Page:EB1911 - Volume 15.djvu/512

Rh Joints of the Upper Extremity.

The sterno-clavicular articulation, between the presternum and clavicle, is a gliding joint, and allows slight upward and downward and forward and backward movements. The two bony surfaces are separated by a meniscus, the vertical movements taking place outside and the antero-posterior inside this. There is a well-marked capsule, of which the anterior part is strongest. The two clavicles are joined across the top of the presternum by an interclavicular ligament.

The acromio-clavicular articulation is also a gliding joint, but allows a swinging or pendulum movement of the scapula on the clavicle. The upper part of the capsule is strongest, and from it hangs down a partial meniscus into the cavity.

Comparative Anatomy.—Bland Sutton regards the interclavicular ligament as a vestige of the interclavicle of Reptiles and Monotremes. The menisci are only found in the Primates, but it must be borne in mind that many Mammals have no clavicle, or a very rudimentary one. By some the meniscus of the sterno-clavicular joint is regarded as the homologue of the lateral part of the interclavicle, but the fact that it only occurs in the Primates where movements in different planes are fairly free is suggestive of a physiological rather than a morphological origin for it.

The is a good example of the ball and socket or enarthrodial variety. Its most striking characteristic is mobility at the expense of strength. The small size of the glenoid cavity in comparison with the head of the humerus, and the great laxity of the capsule, favour this, although the glenoid cavity is slightly deepened by a fibrous lip, called the glenoid ligament, round its margin. The presence of the coracoid and acromial processes of the scapula, with the coraco-acromial ligament between them, serves as an overhanging protection to the joint, while the biceps tendon runs over the head of the humerus, inside the capsule, though surrounded by a sheath of synovial membrane. Were it not for these two extra safeguards the shoulder would be even more liable to dislocation than it is. The upper part of the capsule, which is attached to the base of the coracoid process, is thickened, and known as the coracohumeral ligament, while inside the front of the capsule are three folds of synovial membrane, called gleno-humeral folds.

Comparative Anatomy.—In the lower Vertebrates the shoulder is adapted to support rather than prehension and is not so freely movable as in the Primates. The tendon of the biceps has evidently sunk through the capsule into the joint, and even when it is intra-capsular there is usually a double fold connecting its sheath of synovial membrane with that lining the capsule. In Man this has been broken through, but remains of it persist in the superior gleno-humeral fold. The middle gleno-humeral fold is the vestige of a strong ligament which steadies and limits the range of movement of the joint in many lower Mammals.

The is an excellent example of the ginglymus or hinge, though its transverse axis of movement is not quite at right angles to the central axis of the limb, but is lower internally than externally. This tends to bring the forearm towards the body when the elbow is bent. The elbow is a great contrast to the shoulder, as the trochlea and capitellum of the humerus are closely adapted to the sigmoid cavity of the ulna and head of the radius (see : appendicular); consequently movement in one plane only is allowed, and the joint is a strong one. The capsule is divided into anterior, posterior, and two lateral ligaments, though these are all really continuous. The joint cavity communicates freely with that of the superior radio-ulnar articulation.

The radio-ulnar joints are three: the upper one is an example of a pivot joint, and in it the disk-shaped head of the radius rotates in a circle formed by the lesser sigmoid cavity of the ulna internally and the orbicular ligament in the other three quarters.

The middle radio-ulnar articulation is simply an interosseous membrane, the fibres of which run downward and inward from the radius to the ulna.

The inferior radio-ulnar joint is formed by the disk-shaped lower end of the ulna fitting into the slightly concave sigmoid cavity of the radius. Below, the cavity of this joint is shut off from that of the wrist by a triangular fibro-cartilage. The movements allowed at these three articulations are called pronation and supination of the radius. The head of that bone twists, in the orbicular ligament, round its central vertical axis for about half a circle. Below, however, the whole lower end of the radius circles round the lower end of the ulna, the centre of rotation being close to the styloid process of the ulna. The radius, therefore, in its pronation, describes half a cone, the base of which is below, and the hand follows the radius.

Comparative Anatomy.—In pronograde Mammals the forearm is usually permanently pronated, and the head of the radius, instead of being circular and at the side of the upper end of the ulna, is transversely oval and in front of that bone, occupying the same place that the coronoid process of the ulna does in Man. This type of elbow, which is adapted simply to support and progression, is best seen in the Ungulata; in them both lateral ligaments are attached to the head of the radius, and there is no orbicular ligament, since the shape of the head of the radius does not allow of any supination. The olecranon process of the ulna forms merely a posterior guide or guard to the joint, but transmits no weight. No better example of the maximum changes which the uses of support and prehension bring about can be found than in contrasting the elbow of the Sheep or other Ungulate with that of Man. Towards one or other of these types the elbows of all Mammals tend. It may be roughly stated that, when pronation and supination to the extent of a quarter of a circle are possible, an orbicular ligament appears.

The, or radio-carpal articulation, lies between the radius and triangular fibro-cartilage above, and the scaphoid, semilunar, and cuneiform bones below. It is a condyloid joint allowing flexion and extension round one axis, and slight lateral movement (abduction and adduction) round the other. There is a well-marked capsule, divided into anterior, posterior, and lateral ligaments. The joint cavity is shut off from the inferior radio-ulnar joint above, and the intercarpal joints below.

The intercarpal joints are gliding articulations, the various bones being connected by palmar, dorsal, and a few interosseous ligaments, but only those connecting the first row of bones are complete, and so isolate one joint cavity from another. That part of the intercarpal joints which lies between the first and second rows of carpal bones is called the transverse carpal joint, and at this a good deal of the movement which seems to take place at the wrist really occurs.

The carpo-metacarpal articulations are, with the exception of that of the thumb, gliding joints, and continuous with the great intercarpal joint cavity. The carpo-metacarpal joint of the thumb is the best example of a saddle-shaped joint in Man. It allows forward and backward and lateral movement, and is very strong.

The metacarpo-phalangeal joints are condyloid joints like the wrist, and are remarkable for the great thickness of the palmar ligaments of their capsules. In the four inner fingers these glenoid ligaments, as they are called, are joined together by the transverse metacarpal ligament.

The interphalangeal articulations are simple hinges surrounded by a capsule, of which the dorsal part is very thin.

Comparative Anatomy.—The wrist joint of the lower Mammals allows less lateral movement than does that of Man, while the lower end of the ulna is better developed and is received into a cup-shaped socket formed by the cuneiform and pisiform bones. At the same time, unless there is pretty free pronation and supination, the triangular fibro-cartilage is only represented by an interosseous ligament, which may be continuous above with the interosseous membrane between the radius and ulna, and suggests the possibility that the fibro-cartilage is largely a derivative of this membrane. In most Mammals the wrist is divided into two lateral parts, as it is in the human foetus, but free pronation and supination seem to cause the disappearance of the septum.

Joints of the Lower Extremity.

The sacro-innominate articulation consists of the sacro-iliac joint and the sacro-sciatic ligaments. The former is one of the amphiarthroses or half-joints by which the sacrum is bound to the ilium. The mechanism of the human sacrum is that of a suspension bridge slung between the two pillars or ilia by the very strong posterior sacro-iliac ligaments which represent the chains. The axis of the joint passes through the second sacral vertebra, but the sacrum is so nearly horizontal that the weight of the body, which is transmitted to the first sacral vertebra, tends to tilt that part down. This tendency is corrected by the