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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5 Functional Anatomy of the Upper Extremity.

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Presentation on theme: "Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5 Functional Anatomy of the Upper Extremity."— Presentation transcript:

1 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5 Functional Anatomy of the Upper Extremity

2 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Review of Anatomical Structures Shoulder girdle –An incomplete bony ring in the upper extremity formed by the two scapulae and clavicles Scapula –Flat, triangular bone on the upper posterior thorax Clavicle –“S”-shaped bone articulating with scapula and sternum –“Collar bone” Glenoid fossa –Depression in lateral superior scapula –Socket for shoulder joint Glenoid labrum –Ring of fibrocartilage around rim of glenoid fossa –Deepens socket for shoulder joint

3 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Review of Anatomical Structures (cont.) Bursa –Fibrous, fluid-filled sac that reduces friction –Located between bones, tendons, and other structures Subacromial bursa –Bursa between acromion process and insertion of supraspinatus muscle Coracoid process –Curved process arising from upper neck of scapula –Overhangs shoulder joint

4 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Shoulder Complex Sternoclavicular joint –Articulation between sternum and clavicle Acromioclavicular joint –Articulation between acromion process of scapula and lateral end of clavicle Scapulothoracic joint –Physiological joint between the scapula and thorax Glenohumeral joint –Articulation between the head of the humerus and the glenoid fossa of the scapula

5 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Movements of the Shoulder Complex Dislocation Rotation Elevation and Depression Protraction and Retraction Horizontal Flexion and Extension

6 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Scapular Movements

7 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Shoulder Joint Range of Motion

8 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Shoulder Joint Movement Characteristics Large range of motion (ROM) at shoulder Extreme ROM required by many activities –Swimming, throwing, gymnastics Ligaments and muscles provide stability Scapular and clavicular movements accompany any arm movement Scapulohumeral rhythm –Movement relationship between humerus and scapula during arm raising movements

9 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscular Actions Review Figure 5-9 on page 148 –17 muscles that contribute to scapula and shoulder joint movements are listed Major muscles –Deltoid, trapezius, rhomboids, pectoralis major, latissimus dorsi, serratus anterior –Rotator cuff (4 muscles surrounding shoulder joint) Infraspinatus, supraspinatus, teres minor, subscapularis

10 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Arm Abduction and Flexion

11 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscle Action on the Shoulder Girdle

12 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Shoulder Muscle Strength Generate greatest strength in adduction Abduction used frequently in daily living Weakest movements are internal and external rotation Muscles generate high forces within joint –Almost 90% of body weight at 90° abduction –Implications?

13 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Shoulder Strength & Conditioning Shoulder muscles easy to stretch and strengthen Stretching –Active and passive Strength training –Weight training, limb/body weight exercises Rotator cuff strength and flexibility important –Stabilization of joint –Widely used in daily living

14 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Stretching & Strengthening Exercises Review Figure 5-14 on pages 152 and 153.

15 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury Sprain –Rupture of fibers of ligament Subluxation –Partial dislocation Fracture –Break in bone, often clavicle Ectopic calcification –Hardening of organic tissue through deposit of calcium salts in areas away from the normal sites Degeneration –Deterioration of tissue

16 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury (cont.) Bursitis –Inflammation of bursa Impingement syndrome –Irritation of structures above shoulder joint –Due to repeated compression between greater tuberosity and acromion process Subacromial bursitis –Common from impingement syndrome Bicipital tendinitis –Inflammation of the tendon of the biceps brachii

17 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Elbow and Radioulnar Joints Radiohumeral joint –Articulation between radius and humerus –Capitulum Eminence on distal end of lateral epicondyle Articulates with head of radius at elbow Ulnar-humeral joint –“Elbow” –Articulation between ulna and humerus Medial and lateral epicondyles Carrying angle –Angle between ulna and humerus with elbow extended –10–20°

18 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Carrying Angle

19 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Elbow and Radioulnar Joints (cont.) Radioulnar joints –Articulations between ulna and radius Proximal and distal –Pronation, supination –Interosseous membrane Thin layer of tissue running between ulna and radius –Medial and lateral epicondyles

20 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Elbow Movement Characteristics and Muscular Actions All 3 joints never close packed at same time Movements limited by several factors –Soft tissue, ligaments, joint capsule, muscles 24 muscles cross elbow –Most of these muscles capable of multiple movements –Muscles better at some movements than others

21 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Elbow Flexor Moment Arms

22 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Biceps Brachii Action

23 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Forearm Strength and Conditioning Flexor group nearly twice as strong as extensor Effectiveness of strengthening/stretching exercises –Depends on position of arm Length-tension relationship Numerous exercises

24 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Stretching and Strengthening Exercises Review Figure 5-21 on page 162.

25 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury to Forearm Overuse injuries more common than trauma –Throwing, tennis serve Ectopic bone –Bone formation away from normal site Rupture –Torn or disrupted tissue Muscle Olecranon bursitis –Irritation of the olecranon bursae Commonly caused by falling on elbow

26 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury to Forearm (cont.) Medial tension syndrome –“Pitcher’s elbow” –Medial elbow pain from excessive valgus forces May include ligament sprain, medial epicondylitis, tendinitis, avulsion fracture Osteochondritis dissecans –Inflammation of bone and cartilage resulting in splitting pieces of cartilage into the joint

27 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Wrist & Fingers Manipulation activities Very fine movements Many stable, yet mobile, segments

28 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Joints of the Wrist Radiocarpal –“Wrist” –Ellipsoid joint Flexion/extension, radial/ulnar flexion Distal radioulnar –Ulna makes NO contact with carpals –Does NOT participate in wrist movements Midcarpal –Articulation between two rows of carpals Intercarpal –Articulation between a pair of carpals

29 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Joints of the Wrist (cont.) Carpometacarpal –Articulations between carpals and metacarpals Metacarpophalangeal –Articulations between metacarpals and phalanges Interphalangeal –Articulations between phalanges

30 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscular Actions Most originate outside hand region Thenar eminence –Mound on radial side of palm formed by intrinsic muscles acting on thumb Hypothenar eminence –Mound on ulnar side of palm created by intrinsic muscles acting on little finger

31 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscular Actions (cont.) Muscular actions: –Hand flexion/extension –Hand radial/ulnar flexion –Finger flexion/extension –Finger abduction/adduction –Thumb flexion/extension –Thumb abduction/adduction –Thumb opposition

32 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Conditioning Why condition hand region? –Improve grip strength –Enhance wrist action for throwing, striking –Prevent injury Exercises –Wrist curls –Gripping exercises –Stretching

33 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Contributions of the Wrist & Hand Power grip –Powerful hand position –Maximally flexing fingers around object Precision grip –Fine-movement hand position –Minimally flexing fingers around object Examples: –Eating with fork –Throwing softball –Spiking volleyball –Dribbling basketball –Changing channel with remote control

34 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Grip

35 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury of the Wrist & Hand Bennett’s fracture –Longitudinal fracture of base of first metacarpal Mallet finger –Avulsion of finger extensor tendons at distal phalanx Result of forced flexion Boutonniere deformity –Stiff proximal interphalangeal articulation Caused by injury to finger extensor mechanism

36 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury of the Wrist & Hand (cont.) Jersey finger –Avulsion of finger flexor Result of forced hyperextension Trigger finger –Snapping during flexion and extension of fingers Created by nodules on tendons

37 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Injury of the Wrist & Hand (cont.) Tenosynovitis –Inflammation of sheath surrounding tendon Carpal tunnel syndrome –Pressure and constriction of median nerve Caused by repetitive actions at wrist

38 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Carpal Tunnel

39 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Stretching and Strengthening Exercises Review Figure 5-27 on page 172.

40 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Contribution of Upper Extremity Musculature to Sports Skills or Movements Upper extremity is obviously important in: –Everyday activities Pushing up out of a chair Carrying, lifting –Sporting/leisure activities Swimming, throwing, striking (golf, volleyball)

41 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Overhand Throwing

42 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

43

44 The Golf Swing

45 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

46 Summary Questions What do the upper extremities enable us to do? What stabilizes the structures of the upper extremities? What are potential injuries to the upper extremities? What causes these injuries? How can injuries be prevented? What are some exercises for stretching and strengthening the upper extremities?


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