Post on 08-Jun-2020
PowerPoint® Lecture Slides
prepared by
Karen Dunbar Kareiva
Ivy Tech Community College© Annie Leibovitz/Contact Press Images
Chapter 8 Part B
Joints
© 2017 Pearson Education, Inc.
8.5 Selected Synovial Joints
• Synovial joints are diverse
• All have general features, but some also have
unique structural features, abilities, and
weaknesses
• Five main synovial joints
– Knee
– Shoulder
– Elbow
– Hip
– Jaw
© 2017 Pearson Education, Inc.
Knee Joint
• Largest, most complex joint of body
• Consists of three joints surrounded by single cavity
1. Femoropatellar joint
• Plane joint
• Allows gliding motion during knee flexion
2. Lateral joint and 3. Medial joint
• Lateral and medial joints together are called
tibiofemoral joint
• Joint between femoral condyles and lateral and
medial menisci of tibia
• Hinge joint that allows flexion, extension, and some
rotation when knee partly flexed© 2017 Pearson Education, Inc.
Figure 8.7a The knee joint.
Femur
Articularcapsule
Posterior
cruciate
ligament
Lateral meniscus
Anterior
cruciate
ligament
Tibia
Tendon ofquadricepsfemoris
Suprapatellarbursa
Patella
Subcutaneous
prepatellar bursa
Synovial cavity
Lateral meniscus
Infrapatellar fat pad
Deep infrapatellarbursa
Patellar ligament
Sagittal section through the right knee joint
© 2017 Pearson Education, Inc.
Figure 8.7b The knee joint.
Anterior
Anterior
cruciate
ligament
Articularcartilageon medialtibialcondyle
Medial
meniscus
Posterior
cruciate ligament
Superior view of the right tibia in the knee joint,
showing the menisci and cruciate ligaments
Articularcartilage onlateral tibialcondyle
Lateral
meniscus
© 2017 Pearson Education, Inc.
A&P Flix™: Knee
© 2017 Pearson Education, Inc.
Knee Joint (cont.)
• Joint capsule is thin and absent anteriorly
• Anteriorly, quadriceps tendon gives rise to three
broad ligaments that run from patella to tibia
– Medial and lateral patellar retinacula that flank
the patellar ligament
• Doctors tap patellar ligament to test knee-jerk reflex
• At least 12 bursae associated with knee joint
© 2017 Pearson Education, Inc.
Figure 8.7c The knee joint.
Quadricepsfemoris muscle
Tendon ofquadricepsfemoris muscle
Patella
Lateral
patellar
retinaculum
Fibular
collateral
ligament
Fibula
Medial patellar
retinaculum
Tibial collateral
ligament
Patellar
ligament
Tibia
Anterior view of right knee
© 2017 Pearson Education, Inc.
Knee Joint (cont.)
• Capsular, extracapsular, or intracapsular
ligaments act to stabilize knee joint
• Capsular and extracapsular ligaments help
prevent hyperextension of knee
– Fibular and tibial collateral ligaments: prevent
rotation when knee is extended
– Oblique popliteal ligament: stabilizes posterior
knee joint
– Arcuate popliteal ligament: reinforces joint
capsule posteriorly
© 2017 Pearson Education, Inc.
Figure 8.7d The knee joint.
Tendon ofadductormagnus
Medial head ofgastrocnemiusmuscle
Popliteusmuscle (cut)
Tibial
collateral
ligament
Tendon ofsemimembranosusmuscle
Femur
Articular capsule
Oblique popliteal
ligament
Lateral head ofgastrocnemiusmuscle
Bursa
Fibular collateral
ligament
Arcuate popliteal
ligament
Tibia
Posterior view of the joint capsule, including ligaments
© 2017 Pearson Education, Inc.
Knee Joint (cont.)
• Intracapsular ligaments reside within capsule,
but outside synovial cavity
• Help to prevent anterior-posterior displacement
– Anterior cruciate ligament (ACL)
• Attaches to anterior tibia
• Prevents forward sliding of tibia and stops
hyperextension of knee
– Posterior cruciate ligament
• Attaches to posterior tibia
• Prevents backward sliding of tibia and forward sliding
of femur
© 2017 Pearson Education, Inc.
Figure 8.7e The knee joint.
Posterior
cruciate
ligament
Fibular
collateral
ligament
Medial
condyle
Tibial
collateral
ligament
Anterior
cruciate
ligament
Medialmeniscus
Patellarligament
Patella
Quadricepstendon
Lateralcondyleof femur
Lateralmeniscus
Tibia
Fibula
Anterior view of flexed knee, showing the
cruciate ligaments (articular capsule
removed, and quadriceps tendon cut and
reflected distally)
© 2017 Pearson Education, Inc.
Animation: Rotating Knee
© 2017 Pearson Education, Inc.
Figure 8.7f The knee joint.
Medial femoral
condyle
Anterior cruciate
ligament
Medial meniscus
on medial tibial
condyle
Patella
Photograph of an opened knee joint;
view similar to (e)
© 2017 Pearson Education, Inc.
Clinical – Homeostatic Imbalance 8.1
• Knee absorbs great amount of vertical force;
however, it is vulnerable to horizontal blows
– Common knee injuries involved the 3 C’s:
• Collateral ligaments
• Cruciate ligaments
• Cartilages (menisci)
– Lateral blows to extended knee can result in
tears in tibial collateral ligament, medial
meniscus, and anterior cruciate ligament
– Injuries affecting just ACL are common in
runners who change direction, twisting ACL
– Surgery usually needed for repairs© 2017 Pearson Education, Inc.
Figure 8.8 The “unhappy triad:” ruptured ACL, ruptured tibial collateral ligament, and torn meniscus.
Lateral
Hockey puckPatella
(outline)
Medial
Tibial
collateral
ligament
(torn)
Medial
meniscus
(torn)
Anterior
cruciate
ligament
(torn)
© 2017 Pearson Education, Inc.
Shoulder (Glenohumeral) Joint
• Most freely moving joint in body
• Stability is sacrificed for freedom of movement
• Ball-and-socket joint
– Large, hemispherical head of humerus fits in
small, shallow glenoid cavity of scapula
• Like a golf ball on a tee
• Articular capsule enclosing cavity is also thin
and loose
– Contributes to freedom of movement
© 2017 Pearson Education, Inc.
Figure 8.9a The shoulder joint.
Acromion of scapula
Coracoacromial ligament
Subacromial bursa
Fibrous layer ofarticular capsule
Tendon sheath
Tendon of long headof biceps brachii muscle
Synovial cavity ofthe glenoid cavitycontaining synovialfluid
Articular cartilage
Synovial membrane
Fibrous layer ofarticular capsule
Humerus
Frontal section through right shoulder joint
© 2017 Pearson Education, Inc.
Animation: Rotating Shoulder Joint
© 2017 Pearson Education, Inc.
Figure 8.9b The shoulder joint.
Synovial cavityof the glenoidcavity containingsynovial fluid
Articular cartilage
Fibrous layer ofarticular capsule
Humerus
Cadaver photo corresponding to (a)
© 2017 Pearson Education, Inc.
Shoulder (Glenohumeral) Joint (cont.)
• Glenoid labrum: fibrocartilaginous rim around
glenoid cavity
– Helps to add depth to shallow cavity
– Cavity still only holds one-third of head of
humerus
• Reinforcing ligaments
– Primarily on anterior aspect
– Coracohumeral ligament
• Helps support weight of upper limb
– Three glenohumeral ligaments
• Strengthen anterior capsule, but are weak support© 2017 Pearson Education, Inc.
Figure 8.9c The shoulder joint.
Acromion
Coracoacromial ligament
Subacromial bursa
Coracohumeral
ligament
Transverse humeralligament
Tendon sheath
Tendon of long headof biceps brachiimuscle
Coracoid process
Articular capsulereinforced byglenohumeral
ligaments
Subscapularbursa
Tendon of thesubscapularismuscle
Scapula
Anterior view of right shoulder joint capsule
© 2017 Pearson Education, Inc.
Figure 8.9d The shoulder joint.
Acromion
Coracoid process
Articular capsule
Glenoid cavity
Glenoid labrum
Tendon of long headof biceps brachii muscle
Glenohumeral ligaments
Tendon of thesubscapularis muscle
ScapulaPosterior Anterior
Lateral view of socket of right shoulder joint,
humerus removed
© 2017 Pearson Education, Inc.
Shoulder (Glenohumeral) Joint (cont.)
• Reinforcing muscle tendons contribute most to
joint stability
– Tendon of long head of biceps brachii muscle is
“superstabilizer”• Travels through intertubercular sulcus
• Secures humerus to glenoid cavity
– Four rotator cuff tendons encircle the shoulder
joint
• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres minor© 2017 Pearson Education, Inc.
A&P Flix™: Rotator Cuff Muscles:
Overview (a)
© 2017 Pearson Education, Inc.
A&P Flix™: Rotator Cuff Muscles:
Overview (b)
© 2017 Pearson Education, Inc.
Figure 8.9c The shoulder joint.
Acromion
Coracoacromial ligament
Subacromial bursa
Coracohumeral
ligament
Transverse humeralligament
Tendon sheath
Tendon of long headof biceps brachiimuscle
Coracoid process
Articular capsulereinforced byglenohumeral
ligaments
Subscapularbursa
Tendon of thesubscapularismuscle
Scapula
Anterior view of right shoulder joint capsule
© 2017 Pearson Education, Inc.
Figure 8.9d The shoulder joint.
Acromion
Coracoid process
Articular capsule
Glenoid cavity
Glenoid labrum
Tendon of long headof biceps brachii muscle
Glenohumeral ligaments
Tendon of thesubscapularis muscle
ScapulaPosterior Anterior
Lateral view of socket of right shoulder joint,
humerus removed
© 2017 Pearson Education, Inc.
Figure 8.9e The shoulder joint.
Acromion (cut)
Glenoid cavity
of scapula
Glenoid labrum
Rotator cuffmuscles(cut)
Capsule ofshoulder joint(opened)
Head of humerus
Posterior view of an opened right shoulder joint
© 2017 Pearson Education, Inc.
A&P Flix™: Movement at Glenohumeral Joint:
An Overview
© 2017 Pearson Education, Inc.
A&P Flix™: Movement at Glenohumeral
Joint (a)
© 2017 Pearson Education, Inc.
A&P Flix™: Movement at Glenohumeral
Joint (b)
© 2017 Pearson Education, Inc.
Elbow Joint
• Humerus articulates with radius and ulna
• Hinge joint formed primarily from trochlear notch
of ulna articulating with trochlea of humerus
– Allows for flexion and extension only
• Anular ligament surrounds head of radius
• Two capsular ligaments restrict side-to-side
movement
– Ulnar collateral ligament
– Radial collateral ligament
© 2017 Pearson Education, Inc.
A&P Flix™: Movement of Elbow Joint (b)
© 2017 Pearson Education, Inc.
Figure 8.10a The elbow joint.
Articularcapsule
Synovialmembrane
Humerus
Fat pad
Tendon oftriceps muscle
Bursa
Trochlea
Articular cartilageof the trochlearnotch
Median sagittal section through right elbow
(lateral view)
Synovial cavity
Articular cartilage
Coronoid process
Tendon ofbrachialis muscle
Ulna
© 2017 Pearson Education, Inc.
Figure 8.10b The elbow joint.
Humerus
Anular
ligament
Lateralepicondyle
Articularcapsule
Radial
collateral
ligament
Olecranon
Ulna
Lateral view of right elbow joint
Radius
© 2017 Pearson Education, Inc.
Figure 8.10c The elbow joint.
Humerus
Anular
ligament
Medialepicondyle
Radius
Articularcapsule
Coronoidprocessof ulna
Ulna
Ulnar
collateral
ligament
Cadaver photo of medial view of right elbow
© 2017 Pearson Education, Inc.
Animation: Rotating Elbow
© 2017 Pearson Education, Inc.
Figure 8.10d The elbow joint.
Articularcapsule
Anular
ligament
Coronoidprocess
Medialepicondyle
Ulnar
collateral
ligament
Humerus
Radius
Ulna
Medial view of right elbow
© 2017 Pearson Education, Inc.
A&P Flix™: The Elbow Joint and Forearm:
An Overview
© 2017 Pearson Education, Inc.
Hip (Coxal) Joint
• Ball-and-socket joint
• Large, spherical head of the femur articulates
with deep cup-shaped acetabulum
• Good range of motion, but limited by the deep
socket
– Acetabular labrum: rim of fibrocartilage that
enhances depth of socket (hip dislocations are
rare)
© 2017 Pearson Education, Inc.
Figure 8.11a The hip joint.
Articular
cartilage
Acetabular
labrum
Femur
Hip (coxal) bone
Ligament of the
head of the femur
(ligamentum teres)
Synovial cavity
Articular capsule
Frontal section through the right hip joint
© 2017 Pearson Education, Inc.
A&P Flix™: Movement at Hip Joint: Overview
© 2017 Pearson Education, Inc.
Figure 8.11b The hip joint.
Acetabular
labrum
Synovial
membrane
Ligament of the
head of the femur
(ligamentum teres)
Head of femur
Articular capsule
(cut)
Photo of the interior of the hip joint, lateral view
© 2017 Pearson Education, Inc.
Hip (Coxal) Joint (cont.)
• Reinforcing ligaments include:
– Iliofemoral ligament
– Pubofemoral ligament
– Ischiofemoral ligament
– Ligament of head of femur (ligamentum teres)
• Slack during most hip movements, so not important in
stabilizing
• Does contain artery that supplies head of femur
• Greatest stability comes from deep ball-and-
socket joint
© 2017 Pearson Education, Inc.
Figure 8.11c The hip joint.
Ischium
Iliofemoral
ligament
Ischiofemoral
ligament
Greater
trochanter
of femur
Posterior view of right hip joint,
capsule in place
© 2017 Pearson Education, Inc.
Figure 8.11d The hip joint.
Anterior
inferior iliac
spine
Greater
trochanter
Iliofemoral
ligament
Pubofemoral
ligament
Anterior view of right hip joint, capsule in place
© 2017 Pearson Education, Inc.
Animation: Rotatable Hip
© 2017 Pearson Education, Inc.
Temporomandibular Joint (TMJ)
• Jaw joint is a modified hinge joint
• Mandibular condyle articulates with temporal
bone
– Posterior temporal bone forms mandibular
fossa, while anterior portion forms articular
tubercle
• Articular capsule thickens into strong lateral
ligament
© 2017 Pearson Education, Inc.
Temporomandibular Joint (TMJ) (cont.)
• Two types of movement
– Hinge: depression and elevation of mandible
– Gliding: side-to-side (lateral excursion) grinding
of teeth
• Most easily dislocated joint in the body
© 2017 Pearson Education, Inc.
Figure 8.12a The temporomandibular (jaw) joint.
Mandibular fossaArticular tubercleZygomatic process
Infratemporal fossa
Externalacousticmeatus
Articularcapsule
Ramus ofmandible
Lateralligament
Location of the joint in the skull
© 2017 Pearson Education, Inc.
Figure 8.12b The temporomandibular (jaw) joint.
Articular disc
Mandibularfossa
Articular tubercle
Superior jointcavity
Articularcapsule
Synovialmembranes
Condylarprocess ofmandible
Ramus ofmandible
Inferior jointcavity
Enlargement of a sagittal section through the joint
© 2017 Pearson Education, Inc.
Figure 8.12c The temporomandibular (jaw) joint.
Superior view
Outline ofthe mandibularfossa
Lateral excursion: lateral (side-to-side) movements of the mandible
© 2017 Pearson Education, Inc.
Clinical – Homeostatic Imbalance 8.2
• Dislocation of TMJ is most common because of
shallow socket of joint
• Almost always dislocates anteriorly, causing
mouth to remain open
– To realign, physician must push mandible back
into place
© 2017 Pearson Education, Inc.
Clinical – Homeostatic Imbalance 8.2
• Symptoms: ear and face pain, tender muscles,
popping sounds when opening mouth, joint
stiffness
• Usually caused by grinding teeth, but can also
be due to jaw trauma or poor occlusion of teeth
– Treatment for grinding teeth includes bite plate
– Relaxing jaw muscles helps
© 2017 Pearson Education, Inc.
8.6 Disorders of Joints
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
– Partial menisci removal renders joint less stable but
mobile; complete removal leads to osteoarthritis
– Meniscal transplant possible in younger patients
– Perhaps meniscus grown from own stem cells in
future
© 2017 Pearson Education, Inc.
Figure 8.13 Arthroscopic photograph of a torn medial meniscus.
Femur
Meniscus
Tear inmeniscus
Tibia
© 2017 Pearson Education, Inc.
Common Joint Injuries (cont.)
• Sprains
– Reinforcing ligaments are stretched or torn
– Common sites are ankle, knee, and lumbar
region of back
– Partial tears repair very slowly because of poor
vascularization
– Three options if torn completely
• Ends of ligaments can be sewn together
• Replaced with grafts
• Just allow time and immobilization for healing
© 2017 Pearson Education, Inc.
Common Joint Injuries (cont.)
• Dislocations (luxations)
– Bones forced out of alignment
– Accompanied by sprains, inflammation, and
difficulty moving joint
– Caused by serious falls or contact sports
– Must be reduced to treat
• Subluxation: partial dislocation of a joint
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
• Bursitis
– Inflammation of bursa, usually caused by blow or
friction
– Treated with rest and ice and, if severe, anti-
inflammatory drugs
• Tendonitis
– Inflammation of tendon sheaths, typically caused
by overuse
– Symptoms and treatment similar to those of
bursitis
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• 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: caused by bacteria, treated with
antibiotics
– Chronic forms: osteoarthritis, rheumatoid
arthritis, and gouty arthritis
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Osteoarthritis (OA)
– Most common type of arthritis
– Irreversible, degenerative (“wear-and-tear”)
arthritis
– May reflect excessive release of enzymes that
break down articular cartilage
• Cartilage is broken down faster than it is replaced
• Bone spurs (osteophytes) may form from thickened
ends of bones
– By age 85, half of Americans develop OA, more
women than men
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Osteoarthritis (OA) (cont.)
– OA is usually part of normal aging process
– Joints may be stiff and make crunching noise
referred to as crepitus, especially upon rising
– Treatment: moderate activity, mild pain relievers,
capsaicin creams
• Glucosamine, chondroitin sulfate, and nutritional
supplements not effective
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Rheumatoid arthritis (RA)
– Chronic, inflammatory, autoimmune disease of
unknown cause
• Immune system attacks own cells
– Usually arises between ages 40 and 50, but may
occur at any age; affects three times as many
women as men
– Signs and symptoms include joint pain and
swelling (usually bilateral), anemia, osteoporosis,
muscle weakness, and cardiovascular problems
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Rheumatoid arthritis (RA) (cont.)
– RA begins with inflammation of synovial
membrane (synovitis) of affected joint
– Inflammatory blood cells migrate to joint, release
inflammatory chemicals that destroy tissues
– Synovial fluid accumulates, causing joint swelling
– Inflamed synovial membrane thickens into
abnormal pannus tissue that clings to articular
cartilage
– Pannus erodes cartilage, scar tissue forms and
connects articulating bone ends (ankylosis)
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Rheumatoid arthritis (RA) (cont.)
– Treatment includes steroidal and nonsteroidal
anti-inflammatory drugs to decrease pain and
inflammation
– Disruption of destruction of joints by immune
system
• Immune suppressants slow autoimmune reaction
• Some agents target tumor necrosis factor to block
action of inflammatory chemicals
– Can replace joint with prosthesis
© 2017 Pearson Education, Inc.
Figure 8.14 A hand deformed by rheumatoid arthritis.
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• 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
– In untreated gouty arthritis, bone ends fuse and
immobilize joint
– Treatment: drugs, plenty of water, avoidance of
alcohol and foods high in purines, such as liver,
kidneys, and sardines
© 2017 Pearson Education, Inc.
Inflammatory and Degenerative Conditions
(cont.)
• Lyme disease
– Caused by bacteria transmitted by tick bites
– Symptoms: skin rash, flu-like symptoms, and
foggy thinking
– May lead to joint pain and arthritis
– Treatment
• Long course of antibiotics
© 2017 Pearson Education, Inc.