Joint Of Upper Limb

JOINTS OF THE UPPER EXTREMITIES Chookiet Chalermpanpipat

JOINT

เกิดจากการ articulate กัน ระหว่าง Bone และ Bone หรือ Bone และ Cartilage

JOINT

แบ่งตาม tissue ที่มาเชื่อมต่อ และ motion ของ joi ● Fibrous

joint ● Cartilaginous joint ● Synovial joint

Fibrous joint

● Synarthrosis

joint ● Fibrous tissue

Fibrous joint Suture of the skull  Syndesmoses between tibia-fibula, radiusulna 

Cartilaginous joint Amphiarthrosis joint  Joint is made of cartilage or cartilage+fibrous tissue  2 types 1. Synchondroses มี hyaline cartilage 

อยู่ระหวูางกระด่ก

2. Symphyses มี fibrocartilage อยู่ระหวูาง

กระด่ก แตูมี hyaline cartilage ปกคลุม

Cartilaginous joint - Synchondroses joint ได้แก่ epiphyseal plate ● Permanent joint ได้แก่ rib+costal cartilage ● Temporary

Cartilaginous joint - Symphyses ● Symphysis

pubis ● Intervertebral disc

Synovial joint เป็ น diarthrosis joint มีองค์ประกอบอยู่ 4 ลักษณะคือ 1. Articular (joint) capsule 2. Articular cartilage 3. Synovial membrane 4. Synovial fluid

Synovial joint 1. Gliding (plane) joint 2. Hinge joint 3. Pivot joint 4. Condyloid joint 5. Saddle joint 6. Ball and socket joint

Synovial joint - Gliding joint

ปนการเคลื่อนที่ของกระดูกชิ้นหนึ่ งไปบนกระดูกอีกชิ้นห

Synovial joint - Hinge joint

นไหวในแนวแกนเดียว (uniaxial) เหมือนกับบานพับป

Synovial joint - Pivot joint

อนไหวในแนวแกนเดียว (uniaxial) ตามแนวยาวของก

Synovial joint - Condyloid joint เคลื่อนไหวได้ 2 แนวแกน (biaxial)

Synovial joint - Saddle joint เคลื่อนไหวได้ 2 แนวแกน (biaxial) มีลักษณะ คล้ายอานม้ามา ประกบกัน

Synovial joint - Ball and socket joint เคลื่อนไหวได้มากที่สุด (triaxial) ทั้งทิศทางและมุม

Joints of the upper extremities 1. Sternoclavicular joint 2. Acromioclavicular joint 3. Shoulder joint 4. Elbow joint 5. Proximal radioulnar joint 6. Distal radioulnar joint

Joints of the upper extremities 7. Wrist joint 8. Intercarpal joint 9. Carpometacarpal joint 10. Intermetacarpal joint 11. Metacarpophalangeal joint 12. Interphalangeal joint

Sternoclavicular joint Saddle type (divided into 2 compartments by an articular disc) ● Medial end of clavicle + manubrium sterni ● Ligament – Anterior sternoclavicular ligament Posterior sternoclavicular ligament Interclavicular ligament ●

Costoclavicular ligament

Sternoclavicular joint

Sternoclavicular joint Movement - anterior, posterior, superior, inferior (move like a ball & socket joint) ● Blood supply - internal thoracic, suprascapular arteries ● Nerve - branches of medial supraclavicular, nerve to subclavius ●

Acromioclavicular joint Gliding type of synovial joint ● Lateral end of clavicle + acromion ● Ligament - acromioclavicular ligament, coracoclavicular ligament ●

(trapezoid+conoid ligament)

Acromioclavicular joint

Acromioclavicular joint

Acromioclavicular joint Movement - acromion rotates on clavicle ● Blood supply - suprascapular, thoracoacromion arteries ● Nerve - supraclavicular, lateral pectoral, axillary nerves ●

Shoulder joint Ball and socket type of synovial joint ● Head of humerus + glenoid cavity (deepened by glenoid labrum) ● Ligament - glenohumeral lig., coracohumeral lig., ●

transverse humeral lig. long head of biceps tendon

Shoulder joint Glenohumeral ligaments Superior ● Middle ● Inferior ●

Shoulder joint Rotator cuff Teres minor ● Infraspinatus ● Supraspinatus ● Subscapularis ●

Shoulder joint

Shoulder joint

Shoulder joint Movement - flexion-extention, abductionadduction, rotation ● Blood supply - internal thoracic, suprascapular arteries ● Nerve - suprascapular, axillary, lateral pectoral nerves ●

Elbow joint Hinge type of synovial joint ● Trochea, capitulum of humerus + trochea notch (ulna), radial head ● Ligament - fanlike radial collateral lig. (from lateral epicondyle to anular ligament) ulnar collateral lig. (from medial epicondyle to coronoid ●

process, olecranon process)

Elbow joint

Proximal radioulnar joint Pivot type of synovial joint ● Radial head + radial notch (ulna) ● Ligament - anular ligament ●

Proximal radioulnar joint

Distal radioulnar joint

Pivot tye of synovial joint ● Ulnar head + ulna notch (radius) ● Ligament - weak anterior & posterior lig. ●

Wrist joint ● ● ●

Condyloid type of synovial joint Distal end of the radius + Scaphoid, lunate, triquetrum Ligament - anterior lig., posterior lig., medial collateral lig.

(styloid process of ulna to triquetum), lateral collaeral lig.

(styloid process of radius to scaphoid)

Intercarpal joint Gliding type of synovial joint ● Proximal + distal rows, individual bones + each other ● Ligament - anterior lig., posterior lig., interosseous lig. ●

Carpometacarpal & Intermetacarpal joint Gliding type (except saddle type of the 1st carpometacarpal) ● Carpals + metacarpal bones ● Ligament - anterior lig., posterior lig., interosseous lig. ●

Wrist & Intercarpal & CMC joint

Wrist & Intercarpal & CMC joint

Metacarpophalangeal joint Condyloid type of synovial joint ● Metacarpal heads + bases of proximal phalanges ● Ligament - strong palmar lig., deep transverse metacarpal lig., ●

collateral lig.

Interphalangeal joint Hinge type of synovial joint ● Head of phalanges + bases of more distally located phalanges ● Ligament - palmar lig., collateral lig. ●

Metacarpophalangeal joint

Metacarpophalangeal & Interphalangeal joint