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Types of Synovial Joints
• Six types, based on shape of articular
surfaces:
– Plane
– Hinge
– Pivot
– Condylar
– Saddle
– Ball-and-socket
© 2013 Pearson Education, Inc.
Figure 8.7a 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
© 2013 Pearson Education, Inc.
Figure 8.7b 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
© 2013 Pearson Education, Inc.
Figure 8.7c 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.
Figure 8.7d 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
© 2013 Pearson Education, Inc.
Adduction and
abduction
Figure 8.7e 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 
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
Figure 8.7f 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
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Figure 8.8a The knee joint.
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
© 2013 Pearson Education, Inc.
Figure 8.8b The knee joint.
Anterior
cruciate
ligament
Articular
cartilage
on medial
tibial condyle
Medial
meniscus
Anterior
Articular
cartilage on
lateral tibial
condyle
Lateral
meniscus
Posterior
cruciate
ligament
Superior view of the right tibia in the knee joint, showing
the menisci and cruciate ligaments
© 2013 Pearson Education, Inc.
Knee Joint
• 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
© 2013 Pearson Education, Inc.
Figure 8.8c The knee joint.
Quadriceps
femoris
muscle
Tendon of
quadriceps
femoris
muscle
Patella
Lateral
patellar
retinaculum
Fibular
collateral
ligament
Fibula
Anterior view of right knee
© 2013 Pearson Education, Inc.
Medial
patellar
retinaculum
Tibial
collateral
ligament
Patellar
ligament
Tibia
Ligaments Stabilizing Knee Joint
• Capsular and extracapsular ligaments
– Help prevent hyperextension of knee
– Fibular and tibial collateral ligaments
– Oblique popliteal ligament
– Arcuate popliteal ligament
© 2013 Pearson Education, Inc.
Figure 8.8d 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
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Lateral
condyle
of femur
Lateral
meniscus
Posterior
cruciate
ligament
Medial
condyle
Tibial
collateral
ligament
Anterior
cruciate
ligament
Tibia
Medial
meniscus
Figure 8.8e The knee joint.
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)
PLAY
Animation: Rotatable Knee
© 2013 Pearson Education, Inc.
Figure 8.8f The knee joint.
Medial femoral
condyle
Anterior cruciate
ligament
Medial meniscus
on medial tibial
condyle
Patella
© 2013 Pearson Education, Inc.
Photograph of an opened knee joint;
view similar to (e)
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
© 2013 Pearson Education, Inc.
Figure 8.9 A common knee injury.
Lateral
Hockey puck
Medial
Patella
(outline)
Tibial
collateral
ligament
(torn)
Medial
meniscus
(torn)
Anterior
cruciate
ligament
(torn)
© 2013 Pearson Education, Inc.
Shoulder (Glenohumeral) Joint
• Ball-and-socket joint
– Head of humerus with glenoid cavity of
scapula
• Most freely moving joint in body
– Stability sacrificed
© 2013 Pearson Education, Inc.
Figure 8.10a 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
Frontal section through right shoulder joint
PLAY
Animation: Rotatable Shoulder
© 2013 Pearson Education, Inc.
Synovial membrane
Fibrous layer of
articular capsule
Humerus
Figure 8.10b 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)
PLAY
A&P Flix: Movement at the Glenohumeral joint: An Overview
PLAY
A&P Flix: Movement at the Glenohumeral joint (a)
PLAY
A&P Flix: Movement at the Glenohumeral joint (b)
© 2013 Pearson Education, Inc.
Shoulder Joint
• Reinforcing ligaments
– Primarily on anterior aspect
– Coracohumeral ligament
• Helps support weight of upper limb
– Three glenohumeral ligaments
• Weak and sometimes absent
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Figure 8.10c The shoulder joint.
Acromion
Coracoacromial
ligament
Subacromial
bursa
Coracohumeral
ligament
Greater
tubercle
of humerus
Transverse
humeral
ligament
Tendon sheath
Tendon of
long head
of biceps
brachii
muscle
Anterior view of right shoulder joint capsule
© 2013 Pearson Education, Inc.
Coracoid
process
Articular
capsule
reinforced by
glenohumeral
ligaments
Subscapular
bursa
Tendon of the
subscapularis
muscle
Scapula
Figure 8.10d 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
© 2013 Pearson Education, Inc.
Anterior
Lateral view of socket of right shoulder joint,
humerus removed
Figure 8.10e The shoulder joint.
Acromion
(cut)
Head of
humerus
Muscle of
rotator
cuff (cut)
Anterior view of an opened shoulder joint
© 2013 Pearson Education, Inc.
Glenoid
cavity of
scapula
Capsule of
shoulder
joint
(opened)
Elbow Joint
• Articulation of radius and ulna with
humerus
• Hinge joint
– Primarily trochlear notch of ulna with trochlea
of humerus
– Flexion and extension only
© 2013 Pearson Education, Inc.
Figure 8.11a 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)
© 2013 Pearson Education, Inc.
Elbow Joint
• Anular ligament
– Surrounds head of radius
• Two capsular ligaments restrict side-toside movement
– Ulnar collateral ligament
– Radial collateral ligament
© 2013 Pearson Education, Inc.
Figure 8.11b The elbow joint.
Humerus
Anular
ligament
Radius
Lateral
epicondyle
Articular
capsule
Radial
collateral
ligament
Olecranon
Ulna
Lateral view of right elbow joint
© 2013 Pearson Education, Inc.
Figure 8.11d The elbow joint.
Articular
capsule
Anular
ligament
Humerus
Coronoid
process
Medial
epicondyle
Radius
Ulnar
collateral
ligament
Ulna
Medial view of right elbow
© 2013 Pearson Education, Inc.
Figure 8.11c The elbow joint.
Humerus
Anular
ligament
Medial
epicondyle
Radius
Articular
capsule
Ulnar
collateral
ligament
Coronoid
process
Ulna
Cadaver photo of medial view of right elbow
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Figure 8.12a The hip joint.
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
© 2013 Pearson Education, Inc.
Figure 8.12b 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
© 2013 Pearson Education, Inc.
Hip Joint
• Reinforcing ligaments
– Iliofemoral ligament
– Pubofemoral ligament
– Ischiofemoral ligament
– Ligamentum teres
© 2013 Pearson Education, Inc.
Figure 8.12c The hip joint.
Iliofemoral
ligament
Ischium
Ischiofemoral
ligament
Greater
trochanter
of femur
Posterior view of right hip joint, capsule in place
© 2013 Pearson Education, Inc.
Figure 8.12d The hip joint.
Anterior inferior
iliac spine
Iliofemoral
ligament
Pubofemoral
ligament
Greater
trochanter
Anterior view of right hip joint, capsule in place
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Figure 8.13a The temporomandibular (jaw) joint.
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
© 2013 Pearson Education, Inc.
Figure 8.13b The temporomandibular (jaw) joint.
Articular disc
Articular
tubercle
Mandibular
fossa
Superior
joint
cavity
Articular
capsule
Synovial
membranes
Condylar
process of
mandible
Ramus of
Inferior joint
mandible
cavity
Enlargement of a sagittal section through the joint
© 2013 Pearson Education, Inc.
Figure 8.13c The temporomandibular (jaw) joint.
Outline of the
mandibular
fossa
Superior view
Lateral excursion: lateral (side-to-side) movements of the mandible
© 2013 Pearson Education, Inc.
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 stem cells in future
© 2013 Pearson Education, Inc.
Figure 8.14 Arthroscopic photograph of a torn medial meniscus.
Femur
Meniscus
Tear in
meniscus
Tibia
© 2013 Pearson Education, Inc.
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
© 2013 Pearson Education, Inc.
Common Joint Injuries
• Dislocations (luxations)
– Bones forced out of alignment
– Accompanied by sprains, inflammation, and
difficulty moving joint
– Caused by falls or sports
– Must be reduced to treat
• Subluxation—partial dislocation
© 2013 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
• Bursitis
– Inflammation of bursa, caused by blow or friction
– Treated with rest and ice
– For the first 24 to 72 hrs apply ice for 10 to 20 mins
every hr or two.
• Tendonitis
– Inflammation of tendon sheaths typically caused by
overuse
– Symptoms and treatment similar to bursitis
© 2013 Pearson Education, Inc.
The carpal tunnel is the area under a ligament anterior to the wrist. The median nerve,
which passes through the carpal tunnel, supplies the thumb side of the hand. Repetitive
movements can cause inflammation of structures that surround the median nerve. The
inflammation may compress this nerve, producing numbness, tingling, and pain in the
first three fingers and the thumb side of the hand - a condition known as carpal tunnel
syndrome.
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: bacterial, treated with antibiotics
• Chronic forms: psoriatic arthritis, osteoarthritis,
rheumatoid arthritis, and gouty arthritis
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Psoriasis causes cells to build up rapidly on
the surface of the skin, forming thick silvery
scales and itchy, dry, red patches that are
sometimes painful.
© 2013 Pearson Education, Inc.
• Both psoriatic arthritis and psoriasis are
chronic diseases that get worse over time,
but you may have periods when your
symptoms improve or go into remission
alternating with times when symptoms
become worse.
• Psoriatic arthritis can affect joints on just
one side or on both sides of your body.
The signs and symptoms of psoriatic
arthritis often resemble those of
rheumatoid arthritis. Both diseases cause
joints to become painful, swollen and
warm to the touch.
© 2013 Pearson Education, Inc.
Radiographic changes due to PsA, unlike those of
rheumatoid arthritis, demonstrate characteristic
bony proliferation and erosion. A highly specific
finding of erosive arthritis of PsA is the classic
"pencil-in-cup“ deformity in the phalanges.
© 2013 Pearson Education, Inc.
Osteoarthritis (OA)
• Common, irreversible, degenerative
(''wear-and-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
© 2013 Pearson Education, Inc.
Osteoarthritis (OA)
• More cartilage is destroyed than replaced
in badly aligned or overworked joints
• Exposed bone thicken, enlarge, form
osteophytes, creptitus and restrict
movement
• Treatment: moderate activity, mild pain
relievers, capsaicin creams
– Glucosamine, chondroitin sulfate, and
nutritional supplements not effective
© 2013 Pearson Education, Inc.
Cartilage normally protects the
joint, allowing for smooth
movement. Cartilage also absorbs
shock when pressure is placed on
the joint, like when walking.
Arthritis involves the breakdown of
cartilage. Without the usual amount
of cartilage, the bones of the joint
rub together, causing pain, swelling
and stiffness.
http://www.pennmedicine.org/health_info/arthritis/000088.html
© 2013 Pearson Education, Inc.
Rheumatoid Arthritis (RA)
• Chronic, inflammatory, autoimmune
disease of unknown cause
• 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
© 2013 Pearson Education, Inc.
Rheumatoid Arthritis
• RA begins with synovitis of affected joint
– Inflammatory blood cells migrate to joint,
release inflammatory chemicals that destroy
tissues
– Synovial fluid accumulates  joint swelling
and inflamed synovial membrane which
thickens  pannus that clings to articular
cartilage
– Pannus erodes cartilage, scar tissue forms
and connects articulating bone ends
(ankylosis)
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
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
TNFα to block action of inflammatory chemicals
• Can replace joint with prosthesis
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
Figure 8.15 A hand deformed by rheumatoid arthritis.
© 2013 Pearson Education, Inc.
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
(first metatarsophalangeal joint)
• In untreated gouty arthritis, bone ends
fuse and immobilize joint
• Treatment: drugs, plenty of water,
avoidance of alcohol
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
Lyme Disease
• Caused by bacteria transmitted by tick
• Symptoms: skin rash, flu-like symptoms,
and foggy thinking
• May lead to joint pain and arthritis
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.