UPPER EXTREMITIES (Joints) FLASHCARD

By: Ma. Theresa Monje

 The shoulder complex is composed of?

Clavicle, Scapula and Humerus

 Dynamic stability exists when a moving segment is limited very little by (a)________ and influenced heavily by (b)_________.

(a) Passive Forces

articular surface configuration and; capsular ligaments

(b) Active Forces

Muscular control

 The 3 linkages of the Shoulder Complex are?

 Sternoclavicular Joint Acromioclavicular joint Glenohumeral Joint

 The only structural attachment of the clavicle, scapula and upper extremity to the axial skeleton?

 Sternoclavicular Joint

Why do movement of the clavicle at the SC Joint inevitably produces movement of the scapula under conditions of normal function?

 Because the scapula is attached to the lateral end of the clavicle.

 In order for the scapula to not move during movement of clavicle, equal and opposite motions would have to occur at what Joint?

 Acromioclavicular Joint

 STERNOCLAVICULAR joint is what type of joint?

 Plane Synovial Joint with 3 rotatory and 3 translatory degrees of freedom

 The two Articulating surfaces of STERNOCLAVICULAR JOINT?

 Sternal or medial end of clavicle Notch formed by manubrium of sternum st costal cartilage and 1

 The sternal end of clavicle and the manubrium are incongruent. Incongruent means?

 There is little contact between the articular surface

 What increases congruence between articulating surface of SC JOINT?

 Sternoclavicular Joint Disk

 The superior portion of the medial clavicle does not contact the manubrium at all instead serves as attachment for?

 SC Joint Disk and Interclavicular ligament

 During this movement of the clavicle, the medial end of clavicle rolls and slides on relatively stationary SC disk with upper attachment of disk serving as the pivot point.

 Elevation and Depression

 During this movement, the SC disk and the clavicle slides and rolls on Manubrium with Lower attachment of disk as Pivot point.

 Protraction and Retraction

 Mechanical axis for the motions (Elevation/Depression and Protraction/Retraction) is not on the SC disk but on the?

 Costoclavicular Ligament

 The compartment of SC JOINT found between the SC Disk and Clavicle which is used for Elevation and Depression of the clavicle.

 Lateral Compartment

 The compartment of SC Joint found between SC disk and manubrium and is responsible for Protraction and Retraction of the Clavicle.

 Medial Compartment

 The third compartment responsible for Anterior and Posterior Rotation.

 Costoclavicular Joint

 Three ligaments that reinforces the Sternoclavicular Joint

 Sternoclavicular ligaments Costoclavicular ligaments Interclavicular ligaments

 The ligament of SC joint that checks anterior and posterior translatory movement of the medial end of clavicle.

 Sternoclavicular Ligament

 Ligament of SC joint between clavicle and 1st rib and checks elevation of lateral end of clavicle resulting to inferior gliding of the medial end of clavicle.

 Costoclavicular Ligament

 Ligament of SC joint that resist excessive depression of the distal end of clavicle and superior glide of the medial end of clavicle

 Interclavicular Ligament

 In this type of movement on SC joint, the surface of clavicle is convex while the manubrium and costal cartilage is concave, and the lateral end of clavicle moves in the anterior and posterior axis.

 Elevation and depression

 In this type of movement on SC joint, the clavicle is concave and the manubrium is convex and the lateral end of clavicle moves in a vertical axis.

 Protraction and Retraction

 In this type of movement, the lateral end of clavicle spins between saddle shaped surface of medial clavicle and manubriocostal facet in a longitudinal axis.

 Anterior and Posterior Rotation

 This type of joint is formed by the acromion of scapula and lateral end of clavicle.

 Acromioclavicular Joint

 The three ligaments of Acromioclavicular Joint.

 Superior Acromioclavicular Ligament Inferior Acromioclavicular Ligament Coracoclavicular Ligament

Ligaments of AC Joint

 Ligament of AC joint that assist the AC capsule in apposing articular surface and controlling A-P joint stability;

 Superior and Inferior AC ligaments

 This AC ligaments firmly unites the clavicle and the scapula and provide much of joint stability

 Coracoclavicular Ligament

 The two portions of Coracoclavicular ligament.

 Trapezoid ligament Conoid ligament

 This portion of the Coracoclavicular ligament provides resistance to posterior translatory forces applied to distal clavicle.

 Trapezoid ligament

 This portion of the Coracoclavocular ligament provides primary restraint for AC joint in inferior and superior directions.

 Conoid ligament

 This type of AC movement occurs on vertical axis.

Internal and External Rotations

 In this type of AC movement, there is tilting of scapula in relation to clavicle in an oblique coronal axis.

Anterior and Posterior Tipping

 During this Tipping, the acromion tips forward and the inferior angle tips backward.

Anterior Tipping

 During this type of tipping, the acromion rotates backward, and the inferior angle forward

Posterior Tipping

 In this type of AC movement, the scapula rotates in an oblique A-P axis perpendicular to the plane of the scapula.

Upward and Downward Rotation

 Articulation between the scapula and thorax and said to be not true anatomic joint since it has no usual joint characteristics.

Scapulothoracic joint

 Resting position of the scapula on the posterior thorax.

 2 inches from the midline between 2nd thru 7th ribs Internally rotated 30 45 degree from coronal plane Tipped anteriorly 10-20 degree from the vertical Upwardly rotated 10 20 degree from the vertical

 Principal motion of the scapula during elevation of the arm and is influenced by SC joint elevation/depression, SC joint A/P rotation and P/A rotation of AC joint.

Upward and Downward Rotation

 Movement of the scapula by shrugging the shoulder up and depressing the shoulder downward influenced by elevation and depression of clavicle at SC joint and rotations at AC joint

Elevation and Depression Rotation

 Translatory motion of the scapula toward or away from the vertebral column influenced by protraction and retraction of clavicle at SC joint and rotations at AC joint.

Protraction and Retraction

 Ultimate function of Scapular Motions

 Orient the Glenoid fossa for optimal contact with maneuvering arm To add range of elevation to the arm To provide a stable base for controlled motions between humeral head and glenoid fossa

 Articulation formed by the head of humerus and Glenoid cavity of the scapula.

Glenohumeral Joint

 130 -150 degree angle formed by the axis of humerus head and neck with the shaft at longitudinal axis.

Angle of inclination

 30 degree angle formed by the axis of humerus head and neck with humeral condyles in transverse axis.

Angle of Torsion

 The normal posterior position of the humeral head with regards to the humeral condyles.

 Posterior Torsion, Retrotorsion or Retroversion of humerus

 What increases GH joint congruence?

 Retroversion of humeral head by turning the humeral head back to the glenoid fossa of the scapula Glenoid Labrum enhances total available articular surface of glenoid fossa

Glenoid Labrum

 A thin area of capsule between superior and inferior GH ligaments and is a point of weakness in the GH capsule.

 Foramen of Weitbrecht

 The Glenohumeral joint is reinforced by these three ligaments.

 Superior, middle and Inferior GH ligaments Coracohumeral ligaments

GH ligaments

 This GH ligament passes from superior glenoid labrum to the upper neck of humerus deep to coracohumeral ligament.

 Superior GH ligament

 This GH ligament runs obliquely from the superior anterior labrum to the anterior aspect of the proximal humerus below the superior GH ligament.

 Middle GH ligament

 The three portions of the inferior GH ligament complex (IGHLC).

 Anterior band Posterior band Axillary Pouch

 This GH ligament originate from the base of coracoid process and inserts into scapula and humerus.

Coracohumeral ligament

 Two heads of coracoacromial ligament.

 1st head inserts in the supraspinatus and greater tubercle where it joins the superior GH ligament 2nd head inserts in the subscapularis and lesser tubercle

 The tunnel formed by the two bands contains the ?

 Tendon of the long head of biceps brachii.

 This is formed by the coracoid process acromion and coracoacromial ligament.

Coracoacromial arch

 The coracoacromial arch forms an osteoligamentous vault that covers what structures?

 Humeral head Subacromial bursa Rotator cuff tendons A portion of the tendon of the long head of biceps brachii.

 Coracoacromial arch is very important in preventing the head of humerus from dislocating superiorly, because an unopposed upward translatory force on humerus would?

 Cause the head of humerus from hitting the coracoacromial arch leading to impingement or mechanical abrasion of the underlying structures.

 A combination of subacromial and subdeltoid bursa which separates the supraspinatus tendon and head of humerus from acromion, coracoid process, coracromial ligament and deltoid muscle.

Subacromial Bursa

 The function of Subacromial bursa?

 Permits smooth gliding between the humerus and supraspinatus tendon and surrounding structure. Interruption in this structure can cause pain and limitation of GH motion

 The primary purpose of wrist, elbow and shoulder complex

 Enhancing hand function

 The elbow joint is what type of synovial joint?

 Loose Hinge Joint

 The articulating surface of humerus with ulna and radius.

 Humerus - Trochlea, Coronoid fossa, radial fossa and Capitulum (Anteriorly) and Olecranon Fossa (Posteriorly) Radius - head of radius Ulna Trochlear notch

 Receives head of radius during flexion.

 Radial Fossa

 Receives coronoid process of ulna during flexion.

 Coronoid Fossa

 Receives olecranon process of ulna during extension.

 Olecranon Fossa

 This results to valgus angulation of the forearm.

 The distally oriented projection of the medial portion of trochlea compared to its lateral portion.

 Divides Trochlea into lateral and medial portion.

 Trochlear groove

 Separates capitulum from Trochlea.

 Capitulotrochlear groove

 Divides the trochlear notch into two portions.

 Trochlear ridge

 (1)Part of the trochlea of humerus which corresponds to this (2) part of trochlear notch of Ulna which form articulations.

 (1)

Trochlear groove (2) Trochlear ridge

 This part of Head of radius which fits into the Capitulotrochlear groove?

 Fovea

 Articulation of this joint is through the sliding motion of ulnar trochlear ridge with humeral trochlear groove and is congruent.

 Humeroulnar joint

 Articulation of this joint occurs through sliding of concave radial head over convex capitulum and is incongruent.

 Humeroradial joint

 During this motion of the elbow, the sliding occurs until the olecranon process of ulna enter olecranon fossa of humerus while no contact occurs between capitulum and head of radius.

 Extension

 During this motion of the elbow, sliding occurs until coronoid process reaches the coronoid fossa while the rim of the head of radius slides in the capitulotrochlear groove and enter radial fossa as end of ROM.

 Flexion

 Ligament found in lateral and medial side of most hinge joints to provide stability to the joint and to keep joint surfaces in apposition.

 Collateral ligament

 This type of collateral ligament is located on the ulnar side and a major soft tissue restraint of valgus stress at the medial aspect of the elbow.

 Medial Collateral ligament

 This part of the medial collateral ligament is the primary restraint of valgus stress from 20 120 degree elbow flexion.

 Anterior part of medial collateral ligament ( the posterior part plays less significant role)

 Consist the Lateral Collateral Ligament Complex ?

 Lateral Collateral Ligament Lateral Ulnar Collateral Ligament Annular Ligament

 This component of the Lateral Collateral Ligament complex is a fan shaped structure that extends from the inferior aspect of lateral epicondyle of humerus to head of radius and olecranon process. It offers some protection against varus stress in some position in the elbow and provide resistance to longitudinal distraction of joint surface

 Lateral Collateral Ligament

 This component of Lateral collateral ligament complex is a ligamentous tissue extending from lateral epicondyle to the lateral aspect of the ulna and annular ligament.

 Lateral Ulnar Collateral Ligament

 Lateral deviation of ulna in relation to humerus due to trochleas medial aspect extends more distally than the lateral aspect.

 Carrying angle or Cubitus Valgus

 Average carrying angle in full elbow extension.

 15 degrees

 Abnormal angulation of the elbow

 Varus angulation or Cubitus Varus

 Normally, carrying angle disappears when?

 Forearm is pronated and elbow is in full extension Forearm is supinated and elbow is in full flexion

 What are the factors that affect ROM of HU and HR joints?

 Type of motion
Active flexion 135-145 deg; Passive flexion 150-160 deg

The Position of forearm

Pronation ROM is less Supination ROM is great

Position of shoulder
Due to muscles of biceps and triceps brachii

 Consist the Superior Radioulnar Joint.

Ulnar radial notch Annular ligament Capitulum Head of radius

 Consist the Inferior Radioulnar Joint.

 Ulnar notch of radius Articular disk Ulnar head

 A component of Superior Radioulnar joint located lateral to ulna inferior to trochlear notch and has concave surface covered with articular cartilage

 Ulnar radial notch

 A circular ligament attached to anterior and posterior edges of the notch and encircles the rim of radial head; also covered with articular cartilage.

 Annular ligament

 A component of Inferior radioulnar joint located at distal end of radius along interosseous border.

 Ulnar notch of radius

 Articular disk of RU joint is also known as?

 Triangular Fibrocartilage (TFC) because of its triangular shape

(a part of Triangular Fibrocartilage Complex (TFCC) because of its extensive fibrous connections)

 The Articular disks base is attached to edge of ulnar notch while its apex are attached to?

 Fovea of ulnar head Base of ulnar styloid

 The proximal surface of the Articular disk of RU joint articulates with?

 Ulnar head

 The distal surface of the articular disk of RU joint articulates with?

 Carpal bones

 The pole of the Ulnar head articulates with?

 Articular Disk of RU joint

 The seat of the ulnar head articulates with?

 Ulnar notch of radius

 This movement of the forearm is a result of the crossing over of the radius over ulna at the superior radioulnar joint.

 Pronation

 These are the ligaments that consist the Superior radioulnar joint.

 Annular ligament Quadrate ligament Oblique cord

 This Superior RU ligament forms 4/5 of the ring that encircles the radial head.

 Annular ligament

 This superior RU ligament extends from the inferior edge of radial notch of ulna and inserts into the neck of radius.

 Quadrate ligament

 This RU ligament helps maintain radial head in apposition with radial notch and limits spin of the radial head in supination and pronation.

 Quadrate ligament

 This Superior RU ligament is a flat fascial band on ventral forearm that extends from an attachment just inferior to radial notch of ulna and inserts just below the bicipital tuberosity of radius.

 Oblique Cord

 This superior RU ligament assists in preventing separation of radius and ulna

 Oblique cord

 This consist the ligaments of inferior RU joint

 Dorsal Radioulnar ligament Palmar Radioulnar ligament Interosseous membrane (IOM)

 This ligament of the inferior RU joint is longitudinally oriented collagen fibers extending along margins of articular disk to insert in ulnar fovea and base of ulnar styloid process.

 Dorsal and Palmar radioulnar ligament

(palmar radioulnar ligament is longer than dorsal radioulnar ligament)

 This ligament of the inferior radioulnar joint attaches between the shafts of radius and ulna and maintains space between radius and ulna during forearm rotation.

 Interosseous membrane

 During this motion of the Forearm, the radius and ulna are parallel with one another and the ulnar head moves proximally and medially.

 Supination

 During this motion of the forearm, the radius crosses the forearm and the ulnar head moves distally and dorsally.

 Pronation

 Factors that limits pronation of forearm.

 Passive tension in biceps brachii when elbow is extended Bony approximations of radius and ulna Tension in dorsal RU ligaments and Oblique cord

 Factors that limits supination of forearm.

 Passive tension in palmar RU ligaments and Oblique cord

 Two joints of the Wrist complex.

 Radiocarpal joint Midcarpal joint

 Compose the Proximal joint surface of Radius.

 Lateral radial facet Medial Radial facet TFCC

 The lateral radial facet articulates with?

 Scaphoid

 The medial radial facet articulates with?

 Lunate

 The TFCC articulates with?

 Triquetrum

 The proximal radiocarpal joint surface is oblique, angled slightly volarly and ulnarly . The average inclination of distal radius is?

 23 degrees

 The radioulnar disk is connected medially via these two dense fibrous connective tissue laminae.

 Dorsal and Volar RU ligament Ulnar Collateral ligament

 This dense fibrous connective tissue lamina connects the RU disk medially to the ulnar head of styloid process in the upper lamina

 Dorsal and volar radioulnar ligament

 This dense fibrous connective tissue lamina connects the RU disk medially to the sheath of ECU tendon and triquetrum, hamate and base of 5th metacarpal in lower lamina

 Ulnar Collateral Ligament

 Consist the Proximal row of Carpal bones that articulates with distal radius.

 Scaphoid Lunate and Triquetrum

 These proximal carpal row is reinforced by these ligaments.

 Scapholunate interossious ligament Lunotriquetral interosseous ligament

 This carpal bone do not articulate with radius and acts like a sesamoid bone that increase the moment arm of flexor carpi ulnaris (FCU) tendon.

 Pisiform

 These are factors that affect joint function.

 Joint incongruence and angulation of proximal joint surface Length of ulna in relation to radius

 Effect of joint incongruence and angulation on joint function.

 It results to greater range of flexion and extension and greater ulnar deviation than radial deviation on RC joint

 This is a condition in which the TFCC is thicker because the ulna is shrter than the radius. It may result to abnormal force distribution across RC joint and potential degeneration of the said joint.

 Ulnar negative variance

 In this condition, the TFCC is thinner because ulna is loner than the radius and so there is a potential for impingement of TFCC structures between ulna and radius.

 Ulnar Positive Variance

 This consist the Midcarpal Joint surface.

 The proximal row of carpal bones (scaphoid, lunate and triquetrum) The distal carpal row of carpal bones (

trapezium, trapezoid, capitate and hamate)

 The Midcarpal joint is reinforced by the following ligaments.

 Extrinsic ligament Intrinsic ligament

 This MC ligament connects carpals to radius or ulna proximally or to metacarpals distally

 Extrinsic ligaments

 MC ligaments that connect carpals themselves. Also known as intercarpals or interosseous ligaments.

 Intrinsic ligaments

 Consist the Volar radiocarpal ligament

 Radioscapholunate Radiolunate Radioscaphocapitate

 Compose the Ulnocarpal ligament complex

 TFCC Ulnolunate ligament Ulnar Collateral ligament

 This Volar RC ligament is said to be avascular and is a key factor of scaphoid stability. Injury to this ligament results to scaphoid instability and one of the common wrist problems.

 Scapholunate interosseous ligament

 These compose the Dorsal Carpal ligaments.

 Dorsal radiocarpal ligament Dorsal intercarpal ligament

 Compose of the articulations between distal carpal row and nd through 5th bases of 2 metacarpal.

 Carpometacarpal joint

 The 2nd metacarpal articulates with?

 Primarily with Trapezoid Secondarily with Trapezium and capitate

 3rd metacarpal articulates with?

 Capitate

 4th metacarpal articulates with?

 Capitate and Hamate

 5th metacarpal articulates with?

 Hamate

 The carpal tunnel contains?

 Median nerves 9 flexor tendons

 In Carpometacarpal joint, range of motion (ROM) increases from?

 Radial to ulnar side

 2nd through 4th metacarpophalangeal joints ROM

 Uniaxial (flexion and extension)

 They are immobile metacarpophalangeal joints

 2nd and 3rd MP joints they provide a

fixed and stable axis for movement of 4th and 5th MP joint

 The 5th MP joints ROM?

Saddle Joint opp

biaxial flex/ext, abd/add,

 CMC joints are reinforced by these ligaments.

 Deep Transverse Ligaments

 Arches of the hand.

 Proximal Transverse Arch Distal Transverse Arch Longitudinal Arch

 This arch is formed by the trapezoid, capitate and hamate.

 Proximal Transverse Arch

 Formed by the adjustable 1st, 4th and 5th MP heads around a relatively fixed 2nd and 3rd MP

 Distal Transverse Arch

 The arch that traverse the length of the digit from proximal to distal.

 Longitudinal Arch

 This allow the palm and the digits to conform optimally to the shape of the object being held maximizing the amt. of surface contact, enhancing stability and increasing sensory feedback

 Palmar Arches

 Increases joint congruence at each MP joints, provides stability by limiting hyperextension and therefore provides indirect support to longitudinal arch.

 Volar Plates/Palmar Plates

 Helps stabilize the volar plates over each side of the 4 metacarpals heads

 Sagittal bands

 Ligaments that reinforce MP joints.

Radial Collateral ligament Radial Accessory Collateral ligament Ulnar Collateral ligament Ulnar Accessory Collateral Ligament

 Reference: Joints and Structures by Norkin and Levangie