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Introduction to Limb Arthrology Introduction to Limb Arthrology edited by K. Mohan Iyer Published by Jenny Stanford Publishing Pte. Ltd. 101 Thomson Road #06-01, United Square Singapore 307591 Email: [email protected] Web: www.jennystanford.com British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Introduction to Limb Arthrology All rights reserved. This book, or parts thereof, may not be reproduced in any form Copyright © 2023 by Jenny Stanford Publishing Pte. Ltd. or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. ISBN 978-981-4877-99-2 (Hardcover) ISBN 978-1-003-37276-9 (eBook) I write this dedication with a very heavy heart, full of fond memories for my respected teacher, late Mr. Geoffrey V. Osborne, without whose constant encouragement and freedom, I could not have written this book. Such teachers are extremely rare to find these days, when the turmoil of the daily life overtakes one’s ambitions, duties, and career aspirations. I have a remarkable store of personal and academic memories of the four long years I spent with him at the University of Liverpool, UK, during which I rarely looked upon him as my teacher because he was more of a close friend and father to me. I also dedicate this book, with loving thanks, to My wife, Mrs. Nalini K. Mohan My daughter, Deepa Iyer, MBBS, MRCP (UK), FAFRM (RACP) [Honorary adjunct assistant professor, Bond University, Queensland, and senior lecturer, Griffith University and University of Queensland, Australia] My son-in-law, Kanishka B. My son, Rohit Iyer, BE (IT) My daughter-in-law, Deepti B.U. My grandsons, Vihaan and Kiaan My grandchild, Nisha Iyer Contents Foreword Acknowledgements xv xvii Section I Introduction to General Arthrology 3 I.1 Classification Based on Structure 3 I.2 Classification Based on Function 4 I.3 Types of Joints/Articulations 5 I.4 Basic Structure and General Anatomy of Joints 6 I.5 Development of Limb Buds 7 I.6 Upper Limb 9 I.6.1 Physical Examination 9 I.6.2 Paralysis of the Upper Limb 9 I.6.3 Arterial Blood Supply to the Upper Limb 10 I.6.4 Venous Drainage of the Upper Limb 11 I.6.5 Lymphatics 11 I.6.6 Muscles of the Scapular Region 12 I.6.6.1 Deltoid 12 I.6.6.2 Teres major 12 I.6.6.3 Triceps brachii 12 I.6.6.4 Supraspinatus 13 I.6.6.5 Infraspinatus 13 I.6.6.6 Teres minor 13 I.6.6.7 Subscapularis 13 I.6.7 Nerves of the Scapular Region 14 I.6.8 Arteries of the Scapular Region 15 I.6.9 Topographic Anatomy of the Scapular Region 17 I.6.10 The Human Breast 17 I.6.10.1 Introduction 17 I.6.10.2 Anatomy of human breast 18 I.6.10.3 Vessels and nerves 19 viii Contents I.6.11 Muscles of the Upper Limbs 21 I.6.11.1 Anterior compartment 21 I.6.11.2 Posterior compartment 22 I.6.11.3 Forearm 23 I.6.12 Nerves of the Upper Limbs 27 I.6.12.1 Radial nerve 27 I.6.12.2 Median nerve 28 I.6.12.3 Ulnar nerve 31 I.6.13 Hand and Wrist Anatomy 32 I.6.13.1 Bones of hand 32 I.6.13.2 Compartments of the hand 32 I.6.13.3 Dorsum of the hand 32 I.6.13.4 Palm 33 I.6.13.5 Anatomical snuff box 33 I.6.13.6 Ligaments of the upper limb 34 I.6.13.7 Synovial membrane 34 I.6.13.8 Flexor tendon zones of the hand 34 I.6.13.9 Flexor muscles of the digits 35 I.6.13.10 Digital flexor sheath 35 I.6.13.11 Extensor tendon zones of hand 36 1. Examination of tIh.6e.1 S3h.o1u2l dMeur scles of the hand 3475 1.1 Inspection 45 1.2 Palpation 46 1.3 Range of Movements 48 1.4 Neurologic Examination 50 1.4.1 Reflex Testing 53 1.4.2 Sensation Testing 53 1.5 Special Tests 54 1.5.1 Ossification of the Bones of the Shoulder 54 1.6 Special Tests for the Shoulder 59 1.6.1 Stability of the Shoulder 59 1.6.2 Biceps Tests 61 1.6.3 Impingement Tests 63 1.6.4 Other Tests 64 Contents ix 1.7 Examination of Related Areas 70 1.7.1 Sternoclavicular Joint 71 1.7.2 Acromioclavicular Joint Arthritis 73 1.7.2.1 Shoulder separation 76 1.7.3 Dislocation of the Glenohumeral or Shoulder Joint 82 1.7.4 Scapular Disorders 99 1.7.5 Frozen Shoulder 106 1.7.6 Tuberculosis of the Shoulder 115 1.7.7 Rotator Cuff Tears 116 1.7.8 Biceps Tear 126 1.7.9 Biceps Bursitis/Tendinitis 130 2. Examina1t.i7o.n1 0o f Bthrea cEhlbiaolw N euralgia 113451 2.1 Inspection 141 2.1.1 Ligaments 142 2.1.2 Fat Pads 142 2.1.3 Bursae 142 2.1.4 Blood and Nerve Supply 143 2.1.5 Structures 145 2.2 Physical Examination 147 2.3 Inspection of Elbow 148 2.4 Palpation 149 2.5 Neurologic Examination 156 2.6 Special Tests 157 2.7 Important Lines and Angles 160 3. 2Ex.8a minaEtxioanm oinf athtieo nW orifs Rt ealnadte Hda Anrde (aFsi ngers) 116615 3.1 Anatomy of the Wrist 165 3.2 Functions of Wrist Complex 170 3.3 Inspection of the Hand 172 3.4 Palpation of the Hand 173 3.4.1 Bony Palpation 173 3.4.2 Soft Tissue Palpation 176 3.5 Range of Motion 180 3.5.1 Active Range of Motion 181 3.5.2 Passive Range of Motion 182