Anatomy Made Easy MSS

Transcription

1 Anatomy Made Easy MSS Part 4+5 هذا الملف يشمل التفريغ المحاضرة السادسة Done By :Sajeda Alazzeh Edited by: AWN Academic Team

2 The Appendicular skeletal system Pectoral Girdles (Shoulder Girdles) is made of : - clavicle anteriorly - scapula posteriorly The two bones will ligate at the level of theacromion making theacromioclavicular joint The girdle will limit the movement Super extension & the superabduction.

3 Pectoral Girdle consist of: 1-Clavical(Anteriory) which is connected directly with the Manubrium of the sternum. 2-Scapula(Posteriory) which is connected only through the muscle.

4 Clavicle (Collarbones) has two ends : - acromial flat lateral end - sternal rounded medial end sternoclavicular joint : - it's a synovial joint - has a capsule,two synovial cavities separated by an articular disk,two synovial fluids,and there is an anterior sternoclavicular ligament The acromial part is more or less a fixed joint has no disk but with a tough capsule that will hold the two ends together

5 Cont Clavicle The clavicles are slender, doublycurved long bones subcutaneous bone lying across the superior thorax across the root of the neck

6 - Subclavius muscle runs in the groove provided by the firs rib superior & the clavicle inferior,it will fix the clavicle on the first rib. - 2 thirds convex anteriorly in the medial side & 1 third concave anteriorly Note also the depression in the medial side inferior border fot attachment of costoclaciclaur ligmament

7 In the lateral side,there are the conoid tubercle & the trapezoid ridge where the Conoid & trapezoid ligaments are inserted on, a site for the Small part of the deltoid & the ligament from the humerus to be inserted there.

8 Fracture of clavicle is very common and mostly happen in the middle site, and it is dangerous because the subclavian artery and vein lie immediately inferior the clavicle. Most of the fractures of clavicle includes fragments and dislocation, which may rupture theses vessels, and lead to massive hemorrhage because these are major big vessels, also we worry about the brachial plexus, which lead to paralysis of the whole upper limb if damaged. So whenever you have a clavicular fracture, you have to immobilize the limb

9 Scapula (shoulder blade) The scapulae are triangular, flat bones lying on the dorsal surface of the rib cage, between the second and seventh ribs Has three borders and three angles and a spine Major markings include the suprascapular notch, the supraspinous and infraspinous fossae, the spine, the acromion, and the coracoid process

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11 Cont scapula The borders are the smooth lateral and medial & the rough superior (have a notch called the suprascapular notch where the suprascapular artery pass) The 2 angles are the superior & the inferior Laterally,Glenoid cavity,enlarged by the "Glenoid Rim or Labrum (prevents Dislocation) Below the glenoid cavity are the Infraglenoid tubercle which is a site for long head of the Triceps origin

12 Cont scapula posterior aspect we can notice that the surface is divided by a spine into Supraspinus fossa & Infraspinous fossa into where the Supraspinatus & Infraspinatus Between the Supraspinatus & Infraspinatus there is a tendon, between this tendon & between the capsule that is located at the head of the joint there is always a Bursa,whenever this bursa is deficit at old age limitation in the movement in that area,condition called Rotator cuff muscles movement limitation,result in : - The elevation of the shoulder will be prohibited - Flexion of the forearm is totally limited - The extension is totally limited The abduction & adduction at that level will be permeated Fracture of scaplula cannot be repaired and displacement will not occur. The bursa is located between the capsule and the tendon of the infraspinatus muscle

13 The upper limb Humerus : - Long bone with 2 extremities : proximal one which is closer to the midpoint of the human being has 2 tubercles ;the Lesser tubercle is more oriented anterior <you can feel it> whereas the Greater tubercle is oriented laterally. Triangular shape bone,has 3 surfaces : Anterior,Lateral & Medial they will meet in 3 borders

14 Humerus Proximal humerus includes the head, anatomical and surgical necks, greater and lesser tubercles, and the intertubercular groove Distal humerus includes the capitulum, trochlea, medial and lateral epicondyles, and the coronoid and olecranon fossae Medial portion includes the radial groove and the deltoid process

15 - Medial : Trochlea - Lateral :Capitulum -lateral & medial Epicondyles :sites O f muscle origin for the forearm Anterior View - Superior to the capitulum(rounded structure) are the Radial fossa which receives the Radial head - Superior to the trochlea are the Coronoid fossa which receives the cronoid process. Surgical neck so named because it is more prone to fracture

16 Posterior View -O lecranon fossa receives theolecranon process of the ulna -medial & lateral Epicondyles will appear more clearly, Above them we have supraepiconyler ridge;lateral and medial - Radial groovefor raidal artery -head as well the anatomical & the surgical neck -only the Greater tubercle could be seen,we Can Not see the lesser tubercle,and the capitulum

17 Surgical neck is the most common fracture of humerus, then the head. How to repair? repair it from the lateral aspect because medial aspect you will hit award the anterior aspect, if you approach it from posterior and anterior aspect (axilla) you will hit mainly the nerve which are belong to brachial plexues and artery so that the safest to go from lateral, cutting the deltoid and bone and repair the head of humerus

18 The parts of the radius : Head Neck Radial tuberosity Shaft 1

19 Radius : The lateral bone of the fore arm. thin at its proximal end Oriented to the lateral side of the hand W idened distally

20 Its connected to the ulna by the Interosseous membrane { which has a superior deficit called Interosseous gap,below the proximal part of both bones this gap fot radial nerve and artery. This membrane is a connection formed by the medial border of the radius and the lateral one of the ulna. 20

21 Rounded elevation, participate in forming the Elbow joint. Covered by hyaline cartilage Head superior surface of the head articulates with : ** the capitulum of the humerus. ** Medially,articulates with the radial notch of the ulna 21

22 Neck : Small restriction of the bone below the head. Neck 22

23 RadialTuberosity : Beneath the neck of the radius,on the medial side,is an eminence called the radial tuberosity;its surface is divided into: a posterior,rough portion, for the insertion of the tendon of the biceps brachii. an anterior,smooth portion. 23

24 Shaft : Anterior surface of the distal extremity is covered by hyaline cartilage,and it will articulate with the carpal bones. Laterally, there is Styloid Process which is an inferior protrusion. 24

25 The parts of the Ulna : Upper Extremity : { Cornoid process, Olecranon process,trochlear notch,radial notch }. Lower Extremity : { Head,neck,Styloid process }. 25

26 Ulna : lies medially in the forearm. 26

27 Its upper extremity is bigger and higher than radius upper one,also its longer than the radius, and does not move in supination and pronation, because of the presence of olecranon and coronoid process. 27

28 Upper Extremity : Anterior elevation :. Called Coronoid process 28

29 enter into the Coronoid Fossa of the humerus in case of total Flexion. 29

30 Posterior elevation : called the Olecranon process. 30

31 enter the Olecranon. fossa of the humerus Forms the major portion of the elbow joint with the humerus Preventing the hyperextension of the forearm on the arm. 31

32 Trochlear Notch : The whole gab that is extend from the coronoid process anteriorly to the olecranon process posteriorly celled the Trochlear notch covered usually by a hyaline cartilage and articulate with the Trochlea of the humerous. 32

33 Trochlear Notch 33

34 No Neck at the proximal end! Below that notch u are able to see the UlnarTubersity. Lateral and inferior to the trochlear notch,u will fine the Radial Notch which is articulate with the head of the radius Radial notch: Superior, deeper, lateral aspect. Ulnar notch: Inferior, less deeper, medial aspect.. 34

35 Shaft is the long compartment of the ulna,btw the two extremities Shaft of ulna longer and sharper than the radius Shaft 35

36 Lower Extremity : Head : located distally at the end of the shaft, styloid process : at the posterior side of the ulna Two comparison between the styloid processes Radius: Bigger Ulna: Sharp, smaller 36

37 The styloid process of both bones are very fragile,they may be broken upon { falling down or hyperextension } ;so to prevent it from broken down its protected by very thick capsule which is formed btw the carpal bone and the lower extremities of the forearm There are two separate joints here,one has a disc and the other doesn't! also,lots of ligaments where the retinaculum cover the { ant and post } aspect expand to cover these styloid processes. 37

38 Supination vs Pronation : Prone: body lying face down {overlapping btw the 2 bones of the forearm }.. Supine: body lying face up { as in the anatomical position }.. 38

39 These movements are done by the help of these muscles : Pronator Teres and the Supinator muscle { at the posterior aspect of the forearm } together with the Pronator Quadratus muscle { at the lower aspect of the forearm } 39

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41 Lateral view /Landmarks : Usually the Trochlea is in a 70 degree angle in a semi flect position { this is the normal angle of the elbow joint }! Look at the lines in the image :one pass through capitulum and the head of the radius and the other pass the shaft of the humerus! the image on the next slide Doesn't go through the Ulna!! 41

42 70 degree angle usually 42

43 The parts of the Hand : Carpal Metacarpal Phalanges 43

44 The Hand Consist of the 3 groups: Carpal " 8 bones " Metacarpal " 5 bones Phalanges " 3 for each finger except for the thumb just 2 bones "}. 44

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46 The Carpals : Irregular bones,eight bones arranged in two rows. Mnemonic for memorization : from lateral to medial Stop Letting Those People Touch The C adaver's H and Scaphoid, lunate triquetrum pisiform/ Trapezium,trapezoid,capitie,hamate And this line is bigger more linear 46

47 Scaphoid bone : Laterally,below the distal part of the Radius. The bone is shaped like a cashew nut. 47

48 About 60% of all wrist fractures involve the scaphoid bone Very easy to be fractured and very difficult to be corrected,if u fall down into ur open palm you will fracture it! Difficult to be diagnosed but the pain and the difficulty in moving the thumb,with no or very minimal swallowing. Sometimes the radial nerve is injured,leading to thumb and index paralysis! Untreated scaphoid fractures often do not heal,which can eventually lead to wrist arthritis On the other hand if it is treated by fixing it, it will be repaired by itselt. 48

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50 Trapezium : Located more distal and anterior anterior to scaphoid. together withtrapezoid " 50

51 Capitate : At the midline Pisiform : The small bone that located on medial aspect on top of thetriquetrum.{ sometimes they said that is a sesamoid bone }. 51

52 52

53 Carpal Tunnel : Carpal bones are not straight they are convex if u push here ( on ur carpal bones ) u will have a room which is called CarpalTunnel. This tunnel is covered by a retinaculum which is anterior flexor retinaculum very tough connective tissue that runs from medial to lateral and goes more anterior to be inserted to the Scaphoid bone,triqueturum and Pisiform 53

54 Articulation: Scaphoid and lunate articulate radius at wrist joint. Carpals articulate carpals at intercarpals joint. Carpal articulate metacarpal at metacarpalcarpal joint. Metacarpal acticulate with proximal phalange by metacarpalphalngus joint Phalanges articuklate with each other at interphalages joint Hamate articulate with the 5 th and 4 th metacarpals

55 Tunnel allow all flexor muscle to go underneath for Protection. This tunnel could be comprised leading to : CarbalTunnel Syndrome. 55

56 Metacarpals : Anterior to the carpal you will find them with the palm more toward the base of the digits. They are five in number numbered from 1-5 starting from the lateral to the medial { 1- thumb /2-index /3- middle finger /4-ring /5-little finger }!! 56

57 They are long bones,each one is consist of a proximal Base,intermediate shaft { Body } and distal head 57

58 Phalanges :the bone of digits They are long bones,each digit consists of 3 phalanges proximal phalanx, intermediate phalanx,distal phalanx, except the thumb just has 2 phalanges. They are 14 in number,numbered like the metacarpal from the lateral to the medial aspect! Each phalanx consists of :proximal base, intermediate shaft and distal head 58

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60 There are muscles that ligate them together like Interossi,Lumbrical,with two groups locate at the lateral (Thenar, bigger ) and the other at the medial ( Hypothenar ). 60

61 Types of Fracture and their x-rays : Simple ( closed ) fracture : Linear fracture,with no dislocation. Heals fast and it only needs a cast. 61

62 Compound ( open ) fracture : Here the broken bones are shattered laterally cutting the soft tissues around them where nerves can be injuand sensation may be lost. Surgery is always needed in this type,and the surgeon may pay a good attention to the overlap that happens btw the two parts of the broken bone may lead to shortening of the hand 62

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64 Greenstick : A fracture in a young soft bone,in which the bone is bended and partially break " wiki ". It happens when the young play a football,and fall on his hand :he will feel a pain with swallowing after two hours! compress it and take him to the Dr for a cast! Difficult to be recognized.. *** I think the doc meant Colles fracture NOT Greenstick, since the Greenstick occurs when a bone bends and cracks, instead of breaking completely into separate pieces! 64

65 Greenstick Fracture 65

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67 Supra condylar fracture : Fracture of the lower extremity of the humerus. Usually when they are pinning of the lower extremity of the humerus they calculate the angle 67

68 This is the radius head and neck,and the angle here has changed to be less than 70degree { almost 60 or 55 }. Supracondylar fracture Less than 70degree angle 68

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71 Shoulder-lateral rotation

72 humerus

73 Forearm

74 Elbow joint-lateral Note that this image in pronation

75 Elbow,posterior

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