Posterior region of upper limb

1. Regional anatomy of upper limb Posterior region of upper limb Ling Shucai

2. Parts and regions • Scapular region 肩胛区 • Posterior region of the arm 臂后区 • Posterior region of the elbow 肘后区 • Posterior region of the forearm 前臂后区 • Dorsum of wrist and hand 腕背及手背

3. 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 Trilateral and quadrilateral foramina 三边孔和四边孔 Humeromuscular tunnel 肱骨肌管 The Posterior Region of the Upper Limb

4. Surface anatomy

6. Levator scapular Trapezium Deltoid Rhomboideus Triangle of ausculation Latissimus dorsi Thoracolumbar fascia

8. A C A C B B A 肱骨内上髁 Medial epicondyle B 尺骨鹰嘴 Olecranon C 肱骨外上髁 Lateral epicondyle

9. 肱骨外上髁 桡骨头 尺骨鹰嘴 肘外侧三角

10. The superficial structures

11. Cutaneous n. and superificial v.

12. The deep structures

13. The muscles of upper limb 2 4 3 Muscles of shoulder • Deltoid 三角肌 • Supraspinatus 冈上肌 • Infraspinatus 冈下肌 • Teres minor 小圆肌 • Teres major 大圆肌 • Subscapularis 肩胛下肌 5 1 6 1

14. Myotendinous Cuff(Rotator cuff)肌腱袖

15. Myotendinous Cuff(Rotator cuff)肌腱袖

16. Muscles of arm （posterior view) Triceps brachii 肱三头肌

17. Muscles of forearm （posterior view) 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 尺侧腕伸肌 1 1 2 2 4 3 5 3 5 4

18. 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 1 4 2 3 5 4 2 5 3

19. Arteries of the scapular region肩胛区的动脉 • Suprascapular a. 肩胛上动脉 • Dorsal scapular a. 肩胛背动脉 • Circumflex scapular a. 旋肩胛动脉

20. Innervation 神经支配 • Posterior cord • axillary n. 腋神经 • radial n. 桡神经 • thoracodorsal n. 胸背神经

21. Axillary nerve 腋神经 • Distribution:Deltoid and teres minor muscle; skin over deltoid and upper posterior aspect of arm • Injury: result in deltoid and teres minor paralysis (loss of shoulser abdution and weel external rotation) with loss of sensation over the deltoid

22. Radialnerve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 垂腕

23. Radial nerve injury: Wristdrop 垂腕

24. 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 • Median n. • Ulnar n. • Radial n.

25. Radial n.－skin of radial side of dorsum of hand and radial two and one-half fingers • Median n. • Ulnar n. • Radial n.

26. Regional anatomy

27. 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.

28. Suprascapular n.& a. Supraspinatus Teres minor Axillary n. Infraspinatus Posterio humeral circumflex a. Deep brachial a. Radial n. Teres major Trilateral and quadrilateral foramina

29. Radial n. Deep brachial a. Humeromuscular tunnel 肱骨肌管

30. Posterior interosseous a. Posterior interosseous n.

31. Dorsum of wrist and hand腕背和手背

32. 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

33. Anatomical snuff box 解剖鼻烟壶 • 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..

34. 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:

35. Ulna 尺骨 Radius 桡骨 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

36. Skin incisions

37. 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 6 3 1 4 5 2 7

38. 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

39. 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.