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6. MSK > Upper Limb Joints > Flashcards

Upper Limb Joints Flashcards

1
Q

What type of joint is the acromioclavicular joint?

A

A plane type synovial joint.

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2
Q

Where is the acromioclavicular joint?

A

Where the lateral end of the clavicle articulates with the acromion of the scapula. 2-3cm medially from the tip of the shoulder when palpating.

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3
Q

What is the articulation in the acromioclavicular joint?

A

Lateral end of clavicle and acromion of the scapula.

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4
Q

What is different about the articulating surfaces of the acromioclavicular?

A

The surfaces of the joint are lined with fibrocartilage (not hyaline cartilage), the joint cavity is partially divided by an articular disc, a wedge of fibrocartilage suspended from the upper part of the capsule.

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5
Q

What is the joint capsule of the acromioclavicular joint?

A

Loose fibrous layer which encloses the two articular surfaces, give rise to the articular disc. The posterior aspect of the joint capsule is reinforced by fibres from the trapezius muscle. Internally lined by synovial membrane that secretes synovial fluid.

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6
Q

What are the three ligaments in the acromioclavicular joint?

A

Acromioclavicular - runs horizontally from acromion to lateral clavicle, cover joint capsule, reinforcing its superior aspect.
Conoid - runs vertically from the coracoid process of the scapula to the conoid tubercle of the clavicle.
Trapezoid - runs from the coracoid process of the scapula to the trapezoid line of the clavicle.
Conoid and trapezoid together are the coracoclavicular ligament.

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7
Q

What are the movements permitted by the acromioclavicular joint?

A

A degree of axial rotation and anteroposterior movement.

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8
Q

What is the arterial supply to the acromioclavicular joint?

A

Suprascapular artery - arises from the subclavian artery at the thyrocervical trunk.
Thoraco-acromial artery - arises from the axillary artery.

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9
Q

What is the acromioclavicular joint innervated by?

A

Articular branches of suprascapular and lateral pectoral nerves, arise from the brachial plexus.

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10
Q

When does dislocation of the acromioclavicular joint occur?

A

From a direct blow to the joint or falling on an outstretched hand.

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11
Q

What does a more prominent clavicle suggest about the acromioclavicular joint?

A

There has been a dislocation and a ligamental rupture, torn coracoclavicular ligament so the weight of the upper limb is not supported and the shoulder moves inferiorly.

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12
Q

How is acromioclavicular joint dislocation managed?

A

Ice and rest to ligament reconstruction surgery depending on severity of dislocation.

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13
Q

What type of joint is the sternoclavicular joint?

A

A addle type synovial joint.

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14
Q

What does the sternoclavicular joint consist of?

A

The sternal edge of the clavicle, the manubrim of the sternum, and part of the 1st costal cartilage.

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15
Q

What are the articulating surface of the sternoclavicular joint covered by?

A

Fibrocartilage, separated into two compartments by fibrocartilaginous articular disc.

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16
Q

What does the joint capsule of the sternoclavicular joint consist of?

A

A fibrous outer layer, and inner synovial membrane. The fibrous layer extends from the epiphysis of the sternal end of the clavicle, to the borders of the articular surfaces and the articular disc. The synovial membrane lines the inner surface and produces synovial fluid to reduce friction between the articulating structures.

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17
Q

What are the major ligaments of the sternoclavicular joint?

A 
Sternoclavicular ligaments (anterior and posterior) - strengthen the joint capsule anteriorly and posteriorly.
Interclavicular ligament - spans the gap between sternal ends of each clavicle and reinforces joint capsule superiorly.
Costoclavicular ligament - two parts are separated by bursa and bind at the 1st rib and cartilage inferiorly and to the anterior and posterior borders of the clavicle superiorly. Main stabilising force for the joint, resisting elevation of the pectoral girdle.
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18
Q

What is the arterial supply to the sternoclavicular joint?

A

Internal thoracic artery and suprascapular artery.

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19
Q

What is the sternoclavicular joint innervated by?

A

Medial supraclavicular nerve (C3, C4) and nerve to subclavius (C5, C6).

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20
Q

What are the movements possible at the sternoclavicular joint?

A

Elevation of the shoulders, shrugging the shoulders or abducting the arm over 90 degrees.
Depression of the shoulders, drooping shoulders, or extending the arm at the shoulder behind the body.
Protraction fo the shoulders, moving the shoulder girdle anteriorly.
Retraction of the shoulders, moving the shoulder girdle posteriorly.
Rotation when the arm is raised over the head by flexion the clavicle rotates passively as the scapula rotates, transmitted to clavicle by coracoclavicular ligaments.

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21
Q

How can the movement of the clavicle be felt?

A

By palpating the sternal end of the clavicle and shrugging the shoulders, the sternal end should move inferiorly.

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22
Q

Why does the sternoclavicular joint need to have both mobility and stability?

A

Mobility to accommodate the movements of the upper limb and stability as it’s the only connection between the upper limb and the axial skeleton.

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23
Q

What makes the sternoclavicular joint mobile?

A

It is a saddle joint so has two axes of movement. Its articular disc allows the clavicle and manubrim to slide over each other more freely, allowing for the rotation and movement in a third axis.

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24
Q

What makes the sternoclavicular joint stabile?

A

Strong joint capsule, and strong ligaments - particularly the costoclavicular ligament (transfers stress from clavicle to manubrim.

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25
Q

What are the two main types of sternoclavicular joint dislocation?

A

Anterior dislocations - most common, from a blow to the anterior shoulder.
Posterior dislocations - from a force driving the shoulder forwards or direct impact to the joint.

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26
Q

What type of joint is the glenohumeral joint?

A

A ball and socket joint.

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27
Q

What are the articulating surfaces of the glenohumeral joint?

A

Head of the humerus and the glenoid cavity of the scapula.

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28
Q

What are the articulating surfaces of the glenohumeral joint covered by?

A

Hyaline cartilage, typical of this joint type.

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29
Q

Why is the glenohumeral joint inherently unstable and how is this partly overcome?

A

Because the head of the humerus is much larger than the glenoid fossa. This instability is reduced as the glenoid fossa is deepened by a fibrocartilage rim, the glenoid labrum.

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30
Q

What is the joint capsule of the glenohumeral joint?

A

A fibrous sheath that encloses the structures of the joint. It extends from the anatomical neck of the humerus to the border of the glenoid fossa. The capsule is lax for more mobility. Synovial membrane lines the inner surface of the joint capsule.

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31
Q

How is friction in the glenohumeral joint reduced?

A

By several synovial bursae, the act as cushions between tendons and other joint structures.

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32
Q

What are the two clinically important bursae of the glenohumeral joint?

A

Subacromial - inferior to deltoid and acromion, superior to supraspinatous tendon and joint capsule. Support deltoid and supraspinatous muscles.
Subscapula - between subscapularis tendon and scapular. Reduces wear and tear on the tendon during movement at the shoulder joint.

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33
Q

What are the key ligaments of the glenohumeral joint?

A 
Glenohumeral ligaments (superior, middle, and inferior) - three bands that run with the joint capsule from the glenoid fossa to the anatomical neck of the humerus. Stabilise the anterior aspect of the joint.
Coracohumeral ligament - attaches base of coracoid process to the greater tubercle of the humerus. Supports the superior part of the joint capsule.
Transverse humeral ligament - spans the distance between two tubercles of the humerus. Holds tendon of the long head of the biceps in the intertubecular groove.
Coracoacromial ligament - not just a thickening of the joint capsule as the other are, runs between acromion and coracoid process of scapular - forms coraco-acromial arch. Prevents superior displacement of the humeral head.
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34
Q

What is the arterial supply to the glenohumeral joint?

A

Anterior and posterior circumflex humeral arteries and the suprascapular artery. Branches form an anastamotic network around the joint.

35
Q

What innervates the glenohumeral joint?

A

Axillary, suprascapular and lateral pectoral nerves. Derived from roots C5, C6 of brachial plexus.

36
Q

What are the movements of the glenohumeral joint?

A

Extension - produced by posterior deltoid, latissimusdorsi, and teres major.
Flexion - from biceps brachii, pectoralis major, anterior deltoid and coracobrachialis.
Abduction - first 0-15 degrees from supraspinatous, 15-90 degrees from middle fibres of deltoid, 90+ degrees from rotation of the scapula by trapezius and serratus anterior.
Adduction - from contraction of pectoralis major, latissimus dorsi, and teres major.
Medial rotation - from contraction of subscapularis, pectoralis major, latissimus dorsi, teres major, and anterior deltoid.
Lateral rotation - from contraction of infraspinatous and teres minor.

37
Q

What contributes to the mobility of the glenohumeral joint?

A

The type of joint - ball and socket. Bony surfaces, shallow glenoid cavity and large humeral head. Laxity of the joint capsule.

38
Q

What contributes to the stability of the glenohumeral joint?

A

Rotator cuff muscles - surround the shoulder joint, attach to the tubercles of the humerus and fuse to joint capsule. Pull the humeral head into the glenoid cavity.
Glenoid labrum - fibrocartilaginous ridge surround the glenoid cavity, deepens the cavity so less risk of dislocation.
Ligaments - reinforce joint capsule and form coraco-acromial arch.

39
Q

What can cause an anterior dislocation of the glenohumeral joint?

A

Excessive extension and lateral rotation of the humerus so humeral head is forced anteriorly and inferiorly into weakest part of the joint capsule.

40
Q

What increases the risk of future glenohumeral joint dislocations?

A

Tearing the joint capsule.

41
Q

What can be damaged in the dislocation of the glenohumeral joint?

A

The axillary nerve that runs in close proximity to the shoulder joint. Can also stretch to the radial nerve, bound in the radial groove.

42
Q

What happens if the axillary nerve is damaged in dislocation of the glenohumeral joint?

A

Paralysis of the deltoid, loss of sensation over regimental badge area.

43
Q

What is rotator cuff tendonitis?

A

Inflammation fo the muscle tendons that stabilise the glenohumeral joint, usually from overuse.

44
Q

What is the characteristic sign of rotator cuff tendonitis?

A

Painful arc pain in the middle of abduction, affected area comes into contact with the acromion.

45
Q

What type of functional and structural joint is the elbow joint?

A

Functionally - hinge joint.

Structurally - synovial joint.

46
Q

What are the two articulations of the elbow joint?

A

Trochlear notch of the ulna with the trochlea of the humerus.
Head of the radius with the capitulum of the humerus.

47
Q

What are the movements with the elbow joint?

A

Extension - triceps brachii and anconeus.

Flexion - brachialis, biceps brachii, and brachioradialis.

48
Q

What is the capsule of the elbow joint like?

A

Strong and fibrous to strengthen the joint. Thickened medially and laterally to form collateral ligaments - stabilise the flexing and extending motion of the arm.

49
Q

What are the ligaments of the elbow joint?

A

Radial collateral ligament - lateral side of joint, extending from lateral epicondyle, blending with the anular ligament of the radius.
Ulnar collateral ligament - from medial epicondyle and attaches to coronoid process and olecrannon of ulna.

50
Q

What is a bursa?

A

Membranous sac, filled with synovial fluid.

51
Q

What are the important bursae of the elbow joint?

A

Intratendinosus - within the tendon of the triceps brachii.
Subtendinosus - between olecrannon and the tendon of the triceps brachii, reduced friction between the two in extension/ flexion of the arm.
Subcutaneous - between olecrannon and overlying connective tissue.

52
Q

What is subcutaneous bursitis from?

A

Repeated friction and pressure on the bursa causing inflammation. Or it can become infected and cause inflammation.

53
Q

What is subtendinosus bursitis from?

A

Repeated flexion and extension of the forearm, often in assembly line workers. Flexion is more painful as more pressure is put on the bursa.

54
Q

What normally causes elbow joint dislocation?

A

A child falling hard on a hand with the elbow flexed. The distal end of the humerus is driven through the weakest part of the joint capsule (anterior side). Ulnar collateral ligament is torn and ulnar nerve can be damaged.

55
Q

What are elbow dislocations named according to?

A

By the position of the ulna and radius, not the humerus.

56
Q

What is epicondylitis caused by?

A

Overuse strain of the common tendon for flexor and extensor muscles in the forearm.

57
Q

What is the difference between tennis elbow and golfer’s elbow?

A

Tennis elbow causes pain in the lateral epicondyle from the common extensor origin.
Golfer’s elbow causes pain in the medial epicondyle from the common flexor origin.

58
Q

What causes supraepicondylar fractures?

A

Falling on a flexed elbow, transverse fracture between the two epicondyles.

59
Q

How can supraepicondylar fractures cause Volkmanns contracture?

A

Damage or swelling causes interference with blood supply to forearm via brachial artery. So there is ischameia and then Volkmanns contracture - uncontrolled flexion of the hand. Flexors muscles become fibrotic and short.

60
Q

What are the articulations of the radioulnar joint?

A

Proximal radioulnar joint - near elbow, head of radius and radial notch of the ulna.
Distal radioulnar joint - near wrist, ulnar notch of radius and ulnar head.

61
Q

What is the radial head held in place by in the proximal radioulnar joint?

A

Annular radial ligament, forms a collar around the joint.

62
Q

What are the movements of the proximal radioulnar joint?

A

Pronation - by the pronator quadratus and pronator teres.

Supination - by supinator and biceps brachii.

63
Q

What does the articular disk in the distal radioulnar joint do?

A

Binds the radius and ulna together, and holds them together during movement at the joint.
Separates the distal radioulnar joint from the wrist joint.

64
Q

What movements are possible at the distal radioulnar joint?

A

Pronation - pronator quadratus and pronator teres.

Supination - supination and biceps brachii.

65
Q

What is the interosseous membrane?

A

The sheet of connective tissue between the radius and ulnar between the radioulnar joints.

66
Q

Why are there small holes in the interosseous membrane?

A

As conduit for the forearm vasculature.

67
Q

What are the functions of the interosseous membrane?

A

Holds radius and ulna together during pronation and supination of forearm, providing additional stability.
Acts as a site of attachment for muscles in the anterior and posterior compartments of the forearm.
Transfers forces from the radius to the ulna.

68
Q

What are the two classical fractures of the radius and ulna?

A

Monteggias fracture - from force behind the ulna, proximal shaft of the ulna is fracture and the head of the radius dislocates anteriorly at the elbow.
Galeazzis fracture - fracture of the distal radius, the ulna head dislocates at the distal radioulnar joint.

69
Q

What type of joint is the radiocarpal joint?

A

An ellipsoid type synovial joint (movement along two axes).

70
Q

What are the articulating surfaces of the radiocarpal joint?

A

Distally - proximal row of carpal bones (except pisiform).

Proximally - distal end of the radius and the articular disk.

71
Q

What prevents the ulna being part of the radiocarpal joint?

A

The fibrocartilaginous ligament (articular disk) lies over the superior surface of the ulna so it doesn’t articulate with the carpals.

72
Q

What is the arterial supply of the radiocarpal joint?

A

Branches of the dorsal and palmar carpal arches, derived form ulnar and radial arteries.

73
Q

What is the radiocarpal joint innervated by?

A

Median nerve - anterior interosseous branch.
Radial nerve - posterior interosseous branch.
Ulnar nerve - deep and dorsal branches.

74
Q

What is the joint capsule of the radiocarpal joint like?

A

It is dual layered: fibrous outer layer that attaches to the radius, ulna and proximal row of carpal bones, and the internal layer that is comprised of a synovial membrane that secretes synovial fluid to lubricate the joint.

75
Q

What are the important ligaments of the radiocarpal joint?

A

Palmar radiocarpal - on palmar side of hand, passes from radius to both rows of carpal bones. Increases stability and makes hand follows forearm in supination.
Dorsal radiocarpal - on drosum of hand, from radius to both rows of carpal bones. Increases stability and ensures hand follows forearm in pronation.
Ulnar collateral - from ulnar styloid process to triquetrum and pisiform. Prevents excessive lateral joint displacement.
Radial collateral - from radial styloid process to scaphoid and trapezium. Prevents excessive lateral joint displacement.

76
Q

What are the movements possible at the radiocarpal joint?

A

Flexion - from flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis.
Extension - extensor carpi radialis longus and brevis, extensor carpi ulnaris, and extensor digitorum.
Adduction - extensory carpi ulnaris and flexor carpi ulnaris.
Abduction - abductor pollicis longus, flexor carpi radialis, and extensor carpi radialis longus and brevis.

77
Q

How is the scaphoid commonly fractured?

A

A blow to the wrist.

78
Q

Why is a scaphoid fracture an emergency?

A

Because its blood supply is distal to proximal so a fracture can disrupt blood supply to the proximal portion of the bone and cause avascular necrosis and future arthritis.

79
Q

What is the clinical sign of scaphoid fracture?

A

Tenderness in the anatomical snuffbox.

80
Q

How can the lunate become anteriorly dislocated?

A

By falling on a dorsiflexed wrist.

81
Q

Why does anterior lunate dislocation cause carpal tunnel symptoms?

A

The lunate is forced anteriorly and compresses the carpal tunnel.

82
Q

How does anterior lunate dislocation present?

A

Paresthesia in sensory distribution of the median nerve and weakness of thenar muscles.

83
Q

What is a risk of anterior lunate dislocation?

A

Avascular necrosis.

84
Q

What is a colles’ fracture?

A

Most common wrist pathology, from falling on an outstretched hand. Radius fractures and the distal fragment displaces posteriorly. The ulnar styloid can be damages and avascularised often. Causes a dinner fork deformity.

6. MSK (30 decks)

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