cingulum Upper limb
• S Stylopodium - 1 bone
Zeugopodium - 2 bones
Autopodium - distal part Shoulder (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 joint 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 Synovial joint description
• 1) type and shape of joint General schema of synovial joint • 2) articular surfaces • 3) joint capsule attachment • 4) joint capsule reinforcement – ligaments, muscles • 5) range of movements • 6) midposition • 7) scheme
1-ball (head) 2- collateral ligament 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 biceps 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 Subacromial bursa 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 = Coracoacromial ligament Abduction 0-90 shoulder joint Abduction 90-150 rotation of scapula Luxatio omae ventralis – subcoracoidea Infraspinatus muscle
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- olecranon
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 joints 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 Saddle joint 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 Pelvis
Os sacrum+coccyx Sacroiliac joint Os coxae Symphysis pubica
http://anat.lf1.cuni.cz/muzeum/alb1/index.h tm Os coxae – 3 parts
Os ilium
Os pubis
Os ischii Sacroiliac joint – auricular surace of ilium and auricular surface of sacrum • Amphiarthrosis – 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 – pelvic inlet to horizontal plane External conjugate Pelvis minor – lesser pelvis
Pelvic planes:
1) Pelvic inlet 2) Pelvic width 3) Pelvic narrow 4) Pelvic outlet
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 acetabulum
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 pelvic cavity is more spacious in the female than in the male. • 4 The false pelvis is shallow in the female. • 5 The pubic arch (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