Download TYPES OF THE JOINTS: 1

****This lecture is going to discuss the joint of the upper limb.
JOINTS: The site where two or more bones articulates together.
EX: Shoulder Joint  articulation between the head of humorous and the glenoid
cavity of scapula. [there is a space between the two bones]
TYPES OF THE JOINTS:
Joints are classified according to the tissue between the
articular bones.
Type Of Joints Fibrous Joints
Tissue
Fibrous Tissue
Between The
Articular
Bones
**NOTE**
We should be specific when
describing the articular bones
of a joint.
EX: Head of humorous (not
humorous)
Cartilaginous Joints Synovial joints
Cartilage Tissue
Synovial membrane that
secrets synovial fluid that
makes lubrication between
the articular bones. (Most
Common)
1-FIBROUS JOINT:
Articular bones connected together by fibrous tissue, the movement in this type
of joints is very very limited or even absent.
EX:
(A)Sutural Joint  between the bones of the skull, suture of the vault of the skull
makes a zigzag line.[frontal bone with parietal bone AND parietal bone with the
occipital bone]
(B)Inferior Tibiofibular Joint  between the tibia and fibula in the leg, very limited
or no movement.
2-CARTILAGINOUS JOINT:
Articular bones connected together by cartilage especially hyaline cartilage.
Ex: Fibrocartilaginous intervertebral disc.(between the bodies of the vertebrae)
Types Of Cartilaginous Joint:
(A)Primary Cartilaginous:
The bones are united by plate or part of hyaline cartilage.
EX:
-The growth plate of cartilage between the epiphysis (proximal or distal end of a
long bone) and diaphysis (shaft of a long bone) of the long bone.
-The articulation between the costal cartilage of the ribs with the manubrium (the
broad upper part of sternum), there is a little movement that helps when we do
CPR (Cardiopulmonary resuscitation) for the patient who has loss of
consciousness.
(B)Secondary Cartilaginous Joint:
The bones are united by plate of fibrocartilage, covered by thin layer of hyaline
cartilage.
EX:
-The Intervertebral disc. (between the bodies of the vertebrae)
-Symphysis pubis (uniting of the superior rami of the left and right pubic bones)
3-SYNOVIAL JOINT:
The most common Type in the body, It is called so due to existence of synovial
membrane that secretes synovial fluid that makes lubrication between the
articular bones.
Fatty Pads (bursa) are found in some synovial joint between the tendon and the
joint for lubrication.
The degree of movements in the synovial joint is affected by the shape of the
bones participating in the joint, the strength of the muscle and the ligaments
surrounding the joint.
Ex: Hip joint  ¾ of the head of femur articulates with the acetabulum which
gives less movement, while the muscles surrounding it are bulky so it gives more
strength to the joint.
Shoulder Joint ¼ of the head of humorous articulates with the glenoid cavity of
scapula which gives a free movement.
Rules Of This Joint:
1- Presence of space between the articular bones to allow the free movement
in all directions.
2- The articular bones should be covered by hyaline cartilage to help in the
movement between the bones.
3- Presence of synovial membrane that secretes synovial fluid that makes
lubrication between the articular bones.(The membrane is like the balloon
it is very thin layer between the articular bones but it surrounds them)
4- The joint should be surrounded by fibrous capsule completely from outside
so it supports the joint and provides it with blood and nerve supply, it
extends from the edge of the first articular part till the edge of the other
articular part)
5- It should be surrounded by ligaments to protect the joint in order for it to
move safely.
Types Of Ligaments:
(a) External ligament: outside of the capsule.
(b) Internal ligament: inside the capsule.
Ex:Knee Joint:
***Internal ligament: two cruciate ligaments )‫( (أربطه صليبيه‬anterior and posterior)
-They exist inside the joint between the articular bones.
-The anterior cruciate ligament prevent of the hyper extension of the knee joint.
-90% of the Football players are exposed to the injury (cut) of the anterior
cruciate ligament because they extend the knee joint strongly while shooting the
ball.
-The Posterior cruciate ligament has less tension on it because when you flex the
knee joint the leg bump the back of the thigh.
***External ligament: patellar ligament, medial and lateral collateral ligaments.
***Cartilage )‫(غضاريف‬: medial and lateral semilunar cartilage that helps in the
movement of the articular bones.
-If the football player shoot the ball medially there will be a medial rotation in the
knee joint if the cartilage didn’t take its place correctly there will be an injury.
Ex of the synovial joints:
(a)Hip joint: its similar to the shoulder joint, the head of femur articulates with
the acetabulum of the hip bone (ball and Socket)
CLINECAL NOTE:
Case: In elderly people (above 50) especially the overweight cause pressure on
the joint, the amount of synovial fluid secreted by the synovial membrane
decreases, so friction would occur, sometimes with a sound,, this causes
inflammation, the surfaces will become rough, the temperature will increase and
this will cause severe pain in the joint.
Treatment: Joint Implantation (artificial joint).
Types Of Synovial Joints:
a. Plane Joint:
Ex: sternoclavicular joint, acromioclavicular joint.
Movement: The opposed articular surfaces are flat or almost flat, and this
permits the bones to slide on another.(sometime there is a flat disk inside
the joint that helps in Sliding movement)
b. Hinge Joint:
Ex: elbow joint, knee joint, ankle joint.
Movement: The movement is by axial on two directions. (extension and
flexion)
c. Pivot Joint:
Ex: atlantoaxial joint (facet enters the deltoid process), Superior and
Inferior radioulnar joint. (in pronation and supination the radius moves
by crossing over the ulna-the ulna stays constant)
Movement: Rotatory movement.
d. Condyloid Joint: (concaveconvex)
 articular joints have condyle .
Ex: carpometacarpal joints.
Movement: Flexion, Extension, Abduction, Adduction.
e. Ellipsoid Joint:
Ex: wrist joint (inferior surface of radius articulates with the carpal bones
[scaphoid-lunate], articular disc articulates with triquetral.
Movement: Flexion, extension, abduction, adduction.( rotation is
impossible)
f. Saddle Joint: (2convex+2concave)
Ex: carpometacarpal joint of the thumb. (1st metacarpal articulates with
Trapizuim help in opponens)
Movement: Extension, Flexion, Adduction, Abduction, ROTATORY.
g. Ball and Socket Joint:
**NOTE**
Ex: Shoulder and hip joint.
Movement: all the movements. the shoulder joint: only ¼ of the head of humorous
THE STABILITY OF THE JOINTS:
articulates so the stability of the joint is affected, there
is no inferior ligament so the dislocation of the shoulder
joint is so common because when the person fall down
he stretches out his handdislocation inferiorly.
Reduction can be direct by increasing the stretch and
pushing the head of the humorous inward or by
surgery.
Depends on main factors:
1-shape of the bones.
2-size of the bones.
3-arrengement of the articular surfaces of the bones
4-ligaments: whether they are strong and surrounds the joint completely or it is
absent in some sides.(shoulder joint: ligaments are absent inferiorly)
5-the tones of the muscles around the joint.
THE SHOULDER JOINT:
Type:
synovial ball and socket joint
Articular Bones:
¼ of the head of humorous articulates with glenoid cavity of Scapula.
Capsule:
it surrounds the joint- there is a labrum (fibrocartlige) to increase the depth of
the glenoid cavity that starts at the edge of glenoid till the anatomical neck of
humorous.
lax inferiorly: gives more space for the movement of rotation and abduction.(no
ligament)
Ligaments:
Give stability of the joint and provide the capsule with strength.
-Superiorly Coracoacromial ligament, cooracoclavicular ligament.
-AnteriorlyTransverse humeral ligament: passes from the lesser to Greater
tubercle of humorous.
-Glenohumeral ligament: between the glenoid and the humorous.
-Coracohumeral ligament.
Long Head Of Biceps:
It enters the joint because it originates from the supraglenoid tubercle,
intracapsular extrasynovial it means that its inside the capsule but out of the
synovial membrane.
Subscapular Bursa:
it gives lubrication for all the muscles including the subscapularis muscle.
Synovial Membrane:
lines the capsule and surrounds the articular bones, secretes synovial fluid.
Muscles:
Rotator Cuff muscles: [SITS] supraspinatus (above), infraspinatus(posterior),
teres minor(posterior), suprascapularis(anterior)
Supraspinatus abduction till (15-18) degree.
Deltoid (middle fibers) abduction till 90 degree.
Nerve Supply:
Most of the nerves that pass through the joint give innervation such as: axillary,
suprascapular, upper and lower subscapularis.
Important Relations:
Anteriorly: Brachial Plexus, subscapularis muscle, axillary vessels.
Posteriorly: teres minor, infraspinatus.
Superiorly: deltoid, supraspinatus, subacromial bursa, coracoacromial ligament.
Inferiorly: Long head of triceps.
STERNOCLAVICULAR JOINT:
Articular Bones:
Sternum + the sternal end of the clavicle + first costal cartilage (costoclavicular
ligament).
There is an articular disc (flat fibrocartilaginous) between the two joint which
devides it into two small joints.
Type:
Synovial plane joint.
Movement:
Sliding Movement.
Capsule:
surrounding the joint, reinforced by the ligement.
Ligament:
Anterior and behind the joint mainly.
Costoclavicular ligament: strong ligament runs from the junction of the 1st ribs to
the surface of sternal end of clavicle.
Synovial Membrane:
lines the capsule and surrounds the articular bones, secretes synovial fluid.
Nerve Supply:
Supraclavicular nerve: anterior primary rami of C3+C4.
Movement:
Forward and backward movement of the clavicle it takes place in the medial
compartment under elevation and depression of the clavicle.
Important Relations:
anteriorly: skin, sternocleidomastoid and pectoralis major muscle.
Posteriorly: sternohyoid muscle, brachiocephalic artery and vein, left common
carotid artery.
ACROMIOCLAVICULAR JOINT:
its similar to the sternoclavicular joint.
Ligaments:
Superior and inferior coracoacromial ligament,coracoclavicular ligament.
Type:
Synovial plane joint.
Synovial Membrane:
lines the capsule and surrounds the articular bones, secretes synovial fluid.
Nerve Supply:
The scapular nerve.
Movement:
Gliding movement.
Important Relations:
Anteriorly: Deltoid muscle.
Posteriorly: Trapezius Muscle.
Superiorly: The skin.
Elbow Joint:
Articular bones:
Head of radius articulates with capitulum.
Trochlear notch of ulna articulates with trochlea.
Two process while flexingcoronoid process articulates with the coronoid fossa,
head of radius articulates with the radial fossa.
while extending olecranon process of ulna articulates with olecranon fossa of
humorous.
Type:
Synovial hinge joint
Capsule:
Surround the articular bones.
SUPERIOR RADIOULNAR JOINT WHICH IS AN ARTICULATION BETWEEN THE
HEAD OF RADUIS AND THE NOTCH OF ULNA IS CONNECTED WITH ELBOW JOINT
THAT MEANS:THE SECRETION OF THE SYNOVIAL ARRIVES FOR BOTH JOINTS.
Ligament:
Lateral collateral ligament, medial collateral ligament, anular ligament(around the
head), tendon of biceps.
There is no internal ligament.
Synovial Membrane:
Lines the capsule and surrounds the articular bones, secretes synovial fluid.
Nerve Supply:
Median,Ulnar, Masclocotaneous, Radial.
Movement:
Flexion and extention.
Long axis of extended fore arm lies to an angle to the long axis of the arm
which is called the carrying angle and it disappear when flexing.
Male:167 degree Female:160 degree
when the arm is extended with the palm facing upward the bones of the
humorous and forearm are not perfectly lined, the deviation from a straight line
is referred to as the carrying angle.
Normally females have larger carrying angle than males(when measured from
inside) and less carrying angle (when measured from outside)
Important relations:
Anteriorly: brachialis, the tendon of biceps, the meadian nerve, the brachial
artery.
Posteriorly: the triceps, small bursa for the tendon.
Medially: ulnar nerve behind the medial epicondyle.
laterally: the common extensor tendon, supinator.
PROXIMAL RADIOULNAR JOINT:
-it makes pronation and supination.(the movements occur for the head of the
radius, inferior occur to the notch over the ulna)
-Nerve Supply: median, ulnar nerve, Musclocutaneous.
-Important Relations:
Anteriorly: radial nerve, Supinator.
Posteriorly: Supinator, the common extensor tendon.
WRIST JOINT:
Type:
Synovial ellipsoid joint.
Articular Bones:
Inferior articular surface of radius articulates with scaphoid and lunate.
Articular disc articulates with triquetral
Capsule:
Very limited surrounding the articular bones posteriorly and anteriorly.
Ligament:
Are attached to the styloid process of radius and to the ulna till the carpal bones.
Nerve Supply:
Anterior and posterior interosseous nerve.
Movment:
Flexion, extention,adduction,abduction. (no rotatory (combined) movement)
INTERCARPAL JOINT:
Type:
synovial plane joint
METACARPOPHALANGIAL:
Type:
Synovial condyloid joint
P.S:THE DOCTOR MENTIONED THAT THE MOST IMPORTANT THINGS IN THE
JOINTS IS THE TYPE OF THE JOINT AND ITS MOVEMENT.
Doctors are men who prescribe medicines
of which they know little, to cure diseases
of which the know less, in human being of
whom they know nothing :P
DONE BY: Dana Hussein