Transcript Joints of upper limb

Joints of upper limb
By Dr. Eman AbdelGhany
Joints of Upper
Extremity
• 1-Sternoclavicular
– Synovial-saddle
• 2- Acromioclavicular
– Synovial-plane
• 3- Glenohumeral
joint(shoulder)
– Synovial-ball&socket
1- Sternoclavicular joint
• Articular surfaces:
- sternal end of the clavicle.
- clavicular notch of manubrium sterni.
- first costal cartilage.
• Ligaments:
- costoclavicular ligament.
- interclavicular ligament.
- ant. & post. Sternoclavicular ligaments.
• Blood supply: suprascapular artery & internal thoracic artery.
• Nerve supply: medial supraclavicular nerve & nerve to subclavius.
• NB: It is divided by articular disc into two cavities.
2- Acromioclavicular joint
• Articular surfaces :
- acromial end of the clavicle
- lateral side of acromion process.
• Ligaments:
• Acromioclavicular ligament.
- coracoclavicular ligament ( conoid & trapezoid parts) .
• Blood supply : suprascapular & thoracoacromial arteries.
• Nerve supply : suprascapular & lateral supraclavicular nerves.
NB: Incompletely divided by articular disc into two compartments.
Movements of both joints allow scapular rotation up to 60 degrees.
The Elbow Joint
Elbow joint
• Elbow Joint type:
– Synovial – hinge
• Articular surfaces:
– Humeroulnar ( trochla of humerus+ trochlear notch of ulna )
– Humeroradial (capitulum of humerus + upper surface of head of
radius)
Capsule and synovial membrane are common for elbow & SRUJ
Capsule is attached to humerus, ulna & unular ligament. It is not
attached to radius.
It includes the radial, coronoid & olecranon fossae of the humerus.
Ligaments of the Elbow
1- Ulnar Collateral Ligament
medial side – connects humerus to ulna
(3 bands ant. , post. And oblique bands)
2- Radial Collateral Ligament
Lateral side – connects humerus to radius
3- Annular Ligament
Surrounds radial head/holds it tight
to ulna
Movement
• Muscles Affecting the Elbow:
- Elbow Flexors
1. Brachialis
2. Biceps brachii
3. Brachioradialis
- Elbow Extensors
1. Triceps
2. Anconeus
Relations of elbow joint
1-Anterior: cubital fossa;
Contents
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Median Cubital Vein+epitrochlear lymph node
Brachial & radial + ulnar arteries
Median & radial nerves
Biceps tendon
– Boundaries:
Medial = Pronator teres
Lateral = Brachioradialis
Superior = Line between
Epicodyles
Roof = skin, fascia
+bicipital aponeurosis
Floor = supinator + brachialis muscles
Frolich, Human Anatomy,UpprLimb
Relations of elbow joint ( cont.)
2- Posterior relation : triceps and anconeus
muscles.
3- Medial relation : ulnar nerve & common flexor
origin.
4- Lateral relation : supinator & common extensor
origin.
Blood supply : anastomosis around the elbow
joint.
Nerve supply : musculocutanious + radial + ulnar
nerves.
Radius and Ulna
Joints
• Radioulnar joint
– Radial head rotates around at proximal ulna
– Distal radius rotates around distal ulna
– Annular ligament maintains radial head in its joint
– Joint between shafts of radius & ulna held tightly
together between proximal & distal articulations by an
interosseus membrane (syndesmosis)
• substantial rotary motion between the bones
Manual of
Structural Kinesiology
The Elbow and Radioulnar Joints
6-12
Joints of Upper Extremity
• Proximal Radioulnar joint
– Synovial - pivot
• Distal Radioulnar joint
– Synovial – pivot
• Allows pronation and
supination of forearm
• MiddleRadioulnar joint
Radioulnar Joint
• Proximal (superior)radioulnar joint:
– articulation between circumference of head of radius and radial
notch of ulna .
– not part of “hinge” joint
– Synovial (pivot) joint
– allows for forearm pronation/supination
 Distal ( inferior) radioulnar joint:
- articulation between head of ulna and ulnar notch of radius.
- Not part of wrist joint separated from it by articular disc.
- Synovial pivot joint.
- allows for forearm pronation/supination
 Middle radioulnar joint : fibrous syndesmosis, connect radius &
ulna by interosseous membrane,
Muscles of radioulnar joints
• Radioulnar pronators
– Pronator teres
– Pronator quadratus
– Brachioradialis( begin movement )
• Radioulnar supinators
– Biceps brachii(powerful supination for flexed
elbow)
– Supinator muscle
– Brachioradialis( begin movement)
6-15
1. Radial styloid
2. Scaphoid
3. Lunate
4. Triquetral
5. Pisiform
6. Trapezium
7. Trapezioid
8. Capitate
9. Hamate
10. Metacarpal
11. Proximal phalanx
12. Middle phalanx
13. Distal phalanx
14. ulna styloid
Joints of the •
Upper Extremity
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Radiocarpal joint(wrist):
– Synovial-ellipsoid
– Distal radius with proximal row
of carpals(lunate & scaphoid)
Intercarpal joints
– Synovial-plane
Carpal-metacarpal (2-5)
– Synovial-plane
Trapezium-metacarpal 1st
– Synovial-saddle
Metacarpal-phalangeal
– Synovial-condyloid
Interphalangeal
– Synovial-hinge
Wrist Articulations
• Radiocarpal Joint
– Proximal portion
– Distal portion
– Most surface contact
found
Wrist (radiocarpal ) joint
• Articulation between  (lower end of radius + scaphoid & lunate ),
(triquetral +articular disc)=== the ulna not share in the wrist joint .
• Ligaments :
1- Ulnar collateral (styloid process of ulna to triquetral & pisiform);
2- Radial collateral ligament (styloid process of radius to scaphoid
bone)
3- Ant. & post. Radiocarpal ligaments= thickened capsule.
Relations:
Ant. : carpal tunnel ?
Post. : Extensor compartments?
Lat.: Anatomical snuff box?
Med.: Dorsal branch of ulnar nerve.
Extensor Compartments
•
Anatomic
snuffbox:
– EPL and
EPB
– Scaphoid on
floor
– Radial a.
inside
Extensor Compartments
Movement of the wrist joint
• Wrist Extensors (innervated by radial n.)
• Superficial
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Extensor carpi radialis brevis/longus
Extensor carpi ulnaris
Extensor digitorium
brachioradialis
• Deep compartment
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Extensor pollicus longus/brevis
Abductor pollicus longus
Extensor indices
supinator
• Secured by extensor retinaculum
• Wrist flexors (median n.)
– Superficial
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Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorium superficialis
Pronator teres
– Deep
• Flexor digitorium profundus
• Flexor pollicis longus
• Pronator quadratus
Cross Section just proximal to
Carpal Tunnel
Carpal Tunnel
• Fibro-osseous structure
– Floor is proximal carpal bones
– Roof is transverse carpal ligament
• Tunnel contains 10 structures
– Median n., flexor pollicis longus tendon, 4 slips of
flexor digitorium superficialis, flexor digitorium
profundus
• Compression results in paresthesia 2-4 fingers
and decrease grip
Bones of Wrist (palmar)
Ligaments of Wrist (dorsal)
(palmar)
Hand Anatomy
Tendon Sheaths
• Palmer Aspect
Carpal Tunnel
Wrist Anatomy
Tendon Sheaths
• Dorsal Aspect
(dorsal)
Movement of wrist joint
• Flexion: flexor carpiradialis & ulnaris + palmaris longus helped by;
FDS,FDP,FPL& ABD. P.L.
• Extension: extensor carpiradialis longus+ brevis & extensor
carpiulnaris, helped by extensors of fingures.
• Abduction: flexor carpiradialis+extensor carpiradialis longus &
brevis, helped by Abd. P.L. + Ext.P.L.& brevis
• Adduction: flexor & extensor carpiulnaris.
• Circumduction : combination of flexion , abduction, extension &
adduction.
• Blood supply : palmar & dorsal carpal branches of radial and ulnar
arteries & palmar arches.
• Nerve supply : ant. & post. Interosseus nerves.
Joints of hand and fingures
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Intercarpal: plane synovial
Carpometacarpal joint of (2-5): plane synovial
Carpometacarpal joint of thumb: synovila saddle
Intermetacarpal joints: plane synovial
Metacarpophalangeal joints: synovial condyloid
Interphalangeal joints : synovial hinge
Interphalangeal Joints of 2-5
Fingers
• Hinge Joints
• Motions
Ligaments of the Hand
• Palmar
carpometacarp
al ligaments
• Palmar
metacarpal
ligaments
• Deep
transverse
metacarpal lig
Ligaments of the Digits
• Collateral lig
loose in ext,
tight in flexion,
obliquely
• Volar plate
limits
hyperextension
• hinged joints
(uniaxial) – F/E
Nerve Innervation (dorsal)
Nerve Innervation (palmar)
Stability of radius to ulna
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Interosseus membrane.
Annular ligament.
Disc of inferior radioulnar joint.
Oblique cord.
Supinator & pronator quadratus muscles.
Forces transmitted from the upper limb to axial
skeleton pass through:
• Glenoid cavity.
• Coracoid process.
• Clavicle.
• Costoclavicular ligament.
• 1st rib & sternum.
And neither through acromioclavicular joint nor through sternoclavicular
joint.