Joints. Judi Laprade. Illustrations from: Essential Clinical Anatomy 3 rd ed. (ECA3) Moore, K. and Agur, A. Lippincott Williams and Wilkins, 2007
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1 Slide 1 Joints Judi Laprade Illustrations from: Essential Clinical Anatomy 3 rd ed. (ECA3) Moore, K. and Agur, A. Lippincott Williams and Wilkins, 2007 Grant s Atlas of Anatomy 12 th ed. (GA12) Agur, A. and Dalley, A. Lippincott Williams and Wilkins, 2009 Slide 2 Joints Objectives: To compare and contrast the structure and function of the three main types of joints (fibrous, cartilaginous and synovial). To know the features of a typical synovial joint. To list and characterize the main types of synovial joints. To understand the concept of normal range of motion and factors that limit the range of motion at a particular joint.
2 Slide 3 Joints are classified by their structure and amount or type of movement permitted. Fibrous joints move very little include: a. those that you d find in between the bones of the skull; joined by fibrous tissue, interlocking Slide 4 Slide 5 Fibrous joints: Sutures Fibrous joints: Sutures Fontanelle GA12 GA12 ECA 3 b. those that are a peg-like process fitting in a socket; in the case of teeth, these are secured by peridontium (fibrous tissue) Slide 6
3 Fibrous joints: Syndesmosis c. a joint formed by a fibrous tissue (interosseous membrane) connecting two bones together Interosseous membrane GA12 Slide 7 Types of Joints: Cartilaginous joints Hyaline cartilage connects the articulating bones in a Primary Cartilaginous joint. These joints permit growth of the long bones. ECA 3 Hyaline cartilage Fibrocartilage Fibrocartilage joining two bones is considered a Secondary Cartilaginous joint, such as that found in the spine. These are slightly mobile joints.
4 Slide 8 Slide 9 Cartilaginous joints: Primary (Synchondrosis) Cartilaginous joints: Secondary (Symphysis) Epiphyseal plate (Hyaline cartilage) GA12 11 year old child GA12 Slide 10 Synovial Joints are the most numerous in the body; comprised of two adjacent bones which have articular surfaces covered in cartilage and separated by a joint cavity containing synovial fluid. The bones are connected by the joint capsule which is comprised of a fibrous outer layer (often reinforced by ligaments) & a synovial membrane on the inside (produces synovial fluid) This type of joint is highly movable.
5 MOVEMENT OVERVIEW Movement of limbs, or body occurs in a plane (or through more than one plane), AROUND an axis. (Similar to a wheel around an axle) Movement is produced by muscle pull, It is guided by shape of joint surfaces, It is limited by ligamentous & bony structures or by tissue approximation FRONTAL or CORONAL PLANE SAGITTAL PLANE Transverse plane: Divides body into superior/inferior portions Sagittal plane TRANSVERSE PLANE Parallel to median plane ( divides body into right and left halves) Frontal/coronal plane Divides body into front/ back parts
6 LONGITUDINAL AXIS FRONTAL or CORONAL PLANE TRANSVERSE PLANE SAGITTAL PLANE CORONAL AXIS SAGITTAL AXIS Longitudinal axis: Passes through long bones, along their length Sagittal axis Passes through joint, from front to back Frontal /coronal axis Passes through joint, from side to side
7 MOVEMENT PAIRS Abduction/Adduction Movement of the limb away from (abduct =take away) or towards (adduct =add )the body The movement occurs around a sagittal axis in the coronal plane -ie., at the shoulder joint, move arm out to the side (as if sliding arm up along a wall) Flexion/Extension Flexion is defined as the movement which decreases the angle between articulating segments or adjacent bones. Extension is the movement which increases the angle. ie., flexion of the shoulder moving the arm towards a line which extends up from the body (180 degrees), the angle between the arm & body decreases) Occurs around a coronal axis and moves through the sagittal plane Internal/External Rotation Also known as medial (turning the anterior part of the bone towards the body midline) and lateral (turning the anterior part of the bone away from the body midline) rotation Occurs around a longitudinal/vertical axis within the transverse plane
8 Types of Synovial Joints & their Movements Slide 15 HINGE: -is considered uniaxial as it permits two movements (or one movement pair) -due to its bony arrangement, it allows one movement pair: flexion & extension around its one axis Slide 16 PIVOT: -is also considered uniaxial. -generally one bony process extends through a socket (either bone or ligamentous) and permits rotational movements (medial and lateral or side to side)
9 Slide 17 CONDYLOID: -is considered biaxial joint which permits two degrees of freedom (two movement pairs). - if the joint `rolls` along one axis it will produce flexion & extension -if the joint rolls along the other axis, it will allow abduction & adduction -moving through both planes in sequence produces circumduction Slide 18 PLANE: -generally comprised of two adjacent bony surfaces which are flat -permits sliding or gliding motions in more than one direction -the movement is described typically as anterior, posterior, lateral, medial etc.,
10 Slide 19 BALL & SOCKET: -one portion of the articulation is nearly spherical, the other is a portion or full concave bony area -the congruity of these two opposing surfaces allow for movement in several axes (multiaxial) -therefore permit 3 movement pairs: flexion & extension abduction & adduction internal & external rotation -also produces circumduction if pass through all the planes Slide 20 SADDLE: -both articulation parts are shaped like a saddle (ie., concave in one direction & convex in the direction 90 degrees to the first) -the congruity of these two opposing surfaces is high but is biaxial -therefore permit 2 movement pairs: flexion & extension abduction & adduction
11 Slide 22 ADDITIONAL FEATURES OF A JOINT: Extrinsic ligaments -are ligaments close to the joint (eg., glenohumeral joint) which may reinforce the joint but are connecting other bones primarily (ie., the Acromio Clavicular ligament) Intrinsic ligaments -are ligaments which connect the bones which comprise the joint (eg., GHJ) -sometimes are thickenings of the joint capsule (ie., GHJ ligaments) ADDITIONAL FEATURES OF A JOINT: Bursae - membranous sacs lined by synovial layer, containing egg-white consistency fluid - typically located in areas which are subject to friction (ie., between muscle and bony prominences)
12 Slide 23 A B C D ADDITIONAL FEATURES OF A JOINT: Fibrocartilaginous Rings or Discs - found in several synovial joints - either interposed between the articular surfaces or lining the edge of one articular portion A. Glenoid Labrum: - function is to increase the depth of the glenoid fossa to increase the congruency between the humerus & glenoid fossa. B. Menisci of the Knee: -attached to the tibia -provides depth of articular surface for the femoral condyles to fit into -also has a role in guiding movement between bones & shock absorption C. Hemidiscs -between manubrium & medial end of clavicle -similar functions as menisci D. Disc -between distal end of ulna & proximal row of carpals -bound with fibrocartilage (TFCC) functions to fill gap to complete articulation & absorb forces
13 Slide 24 BLOOD & INNERVATION OF A JOINT: Blood Supply - around joints with large range of motion available, blood supply needs to be extensive in order to avoid being pinched off when reaching the end of movement availability - blood supply is therefore arranged in many `loops` or anastomoses so that if blood from one portions is diminished, blood still gets through from another route Innervation: - follow`s Hilton`s Law which states that the nerves that supply the joint are the same that supply the muscles moving the joint and the skin covering - synovium is relatively insensitive; pain fibers are numerous in the joint capsule`s outer layer - joints main sensation is proprioception information awareness of movement or body position in space. Slide 25 Structures limiting normal joint movement (Range of motion-rom) Skin Subcutaneous tissue Deep fascia Muscle/tendons Joint capsule Ligaments Articular surfaces Bony features
14 Slide 26 Normal End-feel Hard (bone contacting bone e.g. elbow extension) Soft (soft tissue apposition e.g. knee flexion) Firm (due to tension in muscle/tendon or ligament/capsule e.g. ankle dorsiflexion) An End Feel is a diagnostic tool that many health professionals use to assess movement and determine the potential causes of lack of movement. This is performed by taking the patient`s joint passively through its available range of motion and then firmly pushing the joint to it`s limit and `FEELING` or categorizing what stops the motion. Typically expected or normal end feels include: bone on bone (Hard end feel) such as in elbow extension; soft tissue squish (or apposition) such as when the calf & hamstrings meet during knee flexion; or most often, a firm tension due to tightening (lengthening) of a muscle, tendon, ligament or joint capsule (eg., in ankle dorsiflexion or hip flexion) There are several Abnormal End Feels as well that indicate bony blocks, tissue blockage (like meniscus tear), or muscle & ligamentous damage.
15 Slide 28 A joint that is acutely or chronically swollen, can change the stability of the joint. Effusion stretches out the capsule and often the supporting ligaments and when it subsides, the joint is left lax and unstable. This can often be detected using an end feel in the examination. (ie., laxity can be noted if the effusion is gone; early soft end feel can be present when swelling is still present) Effusion and Subsequent Joint Instability Healthy Effused Unstable/Lax Subluxed
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