Joints By Dr.Chaman Lal (CK)

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Introduction to joint, joint types, factors of joint stability, basic joint movements, terminology used in arthrology

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JOINTS:

By: Dr.Chaman Lal B.S.PT, DPT, Dip. in sports Injuries, MPPS(PAK), PG in Clinical Electroneurophysiology (AKUH), Registered.EEGT (USA), Member of ABRET, AANEM & ASET (USA). JOINTS Federal Institute of Health Sciences, Multan

Study Outlines:

Study Outlines Introduction, Functional classifications, Structural classification, Structures comprising a Synovial joint, Movements of joints, Blood supply of Synovial joints, their nerve supply and lymphatic drainage & Factors responsible for joint stability and Development of joints References 2 Joints By:Chaman Lal FIHS (CK) 1/31/2014

Joints (articulations) :

Joints ( articulations ) Arthron (G. a joint) Junctura (L. a joint) Joint: Joint is a junction between two or more bones or cartilages. It is a place, where parts of skeleton meet It allows varying amounts of mobility It is classified by structure or function. Arthrology : The study of joints is called arthrology. Syndesmology : (G. syndesmos= ligament) It is the study of ligaments and related joints. 3 Joints By:Chaman Lal FIHS (CK) 1/31/2014

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Joints By:Chaman Lal FIHS (CK) 4 A. Structural Classification 1. Fibrous Joints: (a) Sutures (b) Syndesmosis & (c) Gomphosis 2. Cartilaginous Joints: (a) Primary cartilaginous joints or synchondrosis & (b) Secondary cartilaginous joints or symphysis Classification of Joints 1/31/2014

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Joints By:Chaman Lal FIHS (CK) 5 Synovial Joints: Plane joints Pivot or trochoid joints Hinge joints Condylar or bicondylar joints Ellipsoid joints Sellar or saddle joints & Ball-and-socket or spheroidal joints Classification of Joints ….cont’d 1/31/2014

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Fibrous Joints:

Fibrous Joints Joints By:Chaman Lal FIHS (CK) 7 In fibrous joints the bones are joined by fibrous tissue. The joints are either immovable or permit a slight degree of movement. These can be grouped in the following three subtypes. Sutures:- These are peculiar to skull, and are immovable. According to the shape of bony margins, the sutures can be plane, serrate, denticulate, squamous, limobus, and of schindylesis type. 1/31/2014

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Fibrous Joints. . . . Cont’d:

Joints By:Chaman Lal FIHS (CK) 13 2. Syndesmosis:- The bones are connected by the interosseious ligament. Example: Inferior tibiofibular joint Fibrous Joints. . . . Cont’d 1/31/2014

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Joints By:Chaman Lal FIHS (CK) 14 3. Gomophosis:- These are peg and socket joints. Example: Tooth in its socket. It is restricted to the fixation of teeth in their alveolar sockets in the mandible and maxillae. The collagen of the periodontium connects dental cement with alveolar bone. Fibrous Joints. . . . Cont’d 1/31/2014

2. Cartilaginous Joints::

2. Cartilaginous Joints: Joints By:Chaman Lal FIHS (CK) 15 In this type of joints the bones are joined by cartilage. There is no synovial cavity, articulating bones tightly connected by fibrocartilage or hyaline cartilage These are of two types: 1. Primary Cartilaginous Joints: (Synchondrosis, or Hyaline cartilage joints) The bones are united by a plate of hyaline cartilage, so that the joint is immovable and strong. These joints are temporary in nature because after a certain age the cartilaginous plate is replaced by bone (synostosis). 1/31/2014

Cartilaginous Joints. . .cont’d:

Cartilaginous Joints. . .cont’d Joints By:Chaman Lal FIHS (CK) 16 Synostosis: = the union or fusion of adjacent bones by the growth of bony substance, either as a normal process during growth or as the result of ankylosis. Example: Joint between epiphysis and diaphysis of a growing long bone, Shpeno-occipital joint, First chondrosternal joint & Costochondral joints. 1/31/2014

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1/31/2014 Joints By:Chaman Lal FIHS (CK) 19 2. Secondary Cartilaginous Joints : (Symphyses or fibrocartilaginous) The articular surfaces are covered by a thin layer of hyaline cartilage and united by a disc of fibrocartilage. These joints are permanent and persist throughout life. In this respect symphyses menti is a misnomer. Typically the secondary cartilaginous joints occur in the median plane of the body, and permit limited movements due to compressible pad of fibrocartilage and the occasional fluid filled cavities, such as in the pubic and manubriosternal joints. Cartilaginous Joints. . .cont’d

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1/31/2014 Joints By:Chaman Lal FIHS (CK) 20 The thickness of fibrocartilage is directly related to the range of movement. Secondary cartilaginous joints may represent an intermediate stage in evolution of synovial joints. Examples: Symphsis pubis, Manubriosternal joint & Intervertebral joints between the vertebral bodies. Cartilaginous Joints. . .cont’d

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3.Synovial Joints:

3.Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 23 Synovial Joints are most evolved , and, therefore most mobile type of joints. Synovial joints has a fluid-filled cavity between articular surface which are covered by articular cartilage. The fluid is known as synovial fluid, which is form of lymph produced by the synovial membrane.

Synovial Joints. . . . Cont’d:

Synovial Joints. . . . Cont’d 1/31/2014 Joints By:Chaman Lal FIHS (CK) 24 This fluid lines the cavity except for the actual articular surfaces and covers the ligaments or tendons which pass through the joint. Synovial fluid act as a lubricant. The form of the articulating surfaces controls the type of movement which takes place at any joint.

Structure of Synovial Joints:

Structure of Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 25 A). Articular Cartilage   B). Synovial (joint) cavity    C). Articular Capsule   D). Synovial Fluid. E). Reinforcing Ligaments   F). Fatty Pads or Articular Discs G). Bursae H). Tendon Sheath A). Bone & shape of articular surfaces. B). Ligaments C). Muscle Tone Factors Influencing Joint Stability

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1/31/2014 Joints By:Chaman Lal FIHS (CK) 27 1.Bone & shape of articular surfaces: It help in maintaing stability only in firm type of joints, like the hip and ankle. Otherwise in most of the joints (shoulder, knee, sacroiliac etc) their role is negligible. 2. Ligament: are important in preventing any over-movement, and in guarding against sudden accidental stresses. 3.Muscle Tone: The tone of different group of muscles acting on the joint is the most important and indispensable factor in maintaining the stability. Factors Influencing Joint Stability…cont’d

Classification of Synovial Joints & their movements:

Classification of Synovial Joints & their movements 1/31/2014 Joints By:Chaman Lal FIHS (CK) 28 Type of Joint Movement A. Plane or Gliding Type Gliding movement B. Uniaxial Joints 1.Hinge Joint 2.Pivot Joint Flexion & Extension Rotation only C. Biaxial Joints 1.Condylar Joint 2. Ellipsoid Joint D. Multiaxial Joint 1.Saddle Joint 2. Ball& Socket joint Flexion and Extension, and limited rotation Flx, Ext, abd, add, & Circumduction Flx, Ext, abd, add, & conjunct rotation Flx, Ext, abd, add,circumduction &rotation

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Characteristics of Synovial Joints:

Characteristics of Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 30 1. Articular surface is covered by hyaline cartilage & sometimes by fibrocartilage. Synovial fluid circulates in the joint cavity to lubricate and nourish the articulating surfaces. Viscosity of fluid is due to hyaluronic acid. The joint cavity may be partially or completely subdivided by an articular disc or meniscus. Joint is surrounded by an articular capsule which is made up of fibrous capsule and sensitive to stretch. Varying degrees of movements are always permitted by synovial joints.

1.Plane Synovial Joints:

1.Plane Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 31 Articular surfaces are more less flat (Plane). They permit gliding movements (translations) in various directions. Plane joints are appositions of almost flat surfaces. Examples: a) Intercarpal joints b) Intertarsal joints c) Joints between articular processes of vertebrae etc.

2. Ginglymi or Hinge Joints:

2. Ginglymi or Hinge Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 32 Articular surfaces are pulley shaped. There are strong collateral ligaments. Movements, are permitted in one plane around and transverse axis. Examples: Elbow joint Ankle joint and Interphalangeal joints.

3. Pivot (Trochoid) Joints:

3. Pivot (Trochoid) Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 33 Articular surfaces comprise a central bony pivot (peg) surrounded by an osteoligamentous ring. Movements are permitted in one plane around a vertical axis. Example: Superior and inferior radio-ulnar joints, Median atlanto-axial joints

4.Condylar (Bicondylar)Joints:

4.Condylar (Bicondylar)Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 34 Articular surfaces include two distinct condyles (convex male surfaces) fitting into reciprocally concave female surfaces (which are also sometimes, known as condyles, such as tibia). These joints permit movements mainly in one plane around a transverse axis, but partly in another plane (rotation) around a vertical axis.

Condylar (Bicondylar)Joints….cont’d:

Condylar (Bicondylar)Joints….cont’d 1/31/2014 Joints By:Chaman Lal FIHS (CK) 35 Example: Knee joint and Right and left jaw joints etc

5.Elliospoid Joints:

5.Elliospoid Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 36 Articular surfaces include an oval, convex, male surface fitting into an elliptical, concave female surface. Example: Wrist Joint Metacarpophalangeal joints & Atlanto-occipital joints

6.Saddle (Sellar) Joints:

6.Saddle (Sellar) Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 37 Articular surfaces are reciprocally concavo-convex. Movements are similar to those permitted by an ellipsoid joint, with addition of some rotation (conjunct rotation) around a third axis which, however, cannot occur independently. Examples: 1 st carpometacarpal joint Sternoclavicular joint & Calcaneocuboid joint.

7.Ball & Socket joint (Spheroidal):

7.Ball & Socket joint (Spheroidal) 1/31/2014 Joints By:Chaman Lal FIHS (CK) 38 Articular surfaces include a globular head (male surface) fitting into a cup-shaped socket (female surface). Movements occur around an indefinite number of axes, which have one common center. Examples: Shoulder joint, Hip joint, Talo-calcaneonavicular joint.

B. Functional Classification:

B. Functional Classification 1/31/2014 Joints By:Chaman Lal FIHS (CK) 39 Functional classification of joint is actually based upon degree of mobility of the joint. There are 3 types of joints according to their functional classification. Synarthroses (Immovable) Amphiarthroses Diarthroses or synovial joints

1.Synarthroses:

1.Synarthroses 1/31/2014 Joints By:Chaman Lal FIHS (CK) 40 These are fixed joints and immovable. The articular surfaces are joined by tough fibrous tissue. Often the edges of the bones are dovetailed into one another as in the sutures of the skull.

2.Amphiarthorses:

2.Amphiarthorses 1/31/2014 Joints By:Chaman Lal FIHS (CK) 41 These allow some movement. A pad of cartilage lies between the bone surfaces, and there is a fibrous capsule to hold the bones and cartilage in place. The cartilages of such joints also act as shock absorbers e.g. the intervertebral discs between the bodies of the vertebrae, where the cartilage is strengthened by extra collagen fibers.

3.Diarthorses or synovial joints:

3.Diarthorses or synovial joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 42 These are known as freely movable joints, though at some of them the movement is restricted by the shape of the articulating surfaces and by the ligament which hold the bones together. These ligaments are of elastic connective tissue. -e.g. Knee joint, shoulder joint, etc

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C. Regional Classification of the Joints:

C. Regional Classification of the Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 44 On regional basis joints are classified as under 3 types; Skull type: Immovable. Vertebral type: Slightly movable Limb type: Freely movable

Movements & Mechanism of Joints:

Movements & Mechanism of Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 45 Angular movement: Movement leading to diminution or increase in angle between two adjoining bones. - Flexion: Decreasing the angle between two bones. - Extension: Increasing the angle between two bones - Abduction: Moving the part away from mid-line. - Adduction: Bringing the part towards the mid-line.

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1/31/2014 Joints By:Chaman Lal FIHS (CK) 46 2. Rotary: -Rotation: Turing upon an axis. - Adjunct rotation: Independent rotations -Conjunct rotation: Rotation which accompany other movements -Circumduction: Moving the Extremity of the part round in a circle so that the whole part inscribes a cone. 3. Gliding: One part slides on another. All synovial joints are diarthroses (freely movable) Synovial Joints. . . . Cont’d

Shape of Articular Surface:

Shape of Articular Surface 1/31/2014 Joints By:Chaman Lal FIHS (CK) 47 The common articular surface shapes are: A) Ovoid: When concave- female ovoids When convex- male ovoids B) Sellar/Saddle shaped: These are convex in one plane, concave in the perpendicular plane

Mechanical Axis of a Bone & movement of a Bone:

Mechanical Axis of a Bone & movement of a Bone 1/31/2014 Joints By:Chaman Lal FIHS (CK) 48 Mechanical Axis of Bone: It is reference point around which joint mechanics can be studies and around which the most habitual conjunct rotation occurs. Spin Simple rotation around the bone’s stationary mechanical axis. Swing: Any other displacement of the bone and its mechanical axis apart from spin is termed a swing. Swing may be pure or impure (swing+element of spin)

Cont’d. . . :

Cont’d. . . 1/31/2014 Joints By:Chaman Lal FIHS (CK) 49 Ovoid Motion: This represents the imaginary surface which would include all possible paths of a point on the mechanical axis at some distance from its related joint. Cardinal Swing: When the mechanical axis moves in the shortest pathway along with the bony movement. Arcuate Swing: When the mechanical axis moves in the longest pathway with the bony movement. Co-spin: When the effect of adjunct rotation is additive to the rotation. Anti-spin: Adjunct rotation which has a nullifying effect on rotation.

Cont’d. . . :

1/31/2014 Joints By:Chaman Lal FIHS (CK) 50 Human Kinesiology: Study of geometry of surfaces & their associated movements is called Kinesiology. Male Surface: An articulating surface which is larger in surface area and always convex in all directions. Female Surface: An articulating surface which is smaller and concave in all directions. Simple Joints: Joints with only two articulating surfaces, i.e., male and female. Compound Joints: Joint possessing more than one pair of articulating surfaces. Degrees of freedom: Number of axes at which the bone in a joint can move. Cont’d. . .

Cont’d. . . :

1/31/2014 Joints By:Chaman Lal FIHS (CK) 51 Uni-axial: Movement of bone at a joint is limited to one axis i.e., with one degree freedom. Biaxial: With two degrees of freedom. Multi-axial: Three axis along with intermediate positions also. Translation: Sliding movements of one articulating surface over the other. Cont’d. . .

Joint Positions:

Joint Positions 1/31/2014 Joints By:Chaman Lal FIHS (CK) 52 Closed Packed Position: When the joint surfaces become completely congruent, their area of contact is maximal and they are tightly compressed. In this position fibrous capsule and ligaments are maximally spiralized and tense; No further movement is possible ; Surfaces can not be separated by disruptive forces; Articular surfaces are liable to trauma, e.g., Shoulder  abduction +lateral rotation: Hip  extension+medial rotation; Knee full extension; Ankle  dorsiflexion

Joint Positions….cont’d:

1/31/2014 Joints By:Chaman Lal FIHS (CK) 53 Loose Packed Position: All other position s of incongruencey, e.g., least packed position. e.g., Shoulder  semiabduction, Hip Semiflexion, Knee Semiflexion Ankle Ventral Position Limitation of Movement (Factors) -Reflex contraction of antagonistic m/s -Due to stimulations of mechanoreceptors in articular tissue, -Ligaments tension, -Approximation of soft parts Joint Positions….cont’d

Mechanism of Lubrication of A Synovial Joints:

Mechanism of Lubrication of A Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 54 1. Synovial Fluid: It is secreted by synovial membrane, is sticky and viscous due to hyaluronic acid (a mucopolysaccharide). It serve the main function of lubrication of the joint. 2.Hyaline Cartilage: It covers the articular surface and provides the slippery surface to reduce the friction.

Cont’d….:

Cont’d…. 1/31/2014 Joints By:Chaman Lal FIHS (CK) 55 3.Intra-articular Fibrocartilages: Articular discs or menisci, complete or incomplete, help in spreading the synovial fluid through the joint cavity, but particularly between the articular surfaces. 4.Haversian Fatty Pads(Haversian Glands): These occupy extra spaces in the joint cavity between the incongruous bony surfaces and perhaps function as swabs to spread the synovial fluid.

Blood Supply of the Synovial Joints:

Blood Supply of the Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 56 The articular and epiphyseal branches given off bye the neighboring arties form a periarticular arterial plexus. Numerous vessels from this plexus pierce the fibrous capsule and form a rich vascular plexus in the deeper parts of the synovial membrane. Circulus vasculosu(Circulus articularis vasculosus) is a looped anastomoses formed bye the blood vessels of the synovial membrane around the articular margins

Nerve Supply of the Synovial Joints:

Nerve Supply of the Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 57 1.The capsule and ligaments possess a rich nerve supply while synovial membrane has a poor nerve supply and relatively insensitive to pain. 2.The articular cartilage is non-nervous and totally insensitive. 3.Articular nerves contains sensory and autonomic fibers.

Nerve Supply of the Synovial Joints…cont’d:

1/31/2014 Joints By:Chaman Lal FIHS (CK) 58 4.Hilton’s Law: (Hilton 1891) It states that a motor nerve to the muscle acting on joint tends to give a branch to that joint (capsule) and another branch to the skin covering the joint. Gardner (1928) further elucidated that each nerve innervates a specific region of the capsule, and that the part of the capsule which is rendered taut by a given muscle is innervated by the nerve supplying its antagonists. Thus the pattern of innervations is concerned with the maintenance of an efficient stability at the joint. Nerve Supply of the Synovial Joints…cont’d

Lymphatic Drainage of Synovial Joints:

Lymphatic Drainage of Synovial Joints 1/31/2014 Joints By:Chaman Lal FIHS (CK) 59 Lymphatic form a plexus in the subintima of synovial membrane, and drain along the blood vessels to the regional deep nodes. Applied Anatomy: -Dislocation of joint -Sprain -Arthritis -Stiffness of joints related to weather -Neuropathic Joint

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