Joints of upper limb By Dr. Eman AbdelGhany. Joints of Upper Extremity 1-Sternoclavicular...

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Joints of upper limb By Dr. Eman AbdelGhany

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Joints of upper limb By Dr. Eman AbdelGhany Slide 2 Joints of Upper Extremity 1-Sternoclavicular Synovial-saddle 2- Acromioclavicular Synovial-plane 3- Glenohumeral joint(shoulder) Synovial-ball&socket Slide 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. Slide 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. Slide 5 The Elbow Joint Slide 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. Slide 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 Slide 8 Movement Muscles Affecting the Elbow: -Elbow Flexors 1. Brachialis 2. Biceps brachii 3. Brachioradialis -Elbow Extensors 1. Triceps 2. Anconeus Slide 9 Frolich, Human Anatomy,UpprLimb 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 Slide 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. Slide 11 Radius and Ulna Slide 12 Manual of Structural Kinesiology The Elbow and Radioulnar Joints6-12 Joints Radioulnar joint 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 Slide 13 Joints of Upper Extremity Proximal Radioulnar joint Synovial - pivot Distal Radioulnar joint Synovial pivot Allows pronation and supination of forearm MiddleRadioulnar joint Slide 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. -allows for forearm pronation/supination Middle radioulnar joint : fibrous syndesmosis, connect radius & ulna by interosseous membrane, Slide 15 6-15 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) Slide 16 1. Radial styloid 2. Scaphoid 3. Lunate 4. Triquetral 5. Pisiform 6. Trapezium 7. Trapezioid 8. Capitate 9. Hamate 10. Metacarpal 11. Proximal phalanx 12. Middle phalanx 13. Distal phalanx 14. ulna styloid Slide 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) Synovial-plane Trapezium-metacarpal 1 st Synovial-saddle Metacarpal-phalangeal Synovial-condyloid Interphalangeal Synovial-hinge Slide 18 Wrist Articulations Radiocarpal Joint Proximal portion Distal portion Most surface contact found Slide 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. Slide 20 Extensor Compartments Anatomic snuffbox: EPL and EPB Scaphoid on floor Radial a. inside Slide 21 Extensor Compartments Slide 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 Slide 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 Slide 24 Cross Section just proximal to Carpal Tunnel Slide 25 Carpal Tunnel Fibro-osseous structure 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 Slide 26 Bones of Wrist (palmar) Slide 27 Ligaments of Wrist (dorsal) Slide 28 (palmar) Slide 29 Hand Anatomy Tendon Sheaths Palmer Aspect Slide 30 Carpal Tunnel Slide 31 Wrist Anatomy Tendon Sheaths Dorsal Aspect Slide 32 (dorsal) Slide 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. Slide 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 Slide 35 Interphalangeal Joints of 2-5 Fingers Hinge Joints Motions Slide 36 Slide 37 Ligaments of the Hand Palmar carpometacarp al ligaments Palmar metacarpal ligaments Deep transverse metacarpal lig Slide 38 Ligaments of the Digits Collateral lig loose in ext, tight in flexion, obliquely Volar plate limits hyperextension hinged joints (uniaxial) F/E Slide 39 Nerve Innervation (dorsal) Slide 40 Nerve Innervation (palmar) Slide 41 Stability of radius to ulna Interosseus membrane. Annular ligament. Disc of inferior radioulnar joint. Oblique cord. Supinator & pronator quadratus muscles. Slide 42 Forces transmitted from the upper limb to axial skeleton pass through: Glenoid cavity. Coracoid process. Clavicle. Costoclavicular ligament. 1 st rib & sternum. And neither through acromioclavicular joint nor through sternoclavicular joint.