department of anatomy upper limb upper limb joints
TRANSCRIPT
WINDSOR UNIVERSITYSCHOOL OF MEDICINESt.Kitts
DEPARTMENT OF ANATOMY
UPPER LIMB
Upper limb joints
TypeArticulationLigamentsMovementsBlood Supply Nerve Supply
Glenohumeral Joint
SHOULDER JOINT
TYPE:◦ Synovial : ball and socket joint
Bony articulation◦ -Head of the Humerus◦ -Glenoid cavity of the Scapula ◦ (deepened by Glenoid labrum)
Important Relation
Anteriorly• Subscapular, • Axillary vessels, BP
Posteriorly• Infraspinatus, TMin
Superiorly• Supraspinatus, • Subacromial Bursa• Coracoacromial lig., Deltoid m.
Inferiorly• Long head of Triceps, Axillary n• Post.circumflex humeral artery.
Contain thin layer of synovial fluid
Located where tendons rub against bone, ligaments, or tendons and when skin moves over bone directly beneath
Subscapular bursa Subacromial (subdeltoid) bursa
Bursa of Shoulder Joint
Subscapular bursa ◦Between tendon of subscapularis muscle and neck of
scapula◦Communicates with cavity of shoulder joint
Subacromial (subdeltoid) bursa ◦Between deltoid, supraspinatus tendon and
glenohumeral capsule◦Does not communicate with cavity of shoulder◦Facilitates movement of deltoid over joint capsule
and supraspinatus tendon under coracoacromial arch
Movements:
Mobile but unstable joint
- The head of the humerus doesn’t fit perfectly with the glenoid fossa and Glenoid labrum
FLEXION• Pectoralis Major• Deltoid m.(anterior.fibres) • Bicpes• Coraco brachialis
EXTENSION * Latissimus Dorsi * teres Major * Triceps –long head
ABDUCTION• Deltoid m.(mid.fibres) • Supraspinatus m.
ADDUCTION• Pectoralis major, Latissimus Dorsi, Teres
Major
LATERAL ROTATION.• Infraspinatus, Teres minor • Deltoid (post. fibres)
MEDIAL ROTATION.• Subscapular, Latisimus Dorsi• Deltoid (ant. fibres)
Stability
Depends mainly on
• Rotator cuff muscle, • deltiod & biceps muscles
The weakest part is • the inferior aspect of the capsule( no
muscles)
ANTERIOR DISLOCATIONShoulder joint is the most commonly dislocated
large joint Common type is anterior dislocation (post. Dislocation
is very rare) Young adult(athletes)
Excessive extension and lateral rotation of the humerus
Head of the humerus comes to lie inferior to the glenoid fossa
Head is pulled (by flexors and adductors of the shoulder joint) forward And upward into the subcoracoid position
ANTERIOR DISLOCATION
Elbow Joint
TYPE: Hinge type of synovial joint
ARTICULATIONS :Trochlea and
spheroidal capitulum of the humerus articulate with the trochlear notch of the ulna and the slightly concave superior aspect of the head of the radius
CAPSULE :
The fibrous layer of the joint capsule surrounds the elbow joint.
The synovial membrane lines the internal surface of the fibrous layer of the capsule and the intracapsular non-articular parts of the humerus.
Ligaments of the Elbow Joint
Lateral: Radial collateral ligament extends from the lateral epicondyle of the humerus and blends distally with the anular ligament of the radius.
Medial: Ulnar collateral ligament extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna.
Movements of the Elbow JointFlexion and extension occur at
the elbow joint.Chief flexors of the elbow joint
are the brachialis and biceps brachii.
Chief extensor of the elbow joint is the triceps brachii.
Bursae around the Elbow Joint
1. Intratendinous olecranon bursa
2. Subtendinous olecranon bursa
3. Subcutaneous olecranon bursa
Bursitis of the Elbow
Student's elbow: Subcutaneous
olecranon bursa is exposed to injury during falls on the elbow and to infection from abrasions of the skin covering the olecranon.
Tennis elbow(Lateral epicondylitis)
It occurs at the common extensor tendon that originates from the lateral epicondyle.
The acute pain that a person might feel occurs as one fully extends the arm.
Golfer's elbow(medial epicondylitis)
Is an inflammatory condition of the medial epicondyle of the elbow.
Proximal radioulnar joint
Type: Pivot type of synovial joint
Articulation: Head of the radius articulates with the radial notch of the ulna
Ligaments: The strong anular ligament, attached to the ulna anterior and posterior to its radial notch.
MovementsPronation and supination.
Pronation: Pronator quadratus (primarily) and pronator teres
Supination: Supinator and biceps brachii.
Subluxation and Dislocation of Radial Head
Pulled elbow or Nursemaid's elbow
The sudden pulling of the upper limb tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius.
Wrist Joint (radiocarpal)
Type: Condyloid (ellipsoid) type of synovial joint
Articulation: The ulna does not participate in the wrist joint.
The distal end of the radius articulate with the proximal row of carpal bones, except for the pisiform.
Movements of the Wrist Joint
Flexion, extension, abduction and adduction (radial deviation and ulnar deviation).
Muscles Moving the Wrist Joint
Tendon Reflexes
Deep Tendon Reflexes will not work if either the sensory or motor component of the nerve to the muscle being tested are injured, or if the spinal cord segment where the reflex is integrated is injured.
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Hypo reflex – problem in Nerves or Roots
Hyper Reflex – Problem in Spinal cord or Brain
Technique :Patient sitting and relaxed. Therapist places her thumb over biceps tendon and applies a brisk tap (to her thumb nail) with reflex hammer
Biceps jerk
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Triceps Jerk
It is initiated by the Cervical spinal nerve 7 nerve root ( C7)