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Ioints Of The Upper Limb Flashcards

0
Q

Elevation

A

Initial 30 degrees may occur without scapular motion
2:1 ratio
Every 3 degrees of movement, 2 degrees at glenohumeral joint and 1 degree at scapulothoracic joint
Scapulohumeral rhythm

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1
Q

Movement of pectoral girdle

A

Sternoclavicular, acromioclavicular and glenohumeral joints

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2
Q

Sternoclavicular joint general

A

Synovial articulation between Sternal end of the clavicle and the manubrium of the sternum and the first costal cartilage
Saddle type of joint but functions as a ball and socket joint

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3
Q

Sternoclavicular joint divisions

A

Divided into two compartments by an articular disc
Disc attached to anterior and posterior SC ligaments and the inter clavicular ligament
Serves as a shock absorber of forces transmitted along clavicle from upper limb
Fracture of clavicle more common than dislocation

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4
Q

Joint capsule of SC joint

A

Surrounds joint, including epiphysis at Sternal end of clavicle
Fibrous layer of capsule attached to margins of articular surfaces
Synovial membrane lines internal surfaces of fibrous layer

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5
Q

Ligaments of SC joint

A

Anterior and posterior SC ligaments reinforce capsule anteriorly and posteriorly
Inter clavicular ligament strengthens capsule superiorly. From Sternal end of one clavicle to Sternal end of the other, also attached to superior border of manubrium
Costoclavicular ligament anchors inferior surface of Sternal end of clavicle to the 1st rib and it’s costal cartilage,limiting elevation of the pectoral girdle

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6
Q

Movement of SC joint

A

Very strong but significantly mobile
During full elevation if limb, clavicle is raised to approximately 60 degree angle
Can also be moved anteriorly or posteriorly over a range up to 25 to 30 degrees

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7
Q

Blood and nervous supply to SC joint

A

Internal thoracic and suprascapular arteries

Branches of medial supra clavicular nerve and subclavian nerve supply SC joint

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8
Q

Acromioclavicular joint general

A

Plane synovial articulation
2 to 3 cm from the point of the shoulder, formed by the lateral part of the acromion of the scapula
The acromial end of the clavicle articulates with the acromion
The articular surfaces, covered with fibrocartilage are separated by an incomplete wedge shaped articular disc

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9
Q

Joint capsule of AC joint

A

Sleeve like, relatively loose fibrous layer is attached to margins of articular surfaces
Synovial membrane lines internal surface of fibrous layer of the capsule
Relatively weak but strengthened superiorly by fibers of the trapezius

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10
Q

Ligaments of AC joint

A

AC ligament

Coracoclavicular ligament: conoid and trapezoid

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11
Q

AC ligament

A

AC ligament: fibrous band from acromion to clavicle: strengthens AC joint superiorly

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12
Q

Coracoclavicular ligament

A

Coracoclavicular ligament: gives most of strength: prevent acromion from being driven under clavicle even when joint is separated: extra articular, strong, subdivided into conoid and trapezoid ligaments, located several centimeters from joint, clavicle to coracoacromial process of scapula. Provides means by which scapula and free limb are suspended from clavicle
Conoid: vertical: apex attached to root of coracoid process, base is to conoid tubercle on inferior surface of clavicle
Trapezoid: nearly horizontal: attached to superior surface of coracoid process and extends laterally to trapezoid line on the inferior surface of the clavicle

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13
Q

AC joint blood and nervous supply

A

Suprascapular and thoraco-acromial arteries

Supra clavicular lateral pectoral and axillary nerves

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14
Q

Glenohumeral joint general

A

Ball and socket synovial joint
High mobility, low stability
Large spherical humeral head articulates with relatively small and shallow glenoid cavity which is deepened slightly by ring like, fibrocartiliginous glenoid labrum
Both articular surfaces: hyaline cartilage
Glenoid cavity accepts about 1/3 of humeral head, which is held in cavity by Rotator cuff

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15
Q

Glenohumeral joint joint capsule

A

Loose fibrous layer surrounds glenohumeral joint and is attached medially to margin of glenoid cavity and laterally to anatomical neck of the humerus. Superiorly encloses proximal attachment of long head of biceps to supra glenoid tubercle
Inferior part of capsule not reinforced by rotator cuff: weakest: lies in folds when arm adducted: becomes taut when abducted
Synovial membrane lines internal surface and reflects onto humerus as far as articular margin of head. Also forms tubular sheath for tendon of long head of biceps brachii
Anteriorly, Communication between subscapular bursa and synovial cavity of joint

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16
Q

Ligaments of glenohumeral joint

A

Glenohumeral, coracohumeral, transverse humeral ligaments, coraco-acromial arch, coraco-acromial ligament

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17
Q

Glenohumeral ligaments

A

Evident only on internal aspect of glenohumeral joint capsule
Strengthen anterior aspect of capusle

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18
Q

Coracohumeral ligament

A

Strong band that passes from base of coracoid process to anterior aspect of greater tubercle, strengthens glenohumeral capsule superiorly

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19
Q

Transverse humeral ligament

A

Broad fibrous band that runs from greater to lesser tubercle, bridging over the intertubercular sulcus and converting the sulcus into a canal for the tendon of the long head of biceps brachii and it’s synovial sheath

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20
Q

Coraco-acromial arch

A

Extrinsic, protective structure formed by smooth inferior aspect of acromion and coracoid process of the scapula, with coraco- acromial ligament spanning between them
Overlies head of humerus, preventing its superior displacement from glenoid cavity
So strong that forceful superior thrust of humerus will fracture shaft of humerus or clavicle first

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21
Q

Blood supply and innervation of glenohumeral joint

A

Anterior and posterior circumflex humeral arteries and branches of suprascapular artery
Suprascapular, axillary and lateral pectoral nerves supply joint

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22
Q

Bursae around glenohumeral joint

A

Subacromial or sub deltoid bursa and subscapular bursa

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23
Q

Subacromial or sub deltoid bursa

A

between acromion, coracoacromial ligament, and deltoid superiorly, and supraspinatus tendon and joint capsule of glenohumeral joint inferiorly. Facilitates movement of supraspinatus tendon under coracoacromial arch and of deltoid over joint capsule and greater tubercle of humerus

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24
Subscapular bursa
Between tendon of subscapularis and neck of scapula Protects tendon where it passes inferior to root of coracoid process and over neck of scapula Usually communicates with cavity of glenohumeral joint through an opening in the fibrous layer of joint capsule
25
Rotator cuff injuries
Usually repetitive use of upper limb above the horizontal Tendinitis of rotator cuff, usually supraspinatus tendon Cannot initiate abduction if upper limb If passively abducted 15 degrees or more, deltoid takes over
26
Dislocation of acromioclavicular joint
Easily injured by direct blow, fall on shoulder or outstretched limb Shoulder separation Severe when both AC and coraco clavicular ligaments are torn When coraco clavicular ligament tears, shoulder separates from clavicle and falls because of weight of limb Makes acromion more prominent and clavicle may move superior to acromion
27
Dislocation of glenohumeral joint
Most in inferior direction but described as anterior or (more rare) posterior Anterior: more often in young adults: excessive extension and lateral rotation, head of humerus driven infero anteriorly Axillary nerve may be injured Capsule torn Strong adductors and flexors may pull into sub coracoid position
28
Calcific supraspinatus tendinitis
Males 50 and up after unusual or excessive use of glenohumeral joint Calcific scapulohumeral bursitis Calcium deposits in supraspinatus tendon irritate subacromial bursa No pain in adduction Pain in 50-130 degrees of abduction
29
Adhesive capsulits of glenohumeral joint
Frozen shoulder Caused by adhesive fibrosis and scarring between inflamed capsule of glenohumeral joint, rotator cuff, subacromial bursa and deltoid Difficulty abducting arm but can obtain apparent abduction of 45 degrees by elevating and rotating scapula Initiated by glenohumeral dislocations, Calcific supraspinatus tendinitis, partial tearing of rotator cuff, bicipital tendinitis
30
Movements of glenohumeral joint
Flexion extension Abduction, adduction Rotation Circumduction
31
Things affecting movement at glenohumeral
Lateral rotation increases range of abduction When arm is abducted without rotation, greater tubercle contacts coracoacromial arch preventing further abduction If Arm is then laterally rotated 180 degrees, tubercles are rotated posteriorly and more articular surface becomes available to continue elevation Stiffening or fixation of joints of pectoral girdle (ankylosis) results in a much more restricted range of movement
32
elbow joint general
hinge type of synovial joint located 2 to 3 cm inferior to the humeral epicondyles spool shaped trochlea and spheroidal capitulum of the humerus articulate with the trochlear notch of the ulna and the slightly concave superior aspect of head of radius, respectively
33
articulation and joint capsule of elbow joint
fibrous layer of joint capsule surrounding joint is attached to humerus at margins of lateral and medial ends of articular surfaces of capitulum and trochlea anteriorly and posteriorly, it is carried superiorly, proximal to the coronoid and olecranon fossae synovial membrane lines internal surface of fibrous layer of joint capsule and intracapsular nonarticular parts of humerus. continuous inferiorly with synovial membrane of proximal radio ulnar joint
34
ligaments of elbow joint
collateral ligaments of elbow joint: strong triangular bands that are medial and lateral thickenings of fibrous layer of the joint capsule radial collateral ligament, anular ligament of radius, ulnar collateral ligament
35
radial collateral ligament
: lateral, fan like, extends from the lateral epicondyle of humerus and blends distally with anular ligament of radius:
36
anular ligament of radius
encircles and hold head of radius in radial notch of the ulna, forming proximal radio-ulnar joint and permitting pronation and supination of forearm
37
ulnar collateral ligament
medial, triangular, extends from medial epicondyle of humerus to coronoid process and olecranon of ulna three bands: 1. anterior cord like band: strongest 2. posterior fan like band: weakest 3. slender oblique band: deepens socket for trochlea of humerus
38
movements of elbow joint
flexion and extension long axis of fully extended ulna makes 170 degree angle with long axis of humerus: carrying angle obliquity of angle is more pronounced in women than in men
39
blood supply and innervation of elbow joint
arteries derived from anastomosis of arteries around elbow joint supplied by musculocutaneous, radial and ulnar nerves
40
bursae around elbow joint
intratendinous olecranon bursa: sometimes present in tendon of triceps brachii subtendinous olecranon bursa: located between olecranon and triceps tendon, just proximal to its attachment to the olecranon subcutaneous olecranon bursa: located in subcutaneous connective tissue over olecrana
41
bicipitoradial bursa
or biceps bursa | separates biceps tendon from anterior part of radial tuberosity
42
proximal radio-ulnar joint general
pivot type of synovial joint that allows movement of the head of the radius on the ulna
43
articulation and joint capsule of proximal radio-ulnar joint
head of radius articulates with radial notch of ulna fibrous layer of joint capsule encloses joint and is continous with that of elbow joint synovial membrane lines internal surface of fibrous layer and nonarticulating aspects of bones synovial membrane is inferior prolongation of synovial membrane of elbow joint
44
ligaments of proximal radio ulnar joint
anular ligament: attaches to ulna, anterior and posterior to radial notch, which forms a collar that, with the radial notch, forms a ring that completely encircles the head of the radius. deep surface lined with synovial membrane which continues distally as a sacciform recess of the proximal radio-ulnar joint on the neck of the radius arrangement allows radius to rotate within anular ligament without binding, stretching or tearing synovial membrane
45
elbow extension joints
humero-ulnar | humeroradial
46
elbow extension limiting structures
musces: flexor muscles of elbow joint capsule: anteriorly bony apposition: between olecranon of ulna and olecranon fossa of humerus
47
elbow flexion joints
humero-ulnar | humeroradial
48
elbow flexion limiting structures
muscle: triceps brachii joint capsule: posteriorly soft tissue:apposition between anterior forearm and arm bony apposition: between head of radius and radial fossa of humerus
49
elbow pronation joints
humeroradial, proximal radio-ulnar, distalradio-ulnar, interosseus membrane
50
elbow pronation limiting structures
muscles:supinator, biceps brachii ligaments: dorsal inferior radio-ulnar, interosseus membrane bony apposition of radius on ulna
51
elbow supination joints
humeroradial proximal radio ulnar distal radio ulnar
52
elbow supination limiting structures
muscles: pronator teres, pronator quadratus ligaments: anterior inferior radio ulnar, interosseus membrane
53
distal radio ulnar joint general
pivot type of synovial joint | radius moves around the relatively flexed distal end of the ulna
54
articulation and joint capsule of distal radio-ulnar joint
fibrocartiliginous articular disc of the distal radio-ulnar joint binds theend of the ulna and radius together. base of disc attaches the medial edge of ulnar notch of radius, and apex is attached to the lateral side of the base of styloid process of ulna proximal surface of this triangular disc articulates with the distal aspect of the head of the ulna. sacciform recess of distal radioulnar joint is extension of synovial membrane
55
ligaments of distal radio-ulnar joint
anterior and posterior ligaments strengthen the fibrous layer of joint capsule. relatively weak
56
movements of proximal and distal radio-ulnar joints
pronation and supination: head of radius rotates within the cup shaped anular ligament and the distal end of the radius rotates around the head of the ulna
57
arteries and nerves of proximal and distal radio-ulnar joints
proximal: supplied by radial portion of peri-articular arterial anastomosis of elbow joint. innervated by musculocutaneous, median and radial nerves distal: anterior and posterior interosseous arteries and nerves pronation: median nerve supination: musculocutaneous and radial
58
bursitis of elbow
subcutaneous olecranon bursitis: students elbow excessive friction between triceps tendon and olecranon pain severe during flexion of forearm because of pressure exerted on inflamed subtendinous olecranon bursa by triceps tendon
59
avulsion of medial epicondyle
in children, can result from a fall that causes severe abduction of external elbow traction on ulnar collateral ligament pulls medial epicondyle distally traction injury of the ulnar nerve is a complication of the abduction type of avulsion of the medial epicondyle
60
ulnar collateral ligament reconstruction
rupture, tearing and stretching more common because of throwing reconstruction: "Tommy John procedure" : transplant of a long tendon from contralateral forearm or leg
61
dislocation of elbow joint
posterior dislocaion may occur when children fall on their hands with their elbow flexed
62
subluxation and dislocation of radial head
nurse maids elbow | dislocation of head of radius, tear of anular ligament

Gross (31 decks)

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