The importance of synovial joint mobilization – scientific basis

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Presentation transcript:

The importance of synovial joint mobilization – scientific basis (please click here)

The TMJ is a Synovial Joint mobile bones are separated by a joint cavity synovial membrane lines the non-articular surfaces of the joint cavity produces synovial fluid THE TMJ FOLLOWS THE SAME BIOLOGICAL RULES AS ALL SYNOVIAL JOINTS

Joints Consist of Connective Tissue cells chondrocytes osteocytes fibroblasts synovial cells fibers collagen reticular elastic ground substance - glycosaminoglycans sodium hyaluronate chondroitin sulfate keratan sulfate

Chondrocytes produce extracellular matrix Collagen Proteoglycans viability of chondrocytes depends on synovial fluid

Articular Cartilage: Components Proteoglycans: osmotically active Collagen: provides structural support

Articular Cartilage Properties Compressibility Resiliency

Synovial Membrane Functions synovial fluid production lubrication nutrition of chondrocytes phagocytosis of substances in joint space

MOTION necessary for joint rehabilitation: diffusion of nutrients from synovial fluid articular cartilage nutrition of chondrocytes & maintenance of cartilage matrix

Articular Cartilage Degradation Excessive Joint Loading Lack of Joint Motion

MOTION necessary to PREVENT ADHESIONS* *Orthopaedic Research – 30 years Akeson WH, et al. Clin Orthop 219:28, 1987 Salter RB. Clin Orthop 242:12, 1989 Ellis E, Carlson DS. Clin Plastic Surg 16(1):133, 1989

Hydrostatic-weeping Lubrication COMPRESSION DYNAMIC MOTION IN A JOINT CONTINUOUSLY PRODUCES A FLUID LAYER WHICH SEPARATES AND PROTECTS THE OPPOSING ARTICULAR SURFACES

Impaired Joint Lubrication Damaged Joint Tissues Impaired Joint Lubrication boundary lubrication hydrostatic-weeping lubrication normal cartilage cartilage degradation synovial inflammation

IMMOBILIZATION EFFECTS JOINTS & SURROUNDING TISSUES synovium articular cartilage muscles ligaments bone periarticular connective tissue Salter RB: Clin Orthop 242:12, 1989 Akeson WH, et al: Clin Orthop 219:28, 1987 Ellis E, Carlson DS: Clin Plastic Surg 16(1):133, 1989

EFFECTS OF IMMOBILIZATION ON SYNOVIUM: obliteration of joint space adhesions

EFFECTS OF IMMOBILIZATION ON CARTILAGE cartilage has no blood supply joint motion is necessary for the pumping action of synovial fluid movement is necessary for cartilage nutrition lubrication repair

EFFECTS OF IMMOBILIZATION ON ARTICULAR CARTILAGE: thinning degeneration erosion impaired nutrition

EFFECTS OF IMMOBILIZATION ON MUSCLES: atrophy decreased muscle fiber diameter decreased blood supply

EFFECTS OF IMMOBILIZATION ON BONE: osteoporosis invasion of subchondral bone by proliferating mesenchymal tissue

EFFECTS OF IMMOBILIZATION ON JOINT CONNECTIVE TISSUES (DISC, CARTILAGE, CAPSULE, LIGAMENTS) reduced collagen mass reduced matrix components reduced water content increased degradation compared to synthesis

SUMMARY EFFECTS OF IMMOBILIZATION ON SYNOVIAL JOINTS: impaired joint homeostasis impaired cartilage nutrition articular cartilage degradation intra-articular adhesions atrophy of muscles subchondral bone resorption impaired lubrication