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Alekzs02.Pdf 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
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