Articulation of the upper extremity.ppt

7/30/2019 Articulation of the upper extremity.ppt

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Articulation of the upper extremity

By Dr. Eyad Skaik M.D. Ph.D.


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Joint architecture classification


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The Shoulder Girdle


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The Shoulder Girdle* The shoulder-joint is an enarthrodial or

ball-and-socket joint.* The bones entering into its formation arethe hemispherical head of the humerus andthe shallow glenoid cavity of the scapula,an arrangement which permits of veryconsiderable movement .

* While the joint itself is protected againstdisplacement by the tendons whichsurround it. The ligaments do not maintainthe joint surfaces in apposition, becausewhen they alone remain the humerus can

be separated to a considerable extent fromthe glenoid cavity; their use, therefore, isto limit the amount of movement.


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* The joint is protected above by an

arch, formed by the coracoidprocess, the acromion, and the

coracoacromial ligament.

* The articular cartilage on the

head of the humerus is thicker at

the center than at the

circumference, the reverse being

the case with the articular

cartilage of the glenoid cavity.


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The ligaments of the shoulder are:* The Articular Capsule: The articular

capsule completely encircles the joint,being attached, above, to thecircumference of the glenoid cavity

beyond the glenoidal labrum; below, tothe anatomical neck of the humerus,approaching nearer to the articularcartilage above than in the rest of itsextent. It is thicker above and belowthan elsewhere, and is so remarkablyloose and lax, that it has no action inkeeping the bones in contact, but

allows them to be separated from eachother more than 2.5 cm., an evident

provision for that extreme freedom ofmovement which is peculiar to thisarticulation.


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* It is strengthened, above, by the Supraspinatus;below, by the long head of the Triceps

brachii; behind, by the tendons of theInfraspinatus and Teres minor; and in front,

by the tendon of the Subscapularis. There areusually three openings in the capsule. Oneanteriorly, below the coracoid process,

establishes a communication between thejoint and a bursa beneath the tendon of theSubscapularis. The second, which is notconstant, is at the posterior part, where anopening sometimes exists between the jointand a bursal sac under the tendon of the

Infraspinatus. The third is between thetubercles of the humerus, for the passage ofthe long tendon of the Biceps brachii .


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Glenohumeral Ligaments

* In addition to the

coracohumeral ligament,

three supplemental

bands, which are namedthe glenohumeral

ligaments, strengthen the

capsule.


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The Transverse Humeral Ligament:

* is a broad band passingfrom the lesser to thegreater tubercle of the

humerus, and alwayslimited to that portion ofthe bone which liesabove the epiphysial line.

It converts theintertubercular grooveinto a canal.


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The Glenoidal Labrum :

* is a fibrocartilaginous rim attachedaround the margin of the glenoidcavity. It is triangular on section,the base being fixed to thecircumference of the cavity, while

the free edge is thin and sharp. It iscontinuous above with the tendonof the long head of the Biceps

brachii, which gives off twofasciculi to blend with the fibroustissue of the labrum. It deepens thearticular cavity, and protects theedges of the bone.


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Synovial membrane:

* is reflected from the margin of the

glenoid cavity over the labrum; it is

then reflected over the inner surface

of the capsule, and covers the lower

part and sides of the anatomical

neck of the humerus as far as the

articular cartilage on the head of the

bone. The tendon of the long head

of the Biceps brachii passes through

the capsule and is enclosed in a

tubular sheath of synovial

membrane.


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* More than eight bursae are

present around the shoulder

joint, the most important of

which is the subacromial bursa.

* The shoulder-joint is capable of

every variety of movement,

flexion, extension, abduction,

adduction, circumduction, androtation.


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Shoulder dislocation

* is a common sport injury

- usually anterior

- posterior and inferior

dislocations are common.

- can be recurrent or habitual


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Acromioclavicular joint

* The acromioclavicular

articulation is an

arthrodial joint between

the acromial end of theclavicle and the medial

margin of the acromion

of the scapula.


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Its ligaments are:

* The Articular Capsule: The articular

capsule completely surrounds the

articular margins, and is

strengthened above and below by

the superior and inferior

acromioclavicular ligaments.

* ligaments:

-The Superior Acromioclavicular

Ligament- The Inferior Acromioclavicular

Ligament


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*The Articular Disk: The articular diskis frequently absent in this articulation.When present, it generally only

partially separates the articularsurfaces, and occupies the upper part ofthe articulation .* The Coracoclavicular Ligament: This

ligament serves to connect the claviclewith the coracoid process of thescapula. It does not properly belong tothis articulation, but is usuallydescribed with it, since it forms a mostefficient means of retaining the

clavicle in contact with the acromion.It consists of two fasciculi, called thetrapezoid and conoid ligaments.


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The movements of this articulation are of two kinds:

(1) a gliding motion of the articular end of the

clavicle on the acromion.

(2) rotation of the scapula forward and backwardupon the clavicle.


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* The Coracoacromial

Ligament:This ligament,

together with the coracoid

process and the acromion,forms a vault for the

protection of the head of

the humerus.


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Rockwood subtypes of AC separation ( dislocation)


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Sternoclavicular Articulation

* It is an arthrodial joint formed by the sternal end of theclavicle, the upper and lateral part of the manibriumsterni, and the cartilage of the first rib.* The Articular Capsule: The articular capsule surroundsthe articulation and varies in thickness and strength. Infront and behind it is of considerable thickness, and forms

the anterior and posterior sternoclavicular ligaments; butabove, and especially below, it is thin.- The Anterior Sternoclavicular Ligament

- The Interclavicular Ligament

- The Costoclavicular Ligament

* This articulation admits of a limited amount of motion innearly every direction, upward, downward, backward,forward, as well as circumduction.


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Scapulothoracic joint

* It is formed between the scapula and the thorax,

there is no bony attachment, scapular muscles

provide stability for the scapula.

* Scapular movements: Elevation, depression

upward rotation and downward rotation

abduction and adduction


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The elbow joint* The elbow-joint is a ginglymus or hinge-joint. The

trochlea of the humerus is received into thesemilunar notch of the ulna, and the capitulum ofthe humerus articulates with the fovea on the headof the radius.

* The articular surfaces are connected together by acapsule, which is thickened medially and laterally,and, to a less extent, in front and behind. Thesethickened portions are usually described as distinctligaments under the following names:

-The Anterior Ligament

-The Posterior Ligament

-The Ulnar Collateral Ligament

-The Radial Collateral Ligament


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The Annular Ligament:* This ligament is a strong band of fibers, which

encircles the head of the radius, and retainsit in contact with the radial notch of the ulna.

* It forms about four-fifths of the osseo-fibrousring, and is attached to the anterior andposterior margins of the radial notch a

thickened band which extends from theinferior border of the annular ligament belowthe radial notch to the neck of the radius isknown as the quadrate ligament.

* The movements allowed in this articulation

are limited to rotatory movements of thehead of the radius within the ring formed bythe annular ligament and the radial notch ofthe ulna.


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Radioulnar synostosis


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The wrist joint

* Distal Radioulnar Articulation: This is a

pivot-joint formed between the head of the

ulna and the ulnar notch on the lower end of

the radius.* The articular surfaces are connected together

by the following ligaments:

-The Volar Radioulnar Ligament.-The Dorsal Radioulnar Ligament.


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Radiocarpal Articulation or Wrist-joint

* The wrist-joint is a condyloid articulation. The parts

forming it are the lower end of the radius and undersurface of the articular disk above; and the navicular,lunate, and triangular bones below. The articularsurface of the radius and the under surface of thearticular disk form together a transversely ellipticalconcave surface, the receiving cavity. The superiorarticular surfaces of the navicular, lunate, and

triangular form a smooth convex surface, thecondyle, which is received into the concavity. The

joint is surrounded by a capsule, strengthened by thefollowing ligaments:

The Volar Radiocarpal Ligament

The Dorsal Radiocarpal Ligament

The Ulnar Collateral LigamentThe Radial Collateral Ligament

* The movements permitted in this joint are flexion,extension, abduction, adduction, and circumduction.


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Intercarpal articulation

* Articulations of the Proximal Row ofCarpal Bones : These are arthrodial joints.

The navicular, lunate, and triangular are

connected by dorsal, volar, and interosseous

ligaments.

* Articulations of the Distal Row of Carpal

Bones : These also are arthrodial joints; thebones are connected by dorsal, volar, and

interosseous ligaments.


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Carpometacarpal Articulation of the

Thumb :

* It enjoys great freedom of movement on account

of the configuration of its articular surfaces,

which are saddle-shaped.

In this articulation the movements permitted areflexion and extension in the plane of the palm of

the hand, abduction and adduction in a plane at

right angles to the palm, circumduction, andopposition.


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CMC ARTHRITIS


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Articulations of the Other Four

Metacarpal Bones with the Carpus

* The joints between the carpus and the

second, third, fourth, and fifth metacarpal

bones are arthrodial. The bones are united by

dorsal, volar, and interosseous ligaments .


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Intermetacarpal ligaments

* The bases of the second, third, fourth and fifth

metacarpal bones articulate with one another

by small surfaces covered with cartilage, and

are connected together by dorsal, volar, andinterosseous ligaments.


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Metacarpophalangeal Joints:

* These articulations are of the condyloid kind, formed

by the reception of the rounded heads of the

metacarpal bones into shallow cavities on the

proximal ends of the first phalanges, with the

exception of that of the thumb, which presents more

of the characters of a ginglymoid joint. Each joint

has a volar and two collateral ligaments. The

movements which occur in these joints are flexion,

extension, adduction, abduction, and circumduction.


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Interphalangeal Joints:

* The interphalangealarticulations are hinge-joints;each has a volar and two

collateral ligaments. Thearrangement of these ligamentsis similar to those in themetacarpophalangeal

articulations. The Extensortendons supply the place ofposterior ligaments.


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THANX

Articulation of the upper extremity.ppt

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