cingulum Upper limb

• S Stylopodium - 1

Zeugopodium - 2

Autopodium - distal part (pectoral) girdle

2 • Klíček 4 1 • Lopatka 3 • PH 5 1 StC 2 1 2 AC 3 GH 4

3 4 SuA

5 TSc junction 5 1 Articulatio sternoclavicularis 2 Articulatio acromioclavicularis

9 2 discus 1 4 6a 6b 3 5

10 7

8

3- lig. interclaviculare 4-lig. sternoclaviculare 5-lig costoclaviculare 6-lig. coracoclaviculare a) lig. trapezoideum b) lig. conoideum 7-lig. coracoacromiale (fornix humeri) 8-lig. coracohumerale 9- lig. acromioclaviculare 10 – lig. transversum scapulae Articulatio acromioclavicularis

C-C C-A

C-H Scapula movements (Movements in thoracoscapular junction) with movements in StC Th3 and AC retraction protraction Th7 elevation depression rotation midposition – palm on the neck Ligamentum coracoclaviculare the strongest stabilizer of the AC joint.

conoid trapezoid

Long head BiBr

Labrum glenoidale Glenoid lip

Long headTriBr Superior aspect of the acromioclavicular joint 1

P

L 1 M

Lig. transversum Fornix humeri scapulae superius

A

X-ray

https://www.auntminnie.com/index.aspx?sec=olce&sub=cotx&pag=cpages&ce_id=11221&pno=1 X-ray

1 2

3 7 5 6 4

1- extremitas acromialis 2-acromion 3-greater turebcle 4-lesser tubercle 5-caput humeri 6-cavitas glenoidalis 7-coracoid process description

• 1) type and shape of joint General schema of synovial joint • 2) articular surfaces • 3) attachment • 4) joint capsule reinforcement – , muscles • 5) range of movements • 6) midposition • 7) scheme

1-ball (head) 2- collateral 3-fibrous capsule 4-synovial capsule 5- articular cartilage (hyaline) 6-articular lip (labrum 7-socket (fossa) 8- muscle with tendon 9-ligament 10-synovial bursa communicating with the joint cavity 11-menisc 12-synovial bursa (subtendinea) Art. humeri

Shape: ball and socket, diarthrosis and multiaxial joint Articulation surfaces - caput humeri – cavitas glenoidalis + labrum glenoidale, Capsule: loose joint capsule – the most movable joint; inside is the tendon of long head of brachii axillary recess Bursae: subtendineous bursa of subscapularis, b. subcoracoidea, b. subacromialis, b. subdeltoidea Fixation: rotators cuff, deltoid muscle ligg. glenohumeralia lig. coracohumerale, lig coracoacromiale – fornix humeri Function: ventral and dorsal flexion, abduction + adduction, rotation, circumduction Ball and socket AN

SN

Ball and socket Caput longum BiBr acromion

Processus coracoideus

Ligg. glenohumeralia Glenohumeral ligg. Most movable joint in the body

humeral head compared to the shallow glenoid fossa (4:1 ratio in surface area) 5 6

Articulatio humeri 4

3

2

1 7 1-collum chirurgicum 8 2-tuberculum minus 3-tuberculum majus 4-collum anatomicum 5-articulatio acromioclavicularis 6-angulus superior scapulae 7-processus coracoideus 8-cavitas glenoidalis Articulatio humeri

Capsula articularis acromion Glenoid lip Supraspinatus Subacromial space

Frontal section Sc

H

Axillary recess BiLH Rotator´s cuff

External rotators: 1 1-m.supraspinatus 2-m. infraspinatus 3-m. teres minor 2

Internal rotator: 4-m. subscapularis 3 4 Anterior aspect SuSpi

InSpi

TeMi CL Tri

SuSpi

Posterior aspect rotators cuff InSpi TeMi Acr

InSpi SuSpi

TeMi

N.Axillaris

Posterior aspect TeMa Rotators cuff and bursae • Fornix Fornix humeri = Abduction 0-90 Abduction 90-150 rotation of scapula Luxatio omae ventralis – subcoracoidea

Subscapularis muscle

Scapula

Deltoid Humerus

Biceps brachii tendon long head Shoulder joint replacement Articulatio cubiti - complex joint art. humeroradialis ball and socket art. humeroulnaris hinge art. radioulnaris prox. cylindric

Hinge Ball and socket

capitulo trochlear groove (lunula obliqua) first affected by Cylindric degeneration

Articulatio cubiti - complex joint art. humeroradialis ball and socket art. humeroulnaris hinge art. radioulnaris prox. cylindric

Lig. quadratum

lig. annulare radii

recessus sacciformis Elbow joint Capsule - loose, above fossas, to neck of radius – sacciform recess, free epicondyles lig. collaterale mediale – O-H, H-Co, Obl. lig. collaterale laterale, lig. anulare radii, lig. quadratum

Function - flexion+extension, supination + pronation Anterior aspect Posterior aspect Posterior aspect Lig. anulare radii Elbow joint

1) Capitulum humeri + fovea capitis radii 2) Trochlea humeri + trochlear notch Ball + socket hinge

3) Articular circumference + radial notch

pivot Art. cubiti - ligamentS

lig. collaterale mediale lig. collaterale laterale

lig. annulare radii 2

1-chorda obliqua 2-BiBr 3-lig. annulare radii

Lig. collaterale mediale - 3 parts: 4-lig. humerocoronoideum 5-lig. olecranohumerale 6-lig. obliquum Cooperi Strong collateral ligament¨s

Lig. collaterale radiale Lig. collaterae ulnare Sagittal section

Fat pad sign ? Intraarticular fracture Flexion x extension

pronation x supination Proximal and distal radioulnar joint

Pronation x supination 1- lateral epikondyle 2-medial epikondyle 3-capitulum humeri X-ray Art. cubiti 4-circumferentia articulares 5-tuberositas radii 6-trochlea humeri 2 7-

5

1

3 4

3 6

7 Carying angle – physiological valgosity of elbow joint 170 degree Pronatio dolorosa

Head of the radius is pulled from anular ligament 2 8 9 1 6 3 5 7

4 1-lateral epikondyle 2-medial epikondyle 3- humeroulnar joint 4- radial tuberosity 5- circumferentia articulares 6- capitulum humeri 7- olecranon 8- coronoid process Ossification of long bones

prenatal postnatal

Bone marrow Nutritive artery

Growth plate compact Bone collar from perichondrium Primary enchondral Secondary enchondral ossification center ossification center in Articular In diaphysis epiphysis cartilage spongy X-ray child´s elbow

2 MONTHS

1

Center of ossification Manifestation Fusion

13 MONTHS 1 2 3 YEARS

2,5 YEAR

Center of ossification Manifestation Fusion 6 YEARS

1 2

Center of ossification Manifestation Fusion 11 years 4 3 6 5 1 2

Center of ossification Manifestation Fusion Capitulum humeri

α

25 – 45 DEGREE Anterior humeral line - goes through the middle of the capitulum humeri

Axis of humero radial joint Fr. supracondylica humeri l. sin. 2/3 dislocata CRIF MIO OS 2xKi sec. Swenson Lesion of n. radialis n. ulnaris Broken forearm child 7 years Repositon Hand articulationes manus

Wrist joint – complex, condyloid (elipsoidal)

Art. carpometacarpalis

Saddle joint Art. mediocarpalis

Art. radiocarpalis

disc art. ossis pisiformis Intercarpal joints – limited mobility art. metacarpophalangeales Carpometacarpal –limited mobility art. interphalangeales 1stCM -saddle Disc in radiocarpal joint

Triangular fibrocartilage disc Types of joints

Interphalangeal trochlear joint Metacarpophalangeal Carpometacarpal

trochlear joint

spheroid joint goes palmary to cylindric joint • proximal phalanx – oval fossa on the base for the head of 2 1 MC 1 1 • middle phalanx + distal phalanx – fossa 0 on the base is divided by the crest 0 (trochlear interphalangeal joint) Types of joints and axes of movements

A- wrist joint condyloid F, E, UD, RD,CD B- M-Ph –spheric-cylindric, F,E, UD, RD C- I-Ph- hinge F,E D- intercarpal – limited movements E- 1st CM – saddle – F,E,Abd,Add Ligaments:

Strong interosseous intercarpal ligg. Ventral and dorsal intercarpal ligg.

Radiate carpal lig– from the head of capitate

Palmar radiocarpal and ulnocarpal lig. strong

Dorsal radiocarpal and ulnocarpal lig. weak

Collateral ligg. – weak

Ventral dorsal and interosseal metacarpeal ligg

Flexor carpi ulnaris Palmar aspect Pisohamate lig Pisometacarpeal lig Deep transverse metacarpal ligament Development of joints in fetus

1,3,4 interosseal carpal ligg. 6,7-disc 2,5-collateral ligg. Lig. metacarpale interosseum

Articular disc Dorsal aspect

Collateral ligg X- ray in ductions

Radial duction Midposition Ulnar duction X-ray in flexion and extension

Palmar flexion Midposition Dorsal flexion X-ray pisiform–triquetrum intercarpal joint oblique projection

IV

V II

I

pisiform

R FCU

U Carpal tunnel

retinaculum flexorum

Carpal tunnel crossection carpi radial and ulnar carpal eminence+ flexor´s retinaculum (flexor´s tendons, median nerve)

1-septum (FPL) 2-flexors retinaculum 8-hamatum 3-pisiforme 9-capitatum 4-triquetrum 10- trapezoideum 5-hamatum 11- trapezium 6-lunatum 7-scaphoideum proximally

distally Carpal tunnel crossection CT

Medial carpal eminence (H, P) Lateral carpal eminence (S, T)

C Sesamoid bone

Primary centers of ossification MC, Ph – prenatal – 7.-12. week Secondary centers of ossification – postnatal 1.-3. year Fusion of centers of ossification – 14.- 20.year – girls earlier Carpal bones centers of ossification postnataly

Endesmal ossification

Phalanges + MC – monoepiphysial bones .At the birth only cartilaginous carpus .Ossification .Bone age

8m

8r Wrist implant Wrist implant Metacarpophalangeal implants Interphalangeal implants

Range of movement Midposition of hand joints Sesamoid Ph bone

MC

hamulus Ti T C H Tr+P S L

U Rad Standart projection os scaphoideum projection growth plate

fracture Fractures • Radial deficiency (absence of thumb and entire radius). • represents a congenitally acquired absence of the preaxial limb- bud of the upper extremity. CT art.radiocarpalis art. mediocarpalis 3 art.carpometacarpalis 2

1 SPEC/CT 22 year old male 12 weeks post scaphoid fracture, still tender

Scaphoid fracture Scaphiod and lunate dislocation

Motorbike accident Lower limb joints Veronika Němcová

Os + Sacroiliac joint Os coxae pubica

http://anat.lf1.cuni.cz/muzeum/alb1/index.h tm Os coxae – 3 parts

Os

Os

Os ischii Sacroiliac joint – auricular surace of ilium and auricular surface of sacrum • – only very small movements • Fibrous cartilage • Sacroiliac ligaments (ventral, dorsal, interoseous) • Iliolumbal ligament Pelvis – ligaments

lig.iliolumbale

ligg.sacroiliaca ventralia

lig.inguinale FORAMEN OBTURATUM lig.sacrospinale symphysis pubica

lig.sacrotuberale Pelvis – ligaments

lig.inguinale

CANALIS OBTURATORIUS

Lacuna vasorum + lacuna musculorum Pelvis – ligaments lig.iliolumbale Posterior aspect

ligg.sacroiliaca dorsalia

FORAMEN ISCHIADICUM MAJUS (GREATER SCIATIC FORAMEN)

lig.sacrospinale

FORAMEN ISCHIADICUM MINUS (LESSER SCIATIC FORAMEN)

lig.sacrotuberale Openings of the pelvis

GREATER SCIATIC FORAMEN

SUPRAPIRIFORM FORAMEN

INFRAPIRIFORM FORAMEN LACUNA MUSCULORUM (MUSCULAR SPACE)

LACUNA VASORUM (VASCULAR SPACE)

OBTURATOR CANAL LESSER SCIATIC FORAMEN Uinal ligament

FORAMEN ISCHIADICUM MAJUS 1- pubic symphysis (GREATER SCIATIC FORAMEN): 2-os coccygis m. piriformis, nerves of the sacral plexus, vessels 3- lig. iliolumbale 4- crista iliaca 5- spina iliaca 6- lig. sacrospinale 7- tuber ischiadicum FORAMEN ISCHIADICUM MINUS 8- lig. sacrotuberale (LESSER SCIATIC FORAMEN) m. obturatorius internus, pudendal nerve, internal pudendal vessels Sacral plexus nerves in greater and lesser sciatic foramen

Superior gluteal nerve, art. + vein

m. piriformis Inferior gluteal nerve, art. + vein m. obturatorius internus Sciatic nerve Pudendal nerve, Posterior cutaneous femoral nerve internal pudendal artery and vein Iliopectineal arch

Inguinal ligament SSp

ST

ObtM x-ray External pelvic diameters

Interspinous distance – 26 cm Intercristal distance – 29 cm Intertrochanteric distance -31cm

External conjugate - 18 cm L5 – Pubic symphysis (superior border) Pelvic inclination – 60 degree – to horizontal plane External conjugate Pelvis minor – lesser pelvis

Pelvic planes:

1) Pelvic inlet 2) Pelvic width 3) Pelvic narrow 4)

Anal triangle Urogenital triangle Pelvic planes

1) Pelvic inlet – Aditus pelvis Promontory – linea terminalis –superior border of pubic symphysis

1- transverse diameter 13cm – between terminal lines 2- straight diameter -11cm 3- diameter obliqua 12cm 2) Pelvic width - amplitudo pelvis middle part of sacrum, symphysis and

Oblique diameter 13,5 cm Obturatory groove- greater sciatic notch 3) Pelvic narrow – angustia pelvis lower end of symphysis, sacrum and sciatic spines

Straight diameter 11,5 cm lower end of symphysis and lower end of sacrum 4) Pelvic outlet – exitus pelvis lower end of symphysis and coccyx and sciatic tuberosities

Straight diameter 9,5 cm (coccyx can move posteriorly so 11,5 cm) lower end of symphysis and lower end of coccyx Pelvic diameters

Pelvic planes: 1

1) Pelvic inlet 2 2) Pelvic width 4 3) Pelvic narrow 3 4) Pelvic outlet

External conjugate 18-20cm Diagonal conjugate 13cm Obstetric conjugate 10,5cm Head of newborn in pelvic planes

1. Aditus pelvis (transverse diameter 13 cm) 2. Amplitudo pelvis (oblique diameter, 13,5cm)

3. Angustia pelvis (straight diameter 11,5cm)

4. Exitus pelvis (straight diameter 9,5 - 11,5cm) X ray pelvis

2

1-SI joint 1 2- air in the large intestine 3- acetabulum 4-caput femoris 5-greater trochanter 3 6-collum femoris 4 5 7-lesser 9 trochanter 8-obturatory 8 6 foramen 9-pubic symphysis 7 Sex differencies in pelvis shape • 1 The pelvic inlet is oval in the female. In the male the sacral promontory is prominent, producing a heart- shaped inlet. • 2 The pelvic outlet is wider in females as the ischial tuberosities are everted. • 3 The is more spacious in the female than in the male. • 4 The false pelvis is shallow in the female. • 5 The (the angle between the inferior pubic rami) is wider and more rounded in the female when compared with that of the male.

Pubic arch Pubic angle Pelvis

http://anat.lf1.cuni.cz/muzeum/alb1/index.htm