Joints of the Upper Limb: Shoulder and Elbow Flashcards
1
Q
classification of joints (4)
A
solid
-fibrous
-cartilagenous
synovial
2
Q
fibrous (3)
A
sutures
syndesmoses
gomphoses
3
Q
cartilaginous (2)
A
synchondroses
symphyses
4
Q
synovial (4)
A
joint capsule
hyaline cartilage
some have articular disc
typically very mobile
5
Q
joint capsule (2)
A
inner synovial membrane
outer fibrous capsule
6
Q
most joints are — joints
A
synovial
7
Q
Synarthrosis =
A
no movement
8
Q
Amphiarthrosis =
A
little movement
9
Q
Diarthrosis =
A
a lot of movement
i.e. most synovial joints
10
Q
movements at synovial joints (4)
A
nonaxial
uniaxial
biaxial
multiaxial
11
Q
nonaxial =
A
no axis of moment (gliding)
12
Q
uniaxial =
A
single axis of movement (hinge)
13
Q
biaxial =
A
2 axes of movement
14
Q
multiaxial =
A
> 2 axes of movement
15
Q
what does the double saddle joint refer to
A
sternoclavicular
16
Q
another term for “saddle joint” is “—
joint”
A
sellar
17
Q
the pectoral girdle (shoulder girdle) includes (2)
A
the scapula and clavicle only
18
Q
sternoclavicular joint (3)
A
• synovial joint
• double saddle (also called
“shallow saddle”)*
• 2 separate synovial cavities
19
Q
The only “true” boney articulation between upper limb & thorax
A
Sternoclavicular Joint
20
Q
sternoclavicular joint is a — joint
A
multiaxial
21
Q
function of the sternoclavicular joint (3)
A
elevation/depression (clavicle and disc)
protraction/retraction (clavicle and sternum)
rotation (both)
22
Q
dislocation of the sternoclavicular joint rarely occur because
A
this is such a strong joint
23
Q
Direction of force transmission through the clavicle also prevents —
A
fracture
24
Q
Forces are usually transmitted along the length of
A
the clavicle, such that the clavicle may fracture, but dislocation of the SC joint typically does
not occur
25
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
26
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
27
Ankylosis of the Sternoclavicular Joint results in (3)
Stiffening, fixation, or fusion of the SC joint.
28
Ankylosis of the Sternoclavicular Joint is associated with --- conditions
arthritic
29
with Ankylosis of the Sternoclavicular Joint, --- mobility is limited
shoulder
30
SAPHO syndrome
an inflammatory disorder that may include synovitis,
| acne, pustulosis, hyperostosis, and osteitis
31
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
32
Acromioclavicular Joint (2)
* synovial joint
| * plane joint
33
supporting or accessory ligaments of the acromiclavicular joint
coracoclavicular ligaments
34
Acromiocclavicular ligament
| has 2 parts:
•superior acromioclavicular
ligament
• inferior acromioclavicular
ligament
35
coracoclavicular ligaments (2)
* conoid ligament
| * trapezoid ligament
36
Grade 1 separated shoulder:
acromioclavicular ligament
| sprain
37
Grade 2 separated shoulder:
acromioclavicular ligament
| tear
38
Grade 3 separated shoulder:
both acromioclavicular and
coracoclavicular ligaments
are torn
39
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
40
Synovial Capsule of Glenohumeral Joint is ---, but very ---
weak
| mobile
41
Synovial Capsule of Glenohumeral Joint is reinforced by tendons of the
rotator cuff muscles
42
Synovial Capsule of Glenohumeral Joint: long tendon of --- --- pierces the
capsule and attaches to
biceps brachii
| supraglenoid tubercle of scapula and glenoid labrum
43
capsular ligaments of glenohmeral joint (2)
glenohumeral ligaments
| coracohumeral
44
glenohumeral ligaments (3)
superior
middle
inferior
45
Bursa
```
“pillows” of
synovial fluid between
muscle and joint capsule
and/or bone and joint
capsule
```
46
bursas (4)
1. subscapular bursa
2. subacromial bursa
(subdeltoid bursa)
3. subcoracoid bursa
4. synovial sheath
(long biceps tendon)
47
Rotator Cuff Muscles tendons reinforce and strengthen
glenohumeral joint
48
Injury to the rotator cuff muscles can
| affect
glenohumeral joint stability
49
Dislocation of the Glenohumeral Joint: freely ---, but relatively --- joint
movile
| unstable
50
glenohumeral joint is commonly ----
dislocated
51
Most dislocations occur in the --- direction (but are described as ---)
downward (inferior)
| anterior
52
The --- structures and the rotator
| cuff tend to prevent upward dislocation
coracoacromial
53
--- dislocations are more rare
Posterior
54
Anterior dislocations occur most often in
young adults, especially athletes
55
Hyperextension with --- rotation
lateral
56
Humeral head is forced in an ---
| direction
infero-anterior
57
Fibrous layer of joint capsule and glenoid
| labrum may ---
tear
58
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.
59
Chronic inflammation in the glenohumeral joint can lead to fibrosis between the
(3)
joint capsule, rotator cuff muscles and synovial bursa
60
Adhesive Capsulitis of the Glenohumeral Joint is also called
"frozen shouldeR:
61
Adhesive Capsulitis of the Glenohumeral Joint is seen in individuals age
40-60
62
Adhesive Capsulitis of the Glenohumeral Joint: --- affected; compensatory scapular movements
Abduction
63
Acromioclavicular joint may become ---
strained
64
May be initiated by (4)
glenohumeral dislocation, supraspinatus tendinitis, bicipital
tendinitis and/or rotator cuff tears
65
The elbow joint consists of 3 separate articulations:
1. humeroulnar articulation
2. humeroradial articulation
3. proximal radioulnar articulation
66
Biceps
Brachialis &
Brachialis
= Flexors
67
Several ligaments around the elbow joint reinforce these articulations
HUMEROULNAR/HUMERORADIAL ARTICULATIONS: (2)
1. medial (ulnar) collateral ligaments
| 2. lateral (radial) collateral ligaments
68
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
69
Subluxation and Dislocation of Radial Head is also known as
"nursemaids elbow"
70
Subluxation and Dislocation of Radial Head: --- age children tend to be vulnerable
preschool
71
Subluxation and Dislocation of Radial Head happens in preschool age children by
children suddenly lifted by their upper limb in a. jerking motion
72
Subluxation and Dislocation of Radial Head:
```
Distal attachment of
annular ligament
becomes torn and radial
head becomes
dislocated
```
73
Lateral Epicondylitis is also known as
"tennis elbow"
74
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)
75
Lateral Epicondylitis occurs due to
repetitive motion injury
76
“Colles” fracture
complete transverse fracture of the distal 2cm of the radius
77
Radius Fractures is common in
adults >50
78
Radius Fractures: distal fragment is displaced ---
dorsally
79
Radius Fractures results from forced extension of
hand on outstretched limb while breaking fall
80
radius fractures are so known as --- --- deformity
"dinner fork"
81
Carpals (wrist): - bones
8
82
Metacarpals (hand) - bones
5
83
```
Phalanges (fingers)
• - bones
• - digits
• each has - segments
• but thumb has only -
```
14
5
3
2
84
Flexion: 40% occurs at --- joint, 60% occurs at --- joint
radiocarpal
| midcarpal
85
Extension: 33% occurs at --- joint, 67% occurs at --- joint
midcarpal
| radiocarpal
86
Radial Deviation =
Abduction (15-25o)
87
Ulnar Deviation =
Adduction (30-45o)
88
Abduction & Adduction mainly occurs at --- joints
midcarpal
89
collateral ligaments (3)
* radial
* ulnar
* phalangeal
90
transverse carpal ligament
Reinforces
carpals and forms
roof of carpal
tunnel
91
metacarpal ligaments
Bind metacarpal
| bones together
92
carpometacarpal ligaments
Bind carpals to
| metacarpals
93
palmar ligaments
```
Bind
metacarpals to
proximal
phalangeal
segments
```
94
intermetacarpal ligaments
Bind metacarpal
| bones together
95
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
