1-Upper limb.pdf

At the end of the lecture, you should be able to : - List the different bones of the UL. - List the characteristic features of each bone. - Differentiate between the bones of the right and left sides. - List the articulations between the different bones.  Bones...

At the end of the lecture, you should be able to : - List the different bones of the UL. - List the characteristic features of each bone. - Differentiate between the bones of the right and left sides. - List the articulations between the different bones.  Bones Different shapes of Come in a bone in next slide Store variety of minerals shapes and sizes From the bone marrow Provides Produce red and white blood cells attachment for muscles support and protect the Enable Example: various organs of Bones movement Thoracic cage the body Protect: Heart and lungs Classification of bones by shape Long bones Limbs and fingers Short bones Wrist and ankles Flat bones Skull and sternum Irregular bones Spine and pelvis Sesamoid bones Patella Bones of upper limb Clavicle Pectoral girdle Scapula Arm Humerus Ulna Forearm Radius Wrist Carpal bones Metacarpals Hand Phalanges  Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand - It is very light Formed of two bones - allows the upper limb to have exceptionally free Scapula movement “posterior” On the other hand, the pelvic girdle “ in lower limb “ has limited movement compare to Clavicle pectoral girdle “Anterior” Clavicle General information Functions long bone lying It serves as a rigid support from which the scapula and free horizontally across the upper limb are suspended root of the neck. keep them away from the trunk doubly curved. so that the arm has maximum freedom of movement It is subcutaneous “under Transmits forces from the UL to the skin” throughout its the axial skeleton length. Provides attachment for muscles All long bones are vertical except for the clavicle is There is NO medullary It forms a boundary of the horizontal cavity. Cervicoaxillary canal for protection of the neurovascular - Clavicle is clear seen in thin people and disappear in It has the appearance of bundle of the UL obese one. an elongated letter - medullary cavity = marrow cavity - clavicles are one of the Cervicoaxillary components Capital (S) lying on one - Cervicoaxillary canal : contain the nerves that come from the neck and supply to the upper limb side  Clavicle The clavicle has : Two Ends Body (shaft) Two Surface - 2 ends - 2 surface Convex Sternal (medial) Superior: - Body (shaft) doubly curved forward: - 3 articulations Next slide enlarged & smooth as it lies triangular 2\3 its medial just deep to the skin Acromial Concave Inferior: (lateral) : forward: rough because strong ligaments bind it to flattened 1\3 its lateral the 1st rib - the clavicle has 2 ends MEDIAL & LATERAL, but all the other long bones have PROXIMAL & DISTAL ends - We said sternal end because it is near to sternum and acromial because it is near to acromion Articulations of Clavicle Clavicle with manubrium Sternoclavicular joint of sternum Clavicle with acromion of Acromioclavicular joint scapula Costoclavicular Joint Clavicle with the 1st rib COSTAE mean rib in Latin - Any bone that form a joint is “smooth” because it is covered by a cartilage Fractures of the Clavicle - The clavicle is commonly - It may be pulled medially by fractured especially in children the adductors of the arm - as forces are impacted to the - The sagging limb is supported outstretched hand during by the other falling After fracture: The weakest part of the clavicle - the medial fragment elevated is : the junction of the middle by the sternomastoid muscle and lateral thirds - lateral fragment drops because of the weight of the UL sternomastoid muscle Scapula Function of scapula: Scapula (shoulder blade): Gives attachment to -it is a triangular flat bone. muscles -extends between the 2nd rib Has a considerable degree till the 7th rib. of movement on the thoracic wall to enable the arm to move freely The glenoid cavity forms Two surface : the socket of the shoulder convex posterior : divided by the spine of the scapula into joint the : 1. supraspinous fossa (the small part above the spine of the scapula) the scapula gives some muscles the 2. infraspinous fossa (the largest part below the spine of the origin point or the insertion point scapula) concave anterior (costal) : it forms the large subscapula fossa Scapula Three processes : Spine : a thick projecting ridge of bone that continues laterally Coracoid : a beaklike process, it has a finger like shape pointed to the shoulder. it resembles is size shape and direction Acromion : forms the subcutaneous point of the shoulder. spine Three angels : Inferior lateral : a shallow concave oval fossa that receives the head of the humerus ( forms the glenoid cavity ) Superior coracoid Three borders : Superior Lateral : axillary: the thickest part of the bone, it acromion terminates at the lateral angle Medial : vertebral Winged Scapula * Etiology : * Clinical appearance : it's due to injury of thoracic long it will protrude posteriorly nerve as in radial mastectomy which causes paralysis of serratus because most of the scapula anterior muscle is well protected by muscles and by it’s association with the thoracic wall, most of it's fractures involve the protruding subcutaneous Acromion. * Symptoms : The medial border and inferior angle of the patient has difficulty in the scapula will no longer be kept raising the arm above the head closely applied to the chest wall (difficult in rotation of the scapula). acromion ‫المكان األكثر عرضة للكسر هنا هو الـ‬  Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand - The arm formed of one bone Humerus has called : Humerus Humerus is : - Typical Long bone. Proximal end - It is the largest bone in the upper limb Body (shaft) Distal end Proximal end of Humerus Head: Smooth it forms 1/3 of a sphere, it articulates with the glenoid cavity of the scapula. Proximal end consist of : Greater tubercle: Head, Neck, Greater and Lesser Tubercles at the lateral margin of the Humerus Lesser tubercle: projects anteriorly. The two tubercles are separated by Intertubercular Groove Anatomical neck: formed by a groove separating the head from the tubercles Surgical Neck: a narrow part distal to the tubercles. Greater tubercle: up and lateral Lesser tubercle: up and forward Shaft of Humerus has two prominent features : Deltoid tuberosity Spiral (Radial) groove A rough elevation Runs obliquely down laterally for the the posterior aspect attachment of deltoid of the shaft muscle It lodges the important radial nerve and vessels Distal end of Humerus Anteriorly Posteriorly Trochlea: Olecranon fossa: (medial) for above the articulation with - Widens as the sharp medial and the ulna trochlea. lateral Supracondylar Ridges and end in the Medial (can be felt) and Capitulum: (lateral) for Lateral Epicondyles articulation with the radius. - They provide muscular Coronoid attachment fossa: above the trochlea Radial fossa: above the capitulum. Here we have 3 fossa : 2 anterior and 1 posterior Explanation ‫كل‬fossa ‫يقابلها‬process ‫يقابل النتوءات أجزاء غائرة‬ - Trochlea  coronoid fossa & Olecranon Fossa - Capitulum  Radial Fossa Articulations of humerus glenoid Head of cavity of Shoulder joint the the humerus scapula Lower end upper of humerus ends of Elbow joint (Trochlea & the radius Capitulum) and ulna Fracture of Humerus The fracture results from falling Most common fractures are of the on the hand Surgical neck especially in elder (transition of force through the people with osteoporosis bones of forearm of the extended limb) Surgical neck The body of the humerus In younger people, can be fractured by fractures of the a direct blow to the arm or greater tubercle results by indirect injury as falling on the from falling on the hand when outstretched hand the arm is abducted Body of the humerus.. the fracture by a DIRECT blow ‫نادر حصول الكسر فيها إال من خالل تلقي كدمة مباشرة‬ Nerves affected in fractures of humerus Radial Axillary nerve nerve spiral Surgical groove neck Distal Medial end of epicondyle humerus Median Ulnar nerve nerve *medial epicondyle : ulnar nerve (‫ األلم الناشئ في هذه المنطقة يكون بسبب هذا العصب‬,‫(عند ارتطام المرفق بطاولة‬  Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand The stabilizing bone of forearm Formed of two bones ULNA RADIUS Ulna LOCATION medial lateral SIZE longer shorter Radius Diminishes in Expand in diameter DIAMETER diameter as it as it moves distally moves distally.  Ulna Proximal end Distal end Body (shaft) - Projects proximally (near to the trunk) Superiorly : Olecranon Small and from the posterior aspect. thick and process rounded - Forms the pointed portion of the elbow cylindrical Coronoid head: lies Inferiorly : Projects anteriorly distally at diminishes in process the wrist diameter it is a long ridge on the anterior side of the coronoid 1. Anterior process where the brachialis Inferior to coronoid process Tuberosity styloid process: Has three muscle attaches of ulna medial distal projection surfaces 2. Medial 3. Posterior Articulates with trochlea of humerus Trochlear Has three notch borders See slide 22 -A smooth rounded concavity( ‫)تقعر‬ Radial Anterior Lateral posterior -lateral to coronoid process. notch (rounded) interosseous (sharp) (sharp) Articulates with the head of the radius ‫ ؟‬Fossa ‫ بـ‬Radial Notch ‫ما سبب عدم تسميتنا للـ‬ ‫ألنها ليست عميقة‬  Radius It is rectangular Proximal end Body (shaft) Distal end - Small & circular. - Has a concave upper surface to Convex at it’s Dorsal Projects dorsally (away articulate with the capitulum of Head lateral surface tubercle from the trunk) humerus. Gradually Radial Projects from the Neck enlarges as it styloid lateral side. passes distally process - Directed medially. Radial - Concavity - Separate the proximal end from (biciptal) Ulnar - Directed medially the body(shaft) notch - Fit in with the ulna’s head tuberosity Insertion point of the biceps brachii muscle forms the radioulnar joint Ulna Radius every fossa in ulna or radius has process in the humerus ‫والعكس صحيح‬ ‫اكثر مكان بارز في االلنا هو الـ‬ Tuberosity of Ulna Articulations of radius & ulna The two bones Distal end of are connected Humerus  by the flexible with the membrane proximal ends of radius and ulna interosseous Elbow membrane joint Distal Proximal Radioulnar Radioulnar joint joint Head of Head of ulna  with radius  ulnar notch of with radial radius notch of ulna  Fractures of the radius & ulna Because the radius & ulna are firmly bound by the interosseous membrane, a fracture of one bone is commonly associated with dislocation of the nearest joint. Example of the fracture of the radius is : colle’s fracture - It is fracture of the distal The typical history end of radius of the fracture - It is the most common includes slipping It results from fracture of the forearm. It is more common forced dorsiflexion in women after of the hand as a middle age because result to ease a fall of osteoporosis by outstretching the upper limb Because of the rich blood supply to the distal end of the colle’s It causes dinner radius, the healing is fracture fork deformity usually good in colle’s fracture the structures distal to the fracture (wrist and hand) are displaced posteriorly  Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand Carpal bones : proximal row Distal row small bones make the wrist more flexible Scaphoid Trapezium 8 short bones, arranged in 2 from lateral irregular rows “each row composed of 4 bones” Lunate Trapezoid Has two surface : 1. The concave surface : to medial Triquetral Capitate anteriorly 2. The convex surface : side to side posteriorly Pisiform Hamate To remember them : Sally Left The Party To Take Cathy Home Fractures of Scaphoid It is the most commonly fractured carpal bone and it is the most common injury of the wrist How it could be fractured ? The pain ! How it union ? The fracture result Pain occurs along Union of the bone of a fall onto the the lateral side of may take several palm when the hand the wrist especially months because of is abducted during dorsiflexion poor blood supply and abduction of the to the proximal part hand of the scaphoid  Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand The hand Formed of Each digit Form the has Three metacarpal skeleton of Phalanges. the hand Except : between the carpus and the Thumb Phalanges phalanges which has only Two Metacarpal we start counting from the THUMB It is composed of Five Metacarpal bones, each has : Base + Shaft + Head The distal ends (Heads) articulate The Bases of the with the proximal metacarpals phalanges to form articulate with the the Knuckles of the carpal bones fist - They are numbered 1-5 from the thumb - The first metacarpal is the shortest and most mobile Phalanges Each phalanx has : Base Proximally + Head distally + Body in between The proximal phalanx is the largest The distal ones are the smallest, The middle ones its distal ends are: are intermediate - flattened in size - expanded distally to form the nail beds Articulations of wrist and hand Bases of the Metacarpal bones  Carpometacarpal with the distal row of the carpal joints bones Metacarpo Heads of metacarpal (knuckles)  phalangeal joints with the Proximal Phalanges Interphalangeal The phalanges articulate with joints each other Distal end of Radius  with the Wrist joint Proximal Raw of Carpal bones Summary Zoom it if it’s not clear  Video: arm and forearm Video: bones of upper limb https://www.youtube.com/watch? https://www.youtube.com/watch v=2ufqUOpm8O0 ?v=715Z0XPtlDI Application: Essential anatomy 5 you can have it for free, ask https://twitter.com/Med_435 Upper Limb part.1 (15 questions) https://www.onlineexambuilder.com/bones-of-the-upper- limb/exam-47458 Quiz: Upper Limb part.2 (15 questions) https://www.onlineexambuilder.com/upper-limb-part- ii/exam-52135