Upper Limb

Handout version

Helen KW Law
Assistant Professor
Health Technology & Informatics
FHSS, Hong Kong Polytechnic University

18th Oct., 2016 Week #7

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Bone structure

Revision

traberculae= stress line

2
Long bone & flat bone

Revision
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Revision
Bone Growth

4
 X-ray of the Left Hand (Anteroposterior)

⽂文字 growing

F/13 M/54
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Fingers, Hand & Wrist

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 Right hand (palmar surface)
ring finger index finger

Distal
interphalangeal joint
little finger
Proximal
Distal phalanx
interphalangeal joint
Middle phalanx
Metacarpo-
phalangeal joint
Proximal phalanx
II
Metacarpal V IV III
Carpo-metacarpal
I joint of the thumb
Pisiform
H C T Trapezium
Triquetrum
Scaphoid
Lunate

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Ulnar Radius
 ⼿手指之間，⼀一粒粒
⽩白⾊色既就係
Sesamoid
X-ray of the Right Thumb bones
l

Anteroposterior (AP) ligament slides on

each other to form
(go around the joint)

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Lunate
 Please label …
X-ray of the Right Thumb

AP Sesamoid bones?
Lateral (LAT)

Distal phalanx I

Proximal phalanx I

Metacarpal I

Lunate
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 Please label …
X-ray of the Left Middle Finger (F/13)

AP AP LAT Lateral (LAT)

Distal phalanx III

Middle phalanx III

Proximal phalanx III

Metacarpals

See anything? 10
 Please label …
Left Hand and fingers

AP 11
 Please label …
X-ray of the Left Hand (F/13)

Anteroposterior Oblique 12
(AP) (OBL)
 Please label …
X-ray of the Left Hand (M/54)

Anteroposterior Oblique 13
(AP) (OBL)
 Please label …
X-ray of the Right Hand (M/54)

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AP OBL
 Revision
Right wrist (radiocarpal) joint

Articular bones:
• radius

• scaphoid
• lunate
• triquetrum

Carpal surface at the

Pisiform lifted away distal end of radius
from the triquetrum

Palmar surface of R
hand 15
 Right wrist - Carpal Bones

Hook of Hamate
Trapezium
Hamate
Pisiform Td Trapezoid
P T
H C
Triquetrum Tm Capitate
S
L
Lunate Scaphoid
Radius

Scaphoid Lunate Triquetrum Pisiform

Trapezium Trapezoid Captitate Hamate 16
 Left Wrist – Carpal Bones

hook(突出黎）
H P
Td C
T Tm

S L

Radius Ulna

Hook of
Hamate

Radial styloid
ulnar styloid

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 Please label …
X-ray of the Left Wrist

T Td
Td C
H Tm
T C S
P
S L L
Ulnar L
styloid
Radius Radius
Ulnar
Ulnar
AP OBL LAT

pisiform 會有d向後左
radius—thumb side—認位
C,L會成⼀一條
直線咁
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Revision
Flexion & Hyperextension of the Wrist

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 Revision
Abduction & Adduction of the Wrist

Abduction Adduction
= Radial = Ulnar
Flexion Flexion
= Radial = Ulnar
deviation deviation

=
Right!
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 right under it

Anatomical snuff box & scaphoid

The radius and scaphoid articulate

deep to the snuffbox

• the most often fractured bones

• localized tenderness within the

snuffbox

• poor blood supply disunion

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 ulnar-deviation

How to visualise the long axis of the scaphoid?

Td
H Tm
T C
P
S L OBL
Radius

Ulnar
AP

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 Please label …
Carpal Tunnel Syndrome
tickling, prickling sensation, pain,
numbness, and other symptoms

?? compression of the median nerve

traveling through the carpal tunnel

Pisiform Trapezium

Hook of Hamate Trapezoid

Triquetrum Scaphoid

Lunate Capitate

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Forearm & Elbow

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 Right forearm

Olecranon Coronoid
Process Process
⽂文字

Ulna

Revision
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Please label …
X ray of the forearms

tubercle of radius

coronoid process
trochlear

olecranon
AP LAT 26
Right Elbow joint and Superior radio-ulnar joint

humerus

radius

Revision
ulna

Supination Pronation 27
 Please label …
X ray of the Left elbow – AP supination

Humerus

Olecranon
Fossa
Medial Lateral
epicondyle epicondyle
articular surface
Trochlea
Capitulum
Olecranon
Process Head of
structure
radius
Coronoid
Neck of
Process
radius

Ulna Radial
Tuberosity
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 Please label …
X ray of the Left elbow - Lateral

tubercle
joint有冇事
liquid may
accumulate

Sail sign:
suggests an occult
fracture

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Humerus and Shoulder

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 Right humerus (Saladin Fig 8.3) Revision

The distal end of the humerus has two smoth condyles. The lateral one
called capitulum …. The medial one called trochlea…. Immediately proximal
to these condyles, the humerus flares out to form two bony processes, the
lateral and medial epicondyle. …. Immediately proximal to the epicondyles,
the margins of the humerus are sharply angular and form the lateral and
medial supracondylar ridges.

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 Left elbow (Image Bank)

trochlea

• The medial part of the trochlea is more prominent than the lateral part
• The medial epicondyle is more prominent than the lateral epicondyle.
• The olecranon fossa is deeper than the radial & coronoid fossae.
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Revision
Right humerus

What is the difference between

the anatomical neck and the

surgical neck?
fructure frequently

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 Left humerus

greater
L
tubercle

surgical
neck
shaft
supracondyle

• epicondyles (medial, lateral)

• condyle (capitulum, trochlea)

• fossae (radial fossa, coronoid fossa, olecranon fossa) 34

Revision
Right Shoulder joint (anterior view)

Glenoid fossa

Subscapular fossa

Head of humerus

Head of humerus articulates with glenoid fossa of scapula 35

Revision
Medial & Lateral Rotation of the arm

Medial (internal) rotation Lateral (external) rotation

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 Medial Rotation of the Arm

Anatomical neck

Glenoid fossa

subscapular
fossa
Head of humerus bicipital groove

Medial rotation of humerus at the shoulder joint

Axis of rotation 37
 Please label …
X ray of the Left humerus

AP LAT 38
AP – Upper arm

Wrong label in
Pocket Atlas

#16 = capitulum

radial tuberosity
#18 = =tubercle of radius

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 Revision
Right scapula

Rotator cuff muscles = sitS

supraspinatus, infraspinatus, teres minor, Subcaspularis 40
Acromioclavicular joint (1) & Sternoclavicular joint (2)

Revision
scapula
1

clavicle

Right side
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 Right shoulder

Humeral head

Glenoid fossa

Greater tubercle

Lesser tubercule

Bicipital groove

Acromion Surgical
neck Ant. neck
Coracoid process
Scapula
Clavicle •lateral
•medial
Acromioclavicular jt •superior
border
Sternoclavicular jt AP 42
 Right shoulder

Humerus

Clavicle

Scapula = Y

Sup. angle of the scapula

Posterior surface

Acromion

Acromioclavicular jt

Coracoid process

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LAT
 Reading List & References

Saladin KS. Human Anatomy (4th edition).

McGraw Hill, 2014
E. Reif. Pocket Atlas of Radiographic
Anatomy (3rd Edition). Thieme Medical
Publisher, 2010.
Martensen KM. Radiographic Image
Analysis (3rd Edition). Saunders
Elsevier, 2011.

+ Other internet resources

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