Joints and Their Classification

Arthrology = study of the joints Kinesiology = study of musculoskeletal movement Classified by freedom of movement
diarthrosis (freely movable) amphiarthrosis (slightly movable) synarthrosis (little or no movement)

Classified how adjacent bones are joined

fibrous, cartilaginous, bony or synovial
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Bony Joint (Synostosis)

Gap between two bones ossifies
frontal and mandibular bones in infants cranial sutures in elderly attachment of first rib and sternum

Can occur in either fibrous or cartilaginous joint

Fibrous Joints (Synarthrosis)

Collagen fibers span the space between bones
sutures, gomphoses and syndesmoses

Fibrous Joint -- Gomphoses

Attachment of a tooth to its socket Held in place by fibrous periodontal ligament
collagen fibers attach tooth to jawbone

Some movement while chewing

Fibrous Joint -- Syndesmosis

Two bones bound by ligament only

interosseus membrane

Most movable of fibrous joints Interosseus membranes unite radius to ulna and tibia to fibula
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Cartilaginous Joint -- Synchondrosis

Bones are joined by hyaline cartilage
rib attachment to sternum epiphyseal plate in children binds epiphysis and diaphysis
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Cartilaginous Joint -- Symphysis

2 bones joined by fibrocartilage
pubic symphysis and intervertebral discs

Only slight amount of movement is possible

Synovial Joint

Joint in which two bones are separated by a space called a joint cavity Most are freely movable
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General Anatomy
Articular capsule encloses joint cavity
continuous with periosteum lined by synovial membrane

Synovial fluid = slippery fluid; feeds cartilages Articular cartilage = hyaline cartilage covering the joint surfaces Articular discs and menisci
jaw, wrist, sternoclavicular and knee joints absorbs shock, guides bone movements and distributes forces

Tendon attaches muscle to bone Ligament attaches bone to bone

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Tendon Sheaths and Bursae

Bursa = saclike extension of joint capsule Tendon sheaths = cylinders of connective tissue lined with synovial membrane and wrapped around a tendon
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Components of a Lever
A lever is a rigid object that swings on a fixed point called a fulcrum Movement occurs when effort overcomes resistance
resistance arm and effort arm are described relative to fulcrum

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Mechanical Advantage of a Lever

Two kinds of levers
lever that helps increase output of force
human moving a heavy object with help of crowbar

lever move object further and faster

movement of row boat with paddle

Types of levers produce either increase in speed or force

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First-Class Lever

Has fulcrum in the middle between effort and resistance Atlanto-occipital joint lies between the muscles on the back of the neck and the weight of the face

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Second-Class Lever

Resistance between fulcrum and effort Resistance from the muscle tone of the temporalis muscle lies between the jaw joint and the pull of the digastric muscle on the chin as it opens the mouth quickly
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Third-Class Lever

Effort between the resistance and the fulcrum

most joints of the body

The effort applied by the biceps muscle is applied to the forearm between the elbow joint and the weight of the hand and the forearm
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Range of Motion
Degrees through which a joint can move Determined by
structure of the articular surfaces strength and tautness of ligaments, tendons and capsule
stretching of ligaments increases range of motion double-jointed people have long or slack ligaments

action of the muscles and tendons

nervous system monitors joint position and muscle tone
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Axes of Rotation

Shoulder joint has 4 degrees of freedom = multiaxial joint Other joints monoaxial or biaxial

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Types of Synovial Joints

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Ball-and-Socket Joints
Smooth hemispherical head fits within a cuplike depression
head of humerus into glenoid cavity of scapula head of femur into acetabulum of hip bone

Multiaxial joint

Distal bone can move around a center in an indefinite number of axes. Main movements are flexion-extension, adduction-abduction, axial rotation and circumduction.

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Condyloid (ellipsoid) Joints

Oval convex surface on one bone fits into a similarly shaped depression on the opp. bone
radiocarpal joint of the wrist metacarpophalangeal joints at the bases of the fingers

Biaxial joints
Distal bone has an ovoid articular surface and is received into an elliptical cavity, wich makes it impossible for the bones to do axial rotation. So main movements here are flexion-extension, adduction-abduction and circumduction.
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Saddle Joints
Each articular surface is shaped like a saddle, concave in one direction and convex in the other
trapeziometacarpal joint at the base of the thumb

Biaxial joint
more movable than a condyloid or hinge joint forming the primate opposable thumb

The saddle joint consists of two opposing surfaces which allows flexion, extension, adduction, abduction, and circumduction, but no axial 21 rotation.

Gliding Joints
Flat articular surfaces in which bones slide over each other Limited monoaxial joint

The main movements are flexionextension and rotation. wrist

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Hinge Joints
One bone with convex surface that fits into a concave depression on other bone
ulna and humerus at elbow joint femur and tibia at knee joint finger and toe joints

Monoaxial joint

Knee,elbow, fingers
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Pivot Joints
One bone has a projection that fits into a ringlike ligament of another First bone rotates on its longitudinal axis relative to the other
atlantoaxial joint (dens and atlas) proximal radioulnar joint allows the radius during pronation and supination

Atlas and Axis, Proximal Radio-Ulnar articulation 24

Flexion, Extension and Hyperextension

Flexion decreases the angle of a joint Extension straightens and returns to the anatomical position Hyperextension = extension beyond 180 degrees
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Flexion, Extension and Hyperextension

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Abduction and Adduction

Abduction is movement of a part away from the midline

hyperabduction raise arm over back or front of head

Adduction is movement towards the midline

hyperadduction crossing fingers
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Elevation and Depression

Elevation is a movement that raises a bone vertically

mandibles are elevated during biting and clavicles during a shrug

Depression is lowering the mandible or the shoulders

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Protraction and Retraction

Protraction = movement anteriorly on horizontal plane
thrusting the jaw forward, shoulders or pelvis forward

Retraction is movement posteriorly

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Circumduction
Movement in which one end of an appendage remains stationary while the other end makes a circular motion Sequence of flexion, abduction, extension and adduction movements
baseball player winding up for a pitch
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Rotation
Movement on longitudinal axis
rotation of trunk, thigh, head or arm

Medial rotation turns the bone inwards Lateral rotation turns the bone outwards
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Supination and Pronation

In the forearm and foot Supination
rotation of forearm so that the palm faces forward inversion and abduction of foot (raising the medial edge of the foot)

Pronation
rotation of forearm so the palm faces to the rear eversion and abduction of foot (raising the lateral edge of the foot)
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Movements of Head and Trunk

Flexion, hyperextension and lateral flexion of vertebral 33 column

Rotation of Trunk and Head

Right rotation of trunk; rotation of head

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Movements of Mandible

Lateral excursion = sideways movement Medial excursion = movement back to the midline
side-to-side grinding during chewing

Protraction retraction of mandible

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Movement of Hand and Digits

Radial and ulnar flexion Abduction of fingers and thumb Opposition is movement of the thumb to approach or touch the fingertips Reposition is movement back to the anatomical position
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Movements of the Foot

Dorsiflexion is raising of the toes as when you swing the foot forward to take a step (heel strike) Plantarflexion is extension of the foot so that the toes point downward as in standing on tiptoe Inversion is a movement in which the soles are turned medially Eversion is a turning of the soles to face laterally
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The Humeroscapular Joint

Most freely movable joint in the body shallowness and looseness deepened by glenoid labrum Supported by ligaments and tendons 3 glenohumeral, coracohumeral, transverse humeral and biceps tendon are important joint stabilizer Supported by rotator cuff musculature tendons fuse to joint capsule and strengthens it supraspinatus, infraspinatus, teres minor and subscapularis, 4 Bursae associated with shoulder joint
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Stabilizers of the Shoulder Joint

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Tendons of Rotator Cuff Muscles

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The Elbow Joint

Single joint capsule enclosing the humeroulnar and humeroradial joints Humeroulnar joint is supported by collateral ligaments. Radioulnar joint is head of radius held in place by the anular ligament encircling the head
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Elbow Joint

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The Coxal (hip) Joint

Head of femur articulates with acetabulum Socket deepened by acetabular labrum Blood supply to head of femur found in ligament of the head of the femur Joint capsule strengthened by ligaments
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Hip Joint
Joint capsule strengthened by ligaments
pubofemoral ischiofemoral iliofemoral

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Dissection of Hip Joint

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The Knee Joint

Most complex diarthrosis
patellofemoral = gliding joint tibiofemoral = gliding with slight rotation and gliding possible in flexed position

Joint capsule anteriorly consists of patella and extensions of quadriceps femoris tendon Capsule strengthened by extracapsular and intracapsular ligaments
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Knee Joint Sagittal Section

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Knee Joint Anterior and Posterior Views

Anterior and lateral cruciate ligaments limit anterior and posterior sliding movements Medial and lateral collateral ligaments prevent rotation of extended knee 48

Knee Joint Superior View

Medial and lateral meniscus absorb shock and shape joint

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Cruciates

Cruciates

Cruciates

Cruciates

Patella

 TKA is one of the most successful and commonly performed orthopedic surgery.
The best results for TKA at 10 15 yrs. compare to or surpass the best result of THA.

Classification
1 3

1- Cruciate retaining 2- Cruciate substituting 3- Mobile bearing 4- Unicondylar

Arthritis and Artificial Joints

Rheumatoid arthritis is autoimmune attack on joint
antibodies attack synovial membrane, enzymes in synovial fluid degrade the cartilage, bones ossify remissions occur, steroids and aspirin control inflammation

Arthroplasty is replacement of diseased joint with artificial device called prosthesis

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Joint Prostheses

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