Download Synovial Joints - Anatomy and Physiology

Joints (Articulations)
Case: Hyaluronic acid injections for knee osteoarthritis
Joseph, a 45 year old construction worker has osteoarthritis. His
knees have been bothering him and his physician recommended
injections of hyaluronic acid.
• Articulation—site where two or more bones
meet
• Functions of joints:
• Give skeleton mobility
• Hold skeleton together
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Functional Classification of Joints
• Based on amount of movement allowed by
the joint
• Three functional classifications:
• Synarthroses—immovable
• Amphiarthroses—slightly movable
• Diarthroses—freely movable
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Structural Classification of Joints
• Based on material binding bones together and
whether or not a joint cavity is present
• Three structural classifications:
• Fibrous
• Cartilaginous
• Synovial
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Fibrous Joints
• Bones joined by dense fibrous connective
tissue
• No joint cavity
• Most are synarthrotic (immovable)
• Three types:
• Sutures
• Syndesmoses
• Gomphoses
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Fibrous Joints: Sutures
• Rigid, interlocking joints containing short
connective tissue fibers
• Allow for growth during youth
• In middle age, sutures ossify and are called
synostoses
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Crouzon's and Apert's Syndrome
Crouzon and Apert syndromes are the most common of the
craniosynostosis syndromes. Craniosynostosis refers to the early
closing of one or more of the sutures of an infant's head. The skull is
normally composed of bones which are separated by sutures. This
diagram shows the different sutures which can be involved.
As an infant's brain grows, open sutures allow the skull to expand
and develop a relatively normal head shape. If one or more of the
sutures has closed early, it causes the skull to expand in the direction
of the open sutures. This can result in an abnormal head shape. In
severe cases, this condition can also cause increased pressure on the
growing brain.
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(a)
Suture
Joint held together with very short,
interconnecting fibers, and bone edges
interlock. Found only in the skull.
Suture
line
Dense
fibrous
connective
tissue
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Figure 8.1a
Fibrous Joints: Syndesmoses
• Bones connected by ligaments (bands of
fibrous tissue)
• Movement varies from immovable to slightly
movable
• Examples:
• Synarthrotic distal tibiofibular joint
• Diarthrotic interosseous connection between
radius and ulna
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(b) Syndesmosis
Joint held together by a ligament.
Fibrous tissue can vary in length, but
is longer than in sutures.
Fibula
Tibia
Ligament
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Figure 8.1b
Fibrous Joints: Gomphoses
• Peg-in-socket joints of teeth in alveolar
sockets
• Fibrous connection is the periodontal ligament
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(c) Gomphosis
“Peg in socket” fibrous joint. Periodontal
ligament holds tooth in socket.
Socket of
alveolar
process
Root of
tooth
Periodontal
ligament
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Figure 8.1c
Cartilaginous Joints
• Bones united by cartilage
• No joint cavity
• Two types:
• Synchondroses
• Symphyses
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Cartilaginous Joints: Synchondroses
• A bar or plate of hyaline cartilage unites the
bones
• All are synarthrotic
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(a)
Synchondroses
Bones united by hyaline cartilage
Epiphyseal
plate (temporary
hyaline cartilage
joint)
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Sternum
(manubrium)
Joint between
first rib and
sternum
(immovable)
Figure 8.2a
Ischiopubic Joint
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Asymmetric Closure of Ischiopubic Synchondrosis in Pediatric Patients: Correlation with Foot
Dominance
OBJECTIVE. The enlarged ischiopubic synchondrosis is a well-known anatomic struc- ture;
however, little is known about its physiology. In early childhood, enlargement of this synchondrosis
occurs bilaterally, whereas before complete ossification, it is frequently found unilaterally. In most
children, the unilateral enlarged ischiopubic synchondrosis is observed in the left hemipelvis, a
finding that was hitherto unexplained. During common athletic activi- ties, increased ground reaction
forces are exerted on the weight-bearing nondominant limb, which in up to 87% of the general
population is the left leg. The asymmetric exertion of these forces may explain the distinct closure
sequence of this temporary joint. The purpose of this study was to correlate unilateral enlarged
ischiopubic synchondrosis with foot dominance.
MATERIALS AND METHODS. The study cohort comprised 32 children who had un- dergone
unenhanced radiography, CT, or MRI for reasons other than bone disorders and who presented with
enlarged ischiopubic synchondroses. In these children, the distribution of en- larged ischiopubic
synchondrosis and foot dominance were evaluated either retrospectively (n = 11) or prospectively (n
= 21).
RESULTS. In this cohort, 78% of patients were right-footed and 22% were left-footed. Nine of the
32 children presented with unilateral enlarged ischiopubic synchondrosis (left, seven [78%] of nine;
right, two [22%] of nine). All children with enlarged left ischiopubic synchondrosis were rightfooted, and all children with enlarged right ischiopubic synchon- drosis were left-footed.
CONCLUSION. Unilateral enlarged ischiopubic synchondrosis is closely correlated with foot
dominance. The asymmetric ossification pattern of the ischiopubic synchondrosis indicates delayed
ossification of this anatomic structure due to asymmetrically applied me- chanical forces to the
nondominant limb.
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Cartilaginous Joints: Symphyses
• Hyaline cartilage covers the articulating
surfaces and is fused to an intervening pad of
fibrocartilage
• Strong, flexible amphiarthroses
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(b)
Symphyses
Bones united by fibrocartilage
Body of vertebra
Fibrocartilaginous
intervertebral
disc
Hyaline cartilage
Pubic symphysis
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Figure 8.2b
Diastasis symphysis pubis
is the separation of normally joinedpubic
bones, as in the dislocation of the bones,
without a fracture.
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Synovial Joints
• All are diarthrotic
• Include all limb joints; most joints of the body
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Synovial Joints
Distinguishing features:
1. Articular cartilage: hyaline cartilage
2. Joint (synovial) cavity: small potential space
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Synovial Joints
Distinguishing features:
3. Articular (joint) capsule:
•
Outer fibrous capsule of dense irregular
connective tissue
•
Inner synovial membrane of loose connective
tissue
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Synovial Joints
Distinguishing features:
4. Synovial fluid:
•
Viscous slippery filtrate of plasma +
hyaluronic acid
•
Lubricates and nourishes articular cartilage
Case: Hyaluronan is also used to treat osteoarthritis of the
knee. Such treatments, called viscosupplementation, are
administered as a course of injections into the knee joint, and
are believed to supplement the viscosity of the joint fluid,
thereby lubricating the joint, cushioning the joint, and
producing an analgesic effect.
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Osteoarthritis is caused by 'wear and tear' on a joint.
Cartilage is the firm, rubbery tissue that cushions your bones at the
joints, and allows bones to glide over one another.
Cartilage can break down and wear away. As a result, the bones rub
together, causing pain, swelling, and stiffness.
Bony spurs or extra bone may form around the joint, and the ligaments
and muscles become weaker and stiffer.
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Ligament
Joint cavity
(contains
synovial fluid)
Articular (hyaline)
cartilage
Fibrous
capsule
Articular
Synovial
capsule
membrane
Periosteum
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Figure 8.3
Synovial Joints
Distinguishing features:
5. Three possible types of reinforcing
ligaments:
•
Capsular (intrinsic)—part of the fibrous
capsule
•
Extracapsular—outside the capsule
•
Intracapsular—deep to capsule; covered by
synovial membrane
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Synovial Joints
Distinguishing features:
6. Rich nerve and blood vessel supply:
•
Nerve fibers detect pain, monitor joint
position and stretch
•
Capillary beds produce filtrate for synovial
fluid
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The cause of RA is unknown. It is an autoimmune
disease, which means the body's immune system
mistakenly attacks healthy tissue.
RA can occur at any age, but is more common in
middle age. Women get RA more often than men.
Infection, genes, and hormone changes may be
linked to the disease.
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Synovial Joints: Friction-Reducing
Structures
• Bursae:
• Flattened, fibrous sacs lined with synovial
membranes
• Contain synovial fluid
• Commonly act as “ball bearings” where
ligaments, muscles, skin, tendons, or bones
rub together
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Coracoacromial
ligament
Subacromial
bursa
Cavity in
bursa containing
synovial fluid
Bursa rolls
and lessens
friction.
Humerus head
rolls medially as
arm abducts.
Humerus
resting
Humerus
moving
(b) Enlargement of (a), showing how a bursa
eliminates friction where a ligament (or other
structure) would rub against a bone
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Figure 8.4b
Prepatellar bursitis, also known as Housemaid's knee, is a
common cause of swelling and pain above the patella (kneecap),
and is due to inflammation of the prepatellar bursa. This structure
is a superficial bursa with a thin synovial lining located between
the skin and the patella. The bursa develops within the first years
of life as a result of mechanical pressure and friction, and it
serves the purpose of reducing friction on underlying structures
and allowing maximal range of motion in the knee. Aseptic
prepatellar bursitis is commonly caused by repetitive work in a
kneeling position, hence the name "housemaid's knee"...
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Synovial Joints: Friction-Reducing
Structures
• Tendon sheath:
• Elongated bursa that wraps completely around
a tendon
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Acromion
of scapula
Coracoacromial
ligament
Subacromial
bursa
Joint cavity
containing
synovial fluid
Fibrous
articular capsule
Tendon
sheath
Tendon of
long head
of biceps
brachii muscle
Hyaline
cartilage
Synovial
membrane
Humerus
Fibrous
capsule
(a) Frontal section through the right shoulder joint
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Figure 8.4a
Stabilizing Factors at Synovial Joints
• Shapes of articular surfaces (minor role)
• Ligament number and location (limited role)
• Muscle tone, which keeps tendons that cross
the joint taut
• Extremely important in reinforcing shoulder
and knee joints and arches of the foot
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Synovial Joints: Movement
• Muscle attachments across a joint:
• Origin—attachment to the immovable bone
• Insertion—attachment to the movable bone
• Muscle contraction causes the insertion to
move toward the origin
• Movements occur 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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Summary of Characteristics of Body Joints
Consult Table 8.2 for:
• Joint names
• Articulating bones
• Structural classification
• Functional classification
• Movements allowed
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Table 8.2 (1 of 4)
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Table 8.2 (2 of 4)
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Table 8.2 (3 of 4)
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Table 8.2 (4 of 4)
Movements at Synovial Joints
1. Gliding
2. Angular movements:
• Flexion, extension, hyperextension
• Abduction, adduction
• Circumduction
3. Rotation
• Medial and lateral rotation
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Movements at Synovial Joints
4. Special movements
•
•
•
•
•
•
Supination, pronation
Dorsiflexion, plantar flexion of the foot
Inversion, eversion
Protraction, retraction
Elevation, depression
Opposition
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Gliding Movements
• One flat bone surface glides or slips over
another similar surface
• Examples:
• Intercarpal joints
• Intertarsal joints
• Between articular processes of vertebrae
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Gliding
(a) Gliding movements at the wrist
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Figure 8.5a
Angular Movements
Movements that occur along the sagittal plane:
• Flexion—decreases the angle of the joint
• Extension— increases the angle of the joint
• Hyperextension—excessive extension beyond
normal range of motion
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Hyperextension
Extension
Flexion
(b) Angular movements: flexion, extension, and
hyperextension of the neck
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Figure 8.5b
Extension
Hyperextension
Flexion
(c) Angular movements: flexion, extension, and
hyperextension of the vertebral column
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Figure 8.5c
Flexion
Extension
Flexion
Extension
(d) Angular movements: flexion and extension at the
shoulder and knee
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Figure 8.5d
Angular Movements
Movements that occur along the frontal plane:
• Abduction—movement away from the midline
• Adduction—movement toward the midline
• Circumduction—flexion + abduction +
extension + adduction of a limb so as to
describe a cone in space
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Abduction
Adduction
Circumduction
(e) Angular movements: abduction, adduction, and
circumduction of the upper limb at the shoulder
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Figure 8.5e
Rotation
• The turning of a bone around its own long axis
• Examples:
• Between C1 and C2 vertebrae
• Rotation of humerus and femur
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Rotation
Lateral
rotation
Medial
rotation
(f) Rotation of the head, neck, and lower limb
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Figure 8.5f
Special Movements
• Movements of radius around ulna:
• Supination (turning hand backward)
• Pronation (turning hand forward)
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Pronation
(radius
rotates
over ulna)
Supination
(radius and
ulna are
parallel)
(a) Pronation (P) and supination (S)
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Figure 8.6a
Special Movements
• Movements of the foot:
• Dorsiflexion (upward movement)
• Plantar flexion (downward movement)
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Dorsiflexion
Dorsiflexion
Plantar
flexion
Plantar
flexion
(b) Dorsiflexion and plantar flexion
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Figure 8.6b
Special Movements
• Movements of the foot:
• Inversion (turn sole medially)
• Eversion (turn sole laterally)
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Inversion
Eversion
(c) Inversion and eversion
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Figure 8.6c
Special Movements
• Movements in a transverse plane:
• Protraction (anterior movement)
• Retraction (posterior movement)
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Protraction
of mandible
Retraction
of mandible
(d) Protraction and retraction
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Figure 8.6d
Special Movements
• Elevation (lifting a body part superiorly)
• Depression (moving a body part inferiorly)
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Elevation
of mandible
Depression
of mandible
(e) Elevation and depression
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Figure 8.6e
Special Movements
• Opposition of the thumb
• Movement in the saddle joint so that the thumb
touches the tips of the other fingers
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Opposition
(f) Opposition
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Figure 8.6f