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Chapter 8 Part B
Joints
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© 2016 Pearson Education, Inc.
PowerPoint® Lecture Slides
prepared by
Karen Dunbar Kareiva
Ivy Tech Community College
8.5 Selected Synovial Joints
• Synovial joints are diverse
• All have general features, but some also have
unique structural features, abilities, and
weaknesses
• Five main synovial joints
– Knee
– Shoulder
– Elbow
– Hip
– Jaw
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Knee Joint
• Largest, most complex joint of body
• Consists of three joints surrounded by single cavity
1. Femoropatellar joint
• Plane joint
• Allows gliding motion during knee flexion
2. Lateral joint and 3. Medial joint
• Lateral and medial joints together are called
tibiofemoral joint
• Joint between femoral condyles and lateral and
medial menisci of tibia
• Hinge joint that allows flexion, extension, and some
rotation when knee partly flexed
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Figure 8.7a The knee joint.
Femur
Articular
capsule
Tendon of
quadriceps
femoris
Suprapatellar
bursa
Posterior
cruciate
ligament
Patella
Subcutaneous
prepatellar bursa
Lateral meniscus
Synovial cavity
Anterior
cruciate
ligament
Tibia
Lateral meniscus
Infrapatellar fat pad
Deep infrapatellar
bursa
Patellar ligament
Sagittal section through the right knee joint
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Figure 8.7b The knee joint.
Anterior
Anterior
cruciate
ligament
Articular
cartilage on
lateral tibial
condyle
Articular
cartilage
on medial
tibial
condyle
Medial
meniscus
Lateral
meniscus
Posterior
cruciate ligament
Superior view of the right tibia in the knee joint,
showing the menisci and cruciate ligaments
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Knee Joint (cont.)
• Joint capsule is thin and absent anteriorly
• Anteriorly, quadriceps tendon gives rise to three
broad ligaments that run from patella to tibia
– Medial and lateral patellar retinacula that flank
the patellar ligament
• Doctors tap patellar ligament to test knee-jerk reflex
• At least 12 bursae associated with knee joint
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Figure 8.7c The knee joint.
Quadriceps
femoris muscle
Tendon of
quadriceps
femoris muscle
Patella
Lateral
patellar
retinaculum
Fibular
collateral
ligament
Fibula
Medial patellar
retinaculum
Tibial collateral
ligament
Patellar
ligament
Tibia
Anterior view of right knee
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Knee Joint (cont.)
• Capsular, extracapsular, or intracapsular
ligaments act to stabilize knee joint
• Capsular and extracapsular ligaments help
prevent hyperextension of knee
– Fibular and tibial collateral ligaments: prevent
rotation when knee is extended
– Oblique popliteal ligament: stabilizes posterior
knee joint
– Arcuate popliteal ligament: reinforces joint
capsule posteriorly
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Figure 8.7d The knee joint.
Tendon of
adductor
magnus
Medial head of
gastrocnemius
muscle
Popliteus
muscle (cut)
Tibial
collateral
ligament
Tendon of
semimembranosus
muscle
Femur
Articular capsule
Oblique popliteal
ligament
Lateral head of
gastrocnemius
muscle
Bursa
Fibular collateral
ligament
Arcuate popliteal
ligament
Tibia
Posterior view of the joint capsule, including ligaments
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Knee Joint (cont.)
• Intracapsular ligaments reside within capsule,
but outside synovial cavity
• Help to prevent anterior-posterior displacement
– Anterior cruciate ligament (ACL)
• Attaches to anterior tibia
• Prevents forward sliding of tibia and stops
hyperextension of knee
– Posterior cruciate ligament
• Attaches to posterior tibia
• Prevents backward sliding of tibia and forward sliding
of femur
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Figure 8.7e The knee joint.
Fibular
collateral
ligament
Lateral
condyle
of femur
Posterior
cruciate
ligament
Medial
condyle
Tibial
collateral
ligament
Lateral
meniscus
Anterior
cruciate
ligament
Tibia
Medial
meniscus
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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Figure 8.7f The knee joint.
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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Clinical – Homeostatic Imbalance 8.1
• Knee absorbs great amount of vertical force;
however, it is vulnerable to horizontal blows
– Common knee injuries involved the 3 C’s:
• Collateral ligaments
• Cruciate ligaments
• Cartilages (menisci)
– Lateral blows to extended knee can result in
tears in tibial collateral ligament, medial
meniscus, and anterior cruciate ligament
– Injuries affecting just ACL are common in
runners who change direction, twisting ACL
– Surgery usually needed for repairs
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Figure 8.8 The “unhappy triad:” ruptured ACL, ruptured tibial collateral ligament, and torn meniscus.
Lateral
Hockey puck
Medial
Patella
(outline)
Tibial
collateral
ligament
(torn)
Medial
meniscus
(torn)
Anterior
cruciate
ligament
(torn)
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Shoulder (Glenohumeral) Joint
• Most freely moving joint in body
• Stability is sacrificed for freedom of movement
• Ball-and-socket joint
– Large, hemispherical head of humerus fits in
small, shallow glenoid cavity of scapula
• Like a golf ball on a tee
• Articular capsule enclosing cavity is also thin
and loose
– Contributes to freedom of movement
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Figure 8.9a The shoulder joint.
Acromion of scapula
Coracoacromial ligament
Subacromial bursa
Synovial cavity of
the glenoid cavity
containing synovial
fluid
Fibrous layer of
articular capsule
Articular cartilage
Tendon sheath
Synovial membrane
Tendon of long head
of biceps brachii muscle
Fibrous layer of
articular capsule
Humerus
Frontal section through right shoulder joint
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Figure 8.9b 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 (Glenohumeral) Joint (cont.)
• Glenoid labrum: fibrocartilaginous rim around
glenoid cavity
– Helps to add depth to shallow cavity
– Cavity still only holds one-third of head of
humerus
• Reinforcing ligaments
– Primarily on anterior aspect
– Coracohumeral ligament
• Helps support weight of upper limb
– Three glenohumeral ligaments
• Strengthen anterior capsule, but are weak support
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Figure 8.9c The shoulder joint.
Acromion
Coracoacromial ligament
Subacromial bursa
Coracohumeral
ligament
Transverse humeral
ligament
Tendon sheath
Tendon of long head
of biceps brachii
muscle
Coracoid process
Articular capsule
reinforced by
glenohumeral
ligaments
Subscapular
bursa
Tendon of the
subscapularis
muscle
Scapula
Anterior view of right shoulder joint capsule
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Figure 8.9d The shoulder joint.
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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Shoulder (Glenohumeral) Joint (cont.)
• Reinforcing muscle tendons contribute most to
joint stability
– Tendon of long head of biceps brachii muscle is
“superstabilizer”
• Travels through intertubercular sulcus
• Secures humerus to glenoid cavity
– Four rotator cuff tendons encircle the shoulder
joint
•
•
•
•
Subscapularis
Supraspinatus
Infraspinatus
Teres minor
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Figure 8.9c The shoulder joint.
Acromion
Coracoacromial ligament
Subacromial bursa
Coracohumeral
ligament
Transverse humeral
ligament
Tendon sheath
Tendon of long head
of biceps brachii
muscle
Coracoid process
Articular capsule
reinforced by
glenohumeral
ligaments
Subscapular
bursa
Tendon of the
subscapularis
muscle
Scapula
Anterior view of right shoulder joint capsule
© 2016 Pearson Education, Inc.
Figure 8.9d The shoulder joint.
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
© 2016 Pearson Education, Inc.
Figure 8.9e The shoulder joint.
Acromion (cut)
Glenoid cavity
of scapula
Rotator cuff
muscles
(cut)
Glenoid labrum
Capsule of
shoulder joint
(opened)
Head of humerus
Posterior view of an opened right shoulder joint
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Elbow Joint
• Humerus articulates with radius and ulna
• Hinge joint formed primarily from trochlear notch
of ulna articulating with trochlea of humerus
– Allows for flexion and extension only
• Anular ligament surrounds head of radius
• Two capsular ligaments restrict side-to-side
movement
– Ulnar collateral ligament
– Radial collateral ligament
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Figure 8.10a The elbow joint.
Articular
capsule
Synovial
membrane
Humerus
Synovial cavity
Articular cartilage
Fat pad
Tendon of
triceps muscle
Bursa
Coronoid process
Tendon of
brachialis muscle
Ulna
Trochlea
Articular cartilage
of the trochlear
notch
Median sagittal section through right elbow
(lateral view)
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Figure 8.10b The elbow joint.
Humerus
Anular
ligament
Lateral
epicondyle
Radius
Articular
capsule
Radial
collateral
ligament
Olecranon
Ulna
Lateral view of right elbow joint
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Figure 8.10c The elbow joint.
Humerus
Anular
ligament
Medial
epicondyle
Radius
Articular
capsule
Coronoid
process
of ulna
Ulna
Ulnar
collateral
ligament
Cadaver photo of medial view of right elbow
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Figure 8.10d The elbow joint.
Articular
capsule
Anular
ligament
Humerus
Coronoid
process
Radius
Medial
epicondyle
Ulnar
collateral
ligament
Ulna
Medial view of right elbow
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Hip (Coxal) Joint
• Ball-and-socket joint
• Large, spherical head of the femur articulates
with deep cup-shaped acetabulum
• Good range of motion, but limited by the deep
socket
– Acetabular labrum: rim of fibrocartilage that
enhances depth of socket (hip dislocations are
rare)
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Figure 8.11a The hip joint.
Articular
cartilage
Acetabular
labrum
Hip (coxal) bone
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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Figure 8.11b The hip joint.
Acetabular
labrum
Synovial
membrane
Ligament of the
head of the femur
(ligamentum teres)
Head of femur
Articular capsule
(cut)
Photo of the interior of the hip joint, lateral view
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Hip (Coxal) Joint (cont.)
• Reinforcing ligaments include:
– Iliofemoral ligament
– Pubofemoral ligament
– Ischiofemoral ligament
– Ligament of head of femur (ligamentum teres)
• Slack during most hip movements, so not important in
stabilizing
• Does contain artery that supplies head of femur
• Greatest stability comes from deep ball-andsocket joint
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Figure 8.11c The hip joint.
Ischium
Iliofemoral
ligament
Ischiofemoral
ligament
Greater
trochanter
of femur
Posterior view of right hip joint,
capsule in place
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Figure 8.11d The hip joint.
Anterior
inferior iliac
spine
Greater
trochanter
Iliofemoral
ligament
Pubofemoral
ligament
Anterior view of right hip joint, capsule in place
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Temporomandibular Joint (TMJ)
• Jaw joint is a modified hinge joint
• Mandibular condyle articulates with temporal
bone
– Posterior temporal bone forms mandibular
fossa, while anterior portion forms articular
tubercle
• Articular capsule thickens into strong lateral
ligament
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Temporomandibular Joint (TMJ) (cont.)
• Two types of movement
– Hinge: depression and elevation of mandible
– Gliding: side-to-side (lateral excursion) grinding
of teeth
• Most easily dislocated joint in the body
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Figure 8.12a The temporomandibular (jaw) joint.
Mandibular fossa
Articular tubercle
Zygomatic process
Infratemporal fossa
External
acoustic
meatus
Articular
capsule
Lateral
ligament
Ramus of
mandible
Location of the joint in the skull
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Figure 8.12b The temporomandibular (jaw) joint.
Articular disc
Mandibular
fossa
Articular tubercle
Superior joint
cavity
Articular
capsule
Synovial
membranes
Condylar
process of
mandible
Ramus of
mandible
Inferior joint
cavity
Enlargement of a sagittal section through the joint
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Figure 8.12c The temporomandibular (jaw) joint.
Superior view
Outline of
the mandibular
fossa
Lateral excursion: lateral (side-to-side) movements of the mandible
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Clinical – Homeostatic Imbalance 8.2
• Dislocation of TMJ is most common because of
shallow socket of joint
• Almost always dislocates anteriorly, causing
mouth to remain open
– To realign, physician must push mandible back
into place
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Clinical – Homeostatic Imbalance 8.2
• Symptoms: ear and face pain, tender muscles,
popping sounds when opening mouth, joint
stiffness
• Usually caused by grinding teeth, but can also
be due to jaw trauma or poor occlusion of teeth
– Treatment for grinding teeth includes bite plate
– Relaxing jaw muscles helps
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8.6 Disorders of Joints
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
Partial menisci removal renders joint less stable but
mobile; complete removal leads to osteoarthritis
– Meniscal transplant possible in younger patients
– Perhaps meniscus grown from own stem cells in
future
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Figure 8.13 Arthroscopic photograph of a torn medial meniscus.
Femur
Meniscus
Tear in
meniscus
Tibia
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Common Joint Injuries (cont.)
• Sprains
– Reinforcing ligaments are stretched or torn
– Common sites are ankle, knee, and lumbar
region of back
– Partial tears repair very slowly because of poor
vascularization
– Three options if torn completely
• Ends of ligaments can be sewn together
• Replaced with grafts
• Just allow time and immobilization for healing
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Common Joint Injuries (cont.)
• 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, antiinflammatory drugs
• Tendonitis
– Inflammation of tendon sheaths, typically caused
by overuse
– Symptoms and treatment similar to those of
bursitis
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Inflammatory and Degenerative Conditions
(cont.)
• 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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Inflammatory and Degenerative Conditions
(cont.)
• Osteoarthritis (OA)
– Most common type of arthritis
– Irreversible, degenerative (“wear-and-tear”)
arthritis
– May reflect excessive release of enzymes that
break down articular cartilage
• Cartilage is broken down faster than it is replaced
• Bone spurs (osteophytes) may form from thickened
ends of bones
– By age 85, half of Americans develop OA, more
women than men
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Inflammatory and Degenerative Conditions
(cont.)
• Osteoarthritis (OA) (cont.)
– OA is usually part of normal aging process
– Joints may be stiff and make crunching noise
referred to as crepitus, especially upon rising
– Treatment: moderate activity, mild pain relievers,
capsaicin creams
• Glucosamine, chondroitin sulfate, and nutritional
supplements not effective
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Inflammatory and Degenerative Conditions
(cont.)
• 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 three 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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Inflammatory and Degenerative Conditions
(cont.)
• Rheumatoid arthritis (RA) (cont.)
– RA begins with inflammation of synovial
membrane (synovitis) of affected joint
– Inflammatory blood cells migrate to joint, release
inflammatory chemicals that destroy tissues
– Synovial fluid accumulates, causing joint swelling
– Inflamed synovial membrane thickens into
abnormal pannus tissue that clings to articular
cartilage
– Pannus erodes cartilage, scar tissue forms and
connects articulating bone ends (ankylosis)
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Inflammatory and Degenerative Conditions
(cont.)
• Rheumatoid arthritis (RA) (cont.)
– Treatment includes steroidal and nonsteroidal
anti-inflammatory drugs to decrease pain and
inflammation
– Disruption of destruction of joints by immune
system
• 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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Figure 8.14 A hand deformed by rheumatoid arthritis.
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Inflammatory and Degenerative Conditions
(cont.)
• Gouty arthritis
– Deposition of uric acid crystals in joints and soft
tissues, followed by inflammation
– 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 and foods high in purines, such as liver,
kidneys, and sardines
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Inflammatory and Degenerative Conditions
(cont.)
• 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
– Active joints have thicker capsules and ligaments
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Developmental Aspects of Joints
• 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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