SPECIAL ARTHROLOGY
Connections of the upper limb
(juncturae ossium membri superioris)
RNDr. Michaela Račanská, Ph.D.
Lecture 8 – DENTISTRY
Connections of the girdle:
scapula + clavicle – art. acromioclavicularis
clavicle + sternum – art. sternoclavicularis
Syndesmoses of the shoulder blade
Connections of the free upper limb:
Humerus + scapula – art. humeri
Humerus + radius + ulna – art. cubiti
Radius + ulna – membrana interossea antebrachii
– art. radioulnaris distalis
Radius + carpal bones– art. radiocarpea
Carpal bones – art. mediocarpea
carpal + metacarpal bones– art. carpometacarpea
Metacarpal bones + phalanges proximales – art. metacarpophalangea
Phalanges – art. interphalangea manus
I. Articulatio sternoclavicularis
Type: compound joint- discus articularis
ball and socket (movements in connection to the scapula
movements)
A. head: facies articularis sternalis claviculae
A. fossa: incisura clavicularis manubrii sterni
AC: tough, short
Ligaments:
lig. sternoclaviculare anterius
lig. sternoclaviculare posterius
lig. interclaviculare
lig. costoclaviculare
Movements: small, to all direction
Type: ball and socket, sometimes discus articularis
AS: facies art. acromialis (clavicula) + facies art. acromii (scapula)
AC: tough, short
ligaments:
lig. acromioclaviculare
lig. coracoclaviculare (lig. trapezoideum + lig. conoideum)
lig. coracoacromiale - fornix humeri
lig. transversum scapulae
movements:
restricted, in connections with movements in sternoclavicular joint
II. Articulatio acromioclavicularis
Syndesmoses of the shoulder blade:
- lig. transversum scapulae
- lig. coracoacromiale - fornix humeri
Movements of the scapula:
- Retraction
- Protraction
- Elevation
- Depresion
- Rotation
Glenohumeral joint (art. humeri)
 Ball-and-socket type of joint → wide range of movement ARTHRODIA (its mobility makes the
joint relatively unstable)
 AS: humeral head articulates with the relatively shallow glenoid cavity of the scapula – deepened
by the ring-like fibrocartilaginous glenoid labrum
 AC: from the margins of the pits to the collum anatomicum humeri, at the ventral side makes
synovial layer around the long head of biceps
 Ligaments:
 lig. coracohumerale
 ligg. glenohumeralia
 lig. coracoacromiale (fornix humeri)
 Bursa subacromialis, subcoracoidea,
subdeltoidea
MOVEMENTS:
Ventral and dorsal flexion
abduktion
(from the horizontal plane together
with movements of the scapula)
adduktion
rotation - supination, pronation
Middle position:
Slow flexion and small abduktion
Articulations of the forearm
ELBOW JOINT (ART. CUBITI)
Type: compound joint
Articulatio humeroulnaris
Type: hinge
A. head: trochlea humeri
A. fossa: incisura trochlearis ulnae
Articulatio humeroradialis
Type: ball and socket
A. head: capitulum humeri
A. fossa: fovea articularis radii
Articulatio radioulnaris proximalis
Type: pivot
A. head: circumferentia articularis radii
A. fossa: incisura radialis ulnae
AC: common for all three parts, attach to the margins of AS, at radius to the collum - recessus sacciformis
Ligaments:
lig. collaterale radiale
lig. collaterale ulnare
lig. obliquum
lig. anulare radii
Movements: flexion, extension
Art. radioulnaris proximalis together
with art. radioulnaris distalis – pronation and supination
Middle position: in slight flexion and pronation
SYNDESMOSES RADIOULNARIS
Interosseous membrane (chorda obliqua)
Distal Radioulnar Joint (pivot)
head of the ulna articulates with the ulnar
notch on the medial side of the distal end of
the radius
AC: free, anables rotation of the distal part of
the radius around the head of the ulna
articular disc binds the ends of the ulna and
radius together
movements - supination and pronation
ARTICULATIO RADIOCARPALIS
Radius and carpal bones
ARTICULATIO MEDIOCARPALIS
between proximal and distal row of carpal bones
ARTICULATIONES INTERCARPALES
conections between carpal bones
ARTICULATIONES CARPOMETACARPALES
distal row of carpal bones with metacarpals
ARTICULATIONES INTERMETACARPALES
between bases of metacarpal bones
ARTICULATIONES METACARPOPHALANGEALES
heads of the metacarpals with the proximal row of
phalanges
ARTICULATIONES INTERPHALANGEALES
Between phalanges
retinaculum musculorum flexorum
(lig. carpi transversum)
between eminentia carpi radialis et ulnaris -> canalis carpi
Articulationes manus
Articulatio radiocarpalis
Type: compound, ellipsoid
A. head: os scaphoideum, os lunatum, os triquetrum
A. fossa: facies articularis carpalis radii, discus articularis
AC: firm and short
Ligaments: common with art. mediocarpalis
Movements: functional unit with medicarpal, intercarpal, carpometacarpal joints
Palmar and dorsal flexion
radial and ulnar duktion
circumduktion
Articulatio mediocarpalis
Type: elipsoid, compound, in the shape of horizontaly placed "S"
A. head, ulnar side: os hamatum, os capitatum
A. head, Radial side: os scaphoideum
A. fossa, ulnar side: os scaphoideum, os lunatum, os triquetrum
A. fossa, radila side: os trapezium, os trapezoideum
AC: firm and short
ligaments:
lig. intercarpea dors., ventr., interossea
lig. radiocarpale palmare et dorsale
lig. ulnocarpale palmare et dorsale
lig. carpi radiatum
lig. collaterale carpi radiale et ulnare
Movements:
functional unit with mediocarpal, intercarpal
and carpometacrapal joints
Palmar and dorsal flexion,
Radial and ulnar duktion, cirkumduktion
midle position: same as the anatomical one
- Wrist and digits are in continuation of the forarm long axes
Articulatio ossis pisiformis:
os pisiforme and os triquetrum - amphiarthrosis
lig. pisohamatum
lig. pisometacarpeum
(continuation of the tendon of m. flexor carpi ulnaris)
Articulationes intercarpales
Connection of bones of the proximal and distal row of the wrist
• ligg. intercapalia dorsalia
• ligg. intercarpalia palmaria
• ligg. intercarpalia interossea
Articulationes carpometacarpales II.-V.
Type: compound
AS: base of the MC II - os trapezium, os trapezoideum, os
capitatum
base of the MC III - os capitatum
base of the MC IV and V - os hamatum
MC bases in between
AC: short, tough
ligaments:
ligg. carpometacarpalia dorsalia
ligg. carpometacarpalia palmaria
ligg. carpometacarpalia interossea
ligg. metacarpea palm., dors., interossea
Movements: amphiarthrosis
Articulatio carpometacarpalis pollicis
Type: saddle
AH: basis ossis metacarpale I
AF: os trapezium
AC: free
Movements: abduktion, adduktion
oposition, reposition
Articulationes intermetacarpales
Ligg. intermetacarpalia
Art. metacarpophalangeales
Type: ball and socket
AH: caput ossis metacarpalis
AF: basis phalangis
AC: free
Ligaments:
ligg. collateralia
ligg. palmaria - fibrocartilago palmaris
lig. metacarpale transversum profundum
Movements: flexion a etension
abduktion and adduktion – in not flexed finger
Type: hinge
AH: caput (trochlea) phalangis
AF: basis phalangis
AC: free
Ligaments:
ligg. collateralia
ligg. palmaria - fibrocartilagines palmares
Movements: flexion and extension
Articulationes interphalangeales
Connection of the lower limb
bones
(juncturae ossium extremitatis inferioris)
includes connection of pelvic girdle and free part of lower limb
Connection of pelvic girdle (juncturae ossium cinguli extremitatis
inferioris)
1. Sacroiliac joint (Articulatio sacroiliaca)
Articular surfaces: facies auriculares ossis sacri et illii
Articular capsule: tight and is attached to margins of AS
Auxiliary facilities: capsule is strengthened by ligg. sacroiliaca ventralia and
dorsalia (ventral and dorsal sacroiliac ligaments), ligg.sacroiliaca interossea
(interosseal sacroiliac ligaments)
Type of joint: amphiartrosis
2. Symphysis pubica
Is formed by cartilagenous discus interpubicus which connects both pubic
bones. Symphysis pubica is 4,5 – 5 cm in hight.
lig. pubicum superius and stronger lig. arcuatum pubis
3. Membrana obturatoria
a stiff membrane which closes foramen obturatum (canalis obturatorius)
4. Ligaments in the pelvic region
Lig. sacrospinale (Sacrospinal ligament)
Lig. sacrotuberale (Sacrotuberal ligament)
Foramen ischiadicum majus (Greater sciatic foramen)
Foramen suprapiriforme and foramen infrapiriforme (Supra- and
infrapiriform foramen)
Foramen ischiadicum minus (Lesser sciatic foramen)
Lig. iliolumbale
5. Pelvis
Aditus pelvis (the pelvic inlet) is bordered by linea terminalis which
separates pelvis major and pelvis minor.
Exitus pelvis (the pelvic outlet) is the region between the subpubic angle,
tubera ischiadica and os coccygis.
Pelvis minor (lesser pelvis) is „true pelvis“ (genital organs, a part of urinary
system), an important childbirth way in female and it has great intersexual
differences.
Sexual differences of pelvis
Male pelvis is higher and narrower.
Female pelvis is lower and wider than in the male.
arcus pubicus (subpubic arch)
ala ossis ilii (ala of iliac bone)
tubera ischiadica (sciatic tuberosity)
symphysis pubis
angulus x arcus subpubicus (subpubic angle x arch)
shape of aditus pelvis (shape of pelvic inlet)
incisura ischiadica major (greater sciatic notch)
Length of superior ramus of pubic bone – prominence of mons pubis
Foramen obturatum
Os sacrum
Internal diameters of pelvis
1. Aditus pelvis = apertura pelvis superior (inlet) transverse diameter about 13 cm
2. Amplitudo pelvis (width of pelvis) about 12 cm
3. Angustia pelvis (narrow part of bone pelvis) about 10 cm
4. Exitus pelvis = apertura pelvis inferior (outlet) about 9 cm
5. Conjugata diagonalis 12.5 – 13 cm (per vaginam)
Inclinatio pelvis
B. External diameters of pelvis
Distantia bispinalis (bispinal diameter) (about 26 cm)
Distantia bicristalis (bicristal diameter) (about 29 cm)
Distantia bitrochanterica (bitrochanteric diameter) (about 31 cm)
Distantia bituberalis (bituberal diameter) (about 12 cm)
Conjugata externa (min. 18 cm)
Connection of free part of lower limb
(juncturae ossium extremitatis liberae inferioris)
1. Articulatio coxae (hip joint)
Articular surfaces: facies lunata of an acetabulum !!!!! + head of the femur
Articular capsule: is attached to the margins of acetabulum. It reaches ventrally
linea intertrochanterica of femur, dorsally is attached to the collum femoris (neck of
femur) medially away from fossa trochanterica.
Auxiliary facilities :
a) Labrum acetabulare formed by cartilage.
b) Lig. transversum acetabuli runs through incisura acetabuli.
c) Lig. iliofemorale
d) Lig. pubofemorale
e) Lig. ischiofemorale
f) Zona orbicularis
g) Lig. capitis femoris
Type of joint: typical spheroid joint (ball-and-socket) with limited movements
(enarthrosis).
Movements – flexion, extension, abduction, adduction and internal and external
rotation.
Total endoprosthesis of hip joint
2. Articulatio genus (knee joint)
Articular surfaces:
Articular capsule: is strong, attached proximally a little above articular surface of the
femur.
Capsula synovialis lines all articular cavity and runs from the sides to intraarticular
ligaments and continues ventrally as a plica synovialis patellaris (synovial patellar
plica), ventraly is divided into two plicae alares (alar plicae).
Intraarticular auxiliary facilities of an articulatio genus (knee joint):
1. Meniscus – Medial and lateral
2. Ligamenta cruciata genus – anterius - limits extension and medial rotation
posterius - limits extension and keeps stability of the joint
Synovial membrane and position of corpus adiposum genus
2.Extraarticular auxiliary facilities (articulatio genus)
a) lig. patellae - tendon of m. quadriceps femoris
b) retinacula patellae mediale and laterale
c) lig. collaterale tibiale (collateral tibial ligament)
d) lig. collaterale fibulare (collateral fibular ligament)
e) lig. popliteum obliquum (oblique popliteal ligament)
Arthroscopy
Type of joint: hinge joint (trochlear)
Movements: flexion and extension.
During a mild flexion is possible slight external and internal rotation.
Middle position of the joint – mild flexion
Bursae synoviales
Suprapatellaris, praepatellaris (subcutanea)
3. Juncturae tibiofibulares (Tibiofibular connections)
Consist of articulatio tibiofibularis, membrana interossea cruris and syndesmosis
tibiofibularis.
A. Articulatio tibiofibularis (tibiofibular joint)
Articular surfaces:
Articular capsule: is short, stiff and attached to….
Auxiliary facilities : lig. capitis fibulae anterius and posterius
Type of joint kloubu: plane, slight movements ahead and back.
B. Membrana interossea cruris
stiff membrane. Serves as a place of attachment for some muscles.
C. Syndesmosis tibiofibularis = fibrous joint between distal
ends of tibia and fibula
In incisura fibularis tibiae is placed distal end of fibula. Syndesmosis
is reinforced by lig. tibiofibulare anterius and lig. tibiofibulare posterius
(tibiofibular anterior and posterior ligaments).
Articulationes pedis (Joints of foot)
1. Articulatio talocruralis (Talocrural joint)
2. Articulationes intertarseae (Intertarsal joints)
Articulatio subtalaris (subtalar joint)
Art. talocalcaneonavicularis (talocalcanear joint)
Art. calcaneocuboidea (calcaneocuboid joint)
„Articulatio tarsi transversa“ (Chopart´s joint)
Articulatio cuneonavicularis (Cuneonavicular joint)
Articulatio cuneocuboidea (Cuneocuboid joint)
3. Articulationes tarsometatarseae (Tarsometatarsal
joints) – Lisfranck´s joint)
4. Articulationes metatarsophalangeae (Metatarsophalangeal joints)
5. Articulationes interphalangeae pedis (Interphalangeal joints)
A. Articulatio talocruralis (talocrural joint)
Articular surfaces:
Articular capsule: is attached to …
Auxiliary facilities: Lig. collaterale mediale consists of four parts running from medial
ankle to adjacent bones (pars tibionavicularis, tibiotalaris anterior, tibiotalaris
posterior and pars tibiocalcanearis).
From the lateral ankle run three ligaments: lig. talofibulare anterius, lig. talofibulare
posterius and lig. calcaneofibulare.
Type of the joint: hinge joint, movements – plantar and dorsal flexion, slight side-toside
movements.
B. Articulationes intertarseae (Intertarsal joints)
a) Articulatio subtalaris (Lower ankle joints)
Articular surfaces: facies articularis calcanea posterior and facies
articularis talaris posterior.
Articular capsule: is short and is attached to…
Auxiliary facilities: lig. talocalcaneum laterale, mediale and inside of
sinus tarsi is located lig. talocalcaneum interosseum.
Type of joint: together with art. talocalcaneonavicularis and
calcaneocuboidea - functional unit.
Axis of movements - through sinus tarsi, inner rotation (pronation) and
external rotation (supination).
b) Articulatio talocalcaneonavicularis (Talocalcaneonavicular joint)
Articular surfaces: facies articularis calcanea anterior and media of talus and facies
articularis talaris anterior and media of calcaneus, caput tali and articular surface of os
naviculare.
Articular capsule: very thin and is attached to ….
Auxiliary features: lig. calcaneonaviculare plantare. Dorsally forms lig.
calcaneonaviculare dorsale a part of lig. bifurcatum. Small dorsal, plantar and
interosseal ligaments join talus, calcaneus and os naviculare.
Type of joint: together with art. subtalaris and calcaneocuboidea form a functional unit.
The axis of movements - through sinus tarsi, inner rotation (pronation) and external
rotation (supination).
c) Articulatio calcaneocuboidea (Calcaneocuboid joint)
Articular surfaces:
Articular capsule: thin and is attached to……..
Auxiliary features: lig. calcaneocuboideum dorsale (a part of lig. bifurcatum),
lig. plantare longum and small ligaments between bones.
Type of joint: amphiarthrosis.
d) Chopart´s joint – articulatio tarsi transversa – it is a fissure between
talus and os naviculare medially and between calcaneus and os
cuboideum laterally. Opening of this fissure - by cut of lig. bifurcatum (lig.
calcaneonaviculare and lig. calcaneocuboideum).
e) Articulationes cuneonavicularis, cuneocuboidea and
intercuneiformia are joints between adjacent tarsal bones; dorsal, plantar
and interosseous ligaments.
C. Articulationes tarsometatarseae (Lisfranc´s joint)
Joint consists of three separated joints:
Articular surfaces:
Articular capsule: is thin and is attached to …
Auxiliary facilities: lig. tarsometatarsea dorsalia, plantaria and interossea.
Type of joint: amphiarthrosis, slight movements, specially during loading of
plantar arch.
Between bases of metatarsal bones - (articulationes intermetatarseae)
– lig. metatarsea dorsalia, plantaria and interossea.
In the fissure of Lisfranc´s joint could be exarticulated toes of the foot.
D. Articulationes metatarsophalangeae
Articular surfaces:
Articular capsule: is attached to ….
Auxiliary facilities: fibrocartilagines plantares, in the joint of the big toe are two
ossa sesamoidea. Collateral ligaments and lig. metatarseum transverum
profundum.
Type of joint: art. spheroidea (ball-and-socket joint), their mobility is restricted by
collateral ligaments – flexion, extension, abduction and adduction.
E. Articulationes interphalangeae pedis
Articular surfaces:
Articular capsule: are attached to …. dorsally fuse with
tendons of extensor muscles.
Auxiliary facilities: collateral ligaments, fibrocartilagines
plantares
Type of joint: art. trochlearis (hinge joint) - flexion and
extension of phalanges.
F. Plantar arch protects (vessels, nerves) before press, especially during
long standing. Weight-bearing points are tuber calcanei and caput of the I. and
V. metatarsal bones.
Two longitudinal plantar arches (medially talus, os naviculare and ossa
cuneiformia and the I.–III. metatarsus, lateraly calcaneus, os
cuboideum and the IV. – V. metatarsus) and one transverse arch
(ossa cuneiformia).
Medial plantar longitudinal arch is higher. Plantar arch is supported by
ligaments and muscles of the foot.
Transverse plantar arch is done by the shape and position of the
cuneiform bones (ossa cuneiformia), and it is carried by m. fibularis
longus mainly.
Longitudinal plantar arch
Lig. plantare longum, m. tibialis posterior et anterior, flexors of toes, aponeurosis plantaris
Transverse plantar arch
m. fibularis longus
m. tibialis ant.
transverse ligaments
Position of calcaneus – normal foot
and flatfoot („Flatfoot“ – pes planus – severe pain
in the foot and leg occurs, due to overstretching
of the long muscles and nerves and vessels of the sole.
Pes planus
Pes planovalgus
Pes cavus
Used pictures come from:
Moore, K. L. (1992): Clinical oriented anatomy. Third edition.
Williams&Wilkins, A Waverly Company.
Gilroy, A. M. et all. (2009): Atlas of Anatomy. Thieme New York, Stuttgart.
Putz, R. (2008):
Atlas of Human Anatomy Sobotta. Elsevier Books.
Platzer, W., Kahle, W., Leonhardt H. (1992):
Locomotor system. Georg Thieme Verlag, Stuttgart,
New York, 4th edition.
Čihák, R. (1987): Anatomie 1. Avicenum, Zdravotnické nakladatelství.
Thank you for your attention!!
The pictures for the presentation were taken from:
Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage.
München:Urban & Schwarzenberg, 1993
Netter: Interactive Atlas of Human Anatomy.
Naňka, Elišková: Přehled anatomie. Galén, Praha 2009.
Čihák: Anatomie I, II, III.
Drake et al: Gray´s Anatomy for Students. 2010
Archiv of the lecturer, archiv of the Department of Anatomy, MU, Brno