There are two sets in each finger (except in the thumb, which has only one joint):
"proximal interphalangeal joints" (PIJ or PIP), those between the first (also called proximal) and second (intermediate) phalanges
"distal interphalangeal joints" (DIJ or DIP), those between the second (intermediate) and third (distal) phalanges
Anatomically, the proximal and distal interphalangeal joints are very similar. There are some minor differences in how the palmar plates are attached proximally and in the segmentation of the flexor tendon sheath, but the major differences are the smaller dimension and reduced mobility of the distal joint.[1]
Interphalangeal ligaments and phalanges. Right hand. Deep dissection. Posterior (dorsal) view.
The PIP joint exhibits great lateral stability. Its transverse diameter is greater than its antero-posterior diameter and its thick collateral ligaments are tight in all positions during flexion, contrary to those in the metacarpophalangeal joint.[1]
The capsule, extensor tendon, and skin are very thin and lax dorsally, allowing for both phalanx bones to flex more than 100° until the base of the middle phalanx makes contact with the condylar notch of the proximal phalanx.[1]
At the level of the PIP joint the extensor mechanism splits into three bands. The central slip attaches to the dorsal tubercle of the middle phalanx near the PIP joint. The pair of lateral bands, to which contribute the extensor tendons, continue past the PIP joint dorsally to the joint axis. These three bands are united by a transverse retinacular ligament, which runs from the palmar border of the lateral band to the flexor sheath at the level of the joint and which prevents dorsal displacement of that lateral band. On the palmar side of the joint axis of motion, lies the oblique retinacular ligament [of Landsmeer] which stretches from the flexor sheath over the proximal phalanx to the terminal extensor tendon. In extension, the oblique ligament prevents passive DIP flexion and PIP hyperextension as it tightens and pulls the terminal extensor tendon proximally.[2]
Palmar structures
In contrast, on the palmar side, a thick ligament prevents hyperextension. The distal part of the palmar ligament, called the palmar plate, is 2 to 3 millimetres (0.079 to 0.118 in) thick and has a fibrocartilaginous structure. The presence of chondroitin and keratan sulfate in the dorsal and palmar plates is important in resisting compression forces against the condyles of the proximal phalanx. Together these structures protect the tendons passing in front and behind the joint. These tendons can sustain traction forces thanks to their collagen fibers.[1]
Palmar ligament
Metacarpophalangeal joint and joints of digit. Palmar aspect. Palmar ligament labelled as volar ligament.
The palmar ligament is thinner and more flexible in its central-proximal part. On both sides it is reinforced by the so-called check rein ligaments. The accessory collateral ligaments (ACL) originate at the proximal phalanx and are inserted distally at the base of the middle phalanx below the collateral ligaments.[1]
The accessory ligament and the proximal margin of the palmar plate are flexible and fold back upon themselves during flexion. The flexor tendon sheaths are firmly attached to the proximal and middle phalanges by annular pulleys A2 and A4, while the A3 pulley and the proximal fibres of the C1 ligament attach the sheaths to the mobile volar ligament at the PIP joint. During flexion this arrangement produces a space at the neck of the proximal phalanx which is filled by the folding palmar plate.[2]
The palmar plate is supported by a ligament on either side of the joint called the collateral ligaments, which prevent deviation of the joint from side to side. The ligaments can partially or fully tear and can avulse with a small fracture fragment when the finger is forced backwards into hyperextension. This is called a "palmar plate, or volar plate injury".[3]
The palmar plate forms a semi-rigid floor and the collateral ligaments the walls in a mobile box which moves together with the distal part of the joint and provides stability to the joint during its entire range of motion. Because the palmar plate adheres to the flexor digitorum superficialis near the distal attachment of the muscle, it also increases the moment of flexor action. In the PIP joint, extension is more limited because of the two so called check-rein ligaments, which attach the palmar plate to the proximal phalanx.[2]
Movements
The only movements permitted in the interphalangeal joints are flexion and extension.
Flexion is more extensive, about 100°, in the PIP joints and slightly more restricted, about 80°, in the DIP joints.
Extension is limited by the volar and collateral ligaments.
The relative length of the digit varies during motion of the IP joints. The length of the palmar aspect decreases during flexion while the dorsal aspect increases by about 24 mm. The useful range of motion of the PIP joint is 30–70°, increasing from the index finger to the little finger. During maximum flexion the base of the middle phalanx is firmly pressed into the retrocondylar recess of the proximal phalanx, which provides maximum stability to the joint. The stability of the PIP joint is dependent of the tendons passing around it.[2]
^Victoria Ruffing, Clifton O. Bingham. "Rheumatoid Arthritis Signs and Symptoms". Johns Hopkins Hospital. Retrieved 2017-08-10. Updated: April 4, 2017
^PJW Venables, Ravinder N Maini. "Diagnosis and differential diagnosis of rheumatoid arthritis". UpToDate. Retrieved 2017-08-10. Last updated: Jan 22, 2016.
External links
Volar Plate Injury - Hand Therapy
Further reading
Brüser, Peter; Gilbert, Alain (1999). Finger bone and joint injuries. Taylor & Francis. ISBN978-1-85317-690-6.
Lluch, Alberto (1997). "Interphalangeal joint anatomy". In Copeland, Stephen (ed.). Joint stiffness of the upper limb. Taylor & Francis. ISBN1-85317-414-9.
This article incorporates text in the public domain from page 333 of the 20th edition ofGray's Anatomy(1918)
interphalangeal, joints, hand, interphalangeal, joints, hand, hinge, joints, between, phalanges, fingers, that, provide, flexion, towards, palm, hand, joints, handthe, joints, hand, distal, interphalangeal, proximal, interphalangeal, metacarpophalangealhuman, . The interphalangeal joints of the hand are the hinge joints between the phalanges of the fingers that provide flexion towards the palm of the hand Joints of the handThe DIP PIP and MCP joints of the hand Distal InterPhalangeal Proximal InterPhalangeal MetaCarpoPhalangealHuman hand bonesDetailsIdentifiersLatinarticulationes interphalangeae manus articulationes digitorum manusTA98A03 5 11 601TA21839FMA35285Anatomical terminology edit on Wikidata There are two sets in each finger except in the thumb which has only one joint proximal interphalangeal joints PIJ or PIP those between the first also called proximal and second intermediate phalanges distal interphalangeal joints DIJ or DIP those between the second intermediate and third distal phalangesAnatomically the proximal and distal interphalangeal joints are very similar There are some minor differences in how the palmar plates are attached proximally and in the segmentation of the flexor tendon sheath but the major differences are the smaller dimension and reduced mobility of the distal joint 1 Contents 1 Joint structure 1 1 Dorsal structures 1 2 Palmar structures 1 2 1 Palmar ligament 2 Movements 3 Clinical significance 4 See also 5 References 6 External links 7 Further readingJoint structure Edit Joints of the hand X ray Interphalangeal ligaments and phalanges Right hand Deep dissection Posterior dorsal view The PIP joint exhibits great lateral stability Its transverse diameter is greater than its antero posterior diameter and its thick collateral ligaments are tight in all positions during flexion contrary to those in the metacarpophalangeal joint 1 Further information Collateral ligament of interphalangeal joints of hand Dorsal structures Edit The capsule extensor tendon and skin are very thin and lax dorsally allowing for both phalanx bones to flex more than 100 until the base of the middle phalanx makes contact with the condylar notch of the proximal phalanx 1 At the level of the PIP joint the extensor mechanism splits into three bands The central slip attaches to the dorsal tubercle of the middle phalanx near the PIP joint The pair of lateral bands to which contribute the extensor tendons continue past the PIP joint dorsally to the joint axis These three bands are united by a transverse retinacular ligament which runs from the palmar border of the lateral band to the flexor sheath at the level of the joint and which prevents dorsal displacement of that lateral band On the palmar side of the joint axis of motion lies the oblique retinacular ligament of Landsmeer which stretches from the flexor sheath over the proximal phalanx to the terminal extensor tendon In extension the oblique ligament prevents passive DIP flexion and PIP hyperextension as it tightens and pulls the terminal extensor tendon proximally 2 Palmar structures Edit In contrast on the palmar side a thick ligament prevents hyperextension The distal part of the palmar ligament called the palmar plate is 2 to 3 millimetres 0 079 to 0 118 in thick and has a fibrocartilaginous structure The presence of chondroitin and keratan sulfate in the dorsal and palmar plates is important in resisting compression forces against the condyles of the proximal phalanx Together these structures protect the tendons passing in front and behind the joint These tendons can sustain traction forces thanks to their collagen fibers 1 Palmar ligament Edit Metacarpophalangeal joint and joints of digit Palmar aspect Palmar ligament labelled as volar ligament The palmar ligament is thinner and more flexible in its central proximal part On both sides it is reinforced by the so called check rein ligaments The accessory collateral ligaments ACL originate at the proximal phalanx and are inserted distally at the base of the middle phalanx below the collateral ligaments 1 The accessory ligament and the proximal margin of the palmar plate are flexible and fold back upon themselves during flexion The flexor tendon sheaths are firmly attached to the proximal and middle phalanges by annular pulleys A2 and A4 while the A3 pulley and the proximal fibres of the C1 ligament attach the sheaths to the mobile volar ligament at the PIP joint During flexion this arrangement produces a space at the neck of the proximal phalanx which is filled by the folding palmar plate 2 The palmar plate is supported by a ligament on either side of the joint called the collateral ligaments which prevent deviation of the joint from side to side The ligaments can partially or fully tear and can avulse with a small fracture fragment when the finger is forced backwards into hyperextension This is called a palmar plate or volar plate injury 3 The palmar plate forms a semi rigid floor and the collateral ligaments the walls in a mobile box which moves together with the distal part of the joint and provides stability to the joint during its entire range of motion Because the palmar plate adheres to the flexor digitorum superficialis near the distal attachment of the muscle it also increases the moment of flexor action In the PIP joint extension is more limited because of the two so called check rein ligaments which attach the palmar plate to the proximal phalanx 2 Movements EditThe only movements permitted in the interphalangeal joints are flexion and extension Flexion is more extensive about 100 in the PIP joints and slightly more restricted about 80 in the DIP joints Extension is limited by the volar and collateral ligaments The muscles generating these movements are Location Flexion Extensionfingers the flexor digitorum profundus acting on the proximal and distal joints and the flexor digitorum superficialis acting on the proximal joints mainly by the lumbricals and interossei the long extensors having little or no action upon these jointsthumb the flexor pollicis longus the extensor pollicis longusThe relative length of the digit varies during motion of the IP joints The length of the palmar aspect decreases during flexion while the dorsal aspect increases by about 24 mm The useful range of motion of the PIP joint is 30 70 increasing from the index finger to the little finger During maximum flexion the base of the middle phalanx is firmly pressed into the retrocondylar recess of the proximal phalanx which provides maximum stability to the joint The stability of the PIP joint is dependent of the tendons passing around it 2 Clinical significance EditRheumatoid arthritis generally spares the distal interphalangeal joints 4 Therefore arthritis of the distal interphalangeal joints strongly suggests the presence of osteoarthritis or psoriatic arthritis 5 See also EditInterphalangeal joints of foot Metacarpophalangeal jointsReferences Edit a b c d e Lluch 1997 pp 259 60 a b c d Bruser amp Gilbert 1999 pp 158 60 Hand Therapy Volar Plate Injury Victoria Ruffing Clifton O Bingham Rheumatoid Arthritis Signs and Symptoms Johns Hopkins Hospital Retrieved 2017 08 10 Updated April 4 2017 PJW Venables Ravinder N Maini Diagnosis and differential diagnosis of rheumatoid arthritis UpToDate Retrieved 2017 08 10 Last updated Jan 22 2016 External links EditDiagram at depuy com Volar Plate Injury Hand TherapyFurther reading EditBruser Peter Gilbert Alain 1999 Finger bone and joint injuries Taylor amp Francis ISBN 978 1 85317 690 6 Lluch Alberto 1997 Interphalangeal joint anatomy In Copeland Stephen ed Joint stiffness of the upper limb Taylor amp Francis ISBN 1 85317 414 9 This article incorporates text in the public domain from page 333 of the 20th edition of Gray s Anatomy 1918 Portal Anatomy Retrieved from https en wikipedia org w index php title Interphalangeal joints of the hand amp oldid 1122043573, wikipedia, wiki, book, books, library,
