Anatomy of Upper and Lower Limbs (ANAT 201) Lecture #03 PDF

Anatomy of Upper and Lower Limbs (ANAT 201) Lecture # 03 Professor BALA Usman [email protected] Usman BALA, PhD 1  Osteology of the Upper Limb Usman BALA, PhD 2 ...

Anatomy of Upper and Lower Limbs (ANAT 201) Lecture # 03 Professor BALA Usman [email protected] Usman BALA, PhD 1  Osteology of the Upper Limb Usman BALA, PhD 2  General Concept of Upper Extremity Usman BALA, PhD 3  OSTEOLOGY - CLAVICLE Type: Long bone, but it has no medullary (bone marrow) cavity Functions 1. Serves as a rigid support from which the scapula and free upper limb are suspended 2. Transmits forces from the upper limb to the axial skeleton. 3. Provides attachment for muscles.  OSTEOLOGY - CLAVICLE Anatomical Features It has two ends; the medial (sternal) end is enlarged & triangular while the lateral (acromial) end flattened. Has an elongated S-shape appearance The medial 2/3 of the shaft is convex forward while the lateral 1/3 is concave forward. It has two surfaces: Superior surface appears smooth Inferior surface is rough due to attachment of ligaments and muscles  OSTEOLOGY - CLAVICLE Articulations The clavicle articulate with two bones- The medial end articulate with the sternum forming the sternoclavicular joint. The lateral end articulate with the acromion of the scapula – forming the acromioclavicular joint.  OSTEOLOGY - CLAVICLE Fracture Fracture of the clavicle is relatively more common, especially in slender children. Note that: The weakest part of the clavicle is the junction between the middle and lateral one-thirds, and it’s the site for most fractures of clavicle  OSTEOLOGY - CLAVICLE Fracture Fractures of the clavicle also occurs during child birth (delivery) especially in babies with broad shoulder, but such fracture heals quickly.  OSTEOLOGY - SCAPULA Type: Large triangular flat bone overlies between the 2nd – 7th ribs. Functions 1. Gives attachment to muscles 2. Has a considerable degree of movement on the thoracic wall to enable the arm to move freely.  OSTEOLOGY - SCAPULA Anatomical Features It has two surfaces; Costal (concave anterior) – which forms the large subscapular fossa Posterior – divided by the spine of the scapula into: Smaller Supraspinous fossa "above the spine Larger Infraspinous fossa - "below the spine". It has : A head and neck, Glenoid fossa with a tubercles above and below it. Supraglenoid and infraglenoid tubercles respectively  OSTEOLOGY - SCAPULA Anatomical Features It has three processes 1. Coracoid process 2. Acromion 3. Spine  OSTEOLOGY - SCAPULA Anatomical Features It has three borders 1. Medial (vertebral) border ; thin and lies between the inferior and superior angles, 2. Lateral (Axillary) border ; thicker and extend from the infraglenoid tubercle 3. Superior border ; thin, sharp and shortest border.  OSTEOLOGY - SCAPULA Anatomical Features It has three angles 1. Superior angle 2. Inferior angle 3. Lateral angle  OSTEOLOGY - SCAPULA Anatomical Features It has four fossae 1. Subscapular fossa 2. supraspinous fossa 3. Infraspinous fossa 4. Glenoid fossa / cavity  OSTEOLOGY - SCAPULA Articulations The scapular articulate with two bones, the clavicle and humerus. The acromion of the scapula articulate with lateral end of the clavicle forming the acromioclavicular joint. The glenoid fossa (cavity) articulates with the head of humerus forming gleno- humeral joint  OSTEOLOGY - SCAPULA Fracture The fracture of the scapula is not common. Because it is well protected by muscles and thoracic wall. Most of its fractures involve the protruding acromion. Because, it’s the most subcutaneous part of the scapula OSTEOLOGY - SCAPULA The Scapula  OSTEOLOGY - HUMERUS Type: Long bone. Functions 1 Allow wide range of movement 2 Transmits forces down to other part of the upper limb. 3 Provides attachment for muscles. Anatomical Features It has two ends; proximal and distal ends (epiphysis) Shaft (diaphysis) in between the two ends  OSTEOLOGY - HUMERUS Proximal end It composed of the 1. Head, 2. Two necks (anatomical and surgical necks) 3. Two tubercles (greater and lesser tubercle) Head Hemispherical, smooth and rounded. Neck Anatomical neck is formed by a groove separating the head from the tubercles. Surgical neck is the narrow part distal to the tubercles.  OSTEOLOGY - HUMERUS Proximal. Tubercle Greater tubercle - large, and projects on the lateral margin of the humerus. Lesser tubercle – small and projects anteriorly. Note that: The two tubercles are separated by Intertubercular groove (bicipital groove) that gives attachments to muscles.  OSTEOLOGY - HUMERUS The Shaft (body) It’s cylindrical in shape and has: a. Three indistinct borders 1. Anterior border 2. Medial border 3. Lateral border b. Three surfaces 1. Anteromedial 2. Anterolateral 3. Posterior The smooth anterolateral surface is marked about its middle by the deltoid tuberosity The posterior surface is crossed obliquely by the spiral (radial) groove  OSTEOLOGY - HUMERUS Distal end It expanded laterally as medial and lateral supracondylar ridges The ridges end as medial and lateral epicondyles (sites for muscles attachment) Has two condyles 1. Capitulum (lateral) is a rounded, convex surface. 2. Trochlea (medial) is a grooved surface like a pulley.  OSTEOLOGY - HUMERUS It has three fossae: 1. Coronoid fossa anterior above the trochlea and accommodate the coronoid process of ulna on full flexion. 2. Radial fossa (anteriorly) above the capitulum and articulate the head on radius during full flexion. 3. Olecranon fossa (posteriorly) above the trochlea and articulate with the olecranon process of the ulna on full extension.  OSTEOLOGY Articulation The humerus articulate with three bones, the scapula, ulna and radius. The proximal part (head) articulate with scapula forming the glenohumearal joint. The distal end articulate with the ulna and radius forming the elbow joint.  OSTEOLOGY - HUMERUS Fracture Most common fractures of the surgical neck especially in elder people with osteoporosis.  OSTEOLOGY - HUMERUS Fracture In younger people, fracture of the greater tubercle due to fall on the point of the shoulder when the arm is abducted. Common in middle aged and elderly  OSTEOLOGY - HUMERUS Fracture Body The body of the humerus can be fractured by a direct blow to the arm or by indirect injury as falling on the oustretched hand. Example Transverse fracture  QUIZ Q1. Which terms below are mismatched? a. liver/abdominal cavity b. lungs/pleural cavity c. stomach/pelvic cavity d. bladder/pelvic cavity  QUIZ Q1. Which terms below are mismatched? a. liver/abdominal cavity b. lungs/pleural cavity c. stomach/pelvic cavity d. bladder/pelvic cavity Q2. When the body is in the correct anatomical position, what does that look like? a. The terms left and right refer to the left and right sides of the observer. b. Hands are at the sides, dorsum of the hand facing forward, legs apart, head slightly to one side. c. Hands are at the sides, palms facing forward, feet together, eyes straight ahead. d. The person must be lying down. Q2. When the body is in the correct anatomical position, what does that look like? a. The terms left and right refer to the left and right sides of the observer. b. Hands are at the sides, dorsum of the hand facing forward, legs apart, head slightly to one side. c. Hands are at the sides, palms facing forward, feet together, eyes straight ahead. d. The person must be lying down. Q3. Bruce has gallbladder problems. Where does Bruce have pain? a. epigastric region b. umbilical region c. right lumbar region d. right upper quadrant Q3. Bruce has gallbladder problems. Where does Bruce have pain? a. epigastric region b. umbilical region c. right lumbar region d. right upper quadrant Q4. If a surgeon makes an incision just inferior to the diaphragm, which body cavity will be opened? a. the abdominopelvic cavity b. the pleural cavity c. the dorsal cavity d. the pericardial cavity Q4. If a surgeon makes an incision just inferior to the diaphragm, which body cavity will be opened? a. the abdominopelvic cavity b. the pleural cavity c. the dorsal cavity d. the pericardial cavity Q5. The __ peritoneum surrounds organs and the __ peritoneum lines the __. This membrane functions to __. a. dural; parietal; cranial cavity; separate brain and spinal cord b. pleural; pericardial; thoracic cavity; protect internal structures c. visceral; parietal; abdominopelvic cavity; allow organs to slide across each other d. parietal; visceral; thoracic cavity; allow expansion of organs Q5. The __ peritoneum surrounds organs and the __ peritoneum lines the __. This membrane functions to __. a. dural; parietal; cranial cavity; separate brain and spinal cord b. pleural; pericardial; thoracic cavity; protect internal structures c. visceral; parietal; abdominopelvic cavity; allow organs to slide across each other d. parietal; visceral; thoracic cavity; allow expansion of organs Q6. Which type of section would separate/ divide the body down the midline between the eyes? a. transverse section b. coronal section c. parasagittal section d. midsagittal section Q6. Which type of section would separate/ divide the body down the midline between the eyes? a. transverse section b. coronal section c. parasagittal section d. midsagittal section  The Bones of the Forearm Radius and Ulna  The Bones of the Forearm RADIUS Type: Long bone Functions It stabilize the forearm Provides attachment for muscles. Anatomical Features It’s the lateral and shorter bone of the forearm. It has: Head proximally, The shaft (diaphysis) – middle Styloid process – Distally  The Bones of the Forearm RADIUS Head Small, circular Its upper surface is concave for articulation with the capitulum. Neck Narrowed and connect the head with the shaft The Shaft (body) It’s cylindrical Narrow superiorly and widens inferiorly. It has has Three surfaces (anterior, posterior and lateral).  The Bones of the Forearm RADIUS Radial Tuberosityis medially directed and separates the proximal end from the body. The distal radius is expanded (increased in girth) and has four distinct surfaces; 1. Lateral surface 2. Medial surface 3. Posterior surface 4. Anterior surface The radial styloid process project from the lateral side of the distal end.  The Bones of the Forearm RADIUS Articulation The radius articulates with the humerus proximally, ulna, and carpal bones distally. A. With humerus to form elbow Joint. Note that: The head of the radius enters into the radial fossa of the humerus on full flexion.  The Bones of the Forearm RADIUS Articulation B. With ulna at proximal and distal radio-ulna joints, allowing the pronation and supination movement. C. With carpal bones (scaphoid and lunate) forming part of the wrist joint.  The Bones of the Forearm ULNA Type: Long bone Functions It stabilize the forearm and provides attachment for muscles. Anatomical Features It is the medial and longer bone of the forearm. It has proximal part, shaft (diaphysis) and the head distally.  The Bones of the Forearm ULNA Proximal end It has two prominent projection (processes), the coronoid and olecranon processes Olecranon process Projects proximally from the posterior aspect. It’s large and has two surfaces, the posterior, (smooth and subcutaneous) and anterior surface (concave), Coronoid process Small and projects anteriorly. It forms the inferior part of the trochlear notch.  The Bones of the Forearm ULNA Proximal end It has two notches, the Trochlear and radial notch Trochlear notch articulates with trochlea of humerus. Radial notch is a smooth rounded concavity lateral to coronoid process. It articulate with the head of the radius to form the proximal radio-ulna joint.  The Bones of the Upper Limb ULNA The Shaft (body) It’s cylindrical Broad superiorly and narrow inferiorly. It has has three surfaces (anterior, posterior and medial). Distal end It has a small rounded head connected to the shaft by the neck. The ulna styloid process project from the medial side of the head.  The Bones of the Forearm ULNA Articulation With humerus, the trochlea of the humerus articulate trochlea notch of the ulna to form the elbow Joint. With radius at proximal and distal radio-ulna joints - allowing the pronation and supination movement. With carpal bones forming part of the wrist joint.  The Bones of the Forearm ULNA Articulation Note: At elbow Joint : The coronoid process of the ulna enters into the coronoid fossa of the humerus on full flexion. While the Olecranon process of the ulna enters into the olecranon fossa of the humerus on full extension. The articulations between the ulna and humerus at the elbow joint allows primarily only flexion & extension, but small amount of abduction & adduction occurs  Fractures of Ulna and radius 1. Colle’s fracture Transverse fracture within the distal 2cm of the radius and considered as the most common fracture of the forearm.  Applied and Clinical Anatomy RADIUS & ULNA – Fracture Note: The radial styloid process is longer than that of ulnar, but in Collen’s fracture. But in Collen’s fracture, it is reverse due to shortening of the radius. Usman BALA, PhD  The Bones of the Hand The hand Carpals – wrist Metacarpals – palm Phalanges – fingers  The Bones of the Hand CARPAL BONES These are bones of the wrist and are eight in number, arranged into two rows of four bones each. The proximal row contains (from lateral to medial side); (i) Scaphoid, (ii) Lunate (iii) Triquetral (iv) Pisiform The distal row contains in the same order: (i) Trapezium, (ii) Trapezoid, (iii) Capitate (iv) Hamate  The Bones of the Hand CARPAL BONES The palmar aspect of the carpus is concave (carpal sulcus) and this concavity is converted into a canal (carpal tunnel) by the flexor retinaculum. While the dorsal surface is convex. Articulation Proximally with the radius to form the wrist joint (radiocarpal joint). Distally, the carpal bones articulate with the metacarpals.  The Bones of the Hand CARPAL BONES Scaphoid It’s large boat shape bone.  The Bones of the Hand CARPAL BONES Lunate It’s crescent in shape  The Bones of the Hand CARPAL BONES Triquetral This bone is three sided  The Bones of the Hand CARPAL BONES Pisiform A small round sesamoid or pea-shaped bone  The Bones of the Hand CARPAL BONES Trapezium It’s an irregular four sided bone Has a prominent tubercle on the palmar surface.  The Bones of the Hand CARPAL BONES Trapezoid It is a small irregular four sided bone  The Bones of the Hand CARPAL BONES Capitate The largest of the carpal bones with a rounded head.  The Bones of the Hand CARPAL BONES Hamate This is a wedge-shaped bone Has a large hook on its palmar surface. The Bones of the Hand A - Scaphoid B - Lunate C - Triqutrum D - Pisiform E - Trapezium F - Trapezoid A B C D G – Capitate H – Hamate E F H G  The Bones of the Hand A - Capitate B - Hamate C - Lunate D - Scaphoid E – Trapezium F - Trapezoid G – Triquetrum H – Pisiform Identify the following bones ?  The Bones of the Hand Metacarpals Type: Long bones, five in number and each one corresponds to the digits. Each metacarpal has Base (proximally), Shaft (body) Rounded head (distally). Base The shape of the bases varies and this is distinct in all the metacarpal bones. Shaft Slightly curved with a longitudinal palmar concavity.  The Bones of the Hand Metacarpals The head Smooth and rounded Articulate with the concavity on the base of the proximal phalanx forming metacarpophalangeal joints. The head of the first metacarpal is wider than the others.  The Bones of the Hand Metacarpals Articulation: The base of the metacarpals articulate with carpals bones forming carpometacarpal joint. The head of the metacarpal articulate with the concavity on the base of the proximal phalanx forming metacarpophalangeal joints  The Bones of the Hand PHALENGES They are long bones, Fourteen (14) in number (in each hand), Three (3) for each finger (2nd to 5th digits) and two for the thumb (1st digit). The phalanges of the thumb are shorter and broader than those of the fingers. Each phalanx has a Base large proximal end Shaft (body) and a Head - smaller distal end (head).  The Bones of the Hand PHALENGES The base Has a concave oval appearance Articulate with the rounded head of the metacarpal. The shaft Is curved along its length, being convex dorsally. The head Rounded and articulate with the base of the next phalanx.  The Bones of the Hand METACARPAL BONES Fracture – Neck of the 1st & 2nd Metacarpal – Boxer’s fracture – Heal rapidly due to enough blood supply – Crushing injury of the hand – multiple metacarpal fracture – Lead to instability of the hand. Usman BALA, PhD  The Bones of the Hand PHALANGES - Fracture – Crushing injury - Accident or fingers caught in car door – Extremely painful due to developed sensation – nerves – Fracture of the distal phalanx is usually commuted and painful hematoma develops. Usman BALA, PhD  Thank You For Listening QUESTIONS Usman BALA, PhD 74  FORMATIVE QUIZ SAMPLES OF QUESTIONS Usman BALA, PhD 75  QUESTION 1 Which major organ lies deep to the right hypochondriac region? A. The stomach B. The spleen C. The liver D. The duodenum E. None of the above  QUESTION 2 Which plane of the body divides it into dorsal and ventral regions? A. Transverse B. Axial C. Coronal D. Sagittal E. Horizontal  QUESTION 3 To which of the following does the “tissue level” of structural organisation refer? A. atoms, ions, molecules and electrolytes B. mitochondria, ribosomes, nucleus, endoplasmic reticulum C. nephron, alveolus, villus, lobule D. muscle, nervous, connective, epithelial E. osteocytes, chondrocytes, myocytes, neurons  QUESTION 4 The “anatomical position” could be described as which of the following? A. Lying down prone B. Lying down supine C. Standing displaying the ventral surface of the body D. Standing with arms abducted and legs adducted E. None of the above  QUESTION 5 The directional term “superior” in anatomy means which of the following? A. cephalic B. ventral C. caudal D. dorsal E. Anterior  QUESTION 6 Which of the following relationships is correct? A. The heart is inferior to the clavicle B. The shoulder is distal to the carpals C. The phalanges are proximal to the metacarpals D. The eye is medial to the eyebrows E. All of the above  QUESTION 7 Which of the following correctly describes the two named body parts? A. the elbow is proximal to the shoulder B. the phalanges are distal to the carpals C. the ribs are proximal to the sternum D. the elbow is distal to the knee E. The femur is distal to the tibia  QUESTION 8 Which one of the following statements is correct? A. the diaphragm separates the brain and spinal cord B. the ventral cavity contains the male and female reproductive system C. the abdomino-pelvic cavity contains the spinal cord. D. the dorsal cavity contains the brain and spinal cord E. All of the above  QUESTION 9 Which is the outermost layer of the skin is called? A. dermis B. epidermis C. stratum lucidum D. reticular dermal layer E. cutaneous  QUESTION 10 Which of the following is NOT a “long” bone? A. Humerus B. Tibia C. Lunate D. Metacarpal E. Phalanges