Bones of the Upper Limbs
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Altered Alignment of the Shoulder Girdle and Cervical Spine in Patients with Insidious Onset Neck Pain and Whiplash- Associated Disorder
Journal of Applied Biomechanics, 2011, 27, 181-191 © 2011 Human Kinetics, Inc. Altered Alignment of the Shoulder Girdle and Cervical Spine in Patients With Insidious Onset Neck Pain and Whiplash- Associated Disorder Harpa Helgadottir, Eythor Kristjansson, Sarah Mottram, Andrew Karduna, and Halldor Jonsson, Jr. Clinical theory suggests that altered alignment of the shoulder girdle has the potential to create or sustain symptomatic mechanical dysfunction in the cervical and thoracic spine. The alignment of the shoulder girdle is described by two clavicle rotations, i.e, elevation and retraction, and by three scapular rotations, i.e., upward rotation, internal rotation, and anterior tilt. Elevation and retraction have until now been assessed only in patients with neck pain. The aim of the study was to determine whether there is a pattern of altered alignment of the shoulder girdle and the cervical and thoracic spine in patients with neck pain. A three-dimensional device measured clavicle and scapular orientation, and cervical and thoracic alignment in patients with insidious onset neck pain (IONP) and whiplash-associated disorder (WAD). An asymptomatic control group was selected for baseline measurements. The symptomatic groups revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle. A difference was found between the symptomatic groups on the left side, whereas the WAD group revealed an increased scapular anterior tilt and the IONP group a decreased clavicle elevation. These changes may be an important mechanism for maintenance and recurrence or exacerbation of symptoms in patients with neck pain. Keywords: neck pain, whiplash, scapula, posture Clinical theory suggests that altered alignment of of Biomechanics. -
The Appendicular Skeleton Appendicular Skeleton
THE SKELETAL SYSTEM: THE APPENDICULAR SKELETON APPENDICULAR SKELETON The primary function is movement It includes bones of the upper and lower limbs Girdles attach the limbs to the axial skeleton SKELETON OF THE UPPER LIMB Each upper limb has 32 bones Two separate regions 1. The pectoral (shoulder) girdle (2 bones) 2. The free part (30 bones) THE PECTORAL (OR SHOULDER) GIRDLE UPPER LIMB The pectoral girdle consists of two bones, the scapula and the clavicle The free part has 30 bones 1 humerus (arm) 1 ulna (forearm) 1 radius (forearm) 8 carpals (wrist) 19 metacarpal and phalanges (hand) PECTORAL GIRDLE - CLAVICLE The clavicle is “S” shaped The medial end articulates with the manubrium of the sternum forming the sternoclavicular joint The lateral end articulates with the acromion forming the acromioclavicular joint THE CLAVICLE PECTORAL GIRDLE - CLAVICLE The clavicle is convex in shape anteriorly near the sternal junction The clavicle is concave anteriorly on its lateral edge near the acromion CLINICAL CONNECTION - FRACTURED CLAVICLE A fall on an outstretched arm (F.O.O.S.H.) injury can lead to a fractured clavicle The clavicle is weakest at the junction of the two curves Forces are generated through the upper limb to the trunk during a fall Therefore, most breaks occur approximately in the middle of the clavicle PECTORAL GIRDLE - SCAPULA Also called the shoulder blade Triangular in shape Most notable features include the spine, acromion, coracoid process and the glenoid cavity FEATURES ON THE SCAPULA Spine - -
Bone Limb Upper
Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior -
Trapezius Origin: Occipital Bone, Ligamentum Nuchae & Spinous Processes of Thoracic Vertebrae Insertion: Clavicle and Scapul
Origin: occipital bone, ligamentum nuchae & spinous processes of thoracic vertebrae Insertion: clavicle and scapula (acromion Trapezius and scapular spine) Action: elevate, retract, depress, or rotate scapula upward and/or elevate clavicle; extend neck Origin: spinous process of vertebrae C7-T1 Rhomboideus Insertion: vertebral border of scapula Minor Action: adducts & performs downward rotation of scapula Origin: spinous process of superior thoracic vertebrae Rhomboideus Insertion: vertebral border of scapula from Major spine to inferior angle Action: adducts and downward rotation of scapula Origin: transverse precesses of C1-C4 vertebrae Levator Scapulae Insertion: vertebral border of scapula near superior angle Action: elevates scapula Origin: anterior and superior margins of ribs 1-8 or 1-9 Insertion: anterior surface of vertebral Serratus Anterior border of scapula Action: protracts shoulder: rotates scapula so glenoid cavity moves upward rotation Origin: anterior surfaces and superior margins of ribs 3-5 Insertion: coracoid process of scapula Pectoralis Minor Action: depresses & protracts shoulder, rotates scapula (glenoid cavity rotates downward), elevates ribs Origin: supraspinous fossa of scapula Supraspinatus Insertion: greater tuberacle of humerus Action: abduction at the shoulder Origin: infraspinous fossa of scapula Infraspinatus Insertion: greater tubercle of humerus Action: lateral rotation at shoulder Origin: clavicle and scapula (acromion and adjacent scapular spine) Insertion: deltoid tuberosity of humerus Deltoid Action: -
Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE -
Complications Associated with Clavicular Fracture
NOR200061.qxd 9/11/09 1:23 PM Page 217 Complications Associated With Clavicular Fracture George Mouzopoulos ▼ Emmanuil Morakis ▼ Michalis Stamatakos ▼ Mathaios Tzurbakis The objective of our literature review was to inform or- subclavian vein, due to its stable connection with the thopaedic nurses about the complications of clavicular frac- clavicle via the cervical fascia, can also be subjected to ture, which are easily misdiagnosed. For this purpose, we injuries (Casbas et al., 2005). Damage to the internal searched MEDLINE (1965–2005) using the key words clavicle, jugular vein, the suprascapular artery, the axillary, and fracture, and complications. Fractures of the clavicle are usu- carotid artery after a clavicular fracture has also been ally thought to be easily managed by symptomatic treatment reported (Katras et al., 2001). About 50% of injuries to the subclavian arteries are in a broad arm sling. However, it is well recognized that not due to fractures of the clavicle because the proximal all clavicular fractures have a good outcome. Displaced or part is dislocated superiorly by the sternocleidomas- comminuted clavicle fractures are associated with complica- toid, causing damage to the vessel (Sodhi, Arora, & tions such as subclavian vessels injury, hemopneumothorax, Khandelwal, 2007). If no injury happens during the ini- brachial plexus paresis, nonunion, malunion, posttraumatic tial displacement of the fractured part, then it is un- arthritis, refracture, and other complications related to os- likely to happen later, because the distal segment is dis- teosynthesis. Herein, we describe what the orthopaedic nurse placed downward and forward due to shoulder weight, should know about the complications of clavicular fractures. -
Skeletal System -Appendicular System
Skeletal System -Appendicular System Chapter 8 Part B Skeleton - Divisions Total number of bones: 206 Divided into two major subdivisions: Axial system….blue Appendicular system….tan Axial system: Composed of bones that form the axis of the body. 80 bones. Appendicular system: Composed of bones that form The limbs. The bones that attach the limbs to the axial. 126 bones. Practice…Practice…Practice…Practice…Practice!! Appendicular Skeleton Appendicular system: Pectoral girdle 4 bones Upper extremity 60 bones Pelvic girdle 2 bones Lower extremity 60 bones 126 bones Appendicular Skeleton Appendicular system: Pectoral girdle 4 bones Upper extremity 60 bones Pelvic girdle 2 bones Lower extremity 60 bones 126 bones Upper Extremity/Limb Upper limbs/extremities are composed of 60 bones…30 bones in each limb: Upperarm – Humerus Forearm – Radius and Ulna Wrist – Carpals Hand – Metacarpals in palm – Phalanges in fingers and thumb Upper Extremity/Limb - Humerus Body/Shaft Humerus: long bone. Has 3 regions: Proximal end articulates with glenoid cavity of scapula. Distal end articulates with radius and ulna. Body/Shaft: diaphysis between proximal and distal ends. Has rough surface – deltoid tuberosity…for deltoid muscle attachment. Upper Extremity/Limb - Humerus Body/Shaft Humerus - Proximal end: Head: rounded projection fits into glenoid cavity of scapula. Greater and lesser tubercles: projections next to the head for muscle attachment. Intertubercular sulcus: groove between the tubercles accommodates tendon of an arm muscle. Upper Extremity/Limb - Humerus Body/Shaft Humerus - Distal end: Anterior surface: Capitulum: small, rounded knob articulates with proximal end of radius of forearm. Trochlea: spool-shaped structure articulates with proximal end of ulna of forearm. -
Right Or Left Bones? Clavicle Ulna
Right or Left Bones? Clavicle Ulna . Together, the clavicles make a . Lay the ulna on the table. “handlebar” shape (low at the middle . Can you see the radial notch? of the chest, higher near the shoulders). o If yes, the open side of the . The blunt tip (sternal end) touches the trochlear (semilunar) notch tells sternum at the middle of the chest. you the bone orientation (see . The round tip (acromial end) touches the photo 1). scapula at the shoulder. o If no, the open side of the . The bumpy side of the clavicle faces the trochlear (semilunar) notch is the rib cage. opposite of the bone orientation . The smooth side of the clavicle faces (see photo 2). outward Radius Fibula . The styloid process always touches the . The smoother tip (head of the fibula) thumb. touches the knee. If the lower end of the radius (near the . The rougher tip (lateral malleolus) styloid process) is rough, you are touches the ankle. looking at the back of the wrist. The point of the lateral malleolus points . If the lower end of the radius is smooth, to the pinkie toe, not the middle of the you are looking at the inside of the wrist. foot. The front of the fibula (anterior view) has an edge. The back of the fibula (posterior view) is flat. References: University of Liverpool Faculty of Health and Life Sciences. (2013). Radius and ulna (right forearm) [Digital photograph]. Retrieved from https://www.flickr.com/photos/liverpoolhls/10819145494. . -
Arm and Cubital Fossa
Two Minute History M1 - Anatomy Dissection: • 300 B.C Arm and Cubital Alexandrian Egypt: King Ptolemy I, its ok Fossa to dissect cadavers of executed, mummies etc… •Herophilus “Father of Anatomy” accused by a rival of DG Simpson, Ph.D. dissecting 600 criminals…..live criminals VCU Department of Anatomy •1300 AD Europe Pope Boniface VIII edict to stop dissection to reduce the flow of bodies “parted out and boiled” from the crusades. Unclear if this is broad ban or very narrow. 1 2 Dissection: Dissection: •1540 parliament passes “The United Company of Barbers and •1700’s with the expansion of medical Surgeons, dissect 4-6 executed schools cadavers are used as tuition criminals/yr (not enough even then) •Competition is very high and medical •1600’s Britain. The executed are schools actively advertise that training includes dissections etc.. dissected in public as punishment • 1628 William Harvey •1828 London had 10 full time (cardiovascular fame). Autopsy & 200 part time body snatchers (“seasonal work” at 312 bodies/yr) of live and dead…. Medicine expands and shortages develop •Inventions to foil grave robbers Harvey dissects father and sister •1828 Robert Knox….and the rest • 1740’s Lots of private medical is amazing history. schools competing for students, William Hogarth The Reward of Cruelty 3 4 market forces develop 1750-1751 Dissection: •Burke was hanged: 25,000 watched. Hare was granted immunity as crowd called “Burke Hare” •1828, knock on the •Burke dissected: 30,000 came to see the open lab door, Knox’s assistant purchases a cadaver -
Rehabilitation Guidelines for Shoulder Debridement, Decompression and Distal Clavicle Excision
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Shoulder Debridement, Decompression and Distal Clavicle Excision Acromion Front View Back View Supraspinatus Supraspinatus Long head of bicep Type I Infraspinatus Short Teres head of bicep Minor Subscapularis Type II Front View Type III Figure 1 Shoulder anatomy Image Copyright 2010 UW Health Sports Medicine Center. Figure 2 Acromion classifications Subscapularis The shoulder is made up of three The rotator cuff connects the bones: the scapula (shoulder blade), humerus to the scapula. The rotator the humerus (upper arm bone) and cuff is formed by the tendons of the clavicle (collarbone). One part of four muscles: the supraspinatus, the scapula, called the glenoid fossa, infraspinatus, teres minor and is coupled with the humerus to Figure 3 Rotator cuff anatomy subscapularis (Figure 3). The stability make up the socket of the shoulder Image property of Primal Pictures, Ltd., primalpictures.com. Use and movement of the shoulder is of this image without authorization from Primal Pictures, Ltd. is (Figure 1). prohibited. controlled primarily by the rotator The glenoid is very shallow and cuff muscles, with assistance from may be performed using instruments flat. The glenoid labrum is a the ligaments, glenoid labrum and (about the size of a pencil which rim of soft tissue that turns the capsule of the shoulder. Labral include a camera and other surgical flat surface of the glenoid into a tears and rotator cuff tears are instruments) inserted through deeper socket that molds to fit often caused by a direct injury to small incisions in the shoulder, to the head of the humerus. -
The Importance of the Clavicle Biomechanics in the Shoulder Movement
Health, Sports & Rehabilitation Medicine Vol. 21, no. 2, April-June 2020, 93–96 REVIEWS The importance of the clavicle biomechanics in the shoulder movement László Irsay1,2, Adela Raluca Nistor2, Alina Ciubean1, Ileana Monica Borda1,2, Rodica Ungur1,2, Ioan Onac1,2,Viorela Ciortea1,2 1 “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania 2 Clinical Rehabilitation Hospital Cluj-Napoca, Romania Abstract The sternoclavicular joint (SC) provides the attachment belt for the upper limb. It is the only direct joint that attaches the upper limb to the trunk. Practically, the clavicle moves while the sternum remains fixed. The SC joint is an important fulcrum for the movement of the shoulder girdle. The disc and ligaments of the SC joint offer such an effective support that the dislocation of the sternoclavicular joint is rare. The acromioclavicular joint (AC) connects the acromial process of the scapula and the clavicle. The movements of the AC joint are minimal, but crucial for the normal shoulder motion. In clinical practice, the movement of the clavicle is often neglected. This movement occurs in 3 planes; the integrity of these movement planes is essential in the complex motion of the arm. Any disturbance in the normal movement of the clavicle will automatically limit the range of motion of the arm, especially the abduction. The researchers consider that, from the practical point of view, the knowledge regarding the biomechanics of the clavicle is critical, since any limitation of the mobility of the shoulder can shroud a pathology that can block the mobility of the clavicle. Keywords: sternoclavicular joint, acromioclavicular joint, shoulder. -
Type III Acromioclavicular Separation: Rationale for Anatomical Reconstruction
A Review Paper Type III Acromioclavicular Separation: Rationale for Anatomical Reconstruction Adam J. Farber, MD, Brett M. Cascio, MD, and John H. Wilckens, MD merge with the parallel fibers of the superior AC liga- ABSTRACT ment, making it the strongest and most biomechanically Treatment of acute type III acromioclavicular separa- important of the AC ligaments.5,9 Urist10 showed that tion is controversial. In some patients, nonoperative AC ligaments are the primary restraint to anterior and treatment is associated with pain, weakness, and stiff- posterior displacement, providing horizontal AC joint ness. Many acromioclavicular joint reconstructions are stability. Fukuda and colleagues11 confirmed the impor- associated with complications and results not sub- tance of AC ligaments in providing horizontal stability stantially better than those of nonoperative treatment. Use of autogenous free tendon graft to anatomically with small (physiological, eg, daily activities) and large reconstruct the acromioclavicular and coracoclavicular (pathologic, eg, injuries) loads, suggesting that AC liga- ligaments offers several advantages over other surgi- ments provide a substantial amount of vertical AC joint cal techniques. These advantages include improved stability at small loads. biomechanical properties, no foreign body implanta- The coracoclavicular (CC) ligament, a strong ligament tion, biological fixation, anatomical reconstruction, and that runs from the outer inferior surface of the clavicle early rehabilitation. to the base of the coracoid