1. ANATOMY
II.COMMITEE

2. BONES & JOINTS OF
THE UPPER LIMB

3. LOWER LIMB: support, stability, and locomotion.
UPPER LIMB:ability to place the hand in the proper position in space by movements at the scapulothoracic, glenohumeral, elbow, radio-ulnar, and wrist joints
LOWER LIMB: support, stability, and locomotion

4. Pectoral girdle& bones of the free part of the upper limb
superior appendicular skeleton
Pelvic girdle & bones of the free part of the lower limb
inferior appendicular skeleton
The clavicles and scapulae of the pectoral girdle are supported, stabilized, and moved by axio-appendicular muscles that attach to the relatively fixed ribs, sternum, and vertebrae of the axial skeleton.

5. CLAVICLE- LITTLE KEY only bony attachment between trunk & upper limb
palpable along its entire length
has a gentle S-shaped contour
forward-facing convex part medial
forward-facing concave part lateral

6. Although designated as a long bone, the clavicle has no medullary (marrow) cavity.
It consists of spongy (trabecular) bone with a shell of compact bone. (Click on the key in the previous slide and read the first sentence)

7. Functions of the clavicle
• Serves as a moveable, rigid support from which the scapula and free limb are suspended, keeping them away from the trunk so that the limb has maximum freedom of motion. The support formed by the clavicle is movable and allows the scapula to move on the thoracic wall at the “scapulothoracic joint,” increasing the range of motion of the limb. Fixing the point of the support in position, especially after its elevation, enables elevation of the ribs for deep inspiration.
• Forms one of the bony boundaries of the cervico-axillary canal (passageway between the neck and the arm), affording protection to the neurovascular bundle supplying the upper limb.
• Transmits shocks (traumatic impacts) from the upper limb to the axial skeleton.

8. scapula posterolateral aspect of the thorax, on the 2nd-7th ribs
three angles (lateral, superior, and inferior)
three borders (superior, lateral, and medial)
two surfaces (costal and posterior)
three processes (acromion, spine, and coracoid process)

9. HUMERUS- ARM BONE largest bone in the upper limb
articulates with the scapula at the glenohumeral joint
articulates with the radius and ulna at the elbow joint
In cross-section, the shaft of the humerus is somewhat triangular with:
anterior, lateral, and medial borders
anterolateral, anteromedial, and posterior surfaces

10. Fossae Coronoid fossa Olecranon fossa Radial fossa
adjacent to the radial fossa superior to the trochlea.
receives the coronoid process of the ulna during full flexion of the elbow.
Olecranon fossa
largest fossa
immediately superior to trochlea on the posterior surface of the distal end of humerus
accommodates the olecranon of the ulna during full extension of the elbow.
Radial fossa
a shallow fossa
immediately superior to the capitulum on the anterior surface of the humerus
accommodates the edge of the head of the radius when the forearm is fully flexed.

11. The two forearm bones serve together to form the second unit of an articulated mobile strut (the first unit being the humerus), with a mobile base formed by the shoulder, that positions the hand. However, because this unit is formed by two parallel bones, one of which (the radius) can pivot about the other (the ulna), supination and pronation are possible. This makes it possible to rotate the hand when the elbow is flexed.

12. Lateral to Medial
Proximal-Distal
S L T P
T T C H

13. Carpal arch
The carpal bones do not lie in a flat plane; rather, they form an arch, whose base is directed anteriorly.
Lateral side of this base is formed by tubercles of the scaphoid and trapezium.
Medial side is formed by the pisiform and the hook of hamate.

14. JOINT TYPE MOVEMENT
Sternoclavicular Saddle, fxn: ball-and-socket Raising (60°) & rotating the clavicle
Anterior and posterior movements of the clavicle
Acromioclavicular Plane Anteroposterior and vertical planes together with some axial rotation
Shoulder Ball and socket Circumduction
Elbow Hinge Flexion and extension
Prox. radioulnar Pivot Pronation & supination
Distal radioulnar Pivot Pronation & supination

15. JOINT TYPE MOVEMENT Wrist Condyloid (ellipsoid) type Circumduction
Intercarpal Plane Gliding
Flexion & extension of the hand
Abduction & adduction of the hand
Carpometacarpal Plane Circumduction, some axial rotation, Thumb- Saddle Opposition [thumb]
Intermetacarpal Plane
Metacarpophalangeal Condyloid Flexion-extension-abduction-adduction
Interphalangeal Hinge Flexion-extension

16. LIGAMENTS Anterior and posterior sternoclavicular ligaments
Costoclavicular ligament
Interclavicular ligament
Acromioclavicular ligament
Coracoclavicular ligament-conoid ligament & trapezoid ligament
Glenohumeral ligaments
Coracohumeral ligament
Transverse humeral ligament
Coracoacromial ligament
Medial (ulnar) and lateral (radial) collateral ligaments
Annular ligament
Anterior and posterior ligaments of the distal radio-ulnar joint
Dorsal and palmar radiocarpal ligaments
Ulnar collateral ligament
Radial collateral ligament
Anterior, posterior, and interosseous ligaments
Palmar and dorsal carpometacarpal and palmar and dorsal intermetacarpal ligaments
Interosseus metacarpal ligaments
Superficial and deep transverse metacarpal ligaments
Medial and lateral collateral ligaments
Palmar ligaments
Sternoclavicular joint
Acromioclavicular joint
Shoulder joint
Elbow joint
Wrist joint
Intercarpal joints
Carpometacarpal & Intermetacarpal joints
Metacarpophalangeal & interphalangeal joints

17. SOME FUNCTIONAL ANATOMY OF THE LIGAMENTS
Anterior & posterior sternoclavicular ligaments reinforce the joint capsule anteriorly & posteriorly.
Interclavicular ligament strengthens the capsule superiorly.
Costoclavicular ligament limits elevation of the pectoral girdle.
Sternoclavicular joint
Acromioclavicular ligament strengthens the acromioclavicular joint superiorly. However, the integrity of the joint is maintained by extrinsic ligaments, distant from the joint itself.
Acromioclaviular joint
coracoclavicular ligament
Glenohumeral ligaments strengthen the anterior aspect of the joint capsule.
Coracohumeral ligament strengthens the capsule superiorly.
Transverse humeral ligament holds the synovial sheath and tendon of the biceps brachii in place during movements of the glenohumeral joint.
Shoulder joint

18. SOME FUNCTIONAL ANATOMY OF THE LIGAMENTS Proximal radio-ulnar joint
Lateral collateral ligament complex doesn't contribute as much to elbow stability as does the medial collateral ligament complex.
Elbow joint
Anular ligament of the radius, which encircles and holds the head of the radius in the radial notch of the ulna.
permits pronation and supination of the forearm.
Proximal radio-ulnar joint
Palmar radiocarpal ligaments
strong and directed so that the hand follows the radius during supination of the forearm.
Dorsal radiocarpal ligaments take the same direction so that the hand follows the radius during pronation of the forearm.
The joint capsule is also strengthened medially by the ulnar collateral ligament. T
The joint capsule is also strengthened laterally by the radial collateral ligament. S
Wrist joint

19. JOINTS OF VERTEBRAL COLUMN
symphyses between vertebral bodies
(n=2 one above, and one below)
synovial joints between articular processes
(n=4, two above and two below)

20. Spinal nerve leaving out the vertebral column
through the intervertebral foramen formed between arches of two adjacent vertebrae

21. Inferior articular process
Plane .
Superior articular process

22. Uncovertebral joints (Luschka’s JOINTS)
Unci of the bodies of C3 or 4 C6 or 7 vertebrae .

23. between the laminae of adjacent vertebrae
tectorial membrane

24. Yes, nodding+lateral flexion & rotation
Atlanto-occipital
Yes, nodding+lateral flexion & rotation
condyloid
connects the anterior arch of the atlas to the anterior margin of the foramen magnum. .
connects the posterior arch of the atlas to the posterior margin of the foramen magnum.
Anterior/Posterior atlanto-occipital membranes

25. Atlanto-axial JOINTS No
Plane Pivot Plane .

26. Atlanto-axial JOINTS No
Plane Pivot Plane .

27. from odontoid process to the medial sides of the occipital condyles.
Tectorial membrane (superior continuation of the posterior longitudinal ligament)
Cruciate ligament
Apical ligament-under the superior longitudinal band of the cruciate ligament
from the apex of the odontoid process to the anterior margin of the foramen magnum
Alar ligament
from odontoid process to the medial sides of the occipital condyles

28. .

29. Pelvic outlet (inferior pelvic aperture)
PELVIS
Pelvic outlet (inferior pelvic aperture)
pubic arch anteriorly
ischial tuberosities laterally
sacrotuberous and sacrospinous ligaments posterolaterally
tip of the coccyx posteriorly

30. Pelvic Inlet (Superior Pelvic Aperture)
Circular opening between abdominal cavity & pelvic cavity
Formed
Anteriorly by pubic symphysis
Posteriorly by sacrum (promontory in the middle)
Laterally by iliopectineal line [border of iliopubic eminence] .

31. Greater pelvis (False pelvis)
Part of the pelvis superior to the pelvic inlet
bounded by
iliac alae posterolaterally
anterosuperior aspect of the S1 posteriorly
Occupied by abdominal viscera ileum and sigmoid colon. .

32. Lesser pelvis (True pelvis)
between pelvic inlet & pelvic outlet
bounded by pelvic surfaces of the hip bones, sacrum, and coccyx.
includes true pelvic cavity & deep parts of the perineum.
Major obstetrical and gynecological significance.

33. Weight from the axial skeleton:
Sacroiliac ligaments ilia
Femurs –during standing-
Ischial tuberosities –during sitting-
Sacrum is actually suspended between the iliac bones
Firmly attached to iliac bones by posterior and interosseous sacroiliac ligaments.

34. male or funnel-shaped pelvis with a contracted outlet
long, narrow, and oval shaped
41% of women
wide pelvis 2% of women

35. Feature Male pelvis Female pelvis General Structure Thick & Heavy
Thin & Light
Greater pelvis
Deep
Shallow
Lesser
pelvis
Narrow and deep, tapering
Wide and shallow,
cylindirical
Pelvic inlet
Heart-shaped, narrow
Oval and rounded, wide
Pelvic outlet
Comparatively small
Comparatively large
Ischial spines
Project further medially into the pelvic cavity
Do not project as far medially into the pelvic cavity & smooth

36. (approximately 70 degrees)
Feature
Male pelvis
Female pelvis
Obturator
foramen
Round
Oval
Acetabulum
Large
Small
Greater schiatic notch
Narrow, inverted V
(approximately 70 degrees)
Almost 90 degrees
Subpubic angle
Smaller
(50-60 degrees)
Larger
(80-85 degrees)
Sacral promontory
Prominent
Not prominent

39. Diagonal conjugate (from inferior pubic lig. to promontory)
Measured by palpating sacral promontory with the tip of the middle finger, using the other hand to mark the level of the inferior margin of the pubic symphysis on the examining hand.
After the examining hand is withdrawn, the distance between the tip of the index finger (1.5 cm shorter than the middle finger) and the marked level of the pubic symphysis is measured to estimate the true conjugate, which should be 11.0 cm or greater.

40. BONES & JOINTS OF
THE LOWER LIMB

41. 2 functional components: Pelvic girdle & bones of the free lower limb
2 functional components:
Pelvic girdle & bones of the free lower limb
Body weight is transferred
Vertebral column
(Sacroiliac joints)
Pelvic girdle
(Hip joints)
Femurs (L. femora)
Skeleton of the lower limb (inferior appendicular skeleton)

42. .

43. Iliofemoral ligament [body's strongest ligament] Y
HIP JOINT
Iliofemoral ligament [body's strongest ligament] Y
anterior inferior iliac spine & acetabular rim proximally & intertrochanteric line distally
prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum
Pubofemoral ligament
arises from the obturator crest of the pubic bone
prevents overabduction of the hip joint
Ischiofemoral ligament [weakest of the three]
arises from the ischial part of the acetabular rim
spirals around the femoral neck, medial to the base of the greater trochanter .

44. Ligament of the head of the femur
a synovial fold conducting a blood vessel.
weak and of little importance in strengthening the hip joint.
attaches to the margins of the acetabular notch & fovea for the ligament of the head. .

45. Movements of the hip joint
During extension of the hip joint, the fibrous layer of the joint capsule, especially the iliofemoral ligament, is tense; therefore, the hip can usually be extended only slightly beyond the vertical except by movement of the bony pelvis (flexion of lumbar vertebrae).
From the anatomical position, the range of abduction of the hip joint is usually greater than for adduction.
About 60° of abduction is possible when the thigh is extended, and more when it is flexed. Lateral rotation is much more powerful than medial rotation. .

46. Patellar ligament patella to the tibial tuberosity.
Collateral ligaments of the knee
stabilize the hinge-like motion of the knee.
tense when the knee is fully extended, contributing to stability while standing.
As flexion proceeds, increasingly loose, permitting and limiting (serving as check ligaments for) rotation at the knee.
Fibular collateral ligament
from lateral epicondyle of femur to lateral surface of the fibular head
Tibial collateral ligament
from medial epicondyle of femur to medial condyle & superior part of medial surface of tibia
weaker than the FCL, is more often damaged. As a result, the TCL and medial meniscus are commonly torn during contact sports such as football. .

47. Oblique popliteal ligament
arises posterior to medial tibial condyle and passes superolaterally toward lateral femoral condyle.
Arcuate popliteal ligament
arises from posterior aspect of fibular head, and spreads over the posterior surface of the knee joint.
strengthens the joint capsule posterolaterally. .

48. Intracapsular (internal) ligaments of the knee joint
1.1. Anterior cruciate ligament (ACL)
weaker of the two cruciate ligaments.
from anterior intercondylar area of tibia to medial side of the lateral condyle of the femur.
limits posterior rolling (turning and traveling) of the femoral condyles on the tibial plateau during flexion.
prevents posterior displacement of the femur on the tibia
prevents hyperextension of the knee joint. .

49. Intracapsular (internal) ligaments of the knee joint
1.2. Posterior cruciate ligament (PCL)
stronger of the two cruciate ligaments.
from posterior intercondylar area of the tibia to lateral surface of medial condyle of femur
limits anterior rolling of the femur on the tibial plateau during extension.
prevents anterior displacement of the femur on the tibia
prevents posterior displacement of the tibia on the femur
helps prevent hyperflexion of the knee joint.
In the weight-bearing flexed knee, the PCL is the main stabilizing factor for the femur (e.g., when walking downhill). .

50. Intracapsular (internal) ligaments of the knee joint
2.1. Medial meniscus is C shaped,
anterior end (horn) is attached to the anterior intercondylar area of the tibia, anterior to the attachment of the ACL.
posterior end is attached to the posterior intercondylar area, anterior to the attachment of the PCL.
Because of its widespread attachments laterally to the tibial intercondylar area and medially to the TCL, the medial meniscus is less mobile on the tibial plateau than is the lateral meniscus.
2.2. Lateral meniscus is nearly circular, smaller, and more freely movable than the medial meniscus. .

51. The stability of the knee joint depends on:
(1) the strength and actions of the surrounding muscles and their tendons
(2) the ligaments that connect the femur and tibia.
The erect, extended position is the most stable position of the knee. .

52. JOINT TYPE MOVEMENT Ankle Hinge dorsiflexion and plantarflexion
Hip Ball and socket flexion-extension, abduction adduction, medial-lateral
rotation, and circumduction
Knee Hinge flexion-extension
combined with gliding and rolling and with rotation about a vertical axis
Superior tibiofibular Plane slight movement during dorsiflexion
Inferior tibiofibular SYNDESMOSIS
Ankle Hinge dorsiflexion and plantarflexion

53. LIGAMENTS Iliofemoral ligament Hip joint Ischiofemoral ligament
Ligament of the head of the femur
Pubofemoral ligament
Extracapsular (external) ligaments
Patellar ligament
Fibular collateral ligament (lateral collateral ligament)
Tibial collateral ligament (medial collateral ligament)
Oblique popliteal ligament
Arcuate popliteal ligament
Intracapsular (internal) ligaments
Anterior and posterior cruciate ligaments
Lateral and medial menisci
Anterior and posterior ligaments of the fibular head
Hip joint
Knee joint
Superior tibiofibular joint
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Ankle joint

54. Axilla & Brachial Plexus
Axillary inlet (Apex)
Walls of axilla
Gateways in the posterior wall
Contents of the axilla
Branches of axillary artery
Axillary vein
axilla
Formation of brachial plexus
Branches of the roots
Branches of the trunks
Branches of the cords
Muscles in the anterior aspect of arm: Musculocutenous nerve
Muscles in the posterior aspect of arm/forearm: Radial nerve
Muscles in the anterior aspect of forearm: Median and ulnar nerves