wrist joint

Articulation: between the distal end of the radius and

articulation disc above and the scaphoid, lunate and
triquetral bones below.
Type: synovial ellipsoid joint.
Capsule: the capsule encloses the joint and it is attached
above to the distal ends of the radius and ulna and below
to the proximal row of carpal bones.
Ligaments: anterior and posterior ligaments strengthen
capsules.
Medial ligament is attached to the styloid process of ulna
and to triquetral bone.
Lateral ligaments are attached to the styloid process of
radius and scaphoid bone.
Synovial membrane: this lines the capsule and it is
attached to the margins of the articular surfaces. The joint
cavity does not communicate with the distal radio ulnar
joint and with intercarpal joints.
Nerve supply: anterior interosseous nerve and deep
branch of radial nerve.
Movements: flexion: performed by flexorcarpi radialis,
flexor carpi ulnaris, palmaris longus
Extension: extensor carpi radialis longus, extensor carpi
radialis brevis, extensor carpi ulnaris, extensor pollicis
longus.
Abduction: flexor carpi radialis, extensor carpi radialis
longus, and brevis.
Adduction: flexor and extensor carpi ulnaris.
Important relations: anteriorly: tendons of flexor group
muscles. and median and ulnar nerve
Posteriorly; tendons of the extensor group muscles
Medial: posterior cutaneous branch of ulnar nerve
Laterally radial artery
Applied anatomy
Wrist injuries: because of the styloid process of radius is
longer than the ulna. abduction of the wrist joint is less
extensive than adduction.
Colle’s fracture: fall on out stretched hand causes this
injury.
Depending on the force of fall and age of the person, fall
on out stretched hand in person causes strains at different
level, from scaphoid to radius to interosseous membrane
to Humerus. to glenoid fossa of scapula to coracoclavicular
ligament to clavicle and finally to sternum. example in
teenager’s clavicle fracture and in elderly persons colle’s
fracture i.e distal end of the radius fracture, dinner fork
deformity….
Ankle joint
consists of deep socket formed by the lower end of the
tibia and fibula, into which is fitted the upper part of the
body of the talus.
Articulation: between the lower end of the tibia, two
malleoli and the body of the talus. the inferior transverse
tibiofibular ligament which runs between the lateral
malleolus and the posterior border of the lower end of the
tibia, deepens the socket into which the body of the talus
fits snugly. The articular surfaces covered with hyaline
cartilage.
Type
Synovial hinge variety joint
Capsule: the capsule encloses the joint and is attached to
the bones near their articular margins.
Ligaments: medial/deltoid ligaments attached to the tip of
the medial malleolus and deep fibres to the non-articular
area of medial surface fits body of the talus.
Lateral ligament: weaker than the medial ligament and
consists of three bands
Anterior talofibular ligament: lateral malleolus to lateral
surface of the talus
Calcaneofibular ligament: tip of the lateral malleolus to the
lateral surface of the calcaneum
Posterior talofibular ligament: runs from the lateral
malleolus to the posterior tubercle of the talus.
Synovial membrane: it lines the capsule. nerve supply
deep peroneal and tibial nerves.
Movements: dorsi flexion by; tibialis anterior,extensor
halusis longus, extensor digitorum longus, peroneus
tertius,
Planter flexion by gastronimius, soleus, plantaris, peroneus
longus and peroneus brevis…
Note: inversion and eversion of the foot is not done by
ankle joint.
Important relations: anteriorly; tibialis anterior, extensor
halucis longus, antrior tibialis vessels and deep peroneal
nerve
Posteriorly: tendocalcaneus, and plantaris
Posterolaterally: the peroneus longus and brevis
Posteromedially: tibialis posterior, posterior tibial vessels,
tibial nerve,
Applied anatomy: ankle joint stability: deep socket formed
by the lower end of the tibia. medial and lateral malleolus
securely hold the talus in position.
Acute sprains of lateral ankle and medial ankle: excessive
inversion of foot with plantar flexion of the ankle, the
anterior talofibular and calcanofibular ligaments torn
causes localised swelling and pain. and excessive eversion
of foot causes torn and pulling of tip of the medial
malleolus by deltoid ligaments causes sprain….
Fracture and dislocation of ankle joint: caused by the fall
on outstretched hand.
Hip joint
Articulations: between hemispherical; head of the femur
and cup shaped depression of the acetabulum of the hip
joint.
Articular surface of the acetabulum is horseshoe shaped
and cavity is deepened by fibrocartilagenous rim called
acetabular labrum.
Articular surface is covered by hyaline cartilage
Type: synovial ball socket joint, multiaxial and diarthrosis.
Capsule: enclose the joint. Attached to the acetabular
labarum. medially and laterally it is attached to the
intertrochanteric line of the femur in front and posterior
aspect of the neck of the bone behind.
Ligaments: iliofemoral ligament: strong and inverted y
shaped, base is attached to the anterior inferior iliac spine
above and below to the upper and lower part of
intertrochanteric line, it prevents over extension during
standing position.
Pubofemoral ligament: is triangular base is attached to the
superior ramus of the pubis. and apex to the lower part of
the intertrochanteric line.it limits extension and abduction.
Ischiofemoral ligament:is spiral shaped and attached to
the body of the ischium and greater trochanter. limits
extension.
Transverse acetabular ligament: bridges the acetabular
notch.
Ligament of the head of the femur/ligamentum fovea: flat
and triangular attached to the head of the femur. lies
within joint and covered by synovial membrane.
Synovial membrane: line the capsule and attached to the
margins of the acetabular surfaces.it encloses the part of
the neck of the femur that lies within the joint capsule.
and ligament of the head of the femur, fat pad of the
acetabular fossa…
Nerve supply
Femoral, obturator and sciatic nerve supply
Movements: Has wide range of movement
Flexion: iliopsosas,rectus femoris,and sartorius
Extension: gluteus maximus and hamstring muscles
Abduction: gluteus medius ,minimus,Sartorius
Adduction: adductor longus,brevis,magnus.
lateral rotation: piriformis, obturator internus and
externus.
medial rotation: gluteus medius and minimus
extensor group muscles are more powerful than flexor
group and lateral rotators more powerful than media
rotators.
Important relations: anteriorly: iloio posoas. Pectineus
and rectus femoris
Poateriorly: quadratus femoris
Superierly; piriformis and gluteus minimus
Inferiorly: obturator externus tendons.
Applied anatomy
Referred pain in hip joint: femoral nerve not only supplies
hip joint also supplies to the medial and front part of the
thigh so hip joint diseases also causes pain medial and
front part of the thigh,
traumatic dislocation of the hip joint: usually causes in
motor vehicle accidents when joint is flexed and
adducted…
congenital dislocation of hip joint; when upper lip of the
acetabulum fails to develop adequately, the head of the
femur not having stable platform so dislocation occurs
easily….
Arthritis of hip joint; pain, stiffness, and deformity. and
causes reffered pain in knee joint.
Knee joint
It is the largest and most complicated joint in the body.
It consists of two condylar joints between between medial
and lateral condyles of the femur and corresponding
condyles of the tibia, and gliding joint between the patella
and patellar surface of the femur.
Note fibula is directly involved in the joint.
Articulation: above the rounded condyles of femur below
are the condyles of the tibia and their menisci and front
the articulation between the lower end of the femur and
patella.
The articular surfaces of the all the three bone are covered
with the hyaline cartilage.
Type: joint between the tibia and the femur is synovial
variety of hinge joint, and the joint between the femur and
patella is synovial verity of plane gliding joint.
Capsule: capsule is attached to the margins of the articular
surface sand also sides and back of the joint is covered by
capsule.
But in front capsule is absent but that is replaced by the
supra patellar bursa.
Ligaments: divides into extra capsular and intracapsular
Extra capsular: ligament patella: stretched between lower
border of the patella and tuberosity of the tibia.
Lateral collateral ligament: attached to lateral condyle of
femur above and head of the fibula below.
Medial collateral ligament: attached between medial
condyle of the femur and medial surface of the shaft of the
tibia. It is firmly attaches to the edge of the medial
meniscus.
Oblique popliteal ligament: it is tendinous expansion
derived from semi membranous muscle, strengthens the
posterior aspect of the joint.
Intra capsular ligaments: cruciate ligament: two strong
intracapsular ligaments cross each other within the joint
cavity. named anterior and posterior according to their
tibial attachments. these are the main bond between the
femur and tibia throughout the joint.
Anterior cruciate ligament: attached to anterior
intercondylar area and to the medial surface of the lateral
condyle of femur.it prevents the posterior displacement of
the femur over tibia, when joint is flexed.
Posterior cruciate ligament: attached to the posterior
intercondylar area and to the lateral surface of the medial
condyle of the femur, it prevents the anterior
displacement the of the femur on the tibia when the knee
joint is flexed.
Menisci (5 marks): these are the c shaped fibrocrtilagelous
structure,
Peripheral borders are thick and attached to the capsule
and inner border is thin and concave. and forms the free
edge.
The upper surfaces are in contact with the femoral
condyles and lower surfaces are in contact with the tibial
condyles.
Functions: these are acts as cushion between the condylar
surfaces and acts as shock absorbers.
Deepens the particular area of the tibial condyles to
receive the convex condyles of the femur.
Gives strength to the joint.
Synovial membrane: it lines the capsule and attached to
the margins of the articular surface s.
In the front it forms suprapatellar bursa and in the back
forms the popliteal bursa.
Anterior bursae of knee joint: supra patellar,pre pattelar,
superficial and deep infra patellar buesae
Posterior bursae: popliteal and semi membranous bursa
Nerve supply: femoral, obturator and common peroneal
nerve and tibial nerve
Movements: flexion is by hamstring muscles, extension is
by quadriceps femoris, medial rotation by graciis,
Sartorius, semi tendinosus and lateral rotation by biceps
femoris.
Important relations: anteriorly; pre patellar bursa
Posteriorly: popliteal vessels and tibial and common
peroneal vessels.
Medialy: Sartorius, garcilis, semitendinosus,
Laterally: biceps femoris and common peroneal nerve.
Applied anatomy: arthroscopy: introduction of lighted
instrument into the synovial cavity of the knee joint
through small incision.to visualise the structures of the
joint for diagnostic purpose.
Haem arthrosis of knee joint: injury to the cruciate
ligaments always accompanies the damage to the other
structures of the knee joint the collateral ligaments are
commonly torn and capsule may be damaged so that the
joint cavity is quickly filled with the blood.
ACL and PCL tear: forced abduction of the tibia on the
femur and forced adduction of the tibia on femur can
cause ACL and PCL tear respectively. sprains and tears
occurs depending on the degree of force applied.
Shoulder joint
Articulation: between the rounded head of the Humerus
and the shallow pear shaped glenoid cavity of the scapula.
The articular surfaces are covered by the hyaline cartilage
and the glenoid cavity deepened by the presence of
fibrocrtilagelous rim called the glenoid labrum.
Type: synovial ball and socket joint, multiaxial, diarthrosis.
Capsule: this surrounds the joint medially to the margins
of the glenoid cavity.
Laterally: anatomical neck of the Humerus.
This capsule is thin and lax, allowing the wide range of the
movements.
Joint is strengthening by the fibrous slips from the tendons
of the subscapularis, supraspinatus and infraspinatus teres
minor (rotator cuff muscles)
Ligaments: gleno humeral ligaments: strengthens the front
of the capsule.
Transverse ligament: strengthens the capsule and bridges
the gap between two tuberosities.
Coracohumeral; strengthen the capsule above and
stretches between root of the coracoid process to greater
tuberosity of the Humerus.
Accessory ligament: coraco acromial ligament extends
between the corocoid process and acromion protects the
join from superiorly.
Synovial membrane: thin lines the capsule and is attached
to the margins of the cartilage covering the articular
surfaces.
Nerve supply: axillary and suprascapular nerve
Movements: flexion: normal flexion by deltoid, pectoralis
major. Biceps, coracobrachialis.
Extension: deltoid, latissimus dorsi and teres major.
Abduction: middle fibers of deltoid. supraspinatus.
Adduction: pectoralis major, latissimus dorsi, teres major,
teres minor.
Lateral rotation: infraspinatus, teres minor, deltoid muscle.
Medial rotation: subscapularis, latissimus dorsi, anterior
fibers of deltoid.
Important relations: anteriorly: subscapularis, axillary
nerve, brachial flexus.
Posteriorly: infraspinatus, teres minor,
Superiorly: supraspinatus, subacromial bursa
coracoacromial ligament, deltoid muscle.
Inferiorly:Triceps long head, auxillary nerve, posterior
circumplex humeral vessels.
Applied anatomy: stability of shoulder joint: shallowing of
glenoid fossa
Tone of muscle subscapularis in front
Supraspinatus above
Infraspinatus and teres minor behind
Least supported part is inferior part of joint.
Dislocation of shoulder joint: antero inferior dislocation:
sudden violence applied to the Humerus with the joint
fully abducted with the Humerus head downwards onto
the inferior weak part of the capsule which tears and
humeral head comes to lie inferior to the glenoid fossa.
Shoulder pain: the synovial membrane, capsule, ligaments
of the shoulder joints are supplied by the suprascapular
nerve, the joint is sensitive to pain, pressure, excessive
traction and distension.
It is important to note that shoulder pain can caused by
the diseases elsewhere example diseases of the spinal cord
and vertebral column can cause pain in shoulder pain and
also irritation of diaphragmatic pleura can cause shoulder
joint pain because both are supplied by the common nerve
that is phrenic nerve and subscapular nerve.
Rotator cuff tendinitis: tearing of tendons of rotator cuff
due to overusage
Elbow joint
Articulation: occurs between the trochlea and capitulum
of the Humerus and trochlear notch of the ulna and head
of the radius.
The articular surfaces covered by the hyaline cartilage.
Type: synovial hinge joint.
Capsule: anteriorly: attached above to the Humerus along
the upper margin of coronoid and radius fossa and front of
the medial and lateral epicondyles and below to the
margin of the coronoid process of the ulna and to the
annular ligament, which surrounds the head of the radius.
Posteriorly attached above to margins of olecranon fossa
of the Humerus and the sides of the olecranon process of
ulna and to the annular ligament.
Ligaments: lateral ligament: triangular attached by its apex
to the lateral epicondyle of the Humerus and base to the
upper margins of the annular ligament
Medial ligament: triangular and consists of three bands,
Anterior band medial epicondyle to medial margin of the
coronoid process
Posterior band: medial epicondyle to the medial side of
the olecranon
Transverse band: bilateral ulnar attachment of the
preceding bands.
Synovial membrane: lines the capsule and covers the fat
pads in three floor of the coronoid, radial, and olecranon
fossae and continuous below with the synovial membrane
of proximal radio ulnar joint.
Nerve supply: branches of medial, ulnar and radial nerve.
Movements: flexion: brachialis, biceps brachii,
Brachioradialis, pronator teres
Extension: triceps and anconeus
Important relations: brachialis, tendon of biceps, median
nerve, brachial artery
Posteriorly: triceps
Medially; ulnar nerve passes behind the medial epicondyle
Laterally: common extensor tendon, supinator
Applied anatomy: stability of the elbow joint by the
wrench shaped articular surface of the olecranon and the
pulley shaped trochlea of the Humerus and it is string by
the media and lateral collateral ligaments.
Dislocation of the elbow: posterior dislocation of the joint
is common whenever falls on outstretched hand occurs in
children because those parts which stabilises the joint are
incompletely developed.
Tennis elbow: tennis elbow is caused by the partial tearing
or degeneration of the origin of superficial extensor
muscles from the lateral epicondyle of the Humerus.
Characterised by the pain tenderness over the lateral
epicondyle of the Humerus, with pain radiating to the
lateral side of the forearm.
It is common in tennis players, violinists and house wives.
Temporomandibular joint
Articulation: between the articular tubercle and the
anterior portion of the mandibular fossa of the temporal
bone above the head of the mandible below. the articular
surfaces are covered by the fibrocartilage.
Type: synovial
Capsule: capsule surrounds the joint and it is attached to
above to the articular tubercle and the margins of the
mandibular fossa and below the neck of the mandible.
Ligaments: lateral temporomandibular ligament:
strengthens the lateral aspect of the capsule and limits the
movement of the mandible in a posterior direction and
thus protects the external auditory meatus.
Spenomandibular ligament:lies on medial aspect of the
joint, attached above the spine of the spenoid bone and
below to the lingual of the mandibular foramen,
.stylomandibular ligament: lies behind and medial to the
joint attached between styloid process and angle of the
mandible.
The articular disc divides the joint into upper and lower
cavities. It is an oval plate of fibro cartilage that is attached
to the capsule.
Synovial membrane: this lines the capsule in the upper
and lower cavities of the joint.
Nerve supply: auriculotemporal and branch of the
mandibular nerve.
Movements: mandible can be depressed, elevated,
protruded, retracted and lateral chewing movements.
Depression of the mandible by the digastric, geniohyoid
and mylohyiods play an important role in pulling the
mandible forward.
Elevation of the mandible: contraction of temporalis and
masseter.
Protrusion of the mandible: in protrusion the lower teeth
are drawn forward over the upper teeth caused by lateral
and medial ptyrygoid muscles. here the articular disc
pulled forward onto the anterior tubercle.
Retraction of the mandible: here articular disc and the
head of the mandible are pulled backward into
The mandibular fossa. Caused by the temporalis muscle.
Lateral chewing movements: alternatevely protruding and
retracting the mandible on each side.
Important relations of the temporomandibular joint:
Mandibular nerve and masseteric nerve and artery.
Posteriorly: tympanic plate of external auditory meatus,
parotid gland
Laterally: parotid gland, fascia and skin
Medially: maxillary artery, vein and auriculo temporal
nerve.
Applied anatomy.
Temporomandibular joint lies immediately in front of the
external auditory meatus. the great strength of the lateral
temporomandibular ligament prevents the the head of the
mandible passing backwards and fracturing the tympanic
plate when severe blow falls on chin.
Dislocation of the temporomandibular joint occurs when
the mandible in depressed position, in this position joint is
unstable and a minor blow on the chin or a sudden
contraction of the lateral pterygoid muscles, during
yawning. in this cases mouth is fixed in an open position.
treatment reduction of the head of the mandible.
JOINTS
A joint, also called an articulation, is any place where
adjacent bones or bone and cartilage come together
(articulate with each other) to form a connection
Function of Joints
•1. Serve as functional junctions between bones.
•2. Bind bones, strokes , and other related tissues
together.
•3. Allow bone growth to occur .
•4. Permit certain structures to change shape during
childbirth (i.e. pubic symphysis).
•5. Enable the body to have movements, lever actions, and
body posture.
Classification of Joints
•1. According to the type of tissue at the joint:
•a) Fibrous joint --uses fibrous connective tissue to
articulate bones.
•b) Cartilaginous joint--uses hyaline cartilage and/or fibro-
cartilage to articulate bones.
•c) Synovial joint --uses auricular cartilage, synovial
membrane, joint capsule, and ligaments to articulate
bones.
•2. According to the amount of movement at the joint:
a) Synarthrotic joint--immovable joint.
b) Amphiarthrotic joint--immovable joint.
c) Diarthrotic joint--freely movable jointFibrous Joints
•a) Occur between bones that have close case contact (
e.g. cranial bones, tibia and fibula, ulna and radius).
•b) Fibrous connective tissue fastens the bones tightly.
•c) Small amount of movement (amphiarthrosis) or no
movements at all is possible (synarthrosis).
•d) Subdivided into:
•--Syndesmosis=uses interosseous ligaments;
amphiarthrotic (e.g. distal end of tibia and fibula).
•--Suture=uses sutural ligaments; synarthrotic (e.g. cranial
sutures in the skull).
•--Gomphosis=uses periodontal ligaments; synarthrotic
(e.g. joining teeth to maxilla and mandible).

Cartilaginous joints
•a) Hyaline cartilage and/or fibro cartilage form the joint.
•b) Usually slightly movable (amphiarthrotic) and very
strong.
•c) Subdivided into:
•--Synchondrosis=uses hyaline cartilage, synarthrotic(e.g.
between the first rib and manubrium).
•--Symphysis=uses hyaline cartilage at the ends of bones,
and a layer of fibrocartilageat the center;
amphiarthrotic(e.g. intervertebraldisk, pubic symphysis).

Synovial Joints
•a) Most joints are synovial joints.
•b) Usually freely movable (diarthrotic).
•c) Contain articular cartilage (at the ends of bones), joint
capsule (fibrous connective tissue surrounding the joint),
and synovial membrane (inner lining of the joint capsule).
•d) Subdivided into:
•--gliding= allows back and forth movement (e.g. carpals
sliding onto one another during wrist movements).
•--hinge= allows folding movement (e.g. elbow joint).
•--pivot= allows rotation around an axis (e.g. between
atlas and axis at the odontoid process).
•--condyloid = allows all
movements except rotation
(e.g. between metacarpals
amid proximal phalanges).
•--saddle= allows all
movements except rotation
(e.g. between carpals and
metacarpals).
•--ball -and -socket = allows
all movements (e.g. shoulder
joint and hip joint).