Correspondence of the sections of the humerus to the anatomical formations. Fracture of the neck of the humerus (Fracture of the neck of the humerus)

The human skeleton has 205-207 bones, of which 64 belong to the skeleton of the upper limbs. Let's consider where the humerus is located, which serves to articulate parts of the arms, takes part in movement, and also takes on the loads associated with the forearm and the entire shoulder girdle.

If we talk about typing, osteology defines this bone as a long, tubular one, part of the free upper limb of the skeleton, since its length significantly exceeds its width. Tubular bones are very strong in their structure, nature has thought out their structure well, and in terms of the strength of resistance to the pressure of the body weight and possible additional weights, they can be compared with cast iron.

The shape and structure of each organ in the skeleton is determined by the function it performs: The humerus bone is involved in connections with the spherical shoulder and complex elbow joints, which determines its features among other tubular bones.

When connected in its upper section to the scapula, for example, a characteristic feature appears - a discrepancy in the size of the structure of the elements. The spherical, convex head is disproportionate to the articular scapular cavity, called in medicine the glenoid. It is almost flat, its diameter is four times smaller than the size of the articular head.

The shock-absorbing element in this connection are parts of the head such as hyaline cartilage and the articular cartilaginous lip. They carry the functions of increasing the depth of the scapular cavity, cushioning and stabilizing the joint. The stability of the joint is also facilitated by the joint capsule - a dense, permeable sac in the walls of which ligaments are located.

This structural feature serves for freedom of range of motion; on the other hand, the head can fall out of the joint during a sudden movement, accompanied by a jerk, and in the case of dislocation, it happens that the cartilaginous lip is torn away from the glenoid.

Let's look at the structure of the humerus:

• apophyses– from the Greek apophysis, i.e. "shoot". These processes serve to attach muscles and fix ligaments;
• epiphyses– the upper and lower ends of the diaphysis are represented by spongy substance;
• diaphysis- the body, represented by a compact substance, contains a channel with a yellow brain in adults and a red brain in children.
• metaphysis– growth zone that occurs until 22-23 years of age;
• hyaline cartilage– covering the ends of the bone;
• periosteum– the outer covering consists of connective tissue; capillaries and nerves pass through here, providing nutrition and communication. The fibrous layer of the periosteum provides good adhesion for tendons and ligaments.

You can clearly see the device in the photo, using the example of the right humerus.

All anatomy and uniqueness are subject to the best movable connection with the area of ​​the shoulder and forearm bones:

1. The shoulder joint is the articulation of the upper end + scapula.
2. Forearm joints:

• humeral + ulnar – through the surface of the lower end, trochlea humeri block, cylindrical in shape;
• humeral + radial - through the surface of the lower epiphysis, capitulum humeri, spherical in shape.

The complex biomechanics of these joints make a variety of hand movements possible.

Proximal epiphysis

The upper, or proximal, end is wider than the body itself and has a rounded head, caput humeri. It is turned towards the scapula, and its smooth sphere is separated by the anatomical neck of the humerus, collum anatomicum. The head of the humerus is covered with hyaline cartilage, providing shock absorption during movements and necessary for proper functioning and mobility.

Under the head there are two apophyses:

• tuberculum majus– large tubercle on the literal surface;
• tuberculum minus- the lesser tubercle of the humerus, located in front of the lateral literal.

The cuff of the shoulder girdle, which is responsible for rotational movements, is attached to these apophyses; along the periphery there is a plexus of nerves of the shoulder, consisting of several bundles.

From each of the apophyses the ridges of the greater and lesser tubercle extend downward. These ridges separate the intertubercular groove, where the biceps brachii tendon lies.

Below the apophyses there is also the narrowest place - the surgical neck of the humerus, a narrowing corresponding to the zone of the epiphysis. It belongs to particularly vulnerable traumatological places, since in this place there is a sharp change in the cross-section: from round at the upper end to trihedral at the lower end.

Body of humerus

Between the upper and lower ends there is a diaphysis, which acts as a lever to receive the main load; it has a heterogeneous cross-section: at the top the shape is cylindrical, and closer to the lower end there is a transition to a triangular form.

This appearance is determined by the anterior, external and internal ridges that extend in this area.

The bones on the body are:

• literal surface– in the area of ​​the upper third of this part of the body, the deltoid tuberosity of the humerus stands out, a relief area along which the muscle of the same name is attached, lifting the shoulder outward to a horizontal plane;
• medial surface– here the groove of the radial nerve descends in a spiral; the ulnar nerve itself, which approaches the bone in this place, as well as the deep brachial arteries, lie in it;
• nutrient opening– located on the medial anterior part and leads into the distal nutrient canal through which small arteries pass.

Reference! Most of the diaphysis consists of a compact substance. On the body of the bone, which borders the medullary cavity, lamellar bone tissue forms the crossbars of the spongy substance. The space of the tubular body is filled with bone marrow.

Distal epiphysis

The distal end of the bone is also called the “lower”, it has a slightly compressed shape in the anterior and posterior planes, the width of the bone here doubles as it approaches the elbow. Its functions are not limited to participation in the elbow joint - nerve and vascular plexuses pass along its periphery, fixing ligaments and muscles.

The lower end contains 2 fused processes - the capitula and the trochlea, and has a pommel of a head, which works as part of the radial and ulnar joints:

1. Internal condyle- on this side of the surface of the epiphysis it forms a block of the shoulder, with which the ulna bone is in coupling and is connected in the joint: its upper end continues upward with the olecranon process. On the posterior surface of the condyle there is a groove where the nerve trunk is located. This groove and condyle can be palpated during examination, which carries a number of diagnostic functions.
2. Outer– the head of the epiphysis on this side of the articular surface already cooperates with the radius. The joint allows the forearm to rotate and bend despite the tight hinge with the block.

Also in the anterior section is the coronoid fossa; the process of the ulna is placed into it when a person bends his arm. The radial fossa is less pronounced, but does the same job for the radial process. Note that the wall lying between the ulnar fossa and the coronoid fossa is very thin and consists of only 2 layers.

Conclusion

The human humerus and its anatomy are well studied and described, yet they are complex, as the arms are one of the most mobile parts of the human body. The basis of our usual daily movements, which we don’t even think about, involves complex and amazing biomechanics.

The shoulder refers to the long tubular bones of humans. The anatomy is simple and is determined by a number of functions performed. On its surface there are anatomical formations, such as the head, medial condyle, as well as tubercles and pits, which serve as attachment points for muscles and ligaments. The humerus functions as a lever. Fractures are very dangerous, because due to damage to the bone marrow canal, a fat embolism can develop or a vessel may become blocked.

Most often, the shoulder suffers as a result of fractures in the area of ​​the anatomical neck.

Structure and anatomy

At the top of the bone there is a round formation - the head, which is an integral part of the joint. It is separated from the rest of the bone by a narrow groove. It is called the anatomical neck. It is in this part that fractures most often occur. Behind it is the place of attachment of the main muscles of the shoulder, represented by two tubercles - large and small, as well as ridges. The lesser tubercle is located in front of the shoulder. There is a tuberosity in the middle of the bone. This is where the deltoid muscle attaches. On the side of the elbow, the humerus ends with 2 epicondyles, between which there is an articular surface. The medial condyle is much larger than the lateral one. There are also 2 recesses located here - the olecranon process or ulnar fossa and the radial one.

Functions of the humerus

The shoulder structure is actually a lever and increases the range of motion of the upper limb. In addition, the bone is involved in maintaining balance when the center of gravity shifts while walking. This element determines the correct support of a person on his hands when climbing stairs and in other specific body positions.

Damage: causes and symptoms

When the shoulder joint is dislocated, a person feels sharp pain.

Dislocation of the shoulder and elbow joint is common and is associated with high mobility of the upper limb. There are anterior, posterior and inferior displacement. If damaged, it becomes difficult to move the limb, pain is felt, and swelling is visualized. When a nerve is pinched, the skin becomes numb. Dislocations are distinguished as new and old. At the same time, a protrusion of the greater tubercle or a fracture of the neck may occur. The shoulder is swollen, painful, there is noticeable hemorrhage, sensitivity in the arm and fingers is lost.

A fracture of the humerus occurs due to significant force. This happens when you fall backward on your elbows or forward on your outstretched arms. Bone fracture occurs in anatomically weak areas. These include:

• anatomical and surgical neck;
• condyle area;
• area of ​​the head of the humerus;
• the middle of the bone.

Immediately after the injury, the patient feels a sharp pain in the arm, as well as the inability to perform actions with it. The exact amount of movement lost depends on the immediate location of the injury. After some time, severe swelling of the shoulder is observed, and bruising and bruising may develop. In this case, the limb is significantly deformed.

Diseases

Among the diseases of this joint, arthritis is common.

A common disease is the introduction of infection into the bone marrow through the blood. Damage to the shoulder occurs because this bone is tubular and has an abundant blood supply. As a result of the development of this disease, bone tissue can decompose, and then pathological fractures form (without the participation of strong external influences). In addition, arthritis of the shoulder and elbow joints may develop.

ENCYCLOPEDIA OF MEDICINE /SECTION^

ANATOMICAL ATLAS

The structure of the humerus

The humerus is a typical long tubular bone that forms the proximal (upper) part of the arm. It has a long body and two ends, one of which articulates with the scapula at the shoulder joint, the other with the ulna and radius bones at the elbow joint.

The apex of the humerus—its proximal end—has a large, smooth, hemispherical articular surface that articulates with the glenoid cavity of the scapula to form the shoulder joint. The head is separated from the rest by a narrow interception - an anatomical neck, below which there are two bony protrusions - the greater and lesser tubercles. These tubercles serve as sites of muscle attachment and are separated by the intertubercular groove.

BODY OF HUMERUS

_(DIAPHYSUS)_

There is a slight narrowing at the top of the body of the humerus - the surgical neck is a common site for fractures. The relatively smooth surface of the diaphysis has two distinctive features. Approximately in the middle of the length of the body of the humerus, closer to its upper epiphysis on the lateral (side) surface, there is a deltoid tuberosity, to which the deltoid muscle is attached. Below the tuberosity, a spiral groove of the radial nerve runs along the posterior surface of the humerus. In the deepening of this groove pass the radial nerve and deep arteries of the shoulder.

The lateral edges of the diaphysis in its lower part pass into protruding medial (internal) and lateral epicondyles. The articular surface is formed by two anatomical formations: the trochlea of ​​the humerus, which articulates with the ulna, and the head of the condyle of the humerus, which articulates with the radius.

Humerus, posterior view

humerus

Articulates with the glenoid cavity of the scapula at the shoulder joint.

Anatomical -

It is the remnant of the growth plate where bone growth occurs in length during childhood.

Body of humerus

The diaphysis makes up the bulk of the length of the bone.

Radial nerve groove

It runs obliquely along the posterior surface of the middle part of the body of the humerus.

Humerus block

Medial epicondyle -

More prominent bony projection than the lateral epicondyle.

Greater tuberosity

Place of muscle attachment.

Humerus, front view

Lesser tubercle

Place of muscle attachment.

Surgical neck

Narrow interception, frequent site of fractures.

Deltoid tuberosity

Insertion site of the deltoid muscle.

Head -

humeral condyle

It has a spherical shape, articulates with the head of the radius.

Lateral epicondyle

External bony prominence.

Anatomical neck

Intertubercular groove

It contains the tendon of the biceps brachii muscle.

At these points the bone can be easily felt under the skin.

Humerus fractures

Most fractures of the upper humerus occur at the level of the surgical neck as a result of a fall on an outstretched arm. Fractures of the body of the humerus are dangerous due to possible injury to the radial nerve, which lies in the groove of the same name on the posterior surface of the bone. Damage to it can cause paralysis of the muscles of the back of the forearm, which is manifested by drooping of the hand. H This x-ray shows a fracture of the upper body of the humerus. This injury usually occurs when falling on an outstretched arm.

In children, fractures of the humerus are often localized in the supracondylar region (in the lower part of the body of the humerus above the elbow joint). Typically, the mechanism of such an injury is a fall on the arm, slightly bent at the elbow. This can damage nearby arteries and nerves.

Sometimes, with complex fractures of the humerus, there is a need to stabilize it with a metal pin, which holds the bone fragments in the correct position.

Medial epicondyle

A bony prominence that can be felt on the inside of the elbow.

Humerus block

Articulates with the ulna.

The long tubular bone, divided into a diaphysis, proximal and distal epiphyses, fossa, tubercle and surgical neck, is the humerus. A fracture in this area is a common occurrence in surgical practice, occurring in both young and elderly people. Shoulder injuries occur due to impacts and falls and are one of the most common household injuries.

What is the humerus

1. Fractures of the upper sections. They can form due to damage to the head, separation of the small or large tuberosity, or fracture of the necks. Falling on an abducted arm, elbow or shoulder are the main causes of injury. Patients complain of pain, swelling, and pain when trying to perform active movements. Passive actions are not very limited. A displaced fracture is accompanied by severe pain, deformation occurs in the joint area, and the limb becomes shorter. Crunching of bones and swelling accompany the damage.
2. Fracture of the middle part of the shoulder. Occurs when you fall on your arm or get hit on the shoulder. There are comminuted, oblique, transverse, and helical fractures. Accompanied by damage to the radial nerve, arteries, and veins. The victim experiences swelling, pain, deformation, crepitus, and pathological bone mobility. The patient cannot straighten his fingers and wrist. To make a diagnosis, an x-ray is taken, based on the results of which treatment is prescribed.
3. Fracture in the lower sections. There are extra-articular and intra-articular fractures. Extra-articular injuries include supracondylar injuries, and intra-articular injuries include injuries to the trochlea, capitate eminence of the humerus, and intercondylar fractures. Supracondylar injuries of the shoulder can be flexion or extension. The shoulder swells greatly and there is severe pain. With flexion fractures, the forearm lengthens, and with extension fractures, it shortens. Injuries to the condyles are accompanied by accumulation of blood in the elbow, while transcondylar injuries are accompanied by pain, swelling, and limitation of movements in the joints.

Treatment

Simple fractures are fixed with a plaster splint for about a month. Immobilization should ensure complete immobility of the arm. If the fragments are displaced, surgical intervention or repositioning is performed under anesthesia. Fractures are fixed with knitting needles, screws, a Turner bandage, and adhesive plaster or skeletal traction is used. For rehabilitation, physical therapy, mechanotherapy, and physiotherapeutic procedures are carried out.

Splint for humerus fracture

To fix the damage, use a Kramer splint, which is placed across the back from the healthy shoulder. For a fracture of the elbow joint, a wire splint is used; for damage to the wrist joint, a long plywood splint is used. Fixation is made on the forearm. In some cases, a ball of cotton wool should be placed in the patient's palm. If the forearm is fractured, 2 splints are applied, after first fixing the arm in the palm-up position. The bent limb is suspended on a scarf.

Photo of the humerus

Video

Humerus, humerus, is a long lever of movement and develops like a typical long tubular bone. According to this function and development, it consists of a diaphysis, metaphyses, epiphyses and apophyses. The upper end is equipped with a spherical articular head, caput humeri (proximal epiphysis), which articulates with the glenoid cavity of the scapula. The head is separated from the rest of the bone by a narrow groove called the anatomical neck, collum anatomicum. Immediately behind the anatomical neck there are two muscular tubercles (apophyses), of which the larger one, tuberculum majus, lies laterally, and the other, smaller one, tuberculum minus, slightly anterior to it. From the tubercles downwards there are bone ridges (for muscle attachment): from the large tubercle - crista tuberculi majoris, and from the small tubercle - crista tuberculi minoris. Between both tubercles and ridges there is a groove, sulcus intertuberculdris, in which the tendon of the long head of the biceps muscle is located. The part of the humerus lying immediately below both tubercles at the border with the diaphysis is called the surgical neck - collum chirurgicum (the place of the most common fractures of the shoulder).

Body of humerus in its upper part it has a cylindrical outline, while at the bottom it is clearly triangular. Almost in the middle of the body of the bone, on its lateral surface there is a tuberosity to which the deltoid muscle, tuberositas deltoidea, is attached. Behind it, along the posterior surface of the body of the bone, from the medial side to the lateral side, a flat groove of the radial nerve, sulcus nervi radidlis, seu sulcus spiralis, runs in the form of a gentle spiral.

The widened and slightly bent anteriorly lower end of the humerus, condylus humeri, ends on the sides with rough projections - the medial and lateral supramidal clefts and, epicondylus medialis et lateralis, lying on the continuation of the medial and lateral edges of the bone and serving for the attachment of muscles and ligaments (apophyses). The medial epicondyle is more pronounced than the lateral one, and on its posterior side it has a groove for the ulnar nerve, sulcus n. ulnaris. An articular surface is placed between the epicondyles for articulation with the bones of the forearm (dysgal epiphysis). It is divided into two parts: medially lies the so-called block, trochlea, which looks like a transversely located roller with a notch in the middle; it serves for articulation with the ulna and is covered by its notch, incisura trochlearis; above the block, both in front and behind, is located along the fossa: in front is the coronoid fossa, fossa coronoidea, behind is the fossa of the olecranon, fossa olecrani. These pits are so deep that the bony partition separating them is often thinned to the point of being translucent, and sometimes even perforated. Lateral to the block is the articular surface in the form of a segment of a ball, the head of the condyle of the humerus, capitulum humeri, which serves for articulation with the radius. Anteriorly above the capitulum there is a small radial fossa, fossa radialis.

Ossification. At the time of birth, the proximal epiphysis of the shoulder still consists of cartilaginous tissue, so the head of the humerus is almost not visible on an x-ray of the shoulder joint of a newborn. Subsequently, three points appear sequentially:

1. in the medial part of the head of the humerus (0-1 year) (this bone core can also be present in a newborn);
2. in the greater tubercle and lateral part of the head (2-3 years);
3. in tuberculum minus (3-4 years).

These nuclei merge into a single head of the humerus (caput humeri) at the age of 4-6 years, and synostosis of the entire proximal epiphysis with the diaphysis occurs only at the 20-23rd year of life. Therefore, on radiographs of the shoulder joint belonging to children and young people, according to the indicated ages, clearings are noted at the site of the cartilage separating the parts of the proximal end of the humerus that have not yet fused from each other. These lucencies, which represent normal signs of age-related changes, should not be confused with cracks or fractures of the humerus.

Which doctors to contact for examination of the humerus:

Traumatologist

What diseases are associated with the humerus:

What tests and diagnostics need to be performed for the humerus:

X-ray of the humerus

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Other anatomical terms starting with the letter "P":

Esophagus

Chin

Spine

Navel (navel)

Penis

Prostate

Crotch

Liver

Parathyroid glands

Pancreas

Bud

Medulla oblongata

Pleura

Peripheral nerves

Membranous labyrinth

Subglottic cavity

Oral cavity

Rectum

Plasma

Vertebrae

Lumbar vertebrae

Shoulder joint

Groin area

Shoulder

Forearm

Finger

Peripheral nervous system

Parasympathetic nervous system

Sweat gland

Sex glands

Prostate

Placenta

Epididymis and periovarian

Paraganglia

Right ventricle

Conduction system of the heart

Atrioventricular node

Pericardium

Brachiocephalic trunk

Subclavian artery

Axillary artery

Brachial artery

Popliteal artery

Anterior tibial artery

Brachiocephalic veins

Anterior jugular vein

Subclavian vein

Vertebral venous plexuses

Right lymphatic duct

Isthmus of the rhombencephalon

Forebrain

The proximal border of the shoulder is the lower edge of m. pectoralis major in front and latissimus dorsi in back. The distal border is a circular line above both condyles of the humerus.

The humerus is divided into a proximal, distal end and diaphysis. The proximal end has a hemispherical head. Its smooth spherical surface faces inward, upward and somewhat backward. It is limited along the periphery by a grooved narrowing of the head - the anatomical neck. Outward and anterior to the head there are two tubercles: the lateral greater tubercle (tuberculum majus) and the lesser tubercle (tuberculum minus), which is located more medially and anteriorly. Below, the tubercles turn into scallops of the same name. The tubercles and scallops are the site of muscle attachment.

Between these tubercles and ridges there is an intertubercular groove. Below the tubercles, corresponding to the zone of the epiphyseal cartilage, a conventional boundary is determined between the upper end and the body of the humerus. This place is somewhat narrowed and is called the “surgical neck”.

On the anterior outer surface of the body of the humerus, below the crest of the tuberculum majoris, there is a deltoid tuberosity. At the level of this tuberosity, a groove runs along the posterior surface of the humerus in the form of a spiral from top to bottom and from inside to outside (sulcus nervi radialis).

The body of the humerus is triangular in the lower part; here three surfaces are distinguished: posterior, anterior medial and anterior lateral. The last two surfaces pass into one another without sharp boundaries and border the rear surface with well-defined edges - outer and inner.

The distal end of the bone is flattened anteroposteriorly and expanded laterally. The outer and inner edges end in well-defined tubercles. One of them, the smaller one, facing laterally, is the lateral epicondyle, the other, the larger one, is the medial epicondyle. On the posterior surface of the medial epicondyle there is a groove for the ulnar nerve.

Below the lateral epicondyle there is a capitate eminence, the smooth articular surface of which, having a spherical shape, is oriented partly downward, partly forward. Above the capitate eminence is the radial fossa.

Medial to the capitate eminence is the block of the humerus (trochleae humeri), through which the humerus articulates with the ulna. In front above the trochlea there is a coronoid fossa, and behind there is a rather deep ulnar fossa. Both fossae correspond to the processes of the same name of the ulna. The area of ​​bone separating the ulnar fossa from the coronoid fossa is significantly thinned and consists of almost two layers of cortical bone.

The biceps brachii muscle (m. biceps brachii) is located closer to the surface than the others and consists of two heads: a long one, starting from the tuberculum supraglenoidale scapulae, and a short one, extending from the processus coracoideus scapulae. Distally, the muscle attaches to the tubercle of the radius. M. coracobrachialis originates from the coracoid process of the scapula, is located medial and deeper than the short head of the biceps muscle and is attached to the medial surface of the bone. M. brachialis originates on the anterior surface of the humerus, lies immediately beneath the biceps muscle, and inserts distally on the tuberosity of the ulna.

The extensors include the triceps brachii muscle (m. triceps brachii). The long head of the triceps muscle starts from the tuberculum infraglenoidae scapulae, and the radial and ulnar heads start from the posterior surface of the humerus. Below, the muscle is attached by the wide aponeurotic tendon to the olecranon process.

The elbow muscle (m. anconeus) is located superficially. It is small and triangular in shape. The muscle originates from the lateral epicondyle of the humerus and the collateral ligament of the radius. Its fibers diverge, lie fan-shaped on the bursa of the elbow joint, partially woven into it, and are attached to the crest of the dorsal surface of the ulna in its upper part. N. musculocutaneus, perforating m. coracobrachialis, passes medially between m. brachialis etc. biceps. In the proximal part of the shoulder it is located outside the artery, in the middle it crosses it, and in the distal part it passes medial to the artery.

Blood supply is provided by a. brachialis and its branches: aa.circumflexae humeri anterior and posterior, etc. The extensors are innervated by the p. radialis. It passes at the top of the shoulder behind a. axillaris, and below is included in canalis humeromuscularis along with a. and v. profunda brachii, which are located medially from the nerve.

The nerve encircles the bone in a spiral manner, descending in the upper part between the long and medial heads of the triceps muscle, and towards the middle of the shoulder it passes under the oblique fibers of the lateral head. In the distal third of the shoulder, the nerve is located between mm. brachialis and brachioradialis.

Rice. 1. Humerus (humerus).

A-front view; B-rear view.

A. 1 - greater tubercle of the humerus; 2 - anatomical neck of the humerus; 3 - head of the humerus; 4 - lesser tubercle of the humerus; 5 - intertubercular groove; 6 - crest of the lesser tubercle; 7 - crest of the greater tubercle; 8 - deltoid tuberosity of the humerus; 9 - body of the humerus; 10 - anteromedial surface; 11 - medial edge of the humerus; 12 - coronoid fossa; 13 - medial epicondyle; 14 - block of the humerus; 15 - head of the condyle of the humerus; 16 - lateral epicondyle; 17 - radial fossa; 18 - anterolateral surface.

B. 1 - head of the humerus; 2 - anatomical neck; 3 - greater tubercle; 4 - surgical neck of the humerus; 5 - deltoid tuberosity; 6 - groove of the radial nerve; 7 - lateral edge of the humerus; 8 - fossa of the olecranon process; 9 - lateral epicondyle of the humerus; 10 - block of the humerus; 11 - groove of the ulnar nerve; 12 - medial epicondyle of the humerus; 13 - medial edge of the humerus.

Skeletal bones are unique formations that arose during the process of evolution. Each bone has a unique structure, best suited for performing work, which is associated not only with supporting the body and moving it in space, but also with protecting organs. The main and largest component of the arm is the humerus, which is surrounded by muscles, nerves and choroid plexuses. There are also joints in which this bone takes part - the humerus and the elbow, with the help of which many functions are performed.

Proximal end

The part that is located near the shoulder joint is called the proximal end. Here is the nerve plexus of the shoulder, the anatomy of which consists of three bundles that can be damaged by injury. The head of the humerus is involved in the formation of the joint; it has a structure that is different from other areas, which allows you to perform the range of arm movements that is familiar to every person.

The head of the bone is smooth and covered with cartilage, which is required for the joint, but it is larger in volume than the surface with which it comes into contact, as a result of which shoulder dislocations occur. Below is the anatomical neck, it is a groove, and the human joint capsule is attached to it.

Below the anatomical neck, the structure suggests the presence of two tubercles - large and small; many muscles are attached to them in humans; there is also a nerve plexus nearby. The rotator cuff of the shoulder, which is responsible for rotation and function, is attached to these formations. The anatomy of these formations is such that it is in this place that fractures appear during a fall, and not only the rotator cuff suffers, but also other muscles, as important anatomical formations of this part of the limb.

A ridge extends down from each of the tubercles, which bears the same name. Together with the tubercles, the ridges form another formation - the intertubercular groove. In this place lies the tendon of the long head of the biceps muscle, which is also involved in the movement of the shoulder joint and its normal function. The rotator cuff is also located in this place, the tendons of which can be damaged if injured.

If you look below, there is a formation that is no different from the body of the bone, but is important in the practical work of a doctor. The anatomy of this section of the shoulder is designed in such a way that a surgical neck is located under the head. This place received its name as the weakest place in humans, which is most often subject to injury. Especially in the elderly, the bone breaks in this area, sometimes with muscle damage from fragments. In a child, this place corresponds to the growth zone of the arm and its bone component.

Body of bone

The main part of the bone is, of course, the body, which performs significant functions; it accounts for the bulk of the mass, like a lever. It is hidden in the thickness of the muscles and has a circular cross-section in the upper section, and a triangular cross-section in the lower section. The triangular shape of the bone is given by ridges, among which there are anterior, external and internal. There are also three surfaces: one back, and also outer and inner. There are nutrient openings in the body area; small arteries of the arm pass through them, delivering blood inside the bone.

In this part of the arm there is one formation located in this place - the groove of the radial nerve. It runs in a spiral, surrounded by muscles, here the radial nerve passes almost close to the bone, which can also be damaged by injury. Then below it goes into the thickness of the muscles, and if the condyle of the bone is fractured, the ulnar nerve, located on the inside, can be damaged. On the inner surface there is another formation no less important for the human hand; it is called the deltoid tuberosity and serves to fix the tendon of the muscle of the same name. Next to it there is also a vascular and nerve plexus.

Distal end

The part near the elbow is called the distal end and has its own structure. The anatomy of this area is such that, in addition to the attachment of muscles, this component of the arm is involved in the formation of the joint. There is also a plexus of blood vessels and nerves that can be damaged by injury or fracture.

The lowest part, which participates in the formation of the joint, is called the condyle of the humerus. Its anatomy is complex, on the inside it is formed by the shoulder block, the ulna bone articulates with it using a joint, and on the outside the head, which forms the articular surface with the radius. But this is not the whole structure of this part of the arm; in addition to the thickness of the soft tissues, the coronoid fossa is located on the front surface, the function of which is that the coronoid process of the ulna bone enters it during flexion. Nearby is a less pronounced radial fossa, its functions are similar, only it is intended for the radius.

On the back of the arm in this section there are also muscles and the choroid plexus. The structure of this section of the shoulder is represented by the olecranon fossa; it enters it during extension of the joint.

In the upper part of the condyle, the epicondyles are located, the muscles are attached to them, as well as the joint capsule. The external and internal epicondyle are distinguished; muscle tendons are fixed to them, the functions of which are to move the forearm and shoulder. Ridges rise upward from each epicondyle; this is the attachment point for the muscles of the shoulder and forearm.

Due to greater muscle attachment, the development of the internal epicondyle occurs more strongly. On its posterior surface is the ulnar nerve plexus and there is a groove for this nerve.

This formation has a protrusion to which the muscles are fixed (flexor carpi radialis); it is called the supracondylar process. The condyles, as the site of attachment of tendons, can be felt under the skin, as well as the groove of the ulnar nerve. These projections can be landmarks that can be used to guess where the choroid or nerve plexus is located.

The structure of any part of the humerus is as simple as it is unique; like a cuff, it is surrounded by muscles, blood vessels and nerves. This powerful lever helps a person perform many functions without which it is difficult to imagine everyday life.

Humerus - people have different meanings for this concept. If we consider anatomy, the shoulder refers to the upper part of the free upper limb, that is, the arm. If we consider the anatomical nomenclature, this section starts from the shoulder joint and ends at the bend of the elbow. According to anatomy, the shoulder is the shoulder girdle. It connects the free upper part to the body. It has a special structure, thanks to which the number and range of movements of the upper limb increases.

Bone anatomy

There are two main bones of the shoulder girdle:

1. Spatula. As you know, this is a flat bone that has a triangular shape. It is located at the back of the body. It has three edges: lateral, medial and superior. Between them there are three angles: upper, lower and lateral. The last of them has a large thickness and a glenoid cavity necessary for the articulation of the scapula and the head of the humerus bone. Adjacent to the depression is a narrowed place - the neck of the scapula. Above the joint cavity there are tubercles - subarticular and supraarticular. The lower corner is easy to feel under the skin; it is located almost at the level of the upper edge of the rib, the eighth in a row. The upper one is located upward and inward.

The costal scapular surface faces the chest. The surface is slightly concave. With its help, the subscapular fossa is formed. The dorsal surface is convex. It has a spine that divides the dorsal scapular surface into two muscles. The spine can be easily felt under the skin. Outwardly, it transitions into the acromion, located above the shoulder joint. It is with the help of its outer extreme point that you can determine the width of the shoulders. There is also a coracoid process, which is necessary for the attachment of ligaments and muscles.

1. Collarbone. It is a tubular bone curved in an S-shape. It connects to the sternum at the medial end, and to the scapula at the lateral end. The collarbone is located under the skin and is easy to feel. It is attached to the chest cage with the help of ligaments and muscles. The connection to the shoulder blade is made using ligaments. Therefore, the lower surface of the clavicle has roughness - lines and tubercles.

The shoulder itself consists of one humerus bone. This is a typical tubular bone. Its body in the upper part has a rounded shape. The lower section has a triangular shape. At the proximal epiphysis of the bone there is the head of the humerus. Its shape is a hemisphere. She, being in this proximal section, is turned towards the scapula. The articular surface rests on it, and the anatomical neck of the humerus bone adjoins it. Outside the neck there are two tubercles that are needed for muscle attachment.

With regard to the greater tubercle of the humerus, we can say that it faces outward. The other tubercle, the small one, faces anteriorly. A crest extends from the greater tubercle of the humerus and the lesser. There is a furrow between them and the ridges. The tendon of the head of the biceps brachii muscle passes through it. There is also a surgical neck, that is, the narrowest part of the shoulder bone, which is located below the tubercles.

The humerus has a deltoid tuberosity. The deltoid muscle is attached to it. During sports training, an increase in this tuberosity and the thickness of the compact bone layer is observed. The groove of the radial nerve runs along the posterior bone surface. The condyle is formed by the distal epiphysis of the humerus.

It has the articular surface necessary to connect to the bones of the forearm. The surface of the joint on the medial side that connects to the ulna is called the trochlea of ​​the humerus. Above it there are pits in front and behind. When flexion and extension of the forearm occur, they include the processes of the elbow bone. The lateral surface is called the head of the condyle of the humerus.

It has a spherical shape and is connected to the radius. The distal end has two epicondyles on both sides, lateral and medial. They are easy to feel under the skin. Their role is to attach ligaments and muscles.

Anatomy of the ligamentous apparatus of the shoulder

It is important to consider the anatomy of not only the bones and their location, but also the ligamentous apparatus.

Damage

The humerus is susceptible to many injuries. One of them is. They are more common in men.

The humerus can break, but in different places:

Fractures of the anatomical neck of the bone, head

They occur as a result of a fall on the elbow or due to a direct blow. If the neck is damaged, wedging of the distal part into the head is observed. The head can be deformed, crushed, and also come off, but in this case it will be turned by the cartilaginous surface towards a fragment of a distal nature.

Signs include bleeding and swelling. The person cannot make active movements and feels pain. If you perform passive rotational movements, the greater tubercle will move together with the shoulder. If the fracture is impacted, the signs are not so pronounced. The victim can make active movements. The diagnosis is confirmed using x-rays.

For impacted fractures of the neck and head, treatment is outpatient. The hand is immobilized. A person takes analgesics and sedatives internally. Physiotherapy is also prescribed. After a month, the splint is replaced with a scarf-type bandage. Working capacity is restored after two and a half months.

Surgical neck fracture

Non-displaced injuries are usually impacted or pinched. If displacement has occurred, the pearl can be adductive or abductive. Adduction fractures occur in the event of a fall with emphasis on the adducted outstretched arm. Abduction fractures occur in the same situation, only the arm is abducted.

If there is no displacement, then local pain is observed, which intensifies with axial load. The humerus may retain its function, but it will be limited. If displacement occurs, the main symptoms are severe pain, pathological mobility, disruption of the shoulder axis, shortening, and dysfunction. First aid consists of administering analgesics, immobilization and hospitalization.

The greater tuberosity suffers mainly from shoulder dislocation. It is torn off and displaced due to reflex contraction of the minor, infraspinatus and supraspinatus muscles. If an isolated fracture occurs, then most likely as a result of a bruise of the shoulder; in this case, displacement is not observed.

Symptoms of such injuries are pain, swelling, and crepitus.

Even passive movements bring severe pain. If the injury is not combined with displacement, immobilization is performed with a Deso bandage. You can also use a scarf. The immobilization period is two or three weeks.

If the fracture is avulsion and combined with displacement, reduction and immobilization is done with a splint or plaster bandage. If there is large swelling and, shoulder traction is used for two weeks. After the patient begins to freely raise the shoulder, abduction of the arm with the splint is stopped. Rehabilitation lasts from two to four weeks.

Fracture of the diaphysis of the bone

It occurs as a result of a blow to the shoulder, as well as a fall on the elbow. Symptoms: dysfunction, shoulder deformity, shortening. Hemorrhage, pain, crepitus and pathological mobility are also observed. First aid is the administration of analgesics and immobilization with a transport splint. Fractures of the diaphysis in the lower and middle third are treated with skeletal traction. Upper third injuries are treated with an abduction splint and shoulder abduction. Immobilization lasts from two to three months.

Fractures in the distal region

Extra-articular fractures can be either extension or flexion, depending on the position of the fall. Intra-articular fractures include transcondylar injuries, V- and T-shaped injuries, and fractures of the head of the condyle. Symptoms include pain, crepitus, abnormal mobility, and flexed forearm. First aid consists of transport immobilization with a splint; you can use a scarf. Analgesics are also administered.

The bones of the shoulder girdle play an important role in movement. They need to be protected, because any damage takes a long time to heal.

- This is a violation of the integrity of the humerus in its upper part, just below the shoulder joint. More often it occurs in elderly and senile women, the cause is a fall on an arm pulled back or pressed to the body. It manifests itself as pain, swelling and limitation of movements in the shoulder joint. Sometimes a bone crunch is detected. To clarify the diagnosis, an x-ray examination is performed. Treatment is usually conservative: anesthesia, reduction and immobilization. If it is impossible to match fragments, an operation is performed.

ICD-10

S42.2 Fracture of the upper end of the humerus

General information

A humeral neck fracture is an injury to the upper end of the humerus. It is more often detected in older women, which is caused not only by osteoporosis, but also by a characteristic restructuring of the metaphysis of the humerus: a decrease in the number of bone beams, an increase in the size of the bone marrow cavities and thinning of the outer wall of the bone in the area of ​​​​the transition of the metaphysis to the diaphysis. A fracture usually occurs as a result of indirect trauma. It may be impacted, accompanied or not accompanied by displacement of fragments.

In most cases, a fracture of the humeral neck is a closed isolated injury; open injuries to this area practically do not occur. With high-energy impacts, combinations with fractures of other limb bones, pelvic fracture, spinal fracture, TBI, rib fractures, blunt abdominal trauma, bladder rupture, kidney damage, etc. are possible. Treatment of humeral neck fractures is carried out by orthopedic traumatologists.

Reasons

According to the observations of specialists in the field of traumatology and orthopedics, usually the cause of a fracture of the humeral neck is an indirect injury (a fall on the elbow, shoulder or hand), which causes bending of the bone in combination with pressure on it along the axis. The effect of the applied forces depends on the position of the hand at the time of injury. If the limb is in a neutral position, the fracture line is usually located transversely. The peripheral fragment is embedded in the head, and an impacted fracture is formed. In this case, the longitudinal axis can be preserved, but more often the formation of a more or less pronounced angle, open posteriorly, is observed.

If the shoulder is in the adduction position at the time of injury, the central fragment “goes” into the abduction position and rotates outward. In this case, the peripheral fragment rotates inward and moves anteriorly and outward. An adduction fracture occurs, in which the angle between the fragments is open posteriorly and inwardly. If the inner edge of the distal fragment is embedded in the head, an impacted adduction fracture of the surgical neck of the humerus is formed. If penetration does not occur (this is quite rare), damage is formed with complete displacement and separation of fragments.

When the shoulder is abducted at the time of injury, the central fragment “goes” into the adduction position and rotates inward. In this case, the peripheral fragment is pulled forward and upward, rotates inwards and moves anteriorly. The fragments form an angle, open posteriorly and outward. This injury is called an abduction fracture. As in the previous case, with abduction injuries, part of the peripheral fragment is usually embedded in the head of the humerus; complete separation and displacement of the fragments is rarely detected. The most common fractures are abduction fractures.

Pathanatomy

The humerus is a long tubular bone consisting of a diaphysis (middle), two epiphyses (upper and lower) and transition zones between the diaphysis and epiphyses (metaphyses). The upper end of the bone is represented by a spherical articular head, immediately below which there is a natural narrowing - the anatomical neck of the shoulder. Fractures in this area are detected very rarely. Just below the anatomical neck there are two tubercles (places of attachment of muscle tendons) - large and small.

Below the tubercles and above the place of attachment of the pectoralis major muscle there is a conventional boundary between the upper end and the diaphysis of the bone. This border is called the surgical neck of the humerus, and it is in this area that fractures most often occur. The articular capsule of the shoulder joint is attached just above the tuberosities, therefore transtubercle fractures, like fractures of the surgical neck of the shoulder itself, belong to the category of extra-articular injuries. The division of these injuries is very arbitrary; taking into account the general symptoms and principles of treatment, most clinicians combine them into the general group of fractures of the surgical neck of the humerus.

Such fractures usually heal well, and the formation of false joints is extremely rare. However, in the presence of a fairly pronounced displacement and absence of reposition in the long-term period, significant limitation of movements is possible, due to both the consolidation of fragments in the wrong position and the proximity of the ligaments and articular capsule, which are easily involved in the adhesive process. The most unfavorable from the point of view of subsequent limitation of function is an unreduced adduction fracture, after which a pronounced limitation of abduction may occur.

Symptoms of a fracture

Patients with impacted fractures of the humeral neck complain of moderate pain in the joint area, which intensifies with movement. The joint is swollen, and hemorrhages are often detected. Active movements are possible, but limited due to pain. Palpation of the humeral head is painful. In displaced fractures, the symptoms are more pronounced: the rounded shape of the joint is disrupted, some prolongation of the acromion process and retraction in the head area are noticeable.

There is a change in the axis of the shoulder: it runs obliquely, with the central end of the axis directed forward and inward. The elbow is displaced posteriorly and is distant from the body, but there is no fixation of the elbow joint (as in a dislocation), and the symptom of spring resistance is not detected. The shortening of the affected shoulder by 1-2 cm is determined. Active movements are impossible, passive movements are sharply limited due to pain and are sometimes accompanied by bone crunching. During rotational movements, the head does not move with the humerus.

When palpating the surgical neck, sharp local pain occurs. In thin patients with poorly developed muscles in the axilla, the end of the distal bone fragment can be palpated. In some cases, a displaced fragment can compress the neurovascular bundle, which is manifested by cyanosis due to impaired venous outflow, swelling of the limb and a feeling of crawling.

Diagnostics

To clarify the diagnosis, radiography of the shoulder joint is prescribed in two projections: direct and “epaulet” (axial). An “epaulet” shot is performed by moving the shoulder away from the body at an angle of 30-40 degrees. Greater abduction is strictly not recommended, as it may aggravate the displacement of the fragments. In doubtful cases, CT scan of the shoulder joint is used. If compression of the neurovascular bundle is suspected, patients are referred for consultation to neurologists or neurosurgeons and vascular surgeons.

Treatment of a humeral neck fracture

Elderly patients with impacted fractures do not require reduction in most cases. The damaged area is anesthetized with novocaine and a fixing bandage is applied for 6 weeks. If a moderately displaced impacted fracture has been diagnosed in a young or middle-aged person, reduction is indicated. For patients of all ages, reduction is performed for comminuted and non-impacted fractures. Then the limb is immobilized, painkillers and UHF are prescribed. Therapeutic exercises begin from the second day, light movements (slight adduction, abduction and rocking) in the shoulder joint - from the fifth day. Subsequently, the range of movements is gradually increased.

As a means for immobilizing a fracture, depending on the nature of the injury and the age of the patient, a regular scarf bandage (in elderly patients) or a snake scarf, on which the bent arm is suspended, can be used. If necessary, the scarf is supplemented with a roller in the armpit area. In some cases, with impacted adduction fractures with angular displacement and easily displaced non-impacted fractures with complete divergence of the fragments, skeletal traction is performed on an abduction or abduction splint.

Surgical treatment is indicated for significant angular displacement, complete separation of fragments and the impossibility of matching the fragments by closed reduction. The operation is performed in a trauma department under general anesthesia. Typically, an anteromedial incision is used. To hold fragments in adults, osteosynthesis is performed with a plate; in children, fixation with knitting needles is possible. The wound is sutured layer by layer and drained.

In the postoperative period, immobilization is performed using a curved Kremer splint or a bandage with a pad in the armpit. Painkillers and antibiotics are prescribed. From the third day, exercise therapy begins with movements in the fingers, elbow and wrist joints. The sutures are removed on the 10th day, movements in the shoulder joint begin on the 20th day after surgery. The results of surgery are usually good.

Very rarely, with fragmentation of the upper parts of the humerus and aseptic necrosis of the head, endoprosthetics of the shoulder joint is indicated. Depending on the age and physical condition of the patient, it is possible to use unipolar endoprostheses (replacement of only the head of the humerus) or total endoprosthesis (replacement of both the head and the glenoid cavity of the scapula). If there are contraindications to endoprosthetics, arthrodesis is performed.