upper limb joints

Question 1

gleno-humeral joint
Classification:

Answer 1

Type: synovial
Subtype: ball and socket

Question 2

Articular surfaces of gleno-humeral joint

Answer 2

Medially: glenoid cavity
Laterally: head of the humerus
Articular surfaces are covered by hyaline cartilage Articular cartilage doesn’t have perichondrium One of the most mobile joints of the body Mobility is at the cost of stability
Anatomically a weak joint

Question 3

Stabilizing factors of gh joint

Answer 3

Coraco-acromial arch forms the secondary socket Musculotendinous cuff
Glenoidal labrum
Surrounding muscles

Question 4

Coraco-acromial arch: gh j

Answer 4

Formed by coracoid process, acromion process and coraco-acromial ligament

Question 5

Musculotendinous cuff (rotator cuff):

Answer 5

Formed by the capsular ligament, supraspinatus, infraspinatus, teres minor and
subscapularis muscles

Question 6

Glenoidal labrum

Answer 6

Made up of white fibro-cartilage
Deepens the glenoid fossa

Question 7

Muscles: gh j

Answer 7

Long head of biceps prevents upward displacement of head
Long head of triceps prevents downward displacement of the head

Question 8

Ligaments of the joint: gh j

Answer 8

Capsular ligament (articular capsule)
- enforced by 3 glenohumeral lig
Coracohumeral ligament- Extends from the root of the coracoid process to the greater tubercle
Transverse humeral ligament- Bridges the gap between greater and lesser tubercles
Glenoidal labrum

Question 9

Capsular ligament: gh j

Answer 9

Medial attachment:
To the glenoidal labrum
Supraglenoid tubercle is intracapsular

Lateral attachment:
To the anatomical neck of the humerus
Inferiorly it extends up to the surgical neck

Capsule is reinforced by 3 glenohumeral ligaments (superior, middle and inferior)

Capsule and surrounding 4 muscles (subscapularis, supraspinatus, infraspinatus and teres minor) form rotator cuff

Capsule has openings for tendon of long head of biceps and subscapular bursa

Question 10

Tendon of long head of biceps at gh j

Answer 10

intracapsular but extrasynovial

Question 11

Relations of shoulder joint:

Answer 11

Anterior:
Anterior fibres of deltoid, short head of biceps and coracobrachialis and subscapularis
Posterior:
Infraspinatus, teres minor and posterior fibres of deltoid
Superior:
Coracoacromial arch, subacromial bursa,deltoid and supraspinatus
Inferior:
Long head of triceps, axillary nerve and posterior circumflex humeral vessels

Question 12

Blood supply: gh j

Answer 12

Anterior and posterior circumflex humeral vessels
Subscapular vessels
Suprascapular vessels

Question 13

Nerve supply:

Answer 13

Axillary, musculocutaneous, suprascapular and lateral pectoral nerves

Question 14

Scapular-humeral mechanism:

Answer 14

-Scapula and upper limb are suspended from the clavicle by coracoclavicular ligament
-Scapula can rotate on the chest wall to change the position of glenoid fossa
- Coracoclavicular ligament forms the axis of rotation of scapula
-180 degrees of abduction is possible
-For every 3 degrees of abduction, 2 degrees occurs at the shoulder joint and one degree by the rotation of scapula
-Scapula is rotated by the combined actions of serratus anterior and trapezius muscles

Question 15

Applied anatomy: gh j

Answer 15

Dislocations:
-Most commonly dislocated large joint (antero-inferior)
-Axillary nerve can be damaged

Frozen shoulder (adhesive capsulitis):
- pain and loss of motion or stiffness in the shoulder
-in older athletes
-Due to Inflammation of the joint
-Movements are restricted and painful

Rotator cuff tendinitis:
AKA subacromial bursitis, suprspinatus tendinitis or pericapsulitis
Cause: excessive overhead activity
painful abduction
Can lead to rupture of supraspinatus tendon

Question 16

Elbow joint type

Answer 16

Type: Synovial
Subtype: Hinge
It is a compound and an uniaxial joint
It has humero-radial and humero-ulnar components
The two components and superior radioulnar joint are collectively called ‘cubital articulation’

Question 17

Articular surfaces: e j

Answer 17

Superiorly: Capitulum and trochelea of humerus
Inferiorly: head of the radius and trochlear notch of ulna
- Articular surfaces are covered by articular cartilage
-Anatomically a strong joint

Question 18

Ligaments: e j

Answer 18

Capsular ligament
Lateral (radial) collateral ligament
Medial (ulnar) collateral ligament-Anterior ligament,Posterior ligament,transverse ligament

Question 19

Capsular ligament: e j

Answer 19

Superior attachment:
To the lower end of humerus
Coronoid, raidal and olecranon fossae are intracapsular
Inferior attachment:
To the margin of trochlear notch of ulna and annular ligament

Question 20

Lateral (radial collateral) ligament:

Answer 20

Triangular, fan shaped
Extends from lateral epicondyle to annular ligament
Gives origin to supinator and extensor carpi radialis brevis muscles

Question 21

Medial (ulnar collateral) ligament:

Answer 21

Triangular in shape
Apex is attached to the medial epicondyle
Has anterior, posterior and oblique bands
Anterior band is attached to coronoid process Posterior band is attached to olecranon process Related to ulnar nerve
Gives origin to flexor digitorum superficialis muscle

Question 22

relations e j

Answer 22

Anterior relations:
Brachialis, tendon of biceps, brachial artery and median nerve
Posterior relations:
Triceps and anconeus
Medial relations:
Ulnar nerve, flexor carpi ulnaris and common flexor origin
Lateral relations:
Supinator, extensor carpi radialis brevis, common extensor tendon

Question 23

Blood supply: e j

Answer 23

Anastomosis around the elbow joint

Question 24

Nerve supply: ej

Answer 24

Median, radial, ulnar and musculocutaneous nerves

Question 25

Carrying angle ej

Answer 25

Angle of 170 degrees, between long axis of the arm and forearm Factors responsible for carrying angle: 1. Medial flange of trochlea is 6mm lower than that of lateral 2. Obliquity of the coronoid process

Question 26

Applied anatomy: e j

Answer 26

Dislocations: Posterior dislocation is associated with fracture of coronoid process Distension: In backward direction Capsule is weak posteriorly Aspiration of fluid can be done by inserting a needle on either side of olecranon Subluxation (pulled elbow): -Head of the radius slips out of the grip of annular ligament -Seen in children -Happens when the forearm is suddenly pulled in pronation Tennis elbow: Abrupt pronation, leading to pain over the lateral epicondyle( lateral epicondylitis) Causes: 1. Sprain of radial collateral ligament 2. Sprain of extensor carpi radialis brevis 3. Inflammation of bursa deep to the extensor carpi radialis brevis golfer's elbow - medial epicondylitis Student's elbow - Inflamed and enlarged subcutaneous olecranon bursa due to resting of elbow on surface.

Question 27

Radioulnar joints Classification:

Answer 27

Superior and inferior radioulnar joints: Type: Synovial Subtype: Pivot Middle (intermediate) radioulnar joint: Type: Fibrous Subtype: Syndesmosis

Question 28

Articular surfaces and lig of superior radioulnar joint:

Answer 28

Head of the radius Radial notch of ulna and annular ligament Ligaments: Capsular ligament, annular ligament, quadrate ligament

Question 29

Articular surfaces and lig of inferior radioulnar joint:

Answer 29

Articular surfaces of the inferior radioulnar joint: Head of the ulna Ulnar notch of the radius Ligaments: Capsular ligament Triangular articular disc

Question 30

Nerve supply: ru j

Answer 30

Superior radioulnar joint: Median, radial and musculocutaneous nerves Inferior radioulnar joint: Anterior and posterior interosseous nerves

Question 31

Blood supply: ru j

Answer 31

Superior radioulnar joint: Anastomosis around the elbow Inferior radioulnar joint: Anterior interosseous artery

Question 32

Muscles ru j

Answer 32

Muscles producing supination: Biceps brachii, supinator and brachioradialis Muscles producing pronation: Pronator teres, pronator quadratus, flexor carpi radialis and brachioradialis

Question 33

Middle (intermediate) radioulnar joint:

Answer 33

-Between shafts of radius and ulna Functions of interosseous membrane: -Binds radius to ulna -Gives attachment to muscles -Weight transmission

Question 34

Wrist Joint (Radiocarpal joint) Classification:

Answer 34

Type: Synovial Subtype: Ellipsoid

Question 35

Articular surfaces: wj

Answer 35

Proximal: Distal end of radius and articular disc of inferior radioulnar joint Distal: Scaphoid, lunate and triquetral bones

Question 36

Ligaments: wj

Answer 36

Capsular ligament Anterior (palmar radiocarpal) Posterior (dorsal radiocarpal Medial collateral Lateral collateral

Question 37

relation wj

Answer 37

Anterior relations: Long flexor tendons with their synovial sheaths Median nerve Posterior relations: Long extensor tendons with their synovial sheaths Lateral relation: Radial artery

Question 38

muscles + movement

Answer 38

Flexion: Flexor carpi radialis, flexor carpi ulnaris Palmaris longus, flexors of fingers Extension: Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Long extensors of digits Adduction: Flexor carpi ulnaris Extensor carpi ulnaris Abduction: Flexor carpi radialis Extensor carpi radialis longus Extensor carpi radialis brevis Abductor pollicis longus Extensor pollicis brevis

Question 39

List and describe some clinical complications with joints

Answer 39

1. Sprains - Damage to cartilage, ligaments due to forceful twisting of joint 2. Bursitis - Inflammation of a bursa - Overuse of a joint 3. Arthritis - Inflamed, swollen, painful joints - Osteoarthritis - Gout 4. Dislocation of joint - Articular surfaces of joint are abnormally displaced 5. Subluxation: - Partial contact is still remained 6. Neuropathic joint - Sensation is completely lost, prone to mechanical damage

Question 40

Describe and draw the Synovial Joint

Answer 40

Structure: 1. Articulating ends of the bones taking part in the synovial joints are enclosed in a fibrous capsule. 2. The articular surfaces of the bones are lined by articular cartilage. - The articular cartilage is a thin layer of hyaline cartilage covering the epiphysis where bone takes part in a joint. - Articular cartilage has no perichondrium (lacks nerve supply and capacity to regenerate), the only nutritional source is the synovial fluid. - Degeneration of the articular cartilage as age advances is the root cause of osteoarthritis. 3. Internal surface of fibrous capsule and the non-articular parts of articulating bones inside the joint cavity are lined by synovial membrane. 4. The joint cavity is filled with synovial fluid (secreted by synovial membrane). This synovial fluid is a lubricant and provides nutrition to articular cartilages. 5. In some joints, the fibrocartilaginous articular discs may be present and the fibrous capsule is strengthened by ligaments (true, and accessory) Altogether, the synovial joints allow for free movements.