Chapter 8 Joints

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Chapter 8 Joints

• Structural Classification of Joints
• Functional Classification of Joints
• Movements
• Special Joints
• Diseases and Disorders

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Structural Joint Classification

• Fibrous
• Sutures better described as synostoses (skull)
• Syndesmoses tibia-fibula slight vs. a lot
  radius-ulna
• Gomphoses tooth attachments periodontal
  ligament
• Cartilaginous
• Synchondroses epiphyseal plates and rib-sternum
• Symphyses intervertebral bones and pubic bones
  where there is fibrocartilage separating the
  bone.
• Synovial

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Functional Classification of Joints

• Synarthroses no movement
• Amphiarthroses limited movement
• Diarthroses extensive motion capabilities in
  mobile joints of limbs

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Fibrous Joints
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Cartilaginous Joints
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Synovial Joint Characteristics

• Articular Cartilage
• Joint Synovial) Cavity
• Articular Capsule (dense irregular fibrous) with
  inner layer that is the synovial membrane
• Synovial Fluid viscous due to hyaluronic acid
• Weeping Lubrication thins w/ warming
• Reinforcing Ligaments
• Capsular or intrinsic ligaments w/in the capsule
• Extracapsular outside
• Intracapsular sort of inside

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Bursae Tendon Sheaths

• Protection where tendons
  rub bones
• Protection of the tendons

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Joint Stability

• Articular Surfaces often only a minor role!
• depth
• fit
• Ligaments
• stretch limitations (6)
• Muscle Tone often THE MOST important
• shoulder knee especially

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Movement Direction

• Driven by muscles that attach to bones or
  connective tissue (CT) at, at least, two points
• Muscle origin immovable or less movable bone
• Insertion more movable bone
• contraction moves the insertion closer to the
  origin
• Nonaxial
• Uniaxial
• Biaxial
• Multiaxial

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Type of Movements of Synovial Joints

• Gliding a.k.a. translational
• carpus and tarsus, and articular processes of
  vertebrae
• Angular ? or ? angle between bones
• Flexion/Extension
• Dorsiflexion/Plantar Flexion
• Abduction/Adduction
• Circumduction
• Rotation C1 to C2 or the radius or lateral or
  medial movement of the hip
• Special Movements

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Types of Synovial Joints

• Plane
• Hinge
• Pivot
• Condyloid
• Saddle
• Ball-and-Socket

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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

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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

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Saddle Joints

• Similar to condyloid joints but allow greater
  movement
• Each articular surface has both a concave and a
  convex surface
• Example carpometacarpal joint of the thumb

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The Knee

• Multiple sets of ligaments
• Motion allowed in flexion that is prohibited by
  ligaments when in extension
• Tibial Collateral (MCL)
• Fibular Collateral (LCL)
• Popliteal
• ACL/PCL
• Capsular ligament support
• Patellar Ligament

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Synovial Joints 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 joint
• Lateral and medial tibiofemoral joints

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Synovial Joints Knee Ligaments and Tendons
Anterior View

• Tendon of the quadriceps femoris muscle
• Lateral and medial patellar retinacula
• Fibular and tibial collateral ligaments
• Patellar ligament

Figure 8.8c
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Synovial Joints Knee Posterior Superficial
View

• Adductor magnus tendon
• Articular capsule
• Oblique popliteal ligament
• Arcuate popliteal ligament
• Semimembranosus tendon

Figure 8.8e
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The Shoulder

• Tremendous flexibility range of motion
• Limited structural support
• Shallow glenoid fossa
• Minor capsular ligaments
• Labrum
• Rotator Cuff

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Rotator Cuff Muscles
Long head of Biceps - stabilizes Supra
Infraspinatus Teres Minor Subscapularis
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The Hip (Os Coxae)

• Highly mobile
• More ligamentous support than shoulder
• Deeper articular fossa in acetabulum
• Labrum diameter lt femoral head
• Heavy musculature and tendons surround

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The Elbow

• Radial Collateral Ligament (Lateral)
• Ulnar Collateral Ligament (Medial) 3 parts
  a.k.a. Tommy John surgery
• Radial Annular Ligament
• Articular Capsular Ligaments

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Common Joint Movement Problems

• Sprains strains stretch or tear support
  ligaments w/ ankle, knee, shoulder and vertebrae
  common sites. Poor healing due to poor blood
  supply, and have lots of pain and immobility.
  Need surgery so ligament lasts
• Cartilage injuries most often is meniscal
  tears, but a big increase in young athletes joint
  surface tears. These are avascular no healing.
  Arthroscopic surgery used
• Dislocation vs. separation (luxation vs.
  subluxation) where bones are out of alignment at
  a joint, accompany sprains. Jaw fingers/thumb,
  and shoulder must reduce
• Bursitis inflammation in a bursa, often with or
  w/o tendonitis. Trauma and friction (abuse)
  causes fluid accumulation. Tx cortisone, rest,
  ice, NSAIDs

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Cont.

• Arthritis joint inflammation, 100 different
  types of degenerative joint disease and
  inflammation! Crippling painful and stiff, w/
  swelling when acute. Infections, trauma, wear
  and tear, etc.
• Osteoarthritis age-related wear, but they may
  be genetically predisposed. NSAIDs ? Surgery.
  Glucosamine and chondroitin sulfate may help
  preserve cartilage, ? crepitus
• Rhuematoid chronic inflammatory disease, ? more
  than ?, 40-50 yr. olds, some much earlier.
  Synovitis ? pannus formation on the joint
  margins. Bilateral and in many joints fingers,
  wrists, ankles, feet. Often occurs with
  exacerbation (relapse) and remission. Believed
  to be an autoimmune disease that may be related
  to bacteria. Enbrel, Remicade, Viox, Celebrex
  have been used to treat (Viox off the market)
• Gout uric acid in blood causes urate crystals
  in joints, more in ? (estrogen? excretion),
  related to diet, often in big toe