상지(upper limb) 뼈(bone)의 구조와 기능에 관한 해부학

거대한 작업의 시작 상지의 뼈 구조와 이름. <img src="https://t1.daumcdn.net/cfile/cafe/166D7E41509A0D1E14" class="txc-image" actualwidth="937" hspace="1" vspace="1" border="0" width="937" style="clear:none;float:none;" id="A_166D7E41509A0D1E142664"/> <img src="https://t1.daumcdn.net/cfile/cafe/16264B4A509A60D736" class="txc-image" actualwidth="997" hspace="1" vspace="1" border="0" width="997" style="clear:none;float:none;" id="A_16264B4A509A60D736071F"/> 상지뼈 중 촉지가 가능한 부위<img src="https://t1.daumcdn.net/cfile/cafe/114ECD43509A0DE51F" class="txc-image" actualwidth="945" hspace="1" vspace="1" border="0" width="945" style="clear:none;float:none;" id="A_114ECD43509A0DE51F42FB"/> <img src="https://t1.daumcdn.net/cfile/cafe/135BC543509A0DE503" class="txc-image" actualwidth="1000" hspace="1" vspace="1" border="0" width="1000" style="clear:none;float:none;" id="A_135BC543509A0DE503DFCA"/> <img src="https://t1.daumcdn.net/cfile/cafe/1266703F509A640009" class="txc-image" actualwidth="1022" hspace="1" vspace="1" border="0" width="1022" style="clear:none;float:none;" id="A_1266703F509A6400097CA8"/> 흉추와 견갑골의 랜드마크- 견갑극(scapular spine)은 흉추 3번 극돌기 부위, 제 4번 늑골부위- 견갑골 하각(inferior angle)은 흉추 7번 극돌기, 제 8번 늑골부위 <img src="https://t1.daumcdn.net/cfile/cafe/1955F135509D7D6F2E" class="txc-image" hspace="1" vspace="1" border="0" actualwidth="837" width="837" style="clear:none;float:none;" id="A_1955F135509D7D6F2EF691"/> <img src="https://t1.daumcdn.net/cfile/cafe/1971873D509A0F6603" class="txc-image" actualwidth="1022" hspace="1" vspace="1" border="0" width="1022" style="clear:none;float:none;" id="A_1971873D509A0F66036E3A"/>- 흉추 11, 12번 늑골은 부유늑골이기 때문에 흉추의 회전이 가능하다.  <img src="https://t1.daumcdn.net/cfile/cafe/205A6F37509C19DE28" class="txc-image" actualwidth="1004" hspace="1" vspace="1" border="0" width="1004" style="clear:none;float:none;" id="A_205A6F37509C19DE284226"/>- 견갑골 면(scapular plane)과 쇄골이 이루는 각도는 60도- 관상면(coronal plane)기준으로 30도각을 이룸.- Retroverted 7˚ and superiorly inclined 5˚ relative to the plane of the scapula. <img src="https://t1.daumcdn.net/cfile/cafe/0170493D509A0F6707" class="txc-image" actualwidth="834" hspace="1" vspace="1" border="0" width="834" style="clear:none;float:none;" id="A_0170493D509A0F6707CE85"/>견갑대(shoulder girdle)와 골반대(pelvic girdle)의 위치관계 <img src="https://t1.daumcdn.net/cfile/cafe/0159993C509A0FDF06" class="txc-image" actualwidth="775" hspace="1" vspace="1" border="0" width="775" style="clear:none;float:none;" id="A_0159993C509A0FDF0685E0"/> <img src="https://t1.daumcdn.net/cfile/cafe/14533247509A110715" class="txc-image" actualwidth="627" hspace="1" vspace="1" border="0" width="627" style="clear:none;float:none;" id="A_14533247509A1107156904"/> <img src="https://t1.daumcdn.net/cfile/cafe/164D2C47509A110720" class="txc-image" actualwidth="688" hspace="1" vspace="1" border="0" width="688" style="clear:none;float:none;" id="A_164D2C47509A11072001C1"/> <img src="https://t1.daumcdn.net/cfile/cafe/01455147509A11082E" class="txc-image" actualwidth="814" hspace="1" vspace="1" border="0" width="814" style="clear:none;float:none;" id="A_01455147509A11082E51D6"/> 견갑절흔 증후군(scapular noutch syndrome)- 견갑구멍(scapular foremen, 견갑공)은 견갑골의 상횡인대(superior transverse ligament)와 견갑절흔(scapular notch)에 의해서 만들어지는 공간- 견갑골의 상횡인대가 골화되면서 구멍(foramen)을 만듬- 이 공간으로 상견갑신경이 유주하므로 자주 포착(entrapment)됨. - 어깨관절의 능동적 회전에 의해서 견갑구멍은 더욱 좁아지고 견갑절흔증후군(scapular noutch syndrome)이 발생- 상견갑신경은 극상근과 극하근을 지배하므로 이 두개의 근육약화, 근위축등이 유발될 수 있음. <img src="https://t1.daumcdn.net/cfile/cafe/1350FD47509A110818" class="txc-image" actualwidth="478" hspace="1" vspace="1" border="0" width="478" style="clear:none;float:none;" id="A_1350FD47509A1108183F05"/> <img src="https://t1.daumcdn.net/cfile/cafe/15324D4D509A119E3A" class="txc-image" actualwidth="853" hspace="1" vspace="1" border="0" width="853" style="clear:none;float:none;" id="A_15324D4D509A119E3AA0F4"/> <img src="https://t1.daumcdn.net/cfile/cafe/1138644D509A119F28" class="txc-image" actualwidth="450" hspace="1" vspace="1" border="0" width="450" style="clear:none;float:none;" id="A_1138644D509A119F28CF26"/> <img src="https://t1.daumcdn.net/cfile/cafe/013DDB33509A13252B" class="txc-image" actualwidth="917" hspace="1" vspace="1" border="0" width="917" style="clear:none;float:none;" id="A_013DDB33509A13252BABFF"/> <img src="https://t1.daumcdn.net/cfile/cafe/206B9733509A132510" class="txc-image" actualwidth="670" hspace="1" vspace="1" border="0" width="670" style="clear:none;float:none;" id="A_206B9733509A132510A2C1"/> 상완골 <img src="https://t1.daumcdn.net/cfile/cafe/1479973C509B48FB37" class="txc-image" actualwidth="483" hspace="1" vspace="1" border="0" width="483" style="clear:none;float:none;" id="A_1479973C509B48FB37414C"/> 상완골과 견갑골 위에서 본 그림 <img src="https://t1.daumcdn.net/cfile/cafe/027BF837509B491501" class="txc-image" actualwidth="864" hspace="1" vspace="1" border="0" width="864" style="clear:none;float:none;" id="A_027BF837509B4915013485"/> <img src="https://t1.daumcdn.net/cfile/cafe/132A9C35509B498C0D" class="txc-image" actualwidth="649" hspace="1" vspace="1" border="0" width="649" style="clear:none;float:none;" id="A_132A9C35509B498C0D5385"/> <img src="https://t1.daumcdn.net/cfile/cafe/1723B435509B498C14" class="txc-image" actualwidth="581" hspace="1" vspace="1" border="0" width="581" style="clear:none;float:none;" id="A_1723B435509B498C14BD5C"/>상완골 측면 뷰 <img src="https://t1.daumcdn.net/cfile/cafe/02288439509B49F201" class="txc-image" actualwidth="485" hspace="1" vspace="1" border="0" width="485" style="clear:none;float:none;" id="A_02288439509B49F2013333"/> <img src="https://t1.daumcdn.net/cfile/cafe/124D3037509B4AA22F" class="txc-image" actualwidth="631" hspace="1" vspace="1" border="0" width="631" style="clear:none;float:none;" id="A_124D3037509B4AA22F25CF"/> 내측에서본 상지 연결 <img src="https://t1.daumcdn.net/cfile/cafe/0238C43E509B4E0717" class="txc-image" actualwidth="679" hspace="1" vspace="1" border="0" width="679" style="clear:none;float:none;" id="A_0238C43E509B4E0717AB91"/>요골과 척골의 구조 <img src="https://t1.daumcdn.net/cfile/cafe/18059E46509B519710" class="txc-image" actualwidth="812" hspace="1" vspace="1" border="0" width="812" style="clear:none;float:none;" id="A_18059E46509B519710DF5A"/> <img src="https://t1.daumcdn.net/cfile/cafe/174D1B4B509B51FB2C" class="txc-image" actualwidth="804" hspace="1" vspace="1" border="0" width="804" style="clear:none;float:none;" id="A_174D1B4B509B51FB2C5A81"/> 외측에서 본 상완골, 요골, 척골, 손가락<img src="https://t1.daumcdn.net/cfile/cafe/024CEA4E509B524F32" class="txc-image" actualwidth="807" hspace="1" vspace="1" border="0" width="807" style="clear:none;float:none;" id="A_024CEA4E509B524F324739"/> <img src="https://t1.daumcdn.net/cfile/cafe/02659550509B52DB1F" class="txc-image" actualwidth="400" hspace="1" vspace="1" border="0" width="400" style="clear:none;float:none;" id="A_02659550509B52DB1F29D3"/> <img src="https://t1.daumcdn.net/cfile/cafe/20416549509B52F32D" class="txc-image" actualwidth="523" hspace="1" vspace="1" border="0" width="523" style="clear:none;float:none;" id="A_20416549509B52F32D3CA6"/> <img src="https://t1.daumcdn.net/cfile/cafe/02411049509B52F32C" class="txc-image" actualwidth="523" hspace="1" vspace="1" border="0" width="523" style="clear:none;float:none;" id="A_02411049509B52F32C1861"/> 손목과 손가락 구조- 우측 손바닥 view-  8개의 carpal bone(lunate, scaphoid, trapezium, trapezoid, capitate, hamate, pisiform, triquetrum) <img src="https://t1.daumcdn.net/cfile/cafe/16154D4A509B53381E" class="txc-image" actualwidth="830" hspace="1" vspace="1" border="0" width="830" style="clear:none;float:none;" id="A_16154D4A509B53381E9BD0"/> 손등에서 본 손목뼈- radiocarpal joint- midcarpal joint <img src="https://t1.daumcdn.net/cfile/cafe/1266C44E509B580020" class="txc-image" actualwidth="617" hspace="1" vspace="1" border="0" width="617" style="clear:none;float:none;" id="A_1266C44E509B58002091F0"/> 손목관절(radiocarpal joint) <img src="https://t1.daumcdn.net/cfile/cafe/153F2B41509B5C6803" class="txc-image" actualwidth="762" hspace="1" vspace="1" border="0" width="762" style="clear:none;float:none;" id="A_153F2B41509B5C6803A9FE"/>수근중앙관절(midcarpal joint) <img src="https://t1.daumcdn.net/cfile/cafe/012FF940509B5CF92D" class="txc-image" actualwidth="743" hspace="1" vspace="1" border="0" width="743" style="clear:none;float:none;" id="A_012FF940509B5CF92D2204"/> <img src="https://t1.daumcdn.net/cfile/cafe/12493042509B5D6A0B" class="txc-image" actualwidth="743" hspace="1" vspace="1" border="0" width="743" style="clear:none;float:none;" id="A_12493042509B5D6A0BAA6F"/> 5개의 어깨관절 1) 흉쇄관절(sternoclavicular joint)2) 견흉관절(scapulothoracic joint)3) 견쇄관절(acromioclavicular joint)4) 관절와 상완관절(glenohumeral joint)5) 견봉하 관절(subacromial joint) <img src="https://t1.daumcdn.net/cfile/cafe/01224E45509B5DC011" class="txc-image" actualwidth="841" hspace="1" vspace="1" border="0" width="841" style="clear:none;float:none;" id="A_01224E45509B5DC0119B10"/> 흉쇄관절과 인대 <img src="https://t1.daumcdn.net/cfile/cafe/013C1035509B63A617" class="txc-image" actualwidth="959" hspace="1" vspace="1" border="0" width="959" style="clear:none;float:none;" id="A_013C1035509B63A6178355"/> 견쇄관절(acromioclavicular joint)과 인대 <img src="https://t1.daumcdn.net/cfile/cafe/144ADD3C509B641C12" class="txc-image" actualwidth="959" hspace="1" vspace="1" border="0" width="959" style="clear:none;float:none;" id="A_144ADD3C509B641C127EF9"/>견흉관절(scapulothoracic joint) <img src="https://t1.daumcdn.net/cfile/cafe/1634FD45509B64E012" class="txc-image" actualwidth="981" hspace="1" vspace="1" border="0" width="981" style="clear:none;float:none;" id="A_1634FD45509B64E012694B"/>scapular 중요한 안정화 근육 두가지1) serratus anterior -=> suction mechanism이라는 표현을 쓴다. winging scapular, long thoracic nerve가 작용2) trapezius muscle의 lower part 견갑골의 안정화- 견갑하근(subscapularis)이 기본- 상부승모근, 견갑거근, 대소능형근, 전거근, 하부승모근 등- 추가로 회전근개(극상근, 극하근, 대소원근, 대흉근), 삼각근, 광배근 등 - 항상 짝힘의 근육장력 평형의 관점에서 안정화를 고려해야 함. <div> </div>어깨 짝힘의 문제 <img src="https://t1.daumcdn.net/cfile/cafe/17399D46509B66721D" class="txc-image" actualwidth="924" hspace="1" vspace="1" border="0" width="924" style="clear:none;float:none;" id="A_17399D46509B66721DD9C8"/> <img src="https://t1.daumcdn.net/cfile/cafe/02770436509B678434" class="txc-image" actualwidth="787" hspace="1" vspace="1" border="0" width="787" style="clear:none;float:none;" id="A_02770436509B678434AF10"/><img src="https://t1.daumcdn.net/cfile/cafe/01092E3B509B68EB04" class="txc-image" actualwidth="969" hspace="1" vspace="1" border="0" width="969" style="clear:none;float:none;" id="A_01092E3B509B68EB04DB8D"/> - Motion at the glenohumeral joint is almost purely rotational. <img src="https://t1.daumcdn.net/cfile/cafe/19556945509B77E337" class="txc-image" actualwidth="981" hspace="1" vspace="1" border="0" width="981" style="clear:none;float:none;" id="A_19556945509B77E337CF1E"/> <img src="https://t1.daumcdn.net/cfile/cafe/166B4145509B77E312" class="txc-image" actualwidth="629" hspace="1" vspace="1" border="0" width="629" style="clear:none;float:none;" id="A_166B4145509B77E3122797"/> <img src="https://t1.daumcdn.net/cfile/cafe/114CB941509B783E0C" class="txc-image" actualwidth="535" hspace="1" vspace="1" border="0" width="535" style="clear:none;float:none;" id="A_114CB941509B783E0C6692"/> <img src="https://t1.daumcdn.net/cfile/cafe/18261341509B784033" class="txc-image" actualwidth="518" hspace="1" vspace="1" border="0" width="518" style="clear:none;float:none;" id="A_18261341509B784033E6FD"/> <img src="https://t1.daumcdn.net/cfile/cafe/132C293B509B796E33" class="txc-image" actualwidth="909" hspace="1" vspace="1" border="0" width="909" style="clear:none;float:none;" id="A_132C293B509B796E33A7DC"/> <img src="https://t1.daumcdn.net/cfile/cafe/13400B3B509B796E21" class="txc-image" actualwidth="932" hspace="1" vspace="1" border="0" width="932" style="clear:none;float:none;" id="A_13400B3B509B796E21BDA0"/> <img src="https://t1.daumcdn.net/cfile/cafe/164DB43B509B796E17" class="txc-image" actualwidth="951" hspace="1" vspace="1" border="0" width="951" style="clear:none;float:none;" id="A_164DB43B509B796E1745E7"/>