Presentation on theme: "Joints (general) Joints of the upper limb Joints of the lower limb"— Presentation transcript:
1 Joints (general) Joints of the upper limb Joints of the lower limb Chapter 9 of Tortora Human anatomyLecturer: Dr. M. SamsamUniversity of Central Florida, Orlando,Pictures from Platzer atlas and textbookof human anatomy and K. Moore anatomy
2 Types of Joints: 1- Continuous (synarthroses) 2- Discontinuous (diarthroses)Continuous Joints:1- Fibrous (syndesmosis)2- Cartilaginous (synchondrosis)1- Fibrous joints: examples:Interosseous memb.Ligamentum FlavumSutures of the skullGomphosis2- Cartilaginous:Primary: Hyaline cartilage between thebones, e.g.: Epiphysial disk.eg: between the epiphysis and the diaphysis, orthe joints between the 3 parts of the hip bone.Secondary: Symphysis
3 Discontinuous Joints: (Diarthroses or Synovial joints) 1- Articular surfaces:Hyaline or Fibrocartilage2- Articular capsule: composed ofSynovial and Fibrous membranes3- Joint cavity:Synovial fluid*Angle of excursion
4 Synovial joints:Additional features: (Possibly)LigamentsIntercalated disks-menisciArticular lipBursaRestricting features:BonesSoft tissueFactors keeping Contact between thearticular surfaces:MusclesCapsular ligamentsSurface adhesionAtmospheric pressure*Pathology:Degeneration of cartilageAnkylosis
5 *Classification of synovial joints: 1-Axes2-degree of freedom3-number of articular surfaces4-shape:1- Plane joints2- Hinge (ginglymus) joints3- pivot (trochoid) joints4- Ellipsoidal joints:5- Saddle (Sellar) joints:6- Ball-and-Socket joints:Fixed joints: (Amphiarthrosis)
6 Sternoclavicular joint: synovial *Saddle type but acts as Ball and socket jointArticular surfaces:Sternal end of clavicle and the manubrium.Articular disk (9).anterior (10) and posterior sternoclavicularand interclavicular ligaments (11).Costoclavicular ligament (8) also supporting the joint.*3 degrees of freedom.Clavicle moves at about 60o by arm elevation.*Movements: elevation and depression of shoulderprotraction, retraction and circumduction.Acromioclavicular joint: synovialPlane joint,Articular surfaces: Acromial surface of clavicle andAcromion process of scapulaacromioclavicular lig.(13)It moves in combination with sternoclavicular Joint.
7 Dislocation is common: anterior dislocation: *Shoulder joint:Ball and socketBetween head of the humerus (ball)and glenoid cavity (socket)Hyaline cartilage covering the surfacesThe cavity is enlarged by articular lip.No strong ligamentsMuscles strengthen the joint (rotator cuff muscles)Axillary recess (6)Long head of biceps brachii muscle passes throughbicipital groove and actually originates fromsupraglenoid tubercle.The capsule is supported by:Coracohumaral Ligament superiorly (7) and3 weak glenohumeral ligaments (sup, middle, inf).A few bursae are associated with joint: subcoracoid.Coracoacromial ligament (10) restricts the movementMovements:3 degrees, multi-axial , Abduction, adductionanteversion (flexion), retroversion (extension),lateral and medial rotation and circumductionDislocation is common: anterior dislocation:Injury to the axillary nerve.
8 Is a compound joint, composed of : *Elbow joint:Is a compound joint, composed of :Humeroradial, humeroulnar and proximal radioulnarJoints.1- joint capsule, is lax and strengthened bybrachialis and triceps muscles.2- humeral epicondyles (outside the capsule)3- Synovial membrane, 4- Fibrous membrane5- Fatty tissue, 8- Annular ligament of the radius9- Superior recessus sacciformis10- Ulnar collateral ligament11- anterior fibers, 12- posterior fibers, 13- oblique F.14- Radial collateral ligamentQuadrate ligament: connects the neck of radius toThe radial notch of ulnaMovements:Flexion, extension, supination and pronationUlnar (medial) collateral ligament injury sprain:Leads to abnormal abduction of the forearm.Radial (lateral) collateral ligament injury sprain:Adduction of forearm is disturbed.*Pulled elbow: subluxation of the head of the radiusReduction: pressing radial head posteriorly (elbowflexed), then extend and supinate the forearm
9 Is a ball and socket like joint but doesn’t function so. Elbow joint, continuedHumeroradial joint:Is a ball and socket like joint but doesn’tfunction so.Humeroulnar is a hinge joint*Joints between radius and ulna:A- Proximal radioulnar joint is a pivot jointB- Inerosseous membrane between radius and ulna(continuous fibrous joint)C- Distal Radioulnar joint: Pivot jointBetween head of Ulna and ulnar notch of Radius7- Inferior recessus sacciformisProximal and distal radioulnar joints are necessarilycombined joints to permit pronation and supination
10 Wrist (radiocarpal) joint: synovial Ellipsoid type, Surfaces: Proximally by Radius and articular disk,and distally by proximal row of carpal bones.Movements: Abduction (radial deviation)Adduction (ulnar deviation), Flexion andDorsiflexion (extension) and circumductionLigaments: ulnar collateral ligament (8)Radial collateral ligament (9)Palmar radiocarpal lig (10),dorsal radiocarpal lig (11)Palmar ulnocarpal lig (12)And many other ligamentsThe joint between carpal bones (midcarpal) isS shape. There is a little movement between thebones of first row but almost no movementbetween the 2nd row and between these and themetacarpals.
11 Carpometacarpal joint of the thumb: Saddle joint (synovial) Movements: Abduction, adduction,opposition, reposition and circumductionCarpometacarpal joints:Are Amphiarthroses (synovial joints)(almost no movement)Metacarpophalangeal joints: synovialAre ball and socket in shape but restrictedmovements due to collateral ligaments.Passive rotation of 50o might be possibleInterphalangeal joints: synovialHinge joints: Collateral and palmar ligamentsMovements: flexion and extension
12 Hip joint: Ball and socket type *Articular surfaces *Joint movements: *Innervation:Sciatic N., Femoral N. and Obturator N.* The joint has five ligaments:*Four of them are extracapsular:Ilio-femoral ligament (10):Lateral part: prevents lateral rotationand adduction of femurMedial part: prevents medial rotation of femurIschio-femoral ligament (12):prevents medial rotation of femurPubo-femoral lig (13):prevents femur abductionOrbicular zone (11):Maintain contact between the headand the socket.Ligament of the head of the femur (6):Intracapsular, contains the Acetabularartery coming from Obturator artery.
16 Knee joint, intrinsic Ligaments, Menisci:Ligaments:*Ant cruciate lig:Prevents backward slidingof femur, produces medial rotation,Locks the knee in extension*Post cruciate lig:prevents femur from forward sliding.*Popliteus M.:Flexes the knee, unlocks the knee,and laterally rotates the femur on tibia.Meniscofemoral ligaments (ant and post)*Tears of the Menisci:Longitudinal and transverseDuring partial flexion and lateralRotation (mostly).Medial meniscus 20 times morethan the lateral one.*Pathology: Unhappy TriadDuring skiing (caught-edge fall)In football (clipping)
17 Flexion and extension: (140o) Femur rolls and glides on menisci Knee joint:Movements:Flexion and extension: (140o)Femur rolls and glides on menisciRotation: Femur and menisci move over tibiaPhases of knee extension:1- Initial phase:Rotation in suprameniscal compartment2- intermediate phase:Femur glides forward in inframeniscalcompartment3- Terminal phase: (screwed home)medial rotation, tight collateral ligamentsObligatory terminal rotation of about 5o.Flexion: during flexion, fibular collateral ligamentis completely relaxed as well as medial collateralligament and both ACL and PCL are taut.Pathology:*Drawer phenomenon*Wobbly joint
18 anterior Talofibular (10) Calcaneofibular lig (11) *Sprains: mostly *Ankle (talocrural)Joint:Articular surfaces:Tibia, fibula, talusType: Hinge jointMonoaxial: transverse axisfrom medial malleolusto lateral malleolus.Movements:plantar flexion 25oand dorsiflexion 35o.*Ligaments:Deltoid lig (3,4,5,6)(crossed by TP and FDL)posterior andanterior Talofibular (10)Calcaneofibular lig (11)*Sprains: mostlyInversion sprains*Tretment: RICE11161-malleolar mortise2-joint capsule3-Deltoid lig:4-tibionavicular part5-tibiocalcaneal part6-tibiotalar part8-navicular bone9-sustentaculum tali10-ant. Talofibular lig11-calcaneofibular lig12-ant. Tibiofibular lig13- Talus14- Calcaneus15- Cuboid16- Biforcate lig17- 2nd matatarsalRed: Chopart’s joint line(transverse tarsal joint)Blue: Lisfranc’s joint line18-plantar calca-cuboid lig19-long plantar lig20-medial cuneiform21-intermediate cuneiform22-lateral cuneiform23-medial tubercle of postprocess of talus24-plantar calc-navicul lig
19 Talocalcaneonavicular J. *Subtalar Joint: (posterior) Subtalar andTalocalcaneonavicular J.*Subtalar Joint:(posterior)Articular surfaces:Talus (the post calcaneal)CalcaneusLigaments:Med and lat talocalcanealAnd interosseous T-C.*TalocalcaneonavicularJoint (anterior):Articular surfacse:1-talus2-calcaneus3-navicular4-plantar calcaneonavicular lig.Type: Ball and SocketMovement: Rotation(inversion and eversion)*Walking on slope mediatedby movements overSubtalar+Transverse tarsal joint:(talocalcaneonavicular andcalcaneocuboid) joints1- subtalar joint2- talocalcaneonavicular J.3-Talus4-Calcaneus5-lat talocalcaneal lig6-Navicular7-plantar calcaneonavicularlig (Spring ligament)8-tense biforcate lig9-Cuboid10-interosseuos talo-calc lig11-calcaneocuboid joint12-dorsal calc-cuboid lig13-dorsal cuboido-navicul lig14-talonavicular lig15-dorsal tarso-metatars lig16-dorsal metatarsal ligs17-long plantar lig18-plantar metatarsal ligs19-tendon Peroneus longus20-tendon tibialis ant21-tendon tibialis post22-tedon peroneus brevis23-plantar calc-cuboid lig24-plantar cuboideo-navicligament.
20 Movements of the foot,The axis of Henke(rotation occurs over this axis)Only look
21 Metatarsophalageal J. Type: Interphalangeal J. Ball and socket joints but,restricted mobility due tocollateral ligaments.Interphalangeal J.Hinge joints
22 Ligaments of the foot:Not importantLongitudinal arches:
25 **Disorder of joints: Injuries: Sprains: when ligaments reinforcing a joint are stretched or torn, very painful.Complete rupture of the ligaments needs surgical repair or removal.Dislocation (luxation): when bones of the joint are forced out of alignmentSubluxation: partial or incomplete dislocation of the joint.Torn cartilage: mainly in the knee joint. Surgical repair and removal of the tornparts (loose body) through arthroscopic surgery.Autologous cartilage implantation: used to heal damaged joint cartilage.Inflammatory and degenerative joint diseases:Bursitis and tendinitis: inflammation of the bursa or tendon.Housemaid’s knee: prepatellar bursitisStudent’s elbow or Olecranon bursitisArthritis: inflammation or degeneration of the joints accompanied by pain,swelling and stiffness.Rheumatoid arthritis: autoimmune disease, sever inflammation of the joints.Ankylosing spondylitis: kind of rheumatoid arthritis affecting sacroiliac jointsand vertebrae (mainly in males).Osteoarthritis: degenerative condition involving articular cartilages mainly inweight-bearing joints.Gouty arthritis: Inflammation caused by high blood levels of uric acid anddeposition of urate salts in the synovial membranes.Lyme disease: arthritis caused by bacteria transmitted by tick bites.