Joints of Upper Limb

Dhruv Gehlot
SHOULDER JOINT
 GLENOHUMERAL JOINT

• It is a joint between the head of humerus &

glenoid cavity of the scapula.
• The shoulder joint is most movable joint
of the body & consequently one of the least
stable.
• Its is most common joint to dislocate &
to undergo recurrent dislocations.
Type
__________ of synovial joint
 GLENOHUMERAL JOINT

• It is a joint between the head of humerus &

glenoid cavity of the scapula.
• The shoulder joint is most movable joint
of the body & consequently one of the least
stable.
• Its is most common joint to dislocate &
to undergo recurrent dislocations.
Type
_ Ball & socket type_ of synovial joint
 Articulation Surfaces

• Large round head of

humerus with relatively
shallow glenoid cavity
of the scapula

• The glenoid cavity is

deepened slightly but
effectively by the
fibrocartilaginous ring
called glenoid labrum
Ligaments
1) Capsular Ligament (joint capsule)
2) Glenohumeral ligaments
3) Coracohumeral ligament
4) Transverse humeral ligament
 1. Capsular Ligament
The thin fibrous layer of the joint capsule surrounds the glenohumeral
joint.
Attached medially - margins of glenoid cavity beyond glenoid labrum
Attached laterally - the anatomical neck of the humerus, except inferiorly
where it extends downwards 1.5 cm or more on the surgical neck of the
humerus.

EXPLANATION
If a person were to develop an infection in the metaphysis (the wider part
of the bone near the growth plate) of the proximal humerus, the
infection could potentially spread to the nearby joint capsule due to its
intracapsular location. This could lead to septic arthritis of the shoulder
joint. In other words, an infection that starts in the bone could potentially
spread to the shoulder joint because a portion of the bone near the joint
is intracapsular, making it more susceptible to joint infections.
Capsular Ligament

Capsular Ligament
 Synovial membrane
The synovial membrane lines the inner surface of the joint capsule & reflects from
it to the glenoid labrum & humerus as far as the articular margin of the head.
The synovial cavity of the joint presents the following features:

(A) It forms tubular sheath around the tendon of biceps brachii where it lies in the
bicipital groove of the humerus.

(B) It communicates with subscapular & infraspinatus bursae, around the joint.

Thus there are three apertures in the joint capsule:

(i) An opening between the tubercles of the humerus for the passage of tendon of
long head of biceps brachii.

(ii) An opening situated anteriorly inferior to the coracoid process to allow

communication between the synovial cavity & subscapular bursa.

(iii) An opening situated posteriorly to allow communication between synovial

cavity & infraspinatus bursa.
SYNOVIAL MEMBRANE
 Glenohumeral Ligament

There are three thickenings in the anterior part

of the fibrous capsule; to strengthen it.
These are called superior, middle, & inferior
glenohumeral ligaments. They are visible only Sup. Glenohumeral
from interior of the joint. ligament

A defect exists between superior & middle

glenohumeral ligaments, which acquire
importance in the anterior dislocation of the Middle Glenohumeral
shoulder joint. ligament

Inf. Glenohumeral
ligament
 Coracohumeral ligament
It is a strong band of fibrous tissue that passes
from the base of the coracoid process
to the anterior aspect of the greater tubercle
of the humerus.

Transverse humeral
ligament:
It is a broad fibrous band, which bridges the bicipital groove
between the greater & lesser tubercles. This ligament
converts the groove into a canal that provides passage to the
tendon of long head of biceps surrounded by a synovial
sheath.
 ACCESSORY LIGAMENTS
1. Coracoacromial ligament: It extends between coracoid
& acromion processes. It protects the superior aspect
of the joint.

2. Coracoacromial arch: The coracoacromial arch is formed

by coracoid process, acromion process, & coracoacromial Coracoacromial arch
ligament between them. This osseoligamentous structure
forms a protective arch for the head of humerus above
& prevents its superior displacement above the glenoid
cavity.

Coracoacromial
Ligament
 BURSAE RELATED TO THE SHOULDER JOINT

1. Subscapular bursa: It lies between the tendon of subscapularis & the

neck of the scapula; & protects the tendon from friction against the neck.
This bursa usually communicates with the joint cavity.

2. Subacromial bursa: It lies between the coracoacromial ligament &

acromion process above, & supraspinatus tendon & joint capsule below. It
continues downwards beneath the deltoid, hence it is sometimes also
referred to as subdeltoid bursa. It is the largest synovial bursa in the body
& facilitates the movements of supraspinatus tendon under the
coracoacromial arch.

3. Infraspinatus bursa: It lies between the tendon of infraspinatus &

posterolateral aspect of the joint capsule. It may sometime communicate
with the joint cavity.
 RELATIONS OF THE SHOULDER JOINT
Superior Inferior Anterior Posterior
Coracoacromial arch Long head of triceps Subscapularis Infraspinatus

Subacromial bursa Axillary nerve Subscapular bursa Teres minor

Coracoacromial arch Post. Circumflex coracobrachialis deltoid

humeral vessels
Short head of biceps
Subacromial bursa brachii

deltoid
RELATIONS OF THE SHOULDER JOINT
 FACTORS PROVIDING STABILITY TO THE SHOULDER JOINT

• Rotator cuff
• Coracoacromial arch
• Long head of biceps tendon
• Glenoid labrum
 ROTATOR CUFF

The rotator cuff is

formed by the blending
together of the tendons
of subscapularis,
supraspinatus,
infraspinatus, & teres
minor around joint
capsule
 Action of the rotator cuff muscles:

Rotator cuff pull the relatively large head of the humerus medially to hold
it against the smaller & shallow glenoid cavity
Coracoacromial arch
The coracoacromial arch forms, the secondary socket of the glenohumeral
joint & protects the joint from the above & prevents the upward
dislocation of the head of humerus.

The long head of biceps brachii

Passes above the head of humerus intracapsular, hence prevents its
upward displacement.

The glenoid labrum

Provides protection by deepening the shallow glenoid cavity.
ARTERIAL SUPPLY
 ARTERIAL SUPPLY

1. Anterior & posterior circumflex humeral

arteries
2. Suprascapular artery
3. Subscapular artery

Suprascapular artery branch of?

Anterior, posterior circumflex humeral, Subscapular

artery branch of ?
 ARTERIAL SUPPLY

1. Anterior & posterior circumflex humeral

arteries
2. Suprascapular artery
3. Subscapular artery

Suprascapular artery branch of Thyrocervical trunk

Anterior, posterior circumflex humeral, Subscapular

artery branch of ?
 ARTERIAL SUPPLY

1. Anterior & posterior circumflex humeral

arteries
2. Suprascapular artery
3. Subscapular artery

Suprascapular artery branch of Thyrocervical trunk

Anterior, posterior circumflex humeral, Subscapular

artery branch of Axillary artery
NERVE SUPPLY
 NERVE SUPPLY
1. Axillary Nerve
2. Suprascapular Nerve
3. Musculocutaneous Nerve

Axillary Nerve
Suprascapular Nerve
Musculocutaneous Nerve
 NERVE SUPPLY
1. Axillary Nerve
2. Suprascapular Nerve
3. Musculocutaneous Nerve

Axillary Nerve Posterior cord of brachial plexus

Suprascapular Nerve
Musculocutaneous Nerve
 NERVE SUPPLY
1. Axillary Nerve
2. Suprascapular Nerve
3. Musculocutaneous Nerve

Axillary Nerve Posterior cord of brachial plexus

Suprascapular Nerve Branch of the upper trunk (C5 &
C6) of the brachial plexus
Musculocutaneous Nerve
 NERVE SUPPLY
1. Axillary Nerve
2. Suprascapular Nerve
3. Musculocutaneous Nerve

Axillary Nerve Posterior cord of brachial plexus

Suprascapular Nerve Branch of the upper trunk (C5 &
C6) of the brachial plexus
Musculocutaneous Nerve Lateral cord of the brachial
plexus
 NERVE SUPPLY
Axillary Nerve Posterior cord of brachial plexus
Suprascapular Nerve Branch of the upper trunk (C5 &
C6) of the brachial plexus
Musculocutaneous Nerve Lateral cord of the brachial
plexus
 MOVEMENTS OF THE SHOULDER JOINT
The shoulder joint has more freedom of mobility than any other joint in the
body, due to the following factors
1 Laxity of joint capsule.
2. Articulation between relatively large humeral head & smaller & shallow
glenoid cavity.

The glenohumeral joint permits four groups of movements:

1. Flexion & extension.
2. Abduction & adduction.
3. Medial & lateral rotation.
4. Circumduction.
MOVEMENTS OF THE SHOULDER JOINT
ACTIONS MUSCLE INVOLVED
Flexion Pectoralis major, deltoid,
coracobrachialis, short head of
biceps brachii
Extension Latissimus dorsi, teres major,
pectoralis major, deltoid, long
head of triceps brachii
Adduction Coracobrachialis, pectoralis
major, latissimus dorsi, teres
major
Abduction Supraspinatus, deltoid
Medial rotation Subscapularis, teres major,
latissimus dorsi, pectoralis
major, deltoid
Lateral rotation Teres minor, infraspinatus,
deltoid
 Flexion at shoulder joint
Muscle involved - Pectoralis major, deltoid, coracobrachialis, short head of biceps
brachii

ROM- 90 Degree
 Extension at shoulder joint
Muscle involved - Latissimus dorsi, teres major, pectoralis major,
deltoid, long head of triceps brachii

ROM- 45 Degree
 Adduction at shoulder joint
Muscle involved - Coracobrachialis, pectoralis major, latissimus dorsi, teres
major

ROM- 45 Degree
 Abduction at shoulder joint
Muscle involved- Supraspinatus, deltoid

ROM- 180 Degree

 Medial rotation at shoulder joint
Muscle involved - Subscapularis, teres major, latissimus dorsi, pectoralis
major, deltoid

ROM- 55 Degree
 Lateral rotation at shoulder joint
Muscle involved - Teres minor, infraspinatus, deltoid

ROM- 45 Degree
 Circumduction at shoulder joint
The circumduction at glenohumeral joint is an orderly sequence of flexion,
abduction, extension & adduction or the reverse. During this movement the
upper limb moves along a circle.
 Mechanism of Abduction
The abduction at shoulder is a complex movement
The total range of abduction is 180°

Abduction up to 90° occurs at the glenohumeral joint.

Abduction from 90° to 120° can occur only if the humerus is rotated laterally.

Abduction from 120° to 180° can occur if the scapula rotates forwards on the chest
wall.

The detailed analysis is as under:

1. The articular surface of the head of humerus permits elevation of arm only up to 90°,
because when the upper end of humerus is elevated, to 90° its greater tubercle
impinges upon the under surface of the acromion & can only be released by lateral
rotation of the arm.

2. Therefore, the arm rotates laterally & carries abduction up to 120°.

3. Abduction above 120° can occur only if scapula rotates. So that the scapula rotates
forwards on the chest wall.
 CLINICAL CORRELATION
Clavicle dislocation - It can be dislocate at either of its ends.
At medial ends, it is usually dislocated forward.
Backward dislocation is rare as it is prevented by the
costoclavicular ligament
Shoulder dislocation - Dislocation of shoulder joint mostly occurs
inferiorly because the joint is least supported on this aspect. It often
injures the axillary nerve because of its close relation to the inferior part
of the joint capsule. However, clinically, it is described as anterior or
posterior dislocation indicating whether the humeral head has descended
anterior or posterior.

The dislocation is usually caused by excessive extension & lateral rotation

of the humerus.

Clinically, it presents as
(a) Hollow in rounded contour of the shoulder
(b) Prominence of shoulder tip
 Frozen shoulder (adhesive capsulitis)
Frozen shoulder (adhesive capsulitis): It is a clinical condition characterized
by pain & uniform limitation of all movements of the shoulder joint, though
there are no radiological changes in the joint. It occurs due to inflammation
of the joint capsule & adhered to joint, hence the name adhesive capsulitis.
This condition is generally seen in individuals with 40–60 years of age.
 Rotator cuff
Rotator cuff disorders: The rotator cuff disorders include calcific supraspinatus
tendinitis
The rotator cuff is commonly injured during repetitive use of the upper limb
above the horizontal level (e.g., in throwing sports, swimming, & weight lifting).

The deposition of calcium in the supraspinatus tendon is common. The calcium

deposition irritates the overlying subacromial bursa causing subacromial bursitis.

whenever the arm is abducted the inflamed bursa is caught between tendon &
acromion, which causes severe pain. In most people, pain occurs during 60°–120°
of abduction (painful arc syndrome).
The rotator cuff disorders usually occur in males after 50 years of age.

The pain due to subacromial bursitis is elicited when the deltoid is pressed just
below the acromion, when the arm is adducted.
The pain cannot be elicited by the pressure on the same point
when the arm is abducted because the bursa slips under
the acromion process
(Dawbarn’s sign)
 Shoulder tip pain
Irritation of the peritoneum underlying diaphragm from any
surrounding pathology causes referred pain in shoulder. This is so
because the phrenic nerve carrying impulses from peritoneum & the
supraclavicular nerve both arises from spinal segment C3, C4
ELBOW JOINT
 HUMERO-ULNAR , HUMERO-RADIAL

• The elbow joint is a joint between the lower end of the humerus &
upper ends of the radius & ulna. It actually includes two articulations:
• (a) humero-ulnar articulation, between the trochlea of the humerus
& trochlear notch of the ulna.

• (b) humero-radial articulation, between the capitulum of the

humerus & the head of radius. On the surface, the joint line of elbow
is situated 2 cm below the line joining the two epicondyles of
humerus.

• Type - ?
 HUMERO-ULNAR , HUMERO-RADIAL

• The elbow joint is a joint between the lower end of the humerus &
upper ends of the radius & ulna. It actually includes two articulations:
• (a) humero-ulnar articulation, between the trochlea of the humerus
& trochlear notch of the ulna.

• (b) humero-radial articulation, between the capitulum of the

humerus & the head of radius. On the surface, the joint line of elbow
is situated 2 cm below the line joining the two epicondyles of
humerus.

• Type - Hinge type of synovial joint.

The upper articular surface- Capitulum & the trochlea of the lower end humerus.

The lower articular surface- Head of the radius & trochlear notch of the ulna.
The capitulum is a rounded hemispherical eminence & possesses smooth articular
surface.

The trochlea is medial to capitulum & resembles a pulley. The medial flange of
trochlea projects to a lower level than its lateral flange.

The trochlear notch of ulna is formed by the upper surface of the coronoid process
& anterior surface of the olecranon process.

The upper end of radius is circular in outline & slightly depressed in the center.
 Ligaments
1. Capsular Ligament-It is a fibrous sac enclosing the joint cavity. The inner
surface of the capsule is lined by the synovial membrane.

2. Medial Ligament (Ulnar Collateral Ligament)- It is triangular in shape,

with its apex attached to the medial epicondyle of the humerus & base to
the coronoid & olecranon process of the ulna.

3. Lateral Ligament (Radial Collateral Ligament)-It extends from the lateral

epicondyle of humerus to the annular ligament with which it blends
Capsular ligament
 Relations of elbow joint
Anterior- Brachialis muscle Medially- Flexor carpi ulnaris
ulnar nerve
Median nerve common flexor origin of
Brachial artery forearm muscles
Tendon of biceps brachii
Laterally – Common extensor
Posterior- Tendon of triceps Supinator
Anconeus ext. carpi radialis brevis
 Bursa related to elbow joint
Four important bursae are related to the elbow joints—
(a) two in relation to the triceps insertion:
(b) two in relation to the biceps insertion:

1. Subtendinous olecranon bursa, a small bursa between triceps tendon &

upper surface of the olecranon process.

2. Subcutaneous olecranon bursa, a large bursa between skin &

subcutaneous triangular area on the posterior surface of the olecranon.

3. Bicipitoradial bursa, a small bursa separating biceps tendon from smooth

anterior part of the radial tuberosity.

4. Bursa separating the biceps tendon from the

oblique cord.
 Blood supply of elbow joint
The blood supply of elbow joints is by arterial anastomosis
around the elbow formed by the branches of brachial, radial,
& ulnar arteries.
 Nerve supply

Nerve supply of elbow joint is by articular branches from:

(a) radial nerve
(b) musculocutaneous nerve
(c) ulnar nerve
(d) median nerve
 Movements

Flexion- brachialis, biceps brachii, brachioradialis

Extension- triceps brachii, anconeus

 Carrying Angle
• The transverse axis of elbow joint is not transverse but oblique being directed
downwards & medially.
• This is because medial flange of trochlea lies about 6 mm below its lateral
flange. Consequently when the elbow is extended the arm & forearm do not lie
in straight line, rather forearm is deviated slightly laterally.
• This angle of deviation of long axis of forearm from long axis of arm is termed
carrying angle.

• The carrying angle disappears during pronation & full flexion of forearm.
• The forearm comes into line with the arm in the midprone position—the
position in which the h& is mostly used.
• The carrying angle varies from 5° to 15° & is more pronounced in females.
• The wider carrying angle in females avoids rubbing of forearms with the wider
female pelvis while carrying loads,
e.g., buckets filled with water from one place to another.
 Carrying
angle

A-C Long axis of the arm

D Long axis of forearm
 Clinical Correlation
Elbow effusion: The distension of elbow joint due to effusion within its cavity
occurs posteriorly because capsule of the joint is thin posteriorly & covering fascia
is also thin. The joint is aspirated by inserting a needle on the posterolateral side,
above the head of radius with elbow at the right angle.

Elbow Arthrocentesis
Technique
• Dislocation of elbow: Posterior dislocations of elbow are more common & are
often associated with fracture of the coronoid process. The dislocation
invariably occurs by falling on an outstretched hand. The triangular relationship
between the olecranon & the epicondyles of humerus is lost.
Note, in normal flexed elbow the tip of olecranon process & two epicondyles of
humerus form an ‘equilateral triangle’.
• Nursemaid’s elbow/pulled elbow (subluxation of head of radius) occurs in
preschool children, 1–3 years old when the forearm is suddenly pulled in
pronation. The head of radius comes out of annular ligament & the elbow is
kept slightly flexed & pronated. An attempt to supinate the forearm causes severe
pain. The reduction is easily achieved by supinating & extending the elbow &
simultaneously applying direct pressure posteriorly on the head of radius.
• Nursemaid’s elbow/pulled elbow (subluxation of head of radius) The reduction
is easily achieved by supinating & extending the elbow & simultaneously applying
direct pressure posteriorly on the head of radius.
• Tennis elbow (lateral epicondylitis): It is a clinical condition characterized by pain
& tenderness over the lateral epicondyle of the humerus with pain during abrupt
pronation. It occurs due to:
(a) sprain of lateral collateral ligament of elbow joint
(b) a tear of the fibers of extensor carpi radialis brevis, or
(c) an inflammation of bursa underneath the extensor carpi radialis brevis
(d) strain or tear of common extensor origin.
• Golfer’s elbow (medial epicondylitis): It is a clinical condition characterized by
pain & tenderness over the medial epicondyle of the humerus. It occurs due to
strain or tear of common flexor origin with subsequent inflammation of medial
epicondyle, following repetitive use of superficial flexors of forearm as during
playing golf.
• Student’s elbow (Miner’s elbow) is characterized by a round fluctuating painful
swelling over the olecranon. It occurs due to inflammation of subcutaneous
olecranon bursa lying over subcutaneous triangular area on the posterior aspect
of the olecranon process.
Radio-Ulnar Joints
 Radio-Ulnar joints
The radius & ulna form two joints between them

Upper end lower end

Superior radio-ulnar inferior radio-ulnar

joints joints

Type- Synovial joint of _______ variety

 Radio-Ulnar joints
The radius & ulna form two joints between them

Upper end lower end

Superior radio-ulnar inferior radio-ulnar

joints joints

Type- Synovial joint of _PIVOT_ variety

 Ligaments of sup. Radio ulnar joint
1. Capsular ligament: The fibrous capsule surrounds the joint.
It is continuous with that of elbow joint and is attached to the annular ligament.

2. Annular ligament: It is a strong fibrous band, which encircles the head of

radius and holds it against the radial notch of ulna.

Attachments-
Medially the annular ligament is attached to the margins of radial notch of ulna.
The upper margin of the ligament is continuous with the capsule of the shoulder
joint.
Laterally, it blends with the radial collateral ligament.

3. Quadrate ligament: It is thin, fibrous ligament, which extends from neck of

radius to the upper part of supinator fossa of ulna just below the radial notch.
 Ligaments of inf. Radio ulnar joint
1. Capsular ligament:
It is a fibrous sac which encloses the joint cavity and is attached to the
margins of articular surfaces. The inner surface of the joint capsule is lined by
synovial membrane.
The synovial lining of the joint sends an upward prolongation in front of the lower
part of the interosseous membrane called recessus sacciformis.

2. Articular disc:
It is a triangular fibrocartilaginous disc and is sometimes referred to by clinicians
as triangular ligament.
Its apex is attached to the base of the styloid process of ulna and its base to the
lower margin of the ulnar notch of radius.
The articular disc separates the inferior radio-ulnar joint from the wrist joint.
 INTEROSSEOUS MEMBRANE OF THE FOREARM
It is the fibrous sheet, which stretches between the interosseous borders of the radius and
ulna.

It holds these bones together and does not interfere with the movements.

This union between radius and ulna is sometimes termed middle radio-ulnar joint. This is a
syndesmosis type of fibrous joint.

Relations- Ant – ant interosseous nerves and vessels

post – post interosseous nerves and vessels

Functions- hold radius and ulna together

Transmits compression force from radius to ulna
Provide attachment of muscles

Oblique cord
It is a strong fibrous band which extends from medial side of tuberosity of
ulna to the lower part of the tuberosity of the radius.
Features Superior radio-ulnar joint Inferior radio-ulnar joint
Type Pivot type of synovial joint Pivot type of synovial joint
Articular surfaces • Circumference of head of • Head of ulna
radius • Ulnar notch of radius
• Fibro-osseous ring formed
by annular
ligament & radial notch of
ulna

Joint cavity Communicates with the cavity Does not communicate with
of elbow joint the cavity of wrist joint

Prime stabilizing Annular ligament Articular disc

factor
Movements Supination & pronation Supination & pronation
Blood supply Elbow joint anastomosis Ant & post Interosseous
arteries
Nerve Supply Musculocutaneous, median, Ant & post interosseous
radial, and ulnar nerves
Movements Supination pronation
 Supination & pronation
Supination & pronation are rotatory movements of the forearm/h& around a
vertical axis.
In a semi-flexed elbow, the palm is turned upwards in supination, & downwards in
pronation.
The movements are permitted at the superior & inferior radioulnar joints.

During pronation, head of radius spins within annular ligament.

As radius with the h& comes medially
across the lower part of ulna,
the interosseous membrane is spiralized.
During supination, the membrane is despiralized.
• The vertical axis of movement of the radius passes through the center of the
head of the radius above, & through the ulnar attachment of the articular disc
below.
• In supination, the radius & ulna lie parallel to each other
• Supination is more powerful than pronation because it is an antigravity
movement. Supination movements are responsible for all screwing movements
of the h&, e.g. tightening nuts & bolts.
• Morphologically, pronation & supination
were evolved for picking up food
& taking it to the mouth.
• Around 50° of supination &
50° of pronation are generally
required to perform many of the
routine activities
 Clinical Correlation

Mnemonic- GRUM GR: Galeazzi – radius UM: Ulna - Monteggia

First Carpometacarpal
joint
 First Carpometacarpal Joint
It is synovial joint of _______variety ?

Articular surfaces

Proximal: Distal surface of the trapezium.

Distal: Proximal surface of the base of 1st metacarpal.

Both proximal and distal articular surfaces are reciprocally concavo-convex;

hence permit wide range of movements at this joint.
 First Carpometacarpal Joint
It is synovial joint of _Saddle_ variety ?

Articular surfaces

Proximal: Distal surface of the trapezium.

Distal: Proximal surface of the base of 1st metacarpal.

Both proximal and distal articular surfaces are reciprocally concavo-convex;

hence permit wide range of movements at this joint.
 Ligaments
1. Capsular ligament
It is thick loose fibrous sac, which encloses the joint cavity.
It is attached proximally to the margins of articular surface of the trapezium
and distally to the circumference of the base of first metacarpal bone.
The inner surface of the capsule is lined by the synovial membrane.

2. Lateral ligament:
It is a broad fibrous band stretching from lateral surface of the trapezium to
the lateral side of the base of 1st metacarpal bone.

3. Anterior (palmar) ligament:

It extends obliquely from palmar surface of trapezium to the ulnar side of the
base of 1st metacarpal.

4. Posterior (dorsal) ligament:

It also extends obliquely from dorsal surface of trapezium to the ulnar side of
the base of 1st metacarpal.
 Relations
The joints are surrounded by various muscles and tendons of the thumb. In
addition, it is related to:
(a) radial artery on its posteromedial sides.
(b) First dorsal interosseous muscle on its medial side.

Blood Supply
By radial artery.

Nerve Supply

By median nerve.
 Movements
The various movements, which take place at the first carpometacarpal joint are as
follows:
1. Flexion and extension.
2. Abduction- away from plane of hand
3. adduction. – adding back to hand
4. Opposition.
5. Circumduction.
THANK YO