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 Ossification centers of bones| Bones of the Upper Limb .

Carpal ossification center; distal ulna and radius ossification center; carpal ossification. Ossification of the carpal bone .

X-rays of the wrists and hands are commonly used to assess the age of the bones. In clinical research, radiographs are compared with a set of standards in the skeletal development radiographs to determine the age of the bones. Ossification centers are usually obvious in the first year; however, they can appear before birth. Each carpal bone usually ossifies from one center after birth . The centers of large bones and hook bones appear first. The axis of each metacarpal bone begins to ossify during the fetal period. The ossification center appears at the head of the four medial metacarpal bones and the bottom of the first metacarpal bone after birth. By the age of 11, all carpal ossification centers are visible .

Surface Anatomy of Upper Limb Bones:

Most upper extremity bones have a palpable segment or surface (except for the lunar and trapezoid), allowing the skilled examiner to distinguish abnormalities caused by trauma (fracture or dislocation) or deformity.

The collarbone is located under the skin and can be easily felt along its entire length. The end of the sternum protrudes above the stem of the . Between the end of the sternum where the collarbone rises is the jugular notch (suprasternal notch). The end of the acromion of the clavicle is usually higher than the acromion, forming a palpable bump at the acromioclavicular (AC) joint. The end of the acromion can be palpated 2-3 cm inside the lateral edge of the acromion, especially when the arm is alternately bent and extended. One or both ends of the clavicle may protrude; if present, this condition is usually bilateral.

Consider the elasticity of the skin above the collarbone and it can be easily clamped in a movable crease. This property of the skin helps tie (knot) the third part of the subclavian artery: the skin on the top of the clavicle is pulled onto the clavicle, and then an incision is made. After the incision, the skin is allowed to return to the position above the collarbone, where it overlaps the artery (so there is no danger during the incision).

When the collarbone passes laterally, you can feel its medial part bulge forward. The large blood vessels and nerves of the upper limbs pass behind this convex surface. The flat acromion end of the clavicle does not reach the shoulder point and is formed by the lateral tip of the acromion of the scapula. The acromion of the scapula is easy to feel and often visible, especially when the deltoid muscle contracts against resistance. The upper surface of the acromion is under the skin and can be traced to the inside of the AC joint. The lateral and trailing edges of the acromion meet to form the acromion angle (Figure 1). 3.10B). The humerus and deltoid muscles in the glenoid form the circular curve of the shoulder. The crests of the scapular spine are all over the skin and are easy to reach.

When the upper limb is in the anatomical position, the

1:superior angle of the scapula lies at the level of the T2 vertebra.

2: medial end of the root of the scapular spine is opposite the spinous process of the T3 vertebra.

3: inferior angle of the scapula lies at the level of the T7 vertebra, near the inferior border of the 7th rib and 7th intercostal space. 

The medial edge of the scapula is palpable below the spine root of the scapula when passing through the 3rd to 7th ribs. The lateral edge of the scapula is covered by teres major and teres minor, making it difficult to touch. Abduct the upper limbs, place the hands behind the head, rotate the scapula, and raise the glenoid so that the medial edge of the scapula is parallel to the sixth rib. Therefore, it can be used to estimate its position and the oblique fissure of the lung deep in the ribs. The lower corner of the scapula is easy to feel and is usually visible. Grasp it while testing the movement of the glenohumeral joint to fix the scapula. The coracoid process of the scapula can be deeply palpated on the outside of the clavicular (triangular thoracic) triangle.

The head of the humerus is surrounded by muscles except for the lower part; therefore, it can only be palpated by pushing the fingers up into the armpit (armpit). The arm must not be completely abducted; otherwise, the axillary fascia will be tight, which will hinder palpation of the humeral head. When the arm is moved and the scapula is fixed (fixed in place), the humeral head can be palpated.

The greater tuberosity of the humerus can be palpated by the deep part of the deltoid muscle below the lateral edge of the acromion with the human arm. In this position, the greater tubercle is the outermost bone point of the shoulder, which, together with the deltoid muscle, gives the shoulder a round outline. When the arm is abducted, the greater tubercle is pulled below the acromion and is no longer palpable.

The small tuberosity of the humerus can be palpated through the deltoid muscle in the front of the arm, about 1 cm outside the tip of the coracoid process, slightly lower than the tip of the coracoid process and difficult to palpate. The rotation of the arm helps to palpate the nodule. The location of the internodal groove or biceps groove between the greater and lesser nodules can be identified by palpating upwards along the long head of the biceps tendon during elbow flexion and extension, as it passes through Groove between nodules. The shaft of the humerus can be palpated with varying clarity through the surrounding muscles. No part of the proximal humeral shaft is located under the skin.

The medial and lateral epicondyles of the humerus are located under the skin and are easily accessible on the medial and lateral sides of the elbow. The medial epicondyle that protrudes posteriorly is more prominent than the lateral epicondyle.

When the elbow joint is partially bent, the lateral epicondyle can be seen. When the elbow is fully extended, the lateral epicondyle can be palpated, but not deep into the depression on the posterior and outer sides of the elbow. The olecranon is easy to reach. Palpate (Figure 3.12). When the elbow joint is extended, please note that the tip of the olecranon and the epicondyle of the humerus are in a straight line. When the elbow is bent, the olecranon descends until its tip forms the apex of an approximately equilateral triangle, and the epicondyle forms an angle at its base. Normal relationships are important in the diagnosis of certain elbow injuries (such as dislocation of the elbow joint).