Download Joints - Dr. Michael P. Gillespie

JOINTS
JOINT
A joint is the junction or pivot point between two
or more bones.
 Movement of the body as a whole results from the
rotation of bones about individual joints.
 Joints transfer and dissipate forces produced by
gravity and muscle activation.

Dr. Michael P. Gillespie
2
ARTHROLOGY
Arthrology is the study of the classification,
structure, and function of joints.
 Aging, long-term immobilization, trauma, and
disease all affect the structure and ultimate
function of joints.
 These factors influence the quality and quantity
of human movement.

Dr. Michael P. Gillespie
3
CLASSIFICATION OF JOINTS

Structural Classification
Presence or absence of a space (synovial cavity)
 Type of Connective Tissue

Dr. Michael P. Gillespie

Functional Classification

Relates to the degree of movement they permit.
4
CLASSIFICATION OF JOINTS BASED
ON MOVEMENT POTENTIAL

Two major types of joints exist within the body:
Synarthroses
 Diarthroses

Dr. Michael P. Gillespie
5
JOINTS OF THE BODY
Dr. Michael P. Gillespie
6
SYNARTHROSES
A synarthrosis is a junction between two bones
that allows slight to essentially no movement.
 Synarthroidial joints can be classified as either
fibrous or cartilaginous based upon the dominant
type of connective tissue.

Dr. Michael P. Gillespie
7
TYPES OF SYNARTHROSES

Fibrous joints
Dense connective tissue (high concentration of
collagen)
 Sutures of the skull
 Joints reinforced by an interosseous membrane
(distal tibiofibular joint).

Dr. Michael P. Gillespie

Cartilaginous joints
Flexible cartilage or hyaline cartilage
 Symphysis pubis
 Interbody joints of the spine
 Manubriosternal joint

8
DIARTHROSES (SYNOVIAL JOINTS)
A diarthrosis is an articulation that allows
moderate to extensive motion.
 Possess a synovial fluid-filled cavity.
 Compose the majority of the joints within the
musculoskeletal system.

Dr. Michael P. Gillespie
9
SEVEN ELEMENTS OF
DIARTHRODIAL JOINTS
Articular cartilage – covers the ends and other
articular surfaces of bones
 Joint capsule (articular capsule) – peripheral
curtain of connective tissue
 Synovial membrane – dcxf vcdx d cxdfv cxfefdsex
 Synovial fluid
 Ligaments

Dr. Michael P. Gillespie
Capsular ligaments
 Extracapsular ligaments

Blood vessels
 Sensory nerves

10
ELEMENTS OF SYNOVIAL JOINTS
Dr. Michael P. Gillespie
11
INTRA-ARTICULAR DISCS (MENISCI)
Intra-articular discs (meninsci) – pads of
fibrocartilage imposed between articular
surfaces.
 These pads increase congruency and improve
force dispersion.
 Examples of intra-articular discs






Tibiofemoral (knee)
Distal radio-ulnar
Sternoclavicular
Acromioclavicular
Temporomandibular
Apophyseal (variable)
Dr. Michael P. Gillespie

12
PERIPHERAL LABRUM
A peripheral labrum of fibrocartilage extends
from the body rims of the glenoid fossa to the
shoulder and the acetabulum of the hip.
 These structures deepen the concave surface of
the joint.
 These structures support and thicken the
attachment of the joint capsule.

Dr. Michael P. Gillespie
13
FAT PADS
Fat pads thicken the joint capsule, causing the
inner surface of the capsule to fill nonarticulating
joint spaces formed by incongruent bony
contours.
 They are prominent in the elbow and knee joints.
 Enlarged and inflamed fat pads can adversely
affect the biomechanics of the joint.

Dr. Michael P. Gillespie
14
BURSAE
A bursa is an extension or outpouching of the
synovial membrane of a diarthroidial joint.
 Bursae are filled with synovial fluid and exists in
areas of potential stress.
 Bursae help to absorb force and protect
periarticular connective tissues, including bone.

Dr. Michael P. Gillespie
15
SYNOVIAL PLICA
Synovial plicae (synovial folds, synovial
redundancies, or synovial fringes) are slack,
overlapped pleats of tissue composed of the
innermost layers of the joint capsule.
 They are found in joints with large capsular
surface area such as the knee and elbow.
 They increase the synovial surface area and
allow full joint motion without undue tension on
the synovial lining.
 Folds that are thickened or adhered due to
inflammation can alter the joint biomechanics.

Dr. Michael P. Gillespie
16
STRUCTURAL CLASSIFICATION OF JOINTS
 Fibrous

Fibrous CT
Lack a synovial cavity
 Cartilaginous


Joints
Cartilage
Lack a synovial cavity
 Synovial
Dr. Michael P. Gillespie

Joints
Joints
Have a synovial cavity
 Dense irregular CT
 Often associated with accessory ligaments

17
FUNCTIONAL CLASSIFICATION OF JOINTS

Synarthrosis (syn = together)

Amphiarthrosis (amphi = on both sides)


A slightly moveable joint
Diarthrosis (moveable joint)
A freely moveable joint
 Synovial joints

Dr. Michael P. Gillespie

Immovable joint
18
FIBROUS JOINTS
Lacks a synovial cavity
 Little or no movement

Dr. Michael P. Gillespie
19
FIBROUS JOINTS
 Sutures

Immovable
Synostosis – suture that is replaced by bone in
the adult
 Syndesmoses



Slightly moveable (amphiarthrosis)
Ligament
Interosseous membrane
Dr. Michael P. Gillespie

 Gomphoses

Dentoalveolar joint
20
CARTILAGINOUS JOINTS
Lacks a synovial cavity
 Allows little or no movement
 Synchondroses


Epiphyseal plate
Symphyses
Pubic symphisis
 Intervertebral discs

Dr. Michael P. Gillespie

21
SYNOVIAL JOINTS
Synovial (Joint) Cavity – space btwn. Bones
 Freely moveable
 The bones are covered by hyaline cartilage
 Contains the following:



Articular capsule
Synovial fluid
Accsessory ligaments and articular discs
Dr. Michael P. Gillespie

22
CLASSIFICATION OF SYNOVIAL JOINTS
BASED ON MECHANICAL ANALOGY
Hinge joint
 Pivot joint
 Ellipsoid joint
 Ball-and-socket joint
 Plane joint
 Saddle joint
 Condyloid joint

Dr. Michael P. Gillespie
23
HINGE JOINT

Primary Angular Motions

Mechanical Analogy


Door hinge
Anatomic Examples
Humero-ulnar joint
 Interphalangeal joint

Dr. Michael P. Gillespie

Flexion and extension only
24
HINGE JOINT
Dr. Michael P. Gillespie
25
PIVOT JOINT

Primary Angular Motions

Mechanical Analogy


Doorknob
Anatomic Examples
Dr. Michael P. Gillespie

Spinning of one member around a single axis of
rotation
Humeroradial joint
 Atlanto-axial joint

26
PIVOT JOINT
Dr. Michael P. Gillespie
27
ELLIPSOID JOINT

Primary Angular Motions

Mechanical Analogy


Flattened convex ellipsoid paired with a concave
trough
Dr. Michael P. Gillespie

Biplanar motion (flexion-extension and abductionadduction)
Anatomic Examples

Radiocarpal joint
28
ELLIPSOID JOINT
Dr. Michael P. Gillespie
29
BALL-AND-SOCKET JOINT

Primary Angular Motions

Mechanical Analogy


Spheric convex surface paired with a concave cup
Anatomic Examples
Dr. Michael P. Gillespie

Triplanar motion (flexion-extension, abductionadduction, and internal-external rotation)
Glenohumeral joint
 Coxofemoral (hip) joint

30
BALL-AND-SOCKET JOINT
Dr. Michael P. Gillespie
31
PLANE JOINT

Primary Angular Motions

Mechanical Analogy


Relatively flat surfaces apposing each other, like a
book on a table
Anatomic Examples
Dr. Michael P. Gillespie

Slide (translation) or combined slide and rotation
Carpometacarpal joints (digits II to IV)
 Intercarpal joints
 Intertarsal joints

32
PLANE JOINT
Dr. Michael P. Gillespie
33
SADDLE JOINT

Primary Angular Motions
Biplanar motion
 Spin between bones is possible, but may be limited by
interlocking nature of joint

Mechanical Analogy


Each member has a reciprocally curved concave and
convex surface oriented at right angles to the other,
like a horse rider and a saddle
Dr. Michael P. Gillespie

Anatomic Examples


Carpometarcarpal joint of the thumb
Sternoclavicular joint
34
SADDLE JOINT
Dr. Michael P. Gillespie
35
CONDYLOID JOINT

Primary Angular Motions
Biplanar motion
 Either flexion-extension and abduction-adduction, or
flexion-extension and axial rotation (internalexternal rotation)

Mechanical Analogy


Dr. Michael P. Gillespie

Mostly spheric convex surface that is enlarged in one
dimension like a knuckle; paired with a shallow
concave cup
Anatomic Examples
Metacarpophalangeal joint
 Tibiofemoral (knee) joint

36
CONDYLOID JOINT
Dr. Michael P. Gillespie
37
SIMPLIFYING THE CLASSIFICATION
OF SYNOVIAL JOINTS

Two articular forms based upon true movement
of the joint.

Essentially all synovial joints of the body with
the notable exception of planar joints can be
categorized under this scheme.
Dr. Michael P. Gillespie
Ovoid joint
 Saddle joint

38
OVOID JOINT
An ovoid joint has paired mating surfaces that
are imperfectly spheric, or egg-shaped, with
adjacent parts possessing a changing surface
curvature.
 The articular surface of one bone is convex and of
the other is concave.
 Most joints of the body are of this variety.

Dr. Michael P. Gillespie
39
SADDLE JOINT
A saddle joint consists of paired convex and
concave surfaces oriented at approximately 90
degrees to each other.
 Each member has a reciprocally curved concave
and convex surface oriented at right angles to the
other, like a horse rider and a saddle.

Dr. Michael P. Gillespie
40
BASIC SHAPES OF JOINT SURFACES
Dr. Michael P. Gillespie
41
Dr. Michael P. Gillespie
42
BIOLOGICAL MATERIALS OF
PERIARTICULAR CONNECTIVE
TISSUES

Fibrous Proteins

Ground Substance
Glycosaminoglycans
 Water
 Solutes


Dr. Michael P. Gillespie

Collagen (type I and II)
Cells
Fibroblasts
 Chondrocytes

43
TYPES OF COLLAGEN IN
PERIARTICULAR CONNECTIVE
TISSUES

Type I
Thick, rugged fibers that elongate when stretched
 Present in ligaments, tendons, fascia, and fibrous
joint capsules

Type II
Thinner fibers than type I
 Provide a framework for maintaining the general
shape and consistency of structures, such as hyaline
cartilage

Dr. Michael P. Gillespie

44
TYPES OF MOVEMENTS AT SYNOVIAL
JOINTS
 Gliding
Simple back and forth movement, limited in
range, planar joints
 Angular

Movements
Increase or decrease in the angle btwn. bones
Dr. Michael P. Gillespie

 Rotation

Bone revolves around a longitudinal axis
 Special
Movements
45
ANGULAR MOVEMENTS
Flexion, extension, lateral flexion,
hyperextension
 Abduction, adduction, and circumduction

Dr. Michael P. Gillespie
46
ROTATION
Medial (internal) rotation
 Lateral (external) rotation

Dr. Michael P. Gillespie
47
SPECIAL MOVEMENTS
Elevation
 Depression
 Protraction
 Retraction
 Inversion

Dr. Michael P. Gillespie
48
SPECIAL MOVEMENTS
Eversion
 Dorsiflexion
 Plantar flexion
 Supination
 Pronation
 Opposition

Dr. Michael P. Gillespie
49
DISLOCATION

Luxation – displacement of a bone from a joint

Subluxation

Incomplete dislocation
Dr. Michael P. Gillespie

Causes tearing or ligaments, tendons, and articular
capsules
50
ARTHROSCOPY
Observaion of the interior of a joint
 Utilizes a lighted, pencil-thin instrument
 Assists in surgery and assessment of the joint
space

Dr. Michael P. Gillespie
51
SPRAIN & STRAIN

The ankle joint is the most often sprained.
 The lumbar spine is another prominent location of
sprain.


Dr. Michael P. Gillespie
Sprain – a forcible wrenching or twisting of the
joint that stretches or tears its ligaments, but
does not dislocate the bones.
Strain – a stretched or partially torn muscle.
52
BURSAE & TENDON SHEATHS

Bursae


Tendon sheaths
Tubelike bursae that wrap around tendons
 Occurs where tendons pass through synovial cavities
 Reduce friction

Dr. Michael P. Gillespie

Saclike structures
Reduce friction in some synovial joints
53
BURSITIS
 An

Dr. Michael P. Gillespie
acute or chronic inflammation of a
bursa
 Caused by trauma or infection
 Repeated excessive exertion
 Symptoms
Pain, swelling, inflammation & limited
movement
 Treatment

Oral anti-inflammatory agents (herbal, O.T.C.
And prescription), corticosteroid injections
54
Dr. Michael P. Gillespie
55
Dr. Michael P. Gillespie
56
Dr. Michael P. Gillespie
57
Dr. Michael P. Gillespie
58
Dr. Michael P. Gillespie
59
Dr. Michael P. Gillespie
60
ROTATOR CUFF INJURY
Supraspinatous
 Infraspinatous
 Teres Minor
 Subscapularis
 Common injury among pitchers and volleyball
players due to excessive circumduction

Dr. Michael P. Gillespie
61
SEPARATED SHOULDER
Injury of the acromioclavicular joint
 Due to forceful trauma such as when the
shoulder strikes the ground in a fall

Dr. Michael P. Gillespie
62
TENNIS ELBOW
Lateral epicondylitis
 Little-league elbow

Dr. Michael P. Gillespie
63
GOLFER’S ELBOW

Medial Epicondylitis
Dr. Michael P. Gillespie
64
DISLOCATION OF THE RADIAL HEAD
The most common upper limb dislocation in
children
 Occurs with a strong pull to the forearm while it
is extended and supinated
 Swinging a child around with outstretched arms

Dr. Michael P. Gillespie
65
SWOLLEN KNEE
Immediate swelling is due to blood loss
 Delayed swelling is due to excessive production of
synovial fluid “water on the knee”

Dr. Michael P. Gillespie
66
DISLOCATED KNEE
Displacement of the tibia relative to the femur
 Most commonly dislocates anteriorly

Dr. Michael P. Gillespie
67
RHEUMATISM

Dr. Michael P. Gillespie
Any painful disorder of the supporting structures
of the body – bones, ligaments, tendons, or
muscles – that is not caused by infection or
injury.
68
ARTHRITIS

A form of rheumatism in which the joints are
swollen, stiff, and painful.
Dr. Michael P. Gillespie
69
TYPES OF ARTHRITIS

Rheumatoid arthritis (RA)

Osteoarthritis (OA)


Degenerative joint disease
Gouty arthritis

A person with gout produces excessive uric acid or is
unable to excrete it properly
Dr. Michael P. Gillespie

Autoimmune disease – the body attacks its own
tissues
70
LYME DISEASE
First reported in Lyme, CT
 Bacteria transported by deer ticks
 The rash often resembles a bull’s eye target,
although some people never develop a rash
 Symptoms

Joint stiffness, fever, chills, headache, stiff neck,
nausea
Dr. Michael P. Gillespie

71
TERMINOLOGY
Arthralgia – pain in a joint
 Bursectomy – removal of a bursa
 Chondritis – inflammation of cartilage
 Synovitis – inflammation of a synovial membrane
in a joint

Dr. Michael P. Gillespie
72