Joints And Ligaments Of The Upper Limb

Question 1

These are the 4 Joints that make up the shoulder:

Answer 1

A. Glenohumeral joint
B. Acromioclavicular joint
C. Sternoclavicular joint
D. Scapulothoracic joint

Question 2

It is the 💡main shoulder joint

It is formed where the ball of the humerus fits into a
shallow socket on the scapula called 💡GLENOID

💡Ball-and-socket joint in which 💡stability is sacrificed to obtain greater freedom of movement

💡Head of humerus (1/3 of a sphere) articulates with 💡shallow glenoid fossa of the scapula

Articular capsule is thin and loose

Muscle tendons contribute to joint stability

Answer 2

GLENOHUMERAL JOINT

Question 3

Stability of the glenohumeral joint is maintained by:

Answer 3

o Thin,loose 💡joint capsule
o 💡Four ligaments coracohumeral, and 💡three glenohumeral
o 💡Tendon of the long head of biceps, which travels thru the intertubercular groove and secures the humerus to the glenoid cavity
o 💡Rotator cuff (four tendons) encircles the shoulder joint and blends with the articular capsule

Question 4

GLENOHUMERAL RANGE OF MOTIONS

Answer 4

§ The shoulder can abduct, adduct, rotate, be raised in front of and behind the torso and move through a full 360 in the sagittal plane.

§ This tremendous range of motion also makes the shoulder extremely unstable, far more prone to dislocation and injury than other joints.

Question 5

ACTION

Shoulder Flexion

Shoulder Extension

Shoulder Abduction

Shoulder Adduction

Shoulder Lateral Rotation

Shoulder Medial Rotation

Answer 5

GLENOHUMERAL RANGE OF MOTIONS

0-90°

0-50

0-180°

180-0°

0-90°

0-90°

Question 6

ANTERIOR DISLOCATION OF GLENOHUMERAL JOINT

MECHANISM OF INJURY

Answer 6

Vulnerable position: level with the shoulder and bent back (like throwing a ball)

When the arm dislocates it falls forward and downward.

Question 7

Types of dislocation (glenohumeral joint)

Answer 7

Subcoracoid
Subclavicular
Subglenoid
Intrathoracic

Question 8

Treatments for glenohumeral dislocation:

Answer 8

Hippocratic maneuver
Stimson maneuver
Tractio/counter traction
Sling and swathe

Question 9

Patient supine on table.
Examiner places 💡sole of the foot against px’s axillary fold for countertraction, grasps px’s wrist with both hands and applies steady longitudinal traction.

Answer 9

Hippocratic maneuver

Question 10

Px prone on the table with affected limb 💡hanging freely over edge: 💡10-15lb weight suspended from wrist. Gradual traction overcomes muscle spasm and in most cases achieves reduction in 20-25 mins.

Answer 10

Stimson Maneuver

Question 11

Clavicle meets the acromion

Joint at the top of the shoulder

Joint between the acromion and the clavicle

Answer 11

ACROMIOCLAVICULAR JOINT

Question 12

FUNCTIONS OF ACROMIOCLAVICULAR JOINT

Answer 12

Allows the ability to raise the arm above the head

Functions as a 💡pivot point acting like a strut to help with movement of the scapula resulting in greater degree of arm rotation

Question 13

THREE LIGAMENT THAT STABILIZED THE ACROMIOCLAVICULAR JOINT:

Answer 13

Acromioclavicular ligament–attaches the clavicle to the acromion of the scapula

Coracoacromial ligament – runs from the coracoid process to the acromion

Coracoclavicular ligament – attaches the clavicle to the coracoid process
• Made up of 2 ligaments:
1. Conoid
2. Trapezoid

Question 14

TREATMENT FOR ACROMIOCLAVICULAR JOINT SEPARATION

Answer 14

Taping and sling

Surgical repair

Question 15

It supports the connection of the 💡arms and shoulders to the main skeleton on the front of the chest

💡Synovial double-plane joint composed of two portions separated by an articular disc

Formed by the:
o Sternal end of the clavicle
o Clavicular notch of the manubrium sterni
o Cartilage of the first rib visible from the outside as the Suprasternal Notch

💡Only joint linking the bones of the arm & shoulder to the main part of the skeleton

Answer 15

STERNOCLAVICULAR JOINT

Question 16

These are the 4 ligaments that hold the sternoclavicular joint:

Answer 16

Intra-articular disc ligament

Costoclavicular ligament

Interclavicular ligament

Capsular ligament

Question 17

It is a ligament of the sternoclavicular joint that attaches to the 💡first rib and divides the joint into two separate spaces. It is 💡very thick and fibrous

Answer 17

Intra-articular disc ligament

Question 18

It is a ligament of the sternoclavicular joint that is 💡short and strong. It attaches 💡underneath the clavicle to the first rib just below. It helps 💡steady the SC joint during certain motions

Answer 18

Costoclavicular ligament

Question 19

It is a ligament of the sternoclavicular joint that supports the 💡end of both clavicle bones near the SC joint. It passes over the 💡top of the sternum, connecting one clavicle to the other.

Answer 19

Interclavicular ligament

Question 20

It is a ligament of the sternoclavicular joint that 💡reinforces the capsule that surrounds the SC joint. It keeps the 💡sternum end of the clavicle from 💡pointing up as the other end of the clavicle drops down.

Answer 20

Capsular ligament

Question 21

STERNOCLAVICULAR JOINT RANGE OF MOTION

Answer 21

§ Clavicle elevation/ depression
§ Clavicle protraction/ depression
§ Clavicle posterior rotation

Question 22

💡Not a true joint, instead a 💡sliding joint between medial border of scapula and ribs 2-7

Function: 💡allow scapular motion against the rib cage

Resting position is angled anteriorly at 💡30° and an upward tilt of 3°

Answer 22

SCAPULOTHORACIC JOINT

Question 23

SCAPULOTHORACIC JOINT RANGE OF MOTION

Answer 23

During shoulder abduction glenohumeral motion to scapulothoracic motion is 💡1:2 (ST does 60°, GH does 120°)

Position fixed primarily by scapular muscle attachment

Question 24

Moving the superior border of the scapula and acromion in an 💡upward direction

Answer 24

ELEVATION

Question 25

Moving the superior border of the scapula and acromion in a 💡downward direction

Answer 25

DEPRESSION

Question 26

Glenoid fossa facing upwards with inferior angle of scapula 💡sliding laterally & anteriorly

Answer 26

UPWARD ROTATION

Question 27

Glenoid fossa facing downwards with inferior angle of scapula 💡sliding medially and posteriorly

Answer 27

DOWNWARD ROTATION

Question 28

Moving the scapula 💡away from the midline

Answer 28

PROTRACTION

Question 29

Moving the scapula 💡toward midline

Answer 29

RETRACTION

Question 30

Type: Synovial hinge joint Location: 2-3 cm inferior to epicondyles of humerus

Answer 30

ELBOW JOINTS

Question 31

Surfaces of elbow joints are covered

Answer 31

Hyaline cartilage

Question 32

ARTICULATIONS of elbow joints

Answer 32

Humero-ulnar joint (hinge joint) | Humeroradial (bone and socket joint)

Question 33

Articulation of an elbow joint between the 💡trochlea and 💡capitulum of the humerus and 💡trochlear notch of the ulna

Answer 33

Humero-ulnar joint (hinge joint)

Question 34

Articulation of an elbow joint between the 💡capitulum | and 💡upper concavesurface of the radial head

Answer 34

Humeroradial (bone and socket joint)

Question 35

LIGAMENTS THAT PROVIDE STABILITY IN ELBOW JOINT

Answer 35

RADIAL (LATERAL) COLLATERAL LIGAMENT ULNAR (MEDIAL) COLLATERAL LIGAMENT

Question 36

They provide stability 💡anteriorly and 💡posteriorly to the elbow joint

Answer 36

Tendons of biceps and triceps brachii

Question 37

ELBOW STABILITY Triangular in shape Extends from 💡lateral epicondyle of humerus and blends distally with 💡anular ligament (head of radius) 💡Important lateral stabilize 💡Oppose varsus (medial) stresses

Answer 37

RADIAL (LATERAL) COLLATERAL | LIGAMENT

Question 38

Also triangular Broad fibrous band that runs from the 💡epicondyle to 💡coronoid and 💡olecranon of ulna Provides 💡protection against Valgus (lateral) processes of ulna.

Answer 38

ULNAR (MEDIAL) COLLATERAL | LIGAMENT

Question 39

ELBOW RANGE OF MOTION

Answer 39

FLEXION: 0-150 degrees EXTENSION: 150-10 degrees PRONATION (inward) 0-90 degrees SUPINATION (outward) 0-90 degrees

Question 40

ELBOW RANGE OF MOTION FLEXION: 0-150 degrees

Answer 40

􀂃 Joint: 💡humero-ulnar 􀂃 Muscles: 💡brachialis & biceps brachii (chief flexors), brachioradialis, and pronator teres muscles 􀂃 limited by the anterior surfaces of the forearm and arm coming into contact

Question 41

ELBOW RANGE OF MOTION EXTENSION: 150-10 degrees

Answer 41

􀂃 Joint: 💡Humeroradial 􀂃 Muscles: 💡triceps brachii (chief extensor) and anconeus muscles 􀂃 checked by the tension of the anterior ligament and the brachialis muscle. ``` 􀂃 Carrying angle: angle where Long axis of FOREARM lies to the long axis of ARM (disappears when fully flexed) o Male: 170 degrees o Female: 167 degrees ```

Question 42

ELBOW RANGE OF MOTION SUPINATION (outward) 0-90 degrees

Answer 42

􀂃 💡Proximal radio-ulnar joint (in conjugation with associated movements of distal radio-ulnar joint) 􀂃 The 💡radius is the one that rotates 􀂃 Supination: 💡supinator (absent resistance) and 💡biceps brachii (w/ resistance) 􀂃 Pronation: 💡pronator quadratus (primarily) and 💡pronator teres (secondarily)

Question 43

􀂃 💡Condyloid synovial joint between: o distal end of the radius o articular disc overlying the distal end of the ulna o scaphoid, lunate, and triquetrum 􀂃 Complex of eight carpal bones 􀂃 💡Ulna does not participate as a bone rather there is an 💡articulate disc lying between ulna and lunate 􀂃 Articulating with the forearm via the wrist joint and distally with the five metacarpals.

Answer 43

WRIST JOINTS

Question 44

It is formed by the 💡articular surfaces of the carpals which then corresponds to the 💡concave surface of the radius and articular disc.

Answer 44

Carpal arch (convex oval shape)

Question 45

The 💡fibrous layer of the joint capsule is | strengthened by strong

Answer 45

Dorsal Palmar radiocarpal ligaments.

Question 46

TWO IMPORTANT LIGAMENTS HOLDING THE WRIST JOINTS IN PLACE: They connect the forearm to the wrist, one on each side of the wrist

Answer 46

ULNAR COLLATERAL LIGAMENT RADIAL COLLATERAL LIGAMENT

Question 47

􀂃 💡Cord shaped 􀂃 Crosses the 💡ulnar edge of the wrist starting from the 💡ulnar styloid process where the ulna meets the wrist joint to the triquetrum 􀂃 2 parts of UCL 􀂃 Connects to the 💡pisiform and to the 💡transverse carpal ligament (a thick band of tissue that crosses in front of the wrist) and the other goes to 💡triquetrum 􀂃 Adds support to a 💡small disc of cartilage where the ulna meets the wrist called 💡The triangular fibro cartilage complex (TFCC)

Answer 47

ULNAR COLLATERAL LIGAMENT

Question 48

It is a small disc of cartilage where the ulna meets the wrist

Answer 48

The triangular | fibro cartilage complex (TFCC)

Question 49

􀂃 strengthens joint capsule 💡laterally 􀂃 attached to the 💡radial styloid process and 💡scaphoid 􀂃 on the 💡thumb side of the wrist 􀂃 starts on the 💡outer edge of the radius at the 💡radial styloid 􀂃 connects to the side of the 💡scaphoid 􀂃 Prevents the wrist from 💡bending too far to the side (away from the thumb)

Answer 49

RADIAL COLLATERAL LIGAMENT

Question 50

WRIST JOINT ROM

Answer 50

``` 􀂃 Wrist flexion 0-90 􀂃 Wrist extension 0-70 􀂃 Wrist abduction 0-25 􀂃 Wrist adduction 0-65 􀂃 Circumduction of the hand consists of successive flexion, adduction, extension, and abduction. ```

Question 51

CARPAL JOINTS

Answer 51

The synovial joints between the carpal bones share a common articular cavity

Question 52

The joint capsule of the carpal joints is reinforced by | numerous ligaments.

Answer 52

o Intrinsic Ligaments: intra-articular intrinsic ligaments connect adjacent carpal bones ``` o Proximal Row 􀁸 scapholunate ligament 􀁸 lunotriqueral ligament o Distal Row 􀁸 trapeziotrapezoid ligament 􀁸 trapeziocapitate ligament 􀁸 capitohamate ligament o Palmar midcarpal 􀁸 scaphotrapeziotrapezoid 􀁸 scaphocapitate 􀁸 triquetralcapitate ```

Question 53

Although movement at the carpal joints (intercarpal joints) is 💡limited, they do contribute to the 💡positioning of the hand in abduction, auction, flexion, and particularly, extension.

Answer 53

True

Question 54

There are 💡five carpometacarpal joints between the metacarpals and the related distal row of carpal bones.

Answer 54

True

Question 55

Movements at this carpometacarpal joint are:

Answer 55

flexion, extension, abduction, adduction, rotation, and circumduction.

Question 56

The carpometacarpal joints between 💡metacarpals II to V and the 💡carpal bones are much less mobile than the carpometacarpal joint of the 💡thumb, allowing only limited 💡gliding movements.

Answer 56

True

Question 57

Movement of the joints increases medially so | 💡metacarpal V slides to the greatest degree.

Answer 57

True

Question 58

It is the main 💡knuckle joints formed by the connections of the phalanges to the metacarpals. It work like a hinge when you bend and straighten your fingers and thumb.

Answer 58

METACARPOPHALANGEAL JOINTS

Question 59

METACARPOPHALANGEAL JOINTS | STABILITY:

Answer 59

COLLATERAL LIGAMENTS** VOLAR PLATE

Question 60

A part of the joint capsule that attaches only to the 💡proximal phalanx, allowing 💡hyperextension. The 💡SITE OF INSERTION for the 💡INTERMETACARPAL LIGAMENTS.

Answer 60

VOLAR PLATE

Question 61

These ligaments 💡restrict the separation of the metacarpal heads.

Answer 61

INTERMETACARPAL LIGAMENTS.

Question 62

MCP JOINT RANGE OF MOTION:

Answer 62

􀂃 MCP: Abduction 0-25 􀂃 MCP: Adduction 20-0 􀂃 MCP: Flexion 0-90 􀂃 MCP: Extension 0-30

Question 63

􀂃 It 💡separates the three phalanges in each finger. 􀂃 These are the 💡hinge type of synovial joint that permit: o 💡FLEXION EXTENSION only o The heads of the phalanges articulate with the bases of more distally located phalanges in the IP joints.

Answer 63

INTERPHALANGEAL JOINTS

Question 64

It is the closest to the MCP joint.

Answer 64

PROXIMAL IP POINT or PIP POINT

Question 65

It is the joint near the end of the finger.

Answer 65

DISTAL IP POINT OR DIP POINT

Question 66

INTERPHALANGEAL JOINTS STABILITY:

Answer 66

COLLATERAL LIGAMENTS** | VOLAR PLATE

Question 67

􀂃 It is the 💡strongest ligament in the PIP joint. 􀂃 It connects the Proximal phalanx to the Middle phalanx on the palm side of the joint. 􀂃 Tightens as the joint is straightened 􀂃 Keeps the joint from hyperextending

Answer 67

VOLAR PLATE

Question 68

ICP JOINTS RANGE OF MOTION:

Answer 68

INTERPHALANGEAL PROXIMAL (PIP) Joints of Fingers: 􀂃 Flexion: 0-120 􀂃 Extension: 120-0 INTERPHALANGEAL DISTAL (DIP) Joints of Fingers: o Flexion: 0-80 o Extension: 80-0