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Musculoskeletal Anatomy of the Upper Limb • • Regions of upper limb: • Shoulder • Arm – brachium • Forearm – antebrachium • Wrist – carpus • Hand – manus • Digits Spaces between structures very important for positioning of neurovascular bundles • Relate surface anatomy and bony landmarks to musculoskeletal structures and so neurovascular anatomy • In upper limb, axilla, cubital fossa and carpal tunnel – axilla contains nerves to upper limb (derived from brachial plexus), arterial supply to limb, veins and lymph vessels and nodes • Bones: • Shoulder – clavicle, scapula • Arm – humerus • Forearm – radius, ulna • Wrist – eight carpals • Metacarpus (no common term for manus referring to metacarpals) – five metacarpals • Digits – 14 phalanges (three each digit except two in first digit) JOINTS • Joint occurs where pair of bones contact, usually named after bones involved • Limb joints need to be mobile so are synovial – cartilage on articulating surfaces, synovial fluid to absorb load and reduce friction, synovial membrane and fibrous capsule • Most joints also contain articular discs/menisci, fat pads, bursae and collateral/accessory ligaments for strength • Basic joint system in upper limb matches basic system in lower limb • Axial skeleton to girdle – sternoclavicular joint • Between girdle bones – acromioclavicular joint (not particularly mobile) • Girdle to propodial (proximal joint) – glenohumeral joint • Propodial to epipodial (mid-limb joint) – humeroradial joint • Between epipodials – proximal and distal radioulnar joints • Epipodial to autopod (distal joint) – radiocarpal joint (no joint with ulna) ! ! • • Between carpals/tarsals – intercarpal joints • Carpal/tarsal to metacarpal/metatarsal – carpometacarpal joint • Between metacarpals/metatarsals – intermetacarpal joint • Metacarpal/metatarsal to phalanges – metacarpophalangeal joints • Between phalanges – interphalangeal joints Two types of movement in space: • Rotation – movement about axis, for synovial joint generally one or two axes of rotation • Translation – sliding along surface, not usually good for synovial joint (causes dislocation) • Categorise joints based on number of axes of rotation or small translation • Ball and socket – three axes of rotation e.g. glenohumeral joint • Hinge – one axis of rotation, movement at right angles to long axis of articulating bones e.g. humeroradial joint • Pivot – one axis of rotation, movement parallel to long axis of articulating bones e.g. proximal radioulnar joint • Ellipsoid – two axes of rotation, sub-equal range of motion e.g. radiocarpal joint, metacarpophalangeal joints • Saddle – two axes of rotation, approximately equal range e.g. carpometacarpal joint of thumb • Planar – small translations e.g. intercarpal joints SHOULDER • • • Bones: • Girdle – clavicle, scapula • Propodial – humerus Joints: • Axis-girdle – sternoclavicular joint • Girdle-girdle – acromioclavicular joint • Girdle-propodial – glenohumeral joint Muscles • Axis-girdle – 7 (four posterior and three anterior) and two neck • Girdle-propodial (attached to trunk) – 8 (four prime movers and four rotator cuff) • Girdle-propodial (attached to limb) – five (three ventral and two dorsal) • Bone surface features occur where soft tissue attaches – type of feature doesn’t reveal type of soft tissue ! ! • • Border – edge • Angle – corner • Process – knob, protuberance • Tubercle – small process • Spine – sharp process • Fossa – pit, concavity • Tuberosity – rounded process • Condyle – convex part of joint surface • Cotyle/socket – concave part of joint surface Clavicle – S-shaped bone with articular surfaces at each end • Superior surface is smooth, inferior surface has roughened areas for ligament attachments • • Medial (sternal) end is triangular, lateral (acromial) end is flatter Scapula – flat, triangular bone with two prominent processes and spine • Coracoid process protrudes to clavicle • Acromion is joined to spine of scapula that extends to medial border • Three borders and three angles – one angle forms glenoid fossa/cavity (articular surface) • • Three fossae – subscapular, supraspinous and infraspinous Names of many major features on scapula relate to location e.g. supraspinous fossa ! !