Flashcards
Upper Extremity Joints
Flashcards do conjunto (51)
- 1Shoulder Girdle• Permits the largest ROM of any joint complex.
• 4 joint complex vs 1 = Increased ROM with less instability.
• Facilitates movements of UE by positioning the GH favourably. - 21. Sternoclavicular Joint - SCJSynovial. Diarthrosis.
• Saddle Joint: stability with
more flexibility than a hinge or
gliding.
• 2 planes / biaxial. - 3The SCJ Articulations:- The clavicle articulates with the
reciprocal notch of the sternum and the
superior surface of the first costal
cartilage.
- The articulating surfaces are not fully
congruent and divided by an articular
disc. - 4Articular Disc / Meniscus SCJThe SC Joint is very incongruent, so a
joint disc is present to enhance joint
contact of the joint surfaces.
• Similar to meniscus of the knee, the SC
Joint disc also acts to absorb forces that
may be transmitted along the clavicle. - 5SCJ - BiomechanicsMovement:
The normal SCJ achieves 35° of
movement both in the coronal and
horizontal plane during shoulder
abduction along with 45° of
rotation in its long axis. - 6Clavicular Motion with Humeral AbductionHumeral Abduction requires Clavicular
elevation and rotation.
• For 90º humeral abduction - the Clavicle
elevates 30 degrees from the SCJ.
• For full 180º humeral abduction - the
Clavicle must rotate 45º degrees posteriorly
(S shape flips) to give the next 30 degrees
of elevation required. - 7Reciprocal movement: Reciprocal (movement at the same time but in opposite directions) movements occur between the ACJ and SCJ.
- 82. Acromioclavicular Joint - ACJSynovial. Diarthrosis.
• Plane / Gliding. - 9Acromioclavicular JointThe AC Joint is the articulation between the lateral
end of the clavicle and a small facet on the
acromion of the scapula.
The articular facets are considered to be
incongruent, in that they vary in configuration. - 10AC Joint Ligaments & Disc• 1 Intrinsic / Capsular: – AC (prevents
posterior dislocation, limits scap roa.)
• 1 Extrinsic: – Coracoclavicular (2 parts:
Conoid and Trapezoid. 1º support lig /
horizontal stability, preventing superior
dislocation, limiting scap rot.)
• Disc: A wedge shaped fibro meniscus
cartilaginous disc projects into the joint
from the superior part of the capsule. - 11ACJ BiomechanicsThe primary function of the ACJ is:
1. To give the Scapula additional ROM.
2. To all the Scapula to follow the changing shape of the thorax as the arm moves.
3. The joint allows transmission of forces from the upper extremity to the Clavicle. - 12ACJ BiomechanicsDuring abduction / flexion of the SH, the
scapula rotates superiorly at the ACJ. During adduction / extension it rotates
inferiorly at the ACJ. (axis perpendicular to the Scapular
Plane)
• During protraction of the SH, the scapula
internally rotate at the ACJ level to fit on the contour of the thorax. During retraction, the Scapula externally rotates. (vertical axis)
• During elevation of the SH, the scapula
anteriorly tilts at the ACJ. During depression the Scapula posteriorly tilts. (adjusts to fit the thorax.) (ML Axis) - 13Biomechanics Image
- 143. Glenohumeral Joint - GHJ• Synovial. Diarthrosis
• Ball & Socket
• Tri-planar / Multiaxial - 15GHj articulationThe glenohumeral articulation involves the
humeral head with the glenoid cavity of
the scapula, and it represents the major
articulation of the shoulder girdle. - 16The Glenoid Cavity & LabrumGlenoid cavity is shallow and holds approx 1/3 of the
humeral head.
(Gleno literally means having a shallow
cavity.)
It is deepened by the Glenoid Labrum, a fibro cartilaginous rim along its periphery.
Capsule is weakest inferiorly / Anterior = direction of
most dislocations. - 17GH Ligaments• Intrinsic / Capsular:
1. Glenohumeral ligs - 3
I. Superior (prevents inf translation)
II. Middle (stab Ant SH, limits ext rot)
III. Inferior (2 bands Ant/Post, limits ext/int rot)
2. Transverse Humeral lig (prevents displacement of
the bicep tendon)
3. Coracohumeral lig (limits inf translation & ext rot.)
• Extrinsic:
1. Coracoacromial lig. Roof of shoulder. Protection. - 18Biomechanics of the GH joint
- 19Biomechanics of the GH jointMinimally constrained (shallow joint) ball
and socket joint allows for significant
movement / mobility.
• = predisposition to instability and
impingements.
• Rotation, gliding and sliding all occur
within the joint.
• Numerous opposing ms vector. - 20Biomechanics of the GH joint• Rottator cuff muscles are responsible for keeping the
head in the socket and manoeuvring
the head for optimal integrity /
contact / clearance during each
movement.
• During abduction - the Rottator cufff muscles pull
the GH head inf and into ext rot
which allows the greater tuberosity
to pass under the acromial hood. - 214. Scapulothoracic Joint - STJNOT A JOINT IN THE TRADITIONAL SENSE
• The “articulation” occurs between the scapula and the thoracic cage - 22Scapulothoracic RhythmScapulohumeral rhythm coordinated motion of
the scapula and humerus, ratio: 2:1
2 Humeral (GHJ) Elevation: 1 Scapulothoracal
Rotation.
Eg. Flexion or Abduction of Humerus to 90° =
60°of GHJ and 30°of STJ motion - 23Humeral Abduction + Scapulothoracic RhythmDynamics between the Scapular, Humerus, AC and SC joints to accommodate 180º
of Humeral abduction.
1. Humerus: abduction 120º + externally rotates 45º .
2. Scapula - upward rotation 60º.
3. SC/AC joints - elevates 30º and then Clavicle posteriorly rotates 45º (flipping the
S shape) to give the further 30º of elevation needed to match the Scapular
motion - 24Elbow Joint• Synovial. Diarthrosis
• Hinge (modified?)
• Gliding ??
• Pivot ??
• 1 plane / uniaxial - 25The Elbow joint - 3 Articulations:The Elbow Joint
3 Articulations:
• Compound joint – Humerus articulates
with 2 bones.
• Humerus (Trochlea) & Ulna (Trochlear
notch)
• Humerus (Capitulum) & Radial Head.
• Radial Head and Ulna (Radial Notch) - 26Ligaments of the Elbow• Unlike the shoulder joint, the
elbow joint has strong ligaments
that limit movements and stabilize
the articulating bones.
• The fibrous capsule is thin
anteriorly and posteriorly allowing
for free range of motion of Flexion
and Extension. - 27Ligaments of the Elbow1. The Medial / Ulnar collateral (3 bundles.) MCL
2. Lateral / Radial collateral ligaments. LCL
• Ligaments reinforce the capsule respectively.
• Originate from the Epicondyles of the Humerus to the respective sides of
the Ulna and Radius where they stabilize the joint in apposing varus and
valgus & distraction movements. - 28Biomechanics of the Elbow• 3 joints within the capsule / cavity:
1. Hinged – Humeroulnar = Main Elbow Joint. (Modified Hinge. Some rot &
translation.)
2. Gliding Plane – Humeroradial. (Acts with the Hinge joint.)
3. Pivot – Superior Radioulnar. (Allows for supination and pronation) - 29Modified hinge jointAxis of rotation for Flexion and Extension at
the elbow runs through the Capitulum and
Trochlea.
• Allows for 145 degrees of active motion
from full Flexion to full Extension. (160
passively.)
• Active flexion is limited by tissue
approximation.
• Active extension is limited by boney
approximation. - 30Plane gliding joint
- 31Pivot joint
- 32Abnormality of carrying an angleThe axis for Pronation and
Supination passes from
the centre of the Radial
head to the Ulna Styloid
distally.
Creating a valgus carrying
angle. - 33Joints of the Wrist1. Radiocarpal joint (True wrist)
• Condyloid
• Synovial
• Distal Radius with proximal row of carpals
2. Intercarpal joints
• Synovial-Plane Gliding
3. Carpal-metacarpal(2-5)
• Synovial-Plane Gliding - 34Joints of the hand4. Trapezium-metacarpal (1)
Synovial-Saddle
5. Metacarpal-phalangeal
Synovial-Condyloid
6. Interphalangeal
Synovial-Hinge - 351. Radiocarpal JointArticulations: Condyloid
• Distal end of the Radius.
• Scaphoid, Lunate, and Triquetrum (proximal row.)
• There is a Radioulnar disc in between the Ulna and
Carpals.
* There is no true articulation between the Ulna and
the carpals. (via disc only) - 36Radiocarpal jointArticular Radial Facets:
• Lateral (46%) ! scaphoid
• Medial (43%) ! lunate
• Inferior disk (11%) ! triquetrum - 37Ligaments of the WristExtrinsic ligaments: bridge
Carpal bones to the Radius
or Ulna and include volar /
palmar and dorsal ligaments.
1. palmar radiocarpal ligament
2. Palmar ulnocarpal ligament
3. Dorsal radiocarpal ligament
4. Ulnar collateral ligament
5. Radial collateral lgament
(Volar are stronger than
Dorsal) - 38Function of the wrist ligaments• Stabilize the wrist joint.
• Limit flexion & extension.
• Limit Radial & Ulnar
deviation. - 39Ligaments of the Wrist Intrinsic ligamentsThe most important intrinsic ligaments
are the Scapholunate interosseous
ligament and Lunotriquetral interosseous
ligament.
2. Dorsal intercarpal ligament
3. Palmar intercarpal ligament
Function:
• Stabilize the carpals
• Provide stabilization between hand and
forearm. - 40Flexor RetinaculumAka Transverse Carpal Ligament:
• Is a strong, fibrous band that arches
over the carpus, holding Flexor
tendons of the digits and the median
nerve tendons in place.
• Creates the “Carpal Tunnel”.
• It attaches medially, to the Pisiform
and hook of Hamate and laterally to
the Scaphoid and Trapezium. - 41Extensor RetinaculumAka Dorsal Carpal Ligament:
• It is a strong, fibrous band of thickened
fascia that holds the Extensor tendons
in place.
• Attached laterally to the lateral margin
of the Radius.
Instead it attaches to
the medial attachment is to the most
medial of the Carpal bones, the
Triquetrum and Pisiformis. - 42Wrist biomechanics movements at the distal Radioulnar joint, Radiocarpals and Midcarpals.Flexion / Extension:
• All occur at the Radiocarpal and midcarpal joints around an axis thru the
Capitate.
• Flexion is initiated in inter-carpal joint
and 60% occurs there.
• Extension is also initiated at mid-carpal
but most occurs in radio-carpal. - 43Wrist BiomechanicsUlnar and Radial Deviation:
• Also occur at the Radiocarpal and mid-carpal
joints around an axis thru the Capitate.
• Ulnar deviation (2x) > Radial.
• Ulnar deviation includes some extension of proximal carpals.
• Radial deviation includes some flexion of
proximal carpals. - 44Arches of the handThere are three distinct arches,
1.longitudinal
2. oblique
3. transverse
These are formed by the bones, ligaments and tendons these are of vital importance
when gripping and manipulating objects. - 45Inter-Carpal / Mid Carpal JointsProximal row of Carpals with distal row of
Carpals.
• A series of “Plane Gliding joints.” - 46Wrist
- 47Carpometacarpal Joints 2-5Between the distal row of Carpal bones and
proximal end of the Metacarpal bones.
• Provide more stability than mobility.
• Plane Gliding Synovial joints with limited
range - mostly passive. - 48Carpometacarpal Joints 1 / TMCTrapeziometacarpal joint:
• Saddle joint
• Trapezium with 1st metacarpal.
• Adds rotary component – very mobile.
• Capsule support. - 49Metacarpal Phalangeal JointsCondyloid
• Flexion and Extension
• Passive rotation - 50Interphalangeal joints• Hinge joints
• Flexion and Extension
• Passive rotation - 51Ligaments of the Hand1. Collateral Ligaments
2. Deep Transverse Metacarpal Ligaments
3. Palmar (Volar) Ligaments (Plates)
4. Cruciate Ligaments
5. Annular Ligaments
Informações
- Descrição
- Grado Superior Biomechanics and Technique FlashCards sobre Upper Extremity Joints, criado por Calvin Soares em 08-06-2022.
- Criado por
- Calvin Soares
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