Joints of Upper Limb II PDF

Noor Odeh Joints of upper limb II Dr. Dima Hamarsheh [email protected] Anatomy (Lec.7) 1  Joints of upper limb II Dr. Dima Hamarsheh [email protected] 1 ~(Frochten ...

Noor Odeh Joints of upper limb II Dr. Dima Hamarsheh [email protected] Anatomy (Lec.7) 1  Joints of upper limb II Dr. Dima Hamarsheh [email protected] 1 ~(Frochten  Elbow joint Articulation: between the trochlea and capitulum of the humerus and the trochlear notch of the ulna and the head of the radius. The articular surfaces are covered with hyaline C =N cartilage. flextion Es extention 6.. Type: Synovial hinge joint &. 95 8. = flextion sig head of radius ma radial Jossa coronoid processa coronial Lossa of Une 2 Capsule: - Anteriorly, it is attached above to the humerus along the upper margins of the coronoid and radial fossae and to the front of the medial and lateral epicondyles and below to the margin of the coronoid process of the ulna and to the anular ligament, which surrounds the head of the radius. Posteriorly, it is attached above to the margins of the olecranon fossa of the humerus and below to the upper margin and sides of the olecranon process of the ulna and to the anular ligament. GCapsule a treor - Capsule posterior 3 4 Ligaments: The fibrous membrane of the joint capsule is thickened medially and laterally to form collateral ligaments, which support the flexion and extension movements of the elbow joint. oster 1- Ulnar collateral ligament ↳ is This is a triangular band Consisting of thick anterior, posterior and inferior parts ferior 2- Radial collateral ligament attached low on the lateral epicondyle and to the anular ligament 5  of synovial - hallmark joint. Syncias * S: B Synovial membrane: This lines the ~, SI joint (fat tissue) capsule and covers fatty pads in the floorsFatty pudsis 8.5 Blood supply. Nerve, of the coronoid, radial, and olecranon 8 = fossae; it is continuous below with the radius, proximal - I siss ulna synovial membrane of the proximal & 5 * s e seasoning- Syngscs., Ji radioulnar joint. * Synovial membrane elbowjoint continue of with Synovid memb of proximal radioulnar joint. Bursae around the elbow joint protrusion synovial membrane of = D along Fibrous membrane 1- Intratendinous bursa. it located btw tendon and fibrous membrane Located within the tendon of triceps brachii -. muscle humer 2- Subtendinous bursa Fossat Between the olecranon and the tendon of endons ↑ triceps brachii muscle Reduce the friction between the two - structures during flexion and extension. - 3- Subcutaneous (olecranon) bursa Between the olecranon and the skin Implicated in olecranon bursitis inflammation common 6 of process my in this bursa.  Nerve supply: Branches from the median, ulnar, musculocutaneous, and radial nerve Blood Supply of the Elbow Joint The articular arteries are derived from the anastomosis around the elbow, which are formed by collateral branches of the brachial and recurrent branches of the ulnar and radial arteries. anastomosis S - brachial Unart radial (collateral) (recurrent branches) 3 I 2 7  - Movement: The elbow joint is capable of flexion and extension Movement Hinge It should be noted that the long axis of the extended forearm lies at an angle to the long axis of the arm. This angle, which opens laterally, is called the carrying angle and is about 170° in the male and 167° in the female. The angle disappears when the elbow joint is fully flexed. & S arrying angle -. 8  Anterior vel I > Important Relations ↑ W Anteriorly: The brachialis, the tendon of the biceps, the median nerve, and the > brachial artery Posteriorly: The triceps muscle, a small bursa intervening Medially: The ulnar nerve passes behind N the medial epicondyle and crosses the medial ligament of the joint. wrench so pulley shaped -> Shape Laterally: The common extensor tendon and the supinator. Stability of Elbow Joint The elbow joint is stable because of the wrench-shaped articular surface of the - olecranon and the pulley-shaped trochlea of the humerus; it also has strong medial and lateral ligaments. 1) Wrench N 2) pully 3) ligaments. 9 Clinical notes: Dislocation of elbow joint: Elbow dislocations are common, and most are posterior. follows falling on the outstretched hand. common in children because the parts of the bones that stabilize the joint are incompletely developed. level of radius andUna o anterior/ posteriordislocation a A proximal I :distal II9Y dislocation (1Is - E 10 joints este s Arthrocentesis of the Elbow Joint when the joint is distended with fluid, the posterior aspect of the joint becomes swollen. Aspiration of joint fluid can easily be performed through the back of the joint on either side of the olecranon process. 11  Proximal radioulnar joint Articulation: Between the circumference of the head of the radius and the anular ligament and Ju Ga the radial notch on the ulna. ↳ around head of radius + radial notch Type: Synovial pivot joint. of ulna ~Capsule: The capsule encloses the joint and is continuous with that of the elbow joint. Ligament: The anular ligament is attached to the anterior and posterior margins of theiradial notch on the ulna and forms a collar around the head of the - radius. It is continuous above with the capsule of the elbow joint. It is not attached to the radius. 12  line the capsule / Synovial membrane: This is continuous above with that of the elbow joint. Below it is attached to the inferior margin of the articular surface of the radius and the lower margin of the radial notch of the ulna. VNerve supply: Branches of the median, ulnar, musculocutaneous, and radial nerves. radial =@° notch ~Movements Pronation and supination of the forearm. Important Relations Anteriorly: Supinator muscle Posteriorly: Supinator muscle and the common extensor tendon 13  Distal Radioulnar Joint Articulation: Between the rounded head of the ulna and the ulnar notch on the radius. Type: Synovial pivot joint. Capsule: The capsule encloses the joint but is deficient superiorly. to allow pass of some vessles. Ligaments: Weak anterior and posterior ligaments strengthen the capsule. 14  - Articular disc: This is triangular and composed of fibrocartilage. It is attached by its apex to the lateral side of the base of the styloid process of the ulna and by its base to the lower border of the ulnar notch of the radius. It shuts off the distal radioulnar joint from the wrist and strongly unites the radius to the Tulna. i - Synovial membrane: This lines the capsule passing from the - edge of one articular surface to that of the other. 15 Nerve supply: Anterior interosseous nerve and the deep branch of the radial nerve. Movement: Pronation is performed by the pronator teres and the pronator quadratus. Supination is performed by the biceps brachii and the supinator. Supination is the more powerful of the two movements because of the strength of the biceps muscle. Important Relations Anteriorly: The tendons of flexor digitorum profundus Posteriorly: The tendon of extensor digiti minimi 16 17 - eis e g  Wrist Joint (Radiocarpal Joint) Articulation: Between the distal end of the radius and the articular disc above and the scaphoid, lunate, and triquetral bones below. The & proximal articular surface forms an ellipsoid concave surface, which is adapted to the ( distal ellipsoid convex surface. Type: Synovial ellipsoid joint. Capsule: The capsule encloses the joint and is attached above to the distal ends of the radius and ulna and below to the proximal row of carpal bones. 18 Ligaments: Anterior and posterior ligaments strengthen the capsule. The medial ligament is attached to the styloid process of the ulna and to the triquetral bone. The lateral ligament is attached to the styloid process of the radius and to the scaphoid bone. is: synovial joints sees". - easises e Synovial membrane: This lines the capsule and is attached to the margins of the articular surfaces. - The joint cavity does not communicate with that of the distal radioulnar joint or with the joint cavities of the intercarpal joints. Nerve supply: Anterior interosseous branch of the median nerve posterior interosseous branch of the radial nerve dorsal and deep branches of the ulnar nerve 19 Blood Supply of the Wrist Joint The articular arteries are derived from the dorsal and palmar carpal arterial arches. Movement: The following movements are possible: flexion, extension, abduction, adduction. Rotation is not possible because the articular surfaces are ellipsoid shaped. The lack of rotation is compensated for by the movements of pronation and supination of the forearm. Because the styloid process of the radius is longer than that of the ulna, abduction of the wrist / joint is less extensive than adduction. 20  Intercarpal Joint Articulation: Between the individual bones of the proximal row of the Carpus, between the individual bones of the distal row of the Carpus Type: synovial plane joint Capsule: the capsule surrounds each joint Ligaments: the bones are united by strong anterior , posterior and interosseous ligaments. - Synovial membrane: the joint cavity of the midcarpal joint Extends not only between the two rows of carpal bones but Also upward between the individual bones forming the proximal Row and downward. - I ·[ line the. capsule if of the join $1,0 5,5615. 21 Nerve supply: anterior interosseous nerve, deep branch of radial nerve and deep branch of the ulnar nerve. Movement: A small amount of gliding movement. (planejoint) 22 Midcarpal joint Articulation: Between the proximal and distal raws of the carpal bones Type: It is condyloid synovial joint Movements: flexion, extension, adduction, abduction and circumduction Intercarpal joints greatly increase the mobility of the hand u 23  Carpometacarpal & Intermetacarpal joints 88i - Type: plane synovial joints Movements: that permit a gliding movement. They share a common joint cavity with the intercarpal joints. - Ligaments: dorsal, palmar, and interosseous ligaments. The carpometacarpal joint of the little finger possessing the greatest range of motion The joint’s primary function is to optomize the grip function of the hand. ↳ palmar/ O S dra terona 24 Carpometacarpal joint of the thumb flexible more. Articulation: Between the trapezium and the saddle shaped base of the first metacarpal joint. Type: synovial saddle-shaped joint. Capsule: surrounds the joint Synovial membrane: lines the capsule and forms a separate joint cavity. 25 Movements: 85 X Flexion: flexor pollicis brevis and opponens pollicis Extension: : extensor pollicis longus and brevis. Abduction: abductor pollicis longus and brevis. Adduction: adductor pollicis Rotation (opposition): the thumb is rotated medially by the opponens pollicis. Nerve Supply of the Carpometacarpal Joint of the Thumb The articular nerves are derived from the anterior interosseous nerve, the posterior interosseous , and the dorsal and deep branches of the ulnar nerve. 26  Metacarpophalangeal Joint Articulation: between the heads of the metacarpal bones and the bases of the proximal phalanges. Type: synovial condyloid joint. Capsule: surrounds the joint. Ligaments: Palmar ligament: strong, fibrocartilage, firmly attached to the phalanx but less to the metacarpal bone. Deep transverse metacarpal ligament: units the palmar ligament of (2-5) joints. Collateral ligament: present at each side of the joints. Synovial membrane : lines the capsule and is attached to the margins of the articular surfaces Movements : Flexion-extension, abduction-adduction 27 and circumduction Interphalangeal joints Type: synovial hinge joints The capsules are thickened by palmar and collateral ligaments and completed posteriorly by the extensor tendon Movement: flexion and extension Nerve and blood supply: metacarpophalangeal and interphalangeal joints are supplied by adjacent nerves and vessels 28 Thank You 29