2-Upper Limb Overview

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What part of the skeleton contains the skull, vertebrates, ribs, and sternum?: axial
What part of the skeleton contains the upper and lower limbs?: appendicular
What connects the bones of the upper limbs with the axial skeleton?: clavicle
What is the name of the joint that is present where the upper limbs are connected with the axial skeleton? What are the benefits/drawbacks of the joint?: sternoclavicular joint
allows for flexibility w/ reduced stability
Name the four segments of the upper extremity. What does each contain?: PECTORAL GIRDLE-clavicle, scapula, anterior and posterior thoracoappendicular muscles, axilla(artery, vein, and brachial plexus)
ARM (brachium)-humerus, muscles of arm and blood vessels
FOREARM (antebrachium)-radius, ulna, muscles & blood vessels
HAND-bones of the wrist-8 carpals, bones of the palm-5 metacarpals, bones of the fingers-14 Phalanx
Describe the sternal end of the clavicle bone and what it articulates with. What joint does it help form?: enlarged and triangular in shape, articulates w/ maubrium of the sternum, forms the sternoclavicular joint
Describe the acromial end. What does it articulate w/? What joint is formed?: flat
acromion of the scapula
acromioclavicular joint
Name the structures on the superior surface of the clavicle from medial to lateral.: shaft of clavicle, deltoid tubercle
Name the structures on the inferior surface of the clavicle from medial to lateral.: impression for the costoclavicular ligament, subclavian groove, conoid tubercle, trapezoid line
What does the ligament that forms the impression for the costoclavicular ligament connect?: clavicle to the 1st rib
Name 4 functions of the clavicle.: only rigid bone support for the upper limb to the body trunk
upper arm flexiblity
protects neurovascular passage in the region
transmits shock
The clavicle contains no bone marrow. What is present in its place?: spongy (cancellous) bone with a shell of compact bone
Name 3 variations of the clavicle.: pierced by a branch of the supraclavicular nerve
thicker and more curved in labor workers
right one may be stronger and shorter
Where are fractures of the clavicle likely to occur?: junction of its middle and lateral thirds
middle 1/3=80%
distal 1/3=15%
proximal 1/3=5%
What is the result of a fractured clavicle?: medial fragment elevates due to the sternocleidomastoid muscle
lateral depresses and shoulder drops
clavicle may be shortened due to pulling from adductor muscles and pec major pulls arm inward
What is the name of an incomplete claviclular fracture in children?: greenstick fracture
When does ossification of the clavicle begin. How many primary ossification centers are there?: 5th & 6th week of embryonic development
2-medial and lateral, will fuse
When do secondary ossification centers of the clavicle appear? When do they complete ossification?: 18-25 years
25-31 years
What must be taken into account when looking at the clavicle for fractures? 2 things: the two cartilaginous regions (ossification centers)
the primary ossification centers may fail to fuse-defect between lateral and medial 2/3 of clavicle
The scapula covers which ribs?: 2-7
What is the name of the costal surface of the scapula? Is it convex of concave?: subscapular fossa
concave
What is portion of the posterior surface of the scapula that divides the superior and inferior parts?: spine of the scapula
The spine of the scapula ends laterally as what?: acromion
What is located above the spine of the scapula?: supraspinous fossa, coracoid process, suprascapular notch
What is located below the spine of the scapula?: infraspinous fossa
What is located on the lateral (axillary border) of the scapula?: acromion, coracoid process, glenoid cavity, head and neck of the scapula
What does the glenoid cavity articulate with? Which way does the glenoid cavity face?: humerus
anterior and superior
What are the functions of the scapula? (3): forms shoulder joint
allows attachment of muscles from axial skeleton and upper limb
enables free movement of arm
Although fractures of the scapula are rare what is the most likely area to be fractured?: acromion
What separates the greater and lesser tubercles of the humerus?: intertubercular groove (bicipital groove)
Is the greater tubercle medial or lateral? lesser tubercle?: lateral
medial to greater tubercle
Which way does the lesser tubercle project?: anteriorly
What separates the tubercles from the head of the humerus?: anatomical neck
What is the most common site of fractures of the humerus?: surgical neck of the humerus
Where is the surgical neck of the humerus located?: distal to the tubercles and the crests descend from them, flanks the intertubercular groove
What two things are located on the body of the humerus? Describe where each is located.: deltoid tuberosity-lateral side, attachment site for deltoid (abducts)
radial groove-posterior, radial nerve and deep artery run in it diagnolly
What is the site of muscle attachment for forearm flexors?: medial supracondylar ridge and medial epicondyle
What is the site of muscle attachment for forearm extensors?: lateral supracondylar ridge and lateral epicondyle
What structures are present at the condyle of the humerus?: medial and lateral epicondyles, capitulum, trochlea, coronoid fossa, olecrons fossa, radial fossa
What part of the humerus articulates with the head of the radius?: capitulum
What does the trochlea of the humerus articulate with?: trochlea notch of ulna
Which fossa(s) of the humerus are located anteriorly? posteriorly?: coronoid and radial

olecranon
When does the coronoid fossa receive the coronoid process of the ulna?: during flexion of elbow
When does the olecranon fossa receive the olecranon of the ulna?: extension of elbow
When does the radial fossa receive the head of the radium?: forearm fully flexed
What humerus type of fracture is common in middle aged and elderly people? Describe what happens to the distal and proximal ends and which muscles cause their movement.: Avulsion fracture-caused by fall on shoulder or hand, proximal end is pulled superior-posterior-laterally by supraspinatus and infraspinatus muscles, distal end is pulled and rotated medially by subscapularis muscle
Which type of fracture is tpically a result from a direct blow to the arm. What happens to the proximal and distal end?: transverse fracture of the body of the humerus
proximal end is pulled laterally by deltoid, distal end is pulled upward by biceps, arm is shortened and fracture ends override
What can be fractured if a person falls on their elbow?: condyles of the humerus
Which nerve injury is related to a surgical neck fracture of the humerus?: axillary
What can be injuried if their is a medial epicondyle fracture?: ulnar nerve
If the distal end of the humerus is fractured what else can be injured?: median nerve
Which of the forearm bones is medial and longer?: ulna
Which part of the ulna articulates with the humerus? (anteriorly): trochlear notch
What is the name of the prominent posterior projection of the ulna?: olecranon
What is the anterior projection of the ulna called?: coronoid process
What is the rounded cavity on the lateral side of the coronoid process called? What does it articulate with?: radial notch
head of the radius
What is located inferior to the coronoid process and attaches to the brachialis muscle tendon?: tuberosity of the ulna
What is the prominent ridge inferior to the radial notch on the lateral surface? What attaches to it?: supinator crest
deep supinator muscle
What is located medial to the supinator crest and lateral to the coronoid process?: supinator fossa
Which end of the ulna is thicker?: proximal
What does the head of the ulna articulate with?: hand bones
What is the small conical process on the distal end of the ulna called? Is it on the pinkie (medial) or thumb (lateral) side?: ulnar styloid process
pinkie side
Which of the forearm bones is lateral?: radius
What does the head of the radius articulate with? (2 things): capitulum of the humerus
notch of the ulna
What is located above and below the neck of the radius?: above-head
below-radial tuberosity
Which styloid process, ulnar or radial, is larger? Which extends more distally?: radial
radial
Discuss the articulations at the elbow. What does each mediate?: trochlea of humerus and trochlear notch of ulna on medial side-flexion&extension
capitulum of humerus and head of radius on lateral side-flexion&extension
radial notch of ulna and head of radius-rotation between radius and ulna
A fracture of the radial or ulnar bone is likely to be associated w/ dislocation of the nearest joint b/c of what?: interosseous membrane binding the two
What is the most common fracture in the forearm and who is particularly susecptible to it?: Colles' fx
50+yr b/c of osteoporosis
What is a cause of Colles' fx? What is the characteristic deformity?: forced dorsiflexion of the hand by outstretching of the upper limb when trying to ease fall, hand pronated
dinner fork appearance, distal fragment displaced dorsally and proximally
Describe what happens to the styloid processes of the ulnar and radius in Colles' fx?: radial styloid is moved proximally, they appear to be at same level
What can be a result of Colles' fx in children?: fx line may extend through distal epiphyseal plate and affect radial growth
Name the proximal carpal bones from laterally to medially.: Scaphoid, Lunate, Triquetrum, Pisiform
Which 2 proximal bones articulate w/ the radius?: scaphoid & lunate
What does the triquetrum articulate with?: articular disc of the distal radioulnar joint
Which carpal bone does the pisiform lie of?: Triquetrum (lies on its palmar surface)
Name the distal carpal bones from laterally to medially.: Trapezium, Trapezoid, Capitate, Hamate
What attaches the carpals to each other?: interosseous ligaments
Which carpal bones participate in forming the radiocarpal joint?: three proximal bones-scaphoid, lunate and triquetrum
What do the metacarpal bones articulate with?: carpals proximally and phalanges distally
Which metacarpal is the thickest and shortest?: first metacarpal (of the thumb)
Which metacarpal has a styloid process? Which side is it located?: third metacarpal
on lateral side of its base
How many phalanges are there?: 14
Which carpal bone is the most frequently fractured?: scaphoid (this is the most common injury of the wrist)
Discuss the location of pain and the fracture line of a fractured scaphoid.: pain is on the lateral side of the wrist and worsens w/ dorsiflexion of the abducted hand, pressing on the anatomical snuff box makes it worse
fx line is hard to see at beginning and shows later in 2-3 weeks after bone reabsorption
Poor blood supply to the proximal part of the scaphoid can result in what?: slow bone union and even avascular necrosis of the proximal fragment, can lead to degenerative joint disease of the wrist, may require surgery
Which nerve may be injured w/ a fractured hamate?: ulnar
Discuss fractures of the metacarpals. What is fracture at the neck region of the 5th metacarpal called?: usually stable b/c all metacarpals are bound together, heal fast b/c of good blood supply
"boxer's fx"-caused by striking a blow w/ clenched fist
Which phalanges are likely to be fractured? What is the most common cause?: distal ones, through crushing forces ie door jam
Name and describe the two layers of fascia of the upper limbs.: superficial-subcutaneous, composed of fat and loose CT, blood vessels and nerves travel in it
deep-dense CT such as collagen fibers, surrounds muscles and bones, divides muscles into compartments
What are the two large veins of the upper limb? Which side does each run on?: cephalic-lateral
basilica-medial
Where do the two veins communicate? Which vein is this done through? What is the clinical significance of this area?: anterior elbow
median cubital vein
venipuncture

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