Articulations

Articulation = joint = point of contact between bones

Joint ClassificationFunctional Name Structural Name Movement Example Description

Synarthroses Fibrous Immovable Syndesmoses ligaments

Sutures skull

Gomphoses Teeth to jaw

Amphiarthroses Cartilaginous (hyaline, fibrocartilage)

Slightly movable

Synchrondosis Ribs, epiphyseal plate

Symphyses Pubis, vertebral discs

Diarthroses Synovial Freely movable Uniaxial Hinge, pivot

Biaxial Saddle, ellipsoidal

Multiaxial Ball and socket, gliding

SynarthrosesFibrous Joints

AmphiarthosesCartilaginous

DiarthrosesSynovial

• Most numerous• Most complex• Structures

– joint capsule • sleevelike encasing around bone ends

to bind them together– synovial membrane

• membrane lining capsule to secrete synovial fluid

– bursae • cushions joints and helps tendons

move– joint cavity

• small space between bones– articular cartilage

• hyaline cartilage covering bone ends– menisci

• pads of fibrocartilage between bones– Ligaments

• strong, dense, white fibrous tissue that hold bones firmly together

bursae

(Hyaline cartilage)

(fibrocartilage)

Knee Joint

Ankle Joint

Anterior interior tibiofibular ligament

Achilles tendon (cut)

Types of Joints

ellipsoidal

Uniaxial Joints permits movement around one axis and one plane

• allows only flexion and extension– examples – elbow, knee

• knee joint – largest joint, most complex, most frequently injured

• projection of one bone articulating with a ring/notch of another bone– examples - between vertebrate

Biaxial Jointspermits movement around two perpendicular axes and planes

• Example– thumb

• only saddle joint in the body

• condyle fits into an elliptical socket

• Example– between radius

and carpals

ellipsoidal

Multiaxial Joints permits movement around three or more axes and planes

• most moveable joints• ball shaped head fits into concave depression• example - shoulder, hip

– humeroscapular joint• most mobile joint

– sacroiliac joint• hip joint

• relatively flat articulating surface that allows gliding movement

• example – between carpals– between tarsals– between vertebrate

Multiaxial

Ball and socket

Multiaxial

Ball and socket

Multiaxial

Gliding

Uniaxial

Hinge

• Goniometer– Used to determine extent of injury and progress of rehabilitation– measures range of motion (degree of angle)

ROM(Range of Motion)

Angular ROM• flexion – decreases angle,

movement towards body• extension – increase angle,

movement away from body• hyperextension – stretching or

extending beyond anatomical position

• plantar flexion – increase angle between top of foot and front of leg (point down)

• dorsiflexion – decrease angle between top of foot and front of leg (point up)

• ABduction – move AWAY from medial plane

• ADduction – move TOWARDS medial plane

• rotation – pivoting a bone on its axis

• circumduction – distal end of a body part moves in a circle

• supination – hand palm side up• pronation – hand palm side down

Circular ROM

Special Movements• inversion – turn sole outward• eversion – turn sole inward• protraction – move part forward• retraction – move part backward• elevation – move part up• depression – move part down

Joint Disorders

• Inflammatory (IJD)– Rheumatoid arthritis– Gout

• Noninflammatory (NIJD)– Osteoarthritis– Tramatic Injuries

• Dislocation• Meniscus tear• Sprain• Ligament tear• Herniated disc

Joint Disorders• Rheumatoid arthritis

– Chronic and systemic– Inflammation of synovial membrane– Cartilage destroyed, bone erosion– Progressive crippling and deformity– Pain, inflammation, decreased mobility, aching,

stiffness– Treat with corticosteroid drugs and NSAIDS

Joint Disorders

• Gouty arthritis– Also referred to as just Gout– Excessive uric acid in blood– Crystals get deposited in synovial fluid– Chronic inflammation and tissue damage– Swelling, tenderness– Pin in wrists, fingers, ankles, knees, elbows– Treat with Allopurinol (inhibits uric acid synthesis)

and Uloric (new med)

Joint Disorders

Osteoarthritis

Rheumatoid arthritis Gout

NIJDC

IJD IJD

Joint Disorders

• Osteoarthritis– Most common NIJD– Wear and tear deterioration– Atrophy of articular cartilage– Formation of new bone at joint surface– Most common in weight-bearing joints– Stiffness, pain, limited movement– Treat symptoms with NSAIDS

Joint Disorders• Dislocation

– Articular surfaces not in proper contact– Tear vessels, nerves, ligaments, muscles– Pain and swelling– Treat with realignment (reduction);

sometimes surgery

Joint Disorders• Sprain

– Stretching of ligaments surrounding joint– Due to twisting motion– Hematoma, limited motion– Treatment: R.I.C.E.

• Rest• Ice• compression• elevation

Degree of Sprains•  1st degree ankle sprain 

– Some stretching or perhaps tearing may have occurred– No loss of function– Mild pain, little bruising– Little or no swelling– Some joint stiffness or difficulty walking

• 2nd degree ankle sprain– Difficulty walking– Moderate to severe pain– Swelling and tenderness in the ankle joint– Bruising may start after 3 to 4 days

• 3rd degree ankle sprain– most serious– Total rupture of a ligament– Walking may not be possible– Severe pain initially and substantial swelling– May require surgery

• Ligament Tears (3rd degree Sprain)• Bruising, pain, swelling, instability• Physical therapy• Partial tear vs. complete tear

– Partial Tear – boot/brace, crutches– Complete Tear - Surgery after most swelling subsides

Joint Disorders

Joint Disorders - Knee

• Meniscus Tear– One of most common athletic injuries– Swelling, pain, instability, limited motion– Treat with arthroscopic surgery

Meniscus

Normal Tear of medial meniscus

• ACL tear

– Women more likely than men

– Will hear a popping sound

– Usually due to twisting motion

• Get hit very hard on the side of your knee, such as during a football tackle

• Overextend the knee joint

• Quickly stop moving and change direction while running, landing from a jump, or turning

– Repair by grafting (not sew back together)

• Patellar tendon autograft (autograft comes from the patient)

• Hamstring tendon autograft

• Quadriceps tendon autograft

• Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon

Joint Disorders - Knee

ACL, MCL, PCL tears

Arthroscopic surgery

• 3-4 very small incisions ¼ in. – fiber-optic light source – video camera – terile saline solution is continuously

pumped through the knee via a cannula

Vertebral Disc Disorders

Herniated disc Treatment

• Steroid epidural– Use long needle to inject steroid into epidural space in

order to shrink the herniation (cartilage)• Surgery

– (microdisectomy)• Cut off protruding cartilage

Steroid Epidural

Knee Arthroscopic Surgery

• http://www.cartilagerepaircenter.org/treatment-options/meniscal-procedures.html

• http://www.youtube.com/watch?v=nAj2_pgTkEA

• http://www.youtube.com/watch?v=kpW2MOOI5yw

Knee Replacement

• http://www.youtube.com/watch?v=H3xkj_1dZQ0

Hip Replacement

• http://www.youtube.com/watch?v=DosqbEy8ecY

• http://www.webmd.com/pain-management/video/hip-restoration

• http://www.youtube.com/watch?v=lh2UX8gQnBM

• http://www.youtube.com/watch?v=vJL8n_82ITM

Ankle Arthroscopy• http://www.youtube.com/watch?

v=A22lTyPnguY

Herniated disc epidural• http://www.youtube.com/watch?

v=97m4VICMJoU

Herniated disc microdisectomy• http://www.youtube.com/watch?

v=rU8YYESYXzc&feature=related