Download Part B

Joints
(Part B)
-------------------Shape of Joints
Knee Joint
Shoulder Joint
Elbow Joint
Hip Joint
Temporal-mandibular Joint
Common Joint Injuries
© 2013 Pearson Education, Inc.
Types of Synovial Joints
• Six types, based on shape
of articular surfaces:
– Plane
– Hinge
– Pivot
– Condylar
– Saddle
– Ball-and-socket
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The shapes of the joint surfaces define the types of movements
that can occur at a synovial joint; they also determine the
classification of synovial joints into six structural types.
Nonaxial movement
Plane joint
Metacarpals
Flat
articular
surfaces
Gliding
Carpals
Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces
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The shapes of the joint surfaces define the types of movements
that can occur at a synovial joint; they also determine the
classification of synovial joints into six structural types.
Hinge joint
Humerus
Ulna
Uniaxial movement
Medial/lateral
axis
Cylinder
Trough
Flexion and extension
Examples: Elbow joints, interphalangeal joints
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The shapes of the joint surfaces define the types of movements that
can occur at a synovial joint; they also determine the classification of
synovial joints into six structural types.
Pivot joint
Uniaxial movement
Vertical axis
Ulna
Radius
Sleeve
(bone and
ligament)
Axle (rounded
bone)
Rotation
Examples: Proximal radioulnar joints, atlantoaxial joint
© 2013 Pearson Education, Inc.
The shapes of the joint surfaces define the types of movements that
can occur at a synovial joint; they also determine the classification of
synovial joints into six structural types.
Biaxial movement
Condylar joint
Medial/
lateral
axis
Phalanges
Metacarpals
Anterior/
posterior
axis
Oval
articular
surfaces
Flexion and
extension
Examples: Metacarpophalangeal (knuckle) joints, wrist joints
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Adduction and
abduction
The shapes of the joint surfaces define the types of movements that
can occur at a synovial joint; they also determine the classification of
synovial joints into six structural types.
Biaxial movement
Saddle joint
Medial/
lateral
axis
Metacarpal Ι
Trapezium
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Articular
surfaces
are both
concave
and convex
Anterior/
posterior
axis
Adduction and
abduction
Example: Carpometacarpal joints of the thumbs
Flexion and
extension
The shapes of the joint surfaces define the types of movements that can
occur at a synovial joint; they also determine the classification of synovial
joints into six structural types.
Multiaxial movement
Ball-and-socket joint
Cup
(socket)
Medial/lateral
axis
Anterior/posterior
axis
Vertical axis
Scapula
Spherical
head
(ball)
Humerus
Flexion and extension
Examples: Shoulder joints and hip joints
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Adduction and
abduction
Rotation
Knee Joint
• Largest, most complex joint of body
• Three joints surrounded by a single
joint cavity
– Femoropatellar joint
• Plane joint
• Allows gliding motion during knee flexion
– Lateral and medial tibiofemoral joints
• Femoral condyles with lateral and medial
menisci of tibia
• Allow flexion, extension, and some rotation
when knee partly flexed
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Tendon of
quadriceps
femoris
Femur
Articular
capsule
Posterior
cruciate
ligament
Suprapatellar
bursa
Patella
Subcutaneous
prepatellar bursa
Synovial cavity
Lateral
meniscus
Lateral meniscus
Anterior
cruciate
ligament
Infrapatellar
fat pad
Deep infrapateller
bursa
Tibia
Patellar ligament
Sagittal section through the right knee joint
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Anterior
Anterior
cruciate
ligament
Articular
cartilage
on medial
tibial condyle
Medial
meniscus
Posterior
cruciate
ligament
Articular
cartilage on
lateral tibial
condyle
Lateral
meniscus
Superior view of the right tibia in the knee joint, showing
the menisci and cruciate ligaments
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Knee Joint
• At least 12 associated bursae
• Capsule is reinforced by muscle tendons
– E.g., quadriceps and semimembranosus tendons
• Joint capsule is thin and absent anteriorly
• Anteriorly, quadriceps tendon gives rise to
three broad ligaments
– Medial and lateral patellar retinacula
– Patellar ligament
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Quadriceps
femoris
muscle
Tendon of
quadriceps
femoris
muscle
Patella
Lateral
patellar
retinaculum
Fibular
collateral
ligament
Fibula
Anterior view of right knee
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Medial
patellar
retinaculum
Tibial
collateral
ligament
Patellar
ligament
Tibia
Ligaments Stabilizing Knee Joint
• Capsular and extracapsular
ligaments
–
–
–
–
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Help prevent hyperextension of knee
Fibular and tibial collateral ligaments
Oblique popliteal ligament
Arcuate popliteal ligament
Tendon of
adductor
magnus
Femur
Articular
capsule
Medial head of
gastrocnemius
muscle
Oblique
popliteal
ligament
Lateral
head of
gastrocnemius
muscle
Popliteus
muscle
(cut)
Bursa
Fibular
collateral
ligament
Tibial
collateral
ligament
Tendon of
semimembranosus
muscle
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Arcuate
popliteal
ligament
Tibia
Posterior view of the joint capsule, including ligaments
Ligaments Stabilizing Knee Joint
• Intracapsular ligaments
– Prevent anterior-posterior displacement
– Reside outside synovial cavity
– Anterior cruciate ligament
• Attaches to anterior tibia
– Posterior cruciate ligament
• Attaches to posterior tibia
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Lateral
condyle
of femur
Lateral
meniscus
Posterior
cruciate
ligament
Medial
condyle
Tibial
collateral
ligament
Anterior
cruciate
ligament
Tibia
Medial
meniscus
Fibular
collateral
ligament
Patellar
ligament
Fibula
Patella
Quadriceps
tendon
Anterior view of flexed knee, showing
the cruciate ligaments (articular
capsule removed, and quadriceps
tendon cut and reflected distally)
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Medial femoral
condyle
Anterior cruciate
ligament
Medial meniscus
on medial tibial
condyle
Patella
Photograph of an opened knee joint;
view similar to (e)
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Knee Joint Injuries
• Absorbs great vertical force
• Vulnerable to horizontal
blows, especially laterally
blows to extended knee
– Three C's
• Collateral ligaments
• Cruciate ligaments
• Cartilages
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A common
knee injury.
Lateral
Hockey puck
Medial
Patella
(outline)
Tibial
collateral
ligament
(torn)
Medial
meniscus
(torn)
Anterior
cruciate
ligament
(torn)
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Shoulder (Glenohumeral) Joint
• Ball-and-socket joint
– Head of humerus with glenoid
cavity of scapula
• Most freely moving joint in
body
– Stability sacrificed
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The shoulder joint.
Acromion
of scapula
Coracoacromial
ligament
Subacromial
bursa
Fibrous layer of
articular capsule
Synovial cavity
of the glenoid
cavity containing
synovial fluid
Articular
cartilage
Tendon
sheath
Tendon of
long head
of biceps
brachii muscle
Synovial membrane
Fibrous layer of
articular capsule
Humerus
Frontal section through right shoulder joint
© 2013 Pearson Education, Inc.
The shoulder joint.
Synovial cavity
of the glenoid
cavity containing
synovial fluid
Articular
cartilage
Fibrous layer of
articular capsule
Humerus
Cadaver photo corresponding to (a)
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Shoulder Joint
• Reinforcing ligaments
– Primarily on anterior aspect
– Coracohumeral ligament
• Helps support weight of upper limb
– Three glenohumeral ligaments
• Weak and sometimes absent
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Shoulder Joint
• Reinforcing muscle tendons
– Tendon of long head of biceps brachii
• Travels through the intertubercular
sulcus
• Secures humerus to glenoid cavity
– Four rotator cuff tendons encircle the
shoulder joint
• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres minor
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Acromion
Coracoacromial
ligament
Subacromial
bursa
Coracohumeral
ligament
Greater
tubercle
of humerus
Transverse
humeral
ligament
Tendon sheath
Tendon of
long head
of biceps
brachii
muscle
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Coracoid
process
Articular
capsule
reinforced by
glenohumeral
ligaments
Subscapular
bursa
Tendon of the
subscapularis
muscle
Scapula
Anterior view of right shoulder joint capsule
Acromion
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
Lateral view of socket of right shoulder
joint, humerus removed
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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
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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
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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
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Median sagittal section through right elbow (lateral view)
Elbow Joint
• Anular ligament
– Surrounds head of radius
• Two capsular ligaments
restrict side-to-side
movement
– Ulnar collateral ligament
– Radial collateral ligament
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Humerus
Anular
ligament
Radius
Lateral
epicondyle
Articular
capsule
Radial
collateral
ligament
Olecranon
Ulna
Lateral view of right elbow joint
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Articular
capsule
Anular
ligament
Humerus
Coronoid
process
Medial
epicondyle
Radius
Ulnar
collateral
ligament
Ulna
Medial view of right elbow
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Humerus
Anular
ligament
Medial
epicondyle
Radius
Articular
capsule
Ulnar
collateral
ligament
Coronoid
process
Ulna
Cadaver photo of medial view of right elbow
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Hip (Coxal) Joint
• Ball-and-socket joint
• Head of the femur
articulates with acetabulum
• Good range of motion, but
limited by the deep socket
– Rim of fibrocartilage Acetabular labrum
• Enhances depth of socket so
hip dislocations rare
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Coxal (hip) bone
Articular cartilage
Acetabular labrum
Ligament of the
head of the femur
(ligamentum teres)
Femur
Synovial cavity
Articular capsule
Frontal section through the right hip joint
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The hip joint.
Acetabular
labrum
Synovial
membrane
Ligament
of the head
of the femur
(ligamentum
teres)
Head
of femur
Articular
capsule (cut)
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Photo of the interior of the hip joint, lateral view
Hip Joint
• Reinforcing ligaments
– Iliofemoral ligament
– Pubofemoral ligament
– Ischiofemoral ligament
– Ligamentum teres
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Iliofemoral
ligament
Ischium
Ischiofemoral
ligament
Greater
trochanter
of femur
Posterior view of right hip joint, capsule in place
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Anterior inferior
iliac spine
Iliofemoral
ligament
Pubofemoral
ligament
Greater
trochanter
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Anterior view of right hip joint, capsule in place
Temporomandibular Joint (TMJ)
• Mandibular condyle articulates
with temporal bone
• Two types of movement
– Hinge—depression and
elevation of mandible
– Gliding—e.g., side-to-side
(lateral excursion) grinding of
teeth
• Most easily dislocated joint in
the body
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Mandibular fossa
Articular tubercle
Zygomatic process
Infratemporal fossa
External
acoustic
meatus
Lateral
ligament
Articular
capsule
Ramus of
mandible
Location of the joint in the skull
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Articular disc
Articular
tubercle
Mandibular
fossa
Superior
joint
cavity
Articular
capsule
Synovial
membranes
Condylar
process of
mandible
Ramus of
mandible
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Enlargement of a
sagittal section through
the joint
Inferior joint
cavity
Outline of the
mandibular
fossa
Superior view
Lateral excursion: lateral (side-to-side) movements of the mandible
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Common Joint Injuries
• Cartilage tears
– Due to compression and shear stress
– Fragments may cause joint to lock or
bind
– Cartilage rarely repairs itself
– Repaired with arthroscopic surgery
• Ligaments repaired, cartilage fragments
removed with minimal tissue damage or
scarring
– Partial menisci removal renders joint
less stable but still mobile; complete
removal leads to osteoarthritis
– Meniscal transplant in younger patients
– Perhaps meniscus grown from own
stem cells in future
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Arthroscopic photograph of a torn medial meniscus.
Femur
Meniscus
Tear in
meniscus
Tibia
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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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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
– Inflammation of bursa, usually
caused by blow or friction
– Treated with rest and ice and, if
severe, anti-inflammatory drugs
• Tendonitis
– Inflammation of tendon sheaths
typically caused by overuse
– Symptoms and treatment similar to
bursitis
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Arthritis
• >100 different types of
inflammatory or degenerative
diseases that damage joints
• Most widespread crippling disease
in the U.S.
• Symptoms: pain, stiffness, and
swelling of joint
• Acute forms: caused by bacteria,
treated with antibiotics
• Chronic forms: osteoarthritis,
rheumatoid arthritis, and gouty
arthritis
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Osteoarthritis (OA)
• Common, irreversible, degenerative (''wearand-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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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
• Usually arises between ages 40 and 50,
but may occur at any age; affects 3 times
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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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 Æ joint swelling
and inflamed synovial membrane which
thickens Æ 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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A hand deformed by rheumatoid arthritis.
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Gouty Arthritis
• Deposition of uric acid crystals in joints and soft
tissues, followed by inflammation
• High fructose leads to metabolic pathway with elevates
uric acid crystals! (high fructose corn syrup)
• 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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Lyme Disease
• Caused by bacteria transmitted by
tick bites
• Symptoms: skin rash, flu-like
symptoms, and foggy thinking
• May lead to joint pain and arthritis
• Treatment
– Long course of antibiotics
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Developmental Aspects of Joints
• By embryonic week 8, synovial joints
resemble adult joints
• Joint's size, shape, and flexibility modified
by use
• Advancing years take toll on joints
– Ligaments and tendons shorten and weaken
– Intervertebral discs more likely to herniate
– Most people in 70s have some degree of OA
• Full-range-of-motion exercise key to
postponing joint problems
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