Download MBBS Anatomy PPT 21 Elbow Radioulnar Wrist Joint Notes

Learning Objectives

? Normal Anatomy Of joint- Elbow,

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raioulnar,wrist and first carpometacarpal joint.

? Important relations of joints
? Muscles producing different movements of

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joints

? Applied anatomy

ELBOW JOINT

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Type

Synovial / Hinge

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compound as it has two

articulations

i)humero ? ulnar &

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ii)humero ? radial

Articular surfaces

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1. Humerus ?by trochlea &

capitulum

2. Ulna ? trochlear notch

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3. Radius ? head

Ligaments:

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Fibrous capsule

Ulnar col ateral

ligament

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a.

Anterior band

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b. Posterior band

c.

Oblique band

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Radial col ateral ligament

Synovial membrane

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Articular Capsule of Elbow Joint

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Relations

? Muscles related

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? Anterior ? brachialis

? Posterior? triceps, anconeus

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? Lateral ?common extensor

tendon, supinator

? Medial ? flexor carpi ulnaris,

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common flexor tendon

? Arterial supply

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? From anastomosis around

elbow joint

? Nerves

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? Musculo-cutaneous and radial

(with contributions from ulnar

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and median nerves)

Anastomosis around Elbow Joint

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Movements

-Flexion

-Extension

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-Carrying angle disappears in flexion

-Muscles producing movements:

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Flexion

-Brachialis

-Biceps

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-Brachioradialis

Extension

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-Triceps

-Anconeus

APPLIED ANATOMY

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Bursitis of olecranon bursa


Dislocation of Elbow Joint

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Supracondylar fracture

? May injure

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brachial artery

leading to

vasospasm- lead

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to ischaemia of

deep flexor

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muscles-

volkman's

ischaemic

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conracture

? Tennis elbow- sprain or partial tear of radial

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collateral ligament due to abrupt pronation-

pain and tenderness at lateral epicondyle

? Golfer's elbow- inflammation of commom

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flexor tendons


RADIOULNAR

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JOINTS

The radius and ulna articulate by ?

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? Synovial

1. Superior radioulnar joint

2. Inferior radioulnar joint

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? Non synovial

Middle radioulnar union

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Superior Radioulnar Joint

This articulation is a trochoid or

pivot-joint between

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? the circumference of the

head of the radius

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? ring formed by the radial

notch of the ulna and the

annular ligament.

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The Annular Ligament (orbicular

ligament)

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It forms about four-fifths of the

osseo- fibrous ring, and is

attached to the anterior and

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posterior margins of the radial

notch

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Its upper border blends with the

capsule of elbow joint while

from its lower border a thin

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loose synovial membrane

passes to be attached to the

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neck of the radius
Its deep surface is smooth,

and lined by synovial

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membrane, which is

continuous with that of the

elbow-joint.

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Quadrate ligament

A thickened band which

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extends from the inferior

border of the annular

ligament below the radial

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notch to the neck of the

radius is known as the

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quadrate ligament.

Middle Radioulnar

Union

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The shafts of the radius and ulna are connected by

Oblique Cord and Interosseous Membrane

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The Oblique Cord (oblique

ligament)

Extend downward and lateral y,

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from the
lateral side of the ulnar tuberosity
to the radius a little below the

radial tuberosity.

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Its fibers run in the opposite

direction to those of the

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interosseous membrane.

The Interosseous Membrane

Descend obliquely downward

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and medially

It extends from the

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interosseous crest of the

radius to that of the ulna.

It is deficient above,

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commencing about 2.5 cm.

beneath the tuberosity of

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the radius.


It helps to transmit

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forces to ulna and

humerus acting

proximally from hand

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to radius

Inferior Radioulnar Joint

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Uniaxial pivot-joint

between head of the ulna and

the ulnar notch on the

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lower end of the radius.

The articular surfaces are

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enclosed by capsule and

connected together by ?

? Articular ligaments

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1.Anterior radioulnar

ligament

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2. Posterior radioulnar

ligament

? Articular disc

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Anterior Radioulnar

ligament

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This ligament is a

narrow band of fibers

extending from the

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anterior margin of the

ulnar notch of the

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radius to the front of
the head of the ulna.
Posterior (Dorsal)Radioulnar

ligament

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This ligament

extends

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between

corresponding

surfaces on

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the dorsal

aspect of the
articulation.

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The Articular Disc

The articular disc is triangular in

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shape placed transversely beneath

the head of the ulna

Its periphery is thicker than its center,

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which is occasionally perforated.

Radius

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Attachment ?

apex to a depression between the

styloid process and the head of

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the ulna;

base, which is thin, to the prominent

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edge between the ulnar notch and

carpal articular surface of the

radius.

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Synovial

Membrane

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The synovial

membrane of this

articulation is

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extremely loose,

It extends upward as a

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recess (recessus

sacciformis)

between the radius

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and the ulna.

Movements

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.
Pronation ? Radius turns anteromedially and

obliquely across the ulna, its proximal end

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remaining lateral and distal end becoming

medial. During this action, interosseous

membrane becomes spiralled.

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Supination ? Radius returns to a position

lateral and paral el to ulna and interosseous

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membrane becomes unspiral ed.

Hand can thus be turned through 140? ? 150?

and with elbow extended this can be

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increased to 360? by humeral rotation and

scapular movement.

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Axis of supination and pronation extends from the center

of the head of the radius to the ulnar attachment of

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articular disc. This is axis of movement of radius

relative to ulna and it does not remain stationery.

In this movement the distal head of the ulna is not

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stationary, but describes a curve in a direction

opposite to that taken by the head of the radius.

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Muscles Producing Movement

Pronation ? Pronator quadratus

Pronator Teres

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Gravity also assists in pronation

When these muscles contract, they pul the distal end of the

radius over the ulna, resulting in pronation of the hand

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Supination ? Supinator

Biceps brachii

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Wrist joint & joints of hand

? Synovial joint

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? Variety ?ellipsoid
? Articular surface-

Proximal-Distal end of

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radius &Inferior surface of

articular disc of inferior

radioulnar joint

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? Distal- Proximal surface of

scaphoid, lunate &

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triquetral

Capsular ligament-

Attached to the

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margin of proximal &

distal surface

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Thickenings in the

capsule-

Anteriorly -

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In lateral part palmar

radiocarpal ligament

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Thickenings in the capsule-
Posteriorly- dorsal radiocarpal ligament
? Ulnar collateral ligament
? Radial collateral ligament

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? Nerve supply- Anterior & posterior

interosseous nerves

? Blood supply- Radial, ulnar & anterior

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interosseous artery

Movements occuring at wrist

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joint

? Flexion 85 degree, occur more at

midcarpal joint by -Flexor carpi

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radialis, FCU act as prime mover

Palmaris longus, FDS, FDP & FPL

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? Extension( 60 degree)- ECRL, ECRB,

ECU act as prime mover assisted by

,Extensor digitorum, EDM & extensor

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indicis

? Adduction( 45 degree)- ECU & FCU

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? Abduction( 15 degree)- ECRL, ECRB

Joints of hand

? Mid carpal ligament-present

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between proximal & distal row of

carpal bones

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Carpometacarpal joint of

thumb-

? Saddle variety of synovial joint

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? Articular surface- Distal surface

of trapezium

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Proximal surface of the first

metacarpal

Movement occuring at first

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Carpometacarpal joint

of thumb-

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? Flexion- FPL, FPB,& OP
? Extension- EPL,EPB and

APL

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? Abduction- APB and APL
? Aduction - AP


? Intercarpal, carpo-

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metacarpal and

intermetacarpal joints -

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all plane joints having

gliding movements only.

? Metacarpophalangeal

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joints- el ipsoid joints

al ows

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? Flexion- Lumbricals,

FDS, FDP , PI & DI

? Extension- ED

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? Abduction- ED and DI
? Adduction-PI and FDS

and FDP of the fingers.

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? Interphalangeal joints- Hinge

joints of the condylar type.

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? Each finger has two joints proximal and

distal.

Flexion at proximal IP joints by FDS and

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FDP

? Flexion at distal IP joints by FDP
Extension at proximal and distal IP joints

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by ED, lumbricals and interossei

? The EI helps in extension of index finger

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and EDM helps in that little finger

Applied

? Wrist joint is commonly involved in

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rheumatoid arthritis

? Back of wrist is common site of

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ganglion

Mechanism of injury In Col es' fracture

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Col es' fracture

Col es' fracture

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? Colles' fracture - fracture of

the distal forearm in which

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broken end of the radius is

bent backwards.

? The fracture is also referred to

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as a "dinner fork" or

"bayonet" deformity due to

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the shape of the resultant

forearm.

? Symptoms may include pain,

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swel ing, deformity, and

bruising.

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? Complications may include

damage to the median nerve.

Smith's fracture

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MCQ

Q. Injury to the following nerve wil affect both

flexion at elbow joint and supination at

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radioulnar joint
a. Radial nerve
b. Musculocutaneous nerve
c. Median nerve

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d. Radial nerve

MCQ

Q. Injury to the following nerve wil affect both

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flexion at elbow joint and supination at

radioulnar joint
a. Radial nerve

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b. Musculocutaneous nerve(Biceps)
c. Median nerve
d. Radial nerve

MCQ

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? Q Following bone do not take part in formation

of wrist joint

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A Lower end of radius
B Lower end of ulna
C Scaphoid
D Lunate

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MCQ

? Q Following bone do not take part in formation

of wrist joint

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A Lower end of radius
B Lower end of ulna
C Scaphoid
D Lunate

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