Chapter 8
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  • 1. Chapter 8 Joints (Articulations)
    • Weakest parts of the skeleton
    • Articulation – site where two or more bones meet
    • Functions of joints
      • Give the skeleton mobility
      • Hold the skeleton together
  • 2. Classification of Joints: Structural
    • Structural classification focuses on the material binding bones together and whether or not a joint cavity is present
    • The three structural classifications are:
      • Fibrous
      • Cartilaginous
      • Synovial
  • 3. Classification of Joints: Functional
    • Functional classification is based on the amount of movement allowed by the joint
    • The three functional classes of joints are:
      • Synarthroses – immovable
      • Amphiarthroses – slightly movable
      • Diarthroses – freely movable
  • 4. Fibrous Structural Joints
    • The bones are joined by fibrous tissues
    • There is no joint cavity
    • Most are immovable
    • There are three types – sutures, syndesmoses, and gomphoses
  • 5. Fibrous Structural Joints: Sutures
    • Occur between the bones of the skull
    • Comprised of interlocking junctions completely filled with connective tissue fibers
    • Bind bones tightly together, but allow for growth during youth
    • In middle age, skull bones fuse and are called synostoses
  • 6. Fibrous Structural Joints: Syndesmoses
    • Bones are connected by a fibrous tissue ligament
    • Movement varies from immovable to slightly variable
    • Examples include the connection between the tibia and fibula, and the radius and ulna
  • 7. Fibrous Structural Joints: Gomphoses
    • The peg-in-socket fibrous joint between a tooth and its alveolar socket
    • The fibrous connection is the periodontal ligament
  • 8. Cartilaginous Joints
    • Articulating bones are united by cartilage
    • Lack a joint cavity
    • Two types – synchondroses and symphyses
  • 9. Cartilaginous Joints: Synchondroses
    • A bar or plate of hyaline cartilage unites the bones
    • All synchondroses are synarthrotic
    • Examples include:
      • Epiphyseal plates of children
      • Joint between the costal cartilage of the first rib and the sternum
  • 10. Cartilaginous Joints: Symphyses
    • Hyaline cartilage covers the articulating surface of the bone and is fused to an intervening pad of fibrocartilage
    • Amphiarthrotic joints designed for strength and flexibility
    • Examples include intervertebral joints and the pubic symphysis of the pelvis
  • 11. Pelvic Girdle (Hip) Figure 7.27a
  • 12. Synovial Joints
    • Those joints in which the articulating bones are separated by a fluid-containing joint cavity
    • All are freely movable diarthroses
    • Examples – all limb joints, and most joints of the body
    • Synovial joints all have the following
      • Articular cartilage
      • Joint (synovial) cavity
      • Articular capsule
      • Synovial fluid
      • Reinforcing ligaments
  • 13. Synovial Joints: General Structure Figure 8.3a, b
  • 14. Table 8.2.1
  • 15. Table 8.2.2
  • 16. Table 8.2.3
  • 17. Synovial Joints: Friction-Reducing Structures
    • Bursae – flattened, fibrous sacs lined with synovial membranes and containing synovial fluid
    • Common where ligaments, muscles, skin, tendons, or bones rub together
    • Tendon sheath – elongated bursa that wraps completely around a tendon
  • 18. Synovial Joints: Stability
    • Stability is determined by:
      • Articular surfaces – shape determines what movements are possible
      • Ligaments – unite bones and prevent excessive or undesirable motion
    • Muscle tone is accomplished by:
      • Muscle tendons across joints acting as stabilizing factors
      • Tendons that are kept tight at all times by muscle tone
  • 19. Synovial Joints: Movement
    • The two muscle attachments across a joint are:
      • Origin – attachment to the immovable bone
      • Insertion – attachment to the movable bone
    • Described as movement along transverse, frontal, or sagittal planes
  • 20. Synovial Joints: Range of Motion
    • Nonaxial – slipping movements only
    • Uniaxial – movement in one plane
    • Biaxial – movement in two planes
    • Multiaxial – movement in or around all three planes
  • 21. Gliding Movements
    • One flat bone surface glides or slips over another similar surface
    • Examples – intercarpal and intertarsal joints, and between the flat articular processes of the vertebrae
  • 22. Angular Movement
    • Flexion — bending movement that decreases the angle of the joint
    • Extension — reverse of flexion; joint angle is increased
    • Dorsiflexion and plantar flexion — up and down movement of the foot
    • Abduction — movement away from the midline
    • Adduction — movement toward the midline
    • Circumduction — movement describes a cone in space
  • 23. Gliding Movements
    • One flat bone surface glides or slips over another similar surface
    • Examples – intercarpal and intertarsal joints, and between the flat articular processes of the vertebrae
  • 24. Angular Movement Figure 8.5b
  • 25. Angular Movement Figure 8.5c, d
  • 26. Angular Movement Figure 8.5e, f
  • 27. Rotation
    • The turning of a bone around its own long axis
    • Examples
      • Between first two vertebrae
      • Hip and shoulder joints
    Figure 8.5g
  • 28. Special Movements Figure 8.6a
  • 29. Special Movements Figure 8.6b
  • 30. Special Movements Figure 8.6c
  • 31. Special Movements Figure 8.6d
  • 32. Special Movements Figure 8.6e
  • 33. Plane Joint
    • Plane joints
      • Articular surfaces are essentially flat
      • Allow only slipping or gliding movements
      • Only examples of nonaxial joints
    Figure 8.7a
  • 34. Types of Synovial Joints
    • Hinge joints
      • Cylindrical projections of one bone fits into a trough-shaped surface on another
      • Motion is along a single plane
      • Uniaxial joints permit flexion and extension only
      • Examples: elbow and interphalangeal joints
  • 35. Pivot Joints
    • Rounded end of one bone protrudes into a “sleeve,” or ring, composed of bone (and possibly ligaments) of another
    • Only uniaxial movement allowed
    • Examples: joint between the axis and the dens, and the proximal radioulnar joint
  • 36. Condyloid or Ellipsoidal Joints
    • Oval articular surface of one bone fits into a complementary depression in another
    • Both articular surfaces are oval
    • Biaxial joints permit all angular motions
    • Examples: radiocarpal (wrist) joints, and metacarpophalangeal (knuckle) joints
  • 37. Saddle Joints
    • Similar to condyloid joints but allow greater movement
    • Each articular surface has both a concave and a convex surface
    • Example: carpometacarpal joint of the thumb
  • 38. Ball-and-Socket Joints
    • A spherical or hemispherical head of one bone articulates with a cuplike socket of another
    • Multiaxial joints permit the most freely moving synovial joints
    • Examples: shoulder and hip joints
  • 39. Synovial Joints: Knee
    • Largest and most complex joint of the body
    • Allows flexion, extension, and some rotation
    • Three joints in one surrounded by a single joint cavity
      • Femoropatellar joint
      • Lateral and medial tibiofemoral joints
  • 40. Synovial Joints: Knee – Other Supporting Structures
    • Anterior cruciate ligament
    • Posterior cruciate ligament
    • Medial meniscus (semilunar cartilage)
    • Lateral meniscus
  • 41. Synovial Joints: Shoulder Stability Figure 8.11a
  • 42. Synovial Joints: Elbow
    • Annular ligament
    • Ulnar collateral ligament
    • Radial collateral ligament
    Figure 8.10a
  • 43. Synovial Joints: Shoulder Stability
    • Weak stability is maintained by:
      • Thin, loose joint capsule
      • Four ligaments – coracohumeral, and three glenohumeral
      • Tendon of the long head of biceps, which travels through the intertubercular groove and secures the humerus to the glenoid cavity
      • Rotator cuff (four tendons) that encircles the shoulder joint and blends with the articular capsule
  • 44. Synovial Joints: Shoulder Stability Figure 8.11a
  • 45. Synovial Joints: Hip Stability
    • Acetabular labrum
    • Iliofemoral ligament
    • Pubofemoral ligament
    • Ischiofemoral ligament
    • Ligamentum teres
    Figure 8.12a
  • 46. Temporomandibular Joint Figure 8.13a, b
  • 47. Sprains
    • The ligaments reinforcing a joint are stretched or torn
    • Partially torn ligaments slowly repair themselves
    • Completely torn ligaments require prompt surgical repair
    Cartilage Injuries
    • The snap and pop of overstressed cartilage
    • Common aerobics injury
    • Repaired with arthroscopic surgery
  • 48. Dislocations
    • Occur when bones are forced out of alignment
    • Usually accompanied by sprains, inflammation, and joint immobilization
    • Caused by serious falls and are common sports injuries
    • Subluxation – partial dislocation of a joint
  • 49. Inflammatory and Degenerative Conditions
    • Bursitis
      • An inflammation of a bursa, usually caused by a blow or friction
      • Symptoms are pain and swelling
      • Treated with anti-inflammatory drugs; excessive fluid may be aspirated
    • Tendonitis
      • Inflammation of tendon sheaths typically caused by overuse
      • Symptoms and treatment are similar to bursitis
  • 50. Arthritis
    • More than 100 different types of inflammatory or degenerative diseases that damage the joints
    • Most widespread crippling disease in the U.S.
    • Symptoms – pain, stiffness, and swelling of a joint
    • Acute forms are caused by bacteria and are treated with antibiotics
    • Chronic forms include osteoarthritis, rheumatoid arthritis, and gouty arthritis
  • 51. Osteoarthritis (OA)
    • Most common chronic arthritis; often called “wear-and-tear” arthritis
    • Affects women more than men
    • 85% of all Americans develop OA
    • More prevalent in the aged, and is probably related to the normal aging process
    • OA reflects the years of abrasion and compression causing increased production of metalloproteinase enzymes that break down cartilage
    • As one ages, cartilage is destroyed more quickly than it is replaced
    • The exposed bone ends thicken, enlarge, form bone spurs, and restrict movement
    • Joints most affected are the cervical and lumbar spine, fingers, knuckles, knees, and hips
  • 52. Osteoarthritis: Treatments
    • OA is slow and irreversible
    • Treatments include:
      • Mild pain relievers, along with moderate activity
      • Magnetic therapy
      • Glucosamine sulfate decreases pain and inflammation
  • 53. Rheumatoid Arthritis (RA)
    • Chronic, inflammatory, autoimmune disease of unknown cause, with an insidious onset
    • Usually arises between the ages of 40 to 50, but may occur at any age
    • Signs and symptoms include joint tenderness, anemia, osteoporosis, muscle atrophy, and cardiovascular problems
      • The course of RA is marked with exacerbations and remissions
    • RA begins with synovitis of the affected joint
    • Inflammatory chemicals are inappropriately released
    • Inflammatory blood cells migrate to the joint, causing swelling
    • Inflamed synovial membrane thickens into a pannus
    • Pannus erodes cartilage, scar tissue forms, articulating bone ends connect
    • The end result, ankylosis, produces bent, deformed fingers
  • 54. Rheumatoid Arthritis: Treatment
    • Conservative therapy – aspirin, long-term use of antibiotics, and physical therapy
    • Progressive treatment – anti-inflammatory drugs or immunosuppressants
    • The drug Enbrel, a biological response modifier, neutralizes the harmful properties of inflammatory chemicals
  • 55. Gouty Arthritis
    • Deposition of uric acid crystals in joints and soft tissues, followed by an inflammation response
    • Typically, gouty arthritis affects the joint at the base of the great toe
    • In untreated gouty arthritis, the bone ends fuse and immobilize the joint
    • Treatment – colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids
  • 56. Developmental Aspects of Joints
    • By embryonic week 8, synovial joints resemble adult joints
    • Few problems occur until late middle age
    • Advancing years take their toll on joints:
      • Ligaments and tendons shorten and weaken
      • Intervertebral discs become more likely to herniate
      • Most people in their 70s have some degree of OA
    • Prudent exercise (especially swimming) that coaxes joints through their full range of motion is key to postponing joint problems