#coracoclavicular

[orthodoc31]

Advances in Diagnosis and Treatment of AC Joint Injuries.

AC (acromioclavicular) joint injuries are a common occurrence, particularly among athletes and individuals engaged in physically demanding activities. These injuries can range from minor strains to severe dislocations, often requiring orthopedic intervention. Recent advances in diagnostic techniques and treatment options have significantly improved patient outcomes in cases of AC joint injury treatment.

Diagnostic Advancements

1. Imaging Modalities: Traditional X-rays have been the standard for diagnosing AC joint injuries. However, recent advancements in imaging, such as ultrasound and magnetic resonance imaging (MRI), provide orthopedic surgeons with a more detailed view of the joint's condition. MRI, in particular, offers superior soft tissue visualization, aiding in accurate diagnosis.

2. Dynamic Stress Testing: Orthopedic surgeons now employ dynamic stress testing to assess the stability of the AC joint. This involves applying controlled stress to the joint while monitoring its response. Dynamic testing enhances the accuracy of injury classification and guides treatment decisions.

Treatment Options

1. Conservative Management: While surgery was once the primary treatment for AC joint injuries, conservative management has gained prominence. Orthopedic surgeons often recommend rest, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs) as initial approaches. Recent studies support this trend, showing favorable outcomes for many patients with less severe injuries.

2. Advanced Surgical Techniques: When surgery is necessary, orthopedic surgeons now have access to advanced techniques. Arthroscopic procedures have become increasingly popular due to their minimally invasive nature and reduced recovery times. Techniques like coracoclavicular ligament reconstruction and use of synthetic grafts have improved surgical outcomes for severe AC joint injuries.

3. Biological Augmentation: Orthopedic surgeons are exploring the use of biological augmentation to enhance healing. Platelet-rich plasma (PRP) and stem cell therapies are being investigated for their potential to promote tissue regeneration and reduce recovery times.

Advances in the diagnosis and treatment of AC joint injuries have revolutionized orthopedic care for these common injuries. With improved diagnostic accuracy and a shift towards conservative management for less severe cases, patients can expect better outcomes and quicker recovery times. For more severe injuries requiring surgery, minimally invasive techniques and biological augmentation hold promise for further enhancing patient recovery and overall satisfaction. Orthopedic surgeons near you should stay informed about these advancements to provide the best possible care for their patients with AC joint injuries.

[traumaengineer]

Paciente 17; casos resueltos y pendientes por subir del 2022, masculino de 50a, dextromano, pescador, quien posterior a accidente en lancha durante su oficio, presenta dolor, aumentó volúmen y deformidad en región acromioclavicular derecha con marcada limitación funcional, fue evaluado por el equipó de guardia indicando estudios radiológicos observando: Luxación acromioclavicular derecha Rockwood V. Escala de Constant previo acto quirúrgico de 12 puntos. Resuelto en nuestro servicio SCOT HRCS, planteando manejo quirúrgico con: Reducción directa mediante técnica que suspención coracoclavicular más cerclaje acromioclavicular con suturas de alta resistencia. Resultados quirúrgicos visibles y comprobables. Pronto las imágenes post rehabilitación. . . . . . . . . . . . . . . . . . . . . . . . #scot #trauma #quirofano #cirugia #ortopedia #osteosintesis #venezuela #medico #medic #emergency #genius #viral #gore #creppypasta #creepy #biomecanica #biomaterial #sutura #arteria #vena #anatomia #codo #hombro #traumatologia #hospital #shoulder #elbow #knee #pain (en Hospital Dr. Rafael Calle Sierra) https://www.instagram.com/p/CljwQUjOzXV/?igshid=NGJjMDIxMWI=

[drguidofierro]

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A post shared by Guido Fierro (@drguidofierro)

El hombro es una articulación intrínsecamente inestable y con gran movimiento. Su estabilidad está dada por los ligamentos. Podemos dividir los ligamentos de la parte lateral del hombro en varios grupos: 1. Los que van de la escápula a la escápula, siendo estos el ligamento coracoacromial y los ligamentos transverso de la escotadura supraescapular y espinoglenoidea. 2. Los que van de la escápula a la clavícula, siendo estos el conoide y el trapezoide. 3. Los que van de la escápula al húmero, siendo estos el coracohumeral y ligamentos glenohumerales superior, medio e inferior (este último es un complejo ligamentario con banda anterior y posterior). 4. Los que van de la clavícula a la escápula, siendo estos los acromioclaviculares. 5. El ligamento del húmero al húmero, que es el ligamento transverso del húmero o de la corredera bícipital. Música: My Go Away Dream Músico: Not The King. 👑 #manguitorotador #anatomíadehombro #shoulderanatomy #shoulderligaments #shoulderligament #shoulderinstability #inestabilidaddehombro #luxaciondehombro #dislocation #shoulderbones #coracoclavicular #coracoclavicularligament #acromioclavicular #acromioclavicularligament #glenohumeraljoint #glenohumeralligament #ligamentoglenohumeral #ligamentoacromioclavicularsuperior #ligamentocoracoacromial (en Unidad De Especialistas Santafe Real) https://www.instagram.com/p/COXwSD7po2I/?igshid=7zfvhmflu5rv

[jonathanclarkphysiotherapy]

Acromioclavicular Joint Sprain

Acromioclavicular Joint (ACJ) Sprain or Separation describes an injury to the ligaments between the Acromion of the Scapula (shoulder blade) and the Clavicle (collar bone). 

The Acromioclavicular ligament is commonly affected, but injuries can also affect the Coracoclavicular or Coracoacromial ligament. Injuries are often caused by a fall to an outstretched arm.

Ligament injuries vary from Grade I (minor separation) - Grade III (severe separation, resulting in total rupture and joint deformity).

Symptoms

Pain (local or global)

Pain on moving arm above head

Swelling and/or bruising

Loss of movement

Physiotherapy

At Jonathan Clark Physiotherapy, we provide advice and education to help you protect your injury. We will often advise the use of ice, anti-inflammatory medication and rest in order to reduce inflammation and pain. Further treatment will focus on providing appropriate support such as taping, as well as ultrasound to aid healing.

Our therapists will aim to normalise your range of movement and provide strengthening rehabilitation to allow you to return to normal levels of functional activity. All treatment is tailored to help avoid long term shoulder problems including weakness and instability.

[meiwoplastination]

New shoulder joint plastinated organ for medical education. #plastinated#organ

clearly shows clavicle, shoulder blade, humerus, acromion, acromioclavicular joint, articular capsule, spina scapulae, coracoclavicular ligament, coracoacromial ligament, coracohumeral ligament, long head of biceps brachii, coracoid process.

[quinn-the-pisces-blog]

What is the AC joint in the shoulder?

The top of the wing bone or scapula is the acromion. The joint shaped wherein the acromion connects to the collar bone or clavicle is the AC joint. Usually there is a protuberance or bump in this vicinity, which can be quite large in a few people normally. This joint, like maximum joints within the frame, has a cartilage disk or meniscus inside and the ends of the bones are protected with cartilage. The joint is held together by way of a pill, and the clavicle is held inside the proper role by using  heavy ligaments known as coracoclavicular ligaments.

 How is the AC joint usually injured?

The AC joint is injured most customarily when one falls at once on the brink of the shoulder. The trauma will separate the acromion far from the clavicle, inflicting a sprain or a real AC joint dislocation. In a moderate damage, the ligaments which aid the AC joint are without a doubt stretched (Grade I), however with extra severe injury, the ligaments can in part tear (Grade II) or absolutely tear (Grade III). In the most intense damage, the stop of the clavicle protrudes below the pores and skin and is visible as a outstanding bump.

AC JOINT SURGERY NYC

How is an AC joint separation identified?

Most frequently the medical exam will demonstrate tenderness or bruising across the top of the shoulder near the AC joint, and the suspected diagnosis can be confirmed the use of an X-ray, which compares the injured aspect with the affected person's different joint.

 What is the proper treatment for a sprained AC joint?

When a joint is first sprained, conservative remedy is certainly the best. Applying ice directly to the factor of the shoulder is beneficial to inhibit swelling and relieve pain. The arm may be supported with a sling which also relieves some of the weight from the shoulder. Gentle movement of the arm can be allowed to prevent stiffness, and exercising putty may be very useful to enhance feature of the elbow, wrist, and hand, but any attempts at full of life shoulder mobilization early on will probable result in more swelling and ache.

 How long does it take for a shoulder separation to heal?

Depending on how extreme the injury is, it is able to heal thoroughly in two to three weeks. In intense cases, the shoulder may not heal without surgery.

 When and why is surgical operation vital for AC joint separations?

Usually surgical operation is reserved for the ones instances in which there may be residual ache or unacceptable deformity within the joint after numerous months of conservative treatment. The ache can occur with direct stress on the joint, which includes with straps from undies or work garb. Sometimes there might be catching, clicking, or ache with overhead sports, consisting of lifting, throwing, or reaching. Finally, in some human beings with very thin skin and little or no muscular and tender tissue padding above their shoulders, the outstanding clavicle after the separation can be taken into consideration unattractive, because the shoulder can appear to be unbalanced.

 Are there other reasons of AC joint ache and incapacity?

Arthritis can occur as an isolated event within the AC joint, causing stiffness, aching, and from time to time swelling. Another condition referred to as DCO, or distal clavicle osteolysis, gives a comparable image, commonly in younger individuals who carry heavy weights. This is referred to as "weightlifter's shoulder."

 What type of surgery can restore AC joint problems?

The most effective kind of surgical operation for AC joint harm involves resection or removal of the cease of the clavicle the use of arthroscopic (mini-surgical) techniques (known as a Mumford method). If the joint becomes painful due to DCO (weightlifter's shoulder) or arthritis, or the separation is only minor, this method can be very first-rate. When the joint is severely displaced, then a more complex system is needed to repair the location of the clavicle. Usually this operation, called a Weaver-Dunn method, is achieved using a two-inch incision over the joint. The end of the clavicle is eliminated, and ligament is transferred from the underside of the acromion into the cut give up of the clavicle to update the ligaments torn in the course of the dislocation. Soon, an arthroscopic technique must be to be had to restore the location of the joint, but at this point, most effective open surgical operation techniques are available.

[rev-medicine]

Focus your attention on the diagram and notes below. Let’s learn shall we? ⤵️ @rev.med    🗣  Sharing is caring. Share this post out with your friends and tell them how simple it is! ✅ Overview    Our collarbone, or anatomically known as the Clavicle (more in the comments) @rev.med   ✅ Landmarks    *Sternal or medial end: rounded end of the clavicle that articulates with the manubrium of the sternum at the sternoclavicular joint. ⁣⁣The inferior surface of the sternal end is marked by a rough oval depression for the costoclavicular ligament. (a ligament of the SC joint)    *Shaft: point of origin & attachment for several muscles - deltoid, trapezius, subclavius, pectoralis major, sternocleidomastoid & sternohyoid. @rev.med    *Acromial or lateral end: flattened end of the clavicle that articulates with acromion of the scapula at the acromioclavicular joint. Serves as an attachment point for 2 ligaments:   ⁣⁣- Conoid tubercle is a bump on the inferior surface of the bone, near the acromial end. It is an attachment point for the conoid ligament. The conoid ligament is a part of the coracoclavicular ligament, which attaches the clavicle to the coracoid process of the scapula. This prominence also serves as a useful landmark to identify the inferior surface of the clavicle.   - Trapezoid line or ridge is an elevation that runs obliquely from the conoid tubercle to the lateral end of the clavicle. It serves as an attachment point for the trapezoid ligament @rev.med    *Costal tuberosity is an oval elevation on the inferior surface of the bone, near the sternal end. It serves as an attachment point for costoclavicular ligament, that attaches the clavicle to the costal cartilage of the first rib.    *Subclavian groove or sulcus is an indentation that runs horizontally along inferior surface of the bone, from the costal tuberosity to conoid tubercle. Also the attachment point for the subclavius muscle.     @rev.med⁣⁣  @rev.med    #clavicle #REVmed #REVupyourbrain #REVmedicine https://www.instagram.com/p/CRRgGfphIng/?utm_medium=tumblr

[toasterness]

Somehow I have managed to do something shitty to one of the ligaments in my right shoulder, right under the collarbone (most likely the coracoclavicular), and it's been aching for weeks now and I need it to STOP PLEASE

[nice3012-blog]

🔈 INJURIES OF THE ACROMIOCLAVICULAR JOINT + SHEAR TEST A fall onto the shoulder or outstretched arm frequently causes dislocation of the acromioclavicular joint and damage to the acromioclavicular ligaments. Ligament injury allows the lateral end of the clavicle to move independently of the scapula, causing it to appear upwardly displaced. The clavicle can be pushed down (with significant pain), but will spring back up when pressure is released (piano-key sign). Three grades of acromioclavicular separation can be distinguished clinically based on the degree of ligament damage (Toss classification). 🔑 TOSSY I The acromioclavicular and coracoclavicular ligaments are stretched but still intact. 🔑 TOSSY II The acromioclavicular ligament is ruptured, with subluxation of the joint. 🔑 TOSSY III Ligaments are all disrupted, with complete dislocation of the acromioclavicular joint. Radiographs in different planes will show widening of the space in the acromioclavicular joint. Comparative-stress radiographs with the patient holding approximately 10kg weights in each hand will reveal the extent of upward displacement of the lateral end of the clavicle on the affected side. 🚑 SHEAR TEST ✅ Purpose To test for acromioclavicular joint pathology or injury ✅ Technique Patient: sitting or standing with the arm dependent or in a neutral position on the lap. Clinician: standing adjacent to the patient. The heel of one hand is placed posteriorly over the spine of the scapula with the fingers pointing upwards; the other hand is positioned in a similar fashion anteriorly over the mid section of the clavicle. The fingers of both hands are then interlocked over the upper trapezius area of the shoulder. ✅ Action The hands are gradually squeezed together, imparting a shear stress through the ACJ created by the approximation of the clavicle and scapula. ✅ Positive test Localized pain over the ACJ or increased joint excursion are considered to be positive findings and are indicative of ACJ pathology or injury. https://www.instagram.com/p/CJ7WDX5AQvn/?igshid=8dohwh13s2a4

[chromoscience]

The Scapula Bone

Source: OpenStax Anatomy and Physiology OpenStax Anatomy and Physiology The scapula is also part of the pectoral girdle and thus plays an important role in anchoring the upper limb to the body. The scapula is located on the posterior side of the shoulder. It is surrounded by muscles on both its anterior (deep) and posterior (superficial) sides, and thus does not articulate with the ribs of the thoracic cage. The scapula has several important landmarks. The three margins or borders of the scapula, named for their positions within the body, are the superior border of the scapula, the medial border of the scapula, and the lateral border of the scapula. The suprascapular notch is located lateral to the midpoint of the superior border. The corners of the triangular scapula, at either end of the medial border, are the superior angle of the scapula, located between the medial and superior borders, and the inferior angle of the scapula, located between the medial and lateral borders. The inferior angle is the most inferior portion of the scapula, and is particularly important because it serves as the attachment point for several powerful muscles involved in shoulder and upper limb movements. The remaining corner of the scapula, between the superior and lateral borders, is the location of the glenoid cavity (glenoid fossa). This shallow depression articulates with the humerus bone of the arm to form the glenohumeral joint (shoulder joint). The small bony bumps located immediately above and below the glenoid cavity are the supraglenoid tubercle and the infraglenoid tubercle, respectively. These provide attachments for muscles of the arm. The scapula also has two prominent projections. Toward the lateral end of the superior border, between the suprascapular notch and glenoid cavity, is the hook-like coracoid process (coracoid = “shaped like a crow’s beak”). This process projects anteriorly and curves laterally. At the shoulder, the coracoid process is located inferior to the lateral end of the clavicle. It is anchored to the clavicle by a strong ligament, and serves as the attachment site for muscles of the anterior chest and arm. On the posterior aspect, the spine of the scapula is a long and prominent ridge that runs across its upper portion. Extending laterally from the spine is a flattened and expanded region called the acromion or acromial process. The acromion forms the bony tip of the superior shoulder region and articulates with the lateral end of the clavicle, forming the acromioclavicular joint. Together, the clavicle, acromion, and spine of the scapula form a V-shaped bony line that provides for the attachment of neck and back muscles that act on the shoulder, as well as muscles that pass across the shoulder joint to act on the arm. The scapula has three depressions, each of which is called a fossa (plural = fossae). Two of these are found on the posterior scapula, above and below the scapular spine. Superior to the spine is the narrow supraspinous fossa, and inferior to the spine is the broad infraspinous fossa. The anterior (deep) surface of the scapula forms the broad subscapular fossa. All of these fossae provide large surface areas for the attachment of muscles that cross the shoulder joint to act on the humerus. The acromioclavicular joint transmits forces from the upper limb to the clavicle. The ligaments around this joint are relatively weak. A hard fall onto the elbow or outstretched hand can stretch or tear the acromioclavicular ligaments, resulting in a moderate injury to the joint. However, the primary support for the acromioclavicular joint comes from a very strong ligament called the coracoclavicular ligament. This connective tissue band anchors the coracoid process of the scapula to the inferior surface of the acromial end of the clavicle and thus provides important indirect support for the acromioclavicular joint. Following a strong blow to the lateral shoulder, such as when a hockey player is driven into the boards, a complete dislocation of the acromioclavicular joint can result. In this case, the acromion is thrust under the acromial end of the clavicle, resulting in ruptures of both the acromioclavicular and coracoclavicular ligaments. The scapula then separates from the clavicle, with the weight of the upper limb pulling the shoulder downward. This dislocation injury of the acromioclavicular joint is known as a “shoulder separation” and is common in contact sports such as hockey, football, or martial arts. Source: Read the full article

[rubensgomescorrea]

Cíngulo do Membro Superior

Sistema articular- articulações do cíngulo do membro superior - acromioclavicular e do ombro

Assista ao vídeo explicativo sobre os ossos, músculos e articulações do cíngulo do membro superior DISPONÍVEL EM: https://www.youtube.com/watch?v=b2hqJPiJXfI&t=153s

O cíngulo do membro superior é compostos pela clavícula e escápula. Ele é importante, pois é a conexão do esqueleto axial com o apendicular superior. Já os membros superiores são compostos pelo úmero, rádio, ulna, ossos do carpo, ossos do metacarpo e pelas falanges. 

Osteologia: Esqueleto Apendicular – Cíngulo do Membro Superior e Membros Superiores

Definição e Pontos Importantes

O cíngulo do membro superior é compostos pela clavícula e escápula. Ele é importante, pois é a conexão do esqueleto axial com o apendicular superior. Já os membros superiores são compostos pelo úmero, rádio, ulna, ossos do carpo, ossos do metacarpo e pelas falanges.

Ainda tem outra classificação, através de segmentos. Assim, o primeiro segmento seria a cintura escapular, o segundo o braço, o terceiro o antebraço, e o quarto e último, a mão.

Uma importante diferença do esqueleto axial e do apendicular, é que os ossos do esqueleto axial são predominantemente planos e irregulares, e isso auxilia para a sua função de estabilidade e proteção. Já os ossos do esqueleto apendicular são predominantemente longos, e isso é coerente com sua principal função de movimentos de grande amplitudes.

Para exemplificar os movimentos do membro superior, citemos: o braço pode se movimentar fazendo os seguintes movimentos: flexão, extensão, abdução, adução, rotação medial (rotação interna), rotação lateral (rotação externa) e circundução, tudo isso por causa da articulação do ombro (glenoumeral).

Cíngulo dos Membros Superiores

Clavícula

Figura: Clavícula 

Fonte:  Cynthia C. Aquino. https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/

A clavícula é o osso que liga propriamente o esqueleto axial ao apendicular, já que ela se articula com o esterno e com o acrômio; daí que ela tem duas faces: face articular esternal e face articular acromial;

presença do sulco do músculo subclávio;

a parte medial da clavícula é côncava, e a lateral é convexa;

superfície superior é mais lisa do que a inferior;

tubérculo conoide e linha trapezoidea: inserção do importante ligamento coracoclavicular;

é um osso muito sujeito à fraturas;

a punção da veia subclávia é feita localizando o terço médio da clavícula;

Escápula

Figura:  Escápula

Fonte:  Cynthia C. Aquino. https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/

Vista Anterior

fossa subescapular: presença de impressões costais;

processo coracoide: tem esse nome porque, de acordo com o anatomista que o nomeou, ele se parece com um corvo;

temos ainda outros acidentes: margem medial, margem superior, margem lateral e ângulo inferior;

Visão Lateral

cavidade glenoidal: pouco profunda; isso é importante, porque a cabeça do úmero fica mais “livre”, já que ela não fica enclausurada em algum tipo de fossa ou buraco; Essa liberdade é um dos fatores para que a o ombro tenha tanta mobilidade;

 tubérculo infraglenoidal: local de inserção para a cabeça longa do músculo tríceps braquial;

tubérculo supraglenoidal: local de inserção da cabeça longa do músculo bíceps braquial;

acrômio: se articula com a clavícula

Vista Posterior

espinha da escápula: é possível a observarmos nas costas!

para fixação dos músculos temos a fossa infra – espinal e fossa supra – espinal; outro acidente importante da escápula é a incisura maior da escápula;

Além disso, ainda na escápula:

face costal e suas margens permitem as inserções musculares e, junto com seu músculo, o subescapular, movem – se livremente sobre a parede torácica adjacente;

a espinha e o acrômio podem ser facilmente palpáveis em um paciente, assim como o ápice do processo coracoide, o ângulo inferior e a maior parte da margem medial da escápula;

Agora, antes de falarmos dos membros superiores, é importante apenas citarmos uma região de transição importantíssima entre o esqueleto axial e o membro superior: a axila. Todas as grandes estruturas, que atravessam o pescoço e o braço, passam através dela. As regiões de transição de uma parte do membro a outra como axila, fossa cubital e túnel do carpo são regiões em que importantes estruturas passam para chegar ao membro. Maiores detalhes sobre essas outras regiões no decorrer desse post.

Membros Superiores Braço: Úmero

Figura:  Epífise Proximal do úmero

Fonte:  Cynthia C. Aquino. https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/

Epífise Proximal

cabeça do úmero: articulação com a cavidade glenoide;

colo anatômico do úmero: sempre depois da cabeça, vem um colo!

colo cirúrgico: como se tivesse uma linha imaginária formando um outro colo, ele é chamado assim, pois nessa região é onde ocorre o maior número de fraturas no úmero. Essa região é a mais suscetível à fratura, pois é a mais fraca. O nervo axilar e a artéria circunflexa posterior do úmero podem ser fraturados nesta região, mas isso é raro. O colo anatômico não é tão suscetível assim à fraturas, porque a fratura teria que atravessar a região mais espessa do úmero! Antes de realizar a redução óssea, é necessário que o nervo axilar seja antes testado para ver se não teve lesão, só assim para o paciente não apresentar posteriormente algum déficit neurológico;

sulco intertubercular: sulco entre os dois tubérculos; O tendão da cabeça longa do bíceps braquial passa através deste sulco. Espessamentos nas margens lateral e medial do assoalho do sulco intertubercular são locais de inserção do peitoral maior, redondo maior e latíssimo do dorso, respectivamente;

tubérculo maior e menor: servem para a inserção dos quatro músculos do manguito rotador da articulação do ombro; No tubérculo maior inserem – se três tendões musculares (músculo supra – espinal, infra – espinal e o redondo menor), já no menor insere – se o músculo subescapular;

Diáfise

tuberosidade deltoidea: tuberosidade para o músculo deltoide se inserir;

sulco do nervo radial: recuso – me a explicar o que é;

Epífise distal

Tróclea: articula – se com a ulna. Tem a forma de uma roldana. É visível na parte posterior do osso.

epicôndilo medial: o nervo ulnar passa pelo braço seguindo para o antebraço ao redor da face posterior do epicôndilo medial e pode ser palpado neste local do osso.

fossas radial, coronoidea (recebe o processo coronoide da ulna) e do olécrano (recebe o olécrano da ulna): acomodam projeções dos ossos do antebraço durante os movimentos da articulação do cotovelo.

Observações

Três nervos estão relacionados ao úmero. A fratura desse osso pode danificar um dos três nervos: nervo axilar (inerva o músculo deltoide, e passa ao redor da parte posterior da região superior do úmero – colo cirúrgico), nervo radial (inerva todos os músculos extensores do membro superior, passa no sulco radial), nervo ulnar (passa posteriormente ao epicôndilo medial – é esse nervo que, quando a gente bate o cotovelo em alguma superfície, nós sentimos um choquinho que incomoda!)

na face medial do osso há um espessamento vertical para a inserção do músculo coracobraquial.

Antes de começarmos a falar do antebraço, uma pequena observação sobre o cotovelo (maiores detalhes, ver o resumo sobre ligamento e articulações): a articulação do cotovelo permite a flexão e extensão do antebraço. A pronação só pode ocorrer no antebraço, e ela ocorre com a sobreposição do rádio sob a ulna. Outra coisa importante é a chamada fossa cubital, é a região em que a gente usa pra doar sangue! É através dela que passa a artéria braquial (maior artéria) e também o nervo mediano.

Observações Clínicas

epicondilite: comum em jogadores de tênis e golfe, por usarem muito os músculos flexores e extensores do antebraço. A dor fica tipicamente na região dos epicôndilos e melhora com o reposo. Às vezes pode ser necessário uma cirurgia. Jogadores de tênis – epicôndilo lateral, jogadores de golfe – epicôndilo medial.

artrite do cotovelo: o cotovelo artrítico pode sofrer processo degenerativo e os pequenos fragmentos ósseos aparecem na cavidade articular. Esses fragmentos podem resultar em apreciável redução da flexão e extensão, alojando – se nas fossas do olécrano e coronoidea.

fratura supracondilar do úmero: fratura na epífise da parte distal do úmero, a cima do nível dos epicôndilos. Os fragmentos são tracionados pelo tríceps. Isso estira a artéria braquial sobre o fragmento proximal e irregular da fratura. Em crianças, os músculos do compartimento anterior do antebraço tornam – se isquêmicos e sofrem contraturas severas. (contratura isquêmica de Volkmann). É interessante observar que nós restringimos o grupo para as crianças. O motivo disso é que, na anatomia da criança, as epífises não são tão desenvolvidas assim, e esses músculos não tem a inserção definida e ficam logo sobre a braquial. Logo, quando acontece essa fratura, eles comprimem a artéria, causando a isquemia.

Antebraço

Figura: Rádio e Ulna 

Fonte:  Cynthia C. Aquino. https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/

Um ponto importante a ser observado nos ossos do antebraço, é que enquanto um tem uma parte proximal bem incorporada (que é o caso da ulna), a parte proximal do rádio é bem pequena, quando comparada. E o inverso ocorre na parte distal. Essa inversão é importante para a estabilidade do antebraço. Embora eles sejam ossos distintos, eles atuam como se fosse um osso só! Entre eles fica uma membrana chamada de membrana interóssea, que atua como uma articulação.

Rádio

Epífise proximal

cabeça do rádio: ela é circular, por causa do movimento de supinação e pronação e da articulação que ele faz com o capítulo do úmero;

colo do rádio: porque sempre depois da cabeça, vem o colo;

tuberosidade radial: tuberosidade para a inserção do tendão do bíceps;

Diáfise

três bordas e três faces;

Epífise distal

incisura ulnar: articulação com a ulna;

processo estiloide: projeção cônica;

Observação Clínica:

queda com a mão estendida resulta em uma fratura típica que é a fratura na cabeça do rádio: na queda, a força é transmitida pra cabeça do rádio, que acaba quebrando. Às vezes é necessário uma reconstrução cirúrgica, e essa fratura ainda pode comprometer totalmente a extensão completa do membro. Na radiografia lateral, aparece o sinal do coxim adiposo. Encontrar isso na radiografia é importante, porque nem sempre a fratura é visível na radiografia. Quando não é visível, mas o paciente apresenta uma história clínica apropriada, aumento da sensibilidade ao redor da cabeça do rádio e o sinal do coxim positivo, então pode começar o tratamento, mesmo que na radiografia não apareça a fratura.

quando os pais tentam subir a criança na calçada puxando ela pelos braços, pode deixar elas com o cotovelo distendido. A cabeça do rádio dela ainda não tá desenvolvida, daí o ligamento anular do rádio é frouxo e permite que a cabeça do rádio subluxe da sua bainha de tecido. Ela é facilmente tratada, é só fazer supinação e compressão da articulação do cotovelo. Quando a cabeça do rádio é realocada, a dor passa na hora!

Outras Observações

as articulações proximal e distal entre o rádio e a ulna permitem que a parte distal do rádio mude de posição sobre a parte adjacente da ulna, resultando na pronação e na supinação da mão;

músculos anteriores do antebraço = pronação da mão. Músculos posteriores do antebraço = supinação da mão;

Ulna

Epífise proximal

olécrano: é a eminência que forma a ponta do cotovelo!

incisura troclear: serve para articulação com a tróclea do úmero;

incisura radial: articula – se com o rádio; inferiormente à incisura radial, situa – se a fossa que permite que a tuberosidade do rádio mude de posição durante a pronação e a supinação

outros dois pontos importantes: tuberosidade ulnar (inserção do músculo braquial) e processo coronoide;

Diáfise

três bordas e três faces;

rugosidade na face superior para a inserção do músculo tríceps braquial.

Epífise distal

cabeça da ulna e processo estiloide (esse processo é medial e saliente, e não é articular);

Observações clínicas:

é comum que as artérias radial e ulnar sejam seccionadas em acidentes como quebrar o vidro com o braço, pq elas são relativamente subcutâneas. O cirurgião pode, muitas vezes, facilmente consertar isso.

três lesões clássicas no rádio e na ulna: Fratura de Monteggia (fratura no terço proximal da ulna e luxação anterior da cabeça do rádio no cotovelo), Fratura de Galeazzi (fratura do terço distal do rádio associada à subluxação – luxação parcial – da cabeça da ulna – epífise distal – na articulação radiocarpal – do punho – ). Fratura de Colles (é a fratura e a luxação posterior da epífise distal do rádio). Quando tem uma fratura do rádio ou da ulna, tem que tirar uma radiografia do cotovelo e do punho também pra excluir luxações.

Mão e Punho

Entre o antebraço e a mão, vem a articulação radiocarpal. Ela permite que a mão seja abduzida, aduzida, fletida, estendida e pode fazer circundução.

A mão é um instrumento de sensibilidade. Por isso, nos coxins palmares dos dedos têm uma quantidade absurda de receptores sensoriais somáticos. A proporção em relação a outros locais da pele é muitoooo maior.

Assim como já falamos da importância por serem regiões de transição: axila, fossa cubital, finalmente falta falarmos do túnel do carpo.

Figura: Túnel do Carpo 

Fonte:  Cynthia C. Aquino. https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/

O nervo mediano e todos os tendões flexores longos que passam do antebraço para os dedos o fazem através do túnel do carpo. Na verdade, tudo distalmente passa pelo túnel do carpo, menos a artéria radial que passa dorsalmente.

Ossos da Mão (ossos do carpo, metacarpo e falanges)

Ossos do Carpo

os ossos do carpo são importantes, porque para ter os movimentos é necessário que tenha um “ponto morto”, que é feito pelos ossos do carpo. Não daria pra ligar o rádio/ulna direto com os dedos, daí a necessidade dos ossos carpais.

fileira proximal (de lateral pra medial): semilunar, escafoide, piramidal e pisiforme (osso sesamoide que se articula com a superfície anterior do piramidal);

fileira distal (de lateral pra medial): trapézio, trapezoide, capitato e hamato (onde fica o hâmulo do Amato).

depois vem os metacarpais de I a V;

depois vem as falanges. Tem três falanges em cada dedo, sendo uma proximal, média e distal, menos o polegar que tem só duas falanges (a proximal e a distal).

Observação clínica:

a lesão carpal mais comum é a fratura do osso escafoide. É incomum ocorrerem outras lesões.   

Referência:

Cynthia C. Aquino: Estudante de medicina do segundo período da Universidade Federal do Rio de Janeiro - Campus Macaé. Oi Medicina. Disponível em:  https://oimedicina.wordpress.com/2012/06/06/esqueleto-apendicular-cingulo-do-membro-superior-e-membros-superiores/ Pesquisado em 11/05/2020.

DRAKE, R. et alli; (2005). p. 623 a 710. Gray's Anatomia para Estudantes. 3a tiragem.

VÍDEO COMPLEMENTAR SOBRE AS ARTICULAÇ��ES DO  Sistema articular- articulações do cíngulo do membro superior - acromioclavicular e do ombro DISPONÍVEL EM:

https://www.youtube.com/watch?v=9iQzYMHFqbw

[traumaengineer]

Paciente 16; tercero del año 2022, masculino de 44a, dextromano, mecánico, quien posterior a accidente de tránsito tipo choque en vehículo 2 ruedas (moto) presenta dolor, aumentó volúmen y deformidad en región acromioclavicular izquierda con marcada limitación funcional, fue evaluado por el equipó de guardia indicando estudios radiológicos observando: Luxación acromioclavicular izquierda Rockwood V. Escala de Constant previo acto quirúrgico de 14 puntos Resuelto en nuestro servicio SCOT HRCS, planteando manejo quirúrgico con: Reducción directa mediante técnica que suspención coracoclavicular más cerclaje acromioclavicular con suturas de alta resistencia. Resultado quirúrgico satisfactorio. Seguiremos..... . . . . . . . . . . . . . . . . . . . #scot #trauma #quirofano #cirugia #ortopedia #osteosintesis #venezuela #medico #medic #emergency #genius #viral #gore #creppypasta #creepy #biomecanica #biomaterial #sutura #arteria #vena #anatomia #codo #hombro #traumatologia #hospital #shoulder #elbow #knee #pain (en Hospital Dr. Rafael Calle Sierra) https://www.instagram.com/p/Cgfy-KWspSu/?igshid=NGJjMDIxMWI=

[drguidofierro]

Cada vez son más comúnes las caídas sobre el hombro, que llevan a lesiones de la articulación entre la clavícula y la escápula - acromion. La estabilidad de esta articulación está dada por los ligamentos acromio claviculares (los que unen la clavícula con el acromion) y los ligamentos coracoclaviculares (conoide y trapezoide). Cuando hay un trauma en el hombro, primero se lesionan los ligamentos acromioclaviculares llevando a lesiones tipo I y luego, si la energía del trauma es suficiente hay una lesión parcial o total de los ligamentos coracoclaviculares. #acjoint #luxacionacromioclavicular #traumadehombro #dolorhombro #dolordehombro #acromioclavicularseparation #acromioclavicularligament (en Unidad De Especialistas Santafe Real) https://www.instagram.com/p/CFcJOnbJ0So/?igshid=9aky1umuw9zi

[buhkybrns]

do u ever think about bucky + his scarring ?  okay , so like : scar tissue is inelastic and won't move as easily ; because of its effect on movement if scar tissue is located by a joint can also cause joint problems from improper form and movement , which may lead to future complications. when connective tissue   ( consider : connective tissue provides the support framework for the functions of the shoulder ; think : subacromial / subdeltoid bursa [ acts as the cushion to reduce friction during motion between the bone & rotator cuff muscle ] , coracoclavicular ligament [ which maintains articulation of the clavicle and is the primary restraint against dislocation ] & articular cartilage , but also the ligaments that hold spinal vertebre together , all of which would be injured not only in the fall but with the integration of the structure for his arm  )   is injured , the nerve tissue in that surrounding area is injured as well , which then reacts by growing smaller , immature nerve branches, which are up to 1,000 times more pain sensitive than normal tissue. and because the the scar tissue forms as a protective measure that will avoid overstretching the muscle , stretching of scar tissue can also be very painful. as scar tissue forms and matures, that tissue becomes tighter , tougher , and less pliable -- without desensitization therapies , a scar will have a considerably more adverse impact on range of motion. not to mention it leaves the entire area more prone to re - injury. additionally , hypertrophic scars ( those raised scars you see targeted around his shoulder ) have been linked to an impact in posture and movement.

[bloomingjellies]

1, 12, and 22 for Tulsi?

@faejilly also asked for 12

1. Their physical weak spots

She tore the acromioclavicular ligament and coracoclavicular ligament in her left shoulder during a bad fall from the uneven bars when she was a teenager. The tear required surgery and rehab and she never regained full strength. It’s not a huge weak spot for her and isn’t noticeable but she does favor that arm when she does acrobatics.

12. Grudges and vendettas

She’s always had a grudge against batarians which, to be honest, can skirt the edges of racism. She does feel a great deal of remorse and guilt for the alpha relay and it makes her examine her prejudice against batarians.

She did not tell Anaya about Elnora’s recording and instead hunted her down herself. She did not like being conned.

22. People who’ve influenced them greatly

Her parents are the biggest and long-lasting negative influence in her life. Anderson was a positive influence for her but she is pretty reticent about it. James is a positive influence as well, though they’ve been in each other’s lives for so long that it’s hard to tell where that influence begins and ends. 

[jasonattaman]

New Post has been published on Dr. Attaman and Dr. Cartier | Pain Management Physicians | (425) 247-3359

New Post has been published on http://bit.ly/310bvMV

Treatments

The Correct Treatment Is Out There!

Our goal for your as our patient is to be able to offer the most effective yet most conservative treatment for your painful issue. This means that if physical therapy, acupuncture, or chiropractic will do the trick, we will prescribe it for you.

In many cases, however, our patients have already tried most such conservative options, and in such a situation we have many different forms of Interventional Pain Management options that can work wonders. Interventional Pain Management is the medical practice of using thin needles to inject medications very accurately and specifically to the painful area(s). Such injections are image-guided, which means that we use a medical imaging device such as x-ray or ultrasound to very gently guide the needle to the painful area. In most cases, we have a specialized interventional pain management procedure developed specifically for your painful condition.

In the rare case you require surgery, we will identify that need and refer you to one of the very best surgeons in the Puget sound. Over the past decade, we have developed a network of outstanding surgeons we work closely with.

Non-Interventional Treatments:

Osteopathic Manipulatioon Physical Therapy Prescription Chiropractic Referral Acupuncture Referral Pain Psychology Referral Massage Therapy Referral

Interventional Pain Management Procedures:

Head: greater and lesser occipital nerve block, supraorbital nerve block, infraorbital nerve block, gasserian ganglion block, sphenopalatine ganglion block, maxillary nerve block

Neck: cervical medial branch block and radiofrequency lesioning (traditional and with CerviCool cooled radiofrequency system), cervical interlaminar epidural block, cervical epidural catheter, zygapophyseal block, superficial cervical plexus block

Thorax: thoracic interlaminar epidural, thoracic transforaminal block, thoracic paravertebral block, thoracic medial branch block and radiofrequency lesioning (traditional and with ThoraCool cooled radiofrequency system), vertebroplasty, thoracic intraarticular zygapophyseal joint blocks, intercostal nerve block under fluoroscopy with contrast, intercostal neurolysis and radiofrequency lesioning

Lumbar: transforaminal epidural blocks, selective nerve root blocks, interlaminar epidural blocks, transforaminal lateral recess blocks, medial branch blocks and radiofrequency lesioning (traditional and with LumbarCool cooled radiofrequency system), intraarticular zygapophyseal joint blocks, pulsed radiofrequency of the dorsal root ganglion, pars defect blocks, hardware screw blocks, vertebroplasty, discography, functional anesthetic discography, Baylis TransDiscal cooled radiofrequency biacuplasty, percutaneous intradiscal coblation nucleoplasty, caudal epidural block, lumbar epidurolysis (Racz technique), sacroiliac joint injection and radiofrequency lesioning (traditional and Baylis SInergy cooled radiofrequency system), intradiscal ozone chemonucleolysis.

Joint Injections: shoulder joint injection, subacromial injection, olecranon bursa injection, hip injection under fluoroscopy, knee injection, trochanteric bursa injection under fluoroscopy, ischial bursa injection, knee injection, ankle joint injection, acromioclavicular joint block, pubic symphysis block under fluoroscopy, xiphisternal block under fluoroscopy

Peripheral Nerve Blocks: suprascapular nerve block and pulsed radiofrequency, median nerve block at the wrist, ulnar nerve block at the wrist, digital nerve block, axillary block with nerve stimulation and ultrasonic guidance, superficial cervical plexus block, ilioinguinal nerve block and pulsed radiofrequency, lateral femoral cutaneous block, genitofemoral nerve block, common peroneal nerve block, genital nerve block, saphenous nerve block, ankle block, pudendal nerve block, pulsed radiofrequency treatment of the pudendal nerve, radiofrequency neurotomy of the genicular nerves (traditional and Coolief cooled radiofrequency system).

Sympathetic System: stellate ganglion block, T2 and T3 thoracic sympathetic block, splanchnic block and neurolysis, celiac plexus block and neurolysis, lumbar sympathetic block and radiofrequency lesioning, hypogastric plexus block and neurolysis, ganglion impar block

Implantable Devices: spinal cord and peripheral nerve field stimulator percutaneous trial and surgical implantation, spinal cord stimulation of the conus medullaris for chronic pelvic pain, intrathecal pump trial, and surgical implantation, tunneled epidural and intrathecal catheters, continuous peripheral nerve catheters

Cryoablation Procedures of all nerves

Ultrasound guided pain procedures of all types

Prolotherapy under fluoroscopic guidance

German Neural Therapy under fluoroscopic guidance

ORTHOBIOLOGIC PROCEDURE OPTIONS

Fully certified by the International Orthopedics Foundation (IOF) in orthobiologic procedures to the following structures:

Knee: Intra-articular with ultrasound (supra-patellar pouch), Intra-articular with fluoroscopy, patellar tendon with ultrasound, quadriceps tendon with ultrasound, lateral compartment through patella-femoral joint with ultrasound, lateral compartment through patella-femoral joint with fluoroscopy, medial collateral ligament, meniscus, and coronal ligaments with ultrasound, lateral collateral ligament to fib head, meniscus, popliteus, biceps femoris with ultrasound, distal iliotibial band insertion with ultrasound, Baker’s cyst drainage with ultrasound, posterior medial corner structures (meniscus, pes anserine tendons, meniscus hamstrings insertions) with ultrasound, medial-lateral retinaculum and POL (posterior oblique ligament) with ultrasound, anterior cruciate ligament with ultrasound, anterior cruciate ligament with fluoroscopy, posterior cruciate ligament with ultrasound, posterior cruciate ligament with fluoroscopy, medial and lateral femoral condyle bone access, medial and lateral tibial bone access

Hip: intra-articular with fluoroscopy, intra-articular with ultrasound, labrum and hip capsular ligaments (iliofemoral, pubofemoral, ischiofemoral) with ultrasound, anterior superior and posterior facets of greater trochanter with ultrasound, proximal iliotibial band with ultrasound, posterior-lateral iliac crest muscle origins with ultrasound, anterior superior iliac spine and associated muscle origins with ultrasound, adductor group tendons with ultrasound, hamstrings origin with ultrasound, femoral nerve block, femoral bone access with fluoroscopy, acetabulum bone access with fluoroscopy, hip intra-articular hydrodilation, ligamentum teres under fluoroscopy

Shoulder: intra-articular with ultrasound, intra-articular with fluoroscopy, sub-deltoid with ultrasound, acromioclavicular joint intra-articular with ultrasound, acromioclavicular joint intra-articular with fluoroscopy, supraspinatus, infraspinatus/teres, subscapularis, biceps tendon, coracoacromio/coracoclavicular ligaments and superior glenohumeral ligament , acromioclavicular joint intra-articular, middle glenohumeral ligament/inferior glenohumeral ligament/posterior capsule with labrum, suprascapular nerve block, shoulder intra-articular hydrodilatation, humerus bone augmentation / intraosseous, superior labrum with ultrasound and fluoroscopy, Interscalene supraclavicular nerve block with ultrasound

Ankle: Ankle tibiotalar joint with ultrasound & fluoroscopy, lateral ankle ligaments (anterior talofibular ligament, calcaneofibular, posterior talofibular ligament) with ultrasound, high lateral ankle ligaments with ultrasound, peroneal tendons (longus and brevis), anterior/posterior tibialis tendon, achilles tendon, tibial nerve block, tibial nerve hydrodissection with ultrasound, deltoid ligament with ultrasound, subtalar joint injection with ultrasound, subtalar joint injection with fluoroscopy, talus bone injection with fluoroscopy, calcaneus bone injection with fluoroscopy

Foot: metatarsalphalangeal joints with ultrasound, metatarsalphalangeal joints with fluoroscopy, plantar fascia with ultrasound, plantar fascia with fluoroscopy, flexor hallucis longus with ultrasound, flexor digitorum longus with ultrasound, digital nerve block with ultrasound, dorsal capsular ligaments of metatarsalphalangeal joints with ultrasound, extensor hallucis longus with ultrasound, extensor digitorum longus with ultrasound, plantar capsular ligaments with ultrasound, plantar plate with ultrasound, sesamoid with ultrasound, talo-navicular under ultrasound, talo-navicular under fluoroscopy, calaneo-cuboid under ultrasound, calaneo-cuboid under fluoroscopy

Elbow: elbow joints with ultrasound and fluoroscopy (radiohumeral and humeroulnar), medial and lateral epicondyle with ultrasound, ulnar collateral ligament with ultrasound, radial collateral ligament/lateral collateral ligament with ultrasound, radial annular ligament, biceps insertion, triceps tendon insertion, ulnar nerve hydrodissection with ultrasound

Hand/Wrist: intercarpal with ultrasound , intercarpal with fluoroscopy, digit intra-articular (metacarpophalangeal joint, proximal interphalangeal joint, distal interphalangeal joint) with ultrasound, Digit intra-articular (metacarpophalangeal joint, proximal interphalangeal joint, distal interphalangeal joint) with fluoroscopy, carpometacarpal intra-articular with ultrasound, carpometacarpal intra-articular with fluoroscopy, carpometacarpal capsular ligaments with Ultrasound, radial, median, ulnar nerve blocks with ultrasound, digit capsular ligaments with ultrasound, flexor tendons with ultrasound, extensor pollicis brevis and abductor pollicis longus tendons with ultrasound, scapholunate ligament with ultrasound, 360 degree wrist ligaments with ultrasound, median, ulnar, radial nerve hydrodissection with ultrasound, flexor tendon sheath hydrodilatation with ultrasound, triangular fibrocartilage (TFCC) complex, RUC/DUC ligaments with ultrasound, radial collateral ligament with ultrasound

Spine: C2-C7 facets under fluoroscopy, C2-C7 facets under ultrasound, Cervical supraspinous/interspinous ligaments under ultrasound, Cervical epidurals (interlaminar or transforaminal) under fluoroscopy, greater and lesser occipital nerves under ultrasound, thoracic intra-articular facets under fluoroscopy, thoracic costovertebral facets under fluoroscopy, thoracic costovertebral facets under ultrasound, intercostal nerves under fluoroscopy, intercostal nerves under ultrasound, thoracic supraspinous/interspinous ligaments under ultrasound, lumbar facets under fluoroscopy, lumbar facets under ultrasound, lumbar supraspinous/interspinous ligaments under ultrasound, Lumbar iliolumbar ligaments under fluoroscopy, lumbar epidurals (interlaminar or transforaminal) under fluoroscopy, caudal epidural under fluoroscopy, caudal epidural under ultrasound, sacroiliac joint under fluoroscopy, sacroiliac joint ligaments under fluoroscopy, intervertebral disc injection.