SANJAY KUMAR YADAVLECTURERKMCTH

Articulation Radial head and osseo-fibrous ring Annular ligament and radial notch of the ulna1/5th Osseo-fibrous ring & 4/5th by annular ligament

Superior radio-ulnar joint

Contd….

Annular ligament is strong fibrous bandAttached to the anterior and posterior margin of radial notchUpper border continuous with fibrous capsule

•Inferiorly, few fibers from lower margin of annular ligament passes over the synovial membrane and attached to the neck of radius•Thin fibrous ligament called quadrate ligament stretches between the neck of the radius and the upper part of supinator fossa of ulnar and closes joint cavity from below, between radius and ulna•Externally blends with the radial collateral ligament

Applied anatomyNursemaid’s Elbow

Subluxation of joint1-5 year of age Girls- 20%

Contd….

• Blood supply: articular branches derived from the anastomoses around the elbow joint

• Nerve supply: small branches from the musculocutaneous, median, radial and ulnar nerves

• Hilton’s Law

Distal radioulnal joint

Pivot joint Head of ulna & ulnar notch of radiusSynovial membrane extremely looseExtend up ward as recess between radius and ulna

Recessus sacciformis

Movement – pronation and suppination along vertical axis

Anterior radioulnar ligamentPosterior radioulnar ligamentNerve supply Anterior & posterior interrossius nerve branch from Median and radial nerve

Radioulnar ligaments

Pronation Pronator quadratusPronator teres

Supination •Supinator•Biceps brachii

Movement

Applied anatomy

Wrist joint

Bi-axial/2 degree of freedom Ellipsoid joint (Condyloid) type of synovial

joint Articular surfaces Proximal articular surface

(Elliptical socket)- Distal articular surface of

radius & articular disc of distal radio-ulnar joint

Distal articular surface: Scaphoid, Lunate & Triquetral.

Wrist joint

Ligaments: possess capsular ligament with synovial membrane, Radial and Ulnar collateral ligament

Capsular ligament: attach close to the peripheral margin of the proximal and distal articular surfaces including the articular disc

Wrist joint Capsule blends Palmar & dorsal radio-carpal

ligaments Palmar radio-carpal ligament Ant. margin of lower part of

radius to ant. Surface of scaphoid, lunate, triquetral & capitate

Palmar ulno-carpal ligament • Ant. Margin of articular disc &

styloid process of ulna to lunate & triquetral

Dorsal radiocarpalligament

Wrist joint

Attachment Posterior margin of lower end of radius dorsal surface of scaphoid, lunate & triquetral bones

Wrist joint

Ulnar collateral ligament Styloid process of Ulna to triquetral and Pisiform bones Radial collateral ligament Styloid process of radius to scaphoid and trapezium

Arterial Supply and Nerve Supply Wrist joint

Nerve supply: anterior and posterior interosseus nerves Hilton’s Laws

Palmar and dorsal carpal arches Anterior interosseous artery Anterior and posterior carpal brances of radial & ulnar arteries, and

Recurrent branches of Deep palmar arches)

Movements Movement of wrist joint: the movements are accompanied by

the movements of intercarpal and midcarpal joint Flexion• FCU, palmaris longus and FCR with assistance from the flexors

of the fingers and thumb Extension • Extensor carpi radialis longus, extensor carpi radialis brevis and

extensor carpi ulnaris with assistance from the long extensor tendons of finger and thumb

Adduction • Flexor carpi ulnaris, extensor carpi ulnaris Abduction • Flexor carpi radialis,extensor carpi radialis longus and

brevis,abductor pollicis longus and extensor pollicis brevis

Applied anatomy

Monteggia's fracture

Proximal third of ulnaAnterior dislocation of head of radius

Galeazzi's fracture

Distal third of radiusSubluxation (partial dislocation) of head of ulna (distal ulna)