Postcranial Skeleton - Upper Appendage - Humerus

Vertebrae  |  Ribs  |  Scapula  |  Upper Appendage  |  Pelvis  |  Lower Appendage

Humerus  |  Radius  |  Ulna  |  Carpals
The shoulder joint (articulatio humeri or
glenohumeral joint)
 is a multiaxial ball (head of humerus) and socket (glenoid
cavity on scapula) joint (Clemente 79; Grant p. 518; Netter 3e
403-405, 4e 421-422).
 The glenoid labrum (fibrocartilage) runs around the rim of the
cavity (Clemente 80; Grant p. 535; Netter 3e 406, 4e 423)
 Flexes, extends, adducts and abducts (circumducts)
  Medially and laterally rotates

The capsule of the joint (Clemente 80-82; Grant p. 532, 536; Netter 3e 406,
4e 423)

 is very loose: if C5 and 6 are lesioned, then the head of the

humerus is held only by ligaments and the capsule can be
pulled away from the glenoid cavity by 1 cm.
 stretches from the margin of the glenoid cavity to the
anatomical neck of the humerus superiorly and to the
surgical neck of the humerus inferiorly. The inferior portion
folds when the arm is adducted.
 The synovial membrane lines the fibrous capsule but NEVER
the articular heads of bone which are covered with hyaline
cartilage.

Important ligaments of the shoulder joint (Clemente 80-82; Grant, p. 532-

535; Netter 3e 406, 4e 423)

 The coracohumeral ligament .

 The transverse humeral ligament
 The superior, middle and inferior glenohumeral ligaments.

The coracohumeral ligament

 is attached from the lateral border of the coracoid process to

the anterior portion of the anatomical neck of the humerus.
 holds the humeral head in the adducted position.
 prevents inferior dislocation.
 limits lateral rotation.

The locking mechanism to prevent inferior dislocation:

1) Slope of the glenoid fossa

2) Tight upper part of the joint capsule and the
coracohumeral ligament.
3) Supraspinatus activity
4) The superior, middle and inferior glenohumeral ligaments.

The transverse humeral ligament holds the long head of the biceps in the
intertubercular groove (Grant p. 532; Netter 3e 406, 4e 423).
The strength of the shoulder joint depends on the :

1) Bony formation
2) Ligaments (coracohumeral ligament)
3) Muscles (rotator cuff/accessory dynamic ligaments):

 Supraspinatus
 Infraspinatus and teres minor
 Subscapularis

Bursae of the shoulder joint (Clemente 82; Grant p. 531-532; Netter 3e

406, 4e 423)

 Subscapularis bursa.
 Subacromial bursa.

A synovial sheath for the long head of the biceps lies in the intertubercular
sulcus.

The coracoacromial arch prevents superior displacement (Clemente 78;

Grant p. 532; Netter 3e 406, 4e 423). It is formed by the :

1) Coracoid process
2) Coracoacromial ligament
3) Acromion

Motor innervation of the shoulder joint (Grant p. 482):

 C5: flexion, abduction and lateral rotation

 C6, 7, 8: extension, adduction and medial rotation
o C5, 6 lesion due to trauma to the shoulder will result in
the "tip-taking" position.

Sensory nerves to the shoulder joint are from the:

 suprascapular nerve,
 axillary nerve,
 lateral pectoral nerve,
 and the posterior cord (C5, 6)
The elbow joint (articulatio cubiti; Clemente 85-87; Grant
p. 546-547; Netter 3e 419-421, 4e 436-438)

 Hinge (ginglymus) joint

 The capsule is loose anteriorly and posteriorly for flexion and
extension.
 The collateral ligaments prevent medial and lateral
displacement (Clemente 86-87; Grant p. 546-547; Netter 3e
421, 4e 438).

Distal end of the humerus (Clemente 87; Grant p. 544; Netter 3e 419, 4e
436):

 trochlea and capitulum

 coronoid fossa (anteriorly) and olecranon fossa (posteriorly)

Proximal end of the ulna:

 coronoid process (with the radial notch laterally and the

tuberosity anteriorly for attachment of the brachialis tendon)
 olecranon process (with a subcutaneous olecranon bursa;
Grant p. 544)
 trochlear (semilunar) notch

Proximal head of the radius is disc-shaped and rotates on the capitulum

(Clemente 87; Grant p. 524-527; Netter 3e 419-420, 4e 438).

Proximal radioulnar joint

The head of the radius is held by the annular ligament attached to the
radial notch (Clemente 87; Grant p. 544-545; Netter 3e 421, 4e 438).

Ligaments at the elbow (Clemente 86-87; Grant p. 546-547; Netter 3e 421,

4e 438)
 a) Radial collateral ligament (lateral ligament): from the lateral
epicondyle to the side of the annular ligament, strengthening the
latter. This also serves as the partial origin for the supinator and
extensor carpi radialis.
b) Ulnar collateral ligament (medial ligament): from the medial
epicondyle to the medial margin of the trochlear notch. The
anterior fibers attach to the coronoid process and form the partial
origin of the flexor digitorum superficialis.

The fibrous capsule extends to the upper margins of the coronoid and
radial fossae anteriorly. Distally, it attaches to the margins of the trochlear
notch and annular ligament.

A synovial fat pads exist between the fibrous capsule and synovial
membrane (Clemente 86; Grant p. 544; Netter 3e 421, 4e 438).

The synovial capsule droops below the lower margin of the annular
ligament and attaches to the neck of the radius to allow for rotation of the
head of the radius (Clemente 86; Grant p. 548; Netter 3e 421, 4e 438).

The intermediate radioulnar joint

is formed by the interosseous membrane between the radius and the ulna
(Clemente 88; Grant p. 551; Netter 3e 422, 4e 439).

The distal radioulnar joint

 The head of the ulna has a semicircular surface for the ulnar
notch of the radius and a distal semilunar surface for the
triangular articular disc attached to the fovea, at the base of the
styloid process. This articular disc separates the distal radioulnar
joint from the radiocarpal joint (Clemente 88, 93; Grant p. 590;
Netter 3e 438, 4e 439, 455).

The wrist (radiocarpal) joint

is formed by the inferior articular surface of the radius and the articular
disc.

Scaphoid, lunate and triquetrum (note their respective positions in radial

and ulnar deviations of the hand; Clemente plate 83; Grant p. 592; Netter
3e 436, 4e 453).
Ligaments (Clemente 92-93; Grant p. 590-591; Netter 3e 424, 425, 4e 437-
438, 4e 454-455).:

 Palmar and dorsal radiocarpal ligaments (from the radius to the

proximal carpals and capitate, anteriorly and posteriorly)
 The radial and ulnar collateral ligaments (from the styloid
processes to the scaphoid and triquetrum respectively)

The midcarpal (transverse carpal) joint (Clemente 93; Grant p. 593;

Netter 3e 438, 4e 455)

 between the proximal and distal rows of the carpal bones

 flexion of the wrist is performed mostly at this joint

Intercarpal ligaments are dorsal and palmar bands radiating from the
capitate and interosseous ligaments.

A slight gliding movement is possible between the carpal bones.

Carpometacarpal joints (Clemente 93; Grant p. 590, 594; Netter 3e

436-438, 4e 455)

 Trapezium and metacarpal 1 (saddle joint)

 Metacarpal 2 is wedged between the trapezium, trapezoid and the
capitate.
 Metacarpal 3 articulates with the distal surface of the capitate
 The hamate articulates with metacarpals 4 and 5

The sides of the metacarpals articulate with one another.

Metacarpophalangeal joints (Clemente 93; Grant p. 595; Netter 3e

440-441, 4e 457-458)

 can flex and extend.

 the collateral ligaments are taut on flexion and slack on extension.
 can abduct and adduct only when the joint is extended.

The extensor expansions serve dorsally as ligaments (Clemente 69; Grant

p. 583; Netter 3e 447, 4e 464-470).

The palmar ligaments or plates (volar accessory ligaments; Clemente 92;

Grant p. 571, 595; Netter 3e 441, 4e 458).
  are formed by a thickening of the capsule.
 are united by the deep transverse metacarpal ligaments
 prevent the metacarpals from spreading.

The digital bands of the palmar aponeurosis are attached to the transverse
ligaments anteriorly. (Clemente 64; Grant p. 561; Netter 3e 442, 4e 459). 
The slips from the extensor expansions are attached to them posteriorly.

The carpometacarpal joint of the thumb allow for flexion, extension,

abduction, adduction and some rotation.

Interphalangeal joints are hinge joints.