Week 5: UE Joints and Injuries Flashcards
Interclavicular ligament
Proximal attachment
Superior surface and sternal end of the clavicle.
Distal attachment
Superior surface and sternal end of the opposite clavicle.
Function
Maintains the relationship between the two clavicles.
Injury mechanism
Rarely injured due to its ability to transmit forces to the clavicle, which, as a result, often fractures.
Pathology of injury
Injury, if it ever occurred, would involve some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°).
annular ligament
Proximal attachment
Anterior margin of the radial notch. The ligament broadens as it progresses posteriorly and may divide into several bands.
Distal attachment
Rough ridge at or behind the posterior margin of the radial notch. Diverging bands may reach the lateral margin of the trochlear notch above and proximal end of the supinator crest below.
Function
Holds the radial head in position relative to the ulna.
Injury mechanism
Acute injury is rare, although the ligament may become damaged during fractures of the radial head or may become over-stretched with repetitive stress.
Pathology of injury
The ligament may become trapped in the joint space in radial head fractures or dislocations. With repetitive stretching, the ligament may lose its elasticity and elongate, thus becoming lax.
CLINICAL RELEVANCE
The annular ligament, along with the radial collateral ligament, is responsible to help stabilize the proximal radioulnar joint by maintaining radial contact with the ulna. This is particularly important during supination and pronation.
bicipital aponeurosis
Biceps brachii is attached by the bicipital aponeurosis to the deep fascia over the medial aspect of the upper forearm and to the subcutaneous border of the ulna. This strong fibrous band crosses in front of the brachial artery and median nerve. The crescentic proximal border can be palpated in the medial part of the cubital fossa.
The ulnar collateral ligament is a triangular-shaped ligament comprised of three parts: a strong stiff anterior part, a thick posterior part, and a weak inferior or oblique band.
Proximal attachment
Anterior surface of the medial epicondyle of the humerus.
Distal attachment
Proximal tubercle on the medial coronoid margin.
Function
Prevents excessive lateral movement of the forearm from the arm (valgus displacement). The ligament is taught throughout most of the range of flexion.
Injury mechanism
Excessive valgus force as occurs with a relative lateral movement of the forearm away from the arm. Especially vulnerable when the elbow is in or near extension. Over stretching of the ulnar collateral ligament is fairly common in the repetitive performance of an overhead throwing motion.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the elbow joint.
CLINICAL RELEVANCE
Ulnar collateral ligament insufficiency often occurs as a result of repetitive overhead throwing in athletics, particularly with pitching in professional baseball. The reconstruction of this ligament, commonly called ‘Tommy John surgery’, requires a carefully planned recovery over an extensive period of time (often 1-2 years). Practitioners who work with competitive and professional athletes are strongly encouraged to have open dialogue with the team’s athletic trainers and, if appropriate, the treating physicians in order to the most ideally incorporate manual therapies.
metacarpal ligaments
In the hand, two sets of metacarpal ligaments connect the bases and heads of the lateral four metacarpals.
Origin and insertion
Metacarpals 2 to 5.
Ant. Sternoclavicular ligament
Proximal attachment
Anterosuperior aspect of the sternal end of the clavicle.
Distal attachment
Anterosuperior aspect of the clavicular notch of the manubrium, extending to the first costal cartilage.
Function
Prevents excessive anterior movement of the head of the clavicle.
Injury mechanism
Forced shoulder retraction and pulling on arm.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the sternoclavicular joint.
Coracoclavicular conoid ligament
Proximal attachment
Medial, horizontal part and posterior aspect of the coracoid process, near its base and anterior to the suprascapular notch.
Distal attachment
Inferior surface of the clavicle, to the conoid tubercle lateral to the subclavian groove.
Function
Prevents excessive superior movement of the distal end of the clavicle and maintains the relationship between the clavicle and the acromion. The conoid part of the coracoclavicular ligament is essential in rotation of the clavicle during abduction of the shoulder joint.
Injury mechanism
Superior blow to the tip of the acromion of the scapula.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the acromioclavicular joint.
CLINICAL RELEVANCE
The trapezoid and conoid ligaments comprise the coracoclavicular ligament (CCL). They provide support for acromioclavicular joint stability and act as a cushion between the rotator cuff and the acromion process.
Palmar radiocarpal ligaments
Proximal attachment
Anterior margin of the distal end of the radius and its styloid process.
Distal attachment
Passes distomedially to the anterior surfaces of the scaphoid, lunate, and triquetrum, with some fibers reaching the capitate. This complex of ligaments is partly intracapsular.
Function
Assists with limiting the wrist extension range of motion and stabilizes the carpal bones on the radius, especially during pronation/supination.
Injury mechanism
Forced hyperextension as occurs in a fall on the outstretched hand.
Pathology of injury
Tearing of the ligament or stretching sprain in less traumatic situations. The pathology may involve damaging other short ligaments of the wrist such as the intercarpal ligaments.
Middle glenohumeral ligament
Proximal attachment
Anterior glenoid margin, inferior to the attachment of the superior glenohumeral ligament.
Distal attachment
Lesser tuberosity, deep to the tendon of subscapularis, with which it blends.
Function
Helps in maintaining joint relationships and helps to prevent anterior dislocation of the humeral head.
Injury mechanism
Forced abduction and external rotation of the humerus.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the glenohumeral joint.
CLINICAL RELEVANCE
Loss of middle glenohumeral ligament integrity will contribute to anterior shoulder instability and chronic anterior dislocation of the shoulder.
coracohumeral ligament
Proximal attachment
Lateral border of the root of the coracoid process.
Distal attachment
Blends into the capsule of the glenohumeral joint above the insertion of subscapularis on the greater tuberosityof the humerus.
Function
Restricts excessive external rotation of the humerus.
Injury mechanism
Anterior dislocation of the humerus.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the glenohumeral joint.
Due to its position and association with glenohumeral joint pathology, the coracohumeral ligament restricts external rotation of the shoulder following extensive immobilization of the shoulder.
CLINICAL RELEVANCE
The transverse humeral ligament was once thought to restrain the long bicipital tendon and prevent it’s dislocation. Cadaveric studies now show that the long bicipital tendon is stabilized by the coracohumeral ligament, which, as it bridges the tubercles, forms a tunnel through which the long bicipital tendon runs.
extensor retinaculum
The extensor retinaculum is a 2cm wide thickening of the dorsal deep fascia of the forearm strengthened by transverse fibers.
Laterally (radically) it is attached to the anterolateral border of the radius immediately proximal to the styloid process. Medially (ulnarly) it attaches to the pisiform and triquetrum.
Transverse humeral ligament
Proximal attachment
Lateral aspect of the lesser tubercle of the humerus.
Distal attachment
Anteroinferior aspect of the greater tubercle of the humerus.
Function
Serves as a retinaculum for the long head of the biceps brachii, securing the tendon in the intertubercular groove of the humerus.
Injury mechanism
May be torn during anterior humeral dislocation (if considerable swelling is present, the ligament may be insufficient in restricting the tendon of biceps brachii within the intertubercular groove).
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the glenohumeral joint.
CLINICAL RELEVANCE
The transverse humeral ligament (THL) was once thought to restrain the bicipital tendon. It is now suggested that the coracohumeral ligament bridges the tubercles, forming a tunnel that helps prevents dislocation of the tendon. It is possible that the THL works more as a retinaculum that prevents ‘bowstringing’ of the tendon. Based on cadaveric studies, it has been proposed that the THL does not exist and that the tissue is, instead, a fibrous extension of the subscapularis or pectoralis major tendons, which insert nearby.
radial collateral ligament of elbow
Proximal attachment
Anteroinferior surface on the lateral epicondyle of the humerus.
Distal attachment
Annular ligament, some of the posterior fibers cross the ligament and attach to the proximal end of the supinator crest of the ulna.
Function
Helps to prevent excessive medial movement of the forearm on the arm (varus force).
Injury mechanism
Infrequently injured in an isolated instance, although the ligament is often torn in dislocation of the elbow. Isolated injury would occur as a result of a sudden force moving the forearm laterally while the arm is fixed or a direct blow to the medial aspect of the elbow while the hand is fixed.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the elbow.
CLINICAL RELEVANCE
The radial collateral ligament, along with the annular ligament, is responsible to help stabilize the proximal radioulnar joint by maintaining radial contact with the ulna. Only a small percentage is supplied by the radial collateral ligament. Excision, if necessary, may not produce any significant loss.
acromioclavicular ligament
Superior surface and lateral end of the clavicle and
Superior surface of the acromion of the scapula, adjacent to the clavicle.
Function
Maintains the relationship between the clavicle and the acromion.
Injury mechanism
Superior blow to the tip of acromion and/or fall on the outstretched hand (force travels through arm to scapula, forcing scapula superiorly (inferior displacement of clavicle).
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the acromioclavicular joint.
palmar carpometacarpal ligaments (In the hand, the dorsal and palmar carpometacarpal ligaments run between the distal row of the carpal bones and the bases of the 2nd to 4th the metacarpals.
Origin
Hamate.
Capitate.
Trapezoid.
Insertion
Metacarpals 2 to 4.
Function
They stabilize the carpometacarpal joints.
Function
Maintains the relationship between the metacarpal bases and adjacent carpal bones.
Injury mechanism
Injury can be due to twisting, hyperextension or hyperflexion forces. Falls onto the outstretched hand may produce injury or dislocation of the carpometacarpal joint.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the carpometacarpal joint.
CLINICAL RELEVANCE
These ligaments create relatively immobile joints, which helps to protect the carpal tunnel from encroachment. Repetitive hyperextension of the wrist with applied pressure, such as when applying effleurage to the body, can be a slow, insidious instigator of damage that is not as obvious as an abrupt injury.
collateral ligaments
Proximal attachment
Distal end of first to fifth metacarpals, first to fifth proximal phalanges, and second to fifth intermediate phalanges, each ligament from both medial and lateral sides.
Distal attachment
Proximal end of first to fifth proximal phalanges, the distal phalanx of thumb, second to fifth intermediate phalanges, and second to fifth distal phalanges, each ligament from both medial and lateral sides.
Function
Restrict varus or valgus stress to the interphalangeal joints.
Injury mechanism
Injury may be sustained if finger is forced ulnarly or radially, or if the joint is dislocated
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the metacarpophalangeal or interphalangeal joints.
flexor retinaculum
he flexor retinaculum is a thickened band of fascia, which spans the carpal bones, from the scaphoid and trapezium to the pisiform and hook of the hamate forming a roof over the carpal tunnel.
Function
It binds down tendons passing through the carpal tunnel preventing them from “bow stringing” over the front of the wrist joint when the muscles contract.
Relations
The tendon of palmaris longus and the ulnar nerve lie on the palmar surface of the flexor retinaculum; the thenar and hypothenar muscles are attached to this surface.
The median nerve lies in the carpal tunnel, directly underneath the flexor retinaculum.
Inferior glenohumeral ligament
Proximal attachment
Middle, inferior edge of the glenoid labrum and glenoid fossa.
Distal attachment
Inferior and medial aspects of the neck of the humerus.
Function
Helps in maintaining joint relationships and helps to prevent antero-inferior dislocation of the humeral head. The ligament is taut when the arm is held in full abduction overhead.
Injury mechanism
Most often ruptured in traumatic dislocation of the glenohumeral joint, caused by excessive external rotation of the humerus combined with abduction.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the glenohumeral joint.
CLINICAL RELEVANCE
Ligamentous laxity of inferior glenohumeral ligament (IGHL) is the most significant contributor to anterior shoulder instability and chronic anterior dislocation of the shoulder. A detached labrum can lead to a compromised IGHL.
The palmar intercarpal ligaments, typically weaker than their counterparts on the dorsal surface, consist of a complex arrangement of transverse fibers connecting the carpal bones of the proximal row, those of the distal row, and via short, irregular fibers these two rows.
Proximal attachment
Proximal row: palmar surface and medial aspect of the scaphoid and lunate.
Distal row: palmar surface and medial aspect of the trapezium, trapezoid, and capitate.
Distal attachment
Proximal row: palmar surface and lateral aspect of the lunate and triquetrum.
Distal row: palmar surface and lateral aspect of the trapezoid, capitate, and hamate.
Function
Serves to maintain the relationship between adjacent carpal bones.
Injury mechanism
Fall on the outstretched hand or any twisting and shearing forces transmitted across the wrist may disrupt any of the small intercarpal ligaments.
Pathology of injury
Stretching or tearing may occur with a sudden stress. Repetitive stress may lead to chronic stretching and eventual breakdown, which in turn causes laxity.
Severe hyperextension injuries of the wrist are normally characterized by tearing of the scapholunate interosseous ligament. Further loading causes the radiocapitate, radiotriquetral, and dorsal radiocarpal ligaments to tear (in successive order). In severe hyperextension, the lunate follows the triquetrum into extension and a ‘dorsal intercalated segment instability’ (DISI) deformity or eventually a ‘scapholunate advanced collapse’ (SLAC) wrist results.
longitudinal fibers of palmar fascia
The fascial structures in the palm comprise distinct longitudinal, transverse and vertical (i.e. at right angles to the plane of the palm) components (these terms are clinical rather than relative to the anatomical position).
The longitudinal fibers are the distal continuations of the fibers of palmaris longus. Distal to the distal palmar skin crease, the longitudinal fibers separate in to 3 layers.
The intermediate longitudinal fibers pass deeply into the tissues of the webs spiraling behind the neurovascular bundles to reach the digits (lateral digital sheet).
On a deeper plane in the mid palm, deep to the transverse fibers of the palmar fascia, a series of vertical fibrous septae separate the flexor tendon sheaths to each digital ray.
PATHOLOGY
The fascial structures of the palm are a complex three dimensional lattice stabilizing the distal palmar skin while allowing limited movement. The fascia protects the underlying tendons, nerves, and blood vessels from receiving the external forces applied to the palm during frictional activities. This type of fascial tissue is markedly absent on the dorsum of the hand where the skin is loose and highly mobile.
The cords of contracture in Dupuytren’s disease tend to follow anatomical ligamentous pathways, and knowledge of the 3 layers of fascia makes surgery more precise.
At the mid-palmar crease the transverse fibers of the palmar aponeurosis lie superficial to the neurovascular bundles and therefore represent a safe surgical landmark.
Dupuytren’s disease
Dupuytren’s Disease is a condition of the palmar fascial continuum with nodules and cords of contractile fibroblastic tissue. The cords follow the line of the palmar fascial fibers and produce flexion contractures of the digits.
The condition is thought to be genetic but intercurrent disease may be significant in the onset.
The metacarpophalangeal joint contracture is normally released by surgical removal of involved fascia (Slide 1, Slide 2). The proximal interphalangeal joint may be involved in the contraction process. The check rein ligaments, in particular, are vulnerable to contraction. Surgical release is possible but may result in recurrent stiffness or hyper extension of the joint.
palmar radiocarpal ligaments
Proximal attachment
Anterior margin of the distal end of the radius and its styloid process.
Distal attachment
Passes distomedially to the anterior surfaces of the scaphoid, lunate, and triquetrum, with some fibers reaching the capitate. This complex of ligaments is partly intracapsular.
Function
Assists with limiting the wrist extension range of motion and stabilizes the carpal bones on the radius, especially during pronation/supination.
Injury mechanism
Forced hyperextension as occurs in a fall on the outstretched hand.
Pathology of injury
Tearing of the ligament or stretching sprain in less traumatic situations. The pathology may involve damaging other short ligaments of the wrist such as the intercarpal ligaments.
interosseous membrane
There are two interosseous membranes in the body and they consist of sheets of fibrous fascia located between the interosseous borders of the shafts of the radius and ulna and the tibia and fibula.
Function
The membranes form a type of fibrous joint known as a syndesmosis between the two bones and provide attachment for the deep muscles of the forearm and leg.
coracoacromial ligament
Proximal attachment
Lateral aspect of the coracoid process.
Distal attachment
Anteroinferior edge of the acromion.
Function
Forms an arch above the humeral head, thereby preventing superior displacement of the humerus on the glenoid fossa of the scapula.
Injury mechanism
Infrequently injured, but may pose problems in impingement syndromes.
Pathology of injury
This ligament is not in a position to be stretched or torn but may pose difficulties when scapulohumeral mechanics are faulty and the humeral head rides superiorly, potentially impinging on the coracoacromial ligament and acromion process.
CLINICAL RELEVANCE
Cadaveric studies show that release of the coracoacromial ligament (CCL) results in greater anterior and inferior glenohumeral joint translations. It is suggested that CCL interacts with the coracohumeral ligament to provide a suspensory function and contributes to glenohumeral stability.
Palmar fascia
The fascial structures in the palm comprise distinct longitudinal, transverse and vertical (i.e. at right angles to the plane of the palm) components (these terms are clinical rather than relative to the anatomical position).
The transverse fibers, deep to the longitudinal fibers and on a distinct plane, are the transverse fibers of the palmar aponeurosis which bridge across the palm forming palmar flexor tendon sheath pulleys.
On a deeper plane in the mid palm, deep to the transverse fibers of the palmar fascia, a series of vertical fibrous septae separate the flexor tendon sheaths to each digital ray.
PATHOLOGY
The fascial structures of the palm are a complex three dimensional lattice stabilizing the distal palmar skin while allowing limited movement. The fascia protects the underlying tendons, nerves, and blood vessels from receiving the external forces applied to the palm during frictional activities. This type of fascial tissue is markedly absent on the dorsum of the hand where the skin is loose and highly mobile.
The cords of contracture in Dupuytren’s disease tend to follow anatomical ligamentous pathways, and knowledge of the 3 layers of fascia makes surgery more precise.
At the mid-palmar crease the transverse fibers of the palmar aponeurosis lie superficial to the neurovascular bundles and therefore represent a safe surgical landmark.
Dupuytren’s disease
Dupuytren’s Disease is a condition of the palmar fascial continuum with nodules and cords of contractile fibroblastic tissue. The cords follow the line of the palmar fascial fibers and produce flexion contractures of the digits.
The condition is thought to be genetic but intercurrent disease may be significant in the onset.
The metacarpophalangeal joint contracture is normally released by surgical removal of involved fascia (Slide 1, Slide 2). The proximal interphalangeal joint may be involved in the contraction process. The check rein ligaments, in particular, are vulnerable to contraction. Surgical release is possible but may result in recurrent stiffness or hyper extension of the joint.
coracoclavicular ligament
(trapezoid portion)
Proximal attachment
Medial, horizontal part and posterosuperior surface of the coracoid process and inferior surface of the clavicle on the trapezoid line
Function
Prevents excessive superior movement of the distal end of the clavicle and maintains the relationship between the clavicle and the acromion. The trapezoid part of the coracoclavicular ligament is essential in rotation of the clavicle during abduction of the shoulder joint.
Injury mechanism
Superior blow to the tip of the acromion.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the acromioclavicular joint.
CLINICAL RELEVANCE
The trapezoid and conoid ligaments comprise the coracoclavicular ligament (CCL). They provide support for acromioclavicular joint stability and act as a cushion between the rotator cuff and the acromion process.
superior glenohumeral ligament
Proximal attachment
Superior part of the glenoid labrum and base of the coracoid process (deep to the coracoacromial ligament).
Distal attachment
Superior part of the neck of the humerus, between the lesser tubercle and the articular margin.
Function
Helps in maintaining joint relationships and helps to prevent anterior dislocation of the humeral head.
Injury mechanism
Forced abduction and external rotation of the humerus.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the glenohumeral joint.
CLINICAL RELEVANCE
An additional important function of the superior glenohumeral ligament is to stabilize the long head of the biceps tendon, forming a sling that helps retain the tendon within the bicipital groove.
Proximal attachment
Palmar surface and distal end of first to fifth metacarpals, first to fifth proximal phalanges, and second to fifth intermediate phalanges.
Distal attachment
Palmar surface and proximal end of first to fifth proximal phalanges, the distal phalanx of the thumb, second to fifth intermediate phalanges, and second to fifth distal phalanges.
Function
Restrict excessive extension of the fingers at the interphalangeal joints.
Injury mechanism
Injury may be sustained if fingers are forced into extension (hyperextension) or flexion.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the metacarpophalangeal or interphalangeal joints.
palmar ulnocarpal ligaments
Proximal attachment
By a rounded fasciculus from the base of the ulnar styloid process and anterior margin of the articular disc (triangular fibrocartilage).
Distal attachment
Palmar side of the bases of the lunate and triquetrum.
Function
Stabilizes the triangular fibrocartilage between the ulna and the carpal bones.
Injury mechanism
Excessive, forced radial deviation of the wrist, as in striking the ground with a golf club during a swing.
Pathology of injury
Tearing of the ligament or stretching in less traumatic situations.
ulnar collateral ligament
proximal attachment
Apex of the ulnar styloid process.
Attached to the ligament’s deep (lateral) aspect is a small fibrocartilaginous meniscus (triangular fibrocartilage), which is the distal boundary of the synovial prestyloid recess.
Distal attachment
Palmar band: medial side of the pisiform.
Dorsal band: medial side of the triquetrum.
Function
Assists in the restriction of excessive radial deviation of the wrist.
Injury mechanism
Acute excessive radial deviation of the wrist or chronic stretching of the ligament through positions of radial deviation as in cyclists on ‘dropped’ handlebars.
Pathology of injury
Acute or chronic stretching eventually causing laxity.
CLINICAL RELEVANCE
By stabilizing movements of the wrist joint, the ulnar collateral ligament helps protect the triangular fibrocartilage complex from excessive wear and from associated inflammatory processes. Manual practitioners are encouraged to protect the collateral ligaments by avoiding excessive ulnar and radial deviations when applying effleurage and other techniques, especially when using moderate to deep levels of pressure.
costoclavicular ligament
Proximal attachment
Superior surface and proximal end of the first rib and its costal cartilage.
Distal attachment
Inferior surface and medial end of the clavicle. The anterior longer fibers angle laterally and the posterior shorter fibers angle medially.
Function
Prevents excessive superior movement of the head of the clavicle. The anterior and posterior fibers prevent excessive anterior and posterior rotation of the clavicle, respectively.
Costoclavicular ligament
Injury mechanism
Extreme elevation or depression of the scapula/shoulder or extreme axial rotation of the clavicle.
Pathology of injury
Some swelling and pain in mild sprain (1st°), fiber stretching/tearing and some loss of function in moderate sprain (2nd°), and complete tearing (rupture) of ligament and obvious loss of function in severe strain (3rd°), as occurs in dislocation of the sternoclavicular joint.
The posterior sternoclavicular ligament supports the sternoclavicular joint.
Origin
Clavicle: sternal end.
Insertion
Manubrium: posterosuperior aspect.
