JOINTS OF THE UPPER LIMB
Department of Anatomy
University of Szeged
2017
View-points of covering of upper limb joints
Terminological name of joint
Terminológical names of joing bony surfaces
Morfological / functional type of joint
Movements (axises) in the joint
Capsule of joint
Ligaments (external, internal) of joint
Special and additional components of joint
(Blood supply and innervation of joint)
Joints of the shoulder girdle:
connections of the upper limb bones with the trunk
Sternoclavicular joint
Acromioclavicular joint
Joints of the free upper limb:
connections between the bones of the upper limb
The humeral or shoulder joint
The cubital or elbow joint
Connections between the bones of the forearm:
Proximal radioulnar joint
Middle radioulnar joint
Distal radioulnar joint
Joints of the hand:
Radiocarpal or wrist joint
Intercarpal joints + joint of the pisiform
Carpometacarpal joint
Metacarpophalangeal joint
Interphalangeal joint
CONNECTIONS BETWEEN BONES OF SHOULDER GIRDLE
ACROMIOCLAVICULAR JOINT
STERNOCLAVICULAR JOINT
STERNOCLAVICULAR JOINT Articular facets:
Facets are covered by fibrocartilage and the joint is Sternal end of clavicle
completely divided by an articular disc.
Ligaments: Clavicular notch of sternum
1. Interclavicular lig.
2. Ant. and post. sternoclavicular lig.
3. Costoclavicular lig.
Movements:
Elevation – depression (around sagittal axis)
Protraction – retraction (around vertical axis)
Rotation
ACROMIOCLAVICULAR JOINT Articular facets:
trapezoid lig. Acromial end of clavicle
coracoacromial
lig.
} coracoclavicular
lig.
Flat acromial surface of the
conoid lig.
acromion
Facets are covered by fibrocartilage, articular
disc is often found.
Movements:
Every movement of the clavicle is assotiated with
the movements of the scapula. Movements of the
scapula are usually accompanied by movements
of the humerus and the shoulder joint
Ligaments:
1. Acromioclavicular lig.
2. Coracoclavicular lig.: it has two parts – trapezoid and conoid
3. Coracoacromial lig. : it bridges the coracoid process and the acromion of the
scapula and forms arch above the shoulder joint called: shoulder vault.
THE HUMERAL or SHOULDER JOINT I.
Articular facets:
Glenoid cavity of scapule
Head of humerus
Bursae (from bursa, a purse):
Like synovial tendon sheaths, are
connective tissue sacs with a slippery
inner surface, and are filled with synovial
fluid.
Bursae below coracoacromial arch:
1. Subdeltoid bursa: 2. Subacromial bursa:
Lies between the tendon of the Lies deep to the acromion. Generally
supraspinatus below and the deltoid communicate with the subdeltoid bursa
and coracoacromial arch above.
THE HUMERAL or SHOULDER JOINT II.
tendon of long head of biceps muscle
glenoid labrum
Fibrous capsule:
Envelops the joint from the glenoid labrum to
the anatomical neck of the humerus. It
includes the origin of the long head of the
biceps muscle (supraglenoid tubercle).
Fibrocartilaginous rim is attached to the margin of glenoid
cavity, the glenoid labrum,
labrum deepens this cavity.
THE HUMERAL or SHOULDER JOINT III.
The capsule forms a sheath around this tendon into the intertubercular
groove as far as the surgical neck a the humerus (intertubercular tendon
sheath).
THE HUMERAL or SHOULDER JOINT IV.
coracohumeral ligament
Ligaments:
Glenohumeral ligament
Coracohumeral ligament
Movements: Ball-and socket; multiaxial joint
glenohumeral ligament
Flexion – extension (anteflexion – retroflexion, anteversion – retroversion)
Abduction – adduction
Rotation – around the construction axis of the arm which origins from the
center of head, to the capitulum of the humerus.
Circumduction
Comment:
the shoulder joint is a weak and the muscles, which surrounded it, give the
support. Paralysis of the muscles causes subluxation of the joint!
THE CUBITAL OR ELBOW JOINT trochoginglymus
1. Humeroulnar joint - 2. Humeroradial joint – 3. Proximal radioulnar joint -
hinge ball and socket pivot
Articular facets: Articular facets: Articular facets:
trochlea of the humerus capitulum of the humerus art. circumference of head of
radius
trochlear notch of the ulna art. facet of the head of radius notch of the ulna
THE CUBITAL OR ELBOW JOINT trochoginglymus
Capsule: broad and thin anteriorly and dorsal, thick at both sides. It attaches to
the epicondyle above, enclosing the radial and coronoid fossa below to the neck
of the radius and to the rim of the olecranon fossa.
Ligaments:
radial collateral
lig.
anterior posterior
ulnar collateral lig.
Movement: in the humeroulnar joint: uniaxial, hinge joint.
Flexion – extension are the only possible movements this
type of joint. Ulna moves on the trochlea
Ligaments of joint:
collateral ulnar lig.
collateral radial lig.
anular radii lig. (inner surface is covered by thin cartilage layer)
Additional components of elbow joint:
sacciform recess (s a thin extension of the articular capsule of the proximal
radioulnar joint, under the anular ligament of radius)
bursa subcutanea olecrani: bursa between the olecranon of the ulna and
the skin.
bursa subtendinea musculi tricipitis brachii
bicipitoradial bursa is a bursa located at the insertion of biceps muscle
Tennis elbow (lateral epicondylitis) is a painful condition of the elbow caused by
overuse (extensor muscles).
Golfer's elbow (medial epicondylitis) causes pain and inflammation in the tendons of
flexor muscles of forearm.
Olecranon bursitis is a condition characterized by pain, redness and swelling
around the elbow, caused by inflammation of the fluid filled sac of the elbow joint.
DISLOCATION (luxatio cubiti): Radius and ulna move away from humerus.
Cubital tunnel syndrome : more commonly known as ulnar neuropathy, occurs
when the ulnar nerve is irritated and becomes inflamed.
CONNECTIONS BETWEEN THE FOREARM
1. Proximal radioulnar joint - pivot
2. Interosseal membrane -
syndesmosis
3. distal radioulnar joint - pivot
The axis about which the movements occur is called
construction axis of the forearm. This axis is the
continuation of the construction axis of the arm
supination pronation
(origins from the center of head, to the capitulum of
the humerus) connects the head of the radius with
Movements the styloid process of the ulna.
CARRYING ANGLE OR PHYSIOLOGIC ABDUCTION
OF THE ARM:
When the forearm is fully extended, the arm and
forearm are not in same line. The forearm is
directed a bit laterally and forms with the arm
the carrying angle about 163o opens to the
lateral side.
163 o
THE JOINTS OF THE HAND
radiocarpal joint
intercarpal joint
carpometacarpal joint
ulna
radius
lunate
sc
pisiform a ph
oi
d
l
tra
ue
te
q
tri
ita
m
ziu
p
e
id
at
ca
pe
zo
m
tra
pe
ha
a
tr
THE RADIOCARPAL or WRIST JOINT ellipsoid joint
Articular facets:
Distal end of radius + articular disc ( which excludes the ulna
from the joint)
Proximal articular surfaces of scaphoid, lunate, triquetrum rise
to a highly convex surface
INTERCARPAL JOINT +
JOINT OF PISIFORM
plain joints
Articular facets:
Proximal and distal row of
carpal bones
THE RADIOCARPAL or WRIST JOINT
Movements: biaxial - ellipsoid joints
VOLARFLEXION ABDUCTION
(radial abduction)
right hand
DORSALFLEXION ADDUCTION
(ulnar abduction)
Ligaments of the hand
Dorsal radiocarpal lig. Palmar radiocarpal lig.
Dorsal ulnocarpal lig. Palmar ulnocarpal lig.
Ulnar and radial collateral ligg.: they are Pisohamate lig.
poorly developed Pisometacarpal lig.
carpi radiatum lig.
dorsal palmar radiocarpal lig.
ulnocarpal palmar
lig. ulnocarpal lig.
dorsal radiocarpal
lig.
radial collateral pisohamate lig.
ulnar lig.
collateral lig.
pisometacarpal
lig.
carpi radiatum lig.
Dorsal aspect
Volar/palmar aspect
CARPAL TUNNEL
Radial carpal eminence:
5 anatomical structures tubercle of the scaphoid and
trapezium
median n.
Ulnar carpal eminence:
flexor carpi radialis m. pisiform and hook of hamate
Flexor retinaculum / lig. carpi trasversum
ANTERIOR ASPECT OF THE WRIST
flexor pollicis longus m.
flexor digitorum superficialis m.
flexor digitorum profundus m.
RADIOGRAPH OF RIGHT HAND
Fingers / digits:
digitus primus /1st finger / pollex
digitus secundus / 2nd finger / index
digitus tertius / 3rd finger / digitus medius
digitus quartus / 4th finger / digitus anularis
digitus quintus / 5th finger / digitus minimus
phalanges
metacarpal bones
carpal bones
THE 1st CARPOMETACARPAL JOINT
Articular facets:
Saddle-shaped articular surface of trapezium Movements:
abduction – adduction
Saddle-shaped articular surface of the base of
opposition – reposition
the 1st metacarpal bone slight rotation
Carpometacarpal joint
Metacarpophalangeal joint
Interphalangeal joints
Articular facets: METACARPOPHALANGEAL JOINTS
Head of the metacarpal Ligaments:
bone Each joint has a palmar and two collateral ligaments.
Palmar lig,:
oval concavity of the Deep transverse metacarpal lig.:
proximal phalages Collateral ligg.: strong rounded cord along the sides
of the joints (with excentric origin)
Movements: ellipsoid joints
Flexion – extension
Abduction – adduction (in flexion is restricted,
because the collateral ligg. are thightened)
Circumduction
ARTICULATIONES INTERMETACARPALES
Type of joint:
Amphiarthrosis / plain joint
Ligament of joint:
palmar metacarpal ligg.
dorsal metacarpal ligg.
interosseal metacarpal ligg.
INTERPHALANGEAL JOINTS
Joints between the
prox. – middle
middle – distal phalanges
This joints include functionally the
metacarpophalangeal and interphalangeal
joint of the thumb.
Ligaments: are same with the ligaments
of metacarpophalangeal joint, except the
collateral ligaments origin centrally.
Type of joint: ginglymus
Movements:
Flexion - extension
This presentation prepared from production of
Andrea Czigner
Annamária Kovács
Roland Weiczner
