Transcript The Muscular System Manual: The Skeletal Muscles of the

KINESIOLOGY:
The Skeletal System and
Muscle Function
Second Edition
Joseph E. Muscolino, DC
Instructor, Purchase College
State University of New York
Owner, The Art and Science of Kinesiology
Stamford, Connecticut
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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1
Chapter 9:
Joints of the
Upper Extremity
Joseph E. Muscolino, DC
Lesson 9.1 Objectives
• Define the key terms of this chapter and state
the meanings of the word origins of this chapter.
• Describe why the term shoulder corset might be
a better term than shoulder girdle.
• Explain why the term shoulder joint complex is a
better term than shoulder joint when describing
movement of the shoulder.
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3
Lesson 9.1 Objectives
(cont’d.)
• Describe the concepts of mobility and
stability as they pertain to the
glenohumeral joint, and explain why the
glenohumeral joint is often called a
muscular joint.
• Explain why the scapulocostal joint is
considered to be a functional joint, not an
anatomic joint.
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4
Lesson 9.1 Objectives
(cont’d.)
• Describe why the sternoclavicular joint can
be classified as either biaxial or triaxial.
• Explain why stabilization of the
sternoclavicular joint is important toward
proper functioning of the upper extremity.
• Describe the importance of
acromioclavicular joint motion to motion of
the shoulder girdle.
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5
Joints of the Upper Extremity
•
•
•
•
•
•
•
Shoulder joint complex
Glenohumeral joint
Scapulocostal joint
Sternoclavicular joint
Acromioclavicular joint
Elbow joint complex
Elbow joint
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6
Joints of the Upper Extremity
(cont’d.)
•
•
•
•
•
•
•
Radioulnar joints
Wrist joint complex
Carpometacarpal joints
Saddle joint of the thumb
Intermetacarpal joints
Metacarpophalangeal (MCP) joints
Interphalangeal joints (IP) of the hand
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7
Section 9.1—Shoulder
Joint Complex
Figure 9-1
Modeled from Neumann DA: Kinesiology of the
musculoskeletal system: foundations for physical
rehabilitation, ed 2, St Louis, 2010, Mosby. Courtesy
Joseph E. Muscolino
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8
Section 9.1—Shoulder
Joint Complex (cont’d.)
Joints of the Shoulder Joint Complex:
•
•
•
•
Glenohumeral (GH) joint
Sternoclavicular (SC) joint
Acromioclavicular (AC) joint
Scapulocostal (ScC) joint
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9
Section 9.1—Shoulder
Joint Complex (cont’d.)
Average Ranges of Motion:
•
•
•
•
•
•
Flexion
Extension
Abduction
Adduction
Lateral rotation
Medial rotation
180 degrees
150 degrees
180 degrees
0 degrees
90 degrees
90 degrees
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10
Section 9.2—Glenohumeral
Joint
Figure 9-2
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Section 9.2—Glenohumeral
Joint (cont’d.)
Figure 9-3
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12
Section 9.2—Glenohumeral
Joint (cont’d.)
Figure 9-4
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13
Section 9.2—Glenohumeral
Joint (cont’d.)
• Structure: Synovial joint
– Ball-and-socket joint
• Function: Diarthrotic
– Triaxial
• Major motions:
– Flexion/extension
– Abduction/adduction
– Lateral/medial rotation
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Section 9.2—Glenohumeral
Joint (cont’d.)
Average Ranges of Motion:
•
•
•
•
•
•
Flexion
Extension
Abduction
Adduction
Lateral rotation
Medial rotation
100 degrees
40 degrees
120 degrees
0 degrees
50 degrees
90 degrees
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15
Section 9.2—Glenohumeral
Joint (cont’d.)
Major ligaments:
• Fibrous joint capsule
• Superior glenohumeral ligament
• Middle glenohumeral ligament
• Inferior glenohumeral ligament
• Coracohumeral ligament
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16
Section 9.2—Glenohumeral
Joint (cont’d.)
Ligaments of the Glenohumeral Joint:
Figure 9-5
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Section 9.2—Glenohumeral
Joint (cont’d.)
Figure 9-6
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Section 9.2—Glenohumeral
Joint (cont’d.)
Figure 9-6
B, from Muscolino JE: The muscular system manual, ed 2, St Louis,
2005, Mosby
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19
Section 9.3—Scapulocostal
Joint
Figure 9-7
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20
Section 9.3—Scapulocostal
Joint (cont’d.)
Nonaxial Actions at the
Scapulocostal Joint:
Figure 9-8
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21
Section 9.3—Scapulocostal
Joint (cont’d.)
Upward Rotation at the Scapulocostal Joint:
Figure 9-9
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Section 9.3—Scapulocostal
Joint (cont’d.)
Tilt Actions at the Scapulocostal Joint:
Figure 9-10
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Section 9.3—Scapulocostal
Joint (cont’d.)
• Structure: Functional joint
• Major motions:
– Protraction/retraction
– Elevation/depression
– Upward/downward rotation
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24
Section 9.4—Sternoclavicular
Joint
Figure 9-11
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Section 9.4—Sternoclavicular
Joint (cont’d.)
• Structure: Synovial joint
– Saddle
• Function: Diarthrotic
– Biaxial
• Major motions:
– Protraction/retraction
– Elevation/depression
– Upward/downward rotation
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26
Section 9.4—Sternoclavicular
Joint (cont’d.)
• Major ligaments:
– Fibrous capsule
– Anterior sternoclavicular ligament
– Posterior SC ligament
– Interclavicular ligament
– Costoclavicular ligament
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27
Section 9.4—Sternoclavicular
Joint (cont’d.)
Average Ranges of Motion:
•
•
•
•
•
•
Elevation
Depression
Protraction
Retraction
Upward rotation
Downward rotation
45 degrees
10 degrees
30 degrees
30 degrees
45 degrees
0 degrees
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28
Section 9.4—Sternoclavicular
Joint (cont’d.)
Figure 9-12
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Section 9.4—Sternoclavicular
Joint (cont’d.)
Figure 9-13
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Section 9.4—Sternoclavicular
Joint (cont’d.)
Figure 9-14
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31
Section 9.4—Sternoclavicular
Joint (cont’d.)
Figure 9-15
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32
Section 9.5—Acromioclavicular
Joint
Figure 9-16
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33
Section 9.5—Acromioclavicular
Joint (cont’d.)
• Structure: Synovial joint
– Plane
• Function: Diarthrotic
– Nonaxial
• Motions allowed: Upward/
downward rotation
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Section 9.5—Acromioclavicular
Joint (cont’d.)
Figure 9-17
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Section 9.5—Acromioclavicular
Joint (cont’d.)
• Major ligaments:
– Fibrous capsule
– Acromioclavicular (AC) ligament
– Coracoclavicular ligament
• Closed-packed position:
– Full upward rotation of the scapula
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36
Section 9.5—Acromioclavicular
Joint (cont’d.)
Figure 9-18
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Lesson 9.2 Objectives
• Explain the concept of scapulohumeral rhythm,
and give an example for each of the six cardinal
ranges of motion of the arm at the shoulder joint.
• Describe the concept and importance of the
carrying angle.
• Describe the component motions that occur at
the proximal and distal radioulnar joints that
create pronation and supination of the forearm.
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38
Joints of the Upper Extremity
•
•
•
•
•
•
•
Shoulder joint complex
Glenohumeral joint
Scapulocostal joint
Sternoclavicular joint
Acromioclavicular joint
Elbow joint complex
Elbow joint
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All rights reserved.
39
Joints of the Upper Extremity
(cont’d.)
•
•
•
•
•
•
•
Radioulnar joints
Wrist joint complex
Carpometacarpal joints
Saddle joint of the thumb
Intermetacarpal joints
Metacarpophalangeal joints
Interphalangeal joints of the hand
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40
Section 9.6—Scapulohumeral
Rhythm
•
•
•
•
Sagittal plane actions
Frontal plane actions
Transverse plane actions
Other coupled actions
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41
Section 9.6—Scapulohumeral
Rhythm (cont’d.)
Figure 9-19
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby. Courtesy Joseph E. Muscolino
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved.
42
Section 9.7—Elbow Joint
Complex
Figure 9-20
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Section 9.7—Elbow Joint
Complex (cont’d.)
Three Articulations:
• Humeroulnar joint
• Humeroradial joint
• Proximal radioulnar joint
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44
Section 9.8—Elbow Joint
Humeroulnar Joint:
• Structure: Synovial joint
– Hinge
• Function: Diarthrotic
– Uniaxial
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Section 9.8—Elbow Joint
(cont’d.)
Humeroradial Joint:
• Structure: Synovial joint
– Atypical ball-and-socket
• Function: Diarthrotic
– Biaxial
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Section 9.8—Elbow Joint
(cont’d.)
Figure 9-21
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Section 9.8—Elbow Joint
(cont’d.)
Figure 9-22
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48
Section 9.8—Elbow Joint
(cont’d.)
Figure 9-23
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49
Section 9.8—Elbow Joint
(cont’d.)
Elbow Joint:
• Major actions: Flexion/extension
• Major ligaments:
– Fibrous capsule
– Medial collateral ligament
– Lateral collateral ligament
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Section 9.8—Elbow Joint
(cont’d.)
Figure 9-24
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Section 9.9—Radioulnar Joints
Three Radioulnar Joints:
• Proximal radioulnar joint
• Middle radioulnar joint
• Distal radioulnar joint
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52
Section 9.9—Radioulnar Joints
(cont’d.)
Radioulnar Joints:
• Major actions: Pronation/supination
Ranges of Motion:
• Pronation
• Supination
160 degrees
0 degrees
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53
Section 9.9—Radioulnar Joints
(cont’d.)
Figure 9-25
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Section 9.9—Radioulnar Joints
(cont’d.)
Pronation and Supination at the RU Joints:
Figure 9-26
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Section 9.9—Radioulnar Joints
(cont’d.)
Ligamentous Structures of the RU Joints:
Figure 9-27
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56
Lesson 9.3 Objectives
• Describe the structure and function of the
hand.
• Describe the structure and function of the
wrist and, specifically, the carpal tunnel.
• Explain why the radiocarpal joint is the
major articulation between the forearm
and the hand.
• Describe the importance of motion at the
4th and 5th carpometacarpal joints.
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57
Joints of the Upper Extremity
•
•
•
•
•
•
•
Shoulder joint complex
Glenohumeral joint
Scapulocostal joint
Sternoclavicular joint
Acromioclavicular joint
Elbow joint complex
Elbow joint
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58
Joints of the Upper Extremity
(cont’d.)
•
•
•
•
•
•
•
Radioulnar joints
Wrist joint complex
Carpometacarpal joints
Saddle joint of the thumb
Intermetacarpal joints
Metacarpophalangeal (MCP) joints
Interphalangeal joints (IP) of the hand
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59
Section 9.10—Overview of the
Wrist/Hand Region
Three Regions:
• Carpus
• Metacarpus
• Phalanges (fingers)
Figure 9-28
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60
Section 9.10—Overview of the
Wrist/Hand Region (cont’d.)
General Organization:
• Wrist joint
– Radiocarpal joint
– Midcarpal joint
•
•
•
•
Carpometacarpal joints
Intermetacarpal joints
Metacarpophalangeal (MCP) joints
Interphalangeal (IP) joints
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61
Section 9.10—Overview of the
Wrist/Hand Region (cont’d.)
Arches of the Hand:
Figure 9-29
B modeled from Neumann DA: Kinesiology of the
musculoskeletal system: foundations for physical
rehabilitation, ed 2, St Louis, 2010, Mosby; A
courtesy of Joseph E. Muscolino
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Section 9.10—Overview of the
Wrist/Hand Region (cont’d.)
Carpal Tunnel:
Figure 9-30
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations
for physical rehabilitation, ed 2, St Louis, 2010, Mosby; courtesy of Joseph E.
Muscolino
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Section 9.10—Overview of the
Wrist/Hand Region (cont’d.)
Dorsal Digital Expansion:
Figure 9-31
From Muscolino JE: The muscular system manual: the skeletal muscles of the human
body, ed 3, St Louis, 2010, Mosby
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Section 9.10—Overview of the
Wrist/Hand Region (cont’d.)
Dorsal Digital Expansion (cont’d.):
Figure 9-31
From Muscolino JE: The muscular system manual: the skeletal muscles of the human
body, ed 3, St Louis, 2010, Mosby
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65
Section 9.11—Wrist
Joint Complex
{Insert Fig. 9-32}
Figure 9-30
Modeled from Neumann DA:
Kinesiology of the
musculoskeletal system:
foundations for physical
rehabilitation, ed 2, St Louis,
2010, Mosby;courtesy Joseph
E. Muscolino
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
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66
Section 9.11—Wrist
Joint Complex (cont’d.)
Joints of the Wrist Joint Complex:
• Radiocarpal joint
• Midcarpal joint
• Intercarpal joints
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Section 9.11—Wrist
Joint Complex (cont’d.)
Radiocarpal and Midcarpal Joints:
• Structure: Synovial joint
– Condyloid
• Function: Diarthrotic
– Biaxial
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Section 9.11—Wrist
Joint Complex (cont’d.)
Radiocarpal and Midcarpal Joints (cont’d.):
• Major Motions Allowed:
– Flexion/extension
– Radial/ulnar deviation
• Closed-Packed Position:
– Extension and slight ulnar deviation
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Section 9.11—Wrist
Joint Complex (cont’d.)
Ligaments of the Wrist Joint Complex:
•
•
•
•
•
•
Fibrous capsule of the radiocarpal joint
Radioulnar disc
Fibrous capsule of the midcarpal joint
Transverse carpal ligament
Extrinsic ligaments
Intrinsic ligaments
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Section 9.11—Wrist
Joint Complex (cont’d.)
Ligaments of the Wrist Joint Complex
(cont’d.):
{Insert Fig. 9-34 A only}
Figure 9-34
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby
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71
Section 9.11—Wrist
Joint Complex (cont’d.)
Ligaments of the Wrist Joint Complex
(cont’d.):
Figure 9-34
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby
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72
Section 9.12—Carpometacarpal
Joints
Figure 9-35
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Section 9.12—Carpometacarpal
Joints (cont’d.)
Second and Third CMC Joints:
• Structure: Synovial joint
– Plane
• Function: Synarthrotic
– Nonaxial
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Section 9.12—Carpometacarpal
Joints (cont’d.)
First, Fifth, and Fourth CMC Joints:
• Structure: Synovial joint
– Saddle
• Function: Diarthrotic
– Biaxial
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Section 9.12—Carpometacarpal
Joints (cont’d.)
Motion of the CMC Joints of the Hand:
Figure 9-36
A, modeled from Neumann DA: Kinesiology of the musculoskeletal system:
foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;
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76
Section 9.12—Carpometacarpal
Joints (cont’d.)
Motion of the CMC Joints of the Hand
(cont’d.):
Figure 9-36
B and C courtesy Joseph E. Muscolino.
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77
Section 9.12—Carpometacarpal
Joints (cont’d.)
Ligaments of the CMC Joints:
•
•
•
•
Fibrous capsules
Dorsal CMC ligaments
Palmar CMC ligaments
Interosseus CMC ligaments
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Section 9.12—Carpometacarpal
Joints (cont’d.)
Dorsal CMC Ligaments
of the CMC Joints:
{Insert Fig. 9-37 A only}
Figure 9-37
Modeled from Neumann DA: Kinesiology of the musculoskeletal system:
foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;
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79
Section 9.12—Carpometacarpal
Joints (cont’d.)
Palmar CMC Ligaments
of the CMC Joints:
{Insert Fig. 9-37 B only}
Figure 9-37
Modeled from Neumann DA: Kinesiology of the musculoskeletal system:
foundations for physical rehabilitation, ed 2, St Louis, 2010 Mosby;
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80
Section 9.12—Carpometacarpal
Joints (cont’d.)
Average Ranges of Motion:
•
•
•
•
Joint
5th CMC
4th CMC
3rd CMC
2nd CMC
Flexion
20 degrees
10 degrees
0 degrees
0–2 degrees
Extension
0 degrees
0 degrees
0 degrees
0 degrees
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Lesson 9.4 Objectives
• Describe the importance of motion at the
first carpometacarpal joint (i.e., the saddle
joint of the thumb).
• Describe the component actions of
opposition and reposition of the thumb.
• Discuss the similarities and differences
between the metacarpophalangeal joints
and the interphalangeal joints.
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82
Joints of the Upper Extremity
•
•
•
•
•
•
•
Shoulder joint complex
Glenohumeral joint
Scapulocostal joint
Sternoclavicular joint
Acromioclavicular joint
Elbow joint complex
Elbow joint
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83
Joints of the Upper Extremity
(cont’d.)
•
•
•
•
•
•
•
Radioulnar joints
Wrist joint complex
Carpometacarpal joints
Saddle joint of the thumb
Intermetacarpal joints
Metacarpophalangeal (MCP) joints
Interphalangeal joints (IP) of the hand
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84
Section 9.13—Saddle
(Carpometacarpal) Joint of the
Thumb
Figure 9-38
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Section 9.13—Saddle Joint of
the Thumb (cont’d.)
CMC Joint of the Thumb:
• Structure: Synovial joint
– Saddle
• Function: Diarthrotic
– Biaxial
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Section 9.13—Saddle Joint of
the Thumb (cont’d.)
Average Ranges of Motion:
•
•
•
•
•
•
Abduction
Adduction
Flexion
Extension
Medial rotation
Lateral rotation
60 degrees
10 degrees
40 degrees
10 degrees
45 degrees
0 degrees
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Section 9.13—Saddle Joint of
the Thumb (cont’d.)
Actions of the Thumb at the Saddle Joint:
Figure 9-39
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Section 9.13—Saddle Joint of
the Thumb (cont’d.)
Ligaments of the Saddle Joint:
•
•
•
•
•
•
Fibrous capsule
Radial collateral ligament
Ulnar collateral ligament
Anterior oblique ligament
Posterior oblique ligament
1st intermetacarpal ligament
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89
Section 9.13—Saddle Joint of
the Thumb (cont’d.)
Figure 9-40
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical
rehabilitation, ed 2, St Louis, 2010, Mosby
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90
Section 9.14—Intermetacarpal
Joints
Figure 9-41
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91
Section 9.14—Intermetacarpal
Joints (cont’d.)
{Insert Fig. 9-41 B only}
Figure 9-41
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92
Section 9.14—Intermetacarpal
Joints (cont’d.)
• Structure: Synovial joint
– Plane
• Function: Amphiarthrotic
– Nonaxial
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93
Section 9.15—
Metacarpophalangeal Joints
{Insert Fig. 9-42}
Figure 9-42
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94
Section 9.15—
Metacarpophalangeal (MCP)
Joints (cont’d.)
• Structure: Synovial joint
– Condyloid
• Function: Diarthrotic
– Biaxial
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95
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
• Major motions allowed:
– Flexion/extension
– Abduction/adduction
• Major ligaments:
– Fibrous capsules
– Radial collateral ligaments
– Ulnar collateral ligaments
– Palmar plates
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96
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
Figure 9-43
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97
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
Figure 9-43
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98
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
Figure 9-43
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99
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
Figure 9-44
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100
Section 9.15—
Metacarpophalangeal Joints
(cont’d.)
Figure 9-44
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101
Section 9.16—Interphalangeal
Joints of the Hand
{Insert Fig. 9-45}
Figure 9-45
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102
Section 9.16—Interphalangeal
Joints of the Hand (cont’d.)
• Structure: Synovial joint
– Hinge
• Function: Diarthrotic
– Uniaxial
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103
Section 9.16—Interphalangeal
Joints of the Hand (cont’d.)
Major Motions
Allowed:
• Flexion
• Extension
Figure 9-46
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104
Section 9.16—Interphalangeal
Joints of the Hand (cont’d.)
Major Ligaments of the IP Joints:
•
•
•
•
•
Fibrous capsule
Radial collateral ligaments
Ulnar collateral ligaments
Palmar plates
Check-rein ligaments (PIP joint only)
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105
Section 9.16—Interphalangeal
Joints of the Hand (cont’d.)
Figure 9-47
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved.
106
Section 9.16—Interphalangeal
Joints of the Hand (cont’d.)
Figure 9-47
Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved.
107