1. Joints of upper limb
Dr A.Prasanna

2. 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.

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

4. 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.

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

6. Sterno clavicular joint Ligaments
Interclavicular ligament
Costoclavicular ligament

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

8. 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.

9. 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. .

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

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

12. Shoulder joint

13. 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.

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

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

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

17. 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

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

19. 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.

20. 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

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

22. 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.

23. 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

24. Elbow joint

25. 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

26. 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.

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

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

29. 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

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

31. 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.

32. Radioulnar joints

33. 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.

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

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

36. 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.

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

38. Wrist joint

39. 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

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

41. Movements Movements : Flexion Extension Abduction Adduction
Circumduction

42. 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.

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

44. 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.

45. Movements
Flexion
Extension
Abduction
Adduction
Opposition

46. 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

47. 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