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Joints of the Upper limb ( A complementary sheet) The elbow Joint : - It’s a synovial hinge joint in which the trochlea and capitulum articulate with the trochlear notch of ulna and the head of radius , the articulate surfaces are covered by hyaline cartilage. - The fibrous capsule : Anteriorly it’s attached above to the upper margins of radial radial and coronoid fossae and to the front of medial and lateral epicondyles , below it’s attached to the anular ligament and coronoid process . 1 To Remind You Joints are classified structurally into three types: 1- synovial joints: the bones forming the joint have a synovial cavity and are united by a capsule of CT and often by accessory ligaments ( eg : knee and hip joints ) 2- Cartilaginous joints: there’s no synovial cavity and bones are held together by cartilage (e.g : intervertebral joints ) 3- fibrous joints: no synovial cavity , bone are held together by dense Irregular CT rich in collagen fibers ( e.g : sutures of the skull bones ) Joints of the Upper limb ( A complementary sheet) posteriorly it’s attached above to the margins of olecranon fossa , below to the olecranon process and anular ligament. - The synovial capsule ( membrane ) : It covers the radial, coronoid and olecranon fossae , and lines the inner surface of the fibrous capsule , and then continues below with the synovial membrane of the proximal radioulnar joint. - Ligaments of the elbow joint : 1- Medial “ ulnar “ collateral ligament : It’s a thick and triangular ligament , consists of three strong bands , extending the medial epicondyle to the coronoid process and olecranon of ulna. - This ligament is crossed by ulnar Nerve. 2- Lateral “ radial “ collateral ligament : It’s a weak and triangular ligament , attached by it’s apex the lateral epicondyle extending to the anular ligament. - Nerve supply : 1234- 2 Radial nerve. Ulnar nerve, Musculocutaneous nerve. Median nerve. Joints of the Upper limb ( A complementary sheet) - Relations : 1- Anteriorly : brachialis , biceptal tendon , brachial artery and the median nerve ( BBBM ) 2- Posteriorly : the triceps muscle and bursa in between. 3- Laterally : the common extensor tendons and supinator muscle . 4- Medially : the ulnar nerve , which crosses the medial ligament and passes behind the medial epicondyle. - Movements : It allows flexion and extension of the forearm , while flexion coronoid process articulates with the coronoid fossa , and while extension olecranon process articulates with the olecranon fossa . The proximal radioulnar Joint : - It’s a synovial pivot joint in which the radial head articulates with the radial notch of ulna . - fibrous capsule of this joint continues with that of the elbow joint and it covers the whole joint . - Synovial membrane : continues with the synovial membrane of the elbow joint and it lines the fibrous capsule. - Ligament : there’s a single ligament which is the anular ligament , extends from the anterior to posterior margins of radial notch like a tie around the head , it continues above with the capsule of elbow joint , [ Remember that supinator muscle is originated form this ligament ] - Nerve supply : ( the same as elbow joint ) 1234- 3 Median nerve. Ulnar nerve. Radial nerve. Musculocutaneous nerve. Joints of the Upper limb ( A complementary sheet) - Movement : Pronation and supination of the forearm. - Relations : 1- Anteriorly : supinator muscle and the radial nerve. 2- Posteriorly : supinator muscle and the common extensor tendons. The distal radioulnar joint : Articulation: Between the rounded head of the ulna and the ulnar notch on the radius. Type : Synovial pivot joint. Capsule : The capsule encloses the joint but is deficient superiorly. Ligaments : Weak anterior and posterior ligaments strengthen the capsule. Articular disc : This is triangular and composed of fibrocartilage. It is attached by its apex to the lateral side of the base of the styloid process of the ulna and by its base to the lower border of the ulnar notch of the radius. It shuts off the distal radioulnar joint from the wrist and strongly unites the radius to the ulna. Synovial membrane: This lines the capsule passing from the edge of one articular surface to that of the other. Nerve supply: 1-Anterior interosseous nerve 2-the deep branch of the radial. movements : pronation and supination ( the same as the proximal one ) Relation : 1- Anteriorly: The tendons of flexor digitorum profundus. 2- Posteriorly: The tendon of extensor digiti minimi. 4 Joints of the Upper limb ( A complementary sheet) Wrist Joint (Radiocarpal Joint) : Articulation: Between the distal end of the radius and the articular disc above and the scaphoid, lunate, and triquetral bones below . The proximal articular surface forms an ellipsoid concave surface, which is adapted to the distal ellipsoid convex surface. Type: Synovial ellipsoid joint. Capsule: The capsule encloses the joint and is attached above to the distal ends of the radius and ulna and below to the proximal row of carpal bones. Ligaments: Anterior and posterior ligaments strengthen the capsule. The medial ligament is attached to the styloid process of the ulna and to the triquetral bone. The lateral ligament is attached to the styloid process of the radius and to the scaphoid bone. Synovial membrane: This lines the capsule and is attached to the margins of the articular surfaces. The joint cavity does not communicate with that of the distal radioulnar joint or with the joint cavities of the intercarpal joints. Nerve supply: ( the same as the distal radioulnar joint ) 1- Anterior interosseous nerve 2-the deep branch of the radial nerve. Movements : flexion, extension, abduction, adduction, and circumduction. Notice that the elbow and the proximal radioulnar joints have the same innervation , and the same about the wrist and distal radioulnar joints. 5 Joints of the Upper limb ( A complementary sheet) Relations : 1-Anteriorly: The tendons of the flexor digitorum profundus and superficialis, the flexor pollicis longus, the flexor carpi radialis, the flexor carpi ulnaris, and the median and ulnar nerves. 2-Posteriorly: The tendons of the extensor carpi ulnaris, the extensor digiti minimi, the extensor digitorum, the extensor indicis, the extensor carpi radialis longus and brevis, the extensor pollicis longus and brevis, and the abductor pollicis longus . 3-Medially: The posterior cutaneous branch of the ulnar nerve. 4-Laterally: The radial artery. Types of the synovial joints ( the Dr didn’t talk about that but we should know what’s meant by each type since he just mentioned them ) 1- Planar : articulated surfaces are flat or slightly curved ( intercarpal joint ) 2- Hinge : convex surface fits into a concave surface ( elbow and interphalangeal joints ) 3- Pivot : rounded or pointed surfaces fits into a rong formed partly by bone and partly by ligament ( radioulnar joints ) 4- Ball-and-socket : ball like surface fits into a cuplike depression ( shoulder and hip joints ) 5- Condyloid : oval-shaped projection fits into an oval-shaped depression ( radiocarpal and metacarpophalangeal joints) 6- Saddle : Articular surface of one bone is saddle-shaped , and the articular surface of the other bone sits in the saddle ( carpometacarpal joint between trapezium and the thumb ) Note : this Sheet is written according to snell’s book , Hope you find it useful أيا صاحبي إن رمت أن تكسب العال و ترقى إلى العلياء غير مزاحم عليك بحسن الصبر في كل ّ حال ٍة فما صابر بما يروم بنادم Done by : Majd Al-majali Yasmeen Aljade 6