JOINTS OF UPPER LIMB
SHOULDER GIRDLE
It is a connection between upper limb and axial skeleton. Bones included scapula and clavicle. Joints included Sterno-clavicular joint and Acromio-clavicular joint.
STERNO-CLAVICULAR JOINT
It is a synovial joint of saddle variety.
Formation of joint :
Medial end of clavicle, clavicular notch of manubrium sternum and upper surface of first costal cartilage an articular disc is present in joint cavity dividing it into 2 compartments. Sternal end of clavicle convex from above downwards and slightly concave antero posteriorly and covered by fibrocartilage.
Ligaments :
Nerve supply : It receives nerve supply from medial supraclavicular nerve.
ACROMIO-CLAVICULAR JOINT
It is the plane synovial type of joint.
Formation :
Lateral end of clavicle and articular facet present on medial margin of acromion process of scapula. Articular surfaces are covered by fibrocartilage.
Ligaments :
This joint shows two ligaments capsule and coraco-clavicular ligament.
Movements of shoulder girdle
Movements of shoulder girdle are associated with movements of scapula and two joints involved in this acromio-clavicular and steno-clavicular joints.
1. Elevation of scapula 2. Depression of scapula 3. Protraction 4. Retraction 5. Forward rotation of scapula 6. Backward rotation of scapula
Nerve supply : It receives nerve supply from medial supraclavicular nerve and lateral pectoral nerve.
SHOULDER GIRDLE
It is a connection between upper limb and axial skeleton. Bones included scapula and clavicle. Joints included Sterno-clavicular joint and Acromio-clavicular joint.
STERNO-CLAVICULAR JOINT
It is a synovial joint of saddle variety.
Formation of joint :
Medial end of clavicle, clavicular notch of manubrium sternum and upper surface of first costal cartilage an articular disc is present in joint cavity dividing it into 2 compartments. Sternal end of clavicle convex from above downwards and slightly concave antero posteriorly and covered by fibrocartilage.
Ligaments :
- Capsular ligament : Attach laterally on the margin of clavicle and medially on margin of sternum and first costal cartilage. Anterior and posterior sterno-clavicular ligaments are thickening of capsular ligaments anteriorly and posteriorly. It goes downwards and medially.
- An articular disc : It shows attachment above on posterosuperior surface of medial end of clavicle below attachment on first costal cartilage.
- Inter clavicular ligaments : Shows attachment on medial end of both clavicles in its upper part.
- Costoclavicular ligaments : It shows attachment above on inferior surface of medial end of clavicle and below shows attachment on first costal cartilage and first rib.
Nerve supply : It receives nerve supply from medial supraclavicular nerve.
ACROMIO-CLAVICULAR JOINT
It is the plane synovial type of joint.
Formation :
Lateral end of clavicle and articular facet present on medial margin of acromion process of scapula. Articular surfaces are covered by fibrocartilage.
Ligaments :
This joint shows two ligaments capsule and coraco-clavicular ligament.
- Capsule : It shows the attachment on margins of clavicle and articular facet of acromion process.
- Coraco-clavicular ligament : Shows two parts conoid and trapezoid. Conoid part shows attachment above to the conoid tubercle on inferior surface of clavicle and below shows attachment on root of coracoid process. Trapezoid part above shows attachment on trapezoid line on inferior surface of lateral part of clavicle and below it shows attachment on upper surface of coracoid process.
Movements of shoulder girdle
Movements of shoulder girdle are associated with movements of scapula and two joints involved in this acromio-clavicular and steno-clavicular joints.
1. Elevation of scapula 2. Depression of scapula 3. Protraction 4. Retraction 5. Forward rotation of scapula 6. Backward rotation of scapula
- Elevation of scapula : Elevation of scapula occurs during shrugging of shoulders. Muscles involved are upper fibres of trapezius and levator scapulae. During this movement elevation of lateral end and depression of medial end of clavicle takes place. This movement takes place around an antero-posterior axis which passes through clavicle above costo-clavicular ligament.
- Depression of scapula : This movement is mainly because of gravity in which weight of upper limb works also lower part of serratus anterior and pectoralis minor muscle can do this actively. During this movement medial end of clavicle elevates and lateral end of clavicle depresses.
- Protraction : For pushing and punching movements. During protraction lateral end of clavicle moves forward and medial end of clavicle backward. Muscles involved are serratus anterior and pectoralis minor.
- Retraction : During this lateral end of clavicle goes backward and medial end of clavicle forward. Muscles involved are middle fibres of trapezius, rhomboids major and minor muscles.
- Forward a rotation of scapula : During this inferior angle of scapula rotates laterally. Clavicle also rotate along a transverse axis in meniso-clavicular compartment of sterno-clavicular joint. This movement occurs during over head abduction of arm. Muscles involved are upper and lower fibres of trapezius and lower 5 digitations of serratus anterior.
- Backward rotation : It is reverse to that of forward rotation. Takes place because of gravity and actively done by increase in length of trapezius and serratus anterior and contraction of levator scapulae and rhomboids. Axis is same as in forward rotation.
Nerve supply : It receives nerve supply from medial supraclavicular nerve and lateral pectoral nerve.
SHOULDER JOINT
It is ball and socket type of synovial joint.
Bones forming joint :
Head of humerus and glenoid cavity of scapula. Head of humerus is covered by an articular hyline cartilage and glenoid cavity shows fibrocartilaginous rim near peripheri named glenoid labrum.
Ligaments :
1.Capsule 2. Glenoid labrum 3. Coraco-humeral ligament 4. Transverse humeral ligament 5. Gleno humeral ligaments
Subscapular bursa between tendon of subscapularis and capsule of joint. It is in communication with joint cavity posteriorly. Subacromial bursa lies between coracoacromial arch and supraspinatus muscle. Other small bursa present in relation with joint are in relation with coracobrachialis, acromion process, coracoid process, teres major and long head of triceps, latissimus dorsi.
Relations :
Anteriorly: Subscapularis, coracobrachialis, short head of biceps and anterior fibres of deltoid
Posteriorly : Infraspinatus, teres minor, posterior fibres of Deltoid
Superiorly : Supraspinatus, subacromial bursa, coraco-acromial arch, deltoid
Inferiorly : Long head of triceps, axillary nerve, posterior circumflex humeral vessels
Inside joint: Tendon of long head of biceps
Blood Supply : Anterior circumflex humeral artery, posterior circumflex humeral artery, suprascapular artery, circumflex scapular artery
Nerve supply: Axillary nerve, suprascapular nerve, lateral pectoral nerve
Movements : During flexion arm moves anteromedially. During extension arm moves backward and laterally. During abduction arm moves laterally and forward. During adduction arm moves medially and backward. During medial rotation hand moves medially with mid flexed elbow. During lateral rotation hand moves laterally with mid flexed elbow. During circumduction distal end of arm form a circle with combination of flexion, extension, abduction, adduction.
Muscles for movements:
Flexion: Clavicular part of pectoralis major, anterior fibres of deltoid, biceps brachii, coracobrachialis
Extension: Posterior fibres of deltoid, teres major but from flexed position to normal position movement is done by latissimus dorsi and sternocostal head of pectoralis major.
Abduction: Lateral fibres of deltoid, supraspinatus, subscapularis, infraspinatus, teres minor, serratus anterior, upper and lower fibres of trapezius. Movement is started by supraspinatus assisted by lateral fibres of deltoid. Subscapularis, infraspinatus, teres minor stabilize head of humerus. Finally serratus anterior, upper and lower fibres of trapezius play a role in over head abduction.
Adduction : Pectoralis major, anterior and posterior fibres of deltoid, latissimus dorsi, teres major, coracobrachialis, long head of triceps.
Medial rotation : Anterior fibres of deltoid, pectoralis major, teres major, latissimus dorsi, subscapularis,
Lateral rotation : Posterior fibres of deltoid, teres minor, infraspinatus
Applied anatomy :
It is ball and socket type of synovial joint.
Bones forming joint :
Head of humerus and glenoid cavity of scapula. Head of humerus is covered by an articular hyline cartilage and glenoid cavity shows fibrocartilaginous rim near peripheri named glenoid labrum.
Ligaments :
1.Capsule 2. Glenoid labrum 3. Coraco-humeral ligament 4. Transverse humeral ligament 5. Gleno humeral ligaments
- Capsule : Attachment of capsule shows attachment medially on margins of glenoid labrum and laterally it shows attachment on anatomical neck of humerus . Attachment of capsule on humerus shows 2 special parts there is a space for tendon of biceps brachii muscle in bicipital groove, inferior attachment of capsule goes slightly down up to surgical neck of humerus. Rotator cuff around capsule supports it. Following muscle tendons form rotator cuff anteriorly by subscapularis, superiorly supraspinatus, posteriorly infraspinatus and terrace minor.
- Glenoid labrum : It is a fibrocartilaginous rim which shows attachment on margin of glenoid cavity. It increases the depth of glenoid fossa.
- Coraco-humeral ligament : It shows attachment on lateral margins of coracoid process and neck of humerus.
- Transverse humeral ligament : It connect to margins of inter tubercular sulcus. Tendon of long head of biceps brachii passes deep to this ligament.
- Gleno-humeral ligaments : It is formed by 3 fibrous bands on anterior aspect of capsule. Superior middle and inferior bands. It connects mainly humerus and glenoid cavity near its margin. It strengthens capsule anteriorly.
Subscapular bursa between tendon of subscapularis and capsule of joint. It is in communication with joint cavity posteriorly. Subacromial bursa lies between coracoacromial arch and supraspinatus muscle. Other small bursa present in relation with joint are in relation with coracobrachialis, acromion process, coracoid process, teres major and long head of triceps, latissimus dorsi.
Relations :
Anteriorly: Subscapularis, coracobrachialis, short head of biceps and anterior fibres of deltoid
Posteriorly : Infraspinatus, teres minor, posterior fibres of Deltoid
Superiorly : Supraspinatus, subacromial bursa, coraco-acromial arch, deltoid
Inferiorly : Long head of triceps, axillary nerve, posterior circumflex humeral vessels
Inside joint: Tendon of long head of biceps
Blood Supply : Anterior circumflex humeral artery, posterior circumflex humeral artery, suprascapular artery, circumflex scapular artery
Nerve supply: Axillary nerve, suprascapular nerve, lateral pectoral nerve
Movements : During flexion arm moves anteromedially. During extension arm moves backward and laterally. During abduction arm moves laterally and forward. During adduction arm moves medially and backward. During medial rotation hand moves medially with mid flexed elbow. During lateral rotation hand moves laterally with mid flexed elbow. During circumduction distal end of arm form a circle with combination of flexion, extension, abduction, adduction.
Muscles for movements:
Flexion: Clavicular part of pectoralis major, anterior fibres of deltoid, biceps brachii, coracobrachialis
Extension: Posterior fibres of deltoid, teres major but from flexed position to normal position movement is done by latissimus dorsi and sternocostal head of pectoralis major.
Abduction: Lateral fibres of deltoid, supraspinatus, subscapularis, infraspinatus, teres minor, serratus anterior, upper and lower fibres of trapezius. Movement is started by supraspinatus assisted by lateral fibres of deltoid. Subscapularis, infraspinatus, teres minor stabilize head of humerus. Finally serratus anterior, upper and lower fibres of trapezius play a role in over head abduction.
Adduction : Pectoralis major, anterior and posterior fibres of deltoid, latissimus dorsi, teres major, coracobrachialis, long head of triceps.
Medial rotation : Anterior fibres of deltoid, pectoralis major, teres major, latissimus dorsi, subscapularis,
Lateral rotation : Posterior fibres of deltoid, teres minor, infraspinatus
Applied anatomy :
- Dislocation : Shoulder joint dislocates commonly inferiorly (subglenoid). Axillary nerve injury may occur in this. Dislocation is due to disproportionate areas of articular surfaces, lax ligaments and capsule.
- Frozen shoulder : Patient suffers from stiffness of joint, painful and restricted movements. This is due to inflammation of rotator cuff. Automatically resolves after some time.
ELBOW JOINT
It is a hinge type of joint.
Bones forming joints :
Above trochlea and capitulum of humerus. Below trochlear notch of ulna and upper concave surface of head of radius respectively. These forms humero-ulnar and humero-radial part. Humero-radial part also continuous with superior radioulnar joint. Medial flange of trochlea 6mm lower than lateral flange so it is responsible for formation of carrying angle which is 163 degrees .
Ligaments :
1. Capsule : Above on humerus capsule shows attachment on lower end of humerus on margins of coronoid fossa, radial fossa, olecranon fossa so trochlea and capitulum are intracapsular. Below it shows attachment on margin of trochlear notch of ulna and annular ligament of superior radioulnar joint.
2. Ulnar collateral ligament : It is triangular shows attachment above on medial epicondyle of humerus by its apex below on medial margin of trochlear notch. It shows three bands anterior, posterior and inferior.
3. Radial collateral ligament : It is triangular and extends from lateral epicondyle of humerus to annular ligament.
Relations :
Anteriorly: Brachialis muscle, brachial artery, median nerve, tendon of biceps brachii
Posteriorly : Anconeus, triceps
Medially : Ulnar nerve, common flexor origin, flexor carpi ulnaris
Laterally : Common extensor origin, supinator muscle, extensor carpi radialis brevis, radial nerve
Blood Supply: From anastomosis around elbow joint.
Nerve supply: Branches of radial nerve, ulnar nerve, median nerve, musculocutaneous nerve and anterior interosseous nerve.
Muscles for movements :
Flexion : Brachialis, biceps brachii, brachioradialis
Extension : Triceps, anconeus
Applied anatomy :
1. Dislocation of elbow joint : Elbow dislocates posteriorly. Coronoid process fracture occurs in it. Three point relation get disturbed between two epicondyles of humerus and olecranon process.
2. Supracondylar fracture : It occurs in childrens. Lower fragment get displaced posteriorly.
It is a hinge type of joint.
Bones forming joints :
Above trochlea and capitulum of humerus. Below trochlear notch of ulna and upper concave surface of head of radius respectively. These forms humero-ulnar and humero-radial part. Humero-radial part also continuous with superior radioulnar joint. Medial flange of trochlea 6mm lower than lateral flange so it is responsible for formation of carrying angle which is 163 degrees .
Ligaments :
1. Capsule : Above on humerus capsule shows attachment on lower end of humerus on margins of coronoid fossa, radial fossa, olecranon fossa so trochlea and capitulum are intracapsular. Below it shows attachment on margin of trochlear notch of ulna and annular ligament of superior radioulnar joint.
2. Ulnar collateral ligament : It is triangular shows attachment above on medial epicondyle of humerus by its apex below on medial margin of trochlear notch. It shows three bands anterior, posterior and inferior.
3. Radial collateral ligament : It is triangular and extends from lateral epicondyle of humerus to annular ligament.
Relations :
Anteriorly: Brachialis muscle, brachial artery, median nerve, tendon of biceps brachii
Posteriorly : Anconeus, triceps
Medially : Ulnar nerve, common flexor origin, flexor carpi ulnaris
Laterally : Common extensor origin, supinator muscle, extensor carpi radialis brevis, radial nerve
Blood Supply: From anastomosis around elbow joint.
Nerve supply: Branches of radial nerve, ulnar nerve, median nerve, musculocutaneous nerve and anterior interosseous nerve.
Muscles for movements :
Flexion : Brachialis, biceps brachii, brachioradialis
Extension : Triceps, anconeus
Applied anatomy :
1. Dislocation of elbow joint : Elbow dislocates posteriorly. Coronoid process fracture occurs in it. Three point relation get disturbed between two epicondyles of humerus and olecranon process.
2. Supracondylar fracture : It occurs in childrens. Lower fragment get displaced posteriorly.
RADIOULNAR JOINTS
SUPERIOR RADIOULNAR JOINT
It is pivot type of joint.
Formation of joint :
Circumference of radial head, radial notch of ulna and annular ligament around head of radius.
Ligaments :
Nerve supply: Branches of radial nerve, ulnar nerve, median nerve and musculocutaneous nerve.
INFERIOR RADIOULNAR JOINT
It is pivot type of joint.
Formation of joints :
Head of ulna, ulnar notch of radius. There is presence of a articular disc below. Articular disc is triangular. Its apex present in a depression head of ulna at lower articular surface and styloid process. Base of disc present between ulnar notch and lower carpal articular surface of radius.
Blood Supply : From palmar and dorsal branches of anterior interosseous artery.
Nerve supply : Anterior and posterior interosseous nerve.
Movements:
Pronation and supination are movements at superior and inferior radio-ulnar joints. In pronation head of radius rotate within annular ligament. Vertical axis for this movement passes above through centre of head of radius and below through ulnar attachment of articular disc. Head of radius moves anteriorly and medially. Palm of hand moves backwards. In supination opposite action takes place and palm faces forwards. Muscles for pronation are pronator quadratus, pronator teres, flexor carpii radialis and gravity. Muscles for supination are supinator, biceps brachii.
INTEROSSEOUS MEMBRANE
It is a fibrous membrane connecting interosseous borders of radius and ulna. Direction of fibres in membrane is downwards and medially. Upper margin of membrane shows gap between upper margin and oblique cord through which posterior interosseous vessels passes. Lower margin of membrane shows space for passage of anterior interosseous vessels to back of forearm.
Relations :
Anteriorly : Flexor pollicis longus, flexor digitorum profundus, anterior interosseous vessels and nerve.
Posteriorly : Supinator, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, extensor indicis, anterior interosseous vessels and posterior interosseous nerve.
Applied anatomy :
SUPERIOR RADIOULNAR JOINT
It is pivot type of joint.
Formation of joint :
Circumference of radial head, radial notch of ulna and annular ligament around head of radius.
Ligaments :
- Annular ligament : It is present around radial head. It shows attachment on margins of radial notch of ulna.
- Quadrate ligament : It is fibrous ligament from radius neck to supinator fossa of ulna.
Nerve supply: Branches of radial nerve, ulnar nerve, median nerve and musculocutaneous nerve.
INFERIOR RADIOULNAR JOINT
It is pivot type of joint.
Formation of joints :
Head of ulna, ulnar notch of radius. There is presence of a articular disc below. Articular disc is triangular. Its apex present in a depression head of ulna at lower articular surface and styloid process. Base of disc present between ulnar notch and lower carpal articular surface of radius.
Blood Supply : From palmar and dorsal branches of anterior interosseous artery.
Nerve supply : Anterior and posterior interosseous nerve.
Movements:
Pronation and supination are movements at superior and inferior radio-ulnar joints. In pronation head of radius rotate within annular ligament. Vertical axis for this movement passes above through centre of head of radius and below through ulnar attachment of articular disc. Head of radius moves anteriorly and medially. Palm of hand moves backwards. In supination opposite action takes place and palm faces forwards. Muscles for pronation are pronator quadratus, pronator teres, flexor carpii radialis and gravity. Muscles for supination are supinator, biceps brachii.
INTEROSSEOUS MEMBRANE
It is a fibrous membrane connecting interosseous borders of radius and ulna. Direction of fibres in membrane is downwards and medially. Upper margin of membrane shows gap between upper margin and oblique cord through which posterior interosseous vessels passes. Lower margin of membrane shows space for passage of anterior interosseous vessels to back of forearm.
Relations :
Anteriorly : Flexor pollicis longus, flexor digitorum profundus, anterior interosseous vessels and nerve.
Posteriorly : Supinator, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, extensor indicis, anterior interosseous vessels and posterior interosseous nerve.
Applied anatomy :
- Subluxation of radial head takes place in children. In this radial head comes out of annular ligament. Condition is known as pulled elbow. This occurs in children less than 6 years age.
WRIST JOINT
It is of ellipsoid type.
Bones forming joints :
Above lower articular surface of radius and articular disc of inferior radioulnar joint. Below scaphoid, lunate, triquetral bones.
Ligaments :
Anteriorly:
Superficial : Flexor carpi ulnaris, palmaris longus, flexor carpi radialis
Middle : Radial artery, median nerve, tendons of flexor digitorum superficialis, ulnar vessel and nerve
Deep : Flexor digitorum profundus, flexor pollicis longus, anterior interosseous vessels and nerve
Posteriorly : Extensor retinaculum present here below which following structures passses from lateral to medial side abductor pollicis longus and extensor pollicis brevis, extensor carpi radialis longus and brevis, extensor pollicis longus, extensor digitorum, extensor indicis, posterior interosseous nerve and vessel, extensor digiti minimi, extensor carpi ulnaris
Blood Supply: Anterior and posterior carpal branches of radial and ulnar artery, branches of anterior interosseous artery, palmar and dorsal metacarpal arteries
Nerve supply: Anterior and posterior interosseous nerve.
Muscles for movements :
Flexion : Flexor carpi radialis and ulnaris, palmaris longus also other flexor muscles of forearm like flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
Extension : Extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis, extensor pollicis longus, extensor digiti minimi
Adduction : Flexor and extensor carpi ulnaris
Abduction : Abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus and brevis
Circumduction : Combination all movements
Applied anatomy : 1. Colles fracture : Fracture of lower end of radius. Distal fragment get displaced posteriorly and upward.
It is of ellipsoid type.
Bones forming joints :
Above lower articular surface of radius and articular disc of inferior radioulnar joint. Below scaphoid, lunate, triquetral bones.
Ligaments :
- Capsule : Above capsule shows attachment on lower end of radius and ulna on margins but head of ulna do not show any attachment because of presence of articular disc. Below it shows attachment on proximal rows of carpal bones.
- Palmar radio-carpal ligament : It shows attachment above on anterior margin of lower end of radius with its styloid process below goes downwards and medially shows attachment on scaphoid, lunate, triquetral bones on its anterior surface.
- Dorsal radio-carpal ligament : It shows attachment above on posterior margin of lower end of radius below goes downwards and medially shows attachment on scaphoid, lunate, triquetral bones on its dorsal surface.
- Ulnar collateral ligament : It shows attachment above on styloid process of ulna below on triquetral and pisiform bones.
- Radial collateral ligament : It extends from styloid process of radius to scaphoid and trapezium bones.
Anteriorly:
Superficial : Flexor carpi ulnaris, palmaris longus, flexor carpi radialis
Middle : Radial artery, median nerve, tendons of flexor digitorum superficialis, ulnar vessel and nerve
Deep : Flexor digitorum profundus, flexor pollicis longus, anterior interosseous vessels and nerve
Posteriorly : Extensor retinaculum present here below which following structures passses from lateral to medial side abductor pollicis longus and extensor pollicis brevis, extensor carpi radialis longus and brevis, extensor pollicis longus, extensor digitorum, extensor indicis, posterior interosseous nerve and vessel, extensor digiti minimi, extensor carpi ulnaris
Blood Supply: Anterior and posterior carpal branches of radial and ulnar artery, branches of anterior interosseous artery, palmar and dorsal metacarpal arteries
Nerve supply: Anterior and posterior interosseous nerve.
Muscles for movements :
Flexion : Flexor carpi radialis and ulnaris, palmaris longus also other flexor muscles of forearm like flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus
Extension : Extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis, extensor pollicis longus, extensor digiti minimi
Adduction : Flexor and extensor carpi ulnaris
Abduction : Abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus and brevis
Circumduction : Combination all movements
Applied anatomy : 1. Colles fracture : Fracture of lower end of radius. Distal fragment get displaced posteriorly and upward.
OTHER JOINTS IN HAND
Intercarpal, Midcarpal, Carpometacarpal, Intermetacarpal are joints of hand also interphalangeal joints are present in between phalanges.
Midcarpal joint are between proximal and distal row of carpal bones. Intercarpal joint are between carpal bones. Carpometacarpal joints are between carpal bones and metacarpal bones. Movements between proximal and distal rows are done alongwith movements of wrist joint.
CARPOMETACARPAL JOINT OF THUMB
It is saddle type of joint.
Bones forming joints :
Distal articular surface of trapezium and inferior articular surface at base of first metacarpal bone. Articular surfaces are concavoconvex.
Ligaments :
Anteriorly: Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Posteriorly : Extensor pollicis longus and brevis
Laterally : Extensor pollicis brevis, abductor pollicis longus
Medially : 1st dorsal interosseous muscle and radial artery
Blood Supply: Radial artery
Nerve supply: Branch of posterior interosseous nerve
Muscles for movements: Flexion, extension takes place in plane of palm and adduction, abduction takes place right angle to plane of palm. Circumduction is combination of all flexion, extension, adduction, abduction. In opposition thumb touches fingers and abduction, flexion, medial rotation takes place at 1st carpometacarpal joint.
Flexion : Flexor pollicis brevis, Opponens pollicis
Extension : Abductor pollicis longus, extensor pollicis brevis and longus
Adduction : Adductor pollicis
Abduction : Abductor pollicis longus and brevis
Opposition : Opponens pollicis, Flexor pollicis brevis, abductor pollicis longus and brevis
Intercarpal, Midcarpal, Carpometacarpal, Intermetacarpal are joints of hand also interphalangeal joints are present in between phalanges.
Midcarpal joint are between proximal and distal row of carpal bones. Intercarpal joint are between carpal bones. Carpometacarpal joints are between carpal bones and metacarpal bones. Movements between proximal and distal rows are done alongwith movements of wrist joint.
CARPOMETACARPAL JOINT OF THUMB
It is saddle type of joint.
Bones forming joints :
Distal articular surface of trapezium and inferior articular surface at base of first metacarpal bone. Articular surfaces are concavoconvex.
Ligaments :
- Capsule : Above capsule shows attachment on margin of trapezium and ulna on margin of base of first metacarpal bone.
- Lateral ligament : Connecting lateral surface of trapezium and lateral side base of 1st metacarpal bone.
- Palmar and dorsal ligaments : Oblique ligaments on dorsal and palmar surface of joint.
Anteriorly: Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Posteriorly : Extensor pollicis longus and brevis
Laterally : Extensor pollicis brevis, abductor pollicis longus
Medially : 1st dorsal interosseous muscle and radial artery
Blood Supply: Radial artery
Nerve supply: Branch of posterior interosseous nerve
Muscles for movements: Flexion, extension takes place in plane of palm and adduction, abduction takes place right angle to plane of palm. Circumduction is combination of all flexion, extension, adduction, abduction. In opposition thumb touches fingers and abduction, flexion, medial rotation takes place at 1st carpometacarpal joint.
Flexion : Flexor pollicis brevis, Opponens pollicis
Extension : Abductor pollicis longus, extensor pollicis brevis and longus
Adduction : Adductor pollicis
Abduction : Abductor pollicis longus and brevis
Opposition : Opponens pollicis, Flexor pollicis brevis, abductor pollicis longus and brevis
METACARPOPHALANGEAL JOINTS
These are ellipsoid type of joints.
Bones forming joints :
Distal articular surface of convex articular surface of head of metacarpal bones and inferior articular surface at base of proximal phalanges.
Ligaments :
Nerve supply: Palmar digital branches of median nerve, branches of ulnar nerve
Muscles for movements:
Flexion : Lumbricals, interossei
Extension: Extensor digitorum also extensor indicis, extensor digiti minimi and extensor pollicis longus with brevis for 2nd, 5th and thumb respectively.
Adduction : Palmar interossei
Abduction : Dorsal interossei also by extensor muscle of fingers
INTERPHALANGEAL JOINTS
These are uniaxial hinge type of joints.
Bones forming joints :
Distal articular surface of proximal and middle phalanx with inferior articular surface at base of middle and distal phalanx respectively. But in thumb between proximal and distal phalanx.
Ligaments :
Nerve supply: Palmar digital branches of ulnar and median nerve
Muscles for movements :
Flexion : Flexor digitorum superficialis for flexion at proximal interphalangeal joints and flexor digitorum profundus for flexion at distal interphalangeal joints. Flexor pollicis longus at interphalangeal joint of thumb.
Extension: Extensor pollicis brevis and longus for interphalangeal joint of thumb. For other fingers Interossei and lumbricals with extensor digitorum tendons at proximal and distal interphalangeal joints. Extensor digiti minimi for 5th finger.
Applied anatomy :
These are ellipsoid type of joints.
Bones forming joints :
Distal articular surface of convex articular surface of head of metacarpal bones and inferior articular surface at base of proximal phalanges.
Ligaments :
- Capsule : Capsule shows attachment on margin of articular surfaces of both bones above and below.
- Palmar ligament : It forms a fibrocartilagenous plate on anterior aspect of capsule.
- Lateral and Medial collateral ligament : These are oblique bands on medial and lateral aspect of joint. Goes downwards and forwardsand get relaxed in extension while taut in flexion of joint.
- Deep transverse metacarpal ligaments : These are three short and flat bands connecting palmar ligaments of second to fifth metacarpophalangeal joints.
Nerve supply: Palmar digital branches of median nerve, branches of ulnar nerve
Muscles for movements:
Flexion : Lumbricals, interossei
Extension: Extensor digitorum also extensor indicis, extensor digiti minimi and extensor pollicis longus with brevis for 2nd, 5th and thumb respectively.
Adduction : Palmar interossei
Abduction : Dorsal interossei also by extensor muscle of fingers
INTERPHALANGEAL JOINTS
These are uniaxial hinge type of joints.
Bones forming joints :
Distal articular surface of proximal and middle phalanx with inferior articular surface at base of middle and distal phalanx respectively. But in thumb between proximal and distal phalanx.
Ligaments :
- Capsule : Shows attachment near articular margin of bones.
- Palmar ligaments : It forms a fibrocartilagenous plate on anterior aspect of capsule. It forms volar plate.
- Collateral ligament : On lateral aspect of head. Shows attachment on volar plate.
Nerve supply: Palmar digital branches of ulnar and median nerve
Muscles for movements :
Flexion : Flexor digitorum superficialis for flexion at proximal interphalangeal joints and flexor digitorum profundus for flexion at distal interphalangeal joints. Flexor pollicis longus at interphalangeal joint of thumb.
Extension: Extensor pollicis brevis and longus for interphalangeal joint of thumb. For other fingers Interossei and lumbricals with extensor digitorum tendons at proximal and distal interphalangeal joints. Extensor digiti minimi for 5th finger.
Applied anatomy :
- Mallet finger : Avulsion and fracture of distal phalanx with extensor tendon. So extension of distal phalanx not possible.