Correspondence of the departments of the humerus to the anatomical formations. Fracture of the neck of the shoulder (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. Consider where the humerus is located, which serves to articulate the parts of the arms, takes part in the movement, and also takes on the loads associated with the forearm and the entire shoulder girdle.

If we talk about typing, then osteology defines this bone as a long, tubular, 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 well thought out their structure, and in terms of the strength of resistance to pressure of 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 participates in connections with the spherical shoulder and complex elbow joints, which determines its features among other tubular bones.

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

The shock-absorbing element in this connection is such parts of the head 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 joint capsule also contributes to the stability of the joint - a dense, permeable bag, in the walls of which the ligaments are located.

Such a feature in the structure serves the freedom of the amplitude of movements, on the other hand, the head may fall out of the joint during a sharp movement, accompanied by a jerk, and in case of dislocation, it happens that the cartilaginous lip comes off the glenoid.

Consider the structure of the humerus:

apophyses- from the Greek apophysis, i.e. "sprout". These processes serve to attach muscles and fix ligaments;
epiphyses- upper and lower ends of the diaphysis, represented by a spongy substance;
diaphysis- the body is represented by a compact substance, it has a channel with a yellow brain in adults and a red one in children.
metaphysis- a zone of growth that occurs up to 22-23 years;
hyaline cartilage- covering the ends of the bone;
periosteum- the outer covering, consists of connective tissue, capillaries and nerves pass here, which provide nutrition and communication. The fibrous layer of the periosteum provides good grip for tendons and ligaments.

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

All anatomy and uniqueness is subject to the best mobile connection with the area of the shoulder, the bones of the forearm:

Shoulder joint - articulation of the upper end + scapula.
Forearm joints:

shoulder + elbow - through the surface of the lower end, trochlea humeri block, cylindrical;
brachial + radial - through the surface of the lower epiphysis, capitulum humeri, spherical shape.

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

proximal epiphysis

The upper, or proximal, end is wider than the body itself, it 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 cushioning during movements and necessary for proper functioning and mobility.

Under the head are two apophyses:

tuberculum majus- a large tubercle on the literal surface;
tuberculum minus- a small tubercle of the humerus, located in front of the lateral literal.

The cuff of the shoulder girdle is attached to these apophyses, which is responsible for rotational movements, 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 tubercle and the lesser tubercle descend downward. These ridges separate the intertubercular groove where the tendon of the biceps brachii lies.

Below the apophyses, the narrowest place is located - the surgical neck of the shoulder, a narrowing corresponding to the zone of the epiphysis. It belongs to especially vulnerable traumatological places, since in this place there is a sharp change in the cross section: from a rounded one at the upper end to a trihedron at the lower one.

Body of the humerus

Between the upper and lower ends there is a diaphysis, which acts as a lever for receiving the main load, it has a non-uniform cross section: at the top, the shape is cylindrical, and closer to the lower end, a transition is made to a trihedral form.

This view is determined by the front, outer and inner ridges that stretch in this area.

On the body of the bone stand out:

literal surface- in the region of the upper third of this part of the body, the deltoid tuberosity of the humerus is distinguished, a relief area along which the muscle of the same name is attached, raising the shoulder outward to the horizontal plane;
medial surface- here the furrow of the radial nerve descends in a spiral, the ulnar nerve itself lies in it, coming close to the bone in this place, as well as the deep brachial arteries;
nutrient hole- located on the medial front and leads to the distal nutrient canal through which small arteries pass.

Reference! Most of the diaphysis is a compact substance. On the body of the bone, which borders the medullary cavity, the 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, fixes ligaments and muscles.

The lower end contains 2 fused processes - the capitulum and the block, has a pommel head, which works as part of the radial and elbow joints:

Internal condyle- on this side of the surface of the epiphysis, it forms a block of the shoulder, with which it is coupled and connected in the joint by the ulna: its upper end continues upward with the olecranon. 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.
Outer- the head of the epiphysis on this side of the articular surface already cooperates with the radius. The joint allows the forearm to pivot and flex despite being tightly hinged with a block.

Also in the front section is the coronary fossa, the process of the ulna is placed in it when a person bends the arm. The radial fossa is less pronounced, but does the same job for the process of the radial bone. Note that the wall between the antecubital fossa and the coronary fossa is very thin and consists of only 2 layers.

Conclusion

The human humerus and its anatomy are well studied and described, yet complex, as the arms are one of the most mobile parts of the human body. At the heart of the daily movements familiar to us, which we don’t even think about, complex and amazing biomechanics are involved.

The shoulder refers to the long tubular bones of a person. 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 fossae, which serve as attachment points for muscles and ligaments. The humerus acts as a lever. Fractures are very dangerous, because due to damage to the bone marrow canal, a fat embolism may develop or a blockage of the vessel may occur.

Most often, the shoulder suffers as a result of fractures in 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 small tubercle is located in front on the shoulder. There is a tuberosity in the middle of the bone. This is where the deltoid muscle attaches. From 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 - the olecranon or cubital fossa and the radius.

Functions of the humerus

The shoulder structure is actually a lever and increases the scope when performing movements of the upper limb. In addition, the bone is involved in maintaining balance when the center of gravity shifts during 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

With a dislocation of the shoulder joint, a person feels a sharp pain.

Dislocation of the shoulder and elbow joint is common, and is associated with high mobility of the upper limb. Distinguish front, rear and bottom offset. In case of damage, movement of the limb becomes difficult, pain is felt, swelling is visualized. When a nerve is pinched, the skin becomes numb. Dislocations are isolated as new and chronic. At the same time, a large tubercle protrusion or a neck fracture may occur. The shoulder is swollen, it hurts, hemorrhage is noticeable, sensitivity is lost in the arm and fingers.

A fracture of the humerus occurs due to a significant force impact. This happens when you fall back on your elbows or forward on outstretched arms. The splitting of bones occurs in anatomically weak places. These include:

anatomical and surgical neck;
area of condyles;
region 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 lost movements depends on the immediate location of the damage. After some time, there is a strong swelling of the shoulder, bruising and bruising is possible. In this case, the limb is significantly deformed.

Diseases

Arthritis is a common disease of this joint.

A common disease is, that is, the introduction of infection into the bone marrow through the blood. The shoulder is affected because this bone is tubular and has an abundant blood supply. As a result of the development of this disease, the bone tissue can decompose, and then pathological fractures are formed (without the participation of a strong external influence). In addition, the development of arthritis of the shoulder and elbow joint is possible.

ENCYCLOPEDIA OF MEDICINE / SECTION ^

ANATOMICAL ATLAS

The structure of the humerus

The humerus is a typical long 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 at the elbow joint.

The tip of the humerus - its proximal end - has a large smooth hemispherical articular surface, which 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 large and small tubercles. These tubercles serve as attachment sites for muscles and are separated by an intertubercular groove.

BODY OF HUMERUS

_(diaphysis)_

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

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

Humerus, posterior view

humerus

It articulates with the glenoid cavity of the scapula at the shoulder joint.

Anatomical -

Represents the remnant of the growth zone, where in childhood there is a growth of the bone in length.

Body of the humerus

The diaphysis makes up the main part of the length of the bone.

Furrow of the radial nerve

Passes obliquely along the posterior surface of the middle part of the body of the humerus.

Humerus block

Medial epicondyle -

A more prominent bony outgrowth than the lateral epicondyle.

Large tubercle

Place of attachment of muscles.

Humerus, front view

Lesser tubercle

Place of attachment of muscles.

Surgical neck

Narrow intercept, frequent site of fractures.

Deltoid tuberosity

Attachment site of the deltoid muscle.

Head -

condyle of the shoulder

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

Lateral epicondyle

External bony prominence.

Anatomic neck

Intertubercular furrow

It contains the tendon of the biceps brachii muscle.

At these points, the bone is easy to feel 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 hand. 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. Its damage can cause paralysis of the muscles of the back of the forearm, which is manifested by drooping of the hand. R This x-ray shows a fracture of the upper body of the humerus. This injury usually occurs from a fall on an outstretched arm,

In children, humerus fractures are often localized in the supracondylar region (in the lower body of the humerus above the elbow joint). Usually, 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, it becomes necessary 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.

A long tubular bone that divides into the diaphysis, proximal and distal epiphyses, fossa, tubercle, and surgical neck is the humerus. Fracture of this area is a common case in surgical practice, it occurs both in young people and in the elderly. Shoulder injury occurs due to bumps and falls and is one of the most common household injuries.

What is the humerus

Fractures of the upper sections. They can form due to damage to the head, separation of a small or large tubercle, fracture of the necks. Falling onto an abducted arm, elbow, or shoulder is a major cause of injury. Patients complain of pain, there is swelling, soreness when trying to make active movements. Passive actions are not heavily restricted. A displaced fracture is accompanied by severe pain, deformity occurs in the joint area, and the limb becomes shorter. Crunch of bones, swelling accompany damage.
Fracture of the middle part of the shoulder. Occurs when falling on the arm, hitting the shoulder. Allocate comminuted, oblique, transverse, helical fractures. Accompanied by damage to the radial nerve, arteries, veins. The victim has swelling, pain, deformity, crepitus, pathological bone mobility. The patient cannot extend the fingers and hand. To make a diagnosis, an x-ray is taken, according to the results of which treatment is prescribed.
Fracture in the lower parts. Distinguish between extra-articular and intra-articular fractures. Extra-articular injuries include supracondylar injuries, and intra-articular injuries of the block, capitate eminence of the humerus and intercondylar fractures. Supracondylar injuries of the shoulder can be flexion, extensor. The shoulder is very swollen, there is severe pain. With flexion fractures, the forearm is lengthened, and with extensor fractures, it is shortened. Injuries of the condyles are accompanied by accumulation of blood in the elbow, transcondylar - pain, swelling, limitation of movement in the joints.

Treatment

Simple fractures are fixed with a plaster splint for a period of about a month. Immobilization should ensure complete immobility of the hand. When the fragments are displaced, surgery or reposition under anesthesia is performed. Fractures are fixed with knitting needles, screws, Turner's bandage, adhesive plaster or skeletal traction is used. For rehabilitation, physiotherapy exercises, mechanotherapy, physiotherapy procedures are carried out.

Splint for fracture of the humerus

To fix the damage, a Kramer splint is used, which is applied along the back from a healthy shoulder. In case of a fracture of the elbow joint, a wire splint is used, in case of damage to the wrist joint, a long plywood splint is used. Fixation is made on the forearm. In some cases, a cotton ball should be placed in the patient's palm. In case of a fracture of the forearm, 2 splints are applied, having previously fixed the arm in a position with the palm up. The bent limb is hung on a scarf.

Photo of the humerus

Video

Humerus, humerus, is a long lever of motion and develops like a typical long bone. According to this function and development, it consists of the diaphysis, metaphyses, epiphyses and apophyses. The upper end is provided 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 are two muscular tubercles (apophyses), of which the larger one, tuberculum majus, lies laterally, and the other, smaller one, tuberculum minus, is slightly anterior to it. Bone ridges go down from the tubercles (for attaching muscles): 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 placed. The part of the humerus lying immediately below both tubercles on the border with the diaphysis is called the surgical neck - collum chirurgicum (the place of the most frequent fractures of the shoulder).

Body of the humerus in its upper part it has a cylindrical outline, while at the bottom it is clearly trihedral. Almost in the middle of the body of the bone on its lateral surface 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, passes in the form of a gentle spiral.

The lower end of the humerus, condylus humeri, expanded and somewhat bent anteriorly, ends on the sides with rough protrusions - medial and lateral epicondyles and, epicondylus medialis et lateralis, lying on the continuation of the medial and lateral edges of the bone and serving to attach muscles and ligaments (apophyses). The medial epicondyle is more pronounced than the lateral one, and on its back side it has a groove for the ulnar nerve, sulcus n. ulnaris. Between the epicondyles is placed the articular surface for articulation with the bones of the forearm (disgal epiphysis). It is divided into two parts: medially lies the so-called block, trochlea, which has the form of 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 of the coronary fossa, fossa coronoidea, behind the fossa of the olecranon, fossa olecrani. These pits are so deep that the bony septum separating them is often thinned to translucence, and sometimes even perforated. Lateral to the block is placed the articular surface in the form of a segment of the ball, the head of the condyle of the humerus, capitulum humeri, which serves for articulation with the radius. In front of the capitulum is a small radial fossa, fossa radialis.

Ossification. By the time of birth, the proximal epiphysis of the shoulder still consists of cartilaginous tissue, therefore, on the radiograph of the shoulder joint of a newborn, the head of the shoulder is almost not determined. In the future, the sequential appearance of three points is observed:

in the medial part of the head of the shoulder (0-1 year) (this bone core can also be in a newborn);
in the greater tubercle and lateral part of the head (2-3 years);
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 the 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 men, according to the indicated ages, enlightenment is noted in place of the cartilage that separates from each other the parts of the proximal end of the humerus that have not yet merged from each other. These lesions, which are normal signs of aging, should not be confused with fractures 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 done 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

Pleura

peripheral nerves

membranous labyrinth

subvocal cavity

Oral cavity

Rectum

Plasma

Vertebrae

Lumbar vertebrae

shoulder joint

Groin area

Shoulder

Forearm

Finger

Peripheral nervous system

parasympathetic nervous system

sweat gland

gonads

Prostate

Placenta

Epididymis and periovary

Paraganglia

Right ventricle

conduction system of the heart

atrioventricular node

Pericardium

Shoulder head 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 rhomboid brain

forebrain

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

In the humerus, the proximal, distal end and diaphysis are distinguished. The proximal end has a hemispherical head. Its smooth spherical surface is turned inwards, upwards and somewhat backwards. It is limited along the periphery by a grooved narrowing of the head - the anatomical neck. Outward and anterior to the head are two tubercles: the lateral large tubercle (tuberculum majus) and the small tubercle (tuberculum minus), which is located medially and anteriorly. From top to bottom, the tubercles pass into the scallops of the same name. The tubercles and scallops are the site of muscle attachment.

Between these tubercles and scallops there is an intertubercular groove. Below the tubercles, corresponding to the zone of the epiphyseal cartilage, a conditional border 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 anterolateral surface of the body of the humerus, below the crest of tuberculum majoris, is the deltoid tuberosity. At the level of this tuberosity, a groove passes in the form of a spiral from top to bottom and from the inside outward (sulcus nervi radialis) along the posterior surface of the humerus.

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

The distal end of the bone is flattened in the anteroposterior and expanded laterally. The outer and inner edges end in well-defined tubercles. One of them, smaller, turned laterally, is the lateral epicondyle, the other, large, 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 down, partly forward. Above the capitate eminence is the radial fossa.

Medially from the capitate eminence is the block of the humerus (trochleae humeri), through which the humerus articulates with the ulna. There is a coronal fossa in front above the block, and a rather deep cubital fossa in the back. Both fossae correspond to processes of the same name on the ulna. The area of the bone that separates the cubital fossa from the coronoid fossa is significantly thinned and consists of almost two layers of cortical bone.

The biceps muscle of the shoulder (m. biceps brachii) is located closer to the surface than the rest, and consists of two heads: a long one, starting from the tuberculum supraglenoidal scapulae, and a short one, extending from the processus coracoideus scapulae. Distally, the muscle is attached to the tubercle of the radius. M. coracobrachialis starts from the coracoid process of the scapula, is located medially 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 directly below the biceps muscle, and inserts distally on the tuberosity of the ulna.

The extensors include the triceps muscle of the shoulder (m. triceps brachii). The long head of the triceps muscle originates from the tuberculum infraglenoidale scapulae, and the radial and ulnar heads from the posterior surface of the humerus. At the bottom, the muscle is attached by a wide aponeurotic tendon to the olecranon.

Elbow muscle (m. anconeus) is located superficially. It is small and has a triangular shape. The muscle originates from the lateral epicondyle of the shoulder and the collateral ligament of the radius. Its fibers diverge, lie fan-shaped on the bag of the elbow joint, partially woven into it, and are attached to the crest of the dorsum 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 outward from the artery, crosses it in the middle, and passes medially to the artery in the distal part.

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

The nerve encircles the bone in a spiral, descending in the upper part between the long and medial heads of the triceps muscle, and towards the middle of the shoulder 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-back view.

A. 1 - large tubercle of the humerus; 2 - anatomical neck of the humerus; 3 - head of the humerus; 4 - small tubercle of the humerus; 5 - intertubercular furrow; 6 - crest of a small tubercle; 7 - crest of a large tubercle; 8 - deltoid tuberosity of the humerus; 9 - body of the humerus; 10 - anterior medial surface; 11 - medial edge of the humerus; 12 - coronal 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 - large tubercle; 4 - surgical neck of the humerus; 5 - deltoid tuberosity; 6 - furrow of the radial nerve; 7 - lateral edge of the humerus; 8 - fossa of the olecranon; 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.

The bones of the skeleton are unique formations that arose in the process of evolution. Each bone has a unique structure, the most suitable for performing work, which is associated not only with maintaining 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, nerve and vascular plexuses. There are also joints in which this bone takes part - the shoulder and 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 during injury. The head of the humerus is involved in the formation of the joint, it has a structure that differs from the rest of the sections, which allows you to perform the usual range of hand movements for each person.

The head of the bone is smooth, 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, dislocations of the shoulder occur. Below is the anatomical neck, it is a groove, and the capsule of the human joint is also attached to it.

Below the anatomical neck, the structure suggests the presence of two tubercles - large and small, to which a person attaches many muscles, and there is also a nerve plexus nearby. The rotator cuff of the shoulder is fixed to these formations, which is responsible for rotation, as well as the performance of the function. The anatomy of these formations is such that it is in this place that fractures appear when falling, and not only the rotator cuff suffers, but also the rest of the muscles, as important anatomical formations of this part of the limb.

Down from each of the tubercles a ridge departs, which bears the same name. Together with the tubercles, the ridges form another formation - the intertubercular furrow. 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. Also in this place is the rotator cuff, the tendons of which can be damaged in case of injury.

If you look below, then there is a formation that does not differ from the body of the bone, but is important in the practice of a doctor. The anatomy of this part of the shoulder is arranged in such a way that a surgical neck is located under the head. This place got its name as the weakest in a person, which is most often injured. Especially in the elderly, the bone breaks in this area, sometimes with damage to the muscles by fragments. In a child, this place corresponds to the growth zone of the arm and its bone component.

body 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 round section in the upper section, and trihedral in the lower section. The trihedral 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 external and internal. There are nutrient holes in the area of the body, small arteries of the hand pass through them, delivering blood into the bone.

In this part of the arm there is one formation located in this place - the furrow of the radial nerve. It runs in a spiral, it is surrounded by muscles, here the radial nerve passes almost close to the bone, which can also be damaged in case of 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 is also located the vascular and nervous 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 attaching muscles, this component of the hand is involved in the formation of the joint. There is also a plexus of blood vessels and nerves that can be damaged during injury or fracture.

The lowest part, which is involved in the formation of the joint, is called the condyle of the humerus. Its anatomy is complex, on the inside it forms a block of the shoulder, the ulna is articulated with it with the help of 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, there is a coronary fossa on the anterior surface, the functions of which are that the coronoid process of the ulna enters into 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 hand in this section there are also muscles and a choroid plexus. The structure of this section of the shoulder is represented by the fossa of the olecranon, it enters it during joint extension.

In the upper part of the condyle, the epicondyles are located, muscles are attached to them, as well as the joint capsule. The external and internal epicondyles are isolated, muscle tendons are fixed to them, the functions of which are to set the forearm and shoulder in motion. Ridges rise from each epicondyle, this is the place of attachment of the muscles of the shoulder and forearm.

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

This formation has a protrusion to which the muscles are fixed (radial flexor of the wrist), it is called the supracondylar process. You can feel the condyles, as a place of attachment of the tendons, under the skin, as well as the groove of the ulnar nerve. These protrusions can be landmarks by which one can guess where the choroid or nerve plexus is located.

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

Humerus - people put different meanings into this concept. If we consider the anatomy, then the shoulder refers to the upper section of the free upper limb, that is, the arm. If we consider the anatomical nomenclature, this section starts from the shoulder joint, and ends with 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, due to which the number and range of motion of the upper limb increases.

Bone Anatomy

Two main bones of the shoulder girdle can be distinguished:

Shoulder blade. As you know, this is a flat bone that has a triangular shape. It is located behind 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 articular cavity, necessary for the articulation of the scapula and the head of the shoulder bone. A narrowed place adjoins the cavity - the neck of the scapula. Above the cavity of the joint 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 top is located up and inside.

The costal scapular surface faces the chest. The surface is slightly concave. With the help of it, a subscapular fossa is formed. The back 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 passes 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 necessary for attaching ligaments and muscles.

Collarbone. It is a tubular bone curved in an S-shaped way. It connects to the sternum at its medial end, and to the scapula at its lateral end. The clavicle is located under the skin, it is easy to feel. It is attached to the breast cell with ligaments and muscles. With a shoulder blade, the connection is made using ligaments. Therefore, the lower surface of the clavicle has roughness - lines and tubercles.

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

With regard to the large tubercle of the humerus, we can say that it is turned outward. Another tubercle, small, is turned anteriorly. A crest departs from the large tubercle of the humerus and the small tubercle. There is a furrow between them and the ridges. It contains the tendon of the head of the shoulder muscle of the biceps type. There is also a surgical neck, that is, the narrowest place of the shoulder bone, which is located below the tubercles.

The humerus has a deltoid tuberosity. Attached to it is the deltoid muscle. In the process of sports training, there is an increase in this tuberosity and the thickness of the compact bone layer. The sulcus of the radial nerve runs along the posterior bone surface. With the help of the distal epiphysis of the humerus, the condyle is formed.

It has an articular surface necessary for connection with the bones of the forearm. The surface of the joint on the side of the medial part, which connects to the ulna, is called the block of the shoulder bone. Above it are holes in front and behind. In them, when flexion and extension of the forearm occurs, the processes of the elbow bone enter. The lateral surface is called the head of the condyle of the shoulder bone.

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

Shoulder ligament anatomy

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

Damage

The humerus is subject to many injuries. One of them are. 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, there is a wedging of the distal part into the head. The head can be deformed, crushed, and also torn off, but in this case it will be turned by the cartilaginous surface to a distal fragment.

Signs are hemorrhage and swelling. A person cannot make active movements, feels pain. If you make passive rotational movements, then the large tubercle will move together with the shoulder. If the fracture is impacted, the signs are not so pronounced. The victim can make active movements. Diagnosis is confirmed by x-ray.

For impacted fractures of the neck and head, treatment is outpatient. Carry out immobilization of the hand. Inside, a person takes analgesics and sedative drugs. Physiotherapy is also prescribed. A month later, the splint is replaced with a kerchief-type bandage. Ability to work is restored in two and a half months.

Fracture of the surgical neck

Injuries without displacement are usually impacted or hammered together. If displacement has occurred, the pearl may be adductive or efferent. Adduction fractures occur in the case of a fall with an 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 increases with the load of the axial plan. The humerus may retain its function, but it will be limited. If a displacement occurs, the main symptoms are sharp pain, pathological mobility, violation of the shoulder axis, shortening, dysfunction. First aid consists in the introduction of analgesics, immobilization and hospitalization.

The large tubercle suffers mainly from dislocation of the shoulder. It comes off and is displaced due to the reflex contraction of the small, infraspinatus and supraspinatus muscles. If an isolated fracture occurs, then, most likely, as a result of a shoulder injury, no displacement is observed in this case.

Symptoms of such injuries are soreness, swelling, crepitus.

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

If the fracture is detachable and is combined with displacement, reposition and immobilization with a splint or plaster bandage is done. If there is a large swelling and, for two weeks, shoulder traction is used. After the patient begins to freely raise the shoulder, the 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. There is also hemorrhage, pain, crepitus, and abnormal mobility. First aid - the introduction of analgesics and immobilization with a transport tire. Fractures of the diaphysis in the lower and middle thirds are treated with skeletal traction. Injuries in the upper third are treated with a splint and shoulder extension. Immobilization lasts from two to three months.

Fractures in the distal

Extra-articular fractures are extensor and flexion, depending on the position during the fall. Intra-articular fractures are transcondylar injuries, V- and T-shaped injuries, as well as fractures of the head of the condyle. Symptoms are tenderness, crepitus, abnormal mobility, and flexed forearm. First aid consists in transport immobilization with a splint, you can apply a scarf. Analgesics are also administered.

The bones of the shoulder girdle play an important role in the implementation of movements. They need to be protected, because any damage is treated for a long time.

- this is a violation of the integrity of the humerus in its upper part, just below the shoulder joint. More often occurs in women of elderly and senile age, the cause is a fall on a hand laid back or pressed to the body. It is manifested by pain, swelling and limitation of movement in the shoulder joint. Sometimes bone crunch is determined. To clarify the diagnosis, an X-ray examination is performed. Treatment is usually conservative: anesthesia, reduction and immobilization. If it is impossible to match the fragments, the operation is performed.

ICD-10

S42.2 Fracture of the upper end of the humerus

General information

Fracture of the neck of the shoulder - damage to the upper end of the humerus. It is more often detected in older women, which is due not only to osteoporosis, but also to a characteristic restructuring of the metaphysis of the humerus: a decrease in the number of bone beams, an increase in the size of the medullary 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 neck of the shoulder is a closed isolated injury; open injuries in this area are almost never found. With high-energy effects, combinations with fractures of other bones of the limbs, pelvic fractures, fractures of the spine, TBI, fractures of the ribs, blunt abdominal trauma, rupture of the bladder, kidney damage, etc. are possible. Treatment of fractures of the neck of the shoulder is carried out by orthopedic traumatologists.

Causes

According to the observations of specialists in the field of traumatology and orthopedics, usually the cause of a fracture of the neck of the shoulder is an indirect injury (falling on the elbow, shoulder or hand), in which there is a flexion of the bone in combination with pressure on it along the axis. The effect of 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 transverse. The peripheral fragment is introduced into the head, an impacted fracture is formed. In this case, the longitudinal axis may be preserved, but the formation of a more or less pronounced angle, open posteriorly, is more often observed.

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

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

Pathoanatomy

The humerus is a long tubular bone consisting of a diaphysis (middle), two epiphyses (upper and lower) and transitional zones between the diaphysis and epiphyses (metaphyses). The upper end of the bone is represented by a spherical articular head, immediately below which is a natural narrowing - the anatomical neck of the shoulder. Fractures in this area are very rare. Just below the anatomical neck 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 conditional border between the upper end and the diaphysis of the bone. This border is called the surgical neck of the shoulder, it is in this area that fractures most often occur. The articular capsule of the shoulder joint is attached just above the tubercles, so transtubercular fractures, as well as fractures of the actual surgical neck of the shoulder, are classified as extra-articular injuries. The division of these injuries is very conditional, taking into account the general symptoms and principles of treatment, most clinicians combine them into a general group of fractures of the surgical neck of the shoulder.

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

Fracture symptoms

Patients with impacted fractures of the neck of the shoulder complain of moderate pain in the joint area, aggravated by movement. The joint is edematous, hemorrhages are often found. Active movements are possible, but limited due to pain. Palpation of the head of the shoulder is painful. With fractures with displacement, the symptoms are more pronounced: the rounded shape of the joint is disturbed, some protrusion of the acromial process and retraction in the head region are noticeable.

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

On palpation of the surgical neck, there is a sharp local pain. In thin patients with poorly developed muscles in the armpit, it is possible to palpate the end of the distal bone fragment. 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, an x-ray of the shoulder joint is prescribed in two projections: direct and "epaulet" (axial). An "epaulette" shot is performed by moving the shoulder away from the body at an angle of 30-40 degrees. Greater abduction is categorically not recommended, as it can aggravate the displacement of fragments. In doubtful cases, CT of the shoulder joint is used. If compression of the neurovascular bundle is suspected, patients are referred for a consultation with neurologists or neurosurgeons and vascular surgeons.

Treatment of a fracture of the neck of the shoulder

Elderly patients with impacted fractures do not require reposition in most cases. The area of damage is anesthetized with novocaine and a fixing bandage is applied for a period of 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, reposition 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 swaying) in the shoulder joint - from the fifth day. Subsequently, the range of motion is gradually increased.

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

Surgical treatment is indicated for significant angular displacement, complete separation of the fragments and the impossibility of matching the fragments by closed reposition. The operation is carried out in the conditions of the trauma department under general anesthesia. As a rule, an antero-medial incision is used. To hold fragments in adults, osteosynthesis with a plate is performed; in children, fixation with knitting needles is possible. The wound is sutured in layers and drained.

In the postoperative period, immobilization is carried out using a curved Kremer splint or 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 joint. The sutures are removed on the 10th day, movements in the shoulder joint begin on the 20th day after the operation. The results of surgery are usually good.

Very rarely, with crushing of the upper parts of the humerus and aseptic necrosis of the head, arthroplasty 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 glenoid cavity of the scapula). If there are contraindications to endoprosthetics, arthrodesis is performed.