Upper Limb

Edward Jaya Hadi

 Skeletal System
Divided into two functional parts :
1. The axial skeleton : head (cranium or skull),
neck (hyoid bone and cervical vertebrae), and
trunk (ribs, sternum, vertebrae, and sacrum).
2. The appendicular skeleton
 CLASSIFICATION OF BONES
• Long bones : the bones of the arms, legs,
hands,and feet
• Short bones—the bones of the wrists and ankles.
• Flat bones—the ribs, shoulder blades, hip
bones,and cranial bones.
• Irregular bones—the vertebrae and facial bones
• Sesamoid bones (e.g., the patella or knee cap)
 Type of bone
• The two types of bone are compact bone and
spongy (trabecular or cancellous) bone. They
are distinguished by the relative amount of
solid matter and by the number and size of the
spaces they contain
• All bones have a superficial thin layer of
compact bone around a central mass of spongy
medullary bone, except where the latter is
replaced by a medullary (marrow) cavity
Long bone
• Epiphysis : The end of a
long bone that is
originally separated
from the main bone by
a layer of cartilage but
later becomes united to
the main bone through
ossification
Long bone
• Epiphysial plate : growth
plate
• Metaphysis : The portion
of a long bone between
the epiphyses and
diaphysis. the part of the
bone that grows.
• The central shaft of a long
bone consisting mainly of
compact bone surrounding
a cavity
Periosteum:
 A glistening-white,
double-layered
membrane of connective
tissue covering the outer
surface of bone.
 It is composed of an
outer fibrous layer of
dense, irregular
connective tissue, and an
inner layer of bone-
forming cells called
osteoblasts.
 The periosteum is richly
supplied with nerve
fibres, lymph vessels, and
blood vessels.
 Upper Limb
• The upper limb consists of four segments
– Shoulder
– Arm
– Forearm
– Hand
PA/AP View
AP View
AP VIEW
 Y view
• patient rotated somewhat so that the scapular
blade is seen on end and projects off the chest
wall.
• The acromion, spine of the scapula, and blade
of the scapula form a “Y”
• This view is usually obtained if a shoulder
dislocation is suspected and also is useful to
look for fractures of the scapular blade.
On this view, the
elements of the scapula
form a Y, and the
humeral head should
overlap the intersecting
arms of the Y
 Axillary view
• The elbow is elevated and the beam
projection is directly down through the
shoulder.
• This allows clear visualization of the relation of
the glenoid to the humeral head
Axillary view
Axillary view
Distal humerus
Radius ulna
 Elbow
• The normal images obtained include an AP and
oblique view with the elbow extended and a
lateral view with the elbow flexed at 90 degrees
• A small dark area is seen just anterior to the
distal humerus. This is the anterior fat pad, and,
although it is normal to see this, it should be
right up against the bone.
• posterior fat pad is never seen normally
On the anteroposterior projection (A), a coronoid apophysis (CA) can be seen along
the medial aspect of the distal humerus. On the lateral view (B), an olecranon
apophysis (OA) is often visualized in older children. The radial epiphysis has not yet
fused.
Forearm
Hand
 Hand
• Examination of the wrist on the AP view begins
with examination of the distal radius and ulna,
particularly the styloid processes of each.
• Next, examine the two rows of carpals (the
proximal row is crescentic). The carpal joint
spaces are usually quite uniform, and you
should look across the carpal/metacarpal and
interphalangeal joints in a sequential process.