Joints And Ligaments Of The Upper Limb Flashcards
These are the 4 Joints that make up the shoulder:
A. Glenohumeral joint
B. Acromioclavicular joint
C. Sternoclavicular joint
D. Scapulothoracic joint
It is the 💡main shoulder joint
It is formed where the ball of the humerus fits into a
shallow socket on the scapula called 💡GLENOID
💡Ball-and-socket joint in which 💡stability is sacrificed to obtain greater freedom of movement
💡Head of humerus (1/3 of a sphere) articulates with 💡shallow glenoid fossa of the scapula
Articular capsule is thin and loose
Muscle tendons contribute to joint stability
GLENOHUMERAL JOINT
Stability of the glenohumeral joint is maintained by:
o Thin,loose 💡joint capsule
o 💡Four ligaments coracohumeral, and 💡three glenohumeral
o 💡Tendon of the long head of biceps, which travels thru the intertubercular groove and secures the humerus to the glenoid cavity
o 💡Rotator cuff (four tendons) encircles the shoulder joint and blends with the articular capsule
GLENOHUMERAL RANGE OF MOTIONS
§ The shoulder can abduct, adduct, rotate, be raised in front of and behind the torso and move through a full 360 in the sagittal plane.
§ This tremendous range of motion also makes the shoulder extremely unstable, far more prone to dislocation and injury than other joints.
ACTION
Shoulder Flexion
Shoulder Extension
Shoulder Abduction
Shoulder Adduction
Shoulder Lateral Rotation
Shoulder Medial Rotation
GLENOHUMERAL RANGE OF MOTIONS
0-90°
0-50
0-180°
180-0°
0-90°
0-90°
ANTERIOR DISLOCATION OF GLENOHUMERAL JOINT
MECHANISM OF INJURY
Vulnerable position: level with the shoulder and bent back (like throwing a ball)
When the arm dislocates it falls forward and downward.
Types of dislocation (glenohumeral joint)
Subcoracoid
Subclavicular
Subglenoid
Intrathoracic
Treatments for glenohumeral dislocation:
Hippocratic maneuver
Stimson maneuver
Tractio/counter traction
Sling and swathe
Patient supine on table.
Examiner places 💡sole of the foot against px’s axillary fold for countertraction, grasps px’s wrist with both hands and applies steady longitudinal traction.
Hippocratic maneuver
Px prone on the table with affected limb 💡hanging freely over edge: 💡10-15lb weight suspended from wrist. Gradual traction overcomes muscle spasm and in most cases achieves reduction in 20-25 mins.
Stimson Maneuver
Clavicle meets the acromion
Joint at the top of the shoulder
Joint between the acromion and the clavicle
ACROMIOCLAVICULAR JOINT
FUNCTIONS OF ACROMIOCLAVICULAR JOINT
Allows the ability to raise the arm above the head
Functions as a 💡pivot point acting like a strut to help with movement of the scapula resulting in greater degree of arm rotation
THREE LIGAMENT THAT STABILIZED THE ACROMIOCLAVICULAR JOINT:
Acromioclavicular ligament–attaches the clavicle to the acromion of the scapula
Coracoacromial ligament – runs from the coracoid process to the acromion
Coracoclavicular ligament – attaches the clavicle to the coracoid process
• Made up of 2 ligaments:
1. Conoid
2. Trapezoid
TREATMENT FOR ACROMIOCLAVICULAR JOINT SEPARATION
Taping and sling
Surgical repair
It supports the connection of the 💡arms and shoulders to the main skeleton on the front of the chest
💡Synovial double-plane joint composed of two portions separated by an articular disc
Formed by the:
o Sternal end of the clavicle
o Clavicular notch of the manubrium sterni
o Cartilage of the first rib visible from the outside as the Suprasternal Notch
💡Only joint linking the bones of the arm & shoulder to the main part of the skeleton
STERNOCLAVICULAR JOINT
These are the 4 ligaments that hold the sternoclavicular joint:
Intra-articular disc ligament
Costoclavicular ligament
Interclavicular ligament
Capsular ligament
It is a ligament of the sternoclavicular joint that attaches to the 💡first rib and divides the joint into two separate spaces. It is 💡very thick and fibrous
Intra-articular disc ligament
It is a ligament of the sternoclavicular joint that is 💡short and strong. It attaches 💡underneath the clavicle to the first rib just below. It helps 💡steady the SC joint during certain motions
Costoclavicular ligament
It is a ligament of the sternoclavicular joint that supports the 💡end of both clavicle bones near the SC joint. It passes over the 💡top of the sternum, connecting one clavicle to the other.
Interclavicular ligament
It is a ligament of the sternoclavicular joint that 💡reinforces the capsule that surrounds the SC joint. It keeps the 💡sternum end of the clavicle from 💡pointing up as the other end of the clavicle drops down.
Capsular ligament
STERNOCLAVICULAR JOINT RANGE OF MOTION
§ Clavicle elevation/ depression
§ Clavicle protraction/ depression
§ Clavicle posterior rotation
💡Not a true joint, instead a 💡sliding joint between medial border of scapula and ribs 2-7
Function: 💡allow scapular motion against the rib cage
Resting position is angled anteriorly at 💡30° and an upward tilt of 3°
SCAPULOTHORACIC JOINT
SCAPULOTHORACIC JOINT RANGE OF MOTION
During shoulder abduction glenohumeral motion to scapulothoracic motion is 💡1:2 (ST does 60°, GH does 120°)
Position fixed primarily by scapular muscle attachment
Moving the superior border of the scapula and acromion in an 💡upward direction
ELEVATION
Moving the superior border of the scapula and acromion in a 💡downward direction
DEPRESSION
Glenoid fossa facing upwards with inferior angle of scapula 💡sliding laterally & anteriorly
UPWARD ROTATION
Glenoid fossa facing downwards with inferior angle of scapula 💡sliding medially and posteriorly
DOWNWARD ROTATION
Moving the scapula 💡away from the midline
PROTRACTION
Moving the scapula 💡toward midline
RETRACTION
Type: Synovial hinge joint
Location: 2-3 cm inferior to epicondyles of humerus
ELBOW JOINTS
Surfaces of elbow joints are covered
Hyaline cartilage
ARTICULATIONS of elbow joints
Humero-ulnar joint (hinge joint)
Humeroradial (bone and socket joint)
Articulation of an elbow joint between the
💡trochlea and 💡capitulum of the humerus and
💡trochlear notch of the ulna
Humero-ulnar joint (hinge joint)
Articulation of an elbow joint between the 💡capitulum
and 💡upper concavesurface of the radial head
Humeroradial (bone and socket joint)
LIGAMENTS THAT PROVIDE STABILITY IN ELBOW JOINT
RADIAL (LATERAL) COLLATERAL
LIGAMENT
ULNAR (MEDIAL) COLLATERAL
LIGAMENT
They provide stability 💡anteriorly and 💡posteriorly to the elbow joint
Tendons of biceps and triceps brachii
ELBOW STABILITY
Triangular in shape
Extends from 💡lateral epicondyle of humerus
and blends distally with 💡anular ligament
(head of radius)
💡Important lateral stabilize
💡Oppose varsus (medial) stresses
RADIAL (LATERAL) COLLATERAL
LIGAMENT
Also triangular
Broad fibrous band that runs from the
💡epicondyle to 💡coronoid and 💡olecranon of ulna
Provides 💡protection against Valgus (lateral)
processes of ulna.
ULNAR (MEDIAL) COLLATERAL
LIGAMENT
ELBOW RANGE OF MOTION
FLEXION: 0-150 degrees
EXTENSION: 150-10 degrees
PRONATION (inward) 0-90 degrees
SUPINATION (outward) 0-90 degrees
ELBOW RANGE OF MOTION
FLEXION: 0-150 degrees
Joint: 💡humero-ulnar
Muscles: 💡brachialis & biceps brachii (chief
flexors), brachioradialis, and pronator teres
muscles
limited by the anterior surfaces of the forearm
and arm coming into contact
ELBOW RANGE OF MOTION
EXTENSION: 150-10 degrees
Joint: 💡Humeroradial
Muscles: 💡triceps brachii (chief extensor) and
anconeus muscles
checked by the tension of the anterior
ligament and the brachialis muscle.
Carrying angle: angle where Long axis of FOREARM lies to the long axis of ARM (disappears when fully flexed) o Male: 170 degrees o Female: 167 degrees
ELBOW RANGE OF MOTION
SUPINATION (outward) 0-90 degrees
💡Proximal radio-ulnar joint (in conjugation with
associated movements of distal radio-ulnar
joint)
The 💡radius is the one that rotates
Supination: 💡supinator (absent resistance)
and 💡biceps brachii (w/ resistance)
Pronation: 💡pronator quadratus (primarily) and
💡pronator teres (secondarily)
💡Condyloid synovial joint between:
o distal end of the radius
o articular disc overlying the distal end of the ulna
o scaphoid, lunate, and triquetrum
Complex of eight carpal bones
💡Ulna does not participate as a bone rather there is
an 💡articulate disc lying between ulna and lunate
Articulating with the forearm via the wrist joint and
distally with the five metacarpals.
WRIST JOINTS
It is formed by
the 💡articular surfaces of the carpals which then
corresponds to the 💡concave surface of the radius
and articular disc.
Carpal arch (convex oval shape)
The 💡fibrous layer of the joint capsule is
strengthened by strong
Dorsal
Palmar
radiocarpal ligaments.
TWO IMPORTANT LIGAMENTS HOLDING
THE WRIST JOINTS IN PLACE:
They connect the forearm to the wrist, one on
each side of the wrist
ULNAR COLLATERAL LIGAMENT
RADIAL COLLATERAL LIGAMENT
💡Cord shaped
Crosses the 💡ulnar edge of the wrist starting from
the 💡ulnar styloid process where the ulna meets
the wrist joint to the triquetrum
2 parts of UCL
Connects to the 💡pisiform and to the 💡transverse carpal ligament (a thick band of tissue that
crosses in front of the wrist) and the other goes to 💡triquetrum
Adds support to a 💡small disc of cartilage where the ulna meets the wrist called 💡The triangular
fibro cartilage complex (TFCC)
ULNAR COLLATERAL LIGAMENT
It is a small disc of cartilage where the ulna meets the wrist
The triangular
fibro cartilage complex (TFCC)
strengthens joint capsule 💡laterally
attached to the 💡radial styloid process and
💡scaphoid
on the 💡thumb side of the wrist
starts on the 💡outer edge of the radius at the 💡radial styloid
connects to the side of the 💡scaphoid
Prevents the wrist from 💡bending too far to the side (away from the thumb)
RADIAL COLLATERAL LIGAMENT
WRIST JOINT ROM
Wrist flexion 0-90 Wrist extension 0-70 Wrist abduction 0-25 Wrist adduction 0-65 Circumduction of the hand consists of successive flexion, adduction, extension, and abduction.
CARPAL JOINTS
The synovial joints between the carpal bones share a common articular cavity
The joint capsule of the carpal joints is reinforced by
numerous ligaments.
o Intrinsic Ligaments: intra-articular intrinsic ligaments connect adjacent carpal bones
o Proximal Row scapholunate ligament lunotriqueral ligament o Distal Row trapeziotrapezoid ligament trapeziocapitate ligament capitohamate ligament o Palmar midcarpal scaphotrapeziotrapezoid scaphocapitate triquetralcapitate
Although movement at the carpal joints
(intercarpal joints) is 💡limited, they do
contribute to the 💡positioning of the hand in abduction, auction, flexion, and particularly,
extension.
True
There are 💡five carpometacarpal joints
between the metacarpals and the related
distal row of carpal bones.
True
Movements at this carpometacarpal joint are:
flexion,
extension, abduction, adduction, rotation, and
circumduction.
The carpometacarpal joints between 💡metacarpals
II to V and the 💡carpal bones are much less mobile
than the carpometacarpal joint of the 💡thumb,
allowing only limited 💡gliding movements.
True
Movement of the joints increases medially so
💡metacarpal V slides to the greatest degree.
True
It is the main 💡knuckle joints formed by the
connections of the phalanges to the
metacarpals.
It work like a hinge when you bend and
straighten your fingers and thumb.
METACARPOPHALANGEAL JOINTS
METACARPOPHALANGEAL JOINTS
STABILITY:
COLLATERAL LIGAMENTS**
VOLAR PLATE
A part of the joint capsule that attaches only
to the 💡proximal phalanx, allowing
💡hyperextension.
The 💡SITE OF INSERTION for the 💡INTERMETACARPAL LIGAMENTS.
VOLAR PLATE
These ligaments 💡restrict the separation of the metacarpal heads.
INTERMETACARPAL LIGAMENTS.
MCP JOINT RANGE OF MOTION:
MCP: Abduction 0-25
MCP: Adduction 20-0
MCP: Flexion 0-90
MCP: Extension 0-30
It 💡separates the three phalanges in each finger.
These are the 💡hinge type of synovial joint that permit:
o 💡FLEXION EXTENSION only
o The heads of the phalanges articulate with the bases of more distally located
phalanges in the IP joints.
INTERPHALANGEAL JOINTS
It is the closest to the MCP joint.
PROXIMAL IP POINT or PIP POINT
It is the joint near the end of the finger.
DISTAL IP POINT OR DIP POINT
INTERPHALANGEAL JOINTS STABILITY:
COLLATERAL LIGAMENTS**
VOLAR PLATE
It is the 💡strongest ligament in the PIP joint.
It connects the Proximal phalanx to the Middle phalanx on the palm side of the joint.
Tightens as the joint is straightened
Keeps the joint from hyperextending
VOLAR PLATE
ICP JOINTS RANGE OF MOTION:
INTERPHALANGEAL PROXIMAL (PIP)
Joints of Fingers:
Flexion: 0-120
Extension: 120-0
INTERPHALANGEAL DISTAL (DIP) Joints
of Fingers:
o Flexion: 0-80
o Extension: 80-0
