1 the skeletal of upper limb 2013

8/13/2019 1 the Skeletal of Upper Limb 2013

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Upper Limb Skeleton

Irwan


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Content:Vignette

What is a limb?

Upper Limb Skeleton

ClavicleScapula

Humerus

Radius

Ulna

Hand (Manus)

Joint of Upper Extremity


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The hands of an 80-year-old

woman with a several-yearhistory of numbness and

weakness are shown in this

photo. Note severe thenar

muscle (abductor pollicis

brevis, opponens pollicis)

wasting of the right hand, with

preservation of hypothenareminence.

What is the diagnosis and

pathophysiology?

Vignette


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Pathophysiology

the median nerve is damaged within the rigid confines of the carpal

tunnel, initially undergoing demyelination followed by axonal

degeneration. Sensory fibers often are affected first, followed bymotor fibers. Autonomic nerve fibers carried in the median nerve

also may be affected.

The cause of the damage is subject to some debate; however, it

seems likely that abnormally high carpal tunnel pressures exist in

patients with CTS. This pressure causes obstruction to venous

outflow, back pressure, edema formation, and ultimately, ischemia

in the nerve.

The risk of development of CTS appears to be associated, at least in

part, with a number of different epidemiologic factors, includinggenetic, medical, social, vocational, avocational, and

demographic.[1] A complex interaction probably exists between

some or all these factors, eventually leading to the development of

CTS. Definite causative factors, however, are far from clear.


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Carpal Tunnel


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Nerve Innervation (dorsal)


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Nerve Innervation (palmar)


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Ventral somatic outgrowth of outer tube

Bones (with bone, cartilage, marrow, NAV, etc.)

Joints

Muscle

NervesVascular supply

No viscera--all innervation is somatic (motoror sensory) from ventral ramus of spinal nerve(except autonomics to blood vessels)

What is a limb?


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Appendicular Skeleton

Pectoral Girdle =

scapula,clavicle

Upperlimb

Arm: humerus Forearm: radius, ulna

Interosseus membrane

Hand: carpals, metacarpals,

phalanges

Review Bones + Landmarks

studied in Lab!!

Upper Limb Skeleton (old hat?)


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Clavicle

also known as the collar bone

has a subtle S-like double curvature

has a more robust and squarish medial end that

articulates with the manubrium of the sternum

has a flatter lateral end for articulation with theacromion of the scapula

the superior surface of the clavicle is much

smoother than the rougher inferior surface whichis studded with the conoid

process, subclavius muscle groove and

costoclavicular groove


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Landmarks

sternal (medial) end

acromial (lateral) end

deltoid tubercle

conoid tubercle trapezoid line

groove for the subclavius muscle

tuberosity/groove for the costoclavicularligament


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A - sternal (medial) end

B - deltoid tuberosity

C - acromial (lateral) end

D - conoid tubercle


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A - tuberosity/groove for costoclavicular ligament

B - conoid tubercle

C - groove for subclavius muscle

D - trapezoid line

E - lateral (acromial) end F - medial (sternal) end


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is part of the shoulder girdle

is found on the upper back where the concave anterior

surface rests against the posterior chest wall

has a roughly triangular body with an overall irregular

appearance

has a smooth lateral cuplike surface that articulateswith the head of the humerus at the shoulder

(glenohumeral) joint

has a large, flat, medially arching process (theacromion) which articulates with the lateral end of the

clavicle at the

acromioclavicular joint

SCAPULA


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A - superior angle

B - supraspinous fossa

C - suprascapular notch D - conoid tubercle

E - coracoid process

F - acromion

G - glenoid fossa

H - infraglenoid

tubercle

I - infraspinous fossa

J - lateral scapular

border

K - inferior angle


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A - superior angle

B - articular facet for

clavicle on acromion

C - acromion

D - conoid tubercle

E - coracoid process

F - neck of scapula

G - subscapular fossa

H - medial border ofscapula


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has a bulbous proximal end that articulates withthe scapula at the shoulder (glenohumeral) joint

has an irregular distal end that articulates with

the radius and ulna (of the forearm)

the round head is medial and somewhat

posteriorly directed

the intertubercular groove can be seen toprogress distally through much of the superior

half of this bone

Humerus


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Image 5.27

A - greater tuberosity

B - lesser tuberosityC - head

D - anatomical neck

(indicated by dashed line)

E - intertubercular groove

F - surgical neck (indicated

by dashed line)

G - medial lip of

intertubercular groove

H - lateral lip of

intertubercular groove

I - deltoid tuberosity


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Image 5.28

A - shaft

B - lateral supracondylarridge

C - medial supracondylar

ridge

D - radial fossaE - coronoid fossa

F - medial epicondyle

G - lateral epicondyle

H - capitulum

I - trochlea


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forms the lateral aspect of the forearm

is a long bone with two articulating ends and an intervening shaft

the proximal end articulates with the capitulum of the humerus

the distal end articulates with the scaphoid and lunate bones of the

wrist

medially, the radius articulates with the ulna at both the proximaland distal radio-ulnar joints

the head of this bone is disc-like and has a concave articular facet

the radial head corresponds with the radial fossa of the humerus

the shaft is relatively round and smooth except for a sharp, thinmedial border

anterior surface of the distal radius is smooth and somewhat concave

the posterior surface of the distal radius is more rough, and bears the

prominent dorsal (Listers) tubercle

Radius


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Image 5.39A - articular

circumference of

radial head

B - neck

C - radial tuberosity

Image 5.40

A - interosseous border

B - pronator ridge

C - styloid process


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forms the medial aspect of the forearm

is a long bone with two articular ends and an intervening shaft

the proximal end is very irregular and robust in appearance

- it articulates with the trochlea of the humerus at the elbow joint as well as

laterally at the proximal and distal radioulnar joint

- the olecranon process fits into the olecranon fossa of humerus, the trochlear

notch articulates with the trochlea of the humerus, and the coronoid processcorresponds with the coronoid fossa of the humerus

the shaft has a slight sigmoid curvature

- the interosseous border is on the lateral side of the shaft

- the shaft itself is more irregular than other long bones (except the fibula)

the expanded proximal shaft becomes progressively smallerdistally, but it bulges out at the ulnar head

- the head/radial articulation has a small styloid process

- when viewed head on, the styloid process is on the medial aspect of the ulnar

head

Ulna


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Image 5.49A - olecranon process

B - trochlear notch

C - coronoid process

D - radial notch

E - supinator crest

F - interosseous border

Image 5.50A - interosseous border

B - head (radial articulation)

C - groove for extensor carpiulnaris tendon

D - styloid process


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the general arrangement of the hand is similar to

that of the foot

there are twenty-seven bones in each hand (one

more than in each foot)

is composed of eight carpal bones (four per row in

two rows), five metacarpal bones, and fourteen

phalanges (three per finger except for the thumb,

which only has two) sesamoid bones (bones which form within

tendons) may also be present

Hand (Manus)


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Image 5.61

A - phalanges

B - metacarpals C - carpals

C1 - scaphoid

C2 - lunate

C3 - triquetral

C4 - pisiform (not pictured)

C5 - trapezium

C6 - trapezoid

C7 - capitate

C8 - hamate


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Image 5.62

A - phalanges

B - metacarpals C - carpals

C1 - scaphoid

C2 - lunate

C3 - triquetral (notpictured)

C4 - pisiform

C5 - trapezium

C6 - trapezoid

C7 - capitate

C8 - hamate

J i t f U E t it


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Sternoclavicular

Synovial-saddleDiarthrosis

Joints of Upper Extremity


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Acromioclavicular

Synovial-plane

Diarthrosis


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Glenohumeral joint

Synovial-ball&socketDiarthrosis

Many ligaments

Muscle reinforcementGreat Mobility


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Elbow Joint

SynovialhingeDiarthrosis

Articulations

Humerus & UlnaHumerus & Radius

Many Ligaments


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Radiocarpal joint Synovial-condyloid

Distal radius with proximal rowof carpals

Intercarpal joints Synovial-plane

Carpal-metacarpal (2-5) Synovial-plane

Trapezium-metacarpal 1 Synovial-saddle

Metacarpal-phalangeal Synovial-condyloid

Interphalangeal Synovial-hinge

ALL DIARTHROSES


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Created by:

dr. Irwan

Bagian Anatomi

FK Unsri

Palembang

Fig 407A


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Fig. 407A

Fig 409A


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Fig. 409A

Fig 422A


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Fig. 422A

Fig 423C


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Fig. 423C

Fig 423A


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Fig. 423A

Fig 423B


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Fig. 423B

1 the skeletal of upper limb 2013

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