Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae...
Transcript of Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae...
![Page 1: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/1.jpg)
Joints of upper limb
David Kachlík
![Page 2: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/2.jpg)
Joints of pectoral girdleJuncturae cinguli membri superioris
• art. sternoclavicularis (sternoclavicular joint)
• art. acromioclavicularis (acromioclavicular joint)
• lig. coracoacromiale seu fornix humeri– prevent arm from abduction above horizontal plane in
fixed scapula
• lig. transversum scapulae superius (above incisura scapulae)
– under: n. suprascapularis
– across: vasa suprascapularia
• lig. transversum scapulae inferius (above incisura spinoglenoidalis)
– passage for n. suprascapularis and vasa suprascapularia
![Page 3: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/3.jpg)
Joints of pectoral girdleJuncturae cinguli membri superioris
![Page 4: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/4.jpg)
Articulatio sternoclavicularis
joint type composed (discus articularis), spheroid (ball-and-socket), limited movements
head facies articularis sternalis claviculae
fossa incisura clavicularis sterni (of manubrium sterni)
articular capsule and its
ligaments
lig. sternoclaviculare anterius et posterius, lig. interclaviculare,
lig. costoclaviculare
movements tri-axial, very limited in all directions
neutral position arm freely hanging along the body (= basic position)
note
clavicle is larger than superior margin of manubrium sterni enlarges incisura
jugularis
very firm joint during limb axis impacts is clavicle more prone to fracture
![Page 5: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/5.jpg)
Articulatio sternoclavicularis
Netter, Altas of Clinical Anatomy
![Page 6: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/6.jpg)
Dislocation in art. sternoclavicularis dx.
![Page 7: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/7.jpg)
Articulatio acromioclavicularis
joint type simple or compound (discus articularis in 50%), plane, amphiarthrosis
head facies articularis acromialis claviculae
fossa facies articularis clavicularis acromii
articular capsule and its
ligaments
lig. acromioclaviculare (above); extracapsular – lig. coracoclaviculare (anterior
portion: lig. trapezoideum, posterior portion: lig. conoideum)
movements tri-axial, very limited in all directions
neutral position arm freely hanging along the body (= basic position)
note
joint prone to injury in direct blow to shoulder – classification after Tossy
(depending on ligament‘s injury) – distorsion, subluxation (rupture of LAC,
rupture of LCC), luxation (ruptures of both ligaments)
![Page 8: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/8.jpg)
Articulatio acromioclavicularis
Čihák R., Anatomie 1, Grada Publishing a.s. 2001
![Page 9: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/9.jpg)
Dislocation ofarticulatio acromioclavicularis
Netter, Altas of Clinical Anatomy
![Page 10: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/10.jpg)
Subluxation of art. acromioclavicularisTossy/Rockwood II
![Page 11: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/11.jpg)
Basic movements of shoulder
• neutral position:
– arm freely, deflected 30° ventrally from frontal plane
• retraction
• protraction
• elevation
• depression
• rotation
![Page 12: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/12.jpg)
Joints of free upper limbJuncturae membri superioris liberi
• articulationes (joints)– articulatio humeri s. glenohumeralis (shoulder joint)– articulatio cubiti (elbow joint)
• art. humeroulnaris (humero-ulnar joint)• art. humeroradialis (humeroradial joint)• art. radioulnaris proximalis (proximal radio-ulnar joint)
– articulatio radioulnaris distalis (distal joint)– articulationes manus (hand joints)
• art. radiocarpalis (wrist joint)• articulationes intercarpales• art. mediocarpalis• art. carpometacarpales• articulationes intermetacarpales• articulationes metacarpophalangeae• articulationes interphalangeae manus
• syndesmosis radioulnaris (radio-ulnar syndesmosis)– membrana interossea antebrachii (antebrachial interssoesous membrane)– chorda obliqua
![Page 13: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/13.jpg)
Articulatio humeri (Art. glenohumeralis) – Shoulder jointjoint type simple, spheroid (ball-and-socket), mobile
head caput humeri
fossa cavitas glenoidalis scapulae (+ labrum glenoidale)
articular capsule and its
ligaments
collum scapulae – collum anatomicum humeri
exception in attachment of articular capsule: capsule pouch vagina synovialis
intertubercularis into sulcus intertubercularis
- looser and folded in inferior margin (recessus axillaris)
ligg. glenohumeralia (sup., medium, inf.) – weakened spot between superior and
middle ligg. = foramen Weitbrechti)
lig. transversum humeri (across sulcus intertubercularis), lig. coracohumerale,
tendons of rotator cuff‘s muscles
capsule weakened ventrally and distally easy luxation
special structures
inside articular capsule: labrum glenoidale, tendo capitis longi musculi bicipitis
brachii
outside bursae synoviales (8): e.g. bursa subacriomialis, subdeltoidea,
subcoracoidea
movementsflexion-extension (=dorsal flexion), abduction (90°)-adduction (+hyperdduction),
internal-external rotation (45°), circumduction
neutral position mild flexion + abduction 45°
note
rotator cuff composed of 4 muscles‘ insertional tendons (m. supraspinatus, m.
infraspinatus, m. teres minor, m. subscapularis)
CD (capitodiaphyseal) angle = 130°
the most mobile joint in the body
![Page 14: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/14.jpg)
Articulatio humeri= Glenohumeral / shoulder joint
![Page 15: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/15.jpg)
Articulatio humeri
Netter, Altas of Clinical Anatomy
![Page 16: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/16.jpg)
Ligaments of shoulder joint
Čihák R., Anatomie 1, Grada Publishing a.s. 2001
Lig. coracohumerale
Lig. glenohumerale medium
Lig. glenohumerale inferius
Lig. glenohumerale superius
Lig. coracoacromialeLig. acromioclaviculare
![Page 17: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/17.jpg)
Rotator cuff
• complex of muscles and their tendons
• protects and fixes shoulder jonit against subluxation
– m. supraspinatus
– m. infraspinatus
– m. teres minor
– m. subscapularis
Netter, Altas of Clinical Anatomy
![Page 18: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/18.jpg)
Stability and movements‘s extent in shoulder joint
• static– labrum glenoidale
– capsula articularis
– ligaments
• dynamic– rotator cuff
– caput longum musculi bicipitis brachii
– m. deltoideus
Čihák R., Anatomie 1, Grada Publishing a.s. 2001
![Page 19: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/19.jpg)
Bursae synoviales of shoulder joint
• bursa subtendinea musculi subscapularis
• bursa subcoracoidea
• bursa subacromialis
• bursa subdeltoidea
• bursa subtendinea musculi infraspinati
• bursa subtendinea musculi teretis majoris Netter, Altas of Clinical Anatomy
![Page 20: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/20.jpg)
Shoulder – lateral view
![Page 21: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/21.jpg)
Periarticular muscles – posterior view
![Page 22: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/22.jpg)
Periarticular muscles – anterior view
![Page 23: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/23.jpg)
Periarticular muscles – superior view
![Page 24: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/24.jpg)
Shoulder - MRI
![Page 25: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/25.jpg)
![Page 26: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/26.jpg)
![Page 27: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/27.jpg)
X-ray: Y projection of shoulder joint
![Page 28: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/28.jpg)
Posterior dislocation of shoulder joint
![Page 29: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/29.jpg)
Complicated anterior luxationof shoulder joint
![Page 30: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/30.jpg)
Articulatio cubiti (Elbow jonit)
joint type
compound (3 bones), bi-axial
a) art. humeroulnaris (trochlear)
b) art. humeroradialis (spheroid)
c) art. radioulnaris proximalis (pivot)
head
a) trochlea humeri
b) capitulum humeri
c) circumferentia articularis radii
fossa
a) incisura trochlearis ulnae
b) fovea articularis radii
c) incisura radialis ulnae
articular capsule and its
ligaments
condylus humeri (epicondyli outside the capsule, serving for muscle origins)
ulna: along the articular surfaces; radius: recessus sacciformis
lig. collaterale radiale et ulnare (3 parts: lig. humerocoronoideum,
olecranohumerale, obliquum Cooperi)
lig. anulare radii, lig. quadratum (forms the floor of recessus sacciformis)
special structures
musculi articulares (m. anconaeus)
corpus adiposum intraarticulare
bursa subcutanea olecrani, bursa subtendinea musculi tricipitis brachi
movementsflexion-extension, pronation-supination (= radius crosses over ulna,
interconnected with movements in art. radioulnaris distalis)
neutral position flexion and mild pronation
note potential hyperxtension in small olecranon or present foramen supratrochleare
![Page 31: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/31.jpg)
Articulatio cubiti
Netter, Altas of Clinical AnatomyGray´s anatomy, 39th edition,
Elsevier Churchill Livingstone 2005
![Page 32: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/32.jpg)
Bursae synoviales of elbow joint
• bursa subcutanea olecrani
• bursa intratendinea olecrani
• bursa subtendinea musculi tricipitis brachii
• bursa bicipitoradialis
• bursa cubitalis interossea
http://www.joint-pain-expert.net/olecranon-bursitis.htmlhttp://pages.uoregon.edu/esorens1/hphy362.pbwiki.com/Elbow+and+Forearm+Anatomy.html
![Page 33: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/33.jpg)
Elbow joint = Articulatio cubiti
![Page 34: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/34.jpg)
Elbow joint = Articulatio cubiti
![Page 35: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/35.jpg)
Elbow joint = Articulatio cubiti
![Page 36: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/36.jpg)
Elbow joint = Articulatio cubiti
![Page 37: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/37.jpg)
X-ray of elbow joint
• postero-anterior projection
• lateral projection
![Page 38: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/38.jpg)
posterior luxationof elbow joint
divergent luxationof elbow joint
![Page 39: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/39.jpg)
![Page 40: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/40.jpg)
Syndesmosis radioulnaris
• membrana interossea antebrachii
• chorda obliqua
• openings for a. interossea anterior + its accompanying veins
Netter, Altas of Clinical Anatomy
![Page 41: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/41.jpg)
Articulatio radioulnaris distalis
joint type simple, mobile, pivot
head circumferentia articularis ulnae
fossa incisura ulnaris radii
articular capsule and its
ligamentsrecessus sacciformis
movements
pronation-supination
(= radius crosses over ulna, interconnected with movements in art. radioulnaris
proximalis)
neutral position mild pronation
note works only together with s art. radioulnaris proximalis
![Page 42: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/42.jpg)
Articulatio radioulnaris distalis
http://www.wheelessonline.com/ortho/distal_radial_ulnar_joint
![Page 43: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/43.jpg)
Luxation of art. radioulnaris distalis
![Page 44: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/44.jpg)
Articulatio radiocarpalis (Wrist joint)
joint type compound (4 bones + discus articularis), mobile, ellipsoid
head os scaphoideum, os lunatum, os triquetrum
fossa facies articularis carpalis radii + discus articularis
articular capsule and its
ligaments
(recessus prestyloideus)
lig. radiocarpale palmare et dorsale; lig. ulnocarpale palmare et dorsale; lig.
collaterale ulnare et radiale (weak and functionally negligible)
special structures discus articularis
movementspalmar flexion-extension (= dorsal flexion), radial and ulnar duction (60°),
circumduction
neutral position continuation of forearm axis
note ulna is not part of the joint!
![Page 45: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/45.jpg)
Wrist = functional unit
• compound, functionally elipsoid– art. radiocarpalis
– art. mediocarpalis (two heads and fosssae)
– artt. intercarpales
– (art. carpometacarpales)
• discus articularis + ligamenta
• movements:– palmar and dorsal flexion
– radial and ulnar duction
– (circumduction)
![Page 46: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/46.jpg)
Wrist = functional unit
Articular cavities
![Page 47: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/47.jpg)
Articulatio radiocarpalis
http://www.prohealthsys.com/anatomy/grays/arthrology/carpometacarpalarticulations.php
Netter, Altas of Clinical Anatomy
![Page 48: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/48.jpg)
1234
5
67
8
9
![Page 49: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/49.jpg)
TFCCtriangular fibrocartilagineous complex
• discus triangularis (lig. subcruentum)
• lig. radioulnare palmare (lig. ulnolunatum et ulnotriquetrum) et dorsale
• meniscus ulnocarpalis
• lig. collaterale carpi ulnare
• (+ vagina tendinis musculi flexoris carpi ulnaris)
http://imaging.consult.com/image/topic/dx/Musculoskeletal?title=TFCC%20Tears&image=fig1&locator=gr1&pii=S1933-0332%2806%2970920-X
![Page 50: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/50.jpg)
Wrist joint - ligaments
• TFCC („triangular fibrocartilagineous complex“)
• discus articularis – triangular shape
• ligaments of articular capsule– palmar (“V“), dorsal (“V“), collaterall (weak)
• interosseous ligaments
![Page 51: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/51.jpg)
Radiocarpal luxation
![Page 52: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/52.jpg)
Articulatio mediocarpalis (Mediocarpal joint)
joint type compound (2 heads and 2 fossae), limited movements
heada) ulnar: os hamatum, os capitatum (functional center of the joint!)
b) radial: os scaphoideum
fossaa) ulnar: os scaphoideum, os lunatum, os triquetrum
b) radial: os trapezium, os trapezoideum
articular capsule and its
ligaments
lig. carpi radiatum
ligg. intercarpalia dorsalia, palmaria, interossea
movementsminimal in all directions, shifts of all bones around the functional head
hand as a whole
neutral position continuation of forearm axis
notearticular cleft in the shape of letter S, composed of artt. intercarpales between
proximal and distal rows of carpal bones
![Page 53: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/53.jpg)
Articulatio mediocarpalis
http://www.prohealthsys.com/anatomy/grays/arthrology/carpometacarpalarticulations.php Gray´s anatomy, 37th edition, Churchill Livingstone 1989
![Page 54: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/54.jpg)
Articulatio carpometacarpalis pollicis
joint type simple, mobile, saddle
head basis ossis metacarpi primi
fossa os trapezium (saddle-shaped surface)
articular capsule and its
ligamentsligg. carpometacarpalia dorsalia, palmaria, interossea
movements flexion-extension, abduction-adduction, circumduction, opposition-reposition
neutral position mild flexion and abduction
note -
![Page 55: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/55.jpg)
Ligamentous apparatus of wrist
stretching radially across the functional center of wrist = caput ossis capitati
• palmar– lig. radiocarpale palmare
– lig. ulnocarpale palmare
– lig. carpi radiatum
– ligg. intercarpalia palmaria
• interosseous– ligg. intercarpalia interossea
![Page 56: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/56.jpg)
Palmar ligaments of wrist
• complex of lig. radiocarpale palmare– lig. radiocapitatum
– lig. radiotriquetrum (radioluntaotriquetrum)
– lig. radioscapholunatum Testuti
• complex of lig. ulnocarpale palmare– lig. ulnolunatum
– lig. ulnotriquetrum
– lig. capitatotriquetrumNetter, Altas of Clinical Anatomy
![Page 57: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/57.jpg)
Functional arrangement of palmar ligaments of wrist
• proximal ligamentous „V“ shackle
– lig. radiotriquetrum + ulnotriquetrum
• distal ligamentous „V“ shackle
– lig. radiocapitatum + capitatotriquetrum
• space of Poirier = locus minoris resistentiae between both shackles
– here luxation of os lunatum occurs
![Page 58: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/58.jpg)
Luxation of os lunatum
![Page 59: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/59.jpg)
Ligamentous apparatus of wrist
• dorsal– lig. radiocarpale dorsale
– lig. ulnocarpale dorsale
– ligg. intercarpalia dorsalia
• collateral– weak ligaments
– lig. collaterale carpi radiale
– lig. collaterale carpi ulnare
![Page 60: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/60.jpg)
Function of carpal and metacarpal joints
• movements:– palmar + dorsal flexion
• total extent up to 170°, 85°to both sides
– radial + ulnar duction
• total extent 60°
– circumduction
• neutral position– in direct continuation of wrist
axis
Čihák R., Anatomie 1, Grada Publishing a.s. 2001
![Page 61: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/61.jpg)
Canalis carpi (Carpal tunnel)
• lig. carpi transversum s. retinaculum musculorum flexorum– between eminentia carpi
ulnaris et radialis
• contents– tendons of flexors
– n. medianus
• cave: compartment syndrome
Netter, Altas of Clinical Anatomy
![Page 62: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/62.jpg)
Canalis ulnarisGuyoni
• n. ulnaris
• a. ulnaris
• vv. ulnares
http://www.scielo.br/scielo.php?pid=s0004-282x2001000100022&script=sci_arttext
http://idsportsmed.com/patient_education/11/991123cca7f68f0b6b5904c2cd937724
![Page 63: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/63.jpg)
Articulationes metacarpophalangeae (5)
joint typesimple, mobile, dorsally spheroid, palmarily cylindric (groove) functionally
ellipsoid
head caput ossis metacarpi
fossa basis phalangis proximalis (+ fibrocartilago palmaris)
articular capsule and its
ligaments
ligg. collateralia (med.+lat.), ligg. palmaria (comprising fibrocartilago), lig.
metacarpale transversum profundum (between individual caput ossis metacarpi)
special structure fibrocartilago palmaris
movementsflexion-extension, in extension ulnar and radial duction, circumduction, (passive
rotation in extension)
neutral position middle flexion
note -
![Page 64: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/64.jpg)
Articulationes interphalangeae proximales et
distales (PIP and DIP jonits)
joint type simple, mobile, trochlear
head trochlea phalangis (of caput phalagis proximalis et media) (crest)
fossa basis phalangis mediae et distalis (groove)
articular capsule and its
ligamentsligg. collateralia (med.+lat.), ligg. palmaria (comprising fibrocartilago)
movements flexion-extension
neutral position middle flexion
note -
![Page 65: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/65.jpg)
MP and IP ligaments
Gray´s anatomy, 39th edition, Elsevier Churchill Livingstone 2005
![Page 66: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/66.jpg)
Vincula
Netter, Altas of Clinical Anatomy
![Page 67: Joints of upper limb - Ústav anatomie | 2. lékařská ... · Joints of pectoral girdle Juncturae cinguli membri superioris •art. sternoclavicularis (sternoclavicular joint) •art.](https://reader030.fdocuments.in/reader030/viewer/2022020217/5d5dfa4a88c9936f1b8b6b95/html5/thumbnails/67.jpg)
Tvary kloubů ruky
a) elipsový
b) kulový
c) kladkový
d) plochý
e) sedlový
Čihák R., Anatomie 1, Grada Publishing a.s. 2001