types of synovial joints. selected synovial joints: the knee this is considered the most complex...

Types of Synovial Joints

Selected Synovial Joints:The Knee

This is considered the most complex joint in the human body. It is actually considered three joints working together.

The Knee

These are:– An intermediate joint between the patella and

distal end of the femur (femoropatellar joint). This is a plane joint.

The Knee

These are:– An intermediate joint between the patella and

distal end of the femur (femoropatellar joint). This is a plane joint.

– A lateral and medial tibiofemoral joints between the femoral condyles and the menisci below.

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(a) Sagittal section through the right knee joint

Femur

Tendon ofquadricepsfemoris

SuprapatellarbursaPatellaSubcutaneousprepatellar bursaSynovial cavityLateral meniscus

Posteriorcruciateligament

Infrapatellarfat pad Deep infrapatellarbursaPatellar ligament

Articularcapsule

LateralmeniscusAnteriorcruciateligamentTibia

Figure 8.8a The knee joint.

The Knee

The menisci help prevent lateral motion and attach to the outer margins of the joint capsule on the tibia. They are easily torn.

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Figure 8.8b The knee joint.

(b) Superior view of the right tibia in the knee joint, showing the menisci and cruciate ligaments

Medialmeniscus

Articularcartilageon medialtibialcondyle

Anterior

Anteriorcruciateligament

Articularcartilage onlateral tibialcondyle

Lateralmeniscus

Posteriorcruciateligament

The knee is unique in that it is not completely enclosed by a capsule.

The knee is unique in that it is not completely enclosed by a capsule. The articular capsule is found only on the lateral and posterior surfaces.

The knee is unique in that it is not completely enclosed by a capsule. The articular capsule is found only on the lateral and posterior surfaces. The anterior surface is covered by three ligaments going from the patella to the tibia.

• These ligaments are:• The patella ligament

• These ligaments are:• The patella ligament &• The medial and lateral patellar retinacula

ligaments. They merge with the articular capsule on each side.

The intracapsular ligaments are the cruciate ligaments.

The intracapsular ligaments are the cruciate ligaments. The anterior and posterior cruciate ligaments cross each other forming an X in the notch between the femoral condyles.

The intracapsular ligaments are the cruciate ligaments. The anterior and posterior cruciate ligaments cross each other forming an X in the notch between the femoral condyles. They prevent anterior and posterior displacement.

Two additional ligaments, the Fibular and Tibial Collateral Ligaments prevent lateral or medial rotation when the knee is extended.

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Figure 8.8c The knee joint.

Quadricepsfemoris muscle

Tendon ofquadricepsfemoris muscle

PatellaLateral patellarretinaculum

Medial patellarretinaculumTibial collateralligament

Tibia

Fibularcollateralligament

Fibula

(c) Anterior view of right knee

Patellar ligament

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Figure 8.8f The knee joint.

Medial femoral condyle

Anterior cruciateligament

Medial meniscus onmedial tibial condyle

Patella

(f) Photograph of an opened knee joint; view similar to (e)

The synovial cavity of the knee has a complicated shape and over one dozen associated bursae. Some are easily injured such as the subcutaneous prepatellar bursa which lies just over the patella (house maid’s knee).

House Maid’s Knee

Knee Injuries

Common knee injuries involve the 3 C’s: – Collateral ligaments,

Knee Injuries

Common knee injuries involve the 3 C’s: – Collateral ligaments, – Cruciate ligaments and

Knee Injuries

Common knee injuries involve the 3 C’s: – Collateral ligaments, – Cruciate ligaments and – Cartilage (menisci).

Knee Injuries

Lateral blows are the most dangerous, tearing the tibial collateral ligament and the medial meniscus and the anterior cruciate ligament.

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Figure 8.9 A common knee injury.

Lateral MedialPatella(outline)

Tibial collateralligament(torn)

Medialmeniscus (torn)

Anteriorcruciateligament (torn)

Hockey puck

Arthroscopic Knee Surgery

Arthroscopy is a common surgical procedure in which a joint (arthro-) is viewed (-scopy) using a small camera.

Arthroscopic Knee Surgery

Arthroscopy gives doctors a clear view of the inside of the knee. This helps them diagnose and treat knee problems.

Arthroscopic Knee Surgery

The orthopaedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see your knee clearly and in great detail.

Arthroscopic Knee Surgery

Knee Replacement

People with degenerative arthritis, chronic injuries often lose that smooth articular cartilage.The result is bone on bone. The knee joints must be replaced.

Knee Replacement

Shoulder (Glenohumeral) Joint

The large head of the humerus fits into the glenoid cavity of the scapula.

The cavity is extended by a fibrocartilage ring called the glenoid labrum.Connective tissue support comes from three groups of ligaments.

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Figure 8.10c The shoulder joint.

AcromionCoracoacromialligamentSubacromialbursaCoracohumeralligament

Greatertubercleof humerus

Transversehumeralligament

Tendon sheathTendon of longhead of bicepsbrachii muscle

Articularcapsulereinforced byglenohumeralligaments

Subscapularbursa

Tendon of thesubscapularismuscle

Scapula

Coracoidprocess

(c) Anterior view of right shoulder joint capsule

Shoulder (Glenohumeral) Joint

B) Three Glenohumeral ligaments strengthen the front of the capsule. These ligaments are weak.

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Figure 8.10d The shoulder joint.

Acromion

Coracoid process

Articular capsule

Glenoid cavityGlenoid labrum

Tendon of long headof biceps brachii muscle

Glenohumeral ligaments

Tendon of thesubscapularis muscle

ScapulaPosterior Anterior

(d) Lateral view of socket of right shoulder joint,humerus removed

Shoulder (Glenohumeral) Joint

C) The Rotator Cuff is formed from four tendons and muscles that encircle the joint. The muscles include the Subscapularis, Supraspinatus Infraspinatus and Teres minor.

Shoulder (Glenohumeral) Joint

Shoulder InjuriesRotator Cuff

Because of its mobility, the stability of the shoulder joint has been sacrificed.

Anterior dislocations are the most common along with damage to the rotator cuff muscles due to severe circumduction.

Shoulder Dislocationand Reduction

Shoulder InjuriesRotator Cuff

Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, pitching in baseball, swimming, – often put the rotator cuff muscles under a lot of stress.

Shoulder InjuriesRotator Cuff

Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of the tendons (often called tendinopathy or tendonitis).

Shoulder InjuriesRotator Cuff

Surgery to repair a torn rotator cuff tendon usually involves:– Removing loose fragments of tendon, bursa, and

other debris from the space in the shoulder where the rotator cuff moves (debridment).

Shoulder InjuriesRotator Cuff

Surgery to repair a torn rotator cuff tendon usually involves:– Removing loose fragments of tendon, bursa, and

other debris from the space in the shoulder where the rotator cuff moves (debridement).

– Making more room for the rotator cuff tendon so it is not pinched or irritated.

Shoulder InjuriesRotator Cuff

Surgery to repair a torn rotator cuff tendon usually involves:– Removing loose fragments of tendon, bursa, and

other debris from the space in the shoulder where the rotator cuff moves (debridement).

– Making more room for the rotator cuff tendon so it is not pinched or irritated.

– Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

Shoulder InjuriesRotator Cuff

Shoulder InjuriesRotator Cuff

Elbow Joint

This is a hinge joint where the radius and ulna articulate with the condyles of the humerus. The ulna’s trochlear notch forms a tight hinge with the trochlear of the humerus. This articulation allows for flexion and extension only.

Elbow Joint

Side to side movement is prevented by the ulnar collateral ligament (triangular) and radial collateral ligament.

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Figure 8.11d The elbow joint.

Articularcapsule

Anularligament

Coronoidprocess

(d) Medial view of right elbow

Radius

Humerus

Medialepicondyle

Ulnarcollateralligament

Ulna

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Figure 8.11c The elbow joint.

Anularligament

Humerus

Medialepicondyle

Ulnarcollateralligament

Ulna

Articularcapsule

Radius

Coronoidprocess

(c) Cadaver photo of medial view of right elbow

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Figure 8.11b The elbow joint.

Humerus

Lateralepicondyle

Articularcapsule

Radialcollateralligament

Olecranonprocess

Anularligament

Radius

Ulna

(b) Lateral view of right elbow joint

Elbow Joint Injuries

Tommy John Surgery

This procedure, more formally known as UCL (Ulnar Collateral Ligament) reconstruction, is designed to repair a torn elbow ligament—an injury typically caused by strong, repetitive overhead throwing motions of the arm.

Tommy John Surgery

It was first performed in 1974 on baseball pitcher Tommy John. The procedure typically lasts about an hour and a half, and patients usually leave the hospital the same day.

Elbow Dislocations

Elbow Dislocations

Hip (Coxal Joint)

This is a ball and socket joint whose movement is limited by strong ligaments. It is formed from the spherical head of the femur and the deeply cupped acetabulum in the pelvis.

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Figure 8.12b The hip joint.

Acetabularlabrum

Synovialmembrane

Ligamentof the headof the femur(ligamentumteres)

Headof femur

Articularcapsule (cut)

(b) Photo of the interior of the hip joint, lateral view

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Figure 8.12c The hip joint.

Ischium

Iliofemoralligament

Ischiofemoralligament

Greatertrochanterof femur

(c) Posterior view of right hip joint, capsule in place

Hip (Coxal Joint)

The ligamentum teres attaches the femur to the acetabulum.

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Figure 8.12a The hip joint.

Articular cartilageCoxal (hip) bone

Ligament ofthe head of the femur (ligamentum teres)

Synovial cavity

Articular capsule

Acetabularlabrum

Femur

(a) Frontal section through the right hip joint

Hip Injuries

Common injuries to the hip joint include fractures and dislocations. Hip fractures typically involve the neck of the femur and are the result of underlying disease such as osteoporosis.

Hip Replacement

Hip replacement surgery, also called total hip arthroplasty, involves removing a diseased hip joint and replacing it with an artificial joint, called a prosthesis.

Hip Replacement

Hip replacement is typically used for people with hip joint damage from arthritis or an injury. Followed by rehabilitation, hip replacement can relieve pain and restore range of motion and function of your hip joint

Lets do a hip replacement!

Temporomandibular Joint

Two distinct movements can occur with the jaw, a hinge like movement and the second is a lateral movement.

Temporomandibular Joint

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Figure 8.13c The temporomandibular (jaw) joint.

(c) Lateral excursion: lateral (side-to-side) movements of the mandible

Outline ofthe mandibularfossa

Superior view

Temporomandibular Joint

A lateral ligament attaches the ramus of the mandible to the zygomatic arch of the temporal bone.

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Figure 8.13a The temporomandibular (jaw) joint.

Zygomatic process

Mandibular fossaArticular tubercle

Infratemporal fossa

Externalacousticmeatus

ArticularcapsuleRamus ofmandible

Lateralligament

(a) Location of the joint in the skull

Injuries to the Jaw

Injuries to the jaw include fractures and dislocations.

Injuries to the Jaw

Injuries to the jaw include fractures and dislocations.

A broken jaw is a break in the jaw bone. A dislocated jaw means the lower part of the jaw has moved out of its normal position at one or both joints .

Dislocation of the Jaw

Symptoms of a dislocated jaw include pain in or around the jaw, the misalignment of teeth, and forward movement of the jaw beyond its regular position. Other symptoms include difficulty opening and closing the mouth.

Dislocation of the Jaw

A dislocated jaw can be caused by forceful yawning or by some sort of trauma or impact with the face. Common causes of jaw dislocation include a punch to the face, sports injuries, and car accidents.

Dislocation of the Jaw

Fractures of the Jaw

A broken jaw) is a common facial injury.

Fractures (these are breaks in the bone) are generally the result of a direct force to the jaw.

Diseases of the joints

Besides trauma, inflammation from over use or repetitive motions are the most common diseases seen in the joints.

Bursitis

Inflammation of a bursal sac usually as the result of chronic irritation

Arthritis

Arthritis is a common term for over 100 conditions which describe degenerative processes found in the joints. Major examples include osteoarthritis, rheumatoid arthritis and gout.

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Figure 8.15 X ray of a hand deformed by rheumatoid arthritis.

Osgood–Schlatter disease

Is also known as tibial tubercle apophyseal traction injury is a rupture of the growth plate at the tibial tuberosity.

Osgood–Schlatter disease

The condition occurs in active boys and girls aged 9–16 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls.

Osgood–Schlatter disease

The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the the tibial tuberosity.Treatment is conservative with rest, RICE (Rest, Ice, Compression, and Elevation),

Shin Splints

Shin splints is a general medical term denoting medial tibial stress syndrome (MTSS), a slow healing and painful condition in the shins, usually caused by exercise such as running, jumping, swimming, cycling, dancing or other sports.

The onset of shin splints is most common after exercise, caused by high impact training, excessive training, poor technique

Knuckle Cracking

When one cracks a knuckle, the stretching of the capsule lowers the pressure inside the joint and creates a vacuum which is filled by the gas previously dissolved in the synovial fluid. This creates a “bubble” which then bursts producing the characteristic “popping” or “cracking” sound.

Knuckle Cracking

There is no evidence that cracking knuckles causes any damage such as arthritis in the joints.

Questions?