Upper Extremity Joints Part 2 ElbowWristHand Elbow Joint

Upper Extremity Joints Part 2 Elbow/Wrist/Hand

Elbow Joint u Components – Humero-ulnar joint u Capsule/Ligaments – Ulnar collateral ligament – Radial collateral ligament (trochlea of humerus & trochlear notch of ulna) – Humero-radial joint (capitulum of humerus & head of radius) u – Radial-ulnar joint (head of radius & notch of ulna) Movements – Flexion/extension – Supination/pronation

Elbow Anterior Capsule

1. Ulnar Collateral Ligament 2. Radial Collateral Ligament 3. Annular Ligament 2 1 3 (left elbow joint)

Cubitus Varus/Valgus (cubital means pertaining to elbow) Change in angulation shown for the left elbow. Varus Valgus inward angulation of distal segment outward angulation of distal segment

Valgus stress testing of the right elbow joint. Which major ligament restricts (checks) valgus movement at the elbow? Which ligament checks varus movement? What does the annular ligament check?

Proximal Radio-Ulnar Joint - Components Circumferential margin of head of radius u Radial notch of ulna u u Allows sup / pronation joint motions (left elbow joint)

Proximal Radio-Ulnar Joint (Capsule and Ligaments) u u u Capsule surrounds elbow joint complex Radial collateral ligament Annular ligament – is an osseofibrous ring that constrains the radial head

Joint Pathologies 2 different mechanisms & types of elbow dislocations 1) Ground impact injury 2) Pulling injury / dislocation of radius Dislocation of ulna “Nursemaid’s Elbow”

Common Joint Pathologies Joint Sprain Injury (result of valgus force) Olecranon Bursa Injury

Forearm – Wrist Joint Complex: Distal Radio. Ulnar Joint - Movement Articulation allows for pronation / supination movement of the forearm

Wrist: Distal Radio-Ulnar (Joint – Components) u Head of ulna u Ulnar notch of radius u Articular disc (TFCC) O: Distal radius I: Ulnar styloid A: Stabilize distal radioulnar joint (while allowing a rolling type of joint movement)

Wrist Joint u Components (simplified) – Radiocarpal – Midcarpal u Capsule / Ligaments (simplified) – Intercarpal ligaments – Palmar & Dorsal radiocarpal ligaments – Ulnar & Radial collateral ligaments u Movements (condyloid joint system) – Flexion / Extension – Radial / Ulnar deviations

Carpals u Proximal Row – Scaphoid, Lunate, Triquetrum, Pisiform u Distal Row – Trapezium, Trapezoid, Capitate, Hamate

Radiocarpal Joint Members u Radius and Disc • Distal radius • Articular disc u Proximal carpal row Scaphoid, Lunate, Triquetrum

Midcarpal Joint Members (between rows) Locate on Image Trapezoid Triquetrum Hamate Scaphoid Lunate Capitate Trapezium Articular Disc

Wrist Joint Ligaments (simplified) u Intercarpal u Palmar (volar) radio-carpal u Dorsal radio-carpal u Radial collateral u Ulnar collateral

Dorsal Wrist Joint Ligaments 1. Intercarpal Ligs 2. Dorsal Radio-carpal Lig 3. Radial Collateral Lig 4. Ulnar Collateral Lig 2 3 4 5 1 5. Radiocarpal Joint Capsule

Palmer Wrist Joint Ligaments 1. Intercarpal Ligs - Pisohamate Lig (Tunnel of Guyon) 2. Palmar Radio-carpal Lig 4 2 3. Radial Collateral Lig 4. Ulnar Collateral Lig P 1 3

Hand / Finger Joints u Components – CMC, MCP, IP joint members u Capsule/ligaments – Collateral ligs and palmar plates u Movements – Thumb opposition/reposition – Thumb circumduction (pseudo) – Flexion/extension – Abduction/adduction

CMC Joint(s) (Carpal-Metacarpal) Only the 1 -CMC joint aids in hand function Joint Anatomy • Trapezium & First-Metacarpal • Saddle shaped contour • Allows for pseudo-joint circumduction

MCP Joints u Components – Head of metacarpal – Base of prox-phalanx u Capsule/ligs – Palmar plate – Collateral ligs – Deep transverse metacarpal ligs u Movements (condyloid) – Flexion/extension – abduction/adduction

IP Joints (interphalangeal) u Components – Head of phalanx – Base of next phalanx u Capsule/ligs – Palmar plate – Collaterals u Movement (hinge) – Flexion/extension

1 2 1. Deep Transverse Metacarpal Ligs 2. Palmar Plates 1 3. Collateral Ligs 2 3

Finger Joint Pathologies Rheumatoid Arthritis (RA) Note the ulnar drift of digits Heberden’s Nodes (OA) Skier’s Thumb: Injury of 1 -MCP ulnar collateral lig. Swan Neck Finger Deformity Is palmar plate injury of PIP joint