Ph.D., Dr. Dávid Lendvai
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1 General arthrology and myology. Joints, muscles and movements of the shoulder and the upper girdle Ph.D., Dr. Dávid Lendvai Anatomy, Histology & Embryology Institute Painting: Daniele Crespi: Pieta
2 General arthrology and myology After Ph.D., Dr. Márk Kozsurek
3 Joints between bones 1. Continuous joints (synarthroses): no gap, more stable but less mobile or completly immobile connections. Depending on the glue connecting bones: a) Fibrous joint (syndesmosis) = connective tissue (ligaments) b) Cartilaginous joint (synchondrosis) = cartilage c) Bony union (synostosis) = fusion of bones
4 a) Fibrous joints (syndesmoses) Connection is made by connective tissue composed of mainly collagen and/or elastic fibres. collagen-rich interosseous membrane between the radius and ulna
5 lumbarpucture, CSF sample elastic liggamenta flava connecting adjacent vertebral arches
6 gomphosis tibiofibular syndesmosis
7 serrate sutures
8 squamous sutures plane sutures
9 b) Cartilaginous joints (synchondroses) Adjacent bones are connected together by hyaline or fibrocartilage. The most of made of hyaline cartilage ossify by the end of puberty. pubic symphysis: as a gap appears inside, this is a transitional form between regular cartilaginous joint and synovial joint - hemidiarthrosis
10
11 sphenooccipital synchondrosis petrooccipital synchondrosis Later all these synchodroses transform into synostoses!
12 c) Bony unions (synostoses) The most of them was cartilagineous connection that later ossified.
13 Joints between bones 1. Continuous joints (synarthroses): no gap, more stable but less mobile or completly immobile connections. 2. Discontinuous joints (synovial joints, diarthroses): hyalin cartilage-covered articulating surfaces isolated by a synovial gap filled by synovial fluid and enclosed by a capsule.
14 General components of synovial joints 1) articulating surfaces determine available movements 2) articular capsule 3) synovial gap and fluid
15 Articular cartilage
16 Articular capsule fibrous membrane fibrocyte nuclei synovial membrane
17 SUBINTIMA INTIMA SLC: "synovial lining cells" epithelium-like connective tissue cells and macrophages synoviocytes (special fibroblasts)
18 Additional components of synovial joints articular ligaments articular lips articular disci, menisci articular muscles
19 Ligaments coracohumeral lig. coracoacromial lig. coracoclavicular lig. Can be a thickenned portion of the capsule (e.g. coracohumeral lig.) or a well defined structure (e.g. coracoacromial lig.). May contribute to the stability of the joint but can limit its movement, too.
20 glenoid labrum: fibroelastic ring that makes the shallow glenoid cavity somewhat deeper. Articular lips
21 acetabular labrum: fibroelastic ring that grabs the head of the femur over its equator
22 sternoclavicular joint: isolated into two noncommunicating cavities by the disk. Articular discs
23 temporomandibular joint (TMJ): discotemporal and discomandibular joints can be distinguished
24 knee joint: incongruence between femoral and tibial condyli is eliminated by fibrocartilagineous menisci Menisci
25 Articular muscle Popliteus muscle Frequently not an individual muscle but a smaller part of a skeletal muscle around the joint. Contracts during flexion and avoids inpinchment of the capsule by pulling the capsule apart.
26 Classification of joints according to the Uniaxial joints: number of axes a) ginglymus (hinge joint): axis of movement is perpendicular to the axis of articulating bones.
27 Uniaxial joints: b) trochoid joint (pivot joint): axis of rotation is parallel to the articulating bones e.g.: atlantooccipital joint
28 Biaxial joints: a) trochoginglymus (hinge-and-pivot joint): combination of the former two types e.g.: elbow joint
29 Biaxial joints: b) ellipsoidal joint : two perpendicular axes e.g.: wrist (radiocarpal) joint
30 Biaxial joint: c) saddle joint: carpometacarpal joint of the thumb
31 Multiaxial joint: a) spheroid joint (ball-and-socket)
32 Multiaxial joint: b) plane joint : limited gliding movement to each direction e.g.: joints of carpal and tarsal bones
33 Describing movements AXES 5: sagittal, 6: transverse, 7: longitudinal PLANES sagittal transverse frontal
34 Flexion extension Abduction adduction Rotation The most of the joints have their specific terms for describing their specific movements.
35 Clinical considerations Rheumatoid artritis Arthrosis
36 Mosaicplasty OATS: osteochondral autograft transfer system
37 Knee and hip prostheses
38 About muscles is general... fusiform biceps biventer plane Mobile end fixed end, origin insertion intersected unipennate bipennate Auxiliary features of muscles: Connective tissue sheaths, fasciae Tendon sheaths and synovial bursae Sesamoid cartilages or bones Fatty bodies
39
40 Note the homologous structure of the capsule, tendon sheaths and bursae: outer fibrous and inner synovial layers.
41 Tendon sheats might be considered as special bursae into which the tendon completly invaginates. Supplying small vessels as well as nerve fibres reach the thendon through the mesotendineum. mesotendineum
42 Mesotendineum is tipically directed toward a bony surface. Lifting the tendon sheath interrupts supplying vessels that leads to the necrosis of the tendons involved.
43 Muscle compartments isolated by fasciae fatty bodies
44 Axis of movement Sesamoid bones Due to the elongation of the moment arms, the same forces result in bigger torques.
45 Joints, muscles and movements of the shoulder and the upper girdle
46 Components of the joint Obligate elements of the joint: Head: caput humeri Socket: cavitas glenoidalis Cartilage Capsule: capsula articularis Ligaments: ligamenta Additional elements of the joint: bursa discs Fibrous cartilage lips Synovial vagina Rotator cuff
47 Shoulder joint (Articulatio humeri) Ball and socket (articulatio spheroidea) Total excursion of the upper limb and the shoulder joint under fixed, or unfixed shoulder. Képek: Benninghoff
48 Bony parts Sobotta Pernkopf Socket: glenoidal cavity Head: head of the humerus The aspect ratio of the head and the socket is ca. 1:6! - inkongruent - unstabil
49 Shoulder girdle Cingulum membri superioris: scapula + clavicule Sobotta Yokochi Fixing the "free" upper limb (membrum liberum superius) to the trunk (thorax) The movement of the bones of shoulder girdle will change their angle with each other Their displacements will increase the range of motion in the shoulder joint
50 Socket Yokochi Glenoidal fossa + Labrum glenoidale Sobotta Labrum glenoidale (earlier: limbus cartilaginis) Complete the edge, but it doesn't make much deeper
51 Capsule Feneis Loose Additional plica and recesses Originates above the glenoidal cavity and the labrum The supraglenoid tubercle is inside of it: The tendon of biceps brachii muscle is also runs inside of the capsule, The capsule covers the inter tubercular groove, and forms an intertubercular synovial vagina Pernkopf Insertion: anatomical neck of humerus Sobotta
52 Capsule Resting position Abducted position Recesses causing wide range of motion Benninghoff
53 Képek: Sobotta Joint of the shoulder girdle Acromioclavicular joint: acromial extremity of claviculae acromion (scapulae) Articular disc Acromioclaviculare ligament restricted free joint!! Articulatio sternoclavicularis: Sternal extremity of claviculae clavicular notch of the sternum Articular disc Ant. & post. Sternoclavicular lig. Interclaviculare lig. The clavicule in these joints can move in all directions. Most limited is the backwards-down movement restricted free joint!!
54 Movements Benninghoff along 3 privileged axis: sagittal: abduction (away) adductio (toward) Axis: through the center of the head of humerus transverse: anteflexio retroflexio tengely: through the center of the head of humerus longitudinal or rotation axis: outer rotation inner rotation Axis: between head and capitulum humeri Sobotta Range of motion of the shoulder joint if the shoulder girdle fixed Upwards in the most restricted (acromion, coracoacromial lig.)
55 Movements Benninghoff Range of motion of the shoulder joint if the shoulder girdle unfixed All the movements together: circumduction Sliding of the scapule Rotation Lift-off from the trunk Faller
56 Muscles Different classifications: According to the axes Origin insertion, as muscle groups (thoracohumeral, spinohumeral and shoulder muscles ) Functional couples ( agonists - antagonists, "muscle clamps" ) Around the shoulder joint just acting upon it acting upon (/as well) Benninghoff
57 Sobotta Shoulder muscles Benninghoff
58 Spinohumeral muscles Benninghoff
59 Thoracohumeral muscles 1 Benninghoff
60 Muscles Functional couples ( agonists - antagonists, "muscle clamps" ) Abductor muscles (around sagittal axis): deltoid m. (mostly acromial part), teres minor m., supra- &infraspinatus m., Trapezius m. (Upper part), serratus anterior m. (above the horizontal dressing muscle"), biceps brachii m. (long head of it) Adductor muscles (around sagittalis axis): deltoid m. (spinal &clavicular part), teres major m., latissimus dorsi m., lower part of trapezius m., biceps brachii m. (short head), triceps brachii m. (long head), coracobrachial,m.,nfra- Spinatus m. (lower part) Képek: Benninghoff
61 Muscles Ante flexors: deltoid m. (mostly clavicular part), pectoralis major m.(mostly clavicular part), coracobrachialis m., biceps brachii m. Retro flexors: latissimus dorsi m. ( apron binding muscle"), deltoid m. (spinal part), teres major m. Képek: Benninghoff
62 Muscles Outer rotators : deltoideus m. (mostly spinal part), supra- & infraspinatus m., teres minor m. Internal rotators: deltoid m. (mostly spinal part), teres major m., latissimus dorsi m., coracobrachialis m., biceps Brachii m., subscapularis m., Képek: Benninghoff
63 Rotator cuff Supraspinatus m. Infraspinatus m. The most important factor, is to keep the head inside of shoulder joint External and intra-articular pressure difference Teres minor m. Subscapularis m. Sobotta
64 (Bursae) Faller 2. Subcutanous acromial bursa 3. Subacromial bursa 4. Subdeltoid bursa 5. Subtendineal bursa subscapularis m. 6. Subtendinea bursa latissimi dorsi m. 7. Subtendinea bursa teretis majoris m. 8. Subtendinea bursa pectoralis majoris m. 9. Subtendinea bursa infraspinati m.
65 Muscle chains Faller Rhomboid Mm. Serratus anterior m. (lower fibres ) (1-2) Trapezius m. (ascending part) Levator scapulae m. (5-6) Trapezius m. (descending part) Pectoralis minor m. (7-8) Trapezius (transverse part) Serratus anterior m. (horizontal fibres) (3-4)
66 Benninghoff
67 Benninghoff
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