Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Chapter 8 Joints Part A

2 Joints (Articulations) Weakest parts of the skeleton Articulation – site where two or more bones meet Functions Give the skeleton mobility Hold the skeleton together

3 Classification of Joints: Structural Structural classification focuses on the material binding bones together and whether or not a joint cavity is present The three structural classifications are: Fibrous Cartilaginous Synovial

4 Classification of Joints: Functional Functional classification is based on the amount of movement allowed by the joint The three functional class of joints are: Synarthroses – immovable Amphiarthroses – slightly movable Diarthroses – freely movable

5 Table

6 Fibrous Structural Joints The bones are jointed by fibrous tissues There is no joint cavity Most are immovable There are three types – sutures, syndesmoses, and gomphoses Figure 8.1a

7 Fibrous Joints Figure 8.3

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9 Fibrous Structural Joints: Sutures Occur between the bones of the skull Comprised of interlocking junctions completely filled with dense irregular CT fibers Bind bones tightly together, but allow for growth during youth In middle age, skull bones fuse and are called synostoses

10 Fibrous Structural Joints: Syndesmoses Bones are connected by a fibrous tissue ligament Movement varies from immovable to slightly variable Examples include the connection between the tibia and fibula, and the radius and ulna

11 Fibrous Structural Joints Figure 8.1b

12 Fibrous Structural Joints: Gomphoses gomph- = wedge-shaped bolt The peg-in-socket fibrous joint between a tooth and its alveolar socket The fibrous connection is the periodontal ligament

13 Fibrous Joints Figure 8.4 The peg-in-socket fibrous joint between a tooth and its alveolar socket The fibrous connection is the periodontal ligament Gomphosis teeth anchored to the jaw with a periodontal ligament Cone shaped socket synarthrotic joint

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15 Cartilaginous Joints Articulating bones are united by cartilage Lack a joint cavity Two types – synchondroses and symphyses Figure 8.2a

16 Cartilaginous Joints Figure 8.2b

17 Cartilaginous Joints Figure 8.2c

18 Cartilaginous Joints: Synchondroses A bar or plate of hyaline cartilage unites the bones All synchondroses are synarthrotic Examples include: Epiphyseal plates of children Joint between the costal cartilage of the first rib and the sternum

19 Cartilaginous Joints: Symphyses Hyaline cartilage covers the articulating surface of the bone and is fused to an intervening pad of fibrocartilage Amphiarthrotic joints designed for strength and flexibility Examples include intervertebral joints and the pubic symphysis of the pelvis

20 Synovial Joints Those joints in which the articulating bones are separated by a fluid-containing joint cavity All are freely movable diarthroses Examples – all limb joints, and most joints of the body

21 Synovial Joints: General Structure Synovial joints all have the following: Articular cartilage Joint (synovial) cavity Articular capsule Synovial fluid Reinforcing ligaments Figure 8.3a

Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Illust - Knee Joint

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24 Synovial Joints: Friction-Reducing Structures Bursae – flattened, fibrous sacs lined with synovial membranes and containing synovial fluid Common where ligaments, muscles, skin, tendons, or bones rub together Tendon sheath – elongated bursa that wraps completely around a tendon

25 Synovial Joints: Friction-Reducing Structures Figure 8.4a, b

26 Synovial Joints: Stability Stability is determined by: Articular surfaces – shape determines what movements are possible Ligaments – unite bones and prevent excessive or undesirable motion Muscles Muscle tendons across joints are the most important stabilizing factor Tendons are kept tight at all times by muscle tone

27 Synovial Joints: Movement Muscle attachment across a joint Origin – attachment to the immovable bone Insertion – attachment to the movable bone Described as movement along transverse, frontal, or sagittal planes

28 Synovial Joints: Range of Motion Nonaxial – slipping movements only Uniaxial – movement in one plane Biaxial – movement in two planes Multiaxial – movement in or around all three planes

29 Gliding Movements One flat bone surface glides or slips over another similar surface Examples – intercarpal and intertarsal joints, and between the flat articular processes of the vertebrae

Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Chapter 8 Movements Part B

31 Angular Movement Flexion Extension Dorsiflexion and plantar flexion of the foot Abduction Adduction Circumduction Figure 8.5a

32 Angular Movement Figure 8.5b

33 Angular Movement Figure 8.5c, d

34 Angular Movement Figure 8.5e, f

35 Rotation The turning of a bone around its own long axis Examples: Between first two vertebrae (C1 & C2) Hip and shoulder joints Figure 8.5g

36 Special Movements Supination and pronation Inversion and eversion Protraction and retraction Elevation and depression Opposition Figure 8.6a

37 Special Movements Figure 8.6b

38 Special Movements Figure 8.6c

39 Special Movements Figure 8.6d

40 Special Movements Figure 8.6e

Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Chapter 8 Types of Synovial Joints

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43 Types of Synovial Joints Plane joints Articular surfaces are essentially flat Allow only slipping or gliding movements Only examples of nonaxial joints Figure 8.7a

44 Types of Synovial Joints Hinge joints Cylindrical projections of one bone fits into a trough-shaped surface on another Motion is along a single plane Uniaxial joints permit flexion and extension only Examples: elbow and interphalangeal joints Figure 8.7b

45 Pivot Joints Rounded end of one bone protrudes into a “sleeve,” or ring, composed of bone (and possibly ligaments) of another Only uniaxial movement allowed Examples: joint between the axis and the dens, and the proximal radioulnar joint Figure 8.7c

46 Condyloid, or Ellipsoidal, Joints Oval articular surface of one bone fits into a complementary depression in another Both articular surfaces are oval Biaxial joints permit all angular motions Examples: radiocarpal (wrist) joints, and metacarpophalangeal (knuckle) joints Figure 8.7d

47 Saddle Joints Similar to condyloid joints but with greater movement Each articular surface has both a concave and a convex surface Example: carpometacarpal joint of the thumb Figure 8.7e

48 Ball-and-Socket Joints A spherical or hemispherical head of one bone articulates with a cuplike socket of another Multiaxial joints permit the most freely moving synovial joints Examples: shoulder and hip joints Figure 8.7f

49 Synovial Joints: Shoulder (Glenohumeral) Ball-and-socket joint in which stability is sacrificed to obtain greater freedom of movement Head of humerus articulates with the glenoid fossa of the scapula

50 Synovial Joints: Shoulder Stability Weak stability is maintained by: Thin, loose joint capsule Four ligaments – coracohumeral, and three glenohumeral Tendon of the long head of biceps, which travels through the intertubercular groove and secures the humerus to the glenoid cavity Rotator cuff (four tendons) encircles the shoulder joint and blends with the articular capsule

51 Synovial Joints: Shoulder Stability Figure 8.8a

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53 Synovial Joints: Shoulder Stability Figure 8.8b

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56 Synovial Joints: Hip Joint Hip (coxal) joint Ball-and-socket joint Head of the femur articulates with the acetabulum Good range of motion, but limited by the deep socket and strong ligaments

57 Synovial Joints: Hip Stability Acetabular labrum Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Ligamentum teres Figure 8.9a

58 Synovial Joints: Hip Stability Figure 8.9c, d

59 Stability: Annular ligament Ulnar collateral ligament Radial collateral ligament Figure 8.10a Synovial Joints: Elbow Hinge joint that allows flexion and extension only Radius and ulna articulate with the humerus

60 Synovial Joints: Elbow Stability Figure 8.10b, d

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62 Synovial Joints: Knee Largest and most complex joint of the body Allow flexion, extension, and some rotation Three joints in one surrounded by a single joint cavity Femoropatellar Lateral and medial tibiofemoral joints

63 Tendon of the quadriceps femoris muscle Lateral and medial patellar retinacula Fibular collateral ligament Tibial collateral ligament Patellar ligament Figure 8.11c Synovial Joints: Major Ligaments and Tendons – Anterior View

64 Anterior cruciate ligament Posterior cruciate ligament Medial meniscus (semilunar cartilage) Lateral meniscus Figure 8.11b Synovial Joints: Knee – Other Supporting Structures

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69 Synovial Joints: Knee – Posterior Superficial View Adductor magnus tendon Articular capsule Oblique popliteal ligament Arcuate popliteal ligament Semimembranosus tendon Figure 8.11e

Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Chapter 8 Pathology

71 Sprains The ligaments reinforcing a joint are stretched or torn Partially torn ligaments slowly repair themselves Completely torn ligaments require prompt surgical repair Cartilage Injuries The snap and pop of overstressed cartilage Common aerobics injury Repaired with arthroscopic surgery

72 Dislocations Occur when bones are forced out of alignment Usually accompanied by sprains, inflammation, and joint immobilization Caused by serious falls and are common sports injuries Subluxation – partial dislocation of a joint

73 Inflammatory and Degenerative Conditions Bursitis An inflammation of a bursa, usually caused by a blow or friction Symptoms are pain and swelling Treated with anti-inflammatory drugs; excessive fluid may be aspirated Tendonitis Inflammation of tendon sheaths typically caused by overuse Symptoms and treatment are similar to bursitis

74 Disc Herniation

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79 Arthritis More than 100 different types of inflammatory or degenerative diseases that damage the joints Most widespread crippling disease in the U.S. Symptoms – pain, stiffness, and swelling of a joint Acute forms are caused by bacteria and are treated with antibiotics Chronic forms include osteoarthritis, rheumatoid arthritis, and gouty arthritis

80 Osteoarthritis (OA) Most common chronic arthritis; often called “wear- and-tear” arthritis Affects women more than men 85% of all Americans develop OA More prevalent in the aged, and is probably related to the normal aging process

81 Osteoarthritis: Course OA reflects the years of abrasion and compression causing increased production of metalloproteinase enzymes that break down cartilage As one ages, cartilage is destroyed more quickly than it is replaced The exposed bone ends thicken, enlarge, form bone spurs, and restrict movement Joints most affected are the cervical and lumbar spine, fingers, knuckles, knees, and hips

82 Osteoarthritis: Treatments OA is slow and irreversible Treatments include: Mild pain relievers, along with moderate activity Magnetic therapy Glucosamine sulfate decreases pain and inflammation SAM-e (s-adenosylmethionine) builds up cartilage matrix and regenerates tissue

83 Rheumatoid Arthritis (RA) Chronic, inflammatory, autoimmune disease of unknown cause, with an insidious onset Usually arises between the ages of 40 to 50, but may occur at any age Signs and symptoms include joint tenderness, anemia, osteoporosis, muscle atrophy, and cardiovascular problems The course of RA is marked with exacerbations and remissions

84 Rheumatoid Arthritis: Course RA begins with synovitis of the affected joint Inflammatory blood cells migrate to the joint, causing swelling Inflamed synovial membrane thickens into a pannus Pannus erodes cartilage, scar tissue forms, articulating bone ends connect The end result, ankylosis, produces bent, deformed fingers

85 Rheumatoid Arthritis: Treatment Conservative therapy – aspirin, long-term use of antibiotics, and physical therapy Progressive treatment – anti-inflammatory drugs or immunosuppressants The drug Embrel, a biological response modifier, removes cells that promote inflammation

86 Gouty Arthritis Deposition of uric acid crystals in joints and soft tissues, followed by an inflammation response Typically, gouty arthritis affects the joint at the base of the great toe In untreated gouty arthritis, the bone ends fuse and immobilize the joint Treatment – colchicine, nonsteroidal anti- inflammatory drugs, and glucocorticoids

87 Developmental Aspects of Joints By embryonic week 8, synovial joints resemble adult joints Few problems occur until late middle age Advancing years take their toll on joints including: Ligaments and tendons shorten and weaken Intervertebral discs become more likely to herniate OA is inevitable, and all people of 70 have some degree of OA Prudent exercise (especially swimming) that coaxes joints through their full range of motion is key to postponing joint problems

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89 Rheumatoid arthritis

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95 1.D e n s 2.F o r a m e n t r a n s v e r s a r i u m o r t r a n s v e r s e f o r a m e n 3.S p i n o u s p r o c e s s o r s p i n e 4.A n t e r i o r a r c h o f a t l a s 5.P o s t e r i o r a r c h o f a t l a s 6.T r a n s v e r s e p r o c e s s 7.A r t i c u l a r f a c e t f o r b a s e o f s k u l l 1.D e n s 2.F o r a m e n t r a n s v e r s a r i u m o r t r a n s v e r s e f o r a m e n 3.S p i n o u s p r o c e s s o r s p i n e 4.A n t e r i o r a r c h o f a t l a s 5.P o s t e r i o r a r c h o f a t l a s 6.T r a n s v e r s e p r o c e s s 7.A r t i c u l a r f a c e t f o r b a s e o f s k u l l 1.Dens 2.Foramen transversarium or transverse foramen 3.Spinous process or spine 4.Anterior arch of atlas 5.Posterior arch of atlas 6.Transverse process 7.Articular facet for base of skull

Human Anatomy & Physiology FIFTH EDITION Elaine N. Marieb Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Pathologies

97 Osteoarthritis Progressive, degenerative 85% of adults “wear & tear” caused by deterioration of articular surfaces due to constant use

98 Osteoarthritis Can be painful, debilitating Treated w/ NSAIDs, corticosteroids, glucosamine/chondroitin

99 Rheumatoid Arthritis Autoimmune disorder Inflammation of synovial membrane causing erosion of articular surfaces and bone. Scar tissue ossifies and fuses bones

100 Gout (gouty arthritis) Inflammation of synovial joint due to the deposition of uric acid crystals. Usually affects the metatarso-phalangeal joint of the hallux of males.

101 Gout (gouty arthritis) Can cause articular surface to erode and the bone ends to fuse if untreated. Drugs, NSAIDs, & diet modification can lessen severity or prevent attacks.

102 Tendonitis Inflammation of tendon sheath due to repetitive use (RSI) “Tennis elbow”, “GameBoy Thumb”, Carpal Tunnel Syndrome

103 Bursitis Inflammation of bursa due to constant pressure, friction, or impact. “water on the knee”, bunions Drainage, NSAIDs

104 Dislocation Called luxation, when articular surfaces are forced out of alignment. Requires reduction and immobilization so that articular capsule can be repaired.

105 Sprain Stretch/tear of ligaments of articular capsule. If ligaments are torn, replacement is necessary

106 Normal Hip

107 Bad Hip

108 Bad Hip

109 Abnorm al Hip

110 Femur cut

111 Prep of femur

112 Insert in femur

113 Porous hip

114 Cemente d Hip

115 Prep of Acet

116 Acetabul um replacem ent

117 Assembl y of acetabul um

118 Joint assembly

119 Ball Insertion

120 Repaired Hip

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122 Reasons for Procedure Knee replacement becomes an option for treating a damaged knee when pain and stiffness limit normal activities and are not relieved by other measures, such as rest, medications, or physical therapy. The procedure is most often performed to: Alleviate knee pain and disability due to osteoarthritis, rheumatoid arthritis, or previous severe knee injury Correct a knee deformity (knee bows in or out)

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