© 2013 Pearson Education, Inc. Types of Synovial Joints • Six types, based on shape of articular surfaces: – Plane – Hinge – Pivot – Condylar – Saddle – Ball-and-socket
Dec 29, 2015
© 2013 Pearson Education, Inc.
Types of Synovial Joints
• Six types, based on shape of articular surfaces:– Plane– Hinge– Pivot– Condylar– Saddle– Ball-and-socket
© 2013 Pearson Education, Inc.
Figure 8.7a 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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Figure 8.7b 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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Figure 8.7c 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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Figure 8.7d 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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Figure 8.7e 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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Figure 8.7f 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.
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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Figure 8.8a The knee joint.
Patellar ligament
Sagittal section through the right knee joint
Anteriorcruciateligament
Posteriorcruciateligament
Tibia
Femur
Lateralmeniscus
Articularcapsule
Lateral meniscus
Synovial cavity
Infrapatellarfat pad
Subcutaneousprepatellar bursa
Patella
Suprapatellarbursa
Tendon ofquadricepsfemoris
Deep infrapatellerbursa
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Figure 8.8b The knee joint.
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
• 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
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Figure 8.8c The knee joint.
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 extracapsular ligaments– Help prevent hyperextension of knee– Fibular and tibial collateral ligaments– Oblique popliteal ligament– Arcuate popliteal ligament
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Figure 8.8d The knee joint.
Tibia
Arcuatepoplitealligament
Obliquepoplitealligament
Bursa
Popliteusmuscle(cut)
Lateralhead ofgastrocnemiusmuscle
Articularcapsule
Medial head ofgastrocnemiusmuscle
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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PLAY Animation: Rotatable Knee
Figure 8.8e The knee joint.
Fibular collateral ligament
Lateral condyle of femur
Lateralmeniscus
Tibia
Fibula
Anterior view of flexed knee, showingthe cruciate ligaments (articularcapsule removed, and quadricepstendon cut and reflected distally)
PosteriorcruciateligamentMedialcondyleTibialcollateralligament
Medialmeniscus
Patellarligament
Patella
Anteriorcruciateligament
Quadricepstendon
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Figure 8.8f The knee joint.
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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Figure 8.9 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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Animation: Rotatable Shoulder
Figure 8.10a The shoulder joint.
Acromionof scapula
Coracoacromialligament
Subacromialbursa
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
PLAY
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Fibrous layer ofarticular capsule
Humerus
Articularcartilage
Synovial cavityof the glenoidcavity containingsynovial fluid
Cadaver photo corresponding to (a)
Figure 8.10b The shoulder joint.
PLAY A&P Flix: Movement at the Glenohumeral joint: An Overview
PLAY A&P Flix: Movement at the Glenohumeral joint (a)
PLAY A&P Flix: Movement at the Glenohumeral joint (b)
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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 intertubercular sulcus • Secures humerus to glenoid cavity
– Four rotator cuff tendons encircle the shoulder joint• Subscapularis• Supraspinatus• Infraspinatus• Teres minor
Shoulder Joint
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Figure 8.10c The shoulder joint.
AcromionCoracoacromialligamentSubacromialbursa
Coracohumeralligament
Greatertubercleof humerus
Transversehumeralligament
Tendon sheath
Tendon oflong headof bicepsbrachiimuscle
Articularcapsulereinforced byglenohumeralligaments
Subscapularbursa
Tendon of thesubscapularismuscleScapula
Coracoidprocess
Anterior view of right shoulder joint capsule
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Figure 8.10d The shoulder joint.
Lateral view of socket of right shoulder joint,humerus removed
Coracoidprocess
Articularcapsule
Glenoid cavity
Glenoid labrum
Tendon of longhead of bicepsbrachii muscleGlenohumeralligamentsTendon of thesubscapularismuscle
Scapula
Posterior Anterior
Acromion
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Figure 8.10e 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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Figure 8.11a The elbow joint.
Humerus
Fat pad
Tendon oftricepsmuscle
Bursa
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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Figure 8.11b The elbow joint.
Humerus
Lateralepicondyle
Articularcapsule
Radialcollateralligament
Olecranon
Anularligament
Radius
Ulna
Lateral view of right elbow joint
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Figure 8.11d The elbow joint.
Articularcapsule
Anularligament
Coronoidprocess
Radius
Humerus
Medialepicondyle
Ulnarcollateralligament
Ulna
Medial view of right elbow
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Cadaver photo of medial view of right elbow
Figure 8.11c The elbow joint.
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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Figure 8.12a The hip joint.
Ligament of thehead of the femur(ligamentum teres)
Coxal (hip) bone
Articular cartilage
Acetabular labrum
Femur
Frontal section through the right hip joint
Synovial cavity
Articular capsule
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Figure 8.12b 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
© 2013 Pearson Education, Inc.
Iliofemoralligament
Ischiofemoralligament
Greatertrochanterof femur
Posterior view of right hip joint, capsule in place
Ischium
Figure 8.12c The hip joint.
© 2013 Pearson Education, Inc.
Iliofemoralligament
Pubofemoralligament
Greatertrochanter
Anterior inferioriliac spine
Anterior view of right hip joint, capsule in place
Figure 8.12d The hip joint.
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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
Figure 8.13a The temporomandibular (jaw) joint.
© 2013 Pearson Education, Inc.
Inferior jointcavity
Superiorjointcavity
Articulartubercle
Articular disc
Mandibularfossa
Articularcapsule
Synovialmembranes
Condylarprocess ofmandible
Ramus of mandible
Enlargement of a sagittal section through the joint
Figure 8.13b The temporomandibular (jaw) joint.
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Figure 8.13c The temporomandibular (jaw) joint.
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 stem cells in future
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Figure 8.14 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 falls or sports – Must be reduced to treat
• Subluxation—partial dislocation
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Inflammatory and Degenerative Conditions• Bursitis
– Inflammation of bursa, caused by blow or friction– Treated with rest and ice – For the first 24 to 72 hrs apply ice for 10 to 20 mins
every hr or two.• Tendonitis
– Inflammation of tendon sheaths typically caused by overuse
– Symptoms and treatment similar to bursitis
The carpal tunnel is the area under a ligament anterior to the wrist. The median nerve, which passes through the carpal tunnel, supplies the thumb side of the hand. Repetitive movements can cause inflammation of structures that surround the median nerve. The inflammation may compress this nerve, producing numbness, tingling, and pain in the first three fingers and the thumb side of the hand - a condition known as carpal tunnel syndrome.
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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: bacterial, treated with antibiotics• Chronic forms: psoriatic arthritis, osteoarthritis,
rheumatoid arthritis, and gouty arthritis
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Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful.
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• Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.
• Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.
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Radiographic changes due to PsA, unlike those of rheumatoid arthritis, demonstrate characteristic bony proliferation and erosion. A highly specific finding of erosive arthritis of PsA is the classic "pencil-in-cup“ deformity in the phalanges.
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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 thicken, enlarge, form osteophytes, creptitus and restrict movement
• Treatment: moderate activity, mild pain relievers, capsaicin creams– Glucosamine, chondroitin sulfate, and
nutritional supplements not effective
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Cartilage normally protects the joint, allowing for smooth movement.
Cartilage also absorbs shock when pressure is placed on the joint, like when walking. Arthritis involves the breakdown of cartilage. Without the usual amount of cartilage, the bones
of the joint rub together, causing pain, swelling and stiffness.
http://www.pennmedicine.org/health_info/arthritis/000088.html
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Rheumatoid Arthritis (RA)
• Chronic, inflammatory, autoimmune disease of unknown cause
• 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 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 articular cartilage
– Pannus erodes cartilage, scar tissue forms and connects articulating bone ends (ankylosis)
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© 2013 Pearson Education, Inc.
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
TNFα to block action of inflammatory chemicals• Can replace joint with prosthesis
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© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
Figure 8.15 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
• More common in men • Typically affects joint at base of great toe
(first metatarsophalangeal joint)• In untreated gouty arthritis, bone ends
fuse and immobilize joint• Treatment: drugs, plenty of water,
avoidance of alcohol
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© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
© 2013 Pearson Education, Inc.
Lyme Disease
• Caused by bacteria transmitted by tick• Symptoms: skin rash, flu-like symptoms,
and foggy thinking• May lead to joint pain and arthritis
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