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.