2024 Human Anatomy and Dissection Day10 (Handout) PDF

2024 Human Anatomy and Dissection: Day 10 Upper arm, forearm, and hand （Posterior: Extensors） じょうわん ぜんわん て 上腕、前腕と手 こうめん しんきん （後面：伸筋） Goals of this lesson Students must understand and be able to descr...

2024 Human Anatomy and Dissection: Day 10 Upper arm, forearm, and hand （Posterior: Extensors） じょうわん ぜんわん て 上腕、前腕と手 こうめん しんきん （後面：伸筋） Goals of this lesson Students must understand and be able to describe: 1. The structures of the triangular space and the quadrangular space. ないそく えきか げき がいそく えきか げき こうぞう （内側腋窩隙と外側腋窩隙の構造） 2. The muscles of the extensors. じょうし しんきん ぐん （上肢の伸筋群） Muscles from the scapula to the humeral head けんこうこつ じょうわん こっとう ふちゃく きん （肩甲骨から上腕骨頭に付着する筋） Muscles attached to the scapula There are 17 muscles attached to the scapula. Trapezius（僧帽筋：そうぼう きん） Deltoid（三角筋：さんかく --） Latissimus Dorsi（広背筋：こうはい --） Levator Scapulae（肩甲挙筋：けんこうきょ --） Rhomboid Minor（小菱形筋：しょう りょうけい --） Rhomboid Major（大菱形筋：だい りょうけい --） Supraspinatus（棘上筋：きょくじょう --） Infraspinatus（棘下筋：きょくか --） Teres Minor（大円筋：だいえん --） Teres Major（小円筋：しょうえん --） Omohyoid（肩甲舌骨筋：けんこう ぜっこつ --） Serratus Anterior（前鋸筋：ぜんきょ --） Subscapularis（肩甲下筋：けんこう か --） Pectoralis Minor（小胸筋：しょうきょう --） Coracobrachialis（烏口腕筋：うこうわん --） Triceps Brachii （long head）（上腕三頭筋長頭：じょうわん さんとう --） Biceps Brachii（上腕二頭筋：じょうわん にとう --） Netter Collection of Medical Illustrations: Musculoskeletal System, Part II - Spine and Lower Limb, Second Edition Posterior scapular region （肩甲骨後面：けんこうこつ こうめん） Posterior scapular region is located deep to the trapezius and deltoid muscles. It contains 4 muscles, which pass between the scapula and proximal end of the humerus. Supraspinatus（棘上筋） Infraspinatus（棘下筋） Teres minor（小円筋） Teres major（大円筋） Gray's Anatomy for Students, Fifth Edition Supraspinatus/Infraspinatus（棘上筋・棘下筋） Supraspinatus（棘上筋） Origin: Supraspinous fossa（棘上窩：きょくじょう か） Insertion: Greater tubercle of the humerus Nerve: Suprascapular nerve （肩甲上神経） Function: Initiation of abduction of arm Infraspinatus（棘下筋） Origin: Infraspinous fossa（棘下窩：きょくか か） Insertion: Greater tubercle of the humerus Nerve: Suprascapular nerve （肩甲上神経） Function: lateral rotation of arm Supraspinatus and infraspinatus together with teres minor and subscapularis form the rotator cuff（回旋筋腱板：かいせんきん けんばん） and supports the glenohumeral （shoulder） joint. Gray's Anatomy for Students, Fifth Edition Suprascapular foramen （肩甲上孔：けんこう じょうこう） Suprascapular foramen is the route through which structures pass between base of neck and posterior scapular region. It is formed by the suprascapular notch （肩甲切痕：けんこう せっこん）and the superior transverse scapular ligament （上肩甲横靭帯：じょう けんこう おう じんたい）, which converts the notch into a foramen. Suprascapular nerve（肩甲上神経）passes through this foramen. But suprascapular AV（肩甲上動・静脈）which follow the same course as the nerve do not pass this foramen and pass immediately superior to the ligament. Netter Collection of Medical Illustrations: Gray's Anatomy for Students, Gray's An Musculoskeletal System, Part I - Upper Limb, Second Edition Fifth Edition Fifth Edit Reference 2024.10.15 Trunks （幹：かん）: 3 The only branches from the trunks of the brachial plexus are two nerves that originate from the superior trunk （upper trunk）: the suprascapular nerve（肩甲上神経：けんこうじょう しんけい） and the subclavius nerve（鎖骨下神経：けんこう か --）. Suprascapular n. = Supraspinatus m. （棘上筋：きょくじょう きん） Infraspinatus m. （棘上筋：きょくか --） Gray's Anatomy for Students, Fourth Edition Supraspinatus m. Infraspinatus m. Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition  Netter Atlas of Human Anatomy: Classic Regional Anatomy Approach, Eighth Edition Muscles and nerve innervation Supraspinatus Infraspinatus = Suprascapular n. Teres minor Deltoid = Axillar n. Gray's Anatomy for Students, Fifth Edition  Muscles and nerve innervation Subscapularis Teres major = Subscapular n. Latissimus dorsi = Thoracodorsal n. Netter Atlas of Human Anatomy: Classic Regional Anatomy Approa Gray's Anatomy for Students, Fifth Edition Triangular space and quadrangular space ないそく えきか げき がいそく えきか げき （内側腋窩隙と外側腋窩隙）  Netter Atlas of Human Anatomy: Classic Regional Anatomy Approach, Eighth Edition Posterior scapular region In the posterior wall of the axilla, there are 3 important spaces. Triangular space（内側腋窩隙） Quadrangular space（外側腋窩隙） Triangular interval（和名無し‼） Those spaces are formed by teres minor（小円筋）, Gray's Anatomy for Students, teres major（大円筋）, long head of Fifth Edition the triceps brachii（上腕三頭筋長頭） and humerus.  Netter Atlas of Human Anatomy: Classic Regional Anatomy Approach, Eighth Edition Triangular space is an area of communication between the axilla and the posterior scapular region. Contents: Circumflex scapular AV（肩甲回旋） Gray's Anatomy for Students, Fifth Edition  Netter Atlas of Human Anatomy: Classic Regional Anatomy Approach, Eighth Edition Quadrangular space provides a passageway for nerves and vessels passing between the axilla and the deltoid regions. Contents: Axillary nerve（腋窩神経） Posterior circumflex humeral AV Gray's Anatomy for Students, （後上腕回旋：こう じょうわん かいせん --） Fifth Edition  Netter Atlas of Human Anatomy: Classic Regional Anatomy Approach, Eighth Edition Triangular interval is where radial nerve（橈骨神経） and deep artery of arm（上腕深動脈） passes out of the axilla traveling through to reach Gray's Anatomy for Students, the posterior compartment of the arm. Fifth Edition In anterior aspect, insertion of the latissimus dorsi will be the good landmark to identify the radial nerve and the axillary nerve with the posterior circumflex humeral AV. Netter Collection of Medical Illustrations: Gray's Anatomy for Students, Fifth Edition Musculoskeletal System, Part I - Upper Limb, Second Edition Reference 2024.10.15 Major branches of the brachial plexus There are 5 major branches from the brachial plexus, which are Musculocutaneous n., Median n., Ulnar n. （3 anterior） and Radial n., Axillary n. （2 posterior）. Lateral cord Musculocutaneous nerve （筋皮神経：きんぴ しんけい） Median nerve （lateral root） （正中神経：せいちゅう --） Posterior cord Radial nerve （橈骨神経：とうこつ --） Axillary nerve （腋窩神経：えきか --） Medial cord Netter Collection of Medical Illustrations: Median nerve （medial root） Musculoskeletal System, Part I - Upper Limb, Second Edition Ulnar nerve （尺骨神経：しゃくこつ --） Compartments in the upper limb じょうし （上肢のコンパートメント） Posterior （extensor） compartments of the upper limb Muscles of the arm/forearm are separated into anterior （flexor） and posterior （extensor） compartments by layers of fascia, intermuscular septa（筋間中隔：きんかん ちゅうかく）, and bone. *Interosseous membrane （骨間膜：こっかんまく）also in the forearm. Gray's Anatomy for Students, Fifth Edition Extensors of the arm じょうわん しんきん ぐん （上腕伸筋群） Extensors of arm（上腕伸筋群） The only muscle of the posterior compartment of the arm is the triceps brachii muscle（上腕三頭筋）. Origin: Long head（長頭）: infraglenoid tubercle of the scapula Medial head（内側頭）: Humerus Lateral head（外側頭）：Humerus Insertion: Olecranon（肘頭） Function: Elbow: Extension Shoulder: Extension and adduction （Long head only） Netter Collection of Medical Illustrations: Musculoskeletal System,Part I - Upper Limb, Second Edition  Reference“Clinical tips” Humerus fracture and radial nerve palsy Fractures from the middle to the distal third of humerus most common for causing radial nerve palsy（橈骨神経麻痺：とうこつ しんけい まひ）. Transverse and spiral fractures the most common types associated with nerve injury. By the radial nerve palsy, wrist drop（下垂手：かすい しゅ）, （Saturday night palsy or honeymoon palsy） occurs. This is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints If the radial nerve is injured in the middle of the upper arm, it will result in a drop hand, and if it is injured on the flexor side of the elbow joint, it will result in a drop finger. *Original text is Japanese Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition 橈骨神経麻痺 後骨間神経麻痺 「橈骨神経麻痺」｜日本整形外科学会 症状・病気をしらべる (joa.or.jp) Extensors of the forearm ぜんわん しんきん ぐん （前腕伸筋群） Extensors of the forearm Muscles in the posterior compartment of the forearm divide into 2 layers. Superficial layer Deep layer Those muscles are associated with movement of the wrist joint, extension of the fingers and thumb, and supination. Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Superficial extensors of the forearm There are 7 muscles in the superficial layer. Brachioradialis （腕橈骨筋：わん とうこつ --） Extensor carpi radialis longus （長橈側手根伸筋：ちょうとうそくしゅこんしんーー） Extensor carpi radialis brevis （短橈側手根伸筋：たん －－－－） Extensor digitorum （指伸筋：し しん ーー） Extensor digiti minimi （小指伸筋：しょうし しんーー） Extensor carpi ulnaris （尺側手根伸筋しゃくそく しゅこん しんーー） Anconeus （肘筋：ちゅう --） All have a common origin from the supraepicondylar ridge and lateral epicondyle（外側上顆：がいそく じょうか） of the humerus and, extend as tendons into Netter Collection of Medical Illustrations: the hand. （Except brachioradialis and anconeus） Musculoskeletal System, Part I - Upper Limb, Second Edition Brachioradialis（腕橈骨筋） Brachioradialis is overlying the anterolateral surface of the forearm in the anatomical position. Because the brachioradialis is anterior to the elbow joint, it acts as an accessory flexor（屈筋） of this joint even though it is in the posterior compartment of the forearm. Origin: Humerus Insertion: Radius Function: Elbow: Flexion （When forearm is midpronated） Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Anconeus（肘筋） Anconeus is innervated by the branch of the radial nerve that innervates the medial head of the triceps brachii muscle. * In Japanese textbook, sometimes this muscle is described as part of triceps brachii muscle and included in the muscles of the upper arm. Origin: Humerus Insertion: Ulna Function: Elbow: accessory extensor Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition （Lateral to medial order） Extensor carpi radialis longus （長橈側手根伸筋） Extensor carpi radialis brevis （短橈側手根伸筋） Extensor digitorum （指伸筋） Extensor digiti minimi （小指伸筋） Extensor carpi ulnaris （尺側手根伸筋） Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Deep extensors of the forearm The deep layer of the posterior compartment of the forearm consists of 5 muscles: Supinator （回外筋：かいがい --） Abductor pollicis longus （長母指外転筋：ちょうぼし がいてん --） Extensor pollicis brevis （短母指伸：たんぼし しん--） Extensor pollicis longus （長母指伸筋：ちょうぼし しん--） Extensor indicis （示指伸筋：じし しん--） Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Artery of posterior forearm Posterior interosseous artery （後骨間動脈：こう こっかん --） （branch of ulnar artery） pass the posterior compartment of forearm. Posterior interosseous nerve （後骨間神経） （branch of radial nerve）, which innervates all muscles in the posterior compartment of the forearm, run parallel to the artery. Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Extensor retinaculum しんきん したい （伸筋支帯）  Extensor retinaculum（伸筋支帯） Extensor retinaculum is the thickened part of the antebrachial fascia（前腕筋膜） that holds the tendons of the extensor muscles in the posterior region of the wrist joint. It has 6 tendon compartments（腱区画） underneath and contain tendons. 1 Abductor pollicis longus, Ext. pollicis brevis 2 Extensor carpi radialis longus/brevis 3 Extensor pollicis longus 4 Extensor indicis, Extensor digitorum 5 Extensor digiti minimi 6 Extensor carpi ulnaris Gray's Anatomy for Students, Fifth Edition No intrinsic muscles in the dorsum of hand!! しゅはい ないざいきん な （手背に内在筋は無い！）  Reference “Clinical tips” Tabatière タバチエレ Tabatière, also known as anatomical snuff box（嗅ぎ煙草入れ：かぎ たばこ いれ） is a triangular deepening on the radio-dorsal aspect of the hand. Scaphoid（舟状骨：しゅうじょう --） and trapezium（大菱形骨：だい りょうけい --） bones forming the floor. Medial border: Tendon of extensor pollicis longus. 1. Snuff box：嗅ぎ煙草入れ 2. Tendon of extensor pollicis longus：長母指伸筋の腱 Lateral border: Tendons of extensor 3. Tendons of extensor pollicis brevis：短母指伸筋の腱 pollicis brevis and abductor pollicis longus 4. 5. Tendons of abductor pollicis longus：長母指外転筋の腱 Scaphoid bone 舟状骨 Deep to the anatomical snuff box lies the 骨折-手根骨(舟状骨骨折)- | しし接骨院・ししフィットは南福岡駅・雑餉隈駅 近くで皆様に施術を！ | 柔道整復師学生の皆さんへ柔道整復学理論国家試験対 radial artery. 策 | しし接骨院・ししフィットは南福岡駅側で施術を患者様に | トータルケア Localized tenderness within the snuffbox (shishi-bone-fit.jp) suggests the scaphoid fracture. Dermatome of the hand （手のデルマトーム） Most of the intrinsic muscles of the hand are innervated by the ulnar nerve. However, dermatome of the hand is more complicated. Dermatome of the hand is mix of ulnar nerve, median nerve, and radial nerve. Netter Collection of Medical Illustrations: Musculoskeletal System, Part I - Upper Limb, Second Edition Anatomical procedures （解剖手順） Anatomical procedures （Day 10） Dissection procedure 1. Mark the skin and make an incision by forceps to the depth of the reticular layer of the dermis. With the scalpel and the forceps, excise the whole skin of the upper limb to the wrist. Excise the skin of hand (Wrist to MP joint) separately. Upper arm 1. Dissect out and identify the teres major and the teres minor. 2. Dissect out and identify the long head of the triceps brachii. 3. Identify the triangular space and the quadrangular space between those muscles. Dissect out the structures within those spaces. Triangular space: The circumflex scapular AV Quadrangular space: The posterior circumflex humeral AV, the axillary nerve 4. Identify the radial nerve and the deep brachial artery inferior to the quadrangular space and follow the radial nerve. Incise the triceps brachii to identify all the radial nerve. Forearm & Hand 1. Incise the extensor retinaculum and open all compartments. 2. Identify the extensor muscles in the forearm, which are the brachioradialis, the extensor carpi radialis longus, the extensor carpi radialis brevis, the extensor digitorum, the extensor digiti minimi, the extensor carpi ulnaris, and the anconeus. 3. Follow the tendons of those muscles. Incise the tendon of the extensor digitorum. Identify the supinator, the abductor pollicis longus, the extensor pollicis brevis, and the extensor pollicis longus. 4. Incise the supinator to expose deep branch of the radial nerve. Goals of this lesson Students must understand and be able to describe: 1. The structures of the triangular space and the quadrangular space. ないそく えきか げき がいそく えきか げき こうぞう （内側腋窩隙と外側腋窩隙の構造） 2. The muscles of the extensors. じょうし しんきん ぐん （上肢の伸筋群）