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Wrist and radioulnar joints

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NAIHS Rishi Pokhrel joints forearm wrist radioulnar

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Wrist and radioulnar joints

  1. 1. JOINTS OF FOREARM MAJ RISHI POKHREL NAIHS Download these slides from www.slideshare.net
  2. 2. • Carpel tunnel syndrome?
  3. 3. • Radioulnar joints • Proximal • Distal • Intermediate • Wrist Joint
  4. 4. Joint • Introduction • Articulating surfaces • Ligaments • Synovial membrane • Special feature e.g. disc, meniscus • Blood supply & innervation • Movements & muscles • Applied
  5. 5. Proximal Radioulnar Joint • Type: Uniaxial pivot joint. • Articulating surfaces – Circumference of the radial head – Fibro-osseous ring formed by ulnar radial notch & annular ligament
  6. 6. Ligaments • Fibrous capsule – continuous with that of elbow joint & attached to the annular ligament
  7. 7. Ligaments • Annular ligament – Strong band, 4/5th of ring – Encircles the radial head, holding it against radial notch of the ulna. – Attached to anterior margin of the notch and rough ridge at or behind the posterior margin of the notch
  8. 8. Ligaments • Quadrate ligament – thin, fibrous – stretches between neck of the radius & upper part of the supinator fossa of the ulna – covers the synovial membrane on the distal surface of the joint – maintains constant tension throughout pronation and supination.
  9. 9. Synovial membrane • continuous with that of elbow joint • Covers proximal radio-ulnar joint & elbow joint as 1 synovial cavity • Prevented from herniation between anterior & posterior free edges of the annular ligament by the quadrate ligament
  10. 10. Vascular supply Periarticular anastomosis around elbow joint
  11. 11. Innervation • Small branches from – Musculocutaneous – Median – Radial – Ulnar • Hilton’s law
  12. 12. Factors maintaining stability • Prime stabilizing factor - annular ligament • Encircles the radial head and holds it against the radial notch of the ulna
  13. 13. Applied anatomy • Pulled elbow • Subluxation of the radial head through annular ligament arising from a sudden jerk • common injury in young children • annular ligament has vertical sides in children compared with more funnel-shaped sides in adults • Reduction by forcefully supinating and flexing elbow which snaps the ligament back into place.
  14. 14. Distal Radioulnar Joint • Uniaxial pivot joint • Articulating surfaces – convex distal head of ulna & concave ulnar notch of the radius – connected by an articular disc.
  15. 15. Ligaments • Fibrous capsule – Thicker anteriorly and posteriorly – Proximal part of the capsule is lax.
  16. 16. • Articular disc – Fibrocartilaginous – Binds distal ends of ulna & radius – Thick periphery, centre thin or sometimes perforated. – Triangular in shape – Apex attached to depression between styloid process and distal articular surface of ulna – Base attached to prominent edge between ulnar notch and carpal articular surface of the radius
  17. 17. Synovial membrane • Projects proximally between radius & ulna - ‘recessus sacciformis’ in front of distal part of the interosseous membrane • Does not communicate with wrist joint
  18. 18. • Blood supply – palmar and dorsal br of the ant interosseous A with post interosseous & ulnar A • Innervation – Branches of ant & post interosseous N
  19. 19. Intermediate Radioulnar Joint • Interosseous membrane • Type: Syndesmosis type of Fibrous joint
  20. 20. Movements • Pronation – Pronator quadratus – pronator teres • Supination – Supinator – Biceps brachii
  21. 21. Wrist / Radiocarpal jt • Type: synovial, biaxial, ellipsoid • Articulating surfaces: – distal end of radius & triangular fibrocartilage – scaphoid, lunate and triquetral
  22. 22. Ligaments • Fibrous capsule • Palmar radiocarpal & ulnocarpal • Dorsal radiocarpal • Radial and ulnar collateral ligaments
  23. 23. • Synovial membrane: lines the fibrous capsule • Vascular supply – Ant interosseous A – Ant & post carpal br of radial and ulnar arteries – Palmar & dorsal metacarpal A – Recurrent rami of the deep palmar arch. • Innervation – Ant & post interosseous – median, ulnar & radial N.
  24. 24. Movements & muscles
  25. 25. Range of movements • flexion (85°), • extension (85°), • adduction or ulnar deviation (45°), • abduction or radial deviation (15°) • circumduction
  26. 26. Muscles • Flexion – FCR, FCU, Palmaris longus – assisted by FDS, FDP, FPL • Extension – ECRL, ECRB, ECU, – assisted by ED, EDM, EI and EPL • Adduction – FCU, ECU • Abduction – FCR, ECRL, ECRB, – abductor pollicis longus and extensor pollicis brevis

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