1. KILIMANJARO CHRISTIAN MEDICAL UNIVERSITY COLLEGE
Faculty of Rehabilitation Medicine
Department of Anatomy and Neuroscience
Course: Anatomy for BSc. Nursing
Anatomy for BSc. Physiotherapy
Course Code: AN 100 &
PAN 101
LECTURE 19
TOPIC: JOINTS
Date: Jan. 13th 2023, from 8:00 am -10:00 am, GYM – Physiotherapy School
and from 1:30 pm to 5:30 pm – GYM - Physiotherapy School
Lecturer: J. S. Kauki, BSc, MSc, on PhD, Email: jskauki@gmail.com.
Office ext. 69 Block C, 3RD Floor, Anatomy and Neuroscience dept.
2. Objectives
• Describe the structural and functional basis for the classifications of joints.
• Explain the importance of ligaments at joints.
• Describe the structure and functions of the three types of fibrous joints.
• Describe the structure and functions of the two types of cartilaginous joints.
• Describe the structure of synovial joints,
• Outline the structure and function of bursae and tendon sheaths,
• List the six types of synovial joints and describe types of synovial joint movements
• Describe the detailed structure of selected joints; TMJ, shoulder joint, Elbow joint, Hip joint and
Knee joint.
3. JOINTS
• Joint Classifications
• Ligaments
• Fibrous Joints
• Sutures
• Syndesmoses
• Interosseous Membranes
• Cartilaginous Joints
• Synchondroses
• Symphyses
• Synovial Joints
• Structure of Synovial Joints
• Bursae and Tendon Sheaths
• Types of Synovial Joints
• Types of Movements at Synovial Joints
• Gliding
• Angular Movements
• Rotation
• Special Movements
Assignment: Factors Affecting Contact and
Range of Motion at Synovial Joints
4. JOINTS
Defined: any place where two bones come together
• General function of Joints:
• Hold the skeleton together
• Allow for increased mobility and flexibility of skeleton
Joints can be classified based on:
• Function: what kind of movement they allow
• Structure: what material is found in the joint and if is there a joint cavity present.
* You are required to know each of these categories.
5. Functional classification
• Synarthroses – joints that have NO
movement.
• Examples: sutures of the skull,
gomphoses- teeth
• Amphiarthroses – partially movable
joints.
• Examples: intervertebral disc and
pubic symphysis
• Diarthroses – freely movable joints.
(The most common type of functional joint
in the body)
• Examples: knee joint, shoulder joint,
finger joints, ankle and wrist joints, etc.
Structural Classification
1. Fibrous joints (synarthroses): adjacent
bones are joined by collagen fibers.
3 kinds: Sutures, Gomphoses and
Syndesmoses.
2. Cartilaginous joints (amphiarthroses): two
bones are joined by cartilage.
2 kinds: Synchondroses, and Symphyses.
3. Synovial joints (Diarthroses): freely
movable and most common joint in the
body.
7. Ligaments
• Ligaments are dense irregular or dense regular connective tissue structures that bind one bone
to another bone
• They come in a variety of forms and are integral parts of joints.
• Ligaments can serve as intrinsic binding structures within the joint itself (such as the sutural
ligaments of the skull or the periodontal ligaments of the teeth), or as extrinsic supporting bands
that stabilize joints while limiting their range of motion (such as the anterior cruciate ligament
of the knee).
• As you study the various joints of the body in the sections that follow, you will learn about the
structures, locations, and functions of a variety of ligaments.
• Review: Sprains and treatments
8. Fibrous joints (synarthroses)
• Fibrous joints are joints in which the
neighboring bones are joined together by a
solid mass of dense irregular connective
tissue.
• The adjoining connective tissue can vary from
small fibrous strands of connective tissue, to
large thick bands, to extensive membranous
sheets.
• There are three types of fibrous joints: sutures,
syndesmoses, and interosseous membranes.
9. Sutures
• A suture is a fibrous joint composed of a thin layer of dense irregular connective tissue called the
sutural ligament.
• Sutures are found only between bones of the skull, eg. coronal suture between the frontal and parietal
bones.
• The irregular, interlocking edges of sutures give them added strength and decrease their chance of
fracturing.
• Sutures are joints that form as the numerous bones of the skull come in contact during development.
• They are immovable or slightly movable joints. In older individuals, sutures are immovable, but in
infants and children they are slightly movable.
• Sutures play important roles as sites of growth and shock absorption in the skull.
• Some sutures, although present during growth of the skull, are replaced by bone in the adult. Such a
suture is called a synostosis or bony joint—a joint in which there is a complete fusion of two separate
bones into one.
• For example, the frontal bone grows in halves that eventually join together across a suture line. Usually
they are completely fused by age 6 and the suture becomes obscure. If the suture persists beyond age 6,
it is called a frontal or metopic suture. A frontal suture is an immovable joint.
10. Syndesmosis
• A is a fibrous joint in which there is a greater distance between the articulating
surfaces and more dense irregular connective tissue than in a suture.
• The dense irregular connective tissue is typically arranged as a bundle
(ligament) and the joint permits limited movement. One example of a
syndesmosis is the distal tibiofibular joint, where the anterior tibiofibular
ligament connects the tibia and fibula.
• Another example of a syndesmosis is called a gomphosis or dentoalveolar
joint, in which a cone-shaped peg fits into a socket.
• The only examples of gomphoses in the human body are the articulations
between the roots of the teeth and their sockets (alveoli) in the maxillae and
mandible.
• The dense irregular connective tissue between a tooth and its socket is the thin
periodontal ligament (membrane).
• A healthy gomphosis permits no movement. Inflammation and degeneration of
the gums, periodontal ligament, and bone is called periodontal disease.
11. Interosseous membrane
• An interosseous membrane is a substantial sheet of dense irregular
connective tissue that binds neighboring
• long bones and permits slight movement.
• There are two principal interosseous membrane joints in the human
body. One occurs between the radius and ulna in the forearm and the
other occurs between the tibia and fibula in the leg.
• These strong connective tissue sheets not only help hold these
adjacent long bones together, they also play an important role in
defining the range of motion between the neighboring bones and
provide an increased attachment surface for muscles that produce
movements of the digits of the hand and foot.
12. Cartilaginous joints (amphiarthroses)
• In a cartilaginous joint the articulating bones are tightly
connected, either by hyaline cartilage or by fibrocartilage.
• The two types of cartilaginous joints are synchondroses and
symphyses.
Synchondroses are an immovable, cartilaginous joint in which the
connecting material is hyaline cartilage.
• An example of a synchondrosis is the epiphyseal (growth) plate
that connects the epiphysis and diaphysis of a growing bone.
• When bones stop growing in length, bone replaces the hyaline
cartilage, and the synchondrosis becomes a synostosis, or bony
joint
13. Symphyses
• This is a cartilaginous joint in which the ends of the articulating bones are covered with hyaline
cartilage, but the bones are connected by a broad, flat disc of fibrocartilage.
• All symphyses occur in the midline of the body.
• The pubic symphysis between the anterior surfaces of the hip bones, which is slightly movable, is one
example of a symphysis.
• This type of joint is also found at the junction of the manubrium and body of the sternum and at the
intervertebral joints between the bodies of vertebrae.
• A portion of the intervertebral disc is made up of fibrocartilage.
• The structure of the intervertebral disc helps to provide the limited range of motion in the vertebral
column while serving as an important shock-absorbing pad between the vertebral bodies.
14. Synovial Joints (diarthroses)
• This type of joint is defined by
the presence of a joint cavity
filled with fluid.
• Most joints of the body fall into
this class.
Examples: knee joint, elbow joint, shoulder
and hip joints and the phalanges of
hands and feet, etc.
Synovial Joint structure
1. Articular capsule – external and internal
2. Joint/synovial cavity – filled with synovial
fluid
3. Articular cartilage – Hyaline cartilage
4. Synovial fluid – viscous/ clear colorless
fluid
5. Ligaments – give the joint reinforcement
and strength
6. Nerves – provide feelings of pain and
stretch
7. Vessels - provide nutrients to joint
15. Additional joint structures
• Ligaments- join bones to bones
• Consists of dense regular connective
tissue.
• Tendons- join muscles to bone
• Consists of dense regular connective
tissue.
• Bursae- fibrous sac lined with
synovial membrane and containing
synovial fluid
• Occurs between bones and tendons or
muscles
• Acts to decrease friction during
movement
16. Hip Joint
Accessory joint
structures
1. Fatty pads -
cushioning
2. Menisci – tough
fibrocartilage
3. Bursae -flattened
fibrous sac lined by
synovial membrane.
4. Tendon sheaths -
fibrous tissue
connecting a
muscle to a bone
17. Knee Joint Anterior view
1. Articular capsule
2. Synovial membrane
3. Medial and lateral menisci
4. Suprapatellar, infrapatellar and prepatellar
bursae
5. Anterior and posterior cruciate ligaments
6. Tibial and fibular collateral ligaments
7. Patellar capsule
8. Articular cartilage
9. Tendon of quadriceps femoris
18.
19. Types of Synovial Joints
1. Plane (gliding) Joints
2. Hinge Joints
3. Pivot Joints
4. Condyloid Joints
5. Saddle Joints
6. Ball and Socket Joints
20. 20
Types of synovial joints; Planar / Gliding joints
• Planar joints permit mainly side-to-side
and back-and-forth gliding movements.
These joints are nonaxial.
• Bone surfaces are flat or slightly curved
• Side to side movement only
• Rotation prevented by ligaments
• Examples
• Intercarpal or intertarsal joints
• Sternoclavicular joint
• Vertebrocostal joints
21. 21
Types of synovial joints cont. … Hinge joint
• A hinge joint contains the convex surface of
one bone fitting into a concave surface of
another bone.
• Movement is primarily flexion or extension in
a single plane.
• Uniaxial like a door hinge
• Examples
• Knee, elbow, ankle, interphalangeal joints
• Movements produced
• Flexion = decreasing the joint angle
• Extension = increasing the angle
• Hyperextension = opening the joint
beyond the anatomical position
22. 22
Types of synovial joints cont. .. Pivot joint
• In a pivot joint, a round or pointed surface of one bone fits
into a ring formed by another bone and a ligament.
• Movement is rotational and monaxial.
• Monoaxial since it allows only rotation around longitudinal
axis
• Examples
• Proximal radioulnar joint
• supination
• pronation
• Atlanto-axial joint
• turning head side to side, eg. saying “no”
23. 23
Types of synovial joints cont. ..
• In an condyloid joint, an oval-shaped
condyle of one bone fits into an elliptical
cavity of another bone (Figure 9.10d).
Movements are flexion-extension, abduction-
adduction, and circumduction.
• Oval-shaped projection fits into oval
depression
• Biaxial = flex/extend or abduct/adduct is
possible
• Examples
• wrist and metacarpophalangeal joints for
digits 2 to 5
Condyloid or Ellipsoidal Joint
24. 24
Types of synovial joints cont. … Saddle joint
• A saddle joint contains one bone whose articular
surface is saddle-shaped and another bone whose
articular surface is shaped like a rider sitting in the
saddle. Movements are flexion-extension, abduction-
adduction, and circumduction.
• One bone saddled-shaped; other bone fits as a person
would sitting in that saddle
• Biaxial
• Circumduction allows tip of thumb travel in
circle
• Opposition allows tip of thumb to touch tip of
other fingers
• Example
• Trapezium of carpus and metacarpal of the
thumb
25. 25
Types of synovial joints cont. .. Ball-and-socket joint
• In a ball-and-socket joint, the ball-shaped surface of one
bone fits into the cuplike depression of another.
• Movements are flexion-extension, abduction-adduction,
rotation, and circumduction.
• Multiaxial
• Flexion/extension
• Abduction/adduction
• Rotation
• Examples (only two!)
• shoulder joint
• hip joint
26. Movements allowed by Synovial Joints
1. Gliding – - bony surfaces of bone slide
or glide over each other
2. Flexion –- bending movement that
decreases the angle
3. Extension – movement the increases the
angle, opposite of lexion
4. Abduction –moving away from
longitudinal axis
5. Adduction –movement toward the
longitudinal axis
6. Circumduction –movement of the limb
such that it describes a cone
7. Rotation – turning the bone or limb
around its long axis
8. Supination –rotating the forearm laterally
such that the palm faces superiorly
9. Pronation –- rotating the forearm
medially such that the palm faces
inferiorly
10.Inversion –- sole of the foot faces or
turns medially
11. Eversion –- sole of the foot turn laterally
12. Protraction –-juttting out of the jaw
13. Retraction –- moving the jaw backward
14. Elevation –- lifting the limb or body
superiorly
15. Depression –- moving the body part
inferiorly
16. Opposition –- to bring the thumb and
index finger tips together
32. 32
DISCUSSION:
FACTORS AFFECTING CONTACT AND RANGE OF MOTION AT SYNOVIAL JOINTS
• Structure and shape of the articulating bone
• Strength and tautness of the joint ligaments
• Arrangement and tension of the muscles
• Contact of soft parts
• Hormones
• Disuse
AGING AND JOINTS
• Various aging effects on joints include decreased production of synovial fluid, a thinning of
the articular cartilage, and loss of ligament length and flexibility.
• The effects of aging on joints are due to genetic factors as well as wear and tear on joints.
33. 33
SELECTED JOINTS OF THE BODY
• Temporal Mandibular Joint (TMJ)
• Shoulder Joint
• Elbow Joint
• Hip Joint
• Knee Joint
34. 34
Tempromandibular Joint (TMJ)
• The TMJ is a combined hinge and planar joint formed by the condylar
process of the mandible, the mandibular fossa, and the articular tubercle
of the temporal bone.
• Movements include opening and closing and protraction and retraction of
the jaw.
• When dislocation occurs, the mouth remains open.
• Synovial joint
• Articular disc
• Gliding above disc
• Hinge below disc
• Movements
• depression
• elevation
• protraction
• retraction
SELECTED JOINTS OF THE BODY
35. 35
Shoulder Joint.
• This is a ball-and-socket joint formed by the
head of the humerus and the glenoid cavity of
the scapula.
• Movements at the joint include flexion,
extension, abduction, adduction, medial and
lateral rotation, and circumduction of the arm .
• This joint shows extreme freedom of
movement at the expense of stability.
• Rotator cuff injury and dislocation or
separated shoulder are common injuries to this
joint.
36. 36
Elbow Joint
• This is a hinge joint formed by the
trochlea of the humerus, the
trochlear notch of the ulna, and the
head of the radius.
• Movements at this joint are
flexion and extension of the
forearm.
• Tennis elbow, little elbows, and
dislocation of the radial head are
common injuries to this joint.
37. 37
Hip Joint
• This ball-and-socket joint is formed by the
head of the femur and the acetabulum of
the hipbone.
• Movements at this joint include flexion,
extension, abduction, adduction,
circumduction, and medial and lateral
rotation of the thigh.
• This is an extremely stable joint due to the
bones making up the joint and the
accessory ligaments and muscles.
38. Principles of Human Anatomy and Physiology, 11e 38
Hip Joint Capsule
• Dense, strong capsule reinforced by ligaments
• iliofemoral ligament
• ischiofemoral ligament
• pubofemoral ligament
• One of strongest structures in the body
39. Knee Joints
• This is the largest and most complex
joint of the body and consists of three
joints within a single synovial cavity.
• Movements at this joint include
flexion, extension, slight medial
rotation, and lateral rotation of the leg
in a flexed position.
• Some common injuries are rupture of
the tibial colateral ligament and a
dislocation of the knee.
40. 40
Knee joint / Tibiofemoral Joint
• Some common injuries are rupture of the tibial colateral
ligament and a dislocation of the knee.
• Between femur, tibia and patella
• Hinge joint between tibia and femur
• Gliding joint between patella and femur
• Flexion, extension, and slight rotation of tibia on femur
when knee is flexed
• This is the largest and most complex joint of the body and consists of three joints within a
single synovial cavity.
• Movements at this joint include flexion, extension, slight medial rotation, and lateral rotation
of the leg in a flexed position.
41. Principles of Human Anatomy and Physiology, 11e 41
Tibiofemoral Joint
• Articular capsule
• mostly ligaments &
tendons
• Lateral & medial menisci =
articular discs
• Many bursa
• Vulnerable joint
• Knee injuries damage
ligaments & tendons since
bones do not fit together well
42. 42
External Views of Knee Joint
• Patella is part of joint capsule anteriorly
• Rest of articular capsule is extracapsular ligaments
• Fibular and tibial collateral ligaments
44. Principles of Human Anatomy and
Physiology, 11e
44
Arthroscopy & Arthroplasty
• Arthroscopy = examination of joint
• instrument size of pencil
• remove torn knee cartilages & repair ligaments
• small incision only
• Arthroplasty = replacement of joints
• total hip replaces acetabulum & head of femur
• plastic socket & metal head
• knee replacement common
45. 45
Techniques for cartilage replacement
• In cartilage transplantation chondrocytes are removed from the patient, grown
in culture, and then placed in the damaged joint.
• Eroded cartilage may be replaced with synthetic materials
• Researchers are also examining the use of stem cells to replace cartilage.
47. 47
DISORDERS: HOMEOSTATIC IMBALANCES: Rheumatism and Arthritis
• Osteoarthritis is a degenerative joint disease commonly known as “wear-and-tear” arthritis.
It is characterized by deterioration of articular cartilage and bone spur formation.
• It is noninflammatory and primarily affects weight-bearing joints.
• Gouty arthritis is a condition in which sodium urate crystals are deposited in soft tissues of
joints, causing inflammation, swelling, and pain.
• If not treated, bones at affected joints will eventually fuse, rendering the joints immobile.
48. 48
Gouty Arthritis
• Urate crystals build up in joints causing pain
• waste product of DNA & RNA metabolism
• builds up in blood
• deposited in cartilage causing inflammation & swelling
• Bones fuse
• Middle-aged men with abnormal gene
49. Principles of Human Anatomy and Physiology, 11e 49
Rheumatoid Arthritis
• Autoimmune disorder
• Cartilage attacked
• Inflammation, swelling & pain
• Final step is fusion of joint
50. 50
• Lyme disease is a bacterial disease which is transmitted by deer ticks. Symptoms
include joint stiffness, fevers, chills, headache, and stiff neck.
• Ankylosing spondylitis affects joints between the vertebrae and between the
sacrum and hip bone. Its cause is unknown.
• Ankle Sprains and Fractures: The ankle is the most frequently injured major
joint. Sprains are the most common injury to the ankle; they are treated with
RICE. A fracture of the distal leg that involves both the medial and lateral
malleoli is called a Pott’s fracture.
