Gross Anatomy of Upper Extremities PDF

GROSS ANATOMY OF UPPER EXTREMITIES Dr. Linus A. ENYE 1  COURSE OUTLINE Introduction to Human Anatomy, Brief history, Anatomical terminologies. General overview of upper limb 2  Shoulder joint...

GROSS ANATOMY OF UPPER EXTREMITIES Dr. Linus A. ENYE 1  COURSE OUTLINE Introduction to Human Anatomy, Brief history, Anatomical terminologies. General overview of upper limb 2  Shoulder joint Elbow joint and and it’s anastomosis. anastomosis, Forearm Axilla, Hand Breast, Brachial plexus, Cubital fossa, 3  RECOMMENDED TEXT 1. Clinically oriented anatomy by Keith Moore and Dailey, latest edtition. 2. Clinical anatomy by Harold Ellis, latest Edition. 3. Gray’s anatomy of the Human Body by Henry Gray, latest Edition. 4. Grant’s Atlas of Anatomy 5. A colour atlas of human anatomy by McMinn, Hutchings, Pegington and Abrahams 6. FRANK NETTER COLOUR ATLAS 4  INTRODUCTION TO HUMAN ANATOMY Human anatomy is the medical science concerned with the study of the structure and the relation and functions of its constituent parts. The term anatomy was derived from a Greek word meaning “to cut up”. The anatomy of every structure of the body is adapted for performing a function, or perhaps several functions. 5  Disciplines in anatomy –Macroscopic/Gross/Topographic –Microscopic/Histology –Developmental/Embryology –Neuroanatomy/Brain and Nervous system 6 BRIEF HISTORY OF ANATOMY 7  Primitive Times Believed that illness and diseases were a punishment from the gods First physicians were witch doctors who treated illness with ceremonies 8  Primitive Times Herbs and plants were 1st known pharmaceuticals. Examples: Foxglove gave digitalis plants leaves were chewed to strengthen & slow heart – Now given by pills, IV, or injections 9 Greeks (1200 BC –200 BC) Made observations about the human body and the effects of disease that led to modern medical sciences Believed illness is a result of natural causes 10 History of Anatomy (Greece) The Greeks were the first to attempt to study objectively the human body. That is why many medical terms are based on the Greek language. 11  Greeks Used therapies such as massage, art therapy and herbal treatments Discovered that diet and cleanliness could prevent disease 12 Greeks explained illness in terms of 4 body humors I. Blood/Sangius-Liver II. Phlegm/Phlegma -lungs III. Yellow bile/Chole -Gallbladder IV. Black bile/Melanchole -Spleen. Thought the humors were governed by Air, Water, Fire, and Earth Healthy person had all four humors in balance. 13  Bloodletting was a way of getting rid of excess humors. 14 Egyptians (3000 BC- 300 BC) Leeches would be use for bloodletting (draining human blood) Does not hurt because their saliva contains a natural anesthetic Their saliva also contains a blood thinner, a vasodilator, and an agent that prevents bacteria from infecting the wound 15  The practice of bloodletting seemed logical when the foundation of all medical treatment was based on the four body humors: blood, phlegm, yellow bile, and black bile. Health was thought to be restored by purging, starving, vomiting or bloodletting 16 ▪ In addition: ▪ Physicians had to know the proper prayers and charms wherewith to approach "Apollo the Healer," who would tell them what kind of herb poultice to put on a wound. 17 ▪ Many “doctors” practiced by trial and error. ▪ If they made a lot of errors, people quit going to them. ▪ Socles, a physician, treated a hunchback by piling three solid stones, each four feet square, on his spine. He was crushed and died, but he became straighter. ▪ Trepanning was also practiced solve intracranial diseases. 18 Hippocrates (460 to 377 BC) 19  Hippocrates(460B.C.-377B.C.) Hippocrates is known as the “Father of Medicine.” He is considered one of the greatest physicians the world has ever known. He was the first to attempt to separate the practice of medicine from religion and superstition. Hippocrates developed his pledge of proper conduct for doctors. Hippocrates - THE FOUR HUMORS Blood was thought to come from the heart Phlegm from the brain Yellow bile from the liver Black bile from the spleen 20 The 4 Humors coincided with the four temperaments recognized by the Greeks The temperaments are: ❖ sanguine (pleasure- seeking and sociable), ❖ choleric (ambitious and leader-like), ❖ melancholic (introverted and thoughtful), ❖ Phlegmatic (relaxed and quiet). 21  Aristotle (384-332 B.C.) Made careful investigations of all kinds of animals, including humans, and pursued a limited type of scientific method in obtaining data. He wrote the first known account of embryology, in which he described the development in a chick embryo. His best-known zoological works are History of Animals, Parts of Animals, and Generation of Animals. Despite his tremendous accomplishments, Aristotle perpetuated some erroneous theories regarding human anatomy. For example, he disagreed with Plato, who had described the brain as the seat of feeling and thought, and proclaimed the heart to be the seat of intelligence. Aristotle thought that the function of the brain, which was bathed in fluid, was to cool the blood that was pumped from 22 the heart, and thus maintain body temperature  Herophilus (about 304 B.C.) Was a court physician to Ptolemy II established anatomy as an independent science. Herophilus began dissecting human cadavers, thus giving r ise to a term anatomy. Using this method, he described various anatomical struc tures: a) The brain and its meninges; b) The vascular network and venous sinuses, and their confl uence (torcular Herophili); c) The nerves, which he distinguished strictly from tendons; d) He differentiated the arteries from veins; e) He also discovered the prostate and duodenum. 23  HISTORY OF ANATOMY (ROME) Human dissections were forbidden during this time in Rome 24  Claudius Galen (120c to 200AD) Roman physician, “team doctor” for the gladiators. Kept them alive so they could fight again. 25 – Proved that arteries carry blood and not air – Believed that blood originated in the liver and flowed outwards to form the flesh 26  Galen believed in the humors of the body, and perpetuated this concept. In his opinion organisms was controlled by thr ee organs: a)the liver, in which physical pneuma was prod uced and than distributed along the veins. b)the heart, in which vital pneuma originated a nd was then transmitted along the arteries. c)the brain, in which the psychic pneuma was concentrated and then distributed along the ner ves. He also gave authoritative explanations for nea rly all body functions. 27  Early anatomical drawing based on misinformation. 28  Leonardo Da Vinci (1452 to 1519) Artists, Painter, Philosopher and Scientist in Renaissance period he was interested in human form, so studied anatomy. He was one of the first scholars to dissect human cadavers. Da Vinci saved and analysed bones and prepared models. Made hundreds of anatomically correct drawings. He dissected bodies in secret. 29 30  Andreas Vesalius (1514 to 1565) He was a Belgian Flenish in origin. Barber surgeon (combination barber, dentist, doctor). Got special permission from the Pope to dissect criminals. First scientist to understand human anatomy. Wrote the first accurate book on human anatomy – de Humanii Corporis Fabrica. 31  He boldly corrected Galen’s many anatomical errors He caused on one hand a revolution in the anatomical world and on the other hand had a stiff opposition from Galen’s followers who where protecting his interest. He was therefore persecuted, slanderously accused of dissecting a noble woman whose heart was still breathing. 32  William Harvey (English) Circa 1578-1657 In opposition to religion he advanced the premise that all animals develop from egg (Omi animal ex ovo) “Father of Anatomy” studied circulatory system Harvey dissected his own freshly dead family members (his father and sister) before burial. 33 34  Shortage of cadavers In England and Scotland, medical schools began to open. No one donated bodies to science – churchgoers believed in literal rising from grave, so dissection spoiled chances of resurrection. Became a tradition to rely on executed prisoners, even up to 18th and 19th centuries. 35 36  Serious Crimes The added punishment of being dissected after death was considered another deterrent from crime. Eg. – Steal a pig: you were hung Kill a person: you were hung and dissected Anatomists were often associated with executioners. 37  Because they needed body parts, anatomists at medical school bought odd things. A man could sell the leg of his son if it had to be amputated 38  Grave Robbing Some medical students raided grave yards; some professors did also. In certain Scottish schools in 1700s, you could trade a corpse for your tuition. 39  Resurrectionists By 1828 in London, body snatchers (or resurrectionists) provided the medical schools with corpses. Not a crime; a dead body could not be owned or stolen. (Anatomy studies were only conducted from October to May to avoid stench of decomposition.) 40  Wealthy people choose to be buried in iron cages, some covered in concrete. Also churches built “dead houses” which were locked and guarded. 41  William Burke and William Hare Circa 1828 2 resurrectionists Both owned a boarding house; they occasionally killed a border who was late on rent. (Killed 15 of them) Did it by pressing pillow to man’s face while Burke lay his body weight on top of victim. Became known as “Burking.” Bones made into skeletons for medical school. Skin used to make wallets. 42  Anatomy Act of 1832 – bodies of poor who were not claimed for burial could be used by anatomists. Operated under this same concept until recently. Donations are on the rise. 43  OUR EXPERIENCE Cadavers are bought from mortuaries. These are said to be unclaimed or abandoned corpses Cadavers scarce The current debate is : “DISSECTION, is it necessary for the training of medical students?” 44 ANATOMICAL TERMINOLOGY 45  Anatomy and medicine have an internationally recognized vocabulary. These terms are expressed in Latin or Greek. This is to avoid ambiguity and allow smooth communication amongst health care professionals worldwide as well as amongst scholars in basic and applied health sciences. 46  Nevertheless health and applied health workers must know the common name these structures are called so that they can understand their patients complain and know how to explain to them. Although these terms seems difficult at the beginning, however, as you learn the origin of most of these terms it begins to make sense. 47  ANATOMICAL POSITION It is the standard reference position of the body used to describe the location of structures. Defined as a situation when a person is standing upright, feet together (toes pointing forward), hands by the side (palms of hand forward), and face looking forward. The mouth is closed and facial expression is neutral. 48 49  This position is adopted worldwide to give anatomicomedical descriptions. Supine position- when lying in anatomical position but facing upward Prone position- when lying in anatomical position but facing downward. 50  ANATOMICAL PLANES Descriptions in anatomy are based on four imaginary planes that passes through the body. (1)Median plane- vertical plane passing longitudinally through the body in its anatomical position dividing the body into two equal halves i.e. left and right (2)Sagittal plane- vertical plane passing parallel to the median plane. 51 (3) Coronal plane-vertical plane passing through the body at right angle to the median plane, thus dividing the body into anterior and posterior (Front & Back) (4) Transverse plane- Horizontal plane passing through the body at right angle to the median and coronal plane, thus dividing the body into superior and inferior (upper & lower parts) 52 53  TERMS OF RELATIONSHIPS Various adjectives, arranged as pairs of opposites, describe the relationship of parts of the body in the anatomical position and compare the relative position of two structures with each other. Superficial, intermediate and deep; are terms used in dissections to describe the position of one structure, such as a muscle, with respect to other structures such as skin and bone. 54  Medial; is a term used to indicate that (in the anatomical position) a structure, is near or nearer to the median plane of the body. E.g. the 5th digit of the hand (L. manus), or little finger. Lateral; stipulates that the structure is farther away from the median plane. E.g. the thumb is farther away from the median plane. Note: that medial and lateral are not synonymous with external and internal as they are used to connote the distance to an organ. 55  Posterior; denotes the back surface of the body or nearer to the back. Dorsal is used interchangeably too but mostly by embryologist and neouroanatomist. Anterior; Anterior denotes the front surface of the body and ventral is equivalent to anterior. Ventral is used mostly by neuroanatomist. Inferior; Refers to a structure that is situated nearer the soles of the feet. Caudal pertains to the tail (L. caudal) and is a useful directional term when referring to the tail region or the trunk. Used by embryologist. 56  Superior; Refers to a structure that is nearer the vertex, the topmost point of the skull. Cranial relates to the cranium (skull) and is a useful directional term when referring to the head region. Used mostly by embryologist. 57 58 TERMS OF MOVEMENTS 59  Various terms describe movements of the limbs and other parts of the body. Movements take place at joints where two or more bones or cartilages articulate with one another. 60  Joint movements are broadly classified as angular and circular. Each of these categories includes specific types of movements, and certain special movements may involve several of the specific types. The description of joint movements are in reference to anatomical position. 61  Angular Movements Angular movements increases or decreases the joint’s angle produced by the articulating bones. The four types of angular movements are flexion, extension, abduction, and adduction. 62  FLEXION Flexion indicates bending or decreasing the angle between the bones or parts of the body. Flexion of the upper limb at the elbow joint is an anterior bending; flexion of the lower limb at the knee joint is a posterior bending. 63  Dorsiflexion; Describes flexion at the ankle joint, as occurs when walking uphill or lifting the toes off the ground. Plantarflexion; Turns the foot or toes toward the plantar surface (e.g., when standing on your toes). 64  EXTENSION Extension indicates straightening or increasing the angle between the bones or parts of the body. Extension usually occurs in a posterior direction, but extension of the lower limb at the knee joint is in an anterior direction. It returns the body part back to its anatomical position. 65  In an extended joint, the angle between the articulating bones is 180°. An exception is the ankle joint, in which there is a 90° angle between the foot and leg in anatomical position. Examples of extension are straightening of the elbow or knee joints from flexion positions. 66  Hyperextension; occurs when a part of the body is extended beyond the anatomical position so that the joint angle is greater than 180°. This can cause injury, such as "whiplash" (e.g.,hyperextension of the neck during a rear car end automobile collision; An important exception applies at the ankle joint; when your foot is extended, it is plantarflexed (e.g., when standing on your toes). 67  Flexion Extension 68  Dorsiflexion Plantarflexion 69  ABDUCTION Means moving away from the median plane in the coronal plane (e.g., when moving an upper limb away from the side of the body). In abduction of the digits (fingers or toes), the term means spreading them apart-moving the other fingers away from the 3rd or middle finger, or moving the other toes away from the 2nd toe. 70  ADDUCTION Means moving toward the median plane in a coronal plane (e.g., when moving an upper limb toward the side of the body). In adduction of the digits, the term means moving them toward the median plane of the hand-moving the other fingers toward the 3rd digit (middle finger). 71  Abduction Adduction 72  Circular Movements In joints that permit circular movement, a bone with a rounded or oval surface articulates with a corresponding depression on another bone. The two basic types of circular movements are rotation and circumduction. 73  ROTATION Involves turning or revolving a part of the body around its longitudinal axis, such as turning one's head to the side. Medial rotation brings the anterior surface of a limb closer to the median plane, Whereas lateral rotation takes the anterior surface away from the median plane. 74 75  CIRCUMDUCTION – Is a circular movement that is a combination of flexion, extension, abduction, and adduction occurring in such a way that the distal end of the part moves in a circle. – Circumduction can occur at any joint at which all the above mentioned movements are possible (e.g., the hip joint shoulder, wrist, metacarpophalangeal, ankle, and metatarsophalangeal joints). 76 77  Special Movements Because the terms used to describe generalized movements around axes do not apply to movement at certain joints or areas of the body, other terms must be used. 78  INVERSION and EVERSION Inversion moves the sole of the foot toward the median plane (facing the sole medially). When the foot is fully inverted it is also plantarflexed. Eversion moves the sole of the foot away from the median plane (turning the sole laterally). When the foot is fully everted it is also dorsiflexed. Both inversion and eversion are clinical terms that are usually used to describe developmental abnormalities. 79  80 Eversion Inversion  OPPOSITION Is the movement by which the pad of the 1st digit (thumb) is brought to another digit pad. 81 We use this movement to pinch, button a shirt, and lift a teacup by the handle. Reposition describes the movement of the 1st digit away from the position of opposition back to its anatomical position.  PROTUSION Is a movement anteriorly (forward) as occurs in protruding the mandible (sticking the chin out). 82 Retrusion is a movement posteriorly (backward) as occurs in retruding the mandible (tucking the chin in). The similar terms protraction and retraction are used most commonly for anterior and posterior movements of the shoulder.  83 Protusion Retrusion  ELEVATION Elevation raises or moves a part of the body superiorly, as in elevating the 84 shoulders when shrugging. Depression lowers or moves a part inferiorly, as in depressing the shoulders when standing at ease. Elevation 85 Depression  PRONATION ▪ Is the movement of the forearm and hand that rotates the radius medially so that the palm of the hand faces posteriorly and its 86 dorsum faces anteriorly, ▪ When the elbow joint is flexed, pronation moves the hand so that the palm faces inferiorly (e.g., placing the palms flat on a table).  SUPINATION Is the movement of the forearm and hand that rotates the radius laterally so 87 that the dorsum of the hand faces posteriorly and the palm faces anteriorly (i.e., moving them into the anatomical position). 88 GOODMORNING 89