Joints Of Upper Extremities

Sternoclavicular Joint a saddle joint - the only bony joint between axial skeleton & upper limb clavicle sits in a saddle socket formed by superolateral manubrium & 1st costal cartilage

Sternoclavicular Joint 1. fibrous capsule - surrounds entire joint, reinforced by ligaments a. synovial capsule - lines fibrous capsule & both sides of disc b. lateral & medial synovial membranes line 2 cavities on either side of disc 2. articular disc - mostly fibrocartilage - strong, thick, very dense a. attached: superiorly - to medial end of clavicle         inferiorly - to junction btw manubrium & 1st costal cartilage b. continuous with sternoclavicular ligament c. absorbs shock & prevents medial displacement of clavicle

Sternoclavicular Joint 3. anterior, posterior sternoclavicular ligaments - thickenings of the fibrous capsule 4. Interclavicular ligament - also a thickening of fibrous capsule - across the jugular notch 5. costoclavicular ligament - extracapsular a. extends from 1st rib & cartilage to inferior medial end of clavicle b. limits elevation of clavicle at medial end 6. Nervous input - medial supraclavicular branches & nerve to the subclavius (C5, C6) 7. Circulatory supply - branches of internal thoracic & suprascapular arteries

Acromioclavicular Joint A plane gliding joint between lateral clavicle & anterior, medial end of acromion Fibrocartilage covers both articulating surfaces

Acromioclavicular Joint 1. fibrous capsule - surrounds joint, reinforced by acromioclavicular ligament & trapezius synovial capsule - lines fibrous capsule 2. acromioclavicular lig - from superior, lateral end of clavicle to superior surface of acromion 3. coracoclavicular lig - extrinsic to capsule reinforces lateral clavicle to coracoid process of scapula, 2 parts: a. conoid ligament - medial, twisted b. trapezoid ligament - lateral to the conoid

Acromioclavicular Joint 4. articular disc - fibrocartilage wedge projects down from articular capsule into joint 5. Nervous input - branches of axillary, lateral pectoral, supraclavicular nerve (C5, C6) 6. Circulatory supply - branches of suprascapular & thoracoacromial arteries

Shoulder Joint humerus in glenoid fossa - hyaline cartilage covers articulating surfaces a ball & socket joint - spheroidal - highly mobile (not terribly stable)

Shoulder Joint 1. glenoid labrum - fibrocartilaginous rim - enlarges effective size of glenoid 2. fibrous capsule - surrounds joint, from base of coracoid to neck of humerus fairly loose & thin, reinforced by ligaments & rotator cuff muscle group synovial membrane - lines capsule, surrounds head of biceps long head in groove 3. glenohumeral ligaments - superior, middle, inferior = thickenings of anterior capsule extend from supraglenoid tubercle (scapula) to neck & lesser tubercle of humerus 4. transverse humeral ligament: from greater to lesser tubercle (humerus) holds biceps long head

Shoulder Joint 5. coracohumeral ligament: from lateral coracoid to anterior neck of humerus, by greater tubercle 6. coracoacromial arch: = coracoid & acromion processes & coracoacromial ligament prevents superior displacement of humerus 7. coracoacromial ligament: D shape - base on coracoid, apex at acromion, covered by deltoid

Shoulder Joint 8. bursae: cushion between skin & bony prominences, or between tendons & bone, ligament, other tendon a. subscapular bursa - between subscapularis tendon & neck of scapula communicates with cavity thru an opening in the capsule b. subacromial/subdeltoid bursa: between deltoid, supraspinatus tendon & fibrous capsule 9. Nervous input - branches of axillary, lateral pectoral, supraclavicular nn (C5, C6) 10. Circulatory supply - branches of ant & post circumflex humeral, suprascapular arteries

Shoulder Dislocation

Glenoid Labrum Tears

Elbow Joint a hinge joint - uniaxial - flexion/ extension movement

Elbow Joint 1. articulations - hyaline cartilage covers articular surfaces a. humeroulnar: btw trochlea of humerus & trochlear notch of ulna - hinge joint b. humeroradial: btw capitulum of humerus & head of radius - gliding joint c. proximal radioulnar joint: btw head of radius & radial notch of ulna - pivot joint 2. fibrous capsule - encloses joint from coronoid process in front to olecranon posteriorly reinforced especially on sides by collateral ligaments lined by synovial membrane - protrudes between annular ligament & head of radius as sacciform recess

Elbow Joint 3. collateral ligaments - intrinsic, thickenings of capsule a. radial: apex from lateral epicondyle of humerus to base at annular ligament of radius b. ulnar: a big D - apex from medial epicondyle of humerus to:     anterior band - base at coronoid process tubercle (ulna)      posterior band - base at medial edge of olecranon      the two bands are joined by oblique band 4. annular ligament: U-shaped band from ant to post sides of radial notch holds radius to ulna 5. nervous input: branch of musculocutaneous, radial (+ ulnar, median, ant interosseous) (C5-7) 6. circulatory supply: elbow anastomosis - formed by ulnar & radial recurrents, collaterals

Wrist condyloid/ellipsoidal joint between radius, articular disc (binds ends of radius & ulna) & scaphoid, lunate, triquetral

Wrist 1. radiocarpal ligaments - dorsal & palmar - strengthen fibrous capsule 2. collateral ligaments a. radial - along lateral side from radius, over scaphoid, trapezium to metacarpal I b. ulnar - along medial side from ulna, over trequetral, pisiform, hamate to metacarpal V 3. Nervous: ant inteross br of median; post inteross br of radial; dorsal & deep branches of ulnar 4. Circulatory supply: dorsal & palmar carpal arterial arches (anterior & posterior interosseous artery, to distal radioulnar joint)

Wrist Intercarpal, Carpometacarpal & Intermetacarpal Joints - gliding plane joints

Fingers Metacarpophalangeal & Interphalangeal Joints - condyloid & hinge joints

Finger 1. collateral ligaments - obliquely across sides of joints 2. palmar ligaments plates - transversely across center of joints deep transverse metacarpal ligaments - hold together #2-5 metacarpals - between plates 3. extensor expansion hoods - dorsal side of fingers 4. Nervous: digital nerve from median & ulnar 5. Circulatory supply: digital a. from superficial palmar arterial arches