肩带
ShoulderGirdle
何谓肩带
(ShoulderGirdle)
?“Girdle”含义
?肩带,又称胸带,由胸骨、锁骨、及肩胛骨肱骨
近端和它们之间连结的关节所形成。
?胸锁关节SternoclavicularJoint
?肩峰锁骨关节AcromioclavicularJoint
?盂肱关节GlenohumeralJoint
?肩胛胸廓关节ScapulothoracicJoint
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
肩带组成构造
?Bones
–锁骨Clavicle
–肩胛骨Scapula
–肱骨近端Proximalendofhumerus
?Articulations
–肩峰所骨关节AcromioclavicularJoint
–胸锁关节SternoclavicularJoint
–肱盂关节Glenohumeral(Shoulder)Joint
–肩胛-胸廓Scapulothoracic"Joint"
锁骨Clavicle
?亦称“锁子骨”。胸腔前上部﹐呈S形的骨头﹐左右各一
块﹐内端与胸骨相连﹐外端与肩胛骨相连
?1、胸腔前上部,横于颈部和胸部交界处,全长于皮下均
可摸到,是重要的骨性标志。锁骨上面光滑,下面粗糙,
形似长骨,但无骨髓腔,可区分为一体两端。中间部分是
锁骨体,内侧2/3凸向前,外侧1/3凸向后。呈S形的骨
头,左右各一块。内侧端粗大,与胸骨柄相关节,称为胸
骨端;外侧端扁平,与肩胛骨的肩峰相关节,称肩峰端。
锁骨支持肩胛骨,使上肢骨与胸廓保持一定距离,利于上
肢的灵活运动。由于位置表浅,锁骨易骨折,并多见于锁
骨中、外1/3交界处。
肩胛骨Scapula
?也叫胛骨、琵琶骨。位于胸廓的后面,是三角形扁骨,
介于第2~7肋之间。分为两个面、三个角和三个缘。前
面为肩胛下窝,是一大而浅的窝。后面有一横行的骨嵴,
称肩胛冈,冈上、下的浅窝,分别称为冈上窝和冈下
窝。肩胛冈的外侧扁平,称肩峰。外侧角肥厚,有梨形
关节面,称关节盂。上角和下角位于内侧缘的上端和下端,
分别平对第2肋和第7肋。可作为计数肋的标志。内侧缘
长而薄,对向脊柱。外侧缘肥厚,对向腋窝。上缘最短,
在靠近外侧角处,有一弯向前外方的指状突起,称喙
突。左右各一,略作三角形。
?传说锁住琵琶骨,可以破除对方的妖术。
?肩胛骨、锁骨和肱骨构成肩关节。
关节连结Articulations
?肩峰锁骨关节Acromio-ClavicularJoint
?胸锁关节Sterno-ClavicularJoint
?肱盂关节Gleno-Humeral(Shoulder)Joint
?肩胛骨-胸廓关节Scapulo-Thoracic"Joint"
肩峰锁骨关节AcromioclavicularJoint
?锁骨外侧端与肩颊骨肩峰所形成之关节
?属平面关节
胸锁关节SternoclavicularJoint
?锁骨内侧端与胸骨柄所形成之关节
?属鞍状关节
肱盂关节Glenohumeral
(Shoulder)Joint
?Ballandsocketarticulationbetweenheadof
humerusandglenoidcavity.
?Favorsmobilityoverstability
Scapulothoracic"Joint"
?Scapulasuspendedonribcagebymuscles
highlymobile
?Scapulamovementsincreasesrangeofmotion
attheshoulderjoint
肩关节Gleno-HumeralJoint
?肩关节的结构特点
?肩关节解剖
?肩关节镜下解剖图
肩关节的结构特点
?肩关节(shoulderjoint):由肱骨头与肩胛骨的关
节盂构成,是典型的球窝关节。
?关节盂小而浅,边缘附有盂唇
肩关节的结构特点
?关节囊薄而松弛
?囊内:肱二头肌长头腱通过
肩关节的结构特点
?囊外:
喙肱韧带、喙肩韧带及
肌腱加强其稳固性。
肩关节的结构特点
?囊下部无韧带和肌加强,最为薄弱,故肩关节脱
位时,肱骨头常从下部脱出,脱向前下方。
?关节面大小相差较大,关节囊薄弱松弛,连接它
约有三条韧带和肌腱,三角肌包裹在肩峰的三面。
肩关节解剖
?由肩胛骨的关节盂与肱骨头组成,又叫肩肱关节(盂肱关
节)。
?因肱骨头较大,呈球形,关节盂浅而小,仅包绕肱骨头的
1/3,关节囊薄而松弛,所以是人体运动范围最大而又最
灵活的关节。
?这个结构上的特点虽然保证了它的灵活性,但它的牢固稳
定性都较其他关节为差,是全身大关节中结构最不稳固的
关节。
肩关节解剖
?常见肩关节向前下脱位,因肩关节的上方有肩峰、喙突及
连于其间的喙肩韧带,可以防止肱骨头向上脱位。且前、
后、上部都有肌肉、肌腱与关节囊纤维层愈合,增强了其
牢固性,而只有关节囊的前下部没有肌肉、肌腱的增强,
这是肩关节的一个薄弱区。
肩关节解剖
?因此当上肢外展时,在外力作用下或跌倒时,如上肢外展
外旋后伸着地,肱骨头可冲破关节囊前下方的薄弱区,移
出到肩胛骨的前方,造成肩关节前脱位。这时患肩塌陷,
失去圆形隆起的轮廓,形成所谓的“方肩”。
肩关节解剖
?活动角度:前屈、后伸、内收、外展、内旋、外旋以及环
转等运动。
?在正常情况下为:前臂上举180°、内收45°、外展90°、外旋
60°、前屈90°、后伸45°、内旋90°
?又肩关节的活动是以胸锁关节为支点,以锁骨为杠杆,因
此肩关节的活动范围又可因“肩胸关节”的活动而增加。
?肩关节的这些特点就决定了肩部易发生疾患的原因。
肩关节镜下解剖图
肱二头肌腱联合体前盂肱中韧带
盂肱关节肱二头肌腱
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
Extrinsicmuscles
Intrinsicmuscles
Attachhumerustotrunk
ShoulderGirdle
肩带的肌肉群
?Extrinsicmuscles
Suspendscapulafromthetrunk.Stabilizeand/oractively
movesscapula
?Intrinsicmuscles
Attachscapulatohumerus
?Musclesofattachingtrunktohumerus
ExtrinsicMuscles
?Trapezius
?LevatorScapulae
?RhomboidMajorandMinor
?SerratusAnterior
?Pectoralisminor
IntrinsicMuscles
?Deltoid
?TeresMajor
?RotatorCuff(activestabilizationofshoulder
joint)
a.Supraspinatus
b.Infraspinatus
c.TeresMinor
d.Subscapularis
Musclesofattachingtrunkto
humerus
?Latissimusdorsi
?PectoralisMajor
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
肩带的稳定度
由关节与其相关韧带提供主要的稳定度
?肩峰锁骨关节Acromio-ClavicularJoint
?胸锁关节Sterno-ClavicularJoint
?肱盂关节Gleno-Humeral(Shoulder)Joint
?肩胛骨-胸廓关节Scapulothoracic"Joint"
肩峰锁骨关节
Acromio-ClavicularJoint
Ligaments
1.AcromioclavicularLigament
2.CoracoclavicularLigament
3.ConoidLigament
4.TrapezoidLigament
肩峰锁骨关节
Acromio-ClavicularJoint
Functions
?Bindclavicletoscapulasupportingweightofupper
limbminimizinguseofmuscleenergy
胸锁关节Sterno-ClavicularJoint
Ligaments
1.Sternoclavicular胸锁韧带
2.anteriorandposterior
3.Interclavicular锁间韧带
4.Costoclavicular肋锁韧带
FibrocartilageDisc
?Strengthensarticulation
肱盂关节
Gleno-Humeral(Shoulder)Joint
Capsule
1.Attachesfromglenoidcavitytoanatomicalneckof
humerus
2.Leastamountofsupportinferiorly
肱盂关节
Gleno-Humeral(Shoulder)Joint
Ligaments
1.Coracoacromial
2.Coracohumeral
3.TransverseHumeralLigament
4.GlenohumeralLigaments
肱盂关节
Gleno-Humeral(Shoulder)Joint
?CoracoacromialLigament
Helpsresistupwarddisplacementoftheheadofthehumerus.
肱盂关节
Gleno-Humeral(Shoulder)Joint
?CoracohumeralLigament
Strengthenssuperiorportionofcapsule
Somesupportduringshoulderabduction
?TransverseHumeralLigament
holdslongheadofbicepsinthegroove
?GlenohumeralLigament
fromuppermarginofglenoidcavityandstrengthenanterior
portionofcapsule
1.Superior
2.Middle
3.Inferior
肱盂关节
Gleno-Humeral(Shoulder)Joint
肱盂关节
Gleno-Humeral(Shoulder)Joint
?RotatorCuffMuscles
1.Activestabilizersofshoulderjoint
2.Depressheadofhumerusinglenoidcavitywhenhumerus
moves
3.Musclesalsohelprotate
肩胛骨-胸廓关节
Scapulothoracic"Joint"
?Stability
Dependentuponactivityofextrinsicmuscles
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
肩胛骨(SCAPULA)的动作
?Inthreedirections(andcombinationsofthethose3)
1.Elevation–Depression
2.Protraction–Retraction
3.UpwardandDownwardRotation
肩胛骨(SCAPULA)的动作
Elevation–Depression
?Elevation=Liftingtheshoulders(shrugging)
Musclesinvolved:Levatorscapulae
Trapezius(upperfibres)
Rhomboids
?Depression=loweringtheshoulders
Musclesinvolved:Trapezius(lowerfibres)
Pectoralismajorandminor
Latissimusdorsi
肩胛骨(SCAPULA)的动作
Protraction–Retraction
?Protraction=shouldersforwards(如推墙壁动作)
Musclesinvolved:Serratusanterior
Pectoralisminor
?Retraction=shouldersback
Musclesinvolved:Rhomboids
Trapezius(middlepart)
肩胛骨(SCAPULA)的动作
UpwardandDownwardRotation
?Upwardrotation=glenoidcavityfaceupwards
Musclesinvolved:Serratusanterior(lowerpart)
Trapezius(upperandlowerparts)
?Downwardrotation=glenoidcavityfacedownwards
Musclesinvolved:Pectoralismajor
Latissimusdorsi
Rhomboids
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
盂肱关节(GLENOHUMERALJOINT)
的动作
?Usuallyinvolvemovingthehumerusonthescapula.
?TypesofMovements:
Flexion-Extension
Abduction-Adduction
ExternalRotation–InternalRotation
盂肱关节(GLENOHUMERALJOINT)
的动作
?Extension-Pectoralismajor(sternalpart),
Deltoid(posterior),Latissimus
dorsi,TeresmajorandTriceps
(scapularhead)
?Flexion-Pectoralismajor(clavicularpart),
Deltoid(anteriorpart)
Bicepsandcoracobrachialis
盂肱关节(GLENOHUMERALJOINT)
的动作
?Adduction-Teresmajor,latissimusdorsi,
Pectoralismajor,Deltoid(Anterior)
?Abduction-Deltoid(Middlepart)
Rotatorcuffactassynergists
盂肱关节(GLENOHUMERALJOINT)
的动作
?Medialrotation-Teresmajor,latissimusdorsi,
Pectoralismajor,Deltoid
(anterior),Subscapularis
?LateralRotation-Deltoid(Posterior),Teres
minor,Infraspinatus
肩带ShoulderGirdle
?肩带组成构造
?肩带的肌肉群
?肩带的稳定度
?肩胛骨(SCAPULA)的动作
?盂肱关节(GLENOHUMERALJOINT)的动作
?神经支配
肌肉近端(起始端)远程(终止端)神经支配动作功能
Extrinsic:Attachscapulatoneckandtrunk
斜方肌
Trapezius
1.枕外隆凸
2.项韧带
3.下位颈椎及胸椎
1.锁骨外侧1/3
2.肩峰
3.肩胛骨棘
副神经Retractsand
upwardlyrotates
scapula
作用在肩带(ShoulderGirdle)的肌肉群
提肩胛肌
Levator
Scapulae
C1-C4横突肩胛骨内侧
上缘
C3,4Elevationand
downwardrotation
ofthescapula
大/小圆肌
Rhomboid
Major&
Minor
1.项韧带
2.C7toT5脊凸
肩胛骨内缘
(肩胛骨棘根部至下角)
肩胛背神经
(C4,C5)
1.Retraction,downwa
rdrotation,some
elevationofthe
scapula,
2.Fixesthescapula
againstthetrunk
肌肉近端(起始端)远程(终止端)神经支配动作功能
Extrinsic:Attachscapulatoneckandtrunk
作用在肩带(ShoulderGirdle)的肌肉群
前距肌
Serratus
Anterior
肋骨第1-8根外侧肩胛骨
前面内侧
长胸神经
(C5,6,7)
1.Protractionand
upwardrotation
ofscapula
2.Fixesscapula
againstthe
thoracicwall
胸小肌
Pectoralis
Minor
肋骨第3,4,&5根肩胛骨喙突内侧胸神经
(C8,T1)
1.Protraction
2.downward
rotationof
scapula
肌肉近端(起始端)远程(终止端)神经支配动作功能
Intrinsic:RotatorCuff(Activestabilizationofshoulderjointbypreventingdownward
displacementofthehumerus)
棘上肌
Supraspinatus
肩胛棘上窝肱骨大结节上方肩胛下神经
(C5,6)
Startsshoulder
abduction
棘下肌
Infraspinatus
肩胛棘下窝肱骨大结节中间肩胛下神经
(C5,6)
Lateralshoulder
rotation
小圆肌
TeresMinor
肩胛骨外侧缘
(位于大圆肌上方)
肱骨大结节下方腋神经(C5,6)Lateralshoulder
rotation
肩胛下肌
Subscapularis
肩胛下窝肱骨小结节肩胛下神经(C5,6)Medialshoulder
rotation
肌肉近端(起始端)远程(终止端)神经支配动作功能
Intrinsic:Attachhumerustoscapula
三角肌
Deltoid
1.锁骨外侧1/3
2.肩峰
3.肩胛骨棘
肱骨干三角肌结
节
腋神经(C5,6)Anteriorportion-flexes,
mediallyrotates
shoulderMiddleportion-
abductstheshoulder
PosteriorPortion-extends,
laterallyrotatesthe
shoulder
大圆肌
Teresmajor
肩胛骨下角肱骨小结节棘肩胛下神经
(C5,6)
1.Adductionandmedial
rotationoftheshoulder2.
Stabilizesshoulderduring
abduction
3.Extendshoulderfrom
flexedposition
肌肉近端(起始端)远程(终止端)神经支配动作功能
Attachhumerustotrunk(Actprimarilyonhumerus;scapulamovespassivelyinresponseto
movementofhumerus)
阔背肌
Latissimus
Dorsi
1.胸腰筋膜
2.荐椎,髂脊
3.T6toL5脊突
二头肌沟(结节间
沟)
胸背神经
(C6,7,8)
1.Extend,Adduct,and
Mediallyrotatethe
shoulder
2.Depressanddownward
rotationofscapula
胸大肌
Pectoralis
Major
1.锁骨内侧1/2
2.胸骨,ribs2-6肋
软骨
二头肌沟(结节间
沟)
胸神经内外侧
枝(C6-T1)
1.Adduction,Flexion,
MedialRotationofthe
shoulder
2.HorizontalAdduction
3.Protractionofscapula
MOVEMENTSOFTHESCAPULA
MotionPrimeMoversNerveCriticalSegment
抬高
Elevation
斜方肌Trapezius-upperAccessory
提肩胛肌LevatorscapulaeN.toL.scapulaeC3,4
大圆肌RhomboideusmajorDorsalscapularC(4),5
小圆肌RhomboideusminorDorsalscapularC(4),5
下压
Depression
阔背肌LatissimusdorsiThoracodorsalC7
胸大肌Pectoralismajor-
sternalhead
PectoralNervesC6,7,8
胸小肌PectoralisminorMedialpectoralC8,T1
MotionPrimeMoversNerveCriticalSegment
MOVEMENTSOFTHESCAPULA
Upward
Rotation
SerratusanteriorLongthoracicC5,6,7
Trapezius-Upper&LowerAccessory
Downward
Rotation
Latissimusdorsi1ThoracodorsalC7
Pectoralismajor-sternal
head1
PectoralNervesC6,7,8,1
PectoralisminorMedialpectoralC8,T1
LevatorscapulaeN.toL.scapulaeC3,4
ProtractionSerratusanteriorLongthoracicC5,6,7
PectoralisminorMedialpectoralC8,T1
Pectoralismajor1PectoralNervesC6,7,8,1
RetractionTrapeziusAccessory
RhomboideusmajorDorsalscapularC(4),5
RhomboideusminorDorsalscapularC(4),5
MOVEMENTSOFTHEGLENOHUMERALJOINT
动作主要动作肌支配神经神经根节数
屈曲Flexion三角肌Deltoid–anteriorAxillaryC5胸大肌Pectoralismajor-
clavicularheadLateralPectoralC5,6
喙肱肌CoracobrachialisMusculocutaneousC5,6,7
伸直Extension三角肌Deltoid-posteriorAxillaryC5阔背肌LatissimusdorsiThoracodorsalC7
大圆肌TeresmajorLowersubscapularC5,6
外展Abduction棘上肌SupraspinatusSuprascapularC5,6
三角肌Deltoid–anteriorAxillaryC5
内收Adduction阔背肌LatissimusdorsiThoracodorsalC7
胸大肌Pectoralismajor-
sternalheadPectoralnervesC6,7,8,1
内转
InternalRotation
肩胛下肌SubscapularisUppersubscapularC5,6
三角肌Deltoid-anteriorAxillaryC5
外转
ExternalRotation
棘下肌InfraspinatusSuprascapularC5,6
小圆肌TeresminorAxillaryC5
三角肌Deltoid-posteriorAxillaryC5
Axillaryborder
ofscapula
ClavicleAcromion
Greater
tubercle
Lesser
tubercle
Humeral
Neck
Humerus
Coracoid
Process
Rib
Coracoid
ProcessClavicleAcromion
Humeral
Head
Humerus
Axillaryborder
ofscapula
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