Section 3 Joints of upper limb

1. 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:

2. coracoacromial ligament acromion coranoid process • 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

3. 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

4. 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

5. ★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

6. 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

7. Dislocation

8. 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

9. 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

10. 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

11. Section 4 Joints of Lower limb Joints of pelvic girdle Sacroiliac joint • Bones: auricular surface of sacrum and ilium • Capsule: very tight and strengthened by ligaments

12. ★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 greaterandlesser sciatic foramina

13. Sacrospinous ligament Greater sciatic foramen Sacrotuberous ligament Lesser sciatic foramen

14. Pubic symphysis Articulation: symphysial surface and interpubic disc (fibrocartilage) Ligaments: superior pubic ligament and arcuate pubic ligament Obturator membrane Obturator canal

15. Obturator canal Obturator membrane

16. 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

17. 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

18. Main difference between male and femal pelvis

19. Main difference between male and femal pelvis Male Female Pelvic inlet Pelvic outet Pelvic cavity Pubic arch 90~1000 70~750

20. Main difference between male and femal pelvis

21. 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

22. Acetabulum labrum Ligament of head of femur Transverse acetebular lig. • 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

23. Pubofemoral lig. Iliofemoral lig. Ischiofemoral lig. Zona orbicularis

24. ★ Knee joint • Bones: lower end of femur, upper end of tibia and patella • Articular capsule: superapatellar bursa, deep infrapatellar bursa, ala folds

25. Fibular collateral lig. Patellar lig. Tibial collateral lig. • Accessory structures • Extra-ligaments • Patellar lig. • Fibular collateral lig. • Tibial collateral lig. • Oblique popliteal ligament

26. - Intra-ligaments • Anterior cruciate ligament • Posterior cruciateligament

27. Medial meniscus(C-shaped) • lateral meniscus(O-shaped) • Movements: flexion and extension; flexed knee joint may be passively rotated Medial lateral

28. Tibiofibular syndesmosis • Tibiofibular joint • Crural interosseous membrane • Anterior and posterior tibiofibular ligaments

29. Joint of foot Talocrural 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

30. 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)

31. Intertarsal joints • Tarsometatarsal joints • Intermetatarsal joints • Metatarsophalangeal joints • Interphalangeal joints

32. 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

33. Lateral longitudinal arch: formed by calcaneus, cuboid, fourth and fifth metatarsals; cuboid is the keystone of this arch

34. 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

35. Normal arch Flatfoot

36. Section 5 Joints of skull • Continuous joints: sutures, synchondrosis or synosteosis

37. 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)