1. The Anterior Region of the Upper Limb
Regional anatomy of upper limb
The Anterior Region of the Upper Limb
Ling Shucai

2. 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

3. The Anterior Region of the Upper Limb
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
Cubital fossa 肘窝
The carpal canal 腕管
The palmar fascial space 手掌筋膜间隙

4. 1.Surface anatomy

5. 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

6. Carring angle 提携角
1650～1700

7. 2.The superficial structures

8. The superficial structures
Cephalic vein
Basilic vein
Median cubital vein
Superficial veins
Cephalic vein 头静脉
Basilic vein 贵要静脉
Median cubital vein 肘正中静脉

9. The lymphatic drainage of upper limb
Lymphatic vessels
Superficial－follow the superficial veins, drain into supratrochlear(滑车上淋巴结） and axillary lymph nodes（腋淋巴结）
Deep－accompany main vessels, end in axillary lymph nodes
lymph nodes
Superficial cubital lymph node
(Supratrochlear lymph node): 肘浅淋巴结（滑车上淋巴结）
Axillary lymph node－arranged in five groups

10. Cutaneous nerves Lateral antebrachial cutaneous n. & cephelic v.
Median cubital v
肘正中静脉.
Lateral antebrachial cutaneous n. & cephelic v.
前臂外侧皮神经和头静脉
Medial antebrachial cutaneous n. & basiic v.
前臂内侧皮神经和贵要静脉
Cutaneous nerves

11. 3. The deep structures

12. Ⅰ.The Muscles 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

13. 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

14. Flexor digitorum superficials
Second layer
Flexor digitorum superficials
指浅屈肌

15. Third layer Fourth layer 旋前方肌 Flexor digitorum profundus 指深屈肌
Flexor pollicis longus
拇长屈肌
Fourth layer
Pronator quadratus
旋前方肌

16. Lateral group－thenar 鱼际 (4)
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
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

17. Intermedial group Lumbricales Palmar interossei Dorsal interossei
蚓状肌(4)
Palmar interossei
骨间掌侧肌(3)
Dorsal interossei
骨间背侧肌(4)

18. Ⅱ. The vessels
Arteries

19. 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

20. 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

21. Muscolocutaneous n.
Brachial a.
Radial n.
Radial recurrent a.
Radial a.
Median n.
Ulnar recurrent a.
Common interosseous a.
Ulnar a., v. & n.

22. Superficial palmar arch 掌浅弓
Formed by ulnar artery（尺动脉） and superficial palmar branch of radial artery（桡动脉）
Curve of arch lies across the palm, level with the distal border of fully extended thumb
Gives rise to three common palmar digital arteries（指掌侧总动脉） each then divides into two proper palmar digital arteries（指固有动脉）

23. 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

24. Deep veins
The deep veins of upper limb: accompany the arteries of the same region and bear similar names

25. Ⅲ. Nerves Musculocutaneous 肌皮神经
Distribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm

26. Median nerve 正中神经 Distribution: Injury: Apehand 猿掌
produces sign of benediction, in which the index and middle fingers cannot be flexed and the thumb cannot be opposed

27. Ulnar nerve
Distribution:
Injury:
Clawhand 爪形手

28. Radial recurrent a.
Radial a.
Radial n.
Median n.
Ulnar n.
Ulnar a.
Ulnar recurrent a.
Brachial a.

29. Innervation of hand
Median n.
Ulnar n.
Radial n.

30. Median n.
Ulnar n.
Radial n.

31. 4. Regional anatomy

32. Ⅰ. Medial bicepital brachii furrow 肱二头肌内侧沟
Musculocutaneous n.
Median n.
Medial brachial cutaneous n.
Ulnar n.
Medial antebrachial cutaneous n.
Superior ulnar coleteral a.
Deep brachial a.

33. Musculocutaneous n.
Median n.
Axillary a.
Brachial a.
Medial antebrachial cutaneous n.
Medial brachial cutaneous n.
Deep brachial a.
Superior ulnar coleteral a.
& Ulnar n.
Inferior ulnar coleteral a.

34. Ⅱ. Cubiral fossa 肘窝 Boundaries
Base－line drawn through epicondylesof humerus （肱骨上髁）
Apex－brachioradialis laterally and pronator teres medially
Roof－skin, superficial faxcia, deep faxcia and aponeurosis of biceps（肱二头肌腱膜）
Floor－brachialis, supinator（旋后肌） and capsule of elbow joint
aponeurosis of biceps

35. 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.

36. Ⅲ. Carpal tunnel 腕管 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 retinaculum and 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

38. Ⅳ. Teninous sheath 腱鞘 Teninous sheath of flexor pollicis longus
Common flexor sheath

39. Ⅴ. The palmar fascial space
手掌筋膜间隙

40. 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

41. 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

42. Intermediate compartment 中间鞘
Formed by palmar aponeurosis, Laeral and medial intermuscular septum, palmar interosseous fascia and abductor policis fascia
Contents: superficial palmar arch, a., v.,n., tendons of flexor digitorum superficialis and profundus, lumbricales, common flexor sheath
Laeral intermuscular septum
Medial intermuscular septum
Palmar aponeurosis
Palmar interosseous fascia
Adductor pollicis
Hypothenar fascia
Thenar fascia

43. Fascia spaces 筋膜间隙 Thenar space 鱼际间隙 Midpalmar space掌中间隙 Thenar space
Midplmar septum
掌中隔

44. 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.

45. Skin incisions

46. 思考题 试述肘窝的境界、内容及排列关系。 试述腕管的境界及穿行结构。 试述掌中间隙和鱼际间隙的境界及炎症蔓延途径。
由浅入深叙述手掌的层次结构。
试述手的神经支配情况（包括皮支和肌支）。
名词解释：肱骨肌管、前臂屈肌后间隙、腕尺侧管、桡侧囊、尺侧囊、指髓间隙。