ANATOMY OF UPPER LIMB

Forearm

 The distal radius is shaped to articulate with the proximal carpal bones
distally, and along its medial or ulnar border it articulates with the distal
ulna.
 The distal radius therefore has three articular components: the scaphoid
fossa, which allows articulation with the scaphoid; the lunate fossa,
which allows articulation with the lunate; and the sigmoid notch, which
allows articulation with the ulna.

 Between the scaphoid and the lunate fossa is a ridge that corresponds
with the scapholunate interval.
 This entire surface is covered with articular cartilage.
 The radial styloid allows attachment of the brachioradialis tendon.
 Also, it is the origin of several important wrist ligaments, including
the radial scapholunate and radial lunocapitate ligaments.
 The third articular component of the distal radius is the sigmoid notch.
 This convex structure allows the radius to rotate around the distal
ulna.
 The distal ulna itself has an ulnar styloid, which contains attachments
to the triangular fibrocartilage complex, including the meniscus
homolog, the volar and dorsal ulnar carpal ligaments, and the ulnar
collateral ligament at the wrist.
 On the dorsal surface, six dorsal compartments contain wrist and
digital extensor tendons
 On the volar surface reside the contents of the carpal canal, with nine
flexor tendons and the median nerve.
 On the ulnar surface, the flexor carpi ulnaris tendon can be palpated
near its insertion on the pisiform.
  The boundaries of the ulnar tunnel, or Guyon's canal, are the volar
carpal ligament and transverse carpal ligament, the hook of the
hamate radially and the pisiform ulnarly.
 Guyon's canal contains the ulnar artery and nerve.
 In the most superficial soft tissue layer of the wrist reside the flexor
carpi radialis layers, flexor carpi ulnaris, and palmaris longus.
 The ulnar shaft, however, remains fixed in its rotation at the
ulnohumeral joint, and the radius rotates around the ulna in pronation
and supination.
 The radius has a lateral bow that is crucial to the maintenance of full
pronation and supination.

Elbow

 Accessible surface structures at the elbow that can be inspected and

palpated include the medial and lateral condyles and the olecranon.
 With the elbow in 90 degrees of flexion, these three palpable points form
a triangle.
 On cross-section, the humerus is circular at the midshaft but flared and
flattened at the distal end.
 Medial and lateral supracondylar columns diverge to increase the
diameter of the distal humerus in the mediolateral plane, and each
condyle contains an articulating portion for the radial head, or ulna, and
nonarticulating epicondyles, which are terminal portions of the
supracondylar ridges on which pronator-flexor muscles and supinator-
extensor muscles originate.
 The three articulations at the elbow are the ulnotrochlear joint, the
radiocapitellar joint, and the proximal radioulnar joint.
 The radial head articulates with the capitellar portion of the lateral
condyle.
 The articular surface of the medial condyle has prominent medial and
lateral ridges that aid in stabilizing the articulation with the ulna.
 Anterior to these two condyles are the coronoid and radial fossa, which
receive the coronoid process of the ulna and the radial head when the
elbow goes into full flexion.
 The proximal ulna contains the olecranon process posteriorly, the
coronoid process anteriorly, and the sigmoid, or semilunar notch, which
articulates with the trochlea.
 The triceps has a broad tendinous insertion into the olecranon posteriorly;
anteriorly, the brachialis inserts on the coronoid process and the
tuberosity of the ulna.
 The radial head lines up in its lesser sigmoid, or radial notch, with the
annular ligament surrounding it.
 Collateral ligaments make up the remainder of the soft-tissue structures
of the elbow, with the most important portion being the anterior band of
the medial or ulnar collateral ligament arising from the medial epicondyle
and attaching to a small process on the medial surface of the coronoid.
 The lesser posterior portion of the medial collateral ligament attaches to
the medial surface of the olecranon process
 There is a similarly triangular fan-shaped lateral collateral ligament,
whose origin is the lateral epicondyle inserting on the annular ligament of
the radius.
 The ulnar nerve passes through the cubital tunnel at the medial column of
the elbow and must be appropriately assessed following injury.

SHOULDER & ARM