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Joints(Part B)
--------------------Shape of Joints
Knee Joint
Shoulder Joint
Elbow Joint
Hip Joint
Temporal-mandibular Joint
Common Joint Injuries
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Types of Synovial Joints
• Six types, based on shape of articular surfaces:
– Plane– Hinge– Pivot– Condylar– Saddle– Ball-and-socket
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.
Flatarticularsurfaces
Gliding
Plane joint Nonaxial movement
Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces
Carpals
Metacarpals
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.
Hinge joint Uniaxial movement
Examples: Elbow joints, interphalangeal joints
Flexion and extension
CylinderTrough
Medial/lateralaxis
Humerus
Ulna
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.
Pivot joint Uniaxial movement
Rotation
Sleeve(bone andligament)
Radius
Examples: Proximal radioulnar joints, atlantoaxial joint
Axle (roundedbone)
Vertical axis
Ulna
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.
Phalanges
Metacarpals
Condylar joint Biaxial movement
Ovalarticularsurfaces
Examples: Metacarpophalangeal (knuckle) joints, wrist joints
Medial/lateralaxis
Flexion andextension
Adduction andabduction
Anterior/posterioraxis
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.
Flexion andextension
Adduction andabduction
Articularsurfacesare bothconcaveand convex
Medial/lateralaxis
Anterior/posterioraxis
Trapezium
Metacarpal Ι
Example: Carpometacarpal joints of the thumbs
Saddle joint Biaxial movement
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The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovialjoints into six structural types.
Sphericalhead(ball)
Examples: Shoulder joints and hip joints
Flexion and extension Adduction andabduction Rotation
Humerus
Scapula
Cup(socket)
Medial/lateralaxis
Anterior/posterioraxis
Vertical axis
Ball-and-socket joint Multiaxial movement
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• Largest, most complex joint of body• Three joints surrounded by a single
joint cavity– Femoropatellar joint
• Plane joint• Allows gliding motion during knee flexion
– Lateral and medial tibiofemoral joints• Femoral condyles with lateral and medial
menisci of tibia• Allow flexion, extension, and some rotation
when knee partly flexed
Knee Joint
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Patellar ligament
Sagittal section through the right knee joint
Anteriorcruciateligament
Posteriorcruciateligament
Tibia
Femur
Lateralmeniscus
Articularcapsule
Lateral meniscusSynovial cavity
Infrapatellarfat pad
Subcutaneousprepatellar bursa
Patella
Suprapatellarbursa
Tendon ofquadricepsfemoris
Deep infrapatellerbursa
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Articularcartilage on lateral tibialcondyle
Posteriorcruciateligament
Lateralmeniscus
Superior view of the right tibia in the knee joint, showingthe menisci and cruciate ligaments
Anteriorcruciateligament
Medialmeniscus
Articularcartilageon medialtibial condyle
Anterior
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Knee Joint
• At least 12 associated bursae
• Capsule is reinforced by muscle tendons– E.g., quadriceps and semimembranosus tendons
• Joint capsule is thin and absent anteriorly
• Anteriorly, quadriceps tendon gives rise to three broad ligaments– Medial and lateral patellar retinacula– Patellar ligament
© 2013 Pearson Education, Inc.Anterior view of right knee
Quadricepsfemorismuscle
Lateralpatellarretinaculum
Tibialcollateralligament
Fibula
Fibularcollateralligament
Patella
Tendon ofquadricepsfemorismuscle
Patellarligament
Medialpatellarretinaculum
Tibia
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Ligaments Stabilizing Knee Joint
• Capsular and extracapsularligaments– Help prevent hyperextension of knee– Fibular and tibial collateral ligaments– Oblique popliteal ligament– Arcuate popliteal ligament
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Tibia
Arcuatepoplitealligament
Obliquepoplitealligament
Bursa
Popliteusmuscle(cut)
Lateralhead ofgastrocnemiusmuscle
ArticularcapsuleMedial head of
gastrocnemiusmuscle
Fibularcollateralligament
Tibialcollateralligament
Tendon ofsemimembranosusmuscle
Posterior view of the joint capsule, including ligaments
FemurTendon ofadductormagnus
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Ligaments Stabilizing Knee Joint
• Intracapsular ligaments – Prevent anterior-posterior displacement– Reside outside synovial cavity– Anterior cruciate ligament
• Attaches to anterior tibia– Posterior cruciate ligament
• Attaches to posterior tibia
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Fibularcollateralligament�
Lateralcondyleof femurLateralmeniscus
Tibia
Fibula
Anterior view of flexed knee, showingthe cruciate ligaments (articularcapsule removed, and quadricepstendon cut and reflected distally)
PosteriorcruciateligamentMedialcondyleTibialcollateralligament
Medialmeniscus
PatellarligamentPatella
Anteriorcruciateligament
Quadricepstendon
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Medial femoralcondyle
Anterior cruciateligament
Medial meniscuson medial tibialcondyle
Patella
Photograph of an opened knee joint;view similar to (e)
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Knee Joint Injuries
• Absorbs great vertical force
• Vulnerable to horizontal blows, especially laterally blows to extended knee
– Three C's• Collateral ligaments• Cruciate ligaments• Cartilages
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A common knee injury.
Lateral
Patella(outline)
Medial
Tibialcollateralligament(torn)
Medialmeniscus(torn)
Hockey puck
Anteriorcruciateligament(torn)
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Shoulder (Glenohumeral) Joint
• Ball-and-socket joint– Head of humerus with glenoid
cavity of scapula• Most freely moving joint in
body– Stability sacrificed
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The shoulder joint.
Acromionof scapulaCoracoacromialligamentSubacromialbursa
Fibrous layer ofarticular capsule
Tendonsheath
Tendon oflong headof bicepsbrachii muscle
Synovial membraneFibrous layer ofarticular capsule
Humerus
Articularcartilage
Synovial cavityof the glenoidcavity containingsynovial fluid
Frontal section through right shoulder joint
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Fibrous layer ofarticular capsule
Humerus
Articularcartilage
Synovial cavityof the glenoidcavity containingsynovial fluid
Cadaver photo corresponding to (a)
The shoulder joint.
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Shoulder Joint
• Reinforcing ligaments– Primarily on anterior aspect– Coracohumeral ligament
• Helps support weight of upper limb– Three glenohumeral ligaments
• Weak and sometimes absent
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• Reinforcing muscle tendons– Tendon of long head of biceps brachii
• Travels through the intertubercularsulcus
• Secures humerus to glenoid cavity– Four rotator cuff tendons encircle the
shoulder joint• Subscapularis• Supraspinatus• Infraspinatus• Teres minor
Shoulder Joint
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AcromionCoracoacromialligamentSubacromialbursaCoracohumeralligamentGreatertubercleof humerusTransversehumeralligamentTendon sheath
Tendon oflong headof bicepsbrachiimuscle
Articularcapsulereinforced byglenohumeralligaments
SubscapularbursaTendon of thesubscapularismuscleScapula
Coracoidprocess
Anterior view of right shoulder joint capsule
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Lateral view of socket of right shoulderjoint, humerus removed
CoracoidprocessArticularcapsuleGlenoid cavity
Glenoid labrum
Tendon of longhead of bicepsbrachii muscleGlenohumeralligamentsTendon of thesubscapularismuscleScapula
Posterior Anterior
Acromion
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The shoulder joint.
Head ofhumerus
Muscle ofrotatorcuff (cut)
Anterior view of an opened shoulder joint
Capsule ofshoulderjoint(opened)
Glenoidcavity ofscapula
Acromion(cut)
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• Articulation of radius and ulna with humerus
• Hinge joint– Primarily trochlear notch of ulna
with trochlea of humerus– Flexion and extension only
Elbow Joint
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Humerus
Fat pad
Tendon oftricepsmuscleBursa
Articular cartilageof the trochlearnotch
Trochlea
Articularcapsule
Synovialmembrane
Synovial cavity
Ulna
Median sagittal section through right elbow (lateral view)
Articular cartilage
Coronoid process
Tendon ofbrachialis muscle
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Elbow Joint
• Anular ligament– Surrounds head of radius
• Two capsular ligaments restrict side-to-side movement– Ulnar collateral ligament– Radial collateral ligament
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Humerus
Lateralepicondyle
ArticularcapsuleRadialcollateralligament
Olecranon
Anularligament
Radius
Ulna
Lateral view of right elbow joint
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ArticularcapsuleAnularligamentCoronoidprocess
Radius
Humerus
MedialepicondyleUlnarcollateralligament
Ulna
Medial view of right elbow
© 2013 Pearson Education, Inc.Cadaver photo of medial view of right elbow
Anularligament
Radius
Articularcapsule
Coronoidprocess
Humerus
Medialepicondyle
Ulnarcollateralligament
Ulna
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• Ball-and-socket joint• Head of the femur
articulates with acetabulum• Good range of motion, but
limited by the deep socket – Rim of fibrocartilage -
Acetabular labrum• Enhances depth of socket so
hip dislocations rare
Hip (Coxal) Joint
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Ligament of thehead of the femur(ligamentum teres)
Coxal (hip) boneArticular cartilage
Acetabular labrum
Femur
Frontal section through the right hip joint
Synovial cavity
Articular capsule
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The hip joint.
Acetabularlabrum
Ligament of the headof the femur(ligamentumteres)
Synovialmembrane
Headof femur
Articularcapsule (cut)
Photo of the interior of the hip joint, lateral view
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Hip Joint
• Reinforcing ligaments– Iliofemoral ligament– Pubofemoral ligament– Ischiofemoral ligament– Ligamentum teres
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IliofemoralligamentIschiofemoralligament
Greatertrochanterof femur
Posterior view of right hip joint, capsule in place
Ischium
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Iliofemoralligament
Pubofemoralligament
Greatertrochanter
Anterior inferioriliac spine
Anterior view of right hip joint, capsule in place
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Temporomandibular Joint (TMJ)
• Mandibular condyle articulates with temporal bone
• Two types of movement– Hinge—depression and
elevation of mandible– Gliding—e.g., side-to-side
(lateral excursion) grinding of teeth
• Most easily dislocated joint in the body
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Ramus of mandible
Articularcapsule
Externalacousticmeatus
Mandibular fossaArticular tubercleZygomatic processInfratemporal fossa
Location of the joint in the skull
Lateral ligament
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Inferior jointcavity
Superiorjointcavity
Articulartubercle
Articular disc
Mandibularfossa
Articularcapsule
Synovialmembranes
Condylarprocess ofmandible
Ramus of mandible
Enlargement of a sagittal section through
the joint
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Superior viewOutline of themandibularfossa
Lateral excursion: lateral (side-to-side) movements of the mandible
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Common Joint Injuries
• Cartilage tears– Due to compression and shear stress– Fragments may cause joint to lock or
bind– Cartilage rarely repairs itself– Repaired with arthroscopic surgery
• Ligaments repaired, cartilage fragments removed with minimal tissue damage or scarring
– Partial menisci removal renders joint less stable but still mobile; complete removal leads to osteoarthritis
– Meniscal transplant in younger patients– Perhaps meniscus grown from own
stem cells in future
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Arthroscopic photograph of a torn medial meniscus.
Femur
Meniscus
Tear inmeniscus
Tibia
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Common Joint Injuries
• Sprains– Reinforcing ligaments stretched or torn– Partial tears slowly repair heal
• Poor vascularization– Three options if torn completely
• Ends sewn together• Replaced with grafts• Time and immobilization
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Common Joint Injuries
• Dislocations (luxations)– Bones forced out of alignment– Accompanied by sprains,
inflammation, and difficulty moving joint
– Caused by serious falls or contact sports
– Must be reduced to treat• Subluxation—partial
dislocation of a joint
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Inflammatory and Degenerative Conditions
• Bursitis– Inflammation of bursa, usually
caused by blow or friction– Treated with rest and ice and, if
severe, anti-inflammatory drugs• Tendonitis
– Inflammation of tendon sheaths typically caused by overuse
– Symptoms and treatment similar to bursitis
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Arthritis
• >100 different types of inflammatory or degenerative diseases that damage joints
• Most widespread crippling disease in the U.S.
• Symptoms: pain, stiffness, and swelling of joint
• Acute forms: caused by bacteria, treated with antibiotics
• Chronic forms: osteoarthritis, rheumatoid arthritis, and gouty arthritis
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Osteoarthritis (OA)
• Common, irreversible, degenerative (''wear-and-tear'') arthritis
• May reflect excessive release of enzymes that break down articular cartilage
• By age 85 half of Americans develop OA, more women than men
• Probably related to normal aging process
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Osteoarthritis (OA)
• More cartilage is destroyed than replaced in badly aligned or overworked joints
• Exposed bone ends thicken, enlarge, form bone spurs, and restrict movement
• Treatment: moderate activity, mild pain relievers, capsaicin creams– Glucosamine, chondroitin sulfate, and
nutritional supplements not effective
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Rheumatoid Arthritis (RA)
• Chronic, inflammatory, autoimmune disease of unknown cause– Immune system attacks own cells
• Usually arises between ages 40 and 50, but may occur at any age; affects 3 times as many women as men
• Signs and symptoms include joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems
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Rheumatoid Arthritis
• RA begins with synovitis of the affected joint
– Inflammatory blood cells migrate to joint, release inflammatory chemicals that destroy tissues
– Synovial fluid accumulates joint swelling and inflamed synovial membrane which thickens pannus that clings to articularcartilage
– Pannus erodes cartilage, scar tissue forms and connects articulating bone ends (ankylosis)
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Rheumatoid Arthritis: Treatment
• Disrupt destruction of joints by immune system
• Steroidal and nonsteroidal anti-inflammatory drugs decrease pain and inflammation
• Immune suppressants slow autoimmune reaction
• Some agents target tumor necrosis factor to block action of inflammatory chemicals
• Can replace joint with prosthesis
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A hand deformed by rheumatoid arthritis.
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Gouty Arthritis
• Deposition of uric acid crystals in joints and soft tissues, followed by inflammation
• High fructose leads to metabolic pathway with elevates uric acid crystals! (high fructose corn syrup)
• More common in men
• Typically affects joint at base of great toe
• In untreated gouty arthritis, bone ends fuse and immobilize joint
• Treatment: drugs, plenty of water, avoidance of alcohol
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Lyme Disease
• Caused by bacteria transmitted by tick bites
• Symptoms: skin rash, flu-like symptoms, and foggy thinking
• May lead to joint pain and arthritis• Treatment
– Long course of antibiotics
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Developmental Aspects of Joints
• By embryonic week 8, synovial joints resemble adult joints
• Joint's size, shape, and flexibility modified by use
• Advancing years take toll on joints– Ligaments and tendons shorten and weaken– Intervertebral discs more likely to herniate– Most people in 70s have some degree of OA
• Full-range-of-motion exercise key to postponing joint problems