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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
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