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Joints: Modified by Dr. Par Mohammadian
8 Joints: Modified by Dr. Par Mohammadian
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Classification of joints
Overview Definitions Classification of joints Fibrous Cartilaginous Synovial Diseases/Injuries
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Joints (Articulations)
Site where two or more bones meet Functions of joints Give skeleton mobility Hold skeleton together Two classifications Functional Structural
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Functional Classification of Joints
Based on Amount of movement joint allows Three functional classifications: Synarthroses (syn=together; arthro=joint) — immovable joints Amphiarthroses (amphi=on both sides) — slightly movable joints Diarthroses (dia=through) — freely movable joints © 2013 Pearson Education, Inc.
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Structural Classification of Joints
Based on Material binding bones together Presence/absence of joint cavity Three structural classifications: Fibrous joints Cartilaginous joints Synovial joints
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Classification of joints
Fibrous Joints Suture Syndesmoses Gomphoses Cartilaginous Joints Synchondroses Sumpheses Synovial Joints General Structure
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Bones joined by dense fibrous connective tissue; No joint cavity
Fibrous Joints Bones joined by dense fibrous connective tissue; No joint cavity Most synarthrotic (immovable) Three types: Sutures Syndesmoses Gomphoses
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Fibrous Joints: Sutures
Joint held together with very short, interconnecting fibers, and bone edges interlock. Found only in the skull. Rigid, interlocking joints Immovable joints for protection of brain Contain short connective tissue fibers Allow for growth during youth In middle age, sutures ossify and fuse Called Synostoses Suture line Dense fibrous connective tissue
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Fibrous Joints: Syndesmoses
Syndesmosis Joint held together by a ligament. Fibrous tissue can vary in length, but is longer than in sutures. Bones connected by ligaments (bands of fibrous tissue) Fiber length varies so movement varies, i.e., Little to no movement at distal tibiofibular joint Large amount of movement at interosseous membrane connecting radius and ulna Fibula Tibia Ligament
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Fibrous Joints: Gomphoses
Gomphosis “Peg in socket” fibrous joint. Periodontal ligament holds tooth in socket. Peg-in-socket joints of teeth in alveolar sockets Fibrous connection is the periodontal ligament Socket of alveolar process Root of tooth Periodontal ligament
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Structural Classification of Joints
Fibrous Joints Suture Syndesmoses Gomphoses Cartilaginous Joints Synchondroses Sumpheses Synovial Joints General Structure
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Bones united by cartilage No joint cavity Not highly movable
Cartilaginous Joints Bones united by cartilage No joint cavity Not highly movable Two types: Synchondroses Symphyses
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Bones united by hyaline cartilage
Cartilaginous Joints: Synchondroses Bar/plate of hyaline cartilage unites bones Temporary epiphyseal plate joints Become synostoses after plate closure Cartilage of 1st rib with manubrium ~ All are synarthrotic Synchondroses Bones united by hyaline cartilage Sternum (manubrium) Epiphyseal plate (temporary hyaline cartilage joint) Joint between first rib and sternum (immovable)
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Bones united by fibrocartilage
Cartilaginous Joints: Symphyses Fibrocartilage unites bone Hyaline cartilage present as articular cartilage Strong, flexible amphiarthroses Symphyses Bones united by fibrocartilage Body of vertebra Fibrocartilaginous intervertebral disc (sandwiched between hyaline cartilage) Pubic symphysis
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Structural Classification of Joints
Fibrous Joints Suture Syndesmoses Gomphoses Cartilaginous Joints Synchondroses Sumpheses Synovial Joints General Structure
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Synovial Joints Bones separated by fluid-filled joint cavity All are diarthrotic Include ~ all limb joints; most joints of body
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Synovial Joints: General Structure
Ligament Joint cavity (contains synovial fluid) Articular (hyaline) cartilage Fibrous layer Synovial membrane (secretes synovial fluid) Articular capsule Periosteum Synovial joints all have the following Articular cartilage Joint (synovial) cavity Articular capsule Synovial fluid Reinforcing ligaments
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Synovial Joints: Friction-Reducing Structures
Acromion of scapula Subacromial bursa Fibrous layer of articular capsule Tendon sheath Tendon of long head of biceps brachii muscle Frontal section through the right shoulder joint Joint cavity containing synovial fluid Articular cartilage Synovial membrane Fibrous layer Humerus Bursae –fibrous sacs lined with synovial membranes & containing synovial fluid Common where ligaments, muscles, skin, tendons, or bones rub together Tendon sheath – elongated bursa that wraps completely around a tendon
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Synovial Joints: Movement
The two muscle attachments across a joint are: Origin – attachment to the immovable bone Insertion – attachment to the movable bone Described as movement along transverse, frontal, or sagittal planes
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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
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Movements of Joints 1. Gliding 2. Angular movements 3. Rotation
Flexion, extension, hyperextension Abduction, adduction Circumduction 3. Rotation Medial and lateral rotation It is VERY important that you learn the terminology for movements of joints. Muscles act mainly to cause movement or fixation of a joint!!!!!!!
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Gliding movements at the wrist
One flat bone surface glides or slips over another similar surface Examples: Intercarpal joints Intertarsal joints Between articular processes of vertebrae Gliding Gliding movements at the wrist
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Angular Movements Increase or decrease angle between two bones
Hyperextension Extension Flexion Angular movements: flexion, extension, and hyperextension of the vertebral column Increase or decrease angle between two bones Movement along sagittal plane Flexion—decreases the angle of the joint Extension—increases the angle of the joint Hyperextension—excessive extension beyond normal range of motion Hyperextension Extension Flexion Angular movements: flexion, extension, and hyperextension of the neck
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Figure 8.5d Movements allowed by synovial joints.
Flexion Hyper- extension Extension Flexion Extension Angular movements: flexion, extension, and hyperextension at the shoulder and knee
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Angular Movements Movement along frontal plane
Abduction—movement away from the midline Adduction—movement toward the midline Circumduction Involves flexion, abduction, extension, and adduction of limb Limb describes cone in space Adduction Abduction Circumduction Angular movements: abduction, adduction, and circumduction of the upper limb at the shoulder
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Rotation of the head, neck, and lower limb
Turning of bone around its own long axis Toward midline or away from it Medial and lateral rotation Examples: Between C1 and C2 vertebrae Rotation of humerus and femur Rotation Lateral rotation Medial Rotation of the head, neck, and lower limb
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Special Movements at Synovial Joints
Supination and pronation of radius and ulna Dorsiflexion and plantar flexion of foot Inversion and eversion of foot Protraction and retraction Elevation and depression of mandible Opposition of thumb of mandible
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Pronation (P) and supination (S) P S
(radius rotates over ulna) Supination (radius and ulna are parallel) Pronation (P) and supination (S) P S Dorsiflexion and plantar flexion Plantar flexion Dorsiflexion
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Inversion and eversion
Opposition
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Protraction and retraction
of mandiblet Protraction of mandible Elevation of mandible Depression Elevation and depression
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Types of Synovial Joints
Six types, based on shape of articular surfaces: Plane Hinge Pivot Condylar Saddle Ball-and-socket
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Plane joint Uniaxial movement Hinge joint Nonaxial movement Humerus
Metacarpals Flat articular surfaces Gliding Carpals Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces Hinge joint Uniaxial movement Humerus Medial/lateral axis Cylinder Trough Ulna Flexion and extension Examples: Elbow joints, interphalangeal joints
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Condylar joint Uniaxial movement Pivot joint Biaxial movement
Vertical axis Sleeve (bone and ligament) Ulna Axle (rounded bone) Rotation Radius Examples: Proximal radioulnar joints, atlantoaxial joint Condylar joint Biaxial movement Medial/ lateral axis Anterior/ posterior axis Phalanges Oval articular surfaces Metacarpals Flexion and extension Adduction and abduction Examples: Metacarpophalangeal (knuckle) joints, wrist joints
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Ball-and-socket joint
Saddle joint Biaxial movement Medial/ lateral axis Anterior/ posterior axis Metacarpal Ι Articular surfaces are both concave and convex Adduction and abduction Flexion and extension Trapezium Example: Carpometacarpal joints of the thumbs Ball-and-socket joint Multiaxial movement Cup (socket) Medial/lateral axis Anterior/posterior axis Vertical axis Scapula Spherical head (ball) Humerus Flexion and extension Adduction and abduction Rotation Examples: Shoulder joints and hip joints
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Largest and most complex joint of the body
Knee Largest and most complex joint of the body Allows flexion, extension, and some rotation Three joints in one surrounded by a single joint cavity Femoropatellar Lateral and medial tibiofemoral joints
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Knee Ligaments and Tendons – Anterior View
Tendon of the quadriceps femoris muscle Lateral and medial patellar retinacula Fibular and tibial collateral ligaments Patellar ligament
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Knee – Other Supporting Structures
Fibular collateral ligament Lateral condyle of femur 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 Tibial Patellar Patella Anterior Quadriceps tendon Anterior cruciate ligament Posterior cruciate ligament Medial meniscus (semilunar cartilage) Lateral meniscus Medial femoral condyle Anterior cruciate ligament Medial meniscus on medial tibial Patella Photograph of an opened knee joint; view similar to (e)
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Figure 8.9 A common knee injury.
Lateral Medial Patella (outline) Hockey puck Tibial collateral ligament (torn) Medial meniscus (torn) Anterior cruciate ligament (torn)
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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 Acromion of scapula Coracoacromial ligament Subacromial bursa Fibrous layer of articular capsule Tendon sheath Tendon of long head of biceps brachii muscle Synovial membrane Humerus Articular cartilage Synovial cavity of the glenoid cavity containing synovial fluid
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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) that encircles the shoulder joint and blends with the articular capsule
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Anterior view of right shoulder joint capsule
Acromion Coracoacromial ligament Subacromial bursa Coracohumeral Greater tubercle of humerus Transverse humeral Tendon sheath Tendon of long head of biceps brachii muscle Articular capsule reinforced by glenohumeral ligaments Subscapular Tendon of the subscapularis Scapula Coracoid process Anterior view of right shoulder joint capsule 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 Posterior Anterior Acromion
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Anterior view of an opened shoulder joint
Figure 8.10e The shoulder joint. Acromion (cut) Glenoid cavity of scapula Head of humerus Capsule of shoulder joint (opened) Muscle of rotator cuff (cut) Anterior view of an opened shoulder joint © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc.
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Elbow Joint Articulation of radius and ulna with humerus Hinge joint
Primarily trochlear notch of ulna with trochlea of humerus Flexion and extension only Articular capsule Synovial membrane Humerus Synovial cavity Articular cartilage Fat pad Coronoid process Tendon of triceps muscle Tendon of brachialis muscle Ulna Bursa Trochlea Articular cartilage of the trochlear notch Median sagittal section through right elbow (lateral view)
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Lateral view of right elbow joint
Anular ligament Surrounds head of radius Two capsular ligaments restrict side-to-side movement Ulnar collateral ligament Radial collateral ligament Humerus Lateral epicondyle Articular capsule Radial collateral ligament Olecranon Anular Radius Ulna Lateral view of right elbow joint
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Medial view of right elbow
Articular capsule Anular ligament Coronoid process Radius Humerus Medial epicondyle Ulnar collateral Ulna Medial view of right elbow Anular ligament Radius Articular capsule Coronoid process Humerus Medial epicondyle Ulnar collateral Ulna
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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 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
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Figure 8.12b The hip joint. Acetabular labrum Synovial membrane
Ligament of the head of the femur (ligamentum teres) Head of femur Articular capsule (cut) Photo of the interior of the hip joint, lateral view © 2013 Pearson Education, Inc. © 2013 Pearson Education, Inc.
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Hip Stability Acetabular labrum Iliofemoral ligament
Pubofemoral ligament Ischiofemoral ligament Ligamentum teres
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Synovial Joints: Hip Stability
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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
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Dislocations (luxations)
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
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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
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Arthritis >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
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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
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Treatment: moderate activity, mild pain relievers, capsaicin creams
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
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Rheumatoid Arthritis (RA)
Chronic, inflammatory, autoimmune disease of unknown cause (Immune system attacks own cells) between ages 40-50, but may occur at any age; affects 3x as many women as men Signs and symptoms include joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems
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RA begins with synovitis of the affected joint
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)
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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
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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
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