GAP - Topic 6 - Humerus - Bones of Upper Limb PDF

Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus TOPIC #6 – BONES OF THE UPPER LIMB – THE HUMERUS Clinical Orientated Anatomy Trail Guide HUMERUS • • The “arm” is the region between the shoulder and the elbow. It consists of the humerus which has a head at...

Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus TOPIC #6 – BONES OF THE UPPER LIMB – THE HUMERUS Clinical Orientated Anatomy Trail Guide HUMERUS • • The “arm” is the region between the shoulder and the elbow. It consists of the humerus which has a head at its proximal end and 2 condyles at its distal end. BONEY LANDMARKS OF THE HUMERUS ➢ Landmarks located on the proximal humerus o Head: spherical shaped ▪ articulates with the glenoid fossa of the scapula to form the glenohumeral joint. o Anatomical Neck: a demarcation that circumscribes the head of the humerus to make up the glenohumeral joint. o Greater Tubercle: large lateral projection at the proximal end of the humerus. ▪ Contains 3 facet surfaces (superior facet, middle facet, and inferior facet). o Lesser Tubercle: a prominent projection of bone located medial to the greater tubercle. o Surgical Neck: boney region representing the location of where the tubercles meet the shaft of the humerus. o Intertubercular Groove (aka. Bicipital Groove): a longitudinal groove located between the greater and lesser tubercles. o Medial Lip of the Intertubercular Groove: sometimes referred to as the crest of the lesser tubercle. o Lateral Lip of the Intertubercular Groove: sometimes referred to as the crest of the greater tubercle. ➢ Landmarks on the shaft of the humerus o Shaft: the diaphysis of the humer Groove Page 1 of 7 Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus ➢ Landmarks located on the shaft of the humerus o Shaft – the diaphysis of the humerus roughly cylindrical o Deltoid Tuberosity - raised prominence on lateral aspect of humerus found approximately halfway on the shaft. o Radial Groove (aka. Spiral Groove): On the posterior aspect of the shaft of the humerus for the passage of the radial artery and posterior branches of the brachial artery (found between the medial and lateral heads of the triceps brachii muscle) ➢ Landmarks located on the distal humerus o Medial and Lateral Condyles: distal end of the humerus. ▪ The articular surface of the medial condyle is called the TROCHLEA. Will articulate with the ulna. ▪ The articular surface of the lateral condyle is called the CAPITULUM. Will articulate with the radius. o Medial and Lateral Epicondyles: protruding eminences that, together, form the widest part of the distal humerus. o Medial and Lateral Supracondylar Ridges: ridges of bone found proximal to the epicondyles. o Radial Fossa: located just proximal to the capitulum, this fossa accommodates the radial head during elbow flexion. o Coronoid Fossa: located just proximal to the trochlea, this fossa accommodates the coronoid process (ulna) during elbow flexion. o Olecranon Fossa: located on the posterior, distal humerus, this fossa accommodates the olecranon process (ulna) during elbow extension. Page 2 of 7 Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus Page 3 of 7 Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus PALPATIONS • The structures to be palpated in this lecture include: o Humerus ▪ Greater tubercle ▪ Lesser tubercle ▪ Bicipital groove ▪ Deltoid tuberosity ▪ Medial/Lateral Supracondylar ridges ▪ Medial/Lateral Epicondyles ▪ Olecranon Fossa PALPATION OF HUMERUS PATIENT POSITION NEUTRAL LANDMARK TRAIL GREATER TUBERCLE • Supine or Seated • Acromion • From the acromion move inferiorly to fall off the edge of the acromion approximately 1 inch. (You may feel a dip between the acromion and the tubercle) • Feel for a round bump deep to the deltoid muscle on the humerus • Use internal and external rotation to feel the tubercle move under your contact DESCRIPTION FUNCTION • Teres minor attachment • Infraspinatus attachment • Supraspinatus attachment PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated or Supine with shoulder rotated 45° • Coracoid process • Move laterally off the coracoid, pass the “dip” which is the joint space until you feel bone again. • Use Internal/External rotation to confirm your location. • You should feel the lesser tubercle moving into your contact with External rotation and disappear with Internal rotation LESSER TUBERCLE DESCRIPTION FUNCTION • Attachment for Subscapularis Page 4 of 7 Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus PATIENT POSITION NEUTRAL LANDMARK TRAIL BICIPITAL GROOVE (INTERTUBICULAR) • Seated/Supine • Lesser Tubercle • Move laterally from the lesser tubercle, use internal and external rotation, you should feel your fingers flicking over the tendon of biceps, this tendon sits in the bicipital groove DESCRIPTION FUNCTION • Pectoralis Major attachment • Latissimus Dorsi attachment • Teres Major attachment PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Acromion • Have patient abduct the arm to 90°follow the contour of the deltoid muscle from the acromion to where the muscle tapers to a point (should be about half way point on the humerus) • Allow the arm to rest by the patient’s side and take a moment to explore and circumscribe the deltoid tuberosity DELTOID TUBEROSITY DESCRIPTION FUNCTION • Deltoid attachment PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Olecranon Process • Palpate medially off the olecranon feeling a small dip before rising up on the medial epicondyle. • You should feel a superficial rounded pointed projection. This will also be the widest part of the distal humerus MEDIAL EPICONDYLE DESCRIPTION FUNCTION • Pronator Teres attachment • Flexor Carpi Radialis attachment • Flexor Digitorum Superficialis attachment • Flexor Carpi Ulnaris attachment • Etc. Page 5 of 7 Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus PATIENT POSITION NEUTRAL LANDMARK TRAIL LATERAL EPICONDYLE • Seated • Olecranon process • Palpate laterally off the olecranon feeling a shallow dip before rising up on the lateral epicondyle. • You should feel a superficial rounded projection. This will also be the widest part of the distal humerus DESCRIPTION MEDIAL SUPRACONDYLAR RIDGE LATERAL SUPRACONDYLAR RIDGE FUNCTION • Extensor Carpi Radialis Brevis attachment • Extensor Digitorum attachment • Extensor Carpi Ulnaris attachment • Extensor Digiti Minimi attachment • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated • Medial Epicondyle • From the medial epicondyle strum proximally until you feel a boney ridge that starts to narrow DESCRIPTION FUNCTION • Brachialis attachment • Triceps Brachii attachment PATIENT POSITION • Seated NEUTRAL LANDMARK • Lateral Epicondyle TRAIL • From the lateral epicondyle strum proximally until you feel a boney ridge that starts to narrow DESCRIPTION FUNCTION • Brachioradialis attachment • Extensor Carpi Radialis Longus attachment • Etc. Page 6 of 7 PATIENT POSITION NEUTRAL LANDMARK TRAIL OLECRANON FOSSA Canadian College of Massage & Hydrotherapy GAP – Topic #6 Bones of the Upper Limb – Humerus • Seated elbow bent to 90 degrees • Olecranon Process • With the elbow flexed, palpate proximally just off the olecranon. • Press through triceps into the fossa which will feel like a small crescent shaped ditch. • Extend the elbow to feel the olecranon process fill the fossa DESCRIPTION FUNCTION • Accommodates the olecranon process during elbow extension Page 7 of 7