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Anatomy
Upper Limb
A 67 year old builder presents to the Emergency Department complaining of a 3 month history of a painful right shoulder. He has seen his GP who suggests a diagnosis of osteoarthritis however the patient would like a second opinion. On examination you note tenderness over the acromioclavicular joint. Which of the following synovial joint types best describes the acromioclavicular joint:
Answer:
The acromioclavicular joint is a plane type synovial joint.Acromioclavicular Joint
Anatomy / Upper Limb / Pectoral Region
Last Updated: 8th April 2019
Table: Anatomical Overview of the Acromioclavicular Joint
| Joint | Acromioclavicular |
|---|---|
| Type | Plane type synovial joint |
| Articulations | Lateral end of clavicle and acromion of scapula |
| Main stabilising factors | Acromioclavicular ligament and coracoclavicular ligament |
Joint Articulations
The acromioclavicular joint is a plane type synovial joint, occurring between the lateral end of the clavicle and the acromion of the scapula.
Joint Ligaments
The acromioclavicular joint is reinforced by two main ligaments; a small acromioclavicular ligament and a much larger coracoclavicular ligament.
The strong coracoclavicular ligament (made up of two ligaments, the conoid and trapezoid ligament) is the main stabilising force, and essentially suspends the weight of the upper limb from the clavicle.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/12/Acromioclavicular-Joint.png)
Acromioclavicular Joint. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
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