UPPER EXTREMITIES (Joints) FLASHCARD

By: Ma. Theresa Monje

• The shoulder complex is composed of?

Clavicle, Scapula and Humerus

• Dynamic stability exists when a moving segment is limited very little by (a)________ and influenced heavily by (b)_________.

(a) Passive Forces • articular surface configuration and;• capsular ligaments

(b) Active Forces• Muscular control

• The 3 linkages of the Shoulder Complex are?

• Sternoclavicular Joint• Acromioclavicular joint• Glenohumeral Joint

• The only structural attachment of the clavicle, scapula and upper extremity to the axial skeleton?

• Sternoclavicular Joint

Why do movement of the clavicle at the SC Joint inevitably produces movement of the scapula under conditions of normal function?

•Because the scapula is attached to the lateral end of the clavicle.

• In order for the scapula to not move during movement of clavicle, equal and opposite motions would have to occur at what Joint?

•Acromioclavicular Joint

• STERNOCLAVICULAR joint is what type of joint?

•Plane Synovial Joint with 3 rotatory and 3 translatory degrees of freedom

• The two Articulating surfaces of STERNOCLAVICULAR JOINT?

• Sternal or medial end of clavicle•Notch formed by

manubrium of sternum and 1st costal cartilage

• The sternal end of clavicle and the manubrium are incongruent. Incongruent means?

• There is little contact between the articular surface

•What increases congruence between articulating surface of SC JOINT?

• Sternoclavicular Joint Disk

• The superior portion of the medial clavicle does not contact the manubrium at all instead serves as attachment for?

• SC Joint Disk and Interclavicular ligament

• During this movement of the clavicle, the medial end of clavicle rolls and slides on relatively stationary SC disk with upper attachment of disk serving as the pivot point.

• Elevation and Depression

• During this movement, the SC disk and the clavicle slides and rolls on Manubrium with Lower attachment of disk as Pivot point.

• Protraction and Retraction

• Mechanical axis for the motions (Elevation/Depression and Protraction/Retraction) is not on the SC disk but on the?

• Costoclavicular Ligament

• The compartment of SC JOINT found between the SC Disk and Clavicle which is used for Elevation and Depression of the clavicle.

• Lateral Compartment

• The compartment of SC Joint found between SC disk and manubrium and is responsible for Protraction and Retraction of the Clavicle.

•Medial Compartment

• The third compartment responsible for Anterior and Posterior Rotation.

•Costoclavicular Joint

• Three ligaments that reinforces the Sternoclavicular Joint

• Sternoclavicular ligaments• Costoclavicular ligaments• Interclavicular ligaments

• The ligament of SC joint that checks anterior and posterior translatory movement of the medial end of clavicle.

• Sternoclavicular Ligament

• Ligament of SC joint between clavicle and 1st rib and checks elevation of lateral end of clavicle resulting to inferior gliding of the medial end of clavicle.

•Costoclavicular Ligament

• Ligament of SC joint that resist excessive depression of the distal end of clavicle and superior glide of the medial end of clavicle

• Interclavicular Ligament

• In this type of movement on SC joint, the surface of clavicle is convex while the manubrium and costal cartilage is concave, and the lateral end of clavicle moves in the anterior and posterior axis.

• Elevation and depression

• In this type of movement on SC joint, the clavicle is concave and the manubrium is convex and the lateral end of clavicle moves in a vertical axis.

• Protraction and Retraction

• In this type of movement, the lateral end of clavicle spins between saddle shaped surface of medial clavicle and manubriocostal facet in a longitudinal axis.

• Anterior and Posterior Rotation

• This type of joint is formed by the acromion of scapula and lateral end of clavicle.

•Acromioclavicular Joint

• The three ligaments of Acromioclavicular Joint.

• Superior Acromioclavicular Ligament• Inferior Acromioclavicular Ligament• Coracoclavicular Ligament

Ligaments of AC Joint

• Ligament of AC joint that assist the AC capsule in apposing articular surface and controlling A-P joint stability;

• Superior and Inferior AC ligaments

• This AC ligaments firmly unites the clavicle and the scapula and provide much of joint stability

• Coracoclavicular Ligament

• The two portions of Coracoclavicular ligament.

• Trapezoid ligament• Conoid ligament

• This portion of the Coracoclavicular ligament provides resistance to posterior translatory forces applied to distal clavicle.

• Trapezoid ligament

• This portion of the Coracoclavocular ligament provides primary restraint for AC joint in inferior and superior directions.

• Conoid ligament

• This type of AC movement occurs on vertical axis.

Internal and External Rotations

• In this type of AC movement, there is tilting of scapula in relation to clavicle in an oblique coronal axis.

Anterior and Posterior Tipping

• During this Tipping, the acromion tips forward and the inferior angle tips backward.

Anterior Tipping

• During this type of tipping, the acromion rotates backward, and the inferior angle forward

Posterior Tipping

• In this type of AC movement, the scapula rotates in an oblique A-P axis perpendicular to the plane of the scapula.

Upward and Downward Rotation

• Articulation between the scapula and thorax and said to be not true anatomic joint since it has no usual joint characteristics.

Scapulothoracic joint

• Resting position of the scapula on the posterior thorax.

• 2 inches from the midline between 2nd thru 7th ribs

• Internally rotated 30 – 45 degree from coronal plane

• Tipped anteriorly 10-20 degree from the vertical

• Upwardly rotated 10 – 20 degree from the vertical

• Principal motion of the scapula during elevation of the arm and is influenced by SC joint elevation/depression, SC joint A/P rotation and P/A rotation of AC joint.

Upward and Downward Rotation

• Movement of the scapula by shrugging the shoulder up and depressing the shoulder downward influenced by elevation and depression of clavicle at SC joint and rotations at AC joint

Elevation and Depression Rotation

• Translatory motion of the scapula toward or away from the vertebral column influenced by protraction and retraction of clavicle at SC joint and rotations at AC joint.

Protraction and Retraction

• Ultimate function of Scapular Motions

• Orient the Glenoid fossa for optimal contact with maneuvering arm

• To add range of elevation to the arm• To provide a stable base for controlled

motions between humeral head and glenoid fossa

• Articulation formed by the head of humerus and Glenoid cavity of the scapula.

Glenohumeral Joint

• 130 -150 degree angle formed by the axis of humerus head and neck with the shaft at longitudinal axis.

Angle of inclination

• 30 degree angle formed by the axis of humerus head and neck with humeral condyles in transverse axis.

Angle of Torsion

• The normal posterior position of the humeral head with regards to the humeral condyles.

• Posterior Torsion, Retrotorsion or Retroversion of humerus

• What increases GH joint congruence?

• Retroversion of humeral head by turning the humeral head back to the glenoid fossa of the scapula• Glenoid Labrum – enhances total

available articular surface of glenoid fossa

Glenoid Labrum

• A thin area of capsule between superior and inferior GH ligaments and is a point of weakness in the GH capsule.

• Foramen of Weitbrecht

• The Glenohumeral joint is reinforced by these three ligaments.

• Superior, middle and Inferior GH ligaments• Coracohumeral ligaments

GH ligaments

• This GH ligament passes from superior glenoid labrum to the upper neck of humerus deep to coracohumeral ligament.

• Superior GH ligament

• This GH ligament runs obliquely from the superior anterior labrum to the anterior aspect of the proximal humerus below the superior GH ligament.

• Middle GH ligament

• The three portions of the inferior GH ligament complex (IGHLC).

• Anterior band• Posterior band • Axillary Pouch

• This GH ligament originate from the base of coracoid process and inserts into scapula and humerus.

Coracohumeral ligament

• Two heads of coracoacromial ligament.

• 1st head inserts in the supraspinatus and greater tubercle where it joins the superior GH ligament• 2nd head inserts in the subscapularis

and lesser tubercle

• The tunnel formed by the two bands contains the ?

• Tendon of the long head of biceps brachii.

• This is formed by the coracoid process acromion and coracoacromial ligament.

Coracoacromial arch

• The coracoacromial arch forms an osteoligamentous vault that covers what structures?

• Humeral head• Subacromial bursa• Rotator cuff tendons• A portion of the tendon of the

long head of biceps brachii.

• Coracoacromial arch is very important in preventing the head of humerus from dislocating superiorly, because an unopposed upward translatory force on humerus would?

• Cause the head of humerus from hitting the coracoacromial arch leading to impingement or mechanical abrasion of the underlying structures.

• A combination of subacromial and subdeltoid bursa which separates the supraspinatus tendon and head of humerus from acromion, coracoid process, coracromial ligament and deltoid muscle.

Subacromial Bursa

• The function of Subacromial bursa?

• Permits smooth gliding between the humerus and supraspinatus tendon and surrounding structure.• Interruption in this structure can

cause pain and limitation of GH motion

• The primary purpose of wrist, elbow and shoulder complex

• Enhancing hand function

• The elbow joint is what type of synovial joint?

• Loose Hinge Joint

• The articulating surface of humerus with ulna and radius.

• Humerus - Trochlea, Coronoid fossa, radial fossa and Capitulum (Anteriorly) and Olecranon Fossa (Posteriorly)

• Radius - head of radius• Ulna – Trochlear notch

• Receives head of radius during flexion.

• Radial Fossa

• Receives coronoid process of ulna during flexion.

• Coronoid Fossa

• Receives olecranon process of ulna during extension.

• Olecranon Fossa

• This results to valgus angulation of the forearm.

• The distally oriented projection of the medial portion of trochlea compared to its lateral portion.

• Divides Trochlea into lateral and medial portion.

• Trochlear groove

• Separates capitulum from Trochlea.

• Capitulotrochlear groove

• Divides the trochlear notch into two portions.

• Trochlear ridge

• (1)Part of the trochlea of humerus which corresponds to this (2) part of trochlear notch of Ulna which form articulations.

• (1) Trochlear groove• (2) Trochlear ridge

• This part of Head of radius which fits into the Capitulotrochlear groove?

• Fovea

• Articulation of this joint is through the sliding motion of ulnar trochlear ridge with humeral trochlear groove and is congruent.

• Humeroulnar joint

• Articulation of this joint occurs through sliding of concave radial head over convex capitulum and is incongruent.

• Humeroradial joint

• During this motion of the elbow, the sliding occurs until the olecranon process of ulna enter olecranon fossa of humerus while no contact occurs between capitulum and head of radius.

• Extension

• During this motion of the elbow, sliding occurs until coronoid process reaches the coronoid fossa while the rim of the head of radius slides in the capitulotrochlear groove and enter radial fossa as end of ROM.

• Flexion

• Ligament found in lateral and medial side of most hinge joints to provide stability to the joint and to keep joint surfaces in apposition.

• Collateral ligament

• This type of collateral ligament is located on the ulnar side and a major soft tissue restraint of valgus stress at the medial aspect of the elbow.

• Medial Collateral ligament

• This part of the medial collateral ligament is the primary restraint of valgus stress from 20 – 120 degree elbow flexion.

• Anterior part of medial collateral ligament

( the posterior part plays less significant role)

• Consist the Lateral Collateral Ligament Complex ?

• Lateral Collateral Ligament• Lateral Ulnar Collateral Ligament• Annular Ligament

• This component of the Lateral Collateral Ligament complex is a fan shaped structure that extends from the inferior aspect of lateral epicondyle of humerus to head of radius and olecranon process.

• It offers some protection against varus stress in some position in the elbow and provide resistance to longitudinal distraction of joint surface

• Lateral Collateral Ligament

• This component of Lateral collateral ligament complex is a ligamentous tissue extending from lateral epicondyle to the lateral aspect of the ulna and annular ligament.

• Lateral Ulnar Collateral Ligament

• Lateral deviation of ulna in relation to humerus due to trochlea’s medial aspect extends more distally than the lateral aspect.

• Carrying angle or Cubitus Valgus

• Average carrying angle in full elbow extension.

• 15 degrees

• Abnormal angulation of the elbow

• Varus angulation or Cubitus Varus

• Normally, carrying angle disappears when?

• Forearm is pronated and elbow is in full extension• Forearm is supinated and elbow is in

full flexion

• What are the factors that affect ROM of HU and HR joints?

• Type of motion Active flexion – 135-145 deg; Passive flexion – 150-160 deg

• The Position of forearmPronation – ROM is lessSupination – ROM is great

• Position of shoulder Due to muscles of biceps and triceps brachii

• Consist the Superior Radioulnar Joint.

• Ulnar radial notch• Annular ligament• Capitulum• Head of radius

• Consist the Inferior Radioulnar Joint.

• Ulnar notch of radius• Articular disk• Ulnar head

• A component of Superior Radioulnar joint located lateral to ulna inferior to trochlear notch and has concave surface covered with articular cartilage

• Ulnar radial notch

• A circular ligament attached to anterior and posterior edges of the notch and encircles the rim of radial head; also covered with articular cartilage.

• Annular ligament

• A component of Inferior radioulnar joint located at distal end of radius along interosseous border.

• Ulnar notch of radius

• Articular disk of RU joint is also known as?

• Triangular Fibrocartilage (TFC) because of its triangular shape

• (a part of Triangular Fibrocartilage Complex (TFCC) because of its extensive fibrous connections)

• The Articular disk’s base is attached to edge of ulnar notch while its apex are attached to?

• Fovea of ulnar head• Base of ulnar styloid

• The proximal surface of the Articular disk of RU joint articulates with?

• Ulnar head

• The distal surface of the articular disk of RU joint articulates with?

• Carpal bones

• The pole of the Ulnar head articulates with?

• Articular Disk of RU joint

• The seat of the ulnar head articulates with?

• Ulnar notch of radius

• This movement of the forearm is a result of the crossing over of the radius over ulna at the superior radioulnar joint.

• Pronation

• These are the ligaments that consist the Superior radioulnar joint.

• Annular ligament• Quadrate

ligament• Oblique cord

• This Superior RU ligament forms 4/5 of the ring that encircles the radial head.

• Annular ligament

• This superior RU ligament extends from the inferior edge of radial notch of ulna and inserts into the neck of radius.

•Quadrate ligament

• This RU ligament helps maintain radial head in apposition with radial notch and limits spin of the radial head in supination and pronation.

• Quadrate ligament

• This Superior RU ligament is a flat fascial band on ventral forearm that extends from an attachment just inferior to radial notch of ulna and inserts just below the bicipital tuberosity of radius.

• Oblique Cord

• This superior RU ligament assists in preventing separation of radius and ulna

• Oblique cord

• This consist the ligaments of inferior RU joint

• Dorsal Radioulnar ligament• Palmar

Radioulnar ligament• Interosseous

membrane (IOM)

• This ligament of the inferior RU joint is longitudinally oriented collagen fibers extending along margins of articular disk to insert in ulnar fovea and base of ulnar styloid process.

• Dorsal and Palmar radioulnar ligament

• (palmar radioulnar ligament is longer than dorsal radioulnar ligament)

• This ligament of the inferior radioulnar joint attaches between the shafts of radius and ulna and maintains space between radius and ulna during forearm rotation.

• Interosseous membrane

• During this motion of the Forearm, the radius and ulna are parallel with one another and the ulnar head moves proximally and medially.

• Supination

• During this motion of the forearm, the radius crosses the forearm and the ulnar head moves distally and dorsally.

•Pronation

• Factors that limits pronation of forearm.

• Passive tension in biceps brachii when elbow is extended• Bony approximations of radius and

ulna• Tension in dorsal RU ligaments and

Oblique cord

• Factors that limits supination of forearm.

• Passive tension in palmar RU ligaments and Oblique cord

• Two joints of the Wrist complex.

• Radiocarpal joint• Midcarpal joint

• Compose the Proximal joint surface of Radius.

• Lateral radial facet•Medial Radial facet• TFCC

• The lateral radial facet articulates with?

• Scaphoid

• The medial radial facet articulates with?

• Lunate

• The TFCC articulates with?

• Triquetrum

• The proximal radiocarpal joint surface is oblique, angled slightly volarly and ulnarly . The average inclination of distal radius is?

• 23 degrees

• The radioulnar disk is connected medially via these two dense fibrous connective tissue laminae.

• Dorsal and Volar RU ligament• Ulnar Collateral ligament

• This dense fibrous connective tissue lamina connects the RU disk medially to the ulnar head of styloid process in the upper lamina

• Dorsal and volar radioulnar ligament

• This dense fibrous connective tissue lamina connects the RU disk medially to the sheath of ECU tendon and triquetrum, hamate and base of 5th metacarpal in lower lamina

• Ulnar Collateral Ligament

• Consist the Proximal row of Carpal bones that articulates with distal radius.

• Scaphoid• Lunate and• Triquetrum

• These proximal carpal row is reinforced by these ligaments.

• Scapholunate interossious ligament • Lunotriquetral interosseous

ligament

• This carpal bone do not articulate with radius and acts like a sesamoid bone that increase the moment arm of flexor carpi ulnaris (FCU) tendon.

•Pisiform

• These are factors that affect joint function.

• Joint incongruence and angulation of proximal joint surface• Length of ulna in relation to radius

• Effect of joint incongruence and angulation on joint function.

• It results to greater range of flexion and extension • and greater ulnar deviation than

radial deviation on RC joint

• This is a condition in which the TFCC is thicker because the ulna is shrter than the radius. It may result to abnormal force distribution across RC joint and potential degeneration of the said joint.

• Ulnar negative variance

• In this condition, the TFCC is thinner because ulna is loner than the radius and so there is a potential for impingement of TFCC structures between ulna and radius.

• Ulnar Positive Variance

• This consist the Midcarpal Joint surface.

• The proximal row of carpal bones (scaphoid, lunate and triquetrum)

• The distal carpal row of carpal bones ( trapezium, trapezoid, capitate and hamate)

• The Midcarpal joint is reinforced by the following ligaments.

• Extrinsic ligament• Intrinsic ligament

• This MC ligament connects carpals to radius or ulna proximally or to metacarpals distally

• Extrinsic ligaments

• MC ligaments that connect carpals themselves. Also known as intercarpals or interosseous ligaments.

• Intrinsic ligaments

• Consist the Volar radiocarpal ligament

• Radioscapholunate• Radiolunate• Radioscaphocapitate

• Compose the Ulnocarpal ligament complex

• TFCC• Ulnolunate ligament• Ulnar Collateral ligament

• This Volar RC ligament is said to be avascular and is a key factor of scaphoid stability. Injury to this ligament results to scaphoid instability and one of the common wrist problems.

• Scapholunate interosseous ligament

• These compose the Dorsal Carpal ligaments.

• Dorsal radiocarpal ligament• Dorsal intercarpal ligament

• Compose of the articulations between distal carpal row and bases of 2nd through 5th metacarpal.

• Carpometacarpal joint

• The 2nd metacarpal articulates with?

• Primarily with Trapezoid• Secondarily with Trapezium and

capitate

• 3rd metacarpal articulates with?

• Capitate

• 4th metacarpal articulates with?

• Capitate and Hamate

• 5th metacarpal articulates with?

• Hamate

• The carpal tunnel contains?

•Median nerves • 9 flexor tendons

• In Carpometacarpal joint, range of motion (ROM) increases from?

• Radial to ulnar side

• 2nd through 4th metacarpophalangeal joints’ ROM

• Uniaxial (flexion and extension)

• They are immobile metacarpophalangeal joints

• 2nd and 3rd MP joints – they provide a fixed and stable axis for movement of 4th and 5th MP joint

• The 5th MP joint’s ROM?

Saddle Joint – biaxial – flex/ext, abd/add, opp

• CMC joints are reinforced by these ligaments.

• Deep Transverse Ligaments

• Arches of the hand.

• Proximal Transverse Arch• Distal Transverse Arch• Longitudinal Arch

• This arch is formed by the trapezoid, capitate and hamate.

• Proximal Transverse Arch

• Formed by the adjustable 1st, 4th and 5th MP heads around a relatively fixed 2nd and 3rd MP

• Distal Transverse Arch

• The arch that traverse the length of the digit from proximal to distal.

• Longitudinal Arch

• This allow the palm and the digits to conform optimally to the shape of the object being held maximizing the amt. of surface contact, enhancing stability and increasing sensory feedback

• Palmar Arches

• Increases joint congruence at each MP joints, provides stability by limiting hyperextension and therefore provides indirect support to longitudinal arch.

• Volar Plates/Palmar Plates

• Helps stabilize the volar plates over each side of the 4 metacarpals heads

• Sagittal bands

• Ligaments that reinforce MP joints.

• Radial Collateral ligament• Radial Accessory Collateral ligament• Ulnar Collateral ligament• Ulnar Accessory Collateral Ligament

• Reference: Joints and Structures by Norkin and Levangie