cingulum upper limb · upper limb • s stylopodium - 1 ... retinaculum 3-pisiforme 4-triquetrum...
TRANSCRIPT
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Upper limb
• S Stylopodium - 1 bone
Zeugopodium - 2 bones
Autopodium - distal part
cingulum
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Shoulder (pectoral) girdle
• Klíček
• Lopatka
• PH
1 StC
2 AC
3 GH
4 SuA
5 TSc junction
12
4
5
3
1
2
3
4
5
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1 Articulatio sternoclavicularis
2 Articulatio acromioclavicularis
12 discus
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
34
56a 6b
7
10
9
8
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Articulatio acromioclavicularis
C-H
C-A
C-C
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Scapula movements
(Movements in
thoracoscapular
junction)
with movements in StC
and AC joint
retraction
protraction
elevation
depression
rotation
midposition –
palm on the neck
Th3
Th7
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Ligamentum coracoclavicularethe strongest stabilizer of the AC joint.
Long head BiBr
Long headTriBr
Labrum glenoidale
Glenoid lip
conoid
trapezoid
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Superior aspect of the acromioclavicular joint 1
1
Fornix humeri
Lig. transversum
scapulae superius
P
A
L
M
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X-ray
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X-ray
1- extremitas acromialis
2-acromion
3-greater turebcle
4-lesser tubercle
5-caput humeri
6-cavitas glenoidalis
7-coracoid process
1 2
3
4
5
6
7
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Synovial joint description
• 1) type and shape of joint
• 2) articular surfaces
• 3) joint capsule attachment
• 4) joint capsule reinforcement
– ligaments, muscles
• 5) range of movements
• 6) midposition
• 7) scheme
General schema of synovial joint
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)
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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 recessBursae: 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
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Ball and socket
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Ball and socket
SN
AN
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Ligg. glenohumeralia
Glenohumeral ligg.
Processus coracoideus
Caput longum BiBr
acromion
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Most movable joint in the body
humeral head compared
to the shallow glenoid
fossa (4:1 ratio in surface
area)
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Articulatio humeri
1-collum chirurgicum
2-tuberculum minus
3-tuberculum majus
4-collum anatomicum
5-articulatio acromioclavicularis
6-angulus superior scapulae
7-processus coracoideus
8-cavitas glenoidalis
1
2
3
4
5 6
7
8
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Capsula articularis
Articulatio humeri
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Frontal section
acromion
BiLH
Axillary recess
Supraspinatus
H
Sc
Glenoid lip
Subacromial bursa
Subacromial space
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Rotator´s cuff
External rotators:
1-m.supraspinatus
2-m. infraspinatus
3-m. teres minor
Internal rotator:
4-m. subscapularis
1
2
3
4
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Anterior aspect
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TeMi
InSpi
SuSpi
TeMi
InSpi
SuSpi
CL Tri
Posterior aspect rotators cuff
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TeMi
InSpi SuSpi
TeMa
N.Axillaris
Acr
Posterior aspect
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Rotators cuff and bursae
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• Fornix Fornix humeri = Coracoacromial ligament
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Abduction 0-90 shoulder joint
Abduction 90-150 rotation of scapula
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Luxatio omae ventralis –
subcoracoidea
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Infraspinatus muscle
Deltoid
Humerus
Biceps brachii tendon
long head
Scapula
Subscapularis
muscle
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Shoulder joint replacement
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capitulo trochlear groove (lunula
obliqua) first affected by
degeneration
Ball and socket
Hinge
Cylindric
Articulatio cubiti - complex joint
art. humeroradialis ball and socket
art. humeroulnaris hinge
art. radioulnaris prox. cylindric
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Articulatio cubiti - complex joint
art. humeroradialis ball and socket
art. humeroulnaris hinge
art. radioulnaris prox. cylindric
recessus
sacciformis
lig. annulare radii
Lig. quadratum
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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
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Anterior aspect
Posterior aspect
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Posterior aspect
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Lig. anulare radii
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Elbow joint
1) Capitulum humeri + fovea capitis radii2) Trochlea humeri + trochlear notch
3) Articular circumference + radial notch
Ball + socket
pivot
hinge
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Art. cubiti - ligamentS
lig. collaterale
mediale lig. collaterale
laterale
lig. annulare radii
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1-chorda obliqua
2-BiBr
3-lig. annulare radii
Lig. collaterale mediale - 3 parts:
4-lig. humerocoronoideum
5-lig. olecranohumerale
6-lig. obliquum Cooperi
2
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Lig. collaterale radiale
Lig. collaterae ulnare
Strong collateral ligament¨s
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Sagittal section
Fat pad sign? Intraarticular fracture
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pronation x supination
Flexion x extension
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Proximal and distal radioulnar joint
Pronation x supination
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X-ray Art. cubiti
1
3
5
43
2
6
7
1- lateral epikondyle
2-medial epikondyle
3-capitulum humeri
4-circumferentia articulares
5-tuberositas radii
6-trochlea humeri
7- olecranon
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Carying angle – physiological valgosity of
elbow joint
170 degree
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Pronatio
dolorosa
Head of the radius is pulled from anular ligament
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1
2
6
5
4
3
7
89
1-lateral epikondyle
2-medial epikondyle
3- humeroulnar joint
4- radial tuberosity
5- circumferentia articulares
6- capitulum humeri
7- olecranon
8- coronoid process
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Ossification of long bones
prenatal postnatal
Bone collar from
perichondrium
Primary enchondral
ossification center
In diaphysis
Secondary enchondral
ossification center in
epiphysis
Growth
plate
Articular
cartilage
spongy
compact
Nutritive
artery
Bone
marrow
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2 MONTHS
13 MONTHS
1
X-ray child´s elbow
Center of ossification Manifestation Fusion
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1
2
2,5 YEAR
3 YEARS
Center of ossification Manifestation Fusion
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6 YEARS
1
2
Center of ossification Manifestation Fusion
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1
2
34
56
11 years
Manifestation FusionCenter of ossification
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Capitulum humeri
25 – 45 DEGREE
α
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Anterior humeral line
- goes through the middle of the
capitulum humeri
Axis of humero radial joint
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Fr. supracondylica humeri l. sin. 2/3 dislocata
CRIF MIO OS 2xKi sec. Swenson
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Lesion of n. radialis n. ulnaris
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Broken forearmchild 7 years
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Repositon
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Art. radiocarpalis
Art. mediocarpalis
Art. carpometacarpalis
Saddle joint
disc
Hand joints
articulationes manus
art. ossis pisiformis
art. metacarpophalangeales
art. interphalangeales
Wrist joint – complex, condyloid
(elipsoidal)
Intercarpal joints – limited mobility
Carpometacarpal –limited mobility
1stCM -saddle
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Disc in radiocarpal joint
Triangular fibrocartilage disc
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Types of joints
1
21
1
0
0
trochlear joint
trochlear joint
spheroid joint
goes palmary to
cylindric joint • proximal phalanx –oval fossa on thebase for the head ofMC
• middle phalanx + distal phalanx – fossa on the base is dividedby the crest(trochlearinterphalangeal joint)Saddle joint
Interphalangeal
Metacarpophalangeal
Carpometacarpal
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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
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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
Palmar aspect
Flexor carpi ulnaris
Pisohamate lig
Pisometacarpeal lig
Deep transverse metacarpal ligament
Ventral dorsal and
interosseal metacarpeal ligg
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1,3,4 interosseal carpal ligg.
6,7-disc
2,5-collateral ligg.
Development of joints in fetus
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Lig. metacarpale interosseum
Articular disc
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Dorsal aspect
Collateral ligg
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X- ray in ductions
Radial duction Midposition Ulnar duction
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X-ray in flexion and extension
Palmar flexion Midposition Dorsal flexion
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X-ray pisiform–triquetrum intercarpal joint oblique projection
pisiform
V
IV
I
II
R
U
FCU
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Carpal tunnel
retinaculum
flexorum
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Carpal tunnel crossection
carpi radial and ulnar carpal eminence+
flexor´s retinaculum
(flexor´s tendons, median nerve)1-septum (FPL)
2-flexors
retinaculum
3-pisiforme
4-triquetrum
5-hamatum
6-lunatum
7-scaphoideum
proximally
distally
8-hamatum
9-capitatum
10- trapezoideum
11- trapezium
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Carpal tunnel crossection
CT
C
Medial carpal eminence
(H, P)
Lateral carpal eminence
(S, T)
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Sesamoid bone
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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
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8m
8r
At the birth only
cartilaginous
carpus
Ossification
Bone age
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Wrist implant
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Wrist implant
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Metacarpophalangeal implants
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Interphalangeal implants
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Range of movement
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Midposition of
hand joints
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S LTr+P
TTi
C H
hamulus
Sesamoid
bone
RadU
Ph
MC
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os scaphoideum projectionStandart projection
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growth plate
fracture
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Fractures
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• Radial deficiency (absence of thumb and entire radius).
• represents a congenitally acquired absence of the preaxial limb-bud of the upper extremity.
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CT
art.radiocarpalis
art. mediocarpalis
art.carpometacarpalis
1
2
3
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SPEC/CT22 year old male
12 weeks post scaphoid fracture, still tender
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Scaphoid fracture
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Scaphiod and lunate dislocation
Motorbike accident
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Lower limb jointsVeronika Němcová
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Pelvis
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tm
Os sacrum+coccyx
Sacroiliac joint
Os coxae
Symphysis pubica
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Os ilium
Os ischii
Os pubis
Os coxae – 3 parts
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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
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Pelvis – ligaments
lig.iliolumbale
ligg.sacroiliaca ventralia
lig.inguinale
lig.sacrospinale
lig.sacrotuberale
symphysis
pubica
FORAMEN
OBTURATUM
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Pelvis – ligaments
CANALIS OBTURATORIUS
lig.inguinale
Lacuna vasorum +
lacuna musculorum
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Pelvis – ligaments
Posterior aspect
lig.sacrospinale
lig.sacrotuberale
lig.iliolumbale
ligg.sacroiliaca dorsalia
FORAMEN
ISCHIADICUM MAJUS
(GREATER SCIATIC
FORAMEN)
FORAMEN ISCHIADICUM MINUS
(LESSER SCIATIC FORAMEN)
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SUPRAPIRIFORM FORAMEN
INFRAPIRIFORM FORAMEN LACUNA
MUSCULORUM
(MUSCULAR SPACE)
LACUNA VASORUM
(VASCULAR
SPACE)
OBTURATOR CANAL
GREATER SCIATIC FORAMEN
LESSER SCIATIC FORAMEN
Openings of the pelvis
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Uinal ligament
1- pubic symphysis
2-os coccygis
3- lig. iliolumbale
4- crista iliaca
5- spina iliaca
6- lig. sacrospinale
7- tuber ischiadicum
8- lig. sacrotuberale
FORAMEN ISCHIADICUM MAJUS
(GREATER SCIATIC FORAMEN):
m. piriformis, nerves of the sacral
plexus, vessels
FORAMEN ISCHIADICUM MINUS
(LESSER SCIATIC FORAMEN)
m. obturatorius internus, pudendal nerve, internal
pudendal vessels
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m. piriformis
m. obturatorius
internus
Superior gluteal nerve, art. + vein
Sciatic nerve
Inferior gluteal nerve, art. + vein
Posterior cutaneous femoral nervePudendal nerve,
internal pudendal
artery and vein
Sacral plexus
nerves
in greater and
lesser sciatic
foramen
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Inguinal ligament
Iliopectineal arch
SSp
ST
ObtM
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x-ray
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External pelvic diameters
Interspinous distance – 26 cm
Intercristal distance – 29 cm
Intertrochanteric distance -31cm
External conjugate - 18 cm
L5 – Pubic symphysis (superior border)
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Pelvic inclination – 60 degree – pelvic inlet to horizontal plane
External conjugate
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Pelvis minor – lesser pelvis
Anal triangleUrogenital triangle
Pelvic planes:
1) Pelvic inlet
2) Pelvic width
3) Pelvic narrow
4) Pelvic outlet
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1- transverse diameter 13cm – between terminal lines
2- straight diameter -11cm
3- diameter obliqua 12cm
1) Pelvic inlet – Aditus pelvisPromontory – linea terminalis –superior border of pubic symphysis
Pelvic planes
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2) Pelvic width - amplitudo pelvis
middle part of sacrum, symphysis and acetabulum
Oblique diameter 13,5 cm
Obturatory groove- greater sciatic notch
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3) Pelvic narrow – angustia pelvislower end of symphysis, sacrum and sciatic spines
Straight diameter 11,5 cm
lower end of symphysis and lower end of
sacrum
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4) Pelvic outlet – exitus pelvislower 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
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Pelvic planes:
1) Pelvic inlet
2) Pelvic width
3) Pelvic narrow
4) Pelvic outlet
1
2
34
External conjugate 18-20cm
Diagonal conjugate 13cm
Obstetric conjugate 10,5cm
Pelvic diameters
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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)
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X ray pelvis
1-SI joint
2- air in the
large intestine
3- acetabulum
4-caput femoris
5-greater
trochanter
6-collum
femoris
7-lesser
trochanter
8-obturatory
foramen
9-pubic
symphysis
1
2
3
5
6
4
7
8
9
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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 femalewhen compared with that of the male.
Pubic arch Pubic angle
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Pelvis
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