Wrist Joint and First Carpo metacarpal joint.pptx

Wrist joint and first carpo

1. WRIST JOINT AND FIRST CARPO-METACARPAL JOINT

2. WRIST JOINT Q. Write a short note wrist joint. • Wrist or radiocarpal joint is the articulation of the forearm with the hand. Type • It is Ellipsoid biaxial variety of synovial joint. • It is compound synovial as more than two bones participate in the joint formation. • Note : It is not the complex synovial joint as the articular disc does not lie in the joint cavity. 2

3. 3 Wrist joint: proximal articular surface (right, inferior view)

4. Articular surfaces Superior or proximal articular surface • It is formed by – Inferior surface of the lower end of radius – Inferior surface of the triangular articular disc of inferior radioulnar joint. – They joint to form elliptical articular facet. Inferior or distal articular surface • It is formed by proximal surfaces of – Scaphoid – Lunate – Triquetrum • It is convex upward. 4

5. 5 Wrist, midcarpal and 1st carpometacarpal joints (right, anterior view)

6. 6 Wrist joint (right, posterior view)

7. WRIST JOINT Ligaments Fibrous capsule • The capsule surrounds the joint cavity and is internally lined by synovial membrane • Fibrous capsule is attached to the margins of superior and inferior articular surfaces. Radial collateral ligament • It extends from the tip of styloid process of radius to the scaphoid. • It is crossed by radial artery. Ulnar collateral ligament • It extends from tip of styloid process of ulna to the medial side of pisiform and triquetrum. Palmar radiocarpal ligament • It extends from anterior margin of lower end of radius to the anterior surfaces of scaphoid, lunate, and triquetrum. Palmar ulnocarpal ligament • It extends from styloid process of ulna and articular disc to the anterior surfaces of lunate and triquetrum. Dorsal radiocarpal ligaments • It extends from posterior margin of the lower end of radius to the posterior surfaces of scaphoid, lunate, and triquetrum. 7

8. 8 Ligaments of wrist joint (right, anterior view)

9. Clinical Integration • Wrist lock : It is a joint lock affecting primary the wrist joint. It is a grabbing technique in martial arts. It is applied by grabbing opponent's hand and bending it. It may occur ligament tears, dislocation, and even bone fractures. • Immobilization of wrist joint : The optimum position for immobilization of wrist is 30° dorsiflexion. MCQ • Aspiration of wrist joint ( arthocentesis ): For aspiration of the wrist joint, the needle should be introduced posteriorly, between the tendons of extensor pollicis longus and extensor digitorum (between third and fourth extensor compartment) (Fig. 19.28). 9

10. 10 Aspiration of wrist joint (right, posterior view)

11. • Midcarpal joint lies between the bones of proximal and distal carpal bones. Viva • Link joint: As the movements of wrist joint and midcarpal joints takes place together, they are functional link joints or wrist complex. Viva • All long flexor tendons of forearm assist for flexion and long extensor tendons for extension of wrist complex. • Adduction mainly occurs at wrist joint, whereas abduction at midcarpal joint. • Flexion mainly occurs at wrist joint, whereas extension at midcarpal joint. 11

12. Clinical Integration • Brunelli procedure : It is a surgical correction of instability of wrist joint (mostly caused by damage to scapholunate ligament) by reconnecting the scaphoid and lunate using the flexor carpi radialis tendon. • Ganglion : It is non-tender cystic swelling of 1–3 cm in size, mostly found on the posterior aspect of wrist. It contains thick, sticky, clear, colorless, jelly-like material (Fig. 19.29). Treatment : In course of time, ganglionic cyst disappears on its own. Occasionally, painful, large, infected cysts need surgical excision. 12

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15. FIRST CARPOMETACARPAL JOINT Q. Write a short note on 1st carpometacarpal joint. • The first carpometacarpal joint is the joint between trapezium and 1st metacarpal (for thumb) (Fig. 20.1, 20.2) Type • Saddle variety of synovial joint. Neet Articular surface • Proximal : Inferior surface of trapezium • Distal : Superior surface of base of 1st metacarpal. • Both the articular surfaces are reciprocally concavoconvex . Hence, it is saddle joint. The shape of the articular surfaces permits free movements at this joint. 15

16. Ligaments • Capsular ligament : It is a thick fibrous sac that attaches with the margins of proximal and distal articular surfaces. Synovial membrane lines the inner surface of capsule. • Lateral ligament : It is a broad ligament. It extends from lateral surfaces of trapezium to the lateral side of base of 1st metacarpal. • Anterior and posterior ligaments : These are oblique bands that extends from anterior and posterior surface of trapezium toward the medial side of base of 1st metacarpal. 16

17. 17 Articular surfaces of first carpometacarpal joint (right, anterior view)

18. FIRST CARPOMETACARPAL JOINT Relations • Anterior : Muscles of thenar eminence • Posterior : Extensor tendons of thumb (EPL, EPB) • Medial : Radial artery, 1st dorsal interosseous muscle • Lateral : Tendon of abductor pollicis longus Blood and Nerve Supply • Blood supply : Radial artery • Inervation : Median nerve 18

19. Movements • As it is saddle variety of synovial joint, it permits variety of movements. • The metacarpal does not lie in the plane of palm. It lies in anterior position and medially rotated 90°. Hence, the movement of thumb (1st metacarpal) takes place at right angle to the corresponding movements of other metacarpals. Viva • Flexion and extension – occur in the plane of palm • Adduction and abduction – occur in a plane perpendicular to the plane of palm. • Opposition – It occurs across the palm to bring thumb in touch with anterior surface of other fingers. Viva • Circumduction – It is the combination of all above movements. 19

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21. Clinical Integration Osteoarthritis • The 1st carpometacarpal joint is the common site of osteoarthritis in postmenopausal women. Clinical fact Osteoarthritis are the degenerative changes that occur with an advancing age. It is a painful condition causing loss of movements at the joint. Rheumatoid arthritis • It is a chronic inflammatory disease of unknown etiology that results int warm, painful, swollen joint. • It commonly involves joints of hands and wrist joints. Student’s activity • Perform the movements of thumb and mention the responsible muscles. 21

22. • Flexion of 1st carpometacarpal joint is accompanied by its medial rotation and extension by its lateral rotation. • Opposition is unique feature of humans that helps in gripping. 22

23. Thank you…………. 23