Anatomy of the joints of the upper limb

1. Wrist joint and joints of the hand
Dr. Mohammed Mahmoud Mosaed

2. Wrist joint
• Articulation:
• Between the distal
end of the radius
and the articular
disc above and the
scaphoid, lunate,
and triquetral bones
below.
• Type: Synovial
ellipsoid joint

3. Wrist joint
• Capsule: The capsule encloses the joint and is attached above to the
distal ends of the radius and ulna and below to the proximal row of
carpal bones.
• Synovial membrane: Lines the capsule and is attached to the margins
of the articular surfaces. The joint cavity does not communicate with
that of the distal radioulnar joint or with the joint cavities of the
intercarpal joints
• Ligaments:
• Anterior and posterior ligaments strengthen the capsule.
• The medial ligament is attached to the styloid process of the ulna and
to the triquetral bone.
• The lateral ligament is attached to the styloid process of the radius and
to the scaphoid bone.
• Nerve supply: Anterior interosseous nerve and the deep branch of the
radial nerve

4. Ligaments & joint space

5. Movements of the wrist joint
• flexion, extension, abduction, adduction, and circumduction.
• Flexion is performed by the flexor carpi radialis, the flexor carpi
ulnaris, and the palmaris longus. These muscles are assisted by the
flexor digitorum superficialis, the flexor digitorum profundus, and
the flexor pollicis longus.
• Extension is performed by the extensor carpi radialis longus, the
extensor carpi radialis brevis, and the extensor carpi ulnaris. These
muscles are assisted by the extensor digitorum, the extensor
indicis, the extensor digiti minimi, and the extensor pollicis longus.
• Abduction is performed by the flexor carpi radialis and the
extensor carpi radialis longus and brevis. These muscles are
assisted by the abductor pollicis longus and extensor pollicis
longus and brevis.
• Adduction is performed by the flexor and extensor carpi ulnaris.
• Rotation is not possible because the articular surfaces are ellipsoid
shaped. The lack of rotation is compensated for by the movements
of pronation and supination of the forearm.

6. movements

7. Important Relations of wrist joint
Anteriorly: The tendons of the flexor digitorum
profundus and superficialis, the flexor pollicis longus,
the flexor carpi radialis, the flexor carpi ulnaris, and the
median and ulnar nerves
Posteriorly: The tendons of the extensor carpi ulnaris,
the extensor digiti minimi, the extensor digitorum, the
extensor indicis, the extensor carpi radialis longus and
brevis, the extensor pollicis longus and brevis, and the
abductor pollicis longus
Medially: The posterior cutaneous branch of the ulnar
nerve
Laterally: The radial artery

8. Hand joints
• Intercarpal Joints
• Articulation: Between the individual bones of the proximal row of
the carpus also between the individual bones of the distal row of the
carpus; and finally, the midcarpal joint, between the proximal and
distal rows of carpal bones
• Type: Synovial plane joints
• Capsule: The capsule surrounds each joint.
• Synovial membrane: This lines the capsule and is attached to the
margins of the articular surfaces. The joint cavity of the midcarpal
joint extends not only between the two rows of carpal bones but also
upward between the individual bones forming the proximal row and
downward between the bones of the distal row.
• Ligaments: The bones are united by strong anterior, posterior, and
interosseous ligaments.
• Nerve supply: Anterior interosseous nerve, deep branch of the
radial nerve, and deep branch of the ulnar nerve
• Movements
• A small amount of gliding movement is possible.

10. Carpometacarpal and Intermetacarpal Joints
• Articulations in carpometacarpal joints the
articulation between the distal raw of the carpal
bones and the metacarbal bones
• They have a common joint cavity.
• Type: carpometacarpal and intermetacarpal
joints are synovial plane joints
• Ligaments anterior, posterior, and interosseous
ligaments.
• Movements A small amount of gliding
movement is possible.

12. Carpometacarpal Joint of the Thumb
• Articulation: Between the trapezium and
the saddle-shaped base of the first
metacarpal bone
• Type: Synovial saddle-shaped joint
• Capsule: The capsule surrounds the joint.
• Synovial membrane: This lines the capsule
and forms a separate joint cavity.

14. Ligaments

15. Movements of the thumb
• Anatomical position of the thumb
• The thumd become at a right angle with the palm of the
hand and with the other fingers
• Movements: The following movements are possible:
• Flexion: Flexor pollicis brevis and opponens pollicis
• Extension: Extensor pollicis longus and brevis
• Flexion and extension occur at the metacarpophalangeal
joint
• Abduction: Abductor pollicis longus and brevis
• Adduction: Adductor pollicis
• Rotation (opposition): The thumb is rotated medially by the
opponens pollicis.
• These movements occur at the carpometacarpal joint of the
thumb

17. Metacarpophalangeal Joints
• Articulation: Between the heads of the
metacarpal bones and the bases of the
proximal phalanges
• Type: Synovial condyloid joints
• Capsule: The capsule surrounds the joint.
• Synovial membrane: This lines the capsule
and is attached to the margins of the
articular surfaces.

18. Metacarpophalangeal Joints
• Ligaments:
• The palmar ligaments are strong and contain some
fibrocartilage. They are firmly attached to the phalanx but
less so to the metacarpal bone. The palmar ligaments of the
second, third, fourth, and fifth joints are united by the deep
transverse metacarpal ligaments, which hold the heads of
the metacarpal bones together.
• The collateral ligaments are cordlike bands present on each
side of the joints . Each passes downward and forward from
the head of the metacarpal bone to the base of the phalanx.
collateral ligaments are taut when the joint is in flexion and
lax when the joint is in extension.

21. Metacarpophalangeal Joints
• Movements
• Flexion: The lumbricals and the interossei, assisted
by the flexor digitorum superficialis and profundus
• Extension: Extensor digitorum, extensor indicis, and
extensor digiti minimi
• Abduction: Movement away from the midline of the
third finger is performed by the dorsal interossei.
• Adduction: Movement toward the midline of the third
finger is performed by the palmar interossei.

22. Interphalangeal Joints
Type: Interphalangeal
joints are synovial
hinge joints that have
a structure similar to
that of the
metacarpophalangeal
joints.

23. Interphalangeal joints
• Articulation:
• The proximal interphalangeal (PIP) joints are formed
by the articulation between the heads of the proximal
phalanges and the bases of the middle phalanges
• The distal interphalangeal (DIP) joints are formed
through the articulation between the heads of the
middle phalanges and the bases of the distal
phalanges
• Capsule and ligaments:
• Each joint is surrounded by a capsule that is
reinforced by radial and ulnar collateral ligaments

25. Movements of the interphalangeal joint
• Flexion by flexor digitorium superfacialis
and flexor digitorum profundus
• Extension by extensor digitorium,
extensor indices and extensor digiti
minimi