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J o i n t A n a t o m y & P h ys i o l o g y v 1 6. 0 5

JOINT ANATOMY & PHYSIOLOGY Student Manual

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CONTENT

MAJ OR J O INT ANAT OMY & PHYSI OLO GY ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

S HOULD ER (GL ENO HUM ERAL) JOINT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

S ho u ld er J oi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

HIP (CO XAL ) JO INT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

H i p Joi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

S ACRO IL IAC JO INT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 S acr oi l ia c Joi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

KNEE JO INT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 K n e e Joi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

JO INTS O F THE ANKLE & FOO T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

A n k le Joi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1

JO INTS O F THE HAND & WR IST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

J oi nt s o f t he H a n d & W r i s t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3

E LBOW JO INT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

E l b o w J oi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5

ACROM IOCL AV ICUL AR JO INT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 T h e A cr o mio cl av ic ul ar J oi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6

S TERNOCLAV ICULAR JO INT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 T h e S t er n ocl av ic ul a r J oi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 8

S TERNAL CO S TAL JO INTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

S t er n a l Cost al Joi nt s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 9

JO INTS O F THE VER TEBR AL COLUM N (S PINE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

J oi nt s o f t he S pi n e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 0

ATLANTO -OCC IPITAL JO INT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

At la nt o - Oc ci pi t al J oi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1

TEM POR OMANDIBUL AR JOINT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

T e m p or o m a n di b ul ar Jo i nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2

JO INT MO TIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

A c ce ss or y / S e c o n da r y Joi nt M ot io n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

Co u p l e d J oi nt Mot i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 4

JO INT C APSUL AR PATTER NS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

J oi nt Ca p s ul ar P at t e r ns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 5



MAJOR JOINT ANATOMY & PHYSIOLOGY KNOWLEDGE EVIDENCE: K9: Detailed joint anatomy for each major joint (shoulder, hip, sacroiliac, knee,

ankle/foot, wrist, elbow, acromioclavicular, sternoclavicular, costal, spine, atlanto-occipital, temporomandibular) K9: Accessory/secondary coupled motions of joints K9: Capsular restrictions and patterns

SHOULDER (GLENOHUMERAL) JOINT

Shoulder Joint

In the shoulder joint stability has been sacrificed to provide the most freely

moveable joint in the body. Shoulder ligaments such as the coracohumeral,

glenohumeral and transverse humeral ligaments are located primarily on the

anterior aspect to reinforce the shoulder joint. Several bursae are associated with

the shoulder joint. The muscles that cross the shoulder are very important in

stabilising the shoulder as well as facilitat ing movements of the joint. These are

known as the rotator cuff group and encircle the joint and blending with the

art icular capsule. Shoulder dislocations are a common shoulder injury.



HIP (COXAL) JOINT

Hip Joint

The hip joint, like the shoulder, is a ball and socket joint with very good movements

but not to the same range as the shoulder joint. Movements occur in all possible

planes but are limited by the deep socket and joint ligaments. The joint is formed

by the art iculat ion of the spherical head of the femur with the acetabulum or

socket. A circular rim of fibrocart ilage called the acetabular labrum lines the

socket. In contrast to the shoulder, the surfaces of the hip joint fit snugly together

such that hip dislocations are rare.

Several st rong ligaments reinforce the joint capsule including the iliofemoral,

pubofemoral and ischiofemoral ligaments. These ligaments are arranged in such a

way that they screw the femur head into the acetabulum. The ligamentum teres or

the ligament at the head of the femur appears to be of no importance in

stabilising the joint and its role is unclear. The arrangement of the muscles

ligaments and structural components of the hip supports standing and weight

bearing. The most common injury to the hip, usually as a result of a fall, is a fracture

to the neck of the femur, this area being the most vulnerable stress point in the

region.

See diagram on following page.



SACROILIAC JOINT

Sacroiliac Joint

The sacroiliac joint is located in the pelvis linking the lilac bone to the sacrum. This

joint t ransfers weight and forces between the upper body and legs and is an

essential component for shock absorpt ion to prevent impact from forces during

walking from reaching the spine. Stabilised by a network of ligaments and muscles

a normal sacroiliac joint has a small amount of movement approximately 2-4mm in

any direction. The ligaments are less st iff in women than in men to allow for mobility

during childbirth.



KNEE JOINT

Knee Joint

The knee joint is the largest and most complex joint in the body. It allows flexion,

extension and some rotat ion. Despite its single joint cavity, the knee consists of

three joints in one.

Femoropatellar Joint

Between the patella and lower end of the femur. This is a plane joint, as the patella

glides over the distal end of the femur during knee movements.

Tibiofemoral Joint

Being the lateral and medial joints between the femoral condyles and the c -

shaped menisci (semi lunar) cart ilages, of the t ibia below. Besides deepening the

shallow t ibial art icular surfaces, the menisci help prevent side to side rocking of the

femur on the t ibia and absorb shock transmitted to the knee joint. A tear to the

menisci can occur frequently due to their light attachments only at the outer

edge. The t ibiofemoral joint acts primarily as a hinge, permitt ing flexion and

extension however it is st ructurally a bicondylar joint with some rotat ion possible

when the knee is part ly flexed. When extended any side to side movements and

rotat ion are strongly resisted by ligaments and the menisci. Three broad ligaments

run from the patella to the t ibia anteriorly. The patellar ligament and medial and

lateral patella ret inacula which merge into the art icular cart ilage on either side.

The patella ligament is actually a continuation of the quadriceps tendon. Doctors

test the knee jerk response by taping on the patellar ligament. At least a dozen

bursae are associated with the knee joint. Several ligaments are important in

stabilising and strengthening the knee joint:

Extra Capsular

Medial and Lateral collateral ligaments - crit ical to preventing medial and lateral

rotat ion when the knee is extended.

Oblique popliteal ligament - an extension of the semimembranous hamstring

muscle on the posterior aspect of the knee joint .

Arcuate popliteal ligament - acts inferiorly and reinforces the joint capsule

posteriorly.



Intra Capsular

Anterior cruciate (cross) ligament

The anterior cruciate passes posteriorly, laterally and upward from the anterior

condyle to attach on the medial surface of the lateral femoral condyles. This

ligament prevents backward sliding of the femur on the t ibia and checks

hyperextension of the knee.

Posterior cruciate ligament

The stronger posterior cruciate ligament is attached to the posterior condylar t ibia

and passes anteriorly, medially and upward to attach to the lateral side of the

medial femoral condyle. This ligament prevents forward sliding of the femur or

backward displacement of the t ibia thus it helps prevent over flexion of the knee

joint.

The knee capsule is heavily reinforced by muscle tendons of the quadriceps and

the semimembranosus hamstring muscle posteriorly. Since the muscles associated

with the joint are major stabilisers of the knee, the greater their st rength and tone,

the less chance of knee injury. Of all the joints in the body the knees are the most

susceptible to sports injuries because of their high reliance on non-art icular factors

for stability and the fact that they carry the body’s weight. Most injuries result from

blows to the lateral side tearing the medial collateral ligament, the medial

meniscus and the anterior cruciate ligament.



JOINTS OF THE ANKLE & FOOT

Ankle Joint

The ankle joint is a hinged synovial joint with primarily movements in one plane, up

and down, plantarflexion and dorsiflexion, however when the range of motion also

includes the subtalar joints (talocalcaneal and talocalcaneonavicular) together it

acts as a universal joint. Several ligaments support the ankle including the medial

(or deltoid) and lateral ligaments. The bony architecture of the ankle is most stable

in dorsiflexion hence a sprained ankle is more likely to occur in plantar flexion due

to stress on the ligament structures. The most common ankle sprain is an inversion

sprain involving the talofibular ligament (one of the lateral ligaments).



Talonavicular Joint

Calcaneocuboidal

Joint

Tibiotalar Joint



JOINTS OF THE HAND & WRIST

Joints of the Hand & Wrist

Radiocarpal (Wrist) Joint

Carpometacarpal Joints

Intercarpal Joints

Intermetacarpal Joints

The wrist joint, also known as the radiocarpal joint, is a synovial joint between the

forearm and hand distally formed by the proximal carpal bones and the distal end

of the radius. The ulna is not part of the wrist joint it art iculates with the radius at the

radioulnar joint. Joint capsules and four ligaments stabilise the wrist . Several

muscular tendons also cross the wrist joint. The wrist is an ellipsoid synovial joint

allowing for movement along two axes. This means that flexion, extension,

adduction and abduction can all occur.

A common injury to the wrist joint is a fracture to the scaphoid or radius bone also

known as a Colles’ fracture whilst the hand is outstretched. Scaphoid fractures are

more common in the younger populat ion as a result of a fall. Colles’ fracture is the

most commonly reported injury e.g. a fall from tripping whilst walking a dog.



ELBOW JOINT

Elbow Joint

The most prominent joint in the upper limbs after the shoulder is the elbow joint . Its

st ructure provides a stable and smoothly operating hinge joint that allows flexion

and extension only. Within the joint both the radius and ulna art iculate with the

condyles (trochlea and capitulum) of the humerus but it is the close gripping of the

trochlea by the ulna t rochlea notch that const itutes the “hinge” and main

stabilising factor of this joint .

A relat ively lax art icular capsule allows for significant freedom for elbow flexion

and extension. However, side to side movements are restricted by two strong

ligaments, the ulnar/medial collateral ligament and the radial/lateral collateral

ligament. Addit ionally, tendons of several muscles, (the biceps, t riceps brachialis

and others cross the elbow joint and provide stability. Flexion of the elbow is limited

by the meeting of the soft t issues of the forearm and arm. Extension is checked by

tension in the medial ligament, tendons of the forearm flexors and the close fit of

the olecranon process into the olecranon fossa.

Lateral Mid Sagittal View Right Elbow



ACROMIOCLAVICULAR JOINT

The Acromioclav icular Joint

The acromioclavicular (AC) joint is one of the three art iculat ions of the shoulder

girdle and links the clavicle to the scapula. The AC joint is a gliding or plane joint,

which is a type of synovial joint. Its function is to allow the scapula to rotate in three

dimensions during arm movements. It also allows forces to be transmitted from the

upper extremit ies to the clavicle. There is a limited degree of movement. Since

movements of the scapula and clavicle occur together lit tle relat ive movement

occurs at the joint itself and most occurs at the sternoclavicular joint. The distal end

of the clavicle is connected to the acromion by the medial and lateral divisions of

the AC ligament providing superior and inferior stability. A fall or blow to the

shoulder often results in sprains to the ac joint as commonly seen in contact sport

players.



AC Joint Sprain/Separation Grade I-III



STERNOCLAVICULAR JOINT

The Sternoclav icular Joint

The sternoclavicular joint (SC joint) is formed by the art iculat ion of the medial

aspect of the clavicle with the manubrium of the sternum. The SC joint is generally

classified as a plane joint with a fibro cart ilage joint disk. The inter clavicular,

anterior and posterior sternoclavicular and the costoclavicular ligaments

reinforcing this joint are very strong often result ing in a fracture to the clavicle

before a dislocation of the joint. Movements at this joint are associated with

motions of the scapula.

Intact sternoclavicular joint



STERNAL COSTAL JOINTS

Sternal Costal Joints

The sternocostal joints are art iculat ions of cart ilage between the true ribs and the

sternum and are arthrodial (plane joint s) allowing gliding movements as required in

breathing. The joints are connected and supported by three ligaments, the

interart icular sternocostal, radiate sternocostal and the costoxiphoid ligaments.



JOINTS OF THE VERTEBRAL COLUMN (SPINE)

Joints of the Spine

There are 2 joints between individual vertebrae:

1. Joints between bodies: Symphysis – intervertebral discs – the discs both

absorb shock and act as a flexible spacer that allows intervertebral

movement

2. Joints between superior and inferior art iculat ing processes (facets): synovial

joint – direct ion/orientat ion and shape of the art iculat ing processes defines

/determines what kind of movements are possible between vertebrae –

especially the degree of rotat ion possible



ATLANTO-OCCIPITAL JOINT

Atlanto-Occipital Joint

The at lanto-occipital joint is the art iculat ion between the at las and the occipital

bone and consists of a pair of condyloid joints. The at lanto-occipital joints are

synovial socket type joints that are shallow in infancy and deepen with age.

Movements allowed include flexion/extension and lateral flexion with some

rotat ion. Muscles such as the anterior and posterior rectus capitus action

movements at this joint.



TEMPOROMANDIBULAR JOINT

Temporomandibular Joint

The temporomandibular joint is the jaw joint frequently referred to as TMJ. The TMJ

is a bilateral synovial hinge joint that connects the mandible (jaw) to the temporal

bones of the skull allowing movements of the jaw up and down (elevation and

depression) and side to side such as in chewing, yawning, and talking.

There are six main components of the joint

Mandibular condyles

Art icular surface of the temporal bone

Capsule

Art icular disc

Ligaments – major - temporomandibular, minor - stylomandibular and

sphenomandibular

Lateral pterygoid muscle

The TMJ is classified as ginglymoarthrodial joint since it is both hinging (ginglymus)

and sliding (arthrodial). The art icular disc separates the TMJ into two dist inct parts

allowing for sliding and hinge movements. The mandible is moved mainly by four

muscles of mast ication: the masseter, medial and lateral pterygoid and the

temporalis allowing movement in different directions as experienced with

chewing. The most common injury to the TMJ is disc displacement , sometimes

called dislocation. TMJ pain or dysfunction however is far more common and

usually involves the muscles tendons and ligaments of mast ication.

See diagrams on following page.



JOINT MOTIONS

Accessory / Secondary Joint Motion

Accessory also called secondary joint movement

is joint movement that is necessary for a full range of motion at the joint but it

is not under direct voluntary control. Accessory movements cannot be performed

by the individual. These movements include roll, spin and slide and they naturally

accompany the physiological movements of a joint. Examples include movements

at the knee and wrist joints.

Coupled Joint Motion

In biomechanical terms, coupled motion is

the phenomenon of a consistent

associat ion of a motion along or about one

axis, whether it be a translat ion or a

rotat ion, with another motion about or

along a second axis; the principal motion

cannot be produced without the

associated motion occurring as well.

For example, in the cervical and upper

thoracic spine, side bending is coupled with

axial rotat ion in the same direction and in

the lumbar spine lateral bending is coupled

with axial rotat ion in the opposite direction.

The importance of coupling in the human

spine is that it allows for increase mobility without compromising stability.



JOINT CAPSULAR PATTERNS

Joint Capsular Patterns

Capsular pattern is known as a series of limitat ions of joint movement when the

joint capsule is the limit ing structure. This pattern affects the whole joint. An

example is the range of movement in the shoulder or glenohumeral joint, from

flexion as the least limited movement to external rotat ion as the most limited

movement.

Knowledge of the capsular patterns improve diagnost ic ability and in the case of

massage therapists a general understanding may lead to client referral if

underlying condit ions are suspected.

There are two patterns of restrict ion in range of motion used in the interpretation of

joint motion:

A capsular pattern of restrict ion is a limitat ion of pain and movement in a joint

specific rat io, which usually occurs when there is arthritis, inflammation or following

prolonged immobilizat ion.

A non-capsular pattern of restrict ion is a limitat ion in a joint in any pattern other

than a capsular one, and may indicate the presence of either a derangement, a

restrict ion of one part of the joint capsule, or an extra-art icular lesion, that prevents

joint motion. In other words, the cause of the restrict ion is outside the joint itself.

Dr. James Cyriax was the first of many authors to extensively study soft t issue

lesions. When inflammation of a joint is present (known as synovit is or capsulit is), not

only does passive stretching of the joint capsule cause pain but there is a limitat ion

in range of motion of the involved joint in a specific pattern; this pattern is always

similar for that particular joint, although each joint has a different capsular pattern.

Capsular patterns are based on clinical findings rather than research which may

explain why there are some difference in the way they are reported.

Capsular patterns have shown to be extremely useful in determining arthritis and

capsular involvement.



JOINT CAPSULAR PATTERN

Temporomandibular (Jaw) Increasing limitation of mouth opening

Occipitoatlanto Extension & side flexion equally limited

Cervical Spine Side flexion & rotations are equally limited,

extension equally limited and flexion is best movement

Glenohumeral (Shoulder) Limitation of Lateral rotation, abduction, less medial rotation

Sternoclavicular Pain at extreme range of movement

Acromioclavicular Pain at extreme range of movement

Humeroulnar (Elbow) Limitation of extension and more limitation of flexion

Radiohumeral Flexion, extension, supination, pronation

Proximal Radioulnar Pain on passive supination and pronation, no limitation

Distal Radioulnar Pain at extremes of rotation

Wrist Flexion & extension equally limited

Thoracic Spine Side flexion & rotation equally limited

Lumbar Spine Side flexion extension & rotation equally limited

SI, Symphysis Pubis, &

Sacrococcygeal Pain when joints stressed



Hip Flexion more limited than extension, Gross limitation of abduction, medial rotation

(order varies)

Knee Limitation of flexion, extension

Tibiofibular Pain when joint stressed

Talocrural (Ankle) Limitation of dorsiflexion more limitation of plantar flexion

Subtalar (Talocalcaneal) Limitation of varus range of movement

For more information, visit these links.

https://sgphysio.wordpress.com/2013/06/02/cyriax-system-of-orthopaedic-medicine/

http://physicaltherapyweb.com/joint-capsular-patterns/

http://www.physio-pedia.com/Capsular_and_Noncapsular_Patterns

http://physicaltherapyweb.com/joint-capsular-patterns/

http://www.physio-pedia.com/Capsular_and_Noncapsular_Patterns

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