Volgograd state medical university Anatomy chair Bones of the upper and lower limbs. There development in phylo- and ontogenesis. Variants and anomalies of upper and lower limbs. A.I. Perepyelkin 2010 The upper and lower limbs. One of the paired appendages of the body used in locomotion or grasping. In humans, an arm or a leg (upper limb or lower limb) with all its component parts (e.g. arm, forearm, and hand); called also membrum [NA] and, formerly, extremitas. Phylogenesis A prototype of limbs of the vertebrate are pair fins of fishes which consist from cartilages rays and represent the simple flexible lever formed under the influence of movement in the liquid environment. Phylogenesis The scapula The primitive reptilian shoulder girdle comprises a dorsal element—the scapula — and two ventral elements, of which the anterior (cranial) is the precoracoid and the posterior (caudal) is the coracoid. The primitive girdle of the lower limb also possesses three elements, of which the ilium is homologous with the scapula, the pubis with the precoracoid and the ischium with the coracoid. The clavicle, which is a membrane bone and therefore morphologically distinct from the others, is an additional element in the shoulder girdle and is not represented in the pelvic girdle. Phylogenesis The scapula The clavicle is absent in animals in which the forelimbs are used principally or entirely for progression, e.g. the ungulates and carnivores, but it is present and well developed in animals which use the limb for prehension, e.g. many rodents, the primates and man. Phylogenesis At ground animals in connection with living conditions there is a transformation of a fin into five-fingered limbs. Phylogenesis The skeleton of the free limb ground vertebrate owing to transition to other way of life strongly changes, though the radiant structure peculiar to fishes, at them remains, being reduced to five rays. Phylogenesis The skeleton of each limb is divided into four main parts: the zonoskeleton, comprising the scapula and clavicle (as a unit) and the hip bone; the stylopodium, comprising the humerus and femur; the zygopodium, comprising the radius and ulna and the tibia and fibula; and the autopodium, comprising the hand and the Phylogenesis The man, unique of all primaties, goes in vertical position, leaning only against back limbs which became lower at it, being on continuation of a vertical axis of a body. Phylogenesis The forward limbs which have become at the person owing to its vertical position, have lost the function of the locomotion. Owing to the labour activity which has allocated the person from circle of animals, they have turned in grasping organ of the body adapted for performance of various and thin movements, necessary for operation. Though forward limbs carry out catching function at monkeys, only at the person hand became the organ of the work. Phylogenesis The hand is adapted to labour activity. The carpal bones decrease. On the contrary, fingers are extended and become rather mobile. The thumb is set aside and can be opposed to all other fingers, including and V finger which a monkey cannot do. Some of them cannot reach a thumb not further III finger. Besides a thumb of them is short. Owing to such structure of the hand of the man is capable not only to grasp a subject how it takes place at anthropoids, but also to clasp it, what is of great importance for catching functions of the hands during the work. All these features of a structure of the upper limb of the person have resulted from improvement of a hand in the course of labour activity. Therefore, how the Frederick Engels said, a hand it is organ of work and at the same time is its product. Phylogenesis The lower limbs of the person serve only for the body movement in the space and at the same time they support everything which is above them. Therefore bones of the lower limbs are more thickly and massive. The mobility between them is less, than at the upper limbs. Phylogenesis Foot as a final support of a body has lost properties the grasping foot which are available for monkeys. Foot has got the form of the arch: a kind of a spring smoothing pushes and concussions in the process of walking and the running. Embryology The first rudiments of limbs at the person appear on 3rd week of embryonal lives in the form of horizontal ledges on each side bodies of the germ, reminding fins of fishes. Ledges extend in the round plate (a rudiment of a hand and foot), in which it is not yet possible to distinguish fingers. Thus, the development of separate links of limbs proceeds in following order: at first the distal links, then averages and, at last, the proximal as though from a trunk grows at development of the upper limb at first the hand, then a forearm and, at last, a shoulder. So, the hand appears from the trunk. The development of the lower limb take places in following order: the foot, the shin and the hip. A human embryo about 9 mm. long. At end of fifth week. (Drawn from stereoscopic photograph of the embryo after fixation.) Towards the end of the fourth week the limbs appear as small elevations or buds from a slight lateral ridge at either side of the trunk. The upper limb bud appears on the lateral body wall at the level of the lower cervical segments and the lower limb bud at the level of the lumbar and upper sacral segments. Each bud consists of a core of somatopleuric mesenchyme covered by ectoderm; at the apex of the limb bud the ectoderm forms a ridge, the apical ectodermal ridge. The example of some pathology. This is sequence of development. The first appears hand from the trunk. The hand appears and something went wrong. That interfered with of normal development of upper limb. The upper and lower limbs are constructed after a common type, but the different functions for which they have become adapted in man have led to structural differences of a very definite kind. Each limb has a girdle, which connects it to the trunk, and three segments. The terminal segment in the upper limb is the hand which is specially adapted for prehension. In the lower limb the terminal segment is the foot which is primarily adapted to constitute an efficient supporting base for the body in the erect attitude, but it is, at the same time, constructed in such a manner as to facilitate locomotion. In order to obtain the full benefit of the prehensile character of the hand, the upper limb is characterised by the wide range of movement which it enjoys—in some situations, e.g. the shoulder joint, actually at the expense of stability. In the lower limb, on the other hand, the demand for stability is the prime factor, and stability is assured, even although some degree of mobility may be sacrificed for the purpose. The shoulder girdle The bones by which the upper and lower limbs are attached to the trunk constitute, respectively, the shoulder and pelvic girdles. The shoulder girdle, which is formed by the scapulae and the clavicles, is deficient both in front and behind. In front, however, it is completed by the upper end of the sternum, with which the medial ends of the clavicles articulate. Behind, the scapulae are separated from each other by a wide gap and are connected to the trunk by muscles only. The pelvic girdle The pelvic girdle is formed by the hip bones, which articulate with each other in front at the pubic symphysis so that the girdle is complete anteriorly. Posteriorly the girdle is incomplete, but the gap is filled by the upper part of the sacrum, with which the hip bones articulate. The pelvic girdle, with the sacrum, forms a complete ring, massive and comparatively rigid, in marked contrast with the lightness and mobility of the shoulder girdle. The upper limb The scapula The scapula is a large, flattened, triangular bone which lies on the posterolateral aspect of the chest wall, covering parts of the second to the seventh ribs. It presents for examination costal and dorsal surfaces, upper, lateral and medial borders, inferior, superior and lateral angles and three bony processes., viz., the spine, its continuation the acromion, and the coracoid process. The lateral angle is truncated and bears the glenoid cavity for articulation with the head of the humerus. This part of the bone may be regarded as the head, and it is connected to the plate-like body by an inconspicuous neck. The scapula Structure: The head, processes, and thickened parts of the scapula contain spongy bone; the rest consists of a thin layer of compact bone. The central part of the supraspinous fossa and the greater part of the infraspinous fossa are thin; occassionally the bone is wanting in these situations, the gaps being filled by fibrous tissue. The clavicle The clavicle lies almost horizontally at the root of the neck and is subcutaneous throughout its whole extent. It acts as a prop which braces back the shoulder and enables the limb to swing clear of the trunk and transmits part of the weight of the limb to the axial skeleton. The lateral or acromial end of the bone is flattened and articulates with the medial side of the acromion, whereas the medial or sternal end is enlarged and articulates with the clavicular notch of the manubrium sterni. The shaft is gently curved and in shape resembles the italic letter f, being convex forwards in its medial two-thirds and concave forwards in its lateral third. The inferior aspect of the intermediate third is grooved in its long axis. Humerus (плечевая кость) The humerus is the longest and largest bone of the upper limb. It comprises expanded upper and lower extremities and a shaft. The rounded head occupies the upper and medial part of the upper end of the bone. The lesser tubercle (tuberosity) projects from the front of the shaft, close to the head, and is limited on its lateral side by a wellmarked groove. Humerus (плечевая кость) The upper end of the humerus consists of the head, and the greater and lesser tubercles. The head of the humerus forms rather less than half a sphere, and its smooth surface is covered with hyaline articular cartilage in the unmacerated specimen. When the arm is at rest by the side, it is directed medially, backwards and upwards to articulate with the glenoid cavity of the scapula. The humeral articular surface is much more extensive than the glenoid cavity, and only a portion of it is in contact with the cavity in any one position of the arm. Humerus (плечевая кость) The anatomical neck of the humerus immediately adjoins the margin of the head and forms a slight constriction, which is least apparent in the neighbourhood of the greater tubercle. The upper end of the humerus joins the shaft at the surgical neck which is closely related on its medial side to the axillary nerve and posterior humeral circumflex artery. Humerus (плечевая кость) The lower end of the humerus, which constitutes the condyle, is expanded transversely, and presents articular and non-articular portions. The articular portion takes part with the radius and the ulna in the formation of the elbow joint. It is divided by a faint groove into a lateral, convex surface, termed the capitulum, and a medial, pulley-shaped surface, termed the trochlea. The skeleton of the hand The carpus comprises eight short bones, which are arranged in a proximal and a distal row, each containing four bones. The bones of the proximal row are named, from the lateral to the medial side, the scaphoid, lunate, triquetral and pisiform; those of the distal row, the trapezium, the trapezoid, the capitate and the hamate. Of these, the pisiform is placed on the palmar surface of the triquetral and is separated from the other carpal bones, all of which articulate with their immediate neighbours. The other bones of the proximal row form an arch convex proximally, which articulates with the radius and the articular disc of the inferior radio-ulnar joint. The concavity of the arch is directed distally and forme a mortise for the proximally projecting parts of the capitate and hamate bones. In this way the two rows are locked to each other and stability is assured. The skeleton of the hand The metacarpus comprises five metacarpal bones, which are numbered from the lateral to the medial side. They are miniature long bones, and each possesses a rounded head, a shaft and an expanded base. The skeleton of the hand The phalanges are fourteen in number, three for each finger and two for the thumb. Each has a head, a shaft and a base or proximal end. In each the shaft tapers to its distal end and its dorsal surface is convex from side to side. The palmar surface is flattened from side to side, but is gently concave forwards in its long axis. The bases of the proximal phalanges are marked by concave, oval facets for articulation with the heads of the metacarpal bones. Their heads are pulley-shaped and encroach farther on the palmar than on the dorsal surfaces. Ossification of the bones of the hand Knowledge of the date of the ossification of the hand bones helps to determinate of the biological age of the patient in the clinical practice. The lower limb Hip The hip bone is a large, irregularly shaped bone, constricted in the middle and expanded above and below. Its lateral surface is marked near its middle by a deep, cupshaped hollow, termed the acetabulum, which forms a secure socket for the rounded head of the femur. Below and in front of the acetabulum the bone presents a large, oval, or triangular gap, termed the obturator foramen. Above the acetabulum the bone forms a wide, flattened plate, with a long, curved upper border termed the iliac crest. Hip The hip bone articulates in front with the corresponding bone of the opposite side and the two bones form the pelvic girdles of the lower limbs. Each consists of three parts, named the ilium, the ischium and the pubis, which are connected by cartilage in the young subject but are united by bone in the adult; the union of the three parts takes place in the walls of the acetabulum. The ilium includes the upper part of the acetabulum and the expanded, flattened area of bone above it; the ischium includes the lower part of the acetabulum and the bone below and behind; the pubis forms the anterior part of the acetabulum and separates the ilium from the ischium in this situation; in addition, it forms the anterior part of the lower portion of the hip bone and meets the pubis of the opposite side in the median plane. The pelvis, so-called from its resemblance to a basin, is a massive bony ring interposed between the movable segments of the vertebral column, which it supports, and the lower limbs, upon which it rests; it is composed of the two hip bones laterally and in front, and the sacrum and coccyx behind. It is divided into the greater (false) and the lesser (true) pelvis by an oblique plane; this passes through the promontory of the sacrum behind and the linea terminalis, formed by the arcuate line of the ilium and the pecten pubis on each side and the pubic crest in front. These two subdivisions communicate with each other through the superior pelvic aperture. Differences between the male and female pelvis Sexual characters are more pronounced in the bones of the pelvis than in any other bones in the body. The female pelvis is specially adapted to facilitate the passage of the foetal head during parturition and it must therefore provide more accommodation than is necessary in the male pelvis, while its depth must be diminished. The essential differences are well summed up by the statement that the male pelvis is a long section of a short cone and the female pelvis is a short section of a long cone. There are, however, very many differences in detail, most of which can be referred to these fundamental distinctions. Differences between the male and female pelvis As a whole, the bones of the female pelvis are more delicate and their muscular impressions are not so well marked. The ilia are more vertical and the distance between the iliac crests is less in the female. As a rule, the iliac fossae are shallower and the curves of the crest, as seen from above, are not so pronounced. The prominence of the hips in the female may be attributed, in part, to the sexual characters of the ilium. Differences between the male and female pelvis The superior aperture of the lesser pelvis is larger in the female and is more nearly circular in outline; in the male it is typically heart-shaped. The cavity of the female pelvis is wider and shallower, and, in the production of this general difference, the following factors are to be noted. (1) The sacrum is shorter and wider in the female and its upper part is straight. (2) The distance between the two pubic tubercles is greater in the female. (3) The sciatic notches are wider and the spines of the ischia do not project inwards to the same extent as they do in the male. The inferior aperture is larger in the female, since (1) the pubic arch is wider and more rounded; whereas in the male it is more pointed and usually much less than a right angle; (2) the ischial tuberosities are more everted; and (3) the coccyx is more movable. The male pelvis possesses one positive sexual character: the margins of the pubic arch are more everted, owing to the larger size of the crura of the penis. The following additional differences should also be mentioned. (1) The acetabula are smaller in the female: they are wider apart and face more definitely forwards. * As a result the transverse diameter of the acetabulum is distinctly less than the distance from its anterior margin to the pubic symphysis. In the male, on the other hand, the two measurements are practically equal Differences between the male and female pelvis The obturator foramen is shorter in the female and tends to be triangular in shape. In the male it is more nearly oval in outline, but this difference is not of great value as a sexual character. The pre-auricular sulcus is better developed in the femaleilium, and this is presumably associated with the existence of a more movable sacro-iliac joint. Despite assertions to the contrary, the auricular surface of the sacrum extends on to the third sacral vertebra in both sexes. Four main types of female pelvis are recognisable according to the shape and dimensions of the superior and inferior apertures, shape and depth of the cavity of the lesser pelvis, dimensions and inclination of the sacrum and other characteristics. The gynaecoid type of pelvis displays the typical characteristics of the female as described above. The android type approaches more to the typical male type with a heart-shaped superior aperture, somewhat funnelshaped pelvic cavity, narrow pubic arch and long narrow sacrum. In the anthropoid type the superior aperture is oval, the anteroposterior exceeding the greatest transverse diameter, the cavity is deep, the inferior aperture is long and narrow but the angle included by the pubic arch approaches 90°. In the platypelloid type the superior aperture has a greater transverse than anteroposterior diameter, the inferior aperture is short and wide, the walls of the lesser pelvis diverge as they pass downwards and the pubic arch is wide. Many pelves are intermediate between these types. Some relation exists between the body build and the possession of a gynaecoid or android type of pelvis. Femur The femur, or thigh bone, is the longest and strongest bone in the body. It possesses a shaft and two extremities. The shaft is almost cylindrical in most of its length, and is curved with a forward convexity. The head, which is rounded, can easily be distinguished from the widely expanded lower end: it projects from the medial side of the upper end of the shaft. In the erect posture the femora are placed obliquely. Their heads are separated by the breadth of the lesser pelvis and their shafts incline downwards and medially, so that the medial sides of the two knees almost touch. As the bones of the legs descend vertically from the knees, the obliquity of the femoral shafts results in the approximation of the feet in the erect attitude and the provision of a narrow base for the support of the weight of the body. The narrowness of the base detracts from the stability of the body but greatly facilitates movements and increases the speed with which they can be executed. The degree of obliquity of the shafts varies in different individuals, but is usually greater in women on account of the greater breadth of the pelvis. The upper end of the femur comprises a head, a neck, a greater and a lesser trochanter. The lower end of the femur and the upper end of the two bones of the leg form the knee joint. Comparison of the girdles of the upper and lower limbs.—The importance of mobility in the upper limb as contrasted with the necessity for stability in the lower limb is well illustrated by the more obvious differences which exist between the two girdles. Girdle of Upper Limb. Consists of two separate bones, viz., the scapula and the clavicle. Reaches the axial skeleton only at the sternoclavicular joint. Is not directly connected to its fellow of the opposite side, except by the interclavicular ligament. Has a shallow fossa for the head of the humerus. Girdle of Lower Limb. Consists of a single bone, viz., the hip bone. Articulates with the vertebral column at the sacro-iliac joint. Articulates with its fellow of the opposite side at the pubic symphysis. Has a deep cup for the head of the femur. The fracture of the left clavicle The clavicle is very frequently fractured. The most common cause is indirect violence, as the result of force applied to the hand or shoulder, and the bone then gives way at the junction of its lateral with its intermediate third, that is to say, at the junction of the two curves, for this is its weakest part. draws it downwards. The medial fragment, as a rule, is little displaced. The greenstick (willow) fracture of the forearm bones of the 8-ages boy. The fracture of the distal end of the radius of the child. The line of fracture passes through the epiphyseal line (growing zone). So fracture in children is known as epiphysiolisis. The fracture of the distal end of the radius of the child. The fracture is known as classical (typical) fracture of the radius. It is termed the Colles’ fracture. The fracture of the shaft of the femur The fracture of the shaft of the child’s femur with forms a large callus Congenital abnormalities of upper and lower limb The study of congenital abnormalities is known as teratology. Of the causative environmental factors responsible for congenital abnormalities only a few have so far been identified. These include radiation, maternal infection, notably with the virus of rubella (German measles) or toxoplasma organism, acute folic acid deficiency during pregnancy and the administration of certain chemicals and many other factors. Foetal abnormalities may result from incompatibility of the maternal and foetal bloods. When an Rh positive foetus is conceived by an Rh negative mother, the antigen stimulates the production in the mother of the antibody which passes through the placenta and adversely affects the foetus. The radiograph of the patient 5 years old with congenital dislocation of the left hip The child with congenital absent of the both humerus, forearm and hand. The person with congenital abnormalities of the upper and lower limbs