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(1)

Anatomy of Upper

Limb

Humaryant

(2)

2

Pendahuluan



Anatomy is the science of the structure of

the body.



Kata anatomi berasal dari kata

“

anatome

” (Yunani) yang dibentuk dari 2

kata:

- ana

= ‘up’

- tome

= ‘a cutting’

_{= ‘a cutting’}



Kata

anatome

ekuivalen dengan kata

“

dissection

”

- dis

= ‘asunder’

- secare

(3)

3

Terminologi Pemerian



Semua deskripsi dalam

anatomi diekspresikan dalam

hubungannya dengan posisi

anatomi.



Posisi anatomi:



Tubuh berdiri tegak;



kedua mata melihat ke

depan pada bidang horizon,



kedua lengan disamping

tubuh dengan telapak tangan

menghadap ke depan



ibujari kaki menghadap lurus

(4)

4

(5)

5

Gerakan

•

Flexio

= membentuk/memperkecil sudut;

•

Extensio

_Extensio

= meluruskan/memperbesar sudut;

_{= meluruskan/memperbesar sudut;}

•

Abductio

(ab = from), menjauhi batang tubuh;

•

Adductio

(ad = to), mendekati batang tubuh;

•

Circumductio

(circum=around),

gabungan/kombinasi gerakan

flexio-abductio-extensio-adductio;;

extensio-adductio;;

(6)

6

Bidang dan Garis



Bidang



Bidang median



Bidang paramedian = sagittal



Bidang horizontal = transversal



Bidang frontal



Bidang coronal



Bidang obliqua = membentuk sudut

dengan bidang-bidang di atas



Bidang- bidang lain (bidang traspilorika,

dsb)

(7)

7

Bidang dan Garis –

Bidang dan Garis – Lanjutan 2Lanjutan 2

• Garis (Linea):

Garis (Linea):

Garis median (linea mediana)

Garis- garis lain: linea

midclavicularis, linea Frankfurt,

(8)

8

Arah

•

Superior

= cranial, cephal (ke

atas/arah kepala);

•

Inferior

= caudal (ke arah ekor/ke

bawah);

•

anterior, ventral (ke depan);

•

posterior, dorsal (ke belakang);

•

Medial;

•

Intermedial;

•

Lateral;

•

Proximal;

•

Distal;

(9)

9

•

Pronatio

= membungkukkan badan (ke

depan) atau memutar lengan bawah

sehingga telapak tangan menghadap ke

belakang (dorsum manus menghadap

ke depan);

•

Supinatio >< pronatio

; untuk

mengingat: “soup” – ination;

•

Protactio

(pro = forward; tracho = I

pull);

(10)

Anatomy :



Surface anatomy



Osteology (bones)



Muscles (include origin, insertion)



vascular (artery, vein) & nerve



Ligament, joint, fascia

(11)

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

(12)

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

(13)

12-13

Surface Anatomy of the Upper

Limb

 Surface features of the Surface features of the

Shoulder Shoulder

 Acromioclavicular JointAcromioclavicular Joint  AcromiunAcromiun

 HumerusHumerus

(14)

12-14

Surface Anatomy of the Upper

Limb

 Surface Features of the Surface Features of the

Armpit Armpit

 apexapex  basebase

 axillary lymph nodesaxillary lymph nodes  anterior wallanterior wall

(15)

12-15

Surface Anatomy of the Upper

Limb

 Surface Features of the Arm Surface Features of the Arm

& Elbow & Elbow

 HumerusHumerus

 Biceps brachii muscleBiceps brachii muscle  Triceps brachii muscleTriceps brachii muscle  Medial epicondyleMedial epicondyle

 Lateral epicondyleLateral epicondyle  OlecronOlecron

 Ulnar nerveUlnar nerve  Cubital fossaCubital fossa

 Median cubital veinMedian cubital vein  Brachial ArteryBrachial Artery

(16)

Surface Anatomy of

Upper Limb



Biceps + Triceps brachii



Olecrenon Process



Medial Epicondyle



Cubital Fossa



Anterior surface elbow



Boundaries

 Medial= Pronator teresMedial= Pronator teres  Lateral= BrachioradialisLateral= Brachioradialis

(17)

12-17

Surface Anatomy of the Upper

Limb

 Surface Features of Surface Features of

the Forearm & Wrist the Forearm & Wrist

 UlnaUlna  RadiusRadius  MusclesMuscles

 Radial ArteryRadial Artery  Pisiform BonePisiform Bone  “Anatomical “Anatomical

Snuffbox” Snuffbox” (

(TABATIERE TABATIERE ANATOMICUM

ANATOMICUM))

(18)

12-18

Surface Anatomy of the Upper

Limb

(19)

Surface

Anatomy of

Upper Limb



Carpal Tunnel

 Carpals concave Carpals concave

anteriorly anteriorly

 Carpal ligament covers itCarpal ligament covers it  Contains: long tendons, Contains: long tendons,

Median nerve Median nerve

 Inflammation of tendons Inflammation of tendons

= compression of Median = compression of Median nerve

nerve



Anatomical Snuffbox

(

tabatiere anatomicum

)

 Lateral = E.pollicis brevisLateral = E.pollicis brevis  Medial = E. pollicis Medial = E. pollicis

longus longus

 Floor = scaphoid, styloid Floor = scaphoid, styloid

of radius of radius

 Contains Radial Artery Contains Radial Artery

(20)

20

SCELETON HUMANUM

1.

Sceleton trunci

2.

Cingulum superius (cingulum membri

superioris)

3.

Sceleton extremitatis superioris =

sceleton membri superioris liberi

4.

Cingulum inferius = cingulum

membri inferioris

5.

Sceleton extremitatis inferioris =

sceleton membri inferioris liberi

6.

Cranium

(21)

21

Pembagian tulang menurut

bentuknya:

• Os longum

Os longum

• Os breve

Os breve

• Os planum

Os planum

• Os pneumaticum

Os pneumaticum

• Os irregularis

Os irregularis

• Os sesamoidea

Os sesamoidea

(22)

22

Markings on a Dried Bone



Facets, facies

(seperti

area-area yang

pipih/datar, halus,

kecil.



Elevasi = peninggian



Elevasi linier

1.

Linea = garis

2.

Crista = rigi



Elevasi bulat

1.

Tuberculum

2.

Tuberositas

3.

Malleolus

4.

trochanter



Elevasi tajam

1.

spina

2.

processus

styloideus

(23)

23

Markings on a Dried Bone

Markings on a Dried Bone Lanjutan 2Lanjutan 2



Depressions = depressi = cekungan



fovea, bila kecil



fossa, bila besar



sulcus, bila memanjang



incissura, bila dijembatani oleh

ligamentum atau oleh tulang



foramen (perforation or hole)



canal, meatus (foramen yang membentuk

saluran), mempunyai mulut (os = ostium)

Os mempunyai dua arti: mulut (orificium) dan tulang.

(24)

Cingulum Membri

Superioris (Gelang Bahu)

• Os clavicula

Os clavicula

• Os scapula

Os scapula

Os scapula berhubungan dengan

os clavicula, dan os clavicula

berhubungan dengan truncus

(25)

25

Sceleton Extremitatis

Superioris

• Os humerus_{Os humerus} • Os radius_{Os radius} • Os ulna_{Os ulna}

• Os lunatumOs lunatum • Os triquetrum_{Os triquetrum} • Os pisiforme_{Os pisiforme}

• Os multangulum majus =_{Os multangulum majus =} Os trapezium

Os trapezium

• Os multangulum minus =_{Os multangulum minus =} Os trapezoideum

Os trapezoideum

• Os capitatum_{Os capitatum} • Os hamatumOs hamatum

•

Ossa

_Ossa

metacarpalia (5)

•

Phalanges (jari-

Phalanges

(jari-jari; tunggal =

jari; tunggal =

phalanx)

(26)

(27)

(28)

scapula



The

scapula

forms

the posterior part

of the shoulder

girdle.



It is a flat,

triangular bone,

with two surfaces,

three borders, and

three angles



The costal/ventral

surface

 Fossa subscapularisFossa subscapularis  Angulus Angulus

(29)

The dorsal

surface



supraspinatou

s fossa,



infraspinatous

fossa.



Spina scapulae (

a prominent

plate)

(30)

Processus

coracoideus



Attachment m.pectoralis

minor



Attachment of

coracoacromial

ligament



Conjoined tendon :

coracobrachialis, bicep

brachii (short head)

(31)

Humerus

 Caput humeriCaput humeri

 nearly hemispherical in form, nearly hemispherical in form,

 is directed upward, is directed upward,

medialward, and a little medialward, and a little

backward, backward,

 articulates with the glenoid articulates with the glenoid

cavity of the scapula. cavity of the scapula.

 TheThe anatomical neck,anatomical neck,

 the the surgical necksurgical neck ((frequently frequently

the seat of fracture the seat of fracture)). .

 Fracture of the anatomical Fracture of the anatomical

(32)



Tuberculum majus



Lateral caput humerus &

tuberculum minus



Insersi m. Supraspinatus, m.

Infraspinatus, m. Teres minor



Tuberculum minus



Directed medialward & forward



Insersi m. Subscapularis



Intertubercular/bicipital groove



Dilalui oleh long tendon biceps

brachii, cabang arteri circumflex

humerus anterior



crests of the greater and

lesser tubercles

(

bicipital

ridges

(33)

 Permukaan antero-lateralPermukaan antero-lateral

 Tuberositas deltoid (insersi m.deltoid)Tuberositas deltoid (insersi m.deltoid)  Sulcus radialis (n.radialis, a.profunda)Sulcus radialis (n.radialis, a.profunda)

 Permukaan antero-medialPermukaan antero-medial

 Insersi m.latissimus dorsi, m.coracobrachialisInsersi m.latissimus dorsi, m.coracobrachialis  Pd distal Pd distal  origo m.brachialis origo m.brachialis

 Permukaan posteriorPermukaan posterior

 M. Triceps brachii (caput lateral, caput M. Triceps brachii (caput lateral, caput medial)

medial)

 Bagian distal humerusBagian distal humerus

 Lateral : Capitulum humerus (artikulasi dgn Lateral : Capitulum humerus (artikulasi dgn caput radii), Fossa radii

caput radii), Fossa radii

 Medial : Trochlea, sisi lateral Medial : Trochlea, sisi lateral _ radius, radius, medial

medial  artikulasi dgn ulna (semilunar artikulasi dgn ulna (semilunar

notch)

 Fossa coronoidFossa coronoid  Fossa olecranonFossa olecranon

 Foramen supratrochlearForamen supratrochlear  Epicondylus lateralEpicondylus lateral

(34)

Radius

 Caput radii (ligamen Caput radii (ligamen

annular)

 Column radiiColumn radii

 Tuberositas radii, insersi Tuberositas radii, insersi

tendon biceps brachii

 Corpus radiiCorpus radii

 Margo volaris : origo flexor Margo volaris : origo flexor

digitorum sublimis, flexor

pollicis longus, insersi

supinator, insersi pronator

quadratus, insersi tendon

brachioradialis

(35)

Radius

 Facies volaris : origo flexor Facies volaris : origo flexor

pollicis longus, pronator pollicis longus, pronator quadratus, ligamen

quadratus, ligamen

radiocarpal volar, foramen radiocarpal volar, foramen nutrient

nutrient

 Facies dorsalis : covered by Facies dorsalis : covered by

supinator, origo abductor supinator, origo abductor pollicis longus (above), pollicis longus (above), Extensor pollicis brevis Extensor pollicis brevis (below)

(below)

 Facies lateralis : insersi Facies lateralis : insersi

supinator, pronator teres, supinator, pronator teres, lower part

lower part  covered by covered by

tendon abd.poll.longus, tendon abd.poll.longus, ext.poll.brevis

(36)

ulna

 Processus coronoideusProcessus coronoideus

 Incisura semilunaris Incisura semilunaris __ dibentuk oleh dibentuk oleh olecranon & processus coronoideus, tmp olecranon & processus coronoideus, tmp artikulasi dgn trochlea humerus

artikulasi dgn trochlea humerus

 Incisura radialis, depresi artikulasi sisi lateral Incisura radialis, depresi artikulasi sisi lateral processus coronoideus, mrp sirkumferensial processus coronoideus, mrp sirkumferensial permukaan artikular caput radius

permukaan artikular caput radius  Corpus ulnaCorpus ulna

 Margo volaris (anterior) : origo M.FDP, Margo volaris (anterior) : origo M.FDP,

pronator quadratus pronator quadratus

 Margo dorsalis : aponeurosis FCU, ECU, FDPMargo dorsalis : aponeurosis FCU, ECU, FDP  Crista interosseaCrista interossea

 Facies volaris (FDP, pronator quadratus)Facies volaris (FDP, pronator quadratus)  Facies dorsalis (supinator, abductor pollicis Facies dorsalis (supinator, abductor pollicis

longus, exstensor pollicis longus, extensor longus, exstensor pollicis longus, extensor indicis propius

indicis propius

(37)

(38)

(39)

(40)

1650 ～ ₁₇₀0

(41)

(42)

(43)

(44)

(45)

(46)

(47)

The

carpal

_carpal

bones



eight in number, are

arranged in two rows.



Those of the proximal

row, from the radial to

the ulnar side, are

named the

navicular,

lunate, triangular,

and

pisiform;



those of the distal row,

in the same order, are

named the

greater

multangular, lesser

multangular,

capitate,

(48)

Common Characteristics of the

Carpal Bones

 Each bone (excepting the Each bone (excepting the

pisiform) presents six

surfaces.

ligamentous attachment; the

dorsal surfaces being the

broader, except in the

navicular and lunate.

 The The superiorsuperior or or proximal,proximal, and and

inferior

inferior or or distal surfacesdistal surfaces are are articular, the superior

articular, the superior

generally convex, the inferior

concave;

 the the medialmedial and and lateral surfaceslateral surfaces

are also articular where they

are in contact with contiguous

bones, otherwise they are

rough and tuberculated.

 The structure in all is similar, The structure in all is similar,

viz., cancellous tissue enclosed

in a layer of compact bone.

(49)

Os

naviculare

(50)

Os

triangular

(51)

The Greater Multangular

Bone

(

os multangulum majus;

trapezium

)

₎

The Lesser

Multangular Bone

(os multangulum

minus; trapezoid

bone)

(52)

Os

capitatum

(53)

(54)

(55)

(56)

metacarpus



consists of five cylindrical

bones which are numbered

from the lateral side (

ossa

metacarpalia I-V

);



each consists of a body and

two extremities



The body (corpus, shaft)



The base/carpal extremity

(basis)



The head/digital extremity

(57)

57

Otot Skeletal

•

Alat gerak aktif (tulang: alat gerak pasif);

•

Musculus = muscle (English). L. mus = mouse;

•

Origo (origin); insertio (insertion);

_{Origo (origin); insertio (insertion);}

•

Tendo: Jaringan ikat fibrous, membulat;

_{Tendo: Jaringan ikat fibrous, membulat;}

•

Aponeurosis: Jaringan ikat fibrous, pipih dan

membranous;

•

Ligamentum: Jaringan ikat fibrous,

penggantung

•

Fascia

_Fascia

(58)

58

Tata Nama Otot



Menurut bentuk

: triangularis, quadratus,

trapezeus,

rhomboideus



Menurut bentuk umum

: longus, serratus

(seperti

gergaji)



Jumlah caput (kepala)

: biceps, triceps,

quadriceps



Struktur (jaringan)

: semitendinous,

semimembranous



Lokasi

: supraspinatus, tibialis anterior



Tempat perlekatan

: brachio-radialis



Fungsi

: extensor, flexor

(59)

59

Origo:

Perlekatan atau ujung sebuah otot yang lebih

terfiir, atau tempat keluarnya syaraf tepi dan

sistem syaraf pusat.

Insersio:

Tempat perlekatan otot ke tulang yang

digerakkannya

Tali fibrosa dari jaringan penyambung dimana

serat-serat otot berakhir dan dimana suatu

otot dilekatkan pada tulang atau struktur lain

(60)

BAHU DAN AXILLA



Otot-otot Regio Pectoralis

1.

M. pectoralis major

2.

M. pectoralis minor

3.

M. subclavius

4.

(61)

(62)

Otot-otot Superficialis

Punggung

1.

M. latissimus dorsi

2.

M. trapezius

3.

M. levator scapulae

4.

M. rhomboid minor

5.

(63)

Major muscles of the

trunk

Trapezius

 Origin: superior nuchal line, Origin: superior nuchal line,

external occipital protuberance,

ligamentum nuchae and spinous

processes of seventh cervical and

all thoracic vertebrae

 Insertion: lateral third of clavicle, Insertion: lateral third of clavicle,

acromion, and spine of

scapulartery

 Acton: upper fibers elevate 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

(64)

Latissimus dorsi

 Origin: spinous Origin: spinous

processes of lower six processes of lower six thoracic and all lumbar thoracic and all lumbar vertebrae, median

vertebrae, median sacral crest, and sacral crest, and

posterior part of iliac posterior part of iliac crest.

crest.

 Insertion: floor of Insertion: floor of

intertubercular groove intertubercular groove of humerus.

of humerus.

 Action: trunk fixed, Action: trunk fixed,

extends, adducts and extends, adducts and medially rotates arm ; medially rotates arm ; arm fixed, elevates arm fixed, elevates trunk.

(65)

The Muscles

Connecting the Upper

Extremity to the

Vertebral Column

The muscles of this

group are:



Trapezius.



Rhomboideus major.



Latissimus dorsi.

(66)

(67)

 Superficial Fascia.Superficial Fascia.—The superficial fascia of the —The superficial fascia of the

anterior thoracic region is continuous with that of the

neck and upper extremity above, and of the abdomen

below. It encloses the mamma and gives off numerous

septa which pass into the gland, supporting its

various lobes. From the fascia over the front of the

mamma, fibrous processes pass forward to the

integument and papilla; these were called by Sir A.

Cooper the

Cooper the ligamenta suspensoria.ligamenta suspensoria.

 Pectoral Fascia.Pectoral Fascia.—The pectoral fascia is a thin —The pectoral fascia is a thin

lamina, covering the surface of the Pectoralis major,

and sending numerous prolongations between its

fasciculi: it is attached, in the middle line, to the front

of the sternum; above, to the clavicle; laterally and

below it is continuous with the fascia of the shoulder,

axilla, and thorax. It is very thin over the upper part

of the Pectoralis major, but thicker

(68)

The Muscles

Connecting the

Upper Extremity to

the Anterior and

Lateral Thoracic

Walls



Pectoralis

major.



Subclavius.



Pectoralis

minor.



Serratus

anterior.

(69)

Pectoralis major

 Origin: medial half of Origin: medial half of

clavicle,sternum,1th-6th costal cartilages.

6th costal cartilages.

 Insertion: crest of Insertion: crest of greater tubercle of

greater tubercle of

humerus.

 Action: flexes, adducts Action: flexes, adducts and rotates arm

and rotates arm

medially; arm fixed,

elevates trunk;

elevates ribs

1-6,aidding in forced

6,aidding in forced

inspiration.

(70)

Frolich, Human

– Pectoralis Minor – Serratus Ventralis – Levator Scapulae

• If ORIGIN on scapula =

Move Arm

– _{Subscapularis} – Supraspinatus

– Infraspinatus

– Teres Minor

– Teres Major

– Latissimus Dorsi (partial O on scap) – Coracobrachialis

pg 299

Rotator Cuff

(71)

Otot-otot Bahu

1.

M. deltoideus

2.

M.

M. supraspinatus

supraspinatus

3.

M.

M. infraspinatus

infraspinatus

4.

M. teres minor

5.

M. teres major

6.

M.

M. subscapularis

(72)

Major muscles of upper

limb

Deltoid

 Origin: lateral third of Origin: lateral third of clavicle, acromion, and

clavicle, acromion, and

spine of scapula

 Insertion: deltoid Insertion: deltoid

tuberosity of humerus

 Action: abductsAction: abducts ，， flexes flexes and medically rotates,

and medically rotates,

extends, and laterally

rotates arm

(73)

Teres major



Origin: dorsal

surface of inferior

angle of scapula



Insertion: crest of

lesser tubercle of

humerus



Action: medially

(74)



Celah Anatomis

:

1.

Spatium quadrilateral



atas depan m. subscapularis



belakang m. teres minor



bawah m. teres major



medial caput longum m. triceps



Lateral oleh collum sirurgicum humeri.

2.

Spatium triangular



atas m. teres minor



bawah m. teres major



lateral caput longum m. triceps



A. circumflexa scapulae, suatu cabang a.

subscapularis melewati spatium



ke fossa

(75)

Frolich, Human Anatomy,UpprLimb

Axilla =

Armpit



Region between arm and chest



Boundaries



Ventral - pectoral muscles



Dorsal = latissimus dorsi,

teres major

subscapularis



Medial = serratus ventralis



Lateral = bicipital groove of

humerus



Axillary lymph nodes,

Axillary vessels

Brachial

Plexus

(76)

 AXILLAAXILLA

 PyramidPyramid antara brachium dan dinding thoraxantara brachium dan dinding thorax

 DasarnyaDasarnya: : fascia axillaris antara inferolateral m. fascia axillaris antara inferolateral m. pectoralis major

pectoralis major,, m. latissimus dorsi m. latissimus dorsi++m. teres major m. teres major di posterior, dinding thorax di medial

di posterior, dinding thorax di medial

 lipatan axilla anteriorlipatan axilla anterior lipatan axilla posteriorlipatan axilla posterior

 ApexApex: : posterior clavicula, superior scapula, dan posterior clavicula, superior scapula, dan costa I

costa I

 dilalui pembuluh-pembuluh axillaris dan saraf-saraf dilalui pembuluh-pembuluh axillaris dan saraf-saraf dari leher menuju extremitas superior.

dari leher menuju extremitas superior.

 Dinding-dinding axilla: Dinding-dinding axilla:

 Dinding anteriorDinding anterior : m. pectoralis major, m.pectoralis : m. pectoralis major, m.pectoralis

minor, m. subclavius, fascia clavipectoralis, dan lig. minor, m. subclavius, fascia clavipectoralis, dan lig.

suspensorium axilla. suspensorium axilla.

 Dinding posteriorDinding posterior : m. subscapularis, m. latissimus : m. subscapularis, m. latissimus

dorsi, m. teres major. dorsi, m. teres major.

 Dinding medialDinding medial: costa I - IV(V) dan spatium intercostalisnya, : costa I - IV(V) dan spatium intercostalisnya,

m. serratus anterior. m. serratus anterior.

(77)

 NODUS LYMPHATICUS AXILLARISNODUS LYMPHATICUS AXILLARIS  Tersusun dalam 6 kelompok :Tersusun dalam 6 kelompok :

1.

1. KelompokKelompok anterior (pectoralis)anterior (pectoralis): di : di bawah m. pectoralis bawah m. pectoralis

minor

minor—be—belakanglakang m. pectoralis major. Menerimam. pectoralis major. Menerima da dari ri lateral mammae dan dinding anterolateral abdomen di

lateral mammae dan dinding anterolateral abdomen di

atas umbilicus

2.

2. KelompokKelompok posterior (subscapularis)posterior (subscapularis): : di depan m. di depan m.

subscapularis, dekat dengan av. subscapularis. Menerima

dari

dari superfisial punggung, superfisial punggung, sasampai sejauh crista iliacampai sejauh crista iliaca

3.

3. KelompokKelompok laterallateral: : sepanjang sisi medial v. axillaris. sepanjang sisi medial v. axillaris.

Menerima

Menerima sebagian bessebagian besar ar extremitas superior (kecuali extremitas superior (kecuali pembuluh limfe superfisial yang mengalirkan cairan limfe

pembuluh limfe superfisial yang mengalirkan cairan limfe

sisi lateral)

4.

4. KelompokKelompok sentral. Disentral. Di tengah axilla. Menerimatengah axilla. Menerima dari ketiga dari ketiga

kelompok di atas

5.

5. KelompokKelompok infraclavicularis (deltoideopectoralis)infraclavicularis (deltoideopectoralis): :

menyertai v. cephalica.

menyertai v. cephalica.di di fascia clavipectoralis pada fascia clavipectoralis pada trigonum deltoideopectorale.

trigonum deltoideopectorale. MMenerimaenerima su superfisial sisi perfisial sisi lateral tangan, lengan bawah dan lengan atas

lateral tangan, lengan bawah dan lengan atas

6.

6. KelompokKelompok apical.apical. di di apex axilla pada pinggir lateral iga 1. apex axilla pada pinggir lateral iga 1.

M

(78)

The Muscles and Fasciæ of

the Arm

 Coracobrachialis.Coracobrachialis.  Brachialis.Brachialis.

(79)

Biceps brachii

 Origin: long head, Origin: long head,

supraglenoid tubercle; supraglenoid tubercle; short head, coracoid short head, coracoid process

process

 Insertion: radical Insertion: radical tuberosity

tuberosity

 Action: supinator of Action: supinator of

forearm, flexor of elbow forearm, flexor of elbow joint, weak flexor of should joint, weak flexor of should joint

joint

Pronator teres

 Origin: medical epicondyle Origin: medical epicondyle of humerus and deep fascia of humerus and deep fascia of forearm

of forearm

 Insertion: middle of lateral Insertion: middle of lateral surface of radius

surface of radius

 Action: pronation of Action: pronation of forearm and flexion of forearm and flexion of elbow

(80)

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

(81)

POSTERIOR AND ANTERIOR COMPARTMENTS

(82)

lacertus fibrosus

(

₍

bicipital

_bicipital

fascia

)

₎



passes obliquely

downward and

medialward

across the

brachial artery,

and is continuous

with the deep

fascia covering

the origins of the

Flexor muscles

(83)

Cubital fossa

Boundariest

 BaseBase －－ line drawn line drawn

through epicondyles of

humerus

 ApexApex －－ brachioradialis brachioradialis laterally and pronator

laterally and pronator

teres medially

 RoofRoof －－ skin, superficial skin, superficial faxcia, deep faxcia and

faxcia, deep faxcia and

aponeurosis of biceps

 FloorFloor －－ brachialis, brachialis,

supinator and capsule

of elbow joint

(84)

－

_－

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

(85)

(86)

(87)

Otot-otot Antebrachium

 Kriteria deskriptif:Kriteria deskriptif:

 2 kelompok extensor (posterior) dan flexor (anterior).2 kelompok extensor (posterior) dan flexor (anterior).  Otot-otot lapisan superficialOtot-otot lapisan superficial:: otot-otot panjang otot-otot panjang

 LapisanLapisan intermedia intermedia (tambahan) (tambahan) pada kelompok flexorpada kelompok flexor: :

dari humerus

dari humerus, radius, & ulna, radius, & ulnadigiti yaitu m. flexor digiti yaitu m. flexor

digitorum superficialis

 Otot-ototOtot-otot lapisan profundalapisan profunda:: otot-otot dari otot-otot dari radius-ulna radius-ulna

menuju digiti (beraksi pada art. radio-carpalis dan art.

metacarpophalangealis).

 dari humerusdari humerusradius & ulna: radius & ulna:

 m. pronator teresm. pronator teres  m. brachioradialism. brachioradialis  m. anconeusm. anconeus

 m. supinator. m. supinator.

 antara antara humerushumerus_ulnaulna::

(88)

Otot-otot Kelompok Anterior (Flexor)

5 otot lapisan superficial (termasuk

intermedia):

1.

M. pronator teres

2.

M. flexor carpi radialis

3.

M. palmaris longus

4.

M. flexor carpi ulnaris

5.

M. flexor digitorum superficialis

3

3 otot profunda:

otot profunda:

1.

M. flexor digitorum profundus

2.

M. flexor pollicis longus

3.

(89)

Otot-otot Kelompok Posterior

(Extensor)

7 otot

-otot

_-otot

lapisan superficial

_{lapisan superficial}

(termasuk intermedia):

1.

M. brachioradialis

2.

M. extensor carpi radialis longus

3.

M. extensor carpi radialis brevis

4.

M. extensor digitorum (communis)

5.

M. extensor digiti minimi

6.

M. extensor carpi ulnaris

7.

(90)

5 o

tot-otot profunda kelompok

posterior:

1.

M. supinator

2.

M. abductor pollicis longus

3.

M. extensor pollicis brevis

4.

M. extensor pollicis longus

5.

(91)

(92)

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

(93)



The Superficial Group



Pronator teres.



Palmaris longus.



Flexor carpi radialis.



Flexor carpi ulnaris.



Flexor digitorum sublimis.



The Deep Group



Flexor digitorum profundus



Flexor pollicis longus.



Pronator quadratus

The Volar

Antibrachial

Muscles

(94)

Posterior Compartment of

Forearm

Extensor digitorum

Extensor carpi ulnaris Ext Carpi Radialis Longus

Brachioradialis Lateral Epicondyle

(95)

Anterior Compartment

Forearm

Flexor Carpi Radialis

Flexor Retinaculum

Medial Epicondyle

Flexor Digitorum Superficialis is deep to other flexors

pg 302

Flexor Carpi Ulnaris

Brachioradialis

Pronator Teres

(96)

(97)

(98)

(99)

(100)

(101)

(102)

(103)

(104)

The Dorsal Antibrachial

Muscles



The Superficial Group

 Brachioradialis.Brachioradialis.

 Extensor digitorum communis.Extensor digitorum communis.  Extensor carpi radialis longus.Extensor carpi radialis longus.  Extensor digiti quinti proprius.Extensor digiti quinti proprius.  Extensor carpi radialis brevis.Extensor carpi radialis brevis.

 Extensor carpi ulnaris.Anconæus.Extensor carpi ulnaris.Anconæus.



The Deep Group

 Supinator.Supinator.

(105)

(106)

(107)

(108)

(109)

(110)

(111)

The muscles of hand



Thumb (thenar eminence)



Little finger (hypothenar eminence)



Middle palm & between metacarpal

bones

(112)



Volar carpal ligament (ligamentum

carpi volare)



Transverse carpal ligament

(ligamentum carpi transversum,

anterior annular ligament)

(113)

Carpal Tunnel

(114)

Carpal Tunnel

(115)

Muscles of thumb

(116)



The Lateral Volar Muscles

 Abductor pollicis brevis.Abductor pollicis brevis.  Flexor pollicis brevis.Flexor pollicis brevis.  Opponens pollicis.Opponens pollicis.

 Adductor pollicis (obliquus).Adductor pollicis (obliquus).

 Adductor pollicis (transversus).Adductor pollicis (transversus).



The Medial Volar Muscles

 Palmaris brevis.Palmaris brevis.

 Flexor digiti quinti brevis.Flexor digiti quinti brevis.  Abductor digiti quinti.Abductor digiti quinti.

 Opponens digiti quintiOpponens digiti quinti



The Intermediate Muscles

 Lumbricales.Lumbricales.

 InterosseiInterossei ( (intervals between the metacarpal intervals between the metacarpal bones, and are divided into two sets, a dorsal

bones, and are divided into two sets, a dorsal

and a volar

(117)

(118)

(119)

(120)

(121)

(122)

(123)

(124)

(125)

Fibrous

Sheaths of

the Flexor

Tendons

(126)

(127)

(128)

(129)

(130)

(131)

(132)

(133)

(134)

(135)

vincula tendina

There are two sets of these;

 ((aa) the ) the vincula brevia, which vincula brevia, which

are two in number in each

finger, and consist of triangular

bands of fibers, one connecting

the tendon of the Flexor

digitorum sublimis to the front

of the first interphalangeal

joint and head of the first

phalanx, and the other the

tendon of the Flexor digitorum

profundus to the front of the

second interphalangeal joint

and head of the second

phalanx;

 ((bb) the ) the vincula longa,vincula longa, which which

connect the under surfaces of

the tendons of the Flexor

digitorum profundus to those of

the subjacent Flexor sublimis

after the tendons of the former

have passed through the latter.

(136)

(137)

(138)

(139)

(140)

(141)

(142)

(143)

(144)

(145)

(146)

(147)

(148)

Vascular supply



Subclavian

_

axillary



radial (same street,

new street sign every

block)



Collateral circulation

 Posterior/anterior Posterior/anterior

circumflex humeral

 Deep brachial a.Deep brachial a.



Radial a. (with median

n.)



deep palmar arch

