CLINICAL ANATOMYOF THE

BONES & JOINTS OF THE UPPER LIMB

Kaan Yücel M.D., Ph.D.

08.January.2014 Wednesday

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Fractures Of The Clavicleone of the most frequently fractured bonescommon in children often caused by an indirect force transmitted from an outstretched hand through the bones of the forearm/ arm to shoulder during a fall

ora fall directly on the shoulder

The weakest part of the clavicle junction of its middle and lateral thirds

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Fractures of the Scapula

usually the result of severe traumaas occurs in pedestrian-vehicle accidentsusually also fractured ribsmost fractures require little treatment scapula is covered on both sides by muscles.

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Fractures of the humerus

most injuries of the proximal end fractures of the surgical neck especially common in elderly people with osteoporosisusually result from a minor fall on the hand, with the force being transmitted up the forearm bones of the extended limb

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Fractures of the Radius and Ulnausually the result of severe injurydirect injury usually produces transverse fractures at the same level usually in the middle third of the bones because of interosseous membrane, a fracture of one bone associated with dislocation of the nearest joint.

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Fractures of the distal end of radiusCommon in adults > 50 more frequently in women osteoporosis

Colles’ fracture complete transverse fracture of the distal 2 cm of the radiusmost common fracture of the forearm distal fragment displaced dorsally often comminuted (broken into pieces)

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usually result of trying to ease a fall by outstretching the upper limb

the force drives the distal fragment posteriorly and superiorlydistal articular surface inclined posteriorly.this posterior displacement produces a posterior bump “dinner-fork deformity” forearm & wrist resemble the shape of a fork.

Fractures of the distal end of radius

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Olceranon Bursitis

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Injuries to the Bones of the HandMost commonly fractured carpal bone Scaphoid boneoften results from a fall on the palm when the hand is abducted Dislocation of the lunate bone occasionally occurs in young adults on the outstretched hand in a way that causes hyperextension of the wrist joint.

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Fractures Of the Metacarpal Bonesoccur as a result of direct violence such as the clenched fist striking a hard object. always angulates dorsally.Boxer’s fracture commonly produces an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones.

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Sternoclavicular Joint Injuriesstrong costoclavicular ligament firmly holds medial end of the clavicle to

first costal cartilage. violent forces directed along the long axis usually result in fracturedislocation occasionally. If the costoclavicular ligament ruptures completely,

difficult to maintain the normal position of the clavicle once reduction has been accomplished.

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Acromioclavicular Joint Dislocation. A severe blow on the point of the shoulder

during blocking or tackling in football or any severe fallcan result in the acromion being thrust beneath the lateral end of clavicle

tearing the coracoclavicular ligamentthis condition shoulder separationdisplaced outer end of the clavicle easily palpable

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Dislocations of the Shoulder Joint.

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Dislocations of the Shoulder Joint. Anterior–Inferior Dislocations

Sudden violence applied to the humerus with the joint fully abducted

tilts the humeral head downward onto the inferior weak part of the

capsule, which tears, and the humeral head comes to lie inferior to the

glenoid fossa.

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Dislocations of the Shoulder Joint. Anterior–Inferior Dislocations

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Dislocations of the Shoulder Joint.

Posterior Dislocations

rare

usually caused by direct violence to the front of the joint.

rounded appearance of the shoulder is seen to be lost

greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle.

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Dislocations of the Shoulder Joint.

Posterior Dislocations

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Stability of the Elbow JointElbow joint is stable because of the wrench-shaped articular surface of the olecranon pulley-shaped trochlea of the humerusstrong medial and lateral ligaments

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Stability of the Elbow JointWhen examining the elbow joint,

the physician must remember the normal relations of the bony points.

medial & lateral epicondyles & top of the olecranon in a straight line

Extension

Flexion bony points form the boundaries of an equilateral triangle.

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Dislocations of the Elbow Jointcommon & most posteriorposterior dislocation follows falling on the outstretched handposterior dislocation common in children

parts of the bones that stabilize the joint are incompletely developed

avulsion of the epiphysis of medial epicondyle common in childhood then medial ligament stronger than bond of union between epiphysis & diaphysis

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Radioulnar Joint Diseaseproximal radioulnar joint communicates w/ elbow joint distal radioulnar joint does not communicate w/ wrist joint

elbow joint infection involves proximal radioulnar joint

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Radioulnar Joint DiseaseStrength of proximal radioulnar joint depends on

integrity of the strong anular ligamentRupture in cases of anterior dislocation of head of radius on capitulum of humerus

In young children head of the radius still small & undeveloped sudden jerk on the arm – radial head pulled down through the anular ligament

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Wrist Joint InjuriesA fall on the outstretched hand strain @ anterior ligament of

wrist jointsynovial effusionjoint painlimitation of movement

Differential diagnosis fractured scaphoid /dislocation of lunate bone

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Falls on the Outstretched HandFORCE TRANSMITTED

Scaphoid boneDistal end of radiusacross the interosseus membrane

Ulna Humerusthrough the glenoid fossa

Scapulato the coracoclavicular ligament

Clavicle

Sternum

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Falls on the Outstretched Hand If forces excessive, different parts of the upper limb under strain. The area affected related to ageYoung child posterior displacement of distal radial epiphysisTeenageClavicle fractureYoung adultScaphoid fractureElderlyColles’ fracture