Upper Limb Osteology - PDF

Faculty of Medicine introduction to the anatomy of the musculoskeletal system Dr BENAMEUR Assistant Professor in Orthopedic Surgery www.um6ss.ma  Objectives: Basics of anatomy Or...

Faculty of Medicine introduction to the anatomy of the musculoskeletal system Dr BENAMEUR Assistant Professor in Orthopedic Surgery www.um6ss.ma  Objectives: Basics of anatomy Orientation in space Terminology Osteology description Human beings, (homo sapiens) are living organisms. The levels of organization of the human body are, from the simplest to the most complex: chemical, cellular, tissue, organic, systemic and finally the level of the organism. Each level represents the association of units of the lower level The chemical and cellular levels are the basic levels. A tissue is a group of similar cells that perform the same specialized function The human body has four types of tissues: 3..  1. Epithelial tissue 2. Connective tissu 3. Muscle tissu 4. Nervous tissue 6 e e  1. Epithelial tissue 2. Connective tissue 3. Muscle tissu 4. Nervous tissue 7 e  1. Epithelial tissue 2. Connective tissu 3. Muscle tissu 4. Nervous tissue 8 e e  1. Epithelial tissue 2. Connective tissu 3. Muscle tissu 4. Nervous tissue 9 e e Anatomical position and Terminology anatomical reference position 10 11 12  the most common anatomical and orientation terms Superio Towards the hea Inferio Towards the fee Ventra Forwar Dorsa Rearwar Media Towards the middl Latera To the opposit Interna Dee Externa Superficia Proxima Near the origin of a structur Dista Far of the origin of the structur 13 p l l l r l l d l l r l d l e t d e e e  Skeleton Limb bones Joints 14  The structure and function of bones: The skeleton is made up of bones, cartilage and joints. Bones are made up of specialized connective tissue Bone tissue. The skeleton has five functions Suppor Protectio Movement Hematopoiesi Mineral and energy storage 15 t n s s :  Different types of bones Long bone – has a long, thin shape. Examples include the bones of the arms and legs (excluding the wrists, ankles and kneecaps). With the help of muscles, long bones work as levers to permit movement. Short bone – has a squat, cubed shape. Examples include the bones that make up the wrists and the ankles. Flat bone – has a flattened, broad surface. Examples include ribs, shoulder blades, breast bone and skull bones. Irregular bone – has a shape that does not conform to the above three types. Examples include the bones of the spine (vertebrae). 16  Faculty of Medicine Osteology of the upper limb Hand Pr BENAMEUR Orthopeadic Surgeon www.um6ss.ma the part of the body at the end of the arm that is used for holding, moving, touching, and feeling things 18  Carpals Metacarpals Proximal Phalanges Intermediate Phalanges Distal Phalanges 19  Carpal Bones arranged in 2 rows: 1. Proximal row (lateral to medial): scaphoid, lunate, triquetrum, and pisiform 2. Distal row (lateral to medial): trapezium, trapezoid, capitate, and hamate 20 21 22 Scaphoid bon The scaphoid bone is the largest carpal bones of the proximal row and it lies beneath the anatomical snuff box. From a palmar view, it is surrounded on the proximal side by the radius, on the distolateral side by the trapezium bone and on the distomedial side by the trapezoid bone. Superomedially, it articulates with the lunate bone and inferomedially with the capitate bone. On the palm of the hand, its tubercle is easily palpable as it sits subcutaneously. 23 e Lunate bon The lunate bone is a crescent shaped structure that has a large proximal articular surface which relates to the radial bone and its articular disk. It sits medially to the scaphoid bone, superior to the capitate bone and lateral to the triquetral bone. It may also sometimes come into contact with the hamate bone at its inferomedial angle. 24 e Triquetral bon The triquetral bone is shaped like a pyramid and, from a palmar perspective, its apex points disto-medially towards the pisiform bone, which is positioned upon its palmar facet. It sits upon the hamate bone, which is in the distal row of carpal bones and its base faces laterally and communicates with the lunate bone 25 e. Pisiform bon Lastly, the pisiform bone is the most medial proximal carpal bone from a palmar stance. It is also the smallest of all the carpal bones and classi ed as a sesamoid bone. Its dorsal surface is faceted, allowing it to articulate with the ventral surface of the triquetral bone. It is palpable and lies within the tendon of the exor carpi ulnaris. 26 fi e fl Trapezium bon The trapezium is the rst and most lateral of the distal row of carpal bones when the hand is viewed from its palmar surface. On the palmar aspect of the bone, there is a palpable tubercle and on its medial side runs a groove that holds the tendon of the exor carpi radialis. The trapezium bone is bordered medially by the trapezoid bone and superiorly by the scaphoid bone. Inferolaterally, its main articulation is with the rst metacarpal bone via a saddle shaped facet. Inferomedially however, it sometimes also articulates with the second metacarpal bone. 27 e fi fi fl Trapezoid bon The trapezoid bone may look very small in comparison to the other bones from a palmar aspect, however it is much wider on its dorsal side. It communicates via its proximal facet with the scaphoid bone, laterally with the trapezium bone, medially with the capitate bone and its distal facet allows it to articulate with the second metacarpal bone How can you remember which is more lateral between the trapezium and trapezoid? Here's now 'TrapeziUM is by the thUMB, trapezOID is by its SIDE' 28 e. ! Capitate bon The capitate bone is the largest of all the carpal bones, both proximally and distally. It is surrounded by the lunate bone proximally, the third metacarpal bone distally, the trapezoid bone laterally and the hamate bone medially 29 e. Hamate bon The last of the eight carpal bones and the distal row is the hamate bone. It is subcutaneously palpable, due to the hamulus, which is a bony notch on its palmar aspect and curves laterally. It exists in aid of the exor digiti minimi brevis and the pisohamate ligament The hamate bone is surrounded from a proximolateral direction by the lunate bone and a proximomedial direction by the triquetral bone. Laterally, it communicates with the capitate bone and, distally, it articulates with both the fourth and fth metacarpal bones. 30 e fl fi. 31  Metacarpals the metacarpal bones or metacarpus, form the intermediate part of the skeletal hand located between the phalanges of the ngers and the carpal bones of the wrist which forms the connection to the forearm 5 long Bone Shaft: Prismoid in form. Curved, concave in front. Antero Medial and antero lateral faces : interosseous muscles. Base, Cuboidal form : distal Row of carpal bones and with the adjoining metacarpal bones Head or digital extremity presents an oblong surface markedly convex from before backward; it articulates with the proximal phalanges 32. s fi  Phalanges The bones of the ngers. Each nger has three phalanges, except for the thumb, which has two. Proximal Phalanx Intermediate or middle phalanx Distal Phalanx 33 fi fi OSTEOLOGY OF THE FOREARM Definition Osteology A subdiscipline of anatomy, anthropology, and paleontology. The detailed study of the structure of bones, skeletal elements, teeths, microbone morphology, function, disease, pathology, the process of ossification (from cartilaginous molds), and the resistance and hardness of bones (biophysics). Forearm The antebrachial region, as it is clinically known, spans the length of the region which extends roughly from elbow to wrist. The radius and the ulna are the bones of the forearm. Forearm Bones Radius: 37  Definitio Radius Long bone (2 epiphysis and 1 shaft), even and asymmetri Lateral bone of the forear Form with the ulna the bones of forear Situatio It articulates Upwards with the capitulum of the humerus by the radial articular fossa Upwards and medially with the Ulna by the radial articular circumference Downwards and medially with the Ulna by the ulnar notch with the Scaphoid and Lunatum through the carpal articular surface Orientatio The biggest end down, the tip laterally and gutters back n n n :. m m c... 39 @ 40 41  Radius Proximal Region The radial head Cylinder about 7-8 mm in diameter. It’s made up of : 2 articular surface Narrowed part: the Neck. : s  The radial fovea :radial cup, Excavation located on the upper face of the radial head It articulates with the humeral capitulu The articular circumference flattened cylinde It articulates with the radial notch of the Ulna Radial Neck. r m  The Shaft Radius Concave medially and forward, Triangular at sectio 3 faces and 3 borders n  Radius Supinato Anterior face = SPFF Flexor pollicis longu Pronator quadratura Flexor digitorum superficiall Posterior face = AE Abductor pollicis longus and extensor policies brevis. Lateral fac = SP Supinato Pronator teres r r e e y  Radius Border Medial Border: Up: Bicipital tuberositi Middle : Interosseous membrane. Down : Branches of Posterior and anterior borders s f s Distal End 47  Distal region Quadrangular prismatic : 5 faces Radius External face : Radial Styloid Anterior Face: pronator quadratus. Lower face :The carpal articular surface is triangular, concave, smooth, and divided by a slight antero- posterior ridge into two parts. Of these, the lateral, triangular, articulates with the scaphoid bone; the medial, quadrilateral, with the lunate bone. Medial face : ulnar notc Posterior face : Lister’s Tubercle: separate 2 gutters: ✓ Lateral gutter: Extensor pollicis longus. ✓ Medial gutter : extensor digitorum communis and extensor indices proprius. h 49 Triangular fibrocartilage complex Ulna 51 52  Ulna Definitio Long Bone, even and asymmetri Medial bone of the forear Situatio It articulates Upwards with the trochlea of the humerus through a deep trochlear notch bounded by two projections: the olecranon, giving attachment to the triceps, and the coronoid process to which brachialis is attached. Laterally with the radius through the radial notc Downwards and laterally with the radius by the ulnar notc Down with the triangular ligamen for CARPAL BONES Orientatio The biggest end u Biggest notch in the front The Tip of the smallest end mediall n : n n p m c t y h h  Proximal en The trochlear notch Humeral trochlea. 2 projections ✓ Olecrano ✓ Coronoid Proces n : d s  Olecrano Posterior and vertical: Elbow relief Posterior Face : triangular. Anterior face : articular. Superior face: Triceps tendon Medial and Lateral faces : ligaments n  Coronoid Proces Horizontal and Anterior Superior face: Articula Medial face: ligament Lateral face : Radial notc. s s r h  The Shaft Concave forwards, triangular 3 faces et 3 borders Faces : Anterior Posterior Médiale Borders : Interosseous Posterior Anterior  Anterior face: Flexor digitorum profundus Pronator quadratus Posterior Face: Abductor Pollicis longu Extensor Pollicis brevi Extensor pollicis longu Extensor indices propriul Anconeus Extensor carpi ulnas Medial Fac Flexor digitorum profundus e s e s  Border Anterior Border : FDP. Lateral Border (interosseous) : Inetrosseous membrane. Posterior border : ECU, FCU   s  ULNA Distal En Cylindrical ➔ Ulnar notch of the radius. 2 protrusions: Ulnar styloid. Ulnar Head :Articular circumference with the radius d