1. Essentials of Human Anatomy & Physiology Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Seventh Edition Elaine N. Marieb Articulations aka. Joints Modified by J. Lunsford 01/2016

2. Fundamental Functions Slide 5.43 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Secure bones  Allow mobility  Remember a joint is an interaction between two or more bones – so be descriptive.

3. Functional Classification of Joints Slide 5.44 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Based on amount of motion allowed  Synarthroses – immovable joints  Amphiarthroses – slightly moveable joints  Diarthroses – freely moveable joints

4. Where in the Body?  Diarthroses found in limbs where mobility is important  Synarthroses and amphiarthroses are found in the axial skeleton where security/strength and protection of organs is important

5. Structural Classification of Joints Slide 5.44 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Structural – based on type of material that binds joint together AND on presence/absence of joint capsule  Fibrous  Cartilaginous  Synovial

6. To Review: Classification of Joints Slide 5.43 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Overall classification is based on 3 criteria: Highlight these in your notes  Amount of motion allowed  Type of material that binds bones together  Presence or absence of joint capsule

7. Structural Classification of Joints Slide 5.45 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Fibrous joints:  Generally immovable - Synarthrotic  Imp info: No joint capsule- Joined by fibrous CT

8. Sutures  Occur between bones of the skull  Edges of bone interlock and fuse

9. Syndesmoses  Connected by ligament or interosseous membrane (longer connecting fibers = a little more “give”)  Examples:  Distal tibiofibular joint  Down the length of the radius and ulna

10. Gomphoses  Tooth held by the periodontal ligament into the mandible/maxilla socket

11. Cartilaginous Joints Slide 5.45 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Immovable or slightly moveable - Amphiarthrotic  Imp Info: Joined by cartilage - No joint capsule

12. Symphyses Slide 5.47 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Pad or plate of FIBROcartilage – slightly movable  Examples  Pubic symphysis  Intervertebral joints Figure 5.27b, c

13. Synchondroses  Connected by bar or plate of HYALINE cartilage – slightly movable  Examples:  Epiphyseal plate  Costal cartilages to ribs

14. Synovial Joints Slide 5.45 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Freely moveable - Diarthrotic  Articulating bone ends are separated by a joint cavity completely filled with synovial fluid  Color code and study the parts of a basic synovial joint

15. Synovial Joint Structure Slide 5.49 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Articular cartilage (hyaline cartilage) covers the ends of bones to cushion & protect  A double layered articular capsule encloses the joint surfaces  Synovial membrane – inner lining – continuous with articular cartilage  Fibrous capsule – outer capsule – continuous with periosteum

16. Synovial Joint Structure  Synovial membrane – secretes synovial fluid into the joint cavity  Synovial fluid lubricates the joint surfaces to reduce friction. It also nourishes the articular cartilage through diffusion of substances

17. Sports Application  Synovial fluid becomes less viscous (thick) when it is warm. This allows the joint to move more freely.  Just another reason to warm up before you stretch and do other activities.  Just like the oil in your car needs to warm up so it can lubricate the car parts!  Ligaments reinforce the joint  Intracapsular, extracapsular, capsular

18. Structures Associated with the Synovial Joint Slide 5.50 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Bursae –  flattened fibrous sacs lined with synovial membrane and filled with synovial fluid  Located where ligaments, muscle, skin, tendons and bone rub together to reduce friction  False (develop at areas of high friction) vs true (born with)  Tendon sheath  Elongated bursa that wraps around a tendon

19. Examples  Non axial – aka plane – gliding motion  Examples: intercarpal, intertarsal  Uniaxial – one plane of motion  Hinge: elbow, knee, interphalangeal, talus with tibia  Pivot: atlantoaxial, proximal radioulnar

20. Examples of Synovial Joints  Biaxial – two planes of motion  Condyloid: metacarpophalangeal, atlanto- occipital, radiocarpal  Saddle: carpometacarpal joints of thumbs only

21. Examples of Synovial Joints  Multiaxial – universal motion  Ball & socket: hip, shoulder

22. Types of Synovial Joints Based on Shape Slide 5.52a Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 5.29a–c

23. Types of Synovial Joints Based on Shape Slide 5.52b Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 5.29d–f

24. The Synovial Joint – know diagram Slide 5.51 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 5.28

28. End of Quiz #1 information Study all information and diagrams in notes

29. Stability of Joints  Articular surfaces: Deeper socket = more stable  Muscle tone is the MAJOR factor that determines joint stability. Bigger muscles = bigger tendons = bigger bone attachment points (Wolff’s law) = more stable  Ligaments: more ligaments = more stability (also the amount of stress on the ligament)

30. Homeostatic Imbalances  Dislocation: Bone out of place  Reduction: putting bone back in place  Sprains  Stretched & torns ligaments  Heal slowly due to poor vascularity of cartilage

31. Inflammatory Conditions Slide 5.53 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Bursitis – inflammation of a bursa usually caused by a blow or friction  Tendonitis – inflammation of tendon sheaths  Treatment: anti-inflammatories and rest

32. Arthritis  3 initial symptoms of all arthritis (over 100 different types):  Pain  Stiffness  Swelling of joint

33. Acute vs. Chronic  Acute: cause - bacterial infection  Symptoms: synovial membrane thickens and fluid production decreases leading to friction and pain  Treat with antibiotics

34. Acute vs. Chronic  Chronic forms are ongoing and longer term:  Each type differs greatly in later symptoms and consequences

35. Osteoarthritis  Define: Chronic Degenerative and non inflammatory  Who affected: aged  Symptoms:  Erosion of articular cartilages, contact of bone surfaces, bone spurs form that enlarge the bone ends, joint motion restricted, stiffness & pain (cont. on next page!)

36. Osteoarthritis  Major symptom: crepitus: crunching noise made by affected joints resulting from contact of roughened articular surfaces  Treatment: analgesics, bedrest, moderate exercise

37. Ostearthritis

38. Osteoarthritis

39. Rheumatoid Arthritis  Define: chronic inflammatory - autoimmune disorder,  Who affected: women age 40+ (also a juvenile version)  Symptoms: bilateral, remissions & exacerbations, synovial membrane thickens & fluid production decreases, cartilage & bone may eventually be eroded away (cont. on next page!)

40. Rheumatoid Arthritis  Pannus: abnormal tissue that clings to articular cartilage – may cause joint fusion known as ANKYLOSIS  Treatments: drug therapy, cold & hot packs, mild exercise to prevent fusion, joint replacement

41. Rheumatoid arthritis

42. Rheumatoid Arthritis

43. Gouty Arthritis  Define: Hyperurecemia – buildup of sodium urate crystals  Who affected: men  Symptoms: usually single joint – swollen & painful  Treatments: drug therapy if continual, cold pack & analgesics, watch diet (liver, kidney, sardines, anything high in purines), avoid alcohol and excessive Vitamin C

45. Ankylosing Spondylitis  variation of rheumatoid arthritis – affects men – progresses superiorly along spine causing spinal fusion

46. Ankylosing spondylitis

47. Ankylosing Spondylitis

48. Extra terms to add  Synovitis: inflammation of synovial membrane of a joint causing swelling & joint movement limitation  Arthroscopy: minimally invasive imaging technque used to visualize/operate within a joint

49. Shoulder Joint  Most freely movable but most least stable  Ball & socket joint  Glenoid labrum: rim of fibrocartilage that deepens glenoid cavity

50. Shoulder Joint  Reinforcing ligaments primarily on anterior aspect (scapula on posterior side)  Muscle tendons are most important in stability  Superstabilizer of joint is the tendon of the long head of the biceps brachii muscle

51. Shoulder Joint

52.  Rotator cuff  4 fused tendons for stability  Can be stretched & injured during vigorous circumduction

54. Shoulder Joint  Dislocates inferiorly/anteriorly due to weakness of reinforcements Be careful of nerves when reducing dislocation!!

55. Elbow Joint  Very stable hinge joint  Main portion of joint is trochlea with semilunar notch

56. Elbow Joint  3 important ligaments  Medial collateral  Lateral collateral  Annular ligament – encloses the radial head for stability during pronation & supination

57. Ligaments of Elbow  Several tendons cross joint to provide stability along with the ligaments

58. Hip Joint  Less movable but very stable  Large muscles & ligaments  Deep socket  Acetabular labrum enhances depth of socket – see next diagram  Hip displacements are rare due to the stability of the joint – It takes great force to dislocate a hip joint

59. Hip Joint Acetabular Labrum

60. Hip Socket  3 main ligaments  Iliofemoral & Pubofemoral & Ischiofemoral

61. Hip Joint  These ligaments are arranged so that the head of the femur is actually screwed deeper into the socket upon standing  Ligamentum teres contains a small artery that supplies nutrients to the head of the femur. Any damage to this artery can lead to severe arthritis

62. Ligamentum teres connects head of femur to acetabulum – contains artery to feed head of femur

63. Hip Joint Replacement – head of femur & acetabulum

64. The Knee

65. Knee Joint Structure  Largest joint in body - Very complex  Joint is only partially enclosed by capsule – capsule is absent anteriorly – This increases the flexibility of the knee  Contains 10 bursae (& maybe additional false bursa)

66. Knee Bursae

67. Menisci  C-shaped fibrocartilage – deepen articular cartilage

68. Menisci  Increases lateral stability - Absorbs shock  Onlyfrequently attached at outer margin so loose ends are torn in sports injuries

69. Reinforcement  Extracapsular – help stabilize entire joint  Patellar ligament  Lateral collateral – critical in preventing lateral angular motion  Medial collateral – critical in preventing medial angular motion  Oblique popliteal  Arcuate popliteal Back of knee

70. Intracapsular  Help prevent displacement of articular surfaces  Anterior cruciate  Attached to the anterior tibia  Prevents overextension  Taut (means tight) when knee is extended  Posterior cruciate  Attached to the posterior tibia  Prevents overflexion  Taut when knee is flexed

71. ACL – knee flexed

72. Stability  The knee is strongly reinforced by muscles, tendons, and ligaments  BUT relatively unprotected by muscle  Muscle strength is very important for stability – bigger muscles = bigger tendons that help to stabilize

73. Muscles

74. Synovial Joint Structure  Miscellaneous structures  Fatty pads – located between fibrous capsule & synovial membrane or bone  Menisci – Fibrocartilage pads – subdivide cavity and improve stability/fit

75. Structures Most Often Injured  Medial Meniscus  Medial Collateral Ligament  Anterior Cruciate Ligament  This ligament is tight (taut) when the joint is extended  The posterior ligament is tight when the joint is flexed – so it is harder to injure