Identify key bone landmarks of the clavicle (shoulder girdle)
- long bone
- provides only upper limb articulation (saddle synovial sternoclavicular joint) between the appendicular and axial skeleton. strong capsule and costoclavicular ligament.
- sternal (round) and acromial (flattened) ends
- distinct ‘S’ curvature
- roughened inferior surface and smooth superior surface.
Identify key bone landmarks of the scapula (shoulder girdle).
- flat bone
- significant muscle attachment
- spine of the scapula.
- acromion: bony projection. joint to clavicle via acromioclavicular ligament.
- coracoid: bony projection. joint to clavicle via coracoclavicular ligament (trapezoid and conoid).
- fossae: broad flat surface
- glenoid fossa
Identify key bone landmarks of the Humerus (arm).
- long bone
- head
- neck (anatomical and surgical)
- tubercles (greater and lesser)
- bicipital/intertubecular groove
- epicondyles (lateral and medial)
- condyles (capitulum and trochlea)
What is the glenohumeral joint (shoulder) and what supportive features make the joint more stable?
- ball and socket synovial joint
- large humeral head and shallow glenoid fossa (relatively incongruent)
- loose/unstable joint capsule
- specialised fibrocartilage called glenoid labrum which surrounds the glenoid fossa.
- rotator cuff muscles
- glenohumeral & coracohumeral ligaments.
Identify key bone landmarks of the ulna.
- olecranon process
- trochlear notch
- ulna tuberosity
- radial notch
- ulna collateral ligament (humerus)
- humeroulna hinge joint
- styloid process (sharp head)
Identify key bone landmarks of the radius.
- radial tuberosity
- ulna notch
- radial collateral ligament (humerus)
- humeroradial hinge joint.
- proximal radioulnar pivot joint and anular ligament of radius (allows for pronation and supination).
Identify the kew bone landmarks of the Radiocarpal Joint (wrist).
- condyloid/Ellipsoid (synovial) joint.
- Articular disc (triangular fibrocartilage) between ulna and carpals
- ligamentous support is very complex.
Identify the landmarks of the joints of the hand
- 8 carpal bones and 5 metacarpal bones
- intercarpal joints
- carpometacarpal joints
1st CMC joint - saddle joint (synovial) (thumb, most degenerative joint in the body)
2nd-5th CMC joints - Plane joints (synovial). - Opponens Pollicis muscle enables opposition in the thumb.
Identify the landmarks of the Joints of the fingers
- 14 phalanges
- metacarpophalangeal joints
- (condyloid joints (synovial))
- interphalangeal joint (thumb)
- hinge joints (synovial)
- commonly subluxated or dislocated
identify the major compartments and regions of the upper limb and deep fascia
- muscles are separated into compartments largely by intermuscular septa.
- Deep fascia surrounds all muscles.
- interosseous membrane: between ulna and radius to seperate muscles.
- bicepts brachii (long and short head - attaches to radial and ulna tuberosity - produces supination)
- coracobrachialis
- brachialis
- triceps brachii (long head, medial head, lateral head).
- all aspects of the triceps brachii cross over the posterior aspect of the elbow joint to attach onto the olecranon process and produce extension.
identify and name the major anterior and posterior axio-appendicular muscles
- trapezius
- latissimus dorsi
- rhomboid minor/major
- levator scapulae
- serratus anterior
- pectoralis minor/major
identify, name and describe the basic functions of the scapulohumeral muscles and muscles of the arm.
- ‘rotator cuff’ muscles (supraspinatus (abduction), infraspinatus and teres minor (external rotation), subscapularis (internal rotation).
- blend with the joint capsule, compress humeral head into glenoid fossa.
- deltoid (broad fan from humerus to the scapula and clavicle, produces shoulder flexion, abduction and extension).
- teres major (attaches more anteriorly to humerus, produces internal rotation at the shoulder).
identify the basic muscle groups of the hand.
- thenar
- hypothenar
- interosseous
- opponens ollicis
deduce the basic actions of muscles in the forearm and hand given their anatomical relationship to joints.
- muscle attaches to carpals/metacarpals = wrist flexor/extensor
- muscle attaches to digits = finger flexor/extensor
- muscles distal attachement into radius = pronator
identify and name the major arteries and veins in the upper limb.
Arteries:
- transverse over the flexor side of joints
- anastomoses at joints
- subclavian artery, auxillary artery, brachial artery, ulnar and radial artery.
- brachial artery is occluded during blood pressure readings
- ulnar artery is the larger branch and principal supply for the forearm and hand.
- radial artery anastomoses (join) with ulnar artery via palmer arches and is easily palpable at the wrist.
Veins:
- superficial veins are highly variable, commonly visible, begin on posterior hand as ‘dorsal venous arch’, easily accessible (intravenous injections, blood samples).
- deep veins accompany major arteries (vena comitans), commonly two present either side of the respective artery.
- cephalic vein
- basilic vein
- median cubital vein
Lymphatic vessels:
- follow superficial veins
flow into axillary lymph nodes
describe the basic organisation of the brachial (arm) plexus (network).
- complex intertwining and mixing of axons for motor and sensory supply to distinct regions of the upper limb.
- five distinct sections (roots, trunks, divisions, cords and terminal branches.
- cords named in reference to their anatomical relationship with axillary artery
identify and describe the features of the five terminal branches of the brachial plexus.
- musculocutaneous nerve
- continuation of the lateral cord.
- pierces coracobrachialis to enter the anterior compartment of the arm.
- supplies he anterior compartment of the arm. - median nerve
- receives contributions from medial and lateral cords
- no branching arm
- travels across the midline of the anterior elbow to enter the forearm
- major supply for the anterior compartment of the forearm
- travels across the midline of the anterior wrist to enter the hand
- minor supply of hand musculature. - Ulnar nerve
- continuation of the medial cord
- no branching in the arm
- travels posterior to the medial epicondyle.
- minor supply for the anterior compartment of the forearm
- major supply of hand musculature - Axillary Nerve
- smaller branch of the posterior cord
- immediately exits out the axilla (armpit)
- wraps around humerus posteriorly to supply the deltoid and teres minor - Radial Nerve
- largest branch of the posterior cord
- passes anteriorly for a short distance in the distal arm, over the lateral epicondyle.
- significant supply to the posterior compartment of the arm and forearm.
identify key bony landmarks of all bones in the pelvic girdle.
- interface between axial skeleton and lower limb.
- ring structure permits force transfer and protection of pelvic contents.
- hemipelvis formed by fusion of three bones.
- multiple differences between male (dense, verticle, smaller cavity) and female pelvis.
- lateral shift of ‘ala’ (broad, wingg-like superior portion of pelvis) of ilium has been vital for sustained upright bipedal locomotion.
- anterior superior iliac spine
- greater sciatic notch
- ischial spine
- lesser sciatic notch
- ischial tuberosity
- acetabulum
- pubic tubercle
identify key bony landmarks of all bones in the thigh.
femur:
- head
- neck
- trochanters (greater and lesser)
- linea aspera
- epicondyles (lateral and medial)
- condyles (lateral and medial)
- intercondylar notch/fossa
identify key bony landmarks of all bones in the leg
Tibia and Fibula
- long bones
tibia is larger and weight bearing bone with significant articular surfaces at the tibial plateau and trochlear notch
very palpable landmarks on both bones
- tibial tuberosity (tibia)
- fibular head (fibula)
- medial malleolus (tibia)
- lateral malleolus (fibula)
identify, name, classify and describe the major articulations of the lower limb and foot
knee joint
- 2 synovial joints within one capsule
- femur with patella (patelofemoral)
- femur with tibia (tibiofemoral)
modified hinge joint
- flexion, extension and rotation movement.
medial and lateral meniscus
- improve contact between incongruent tibio-femoral joint surfaces
- shock absorbers
- spread synovial fluid
strong ligamentous support but highly susceptible to damage
- medial and lateral collateral ligaments
- anterior and posterior cruciate ligaments
tibiofibular joints
- superior: plane synovial joint, allows sliding movement.
- inferior: fibrous syndesmosis joint, prevents tibia and fibula from separating
Talocrucal Joint (Ankle)
- hinge joint (complicated axis): distal tibia and fibula with the trochloa of the talus.
- talocrural joint permits dorsiflexion and plantarflexion.
- trochlea of the talus is wider more anteriorly. This contributes to increased stability when the ankle is dorsiflexed.
Joints of the Foot
- intertarsal, tarsometatarsal, metatarsophalangeal and interphalangeal joints.
- 1st metatarsophalangeal joint is vital in creating efficient loading through the lower limb in gait.
Explain the line of gravity
- passes behind hip joint (resisted by anterior capsule)
- slightly in front of knee (resisted by ligaments and posterior capsule)
- long way in front of ankle (resisted by calf muscles and soleus).
what are the features of the hip joint and its specialised features
- ball and socket synovial joint
- large femoral head + relatively deep acetabulum, relatively congruent
- additional supportive features
- specialised fibrocartilage (acetabular labrum)
- strong fibrous capsule
- ligamentous: iliofemoral, pubofemoral & ischiofemoral, particularly taught during hip extension.
