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)