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Introduction
1. Cardiopulmonary system
2. Pulmonary system
3. Neuromuscular system
4. Pediatrics
5. Musculoskeletal system
5.1 Anatomy of musculoskeletal system
5.2 Foundation content of musculoskeletal system
5.3 Upper extremity anatomy
5.4 Special tests of upper extremity
5.5 Comparing clinical presentation and interventions for upper extremity
5.6 Lower extremity anatomy
5.7 Special tests of lower extremity
5.8 Comparing clinical presentation and interventions of lower extremity
5.9 Spine, pelvis, and temporomandibular joint anatomy
5.10 Special tests of the spine, pelvis, and tempromandipular joint
5.11 Comparing clinical presentation and interventions for the spine, pelvis, and tempromandipular joint
5.12 Other MSK conditions
5.13 Gait
5.14 Prosthetics and orthotics
5.15 Medications, imaging, and fractures
5.16 Surgical protocols
6. Other system
7. Non systems
Wrapping up
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5.3 Upper extremity anatomy
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5. Musculoskeletal system
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Upper extremity anatomy

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Skeletal anatomy of upper extremity
Skeletal anatomy of upper extremity

Functional anatomy of the upper extremity

Shoulder region

The shoulder region is composed of three (3) primary bony structures — the humerus, scapula, and clavicle. These bony structures form the glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and scapulothoracic joints.

The primary movements of the shoulder  that are aided by the four joints of the shoulder are:

  • Shoulder flexion/extension
  • Shoulder elevation/depression
  • Shoulder external rotation/internal rotation
  • Shoulder abduction/adduction
  • Scapular elevation/depression
  • Scapular upward rotation/downward rotation
  • Scapular abduction/adduction

The glenohumeral joint articulates the humeral head into a concave glenoid fossa. The ligaments that aid in stability are the superior, middle, and inferior glenoid ligaments.

  • The superior glenoid ligaments prevent excessive internal rotation and inferior translation.
  • The middle glenoid ligament prevents excessive external rotation and anterior translation.
  • The inferior glenoid ligament prevents external rotation, internal rotation, and translation anteriorly and superiorly.
Glenohumeral joint
Glenohumeral joint

The glenoid humeral joint has other important anatomical features:

  • Labrum — articular cartilage lining the glenoid fossa, aiding in the lubrication of the joint
  • Bursae — act as fluid-filled sacs that provide cushioning and friction reduction between tendons, joints, muscles, and bone
  • Long head of biceps tendon- tendon lies within the glenoid fossa and provides stability anteriorly to the humeral head
Rotator cuff
Rotator cuff

The sternoclavicular joint articulates with the sternum and the clavicle via a fibrocartilage. This articulation is the only point of connection between the axial skeleton and the appendicular limbs.

The sternoclavicular joint is essential for maintaining upper limb stability, facilitating movement, and protecting underlying structures. Its unique structure and design allow for a wide range of motion while assisting with breathing and the protection of underlying structures.

Sternoclavicular joint
Sternoclavicular joint

The acromioclavicular joint connects the scapula to the clavicle, allowing motion of the shoulder, stabilization and movement of the scapula, and stability to the shoulder girdle.

The acromioclavicular joint is stabilized by the acromioclavicular ligament and the coracoacromial ligament. This joint lies within a small capsule that provides additional support and protection.

Coracoclavicular joint
Coracoclavicular joint

The scapulothoracic joint is a non-synovial joint supported by muscles, soft tissue, and bursae. It’s made up of the sternoclavicular and acromioclavicular joints, plus the junction between the scapula and the chest wall. The scapulothoracic joint is important to maintain scapular and shoulder movement during arm movements.

Elbow region

The elbow region consists of connections of bony structures between the distal humerus and the proximal radius and ulna. Four (4) joints comprise the elbow: humeroulnar, humeroradial, proximal radioulnar, and distal radioulnar.

Elbow joint
Elbow joint

The primary movements of the elbow that are aided by the four joints of the elbow are:

  • Elbow flexion/extension
  • Forearm supination/pronation

The elbow joint has other important anatomical features:

  • Capsule- a thin structure that surrounds the anterior and posterior components of the joint
  • Bursae- act as fluid-filled sacs that provide cushioning and friction reduction between tendons, joints, muscles, and bone

The ligaments that aid in the movement of the elbow region are:

  • Ulnar collateral ligament
    • Ligament is triangular in shape, running anteriorly, posteriorly, and obliquely to reinforce the medial humeroradial joint
  • Radial collateral ligament
    • Fan-shaped ligament that runs from the lateral epicondyle to the annular ligament, to support the humeroradial joint laterally
  • Annular ligament
    • Cone-shaped ligament that envelopes the radial head and attaches to the medial ulna; protects the radial head
  • Quadrate ligament
    • Extends from the radial notch on the ulna surface to the neck of the radius; reinforces the inferior portion of the joint capsule
  • Distal radioulnar ligament
    • Composed of the anterior and posterior radioulnar ligaments to provide strength to the capsule

Wrist and hand region

The wrist and hand region is composed of the distal radius, the distal ulna, the carpals, the metacarpals, and the phalanges. There are six (6) joints of the wrist and hand: radiocarpal joint, midcarpal joint, carpometacarpal joint (CMC), metaphalangeal joint (MCP), proximal interphalangeal joint (PIP), and distal interphalangeal joint (DIP).

The primary movements of the wrist and hand region are:

  • Wrist flexion/extension
  • Wrist radial deviation/ulnar deviation
  • Finger flexion/extension
  • Finger abduction/adduction
  • Intrinsic finger movement
Carpal bones
Carpal bones
Anatomy of hand
Anatomy of hand

The wrist and hand joint has other important anatomical features:

  • Capsule of wrist and hand — provide support to internal structures
  • Volar plate— present on the palmar aspect of the MCP, PIP, and DIP to protect joints
  • Extensor hood — fibrous connection on the dorsum of the finger that aids in extension of the PIP and DIP
  • Nerves— radial, median, and ulnar are the primary nerves of innervation for the wrist and hand

Ligaments of the wrist:

  • Dorsal radiocarpal
    • Limits flexion, pronation
  • Radiate
    • Stabilizes the hand
  • Radial collateral ligament
    • Limits ulnar deviation
  • Ulnar collateral ligament
    • Limits radial deviation
  • Palmar ulnocarpal
    • Limits extension and supination
  • Palmar radiocarpal
    • Limits extension and supination through the knuckles

Ligaments of fingers:

  • Collateral ligaments
    • Oriented from the lateral condyle to the distal phalanx and on the lateral volar plate to each metacarpal, PIP, and DIP
    • All fibers tighten during flexion, but only volar fibers tighten during extension
  • Accessory
    • Oriented from the  condylar head to the volar plate
  • Transverse
    • Provide stability linking the MCP joints and reinforcing the anterior capsule

Upper extremity range of motion normals

Shoulder range

  • Flexion: 160—180 degrees
  • Extension: 50—60 degrees
  • Abduction: 170—180 degrees
  • Adduction: 50—75 degrees
  • External rotation: 80—90 degrees
  • Internal rotation: 60—100 degrees

Elbow range

  • Flexion: 140—150 degrees
  • Extension: 0—10 degrees
  • Supination: 90 degrees
  • Pronation: 80—90 degrees

Wrist range

  • Flexion: 60—70 degrees
  • Extension: 60—75 degrees
  • Radial deviation: 15 degrees
  • Ulnar deviation: 30—45 degrees

MCP range

  • Flexion: 85—90 degrees
  • Extension 30—45 degrees

PIP range

  • Flexion: 100—115 degrees
  • Extension: 0 degrees

DIP range

  • Flexion: 80—90 degrees
  • Extension: 20 degrees

1st CMC range

  • Flexion: 45—50 degrees
  • Abduction: 60—70 degrees
  • Adduction: 30 degrees

1st MCP range

  • Flexion: 50—55 degrees
  • Extension: 0 degrees

1st IP range

  • Flexion: 85—90 degrees
  • Extension: 0—5 degrees

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