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Humerus and Shoulder Joint
 

Humerus and Shoulder Joint

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    Humerus and Shoulder Joint Humerus and Shoulder Joint Presentation Transcript

    • COLLEGE OF ALLIED HEALTH AND SCIENCES BY Hermizan Halihanafiah Bsc Biomedicine (Hons) UKM SHOULDER JOINT AND HUMERUS
    • INTRODUCTION
      • Upper limbs consist of 60 bones.
        • Arm : Humerus
        • Forearm : Ulna and Radius
        • Wrist : Carpals
        • Palm : Metacarpals
        • Hand : Phalanges
    • HUMERUS BONE
      • Arm bone.
      • Longest and largest bone of UL.
      • Articulates proximally with the scapula and distally with both radius and ulna.
    • Humerus
      • Proximal end of the humerus features a rounded head that articulates with glenoid cavity of scapula to form glenohumeral joint.
      • Distal to the head is the anatomical neck, the site of epiphyseal line, which is visible as an oblique groove.
      Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft
    • Glenohumeral Joint / Shoulder Joint
    •  
    • Humerus Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft
      • The greater tubercle is a lateral projection distal to the anatomical neck.
      • It is the most laterally palpable bony landmark of the shoulder region.
      • The lesser tubercle projects anteriorly.
      Anterior view of proximal humerus
    • Humerus Head Greater Tubercle Lesser Tubercle Intertubecular Sulcus Anatomical Neck Surgical Neck Shaft Anterior view of proximal humerus
      • Between both tubercles runs an intertubercular sulcus (bicipital groove).
      • The surgical neck is a constriction in the humerus just distal to the tubercles, where the head tapers the shaft, name because fractures often occur here.
    • Cont…
      • The body (shaft) of the humerus is roughly cylindrical at its proximal end, but gradually becomes triangular until it is flattened and broad at its distal end.
      • Laterally, at the middle portion of the shaft, there is roughened, V-shape area called the deltoid tuberosity where attachment for deltoid muscle.
      Deltoid Tuberosity
    • Cont…
      • Several prominent features are evident at the distal end of the humerus.
      • The capitulum is a rounded knob on the lateral aspect of the bone that articulates with the head of the radius.
      Capitulum Trochlear
    • Cont…
      • The radial fossa is an anterior depression that receive the head of radius when the forearm is flexed.
      • The trochlea, located medial to the capitulum , is a spool shaped surface that articulates with the ulna.
      Capitulum Trochlear Radial Fossa
    • Cont…
      • The coronoid fossa is anterior depression that receive the coronoid process of the ulna when forearm is flexed .
      Capitulum Trochlear Radial Fossa Coronoid Fossa
      • The olecranon fossa is a posterior depression that receives the olecranon of the ulna when the forearm is extended.
      Olecranon Fossa Posterior View
    • Cont….
      • The medial epicondyle and lateral epicondyle are rough projections on either side of the distal end to which the tendons of most muscles of the forearm are attached.
      • The ulnar nerve lies on the posterior surface of the medial epicondyle and may easily be palpated by rolling a finger over the skin above the medial epicondyle.
      Medial Epicondyle Lateral Epicondyle
    • Elbow Joint Lateral View Anterior View
    • Ulnar Nerve
    •  
    • MOVEMENT OF THE ARM (SHOULDER JOINT)
      • Flexion
      • Extension
      • Abduction
      • Adduction
    • MOVEMENT OF THE ARM (SHOULDER JOINT)
      • Medial rotation
      • Lateral rotation
      • Horizontal abduction
      • Horizontal adduction
      • Circumduction
    • Muscles of the Thorax that Move the Humerus
      • Axial muscles
        • Pectoralis major
        • Latissumus dorsi
      • Scapular muscles
        • Fiber of deltoid
        • Rotator cuff
        • Teres major
        • Coracobrachalis
        • Long & short head of biceps
        • Long head of triceps
    • Clavicle origin of Pectoralis Major
      • Origin – medial half of anterior clavicle
      • Insertion – lateral lip of intertubercular sulcus of humerus
      • Action – Flexion, adduction and medial rotation arm at shoulder joint.
      • Nerve supply
        • Medial and lateral pectoral nerve
    • Sternal origin of Pectoralis Major
      • Origin – anterior surface of sternum, costal cartilage of 2 nd -6 th ribs.
      • Insertion – lateral lip of intertubercular sulcus of humerus
      • Action – extend arm at shoulder joint.
      • Nerve supply
        • Medial and lateral pectoral nerve
    • Latissimus Dorsi
      • Origin – Spines of inferior 6 thoracic vertebrae (T6-T12), lumbar vertebrae (L1-L5), crest of sacrum and illiac crest of hip bone and inferior four ribs.
      • Insertion – Intertubecular sulcus of humerus
      • Action
        • Extends, adduction and medial rotation arm at shoulder joint.
      • Nerve supply - Thoracodorsal nerve
    • Latissimus Dorsi
    • Fiber of Deltoid
      • Consists 3 fibers
      • Anterior, middle and posterior fibers.
      • Responsible for movements of the humerus at GH joint
      • Nerve supply – axillary nerve.
    • Anterior Fiber of Deltoid
      • Origin – anterior border of the lateral one third of the clavicle
      • Insertion – deltoid tuberosity
      • Action – flexion and middle rotation arm at GH joint.
    • Middle fiber of Deltoid
      • Origin – lateral border and superior surface of the acromion process of the scapula
      • Insertion – deltoid tuberosity
      • Action – abduction arm at GH joint
    • Posterior Fiber of Deltoid
      • Origin – inferior lip of the crest of the spine of the scapula]
      • Insertion – deltoid tuberosity
      • Action – extension and lateral rotation arm at GH joint.
    • Rotator Cuff Muscles
      • Consists 4 muscles
      • S – Supraspinatus
      • I – Infraspinatus
      • T – teres minor
      • S – Subscapularis
      • Group of muscles that stabilize GH joint.
    •  
    • Supraspinatus Muscle
      • Origin – supraspinous fossa of scapula
      • Insertion – Greater tubercle of humerus (superior aspect)
      • Action – initially abduction (15 degrees) at shoulder joint, stabilizing shoulder joint
      • Nerve supply - Suprascapular nerve
    • Infraspinatus Muscle
      • Origin – Infraspinous fossa of scapula
      • Insertion – Greater tubercle of humerus (middle aspect)
      • Action – Laterally rotation and adduction arm at shoulder joint
      • Nerve supply - Suprascapular nerve
    • Teres Minor
      • Origin – Inferior lateral border of scapula
      • Insertion – Greater tubercle of humerus (posterior inferior aspect)
      • Action – Laterally rotation, extends and adduction arm at shoulder joint
      • Nerve supply – axillary nerve
    • Subscapularis Muscle
      • Origin – subscapular fossa of scapula
      • Insertion – lesser tubercle of humerus
      • Action – Medial rotation arm at shoulder joint
      • Nerve supply – upper and lower subscapular nerve
    • Teres Major
      • Origin – Inferior angle of scapula
      • Insertion – medial lip of Intertubecular sulcus of humerus
      • Action
        • Extends arm at shoulder joint
        • Assist in adduction and medial rotation of arm at shoulder joint.
      • Nerve supply
        • Lower subscapular nerve
    • Coracobrachialis
      • Origin - Coracoid process of scapula
      • Insertion - Middle of medial surface of shaft of humerus.
      • Action - Flexion and adduction arm at shoulder joint.
      • Nerve supply - Musculocutaneous nerve
    • Biceps Brachii
      • Consists 2 head
      • Long head and short head of biceps
    • Short head of Biceps
      • Origin – Coracoid process of scapula
      • Insertion – radial tuberosity of radius and bicipital aponeurosis
      • Action – Flexion forearm at elbow joint, supination at radioulnar joint and assist flexion arm at GH joint .
      • Nerve supply - Musculocutaneous nerve
    • Long head of Biceps
      • Origin – Tubercle above the glenoid cavity of scapula (supraglenoid tubercle)
      • Insertion – Radial tuberosity of radius and bicipital aponeurosis
      • Action – flexion forearm at elbow joint, supination forearm at radioulnar joint and assist flexion arm at GH joint.
      • Nerve supply - Musculocutaneous nerve
    • Long head of Triceps
      • Origin – tubercle below to glenoid cavity of scapula (infraglenoid tubercle)
      • Insertion – Olecranon of ulna
      • Action - Extends forearm at elbow joint , Extends arm at shoulder joint
      • Nerve supply - Radial nerve
    • Shoulder Joint
      • Definition
        • Ball and socket joint
        • Formed by the head of humerus articulates with glenoid cavity of scapula.
        • Also referred as glenohumeral joint or humeroscapular joint.
    • Glenohumeral Joint / Shoulder Joint
    • Movements
      • Allows for flexion, extension, abduction, adduction, medial rotation , lateral rotation and circumduction of arm.
      • Has more freedom of movement than other joint of body.
    • Extension / flexion of shoulder Extension Flexion
    • Abduction / adduction of Shoulder Abduction Adduction
    • Lateral / medial rotation of Shoulder Lateral / external rotation Medial / internal rotation
    • Horizontal adduction / abduction of Shoulder Horizontal Adduction Horizontal Abduction
      • This freedom of movements results from the looseness of the articular capsule and shallowness of the glenoid cavity in relation to the large size of the head of humerus.
      • Although the ligaments of the shoulder strengthen it to some extent, most of the strength results from the muscle surround the joint, especially rotator cuff muscles.
      Shoulder Joint
      • Rotator cuff muscles work as a group to hold head of humerus in the glenoid cavity.
      Shoulder Joint
    • Anatomical Components of Shoulder Joint
      • Articular capsule.
        • Thin, loose sac that completely envelops the joint and extends from glenoid cavity to the anatomical neck of humerus.
        • Inferior part of the capsule is its weakest area.
      • Coracohumeral Ligament
        • Strong, broad ligament that strengthen the superior part of the articular capsule.
        • Provides stability superiorly, preventing superior translation.
        • Extends from the coracoid process of the scapula to the greater tubercle of humerus.
      Anatomical Components of Shoulder Joint
      • Glenohumeral Ligament
        • 3 ligaments (middle, inferior and superior) over the anterior surface of the joint.
        • This 3 ligaments joint together known as capsular ligament.
        • Extend from the glenoid cavity to the lesser tubercle and anatomical neck of the humerus.
        • Often indistinct or absent and provide only minimum strength
      Anatomical Components of Shoulder Joint
      • Transverse Humeral Ligament
        • Narrow sheet ligament.
        • Extends from the greater tubercle to the lesser tubercle of the humerus.
      Anatomical Components of Shoulder Joint
      • Glenoid labrum
        • Narrow rim of fibrocartilage around the edge of the glenoid cartilage.
        • Slightly deepens and enlarges the glenoid cavity.
      Anatomical Components of Shoulder Joint
      • Bursae
        • 4 bursae are associated with the shoulder joint.
        • They are subscapular bursa, subdeltoid bursa, subacromial bursa and subcoracoid bursa.
        • It provides a cushion between bones and tendons and/or muscles around a joint; bursae are filled with synovial fluid and are found around almost every major joint of the body.
      Anatomical Components of Shoulder Joint
    •  
    •  
    •  
    • Common Shoulder Injury
      • Rupture of the long head of biceps
      • Rotator cuff injury / strain
      • Subluxation of shoulder joint
      • Humerus fracture
    • Introduction of Axilla
      • The axilla (or armpit , underarm , or oxter ) is the area on the human body directly under the joint where the arm connects to the shoulder.
    • Bones Boundaries
    • Boundaries of Axilla
      • Superior
        • Outer border of the 1 st ribs
        • Superior border of scapula
        • Posterior border of clavicle
      • 2. Medial
        • Serratus anterior
        • ribcage
    • Medial muscles of Axilla
    • Cont…
      • 3. Anterior
        • Pectoralis minor
        • Pectoralis major
        • Subclavius
        • The lower border of Pectoralis major forms the rounded anterior axillary fold
      • 4. Posterior
        • Subscapularis above
        • Teres major
        • Latissimus dorsi
        • The posterior axillary fold is a compound structure consisting of the latissimus dorsi and teres major muscles .
    • Anterior Muscles of Axilla
    • Posterior Muscles of Axilla
    • Anterior Axillary Fold
    • Cont….
      • 5. Lateral
        • Intertubercular sulcus of humerus
        • tendon of long head of biceps
        • coracobrachialis and the short head of the biceps brachii are in the axilla
      • 6. Floor / base
        • by the skin (visible surface of armpit)
    • Lateral of Axilla
    • Content of the Axilla
      • The axilla contain the:
        • Axillary artery and vein and their branches
        • Brachial plexus and their branches
        • Axillary lymph nodes
        • Muscles
        • Fascia
    •  
    • Thank You!!!