Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Systematic Anatomy

Locomotor system - Part 3 Upper & their articulations

Dr.Hongqi Zhang (张红旗) Department of Anatomy, Fudan University Email: [email protected]

1 Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- HongqiThe ZHANG-Department bones of Anatomy-Fudanof upper University limb and their articulations

The is characterized by considerable mobility and is adapted for grasping & manipulation.

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University of the upper limb-64 Bones of 1 1 Free upper limb bones 1 1 1 8 5 Phalangeal bones 14 Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

S-shaped long bone Fracture of the clavicle 1 shaft & 2 ends Medial 2/3 convex forward Lateral 1/3 convex backward Sternal end medially

Easily fracture point Acromial end laterally Superior surface Inferior surface

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University A broad triangular flat bone Lie on posterolateral aspect of the thorax Scapula Overlying the 2nd -7th ribs Three angles, three borders, two surfaces

Scapular Sup.border notch Sup.angle

Supraglenoid tubercle Glenoid cavity Inf.scapular fossa Lat.angle

Infraglenoid tubercle Med.border

Lat.border

Ant. surface Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan UniversityInf.angle Copy Right- Hongqi ZHANG-DepartmentScapula of Anatomy-Fudan University

Scapular Coracoid notch process Acromion Sup.angle Acromion

Supraspinatous fossa Lat.angle Scapular spine Infraspinatous fossa

Lat.border Med.border

Inf.angle

Post. surface Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Free upper limb bones

1 1-Humerus 1 2-Ulna 1 3-Radius 1 2 4-Carpal bones 8 3 4 5-Metacarpal bones 5 5 6-Phalangeal bones 14 6

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-DepartmentHumerus of Anatomy-Fudan University

Anatomical neck Head of humerus Greater tubercles Head of humerus Greater tubercles Lesser tubercles Intertubercular sulcus Crest of lesser Crests of Surgical tubercle Surgical neck neck

Detoid tuberosity Sulcus for Long bone radial n. One shaft Two ends

Radial fossa Coronoid fossa fossa Lat.epicondyle Medial Med.epicondyle epicondyle Lat.epicondyle Capitulum of humerus Sulcus for Trochlea of humerus Trochlea of humerus ulnar n. Copy Right-Ant. surface Hongqi ofZHANG-Department humerus of Anatomy-FudanPost. surface University of humerus CopyRadius Right- Hongqiand ulnarZHANG-Department of Anatomy-FudanOlecranon University Articular fovea Coronoid process Articular circumference of ulna Neck of radius Ulnar tuberosity Interosseous border

Interosseous border

Ulnar notch Articular circumference Head of ulnar Carpal articular surface Styloid process Styloid process Copy Right- Hongqi Ant.ZHANG-Department surface of radius of Anatomy-Fudanand ulnar University Copy Right- HongqiOlecranon ZHANG-Department of Anatomy-Fudan University

Head of radius Neck of radius

Radial tuberosity Shaft of ulnar

Radius & ulnar Shaft of radius

Head of Styloid process Ulnar of radius of ulnar notch Copy Right- Hongqi ZHANG-DepartmentPost. surface of radius of Anatomy-Fudan and ulnar University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Bones of the

Carpal 8 Metacarpal 5 Phalangeal 14

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Carpal bones

Proximal row (lateral to medial) S- Scaphoid L- Lunate T- Triquetral P- Pisiform Distal row (lateral to medial) Tm- Td- Trapezoid C- Capitate H- Hamate

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-DepartmentCarpal bones of Anatomy-Fudan University

Proximal row (lateral to medial) A - Scaphoid B - Lunate C - Triquetral D - Pisiform Distal row (lateral to medial) E -Trapezium F -Trapezoid G -Capitate H -Hamate

1-radius 2- ulnar 3- third metacarpal 4-first metacarpal Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyDescription Right- Hongqi ZHANG-Department of bones ofof Anatomy-Fudan upper limb University

Bone Part Description Scapula • • Depression that articulates with humerus • Spine • Long, posterior process for muscle attachment • Acromion process • Articulates with clavicle Clavicle • Acromial end • Articulates with acromion of scapula • Sternal end • Articulates with manubrium of sternum Humerus • Head • Round process that articulates with scapula • Deltoid tubercle • Round process for the deltoid muscle • Posterior, oval depression for the • olecranon process of the ulna • Capitulum • Round process superior to radius • Concave surface that articulates Copy Right-• Trochlea Hongqi ZHANG-Departmentwith ulna of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Description of bones of upper limb

Bone Part Description Radius • Head • Articulates with the ulna

Ulna • Olecranon process • Fits into olecranon fossa of • Semilunar notch humerus • “Half-moon” depression that articulates with the trochlea of ulna

Carpals • Scaphoid • Lunate • Proximal row (8) • Triquetrum• Pisiform • Trapezium• Trapezoid • Distal row • Capitate • Hamate

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Joints of the upper limb

Joints of should girdle

Joints of the free upper limb bone

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Joints between clavicle and trunk bones

Acromion Coracoacroial lig. Acromioclavicular joint Coranoid process Sternoclavicular joint

The medial end of the clavicle articulate with the manubrium sterni and it is the only joint between the shoulder girdle & axial skeleton.the lateral end articulates with the acromion of the scapula. Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyJoints Right- Hongqibetween ZHANG-Department clavicle of Anatomy-Fudanand trunk University bones

Anterior sternoclavicular lig. Interclavicular lig.

Costoclavicular lig. Articular disc

1st costal cartilage Sternocostal Manubrium synchondrosis of 1st rib

The medial end of the clavicle articulate with the manubrium sterni and it is the only joint between the shoulder girdle & axial skeleton. The lateral end articulates with the acromion of the scapula. Movements: Elevation and depression Forward and backward Rotation and circumduction Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Joints of free upper limb bone

The Shoulder joint The joint The Joint of the ulna & the radius The Wrist joint The Joints of the hand

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyShoulder Right- Hongqi joint-one ZHANG-Department of the of most Anatomy-Fudan important University ones

Acromion Classification: Coracohumeral lig. Ball and socket joint Articular Long head of cartilage biceps brachii Multiaxial synovial joint Articular cavity

The most flexible joint Glenoid Intertubercular labrum Bones: synovial sheath Articular Head of humerus and capsule Glenoid cavity of scapula Capsule: Thin and lax, especially (lower part) Attachments: Proximal to glenoid labrum Articular capsule Distal to anatomical neck Lower wall of capsule is lax Tendon of long head of biceps brachii Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyShoulder Right- Hongqi joint-one ZHANG-Department of the of most Anatomy-Fudan important University ones

Acromioclavicular joint Coracoclavicular lig. Coracoacrominal lig. Sup.transverse scapular lig. Coracohumeral lig.

Tendon of supraspinatus

Tendon of Articular capsule subscapularis

Tendon of long head of biceps

Shoulder joint (anterior aspect)

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyShoulder Right- Hongqi joint-one ZHANG-Department of the of most Anatomy-Fudan important University ones

Subacromial bursa Coracoacrominal lig. Coracohumeral lig. Tendon of supraspinatus Tendon of long head of biceps

sup.glenohumeral lig. Tendon of infraspinatus Mid.glenohumeral lig.

Glenoid labrum Tendon of subscapularis

Inf.glenohumeral lig. Tendon of teres minor

Glenoid cavity

Structuer of shoulder joint (sagittal section) Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyShoulder Right- Hongqi joint-one ZHANG-Department of the of most Anatomy-Fudan important University ones

Acromion Coracohumeral lig. • Accessory structures Articular Long head of cartilage bieps brachii – Glenoid labrum: Articular cavity Glenoid Coracohumeral lig. Intertubercular labrum synovial sheath Articular • Movements: capsule Flextion, extension, Adduction, abduction, Medial rotation

Lateral rotation, Easy to dislolcate to ant. Circumduction and inferior direction

Copy Right- Hongqi ZHANG-Department ofAnterior Anatomy-Fudan dislocation University of right shoulder CopyElbow Right- joint-one Hongqi ZHANG-Department of the of Anatomy-Fudan University most important ones Bones: lower end of humerus,upper ends of radius and ulna 1 – Humeroulnar joint-1 2 Formed by trochlear of humerus & Ant. view troclear noch (hinge) – Humeroradial joint- 2 Formed by capitulum of humerus & head of radius (ball and socket) – Proximal radioulnar joint- 3 – Formed by articular circumference 3 of radius and radial notch of ulna Copy Right- Hongqi ZHANG-Department of Anatomy-FudanAnt. view UniversityPost. view CopyElbow Right- Hongqi joint-one ZHANG-Department of the of Anatomy-Fudan University most important ones

Capsule: thin and lax 1 Ligaments 2 Radial collateral lig -1. Attached to lateral epicondyle & annular ligament of radius ulna Ulnar collateral lig -2. Attached to medial epicondyle to 3 medial border of trochlear notch Annular lig.of radius -3 Attached to ant. & post.margins of radial notch of ulna, surrounds the head of radius Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Elbow joint-one of the most important ones

Olecranon fossa Coronoid fossa Post.wall of articular capsule

Trochlea of humerus Trochlea notch Ant.wall of articular capsule Coronoid process

Trochlea of Annular lig.of radius humerus

Tendon of Olecranon biceps brachii

Elbow in extension Elbow in flection Elbow joint Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University CopyArticulation Right- Hongqi ZHANG-Department between of Anatomy-Fudanradius & University ulna

1-Proximal radioulnar joint Proximal radioulnar joint 2-Distal radioulnar joint Oblique cord

Formed by head of ulna, Ulnar ulnar notch of radius Radius and an articular disc Interosseous membrane of 3-Interosseous membrane of forearm A fibrous membrane between Annular lig.of radius the shaft of radius and ulna

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right-The Hongqi movement ZHANG-Department of the of Anatomy-Fudan forearm bonesUniversity

Ant.view supination Ant.view pronation Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University The movement of the forearm bones

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Joints of the hand

Interphalangeal joint

Matacarpophalangeal joint

Intermetacarpal joint

Carpometacarpal joint Intercarpal joint

Radiocarpal joint

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Joints of hand

Radiocarpal joint (ellipsoid) Bones Radius Carpal articular surface of Ulna radius & articular disc below the ulna Proximal row of carpal: Scaphoid, lunate, triquetral bones,but not pisiform Capsule: Lax & strengthened by surrounding lig. Movements: Flexion & extension, Adduction & abduction, Thumb & circumduction Ligaments of wrist coronal section-dorsal view

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-DepartmentJoints of the of Anatomy-Fudanhand University

Intercarpal joints Carpometacarpal joints: ★ Carpometacarpal joint of Ulna Radius thumb Bones: trapezium and base of first metacarpal Movement: Flexion & extension, Adduction & abduction Thumb and opposition Intermetacarpal joints Metacarpophalangeal joints Interphalangeal joints

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Bone of the upper limb-64 Bones of Shoulder girdle Clavicle 1 Scapula 1 Bones of free upper limb Humerus 1 Ulna 1 Radius 1 Carpal bones 8 Metacarpal bones 5 Phalangeal bones 14 Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Muscle of rotator cuff posterior view

Muscle of rotator cuff Anterior view

Shoulder joint dislocation & reduction method Dislocation of should joint 肩关节脱位 最常见，约占全身关节脱位的50%，这与肩关节的解剖生理特点有关，如肱骨 头大，关节盂浅而小，关节囊松弛，其前下方组织薄弱，关节活动范围大，遭受外 力的机会多等。肩关节脱位多发生在青壮年、男性较多。 手法复位:脱位后应尽快复位，选择适当麻醉。 足蹬法患者仰卧，术者位于患侧， 双手握住患肢腕部，足跟置于患侧腋窝，两手用稳定持续的力量牵引，牵引中足跟 向外推挤肱骨头，同时旋转，内收上臂即可复位。复位时可听到响声。 The dislocation ofShoulder joint The most common, account for 50% of whole body dislocation. which is associated with its anatomical and physiological features, such as the humeral head is large, the glenoid is shallow and small, relaxation of the joint capsule and the bottom of the capsule is weak, the scope of joint activities is large etc. it usually occurred in young adults, men more than women. Manul reduction should be reset ASAP after the dislocation, Doctor should select appropriate anesthesia. If foot pedal method is taken, patients is in supine position, doctor stand in injured side of patients, both holding the wrist of injured side, heel in the ipsilateral axillary fossa, traction is taken with stable and continuous power, while traction the doctor’s heel push outward humerous head, at the same time, adduct the upper reset success. At this time if Reset is ok and you can hear the sound. Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Elbow: lateral radiograph Elbow: anteroposterior radiograph

Copy Right-Subluxation Hongqi of ZHANG-Department radius capitulum of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University SubluxationCopy Right- Hongqi of radius ZHANG-Department capitulum of Anatomy-Fudan and manual University reduction

Fournier first described in1671 . It is one of the common elbow injuries in infants and young children. The age of onset was 1 to 4 years old, and the highest incidence was 2 to 3 years old, accounting for 62.5%. Boys more than girls , left more than right side. When the elbow extension and forearm pronation suddenly by vertical traction result in radial head subluxation This disease is treated mainly by manual reduction, without traction. When the elbow is restored, the elbow joint is rotated from the process of the extension to the flexion, and the feeling of the sense of jumping on the radial joint of the humerus can be felt when the reset is successful. After the restoration, the elbow and the forearm can move freely, without any obstacle on the forearm, and the week after the reset is suspended for 1 weeks. Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University X-ray of upper limb bones-fracture

The fracture of the humerus Double fracture of the forearm

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Fracture of the distal end of the radius

Colles’fracture Within 2.5cm distal end of radius

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- HongqiX-ray ZHANG-Department of hand bones of Anatomy-Fudan - fracture University

Wrist and hand; Metacarpal fracture

Copyanteroposterior Right- Hongqi ZHANG-Department radiograph of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Upper Limb X-ray

Dislocation of shoulder joint Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Ant.view(left) Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- HongqiUpper ZHANG-Department Limb ofX-ray Anatomy-Fudan University

Surgical neck fracture Fracture of the ulnar

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University

Kyphosis Scoliosis Column convex backward Column convex laterally

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University The important contents today

Master the name,number and location of the upper limb bones Master the morphological feature of the scapular, humerus,ulna and radius Master the arrangement of the hand bone Master the structure and movement of the shoulder joint, elbow joint & the wrist joint.

Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University Copy Right-knowledge Hongqi ZHANG-Department related of Anatomy-Fudanto the clinic University

Fracture of clavicle Fracture of scapula Fracture of surgical neck of humerus Fracture of shaft of humerus Supracondylar fracture of the humerus Fracture of ulna Fracture of radius Double fracture of both radius &ulna Colle’s fracture Within 2.5 cm distal end of radius Shoulder dislocation Subluxation of capitulum radius Copy Right- Hongqi ZHANG-Department of Anatomy-Fudan University The end! See you next time !

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