Joints PDF

JOINTS JOINTS DR AISHA MOHD DIN Department Department of of Basic Basic Sciences Sciences  Objectives Joints and their classification – bony joints – fibrous joints – cartilaginous joints Synovial joints Anat...

JOINTS JOINTS DR AISHA MOHD DIN Department Department of of Basic Basic Sciences Sciences  Objectives Joints and their classification – bony joints – fibrous joints – cartilaginous joints Synovial joints Anatomy of joints – humeroscapular joint – elbow joint – hip joint – knee joint  Joints and Their Classification Arthrology = study of the joints Kinesiology = study of musculoskeletal movement Classified byLoading… 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 articulate together = Joints  Bony Joint (Synostosis) two bones fuse together 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 – Loading… sutures, gomphoses and syndesmoses Joints  Fibrous Joint -- Sutures Immovable fibrous joints – bind skull bones together Serrate - interlocking lines Y – coronal, sagittal and lambdoid sutures Lap - overlapping beveled edges – temporal and parietal bones Plane - straight, nonoverlapping edges – palatine processes of the maxillae Types of Sutures zigzag 9-0  Fibrous Joint -- Gomphoses Attachment of a tooth to its socket Held in place by fibrous periodontal ligament (moveable) – collagen fibers attach tooth to jawbone Some movement while chewing stress provide mechanical to bone.  Fibrous Joint -- Syndesmosis ulna , radius , fibula Two bones bound radio ulnar joints. by ligament only – interosseus membrane Most movable of fibrous joints Long collagenous fibers Interosseus membranes unite radius to ulna and tibia to fibula  Cartilaginous Joint Synchondrosis Symphysis Loading…  Cartilaginous Joint -- Synchondrosis Bones are joined by hyaline cartilage – rib attachment to sternum – other costal cartilages are joined to the sternum by synovial joints 10 ribs S trueMee libs Cartilaginous Joint -- Synchondrosis epiphyseal plate in children binds epiphysis and diaphysis enolchondriocytes  Cartilaginous Joint -- Symphysis 2 bones joined by fibrocartilage – pubic symphysis and intervertebral discs (between two vertine – provides flexibility to spine Only slight amount of movement is possible  Synovial Joint between two bones , I disty don't eat articulate - eachout - oe [ outer layer Articular - where A bind torhe Joint in which two bones are separated by a space called a joint cavity Most are freely movable  condrocytes cell > synarial - Fluid > - General Anatomy synomial frid become Articular capsule encloses joint cavity – continuous with periosteum – lined by synovial membrane Articular cartilage = hyaline cartilage covering the joint surfaces Synovial fluid is rich in albumin and hyaluronic acid Nourishes the articular cartilages Removes their wastes and prevents friction during Spear : bon tapm" produce bone movements [prevent heat  General Anatomy e tems tibia patella , Menisci – knee joints not full cartilage – cartilages extend inward – do not entirely cross the joint – improve the fit between the no hyaline cartilage bones vessel cause there is lot blood and a – stabilize the joint synovidl – reduces the chance of ada igament - Ruid dislocation to make point add strong hyaline contilage Tendon attaches muscle to bone Ligament attaches bone to bone (expose Nex to and extension  General Anatomy Accessory structures 1.Tendon Sheet of tough collagenous connective tissue that attaches a muscle to a bone 2. Ligament Attaches one bone to another 3. Bursa 1 got cushion surround it Fibrous sac filled with synovial fluid Between adjacent muscles, bone and skin ---- Cushion muscles Bursitis- inflammation of bursa ↳ when got body stroke up  Axes of Rotation Shoulder joint has 3 degrees of freedom = multiaxial joint Other joints – uniaxial or biaxial Types of Synovial Joints tangan Intert - one movement Nexion extension geleng kepala the bones are gliding each other - radioulnar joint - Cl and C2 -carpal bones - moximal - metacarpal -Distal between 2 bone there is synovial fluid  Ball-and-Socket Joints Smooth hemispherical head fits within a cuplike depression articulate – head of humerus into fit [ glenoid cavity of scapula7 – head of femur into acetabulum of hip bone Multiaxial joint - Chip joint  Condyloid (ellipsoid) Joints Oval convex surface on one bone fits into a similarly shaped depression on the next – radiocarpal joint of the wrist – metacarpophalangeal joints at the bases of the fingers Biaxial joints convex  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  Gliding Joints Flat articular surfaces in which bones slide over each other Limited uniaxial joint Considered amphiarthroses (slightly movable)  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 Uniaxial joint macam pintu  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 more like the peverjoint  Flexion, Extension and Hyperextension Flexion decreases the angle of a joint Extension straightens and returns to the anatomical position Hyperextension = extension beyond 180 degrees Flexion, Extension and Hyperextension  Abduction and Adduction Loading… 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  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  Protraction and Retraction Protraction = movement anteriorly on horizontal plane – thrusting the jaw forward, shoulders or pelvis forward Retraction is movement posteriorly  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  Rotation Movement on longitudinal axis – rotation of trunk, thigh, head or arm Medial rotation turns the bone inwards Lateral rotation turns the bone outwards 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)  Movements of Head and Trunk Flexion, hyperextension and lateral flexion of vertebral column  Rotation of Trunk and Head Right rotation of trunk; rotation of head  Movements of Mandible Lateral excursion = sideways movement Medial excursion = movement back to the midline – side-to-side grinding during chewing Protraction – retraction of mandible  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  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  tendor igament is to support The Glenohumeral Joint Most freely movable joint in the body – dislocate shallowness and looseness compared to knee print senarg – 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, attach to make it stable · 4 Bursae associated with shoulder joint Tendon the femur articulate on fibia its tight when the point · make shoulder Staffe Stabilizers of the Shoulder Joint Tendons of Rotator Cuff Muscles lateral view  Dissection of Shoulder Joint give contour · four shoulder  The Elbow Joint Single joint capsule enclosing the humeroulnar and humeroradial joints and Numerous unaw Humeroulnar joint is supported by collateral ligaments. radius and ulnar Radioulnar joint is head of radius held in place by the anular ligament encircling the head Elbow Joint  The Hip Joint head of femur / add blood vessel to the head of femar. nutrient it will supply 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 make the hip Nint stronger Hip Joint Joint capsule strengthened by around ligaments the – pubofemoral hip – ischiofemoral joint – iliofemoral O Dissection of Hip Joint - dalam compared ↑ Shader head deat Kar  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 Knee Joint – Sagittal Section &  Knee Joint – Anterior and Posterior Views femur and tibia capsule looking - extension · an knee Anterior and lateral cruciate ligaments limit anterior and posterior sliding movements Medial and lateral collateral ligaments prevent rotation of extended knee  Knee Joint – Superior View tear · ligament took so long to recover sbb takde blood Vessel. in our · cartilage body have no blood supply that can carry of and nutrients Medial and lateral meniscus absorb shock and shape joint Dissection of Knee Joint  Arthritis cartilage inflammation Arthritis is a broad term for pain and inflammation Osteoarthritis results from years of joint wear - form lobang. – articular cartilage softens and degenerates – accompanied by crackling sounds called crepitus – Dbone spurs develop on exposed bone tissue causing pain 9-0  Arthritis and Artificial Joints autoimmune (all immune system recognizes Rheumatoid arthritis is autoimmune attack on joint – antibodies attack synovial membrane, enzymesandin synovial fluid degrade the form spore cartilage, bones ossify prevention : – remissions occur, steroids and aspirin control inflammation Arthroplasty is replacement of diseased joint with artificial device called prosthesis where the knee cannot walk anyone Rheumatoid Arthritis  Joint Prostheses - G Vital vertebrae column femur Gan head of... THANK YOU ANATOMY AND PHYSIOLOGY Skeletal System (Part 1) October 20 1  LEARNING OUTCOMES At the end of the lessons, student will be able to: Understand the functions of skeletal system Describe the structure of compact bone and spongy bone Understand the osteogenesis process Understand the structure and types of axial and appendicular skeleton Describe the types of joints and it’s movement October 20 2  The Skeletal System: An Introduction The skeletal system includes Bones of the skeleton Major cells in the bone Cartilages, ligaments and other connective tissues that stabilize and connect the bones October 20 3  Functions of the skeletal system Support Movement Protection Storage of minerals and lipids Blood cell production October 20 4  Structures of bone Diaphysis Epiphyses Metaphysis Articular cartilage Marrow cavity Filled with red or yellow marrow October 20 5 October 20 6  Compact bone and spongy bone Basic unit of compact bone is an osteon Osteocytes arranged around a central canal (Haversian canal) Formed layers (lamellae) Projection from osteocytes (canaliculi) Perforating canals (Volksman canal) extend between adjacent osteons Spongy bone contains trabeculae → no central canal October 20 7 October 20 8 October 20 9 Bone Histology October 20 10  Osseous tissue Supporting tissue with a solid matrix Crystals of hydroxyapatite Minerals deposited in lamellae Covered by periosteum Cells in bone: Osteoprogenitor cells (immatured) Differentiate into osteoblasts Osteoblasts synthesize new matrix (osteoid) Osteogenesis Osteocytes = mature bone cells in lacunae Connected by canaliculi Osteoclasts dissolve bone matrix Osteolysis October 20 11 October 20 12  Bone development and growth Ossification = converting cartilage tissue to bone tissue Calcification = depositing calcium salts within tissues (embedded inside the extracellular matrix) → crystallize the Extracellular Matrix (ECM) (harden) October 20 13  Ossification Intramembranous ossification Begins with osteoblast differentiation Dermal bones produced Begins at ossification center Flat bone Endochondral ossification Cartilage model gradually replaced by bone at metaphysis Increasing bone length Appositional growth increases bone diameter October 20 14 Intramembranous October 20 15 Endochondral October 20 16 October 20 17 October 20 18  The skeleton is a calcium reserve 99% body’s calcium in the skeleton Calcium ion concentration maintained by GI tract and kidneys (produce calcitrol to enhance Ca absorption in GI) Calcitonin (thyroid gland) and PTH regulate blood calcium levels Calcitonin decreases blood calcium levels PTH increases blood calcium levels October 20 19 October 20 20  Fracture repair Fracture hematoma External callus Internal callus October 20 21 October 20 22  A Classification of Bones Bone shapes Long Flat Short Irregular Sesamoid Sutural October 20 23  Bone shapes Characteristic Location Long bones Much longer than their Upper limbs: Humerus, wide (long). radius and ulna. (arm) Lower limbs: femur, tibia and fibula. (thigh) Short bones Roughly cube shaped carpals of hands (wrist) and tarsals of feet (ankle) Flat bones Thin, flattened Skull, Sternum, Scapula and ribs. Irregular bones Complex shape. Vertebrae and Pelvic bone Sesamoid bones Small, flat & shape like Patella (knee cap) sesame seed. Sutural bones Small, flat & irregularly Between the flat bones of shaped bones the skullOctober 20 24  Flat bone October 20 25 Sutural bone  Division of the Skeleton Axial Appendicular Skeleton Skeleton October 20 26  Features in bone Openings Fissure = narrow slit between adjacent bone. Allows BV and Nerves (Eg; superior orbital fissure) Foramen = round opening. Allow BV and Nerves (Eg; mental foramen) Fossa = shallow depression. Eg; lacarimal fossa) Sulcus = furrow along a bone surface that accomodates BV, nerves and tendon (Eg; intertubucular sulcus of humerus) Meatus = tubelike opening (Eg; external auditory meatus of temporal bone) October 20 27 October 20 28  Process form joints Condyle = large rounded protubance (Eg: lateral condyle femur) Facet = Smooth flat articular surface (Eg; Superior articular facet of vertebrae) Head = rounded articular projection supported on the neck (Head of femur) October 20 29  Process form attachment point of Connective Tissue Crest = prominent elongated projection (Eg; Illiac crest of hip bone) Epicondyle = projection above condyle (Eg; medial epicondyle of femur) Line = long and narrow ridge (Eg; linea aspera femur) October 20 30  Spinous process = sharp and slender projection (Eg; spinous process of vertebrae) Trochanter = very large projection (Eg; greater trochanter of femur) Tubercule = knob or rounded projection (Eg; greater tubercle of femur) Tuberosity = large, rounded and roughenend projection (Eg; ischial tuberosity of the hip bone) October 20 31 Blue = Axial Skeleton [skull, vertebral column, ribs, sternum] SUBTOTAL = 80 Black = Appendicular Skeleton [pectoral girdle, pelvic girdle, upper limbs, lower limbs] SUBTOTAL = 126 TOTAL = 206 October 20 32  AXIAL SKELETON Skull Vertebral column Auditory ossicles Thoracic and hyoid bone cage October 20 33  The skull Cranial Bone (8 bones) The cranium encloses cranial cavity Parietal = 2 (greater portion of sides and roof of skull, internal surface contains many protrusion and depression) Temporal = 2 (inferior to parietal, internal and external auditory meatus) Frontal = 1 forehead (anterior of cranium, roof of orbits) Occipital = 1 (posterior of cranium, foramen magnum) October 20 34  The skull Sphenoid = 1 (middle part of base skull; holding other cranial bone, like butterfly) Ethmoid = 1 (anterior to sphenoid and posterior to nasal bone; support structure of nasal cavity) Sagittal suture = between 2 Parietal Squamous suture = Parietal and Temporal Coronal suture = Parietal and Frontal Lambdoid suture = Parietal and Occipital October 20 35 October 20 36  Face Bones Facial bones surround and protect the entrances to the respiratory and digestive tracts Nasal = 2 Maxillae = 2 Zygomatic = 2 Lacrimal = 2 Palatine = 2 Mandible = 1 Vomer = 1 October 20 37 Nasal bones Superior border of external areas Midline, bridge of nose Maxillae Largest facial bones Form the upper jaw and most of the hard palate October 20 38 Zygomatic bone Cheekbone, project posteriorly Temporal process articulates with zygomatic process of temporal bone Lacrimal bones Sit medially in orbit Posterior and lateral to nasal bone Smallest facebone Lacarimal fossa (connect to nasal cavity) October 20 39 Palatine 2 small “L” shaped bones Form the posterior hard palate and floor of the nasal cavity Mandible Bone of the lower jaw Strongest facebone Vomer Inferior portion of the nasal septum October 20 40 October 20 41 Hyoid bones Unpair 1 U shape bone Suspended from styloid processes of temporal bone Via ligaments and muscles Supports the larynx Auditory ossicles 6 (Malleus, Incus , Stapez) left and right October 20 42 October 20 43  Vertebral column Consist of vertebrae, sacrum, coccyx 7 cervical vertebrae (C) 12 thoracic vertebrae (T) 5 lumbar vertebrae (L) Sacrum and coccyx are fused vertebrae October 20 44 October 20 45  Spinal curvature Four spinal curves Cervical and lumbar are convex Thoracic and sacral concave are curves Abnormal curves Scoliosis Kyphosis Lordosis October 20 46 October 20 47  Vertebral anatomy Typically has a body and vertebral arch Superior and inferior articular processes Transverse process Separated by intervertebral discs October 20 48 October 20 49  Cervical vertebrae Has distinctive shape Atlas (1st Cervical, no body) Large relative size of vertebral foramen Axis (2nd Cervical, dens=protrudes superiorly from the axis) October 20 50  Notched (v shape) spinous processes Transverse processes with transverse foramina = vertebral arteries pass towards brain October 20 51  Thoracic vertebrae Heart-shaped body Long slender spinous processes Extra articular facets at transverse process Rib attachment Small vertebral foramen compared to spinal vertebrae October 20 52  Lumbar vertebrae Large and thick body Most massive Least mobile Subjected to great stresses Superior articular facet face medially October 20 53  Sacrum & coccyx 5 sacral vertebrae fused together Protects reproductive, digestive and urinary organs Articulates with pelvic girdle and fused elements of coccyx Spinous process from 1st to 4th sacral bone formed medial sacral crest October 20 54  Thoracic cage The ribs Costal rib (true ribs) = 1-7 are attached to sternum False rib = 8-12 do not attached directly to sternum 8-10 attached to sternum by costal cartilage 11-12 not attached to sternum at all. Known as floating ribs Sternum Manubrium Body Xiphoid process October 20 55 October 20 56  APPENDICULAR SKELETON Pectoral Pelvic Upper Lower girdle girdle limbs limbs Scapula & Hip bones Humerus, Femur, tibia, clavicle ulna, radius, fibula, patella, (shoulder) carpals, tarsals, metacarpals & metatarsals & phalanges phalanges October 20 57  Pectoral girdle (shoulder girdle) Articulates the upper limbs with the trunk Consists of clavicle and scapula Clavicle and scapula Position the shoulder joint Help move the upper limb Provide a base for muscle attachment Scapula markings are attachment sites for tendons/ligaments of shoulder joint October 20 58 October 20 59  The upper limbs Consists of Humerus, Radius,Ulna, Carpal, Metacarpal, Phalanges Humerus (arm) October 20 60  Radius and ulna Forearm October 20 61  Carpal (Wrist) 8 bones Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate October 20 62  Metacarpal (5 bones) Phalanges (14 bones) Fingers Proximal Intermediate Distal October 20 63  The pelvic girdle and lower limbs More massive than the pectoral girdle 2 coxal bone Fusion of ilium, ischium and pubis October 20 64  Ilium Largest hip bone Within acetabulum, fused to the ischium (posteriorly) and the pubis (anteriorly) Pubic Pubic symphysis limits left to right Pelvis Composed of the hipbones, sacrum and coccyx Subdivided into the false (greater) and true (lesser) pelvis October 20 65 The difference between male and female pelvic bone October 20 66  The lower limbs Femur is the longest bone in the body Articulates with the tibia at the knee Patella is a large sesamoid bone Fibula parallels tibia laterally October 20 67 October 20 68 October 20 69 October 20 70  Tarsus, metatarsal and phalanges Has seven tarsal bones Pattern of metatarsal bones and phalanges parallels that of the hand All toes have three phalanges except the hallux (two phalanges) Ankle and arches When standing, most of the weight of the body is transferred from the talus to the calcaneous Rest is passed on to metatarsals Weight transfer occurs along longitudinal arch Transverse arch October 20 71 October 20 72 October 20 73 October 20 74  JOINT Definition The point at which two or more bones are connected. Functions Gives the skeleton mobility and hold it together. October 20 75  Structural classification of joint Based on material binding the bones together bones can be classified as:  Fibrous joint  Cartilaginous joint  Synovial joints October 20 76  Classification based on degree of movement No movement (immovable), Synarthosis Slight movement (slightly movable) Amphiarthosis Free movement (freely movable) Diarthosis October 20 77  Fibrous joint Examples: Suture = skull bones bound together by dense connective tissue Fontanels in baby’s skull Gomphosis = teeth bound to bony sockets by periodontal ligaments Syndesmoses = two bones bound by rigid cartilaginous bridge (Eg; tibia and fibula, radius and ulna) October 20 78  FIBROUS JOINT Do not allow movements (Immovable joints). October 20 79 Ghomposes Syndesmoses October 20 80  CARTILAGINOUS JOINTS Synchondroses = connected by hyaline cartilage Eg: first rib and manubrium Immovable joint (synarthosis) Symphyses = connected by broad hyaline or flat fibrocartilage Eg: invertebral disc between body of vertebrae and manubrium and sternum Known as amphiarthosis (slightly movable joints) October 20 81 Cartilagenous Joint Sternum consist of : Manubrium Body Xiphoid process October 20 82  SYNOVIAL JOINT Freely movable joints Bony surfaces enclosed within articular capsule Bony surfaces covered by articular cartilage Bony surfaces lubricated by synovial fluid There are 6 types of synovial joints: October 20 83  Synovial Joint Bones are separated by a fluid –containing joint cavity. Allow free movement (freely movable joints). Most joints of the body fall into this class. eg. all the joints of the limbs. October 20 84  Structural classification of joints Gliding (plane) joints permit movement in a single plane Saddle joints are biaxial joints with one concave and one convex bone face Hinge joints are monaxial joints permitting angular motion in one plane Pivot joints are monaxial joints that permit rotation Ball-and-socket joints are triaxial joints that permit rotation and other movements Ellipsoid joints are biaxial joints that pit one bone in an oval depression of another October 20 85  Ligament Description Tissue that link two bones together at joints. Elastic, strong and tough. Functions Strengthen the joint Limit movement to certain directions. October 20 86  Tendon Description Tissue that attach muscles to bones. Inelastic, strong and tough. Functions Helps in joint movements. Limit the movements of muscle. October 20 87  Intervertebral articulations Gliding joints Vertebral bodies form symphyseal joints cushioned by intervertebral discs Outer anulus fibrosus and inner nucleus pulposus Stabilized by ligaments October 20 88 Shoulder joint (glenohumoral joint) Glenoid cavity and head of humerus Ball and socket diarthroses Stabilized by ligaments Strength and stability sacrificed for range of motion October 20 89  The elbow joint Permits only flexion and extension Hinge diarthroses Reinforced with strong ligaments October 20 90  Hip joint Ball and socket diarthroses Acetabulum and head of femur Permits flexion/extension, abduction/ adduction, circumduction, rotation Stabilized by numerous ligaments October 20 91  Knee joint Hinge joint with incomplete articular capsule Formed by the condyles of the femur and the condylar surfaces of the tibia Accessory structures help stabilize lateral movements Permits flexion/extension, limited rotation Supported by ligaments October 20 92  Joint problems with aging Joint problems associated with aging Relatively common Rheumatism – general term for pain and stiffness in muscular and skeletal elements Arthritis – all rheumatic diseases affecting synovial joints Musculoskeletal system Encompasses the extensive interactions between the muscular and skeletal systems October 20 93 October 20 94  Aging and the Skeletal System Effects of aging include Osteopenia Osteoporosis October 20 95  Angular movement Flexion VS Extension October 20 96  Adduction VS Abduction October 20 97  Circumduction October 20 98  Rotation Supination VS Pronation October 20 99  Right Rotation VS Left Rotation October 20 100  Medial Rotation VS Lateral Rotation October 20 101  Inversion VS Eversion October 20 102  Dorsiflexion VS Plantar Flexion October 20 103  Opposition VS Reposition October 20 104  Protraction VS Retraction October 20 105  Elevation VS Depression October 20 106