 Hello everyone, welcome to this session on joints of the upper limb. In this session we will be revising all the joints of the upper limb. So here I have listed down the major joints of the upper limb. There is the shoulder joint, then elbow joint, and breast joint and first carpo metacarpal joint. These are the joints which are most frequently asked in examination. So we will be covering these joints under these headings. We have the standard headings in which any joint is described. So let's start with the shoulder joint first. Here in this image we can see the right shoulder region. So shoulder joint will be covering under these headings. So let's start with the first heading that is the type of the joint. Shoulder joint is which type of joint. It is an example of a ball and socket variety of synovial joint. Then what are the articular surfaces which form the shoulder joint? Here we can see the head of the humerus. The ball component of ball and socket is formed by the head of the humerus and socket is formed by the glenoid cavity. The glenoid cavity is a part of scapula. And surrounding the glenoid cavity there is a thick margin which is referred to as glenoidal labrum. So glenoid cavity and glenoidal labrum they form the socket. So this is the ball and socket variety of synovial joint. And let's cover the ligaments of the shoulder joint. Shoulder joint is an example of a synovial joint. Okay, so any synovial joint when we study it has a capsule covering it. So capsular ligament is the first ligament which we can say. Then with respect to the humerus we can remember three ligaments. One is the gleno-humeral ligament. It is nothing but a thickening on the inner aspect of the fibroscapsule. Okay, there are three bands of gleno-humeral ligament. Then there's a ligament from the base of the corocod process up to the graded tubercle that is the coraco-humeral ligament. And there is a ligament which stretches in between the greater and the lesser tubercles of the humerus that is the transverse-humeral ligament. Okay, so with respect to the humerus three ligaments are gleno-humeral ligament, coraco-humeral ligament and transverse-humeral ligament. Okay, and one was the capsular ligament. So these are the four ligaments in the shoulder joint. Okay, and there's some accessory ligaments as well. Here there will be a ligament extending from the corocod process to the acromion process that is the coraco-acromion ligament that forms the coraco-acromion arch. Okay, and then let's cover the relations of the shoulder joint. Here in this image we can see the various relations of shoulder joint. Okay, first orient yourself towards the image. This is the anterior aspect. This is the posterior aspect. This is the superior and this is the inferior aspect. Okay, so schematic diagram to show the various relations of shoulder joint. On the anterior aspect what we can see, the post-success in the anterior relation of the shoulder joint are deltoid, coracobrachialis and short head of the bicep, sub-scapularis muscle and underneath it there is a bursa that is the sub-scapular bursa. Okay, these are the anterior relations. Let's cover the posterior relations. Posteriorly also there is deltoid. So here there will be the posterior fibres of deltoid, then infraspinatus muscle and teres minor muscle. Okay, so these three structures are forming the posterior relations of the shoulder joint. An inferior relation is formed by the axillary nerve and posterior circumflex, humeral vessels and there is a muscle that is the long head of the triceps, long head of triceps, brachy. These structures are forming the inferior relation and when we see the superior relation that is here is the supraspinatus muscle and then there is the coracoacromial arch. Okay, this is the corocod process, this is the acromion process connecting between them is the coracoacromial ligament and these three structures together are referred to as the coracoacromial arch. Okay, these are the various relations of the shoulder joint. Apart from relations, bursae of the shoulder joint are also visible here. Bursa are nothing but extensions of the synovial membrane. This forming a cavity here, this is the sub-scapular bursae, then there is sub-acromial bursae and infraspinatus bursae. Okay, so three bursae visible are the sub-scapular bursae, sub-acromial bursae and intraspinatus bursae. So, we have covered these five headings. Let's start with the blood supply of the shoulder joint. So, shoulder joint will be supplied by the vessels which are nearby. So, here as we know, the circumflex humeral vessels, anterior circumflex humeral artery, the posterior circumflex humeral artery and near the scapular there is supra scapular artery and sub scapular artery. Okay, so all these vessels will be supplying the shoulder joint. The nerve supply will be by the nerves which are surrounding the shoulder joint. At the surgical neck of the humerus, we know that there's a nerve that is the axillary nerve. Then supra scapular nerve which is nearby that that also supplies the shoulder joint. And the nerve of the anties compartment of the arm, muscular quitenius nerve also gives the branch to the shoulder joint. Okay, so three nerves supplying the shoulder joint are axillary nerve, supra scapular nerve and muscular quitenius nerve. Okay, let's cover the movements of the shoulder joint. The shoulder joint is a multi-axial joint. So, multiple movements are possible. Flexion extension, then adduction, abduction, medial rotation, lateral rotation and combination of these movements will be referred to as circumduction. Okay, so when we study the movements, the muscles producing these movements also we should be knowing. So, flexion is brought about by pectoralis major muscle and the anterior fibers of the deltoid muscle. Extension is brought about by the posterior fibers of the deltoid and latissimus dorsi muscle. Okay, when we study the muscles producing action, there are some accessory muscles as well. But for exam point of view, we should at least know the chief muscles which cause that particular action. For adduction, there is cernopostile part of the pectoralis major and latissimus dorsi. For latissimus dorsi, three actions we can remember, adduction, medial rotation and extension. Okay, just like in swimming, adduction, medial rotation and extension. So, here we can see latissimus dorsi is in adduction also. Latissimus dorsi is in medial rotation also. Latissimus dorsi is also seen in extension. Okay, then abduction, initiation of abduction is by supra-spinates muscle. And 15 to 90 degrees of abduction is by the deltoid muscle. Okay, beyond which it is done by ceritus anterior and upper and lower fibers of the trapezius muscle. And medial rotation is by the subcapularis muscle which is attached along the lesser tubercle. When it contracts, it will pull the humus medially. So, it will cause the medial rotation of the shoulder joint. And lateral rotation is by the four CF fibers of deltoid as well as muscles which are attached along the greater tubercle. So, in plus, fine, it is steris minus when they contract, they will cause the lateral rotation at the shoulder joint. Let's cover the applied anatomy related to the shoulder joint. So, because of the wide range of mobility, shoulder joint is more prone to dislocation. Okay, and dislocation of the shoulder joint mostly occurs on the inferior aspect. When you study about the attachment of the capsule or ligament, it is weak along the inferior aspect. Okay, the shoulder joint mostly it dislocates on the inferior aspect and then it is called anteriorly. So, clinical presentation is anterior dislocation of the shoulder. Okay, then pros and shoulder, pros and shoulder refers to the inflammation and shrinking of the joint capsule. Okay, when the joint capsule is shrunken, that leads to adhesive capsulitis also referred to as pros and shoulders, which is restricts the movement of the shoulder joint. Then osteoarthritis is inflammation of the joint and this rotator cuff disorders are important. And the supraspinitis tendonitis is most common due to repeated actions. The supraspinitis tendon, it may get infected. It is referred to as supraspinitis tendonitis and it further leads to inflammation of the bursa, which is just below the acromion, that is the subacromial bursitis. Okay, so in subacromial bursitis, two things are seen. One is painful arc syndrome. That means in this 60 to 90 degrees of abduction is affected. It is very painful when the patient tries to abduct the arm between 16 to 90 degrees. Okay, and the oban sign is when in an abducted shoulder, when we press just below the acromion, there will be extreme pain in that region. But when the same point is pressed on abduction, pain disappears because the bursa slips under the acromion. Okay, subacromial bursa shifts below the acromion in an abducted shoulder. Okay, in an abducted shoulder, pain is there. In an abducted shoulder, pain disappears when a pressure is applied just below the acromion, that is referred to as oban sign. So, we have briefly covered the shoulder joint in details. Let's move on to the next joint. Here we can see this is the elbow joint. So, elbow joint is which type of joint is an example of a hinge variety of trinomial joint. Okay, you see elbow joint, it is actually formed by two joints. One is the joint between ulna and humerus and other is the joint between radius and humerus. Okay, this joint is a typical hinge joint between ulna and humerus. Okay, humero ulnar joint, humero radial joint. It is structurally a ball and socket variety of trinomial joint. Okay, ball component is formed by the capitulum and socket is formed by the depression which is just above the head of the radius. But elbow joint overall is referred to as hinge joint because major component is formed by the ulna and the humerus. Okay, when more than two bones are taking part in the joint, that is referred to as a compound variety of trinomial joint. You should know the differences between a compound joint and a complex joint. Then more than two bones take part in the formation of the joint, that is the compound joint and when there is an articular disc in between the joint cavity that is referred to as a complex joint. Okay, then articular surfaces in the humerus there is capitulum and trochlea. In the ulna there is trochlear notch of the ulna and the head of the radius. Okay, these form the articular surfaces. Then ligaments of the shoulder joint. So, since it is a synovial joint there is a capsular ligament. Then on the medial aspect there will be medial collateral ligament also referred to as ulnar collateral ligament. On the lateral aspect there is radial collateral ligament also referred to as the lateral collateral ligament. Let's study about various relations of the elbow joint. So, in front of the elbow joint there will be structures of the cubital fossa. So, this we can see the brachialis which forms the floor of the cubital fossa. These are the contents of cubital fossa, medial nerve, brachial artery, biceps tendon. Okay, all these structures form the anterior relations of the elbow joint. Then medial relations are formed by the plexigrapi ulnaris. Then there's a common flexor origin which is attached to the flexor muscles of the anterior compartment of the forearm and ulnar nerve. Okay, and lateral relations, there is extensor carpi radialis brevis. Then common extensor origin, these two structures form the lateral relations. In posterior relations three structures are listed that is the tendon of the triceps, an anconius and small nerve to anconius. Okay, so all these structures are forming the posterior relations of the elbow joint. We have covered these four headings. Barça around the elbow joint, there are three barça which are listed. Just behind the olegron process there is subcutaneous olegron barça, there is sub tendinous olegronon barça and bicepito radial barça. Okay, then blood supply of the elbow joint will be supplied by the anastomosis around the elbow joint. Okay, anastomosis is formed by the blood vessels which are the brachial artery, the radial artery and the ulnar artery. Okay, so these are the chief blood supply for the elbow joint. The nerve supplies by the major nerves of the upper limb. Okay, so which are the major nerves of the upper limb, the median nerve, ulnar nerve, radial nerve as well as musculoskeletal nerve. Okay, all these nerves will supply the elbow joint. Moments of the elbow joint, since it is a typical hinge joint, only two moments are possible that is flexion and extension. So flexion is brought about by which muscles that is brachialis muscles which is a chief flexor of the elbow joint, brachialis as well as bicep brachae muscle. Okay, these two muscles cause flexion. Additionally brachialis muscle can also cause flexion in semi-prone position. Okay, and extension is brought about by triceps brachae and anconis. Anconis is the weak extensor at the elbow joint. These are the various movements and muscles producing the movements. So let's cover the applied anhydrites related to the elbow joint. So fluid may get collected in the elbow joint and it may push the joint capsule and joint capsule is more pushed on the posterior aspect. Okay, in the posterior aspect the joint capsule is little weak. So elbow effusion is more appreciated along the posterior aspect of the elbow. There may be dislocation of the elbow. Radius and ulna it may displace from the joint line and whenever there is dislocation there is something called as three point relation of the elbow which is disturbed. Okay, so which are those three points one is the olecron process then medial epicondyle and lateral epicondyle. Okay, usually they lie in one horizontal line but when there is dislocation this line will be disturbed. Okay, there is one more clinical condition called as supra-condyler fracture of the humerus. In that case the three point relationship will be maintained. Okay, so this three point relationship is important to differentiate between elbow dislocation and supra-condyler fracture of the humerus. And there is something called as nursemaid's elbow or pulled elbow. Usually occurs below three years of age when we try to hold the baby with the forearm. So at times the radius the head of the radius it may get dislocated or we can say subluxated from the capitolum that is referred to as nursemaid's elbow or pulled elbow. Okay, then tennis elbow is inflammation of the lateral epicondyle. Lateral epicondyle it is also muscles which are attached along the lateral epicondyle. So these get inflamed in tennis elbow. Okay, so the extension of the forearm is affected in this condition. Then golfer's elbow is referred to as medial epicondyle it is. Okay, when the medial epicondyle is inflamed as well as when the muscles which are originating from the medial epicondyle if they are inflamed that is referred to as golfer's elbow. In this there will be weakness in flexion of the forearm. Then student's elbow is the inflammation of the subcutaneous olecranon bursa. Okay, you have to repeatedly keeping the elbow on the desk at times that subcutaneous olecranon bursa that gets gets inflamed. Okay, so this is student's elbow. So the way is applied anatomy with respect to the elbow joint. Let's cover the wrist joint now. So again we will be covering under the standard heading. So wrist joint is which type of joint is an example of a ellipsoid variety of sinoval joint. Okay, one side is concave other side is convex. Articulating surfaces is formed by the on the proximal aspect there is the distilled surface of the radius and on the other side there is the proximal row of carpal bones. Okay, poid, lunate as well as triquital comes in extreme adduction. Okay, ulna doesn't take part in the formation of wrist joint that is important. This joint is also referred to as radio carpal joint. Okay, so how ulna separated from the wrist joint here we can see this structure this is the articular disc which separates the ulna from the wrist joint then various ligaments of the wrist joint since it is a sinoval joint there will be capsular ligament on the lateral aspect there is radial collateral ligament on the medial aspect ulnar collateral ligament then on the anterior aspect there is parmar radio carpal ligament and parmar ulno carpal ligament okay and posteriorly there is only ligament from radius to the carpal bone so that will be referred to as dorsal radio carpal ligament. Okay, so I will repeat the ligaments again one is the capsular ligament then radial collateral ligament ulnar collateral ligament then parmar radio carpal parmar ulno carpal and on the dorsal aspect that is dorsal radio carpal okay then relations at the wrist joint for relations we can imagine so which all structures are in the front of the wrist joint we can imagine the structures of the carpal tunnel the flexor tendons all flexor tendons tendons of flexor radium superficially flexor radium profundus median nerve okay we form the structures of the carpal tunnel that will be on the anterior aspect and posterior aspect there will be extensor tendons of the wrist and the digits okay then laterally laterally there is radial artery as well as the tendons of abductor policies longer and extensor policies brevis and medially there is dorsal cutaneous branch of the ulnar nerve okay so all these are the relations of the wrist joint then blood supply of wrist joint is by the parmar and the dorsal carpal arches okay blood vessels which are surrounding it then nerve supply of the wrist joint so there is a nerve on the anterior aspect of the wrist joint there is anterior interosseous nerve and now on the posterior aspect is posterior interosseous nerve okay so these interosseous nerves supply the wrist joint movements are flexion extension adduction abduction and combination of these movements will be referred to as circumduction okay so flexion is brought about the plexus api radialis flexor copy ulnaris and parmaris longus extension brought about the extensor copy radialis longus extensor copy radialis brevis and extensor copy ulnaris then abduction will be brought about the flexor copy radialis extensor copy radialis longus brevis as well as there is abductor policies longus and adduction is brought about by flexor copy ulnaris and extensor copy ulnaris and this is the applied anatomy with respect to the wrist joint ganglion it is a cystic swelling surrounding the tendons okay the sinoval sheet which surrounds the tendon that get inclined and a swelling occurs that is referred to as ganglion aspiration of the wrist joint is done whenever there is effusion in the wrist joint and immobilization of the wrist means whenever the plaster cast has to be applied in this region the position of the wrist should be 30 degrees dorsiflexion okay it's referred to as the optimum position of the wrist joint okay this was about applied anatomy with respect to the wrist joint let's start with the first carpometa carpal joint so it is which type of joint is an example of a saddle variety of synovial joint okay saddle because concave convex articular surface articular surface is the distal surface of the trapezium and proximal surface of the base of the first metacarpal in ligaments first ligament which we can remember is the capsular ligament and that is a synovial joint and there's an anterior ligament there's one posterior ligament and there's one ligament on the lateral aspect lateral ligament so four ligaments are capsular ligament anterior ligament posterior ligament and lateral ligament okay relations of first carpometa carpal joint anteriorly there will be muscles of the inner eminence posteriorly there will be extensors of the thumb okay extensor policies longest extensor policies bravis those will be on the posterior aspect laterally there is abductor policies longest muscle and medially there is first dorsal introscii muscle and radial artery okay blood supplies by the radial artery which is near to this joint now supplies by the median nerve which is close to this joint in movements multiple movements are possible flexion extension adduction abduction there's an action this called less position okay and combination of all movements will be referred to as circumduction okay movements in the plane of the palm is flexion and extension movements perpendicular to the plane plane of the palm is adduction and abduction and when the thumb touches the other digit that is referred to as opposition and combination of all moments will be referred to as circumduction okay and muscles producing these movements can remember by the name flexion will be produced by flexor policies longest flexor policies bravis extension will be produced by extensor policies longest bravis adduction by adductor policies then abduction by abductor policies longest and bravis opposition by opponents policies okay applied and act me with respect to the first copper metacarpal joint as a clinical condition called as d quervain sinusinoitis it is inflammation of the tendons of abductor policies longest and extensor policies bravis okay and ape thumb deformity in which the thumb lies close to the palm it is due to the injury of the median nerve okay so in carpal tunnel syndrome or if there is injury of median nerve higher up will lead to ape thumb deformity and bennett's fracture it is fracture of the base of the first metacarpal bone okay that will affect the first copper metacarpal joint okay so this was all the major joints of the upper limb so which which other joints are left one is the acromio clavicular joint the lateral end of the clavicle it articulates with the acromion process of the scapula it is a plane variety of cyanobel joint sternoclavicular joint on the medial aspect the medial end of the clavicle it articulates with the sternum that is sternoclavicular joint it is a saddle variety of cyanobel joint okay and both these joints are complex type because there is articular disc is intervene between the joint cavity okay then radial nerve joints superior radial nerve joint and inferior radial nerve joint these are pivot variety of cyanobel joint and middle radial nerve joint is the same disc muscles okay it's an example of a fibrous joint here the joints in the hand first carpal metacarpal we have said that was the saddle variety of cyanobel joint remaining are are plane variety of cyanobel joint okay intercarpal joints are also plane variety of cyanobel joint inter metacarpal joints are also plane variety and metacarpal pharyngeal joint this is a ellipsoid variety of cyanobel joint and interpharyngeal joint it is a hinge variety of cyanobel joint let's summarize what we have covered in this particular session so in this summary I've just listed down the various types of the joint which are present in upper limb shoulder joint is ball and socket an elbow joint is a hinge joint rest is an ellipsoid joint first carpal metacarpal saddle variety of cyanobel joint acromioclavicular and sternoclavicular plane and saddle superior inferior radial nerve is a pivot variety of cyanobel joint middle radial nerve joint is a thin disc muscles okay so we see the joint only one joint is fibrous that is the middle radial nerve joint rest all joints are cyanobel joint okay so this this also we have covered maximum joints in the hand are plane cyanobel joint metacarpal pharyngeal joint is ellipsoid and interpharyngeal joint is a hinge joint okay so we have covered all the joints of the upper limb so if you all want pdf handout you can you all can request at this WhatsApp number and please do watch other videos of this YouTube channel okay thank you