Fundamentals
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The appendicular skeleton consists of the bones of the upper and lower limbs and the shoulder and pelvic girdles, through which the limbs attach to the axial skeleton (Figure 2). The upper limb can be divided into the arm, forearm and hand. Similarly, the lower limb can be divided into the thigh, leg, and foot. The upper limb bones are the humerus in the arm, the ulna and radius in the forearm, and the carpals, metacarpals, and phalanges of the hand. The shoulder girdle consists of the clavicles (collarbones), which attach to the sternum (breastbone) medially, and the scapulae (shoulder blades). The scapulae are connected to the trunk by muscular attachments only. The major joints of the upper limb are the shoulder, elbow, wrist, and the articulations of the individual digits. The shoulder is a ball and socket joint. The ball is the proximal end of the humerus, which sits in the shallow socket of the scapula known as the glenoid fossa (see shoulder complex – joints ). This enables the shoulder to be extremely versatile in its movements and it is capable of multiaxial rotation (see planes and axes of movement ). The humerus is held in place by strong ligaments and tendinous attachments. The elbow is a hinge joint formed by the articulation of the humerus and ulna and, therefore, has one main axis of rotation for flexion-extension (see elbow – joints). The articulation between the radius and the ulna is responsible for pronation and supination of the hand. With the elbow flexed to 90° from the anatomical position, the hand is in a supinated position when it is palm up and pronated when palm down.
Upper Limb
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
Dermatomes and nerve distributionBrachial plexusBlocksInterscalene blockSupra and infraclavicular blockAxillary blockMedian, radial and ulnar nerve blocksThe upper limb is divided into the shoulder, arm (between shoulder and elbow), forearm (between elbow and wrist) and hand. The axilla, cubital fossa and carpal tunnel are important areas of transition in the upper limb.
Limb trauma
Ian Greaves in Military Medicine in Iraq and Afghanistan, 2018
So far, we have tended to concentrate on the lower extremity, with little reference to the upper limb. However, it is probably the upper limb that allows the wounded soldier to maintain independence in activities of daily living if the residual extremity is managed to its optimum outcome. A total of 1949 upper limb injuries in 1067 UK soldiers occurred over the 10 years from 2004 to 201460 (890 in Afghanistan, 177 in Iraq; Roberts et al., unpublished). A review of all upper limb injury patterns is ongoing. The following paragraphs provide a summary of the findings to date that offer important messages for future surgeons.
Upper limb and eye movement coordination during reaching tasks in people with stroke
Published in Disability and Rehabilitation, 2018
Katie L. Meadmore, Timothy A. Exell, Jane H. Burridge, Ann-Marie Hughes, Christopher T. Freeman, Valerie Benson
Purpose: To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke. Methods: Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session. Results: Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group. Conclusion: Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support.Implications for RehabilitationDeficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks.Upper limb support can reduce deficits in hand-eye coordination.Stroke rehabilitation outcomes should consider motor and oculomotor performance.
Does upper limb strength play a prominent role in health-related quality of life in stroke patients discharged from inpatient rehabilitation?
Published in Topics in Stroke Rehabilitation, 2020
Eline C. C. van Lieshout, Ingrid G. van de Port, Rick M. Dijkhuizen, Johanna M. A. Visser-Meily
ABSTRACT Background: Impairments in arm function are a common problem in stroke survivors and have a large impact on health-related quality of life (HRQoL). Little is known about the longitudinal relationship between recovery of upper limb strength and changes in HRQoL. Objectives: This study aimed to determine to what extent changes in HRQoL are related to changes in upper limb strength after discharge from inpatient rehabilitation. Methods: 250 patients from an RCT were assessed at discharge from inpatient rehabilitation (baseline) and at 12 weeks post-discharge (follow-up). The Stroke Impact Scale was used to measure HRQoL, and the Motricity Index Arm was used to measure upper limb strength. Hierarchical regression analysis was performed to determine the predictive value of upper limb strength on HRQoL, relative to demographic and clinical characteristics. Regression analysis was used to determine the relation between upper limb strength improvement and HRQoL improvement. Results: Upper limb strength at baseline was a major predictor of HRQoL at follow-up, after accounting for demographic and clinical characteristics (p
The volume and timing of upper limb movement in acute stroke rehabilitation: still room for improvement
Published in Disability and Rehabilitation, 2020
Ruth McLaren, Nada Signal, Sue Lord, Steve Taylor, Jeanette Henderson, Denise Taylor
Objective: To observe upper limb activity patterns of people with stroke during sub-acute rehabilitation to inform the development of treatment strategies for upper limb rehabilitation. Design: Observational study of upper limb activity. Methods: Twenty participants admitted for sub-acute rehabilitation following stroke were observed during a week day for 1 minute every 10 min between 7 am and 7 pm. Upper limb activity was recorded and categorized into five types of movement. Results: Participants used either one or both upper limbs for 45.8% of the observation time. The affected arm moved 26.4% of the time, with most movement occurring in conjunction with the unaffected arm (18.9% of the time) and only 7.5% of the time being movement of the affected arm by itself. The largest proportion of upper limb activity was observed during mealtimes. Conclusions: Recognition of the need to improve upper limb outcomes after stroke has not yet translated into changes in the amount of upper limb activity undertaken during sub-acute rehabilitation. Opportunities to rehabilitate the hemiplegic upper limb are not fully realized. The dominance of bilateral movement in the early stages after stroke may provide scope for interventions that maximize this aspect of motor control.IMPLICATIONS FOR REHABILITATIONDespite advances in rehabilitation, time spent in upper limb activity following stroke is very low, particularly in the affected arm.Most movement of the affected arm occurs in conjunction with the unaffected arm.There is an urgent need to redress this low level of movement, given the importance of upper limb recovery to quality of life for people following stroke.
Related Knowledge Centers
- Arm
- Deltoid Muscle
- Embryology
- Forearm
- Axilla
- Limb
- Shoulder