Anatomy Medicine - Joints of the Upper Limb

Joint of the Upper Limb

1. Joints of the Upper Limb

2. Overview Elbow Joint Wrist Joint Radio-Ulnar Joint Proximal radio-ulnar Distal Radio-ulnar Intercarpal, carpometacarpal, intermetacarpal Metacarpophalangeal joint Interphalangeal

3. ELBOW JOINT Synovial Hinge joint A rticulation: Trochlea of the humerus with trochlear notch of ulna Capitulum of the humerus with proximal surface of the head of radius

4. ELBOW JOINT Fibrous Capsule/Joint Capsule ANTERIOR -Proximal attachment: medial and lateral epicondyles and upper margins of radial and coronoid fossae -Distal: coronoid process and annular ligament of radius POSTERIOR -line joining the epicondyles across the floor of olecranon fossa to the articular margin of the olecranon

5. ELBOW JOINT LIGAMENTS: Radial/Lateral Collateral Ligament -lateral epicondyle to lateral and posterior part of annular ligament Ulnar/Medial Collateral Ligament- medial epicondyle to coronoid process and olecranon - Anterior band -Posterior band -Oblique/transverse band

6. ELBOW JOINT Synovial Membrane l ines the deep surface of the fibrous capsule and the intracapsular non-articular parts of the bones On the bony fossae—olecranon, coronoid, and radial—the synovial membrane is separated from the fibrous capsule by pads of fat which slide into the fossae when the bony processes are withdrawn during flexion and extension continuous with that of the proximal radio-ulnar joint on the lateral side Nerve supply of the joint is from all the adjacent nerves—median, ulnar, radial, posterior interosseous, and musculocutaneous

7. ELBOW JOINT Movements Flexion Extension “the carrying angle” 165 degrees laterally with humerus Humero -ulnar part Modified saddle joint

8. ELBOW JOINT CLINICAL CORRELATION   8 Posterior Dislocation Falling on the outstretched hand Common in children Avulsion of epiphysis of medial epicondyle Arthrocentesis of Elbow Joint Back of the joint on either side of the olecranon process Ulnar Nerve Damage with Elbow Joint Injuries The nerve can be involved in scar tissue formation or can become stretched due to lateral deviation of the forearm in a badly reduced supracondylar fracture. Movements of elbow joint, continued friction between medial epicondyle and stretched ulnar nerve results in ulnar palsy

9. WRIST JOINT Synovial Ellipsoid Articulation: convex surface of scaphoid, lunate, and triquetrum Concave distal surface of radius Triangular articular disc Triangular articular disc separates ulna from the joint Joins the medial edge of the articular surface of radius to the styloid process of ulna The oblique direction of radiocarpal joint reduces the likelihood of posterior dislocation of any carpal bone

10. WRIST JOINT

11. WRIST JOINT Radial and ulnar collateral ligaments Passes the margins of distal end of radius and ulna and articular disc to the scaphoid Medially and Laterally from the styloid process of radius and ulna to the scaphoid and triquetrum Nerve Supply: anterior and posterior interosseous nerves and dorsal branch of the ulnar nerve Fibrous Capsule

12. WRIST JOINT Abduction radial deviation Adduction  ulnar deviation Flexion Extension Movement

13. CLINICAL CORRELATION   Fall on the outstretched hand can strain the anterior ligament of the wrist joint, producing synovial effusion, joint pain, and movement can be limited. These symptoms must not be confused with those produced by a fractured scaphoid or dislocation of the lunate bone, which are similar

14. RADIO-ULNAR JOINT PROXIMAL RADIO-ULNAR JOINT Articulation: side of cylindrical head of radius Radial notch of ulna Strengthened by annular and quadrate ligaments

15. RADIO-ULNAR JOINT PROXIMAL RADIO-ULNAR JOINT Annular Ligament of Radius strong, fibrous collar Encircles head of radius and retains it in contact with the radial notch on the ulna attached to the posterior and anterior surface of the radial notch Slightly conical and loosely attached to the neck of radius thus the head of the radius is free to turn within the ligament but cannot be pulled down out of it Quadrate ligament Between the neck of the radius and the lower margin of the radial notch of the ulna

16. RADIO-ULNAR JOINT PROXIMAL RADIO-ULNAR JOINT Synovial Membrane continues with the elbow joint Line deep surface of the annular ligament and is reflected upwards from its distal margin to surround the intracapsular part of the neck of the radius Nerve Supply: Branch of media, musculocutaneous, radial and ulnar nerve

17. RADIO-ULNAR JOINT DIST AL RADIO-ULNAR JOINT Articulation: head of ulna Ulnar notch of radius Held together by the articular disc of the wrist joint , interosseous membrane , and a weak fibrous capsule

18. RADIO-ULNAR JOINT DIST AL RADIO-ULNAR JOINT Articulation: head of ulna Ulnar notch of radius Held together by the articular disc of the wrist joint , interosseous membrane , and a weak fibrous capsule

19. RADIO-ULNAR JOINT DIST AL RADIO-ULNAR JOINT Articular Disc Triangular fibrocartilaginous Base is attached to distal margin of ulnar notch Apex is attached to a depression at the root of the ulnar styloid process Separates distal radio-ulnar joint from the wrist joint Fibrous Capsule Consist of lax fibers between anterior and posterior borders of the disc and the adjacent surfaces of radius and ulna Extend proximally to distal border of interosseous membrane enclosing a prolongation of the joint cavity

20. RADIO-ULNAR JOINT DIST AL RADIO-ULNAR JOINT Synovial Membrane Lines the fibrous capsule and proximal surface of the articular disc Interosseous Membrane of Forearm Stretches between interosseous borders of ulna and radius and holds them together, allowing movements Increases the area of origin for the deep flexor and extensor muscles of the forearm N Nerve Supply: anterior interosseous and deep branch of radial nerve

21. RADIO-ULNAR JOINT MOVEMENTS Pronation Supination

22. CLINICAL CORRELATION   Radio-ulnar Joint Disease The proximal radioulnar joint communicates with the elbow joint, whereas the distal radioulnar joint doesn’t. This means that infection of the elbow joint invariably involves the proximal radioulnar joint. The strength of the proximal radioulnar joint depends on the integrity of the strong anular ligament. Rupture occurs in cases of anterior dislocation of the head of the radius on the capitulum of the humerus. In small children, a sudden jerk on the arm can pull radial head down through the anular ligament

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