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CH
8
JOINTS
What
are
joints?
Articulation
–
a
site
where
two
or
more
bones
meet
Functions:
• Give
skeleton
mobility
• Hold
skeleton
together
CLASSIFICATION
OF
JOINTS
• Classified
by
structure
and
by
function
• Structural
classification:
-‐ Based
on
material
binding
bones
together
and
whether
or
not
a
joint
cavity
is
present
-‐ Three
structural
classifications:
à
Fibrous
à
Cartilaginous
à
Synovial
• Functional
classification:
-‐ Based
on
amount
of
movement
allowed
by
the
joint
-‐ Three
functional
classifications:
à
Synarthrotic
–
immovable
à
Amphiarthrotic
–
slightly
movable
à
Diarthrotic
–
freely
movable
When
classifying
bones
à
structure
first
then
movement
Fibrous
Joints:
• Bones
are
joined
by
fibrous
tissue
(namely
dense
fibrous
connective
tissue)
• No
joint
cavity
• Most
are
synarthrotic
(immovable)
Three
types
-‐
Sutures:
• Occur
only
between
bones
of
the
skull
• Rigid,
interlocking
joints
• Bones
connected
by
short
connective
tissue
fibres
• Allow
for
growth
during
childhood
• During
middle
age,
sutures
ossify
(closed
sutures
are
called
synostoses)
• Immovable
nature
of
sutures
is
used
for
protection
Syndesmoses:
• Bones
are
connected
by
ligaments
• Movement
varies
from
immovable
to
slightly
movable
• Examples:
synarthrotic
tibiofibular
joint,
diarthrotic
interosseous
connection
between
radius
and
ulna
Gomphoses:
• Peg-‐in-‐socket
joints
of
teeth
in
alveolar
sockets
• Fibrous
connection
is
the
periodontal
ligament
Cartilaginous
Joints:
• Bones
united
by
cartilage
• No
joint
cavity
Two
types
–
Synchondroses:
• Bar
or
plate
of
hyaline
cartilage
unites
bones
• All
are
synarthrotic
• Example:
epiphyseal
plates
in
the
long
bones
of
children
(temporary
joints
that
eventually
become
synostoses),
immovable
joint
between
costal
cartilage
of
first
rib
and
the
manubrium
of
the
sternum
Symphyses:
• Hyaline
cartilage
covers
the
articulating
surfaces
and
is
fused
to
an
intervening
pad
of
fibrocartilage
• Strong,
flexible
• Amphiartrotic
(slightly
movable)
• Examples:
pubic
symphysis,
intervertebral
joints
SHS111
Anatomy
&
Physiology
I
-‐
2
Synovial
Joints:
• All
are
diarthrotic
(freely
movable)
• Include
all
limb
joints
and
most
joints
of
the
body
Distinguishing
features:
1. Articular
cartilage:
hyaline
cartilage
2. Joint
(synovial)
cavity:
small
potential
space
inside
capsule,
full
of
synovial
fluid
3. Articular
(joint)
capsule
(all
connective
tissue
that
surrounds
the
joint):
à
Outer
fibrous
capsule
of
dense
irregular
connective
tissue
à
Inner
synovial
membrane
of
loose
connective
tissue
(lines
fibrous
capsule
internally
and
covers
all
joint
surfaces
that
are
not
covered
in
hyaline
cartilage)
4. Synovial
fluid:
à
Viscous
slippery
filtrate
of
plasma
and
hyaluronic
acid
à
Lubricates
(reduces
friction)
and
nourishes
articular
cartilage
5. Reinforcing
ligaments:
à
capsular
(intrinsic)
–
part
of
the
capsule
(eg.
medial
collateral
ligament
in
knee)
à
intracapsular
–
inside
capsule
(eg.
ACL
in
knee)
à
extracapsular
–
outside
capsule
(eg.
lateral
collateral
ligament
on
lateral
side
of
knee)
6. Rich
nerve
and
blood
vessel
supply:
à
Nerve
fibres
detect
pain,
monitor
joint
position
and
stretch
à
Capillary
beds
produce
filtrate
for
synovial
fluid
Other
features
of
some
synovial
joints:
• Fatty
pads:
pocket
of
fat
for
extra
protection
(between
the
fibrous
capsule
and
the
synovial
membrane)
• Articular
discs:
fibrocartilage
separating
the
articular
surfaces
(menisci).
They
improve
the
fit
between
articulating
bone
ends,
making
the
joint
more
stable.
(occur
in
knee,
jaw
and
a
few
other
joints)
Friction-‐reducing
structures:
Bursae:
• flattened,
fibrous
sacs
lined
with
synovial
membranes
• contain
synovial
fluid
• act
as
‘ball
bearings’
• occur
where
ligaments,
muscles,
skin,
tendons,
or
bones
rub
together
Tendon
sheath:
• an
elongated
bursa
that
wraps
completely
around
a
tendon
subjected
to
friction
• common
where
several
tendons
are
crowded
together
within
narrow
canals
Stabilizing
factors
at
synovial
joints:
• Shape
of
articular
surface
(minor
role)
-‐
Eg.
the
ball
and
deep
socket
of
the
hip
joint
is
extremely
stable)
• Ligaments
number
and
location
(limited
role)
–
prevent
excessive
and
undesirable
motion
(but
ligaments
can
only
stretch
about
6%
of
their
length
before
they
snap)
• Muscle
tone
(keep
tendons
that
cross
the
joint
taut)
–
most
important
stabilizing
factor,
extremely
important
in
stabilizing
the
shoulder
and
knee
joints
and
arches
of
the
foot.
Movements
allowed
by
synovial
joints:
Muscle
attachments
across
a
joint:
• Origin:
attachment
to
the
immovable
bone
• Insertion:
attachment
to
the
movable
bone
(muscles
contraction
causes
the
insertion
to
move
toward
the
origin)
• Movement
occurs
along
transverse,
frontal
and
sagittal
planes
• Range
of
motion:
à
nonaxial
movement
–
slipping
movements
only
(eg.
ribs
to
vertebrae)
à
uniaxial
movement
–
movement
in
one
plane
à
biaxial
movement
–
movement
in
two
planes
à
multiaxial
movement
–
movement
in
or
around
all
three
planes
• Three
general
types
of
movements:
Gliding
movements:
à
Simplest
joint
movement
à
Occurs
when
one
flat,
or
nearly
flat,
bone
surface
glides
or
slips
over
another
without
appreciable
angulation
or
rotation
à
Example:
intercarpal
and
intertarsal
joints,
between
flat
articular
processes
of
the
vertebrae
Angular
movements:
à
Increase
or
decrease
the
angle
between
two
bones
à
May
occur
in
any
plane
of
the
body
à
Include
flexion
(decreases
angle
of
the
joint)
extension
(increases
angle
of
the
joint)
hyperextension
(excessive
extension
beyond
anatomical
position)
abduction
(moving
limb
away
from
midline
of
body)
adduction
(moving
limb
towards
midline
of
body)
circumduction
(moving
a
limb
so
that
it
describes
a
cone
in
space)
Rotation:
à
Turning
of
a
bone
around
its
own
long
axis
à
Medial
and
lateral
rotation
à
Example:
between
C1
and
C2
vertebrae,
rotation
of
humerus
and
femur
• Special
types
of
movement:
à
Supination:
palm
facing
anteriorly
or
superiorly
(palm
facing
up,
holding
a
cup
of
soup)
NOTE:
hand
is
supinated
in
the
anatomical
position
à
Pronation:
palm
faces
posteriorly
or
inferiorly
(palm
facing
down,
radius
crosses
ulna)
NOTE:
pronation
and
supination
refers
to
the
movement
of
the
radius
around
the
ulna
à
Dorsiflexion:
flexing
foot
à
Plantar
flexion:
pointing
foot
à
Inversion:
sole
of
the
foot
turns
in
medially
à
Eversion:
sole
of
the
foot
turns
out
laterally
à
Protraction:
nonangular
anterior
movements
in
the
transverse
plane
(eg.
pushing
jaw
out)
à
Retraction:
nonangular
posterior
movements
in
the
transverse
plane
(eg.
pulling
jaw
in)
à
Elevation:
lifting
a
body
part
superiorly
(eg.
scapula
is
elevated
when
you
shrug
your
shoulders)
à
Depression:
moving
the
elevated
part
inferiorly
(eg.
when
chewing,
mandible
is
elevated
then
depressed)
à
Oppostion:
this
movement
is
the
action
when
you
touch
your
thumb
to
the
tips
of
the
other
fingers
on
the
same
hand
Types
of
Synovial
Joints
• Plane
joints:
articular
surfaces
are
essentially
flat
and
they
allow
only
short
nonaxial
gliding
movements
(eg.
gliding
joints)
• Hinge
joints:
motion
is
along
a
single
plane
(uniaxial)
and
permits
flexion
and
extension
only
(eg.
elbow,
knee,
interphalangeal
joints)
• Pivot
joints:
only
movement
allowed
is
uniaxial
rotation
of
one
bone
around
its
own
long
axis
(eg.
the
joint
between
the
atlas
and
dens
of
the
axis)
• Condyloid
joints:
the
oval
articular
surface
of
one
bone
fits
into
a
complementary
depression
in
another
(eg.
radiocarpal
(wrist)
joints
and
the
metacarpophalangeal
(knuckle)
joints)
• Saddle
joints:
resemble
condyloid
joints
but
they
allow
greater
freedom
of
movement.
Each
articular
surface
has
both
concave
and
convex
areas.
These
articular
surfaces
fit
together,
concave
to
convex
surfaces.
(Eg.
carpometacarpal
joints
of
the
thumbs)
• Ball-‐and-‐socket
joints:
the
spherical
or
hemispherical
head
of
one
bone
articulates
with
the
cuplike
socket
of
another
(multiaxial.
Eg.
shoulder
and
hip)
Elbow
Joint:
• Radius
and
ulna
articulate
with
the
humerus
• Hinge
joint
–
formed
mainly
by
trochlear
notch
of
ulna
and
trochlear
of
humerus
• Hook
into
olecranon
fossa
• Flexion
and
extension
only
• Anular
ligament
–
wraps
entirely
around
head
of
radius
• Two
capsular
ligaments
restrict
side-‐to-‐side
movement:
-‐ Ulnar
collateral
ligament
-‐ Radial
collateral
ligament
-‐ Treatment:
pendulum
swinging
from
conservative
RA
therapy
utilizing
aspirin,
long-‐term
antibiotic
therapy,
and
physical
therapy
to
a
more
progressive
treatment
course
using
immune-‐suppressants
such
as
methotrexate,
or
anti-‐inflammatory
drugs.