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Long bone Anatomy and physiology Cortical bone (Compact bone) – Hard bone Cancellous bone (Spongy bone) – Medulary cavity. Meshwork occupied by bone marrow, fat tissue, nerves and blood vessels. Production of blood cells and provision of a vascular supply to the bone itself. Blood comes out of the bone through venous sinusoids to outgoing veins into the circulation.
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Humerus - Anatomy Long bone – The longest bone in the upper extremity. Body, Two extremities Upper extremity – Head, Lesser and Greater tubercle, neck. Intertubercular Canal. Muscles, Ligaments and other tissues around.
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Shoulder Anatomy Looking at the Shoulder Front to Back (AP) we need to locate 2 major landmarks
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Shoulder Anatomy The Acromion and the Coracoid Process
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Draw an Imaginary line between these two points Shoulder Anatomy
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In the middle of that line draw another line down, toward the Elbow. This is the Humeral Head Shoulder Anatomy
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We will be looking for the Greater Tubercle, which is palpable. Shoulder Anatomy
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Locating the Humeral Head
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First thing first – Anatomical position….
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Positioning of the patient Position the patients hand on top of the Umbilicus – this is called Abduction. Try to keep patient laying straight on his back with arm close as possible to body- this is called a Supine position When adducting the arm, the Humeral Head rotates and the GT moves forward…
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Why do we rotate the arm ? 1.To protect nerves, tendons and blood vessels. 2.To maximum expose the GT.
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Locations: Acromion – Coracoid Clavicle
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Reminder: The shoulder should be Adducted. The palm of the hand should be placed on the Umbilicus. Acromion – Coracoid approach (1):
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Draw the imaginary line connecting the Acromion and the Coracoid Process. Acromion – Coracoid approach (2):
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From the midpoint of the line, go 2 fingers Distally (This is the Humeral Head) Acromion – Coracoid approach (3):
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In certain patients the area where the Humeral Head is closest to the skin is one finger Anteriorly (Toward the Chest) Acromion – Coracoid approach (4):
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Follow the Clavicle to the Lateral end of the Acromion Clavicular approach (1)
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Go 2 fingers Distally (Toward the Elbow), This is the Humeral Head Clavicular approach (2)
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In certain patients the area where the Humeral Head is closest to the skin is one finger Anteriorly (Toward the Chest) Feel the Greater Tubercle. Clavicular approach (3)
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Summary: Draw the imaginary line connecting the Acromion and the Coracoid Process. From the midpoint of the line, go 2 fingers Distally (This is the Humeral Head) In certain patients, in addition: Go one finger Anteriorly (Toward the Chest) Clavicular approach (4)
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Location *Once located the insertion site, confirm the exact position, by verifying the Greater Tubercle’s outer margins.
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Avoid this…
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