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JOINTS
By: Dr.Chaman Lal
B.S.PT, DPT, Dip. in sports Injuries, MPPS(PAK), PG in Clinical Electroneurophysiology (AKUH), Registered.EEGT (USA), Member of ABRET, AANEM & ASET (USA).
Study Outlines
Introduction, Functional classifications, Structural classification, Structures comprising a Synovial joint, Movements of joints,
nerve supply and lymphatic drainage & Factors responsible for joint stability and Development of joints References
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Joints (articulations)
Arthron (G. a joint) Junctura (L. a joint)
Joint: Joint is a junction between two or more bones or cartilages. It is a place, where parts of skeleton meet It allows varying amounts of mobility It is classified by structure or function. Arthrology: The study of joints is called arthrology. Syndesmology: (G. syndesmos= ligament) It is the study of ligaments and Joints By:Chaman Lal FIHS (CK) 1/31/2014 3 related joints.
Classification of Joints
A. Structural Classification
1. Fibrous Joints: (a) Sutures (b) Syndesmosis & (c) Gomophosis 2. Cartilaginous Joints: (a) Primary cartilaginous joints or synchondrosis & (b) Secondary cartilaginous joints or Joints By:Chaman Lal FIHS (CK) symphysis 4
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3. Synovial Joints:
(a)Plane joints
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Fibrous Joints
In fibrous joints the bones are joined by
fibrous tissue. The joints are either immovable or permit a slight degree of movement. These can be grouped in the following three subtypes. 1. Sutures:These are peculiar to skull, and are immovable. According to the shape of bony margins, the sutures can be plane, serrate, denticulate, squamous, limobus, and of schindylesis type.
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2.
Syndesmosis:
The bones are connected by the interosseious ligament. Example: Inferior tibiofibular joint
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3.
Gomophosis:-
These are peg and socket joints. Example: Tooth in its socket.
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It is restricted to the fixation of teeth in their alveolar sockets in the mandible and maxillae. The collagen of the periodontium connects dental Joints By:Chaman Lal FIHS (CK) cement with alveolar
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2.
Cartilaginous Joints:
In this type of joints the bones are joined by cartilage. There is no synovial cavity, articulating bones tightly connected by fibrocartilage or hyaline cartilage These are of two types: 1. Primary Cartilaginous Joints: (Synchondrosis, or Hyaline cartilage joints) The bones are united by a plate of hyaline cartilage, so that the joint is immovable Joints By:Chaman Lal FIHS (CK) 1/31/2014 15 and strong.
Synostosis: = the union or fusion of adjacent bones by the growth of bony substance, either as a normal process during growth or as the result of ankylosis. Example: a) Joint between epiphysis and diaphysis of a growing long bone, b) Shpeno-occipital joint, c) First chondrosternal joint & d) Costochondral joints.
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2.
layer of hyaline cartilage and united by a disc of fibrocartilage. These joints are permanent and persist throughout life. In this respect symphyses menti is a misnomer. Typically the secondary cartilaginous joints occur in the median plane of the body, and permit limited movements due to compressible Joints By:Chaman Lal FIHS (CK) 1/31/2014 19 pad of fibrocartilage and the occasional fluid
The
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thickness of fibrocartilage is directly related to the range of movement. Secondary cartilaginous joints may represent an intermediate stage in evolution of synovial joints. Examples: a) Symphsis pubis, b) Manubriosternal joint & c) Intervertebral joints between the
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3.Synovial Joints
Synovial Joints are most evolved ,
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and, therefore most mobile type of joints. Synovial joints has a fluid-filled cavity between articular surface which are covered by articular cartilage. The fluid is known as synovial fluid, which is form of lymph
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the actual articular surfaces and covers the ligaments or tendons which pass through the joint. Synovial fluid act as a lubricant. The form of the articulating surfaces controls the type of movement which takes place at any joint.
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G). Bursae
H). Tendon Sheath
Factors Influencing Joint Stability A). Bone & shape of articular surfaces. B). Ligaments C). Muscle Tone
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It help in maintaing stability only in firm type of joints, like the hip and ankle. Otherwise in most of the joints (shoulder, knee, sacroiliac etc) their role is negligible. 2.Ligament: are important in preventing any over-movement, and in guarding against sudden accidental stresses. 3.Muscle Tone: The tone of different group of muscles acting on the joint is the most important and indispensable factor in Joints By:Chaman Lal FIHS (CK) 1/31/2014 27 maintaining the stability.
Type of Joint
A. Plane or Gliding Type
B.Uniaxial Joints 1.Hinge Joint 2.Pivot Joint C. Biaxial Joints 1.Condylar Joint 2. Ellipsoid Joint 28
Flexion and Extension, and limited rotation Flx,Ext, abd, add, & Circumduction
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Flx,Ext, abd, add, & conjunct Joints By:Chaman Lal FIHS (CK) D. Multiaxial rotation
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cartilage & sometimes by fibrocartilage. Synovial fluid circulates in the joint cavity to lubricate and nourish the articulating surfaces. Viscosity of fluid is due to hyaluronic acid. The joint cavity may be partially or completely subdivided by an articular disc or meniscus. Joint is surrounded by an articular capsule which is made Joints upBy:Chaman of fibrous capsule and 30 1/31/2014 Lal FIHS (CK)
1.Plane Synovial Joints Articular surfaces are more less flat (Plane). They permit gliding movements (translations) in various directions. Plane joints are appositions of almost flat surfaces. Examples: a) Intercarpal joints b) Intertarsal joints c) Joints between articular processes of vertebrae etc.
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There are strong collateral ligaments. Movements, are permitted in one plane around and transverse axis. Examples: a) Elbow joint b) Ankle joint and c) Interphalangeal joints.
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pivot (peg) surrounded by an osteoligamentous ring. Movements are permitted in one plane around a vertical axis. Example: a) Superior and inferior radio-ulnar joints, a) Median atlanto-axial joints
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4.Condylar (Bicondylar)Joints
Articular surfaces include two distinct
condyles (convex male surfaces) fitting into reciprocally concave female surfaces (which are also sometimes, known as condyles, such as tibia). These joints permit movements mainly in one plane around a transverse axis, but partly in another plane (rotation) around a vertical
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Example:
Condylar (Bicondylar)Joints.contd
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5.Elliospoid Joints
Articular surfaces
include an oval, convex, male surface fitting into an elliptical, concave female surface. Example: a) Wrist Joint b) Metacarpophalange al joints & c) Atlanto-occipital 36 Joints By:Chaman Lal FIHS (CK)
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convex. Movements are similar to those permitted by an ellipsoid joint, with addition of some rotation (conjunct rotation) around a third axis which, however, cannot occur independently. Examples: a) 1st carpometacarpal joint b) Sternoclavicular joint & c) Calcaneocuboid joint.
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head (male surface) fitting into a cupshaped socket (female surface). Movements occur around an indefinite number of axes, which have one common center. Examples: a) Shoulder joint, b) Hip joint, c) Talo-calcaneonavicular joint.
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B. Functional Classification
Functional classification of joint is
actually based upon degree of mobility of the joint. There are 3 types of joints according to their functional classification.
1. Synarthroses (Immovable) 2. Amphiarthroses 3. Diarthroses or synovial joints
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1.Synarthroses These are fixed joints and immovable. The articular surfaces are joined by tough fibrous tissue. Often the edges of the bones are dovetailed into one another as in
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2.Amphiarthorses
These allow some movement. A pad
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of cartilage lies between the bone surfaces, and there is a fibrous capsule to hold the bones and cartilage in place. The cartilages of such joints also act as shock absorbers e.g. the intervertebral discs between the bodies of the vertebrae, where the cartilage is strengthened
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joints, though at some of them the movement is restricted by the shape of the articulating surfaces and by the ligament which hold the bones together. These ligaments are of elastic connective tissue. -e.g. Knee joint, shoulder joint, etc
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Movements & Mechanism of Joints Angular movement: Movement leading to diminution or increase in angle between two adjoining bones. -Flexion: Decreasing the angle between two bones. -Extension: Increasing the angle between two bones -Abduction: Moving the part away from mid-line. -Adduction: Bringing the part towards the
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2. Rotary: -Rotation: Turing upon an axis. -Adjunct rotation: Independent rotations -Conjunct rotation: Rotation which accompany other movements -Circumduction: Moving the Extremity of the part round in a circle so that the whole part inscribes a cone. 3. Gliding: One part slides on another. All synovial joints are diarthroses (freely movable) Joints By:Chaman Lal FIHS (CK) 1/31/2014 46
shapes are: A) Ovoid: When concave- female ovoids When convex- male ovoids B) Sellar/Saddle shaped: These are convex in one plane, concave in the perpendicular plane
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It is reference point around which joint mechanics can be studies and around which the most habitual conjunct rotation occurs. Spin Simple rotation around the bones stationary mechanical axis. Swing: Any other displacement of the bone and its mechanical axis apart from spin is termed a swing. Joints By:Chaman Lal FIHS (CK) 1/31/2014 48
Contd. . .
Motion: This represents the imaginary surface which would include all possible paths of a point on the mechanical axis at some distance from its related joint. Cardinal Swing: When the mechanical axis moves in the shortest pathway along with the bony movement. Arcuate Swing: When the mechanical axis moves in the longest pathway with the bony movement. Co-spin: When the effect of adjunct rotation is additive to the rotation. Joints By:Chaman Lal FIHS (CK) 1/31/2014a Anti-spin: Adjunct rotation which has 49
Ovoid
Contd. . .
surfaces & their associated movements is called Kinesiology. Male Surface: An articulating surface which is larger in surface area and always convex in all directions. Female Surface: An articulating surface which is smaller and concave in all directions. Simple Joints: Joints with only two articulating surfaces, i.e., male and female. Compound Joints: Joint possessing more than one pair of articulating surfaces. Degrees of freedom: Number of axes at which By:Chaman Lal FIHS (CK) 1/31/2014 50 theJoints bone in a joint can move.
Contd. . .
is limited to one axis i.e., with one degree freedom. Biaxial: With two degrees of freedom. Multi-axial: Three axis along with intermediate positions also. Translation: Sliding movements of one articulating surface over the other.
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Joint Positions
Closed Packed Position:
When the joint surfaces become completely congruent, their area of contact is maximal and they are tightly compressed. In this position fibrous capsule and ligaments are maximally spiralized and tense; No further movement is possible ; Surfaces can not be separated by disruptive forces; Articular surfaces are liable to trauma, e.g., Shoulder abduction +lateral rotation: Hip extension+medial rotation; Knee full extension; Ankle dorsiflexion 1/31/2014 52 Joints By:Chaman Lal FIHS (CK)
Joint Positions.contd
All other position s of incongruencey, e.g., least packed position. e.g., Shoulder semiabduction, Hip Semiflexion, Knee Semiflexion Ankle Ventral Position Limitation of Movement (Factors) -Reflex contraction of antagonistic m/s -Due to stimulations of mechanoreceptors in articular tissue, -Ligaments tension, -Approximation of soft parts
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synovial membrane, is sticky and viscous due to hyaluronic acid (a mucopolysaccharide). It serve the main function of lubrication of the joint. 2.Hyaline Cartilage: It covers the articular surface and provides the slippery surface to reduce the friction.
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Contd.
3.Intra-articular
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Fibrocartilages: Articular discs or menisci, complete or incomplete, help in spreading the synovial fluid through the joint cavity, but particularly between the articular surfaces. 4.Haversian Fatty Pads(Haversian Glands): These occupy extra spaces in the joint cavity between the incongruous bony surfaces and perhaps function as swabs to spread the synovial fluid.
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Blood Supply of the Synovial Joints The articular and epiphyseal branches given off bye the neighboring arties form a periarticular arterial plexus. Numerous vessels from this plexus pierce the fibrous capsule and form a rich vascular plexus in the deeper parts of the synovial membrane. Circulus vasculosu(Circulus articularis vasculosus) is a looped anastomoses formed bye the blood vessels of the synovial membrane around the articular
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a rich nerve supply while synovial membrane has a poor nerve supply and relatively insensitive to pain. 2.The articular cartilage is non-nervous and totally insensitive. 3.Articular nerves contains sensory and autonomic fibers.
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It states that a motor nerve to the muscle acting on joint tends to give a branch to that joint (capsule) and another branch to the skin covering the joint. Gardner (1928) further elucidated that each nerve innervates a specific region of the capsule, and that the part of the capsule which is rendered taut by a given muscle is innervated by the nerve supplying its antagonists. Joints By:Chaman Lal FIHS (CK) 1/31/2014 58 Thus the pattern of innervations is
Lymphatic Drainage of Synovial Joints Lymphatic form a plexus in the subintima of synovial membrane, and drain along the blood vessels to the regional deep nodes. Applied Anatomy:
-Dislocation of joint -Sprain -Arthritis -Stiffness of joints related to weather -Neuropathic Joint
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