Download - 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