Types of Synovial Joints. Selected Synovial Joints: The Knee This is considered the most complex...

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Types of Synovial Joints

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Types of Synovial Joints Slide 2 Selected Synovial Joints: The Knee This is considered the most complex joint in the human body. It is actually considered three joints working together. Slide 3 The Knee These are: An intermediate joint between the patella and distal end of the femur (femoropatellar joint). This is a plane joint. Slide 4 The Knee These are: An intermediate joint between the patella and distal end of the femur (femoropatellar joint). This is a plane joint. A lateral and medial tibiofemoral joints between the femoral condyles and the menisci below. Slide 5 Copyright 2010 Pearson Education, Inc. (a) Sagittal section through the right knee joint Femur Tendon of quadriceps femoris Suprapatellar bursa Patella Subcutaneous prepatellar bursa Synovial cavity Lateral meniscus Posterior cruciate ligament Infrapatellar fat pad Deep infrapatellar bursa Patellar ligament Articular capsule Lateral meniscus Anterior cruciate ligament Tibia Figure 8.8a The knee joint. Slide 6 The Knee The menisci help prevent lateral motion and attach to the outer margins of the joint capsule on the tibia. They are easily torn. Slide 7 Copyright 2010 Pearson Education, Inc. Figure 8.8b The knee joint. (b) Superior view of the right tibia in the knee joint, showing the menisci and cruciate ligaments Medial meniscus Articular cartilage on medial tibial condyle Anterior cruciate ligament Articular cartilage on lateral tibial condyle Lateral meniscus Posterior cruciate ligament Slide 8 The knee is unique in that it is not completely enclosed by a capsule. Slide 9 The articular capsule is found only on the lateral and posterior surfaces. Slide 10 The knee is unique in that it is not completely enclosed by a capsule. The articular capsule is found only on the lateral and posterior surfaces. The anterior surface is covered by three ligaments going from the patella to the tibia. Slide 11 These ligaments are: The patella ligament Slide 12 These ligaments are: The patella ligament & The medial and lateral patellar retinacula ligaments. They merge with the articular capsule on each side. Slide 13 The intracapsular ligaments are the cruciate ligaments. Slide 14 The anterior and posterior cruciate ligaments cross each other forming an X in the notch between the femoral condyles. Slide 15 The intracapsular ligaments are the cruciate ligaments. The anterior and posterior cruciate ligaments cross each other forming an X in the notch between the femoral condyles. They prevent anterior and posterior displacement. Slide 16 Two additional ligaments, the Fibular and Tibial Collateral Ligaments prevent lateral or medial rotation when the knee is extended. Slide 17 Copyright 2010 Pearson Education, Inc. Figure 8.8c The knee joint. Quadriceps femoris muscle Tendon of quadriceps femoris muscle Patella Lateral patellar retinaculum Medial patellar retinaculum Tibial collateral ligament Tibia Fibular collateral ligament Fibula (c) Anterior view of right knee Patellar ligament Slide 18 Copyright 2010 Pearson Education, Inc. Figure 8.8f The knee joint. Medial femoral condyle Anterior cruciate ligament Medial meniscus on medial tibial condyle Patella (f) Photograph of an opened knee joint; view similar to (e) Slide 19 The synovial cavity of the knee has a complicated shape and over one dozen associated bursae. Some are easily injured such as the subcutaneous prepatellar bursa which lies just over the patella (house maids knee).(house maids knee). Slide 20 House Maids Knee Slide 21 Knee Injuries Common knee injuries involve the 3 Cs: Collateral ligaments, Slide 22 Knee Injuries Common knee injuries involve the 3 Cs: Collateral ligaments, Cruciate ligaments and Slide 23 Knee Injuries Common knee injuries involve the 3 Cs: Collateral ligaments, Cruciate ligaments and Cartilage (menisci). Slide 24 Knee Injuries Lateral blows are the most dangerous, tearing the tibial collateral ligament and the medial meniscus and the anterior cruciate ligament. Slide 25 Slide 26 Slide 27 Copyright 2010 Pearson Education, Inc. Figure 8.9 A common knee injury. LateralMedial Patella (outline) Tibial collateral ligament (torn) Medial meniscus (torn) Anterior cruciate ligament (torn) Hockey puck Slide 28 Arthroscopic Knee Surgery Arthroscopy is a common surgical procedure in which a joint (arthro-) is viewed (-scopy) using a small camera. Slide 29 Arthroscopic Knee Surgery Arthroscopy gives doctors a clear view of the inside of the knee. This helps them diagnose and treat knee problems. Slide 30 Arthroscopic Knee Surgery The orthopaedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see your knee clearly and in great detail. Slide 31 Arthroscopic Knee Surgery Slide 32 Knee Replacement People with degenerative arthritis, chronic injuries often lose that smooth articular cartilage. The result is bone on bone. The knee joints must be replaced. Slide 33 Knee Replacement Slide 34 Shoulder (Glenohumeral) Joint The large head of the humerus fits into the glenoid cavity of the scapula. The cavity is extended by a fibrocartilage ring called the glenoid labrum. Connective tissue support comes from three groups of ligaments. Slide 35 Shoulder (Glenohumeral) Joint A) Coracohumeral ligament provides the only strong support of the upper limb. It runs from the coracoid process to the greater tubercle of the humerus. Slide 36 Copyright 2010 Pearson Education, Inc. Figure 8.10c The shoulder joint. Acromion Coracoacromial ligament Subacromial bursa Coracohumeral ligament Greater tubercle of humerus Transverse humeral ligament Tendon sheath Tendon of long head of biceps brachii muscle Articular capsule reinforced by glenohumeral ligaments Subscapular bursa Tendon of the subscapularis muscle Scapula Coracoid process (c) Anterior view of right shoulder joint capsule Slide 37 Shoulder (Glenohumeral) Joint B) Three Glenohumeral ligaments strengthen the front of the capsule. These ligaments are weak. Slide 38 Copyright 2010 Pearson Education, Inc. Figure 8.10d The shoulder joint. Acromion Coracoid process Articular capsule Glenoid cavity Glenoid labrum Tendon of long head of biceps brachii muscle Glenohumeral ligaments Tendon of the subscapularis muscle Scapula PosteriorAnterior (d) Lateral view of socket of right shoulder joint, humerus removed Slide 39 Shoulder (Glenohumeral) Joint C) The Rotator Cuff is formed from four tendons and muscles that encircle the joint. The muscles include the Subscapularis, Supraspinatus Infraspinatus and Teres minor. Slide 40 Shoulder (Glenohumeral) Joint Slide 41 Shoulder Injuries Rotator Cuff Because of its mobility, the stability of the shoulder joint has been sacrificed. Anterior dislocations are the most common along with damage to the rotator cuff muscles due to severe circumduction. Slide 42 Slide 43 Shoulder Dislocation Shoulder Dislocation and ReductionReduction Slide 44 Shoulder Injuries Rotator Cuff Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation for example, pitching in baseball, swimming, often put the rotator cuff muscles under a lot of stress. Slide 45 Shoulder Injuries Rotator Cuff Problems with the rotator cuff muscles can be classed into two categories Tears of the tendons/muscles, and inflammation of the tendons (often called tendinopathy or tendonitis). Slide 46 Shoulder Injuries Rotator Cuff Surgery to repair a torn rotator cuff tendon usually involves: Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridment).rotator cuff moves Slide 47 Shoulder Injuries Rotator Cuff Surgery to repair a torn rotator cuff tendon usually involves: Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement).debridement Making more room for the rotator cuff tendon so it is not pinched or irritated. Slide 48 Shoulder Injuries Rotator Cuff Surgery to repair a torn rotator cuff tendon usually involves: Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement).debridement Making more room for the rotator cuff tendon so it is not pinched or irritated. Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus). Slide 49 Shoulder Injuries Rotator Cuff Slide 50 Slide 51 Elbow Joint This is a hinge joint where the radius and ulna articulate with the condyles of the humerus. The ulnas trochlear notch forms a tight hinge with the trochlear of the humerus. This articulation allows for flexion and extension only. Slide 52 Elbow Joint Side to side movement is prevented by the ulnar collateral ligament (triangular) and radial collateral ligament. Slide 53 Copyright 2010 Pearson Education, Inc. Figure 8.11d The elbow joint. Articular capsule Anular ligament Coronoid process (d) Medial view of right elbow Radius Humerus Medial epicondyle Ulnar collateral ligament Ulna Slide 54 Copyright 2010 Pearson Education, Inc. Figure 8.11c The elbow joint. Anular ligament Humerus Medial epicondyle Ulnar collateral ligament Ulna Articular capsule Radius Coronoid process (c) Cadaver photo of medial view of right elbow Slide 55 Copyright 2010 Pearson Education, Inc. Figure 8.11b The elbow joint. Humerus Lateral epicondyle Articular capsule Radial collateral ligament Olecranon process Anular ligament Radius Ulna (b) Lateral view of right elbow joint Slide 56 Elbow Joint Injuries Slide 57 Tommy John Surgery This procedure, more formally known as UCL (Ulnar Collateral Ligament) reconstruction, is designed to repair a torn elbow ligamentan injury typically caused by strong, repetitive overhead throwing motions of the arm. Slide 58 Tommy John Surgery It was first performed in 1974 on baseball pitcher Tommy John. pitcher The procedure typically lasts about an hour and a half, and patients usually leave the hospital the same day. Slide 59 Slide 60 Slide 61 Elbow Dislocations Slide 62 Slide 63 Hip (Coxal Joint) This is a ball and socket joint whose movement is limited by strong ligaments. It is formed from the spherical head of the femur and the deeply cupped acetabulum in the pelvis. Slide 64 Copyright 2010 Pearson Education, Inc. Figure 8.12b The hip joint. Acetabular labrum Synovial membrane Ligament of the head of the femur (ligamentum teres) Head of femur Articular capsule (cut) (b) Photo of the interior of the hip joint, lateral view Slide 65 Hip (Coxal Joint) There is a thick articular capsule with several strong ligaments reinforcing the capsule. These include the: Iliofemoral ligament Pubofemoral ligament & Ischiofemoral ligament Slide 66 Copyright 2010 Pearson Education, Inc. Figure 8.12c The hip joint. Ischium Iliofemoral ligament Ischiofemoral ligament Greater trochanter of femur (c) Posterior view of right hip joint, capsule in place Slide 67 Hip (Coxal Joint) The ligamentum teres attaches the femur to the acetabulum. Slide 68 Copyright 2010 Pearson Education, Inc. Figure 8.12a The hip joint. Articular cartilage Coxal (hip) bone Ligament of the head of the femur (ligamentum teres) Synovial cavity Articular capsule Acetabular labrum Femur (a) Frontal section through the right hip joint Slide 69 Hip Injuries Common injuries to the hip joint include fractures and dislocations. Hip fractures typically involve the neck of the femur and are the result of underlying disease such as osteoporosis. Slide 70 Slide 71 Slide 72 Slide 73 Hip Replacement Hip replacement surgery, also called total hip arthroplasty, involves removing a diseased hip joint and replacing it with an artificial joint, called a prosthesis. Slide 74 Hip Replacement Hip replacement is typically used for people with hip joint damage from arthritis or an injury. Followed by rehabilitation, hip replacement can relieve pain and restore range of motion and function of your hip joint Lets do a hip replacement! Slide 75 Slide 76 Temporomandibular Joint Two distinct movements can occur with the jaw, a hinge like movement and the second is a lateral movement. Slide 77 Temporomandibular Joint Slide 78 Copyright 2010 Pearson Education, Inc. Figure 8.13c The temporomandibular (jaw) joint. (c)Lateral excursion: lateral (side-to-side) movements of the mandible Outline of the mandibular fossa Superior view Slide 79 Temporomandibular Joint A lateral ligament attaches the ramus of the mandible to the zygomatic arch of the temporal bone. Slide 80 Copyright 2010 Pearson Education, Inc. Figure 8.13a The temporomandibular (jaw) joint. Zygomatic process Mandibular fossa Articular tubercle Infratemporal fossa External acoustic meatus Articular capsule Ramus of mandible Lateral ligament (a) Location of the joint in the skull Slide 81 Injuries to the Jaw Injuries to the jaw include fractures and dislocations. Slide 82 Injuries to the Jaw Injuries to the jaw include fractures and dislocations. A broken jaw is a break in the jaw bone. A dislocated jaw means the lower part of the jaw has moved out of its normal position at one or both joints. Slide 83 Dislocation of the Jaw Symptoms of a dislocated jaw include pain in or around the jaw, the misalignment of teeth, and forward movement of the jaw beyond its regular position. Other symptoms include difficulty opening and closing the mouth. Slide 84 Dislocation of the Jaw A dislocated jaw can be caused by forceful yawning or by some sort of trauma or impact with the face. Common causes of jaw dislocation include a punch to the face, sports injuries, and car accidents. Slide 85 Dislocation of the Jaw Slide 86 Fractures of the Jaw A broken jaw) is a common facial injury. Fractures (these are breaks in the bone) are generally the result of a direct force to the jaw. Slide 87 Slide 88 Diseases of the joints Besides trauma, inflammation from over use or repetitive motions are the most common diseases seen in the joints. Slide 89 Bursitis Inflammation of a bursal sac usually as the result of chronic irritation Slide 90 Slide 91 Arthritis Arthritis is a common term for over 100 conditions which describe degenerative processes found in the joints. Major examples include osteoarthritis, rheumatoid arthritis and gout. Slide 92 Slide 93 Copyright 2010 Pearson Education, Inc. Figure 8.15 X ray of a hand deformed by rheumatoid arthritis. Slide 94 OsgoodSchlatter disease Is also known as tibial tubercle apophyseal traction injury is a rupture of the growth plate at the tibial tuberosity. Slide 95 OsgoodSchlatter disease The condition occurs in active boys and girls aged 916 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls. Slide 96 OsgoodSchlatter disease The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the the tibial tuberosity. Treatment is conservative with rest, RICE (Rest, Ice, Compression, and Elevation),RICE Slide 97 Slide 98 Shin Splints Shin splints is a general medical term denoting medial tibial stress syndrome (MTSS), a slow healing and painful condition in the shins, usually caused by exercise such as running, jumping, swimming, cycling, dancing or other sports. Slide 99 The onset of shin splints is most common after exercise, caused by high impact training, excessive training, poor technique Slide 100 Knuckle Cracking When one cracks a knuckle, the stretching of the capsule lowers the pressure inside the joint and creates a vacuum which is filled by the gas previously dissolved in the synovial fluid. This creates a bubble which then bursts producing the characteristic popping or cracking sound. Slide 101 Knuckle Cracking There is no evidence that cracking knuckles causes any damage such as arthritis in the joints. Slide 102 Questions?