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BONES AND JOINTS OF THE UPPER LIMB UPPER LIMB – BONES AND JOINTS UPPER LIMB consists of 4 major segments: SHOULDER: • ovelaps parts of thorax, trunk and lower lateral neck • includes: pectoral scapular, deltoid regions • the pectoral (shoulder) girdle: - incomplete posteriorly by scapulea - complete anteriory by clavicules and manubrium of the sternum ARM: • longest part of the upper limb • consists of anterior and posterior regions of the arm FOREARM: • between the elbow and wrist • inculdes anterior and posterios regions of the forearm HAND: • is formed around the carpus, metacarpus and phalanges • is composed of the wrist, palm, dorsum od the hand and digits UPPER LIMB – BONES AND JOINTS BONES MUSCLES JOINTS Clavicle Scapula Humerus Radius Ulna Carpal bones Metacarpals Phalanges Pectoralis major and minor muscle Trapezius muscle LaTssimus dorsi muscle Scapulohumeral muscles Subclavius muscle Levator scapulae muscle Rhomboids Glenohumeral joint Elbow joint Wrist joint Sternoclavicular joint Acromioclavicular joint Proximal and distal radio-ulnar joint Intercarpals joints Carpometacarpal joints Intermetacarpal joints Metacarpohalangeal joints Interphalangeal joints OTHERS Axilla Axillary artery Axillary vein Axillary lymph nodes UPPER LIMB – BONES AND JOINTS- CLAVICLE HOW TO RECOGNIZE LEFT – RIGHT CLAVICLE BONE? CLAVICLE (COLLAR BONE) • long bone • has not medullary (marrow) cavity Consists of: • the shaU of clavicle – has double curve in a horizontal plane • the sternal end • the acromial end STERNAL END: • arTculates with the mandibrium of the sternum • is rather plumb • is enlarged and traingular • the medial 2/3 of the shaU are convex anteriorly ACROMIAL END: • arTculates with the acromion of the scapula (acromioclavicular joint – AC joint) • is more pointed • the lateral 1/3 is concave anteriorly SUPERIOR SURFACE OF THE CLAVICLE: • is smooth INFERIOR SURFACE OF THE CLAVICLE: • is rough, because of the ligaments bind it • the subclavian groove in the medial third • medially posiToned is the conoid tubercle • and lateral the trapezoid line UPPER LIMB – BONES AND JOINTS- SCAPULA SCAPULA (SHOULDER BLADE) • flat bone • triangular shape – 3 margins and 3 angles • lies on the posterolateral aspect of the thorax • overlying the 2nd to 7th ribs • body, head, neck STRUCTURES OF THE SCAPULA POSTERIOR SURFACE: • is unevenly divided and convex • divided by the spine of the scapula into: - infraspinous and infraspinous fossa • the spine conTnues laterally as the expanded acromion • the acromion arTculates with the acromial end of clavicle – (acromioclavicular joint – AC joint) • AC joint is superior to the shoulder joint • the spine of scapula is the point of a]achment of the deltoid muscle UPPER LIMB – BONES AND JOINTS- SCAPULA STRUCTURES OF THE SCAPULA ANTERIOR SURFACE: • anterior surface = costal surface • physiological scapulothoracic joint • subscapular fossa UPPER LIMB – BONES AND JOINTS - SCAPULA • the spine and the acromion are places for the a]ached muscles, parTculary the trapezius SCAPULA (SHOULDER BLADE) STRUCTURES OF THE SCAPULA LATERAL BORDER: • superolaterally surface has the glenoid cavity • the glenoid cavity is on the head of the scapula • oval and concave glenoid cavity arTculates with the head of the humerus (glenohumeral joint) • anterolaterally, superior to the glenoid cavity is the coracoid process • the coracoclavicular ligament a]aches the coracoid process SCAPULA (SHOULDER BLADE) STRUCTURES OF THE SCAPULA SUPERIOR BORDER: • the suprascapular notch is where the superior border joins the base of the coracoid process • the suprascapular nerve passes through the suprascapular notch, which is bridge by superior transverse scapular ligament • ossificaTon of this ligament can result in compression of the nerve with weekening of the dependent muscles: supra- and infraspinatus MEDIAL BORDER: • called the vertebral border • runs parallel to and approximately 5cm lateral to the spinous processes LATERAL BORDER: • thickest part of the bone • bears the broadened head of the scapula • called the axillary border UPPER LIMB – BONES AND JOINTS - HUMERUS HUMERUS (ARM BONE) HUMERUS • PROXIMAL HUMERUS • SHAFT OF HUMERUS • DISTAL HUMERUS The humerus is the largest bone in the upper limb, arTculates with the scapula (the glenohumeral joint) and the radius and ulna (the elbow joint) The proximal humerus has: • HEAD • ANATOMICAL NECK • SURGICAL NECK • GREATER TUBERCLE • LESSER TUBERCLE UPPER LIMB – BONES AND JOINTS - HUMERUS HUMERUS (ARM BONE) PROXIMAL HUMERUS THE HEAD OF HUMERUS: • arTculates with the glenoid cavity of the scapula (the glenohumeral joint) THE ANATOMICAL NECK: • is formed by the groove circumscribing the head and separaTng it from the greater and the lesser tubercles • provides a]achment for fibrous joint capsule THE SURGICAL NECK: • proximal end of shaU • is a narrow part distal to the head and tubercles • a common site of fractures THE GREATER TUBERCLE: • is at the lateral margin of the humerus • provides inserTon for supraspinatus infraspinatus and teres minor muscles UPPER LIMB – BONES AND JOINTS - HUMERUS HUMERUS (ARM BONE) PROXIMAL HUMERUS THE LESSER TUBERCLE: provides inserTon for subscapularis muscle THE INTERTUBERCULAR SULCUS (BICIPITAL GROOVE): • separates the tubercles • transmits tendon of the long head of the biceps muscle • bridged by transverse humeral ligament UPPER LIMB – BONES AND JOINTS - HUMERUS • DISTAL HUMERUS HUMERUS • PROXIMAL HUMERUS • SHAFT OF HUMERUS HUMERUS (ARM BONE) The humerus is the largest bone in the upper limb, arTculates with the scapula (the glenohumeral joint) and the radius and ulna (the elbow joint) The shaU of the humerus has two prominent features: • the deltoid tuberosity (laterally) • the radial groove (posteriorly) DELTOID GROOVE (SPIRAL GROOVE): • separates origins of lateral and medial heads of triceps brachii muscle • contains radial nerve and profunda brachii artery UPPER LIMB – BONES AND JOINTS - HUMERUS HUMERUS (ARM BONE) SHAFT OF HUMERUS • the radial nerve may be injured during fractures in the shaU area • resulTng in a clinically obvious lesion of the radial nerve (radial nerve paralysis) • the nerve may also be damaged by compression (“park bench paralysis” or “saturday night palsy”) – main effect: WRIST DROP The inferior end of the humerus: • widens as the sharp medial and lateral supraepicondylar ridges form