Shoulder Region

Gross Anatomy


ICM: Physical Exam of the Upper Limb



ANNOUNCEMENTS
  1. This afternoon is devoted to physical examination of the upper limb. Members of the Orthopaedics Department will teach physical examination techniques and provide clinical correlations. The following outlines and study questions are provided to assist you in reviewing joints of the upper limb prior to your physical examination small group experience. The physical examination topics that will be covered in the Introduction to Clinical Medicine course are also provided here for your convenience.

  2. 1:00 - 2:00 PM - Lecture

  3. 2:00-4:00 PM - Small Group Sessions in the 8th floor labs (EdII)



ASSIGNMENTS
Woodburne & Burkel: 169-186
Grant's Dissector: 181-183; Start at "Joints of the Upper Limb", Continue through the end of the chapter.



WHEN YOU FINISH THIS SECTION, YOU SHOULD BE ABLE TO PERFORM THE FOLLOWING TASKS AND ANSWER THESE QUESTIONS
  1. Describe the array of deficits expected from a lesion of the C5 and C6 roots of the brachial plexus. Do the same for a lesion of the C8 and T1 roots.

  2. Name two locations where the ulnar nerve is susceptible to injury. What anatomical features or relationships are the basis for this susceptibility?

  3. Why do fractures of the mid-shaft of the humerus endanger the radial nerve? What is wrist drop?

  4. When examining deep cuts over the anterior surface of the distal forearm and wrist, which nerves should you test for function?

  5. Why should you be especially cautious when examining deep cuts over the thenar eminence?

  6. If you are unable to grasp a dollar bill between the adjacent surfaces of the 3rd and 4th digits, which nerve has been injured?



JOINT REVIEW

Below are listed the main features of the joints of the upper limb that you should review before going to the Introduction to Clinical Medicine small group sessions.





UPPER LIMB NERVE INJURIES

Listed below are the most common nerve lesions of the upper limb region. You should be familiar with the deficits that occur with each lesion. Please note that some of these nerves may be damaged at more than one proximal-distal level, resulting in a different patient presentation for each level of injury.



PHYSICAL EXAMINATION OF THE UPPER LIMB

The topics listed below will be covered in the lecture and small group sessions.

SHOULDER

ELBOW

WRIST AND HAND







ANATOMY TABLES FOR TODAY'S TOPIC

Joints of the Upper Limb

JointDescriptionSignificance
coracoclavicular ligamentsyndesmosisconnects upper surface of coracoid process to under surface of clavicle; often subdivided into conoid (posteromedial) & trapezoid ligaments
annular ligamentsyndesmosissurrounds radial head, holding it against ulna
interosseous membranesyndesmosisconnects shafts/diaphyses of radius & ulna
coracoacromial ligamentsyndesmosisconnects coracoid process with acromion; passes superior to humeral head & supraspinatus tendon
transverse scapular ligament, superiorsyndesmosispasses across scapular notch, converting it into a foramen containing suprascapular nerve
sternoclavicular ligamentsyndesmosis, capsular ligamentconnects clavicle with sternum; described as separate anterior & posterior ligaments
glenohumeral ligament, inferiorsyndesmosis, capsular ligamentconnects humerus to scapula; represents an anteroinferior thickening of the shoulder joint capsule
glenohumeral ligament, middlesyndesmosis, capsular ligamentconnects humerus to scapula; represents an anterointermediate thickening of the shoulder joint capsule
glenohumeral ligament, superiorsyndesmosis, capsular ligamentconnects humerus to scapula; represents an anterosuperior thickening of the shoulder joint capsule
shoulder jointsynovial, ball & socket, amphiarthrosisconnects humerus & scapula; glenoid labrum deepens the socket, glenohumeral ligaments/bands add strength anteriorly; tendon of long head of biceps passes through shoulder joint
sternoclavicular jointsynovialconnects clavicle with sternum; is subdivided by fibrous articular disc, strengthened by sternoclavicular & interclavicular ligaments
ulnar collateral ligament, elbowsyndesmosisconnects medial epicondyle of humerus with ulna
radial collateral ligament, elbowsyndesmosisconnects lateral epicondyle of humerus with radius
elbow jointsynovial, hinge/gingylmus, diarthrosiscomplex joint consisting of humeroradial, humeroulnar and proximal radioulnar articulations; strengthened primarily by radial & ulnar collateral ligaments
radioulnar joint, proximalsynovial, pivotconnects radial head with ulna; annular ligament holds radial head against radial notch of ulna
radioulnar joint, distalsynovial, pivotconnects ulnar head to distal radius; fibrocartilaginous articular disk attaches to styloid process of ulna & distal radius medially
oblique cordsyndesmosisconnects radial shaft to ulnar shaft; passes obliquely lateral & distal from lateral surface of ulna to attach to radius medially near radial tuberosity
interosseous membrane, forearmsyndesmosisconnects shafts of radius & ulna, oriented primarily obliquely distomedially
wrist jointsynovial, gliding, hingeconnects distal radius with proximal row of carpal bones
midcarpal jointsynovial, glidingconnects proximal & distal rows of carpal bones
ulnar collateral ligament, wristsyndesmosisconnects styloid process of ulna to pisiform & triquetrum
radial collateral ligament, wristsyndesmosisconnects styloid process of radius with scaphoid & trapezium
intercarpal ligaments, dorsalsyndesmosisconnects dorsal surfaces of adjacent carpal bones, running primarily transversely
intercarpal ligaments, palmarsyndesmosis
carpometacarpal joint, thumbsynovial, saddle (sellar), biaxialconnects trapezium with metacarpal of thumb
carpometacarpal joint, fingerssynovial, plane or modified saddleconnects distal carpal bones with metacarpals of fingers
transverse metacarpal ligaments, deepsyndesmosisconnects metacarpophalangeal joints 2-5 together on their palmar surface
metacarpophalangeal jointssynovial, condyloid or ellipsoidconnects metacarpal head to base of proximal phalanx; strengthened by collateral ligaments
interphalangeal jointssynovial, hingeconnect proximal & middle phalanges (proximal interphalangeal joint) and middle & distal phalanges (distal interphalangeal joint); strengthened by collateral ligaments


The material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York
Copyright 1995
Unauthorized use is prohibited.



COMPUTER ASSISTED INSTRUCTION
Sample Test Questions
Crossword Puzzle
Links to Related World Wide Web Sites
Radiology Atlas Images
Marvin Computer Lab Models
Anatomy Tables
Review Questions for Gross Anatomy: 11. Joints of the Upper Limb
Human Anatomy
Netter Interactive Atlas
A.D.A.M.


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