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1
Q

• Joints

A

are called articulation

2
Q

Joint are named or classified according to

A

o the bones or portion of bones that join together
o the major connective tissue type that binds them together and whether a fluid-filled joint capsule is present
o their degree of motion

3
Q

degree of motion

A

 cannot be both highly mobile and very strong

• greater the range of motion – weaker the joint

4
Q

range of motion ?
what is it ?
and different range of motion ?

A

 range of motion = amount of mobility possible for a given joint:
• active range of motion – by muscle contraction
• passive range of motion – movement through outside force acting on joint
• luxation (dislocation) – when articulating surfaces of bones are moved out of proper alignment

5
Q

luxation

A

o often damages supporting ligaments and articular cartilage (clinical note p. 206)
o subluxation = partial dislocation
o sprain- when ligaments are damaged – may be stretched or torn

6
Q

Functional categories ? (table 8.1)

A

synarthroses, amphiarthroses, diarthroses

7
Q

common joints in axial skeleton ?

A

• immovable (synarthroses) and slightly moveable (amphiarthroses) joints more common in axial skeleton

8
Q

msot common joints in appendicular skeleton ?

A

• freely moveable (diarthroses) joints more common in appendicular skeleton

9
Q

Synarthroses

A

• Synarthroses = immovable joints
o have no joint cavity
o bony edges very close together
o suture – seams between bones

10
Q

suture ?

A

 sutural ligament = fibrous connective tissue between bones plus continuous periosteum over both surfaces (outer and inner) of connected bones
 can be completely immovable in adults
 opposing bones interdigitate (interweave) – increases stability
 fontanel = found in newborns
• membranous areas between bones
• allows flexibility of skull during birth process and growth of the head after birth

11
Q

gomphosis

A

= joint between teeth and alveoli (sockets) of mandible and maxilla
 periodontal ligaments = fine bundles of fibrous connective tissue that allow slight give during mastication (chewing)
 periodontal disease = plaque and bacteria that migrate from inflamed gingiva (gums) and accumulate in tooth socket
• results in inflammation and destruction of periodontal ligaments leading to tooth loss
• treated by proper brushing, flossing and professional cleaning to remove plaque

12
Q

synchondrosis

A

bones joined by hyaline cartilage
 sternocostal synchondrosis of first rib
 epiphyseal plates of growing bones
• temporary and are converted to synostosis = when epiphysis and diaphysis fuse

13
Q

amphiarthroses

A

= slightly moveable joints

o bones farther apart than synarthroses

14
Q

o syndesmosis (part of amphiarthroses )

A

ligament made of fibrous connective tissue

 distal radius and ulna

15
Q

o symphysis (part of amphiarthroses )

A

= wedge or pad of fibrocartilage between bones
 manubrium and body of sternum, symphysis pubis, intervertebral disks
• during pregnancy – hormones act on connective tissue of joints – especially symphysis pubis
o become stretchable allowing joints to loosen and pelvic opening to enlarge

16
Q

• Synovial joints

A

freely moveable joints

o most complex joints that all contain articular cartilage, a joint capsule, synovial fluid, and accessory structures

17
Q

o articular cartilage

A

hyaline cartilage

covers surfaces of articulating bones

18
Q

o joint capsule

A

surrounds joint cavity containing synovial fluid
 outer fibrous capsule = dense regular connective tissue
• continuous with fibrous layer of periosteum
• portions may thicken forming ligaments
• contains sensory nerve endings – pain and proprioception

 inner synovial membrane – lines joint cavity except over articular cartilage
• delicate membrane with mixture of modified connective tissue cells
• produces synovial fluid

19
Q

o synovial fluid

A

= serum filtrate and secretions from synovial cells
 mixture of polysaccharides, proteins, and lipids
• major polysaccharide = hyaluronic acid
 thin layer of fluid lubricates articular surface reducing friction and acts as shock absorber
 nourishes chondrocytes
• circulation of synovial fluid by joint movement with cycles of compression and expansion

20
Q

o accessory structures

A
pads of cartilage or fat, ligaments, tendons and bursae
	meniscus (articular disk) 
	fat pads 
	ligaments
	tendons 
	bursa 
o	bursitis
21
Q

meniscus

A

(articular disk) = crescent-shaped pad of fibrocartilage attached to fibrous joint capsule
• allow for variations in shape of articular surface or restricts movements at joint

22
Q

 fat pads

A

= found around periphery of joint and covered by synovial membrane
• fill spaces and provide protection

23
Q

 ligaments

A

dense regular connective tissue that support, strengthen and reinforce synovial joints
• intrinsic (intracapsular) ligaments = localized thickening of fibrous layer of joint capsule
• extrinsic (extracapsular) ligaments – separate from and outside of joint capsule

24
Q

tendons

A

not part of the articulation but usually pass across or around a joint

25
Q

bursa

A

small synovial-filled sacs
• extension of synovial membrane some distance away from joint cavity
• cushion between structures such as tendons on bones and can form tendon sheaths
o bursitis = inflammation of bursa

26
Q

Classification of synovial joints

A

• classified based on shape of adjoining articular surfaces which determines range of motion

  • gliding (plane ) joint
  • pivot joint
  • saddle joint
  • hinge joint
  • ellipsoid joint
  • ball and socket joint
27
Q

gliding (plane ) joint

A

– provide slight linear motion

 monaxial = movement around one axis

28
Q

pivot joint

A

– monaxial – restricts movement to rotation around single axis
 cylindrical bony process that rotates within ring composed partly of bone and ligament

29
Q

saddle joint

A

articular surfaces resemble a saddle – concave on one axis, convex on the other
 biaxial = movement around 2 axes situated at right angles to each other

30
Q

hinge joint

A

– monaxial joint with convex cylinder in one bone applied to a corresponding concavity in the other

31
Q
  • ellipsoid joint
A

oval articular surface and corresponding depression in opposing surface
 biaxial because shape limits range of motion

32
Q
  • ball and socket joint
A

head (ball) at end of one bone and cup-shaped socket in adjacent bone
 triaxial – allows movement around several axes – wide range of movement

33
Q

gliding motion

A

– surfaces slide or glide over one another

34
Q

angular motion

A

• based on reference to individual in anatomical position

o one linear structure bends relative to another part of the structure – changing the angle between them

35
Q

abduction

A

abduction = movement of appendicular skeleton away from midline (longitudinal axis of the body)

36
Q

adduction

A

= movement of appendicular skeleton toward (“adding to”) midline

37
Q

flexion

A

= movement in anterior-posterior plane that reduces angle between bones

38
Q

extension

A

o = movement in anterior-posterior plane that increases angle between bones
♣ generally straightening from a flexed position
♣ hyperextension = abnormal, forced extension of a joint beyond its normal range of motion

39
Q

circumduction

A

= movement in a cone-shape with fixed end proximally located

40
Q

rotation

A

rotates a structure around its axis

41
Q

left or right rotation =

A

movement of head in “no” position

42
Q

internal (medial) rotation

A

= turns long axis of anterior aspect of limb inward

43
Q

external (lateral) rotation

A

turns long axis of anterior aspect of limb outward

44
Q

pronation

A

rotation of forearm so palm of the hand faces posteriorly

45
Q

supination

A

o = rotation of forearm so palm of the hand faces anteriorly (anatomical position)
♣ occurs in freely moveable joints – hip, shoulder

46
Q

special movements

A

– unique to only one or two joints

47
Q

inversion and eversion

A

turns ankle in, plantar surfaces toward each other or turns out

48
Q

plantar flexion and dorsiflexion

A
o	= movement of foot - toward floor (standing on toes), or 
toward shin (walking on heels)
49
Q

elevation and depression

A

o movement in superior or inferior direction - mandible open and close, shoulders shrugging

50
Q

protraction and retraction

A

o – movement of body part anteriorly or posteriorly – head, mandible, shoulder
♣ lateral and medial excursion – mandible side to side (grinding teeth)

51
Q

opposition

A

special movement of thumb that brings pad-to-pad contact with palm or any other finger

52
Q

fibrocartilage pads

A

• fibrocartilage pads - separate and cushion symphysis joints between adjacent vertebral bodies from C2 to the sacrum

53
Q

annulus fibrosus

A

outer layer of fibrous cartilage surrounded by ring of collagenous fibers

54
Q

nucleus pulposus

A

o inner portion
♣ soft, elastic, gelatinous core – 75% water + scattered reticular and elastic fibers
♣ shock absorbers

o movements of vertebral column compress nucleus pulposus and displace it in opposite direction
♣ permits smooth gliding of vertebrae
o accounts for ¼ length of vertebral column
♣ less water content with age and replacement with fibrous cartilage = decrease in height and increase chance of injury (compression fractures)

55
Q

intervertebral disc disease (IVDD

A

o painful condition associated with disc degeneration that affects spinal nerves

buliging disc
herniated disc
sciatica
laminectomy

56
Q

bulging disc

A

= distortion of annulus fibrosus – partially forcing it into the vertebral canal

57
Q

herniated disc

A

♣ rupture of annulus fibrosus with protrusion of nucleus pulposus
• distorts nerves, produces pain, alters function

58
Q

sciatica

A

♣ = painful compression of roots of sciatic nerve

• treatment: rest, back braces, analgesics, physical therapy

59
Q

laminectomy

A

surgery in 10% of cases -removes disc and vertebral bodies fused together

60
Q

Shoulder Joint (Fig 8.9)

A

= glenohumeral joint
• ball and socket joint – loose shallow joint with greatest mobility but least stability
• most commonly dislocated joint in the body – usually dislocated inferiorly into axilla (Clinical note, p.219)

61
Q

glenoid labrum

A

fibrocartilage ring that slightly build up the shallow glenoid cavity of the scapula

• stability of joint maintained by glenohumeral ligaments and tendons of four specific appendicular muscles that support shoulder and limit range of motion

62
Q

rotator cuff

A

o = four muscles that hold humeral head tightly in glenoid cavity
♣ tendons of supraspinatus, infraspinatus, teres minor, and subscapularis

63
Q

bursae

A

• reduce friction where large muscles and tendons pass across the joint capsule
o dense fibrous connective tissue filled with synovial fluid
• common shoulder disorders include: tendinitis, bursitis, and arthritis

64
Q

Knee Joint

A

= modified hinge joint between femur and tibia

allows flexion, extension and small amount of rotation

65
Q

knee joint

structurally composed of 2 joints

A

• structurally composed of 2 joints:
o tibiofemoral joint – proximal end of tibia and distal end of femur
patellofemoral joint – patella and patellar surface of femur

66
Q

lateral and medial menisci (knee joint)

A

= thick articular disks of fibrocartilage deepen the articular surface of the tibia

67
Q

fat pads (knee)

A

• around margins of joint aid in cushioning and reducing friction

68
Q

major tendons and ligaments that provide joint stability (knee)

A

quadriceps tendons
patellar ligament
o extracapsular ligaments
intracapsular ligaments

69
Q

quadriceps tendon (knee)

A

o quadriceps tendon = tendons from muscles responsible for extending lower leg
♣ passes over anterior surface of joint
patella = largest sesamoid bone embedded within tendon

70
Q

patellar ligament (knee)

A

extends from patella to tibial tuberosity on anterior surface of tibia

71
Q

extracapsular ligaments (knee)

A

♣ tibial (medial) and fibular (lateral) collateral ligaments – stabilize medial and lateral sides respectively
♣ popliteal ligaments – extend on posterior surface from femur to heads of tibia and fibula

72
Q

intracapsular ligaments – (knee)

A

o extend between the intercondylar eminence of the tibia to the condyles of the femur
♣ direction names refer to their sites of origin on the tibia
♣ anterior cruciate ligament (ACL) – prevents anterior displacement of tibia relative to femur
• tightens during full extension of knee pushing meniscus between tibia and femur locking knee in place
♣ posterior cruciate ligament (PCL) – prevents posterior displacement of the tibia

73
Q

number of bursae associated with patella (knee)

A

o suprapatellar bursa = superior extension of joint capsule that allows the anterior thigh muscles to move over the distal end of the femur
o subcutaneous prepatellar bursitis = ‘housemaid’s knee’ – excessive working on hands and knees
o subcutaneous infrapatellar bursitis = ‘clergyman’s knee’ – excessive kneeling – carpet layers, roofers

74
Q

• injuries

knee

A

o blows to the lateral side of the knee far more common than medial side of knee
♣ football tackle to lateral side
o medial meniscus fairly tightly attached to medial collateral ligament and damaged 20 x more than lateral meniscus
♣ torn meniscus – ‘clicking’ sound during extension of leg
♣ anterior cruciate ligament tear – when knee driven anteriorly or hyperextended
• more common in women – from planting foot and twisting

75
Q

Aging Changes

A

• tissue repair slows, new blood vessel development decreases, articular cartilage wears down, production of synovial fluid decreases

76
Q

arthritis

A

• inflammation of joint leading to pain and stiffness of joint – resulting from infectious agents, metabolic disorders, trauma, immune disorders
o degenerative joint disease (osteoarthritis) = most common type – associated with advanced age – delayed with regular physical activity, stretching and healthy diet

77
Q

rheumatoid arthritis (RA)

A

o = second most common type of arthritis
♣ connective tissue disorder
♣ autoimmune disease that predominantly affects joints – commonly destroying small joints in hands and feet
♣ have rheumatoid protein factor in blood