© 2013 Pearson Education, Inc. Types of Synovial Joints Six types, based on shape of articular...

© 2013 Pearson Education, Inc.

Types of Synovial Joints

• Six types, based on shape of articular surfaces:– Plane– Hinge– Pivot– Condylar– Saddle– Ball-and-socket


Figure 8.7a The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Flatarticularsurfaces

Gliding

Plane joint Nonaxial movement

Examples: Intercarpal joints, intertarsal joints, joints between vertebral articular surfaces

Carpals

Metacarpals


Figure 8.7b The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Hinge joint Uniaxial movement

Examples: Elbow joints, interphalangeal joints

Flexion and extension

CylinderTrough

Medial/lateralaxis

Humerus

Ulna


Figure 8.7c The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Pivot joint Uniaxial movement

Rotation

Sleeve(bone andligament)

Radius

Examples: Proximal radioulnar joints, atlantoaxial joint

Axle (roundedbone)

Vertical axis

Ulna


Figure 8.7d The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Phalanges

Metacarpals

Condylar joint Biaxial movement

Ovalarticularsurfaces

Examples: Metacarpophalangeal (knuckle) joints, wrist joints

Medial/lateralaxis

Flexion andextension

Adduction andabduction

Anterior/posterioraxis


Figure 8.7e The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Flexion andextension

Adduction andabduction

Articularsurfacesare bothconcaveand convex

Medial/lateralaxis


Trapezium

Metacarpal Ι

Example: Carpometacarpal joints of the thumbs

Saddle joint Biaxial movement


Figure 8.7f The shapes of the joint surfaces define the types of movements that can occur at a synovial joint; they also determine the classification of synovial joints into six structural types.

Sphericalhead(ball)

Examples: Shoulder joints and hip joints

Flexion and extension Adduction andabduction Rotation

Humerus

Scapula

Cup(socket)

Medial/lateralaxis


Vertical axis

Ball-and-socket joint Multiaxial movement


• Largest, most complex joint of body• Three joints surrounded by a single joint

cavity– Femoropatellar joint

• Plane joint• Allows gliding motion during knee flexion

– Lateral and medial tibiofemoral joints • Femoral condyles with lateral and medial menisci

of tibia• Allow flexion, extension, and some rotation when

knee partly flexed

Knee Joint


Figure 8.8a The knee joint.

Patellar ligament

Sagittal section through the right knee joint

Anteriorcruciateligament

Posteriorcruciateligament

Tibia

Femur

Lateralmeniscus

Articularcapsule

Lateral meniscus

Synovial cavity

Infrapatellarfat pad

Subcutaneousprepatellar bursa

Patella

Suprapatellarbursa

Tendon ofquadricepsfemoris

Deep infrapatellerbursa


Figure 8.8b The knee joint.

Articularcartilage on lateral tibialcondyle

Posteriorcruciateligament

Lateralmeniscus

Superior view of the right tibia in the knee joint, showingthe menisci and cruciate ligaments


Medialmeniscus

Articularcartilageon medialtibial condyle

Anterior


Knee Joint

• 12 associated bursae• Capsule is reinforced by muscle tendons

– E.g., quadriceps and semimembranosus tendons

• Joint capsule is thin and absent anteriorly• Anteriorly, quadriceps tendon gives rise to

three broad ligaments– Medial and lateral patellar retinacula– Patellar ligament


Figure 8.8c The knee joint.

Anterior view of right knee

Quadricepsfemorismuscle

Lateralpatellarretinaculum

Tibialcollateralligament

Fibula

Fibularcollateralligament

Patella

Tendon ofquadricepsfemorismuscle

Patellarligament

Medialpatellarretinaculum

Tibia


Ligaments Stabilizing Knee Joint

• Capsular and extracapsular ligaments– Help prevent hyperextension of knee– Fibular and tibial collateral ligaments– Oblique popliteal ligament– Arcuate popliteal ligament


Figure 8.8d The knee joint.

Tibia

Arcuatepoplitealligament

Obliquepoplitealligament

Bursa

Popliteusmuscle(cut)

Lateralhead ofgastrocnemiusmuscle

Articularcapsule

Medial head ofgastrocnemiusmuscle

Fibularcollateralligament

Tibialcollateralligament

Tendon ofsemimembranosusmuscle

Posterior view of the joint capsule, including ligaments

FemurTendon ofadductormagnus


Ligaments Stabilizing Knee Joint

• Intracapsular ligaments – Prevent anterior-posterior displacement– Reside outside synovial cavity– Anterior cruciate ligament

• Attaches to anterior tibia

– Posterior cruciate ligament• Attaches to posterior tibia


PLAY Animation: Rotatable Knee

Figure 8.8e The knee joint.

Fibular collateral ligament

Lateral condyle of femur

Lateralmeniscus

Tibia

Fibula

Anterior view of flexed knee, showingthe cruciate ligaments (articularcapsule removed, and quadricepstendon cut and reflected distally)

PosteriorcruciateligamentMedialcondyleTibialcollateralligament

Medialmeniscus

Patellarligament

Patella


Quadricepstendon


Figure 8.8f The knee joint.

Medial femoralcondyle

Anterior cruciateligament

Medial meniscuson medial tibialcondyle

Patella

Photograph of an opened knee joint;view similar to (e)


Knee Joint Injuries

• Absorbs great vertical force• Vulnerable to horizontal blows, especially

laterally blows to extended knee– Three C's

• Collateral ligaments• Cruciate ligaments• Cartilages


Figure 8.9 A common knee injury.

Lateral

Patella(outline)

Medial

Tibialcollateralligament(torn)

Medialmeniscus(torn)

Hockey puck

Anteriorcruciateligament(torn)


Shoulder (Glenohumeral) Joint

• Ball-and-socket joint– Head of humerus with glenoid cavity of

scapula• Most freely moving joint in body

– Stability sacrificed


Animation: Rotatable Shoulder

Figure 8.10a The shoulder joint.

Acromionof scapula

Coracoacromialligament

Subacromialbursa

Fibrous layer ofarticular capsule

Tendonsheath

Tendon oflong headof bicepsbrachii muscle

Synovial membraneFibrous layer ofarticular capsule

Humerus

Articularcartilage

Synovial cavityof the glenoidcavity containingsynovial fluid

Frontal section through right shoulder joint

PLAY


Fibrous layer ofarticular capsule

Humerus

Articularcartilage

Synovial cavityof the glenoidcavity containingsynovial fluid

Cadaver photo corresponding to (a)

Figure 8.10b The shoulder joint.

PLAY A&P Flix: Movement at the Glenohumeral joint: An Overview

PLAY A&P Flix: Movement at the Glenohumeral joint (a)

PLAY A&P Flix: Movement at the Glenohumeral joint (b)


Shoulder Joint

• Reinforcing ligaments– Primarily on anterior aspect– Coracohumeral ligament

• Helps support weight of upper limb

– Three glenohumeral ligaments• Weak and sometimes absent


• Reinforcing muscle tendons– Tendon of long head of biceps brachii

• Travels through the intertubercular sulcus • Secures humerus to glenoid cavity

– Four rotator cuff tendons encircle the shoulder joint• Subscapularis• Supraspinatus• Infraspinatus• Teres minor

Shoulder Joint


Figure 8.10c The shoulder joint.

AcromionCoracoacromialligamentSubacromialbursa

Coracohumeralligament

Greatertubercleof humerus

Transversehumeralligament

Tendon sheath

Tendon oflong headof bicepsbrachiimuscle

Articularcapsulereinforced byglenohumeralligaments

Subscapularbursa

Tendon of thesubscapularismuscleScapula

Coracoidprocess

Anterior view of right shoulder joint capsule


Figure 8.10d The shoulder joint.

Lateral view of socket of right shoulder joint,humerus removed

Coracoidprocess

Articularcapsule

Glenoid cavity

Glenoid labrum

Tendon of longhead of bicepsbrachii muscleGlenohumeralligamentsTendon of thesubscapularismuscle

Scapula

Posterior Anterior

Acromion


Figure 8.10e The shoulder joint.

Head ofhumerus

Muscle ofrotatorcuff (cut)

Anterior view of an opened shoulder joint

Capsule ofshoulderjoint(opened)

Glenoidcavity ofscapula

Acromion(cut)


• Articulation of radius and ulna with humerus

• Hinge joint– Primarily trochlear notch of ulna with trochlea

of humerus– Flexion and extension only

Elbow Joint


Figure 8.11a The elbow joint.

Humerus

Fat pad

Tendon oftricepsmuscle

Bursa

Articular cartilageof the trochlearnotch

Trochlea

Articularcapsule

Synovialmembrane

Synovial cavity

Ulna

Median sagittal section through right elbow (lateral view)

Articular cartilage

Coronoid process

Tendon ofbrachialis muscle


Elbow Joint

• Anular ligament– Surrounds head of radius

• Two capsular ligaments restrict side-to-side movement– Ulnar collateral ligament– Radial collateral ligament


Figure 8.11b The elbow joint.

Humerus

Lateralepicondyle

Articularcapsule

Radialcollateralligament

Olecranon

Anularligament

Radius

Ulna

Lateral view of right elbow joint


Figure 8.11d The elbow joint.

Articularcapsule

Anularligament

Coronoidprocess

Radius

Humerus

Medialepicondyle

Ulnarcollateralligament

Ulna

Medial view of right elbow


Cadaver photo of medial view of right elbow

Figure 8.11c The elbow joint.

Anularligament

Radius

Articularcapsule

Coronoidprocess

Humerus

Medialepicondyle

Ulnarcollateralligament

Ulna


• Ball-and-socket joint• Head of the femur articulates with

acetabulum• Good range of motion, but limited by the

deep socket – Rim of fibrocartilage - Acetabular labrum

• Enhances depth of socket so hip dislocations rare

Hip (Coxal) Joint


Figure 8.12a The hip joint.

Ligament of thehead of the femur(ligamentum teres)

Coxal (hip) bone

Articular cartilage

Acetabular labrum

Femur

Frontal section through the right hip joint

Synovial cavity

Articular capsule


Figure 8.12b The hip joint.

Acetabularlabrum

Ligament of the headof the femur(ligamentumteres)

Synovialmembrane

Headof femur

Articularcapsule (cut)

Photo of the interior of the hip joint, lateral view


Hip Joint

• Reinforcing ligaments– Iliofemoral ligament– Pubofemoral ligament– Ischiofemoral ligament– Ligamentum teres


Iliofemoralligament

Ischiofemoralligament

Greatertrochanterof femur

Posterior view of right hip joint, capsule in place

Ischium

Figure 8.12c The hip joint.


Iliofemoralligament

Pubofemoralligament

Greatertrochanter

Anterior inferioriliac spine

Anterior view of right hip joint, capsule in place

Figure 8.12d The hip joint.


Temporomandibular Joint (TMJ)

• Mandibular condyle articulates with temporal bone

• Two types of movement– Hinge—depression and elevation of mandible– Gliding—e.g., side-to-side (lateral excursion)

grinding of teeth• Most easily dislocated joint in the body


Ramus of mandible

Articularcapsule

Externalacousticmeatus

Mandibular fossaArticular tubercleZygomatic processInfratemporal fossa

Location of the joint in the skull

Lateral ligament

Figure 8.13a The temporomandibular (jaw) joint.


Inferior jointcavity

Superiorjointcavity

Articulartubercle

Articular disc

Mandibularfossa

Articularcapsule

Synovialmembranes

Condylarprocess ofmandible

Ramus of mandible

Enlargement of a sagittal section through the joint

Figure 8.13b The temporomandibular (jaw) joint.


Figure 8.13c The temporomandibular (jaw) joint.

Superior viewOutline of themandibularfossa

Lateral excursion: lateral (side-to-side) movements of the mandible


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

• Ligaments repaired, cartilage fragments removed with minimal tissue damage or scarring

– Partial menisci removal renders joint less stable but still mobile; complete removal leads to osteoarthritis

– Meniscal transplant in younger patients– Perhaps meniscus grown from stem cells in future


Figure 8.14 Arthroscopic photograph of a torn medial meniscus.

Femur

Meniscus

Tear inmeniscus

Tibia



• Sprains– Reinforcing ligaments stretched or torn– Partial tears slowly repair heal

• Poor vascularization

– Three options if torn completely• Ends sewn together• Replaced with grafts• Time and immobilization



• Dislocations (luxations)– Bones forced out of alignment– Accompanied by sprains, inflammation, and

difficulty moving joint– Caused by falls or sports – Must be reduced to treat

• Subluxation—partial dislocation


Inflammatory and Degenerative Conditions• Bursitis

– Inflammation of bursa, caused by blow or friction– Treated with rest and ice – For the first 24 to 72 hrs apply ice for 10 to 20 mins

every hr or two.• Tendonitis

– Inflammation of tendon sheaths typically caused by overuse

– Symptoms and treatment similar to bursitis

The carpal tunnel is the area under a ligament anterior to the wrist. The median nerve, which passes through the carpal tunnel, supplies the thumb side of the hand. Repetitive movements can cause inflammation of structures that surround the median nerve. The inflammation may compress this nerve, producing numbness, tingling, and pain in the first three fingers and the thumb side of the hand - a condition known as carpal tunnel syndrome.


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: bacterial, treated with antibiotics• Chronic forms: psoriatic arthritis, osteoarthritis,

rheumatoid arthritis, and gouty arthritis


Psoriasis causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful.


• Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.

• Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.


Radiographic changes due to PsA, unlike those of rheumatoid arthritis, demonstrate characteristic bony proliferation and erosion. A highly specific finding of erosive arthritis of PsA is the classic "pencil-in-cup“ deformity in the phalanges.


Osteoarthritis (OA)

• Common, irreversible, degenerative (''wear-and-tear'') arthritis

• May reflect excessive release of enzymes that break down articular cartilage

• By age 85 half of Americans develop OA, more women than men

• Probably related to normal aging process


Osteoarthritis (OA)

• More cartilage is destroyed than replaced in badly aligned or overworked joints

• Exposed bone thicken, enlarge, form osteophytes, creptitus and restrict movement

• Treatment: moderate activity, mild pain relievers, capsaicin creams– Glucosamine, chondroitin sulfate, and

nutritional supplements not effective


Cartilage normally protects the joint, allowing for smooth movement.

Cartilage also absorbs shock when pressure is placed on the joint, like when walking. Arthritis involves the breakdown of cartilage. Without the usual amount of cartilage, the bones

of the joint rub together, causing pain, swelling and stiffness.

http://www.pennmedicine.org/health_info/arthritis/000088.html

http://www.pennmedicine.org/health_info/arthritis/000088.html


Rheumatoid Arthritis (RA)

• Chronic, inflammatory, autoimmune disease of unknown cause

• Usually arises between ages 40 and 50, but may occur at any age; affects 3 times as many women as men

• Signs and symptoms include joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems


Rheumatoid Arthritis

• RA begins with synovitis of affected joint– Inflammatory blood cells migrate to joint,

release inflammatory chemicals that destroy tissues

– Synovial fluid accumulates joint swelling and inflamed synovial membrane which thickens pannus that clings to articular cartilage

– Pannus erodes cartilage, scar tissue forms and connects articulating bone ends (ankylosis)


Rheumatoid Arthritis: Treatment

• Disrupt destruction of joints by immune system• Steroidal and nonsteroidal anti-inflammatory

drugs decrease pain and inflammation• Immune suppressants slow autoimmune

reaction• Some agents target tumor necrosis factor

TNFα to block action of inflammatory chemicals• Can replace joint with prosthesis


Figure 8.15 A hand deformed by rheumatoid arthritis.


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

(first metatarsophalangeal joint)• In untreated gouty arthritis, bone ends

fuse and immobilize joint• Treatment: drugs, plenty of water,

avoidance of alcohol


Lyme Disease

• Caused by bacteria transmitted by tick• Symptoms: skin rash, flu-like symptoms,

and foggy thinking• May lead to joint pain and arthritis

© 2013 Pearson Education, Inc. Types of Synovial Joints Six types, based on shape of articular...

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