The topographic anatomy of the upper limb will be briefly discussed in this article. The boundaries of this area fully correspond to the scapula. It is characterized by thick and inactive skin, while its own fascia is rather thin, and the superficial fascia is very dense. The latissimus dorsi and trapezius dorsal muscles are covered with their own fascia. A deep leaf, which belongs to its own fascia, is rather dense, it is attached along the edges of the fossa - infraspinatus and supraspinatus. Together with the scapula, they form bone-fibrous receptacles, where the muscles of the same name are located. On the costal (anterior) scapular surface are the cellular space and the subscapularis muscle.
The formations of this area are supplied with blood through the subscapular and suprascapular arteries, as well as the transverse cervical artery. The main nerves of the area are nn. suprascapularis et subscapularis. The topographic anatomy of the upper limb is unique.
deltoid region
The boundaries of this area are limited deltoid muscle. The skin in the deltoid region is rather inactive and dense. Own fascia lies under the superficial fascia and subcutaneous tissue. The sheath of the deltoid muscle is formed by its own fascia, it gives off spurs into its thickness. The subdeltoid space is located directly under the muscle. The subdeltoid space contains the main neurovascular bundle (a. circumflexa humeri anterior, n. axillaris and the veins of the same name), as well as the tendons of the muscles of the deltoid region.
It is projected to the point where a vertical line intersects, drawn from the posterior edge of the deltoid muscle to the posterior corner of the acromion. What else is included in the topographic anatomy of the upper limb?
Subclavian region
The boundaries of this area are limited from above by the clavicle, from below - by a horizontal line that is drawn along the edge of the third rib (in women - along the upper edge of the mammary gland), by the edge of the sternum - medially, laterally - by the front edge of the deltoid muscle.
The subclavian region of the upper limb is characterized by thin and mobile skin. The subcutaneous tissue is very well developed and has a cellular structure. Skin nerves stretch in the fiber, namely nn. supraclaviculares, which also extend from the lateral and anterior branches of the intercostal nerves. The topography and anatomy of the human upper limb has been studied for a long time.
The own fascia of this area forms a case in which the pectoralis major muscle is located. She also gives her partitions into the thickness of the pectoralis major muscle. This is due to the isolated nature of purulent processes occurring in the muscle. Between the fascia clavipectoralis, which covers the pectoralis minor, and the pectoralis major, there is a cellular superficial subpectoral space. It does not exclude the localization of lymphomas. Pus can penetrate along the nerves and vessels that perforate their own fascia, under the pectoralis major muscle. The topographic anatomy of the upper limb is extensive.
superficial fascia
The superficial fascia of this area is rather thin; for women, its compaction downwards from the collarbone is typical. There it forms a ligament that supports the mammary gland.
The fascia clavipectoralis is attached to the clavicle, ribs, and coracoid process, forming sheaths in which the subclavian and pectoralis minor muscles are attached. It grows together with the fascia at the lower edge belonging to the pectoralis major muscle. As a result, lig is formed. suspensorium axillae. Deep subpectoral space is located under small muscle chest. In the subclavian region, it is customary to distinguish three triangles projected onto the armpit, in particular, onto its anterior wall.
The subclavian artery, bundles and veins of the brachial plexus are projected to the middle of the clavicle. This projection fully corresponds to the groove, which is located between the pectoralis major muscle and the deltoid muscle. This is not the whole topographic anatomy of the upper limb.
Armpit
The boundaries of this area are limited in front by the lower edge of the pectoralis major muscle, laterally - by a line that connects the edges of the large muscle on the chest and the latissimus muscle on the back on the shoulder, behind - by the lower edge of the latissimus dorsi muscle and the large round muscle.
If a person abducts the upper limb, the axillary region takes the form of a depression or fossa. If you remove the skin, fascia and subcutaneous fatty tissue, the fossa takes the form of a cavity.
The skin of the axillary region is very thin, has mobility, and is covered with hair. It contains quite a lot of sebaceous and apocrine sweat glands. If an inflammatory process develops in them, the formation of hydroadenitis and boils is not excluded. In this area, the subcutaneous tissue is rather poorly developed, it is located in layers. Almost completely absent superficial fascia. Topographic anatomy and operative surgery of the upper limb are of great importance in medicine.
own fascia
The fascia in the center of the axillary region is very thin, it has multiple gaps through which nerves and skin vessels stretch. Own fascia thickens at the edges, and then passes into the fascia, which covers the muscles of the walls of the armpit. Further, it passes into the brachial fascia. If you remove your own fascia, the muscles that the muscular cavity is limited to are found. It has a shape resembling a truncated quadrangular pyramid, the base of which is turned downwards. This is described in the book by O.P. Bolshakov "Topographic anatomy of the upper limb".
Small and large pectoral muscles
The anterior wall of the armpit is formed by the small and big muscle on the chest, posterior - subscapularis, teres major and latissimus dorsi, medial - outer surface chest And serratus muscle anterior, lateral - the coracoid brachialis muscle and the medial surface, including the humerus and the short head of the biceps muscle.
The armpit contains loose fatty tissue, the brachial plexus and nerves that depart from it, blood vessels, lymph nodes, v. axillaris and its tributaries, a. axillaris and its branches.
Arteries, veins and bundles located in this area are projected onto the border between the middle and anterior thirds of the armpit width.
We have considered the topographic anatomy of the upper limb.
radial furrow, sulcus radialis, limited:
- laterally: m. brachioradialis;
- medially: m. flexor carpi radialis;
- furrow contents: 1) a. radialis; 2) vv. radiales; 3) ramus superficialis n. radialis(it passes in the upper part of the furrow, and then passes to the back surface).
Median sulcus, Sulcus medianus, limited:
- laterally: m. flexor carpi radialis;
- medially: ;
- furrow contents: n. medianus.
Ulnar furrow, sulcus ulnaris, limited:
- laterally: m. flexor digitorum superficialis;
- medially: m. flexor carpi ulnaris;
- furrow contents: 1) a. ulnaris; 2) vv.ulnares; 3) n. ulnaris.
supinator canal, canalis supinatorius, limited:
- laterally: m. supinator;
- medially: collum radii;
- channel content: ramus profundus n. radialis.
Topography of the hand
palmar surface(Fig. 5.24B):
a) the synovial sheaths of the flexor muscles protrude above the edge retinaculum flexorum 1-2 cm in the proximal and distal directions;
b) tendon sheath long flexor thumb continues to the base of the nail phalanx;
c) the common sheath of the flexors blindly ends in the middle of the palm, and in the little finger area it reaches the nail phalanx;
d) on the fingers, the tendons of the superficial and deep flexors going to the II-IV fingers have isolated, blindly ending synovial cases, located from the base of the nail phalanges to the heads of the metacarpal bones.
Back surface(Fig. 5.25A):
The synovial sheaths of the rear of the hand surround the extensor tendons of the hand and fingers and lie under retinaculum extensorum. Synovial sheaths extend proximally and distally beyond its limits. In the proximal direction, individual synovial sheaths protrude from under retinaculum extensorum 2-3 cm, distally they continue to the middle of the metacarpal bones.
There are six synovial sheaths on the back of the hand:
the first is for the tendons of the long abductor and short extensor muscles of the thumb, vagina tendinum mm. abductoris longi and extensoris brevis pollicis;
the second - for the tendons of the short and long radial extensor of the hand, vagina tendinum mm. extensorum carpi radialium;
the third is for the tendon of the long extensor of the thumb, vagina tendinis m. extensoris pollicis longi;
the fourth - for the tendons of the extensor of the fingers and the extensor of the index finger, vagina tendinum mm. extensoris digitorum and extensoris indicis;
fifth - for the tendon of the muscle that extends the thumb, vagina tendinis m. extensoris digiti minimi;
sixth - for the tendon of the ulnar extensor of the hand, vagina tendinis m. extensoris carpi ulnaris.
Anatomical snuffbox- a triangular-shaped gap that borders in front and outside with m. extensor pollicis brevis And m. abductor pollicis longus, and behind - with a tendon m. extensor pollicis longus. The bottom of the anatomical snuffbox is formed by the scaphoid and trapezius bones. Its pinnacle is bassis os metacarpalia (I), and the base is the outer edge of the radius. The anatomical snuffbox is topographically connected with the radial artery, which penetrates into it under the tendons. mm. extensor pollicis brevis And m. abductor pollicis longus.
Ulnar fossa (fossa cubitalis) from above it is limited by the shoulder muscle; from the lateral side - by the brachioradialis muscle, from the medial side - by the round pronator; the bottom of the cubital fossa is formed by the brachialis muscle.
IN anterior region of the forearm (regio antebrachii anterior) allocate 3 furrows:1 - radial groove (sulcus radialis); 2 - median sulcus (sulcus medianus); 3 - ulnar groove (sulcus ulnaris).
Radial sulcus (sulcus radialis) limited to the brachioradialis muscle and the radial flexor of the wrist. This groove contains the radial artery, veins and superficial branch of the radial nerve.
Median sulcus (sulcus medianus) limited by the flexor carpi radialis and flexor digitorum superficialis. The median nerve is located in the median sulcus.
Ulnar furrow (sulcus ulnaris) located between the superficial flexor of the fingers and the ulnar flexor of the wrist. In this groove, the ulnar artery, veins and ulnar nerve are found.
In the anterior region of the wrist (regio carpalis anterior ) under the flexor retinaculum are formed 3 channels: 1 - canal of the wrist (canalis carpi) (middle channel); 2 - radial canal of the wrist (canalis carpi radialis) (lateral canal); 3 - ulnar canal of the wrist (canalis carpi ulnaris) (medial canal).
In the canal of the wrist (canalis carpi) muscle tendons are located, surrounded by two synovial sheaths: the tendons of the superficial flexor of the fingers (m. flexor digitorum superficialis) and the deep flexor of the fingers (m. flexor digitorum profundus); tendons of the long flexor of the thumb (m. flexor pollicis longus); and median nerve.
In the radial canal of the wrist (canalis carpi radialis) the tendon of the radial flexor of the wrist is located ( m. flexoris carpi radialis).
In the ulnar canal of the wrist (canalis carpi ulnaris) the ulnar nerve (nervus ulnaris), the ulnar artery (arteria ulnaris) and the ulnar veins (venae ulnares) pass through.
Rice. Topography of the anterior wrist
Under the extensor retinaculum (retinaculum extensorum), due to the fascial septa extending from it to the bones of the wrist, 6 channels for the tendons of the extensor muscles of the hand and fingers, surrounded by synovial sheaths:
1 - tendon of the long abductor muscle and short extensor of the thumb (tendinum mm. abductoris longi et extensoris brevis pollicis);
2 - tendon of the radial extensor of the wrist (tendinum m. extensor carpi radialis);
3 - tendon of the long extensor of the thumb (tendinum m. extensor pollicis longi);
1. Skin (cutis) thin, mobile on the inner surface of the forearm, saphenous veins shine through it. The skin of the anterior forearm in lean subjects (Fig. 2-46) usually shows a radial sulcus of the forearm. (sulcus radialis), located between the elevation of the brachioradialis muscle on the radial side and the elevation of the pronator teres and flexor carpi radialis on the ulnar side. The radial groove of the forearm at the top passes into the cubital fossa (fossa cubiti).
2. Fat deposits (panniculus adiposus), tend to be thicker in children early age and women. Superficial veins and cutaneous nerves pass through the fat deposits (Fig. 2-47).
Lateral saphenous vein of the arm (v.
cephalic) passes along the anterior surface of the forearm near the radial edge along with the lateral cutaneous nerve of the forearm (n. cutaneus antebrachii lateralis), which is a branch of the musculocutaneous nerve (n. musculocutaneus).
Medial saphenous vein of the arm (v. basilica) runs along the anterior surface of the forearm near the ulnar edge along with the medial cutaneous nerve of the forearm (n. cutaneus antebrachii medialis), arising from the medial bundle of the brachial plexus.
Intermediate vein of the forearm (v. intermedia antebrachii) occurs intermittently, passes in the middle of the palmar surface of the forearm and enters the cubital fossa.
3. Superficial fascia (fascia superficialis)
weakly expressed, loosely connected with the self-
Rice. 2-46. External landmarks of the anterior region of the forearm. 1 - styloid process of the radius, 2 - radial flexor of the wrist, 3 - ulnar fossa, 4 - tendon of the biceps muscle of the shoulder, 5 - medial saphenous vein of the arm, 6 - intermediate saphenous vein of the forearm, 7 - long palmar muscle, 8 - ulnar flexor of the wrist , 9 - proximal skin fold of the wrist, 10 - distal skin fold of the wrist. (From: Forged VV, Travin AL.
fascia of the forearm, which in case of injury contributes to the detachment of the surface layers from its own fascia and the formation of patchwork wounds.
4. Own fascia of the forearm (fascia
antebrachii).
5. Muscles of the anterior region of the forearm
placed in four layers.
The first layer is formed by the following muscles (Figure 2-48).
Rice. 2-47. Superficial vessels and nerves of the forearm. 1 - palmar branch of the median nerve, 2 - superficial branch of the radial nerve, 3 - brachioradialis muscle, 4 - radial flexor of the wrist, 5 - lateral cutaneous nerve of the forearm 6 - posterior cutaneous nerve of the forearm, 7 - fascia of the forearm, 8 - medial cutaneous nerve of the forearm, 9 - medial saphenous vein of the arm, 10 - ulnar flexor of the wrist, 11 - superficial flexor of the fingers , 12 - long palmar muscle, 13 - palmar branch of the ulnar nerve, 14 - flexor retinaculum. (From: Forged V.V., Travin A.A. Surgical anatomy of the upper limb. - M., 1965.)
Rice. 2-48. The first layer of muscles of the anterior region of the forearm. 1 - long flexor of the thumb, 2 - brachioradialis muscle, 3 - superficial flexor of the fingers, 4 - biceps shoulder, 5 - aponeurosis of the biceps muscle of the shoulder, 6 - round pronator, 7 - radial flexor of the wrist, 8 - long palmar muscle, 9 - ulnar flexor of the wrist, 10 - flexor retinaculum. (From: Sinelnikov R.D. Atlas of human anatomy. - M., 1972. - T. I.)
♦ Shoulder (t. brachioradialis) located at the radial edge of the forearm, begins in the lower third of the shoulder from the lateral intermuscular septum of the shoulder (septum intermusculare brachii
laterale) and is attached by a long tendon over the styloid process of the radius (processus styloideus radii). The muscle flexes the forearm, while either its partial supination occurs (if the hand was in the pronation position), or, with muscle contraction, some of its pronation (if the hand is supinated). In other words, when this muscle contracts, the forearm occupies an intermediate position between pronation and supination. The brachioradialis muscle is innervated by the radial nerve (n. radialis).
♦ Round pronator (i.e. pronator teres) starts with two heads: humeral (caput humerale) from the medial epicondyle (epicondylus medialis) and ulnar (caput ulnare) from the coronoid process of the ulna (processus coronoideus ulnae). Heading obliquely down and outward, the tendon of the muscle flexes the radius, to which it is attached. The muscle not only penetrates, but also flexes the forearm. The pronator teres is innervated by the median nerve. (n. medianus).
♦ Flexor carpi radialis (t. flexor carpi radialis) starts from the medial epicondyle (epicondylus medialis) and crosses the forearm in an oblique direction. In the middle third of the forearm, the muscle turns into a tendon, passes with its tendon under the flexor retinaculum (retinaculum flexorum) in the radial carpal tunnel (canalis carpi radialis), located in the groove of the trapezoid bone (os trapezium), and is attached to the bases of the II and III metacarpal bones. The muscle is located in the first layer of the anterior group. The radial flexor of the wrist is innervated by the median nerve (n. medianus).
♦ Longus volar muscle (t. palmaris longus) also originates from the medial epicondyle (epicondylus medialis), goes down and with a thin tendon passes over the flexor retinaculum (retinaculum flexorum) woven into the palmar aponeurosis (aponeurosis palmaris). The muscle is innervated by the median nerve (n. medianus).
♦ Flexor carpi ulnaris (i.e. flexor carpi ulnaris) starts with two heads
kami: shoulder (caput humerale) from the medial epicondyle (epicondylus medialis) and ulnar (caput ulnare) from the top third rear surface ulna. In the middle third of the forearm, the muscle passes into the tendon, which is attached to the pisiform bone. (os pisiforme). The muscle is innervated by the ulnar nerve (n. ulnaris). In the second layer (Fig. 2-49) is the superficial flexor of the fingers (i.e. flexor digitorum superficialis). which begins with two heads: humeroulnar (caput humeroulnare) from the medial epicondyle (epicondylus medialis) and coronoid process of the ulna (processus coronoideus ulnae) and radiation (caput radiale) from the upper third of the anterior surface of the radius. Connecting in the middle third of the forearm, the abdomen of the muscle is divided into four parts, passing into four tendons, which are further under the flexor retinaculum (retinaculum flexorum) through the carpal tunnel (canalis carpi) pass to the brush. At the level of the base of the proximal phalanges, each tendon divides into two legs and attaches to the base of the middle phalanges. The muscle flexes the middle phalanges of the II-V fingers. With isolated damage to the tendon of the superficial flexor, flexion of the finger is not disturbed. The superficial flexor of the fingers is innervated by the median nerve. (n. medianus). The second layer of muscles is separated from the third by a deep plate of the forearm's own fascia, which divides the anterior compartment of the forearm into superficial and deep sections. The third layer of muscles (Figure 2-50) is formed by the deep flexor of the fingers and the long flexor of the thumb. ♦ Deep finger flexor originates from the ulna and interosseous membrane (membrana interossea). In the middle of the forearm, the muscle is divided into four tendons, which through the carpal tunnel (canalis carpi) pass to the hand, go to the fingers, penetrate between the legs of the superficial flexor and attach to the base of the distal phalanges of the II-V fingers. The muscle flexes the middle and distal phalanges
Rice. 2-49. The second layer of muscles of the anterior region of the forearm. 1 - square pronator, 2 - long flexor of the thumb, 3 - brachioradialis muscle, 4 - long radial extensor of the wrist, 5 - supinator, 6 - superficial flexor of the fingers, 7 - ulnar flexor of the wrist. (From: Sinelnikov R.D. Atlas of human anatomy. - M., 1972.-T. I.)
II-V fingers. With an isolated injury to the deep flexor tendon, there is no flexion of the distal phalanx, but flexion in the proximal interphalangeal and metacarpal is possible.
Rice. 2-50. The third layer of muscles of the anterior region of the forearm. 1 - square pronator, 2 - brachioradialis muscle, 3 - round pronator, 4 - long radial extensor of the wrist, 5 - supinator, 6 - long flexor of the thumb, 7 - deep flexor of the fingers, 8 - ulnar flexor of the wrist. (From: Forged V.V., Travin A.A. Surgical anatomy of the upper limb. - M., 1965.)
phalangeal joints. If the tendons of the superficial and deep flexors of the fingers are damaged, flexion in the interphalangeal joints is impossible, but flexion in the metacarpophalangeal joints is possible.
in the joint due to the interosseous and vermiform muscles. The two lateral heads of the deep flexor of the fingers are innervated by the median nerve (n. medianus), two medial heads - ulnar nerve (n. ulnaris).♦ Flexor thumb longus (i.e. flexor pollicis longus) starts from the external epicondyle and the palmar surface of the radius in the upper third of the forearm. In the lower third of the forearm, the muscle passes into the tendon passing through the carpal tunnel (canalis carpi) and is attached to the base of the distal phalanx of the first finger. The muscle is innervated by the median nerve (n. medianus).
The fourth layer of muscles (Fig. 2-51) is formed
called a square pronator (t. pronator quadratus), which originates on the volar surface of the ulna, runs transversely, and inserts on the volar surface of the radius. The muscle pronates the forearm, rotating the radius around the ulna. The quadrate pronator is innervated by the median nerve. (n. medianus). Between the muscles of the third layer and the square pronator in the lower third of the forearm, on the border with the wrist, there is a space Pi-rogov-ferry, where pus can break through with tendovaginitis of the thumb and little finger. 6. Beam (radius) and ulnar (ulna) bones connected by the interosseous membrane of the forearm (membrana interossea antebrachii).
DEEP VESSELS AND NERVES OF THE ANTERIOR REGION OF THE FOREARM
1. Radial artery (a. radialis) departs from the brachial artery in the cubital fossa, goes to the lateral canal of the forearm (canalis antebrachii lateralis; rice. 2-52), where it passes accompanied by the superficial branch of the radial nerve (ramus superftcialis n. radialis).
Lateral canal of the forearm (canalis
antebrachii lateralis) located at the bottom of the radial groove (sulcus radialis), the projection of which corresponds to the line connecting
the outer edge of the tendon of the biceps muscle with the styloid process of the radius.
The lateral canal of the forearm is limited
medially with round pronator (i.e. pronator teres) and flexor carpi radialis (t. flexor carpi radialis), lateral - brachioradialis muscle (t. brachioradialis), front - fascia of the forearm (fascia antebrachii), behind - supinator (i.e. supinator) in the upper third of the forearm, round pronator (i.e. pronator teres) in the middle third of the forearm, long flexor of the thumb (i.e. flexor pollicis longus) in the lower third of the forearm.
2. Superficial branch of the radial nerve
(ramus superficialis n. radialis) in the middle
a third of the forearm accompanies the radial
artery, in the lower third of the forearm from
leans away from the radial artery lateral
but, passes under the tendon of the brachioradialis
howling muscles and goes to the back
surface of the forearm, and then pass
feeds on the hand, where it innervates two from to
lovina finger on the radial side.
The ulnar artery, moving away from the brachial artery
teria in the cubital fossa between the heads of the round pronator, gives off the common interosseous artery (a. interossea communis). The common interosseous artery between the deep flexor of the fingers and the long flexor of the thumb reaches the interosseous membrane, where it divides into two branches: the anterior interosseous artery and the posterior interosseous artery.
♦ Anterior interosseous artery (a. interossea anterior) located on the anterior surface of the interosseous membrane. An artery that accompanies the median nerve departs from the anterior interosseous artery (a. comitans n. mediani). In the lower third of the forearm, the anterior interosseous artery passes behind the quadrate pronator and passes through the opening in the interosseous membrane into the posterior muscle bed. The anterior interosseous artery is of great importance for the bypass circulation during ligation of the radial and ulnar arteries.
♦ Posterior interosseous artery (a. interossea posterior) goes to the rear
Rice. 2-51. The fourth layer of muscles of the anterior region of the forearm. 1 - supinator, 2 - round pronator, 3 - interosseous membrane, 4 - square pronator. (From: Sinelnikov R.D. Atlas of human anatomy. - M., 1972. - T. i.)
shoulders through a hole in the interosseous
membrane. Further, the ulnar artery passes behind the brachial head of the round pronator and the median nerve down and medially, lies in the middle third of the forearm in the medial canal of the forearm (canalis antebrachii medialis; rice. 2-53), approaching the ulnar nerve passing through the canal (n. ulnaris). The medial canal of the forearm is bounded medially by the flexor carpi ulnaris (i.e. flexor carpi ulnaris), laterally - superficial finger flexor (i.e. flexor digitorum supeificialis), sp-
Rice. 2-52. Lateral canal of the forearm. 1 - superficial branch of the radial nerve, 2 - long flexor of the thumb, 3 - supinator, 4 - brachioradialis muscle, 5 - radial artery, 6 - round pronator, 7 - radial flexor of the wrist. (From: Forged V.V., Travin A.A. Surgical anatomy of the upper limb. - M., 1965.)
Rice. 2-53. The medial canal of the forearm and its contents. 1 - median nerve, 2 - anterior interosseous nerve, 3 - common interosseous artery, 4 - ulnar nerve, 5 - ulnar artery, 6 - superficial flexor of the fingers, 7 - ulnar flexor of the wrist. (From: Forged V.V., Travin A.A. Surgical anatomy of the upper limb. - M., 1965.)
redi - own fascia of the forearm (fascia antebrachii), behind - deep finger flexor (i.e. flexor digitorum profundus). The ulnar artery, in addition to the common interosseous artery, gives off muscle branches to the forearm.
4. Ulnar nerve (n. ulnaris) on the forearm
passes between the two heads of the elbow
thoracic flexor of the wrist (i.e. flexor carpi
ulnaris) and lies in the medial canal
forearms (canalis antebrachii medialis), Where
in the middle third of the forearm approaches him
dit ulnar artery. In the lower third
forearm departs from the ulnar nerve
dorsal branch (ramus dorsalis n. ulnaris),
which is under the tendon of the elbow
the body of the wrist wraps around the ulna, about
butts the fascia of the forearm and in the subcutaneous
fiber goes to the rear of the hand, where in-
unnerves two and a half fingers with lok
your side. Ulnar vascular-not
straight bundle along the medial canal
forearm reaches the wrist and through
ulnar canal of the wrist (canalis carpi
ulnaris) passes to the brush.
5. Median nerve (n. medianus; rice. 2-54)
penetrates on the forearm between the shoulder
and ulnar heads of the round pronator
(i.e. pronator teres) and then lies strictly
in the middle of the forearm between the surfaces
nym and deep flexors of the fingers (tt.
flexor digitorum superficialis and flexor digitorum
profundus). From the median nerve between
by the dexterity of the round pronator departs pe
medial interosseous nerve of the forearm (P.
interosseus antebrachii anterior), which is in
guiding the vessels of the same name about
walks between the deep flexor of the fingers
and flexor thumb longus
brushes, lies on the front surface
interosseous membrane and goes down posture
di quadrate pronator, giving branches
to nearby muscles. In the lower third
forearm median nerve laterally
bends around the superficial flexor of the fingers
(i.e. flexor digitorum superficialis) and on the verge
ce with the wrist lies between the tendons
mi flexor carpi radialis (i.e. flexor
carpi radialis) laterally, superficial
finger flexor (i.e. flexor digitorum
superficialis) medially, long palmar
muscles (t. palmaris longus) front and deep
lateral flexor of fingers (i.e. flexor digitorum profundus) behind. Next, the median nerve along with the tendons three muscles(superficial and deep flexors of the fingers and long flexor of the thumb) passes to the hand through the carpal tunnel (canalis carpi).
Shoulder - the topographic region of the upper limb, limited: from above - by a line connecting the lower edges of the large chest muscle and latissimus dorsi; from below - a line drawn two transverse fingers above the level of the epicondyles humerus. Vertical lines through the epicondyles of the humerus separate the anterior region of the shoulder from the posterior region.
Layered structure of the anterior region of the shoulder
Leather relatively thin, especially in the medial part of the region, quite mobile. It is innervated by the medial cutaneous nerve of the shoulder and the cutaneous nerves of the axillary and radial nerves.
Subcutaneous tissue loose. The superficial fascia is quite well expressed in the lower third of the region, where it forms a case for the saphenous veins and nerve, in other places it is weakly expressed.
Own fascia (fascia of the shoulder) from above passes into the axillary, deltoid, pectoral fascia and fascia of the latissimus dorsi muscle, from below - into the fascia of the forearm. Throughout the middle third of the shoulder in the projection of the medial ulnar groove in the splitting of its own fascia, which is called Pirogov's interfascial canal, the medial saphenous vein of the arm and the cutaneous nerve of the forearm pass (the vein lies on the lateral side of the nerve). The fascia of the shoulder is fixed to the epicondyles of the humerus and the olecranon of the ulna. From it in the direction of the humerus two intermuscular septa of the shoulder, separating the anterior fascial bed from the posterior one (Fig. 28). The medial intermuscular septum of the shoulder forms the sheath of the neurovascular bundle, which is projected along the medial edge of the biceps brachii. walls anterior fascial bed of the shoulder are: in front - own fascia, behind - the humerus with intermuscular septa attached to it.
Rice. 28.
1 - median nerve; 2 - brachial artery and veins; 3 - biceps muscle of the shoulder; 4 - lateral cutaneous nerve of the forearm; 5 - lateral saphenous vein of the arm; 6 - shoulder muscle; 7 - humerus; 8 - radial nerve; 9 - brachioradialis muscle; 10- lateral intermuscular septum of the shoulder; 11 - triceps shoulder 12 - medial intermuscular septum of the shoulder; 13 - ulnar nerve; 14 - medial cutaneous nerve of the forearm; 15 - medial saphenous vein of the arm
muscles the anterior fascial bed of the shoulder - the flexor muscles of the shoulder and forearm, innervated by the musculocutaneous nerve. These include:
- coracobrachial muscle- located in the upper third of the shoulder; the musculocutaneous nerve passes through its thickness, which then goes down and laterally between the biceps and shoulder muscles;
- long and short heads biceps brachii(the long head lies more superficially);
- shoulder muscle- starts from the humerus below the place of attachment of the coracobrachial and deltoid muscles.
The composition of the neurovascular bundle of the anterior fascial bed of the shoulder includes brachial artery (a. brachialis) and namesake veins, median And ulnar nerve. The projection line of the brachial artery begins at a point on the border of the anterior and middle third of the width of the axillary fossa, ends in the middle of the elbow bend (1 cm medial to the tendon of the biceps muscle of the shoulder). In the upper third of the shoulder, the median nerve lies in front, and in the lower third - on the medial side relative to the brachial artery. The ulnar nerve in the upper third of the shoulder is part of the anterior fascial bed, located on the medial side of the brachial artery. At the border of the middle and lower thirds of the shoulder, the nerve pierces the medial intermuscular septum and passes into the posterior fascial bed. Most superficially, it is located behind the medial epicondyle of the humerus and in this place can be injured.
Starts from the brachial artery deep artery of the shoulder(departs in the upper third of the shoulder), upper And inferior collateral ulnar artery. They originate, respectively, in the middle and lower third of the shoulder (the superior collateral artery accompanies the ulnar nerve). The ulnar and median nerves do not give branches on the shoulder.
Bone base of the shoulder makes up the diaphysis of the humerus.
