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JOINTS
OF
THE UPPER LIMB
06-08. 01. 2014
Kaan Yücel
M.D., Ph.D.
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Dr.Kaan Yücel
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Joints of the upper limb
Movement of the pectoral girdle involves the sternoclavicular, acromioclavicular, and glenohumeral joints,
usually all moving simultaneously. Functional defects in any of the joints impair movements of the pectoral girdle.
Mobility of the scapula is essential for free movement of the upper limb. The clavicle forms a strut that holds the
scapula, and hence the glenohumeral joint, away from the thorax so it can move freely.
Sternoclavicular joint: the only articulation between the upper limb and the axial skeleton. The sternal end of the
clavicle articulates with the manubrium and a small part of the 1st costal cartilage. Saddle type, but functions as a
ball-and-socket joint.
Acromioclavicular joint: The acromial end of the clavicle articulates with the acromion of the scapula. Plane type.
Glenohumeral (Shoulder) joint: More freedom of movement than any other joint in the body. Humeral head
articulates with the relatively shallow glenoid cavity of the scapula, which is deepened slightly but effectively by the
glenoid labrum (L., lip). Ball-and-socket type of synovial joint.
Elbow joint: The spool-shaped 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, respectively; therefore, there are
humeroulnar and humeroradial articulations. Hinge type
Proximal (Superior) radio-ulnar joint: The head of the radius articulates with the radial notch of the ulna. Pivot type.
Distal (Inferior) radio-ulnar joint: The head of the ulna articulates with the ulnar notch on the medial side of the
distal end of the radius.Pivot type.
Wrist (Radiocarpal) joint: The wrist (carpus), the proximal segment of the hand, is a complex of eight carpal bones,
articulating proximally with the forearm via the wrist joint and distally with the five metacarpals. The ulna does not
participate in the wrist joint. The distal end of the radius and the articular disc of the distal radio-ulnar joint
articulate with the proximal row of carpal bones, except for the pisiform. Condyloid (ellipsoid) type.
Intercarpal joints: Carpal bones (the intercarpal joints interconnect the carpal bones). Plante type.
Carpometacarpal joints: The distal surfaces of the carpals of the distal row articulate with the carpal surfaces of the
bases of the metacarpals. The important carpometacarpal joint of the thumb is between the trapezium and the base
of the 1st metacarpal; it has a separate articular cavity. Like the carpals, adjacent metacarpals articulate with each
other. The carpometacarpal and intermetacarpal joints are the plane type of synovial joint, except for the
carpometacarpal joint of the thumb, which is a saddle joint. The metacarpophalangeal joints are the condyloid type
of synovial joint that permit movement in two planes: flexion-extension and adduction-abduction. The
interphalangeal joints are the hinge type of synovial joint that permit flexion-extension only.The heads of the
metacarpals articulate with the bases of the proximal phalanges, and the heads of the phalanges articulate with the
bases of more distally located phalanges.
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Joints of the upper limb
1. JOINTS OF THE UPPER LIMB
Joints of the pectoral girdle
Proximal (Superior) and Distal (Inferior) radio-
Acromioclavicular joint & Sternoclavicular joint
ulnar joints
Glenohumeral (Shoulder) joint
Radiocarpal (Wrist) joint
Elbow joint
Intercarpal joints
Carpometacarpal and intermetacarpal joints
Figure 1. Joints of the upper limb
http://home.comcast.net/~wnor/lesson5jointsofupperlimb.htm
The three joints in the shoulder complex are the sternoclavicular, acromioclavicular, and glenohumeral
joints.
The sternoclavicular joint and the acromioclavicular joint link the two bones of the pectoral girdle to
each other and to the trunk. The combined movements at these two joints enable the scapula to be positioned
over a wide range on the thoracic wall, substantially increasing "reach" by the upper limb.
The glenohumeral joint (shoulder joint) is the articulation between the humerus of the arm and the
scapula.
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STERNOCLAVICULAR JOINT
1. Articulation between Sternum and clavicle
2. Distinct feature of the joint the only articulation between the upper limb and the axial skeleton. It can be
readily palpated because the sternal end of the clavicle lies superior to the manubrium of the sternum.
3. Synovial joint type Saddle type, but functions as a ball-and-socket joint
4. Articular disc Yes. The articular disc divides the sternoclavicular joint into two compartments.
5. Articular surfaces The sternoclavicular joint occurs between the sternal end of the clavicle and the
clavicular notch of the manubrium of sternum together with a small part of the first costal cartilage.
6. Ligaments of the sternoclavicular joint
The sternoclavicular joint is surrounded by a joint capsule and is reinforced by four ligaments:
Anterior and posterior sternoclavicular ligaments
Costoclavicular ligament
Interclavicular ligament
The anterior and posterior sternoclavicular ligaments are anterior and posterior, respectively, to the joint.
The interclavicular ligament links the ends of the two clavicles to each other and to the superior surface of
the manubrium of sternum.
The costoclavicular ligament is positioned laterally to the joint and links the proximal end of the clavicle to
the first rib and related costal cartilage.
Anterior and posterior sternoclavicular ligaments reinforce the joint capsule anteriorly and
posteriorly. The interclavicular ligament strengthens the capsule superiorly. The costoclavicular ligament
anchors the inferior surface of the sternal end of the clavicle to the 1st rib and its costal cartilage, limiting
elevation of the pectoral girdle.
The strength of the sternoclavicular joint depends on ligaments and its articular disc. The disc is
firmly attached to the anterior and posterior sternoclavicular ligaments, thickenings of the fibrous layer of
the joint capsule, as well as the interclavicular ligament. The great strength of the sternoclavicular joint is a
consequence of these attachments. Thus, although the articular disc serves as a shock absorber of forces
transmitted along the clavicle from the upper limb, dislocation of the clavicle is rare, whereas fracture of the
clavicle is common.
7. Movements of the sternoclavicular joint
Raising (60°) & rotating the clavicle
Anterior and posterior movements of the clavicle
The sternoclavicular joint allows movement of the clavicle, predominantly in the anteroposterior and
vertical planes, although some rotation also occurs. Although the sternoclavicular joint is extremely strong, it
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Joints of the upper limb
is significantly mobile to allow movements of the pectoral girdle and upper limb. During full elevation of the
limb, the clavicle is raised to approximately a 60° angle. When elevation is achieved via flexion, it is
accompanied by rotation of the clavicle around its longitudinal axis.
Figure 2. Sternoclavicular joint
http://www.daviddarling.info/encyclopedia/S/sternoclavicular_joint.html
CLINICAL ANATOMY
Sternoclavicular Joint Injuries
The strong costoclavicular ligament firmly holds the medial end of the clavicle to the first costal
cartilage. Violent forces directed along the long axis of the clavicle usually result in fracture of that bone, but
dislocation of the sternoclavicular joint takes place occasionally. If the costoclavicular ligament ruptures
completely, it is difficult to maintain the normal position of the clavicle once reduction has been
accomplished.
ACROMIOCLAVICULAR JOINT
1. Articulation between Acromion of scapulae and clavicle
2. Distinct feature of the joint Located 2-3 cm from the “point” of the shoulder formed by the lateral part of
the acromion
3. Synovial joint type Plane type
4. Articular disc Yes. The articular surfaces are separated by an incomplete wedge-shaped articular disc.
5. Articular surfaces The acromial end of the clavicle articulates with the acromion of the scapula. The
articular surfaces, covered with fibrocartilage.
6. Ligaments of the acromioclavicular joint
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Intrinsic ligament of the acromioclavicular joint
Acromioclavicular ligament
Extrinsic ligament of the acromioclavicular joint
Coracoclavicular ligament- conoid ligament and trapezoid ligament
The acromioclavicular ligament is a fibrous band extending from the acromion to the clavicle that
strengthens the acromioclavicular joint superiorly. However, the integrity of the joint is maintained by
extrinsic ligaments, distant from the joint itself.
The much larger coracoclavicular ligament is a strong pair of bands that unite the coracoid process of
the scapula to the clavicle, anchoring the clavicle to the coracoid process.
The coracoclavicular ligament is not directly related to the joint. However,it is an important strong
accessory ligament, providing much of the weightbearing support for the upper limb on the clavicle. It
maintains the position of the clavicle on the acromion. It spans the distance between the coracoid process of
the scapula and the inferior surface of the acromial end of the clavicle.
The coracoclavicular ligament consists of two ligaments, the conoid and trapezoid ligaments, which
are often separated by a bursa.
The vertical conoid ligament is an inverted triangle (cone), is attached to the root of the coracoid process. Its
wide attachment (base of the triangle) is to the conoid tubercle on the inferior surface of the clavicle. The
nearly horizontal trapezoid ligament is attached to the superior surface of the coracoid process and extends
laterally to the trapezoid line on the inferior surface of the clavicle.
In addition to augmenting the acromioclavicular joint, the coracoclavicular ligament provides the
means by which the scapula and free limb are (passively) suspended from the clavicular strut.
7. Movements of the acromioclavicular joint
The acromioclavicular joint allows movement in the anteroposterior and vertical planes together
with some axial rotation. The acromion of the scapula rotates on the acromial end of the clavicle. These
movements are associated with motion at the physiological scapulothoracic joint.
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Figure 3. Acromioclavicular joint
http://www.rahulgladwin.com/medimages/index.php?level=picture&id=96
CLINICAL ANATOMY
Acromioclavicular Joint Dislocation
A severe blow on the point of the shoulder, as is incurred during blocking or tackling in football or
any severe fall, can result in the acromion being thrust beneath the lateral end of the clavicle, tearing the
coracoclavicular ligament. This condition is known as shoulder separation. The displaced outer end of the
clavicle is easily palpable.
GLENOHUMERAL (SHOULDER) JOINT - ARTICULATIO HUMERI
1. Articulation between Humerus and scapula
2. Distinct feature of the joint Ball-and-socket type of synovial joint that permits a wide range of movement;
however, its mobility makes the joint relatively unstable. The glenohumeral joint has more freedom of
movement than any other joint in the body.
3. Synovial joint type Ball-and-socket type
4. Articular disc No.
5. Articular surfaces The large, round humeral head articulates with the relatively shallow glenoid cavity of
the scapula, which is deepened slightly but effectively by the ring-like, fibrocartilaginous glenoid labrum (L.,
lip). Both articular surfaces are covered with hyaline cartilage. The glenoid cavity accepts little more than a
third of the humeral head, which is held in the cavity by the tonus of the musculotendinous rotator cuff
muscles.
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6. Ligaments of the glenohumeral joint
Glenohumeral ligaments
Coracohumeral ligament
Transverse humeral ligament
Coracoacromial ligament
The fibrous membrane of the joint capsule is thickened:
Glenohumeral ligaments
 three fibrous bands, evident only on the internal aspect of the capsule
 anterosuperiorly in three locations to form superior, middle, and inferior glenohumeral ligaments
 pass from the superomedial margin of the glenoid cavity to the lesser tubercle and inferiorly related
anatomical neck of the humerus.
 strengthen the anterior aspect of the joint capsule of the joint.
Coracohumeral ligament
 strong broad band
 passes from the base of the coracoid process to the anterior aspect of the greater tubercle of the
humerus.
 strengthens the capsule superiorly.
Transverse humeral ligament

a broad fibrous band
 between the greater and lesser tubercles of the humerus, bridging over the intertubercular sulcus
 converts the groove into a canal, which holds the synovial sheath and tendon of the biceps brachii in
place during movements of the glenohumeral joint.
The coraco-acromial arch is an extrinsic, protective structure formed by the smooth inferior aspect of
the acromion and the coracoid process of the scapula, with the coracoacromial ligament spanning between
them. This osseoligamentous structure forms a protective arch that overlies the humeral head, preventing
its superior displacement from the glenoid cavity. The coraco-acromial arch is so strong that a forceful
superior thrust of the humerus will not fracture it; the humeral shaft or clavicle fractures first.
Transmitting force superiorly along the humerus (e.g., when standing at a desk and partly supporting the
body with the outstretched limbs), the humeral head presses against the coraco-acromial arch.
Joint stability is provided by surrounding muscle tendons and a skeletal arch formed superiorly by the
coracoid process and acromion and the coracoacromial ligament.
7. Movements of the glenohumeral joint
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Flexion of the humerus
Extension of the humerus
Abduction of the humerus
Adduction of the humerus
Medial and lateral rotation of the humerus
Circumduction
The glenohumeral joint has more freedom of movement than any other joint in the body. This
freedom results from the laxity of its joint capsule and the large size of the humeral head compared with the
small size of the glenoid cavity. The glenohumeral joint allows movements around three axes and permits
flexion-extension, abduction-adduction, rotation (medial and lateral) of the humerus, and circumduction.
Lateral rotation of the humerus increases the range of abduction. When the arm is abducted without
rotation, available articular surface is exhausted and the greater tubercle contacts the coraco-acromial arch,
preventing further abduction. If the arm is then laterally rotated 180°, the tubercles are rotated posteriorly
and more articular surface becomes available to continue elevation.
Circumduction at the glenohumeral joint is an orderly sequence of flexion, abduction, extension, and
adduction—or the reverse. Unless performed over a small range, these movements do not occur at the
glenohumeral joint in isolation; they are accompanied by movements at the two other joints of the pectoral
girdle (sternoclavicular and acromioclavicular joints).
8. Bursae around the glenohumeral joint
Several bursae (sac-like cavities), containing capillary films of synovial fluid secreted by the synovial
membrane, are situated near the glenohumeral joint. Bursae are located where tendons rub against bone,
ligaments, or other tendons and where skin moves over a bony prominence. The bursae around the
glenohumeral joint are of special clinical importance because some of them communicate with the joint
cavity (e.g., the subscapular bursa). Consequently, opening a bursa may mean entering the cavity of the
glenohumeral joint.
Subscapular Bursa: is located between the tendon of the subscapularis and the neck of the scapula. The
bursa protects the tendon where it passes inferior to the root of the coracoid process and over the neck of
the scapula.
Subacromial Bursa (Subdeltoid bursa): is located between the acromion, coraco-acromial ligament,
superiorly and joint capsule of the glenohumeral joint inferiorly.
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Figure 4. Glenohumeral (shoulder) joint
Figure 5. Bursae around the shoulder joint
http://aftabphysio.blogspot.com/2010/08/joints-of-upper-limb.html
http://www.shoulderdoc.co.uk/patient_info/shoulder-anatomy.asp
CLINICAL ANATOMY
Dislocations of the Shoulder Joint
Anterior–Inferior Dislocations
Sudden violence applied to the humerus with the joint fully abducted tilts the humeral head downward onto
the inferior weak part of the capsule, which tears, and the humeral head comes to lie inferior to the glenoid
fossa.
Posterior Dislocations
Posterior dislocations are rare and are usually caused by direct violence to the front of the joint. On
inspection of the patient with shoulder dislocation, the rounded appearance of the shoulder is seen to be
lost because the greater tuberosity of the humerus is no longer bulging laterally beneath the deltoid muscle.
ARTICULATIO CUBITI
ELBOW JOINT
.
1. Articulation between Humerus, ulna and radius
2. Distinct feature of the joint Located 2-3 cm inferior to the epicondyles of the humerus
3. Synovial joint type Hinge type
4. Articular disc No.
5. Articular surfaces The elbow joint is a complex joint involving three separate articulations, which share a
common synovial cavity.
The joints between the trochlear notch of the ulna and the trochlea of the humerus and between the head
of the radius and the capitulum of the humerus are primarily involved with hinge-like flexion and extension
of the forearm on the arm and, together, are the principal articulations of the elbow joint.
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The joint between the head of the radius and the radial notch of the ulna, the proximal radio-ulnar joint, is
involved with pronation and supination of the forearm.
The articular surfaces of the bones are covered with hyaline cartilage.
The synovial membrane is separated from the fibrous membrane of the joint capsule by pads of fat in
regions overlying the coronoid fossa, the olecranon fossa, and the radial fossa. These fat pads accommodate
the related bony processes during extension and flexion of the elbow.
6. Joint capsule of elbow joint The fibrous layer of the joint capsule surrounds the elbow joint. The joint
capsule is weak anteriorly and posteriorly but is strengthened on each side by collateral ligaments.
These ligament support the flexion and extension movements of the elbow joint.
In addition, the external surface of the joint capsule is reinforced laterally where it cuffs the head of the
radius with a strong anular ligament of radius. Although this ligament blends with the fibrous membrane of
the joint capsule in most regions, they are separate posteriorly. The anular ligament of radius also blends
with the radial collateral ligament
7. Ligaments of the elbow joint
Medial (ulnar) and lateral (radial) collateral ligaments
The collateral ligaments of the elbow joint are strong triangular bands that are medial and lateral thickenings
of the fibrous layer of the joint capsule.
The lateral, fan-like radial collateral ligament extends from the lateral epicondyle of the humerus
and blends distally with the anular ligament of the radius, which encircles and holds the head of the radius in
the radial notch of the ulna. The anular ligament forms the proximal radio-ulnar joint and permits pronation
and supination of the forearm.
The medial, triangular ulnar collateral ligament extends from the medial epicondyle of the humerus
to the coronoid process and olecranon of the ulna and consists of three bands: (1) the anterior cord-like
band is the strongest, (2) the posterior fan-like band is the weakest, and (3) the slender oblique band
deepens the socket for the trochlea of the humerus.
The anular ligament of radius and related joint capsule allow the radial head to slide against the
radial notch of the ulna and pivot on the capitulum during pronation and supination of the forearm.
8. Movements of the elbow joint
Flexion and extension
Flexion and extension occur at the elbow joint. The long axis of the fully extended ulna makes an angle of
approximately 170° with the long axis of the humerus. This angle is called the carrying angle, named for the
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way the forearm angles away from the body when something is carried. The obliquity of the ulna and thus of
the carrying angle is more pronounced (the angle is approximately 10° more acute) in women than in men. It
is said to enable the swinging limbs to clear the wide female pelvis when walking. In the anatomical position,
the elbow is against the waist.
9. Bursae of the elbow joint Only some of the bursae around the elbow joint are clinically important.
The three olecranon bursae are the:
•Intratendinous olecranon bursa, which is sometimes present in the tendon of triceps brachii.
•Subtendinous olecranon bursa, which is located between the olecranon and the triceps tendon, just
proximal to its attachment to the olecranon.
•Subcutaneous olecranon bursa, which is located in the subcutaneous connective tissue over the olecranon.
Figure 6. Elbow joint
http://www.aaos75th.org/stories/patient_story.htm?id=11
Figure 7. Bursae around the elbow joint
http://www.joint-pain-expert.net/olecranon-bursitis.html
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CLINICAL ANATOMY
Stability of the Elbow Joint
The elbow joint is stable because of the wrench-shaped articular surface of the olecranon and the
pulley-shaped trochlea of the humerus; it also has strong medial and lateral ligaments. When examining the
elbow joint, the physician must remember the normal relations of the bony points. In extension, the medial
and lateral epicondyles and the top of the olecranon are in a straight line; in flexion, the bony points form
the boundaries of an equilateral triangle.
Dislocations of the Elbow Joint
Elbow dislocations are common, and most are posterior. Posterior dislocation usually follows falling
on the outstretched hand. Posterior dislocations of the joint are common in children because the parts of
the bones that stabilize the joint are incompletely developed. Avulsion of the epiphysis of the medial
epicondyle is also common in childhood because then the medial ligament is much stronger than the bond
of union between the epiphysis and the diaphysis.
PROXIMAL(SUPERIOR) RADIO-ULNAR JOINT
1. Articulation between Radius and ulna proximally
2. Distinct feature of the joint 3. Synovial joint type Pivot type
4. Articular disc No.
5. Articular surfaces The head of the radius articulates with the radial notch of the ulna.
6. Ligaments of the proximal radio-ulnar joint
Annular ligament
The radial head is held in position by the anular ligament of the radius. The strong anular ligament is
attached to the ulna anterior and posterior to its radial notch. It surrounds the articulating bony surfaces
and forms a collar that, with the radial notch, creates a ring that completely encircles the head of the radius.
7. Movements of the proximal radio-ulnar joint
Supination & pronation
The proximal (superior) radio-ulnar joint is a pivot type of synovial joint that allows movement of the head of
the radius on the ulna.
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During pronation and supination, it is the radius that rotates; its head rotates within the cup-shaped
collar formed by the anular ligament and the radial notch on the ulna. Distally, the end of the radius rotates
around the head of the ulna. Almost always, supination and pronation are accompanied by synergistic
movements of the glenohumeral and elbow joints that produce simultaneous movement of the ulna, except
when the elbow is flexed.
Figures 8 & 9. Proximal radio-ulnar joint
http://teachmeanatomy.net/upper-limb-2/joints-of-the-upper-limb/radioulnar-joints http://www.msdlatinamerica.com/ebooks/HandSurgery/sid484870.html
DISTAL (INFERIOR) RADIO-ULNAR JOINT
1. Articulation between Radius and ulna distally
2. Distinct feature of the joint 3. Synovial joint type Pivot type
4. Articular disc Yes. A fibrocartilaginous, triangular articular disc of the distal radioulnar joint (sometimes
referred to by clinicians as the “triangular ligament”) binds the ends of the ulna and radius together and is
the main uniting structure of the joint. The articular disc separates the cavity of the distal radio-ulnar joint
from the cavity of the wrist joint.
5. Articular surfaces The rounded head of the ulna articulates with the ulnar notch on the medial side of the
distal end of the radius.
6. Ligaments of the distal radio-ulnar joint
Anterior and posterior ligaments
Anterior and posterior ligaments strengthen the fibrous layer of the joint capsule of the distal radio-ulnar
joint. These relatively weak transverse bands extend from the radius to the ulna across the anterior and
posterior surfaces of the joint.
7. Movements of the distal radio-ulnar joint
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The radius moves around the relatively fixed distal end of the ulna. The distal radio-ulnar joint allows the
distal end of the radius to move anteromedially over the ulna. During pronation of the forearm and hand,
the distal end of the radius moves (rotates) anteriorly and medially, crossing over the ulna anteriorly. During
supination, the radius uncrosses from the ulna, its distal end moving (rotating) laterally and posteriorly so
the bones become parallel.
Figure 10. Distal radio-ulnar joint
http://en.wikipedia.org/wiki/File:Gray334.png
CLINICAL ANATOMY
Radioulnar Joint Disease
The proximal radioulnar joint communicates with the elbow joint, whereas the distal radioulnar joint
does not communicate with the wrist joint. In practical terms, this means that infection of the elbow joint
invariably involves the proximal radioulnar joint.
The strength of the proximal radioulnar joint depends on the integrity of the strong anular ligament.
Rupture of this ligament occurs in cases of anterior dislocation of the head of the radius on the capitulum of
the humerus. In young children, in whom the head of the radius is still small and undeveloped, a sudden jerk
on the arm can pull the radial head down through the anular ligament.
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WRIST JOINT (RADIOCARPAL JOINT)
1. Articulation between Radius and carpal bones
2. Distinct feature of the joint
3. Synovial joint type Condyloid (ellipsoid) type
4. Articular disc Yes.
5. Articular surfaces The wrist (carpus), the proximal segment of the hand, is a complex of eight carpal
bones, articulating proximally with the forearm via the wrist joint and distally with the five metacarpals. The
ulna does not participate in the wrist joint. The distal end of the radius and the articular disc of the distal
radio-ulnar joint articulate with the proximal row of carpal bones, except for the pisiform.
6. Ligaments of the wrist joint
Dorsal and palmar radiocarpal ligaments
Ulnar collateral ligament
Radial collateral ligament
The fibrous layer of the joint capsule is strengthened by strong dorsal and palmar radiocarpal
ligaments. The palmar radiocarpal ligaments pass from the radius to the two rows of carpals. They are strong
and directed so that the hand follows the radius during supination of the forearm. The dorsal radiocarpal
ligaments take the same direction so that the hand follows the radius during pronation of the forearm.
The joint capsule is also strengthened medially by the ulnar collateral ligament, which is attached to
the ulnar styloid process and triquetrum. The joint capsule is also strengthened laterally by the radial
collateral ligament, which is attached to the radial styloid process and scaphoid.
7. Movements of the wrist joint
Flexion
Extension
Abduction (Radial deviation)
Adduction (Ulnar deviation)
Circumduction
The movements at the wrist joint may be augmented by additional smaller movements at the
intercarpal and midcarpal joints. The movements are flexion—extension, abduction—adduction (radial
deviation-ulnar deviation), and circumduction. The hand can be flexed on the forearm more than it can be
extended; these movements are accompanied (actually, are initiated) by similar movements at the
midcarpal joint between the proximal and the distal rows of carpal bones. Adduction of the hand is greater
than abduction. Most adduction occurs at the wrist joint. Abduction from the neutral position occurs at the
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midcarpal joint. Circumduction of the hand consists of successive flexion, adduction, extension, and
abduction.
8. Surface anatomy of the wrist joint The position of the joint is indicated approximately by a line joining
the styloid processes of the radius and ulna, or by the proximal wrist crease.
Figure 11. Wrist (Radiocarpal) joint
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CLINICAL ANATOMY
Wrist Joint Injuries
A fall on the outstretched hand can strain the anterior ligament of the wrist joint, producing synovial
effusion, joint pain, and limitation of movement. These symptoms and signs must not be confused with
those produced by a fractured scaphoid or dislocation of the lunate bone, which are similar.
Falls on the Outstretched Hand
In falls on the outstretched hand, forces are transmitted from the scaphoid to the distal end of the
radius, from the radius across the interosseous membrane to the ulna, and from the ulna to the humerus;
thence, through the glenoid fossa of the scapula to the coracoclavicular ligament and the clavicle, and
finally, to the sternum. If the forces are excessive, different parts of the upper limb give way under
the strain. The area affected seems to be related to age. In a young child, for example, there may be a
posterior displacement of the distal radial epiphysis; in the teenager the clavicle might fracture; in the young
adult the scaphoid is commonly fractured; and in the elderly the distal end of the radius is fractured about 1
in. (2..5 cm) proximal to the wrist joint (Colles’ fracture).
INTERCARPAL JOINTS
1. Articulation between carpal bones (the intercarpal joints interconnect the carpal bones)
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2. Distinct feature of the joint 3. Synovial joint type Plane type
4. Articular disc No.
5. Articular surfaces
Joints between the carpal bones of the proximal row.
Joints between the carpal bones of the distal row.
The midcarpal joint, a complex joint between the proximal and distal rows of carpal bones.
The pisotriquetral joint, formed from the articulation of the pisiform with the palmar surface of the
triquetrum.
6. Ligaments of the intercarpal joints
Anterior, posterior, and interosseous ligaments
7. Movements of the intercarpal joints
Gliding
Flexion & extension of the hand
Abduction & adduction of the hand
The gliding movements possible between the carpals occur concomitantly with movements at the wrist
joint, augmenting them and increasing the overall range of movement. Flexion and extension of the hand
are actually initiated at the midcarpal joint, between the proximal and the distal rows of carpals. Most
flexion and adduction occur mainly at the wrist joint, whereas extension and abduction occur primarily at
the midcarpal joint. Movements at the other intercarpal joints are small, with the proximal row being more
mobile than the distal row.
CARPOMETACARPAL & INTERMETACARPAL JOINTS
1. Articulation between carpal bones & metacarpals, between metacarpals
2. Distinct feature of the joint 3. Synovial joint type Plane type plane except for the carpometacarpal joint of the thumb, which is a saddle
joint.
4. Articular disc No.
5. Articular surfaces The distal surfaces of the carpals of the distal row articulate with the carpal surfaces of
the bases of the metacarpals at the carpometacarpal joints. The important carpometacarpal joint of the
thumb is between the trapezium and the base of the 1st metacarpal; it has a separate articular cavity. Like
the carpals, adjacent metacarpals articulate with each other; intermetacarpal joints occur between the
radial and ulnar aspects of the bases of the metacarpals.
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6. Ligaments of the carpometacarpal and intermetacarpal joints
Palmar and dorsal carpometacarpal and palmar and dorsal intermetacarpal ligaments
Interosseus metacarpal ligaments
Superficial and deep transverse metacarpal ligaments
The bones are united in the region of the joints by palmar and dorsal carpometacarpal and palmar and
dorsal intermetacarpal ligaments and by interosseous intermetacarpal ligaments. In addition, the
superficial and deep transverse metacarpal ligaments (the former part of the palmar aponeurosis),
associated with the distal ends of the metacarpals, play a role in limiting movement at these two joints as
they limit separation of the metacarpal heads.
7. Movements of the carpometacarpal and intermetacarpal joints
The carpometacarpal joint of the thumb permits angular movements in any plane (flexion-extension,
abduction-adduction, or circumduction) and a restricted amount of axial rotation. Most important, the
movement essential to opposition of the thumb occurs here.
Almost no movement occurs at the carpometacarpal joints of the 2nd and 3rd digits, that of the 4th
digit is slightly mobile, and that of the 5th digit is moderately mobile, flexing and rotating slightly during a
tight grasp. When the palm of the hand is “cupped” (as during pad-to-pad opposition of thumb and little
finger), two thirds of the movement occur at the carpometacarpal joint of the thumb, and one third occurs
at the carpometacarpal and intercarpal joints of the 4th and 5th fingers.
METACARPOPHALANGEAL & INTERPHALANGEAL JOINTS
1. Articulation between metacarpals and phalanges and between phalanges
2. Distinct feature of the joint 3. Synovial joint type The metacarpophalangeal joints are the condyloid type of synovial joint that permit
movement in two planes: flexion-extension and adduction-abduction. The interphalangeal joints are the
hinge type of synovial joint that permit flexion-extension only.
4. Articular disc No.
5. Articular surfaces The heads of the metacarpals articulate with the bases of the proximal phalanges in the
metacarpophalangeal (MP) joints, and the heads of the phalanges articulate with the bases of more distally
located phalanges in the interphalangeal (IP) joints.
6. Ligaments of the carpometacarpal and intermetacarpal joints
Medial and lateral collateral ligaments
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Palmar ligaments
The fibrous layer of each MC and IP joint capsule is strengthened by two (medial and lateral) collateral
ligaments. These ligaments have two parts:
• Denser cord-like parts pass distally from the heads of the metacarpals and phalanges to the bases of the
phalanges.
• Thinner fan-like parts pass anteriorly to attach to thick, densely fibrous or fibrocartilaginous plates, the
palmar ligaments (plates), which form the palmar aspect of the joint capsule.
The fan-like parts of the collateral ligaments cause the palmar ligaments to move like a visor over the
underlying metacarpal or phalangeal heads.
The palmar ligaments of the 2nd-5th MP joints are united by deep transverse metacarpal ligaments that
hold the heads of the metacarpals together.
7. Movements of the carpometacarpal and intermetacarpal joints
Flexion-extension, abduction-adduction, and circumduction of the 2nd-5th digits occur at the 2nd-5th MP
joints. Movement at the MP joint of the thumb is limited to flexion-extension. Only flexion and extension
occur at the IP joints.
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