Bones of the Upper Limb

[...]... considerable variety of incident, and by actions which even the most favourable judgment cannot regard with unmixed complacency The twelve jurymen sat in their places, in the jury-box to the left of the judge The witnesses summoned on behalf of the Crown were the Honourable William Dickson and the Honourable William Claus, both of whom were members of the Legislative Council of Upper Canada The former gentleman... followed, the ultimate result of which was a decision in Mr Gourlay's favour But it was the old story of Jarndyce v Jarndyce The protracted litigation had eaten up the substance of the successful litigant, and upon the promulgation of the decree the Wiltshire Radical was a ruined man This would have been a matter of secondary importance to the heir of a wealthy Fifeshire laird, but unhappily his father... from the United States which had been adopted after the War of 1812-15 He was the owner of an immense quantity of uncultivated land in the Province, including the township of Dumfries already men[Pg 26]tioned, which he was desirous of selling to incoming settlers The shutting out of United States immigrants tended to retard the progress of settlement and the sale of his property His anger against the. .. he writes, "in one of the cells of the jail, my health had begun to suffer, and, on complaint of this, the liberty of walking through the passages and sitting at the door was granted This liberty prevented my getting worse the four succeeding months, although I never enjoyed a day's health, but by the power of medicine At the end of this period I was again locked up in the cell, cut off from all conversation... memorial for their consideration, but on this occasion was not visited I complained to a magistrate through the door, who promised to mention my case to the chairman of the sessions, but the chairman happened to be brother of one of those who had signed my commitment, and the court broke up without my obtaining the smallest relief Exasperation of mind, now joined to the heat of the weather, which was... for the cause of truth and justice But his sufferings during the ensuing six months were of a nature well calculated to sap the health of the most robust, to rack the frame of an athlete, to tame the wildest enthusiasm, and to subjugate the strongest will When we read of what the gentle and erudite John Fisher or the eloquent and upright Sir John Eliot underwent in the Tower for conscience sake, the. .. in advance of most of his professional brethren of that day, and he had cultivated his natural abilities by constant watchfulness and study His features, one and all, were well and sharply defined, and he was probably the handsomest man at Bones of the Upper Limb Bones of the Upper Limb Bởi: OpenStaxCollege The upper limb is divided into three regions These consist of the arm, located between the shoulder and elbow joints; the forearm, which is between the elbow and wrist joints; and the hand, which is located distal to the wrist There are 30 bones in each upper limb (see [link]) The humerus is the single bone of the upper arm, and the ulna (medially) and the radius (laterally) are the paired bones of the forearm The base of the hand contains eight bones, each called a carpal bone, and the palm of the hand is formed by five bones, each called a metacarpal bone The fingers and thumb contain a total of 14 bones, each of which is a phalanx bone of the hand Humerus The humerus is the single bone of the upper arm region ([link]) At its proximal end is the head of the humerus This is the large, round, smooth region that faces medially The head articulates with the glenoid cavity of the scapula to form the glenohumeral (shoulder) joint The margin of the smooth area of the head is the anatomical neck of the humerus Located on the lateral side of the proximal humerus is an expanded bony area called the greater tubercle The smaller lesser tubercle of the humerus is found on the anterior aspect of the humerus Both the greater and lesser tubercles serve as attachment sites for muscles that act across the shoulder joint Passing between the greater and lesser tubercles is the narrow intertubercular groove (sulcus), which is also known as the bicipital groove because it provides passage for a tendon of the biceps brachii muscle The surgical neck is located at the base of the expanded, proximal end of the humerus, where it joins the narrow shaft of the humerus The surgical neck is a common site of arm fractures The deltoid tuberosity is a roughened, V-shaped region located on the lateral side in the middle of the humerus shaft As its name indicates, it is the site of attachment for the deltoid muscle 1/14 Bones of the Upper Limb Humerus and Elbow Joint The humerus is the single bone of the upper arm region It articulates with the radius and ulna bones of the forearm to form the elbow joint Distally, the humerus becomes flattened The prominent bony projection on the medial side is the medial epicondyle of the humerus The much smaller lateral epicondyle of the humerus is found on the lateral side of the distal humerus The roughened ridge of bone above the lateral epicondyle is the lateral supracondylar ridge All of these areas are attachment points for muscles that act on the forearm, wrist, and hand The powerful grasping muscles of the anterior forearm arise from the medial epicondyle, which is thus larger and more robust than the lateral epicondyle that gives rise to the weaker posterior forearm muscles The distal end of the humerus has two articulation areas, which join the ulna and radius bones of the forearm to form the elbow joint The more medial of these areas is the trochlea, a spindle- or pulley-shaped region (trochlea = “pulley”), which articulates with the ulna bone Immediately lateral to the trochlea is the capitulum (“small head”), a knob-like structure located on the anterior surface of the distal humerus The capitulum articulates with the radius bone of the forearm Just above these bony areas are two small depressions These spaces accommodate the forearm bones when the elbow is fully bent (flexed) Superior to the trochlea is the coronoid fossa, which receives the coronoid process of the ulna, and above the capitulum is the radial fossa, which receives 2/14 Bones of the Upper Limb the head of the radius when the elbow is flexed Similarly, the posterior humerus has the olecranon fossa, a larger depression that receives the olecranon process of the ulna when the forearm is fully extended Ulna The ulna is the medial bone of the forearm It runs parallel to the radius, which is the lateral bone of the forearm ([link]) The proximal end of the ulna resembles a crescent wrench with its large, C-shaped trochlear notch This region articulates with the trochlea of the humerus as part of the elbow joint The inferior margin of the trochlear notch is formed by a prominent lip of bone called the coronoid process of the ulna Just below this on the anterior ulna is a roughened area called the ulnar tuberosity To the lateral side and slightly inferior to the trochlear notch is a small, smooth area called the radial notch of the ulna This area is the site of articulation between the proximal radius and the ulna, forming the proximal radioulnar joint The posterior and superior portions of the proximal ulna make up the olecranon process, which forms the bony tip of the elbow Ulna and Radius The ulna is located on the medial side of the forearm, and the radius is on the lateral side These bones are attached to each other by an interosseous membrane 3/14 Bones of the Upper Limb More distal is the shaft of the ulna The lateral side of the shaft forms a ridge called the ...Sarcoidosis of the Upper Lung Fields Simulating Pulmonary Tuberculosis Alvin S. Teirstein, M.D., F.C.C.P." and Louis E. Siltzbach, M.D., F.C.C.P."" Fifty-four of 616 patients (9 percent) with sarcoidosis exhibited upper lung field radiographic abnormalities, which mimicked adult tuberculosis. Difficulty in diagnosis occurred when patients presented with residual upper zonal shadows, which had persisted after clearing of lower and midzooal densities. The abnormal- ities of sarcoidosis appeared as streaks and nodules simulating acinonodose tu- berculosis. Contraction of the upper zones with retraction of the mediastinal structures may be just as prominent as in fibrotic tuberculosis. Bube can some- times be mistaken for tuberculous cavities, and small multiple radiolucencies may be mistaken for tuberculous bronchiectasii Awareness that upper zonal sarcoidosis rewesents a residual manifestation of the more usual att tern of hilar adenopathy a;ld diffuse lower and midzonal infiltrations, aids in dkkngnishing this radiographic pattern from that of adult tuberculosis. Obtaining a radiograph dating back tian earlier stage can be crucial in making this differentiation. when confronted with upper lung field abnormalities, the diagnosis of sarcoidosis as well as tuberculosis should come to mind and appropriate clinical support should be sought. he radiographic patterns of pulmonary sarcoido- Tsis when localized to the upper lung zones may closely mimic the typical appearance of pulmonary tuberculosis, often leading to confusion in diagnosis. Symmetrical bilateral hilar and right paratracheal lymphadenopathy is recognized as the hallmark of early intrathoracic sarcoidosis ( stage 1 ).I Later, in approximately one half of the patients, pulmonary mottling appears and may assume either a micro- nodular, reticular or confluent patchy configuration (stage 2). These radiographic shadows may be diffusely distributed or they may be localized. Final- ly, in the third stage, the enlarged mediastinal lymph nodes regress and only the pulmonary components of intrathoracic involvement may remain2 When in the third stage, residual parenchymal infiltrations are predominantly localized to the upper lung zones, 'Associate Clinical Professor of Medicine, The Mount Sinai School of Medicine, New York. "Clinical Professor of Medicine, The Mount Sinai School of Medicine, New York. The work was supported by USPHS, National Heart and Lung Institute Grant No. HL 13853, and The Sadie and Louis Elow Foundation. Manuscript received December 21, 1972; revision accepted March 28. 1973. Reprint requests: Dr. Teirstein, 70 East 90th Street, New York City 10028 CHEST, VOL. 64, NO. 3, SEPTEMBER, 1973 they may easily be confused radiographically with the lesions of pulmonary tuberculosis, especially when earlier radiographs have not as yet become available. Among 616 patients with a tissue-con- firmed diagnosis of sarcoidosis observed at the Mount Sinai Hospital, New York, we found 54 pa- tients (9 percent ) whose radiographs disclosed such pulmonary densities in the upper zones without the accompanying tell-tale hilar adenopathy. All 54 subjects had histologic findings compatible with sarcoidosis on organ biopsy or a positive Kveim test reaction or both. Tuberculin skin testing was carried through the second-strength purified protein derivative (PPD) (250 TU [...]... presents the story of past peoples of the Upper Mississippi River Valley from the first inhabitants through the era of European contact The story is preceded by an introduction to archaeology, providing the reader a context for archaeological interpretation The topography and resources available to Native people of the Upper Mississippi Valley are then described The Mississippi River drains a vast portion of. .. stage in the prehistory of the Upper Mississippi Valley, subsistence remains indicate what economic activities were being pursued during each part of the seasonal round introduction to archaeology | 17 c h a p t e r t w o Environment of the Upper Mississippi River Valley The portion of the Upper Mississippi River that cuts through the unglaciated Driftless Area (fig 2.1) is a unique setting of rich and... dating, and the seriation of artifacts by style are used with regularity in the Upper Mississippi River Valley Stratigraphy involves interpreting the vertical placement of artifacts within individual layers, or strata, in the soil at sites This method is based on the geologic “law of superposition,” which holds that the layer on the bottom of a sequence of layers will be the oldest, while those on the top... colleagues at the University of Wisconsin–La Crosse and the Mississippi Valley Archaeology Center We would like to thank the College of Liberal Studies at the University of Wisconsin–La Crosse for a grant to support graphics for this book Illustrations were prepared with the assistance of Jody Bruce, Jean Dowiasch, Jiro Manabe, Laura Jankowski, Megan Rivers, and Liz Schultz We are grateful for the detailed... inhabited the Upper Mississippi basin were influenced by a sequence of environmental changes Shifts in lifestyles, as reflected by their artifacts, often correspond with shifts in climatic regimes Archaeologists base many of their interpretations about the past on the artifactual remains and the contexts of those remains This reliance on artifacts is especially critical in the Upper Mississippi Valley because... of paperwork, these moments of discovery make archaeology a career to envy This book is dedicated to the hundreds BioMed Central Page 1 of 10 (page number not for citation purposes) Journal of NeuroEngineering and Rehabilitation Open Access Research Control of the upper body accelerations in young and elderly women during level walking Claudia Mazzà* † , Marco Iosa † , Fabrizio Pecoraro † and Aurelio Cappozzo † Address: Department of Human Movement and Sport Sciences, Università degli Studi di Roma "Foro Italico", Rome, Italy Email: Claudia Mazzà* - claudia.mazza@iusm.it; Marco Iosa - marco.iosa@iusm.it; Fabrizio Pecoraro - fabrizio.pecoraro@iusm.it; Aurelio Cappozzo - aurelio.cappozzo@iusm.it * Corresponding author †Equal contributors Abstract Background: The control of the head movements during walking allows for the stabilisation of the optic flow, for a more effective processing of the vestibular system signals, and for the consequent control of equilibrium. In young individuals, the oscillations of the upper body during level walking are characterised by an attenuation of the linear acceleration going from pelvis to head level. In elderly subjects the ability to implement this motor strategy is reduced. The aim of this paper is to go deeper into the mechanisms through which the head accelerations are controlled during level walking, in both young and elderly women specifically. Methods: A stereophotogrammetric system was used to reconstruct the displacement of markers located at head, shoulder, and pelvis level while 16 young (age: 24 ± 4 years) and 20 older (age: 72 ± 4 years) female volunteers walked at comfortable and fast speed along a linear pathway. The harmonic coefficients of the displacements in the medio-lateral (ML), antero-posterior (AP), and vertical (V) directions were calculated via discrete Fourier transform, and relevant accelerations were computed by analytical double differentiation. The root mean square of the accelerations were used to define three coefficients for quantifying the attenuations of the accelerations from pelvis to head, from pelvis to shoulder, and from shoulder to head. Results: The coefficients of attenuation were shown to be independent from the walking speed, and hence suitable for group and subject comparison. The acceleration in the AP direction was attenuated by the two groups both from pelvis to shoulder and from shoulder to head. The reduction of the shoulder to head acceleration, however, was less effective in older women, suggesting that the ability to exploit the cervical hinge to attenuate the AP acceleration is challenged in this population. Young women managed to exploit a pelvis to shoulder attenuation strategy also in the ML direction, whereas in the elderly group the head acceleration was even larger than the pelvis acceleration. Conclusion: The control of the head acceleration is fundamental when implementing a locomotor strategy and its loss could be one of the causes for walking instability in elderly women. Published: 17 November 2008 Journal of NeuroEngineering and Rehabilitation 2008, 5:30 doi:10.1186/1743-0003-5-30 Received: 15 February 2008 Accepted: 17 November 2008 This article is available from: http://www.jneuroengrehab.com/ BioMed Central Page 1 of 6 (page number not for citation purposes) World Journal of Surgical Oncology Open Access Case report Merkel cell carcinoma of the upper extremity: Case report and an update Michail Papamichail* 1 , Ioannis Nikolaidis 2 , Nicolas Nikolaidis 3 , Chryssoula Glava 2 , Ioannis Lentzas 2 , Konstantinos Marmagkiolis 4 , Kriton Karassavsa 1 and Michail Digalakis 1 Address: 1 General Hospital of Athens, ''Asklipion Voulas", Athens, Greece, 2 Tzaneion General Hospital, Piraeus, Greece, 3 Aberdeen Royal Infirmary Hospital, Aberdeen, UK and 4 Montreal Heart Institute, Montreal QC, Canada Email: Michail Papamichail* - mp2006gr@yahoo.co.uk; Ioannis Nikolaidis - ioannisnikolaidis@yahoo.gr; Nicolas Nikolaidis - nicnik1977@yahoo.com; Chryssoula Glava - chryssa_mo@hotmail.com; Ioannis Lentzas - lentzdoc@hotmail.com; Konstantinos Marmagkiolis - c.marmagiolis@gmail.com; Kriton Karassavsa - mp2006gr@yahoo.co.uk; Michail Digalakis - mp2006gr@yahoo.co.uk * Corresponding author Abstract Background: Merkel cell carcinoma is a rare but aggressive cutaneous primary small cell carcinoma. It is commonly seen in elderly affecting the head, neck, and extremities. Macroscopically may be difficult to distinguish MCC from other small cells neoplasms especially oat cell carcinoma of the lung. Case presentation: It is presented a case report concerning a 72 years old male with a MMC on the dorsal aspect of the right wrist. The patient underwent a diagnostic excisional biopsy and after the histological confirmation of the diagnosis a second excision was performed to achieve free margins. No postoperative radiation or adjuvant chemotherapy was given and within 9 years follow up no recurrence was reported. Conclusion: Although most cases present as localized disease treatment should be definitive due to high rates of local or systemic recurrence. Treatment includes excision of the lesion, lymphadenectomy, postoperative radiotherapy and chemotherapy depending on the stage of the disease. Even when locoregional control is achieved close surveillance is required due to high rates of relapse. Background Merkel cell carcinoma (MCC) is a rare cutaneous malig- nancy that was first described by Toker in 1972 [1]. This rare aggressive neoplasm is thought to originate from the neurocrest derivatives round shaped Merkel cells located in the basal layer of the epidermis and containing neuro- secretory granules [2-5]. Although aetiology is not fully illuminated, there are sev- eral risk factors that contribute to its pathogenesis. Those include UV light, sun-related skin malignancies (Squa- mous Cell Carcinoma, Basal Cell Carcinoma), psoriasis treatment with methoxsalen and arsenic exposure. Patients on immunosuppressive agents or patients with diagnosis of AIDS, chronic lymphocytic leukemia, con- Published: 7 March 2008 World Journal of Surgical Oncology 2008, 6:32 doi:10.1186/1477-7819-6-32 Received: 5 October 2007 Accepted: 7 March 2008 This article is available from: http://www.wjso.com/content/6/1/32 © 2008 Papamichail et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. World Journal of Surgical Oncology 2008, 6:32 http://www.wjso.com/content/6/1/32 Page 2 of 6 (page number not for citation purposes) genital dysplasia syndrome and organ recipients carry a higher risk as well [6-11]. Clinically, MCC appears as a painless, firm, non tender, ulcerated skin lesion commonly less than 2 cm in size at the time of presentation [4,8]. Most cases present as local- ized disease (70%–80%) followed by regional lymph node involvement (9%–26%) and distant metastasis (1%–4%) [8]. These characteristics often raise the suspi- cion of a skin malignancy but confirmation of diagnosis is ... of the hand at the wrist The distal carpal bones also articulate with the metacarpal bones of the hand Bones of the Hand This radiograph shows the position of the bones within the hand Note the. .. ulna bones of the forearm These will pass the force through the elbow joint into the humerus of the arm, and 13/14 Bones of the Upper Limb then through the glenohumeral joint into the scapula The. .. finishes on the lateral side 5/14 Bones of the Upper Limb Bones of the Wrist and Hand The eight carpal bones form the base of the hand These are arranged into proximal and distal rows of four bones