1 copyright © 2011, 2007 by mosby, inc., an affiliate of elsevier inc. all rights reserved. joseph...

1Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Joseph E. Muscolino, DCInstructor, Purchase CollegeState University of New YorkOwner, The Art and Science of KinesiologyStamford, Connecticut

KINESIOLOGY:The Skeletal System and Muscle FunctionSecond Edition

Chapter 9:Joints of theUpper ExtremityJoseph E. Muscolino, DC

Lesson 9.1 Objectives

• Define the key terms of this chapter and state the meanings of the word origins of this chapter.

• Describe why the term shoulder corset might be a better term than shoulder girdle.

• Explain why the term shoulder joint complex is a better term than shoulder joint when describing movement of the shoulder.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

3

Lesson 9.1 Objectives(cont’d.)

• Describe the concepts of mobility and stability as they pertain to the glenohumeral joint, and explain why the glenohumeral joint is often called a muscular joint.

• Explain why the scapulocostal joint is considered to be a functional joint, not an anatomic joint.


4

Lesson 9.1 Objectives(cont’d.)

• Describe why the sternoclavicular joint can be classified as either biaxial or triaxial.

• Explain why stabilization of the sternoclavicular joint is important toward proper functioning of the upper extremity.

• Describe the importance of acromioclavicular joint motion to motion of the shoulder girdle.


5

Joints of the Upper Extremity

• Shoulder joint complex

• Glenohumeral joint

• Scapulocostal joint

• Sternoclavicular joint

• Acromioclavicular joint

• Elbow joint complex

• Elbow joint


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• Radioulnar joints

• Wrist joint complex

• Carpometacarpal joints

• Saddle joint of the thumb

• Intermetacarpal joints

• Metacarpophalangeal (MCP) joints

• Interphalangeal joints (IP) of the hand

Joints of the Upper Extremity(cont’d.)


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Section 9.1—ShoulderJoint Complex


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Figure 9-1

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby. Courtesy Joseph E. Muscolino

Section 9.1—ShoulderJoint Complex (cont’d.)

Joints of the Shoulder Joint Complex:

• Glenohumeral (GH) joint

• Sternoclavicular (SC) joint

• Acromioclavicular (AC) joint

• Scapulocostal (ScC) joint


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Section 9.1—ShoulderJoint Complex (cont’d.)

Average Ranges of Motion:

• Flexion 180 degrees

• Extension 150 degrees

• Abduction 180 degrees

• Adduction 0 degrees

• Lateral rotation 90 degrees

• Medial rotation 90 degrees


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Section 9.2—Glenohumeral Joint


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Figure 9-2

Section 9.2—Glenohumeral Joint (cont’d.)


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Figure 9-3



13

Figure 9-4


• Structure: Synovial joint– Ball-and-socket joint

• Function: Diarthrotic– Triaxial

• Major motions:– Flexion/extension – Abduction/adduction– Lateral/medial rotation


14



• Flexion 100 degrees

• Extension 40 degrees

• Abduction 120 degrees

• Adduction 0 degrees

• Lateral rotation 50 degrees

• Medial rotation 90 degrees


15


Major ligaments:

• Fibrous joint capsule

• Superior glenohumeral ligament

• Middle glenohumeral ligament

• Inferior glenohumeral ligament

• Coracohumeral ligament


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Ligaments of the Glenohumeral Joint:


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Figure 9-5



18

Figure 9-6



19

Figure 9-6

B, from Muscolino JE: The muscular system manual, ed 2, St Louis, 2005, Mosby

Section 9.3—Scapulocostal Joint


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Figure 9-7

Section 9.3—Scapulocostal Joint (cont’d.)

Nonaxial Actions at the

Scapulocostal Joint:


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Figure 9-8


Upward Rotation at the Scapulocostal Joint:


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Figure 9-9


Tilt Actions at the Scapulocostal Joint:


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Figure 9-10


• Structure: Functional joint

• Major motions: – Protraction/retraction– Elevation/depression– Upward/downward rotation


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Section 9.4—Sternoclavicular Joint


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Figure 9-11

Section 9.4—Sternoclavicular Joint (cont’d.)

• Structure: Synovial joint– Saddle

• Function: Diarthrotic– Biaxial

• Major motions: – Protraction/retraction– Elevation/depression– Upward/downward rotation


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• Major ligaments: – Fibrous capsule– Anterior sternoclavicular ligament – Posterior SC ligament– Interclavicular ligament – Costoclavicular ligament


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• Elevation 45 degrees

• Depression 10 degrees

• Protraction 30 degrees

• Retraction 30 degrees

• Upward rotation 45 degrees

• Downward rotation 0 degrees


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29

Figure 9-12



30

Figure 9-13



31

Figure 9-14



32

Figure 9-15

Section 9.5—Acromioclavicular Joint


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Figure 9-16

Section 9.5—Acromioclavicular Joint (cont’d.)

• Structure: Synovial joint– Plane

• Function: Diarthrotic– Nonaxial

• Motions allowed: Upward/downward rotation


34



35

Figure 9-17


• Major ligaments: – Fibrous capsule – Acromioclavicular (AC) ligament – Coracoclavicular ligament

• Closed-packed position: – Full upward rotation of the scapula


36



37

Figure 9-18


• Explain the concept of scapulohumeral rhythm, and give an example for each of the six cardinal ranges of motion of the arm at the shoulder joint.

• Describe the concept and importance of the carrying angle.

• Describe the component motions that occur at the proximal and distal radioulnar joints that create pronation and supination of the forearm.


38








• Elbow joint


39






• Metacarpophalangeal joints

• Interphalangeal joints of the hand



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Section 9.6—Scapulohumeral Rhythm

• Sagittal plane actions

• Frontal plane actions

• Transverse plane actions

• Other coupled actions


41

Section 9.6—Scapulohumeral Rhythm (cont’d.)


42

Figure 9-19

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby. Courtesy Joseph E. Muscolino

Section 9.7—Elbow Joint Complex


43

Figure 9-20

Section 9.7—Elbow Joint Complex (cont’d.)

Three Articulations:

• Humeroulnar joint

• Humeroradial joint

• Proximal radioulnar joint


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Section 9.8—Elbow Joint

Humeroulnar Joint:

• Structure: Synovial joint– Hinge

• Function: Diarthrotic– Uniaxial


45

Section 9.8—Elbow Joint (cont’d.)

Humeroradial Joint:

• Structure: Synovial joint– Atypical ball-and-socket



46



47

Figure 9-21



48

Figure 9-22



49

Figure 9-23


Elbow Joint:

• Major actions: Flexion/extension

• Major ligaments: – Fibrous capsule – Medial collateral ligament – Lateral collateral ligament


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51

Figure 9-24

Section 9.9—Radioulnar Joints

Three Radioulnar Joints:

• Proximal radioulnar joint

• Middle radioulnar joint

• Distal radioulnar joint


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Section 9.9—Radioulnar Joints (cont’d.)

Radioulnar Joints:

• Major actions: Pronation/supination

Ranges of Motion:

• Pronation 160 degrees

• Supination 0 degrees


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54

Figure 9-25


Pronation and Supination at the RU Joints:


55

Figure 9-26


Ligamentous Structures of the RU Joints:


56

Figure 9-27


• Describe the structure and function of the hand.

• Describe the structure and function of the wrist and, specifically, the carpal tunnel.

• Explain why the radiocarpal joint is the major articulation between the forearm and the hand.

• Describe the importance of motion at the 4th and 5th carpometacarpal joints.


57








• Elbow joint


58










59

Section 9.10—Overview of the Wrist/Hand Region

Three Regions:

• Carpus

• Metacarpus

• Phalanges (fingers)


60

Figure 9-28

Section 9.10—Overview of the Wrist/Hand Region (cont’d.)

General Organization:• Wrist joint

– Radiocarpal joint– Midcarpal joint

• Carpometacarpal joints• Intermetacarpal joints• Metacarpophalangeal (MCP) joints• Interphalangeal (IP) joints


61


Arches of the Hand:


62

Figure 9-29

B modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby; A courtesy of Joseph E. Muscolino


Carpal Tunnel:


63

Figure 9-30

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby; courtesy of Joseph E. Muscolino


Dorsal Digital Expansion:


64

Figure 9-31

From Muscolino JE: The muscular system manual: the skeletal muscles of the human body, ed 3, St Louis, 2010, Mosby


Dorsal Digital Expansion (cont’d.):


65

Figure 9-31

From Muscolino JE: The muscular system manual: the skeletal muscles of the human body, ed 3, St Louis, 2010, Mosby

Section 9.11—WristJoint Complex

{Insert Fig. 9-32}


66

Figure 9-30

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physicalrehabilitation, ed 2, St Louis, 2010, Mosby;courtesy Joseph E. Muscolino

Section 9.11—WristJoint Complex (cont’d.)

Joints of the Wrist Joint Complex:

• Radiocarpal joint

• Midcarpal joint

• Intercarpal joints


67


Radiocarpal and Midcarpal Joints:

• Structure: Synovial joint– Condyloid



68


Radiocarpal and Midcarpal Joints (cont’d.):

• Major Motions Allowed: – Flexion/extension– Radial/ulnar deviation

• Closed-Packed Position: – Extension and slight ulnar deviation


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Ligaments of the Wrist Joint Complex:

• Fibrous capsule of the radiocarpal joint• Radioulnar disc• Fibrous capsule of the midcarpal joint• Transverse carpal ligament• Extrinsic ligaments• Intrinsic ligaments


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Ligaments of the Wrist Joint Complex

(cont’d.):

{Insert Fig. 9-34 A only}


71

Figure 9-34

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby


Ligaments of the Wrist Joint Complex

(cont’d.):


72

Figure 9-34


Section 9.12—Carpometacarpal Joints


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Figure 9-35

Section 9.12—Carpometacarpal Joints (cont’d.)

Second and Third CMC Joints:


• Function: Synarthrotic– Nonaxial


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First, Fifth, and Fourth CMC Joints:




75


Motion of the CMC Joints of the Hand:


76

Figure 9-36

A, modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;


Motion of the CMC Joints of the Hand

(cont’d.):


B and C courtesy Joseph E. Muscolino.

77

Figure 9-36


Ligaments of the CMC Joints:

• Fibrous capsules

• Dorsal CMC ligaments

• Palmar CMC ligaments

• Interosseus CMC ligaments


78


Dorsal CMC Ligaments

of the CMC Joints:

{Insert Fig. 9-37 A only}


79

Figure 9-37

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;


Palmar CMC Ligaments

of the CMC Joints:

{Insert Fig. 9-37 B only}


80

Figure 9-37

Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;



Joint Flexion Extension

• 5th CMC 20 degrees 0 degrees

• 4th CMC 10 degrees 0 degrees

• 3rd CMC 0 degrees 0 degrees

• 2nd CMC 0–2 degrees0 degrees


81


• Describe the importance of motion at the first carpometacarpal joint (i.e., the saddle joint of the thumb).

• Describe the component actions of opposition and reposition of the thumb.

• Discuss the similarities and differences between the metacarpophalangeal joints and the interphalangeal joints.


82








• Elbow joint


83










84

Section 9.13—Saddle (Carpometacarpal) Joint of the

Thumb


85

Figure 9-38

Section 9.13—Saddle Joint of the Thumb (cont’d.)

CMC Joint of the Thumb:




86



• Abduction 60 degrees• Adduction 10 degrees• Flexion 40 degrees• Extension 10 degrees• Medial rotation 45 degrees• Lateral rotation 0 degrees


87


Actions of the Thumb at the Saddle Joint:


88

Figure 9-39


Ligaments of the Saddle Joint:

• Fibrous capsule• Radial collateral ligament• Ulnar collateral ligament• Anterior oblique ligament• Posterior oblique ligament• 1st intermetacarpal ligament


89



90

Figure 9-40


Section 9.14—Intermetacarpal Joints


91

Figure 9-41

Section 9.14—Intermetacarpal Joints (cont’d.)

{Insert Fig. 9-41 B only}


92

Figure 9-41

Section 9.14—Intermetacarpal Joints (cont’d.)


• Function: Amphiarthrotic– Nonaxial


93

Section 9.15—Metacarpophalangeal Joints

{Insert Fig. 9-42}


94

Figure 9-42

Section 9.15—Metacarpophalangeal (MCP)

Joints (cont’d.)• Structure: Synovial joint

– Condyloid



95


(cont’d.)• Major motions allowed:

– Flexion/extension– Abduction/adduction

• Major ligaments: – Fibrous capsules– Radial collateral ligaments– Ulnar collateral ligaments– Palmar plates


96


(cont’d.)


97

Figure 9-43


(cont’d.)


98

Figure 9-43


(cont’d.)


99

Figure 9-43


(cont’d.)


100

Figure 9-44


(cont’d.)


101

Figure 9-44

Section 9.16—Interphalangeal Joints of the Hand

{Insert Fig. 9-45}


102

Figure 9-45

Section 9.16—Interphalangeal Joints of the Hand (cont’d.)

• Structure: Synovial joint– Hinge

• Function: Diarthrotic– Uniaxial


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Major Motions

Allowed:

• Flexion

• Extension


104

Figure 9-46


Major Ligaments of the IP Joints:

• Fibrous capsule

• Radial collateral ligaments

• Ulnar collateral ligaments

• Palmar plates

• Check-rein ligaments (PIP joint only)


105



106

Figure 9-47


107



Figure 9-47


1 copyright © 2011, 2007 by mosby, inc., an affiliate of elsevier inc. all rights reserved. joseph...

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