Joints of the upper limb.pdf

Joints of The Upper Limb
By
Dr. Bahaa Ali, M.D.
Assist. Prof. Anatomy and Embryology, College of Medicine, Jouf university
ILOs
• Describe the joints of the upper limb regarding articular surfaces,
capsule, ligaments, synovial membrane, bursae, relations, nerve supply,
movements and muscles responsible for each movement, stability and
applied anatomy.
Shoulder (Glenohumeral) joint
• Type: synovial; multiaxial (ball and socket).
• Articular surfaces: globular head of humerus
and the glenoid cavity of scapula.
• Labrum glenoidale: is fibrocartilagenous rim.
It deepens and widens the articular socket of
glenoid.
Fibrous capsule
Attachments:
1. Medially: attached to the margin of the
glenoid cavity.
2. Laterally: Attached to anatomical neck
all around except inferiorly where it
descends onto the surgical neck.
Perforation: the capsule has a normal
lateral perforation for the tendon of long
head of biceps.
Synovial membrane
It lines the fibrous capsule.
Related bursae
1. Subcutaneous bursa.
2. Subacromial bursa.
3. Subscapular bursa.
4. Infraspinatus bursa.
5. Subcoracoid bursa.
Ligaments
1. 3 gleno-humeral ligaments
(weak).
2. Coraco-humeral ligament
(stronger).
3. Coracoacromial ligament.
4. Transverse humeral.
ligament.
A. The joint is supported by muscles
as follows:
1. Above, in front and behind by
(rotator cuff muscles).
2. Long head of biceps from above.
3. Deltoid covers the joint in front,
behind and laterally.
4. Below:
• No muscular support.
• Long head of triceps supports
only during abduction of the
arm.
B. The joint is also supported by
ligaments (mention them).
Support of shoulder joint
The shoulder joint is weak (unstable, not
secure and easily dislocated) due to:
1. Fitting of bony parts is not good.
2. Weak and lax capsule and ligaments.
3. Unsupported from below.
Applied anatomy: shoulder dislocation
commonly occurs inferiorly.
Stability of shoulder joint
Plane of the scapula
Movements of shoulder joints
• Flexion
• Extension
• Abduction
• Adduction
• Medial rotation
• Lateral rotation
• Circumduction
Movements of shoulder joint
and muscles producing them
Movements of the
shoulder girdle
• These are movements which take
place at the sternoclavicular and
acromioclavicular joints (both
are synovial)
• These movements are:
1. Elevation of scapula
2. Depression of scapula
3. Protraction of scapula
4. Retraction of scapula
5. Upward rotation of scapula
6. Downward rotation of scapula
Elbow joint
Type: synovial, uniaxial (hinge) joint.
Articular surfaces:
• Proximally: the trochlea, capitulum and
coronoid fossa of humerus.
• Distally: trochlear notch of ulna and head of
radius.
• Capsule: it is attached to the lower end of
humerus and the upper end of both ulna and
radius surrounding the articular surfaces.
N.B. capsule of the elbow joint also enclose the
superior radioulnar joint.
Synovial membrane: it lines the fibrous capsule
and is continuous with the synovial membrane of
the superior radioulnar joint.
Ligaments:
1. Medial (ulnar) collateral ligament.
2. Lateral (radial) collateral ligament.
Movements:
1. Flexion: mainly by brachialis and biceps.
It is assisted by brachioradialis and
superficial flexors of the forearm.
2. Extension: triceps muscle assisted by
anconeus.
Radioulnar joints
1.Superior radioulnar joint
Type: Synovial, uniaxial (pivot) joint.
Articular surfaces:
The circumference of the head of radius
rotates against the radial notch of ulna.
Capsule: its capsule is enclosed within the
capsule of the elbow joint.
Synovial membrane: the synovial
membrane is a downward prolongation of
the synovial membrane of the elbow joint.
Ligaments:
1. Annular ligament
2. Quadrate ligament
Clinical anatomy: tear of the annular
ligament will result in pulled elbow.
2. Inferior radioulnar joint
Type: Synovial, uniaxial (pivot) joint.
Articular surfaces:
1.The head of ulna
2.The ulnar notch of radius.
3.The articular disc: its upper
surface articulates with the head
of ulna, while its lower surface
articulates with the lunate bone.
It separates the cavity of inferior
radio-ulnar joint from that of the
wrist joint
Pronation and Supination
Joints: they occur at the superior and inferior
radioulnar joints (pivot joints).
In Supination:
• The palm faces forwards.
• The radius and ulna lie parallel to each other.
• The thumb is directed laterally.
• Muscles: biceps brachii and supinator.
In Pronation:
• The shaft of radius lies across the front of the shaft
of ulna.
• The hand moves with the radius so that the palm
now looks backwards.
• Muscles: pronator teres and pronator quadratus.
Wrist (radiocarpal joint)
Type: synovial, biaxial (ellipsoid) joint.
Articular surfaces:
A. Proximal articular surfaces is formed by:
1.The inferior surface of lower end of radius
2.The articular disc of inferior radioulnar joint
B. Distal articular surfaces: is formed by three
carpal bones; from lateral to medial they are
scaphoid, lunate and triquetral bones.
Capsule: the capsule is attached to the margins of
the articular surfaces.
N.B. The ulna does not come in direct contact
with the carpal bones and does not share in the
formation of the wrist joint because of the
presence of the articular disc of cartilage below
the head of ulna. Therefore, the wrist joint is
called radio-carpal joint.
Ligaments:
1. Radial collateral ligament
2. Ulnar collateral ligament
3. Palmar radiocarpal ligament
4. Palmar ulocarpal ligament
5. Dorsal radiocarpal ligament
Movements:
Flexion: e.g. flexor capi radialis and
flexor carpi ulnaris.
Extension: e.g. extensor carpi
radialis longus, brevis and extensor
carpi ulnaris.
Abduction: extensor carpi radialis
longus, brevis and flexor carpi
radialis.
Adduction: extensor carpi ulnaris
and flexor carpi ulnaris.
Joints of the hand
All are synovial joints. They include:
• Intercarpal joints: between the carpal bones.
• Carpometacarpal joints: five joints between
the metacarpals and the related distal row of
carpal bones.
• Metacarpophalangeal joints: five joints
between the heads of the metacarpals and the
proximal phalanges of the digits.
• Proximal and distal interphalangeal joints.
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Joints of the upper limb.pdf

  • 1. Joints of The Upper Limb By Dr. Bahaa Ali, M.D. Assist. Prof. Anatomy and Embryology, College of Medicine, Jouf university
  • 2. ILOs • Describe the joints of the upper limb regarding articular surfaces, capsule, ligaments, synovial membrane, bursae, relations, nerve supply, movements and muscles responsible for each movement, stability and applied anatomy.
  • 3. Shoulder (Glenohumeral) joint • Type: synovial; multiaxial (ball and socket). • Articular surfaces: globular head of humerus and the glenoid cavity of scapula. • Labrum glenoidale: is fibrocartilagenous rim. It deepens and widens the articular socket of glenoid.
  • 4. Fibrous capsule Attachments: 1. Medially: attached to the margin of the glenoid cavity. 2. Laterally: Attached to anatomical neck all around except inferiorly where it descends onto the surgical neck. Perforation: the capsule has a normal lateral perforation for the tendon of long head of biceps.
  • 5. Synovial membrane It lines the fibrous capsule.
  • 6. Related bursae 1. Subcutaneous bursa. 2. Subacromial bursa. 3. Subscapular bursa. 4. Infraspinatus bursa. 5. Subcoracoid bursa.
  • 7. Ligaments 1. 3 gleno-humeral ligaments (weak). 2. Coraco-humeral ligament (stronger). 3. Coracoacromial ligament. 4. Transverse humeral. ligament.
  • 8. A. The joint is supported by muscles as follows: 1. Above, in front and behind by (rotator cuff muscles). 2. Long head of biceps from above. 3. Deltoid covers the joint in front, behind and laterally. 4. Below: • No muscular support. • Long head of triceps supports only during abduction of the arm. B. The joint is also supported by ligaments (mention them). Support of shoulder joint
  • 9. The shoulder joint is weak (unstable, not secure and easily dislocated) due to: 1. Fitting of bony parts is not good. 2. Weak and lax capsule and ligaments. 3. Unsupported from below. Applied anatomy: shoulder dislocation commonly occurs inferiorly. Stability of shoulder joint
  • 10. Plane of the scapula
  • 11. Movements of shoulder joints • Flexion • Extension • Abduction • Adduction • Medial rotation • Lateral rotation • Circumduction
  • 12. Movements of shoulder joint and muscles producing them
  • 13. Movements of the shoulder girdle • These are movements which take place at the sternoclavicular and acromioclavicular joints (both are synovial) • These movements are: 1. Elevation of scapula 2. Depression of scapula 3. Protraction of scapula 4. Retraction of scapula 5. Upward rotation of scapula 6. Downward rotation of scapula
  • 14. Elbow joint Type: synovial, uniaxial (hinge) joint. Articular surfaces: • Proximally: the trochlea, capitulum and coronoid fossa of humerus. • Distally: trochlear notch of ulna and head of radius. • Capsule: it is attached to the lower end of humerus and the upper end of both ulna and radius surrounding the articular surfaces. N.B. capsule of the elbow joint also enclose the superior radioulnar joint. Synovial membrane: it lines the fibrous capsule and is continuous with the synovial membrane of the superior radioulnar joint.
  • 15. Ligaments: 1. Medial (ulnar) collateral ligament. 2. Lateral (radial) collateral ligament. Movements: 1. Flexion: mainly by brachialis and biceps. It is assisted by brachioradialis and superficial flexors of the forearm. 2. Extension: triceps muscle assisted by anconeus.
  • 16. Radioulnar joints 1.Superior radioulnar joint Type: Synovial, uniaxial (pivot) joint. Articular surfaces: The circumference of the head of radius rotates against the radial notch of ulna. Capsule: its capsule is enclosed within the capsule of the elbow joint. Synovial membrane: the synovial membrane is a downward prolongation of the synovial membrane of the elbow joint. Ligaments: 1. Annular ligament 2. Quadrate ligament Clinical anatomy: tear of the annular ligament will result in pulled elbow.
  • 17. 2. Inferior radioulnar joint Type: Synovial, uniaxial (pivot) joint. Articular surfaces: 1.The head of ulna 2.The ulnar notch of radius. 3.The articular disc: its upper surface articulates with the head of ulna, while its lower surface articulates with the lunate bone. It separates the cavity of inferior radio-ulnar joint from that of the wrist joint
  • 18. Pronation and Supination Joints: they occur at the superior and inferior radioulnar joints (pivot joints). In Supination: • The palm faces forwards. • The radius and ulna lie parallel to each other. • The thumb is directed laterally. • Muscles: biceps brachii and supinator. In Pronation: • The shaft of radius lies across the front of the shaft of ulna. • The hand moves with the radius so that the palm now looks backwards. • Muscles: pronator teres and pronator quadratus.
  • 19. Wrist (radiocarpal joint) Type: synovial, biaxial (ellipsoid) joint. Articular surfaces: A. Proximal articular surfaces is formed by: 1.The inferior surface of lower end of radius 2.The articular disc of inferior radioulnar joint B. Distal articular surfaces: is formed by three carpal bones; from lateral to medial they are scaphoid, lunate and triquetral bones. Capsule: the capsule is attached to the margins of the articular surfaces. N.B. The ulna does not come in direct contact with the carpal bones and does not share in the formation of the wrist joint because of the presence of the articular disc of cartilage below the head of ulna. Therefore, the wrist joint is called radio-carpal joint.
  • 20. Ligaments: 1. Radial collateral ligament 2. Ulnar collateral ligament 3. Palmar radiocarpal ligament 4. Palmar ulocarpal ligament 5. Dorsal radiocarpal ligament
  • 21. Movements: Flexion: e.g. flexor capi radialis and flexor carpi ulnaris. Extension: e.g. extensor carpi radialis longus, brevis and extensor carpi ulnaris. Abduction: extensor carpi radialis longus, brevis and flexor carpi radialis. Adduction: extensor carpi ulnaris and flexor carpi ulnaris.
  • 22. Joints of the hand All are synovial joints. They include: • Intercarpal joints: between the carpal bones. • Carpometacarpal joints: five joints between the metacarpals and the related distal row of carpal bones. • Metacarpophalangeal joints: five joints between the heads of the metacarpals and the proximal phalanges of the digits. • Proximal and distal interphalangeal joints.