1. Joints

2. Classifications
2 ways to classify:
1) Functional
2) Structural

3. Functional Classification:
Immovable joints- Synarthroses
Slightly moveable- Amphiarthroses
Freely moveable- Diarthroses

4. Structural Classification:
1) Fibrous- joined by fibrous tissue- immovable example:
Sutures- of the skull
Syndesmoses- interosseous
Gomphoses- tooth sockets

5. 2) Cartilaginous- united by cartilage Examples:
Synchondroses- epiphyseal plates
Symphyses- pubic, intervertebral discs

6. 3. Synovial- all those joints that have the bones separated by a fluid containing joint cavity

7. All Synovial joints have:
1. Articular cartilage (hyaline)
2. Joint (synovial) cavity
3. Articular capsule (double layer)
4. Synovial membrane
5. Synovial Fluid (secreted by the membrane)
6. Reinforcing ligaments

8. Synovial Joint

9. Certain synovial joints also have:
1. Bursa- flattened fibrous sacs of lubricant
2. Tendon Sheaths- an elongated bursa that wraps completely around a tendon

11. Factors that influence stability:
1. Articular surfaces- the way the bones fit together
2. Ligaments- the more the better
3. Muscle tone- keeps tendons tight

12. Types of Synovial Joints
Plane Joints – gliding joints – carpals
Hinge joint- elbow, finger
Pivot joint- atlas / axis
Saddle Joint- thumb
Ball and Socket Joint- shoulder, hip

14. Movements: Gliding- between the carpals, tarsals, vertebrae
Flexion- decrease angle, bring bones together
Extension- increase angle, bring bones apart
Dorsiflexion- toe points up
Plantar flexion- toe points down
Abduction- move limb away from midline
Adduction- move limb toward midline

15. Movements Continued
Circumduction- move a limb in a cone in space Rotation- turning a bone around it’s axis Supination- move hand into anatomical position Pronation- move hand medial, palm face back Inversion- move foot medially Eversion- move foot laterally Protraction- anterior non lateral movement Retraction- posterior non angular movement

16. Movements Continued Elevation- lift the body part superior
Depression- move the body part inferior
Opposition- movement of thumb

17. Shoulder Joint Glenohumeral joint
Loose joint= free movement= instability

19. Shoulder Joint Consists of:
Glenoid labrum
Corocohumeral ligament
Glenohumeral ligaments (3)
Transverse humeral ligaments (3)
Also has several bursae

21. The greatest contribution to shoulder stability is the muscle tendons:
Long head of the biceps brachi- secures the head of the humerus tightly against the glenoid cavity.
4 other tendons:
Subscapularis
Supraspinatus Rotator Cuff
Infraspinatus
Teres minor

24. Shoulder
The Rotator Cuff can be severely stretched when subjected to vigorous circumduction-Example: Baseball

25. Hip (Coxal) Joint Less free movement = higher stability Ligaments:
Labrum acetabular
Iliofemeral ligament
Pubofemoral ligament
Ischiofemoral ligament
Most tendons of bulky hip and thigh muscles contribute to the stability

26. Elbow Joint Flexion and extension – No side to side movement
Capsule surrounded by annular ligament
Ulnar collateral ligament (medial)
Radial collateral ligament (lateral)
Tendons of several muscles- biceps, triceps, brachialis,- to reinforce it.

27. Knee Joint Largest, Most Complex Extension, flexion, some rotation
Includes the Femoral- patella joint
-where the patella glides over the femur

30. The knee normally acts as a hinge joint permitting extension and flexion
When it is partially flexed some side movement is possible
When it is extended, the ligaments resist side to side or rotation

31. The knee joint capsule is incomplete-
anterior side is open
posterior and sides are enclosed by a thin joint capsule
Anterior is the patella and the patella ligament
There are also a dozen bursae

33. Around the outside of the incomplete capsule are ligaments:
Fibular collateral ligaments- lateral
from lateral epicondyle of the femur to
head of fibula
Tibial collateral ligaments- medial
-from medial epicondyle of the femur to
medial condyle of tibia
Oblique popliteal ligament- posterior
Arcuate popliteal ligament- posterior

35. Ligaments inside the capsule- intracapsular
Cruciate ligaments form X within the notch between the condyles
They prevent anterior/posterior displacement
Anterior Cruciate Ligament- anterior tibia to posterior medial side of lateral condyle of the femur
Posterior Cruciate Ligament- posterior tibia to anterior lateral side of the medial condyle of the femur (stronger)

37. Knee capsule is heavily reinforced by muscle and tendons:
Strong tendons of quadriceps, semimembranous
Meniscus (semilunar cartrilage) are attached at the ends of the tibia
Prevent side to side rocking
Absorb shock

38. Knee Injury The knee can absorb vertical impact
It is susceptible to side to side or twisting impact
Most likely to tear: in order
1) medial collateral ligament
2) medial meniscus
3) Anterior Cruciate Ligament (ACL)

39. Joint Imbalances
Sprains- ligaments are stretched or torn, they heal slowly, if torn they may need to be surgically repaired
Cartilage injuries- damage to articular cartilage can be corrected by arthroscopic surgery
Dislocation- bones are forced out of their normal location. Repeats are common because the joint and ligaments stretch

41. Inflammation
Bursitis- inflammation of a bursa caused by direct injury or friction
Tendonitis- inflammation of a tendon sheath
Arthritis- inflammatory or degenerative diseases that affects joints

42. 3 types of Arthritis
1. Osteoarthritis- (OA) most common, degenerative joint disease, associated with aging , athletes
Breakdown of articular cartilage,
Exposed bone forms spurs and resis movements, stiffness on rising
Most common in hands, cervical vertebrae, lumbar, and weight bearing knees and hips
Bone make cracking noises
Slow, irreversible course

43. Autoimmune
2. Rheumatoid Arthritis- (RA) Chronic inflammatory disorder, auto immune disease
- body attacks it’s own tissue
Affects fingers, wrist, ankles, feet, small joints
Begins with inflammation of synovial joint because of bacteria or virus, attacks cartilage, causes swelling, stiffness, scar tissue, bent fingers

44. Patient with RA

45. Gout
3. Gouty Arthritis- uric acid in the blood rise and crystals are deposited in the soft tissue of the joint
Causes acutely painful attacks (usually in the big toe)