2.9.Joints of the upper limbs

Question 1

what forms a joint?

what attaches bone to bone?

joints in classes. list feature and associated subtypes

Answer 1

two bones articulating with eachother

ligaments

3classes

1. fibrous
   
   1. immovable bones are attached by dense connecrive tissue (fibrous tissue)
   2. types
      
      1. suture
      2. gomphosis
      3. syndesmosis
2. cartilaginous
   
   1. two bones are joined by cartilage
   2. two types
      
      1. primary(synchondrosis)
      2. secondary(symphysis)
3. synovial
   
   1. movment is restricted by muscles and ligaments
   2. three class of levers

Question 2

slide 3

Answer 2

1. fibrous tissue that connects bones together
2. a fold of peritoneum, or other membrane
3. the remnants of a tubular structure from the fetal period of life

Question 3

Describe immobile joints. list subtypes, facts and examples

Answer 3

1. immovable
   
   1. bones are attached by dense connective tissue
      
      1. fibrous tissue
2. three types of fibrous joints
   
   1. suture
      
      1. bones of skull
   2. gomphosis
      
      1. peg fits into socket
      2. example
         
         1. teeth
   3. syndesmosis
      
      1. joining of two bones by an interosseous membrane
      2. permits slight movement
      3. example
         
         1. interosseous membrane between tibia-fibia and radius-ulna

Question 4

define cartilagenous joints, structure, function and subtypes

Answer 4

1. cartilagenous joints
   
   1. struture
      
      1. two bones are joined by cartliage
   2. mobility
      
      1. more mobile than fibrous joints
   3. types
      
      1. primary(synchondrosis)
         
         1. bones are connected by hyaline cartilage
         2. example
            
            1. sternocostal joint
            2. fusion of long bones
      2. secondary (symphisis)
         
         1. fibrocartilaginous joints
         2. example
            
            1. pubic symphysis
            2. intervertebral disks

Question 5

define synovial joints, structure, function and types.

Answer 5

synovial joints

1. structure
   
   1. enclosed by a noint capsule, lines with synovial membrane
      
      1. secretes synovial fluid that lubricates an nouriches articulating surfaces
   2. free mobile joints
      
      1. movment is restricted by muscles and ligaments
   3. articular surface of bones
      
      1. coverd in hyaline cartilage
2. function
   
   1. all range of motion
   2. increase felxibility = incresase instability
3. types-add in examples
   
   1. plane
   2. saddle
   3. hinge
   4. ball and socket
   5. pivot
   6. condyloid
   7. ellipsoid

Question 6

bones act as ____, joints act as _________.

explain the orders

Answer 6

bones act as the lever, joints act as the folcrum.

1. 3 orders of levers based on
   
   1. fulcrum position, direction and position of effort exerted
   2. resistance is always in the direction of gravity
   3. class of levers
      
      1. ​first class
      2. second class
      3. third class

Question 7

joints of the upper limb

Answer 7

Question 8

what happens with the highly mobile upper limb? is there an expense

Answer 8

the upper limb is highly mobile for positioning the hand in space

1. increase mobility=decrease stability

Question 9

how do muscles act on joints?

muslces work ______ to create movement.

Answer 9

muscles act on joints they cross

1. muscle attachments and orientation of muscle fibers determine action of muscle

muslces work together to create movement.

1. agonis/antagonist
2. synergist

Question 10

what are the joints acting on the shoulder?

Answer 10

Question 11

describe the articulation, structure and motion of the sternoclavicular joint

Answer 11

1. sternoclavicular joint
   
   1. articulation
      
      1. manubrium of sternum
      2. clavicle
   2. structure
      
      1. synovial joint with an articular disc
      2. ligaments
         
         1. interclavicular ligament
         2. anterior and posterior sternoclavicular ligaments
         3. costoclavicular ligaments
      3. muscles
         
         1. none
   3. motions
      
      1. predominantly in the anteroposterior and vertical planes
      2. some rotation

Question 12

define the joint, articulation, structures, joint type and motions

Answer 12

1. acromioclavicular joint
   
   1. articulation
      
      1. acrominon process of the scapula
      2. clavicle
   2. structure
      
      1. synovial joint
      2. ligament
         
         1. acromioclavicular ligament
         2. coracoclavicular ligament
            
            1. trapezoid ligament
            2. conoid ligament
      3. muslces
         
         1. no muscle “crosses” the joint and acts on it
   3. motion
      
      1. anteroposterior and vertical planes
      2. some light axial rotation

Question 13

BMX rider presents in the ER with the following signs.

talk about the cause and grades

Answer 13

1. shoulder seperation
   
   1. cause
      
      1. injury to acromioclavivular and/or coracoclavicular ligaments
         
         1. weight of upper limb pulls scapula and acromion inferioly below clavicle
            
            1. clavicle overides acromion (piano key sign)
      2. ac moint is relatively weak to allow for mobility
         
         1. integrity/strength of joint predominantly from coracoclavicular ligament
   2. grades
      
      1. partially stretched AC ligament
         
         1. coracoclavicular ligaments intact
      2. torn AC ligament with some discplacement
         
         1. coracoclavicular ligaments intact
      3. copmlete seperation of joint. AC and coracoclavicular separation of joint.
         
         1. AC and coracoclavicular ligaments are torn
      4. 4-6
         
         1. very uncommon involving other joints

Question 14

Answer 14

Question 15

Answer 15

Question 16

define joint, list structures, structures, functions and location (for ligaments)

Answer 16

1. glenoid labrum
   
   1. structure
      
      1. fibrocartilaginous
      2. deepens glenoid cavity
   2. function
      
      1. creates vaccum effect
      2. w/o labrum
         
         1. glenohumeral stability decrease by 20%
2. capsule
   
   1. structure
      
      1. attaches from glenoid cavity to anatomical neck of humerus
   2. function
      
      1. least amount of support inferiorly
3. ligaments
   
   1. coracoacromial (CAL)
      
      1. ​location
      2. function
         
         1. helps resist upward displacment of the head of humerus
   2. coracohumeral (CHL)
      
      1. ​location
      2. function
         
         1. strengthens superior portion of capsule
         2. some support during should abduction
   3. transverse humeral ligament
      
      1. ​location
      2. function
         
         1. holds long head of biceps in the groove
   4. glenohumeral ligament
      
      1. location
         
         1. all 3 parts attach from upper margin of glenoid cavity
      2. function
         
         1. strengthen anterior portion of capsule

Question 17

Patient presents in er after wrestling match. what is the diagnosis, location, susceptibility, function and possible damage?

Answer 17

1. GH joint is most suseptible to dislocation in
   
   1. ABDUCTION AND EXTERNAL ROTATION
      
      1. this movement puts the head of the humerus inferior and anterior. There is nothing to stop the head of the humerus to stop it from exiting the cavity.
2. once out of the glenoid cavity, the strong pec major pulls the humerus anterosuperioly
   
   1. b/c of its position, the axillary nerve may be damaged

Question 18

define the movements and structures

Answer 18

Question 19

describe the thoraco-scapular joint articulatin, function

Answer 19

1. thoraco-scapular joint
   
   1. articulation
      
      1. posterior thoracic cage
         
         1. convex surface
      2. anterior scapula
         
         1. concabe surface
   2. function
      
      1. movment due to the superficial back muscles
         
         1. elevation/depression
         2. protaction/retraction
         3. upward/downward

Question 20

describe the photo

what is it AKA? describe pathopysioloby and signs/symptoms

Answer 20

snapping scapula aka:scapulathoracic bursitis/creptius

1. pathophysiology
   
   1. caused by bony alteration or inflamed soft tissue
   2. may be painful or painless
   3. can occur as a result of microtrauma(chronic) or macrotrauma(acute)
   4. often due to over-use injury worse with over-head movements
2. bursitis
   
   1. ​inflammation of fluid-filled sacs that cushion and reduce friction of bones, tendons, muscles
3. crepitus
   
   1. a grating sound/sensation produced by friction between bone and cartilge

Question 21

define the joints structures. note the epichodnyles and palpable bony features

Answer 21

1. epicondyles on humerus
   
   1. medial
      
      1. attachment for flexors
   2. lateral
      
      1. attachment for extensors
2. note palpable bony features
   
   1. radius
      
      1. head, body, dorsal tubrecle and styloid process
   2. ulna
      
      1. olecranon, posterior border, head, and styloid process of the ulna
   3. metacarpal bones and phalanges.

Question 22

Answer 22

Question 23

wht is this joint. describe the articulation, structure, ligaments, bursa, and important functions

Answer 23

elbow joint

1. joint
   
   1. hinge
2. articuation/structure
   
   1. medially
      
      1. formed by trochlea of humerus
      2. trochlear notch of the ulna
   2. laterally
      
      1. capitulum of the humerus
      2. head of the radius
   3. ligaments
      
      1. colateral ligaments
         
         1. ulnar colateral ligament medially
            
            1. aka: medial collateral ligament
         2. radial collateral ligament laterally
            
            1. aka:​lateral collateral ligament
            2. blends distally with the annular ligament of the radius
         3. bursa
            
            1. subtendinous olecranon
               
               1. bursa between the triceps tendon and olecranon
            2. subcutaneous olecranon bursa
               
               1. may become inflamed from repeated friction to produce bursitis (students elbow)
         4. joint capsule
3. function
   
   1. major support
      1.

Question 24

what is this image of?

Answer 24

students elbow-form of bursitis

1. subcutaneous olecranon bursa becomes inflamed from repeated friction to produce olecranon bursitis

Question 25

Answer 25

1. forearm positions/action
   
   1. action
      
      1. flexion/extension
      2. pronation/supination
   2. carrying angle
      
      1. seen with elbow extended and aupinated
      2. ~5-15 degree
         
         1. between the long axis of the humerus and that of the ulna
         2. slightly larger in females

Question 26

discuss this persons presentatin, % are what type? list cuase and complcations

Answer 26

1. elbow dislocation
   
   1. 90% are posterior dislocations
   2. cause
      
      1. fractures may occur in association with elbow dislocations
   3. complications
      
      1. nerovascular injuries (e.g. to the brachial artery or median nerve) may result

Question 27

discuss this jiont, structures, articulation, and give compromise

Answer 27

1. proximal radio-ulnar joint
   
   1. articulation
      
      1. the proper placement of the ulna and radius is established by this joint
   2. structures
      
      1. ligament
         
         1. annular ligament
            
            1. holds the head of readius in place
            2. attahes to the ulna at the anterior and posterior margins of the radial notch, encircling the head of the radius
   3. compromise
      
      1. subject to subluxation (where a connecting bone is partially out of the joint)
         
         1. nursmaids elbow

Question 28

What is the condition featured in this xray? discuss the deformity and the cause

Answer 28

1. nursemaids elbow
   
   1. ​​deformity
      
      1. radial head sublaxtion
      2. dislocation or subluxation of radial head from annular ligament
   2. cause
      
      1. common in young children when the child is suddenly lifted by the hand and the forearm is pronated

Question 29

discuss the structures, joint, articulation and supporting structures

Answer 29

distal radioulnar jiont

1. jiont
   
   1. pivot type of synovial joint
2. articulation
   
   1. ulnar notch of radius rotates around the head of the unla
3. supporting structures
   
   1. articular disc (trangular ligament)
      
      1. contents
         
         1. fibrocartilage
      2. function
         
         1. binds the ends of the ulna and radius together
      3. main support of distal radioulnar joint

Question 30

Answer 30

1. carpal bones
   
   1. proximal row
      
      1. scaphoid
      2. lunate
      3. triquetrum
      4. pisiform
   2. distal row
      
      1. trapeqium
      2. trapezoid
      3. capitate
      4. hamate
2. bones of the hand proper-formed by 5 metacarpal bones
   
   1. each has a
      
      1. base
         
         1. the proximal(carpal) end
      2. shaft
         
         1. curved longitudinally
      3. head-kmnuckle
3. phalanges
   
   1. digits 2-5
      
      1. each has
         
         1. 3 phalanges
            
            1. proximal
            2. middle
            3. distal
   2. thumb
      
      1. 2 phalanges
         
         1. proximal
         2. disatal

Question 31

list the joints of the hand state the location and structures

Answer 31

1. joints of the hand
   
   1. carpometacarpal joints(CM)
      
      1. location
         
         1. between the distal row of carpal bones and the metacarpal bones
      2. structure/function
         
         1. first CM joint
            
            1. is a saddle (sellar) joint permitting substantial movement in two direction
   2. metacarpophalangeal joints(MP)
      
      1. locatin
         
         1. between the metacarpal bones and bases of the proximal phalanges
      2. structure
         
         1. sesamoid bones at 1st and 2nd MP joints
         2. have a fibrous articular capsule
            
            1. strengthend medially and laterally by collateral ligaments
   3. proximal interphalangeal(PIP)
      
      1. loation
         
         1. between the proximal and middle phalanges
   4. distal interphalangeal(DIP)
      
      1. location
         
         1. between the middle and distal phalanges
   5. interphanageal joints
      
      1. are hinge jionts that allow only flexion and extension movements
      2. structure
         
         1. have a fibrous capsule that is strengthend on the medial and lateral sides by collateral ligaments

Question 32

what is the role of the retinaculum? finish

Answer 32

carpal tunnel syndrome

Question 33

describe the motions of the wrist

Answer 33

1. flexion/extension
2. adduction(ulnar deviation)
3. abduction(radial deviation)
4. circumduction-not rotation