The shoulder, elbow, wrist and hand joints

Question 1

What are the limiting factors for the movement of the elbow?

Answer 1

Soft tissue apposition in the anterior forearm + upper arm. Coronoid process contacting coronoid fossa + radial head contacting radial fossa. Tension in posterior capsule. Tension in triceps

Question 2

What is the carrying angle?

Answer 2

The natural bend at the elbow; is larger in females b/c of hips

Question 3

What is cubitus varus and valgus?

Answer 3

Varus means that carrying angle is <5 degrees, valgus means that carrying angle is >15 degrees

Question 4

How is the joint congruency poor?

Answer 4

Lateral side of the elbow is not well designed to resists traction, leading to “pulled elbow” in children

Question 5

What articulations are involved in the cubital joint?

Answer 5

Trocheal notch of ulna with the the trochlea of humerus. Head of radius with capitulum of humerus.

Question 6

What articulation is involved in the superior radioulnar joint?

Answer 6

Radial head + fibrous osseous ring formed by concave radial notch and annular ligament

Question 7

What is the annular radial ligament?

Answer 7

Ligament which forms a collar around the superior radioulnar joint; lined with a synovial membrane

Question 8

What is the ulnar collateral ligament?

Answer 8

On the medial side; origins from medial epicondyle and attaches to coronoid process + olecranon of ulna

Question 9

What is the radial collateral ligament?

Answer 9

On the lateral side; origins from lateral epicondyle and blends with annular ligament

Question 10

What is the function of interosseous membrane?

Answer 10

Provides attachment site for muscles; transfers forces from radius to ulna. Posterior and anterior fibres run at 90 degrees to each other

Question 11

What are the articulations of the sternoclavicular joint?

Answer 11

Clavicle with the manubrium of the sternum

Question 12

What increases the congruency of the sternoclavicular joint?

Answer 12

The intra-articular disc; binds at top and bottom

Question 13

What ligaments are involved in the sternoclavicular joint?

Answer 13

Interclavicular, anterior + posterior sternoclavicular, costoclavicular

Question 14

Which ligament spans the gap between the sternal ends of the clavicle, and how does it reinforce the joint capsule?

Answer 14

Interclavicular; reinforces superiorly

Question 15

Which ligament reinforces the sternoclavicular joint capsule anteriorly and posteriorly?

Answer 15

The anterior and posterior sternoclavicular ligaments

Question 16

Which ligament extends from the first rib to the clavicle, and what is the function of this ligament?

Answer 16

Costoclavicular; acts as falcrum for clavicle elevation and depression; axis of rotation during protraction and retraction

Question 17

Which articulations are involved in the acromioclavicular joint?

Answer 17

Lateral end of clavicle with the acromion of the scapula

Question 18

Which ligaments are involved in the acromioclavicular joint?

Answer 18

Acromioclavicular, coracoclavicular (conoid and trapezoid)

Question 19

Which ligament of the acromioclavicular joint is intrinsic?

Answer 19

The acromioclavicular

Question 20

Which ligament of the acromioclavicular joint is extrinsic?

Answer 20

The coracoclavicular

Question 21

Where does the acromioclavicular ligament extend from and to, and how does it reinforce the joint capsule?

Answer 21

Extends horizontally from acromion to lateral clavicle; reinforces superiorly

Question 22

Which ligament extends vertically from coracoid process of scapula to conoid tubercle of clavicle?

Answer 22

Conoid ligament

Question 23

Where does the trapezium ligament extend to and from?

Answer 23

Extends from coracoid process of scapula to trapezoid line of clavicle

Question 24

What articulations are involved in the glenohumeral joint?

Answer 24

The head of humerus with the glenoid fossa of scapula

Question 25

What improves the congruency of the glenohumeral joint, and why?

Answer 25

The glenoid labrum; deepens fossa as humerus so much larger

Question 26

Which ligaments are involved in the GHJ?

Answer 26

Glenohumeral ligaments (superior, medial, inferior), coracohumeral, transverse humeral

Question 27

Where do the glenohumeral ligaments extend to and from?

Answer 27

Extend from humerus to glenoid fossa

Question 28

Where does the coracohumeral ligament extend to and from?

Answer 28

Attaches base of coracoid process to greater tubercle of humerus

Question 29

Where does the transverse humeral ligament extend to and from?

Answer 29

Spans the two tubercles of the humerus

Question 30

What is the scapulothoracic articulation?

Answer 30

Only bony attachment attaching upper limb to axial skeleton; fulfils function of joints but has no joint capsule

Question 31

What is the vital bursa of the shoulder?

Answer 31

Subacromial/sub deltoid bursa; in 90% of people, exists as one big

Question 32

What is the subacromial articulation?

Answer 32

A pseudo-joint, where the bone articulated against another restraining surface

Question 33

What is the major group of structures which stabilises the GHJ?

Answer 33

The rotator cuff

Question 34

Name the muscles of the rotator group

Answer 34

SITS: supraspinatus, infraspinatus, teres minor, subscapularis (+Biceps LH)

Question 35

What is the intra-articular pressure of the GHJ?

Answer 35

Negative pressure, sucks in humeral head; one capsule is injured or joint dislocated, pressure is lost forever

Question 36

What articulations are involved in the radiocarpal joint?

Answer 36

Distal surface of radius with scaphoid, lunate + triquetral

Question 37

What is the function of the triangular fibrocartilage complex?

Answer 37

Allows better load absorption; allows pronation and supination whilst maintaining wrist flexion/extension; attaches to ulna styloid process + edge of radius, and articulates with triquetral

Question 38

What articulations are involved in the midcarpal joint?

Answer 38

Articulation b/w proximal row of carpus + distal row

Question 39

What ligaments stabilise the wrist joint?

Answer 39

Palmar radiocarpal, dorsal radiocarpal, ulnar collateral, radial collateral

Question 40

Which ligaments ensure the hand follows the forearm in supination and pronation?

Answer 40

Palmar radiocarpal (sup), dorsal radiocarpal (pro)

Question 41

Where does the palmar radiocarpal ligament extend to and from?

Answer 41

Extends from anterior inferior radius to both rows of carpal bones

Question 42

Where does the dorsal radiocarpal ligament extend to and from?

Answer 42

From posterior inferior radius to both rows of carpal bones

Question 43

Which ligaments prevent excess lateral joint displacement?

Answer 43

Ulnar and radial collateral

Question 44

Where does the ulnar collateral ligament extend to and from?

Answer 44

Ulnar styloid process to triquetrum + pisiform

Question 45

Where does the radial collateral ligament extend to and from?

Answer 45

Radial styloid process to scaphoid + trapezium

Question 46

What are the articulations of the intercarpal joints?

Answer 46

Between every carpus; allows tiny bits of movement

Question 47

What are the articulations of carpometacarpal joints?

Answer 47

Between carpus bones and metacarpals

Question 48

Why is the 1st carpometacarpal prone to grinding?

Answer 48

Tendons which move joint lie parallel to 1st metacarpal, and so joint is compressed by muscle contraction

Question 49

What allows opposition and reposition?

Answer 49

The passive rotation of CMC joint; compound movement of flexion, adduction and passive medial rotation

Question 50

What movements are thumb flexion and extension?

Answer 50

Thumb moving laterally and medially

Question 51

What movements are thumb abduction and adduction?

Answer 51

Thumb moving away from and towards palm at 90 degrees angle

Question 52

What are the three arches of the hand?

Answer 52

The proximal transverse, distal transverse, and longitudinal

Question 53

Which arch is formed by the distal row of the carpus bones?

Answer 53

Proximal transverse arch

Question 54

Which arch forms the carpal tunnel?

Answer 54

Proximal transverse arch

Question 55

Which transverse arch is relatively mobile?

Answer 55

Distal transverse arch

Question 56

Which arch follows the shape of the 2nd and 3rd rays?

Answer 56

Longitudinal arch

Question 57

What are rays comprised of?

Answer 57

The finger bones, associated metacarpal and carpal bones

Question 58

Which carpal bone do the 4th and 5th rays share?

Answer 58

Hamate

Question 59

Which rays are more rigid?

Answer 59

2nd and 3rd; joints of digits rigidly joined to distal row of carpus

Question 60

Which rays are more mobile?

Answer 60

1st, 4th and 5th; joints form mobile radial and ulnar borders

Question 61

What is the purpose of the carpal tunnel?

Answer 61

Allows space for structures to pass from forearm to hand

Question 62

Which ligaments pin and tie the proximal transverse arch to form the carpal tunnel?

Answer 62

The transverse carpal ligament, flexor retinaculum, and palmar aponeurosis

Question 63

What causes carpal tunnel syndrome?

Answer 63

Any swelling of the wrist or inflammation of the tendons within, which will compress the median nerve

Question 64

What hand features do the metacarpophalangeal joints form?

Answer 64

The knuckles

Question 65

What movements are allowed at the metacarpophalangeal joints?

Answer 65

Flexion, extension, abduction, adduction

Question 66

Which ligaments are present at metacarpophalangeal joints?

Answer 66

Medial and lateral collateral ligaments

Question 67

Where are fibrous digital sheaths and palmar plates present?

Answer 67

Metacarpophalangeal joints and interphalangeal joints

Question 68

What does the deep transverse metacarpal ligament do?

Answer 68

Binds metacarpophalangeal joints 2-4 together

Question 69

What are the interphalangeal joints?

Answer 69

Joints between phalanges; digits 2-5 have proximal and distal; thumb only has one