2-Joints of Upper Limb

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What are the 3 real joints of the pectoral girdle? conceptual joint?: Sternoclavicular, acromioclavicular, glenohumeral
-scapulothoracic
What are the movements of the scapula?: elevate or depress
protraction (lateral or forward movement) or retraction (medial or backward movement)
rotation
What divides the 2 compartments of the SC joint?: articular disc and interclavicular ligament
What type of joint is the SC joint?: saddle type synovial joint, functions like a ball and socket
What is the articular disc of the SC joint fixed to?: fibrous articular capsule
What kind of cartilage is the articular cartilage of the SC joint?: fibrocartilage
What is the articulation of the SC joint?: sternal end of clavicle w/ manubrium of sternum and 1st costal cartilage
What forms the anterior and posterior SC ligaments?: the anterior and posterior thickening of the articular capsule
Name the ligaments of the SC joint. What is there purpose?: anterior and posterior, interclavicular, costoclavicular
make joint strong and prevent dislocation
What arteries supply the SC joint?: internal thoracic and suprascapular arteries
What nerve supplis the SC joint?: medial
Although dislocation of the SC joint is rare where would it most likely occur in a young person? Why?: epiphyseal plate, b/c this cartilaginous structure doesn't close (calcify into a bone) until 23-25 years
What is ankylosis? What should be done to correct it?: fixation which affects movement of the shoulder, need to remove a section of the clavicle in the middle to permit scapular movement
What type of joint is the acromioclavicular joint?: plane type synovial joint
What is the articulation of the AC joint?: acromial end of clavicle and acromion of scapula
What type of cartilage covers the articular surfaces of the AC joint?: fibrocartilage
Describe the articular capsule of the AC joint?: sleeve like, loose, fibrous capsule
What part of the articular capsule of the AC joint is strengthened? What strengthens it?: superior portion by the trapezius
What are the ligaments of the AC joint?: acromioclavicular, coracoacromial, coracoclavicular
Which ligament makes up the superior thickening of the fibrous articular capsule of the AC joint?: acromioclavicular ligament
Where is the coracoacromial ligament located?: between the coracoid process and acromion
Name the 2 ligaments that make up the coracoclavicular ligament. Which is medial? lateral?: conoid ligament-medial
trapezoid ligament-lateral
Where does the conoid ligament stretch?: from root of coracoid process of scapula to conoid tubercle of clavicle
Where does the trapezoid ligament stretch?: from superior surface of coracoid process of scapula to trapezoid line of clavicle
What is the function of the coracoclavicular ligament?: strengthens AC joint and suspends scapula from the clavicle
What arteries supply the AC joint?: suprascapular and thoracoacromial arteries
Which nerves supply the AC joint?: supraclavicular, lateral pectoral, and axillary nerves
Is dislocation of the AC joint common?: yes
What is torn in the dislocation of the AC joint?: coracoclavicular ligament and fibrous capsule of AC joint
What is the result of a torn coracoclavicular ligament?: downward separation of the upper limb from the clavicle making the acromion more prominent
What type of joint is the glenohumeral joint? Is it stable?: ball-and socket synovial joint
unstable
What is the articulation of the glenohumeral joint?: humeral head w/ glenoid cavity
What deepens the glenoid cavity? What type of structure is this?: glenoid labrum
ringlike fibrocartilaginous structure
What allows the humeral head to sit a little more than 1/3 of its surface into the glenoid cavity?: glenoid labrum
What keeps the humeral head in the glenoid cavity?: rotator cuff
Which muscles make up the rotator cuff?: (SITS down & back) suprapinatus, infraspinatus, teres minor, subscapularis
What type of cartilage covers the articular surfaces of the glenohumeral joint?: hyaline
Which sides of the articular capsule of the glenohumeral joint are strengthened? weak?: -medial, lateral and superior
-inferior
What does the fibrous capsule of the GH joint attach to medially? laterally? superiorly? inferiorly?: medial-glenoid cavity
lateral-anatomical neck of humerus
superior-scapula just under root of coracoid process
inferior-capsule is loose
The attachment of the superior portion of the articular capsule to the scapula just underneath the root of the coracoid process encloses what?: the attachment of the long head of the biceps brachii
Which tendon passes through the joint capsule in between the tubercles of the humerus?: tendon of the long head of the biceps
What lines up the inner surface of the capsule including the tendon of the long head of the biceps?: synovial membrane
Where are the apertures (openings) of the articular capsule of the glenohumeral joint located? What does each allow for?: -between the tubercles of the humerus alowing tendon of long head of humerus to pass
-anterior and inferior to coracoid process allowing communications between the synovial cavity of the joint w/ the subscapular bursa
Which ligaments are involved w/ the glenohumeral joint?: glenohumeral, coracohumeral, transverse humeral, coarcoacromial
Which ligament of the glenohumeral joint reinforces the anterior aspect of the capsule?: glenohumeral ligament
Which ligament of the glenohumeral joint forms part of the capsule on the superior side?: coracohumeral
Which ligament of the glenohumeral joint runs from the greater to lesser tubercle of the humerus?: transverse humeral
Where does the coracoacromial ligament run from? What does it prevent?: from acromion to coracoid process
prevents superior dislocation of the glenohumeral joint
What is the most mobile joint of the body?: glenohumeral joint
What movements is the glenohumeral joint allowed to make?: flexion-extension, abduction-adduction, rotation medially-laterally, circumduction
What movements can the SC joint make?: upward (60 degrees), anterior, posterior, inferior (25-30 degrees)
What movements can the AC joint make?: rotation of acromion as much as 50 degrees under the clavicle when scapula is moved by thoracoappendicular muscles
Which muscle groups move the glenohumeral joint? Which is direct? indirect?: thoracoappendicular muscles-indirect
scapulohumeral muscles-direct
Name the chief flexors of the GH joint? Which muscles assist?: -pec major and deltoid
-coracobrachialis and biceps brachii assist
Name the chief extensor(s) of the GH joint.: latissimus dorsi
Name the chief abductor(s) of the GH joint. adductor(s).: abductor-deltoid
adductor-pec major and latissimus dorsi
Name the chief medial rotator of the GH joint. lateral.: medial-subscapularis
lateral-infraspinatus
What are the chief muscles that hold the head of the humerus to the glenoid cavity?: rotator cuff
Which muscles resist downward dislocation of the GH joint? (4): coracobrachialis, short head of biceps, long head of triceps, deltoid
What arteries supply the GH joint?: suprascapular artery, anterior and posterior circumflex arteries
Which nerves supply the GH joint? (3): suprascapular, axillary and lateral pectoral
Which bursa are located around the glenohumeral joint? (3): subscapular, subacromial, subdeltoid
What is the subscapular bursa between? What does it protect?: tendon of subscapularis and neck of scapula
potects the tendon
Where is the subacromial or subdeltoid bursa located?: between the fibrous capsule of the GH joint and deltoid as well as the tendon of the supraspinatus, inferior to the acromion and coracoacromial ligament
Which bursa is affected in calcific supraspinatus tendonitis? What is another name for this? When might it occur?: subacromial bursa
painful arc syndrome
after unusal or excessive use of shoulder
What may become inflammed w/ a rotator cuff injury?: synovial cavity or subacromial bursa
How can one test for degenerative tendonitis?: -ask pt to lower fully abducted limb slowly, at 90 degrees abduction the limb will suddenly drop
ask pt to abduct arm from zero degrees, pain is generated within 15 degrees of abduction
When there is pain generated within 15 degrees of abduction which muscle may be injured?: supraspinatus
Which type of GH joint dislocation is the most common?: inferior anterior-caused by hard blow when the joint is fully abducted
Which direction is the dislocated humeral head pulled?: anterosuperiorly toward subcoracoid location
Which nerve may be injured w/ GH joint dislocation?: axillary
Who is most likely to get a glenoid labrum tear?: baseball throwers
What is fibrosis and scarring in the articualr capsule resulting from injuries around the joint called?: adhesive capsulitis of the GH joint (frozen shoulder)
What can cause adhesive capsulitis of the GH joint?: calcific supraspinatus tendonitis, partial tearing of rotator cuff, bicipital tendonitis
When a patient has adhesive capsulitis of the glenohumeral joint what may the patient have difficulty doing?: abducting arm
What type of joint is the elbow joint?: hinge type synovial joint
What are the articular surfaces of the elbow joint covered with?: hyaline cartilage
Describe the articulation of the elbow joint.: humeroulnar articulation-trochlea of humerus w/ throchlear notch of ulna
humeroradial articulation-capitulum of humerus w/ head of radius
Where is the articular capsule of the elbow joint weak? strong?: weak-anterior & posterior
stong-on each side
The thickening of the fibrous capsule on the medial and lateral sides become which ligaments?: radial collateral
ulnar collateral
Where does the radial collateral ligament stretch?: from lateral epicondyle to anular ligament of radius
Where does the ulnar collateral ligament stretch?: medial epicondyle to the coronoid process and olecranon of the ulna
What are the 3 bands of the ulnar collateral ligament? Which is strongest? weakest?: anterior cordlike band-strong
posterior fanlike band-weak
oblique band
What does the oblique band of the ulnar collateral ligament do?: deepens socket for the trochlea
What type of movement does the elbow joint do?: flexion-extension
What are the chief flexors of the elbow joint?: brachialis, biceps brachii, brachioradialis
What is the assistant flexor of the elbow joint? When is it used?: pronator teres
used when flexion is resisted
What is the chief extensors of the elbow joint? Assistant?: -triceps brachii
-anconeus
What provides the blood supply to the elbow joint?: arterial anastomoses around the elbow
Which nerves supply the elbow joint?: musculocutaneous, radial, ulnar
Which bursa are located around the elbow?: intratendinous olecranon
subtendinous olecranon
subcutaneous olecranon
Where is the intratendinous olecranon bursa located?: inside the tendon of the triceps brachii
Where is the subtendinous olecranon bursa located?: between olecranon and distal attachment of triceps tendon
Where is the subcutaneous olecranon bursa located?: subcutaneous CT over olecranon
Which bursa of the elbow is most likely to get bursitis? Why?: subcutaneous olecranon, b/c of location and repeated pressure of friction
Which type of bursitis of the elbow is least common?: subtendinous olecranon
What is avulsion of medial epicondyle? Who does it occur in?: young people due to not fused epiphysis, caused by falls or severe abduction of extended elbow, medial epicondyle is pulled distally by the ulnar collateral ligament
What nerve may be injured in avulsion of the medial epicondyle?: ulnar
Which way is the elbow joint commonly dislocated?: posteriorly
What does the proximal radioulnar joint allow for?: allows the head of the radius to move on the ulna
What is the articulation of the proximal radioulnar joint?: head of radius w/ radial notch of ulna
Which ligament forms a ring that completely encircles the head of the radius to the radial notch of the ulna?: anular ligament
What 2 joints work together for pronation and supination of the forearm?: proximal radioulnar joint and distal radioulnar joint
What muscles work to supinate the forearm when there is no resistance? with resistance and elbow flexed?: supinator
biceps
What muscles are assistant supinators of the forearm?: extensor pllicis longus and extensor carpi radialis longus
What is the primary pronator muscle of the forearm? Secondary? assistants?: -pronator quadratus
-pronator teres
-flexor carpi radialis, palmaris longus, brachioradialis
What arteries supply blood to the proximal radioulnar joint?: anterior and posterior interosseous arteries
What is the nerve supply to the proximal radioulnar joint?: musculocutaneous and radial (supination), median (pronation)
What is subluxation and dislocation of the radial head? Who is it likely to occur in? How does it happen?: head of the radius is pulled out of anular ligament, ligament may be torn
in preschool children
-particularly girls
-sudden lifting of the child's body by pulling the arm
Describe the articulation of the distal radioulnar joint: head of ulna w/ ulnar notch of radius
What type of cartilage makes up the articular disc of the distal radioulnar joint?: fibrocartilage
Where is the articular disc of the distal radioulnar joint located? What do the medial and lateral ends attach too?: distal end of ulna w/ medial end attached to the styloid process of the ulna, lateral end attaches to the medial side of the ulnar notch on the radius (L shape)
The articular capsule of the distal radioulnar joint extends superiorly to form what?: "sacciform recess" important for joint to function
Thickening of the fibrous capsule anteriorly and posteriorly forms what ligaments?: anterior and posterior ligament
Which arteries supply the distal radioulnar joint?: anterior and posterior interosseous arteries
Which nerves innervate the distal radioulnar joint?: anterior and posterior interosseous nerves
What type of joint is the wrist (radiocarpal)?: condyloid type
Describe the articulation of the wrist joint?: distal end of radius plus the articular disc of the distal radioulnar joint w/ the three first row carpal bones (scaphoid, lunate, and triquetrum)
Where does the fibrous capsule strengthen? What ligaments are formed?: palmar and dorsal sides forming palmar and dorsal radiocarpal ligaments
also the medial and lateral sides strengthen and form ulnar and radial collateral ligament
What movements can be made by the wrist joint?: flexion-extension, abduction-adduction, circumduction
The movement of the wrist joint is accompanied by movement of which other joints?: intercarpal and midcarpal joints
Which muscles help with flexion of the wrist joint? Assistant flexors?: -flexor carpi radialis and flexor carpi ulnaris
-FDS and FDP, flexors of the thumb-flexor pollicis longus, palmaris longus, and abductor pollicis longus
Which muscles help with extension of the wrist? Assist?: -extensor carpi radialis longus and brevis, extensor carpi ulnaris
-extensor digitorum, extensor digiti minimi and indicis, extensor pollicis longus and brevis
What muscles help w/ abduction of the wrist?: flexor carpi radialis and extensor carpi radialis longus and brevis, abductor pollicis longus
What muscles help w/ adduction of the wrist?: flexor and extensor carpi ulnaris
Which arteries supply the wrist joint?: branches from the palmar and dorsal carpal arches
Which nerves supply the wrist joint?: median, ulnar, and radial nerves
How can dislocation of the lunate occur? What nerve is involved?: dorsiflexed wrist, lunate dislocated into carpal tunnel on palm side pressing on median nerve
Which direction is the distal radial epiphysis dislocated?: dorsally
What are the articulations of the intercarpal joints?: -between carpal bones in proximal row
-between carpal bones in distal row
-midcarpal joint between proximal and distal row
-pisotriquetral joint between pisiform and triquetrum on palm side
Discuss the articular capsule of the intercarpal joints?: common fibrous articular capsule encloses all the intercarpal joints as well as medial four carpometacarpal and intermetacarpal joints, the wrist joint and 1st carpometacarpal (trapezium & 1st metacarpal) joint have their own joint capsule
Which ligaments are involved in the intercarpal joints?: anterior, posterior and interosseous ligaments
Discuss the movement of the intercarpal joints.: small amount of gliding between carpals
Which arteries supply the intercarpal joints?: branches from the palmar and dorsal carpal arches
What the the nerves that innervate the intercarpal joints?: median and ulnar
What type of joints are the carpometacarpal and intermetacarpal joints?: plane synovial joints except the carpometacarpal joint of the thumb, which is a saddle type synovial joint
Describe the articulations of the carpometacarpal and intermetacarpal joints.: distal row of carpals w/ base of metacarpals and in between base of medial four metacarpals (3 joints), betweent he trapezium and base of 1st metacarpal for the thumb
Discuss the articular capsules of the carpometacarpal and intermetacarpal joints.: medial four carpometacarpal and intermetacarpal joints have a common joint capsule w/ the intercarpal joints, 1st carpometacarpal joint has its own capsule
Name the ligaments or the carpometacarpal and intermetacarpal joints.: anterior, posterior and interosseous
Describe the movements of the carpometacarpal and intermetacarpal joints.: flexion-extension, abduction-adduction, circumduction happens at carpometacarpal joints
What is the blood supply of the carpometacarpal and intermetacarpal joints?: deep palmar arch and palmar metacarpal arteries
What nerves innervate the carpometacarpal and intermetacarpal joints?: median, ulnar and radial
What type of joints are the metacarpophalangeal joints?: condyloid type synovial
What type of joints are the interphalangeal joints?: hinge type synovial joints
What is the difference between the metacarpophalangeal and interphalangeal joints?: metacarpophalangeal joints can wiggle, flex-extend
interphalangeal can't wiggle
Describe the articulation of the metacarpophalangeal and inerphalangeal joints.: head of proximal bones articulate w/ base of distal bones
The fibrous capsule of the metacarpophalangeal and interphalangeal joints is strengthened on the sides to form what ligament?: collateral ligament
The thickened fibrous or fibrocartilage plate on the palmar side of the metacarpophalangeal and interphalangeal joints forms what ligament?: palmar
Which ligament connects the heads of the medial four metacarpals together?: transverse metacarpal
What is the movement of the metacarpophalangeal joints?: flexion-extension, abduction-adduction and circumduction
What is the movement of the interphalangeal joints?: flexion-extension
Which arteries supply the metacarpophalangeal and interphalangeal joints?: digital arteries from the superifical palmar arch
Which nerves innervate the metacarpophalangeal and interphalangeal joints?: median and ulnar
What ligament is injured in bull rider's thumb? Where is the fracture?: sprain of the radial collateral ligament of the 1st metacarpophalangeal joint
fracture on the lateral part of the proximal phalanx of the thumb
What can cause skier or gamekeeper's thumb? Which ligament is damaged? Where might fracture occur?: over abduction-extension of the thumb
collateral ligament of the 1st metacarpophalangeal joint, may have fracture on the head of the 1st metacarpal

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