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EXTREMITAS SUPERIOR (I)
Dr. Candra Rini HP., M.Kes
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Regio :
• Tora!a"is (dengan #ossa A$i""aris)
• %ra!ii e& !'i&i• An&era!ii
• Man's
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Ko*onen dan +a*isan :
• C'&is• #as!ia S'*er!ia"is
• #as!ia Pro-'nd's
• M's!'"'s
• Ossae
Di"enga*i dengan :• Ar&i!'"a&io
• /as!'"ar
• +i*e
• 0er1's
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Ossa Meri S'*erioris
• Cing'"' Meri S'*erioris (Cing'"'Pe!&ora"e) = Gelang bahu =Pectoral/shoulder girdle2 C"a1i!'"a
2 S!a*'"a• Pars "iera eri s'*erioris
2 H'er's
2 Radi's, '"nae
2 Ossa Car*i (!ar*a"ia), ossa e&a!ar*i(e&a!ar*a"ia), Ossa *a"anges(digi&or')
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RE3IO THORACA+ISe& #OSSA AXI++ARIS
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Ossa
• C"a1i!'"a
• S!a*'"a
4 Meerian area &eresar 'n&'*er"ea&an o&o&.
4 Terda*a& *erea&an dari 56 o&o& 77 er''ngan dengan *ergeraan
es&rei&as s'*erior.
• H'er's
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S'r-a!e Ana&o8
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Ar&i!'"a&io• Ar&i!'"a&iones Cing'"i Pe!&ora"is,
C"a1i!'"a dg &'"ang9 di dea&n8a
&dd :
2 Ar&i!'"a&io a!roio!"a1i!'"aris
2 Ar&i!'"a&io s&erno!"a1i!'"aris
• Ar&i!'"a&io g"eno'era"is
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Ar&i!'"a&io a!roio!"a1i!'"aris
4 S8no1ia"4 3eraan &er'&aa an&ero*os&erior
1er&i!a" *"ane, ersaa geraan ro&asia$ia"
4 Di"i*'&i o; !a*s'"a
4 Di*er'a& o; "igaen :
2 +ig. A!roio!"a1i!'"are
2 +ig. !ora!oa!roia"2 +ig. Cora!o!"a1i!'"are, &eragi+ig. Tra*e<oid
+ig. Conoid
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Ar&i!'"a&io s&erno!"a1i!'"aris :
4 An&ara agian edia" !"a1i!'"a dengan in!is'ra!"a1i!'"aris *ada an'ri' s&erni
4 S8no1ia" sadd"e sa*e
4 Ca1' ar&i!'"a&io &eragi 9 o"e dis!'s ar&i!'"aris
4 3eraan *d !"a1i!'"a &er'&aa an&ero*os&erior 1er&i!a" *"ane, ='ga da*a& sedii& ro&asi
4 Di"i*'&i o; !a*s'"a
4 Di*er'a& o; "igaen :2 +ig. S&erno!"a1i!'"are an&eri's
2 +ig. S&erno!"a1i!'"are *os&eri's2 +ig. In&er!"a1i!'"are
2 +ig. !os&o!a1i!'"are
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• Ar&i!'"a&io g"eno'era"is2 Sendi s8no1ia", a"" so!e&
2 An&ara !a*'& 'eri dan !a1i&as g"enoida"iss!a*'"a
2 S&ai"i&as sendi 2 's!'"'s9 ro&a&or !'> :
. s'*ras*ina&'s. in-ras*ina&'s
. &eres inor
. s's!a*'"aris
2 Ca*'& "ong' . i!e*s ra!ii2 Pro!ess's9 dari ossa 8ang erai&an
2 +igaen9 es&ra2!a*s'"ar
2 3eraan : ?e$i, es&ensi, ad'si, add'si,
ro&asi edia", ro&asi "a&era", !ir!'d'si
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2 Di*er'a& o"e :+ig. 3"eno'era" s'*, edia, in-.
+ig. Cora!o'era"
+ig. H'era" &rans1ers'
2 /as! :Ra's an&. *os&. A. !ir!'?e$a 'eri
A. s'*ras!a*'"aris
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M's!'"'s
• An&erior
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M's!'"'s• Pos&erior
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M's!'"'s• Pos&erior
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M's!'"'s• Ro&a&or !'>
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#ossa A$i"aris
• A$i""a (ar*i&) : area eren&'*iraid erisi s&r'&'rne'ro1as! *en&ing 8ang er=a"ane"a"'i regio a'.
• E"een ne'ro1as!'"ar ini&er'ng's da"a @a$i""ar8sea&, 8ang er'*aane"an='&an "angs'ng dari -as!ia*re1er&era"e dari "eer
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• %a&as A$i""a :4 Basis: -as!ia a$i""aris '"i&
4 Apex: !os&ae I, !"a1i!'"a, agian s'*eriors!a*'"a =a"an 'n&' eragai s&r'&'r9*en&ing as';e"'ar a' "engan.
4 Dinding anterior : . *e!&ora"is a=or
and inor4 Dinding posterior : . s's!a*'"aris,
&eres a=or, and "a&issi's dorsi
4 Dinding medial : !os&ae I, ICS I .
serra&'s an&erior.4 Dinding lateral : 'er's (s'"!'s
in&er&'er!'"aris)
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• S&r'&'r 8ang *en&ing da"a a$i""a:
4 A. Axillaris (&eragi agian)
4 V. Axillaris4 Limfonodi Axillaris ( e"o*o)
4 Plexus nervosus Brachialis(1en&ra" rai C2T5)
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• #as!ia9 8ang ada di a$i""a :4 Fascia Pectorale : eas'i .
*e!&ora"is a=or &eria& *adas&ern' !"a1i!'"a
4 Fascia Clavipectorale : eas'i. s'!"a1i's *e!&ora"is inor
4 Fascia Axillaris : een&' asis
a$i""a4 Axillary sheath: eas'i s&r'&'r
ne'ro1as!'"ar a$i""a
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Foramen Suprascapular
• Teren&' o"e :
2 In!is'ra s'*ras!a*'"aris s!a*'"a
2 +ig. S'*ras!a*'"ar (s!a*'"ar&rans1ers's s'*.)
• Di"a"'i o;:
2 n. s'*ras!a*'"aris
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Hiatus Axillaris Medialis (TriangularisSpace)• Teren&' o"e :
2 Pinggir edia" !a*'& "ong' &ri!e*s
ra!ii2 Pinggir s'*erior . &eres a=or
2 Pinggir in-erior . &eres inor
• Di"a"'i o;:2 A. !ir!'?e$a s!a*'"aris
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Hiatus Axillaris ateralis(!uadrangularis Space)
• Teren&' o"e :
2 Pinggir in-erior . &eres inor
2 Co""' 'eri
2 Pinggir s'*erior . &eres a=or
2 Pinggir "a&era" !a*'& "ong' &ri!e*sra!ii
• Di"a"'i o;:2 n. a$i""aris
2 /asa !ir!'?e$a 'eri *os&erior
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Triangular "nter#al
• Teren&' o"e :
2 Pinggir "a&era" dari !a*'& "ong' .&ri!e* ra!ii
2 %a&ang 'er's
2 Pinggir in-erior . &eres a=or
• Di"a"'i o;:
2 n. radia"is
2 A. *ro-'nda ra!ii
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/as!'"arisasi
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/as!'"arisasi
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• Ar&i!'"a&io a' 77 1as!'"aranas&oosis.
s'**"8 :4 56 o&o& 8ang e"ea& *d s!a*'"a ( O&o& a'
"ain)
4 Sir'"asi !o""a&era" "engan a&as.
ar&eri9 *en&ing da"a anas&oosis ini :
4 A. s!a*'"aris dorsa"is dan !er1i!a"is &rans1ers's(ar&er8 &8ro!er1i!a"is) dari A. s'!"a1ia
4 Caang s'*ras!a*'"ar (ar&er8 &8ro!er1i!a"is)dari A. s'!"a1ia
4 Caang s's!a*'"aris dan !aang s!a*'"aris!ir!'?e$a !aang &ora!odorsa"is
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+i-onodi A$i""a• Ter"e&a *ada =aringan ia& "ea a$i""a
• Meneria !airan "i-e dari daera :4 +engan a&as
4 %agian dinding dada
&er'&aa daera aae ( F 6G drainase"i-a&i dari aae e"a"'i "i-onodi disini).
• Teragi en=adi e"o*o:4 Cen&ra" nodes
4 +a&era" (ra!ia") nodes
4 Pos&erior (s's!a*'"ar) nodes
4 An&erior (*e!&ora") nodes
4 A*i!a" (s'!"a1ian) nodes
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K"inis :• Tendini&is 'rsi&is
• Ro&a&or !'> in='r8
• C"a1i!'"ar -ra!&'re
• So'"der dis"o!a&ion
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• Tendini&is 'rsi&is3eraan *ada sendi a' da*a&
en8eaan in?aasi &endon disei&ar sendi &s in?aasi se'nder*ada 'rsa
08eri sendi
Da*a& &er=adi dengan a"siasi da"a&endon 8ang enga"ai degenerasi
Tendon .s'*rasina&'s 77
Karena da*a& &er=e*i& o"e &'er!'"'a='s 'eri, a!roion, "ig.Cora!oaroia"is.
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• Ro&a&or C'> In='r8
4 77 &endon . s'*ras*ina&'s
4 ad'!&ion ?e$ion 8ang er'"ang(is. 3eraan e"e*ar) &er=adigesean an&ara &endon dg a!roion
"ig.!ora!oa!roia"
&i'" !airan&endon ; r'*&'r.
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• C"a1i!'"are -ra!&'re4 77 &er=adi &'. Pada ana9
4 Karena =a&' ( &angan &er&ari), a&a'&ra'a "angs'ng *ada a'.
4#ra&'r 5; edia"
=arang4 #ra&'r 5; &enga 77•Co*"e&e -ra!&'re -ragen &'"ang
*ro$ia" &er&ari e s'*erior o; .s&erno!"eidoas&oide's, sedangan 8angdis&a" &er&ari e in-erior o"e a'.
4 #ra&'r 5; "a&era" da*a& &i'"!airan *ada "ig.!ora!o!"a1i!'"ar.
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• So'"der dis"o!a&ion
4 Ha*ir G dis"oasi a' (ar&i!'"a&io
g"eno'era") e ara an&erior.4 Ter=adi arena ad'!&ion, e$&ension, "a&era"
(e$&erna") ro&a&ion "engan *ada a'(isa"n8a *ada geraan e"e*ar) s&ress
*ada !a*s'"e e"een an&erior ro&a&or !'>(&endon . s's!a*'"aris).
4 Ti*e dis"oasi an&erior :• S'!ora!oid (77)
• S'g"enoid
• S'!"a1i!'"ar (=arang)
4 0. a$i""aris (77) n. 's!'"o!'&aneo'sner1es da*a& &ergangg'
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seian
Re-erensi
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Re-erensi :
• Hansen +aer& : 0e&&ers C"ini!a" Ana&o8,5s& ed
• To*son : 0e&&ers Con!ise A&"as o-Or&o*aedi! Ana&o8
• Drae, e& a" : 3ra8s Ana&o8 -or S&'den&s
• Sne"" : Ana&oi K"ini 'n&' MaasisaKedo&eran, ed J
• #ai< Mo>a& : Ana&o8 a& a 3"an!e
• Moore Da""e8 : C"ini!a""8 Orien&ed Ana&o8,
&
ed