1. Human Anatomy & Physiology Ninth Edition PowerPoint ® Lecture Slides prepared by Barbara Heard, Atlantic Cape Community College © 2013 Pearson Education, Inc.© Annie Leibovitz/Contact Press Images C H A P T E R Joints: Part B 8

2. © 2013 Pearson Education, Inc. Types of Synovial Joints Six types, based on shape of articular surfaces: –Plane –Hinge –Pivot –Condylar –Saddle –Ball-and-socket

3. © 2013 Pearson Education, Inc. Figure 8.7a The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Flat articular surfaces Gliding Plane joint Nonaxial movement Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces Carpals Metacarpals

4. © 2013 Pearson Education, Inc. Figure 8.7b The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Hinge joint Uniaxial movement Examples: Elbow joints, interphalangeal joints Flexion and extension Cylinder Trough Medial/lateral axis Humerus Ulna

5. © 2013 Pearson Education, Inc. Figure 8.7c The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Pivot joint Uniaxial movement Rotation Sleeve (bone and ligament) Radius Examples: Proximal radioulnar joints, atlantoaxial joint Axle (rounded bone) Vertical axis Ulna

6. © 2013 Pearson Education, Inc. Figure 8.7d The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Phalanges Metacarpals Condylar joint Biaxial movement Oval articular surfaces Examples: Metacarpophalangeal (knuckle) joints, wrist joints Medial/ lateral axis Flexion and extension Adduction and abduction Anterior/ posterior axis

7. © 2013 Pearson Education, Inc. Figure 8.7e The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Flexion and extension Adduction and abduction Articular surfaces are both concave and convex Medial/ lateral axis Anterior/ posterior axis Trapezium Metacarpal Ι Example: Carpometacarpal joints of the thumbs Saddle joint Biaxial movement

8. © 2013 Pearson Education, Inc. Figure 8.7f The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types. Spherical head (ball) Examples: Shoulder joints and hip joints Flexion and extension Adduction and abduction Rotation Humerus Scapula Cup (socket) Medial/lateral axis Anterior/posterior axis Vertical axis Ball-and-socket joint Multiaxial movement

9. © 2013 Pearson Education, Inc. Largest, most complex joint of body Three joints surrounded by a single joint cavity –Femoropatellar joint Plane joint Allows gliding motion during knee flexion –Lateral and medial tibiofemoral joints Femoral condyles with lateral and medial menisci of tibia Allow flexion, extension, and some rotation when knee partly flexed A&P Flix™: Movement at the Knee Joint Knee Joint PLAY

10. © 2013 Pearson Education, Inc. Figure 8.8a The knee joint. Patellar ligament Sagittal section through the right knee joint Anterior cruciate ligament Posterior cruciate ligament Tibia Femur Lateral meniscus Articular capsule Lateral meniscus Synovial cavity Infrapatellar fat pad Subcutaneous prepatellar bursa Patella Suprapatellar bursa Tendon of quadriceps femoris Deep infrapateller bursa

11. © 2013 Pearson Education, Inc. Figure 8.8b The knee joint. Articular cartilage on lateral tibial condyle Posterior cruciate ligament Lateral meniscus Superior view of the right tibia in the knee joint, showing the menisci and cruciate ligaments Anterior cruciate ligament Medial meniscus Articular cartilage on medial tibial condyle Anterior

12. © 2013 Pearson Education, Inc. Knee Joint At least 12 associated bursae Capsule is reinforced by muscle tendons –E.g., quadriceps and semimembranosus tendons Joint capsule is thin and absent anteriorly Anteriorly, quadriceps tendon gives rise to three broad ligaments –Medial and lateral patellar retinacula –Patellar ligament

13. © 2013 Pearson Education, Inc. Figure 8.8c The knee joint. Anterior view of right knee Quadriceps femoris muscle Lateral patellar retinaculum Tibial collateral ligament Fibula Fibular collateral ligament Patella Tendon of quadriceps femoris muscle Patellar ligament Medial patellar retinaculum Tibia

14. © 2013 Pearson Education, Inc. Ligaments Stabilizing Knee Joint Capsular and extracapsular ligaments –Help prevent hyperextension of knee –Fibular and tibial collateral ligaments –Oblique popliteal ligament –Arcuate popliteal ligament

15. © 2013 Pearson Education, Inc. Figure 8.8d The knee joint. Tibia Arcuate popliteal ligament Oblique popliteal ligament Bursa Popliteus muscle (cut) Lateral head of gastrocnemius muscle Articular capsule Medial head of gastrocnemius muscle Fibular collateral ligament Tibial collateral ligament Tendon of semimembranosus muscle Posterior view of the joint capsule, including ligaments Femur Tendon of adductor magnus

16. © 2013 Pearson Education, Inc. Ligaments Stabilizing Knee Joint Intracapsular ligaments –Prevent anterior-posterior displacement –Reside outside synovial cavity –Anterior cruciate ligament Attaches to anterior tibia –Posterior cruciate ligament Attaches to posterior tibia

17. © 2013 Pearson Education, Inc. PLAY Animation: Rotatable Knee Figure 8.8e The knee joint. Fibular collateral ligament Lateral condyle of femur Lateral meniscus Tibia Fibula Anterior view of flexed knee, showing the cruciate ligaments (articular capsule removed, and quadriceps tendon cut and reflected distally) Posterior cruciate ligament Medial condyle Tibial collateral ligament Medial meniscus Patellar ligament Patella Anterior cruciate ligament Quadriceps tendon

18. © 2013 Pearson Education, Inc. Figure 8.8f The knee joint. Medial femoral condyle Anterior cruciate ligament Medial meniscus on medial tibial condyle Patella Photograph of an opened knee joint; view similar to (e)

19. © 2013 Pearson Education, Inc. Knee Joint Injuries Absorbs great vertical force Vulnerable to horizontal blows, especially laterally blows to extended knee –Three C's Collateral ligaments Cruciate ligaments Cartilages

20. © 2013 Pearson Education, Inc. Figure 8.9 A common knee injury. Lateral Patella (outline) Medial Tibial collateral ligament (torn) Medial meniscus (torn) Hockey puck Anterior cruciate ligament (torn)

21. © 2013 Pearson Education, Inc. Shoulder (Glenohumeral) Joint Ball-and-socket joint –Head of humerus with glenoid cavity of scapula Most freely moving joint in body –Stability sacrificed

22. © 2013 Pearson Education, Inc. Animation: Rotatable Shoulder Figure 8.10a The shoulder joint. Acromion of scapula Coracoacromial ligament Subacromial bursa Fibrous layer of articular capsule Tendon sheath Tendon of long head of biceps brachii muscle Synovial membrane Fibrous layer of articular capsule Humerus Articular cartilage Synovial cavity of the glenoid cavity containing synovial fluid Frontal section through right shoulder joint PLAY

23. © 2013 Pearson Education, Inc. Fibrous layer of articular capsule Humerus Articular cartilage Synovial cavity of the glenoid cavity containing synovial fluid Cadaver photo corresponding to (a) Figure 8.10b The shoulder joint. PLAY A&P Flix: Movement at the Glenohumeral joint: An Overview PLAY A&P Flix: Movement at the Glenohumeral joint (a) PLAY A&P Flix: Movement at the Glenohumeral joint (b)

24. © 2013 Pearson Education, Inc. Shoulder Joint Reinforcing ligaments –Primarily on anterior aspect –Coracohumeral ligament Helps support weight of upper limb –Three glenohumeral ligaments Weak and sometimes absent

25. © 2013 Pearson Education, Inc. Reinforcing muscle tendons –Tendon of long head of biceps brachii Travels through the intertubercular sulcus Secures humerus to glenoid cavity –Four rotator cuff tendons encircle the shoulder joint Subscapularis Supraspinatus Infraspinatus Teres minor A&P Flix™: Rotator Cuff Muscles: An Overview (a) A&P Flix™: Rotator Cuff Muscles: An Overview (b) Shoulder Joint PLAY

26. © 2013 Pearson Education, Inc. Figure 8.10c The shoulder joint. Acromion Coracoacromial ligament Subacromial bursa Coracohumeral ligament Greater tubercle of humerus Transverse humeral ligament Tendon sheath Tendon of long head of biceps brachii muscle Articular capsule reinforced by glenohumeral ligaments Subscapular bursa Tendon of the subscapularis muscle Scapula Coracoid process Anterior view of right shoulder joint capsule

27. © 2013 Pearson Education, Inc. Figure 8.10d The shoulder joint. Lateral view of socket of right shoulder joint, humerus removed Coracoid process Articular capsule Glenoid cavity Glenoid labrum Tendon of long head of biceps brachii muscle Glenohumeral ligaments Tendon of the subscapularis muscle Scapula PosteriorAnterior Acromion

28. © 2013 Pearson Education, Inc. Figure 8.10e The shoulder joint. Head of humerus Muscle of rotator cuff (cut) Anterior view of an opened shoulder joint Capsule of shoulder joint (opened) Glenoid cavity of scapula Acromion (cut)

29. © 2013 Pearson Education, Inc. Articulation of radius and ulna with humerus Hinge joint –Primarily trochlear notch of ulna with trochlea of humerus –Flexion and extension only A&P Flix™: Movement at the Elbow Joint Elbow Joint PLAY

30. © 2013 Pearson Education, Inc. Figure 8.11a The elbow joint. Humerus Fat pad Tendon of triceps muscle Bursa Articular cartilage of the trochlear notch Trochlea Articular capsule Synovial membrane Synovial cavity Ulna Median sagittal section through right elbow (lateral view) Articular cartilage Coronoid process Tendon of brachialis muscle

31. © 2013 Pearson Education, Inc. Elbow Joint Anular ligament –Surrounds head of radius Two capsular ligaments restrict side-to- side movement –Ulnar collateral ligament –Radial collateral ligament

32. © 2013 Pearson Education, Inc. Figure 8.11b The elbow joint. Humerus Lateral epicondyle Articular capsule Radial collateral ligament Olecranon Anular ligament Radius Ulna Lateral view of right elbow joint

33. © 2013 Pearson Education, Inc. Animation: Rotatable Elbow Figure 8.11d The elbow joint. Articular capsule Anular ligament Coronoid process Radius Humerus Medial epicondyle Ulnar collateral ligament Ulna Medial view of right elbow PLAY

34. © 2013 Pearson Education, Inc. Cadaver photo of medial view of right elbow Figure 8.11c The elbow joint. Anular ligament Radius Articular capsule Coronoid process Humerus Medial epicondyle Ulnar collateral ligament Ulna A&P Flix™: The Elbow Joint and Forearm: An overview PLAY

35. © 2013 Pearson Education, Inc. Ball-and-socket joint Head of the femur articulates with acetabulum Good range of motion, but limited by the deep socket –Rim of fibrocartilage - Acetabular labrum Enhances depth of socket so hip dislocations rare A&P Flix™: Movement at the Hip Joint: An Overview Hip (Coxal) Joint PLAY

36. © 2013 Pearson Education, Inc. Figure 8.12a The hip joint. Ligament of the head of the femur (ligamentum teres) Coxal (hip) bone Articular cartilage Acetabular labrum Femur Frontal section through the right hip joint Synovial cavity Articular capsule

37. © 2013 Pearson Education, Inc. Figure 8.12b The hip joint. Acetabular labrum Ligament of the head of the femur (ligamentum teres) Synovial membrane Head of femur Articular capsule (cut) Photo of the interior of the hip joint, lateral view

38. © 2013 Pearson Education, Inc. Hip Joint Reinforcing ligaments –Iliofemoral ligament –Pubofemoral ligament –Ischiofemoral ligament –Ligamentum teres

39. © 2013 Pearson Education, Inc. PLAY Animation: Rotatable Hip Iliofemoral ligament Ischiofemoral ligament Greater trochanter of femur Posterior view of right hip joint, capsule in place Ischium Figure 8.12c The hip joint.

40. © 2013 Pearson Education, Inc. Iliofemoral ligament Pubofemoral ligament Greater trochanter Anterior inferior iliac spine Anterior view of right hip joint, capsule in place Figure 8.12d The hip joint.

41. © 2013 Pearson Education, Inc. Temporomandibular Joint (TMJ) Mandibular condyle articulates with temporal bone Two types of movement –Hinge—depression and elevation of mandible –Gliding—e.g., side-to-side (lateral excursion) grinding of teeth Most easily dislocated joint in the body

42. © 2013 Pearson Education, Inc. Ramus of mandible Articular capsule External acoustic meatus Mandibular fossa Articular tubercle Zygomatic process Infratemporal fossa Location of the joint in the skull Lateral ligament Figure 8.13a The temporomandibular (jaw) joint.

43. © 2013 Pearson Education, Inc. Inferior joint cavity Superior joint cavity Articular tubercle Articular disc Mandibular fossa Articular capsule Synovial membranes Condylar process of mandible Ramus of mandible Enlargement of a sagittal section through the joint Figure 8.13b The temporomandibular (jaw) joint.

44. © 2013 Pearson Education, Inc. Figure 8.13c The temporomandibular (jaw) joint. Superior view Outline of the mandibular fossa Lateral excursion: lateral (side-to-side) movements of the mandible

45. © 2013 Pearson Education, Inc. Common Joint Injuries Cartilage tears –Due to compression and shear stress –Fragments may cause joint to lock or bind –Cartilage rarely repairs itself –Repaired with arthroscopic surgery Ligaments repaired, cartilage fragments removed with minimal tissue damage or scarring –Partial menisci removal renders joint less stable but still mobile; complete removal leads to osteoarthritis –Meniscal transplant in younger patients –Perhaps meniscus grown from own stem cells in future

46. © 2013 Pearson Education, Inc. Figure 8.14 Arthroscopic photograph of a torn medial meniscus. Femur Meniscus Tear in meniscus Tibia

47. © 2013 Pearson Education, Inc. Common Joint Injuries Sprains –Reinforcing ligaments stretched or torn –Partial tears slowly repair heal Poor vascularization –Three options if torn completely Ends sewn together Replaced with grafts Time and immobilization

48. © 2013 Pearson Education, Inc. Common Joint Injuries Dislocations (luxations) –Bones forced out of alignment –Accompanied by sprains, inflammation, and difficulty moving joint –Caused by serious falls or contact sports –Must be reduced to treat Subluxation—partial dislocation of a joint

49. © 2013 Pearson Education, Inc. Inflammatory and Degenerative Conditions Bursitis –Inflammation of bursa, usually caused by blow or friction –Treated with rest and ice and, if severe, anti- inflammatory drugs Tendonitis –Inflammation of tendon sheaths typically caused by overuse –Symptoms and treatment similar to bursitis

50. © 2013 Pearson Education, Inc. Arthritis >100 different types of inflammatory or degenerative diseases that damage joints Most widespread crippling disease in the U.S. Symptoms: pain, stiffness, and swelling of joint Acute forms: caused by bacteria, treated with antibiotics Chronic forms: osteoarthritis, rheumatoid arthritis, and gouty arthritis

51. © 2013 Pearson Education, Inc. Osteoarthritis (OA) Common, irreversible, degenerative (''wear-and-tear'') arthritis May reflect excessive release of enzymes that break down articular cartilage By age 85 half of Americans develop OA, more women than men Probably related to normal aging process

52. © 2013 Pearson Education, Inc. Osteoarthritis (OA) More cartilage is destroyed than replaced in badly aligned or overworked joints Exposed bone ends thicken, enlarge, form bone spurs, and restrict movement Treatment: moderate activity, mild pain relievers, capsaicin creams –Glucosamine, chondroitin sulfate, and nutritional supplements not effective

53. © 2013 Pearson Education, Inc. Rheumatoid Arthritis (RA) Chronic, inflammatory, autoimmune disease of unknown cause –Immune system attacks own cells Usually arises between ages 40 and 50, but may occur at any age; affects 3 times as many women as men Signs and symptoms include joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems

54. © 2013 Pearson Education, Inc. Rheumatoid Arthritis RA begins with synovitis of the affected joint –Inflammatory blood cells migrate to joint, release inflammatory chemicals that destroy tissues –Synovial fluid accumulates  joint swelling and inflamed synovial membrane which thickens  pannus that clings to articular cartilage –Pannus erodes cartilage, scar tissue forms and connects articulating bone ends (ankylosis)

55. © 2013 Pearson Education, Inc. Rheumatoid Arthritis: Treatment Disrupt destruction of joints by immune system Steroidal and nonsteroidal anti-inflammatory drugs decrease pain and inflammation Immune suppressants slow autoimmune reaction Some agents target tumor necrosis factor to block action of inflammatory chemicals Can replace joint with prosthesis

56. © 2013 Pearson Education, Inc. Figure 8.15 A hand deformed by rheumatoid arthritis.

57. © 2013 Pearson Education, Inc. Gouty Arthritis Deposition of uric acid crystals in joints and soft tissues, followed by inflammation More common in men Typically affects joint at base of great toe In untreated gouty arthritis, bone ends fuse and immobilize joint Treatment: drugs, plenty of water, avoidance of alcohol

58. © 2013 Pearson Education, Inc. Lyme Disease Caused by bacteria transmitted by tick bites Symptoms: skin rash, flu-like symptoms, and foggy thinking May lead to joint pain and arthritis Treatment –Long course of antibiotics

59. © 2013 Pearson Education, Inc. Developmental Aspects of Joints By embryonic week 8, synovial joints resemble adult joints Joint's size, shape, and flexibility modified by use Advancing years take toll on joints –Ligaments and tendons shorten and weaken –Intervertebral discs more likely to herniate –Most people in 70s have some degree of OA Full-range-of-motion exercise key to postponing joint problems