaccrest.

(2)Insertion:floorofintertuberculargrooveofhumerus.

(3)Action:trunkfixed,extends,adductsandmediallyrotatesarm;armfixed,elevatestrunk.

(4)Nervesupply:thoracodorsalnerve

3.Levatorscapulae

4.Rhomboideus

Ⅱ)Deepgroup

1.Erectorspinae

(1)Position:fillsthevertebralgrooveoneachsideofthespine

(2)Action:extendsvertebralcolumn(drawheadbackwar).

2.Splenius

Ⅲ)Thoracolumbarfascia

1.Thickfasciaoflowerback

2.Formedofdeepfasciacombinedwithfusedaponeurosesoforiginoflatissimusdorsi,internalobliqueandtransversusabdominis

3.Dividesintothreelayersthatattachtovertebraeasfollows:

(1)Posteriorlayer

1)Posteriortoerectorspinae

2)Attachestospinousprocesses

(2)Middlelayer

1)Betweenerectorspinaeandquadratuslumborum

(3)Anteriorlayer

1)Anteriortoquadratuslumborum

2)Attachestotrasverseprocesses

Ⅳ)Musculartriangles

1.Ausculatorytriangle

1)Thesiteonthebackwherebreathsoundsmaybemosteadilyheardwithastethoscope.

2)Boundaries:thelatissimusdorsi,thetrapezius,andthemedialborderofthescapula.Therhomboidmajorformsthefloor.

2.Superiorlumbartriangle

Boundaries:thelateralborderoferectorspinae,posteriorborderofobliquusinternusabdominisand12thrib.Thebaseofthetriangleformedbyaponeurosisoftransversesabdominis.

3.Inferiorlumbartriangle

1)Thesitewherepusmayemergefromtheabdomenwall.

2)Boundaries:thelatissimusdorsi,theposteriorborderoftheexternalobliquemuscleoftheabdomen,andtheiliaccrest.Thebaseofthetriangle]formedbyobliquusinternusabdominis.

Ⅱ.Musclesofshoulder

Ⅰ)Deltoid

1.Origin:lateralthirdofclavicle,acromion,andspineofscapula

2.Insertion:deltoidtuberosityofhumerus

3.Action:abductsthearm，anteriorfibersflexandmediallyrotatearm;posteriorfibersextendandlaterallyrotatearm

4.Nervesupply:axillarynerve

Ⅱ)Supraspinatus

Ⅲ)Infraspinatus

Ⅳ)Teresminor

Ⅴ)Teresmajor

1.Origin:dorsalsurfaceofinferiorangleofscapula

2.Insertion:crestoflessertubercleofhumerus

3.Action:mediallyrotatesandadductsarm

4.Nervesupply:subscapularnerve

Ⅵ)Subscapularis

Ⅲ.Contentsofposteriorosseofascialcompartmentofthearm

Ⅰ)Muscle:Tricepsbrachii

1.Origin:

(1)Longheadfrominfraglenoidtubercleofscapula

(2)lateralheadfromabovethespiralgroove

(3)medicalheadfrombelowthespiralgroove

2.Insertion:olecranonofulna

3.Action:extendselbowjoint,longheadcanextendandadductshoulderjoint

4.Nervesupply:Radialnerve

1)Origin:Fromtheposteriorcordofthebrachialplexus

2)Course:Windsaroundthebackofthearminthespinalgrooveofthebackofthehumerusbetweentheheadsofthetriceps.Itpiercesthelateralfascialseptumabovetheelbowanddividesintosuperficialanddeepbranches.

3)Distribution:tricpsandskinonbackofarm

Ⅱ)Bloodsupply:deepbrachiala.andulnarcollaterala.

Ⅲ)Structurespassingthroughthecompartment:radialnerveandulnarnerve

Ⅳ)Humeromusculartunnel:

1.Composition:Formedbytricepsbrachiiandgrooveforradialnerveofhumerus

2.Structurespassingthroughthehumeromusculartunnel

1)Radialnerve

2)Deepbrachialartery

Ⅳ.Contentsofposteriorosseofascialcompartmentoftheforearm

1.Muscle(10)

2.Bloodsupplytothemuscles:posteriorinterosseousartery.

3.Nervesupplytothemuscles:deepbranchofradialnerve

Ⅰ)PosteriorgroupMusclesofforearm

1.Superficiallayer(5)

(1)Extensorcarpiradialislongus

(2)Extensorcarpiradialisbrevis

(3)Extensordigitorum

(4)Extensordigitiminimi

(5)Extensorcarpiulnaris

2.Deeplayer(5)

(1)Supinator

1)Origin:lateralepicondyleofhumerusandupperpartoflateralborderofulna

2)Insertion:upperthirdofanteriorsurfaceofradius

3)Action:supinationofforearm

4)Nervesupply:radialnerve

(2)Abductorpollicislongus

(3)Extensorpollicisbrevis

(4)Extensorpollicislongus

(5)Extensorindicis

3.Action:extendradiocapraljointandfingers,andsupinateforearm

Ⅱ)Deepbranchofradialnerve

1.Course:

(1)Windsaroundthelateralsideoftheneckoftheradiuswithinthesupinator

(2)Entertheposteriorcompartmentoftheforearm,anditdescendsbetweenthemuscles

2.Distribution:Extensormusclesofforearm;skinonbackofforearm

3.Injury:wristdrop

Ⅲ)Posteriorinterosseousartery

TheWristandHand

LearningObjiective

1.Knowtheboundariesandcontentsoftheanatomical“snuffbox”.

2.Masterthecompositionandcontentsofthecarpaltunnel.

3.Knowthegroupsofthemusclesofhand.

4.Mastertheformationandlocationofthesuperficialanddeeppalmararches.

5.Mastertheinnervationofthemusclesandskinofthehand.

6.Knowthepositionofthefascialspacesofthepalm.

7.Knowthepulpspaceofthefingers.

Keystone

1.Thecompositionandcontentsofthecarpaltunnel.

2.Theformationandlocationofthesuperficialanddeeppalmararches.

3.Theinnervationofthemusclesandskinofthehand.

QuestionsRequiringShortAnswer

1.Describethecompositionandcontentsofthecarpaltunnel.

2.Describetheformationandlocationofthesuperficialanddeeppalmararches.

3.Brieflydescribetheinnervationofthemusclesandskinofthehand.

ReadingandComprehension

Ⅰ.Wrist

Ⅰ)Anteriorregionofwrist

1.Palmarcarpalligament

2.Flexorretinaculum

(1)Thickeningofdeepfasciainthehand

(2)Attachedlaterallytoscaphoidandtrapeziumandmediallytopisiformandhamate

3.Ulnarcarpalcanal

(1)Formedbythedistalpartofpalmarcarpalligamentandflexorreticulum

(2)Transmittheulnara.,v.andn.

4.Radialcarpalcanal

(1)Theradialendofflexorreticulumisattachedtothetuberclesofscaphoidandtrapezium

(2)Transmittendonofflexorcarpiradialis

5.Carpaltunnel

(1)Composition:Formedbyflexorretinaculumandcarpalgroove

(2)Structurespassingthroughthecarpaltunnel

1)Mediann.

2)Thetendonsofflexordigitorumsuperficialisandflexordigitorumprofundusenclosedbycommonflexorsynovialsheath

3)Thetendonofflexorpollicislongusenclosedbysynovialsheathforflexorpollicislongus

Ⅱ)Posteriorregionofwrist

1.Extensorretinaculum

(1)Thickeningofdeepfasciaofforearmawrist

(2)Attachedlaterallytoradiusandmediallytostyloidprocessofulnaandtriquetralbone

(3)Formssixfibrouscompartmentsforextensortendonspassingfromforearmintohand

1)tendonsofabductorpollicislongusandextensorpollicisbrevisandtheirsynovialsheaths;

2)tendonsofextensorcarpiradialislongusandbrevisandtheirsynovialsheaths;

3)tendonofextensorpollicislongusanditssynovialsheath;

4)tendonsofextensordigitorum,extensorindicisandtheirsynovialsheaths;

5)tendonofextensordigitiminimianditssynovialsheaths;

6)tendonofextensorcarpiulnarisanditssynovialsheaths

2.Anatomical“snuffbox”

(1)Boundaries

1)Medial:tendonoftheextensorpollicislongs

2)Lateral:tendonsoftheabductorpollicislongusandextensorpollicisbrevis

3)Proximal:styloidprocessofradius

4)Floor:scaphoidandtrapeziumbones

5)Radiala.crossesthefloorofthesnuff,somayfelltheradialpulseinthisfossa

Ⅱ.Palmofhand

Ⅰ)Deepfasciaofthepalm

1.Superficiallayer

(1)Thenarfascia

(2)Hypothenarfascia

(3)Palmaraponeuros:isthicktriangularmembrane

2.Deeplayer:palmarinterosseousfascia

Ⅱ)Osseofascialcompartmentsofpalm

1.Lateralcompartment

2.Medialcompartment

3.Intermediatecompartment

(1)Boundaries

1)Palmaraponeurosis

2)Laeralandmedialintermuscularseptum

3)Palmarinterosseousfascia

(2)Contents

1)superficialpalmararch,a.,v.,n.

2)tendonsofflexordigitorumsuperficialisandprofundus

3)lumbrical