(Netter Basic Science) Frank H. Netter - Atlas of Human Anatomy-Elsevier (2018)

Structures with High* Clinical Significance
ANATOMICAL STRUCTURES
Clavicle
Humerus
Ulna
Radius
Scaphoid
SKELETAL SYSTEM
MUSCULAR SYSTEM
Rotator (compressor) cuff
muscles
Supraspinatus tendon
Biceps brachii tendon
Long head of biceps brachii
Posterior forearm muscles
Anterior forearm muscles
CLINICAL IMPORTANCE
Most clavicular fractures are caused from a fall on an outstretched arm or direct
trauma delivered to the lateral side of the shoulder. Middle third of the clavicle is
most commonly fractured due to the changing bony morphology of the clavicle, its
strutlike function, and ligament attachments.
The proximal humerus, especially the surgical neck, is fractured due to low-energy
falls in the elderly and high-energy trauma in youth. The axillary nerve is in harm’s
way and the circumflex humeral arteries can be injured. Midshaft fractures are also
relatively common and place the radial nerve in harm’s way.
Subcutaneous location of olecranon makes it vulnerable to fracture by direct trauma,
especially when elbow is flexed; ulnar styloid process may also be fractured in
distal radial fractures
Fractures of distal radius are most common fracture of upper extremity, typically
caused by fall on outstretched hand
Most commonly fractured carpal bone; fracture is often due to fall on outstretched
hand
Injuries to this group of muscles can be from an acute injury or chronic overuse injury
leading to common causes of shoulder pain and disability
Most commonly injured rotator (compressor) cuff muscle tendon complex. Often torn
beneath the acromion
Proximally the long head of the biceps tendon tears in the elderly from falls on an
outstretched arm, and distally the biceps tendon is used to perform flexor
compartment reflex assessing the C5 and C6 spinal nerves
When long head has been ruptured, it pulls off supraglenoid tubercle and retracts
down into arm; muscle bulges (Popeye deformity) at midshaft of humerus
Repetitive use of muscles arising from common extensor origin can damage tendons
and produce pain over lateral epicondyle, associated with tennis elbow
Repetitive use of muscles arising from common flexor origin can damage tendons and
produce pain over medial epicondyle, associated with golfer’s elbow
PLATE
NUMBERS
408, 409
409–411
426, 429
429
439, 440, 442
412, 415, 422
415–417, 422
421, 423
421
431
432, 433
NERVOUS SYSTEM
Long thoracic nerve Injury may produce “winged scapula” caused by denervation of serratus anterior 417, 419
Axillary nerve
Median nerve
Recurrent branch of median
nerve
Ulnar nerve
Radial nerve
Table 7.1
Position of nerve close to medial aspect of humeral head makes it vulnerable to injury
with fractures of surgical neck of humerus or humeral dislocations
Commonly compressed in carpal tunnel, producing pain and paresthesia in lateral
three and one-half digits
422
450, 466
May be injured in superficial lacerations of palm over thenar eminence 449
Vulnerable to compression or injury where it passes posterior to medial epicondyle of
humerus, and at wrist in ulnar tunnel (Guyon’s canal)
Vulnerable to compression or injury where it lies against humerus in radial groove
(e.g., with humeral fracture); common symptom is “wrist drop” due to weakness of
wrist extensors
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463, 467
468, 469
Clinical Tables