chapter 5 functional anatomy of the upper extremitydownloads.lww.com/.../9780781791281_ha… · ppt...

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 5Functional Anatomy of the Upper

Extremity


Review of Anatomical Structures• Shoulder girdle

– An incomplete bony ring in the upper extremity formed by the two scapulae and clavicles• Scapula

– Flat, triangular bone on the upper posterior thorax• Clavicle

– “S”-shaped bone articulating with scapula and sternum– “Collar bone”

• Glenoid fossa– Depression in lateral superior scapula– Socket for shoulder joint

• Glenoid labrum– Ring of fibrocartilage around rim of glenoid fossa– Deepens socket for shoulder joint


Review of Anatomical Structures (cont.)

• Bursa– Fibrous, fluid-filled sac that reduces friction– Located between bones, tendons, and other structures

• Subacromial bursa– Bursa between acromion process and insertion of

supraspinatus muscle• Coracoid process

– Curved process arising from upper neck of scapula– Overhangs shoulder joint


The Shoulder Complex• Sternoclavicular joint

– Articulation between sternum and clavicle• Acromioclavicular joint

– Articulation between acromion process of scapula and lateral end of clavicle• Scapulothoracic joint

– Physiological joint between the scapula and thorax• Glenohumeral joint

– Articulation between the head of the humerus and the glenoid fossa of the scapula


Movements of the Shoulder Complex

• Dislocation• Rotation• Elevation and Depression• Protraction and Retraction • Horizontal Flexion and Extension


Scapular Movements


Shoulder Joint Range of Motion


Shoulder Joint Movement Characteristics• Large range of motion (ROM) at shoulder• Extreme ROM required by many activities

– Swimming, throwing, gymnastics• Ligaments and muscles provide stability• Scapular and clavicular movements accompany any arm

movement• Scapulohumeral rhythm

– Movement relationship between humerus and scapula during arm raising movements


Muscular Actions• Review Figure 5-9 on page 148

– 17 muscles that contribute to scapula and shoulder joint movements are listed

• Major muscles– Deltoid, trapezius, rhomboids, pectoralis major, latissimus

dorsi, serratus anterior – Rotator cuff (4 muscles surrounding shoulder joint)

• Infraspinatus, supraspinatus, teres minor, subscapularis


Arm Abduction and Flexion


Muscle Action on the Shoulder Girdle


Shoulder Muscle Strength• Generate greatest strength in adduction• Abduction used frequently in daily living• Weakest movements are internal and external rotation• Muscles generate high forces within joint

– Almost 90% of body weight at 90° abduction– Implications?


Shoulder Strength & Conditioning• Shoulder muscles easy to stretch and strengthen• Stretching

– Active and passive• Strength training

– Weight training, limb/body weight exercises• Rotator cuff strength and flexibility important

– Stabilization of joint– Widely used in daily living


Stretching & Strengthening Exercises• Review Figure 5-14 on pages 152 and 153.


Injury• Sprain

– Rupture of fibers of ligament• Subluxation

– Partial dislocation• Fracture

– Break in bone, often clavicle • Ectopic calcification

– Hardening of organic tissue through deposit of calcium salts in areas away from the normal sites

• Degeneration– Deterioration of tissue


Injury (cont.)• Bursitis

– Inflammation of bursa• Impingement syndrome

– Irritation of structures above shoulder joint– Due to repeated compression between greater tuberosity

and acromion process• Subacromial bursitis

– Common from impingement syndrome• Bicipital tendinitis

– Inflammation of the tendon of the biceps brachii


Elbow and Radioulnar Joints• Radiohumeral joint

– Articulation between radius and humerus– Capitulum

• Eminence on distal end of lateral epicondyle• Articulates with head of radius at elbow

• Ulnar-humeral joint– “Elbow”– Articulation between ulna and humerus

• Medial and lateral epicondyles• Carrying angle

– Angle between ulna and humerus with elbow extended– 10–20°


Carrying Angle


Elbow and Radioulnar Joints (cont.)

• Radioulnar joints– Articulations between ulna and radius

• Proximal and distal– Pronation, supination– Interosseous membrane

• Thin layer of tissue running between ulna and radius

– Medial and lateral epicondyles


Elbow Movement Characteristics and Muscular Actions• All 3 joints never close packed at same time• Movements limited by several factors

– Soft tissue, ligaments, joint capsule, muscles• 24 muscles cross elbow

– Most of these muscles capable of multiple movements

– Muscles better at some movements than others


Elbow Flexor Moment Arms


Biceps Brachii Action


Forearm Strength and Conditioning• Flexor group nearly twice as strong as extensor• Effectiveness of strengthening/stretching exercises

– Depends on position of arm• Length-tension relationship• Numerous exercises


Stretching and Strengthening Exercises• Review Figure 5-21 on page 162.


Injury to Forearm• Overuse injuries more common than trauma

– Throwing, tennis serve• Ectopic bone

– Bone formation away from normal site• Rupture

– Torn or disrupted tissue • Muscle

• Olecranon bursitis– Irritation of the olecranon bursae

• Commonly caused by falling on elbow


Injury to Forearm (cont.)• Medial tension syndrome

– “Pitcher’s elbow”– Medial elbow pain from excessive valgus forces

• May include ligament sprain, medial epicondylitis, tendinitis, avulsion fracture

• Osteochondritis dissecans– Inflammation of bone and cartilage resulting in

splitting pieces of cartilage into the joint


Wrist & Fingers• Manipulation activities• Very fine movements• Many stable, yet mobile, segments


Joints of the Wrist• Radiocarpal

– “Wrist”– Ellipsoid joint

• Flexion/extension, radial/ulnar flexion• Distal radioulnar

– Ulna makes NO contact with carpals– Does NOT participate in wrist movements

• Midcarpal – Articulation between two rows of carpals

• Intercarpal– Articulation between a pair of carpals


Joints of the Wrist (cont.)• Carpometacarpal

– Articulations between carpals and metacarpals• Metacarpophalangeal

– Articulations between metacarpals and phalanges• Interphalangeal

– Articulations between phalanges


Muscular Actions• Most originate outside hand region• Thenar eminence

– Mound on radial side of palm formed by intrinsic muscles acting on thumb

• Hypothenar eminence– Mound on ulnar side of palm created by intrinsic

muscles acting on little finger


Muscular Actions (cont.)• Muscular actions:

– Hand flexion/extension– Hand radial/ulnar flexion– Finger flexion/extension– Finger abduction/adduction– Thumb flexion/extension– Thumb abduction/adduction– Thumb opposition


Conditioning• Why condition hand region?

– Improve grip strength– Enhance wrist action for throwing, striking– Prevent injury

• Exercises– Wrist curls– Gripping exercises– Stretching


Contributions of the Wrist & Hand• Power grip

– Powerful hand position– Maximally flexing fingers around object

• Precision grip– Fine-movement hand position– Minimally flexing fingers around object

• Examples:– Eating with fork– Throwing softball– Spiking volleyball– Dribbling basketball– Changing channel with remote control


Grip


Injury of the Wrist & Hand• Bennett’s fracture

– Longitudinal fracture of base of first metacarpal• Mallet finger

– Avulsion of finger extensor tendons at distal phalanx• Result of forced flexion

• Boutonniere deformity– Stiff proximal interphalangeal articulation

• Caused by injury to finger extensor mechanism


Injury of the Wrist & Hand (cont.)

• Jersey finger– Avulsion of finger flexor

• Result of forced hyperextension• Trigger finger

– Snapping during flexion and extension of fingers• Created by nodules on tendons


Injury of the Wrist & Hand (cont.)

• Tenosynovitis– Inflammation of sheath surrounding tendon

• Carpal tunnel syndrome– Pressure and constriction of median nerve

• Caused by repetitive actions at wrist


Carpal Tunnel


Stretching and Strengthening Exercises• Review Figure 5-27 on page 172.


Contribution of Upper Extremity Musculature to Sports Skills or Movements• Upper extremity is obviously important in:

– Everyday activities• Pushing up out of a chair• Carrying, lifting

– Sporting/leisure activities• Swimming, throwing, striking (golf, volleyball)


Overhand Throwing


The Golf Swing


Summary Questions• What do the upper extremities enable us to do?• What stabilizes the structures of the upper extremities?• What are potential injuries to the upper extremities?• What causes these injuries?• How can injuries be prevented?• What are some exercises for stretching and

strengthening the upper extremities?

chapter 5 functional anatomy of the upper extremitydownloads.lww.com/.../9780781791281_ha… · ppt...

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