9 - Lecture Articulations

An Introduction to Articulations Learning Outcomes 9-1 Contrast the major categories of joints, and explain the relationship between structure and function for each category. 9-2 Describe the basic structure of a synovial joint, and describe common synovial joint accessory structures and their functions. 9-3 Describe how the anatomical and functional properties of synovial joints permit movements of the skeleton. 9-4 Describe the articulations between the vertebrae of the vertebral column.

An Introduction to Articulations Learning Outcomes 9-5 Describe the structure and function of the shoulder joint and the elbow joint. 9-6 Describe the structure and function of the hip joint and the knee joint. 9-7 Describe the effects of aging on articulations, and discuss the most common age-related clinical problems for articulations. 9-8 Explain the functional relationships between the skeletal system and other body systems.

An Introduction to Articulations Body movement occurs at joints (articulations) where two bones connect Joint Structure Determines direction and distance of movement (range of motion or ROM) Joint strength decreases as mobility increases

9-1 Classification of Joints Two Methods of Classification Functional classification is based on range of motion of the joint Structural classification relies on the anatomical organization of the joint

9-1 Classification of Joints Functional Classifications Synarthrosis (immovable joint) Amphiarthrosis (slightly movable joint) Diarthrosis (freely movable joint)

9-1 Classification of Joints Structural Classifications Bony Fibrous Cartilaginous Synovial

Table 9-1 Functional and Structural Classifications of Articulations 8

Table 9-1 Functional and Structural Classifications of Articulations

Table 9-1 Functional and Structural Classifications of Articulations 10

9-1 Classification of Joints Synarthroses (Immovable Joints) Are very strong Edges of bones may touch or interlock Four types of synarthrotic joints Suture Gomphosis Synchondrosis Synostosis

9-1 Classification of Joints Suture Bones interlocked Are bound by dense fibrous connective tissue Are found only in skull Gomphosis Fibrous connection (periodontal ligament) Binds teeth to sockets

9-1 Classification of Joints Synchondrosis Is a rigid cartilaginous bridge between two bones Epiphyseal cartilage of long bones Between vertebrosternal ribs and sternum Synostosis Fused bones, immovable Metopic suture of skull Epiphyseal lines of long bones

9-1 Classification of Joints Amphiarthroses More movable than synarthrosis Stronger than freely movable joint Two types of amphiarthroses Syndesmosis Bones connected by ligaments Symphysis Bones separated by fibrocartilage

9-1 Classification of Joints Synovial Joints (Diarthroses) Also called movable joints At ends of long bones Within articular capsules Lined with synovial membrane

9-2 Synovial Joints Articular Cartilages Pad articulating surfaces within articular capsules Prevent bones from touching Smooth surfaces lubricated by synovial fluid Reduce friction

9-2 Synovial Joints Synovial Fluid Contains slippery proteoglycans secreted by fibroblasts Functions of synovial fluid Lubrication Nutrient distribution Shock absorption

9-2 Synovial Joints Accessory Structures Cartilages Fat pads Ligaments Tendons Bursae

9-2 Synovial Joints Cartilages Fat Pads Ligaments Cushion the joint Fibrocartilage pad called a meniscus (or articular disc; plural, menisci) Fat Pads Superficial to the joint capsule Protect articular cartilages Ligaments Support, strengthen joints Sprain – ligaments with torn collagen fibers

9-2 Synovial Joints Tendons Bursae Attach to muscles around joint Help support joint Bursae Singular, bursa, a pouch Pockets of synovial fluid Cushion areas where tendons or ligaments rub

9-2 Synovial Joints Factors That Stabilize Synovial Joints Prevent injury by limiting range of motion Collagen fibers (joint capsule, ligaments) Articulating surfaces and menisci Other bones, muscles, or fat pads Tendons of articulating bones

Figure 9-1a The Structure of a Synovial Joint Medullary cavity Spongy bone Periosteum Fibrous joint capsule Synovial membrane Articular cartilages Joint cavity (containing synovial fluid) Compact bone Synovial joint, sagittal section 22

Figure 9-1b The Structure of a Synovial Joint Quadriceps tendon Bursa Joint capsule Femur Patella Synovial membrane Articular cartilage Meniscus Fat pad Patellar ligament Intracapsular ligament Joint cavity Tibia Meniscus Knee joint, sagittal section 23

9-2 Synovial Joints Injuries Dislocation (luxation) Articulating surfaces forced out of position Subluxation A partial dislocation Sprain Tear in a ligament due to joint being carried through ROM greater than normal but without dislocation or fracture Strain Tear in a muscle

9-3 Movements Three Types of Dynamic Motion Linear movement (gliding) Angular movement Rotation Planes (Axes) of Dynamic Motion Monaxial (1 axis) Biaxial (2 axes) Triaxial (3 axes)

Figure 9-2 A Simple Model of Articular Movement Initial position Gliding movement Angular movement Circumduction Rotation 26

9-3 Movements Types of Movement at Synovial Joints Terms describe: Plane or direction of motion Relationship between structures

9-3 Movements Types of Movement at Synovial Joints Gliding Movement Two surfaces slide past each other Between carpal or tarsal bones

9-3 Movements Angular Movement Flexion Extension Angular motion Anterior–posterior plane Reduces angle between elements Extension Increases angle between elements

9-3 Movements Angular Movement Hyperextension Angular motion Extension past anatomical position

Figure 9-3a Angular Movements Extension Flexion Hyperextension Flexion Flexion Hyper- extension Extension Extension Flexion Hyperextension Extension Flexion/extension 31

9-3 Movements Angular Movement Abduction Adduction Angular motion Frontal plane Moves away from longitudinal axis Adduction Moves toward longitudinal axis

Figure 9-3b Angular Movements Abduction Abduction Adduction Adduction Abduction Adduction Abduction Adduction Abduction/adduction 33

Figure 9-3c Angular Movements Adduction Abduction Adduction/abduction 34

9-3 Movements Angular Movement Circumduction Circular motion without rotation Angular motion

9-3 Movements Types of Movement at Synovial Joints Rotation Direction of rotation from anatomical position Relative to longitudinal axis of body Left or right rotation Medial rotation (inward rotation) Rotates toward axis Lateral rotation (outward rotation) Rotates away from axis

Figure 9-4a Rotational Movements Head rotation Right rotation Left rotation Lateral (external) rotation Medial (internal) rotation 37

9-3 Movements Rotation Pronation Supination Rotates forearm, radius over ulna Supination Forearm in anatomical position

Dorsiflexion (ankle flexion) Plantar flexion (ankle extension) 9-3 Movements Special Movements Inversion Twists sole of foot medially Eversion Twists sole of foot laterally Dorsiflexion Flexion at ankle (lifting toes) Plantar flexion Extension at ankle (pointing toes) Dorsiflexion (ankle flexion) Plantar flexion (ankle extension)

9-3 Movements Opposition Thumb movement toward fingers or palm (grasping) Reposition Opposite of opposition Protraction Moves anteriorly In the horizontal plane (pushing forward) Retraction Opposite of protraction Moving anteriorly (pulling back) Retraction Protraction

9-3 Movements Special Movements Elevation Depression Lateral flexion Moves in superior direction (up) Depression Moves in inferior direction (down) Lateral flexion Bends vertebral column from side to side

Figure 9-5 Synovial Joints Depression Elevation 42

Figure 9-5 Synovial Joints Lateral flexion 43

9-3 Movements Classification of Synovial Joints by Shape Gliding Hinge Pivot Condylar Saddle Ball-and-socket

9-3 Movements Gliding Joints Hinge Joints Pivot Joints Flattened or slightly curved faces Limited motion (nonaxial) Hinge Joints Angular motion in a single plane (monaxial) Pivot Joints Rotation only (monaxial)

Figure 9-6 Synovial Joints Gliding joint Movement: slight nonaxial or multiaxial Clavicle Examples: • Acromioclavicular and claviculosternal joints Manubrium • Intercarpal and intertarsal joints • Vertebrocostal joints • Sacro-iliac joints 46

Figure 9-6 Synovial Joints Hinge joint Movement: monaxial Examples: Humerus • Elbow joint • Knee joint • Ankle joint Ulna • Interphalangeal joint 47

Figure 9-6 Synovial Joints Pivot joint Movement: monaxial (rotation) Examples: Atlas • Atlanto-axial joint • Proximal radio-ulnar joint Axis 48

9-3 Movements Condylar Joints Saddle Joints Ball-and-socket Joints Oval articular face within a depression Motion in two planes (biaxial) Saddle Joints Two concave, straddled (biaxial) Ball-and-socket Joints Round articular face in a depression (triaxial)

Figure 9-6 Synovial Joints Condylar joint Movement: biaxial Examples: • Radiocarpal joint Scaphoid bone • Metacarpophalangeal joints 2–5 • Metatarsophalangeal joints Ulna 50

Figure 9-6 Synovial Joints Saddle joint Movement: biaxial Examples: • First carpometacarpal joint III II Metacarpal bone of thumb Trapezium 51

Figure 9-6 Synovial Joints Ball-and-socket joint Movement: triaxial Examples: Scapula • Shoulder joint • Hip joint Humerus 52

9-3 Movements Joints A joint cannot be both mobile and strong The greater the mobility, the weaker the joint Mobile joints are supported by muscles and ligaments, not bone-to-bone connections

9-4 Intervertebral Articulations C2 to L5 spinal vertebrae articulate: At inferior and superior articular processes (gliding joints) Between adjacent vertebral bodies (symphyseal joints)

9-4 Intervertebral Articulations Intervertebral Discs Pads of fibrocartilage Separate vertebral bodies Anulus fibrosus Tough outer layer Attaches disc to vertebrae Nucleus pulposus Elastic, gelatinous core Absorbs shocks

Figure 9-7 Intervertebral Articulations Superior articular facet Intervertebral Disc Vertebral end plate Intervertebral foramen Anulus fibrosus Ligamentum flavum Nucleus pulposus Spinal cord Posterior longitudinal ligament Spinal nerve Interspinous ligament Supraspinous ligament Anterior longitudinal ligament 56

9-4 Intervertebral Articulations Vertebral Joints Also called symphyseal joints As vertebral column moves: Nucleus pulposus shifts Disc shape conforms to motion Intervertebral Ligaments Bind vertebrae together Stabilize the vertebral column

9-4 Intervertebral Articulations Six Intervertebral Ligaments Anterior longitudinal ligament Connects anterior bodies Posterior longitudinal ligament Connects posterior bodies Ligamentum flavum Connects laminae

9-4 Intervertebral Articulations Six Intervertebral Ligaments Interspinous ligament Connects spinous processes Supraspinous ligament Connects tips of spinous processes (C7 to sacrum) Ligamentum nuchae Continues supraspinous ligament (C7 to skull)

9-4 Intervertebral Articulations Damage to Intervertebral Discs Slipped disc Bulge in anulus fibrosus Invades vertebral canal Herniated disc Nucleus pulposus breaks through anulus fibrosus Presses on spinal cord or nerves

Figure 9-8a Damage to the Intervertebral Discs Normal intervertebral disc L1 Slipped disc L2 A lateral view of the lumbar region of the spinal column, showing a distorted intervertebral disc (a “slipped” disc) 61

Figure 9-8b Damage to the Intervertebral Discs Compressed area of spinal nerve Spinal nerve Spinal cord Nucleus pulposus of herniated disc Anulus fibrosus A sectional view through a herniated disc, showing the release of the nucleus pulposus and its effect on the spinal cord and adjacent spinal nerves 62

9-4 Intervertebral Articulations Movements of the Vertebral Column Flexion Extension Lateral flexion Rotation

9-5 The Shoulder Joint The Shoulder Joint Also called the glenohumeral joint Allows more motion than any other joint Is the least stable Supported by skeletal muscles, tendons, ligaments Ball-and-socket diarthrosis Between head of humerus and glenoid cavity of scapula

9-5 The Shoulder Joint Socket of the Shoulder Joint Glenoid labrum Deepens socket of glenoid cavity Fibrocartilage lining Extends past the bone

9-5 The Shoulder Joint Processes of the Shoulder Joint Acromion (clavicle) and coracoid process (scapula) Project laterally, superior to the humerus Help stabilize the joint Shoulder Separation Dislocation of the shoulder joint

9-5 The Shoulder Joint Shoulder Muscles (Rotator Cuff) Shoulder Bursae Supraspinatus Infraspinatus Subscapularis Teres minor Shoulder Bursae Subacromial Subcoracoid Subdeltoid Subscapular

Figure 9-9a The Shoulder Joint Acromioclavicular ligament Coracoclavicular ligaments Tendon of supraspinatus muscle Clavicle Acromion Articular capsule Coraco-acromial ligament Subdeltoid bursa Coracoid process Scapula Synovial membrane Articular cartilages Joint cavity Humerus Glenoid labrum Articular capsule Anterior view, frontal section 68

Figure 9-9b The Shoulder Joint Acromioclavicular ligament Clavicle Coraco-acromial ligament Coracoclavicular ligaments Tendon of supraspinatus muscle Tendon of biceps brachii muscle Coracohumeral ligament (cut) Acromion Coracoid process Subacromial bursa Subcoracoid bursa Tendon of infraspinatus muscle Subscapular bursa Subscapularis muscle Teres minor muscle Glenohumeral ligaments Articular capsule Glenoid cavity Scapula Glenoid labrum Lateral view of pectoral girdle 69

9-5 The Elbow Joint The Elbow Joint A stable hinge joint Humero-ulnar joint Humeroradial joint

Figure 9-10a The Right Elbow Joint Showing Stabilizing Ligaments Humerus Radial collateral ligament Radial tuberosity Antebrachial interosseous membrane Radius Ulna Capitulum Annular ligament (covering head and neck of radius) Lateral view 71

Figure 9-10b The Right Elbow Joint Showing Stabilizing Ligaments Tendon of biceps brachii muscle Annular ligament Humerus Articular capsule Antebrachial interosseous membrane Medial epicondyle Ulnar collateral ligament Radius Ulna Olecranon of ulna Medial view 72

9-6 The Hip Joint The Hip Joint Also called coxal joint Strong ball-and-socket diarthrosis Wide range of motion Head of femur fits into socket of acetabulum

Figure 9-11a The Right Hip Joint Iliofemoral ligament Fibrocartilage pad Acetabular labrum Ligament of the femoral head Acetabulum Transverse acetabular ligament (spanning acetabular notch) Fat pad in acetabular fossa A lateral view with the femur removed 74

Figure 9-11b The Right Hip Joint Pubofemoral ligament Greater trochanter Iliofemoral ligament Lesser trochanter An anterior view 75

Figure 9-11c The Right Hip Joint Iliofemoral ligament Ischiofemoral ligament Greater trochanter Lesser trochanter Ischial tuberosity A posterior view, showing addi- tional ligaments that add strength to the capsule 76

9-6 The Knee Joint The Knee Joint A complicated hinge joint Transfers weight from femur to tibia Articulations of the knee joint Two femur–tibia articulations At medial and lateral condyles One between patella and patellar surface of femur

9-6 The Knee Joint The Articular Capsule and Joint Cavity Medial and lateral menisci Fibrocartilage pads At femur–tibia articulations Cushion and stabilize joint Give lateral support

9-6 The Knee Joint Seven Major Supporting Ligaments Patellar ligament (anterior) 2. & 3. Two popliteal ligaments (posterior) 4. & 5. Anterior and posterior cruciate ligaments (inside joint capsule) Tibial collateral ligament (medial) Fibular collateral ligament (lateral)

Figure 9-12a The Right Knee Joint Quadriceps tendon Patella Joint capsule Patellar retinaculae Tibial collateral ligament Fibular collateral ligament Patellar ligament Tibia Anterior view, superficial layer 80

Figure 9-12b The Right Knee Joint Femur Joint capsule Plantaris muscle Gastrocnemius muscle, medial head Gastrocnemius muscle, lateral head Bursa Fibular collateral ligament Tibial collateral ligament Cut tendon of biceps femoris muscle Popliteal ligaments Popliteus muscle Tibia Fibula Posterior view, superficial layer 81

Figure 9-12c The Right Knee Joint Patellar surface Fibular collateral ligament Posterior cruciate ligament Lateral condyle Medial condyle Tibial collateral ligament Lateral meniscus Cut tendon Medial meniscus Anterior cruciate ligament Tibia Fibula Deep anterior view, flexed 82

Figure 9-12d The Right Knee Joint Femur Posterior cruciate ligament Fibular collateral ligament Medial condyle Lateral condyle Tibial collateral ligament Lateral meniscus Medial meniscus Cut tendon Anterior cruciate ligament Fibula Tibia Deep posterior view, extended 83

9-7 Effects of Aging on Articulations Degenerative Changes Rheumatism A pain and stiffness of skeletal and muscular systems Arthritis All forms of rheumatism that damage articular cartilages of synovial joints Osteoarthritis Caused by wear and tear of joint surfaces, or genetic factors affecting collagen formation Generally in people over age 60

9-7 Effects of Aging on Articulations Rheumatoid Arthritis An inflammatory condition Caused by infection, allergy, or autoimmune disease Involves the immune system Gouty Arthritis Occurs when crystals (uric acid or calcium salts) Form within synovial fluid Due to metabolic disorders

9-7 Effects of Aging on Articulations Joint Immobilization Reduces flow of synovial fluid Can cause arthritis symptoms Treated by continuous passive motion or CPM (therapy) Bones and Aging Bone mass decreases Bones weaken Increases risk of hip fracture, hip dislocation, or pelvic fracture

9-8 Integration with Other Systems Bone Recycling Living bones maintain equilibrium between: Bone building (osteoblasts) And breakdown (osteoclasts)

9-8 Integration with Other Systems Factors Affecting Bone Strength Age Physical stress Hormone levels Calcium and phosphorus uptake and excretion Genetic and environmental factors

9-8 Integration with Other Systems Bones Support Body Systems Support and protect other systems Store fat, calcium, and phosphorus Manufacture cells for immune system

9-8 Integration with Other Systems Bones Support Body Systems Disorders in other body systems can cause: Bone tumors Osteoporosis Arthritis Rickets (vitamin D deficiency)