palm and thigh樣式編輯母版文本樣式

1、Hand Radial artery(1), median nerve(2), ulnar artery(4), ulnar nerve(3)Anatomical snuff box 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 lat

2、erally. The floor of the snuff box is the scaphoid and trapezium bones and crossed by the radial artery.anatomical snuff box 位置：位于手背外側(cè)部的淺凹。位置：位于手背外側(cè)部的淺凹。 境界：橈側(cè)界為拇長展肌腱境界：橈側(cè)界為拇長展肌腱(1)和拇短伸肌腱和拇短伸肌腱(2)；尺側(cè)界為拇長；尺側(cè)界為拇長伸肌腱伸肌腱(3)；近側(cè)界為橈骨莖突；窩底為手舟骨和大多角骨。；近側(cè)界為橈骨莖突；窩底為手舟骨和大多角骨。 內(nèi)容：有橈動脈通過（在鼻煙壺可觸及橈動脈搏動）。內(nèi)容：有橈動脈通過（在鼻

3、煙壺可觸及橈動脈搏動）。Muscles of hand Lateral groupthenar (4) Abductor pollicis brevis Flexor pollicis brevis Opponents pollicis Adductor pollicis Action: flex, abduct, adduct and oppose thumb Medial grouphypothenar (3) Abductor digiti minimi Flexor digiti minimi Brevis Opponents digiti minimi Action: flex, a

4、bduct , and oppose little fingerIntermedial group Lumbricales (4)flex fingers at MP (metacarpodigitals)joints; extend fingers at IP joints Palmar interossei (3) adduct fingers towards middle finger at MP joints Dorsal interossei (3)abduct fingers away from middle finger at MP joints palm superficial

5、 structures skin superficial fascia deep structures skin Osseofascial compartments and its contents fascia space carpal tunnePalm of handFlexor retinaculumThickening of deep fascia in the handAttached laterally to scaphoid and trapezium and medially to pisiform and hamateCarpal tunnelFormed by flexo

6、r retinaculum and carpal grooveTransmits 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 carpal canalcommon flexor sheathtendinous sheath of flexor pollicis longusCo

7、mmon flexor sheathTendinous sheath of flexor pollicis longusThe carpal canal syndrome- sensory loss over the lateral 2/3 of the palm and lateral 32 fingers, atrophy of the thenar m. and lateral two lumbrical m. The characteristic deformity is referred to as “ape hand”. Deep palmar fasciaSuperficial

8、layer Thenar fascia Hypothenar fascia Palmar aponeurosis thick triangular membrane Deep layerpalmar interosseous fasciaOsseofascial compartments of palm Lateral compartment Medial compartment Intermediate compartmentLaeral intermuscular septumMedial intermuscular septumPalmar aponeurosisPalmar inter

9、osseous fasciaAdductor pollicisHypothenar fasciaThenar fasciaIntermediate compartmentFormed 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, co

10、mmon flexor sheathFascia spaces Thenar space Midpalmar spaceMidpalmar spaceThenar spaceMidplmar septumThe thenar space is shown as purple in the diagrams here. In the cross section, the midpalmar space is blue, the radial bursa is light blue and the ulnar bursa is red.) Radial: thenar eminence, radi

11、al bursa Ulnar: Middle metacarpal, ulnar bursa Superficial: Carpal tunnel Deep: Adductor pollicis Clinical Significance: The thenar space lies just superficial to the adductor pollicis muscle, forming a plane connecting the deep aspects of the radial bursa and the ulnar bursa. Abscess or space occup

12、ying lesions may spread transversely through the thenar space deep in the palm between the thumb and the carpal tunnel. The midpalmar space lies between the flexor tendons and the fascia over the second and third volar interossei and the third and fourth metacarpals. It is bounded radially by the ve

13、rtical or oblique septum and ulnarly by the fascia of the hypothenar muscles. Distally lie the vertical septa of the palmar fascia, and proximally there is a thin fascial layer at the distal end of the carpal canal.Both midpalmar and thenar space infections can result from a penetrating wound or ext

14、ension of infections from elsewhere. In the case of the midpalmar space, flexor tenosynovitis of the ulnar three digits or distal palmar abscesses are possible causes. For thenar space infections, tenosynovitis of the thumb or index finger or extension from a midpalmar space or radial bursa infectio

15、n can be the cause.Midpalmar infections will result in dorsal swelling like all palmar infections, however, only midpalmar space infections will result in the loss of concavity of the palmar aspect of the hand. Motion of the middle and ring fingers is painful and limited. Thenar space infections pre

16、sent with a marked swelling of the thenar eminence that forces the thumb into abductionDorsum of handExtensor retinaculum Thickening of deep fascia of forearm a wrist Attached laterally to radius and medially to styloid process of ulna and triquetrum Forms six fibrous compartments for extensor tendo

17、ns passing from forearm into hand:三、手三、手 背背 skin superficial fascia dorsal venous network of hand dorsal branch of ulnar nerve superficial branch of radial nerveextensor retinaculumSix osseofibrous tublesradiusulna tendons of abductor pollicis longus and extensor pollicis brevis and their synovial s

18、heaths; tendons of extensor carpi radialis longus and brevis and their synovial sheaths; tendon of pollicis longus and its synovial sheath; tendons of extensor digitorum, extensor indicis and their synovial sheaths; tendon of extensor digiti minimi and its synovial sheaths; tendon of extensor carpi

19、ulnaris and its synovial sheaths Fascia of the dorsal hand The superficial fascia Deep fasciathe dorsal fascia of hand Superficial layer (dorsal aponeurosis) Deep layer (dorsal interosseous fascia)Two spaces The dorsal subcutaneous space The dorsal subaponeurotic spaceSuperficial fasciaDorsal aponeu

20、rosisDorsal interosseous fasciaDorsal subcutaneous spaceDorsal subaponeurotic spaceNerves 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 Ul

21、nar n.hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingers Radial n.skin of radial side of dorsum of hand and radial two and one-half fingers Fingers Pulp space On the palmar side of the tips of the fingers

22、 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

23、 from spreading proximally along the finger. finger（一）（一）淺層結(jié)構(gòu)淺層結(jié)構(gòu)Superficial structures 皮膚皮膚 Skin 淺筋膜淺筋膜 Superficial fascia 指髓間隙指髓間隙 Pulp space 血管神經(jīng)血管神經(jīng) Vessels and nervesFibrous sheath of tendonSynovial sheath of tendonMesotendineumVinculum Fibrous layerSynovial layertendinous sheath of fingers ves

24、sels :Two proper palmar digital arteraries and two dorsal digital arteries，runing at the sides of each fingers Nerves：accompay with the vessels and with the same name.the long thoracic n. serratus anterior the musculocutaneous nerve anterior group of the armlateral pectoral nerv the pectoralis major

25、 medial pectoral nerv pectoralis minor the median nerve the most of anterior group of the forearm and part muscles of handthe ulnar nerve the part of anterior group of the forearm and part muscles of hand the radial nerve posterior group of arm and posterior group of the forearmthe axillary nerve de

26、ltoid the thoracodorsal nerve latissimus dorsi 1). The musculocutaneous n.-arises from lateral cord.-becomes the lateral antebrachial cutaneous n.-muscular branches innervate the coraco- brachialis, biceps branchii and brachialis m.-cutaneous branches is distributed to the skin of the lateral side o

27、f the forearm.2). The median n.-arises by two roots, one from the lateral and one from the medial cord.-motor fibers innervate the muscles in front of the forearm, except the brachioradialis, the flexor carpi ulnaris and the medial half of the flexor digitorum profundus.-sensory fibers is distribute

28、d to the skin of the lateral 2/3 palmar and fingers.-“ape-like” hand3). The ulnar n.-arises from medial cord. -muscular branches innervate the flexor carpi ulnaris and the medial half of the flexor digitorum profundus.-sensory fibers is distributed to the skin of the medial 1/3 palmar and fingers, a

29、s well as the ulnar half of the dorsum of the hand. Clawhand4). The radial n.-arises from posterior cord. -muscular branches innervate the muscles of the posterior groups of the upper limb, as well as the brachioradialis. -sensory fibers is distributed to the skin on the dorsum of both the arm and f

30、orearm, skin on the radial side of the dorsum of the hand.-“wrist drop”Median NerveUlnar NerveRadial Nerve IRadial Nerve IICutaneous Innervation UE ICutaneous Innervation UE II手手部部皮皮膚膚切切口口Regions of the lower limbParts and regions of the lower limb Gluteal regionbetween iliac crest superiorly and gl

31、uteal fold inferiorly Thighbetween hip and knee kneejoint between leg and thigh Legbetween knee and foot Ankle Foot The function The locomotion and weight bearing. To support the weight and to make the erection of the body besides walking and moving The characteristics of the lower limb as compared

32、with the upper limb 1) The thick and large bones 2) The tough and tensile ligaments 3) The thick and bulky muscles 4) The more stabilization of articular movementISurfaceLandmarks1. The iliac crest (fourth lumber vertebra).2. The anterior superior iliac spine 3. The posterior superior iliac spine4.

33、The pubic tubercle5. The tuberosity of ischium6. The greater trochanter of the femur7. The patella8. The popliteal fossa9. The medial and lateral condyles of the femur10. The medial and lateral condyles of the tibia11. The head of the fibula12. The anterior margin of the tibiaSurface anatomy Gluteal

34、 region and thighanterior superior and inferior iliac spines，tubercle of iliac crest，ischial tuberosity，greater trochanter, pubic tubercle, pubic crest, superior border of pubic symphysis Kneepatella ligament, tuberosity of tibia, medial and lateral condyles and epicondyles, tendon of biceps femoris

35、, tendons of semitendinosus and semimembranosus, head of fibula Leganterior border of tibia, neck of fibula Ankle and footmedial and lateral malleolus, calcaneal tuberosity, tuberosity of navicular bone, and tuberosity of fifth metatarsal boneThe skin of the anterior surface is thin, specially the d

36、orsum. The skin of the posterior surface is thick, specially sole of foot. The superficial fascia is abundant in the superficial vein, lymphatic vessel , lymph nodes and cutaneous nerves. ( (一）淺層結(jié)構(gòu)一）淺層結(jié)構(gòu)1. skin2. Superficial fascia3. Structures in superificial fascia Great saphenous vein Saphenous n

37、erve Superficial peroneal n. Small saphenous vein Dorsal venous arch Sural nerveBlood vessels and nerve of medial side of thigh Obturator a. : arises from internal iliac artery in the lesser pelvis, passes through the obturator canal where it divides into anterior and posterior branches. Obturator n

38、.: arises from the lumbar plexus in the abdomen. It enters the thigh through the obturator canal where it divides into anterior and posterior branches. The anterior branch descends anterior to the adductor brevis. The posterior branch descends between adductors brevis and magnus supplying both.Anter

39、ior and Medial Region of ThighSuperficial structuressuperficial fasciaSuperficial arteries: superficial epigastric a. superficial iliac circumflex a. external pudendal a.Superficial veinsgreat saphenous v., superficial epigastric v. superficial iliac circumflex v. external pudendal v. superficial me

40、dial femoral v. superficial lateral femoral v.Superficial inguinal lymph nodes: superior group inferior group Cutaneous nerves: lateral femoral cutaneous n. anterior and medial cutaneous branches of femoral n. 縫匠肌縫匠肌 L.C. lateral femoral cutaneous nerve I.C. anterior cutaneous branches of femoral ne

41、rve M.C. medial cutaneous branches of femoral nerve OBT. cutaneous branches of obturator nerve I ING ilioinguinal nerve GEN.FEM femoral branch of genitofemoral nervecutaneous nerve1)lateral femoral cutaneous nerve2）anterior cutaneous branches of femoral nerve3） medial cutaneous branches of femoral n

42、erve4） cutaneous branches of obturator nerve5） ilioinguinal nerve6）femoral branch of genitofemoral nerveThe deep fascia The deep fascia is the compact(dense) and tenacity. In the thigh The deep fascia of the anterior part of thigh is thick and called as the fascia lata. The lateral part of the fasci

43、a lata is quite thick and strong, and extends from the anterior portion of the iliac crest superiorly to the lateral condyle of the tibia inferiorly, named the iliotibial tract. Just inferolateral to the pubic tubercle, there is an oval deficiency in the fascia, known as the saphenous hiatus. Deep f

44、ascia fascia lata Iliotibial tract Saphenous hiatus falciform margin cribriform fascia The muscles The muscles of the anterior and lateral regions of the thigh1) The anterior group The iliopsoas ( the psoas major iliacus) The tensor fasciae latae2 ) The anterior group of the muscle of thigh The quad

45、riceps femoris (rectus femoris, vastus medialis,lateralis, intermedius) The sartorius 3) The medial group The pectineus, adductor longus, gracilis, adductor brevis, adductor magnus. Muscles of lower limbThe muscles of lower limb are divided into: the muscles of hip, thigh, leg and foot.Muscles of hi

46、p anterior group Iliopsoas iliacus psoas major Psoas minor 50 % Tensor fasciae latae Muscles of thighAnterior groupSartorius QuadricepsRectus femoris Vastus medialis Vastus lateralis Vastus intermediusMedial group Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis adduct thigh at hip

47、 jointPosterior groupBiceps femoris Semitendinosus Semimembranosus flex the leg at knee joint extend the thigh at hip jointIntermuscular Septum and Osseofascial Sheath of Thighposterior intermuscular septumLateral intermuscular septumMedial intermuscular septumPosterior osseofascial sheathMedial oss

48、eofascial sheathAnterior osseofascial sheathThe regional structuresThe lacuna musculorum & lacuna vasorum: gaps situated between the inguinal ligament and hip bone. This gap is divided into the Lacuna musculorum laterally and lacuna vasorum medially by the iliopectineal arch. They are the passag

49、es from the abdomen to the thigh.Lacuna musculorum Bounded by lateral portion of inguinal ligament anteriorly, ilium posterolaterally, iliopectinal arch mediallyContents: iliopsoas, femoral n. and lateral femoral cutaneous n. Iliopectinal archFemoral n.IliopsoasLateral femoral cutaneous n. Lacuna va

50、sorum anteriorthe inguinal lig. p the pectineal lig.Lateral:the iliopectineal arch, medial :the lacunar Bounded by medial portion of inguinal ligament anteriorly, pectineal ligament posteromedially, lacunar ligament medially, and iliopectinal arch posterolaterallyContents: femoral a. and v the femor

51、al canal the lymphatic vessels femoral sheath, genital branch of genitofemoral n. and femoral ringFemoral a.Femoral v.Femoral ringFemoral triangleThis triangle is bounded by: the inguinal ligament (base) superiorly; the medial border of sartorius laterally; the medial border of adductor longus media

52、lly. Inferiorly, the apex of the triangle is continuous with adductor canal.The anterior wall is fascia lataThe posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to lateral side. The femoral triangleThe position: superomedial part of the thighThe formation The superio

53、r boundary: the inguinal lig. The lateral boundary: the medial border of sartoriusThe medial boundary: the medial border of adductor longusThe floor: the iliopsoas, pectineus, adductor longusThe roof: the skin, superficial fascia and deep fasciaThe apex: directed downwards and communicates with the

54、adductor canalContents of the femoral triangle From the lateral to the medial : femoral nerve; femoral sheath from the lateral to the medial: femoral artery; femoral vein; femoral canal; deep inguinal lymph nodes1. The femoral artery and its branchesthe profunda femoris artery，The lateral and medial

55、 circumflex arteries，The deep external pudendal2. The femoral vein and its tributaries.3. Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein. 4. The femoral nerve.5. The femoral canal.Femoral nerveIt arises from the lumbar plexus in the abdomen, and enters the thig

56、h posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2 cm below the inguinal ligament. Muscular branche to: pectineus, sartorius, quadriceps femoris Its cutaneous branches are intermediate, medial femoral cutaneous nerves and the saphe

57、nous nerve. Its articular branches pass to the hip and knee joints. Cutaneous branches: (1) Anterior cutaneous nerves of the thigh (medial and lateral). (2) Saphenous nerve is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the grea

58、t saphenous vein to the medial side of the leg and foot.Femoral artery This is the main artery of the lower limb and is directly continuous with the external iliac artery of the abdomen behind the inguinal ligament at the mid- inguinal point. It becomes the popliteal artery by passing through the ad

59、ductor tendinous opening.Profunda femoris deep femoral a. arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament. gives off the lateral femoral circumflex a., medial femoral circumflex a. & 3-4 branches of the perforating a. Lateral circumflex artery

60、It arises from the profunda near its origin and runs laterally among the branches of the femoral nerve and then deep to rectus femoris. Here it divides into ascending, transverse, and descending branches. Medial circumflex artery arises either from the profunda near its origin or occasionally direct from th