Limbs applied anatomy 2015
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a mixed slide of limbs applied anatomy.Thanks to some slideshare gurus like Dr. Salman Khan and Muahammad Ramzan Ul Rehman .this is just a collection of information which I have made for the medical community.
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Limbs applied anatomy 2015
- 1. The Applied Anatomy of the Limbs Presenter: Dr. D B Mwale Moderator: Dr Munthali
- 2. Content o Embryological Development o Lower Limb o Gross Anatomy o Applied Anatomy o Upper Limb o Gross Anatomy o Applied Anatomy
- 3. Frolich, Human Anatomy,UpprLimb What is a limb? Ventral somatic outgrowth of outer tube Bones (with bone, cartilage, marrow, NAV, etc.) Joints Muscle Nerves Vascular supply No viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels) From paraxial mesoderm (i.e. somites): Dermatome gives rise to connective tissue of the dermis Myotome gives rise to limb muscles From lateral plate mesoderm: Bones of arm, forearm, hand, thigh, leg and foot Blood vessels Connective tissue (except for that of the dermis) Peripheral nerve elements,are derived from neural crest
- 4. EMBRYOLOGY initial growth and patterning of the limbs occurs during weeks 4 – 8. Limb buds appear at about 4 weeks and much of the basic structures of the limbs (bones and muscle groups) are established by 8 weeks. After 8 weeks, the limb elements then just increase in size. Disruption of growth and/or patterning can result in many possible defects: Amelia: absence of an entire limb (e.g. early loss of Fgf signaling) Meromelia: absence of part of a limb (e.g. later or partial loss of Fgf signaling) Phocomelia: short, poorly formed limb (e.g. partial loss of Fgf; Adactyly: absence of digits (e.g. even later loss of Fgf) Ectrodactyly: “Lobster-Claw” deformity (variant of adactyly –middle digit is lost) Polydactyly: extra digits Syndactyly: fusion of digits
- 5. Frolich, Human Anatomy,UpprLimb Sensory from limb (dermatomes/sensory skin segments from spine) Dermatomes extend over limbs Twisted orientation reflects twisting of limb during development Named nerves generally innervate skin over muscles that they innervate
- 6. Surface Anatomy Gluteal region / posterior pelvis Iliac crest Gluteus maximus Cheeks Natal/gluteal cleft Vertical midline; “Crack” Gluteal folds Bottom of cheek; “prominence”
- 7. Surface Anatomy Anterior thigh and leg Palpate Patella Condyles of femur Femoral Triangle Floor: pectineus, iliopsoas and adductor longus muscles. Roof : fascia lata Boundaries: Sartorius (lateral) Adductor longus (medial) Inguinal ligament (superior) Contents: Femoral artery, vein and nerve, lymph nodes
- 8. Surface Anatomy Posterior leg Popliteal fossa Diamond-shape fossa behind knee Boundaries Biceps femoris (superior- lateral) Semitendinosis and semimembranosis (superior-medial) Gastrocnemius heads (inferior) Contents Popliteal artery and vein Floor : posterior surface of the knee joint capsule, and posterior surface of the femur. Roof : popliteal fascia and skin Calcaneal (Achilles) tendon
- 10. Bones of the Lower Limb Function: Locomotion Carry weight of entire erect body Support Points for muscular attachments Components: Thigh Femur Knee Patella Leg Tibia (medial) Fibula (lateral) Foot Tarsals (7) Metatarsals (5) Phalanges (14)
- 11. Thigh Femur Largest, longest, strongest bone in the body!! Receives a lot of stress Courses medially More in women! Articulates with acetabulum proximally Articulates with tibia and patella distally
- 12. Knee Patella Triangular sesamoid bone Protects knee joint Improves leverage of thigh muscles acting across the knee Contained within patellar ligament
- 13. Leg Tibia Receives the weight of body from femur and transmits to foot Second to femur in size and weight Articulates with fibula proximally and distally Interosseous membrane Fibula Does NOT bear weight Muscle attachment Not part of knee joint Stabilize ankle joint
- 14. Foot Function: Supports the weight of the body Act as a lever to propel the body forward Parts: Tarsals Talus = ankle Between tibia and fibula Articulates with both Calcaneus = heel Attachment for Calcaneal tendon Carries talus Navicular Cuboid Medial, lateral and intermediate cuneiforms
- 15. Foot 3 arches Medial Lateral Transverse Has tendons that run inferior to foot bones Help support arches of foot Function Recoil after stepping Longitudinal
- 16. Joints of Lower Limb Hip (femur + acetabulum) Ball + socket Multiaxial Synovial Knee (femur + tibia) Hinge (modified) Biaxial Synovial Contains menisci, bursa, many ligaments Knee (femur + patella) Plane Gliding of patella Synovial
- 17. Joints of Lower Limb Proximal Tibia + Fibula Plane, Gliding Synovial Distal Tibia + Fibula Slight “give” (synarthrosis) Fibrous (syndesmosis) Ankle (Tibia/Fibula + Talus) Hinge, Uniaxial Synovial Intertarsal & Tarsal-metatarsal Plane, synovial Metatarsal-phalanges Condyloid, synovial Interphalangeal Hinge, uniaxial
- 18. Muscles
- 19. Muscles of Thigh & Hip Gluteals Posterior pelvis Extend thigh Rotate thigh Abducts thigh Anterior Compartment Thigh Flexes thigh at hip Extends leg at knee Medial/Adductor Compartment Adducts thigh Medially rotates thigh Posterior Compartment Thigh Extends thigh Flexes leg
- 20. Anterior Compartment Thigh Quadriceps femoris Rectus femoris Origin – anterior inferior iliac spine, margin of acetabulum Insertion – patella and tibial tuberosity via the patellar ligament Action – extends knee, flexes thigh Vastus lateralis Vastus medialis Vastus intermedius Origin - femur Insertion – patella and tibial tuberosity via the patellar ligament Action – extends knee Sartorius Origin - anterior superior iliac spine Insertion – medial tibia Action - flex, abduct, lat rotate thigh; weak knee flexor All above innervated by the femoral nerve!!!
- 21. Anterior Compartment Thigh Iliopsoas Origin - Ilia, sacrum, lumbar vertebrae Insertion – lesser trochanter Action – flexor of thigh Innervation – femoral nerve
- 22. Adductors MEDIAL COMPARTMENT Adductor longus Adductor brevis Adductor magnus Origin – inferior pelvis Insertion - femur Action – adducts and medial rotates Innervation – Obturator nerve Pectineus Origin - pubis Insertion – lesser trochanter Action – adducts, medial rotates Innervation – femoral, sometimes obturator Gracilis Origin - pubis Insertion – medial tibia Action – adducts thigh, flex, medial, rotates leg Innervation – Obturator nerve innervated by the obturator nerve Arterial supply is via the obturator artery.
- 23. Posterior Compartment – Hamstring Biceps femoris (2 heads) Origin – ischial tuberosity, distal femur Insertion - lateral tibia, head fibula Action - thigh extension, knee flexion, lateral rotation Semitendinosus Semimembranosus Origin - ischial tuberosity Insertion - medial tibia Action - thigh extension, knee flexion, medial rotation Sciatic nerve innervates all of the above muscles!!!
- 24. Muscles of the Leg o Anterior Compartment o Dorsiflex ankle, invert foot, extend toes o Innervation: Deep fibular nerve o Lateral Compartment o Plantarflex, evert foot o Innervation: Superficial Fibular nerve o Posterior Compartment o Superficial and deep layers o Plantarflex foot, flex toes o Innervation: Tibial nerve
- 25. Anterior Compartment Tibialis anterior Origin - tibia Insertion - tarsals Action - dorsiflexion, foot inversion Extensor digitorum longus Origin – tibia and fibula Insertion - phalanges Action – toe extension Extensor hallucis longus Origin – fibula, interosseous membrane Insertion – big toe Action - extend big toe, dorsiflex foot All innervated by deep fibular nerve
- 26. Lateral Compartment Fibularis (peroneus) longus Origin – lateral fibula Insertion – 5th metatarsal, tarsal Action - plantarflex, evert foot Fibularis (peroneus) brevis Origin – distal fibula Insertion - proximal fifth metatarsal Action – same as above!! All innervated - superficial fibular nerve
- 27. Superficial Posterior Compartment Triceps surae Gastrocnemius (2 heads) Origin - medial and lateral condyles of femur Insertion - posterior calcaneus via Achilles tendon Soleus Origin – tibia and fibula Insertion – same as above Action of both – plantarflex foot Plantaris (variable) Origin – posterior femur Insertion – same as above! Action – plantarflex foot, week knee flexion All innervated by the tibial nerve
- 28. Deep Posterior Compartment Popliteus Origin - lateral condyle femur and lateral meniscus Insertion – proximal tibia Action – flex and medially rotate leg Flexor digitorum longus Origin - tibia Insertion - distal phalanges of toe 2-5 Action – plantarflex and invert foot, flex toe Flexor hallucis longus Origin - fibula Insertion - distal phalanx of hallux Action - plantarflex and invert foot, flex toe Tibialis posterior Origin – tibia, fibula, and interosseous membrane Insertion - tarsals and metatarsals Action - plantarflex and invert foot All innervated by the tibial nerve
- 30. Innervation
- 31. Plexuses of the Lower Limb “Lumbosacral plexus” Lumbar Plexus Arises from L1-L4 with contribution from T12. Lies within the psoas major muscle Mostly anterior structures Sacral Plexus Arises from spinal nerve L4- S4 Lies caudal to the lumbar plexus Mostly posterior structures
- 32. Lumbar Plexus Femoral nerve Cutaneous branches Thigh, leg, foot (e.g. saphenous nerve) Motor branches Anterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas) Obturator nerve Sensory Skin medial thigh; hip, knee joints Motor Adductor muscles Lateral femoral cutaneous Sensory Skin lateral thigh Genitofemoral Sensory Skin scrotum, labia major, anterior thigh Motor Cremaster muscle
- 33. Sacral Plexus Sciatic Motor: Hamstring Branches into: Tibial nerve Cutaneous Posterior leg and sole of foot Motor Posterior leg, foot Common fibular (peroneal) nerve Cutaneous Anterior and lateral leg, dorsum foot Motor Lateral compartment, tibialis anterior, toe extensors Superior gluteal nerve Motor Gluteus medius and minimus, tensor fasciae latae
- 34. Sacral Plexus (continued) Inferior gluteal nerve Motor Gluteus maximus Posterior femoral cutaneous nerve Sensory Inferior buttocks, posterior thigh, popliteal fossa Pudendal nerve Sensory External genitalia, anus Motor Muscles of perineum
- 35. Vasculature
- 36. Arteries Common iliac (from aorta) branches into: Internal iliac Supplies pelvic organs External iliac Supplies lower limb
- 37. Arteries Internal iliac branches into: Cranial and Caudal Gluteals (Superior and Inferior) Gluteals Internal Pudendal Perineum, external genitalia Obturator Adductor muscles Other branches supply rectum, bladder, uterus, vagina, male reproductive glands
- 38. Arteries External iliac becomes……. Femoral Once passes the inguinal ligament Lower limb Branches into Deep femoral Adductors, hamstrings, quadriceps Branches into Medial/lateral femoral circumflex Head and neck of femur Femoral becomes…… Popliteal (continuation of femoral) Branches into: Geniculars Knee Splits into: Anterior Tibial Anterior leg muscles, further branches to feet Posterior Tibial Flexor muscles, plantar arch, branches to toes
- 39. Veins Deep Veins: Mostly share names of arteries Ultimately empty into Inferior Vena Cava Plantar Tibial Fibular Popliteal Femoral External/internal iliac Common iliac Superficial Veins Dorsal venous arch (foot) Great saphenous (empties into femoral) Small saphenous (empties into popliteal)
- 40. Applying The Anatomy In The Lower Limb
- 41. FEMUR SURGICAL APPLICATION Intracapsular fractures Common in elderly Damage medial femoral circumflex artery – avascular necrosis of the femoral head Femoral shaft fractures Can damage the femoral artery and nerve
- 42. Sciatic Nerve Injury o Penetrating wounds o Fractures of the pelvis o Dislocations of the hip joint (posterior) Most frequently injured during I.M. İnjections oUse upper outer quad of buttock. Most nerve lesions are incomplete – Sciatica [Sciatic neuralgia] Motor: Hamstring muscles paralyzed, but weak flexion of the knee is possible tnx to sartorius (femoral nerve) & gracilis (obturator nerve). All the muscles below the knee are paralyzed, foot drop. Sensory: Sensation is lost below the knee, except for a narrow area down the medial side of the lower part of the leg and along the medial border of the foot as far as the ball of the big toe, which is supplied by the saphenous nerve (femoral nerve). 42
- 43. Femoral Hernia bowel pushes into the femoral canal, underneath the inguinal ligament. It presents as a lump situated inferolaterally to the pubic tubercle. common in women, due to their wider bony pelvis.
- 44. Rapid access to a large vein is needed Femoral Vein Catheterization Anatomy of the Procedure 1. The skin of the thigh below the inguinal ligament is supplied by the genitofemoral nerve; this nerve isblocked with a local anesthetic. 2. The femoral pulse is palpated midway between the anterior superior iliac spine and the symphysis pubis, andthe femoral vein lies immediately medial to it. 3. At a site about two fingerbreadths below the inguinal ligament, the needle is inserted into the femoral vein. 44
- 45. LEG SURGICAL APPLICATION: Footdrop It is most commonly seen when the common fibular nerve (from which the deep fibular nerve arises) is damaged. Superficial course around fibular neck Most injured nerve in the lower limb The unopposed pull of the plantarflexor muscles produces permanent plantarflexion. the patient can flick the foot outwards while walking – known as an ‘eversion flick‘.
- 46. A varicosed vein Larger diameter than normal, elongated & tortuous Commonly occurs in the superficial veins of the lower limb Varicose Veins Responsible for considerable discomfort and pain Every time the patient exercises, high-pressure venous blood escapes from the deep veins into the superficial veins and produces a varicosity, and gets worse by time. 46
- 47. Passengers who sit immobile for hours on long-distance flights are very prone to deep vein thrombosis in the legs. Preventative measures include stretching of the legs every hour to improve the venous circulation. Prevention of deep vein thrombosis associated with flying • Exercise the calf muscle foot • Drink plenty of water to avoid a lack of fluid in the body (dehydration) muscles regularly • Elastic compression stockings in pts with risk factors. Deep Vein Thrombosis & Long-Distance Air Travel 47
- 48. SURGICAL APPLICATION Trendelenberg Sign - This signifies that the abductor muscles on the standing limb are greatly weakened or paralysed. For example, if the left leg was raised, and pelvic drop was observed on that side, the abductor muscles on the right leg are the cause. During walking, a weakness in the abductor muscles gives rise to a characteristic gait. As the pelvis drops on one side, the trunk lurches to the opposite side, in an effort to maintain a steady pelvic level. This is called the Trendelenberg gait.
- 49. UPPER LIMB Frolich, Human Anatomy,UpprLimb
- 50. Frolich, Human Anatomy,UpprLimb Sensory territory of nerves Brachial plexus serves to re-direct spinal routes into named nerves covering certain territory Cutaneous branches of medial cord/ulnar nerve
- 51. Frolich, Human Anatomy,UpprLimb Upper Limb Skeleton Scapula Humerus Radius, ulna Carpals--proximal, distal (x8) Digits Metacarpals (x5) Phalanges (x14)
- 53. A=Scaphoid B=Lunate C=Triquetrum (Triangular)*Piramidal D=Pisiform Distal: E=Trapezium F=Trapezoid G=Capitat e H=Hamate Others: 1=Radius 2=Ulna 3=Metacarpus
- 54. Frolich, Human Anatomy,UpprLimb Surface Anatomy of Upper Limb Biceps + Triceps brachii Olecrenon Process Medial Epicondyle Cubital Fossa Anterior surface elbow Contents Median Cubital Vein Brachial Artery Median Nerve Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles pg 786 + 784
- 55. Frolich, Human Anatomy,UpprLimb Surface Anatomy of Upper Limb Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse)pg 306, 788
- 56. Frolich, Human Anatomy,UpprLimb • If INSERTION on scapula = Move scapula – Rhomboids – Trapezius – Pectoralis Minor – Serratus Ventralis – Levator Scapulae • If ORIGIN on scapula = Move Arm – Subscapularis – Supraspinatus – Infraspinatus – Teres Minor – Teres Major – Latissimus Dorsi (partial O on scap) – Coracobrachialis pg 299 Rotator Cuff Use location of Insertion to determine exact movement!!
- 57. Frolich, Human Anatomy,UpprLimb Axilla = Armpit Region between arm and chest Boundaries Ventral - pectoral muscles Dorsal = latissimus dorsi, teres major subscapularis Medial = serratus ventralis Lateral = bicipital groove of humerus Contents Axillary lymph nodes, Axillary vessels n Brachial Plexus
- 58. Frolich, Human Anatomy,UpprLimb POSTERIOR AND ANTERIOR COMPARTMENTS
- 59. Brachial Plexus • Posterior Compartment—posterior cord • Anterior compartment—medial, lateral cords • Name of cord is relative to axillary artery
- 60. Parts of Brachial Plexus Really Tired? Drink Coffee Buddy! R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES
- 61. Frolich, Human Anatomy,UpprLimb ANTERIOR MUSCLES M-C Biceps brachialis Median Forearm flexors Thumb intrinsics (1M$ nerve) Ulnar Flexor carpi ulnaris Hand intrinsics POSTERIOR MUSCLES Muscles (radial nerve) Triceps Anconeus Brachioradialis Carpal, digit extensors
- 62. Frolich, Human Anatomy,UpprLimb Muscles and nerves by compartment ANTERIOR POSTERIOR NERVES M-C, ulnar, median Radial MOVEMENT Flexion Extension MUSCLES Biceps, flexors Triceps, extensors TWIST Flexors from medial epicondyle Extensors from lateral epicondyle
- 63. FOREARM POSTERIOR known as the extensor muscles. all innervated by the radial nerve. muscles divided into deep and superficial compartments separated by a layer of fascia.
- 64. FOREARM POSTERIOR Superficial muscles Extensor Carpi Radialis Longus and Brevis,Extensor Digitorum,Extensor Digiti Minimi and Extensor Carpi Ulnaris Deep Muscles the supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. With the exception of the supinator, these muscles act on the thumb and the index finger
- 65. Frolich, Human Anatomy,UpprLimb Posterior Compartment of Forearm Extensor digitorum Extensor carpi ulnaris Ext Carpi Radialis Longus Brachioradialis Lateral Epicondyle Posterior View
- 66. FOREARM- ANTERIOR Superficial Compartment all originate from a common tendon - medial epicondyle of the humerus. Flexor Carpi Ulnaris attaches to the pisiform carpal bone., Flexion and adduction at the wrist, innervated by Ulnar nerve. Palmaris Longus attaches to the flexor retinaculum of the wrist; Flexion at the wrist; innervated by Median nerve. Flexor Carpi Radialis attaches to the base of metacarpals II and III; Flexion and abduction at the wrist; innervation by Median nerve. Pronator Teres attaches laterally to the mid-shaft of the radius; Pronation of the forearm, innervation by Median nerve.
- 67. FOREARM Intermediate compartment flexor digitorum superficialis splits into four tendons and attach to the middle phalanges of the four fingers. Flexes the metacarpophalangeal joints and proximal interphalangeal joints at the 4 fingers, and flexes at the wrist. Innervated by Median nerve.
- 68. FOREARM - ANTERIOR Deep Compartment Flexor Digitorum Profundus flex the distal interphalangeal joints of the fingers, flexes the metacarpophalangeal joints and the wrist. Innervated by ulnar nerve (medial) and median nerve (lateral) Flexor Pollicis Longus Flexes the interphalangeal joint and metacarpophalangeal joint of the thumb; innervated by Median Nerve. Pronator Quadratus Pronates the forearm; Innervated by Median Nerve.
- 69. Frolich, Human Anatomy,UpprLimb Anterior Compartment Forearm Flexor Carpi Radialis Flexor Retinaculum Medial Epicondyle Flexor Digitorum Superficialis is deep to other flexors pg 302 Flexor Carpi Ulnaris Brachioradialis Pronator Teres Anterior View
- 70. Carpal Tunnel Formed by the carpal bones and overlying flexor retinaculum (attaches to the pisiform, hook of hamate, the scaphoid and the trapezium bones). Structures passing through: Median nerve Tendons of flexor digitorum superficialis/profundus Flexor pollicis longus Flexor carpi radialis (not in carpal tunnel)
- 71. Muscles of the Hand Thenar muscles : abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and adductor pollicis. All act on the thumb Innervated by the median nerve Hypothenar Muscles : Abductor digiti minimi, flexor digiti minimi and oppponens digiti minimi. Innervated by the ulnar nerve All act on the small finger Interosseous muscles: 8 muscles Flex metacarpophalangeal joints and extension of interphalangeal joints Adduction and Abduction of fingers, in relation to the middle finger
- 72. Muscles of the Hand
- 73. Frolich, Human Anatomy,UpprLimb Routes of nerves (in human) M-C: between biceps brachii and brachialis Median: medial/posterior to biceps, branches into forearm flexors at elbow then to hand through carpal tunnel Recurrent median (1M$) superficial at wrist to thumb over thenar emminence) deficit - ape’s hand Ulnar: medial in arm, posterior to medial epicondle of humerus (funny bone) down medial forearm medial to carpal tunnel into palm Radial: deep posterior arm around lateral epicondyle of humerus to forearm (deep and superficial branches)
- 74. Frolich, Human Anatomy,UpprLimb Vascular supply Subclavianaxillary radial (same street, new street sign every block) Collateral circulation Posterior/anterior circumflex humeral Deep brachial a. Radial a. (with median n.) deep palmar arch Ulnar a. (with ulnar n.) superficial palmar arch
- 75. APPLIED ANATOMY OF UPPER LIMB
- 76. SCAPULAR articulates with humerus at the glenohumeral joint, and with clavicle at acromioclavicular joint. SURGICAL APPLICATION The long thoracic nerve innervates the serratus anterior, which originates from ribs 2-8, and attaches the costal face of the scapula, pulling it against the ribcage. Damage to this nerve causes winging of the scapular
- 77. WINGING SCAPULAR
- 78. CLAVICLE SURGICAL APPLICATION: Fracture of the Clavicle Common fracture point is the junction of the medial 2/3 and lateral 1/3, due to fall on shoulder or outstretched hand. lateral end of the clavicle is displaced inferiorly by the weight of the arm, and medially, by the pectoralis major. The medial end is pulled superiorly, by the sternocleidomastoid muscle. The suprascapular nerves may be damaged, these innervate the lateral rotators of the shoulder – so unopposed medial rotation of the upper limb – the ‘waiters tip’ position.
- 80. WAITER’S TIP
- 81. HUMERUS SURGICAL APPLICATION: Surgical Neck Fracture This is a frequent site of fracture, this occurs by falling on an outstretched hand. May result in damage to axillary nerve and posterior circumflex artery. Damage to the axillary nerve will result in paralysis to the deltoid and and teres minor muscles; the patient will not be able to abduct their arm loss of sensation of the skin over the deltoid (regimental badge area).
- 83. HUMERUS SURGICAL APPLICATION: Mid-shaft Fracture A mid-shaft fracture could damage the radial nerve and profunda brachii artery – in radial groove. The radial nerve innervates the extensors of the wrist. This results in unopposed flexion of the wrist - ‘wrist drop’. sensory loss over the dorsal surface of the hand, and the proximal ends of the lateral 3 and a half fingers dorsally.
- 84. WRIST DROP
- 85. HUMERUS SURGICAL APPLICATION: Distal Humeral Fracture A supraepicondylar fracture - interference to the blood supply of the forearm from the brachial artery - Volkmann’s ischaemic contracture – uncontrolled flexion of the hand, as flexors muscles become fibrotic and short. damage to the medial, ulnar or radial nerves. A medial epicondyle fracture could damage the ulnar nerve - ulnar claw is the result.
- 87. CLAW HAND
- 88. SURGICAL APPLICATION – Common Fractures of the Ulna The interosseous membrane transmits force from one bone to the other, thus, fractures of both the forearm bones are not uncommon. There are two classical fractures: Monteggia’s Fracture – The proximal shaft of ulna is fractured, and the head of the radius dislocates anteriorly at the elbow. Galeazzi’s Fracture – A fracture to the distal radius, with the ulna head dislocating at the distal radio- ulnar joint.
- 90. SURGICAL APPLICATION: Common Fractures of the Radius Colles’ Fracture – The most common type of radial fracture. A fall onto an outstretched hand causing a fracture of the distal radius, with posterior displacement of wrist - ‘dinner fork deformity’. Smith’s Fracture – A fracture caused by falling onto the back of the hand. It is the opposite of a Colles’ fracture, as the distal fragment is now placed anteriorly.
- 91. COLLE’S FRACTURE
- 92. SURGICAL APPLICATION: Fractures of the Carpal Bones The two carpal bones that are most commonly fractured are the scaphoid and lunate. Scaphoid fracture tenderness in the anatomical snuffbox cut off the blood supply to the proximal part of the bone , causing avascular necrosis. lunate fracture occurs when falling on a outstretched hand can be associated with some median nerve damage.
- 93. CARPAL TUNNEL Clinical Relevance: Carpal Tunnel Syndrome Compression of the median nerve The typical signs of carpal tunnel syndrome are pins and needles in the sensory distribution of the median nerve and weakness of thenar muscles. It can be treated by cutting into the flexor retinaculum, relieving the pressure.