2. Long bone Anatomy and physiology Cortical bone (Compact bone) – Hard bone Cancellous bone (Spongy bone) – Medulary cavity. Meshwork occupied by bone marrow, fat tissue, nerves and blood vessels. Production of blood cells and provision of a vascular supply to the bone itself. Blood comes out of the bone through venous sinusoids to outgoing veins into the circulation.

4. Humerus - Anatomy Long bone – The longest bone in the upper extremity. Body, Two extremities Upper extremity – Head, Lesser and Greater tubercle, neck. Intertubercular Canal. Muscles, Ligaments and other tissues around.

8. Shoulder Anatomy Looking at the Shoulder Front to Back (AP) we need to locate 2 major landmarks

9. Shoulder Anatomy The Acromion and the Coracoid Process

10. Draw an Imaginary line between these two points Shoulder Anatomy

11. In the middle of that line draw another line down, toward the Elbow. This is the Humeral Head Shoulder Anatomy

12. We will be looking for the Greater Tubercle, which is palpable. Shoulder Anatomy

13. Locating the Humeral Head

14. First thing first – Anatomical position….

15. Positioning of the patient Position the patients hand on top of the Umbilicus – this is called Abduction. Try to keep patient laying straight on his back with arm close as possible to body- this is called a Supine position When adducting the arm, the Humeral Head rotates and the GT moves forward…

16. Why do we rotate the arm ? 1.To protect nerves, tendons and blood vessels. 2.To maximum expose the GT.

17. Locations: Acromion – Coracoid Clavicle

18. Reminder: The shoulder should be Adducted. The palm of the hand should be placed on the Umbilicus. Acromion – Coracoid approach (1):

19. Draw the imaginary line connecting the Acromion and the Coracoid Process. Acromion – Coracoid approach (2):

20. From the midpoint of the line, go 2 fingers Distally (This is the Humeral Head) Acromion – Coracoid approach (3):

21. In certain patients the area where the Humeral Head is closest to the skin is one finger Anteriorly (Toward the Chest) Acromion – Coracoid approach (4):

22. Follow the Clavicle to the Lateral end of the Acromion Clavicular approach (1)

23. Go 2 fingers Distally (Toward the Elbow), This is the Humeral Head Clavicular approach (2)

24. In certain patients the area where the Humeral Head is closest to the skin is one finger Anteriorly (Toward the Chest) Feel the Greater Tubercle. Clavicular approach (3)

25. Summary: Draw the imaginary line connecting the Acromion and the Coracoid Process. From the midpoint of the line, go 2 fingers Distally (This is the Humeral Head) In certain patients, in addition: Go one finger Anteriorly (Toward the Chest) Clavicular approach (4)

26. Location *Once located the insertion site, confirm the exact position, by verifying the Greater Tubercle’s outer margins.

27. Avoid this…