1. Articulations

2. Fibrous Joints
Include all articulations where bones are held tightly together by fibrous connective tissue—called sutural ligament
Very little material separates the ends of bones, no appreciable movement is allowed
Also called synarthroses (syn=together, arthron=joint)—nonmovable joint
Two Types:
Sutures
Syndesmoses

3. Sutures
Bone interdigitations (grooves) fit closely and firmly together
Connecting fibers spanning between bones very short
Found only in flat bones of skull
In early adulthood, fibers of suture are replaced by bone
Bones fuse together
Called synostosis (held together by bone)

4. Syndesmoses Syndesmosis=together by bands
Held together by fibrous connective tissue
Bone ends farther apart than in suture, thus connective tissue fibers joining bones longer
Bones not held as firmly as suture, thus a “give” motion occurs
Examples:
Joint between distal ends of tibia and fibula
Joints in the mid-radius/ulna and the mid-tibia/fibula

5. Cartilaginous Joints Bones united by cartilage
Sight movement is possible—called amphiarthroses (amphi=on both sides)
Two types
Synchondroses
symphyses

6. Synchondroses “together by cartilage”
Held together by hyaline cartilage
Many temporary, eventually replaced by bone
Examples
Area between the epiphyses and the diaphysis of long bones
Certain skull bones
Joint of first ten ribs and the costal cartilage is a permanent synchondroses

7. Symphyses
Aricular surfaces covered with thin layer of hyaline cartilage
A fibrocartilaginous pad separates the bones—the pads (discs) are compressible, serve as shock absorbers
Examples:
Intervertebral discs: pads between adjacent vertebrae
The junction of the pubis bones—pubic synapse
The midline symphysis between the two halves of the mandible

8. Synovial Joints The majority of joints
Freely movable—limited by ligaments, muscles, tendons, or adjoining bones
Referred to as diarthroses=“through joint” indicating only slight limitations to the movement of such joints
Have a fluid-filled joint cavity
Four distinguishing features:
Articular cartilage (thin layer of hyaline cartilage covering surface of bone
Articular capsule (a double-layer membrane surrounding joint)
Synovial membrane (loose connective tissue whose inner surface supplied by capillaries
Synovial fluid (thick fluid that provides nutrients to articular cartilages, lubricates joint)

9. Synovial Joints continued
Synovial joint also may have articular discs or menisci
Articular discs divide synovial cavity into two separate cavities
Examples:
Jaw
Sternoclavicular joint
Distal radioulnar joint
Synovial membranes form two structures that are not actually part of the synovial joint but are associated with them:
Bursae: a small sac lined with synovial membranes. Act as cushions between the structures they separate
Some are subcutaneous—between bone and skin
Most located between tendons and bone
Tendon Sheaths: cylindrical synovial sacs that wrap around tendons, found where tendons cross joints

10. Synovial Joint Movement
Identified by the type of movement they permit
Many have axis of rotation
Uniaxial joints—have only one axis of motion and move on one plane (elbow and knee)
Biaxial joints—have two axes allowing movement in two planes that are at right angles to each other (between tarsals and metatarsals, carpals and metacarpals)
Triaxial joints—more than two axes and move in three planes (hip and shoulder)
General movements: gliding, angular, circumduction, and rotation

11. Gliding Simplest most common type of movement
Surfaces of adjoining bones move back and forth
The articulating surfaces are flat or slightly concave
Examples:
Joint between head of ribs and the bodies of the vertebrae
Joint between the tubercles of the ribs and the transverse processes of the vertebrae
Intercarpal and intertarsal joints

13. Angular Movement Flexion Extension
When a bone is moved in an anterior-posterior plane in a manner as to decrease the angle between in and the adjoining bones
Example: bending the elbow, bringing the thigh up toward the abdomen, bringing the calf of the leg up toward the back of the thigh
Pulling the heel upward, lowering the toe region of the foot is plantar flexion
Extension
Opposite of flexion
Causes the angle between adjoining bones to increase
Occurs when a flexed joint is placed back in its anatomical position
Hyperextension occurs when part is moved beyond a straight position—arching the back or bringing the limbs posteriorly beyond the plane of the body
Raising the toe region toward the shin is called dorsiflexion

14. Angular movement continued
Abduction
When a part is moved away from the midline of the body
Example, moving the fingers away from the midline of the hand
Adduction
The opposite of abduction
When a part is moved toward the midline of the body
Example: moving the fingers toward the midline of the hand
Circumduction
Delineates a cone, the base of the bone is outlined by the movement of the distal end of the bone, with the apex of the cone lying in the articular cavity
Movement combines flexion, abduction, extension, and adduction
Example: shoulder and hip

15. Angular movement continued
Rotation
The motion of a bone around a central axis without any displacement of that axis
If the anterior surface of a bone moves inward, called medial rotation
If the anterior surface turns outward it is lateral rotation
Supination
The outward rotation of the fore-arm, causing the palm to face upward or forward and the radius and ulna to be parallel
Supination occurs when the arms in the anatomical position
Pronation
The inward rotation of the fore-arm, causing the radius to cross diagonally over the ulna and the palm to face downward or backward

16. Angular Movement continued
Special movements
Elevation: raising the part, examples: raising the scapula or mandible
Depression: lowering the part, example: lowering scapula or mandible
Inversion: twisting of the foot so that the sole faces inward with its inner margin raised
Eversion: twisting of the foot so that the sole faces outward with its outer margin raised
Protraction: the motion that moves a part forward, such as the mandible
Retraction: the motion that returns a protracted part to its usual position

17. Types of Synovial Joints
Nonaxial joints
Gliding (arthrodial) joints: formed primarily by the apposition of flat, or only slightly curved, articular surfaces. Movement is allowed in any direction, being llimited only by ligaments or bony processes that surround the articulation. Example: vertebrae and between most carpal and tarsal bones
Uniaxial joints
Hinge (ginglymus) joints: the articular surfaces are shaped such that the only movements possible are flexion and extension. Examples: elbow, knee, and joints between the phalanges
Pivot (trochoid) joints: rotation around the longitudinal axis of the bone. Examples: rotation of atlas around the axis, proximal articulations between the radius and ulna

18. Types of Synovial joints continued
Biaxial Joints
Condyloid (ellipsoid) joints: have one articular surface slightly concave and other slightly convex, movement is allowed in two planes that are at right angles to each other. Flexion, extension, abduction, and adduction can occur at condyloid joints. Circumduction is possible, but axial rotation is not. Examples: between radius and carpals, the occipital condyles of skill and the atlas, metacarpophalangeal and metatrasophalangeal joints
Saddle joints: allow the same movement as the condyloid joints. The articular surface of each bone is concave in one direction and convex in the other; the bones fit together just as two saddles would if the riding surface of one were rotated 90 degrees. Only one saddle joint, the thumb
Triaxial Joints
Spheroid (ball and socket) joints: formed by a spherical head of one bone fitting into a cup-shaped cavity on another. Movement in indefinite number of axes—flexion, extension, abduction, adduction, circumduction, medial and lateral rotation. Only 2—shoulder and hip

19. Clinical Significance of Articulations
Sprains
Result from the twisting or overstretching of a joint causing a ligament to tear or separate from bony attachment---excessive tissue fluid accumulates and causes swelling
Dislocations
Articular surfaces are forcibly displaced
Severe dislocations result in bones and surrounding tendons and ligaments being damaged
Most common in shoulder, thumb, and fingers

20. Clinical Continued Bursitis Tendinitis
When one or more bursae surrounding a joint becomes inflamed
May result from injury, heavy exercise, or infection
Results in discomfort and limiting motion
Tendinitis
The inflammation of tendon sheaths around a joint
Local tenderness at the point of inflammation and severe pain upon movement of joint
Results from trauma to, or excessive use of a joint
Most common in wrist, elbow, or shoulder

22. Clinical continued Slipped Disc
The relatively soft nucleus pulposa within the intervertebral disc is squeezed to the side of the disc
Results from trauma or improper distribution of weight along the vertebral column resulting in poor posture
Causes the disc to protrude and/or rupture—result in severe pain along the path of nerves, numbness, if nerve damage results—weakness and degeneration of muscles

23. Clinical continued Torn Menisci
Sudden changes of direction while bearing body weight can cause the menisci of knee to tear loose
Causes severe pain and swelling of the joint
Arthroscopic surgery repairs damaged menisci
Arthroscope (needlelike viewing instrument ) inserted in the knee
Fiber-optic light allows doc to see injury and small incisions are made to insert cutting instruments
Performed under local anesthesia, patient returns home same day

24. Clinical Continued Arthritis
Pathological changes in the joint membranes, cartilage, and bone cause swelling and pain
Causes of arthritis unknown, but trauma, infection by bacteria (staphylococci, streptococci, and gonococci) and metabolic disorders have been implicated
May be genetically inherited
Types:
Osteoarthritis
Rheumatoid arthritis
Gouty arthritis

25. Osteoarthritis Most common form of arthritis
Chronic inflammation that causes the articular cartilage in the affected joint to degenerate
Causes pain, swelling, and stiffness
As articular cartilage degenerates, bony spurs develop and restrict the movement of the joint

26. Rheumatoid Arthritis Severely damages the joint
Affects principally small joints of the body—hands, feet, knees, ankles, elbows, and wrists
Affects women more than men
Begins with inflammation of the synovial membrane of the joint, swelling and pain occur--Inflamed synovial fluid produces pannus (abnormal tissue that grows over surface of articular cartilage)
Articular cartilage beneath pannus is destroyed, pannus fills joint space and becomes invaded by fibrous tissue—restricts movement
Calcification of pannus may ankylose (fuse) the joint

29. Gouty Arthritis
Gout is characterized by sudden severe pain and swelling of joint
Primarily affects toes, insteps, ankles, heels, knees, and wrists
More common in males
Inherited genetic defect that causes either and increased production of uric acid or a reduction in the ability of the kidney to excrete uric acid
Causes hypouricemia (increase level of uric acid in blood)
Body fluids become supersaturated and result in the formation of sodium urate crystals in the soft tissues of the body as well as joints
Causes inflammation that eventually may erode the articular cartilage and underlying bone—causes intense pain and immobility

31. Effects of Aging
Aging causes a progressive loss of cartilage surface of joints
Called degenerative osteoarthropathy
Varies greatly from individual to individual
Women develop bony swellings (Heberden’s nodes) in terminal phalanges
Men most commonly develop degenerative osteoarthropathy n spine
By age 80, virtually everyone has some degenerative osteoarthropathy of knee and elbow, and to some degree hip and shoulder
Chronic pain and pressure result