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RADIOLOGICAL ANATOMY OF UPPER LIMB BY DR BHASKAR 2ND YEAR RESIDENT IN SVIMS
Th e upper limb consists of the shoulder, arm, forearm and hand.
Those regions are connected by the shoulder, elbow and wrist joints overlain by transitional zones, the axilla, antecubital fossa and carpal tunnel, which facilitate the passage of neurovascular structures.
SHOULDER JOINT
The three bones that make up the shoulder joint include the clavicle (collarbone), scapula (shoulder blade), and humerus (long bone of the arm).
The shoulder has two joints that work together to allow arm movement.
The acromioclavicular (AC) joint is a gliding joint formed between the clavicle and the acromion. The acromion is the projection of the scapula that forms the point of the shoulder. The AC joint gives us the ability to raise the arm above the head.
The glenohumeral joint, or shoulder joint, is a ball-and-socket type joint. The "ball" is the top, rounded part of the humerus, and the "socket" is the bowl-shaped part of the scapula, called the glenoid, into which the ball fits. This joint allows the arm to move in a circular rotation as well as towards and away from the body.
Shoulder has great mobility at the cost of stability & most vulnerable joint for Injury.
Articular surface incongruity is the cause for instability. Stability of the joint maintained by
coracoacromial arch or secondary
socket
musculotendinous cuff of the shoulder
deepening of the glenoid cavity by the glenoid labrum.
muscles attaching humerus to the
pectoral girdle.
LIGMENTS
GLENOID LABRUM
CAPSULAR LIGAMENT
GLENOHUMERAL LIGAMENT
CORACOHUMERAL LIGAMENT
TRANSVERSE HUMERAL LIGAMENT
CORACOACROMIAL LIGAMENT
CORACOCLAVICULAR LIGAMENT
MUSCLES OF THE ROTATORY CUFF Rotator cuff is a structure formed by supra spinatus,infraspinatus,teres minor and
subscapularis muscles and their connection with articular capsule of the shoulder joint and attachments of tendons to humerus.
TUBERCULUM MAJUS Supraspinatus Infraspinatus Teres minor
TUBERCULUM MINUS Subscapularis In childhood the particular muscles of the rotator cuff can be differentiated. In
maturity these muscles are fussed, and it is not possible to differentiate the particular muscles in the cuff.
PLAIN X-RAY
Provides a comprehensive anatomical overview at low cost and low radiation dose, generally, the first imaging test.
Combined with the clinical assessment, plain films alone will often allow a reasonable provisional diagnosis and management plan to be formulated without the need for more sophisticated tests.
Regular views
AP Internal & External rotation
Axillary
Specialized views
Abduction ( Baby arm ) view
Grashey’s or Glenoid cavity view
Y view or Lateral scapular view
Apical oblique view
Stryker notch
West point view
Outlet or Tunnel views
AP Internal Rotation ProjectionPart Position: The patient is rotated to be at 30° to the bucky. The coracoid is centered to the bucky and the arm internally rotated until the elbow epicondyles are perpendicular to the film
Demonstrates
the position of the humeral head relative to the glenoid fossa by tracing the smooth transition from the medial humerus across the glenoid fossa to the axillary border of the scapula, creating a smooth continuous arc.
Specifically outline the greater and lesser tuberosities. The distal clavicle, scapula, and upper ribs are also visible.
AP External Rotation ProjectionPart Position: The patient is rotated to 30° to the bucky. The coracoid is centered to the bucky, and the arm externally rotated until the elbow epicondyles are parallel to the film.
Demonstrates
Alignment: Elevation of the humerus within the glenoid fossa is a sign of rotator cuff tendon tear.
Additional landmarks are the distance between the undersurface of the acromion and the opposing humeral head (acromiohumeral space, normally 10 mm) and glenohumeral joint space (4-6 mm).
Abduction ProjectionPart Position: The patient’s back is flat to the bucky. The arm is abducted to 90°, the elbow is flexed to 90°, and the palm of the hand faces the tube. Demonstrates
Alignment: Elevation of the humerus within the glenoid is a sign of rotator cuff tendon tear and is accentuated more in this view than in any other projection; it is judged abnormal when the space is < 5 mm (acromiohumeral distance). The distal clavicle and acromion should be aligned.
The greater and lesser tuberosities are superimposed and approximate the undersurface of the acromion. At the scapula the glenoid rim, scapula neck, axillary border, acromion, coracoid, and spine can all be identified.
Axillary view
Demonstrates: glenohumeral joint narrowing (best view), Os Acromionale, glenoid version, glenoid erosion, humeral head subluxation.
Helpful for: determining the amount of acromion which remains in patients who have undergone previous surgery; relation of humeral head to glenoid; Hill-Sachs lesions, Os Acromionale, AC joint, Shoulder dislocation,
Scapular Y view
Demonstrates: lateral projection of scapular body and humeral head overlapping the glenoid.
Helpful for: Shoulder dislocation;Proximal humerus fx. ; scapular body fracture
Neer view , Supraspinatus Outlet view
Demonstrates: outlet/impingement of the supraspinatus and coracoacromial arch.
Helpful for: Subacromial impingement, assessing acromial morphology, unfused acromial epiphysis.
APVIEW
IN ANTERIOR DISLOCATION
Humeral head and glenoid surfaces are not alignedThe humeral head lies below the coracoid
Y VIEW
The humeral head lies anterior to the glenoid and inferior to the coracoid process
The humeral head surface is no longer aligned with the glenoid.The humeral head lies anterior to the glenoid
Posterior dislocation
The glenohumeral joint is widened
Cortical irregularity of the humeral head indicates an impaction fracture
Following posterior dislocation the humerus is held in internal rotation and the contour of the humeral head is said to resemble a 'light bulb
Posterior shoulder dislocation - Y view
The humeral head (blue line) no longer overlies the glenoid (red line)
The correct position of the humeral head is shown (green line
Glenohumeral joint Superiorly coracoacromial arch and coracoacromial ligament long head of the biceps tendon tendon of the supraspinatus muscle
Anteriorly anterior labrum glenohumeral ligaments SGHL, MGHL, IGHL (anterior band) subscapularis tendon
Posteriorly posterior labrum posterior band of the IGHL infraspinatus and teres minor tendon
ACJ
The ACJ is a plane synovial joint between the lateral surface of the clavicle and the medial surface of the acromion.
Stabilization is by a combination of static reinforcement by ligaments and dynamic reinforcement by muscles.
LIGAMENTS
Acromioclavicular ligament
coracoclavicular ligament
conoid ligament(main stabilizer in preventing superior and anterior displacement and rotation )
trapezoid ligament(e main stabilizer in the posterior direction and limits rotation)
coracoacromial ligament(protecting the humerus from superior subluxation)
. MUSCLES
deltoid
trapezius
Mechanism
.Direct blow to the acromion with the shoulder in the adducted position.
.The scapula is pushed inferoanteriorly relative to the clavicle with resulting sequential stretching or tearing of the acromioclavicular ligaments, coracoclavicular ligaments, and trapezius insertion
Acromioclavicular joint Acromioclavicular joint (ACJ) - Normal
The inferior margins of the acromion and clavicle are well aligned (red lines) indicating integrity of the acromioclavicular ligaments
The coracoid is not widely separated from the clavicle - this indicates integrity of the coracoclavicular ligaments.
Acromioclavicular joint disruption
The inferior surfaces of the clavicle and acromion are not aligned - indicating disruption of the acromioclavicular ligaments
The coracoclavicular distance is also wide - indicating coracoclavicular ligament injury
LIGMENTS
GLENOID LABRUM
CAPSULAR LIGAMENT
GLENOHUMERAL LIGAMENT
CORACOHUMERAL LIGAMENT
TRANSVERSE HUMERAL LIGAMENT
CORACOACROMIAL LIGAMENT
CORACOCLAVICULAR LIGAMENT
GLENOID LABRUM
It’s a fibrocartilagenous rim attached to margin of glenoid cavity
It further strengthens by long head of biceps origin and sup glenohumeral ligament
It is a STATIC stabiliser of joint and prevents excessive rollback of humerus
Sublabral recess
JOINT CAPSULE
It is lax and attaches along epiphyseal lines of glenoid and humeral head and extends onto surgical neck medially.
Capsule is surrounded by synovial
membrane which prolongs along
tendon of biceps as tubular sheath.
APPLIED ANATOMY-OSTEOMYELITIS of humerus upper end spreads directly to joint due to capsule extension to medial side of neck
GLENOHUMERAL LIGAMENTS The glenohumeral ligaments (GHLs), joint capsule, and glenoid labrum are parts of
the passive stabilizing mechanisms of the glenohumeral joint.
The GHLs are localized thickenings of the glenohumeral joint capsule that extend from the anterior and inferior glenoid margin of the joint to the anatomical neck of the humerus.
Three ligaments have been described:
1)the superior glenohumeral ligament (SGHL)
2) the middle glenohumeral ligament (MGHL)
3)the inferior glenohumeral ligament (IGHL)
which are composed of an anterior band, a posterior band, and an axillary recess.
The main two functions of the GHLs are
A) avoid superior-inferior translation
B) to maintain anterior stability
GLENOHUMERAL LIGAMENTS
SUPERIOR-It is the most superior capsular thickening from labrum anterior to long head of biceps at level of coracoid base
It passes under supraspinatus and inserts on ANATOMICAL NECK medial to anterosuperior base of lesser tuberosity.
MIDDLE
MIDDLE GLENOHUMERAL-most variable in size
Arises just inferior to superior GHL and inserts along middle area of ANATOMICAL NECK opposite to lesser tuberosity
Inferior glenohumeral ligament
sometimes referred to as the inferior glenohumeral ligament complex 4
runs from the inferior two-thirds of the glenoid labrum and/or neck to the lateral humerus
composed of three parts: anterior band
posterior band
axillary pouch: laxity between anterior and posterior bands
most important of the three GHLs as it prevents dislocation at extreme range of motion and is the main stabiliser of the abducted shoulder
APPLIED ASPECTS OF GLENOHUMERAL LIGAMENTS
They restrain the selective arcs of abduction and external rotation.
In arm dependent position all are slack.
The SUPERIOR GHL is primary resistrant to inferior translation of adducted shoulder
The MIDDLE GHL limits external rotation at 45* of abduction
The INFERIOR GHL limits external rotation at 45 to 90* of abduction[mainly superior band of it].
CORACOHUMERAL LIGAMENT-arises from lateral base of coracoid process and extends onto both tuberosities.
It forms roof of bicipital tendon sheath and strengtens capsule anteriorly.
Importance-resists inferior and posterior translation.
.
TRANSVERSE HUMERAL LIGAMENT-bridges upper part of bicipital groove through which long head of biceps passes down
It’s a trapezoidal ligament from base of acromian to apophysis of coracoid
It along with coracoid and acromian forms CORACOACROMIAL ARCH which is a SECONDARY SOCKET to humerus head.
It plays role in resisting upward displacement of humerus
MUSCLES OF THE ROTATORY CUFF Rotator cuff is a structure formed by supra spinatus,infraspinatus,teres minor and
subscapularis muscles and their connection with articular capsule of the shoulder joint and attachments of tendons to humerus.
TUBERCULUM MAJUS Supraspinatus Infraspinatus Teres minor
TUBERCULUM MINUS Subscapularis In childhood the particular muscles of the rotator cuff can be differentiated. In
maturity these muscles are fussed, and it is not possible to differentiate the particular muscles in the cuff.
Muscles Relating to the Shoulder Joint which do not form the Rotatory Cuff.Biceps brachii
.Deltoid.
.Teres major.
.Coracobrachialis
.Rhomboidei.
.Latissimus dorsi.
.Trapezius.
.Pectoralis major & minor.
.Triceps brachii.
.Levator scapulae.
.Serratus anterior
MUSCLE ORIGIN INSERTION NERVE SUPPL ACTION
DELTOID-4septa originAnt border lat 1/3rd clavicleAcromian lateral borderLower lip crest of spine of scapula
Deltoid tuberosity on humerus
Axillary nerve[c5,6] Acromial fibres-abductors From90*Anterior fibres-flexors and medial rotatorsPosterior fibres-extensors and lateral rotators
SUPRASPINATUS-medial2/3Of supraspinatus fossa
Greater tubercle upperimpresi
Suprascapular nerve[c5,6]
Initiator of abduction0*15* steadies humeralhead
INFRASPINATUS-medial2/3 of infraspinatus fossa
Greater tubercle Suprascapular nerve[c5,6]
Lateral rotator of arm
TERES MINOR-Upper2/3 of dorsal surface of scapula
Greater tubercle Axillary nerve[c5,6] Lateral rotator of arm
SUBSCAPULARIS-medial 2/3 of subscapular fossa
Lesser tubercle Upper ,lower subscapular N
Medial rotator and adductor of arm
BICEPS-Short head-tip of coracoidLong head-supraglenoid
Radial tuberosity of posteriorly
Musculocutaneous nerve[c5,6]
Strong supinator when forearm flexedFlexor of elbowShort head-arm flexorLong head-prevents upward displacement
Teres minor lateral border of scapula
Greater tubercle External rotation
Table of page 143 chaurasia
MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION
PECTORALIS MAJORAnt surface of claviclAnt manubrium[ant lamina]2nd-6th coastal cartilageExternal oblique abdominus aponeurosis[post lamin]
Bilaminar tendon on lateral lip.two lamina are continous Fibres from sternum and aponeurosis are twisted and inserted
Medial and lateral pectoral nerve
Adduction and medial rotation of shoulderClavicular-arm flexorSternoclavicular part-extension of flexed arm against resistance
LATTISMUS DORSI-Outer lip of iliac crest post 1/3rd
Posterior layer of lumbar fasciaT7-12 spinous processLower 4ribsInf angle scapula
Winds round lower border of teres major and forms posterior axillary foldTendon is twisted upside down insert into intertubercular sulcus of humerus
Thoracodorsal nerve[c6,7,8]
Adduction,extension,medial rotation of shoulderHelps in voilent expiratory effortClimbing muscleHolds inferior angle of scapula in place
TERES MAJOR-Lower 1/3rd of dorsal surface of lateral and inferior angle scapula
Medial lip of bicipital groove
Lower subscapular nerve[c5,6]
Medial rotator and adductor arm
Anatomy of the rotator cuff interval.
Sagittal T1-weighted fat-suppressed MR arthrogram image shows the
rotator cuff interval, defined by the borders of the supraspinatus tendon
(white arrow) and subscapularis tendon (white curved arrow). The rotator
interval capsule (black arrow) and long head of the biceps tendon
(arrowhead) 56
MR imaging can provide information about
1)rotator cuff tears such as
A) tear dimensions,
B) tear depth or thickness,
C) tendon retraction,
D) tear shape that can influence treatment selection and help determine the prognosis.
In addition,
A) tear extensionto adjacent structures,
B)muscle atrophy,
C)size of muscle cross-sectional area, and fatty degeneration
Rotator cuff tears can be classified according to size.
DeOrio and Cofield (40) classified rotator cuff tears on the basis of greatest dimension as
either small (1 cm),
medium (1–3 cm),
large (3–5 cm), or
massive (5 cm) .
The dimensions of rotator cuff tears may have implications
for selection of treatment and surgical approach,
postoperative prognosis, and tear recurrence.
SUBACROMIAL BURSA-
protect suprspinatus
SUBSCAPULARIS BURSA
INFRASPINATUS BURSA
SUBACROMIAL BURSA extends from below the acromion, over
the shoulder and the greater tuberosityof the humerus
laterally, the bursa lies over the superior surface of the supraspinatus and infraspinatus tendons
it sits deep to the deltoid muscle
STANDARD POSITION
Patients are placed in the supine position with the arm beside the body for most indications. There is no consensus regarding arm rotation.
In general, an approximately neutral position of the arm is obtained by asking the patient to place his hand at the side of the body, with the thumb pointing upwards.
Try to avoid both internal and external rotation because in these positions distribution of the contrast medium or joint effusion may no longer be optimal and because anatomy may be distorted.
ABER position
ABER position is obtained in the supine position with the patient placing his hand underneath his head, resulting in external rotation and abduction of the humerus.
The sections are axial oblique and are planned on a oblique coronal sequence parallel to the axis of the proximal humerus.
In this position, tears of the anteroinferior labrum become more conspicuous because the labrum is pulled from the glenoid by the capsule and glenohumeral ligaments.
The ABER position may also be useful for the detection of rotator cuff abnormalities .
The sensitivity for tears of the undersurface of the rotator cuff and/or of the infraspinatus tendon was improved when the ABER position was employed.
70IMAGING PLANES
Three main imaging planes which are applied in most MR examinations of the glenohumeral joint:
THE ANGLED CORONAL,
THE ANGLED SAGITTAL,
THE AXIAL PLANE.
71ANGLED CORONAL
Planned on axial localizers parallel to the supraspinatus Muscle or perpendicular to the glenoid surface.
Slice thickness is 3–4 mm in most published protocols, field-of-view typically between 12 and 16 cm, with an
image matrix of 256. Coronal oblique images are most useful for determining abnormalities of
the supraspinatus, the superior labrum, the Acromioclavicular joint, and the deltoid muscle.
72ANGLED SAGITTAL
Planned perpendicular to the supraspinatus muscle or parallel to the glenoid surface.
They should include the entire humeral head and the tuberosities, where the rotator cuff tendons insert.
73AXIAL
Axial images are best planned on coronal localizers. Typically, slice thickness is 3–4 mm. Slices may be
thinner if three-dimensional (3D) gradient-echo sequences are obtained.
If the slices should include both the acromioclavicular joint and the axillary recess, slice thickness may have to be increased to 4 mm. Other imaging parameters are similar to those of the angled coronal and axial images
74SEQUENCES
A combination of angled coronal T1-weighted and T2-weighted spin-echo images is commonly used for assessment of the supraspinatus tendon.
T1-weighted images provide anatomical details and information about early degeneration of the supraspinatus tendon.
T2-weighted images are superior in detecting partial or full-thickness defects of the rotator cuff.
75
Proton-density images can replace the T1-weighted images in imaging of the rotator cuff. Their sensitivity is inferior, however, to T1-weighted images in bone marrow abnormalities.
In the past, dual echo images have commonly been acquired.
The repetition time (TR) for standard spin echo sequences was typically close to 2000 ms, the echo times (TE) 20 and 80 ms. There is a tendency to replace such classical sequences by long TR/intermediate TE (40–50 ms) sequences without dual echo.
Instability
For instability imaging, the axial plane is most important.
If non-enhanced MR images are obtained, T2-weighted, proton-
density or dual-echo spin echo images, gradient-echo images or
a combination of these two types of sequences have been
recommended.
76
Axial anatomy
Look for an os acromiale
supraspinatus tendon is parallel to the axis of the muscle
biceps tendon is attached at the 12 o'clock position.
Notice superior labrum and attachment of the superior glenohumeral ligament. At this level look for SLAP-lesions and variants like sublabral foramen.At this level also look for Hill-Sachs lesion on the posterolateral margin of the humeral head.
The fibers of the subscapularis tendon hold the biceps tendon within its groove
At this level study the middle GHL and the anterior labrum. Look for variants like the Buford complex. Study the cartiage.
INFERIOR GHL
Coronal views
.
When we plan the coronal oblique series, it is best to focus on the axis of the supraspinatus tendon.
Notice coracoclavicular ligament and short head of the biceps.
Notice coracoacromial ligament
Notice suprascapular nerve and vessels
Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament
Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear.
Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon
Study the attachment of the IGHL at the humerus. Study the inferior labral-ligamentary complex. Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament)
Look for tears of the infraspinatus tendon.
Sagittal anatomy1.Notice rotator cuff muscles and look for atrophy
Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon
Sometimes at this level labral tears at the 3-6 o'clock position can be visualized.
Study the biceps anchor.
Notice shape of the acromion
Look for impingement by the AC-joint. Notice the rotator cuff interval with coracohumeral ligament.
Look for supraspinatus tears.
ELBOW JOINT The elbow is a complex synovial joint formed by the articulations of the
humerus , the radius and the ulna .
Articulations. The elbow joint is made up of three articulations:
radiohumeral: capitellum of the humerus with the radial head
ulnohumeral: trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulna
radioulnar: radial head with the radial notch of the ulna (proximal radioulnar joint )
In full flexion, the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus and in full extension the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus
Ligaments
medial (ulnar) collateral ligament complex
lateral (radial) collateral ligament complex
Adult Elbow - AP View
Part Position: Arm fully extended, and the hand supinated. If the elbow cannot be extended,two APs are done, onea with the forearm on the film and the second with the humerus on the film
The axial relationships of the humerus to the ulna (carrying angle) should be assessed.
Adult Elbow - Oblique View.
.
Clinicoradiologic Correlations: The elbow plane is especially useful for depicting the tip of the coronoid and olecranon processes of the ulna,trochlea, coronoid process, and medial epicondyle.
Part Position: Arm fully extended and the forearm pronated
Adult Elbow - Lateral View.
Part Position: Elbow flexed to 90°, with the ulnar surface of the forearm flat on the film. The hand is in the true lateral position. The humerus must also be parallel to the film plane, with the shoulder abducted to 90°.
This is a useful view for evaluating the post-traumatic elbowfor fracture. It is this view that will demonstrate joint effusion, which is often a marker forsubtle fracture or effusions.
Tendon attachments
Common flexor tendonAttaches at the medial epicondyle
Ulnar collateral ligament or UCLStarts at the undersurface of the medial epicondyle and runs down to the sublime tubercle, which is the medial side of the coronoid process.
Common extensor tendonOriginates at the lateral epicondyle.
Lateral collateral ligamentOriginates just underneath the attachment of the common extensor tendon.
Lateral ulnar collateral ligamentThis is a somewhat confusing term for a tendon that also originates just underneath the common extensor tendon. It swings down behind the radial head and attaches at the area of the ulna that is called the supinator crest - see lateral view.
Biceps tendonAttaches on the radial tuberosity.
Brachialis tendonAttaches on the coronoid process.
Annular ligamentAttaches on the volar side of the sigmoid notch of the ulna and runs around the radial head and attaches on the dorsal side of the sigmoid notch.
Use the axis of the epicondyles on a axial localizer to plan the coronal scan.The sagittal images are scaned perpendicular to the coronal scan.
ulnar collateral ligament the ulnar collateral ligament (UCL) is situated
on the medial side and it has three components.
The anterior bundle is the strongest component and is the primary restraint against valgus forces.On MR this is the most important structure.
The posterior bundle attaches distally in a fan-shape on the olecranon.It forms the floor of the cubital tunnel.
The transverse bundle runs from the olecranon to the olecranon, so it doesn't do much
The UCL (in yellow) originates on the undersurface of the medial epicondyle just beneath the origin of the common flexor tendon.It attaches on a small process on the medial side of the coronoid, which is called the sublime tubercle.
tear
Lateral Collateral Ligament
consists of the radial collateral, the lateral ulnar collateral and the annular ligament.
Common Extensor Tendon
•
The common extensor tendon originates at the lateral epicondyle.On a T1W-images the tendon should have a low signal intensity (yellow arrow).
he common flexor tendon originates at the medial epicondyle.On a T1W-images the tendon should have a low signal intensity (red arrow)
Medial EpicondylitisThis is the counterpart of the lateral epicondylitis and also known as the golfer's elbow.Here the common flexor tendon is involved.On the sagittal image it is clear that it is only partial tearing.
biceps tendon
axial images of the biceps tendon from the musculotendinous junction to the attachment on the radial tuberositas.
The brachialis originates from the lower half of the front of the humerus, near the insertion of the deltoid muscle.It lies deeper than the biceps brachii, and is a synergist that assists the biceps in flexing the elbow.
The thick tendon inserts on the anterior surface of the coronoid process of the ulna.
1, Radial head. 2, Extensor carpi radialis longus muscle. 3, Triceps muscle (lateral head). 4, Cephalic vein. 5, Brachoradialis muscle. 6, Supinator muscle. 7, Extensor carpi ulnaris muscle
1, Radial head. 2, Supinator muscle. 3, Anconeus muscle. 4, Triceps muscle (lateral head). 5, Biceps brachii muscle. 6, Extensor carpi radialis longus muscle.7, Cephalic vein. 8, Capitellum.
1, Radial head. 2, Supinator muscle. 3, Anconeus muscle. 4, Capitellum. 5,Triceps muscle (lateral head). 6, Extensor carpi radialis longus muscle. 7, Biceps brachii muscle. 8, Cephalic vein. 9, Brachoradialis muscle.
1, Ulna. 2, Trochlea. 3, Humerus. 4, Triceps muscle (lateral head). 5, Biceps brachii muscle. 6, Brachialis muscle. 7, Ulnar artery and vein.
1, Olecranon.
2, Triceps muscle (lateral head).
3, Humerus.
4, Biceps brachii muscle.
5, Brachialis muscle.
6, Ulnar artery and vein.
7, Pronator teres muscle.
1, Olecranon.
2, Triceps muscle (lateral head).
3, Humerus.
4, Biceps brachii muscle.
5, Brachialis muscle.
6, Brachial artery and vein.
7, Trochlea.
8, Coronoid process.
9, Pronator teres muscle.
10, Flexor digitorum profundus muscle.
1, Olecranon.
2, Trochlea.
3, Humerus.
4, Triceps tendon.
5, Triceps muscle (lateral head).
6, Brachialis muscle.
7, Coronoid process.
8, Pronator teres muscle.
9, Flexor digitorum superficialis muscle.
10, Flexor digitorum profundus muscle.
1, Olecranon. 2, Trochlea. 3, Triceps muscle (lateral head). 4, Brachialis muscle. 5,Flexor digitorum superficialis muscle. 6, Flexor digitorum profundus muscle.
1, Ulna. 2, Anconeus muscle. 3, Extensor carpi ulnaris muscle. 4, Supinator muscle. 5, Extensor digitorum muscle. 6, Extensor carpi radialis longus muscle. 7, Brachoradialis muscle. 8, Radius. 9,Pronator teres muscle. 10, Flexor carpi radialis muscle. 11, Flexor digitorum superficialis muscle. 12,Flexor carpi ulnaris muscle. 13, Flexor digitorum profundus muscle.
1, Ulna.
2, Anconeus muscle.
3, Extensor digitorum muscle.
4, Extensor carpi radialis longus muscle.
5, Brachoradialis muscle.
6, Radial head.
7, Brachialis muscle.
8, Pronator teres muscle.
9, Flexor carpi radialis muscle.
10, Flexor digitorum superficialis muscle.
11, Flexor digitorum profundus muscle.
1, Ulna
. 2, Anconeus muscle.
3, Extensor digitorum muscle.
4, Extensor carpi radialis longus muscle.
5, Brachoradialis muscle.
6, Brachialis muscle.
7, Pronator teres muscle.
8, Flexor carpi radialis muscle.
9, Flexor digitorum superficialis muscle.
1, Humerus.
2, Ulna.
3, Anconeus muscle.
4, Extensor digitorum muscle.
5, Extensor carpi radialis longus muscle.
6, Brachoradialis muscle.
7, Brachialis muscle.
8, Pronator teres muscle.
1, Medial epicondyle (Humerus). 2, Olecranon fossa. 3, Muscle triceps. 4, Lateral epicondyle (Humerus). 5, Extensor carpi radialis longus muscle. 6, Brachoradialis muscle. 7, Biceps brachii muscle. 8, Brachialis muscle. 9, Pronator teres muscle.
1, Triceps muscle (Long head). 2, Triceps muscle (Medial head). 3, Humerus. 4, Triceps muscle (lateral head). 5, Extensor carpi radialis longus muscle. 6, Brachoradialis muscle. 7, Biceps brachii muscle. 8,Brachialis muscle.
1, Olecranon.2, Triceps muscle (lateral head). 3, Triceps tendon. 4, Flexor carpi ulnaris muscle. 5, Flexor digitorum profundus muscle.. 6, Anconeus muscle.
1, Olecranon.
2, Humerus.
3, Triceps muscle (lateral head).
4, Flexor carpi ulnaris muscle.
5, Flexor digitorum profundus muscle.
6, Extensor digitorum muscle.
7,Extensor carpi ulnaris muscle.
8, Anconeus muscle.
1, Ulna.
2, Lateral epicondyle.
3, Triceps muscle (lateral head).
4, Medial epicondyle.
5, Flexor digitorum superficialis muscle.
6, Flexor digitorum profundus muscle.
7, Supinator muscle.
8, Extensor digitorum muscle.
9, Extensor carpi ulnaris muscle.
1, Radial head. 2, Extensor carpi radialis longus muscle. 3, Capitellum. 4,Trochlea. 5, Pronator teres muscle. 6, Flexor digitorum superficialis muscle. 7,Supinator muscle.
1, Cephalic vein. 2, Brachoradialis muscle. 3, Brachialis muscle. 4, Basilic vein. 5,Pronator teres muscle. 6, Flexor carpi radialis muscle. 7, Extensor carpi radialis longus and brevis muscle.
