Joints and Ligaments of Upper Limb
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Acromioclavicular (AC) Joint
Synovial plane joint, allows gliding movement when scapula rotates. Reinforced by coracoclavicular ligament (Conoid and trapezius ligaments).
Dislocation of AC Joint (Separated shoulder)
Fall on shoulder with impact taken by acromion or on outstretched arm. Acromion separated from clavicle with rupture of coracoclavicular ligament.
Double synovial (gliding) joint united by fibrous capsule. Reinforced by anterior and posterior sternoclavicular, interclavicular, and costoclavicular ligaments. Allows elevation/depression, retraction, and circumduction of shoulder.
Glenohumeral Joint (Shoulder)
Synovial ball-and-socket joint between glenoid cavity of scapula and head of humerus. Both articular surfaces are covered with hyaline cartilage.
Attached superiorly to margin of glenoid cavity and inferiorly to anatomic neck of humerus. Capsule is reinforced by rotator cuff, glenohumeral ligaments, and coracohumeral ligaments.
Fibrocartilaginous, deepens glenoid cavity. Communicates with subscapular bursa and allows abduction, adduction, flexion, extension, circumduction, and rotation.
What nerves are found in the glenohumeral joint?
Axillary, suprascapular, and lateral pectoral nerves.
What vessels supply blood to the glenohumeral joint?
Branches of suprascapular, anterior and posterior humeral circumflex, and scapular circumflex arteries.
Subluxation (Dislocation) of glenohumeral joint
Anteroinferior direction b/c of lack of support of tendons of rotator cuff. Stretches fibrous capusle, avulses glenoid labrum and may injure axillary nerve and humeral circumflex vessels.
Referred pain to shoulder
Indicates involvement of phrenic nerve or diaphragm. Supraclavicular nerve (C3-C4) supplies sensory fibers over should has same origin as phrenic nerve which supplies diaphragm.
Rotator (Musculotendinous) Cuff
Formed by tendons of supraspinatus, infraspinatus, teres minor, and subscapularis (SITS); fuses with joint capsule; provides mobility. Keeps head of humerus in glenoid fossa during movement and stabilizes shoulder joint.
Rupture of rotator cuff
Chronic wear and tear or acute fall on outstretched arm. Severe limitation of shoulder motion, mainly abduction.
What are the 3 glenohumeral ligaments?
Superior, middle, and inferior glenohumeral ligaments. Between scapula and humeral head.
Superior glenohumeral ligament
Extends from supraglenoid tubercle to upper part of lesser tubercle of humerus.
Middle glenohumeral ligament
Extends from supraglenoid tubercle to lower anatomic neck of humerus
Inferior glenohumeral ligament
Supraglenoid tubercle to lower part of lesser tubercle of humerus
Transverse Humeral Ligament
Extends between greater and lesser tubercles and holds tendon of head of biceps brachii in intertubercular groove
Extends from coracoid process to greater tubercle
Coracoid process to acromion
Coracoid process to clavicle and consists of trapezoid and conoid ligaments.
What are the 3 bursae around the shoulder?
- 1) Subacromial bursa
- 2) Subdeltoid bursa
- 3) Subsscapular bursa
- Fx: form lubricating mechanism b/w rotator cuff and coracoacromial arch during mvmt of shoulder
Lies b/w coracoacromial arch and supraspinatus muscle. Usually communicates with subdeltoid bursa and protects supraspinatus tendon against friction with acromion.
B/w deltoid muscle and shoulder joint capsule. Usually communicates with subacromial bursa and facilitates mvmt of deltoid muscle over joint capsule and supraspinatus tendon.
B/w supscapularis tendon and neck of scapula and communicates with synovial cavity of shoulder joint.
Synovial hinge joints: 1) humeroradial 2) humeroulnar joints. Flexion and extension. Also includes proximal radioulnar (pivot) joint within common articular capsule.
What 4 nerves innervate the elbow?
- 1) Musculocutaneous
- 2) Radial
- 3) Median
- 4) Ulnar
What vessels provide blood supply to the elbow?
Anastomosis formed by branches of brachial artery and recurrent branches of the radial and ulnar arteries.
What are the 3 ligaments in the elbow?
- 1) Annular Ligament
- 2) Radial Collateral Ligament
- 3) Ulnar Collateral Ligament
Fibrous band, 4/5 of a circle aroudn radial head. 1/5 of circle formed by radial notch. Encircles head of radius, keeps in position. Fuses with radial collateral ligament and articular capsule.
What can happen when picking up a child by the forearm?
Subluxation of radial head from annular ligament
Radial Collateral Ligament
Extends from lateral epicondyle to anterior and posterior margins of radial notch of ulna and annular ligament of ulna.
Ulnar Collateral Ligament
Triangular, 3 bands: anterior, posterior and oblique bands. Extends from medial epicondyle to coronoid process and olecranon of ulna.
Proximal radioulnar joint
Synovial pivot joint. Head of radius articulates with radial notch of ulna and allows pronation and supination. Radial head rotates within encircling annular ligament.
Distal radioulnar joint
Forms a synovial pivot joint b/w head of ulna and ulnar notch of radius and allows pronation and supination.
Radiocarpal (Wrist) Joint
- Synovial condylar joint formed superiorly by radius and articular disk and inferiorly by proximal row of carpal bones (schaphoid, lunate, and rarely triquetrum)
- Strengthened by radial and ulnar collateral ligaments and dorsal and palmar radiocarpal ligaments. Allows flexion, extension, abduction, adduction, and circumduction.
Synovial plane joint b/w proximal and distal rows of carpal bones and allows gliding and sliding movements.
- Form synovial saddle (sellar) joints between carpal bone (trapezium) and first metacarpal bone, allowing flexion and extension, abduction, adduction, and circumduction.
- Forms plane joints between carpal bones and medial 4 metacarpal bones, allowing simple gliding mvmt
Metacarpophalangeal Joints (MCP)
Condyloid joints that allow flexion, extension, abduction and adduction.
Hinge joints that allow flexion and extension.
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