Joints of upper limb Dr A.Prasanna

Objectives Describe the organization of joints of upper limb Classify the different joints of the upper limb Describe the gross anatomy of various joints of upper limb. Describe the movements possible in the various joints and muscles involved. Explain the factors which contribute to the stability of the joints.

Joints of upper limb Sternoclavicular joint Acromioclavicular joint Shoulder joint Elbow joint Radio ulnar joints Wrist joint First carpometacarpal joint.

Sterno clavicular joint Type : Synovial joint. Sub type :Plane joint. Articular surfaces :Sternal end of clavicle, manubrium sterni, and the cartilage of the first rib. An articular disc present between the articulating surfaces Ligaments: Articular capsule. Interclavicular. Anterior sternoclavicular. Posterior sternoclavicular. Costoclavicular.

Sterno clavicular joint -Ligaments Articular capsule Anterior sternoclavicular ligament Posterior sternoclavicular ligament

Sterno clavicular joint Ligaments Interclavicular ligament Costoclavicular ligament

Sterno clavicular joint Blood supply :Internal thoracic and suprascapular arteries. Nerve supply :Medial supraclavicular nerves.

Sterno clavicular joint Movements: Elevation of clavicle - by trapezius, sternocleidomastoid Depression of clavicle – pectoralis minor ,subclvius. Forward movement of clavicle – by serratus anterior. Backward movement of clavicle – by trapezius, rhomboids.

Acromio clavicular joint Type : Plane synovial joint. Articular surfaces : Lateral end of the clavicle Medial margin of acromion process Ligaments: Articular capsule. Superior acromioclavicular ligament. Inferior acromioclavicular ligament. Coracoclavicular ligament. .

Acromio clavicular joint Blood supply : Suprascapular and thoracoacromial arteries. Nerve supply :Lateral supraclavicular nerves.

Acromio clavicular joint Movements: Gliding motion Rotation of the scapula forward and backward upon the clavicle.

Shoulder joint

Shoulder joint Articular capsule. Type : Synovial joint. Sub type: Ball and socket. Articular surfaces : Head of the humerus Shallow glenoid cavity of the scapula An arrangement which permits maximum movement Ligaments: Articular capsule. Coracohumeral ligament. Glenohumeral ligament. Transverse humeral ligament. Glenoidal labrum.

Shoulder joint Coracohumeral ligament It strengthens the upper part of capsule. It arises from coracoid process, and passes to greater tubercle of the humerus

Ligaments Glenohumeral ligaments are three supplemental bands Strengthen the capsule Transverse humeral ligament Converts the intertubercular groove into a canal Contains Biceps tendon

Ligaments Glenoidal labrum is a fibrocartilaginous rim attached around the margin of the glenoid cavity. It deepens the articular cavity

Relations Superior: Inferior: Anterior : Posterior : Deltoid Coracoacromial ligament Subacromial bursa Supraspinatus Inferior: Long head of triceps Axillary nerve posterior circumflex vessels. Anterior : Subscapularis Coracobrachialis Short head of biceps Deltoid. Posterior : Infraspinatus Teres minor

Blood supply : Articular branches of the anterior and posterior humeral circumflex, and transverse scapular arteries. Nerve supply : Axillary and suprascapular nerves.

Movements Movements : Flexion : (Drawn forward) Pectoralis major Anterior fibers of the deltoid Coracobrachialis When the forearm is flexed, by the biceps brachii. Extension : (Drawn backward) Latissimus dorsi Teres major Posterior fibers of the deltoid When the forearm is extended, by the triceps brachii.

Movements Movements : Abduction : Adduction: Initial 15° by supraspinatus Upto 90 ° by middle fibres of deltoid. Upto 180 by lateral rotation of scapula Adduction: Subscapularis Pectoralis major Latissimus dorsi Teres major

Movements Movements : Medial rotation : Lateral rotation: Subscapularis Latissimus dorsi Teres major Pectoralis major Anterior fibers of Deltoid. Lateral rotation: Infraspinatus Teres minor.

Applied anatomy Instability of the shoulder joint: Shallow glenoid fossa of the scapula Lack of support by weak ligaments Make this joint an unstable structure. It is strengthened by tendons of rotator cuff fused to the underlying capsule Subscapularis in front Supraspinatus above Infraspinatus and teres minor behind Inferior aspect of the joint is weak which is not protected by ligament or muscle.

Applied anatomy Dislocations of the shoulder joint : Shoulder joint is commonly dislocated. Anterior inferior dislocation: is common Sudden violence applied to the humerus with the joint fully abducted Tilts the humeral head downward onto the inferior weak part of the capsule

Elbow joint

Elbow joint Type : Synovial joint. Sub type: Hinge variety. Articular surfaces : Trochlea of the humerus articulates trochlear notch of the ulna And the capitulum of humerus articulates with head of the radius. Ligaments: Articular capsule. Anterior ligament. Posterior ligament. Radial collateral ligament. Ulnar collateral ligament

Ligaments Articular capsule : The articular surfaces are connected together by a capsule Which is thickened medially and laterally, and, to a less extent, in front and behind. These thickened portions are usually described as distinct ligaments.

Relations Anterior: Brachialis Median nerve Brachial artery Tendon of biceps. Posterior: Triceps brachii Anconeus.

Relations Lateral: Supinator Medial : Ulnar nerve Fexor carpi ulnaris.

Blood supply : 1. Branches from the profunda brachii artery. 2. Superior and inferior ulnar collateral branches of the brachial artery. 3. Anterior, posterior, and interosseous recurrent branches of the ulnar artery. 4. Recurrent branch of the radial artery. Nerve supply : Ulnar and median nerves

Movements Movements : Flexion and extension. Flexion : Brachialis Biceps Extension : Triceps Anconeus.

Applied anatomy Stability of the elbow joint: Elbow joint is stable because of Of close fitting articular surfaces It also has strong medial and lateral ligaments.

Radioulnar joints

Superior radioulnar joint Type : Synovial joint. Sub type: Pivot variety. Articular surfaces : Between head of radius Anular ligament and radial notch on the ulna. Ligaments: Articular capsule encloses the joint And is continuous with that of elbow joint. Annular ligament is attached to anterior and posterior margins of the radial notch And forms a collar around the head of radius.

Superior radioulnar joint Nerve supply : Branches of Median nerve Ulnar nerve Musculocutaneous nerve Radial nerve

Middle radioulnar joint Interosseous membrane Transfers the weight from radius to ulna

Inferior radioulnar joint Type : Synovial joint. Sub type: Pivot variety. Articular surfaces : Between the rounded head of ulna And the ulnar notch on radius. Articular disc - triangular, made up of fibro cartilage. Ligaments: Articular capsule encloses joint. Anterior ligament Posterior ligament. Nerve supply : Anterior interosseous and radial nerve.

Movements Movements : Supination and pronation. Supination: Pronation: Biceps brachii Supinator. Pronation: Pronator teres and pronator quadratus.

Wrist joint

Wrist joint Type : Synovial joint. Sub type: elipsoid variety. Articular surfaces : Above - Lower end of the radius and articular disc. Below - Lunate, and scaphoid bones. Ligaments: Articular capsule. Anterior radiocarpal ligament. Posterior radiocarpal ligament. Radial collateral ligament. Ulnar collateral ligament

Relations Relations : Anterior: Posterior: Lateral: Long flexor tendons Median nerve. Posterior: Extensor tendons. Lateral: Radial artery.

Movements Movements : Flexion Extension Abduction Adduction Circumduction

Muscles producing movements Flexion : Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Flexors of fingers. Extension : Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extensors of fingers. Abduction : Extensor carpi radialis brevis. Adduction: Extensor carpi ulnaris.

Blood supply : Branches of Radial and ulnar arteries. Nerve supply : Ulnar nerve Posterior interosseous nerve

1st Carpometacarpal joint Type : Synovial joint. Sub type: Saddle (articular surfaces are concavo convex). Articular surfaces : Between the distal part of trapezium And base of first metacarpal bone. Ligaments: Articular capsule encloses joint. Anterior ligament. Posterior ligament. Blood supply : Radial artery. Nerve supply: Median nerve.

Movements Flexion Extension Abduction Adduction Opposition

Muscles producing movements Flexion : Flexor pollicis brevis Opponens pollicis. Extension : Extensor pollicis longus and brevis Abduction : Abductor pollicis longus and extensor pollicis brevis Adduction: Adductor pollicis Opposition : Opponens pollicis

Learning outcomes At the end of this lecture students should be able to: Describe the various joints of upper limb Describe the articular surface, ligaments,blood supply and nerve supply of various joints of upper limb. Discuss the various movements possible in the major joints Enumerate the muscles involved in the joint movements. Explain the clinical anatomy of the major joints