Anatomy of Superior and inferior radioulnar joint

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  • Anatomy of Superior and inferior radioulnar joint

    1. 1. MOB TCD Superior and Inferior Radioulnar Joint Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin
    2. 2. MOB TCD Supination • Supination is when the bones of forearm are parallel • Palm of hand is facing anteriorly • Supination with the elbow flexed is a more powerful movement than pronation
    3. 3. MOB TCD Pronation • Radius crosses the ulnar • Palm of the hand is facing posteriorly • Radial styloid is more distal than ulnar styloid • The axis of rotation passes through the middle of the head of the radius to the base of the styloid process of the ulna
    4. 4. MOB TCD Supination and Pronation • • • • • • • Three joints Superior radioulnar joint Interosseous membrane Inferior radioulnar joint Axis of rotation Middle of head of radius Base of styloid process of ulnar
    5. 5. MOB TCD Superior Radioulnar Joint • • • • • • • • Synovial pivot joint Circumference of head of radius Radial notch of ulnar Annular ligament covered with articular cartilage Quadrate membrane Capsular ligament Articular surfaces hyaline cartilage Synovial membrane continuous with elbow joint
    6. 6. MOB TCD Superior Radioulnar Joint • Annular ligament attached to anterior and posterior borders of radial notch • Lateral ligament of elbow to upper margin • Annular ligament covered with articular cartilage
    7. 7. MOB TCD Superior Radioulnar Joint • Capsule is attached • Lower border of the annular ligament • Neck of radius • Ulnar below the radial notch
    8. 8. MOB TCD Superior Radioulnar Joint • Quadrate membrane • Lower margin of the radial notch ulnar • Neck of radius • Synovial membrane • Lines capsule, non-articular structures • Continuous above the annular ligament with synovial membrane of elbow
    9. 9. MOB TCD Interosseous Membrane • Syndesmosis • Fibres pass mainly downwards and medially • Radius to ulna • Extends origins of muscles • Pierced by anterior interosseous artery • Transmits force from radius to ulna
    10. 10. MOB TCD Interosseous Membrane
    11. 11. MOB TCD Superior Radioulnar Joint • Radial styloid is more distal than ulnar • Synovial pivot joint • L-shaped ulnar notch of radius • Lateral and distal aspect of head of ulna • Triangular fibrocartilaginous disc
    12. 12. MOB TCD Inferior Radioulnar Joint • Radial styloid process is more distal than ulnar styloid process
    13. 13. MOB TCD Inferior Radioulnar Joint • Synovial pivot • L-shaped • Medial and distal aspect of head of ulna • Ulnar notch of radius • Triangular cartilaginous disc
    14. 14. MOB TCD Inferior Radioulnar Joint • Articular surfaces • Hyaline cartilage • Capsule just beyond articular margins • Synovial membrane lines capsule and non-articular structures • Radial styloid process is more distal than ulnar styloid process
    15. 15. MOB TCD Supinators: Biceps Brachii and Supinator • Biceps brachii with the elbow flexed • More powerful • Musculocutaneous C5,6 • Supinator (two heads) with elbow extended • Posterior interosseous C5,6
    16. 16. MOB TCD Supinator • Supinator has two heads of origin • The superficial head arises from the lateral epicondyle of the humerus, the lateral ligament of the elbow and the annular ligament • The deep head arises from the supinator crest and supinator fossa of the ulna
    17. 17. MOB TCD Supinator • Supinator is inserted into the upper third of the outer surface of the radius • When the elbow is extended • The supinator muscle supinates the forearm i.e. it rotates the radius to turn the palm anteriorly • Supplied by the posterior interosseous nerve C6,7, which passes between the two heads
    18. 18. MOB TCD Pronator Teres • Arises from two heads • The common flexor origin • The medial margin of the coranoid process of the ulna
    19. 19. MOB TCD Pronator Teres • It is inserted into the most convex aspect of the shaft of the radius • The radial artery passes superficial to the two heads • The ulnar artery deep to the two heads • The median nerve between the two heads • Its action is to assist pronator quadratus in rapid or forceful pronation of the forearm • It is also a weak flexor of the elbow • Median nerve C6
    20. 20. MOB TCD Pronator Quadratus • Arises from the anterior aspect of the distal portion of the ulna • Inserted into the distal aspect of the radius • It is a pronator of the forearm • Supplied by the anterior interosseous branch of the median nerve • The pronator quadratus is the prime mover in pronation • Pronator teres contracts when further speed or strength is required
    21. 21. MOB TCD Brachioradialis • Arises from the upper third of the lateral supracondylar line of the humerus • Inserted into the distal aspect of the radius • Radial nerve C5,6 • Flexor of elbow • In the mid position it can initiate, either pronation or supination • It is used, for example, in the back cast when fly-fishing
    22. 22. MOB TCD Radial Epiphysis • Slipped radial epiphysis
    23. 23. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”

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