Does not belong to the proximal row of carpal bones. Key concepts affecting the bones of the wrist and pain in this area. Diseases and injuries

The proximal, or first row of carpal bones, closest to the forearm, is formed, counting from the thumb, by the following bones: scaphoid,os scaphoideum,semilunar,os lunatumtriangular,os triquetrum And pisiform,os pisiforme.

The distal, or second, row of the wrist consists of bones: trapezoids,os trapezium,trapezoidal,os trapezoideum,capitate,os capitatum And hook-shapedos hamatum. The names of the bones reflect their shape. On the surfaces of each bone there are articular facets for articulation with neighboring bones. In addition, on the palmar surface of some carpal bones, tubercles protrude for the attachment of muscles and ligaments. The bones of the wrist in their totality represent a kind of arch, convex on the back side, groove-like concave on the palmar side, called carpal groove,sulcus carpi.

2. Metacarpal bones, ossametacarpalia

The metacarpal bones are named in the order I, II, III, etc., starting from the thumb side. Each metacarpal bone consists of grounds,basis diaphysis, or bodies,corpus and rounded heads,caput. The bases of the II-V metacarpal bones bear flat articular facets at their proximal ends for connection with the bones of the second row of the wrist, and on the sides for articulation with each other. The base of the first metacarpal bone has a saddle-shaped articular surface, articulated with the os trapezium, but there are no lateral facets. The heads of the metacarpal bones bear convex articular surfaces for articulation with the proximal phalanges of the fingers.

3. Finger bones, ossadigitorummanus

Each finger consists of three phalanges: proximal,phalanx proximalis, average, phalanx media And distal,phalanx distalis. The exception is the thumb, which has only two phalanges - proximal and distal.

The phalanx is represented, like the metatarsal bones, in 3 parts. The base of the proximal phalanx bears a single articular fossa for articulation with the round head of the corresponding metacarpal bone, and the bases of the middle and distal phalanges each have two flat fossae separated by a ridge. They articulate with the heads of the proximal and middle phalanges, respectively, which have the shape of a block with a notch in the middle.

Girdle of the lower limb, cingulum membri inferioris consists of a paired pelvic bone.

Pelvic bone, os sokhae

The pelvic bone is made up of three separate bones ileum,os ilium, pubic (pubic)os pubis and ischialos ischii. The fusion of these bones occurs in the area of ​​greatest load - in the area of ​​the acetabulum, which is the articular fossa of the hip joint, in which the articulation of the lower limb girdle with the free lower limb occurs. acetabulum,acetabulum(vinegar, from acetum - vinegar), is placed on the outside of the pelvic bone and serves to articulate with the head of the femur. It is delimited circumferentially by a high edge, which is interrupted on its medial side by a notch, incisura acetabuli. The articular smooth surface of the acetabulum has the shape of a crescent, facies lunata, while the center of the cavity, the so-called fossa acetabuli, and the part nearest the notch are rough.

1. Ilium, os ilium.

The ilium with its lower section, called body,corpus ossis iii, merges with the rest of the pelvic bone in the area of ​​the acetabulum; the upper, widened and thin part forms wing of the ilium,ala ossis ilii, ending upward with a free S-shaped curved comb,Christa Iliaca. The ridge at the front ends anterior superior spine,spina iliaca anterior superior, and behind - posterior superior spine,spina iliaca posterior superior. Below each of these spines, on the anterior and posterior edges of the wing there is another spine: spina iliaca anterior inferior and spina iliaca posterior inferior. The lower awns are separated from the upper ones by notches. Below and anterior to the anterior inferior spine, at the junction of the ilium and the pubis, there is iliopubic eminence,eminentia iliopubica, and downward from the posterior inferior spine lies a deep greater sciatic notch,incisura ischiadica major, closing further down ischial spine,spina ischiadica,, already located on the ischium. The inner surface of the iliac wing is smooth, concave and forms iliac fossa,fossa iliaca. Posteriorly and downward from the latter lies the so-called auricular articular surface,facies auricularis, the place of articulation with the conominal surface of the sacrum, and behind and superior to the articular surface is tuberosity,tuberositas iliaca, to which the interosseous sacroiliac ligaments are attached. The iliac fossa is separated from the inner surface of the underlying body of the ilium arcuate line,linea arcuata.

2. Pubic (pubic) bone, os pubis.

The pubic bone has a short, thickened body,corpus ossis pubis, adjacent to the acetabulum, then upper and lower branches,ramus superior And ramus inferior ossis pubis, located at an angle to each other. At the apex of the angle facing the midline there is an oval shape symphyseal surface,facies symphysialis, the junction with the pubic bone of the other side. 2 cm lateral from this surface there is a small pubic tubercle,tuberculum pubicum from which it extends along the posterior edge of the upper surface of the ramus superior pubic ridge, pecten ossis pubis, passing further posteriorly into the above-described linea arcuata of the ilium. On the lower surface of the superior ramus of the pubis there is obturator groove,sulcus obturatorius, the site of passage of the obturator vessels and nerve.

3. Ischium, os ischii.

The ischium has body,corpus ossis ischii, part of the acetabulum, and branch,ramus ossis ischii, forming an angle with each other, the apex of which is greatly thickened and represents the so-called ischial tuberosity,tuber ischiadicum. Along the posterior edge of the body, up from the ischial tuberosity, is located lesser sciatic notch,incisura ischiadica minor, separated ischial spine,spina ischiadica from greater sciatic notch,incisura ischiadica major. The branch of the ischium, moving away from the ischial tuberosity, then merges with the lower branch of the pubis. As a result, the pubic and ischium bones surround with their branches obturator foramen,foramen obturatum, which lies inferiorly and medially to the acetabulum and has the shape of a triangle with rounded corners.

The free lower limb is divided into the thigh (femur), lower leg (crus) and foot (pes).

Skeleton of the free lower limb (skeleton membraneinferioris) consists of the femur, two leg bones and foot bones. In addition, there is another small (sesamoid) bone adjacent to the femur - the patella.

Femur, femur

The proximal epiphysis of the bone is presented head,caput femoris. Down from the middle on the head there is a small rough dimple of the head of the femur,fovea capitis femoris,– the site of attachment of the ligament of the head of the femur. The head is connected to the rest of the bone through cervix,collum femoris. At the junction of the neck and the body of the femur, two bony tubercles, called trochanters (apophyses), protrude. Big skewer, trochanter major And small skewer,trochanter minor. Both trochanters are connected to each other on the back of the femur by an oblique ridge, crista intertrochanterica, and on the front surface - linea intertrochanterica.

The body of the femur is slightly curved anteriorly and has a trihedral-rounded shape; on its back side there is a trace of the attachment of the thigh muscles, rough line,linea aspera, consisting of two lips - lateral,labium laterale, And medial,labium mediale. Both lips in their proximal part have traces of attachment of the so-called muscles, the lateral lip - gluteal tuberosity,tuberositas glutea, medial – comb line,linea pectinea. At the bottom, the lips, diverging from each other, limit a smooth triangular area on the back of the thigh - popliteal surface,facies poplitea.

The lower, distal epiphysis of the femur forms two rounded, wrapping backwards condyle,condylus medialis And cundylus lateralis. On the anterior side, the articular surfaces will form a slight concavity in the sagittal direction - patellar surface,facies patellaris, since the patella, patella, is adjacent to it with its back side when the knee joint is extended. Posteriorly the condyles are separated by a deep intercondylar fossa,fossa intercondylaris. On the side of each condyle, above its articular surface, there is a rough tubercle called epicondylus medialis medial condyle and epicondylus lateralis at the lateral one.

Patella, patella

Patella is nothing more than a large sesamoid bone embedded in the thickness of the tendon of the quadriceps femoris muscle, passing in front of the knee joint. It has an upper wide end, called basis,basis patellae, and lower or top,apex patellae. The posterior surface is equipped with a smooth articular surface, facies articularis, which the patella is adjacent to the aforementioned facies patellaris of the femur.

The skeleton of the lower leg consists of two long tubular bones of unequal thickness - the tibia and fibula. The first lies medially, and the second lies laterally.

tibia, tibia

The proximal epiphysis forms two condyle – medial,condylus medialis, And lateral,condylus lateralis. The condyles are equipped with concave tops articular surfaces,facies articularis superior for articulation with the condyles of the femur. Both articular surfaces of the tibial condyles are separated from each other intercondylar eminence,eminentia intercondylaris, in front of which is anterior intercondylar fossa (field)area intercondylaris anterior, and behind - area intercondylaris posterior(all these formations are caused by the attachment of intra-articular ligaments). The articular surfaces are surrounded by a thickened edge - the metaphysis, where the articular capsule of the joint is attached. Somewhat lower than the latter, already on the anterior surface of the tibia, is located rough tuberosity,tuberositas tibiae(apophysis), the site of attachment of the quadriceps tendon (in the form of the patellar ligament). In the region of the posterolateral part of the lateral condyle there is a small flat articular surface - the place of articulation with the head of the fibula, faсies artucilaris fibularis. The body of the tibia has a triangular shape. Between 3 faces there are 3 surfaces. The lower distal epiphysis on the medial side has a downward medial malleolus, malleolus medialis. Located at the lower end of the tibia facies articularis inferior for articulation with the bones of the foot. On the lateral edge of the distal end of the tibia there is a notch, incisura fibularis, junction with the fibula.

Fibula, fibula (Greek)re r one )

The fibula is a thin and long bone with thickened ends. The upper proximal epiphysis forms head, caput fibulae, which by means of a flat roundish articular surface, facies articularis capitis fibulae articulates with the lateral condyle of the tibia. The body of the fibula is triangular in shape and somewhat twisted along its longitudinal axis. The lower (distal) epiphysis of the fibula, thickening, forms lateral malleolus, malleolus lateralis, with smooth articular surface, facies articularis malleoli.

The foot is divided into tarsus, metatarsus and toes.

Tarsus, tarsus, is formed by seven short spongy bones, ossa tarsi, which, like the carpal bones, are arranged in two rows. The posterior, or proximal, row is made up of two relatively large bones: ram and lying underneath calcaneal. The anterior or distal row consists of medial and lateral sections. The medial department is formed scaphoid and three sphenoid bones. There is only one in the lateral section cuboid bone.

Talus

Comprises body, corpus tali, which in front continues into a narrowed neck, collum tali, ending head, caput tali. The body of the talus on its upper side bears the so-called block, trochlea tali, for articulation with the bones of the lower leg. The upper surface of the trochlea is articular, facies superior for articulation with the distal articular surface of the tibia. Lying on both sides of its two lateral articular surfaces of the block, facies malleolares medialis et lateralis are the point of articulation with the ankles. On the underside of the talus there are two (anterior and posterior) articular surfaces for articulation with the calcaneus. Between them runs a deep, rough talus groove sulcus tali.

Heel bone, calcaneus

On the upper side of the bone there are articular surfaces corresponding to the lower articular surfaces of the talus. A process of the calcaneus, called sustentaculum tali, talus support. This name is given to the process because it supports the head of the talus. The articular facets located in the anterior part of the calcaneus are separated from the posterior articular surface of this bone by calcaneal groove,sulcus calcanei, which, adjacent to the same groove of the talus, forms together with it a bone tarsal sinus,sinus tarsi, opening on the lateral side on the dorsum of the foot. On the distal side of the calcaneus, facing the second row of tarsal bones, there is a saddle-shaped articular surface for articulation with the cuboid bone, facies articularis cuboidea. Posteriorly, the body of the calcaneus ends in the form of a rough calcaneal tubercle,tuber calcanei.

scaphoid bone, os naviculare located between the head of the talus and the three sphenoid bones.

Three sphenoid bones,ossa cuneiformia, are called so by their external appearance and are designated as os cuneiforme mediate, intermedium et laterale.

Cuboid bone, os cubeideumh lies on the lateral edge of the foot between the heel bone and the bases of the IV and V metatarsal bones. An oblique ridge protrudes on the plantar side of the bone, tuberositas ossis cuboidei, in front of which passes furrow,sulcus tendinis m. peronei longi.

Metatarsus, metatarsusWith consists of five metatarsal bones, ossa metatarsalia, relating to short (monoepiphyseal) tubular bones and resembling the metacarpal bones on the hand. Like the latter, they have a proximal end, or base, basis, middle part, or body, corpus, and the distal end, head, caput. They count starting from the medial edge of the foot. With their bases, the metatarsal bones articulate with the bones of the distal row of the tarsus. The heads are flattened laterally and, like the heads of the metacarpal bones, have pits on the sides for attaching ligaments. The first metatarsal bone is the shortest and thickest, the second metatarsal bone is the longest.

Toe bones, phalanx, phalanges digitorum pedis – short tubular monoepiphyseal bones, differ from similar hand bones in their small size. The toes, like the hands, consist of three phalanges, with the exception of the first toe, which has only two phalanges. The distal phalanges have a thickening at their end, tuberositas phalangis distalis, which is their main difference.

Sesamoid bones are found in the area of ​​the metatarsophalangeal joints (constantly in the area of ​​the first finger) and the interphalangeal joint of the first finger.

Bone variants and abnormalities

Variants and anomalies of spinal development . The complete absence of vertebral bodies is called asomy, the development of one half of the vertebral body is called hemisomy. Stopping growth in the height of the vertebral body - platyspondyly - is characterized by a change in the shape of the vertebrae; they are flattened or have the shape of a biconcave lens. Non-fusion of the vertebral arches (spina bifida posterior) is caused by the lack of fusion of the two halves of the vertebral arches along the midline. Most often, anomalies of this kind occur in the lumbar and sacral spine. The first cervical vertebra can fuse with the occipital bone (assimilation of the atlas), combined with splitting of its posterior arch. The number of sacral vertebrae due to the assimilation of the lumbar vertebrae can reach 6–7 (sacralization). Less commonly observed is a decrease in the number of sacral vertebrae with a simultaneous increase in the number of lumbar vertebrae (lumbarization). Pathological curvature of the spine in the posterior-lateral direction is called kyphoscoliosis. Excessive curvature of the lumbar spine - hyperlordosis and weak expression of all curves - flat back - are variants of the structure of the spine.

Variants and anomalies of the limb skeleton . The ossification point in the acromion may not fuse with the spine of the scapula, the bends of the clavicle vary, above the medial epicondyle of the humerus, there may be a process - processus supracondylaris - sometimes very long and curved. The olecranon process of the ulna may not fuse with its diaphysis. Severe deformities include the absence of an upper limb - amelia, severe underdevelopment of the bones of the shoulder and forearm - phocomelia (a limb in the form of a “fin”). Absence of the radius – aplasia. Accessory bones of the wrist may develop, in particular the central bone (os centrale). It is possible to develop additional fingers - polydactyly, on the side of the thumb or little finger, as well as fusion of the fingers - syndactyly.

In the pelvic bone, underdevelopment of the acetabulum leads to congenital dislocation of the hip. The strong development of the gluteal tuberosity on the femur forms the third trochanter. Additional tarsal bones, transformation of the posterior process of the talus into an independent triangular bone (os trigonum), and the presence of additional toes on the foot may be observed. A severe deformity is the fusion of the lower extremities - sirenomelia. Disruption of the relationship between the increase in length of the bones of the limbs and the growth of the epiphyses leads to a disproportion of the sections of long tubular bones - achondroplasia.

Variants and anomalies of development of the skull bones. In 10% of cases, a frontal suture is preserved between the two parts of the scales of the frontal bone - sutura metopica. Failure of fusion of the anterior and posterior halves of the body of the sphenoid bone leads to the formation of the craniopharyngeal canal in the center of the sella turcica. The upper part of the squama of the occipital bone can be separated from the rest of the bone, resulting in the formation of the interparietal bone os interparietale. In the lambdoid suture there are additional bones - suture bones - ossa suturalia. Assimilation of the atlas is observed - fusion of the condyles of the occipital bone with the first cervical vertebra - cranioschisis. The highest fourth concha of the ethmoid bone is quite common. The styloid process of the temporal bone may be absent, or, conversely, be very long, being an ossified stylohyoid ligament. In the upper jaw there is a different number and shape of the dental alveoli. An unpaired incisive bone is found, and the size and shape of the frontal and maxillary sinuses vary. Failure of fusion of the palatine processes of the upper jaw and the horizontal plates of the palatine bones leads to the formation of a “cleft palate” - cleft palate (palatum fissum). The nasal bones vary greatly in size and shape; they can fuse into one bone, or be replaced by the frontal process of the upper jaw. Often there is a curvature of the vomer to the right or left. The right and left halves of the lower jaw may not fuse with each other. A severe deformity is severe underdevelopment of the brain skull - anencephaly.

doctrine of CONNECTIONS I BONES –

arthrology ( arthrology )

General arthrology

Bone joints hold the bones of the skeleton together into a single unit. They have different structures and have properties such as strength, mobility and elasticity, which allows them to hold bones relative to each other, providing them with greater or less mobility. The section of anatomy devoted to the study of bone joints is calledarthrology (Greekarthros – joint) orarthrosyndesmology .

Classification of bone joints.

There are two types of bone connections:

Continuous connections – between the bones there is a layer of connective tissue or cartilage that is inactive or completely immobile.

2. Intermittent (synovial)connections , orjoints – characterized by the presence of a cavity between the bones and a synovial membrane lining the joint capsule from the inside, and have sufficient mobility.

Symphyses , orsemi-joints – have a small gap in the cartilaginous or connective tissue layer between the connecting bones, occupy a transitional position from continuous to discontinuous connections, are strengthened by ligaments, and are relatively mobile (the pubic symphysis, connections of a number of vertebral bodies, the manubrium of the sternum with the body).

Continuous joints of bones (synarthroses).

Continuous bone connections have greater elasticity and strength; movements in such connections are limited. Depending on the nature of the connective tissue between bones, three types of continuous connections are distinguished:

1) syndesmosis (syndesmosis) – fibrous connection;

2) synchondrosis (synchondrosis) – cartilaginous connection;

3) synostosis (synostosis) – bone connection.

Fibrous connections are strong connections between bones using dense fibrous connective tissue. There are several types of fibrous compounds: syndesmosis itself, suture, impaction.

Syndesmosis, syndesmosis , formed by connective tissue, the fibers of which grow together with the periosteum of the connecting bones and pass into it without a pronounced border. A typical syndesmosis is the distal tibiofibular joint. Syndesmoses also include ligaments and interosseous membranes (membranes).

bunch, ligamentum , - these are thick bundles, cords, plates of fibrous connective tissue. They can be independent formations or, most often, relate to joints. By spreading from one bone to another, ligaments strengthen the joints, hold and direct movements in them. Ligaments, complementing almost every joint, are subject to certain patterns in their location - outside the joint or in its cavity. In addition to dense fibrous fibrous tissue, in some places the ligaments are made of elastic tissue - synelastosis. An example of them are the ligaments of the spinal column, stretched between the arches of the vertebrae, which are yellow in color and therefore called yellow.

interosseous membrane, membrane interossea , stretched between the bodies (diaphyses) of long tubular bones (forearm and lower leg), closes the natural openings of the bone (pelvic obturator membrane), often it serves as the origin of muscles.

The seam, sutura , – a type of fibrous joint in which there is a narrow layer of connective tissue between the connecting bones. Bone connections through sutures are found only in the skull. Depending on the configuration, there areserrated seam , in which the edges of the bones are connected by means of small or large teeth (between the bones of the cranial vault);scaly seam when the bones are connected, as if their edges overlap each other, like fish scales (between the parietal and temporal bones); flat seam , where the bones are connected with smooth edges using a narrow layer of connective tissue (between the bones of the facial skull). A special type of seam is schindylosis.

Injection, gomphosis , – connection of teeth with the bone tissue of the dental alveolar sockets. Between the tooth and the bone there is a thin layer of connective tissue - periodontium.

Cartilaginous connections bones are characterized by strength, elasticity and low mobility. If cartilage in the area of ​​bone connection exists throughout life, then such synchondrosis is permanent (between a number of bones at the base of the skull, some costosternal joints). In cases where the cartilaginous plate between the bones is replaced by bone tissue with age, the connection of the bones is called synostosis (between different parts of the bones of the base of the skull, sacrum, pelvic bone).

Discontinuous bone connections (diarthrosis)

Discontinuous or synovial joints of bones –joints (lat. –articulationes) (Fig. 6) – are part of the musculoskeletal system. In every jointNecessarily there are: 1) articular surfaces of bones covered with cartilage; 2) joint capsule; 3) articular cavity with a small amount of synovial fluid. Some joints have auxiliary education – intra-articular discs and menisci, synovial bursae, articular lips. The auxiliary structures also include ligaments.

Rice. 6. Joint structure:

1 – periosteum, 2 – synovial membrane of the joint capsule; 3 – fibrous membrane of the joint capsule; 4 – articular cavity; 5 and 6 – articular surfaces of bones covered with articular cartilage

Articular surfaces , faceis articulares , most articulating bones correspond to each other - they are congruent. If one articular surface is convex (articular head), then the second is concave (articular cavity). Articular cartilage has a thickness of 0.2 to 5 mm. It itself is smooth, smoothes out the unevenness of the articular surfaces of the bones and plays the role of a shock absorber in the joint.

joint capsule, capsule articularis , forms a cavity around the joint, attaching to the articulating bones close to the articular surfaces or slightly receding from them. The joint capsule has two layers: the outer layer is the fibrous membrane and the inner layer is the synovial membrane. Fibrous membrane quite thick and durable. In some places it forms ligaments are cords, like ribbons. These ligaments further strengthen the joints. If the ligament is located outside the joint capsule, then it is called an extracapsular ligament; if the ligament is located in the thickness of the joint capsule, then such a ligament is called an intracapsular ligament. The thickness and shape of the ligaments depend on the functional characteristics and structure of the joint. Ligaments are a passive brake that limits movement in the joint and also protects it from movements that lead to damage to the joint. Synovial membrane - a thin layer of cells that, in the articular capsule, lines the capsule itself from the inside and extends to areas of the bone in the joint that are not covered with cartilage. The synovial membrane has microscopic villi rich in small blood vessels. The inner surface of the joint capsule, covered with a synovial membrane, is always moistened with synovial fluid, which is secreted by the cells of the synovial membrane. Synovial fluid is viscous and acts as a lubricant in the joint.

joint cavity, cavitas articularis , It is a slit-like space between the articular surfaces of the bones, which is limited by the articular capsule. The shape of the articular cavity depends on the shape of the joint. A normal joint cavity always contains small amounts of synovial fluid (1-3 ml).

Articular disc and meniscus, discus , meniscus articularis , - cartilaginous plates of various shapes, located between the articular surfaces of the articulating bones that do not quite correspond to each other. The disc is usually a solid cartilaginous plate fused along the outer edge with the articular capsule. The disc, as a rule, divides the joint cavity into two chambers - two floors. Menisci are not solid semilunar-shaped cartilaginous plates that are wedged between the articular surfaces. Discs and menisci shift when moving in the joint, smooth out unevenness of the articulating surfaces, and also act as shock absorbers.

Articular lip, labrum articulare , located along the edge of the concave articular surface, complements and deepens this surface (hip, shoulder joint). With its base, the articular lip is attached to the edge of the articular surface. The inner, concave edge of the articular labrum faces the articular cavity.

In the thinned part of the fibrous membrane, protrusion of the synovial membrane from the joint capsule occurs. This protrusion is called synovial bursa, bursa synovialis , the shape and size of which are different. They are located, as a rule, between the surfaces of the bone and the tendons moving near the bone. In this case, the bursa acts as a cushion, eliminating friction between the tendon and the bone.

Biomechanics of joints

In joints, depending on their structure, movements can occur around different axes (Fig. 7).

In the biomechanics of joints, the following axes of rotation are distinguished: frontal, sagittal, vertical.

Aroundfrontal axis flexion and extension are performed. Atflexion ( flexio ) one bone moves relative to another bone around an axis in such a direction that the angle between the articulating bones decreases. Duringextension ( extensio ) movements of the bones of the joint occur in the opposite direction, while the angle between the joint-forming bones increases.

Aroundsagittal axis adduction and abduction are carried out (the sagittal axis passes through the center of the joint from front to back). Whencasts ( adductio ) one of the articulating bones approaches the median plane, whenlead ( abductio ) - moves away from her.

Aroundvertical axis rotational movements are possible. At the same time the bonerotates ( rotacio ) around its longitudinal axis in one direction or another (inward or outward).Roundabout Circulation ( circumductio ) - this is a sequential movement around all axes in which the free end of a limb (or bone) describes a circle.

Volume (span) of movements in joints depends on the difference in angular values ​​(expressed in angular degrees) of the articulating surfaces.

Fig 7. Types of movements in joints

The greater this difference, the greater the range of motion in the joint. With equal lengths of the articular surfaces, the range of motion in the joints is insignificant. The amount of movement in the joints is influenced by the number of ligaments, their location, the location of the muscles surrounding the joint, and the bone formations located next to the joint.

Classification of joints

The joints are differentnumber of articular surfaces :

simple joint, art . simplex – formed by two articular surfaces;

compound joint, art . composita – formed by three or more articular surfaces.

In addition, there are:

– complex joint, art . complexa – If There is a disc or meniscus between the articulating articular surfaces;

– combined joint, art . combine – represented by two anatomically isolated joints acting together.

The articular surfaces resemble segments of various geometric shapes: a cylinder, an ellipse, a ball. Accordingly, joints are distinguished according to form : cylindrical, ellipsoidal and spherical . There are varieties of the above-mentioned forms of joints.

The shape of the articular surfaces determinesnumber of axes , around which movement occurs in the joints. A cylindrical joint allows movement around one axis, an ellipsoidal joint allows movement around two axes, and a ball and socket joint allows movement around three axes as well as circular movements. Since there is a direct relationship between the shapes of the articular surfaces and the number of axes around which movement in the joint is possible, on this basis there is a biomechanical (anatomical and physiological) classification of joints:

1) joints with one axis of movement (uniaxial);

2) joints with two axes of movement (biaxial);

3) joints with many axes of movement, of which three are main (multi-axial).

Uniaxial joints . cylindrical joint, art . trochoidea – the convex articular surface has the shape of a cylinder, the other articular surface has an articular cavity of the same shape. The axis of the joint coincides with the longitudinal axis of the articulating bones (median atlantoaxial joint). trochlear joint, art . gingl at mus – there is a bony ridge on the convex articular cylindrical surface, and on the other articular surface, in the articular cavity, there is a guide groove. The trochlear articular surface is located transverse to the length of the bones forming the joint. Movements in the trochlear joint occur around the frontal axis - flexion and extension (interphalangeal joints). Helical joint - a type of block joint. In it, the guide ridge and groove of the articular surfaces are located at an angle to the axis of rotation (elbow joint).

Biaxial joints . Ellipsoid joint, art . ellipsoidea – articular surfaces are segments of an ellipse in the form of a head and a corresponding fossa. Movement in the joint is possible around two mutually perpendicular axes - flexion and extension occur around the frontal axis, and adduction and abduction occur around the sagittal axis (wrist joint). saddle joint, art . sellaris - formed by saddle-shaped articular surfaces, the concavity of one articular surface corresponds to the concavity of the other surface. Movements can be carried out in two mutually perpendicular axes, similar to the ellipsoidal joint (carpometacarpal joint of the thumb). condylar joint, art . bicondylaris - a convex articular surface located on the rounded process of the bone - the condyle. The joint represents a transitional shape from a trochlear to an ellipsoidal joint. The condylar joint has two articular heads, and the ellipsoidal joint has one. Movements in the condylar joint are possible around two axes - flexion and extension occur around the frontal axis, rotation occurs around the vertical axis (knee joint).

Multi-axis joints. ball and socket joint, art . sph A eroidea – the convex articular surface is called the head and has the shape of a ball, the concave articular surface has the appearance of a depression corresponding to the head. Movements in the ball and socket joint can be performed on a large scale around three or more axes (shoulder joint). cup joint, art . cotylica - a type of ball-and-socket joint. In this joint, the concave surface covers the head more than half. The difference in the angular sizes of the articular surfaces of the head and socket is small (less than that of a ball-and-socket joint, in which the articular cavity is smaller than the head), so the range of motion in the cup-shaped joint is limited (hip joint). flat joint, art . plana – has a slightly curved articular surface resembling a segment of a large diameter ball. Movements in the joint can be carried out around three axes, but their volume is limited due to the slight difference in the size of the articular surfaces and the slight difference in the curvature of these surfaces (intervertebral joints). Amphiarthrosis, amphyartroses (tight joints) - flat, have almost congruent articular surfaces, a tightly stretched capsule and very strong ligaments. The movements are extremely insignificant and are of a sliding nature (sacroiliac joint).

Private arthrology

Connections of the skull bones

The bones of the skull are in most cases connected to each other using continuous connections: sutures,sutura serrata – serrated (coronoid, sagittal, lambdoid) andscaly – squamosa ( the bones of the roof of the skull are connected), andflat – plana – bones of the facial skull; through cartilage - the bones of the base of the skull (temporary and permanent synchondrosis). Only the lower jaw forms a paired joint with the temporal bone.

Temporomandibular joint,art. temporomandibularis, - Rice. 8.

Classification. The joint is complex and combined at the same time. It is ellipsoidal (condylar) in shape. Biaxial.

Structure. The articular surfaces are the head of the mandible and the mandibular fossa of the temporal bone. The capsule covers the neck of the mandible and the mandibular fossa of the temporal bone. The joint is strengthened by ligaments, the main of which is considered lateral, lig. laterale.

Rice. 8. Temporomandibular joint. Outside view.

The joint is openedgittal section: 1 – condylar process of the mandible, 2 – intra-articular disc, 3 – mandibular fossa, 4 – sustubercle, 5 – lateral roofcapitis muscle, 6 – medialpterygoid muscle

Outside the joint there are two ligaments: sphenoid-mandibular and styloid-mandibular. The congruence of the articular surfaces is ensured by the articular disc, which divides the articular cavity into two floors.

Functions. The following movements are possible in the joint: lowering and raising the lower jaw (opening and closing the mouth) - around the frontal axis; movement of the lower jaw to the right and left - around the vertical axis; additional movement – ​​displacement of the lower jaw forward (advancement) and backward.

Joints of the trunk bones

Vertebral connections – (Fig. 9). In the spinal column, the anatomical parts of the vertebrae (body, arch, processes) are connected by all types of joints presented in the classification.

Rice. 9. Vertebrae and their connections, view from the side :

1 – fibrousring; 2 –interposeshole; 3 – interspinous ligament; 4 – supraspinous ligament; 5 - ligamentum flavum; 6 –spinous process; 7 – spinal canal; 8 -anterior longitudinal ligament; 9 -posterior longitudinal ligament, 10 –nucleus pulposus; eleven -bodyvertebra

The bodies of adjacent vertebrae are connected throughintervertebral discs, discusintervertebralis. The intervertebral disc consists of central and peripheral parts. The peripheral part is represented by connective tissue, the fibers of which formfibrous ring, anulusfibrosus.

The central part of the disc consists of an elastic substance callednucleus pulposus, nucleuspulposus(cartilage). With the help of fibers of the annulus fibrosus, adjacent vertebrae are connected to each other, and the nucleus pulposus acts as a shock absorber. In the absence of the nucleus pulposus, a gap is formed inside the disc, which allows this connection of the vertebral bodies to be classified as semi-joints (symphyses). The connection of the vertebral bodies is strengthened by twolongitudinal ligaments, ligg . longitudinalia – front and back. Between the arches and processes of the vertebrae (spinous and transverse) there is also a complex of ligaments that strengthen their connection: yellow, inter- and supraspinous, intertransverse ( ligg . flava , inter - et supraspinalia , intertransversaria ).

Facet (or intervertebral) joints,artt. zygapophysiales.

Classification. ABOUT refer to combined, flat, multi-axial.

Structure. They are formed by the articular processes of adjacent vertebrae. The capsule is attached along the edge of the articular surfaces. They are strengthened by a complex of ligaments between the bodies, arches, and processes of the vertebrae (see above).

Functions. Movements are limited in scope between individual vertebrae, but in general the spinal column is quite mobile: around the frontal axis - forward flexion and backward extension; around the sagittal axis – tilts to the right and left; around the vertical axis - turns (torsio) to the right and left.

Atlanto-occipital joint,art. atlantooccipitalis.

Classification.Combined, elliptical, biaxial.

Structure.Cunion of the 1st cervical vertebra with the occipital bonec consists of two joints, symmetrically located to the right and left of the foramen magnum inferior to the occipital bone, which function as a single joint. The articular surfaces of each joint are formed by the condyle of the occipital bone and the superior articular fossa of the 1st cervical vertebra. The capsule is attached along the edge of the articular surfaces. Joints are strengthened front and back atlanto-occipital membranes, membraneatlantooccipitalis.

Functions. Movements in both joints occur around two axes: frontal - flexion and extension of the head (nodding movements); sagittal - the head is abducted from the midline of the body and brought to the midline (head tilted to the shoulder).

Median atlantoaxial joint,art. atlantoaxialismediana.

Classification. Simple, cylindrical, uniaxial.

Structure. Formed by the anterior and posterior surfaces of the tooth of the axial (2nd) vertebra, the articular fossa of the anterior arch of the atlas (1st vertebra), as well as transverse ligament of the atlas, lig. transversumatlantis, which is located between the lateral masses of the atlas behind the tooth. The capsule is attached along the edge of the articular surfaces.

Functions. The joint allows rotational movements around the longitudinal axis of the tooth, which are carried out together with the skull.

Sideatlantoaxialjoint, art. atlantoaxialis lateralis.

Classification.The joint is combined, flat.

Structure. The right and left atlantoaxial joints are formed by the inferior articular fossa on the lateral mass of the atlas and the superior articular surface on the body of the axial vertebra. The capsule is attached along the edge of the articular surfaces. Joints are strengthened by a complex of ligaments.

Functions. Movement in both lateral atlantoaxial joints occurs simultaneously with movement in the medial atlantoaxial joint. When rotating in the middle atlantoaxial joint, the lateral atlantoaxial joints slide and shift their articular surfaces relative to each other.

Spinal column as a whole

The spinal column represents the support of the body and is, as it were, a flexible axis of the entire body. It connects to the ribs, bones of the pelvic girdle and the skull. The spinal column is involved in the formation of the walls of the chest and abdominal cavities, the pelvis, and is a container for the spinal cord. Absorbs shocks that occur when walking, jumping and running. It has S-shaped physiological bends: forward –lordosis (cervical and lumbar); back -kyphosis (thoracic and sacral). Lateral bends -scoliosis (pathology). In a newborn, the spinal column is almost straight. The development of curves occurs after birth: when the child begins to hold his head up, cervical lordosis occurs; when he begins to sit, thoracic kyphosis appears; when he begins to stand and walk, lumbar lordosis and sacral kyphosis develop.

Rib connections

rib head joint,art. capitis costae.

Structure. The joint is formed by the articular surfaces of the costal fossae (or semi-fossae) on the bodies of two adjacent thoracic vertebrae, as well as the articular surface of the rib head. The capsule is attached along the edge of the articular surfaces. Joints are strengthened by intra-articular ligaments: rib heads and radiate ligaments, ligg. capitiscostaeintraarticulareetradiatae. The intraarticular ligament of the rib head is absent inI, II, XIIribs

Costotransverse joint,art. costotransversaria.

Structure.The joint is formed by the articulation of the articular surface of the tubercle of the rib and the costal fossa on the transverse processII- X thoracic vertebrae. The capsule is attached along the edge of the articular surfaces. Joints are strengthened by a complex of upper and lower costotransverse ligaments, ligg. costotransversaria.

Functions. The costovertebral joints are functionally combined. Movements in the joints are possible around their common axis, passing through the centers of the joints along the neck of the rib. When the ribs rotate around such an axis, they lower and rise.

Connection of front ends ribshappens in different ways.First rib forms hyaline synchondrosis with the sternum. Resttrue ribs (withIIByVII) form simple flat joints. The joint capsule is strengthened by the radiate sternocostal ligaments.False ribs (VIII- X) are connected by their cartilaginous endsc overlying ribs according to the type of syndesmosis. Sometimes intercartilaginous joints form between the cartilages of these ribs. Front ends hesitant (XIAndXII) ribs lie freely.

The chest as a whole

The rib cage is an osteochondral formation consisting of 12 thoracic vertebrae, 12 pairs of ribs and the sternum, connected to each other. It is a container and protection for the heart and large vessels, lungs, esophagus and other organs. Thanks to the movements of the chest, inhalation and exhalation are carried out. In the chest there are upper and lower openings (apertures), the substernal angle formed by the right and left costal arches. The shape of the chest depends on the person’s body type: with a dolichomorphic type, the chest flat shape , with mesomorphic –cylindrical , with brachymorphic –conical . There are many transitional forms depending on gender and age. Some diseases also affect the shape of the chest: rachitic, keeled, cobbler's chest and others.

Connections of the bones of the shoulder girdle and free upper limb

sternoclavicular joint,art. sternoclavicularis- rice. 10.

Classification.Complex, saddle-shaped, multi-axis

Structure. Formed by the articular surface of the sternal end of the clavicle and the clavicular notch of the manubrium of the sternum. The articular surfaces do not correspond in shape to each other. Between them is an articular disc, which eliminates the incongruence and divides the joint cavity into two chambers. The capsule is attached along the edge of the articular surfaces. Strengthened by ligaments: anterior and posterior sternoclavicular, interclavicular and clavicular-costal, ligg. sternoclaviculareanter. etpost., interclaviculare, costoclaviculare.

Rice. 10. Sternoclavicular joints, front view:

(greatsternoclavicular jointbecoming opened frontalcut): 1 – intra-articular disc; 2 –interclavicular ligament; 3 –anterior sternoclavicularligament; 4 -collarbone,5 – lanefirst rib; 6 –costalclavicular ligament;7 – handsternum yatka

Functions. The following movements are possible in the joint: raising and lowering the clavicle around the sagittal axis, movement of the acromial end of the clavicle back and forth around the vertical axis and circular movement.

acromioclavicular joint,art. acromioclavicularis.

Classification.The shape of the joint is flat, multi-axial.

Structure. The joint is formed by the articular surfaces of the acromial end of the clavicle and the acromial process of the scapula. In 1/3 of cases, an articular disc is located between them. The capsule is attached along the edge of the articular surfaces. The joint is strengthened acromioclavicular and coracoclavicular, ligg. acromioclaviculareetcoracoclaviculare, ligaments.

Functions. In the acromioclavicular joint, movements around three axes are possible (see sternoclavicular joint), but their volume is insignificant, because The ligaments that strengthen the joint limit these movements.

shoulder joint,art. humeri- rice. 11.

Rice. eleven. Shoulder joint, right vy (the joint is opened frontally ny cut):

1 – collarbone; 2 – coracoclavicular ligament; 3 – articular labrum; 4 – articular capsule; 5 – tendonlong headbiceps brachii; 6 – brachial bone; 7 – head of the humerus; 8 – articular capsule; 9 – articular cavity; 10 – articular cavity (cartilage); 11 – lateral angle of the scapula; 12 – neck of the scapula; 13 – spine of the scapula; 14 – superior transverse scapular ligament

Classification. Simple, typical ball and socket joint, multiaxial.

Structure.The joint is formed by the head of the humerus and the glenoid cavity of the scapula. The surface of the head of the humerus is 3 times larger than the surface of the glenoid cavity of the scapula. The depression is somewhat deepened by the articular cartilaginous lip. The joint capsule is thin and free, which allows the articular surfaces to move away from each other up to 3 cm during movement. The capsule is attached along the neck of the scapula and on the humerus along its anatomical neck. The joint is strengthened weak coracobrachial, lig. Withoracohumerale, ligament and surrounding muscles. The role of the arch (roof) for the shoulder joint is performed by one of the scapula’s own ligaments - coracoacromial,ligcoracoacromiale, which prevents upward dislocation of the humerus.

Functions. Movements in the joint are carried out around the axes: sagittal - abduction (to the horizontal level) and adduction; around the frontal axis - flexion (raising the arm forward) to a horizontal level and extension (bending backward); around the vertical axis - rotation of the shoulder together with the forearm outward and inward. Circular movements are possible in the shoulder joint.

elbow joint,art. cubiti- rice. 12.

The elbow joint is a complex joint because it is formed by the articulation of three bones: the humerus, the ulna and the radius. Between them, three joints are formed, enclosed in one articular capsule: humeroulnar, brachioradial and radioulnar (proximal). The articular capsule of the elbow joint is strengthened by three ligaments: annular, radial and ulnar collateral, ligg. anulare, collateraleradialeetulnare.

Functions. Movements around the frontal and vertical axes are possible in the elbow joint. The frontal axis coincides with the axis of the trochlea of ​​the humerus; flexion and extension of the forearm are carried out around it.

When bending the elbow joint, a slight movement of the forearm occurs inward (medially) - the hand rests not on the shoulder joint, but on the chest. Rotation occurs around a vertical axis.

shoulder joint, art . humeroulnaris .

Classification.Block-shaped (helical) joint, uniaxial.

Structure.The joint is formed by the articulation of the trochlea of ​​the humerus and the trochlear notch of the ulna.

Functions. The existing recess on the block allows for a screw motion in the joint with a slight deviation from the midline of the block - flexion and extension around the frontal axis.

Rice. 12 . Elbow joint (opened) and joints of bones shoulders, front view:

1 – articular capsule; 2 – block of the humerus; 3 – collateral ulnar ligament; 4 – humeroulnar joint; 5 – coronoid process; 6 –proximal radioulnar joint; 7 – ulna; 8 – radius; 9 -annular ligament of the radius; 10 – articular semicircle; 11 – humeroradial joint; 12 – collateral radial ligament; 13 – head of the humerus

humeral joint, art . humeroradialis .

Classification. By shape This is a ball and socket joint.

Structure. Joint formed by the articulation of the head of the condyle of the humerus and the glenoid fossa of the head of the radius.

Functions. The following movements are possible in the joint: flexion-extension (frontal axis) and rotation (vertical axis).

Radioulnar (proximal) joint, art . radioulnaris proximalis .

Classification.

Structure. The joint is formed by the articulation of the articular circumference of the head of the radius and the radial notch of the ulna.

Functions. Rotational movements around the vertical axis are possible in the joint (pronation - supination).

Radioulnar (distal) joint, art . radioulnaris distalis .

Classification.It is a cylindrical, uniaxial joint.

Structure. Joint formed by the articulation of the articular circumference of the head of the ulna and the ulnar notch of the radius. The distal radioulnar joint is separated from the wrist joint by a triangular-shaped disc. The capsule and ligamentous apparatus are common to the wrist joint.

Functions. The proximal and distal radioulnar joints together form a combined cylindrical (rotator) joint: the radius rotates around the ulna. Movements in these joints are carried out simultaneously around the vertical axis (pronation - supination).

wrist joint,art. radiocarpea- rice.13.

Classification. The structure of the joint is complex. The shape of the articular surfaces is elliptical with two axes of movement.

Structure. Joint formed by the carpal articular surface of the radius, the articular disc and the articular surfaces of the carpal bones: scaphoid, lunate, triquetrum. The capsule is attached along the edge of the articular surfaces, capturing the radius, ulna and bones of the proximal row of the wrist. Strengthened by ligaments: carpal collateral radial and ulnar, radiocarpal palmar and dorsal, ligg. collateralecarpiradialeetulnare, radiocarpeumpalmareetdorsale.

Functions. Movements in the joint around the frontal (flexion and extension of the hand) and sagittal (abduction and adduction of the hand) axes.

Joints of the hand -rice. 13.

midcarpal joint,art. mediocarpea. The joint is formed by the articular surfaces of the first and second rows of carpal bones.

Rice. 13. Joints and ligaments of the hand. Frontal cutting:

1 – interosseous membrane of the forearm; 2 – radius, 3 – interosseous intercarpal ligaments; 4 – wristjoint, 5 – midcarpal joint; 6 – scaphoid bone; 7 – radial collateral ligament of the wrist, 8 – intercarpal interosseous ligaments; 9 – trapezoid bone; 10 – trapezium bone; 11 – carpometacarpal joint of the thumb; 12 – carpometacarpal joint; 13 – intermetacarpal interosseous ligaments; 14 – intermetacarpal joint; 15 – carpometacarpal joint; 16 – capitate bone; 17 – hamate bone; 18 – triquetral bone; 19 – intercarpal joint; 20 -ulnar collateral ligament of the wrist; 21 – lunate bone; 22 –articular disc; 23 –distal radioulnar joint,24 – bag-shaped depression; 25 –elbow bone

The joint is complex, closer to elliptical in shape. The ligamentous apparatus and, in most cases, the capsule are common with the wrist joint.

Intercarpal joints,artt. intercarpeae, located between the individual bones of the wrist, flat, inactive.

Carpometacarpal joints,artt. Witharpometacarpeae, formed by the articular surfaces of the second row of carpal bones and the articular surfaces of the bases of the metacarpal bones. Carpometacarpal joints II- Vfingers - closer to ellipsoid in shape, have little mobility.

Carpometacarpal joint of the 1st finger, art . carpometacarp e a pollicis , is a simple, saddle-shaped joint. Formed by the articular surfaces of the trapezium bone and the base of the first metacarpal bone. The capsule is attached along the edge of the articular surfaces. Functions. Movements in this joint are carried out around two axes: sagittal and frontal. Around the sagittal axis - adduction and abduction of the thumb relative to the index finger, and around the frontal axis - flexion with simultaneous opposition to the other fingers and extension of the thumb.

intermetacarpal joints,artt. intercarpeae, formed by adjacent lateral surfaces of the basesII- V metacarpal bones. These joints are flat; in them there is a slight displacement of the bones relative to each other during flexion and extension of the hand.

Metacarpophalangeal joints,artt. metacarpophalangeae, formed by the articular surfaces of the heads of the metacarpal bones and the bases of the proximal phalanges. The articular surfaces of the heads are rounded, and the articular sockets are ellipsoidal. The capsule is attached along the edge of the articular surfaces. Strengthened by ligaments: lateral, ligg . collateralia (collateral), palmar, ligg. palmaria (contain fibrous cartilage),deep transverse metacarpal, lig. metacarpeatransversaprofunda. Functions. In the joints, movements around the frontal axis are possible - flexion and extension of the fingers, around the sagittal axis - abduction and adduction of the fingers.

interphalangeal joints,artt. interphalangeae. Classification. Simple, typical trochlear, uniaxial joints. Structure. Formed by the articular surfaces of the articulating phalanges (the head and base of adjacent bones participate in the formation of the joint). The capsule is attached along the edge of the articular surfaces. Joints are strengthened by the complex collateral and palmar, ligg. collateraliaetpalmaria, ligamentsFunctions.In the joints, movement around the frontal axis is possible - flexion and extension of the phalanges of the fingers.

Connections of the bones of the pelvic girdle and free lower limb

Pelvic joints.

Represented by almost all types of connections. Syndesmoses are the own ligaments of the pelvic bone (sacrospinous and sacrotuberous) and the obturator membrane. Synchondrosis - the presence of a cartilaginous layer between the individual bones of the pelvis (iliac, pubic, ischial); Synostosis occurs by age 16. Half-joints – pubic symphysis .

Sacroiliac joint,art. sacroiliac.

Classification.The shape is a flat joint, tight(amphiarthrosis).

Structure. The formation of the joint involves the ear-shaped articular surfaces of the sacrum and the pelvic (ilium) bone, which are almost ideally suited to each other. The capsule, quite strong, is attached along the edge of the articular surfaces. Strengthened by dense and strong sacroiliac ligaments: interosseous, anterior, posterior, andiliopsoas, ligg. sacroiliacinterossea, anterior, posterioretiliolumbale.

Functions.Movement in the joint is limited - slight sliding.

pubic symphysis,symphysispubica. Connects both pubic bones with symphysial surfaces facing each other, between which there is a fibrocartilaginous plate ( interpubic disc, discus interpubicus ) with a narrow synovial cleft. Strengthened by dense periosteum and ligaments -superior pubis and arcuate pubis, ligg. pubicumsuperiusetarcuatumpubis.

Pelvis as a whole

Basin (fig.. 14) formed by two pelvic bones, the sacrum with the coccyx and their connections.

Rice. 14. Dimensions of the female pelvis (ras saw in the sagittal plane):

1 – coccyx; 2 – straight diameter (exit from the small pelvis), 3 – pelvic axis; 4 – pelvic tilt angle; 5 -straight diameter (pelvic cavity); 6 –diagonal conjugate; 7 –true (ginon-cological) conjugate; 8 – anatomic conjugate (straight sizeentrance to the pelvis); 9 – cape

It is a container and protection for many internal organs: the uterus, bladder, rectum, etc. The border line divides the pelvis into the small and large pelvis. The large pelvis is limited by the wings of the ilium, the small pelvis by the ischial and pubic bones, the sacrum, coccyx, pubic symphysis, pelvic ligaments and obturator membranes. There are age and gender differences in the structure of the pelvis. The female pelvis is much wider and shorter than the male pelvis. This is achieved by expanding the wings of the ilium, a flatter sacrum, an increase in the subpubic angle (obtuse in women), etc. Anatomical data on the structural features and size of the female pelvis are taken into account in obstetrics. The following dimensions of the large pelvis are determined: spinous (25-27 cm) – the distance between the anterior-superior iliac spines,ridge (28-29 cm) – the distance between the most distant points of the iliac crests andtrochanteric (30-32 cm) – distance between the greater trochanters of the femurs –distances . Pelvic dimensions:anatomical conjugate , or the direct size of the entrance to the small pelvis is 11.5 cm (the distance between the upper edge of the pubic symphysis and the promontory of the sacrum); obstetric, ortrue conjugate – 11 cm (distance between the middle of the posterior surface of the pubic symphysis and the promontory of the sacrum);diagonal conjugate – 12.5 cm (distance between the lower edge of the pubic symphysis and the promontory of the sacrum); the transverse size of the entrance to the pelvis is 13-15 cm (the distance between the most distant points of the border line); the direct size of the outlet from the pelvis is 9-11 cm (the distance between the lower edge of the pubic symphysis and the coccyx); the transverse size of the outlet from the pelvis is 11 cm (the distance between the inner surfaces of the ischial tuberosities).

hip joint,art. coxae– rice. 15.

Classification. Simple, cup-shaped, multi-axial joint.

Structure.Formed by the acetabulum of the pelvic bone and the femoral head. Enlarges the glenoid cavitycartilaginous lip, labrumacetabulare.

Rice. 15. Hip joint, front opened detailed:

1 – articular fossa; 2 – articular cavity; 3 – head of the femur; 4 -ligament of femoral headsti; 5 – transverse acetabular ligament; 6 – obturator membrane; 7 –circular zone; 8 – lesser trochanter; 9 – femur; 10 – greater trochanter; eleven - joint capsule; 12 - circular zone; 13 -acetabular lip; 14 – ilium

The capsule is attached around the circumference of the acetabulum, and on the femur - along the intertrochanteric line (in front) and along the neck of the femur parallel to the intertrochanteric ridge (back). Located inside the joint cavityfemoral head ligament , which connects the head to the notch of the acetabulum, strengthens the joint, softens shocks during movement, and conducts blood vessels to the femoral head. N lateral ligaments of the joint:iliofemoral, pubofemoral, ischiofemoral, circular zone, ligg. iliofemorale, pubofemorale, ischiofemorale, zoneorbicularis.

Functions.It allows movements around three axes, but their volume is less than in the shoulder joint. Around the frontal axis, flexion and extension are possible: when flexing, the thigh moves forward and presses against the abdomen (such maximum flexion is possible due to the peculiarities of the attachment of the synovial membrane of the articular capsule - it is not attached to the femur at the back), when extension, the thigh moves backward. Around the sagittal axis, the leg is adducted and abducted relative to the midline of the body. Rotation is possible around the vertical axis (inward and outward).

Knee-joint,art. genus– rice. 15.

Classification.The joint is complex, complex, condylar in shape, biaxial.

Rice. 15. Knee joint, right. Opened. View front. The joint capsule has been removed.

1 – patellar surface; 2 –medial condyle; 3 –posterior cruciate ligament;4 – tibiavaya collateral ligament; 5 -medial meniscus; 6 – transverse knee ligament; 7 – tibia; 8 - tibiavaya collateral ligament; 9 – fibula; 10 – interosseous membrane of the leg; 11 – anterior ligament of the head of the fibula; 12 -fibular collateral ligament; 13 -lateral meniscus; 14 – front edgecentiform ligament

Structure. One of the largest and most complex human joints. It is formed by the articular surfaces of the condyles and the patella surface of the femur, the upper articular surface of the tibia and the articular surface of the patella, which articulates only with the femur. The capsule is attached to the edges of the articular surfaces of the patella, femoral and tibial condyles. The joint is supplemented with intra-articular cartilage: lateral and medial menisci, meniscuslateralisetmedialis. The shape of the lateral and medial menisci is different; they increase the congruence of the articulating bones, provide reliability during support, and improve the biomechanical capabilities of the joint. The anterior horns of the menisci are connected to each other transverse knee ligament lig. transversumgenus.

The knee joint has many synovial bursae, the main of which are: suprapatellar, deep infrapatellar and the prepatellar bursa complex. Strengthened by ligaments: internal – anterior and posterior cruciate, ligg. cruciatagenusanteriusetposterius, and external -collateral tibial and fibular, ligg. collateraletibialeetfibulare. The patella has its own ligament -lig. patellae.

Functions. Movements around two axes are possible in the joint: frontal and vertical. The lower leg flexes and extends around the frontal axis. Around the vertical axis (provided the knee is bent), rotation of the lower leg is possible.

tibiofibular joint,art. tibiofibularis.

Classification.The joint is simple, flat, inactive.

Structure. Articulation of the articular surface of the head of the fibula with the fibular articular surface of the tibia. The capsule is attached along the edge of the articular surfaces. Strengthens front and back ligaments of the head of the fibula, ligg. capitisfibulae.

Functions.Movement in the joint is limited.

In the lower part, the fibula and tibia are connected bytibiofibular syndesmosis, syndesmosis tibiofibularis , strengthened in front and behind by ligaments of the same name.

Ankle joint,art. talocruralis- rice. 16.

Classification. WITH false, block-shaped, uniaxial joint.

Structure. Formed by the lower articular surface of the tibia, the articular surfaces of the ankles of both tibias and the block of the talus. The capsule is attached along the edge of the articular surfaces. The joint is strengthened by external ligaments: deltoid, lig. deltoideum(medially);calcaneofibular, anterior and posterior talofibular, ligg. calcaneofibulare, talofibulareanteriusetposterius (lateral).

Functions. Movements around the frontal axis are possible in the joint - flexion (plantar) and extension of the foot.

WITHfoot statutes-rice . 16, 17.

Tarsal joints,artt. intertarsea. Includes joints formed by the calcaneus, talus, navicular, cuboid and sphenoid bones: subtalar, talocaleonavicular, calcaneocuboid, wedge-navicular.Separate capsules for each joint are attached along the edge of the articular surfaces.

The tarsal joints are strengthened by a complex of dorsal and plantar ligaments, among which it is worth notinglong plantar ligament, lig. plantarelongum, as the most significant in the formation of the arches of the feet. This ligament starts from the lower surface of the calcaneus, runs along the foot and is attached in a fan-shaped manner to the base of all metatarsal bones and to the cuboid bone.

Rice. 16. Joints and ligaments of the foot, right. Back surface:

1 – calcaneocuboid joint;2 – talonavicular joint; 3 – medial malleolus; 4 – ankle joint; 5 – deltoid ligament; 6 – talonavicular ligament; 7 – calcaneonavicular ligament; 8 – calcaneocuboid ligament; 9 -dorsal wedge-navicular ligaments; 10 – dorsal intersphenoidal ligaments; 11 – articular capsule of the 1st metatarsophalangeal joint; 12 – collateral ligaments; 13 – metatarsophalangeal joint of the 4th finger; 14 – dorsal metatarsal ligaments; 15 – dorsal tarsometatarsal ligaments; 16 – dorsal cuboid ligament; 17 – interosseous talocalcaneal ligament; 18 – lateral talocalcaneal ligament; 19 – calcaneofibular ligament; 20 – lateral malleolus; 21 – anterior talofibular ligament; 22 – anterior tibiofibular ligament; 23 – transverse tarsal joint; 24 – bifurcated ligament

Functions. IN In the subtalar and talocalcaneal-navicular joints, single movements are possible: when the foot is adducted and rotated outward (the inner edge of the foot is raised), it flexes, and when it is abducted and rotated inward (the outer edge of the foot is raised), the foot is extended. Movement in other joints is limited. Only a slight rotation around the anteroposterior axis is possible as an addition to movements in the talocaleonavicular joint.

subtalar joint,art. subtalaris. Formed by the posterior articular surfaces of the talus and calcaneus. This is a simple, cylindrical joint.

talocaleonavicular joint,art. talocalcaneonavicularis. Formed by the articular surface of the scaphoid, the anterior and middle articular surfaces of the talus and calcaneus. A complex joint, the shape is close to spherical.

calcaneocuboid joint,art. calcaneocuboidea. Formed by the articular surfaces of the calcaneus and cuboid bones. Simple, saddle-shaped joint.

Wedge-navicular joint,art. cuneonavicularis. Connects the three wedge-shaped bones of the foot with the navicular bone. Complex, flat, inactive joint.

For practical reasonscalcaneocuboid Andtalonavicular joints are treated as a single unittransverse joint tarsals (Shopar's joint ) – art. tarsitransversa. To isolate it, it is necessary to cut a certain ligament, which is the “key” to this joint -bifurcated ligament lig. bifurcatum, consisting ofcalcaneocuboid Andcalcaneonavicular, ligg. calcaneocuboideumetcalcaneonaviculare, ligaments

Tarsometatarsal joints,artt. tarsometatarseae. These are flat, inactive joints. They are represented by three isolated joints: one is the connection of the medial cuneiform bone with the 1st metatarsal bone; the second is the connection of the 2nd and 3rd metatarsal bones with the intermediate and lateral cuneiform bones; the third is the articulation of the cuboid bone with the 4th and 5th metatarsal bones. The capsules are separate for each group of joints, are attached along the edge of the articular surfaces and are strengthened by a complex of dorsal and plantar ligaments.

intermetatarsal joints,artt. intermetatarseae, formed by the surfaces of the bases of the metatarsal bones facing each other. Movement in the joints is limited.

metatarsophalangeal joints,artt. metatarsophalangeae, formed by the heads of the metatarsal bones and the bases of the proximal phalanges of the fingers. The articular surfaces of the heads are spherical, and the articular fossae of the phalanges are oval. The capsule is attached along the edge of the articular surfaces. Strengthened by ligaments: lateral (collateral), plantar , deep transverse metatarsal, ligg. collateralia, plantaria, metatarseatransversaprofunda. Functions. In the joints, flexion and extension are possible, as well as slight abduction and adduction of the phalanges relative to each other.

interphalangeal joints,art. interphalangeae. Are analogues of the interphalangeal joints of the hand, however have less mobility, since the foot, having lost the properties of a grasping organ, serves as a support.

Foot as a whole

The foot is adapted to perform a supporting function, which is facilitated by the presence of tight joints and powerful ligaments. The foot is a vaulted formation. There are five longitudinal arches and one transverse arch. All five longitudinal arches begin on the calcaneus, fan-shapedly go forward, along the tarsal bones to the heads of the metatarsal bones. At the level of the highest points of the longitudinal arches, an arched transverse arch is formed. The arches of the foot are held in place by the shape of the adjacent bones, the ligaments (passive “tightening” of the arches) and the muscle tendons (active “tightening”). The arches of the foot are an anatomical and functional device for supporting and moving the human body.

Rice. 17. Joints and ligaments of the foot, right:

1 – tibia; 2 – ankle joint; 3 – deltoid ligament (anterior talotibial part); 4 – deltoid ligament (scaphotibial part); 5 – transverse tarsal joint; 6 – talonavicular joint; 7 – scaphoid bone; 8 – wedge-navicular joint; 9 – interosseous intersphenoid ligament; 10 – intermediate sphenoid bone; 11 – lateral sphenoid bone; 12 – tarsometatarsal joint; 13 – interosseous wedge-metatarsal ligament; 14 – collateral ligaments; 15 – interphalangeal joints of the foot; 16 – metatarsophalangeal joint; 17 – interosseous metatarsal ligaments; 18 – intermetatarsal joints; 19 – cuboid bone; 20 – interosseous sphenocuboid ligament; 21 – tarsometatarsal joint; 22 – cuboidal ligament; 23 – calcaneocuboid joint; 24 – bifurcated ligament (calcaneocuboid ligament); 25 – bifurcated ligament (calcaneonavicular ligament); 26 – interosseous talocalcaneal ligament; 27 – subtalar joint; 28 – posterior talofibular ligament; 29 – fibula

Ossa carpi, arranged in two rows. The upper, or proximal, row is adjacent to the distal part of the bones of the forearm, forming an elliptical articular surface convex towards the forearm; the other row is the lower, or distal, facing the metacarpus.

The second row of carpal bones consists of the trapezium bone, trapezoid bone, capitate bone and hamate bone, respectively.

Occasionally, on the dorsum of the wrist there is an unstable central bone, os centrale, lying between the scaphoid, trapezium and capitate bones.

The scaphoid bone, os scaphoideum, occupies the most lateral position in the first row of carpal bones. Its palmar surface is concave and in the outer-inferior section continues into the tubercle of the scaphoid bone, tuberculum ossis scaphoidei.

The dorsal surface of the bone is a narrow strip that proximally continues into a convex articular surface that articulates with the carpal articular surface of the distal epiphysis of the radius. The inferomedial part of the bone bears a concave articular surface that articulates with the capitate bone. Above it, on the medial side of the bone, is the articular surface for articulation with the lunate. The lateral inferior surface of the bone articulates with the trapezium bone and the trapezoid bone.

The lunate bone, os lunatum, is located medial to the scaphoid. The upper surface of the bone is convex. It articulates with the carpal articular surface of the radius. The lower surface of the bone is concave, in the lateral part there is an articular surface for articulation with the capitate bone, and in the medial part there is an articular surface for articulation with the hamate bone.

The lateral side of the bone has an articular surface that articulates with the scaphoid bone. The medial surface of the bone articulates with the triquetrum.

The triquetrum bone, os triquetrum, occupies the most medial position in the first row of carpal bones. The upper surface of the bone is convex, bearing an articular surface for articulation with the distal forearm.

The lateral part of the bone has a flat articular surface that articulates with the lunate; the inferior, slightly concave surface articulates with the hamate, and the palmar surface with the pisiform.

The pisiform bone, os pisiforme, is ovoid in shape. It belongs to the sesamoid bones, ossa sesamoidea, and lies deep in the tendon of the flexor carpi ulnaris. On the dorsal, posterior, side of the pisiform bone there is a small flat articular surface through which it articulates with the triquetral bone.

Trapezium bone
The trapezium bone, os trapezium, is located distal to the scaphoid, occupying the most lateral position in the second row of carpal bones. The upper surface of the bone bears an articular platform for articulation with the scaphoid bone. The lower surface of the bone has a saddle-shaped articular surface that articulates with the base of the 1st metacarpal bone. On the medial part of the bone there are two concave articular surfaces: a large upper one and a smaller lower one. The first serves for articulation with the trapezoid bone, the second - with the base of the second metacarpal bone.

On the front (palm) surface of the bone in the lateral section there is a small protrusion - the tubercle of the trapezium bone, tuberculum ossis trapezii. Inwardly from it there is a groove - a trace of the contact of the flexor carpi radialis, m. flexor carpi radialis.

Trapezoid bone
The trapezoid bone, os trapezoideum, is located next to the trapezium bone. Its lower saddle-shaped articular surface articulates with the second metacarpal bone.
The upper surface of the bone is concave and articulates with the scaphoid bone, the lateral, somewhat convex surface, with the trapezium bone, and the medial, concave surface, with the capitate bone.

The capitate bone, os capitatum, is the largest of the carpal bones; in the proximal part it has a spherical head. The rest of the bone is somewhat thickened. The medial surface articulates with the hamate bone, and the lateral, somewhat convex surface, articulates with the trapezoid bone. The lower surface of the bone articulates with the base of the III metacarpal bone through a flat articular platform: the lateral surfaces of the bone have small articular surfaces for articulation with the bases of the II and IV metacarpal bones.

The hamate bone, os hamatum, is located next to the capitate bone, closing the second row of carpal bones on the medial, ulnar, side. On the anterior, palmar, surface of the bone there is a well-developed process, somewhat curved to the lateral, radial side, the hook of the hamate, hamulus ossis hamati. The proximal surface of the bone articulates with the lunate bone, the lateral one with the capitate bone, and the medial surface, somewhat convex, with the triquetral bone. On the distal surface of the bone there are two articular platforms for articulation with the IV and V metacarpal bones.

All bones of the wrist, ossa carpi, are connected by joints and ligaments.

The upper, or proximal, edge of the wrist, facing the bones of the forearm, is convex more in the transverse direction.

The lower, or distal, edge of the wrist is relatively smooth. The posterior, or dorsal, surface of the wrist is convex.

The anterior, palmar, surface of the wrist is concave and is called the carpal groove, sulcus carpi. The lateral edges of the groove are limited by two eminences: on the lateral side - the radial eminence of the wrist, formed by the tubercles of the scaphoid bone and the trapezium bone, on the medial side - the ulnar eminence of the wrist, formed by the pisiform bone and the hook of the hamate. A number of carpal bones can be easily felt through the skin. Thus, the scaphoid bone is palpated slightly downward and posterior to the styloid process of the radius; the lunate bone is palpated next to the previous one on the back of the hand; pisiform - with partial flexion of the hand at the wrist joint; capitate - on the back of the hand, better when it is bent at the wrist joint.

The upper limbs of a person are important for a full existence. They perform many functions that a person cannot do without. The palm and fingers are the main part of the hand. The joints and bones of the hand are responsible for their motor, grasping and other important reflexes. Its traumatism limits human capabilities.

Anatomy and functionality of the hand

Considering the functionality of the palm, it is the main organ for performing various activities, having an appropriate anatomical structure. According to its structure, the human hand consists of several sections: muscular, circulatory, and also the nervous system. Thanks to this, the hand has high sensitivity and is able to contact the external environment.

Joints and bones

The anatomy of the bones of the human hand is presented in the form of small joints of various shapes and consists of several sections: the wrist joint, the metacarpal region, and the phalanges of the fingers. They are all combined and have different functions that depend on each other. This raises the question: how many bones are there in the human hand? Having examined the structure in more detail, you can easily count them yourself. Approximately, the hand of the lower limb has about 30 bones. This can be clearly seen in the X-ray image.

The wrist joint is presented in the form of two proximal rows consisting of eight small bones. The triquetral, lunate and scaphoid bones, connected by fixed joints, are localized at the edge, and the pisiform is located on the side, near the thumb. It is designed to increase muscle strength. The back of the first row on the side of the elbow connects with the radius and ulna bones, forming the wrist joint.

The next row is represented by four bones. On the back side it is united with the first, and its front part is united with the metacarpus. The shape of the wrist from the palm side has a concave appearance. The spaces between the eight bones of the wrist are filled with cartilage tissue, tendons, blood vessels, and nerve branches. Thanks to the articulation of these bones with the forearm, the arm is endowed with a rotational function, which allows movements in various directions: up, down, left, right, in a circle.

Metacarpal region

The metacarpus is presented in the form of five hollow bones, articulated with the wrist by fixed joints in the proximal part, and on the opposite side - by the first phalanges. The metacarpal bones have a base, body and head with a spherical ending, allowing the fingers to be extended or clenched into a fist.

Human fingers consist of three parts - phalanges, with the exception of the thumb.

They are divided into 3 categories.

1. The proximal phalanges, which arise from the metacarpus.
2. Central.
3. Nails.

The beams have increased sensitivity, performing micromotor functions, thanks to which a person can perform actions with the smallest objects.

Ligaments of the hand

The bones of the hand are strengthened by multiple ligaments. They have good elasticity and strength due to the density of their fabrics and connecting fibers. The function of ligaments is to protect bones and joints from unwanted movements or injury. However, the ligaments themselves can also be susceptible to damage. They can become stretched due to falls or excessive stress. Breaks are very rare.

The sealing structure of the palms consists of several types of ligaments:

• interarticular;
• rear;
• palmar;
• collateral.

The inner side of the palmar bones is hidden by the retinaculum of the flexor tendons. Here is a canal in which the tendons of the finger flexor muscles are located. The ligaments branch throughout the palm, forming a kind of fibrous layer. The back of the hand has fewer ligaments.

The joints that connect the phalanges of the fingers are sealed by lateral ligaments. The flexor ligaments on both sides contribute to the formation of fibrous sheaths for their muscles. The synovial spaces between the ligaments protect the tendons from external physical damage.

Musculature

All manipulations carried out by the fingers are due to the muscles, as well as its uninterrupted, well-coordinated activity. These muscles are localized exclusively on the side of the palm. Only the tendons are located on the outside.

Based on location, muscles are divided into three main categories.

• Muscular structure of the thumb.
• Group of three central fingers.
• Muscles of the little fingers.

The middle category includes the interarticular muscles that unite the metacarpal region, as well as the lumbrical muscles adjacent to the phalanges. The former are responsible for extending the fingers, and the latter contribute to their bending. The muscles of the thumb are responsible for all its manipulations.

The category of muscles responsible for the activity of the smallest finger also contribute to all its movements. The forearm muscle groups are responsible for the functionality of the hand in relation to the forearm. Their activity largely depends on the tendons extending from the forearm.

All of the above systems of the human hand will not be able to fully function without normal blood flow. Bones, ligaments, tendons, and muscle tissue are entangled with blood and nerve branches. They promote high activity, as well as rapid tissue restoration. The radial and ulnar arterial vessels depart from the joints of the forearm. They pass along the carpal crotch, rushing between the muscle masses and the bone structure of the palm. In its central part they unite, forming a superficial palmar arch.

Smaller blood vessels branch off from this arch and spread out across the fingers. They also have a general circulation and also connect with each other, creating a kind of web. This is a very convenient location of the vessels, since in case of injury, a small part of the arteries or capillaries suffers.

As for the nervous system, its branches run through the entire hand, ending at the tips of the fingers, due to which they have increased sensitivity. The pads contain receptors that respond to touch, temperature or painful touch. Thus, for full-fledged operation, the uninterrupted functioning of all structures and systems is necessary.

Diseases and injuries

Quite often, the joints or bones of the distal part of the lower extremities are subject to various injuries or pathological disorders. The most common problems associated with hand injuries:

• injuries;
• inflammation;
• vascular diseases.

When the joints of the lower extremities are damaged, problems arise with disruption of the functions of different parts of the palmar part, and accordingly, a person’s performance decreases.

Injury to the hand

The most common cause of injury is work or sports. An incorrect approach to physical activity, violation of safety regulations at work, and carelessness at home often lead to fractures, bruises, cracks or dislocations of bones or joints. The right hand is most often affected. Such damage can cause complications and the development of pathological processes that lead to disability or temporary absence of certain functions.

Inflammation of the wrist joint

With open joint injuries, there is a risk of infection, which can cause inflammatory diseases. They, in turn, can give complications that will lead to new consequences.

• As a result of inflammation of the carpal bone tissue, tendinitis can develop.
• Inflammation of the wrist nerve leads to carpal tunnel syndrome, which is accompanied by pain and limited motor functions.
• If the radial articulation is damaged, there is a risk of osteoarthritis, with subsequent bone deformation.
• Rheumatoid arthritis is a consequence of improper treatment of injury and fusion of bone tissue. It is accompanied by severe pain, as well as peculiar crunching sounds.
• Another result of incorrect treatment is impaired blood flow, which contributes to cell death. The result is aseptic necrosis.
• Synovial swelling of the fingers leads to impaired extensor functions.

People who participate in extreme sports involving acrobatics or gymnastics may develop de Quervain's disease. This causes severe pain in the thumb area. With diseases of the cervical spine, there is a risk of trembling syndrome, when uncontrollable trembling is observed when the arms are tense.

Bone inflammation can be caused by cardiovascular pathologies or unstable functioning of the endocrine system. With angina pectoris, a person may experience a burning sensation and tingling sensation in the fingers, and in people with diabetes, blood circulation in the lower extremities is often impaired. The same symptoms may be present in pregnant women. This is due to hormonal changes during fetal development.

Pathological disorders

The most common pathological disorders are the following diseases.

• Rheumatoid polyarthritis. It occurs against the background of infectious diseases, being the most common ailment. It occurs in adults, children or the elderly, especially women. The obvious causes of this disease are: rubella, herpes, hepatitis.
• Polyosteoarthrosis is the second pathological disorder after polyarthritis. It usually spreads to the joints of the lower extremities, which can subsequently become deformed and bulge. The disease can manifest itself as an independent disease or as a complication of other pathologies. Mainly found in older women.
• Gouty arthritis is a pathological condition characterized by a metabolic disorder in which the secretion of uric acids increases, spreading throughout the body. This disease affects not only the joints of the hand.
• Arthropathy is an axial lesion of the bone joints, which affects the fingers. Symptoms of the pathology are intense pain, swelling, severe swelling, and redness. Without timely treatment, the disease progresses, completely destroying the joints.
• The infectious form of arthritis affects single bones and is accompanied by constant, pulsating pain. The affected joint is characterized by swelling, changes in skin color, and impaired activity of the fingers.

The best prevention of the development of pathological changes is therapeutic exercises. By regularly performing a special set of exercises, you can avoid multiple complications. In addition, physical education has never been harmful to the body.

The hand is the distal part of the human arm. It is thanks to this anatomical education that we can perform any work, even the most complex and elegant. The movements of the fingers are so precise that it allows a person to master many extraordinary professions, for example, a jeweler, an artist, a musician, and in everyday life, the hands perform important functions every minute, without which people’s lives would be much more difficult.

The hand is a very complex anatomical structure that works very harmoniously due to certain features.

The human hand consists of 3 sections:

• wrist,
• pyastok,
• fingers.

Each of these parts has a complex skeleton, which provides structural strength and the ability to perform small movements; numerous ligaments, tendons, joints, joint capsules and fascia, which give the hand elasticity, flexibility and precision; muscles that are responsible for graceful movements and also protect the hand from damage; nerve fibers that control the activity of the hands; blood vessels that nourish soft tissues and bones; skin, rich in nerve endings and all kinds of receptors (touch, temperature, pressure, pain, etc.).

Each component of the brushes has its own complex and important functions, but together they provide a variety of manipulations, from the simplest to the incredibly complex and elegant. Let's take a closer look at the layer-by-layer structure of the human hand.

Hand bones

According to the general principle, the skeleton of the hand can be divided into 3 parts: the wrist, the heel and the fingers.

Wrist

This is a combination of eight short spongy bones, which are arranged in two rows of four bones each. The names of the bones correspond to their shape:

• proximal row (direction of listing - from the outside to the inside): scaphoid, lunate, triquetral, pisiform;
• distal row (direction of listing is identical): trapezium bone, trapezoid, capitate, hamate.

Sometimes (in a small proportion of people) between the scaphoid, capitate and trapezoid bones there is an additional central bone, which is usually fused to the scaphoid.

The first 3 bones of the proximal row together form an elliptical articular surface for articulation with the radius and form the wrist joint. On the surface of each of the described bones there is one or more articular surfaces for articulation with neighboring bones. Also on the palmar surfaces of individual bones there are tubercles for attaching muscles and ligaments.

Piastok

The metacarpal bones are listed from the thumb to the little finger. These are long tubular bones that have a triangular shape. Each bone has a base, a body and a head.

The bases of the 2-5 metacarpal bones have articular surfaces for articulation with each other, as well as with the bones of the distal row of the wrist. The first metacarpal bone has only one articular facet for connection with the trapezium bone. The heads of the metacarpal bones have spherical articular surfaces for articulation with the proximal phalanges of the fingers.

Skeleton of fingers

All the bones of the fingers are called phalanges; they are long tubular formations. Among them, there are proximal, median and distal phalanges, each of which is divided into a base, body and head (similar to the metacarpal bones). The human thumb has only two phalanges and does not contain a median one, like other fingers.

Skeleton of fingers

Joints and ligamentous apparatus

All connections of the hand can be divided into groups:

• bones of the forearm with bones of the wrist;
• carpal bones between each other;
• between the bones of the wrist and metacarpus;
• metacarpal bones among themselves;
• bones of the metacarpus and phalanges of the fingers;
• fingers of the hands between each other.

The wrist joint is formed by the proximal row of 3 carpal bones (scaphoid, lunate, triquetrum) and the articular surface of the radius. The joint is complex in its structure and shape, elliptical, biaxial. The joint is reinforced with several strong and elastic ligaments. Movements in the joint: adduction and abduction, flexion and extension.

The wrist joints are simple, flat, multi-axial and inactive and are called intercarpal joints. The combination of intercarpal joints that are located between the proximal and distal rows of carpal bones is called the midcarpal joint, which is strengthened by several ligaments.

The carpometacarpal joints are formed by the distal row of carpal bones and the bases of the metacarpal bones, strengthened by ligaments on the palmar and dorsum of the hand.

The intermetacarpal joints are located between the lateral surfaces of the bases of the 2-5 metacarpal bones and are also strengthened by their ligaments.

The metacarpophalangeal joints are located between the heads of the metacarpal bones and the bases of the proximal phalanges of the fingers. The joints are strengthened by annular and palmar ligaments.

The interphalangeal joints are formed by the heads and bases of adjacent phalanges. The joints in structure and function are simple, uniaxial, block-shaped, which ensures movements around the frontal axis - flexion and extension. Strengthened by annular and palmar ligaments.

Anatomy of the hand: joints and ligaments

Muscles of the hand

Movements of the hands would be impossible without the participation of muscles. The muscles of the hand provide coordination, clarity and strength of movements. The muscular apparatus of this part of the body consists of a large number of individual muscle fibers located on both sides (palm and back) in several layers.

The muscles of the hands are located mainly on the palmar surface. Among them the following groups are distinguished:

• muscles of the eminence of the thumb (thenar);
• muscles of the eminence of the little finger (hypotenar);
• middle muscle group.

Muscular apparatus of the right hand

Thenar muscles include the abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and adductor pollicis. Their functions are adduction and abduction, flexion and extension, and opposition of the thumb.

The hypothenar muscles include the palmaris brevis, abductor digiti minimi, flexor digiti minimi brevis, and opponens minimi brevis. Their functions are abduction, flexion of the little finger, and its opposition to the thumb.

The medial muscle group consists of the lumbrical muscles, palmaris and dorsal interosseous muscles. Their functions are flexion and extension, adduction and abduction of the phalanges of the 2-5 fingers.

Innervation and blood supply

Sensory and motor innervation of the hands is provided by three nerves: median, radial and ulnar.

The median nerve is formed by branches of the C6-T1 spinal cord roots and innervates the thenar muscles, the skin of fingers 1-4 on the palmar surface and the distal phalanges of these fingers on the dorsal surface. When this nerve fiber is damaged, carpal tunnel syndrome develops, one of the most common types of neuropathies, or tunnel syndromes.

Innervation of the hands

The ulnar nerve is formed by the nerve roots of the C8-T1 spinal cord segments. Provides innervation to almost all internal muscles of the palm, the skin of the 4th-5th finger on the palm and back of the hand. When the nerve fiber is damaged, ulnar nerve neuropathy occurs (one of the common types of tunnel syndromes).

The radial nerve is formed by the roots of the spinal cord C5-C8. Innervates the skin of the back of 1-3 fingers and a small area of ​​skin of the thumb from the palmar surface. When this nerve is damaged, radial neuropathy occurs.

The blood supply to the hands is carried out through two arteries - the radial and ulnar, which form the deep and superficial arterial arches. The vascular network of the hands is very developed and rich in numerous anastomoses, which ensures good tissue nutrition and efficient functioning of the limb.

Features of the skin

Skin covers the entire human body and provides a protective function. The skin has its own characteristics in different areas. For example, the skin on the palmar surface of the hands is much thicker than on the back. This is due to the constant impact of friction, pressure, chemical and mechanical influence on this area of ​​the upper limb. This ensures reliable protection of the muscles, joints, ligaments, bones, blood vessels and nerves of the hand. However, the palmar surface of the skin of the hands, and even more so the fingertips, are equipped with a large number of sensitive receptors, which provides a high level of tactile abilities in this area of ​​the body. The back of the skin contains an abundance of sebaceous and sweat glands.

Very often you can hear that the condition of the skin of the hands reflects the true age of a person. This is true, because it is this area of ​​the skin that is constantly exposed to negative environmental factors, including ultraviolet radiation. Therefore, if a woman wants to look young, it is important to take care not only of the health and beauty of her facial skin, but also her hands, so that they do not reveal her true age.

Brush functions

The hand is a unique and universal part of the human body, which is the main organ of labor.

Undoubtedly, the main function of the hand is to perform complex and ultra-precise movements, but an important task of this part of the hand is to provide the sense of touch. A large number of receptors are concentrated in the fingertips, thanks to which blind people can determine the shape, size of an object, read, etc.

The carpal bones are formed by a collection of 8 small spongy bones, which are arranged in two rows, each of which contains 4 bones.

The first or proximal row, located closer to the forearm, consists of the following bones, presented in order, starting with the thumb:

• scaphoid or os scaphoideum;
• semilunar or os lunatum;
• triangular or os triquetrum;
• pisiform or os pisiforme.

The union of the first three ossicles forms an elliptical articular surface that articulates the carpus and the distal end of the radius. The pisiform bone of the wrist, which is usually referred to as the sesamoid bone, in turn, is attached to the triquetral bone.

The second row of carpal bones - distal - is formed by the following bones:

• trapezium or os trapezium;
• trapezoid or os trapezoideum;
• capitate or os capitation;
• uncinate or os hamatum.

The surface of each bone is equipped with special articular facets that help the ossicles connect to nearby bones. Also on the palmar surfaces of a number of carpal bones there are tubercles to which ligaments and muscles are attached. These bones include: scaphoid, trapezium, hamate.

The general appearance of the carpal bones has the shape of an arch, the convex part of which is located on the back of the hand, the concave part on the palm.

Almost all 8 carpal bones have six surfaces (except for the pisiform). Moreover, all bones, without exception, are articular: their lower surface forms the articular fossae, and the upper surface forms the articular heads. Between the lateral surfaces of the bones there are also articulations that connect the carpal bones to each other.

Injuries to the bones of the wrist

The most common wrist injuries include dislocations and fractures:

• Dislocations of the wrist bones. Dislocations come in many varieties, depending on the bones involved in the injury. Most often, dislocations of the lunate bone occur, a little less often - of the scaphoid, and rarely - of the pisiform. Lunate dislocation is quite difficult to recognize even with the help of x-ray examination. However, the main symptoms are the following: the presence of a protrusion in the center of the palmar side of the wrist and a recess on the back, a sensation of pain when straightening the fingers, which are often motionless or take the form of half-bent ones. In addition, the wrist joint swells on the palm side, and movements are painful. The dislocation is reduced by countertraction, traction or pushing using the Beler method. Dislocation of the scaphoid is often accompanied by a fracture. It can be diagnosed only with the help of x-ray examination. Such a dislocation is reduced under anesthesia or local anesthesia by traction, after which a bandage is applied, special gymnastics and physiotherapy are prescribed. A pisiform carpal dislocation usually does not have a negative impact on the function of the hand and wrist. Surgical treatment is prescribed, in which the bone is sutured in its place, and sutures are applied to the ligamentous apparatus;
• Fractures of the wrist bones are quite rare, but the scaphoid bone is most susceptible to fractures. In more rare cases (as with dislocations), fractures of the lunate and pisiform bones are possible. Fractures of other wrist bones are exceptional cases. A fracture of the scaphoid bone is possible in situations involving a fall on a bent arm, a blow to a hard surface with a fist, or a direct blow to the palm. In most cases, a fracture breaks the scaphoid bone into two pieces. Symptoms of a fracture are as follows: pain in the wrist joint, increasing with load on the first or second fingers, inability to clench the hand into a fist due to pain. Diagnosis is made using X-ray examination, treatment includes immobilization for a period of 1 to 6 months. If the fracture of the wrist bone is not accompanied by displacement, it is recommended to apply a plaster cast for approximately 3 months. If there is displacement, osteosynthesis of bone fragments is performed with screws. In this case, the period of immobilization increases to 2 months. A fracture of the lunate bone occurs when falling on the hand or as a result of a direct blow. After the injury, there is swelling of the joint and pain that intensifies when the hand is extended to the back. Treatment involves the application of a plaster splint, which is worn for 1.5 to 2 months. As a rule, complications during bone fusion are not observed. The rarest type of fracture of the wrist bones is a fracture of the pisiform bone, the injury of which is caused by blows to the area of ​​injury or a blow with the edge of the hand on a hard surface. Symptoms include pain in the area of ​​the wrist joint on the little finger side, which intensifies when clenching the hand into a fist or trying to bend the little finger. Treatment involves immobilization lasting at least 1 month.