Joints of upper limb

I. Joints of shoulder girdle:

1. The acromioclavicular joint
2. The sternoclavicular joint

II. Joints of free upper limb:

1. The glenohumeral joint (shoulder joint)
2. Elbow Joint
3. Joints between ulna and radius
4. Joints of hand (wrist joint complex)
I. Joints of shoulder girdle:
1. Sternoclavicular joints
– a synovial saddle joint composed of two portions（the
sternal end of the clavicle and the manubrium ）separated
by an articular disc.
– allows movement of the clavicle, predominantly in the
anteroposterior & vertical planes, although some rotation
also occurs.
3. Acromioclavicular joints （ AC joint）
– the junction between the acromion and the clavicle.
– allows the ability to raise the arm above the head.
– a gliding synovial joint.
II. Joints of free upper limb:
1. Glenohumeral joint (shoulder Joint )
• synovial ball and socket joint
• involves articulation between the
glenoid fossa of the scapula and the
head of the humerus .
• Permits a wide range of movement
• shallowness and looseness
• deepened by glenoid labrum
• much easier to dislocate than most
other joints in the body.
(1) Stabilizers of the Glenohumoral joint
The glenohumeral joint is stabilized by
ligaments, tendons, cartilage and muscles
CHL
1) ligaments :
Tr
①Glenohumeral ligaments
THL
(SGHL, MGHL, IGHL)
②Coracohumeral ligament
(CHL)
③Transverse humeral ligament
(Tr, a broad band passing from
the lesser to the greater
tubercle of the humerus)
Stabilizers of the Glenohumoral joint
2) Tendon:
• biceps tendon (long
and short heads)
THL
3) Glenoid labrum

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• Stabilizers of the Glenohumoral joint

4) Muscles (rotator cuff)

– The rotator cuff is the group of

muscles and their tendons that
act to stabilize the shoulder joint.

– Four muscles of the rotator cuff：

• Supraspinatus

• Infraspinatus

• teres minor

• subscapularis
• Stabilizers of the Glenohumoral joint

• One main purpose of the

rotator cuff muscles is pull the
humerus into the scapula
such that the two bones are
fitted tightly against one
another.
• Stabilizers of the Glenohumoral joint

• The four muscles of the

rotator cuff, along with the
teres major and the deltoid,
make up the six
scapulohumeral muscles of
the human body
Tendons of Rotator Cuff Muscles

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5) Ligaments above the shoulder joint
① Coracoclavicular ligament(CCL)
② Coracoacromial ligaments (CAL)

CCL
CAL
(2) Dislocated shoulder
• Occurs when the humerus separates from the scapula
at the glenohumeral joint.
• The shoulder joint has the greatest range of motion of
any joint in the body and as a result is particularly
susceptible to dislocation.
• Approximately half of major joint dislocations are of the
shoulder.
• Partial dislocation of the shoulder is referred to as
subluxation (半脱拉).
1) Types of shoulder dislocation

①anterior dislocation of the shoulder

( forward, 95%)
– sub-coracoid
– Sub-glenoid
– subclavicular
②posterior dislocation of the shoulder ( backward, 4%)
– electrocution
– Seizure
Types of shoulder dislocation
3) Inferior dislocation of the shoulder(downward, < 1%)
– Called as subluxation (半脱拉)
2. Elbow Joint
• is formed by the humerus ,
radius and ulna.
• Including ①humeroulnar
joint ,②humeroradial joint
③proximal radioulnar joints.

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2. The Elbow Joint
(1) Features of structure:
• Three joints were covered by one
joint capsule
• The joint capsule is thin and loose
anteriorly and posteriorly
• The joint capsule is thick and strong
on either side strengthened by
collateral ligment (ulnar lig. and
radial lig.)
• The arm forms an obtuse angle (the
carrying angle, 5 to 15 °) with the
forearm.
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(2) Obtuse angle (carrying angle, 5 to 15 °)
• The angle formed by the axes of the
arm and the axes of forearm when
the elbow is fully extended and
forearm is supinated.
• This angle allows your forearms to
clear your hips when you swing your
arms, such as during walking. It is
also important when carrying
objects.
• Certain fractures of the elbow can
• If the angle is decreased
increase the carrying angle of the
so that the arm points
elbow, causing the arms to stick out
toward the body, it is
too much from the body. This is
called a “gunstock
called an excessive carrying angle.
deformity(枪托畸形）."
(3) The movement
• the simple hinge-joint

• flexion and extension

• Proximal radioulnar joint is a pivot , which allows for

movements of rotation （pronation and supination).
(4) Ligments of the elbow Joint
1) Ulnar Collateral Ligament(UCL)
2) Radial Collateral Ligament
3) Annular Ligament: stabilizes and
encircles the head of the radius
(5) Elbow dislocate
3. Joints between ulna and radius
(1) proximal radioulnar joint
(pivot-joint )
– between the head of the
radius and the radial notch
of the ulna and the annular
ligament.
(2) distal radioulnar joint (pivot-
joint )
– between the head of the
ulna and the ulnar notch of
the distal radius.
(3) interosseous membrane of
forearm.
4. Joints of hand (wrist joint complex)

• formed between the distal

ends of the radius and ulna
and the carpal bones.

• Includes:

(1) Wrist joint

(2) Joints between carpus

(3) Joints between digits

(1) The wrist joint (radiocarpal joint)
– the joint between distal end of
the radius, triangular articular
disc and the proximal row of
carpus (scaphoid, lunate,
triquetral).

– It is a ellipsoid synovial joint .

(2) Joints between carpus
– intercarpal joints
– carpometacarpal (CMC)
joints
– intermetacarpal joints
(3) Joints between digits
– Metacarpophalangeal joints
(Ellipsoid Joint)
– Interphalangeal joints
(Hinge Joint)
 Joints of lower limbs
I. Joints of pelvic girdle
1. Sacroiliac joints
2. Pubic symphysis

II. Joints of free lower limbs

1. The hip joint
2. Knee joint
3. Tibiofibular joints
4. Joints of foot
I. Joints of pelvic girdle
1. Sacroiliac joints
– Is formed between the
auricular surfaces of the
sacrum and the two hip
bones.
– It is amphiarthroses,
enclosed by very taut joint
capsules.
– strengthened by the
anterior, and posterior
sacroiliac ligaments and
iliolumber lig.
2. The pubic symphysis
– is the midline cartilaginous joint uniting the left
and right pubic bones.
3. Ligaments of pelvic
1) The sacrotuberous
ligament
– runs from the sacrum to
the tuberosity of the
ischium.
2)The sacrospinous ligament
– Between the ischial
spine of the sacrum and
coccyx.
3) The obturator membrane • The greater and lesser sciatic foramen
– is a thin fibrous sheet, – Formed by the sacrotuberous and
which almost sacrospinous ligaments, and
completely closes the greater and lesser sciatic notches.
obturator foramen.
II. Joints of free lower limbs
1. The hip joint
– formed by the femoral head and
acetabulum
– is a ball and socket joint
– the acetabulum is deepened by
acetabular labrum.
– The joint capsule is tight ,thick and
strong
– support the weight of the dynamic in
both static and dynamic postures.
– The range of movement is wide but
limited
(1) Strengthened ligaments of the hip joint:
1) intracapsule ligment
①the round ligament of the femur - connect the head of the
femur to the acetabulum.
② transverse acetabular ligament - crosses the acetabular
notch, which is in reality a portion of the acetabular labrum.
(1) Strengthened ligaments of the hip
joint:

2) extracapsular ligaments：

• pubofemoral

• Iliofemoral

• ischiofemoral
 2. Knee joint
• the largest and most complicated
joint in the human body.
• consists of two articulations:
(1) tibiofemoral joint (gliding)
• between the femur and tibia
(2) patellofemoral joint (gliding)
• between the femur and
patella.
• Flexion and extension
Knee Joint – Sagittal Section

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 Knee Joint
• The joint capsule anteriorly consists of patella and
extensions of quadriceps femoris tendon

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• Capsule strengthened by extracapsular and intracapsular ligaments
1) Extracapsular ligaments:
– patellar ligament
– medial (tibial) collateral ligament
(MCL )
– lateral (fibular) collateral ligament
(LCL ）
– oblique popliteal ligament

oblique popliteal ligament

Extracapsular ligaments of Knee
2) Intracapsular ligaments :
• The knee is stabilized by a pair of cruciate ligaments.
①Anterior cruciate ligament (ACL)
– from the lateral condyle of femur to the anterior
intercondyloid area of the tibia.
– prevents the tibia from being pushed too far anterior and
medial rotation of the tibia in relation to the femur.
– often torn during twisting or bending of the knee.
2) Intracapsular ligaments :
2) Intracapsular ligaments :

②Posterior cruciate ligament (PCL)

– from medial condyle of femur to
the posterior intercondylar area of
tibia.
– prevents the tibia from being
pushed too far posterior relative
to the femur.
– Common causes of injuries are direct blows to the flexed
knee, such as the knee hitting the dashboard in a car accident
or falling hard on the knee, both instances displacing the tibia
posterior to the femur
2) Intracapsular ligaments :
③Transverse ligament

– connects the anterior

convex margin of the
lateral meniscus to the
anterior end of the medial
meniscus.

– Protection of menisci when

knee flexion and
extension.
3) cartilage of the Knee Joint
①hyaline cartilage covers the surface along which the joints
move.
②fibrous cartilage (the
meniscus) has tensile
strength and can resist
pressure.
– the medial meniscus （bigger ,
C-shaped)
– the lateral meniscus (smaller,
O-shaped)
– protect the ends of the bones
from rubbing
– may be cracked, or torn,
– deepen the tibial sockets into
when the knee is forcefully
which the femur attaches.
rotated and/or bent.
– play a role in shock absorption.
Knee (meniscus)
 4) Knee dislocation
– an unusual and extremely
serious injury.

– A knee dislocation occurs when

the femur and tibia lose contact
between each other.

– occur with automobile

accidents, severe falls and
sports injuries.
3. Tibiofibular joints

(1) The superior (proximal)

tibiofibular joint
• between the lateral condyle of
the tibia and the head of the
fibula.
(2) The inferior (distal) tibiofibular
joint is formed by the medial side of
the lower end of the fibula, and a
rough concave surface on the
lateral side of the tibia.
(3) Interosseous membrane (tibiofibular syndesmosis)
• between the tibia and the fibula.
 4. Joints of foot

(1) The ankle joint (or talocrural

joint )
– is formed by the distal ends of
the tibia and fibula with the
proximal end of the talus bone.
where the foot and the leg meet

– Strengthened the medial and

lateral deltoid ligaments
(2) The intertarsal joints
– the articulations found
between the tarsal bones.
– include joints:
① Talocalcaneal (subtalar
joint)
② Talocalcaneonavicular
③ Calcaneocuboid
④ Cubonavicular
⑤ Cuneonavicular
⑥ Cuneocuboid
⑦ Intercuneiform
(2) The intertarsal joints
– the articulations found
between the tarsal bones.
– include joints:
– ⑧The transverse tarsal joint
is formed by the articulation
of the calcaneus with the
cuboid (the calcaneocuboid
joint), and the articulation of
the talus with the navicular
(the talocalcaneonavicular
joint).
(3) The tarsometatarsal joints (or Lisfrance’s joint)
(4) The intermetatarsal joints
(5) The metatarsophalangeal joints
(6) The interphalangeal joints of foot
Ankle dislocation

• The ankle dislocates as a result of

a fall, motor-vehicle crash, or
sporting injury.
• In addition to the bony injury,
there can be damage to blood
vessels, nerves, and skin.
III. Disorders of Joints
1. Injury
（1） Sprain (扭伤)- stretching or tearing of a ligament
（2) Dislocation (脱位)
2. Inflammatory Conditions
1) Bursitis
- inflammation of a bursa
– Bursae are sacs of fluid that
serve to protect boney
prominences.
2. Inflammatory Conditions
2) Tendinitis (肌腱炎）
- inflammation of a tendon sheath
3) Osteoarthritis （骨关节炎）
- most common type of arthritis
- degenerative condition of the
articular cartilage
- Enzymes wear down the cartilage
matrix due to “wear and tear”
- Symptoms may include joint pain,
tenderness, stiffness, locking, and
sometimes an effusion.
4) Rheumatoid Arthritis （ Rheumatoid Arthritis）
- a chronic, systemic inflammatory disorder that may
affect many tissues and organs
- principally attacks synovial joints.
- autoimmune in origin
- lead to the destruction of articular cartilage and
ankylosis (僵硬) of the joints.