1. The upper limb
山东大学医学院 解剖教研室
李振华

2. The muscles of back Superficial group Deep 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

3. The muscles of thorax Extrinsic muscles Intrinsic 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

4. 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

5. 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.

6. Erector spinae
Position: fills the vertebral groove on each side of the spine
Action: extends vertebral column (draw head backwar)

7. 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.

8. The Muscles of Upper Limb
Muscles of shoulder
Deltoid
supraspinatus
Infraspinatus
Teres minor
Teres major
subscapularis

9. Posterior group – triceps brachii肱三头肌
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

10. 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

11. Fourth layer－ pronator quadratus 旋前方肌
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

12. Second layer－ flexor digitorum superficials 指浅屈肌

13. 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

14. 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

15. 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
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

16. 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

17. 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

18. Teres major Origin: dorsal surface of inferior angle of scapula
Insertion: crest of lesser tubercle of humerus
Action: medially rotates and adducts arm

19. Biceps brachii Pronator teres
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

20. 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

21. 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

22. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Median cubital vein 肘正中静脉
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

30. 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

31. 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

32. 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

33. 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.

34. Position: Main branches
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

35. Posterior cord
radial n. 桡神经
axillary n. 腋神经
thoracodorsal n. 胸背神经

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

37. Median 正中神经 Injury: Apehand 猿手
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

38. 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

39. 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

40. 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

41. Regional anatomy of upper limb
山东大学医学院 解剖教研室
李振华

42. 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

43. 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

44. 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..

45. Carring angle 提携角
1650～1700

46. 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

47. 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

48. 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

49. Axillary fossa 腋窝
The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity

50. 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

51. 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.

52. 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.

53. 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

54. 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.

55. Position: Main branches
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

56. Posterior cord
radial n. 桡神经
axillary n. 腋神经
thoracodorsal n. 胸背神经

57. 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

58. 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

59. 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

60. 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

61. 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.

62. 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

63. Teninous sheath of flexor pollicis longus
Common flexor sheath

65. Skin incisions

66. Superficial fascia Cephalic v. Lateral cutaneous branch
Anterior cutaneous branch

67. 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.

68. Axillary a.
Thoracoacromial a.
Lateral pectoral n.
Musculocutaneous n.
Medial antebrachial cutaneous n.
Median n.
Ulnar n.
Medial brachial cutaneous n.
Long thoracic n. & lateral thoracic a.
Intercostobrachial n.
Thoracodorsal n. & a.

69. Posterior humeral circumflex a. & axillary n.
Circumflex scapular a.
Radial n.

70. Musculocutaneous n.
Median n.
Medial brachial cutaneous n.
Deep brachial a.
Ulnar n.
Superior ulnar coleteral a.
Medial antebrachial cutaneous n.

71. 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.

72. Lateral anterachial cutaneous n. & cephelic v.
Medial interracial cutaneous n. & basiic v.
Median cubital v.

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

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

75. Palmar aponeurosis

76. Superficial palmar a.
Ulnar a.
recurrent n.

77. Posterior region of upper limb
山东大学医学院 解剖教研室
李振华

78. Skin incisions

79. Cutaneous n. and superificial v.

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

81. Suprascapular n.& a.
Supraspinatus
Teres minor
Axillary n.
Infraspinatus
Posterio humeral circumflex a.
Deep brachial a.
Radial n.
Teres major

82. Radial n.
Deep brachial a.

83. Posterior interosseousa.
Posterior interosseous n.

85. Hand
山东大学医学院 解剖教研室
李振华

86. Palm of hand 手掌 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

87. Tendinous sheath of flexor pollicis longus
Common flexor sheath

89. 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

90. 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
Medial intermuscular septum
Palmar aponeurosis
Thenar fascia
Hypothenar fascia
Adductor pollicis
Palmar interosseous fascia

91. Intermediate compartment 中间鞘
Formed by palmar 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

92. 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

93. 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:

94. 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

95. 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

96. Two spaces The dorsal subcutaneous space 手背皮下间隙
The dorsal subaponeurotic space 手背腱膜下间隙
Dorsal subaponeurotic space
Superficial fascia
Dorsal aponeurosis
Dorsal interosseous fascia
Dorsal subcutaneous space

97. 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

98. Radial n.－skin of radial side of dorsum of hand and radial two and one-half fingers

99. 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.

100. 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。