Joints of the Upper Limb: Shoulder and Elbow Flashcards
classification of joints (4)
solid
-fibrous
-cartilagenous
synovial
fibrous (3)
sutures
syndesmoses
gomphoses
cartilaginous (2)
synchondroses
symphyses
synovial (4)
joint capsule
hyaline cartilage
some have articular disc
typically very mobile
joint capsule (2)
inner synovial membrane
outer fibrous capsule
most joints are — joints
synovial
Synarthrosis =
no movement
Amphiarthrosis =
little movement
Diarthrosis =
a lot of movement
i.e. most synovial joints
movements at synovial joints (4)
nonaxial
uniaxial
biaxial
multiaxial
nonaxial =
no axis of moment (gliding)
uniaxial =
single axis of movement (hinge)
biaxial =
2 axes of movement
multiaxial =
> 2 axes of movement
what does the double saddle joint refer to
sternoclavicular
another term for “saddle joint” is “—
joint”
sellar
the pectoral girdle (shoulder girdle) includes (2)
the scapula and clavicle only
sternoclavicular joint (3)
• synovial joint
• double saddle (also called
“shallow saddle”)*
• 2 separate synovial cavities
The only “true” boney articulation between upper limb & thorax
Sternoclavicular Joint
sternoclavicular joint is a — joint
multiaxial
function of the sternoclavicular joint (3)
elevation/depression (clavicle and disc)
protraction/retraction (clavicle and sternum)
rotation (both)
dislocation of the sternoclavicular joint rarely occur because
this is such a strong joint
Direction of force transmission through the clavicle also prevents —
fracture
Forces are usually transmitted along the length of
the clavicle, such that the clavicle may fracture, but dislocation of the SC joint typically does
not occur
Most SC dislocations are the result of —- in individuals >— years of age
fractures through the epiphyseal plate at the sternal end of the clavicle
25
A 41-year-old, right-handed male farmer was struck in the chest by a charging bull
that forced him to the ground and trampled on him. He presented with complaints
of pain localized to the right sternoclavicular area, intermittent right upper
extremity paresthesias, and occasional subjective feelings of shortness of breath.
He denied hand, wrist or elbow weakness and had no difficulty swallowing. On
clinical examination he had a “stooped” posture with protraction of his right
scapula. There was bruising over the right sternoclavicular joint, with obvious local
deformity. The range of motion of his right arm was markedly limited secondary to
pain. What does the 3 dimensional CT scan below suggest is the cause of his
physical distress?
Right sternoclavicular dislocation
Ankylosis of the Sternoclavicular Joint results in (3)
Stiffening, fixation, or fusion of the SC joint.
Ankylosis of the Sternoclavicular Joint is associated with — conditions
arthritic
with Ankylosis of the Sternoclavicular Joint, — mobility is limited
shoulder
SAPHO syndrome
an inflammatory disorder that may include synovitis,
acne, pustulosis, hyperostosis, and osteitis
A 35 year-old woman crashes her bicycle into a tree when she rides off a rocky
ledge while participating in a mountain bike race. She landed on her left arm and
sustained a fractured olecranon. In addition, she complained of pain when trying
to move her left shoulder and there was a rather prominent lump with swelling
and edema over the superior aspect of her left shoulder. What additional injury
has she likely sustained?
Right shoulder separation
Acromioclavicular Joint (2)
- synovial joint
* plane joint
supporting or accessory ligaments of the acromiclavicular joint
coracoclavicular ligaments
Acromiocclavicular ligament
has 2 parts:
•superior acromioclavicular
ligament
• inferior acromioclavicular
ligament
coracoclavicular ligaments (2)
- conoid ligament
* trapezoid ligament
Grade 1 separated shoulder:
acromioclavicular ligament
sprain
Grade 2 separated shoulder:
acromioclavicular ligament
tear
Grade 3 separated shoulder:
both acromioclavicular and
coracoclavicular ligaments
are torn
A 35 year old woman robs a local grocery store and flees on foot, pursued
by the store owner. Before law enforcement arrives and catches up to
them, the store owner manages to subdue the woman. The store owner
grabs the woman by both of her arms and pulls them behind her, such that
her arms are extended behind her back and laterally rotated. She winces
in pain as her left shoulder becomes dislocated. Which of the following
nerves has likely been injured?
Axillary
Synovial Capsule of Glenohumeral Joint is —, but very —
weak
mobile
Synovial Capsule of Glenohumeral Joint is reinforced by tendons of the
rotator cuff muscles
Synovial Capsule of Glenohumeral Joint: long tendon of — — pierces the
capsule and attaches to
biceps brachii
supraglenoid tubercle of scapula and glenoid labrum
capsular ligaments of glenohmeral joint (2)
glenohumeral ligaments
coracohumeral
glenohumeral ligaments (3)
superior
middle
inferior
Bursa
“pillows” of synovial fluid between muscle and joint capsule and/or bone and joint capsule
bursas (4)
- subscapular bursa
- subacromial bursa
(subdeltoid bursa) - subcoracoid bursa
- synovial sheath
(long biceps tendon)
Rotator Cuff Muscles tendons reinforce and strengthen
glenohumeral joint
Injury to the rotator cuff muscles can
affect
glenohumeral joint stability
Dislocation of the Glenohumeral Joint: freely —, but relatively — joint
movile
unstable
glenohumeral joint is commonly —-
dislocated
Most dislocations occur in the — direction (but are described as —)
downward (inferior)
anterior
The — structures and the rotator
cuff tend to prevent upward dislocation
coracoacromial
— dislocations are more rare
Posterior
Anterior dislocations occur most often in
young adults, especially athletes
Hyperextension with — rotation
lateral
Humeral head is forced in an —
direction
infero-anterior
Fibrous layer of joint capsule and glenoid
labrum may —
tear
Anterior disclocation from a hard low to the humerus while fully abducted (2)
• Tilts humeral head inferiorly and pushes it
through the weaker part of the joint capsule
• Joint capsule may tear and such that the
humeral head is positioned inferior to the
glenoid cavity and anterior to the infraglenoid
tubercle.
Chronic inflammation in the glenohumeral joint can lead to fibrosis between the
(3)
joint capsule, rotator cuff muscles and synovial bursa
Adhesive Capsulitis of the Glenohumeral Joint is also called
“frozen shouldeR:
Adhesive Capsulitis of the Glenohumeral Joint is seen in individuals age
40-60
Adhesive Capsulitis of the Glenohumeral Joint: — affected; compensatory scapular movements
Abduction
Acromioclavicular joint may become —
strained
May be initiated by (4)
glenohumeral dislocation, supraspinatus tendinitis, bicipital
tendinitis and/or rotator cuff tears
The elbow joint consists of 3 separate articulations:
- humeroulnar articulation
- humeroradial articulation
- proximal radioulnar articulation
Biceps
Brachialis &
Brachialis
= Flexors
Several ligaments around the elbow joint reinforce these articulations
HUMEROULNAR/HUMERORADIAL ARTICULATIONS: (2)
- medial (ulnar) collateral ligaments
2. lateral (radial) collateral ligaments
A 4 year-old girl presents in the ED with a painful right arm. She refuses
to move her arm and holds it close to her body. There is no evident
swelling or bruising. Her parents report that earlier that day they had been
visiting a local city festival. At one point while crossing a busy street, the
girl started forward into a crosswalk and the mother quickly grabbed the
girl by the right hand and pulled her back, fearing that a car was coming.
What is the likely diagnosis?
Subluxation of the radial head
Subluxation and Dislocation of Radial Head is also known as
“nursemaids elbow”
Subluxation and Dislocation of Radial Head: — age children tend to be vulnerable
preschool
Subluxation and Dislocation of Radial Head happens in preschool age children by
children suddenly lifted by their upper limb in a. jerking motion
Subluxation and Dislocation of Radial Head:
Distal attachment of annular ligament becomes torn and radial head becomes dislocated
Lateral Epicondylitis is also known as
“tennis elbow”
Lateral Epicondylitis
tendons of forearm extensors become inflammed and/or torn at their lateral epicondylar
attachment (in particular the tendon of extensor carpi radialis brevis)
Lateral Epicondylitis occurs due to
repetitive motion injury
“Colles” fracture
complete transverse fracture of the distal 2cm of the radius
Radius Fractures is common in
adults >50
Radius Fractures: distal fragment is displaced —
dorsally
Radius Fractures results from forced extension of
hand on outstretched limb while breaking fall
radius fractures are so known as — — deformity
“dinner fork”
Carpals (wrist): - bones
8
Metacarpals (hand) - bones
5
Phalanges (fingers) • - bones • - digits • each has - segments • but thumb has only -
14
5
3
2
Flexion: 40% occurs at — joint, 60% occurs at — joint
radiocarpal
midcarpal
Extension: 33% occurs at — joint, 67% occurs at — joint
midcarpal
radiocarpal
Radial Deviation =
Abduction (15-25o)
Ulnar Deviation =
Adduction (30-45o)
Abduction & Adduction mainly occurs at — joints
midcarpal
collateral ligaments (3)
- radial
- ulnar
- phalangeal
transverse carpal ligament
Reinforces
carpals and forms
roof of carpal
tunnel
metacarpal ligaments
Bind metacarpal
bones together
carpometacarpal ligaments
Bind carpals to
metacarpals
palmar ligaments
Bind metacarpals to proximal phalangeal segments
intermetacarpal ligaments
Bind metacarpal
bones together
Some of the ligaments of the hand and wrist
contribute to the formation
of
spaces within the wrist &
hand, through which tendons,
nerves, and arteries must pass
