Upper Limb Anatomy PDF

UPPER LIMB RFD 14103 Applied Anatomy  LESSON OBJECTIVES At the end of this lesson, students should be able: ◦ To state the bone and structure of upper limb ◦ To palpate the structure of upper limb ◦ To explain the location of structure and function of each bone of upper limb WHAT...

UPPER LIMB RFD 14103 Applied Anatomy  LESSON OBJECTIVES At the end of this lesson, students should be able: ◦ To state the bone and structure of upper limb ◦ To palpate the structure of upper limb ◦ To explain the location of structure and function of each bone of upper limb WHAT IS ANATOMY??  WHAT IS APPLIED ANATOMY?? It is the application of the anatomy knowledge in finding the anatomy structure  INTRODUCTION TO APPLIED ANATOMY It involves the skill of palpation which is the technique used in physical examination in which the examiner feels with the hands: Texture Size Consistency Location of certain body parts  WHAT IS PALPATION?? Technique of examining parts of the body by touching and feeling them  TYPES OF PALPATION STATIC PALPATION MOTION PALPATION it is a technique of using one hand it is a technique to feel the motion to feel or examine the body part for of specific body segment. the alignment and symmetry of the surrounding soft tissue. It used to palpate tone, heat and it used to palpate the dysfunction pain. between the joints. INTRODUCTION OF UPPER LIMB ◦ Upper limb composed of a few bones located at the upper part of the body. ◦ Shoulder: Proximal part of the limb ◦ Arm: Extends between the shoulder and the elbow ◦ Forearm: Extends between the elbow and the wrist ◦ Hand: Distal to the forearm ◦ Midway along the upper extremity, there is a complex modified hinge articulation called the elbow. ◦ The elbow accommodates flexion, extension as well as rotation movements of the forearm. ◦ The elbow is much more stable than the shoulder. ◦ Due to that anatomical structure and position, the shoulder is highly mobile, but extremely unstable. 1.1 SHOULDER GIRDLE  SHOULDER GIRDLE ◦ It composed of 3 bones: 1. Scapula 2. Clavicle 3. Humerus ◦ The shoulder girdle facilitate the placement of the hand in space  SHOULDER GIRDLE 4 Articulation Joints  Scapula  Lies flatly on the posterior aspect of the thorax  Approximately 45 degrees forward from the Glenoid Cavity midsagittal plane.  At the superolateral corner of the scapula  A shallow socket  The spherical head of the humerus is normally directed posteromedially within the glenoid cavity.  SCAPULOTHORACIC JOINT ◦ A nonsynovial articulation. ◦ Composed of the broad, flat, triangular scapula overlying the thoracic cage and is separated from the thoracic cage by a large bursa. ◦ The plane of the scapula lies 45 degrees forward from the midcoronal plane of the body. BONY LANDMARKS OF SHOUDLER  PALPATION OF SUPRASTERNAL NOTCH ◦ Is a bony structure located at the middle of the thorax, between 2 clavicle. ◦ Palpation : Stand facing the seated patient and use the middle or index finger to locate the triangular notch between the two clavicles. ◦ This is the suprasternal notch Palpation of suprasternal notch  PALPATION OF STERNOCLAVICULAR JOINT Is the articulation between sternum and clavicle. Palpation: from the suprasternal notch, move thumb slightly superiorly and laterally until feel the joint line between the sternum and the clavicle. The joints should be examined simultaneously to allow for comparison of heights and location. Palpation of sternoclavicular joint  PALPATION OF CLAVICLE ◦ Palpation: Move laterally from the sternoclavicular joint along the superiorly and anteriorly bony curved surface. ◦ The supraclavicular lymph nodes are found on the superior surface of the clavicle, lateral to the sternocleidomastoid. ◦ If any enlargement or tenderness, an infection or malignancy is suspected. Palpation of clavicle  PALPATION OF ACROMIOCLAVICULAR JOINT ◦ Is the articulation between acromion process and clavicle. ◦ Palpation : move the thumb laterally along the clavicle from the convexity at the medial aspect to the concavity on the lateral aspect of the clavicle. Therapist will be able to palpate the gap, or joint line where the clavicle is slightly superior to the acromion. ◦ It can be located by asking the patient to extend the shoulder while therapist palpate the movement at the acromioclavicular joint. Palpation of acromioclavicular joint  PALPATION OF ACROMION PROCESS It is the bony structure of the scapula which directed anterolaterally Palpation: move thumb laterally from acromioclavicular joint until feel the broad, and flat surface bony structure. It is the acromion process. Palpation of acromion process  PALPATION OF GREATER TUBEROSITY OF HUMERUS ◦ Palpation : Allow the thumb to follow to the most lateral aspect of the acromion and it will drop off inferiorly onto the greater tuberosity of the humerus. Palpation of greater tuberosity  PALPATION OF CORACOID PROCESS ◦ Palpation : from the acromioclavicular joint, move thumb on a diagonal inferiorly and medially until feel the prominence bony structure. It is coracoid process. Palpation of coracoid process  PALPATION OF SHOULDER MUSCLES  PALPATION OF SHOULDER FLEXOR ◦ The primary flexors of the shoulder:  Anterior Deltoid  Coracobrachialis. ◦ Secondary shoulder flexors:  Clavicular head of the pectoralis major  Middle Deltoid  Biceps brachii  Serratus anterior  Trapezius. Primary shoulder flexor  ◦ Position of patient: Sitting with the arm at the side and the elbow slightly flexed. The patient should then attempt to flex the shoulder to about 90 degrees without rotation ◦ Resisted test: Stand beside the patient and place one hand on the upper thorax to stabilize the body, and place therapist other hand just proximal to the elbow joint so that therapist can apply a downward force on the lower arm. ◦ Ask the patient to attempt to elevate the arm Testing shoulder flexor directly upward against therapist resistance. against gravity  PALPATION OF SHOULDER FLEXOR WITH GRAVITY ELIMINATED ◦ can be perform with the patient lying on the side with the tested arm upward. ◦ The arm is placed on a powdered board and the patient is asked to flex through the range of motion in the coronal plane Shoulder flexion with gravity eliminated  Painful resisted shoulder flexion may be due to inflammation/injury of the contracting muscles. Weakness of shoulder flexion results in an inability to perform many activities of daily living and self care.  PALPATION OF SHOULDER EXTENSOR ◦ Primary shoulder extensors:  Latissimus dorsi  Teres major  Posterior deltoid ◦ Secondary shoulder extensors:  Teres minor  Long head of the triceps Primary shoulder extensor ◦ Position of patient: Prone lying. Patient with the shoulder internally rotated and adducted so that the palm is facing upward. ◦ Resisted test: Stabilize the thorax in its upper portion with one hand and hold the patient’s arm proximal to the elbow with therapist other hand while applying downward resistance as the patient attempts to elevate the arm from the examining table straight upward. Testing shoulder extensor Against gravity PALPATION OF SHOULDER EXTENSOR WITH GRAVITY ELIMINATED ◦ Patient position: side lying with arms upwards ◦ The arm is placed on a powdered board and the patient attempts to extend the shoulder through the range of motion. Testing shoulder extension with gravity eliminated  Painful resisted shoulder extension may be due to inflammation/injury of the contracting muscles. Weakness of shoulder extension will limit the patient’s ability to use their arms for climbing, walk with crutches, swim, or row a boat. PALPATION OF SHOULDER ABDUCTOR ◦ Primary shoulder abductors: Middle deltoid Supraspinatus muscles ◦ Synergists: Anterior deltoid Posterior deltoid Serratus anterior. Primary shoulder abductor ◦ Position of patient: Sitting with the arm abducted to 90 degrees and the elbow slightly flexed. ◦ Resisted test: Stand behind the patient and put one hand over the upper trapezius next to the neck to stabilize the thorax. ◦ Place therapist hand over the arm just proximal to the elbow joint and apply downward resistance as the patient attempts to abduct the arm upward. Testing shoulder abductor against gravity PALPATION OF SHOULDER ABDUCTOR WITH GRAVITY ELIMINATED ◦ Patient’s position: supine lying with the arm at the side and the elbow flexed. ◦ The patient attempts to abduct the arm with the weight of the arm supported by the examining table through the range of motion Shoulder abductor with gravity eliminated ◦Painful resisted shoulder abduction may be due to inflammation/injury of the contracting muscles. ◦Weakness of shoulder abductor causes a significant restriction in the patient’s ability to perform activities of daily living and self- care. PALPATION OF SHOULDER ADDUCTOR ◦ Primary shoulder adductor:  Pectoralis major muscle. ◦ Accessory muscles: Latissimus dorsi Anterior deltoid Teres major. Primary shoulder adductor ◦ Position of patient: Supine with the shoulder abducted to about 90 degrees. The patient horizontally adducts the shoulder, bringing the arm across the chest. ◦ Resisted test: Place one threrapist hand behind the patient’s shoulder to stabilize the thorax. ◦ Another therapist hand hold the patient’s arm with the thumb facing posteriorly so that therapist can apply a resisting force away from the midline of the patient as the patient attempts to adduct the arm against therapist resistance. Testing shoulder adductor (gravity eliminated) PALPATION OF SHOULDER ADDUCTOR WITH GRAVITY ELIMINATED ◦ Patient’s position: sitting, with the upper extremity on an examining table and the elbow extended. ◦ The patient attempts to swing the arm forward across the body while the weight of the arm is supported by the examining table. Testing shoulder adductor with gravity eliminated ◦Painful resisted shoulder adductors may be due to inflammation/injury of the contracting muscles. ◦Weakness of shoulder shoulder adduction can result in restricted bimanual activities. For example, carrying a heavy object at the level of the waist would be difficult. PALPATION OF SHOULDER EXTERNAL ROTATOR External rotators of the shoulder: Infraspinatus Teres minor ◦ Synergist: Posterior deltoid Primary shoulder external rotator ◦ Position of patient: Prone with the shoulder abducted to 90 degrees and the elbow bent at 90 degrees. ◦ The upper arm is supported by the examining table, with a pillow or folded towel placed underneath the upper arm. ◦ Resisted test: While stabilizing the scapula with the palm and fingers of one hand, take the patient’s arm just above the wrist with therapist other hand and apply downward resistance as the patient attempts to upwardly rotate the shoulder so that the hand is elevated above the level of the examining table. Testing external rotator against gravity PALPATION OF SHOULDER EXTERNAL ROTATION WITH GRAVITY ELIMINATED ◦ Patient’s position: Supine lying, with the Testing external rotation test arm abducted 90 degrees. The patient with gravity eliminated attempts to externally rotate the arm while therapist stabilize the scapula with therapist hands. ◦Painful resisted shoulder external rotations may be due to inflammation/injury of the contracting muscles. Weakness of external rotation will prevent abduction of the shoulder to more than 95 degrees due to the impingement of the greater tuberosity of the humerus against the acromion.  PALPATION OF SHOULDER INTERNAL ROTATOR ◦ Primary internal rotators: Latissimus dorsi Teres major Subscapularis Pectoralis major. Primary shoulder internal rotator ◦ Position of patient: Prone with the arm abducted 90 degrees and the elbow flexed to 90 degrees. ◦ Resisted test: Place one hand on the upper arm to stabilize it. ◦ Place therapist hand above the patient’s wrist and push downward as the patient attempts to push therapist hand upward against the Testing shoulder internal resistance. rotator against gravity  PALPATION OF SHOULDER INTERNAL ROTATOR WITH GRAVITY ELIMINATED ◦ Patient’s position: Prone lying with the tested arm hanging from the table and in external rotation. ◦ The patient attempts to internally rotate the arm from the externally rotated position while therapist support the scapula and thorax with therapist forearm and hand. Testing shoulder internal rotator with gravity eliminated