ANAT Joints Lecture Notes PDF

(007) JOINTS DR. TAGORDA | 10/28/2020 OUTLINE (Based on the material binding them and presence or absence I. JOINTS...

(007) JOINTS DR. TAGORDA | 10/28/2020 OUTLINE (Based on the material binding them and presence or absence I. JOINTS of a joint cavity) A. Definition Bony fusion - Bone (Binding material) II. CLASSIFICATION OF JOINTS Fibrous - Fibrous tissue (Binding material) A. Functional classification Cartilagenous - Cartilage (Binding material) B. Structural classification Synovial - consist of Synovial fluid III. TYPES OF JOINTS A. Bony fusion B. Fibrous joint III.TYPES OF JOINTS a. Sutures b. Gomphoses TABLE OF JOINT TYPES c. Syndesmoses C. Cartilaginous Functional Synarthroses Amphiarthroses Diarthroses a. Synchondroses cross (Immovable (Some (Freely b. Symphyses joints) movement) movable) D. Synovial a. General Structure of Synovial Joints 1. Articular Cartilage 2. Joint (Synovial cavity) Bony Fusion Synostosis 3. Articular (or joint) capsule (frontal- 4. Synovial fluid metopic suture; 5. Reinforcing ligaments (some joints) epiphyseal 6. Nerves lines) 7. Blood vessels b. Movements allowed by synovial joints Fibrous Suture (skull Syndesmoses – Syndesmoses c. Synovial joint classified by shape of only) – fibrous ligaments – ligament articular surfaces tissue is between bones; longer 1. Plane continuous with ligaments are (example: 2. Hinge periosteum short so, with radioulnar 3. Condyloid some movement interosseous 4. Saddle Gomphoses (example: tib-fib membrane) 5. Ball and Socket (teeth) – ligament) ligament is IV. DISORDERS OF THE JOINT periodontal A. Injuries ligament B. Inflammatory and degenerative conditions Cartilagenous Synchondroses Sympheses – a. Bursitis (bone united – hyaline fibrocartilage b. Tendonisitis by cartilage cartilage (examples: c. Arthritis only) (examples: between discs, d. Rheumatoid arthritis manubrium-1st pubic e. Gouty arthritis rib, epiphyseal symphesisS plates) Synovial ALL ARE DIARTHROTIC I. JOINTS - site where two or more bones join together, whether or not movement occurs between them - classified according to the tissues that lie between the bones: fibrous joints, cartilaginous joints, and synovial joints In amphiarthroses and diarthroses, the difference can be seen at the LENGTH OF THE LIGAMENTS that joins II.CLASSIFICATION OF JOINTS different bones. Amphiarthroses (some or small movements) - Short ligaments A. FUNCTIONAL CLASSIFICATION (Focuses on amount of movement) Diarthroses (freely movable) - longer ligaments Synarthroses(Immovable Joints) A. BONY FUSION Amphiarthroses (slightly movable joints) (Ex. frontal=metopic suture; epiphyseal lines) Diarthroses(Freely movable joints) Frontal = Frontal sutures B. STRUCTURAL CLASSIFICATION Epiphyseal line - in long bones PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 B. FIBROUS JOINTS b. GOMPHOSES – no movement Bones connected by fibrous tissue: ls a “PEG-IN SOCKET” Dense regular connective tissue Only example is TOOTH with its socket No joint cavity Ligament is a short periodontal ligament (structure between the tooth and the alveolar process) Slightly immovable or not at all Example of fibrous joint without movement - have no cavities & permit little movement Fig. 1 Photomicrograph Dense regular connective tissue from tendon (1000x) Fig. 3 Gomphoses - articulating surfaces of bones are tightly linked by fibrous tissue that fills the joint space. Thus, very little movement. c. SYNDESMOSES - some movement or freely movable In Greek: "LIGAMENT" e.g. sutures of the vault of the skull and inferior tibiofibular joints Bones connected by ligaments only Amount of movement depends on length of the a. SUTURES – no movement fibers: longer than in sutures - prevent excessive movement in joints Only between bones of skull - are connected by fibrous connective tissue Fibrous tissue continuous with periosteum - occur as the inferior tibiofibular and Ossify and fuse in middle age: now technically tympanostapedial syndesmoses. called "SYNOSTOSES" Bony, junctions/fusion -are joined by fibrous connective tissue and found between flat bones of the skull. Fig. 4. Syndesmoses Fig. 2 Suture PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 C. CARTILAGENOUS JOINTS Examples: Articulating bones united by cartilage Lack a joint cavity Intervertebral discs Not highly movable Pubic symphysis of the pelvis - the space between the articulating bony surfaces is filled with cartilaginous pad TWO TYPES OF CARTILAGENOUS JOINTS - Synchondroses (singular: synchondrosis) - Symphyses (singular: symphysis) a. SYNCHONDROSIS / SYNCHONDROSES Literally:"junction of cartilage" Hyaline cartilage unites the bones Immovable (synarthroses) - Primary cartilaginous joints - Joint in which the articulating bones are united by Fig. 6 Symphyses plate/ bar of hyaline cartilage. - Permit little to no movement but allow growth in length during childhood & adolescence. ❖ temporary form - epiphyseal plate bet. epiphysis and diaphysis of growing bone. ❖ permanent - the 1st sternocostal joint bet. the first rib and manubrium sterni. Examples: Epiphyseal plates (growth plate) Joint between first rib's costal cartilage and manubrium of the sternum Fig. 7 Synchondroses and symphyses D. SYNOVIAL JOINT Includes most of the body joints Fig. 5 Synchondroses All are diathroses (freely movable joints) All contain fluid filled joint cavity b. SYMPHYSIS/ SYMPHYSES - Articular surfaces of the bones are covered by a - Secondary cartilaginous joints thin layer of hyaline cartilage & separated by - are slightly movable joints fluid-filled joint cavity. e.g. pubic symphysis & intervertebral disks. - This arrangement permits a great degree of freedom of movement. Literally "GROWING TOGETHER" - The cavity of the joint is lined by a synovial FIBROCARTILAGE unites the bones membrane, which extends from the margins of one articular surface to those of the other. Slightly movable (amphiarthroses) - Capsule is a tough fibrous membrane of the joint Resilient shock absorber which protects the external synovial membrane. Provide strength and flexibility Hyaline cartilage on articular surfaces - located along the midline of the body - the intervertebral joints between the vertebral bodies, the manubriosternal joint & symphysis pubis are symphyseal joints. PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 6. Nerves Detect pain Monitor stretch (one of the ways of monitoring posture and movement) 7. Blood vessels Rich in blood supply Extensive capillary bed in synovial membrane (produce blood filtrate) NOTE: The different joints are rich in blood supply Fig. 8 Synovial Joint a. GENERAL STRUCTURE OF SYNOVIAL JOINTS 1. Articular cartilage Hyaline Spongy cushion absorbs compression Protect ends of bins from being crushed distal lining of the bone OSTEOARTHRITIS - damage in articular cartilage specially in adults or older patients. Without AC there is know smooth rubbing between bones forming the synovial joints - In certain synovial joints (e.g. knee joint, temporomandibular joint), discs / wedges of fibrocartilage 2. Joint (synovial) cavity are interspersed bet. articular surfaces of bones referred to Potential space - it becomes a space when as articular discs. there is something inside (Synovial fluid). - Some synovial joints (e.g. hip & knee joints) contain fatty Without SF there is no space that is why it pads lying bet. the synovial membrane and the fibrous is called a POTENTIAL SPACE capsule or bone. occupied by synovial fluid Small amount of synovial fluid Some joints have: Articular disc or meniscus 3. Articular (or joint) capsule - Literally crescent Two layered - Only seen in some joints Outer layer: fibrous capsule of dense irregular connective continuous with periosteum Inner: synovial membrane of loose connective tissue( makes synovial fluid) 4. Synovial fluid Filtrate of blood Contain special glycoproteins Nourishes cartilage and function as slippery lubricant Weeping lubrication - a viscous fluid produced by a synovial membrane which lubricates the articular surfaces. 5. Reinforcing ligament Capsular: most thickened parts of capsule Extracapsular Intracapsular - closely associated with articular disc. PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 - Those with bone ends of different shapes or fitting poorly - Extension - Some to allow two kinds of movement of fibrocartilage - Abduction Example: knee, temperomandibular joint, sternoclavicular. - Adduction - Circumduction Rotation Special movements - Pronation - Supination - Dorsiflexion - Plantar flexion - Inversion - Eversion - Protraction - Retraction - Elevation - Depression - Opposition c. Synovial joint classified by shape of articular surfaces 1. Plane (gliding) - The apposed articular surfaces are flat or almost flat, which permits the bones to slide to one another Bursae and tendon Sheaths - United by two flat articular surfaces & allow simple - Contain synovial fluid gliding/ sliding of one bone over the other. - They are not joints but often associated with joints ex: sternoclavicular & acromioclavicular joints - The act like ball bearings - Bursae means "purse" in Latin 2. Hinge (ginglymus) - Flattened sacs lined by synovial membrane. Where - resembles the hinge on a door, so that flexion and ligament, muscle, tendon or bone overlap each other and extension movements are possible rub together - ex. elbow, knee, and ankle joints. - Tendon sheath - Only present in tendon subjected to friction - Elongated bursa that wraps around tendon 3. Pivot (trochoid) - surrounded by a bony-ligamentous ring - rotation is the only movement possible - ex. atlantoaxial and superior radioulnar joint - formed by a central bony pivot turning within a bony ring & allow only rotation. Occur in the superior & inferior radioulnar joints and in the atlantoaxial joint. ex: median atlantoaxial & superior radioulnar joints 4. Condyloid (ellipsoidal) - have two distinct convex surfaces that articulate with two concave surfaces - movements of flexion, extension, abduction, and adduction are possible together with a small amount of rotation - allow flexion and extension and occur in the wrist (radiocarpal), metacarpophalangeal, knee (tibiofemoral), and atlantooccipital joints. ex: metacarpophalangeal joints in the hands (knuckle) and feet Don’t be confused with the bursa and the tendon sheath. They contain synovial fluid but they are not synovial joints. 5. Saddle (sellar) - articular surfaces are reciprocally concavo-convex and resemble a saddle on a horse’s back b. MOVEMENT ALLOWED BY SYNOVIAL JOINTS - Resemble a saddle on a horse’s back and allow Gliding flexion and extension, abduction and adduction, Angular movement ↑ or ↓ the angle and circumduction but no axial rotation. between two Bones - permit flexion, extension, abduction, adduction, - Flexion and rotation PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 - Occur in the carpometacarpal joint of the thumb and between the femur and patella. ex: carpometacarpal joint of thumb 6. Ball and socket (spheroidal or cotyloid) - a ball-shaped head of one bone fits into a socket- like concavity on another - permits free movements including flexion, extension, abduction, adduction, medial rotation, lateral rotation, and circumduction ex. shoulder joint and hip joint, glenohumeral (shoulder) & hip joint 2. Elbow Joint - Hinge: allows only flexion and extension - either increase or decrease the angle (angular movement: extension or flexion) EXAMPLE OF SELECTED SYNOVIAL JOINTS 1. Shoulder (Glenohumeral) Joint - Stability sacrificed for mobility - Ball and socket: head of humerus with glenoid cavity of scapula - Glenoid labrum: made up of rim of fibrocartilage - Thin, loose capsule - Strongest ligament: coracohumeral - Muscle tendons help stability - Disorders PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 4. Hip (COXAL) Joint - Ball and socket 3. Wrist Joint - moves in all axes but limited by ligaments and deep socket - Two major joint surfaces - Three ext. ligaments “screw in” head of femur when standing - Several ligaments stabilize Iliofemoral - strong, anterior V-shaped ligament i. Radiocarpal joint Pubofemoral - Between radius and proximal carpals (scaphoid - triangular thickening and lunate) Ischiofemoral - Example of condyloid joint - Flexion, extension, adduction, abduction, - spiraling posterior ligament circumduction The three ligaments contribute to the stability of the hip joint. ii. Intercarpal or midcarpal joint - Between the proximal and distal rows of carpals - Joint formed by the different carpal joints PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 a) Anterior cruciate (ACL). b) Posterior cruciate 5. Knee Joint - Largest and most complex - Primarily a Hinge - Compound and bicondyloid: femur and tibia both have 2 condyles - Femoropatellar joint shares joint cavity - At least a dozen bursae - Prepatellar - Suprapatellar Cruciate Ligaments - Cross each other (cruciate means cross) - Anterior cruciate (ACL) Anterior intercondylar area of tibia to medial side of lateral condyle of femur - Posterior Cruciate Posterior intercondylar area of tibia to lateral side of medial condyle Named according to its origin. - acts as restraining straps - Lock the knee Cruciate ligament is a ligament usually torn in soccer and basketball players. Surgery is delicate since this involves ligaments. Recovery takes a long time at least 8 weeks when ligaments are sutured. Cruciate ligaments. anterior views flexed knee PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 6. Ankle Joint - Hinge joint Sternoclavicular joint Sternoclavicular movement IV. DISORDER OF JOINTS Ankle joint A. INJURIES Sprains (include ligaments) - ligament sprain: 7. Sternoclavicular Joint injury caused by abnormal or excessive force at a joint, but without dislocation of the joint or fracture - Saddle joint of a bone; ligaments reinforcing a joint are stretched or torn Example - trapezium and metacarpal 1 (thumb). allowing opposition Strains (include muscles) - Commonly called a - Sternum and 1st costal (rib) cartilage articulate with clavicle “pulled muscle,” a strain is excessive stretching - very stable: clavicle usually breaks before dislocation of joint and possible tearing of a muscle due to muscle When there is trauma in the clavicle before it overuse or abuse becomes dislocated it will break first. One may sustain a Dislocations (luxation) - occurs when bones are fracture of the clavicle first before dislocation. out of alignment - Only bony attachment of axial skeleton of pectoral girdle Torn cartilage - typically occur when a meniscus is subjected to compression and shear stress at the same time; avascular and it rarely can obtain sufficient nourishment to repair itself, so it usually stays torn. B. INFLAMMATORY AND DEGENERATIVE CONDITIONS a. Bursitis - inflammation or infection in bursa - caused by blow or friction PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 Types of bursa: Housemaid’s knee / Water on the knee - painful bursitis on prepatellar bursa Student’s elbow / Olecranon bursitis - prolonged leaning on one’s elbows may damage the bursa close to the olecranon b. Tendonitis - Inflammation or infection in tendons - Inflammation of tendon sheaths - Typically caused by overuse c. Arthritis - Inflammation or infection of different joints 1. Osteoarthritis (“DJD” - degenerative joint disease) inflammation of the joint secondary to degenerative disease. Because of aging there would be no smooth gliding motion between the bones. most common chronic arthritis often called the “wear-and-tear arthritis” 2. Rheumatoid arthritis Autoimmune disorder that the body develops antibodies that would destroy elements of the synovial joint causing the inflammation of joints. usually arises between the ages of 30 and 50 chronic inflammatory disorder 3. Gouty arthritis (crystal arthropathy) Lot of calcium is deposited in the different joints called “gout” that may trigger the inflammation. Usually seen in alcoholics. initial attack typically affects one joint, often at the base of the great toe. Gout is far more common in men than in women because men naturally have higher blood levels of uric acid PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.  (007) JOINTS DR. TAGORDA | 10/28/2020 TEST YOURSELF 4. What structure is colored yellow in the previous number (3)? A. Costoclavicular ligament 1. Name the ligament numbered 2 B. Intraclavicular ligament C. Anterior sternoclavicular ligament 1 D. None of the above 3 2 5. Refer to number 3, where can you find these ligaments? A. Elbow Joint 4 B. Ankle Joint C. Shoulder Joint D. Sternoclavicular Joint 6. This is an autoimmune disorder characterized by antibodies that would destroy elements of the synovial joint which will eventually lead to inflammation of joints. A. Rheumatoid Arthritis A. Pubofemoral ligament B. Crystal Arthropathy B. Iliofemoral ligament C. Strain C. Anular ligament D. Osteoarthritis D. Iliac spine 2. What are the two ligaments you can find in picture shown? 7. True or false. Tendon and bursa are synovial joint. 8. A structure of synovial joint that has an outer layer of fibrous capsule of dense irregular connective tissue and an inner layer made up of loose connective tissue. 9. Two types of cartilaginous joints. 10. These ligaments contribute to the stability of the hip joint I. Iliofemoral II. Pubofemoral III. Ischiofemoral IV. Anular A. I and II only I. Anterior Cruciate Ligament (ACL) B. II and III only II. Anular Ligament C. I, II and III III. Tibial collateral ligament D. All of the above IV. Posterior Cruciate Ligament A. I and III B. III and IV ANSWERS C. I and IV 1. A D. I and II 2. C 3. A 4. B 5. D 3. Name the ligament in color green. 6. A 7. False 8. Articular (or joint) capsule 9. Synchondroses and symphyses 10. C REFERENCES Snell, Richard S. (2012). Clinical Anatomy by Regions (9th ed.). Philadelphia: Lippincott Williams & Wilkins. A. Costoclavicular ligament B. Intraclavicular ligament Marieb, Elaine N. & Hoehn, Katja (2013). Human Anatomy and C. Anterior sternoclavicular ligament Physiology (9th ed.). USA: Pearson, Inc. D. None of the above PREPARED & EDITED BY: LAPIDEZ, R., LAZO, R., LEONARDIA, R., LEONES C., OLUKOKUN, S., ORENIA R., OROZO, M., PA-A, A.