1. The appendicular skeleton consists of the pectoral girdle, upper extremities, pelvic girdle, and lower extremities.

2. In this lecture we will focus just on the pectoral girdle and upper limbs

3. The pectoral girdle is not a complete girdle

4. The pectoral girdle provides for attachment of the arms and many of the arms’ associated muscles. It is a delicate structure.

5. The only bones that keep the scapulae and the shoulders laterally are the delicate clavicles .

6. Congenital absence of clavicles

7. Clavicle (collar bone) Inferior view Superior view

8. Epaulettes were originally designed as armor to help protect the delicate clavicle.

9. Currently epaulettes are minimal and just used for attachment of symbols of military rank.

10. Sternoclavicular joint Acromioclavicular joint (A-C joint).

11. Note the conoid tubercle on the inferior, lateral end of the clavicle that serves as an attachment site for several ligaments. Superior view Inferior view

12. Master Long is going to easily fracture his opponent’s right clavicle so his opponent will be unable to use that arm.

13. ACCORDING TO THE CLINICAL VIEW IN YOUR TEXT, WHY IS A POSTERIOR FRACTURE OF THE CLAVICLE POTENTIALLY MORE SERIOUS THAN AN ANTERIOR FRACTURE? A MORE LIKELY TO BREAK THE SKIN B MORE LIKELY TO DAMAGE BLOOD VESSELS C MORE LIKELY TO ENTER HEART D MORE LIKELY TO INJURE ULNAR NERVE E MORE LIKELY TO TEAR DIAPHRAGM

14. The scapula normally lays over ribs #2-#7 on the posterior aspect of the rib cage.

15. Left scapula

16. Anterior Posterior

17. The head of the humerus articulates with the glenoid cavity .

18. Subscapular fossa on anterior surface of scapula.

19. Humerus clavicle Scapula

20. The humerus is the longest bone of the upper extremity. groove

21. The distal end of the humerus is modified to articulate with the two bones of the forearm.

23. The radial fossa accommodates the head of the radius and the coronoid fossa of the humerus receives the coronoid process of the ulna when the elbow is flexed. Anterior view

24. The olecranon fossa of the humerus receives the olecranon of the ulna when the elbow is extended Posterior view

25. WHICH OF THE FOLLOWING IS CORRECT ABOUT THE DISTAL MEDIAL END OF THE HUMERUS? A NEAR THE ULNAR NERVE B SHAPED LIKE A PULLEY C ARTICULATES WITH THE ULNA D FORMS A FIRM HINGE JOINT WITH THE FOREARM E ALL OF THE ABOVE

26. The antebrachium contains the ulna on the medial side and the radius on the lateral (thumb) side.

27. Note the head of the radius and the radial notch in nearby ulna

28. The radius is lateral to the ulna. Note the head , neck , the radial tuberosity , the shaft , and the styloid process on the lateral tip. Trochlear notch

29. Note styloid processes on distal radius and ulna and ulnar notch on medial distal end of the radius

30. The proximal end of the ulna forms the trochlear notch . Note the anterior coronoid process and the posterior olecranon . The radial notch , mentioned earlier, accommodates the nearby head of the radius

31. The distal end of the ulna is called the head . It has a medial projection called the styloid process . The distal ulna also once again articulates with the nearby radius. Trochlear notch

32. The styloid processes of the distal ulna and radius create a “U-shaped” arrangement to help stabilize the bones of the wrist.

33. The interosseous membrane helps keep the radius and ulna a fixed distance from one another and also allows rotation of the forearm.

34. Ended here Tuesday

35. Crucifixion is NOT normally performed in the hand

36. Crucifixion is properly performed in the wrist or between distal ends of radius and ulna

37. The Governor of California shown properly crucified with nails in wrist or between distal end of radius and ulna. Note the vulture perched on arm that is soon to be lunch.

38. It damages median nerve

40. Shroud of Turin black and white image.

41. Color image of blood

42. In the Shroud of Turin the tibia and fibula are NOT broken.

43. There are 8 carpal bones in the wrist.

44. The bones of the manus at work on a keyboard

45. Kermit gets a surprise!

46. The palm of the manus is composed of 5 metacarpals numbered 1-5 with #1 leading to the thumb.

47. The fingers (digits) contain phalanges . All the digits have three phalanges, except for the thumb (finger #1) that only has two.

48. What specific phalanges have been “nailed”?

49. In this posterior x-ray of a child’s right hand, what specific bone has been fractured?

50. What specific bone(s) of this person’s left hand have been “forked”?

51. WHAT BONE IS ENCIRCLED BY A WEDDING RING? A METACARPAL #3 OF RIGHT HAND B PROXIMAL BONE OF POLLEX C DISTAL PHALANX OF FINGER #5 OF RIGHT HAND D BONE MEDIAL TO METACARPAL #4 AND MIDDLE PHALANX #4 E MIDDLE PHALANX OF FINGER #3 OF LEFT HAND

52. One of many ways to fracture the delicate clavicle .

53. Crack the whip

54. Left clavicular fracture

55. Matt Crivello’s fractured clavicle from football

56. Jagged ends of a fractured clavicle can easily damage underlying arteries and veins unless the injured arm is quickly immobilized.

57. Matt Crivello’s fractured clavicle from football after repair

58. Blows strong enough to fracture the scapula may also result in fracture of the underlying ribs.

60. Scapular fracture through the glenoid cavity

61. Blows or falls on the tip of the shoulder can lead to dislocation of the acromion process of the scapula from the clavicle (A/C separation).

62. When examining patient it is a good idea to palpate the normal shoulder and compare to bad shoulder. Normal

63. Acromioclavicular separation (A/C separation) in the right shoulder

66. One way to reposition bones of a dislocated shoulder.

67. Fracture of the shaft of the humerus may damage nearby nerves.

68. Open fracture of humeral shaft.

70. Supracondylar fracture of the humerus.

71. Supracondylar fracture and midline fracture of distal humerus.

72. Anterior view of repair of fracture shown in previous slide

73. Lateral view of repair of fracture shown in previous slide.

75. Dislocation of the elbow.

76. The muscular tendons which attach to the lateral epicondyle of the humerus are put under tremendous stress during the backhand stroke.

78. Note vibration-stopping rubber bands on racquet and support band on forearm

80. A child who lived next door to me did this by falling off the trampoline

82. Colles’fracture. Fracture of the distal end of the radius causing a “silver fork” deformity.

83. Fracture of the distal end of the radius results in a characteristic “silver fork” deformity. This type of fracture is called a Colles’ fracture .

84. IF YOU WERE LAYING IN THE PARK PROPPED UP BY ONE FULLY EXTENDED ARM AND A HEAVY CHILD RAN INTO THE POSTERIOR OF THIS SAME EXTENDED ARM, WHAT WOULD MOST LIKELY OCCUR ? A FRACTURE OF THE OLECRANON B A-C SEPARATION C COLLES FRACTURE D SCAPULAR FRACTURE E FRACTURE OF A SESAMOID BONE