The Joint

and
Joints of the Upper Extremity

Maria Theresa R. de Leon,MD,MSPT,FPARM

 JOINTS

 Joints  Articulations
 Areas where two or more bones
meet
 Serve for Mobility and Protection

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 Classification of Joints

Structural Binding material

• fibrous
• cartilaginous
• synovial
Functional Movements
• synarthroses (immovable)
• amphiarthroses (slightly movable)
• diarthroses (freely movable)

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 Fibrous Joints

 Held together with fibrous tissue

 Little movement
 Length of fibers --movement
– Sutures (synarthroses)
– Syndesmoses
Interosseous membrane (amphiarthrosis)
– Gomphosis  peg in socket (synarthrosis)

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 Cartilaginous Joints

 United by cartilage
 No joint cavity
– Synchondrosis - primary
Bar or plate of cartilage
Epiphyseal plate (syntosis)
no movement

Ex : union of epiphysis and diaphysis , 1st rib

and manubrium sterni

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 Cartilaginous Joints
Symphysis –
secondary
Fusion of articular cartilages , fibro cartilage
Bones are covered by thin layer of hyaline
cartilage
Ex : Pubic symphysis, vertebral discs
(Amphiarthroses)

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 Synovial Joints
 fluid filled cavity
 All Diarthrotic
 General features:
 Articular cartilage (hyaline)
 Joint cavity (synovial fluid)
 Articular capsule
fibrous capsule, synovium
 Synovial fluid
 Reinforcing ligaments

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 Synovial Joints
 Permit free joint movement
 Kind of motion available at the joint is
described as degrees of freedom (DOF)
 amount and kind of motion are dictated by
the articular surfaces

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 Structure of Synovial Joints:

 Reinforcing Ligaments
 Capsule  defines the boundary between the articular &
peri-articular tissues. Varies in thickness
 Intrinsic
(Capsular)
 part of fibrous capsule
 Extracapsular
 outside capsule
 Intracapsular
 deep to capsule
 covered by synovium
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 Structure of Synovial Joints:

Other Structures
 Fat pads
 between fibrous capsule and
synovial membrane
 Articular discs (Menisci)
 improve fit between bones
 increase joint stability

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 Structure of Synovial Joints:

 Bursae
 synovial membrane sacs
 ball bearings
 Tendon sheath
 elongate bursae wrapped around tendons
 reduce friction
* Capsule, Ligaments, Tendons are made up of Type I
Collagen Fibers aligned with axis of tensile strength

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 The Synovium

 synovial membrane is innermost portion of capsular

ligament of a synovial joint; it may be continuous with
bursae about the joint
 richly supplied with blood vessels, lymphatics, and
nerves
 richness of blood capillaries and their proximity to
inner surface account for hemorrhage into joints that
may follow minor injuries

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 Histology of the Synovial Membrane

 comprised of a sheet of fibrous connective

tissue,
 cells resemble fibroblasts
 it has no epithelial component
 Synovial lining cells reside in a matrix rich in
collagen fibrils & proteoglycans

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 Synovial Fluid

 A thin film of synovial fluid covers the surfaces of

synovium & cartilage within the joint space
 essential nutrients & metabolic by-products are
cleared by perfusion of the local vasculature
 Synovial microvessels contain fenestrations that
facilitate diffusion-based exchange between the
plasma & the surrounding interstitium

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 Synovial Fluid
 An ultrafiltrate of blood plasma plus hyaluronic acid
and glycoproteins
 contains 3-4 mg/ml hyaluronan (hyaluronic acid), a
polymer of disaccharides composed of D-glucuronic
acid and D-N-acetyl glucosamine joined by
alternating beta-1,4 and beta-1,3 glycosidic bonds
 Hyaluronan increases the viscosity and elasticity of
articular cartilages and lubricate the surfaces
between synovium and cartilage

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 Articular Cartilage

 Specialized connective tissue that covers the

weight bearing surfaces
 Extra cellular matrix is composed of an
extensive network of collagen fibrils that
confers tensile strength & an interlocking
mesh of proteoglycans that provides
compressive stiffness through the ability to
absorb & extrude water

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 Articular Cartilage

 Is bathed in Synovial Fluid, a lubricant that serves as

nutrition for chondrocytes
 Contains >70% water
 90% of dry weight consists of 2 components: Type 2
Collagen and Aggrecan
 Physical Properties are determined by the unique
fibrillar collagen network interspersed with
proteogycan aggregates that bestow tensile
strength & resistance

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 Articular Cartilage

 Normal tissue is White & appears

Translucent
 Avascular, nourished by diffusion from the
vasculature of the subchondral bone & from
synovial fluid
 Hypocellular (chondroctes comprise only 1%
to 2%)

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 Movements
 Nonaxial, uniaxial, biaxial, multiaxial.
 Gliding movements
– 2 flat bone surfaces gliding on each other.
 Angular movements
– angle between bones changes
 Flexion
– decreasing angle and brings 2 bones closer together
 Extension
– opposite of flexion. same joints

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 Movements
 Abduction
– movement away from midline of body
 Adduction
– opposite of abduction
 Circumduction
– limb describes a cone.
 Rotation
– bone turns on long axis.
 Special movements-
– -pro- and re-traction, elevation and depression, opposition.

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 Classification of Synovial Joints

Plane
Hinge
Saddle
Condyloid
Pivot
Ball & Socket

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 Plane
 Gliding
 Bones glide face to face limited by
ligaments
 Ex : intercarpal and intertarsal joints

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 Hinge

 Ginglymus
 convex projection into concavity,
 single plane motion
 Movement about transverse axis
 Flexion and extension
 Ex : elbow and knee joint

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 Saddle
 Increased movement of hinge joint by adding axis of
movement about transverse plane
 Both surfaces saddle shaped
 Flexion, extension, adduction, abduction
 Ex ; 1st Carpometacarpal joint (thumb)

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 Condyloid

 Ellipsoidal
 Modified ball and socket
 biaxial, oval protuberance and concavity
 Opposing surfaces are ellipsoidal not spherical

 Permitting circumduction

 Ex : wrist joint

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 Pivot Joint

 Trochoid
 rotation along long axis
 Cylindrical form moving with complete or
partial ring
 Only vertical axis is present
 Ex : radioulnar

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 Ball and Socket

 Enarthrosies
 Freest movement
 Spherical head in a cup-like cavity
 With wide play of condyloid movement
permitting rotation
 Ex : hip and shoulder joint

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 Joints of the Upper Extremity

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 Shoulder Joint

 Shoulder unit
 Bones : clavicle, scapula and humerus,
sternum, ribs
 primary function is to preposition the hand in
the space
 Known as Shoulder girdle

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 Shoulder Girdle

 Glenohumeral
– humerus articulating with glenoid fossa of scapula
 Sternoclavicular (SC)
– proximal clavicle articulating with manubrium and
cartilage of rib 1
 Acromioclavicular (AC)
– acromion process of scapula articulating with
distal clavicle
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 Shoulder Girdle

 Coracoclavicular
– coracoid process of scapula articulating with
inferior clavicle
 Scapulothoracic
– anterior scapula articulating with thoracic wall

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 Sternoclavicular

 sternal end of the clavicle and the manubrium sterni and the
1st costal cartilage
 Synovial joint , double plane
 Supported by anterior and posterior sternoclavicular ligament
 Nerve supply : Supraclavicular and nerve to subclavius
 Forward and backward movement of the clavicle and elevation
and depression

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 Acromioclavicular

 between the acromion process of the scapula and

lateral end of the clavicle
 Synovial, plane joint
 Supported by superior and inferior acromioclavicular
ligaments
 Nerve supply : suprascapular nerve

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 Scapulothoracic

 Not a true joint

 Lacks characteristic of the joint except motion
 Amplify movement of glenohumeral joint
 Shock absorber of the shoulder
 Permits elevation and depression, abduction and adduction and
downward (medial) and upward
( lateral) rotations and scapular tilt

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 Glenohumeral
 Between the rounded head of humerus and the shallow pear
shape glenoid cavity of the scapula
 Deepened by glenoid labrum
 Synovial, ball and socket joint
 Supported by glenohumeral ligament anteriorly, coracohumeral
ligament above
 Nerve supply : Axillary and suprascapular
 Wide rage of movement ( flexion , ext. add, abd, lateral and
medial rotation, circumduction )

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 Glenohumeral

Supporting structure
 Labrum
 Capsule
 Three glenohumeral ligaments
 Coracohumeral ligament
 Surrounding structures (muscles)

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 Elbow Joint

 Trochlea and capitellum of humerus and

trochlea notch of ulna and head of radius
 Synovial, hinge joint
 Lateral ligament , medial ligament ( medial,
posterior and transverse bands)
 Nerve supply Median, ulnar,
musculocutaneous and radial nerves
 Flexion and extension movement

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 Elbow Joint

Carrying angle
 long axis of extended forearm with the long
axis of the arm
( disappears when flexed)

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 Superior Radioulnar Joint
 articulation between head of radius and the annular ligament
and the radial notch of the ulna
 Synovial, pivot joint
 Pronation and supination
 Annular ligament – anterior and posterior margins of the radial
notch and forms a collar around radial head
 Small quadrate ligament bet neck of radius and below radial
notch
 Nerve supply : median, ulnar, musculocutaneous and radial

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 Inferior Radioulnar Joint

 Rounded head of ulna and the ulnar notch of the

radius
 Synovial , pivot joint
 weak anterior and posterior ligaments
 Nerve supply : anterior and posterior interosseous
nerves
 Supination and pronation
 Ulna moving laterally

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 Wrist Joint
 Radiocarpal joint
 Lower end of radius and the scaphoid, lunate and triquetral
bones
 Synovial , ellipsoidal or condyloid
 Anterior and posterior ligaments and medial and lateral
ligaments
 Nerve Supply : Anterior and posterior interosseous and the
deep branch of ulnar nerves
 Flexion, extension, abduction, adduction and circumduction

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 Intercarpal Joint

 between the proximal and distal raw of carpal bones

, and between the individual bones of the proximal
and distal carpus
 Synovial , plane joint
 Anterior, posterior and interroseous ligaments
 Nerve supply : Anterior and posterior interosseous
and the deep branch of ulnar nerves
 Gliding movement

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 Hands and Fingers

 Carpometacarpal joint of the thumb

 Metacarpal joints
 Interphalangeal joints

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 Carpometacarpal joint of the thumb

 Between trapezium and the 1st metacarpal

 Synovial, saddle joint
 Flexion, extension, abduction, adduction and
certain amount of rotation (opposition)

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 Metacarpophalangeal joints

 Between heads of metacarpal and the bases of

proximal phalanges ( D2-D5)
 Synovial , ellipsoidal (condyloid)
 Flexion, extension, abduction and adduction
 Palmar ligaments, deep transverse carpal ligament ,
collateral ligaments (taut in flexion)

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 Interphalangeal joints

 Between phalanges
 Synovial hinge joints
 Flexion and extension
 Just like metacarpophalangeal joint structure

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 Thank you

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