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ARTICULAR SYSTEM
- Made up of joints including associated ligaments
- Bones and/or cartilages meet at joints
Types of joints
Primary Cartilaginous Joints
Secondary Cartilaginous
Joints
Unpaired, located exclusively in
the midline
Bi-axial
Pair of movements
2 axes (perpendicular)
Hinge:
Flexion/extension
Condylar (fingers/toes),
ellipsoid (wrist), saddle
Multi-axial
2 pairs of movements
2 horizontal axes
perpendicular to each
other
Ball and socket joints
Pivot: Rotation
(thumb)
Compound
More than 1 pair:
Elbow, knee
Complex
Multiple
compartments
Complete partition by
fibrocartilage disc,
incomplete by
menisci
Sellar
Concave in one direction and
convex on the other
Non-bony and articular
In hip and ankle, proximal
radioulnar
Ligaments can have articular
surface lined with cartilage
Discs and menisci are articular
Joint degeneration
Due to overuse and ageing
Articular cartilage becomes progressively thinner
Seen as narrowing of radiological joint space
Bony articular surfaces come into closer proximity
Contact results in severe pain due to exposure of sensory
nerve supply
Osteophyte formation
Due to degenerative arthritis
Proliferation of exposed bone with rich blood supply
Decreases joint mobility, may cause bony fusion
Encroachment (intrude) on adjacent structures (Spinal canal
or intervertebral foramen)
Description
Encloses a synovial joint, defining its boundary
A dense connective tissue made up of collagen fibres
Aka Capsular Ligament
Intracapsular: Structures that are within the joint
Reinforced
o By ligaments
o By muscle attachments at particular sites
May have deficiencies
o To allow exit for an intracapsular tendon, or
o For bursa to communicate with joint cavity
Attachments of fibrous capsule
Capsule attaches to articular margins, where collagen fibres
merge with those of periosteum
Capsule may attach to ligament rather than bone
Ligament: Bone to bone
Tendon: Muscle to bone
Elbow joint
o Radius rotation permitted due to merging with annular
ligament of proximal radioulnar joint
o Allows mobility but contributes to stability
Migration of capsule from epiphysial plate
Initially attached to periphery (Outer) of epiphyseal plate
Can migrate towards, or away from articular margin
Synovial cavity
Defined as the space within the interior of a joint
Most joints have a single, discrete joint cavity
Can be partly or completely subdivided compartments
More than one joint can share the same cavity (elbow with
proximal radioulnar joint)
Synovial membrane
A serous membrane with a layer of flattened cells
(mesothelium) on a thin bed of loose CT
Highly vascular, can have folds or fringes
Secretes fluid into joint cavity
Lines internal surface of capsule and all non-articular
structures on the interior of a synovial joint
Characteristics
o Extremely delicate
o Does not extend over articular cartilage
o Covers periosteum
Synovial fluid
Less than 1ml in joint
Provides
o Barrier between articular apposing cartilage surfaces
o Nutrition for articular cartilage
o Acts as an adaptable lubricant for articular cartilage
Viscosity decreases with increased loading, minimising friction
Synovial Effusion
Accumulation of synovial fluid
Due to irritation of synovial
membrane
- Causes increased blood supply
due to vessel dilation
- Leads to increase in synovial
fluid secretion
Joint swelling
Haemarthrosis
Accumulation of blood in
synovial cavity
Due to severe trauma, where
structures lined with synovial
membrane are torn.
Can occur with minimal trauma
in haemophiliac
Joint swelling that is warm to the
touch
Joint swelling
Introduction of microbes into synovial cavity
Causes accumulation of pus
May lead to permanent joint destruction due to erosion of
articular surfaces
Loose body
Loose body from fragment of articular cartilage can survive in
joint cavity
o Due to nutrition it receives from synovial fluid
Can cause locking of joint
o If loose body is trapped between articular surfaces
o Interference with movement is episodic
LIGAMENTS
- Fibrous connections between bones
- Within a joint or between two joints acting as a functional
unit
- Positioned along the axis of movement
Structu
re
Elastic
Large number
of yellow
elastic fibres
Ability
Stretch and
recoil, not
injury prone
Charact
eristic
Poor nerve
supply
Exampl
e
Ligamenta
flava of
vertebral
column
Intrinsic
Thickening
s of fibrous
capsule of
synovial
joint
Reinforce
capsule
Extrinsic
Can be
extracapsula
r or
intracapsular
Contribute to
stability w/o
impeding
mobility
Separate
from capsule
Cruciate
ligaments at
knee joint
Collateral
Blend with
joint capsule,
forming
intrinsic
ligaments
Prevent
unwanted
side-to-side
movement
Located on
medical and
lateral sides
of hinge joints
Hinge joints
(Knee) allow
some rotation
Accessory
Extrinsic
ligaments of a
joint, located a
distance from it
Function with
the associated
joint despite
distance
Spine
(vertebral
arches and
bodies),
clavicle,
interosseus
membrane of
forearm and
leg
Labrum
Deepens the socket of a ball and socket joint
Made of fibrocartilage
No synovial membrane cover
Avascular
Menisci and Disc
Made of fibrocartilage
No synovial membrane (Are articular)
Assist with spreading synovial fluid
Thicker at periphery where they attach to fibrous capsule.
Receives vascular supply here
Central part of structure is avascular, receiving nutrition from
synovial fluid
Resists compression and may be weight bearing
Disc: Subdivides a synovial cavity (Sternoclavicular and
temporomandibular)
Menisci: Partial subdivision (Knee)
Labrum/menisci tears
Labrum does not heal due to avascularity
Disc/menisci tend not to heal except at periphery, where they
have a vascular supply
o If trapped between bony condyles, it may split
longitudinally
o Dislodged fragment: survive as loose body in joint cavity
Intracapsular tendon
Tendon: Fibrous band which is part of muscle Connects
fleshy part of muscle to bony attachment
Tendons that leaves a joint through a defect in fibrous capsule
Tendon is covered by synovial membrane when it is
intracapsular
Found in shoulders/knee Contributes to shoulder stability
and enables rotation that unlocks the knee joint
Bursae
Fluid sacs that aid mobility
Double fold of serous membrane interposed between
structures that rub together, reducing friction
Bursae can communicate via deficiency in fibrous capsule
Synovial fluid may pass between synovial cavity and its
communicating bursae
Bursitis
o Trauma/infection of a bursae may result in inflammation
o Accumulation of synovial fluid, blood or pus can occur
Joint cavity communication
Fat Pad
Intracapsular but extra-synovial
Fill unoccupied space in a joint
Absorb compressive forces between bones
Contribute to spread of synovial fluid Acts as swab and
creates extra folds of synovial membrane, increasing surface
area
Pinched fat pad
o Refers to trapped fat pad between bony surface
o Cause pain and synovial effusion
Passive/active movements
Passive: Movement occurs not due to contraction of
associated muscles (Gravity)
Pairs of movements
- Determined by shape of articular surfaces
Flexion
Abductio Medial
Planta
Inversio
n
rotation Flexion
n
Extensio
Adduction Lateral
Dorsiflexio Eversion
n
rotation
n
Roll (like a wheel)
Spin
(top)
- Another type of movement: Slide (ski)
Pronatio
n
Supinatio
n
Underlying Bone
Articular surfaces receive pain fibres
Pain fibres are protected from exposure/pressure by overlying
hyaline articular cartilage (aneural)
Degenerative Arthritis
o Lead to progressive exposure of underlying bone,
resulting in severe pain during movement/weight
bearing
Innervated capsule and ligaments
Main fibrous tissue elements of joints (capsule and ligaments)
receive rich supply of proprioceptive fibres
Conveys deep somatic sensation (Stretch and joint position)
Receive rich supply of pain fibres, together with periosteum
Capsular/Ligamentous injury
o Painful, results in significant loss of proprioception
o Particularly joint position sense
o Predisposes to future injury by impairment in both
voluntary and reflex control of muscles contributing to
joint stability
Articular branches of nerves (???)
Nerves supplying muscles that produce movements at a joint
also supply the joint
Stretched capsule leads to increased contraction of overlying
flexor muscle group
Stretched capsule on opposite aspect of joint leads to
increased contraction of its overlying extensor muscle group
Vascular synovium and bone
Synovial membrane and bone beneath articular surfaces
receive a rich blood supply
Numerous vascular foramina located all over bone, except
articular avascular surface (hyaline cartilage No blood
vessels, lymph vessels, or nerve fibres)
o Receives nutrition from synovial fluid