Articulations
Articulation = joint =
point of contact between bones
Joint Classification
Functional Name
Synarthroses
Amphiarthroses
Diarthroses
Structural Name
Fibrous
Cartilaginous
(hyaline, fibrocartilage)
Synovial
Movement
Immovable
Slightly
movable
Freely movable
Example
Description
Syndesmoses
ligaments
Sutures
skull
Gomphoses
Teeth to jaw
Synchrondosis
Ribs, epiphyseal plate
Symphyses
Pubis, vertebral discs
Uniaxial
Hinge, pivot
Biaxial
Saddle, ellipsoidal
Multiaxial
Ball and socket,
gliding
Synarthroses
Fibrous Joints
Amphiarthoses
Cartilaginous
Diarthroses
Synovial
•
•
•
Most numerous
Most complex
Structures
–
joint capsule
•
–
synovial membrane
•
bursae
–
hyaline cartilage covering bone ends
menisci
•
–
small space between bones
articular cartilage
•
–
cushions joints and helps tendons
move
joint cavity
•
–
membrane lining capsule to secrete
synovial fluid
bursae
•
–
sleevelike encasing around bone ends
to bind them together
pads of fibrocartilage between bones
Ligaments
•
strong, dense, white fibrous tissue that
hold bones firmly together
Knee Joint
(Hyaline cartilage)
(fibrocartilage)
Ankle Joint
Anterior interior
tibiofibular ligament
Achilles tendon (cut)
Types of Joints
ellipsoidal
Uniaxial Joints
permits movement around one axis and one plane
• projection of one bone articulating with a
ring/notch of another bone
– examples - between vertebrate
• allows only flexion and extension
– examples – elbow, knee
• knee joint
– largest joint, most complex, most frequently injured
Biaxial Joints
permits movement around two perpendicular axes and planes
• Example
– thumb
• only saddle
joint in the
body
• condyle fits into an
elliptical socket
• Example
– between radius
and carpals
ellipsoidal
Multiaxial Joints
permits movement around three or more axes and planes
• most moveable joints
• ball shaped head fits into concave depression
• example - shoulder, hip
– humeroscapular joint
• most mobile joint
– sacroiliac joint
• hip joint
• relatively flat articulating surface that allows
gliding movement
• example
– between carpals
– between tarsals
– between vertebrate
ROM
(Range of Motion)
• Goniometer
– Used to determine extent of injury and progress of rehabilitation
– measures range of motion (degree of angle)
Angular ROM
•
•
•
•
•
•
•
flexion – decreases angle,
movement towards body
extension – increase angle,
movement away from body
hyperextension – stretching or
extending beyond anatomical
position
plantar flexion – increase
angle between top of foot and
front of leg (point down)
dorsiflexion – decrease angle
between top of foot and front of
leg (point up)
ABduction – move AWAY from
medial plane
ADduction – move TOWARDS
medial plane
Circular ROM
• rotation – pivoting a bone on its
axis
• circumduction – distal end of a
body part moves in a circle
• supination – hand palm side up
• pronation – hand palm side down
Special Movements
•
•
•
•
•
•
inversion – turn sole outward
eversion – turn sole inward
protraction – move part forward
retraction – move part backward
elevation – move part up
depression – move part down
Joint Disorders
• Inflammatory (IJD)
– Rheumatoid arthritis
– Gout
• Noninflammatory (NIJD)
– Osteoarthritis
– Tramatic Injuries
•
•
•
•
•
Dislocation
Meniscus tear
Sprain
Ligament tear
Herniated disc
Joint Disorders
• Rheumatoid arthritis
– Chronic and systemic
– Inflammation of synovial membrane
– Cartilage destroyed, bone erosion
– Progressive crippling and deformity
– Pain, inflammation, decreased mobility, aching,
stiffness
– Treat with corticosteroid drugs and NSAIDS
Joint Disorders
• Gouty arthritis
– Also referred to as just Gout
– Excessive uric acid in blood
– Crystals get deposited in synovial fluid
– Chronic inflammation and tissue damage
– Swelling, tenderness
– Pin in wrists, fingers, ankles, knees, elbows
– Treat with Allopurinol (inhibits uric acid synthesis)
and Uloric (new med)
Joint Disorders
NIJDC
Osteoarthritis
IJD
Rheumatoid arthritis
IJD
Gout
Joint Disorders
• Osteoarthritis
– Most common NIJD
– Wear and tear deterioration
– Atrophy of articular cartilage
– Formation of new bone at joint surface
– Most common in weight-bearing joints
– Stiffness, pain, limited movement
– Treat symptoms with NSAIDS
Joint Disorders
• Dislocation
–
–
–
–
Articular surfaces not in proper contact
Tear vessels, nerves, ligaments, muscles
Pain and swelling
Treat with realignment (reduction);
sometimes surgery
Joint Disorders
• Sprain
– Stretching of ligaments surrounding joint
– Due to twisting motion
– Hematoma, limited motion
– Treatment: R.I.C.E.
•
•
•
•
Rest
Ice
compression
elevation
Degree of Sprains
•
1st degree ankle sprain
–
–
–
–
–
•
2nd degree ankle sprain
–
–
–
–
•
Some stretching or perhaps tearing may have occurred
No loss of function
Mild pain, little bruising
Little or no swelling
Some joint stiffness or difficulty walking
Difficulty walking
Moderate to severe pain
Swelling and tenderness in the ankle joint
Bruising may start after 3 to 4 days
3rd degree ankle sprain
–
–
–
–
–
most serious
Total rupture of a ligament
Walking may not be possible
Severe pain initially and substantial swelling
May require surgery
Joint Disorders
• Ligament Tears (3rd degree Sprain)
• Bruising, pain, swelling, instability
• Physical therapy
• Partial tear vs. complete tear
– Partial Tear – boot/brace, crutches
– Complete Tear - Surgery after most swelling subsides
Joint Disorders - Knee
• Meniscus Tear
– One of most common athletic injuries
– Swelling, pain, instability, limited motion
– Treat with arthroscopic surgery
Meniscus
Normal
Tear of medial meniscus
Joint Disorders - Knee
• ACL tear
– Women more likely than men
– Will hear a popping sound
– Usually due to twisting motion
• Get hit very hard on the side of your knee, such as during a
football tackle
• Overextend the knee joint
• Quickly stop moving and change direction while running,
landing from a jump, or turning
– Repair by grafting (not sew back together)
• Patellar tendon autograft (autograft comes from the patient)
• Hamstring tendon autograft
• Quadriceps tendon autograft
• Allograft (taken from a cadaver) patellar tendon, Achilles
tendon, semitendinosus, gracilis, or posterior tibialis tendon
ACL, MCL, PCL tears
Arthroscopic surgery
•
3-4 very small incisions ¼ in.
– fiber-optic light source
– video camera
– terile saline solution is continuously
pumped through the knee via a
cannula
Vertebral Disc Disorders
Herniated disc Treatment
• Steroid epidural
– Use long needle to inject steroid into epidural space
in order to shrink the herniation (cartilage)
• Surgery
– (microdisectomy)
• Cut off protruding cartilage
Steroid Epidural
Knee Arthroscopic Surgery
• http://www.cartilagerepaircenter.org/treatm
ent-options/meniscal-procedures.html
• http://www.youtube.com/watch?v=nAj2_pg
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• http://www.youtube.com/watch?v=kpW2M
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Knee Replacement
• http://www.youtube.com/watch?v=H3xkj_1
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Hip Replacement
• http://www.youtube.com/watch?v=DosqbE
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• http://www.webmd.com/painmanagement/video/hip-restoration
• http://www.youtube.com/watch?v=lh2UX8
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• http://www.youtube.com/watch?v=vJL8n_
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Ankle Arthroscopy
• http://www.youtube.com/watch?v=A22lTy
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Herniated disc epidural
• http://www.youtube.com/watch?v=97m4VI
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Herniated disc microdisectomy
• http://www.youtube.com/watch?v=rU8YYE
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