CH 4: Upper Extremities

amount of bones in each hand and wrist

27

Phalanges

fingers/thumbs

amount of phalanges

14

metacarpals

palm

amount of metacarpals

5

carpals

wrist

amount of carpals

8

each finger and thumb is called a

digit

three phalanges

proximal, middle, distal

the thumb has only ____ and ____ phalanges

proximal and distal

the phalanx consists of the

head, body, and base

how many metacarpals

5

the first metacarpal is on the

thumb/lateral side

the body of the metacarpals is

concave on the anterior side and convex on the posterior side

the thumb has only two

phalanges

the IP joint of the thumb is between the

distal and proximal phalanx

the joint between the first metacarpal and the proximal phalanx

MCP joint

in an xray of the thumb what is included

distal phalanx to the base of the first metacarpal

the 2-5 fingers have

three phalanges and joints

distal interphalangeal joint (DIP)

joint between middle and distal phalanges

proximal interphalangeal joint (PIP)

between proximal and middle phalanges

most proximal phalangeal joint

metacarpophalangeal joint

the metacarpals articulate with phalanges

at distal ends

proximally metacarpals articulate with

carpals (CMC)

the 1st phalange articulates with

trapezium

the 2nd phalange articulates with

trapezoid

the 3rd phalange articulates with the

capitate

the 4th and 5th phalange articulates with

hamate

carpals

split into proximal and distal rows

proximal carpals

scaphoid, lunate, triquetrum, pisiform

scaphoid

largest proximal, articulates with radius proximally, most fractured

lunate

articulate with radius, deep concavity on distal surface where it articulates with capitate

triquetreum

three articular surfaces, distinguished by pyramidal shape, anterior articulation with small pisiform

pisiform

smallest, anterior to triquetrum, most evident in carpal canal/tangential

distal carpals

trapezium, trapezoid, capitate, hamate

trapezium

four sides, irregular, medial and distal to scaphoid, proximal to first metacarpal

trapezoid

four-sided, smallest distal

capitate

largest carpal, round head fits into concavity of scaphoid/lunate

hamate

last carpal in distal row on medial aspect, hook process

carpal sulcus (canal/tangential)

demonstrates the carpal sulcus formed by concave anterior/palmar aspect of the carpals, hyperextend wrist

forearm

second group of the upper limb, contains the radius and ulna

the radius and ulna articulate with each other at the

proximal and distal radioulnar joints

the proximal and distal radioulnar joints all for

rotational movement of the wrist and hand

styloid process

small conical projections on extreme distal ends of the radius and ulna

ulnar notch

small depression on the medial aspect of the distal radius

the head of the ulna fits into the ulnar notch forming the

distal radioulnar joint

head of the ulna

located near the wrist at the distal end of the ulna, when pronated it is felt on the little finger side of the distal forearm

head of radius

Located at the proximal end of the radius near the elbow joint

shaft/body

the long midportion of the radius/ulna

the radius is

shorter, directly involved in wrist joints, rotates around the ulna

the ulna is

stationary

radial tuberosity

the rough oval process on the medial and anterior side of the radius

proximal ulna

longer of the two, primarily involved in formation of the elbow joint

olecranon and coronoid processes

beak-like processes of the proximal ulna, posterior aspect of the elbow joint

trochlear notch (semilunar)

medial margin of coronoid process opposite of radial notch

radial notch

small shallow depression located on the lateral aspect of the proximal ulna

the head of the radius articulates with the ulna at the radial notch forming the

proximal radioulnar joint

the proximal radioulnar joint combines with the distal radioulnar joint to

allow rotation of the forearm during prontation

during pronation the radius

crosses over the ulna near the upper third of the forearm

humeral condyle

Expanded distal end of the humerus

articular portion of the humeral condyle is split into

trochlea and capitulum

trochlea

pulley, two rim-like margins and smooth depressed center (trochlear sulcus/groove), located more medially and articulates with the ulna

capitulum

little head, later aspect and articulates with head of radius (cap and head)`

lateral epicondyle

small projection on the lateral aspect of the distal humerus above the capitulum

medial epidondyle

larger and more prominent than the lateral and is located on the medial edge of the distal humerus

shallow anterior depressions

coronoid fossa and radial fossa

deep posterior depressions

olecranon fossa

a lateral view of the elbow shows the

head and neck of the radius, the radial tuberosity, and large concave trochlear notch

true lateral evlow

90 degree flexion, fat pads, three arcs

trochlear sulcus

smallest and first

second/intermediate arc

double lined as the outer ridges or rounded edges of the capitulum and trochlea

the trochlear notch of the ulna is the

third arc of a true lateral

all IP joints are

ginglymus (hinge), flexion/extension

MCP joints are

ellipsoidal (condyloid), flexion/extension, abduction/adduction, circumduction

CMC joint of the thumb

saddle joint, all movement

2nd-5th CMC joints are

Plane (gliding) type

intercarpal joint

plane movement

wrist joint

ellipsoidal (condyloid) freely moveable

elbow joint

synovial, freely moveable, ginglymus (hinge)

proximal radioulnar joint

pivot/trochoidal

ulnar deviation

wrist opens up, carpals on opposite of wrist, scaphoid, trapezium, trapezoid

radial deviation

less frequent, carpals on ulnar side, hamate, pisiform, triquetrum, lunate

forearm should be radiographed in

AP with hand supinated (PA causes superimposition)

lateral rotation of the elbow

separates the proximal radius and ulna

medial rotation of the elbow

superimposes the proximal radius and ulna

displacement of fat pads

indicates injury

scaphoid fat pads

wrist, PA and oblique, absence/displacement may indicate fracture on radial aspect

pronator fat pad

wrist, is on the anterior surface, fractures of the distal radius are indicated by displacement or obliteration of the plan of fat pad

anterior fat pad

elbow, superimposed coronoid and radial pads, is seen like a teardrop located anterior to distal humerus, trauma elevates it

posterior fat pad

elbow, deep in olecranon process, not visible, if visible on a 90 degree lateral there is a trauma

supinator fat pad

elbow, long thin stripe anterior to proximal radius, diagnoses of radial head/neck fractures

arthrography

commonly used to image tendinous, ligamentous, and capsular pathology associated with diarthroidal joints, contrast injected into joint capsule

CT/MR

often used on upper limbs to evaluate soft tissue and skeletal involvement of lesions and soft tissue injuries

nuclear medicine

bone scan demonstrates ostemyeltitis, metastatic bone lesions, stress fractures, and cellulitis, pathological processes within 24 hours of onset, asses physiologic aspect

Bone metastasis

transfer of disease/cancerous lesions from one part that may not be directly connected. Metastasis is the most common of all malignant bone tumors.

Bursisitis

inflammation of the bursae (fluid filled sac enclosing joints) formation of calcification of associated tendons, pain and limited movement

Carpal tunnel syndrome

painful disorder of the wrist and hand resulting from compresion of the median nerve as it passes through the center of the wrist, middle aged women

Barton fracture

posterior lip of distal radius

Bennett fracture

base of the first metcarpal extending into the carpometacarpal joint, complicated by subluxation with posterior displacement

Boxer fracture

transverse fracture that extends through metacarpal neck, fifth metacarpal