it is general information about joints

1. JOINTS

2. JOINTS
• DEFINITION
• CLASSIFICATION
• SYNOVIAL JOINTS
• BLOOD SUPPLY
• NERVE SUPPLY
• KINESIOLOGY
• APPLIED ASPECTS

3. DEFINITION
• “It is the junction between two or more bones”
• It is meant for movement and growth.
• Also called as articulation
• ARTHROLOGY:-
• “It is the science which deals with the study of
joints”

5. CLASSIFICATION
DEPENDING ON
STRUCTURE
Cartilaginous
joints
Fibrous joints Synovial joints
Amphiarthroses
(restricted mobility)
Synarthroses
(immovable)
Diarthroses
(freely movable)
DEPENDING ON
FUNCTION

6. Articular surface are joined by
tough fibrous tissue.
Fibrous joints
Sutures Syndesmoses Gomphosis

7. SUTURES
• Most of the Joints of the skull
• Appear b/w the bones which ossify in membranes except
clavicle
Suture membranes (Ligaments) present between opposed
margins
They binds periosteum and promote bone growth.
Ossification till twenties, then resulting in synostosis.

8. SERRATE SUTURE
• Edges of the bones present saw toothed
appearance
• E.g.: sagittal suture

9. DENTICULATE SUTURE
• The margins looks
like teeth, with the tips
being broader than
roots.
• E.g.: Lambdoid suture

10. SQUAMOUS SUTURE
• Edges of bones are
united by overlapping
• E.g.: suture b/w
parietal bone and
squamous part of
temporal bone

11. PLANE SUTURE
• Margins of bone are
plane and united by
sutural ligament
• E.g.: articulation b/w
palatine process of
two maxillae

12. WEDGE OR GROOVE
(schindylesis)
• The edge of one bone fits in the groove of the
other bone
• E.g.: b/w rostrum of sphenoid and the upper
margin of vomer.

13. SYNDESMOSES
• Here surfaces of
bones are united by
interosseus ligaments
and bones lie some
distance apart.
E.g:
1. Inferior tibio-fibular
joint
2. Interosseous
membranes of the
forearm and leg
3. Ligamenta flava.

14. Interosseous membranes

15. GOMPHOSIS
(peg and socket)
• Here roots of the
teeth fit in the sockets
of the jaw and are
united by fibrous
tissue.

16. AMPHIARTHROSES
(CARTILAGINOUS JOINTS)
• Bones are joined by cartilage.
• Fibrous capsule to hold the joint in place.
• Restricted movements are possible.
Types
Synchondroses
(Primary cartilaginous joints )
Symphyses
(Secondary cartilaginous joint )

17. SYNCHONDROSES
• Here bones are
united by a plate of
hyaline cartilage-
temporarily –later
completely replaced
by bone ( synostosis )
• No movement
possible
• Primarily designed for
the bone growth
Examples:
1. Junction b/w
epiphysis and
diaphysis
2. Articulation b/w basi-
occiput and basi-
sphenoid
3. First chondro-sternal
joint

18. Junction b/w epiphysis
and diaphysis

19. Articulation b/w basi-occiput and
basi-sphenoid
• Synostosis at 25
years
• Early Synostosis
before eruption of
permanent teeth
leads to dental
malocclution (short
maxilla)

20. First chondro-sternal joint

21. SYMPHYSES
• Articular surface covered by hyaline cartilage
and are united by a plate of fibro cartilage.
• Some times the joints are enveloped by
incomplete fibrous capsule
• They persists through out life and are in median
plane of the body
• Limited movement is possible due to
compression of fibro cartilage.
• Thickness of fibro cartilage is related to range of
movement.
• Represents intermediate stage in evolution of
synovial joints.

22. 1. Intervertebral discs
• Structure
• Annulus fibrosus- concentric layer of fibers.
• Nucleus pulposus- gelatinous- water
• cartilage cells, multinucleated notochordal cells
• Functions: shock-absorber, resistance to
compression

24. • Present in anterior arch of pelvis in between body
of two pubic bone.
• When medial thrusts of femoral head are
transmitted through the anterior arch- interpubic
disc resists the force by acting as a shock
absorber.
2. Symphysis pubis

25. 3. Manubrio-sternal joint
• Pump handle movement
responsible for increase
in anteroposterior
diameter.
• After 60 years partly or
completely replaced by
bone.

26. DIARTHROSES
(SYNOVIAL JOINTS)
Most evolved and most movable
CHARACTERSTICS:-
1. Articular cartilage
2. Cavity with viscous Synovial
fluid
3. Complete articular capsule
with outer fibrous capsule
and inner Synovial
membrane
4. Ligaments
5. Articular disc or meniscus.
6. Bursa.

27. ARTICULAR CARTILAGE
• Hyaline cartilage
• Avascular. Non-nervous,
elastic.
• Damaged- cannot be
replaced by hyaline
cartilage but by fibrous
tissue - indispensable.
• On convex articular
surface.
• On concave articular
surface.

28. Cont..
Functions:
• Smooth gliding surface and reduce the
force of compression or muscle action.
• Coefficient of friction is equal to ice on ice.
• The surface shows undulations - filled with
Synovial fluid - i.e...., it is extremely porous
and absorbs Synovial fluid in resting
condition – on compression fluid is
squeezed out.
• Regulates the epiphysial growth.

29. Cont..
Nutrition:
1. From Synovial fluid
2. By diffusion from the capillaries at the
periphery of the articular cartilage
3. By diffusion from the adjacent epiphysial
blood vessels.

30. SYNOVIAL FLUID
• Viscous, glary fluid
• It is dialysate of blood
plasma into which
hyaluronic acid is added.
• Hyaluronic acid is a high
polymer of
mucopolysacharide and
secreted by the Synovial
cells and mast cells of
Synovial membrane.
• Viscosity depends on
concentration of
hyaluronic acid.

31. Cont..
Alkaline
Cellular contents:
• Monocytes,
lymphocytes,
macrophages,
Synovial cells and
few leucocytes.
• Proteins traces.

32. Cont..
Functions:
1.Nutrition to articular capsule
2.Lubrication of joint cavity to prevent wear and
tear:- this is helped by,
A) Incongruous articular surfaces- this provides
space for the flushing of fluid- Synovial fluid
spread as an elastic fluid film over moving
articular surface.
B) Viscosity of fluid maintains the lubrication, dep on
concentration of hyaluronic acid.
C) More movements of the joint increase the
lubrication.
Joint cracks

33. ARTICULAR CAPSULE
• Outer- fibrous capsule
• Inner- Synovial
membrane.
FIBROUS CAPSULE-
• Completely invests joint
• Attached on the bones
close to articular cartilage
continuously.
• Formed by bundles of
collagen fibers-irregular
spirals-
• Sensitive to changes of
position of joint.

34. Cont.
Functions:
1.Binds articulating bones
together.
2.Supports Synovial
membrane
3.Watch dog action-
sensory nerve endings
ramify on the capsule-
when stimulated-
contraction of muscles
by reflex- protect the
joint from over
stretching.

35. SYNOVIAL MEMBRANE
Highly vascular & cellular connective
tissue- lines inner aspects of fibrous capsule
& bones lying within the joint- but cease at
the periphery of the articular capsule,
articular disc or meniscus.

36. Functions
• Secretes Synovial fluid-
gives nutrition to
articular cartilage.
• Liberates hyaluronic
acid- maintains
viscosity of synovial
fluid.
• Phagocytic activity-
particulate matter and
worn out cartilage cells.

37. Cont..
Types:
1. Fibrous: Synovial
lining adherent to the
fibrous capsule
2.Areolar: where
Synovial membrane
freely moves over the
fibrous capsule
3.Adipose: covers intra
articular pad of fat.

38. LIGAMENTS
• Holds the bones in position.
Types- True and False
• True – Thickening of
collagen of the fibrous
capsule.
• False- form additional bonds
of union b/w the bones.
Functions-
• Permit desirable movement
and prevent undesirable
movement.
• Stability of joints.

39. ARTICULAR DISC
( MENISCUS )
• Fibro-cartilaginous
disc, attached at the
periphery of capsule.
• Divides joint
completely/
incompletely.

40. Cont..
• Articular disc- divides joint completely.
• E.g.- TM joint, sternoclavicular joint,
inferior radio ulnar joint

41. Cont..
• Articular meniscus- divides joint
incompletely
• E.g.- knee joint, acromio-clavicular joint

42. Cont..
Functions:-
1. Helps in lubrication of joints
2. Smoothens gliding and angular
movements.
3. Prevents wear and tear of the
articular cartilage.

43. Bursa
• Sometimes the capsule opening through
which synovial membrane comes out to
act as bursa.
• It is a device to reduce friction between
two mobile but tightly opposed surfaces,
permitting complete freedom of movement
within the limited range.
• Types : Subcutaneous, subtendinous,
sub muscular, subfacial, inter ligamentous,
communicating.

44. CLASSIFICATION--- SYNOVIAL JOINTS
According to no. of articulating bones
1. Simple joints.
2. Compound joints.
3. Complex joints.

45. Simple joints
When 2 bones enters in
the articulation.
Example:
Interphalangeal joints of
fingers and toes.

46. Compound joints
More than 2 articular
bones sharing a
common articular
capsule.
Example:
1. Ankle joint.
2. Radio-carpal joint.

47. Complex joints
Joints containing articular discs or meniscus
Example:
1. Knee joint.
2. Sternoclavicular joint.

48. Acc. To axis of movement/shape
of articular surface
Uniaxial Biaxial Polyaxial Plane
1 degree
freedom of
movement
2 degree
freedom of
movement
3 degree
freedom of
movement
Articular
surface flat
1.Hinge 1.Ellipsoid 1.Ball &
socket
2.Pivot 2.Saddle
3.Condylar

49. UNIAXIAL JOINTS
HINGE (Ginglymus)-
• Moves around
Transverse axis
• Articular surface-
convex
• Other reciprocally
curved.
• E.g.- elbow, ankle
interphalangial joints
of fingers and toes

50. UNIAXIAL JOINTS cont..
Pivot type: ( Trochoid)
Vertical axis movement
One bone acts as pivot
and is encircled by
osseo-ligamentous
ring
E.g.1. Atlanto axial joint
2. Superior & inferior
radioulnar joints.

51. UNIAXIAL JOINTS cont..
• Condylar joint
Movement takes place
mainly on transverse axis
and partly on vertical
axis.
Modified hinge joint.
Each bone has two articular
surfaces called condyles
enveloped in same.
capsule.
e.g., Knee and jaw joints

52. BIAXIAL JOINTS
• Presents two degree
of movements.
• Two types
• 1.Ellipsoid joint
• 2. Saddle joint

53. BIAXIAL JOINTS cont..
• Ellipsoid joint
• Here oval convex male
surface fitting into
elliptically concave
female surface.
• Movements- transverse &
anteroposterior axis-
flexion, extension,
adduction, abduction &
Circumduction but no
rotation on vertical axis.
• Example: Radio carpal
joint, Atlanto-occipital
joint.

54. BIAXIAL JOINTS cont..
Saddle joint
Opposing articular
surfaces are concavo
convex in reciprocal
manner.
Movements are similar to
ellipsoid joint but rotation
is present- conjunct
rotation.
e.g., Carpometacarpal
joint of thumb, sterno-
Clavicular joint.

55. POLYAXIAL JOINTS
• Three degree freedom of movement.
• Ball & socket / spheroidal joints.
• Example: Shoulder & hip joints, talo-calcaneo-
navicular joint, inco-stapedial joint ( restricted
ball & socket joint)

56. •Spheroidal articular surface of one bone moves
within the socket of other bone.
•Around three independent axis with one
common centre - transverse, vertical and
antero - posterior

59. Blood supply
• Epiphyseal vessels- Enter the long bone at or
near the attachment of the fibrous capsule- give
articular branches- form rich capillary plexus in
Synovial membrane- circulus vasculosus
• These end around the articular margin in a
fringe of looped anastomosis.

60. Nerve supply
• Articular capsule and ligaments have rich nerve
supply.
1.Sensory 2.Autonomic ( vasomotor)
• Sensory- form Ruffini endings and paccinian
corpuscles- convey proprioceptive sensation-
concerned with control of posture, locomotion
and perception of position and movement.
• Some sensory fibers form free nerve endings-
pain sensation.

61. Cont..
Hiltons law- says that,
• Nerves which supply the joint also give
branches to the muscles regulating the
movements of the joint and skin over the
joint.
• Irritation of the nerve in joint disease-
reflex spasm of the muscles and fix the
joint in the position of comfort and the pain
referred to the skin.

62. Cont..
Gardner's observation- says that
• The part of the capsule which is rendered taut by
the contraction of a group of muscles, is
supplied by a nerve which innervates their
antagonistic muscles.
• E.g.- Inferomedial part of the capsule of hip joint
is stretched during abduction- this part of the
capsule is supplied by the Obturator nerve which
also supplies the adductors of the hip joint- this
establish the local reflex arcs- helpful for the
stability of the joint.

63. • LAST’S FORMULATION ( R.J LAST)
1.Four contiguous spinal segments regulate
movements of a particular joint : upper two
segments control one movement, lower
two segments regulate opposite
movement.
2.For a joint one segment more distal in the
limb, the Centers lie en block, one
segment lower in the cord.

64. APPLIED ASPECT
• ARTHRITIS
• ARTHRALGIA
• OSTEOARTHRITIS
• DISLOCATION
• INTRA ARTICULAR FRACTURE
• LIGAMENT TEARS
• SYNOVIAL CYST
• JOINT ASPIRATION
• INTRA ARTICULAR INJECTIONS
• JOINT REPLACEMENT
• ARTHROSCOPY

65. Arthritis

66. Arthritis cont..

67. Osteo arthritis

68. Dislocation

70. Intra articular fracture

72. Sprain(Ligament Tear)

74. Synovial cyst

75. Joint aspiration

77. Intra-articular injections

79. Joint Replacement

80. Arthroscopy