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1-Upper Limb.Pdf At the end of the lecture, you should be able to : - List the different bones of the UL. - List the characteristic features of each bone. - Differentiate between the bones of the right and left sides. - List the articulations between the different bones. Bones Come in a Different shapes of bone in next slide Store variety of minerals shapes and sizes From the bone marrow Provides Produce red and white blood cells attachment for muscles support and protect the Enable various organs of Bones movement Example: the body Thoracic cage Protect: Heart and lungs Classification of bones by shape Long bones Limbs and fingers Short bones Wrist and ankles Flat bones Skull and sternum Irregular bones Spine and pelvis Sesamoid bones Patella Bones of upper limb Clavicle Pectoral girdle Scapula Arm Humerus Ulna Forearm Radius Wrist Carpal bones Metacarpals Hand Phalanges Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand - It is very light - allows the upper limb to have exceptionally free Scapula movement “posterior” On the other hand, the pelvic girdle “ in lower limb “ has limited movement compare to Clavicle pectoral girdle “Anterior” Formed of two bones of two Formed Clavicle General information Functions • long bone lying • It serves as a rigid support from which the scapula and free horizontally across the upper limb are suspended root of the neck. • keep them away from the trunk • doubly curved. so that the arm has maximum • It is subcutaneous “under freedom of movement • Transmits forces from the UL to the skin” throughout its the axial skeleton length. • Provides attachment for muscles All long bones are vertical except for the clavicle is • There is NO medullary • It forms a boundary of the horizontal cavity. Cervicoaxillary canal for protection of the neurovascular - Clavicle is clear seen in thin people and disappear in • It has the appearance of bundle of the UL obese one. - medullary cavity = marrow cavity an elongated letter - clavicles are one of the Cervicoaxillary components Capital (S) lying on one - Cervicoaxillary canal : contain the nerves that come side from the neck and supply to the upper limb Clavicle Two Ends Body (shaft) Two Surface The clavicle has : - 2 ends - 2 surface Sternal (medial) Convex Superior: - Body (shaft) doubly curved enlarged & forward: smooth as it lies - 3 articulations Next slide triangular 2\3 its medial just deep to the skin Acromial Concave Inferior: (lateral) : forward: rough because strong ligaments bind it to flattened 1\3 its lateral the 1st rib - the clavicle has 2 ends MEDIAL & LATERAL, but all the other long bones have PROXIMAL & DISTAL ends - We said sternal end because it is near to sternum and acromial because it is near to acromion Articulations of Clavicle Clavicle with manubrium Sternoclavicular joint of sternum Clavicle with acromion of Acromioclavicular joint scapula Costoclavicular Joint Clavicle with the 1st rib COSTAE mean rib in Latin - Any bone that form a joint is “smooth” because it is covered by a cartilage Fractures of the Clavicle - The clavicle is commonly - It may be pulled medially by fractured especially in children the adductors of the arm - as forces are impacted to the - The sagging limb is supported outstretched hand during by the other falling After fracture: The weakest part of the clavicle - the medial fragment elevated is : the junction of the middle by the sternomastoid muscle and lateral thirds - lateral fragment drops because of the weight of the UL sternomastoid muscle Scapula Function of scapula: Scapula (shoulder blade): • Gives attachment to -it is a triangular flat bone. muscles -extends between the 2nd rib • Has a considerable degree till the 7th rib. of movement on the thoracic wall to enable the arm to move freely • The glenoid cavity forms Two surface : the socket of the shoulder joint • convex posterior : divided by the spine of the scapula into the : 1. supraspinous fossa (the small part above the spine of the scapula) the scapula gives some muscles the 2. infraspinous fossa (the largest part below the spine of the origin point or the insertion point scapula) • concave anterior (costal) : it forms the large subscapula fossa Scapula Three processes : •Spine : a thick projecting ridge of bone that continues laterally •Coracoid : a beaklike process, it has a finger like shape pointed to the shoulder. it resembles is size shape and direction •Acromion : forms the subcutaneous point of the shoulder. spine Three angels : • Inferior • lateral : a shallow concave oval fossa that receives the head of the humerus ( forms the glenoid cavity ) • Superior coracoid Three borders : • Superior • Lateral : axillary: the thickest part of the bone, it acromion terminates at the lateral angle • Medial : vertebral Winged Scapula * Etiology : * Clinical appearance : it's due to injury of thoracic long it will protrude posteriorly nerve as in radial mastectomy which causes paralysis of serratus because most of the scapula anterior muscle is well protected by muscles and by it’s association with the thoracic wall, most of it's fractures involve the protruding subcutaneous Acromion. * Symptoms : The medial border and inferior angle of the patient has difficulty in the scapula will no longer be kept raising the arm above the head closely applied to the chest wall (difficult in rotation of the scapula). المكان اﻷكثر عرضة للكسر هنا هو الـ acromion Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand - The arm formed of one bone Humerus has called : Humerus Humerus is : - Typical Long bone. Proximal end - It is the largest bone in the upper limb Body (shaft) Distal end Proximal end of Humerus Head: Smooth it forms 1/3 of a sphere, it articulates with the glenoid cavity of the scapula. Proximal end consist of : Greater tubercle: Head, Neck, Greater and Lesser Tubercles at the lateral margin of the Humerus Lesser tubercle: projects anteriorly. The two tubercles are separated by Intertubercular Groove Anatomical neck: formed by a groove separating the head from the tubercles Surgical Neck: a narrow part distal to the tubercles. Greater tubercle: up and lateral Lesser tubercle: up and forward Shaft of Humerus has two prominent features : Deltoid tuberosity Spiral (Radial) groove A rough elevation Runs obliquely down laterally for the the posterior aspect attachment of deltoid of the shaft muscle It lodges the important radial nerve and vessels Distal end of Humerus Anteriorly Posteriorly Trochlea: Olecranon fossa: (medial) for above the articulation with trochlea. - Widens as the sharp medial and the ulna lateral Supracondylar Ridges and end in the Medial (can be felt) and Capitulum: (lateral) for Lateral Epicondyles articulation with the radius. - They provide muscular Coronoid attachment fossa: above the trochlea Radial fossa: above the capitulum. Here we have 3 fossa : 2 anterior and 1 posterior Explanation processيقابلها fossaكل يقابل النتوءات أجزاء غائرة - Trochlea coronoid fossa & Olecranon Fossa - Capitulum Radial Fossa Articulations of humerus Head of glenoid cavity of the • Shoulder joint the humerus scapula Lower end upper of humerus ends of • Elbow joint (Trochlea & the radius Capitulum) and ulna Fracture of Humerus The fracture results from falling Most common fractures are of the on the hand Surgical neck especially in elder (transition of force through the people with osteoporosis bones of forearm of the extended limb) Surgical neck The body of the humerus In younger people, can be fractured by fractures of the a direct blow to the arm or greater tubercle results by indirect injury as falling on the from falling on the hand when outstretched hand the arm is abducted Body of the humerus .. the fracture by a DIRECT blow نادر حصول الكسر فيها إﻻ من خﻻل تلقي كدمة مباشرة Nerves affected in fractures of humerus • Radial • Axillary nerve nerve spiral Surgical groove neck Distal Medial end of epicondyle humerus • Median • Ulnar nerve nerve )عند ارتطام المرفق بطاولة, اﻷلم الناشئ في هذه المنطقة يكون بسبب هذا العصب) medial epicondyle : ulnar nerve* Bones of upper limb Pectoral girdle Arm Forearm Wrist Hand The stabilizing bone of forearm ULNA RADIUS Ulna LOCATION medial lateral SIZE longer shorter Diminishes in Radius Expand in diameter DIAMETER diameter as it as it moves distally moves distally. Formed of two bones of two Formed Ulna Proximal end Distal end Body (shaft) - Projects proximally (near to the trunk) Superiorly : Olecranon Small and from the posterior aspect. thick and process - Forms the pointed portion of the elbow rounded cylindrical Coronoid head: lies Inferiorly : Projects anteriorly distally at diminishes in process the wrist diameter it is a long ridge on the 1. Anterior anterior side of the coronoid Tuberosity styloid process: Has three process where the brachialis Inferior to coronoid process medial distal 2. Medial muscle attaches of ulna projection surfaces 3. Posterior Articulates with trochlea of humerus Trochlear Has three notch borders See slide 22 (تقعر )A smooth rounded concavity- Radial Anterior posterior -lateral to coronoid process. Lateral notch (rounded) interosseous (sharp) (sharp) Articulates with the head of the radius ما سبب عدم تسميتنا للـ Radial Notch بـ Fossa ؟ ﻷنها ليست عميقة Radius It is rectangular Proximal end Body (shaft) Distal end - Small & circular. - Has a concave upper surface to Convex at it’s Dorsal Projects dorsally (away articulate with the capitulum of Head lateral surface tubercle from the trunk) humerus. Gradually Radial Projects from the Neck enlarges as it styloid lateral side. passes distally
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