Upper Limb Skeleton

Irwan

Content:

Vignette What is a limb? Upper Limb Skeleton Clavicle Scapula Humerus Radius Ulna Hand (Manus) Joint of Upper Extremity

Vignette
The hands of an 80-year-old woman with a several-year history of numbness and weakness are shown in this photo. Note severe thenar muscle (abductor pollicis brevis, opponens pollicis) wasting of the right hand, with preservation of hypothenar eminence. What is the diagnosis and pathophysiology?

Pathophysiology
the median nerve is damaged within the rigid confines of the carpal tunnel, initially undergoing demyelination followed by axonal degeneration. Sensory fibers often are affected first, followed by motor fibers. Autonomic nerve fibers carried in the median nerve also may be affected. The cause of the damage is subject to some debate; however, it seems likely that abnormally high carpal tunnel pressures exist in patients with CTS. This pressure causes obstruction to venous outflow, back pressure, edema formation, and ultimately, ischemia in the nerve. The risk of development of CTS appears to be associated, at least in part, with a number of different epidemiologic factors, including genetic, medical, social, vocational, avocational, and demographic.[1] A complex interaction probably exists between some or all these factors, eventually leading to the development of CTS. Definite causative factors, however, are far from clear.

Carpal Tunnel

Nerve Innervation (dorsal)

Nerve Innervation (palmar)

What is a limb?
Ventral somatic outgrowth of outer tube
Bones (with bone, cartilage, marrow, NAV, etc.) Joints Muscle Nerves Vascular supply

No viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)

Upper Limb Skeleton (old hat?)

Appendicular Skeleton Pectoral Girdle = scapula,clavicle Upperlimb
Arm: humerus Forearm: radius, ulna
Interosseus membrane

Hand: carpals, metacarpals, phalanges

Review Bones + Landmarks studied in Lab!!

Clavicle

also known as the collar bone has a subtle S-like double curvature has a more robust and squarish medial end that articulates with the manubrium of the sternum has a flatter lateral end for articulation with the acromion of the scapula the superior surface of the clavicle is much smoother than the rougher inferior surface which is studded with the conoid process, subclavius muscle groove and costoclavicular groove

Landmarks

sternal (medial) end acromial (lateral) end deltoid tubercle conoid tubercle trapezoid line groove for the subclavius muscle tuberosity/groove for the costoclavicular ligament

A - sternal (medial) end B - deltoid tuberosity C - acromial (lateral) end D - conoid tubercle

A - tuberosity/groove for costoclavicular ligament B - conoid tubercle C - groove for subclavius muscle D - trapezoid line E - lateral (acromial) end F - medial (sternal) end

SCAPULA is part of the shoulder girdle is found on the upper back where the concave anterior surface rests against the posterior chest wall has a roughly triangular body with an overall irregular appearance has a smooth lateral cuplike surface that articulates with the head of the humerus at the shoulder (glenohumeral) joint has a large, flat, medially arching process (the acromion) which articulates with the lateral end of the clavicle at the acromioclavicular joint

A - superior angle B - supraspinous fossa C - suprascapular notch D - conoid tubercle E - coracoid process F - acromion G - glenoid fossa H - infraglenoid tubercle I - infraspinous fossa J - lateral scapular border K - inferior angle

 A - superior angle B - articular facet for clavicle on acromion C - acromion D - conoid tubercle E - coracoid process F - neck of scapula G - subscapular fossa H - medial border of scapula

Humerus
has a bulbous proximal end that articulates with the scapula at the shoulder (glenohumeral) joint has an irregular distal end that articulates with the radius and ulna (of the forearm) the round head is medial and somewhat posteriorly directed the intertubercular groove can be seen to progress distally through much of the superior half of this bone

Image 5.27
A - greater tuberosity B - lesser tuberosity C - head D - anatomical neck (indicated by dashed line) E - intertubercular groove F - surgical neck (indicated by dashed line) G - medial lip of intertubercular groove H - lateral lip of intertubercular groove I - deltoid tuberosity

Image 5.28
A - shaft B - lateral supracondylar ridge C - medial supracondylar ridge D - radial fossa E - coronoid fossa F - medial epicondyle G - lateral epicondyle H - capitulum I - trochlea

Radius
forms the lateral aspect of the forearm is a long bone with two articulating ends and an intervening shaft the proximal end articulates with the capitulum of the humerus the distal end articulates with the scaphoid and lunate bones of the wrist medially, the radius articulates with the ulna at both the proximal and distal radio-ulnar joints the head of this bone is disc-like and has a concave articular facet the radial head corresponds with the radial fossa of the humerus the shaft is relatively round and smooth except for a sharp, thin medial border anterior surface of the distal radius is smooth and somewhat concave the posterior surface of the distal radius is more rough, and bears the prominent dorsal (Listers) tubercle

Image 5.39
A - articular circumference of radial head B - neck C - radial tuberosity

Image 5.40
A - interosseous border B - pronator ridge C - styloid process

Ulna
forms

the medial aspect of the forearm is a long bone with two articular ends and an intervening shaft the proximal end is very irregular and robust in appearance
- it articulates with the trochlea of the humerus at the elbow joint as well as laterally at the proximal and distal radioulnar joint - the olecranon process fits into the olecranon fossa of humerus, the trochlear notch articulates with the trochlea of the humerus, and the coronoid process corresponds with the coronoid fossa of the humerus

the shaft has a slight sigmoid curvature

- the interosseous border is on the lateral side of the shaft - the shaft itself is more irregular than other long bones (except the fibula)

the expanded proximal shaft becomes progressively smaller distally, but it bulges out at the ulnar head
- the head/radial articulation has a small styloid process - when viewed head on, the styloid process is on the medial aspect of the ulnar head

Image 5.49
A - olecranon process B - trochlear notch C - coronoid process D - radial notch E - supinator crest F - interosseous border

Image 5.50
A - interosseous border B - head (radial articulation) C - groove for extensor carpi ulnaris tendon D - styloid process

Hand (Manus)
the general arrangement of the hand is similar to that of the foot there are twenty-seven bones in each hand (one more than in each foot) is composed of eight carpal bones (four per row in two rows), five metacarpal bones, and fourteen phalanges (three per finger except for the thumb, which only has two) sesamoid bones (bones which form within tendons) may also be present

Image 5.61
A - phalanges B - metacarpals C - carpals C1 - scaphoid C2 - lunate C3 - triquetral C4 - pisiform (not pictured) C5 - trapezium C6 - trapezoid C7 - capitate C8 - hamate

Image 5.62
A - phalanges B - metacarpals C - carpals C1 - scaphoid C2 - lunate C3 - triquetral (not pictured) C4 - pisiform C5 - trapezium C6 - trapezoid C7 - capitate C8 - hamate

Joints of Upper Extremity

Sternoclavicular
Synovial-saddle Diarthrosis

 Acromioclavicular
Synovial-plane Diarthrosis

 Glenohumeral joint
Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility

 Elbow Joint
Synovial hinge Diarthrosis

Articulations
Humerus & Ulna Humerus & Radius

Many Ligaments

 Radiocarpal joint
Synovial-condyloid Distal radius with proximal row of carpals

Intercarpal joints
Synovial-plane

Carpal-metacarpal (2-5)
Synovial-plane

Trapezium-metacarpal 1
Synovial-saddle

Metacarpal-phalangeal
Synovial-condyloid

Interphalangeal
Synovial-hinge

ALL DIARTHROSES

Created by: dr. Irwan Bagian Anatomi FK Unsri Palembang

Fig. 407A

Fig. 409A

Fig. 422A

Fig. 423C

Fig. 423A

Fig. 423B