Starting in name of Allah, The most Beneficent, The

Most Merciful
CLINICAL ANATOMY OF UPPER LIMB
  Composition of upper limb

The upper extremity or arm is a functional unit of the upper body. It

consists of three sections, the upper arm, forearm, and hand. It
extends from the shoulder joint to the fingers and contains 30 bones.
It also consists of many nerves, blood vessels (arteries and veins),
and muscles.

 
  Clavicle Fracture:
A clavicle fracture is a break in the collarbone, one of the main bones in
the shoulder. This type of fracture is fairly common—a Most clavicle
fractures occur when a fall onto the shoulder or an outstretched arm
puts enough pressure on the bone that it snaps or breaks. A broken
collarbone can be very painful and can make it hard to move your arm.
Symptoms:
•Sagging of the shoulder downward and
forward
•Inability to lift the arm because of pain
•A deformity or "bump" over the break
•A grinding sensation when you try to raise
the arm
•Bruising, swelling, and/or tenderness over
the collarbone
 CLAVICULAR COMPRESSION OF BRACHIAL PLEXUS,
SUBCLAVIAN ARTERY AND SUBCLAVIAN VEIN

Thoracic outlet syndrome:

The interval between the clavicle and first rib in some patients
may become narrowed and thus is responsible for
compression of nerves and blood vessels.
 SCAPULAR FRACTURE
 A scapular fracture is a fracture of the scapula, the shoulder
blade. The scapula is sturdy and located in a protected place, so it
rarely breaks. When it does, it is an indication that the individual
was subjected to a considerable amount of force and that severe
chest trauma may be present.
 Treatment:
Most fractures of the scapula can be
treated without surgery. Treatment
involves immobilization with a sling or a
shoulder immobilizer, icing and pain
medications. The sling is usually kept for
comfort for the first two weeks with
subsequent increase of the shoulder's
range of motion.
 SCAPULAR FRACTURE AND WINGED SCAPULA

 Dropped shoulder syndrome may also be caused by weak or too-long neck

muscles, which elevate the trapezius and other muscles in
the shoulder, causing compression of the cervical nerve root. It is caused by
paralysis of trapezius muscle.
Scapular winging, sometimes called
a winged scapula, is a condition that affects
the shoulder blades. ... Scapular
winging occurs when a shoulder
blade sticks out. It is caused by paralysis of
the serratus anterior muscle.
Imbalance can be detected by meticulous
physical examination.
 PROXIMAL HUMERUS HEAD FRACTURE

 A proximal Humerus fracture is a break of the upper part of the

bone of the arm (Humerus). Symptoms include pain, swelling, and
a decreased ability to move the shoulder. Complications may
include axillary nerve or axillary artery injury. The cause is
generally a fall onto the arm or direct trauma to the arm.
 Treatment: Arm sling, specific exercises, surgery
 Causes: Fall onto the arm, direct trauma to the arm
 DISTAL END OF HUMERUS FRACTURE

 It occurs when there is a break anywhere within the distal region (lower end)

of the Humerus. The bone can crack just slightly or break into many pieces.
The broken pieces of bone may line up straight or may be far out of place
(displaced fracture).
 Causes:
Falling directly on the elbow. Receiving a direct blow to
the elbow from something hard, Falling on an
outstretched arm with the elbow held tightly to brace
against the fall.
Treatment : It may be treated with or without surgery, depending on
the fracture pattern and associated injuries (i.e., nerve injury or
open fracture).
 GREATER TUBEROSITY FRACTURE
 Fractured by direct trauma, displaced by glenoid labrum, or avulsed by
violent contraction of supraspinatus muscles. When associated with
shoulder dislocation, severe tearing of rotator cuff with fracture can
result in greater tuberosity remaining displaced posteriorly.
 Open reduction of fracture is necessary to attach the rotator cuff back
into place.
 Lesser tuberosity fracture:
 Posterior dislocation of shoulder joint. The bone fragment receives
insertion from subscapularis tendon. 
SURGICAL NECK FRACTURE
 Surgical neck of humerus lie immediately distal to the lower
tuberosity.
 Can be fractured
Directly by blow on lateral aspect of shoulder
Indirectly by falling on outstretched shoulder. humeral blood
vessels can easily be damaged.
 Axillary nerve and circumflex
 Shaft of humerus fractures:
 Distal end of Humerus fractures
 VOLKMANN'S ISCHEMIC CONTRACTURE

 a permanent shortening (contracture) of forearm muscles,

usually resulting from injury, that gives rise to a clawlike
deformity of the hand, fingers, and wrist. It is more common in
children. A similar condition can occur in the foot.
 ELBOW JOINT DISLOCATION
 A dislocated elbow occurs when the bones that make up the joint are
forced out of alignment — typically when you land on an outstretched
hand during a fall. The elbow is the second most
commonly dislocated joint after the shoulder in adults, and the most
commonly dislocated joint in children.
 Elbow joint arthrocentesis:
Elbow arthrocentesis is a procedure performed to aspirate the
contents of a joint cavity to evaluate and
treat elbow effusion. Arthrocentesis is considered a minor
surgical procedure

Joint aspiration is a procedure to remove excess

fluid through a needle from a joint (commonly a
knee, ankle, elbow or hip).
 ULNAR NERVE DAMAGE WITH ELBOW JOINT INJURIES
 Ulnar nerve compression at the elbow is called "cubital tunnel syndrome."
Numbness and tingling in the hand and fingers are common symptoms of cubital
tunnel syndrome. In most cases, symptoms can be managed with nonsurgical
treatments like changes in activities and bracing.
Treatment
A simple fracture will heal well with
conservative cast treatment. Some types
of elbow fractures, however, including those in
which the pieces of bone are significantly out of
place, may require surgery.
 ULNAR AND RADIAL FRACTURES

Radius and ulnar shaft fractures, also known as adult both bone forearm fractures, are common fractures of the
forearm caused by either direct trauma or indirect trauma (fall).
Diagnosis is made by physical exam and plain orthogonal radiographs.
Treatment is generally surgical open reduction and internal fixation with compression plating of both the ulna and
radius fractures
Symptoms:
pain and swelling
loss of forearm and hand function
Related conditions:
Monteggia’s fracture:
A fracture of one arm may be associated with the dislocation of other.
Galeazzi’s fracture: the proximal third of radius is fractured and the distal end of ulna is dislocated at the distal
radioulnar joint.
Colles’ fracture: distal end of radius fractured.
Smith’s fracture: occurs from the fall on back hand.
 DUPUYTREN CONTRACTURE
 Dupuytren contracture is a hand deformity that usually develops over
years. The condition affects a layer of tissue that lies under the skin of
your palm. Knots of tissue form under the skin — eventually creating a
thick cord that can pull one or more fingers into a bent position.
 Fascial spaces of palm and infections:
 Spaces of hand are formed
by fascia and fascial septae. Fascia and fascial septae of
the hand are arranged in such a manner that many spaces are
formed. These spaces are important as they can get infected and
distended with pus.
 Treatment for deep space infections includes antibiotics and pain
and pain relieving medications and surgical drainage.
 ROTATOR CUFF TENDINITIS

Rotator cuff tendonitis is an inflammation of a group of muscles in the shoulder together

with an inflammation of the lubrication mechanism called the BURSA.
Causes and symtoms :It can be the result of keeping your shoulder in one position for a while,
sleeping on your shoulder every night, or participating in activities that require lifting your arm over
your head. Athletes playing sports that require lifting their arm over their head commonly
develop rotator cuff tendinitis.
Supraspinatus Tendon Rupture: This can occur in due to a trauma or repeated micro-trauma
and present as a partial or full thickness tear. Most of the time the tear occurs in the tendon
or as an avulsion from the greater tuberosity.
causes:

Thiscan occur in due to a trauma or repeated micro-trauma and present as a partial or full thickness
tear.  Most of the time the tear occurs in the tendon or as an avulsion from the greater tuberosity.
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 FOREARM COMPARTMENT SYNDROME

Compartment syndrome of the forearm is primarily a clinical diagnosis. Patients often present within
a few hours of the inciting event, sometimes even within 48 hours. They present with a swollen, tense,
tender forearm with overlying skin that is often pink.
Causes: It is most often due to injury, such as fracture, that causes bleeding in a muscle, which
then causes increased pressure in the muscle. This pressure increase causes nerve damage due to decreased blood
supply.
Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes
painful and tender. The pain may also extend into the back of the forearm and grip strength may be weak. Onset
of symptoms is generally gradual.
Symptoms: Painful and tender outer part of the skin.
Causes: Excessive use of the muscles and heavy weight lifting.
Treatment: Changing activities, physical therapy
 HAND AND WRIST BONE INJURY

Fractures
of the metacarpals (the bones in your hand just before your knuckles) and your
phalanges (the bones between the joints of your fingers) are also common sports injuries.

Wrist Fractures
Scaphoid fractures account for many wrist fractures. The scaphoid bone is one of eight
small bones that make up the wrist. Wrist fractures are common both in sports and motor
vehicle accidents.
Treatment: Rest your wrist for at least 48 hours.
Ice your wrist to reduce pain and swelling. ...
Compress the wrist with a bandage.
Elevate your wrist above your heart, on a pillow or the back of a chair. ...
Take anti-inflammatory painkillers. ...
 SOME OTHER INJURIES OF HAND
 Dislocation of the lunate bone
 Fracture of the metacarpal bones
 Bennet’s fracture(fracture of the base of the metacarpal bone of
thumb .
 Fracture of the phalanges.
 OTHER JOINT INJURIES RELATED TO UPPER LIMB

 Sternoclavicular joint injuries  if your SC

joint has dislocated. Dislocation causes severe pain that gets worse with any
arm movements. In anterior dislocation, the end of the clavicle juts out near
the sternum. This causes a hard bump in the middle of the chest. In
posterior dislocation, a bump is usually not obvious.

 Acromioclavicular joint injuries

 It is a common injury in athletes and characterized by painful impairment of
shoulder function and elevation (“pseudo-elevation“) of the lateral clavicle.
Persistent AC joint instabilities can result in persistent pain and functional
impairment of the shoulder girdle.
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