INDEX
1. INTRODUCTION
2. STERNOCLAVICULAR JOINT
3. ACROMIOCLAVICULAR
JOINT
4. CORACOCLAVICULAR JOINT
5. GLENOHUMERAL JOINT
6. ELBOW JOINT
7. PROXIMAL
RADIOULNAR JOINT
8. DISTAL RADIOULNAR JOINT
9. RADIOCARPAL JOINT
10.
INTERCARPAL JOINTS
11.
CARPOMETACARPAL AND
INTERMETACARPAL JOINTS
12.
FIRST CARPOMETACARPAL JOINT
13.
METACARPOPHALANGEAL AND
INTERPHALANGEAL JOINTS
INTRODUCTION
Joints are sites where two or more bones or cartilages
articulate. Free movements occur at synovial joints. The shoulder girdle
connects the upper limb to the axial skeleton . Shoulder joint is the most
freely mobile joint. The carrying angle in relation to elbow joint is to
facilitate carrying objects like buckets without hitting pelvis.
Supination and pronation are
basic movement for the survival of human being. During pronation , food is
picked and by supination , it is put at the mouth.
The first carpometacarpal
joint allows movement of opposition of thumb with the fingers for picking up
or holding things.
Joints of the Upper Limb
1.Sternoclavicular Joint
Ø Type of joint
•
Saddle type synovial joint; but it functions like a
ball-and-socket joint
•
ATYPICAL: fibrocartilage cover articular surfaces
Ø Articulating surfaces
•
Sternal facet of
clavicle, clavicular facet of manubrium
•
There is also an
ARTICULAR DISC
Ø Articular capsule
•
Surrounds the joint,
including the clavicular epiphysis
•
Attached to the
articular disc
•
Lined with
synovial membrane, contains synovial fluid
Ø Ligaments
•
Anterior and posterior
sternoclavicular ligaments
•
Interclavcular
ligament
• Costoclavicular ligament
Ø Stability factors
•
Not many muscles around, and the surfaces are incongruous, so
the joint relies on the ligaments for stability.
•
Anterior and posterior sternoclavicular ligaments reinforce
it anteriorly and posteriorly
•
Interclavicular ligament reinforces it superiorly
•
Costoclavicular ligament reinforces it inferiorly
•
Articular disc limits medial displacement
Ø Movements
•
Flexion, extension, rotation, anterior and posterior
•
movement, circumduction
Ø Blood supply
•
Internal thoracic and subscapular arteries
Ø Nerve supply
•
Nerve to subclavius
•
Medial supraclavicular nerve
2. Acromioclavicular joint
Ø Type of joint
•
Plane type synovial joint
Ø Articulating surfaces
•
Acromial end of the clavicle, and the acromion process of the
scapula
Ø Articular capsule
•
Attached to the margins of the articular surfaces Lined with
synovial membrane Contai ns synovial fluid Strengthened superiorly by fibers
from the trapezius
Ø Ligaments
•
Acromioclavicular ligament
•
Conoid ligament
•
Trapezoid ligament
Ø Stability factors
•
Coracoacromial ligament
•
Stability is maintained by extrinsic ligaments, far from the
joint itself
•
Acromioclavicular ligament
•
Conoid and trapezoid ligaments anchor the clavicle to the
coracoid process, suspending the free limb and scapula from the clavicle
Ø Movements
•
The acromian rotates on the clavicle
Ø Blood supply
•
Suprascapular and thoracoaromial arteries
Ø Nerve supply
•
Lateral pectoral and axillary nerve
•
Subcutaneous lateral supraclavicular nerve
3. Coracoclavicular joint
Ø Type of joint
•
Not really much of a joint, as the two bones don’t really
articulate. There is a rare anatomical abnormality when they actually come into
contact, but normally the coracoid process attaches indirectly to the clavicle
by means of the strong coracoclavicular ligaments, the conoid and the
trapezoid.
Ø Articulating surfaces
•
Normally, none.
•
The superior surface of the coracoid process attaches to the
conoid and the trapezoid line of the clavicle by the ligaments abovementioned
Ø Articular capsule
•
No capsule
Ø Ligaments
•
Conoid ligament
•
Trapezoid ligament
Ø Stability factors
•
Conoid and trapezoid ligaments anchor the clavicle to the
coracoid process, suspending the free limb and scapula from the clavicle
Ø Movements
•
There is limited movement at this joint; the clavicle rotates
on the acromion.
Ø Blood supply
•
Suprascapular and thoracoaromial arteries
Ø Nerve supply
•
Lateral pectoral and axillary nerve
•
Subcutaneous lateral supraclavicular nerve
4. Glenohumeral joint
Ø Type of joint
•
Ball and socket synovial joint
Ø Articulating surfaces
•
Humeral head articulates with the glenoid cavity.
•
The cavity is deepened by the glenoid labrum.
•
About 1/3rd of the head actually sits in the cavity.
Ø Articular capsule
•
Attaches proximally to the margins of the glenoid cavity, and
distally to the anatomical neck of the humerus.
•
IT HAS HOLES IN IT.
•
One hole admits the tendon of the long head of biceps
brachii, and the other communicates with the subscapular bursa.
•
THE WEAKEST PART is the inferior part which is not reinforced
by the rotator cuff muscles
Ø Ligaments
•
Glenohumeral ligaments: intrinsic ligaments, three fibrous
thickenings of the capsule, anteriorly
•
Coracohumeral ligament – from the base of coracoid to the anterior
aspect of the greater tubercle
•
Transverse humeral ligament- acts as the roof over the
bicipital groove
•
Coracoacromial ligament- forms the roof over the glenohumeral
joint
Ø Stability factors
•
The joint is too shallow to be stable; stability is
sacrificed to mobility
•
The socket is deepened by the glenoid labrum
•
The joint is stabilized mainly by muscles:
§ supraspinatus
§ infraspinatus
§ teres minor
§ subscapularis
•
they hold the ball in the socket
•
the coracoacromial arch and supraspinatus tendon limit
superior displacement
•
supraspinatus and teres minor limit posterior
Ø Movements
•
Greatest freedom of movement of any joint in the body
•
Flexion/extension, abduction/adduction, medial and lateral
rotation, circumduction
•
Assisted by the movement of the pectoral girdle (the scapula
and the clavicle)
Ø Blood supply
•
Anterior and posterior circumflex humeral arteries
•
Branches of the suprascapular artery
Ø Nerve supply
•
Suprascapular, axillary and lateral pectoral nerves.
Ø Clinical anatomy
•
FROZEN SHOULDER – Synovial membrane become adherent to
each other.
•
SHOULDER TIP PAIN – Irritation of peritoneum underlying
diaphragm due to surrounding pathology causes referred pain in shoulder.
Factors Influencing the Stability of
the Glenohumeral Joint
•
MAINLY, THE ROTATOR CUFF: supraspinatus, infraspinatus,
subscapularis and teres minor
•
They hold the head of humerus in the glenoid fossa
•
SOMEWHAT, THE LIGAMENTS:
•
Glenohumeral
•
Coracohumeral
•
Coracoacromial arch
•
SLIGHTLY, THE GLENOID LABRUM
5. Elbow Joint
Ø Type of joint
•
typical synovial hinge joint
Ø Articulating surfaces
•
Trochlea of humerus articulates with the trochlear notch of
the ulna.
•
Capitulum of the humerus articulates with the head of radius
the surfaces are most congruent when the arm is halfway pronated, and the elbow
is flexed to a right angle.
Ø Articular capsule
•
laterally and medially, just attaches to the margins of the
articular surfaces.
•
Anteriorly and posteriorly, the capsule comes up more
proximally, to enclose the coronoid fossa and the olecranon fossa. Distally, it
blends with the capsule of the proximal radioulnar joint .
Ø Ligaments
•
all are intrinsic- thickened parts of the joint capsule the
lateral one is the Radial Collateral ligament - blends distally with the
annular ligament of the radius; attaches to radial notch margins the medial one
is the Ulnar Collateral ligament
•
- triangular, fan-like
•
- the ANTERIOR band is the STRONGEST
•
- the POSTERIOR band is the weakest
•
- the slender and feeble OBLIQUE band
•
merely serves to deepens the socket for the
•
trochlea of the humerus
Ø Stability factors
•
Major stability factor: bony alignment; The bones articulate well,
the olecranon fossa limits hyperextension, and the coronoid fossa limits
hyperflexion. The medial and lateral collateral ligaments serve to limit
abduction and adduction- a minorstability factor
Ø Movements
•
It is PERMANENTLY ABDUCTED to 17 degrees:
•
The “carrying angle” =
this angle is 10 degrees greater in women
•
it DISAPPEARS when the
arm is PRONATED
•
but the elbow only allows flexion and extension
•
FLEXORS: biceps brachii, brachialis, brachioradialis
•
EXTENSORS: Triceps Brachii, Anconeus
•
when the forearm is
supinated, the biceps brachii helps flex it
•
when the forearm is
pronated, the pronator teres helps flex it.
•
major flexor is the
brachialis; minor flexor is brachioradialis
Ø Blood supply
•
Derived from the anastomosis around the elbow joint
Ø Nerve supply
•
Musculocutaneous, ulnar and median nerve
Ø BURSAE: under every muscle
attachment… the most important are:
•
- Intratendinous olecranon bursa sometimes inside the
tendon of the triceps
•
- Subtendinous olecranon bursa between the olecranon and
the triceps tendon
•
- Subcutaneous olecranon bursa in the subcutaneous tissue
over the olecranon
Ø Clinical anatomy
•
Tennis elbow – Tenderness over lateral epicondyle of humerus.
•
Golfer’s elbow – Microtrauma of medial epicondyle of humerus.
•
Student’s (Miner’s)elbow - Effusion into bursa over
subcutaneous posterior surface of the olecranon process .
•
Cubitus valgus – When carrying angle is more,ulnar nerve get
stretched.
•
Cubitus varus - When carrying angle is less.
6. Proximal Radioulnar
Joint
Ø Type of joint
•
Pivot type synovial joint
Ø Articulating surfaces
•
The head of radius articulates with the radial notch of the ulna
Ø Articular capsule
•
The fibrous part blends into the elbow joint
•
The synovial part is continuous with the elbow joint
•
There is also a SACCIFORM RECESS of the joint, a distal
extension of it down the radius which allows the radius to rotate without
tearing the synovium
Ø Ligaments
•
The ANULAR ligament encircles the head of the radius
Ø Stability factors
•
The bones articulate well
•
The ANULAR ligament is the main stability factor, preventing
dislocation of the radial head.
•
The INTEROSSEOUS MEMBRANE also prevents distraction of the
radius
•
The joint is surrounded by muscles eg. brachioradialis and
brachialis, which contribute to its stability in a minor way
Ø Movements
•
Pronation and supination
•
Supination is the palm turning up, as if to receive alms
•
The axis of rotation passes through the head of radius and through the site of attachment of of
radius and ulna distally
•
THE RADIUS IS THE ONE THAT ROTATES the ulna stays stationary
Ø Blood supply
•
Supplied by the radial portion of the periarticular arterial
anastomosis of the elbow, which is the anastomosis of radial and middle
collateral arteries with the radial and recurrent inteosseous arteries
Ø Nerve supply
•
Supplied by the musculocutaneous, median and radial nerves,
where pronation is work of the median
supination is the work of the radial and musculocutaneous nerves
7.Distal Radioulnar Joint
Ø Type of joint
•
Pivot type of synovial joint
Ø Articulating surfaces
•
The head of ulna articulates with the ulnar notch of the
medial distal radius which separates the the cavity of the distal radioulnar
joint from the cavity of the wrist joint
Ø Articular capsule
•
The synovial membrane extends supeiorly between the radius and
the ulna to form a SACCIFORM RECESS, which accommodates for the twistng of the
capsule.
Ø Ligaments
•
Intrinsic ANTERIOR and POSTERIOR ligaments strengthen the
joint capsule
•
These are weak transverse bands
Ø Stability factors
•
The ARTICULAR DISC is the main uniting structure of the
joint, because it bings the ends of the radius and the ulna together
Ø Movements
•
During pronation, the radius crosses the ulna
•
During supination, the radius is parallel with the ulna
•
Supination is produced by Supinator
•
Pronation is produced by the Pronator Quadratus as well as
Pronator Teres FCR, PL and brachioradialis also help when the forearm is
mid-pronated
Ø Blood supply
•
Anterior and posterior interosseous arteries
Ø Nerve supply
•
Anterior and posterior interosseous nerves
8. Radiocarpal joint
Ø Type of joint
•
Condyloid (ellipsoid) type of synovial joint
Ø Articulating surfaces
•
Three of the carpal bones (scaphoid, triquetrum and lunate)
articulate with the radius
•
The pisiform and the ulna don’t participate
Ø Articular capsule
•
Stretches from the distal ends of the radius and ulna, to the
proximal row of carpal bones (but not the pisiform)
Ø Ligaments
•
The PALMAR radiocarpal ligaments stretch from the radius to
both of the two rows of carpal bones;
•
The DORSAL radiocarpal ligament does the same
•
these ligaments make sure the hand follows the radius in its
rotation
•
the ULNAR COLLATERAL LIGAMENT passes from the ulnar styloid
to the triquetrum
•
the RADIAL COLLATERAL LIGAMENT passes from the radial styloid
to the triquetrum
Ø Clinical anatomy
•
RHEUMATOID ARTHRITIS
•
GANGLION – It is a cystic swelling resulting from mucoid
degeneration of synovial sheaths around tendon.
9. Intercarpal joints
Ø Type of joint
•
Plane synocial joints
Ø Articulating surfaces
•
Joints between carpal bones of the middle row
•
Joints between carpal bones of the distal row
•
MIDCARPAL JOINT: between the proximal and distal rows of the
joints
•
PISOTRIQUETRAL JOINT: articulation between the pisiform and
the palmar surface of the triquetrum
Ø Articular capsule
•
The articular cavity is common to all intercarpal and
carpometacarpal joints – EXCEPT the thumb, which has its own carpometacarpal
capsule.
Ø Ligaments - All
the carpals are united with anterior, posterior and interosseous ligaments
Ø Stability factors
•
The ligaments above contribute most;
•
The fibrous articular capsule wraps the carpal bones up, and
keeps them together
Ø Movements
•
Slight movemens which extent the range of motion available at
the radiocarpal joint
Ø Blood supply
•
Dorsal and palmar carpal arches
Ø Nerve supply
•
Anterior interosseous branch of the median nerve
•
Dorsal and deep branches of the ulnar nerve
10. Carpometacarpal and
Intermetacarpal joints
Ø Type of joint
•
Plane type synovial joints- EXCEPT the carpometacarpal joint
of the thumb, which is a saddle type joint
Ø Articulating surfaces
•
Distal surfaces of the carpal bones articulate with the bases
of the metacarpals
•
The important thumb joint is the articulation between the
trapezium and the bease of the first metacarpal
•
The INTERMETACARPAL joints ar adjacent metacarpals
articulating with each other’s bases
Ø Articular capsule
•
The medial four carpometacarpal joints, and the three
intermetacarpal joints, are all enclosed by the same articular capsule.
• The thumb CMC joint has
its own capsule
Ø Ligaments
•
All thse bones are united by the palmar and dorsal
carpometacarpal ligaments, and by the intermetacarpal ligaments.
•
The DEEP TRANSVERSE METACARPAL LIGAMENT and the SUPERFICIAL
TRANSVERSE METACARPAL LIGAMENT (which is part of the palmar aponeurosis) both
work to prevent separation of the metacarpal bases
Ø Stability factors
•
The above ligaments are he major stability factors
Ø Movements
•
Almost no movement at the CMCs of the 2nd and 3rd fingers,
•
Slight movement at the 4th CMC
•
Moderate movement of the 5th CMC (flexion, extension and
rotation)
Ø Blood supply
•
Periarticular arterial anasomoses of the wrist and hand
(basically, the arterial arches)
Ø Nerve supply
•
Anterior interosseous branch of the median nerve, posterior
interossous branch of the radial nerve, and dorsal and deep branches of the
ulnar nerve
Ø Clinical anatomy
•
De Quervains tenosynovitis – Synovial lining of tendons of
extensor pollicis brevis and abductor pollicis longus can get inflamed due to
repetitive strain and causes painful condition.
11. First carpometacarpal joint
Ø Type of joint
•
Saddle-type synovial joint
Ø Articulating surfaces
•
Trapezium and the base of the 1st metacarpal
Ø Articular capsule
•
Coveres the articulating surfaces
Ø Ligaments
•
anterior oblique (volar) ligament (AOL)
•
dorsoradial ligament,
•
posterior oblique ligament
•
intermetacarpal ligament.
Ø Stability factors - Ligaments,
mainly
Ø Movements
•
Angular movements in any plane:
•
Flexion- extension
•
Adduction-abduction
•
(thus, circumduction)
•
opposition
Ø Blood supply
•
Periarticular arterial anasomoses of the wrist and hand
(basically, the arterial arches)
Ø Nerve supply
•
Anterior interosseous branch of the median nerve, posterior
interossous branch of the radial nerve, and dorsal and deep branches of the
ulnar nerve
Ø Clinical anatomy
•
The joint can undergo degenerative changes with age which
causes a painful condition of base of the thumb.
12. Metacarpophalangeal and
interphalangeal joints
Ø Type of joint
•
Metacarpophalangeal joints are condyloid synovial joints
•
Interphalangeal joints are hinge joints
Ø Articulating surfaces
•
Bases and heads
Ø Articular capsule
•
Joint capsules surround each joint, attaching to the margins
Ø Stability factor
•
ligaments
Ø Movements
•
MCPS: flexion, extension, adduction, abduction
Ø Ligaments
•
Each MCP ad ICP joint is reinforced by a medial and lateral
collateral ligaments
•
Each of these ligaments has two parts:
•
The dense cord-like part passes from one head to the next
base; the thin fan-like part passes anteriorly to fuse with the anterior (palmar)
part of the joint capsule
•
The cord-like parts are slack dring extension and taught
during flexion- this means you usually cannot spread (abduct) the fingers when
the fingers are fully flexed
•
The fan-like parts move like a visor over the underlying heads
•
The palmar ligament (thick part of the capsule) blend with
the digital sheaths and provide grooves for the flexor tendons to glide in.
•
At the MCPs, THE PALMAR LIGAMENTS ARE UNITED by the deep
transverse metacarpal ligament
Ø Blood supply
•
Digital arteries
Ø Nerve supply
•
Digital nerves from the median and ulnar nerves
