Shoulder hurts. Causes, types of pain, pathologies that cause pain. Intermuscular septa Fascia of the shoulder joint
On the shoulder, thanks to its own fascia, the anterior flexor muscle group and the posterior extensor muscle group are isolated. Own fascia surrounds the shoulder muscles with a cylindrical case, gives the medial and lateral septa to the bone, forming the anterior and posterior muscle containers, and on the medial side, the neurovascular sheath.
Front muscle group
Coracobrachialis muscle originating from the apex of the coracoid process of the scapula and inserting on the humerus at the level of the tendon deltoid muscle. Function: flexion and adduction of the shoulder, outward rotation. With a fixed shoulder, it shifts the scapula downward and anteriorly; It is supplied from the arteries that envelop the humerus and is innervated by the musculocutaneous nerve of the brachial plexus.
The biceps muscle of the shoulder with short and long heads, the beginning of the short one - from the coracoid process, the long one - from the supraarticular scapular tubercle. Both heads in the middle of the shoulder merge into a single abdomen, which passes into a tendon with attachment to the tuberosity of the radius. The tendon of the long head passes between the tubercles of the humerus into the shoulder joint and an intertuberculous synovial sheath is formed around it, and the distal tendon, attached to the radial tuberosity, passes along the medial side of the shoulder into the aponeurosis of the biceps muscle, which strengthens the cubital fossa and fascia of the forearm. Function: flexion in the shoulder and elbow joints, supination in the elbow joint; it is supplied with blood by the brachial artery and its collateral ulnar branches: (upper, lower) and recurrent radial artery; innervated by the musculocutaneous nerve.
The brachialis muscle originates from the lower two-thirds of the humeral diaphysis, attaches to the tuberosity of the ulna. Part of the fibers is woven into the capsule elbow joint in which the muscle performs flexion. It is supplied with blood by the collateral ulnar, recurrent radial arteries involved in the formation of the arterial network of the elbow joint; innervated by the musculocutaneous nerve.
Posterior muscle group
The triceps muscle of the shoulder with the beginning of the lateral and medial heads from the upper third of the shoulder diaphysis, and the long one from the subarticular tubercle of the scapula. Three heads, merging, form a powerful abdomen, which is attached to the olecranon by a wide tendon and is woven behind into the capsule of the elbow joint and the fascia of the forearm. Function: extension of the forearm, the long head extends and adducts the shoulder in the shoulder joint. It is supplied by the surrounding shoulder and collateral ulnar arteries, the deep brachial artery, and is innervated by the radial nerve.
The ulna muscle is a small, triangular muscle that originates from the lateral epicondyle of the shoulder and attaches to the olecranon and the posterior surface of the diaphysis of the ulna and fascia of the forearm, helps the triceps in extension. It is supplied with blood by the recurrent interosseous artery, innervated by the radial nerve.
The muscles and fascia of the shoulder along the anterior surface form lateral and medial grooves, which are clearly visible when the biceps is contracted. In the depth of the medial groove, there is a neurovascular bundle of the shoulder as part of the brachial artery and vein, the median nerve, which in the upper third lies laterally from the artery and vein, crosses them from above in the middle third, and lies medially from them in the lower third. In the lateral sulcus, the cephalic saphenous vein is located superficially, which passes higher into the deltoid-pectoral sulcus. The ulnar nerve passes medially from the brachial bundle, accompanied by the collateral ulnar arteries and veins.
Behind the shoulder there is a canal of the radial nerve (shoulder-muscular), in the formation of which the triceps muscle and the groove of the radial nerve, which spirally envelops the humerus along the diaphysis, participate. The inlet (upper) hole is located between the medial, lateral heads of the triceps and the humerus, the outlet is in lateral groove between the brachial and brachioradialis muscles. The radial nerve and deep brachial vessels pass through the canal. At the level of the middle third of the shoulder, they can be damaged in case of fractures and incorrect application of the tourniquet, because. lie on the bone. The long head of the triceps is involved in delimiting the three- and four-sided holes in the back wall of the armpit.
Subcutaneous fascia upper limb weakly expressed. Actually fascia (fascia propria) throughout its length differs in different thicknesses, its individual plates are highly developed and form sheaths for muscles and tendons, line pits and channels. Depending on the covered muscle groups, fasciae are isolated shoulder girdle, fascia of the shoulder, fascia of the forearm and fascia of the hand. The muscles of the shoulder girdle cover several fasciae. Deltoid fascia (fascia deltoidea) covers the deltoid muscle. It consists of two sheets: a thin superficial one, covering the muscle from the outside and passing at its front edge into the fascia of the chest, and a more powerful deep one, surrounding the muscle and separating it from the muscles of the shoulder girdle and joint capsule. shoulder joint. The deep leaf passes into the fascia that covers triceps muscle.
| Rice. 124. Muscles and fascia of the shoulder (cross section): 1 - fascia of the shoulder; |
|
 | Rice. 125. Muscles and fasciae of the forearm (cross section): 1 - superficial flexor of the fingers; |
 | Rice. 126. Synovial sheaths of the tendons of the dorsal surface of the hand: 1 - the sheath of the tendons of the long abductor muscle and short extensor thumb of the hand; |
 | Rice. 127. Synovial sheaths of the tendons of the palmar surface of the hand: 1 - sheath of the tendon of the radial flexor of the wrist; |
The supraspinous fascia (fascia supraspinata) covers the supraspinatus muscle. It has a dense structure and is strongly stretched along the edges.
The infraspinatus fascia (fascia infraspinata) is attached along the edges of the infraspinatus fossa (fossa nifraspinata), grows together with a deep sheet of the deltoid fascia and forms a sheath for the infraspinatus muscle and the small round muscle.
Subscapular fascia (fascia subscapularis) covers the subscapularis muscle. It is quite thin and weakly expressed, attached along the edges of the subscapular fossa.
Shoulder fascia (fascia brachii) (Fig. 124) is quite dense, especially in the middle third of the shoulder and below the deltoid muscle. In the lower half of the shoulder, intermuscular septums are located frontally, heading towards the humerus, which separate the anterior and posterior muscle groups from each other. They form fascial sheaths for the flexors and extensors of the shoulder and are the site of attachment of some of the muscles of the shoulder. Lateral intermuscular septum (septum intermusculare brachii laterale) (Fig. 124) departs from the fascia of the shoulder and is attached along the outer edge of the humerus. The medial intermuscular septum (septum intermusculare brachii mediale) (Fig. 124) also departs from the fascia of the shoulder and goes along the inner surface of the shoulder, attaching along the inner edge of the humerus.
The continuation of the fascia of the shoulder is the fascia of the forearm (fascia antebrachii) (Fig. 125). It is tightly connected with superficial muscles forearm. In the area of the elbow joint, the fascia of the shoulder is the most dense, here are the points of origin of some muscles of the forearm. This fascia also has a number of partitions that separate muscle groups and individual muscles from each other and form fascial sheaths for them. In the upper part, the fascia of the shoulder fuses with the aponeurosis of the biceps brachii muscle, and in the lower part it forms transversely directed bundles that form a circular ligament and cover the tendons of the muscles of the wrist joint when they pass to the hand.
Under the circular ligament on the back of the hand are channels in which the extensor sheaths lie. In the first from the radius, the vagina (vagina tendinum mm. abductoris longi et extensoris pollicis brevis) contains the tendons of the long abductor muscle and the short extensor of the thumb (Fig. 126), in the second vagina (vagina tendinum mm. extensorum carpi radialium) - the tendons of the radial wrist extensors (long and short) (Fig. 126), in the third vagina (vagina tendinis m. extensoris pollicis longi) - the tendon of the long extensor of the thumb (Fig. 126), in the fourth vagina (vagina tendinum mm. extensoris digitorum et extensoris indicis) - tendons of the extensor of the fingers and the extensor of the index finger (Fig. 126), in the fifth vagina (vagina tendinis m. extensoris digiti minimi) - the extensor tendon of the little finger (Fig. 126), in the sixth vagina (vagina tendinis m. extensoris carpi uenaris) - the tendon of the ulnar extensor of the wrist (Fig. 126).
On the palmar surface are the common synovial sheath of the tendons of the flexor fingers (superficial and deep) (vagina communis mm. Flexorum) (Fig. 127), the synovial sheath of the tendons of the long flexor of the thumb (vagina tendinis m. Flexoris pollicis longi) (Fig. 127) and the sheath of the tendon of the radial flexor of the wrist (vagina tendinis m. Flexoris carpi radialis) (Fig. 127). Also on the palmar surface are three similar tendon sheaths of the fingers (vaginae tendinum digitorum manus) (Fig. 127), which contain the tendons of the deep and superficial flexors of the index, middle and ring fingers. The tendon sheath of the little finger (vagina tendinis digitis minimi) (Fig. 127) is connected to the common sheath of the flexors.
The fascia of the hand (fascia manus) is a continuation of the fascia of the forearm. On the palmar surface of the hand are the superficial and deep fascia of the hand. The superficial fascia is a thin plate covering the muscles of the eminence of the thumb and little finger. In the central sections, the fascia thickens, passing into the palmar aponeurosis (aponeurosis palmaris). Deep fascia - a thin sheet of loose fiber covering the interosseous palmar muscles. Between the deep fascia and the palmar aponeurosis are the fibrous sheaths of the flexor tendons of the fingers. On the back of the hand, superficial and deep leaves of the dorsal fascia of the hand are also isolated. The superficial one covers the extensor tendons, and the deep one covers the interosseous muscles.
rice. 361
deltoid fascia, fascia deltaidea, covers the muscle of the same name and consists of two sheets: superficial, lamina superficialis, and deep, lamina profunda.
surface leaf poorly developed, covers the outer surface of the muscle and passes along the sulcus deltoideopectoralis into the fascia pectoralis propria.
deep leaf fascia, denser, covers the inner surface of the deltoid muscle, separating it from the articular bag of the shoulder joint and from the muscles of the shoulder girdle.
Supraspinatus fascia, fasciasupraspinata, covers outside m. supraspinatus in the form of a dense, tightly stretched connective tissue sheet over the fossa supraspinata, attached to the edges of the fossa supraspinata (Fig. 365).
Infraspinatus fascia, fascia infra-spinata, covers m. infraspinatus and m. teres minor; it is well expressed, grows together with a deep sheet of the fascia of the deltoid muscle at the posterior edge of the latter. The infraspinatus fascia, like the supraspinatus, does not have a deep leaf.
Subscapular fascia, fascia subscapularis (Fig. 354) covers the muscle of the same name; weakly expressed.
Axillary fascia, fascia axillaris (Fig. 367), stretched over the axillary fossa, closing it from below. Fascia passes through the outer edge m. pectoralis major and merges with the superficial sheet of the thoracic fascia. Behind it continues into the fascia m. latissimus dorsi and m. teres major, above - into the fascia of the deltoid muscle and below - into the fascia of the shoulder.
Axillary fascia has a number of openings through which blood and lymphatic vessels pass. In the outer section, it is reinforced by the axillary tendon arch, which is thrown from the tendon m. pectoralis major to tendon m. latissimus dorsi. The axillary arch is unstable in shape and degree of development, sometimes it is accompanied by a small number of muscle bundles.
Shoulder fascia, fascia brachii, envelops the muscles of the shoulder with a fairly dense cover. It is a continuation of the deltoid and axillary fascia, and, moving to the forearm, it bears the name of the fascia of the forearm, fascia antibrachii. From shoulder fascia in the gap between the anterior and posterior muscle groups of the shoulder, on both sides, processes depart, fused with the periosteum of the humerus, the medial and lateral intermuscular septa, septum intermusculare mediate and septum intermusculare laterale (Fig. 361, 365, 397). The first of them is fixed along the inner surface of the humerus from the place of attachment of the t. coracobrachialis to the epicondylus medianlis, the second - along the outer edge of the humerus from the tuberositas deltoidea to the epicondylus lateralis.
The shoulder fascia and these intermuscular septa associated with it and with the bone form two fascial sheaths. In the anterior lies the anterior, in the posterior - the posterior muscle groups of the shoulder (Fig. 397).
The fasciae covering the upper limb differ in their length with different thicknesses. Fascial plates in a number of places form well-defined sheaths and line pits, channels, etc., of various sizes.
IN upper limb girdle the following fasciae are distinguished (see fig.):
- A) deltoid fascia, fascia deltoidea, formed by two sheets: a weaker surface and a more powerful deep. The superficial sheet covers the deltoid muscle from the outside and, having reached the anterior edge of the muscle, passes into thoracic fascia, fascia pectoralis. Deep leaf surrounds m. deltoideus, separating it from the muscles of the girdle of the upper limb (m. infraspinatus, m. teres minor) and the capsule of the shoulder joint, and passes into the fascia covering the triceps muscle;
- b) supraspinous fascia, rather dense, stretched along the edges of the supraspinatus fossa, covers the muscle of the same name;
- V) infraspinatus fascia attached along the edges of the infraspinatus fossa and, growing together with a deep sheet of the fascia of the deltoid muscle, forms a vagina for m. infraspinatus and m. teres minor;
- G) subscapular fascia thin, very weakly expressed, attached along the edges of the fossa of the same name, covering the subscapularis muscle.
Axillary fascia, fascia axillaris, is a relatively dense sheet that covers the bottom of the axillary fossa and has a number of holes formed by the nerves passing here, blood and lymphatic vessels. Without clear boundaries, it passes above into the fascia of the deltoid muscle, below - into the fascia of the shoulder, and behind - into the fascia covering m. latissimus dorsi and m. teres major.
Shoulder fascia, fascia brachii, is well expressed (see Fig. , ). The densest in the middle third of the shoulder and below the deltoid muscle. In the lower half of the shoulder, between the flexors and extensors, there are two frontally located intermuscular septa - lateral and medial, forming fascial sheaths for these muscle groups and serving as a place of attachment for some parts of the muscles of the shoulder and forearm. Lateral intermuscular septum of the shoulder, septum intermusculare brachii laterale, moving away from the fascia of the shoulder, covering the outer surface of the shoulder, goes inward and is attached along the outer edge of the humerus, starting from the deltoid tuberosity to the lateral epicondyle, separating the lateral and medial heads m. tricipitis from m. brachialis and m. brachioradialis. Medial intermuscular septum of the shoulder, septum intermusculare brachii mediate, more powerful, departs from the fascia of the shoulder and is located on the inner surface of the shoulder, where it is fixed along the inner edge of the humerus from the distal end of m. coracobrachialis to the medial epicondyle, separating the medial head m. tricipitis from m. brachialis and m. pronator teres. In some sections, the fascia of the shoulder is perforated by nerves and blood vessels.
Fascia of the forearm fascia antebrachii(see Fig.,,,), is a continuation of the fascia of the shoulder. It reaches its greatest density in the region of the elbow joint, where a number of muscles of the forearm originate from it. Numerous thin septa extend from the fascia along the entire length, lying between individual muscle groups and forming fascial sheaths for them. Along the entire circumference of the forearm, the fascia of the forearm is tightly fused with superficially lying muscles. At the top, it fuses with the fibrous plate - the aponeurosis of the biceps muscle of the shoulder; from below, the fascia forms well-defined transversely directed bundles, covering the area of the wrist joint (see Fig.).
The fascial septa and bones of the forearm, as well as the interosseous membrane in the upper half of the forearm, form three muscle beds: lateral, posterior, and anterior. IN lateral bed lie m. brachioradialis and mm. extensores carpi radialis, in the posterior bed (extensors) - m. extensor digitorum, m. extensor digiti minimi, m. extensor carpi ulnaris, m. anconeus and m. supinator. IN front bed, which is divided by the fascial plate into two sections - superficial and deep, all the muscles of the anterior group of the forearm lie. At the same time, in the deep section of the anterior bed, m. flexor digitorum profundus and m. flexor pollicis longus, and in the surface - m. pronator teres, m. flexor carpi radialis, m. flexor digitorum superficialis, m. palmaris longus and m. flexor carpi ulnaris. In the lower half of the forearm, the number of fascial beds remains the same, but their size decreases, since they surround not the muscles, but the tendons extending from them.
Fascia brush, both on the palmar and on the back surface (see Fig.,), are a direct continuation of the fascia of the forearm.
On the palmar side of the hand, two fascia are distinguished - superficial and deep. The superficial fascia has the appearance of a thin plate covering the muscles of the eminence of the thumb and little finger. In the central parts of the palm, the fascia thickens significantly and passes into palmar aponeurosis, aponeurosis palmaris. In shape, the aponeurosis has the form of a triangle, turned with its base down to the fingers, and with its apex up, to the forearm, where it fuses with flexor retinaculum, retinaculum flexorum, which, located above the groove of the wrist, forms carpal canal, canalis carpi. In this canal lie the tendon sheath of the long flexor of the thumb and the common synovial sheath of the flexors of the fingers. In the region of the apex, the tendon m is woven into the aponeurosis. palmaris, the fibers of which diverge fan-shaped in the thickness of the aponeurosis, reaching the base of the fingers. Here they are grouped into large bundles.
The longitudinal bundles of the palmar aponeurosis are strengthened by the compacted part of the superficial fascia, which is the superficial transverse metacarpal ligaments, ligg. metacarpea transversa superficialia(see fig.). In addition, the palmar aponeurosis also contains transverse bundles, fasciculi transversi, especially well expressed at the base of the interdigital spaces (see Fig.).
The deep fascia of the hand - the palmar interosseous fascia - is a relatively thin sheet of loose fiber covering the interosseous palmar muscles. Between the deep fascia and the palmar aponeurosis are the tendons of the flexors of the fingers, blood vessels and nerves.
Both fascia fuse on the sides, forming a space where these tendons and worm-like muscles pass.
The palmar fascia of the fingers forms fibrous sheaths of fingers, vaginae fibrosae digitorum manus in which the flexor tendons of the fingers pass. Inside, these sheaths are lined with a synovial membrane. The walls of these fibrous sheaths of the fingers are reinforced by a series of ligaments. The following are the most well developed: annular part of the fibrous sheath, pars anularis vaginae fibrosae, lying at the level of the phalanges of the fingers, and cruciform part of the fibrous sheath, pars cruciformis vaginae fibrosae, lying at the level of the interphalangeal joints (see Fig.). In addition, there are lateral ligaments, ligg. collateralia.
On the dorsum of the hand is dorsal fascia of the hand, fascia dorsalis manus, which is divided into superficial, covering the extensor tendons, and deep fascia, covering the dorsal interosseous muscles.
Table of contents of the subject "Shoulder joint (articulatio humeri). Anterior region of the shoulder.":1. Shoulder joint (articulatio humeri). External landmarks of the shoulder joint. Projection of the joint space of the shoulder joint.
2. Anatomical neck of the humerus. Surgical neck of the humerus. Articular capsule of the shoulder joint.
3. Fibrous layer of the joint capsule. Shoulder ligaments. Muscles that strengthen the shoulder joint.
4. Synovial bags of the shoulder joint. Topography of synovial bags of the shoulder joint. Ways of distribution of purulent processes of the shoulder joint.
5. Collateral circulation in the shoulder girdle. Scapular arterial collateral circle. Occlusion of the axillary artery. Violation of blood flow in the axillary artery.
6. Anterior region of the shoulder. External landmarks of the anterior region of the shoulder. Borders of the anterior region of the shoulder. Projection on the skin of the main neurovascular formations of the anterior region of the shoulder.
7. Layers of the anterior region of the shoulder. Anterior fascial bed of the shoulder. Muscle of Kasserib. Posterior fascial bed of the shoulder. Walls of the fascial bed of the shoulder.
8. Topography of vessels and nerves of the anterior fascial bed of the shoulder. Location of nerves and vessels on the shoulder.
9. The connection of the fiber of the anterior region of the shoulder with neighboring regions. Holes in the anterior region of the shoulder. Communications of the anterior region of the shoulder.
Layers of the anterior region of the shoulder. Anterior fascial bed of the shoulder. Muscle of Kasserib. Posterior fascial bed of the shoulder. Walls of the fascial bed of the shoulder.
Skin in the anterior region of the shoulder relatively thin, especially in the medial part of the region, quite mobile. In the skin of the medial surface of the upper half of the shoulder, the medial cutaneous nerve of the shoulder, p. cutaneus brachii medialis, branches from the medial bundle of the brachial plexus.
Subcutaneous adipose tissue of the anterior region of the shoulder loose. superficial fascia quite well expressed in the lower third of the region, where it forms a case for superficial neurovascular formations, in other places it is weakly expressed.
Surface formations of the area: on the medial side (along the sulcus bicipitalis medialis) in the lower third of the shoulder is the medial saphenous vein of the arm, v. basilica, and next to it are branches of p. cutaneus antebrachii medialis. On the lateral side, along the sulcus bicipitalis lateralis, the lateral saphenous vein of the arm, v. cephalica, which at the upper border of the region passes into sulcus deltopectoralis.
Own fascia of the shoulder, fascia brachii, surrounds the entire shoulder. On the border of the middle and lower third of the shoulder in the medial groove of the shoulder in its own fascia there is a hole through which the splitting of the fascia ( Pirogov Canal) enters v. basilica, and p. cutaneus antebrachii medialis emerges from it.
From the inner surface of its own fascia from the medial and lateral sides to the humerus depart intermuscular septa(septa intermusculare laterale et mediale), as a result of which two fascial beds are formed on the shoulder: anterior and posterior.
The walls of the anterior fascial bed of the shoulder, Compartmentum brachii anterius, are: in front - own fascia, behind - the humerus with intermuscular septa attached to it (Fig. 3.16).
Rice. 3.16. Fascial beds of the shoulder in a transverse section of the middle third. 1 - m. biceps brachii; 2 - m. bracliialis; 3 - n. mus-culocutaneus; 4 - n. medi-anus; 5-a. bracliialis; 6-v. basilica et n. cutaneus an-tebrachii medialis in Pirogov's canal; 7 - n. ulnaris; 8 - septum intermusculare mediale; 9 - fascia brachii; 10 - m. triceps brachii; 11-n. radialis et a. collateral radialis; 12 - septum intermusculare laterale.
The contents of the anterior bed are muscles: lying deeper coracobrachial (upper third of the shoulder), short head of the biceps of the shoulder and shoulder (two lower thirds of the shoulder), and superficially - the long head of the biceps of the shoulder. shoulder muscle, or kasserib muscle [Casserio], covers deep fascia.
WITH inside first the coracobrachial, and then the biceps of the shoulder along its entire length in fascial case, formed due to the medial intermuscular septum, the main neurovascular bundle of the region is located - the brachial artery, the accompanying veins and the median nerve.
Posterior fascial bed of the shoulder, conipartirnenturn brachii posterius, limited in front by the humerus with partitions, behind - by its own fascia. In the back bed is m. triceps brachii.
Shoulder muscle anatomy instructional video
The anatomy of the muscles of the shoulder on the preparation of the corpse is disassembled
