2Joints Articulations: The site where 2 or more bones meet. Joints are the weakest part of the skeleton.ClassificationFunctional: Amount of movement allowed 1). Synarthroses: Immovable joints2). Amphiarthrosis: Slightly movable joint3). Diarthroses: Fully movable jointsSynarthrotic joints These joints offer no mobility. "Syn-" means together, and "arthr-" stands for joint. So, this is a joint that is stuck together. It doesn't move. The sutures in your skull are an example of this type of joint.Amphiarthrotic joints These joints of some mobility. "Amphi-" means both or dual, and you may remember this term from when you learned about how phospholipids were amphipathic (both hydrophilic and hydrophobic). The term amphiarthrotic means then, that these joints offer both a bit of mobility and a bit of sturdiness. An example of an amphiarthrotic joint is found in your vertebral column. Every vertebra can move against the next vertebra through their joint together which contains an intervertebral disk. This offers the vertebrae limited mobility. You should realize, though, that your entire vertebral column allows for pretty good movement (like when you go to bend down and touch your toes)... that is because you have many of these limited-movement joints along the entire vertebral column, so all of them combined total up to a fair amount of movement.Diarthrotic joints These joints are considered to be freely movable. The term diarthrotic means (I would guess) that the joint acts as if there are two ("di-") separate bones within the one joint. However, keep in mind that just because a joint is diarthrotic does not mean that it can move in any direction or that it can bend completely. All synovial joints are diarthrotic joints.
3Joints Classification Structural: based on material binding the bone. 1). Fibrous: Bone ends united by collagenic fibersa). Suturesb). Syndesmosesc). GomphosesFibulaTibiaLigament(b) SyndesmosisJoint held together by a ligament.Fibrous tissue can vary in length, butis longer than in sutures.A syndesmosis is a joint where the rough edges of two bones are held together by thick connective ligaments. The connection of the lower leg bones, the tibia and fibula, is a syndesmosis. The tibia is the main bone of the lower leg. The fibula is the small, thin bone that runs down the outer edge of the tibia.Only a few joints in the body are syndesmosis joints. In addition to the ankle syndesmosis (the connection of the tibia and fibula), syndesmosis joints are also located in the lower spine, where the top of the triangular-shaped sacrum bone fits between the pelvis bones.Most joints in the body are synovial joints. Synovial joints are enclosed by a ligament capsule and contain a fluid, called synovium, that lubricates the joint. The ankle syndesmosis sits next to the ankle synovial joint, where the tibia meets the talus bone.The ankle syndesmosis is supported and held together by three main ligaments. The ligament crossing just above the front of the ankle and connecting the tibia to the fibula is called the anterior inferior tibiofibular ligament (AITFL). The posterior fibular ligaments attach across the back of the tibia and fibula. These ligaments include the posterior inferior tibiofibular ligament (PITFL) and the transverse ligament. The interosseous ligament lies between the tibia and fibula. (Interosseous means between bones.) The interosseus ligament is a long sheet of connective tissue that connects the entire length of the tibia and fibula, from the knee to the ankle.The syndesmosis ligaments hold the bottom ends of the tibia and fibula in place. This arrangement forms the upper surface of the ankle joint. The ankle joint is a hinge joint. The hinge is formed where the tibia and fibula sit above the talus bone. This connection is called a mortise and tenon, a stable connection that woodworkers and craftsmen routinely use to create strong and stable constructions.A syndesmosis is an articulation in which adjacent bones are bound together by a ligament. The syndesmosis of the ankle is made up of anterior tibiofibular ligament, interosseous ligament, and posterior-fibular ligaments.
4Joints Classification 2). Cartilaginous Joints Bones are united by cartilagea). Synchondrosisb). Symphysesc). Synovial JointsWhere the connecting medium is cartilage, a joint is termed a synchondrosis. An example of a synchondrosis joint is the sternocostal joint (where the ribs meet the sternum). In this example, the rib will join up with the sternum via the costal cartilage.
5Immovable Joints (synarthrosis) Fibrous JointsImmovable Joints (synarthrosis)suturesutures of the skull are fibrous joints with very short connecting fibersBones united by ligament
6Immovable Joints (synarthrosis) Fibrous JointsImmovable Joints (synarthrosis)(syndesmosis)Bones united by ligament
7Immovable Joints (synarthrosis) Fibrous JointsImmovable Joints (synarthrosis)Interosseous membrane(syndesmosis)Bones united by ligament
8Gomphosis Ligaments hold tooth in bony socket Immovable joint enamel dentinpulpgumSocket of alveolar processroot of toothPeridontal ligament (membrane)Ligaments hold tooth in bony socketImmovable joint
9Slightly Movable (ampharthrosis) and Immovable (synarthrosis) Joints Cartilagenous JointsSlightly Movable (ampharthrosis) and Immovable (synarthrosis) JointsLacks a synovial cavityBones connected by fibrocartilage or hyaline cartilage2 typessynchondrosissymphyses- Symphyses - adjoining bones are interconnected by a disk of fibrocartilage(e.g.: pubic symphysis and intervertebral joints)- Synchondroses - cartilaginous joints with hyaline cartilage between the articulating bones(e.g.: epiphyseal plate and costochondral articulations bet. ribs & sternum)
10Immovable Joint (synchondrosis) Cartilagenous JointsImmovable Joint (synchondrosis)Synchondrosis JointThis type of immovable joint is a cartilaginous joint in which the connecting tissue is hyaline cartilage. (eg. epiphyseal plate).
11Slightly Movable Joint (ampharthrosis) Cartilagenous JointsSlightly Movable Joint (ampharthrosis)Symphysis Joint A symphysis occurs where there is much more cartilage present than in a synchondrosis. Adjacent bones are separated by, and fused to, a fibrocartilaginous pad.pubic symphysissymphysis
15Shoulder jointGlenohumeral (shoulder) joint - formed by the head of the humerus and scapular glenoid fossaThis is a ball & socket joint and the most movable joint of the body, and relatively easily dislocated; allows circumduction and rotation of the armLigaments pass around the shoulder rim, between the corocoid process & greater tubercle, and between the greater & lesser tuberclesThe stability of the shoulder is provided mainly by the tendons of the subscapularis, infraspinatus, and teres minor muscles- forms the musculotendinous (rotator) cuff
18Cruciate Ligaments Knee Joint Fig The cruciate ligaments prevent undesirable movements at the knee joint. a) when the knee is flexed or extended, the anterior cruciate prevents anterior slipping movements of the tibia
19Ankle Joint Talocrural (ankle) joint - the 2 articulations within the ankle are:The medial malleolus of the tibia articulates with the tallusThe lateral malleolus of the fibula articulates with the tallusThese are synovial, hinge joints that allow dorsiflexion and plantar flexion
20Temporomandibular Joint Complex JointArticular discGliding above discHinge below discMovements:depressionelevationprotractionretractionThe temporomandibular joint is one of the most complex joints in the body. The healthy TMJ opens and closes like a hinge but also allows the lower jaw to slide forward. There are two TMJ’s, located right in front of each ear.The temporomandibular joint is affected by physical and emotional stress. What’s more, the joint is constantly affected by the mechanics of your bite and your jaw movements. Stress, fatigue, jaw muscle tension, and changes in your bite can all affect the TMJ.Many people have problems with the TMJ. These include clicking and popping noises, limited mouth opening, locking, and pain. Common causes include bruxism (grinding the teeth), occlusal (bite) problems, and injuries. Stress or tension in the muscles of the jaw can also cause similar symptoms. These problems with the TMJ are collectively called TMD—Temporomandibular Disorder.
21ElbowThe temporomandibular joint is one of the most complex joints in the body. The healthy TMJ opens and closes like a hinge but also allows the lower jaw to slide forward. There are two TMJ’s, located right in front of each ear.The temporomandibular joint is affected by physical and emotional stress. What’s more, the joint is constantly affected by the mechanics of your bite and your jaw movements. Stress, fatigue, jaw muscle tension, and changes in your bite can all affect the TMJ.Many people have problems with the TMJ. These include clicking and popping noises, limited mouth opening, locking, and pain. Common causes include bruxism (grinding the teeth), occlusal (bite) problems, and injuries. Stress or tension in the muscles of the jaw can also cause similar symptoms. These problems with the TMJ are collectively called TMD—Temporomandibular Disorder.
22Types of Synovial Joints Planar JointHinge JointPivot JointSaddle JointBall & Socket JointCondyloid or Ellipsoid Joint
24Hinge Joint Convex surface of bone fits in concave surface of 2nd bone Unixlateral like a door hingeExamples:Knee, elbow, ankle, interphalangeal jointsMovements produced:flexionextensionhyperextension
25Planar Joint Bone surfaces are slightly curved Side to side movement onlyRotation prevented by ligamentsExamples:intercarpal to intertarsal jointssternoclavicular jointvertebrocostal joints
26Pivot JointRounded surface of bone articulates with the ring formed by the 2nd bone & ligamentMonoaxial since it only allows rotation around longitudinal axisExamples:proximal radioulnar jointsupinationpronationatlanto-axial jointTurning head side to side “no”
27Saddle JointOne bone saddle-shaped, other bone fits like a person riding on the saddleBiaxialcircumduction allows the tip of the thumb to travel in a circleOpposition allows thumb to touch tip of other fingersExamples:Trapezium of carpus and metacarple of thumb
28Ball & Socket Joint Ball fitting into a cup-like depression Multiaxial flexion/extensionabduction/adductionrotationExamples:shoulder jointhip joint
29Condyloid Joint Oval-shaped depression fits into oval depression Biaxial= flex/extend or adduct/abduct is possibleExamples:Wrist and metacarpophelangeal joints for 2 to 5 digits
30Figure 8.5a Movements allowed by synovial joints. Gliding(a) Gliding movements at the wristFigure 8.5a Movements allowed by synovial joints.
31Figure 8.5b Movements allowed by synovial joints. (b) Angular movements: flexion, extension, andhyperextension of the neckHyperextensionExtensionFlexionFigure 8.5b Movements allowed by synovial joints.
32Figure 8.5c Movements allowed by synovial joints. HyperextensionFlexionExtension(c) Angular movements: flexion, extension, and hyperextension of the vertebral columnFigure 8.5c Movements allowed by synovial joints.
33Figure 8.5d Movements allowed by synovial joints. ExtensionFlexion(d) Angular movements: flexion and extension at the shoulder and kneeFigure 8.5d Movements allowed by synovial joints.
34Figure 8.5e Movements allowed by synovial joints. AbductionAdduction(e) Angular movements: abduction, adduction, and circumduction of the upper limb at the shoulderCircumductionFigure 8.5e Movements allowed by synovial joints.
35Figure 8.5f Movements allowed by synovial joints. LateralrotationMedialRotation(f) Rotation of the head, neck, and lower limbFigure 8.5f Movements allowed by synovial joints.
36Figure 8.6a Special body movements. Supination(radius andulna areparallel)(a) Pronation (P) and supination (S)Pronation(radiusrotatesover ulna)Figure 8.6a Special body movements.
37Figure 8.6b Special body movements. DorsiflexionPlantar flexion(b) Dorsiflexion and plantar flexionFigure 8.6b Special body movements.
38Figure 8.6c Special body movements. EversionInversion(c) Inversion and eversionFigure 8.6c Special body movements.
39Figure 8.6d Special body movements. Protractionof mandibleRetraction(d) Protraction and retractionFigure 8.6d Special body movements.
40Figure 8.6e Special body movements. Elevationof mandibleDepression(e) Elevation and depressionFigure 8.6e Special body movements.
41Figure 8.6f Special body movements. (f) OppositionOppositionFigure 8.6f Special body movements.
42Type of joint movement: Flexion- bent kneeExtension- extend kneeHyperextension- bring leg backDorsi flexion- healPlantar flexion- toeAbduction- leg outAdduction-leg inRotation- twistingCircumduction- circular motionSupination- palm upPronation- palm downEversion- foot outInversion- foot inProtraction- chin forwardRetraction- chin backElevation- shoulders upDepression- shoulders down
43Factors Influencing Joint Stability A)The shape of articular surfaces.B) LigamentsC) Muscle ToneFactors Influencing Joint StabilityA). The shape of articular surfaces.Shallow poor fitting articular surfaces hinder stability whereas well fitting articular surfaces (ie. femur-coxal) improve stability.B). LigamentsLigaments unit the bones and prevent excessive and undesirable motion.C). Muscle ToneMuscle tendons are the most important stabilizing factor.
44Disorders and Imbalances BursitisTendonitisLyme diseaseAnkle sprains and fracturesOsteoarthritisGouty ArthritisRheumatoid ArthritisWhat is a bursa? Every person has hundreds of bursa scattered throughout the body. The function of a bursa is to decrease friction between two surfaces that move in different directions.The bursa can be thought of as a Ziplock bag with a small amount of oil and no air inside. Imagine rubbing this bag between your hands; movement of your hands would be smooth and effortless. That is what a bursa functions as--a smooth, slippery surface between two moving objects.You tend to find a bursa at points where muscles and tendons glide over bones. Without the bursa between these surfaces, movements would be painful. What is bursitis? Bursitis is the inflammation of a bursa. Normally, the bursa provides a slippery surface that has almost no friction. A problem arises when a bursa becomes inflamed. The bursa loses its gliding capabilities, and becomes more and more irritated when it is moved.When the condition called bursitis occurs, the normally slippery bursa becomes swollen and inflamed. The added bulk of the swollen bursa causes more friction within an already confined space. Also, the smooth gliding bursa becomes gritty and rough. Movement of an inflamed bursa is painful and irritating.What causes bursitis? Bursitis usually results from a repetitive movement or due to prolonged and excessive pressure. Patients who rest on their elbows for long periods or those who bend their elbows frequently and repetitively (for example, a custodian using a vacuum for hours at a time) can develop elbow bursitis, also called olecranon bursitis. Similarly in other parts of the body, repetitive use or frequent pressure can irritate a bursa and cause inflammation.Another cause of bursitis is a traumatic injury. Following trauma, such as a car accident or fall, a patient may develop bursitis. Usually a contusion causes swelling within the bursa. The bursa, which had functioned normally up until that point, now begins to develop inflammation, and bursitis results. Once the bursa is inflamed, normal movements and activities can become painful.Systemic inflammatory conditions, such as rheumatoid arthritis, may also lead to bursitis. These types of conditions can make patients susceptible to developing bursitis.Causes of TendonitisThere are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a "watershed zone," an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing--that's why we see common tendon problems in the same parts of the body.Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force.Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.Symptoms of TendonitisTendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:Tenderness directly over the tendonPain with movement of muscles and tendonsSwelling of the tendon
45Disorders and Imbalances Lyme diseaseLyme disease is caused by bites from an infected tick. The human body mounts a reaction to the infecting organism that triggers production of inflammatory agents throughout the body. These "inflammatory agents" are the chemicals produced by the body's immune system that normally fight off infection. Symptoms of Lyme DiseaseDoctors divide the symptoms of Lyme disease into three phases: early localized, early disseminated, and late disease. The three phases of symptoms can overlap. Many patients never show early symptoms at all.Early localized disease refers to a red rash in the area of the tick bite. This rash shows up within a month of infection. The bite itself is usually found near the waist or belt line, or in other warm, moist areas of the body. The bite may burn, itch, or hurt. The rash usually grows over a period of days and may be in a "bulls eye" pattern, red with a white spot in the middle, or completely red.Most patients with early localized Lyme disease also complain of flu-like symptoms, such as headaches, fatigue, and muscle and joint pain.Early disseminated disease shows up days to months after the tick bite. Patients may not remember any rashes or bites. The most common symptoms of early disseminated disease are cardiac and nervous system problems. Some patients who have the rash and are not treated with antibiotics develop heart problems. These may include heart blockage and weakening of the heart muscle. Heart symptoms may clear up on their own.Some patients who don't receive antibiotics develop damage to the nervous system. Neurologic symptoms also tend to go away on their own, but very slowly. These neurologic symptoms can include meningitis and headaches. Individual nerves can be affected causing numbness, weakness, and pain in the areas the damaged nerve travels.Late disease symptoms develop months or even years after the tick bite. Some patients who have late disease symptoms have never had any other symptoms of Lyme disease. Late disease causes arthritis pain that comes and goes in many joints. People with late Lyme disease may develop chronic arthritis of one knee.Many patients who have had Lyme disease describe headaches, fatigue, and joint pain that can last for months after treatment. These problems generally go away without any extra treatment, but very slowly.Doctors diagnose Lyme disease based on your health history and a physical exam. Your doctor may order blood tests, but they are only used to confirm the diagnosis. The techniques used to test your blood are called ELISA and Western blot. Both tests can sometimes give false positive or unclear results. If you have had the infection for less than six weeks, your body may not even be making enough antibodies to be detected in the tests.In very rare cases, the lubricating fluid of a joint (synovial fluid) or spinal fluid may need to be analyzed to confirm Lyme disease.Treatment of Lyme DiseaseTwo to four weeks of antibiotics almost always cures Lyme disease. Early treatment usually prevents later heart, nerve, and joint symptoms. If you have symptoms of early disseminated or late disease, your doctor will probably start you on intravenous (IV) antibiotics.Headaches, fatigue, and muscle and joint pain may continue for months after finishing the antibiotics. Neurologic damage may take even longer to go away, as the nervous system regenerates only one or two millimeters each day. This does not mean that you need more antibiotics. Your body just needs more time to heal. If the antibiotics do not help your symptoms at all, you and your doctor should consider that Lyme disease may not be the cause of your symptoms and look for other possible causes.
46Disorders and Imbalances Ankle Sprain Type 1The most common way the ankle can be injured is by an ankle sprain. When an ankle is sprained ligaments on the ankle are either stretched, partially torn or completely torn. The most common type of sprain is an inversion injury, where the foot is rotated inward. Ankle sprains can range from mild, to moderate, and severe. Type 1 ankle sprain is a mild sprain. It occurs when the ligaments have been stretched or torn minimally.
47Disorders and Imbalances Ankle Sprain Type 2Type II ankle sprain is a moderate level of sprain. It occurs when some of the fibers of the ligaments are torn completely
48Disorders and Imbalances Ankle Sprain Type 3Type III ankle sprain is the most severe ankle sprain. It occurs when the entire ligament is torn and there is great instability of the ankle joint.
49OsteoarthritisDegenerative joint diseaseaging, wear & tearNon inflammatoryOnly cartilage is affected, not synovial membraneDeterioration of cartilage produces bone spursRestricts movementPain upon awakening—disappears with movement
50Gouty ArthritisUric crystals build up in joints—painwaste products of DNA & RNA metabolismbuilds up in blooddeposited in cartilage causing inflammation and swellingBones fuseMiddle-aged men with abnormal gene
51Rheumatoid ArthritisAutoimmune disorderCartilage attackedInflammation, swelling & painFinal step is fusion in joint
53Arthroscopy & Arthroplasty Arthroscopy- examination of jointinstrument size of pencilremove torn knee cartilagesmall incisions onlyArthroplasty- replacement of jointstotal hip replaces acetablum & head of femurplastic socket & metal headknee replacement commonFactors Influencing Joint StabilityA). The shape of articular surfaces.Shallow poor fitting articular surfaces hinder stability whereas well fitting articular surfaces (ie. femur-coxal) improve stability.B). LigamentsLigaments unit the bones and prevent excessive and undesirable motion.C). Muscle ToneMuscle tendons are the most important stabilizing factor.
54Arthroscopy Examination of Joint The viewing scope (arthroscope) and other instruments are inserted into the knee joint. This allows your surgeon to view the ligaments, knee disc (meniscus), knee bone (patella), lining of the joint (synovium), and the rest of the joint. Arthroscopy is also used to view the inside of the knee while ligaments or tendons are repaired from the outside. Damaged tissues are then removed.
58INQUIRYWhat is a meniscus?Demonstrate adduction.What does the acronym RICE stand for?What type of joint is a synovial joint?Where is a planar joint found?Why is it a good idea to warm up before running?What is gout?What causes lyme disease?