Section 3 Joints of upper limb Joints of should girdle Sternoclavicular joint –Bones: sternal end...

Section 3 Joints of upper limb Joints of should girdle• Sternoclavicular joint

– Bones: sternal end of clavicle, clavicular notch of sternum, and first costal cartilage

– Articular capsule: strong reinforced by ligaments

– An articular disc is attached to the capsule, dividing the joint into two cavities.

– Movements:

• Acromioclavicular joint

– Bones: acromion and acromial end of clavicle

– Movement: rotation of scapula on clavicle

• Coracoacromial arch

formed by coracoacromial ligament, coranoid process, and acromion, that prevents the shoulder joint

from superior dislocation

coranoid process

acromioncoracoacromial ligament

Joints of free upper limb

★Shoulder joint (ball and socket)

• Bones: head of humerus and glenoid cavity of scapula

• Capsule: – Thin and lax, especially

lower part– Tendon of long head of

biceps brachii passes though the cavity

• Accessory structures– Glenoid labrum:

fibrocartilaginous ring on periphery of glenoid cavity

– Coracohumeral ligament ：runs from coracoid process to greater tubercle

• Movements: flexion-extension,

adduction-abduction,

medial and lateral rotation,

circumduction

★ Elbow joint• Bones: lower end of humerus, upper

ends of radius and ulna– Humeroulnar joint : formed by

trochlear of humerus and troclear notch (hinge)

– Humeroradial joint: formed by capitulum of humerus and head of radius (ball and socket)

– Proximal radioulnar joint: formed by articular circumference of radius and radial notch of ulna

• Capsule: thin and lax anteriorly and posteriorly, strongly thickened on either side by collateral ligaments

• Ligaments:– Radial collacteral ligament: attached

to lateral epicondyle and annular ligament of radius

– Ulnar collacteral ligament: attached to medial epicondyle to medial border of trochlear notch

– Annular ligament of radius: attached to anterior and posterior margins of radial notch of ulna, surrounds the head of radius

• Movements: flexion and extension, pronation and supination

Dislocation

Joints between radius and ulna

• Proximal radioulnar joint• Distal radioulnar joint: formed by head

of ulna, ulnar notch of radius and an articular disc

• Interosseous membrane of forearm: a fibrous membrane between the shaft of radius and ulna

Joints of hand

★ Radiocarpal joint (ellipsoid)

• Bones– Carpal articular surface of radius

and articular disc below the ulna

– Proximal row of carpal: scaphoid, lunate, and triquetrum, but not pisiform

• Capsule: lax and strengthened by surrounding ligament

• Movements: flexion, extension, adduction, abduction, and circumduction

• Intercarpal joints• Carpometacarpal joints: Carpometacarpal joint

of thumb(saddle)– Bones: trapezium and

base of first metacarpal– Movement: flexion,

extension, adduction, abduction, and opposition

• Intermetacarpal joints• Metacarpophalangeal

joints• Interphalangeal joints

Section 4 Joints of Lower limbJoints of pelvic girdleSacroiliac joint• Bones: auricular surface of sacrum and ilium• Capsule: very tight and strengthened by ligaments

★ Sacrotuberous ligament: runs from lateral margins of sacrum and coccyx to the inner margin of ischial tuberosity

★ Sacrospinous ligament: runs from ischial spine to lateral margins of sacrum and coccyx

• These two ligaments convert the sciatic notches the greater and lesser sciatic foramina

Sacrotuberous ligament

Sacrospinous ligament

Greater sciatic foramen

Lesser sciatic foramen

• Pubic symphysis– Articulation: symphysial

surface and interpubic disc (fibrocartilage)

– Ligaments: superior pubic ligament and arcuate pubic ligament

• Obturator membrane• Obturator canal

Obturator membrane

Obturator canal

Bony pelvis• Composition: formed by paired hip

bones, sacrum, coccyx, and their articulations

• In anatomical position, anterior superior iliac spines and pubic tubercles on same vertical plane, while the tip of coccyx and superior border of pubic symphysis on same horizontal plane

• Terminal line: formed by promontory of sacrum, arcuate line, pectin of pubis, pubic tubercle, upper border of pubic symphysis

• Two portions: a greater pelvis and a lesser pelvis

Lesser pelvis• pelvic inlet (terminal

line): • Pelvic outlet : formed

by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic, symphysis

• Pelvic cavity• Pubic arch, subpubic

angle

Main difference between male and femal

pelvis

Main difference between male and femal pelvis

Female Male

Pelvic inlet

Pelvic outet

Pelvic cavity

Pubic arch90~1000

70~750

Main difference between male and femal

pelvis

Male Female

Overall Narrow and long Wide and short

Iliac ala More vertical More horizontal

Inlet Oval or heart shaped Round

Subpubic angle

Acute angle (about 70~750)

Right angle (about 90~1000)

Pelvic cavity Deep narrow Shallower, wide

Outlet Small Larger

Joints of free lower limb★ Hip joint• Bones: acetabulum and

femoral head• Articular capsule attachments

– Above: margins of acetabulum and transverse acetebular ligament

– Below: in front to intertrochanteric line; behind, to the neck of femur above 1cm above the intertrochanteric crest

• Accessory structures – Acetabulum labrum,

transverse acetebular ligament

– Ligaments• Iliofemoral lig. • Ligament of head of

femur• Pubofemoral lig. • Ischiofemoral ligament• Zona orbicularis

• Movement: flexion-extention, adduction-abduction medial and lateral rotation,

circumduction

Transverse acetebular lig.

Ligament of head of femur

Acetabulum labrum

Iliofemoral lig.

Ischiofemoral lig.

Pubofemoral lig.

Zona orbicularis

★Knee joint• Bones: lower end of femur, upper end of tibia and

patella

• Articular capsule: superapatellar bursa, deep infrapatellar bursa, ala folds

• Accessory structures– Extra-ligaments

• Patellar lig.

• Fibular collateral lig.

• Tibial collateral lig.

• Oblique popliteal ligament

Patellar lig.

Fibular collateral lig.

Tibial collaterallig.

- Intra-ligaments• Anterior cruciate ligament• Posterior cruciateligament

– Medial meniscus (C-shaped)– lateral meniscus (O-shaped)

• Movements: flexion and extension; flexed knee joint may be passively rotated

lateralMedial

Tibiofibular syndesmosis• Tibiofibular joint • Crural interosseous

membrane • Anterior and posterior

tibiofibular ligaments

Joint of footTalocrural joint (ankle

joint)• Bones: lower ends of tibia

and fibula, talus• Articular capsule: thin and

lax in front and behind, and supported on each side by strong collateral ligaments

• Ligments– Medial lig.

– Lateral lig.

• Movements: dosiflexion (extension) and plantar flexion (flexion); when the ankle joint is fully plantar flexed, small amounts of abduction, and adduction

are possible(wrench)

• Intertarsal joints

• Tarsometatarsal joints

• Intermetatarsal joints

• Metatarsophalangeal joints

• Interphalangeal joints

Arches of foot• Medial longitudinal arch: formed by calcaneus, navicular,

three cuneiforms and first to third metatarsal bones, head of talus is the keystone of this arch

• Lateral longitudinal arch:

formed by calcaneus, cuboid, fourth and fifth metatarsals; cuboid is the keystone of this arch

• Tranverse arch: formed by cuboid, three cuniforms and all

metatarsals; the intermediate cuneiform is the keystone of this arch

• Function: give to foot strength stability and resilience; protect plantar vessels and nerves

Normal arch Flatfoot

Section 5 Joints of skull

• Continuous joints:

sutures,

synchondrosis or

synosteosis

Temporomandibular joint• Aticulating surfaces

– Mandibular fossa and articular tubercle, above

– Head of mandible, below• Capsule: thin and lax in front

and behind; strengthened by the lateral ligament

• Articular disc: separates surfaces, forming upper and lower compartments within joint

• Movement: mandible may be elevated or depressed, protruded or retracted; rotation may also occurs as in chewing( a slight amount of side to side movement is also permitted)