1. Articulations Articulation = joint = point of contact between bones

2. Joint Classification Functional NameStructural NameMovementExampleDescription SynarthrosesFibrousImmovableSyndesmosesligaments Suturesskull GomphosesTeeth to jaw AmphiarthrosesCartilaginous (hyaline, fibrocartilage) Slightly movable SynchrondosisRibs, epiphyseal plate SymphysesPubis, vertebral discs DiarthrosesSynovialFreely movableUniaxialHinge, pivot BiaxialSaddle, ellipsoidal MultiaxialBall and socket, gliding

3. Synarthroses Fibrous Joints

4. Amphiarthoses Cartilaginous

5. Diarthroses Synovial Most numerous Most complex Structures –joint capsule sleevelike encasing around bone ends to bind them together –synovial membrane membrane lining capsule to secrete synovial fluid –bursae cushions joints and helps tendons move –joint cavity small space between bones –articular cartilage hyaline cartilage covering bone ends –menisci pads of fibrocartilage between bones –Ligaments strong, dense, white fibrous tissue that hold bones firmly together bursae

6. (Hyaline cartilage) (fibrocartilage) Knee Joint

7. Ankle Joint Anterior interior tibiofibular ligament Achilles tendon (cut)

9. Types of Joints ellipsoidal

10. Uniaxial Joints permits movement around one axis and one plane allows only flexion and extension –examples – elbow, knee knee joint –largest joint, most complex, most frequently injured projection of one bone articulating with a ring/notch of another bone –examples - between vertebrate

11. Biaxial Joints permits movement around two perpendicular axes and planes Example –thumb only saddle joint in the body condyle fits into an elliptical socket Example –between radius and carpals ellipsoidal

12. Multiaxial Joints permits movement around three or more axes and planes most moveable joints ball shaped head fits into concave depression example - shoulder, hip –humeroscapular joint most mobile joint –sacroiliac joint hip joint relatively flat articulating surface that allows gliding movement example –between carpals –between tarsals –between vertebrate

13. Multiaxial Ball and socket

14. Multiaxial Ball and socket

15. Multiaxial Gliding

16. Uniaxial Hinge

17. Goniometer –Used to determine extent of injury and progress of rehabilitation –measures range of motion (degree of angle) ROM (Range of Motion)

18. Angular ROM flexion – decreases angle, movement towards body extension – increase angle, movement away from body hyperextension – stretching or extending beyond anatomical position plantar flexion – increase angle between top of foot and front of leg (point down) dorsiflexion – decrease angle between top of foot and front of leg (point up) ABduction – move AWAY from medial plane ADduction – move TOWARDS medial plane

19. rotation – pivoting a bone on its axis circumduction – distal end of a body part moves in a circle supination – hand palm side up pronation – hand palm side down Circular ROM

20. Special Movements inversion – turn sole outward eversion – turn sole inward protraction – move part forward retraction – move part backward elevation – move part up depression – move part down

21. Joint Disorders Inflammatory (IJD) –Rheumatoid arthritis –Gout Noninflammatory (NIJD) –Osteoarthritis –Tramatic Injuries Dislocation Meniscus tear Sprain Ligament tear Herniated disc

22. Joint Disorders Rheumatoid arthritis –Chronic and systemic –Inflammation of synovial membrane –Cartilage destroyed, bone erosion –Progressive crippling and deformity –Pain, inflammation, decreased mobility, aching, stiffness –Treat with corticosteroid drugs and NSAIDS

23. Joint Disorders Gouty arthritis –Also referred to as just Gout –Excessive uric acid in blood –Crystals get deposited in synovial fluid –Chronic inflammation and tissue damage –Swelling, tenderness –Pin in wrists, fingers, ankles, knees, elbows –Treat with Allopurinol (inhibits uric acid synthesis) and Uloric (new med)

25. Joint Disorders Osteoarthritis Rheumatoid arthritis Gout NIJDC IJD

26. Joint Disorders Osteoarthritis –Most common NIJD –Wear and tear deterioration –Atrophy of articular cartilage –Formation of new bone at joint surface –Most common in weight-bearing joints –Stiffness, pain, limited movement –Treat symptoms with NSAIDS

27. Joint Disorders Dislocation –Articular surfaces not in proper contact –Tear vessels, nerves, ligaments, muscles –Pain and swelling –Treat with realignment (reduction); sometimes surgery

28. Joint Disorders Sprain –Stretching of ligaments surrounding joint –Due to twisting motion –Hematoma, limited motion –Treatment: R.I.C.E. Rest Ice compression elevation

29. Degree of Sprains 1 st degree ankle sprain –Some stretching or perhaps tearing may have occurred –No loss of function –Mild pain, little bruising –Little or no swelling –Some joint stiffness or difficulty walking 2 nd degree ankle sprain –Difficulty walking –Moderate to severe pain –Swelling and tenderness in the ankle joint –Bruising may start after 3 to 4 days 3 rd degree ankle sprain –most serious –Total rupture of a ligament –Walking may not be possible –Severe pain initially and substantial swelling –May require surgery

30. Ligament Tears (3 rd degree Sprain) Bruising, pain, swelling, instability Physical therapy Partial tear vs. complete tear –Partial Tear – boot/brace, crutches –Complete Tear - Surgery after most swelling subsides Joint Disorders

31. Joint Disorders - Knee Meniscus Tear –One of most common athletic injuries –Swelling, pain, instability, limited motion –Treat with arthroscopic surgery

32. Meniscus Normal Tear of medial meniscus

33. ACL tear –Women more likely than men –Will hear a popping sound –Usually due to twisting motion Get hit very hard on the side of your knee, such as during a football tackle Overextend the knee joint Quickly stop moving and change direction while running, landing from a jump, or turning –Repair by grafting (not sew back together) Patellar tendon autograft (autograft comes from the patient) Hamstring tendon autograft Quadriceps tendon autograft Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon Joint Disorders - Knee

34. ACL, MCL, PCL tears

35. Arthroscopic surgery 3-4 very small incisions ¼ in. –fiber-optic light source –video camera –terile saline solution is continuously pumped through the knee via a cannula

37. Vertebral Disc Disorders

38. Herniated disc Treatment Steroid epidural –Use long needle to inject steroid into epidural space in order to shrink the herniation (cartilage) Surgery –(microdisectomy) Cut off protruding cartilage

39. Steroid Epidural

40. Knee Arthroscopic Surgery http://www.cartilagerepaircenter.org/treatm ent-options/meniscal-procedures.htmlhttp://www.cartilagerepaircenter.org/treatm ent-options/meniscal-procedures.html http://www.youtube.com/watch?v=nAj2_pg TkEAhttp://www.youtube.com/watch?v=nAj2_pg TkEA http://www.youtube.com/watch?v=kpW2M OOI5ywhttp://www.youtube.com/watch?v=kpW2M OOI5yw Knee Replacement http://www.youtube.com/watch?v=H3xkj_1 dZQ0http://www.youtube.com/watch?v=H3xkj_1 dZQ0

41. Hip Replacement http://www.youtube.com/watch?v=DosqbE y8ecYhttp://www.youtube.com/watch?v=DosqbE y8ecY http://www.webmd.com/pain- management/video/hip-restorationhttp://www.webmd.com/pain- management/video/hip-restoration http://www.youtube.com/watch?v=lh2UX8 gQnBMhttp://www.youtube.com/watch?v=lh2UX8 gQnBM http://www.youtube.com/watch?v=vJL8n_ 82ITMhttp://www.youtube.com/watch?v=vJL8n_ 82ITM

42. Ankle Arthroscopy http://www.youtube.com/watch?v=A22lTy PnguYhttp://www.youtube.com/watch?v=A22lTy PnguY Herniated disc epidural http://www.youtube.com/watch?v=97m4VI CMJoUhttp://www.youtube.com/watch?v=97m4VI CMJoU Herniated disc microdisectomy http://www.youtube.com/watch?v=rU8YYE SYXzc&feature=relatedhttp://www.youtube.com/watch?v=rU8YYE SYXzc&feature=related