Upper extremity joints Flashcards
shoulder complex
Four articulations involving
sternum, clavicle, ribs, scapula, and humerus
Sternoclavicular joint
Saddle type synovial joint
Functions as a ball and socket
Articular disc connecting medial end of clavicle to the first costal cartilage and sternum
Thickening of the fibrous capsule form the anterior and posterior sternoclavicular ligaments
Costcoclavicular ligament
First rib and it’s costal cartilage to the anterior margin of the medial end of the clavicle
bloos supply of the sternoclavicular
Internal thoracic and suprascapular arteries
nerve supply of a sternoclavicular joint
Branches of medial supraclavicular nerve (C3,C4)
Nerve to subclavius (C5, C6)
sternoclavicular joint injuries
Less than 5% of shoulder girdle injuries are SC joint fractures, or dislocations
more common in children and adolescents
High energy mechanisms
Most cases involve the medial and the clavicle displaced anteriorly
Most treated non-operatively
Acromioclavicular joint
Plane synovial joint
Junction of lateral end of clavicle to the acromion process of Scapula
Coracoclavicular ligament
Strengthens lateral end of the clavicle by attaching to clavicle
Two parts trapezoid, and conoid
blood supply of acromioclavicular joint
Suprascapular and thoracoacromial arteries
nerve supply of acromioclavicular joint
Lateral pectoral and axillary nerves
scapular dyskinesia
alteration in the normal position or motion of Sscapula during couple scapulohumeral movements
Present and 68 to 100% of shoulder injuries
Clinicians, observe, scapular, motion, and congruence during self-directed upper extremity movements
Scapular dyskinesia Kibler types
type 1- inferior angle prominence
Type 2- medial border prominence
Type 3- superior border prominence
Type 4- symmetrical normal
Scapulothoracic joint
not a true synovial joint
Muscular joint between convex surface of posterior thoracic cage, and concave surface of anterior Scapula
Glenohumeral joint
ball and socket synovial joint
Head of humerus and glenoid fossa
Both surface is covered by hyaline cartilage
Glenoid labrum deepens shallow socket of glenoid fossa for better fit
Superior portion of labrum blends with the tendon of long head of biceps brachii
slap tear
Superior labrum anterior to posterior tear
May occur due to
motor vehicle accident
Fall on outstretched arm
Forceful pull on arm
Rapid or forceful movement of arm
Shoulder dislocation
Glenohumeral joint capsule
fibrous capsule thing and loose allowing for wide ROM
lined by synovial membrane
extension of capsule from versa about the shoulder
intrinsic ligaments of the GH joint
Glenohumeral ligaments
transverse humeral ligament
Coracohumoral ligament
Glenohumeral ligaments
Three fibrous bands found only on the internal aspect of the capsule
They radiate laterally from the supraglenoid tubercle into three bands, superior, middle and inferior
They function to strengthen the anterior capsule of the joint
transverse humeral ligament
Attaches from the greater to lesser tubercle, converting the groove into a canal
Maintains the position of the long head of the biceps tendon in the bicipital groove, and the synovial sheath
coracohumeral ligament
extending from the base of the coracoid to the anatomical neck of the humerus
Functions to strengthen the superior part of the capsule
Coracoacromial ligament
Extrinsic ligament
Spans from the coracoid process to the acromion process
Helps form the coracoacromial arch which protects the humerus from superior displacement
Acromion, coracoid, and coracoacromial ligament form the arch
Subscapular bursa
located between subscapularis tendon and the neck of the scapula
Extension of the synovial capsule
subtendinois bursa
Extension of the synovial capsule under the transverse humoral ligament for protection of the long head of the biceps brachii tendon
Subacromial bursa
between acromion and supraspinatus tendon
Extends between deltoid, and the proximal end of the humerus to form the subdeltoid bursa
Glenohumeral joint blood supply
Anterior and posterior circumflex, arteries and branches from the suprascapular artery
Glenohumeral nerve supply
Suprascapular, lateral pectoral and axillary nerve supply the glenohumeral joint
painful arc for acromioclavicular
170° to an 180
Painful arc for Glenohumeral
45-60 to 120
Scapulohumeral rhythm
After 30° of abduction rhythm is remarkably constant at 2:1 ratio
every 3° of shoulder abduction…
2° comes from a Glenohumeral abduction and 1° comes from ST upward rotation
kinematic principles of Scapulohumeral abduction
- 2:1 ratio of GH to ST motion
- 60° of ST upward rotation result from simultaneous elevation of the clavicle at the SC joint, combine with the upward rotation of the scapula at the AC joint
- clavicle retracts at SC joint during full SH abduction about 15°.
- Sscapula posteriorly tells about 20° and externally rotate about 10°.
- Clavicle, rotates, posteriorly around long axis.
- humerus naturally externally rotate during SH abduction.
Long head of the biceps attaches to
Superior part of labrum and may contribute to slap lesions
elbow joint
Complex joint that involves three articulations collectively known as cubital articulation
Humeroulnar, humeroradial
2 hinge joints
proximal radioulnar
pivot joint
intrinsic ligaments of the elbow joint
Consist of collateral ligaments on the medial and lateral sides that are thickening of the fibrous capsule
Ulnar collateral
radial collateral
Ulnar collateral ligament
anterior posterior and oblique
These three bands extend from the medial epicondyle to the coronoid and olecranon processes
Anterior band is the strongest
Posterior is the weakest
Oblique band deepens the socket for the trochlea of the humerus
Radial collateral
Extends from the lateral epicondyle to the annular ligament
annular ligament
Thickening of the capsule of the proximal radioulnar joint, which encircles and holds the head of the radius in the radial notch of the ulna
Allows for pronation and supination with dislocation
subcutaneous olecranon bursa
Between the skin and the olecranon
subtendinous olecranon bursae
Between the tricep tendon and olecranon
intratendinous olecranon bursa
Sometimes present in tendon of the triceps brachii
Radioulnar bursae
Between extensor digitorum, radiohumeral joint, and the supinator muscle
bicipitoradial bursae
between the biceps tendon, and the anterior part of the radial tuberosity
blood supply of the elbow joint
Anastomosis around the joint
Nerve supply of the elbow joint
Musculotaneous, radial and ulnar nerves
hinge joint action joints
Humeroradial
Humeroulnar
Flexion and extension
normal carrying angle
Females: 10 to 15°
Males : 5 to 10°
cubitus valgas
Greater than 15°
Cubitus varus
less than 5°
Gunstock
Radiocarpal joint involves
Distal end of the radius
Scaphoid
Lunate
TFCC
main function of TFCC
Separate joint cavities of the Radiocarpal and distal radioulnar joints
Proximal radioulnar joint
Head of the radius articulates with the radial notch of the ulna
radius is held in place by the strong annular ligament
Ligament is lined with synovial membrane to decrease fiction build up and prevent disruption of the capsule
proximal radioulnar, joint movements
Head of the radius rotates from within the annual ring created by the ligament
Rotation allows for supination and pronation of the hand
Blood supply of the proximal radioulnar joint
Anterior and posterior interosseous arteries
Innervation of the proximal radioulnar joint
Musculocutaneous
Radial
Median
Distal radioulnar joint
pivot joint with radius, moving around the relatively fixed distal end of the ulna
Fibrocartilaginous Articular disc which binds the radius to the ulna, and is sometimes referred to as the triangular fibrocartilage complex (TFCC)
Blood supply of distal radioulnar joint
Anterior and posterior interosseous arteries
innervation of distal radioulnar joint
Anterior and posterior interosseous nerve
triarticular forearm complex
consist of proximal middle and distal radioulnar joint
Radiocarpal joint
Condyloid synovial joint
Fibrous capsule surrounding the joint and attaching to the distal end of the radius and ulna, and the proximal row of carpal bones
Lined synovial membrane
Intrinsic ligaments of radiocarpal joint
Palmar Radiocarpal ligament
Dorsal Radiocarpal lig
Ulnar collateral ligament
Radial collateral ligament
Palmar Radiocarpal ligament
Extend from the radius to the two rows of carpal bones
These strong ligaments support that joint and direct the hand to follow the radius during supination of the forearm
dorsal radiocarpal ligament
dorsal surface and provide similar function as the Palmar ligaments
Ulnar collateral ligament
Attached at the ulnar styloid process and extends to triquetrum strengthening the medial aspect of the capsule
Radial collateral ligament
Attaches to the radial styloid process and the scaphoid
Strengthening the lateral aspect of the joint capsule
The articular disc of the distal radioulnar joint intervenes between
The head of the ulna and the carpals
blood supply of the radiocarpal joint
Dorsal and Palmar arches
innervation of Radiocarpal joint
Anterior interosseous nerve
Posterior interosseous nerve
Ulnar nerve
kinematics of radiocarpal joint sagittal plane
Sagittal plane motion
Best appreciated by seeing the rest as an articulated Central column
Formed by linkages between
Distal radius
lunate
Capitate
Third metacarpal
Kinematics of radiocarpal joint frontal plane
ulnar and radial deviation
Synchronous convex on concave rotations at Radiocarpal and midcarpal joints
