Joints!Joints! 3 types of joints if we classify by function 3 types of joints if we classify by function

(i.e., by the degree of movement (i.e., by the degree of movement possible):possible):

1.1. Diarthroses (Synovial)Diarthroses (Synovial) Freely moveable jointsFreely moveable joints Shoulder, knee, hip, elbow, interphalangeal, tarsal, Shoulder, knee, hip, elbow, interphalangeal, tarsal,

and carpal jointsand carpal joints

2.2. Amphiarthroses (Cartilaginous) Amphi-slightlyAmphiarthroses (Cartilaginous) Amphi-slightly Slightly moveable jointsSlightly moveable joints Intervertebral discs, costosternal joints, pubic Intervertebral discs, costosternal joints, pubic

symphysissymphysis

3.3. Synarthroses (Fibrous) Syn--togetherSynarthroses (Fibrous) Syn--together Joints with little or no movement Joints with little or no movement Skull sutures, teeth in sockets, 1Skull sutures, teeth in sockets, 1stst costosternal joint. costosternal joint.

Joint ClassificationJoint Classification We can also classify We can also classify

joints by structure:joints by structure:

1.1. Synovial jointsSynovial joints:: Bones separated by Bones separated by

a joint cavity; a joint cavity; lubricated by lubricated by synovial fluid; synovial fluid; enclosed in a enclosed in a fibrous joint fibrous joint capsule.capsule.

Shoulder, hip, Shoulder, hip, elbow, knee, carpal, elbow, knee, carpal, interphalangealinterphalangeal

How would we classify these joints functionally?

Joint ClassificationJoint Classification2.2. Fibrous jointsFibrous joints::

Bones held Bones held together by together by collagenous fibers collagenous fibers extending from the extending from the matrix of one bone matrix of one bone into the matrix of into the matrix of the next.the next.

No joint cavityNo joint cavity Little or no Little or no

movement occurs movement occurs between bonesbetween bones

Skull sutures, teeth Skull sutures, teeth joints, distal joints, distal radioulnar joints & radioulnar joints & tibiofibular jointstibiofibular joints

Types of Fibrous JointsTypes of Fibrous JointsThere areThere are three three types of fibrous joint:types of fibrous joint: SuturesSutures—very tight articulations between —very tight articulations between

adjacent bones. Only found in the skull.adjacent bones. Only found in the skull. SyndesmosisSyndesmosis—the bones are held together —the bones are held together

by strong, fibrous connective tissue. Bones by strong, fibrous connective tissue. Bones may be held together by ligaments or may be held together by ligaments or interosseous membranes. Very little interosseous membranes. Very little movement is possible.movement is possible.

GomphosisGomphosis—a unique peg-and-socket joint at —a unique peg-and-socket joint at which no movement occurs. Only found which no movement occurs. Only found between the permanent teeth and the maxilla.between the permanent teeth and the maxilla.

Joint ClassificationsJoint Classifications3.3. Cartilaginous jointsCartilaginous joints::

Bones held together by cartilage; no joint cavityBones held together by cartilage; no joint cavity Epiphyseal plates of long bones, costosternal Epiphyseal plates of long bones, costosternal

joints, joints, pubic symphysispubic symphysis, intervertebral discs, intervertebral discs

Types of Cartilaginous Types of Cartilaginous JointsJoints

There are two types of cartilalaginous joints:There are two types of cartilalaginous joints:1. Symphysis—Examples include the 1. Symphysis—Examples include the

intervertebral discs and the symphysis pubis.intervertebral discs and the symphysis pubis.

2. Synchondrosis—Examples include the 2. Synchondrosis—Examples include the epiphyseal growth plate in a long bone.epiphyseal growth plate in a long bone.

Herniated DiscHerniated Disc

Disc Surgery Herniated - Learn about Herniated Disc Surgery

YouTube - Back Surgery for Disc Herniation

Structure and FunctionStructure and Function Joints are Joints are

designed for their designed for their function.function.

Let’s look at Let’s look at sutures as our 1sutures as our 1stst example:example: What function What function

do you suppose do you suppose sutures are sutures are designed for?designed for?

Structure and FunctionStructure and Function Let’s look at some symphyses.Let’s look at some symphyses.

What kind of joint is a symphysis? What kind of What kind of joint is a symphysis? What kind of movement is possible?movement is possible?

Name a symphysis! (Name a symphysis! (an obvious one is in the picturean obvious one is in the picture)) What connects the bones in these joints?What connects the bones in these joints?

Structure and FunctionStructure and Function Now let’s talk about Now let’s talk about

synovial joints.synovial joints. How do they differ How do they differ

from the previous 2?from the previous 2? 5 main structural 5 main structural

characteristics:characteristics:

1.1. Articular cartilageArticular cartilage What kind of What kind of

cartilage is it? (cartilage is it? (H _ H _ _ _ _ _ _ _ _ _ _ _ ))

Where do we find Where do we find it? it?

What does it do?What does it do?

Structure and FunctionStructure and Function2.2. Articular capsuleArticular capsule

2 layered. Surrounds both 2 layered. Surrounds both articular cartilages and the articular cartilages and the space btwn them.space btwn them.

External layer is made of External layer is made of dense irregular CT & is dense irregular CT & is continuous w/ the perisoteum.continuous w/ the perisoteum.

Inner layer is a synovial Inner layer is a synovial membrane made of loose membrane made of loose connective tissue.connective tissue. It covers all internal joint surfaces It covers all internal joint surfaces

except for those areas covered except for those areas covered by the articular cartilage.by the articular cartilage.

Structure and FunctionStructure and Function3.3. JointJoint (Synovial) Cavity(Synovial) Cavity

The potential space within The potential space within the joint capsule and the joint capsule and articular cartilagearticular cartilage

4.4. Synovial FluidSynovial Fluid A small amount of slippery A small amount of slippery

fluid occupying all free fluid occupying all free space w/i the joint capsulespace w/i the joint capsule

Formed by filtration of Formed by filtration of blood flowing through blood flowing through capillaries in the synovial capillaries in the synovial membranemembrane

Synovial fluid becomes Synovial fluid becomes less viscous as joint less viscous as joint activity increases. activity increases.

Structure and Structure and FunctionFunction

5.5. ReinforcingReinforcing LigamentsLigaments

What kind of tissue What kind of tissue are they?are they?

What do you What do you suppose their suppose their function is?function is?

Double-jointed-Double-jointed-ness results from ness results from extra-stretchy extra-stretchy ligaments and joint ligaments and joint capsules. Is this capsules. Is this necessarily a good necessarily a good thing?thing?

Other Synovial StructuresOther Synovial Structures The knee and hip joints The knee and hip joints

have cushioning fatty pads have cushioning fatty pads btwn the fibrous capsule btwn the fibrous capsule and the synovial membrane and the synovial membrane or bone.or bone.

Discs of fibrocartilage (i.e., Discs of fibrocartilage (i.e., meniscimenisci) which improve the ) which improve the fit btwn bone ends, thus fit btwn bone ends, thus stabilizing the joint.stabilizing the joint. Found in the knee, jaw, and Found in the knee, jaw, and

sternoclavicular joint.sternoclavicular joint. BursaeBursae are basically bags are basically bags

of lubricant - fibrous of lubricant - fibrous membrane bags filled w/ membrane bags filled w/ synovial fluid. Often found synovial fluid. Often found where bones, muscles, where bones, muscles, tendons, or ligaments rub tendons, or ligaments rub together.together.

Synovial JointsSynovial Joints

YouTube - Types of Synovial Joints

Types of Synovial Types of Synovial JointsJoints1.1. PlanePlane jointsjoints

Articular surfaces are flat and Articular surfaces are flat and allow short slipping or allow short slipping or gliding movements.gliding movements.

Intercarpal and intertarsal Intercarpal and intertarsal jointsjoints

2.2. Hinge jointsHinge joints A cylindrical projection of A cylindrical projection of

one bone fits into a trough-one bone fits into a trough-shaped surface on another shaped surface on another (like a hotdog in a bun)(like a hotdog in a bun)

Movement resembles a door Movement resembles a door hinge.hinge.

Elbow joint – ulna and Elbow joint – ulna and humerus; Interphalangeal humerus; Interphalangeal joints joints

Type of Synovial Type of Synovial JointsJoints

3.3. Pivot jointsPivot joints Rounded end of one bone Rounded end of one bone

protrudes into a ring protrudes into a ring formed by another bone or formed by another bone or by ligaments of that bone.by ligaments of that bone.

Proximal radioulnar jointProximal radioulnar joint Atlas-axial jointAtlas-axial joint

4.4. Condyloid jointsCondyloid joints Oval articular surface of Oval articular surface of

one bone fits into a one bone fits into a complementary depression complementary depression on another.on another.

Radiocarpal jointsRadiocarpal joints Metacarpophalangeal Metacarpophalangeal

jointsjoints

Types of Types of Synovial JointsSynovial Joints5.5. Saddle jointsSaddle joints

Each articular surface has Each articular surface has convex and concave areas. convex and concave areas. Each articular surface is saddle-Each articular surface is saddle-shaped.shaped.

Carpometacarpal joints of the Carpometacarpal joints of the thumbs.thumbs.

6.6. Ball-and-Socket jointsBall-and-Socket joints Spherical or semi-spherical head Spherical or semi-spherical head

of one bone articulates with the of one bone articulates with the cuplike socket of another.cuplike socket of another.

Allow for much freedom of Allow for much freedom of motion.motion.

Shoulder and hip joints.Shoulder and hip joints.

The KneeThe Knee Largest and most complex Largest and most complex

diarthrosis in the body.diarthrosis in the body. Primarily a hinge joint, but Primarily a hinge joint, but

when the knee is flexed, it is when the knee is flexed, it is also capable of slight also capable of slight rotation and lateral gliding.rotation and lateral gliding.

Actually consists of 3 joints:Actually consists of 3 joints: Patellofemoral jointPatellofemoral joint Medial and lateral Medial and lateral

tibiofemoral jointstibiofemoral joints The joint cavity is only The joint cavity is only

partially enclosed by a partially enclosed by a capsule – on the medial, capsule – on the medial, lateral, and posterior sides.lateral, and posterior sides.

The KneeThe Knee The lateral and medial The lateral and medial

condyles of the femur condyles of the femur articulate with the articulate with the lateral and medial lateral and medial condyles of the tibia. condyles of the tibia. Between these Between these

structures, we have the structures, we have the lateral and medial lateral and medial menisci.menisci.

Anteriorly, the patellar Anteriorly, the patellar ligament binds the ligament binds the tibia to the inferior tibia to the inferior portion of the patella. portion of the patella. The superior portion The superior portion of the patella is then of the patella is then connected to the connected to the quadriceps femoris quadriceps femoris musclemuscle

The KneeThe Knee At least a dozen At least a dozen

bursae are bursae are associated with the associated with the knee.knee.

Multiple ligaments Multiple ligaments are present.are present. The The fibular collateral fibular collateral

ligamentligament extends extends from the lateral from the lateral epicondyle of the epicondyle of the femur to the head of femur to the head of the fibula. the fibula.

The The tibial collateral tibial collateral ligamentligament connects connects medial epicondyle of medial epicondyle of the femur to the the femur to the medial condyle of the medial condyle of the tibial shaft and is tibial shaft and is also fused to the also fused to the medial meniscus.medial meniscus.

Both of these Both of these ligaments prevent ligaments prevent excessive rotationexcessive rotation

The KneeThe Knee The The anterior and anterior and

posterior cruciate posterior cruciate ligamentsligaments are also very are also very important.important. ACL connects the ACL connects the anterioranterior

intercondylar area of the intercondylar area of the tibia to the medial side of tibia to the medial side of the lateral femoral condyle.the lateral femoral condyle. Prevents forward sliding of Prevents forward sliding of

the tibia and the tibia and hyperextension of the knee.hyperextension of the knee.

PCL connects the PCL connects the posteriorposterior intercondylar area of the intercondylar area of the tibia to the lateral side of tibia to the lateral side of the medial femoral the medial femoral condyle.condyle. Prevents backward Prevents backward

displacement of the tibia or displacement of the tibia or forward sliding of the femur.forward sliding of the femur.

Clinical Conditions ArthritisArthritis describes about describes about

100 different types of 100 different types of inflammatory or inflammatory or degenerative joint degenerative joint diseases.diseases.

OsteoarthritisOsteoarthritis Most common arthritis. Most common arthritis. Normal joint use prompts Normal joint use prompts

the release of cartilage-the release of cartilage-damaging enzymes. If damaging enzymes. If cartilage destruction cartilage destruction exceeds cartilage exceeds cartilage replacement, we’re left with replacement, we’re left with roughened, cracked, eroded roughened, cracked, eroded cartilages. cartilages.

Eventually bone tissue Eventually bone tissue thickens and forms spurs thickens and forms spurs that can restrict movement.that can restrict movement.

Most common in C and L Most common in C and L spine, fingers, knuckles, spine, fingers, knuckles, knees, and hips.knees, and hips.

Clinical Conditions

Rheumatoid arthritisRheumatoid arthritis Chronic inflammatory Chronic inflammatory

disorderdisorder Marked by flare-upsMarked by flare-ups Autoimmune disease.Autoimmune disease.

Body creates antibodies Body creates antibodies which attack the joint which attack the joint surfacessurfaces

The synovial membrane can The synovial membrane can inflame and eventually inflame and eventually thicken into a thicken into a pannuspannus – an – an abnormal tissue that clings abnormal tissue that clings to the articular cartilage.to the articular cartilage.

The pannus erodes the The pannus erodes the cartilage and eventually cartilage and eventually scar tissue forms and scar tissue forms and connects the 2 bone ends. connects the 2 bone ends. This scar tissue can later This scar tissue can later ossify, fusing the bones ossify, fusing the bones together. This is known as together. This is known as ankylosisankylosis..

Gouty arthritisGouty arthritis When nucleic acids are metabolized When nucleic acids are metabolized

uric acid is produced. Normally uric uric acid is produced. Normally uric acid is excreted in the urine.acid is excreted in the urine.

If blood [uric acid] rises due to If blood [uric acid] rises due to decreased excretion or increased decreased excretion or increased production, it may begin to form production, it may begin to form needle-shaped crystals in the soft needle-shaped crystals in the soft tissues of joints.tissues of joints.

Inflammation ensues causing painful Inflammation ensues causing painful arthritis.arthritis.

Clinical Conditions

Gout Risk FactorsGout Risk FactorsRisk factors for developing gout include obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics (hydrochlorothiazide [Dyazide]), low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric-acid levels in the blood and lead to gout. Furthermore, certain diseases lead to excessive production of uric acid in the body. Examples of these diseases include leukemias, lymphomas, and hemoglobin disorders.

BursitisBursitisBursitis is the painful inflammation or irritation of the bursa. The bursa is a soft, fluid-filled sac that covers and cushions the movement between the bones, tendons and muscles near the joints.

Bursitis usually occurs under the shoulder muscles, at the elbows (called epitrochlear bursitis or "tennis elbow"), the hip sockets (called trochanteric bursitis), heel bones (called retrocalcaneal bursitis) or the kneecaps (called infrapatellar bursitis or "housemaid's knee"). It can also occur in the buttocks (called ischiogluteal bursitis) or the thigh (called trochanteric bursitis).

BuristisBuristis

http://www.livestrong.com/video/1662-http://www.livestrong.com/video/1662-bursitis-health-byte/bursitis-health-byte/

Causes of BursitisCauses of BursitisMost commonly, bursitis is caused by trauma, infection, and crystal deposits. Some specific factors include: Overuse or injury to the joint areas from playing or working

Incorrect posture at work or rest, or poor conditioning before exercise or playing sports

An abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a particular joint) that stresses soft tissue structures.

Sometimes in association with other diseases or conditions, such as rheumatoid arthritis, gout, tuberculosis or psoriatic arthritis

Staphylococcal or other (bacterial) infection

Symptoms of BursitisSymptoms of Bursitis

Symptoms of bursitis may include:

Pain that increases with movement of joint

Tenderness of joint

Limited movement in the affected areas Swelling and redness in affected areas

Treatments of BursitisTreatments of BursitisTreatment for bursitis includes applying the R.I.C.E therapy, protecting the area, and anti-inflammatory drugs.

It can help to protect bursae close to the skin, such as the ankles and knees, with padding. Additionally, deep-heat therapy (diathermy) can also relieve the discomfort and inflammation of bursitis.

Anti-inflammatory medications, such as aspirin or over-the-counter nonsteroidal drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin can often be helpful. If the cause of the bursitis is bacterial, antibiotics will be administered.

If the inflammation does not respond to the R.I.C.E. therapy and medications, surgical drainage (aspiration) of fluid from the bursa and the injection of corticosteroids into the bursa is an alternative treatment.

Surgical removal of the bursa is a possibility for chronic bursitis.

With adherence to treatment, bursitis usually subside in seven to 14 days.