DELTOID AREA

From Big Medical Encyclopedia

DELTOID AREA [regio deltoidea (PNA, JNA, BNA)] — the area of a body corresponding to the location of a deltoid muscle, shoulder joint; it is called on looking alike the overturned letter of the Greek alphabet Δ (delta).

Anatomy

Borders of area are: in front — a deltovidnogrudny furrow (sulcus deltoideopectoralis); behind — the rear edge of a deltoid muscle; above — the line going on a scapular awn (spina scapulae) from its middle to an akromion (acromion) and further on a lateral third of a clavicle; from below — the line of a convergence of edges of a deltoid muscle located on an outer surface of a shoulder is 13 — 16 cm lower than an akromion. In D. islands distinguish the following layers: skin, hypodermic cellulose and superficial fascia; the last two layers are more expressed at women.

Fig. 1. Muscles of the right shoulder girdle and shoulder (upper third): 1 — a big pectoral muscle; 2 — a lateral saphena of a hand; 3 — an outside oblique muscle of a stomach; 4 — a front gear muscle; 5 — a biceps of a shoulder; 6 — a humeral muscle; 7 — a lateral head of a tricipital muscle of a shoulder; 8 — the broadest muscle of a back; 9 — a big round muscle; 10 — a small round muscle; 11 — a deltoid muscle; 12 — a trapezoid muscle.
Fig. 2. Vessels, nerves and mucous bags of an upper third of a shoulder and deltoid area: 1 — a subacromial bag; 2 — a subtendinous bag of an infrascapular muscle; 3 — a subdeltoid bag; 4 — a deltoid muscle; 5 — a deltoid branch of a deep artery of a shoulder; 6 — lateral head of a tricipital muscle of a shoulder; 7 — a long head of a tricipital muscle of a shoulder; 8 — a beam nerve; 9 — a humeral artery; 10 — a big round muscle; 11. — back cutaneous nerve of a shoulder; 12 — the back artery which is bending around a humeral bone; 13 — an axillary nerve; 14 — a small round muscle.
Fig. 3. Skin vessels and nerves of deltoid area: 1 — lateral (back) supraclavicular nerves; 2 — a lateral saphena of a hand; 3 — a back cutaneous nerve of a shoulder; 4 — a lateral cutaneous nerve of a shoulder; 5 — skin branches of the back artery which is bending around a humeral bone and the veins accompanying them; 6 — branches of an upper lateral cutaneous nerve.
Fig. 4. A cross cut of the right axillary hollow (across Pirogov). The cut is carried out through a surgical neck of a humeral bone and a body of a shovel: 1 — an axillary artery; 2 — a big pectoral muscle; 3 — myshechno - a cutaneous nerve; 4 — a lateral saphena of a hand; 5 — an axillary vein; 6 — a sinew of a biceps of a shoulder; 7 — a humeral bone; 8 — a deltoid muscle; 9 — an axillary nerve; 10 — a beam nerve; 11 and 13 — a shovel; 12 — an infrascapular muscle; 14 — an edge; 15 — the right lung; 16 — an elbow nerve; 17 — a median nerve.

Deltoid fascia (fasc. deltoidea) forms two leaves: outside and internal, covering a deltoid muscle outside and from within and forming her fascial vagina. The deltoid muscle (m. deltoideus) having the fan-shaped direction of yarns (fig. 1) consists of 3 parts. Front, clavicular, a part of a muscle begins from a lateral third of a clavicle. The average bunches making an outside, acromial part of a muscle originate from an akromion. Back, scapular, a part of a deltoid muscle departs from a lateral half of a scapular awn. Yarns converge towards deltoid tuberosity (tuberositas deltoidea) of a humeral bone where are attached. Reduction of front bunches of a muscle causes bending of a shoulder, back — extension and averages — assignment of a shoulder (to 90 °). The deltoid muscle covers a shoulder joint and an upper half of a humeral bone (a head and almost all upper half of its diaphysis, including a surgical neck). Between a deltoid muscle with her fascial vagina and a humeral bone with a shoulder joint there is a subdeltoid space (spatium subdeltoideum) containing friable connecting fabric, sinews of some muscles, vessels and nerves (fig. 2). In an upper part of subdeltoid space between a big hillock of a humeral bone and a deltoid muscle the large synovial subdeltoid bag (bursa subdeltoidea) lies. Take place in posterosuperior department of subdeltoid space to a big hillock of a humeral bone of a sinew of a supraspinal muscle (m. supraspinatus), podostny (m. infraspinatus) and small round (m. teres minor) of muscles. In anterosuperior department of subdeltoid space there passes the sinew of an infrascapular muscle (m. subscapularis) which is attached to a small hillock of a humeral bone. Between big and small hillocks in an intergrumous furrow (sulcus intertubercularis) passes a sinew of a long head of a biceps of a shoulder in a synovial vagina. Medialny this furrow the short head of the same muscle, and even more medially and more deeply — a coronoid and humeral muscle (m. coracobrachialis), shovels which are attached to a coracoid lies. Podostny, infrascapular and coronoid and humeral muscles have special bags — a subtendinous bag of a podostny muscle (bursa subtendinea m. infraspinati), subtendinous bag of an infrascapular muscle (bursa subtendinea m. subscapularis) and coronoid and humeral bag (bursa coracobrachialis). The subdeltoid space on the course of an axillary nerve and the back artery surrounding a humeral bone is reported through a quadrilateral opening (foramen quadrilaterum) with an axillary pole, on the course of a sinew of a supraspinal muscle — with supraspinal space of a shovel, on the course of sinews podostny and small round muscles — with podostny space, on the course of a sinew of an infrascapular muscle — with infrascapular space. At the level of a surgical neck of a shoulder in subdeltoid space there pass (fig. 3 and 4) the axillary nerve (n. axillaris), arteries and veins which are bending around a humeral bone — front and back (aa. et vv. circumflexae humeri ant. et post.). In a deltoid and chest furrow there passes the lateral saphena of a hand (v. cephalica), getting through an interval between a clavicle, big chest and deltoid muscles into an axillary hollow and falling into a subclavial vein. Limf, vessels from the educations which are in D. of the lake go on hypodermic cellulose (superficial limf, vessels) and on the course of arteries of area (deep limf, vessels) to axillary (nodi lymphatici axillares) and in deep cervical limf, nodes (nodi lymphatici cervicales protundi).

The main nerve of D. of the lake is the axillary nerve (n. axillaris) arising from a back bunch of a brachial plexus. It innervates a deltoid muscle, a shoulder joint, an upper epiphysis of a humeral bone, D.'s skin of the lake

Pathology

Damages

Rather often D. of the lake is exposed to traumatic damages. Bruises and D.'s hematomas of the lake can be followed by deformation of this area, dysfunction of a deltoid muscle and shoulder joint. Treatment of these damages if it is not followed by injury of bones and sheaves, does not differ from treatment of bruises and hematomas of other localizations (see. Hematoma , Hurt ).

Open damages Of the lake can be getting into a cavity of a shoulder joint that significantly complicates the forecast and demands special methods of treatment (see. Shoulder joint ). Treatment of the wounds which are not getting into a joint does not differ in any features (see. Wounds, wounds ).

Islands treat frequent damages of D. a rupture of an acromial and clavicular joint and a change of an acromial shoot of a shovel. These damages arise during the falling on an outer surface of the given shoulder or arm-distance. At a rupture of an acromial and clavicular joint there is a disturbance of an integrity coronoid and clavicular (lig. coracoclaviculare) and acromial and clavicular (lig. acromioclaviculare) sheaves and dislocation or an incomplete dislocation of the acromial end of a clavicle owing to what the end of a clavicle is displaced under skin. Clinically at the same time sharp local morbidity in the field of an acromial and clavicular joint is defined; at survey and a palpation is available patol, the vystoyaniye of the acromial end of a clavicle which during the pressing on it is easily set, but is displaced again after the termination of pressure upon it (a symptom of a key). Oxycinesias in a shoulder joint, weakness of an upper extremity are at the same time noted. At a change of an acromial shoot the considerable swelling of soft tissues in the field of a shoulder girdle, morbidity and restriction of movements in a shoulder joint is observed. First aid consists in fixing of a hand a bandage like Dezo (see. Desmurgy ) or on a kerchief. The rupture of an acromial and clavicular joint with dislocation of the acromial end of a clavicle demands surgical treatment. A change of an acromial shoot treat conservatively more often — by fixing of an upper extremity a bandage like Dezo for a period of up to 4 weeks with the subsequent LFK and physical therapy. Changes of a head and a surgical neck of a shoulder are followed by deformation and considerable hypostasis of soft tissues in a shoulder joint. At dislocations of a shoulder characteristic deformation of an outside contour of a shoulder joint takes place (see. Shoulder joint, pathology ). At fractures of a neck of a shoulder and dislocations of a shoulder at the time of an injury or in inept attempts of reposition of fragments or elimination of dislocation the axillary nerve (n. axillaris), and sometimes and an axillary artery (a. axillaris) can be injured. Injury of an axillary nerve leads to paresis or paralysis of a deltoid muscle. Dysfunction of assignment of a shoulder is characteristic of these damages: assignment of a shoulder to 90 ° in these cases is possible only due to the movements of a shovel. At persistent paralysis there is an atrophy of a deltoid muscle to development eventually the dangling joint (see). Treatment of paresis of a deltoid muscle conservative — physical therapy, massage, LFK. Persistent paralyzes of a deltoid muscle demand operational treatment — movement of muscles to the place of deltoid or an artificial ankylosis of a shoulder joint (see. Shoulder joint , operations).

Inflammations

Rather often meet acute and hron, a subdeltoid bursitis. The acute bursitis develops owing to the opened or closed injury more often. Its main symptoms are pains and a painful swelling in the field of a big hillock of a humeral bone. In early stages of a disease rest, UF-or UVCh-radiation, antibiotic treatment are shown. At a purulent bursitis, the diagnosis to-rogo is established on the basis of emergence of local and general signs of purulent process and can be confirmed with a puncture, operational treatment is shown. The main symptom hron, a subdeltoid bursitis are pains and restriction of movements in a shoulder joint. Quite often at hron, a bursitis in a subdeltoid bag calcification — bursitis calcarea develops. At hron, a bursitis conservative treatment is shown: physiotherapeutic procedures, punctures of a synovial bag with administration of suspension of a hydrocortisone in it and only at failure of these methods — operational treatment — excision of a synovial bag (see. Bursitis , Synovectomy ).

Hron, an inflammation subdeltoid or subtendinous synovial bags — one of the frequent reasons of development humeroscapular periarthritis (see).

At D.'s injury of the lake, a purulent subdeltoid bursitis, osteomyelitis of an upper metaphysis of a humeral bone phlegmon of subdeltoid space can develop. Its main symptoms are change of a configuration of D. of the lake, pain, the fluctuation more often determined by the first or rear edge of a deltoid muscle. Pus from subdeltoid space can spread in an axillary pole, to a back surface of a shoulder, in over - or a podostny pole of a shovel, in subpektoralny space. The final diagnosis of phlegmon of subdeltoid space usually is established by a puncture. Treatment operational: the broad opening of phlegmon made on front is more rare on the rear edge of a deltoid muscle, and sufficient drainage of subdeltoid space. Through D. the lake provide quick accesses to a shoulder joint and periartikulyarny fabrics (see. Shoulder joint, operations ).


Bibliography: Voyno-Yasenetsky B. F. Sketches of purulent surgery, page 171, L., 1956; Kovanov V. V. and Anikina T. I. Surgical anatomy of fastion and kletchatochny spaces of the person, page 100, M., 1967; Kovanov V.V.itravina.A. Surgical anatomy of upper extremities, page 261, M., 1965; The Multivolume guide to orthopedics and traumatology, under the editorship of N. P. Novachenko, t. 3, page 402, M., 1968; H and to l and V. D. Ortopediya's N, book 2, page 527, M., 1957; Traumatic nerve lesions of the upper limb, ed. by J. Michon a. E. Mobery, Edinburgh — L., 1 975. Yu. M. Lopukhin;

S. S. Mikhaylov, And. H. Maksimenkov (An.).

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