前臂肌肉解剖ppt課件

1、1GROSS ANATOMY OF THE FOREARM2Main MenuBones of the forearm.Superficial muscles of the anterior compartment. Deep muscles of the anterior compartment.Arteries and nerves of the anterior compartment.Superficial muscles of the posterior compartment.Deep muscles of the posterior compartment.Arteries an

2、d nerves of the posterior compartment.Acknowledgements34Bones of the forearmThe radius proximally articulates with the humerus at the elbow joint. Distally it articulates with the scaphoid and lunate bones of the carpus, and with the ulna at the distal radioulnar joint.The ulna is the more medial of

3、 the two bones. Its proximal end articulates with the humerus at the elbow joint. Distally it articulates with the radius. It is excluded from the wrist joint by the articular disc.The interosseous membrane bind the radius and the ulna together.HeadInterosseous membraneRadiusHumerusTuberosity of rad

4、iusUlnaHeadFig 1. Anterior view of bones of the forearm.567總體記憶總體記憶前臂共有前臂共有1818塊肌肉塊肌肉分為屈肌與伸肌二部分分為屈肌與伸肌二部分屈肌屈肌8 8塊塊分為淺層與深層分為淺層與深層淺層有淺層有5 5塊塊深層有深層有3 3塊塊伸肌伸肌1010塊塊淺深各淺深各5 5塊塊前臂屈肌屈肌8塊伸肌10塊淺5深3淺5深58旋前圓肌橈側(cè)屈腕肌掌長(zhǎng)肌指淺屈肌尺側(cè)屈腕肌9Superficial muscles of the anterior compartment. Title page. 1234The superficial musc

5、les of the anterior compartment include pronator teres旋前圓肌, flexor carpi radialis橈側(cè)腕屈肌, palmaris longus掌長(zhǎng)肌, and flexor carpi ulnaris. Also included in this group is flexor digitorum superficialis. The superficial group of muscles all have the same origin, which is attached to the medial epicondyle o

6、f the humerus肱骨內(nèi)上髁. FOR FURTHER DETAILS CLICK ON EACH INDIVIDUAL MUSCLE BELOW.Pronator teresFlexor carpi radialisFlexor carpi ulnarisFlexor digitorum superficialisPalmaris longus (not included in the diagram).Fig 2. Showing superficial muscles of the posterior compartment.Brachio-radialis10Pronator

7、Teres5te7ri:zThe pronator teres has two heads, the humeral head and the ulnar head. The median nerve正中神經(jīng)enters the forearm between the two heads.Origin :-Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial border of the coronoid process冠突,冠狀突of the ulna.Insertion附著附著 :-Lateral aspect o

8、f the shaft of the radius.Nerve supply :- Median nerve, C6 and C7.Action :- Pronation of the forearm. Flexion of the forearm.Pronator teresRadiusFig 3. Pronator teres.11*Flexor carpi radialis, palmaris longus, and flexor carpi ulnarisFlexor carpi radialisOrigin:- Medial epicondyle of the humerus.Ins

9、ertion:- Base of the second and third metacarpal bones.Nerve supply:- Median nerve, C6 and C7.Action:- Flexes the hand at the wrist joint. Abducts the hand at the wrist joint.Palmaris longus Origin:- Medial epicondyle of the humerus. Insertion:- Flexor retinaculum and palmar aponeurosis. Nerve suppl

10、y:- Median nerve, C7 and C8 Action:- Flexes the hand at wrist joint.Flexor carpi ulnaris.Origin:- Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial aspect of the olecranon鷹嘴( process of the ulna and the posterior border of the ulna. Insertion:- Pisiform bone豌豆?fàn)畹? hook of the hamate,

11、and base of the fifth metacarpal bone. Nerve supply:- The ulnar nerve, C7, C8, and T1. Action:- Flexes the hand at wrist joint. Adducts the hand at wrist jointPronator teresFlexor carpi radialisPalmaris longusFlexor carpi ulnarisFig 4. Flexor carpi radialis and ulnaris and palmaris longus12Flexor di

12、gitorum superficialis.Origin:-Humeroulnar head: Medial epicondyle of the humerus and the medial margin of the coronoid process of the ulna.Radial head: Rising from the oblique line on the anterior surface of the shaft of the radius.Insertion:- The muscle belly gives rise to four tendons distally. Ea

13、ch of the tendon attaches to the sides of the middle phalanx指骨,趾骨 of the four medial finger.Nerve supply:- Median nerve, C8 and T1.Action:- Flexes the middle phalanx of fingers. Flexes the proximal phalanx of fingers (weak). Flexes the wrist.Flexor digitorum superficialis.Fig 5. Flexor digitorum sup

14、erficialis.13指深屈肌拇長(zhǎng)屈肌旋前方肌14Deep Muscles of the anterior compartment. Title pageThe deep muscles of the forearm comprise of the flexor pollicis longus, flexor digitorum profundus and pronator quadratus.For further details click on each of the individual muscles.1. Flexor digitorum profundus.2. Flexor

15、 pollicis longus.Pronator quadratus not shown.112Brachio-radialis (cut)Tendon of carpi flexor radialis (cut)Fig 6. Deep muscles of the anterior compartment.Return to main menu15Flexor digitorum profundus and flexor pollicis longusFlexor pollicis longusOrigin:- Middle of the anterior surface of the s

16、haft of the radius and from the adjoining part of the interosseous membrane.Insertion:- The tendon passes distally through the carpal tunnel and attaches to the distal phalanx of the thumb.Nerve supply:- The anterior interosseous branch of the median nerve.Action:- Flexes the phalanges of the thumb.

17、Flexor digitorum profundus深的深的Origin:- Upper three-quarters of the anteriomedial shaft of the ulna.Insertion:- The muscle divides into four tendons just prior to traversing the carpal tunnel. They attach to the distal phalanx of the four fingers.Nerve supply:- The medial part is supplied by the ulna

18、r nerve, the lateral portion is supplied by the anterior interosseous branch of the median nerve, C8 and T1.Action:- Flexes the finger. Exclusive flexor of the distal phalanx. Weak flexor of the wrist. Flexor pollicis longusPronator quadratusFlexor digitorum profundusFig 7. Flexor digitorum profundu

19、s and flexor pollicis longus.Return to title page16Pronator QuadratusOrigin:- Lower quarter of the anterior surface of the shaft of the ulna.Insertion:- Lower quarter of the anterior surface of the shaft of the radius.Nerve supply:- The anterior interosseous branch of the median nerve.Action:- Prona

20、tes the forearm.Pronator quadratusFlexor carpi radialis (cut)Flexor pollicis longusFlexor digitorum profundusFlexor carpi ulnaris (cut)Fig 8. Pronator quadratus.Return to title page17Arteries and Nerves of the anterior compartment. Title page Ulnar artery:- Larger than the radial artery. It passes b

21、etween the arch formed by the radial and ulnar attachment of the flexor digitorum superficialis and descends through the anterior compartment. It enters the palm of the hand in front of the flexor retinaculum, and promptly divides in superficial and deep palmer branches.Branches- Muscular branches-

22、to the muscles of the anterior compartment. Recurrent branches- to the anastomosis around the wrist jointBranches to the anastomosis around the wrist jointCommon interosseous artery- arises in the upper part of the ulnar artery and then divides in the anterior and posterior interosseous arteries.Ant

23、erior interosseous artery:- arises from the common interosseous artery and descends in the anterior compartment to eventually join the anastomosis around the wrist joint. It supplies the deep flexor muscles, and gives off nutrient branches to the the radius and ulna. Brachial arteryMedian nerveUlnar

24、 nerveRadial nerveUlnar arteryFig 9. Arteries and nerves of the anterior compartment.NextReturn to nerves18Arteries and Nerves of the anterior compartment.Posterior interosseous artery- arises from the common interosseous artery and and enters the posterior compartment.Radial artery:- It begins in t

25、he cubital fossa肘窩when the brachial artery divides into the radial and ulna artery. It passes distally, travels under the brachioradialis, resting on the deep flexor muscles. The artery briefly travels on the lateral side of the radius, before travelling over the anterior surface of the radius. The

26、artery then winds around the lateral aspect of the wrist, before entering the palm of the hand to form the deep palmer arch.Branches-Muscular branches: to the neighbouring muscles.Branches to the anastomosis around the wrist and elbow joint.Superficial palmer joint: arises just above the wrist, freq

27、uently joins the ulnar artery to give rise to the superficial palmer arch.Radial nerveSuperficial radial nerveRadial arteryBrachial arteryMedian nerveUlnar nerveUlnar arteryMedian nerveFig 10. Arteries and nerves of the anterior compartment.Return to nerves19Nerves of the anterior compartmentMedian

28、Nerve (fig 9, fig 10)The median nerve leaves the cubital fossa in between the two heads of the pronator teres. It descends between the superficial and deep flexor muscles. At the wrist it lies superficially, before entering the palm behind the flexor retinaculum.Branches:-Muscular branch:- all the s

29、uperficial muscles of the anterior compartment except flexor carpi ulnaris.Articular branches: to the elbow jointAnterior interosseous nerve: arises from the median nerve as it emerges from the two heads of the pronator teres. (see below)Palmer cutaneous Branch: Distributed to the skin over the late

30、ral part of the palm.Anterior interosseous nerve It arises from the median nerve (see above) and then descends down the anterior surface of the interosseous membrane. Branches-Muscular branches: all the muscles of deep flexion in the anterior compartment except the medial part of digitorum profundus

31、.Articular branches: to the wrist joint, the distal radioulnar joint, and the joints of the carpus.Ulnar Nerve(fig9, fig 10)The ulnar nerve passes behind the medial epicondyle and enters the forearm between the two heads of flexor carpi ulnaris. It descends between the flexor carpi ulnaris and the f

32、lexor digitorum profundus. The ulnar nerve becomes superficial at the wrist, before entering the palm in front of the flexor retinaculum.Branches-Muscular branches: to the flexor carpi ulnaris and to the medial half of the flexor digitorum profundus.Articular branches: to the elbow joint.Palmar cuta

33、neous branch: arises in the middle of the forearm, Supplies skin over the thenar eminence魚(yú)際.Dorsal cutaneous branch: arises in the distal third of the of the forearm, and passes medially to the dorsum of the hand. Return to main menu20橈側(cè)腕長(zhǎng)伸肌橈側(cè)腕短伸肌指伸肌小指伸肌尺側(cè)腕伸肌21Superficial muscles of the posterior co

34、mpartment. Title pageThe superficial muscles of the anterior compartment are mainly concerned with the extension at wrist joint and of the digit. The muscles in this group comprise of the Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, and the two

35、more lateral lying brachioradialis and extensor carpi radialis longus.NB- The anconeus also lies in the posterior compartment but is functionally very different to the rest of the muscles in this group. Its action are to aid the triceps in extension at the elbow joint.Click below on each of the musc

36、les for further detail about each of the individual muscles.1. Extensor carpi radialis longus2. Extensor digitorum3. Extensor carpi ulnaris4. Extensor digiti minimiBrachioradialis and extensor carpi brevis are not included in the figure.24Anconeus231Fig 11. Superficial muscles of the posterior compa

37、rtment.Return to main menu22Extensor carpi radialis longus and brevis, and extensor carpi ulnarisExtensor carpi radialis longusOrigin:- From the lower third of the lateral supracondylar ridge of the humerus.Insertion:- Posterior surface of the base of the second metacarpal bone.Nerve supply:- Radial

38、 nerve, C6 and C7.Action:- Extends and abducts the hand at the wrist joint.Extensor carpi radialis brevisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the third metacarpal bone.Nerve supply:- Posterior interosseous nerv

39、e, C7 and C8.Action:- Extends and abducts the hand at the wrist joint.Extensor carpi ulnarisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the fifth metacarpal bone.Nerve supply:- Posterior interosseous nerve, C7 and C8A

40、ction:- Extends and adducts the hand at wrist joint.Extensor carpi radialis longusExtensor carpi radialis brevisExtensor carpi ulnarisFig 12. Extensor carpi radialis brevis and longus and extensor carpi ulnaris. Return to title page23Extensor digitorum and extensor digiti minimiExtensor digitorumOri

41、gin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- The muscle divides into four tendons which pass to the fingers and form the dorsal expansion. On the dorsum of the hand these are interconnected by fibrous tissue. Near the proximal interphalangeal joint of ea

42、ch finger the expansions divide into the central part, which inserts into base of the middle phalanx, and the two lateral parts, which insert into the base of the distal phalanx. Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Mainly it extends the metacarpophalangeal joint, but it al

43、so assists in extending the proximal and distal interphalangeal joint and the arm. Extensor digiti minimi Origin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Via two tendons to the dorsal expansion for the little finger.Nerve supply:- Posterior interosseous

44、nerve, C7 and C8Action:- Assists in the extension of the little finger.Extensor digitorumExtensor digiti minimiFig 13. Extensor digitorum and extensor digiti minimi.Return to title page24BrachioradialisOrigin:- From the upper twp thirds of the lateral supracondylar ridge of the humerus.Insertion:- B

45、ase of the styloid process of the radius.Nerve supply:- Radial nerve, C5 and C6.Action:- It flexes the forearm (despite being being served by an extensor nerve), assists in rotating or restoring the arm into midprone position, depending on the initial position. Brachio-radialisExtensor carpi radiali

46、s longusExtensor carpi radialis brevisFlexor carpi radialisFig 15. Brachioradialis (anterior view).Fig 14 Brachioradialis (lateral view).Return to title page25Deep muscles in the posterior compartment. Title pageThe deep muscles of the fore arm consist of three muscles that act on the thumb, the ext

47、ensor indicis and supinator. Except for the supinator they all originate from only the forearm bones.For further details on each of the bones click on the individual muscles.1. Supinator.2. Abductor pollicis longus.3. Extensor pollicis longus.4. Extensor indicis.5. Extensor pollicis brevis.12435Fig

48、16. Deep muscles of the posterior compartment.Return to main menu26Extensor pollicis longus and brevis, and abductor pollicis longusAbductor pollicis longusOrigin:- Middle of the posterior surface of the shaft of the ulna and radius.Insertion:- Posterior surface of the base of the first metacarpal b

49、one.Nerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Abducts and extends the thumb.Extensor pollicis longusOrigin:- From the posterior surface of the ulna.Insertion:- Posterior surface of the base of the distal phalanx of the thumb.Nerve supply:- The posterior interosseous nerve,

50、C7 and C8.Action:- Extends the thumb.Extensor pollicis brevisOrigin:- Posterior surface of the radius.Insertion:- Posterior surface of the proximal phalanx of the thumbNerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Extends the thumb.Anatomical snuff box: medial boundary is the t

51、he tendon of the extensor pollicis longus and the lateral boundary is the tendon of the abductor pollicis longus and extensor pollicis brevis.Abductor pollicis longus.Extensor pollicis longusFig 17. Abductor pollicis longus, extensor pollicis longus and brevis.Extensor pollicis brevisReturn to title

52、 page27SupinatorSupinatorSupinatorThe supinator consists of oblique and a transverse head.Origin:- Origin:- Oblique head: From the lateral epicondyle of the humerus and collateral ligament of the elbow joint.Transverse head: Supinator crest of the ulna.Insertion:- Insertion:- Both heads wind lateral

53、ly around the proximal part of the radius, attaching to the anterior aspect of the radius.Nerve supply:- Nerve supply:- Posterior interosseous nerve, C6 and C7.Action:- Action:- Supinates the forearm (mainly assists as the biceps brachii is main supinator of the forearm).Transverse headOblique headF

54、ig 18. Supinator muscle (anterior view).Return to title page28Extensor indicisOrigin:- Origin:- Posterior surface of the ulna.Insertion:- Insertion:- Dorsal expansion of the index fingerNerve supply:- Nerve supply:- Posterior interosseous nerve, C7 and C8.Action:- Action:- Extends the index finger.Return to title pageExtensor indicisFig 19. Extensor pollicis29Arteries and nerves in the posterior compartment. Title pageArteriesArteriesPosterior inter