CLINICAL ANATOMY OF THE BONES & JOINTS OF THE UPPER LIMB

1. CLINICAL ANATOMY OF THE BONES & JOINTS OF THE UPPER LIMB • 08.January.2014 Wednesday Kaan Yücel M.D., Ph.D.

2. Fractures Of The Clavicle • one of the most frequently fractured bones • common in children • often caused by an indirect force transmitted from an outstretched hand through the bones of the forearm/ arm to shoulder during a fall • or • a fall directly on the shoulder • The weakest part of the clavicle • junction of its middle and lateral thirds

3. Fractures of the Scapula • usually the result of severe trauma • as occurs in pedestrian-vehicle accidents • usually also fractured ribs • mostfractures require little treatment scapula is covered on both sides by muscles.

4. Fractures of the humerus • mostinjuries of the proximal end fractures of the surgical neck • especially common in elderly people with osteoporosis • usually result from a minor fall on the hand, with the force being transmitted up the forearm bones of the extended limb

5. Fractures of the Radius and Ulna • usually the result of severe injury • direct injury usually produces transverse fractures at the same levelusually in the middle third of the bones • becauseof interosseous membrane, a fracture of one bone associated with dislocation of the nearest joint.

6. Fractures of the distalend of radius • Common in adults > 50 • more frequently in women osteoporosis • Colles’fracture • complete transverse fracture of the distal 2 cm of the radius • most common fracture of the forearm • distal fragment displaced dorsally • often comminuted (broken into pieces)

7. usually result of trying to ease a fall by outstretching the upper limb • theforce drives the distal fragment posteriorly and superiorly • distal articular surface inclined posteriorly. • this posterior displacement produces a posterior bump • “dinner-fork deformity” forearm & wrist resemble the shape of a fork. Fractures of the distalend of radius

8. OlceranonBursitis

9. Injuries to the Bones of the Hand • Mostcommonlyfracturedcarpal bone Scaphoid bone • often results from a fall on the palm when the hand is abducted • Dislocation of the lunate bone • occasionally occurs in young adults on the outstretched hand • in a way that causes hyperextension of the wrist joint.

10. Fractures Of theMetacarpalBones • occur as a result of direct violence • such as the clenched fist striking a hard object. • always angulates dorsally. • Boxer’s fracture commonly produces an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones.

11. Sternoclavicular Joint Injuries • strongcostoclavicular ligament firmly holds medial end of the clavicle to • first costal cartilage. • violentforces directed along the long axis usually result in fracture • dislocation occasionally. • If the costoclavicular ligament ruptures completely, • difficult to maintain the normal position of the clavicle once reduction has been accomplished.

12. Acromioclavicular Joint Dislocation • A severe blow on the point of the shoulder • during blocking or tackling in football or any severe fall • can result in the acromion being thrust beneath the lateral end of clavicle • tearing the coracoclavicularligament • this condition shoulder separation • displaced outer end of the clavicle easily palpable .

13. Dislocations of the Shoulder Joint .

14. Dislocations of the Shoulder Joint Anterior–Inferior Dislocations Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto the inferior weak part of the capsule, which tears, and the humeral head comes to lie inferior to the glenoid fossa. .

15. Dislocations of the Shoulder Joint Anterior–Inferior Dislocations .

16. Dislocations of the Shoulder Joint . Posterior Dislocations rare usually caused by direct violence to the front of the joint. rounded appearance of the shoulder is seen to belost greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle.

17. Dislocations of the Shoulder Joint . Posterior Dislocations

18. Stability of the Elbow Joint Elbowjoint is stable because of the wrench-shaped articular surface of the olecranon pulley-shaped trochlea of the humerus strong medial and lateral ligaments

19. Stability of the Elbow Joint • When examining the elbow joint, • the physician must remember the normal relations of the bony points. • medial & lateral epicondyles & top of the olecranonin a straight line Extension Flexion bony points form the boundaries of an equilateral triangle.

20. Dislocations of the Elbow Joint • common & most posterior • posteriordislocation follows falling on the outstretched hand • posterior dislocationcommon in children • parts of the bones that stabilize the joint are incompletely developed • avulsionof the epiphysis of medialepicondyle common in childhood • thenmedial ligament stronger than bond of union between epiphysis & diaphysis

21. Radioulnar Joint Disease • proximalradioulnar joint communicates w/ elbow joint • distal radioulnar joint does not communicate w/ wrist joint • elbow jointinfectioninvolves proximal radioulnarjoint

22. Radioulnar Joint Disease Strengthof proximal radioulnar joint depends on integrity of the strong anularligament Rupturein cases of anterior dislocation of head of radius on capitulumof humerus In young children head of the radius still small & undeveloped sudden jerk on the arm – radialheadpulleddownthroughtheanularligament

23. Wrist Joint Injuries • A fall on the outstretched hand strain @ anterior ligament of wrist joint • synovial effusion • joint pain • limitation of movement • Differentialdiagnosisfractured scaphoid /dislocation of lunate bone

24. Falls on the Outstretched Hand FORCE TRANSMITTED Scaphoid bone Distalend of radius acrosstheinterosseusmembrane Ulna Humerus throughtheglenoid fossa Scapula tothecoracoclavicularligament Clavicle Sternum

25. Falls on the Outstretched Hand If forces excessive, different parts of the upper limb understrain. The area affected related to age Young child posterior displacement of distal radial epiphysis Teenage Claviclefracture Youngadult Scaphoidfracture Elderly Colles’ fracture