Vous êtes sur la page 1sur 9

ARTICULAR SYSTEM AND JOINTS

ARTICULAR SYSTEM
- Made up of joints including associated ligaments
- Bones and/or cartilages meet at joints
Types of joints
Primary Cartilaginous Joints

Secondary Cartilaginous
Joints
Unpaired, located exclusively in
the midline

Temporary (developing long


bones Epiphyseal plates),
paired
Fibrous and cartilaginous joints are solid and lack a joint cavity
Fibrous
Cartilaginous
Primary
Secondary
Bones bridged by
Bones bridged by
Thin layer of hyaline
fibrous tissue
hyaline cartilage
cartilage, with thick
fibrocartilage
Periosteum of each
sandwiched
bone is continuous
between them
with the fibrous
tissue of joint
Not mobile but
Do not allow
Restricted
allow for growth
movement but allow movement but can
for growth
withstand large
pressure
Sutures: Unite to
Epiphysial (growth)
Public symphysis
form synostosis,
plate, temporary
Intervertebral disc
fibrous joints
Manubriosternal
obliterated
Costal cartilages at
joint
thoracic cage
Syndesmosis (distal
ends of tibia/fibula)
Gomphosis (Tooth
socket)
SYNOVIAL JOINTS
- Allow for extensive movement
- Characterised by joint cavity with hyaline cartilage at joints
- Shape of articular surface determines particular movements
permitted
Types of synovial joints
Uni-axial
Pair of movements
One axis

Bi-axial
Pair of movements
2 axes (perpendicular)

Hinge:
Flexion/extension

Condylar (fingers/toes),
ellipsoid (wrist), saddle

Multi-axial
2 pairs of movements
2 horizontal axes
perpendicular to each
other
Ball and socket joints

Pivot: Rotation

(thumb)

Simple. Compound and complex joints


Simple
One pair of articular
surfaces (synovial)

Compound
More than 1 pair:
Elbow, knee

Complex
Multiple
compartments
Complete partition by
fibrocartilage disc,
incomplete by
menisci

ARTICULAR SURFACES AND CARTILAGE


- Each pair of joints are covered by articular cartilage to bear
weight, resist compression and reduce friction
- Ensures no direct contact between bone surfaces unless
overlying cartilage has worn away
- Can be convex, concave, or both
Ovoid
Convex or concave in all
directions
Bony and non-articular
In hip and knee
In form of pit/fossa/notch,
providing attachment for intraarticular ligaments or menisci
May have fat pad

Sellar
Concave in one direction and
convex on the other
Non-bony and articular
In hip and ankle, proximal
radioulnar
Ligaments can have articular
surface lined with cartilage
Discs and menisci are articular

Joint degeneration
Due to overuse and ageing
Articular cartilage becomes progressively thinner
Seen as narrowing of radiological joint space
Bony articular surfaces come into closer proximity
Contact results in severe pain due to exposure of sensory
nerve supply

Osteophyte formation
Due to degenerative arthritis
Proliferation of exposed bone with rich blood supply
Decreases joint mobility, may cause bony fusion
Encroachment (intrude) on adjacent structures (Spinal canal
or intervertebral foramen)

Articular cartilage damage


- Fragment of cartilage can break off causing loose body to form
- Can expose underlying bone
- Triggers early onset of degenerative artiritis at joint
FIBROUS CAPSULE

Description
Encloses a synovial joint, defining its boundary
A dense connective tissue made up of collagen fibres
Aka Capsular Ligament
Intracapsular: Structures that are within the joint
Reinforced
o By ligaments
o By muscle attachments at particular sites
May have deficiencies
o To allow exit for an intracapsular tendon, or
o For bursa to communicate with joint cavity
Attachments of fibrous capsule
Capsule attaches to articular margins, where collagen fibres
merge with those of periosteum
Capsule may attach to ligament rather than bone
Ligament: Bone to bone
Tendon: Muscle to bone
Elbow joint
o Radius rotation permitted due to merging with annular
ligament of proximal radioulnar joint
o Allows mobility but contributes to stability
Migration of capsule from epiphysial plate
Initially attached to periphery (Outer) of epiphyseal plate
Can migrate towards, or away from articular margin

SYNOVIAL MEMBRANE AND CAVITY


-

Synovial cavity
Defined as the space within the interior of a joint
Most joints have a single, discrete joint cavity
Can be partly or completely subdivided compartments
More than one joint can share the same cavity (elbow with
proximal radioulnar joint)
Synovial membrane
A serous membrane with a layer of flattened cells
(mesothelium) on a thin bed of loose CT
Highly vascular, can have folds or fringes
Secretes fluid into joint cavity
Lines internal surface of capsule and all non-articular
structures on the interior of a synovial joint
Characteristics
o Extremely delicate
o Does not extend over articular cartilage
o Covers periosteum
Synovial fluid
Less than 1ml in joint

Provides
o Barrier between articular apposing cartilage surfaces
o Nutrition for articular cartilage
o Acts as an adaptable lubricant for articular cartilage
Viscosity decreases with increased loading, minimising friction
Synovial Effusion
Accumulation of synovial fluid
Due to irritation of synovial
membrane
- Causes increased blood supply
due to vessel dilation
- Leads to increase in synovial
fluid secretion
Joint swelling

Haemarthrosis
Accumulation of blood in
synovial cavity
Due to severe trauma, where
structures lined with synovial
membrane are torn.
Can occur with minimal trauma
in haemophiliac
Joint swelling that is warm to the
touch

Joint swelling
Introduction of microbes into synovial cavity
Causes accumulation of pus
May lead to permanent joint destruction due to erosion of
articular surfaces
Loose body
Loose body from fragment of articular cartilage can survive in
joint cavity
o Due to nutrition it receives from synovial fluid
Can cause locking of joint
o If loose body is trapped between articular surfaces
o Interference with movement is episodic

LIGAMENTS
- Fibrous connections between bones
- Within a joint or between two joints acting as a functional
unit
- Positioned along the axis of movement

Structu
re

Elastic
Large number
of yellow
elastic fibres

Ability

Stretch and
recoil, not
injury prone

Charact
eristic

Poor nerve
supply

Exampl
e

Ligamenta
flava of
vertebral
column

Intrinsic
Thickening
s of fibrous
capsule of
synovial
joint
Reinforce
capsule

Extrinsic
Can be
extracapsula
r or
intracapsular
Contribute to
stability w/o
impeding
mobility
Separate
from capsule
Cruciate
ligaments at
knee joint

Collateral
Blend with
joint capsule,
forming
intrinsic
ligaments
Prevent
unwanted
side-to-side
movement
Located on
medical and
lateral sides
of hinge joints
Hinge joints
(Knee) allow
some rotation

Accessory
Extrinsic
ligaments of a
joint, located a
distance from it
Function with
the associated
joint despite
distance
Spine
(vertebral
arches and
bodies),
clavicle,
interosseus
membrane of
forearm and
leg

Grades of ligament injury


1
2
3

Microscopic strain: Few fibres rupture


Partial tear
Complete tear
- Usually occur at weakest point, at or near attachments
(bone)
- Can be maxed by stabilising structures such as muscle:
Protective reflex muscle spasm
- Can be masked if sensory nerve fibres within ligaments
are also severed
Ligament vulnerability
Arranged in discrete parts rather than continuous band
o To allow for more joint mobility
o However, it is weaker, thus more vulnerable
Ligament stress test
Comparing observable movement between injured and
uninjured side
Confirmed on X-ray: Stress view
With ligament sprain, pain is exacerbated by stressing
ligament
Laxity and loss of proprioception
Laxity: Predispose a ligament to future injury by allowing
excessive range of normal/abnormal movements
Loss of proprioception predisposes to future injury due to
impairment of muscle control

SPECIAL JOINT STRUCTURES


-

Labrum
Deepens the socket of a ball and socket joint
Made of fibrocartilage
No synovial membrane cover
Avascular
Menisci and Disc
Made of fibrocartilage
No synovial membrane (Are articular)
Assist with spreading synovial fluid
Thicker at periphery where they attach to fibrous capsule.
Receives vascular supply here
Central part of structure is avascular, receiving nutrition from
synovial fluid
Resists compression and may be weight bearing
Disc: Subdivides a synovial cavity (Sternoclavicular and
temporomandibular)
Menisci: Partial subdivision (Knee)
Labrum/menisci tears
Labrum does not heal due to avascularity
Disc/menisci tend not to heal except at periphery, where they
have a vascular supply
o If trapped between bony condyles, it may split
longitudinally
o Dislodged fragment: survive as loose body in joint cavity
Intracapsular tendon
Tendon: Fibrous band which is part of muscle Connects
fleshy part of muscle to bony attachment
Tendons that leaves a joint through a defect in fibrous capsule
Tendon is covered by synovial membrane when it is
intracapsular
Found in shoulders/knee Contributes to shoulder stability
and enables rotation that unlocks the knee joint
Bursae
Fluid sacs that aid mobility
Double fold of serous membrane interposed between
structures that rub together, reducing friction
Bursae can communicate via deficiency in fibrous capsule
Synovial fluid may pass between synovial cavity and its
communicating bursae
Bursitis
o Trauma/infection of a bursae may result in inflammation
o Accumulation of synovial fluid, blood or pus can occur
Joint cavity communication

o Infection introduced into bursa that communicates with


a synovial cavity may easily spread directly by synovial
fluid into joint, leading to septic arthritis
-

Fat Pad
Intracapsular but extra-synovial
Fill unoccupied space in a joint
Absorb compressive forces between bones
Contribute to spread of synovial fluid Acts as swab and
creates extra folds of synovial membrane, increasing surface
area
Pinched fat pad
o Refers to trapped fat pad between bony surface
o Cause pain and synovial effusion

JOINT MOBILITY AND STABILITY


- Mobility: Capacity for movement
- Stability: Capacity to resist excessive/unwanted movement
-

Passive/active movements
Passive: Movement occurs not due to contraction of
associated muscles (Gravity)

Pairs of movements
- Determined by shape of articular surfaces
Flexion
Abductio Medial
Planta
Inversio
n
rotation Flexion
n
Extensio
Adduction Lateral
Dorsiflexio Eversion
n
rotation
n
Roll (like a wheel)
Spin
(top)
- Another type of movement: Slide (ski)

Pronatio
n
Supinatio
n

Factors responsible for joint stability


Ligamentous
Bone
Muscular
Prevent unwanted
Joint
Give support. Tendons blend
movements, resist
itself
with capsule to form a cuff,
distraction of
acting as dynamic ligaments.
articular surfaces
Controlled automatically by
stretch reflexes
-

Close packed position


Position of maximal stability
Articular surfaces are most apposed
Majority of ligaments are maximally taut
Least volume in synovial cavity, discomfort if presence of
effusion
Loose-packed
o Allows normal movement to take place
o Articular surface not fully apposed

o Not all ligaments taut


Joint dislocation and subluxation
Dislocation: Articular surfaces are completely separated
Subluxation: Partial dislocation, still some contact
Result of dislocation/subluxation
o Stretch/tear of joint capsule and ligaments
o Damage associated structures (synovial membrane,
bone, articular cartilage, menisci)
o Reflex spasm kicks in to protect joint, but makes
reduction of dislocation more difficult
o Can cause ligamentous laxity, predisposing future injury

NEUROVASCULAR SUPPLY OF JOINTS


-

Underlying Bone
Articular surfaces receive pain fibres
Pain fibres are protected from exposure/pressure by overlying
hyaline articular cartilage (aneural)
Degenerative Arthritis
o Lead to progressive exposure of underlying bone,
resulting in severe pain during movement/weight
bearing
Innervated capsule and ligaments
Main fibrous tissue elements of joints (capsule and ligaments)
receive rich supply of proprioceptive fibres
Conveys deep somatic sensation (Stretch and joint position)
Receive rich supply of pain fibres, together with periosteum
Capsular/Ligamentous injury
o Painful, results in significant loss of proprioception
o Particularly joint position sense
o Predisposes to future injury by impairment in both
voluntary and reflex control of muscles contributing to
joint stability
Articular branches of nerves (???)
Nerves supplying muscles that produce movements at a joint
also supply the joint
Stretched capsule leads to increased contraction of overlying
flexor muscle group
Stretched capsule on opposite aspect of joint leads to
increased contraction of its overlying extensor muscle group
Vascular synovium and bone
Synovial membrane and bone beneath articular surfaces
receive a rich blood supply
Numerous vascular foramina located all over bone, except
articular avascular surface (hyaline cartilage No blood
vessels, lymph vessels, or nerve fibres)
o Receives nutrition from synovial fluid

Effects of injury on vascular joint tissues


o Mild: Synovial fluid
o Severe: Bleeding into joint cavity (Haemarthrosis),
intracapsular bone fractures
o Degeneration of articular cartilage: Exposure of vascular
bony surfaces, causing bone proliferation (arthritis)
Vascular capsule and ligaments
Poor blood supply in these locations
Injury: Slow and inadequate repair, results in ligamentous
weakness, lengthening (?) and loss of proprioception
Articular hyaline cartilage
Aneural, avascular, no lymph
No pain, but result of injury exposes bone=pain
Does not undergo normal healing
Articular vessels
Major artery of limb tends to give branches as it passes near a
joint
Branches link with each other (anastomose) within
surrounding muscles, ensuring adequate blood supply
Forms alternative pathways when an artery is kinked (by
flexion)
Anastomosis around joint
o Provides articular branches to joint
o Forms vascular circle located at capsular attachment
o Arteries to capsule and arteries to associated bone arise
from vascualr circle
o Joint structures that receive arterial supply has
corresponding venous drainage
Many vascular foramina in bone, near articular margin, are for
veins