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Arthrology:
The Study of
The Joints
© Jim Swan
1
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1
Classification of Joints by Movement
• Synarthroses (synarthrotic joints) – non movable
most fibrous joints
e.g. sutures
• Amphiarthroses (amphiarthrotic joints) – semimovable
mostly cartilaginous
e.g. intervertebral disks
• Diarthroses (diarthrotic joints) – movable joints
synovial joints
2
2
Classification of Joints by Structure
Fibrous joints – composed of fibrous (inelastic)
connective tissue.
sutures – between cranial bones
syndesmoses – e.g. tibia-fibular joint,
Non-movable
3
Fibrous joints are mostly non-movable joints, but some are slightly
movable.
3
Sutures
Dense fibrous
connective
tissue
Figure 8.1
4
In sutures there is a layer of dense fibrous (inelastic connective) tissue
between the bones.
4
Syndesmoses
Fibula
Tibia
Ligament
Figure 8.1
5
In syndesmoses there is a fibrous ligament connecting the bones
together.
5
Cartilaginous Joints - formed by cartilage, are
semimovable
synchondroses – costal cartilage and
epiphyseal plate – hyaline cartilage.
symphyses – intervertebral disks and
symphysis pubis – fibrocartilage
6
6
Synchondroses
Costal cartilage
First rib and
sternum
Hyaline cartilages
Epiphyseal plate
7
Although all the cartilage connecting ribs with sternum is similar in
structure, only that connecting the first rib is considered a
synchondrosis. Epiphyseal plates are also considered as
synchondroses, although they are no longer joints once ossification is
complete.
7
Symphyses
Intervertebral disk
Symphysis
pubis
8
Both the intervertebral disks and the symphysis pubis are composed of
the same fibrocartilage structure.
8
Synovial Joints
• movable joints
• contain a joint capsule of synovial membrane
9
9
Figure 8.3
Structure of a
Synovial Joint
periosteum
Extracapsular ligament
Fibrous capsule
}
Synovial membrane
Articular
capsule
Articular cartilage
Joint cavity
10
The joint cavity inside the articular capsule is filled with synovial fluid
which lubricates the movement of the joint. Extracapsular ligaments
are found on virtually all synovial joints, as well as some other joints.
They hold the bones in position. Certain synovial joints, for example the
knee, also have intracapsular ligaments. These control degree and
direction of movement.
10
Friction Reducing Structures:
Bursae and Tendon Sheaths
Bursitis
Bursitis ––
Tendon sheath of
inflammation
inflammation
of aa
bursa,
usually
bursa,
usually
bursa
caused
caused by
by
excessive
excessive use
use or
or
injury.
injury.
Subacromial
bursa
ligament
Bursal cavity
Articular cavity
11
Bursae and tendon sheaths are synovial sacks located outside the joint.
They lubricate the movement of ligaments and tendons allowing them to
slide against other structures without tearing.
11
Types of Synovial
Joints:
Non-axial Joints
Figure 8.7 (a)
Gliding or planar joints – bones slide
against one another.
e.g. between carpals or tarsals
12
A Plane joint is a non-axial joint. Its sliding movement allows flexibility of
the wrist and ankle.
12
Uniaxial Joints –
movement in one axis
e.g. hinge joints:
Elbow, knee.
Pivot joints:
e.g. radius with
ulna and humerus,
atlas-axis
Figure 8.7 (b)
13
Hinge joints are uniaxial joints, they move in one plane or on one axis
only. Flexion and extension are the reciprocal movements at these
joints.
13
Movements at Uniaxial Joints:
180o
Flexion – decreasing the
angle between two bones or
parts.
•Begin at anatomical position
•Reduce angle from 180o
14
Consider each movement beginning with the body in anatomical
position. A straight line drawn through the body indicates angles of 180
degrees at anatomical position. Reducing those angles ofr knee or
brachium produces flexion.
14
Extension – increasing the angle between two
bones or parts.
Beyond
anatomical
position is
Return to
hyperextension
anatomical
position
Increase
angle back to
anatomical
position
15
The reference axis is shown by the line running in a cephalocaudal
direction through the entire body.
15
Hyperextension
Flexion
Flexion and
Extension of the
Verterbral
Column
Extension
When
When extension
extension
proceeds
proceeds beyond
beyond
anatomical
anatomical position
position
itit is
called
is called
hyperextension.
hyperextension.
16
The reference axis is shown by the line running in a cephalocaudal
direction through the entire body.
16
Flexion and Extension of the Head
Extension
Flexion
Hyperextension
17
Reference axis is shown by the line running in a cephalocaudal
direction through the entire body.
17
Figure 8.7 (c)
Pivot Joint - rotation
Radius rotates on its own axis.
Atlas and head rotate around
odontoid process of axis
18
Pivot joints are also uniaxial, the one axis being in the center of the
movement.
18
Rotation of
the Head and
Thigh
19
The brachium also rotates in the shoulder joint. To best demonstrate
and distinguish between pronation and supination, first bend the elbow.
19
Rotation of the Radius
Supination – to move palm up
Pronation – to move palm down
20
Despite popular usage, supination and pronation refer only to the hand.
20
Biaxial Joints – movement in two axes
e.g. condyloid joints,
saddle joint
Other condyloid joints include
the occipito-atlas and the
tibia-talus joints.
Figure 8.7 (d)
21
Condyloid and saddle joints are very similar with slightly different
shapes. Both are biaxial joints. The movements performed are flexion,
extension, adduction, and abudction, along with circumduction, a
combination of the other four.
21
Abduction –
to move
away from
the midline
or apart.
Adduction –
to move
toward the
midline or
together.
Additional
Movements at
Biaxial Joints
Circumduction – a sequence
of movements in which one
end inscribes a circle.
22
The reference for abduction and adduction is the midline of the body,
or another adjacent part.
22
Multiaxial Joints
e.g. ball-and-socket joints:
shoulder, hip
• Perform movements in more than two axes.
• Perform all movements discussed
Flexion, extension, rotation,
adduction, abduction,
circumduction
Figure 8.7 (f)
23
23
Movements of the Foot
dorsiflexion:
point toes up
plantarflexion:
point toes down
24
The axis for these movements runs bilaterally through the ankle.
24
Inversion and Eversion
Inversion,
incorrectly called
supination
Eversion,
incorrectly called
pronation
Left foot
25
25
Other Movements
Elevation – to raise a part
Depression – to lower a part
Protraction – to move a part forward
Retraction – to move a part backward
26
You can elevate and depress many parts such as the scapula, pelvis,
jaw, etc. These parts also can protract and retract.
26
The Shoulder
bursae
ligaments
Articular
capsule
beneath
ligament
Tendon of the
long head of the
biceps brachii
Tendon of subscapularis
Figure 8.8 a
27
Multiple ligaments help to hold the humerus in position, but the primary
structural support for the shoulder is the muscle group called the
rotator cuff.
27
Right Shoulder
Glenoid fossa
Articular
capsule
Tendon of long head
of biceps brachii
Tendon of
subscapularis
Figure 8.8 b
28
Here you see some of the tendons of rotator cuff muscles (the biceps is
NOT a rotator cuff muscle).
28
Left Shoulder, Ant. View
glenoid fossa
29
Notice the shallowness of the glenoid fossa. For this reason it requires
muscular support in the form of the rotator cuff.
29
Left Shoulder, extended
30
30
The Elbow Joint
Figure 8.10 a
Tendon of biceps b.
trochlea
Tendon of
triceps b.
Articular
cartilage
synovial cavity
Trochlear notch
31
Located in the elbow actually are two joints: a hinge joint whose axis
runs bilaterally through the trochlea; a pivot joint between the
capitulum of the humerus and the head of the radius.
31
Collateral
Collateralligaments
ligamentsstabilize
stabilize
the
thejoint
jointon
oneach
eachside,
side,prevent
prevent
lateral
and
medial
lateral and medial
displacement
displacementof
ofbones.
bones.
Figure 8.10 b
Annular ligament
Articular
capsule
Radial (lateral)
collateral ligament
32
The radial head fits neatly in the collar produced by the annular
ligament and turns within this collar.
32
Figure 8.10 d
Annular ligament
Ulnar (medial)
collateral ligament
33
33
Elbow radiograph, lateral view
34
The bones of the elbow and location of the articular capsules are clearly
visible.
34
Elbow radiograph, dorsal view
35
The articular cartilage and capsule, not being radio-opaque, shows up
clearly as a dark space between the bones.
35
Hip Joint
Articular
capsule
Syovial cavity
Ligamentum
teres
Intracapsular
Intracapsularligaments
ligaments
––lie
within
the
lie within thejoint
joint
capsule
to
stabilize
capsule to stabilizeand
and
restrict
restrict range
range of
of motion.
motion.
Figure 8.9 a
Articular
capsule36
Unlike the shoulder, the hip joint has a deep fossa which supports the
tremendous force placed on it. Even walking normally places a force on
this joint of many times the body’s weight.
36
Extracapsular Ligaments of the Hip
iliofemoral
ligament
pubofemoral
ligament
Figure 8.9 c, d
ischiofemoral
ligament
37
Each ligament which supports the hip joint has a name that indicates its
location.
37
There is no
audio file
for this
slide
Hip Joint Radiograph
38
Notice the deep acetabular fossa, the sacroiliac joint, and the pubic
symphysis, all soft tissues which show up as black areas between the
bones.
38
Articular cartilage
The Knee
Quadriceps
tendon
Articular
capsule
femur
patella forms
forms
fulcrum
for
knee
fulcrum
forcavity
knee
Synovial
movement
movement
bursae
Patellar
meniscus
ligament
Absorbs
Absorbs shock,
shock, tibia
facilitates
Inserts on tibial
facilitates
movement
tuberosity
movement
39
Figure 8.11 (a) Midsagittal view of right knee
The knee has both extracapsular and intracapsular structures for
support. The knee joint actually involves three bones: tibia, femur, and
patella.
39
Quadriceps
tendon
Lateral patellar
retinaculum
Lateral (fibular)
collateral
ligament
Retinacula
Retinacularestrict
restrictlateral
lateral
displacement
displacementof
ofthe
thepatella.
patella.
Collateral
Collateral ligaments
ligaments control
control side-toside-toside
displacement
of
bones
at the
s
joint.
Figure 8.11 (c) joint.
patella
Medial (tibial)
collateral ligament
Medial patellar
retinaculum
Patellar
ligament
40
40
Extracapsular Ligaments of the Knee
Fibular (lateral)
collateral ligament
Tibiofibular
ligament
Tibial (medial)
collateral ligament
Patellar ligament
Figure 8.11 (b) Anterior view of right knee
PDF: Arthroscopic Surgery of the Knee
41
Hypothetically removing the articular capsule and opening up the knee
reveals the intracapsular ligaments and the menisci. Only the
extracapsular structures are labeled here.
41
Intracapsular Structures of the Knee
Anterior cruciate
ligament
Posterior cruciate
ligament
Lateral
meniscus
Medial
meniscus
Cruciate
Cruciate ligaments
ligaments control
control
front-to-back
displacement
front-to-back displacement
and
and twisting.
twisting.
Figure 8.11 (b) Anterior view of right knee
42
Here are labeled the intracapsular structures.
42
Intracapsular
Ligaments
…
… or
or posterior
posterior
displacement
displacement of
of femur
femur
against
against tibia
tibia
Anterior
cruciate
Restricts
Restricts anterior
anterior
displacement
displacement of
of tibia
tibia
against
against femur…
femur…
The anterior cruciate ligament attaches at an anterior position on the tibia. It
restricts anterior displacement of tibia against femur, or posterior displacement of
the femur against the tibia.
1
Intracapsular
Ligaments
…or
…or anterior
anterior
displacement
displacement of
of femur
femur
against
against tibia
tibia
Posterior
cruciate
Restricts
Restricts posterior
posterior
displacement
displacement of
of tibia
tibia
against
against femur…
femur…
The posterior cruciate attaches at a posterior position of the tibia and restricts
posterior displacement of tibia against femur, or the anterior displacement of the
femur against the tibia.
2
There is no
audio file
for this
slide
Knee Radiograph
44
Articular capsules and other soft tissues appear as dark spaces
between the bones.
44
Arthritis: Inflammation of the joints
osteoarthritis –
•most common type of arthritis (90%)
•deterioration of the articular cartilage which then
leads to the formation of calcifications or bone
spurs.
• little, if any, actual inflammation occurs.
• articular cartilage deteriorates because of age,
stress, and injury.
45
45
A
B
Above: Osteoarthritis of the
shoulder joint (humeral head).
Right: osteoarthritis of the
vertebral column.
46
On the left is seen osteoarthritis of the shoulder joint. The normal
articular cartilage is shown by A, the result of the arthritis is seen as the
calcifications in B. Note the calcified masses between the vertebrae in
the photo on the right.
46
Rheumatoid arthritis • the most severely debilitating form of arthritis
• affects less than 10% of arthritis sufferers.
• autoimmune disease:
ƒimmune system cells release chemicals which
attack the joint tissues.
ƒ Severe inflammation results in great pain.
ƒ fibrous tissue causes stiffness
ƒ fibrous tissue may ossify to immobilize joint
47
Pain relieving drugs and surgery, even joint replacement, are the
treatments.
47
Gouty arthritis • genetic disorder in the ability to metabolize uric
acid.
•uric acid crystals build up in the soft joint tissues
and causes their inflammation and destruction.
Anti-inflammatory
Anti-inflammatory drugs
drugs and
and diet
diet
management
used
for
treatment.
management used for treatment.
48
48
Joint Injuries
A sprain involves twisting of the joint, often with
accompanying stretching and tearing of
ligaments.
A strain - a pulling of a muscle tendon and other
connective tissues in muscles, but not the joint
tissues.
luxation is a dislocation in which a bone such as
the humerus or femur pulls away from its
position in the socket of the joint.
A separation occurs when the fibrous tissue in a
syndesmosis stretches or tears.
49
These ligaments are slow to heal because of their lack of
vascularization; support or immobilization is the treatment. With very
severe sprains involving intracapsular ligaments surgery may be
performed to reattach the ligaments or replace them with a portion of a
ligament from some other location.
Small strains are normal and the inflammation produced causes the
soreness you may experience after strenuous exercise. Major pulls
result from more severe stretching and take longer to heal.
A complete luxation may stretch or tear accompanying ligaments to the
point they will not return to normal. Partial dislocation or subluxation is
more common and the bone can usually be returned manually to its
normal position.
The most common separation is a shoulder separation in which the
clavicle pulls away from its attachment to the acromion process of the
scapula.
49