MS PT-2S
Lecture#
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JOINTS
By: Dr.Chaman Lal PT
B.S.PT, PPDPT (M.Phil Physiotherapy), MPH (M.Phil Public Health),
Master in Physical Education & Sports Injuries (UOS),
Dip. in sports Injuries, PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA), Member of ABRET, AANEM & ASET (USA),
MPPS(PAK), MPPTA(PAK), PhD Physiotherapy Scholar (Malaysia)
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 and
Development of joints
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 References
Joints (articulations)
 Arthron (G. a joint)
 Junctura (L. a joint)
Joint:
Joint is a junction between two or more
bones or cartilages.
It is a place, where parts of skeleton meet
 It allows varying amounts of mobility
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 It is
classified by structure or function.
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Classification of Joints
A. Structural Classification
1.
Fibrous Joints:
(a) Sutures
(b) Syndesmosis &
(c) Gomophosis
2.
Cartilaginous Joints:
(a) Primary cartilaginous joints or synchondrosis &
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(b)
Secondary cartilaginous joints or symphysis
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Classification of Joints ….cont’d
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 &
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Fibrous Joints
 In fibrous joints the bones are joined by fibrous tissue.
The joints are either immovable 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 bony margins, the sutures
can be plane, serrate, denticulate, squamous,
limobus, and of schindylesis type.
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Fibrous Joints. . . . Cont’d
2. Syndesmosis:The
bones
are
connected
by
the
interosseious ligament.
Example:
tibiofibular joint
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Inferior
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Fibrous Joints. . . . Cont’d
3. Gomophosis:- These
are peg and socket joints.
Example: Tooth in its socket.
It is restricted to the
fixation of teeth in their
alveolar sockets in the
mandible and maxillae.
The collagen of the
periodontium connects
dental cement with
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Chaman Lal PT
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bone.
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2.Cartilaginous Joints:
In this type of joints the bones are joined by cartilage.
There is no synovial cavity, articulating bones tightly
connected by fibrocartilage or hyaline cartilage
These are of two types:
 1. Primary Cartilaginous Joints:
(Synchondrosis, or Hyaline cartilage joints)
 The bones are united by a plate of hyaline cartilage,
so that the joint is immovable and strong.
 These
areLaltemporary
in nature because after a
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PT
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Cartilaginous Joints. . .cont’d
 Synostosis: = The union or fusion of adjacent bones
by the growth of bony substance, 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) Spheno-occipital joint,
c) First chondrosternal joint &
d) Costochondral joints.
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Cartilaginous Joints. . .cont’d
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 filled cavities, such as in the pubic and
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manubriosternal joints.
Cartilaginous Joints. . .cont’d
 The thickness of fibrocartilage is directly related
to the range of movement.
 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 vertebral
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bodies.
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3.Synovial Joints
 Synovial Joints are most evolved , and,
therefore most mobile type of joints.
 Synovial joints has a fluid-filled cavity
between articular surface which are
covered by articular cartilage.
 The fluid is known as synovial fluid, which
is form of lymph produced by the synovial
membrane.
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Synovial Joints. . . . Cont’d
 This fluid lines the cavity except for the
actual articular surfaces and covers the
ligaments or tendons which pass through
the joint.
 Synovial fluid act as a lubricant.
 The form of the articulating surfaces
controls the type of movement 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). BursaeFactors Influencing Joint Stability
 H). Tendon Sheath

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PT articular surfaces.
A).JOINTS
BoneBy:Dr
& Chaman
shapeLalof
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Factors Influencing Joint Stability…cont’d
 1.Bone & shape of articular surfaces:
It help in maintaing stability only in firm type of
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 overmovement, 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
JOINTS By:Dr Chaman
Lal PT
factor
in maintaining the stability.
28indispensable
Classification of Synovial Joints & their
Type of Joint
Movement
movements
A. Plane or
Gliding Type
Gliding movement
B.Uniaxial Joints
1.Hinge Joint
Flexion & Extension
2.Pivot Joint
Rotation only
C. Biaxial Joints
1.Condylar Joint
2. Ellipsoid Joint
D. Multiaxial Joint
1.Saddle Joint
2. Ball& Socket joint
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Flexion and Extension, and limited rotation
Flx,Ext, abd, add, & Circumduction
Flx,Ext, abd, add, & conjunct rotation
Flx,Ext, abd, add,circumduction &rotation
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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 sensitive to stretch.
 Varying
degrees
ofPTmovements are always permitted
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Chaman Lal
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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
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Lal PT
processes
of vertebrae
etc.
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 and
c) 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 inferior
radio-ulnar joints,
b) Median atlanto-axial joints
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4.Condylar (Bicondylar)Joints
 Articular surfaces include two distinct
condyles (convex male surfaces) fitting into
reciprocally concave female surfaces (which
are also sometimes, known as condyles, such
as tibia).
 These joints permit movements mainly in
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one plane around a transverse axis, but partly
in another plane (rotation) around a vertical
axis.
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 Example:
a)
Knee joint and
b)
Right and left
jaw joints etc
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Condylar (Bicondylar)Joints….cont’d
5.Elliospoid Joints
 Articular surfaces include
an oval, convex, male
surface fitting into an
elliptical, concave female
surface.
 Example:
a) Wrist Joint
b) Metacarpophalangeal
joints &
38c)
Atlanto-occipital
JOINTS By:Dr Chaman Lal PTjoints
6.Saddle (Sellar) Joints
 Articular surfaces are reciprocally concavo-convex.
Movements are similar to those permitted by an
ellipsoid joint, with addition of some rotation (conjunct
rotation) around a third axis which, however, cannot
occur independently.
 Examples:
a) 1st carpometacarpal joint
b) Sternoclavicular joint &
c) Calcaneocuboid joint.
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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 one common 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 to their
functional classification.
1. Synarthroses (Immovable)
2. Amphiarthroses
3. Diarthroses or synovial joints
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JOINTS By:Dr Chaman Lal PT
1.Synarthroses
 These are fixed joints
and immovable. The
articular surfaces are
joined by tough
fibrous tissue.
 Often the edges of
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the
bones
are
dovetailed into one
another as in the
sutures
of the skull.
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2.Amphiarthorses
 These allow some movement.
A pad of
cartilage lies between the bone surfaces, and
there is a fibrous capsule to hold the bones
and cartilage in place. The cartilages of such
joints also act as shock absorbers e.g. the
intervertebral discs between the bodies of the
vertebrae, where the cartilage is strengthened
by extra collagen fibers.
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3.Diarthorses or synovial joints
 These are known as freely movable joints,
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 of elastic
connective tissue.
-e.g. Knee joint, shoulder joint, etc
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C. Regional Classification of the
Joints
 On regional basis joints are classified as
under 3 types;
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1.
Skull type:
2.
Vertebral type: Slightly movable
3.
Limb type:
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Immovable.
Freely movable
Movements & Mechanism of Joints
 Angular movement: Movement leading to
decrease or increase in angle between two
adjoining bones.
-Flexion: Decreasing the angle between two
bones.
-Extension: Increasing the angle between two
bones
-Abduction: Moving the part away from mid-line.
-Adduction:
Bringing
the
part
towards
the
midJOINTS By:Dr Chaman Lal PT
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line.
Synovial Joints. . . . Cont’d
2. Rotary:
-Rotation: Turing upon an axis.
-Adjunct rotation: Independent rotations
-Conjunct rotation: Rotation which accompany
other movements
-Circumduction: Moving the Extremity of the
part round in a circle so that the whole part inscribes a
cone.
3. Gliding: One part slides on another.
§
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By:Dr Chaman
Lal PT
AllJOINTS
synovial
joints
are diarthroses (freely movable)
Shape of Articular Surface
 The common articular surface shapes are:
 A)
Ovoid: When concave- female
ovoids
 When convex- male ovoids
 B)Sellar/Saddle shaped: These are
convex in one plane, concave in the
perpendicular plane
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Mechanical Axis of a Bone & movement of a Bone
 Mechanical Axis of Bone:
It is reference point around which joint mechanics
can be studies and around which the most habitual
conjunct rotation occurs.
Spin Simple rotation around the bone’s stationary
mechanical axis.
Swing: Any other displacement of the bone and its
mechanical axis apart from spin is termed a swing.
Swing
may be pure or impure (swing+element of spin)
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Cont’d. . .
 Ovoid Motion: This represents the imaginary surface
which would include all possible paths of a point on
the mechanical axis at some distance from its related
joint.
 Cardinal Swing: When the mechanical axis moves in
the shortest pathway along with the bony movement.
 Arcuate Swing: When the mechanical axis moves in
the longest pathway with the bony movement.
 Co-spin: When the effect of adjunct rotation is
additive to the rotation.
53
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Anti-spin:
Adjunct rotation which has a nullifying
Cont’d. . .
 Human Kinesiology: Study of geometry of surfaces &
their associated movements is called Kinesiology.
 Male Surface: An articulating surface which is larger in
surface area and always convex in all directions.
 Female Surface: An articulating surface which is
smaller 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.
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 Degrees of freedom: Number of axes at which the
Cont’d. . .
 Uni-axial: Movement of bone at a joint is
limited to one axis i.e., with one degree
freedom.
 Biaxial: With two degrees of freedom.
 Multi-axial:
Three axis
intermediate positions also.
 Translation:
along
with
Sliding movements of one
articulating surface over the other.
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Joint Positions
 Closed Packed Position:
When the joint surfaces become completely
congruent, their area of contact is maximal and they are
tightly compressed.
qIn this position fibrous capsule and ligaments are
maximally spiralized and tense;
qNo further movement is possible ;
qSurfaces can not be separated by disruptive forces;
qArticular surfaces are liable to trauma, e.g.,
JOINTS By:Drabduction
Chaman Lal PT +lateral rotation:
Shoulder
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Joint Positions….cont’d
 Loose Packed Position:
All other positions of incongruencey, e.g., least packed
position.
e.g., Shoulder  semiabduction,
Hip Semiflexion,
Knee Semiflexion
Ankle Ventral Position
Limitation of Movement (Factors)
-Reflex
of antagonistic m/s
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Mechanism of Lubrication of A Synovial Joints
 1. Synovial Fluid: It is secreted by synovial
membrane, is sticky and viscous due to
hyaluronic acid (a mucopolysaccharide). It
serve the main function of lubrication of the
joint.
 2.Hyaline Cartilage: It covers the articular
surface and provides the slippery surface to
reduce the friction.
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Cont’d….
 3.Intra-articular Fibrocartilages: Articular
discs or menisci, complete or incomplete, help in
spreading the synovial fluid through the joint
cavity, but particularly between the articular
surfaces.
 4.Haversian Fatty Pads(Haversian Glands):
These occupy extra spaces in the joint cavity
between the incongruous bony surfaces and
perhaps function as swabs to spread the synovial
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fluid.JOINTS By:Dr Chaman Lal PT
Blood Supply of the Synovial Joints
 The articular and epiphyseal branches given off by
the neighboring arties form a periarticular arterial
plexus.
 Numerous
vessels from this plexus pierce the
fibrous capsule and form a rich vascular plexus in
the deeper parts of the synovial membrane.
 Circulus
vasculosus(Circulus
articularis
vasculosus) is a looped anastomoses formed by the
blood vessels of the synovial membrane around the
articular
margins
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Chaman Lal PT
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Nerve Supply of the Synovial Joints
 1.The capsule and ligaments possess a rich
nerve supply while synovial membrane has a
poor nerve supply and relatively insensitive to
pain.
 2.The articular cartilage is non-nervous and
totally insensitive.
 3.Articular
nerves contains sensory and
autonomic fibers.
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Nerve Supply of the Synovial Joints…cont’d
 4.Hilton’s Law: (Hilton 1891)
“It states that a motor nerve to the
muscle acting on joint tends to give a
branch to that joint (capsule) and
another branch to the skin covering
Dr. John Hilton
the joint”.
FRCS, FRS, FZS (1804 –
September 14, 1878), British
surgeon, was born at Castle
Hedingham, in Essex.
In simple words,
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“The motor nerve supply of the
Cont’d. . . . .
 The principle that the nerve supplying a joint also
supplies both the muscles that move the joint and the
skin covering the articular insertion of those muscles.
 Gardner (1928) further elucidated that each nerve
innervates a specific region of the capsule, and that
the part of the capsule which is rendered taut by a
given muscle is innervated by the nerve supplying its
antagonists.
 Thus the pattern of innervations is concerned with
the maintenance of an efficient stability at the joint.
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Lymphatic Drainage of Synovial
 Lymphatic form a plexus
Jointsin the subintima of
synovial membrane, and drain along the blood
vessels to the regional deep nodes.
Applied Anatomy:
-Dislocation of joint
-Sprain (A sprain is a stretching or tearing of ligaments)
-Strain(A strain is a stretching or tearing of muscle or
tendon)
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-Arthritis
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