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Upper Extremity Lecture #1

Terms in this set (64)

What three things characterize the upper limb
-mobility
-ability to grasp
-ability to manipulate
Is the upper limb weight-bearing?
Why?
No
-stability has been sacrificed for mobility
Most mobile?
Digits
Pectoral Girdle
-what is it?
-what is it made up of?
-where is it incomplete?
-where is it completed and by what?
-bony ring
-made up of clavicles and scapulae
-incomplete posteriorly
-completed anteriorly by the manubrium
What are the four segments up the upper limb?
1. pectoral girdle
2. arm
3. forearm
4. hand
Where are the muscles attached that support and stabilize the pectoral girdle?
-ribs
-sternum
-vertebrae
Clavicle shape
doubly-curved long bone
Sternal End of Clavicle
-which side is it
-describe shape
-what does it articulate with?
-what is the name of this joint?
-medial
-enlarged, triangular
-articulates with the manubrium of the sternum
-the sternoclavicular joint (SC joint)
Acromial End of Clavicle
-which side is it
-describe shape
-what does it articulate with
-name of this joint?
-lateral
-flat
-acromion of scapula
-acromioclavicular joint (AC joint)
Fracture of Clavicle
-weakest part?
-what happens after fracture?
-junction of medial and lateral thirds
-SCM elevates the medial fragment of the bone and the trapezius is unable to hold the lateral fragment up because of the weight of the upper limb...shoulder drops
Scapula
-shape
-where does it lie
-what ribs does it overlay in normal position?
-which side is concave and which side is convex and where are the fossas?
-what do the three fossas provide?
-triangular flat bone
-lies on the posterolateral aspect of thorax
-overlies the 2nd through 7th ribs
-concave costal surface with a large subscapular fossa
and a convex posterior side that has the supraspinous fossa and the infraspinous fossa
-provide broad surface for fleshy attachments
Spine of Scapula
-what is it?
-what does it continue as and in what direction?
-what does it form?
-what does it articulate with?
-thick projecting ridge of bone
-continues laterally as the flat expanded acromion
-forms subcutaneous POINT OF THE SHOULDER
-articulates with the acromial end of the clavicle
What does the lateral surface of the scapula form superolaterally?
the glenoid cavity
Coracoid Process
-shape?
-directional relationship to glenoid cavity?
-what direction does it project?
-what does it resemble?
-beak-like
-the coracoid process is superior to the glenoid cavity
-projects anterolaterally
-resembles a bent finger pointing forward in size, shape and direction
Scapula
-what are the three borders?
-what are the three angles?
-medial, later, superior border
-superior, inferior, lateral angle
Medial border of scapula relationship to the spinous processes of thoracic vertebrae?
should be about 5cm parallel to the spinous processes but symmetry is more important than the actual distance
Lateral Border of the Scapula
-what direction does it run from the inferior angle?
IT RUNS SUPEROLATERALLY TOWARDS THE APEX OF THE AXILLA
Glenoid Cavity
-what is it for?
-describe shape
-dimensions
-which way does the glenoid cavity face?
-what feature does it have and what is the benefit?
-glenoid cavity is for reception of the humeral head
-it is a shallow, concave, oval fossa
-it is 4 cm long by 2-3 cm wide
-glenoid cavity faces ANTEROLATERALLY AND SLIGHTLY SUPERIOR
-has an inferior lip to better support the head of the humerus
Humerus
-largest bone of?
-what does it articulate with?
-largest bone of upper limb
-articulates with scapula at scapulohumeral joint and the radius and ulna at the elbow joint
Features of the proximal head of the humerus
-head
-anatomic and surgical necks
-greater and leser tubercles
Tubercle Location
-Greater
-Lesser
-greater at lateral margin of humerus
-lesser projects anteriorly from bone
Intertubercular groove
-purpose
-other name
-what inserts here?
-separates tubercles
-bicipital groove
-biceps insert here
Where is the humerus most likely to fracture?
-location
the surgical neck
-located distal to the tubercles, narrow
What are the two prominent features of the humerus?
The deltoid tuberosity and the oblique radial groove
Deltoid Tuberosity
-location
-what attaches here
-laterally located
-deltoid muscle
Oblique Radial Groove
-location
-what lies here?
-what do they pass between?
-posteriorly location
-RADIAL NERVE AND DEEP ARTERY
-pass between medial and long head and then the lateral heads of the triceps brachii muscle
Features of the Condyle of the humerus
-epicondyles
-trochlea
-capitulum
-olecranon
-coronoid
-radial fossae
What are the two articular surfaces of the condyle of the humerus? And what do they articulate with?
-the lateral capitulum - articulates with the head of the radius
-medial trochlea - articulates with proximal end of ulna
Coronoid Fossa
-anterior or posterior?
-directional relationship to trochlea?
-what does it receive? and when?
-anterior
-superior
-receives coronoid process (anterior) of ulna during full elbow flexion
Olecranon Fossa
-anterior or posterior?
-what does it receive? and when?
-posterior
-receives olecranon of ulna during full elbow extension
Radial Fossa
-anterior or posterior?
-directional relationship to the capitulum?
-shallower or deeper than coronoid fossa?
-what does it receive and when?
-anterior
-superior to capitulum
-shallower fossa
-receives edge of head of radius during elbow flexion
Fracture of humerus
-most commonly fractured on proximal end?
-who is this common in?
-with what condition?
-what nerve could be affected by this break?
-surgical neck
-elderly
-osteoperosis
-AXILLARY NERVE
Fracture of the Humerus - Avulsion Fracture
-what happens in an avulsion fracture?
-what is avulsed in the humerus?
-who is this common in?
-how does this usually occur?
-tendon or ligament pulls off part of bone
-greater tubercle is avulsed
-middle-aged or elderly
-occurs from a fall on the point of the shoulder (the acromion)
Avulsion Fractures in younger people
-what happens to tubercle
-what is it a result of?
-tubercle pulls away from head
-result of fall on hand when arm is abducted
Fracture of the Humerus - Condyle Fracture
-what are the three types?
-how does intercondylar fracture happen?
-what happens anatomically?
-medial or lateral condyles or intercondylar fracture
-result of a fall on the point of a flexed elbow
-olecranon of ulna drives like a wedge into the condyle of the humerus splitting off one or both parts from humeral body
Surgical Neck Nerve
Axillary Nerve
Radial Groove Nerve (and artery)
radial nerve and deep artery
Distal End of Humerus Nerve
medial nerve
Medial Epicondyle Nerve
ulnar nerve (funny bone)
Ulna
-job of this bone
-location in forearm
-comparison in length in forearm
-stabilizing bone of forearm
-medial bone
-longer of the two forearm bones
What are the two prominent projections of the proximal end of the ulna?
1. the olecranon
2. the coronoid process
Olecranon - what direction does it project?
-what does the anterior surface of the olecranon form?
-what does it articulate with?
projects proximally from its posterior aspect
-forms the posterior wall of the trochlear notch
-articulates with the trochlea of the humerus
Coronoid Process - what direction does it project?
Projects anteriorly
Radial Notch
-on what bone?
-where on bone?
-shape?
-what does it articulate with?
-located on ulna
-on the lateral side of the coronoid process
-smooth, rounded concavity
-articulates with the head of the radius
Ulnar Tuberosity
-anterior or posterior?
-directional relationship to the coronoid process?
-what attaches here?
-anterior
-inferior to coronoid process
-attachment for brachialis muscle - powerful elbow flexor
Proximal End of Ulna
-describe as a pipe wrench
-upper jaw is the olecranon
-lower jaw is the coronid process
-trochlear notch is the mouth of the wrench
-olecranon and coronoid process grasp trochlea of humerus the way a pipe wrench clasps pipe
Supinator Crest of Ulna
-directional relationship to radial notch
-what surface of the ulna is it on?
-what is it?
-located just below the radial notch
-on lateral surface of ulna
-a prominent ridge
Supinator Fossa of Ulna
-what is it and where is it located?
-what attaches here?
-a concavity located in between the supinator crest of the ulna and the distal part of the coronoid process
-deep part of supinator muscle attaches to supinator fossa and supinator crest
Body of Ulna
-shape from proximal to distal
-where is the head located?
-what else is located distally?
-thick to thin
-head located distally
-ulnar styloid process located distally
Articulation of ulna and humerus
-main type of movement
-other type of movement possible
-when does this occur
-flexion and extension
-small amount of abduction adduction (wobble) possible during
-pronation and supination of forearm
Radius
-3 proximal features?
-head
-necl
-medially directed tuberosity
Head of Radius
-proximal or distal?
-is head concave or convex?
-what does it articulate with and when?
-what else does it articulate with peripherally?
-what is the head covered in?
-proximal
-concave
-articulates with capitulum of humerus during flexion and extension
-articulates peripherally with radial notch of ulna
-head is covered in articular cartilage
Neck of Radius
-what is it located in between?
relatively constricted between the head which overhangs it and the radial tuberosity
Radial Tuberosity
-shape
-what does it separate
-oval
-separates head and neck from the body
Body of Radius
-shape
-girth as it passes distally?
-shape at distal end when sectioned transversely?
-lateral convexity shape
-thicker as it goes distally
-rectangular
Distal Features of the Radius
-ulnar notch
-radial styloid process
-dorsal tubercle
Ulnar Notch of Radius
-on what side?
-what does it accomodate?
-medially located concavity
-accomodates head of ulna
Radial Styloid Process
-what side?
lateral aspect
Dorsal Tubercle
-where does it project?
-what is it a passage for?
-projects dorsally
-passage for tendons and muscles of the forearm
Radial Styloid Process
-size comparison to ulnar styloid process
-spacial relationship to ulnar styloid process
-larger
-extends 1 finger's breadth further distally
Fracture of Radius and Ulna
-what does a direct injury usually produce?
-where in the bone is it most likely to break?
-results in transverse fractures at the same level
-middle third most likely to break
Isolated Fracture of Radius or Ulna
-what is likely to occur?
-why does this happen?
-likely to dislocate associated nearest joint
-because of the interosseus membrane
Colles' Fracture
-what type of fracture and where does it occur
-common or uncommon
-where is the distal fragment displaced
-what type of break usually
-what position is the hand in when falling
-other name of break
-is blood supply good to this area?
-transverse fracture in the distal 2 cm of the radius
-most common fracture of the forearm
-distal fragment displaced dorsally
-comminuted
-hand is dorsiflexed and hand is pronated
-good blood supply so bony union is possible
Reversal of Lengths in Colles' Fracture
-radial styloid process usually projects further distally but when Colles' fracture occurs, the relationship can be reversed
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