Joints by Dr.Chaman Lal (CK)

8/13/2019 Joints by Dr.Chaman Lal (CK)

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By: Dr.Chaman LalB.S.PT, DPT, Dip. in sports Injuries, MPPS(PAK),

PG in Clinical Electroneurophysiology (AKUH),

Registered.EEGT (USA),Member of ABRET, AANEM & ASET (USA).

JOINTS

Federal Institute of Health Sciences,Multan


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Study Outlines Introduction,

Functional classifications, Structural classification,

Structures comprising a Synovial joint,

Movements of joints, Blood supply of Synovial joints, their

nerve supply and lymphatic drainage &

Factors responsible for joint stability andDevelopment of joints

References

2 Joints By:Chaman Lal FIHS (CK) 1/31/2014


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Joints(articulations)Arthron (G. a joint)

Junctura (L. a joint)Joint:Joint is a junction between two or morebones or cartilages.

It is a place, where parts of skeleton meet It allows varying amounts of mobility It is classified by structure or function.

Arthrology: The study of joints is calledarthrology.

Syndesmology: (G. syndesmos=ligament) It is the study of ligaments andrelated joints.3 Joints By:Chaman Lal FIHS (CK) 1/31/2014


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Joints By:Chaman Lal FIHS (CK)4

A. Structural Classification1. Fibrous Joints:

(a) Sutures

(b) Syndesmosis &(c) Gomophosis

2. Cartilaginous Joints:

(a) Primary cartilaginous joints orsynchondrosis &

(b) Secondary cartilaginous joints or

symphysis

Classification of Joints

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3. Synovial Joints:

(a)Plane joints(b)Pivot or trochoid joints

(c)Hinge joints(d)Condylar or bicondylar joints

(e)Ellipsoid joints(f)Sellar or saddle joints &

(g)Ball-and-socket or spheroidal

Classification of Joints .contd

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Joints By:Chaman Lal FIHS (CK)6 1/31/2014


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Fibrous Joints


In fibrous joints the bones are joined by

fibrous tissue. The joints are eitherimmovable or permit a slight degree of

movement. These can be grouped in the

following three subtypes.1. Sutures:-

These are peculiar to skull, and are

immovable. According to the shape of bonymargins, the sutures can be plane, serrate,

denticulate, squamous, limobus, and of

schindylesis type.1/31/2014


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2.

Syndesmosis:

-

The bones are

connected by the

interosseious

ligament.Example: Inferior

tibiofibular joint

Fibrous Joints. . . . Contd

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3. Gomophosis:- These are peg andsocket joints.

Example: Tooth in itssocket.

It is restricted to the

fixation of teeth intheir alveolar socketsin the mandible andmaxillae. Thecollagen of theperiodontiumconnects dental

cement with alveolar

Fibrous Joints. . . . Contd

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2. Cartilaginous Joints:


In this type of joints the bones are joined by

cartilage.There is no synovial cavity, articulatingbones tightly connected by fibrocartilageor hyaline cartilage

These are of two types:

1. Primary Cartilaginous Joints:

(Synchondrosis, or Hyaline cartilagejoints)

The bones are united by a plate of hyalinecartilage, so that the joint is immovable

and strong. 1/31/2014


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Cartilaginous Joints. . .contd


Synostosis: =the union or fusion of

adjacent bones by the growth of bonysubstance, either as a normal process

during growth or as the result of ankylosis.

Example:a) Joint between epiphysis and diaphysis of a

growing long bone,

b) Shpeno-occipital joint,c) First chondrosternal joint &

d) Costochondral joints.

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2. Secondary Cartilaginous Joints:

(Symphyses or fibrocartilaginous) The articular surfaces are covered by a thin

layer of hyaline cartilage and united by a disc

of fibrocartilage. These joints are permanent and persist

throughout life. In this respect symphyses

menti is a misnomer.

Typically the secondary cartilaginous joints

occur in the median plane of the body, and

permit limited movements due to compressible

pad of fibrocartilage and the occasional fluid



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The thickness of fibrocartilage is

directly related to the range ofmovement.

Secondary cartilaginous joints may

represent an intermediate stage in

evolution of synovial joints.

Examples:a) Symphsis pubis,

b) Manubriosternal joint &

c) Intervertebral joints between the



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3.Synovial Joints


Synovial Joints are most evolved ,

and, therefore most mobile type ofjoints.

Synovial joints has a fluid-filledcavity between articular surface

which are covered by articular

cartilage.The fluid is known as synovial

fluid, which is form of lymph

S no ial Joints Contd


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Synovial Joints. . . . Contd


This fluid lines the cavity except for

the actual articular surfaces andcovers the ligaments or tendons

which pass through the joint.

Synovial fluid act as a lubricant.

The form of the articulating

surfaces controls the type ofmovement which takes place at

any joint.


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Structure of Synovial Joints


A). Articular Cartilage

B). Synovial (joint) cavity

C). Articular Capsule

D). Synovial Fluid.

E). Reinforcing Ligaments

F). Fatty Pads or Articular Discs G). Bursae

H). Tendon Sheath

A). Bone & shape of articular surfaces.

B). Ligaments

C). Muscle Tone

Factors Influencing Joint Stability


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1.Bone & shape of articular surfaces:

It help in maintaing stability only in firm typeof joints, like the hip and ankle. Otherwise in

most of the joints (shoulder, knee, sacroiliac

etc) their role is negligible.

2.Ligament: are important in preventing any

over-movement, and in guarding against

sudden accidental stresses.

3.Muscle Tone: The tone of different group of

muscles acting on the joint is the most

important and indispensable factor in

maintaining the stability.

Factors Influencing Joint Stabilitycontd

t


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movements

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Type of Joint Movement

A.Plane or

Gliding Type

Gliding movement

B.Uniaxial

Joints

1.Hinge Joint2.Pivot Joint

Flexion & Extension

Rotation only

C. Biaxial

Joints

1.CondylarJoint

2. Ellipsoid

JointD. Multiaxial

Flexion and Extension, and limited

rotationFlx,Ext, abd, add, & Circumduction

Flx,Ext, abd, add, & conjunct

rotation


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Ch t i ti f S i l J i t


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Characteristics of Synovial Joints


1. Articular surface is covered by hyaline

cartilage & sometimes by fibrocartilage.

Synovial fluid circulates in the joint cavity

to lubricate and nourish the articulating

surfaces. Viscosity of fluid is due to

hyaluronic acid.

The joint cavity may be partially or

completely subdivided by an articular disc

or meniscus.

Joint is surrounded by an articular capsule

which is made up of fibrous capsule and


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1.Plane Synovial Joints


Articular surfaces are more less flat

(Plane). They permit gliding movements(translations) in various directions. Plane

joints are appositions of almost flat

surfaces.Examples:

a) Intercarpal joints

b) Intertarsal joints

c) Joints between articular

processes of vertebrae etc.


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2. Ginglymi or Hinge Joints


Articular surfaces are pulley shaped.

There are strong collateral ligaments.Movements, are permitted in one plane

around and transverse axis.

Examples:

a) Elbow joint

b) Ankle joint andc) Interphalangeal joints.


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3. Pivot (Trochoid) Joints


Articular surfaces comprise a central bony

pivot (peg) surrounded by an

osteoligamentous ring. Movements are

permitted in one plane around a vertical

axis.

Example:

a)Superior and inferiorradio-ulnar joints,

a) Median atlanto-axial joints


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Condylar (Bicondylar)Joints contd


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Condylar (Bicondylar)Joints.cont d


Example:

a) Knee joint

andb) Right and left

jaw joints etc


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6 S ddl (S ll ) J i t


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6.Saddle (Sellar) Joints


Articular surfaces are reciprocally concavo-

convex. Movements are similar to thosepermitted by an ellipsoid joint, with addition

of some rotation (conjunct rotation) around a

third axis which, however, cannot occur

independently.

Examples:

a) 1stcarpometacarpal joint

b) Sternoclavicular joint &

c) Calcaneocuboid joint.

7 Ball & Socket joint (Spheroidal)


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7.Ball & Socket joint (Spheroidal)


Articular surfaces include a globular

head (male surface) fitting into a cup-shaped socket (female surface).

Movements occur around an indefinite

number of axes, which have onecommon center.

Examples:

a) Shoulder joint,

b) Hip joint,

c) Talo-calcaneonavicular joint.


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B. Functional Classification


Functional classification of joint is

actually based upon degree of mobility

of the joint.

There are 3 types of joints according totheir functional classification.

1. Synarthroses (Immovable)2. Amphiarthroses

3. Diarthroses or synovial joints

1 S th


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1.Synarthroses


These are fixed

joints andimmovable. The

articular surfaces

are joined bytough fibrous

tissue.

Often the edgesof the bones are

dovetailed into

one another as in


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2.Amphiarthorses


These allow some movement. A padof cartilage lies between the bone

surfaces, and there is a fibrous

capsule to hold the bones andcartilage in place. The cartilages of

such joints also act as shock

absorbers e.g. the intervertebral discsbetween the bodies of the vertebrae,

where the cartilage is strengthened


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3.Diarthorses or synovial joints


These are known as freely movablejoints, though at some of them the

movement is restricted by the shape

of the articulating surfaces and by the

ligament which hold the bones

together. These ligaments are ofelastic connective tissue.

-e.g. Knee joint, shoulder joint, etc


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C Regional Classification of the


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C. Regional Classification of theJoints


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On regional basis joints areclassified as under 3 types;

1. Skull type: Immovable.

2. Vertebral type: Slightly

movable3. Limb type: Freely

movable

Movements & Mechanism of Joints


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Movements & Mechanism of Joints


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Angular movement:Movement leading

to diminution or increase in anglebetween two adjoining bones.

-Flexion: Decreasing the angle

between two bones.-Extension: Increasing the angle

between two bones

-Abduction:Moving the part away frommid-line.

-Adduction: Bringing the part towards the

-


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Shape of Articular Surface


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The common articular surfaceshapes are:

A) Ovoid:When concave- female

ovoids

When convex- male ovoids

B) Sellar/Saddle shaped: Theseare convex in one plane, concave

in the perpendicular plane


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Contd. . .


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Human Kinesiology: Study of geometry ofsurfaces & their associated movements is called

Kinesiology. Male Surface:An articulating surface which is

larger in surface area and always convex in alldirections.

Female Surface: An articulating surface which issmaller and concave in all directions.

Simple Joints: Joints with only two articulating

surfaces, i.e., male and female. Compound Joints: Joint possessing more than

one pair of articulating surfaces.

Degrees of freedom: Number of axes at which

the bone in a joint can move.

Cont d. . .


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Joint Positions


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Joint Positions


Closed Packed Position:

When the joint surfaces become completely

congruent, their area of contact is maximal andthey are tightly compressed.

In this position fibrous capsule and ligamentsare maximally spiralized and tense;

No further movement is possible ;

Surfaces can not be separated by disruptiveforces;

Articular surfaces are liable to trauma, e.g.,Shoulderabduction +lateral rotation:

Hipextension+medial rotation;

Knee

full extension; Ankle

dorsiflexion

Joint Positions contd


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Loose Packed Position:

All other position s of incongruencey, e.g., least

packed position.e.g., Shouldersemiabduction,HipSemiflexion,KneeSemiflexion

AnkleVentral PositionLimitation of Movement (Factors)-Reflex contraction of antagonistic m/s

-Due to stimulations of mechanoreceptors inarticular tissue,-Ligaments tension,-Approximation of soft parts

Joint Positions.cont d

Mechanism of Lubrication of A Synovial


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Mechanism of Lubrication of A Synovial

Joints


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1. Synovial Fluid: It is secreted bysynovial membrane, is sticky and

viscous due to hyaluronic acid (a

mucopolysaccharide). It serve themain function of lubrication of the

joint.

2.Hyaline Cartilage: It covers the

articular surface and provides the

slippery surface to reduce the friction.

Contd


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Cont d.


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3.Intra-articular Fibrocartilages:

Articular discs or menisci, complete orincomplete, help in spreading thesynovial fluid through the joint cavity,but particularly between the articularsurfaces.

4.Haversian Fatty Pads(HaversianGlands):

These occupy extra spaces in the jointcavity between the incongruous bonysurfaces and perhaps function as

swabs to s read the s novial fluid.

Blood Supply of the Synovial Joints


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Blood Supply of the Synovial Joints


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The articular and epiphyseal branches

given off bye the neighboring arties form

a periarticular arterial plexus.

Numerous vessels from this plexus

pierce the fibrous capsule and form arich vascular plexus in the deeper parts

of the synovial membrane.

Circulus vasculosu(Circulus articularisvasculosus) is a looped anastomoses

formed bye the blood vessels of the

synovial membrane around the articular

Nerve Supply of the Synovial Joints


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Nerve Supply of the Synovial Joints


1.The capsule and ligaments possess

a rich nerve supply while synovialmembrane has a poor nerve supply

and relatively insensitive to pain.

2.The articular cartilage is non-nervousand totally insensitive.

3.Articular nerves contains sensory

and autonomic fibers.

Nerve Supply of the Synovial Jointscontd


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4.HiltonsLaw: (Hilton 1891)

It states that a motor nerve to the muscle

acting on joint tends to give a branch to thatjoint (capsule) and another branch to the

skin covering the joint.

Gardner (1928) further elucidated that eachnerve innervates a specific region of the

capsule, and that the part of the capsule

which is rendered taut by a given muscle isinnervated by the nerve supplying its

antagonists.

Thus the pattern of innervations is

Joints


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Joints


Lymphatic form a plexus in the

subintima of synovial membrane, anddrain along the blood vessels to theregional deep nodes.

Applied Anatomy:-Dislocation of joint

-Sprain

-Arthritis-Stiffness of joints related to weather

-Neuropathic Joint


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J i t B Ch L l FIHS (CK)

Joints by Dr.Chaman Lal (CK)

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