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JOINTS OF THE UPPER LIMB
Summary of Lecture Notes
Bertalan Dudas MD
2004
Joints of the upper limb
Sternoclavicular joint - attachment of the upper limb to the trunk
Type: Modified ball and socket joint (according to the articular surfaces it is rather a saddle,
but because the disk it functions like ball and socket)
Articular surfaces:
• Clavicular articular surface of manubrium sterni covered by fibrous cartilage
• Sternal articular facet of the clavicle covered by fibrous cartilage
• Fibrocartilagenous disk separates the articular cavity and adjusts the incongruity of the
articular surfaces
Articular elements:
Capsule: tight
Ligaments:
1. Interclavicular ligament
2. Sternoclavicular ligaments (anterior and posterior)
3. Costoclavicular ligament from the 1st rib
Blood supply: everything around
1. Internal thoracic artery
2. Suprascapular artery
3. Supreme thoracic arteries
4. Clavicular branch of thoracoacromial artery
Innervation:
1. Subclavian nerve
2. Supraclavicular nerves
Acromioclavicular joint
Type: Plane joint (gliding)
Articular surfaces:
• Clavicular articular surface of acromion sterni covered by fibrous cartilage
• Acromial articular facet of the clavicle covered by fibrous cartilage
• Incomplete fibrocartilagenous disk between
Articular elements:
Capsule: tight
Ligaments:
1. Acromioclavicular ligaments
2. Coracoclavicular ligaments
• Conoid ligament (to the conoid tubercle; medial)
• Trapezoid ligament (to the trapezoid line; lateral)
Blood supply:
1. Lateral thoracic arteries
2. Acromial branch of thoracoacromial artery
Innervation:
1. Axillary nerve
2. Supraclavicular nerves
3. Lateral pectoral nerve
Glenohumeral (shoulder) joint
Type: Ball and socket
Articular surfaces:
1. Head of the humerus covered by hyalin cartilage
2. Glenoid cavity of the scapula covered by hyalin cartilage and enlarged by a
fibrocartilagenous rim: labrum glenoidale
• Tendon of long head of biceps is attached to the supraglenoid tubercle and to
the superior part of the labrum
• Tendon of long head of triceps is attached to the infraglenoid tubercle and to
the inferior part of the labrum
Articular elements:
Capsule:
1. Originates from the labrum
2. Attached on the anatomical neck of humerus
3. Follows the biceps tendon with a synovial sheath in the intertubercular groove
4. Loose; surrounding muscles have crucial role to keep the articular surfaces together
(“muscle-dependent joint”)
5. At adducted arm it forms the axillary recess
6. Articular cavity communicates with bursae (subdeltoid, subacromial and
subscapularis)
Ligaments:
1. Coracohumeral ligament – blending with the capsule
2. Coracoacromial ligament – “roof” of the joint, prevents superior dislocation
3. Transverse humeral ligament – holds the biceps tendon in the intertubercular groove
4. Glenohumeral ligaments (superior, middle and inferior)
• Thickened regions of the anterior part of articular capsule of shoulder joint
• Easily distinguishable from inside the shoulder joint but not easily seen from
outside
• Converge on the supraglenoid tubercle with the biceps tendon
Blood supply:
1. Suprascapular artery
2. Anterior and posterior circumflex humeral arteries
Innervation:
1. Suprascapular nerve
2. Axillary nerve
3. Lateral pectoral nerve
Elbow joint
Type:
Compound (hinge-pivot = “trochogynglimus”)
Articular surfaces: covered by hyalin cartilage
Humeroradial joint: Capitulum humeri with the fovea of the head of radius
Humeroulnar joint: trochlea humeri with the trochlear notch of the ulna
Proximal radioulnar joint: articular circumference of the head of radius with the radial notch
of ulna
Articular elements:
Capsule: thin, loose, between the synovial (3) and fibrous (4) layers of the capsule there is
large amount of fat (5)
Ligaments:
1. Ulnar collateral ligament – triangular ligament between the humerus and ulna on the
medial side of the elbow
• Anterior fibers
• Posterior fibers
• Oblique fibers
2. Radial collateral ligament – from the humerus radiating into the annular ligament on the
lateral side of the elbow
3. Annular ligament – between the anterior and posterior edge of the radial notch of the
ulna encircling the articular circumference of the radius. Deep fibers are attached to the
radius and often called quadrate ligament.
Blood supply:
Arterial rete of the elbow formed by 7 arteries:
1. Superior ulnar collateral artery (from brachial artery)
2. Inferior ulnar collateral artery (from brachial artery)
3. Radial collateral artery (from deep brachial artery)
4. Middle collateral artery (from deep brachial artery)
5. Ulnar recurrent artery (from ulnar artery)
6. Radial recurrent artery (from radial artery)
7. Interosseous recurrent artery (from interosseous artery)
Innervation: by all the antebrachial nerves:
1. Ulnar nerve – ulnar part of the joint
2. Radial nerve – posterior, radial part of the joint
3. Median nerve – anterior part of the joint
4. Musculocutaneous nerve - radial part of the joint
Distal radioulnar joint
Type: Pivot joint
Articular surfaces:
• Head of the ulna
• Ulnar notch of the radius
Articular elements:
Capsule: loose
Ligaments: thin capsular ligaments
Blood supply: Anterior and posterior interosseous arteries
Innervation: Median and radial nerves
Interosseous membrane
1. Syndesmosis (fibrous joint) between the radius and ulna
2. Separates the flexor and extensor compartments
3. Strongest fibers run is the oblique cord (9)
4. Allows supination - pronation
Radiocarpal (wrist) joint
Type: Ellipsoid joint (biaxial)
Articular surfaces:
• Carpal articular surface of radius covered by hyalin cartilage
• Fibrocartilagenous disk attached to the ulnar side of the radius separating the wrist
joint from the distal radioulnar joint
• Proximal row of the carpal bones (except pisiform)
Articular elements:
Capsule: loose, thin, reinforced by several ligaments
Ligaments:
• Palmar radiocarpal ligament
• Palmar ulnocarpal ligament
• Dorsal radiocarpal ligament
• Ulnar collateral ligament
•
Radial collateral ligament
Blood supply: Branches of the palmar and dorsal carpal arches
Innervation: Branches of the median, ulnar and radial nerves
Joints of the carpus-metacarpus
Type: Plane joints
Intercarpal joints – Palmar, dorsal, interosseous intercarpal ligaments
Strongest ones:
• Ligamentum carpi radiatum (palmar side)
• Pisohamate ligament (palmar side)
• Arcuate ligament (dorsal side)
Carpometacarpal joints – Palmar, dorsal, interosseous carpometacarpal ligaments
Strongest ones:
• Pisometacarpal ligament
• Hamatometacarpal ligament
The carpometacarpal joint of the pollex is special, it is saddle (biaxial) joint.
Movements: abduction-adduction, opposition-reposition
Intermetacarpal joints – Palmar, dorsal, interosseous intermetacarpal ligaments
Interosseous ligaments of intercarpal, carpometacarpal and intermetacarpal joints are inside
the articular cavity connecting the neighbouring bones
Blood supply: Branches of the palmar and dorsal carpal arches
Innervation: Branches of the median, ulnar and radial nerves
Joints of the digits
Metacarpophalangeal joints
• Ball and socket in shape
• Between the head of the metacarpal and the base of the proximal phalanx
• Movements: flexion – extension, abduction-adduction
• Loose capsule
• Collateral ligaments – stretched in flexed position, so abduction-adduction is
impossible
Proximal intephalangeal joints
• Hinge joint, flexion-extension
• Between the head of the proximal phalanx and the base of the middle phalanx
•
Collateral ligaments
Distal intephalangeal joints
• Hinge joint, flexion-extension
• Between the head of the middle phalanx and the base of the distal phalanx
• Collateral ligaments
Note: pollex has only one interphalangeal joint!
List of ligaments of the upper limb (summary)
Interclavicular ligament
Sternoclavicular ligaments (anterior and posterior)
Costoclavicular ligament from the 1st rib
Acromioclavicular ligaments
Coracoclavicular ligaments
• Conoid ligament
• Trapezoid ligament
Coracohumeral ligament
Coracoacromial ligament
Transverse humeral ligament
Glenohumeral ligaments (superior, middle and inferior)
Ulnar collateral ligament
• Anterior fibers
• Posterior fibers
• Oblique fibers
Radial collateral ligament
Annular ligament
Interosseous membrane
Palmar radiocarpal ligament
Palmar ulnocarpal ligament
Dorsal radiocarpal ligament
Ulnar collateral ligament
Radial collateral ligament
Intercarpal ligaments (palmar, dorsal, interosseous)
Ligamentum carpi radiatum
Pisohamate ligament
Arcuate ligament
Carpometacarpal ligaments (palmar, dorsal, interosseous)
Pisometacarpal ligament
Hamatometacarpal ligament
Intermetacarpal ligaments (palmar, dorsal, interosseous)
Collateral ligaments of the metacarpophalangeal, proximal and distal intephalangeal joints