Joints of the Upper Limb

What are the criteria of synovial joint? A) Typical synovial joints  the bone ends taking part are covered by HYALINE cartilage  surrounded by a capsule enclosing a joint cavity  the capsule is reinforced externally or internally or both by ligaments  the capsule is lined internally by synovial membrane  the joint is capable of varying degrees of movement B) Atypical synovial joints  the articular surfaces of bone are covered by fibrocartilage  there is interarticular disc

Types of Synovial Joints Based on Shape & Movement

Types of Synovial Joints Based on Shape

OUTLINE OF SYNOVIAL JOINTS OUTLINE OF SYNOVIAL JOINTS TYPE ARTICULATION SURFACES CAPSULE LIGAMENTS SYNOVIAL MEMBRANE STABILITY OF JOINT MOVEMENT

Movement of the pectoral girdle Movement of the pectoral girdle  Sternoclavicular  Acromioclavicular  Glenohumeral(SHOULDER JOINT) o Both movements of SC & AC responsible for movement of entire shoulder girdle(scapula & clavicle o Mobility of the scapula is essential for free movement of the shoulder joint o Movement occurs in a 1:2 ratio

STERNOCLAVICULAR JOINT

STERNOCLAVICULAR JOINT STERNOCLAVICULAR JOINT  Type Atypical of synovial joint of saddle  Articular bones o sternal end of the clavicle o manubrium and the 1st costal cartilage.  Capsule: o Attached around articular surfaces of both articulating bones. o Thickened anteriorly & posteriorly forming ant. & post. Sternoclavicular ligaments  synovial membrane o lines the internal surface of the fibrous layer of the joint capsule

STERNOCLAVICULAR JOINT STERNOCLAVICULAR JOINT  Ligaments 1- Ant. & post. sternoclavicular ligaments 2-interclavicular ligament 3-costoclavicular ligament  Movements o Its movement is accompany the movement of acromioclavicular joint o But in opposite direction o Both movements responsible the movement of entire shoulder girdle

STERNOCLAVICULAR JOINT STERNOCLAVICULAR JOINT  Articular disc o Complete disc of fibrocartilage o Divide joint cavity into TWO compartments (medial & lateral)  Stability : Very stable joint due to o Strong ligaments and o articular disc

STERNOCLAVICULAR JOINT STERNOCLAVICULAR JOINT  Movement o Elevation o Depression o Retraction o Protraction

ACROMIOCLAVICULAR JOINT

ACROMIOCLAVICULAR JOINT ACROMIOCLAVICULAR JOINT  Type : Atypical of synovial joint of plane variety  Articulation : o acromial end of the clavicle o acromion of the scapula.  Capsule: relatively weak, strengthened superiorly by fibers of the trapezius.  synovial membrane lines the internal surface of the fibrous layer of the joint capsule

ACROMIOCLAVICULAR JOINT ACROMIOCLAVICULAR JOINT  Articular disc : o Incomplete fibrocartilage o Attach to upper part of capsule o Divide joint cavity partially into 2 compartment

ACROMIOCLAVICULAR JOINT ACROMIOCLAVICULAR JOINT  Ligaments 1- acromioclavicular ligament 2- coracoclavicular ligament (conoid, trapezoid )  Stability : o Very stable o depends on coracoclavicular ligament  Movements: o A gliding movement o takes place when the scapula rotates or when the clavicle is elevated or depressed

ELBOW JOINT ELBOW JOINT

 Type &Variety ; synovial of Hinge variety (uniaxial)  Articular surfaces: o Trochlea & capitulum of the lower end of the humerus o Trochlear notch of ulna & head of radius  Capsule: o thin in front &behind o thick at side

ELBOW JOINT ELBOW JOINT  Ligament : o as every hinge joint supported by 2 strong collateral ligament 1) radial collateral ligament Strong triangular ligament on the late side Apex attach to lat. Epicondyle Base to annular ligament 2) Ulnar collateral ligament Strong triangular ligament on the med. Side Apex attach to med.. Epicondyle Its ant. border : extend from med. Epicondyle to medial border of the coronoid process of ulna Post border extends from med. Epicondyle to med. Margin of olecranon process Lower border extends from coronoid process to olecronan process N.B : Ulnar collateral ligament is crossed by ulnar n.  Movement; Flexion,extension

SUPERIOR(PROXIMAL) RADIOULNAR JOINT SUPERIOR(PROXIMAL) RADIOULNAR JOINT

proximal radio-ulnar joint proximal radio-ulnar joint  Type &Varity : synovial, pivot  Articular surfaces 1- head of radius 2- radial notch of ulnar& annular ligament  Capsule; o Covers the annular ligament o Above continuous with of elbow capsule o Below loosely attached to the neck of the radius

proximal radio-ulnar joint proximal radio-ulnar joint  Ligaments : 1) annular ligament o strong curved o form ¾ of the circle With radial notch 2) Quadrate ligament o thin quadrangular fibrous band o extends from lower border of radial notch of ulna medially to the neck of radius laterally o closing the joint infromedially N.B: cavity of proximal radioulnar joint is continuous with elbow joint cavity above  Movement o supination & pronation

pulled elbow(nursemaid ′ s elbow  there is difference in the shape of annular ligament in adult and child  which is the basis of this clinical condition In adult o Its cup shaped o firmly attach to the neck of the radius o So prevent its downward displacement In child its head tends to slip out of the ring due to o the tubular shape of the ligament & o the smaller circumference of the head of the radius resulting pulled elbow

INFERIOR(PROXIMAL) RADIOULNAR JOINT INFERIOR(PROXIMAL) RADIOULNAR JOINT

Distal radio-ulnar joint Distal radio-ulnar joint  Type &variety : synovial, pivot  Articular surfaces: o Head of ulnar medially o Ulnar notch of lower end of radius laterally o Triangular articular disc inferiorly  Capsule: o attached around the articular surface o Project upward (together with its lining synovial membrane) Forming small pouch between radius & ulna

Distal radio-ulnar joint Distal radio-ulnar joint  Articular disc: o thick triangular band of fibrocartilage apex attach medially to styloid process of ulna Base attached laterally to lower border of ulnar notch of the radius upper concave surface articulate with head of ulna Lower convex surface articulate with lunate triaquetral bone o It Separate inferior radioulnar joint above from wrist joint below  Movement: Supination & pronation

supinationpronation 1 ) It is initiated by brachioradialis (rotates the radius from full PRONATION to midprone position. 2) It is completed by -supinator (when elbow is extended) -Biceps (when elbow is flexed) 1 ) It is initiated by brachioradialis (rotates the radius from full SUPINATION to midprone position. 2) It is completed by -Pronator teres - pronator quadratus

Interosseous membrane  considered a fibrous joint between the radius & ulna  Function 1-Connects the moving radius to the fixed ulna 2-Provide wide surface area for muscle attachment 3-Transmits the forces applied wrist → radius → interosseous membrane → ulna → humerus → shoulder girdle →clavicle  A fall on an outstretched hand may cause 1- Scaphoid fracture 2- lunate dislocation 3- Fracture of radius head (colle ′ s fracture) 4- Supracondylar fracture of humerus 5 - Clavicle fracture

WRIST JOINT (RADIOCARPAL) WRIST JOINT (RADIOCARPAL)

WRIST JOINT WRIST JOINT  Type &varity ;  Synovial, condyloid, biaxial  Articular surfaces: o Superiorly ;concavity formed by lower surface of lower end of radius articular disc below the head of ulna o Inferiorly ;convex articular surface formed by scaphoid, lunate,triquetral bones of the proximal carpal row N.B: Head of ulnar, pisiform not enter in the formation of the joint  Capsule o Attach to margins of the lower end of radius close to articular surface o Distally attach to scaphoid, lunate & triquetral bone

WRIST JOINT WRIST JOINT  Ligament 1) Ant. palmar radiocarpal ligament 2) Post. Dorsal radiocarpal ligament 3) Ulnar medial collateral ligament 4) Radial lateral collateral ligament  Movement flexion.,extension, adduction and abduction

JOINTS OF THE HAND JOINTS OF THE HAND

1) Intercarpal joints  plane Varity  Adjacent surface of carpal bones  Slight sliding movement 2) Midcarpal joints  between proximal & distal rows of carpal bones.  Condyloid, movement same as wrist 3) Carpometocarpal joint of thumb  between trapezium & base of 1st metacarpal bone  saddle Varity  Movement: flexion, extension, abduction, adduction, opposition 4) Carpometocarpal joints of the medial 4 fingers  plane 5) Metacarpophalangeal joints  condyloid  Movement; flexion,extension, abduction& adduction 6) Interphalangeal joints  hinge  Movement: flexion,extension

1.Hamate Has a hook 2. Capitate is the largest & earliest to ossify 3. Scaphoid is the most commonly fractured & vascular necrosis 4.Lunate is the most commonly dislocated 5. Pisiform is considered as a sesamoid bone in the tendon of flexor carpi ulnaris

Scaphoid fracture

lunate dislocation

Fracture of Clavicle

Movements of the thumb Movements of the thumb

Functional anatomy of the thumb The anatomical peculiarity of thumb are Has 2 phalanges and one metacarpal bones 1st metacarpal bone is at right angle to plane of other metacarpal bones 1st metacarpal bone articulate with trapezoid to form 1st carpometacarpal joint which is of saddle Varity which confirm great mobility of thumb hence functionally it regarded as half of hand because it has a free mobility compared to other fingers Apposal thumb is a human character, it is design for grasping objects and the hand may be regarded as a pincer-like mechanism between the thumb and fingers. A hand without thumb is a hook not a pincer

Movements of the thumb Flexion Extension Adduction Abduction Opposition

Movements of the thumb o the most important part of the hand is the thumb  because of the ability of opposition of the thumb o you are unable to do much without the thumb o From the mechanical point of view, the hand may be regarded as a pincer-like mechanism between the thumb and fingers

Movements of the thumb Movements of the thumb A hand without thumb is a hook not a pincer

Function of the hand The hand is  the grasping  main tactile organ in the body

Types of grips There are two types of gripping: Power grip Precision grip

Power grip In this grip  the fingers and thumb are flexed and wrapped around the object  as in holding a hammer or a screwdriver

Power grip in this case  it is the long flexor tendons (i.e. muscles of the forearm) are contracted  aided by the extensors of the wrist

Precision grip is performed when  the thumb is opposed to the other fingers  and the hand acting as a pincer

Precision grip In this case  it is mainly the short intrinsic muscles of the hand that are acting  as in holding a forceps in carrying a careful dissection

Neutral position (of rest) forearm semiprone wrist slightly extended second to the fifth fingers are partially flexed

Neutral position (of rest) note that the plane of the thumb nail lies at a right angle to the plane of the four finger nails