Gross Anatomy of Joints HH PDF

Structure & Function of Human I (GTU 101/3) SKELETAL SYSTEM: GROSS ANATOMY OF JOINTS Assoc. Prof. Dr. Hermizi Hapidin Pusat Pengajian Sains Kesihatan (PPSK) Universiti Sains Malaysia Email. Add.: [email protected] Ext. No.: 7634  CONTENTS : 1) Definition of Joint 2) Classificatio...

Structure & Function of Human I (GTU 101/3) SKELETAL SYSTEM: GROSS ANATOMY OF JOINTS Assoc. Prof. Dr. Hermizi Hapidin Pusat Pengajian Sains Kesihatan (PPSK) Universiti Sains Malaysia Email. Add.: [email protected] Ext. No.: 7634  CONTENTS : 1) Definition of Joint 2) Classification of Joints 3) Movements at Synovial Joints 4) Types of Synovial Joints 5) Introduction to Major Joints of the body  JOINT Definition: An articulation – the place of union or junction between two or more bones or parts of the skeleton  Joints exhibit a variety of form and function  Some joints have no movement, others allow only slight movement and some are freely movable  Function of joints: Give the skeleton mobility Hold the skeleton together  JOINT  Factors stabilizing a joint: 1. Articular surfaces of bones - shape determines what movements are possible 2. Ligaments - (elastic and fibrous) unite bones and prevent excessive or undesirable motion 3. Muscle tone – kept tight the tendons Elbow joint  CLASSIFICATION OF JOINTS STRUCTURAL FUNCTIONAL Fibrous Synovial Synarthrosis Diarthrosis Cartilaginous Amphiarthrosis STRUCTURAL CLASSIFICATION OF JOINTS  The structural classification is based on two criteria: ❖ the presence or absence of a space between the two articulating bones – a synovial cavity ❖ the type of connective tissue that binds the bones together  Structurally, joint is classified as: i. Fibrous joints - held together by fibrous connective tissue ii. Cartilaginous joints - held together by cartilage iii. Synovial joints - have a synovial cavity FUNCTIONAL CLASSIFICATION OF JOINTS  The functional classification is based on the amount of movement allowed by the joint  Functionally, joint is classified as: i. Synarthrosis (syn = together) - an immovable joint - plural = synarthroses ii. Amphiarthrosis (amphi = on both side) - a slightly movable joint - plural = amphiarthroses iii. Diarthrosis - a freely movable joint - permit several types of movement - plural = diarthroses  i. Fibrous Structural Joints  The bones are joined by fibrous connective tissues  There is no joint cavity or synovial cavity  There are four types: ❖ Sutures ❖ Syndesmoses ❖ Gomphoses ❖ Interosseous membranes  a) Sutures ▪ Occur between the bones of the skull ▪ Comprised of interlocking junctions completely filled with thin layer of dense irregular connective tissue ▪ Bind bones tightly together, but allow for growth during youth ▪ Example; coronal suture between parietal and frontal bone ▪ Suture is immovable – it is classified functionally as synarthrosis F P P  b) Syndesmoses  Syndesmo = band or ligament  Bones are connected by dense connective tissue, typically arranged as a bundle (ligament)  Permits slight movement, classified functionally as amphiarthrosis  One example; distal tibiofibular joint (anterior tibiofibular ligament connects the tibia and fibula) Distal tibiofibular joint  c) Gomphoses ▪ Gompho = a bolt or nail ▪ The peg and socket fibrous joint ▪ One example; articulations of roots of the teeth (peg) with the sockets (alveoli) of the alveolar processes of the maxillae & mandible ▪ The fibrous connection is the periodontal ligament ▪ Gomphosis permits no movement = synarthrosis Peg = tooth, Socket = alveolar process of maxilla or mandible  d) Interosseous Membrane ▪ A sheet of dense irregular connective tissue that binds neighboring long bones ▪ Permits slight movement; functionally classified as amphiarthrosis ▪ Two examples; interosseous membrane between radius and ulna (forearm), interosseous membrane between tibia and fibula in leg Interosseous Interosseous membrane membrane Interosseous membrane between tibia and fibula Interosseous membrane between radius and ulna  Types of Fibrous Joints Periodontal ligament Suture line a) Suture between skull bones c) Gomphosis between tooth and socket of alveolar process Tibiofibular ligament b) Syndesmosis between tibia and fibula (distal tibiofibular joint) d) Interosseous membrane radius and ulna ii. Cartilaginous Structural Joints  Articulating bones are united by cartilage (hyaline cartilage or fibrocartilage)  Like fibrous joint, cartilaginous joint lacks a joint cavity or synovial cavity  Allows little or no movement  Two types: ❖ Synchondroses ❖ Symphyses Synchondroses Symphysis  a) Synchondroses (condro = cartilage)  Connecting material unites the bones is hyaline cartilage  All synchondroses are synarthrotic (immovable joint)  Examples include: a. Epiphyseal plates of children b. Joint between the costal cartilage of the first rib & the sternum Epiphyseal plate Joint between costal cartilage of 1st rib and sternum  b) Symphyses (simfisis = growing together)  Two bones are joined by fibrocartilage  Ends of articulating bones are covered with hyaline cartilage, but a broad & flat disc of fibrocartilage connects the bones  All occur in the midline of the body  Amphiarthrotic joints (a slightly Pubic symphysis movable) designed for strength and flexibility  Examples include: a. Intervertebral joints Intervertebral joint between b. Pubic symphysis of the pelvis the bodies of vertebrae  Types of Cartilaginous Joints Synchondroses - Epiphyseal plate Synchondroses – Joint between 1st rib and sternum Symphyses – Pubic symphysis and Intervertebral joint  iii. Synovial Structural Joints  The unique characteristic of synovial joint is the present of a space = synovial/joint cavity  All are freely movable (diarthroses)  Examples – all limb joints, and most joints of the body iii. Synovial Joints (General Structure)  Structure of typical synovial joint: Articular cartilage Joint (synovial) cavity Articular capsule Synovial fluid Accessory ligaments Menisci iii. Synovial Joints (General Structure) iii. Synovial Joints (General Structure) Articular cartilage Fibrous capsule Ligament Tendon Synovial membrane Synovial fluid Frontal section  iii. Synovial Joints (General Structure) ▪ Bones at the synovial joint are covered by a layer of hyaline cartilage - articular cartilage ▪ Articular capsule surrounds synovial joint, encloses synovial cavity and unites articulating bones  Articular capsule is lined internally by synovial membrane  Synovial cavity contains synovial fluid - lubricates joint  Many synovial joints also contain accessory ligaments - extra or intracapsular ligaments support the joint  May contain articular discs or menisci – pads of fibrocartilage (maintain stability of joint)  iii. Synovial Joints (Extra Structure)  Bursae; flattened, fibrous sacs lined with synovial membranes & containing synovial fluid - common where ligaments, muscles, skin, tendons or bones rub together  Tendon sheath; a membrane / fibrous sheath covering a tendon  Fat pad; an accumulation of encapsulated adipose tissue Shoulder joint Subacromial bursa Tendon sheath Fat Bursa iii. Synovial Joints (Extra Structure) Shoulder joint (synovial joint with bursa and tendon sheath)  iii. Synovial Joints Could be:  Without articular disc (hip joint or ball and socket joint)  With articular disc (knee joint, temporomandibular joint) Meniscus or articular disc  iii. Synovial Joints Articular disc Temporomandibular joint (synovial joint with articular disc or meniscus)  iii. Movements at Synovial Joints  Body movement - when the muscle contract across the joint and the insertion moves toward the origin  Range of motion: Nonaxial – slipping movements only Uniaxial – movement in one plane Biaxial – movement in two planes Multiaxial / Triaxial – movement in Origin – attachment to the immovable bone Insertion – attachment to the movable bone or around all three planes iii. Types of Movements at Synovial Joints  Movements at synovial joints are grouped into FOUR main categories: 1) Gliding 2) Angular 3) Rotation 4) Special 1). Gliding Movements at Synovial Joints ▪ Simple movement - one flat bone surface glides or slips over another similar surface ▪ Examples – intercarpal and intertarsal joints, and between the flat articular processes of the vertebrae Consists of side-to-side and back-and-forth motions (intercarpal joints) 2). Angular Movements at Synovial Joints ▪ There is an increase or a decrease in the angle between articulating bones ▪ Major angular movements are: i. Flexion ii. Extension iii. Dorsiflexion and plantar flexion iv. Lateral extension v. Hyperextension vi. Abduction vii. Adduction viii. Circumduction 3). Angular Movements at Synovial Joints  Flexion - decreases the angle of the joint  Extension - joint angle is increased - hyperextension  Dorsiflexion and plantar flexion Elbow joint - up and down movement of the foot Ankle joint Hip joint 3). Angular Movements at Synovial Joints  Abduction - movement away from the midline  Adduction - movement toward the midline  Circumduction - movement describes a cone in space Hip joint Shoulder joint Hip joint  4). Rotation at Synovial Joints  The turning of a bone around its own long axis  Examples: Between first two vertebrae Hip and shoulder joints Hip joint Shoulder joint Atlanto-axial joint  4). Special Movements at Synovial Joints  Occur only at certain synovial joint  They include: Inversion and eversion Protraction and retraction Intertarsal joint Elevation and depression Supination and pronation Opposition Radioulnar joint Temporomandibular joint  4. Special Movements at Synovial Joints Anterior view of the right forearm. A. In full supination the radius (lateral) and ulna (medial) are parallel. B. Moving into full pronation, the radius crosses over the ulna.  iv. Types of Synovial Joints  Depending upon the shape of the articulating surfaces, synovial joint are divided into six subtypes: 1) Planar joint 2) Hinge joint 3) Pivot joint 4) Condyloid joint 5) Saddle joint 6) Ball-and-socket joint  iv. Types of Synovial Joints (Planar Joint) ▪ Also called as the plane or gliding joint ▪ Articulating surfaces of bones are flat or slightly curved ▪ Many planar joints are biaxial (permit movement around two axes) ▪ Examples of planar joints: Intercarpal joints (between carpal bones at the wrist) Intertarsal joints (between tarsal bones at the ankle) Planar joint between navicular and 2nd and 3rd cuneiforms of tarsus in foot (at ankle) One flat bone slides over another  iv. Types of Synovial Joints (Hinge Joint) ▪ Convex surface of bone fits into the concave surface of another bone ▪ Motion is along a single plane – opening and closing motion like that of hinged door ▪ Monaxial or uniaxial, because permit flexion and extension only ▪ Examples: knee, elbow, ankle and interphalangeal joints Hinge joint between trochlea of humerus and trochlear notch of ulna at elbow A hinge joint allows extension and flexion  iv. Types of Synovial Joints (Pivot Joint) ▪ Rounded or pointed surface of one bone articulates with a ring formed partly by another bone and partly by a ligament ▪ Only monaxial or uniaxial movement allowed (only allows rotation around its own longitudinal axis) ▪ Examples: Atlanto-axial and radioulnar joints Pivot joint (joint between atlas and axial bones) Pivot joint between head of radius and Head rotation at atlanto-axial joint radial notch of ulna (radioulnar joint) iv. Types of Synovial Joints (Condyloid Joint) ▪ Convex oval-shaped projection of one bone fits into the oval- shaped depression of another bone (ellipsoidal joint) ▪ Biaxial – permits flexion-extension and abduction-adduction movements ▪ Examples: Radiocarpal (wrist) and metacarpophalangeal (knuckle) joints Metacarpals Phalanges The oval surface of one bone fits into the depression of Condyloid joint between radius and scaphoid another bone and lunate bones of carpus (wrist) Metacarpophalangeal joint iv. Types of Synovial Joints (Saddle Joint) ▪ Articular surface of one bone is saddle-shaped and the articular surface of the other bone fits into the ‘saddle’ as a sitting rider would sit ▪ Modified condyloid joint but allow greater movement ▪ Biaxial – allowing flexion-extension, abduction-adduction and rotation* (passive movement = opposition of thumb) to occur ▪ Example: Carpometacarpal joint of the thumb A saddle joint allows movement back and forth and up and down, but does Saddle joint between trapezium of carpus Thumb Thumb not allow for rotation like a (wrist) and metacarpal of thumb extension flexion ball and socket joint iv. Types of Synovial Joints (Ball-and-Socket Joint)  A spherical or hemispherical head of one bone articulates with a cuplike socket of another bone  Triaxial (multiaxial), permit the most freely moving synovial joints – flexion-extension, abduction-adduction, circumduction & rotation can occur at this joint  Examples: Shoulder and hip joints Ball-and-socket joint between head of A ball and socket joint allows for radial movement femur and acetabulum of hip bone in almost any direction (hip joint)  Major Synovial Joints of the body: (a) Knee Joint  Largest and most complex joint of the body (hinge joint)  Allows flexion, extension, and some rotation  Three joints in one surrounded by a single joint cavity: ▪ Femoropatellar joint ▪ Lateral tibiofemoral joints ▪ Medial tibiofemoral joints Femoropatellar joint Femoropatellar Femur Patella joint Lateral Medial femoral femoral condyle condyle Lateral Medial tibiofemoral tibiofemoral condyle condyle Tibia Fibula Knee joint  Major Synovial Joints of the body: a) Knee Joint Tendons and Ligaments: Tendon of the quadriceps femoris muscle Lateral and medial patellar retinacula Fibular and tibial collateral ligaments Patellar ligament Anterior superficial view (Right knee joint)  Major Synovial Joints of the body: a) Knee Joint Other Supporting Structures:  Anterior cruciate ligament (ACL)  Posterior cruciate ligament (PCL)  Lateral/fibular collateral ligament  Medial/tibial collateral ligament  Medial meniscus (semilunar cartilage)  Lateral meniscus Anterior deep view (Right knee joint)  Major Synovial Joints of the body: a) Knee Joint Posterior Superficial View:  Adductor magnus tendon  Articular capsule  Popliteal ligament  Semimembranosus tendon  Knee Joint – Anterior and Posterior Views Femur Femur Medial Patellar surface condyle Lateral Medial condyle Tibial Anterior cruciate condyle collateral ligament Posterior cruciate ligament ligament Fibular Fibular collateral collateral Anterior cruciate ligament ligament Medial ligament meniscus Lateral meniscus Lateral Medial meniscus meniscus Posterior Articular cartilage Tibial collateral cruciate of tibia Transverse ligament ligament ligament Patellar ligament (cut) Fibula Fibula Tibia Tibia (a) Anterior view (b) Posterior view Major Synovial Joints of the body: b) Shoulder Joint  Ball-and-socket joint in which stability is sacrificed to obtain greater freedom of movement  Head of humerus articulates with the glenoid fossa of the scapula (glenohumeral / humeroscapular joint) Frontal section Major Synovial Joints of the body: b) Shoulder Joint Movements at shoulder joint Major Synovial Joints of the body: b) Shoulder Joint Shoulder Stability:  Thin, loose joint capsule  Four ligaments – coracohumeral, and three glenohumeral  Tendon of the long head of biceps brachii muscle, which travels through the intertubercular groove and secures the humerus to the glenoid cavity Anterior view (Right shoulder joint) Stabilizers of the Shoulder Joint Acromioclavicular ligament Acromion Clavicle Subacromial Coraco- bursa clavicular ligament Supraspinatus tendon Coraco- Coracohumeral acromial ligament ligament Subdeltoid bursa Coracoid process Subscapularis tendon Transverse Subcoracoid humeral bursa ligament Subscapular Tendon sheath bursa Biceps brachii tendon (long head) Glenohumeral Humerus ligaments Anterior view Major Synovial Joints of the body: b) Shoulder Joint Shoulder Stability:  Rotator cuff (four tendons) that encircles the shoulder joint and blends with the articular capsule ▪ Subscapularis muscle ▪ Supraspinatus muscle ▪ Infraspinatus muscle ▪ Teres minor muscle Major Synovial Joints of the body: c) Elbow Joint  Hinge joint that allows flexion and extension only  Radius and ulna articulate with the humerus Elbow joint  c) Elbow Joint Ligaments:  Annular ligament  Ulnar collateral ligament  Radial collateral ligament Humerus Radius Ulna Lateral view Major Synovial Joints of the body: d) Hip Joint  Ball-and-socket joint (Coxal joint)  Head of the femur articulates with the acetabulum of the hip bone  Good range of motion, but limited by the deep socket and strong ligaments Frontal section Major Synovial Joints of the body: d) Hip Joint Movements of hip joint Major Synovial Joints of the body: d) Hip Joint Hip Stability:  Acetabular labrum  Transverse acetabular ligament  Iliofemoral ligament  Pubofemoral ligament  Ischiofemoral ligament Iliofemoral ligament  Ligamentum teres Pubofemoral ligament Ischiofemoral ligament Anterior view Posterior view Major Synovial Joints of the body: d) Hip Joint Ilium Iliofemoral ligament Ischiofemoral Pubofemoral ligament ligament Iliofemoral ligament Pubis Greater trochanter Greater trochanter Ischial tuberosity Femur Lesser trochanter Femur (a) Anterior view (b) Posterior view  Major Synovial Joints of the body: e) TMJ Temporomandibular joint (TMJ):  Mandibular condyle articulate with the temporal bone  Two types of movement; ▪ Hinge – depression and elevation of mandible ▪ Side to side – (lateral excursion) grinding of teeth Articular tubercle of temporal Condylar bone process of mandible Sagittal section (Right temporomandibular joint) Temporomandibular joint Clinical Application: TMJ Dislocation  TMJ dislocation commonly follows extreme opening of the mouth (eg., eating, yawning, laughing, singing, vomiting, dental treatment) and is less often caused by trauma  Occurs when the condyle (mandible) travels anteriorly along the articular eminence and becomes locked in the anterior superior aspect of the eminence, preventing closure of the mouth  THANK YOU … Artificial Hip Joint