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By: Dr.Chaman LalB.S.PT, DPT, Dip. in sports Injuries, MPPS(PAK),
PG in Clinical Electroneurophysiology (AKUH),
Registered.EEGT (USA),Member of ABRET, AANEM & ASET (USA).
JOINTS
Federal Institute of Health Sciences,Multan
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Study Outlines Introduction,
Functional classifications, Structural classification,
Structures comprising a Synovial joint,
Movements of joints, Blood supply of Synovial joints, their
nerve supply and lymphatic drainage &
Factors responsible for joint stability andDevelopment of joints
References
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Joints(articulations)Arthron (G. a joint)
Junctura (L. a joint)Joint:Joint is a junction between two or morebones or cartilages.
It is a place, where parts of skeleton meet It allows varying amounts of mobility It is classified by structure or function.
Arthrology: The study of joints is calledarthrology.
Syndesmology: (G. syndesmos=ligament) It is the study of ligaments andrelated joints.3 Joints By:Chaman Lal FIHS (CK) 1/31/2014
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A. Structural Classification1. Fibrous Joints:
(a) Sutures
(b) Syndesmosis &(c) Gomophosis
2. Cartilaginous Joints:
(a) Primary cartilaginous joints orsynchondrosis &
(b) Secondary cartilaginous joints or
symphysis
Classification of Joints
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3. Synovial Joints:
(a)Plane joints(b)Pivot or trochoid joints
(c)Hinge joints(d)Condylar or bicondylar joints
(e)Ellipsoid joints(f)Sellar or saddle joints &
(g)Ball-and-socket or spheroidal
Classification of Joints .contd
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Fibrous Joints
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In fibrous joints the bones are joined by
fibrous tissue. The joints are eitherimmovable or permit a slight degree of
movement. These can be grouped in the
following three subtypes.1. Sutures:-
These are peculiar to skull, and are
immovable. According to the shape of bonymargins, the sutures can be plane, serrate,
denticulate, squamous, limobus, and of
schindylesis type.1/31/2014
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2.
Syndesmosis:
-
The bones are
connected by the
interosseious
ligament.Example: Inferior
tibiofibular joint
Fibrous Joints. . . . Contd
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3. Gomophosis:- These are peg andsocket joints.
Example: Tooth in itssocket.
It is restricted to the
fixation of teeth intheir alveolar socketsin the mandible andmaxillae. Thecollagen of theperiodontiumconnects dental
cement with alveolar
Fibrous Joints. . . . Contd
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2. Cartilaginous Joints:
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In this type of joints the bones are joined by
cartilage.There is no synovial cavity, articulatingbones tightly connected by fibrocartilageor hyaline cartilage
These are of two types:
1. Primary Cartilaginous Joints:
(Synchondrosis, or Hyaline cartilagejoints)
The bones are united by a plate of hyalinecartilage, so that the joint is immovable
and strong. 1/31/2014
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Cartilaginous Joints. . .contd
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Synostosis: =the union or fusion of
adjacent bones by the growth of bonysubstance, either as a normal process
during growth or as the result of ankylosis.
Example:a) Joint between epiphysis and diaphysis of a
growing long bone,
b) Shpeno-occipital joint,c) First chondrosternal joint &
d) Costochondral joints.
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2. Secondary Cartilaginous Joints:
(Symphyses or fibrocartilaginous) The articular surfaces are covered by a thin
layer of hyaline cartilage and united by a disc
of fibrocartilage. These joints are permanent and persist
throughout life. In this respect symphyses
menti is a misnomer.
Typically the secondary cartilaginous joints
occur in the median plane of the body, and
permit limited movements due to compressible
pad of fibrocartilage and the occasional fluid
Cartilaginous Joints. . .contd
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The thickness of fibrocartilage is
directly related to the range ofmovement.
Secondary cartilaginous joints may
represent an intermediate stage in
evolution of synovial joints.
Examples:a) Symphsis pubis,
b) Manubriosternal joint &
c) Intervertebral joints between the
Cartilaginous Joints. . .contd
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3.Synovial Joints
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Synovial Joints are most evolved ,
and, therefore most mobile type ofjoints.
Synovial joints has a fluid-filledcavity between articular surface
which are covered by articular
cartilage.The fluid is known as synovial
fluid, which is form of lymph
S no ial Joints Contd
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Synovial Joints. . . . Contd
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This fluid lines the cavity except for
the actual articular surfaces andcovers the ligaments or tendons
which pass through the joint.
Synovial fluid act as a lubricant.
The form of the articulating
surfaces controls the type ofmovement which takes place at
any joint.
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Structure of Synovial Joints
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A). Articular Cartilage
B). Synovial (joint) cavity
C). Articular Capsule
D). Synovial Fluid.
E). Reinforcing Ligaments
F). Fatty Pads or Articular Discs G). Bursae
H). Tendon Sheath
A). Bone & shape of articular surfaces.
B). Ligaments
C). Muscle Tone
Factors Influencing Joint Stability
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1.Bone & shape of articular surfaces:
It help in maintaing stability only in firm typeof joints, like the hip and ankle. Otherwise in
most of the joints (shoulder, knee, sacroiliac
etc) their role is negligible.
2.Ligament: are important in preventing any
over-movement, and in guarding against
sudden accidental stresses.
3.Muscle Tone: The tone of different group of
muscles acting on the joint is the most
important and indispensable factor in
maintaining the stability.
Factors Influencing Joint Stabilitycontd
t
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movements
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Type of Joint Movement
A.Plane or
Gliding Type
Gliding movement
B.Uniaxial
Joints
1.Hinge Joint2.Pivot Joint
Flexion & Extension
Rotation only
C. Biaxial
Joints
1.CondylarJoint
2. Ellipsoid
JointD. Multiaxial
Flexion and Extension, and limited
rotationFlx,Ext, abd, add, & Circumduction
Flx,Ext, abd, add, & conjunct
rotation
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Ch t i ti f S i l J i t
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Characteristics of Synovial Joints
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1. Articular surface is covered by hyaline
cartilage & sometimes by fibrocartilage.
Synovial fluid circulates in the joint cavity
to lubricate and nourish the articulating
surfaces. Viscosity of fluid is due to
hyaluronic acid.
The joint cavity may be partially or
completely subdivided by an articular disc
or meniscus.
Joint is surrounded by an articular capsule
which is made up of fibrous capsule and
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1.Plane Synovial Joints
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Articular surfaces are more less flat
(Plane). They permit gliding movements(translations) in various directions. Plane
joints are appositions of almost flat
surfaces.Examples:
a) Intercarpal joints
b) Intertarsal joints
c) Joints between articular
processes of vertebrae etc.
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2. Ginglymi or Hinge Joints
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Articular surfaces are pulley shaped.
There are strong collateral ligaments.Movements, are permitted in one plane
around and transverse axis.
Examples:
a) Elbow joint
b) Ankle joint andc) Interphalangeal joints.
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3. Pivot (Trochoid) Joints
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Articular surfaces comprise a central bony
pivot (peg) surrounded by an
osteoligamentous ring. Movements are
permitted in one plane around a vertical
axis.
Example:
a)Superior and inferiorradio-ulnar joints,
a) Median atlanto-axial joints
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Condylar (Bicondylar)Joints contd
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Condylar (Bicondylar)Joints.cont d
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Example:
a) Knee joint
andb) Right and left
jaw joints etc
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6 S ddl (S ll ) J i t
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6.Saddle (Sellar) Joints
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Articular surfaces are reciprocally concavo-
convex. Movements are similar to thosepermitted by an ellipsoid joint, with addition
of some rotation (conjunct rotation) around a
third axis which, however, cannot occur
independently.
Examples:
a) 1stcarpometacarpal joint
b) Sternoclavicular joint &
c) Calcaneocuboid joint.
7 Ball & Socket joint (Spheroidal)
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7.Ball & Socket joint (Spheroidal)
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Articular surfaces include a globular
head (male surface) fitting into a cup-shaped socket (female surface).
Movements occur around an indefinite
number of axes, which have onecommon center.
Examples:
a) Shoulder joint,
b) Hip joint,
c) Talo-calcaneonavicular joint.
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B. Functional Classification
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Functional classification of joint is
actually based upon degree of mobility
of the joint.
There are 3 types of joints according totheir functional classification.
1. Synarthroses (Immovable)2. Amphiarthroses
3. Diarthroses or synovial joints
1 S th
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1.Synarthroses
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These are fixed
joints andimmovable. The
articular surfaces
are joined bytough fibrous
tissue.
Often the edgesof the bones are
dovetailed into
one another as in
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2.Amphiarthorses
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These allow some movement. A padof cartilage lies between the bone
surfaces, and there is a fibrous
capsule to hold the bones andcartilage in place. The cartilages of
such joints also act as shock
absorbers e.g. the intervertebral discsbetween the bodies of the vertebrae,
where the cartilage is strengthened
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3.Diarthorses or synovial joints
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These are known as freely movablejoints, though at some of them the
movement is restricted by the shape
of the articulating surfaces and by the
ligament which hold the bones
together. These ligaments are ofelastic connective tissue.
-e.g. Knee joint, shoulder joint, etc
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C Regional Classification of the
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C. Regional Classification of theJoints
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On regional basis joints areclassified as under 3 types;
1. Skull type: Immovable.
2. Vertebral type: Slightly
movable3. Limb type: Freely
movable
Movements & Mechanism of Joints
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Movements & Mechanism of Joints
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Angular movement:Movement leading
to diminution or increase in anglebetween two adjoining bones.
-Flexion: Decreasing the angle
between two bones.-Extension: Increasing the angle
between two bones
-Abduction:Moving the part away frommid-line.
-Adduction: Bringing the part towards the
-
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Shape of Articular Surface
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The common articular surfaceshapes are:
A) Ovoid:When concave- female
ovoids
When convex- male ovoids
B) Sellar/Saddle shaped: Theseare convex in one plane, concave
in the perpendicular plane
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Contd. . .
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Human Kinesiology: Study of geometry ofsurfaces & their associated movements is called
Kinesiology. Male Surface:An articulating surface which is
larger in surface area and always convex in alldirections.
Female Surface: An articulating surface which issmaller and concave in all directions.
Simple Joints: Joints with only two articulating
surfaces, i.e., male and female. Compound Joints: Joint possessing more than
one pair of articulating surfaces.
Degrees of freedom: Number of axes at which
the bone in a joint can move.
Cont d. . .
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Joint Positions
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Joint Positions
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Closed Packed Position:
When the joint surfaces become completely
congruent, their area of contact is maximal andthey are tightly compressed.
In this position fibrous capsule and ligamentsare maximally spiralized and tense;
No further movement is possible ;
Surfaces can not be separated by disruptiveforces;
Articular surfaces are liable to trauma, e.g.,Shoulderabduction +lateral rotation:
Hipextension+medial rotation;
Knee
full extension; Ankle
dorsiflexion
Joint Positions contd
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Loose Packed Position:
All other position s of incongruencey, e.g., least
packed position.e.g., Shouldersemiabduction,HipSemiflexion,KneeSemiflexion
AnkleVentral PositionLimitation of Movement (Factors)-Reflex contraction of antagonistic m/s
-Due to stimulations of mechanoreceptors inarticular tissue,-Ligaments tension,-Approximation of soft parts
Joint Positions.cont d
Mechanism of Lubrication of A Synovial
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Mechanism of Lubrication of A Synovial
Joints
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1. Synovial Fluid: It is secreted bysynovial membrane, is sticky and
viscous due to hyaluronic acid (a
mucopolysaccharide). It serve themain function of lubrication of the
joint.
2.Hyaline Cartilage: It covers the
articular surface and provides the
slippery surface to reduce the friction.
Contd
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Cont d.
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3.Intra-articular Fibrocartilages:
Articular discs or menisci, complete orincomplete, help in spreading thesynovial fluid through the joint cavity,but particularly between the articularsurfaces.
4.Haversian Fatty Pads(HaversianGlands):
These occupy extra spaces in the jointcavity between the incongruous bonysurfaces and perhaps function as
swabs to s read the s novial fluid.
Blood Supply of the Synovial Joints
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Blood Supply of the Synovial Joints
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The articular and epiphyseal branches
given off bye the neighboring arties form
a periarticular arterial plexus.
Numerous vessels from this plexus
pierce the fibrous capsule and form arich vascular plexus in the deeper parts
of the synovial membrane.
Circulus vasculosu(Circulus articularisvasculosus) is a looped anastomoses
formed bye the blood vessels of the
synovial membrane around the articular
Nerve Supply of the Synovial Joints
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Nerve Supply of the Synovial Joints
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1.The capsule and ligaments possess
a rich nerve supply while synovialmembrane has a poor nerve supply
and relatively insensitive to pain.
2.The articular cartilage is non-nervousand totally insensitive.
3.Articular nerves contains sensory
and autonomic fibers.
Nerve Supply of the Synovial Jointscontd
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4.HiltonsLaw: (Hilton 1891)
It states that a motor nerve to the muscle
acting on joint tends to give a branch to thatjoint (capsule) and another branch to the
skin covering the joint.
Gardner (1928) further elucidated that eachnerve innervates a specific region of the
capsule, and that the part of the capsule
which is rendered taut by a given muscle isinnervated by the nerve supplying its
antagonists.
Thus the pattern of innervations is
Joints
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Joints
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Lymphatic form a plexus in the
subintima of synovial membrane, anddrain along the blood vessels to theregional deep nodes.
Applied Anatomy:-Dislocation of joint
-Sprain
-Arthritis-Stiffness of joints related to weather
-Neuropathic Joint
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J i t B Ch L l FIHS (CK)