Shoulder Connections

· synovial, intermittent connections, i.e. joints: sternoclavicular, acromioclavicular;

· fibrotic, continuous connections: proper ligaments of the scapula - coraco-acromial, upper transverse above the notch of the scapula along the upper edge, lower transverse - between the base of the acromion and the posterior edge of the glenoid cavity of the scapula; clavicular costal ligament - between the lower surface of the sternal end of the clavicle and the first rib.

sternoclavicular joint- flat or saddle-shaped, with three axes, but limited range of motion, complex (presence of a disc) and combined (simultaneous work with the acromioclavicular joint).

The joint includes:

articular surfaces on the handle of the sternum in the form of a clavicular notch;

at the sternal end of the clavicle - the articular surface is flat or saddle-shaped

Articular capsule reinforced with ligaments: anterior and posterior sternoclavicular and interclavicular;

The joint cavity and the articular disc inside it, which contributes to the compatibility of the articular surfaces and divides the cavity into two chambers.

acromioclavicular the joint is a flat shape with three axes, but a small range of motion, in the presence of a disc in 1/3 of cases - a complex and combined joint.

He has:

flat or curved articular surfaces inclined towards each other;

The articular capsule, strengthened by the acromioclavicular and coracoclavicular ligaments, in the latter, the trapezoid and cone-shaped parts are distinguished; both powerful ligaments severely limit the mobility of the joint;

The joint cavity, lined with a synovial membrane, in the presence of a disc, it is divided into two chambers.

Lifting around the frontal axis is carried out with the help of the muscles: levator scapula, rhomboid, sternocleidomastoid, trapezius, which are supplied with blood by the transverse artery of the neck, superficial and ascending cervical arteries, superior thyroid, suprascapular, occipital and posterior intercostal arteries. Innervated these muscles are accessory nerve (XI pair) and short nerves of the brachial plexus: thoracodorsal, posterior scapular, as well as muscular branches of the cervical plexus.

Lowering around the frontal axis occurs with the lower bundles of muscles: trapezius, serratus anterior, pectorals: small and large - the blood supply of which, in addition to the trapezius, comes from the thoracoacromial, anterior and posterior intercostal, thoracodorsal and thoracic lateral arteries, and the innervation - pectoral, long thoracic nerves of the brachial plexus.

Movement anteriorly and laterally along the sagittal axis occurs with the help of the muscles: trapezius, rhomboid and latissimus dorsi, which are supplied with blood by the thoracodorsal artery surrounding the shoulder, and posterior intercostal; innervated by the thoracodorsal nerve of the brachial plexus.

The movements of the scapula posteriorly and to the medial side are carried out by the trapezius and rhomboid muscles, and through the humerus - the latissimus dorsi muscle. The turn of the scapula with the lower angle outward is performed by the serratus anterior muscle with its lower bundles and the trapezius muscle with its upper bundles, and the lower angle to the spine (medially) is rotated by the rhomboid muscles and the pectoralis minor.

20(II) Shoulder joint

The shoulder joint is formed by the articulation of the head of the humerus with the articular cavity of the scapula, which is complemented by a cartilaginous articular lip of a triangular section. The outer fibrous sheet of the capsule is attached along the anatomical neck of the shoulder, excluding the large and small tubercles and along the edge of the articular lip and the cavity of the scapula. At the top, it is thickened and strengthened by a powerful coraco-brachial ligament. In addition, the capsule is strengthened by the tendons of the supra- and infraspinatus, subscapularis and small round muscles, which are attached to the large and small shoulder tubercles. The synovial sheet of the capsule forms around the tendon of the long head of the biceps, passing through the joint, an intertubercular synovial sheath of a finger-shaped form (vagina synovialis intertubercularis). At the base of the coracoid process there is a dry synovial bag of the subscapularis muscle, which communicates with the joint cavity.

In terms of shape and structure, the shoulder joint is simple and spherical and has a large range of motion along three axes - frontal (flexion and extension within 120 °), sagittal (abduction and adduction - 100 °) and vertical (rotation - 135 ° and circular rotation together with the forearm and brush).

This range of motion is facilitated by a spacious joint cavity with a thin and movable capsule, rounded and different-sized articular surfaces, and an abundance of powerful muscles around the joint. The capsule is thinnest in front, behind and on the inside - therefore, dislocations of the head occur in these directions.

The shoulder girdle, or upper limb girdle, is a bony structure that connects to and supports the upper limbs. It consists of the clavicles on the anterior surface of the chest and the shoulder blades lying on the back of the chest.

The upper limbs are connected to the skeleton through the shoulder girdle, which consists of the clavicles and shoulder blades. He, in turn, has only one connection with the axial skeleton - the inner end of the clavicle, which joins the joint to the sternum. The stability of the shoulder girdle is provided by the muscles and ligaments attached to the skull, ribs, sternum and vertebrae.

Collarbone

Joints of the clavicle

In addition, the articulation is stabilized by the costoclavicular ligament, which connects the lower surface of the clavicle to the first rib. In the sternoclavicular joint, only a small range of motion is possible. The outer end of the clavicle may rise when the shoulder is lifted, or move forward when the person raises their arms in front of them.

The acromioclavicular joint is formed by the outer end of the clavicle and the acromial process of the scapula. This joint allows the scapula to rotate relative to the collarbone under the influence of the muscles that connect it to the rest of the skeleton.

shoulder blade

The shoulder blades are located on both sides of the chest between the muscles of the back at the level from the 2nd to the 7th pair of ribs. These bones in the form of an irregular triangle have three edges: medial (internal), lateral (external) and superior - and three angles: superior, inferior and lateral.

surfaces

bony prominences

Pterygoid scapula

As a result, the inner edge and lower angle of the scapula move outward from the chest, and the scapula rises like a wing, which is most noticeable when the hand presses on a door or wall. Therefore, this condition is called a pterygoid scapula.

The human body. Outside and inside. №44 2009

Shoulder blades, upper limbs, hands.
What are the functions of the scapula (shoulders)?
Human hands perform many different movements. The arms are not as strong as the lower limbs, but they are capable of a variety of manipulations with which we can explore and learn about the world around us. The upper limb consists of four segments: the shoulder girdle, shoulder, forearm and hand. The skeleton of the shoulder girdle is formed by the clavicle and shoulder blades, to which the muscles and the upper part of the sternum are attached. Through the joint, one end of the clavicle is connected to the upper part of the sternum, the other to the shoulder blade. On the scapula is located the articular cavity - a pear-shaped depression, into which the head of the humerus enters. Shoulders can be lowered, raised, retracted back and forth, i.e. shoulders provide the maximum range of motion of the upper limbs.
The structure of the hand
The shoulders and hands are connected by means of the humerus, ulna and radius bones. All three bones are connected to each other with the help of joints. At the elbow joint, the arm can be bent and extended. Both bones of the forearm are connected movably, therefore, during movement in the joints, the radius rotates around the ulna. The brush can be rotated 180 degrees!
The structure of the brush
The carpal joint connects the hand to the forearm. The hand consists of a palm and five protruding parts - fingers.
The arm is attached to the body through the bones of the shoulder girdle, joints and muscles. Consists of 3 parts: shoulder, forearm and hand.
Shoulder blades, upper limbs, hands includes 27 small bones. The wrist consists of 8 small bones connected by strong ligaments. The bones of the wrist, articulating with the bones of the metacarpus, form the palm of the hand. Attached to the bones of the wrist are 5 bones of the metacarpus. The first metacarpal is the shortest and flattest. It connects to the bones of the wrist through a joint, so a person can freely move his thumb, move it away from the rest. The thumb has two phalanges, the other fingers have three.
Muscles of the shoulder girdle, arms and hands
The muscles of the arm are represented by the muscles of the shoulder, forearm and hand. Most of the muscles that move the hands and fingers are located in the forearm. Most of them are long muscles. With the participation of the muscles of the tendon, located near the bones of the wrist, perform a flexion-extensor function. Tendons are firmly held by ligaments and connective tissue. Muscle tendons run through canals. The walls of the channels are lined with a synovial membrane, which ends at the tendons and forms their synovial sheaths. The fluid in the vagina acts as a lubricant and allows the tendons to glide freely.
Biceps brachii (biceps)
The biceps brachii (biceps) is connected to the forearm by ligaments and tendons. The upper part of the muscle is divided into two heads, which are attached to the shoulder blade by means of tendons. At the site of their attachment is a synovial bag. The main function of the biceps of the shoulder performs when bending and raising the arm, therefore, in people doing hard physical work or actively involved in sports, these muscles are very well developed.
Triceps brachii (triceps)
The bundles of all three parts of the muscle are connected into one and pass into the tendon. At the point where the muscle passes into the tendon, there is a synovial bag (Latin bursa olecrani). The triceps muscle, located on the back of the shoulder, and the deltoid muscle (lat. T. deltoideus), located above the shoulder joint, are attached to the shoulder blade. The shoulder blade is supported by the levator muscle. Other muscles of the shoulder girdle are located in the chest and neck.

The structure and topography of the bones of the shoulder girdle (collarbone, scapula)

The skeleton of the girdle of the upper limb (shoulder girdle) is formed by two paired bones: the scapula and the clavicle.

The scapula (scapula) is a flat bone, two surfaces are distinguished on it - costal and dorsal, three edges - upper, medial and lateral, three corners - lateral, upper and lower. The lateral angle is thickened, it has a glenoid cavity for articulation with the humerus. Above the glenoid cavity is the coracoid process. The costal surface of the scapula is concave and is called the subscapular fossa (the subscapularis muscle starts from it). The dorsal surface is divided by the spine of the scapula into two pits - supraspinatus and infraspinatus (they contain the muscles of the same name). The spine of the scapula ends with a protrusion - the acromion (shoulder process). It has an articular surface for articulation with the clavicle.

The clavicle (clavicula) is an s-shaped curved bone, has a body and two ends - the sternal and acromial. The sternal end is thickened and connects to the handle of the sternum, the acromial end is flattened and connects to the acromion of the scapula.

The structure of the bones of the free upper limb (humerus, bones of the forearm and hand)

Humerus (humerus) - a long tubular bone, consists of a body and two ends. At the proximal end there is a head, separated from the rest of the bone by an anatomical neck. Below the anatomical neck on the outside there are two elevations: a large and small tubercles, separated by an intertubercular groove. Distal to the tubercles is the surgical neck - this is a slightly narrowed area of ​​\u200b\u200bthe bone (here most often the bone breaks). The upper part of the body of the humerus is cylindrical in shape, and the lower is trihedral. The distal end of the bone is thickened and is called the condyle of the humerus. On the sides it has protrusions - the medial and lateral epicondyles. Below is the head of the condyle of the humerus for connection with the radius and the block of the humerus for articulation with the ulna. Above the block in front is the coronary fossa, in the back - a deeper fossa of the olecranon (the processes of the same name of the ulna enter into them).

The bones of the forearm - the radius is located laterally, the ulna - medially. Both are long tubular bones.

Bones of the hand (ossa manus) - bones of the wrist, metacarpal bones and phalanges (fingers).

The bones of the wrist are arranged in two rows. Proximal row (in the direction from the radius to the ulna): navicular, lunate, triquetral, pisiform bones. The first three bones are arcuately curved, forming an elliptical surface for articulation with the radius. Distal row: bone - trapezium, trapezoid, capitate and hamate bones. The bones of the wrist on the back form a bulge, and with the palmar - a concavity in the form of a gutter.

Metacarpal bones - there are 5 of them, these are short tubular bones. Each has a base, body and head. The bones are counted from the side of the thumb (I, II, etc.).

The phalanges of the fingers are tubular bones. The thumb has two phalanges: proximal and distal, and the remaining fingers have three phalanges: proximal, middle and distal. Each phalanx has a base, body and head.

I. JOINTS OF BONES OF THE BELT OF THE UPPER LIMB.

The clavicle connects to the sternum and shoulder blade. It communicates with the sternum through sternoclavicular joint , articulation sternoclavicularis (fig.17). The articular surfaces are the saddle surface of the sternal end of the clavicle and the clavicular notch of the manubrium of the sternum. Between these surfaces is the articular disc, discus articularis, dividing the articular cavity into two capsules.

The joint capsule is strengthened by three ligaments: front and posterior sternoclavicular, ligg. sternoclavicularia anterius et posterius, and costoclavicular, lig. costoclaviculare. The costoclavicular ligament is very strong, connects the lower surface of the sternal end of the clavicle with the upper surface of the cartilage of the 1st rib.

Figure 17. Sternoclavicular joints (front view). 1 - discus articularis; lig. interclaviculare; 2-lig. interclaviculare; 3-lig. sternoclaviculare anterius; 4 - clavicula; 5-lig. costoclaviculare; 6, costa I; 7 - manubrium sterni.

The upper posterior surfaces of the sternal ends of both clavicles are connected by passing over the jugular notch interclavicular ligament, lig. interclaviculare.

The joint is simple, complex, flat, triaxial (multiaxial). Around the sagittal axis, the clavicle rises and falls, and around the vertical axis, the clavicle moves forward and backward. Rotational movements of the clavicle around its longitudinal frontal axis are possible, but only when working together with the shoulder joint, with flexion and extension of the free upper limb in it.

Figure 18. Right acromioclavicular and shoulder joints. 1-lig. coracoacromiale; 2-lig. trapezoideum; 3-lig. conoidum; 4 - clavicula; 5 - processus coracoideus; 6 - tendo m. bicipitis brachii (caput longum); 7 - capsula articularis; (8) labrum glenoidale; 9 - cavitas glenoidalis; 10 - acromion; 11-lig. acromioclaviculare; 12 - art. acromioclavicularis.

The clavicle is connected to the scapula by acromioclavicular joint , articulation acromioclavicularis (fig.18). The articular surfaces are located at the acromial end of the clavicle and the inner edge of the acromion of the scapula. Between these surfaces in 1/3 of cases there is an articular disc, discus articularis.

The joint capsule is strengthened by two ligaments: from above - acromioclavicular, lig. acromioclaviculare, below - coracoclavicular, lig. coracoclaviculare. The last ligament is formed from two ligaments starting from the base of the coracoid process of the scapula and ending on the cone-shaped tubercle of the clavicle (lig. conoideum) and on its trapezoid line (lig. trapezoideum).

Morphofunctional characteristics of the joint. The joint is simple, complex in 1/3 cases, flat, low-amplitude movements occur around three axes.

Ligaments of the scapula. The scapula has three ligaments of its own, which have nothing to do with the described joints. Coracoacromial ligament, lig. coracoacromiale, stretched between the acromial and coracoid process of the scapula above the shoulder joint and prevents excessive abduction of the free upper limb in the shoulder joint.

Superior transverse ligament, lig. transversum scapulae superius, is located above the notch of the scapula, turning it into a hole.

Inferior transverse ligament of scapula, lig. transversum scapulae inferius, located between the base of the acromion and the posterior edge of the glenoid cavity of the scapula.

Elevation of the collarbone and scapula- m. levator scapulae, mm. rhomboidei, m. sternocleidomastoideus, m. trapezius (upper bundles)

Descent of the collarbone and scapula- m. trapezius, m. serratus anterior (lower bundles), m. pectoralis minor, m. subclavius

Traffic clavicle forward(shoulder blades - to the lateral side) - m. serratus anterior, m. pectoralis minor, m. pectoralis major. Traffic clavicle back(shoulder blades - to the medial side) - m. trapezius, mm. rhomboidei, m. latissimus dorsi

Pronation shoulder blades (turning the lower angle outward) - m. serratus anterior (lower teeth), m. trapezius (upper bundles). Supination shoulder blades (rotation by the lower angle inwards) - mm. rhomboidei, m. pectoralis minor

II. FREE UPPER LIMB JOINTS

shoulder joint , art . humeri . In it, the articulation of the free upper limb with its belt (Fig. 19) occurs by connecting the surface of the articular cavity of the scapula and the head of the humerus. The congruence of the glenoid cavity of the scapula is increased by articular lip, labrum glenoidale, which is attached along the edges of the cavity.

The joint capsule is thin, free, allowing the articular surfaces to move away from each other up to 2-3 cm. There is only one coracohumeral ligament, lig. coracohumerale. This is a thickened upper part of the joint capsule, up to 3 cm wide, located between the base of the coracoid process of the scapula and the upper part of the anatomical neck of the humerus.

The synovial membrane of the joint has two protrusions: the first of them is intertubercular synovial sheath, vagina synovialis intertubercularis, envelops the tendon of the long head of the biceps brachii; the second is dry bag subscapularis muscle, bursa subtendinea m. subscapularis, at the base of the coracoid process.

Morphofunctional characteristics of the joint. The shoulder joint is simple, spherical, triaxial (multiaxial). The structure of the joint determines its greatest mobility in the human body. Flexion and extension of the upper limb occurs around the frontal axis, abduction and adduction around the sagittal axis, supination and pronation around the vertical axis. In the joint, circular movements (circumduction) are also possible.

Fig 19. Right shoulder joint. A - front view, B - frontal cut. 1-lig. coracohumerale; 2-lig. coracoacromiale; 3 - processus coracoideus; 4 - scapula; 5 - capsula articularis; 6 - humerus; 7 - tendo m. bicipitis brachii (caput longum); 8 - tendo m. subscapularis; 9 - acromion; 10 - ligamentum transversum scapulae superius; 11 - cavum articulare; 12 - membrana fibrosa; 13 - membrana synovialis.

When the limb moves above the level of the shoulder, all joints of the girdle of the upper limb are included in the work.

Muscles that provide movement in the joint:

bending shoulder - m. deltoideus (front bundles), m. pectoralis major, m. biceps brachii, m. coracobrachialis.

Extension shoulder - m. deltoideus (posterior bundles), m. triceps brachii (long head), m. latissimus dorsi, m. teres major, m. infraspinatus.

lead shoulder - m. deltoideus, m. supraspinatus.

Casting shoulder - m. pectoralis major, m. latissimus dorsi, m. subscapularis, m. infraspinatus.

Pronation shoulder - m. deltoideus (front bundles), m. pectoralis major, m. latissimus dorsi, m. teres major, m. subscapularis.

Supination shoulder - m. deltoideus (posterior bundles), m. teres minor, m. infraspinatus

elbow joint , articulation cubity . In this joint, the articular surfaces of three bones are articulated: the humerus, ulna and radius (Fig. 20). Articulating bones form three joints enclosed in one capsule:

1. Shoulder joint, articulatio humeroulnaris, is formed by a block of the humerus and a block-shaped notch of the ulna. The joint is simple, helical (a kind of blocky), uniaxial.

2. Shoulder joint, articulatio humeroradialis, is formed by the head of the humerus and the articular fossa of the head of the radius. The joint is simple, spherical, triaxial.

3. Proximal radioulnar joint, articulatio radioulnaris proximalis, is formed by the circumference of the radius and the radial notch of the ulna. The joint is simple, cylindrical, uniaxial.

The capsule of the elbow joint is relatively free. In the joint cavity are the coronal and ulnar fossa of the humerus, as well as the olecranon of the ulna. The joint has three ligaments. Located on the sides ulnar and radial collateral ligament, ligg. collaterale ulnare et radiale. The ulnar collateral ligament connects the medial epicondyle of the humerus to the edge of the trochlear notch of the ulna. The radial collateral ligament starts from the lateral epicondyle, covers the neck of the radius with two legs in front and behind, and ends at the anterolateral edge of the trochlear notch of the ulna and in the annular ligament.

Third annular ligament radius, lig. annulare radii, is represented by fibrous fibers that arc around the neck and head of the radius and are fixed to the edges of the radial notch of the ulna.

Morphofunctional characteristics of the joint. The elbow joint is a complex joint, and movements in it are possible in two ways. Around the frontal axis, flexion and extension of the forearm occurs, and movements are carried out in the humeroulnar and humeroradial joints.

Fig.20. Right elbow joint: A - front view, B - the joint cavity is opened. 1 - humerus; 2 - radius; 3, ulna; 4 - capsula articularis; 5-lig. collateral radiale; 6-lig. collaterale ulnare; 7-lig. anulare radii; 8-lig. quadratum; 9 - tendo m. bicipitis brachii (cut off); 10, chorda obliqua; 11 - capitulum humeri; 12 - art. humeroradialis; 13 - trochlea humeri; 14 - processus coronoideus.

Around the vertical axis, rotation (supination and pronation) occurs in the proximal and distal humeroradial joints, because these joints are combined.

Muscles that provide movement in the joint:

bending forearms - m. brachialis, m. biceps brachii, m. pronator teres

Extension forearms - m. triceps brachii, m. anconeus Pronation forearms - m. pronator teres, m. pronator quadratus

Supination forearms - m. supinator, m. biceps brachii

Joints of the bones of the forearm .

The ulna and radius are connected by continuous and discontinuous connections. Continuous connection (syndesmosis) is represented by interosseous membrane of the forearm, membrana interossea antebrachii, connecting the diaphysis of the bones of the forearm (Fig. 2c).

Discontinuous joints include two radioulnar joints, proximal and distal. The first is described above, it enters the elbow joint. Distal radioulnar joint , articulation radioulnaris distalis , formed by the articular surfaces of the head of the ulna and the ulnar notch of the radius. Within the joint between the bones is located cartilage disc, discus articularis, which separates this joint from the wrist joint.

Morphofunctional characteristics of the joint. The joint is simple, combined, cylindrical, uniaxial. Rotational movements (pronation and supination) occur in it.

wrist joint , articulation radiocarpalis . The joint connects the bones of the forearm with the hand (Fig. 21). It is formed by the carpal surface of the radius, the articular disc on the side of the ulna, and the bones of the proximal row of the wrist: scaphoid, lunate, triquetral.

The joint capsule is thin, especially at the back, and is reinforced by four ligaments. From the beam side radial collateral ligament, lig. collaterale carpi radiale, located between the styloid process of the radius and the scaphoid (Fig. 22). On the elbow side is ulnar collateral ligament, lig. collaterale carpi ulnare, connecting the styloid process of the ulna with the triquetral and pisiform bones.

Figure 21. Frontal cut through the left wrist joint and joints of the hand. 1 - radius; 2 - art. radiocarpalis; 3-lig. collaterale carpi radiale; 4 - art. mediocarpalis; 5 - art. intercarpalis; 6 - art. carpometacrpalis; 7 - art. intermetacarpalis; 8-ligg. intercarpalia interossea; 9 - discus articularis; 10-ligg. collaterale carpi ulnare; 11 - art. radioulnaris distalis; 12 - ulna.

On the palmar and dorsal sides are the palmar and dorsal radiocarpal ligaments, respectively. Lig. radiocarpale palmare is attached to the anterior edge of the articular surface of the radius and bones - scaphoid, lunate, trihedral, capitate. Lig. radiocarpale dorsale goes from the posterior edge of the articular surface of the radius to the scaphoid, lunate and triquetrum.

Morphofunctional characteristics of the joint. The joint is complex, ellipsoid, biaxial. Around the frontal axis, flexion and extension of the hand is carried out, and around the sagittal axis - abduction and adduction.

Muscles that provide movement in the joint:

bending brushes - m. flexor carpi ulnaris, m. flexor carpi radialis, m. flexor digitorum superficialis, m. flexor digitorum profundus, m. flexor pollicis longus, m. palmaris longus

Extension brushes - mm. extensores carpi radialis longus et brevis, m. extensor carpi ulnaris, m. extensor digitorum, mm. extensores pollicis longus et brevis, m. extensor indicis, m. extensor digiti minimi

lead brushes - simultaneous reduction - m. flexor carpi radialis, m. extensor carpi radialis longus, m. extensor carpi radialis brevis

Casting brushes - simultaneous reduction - m. flexor carpi ulnaris, m. extensor carpi ulnaris

Joints of the bones of the hand .

The bones of the hand are interconnected by numerous joints and ligaments (Fig. 21).

1. Mid-carpal joint , articulation mediocarpalis , is formed on the basis of the articular surfaces of the proximal and distal rows of carpal bones, with the exception of the pisiform bone.

The articular cavity of the joint is the articular surfaces of the bones of the proximal row, and the articular head is the articular surfaces of the bones of the distal row.

Fig.22. Dorsal surface of the right wrist joint. 1-lig. radiocarpeum; 2-lig. collaterale carpi ulnare; 3 - os triquetrum; 4-ligg. intercarpea dorsalia; 5 - os hamatum; 6-ligg. carpometacarpea dorsalia; 7-ligg. metacarpea dorsalia; 8-lig. collaterale carpi radiale; 9, os scaphoideum; 10 - os trapezium; 11 - art. carpometacarpea policis; 12, os trapezoideum; 13 - os capitatum.

2. Intercarpal joints , articulationes intercarpales , located between the individual bones of the wrist, between some of them are intraarticular interosseous intercarpal ligaments, ligg. intercarpalia interossea.

The capsules of the midcarpal and intercarpal joints are strengthened by several ligaments. On the palmar surface there is radiate ligament of the wrist, lig. carpi radiatum. Its fibers diverge from the capitate bone to adjacent bones. Here are located palmar intercarpal ligaments, ligg. intercarpalia palmaria. On the dorsum are localized dorsal intercarpal ligaments, ligg. intercarpalia dorsalia (Fig. 22). The intercarpal ligaments run from one wrist bone to another.

The intercarpal joints include pisiform joint, articulatio ossis pisiformis, located between the pisiform and triquetral bones.

Morphofunctional characteristics of the joint. The mid-carpal and most inter-carpal joints are complex, flat, combined, multi-axial joints, with a small range of motion.

3. Carpometacarpal joints , articulationes carpometacarpales , are formed by the distal articular surfaces of the distal row of carpal bones and the surfaces of the bases of the metacarpal bones.

Carpometacarpal joints II - V fingers have a common tight capsule, reinforced with strong ligaments on the palmar and back sides, these are palmar carpometacarpal ligaments, ligg. carpometacarpalia palmaria, and dorsal carpometacarpal ligaments, ligg. carpometacarpalia dorsalia.

Morphofunctional characteristics of the joint. The described joints are complex, combined, flat, multiaxial, with a small amplitude of motion.

Carpometacarpal joint of thumb , articulation carpometacarpalis pollicis , isolated from the carpometacarpal joints described. It is formed by the saddle-shaped surfaces of the trapezoid bone and the base of the first metacarpal bone, and has a relatively free capsule.

Morphofunctional characteristics of the joint. The joint is simple, saddle-shaped, biaxial. Movements are carried out around two mutually perpendicular axes. Around the sagittal axis, the thumb is adducted and abducted relative to the index finger. Around the frontal axis, flexion and extension of the thumb occurs along with the metacarpal bone. Since the frontal axis is located at a certain angle to the frontal plane, when the thumb is bent, it simultaneously opposes all other fingers of the hand. In this joint, circular movements are also possible, resulting from a combination of movements around the frontal and sagittal axes.

Fig.23. The wrist joint, ligaments and joints of the right hand. 1 - radius; 2 - os lunatum; 3-lig. radiocarpeum palmare; 4-lig. collaterale carpi radiale; 5-lig. carpi radiatum; 6 - os capitatum; 7 - art. carpometacarpea policis; 8-ligg. collateralia; 9, ulna; 10 - art. radioulnaris distalis; 11-lig. collaterale carpi ulnare; 12, os pisiforme; 13-lig. pisohamatum; 14 - hamulus ossis hamati; 15 - art. matecarpophalangea (opened); 16 - art. interphalangea (revealed); 17 - tendo m. Flexoris digitirum profundi.

Muscles that provide movement in the joint:

bending thumb brush - m. flexor pollicis longus, m. flexor pollicis brevis

Extension thumb brush - m. extensor pollicis longus, m. extensor pollicis brevis

Casting thumb brush - m. adductor pollicis

lead thumb brush - m. abductor pollicis longus, m. abductor pollicis brevis

Contrasting the thumb- m. opponens pollicis

4. Metacarpal joints , articulationes intermetacarpales . They are formed by the surfaces of the bases of the II-V metacarpal bones adjacent to each other. Their capsule is common with the capsule of the carpometacarpal joints. Interosseous joints are strengthened rear and palmar metacarpal ligaments, ligg. carpometacarpalia dorsalia et palmaria, and interosseous intraarticular metacarpal ligaments, ligg. metacarpalia interossea.

5. Metacarpophalangeal joints , articulationes metacarpophalangeales , formed by the articular surfaces of the heads of the metacarpal bones and the bases of the proximal phalanges. Joint capsules are strengthened collateral ligaments, ligg. collateralia. From the palmar surface, the capsule thickens palmar ligaments, ligg. palmaria, and deep transverse metacarpal ligaments, ligg. metacarpalia transversa profunda.

The joints are simple, spherical, triaxial. Movements are possible around the frontal axis - flexion and extension, sagittal - abduction and adduction, as well as circular movements.

6. Interphalangeal joints , articulationes interfalangeales manus , are formed due to the articular surfaces of the heads of the proximal phalanges and the bases of the adjacent distal phalanges (Fig. 23).

The capsules are free and reinforced with collateral ligaments, ligg. collateralia, and on the palmar side - palmar ligaments, ligg. palmaria.

Morphofunctional characteristics of the joints. The joints are typical block-shaped, simple, uniaxial. Movements occur around the frontal axis - flexion and extension.