Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
LO: Topographical and Surface Anatomy of Bones and Joints of the Upper Limb Basic Anatomical Structures and Principles (syllabus) Understand the concepts and associated principles, functional and clinical applications of the topographical anatomy of the bones, joints and muscles of the upper limb. Surface and functional anatomy (syllabus) Understand and explain the relevant surface and functional anatomy of the bones, joints and muscles of the upper limb. Shoulder Complex Palpate and draw on each other the following bony landmarks: sternoclavicular joints, acromioclavicular joints, shaft of clavicles Acromion, spine, corocoid process, medial border, inferior angle of scapula Greater and lesser tubercles of the humerus (This is the humerus of the left arm – the greater tubercle will always be more lateral than the lesser tubercle) Demonstrate the movements of the scapula (noting the muscle groups producing each); Pectoralis Minor: With ribs fixed, draws scapula forwards and downwards (with scapula fixed, it will draw the ribs superiorally) Serratus Anterior: Prime mover to protract and hold scapula against chest wall; rotates scapula so its inferior angle moves laterally and upwards; raises point of shoulder; important role in abduction and raising of arm and in horizontal arm movements Trapezius: Stabilises, raises, retracts and rotates scapula. Middle fibres retract causing adduction of the scapulae. Superior fibres retract causing elevation of the scapulae. Can also help to extend the head by retraction of the inferior fibres, which pull (or depress) the scapulae Levator Scapulae: Elevates/adducts in concert with the superior fibres of the trapezius (also tilts glenoid cavity downwards when scapula is fixed, flexes neck to the same side) Rhomboids: Act together (and with middle traps) to retract scapula (square the shouldars); rotate glenoid cavity downwards (when arm is lowered against resistance) and helps to stabilise the scapula Assess the shoulder joint by the steps of: Inspection Look for swellings, scars, asymmetry, redness Palpation Fell for tenderness and swelling. Move the joint and feel the AC joint, the clavicle and the SC joint Movements: noting the muscle groups producing each Abduction – usually possible to 90 degrees Elevation – usually possible to 180 degrees Adduction – usually possible to 50 degrees External rotation – usually possible to 65 degrees Internal rotation – usually possible to 90 degrees Flexion – usually possible to 180 degrees Extension – usually possible to 65 degrees Explain to role of ‘rotator cuff’ muscles Rotator muscles are the Supraspinatus, Infraspinatus, Teres minor, Subscapularis (SITS) o o o o Subscapularis: Chief medial rotator of the humerus (assisted by pec major). Also helps to hold the head of the humerus in the glenoid cavity, thereby stabilising the shoulder joint Supraspinatus: Stabilises shoulder joint and helps to prevent downward dislocation of the humerus. Also assists with abduction Infraspinatus: Rotates humerous laterally and also helps to hold the head of the humerus in the glenoid cavity Teres minor: same action as the infraspinatus, but also adducts arm Elbow Complex Palpate and draw on each other the following bony landmarks; head, dorsal tubercle, styloid process of radius Olecranon process, posterior border of shaft, head, styloid process of ulna Assess the elbow joints by the steps of: Inspection Look for swellings, scars, asymmetry, redness Palpation Feel for tenderness, especially over the lateral epicondyles. Palpate for any discreet swellings Movements: noting the muscle groups producing each Move the elbow joint passively. Normal flexion is possible to 150 degrees Demonstrate the ‘carrying angle’ With the arms extended at the sides and the palms facing forward, the forearm and hands are normally slightly away from the body. This is the normal "carrying angle" of the elbow, which is 5 to 15 degrees. This angle permits the forearms to clear the hips in swinging movements during walking, and is important when carrying objects. The carrying angle permits the arm to be swung without contacting the hips. Women on average have smaller shoulders and wider hips than men, which may necessitate a greater carrying angle. There is, however, extensive overlap in the carrying angle between individual men and women, and a sex-bias has not been consistently observed in scientific studies. Demonstrate the Movements of the radio-ulner joint (noting the muscle groups producing each) Triceps brachii: Primary forearm extensor and antagonist of forearm flexors Anconeus: Abducts ulna during forearm pronation; synergist of triceps brachii in elbow extension Biceps brachii: flexes elbow joint and supinates forearm (also weak flexor of arm at the shoulder) Brachialis: Major forearm flexor (lifts ulnar as biceps lift the radius) Brachioradialis: Synergist in forearm flexion; acts to best advantage when forearm is partially flexed and semi-pronated. During rapid extension and flexion, it also works to stabilise the elbow Palpate the following; tendon of biceps in the cubital fossa bicipital aponeurosis olecranon bursa Wrist and Hand Palpate and draw on each other the following bony landmarks; Tubercle of scaphoid and crest of trapezium Pisiform bone and hook of hamete Heads of metacarpals Draw in the flexor retinaculum (noting relationship with the distal skin crease of the wrist) Palpate the bones forming the floor of the “anatomical snuff box” noting in particular the scaphoid bone) (Scaphoid is the major bone of the floor of the anatomical snuff box) Assess the wrist joint by the steps of; Inspection Erythema, atrophy, scars and rashes, inflammation, deformity, Palpation Feel gently for synovitis (boggy swelling) and effusions. Dorsifex and palmar flex, then test ulnar and radial deviations, noting any tenderness, limitation or joint crepitus Movements: noting the muscles groups producing each Flexor carpi radialis: Flexor of wrist, abducts hand (and weak synergist of elbow flexion) Palmaris longis: Weak wrist flexor, tenses skin and fascia of hand during movements (and weak synergist of elbow flexion) Flexor carpi ulnaris: Flexes and adducts hand at wrist Flexor digitorum superficialis: Flexes wrist and middle phalanges of fingers 2-5 Flexor digitorum profundis: Flexes distal phalanges 4 and 5 at distal interphalangeal joints and assists in wrist flexing Extensor carpi radialis longus: Extend and abduct hand at the wrist joint; ECRL active during fist clenching Extensor carpi radialis brevis: Same as above Extensor digitorum: Extends wrist (and is the prime mover of finger extension) Extensor carpi ulnaris: Extends and adducts hand at wrist joint (active during fist clenching) Abductor pollicus longis: Abducts wrist Demonstrate (noting the muscle groups producing each): Movement of the thumb Flexor pollicus longis (FPL): Flexes phalanges of thumb Abductor pollicis longus (APL): Abducts thumb and extends it at carpometacarpal joint Extensor pollicis longus (EPL): Extends distal phalanx of thumb at interphalangeal joint; extends metacarpophalangeal and carpometacarpal joints Extensor pollicus brevis: Extends proximal phalanx of thumb at metacarpophalangeal joint; extends carpometacarpal joint Opponens pollicis: To oppose thumb, it draws 1st metacarpal medially to centre of palm and rotates it medially Abductor pollicis brevis: Abducts thumb; helps oppose it Flexor pollicis brevis: Abducts thumb; helps oppose it Flexor pollicis brevis: Flexes thumb Superficial head, Deep head, adductor pollicus, oblique head and transverse head: Adducts thumb toward lateral border of palm Movements of the fingers Flexor digitorum superficialis (FDS), Humeroulnar head and Radial head: Flexes middle phalanges at proximal interphalangeal joints of the middle four fingers; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints Extensor digitorum: Extends medial 4 fingers primarily at metacarpophalangeal joints, secondarily at interphalangeal joints Extensor digiti minimi (EDM): Extends 5th finger primarily at the metacarpophalangeal joint, secondarily at interphalangeal joint Extensor indicis: Extends 2nd finger (enabling its independent extension); helps extend wrist at hand Abductor digit minimi: Abducts 5th finger and assists in flexion of its proximal phalanx Flexor digiti brevis: Flexes proximal phalanx of 5th finger Opponens digit minimi: Draws 5th metacarpal anterior and rotates it, bringing 5th finger into opposition with thumb Lumbricals (1st – 4th): Flex metacarpophalangeal joints; extend interphalangeal joints of 2nd – 5th fingers Dorsal interossei, 1st – 4th: Abduct 2nd – 4th fingers from axial line; act with the lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints Palmar interossei 1st – 3rd: Adduct 2nd, 4th and 5th fingers towards axial line; assist lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints; extensor expansions of 2nd – 4th fingers Explain the role of the dorsal digit expansion in movements of the fingers; The functional significance of the dorsal digit expansion is to allow the complex movements of the fingers to occur. For example, writing involves the flexing of some joints and extension of others and therefore a balance between flexors and extensors is necessary. Palpate the tendons at the front and back of the wrist;