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Mechanics of movement of joints

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Mechanics of movement of joints

  1. 1. MECHANICS OF MOVEMENT <ul><li>Tissues and Structures Involved </li></ul><ul><ul><li>Muscle </li></ul></ul><ul><ul><li>Nerve </li></ul></ul><ul><ul><li>Bone </li></ul></ul><ul><ul><li>Cartilage </li></ul></ul><ul><li>What are Tendons? </li></ul><ul><li>Role of Joints </li></ul><ul><li>Mechanics of Joints </li></ul><ul><li>Making it all work </li></ul>Frolich, Human Anatomy, Mechanics of Movement
  2. 2. Nerve and Muscle--the Motor Unit <ul><li>Motor neurons review </li></ul><ul><ul><li>Ventral horn spinal cord </li></ul></ul><ul><ul><li>Ventral root to spinal nerve to dorsal or ventral ramus </li></ul></ul><ul><ul><li>Nerve is bundle mixed neurons </li></ul></ul><ul><ul><li>One motor neuron synapes with several muscle cells </li></ul></ul><ul><li>Motor Unit is one motor neuron plus the muscle cells it synapses </li></ul><ul><li>“ Action potential”--controlled conduction of electrical messages in neurons and muscle by depolarization of cell membrane </li></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 14.6, M&M
  3. 3. Neuro-Muscular Junction Frolich, Human Anatomy, Mechanics of Movement Action potential in nerves triggers chemical release at synapse which triggers action potential in muscle Fig. 14.5, M&M
  4. 4. Frolich, Human Anatomy, Mechanics of Movement See also photo in Fig. 10.2 from M&M to see capillaries around muscle cells
  5. 5. Bone and Cartilage <ul><li>Bone as tissue </li></ul><ul><li>Bones as structures formed from bone, cartilage and other tissues </li></ul><ul><li>Location of cartilage in skeleton and relation to joints </li></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 6.1, M&M
  6. 6. HOW MOVEMENT HAPPENS: Muscles Pull on Tendons to Move Bones at Connections called Joints or Articulations Frolich, Human Anatomy, Mechanics of Movement
  7. 7. Tendon <ul><li>Generally regular connective tissue </li></ul><ul><li>Musculo-skeletal connections </li></ul><ul><ul><li>Muscle to bone </li></ul></ul><ul><ul><li>Muscle to muscle </li></ul></ul><ul><ul><li>Bone to bone </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 4.15f, M&M
  8. 8. Tendons <ul><li>Tendons are structures that connect bone to muscle and are made up of tendon tissue </li></ul><ul><li>Can have various shapes </li></ul><ul><li>Typical is cord-like tendon of biceps </li></ul><ul><li>Sheeths are common--”aponeuroses” e.g. acromiotrapezius origin from thoracic vertebral spines </li></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 10.3, M&M
  9. 9. Ligaments Frolich, Human Anatomy, Mechanics of Movement <ul><li>Ligaments connect bone-to-bone or reinforce joints--they are made up of tendinous tissue as well </li></ul><ul><li>E.g. knee ligaments </li></ul>Fig. 9.12, M&M
  10. 10. Joints or Articulations <ul><li>Connections between bones </li></ul><ul><li>Usually, but not always allow for movement </li></ul><ul><li>Formed from various connective tissues </li></ul><ul><ul><li>Fibrous </li></ul></ul><ul><ul><li>Cartilaginous </li></ul></ul><ul><ul><li>Synovial (most complex--typical limb joints) </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement
  11. 11. Fibrous joints <ul><li>Suture </li></ul><ul><ul><li>Bones tightly bound by minimal fiber </li></ul></ul><ul><ul><li>Only found in skull </li></ul></ul><ul><li>Syndemoses </li></ul><ul><ul><li>Bones connected by ligaments </li></ul></ul><ul><ul><li>E.g. tibiofibular ligament, interosseous membrane of radius/ulna </li></ul></ul><ul><li>Gomphoses </li></ul><ul><ul><li>Peg in socket joint </li></ul></ul><ul><ul><li>Only found in teeth/alveoli </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 9.1 a, M&M
  12. 12. Fibrous joints <ul><li>Suture </li></ul><ul><ul><li>Bones tightly bound by minimal fiber </li></ul></ul><ul><ul><li>Only found in skull </li></ul></ul><ul><li>Syndemoses </li></ul><ul><ul><li>Bones connected by ligaments </li></ul></ul><ul><ul><li>E.g. tibiofibular ligament, interosseous membrane of radius/ulna </li></ul></ul><ul><li>Gomphoses </li></ul><ul><ul><li>Peg in socket joint </li></ul></ul><ul><ul><li>Only found in teeth/alveoli </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 8.4, M&M Fig. 9.1 b, M&M
  13. 13. Fibrous joints <ul><li>Suture </li></ul><ul><ul><li>Bones tightly bound by minimal fiber </li></ul></ul><ul><ul><li>Only found in skull </li></ul></ul><ul><li>Syndemoses </li></ul><ul><ul><li>Bones connected by ligaments </li></ul></ul><ul><ul><li>E.g. tibiofibular ligament, interosseous membrane of radius/ulna </li></ul></ul><ul><li>Gomphoses </li></ul><ul><ul><li>Peg in socket joint </li></ul></ul><ul><ul><li>Only found in teeth/alveoli </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 9.1 c, M&M
  14. 14. Cartilaginous Joints <ul><li>Synchondrosis </li></ul><ul><ul><li>Hyaline cartilage unites bones </li></ul></ul><ul><ul><li>Epiphyseal growth plates </li></ul></ul><ul><ul><li>Costal cartilage-sternum </li></ul></ul><ul><li>Symphyses </li></ul><ul><ul><li>Fibrocartilage unites bones </li></ul></ul><ul><ul><li>Pubic symphysis </li></ul></ul><ul><ul><li>Intervertebral disc </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement Fig. 9.2, M&M
  15. 15. Synovial Joints <ul><li>Most common joints in body </li></ul><ul><li>Most mobile joints </li></ul><ul><li>Have </li></ul><ul><ul><li>Articular surfaces on bone with hyaline cartilage </li></ul></ul><ul><ul><li>Completely enclosed joint capsule formed from ligamentous connective tissue </li></ul></ul><ul><ul><li>Synovial fluid within capsule lubricates joint </li></ul></ul><ul><ul><li>Some have meniscus or articular disc (e.g. knee, jaw joint) </li></ul></ul>Frolich, Human Anatomy, Mechanics of Movement
  16. 16. Frolich, Human Anatomy, Mechanics of Movement Also see Fig. 9.3, M&M
  17. 17. Frolich, Human Anatomy, Mechanics of Movement
  18. 18. Frolich, Human Anatomy, Mechanics of Movement
  19. 19. Synovial Joint Shape Types <ul><li>Plane joints --intercarpal joints </li></ul><ul><li>Hinge joints --elbow,ankle, interj-phalangeal </li></ul><ul><li>Pivot joints --radio-ulnar joint </li></ul><ul><li>Condyloid joints (egg into oval)--metacarpo-phalangeal </li></ul><ul><li>Saddle joints --carpo-metacarpal joint of thumb </li></ul><ul><li>Ball-and-socket --hip, shoulder </li></ul><ul><li>The type of joint, in part, determines the range and direction of movement </li></ul>Frolich, Human Anatomy, Mechanics of Movement
  20. 20. Frolich, Human Anatomy, Mechanics of Movement Fig. 9.9, M&M
  21. 21. Frolich, Human Anatomy, Mechanics of Movement
  22. 22. Frolich, Human Anatomy, Mechanics of Movement
  23. 23. Frolich, Human Anatomy, Mechanics of Movement
  24. 24. Frolich, Human Anatomy, Mechanics of Movement
  25. 25. Frolich, Human Anatomy, Mechanics of Movement
  26. 26. Frolich, Human Anatomy, Mechanics of Movement
  27. 27. X-ray of hand affected by arthritis Frolich, Human Anatomy, Mechanics of Movement
  28. 28. Artificial Hip Joint Frolich, Human Anatomy, Mechanics of Movement
  29. 29. Arthritis <ul><li>Arthritis = inflammation of the joints. Term also used by lay people to describe pain in soft tissues. </li></ul><ul><li>Over 200 forms of arthritis. </li></ul><ul><li>About 30% of adults have arthritis. </li></ul><ul><li>Major symptom = in or around joints </li></ul>PAIN
  30. 30. ARTHRITIS <ul><li>OSTEOARTHRITIS : common in older people. The articular cartilage begins to break down, and bone spurs start to grow. </li></ul><ul><li>RHEUMATOID ARTHRITIS : It’s an autoimmune disease where body attacks and destroys the cartilage in synovial joints. It is NOT known for having spurs, like osteoarthritis. </li></ul><ul><li>GOUTY ARTHRITIS (gout). Caused by eating too much red meat or protein. The breakdown product is urea, and acid, which causes uric acid crystals in the cooler areas of the body, especially big toes. </li></ul>
  31. 31. Risk Factors for Arthritis <ul><li>Age > 40 years </li></ul><ul><li>Women > men </li></ul><ul><li>Obesity </li></ul><ul><li>Previous joint injury </li></ul><ul><li>Ethnic background </li></ul>
  32. 32. Osteoarthritis <ul><li>Your mother, who is overweight, has pain in both knees whenever she walks too far. Her knees are stiff in the morning and hurt before it rains. The pain gets better when she rests or takes acetaminophen, ibuprofen, or naprosyn over the counter. Her knees are big, bony, and sometimes swollen, but don’t get red or warm. </li></ul>
  33. 33. Osteoarthritis <ul><li>21 million Americans have osteoarthritis </li></ul><ul><li>Breakdown in cartilage and new bone formation </li></ul><ul><li>Increased risk with older age, obesity, overuse or previous injury to joints </li></ul>
  34. 34. Osteoarthritis <ul><li>Common spots of osteoarthritis </li></ul><ul><ul><li>hips </li></ul></ul><ul><ul><li>knees </li></ul></ul><ul><ul><li>hands, especially base of thumb </li></ul></ul><ul><ul><li>base of great toe </li></ul></ul><ul><ul><li>spine </li></ul></ul><ul><li>What is not osteoarthritis? Red, hot joints </li></ul>
  35. 35. Frolich, Human Anatomy, Mechanics of Movement
  36. 36. Osteoarthritis <ul><li>Treatment </li></ul><ul><ul><li>weight reduction </li></ul></ul><ul><ul><li>exercise </li></ul></ul><ul><ul><li>physical and occupational therapy </li></ul></ul><ul><ul><li>joint protection </li></ul></ul><ul><ul><li>pain relief </li></ul></ul><ul><ul><ul><li>over the counter medications, esp. acetaminophen </li></ul></ul></ul><ul><ul><ul><li>prescription medications </li></ul></ul></ul><ul><ul><ul><li>joint injections </li></ul></ul></ul><ul><ul><li>joint replacement </li></ul></ul>
  37. 37. Gout <ul><li>Your brother, who has high blood pressure, woke up in the middle of the night with excruciating pain in his right great toe. It hurt so bad he could not stand to have the sheet rest on his foot last night; he couldn’t sleep. The joint at the base of the toe is red, hot, swollen and very tender . His other joints are OK. He had an episode just like this 5 months ago, and it went away by itself, over 5-7 days. </li></ul>
  38. 38. Gout <ul><li>Gout is caused by too much uric acid in the body. Crystals of uric acid form inside a joint and cause inflammation, which makes the joint red, hot, swollen and painful . </li></ul><ul><ul><li>runs in families </li></ul></ul><ul><ul><li>more common in men, women after menopause, and African Americans. </li></ul></ul><ul><ul><li>Other risk factors include </li></ul></ul><ul><ul><ul><li>obesity </li></ul></ul></ul><ul><ul><ul><li>high blood pressure </li></ul></ul></ul><ul><ul><ul><li>drinking too much alcohol </li></ul></ul></ul><ul><ul><ul><li>kidney failure </li></ul></ul></ul><ul><ul><ul><li>water pills </li></ul></ul></ul>
  39. 39. Gout <ul><li>Treatment: See a doctor for evaluation and medicine to reduce inflammation and pain. May need to medicine to prevent future attacks. </li></ul><ul><li>Can develop into chronic arthritis and cause joint destruction. </li></ul>
  40. 40. Tendonitis <ul><li>Your son just spent two weeks painting his house. Now, his shoulders hurt whenever he reaches overhead, even to put on a shirt. He has never had any shoulder pain before and his other joints are fine. </li></ul>
  41. 41. Frolich, Human Anatomy, Mechanics of Movement
  42. 42. Tendonitis <ul><li>Diagnosis = shoulder tendonitis. Tendonitis = inflammation of a tendon. A tendon is a tissue cord that holds a muscle onto a bone. </li></ul><ul><li>Treatments </li></ul><ul><ul><li>reduce/stop doing whatever caused it </li></ul></ul><ul><ul><li>non-steroidal anti-inflammatory agents </li></ul></ul><ul><ul><li>steroid injections </li></ul></ul><ul><ul><li>physical therapy – splinting, heat, ice </li></ul></ul>
  43. 43. Bursitis <ul><li>Bursitis = inflammation of a bursa. A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. </li></ul><ul><li>Common sites of bursitis </li></ul><ul><ul><li>outer shoulder area </li></ul></ul><ul><ul><li>outer hip area </li></ul></ul><ul><ul><li>elbow </li></ul></ul><ul><ul><li>over and below the knee cap </li></ul></ul>
  44. 44. Frolich, Human Anatomy, Mechanics of Movement
  45. 45. Rheumatoid arthritis Frolich, Human Anatomy, Mechanics of Movement <ul><li>chronic, progressive inflammatory disorder which attacks the smaller synovial joints of the hands and feet and can cause  synositis  and erosion of the cartilage of the joints. </li></ul><ul><li>Sometimes bigger joints like the shoulder and knees can also get involved. </li></ul><ul><li>This inflammatory process  can also extend to the lungs, heart, skin and the eyes. </li></ul>
  46. 46. Frolich, Human Anatomy, Mechanics of Movement <ul><li>Typical feature in RA is early morning stiffness </li></ul><ul><li>Rheumatoid Arthritis Pain which later is relieved by movements. </li></ul><ul><li>This pain and stiffness typically also appears after a period of inactivity being again relieved by movements. </li></ul><ul><li>This is a differentiating point with Osteoarthritis where the pain is aggravated by movement and only one of the larger joint is involved. </li></ul><ul><li>The tendons, the cartilage and the bone surfaces of the joint get eroded leading to limitations of movement and deformity of the joint. </li></ul><ul><li>It becomes increasingly difficult to perform daily minor tasks like holding a glass or a spoon. </li></ul>
  47. 47. Frolich, Human Anatomy, Mechanics of Movement <ul><li>OTHER ORGANS AND PARTS OF THE BODY, BESIDES THE JOINTS. </li></ul><ul><li>Skin:   Small  rheumatoid  nodules  appear subcutaneously ( below the skin).They may vary in size from a few millimeters to a few centimeters. They usually appear on the bony prominences. Reddish or purplish discoloration patches appear on the skin due to  vasculitis  of the small blood capillaries. </li></ul><ul><li>Glands   around the eyes and throat become enlarged due to inflammation leading to dryness of the eyes and the throat . </li></ul><ul><li>Inflammation of the Pleura  ( lining of the lungs) leads to Pleurisy which gives rise to symptoms of chest pain which increases on deep breathing, cough and shortness of breadth. </li></ul><ul><li>Inflammation of the Pericardium  due to  RA  causes chest pain due to pericarditis, </li></ul><ul><li>Patients of RA are prone to  atherosclerosis,  thereby making them more inclined to get a heart attack or a stroke. </li></ul><ul><li>Anaemia i s also caused by RA because it causes reduction in the red blood cells in the blood. </li></ul><ul><li>Carpal Tunnel Syndrome  is caused due to pinching of the median nerve as a result of the swelling of the wrist joints. </li></ul><ul><li>Osteoporosis  (reduced  bone density) results due to immobilization of the joints  and can also occur due to side effects of medication given for RA. ( such as steroids). </li></ul>
  48. 48. Frolich, Human Anatomy, Mechanics of Movement Rheumatoid Arthritis Treatment. (A) Therapy for Rheumatoid Arthritis. 1. Physiotherapy   for Rheumatoid Arthritis  is where the physio guides you to exercise the muscles of the affected joints to maintain the mobility and reduce pain 2. Occupational Therapy for Rheumatoid Arthritis Rheumatoid Arthritis Drugs  are basically used for relief of symptoms and to suppress the auto immune system which causes Rheumatoid Arthritis. 1. Non steroid anti inflammatory drugs (NSAIDs) Surgery for Rheumatoid Arthritis
  49. 49. Frolich, Human Anatomy, Mechanics of Movement
  50. 50. Serious types of arthritis <ul><li>Lupus (systemic lupus erythematosus) </li></ul><ul><li>Scleroderma </li></ul><ul><li>Sjogren’s syndome </li></ul><ul><li>Lyme disease </li></ul><ul><li>Ankylosing spondylitis </li></ul><ul><li>Psoriatic arthritis </li></ul><ul><li>Infectious arthritis </li></ul>
  51. 51. Skin Cancer <ul><li>This is the most common cancer in the USA, and its major risk factor is exposure to ultraviolet light. </li></ul><ul><li>1) BASAL CELL CARCINOMA : Cancer of the blood vessels. </li></ul><ul><li>Almost never metastasizes or crosses the basement membrane </li></ul><ul><li>Looks like shiny nodules </li></ul><ul><li>2) SQUAMOUS CELL CARCINOMA </li></ul><ul><li>25% of all cancers </li></ul><ul><li>Will metastasize if not treated. </li></ul><ul><li>3) MELANOMA: cancer of the melanocytes of the epidermis </li></ul><ul><li>Highly metastatic. </li></ul><ul><li>Asymmetrical, sharp but irregular borders and edges </li></ul><ul><li>Not uniform in color. </li></ul>
  52. 52. BURNS <ul><li>FIRST DEGREE: Minor burn to the epidermis; sunburn </li></ul><ul><li>SECOND DEGREE: Dermis separates from epidermis; blister </li></ul><ul><li>THIRD DEGREE: Hypodermis is burned. (most severe type of burn) </li></ul>
  53. 53. TYPES OF FRACTURES <ul><li>COMMINUTED : The most serious; bone shatters into many small pieces. Bone graft might be needed. </li></ul><ul><li>SPIRAL : Bone was twisted. </li></ul><ul><li>GREENSTICK: most common in children </li></ul><ul><li>COMPRESSION : bone is crushed, like the vertebrae in osteoporosis. </li></ul><ul><li>STRESS : least serious, get tiny, almost invisible breaks. </li></ul><ul><li>COMPOUND FRACTURES : Bone breaks and goes through skin. Increased chance of infections, which can be life-threatening. </li></ul><ul><li>SIMPLE FRACTURES : Skin is not broken. </li></ul><ul><li>PATHOLOGICAL FRACTURE: When the bone (especially the hip bone of someone with osteoporosis) breaks first, then the patient falls. </li></ul>
  54. 54. Prelim exam: Tuesday next week <ul><li>Introduction </li></ul><ul><li>Anatomical terms and Directions </li></ul><ul><li>Skin – clinical </li></ul><ul><li>Bones – bone formation, clinical </li></ul><ul><li>Joints </li></ul><ul><li>- scantron </li></ul>Frolich, Human Anatomy, Mechanics of Movement

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