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RADIUS BONE & BONES OF HAND LEARNING OBJECTIVES Students should able to • Recognize the bones of forearm &hand • Determine side of bones. • Identify the features of bones. • Identify the muscles attached to bones. • Identify clinical significance of bones. RADIUS BONE • Lateral bone of forearm • Three Parts • Upper end Head Neck Tuberosity • Shaft • Lower end DETERMINATION OF SIDE • Upper end rounded & bears the head. • Lower end more wider than the upper end • Lateral surface of shaft is convex & its anterior surface is concave in lower part • Styloid process projects from lateral surface of the lower end HEAD Disc-shaped, overhangs the neck on all sides • Medially it articulates with radial notch of ulna. • Upper surface articulates with capitulum-- form elbow joint • It is covered with hyaline cartilage. • Medial surface articulates with radial notch of ulna to form superior radio-ulnar joint . HEAD Attachment Annular ligament to the articular cicumference of head NECK • Constricted part below head • Surrounded by lower part of annular ligament • Attachments: Supinator is inserted into the lateral anterior &posterior aspects of neck TUBEROSITY Lies below the medial part of the neck. • Attachments: • Biceps brachii is inserted into rough posterior part. • Smooth anterior part is related to bursa. SHAFT • Narrow above, broader below • Three borders. • Interosseous(medial) • Anterior • Posterior Three surfaces • • Anterior • Posterior • Lateral BORDERS INTEROSSEOUS (MEDIAL) BORDER • Sharp except at its upper part • Begins from posterio-inferior part of radial tuberosity • Lower end form posterior boundary of small triangular area above ulnar notch of radius Attachment on interosseous border • Pronator quadratus is inserted • Gives attachment to interosseous membrane in lower 3\4 ANTERIOR BORDER • Begins just below antero-lateral part of radial tuberosity • Upper & lower parts are sharp Attachments on anterior border • Origin of Flexor digitorum superficialis from upper & lower parts • Extensor retinaculum is attached to lower edge POSTERIOR BORDER • Begins from posterio-inferior part of tuberosity • End in dorsal tubercle at back of lower end • Prominent in middle part SURFACES ANTERIOR SURFACE • Lies between anterior and interosseous border • Presents nutrient foramen directed up ward Attachments on anterior surface • Origin to flexor pollicis longus from upper 2\3 • Insertion to pronator quadratus in lower 1\4 POSTERIOR SURFACE • • • Lies between interosseous & posterior borders Origin of Abductor pollicis longus from upper part Origin of Extensor pollicis brevis from lower part . LATERAL SURFACE • Lies between anterior&posterior borders • Rough ridge in middle part gives insertion to pronator teres • Insertion to supinator into V Shape area at upper part • Brachioradialis is inserted just above styloid process LOWER END • Expanded &rectangular • Has five surfaces • Lateral surface • Medial surface • Anterior surface • Posterior surface • Inferior surfaces • LATERAL SURFACE • Present styloid process • Radial collateral ligament of wrist joint is attached at tip of styloid process • Brachiodialis is inserted into lower part of lateral surface • Two grooves lateral to styloid process for tendons of Abductor pollicis longus &Extensor pollicis brevis MEDIAL SURFACE • • Bears ulnar notch for articulation with head of ulna Articular disc of inferiorradio-ulnar joint is attached to ridge at lower part. ANTERIOR SURFACE • In form of thick prominent ridge • Radial artery is palpated as radial pulse • Pronator quadratus is inserted into the lower part of anterior surface POSTERIOR SURFACE • Irregular • Present dorsal tubercle(of lister) • Four grooves for extensor tendons INFERIOR SURFACE • Bears triangular area for Scaphoid bone • Medially, quadrangular area for Lunate • Takes part in forming wrist joint CLINICAL ANATOMY Fractures of radius Fracture of head • Can occur from fall on outstretched hand Fracture of neck of radius • Occur in young children FRACTURES OF SHAFT OF RADIUS • May or may not occur with ulna • Displacement of fractured fragment depends on pull of muscle • Supinator and biceps supinate the proximal fragment • Pronator quadratus pronates the distal fragment • Brachioradialis and extensor carpi radialis and brevis shortens the fore arm COMBINE FRACTURES OF RADIUS AND ULNA • • • Shaft of ulna fractured by a force from behind Bowing forward of ulnar shaft with anterior dislocation of radial head Rupture of annular ligament COMBINE FRACTURES OF RADIUS AND ULNA • Proximal third of radius is fractured • Distal end of ulna is dislocated at distal radio ulnar joint FRACTURES OF DISTAL END Colles’ fracture • Fall on outstretched hand • Distal fragment is displaced posteriorly and superiorly • The fore arm and wrist resembles the shape of dinner fork • Dinnerfork deformity • Reverse colles’s fracture • Distal fragment displaced anteriorly • Fall on back of hand • BONES OF HAND • Eight carpal bones • Five metacarpal bones • Fourteen phalanges CARPAL BONES • Eight carpal bones • Arranged in two rows Proximal row Medial to lateral • Scaphoid • Lunate • Triquetral • Pisiform Distal row • Trapezium • Trapezoid • Capitate • Hamate CHARACTERISTICS OF EACH BONE Each bone has six surfaces. Scaphoid is boat –shaped • tubercle on its lateral side Lunate is half moon shaped or crescentic Triquetral is pyramidal shape • has oval facet on distal part of palmar surface Pisiform is pea shaped • only one oval facet on proximal part of dorsal surface Trapezium is quadrangular in shape • crest & groove anteriorly Trapezoid resemble shoe of baby Capitate is largest with rounded head Hamate is wedge –shaped with hook near base ATTACHMENTS Most important structure related with carpal bones --------- FLEXOR RETINACULUM Attachment: Lateral scaphoid anterior border of lower end Medial • Pisiform • Hamitate • • CLINICAL ANATOMY Fracture of scaphoid • • • Most common fractured bone among carpal bone Non union & avascularity common problem Tenderness & swelling in anatomical snuff box Dislocation of lunate • • • • Most common dislocated bone of carpal bone May compress median nerve in front of wrist Carpal tunnel syndrome CARPAL TUNNEL SYNDROME Carpal tunnel: • osseofibrous space formed by anterior concave surface of carpus and flexor retinaculum • Passage of long flexor tendon and median nerve CARPAL TUNNEL SYNDROME • Syndrome is caused by compression of median nerve due to reduced size of canal • Pain and paraesthesia of lateral one and half finger • Weakness of thenar muscle METACARPAL BONES • Short long bones • Numbered from lateral to medial side • 1st metacarpal Shorter & thicker articulates with trapezium. Other metacarpal bones • Expanded bases articulate with distal row of carpal bones & with each other • Middle metacarpal show styloid process • Heads has boldly rounded articular facets • Form concavity for palm • Heads form knuckles of fist PHALANGES 14 in number Parts Base Shaft Head
