Chapter 9: Articulations

Functional Classifications
Synarthrosis:
no movement

Amphiarthrosis:
little movement

Diarthrosis:
more movement

Functional Classification

Table 91

Structural Classifications
Bony Fibrous Cartilaginous Synovial

Structural Classification

Table 92

4 Types of Synarthrotic Joints

Sutures - bound by dense fibrous connective tissue; found only in skull Gomphosis - binds teeth to sockets (periodontal ligament) Synchondrosis - epiphyseal cartilage of long bones & b/t vertebrosternal ribs and sternum
Synostosis - fused bones, epiphyseal lines of long bones

2 Types of Amphiarthroses
Syndesmosis:
bones connected by ligaments

Symphysis:
bones separated by fibrocartilage

Synovial Joints (Diarthroses)

Also called freely moveable joints Lined with synovial membrane Articular cartilages (hyaline) pad articulating surfaces within articular capsules & prevent bones from touching Smooth surfaces lubricated by synovial fluid

Functions of Synovial Fluid

1. Lubrication 2. Nutrient distribution 3. Shock absorption

Synovial Joints: Accessory Structures

Cartilages - cushion the joint:
fibrocartilage meniscus (articular disc)

Fat pads - superficial to the joint capsule; protect articular cartilages Ligaments - support, strengthen joints
Sprain - ligaments with torn collagen fibers

Tendons - attach to muscles around joint Bursae - Pockets of synovial fluid that cushion areas where tendons or ligaments rub

Synovial Joints: Range of Motion

Nonaxial slipping movements only Uniaxial movement in one plane Biaxial movement in two planes Multiaxial movement in or around all three planes

Joint movements To be read for labDO NOT FORGET!

Linear Motion
Also called gliding 2 surfaces slide past each other:
between carpal or tarsal bones

Flexion/Extension
Angular motion in A/P plane Flexion reduces angle between elements Extension Increases angle between elements

Figure 93a

Abduction/Adduction
Angular motion in frontal plane Abduction moves away from longitudinal axis Adduction moves toward longitudinal axis

Figure 93b, c

Circumduction
Circular motion without rotation Angular motion

Figure 93d

Rotation

Left or right rotation Medial rotation (inward rotation):

rotates toward axis

Lateral rotation (outward rotation):

rotates away from axis

Pronation and Supination

Pronation:
rotates forearm, radius over ulna

Supination:
forearm in anatomical position

Inversion and Eversion

Inversion:
twists sole of foot medially

Eversion:
twists sole of foot laterally

Figure 95a

Dorsiflexion and Plantar Flexion

Dorsiflexion:
flexion at ankle (lifting toes)

Plantar flexion:
extension at ankle (pointing toes)

Figure 95b

Opposition
Thumb movement toward fingers or palm (grasping)

Figure 95c

Protraction and Retraction

Protraction:
moves anteriorly in the horizontal plane (pushing forward)

Retraction:
opposite of protraction moving anteriorly (pulling back)

Figure 95d

Elevation and Depression

Elevation:
moves in superior direction (up)

Depression:
moves in inferior direction (down)

Lateral Flexion
Bends vertebral column from side to side

Figure 95f

6 subtypes of synovial joints

Gliding intercarpals, SI Pivot atlas/axis, radioulnar Hinge elbow, knee, TMJ, interphalangeal Ellipsoidal Occ/C1, radius to carpals Saddle trapezium to 1st metacarpal Ball & socket shoulder/hip

 Plane joints
Articular surfaces are essentially flat Allow only slipping or gliding movements Only examples of nonaxial joints

Hinge joints
Cylindrical projections of one bone fits into a trough-shaped surface on another Motion is along a single plane Uniaxial joints permit flexion and extension only Examples: elbow and interphalangeal joints

 Pivot joints
bone protrudes into a sleeve, or ring, composed of bone (and possibly ligaments) of another Only uniaxial movement allowed Examples: joint between the axis and the dens, and the proximal radioulnar joint

Condyloid joints
Oval articular surface of one bone fits into a complementary depression in another Both articular surfaces are oval Biaxial joints permit all angular motions Examples: radiocarpal (wrist) joints, and metacarpophalangeal (knuckle) joints

 Saddle Joints
Similar to condyloid joints but allow greater movement Each articular surface has both a concave and a convex surface Example: carpometacarpal joint of the thumb

Ball-and-Socket Joints
A spherical or hemispherical head of one bone articulates with a cuplike socket of another Multiaxial joints permit the most freely moving synovial joints Examples: shoulder and hip joints

Intervertebral Articulations
C2 to L5 spinal vertebrae articulate:
at inferior and superior articular processes (gliding joints) between adjacent vertebral bodies (symphyseal joints)

Figure 97

Intervertebral Discs
Intervertebral discs:
pads of fibrocartilage that separate vertebral bodies

Anulus fibrosus:
tough outer layer that attaches disc to vertebrae

Nucleus pulposus:
elastic, gelatinous core that absorbs shocks

6 Intervertebral Ligaments
1. Anterior longitudinal ligament:
connects anterior bodies connects posterior bodies

2. Posterior longitudinal ligament:

3. Ligamentum flavum:

connects laminae
connects spinous processes

4. Interspinous ligament: 5. Supraspinous ligament:

6. Ligamentum nuchae:

connects tips of spinous processes (C7 to sacrum)

continues supraspinous ligament (C7 to skull)

Damage to Intervertebral Discs

Slipped disc:
bulge in anulus fibrosus invades vertebral canal

Herniated disc:
nucleus pulposus breaks through anulus fibrosus presses on spinal cord or nerves

The Knee Joint

Figure 912a, b

The Knee Joint

2 femurtibia articulations:
1 at medial and lateral condyles 1 between patella and patellar surface of femur

7 Ligaments of the Knee Joint

Patellar ligament (anterior) 2 popliteal ligaments (posterior) Anterior and posterior cruciate ligaments (inside joint capsule) Tibial collateral ligament (medial) Fibular collateral ligament (lateral) Medial and lateral menisci: fibrocartilage pads
at femurtibia articulations to cushion and stabilize joint & give lateral support

Sprains
The ligaments reinforcing a joint are stretched or torn Partially torn ligaments slowly repair themselves Completely torn ligaments require prompt surgical repair

Strains
The muscles or tendons are stretched or torn Healing generally better than with a sprain, however it depends on the location of the strain with relationship of the joint

Inflammatory and Degenerative Conditions

Bursitis
An inflammation of a bursa, usually caused by a blow or friction Symptoms are pain and swelling Treated with anti-inflammatory drugs; excessive fluid may be aspirated

Tendonitis
Inflammation of tendon sheaths typically caused by overuse Symptoms and treatment are similar to bursitis

Arthritis
More than 100 different types of inflammatory or degenerative diseases that damage the joints Most widespread crippling disease in the U.S. Symptoms pain, stiffness, and joint swelling Acute forms are caused by bacteria and are treated with antibiotics Chronic forms include osteoarthritis, rheumatoid arthritis, and gouty arthritis

Osteoarthritis (OA)
Most common chronic arthritis; often called wear-andtear arthritis AKA: Degenerative Joint Disease (DJD) Affects women more than men 85% of all Americans develop OA More prevalent in the aged, and is probably related to the normal aging process As one ages, cartilage is destroyed more quickly than it is replaced The exposed bone ends thicken, enlarge, form bone spurs, and restrict movement Joints most affected are the cervical and lumbar spine, fingers, knuckles, knees, and hips

Rheumatoid Arthritis (RA)

Chronic, inflammatory, autoimmune disease of unknown cause, with an insidious onset Usually arises between the ages of 40 to 50, but may occur at any age Signs and symptoms include joint tenderness, anemia, osteoporosis, muscle atrophy, and cardiovascular problems
The course of RA is marked with exacerbations and remissions

Gouty Arthritis
Deposition of uric acid crystals in joints and soft tissues, followed by an inflammation response Typically, gouty arthritis affects the joint at the base of the great toe In untreated gouty arthritis, the bone ends fuse and immobilize the joint Treatment colchicine, nonsteroidal antiinflammatory drugs, and glucocorticoids