Upper limb

• S Stylopodium - 1 bone

Zeugopodium - 2 bones

Autopodium - distal part

cingulum

Shoulder (pectoral) girdle

• Klíček

• Lopatka

• PH

1 StC

2 AC

3 GH

4 SuA

5 TSc junction

12

4

5

3

1

2

3

4

5

1 Articulatio sternoclavicularis

2 Articulatio acromioclavicularis

12 discus

3- lig. interclaviculare

4-lig. sternoclaviculare

5-lig costoclaviculare

6-lig. coracoclaviculare a) lig. trapezoideum

b) lig. conoideum

7-lig. coracoacromiale (fornix humeri)

8-lig. coracohumerale

9- lig. acromioclaviculare

10 – lig. transversum scapulae

34

56a 6b

7

10

9

8

Articulatio acromioclavicularis

C-H

C-A

C-C

Scapula movements

(Movements in

thoracoscapular

junction)

with movements in StC

and AC joint

retraction

protraction

elevation

depression

rotation

midposition –

palm on the neck

Th3

Th7

Ligamentum coracoclavicularethe strongest stabilizer of the AC joint.

Long head BiBr

Long headTriBr

Labrum glenoidale

Glenoid lip

conoid

trapezoid

Superior aspect of the acromioclavicular joint 1

1

Fornix humeri

Lig. transversum

scapulae superius

P

A

L

M

X-ray

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X-ray

1- extremitas acromialis

2-acromion

3-greater turebcle

4-lesser tubercle

5-caput humeri

6-cavitas glenoidalis

7-coracoid process

1 2

3

4

5

6

7

Synovial joint description

• 1) type and shape of joint

• 2) articular surfaces

• 3) joint capsule attachment

• 4) joint capsule reinforcement

– ligaments, muscles

• 5) range of movements

• 6) midposition

• 7) scheme

General schema of synovial joint

1-ball (head)

2- collateral ligament

3-fibrous capsule

4-synovial capsule

5- articular cartilage (hyaline)

6-articular lip (labrum

7-socket (fossa)

8- muscle with tendon

9-ligament

10-synovial bursa communicating with the joint cavity

11-menisc

12-synovial bursa (subtendinea)

Art. humeri

Shape: ball and socket, diarthrosis and multiaxial joint

Articulation surfaces - caput humeri –

cavitas glenoidalis + labrum glenoidale,

Capsule: loose joint capsule – the most movable joint;

inside is the tendon of long head of biceps brachii

axillary recessBursae: subtendineous bursa of subscapularis, b. subcoracoidea, b.

subacromialis, b. subdeltoidea

Fixation: rotators cuff, deltoid muscle

ligg. glenohumeralia

lig. coracohumerale,

lig coracoacromiale – fornix humeri

Function: ventral and dorsal flexion, abduction +

adduction, rotation, circumduction

Ball and socket

Ball and socket

SN

AN

Ligg. glenohumeralia

Glenohumeral ligg.

Processus coracoideus

Caput longum BiBr

acromion

Most movable joint in the body

humeral head compared

to the shallow glenoid

fossa (4:1 ratio in surface

area)

Articulatio humeri

1-collum chirurgicum

2-tuberculum minus

3-tuberculum majus

4-collum anatomicum

5-articulatio acromioclavicularis

6-angulus superior scapulae

7-processus coracoideus

8-cavitas glenoidalis

1

2

3

4

5 6

7

8

Capsula articularis

Articulatio humeri

Frontal section

acromion

BiLH

Axillary recess

Supraspinatus

H

Sc

Glenoid lip

Subacromial bursa

Subacromial space

Rotator´s cuff

External rotators:

1-m.supraspinatus

2-m. infraspinatus

3-m. teres minor

Internal rotator:

4-m. subscapularis

1

2

3

4

Anterior aspect

TeMi

InSpi

SuSpi

TeMi

InSpi

SuSpi

CL Tri

Posterior aspect rotators cuff

TeMi

InSpi SuSpi

TeMa

N.Axillaris

Acr

Posterior aspect

Rotators cuff and bursae

• Fornix Fornix humeri = Coracoacromial ligament

Abduction 0-90 shoulder joint

Abduction 90-150 rotation of scapula

Luxatio omae ventralis –

subcoracoidea

Infraspinatus muscle

Deltoid

Humerus

Biceps brachii tendon

long head

Scapula

Subscapularis

muscle

Shoulder joint replacement

capitulo trochlear groove (lunula

obliqua) first affected by

degeneration

Ball and socket

Hinge

Cylindric

Articulatio cubiti - complex joint

art. humeroradialis ball and socket

art. humeroulnaris hinge

art. radioulnaris prox. cylindric

Articulatio cubiti - complex joint

art. humeroradialis ball and socket

art. humeroulnaris hinge

art. radioulnaris prox. cylindric

recessus

sacciformis

lig. annulare radii

Lig. quadratum

Elbow joint

Capsule - loose, above fossas, to neck of

radius – sacciform recess, free epicondyles

lig. collaterale mediale – O-H, H-Co, Obl.

lig. collaterale laterale,

lig. anulare radii,

lig. quadratum

Function - flexion+extension, supination +

pronation

Anterior aspect

Posterior aspect

Posterior aspect

Lig. anulare radii

Elbow joint

1) Capitulum humeri + fovea capitis radii2) Trochlea humeri + trochlear notch

3) Articular circumference + radial notch

Ball + socket

pivot

hinge

Art. cubiti - ligamentS

lig. collaterale

mediale lig. collaterale

laterale

lig. annulare radii

1-chorda obliqua

2-BiBr

3-lig. annulare radii

Lig. collaterale mediale - 3 parts:

4-lig. humerocoronoideum

5-lig. olecranohumerale

6-lig. obliquum Cooperi

2

Lig. collaterale radiale

Lig. collaterae ulnare

Strong collateral ligament¨s

Sagittal section

Fat pad sign? Intraarticular fracture

pronation x supination

Flexion x extension

Proximal and distal radioulnar joint

Pronation x supination

X-ray Art. cubiti

1

3

5

43

2

6

7

1- lateral epikondyle

2-medial epikondyle

3-capitulum humeri

4-circumferentia articulares

5-tuberositas radii

6-trochlea humeri

7- olecranon

Carying angle – physiological valgosity of

elbow joint

170 degree

Pronatio

dolorosa

Head of the radius is pulled from anular ligament

1

2

6

5

4

3

7

89

1-lateral epikondyle

2-medial epikondyle

3- humeroulnar joint

4- radial tuberosity

5- circumferentia articulares

6- capitulum humeri

7- olecranon

8- coronoid process

Ossification of long bones

prenatal postnatal

Bone collar from

perichondrium

Primary enchondral

ossification center

In diaphysis

Secondary enchondral

ossification center in

epiphysis

Growth

plate

Articular

cartilage

spongy

compact

Nutritive

artery

Bone

marrow

2 MONTHS

13 MONTHS

1

X-ray child´s elbow

Center of ossification Manifestation Fusion

1

2

2,5 YEAR

3 YEARS

Center of ossification Manifestation Fusion

6 YEARS

1

2

Center of ossification Manifestation Fusion

1

2

34

56

11 years

Manifestation FusionCenter of ossification

Capitulum humeri

25 – 45 DEGREE

α

Anterior humeral line

- goes through the middle of the

capitulum humeri

Axis of humero radial joint

Fr. supracondylica humeri l. sin. 2/3 dislocata

CRIF MIO OS 2xKi sec. Swenson

Lesion of n. radialis n. ulnaris

Broken forearmchild 7 years

Repositon

Art. radiocarpalis

Art. mediocarpalis

Art. carpometacarpalis

Saddle joint

disc

Hand joints

articulationes manus

art. ossis pisiformis

art. metacarpophalangeales

art. interphalangeales

Wrist joint – complex, condyloid

(elipsoidal)

Intercarpal joints – limited mobility

Carpometacarpal –limited mobility

1stCM -saddle

Disc in radiocarpal joint

Triangular fibrocartilage disc

Types of joints

1

21

1

0

0

trochlear joint

trochlear joint

spheroid joint

goes palmary to

cylindric joint • proximal phalanx –oval fossa on thebase for the head ofMC

• middle phalanx + distal phalanx – fossa on the base is dividedby the crest(trochlearinterphalangeal joint)Saddle joint

Interphalangeal

Metacarpophalangeal

Carpometacarpal

Types of joints and axes of

movements

A- wrist joint condyloid F, E, UD, RD,CD

B- M-Ph –spheric-cylindric, F,E, UD, RD

C- I-Ph- hinge F,E

D- intercarpal – limited movements

E- 1st CM – saddle – F,E,Abd,Add

Ligaments:

Strong interosseous intercarpal

ligg.

Ventral and dorsal intercarpal ligg.

Radiate carpal lig– from the head

of capitate

Palmar radiocarpal and

ulnocarpal lig. strong

Dorsal radiocarpal and ulnocarpal

lig. weak

Collateral ligg. – weak

Palmar aspect

Flexor carpi ulnaris

Pisohamate lig

Pisometacarpeal lig

Deep transverse metacarpal ligament

Ventral dorsal and

interosseal metacarpeal ligg

1,3,4 interosseal carpal ligg.

6,7-disc

2,5-collateral ligg.

Development of joints in fetus

Lig. metacarpale interosseum

Articular disc

Dorsal aspect

Collateral ligg

X- ray in ductions

Radial duction Midposition Ulnar duction

X-ray in flexion and extension

Palmar flexion Midposition Dorsal flexion

X-ray pisiform–triquetrum intercarpal joint oblique projection

pisiform

V

IV

I

II

R

U

FCU

Carpal tunnel

retinaculum

flexorum

Carpal tunnel crossection

carpi radial and ulnar carpal eminence+

flexor´s retinaculum

(flexor´s tendons, median nerve)1-septum (FPL)

2-flexors

retinaculum

3-pisiforme

4-triquetrum

5-hamatum

6-lunatum

7-scaphoideum

proximally

distally

8-hamatum

9-capitatum

10- trapezoideum

11- trapezium

Carpal tunnel crossection

CT

C

Medial carpal eminence

(H, P)

Lateral carpal eminence

(S, T)

Sesamoid bone

Primary centers of ossification MC, Ph – prenatal – 7.-12. week

Secondary centers of ossification – postnatal 1.-3. year

Fusion of centers of ossification – 14.- 20.year – girls earlier

Carpal bones centers of ossification postnataly

Endesmal ossification

Phalanges + MC –

monoepiphysial

bones

8m

8r

At the birth only

cartilaginous

carpus

Ossification

Bone age

Wrist implant

Wrist implant

Metacarpophalangeal implants

Interphalangeal implants

Range of movement

Midposition of

hand joints

S LTr+P

TTi

C H

hamulus

Sesamoid

bone

RadU

Ph

MC

os scaphoideum projectionStandart projection

growth plate

fracture

Fractures

• Radial deficiency (absence of thumb and entire radius).

• represents a congenitally acquired absence of the preaxial limb-bud of the upper extremity.

CT

art.radiocarpalis

art. mediocarpalis

art.carpometacarpalis

1

2

3

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SPEC/CT22 year old male

12 weeks post scaphoid fracture, still tender

Scaphoid fracture

Scaphiod and lunate dislocation

Motorbike accident

Lower limb jointsVeronika Němcová

Pelvis

http://anat.lf1.cuni.cz/muzeum/alb1/index.h

tm

Os sacrum+coccyx

Sacroiliac joint

Os coxae

Symphysis pubica

Os ilium

Os ischii

Os pubis

Os coxae – 3 parts

Sacroiliac joint – auricular surace of ilium and auricular surface of sacrum

• Amphiarthrosis – only very small

movements

• Fibrous cartilage

• Sacroiliac ligaments (ventral, dorsal,

interoseous)

• Iliolumbal ligament

Pelvis – ligaments

lig.iliolumbale

ligg.sacroiliaca ventralia

lig.inguinale

lig.sacrospinale

lig.sacrotuberale

symphysis

pubica

FORAMEN

OBTURATUM

Pelvis – ligaments

CANALIS OBTURATORIUS

lig.inguinale

Lacuna vasorum +

lacuna musculorum

Pelvis – ligaments

Posterior aspect

lig.sacrospinale

lig.sacrotuberale

lig.iliolumbale

ligg.sacroiliaca dorsalia

FORAMEN

ISCHIADICUM MAJUS

(GREATER SCIATIC

FORAMEN)

FORAMEN ISCHIADICUM MINUS

(LESSER SCIATIC FORAMEN)

SUPRAPIRIFORM FORAMEN

INFRAPIRIFORM FORAMEN LACUNA

MUSCULORUM

(MUSCULAR SPACE)

LACUNA VASORUM

(VASCULAR

SPACE)

OBTURATOR CANAL

GREATER SCIATIC FORAMEN

LESSER SCIATIC FORAMEN

Openings of the pelvis

Uinal ligament

1- pubic symphysis

2-os coccygis

3- lig. iliolumbale

4- crista iliaca

5- spina iliaca

6- lig. sacrospinale

7- tuber ischiadicum

8- lig. sacrotuberale

FORAMEN ISCHIADICUM MAJUS

(GREATER SCIATIC FORAMEN):

m. piriformis, nerves of the sacral

plexus, vessels

FORAMEN ISCHIADICUM MINUS

(LESSER SCIATIC FORAMEN)

m. obturatorius internus, pudendal nerve, internal

pudendal vessels

m. piriformis

m. obturatorius

internus

Superior gluteal nerve, art. + vein

Sciatic nerve

Inferior gluteal nerve, art. + vein

Posterior cutaneous femoral nervePudendal nerve,

internal pudendal

artery and vein

Sacral plexus

nerves

in greater and

lesser sciatic

foramen

Inguinal ligament

Iliopectineal arch

SSp

ST

ObtM

x-ray

External pelvic diameters

Interspinous distance – 26 cm

Intercristal distance – 29 cm

Intertrochanteric distance -31cm

External conjugate - 18 cm

L5 – Pubic symphysis (superior border)

Pelvic inclination – 60 degree – pelvic inlet to horizontal plane

External conjugate

Pelvis minor – lesser pelvis

Anal triangleUrogenital triangle

Pelvic planes:

1) Pelvic inlet

2) Pelvic width

3) Pelvic narrow

4) Pelvic outlet

1- transverse diameter 13cm – between terminal lines

2- straight diameter -11cm

3- diameter obliqua 12cm

1) Pelvic inlet – Aditus pelvisPromontory – linea terminalis –superior border of pubic symphysis

Pelvic planes

2) Pelvic width - amplitudo pelvis

middle part of sacrum, symphysis and acetabulum

Oblique diameter 13,5 cm

Obturatory groove- greater sciatic notch

3) Pelvic narrow – angustia pelvislower end of symphysis, sacrum and sciatic spines

Straight diameter 11,5 cm

lower end of symphysis and lower end of

sacrum

4) Pelvic outlet – exitus pelvislower end of symphysis and coccyx and sciatic tuberosities

Straight diameter 9,5 cm (coccyx can move

posteriorly so 11,5 cm)

lower end of symphysis and lower end of coccyx

Pelvic planes:

1) Pelvic inlet

2) Pelvic width

3) Pelvic narrow

4) Pelvic outlet

1

2

34

External conjugate 18-20cm

Diagonal conjugate 13cm

Obstetric conjugate 10,5cm

Pelvic diameters

Head of newborn

in pelvic planes

1. Aditus pelvis

(transverse

diameter 13 cm)

2. Amplitudo pelvis

(oblique diameter, 13,5cm)

3. Angustia pelvis

(straight diameter

11,5cm)

4. Exitus pelvis

(straight diameter 9,5 -

11,5cm)

X ray pelvis

1-SI joint

2- air in the

large intestine

3- acetabulum

4-caput femoris

5-greater

trochanter

6-collum

femoris

7-lesser

trochanter

8-obturatory

foramen

9-pubic

symphysis

1

2

3

5

6

4

7

8

9

Sex differencies in pelvis shape• 1 The pelvic inlet is oval in the female. In the male the sacral promontory is prominent, producing a heart-

shaped inlet.

• 2 The pelvic outlet is wider in females as the ischial tuberosities are everted.

• 3 The pelvic cavity is more spacious in the female than in the male.

• 4 The false pelvis is shallow in the female.

• 5 The pubic arch (the angle between the inferior pubic rami) is wider and more rounded in the femalewhen compared with that of the male.

Pubic arch Pubic angle

Pelvis

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