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Joints of upper limb By Dr. Eman AbdelGhany.

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Presentation on theme: "Joints of upper limb By Dr. Eman AbdelGhany."— Presentation transcript:

1 Joints of upper limb By Dr. Eman AbdelGhany

2 Joints of Upper Extremity
1-Sternoclavicular Synovial-saddle 2- Acromioclavicular Synovial-plane 3- Glenohumeral joint(shoulder) Synovial-ball&socket 2 1 3

3 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.

4 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.

5 The Elbow Joint

6 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.

7 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

8 Movement Muscles Affecting the Elbow: Elbow Flexors 1. Brachialis
2. Biceps brachii 3. Brachioradialis Elbow Extensors 1. Triceps 2. Anconeus

9 Relations of elbow joint
1-Anterior: cubital fossa; Contents 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

10 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.

11 Radius and Ulna

12 The Elbow and Radioulnar Joints
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

13 Joints of Upper Extremity
Proximal Radioulnar joint Synovial - pivot Distal Radioulnar joint Synovial – pivot Allows pronation and supination of forearm MiddleRadioulnar joint

14 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. Middle radioulnar joint : fibrous syndesmosis, connect radius & ulna by interosseous membrane,

15 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)

16 Radial styloid Scaphoid Lunate Triquetral Pisiform Trapezium Trapezioid Capitate Hamate Metacarpal Proximal phalanx Middle phalanx Distal phalanx ulna styloid

17 Joints of the Upper Extremity
Radiocarpal joint(wrist): Synovial-ellipsoid Distal radius with proximal row of carpals(lunate & scaphoid) Intercarpal joints Synovial-plane Carpal-metacarpal (2-5) Trapezium-metacarpal 1st Synovial-saddle Metacarpal-phalangeal Synovial-condyloid Interphalangeal Synovial-hinge

18 Wrist Articulations Radiocarpal Joint Proximal portion Distal portion
Most surface contact found

19 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.

20 Extensor Compartments
Anatomic snuffbox: EPL and EPB Scaphoid on floor Radial a. inside

21 Extensor Compartments

22 Movement of the wrist joint
Wrist Extensors (innervated by radial n.) Superficial Extensor carpi radialis brevis/longus Extensor carpi ulnaris Extensor digitorium brachioradialis Deep compartment Extensor pollicus longus/brevis Abductor pollicus longus Extensor indices supinator Secured by extensor retinaculum

23 Wrist flexors (median n.)
Superficial Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorium superficialis Pronator teres Deep Flexor digitorium profundus Flexor pollicis longus Pronator quadratus

24 Cross Section just proximal to Carpal Tunnel

25 Carpal Tunnel Fibro-osseous structure Tunnel contains 10 structures
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

26 Bones of Wrist (palmar)

27 Ligaments of Wrist (dorsal)

28 (palmar)

29 Hand Anatomy Tendon Sheaths Palmer Aspect

30 Carpal Tunnel

31 Wrist Anatomy Tendon Sheaths Dorsal Aspect

32 (dorsal)

33 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.

34 Joints of hand and fingures
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

35 Interphalangeal Joints of 2-5 Fingers
Hinge Joints Motions


37 Ligaments of the Hand Palmar carpometacarpal ligaments
Palmar metacarpal ligaments Deep transverse metacarpal lig

38 Ligaments of the Digits
Collateral lig loose in ext, tight in flexion, obliquely Volar plate limits hyperextension hinged joints (uniaxial) – F/E

39 Nerve Innervation (dorsal)

40 Nerve Innervation (palmar)

41 Stability of radius to ulna
Interosseus membrane. Annular ligament. Disc of inferior radioulnar joint. Oblique cord. Supinator & pronator quadratus muscles.

42 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.

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