3.bones of upperlimb

7/27/2019 3.Bones of Upperlimb

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BONES OF UPPERLIMB


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Bones pectoral (shoulder) girdle

clavicle scapula

Humerus Radius Ulna carpals metacarpals Phalanges


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SHAFTDivided into Lateral 1/3rd

Medial 2/3rd


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Lateral 1/3rd

Anterior border concave forwards

Posterior border is convex backwards

Superior surface is subcutaneous

Inferior surface containsElevationconoid tubercle

Ridge Trapezoid ridge


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LATERAL END OR Acromial end

Articulates with aromion process of scapula toform Acromioclavicular joint


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MEDIAL END Or Sternal end

Articulates with clavicular notch of ofmanibrium sterni to form Sternoclavicular

joint.


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Side DeterminationThe lateral end is flat

The medial end is large and quadrilateral

The medial 2/3

rd

is convex forwardThe lateral 1/3rd is concave forward

The inferior surface is grooved longitudinally

in its middle 1/3rd


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Peculiarities of the ClavicleOnly long bone that lies horizontally

First bone to start ossifying

No medullary cavity (not always true)


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Sex DeterminationFemales: Shorter, lighter, thinner ,smoother

and less curved

The lateral End of the clavicle is little below

the medial end

Males: The lateral end is at the same level or

slightly higher than the medial end.


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Joints of the clavicle:

They are two in number:

Medially sternoclvicular joint

Laterally acromioclavicular joint

Ligaments:

medially two ligaments:

Sternocalvicular ligament Costoclavicular ligament


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Laterally:

Acromioclavicular ligament

Coracoclavicular ligament

Muscles attached to the clavicle:Medially: sternomastoid and pectoralis major

Laterally: deltoid and trapezius

Inferiorly: the subclavius is attached


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CLINICAL CONSIDERATIONS Fracture of the Clavicle

commonly fractured, often by indirect force

resulting from violent impacts to the

outstretched hand during a fall transmitted

through the bones of the forearm and

shoulder or by falls directly onto the

shoulder itself


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weakest part of clavicle junction of middle

and lateral thirds

medial fragment is elevated by

sternocleidomastoid; lateral fragment is

depressed by weight of shoulder and pulled

medially by adductor muscles overriding offragments

often incomplete in childrengreenstick

fracture


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What is a green stick fracture?

If a bone is fractured on one side and is not

fractured on the other side, then it is called a

green stick fracture


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Clavicle is congenitally absent or imperfectly

developed in some disorders like cleidocranial

dysostosis


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Hypoplasia of clavicle


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SCAPULA it is a flat bone, roughly triangular in shape,

placed on a posterolateral aspect of the

thoracic cage.

the bone that connects the humerus (arm

bone) with the clavicle (collar bone).
http://en.wikipedia.org/wiki/Trianglehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Claviclehttp://en.wikipedia.org/wiki/Claviclehttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Triangle


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Surfaces

Costal (Front, Ventral, Anterior)

presents a broad concavity, the subscapular

fossa.

The medial two-thirds of this fossa are markedby several oblique ridges, which run

lateralward and upward

The ridges give attachment to the tendinous

insertions, and the surfaces between them to

the shelby, of the Subscapularis.
http://en.wikipedia.org/wiki/Subscapularishttp://en.wikipedia.org/wiki/Subscapularis


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The lateral third of the fossa is smooth and

covered by the fibers of subscapularis muscle.


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Dorsal (Back, Posterior)

The dorsal surface is arched from above

downward, and is subdivided into two

unequal parts by the spine; the portion above

the spine is called the supraspinous fossa, and

that below it the infraspinous fossa.
http://en.wikipedia.org/wiki/Supraspinous_fossahttp://en.wikipedia.org/wiki/Infraspinous_fossahttp://en.wikipedia.org/wiki/Infraspinous_fossahttp://en.wikipedia.org/wiki/Supraspinous_fossa


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The supraspinous fossa, the smaller of the

two, is concave, smooth

its medial two-thirds give origin to the

Supraspinatus.
http://en.wikipedia.org/wiki/Supraspinatushttp://en.wikipedia.org/wiki/Supraspinatus


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The infraspinous fossa is much larger

toward its vertebral margin a shallow

concavity is seen at its upper part

its center presents a prominent convexity

the axillary border is a deep groove whichruns from the upper toward the lower part.


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The medial two-thirds of the fossa give origin

to the Infraspinatus; the lateral third is

covered by this muscle.
http://en.wikipedia.org/wiki/Infraspinatushttp://en.wikipedia.org/wiki/Infraspinatus


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Borders

There are three borders of the scapula:

The superior border is the shortest and

thinnest; it is concave, and extends from the

medial angle to the base of the coracoid

process.
http://en.wikipedia.org/wiki/Superior_border_of_scapulahttp://en.wikipedia.org/wiki/Medial_anglehttp://en.wikipedia.org/wiki/Coracoid_processhttp://en.wikipedia.org/wiki/Coracoid_processhttp://en.wikipedia.org/wiki/Coracoid_processhttp://en.wikipedia.org/wiki/Coracoid_processhttp://en.wikipedia.org/wiki/Medial_anglehttp://en.wikipedia.org/wiki/Superior_border_of_scapula


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The axillary border (or "lateral border") is the

thickest of the three. It begins above at the

lower margin of the glenoid cavity, and

inclines obliquely downward and backward tothe inferior angle
http://en.wikipedia.org/wiki/Axillary_borderhttp://en.wikipedia.org/wiki/Glenoid_cavityhttp://en.wikipedia.org/wiki/Glenoid_cavityhttp://en.wikipedia.org/wiki/Axillary_border


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The vertebral border (or "medial border") is

the longest of the three, and extends from the

medial to the inferior angle.
http://en.wikipedia.org/wiki/Vertebral_borderhttp://en.wikipedia.org/wiki/Vertebral_border


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The acromion

The acromion forms the summit of the

shoulder, and is a large, somewhat triangular

or oblong process, flattened from behind

forward, projecting to overhang the glenoid

cavity
http://en.wikipedia.org/wiki/Acromionhttp://en.wikipedia.org/wiki/Acromion


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clinical

scapular fractures are uncommon; when they

do occur, they are an indication that severe

chest trauma has occurred.
http://en.wikipedia.org/wiki/Chest_traumahttp://en.wikipedia.org/wiki/Chest_trauma


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winged scapula

Is a condition in which the medial border (the

side nearest the spine) of a person's scapula is

abnormally positioned outward and

backward. The resulting appearance of theupper back is said to be wing-like because the

inferior angle of the shoulder blade protrudes

backward rather than lying mostly flat like inpeople without the condition.
http://en.wikipedia.org/wiki/Winged_scapulahttp://en.wikipedia.org/wiki/Winged_scapula


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Winged Scapula


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HUMERUSLongest bone

Three parts: Upper End

Lower End

Shaft


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Upper EndHead dierected medially,backwards and

upwards

Articulates with gleniod cavity of scapula to

form shoulder joint

Line separating head and upperend is

anatomical neck

Greater tubercle forms lateral part


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Intertubercular sulucs or bicipital groove

Separates lesser tubercle medially from

anterior part of greater tubercle


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The shaftRounded in upper half

Triangular in lower half

Three borders

Three surfaces


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BordersAnterior border:

upper 1/3rd forms lateral lip of intertubercular

sulcus

Middle part forms anterior margin of detoid

tuberosity

Lower half smooth and rounded


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Lateral Border:

Lower end forms the lateral supracondylar

ridge

Upper part , barely traceable

Middle part interrupted by radial or spiral

groove


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Medial Border:

Upper part forms medial lip of intertubercular

sulcus

Middle presents rough strip and continuous

below with medial supracondylar ridge


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Lower EndForms condyle from side to side

Articular and non articular part


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Articular part:

Capitulum: rounded projection, articulates

with head of radius

Trochlea :pulley-shaped,articulates with

trochlear notch of ulna.

Medial edge projects 6mmdownwards than

lateral edge

Results formation of carrying angle


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Non articulate Part:

Medial condoyle : prominent bony projection

on medial side ,subcutaneous, felt on medial

side of elbow.

Lateral condoyle: smaller, anterolateral part

has muscular impression

Sharp lateral margin above lower end called

lateral supracondylar ridge

Medial supracondylar ridge on medial side


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Clinical

Fracture of the Shaft of the Humerus

results from a direct blow to the arm

may injure the radial nerve in the radial

groove as it winds around the humeral body

paralysis of the elbow, wrist, and digit

extensorswrist drop

L t l E i d liti


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Lateral Epicondylitis

also known as elbow tendinitis, golfers

elbow, tennis elbow repeated forceful flexion and extension of the

wrist strain attachment of common tendon

inflammation of periosteum of lateralepicondyle

pain felt over lateral epicondyle and radiates

down posterior aspect of forearm pain often felt when opening a door or lifting

a glass


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Neck: enclosed by narrow lower margin of

annular ligament

Head and neck rotate freely within socket

Tuberosity :lies below medial part of neck,

rough posterior part and smooth anterior part


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Posterior border: mirror image of anterior

border

Clear defined middle 1/3rd

Upper oblique part know as posterior oblique

line


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Lateral surface: prolong downwards to form

styloid process

Inferior surface: bears triangular area for

scaphoid bone, medial quadrangular area for

lunate bone, takes part in forming wrist bone


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Side determinationSmaller ,circular upper end followed by

constricted neck just medial to neck is radial

tuberosity

Wider lower end : thick with pointed styliodprocesses on lateral aspect and prominent

dorsal tubercle on posterior surface

Medial border is thin and sharp


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SMITHS #


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Coronoid Process: projects forward from shaft


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Coronoid Process: projects forward from shaft

just below olecranon ,has four surfaces

superior, anterior,medial and lateral Superior surface forms lower part of trochelar

notch

Anterior surface, triangular, rough,lowercorner forms ulnar tuberosity

Lateral surface upper part marked by radial

notch for head of radius ,lower part formsdepressed area to accommodate radial

tuberosity


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Shaft


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3 borders and 3 surfaces

Borders

Interosseous or lateral border: sharpest in

middle 2/4th

,inferiorly traced to lateral side ofhead,superiorly continous with supinator crest


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SurfacesAnterior surface:between anterior and

interossoeus border,nutrient formen on upper

part ,upward directed.

Medial surface : between anterior and

posterior borders

Posterior surface:between posterior and

interosseous border,subdivide by two lines

into three areas.


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Styloidprocess projects downwards fromposteromedial side of lower end of ulnar

Posteriorly between head and styloid process

groove for tendon of extensor carpi ulnaris

present


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Facture of olecranon is common by a FALL ONTHE POINT OF ELBOW.

Fracture of coronoid is uncommon


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MADELUNG DEFORMITY


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MADELUNG DEFORMITY

The carpal bones


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Crapus made up of 8 bones,arranged in 2 rows

Proximal row (lateral to medail): the scaphoid,

the lunate, the triquetral, the psisform bones

Distal row(same order): the trapezius,the

trapezoid,the capitate,the hamate


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The trapezium:quadrangular,has crestandgroove anteriorlyand concavoconvex articular

surface distally

The trapezoid: resembles shoe of baby

The capitate: largest carpal bone,rounded end

The hamate:wedge shape ,hook near base


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Side determination


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Proximal row convex proximally and

Concave distally

Distal row convex proximally and flat distally


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METACARPALS located between the phalanges (bones of the

fingers) distally and the carpus which forms

the connection to the forearm

Its equivalent in the foot is the metatarsals
http://en.wikipedia.org/wiki/Phalangeshttp://en.wikipedia.org/wiki/Distalhttp://en.wikipedia.org/wiki/Carpushttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Forearmhttp://en.wikipedia.org/wiki/Carpushttp://en.wikipedia.org/wiki/Distalhttp://en.wikipedia.org/wiki/Phalanges


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Shaft

Base

Head


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The body(corpus; shaft)

convex behind,

concave in front.


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The medialand lateral surfacesare concave,for the attachment of the interosseus muscles,

and separated from one another by a

prominent anterior ridge.
http://en.wikipedia.org/wiki/Interosseus_musclehttp://en.wikipedia.org/wiki/Interosseus_muscle


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The dorsal surfacepresents in its distal two-thirds a smooth, triangular, flattened area

which is covered in by the tendons of the

Extensor muscles

This surface is bounded by two lines, which

commence in small tubercles situated oneither side of the digital extremity


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Base The base or carpal extremity(basis) is of a

cuboidal form, and broader behind than in

front: it articulates with the carpus, and with

the adjoining metacarpal bones


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Head The heador digital extremity(capitulum)

presents an oblong surface markedly convex

from before backward, less so transversely,

and flattened from side to side; it articulateswith the proximal phalanx.

Articulations


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the first with the trapezium;

the second with the trapezium, trapezoid,

capitate and third metacarpal;

the third with the capitate and second andfourth metacarpals;

the fourth with the capitate, hamate, and

third and fifth metacarpals;

and the fifth with the hamate and fourth

metacarpal.


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Bennett's fracture is a fracture of the base ofthe first metacarpal bone which extends into

the carpometacarpal (CMC) joint

Thumb is forced into semiflex and can not be

opposed

Fist cannot be clenched
http://en.wikipedia.org/wiki/Fracturehttp://en.wikipedia.org/wiki/First_metacarpal_bonehttp://en.wikipedia.org/wiki/Carpometacarpal_jointhttp://en.wikipedia.org/wiki/Carpometacarpal_jointhttp://en.wikipedia.org/wiki/First_metacarpal_bonehttp://en.wikipedia.org/wiki/Fracture


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PHALANGES


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14 phalanges in each hand

Base

Shaft

head


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Distal phalanges: are at the tips of the fingersand toes.

Proximal phalanges: are closest to the hand

(or foot) and articulate with the metacarpalsof the hand, or metatarsals of the foot.

Middle or intermediate phalanges: are

between the distal and proximal. The thumband big toe do not have middle phalanges.
http://en.wikipedia.org/wiki/Distal_phalangeshttp://en.wikipedia.org/wiki/Proximal_phalangeshttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Foothttp://en.wikipedia.org/wiki/Metacarpalhttp://en.wikipedia.org/wiki/Metatarsalhttp://en.wikipedia.org/wiki/Intermediate_phalangeshttp://en.wikipedia.org/wiki/Intermediate_phalangeshttp://en.wikipedia.org/wiki/Metatarsalhttp://en.wikipedia.org/wiki/Metacarpalhttp://en.wikipedia.org/wiki/Foothttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Proximal_phalangeshttp://en.wikipedia.org/wiki/Distal_phalanges


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3.bones of upperlimb

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