JOINTS

JOINTS
JAI NARAIN VYAS UNIVERSITY, JODHPUR
ASSISTANT PROFESSOR:- ASHWIN SINGH
CHOUHAN
DEPARTMENT:- PHARMACOLOGY
E-mail:- anshukavya1993@gmail.com

JNVU PHARMACY, JODHPUR
A joint generally means a point where two or more
things are connected together. In this scenario, it is the
point where two bones intersect.
Joint means an articulation or in other words, a strong
connection that joins the bones, teeth, and cartilage
together.
It is necessary for all types of movement in the body
involving bones. The force generated by muscles is used
to carry out movement through various joints.
The degree and ease of movement at different joints
vary with a lot of different factors. They could be
classified based on two different things.
JOINT

FUNCTION OF JOINTS
Serve as functional junctions between bones.
Bind bones, strokes , and other related tissues together.
Allow bone growth to occur .
Permit certain structures to change shape during
childbirth (i.e. pubic symphysis).
Enable the body to have movements, lever actions, and
body posture

CLASSIFICATION OF JOINTS
According to the type of tissue at the joint
Fibrous joint :- uses fibrous connective tissue to
articulate bones.
Cartilaginous joint :- uses hyaline cartilage and/or
fibrocartilage to articulate bones.
Synovial joint :- uses auricular cartilage, synovial
membrane, joint capsule, and ligaments to articulate
bones.
According to the amount of movement at the joint
Synarthrotic joint :- immovable joint.
Amphiarthrotic joint :- immovable joint.
Diarthrotic joint :- freely movable joint.

TYPE OF
JOINT
MOVEMENT EXAMPLE
PIVOT
Uniaxial joint; allows rotational
movement
Atlantoaxial joint (C1–C2 vertebrae
articulation); proximal radioulnar joint
HINGE
Uniaxial joint; allows flexion/extension
movements
Knee; elbow; ankle; interphalangeal
joints of fingers and toes
CONDYLOID
Biaxial joint; allows flexion/extension,
abduction/adduction, and circumduction
movements
Metacarpophalangeal (knuckle) joints
of fingers; radiocarpal joint of wrist;
metatarsophalangeal joints for toes
SADDLE
Biaxial joint; allows flexion/extension,
abduction/adduction, and circumduction
movements
First carpometacarpal joint of the
thumb; sternoclavicular joint
PLANE
Multiaxial joint; allows inversion and
eversion of foot, or flexion, extension,
and lateral flexion of the vertebral
column
Intertarsal joints of foot; superior-
inferior articular process articulations
between vertebrae
BALL-AND-
SOCKET
Multiaxial joint; allows
flexion/extension, abduction/adduction,
circumduction, and medial/lateral
rotation movements
Shoulder and hip joints
MOVEMENTS OF THE JOINTS

CLASSIFICATION OF JOINTS
On the basis of structure
On the basis of extent of their function (degree of
movement)
CLASSIFICATION OF JOINTS ON THE BASIS
OF STRUCTURE
This classification is based on the presence or absence of
joint cavity and kinds of supporting tissue that binds two
bones together.
Fibrous joint
Cartilaginous joint
Synovial joint

CARTILAGINOUS JOINTS
SYNOVIAL JOINTS
FIBROUS JOINT

FIBROUS JOINT
Fibrous joint lacks joint cavity.
Two bones are joined together by fibrous connective
tissue.
Fibrous joints are joined together tightly so they are
generally immobile in adults although some allows slight
movement.

TYPES OF FIBROUS JOINTS
Suture:
Syndesmosis
Gomphosis
1. Suture:
A suture is a tight union between two or more bones in a
skull of adult.
They are rarely movable.
Example; sagital sature, squamousal suture, lambdoidal
suture and coronal suture
2. Syndesmosis:
In this joints, bones are close together but not touching each
other
Bones are held together by collagen fibers
Examples; inferior Tibio-fibula joint, Radius-ulna joint
3. Gomphosis:
It is fibrous joint made up of peg and socket.
Example; the root of each teeth is anchored into its socket by
fibrous ligament.

CARTILAGINOUS JOINTS
In cartilaginous joints, bones are united together by a
plate of hyaline cartilage.
Cartilaginous joints lack joint cavity.
They are slightly movable or immobile.

Synchondrosis
Symphysis
1. Synchondrosis:
It is primary cartilaginous joint.
Synchondrosis is a temporary joint, composed of epiphyseal
plate made up of hyaline cartilage that joints epiphysis and
diphysis.
The chief function of synchondrosis is to permit growth of
bone but not movement.
A synchondrosis is eventually replaced by bone when large
bone stops growth. However few synchondrosis are still
present in adults.
Example; sternoclavicular joint
2. Symphysis:
It is called as secondary synchondosis.
In this joint, two bones are covered by thin layer of hyaline
cartilage.
There is presence of a disk of fibro-cartilage between two
bones that acts as shock absorber.
Example; pubis symphysis

SYNOVIAL JOINTS
Most of the permanent joints of body is synovial joint
All of the synovial joints allow greatest range of
movement.
Movement is possible because, the end of bone at
articulation is covered with smooth hyaline cartilage and
joint is lubricated by thick fluid called synovial fluid.
The joint is covered by flexible articular capsule

TYPES OF SYNOVIAL JOINTS
Hinge joint
Pivot joint
Condyloid joint
Gliding joint
Saddle joint
Ball and Socket joint

1. Hinge joint:
Hinge joint roughly resembles the hinge on the lid of a
box.
The movement of hinge joint is uniaxial.
The convex surface of one bone fits on concave surface
of other bone to permit uniaxial movement.
Example; Knee joint, Elbow joint, Ankle joint
2. Pivot joint:
Pivot joint is composed of a central bony pivot
surrounded by a collar made partly of bone and partly of
ligament.
The movement of pivot joint is uniaxial and is able to
rotate around a central axis.
Example; Atlantoaxial joint between atlas and axis.

3. Condyloid joint:
Condyloid joints are modification of ball and socket
joint.
The movement of condyloid joint is biaxial, because of
ligament and muscles.
Example; Metacarpophalangeal joint of fingers (except
Thumb)
4. Gliding joint:
Gliding joints are always small and formed by flat
articular surface so that one bone slides on another bone.
The movement of gliding joint is multiaxial.
Examples; Articular process of Vertebrae, Clavicular joint

5. Saddle joint:
The saddle joint is so named because both the bones at
articulation are shaped like saddle.
Bones have both concave and convex area at right
angle to each other.
Examples; Carpometacarpal joint of thumb.
6. Ball and Socket joint:
Ball and socket joint is composed of globe like head of
one bone that fits into a cup like cavity on another bone.
It is the most freely movable joint of all joints.
The movement of ball and socket joint is multiaxial.
Examples; shoulder and hip joints

CLASSIFICATION OF JOINTS ON THE BASIS
OF DEGREE OF MOVEMENT
Immobile joint ( Synarthrosis): examples; suture of
skull, syndesmosis, gomphosis, synchondrosis
Slightly movable joint ( Amphi-arthrosis):
examples; symphysis
Freely movable joint ( Diarthrosis): examples;
Synovial joints

Suture and Fontanelle
Skull contains 29 bones, except for mandible, ear ossicles and
hyoid bone, all other skull bones are joined by suture.
Suture is an immobile joint between bones of skull.
During fetal life and early childhood, the skull bones are joined
by palpable membrane rather than tight fitting suture because
it is relatively easy for skull bone to move and overlaps during
birth through narrow birth canal.
Some of the larger membranous areas between such
incompletely ossified skull bones are called Fontanelle.
The Fontanelle allows the skull to expand as child brain grown
and develops few year after postnatal life.
Types of sutures:
Coronal suture: it lies between Frontal and Parietal bone
Lambdoidal suture: It lies between Occipital and parietal
bone
Sagital suture: It lies between left and right parietal bone
Squamousal suture: It lies between Temporal and parietal
bone JNVU PHARMACY, JODHPUR

Types of Fontanelles:
1.Frontal or anterior fontanelle:
It is located between angles of two Parietal bone and two
sections of frontal bones.
It is diamond shaped.
It closes about 12-18 month after birth.
2. Occipital fontanelle:
It is located between occipital bone and two parietal
bones.
It closes about 2 month after birth.
3. Sphenoid fontanelle:
It is located at junction of frontal, parietal, temporal and
sphenoid bones.
It closes about 3 month after birth,
4. Mastoid fontanelle:
It is located at the junction of occipital, parietal and
temporal bones.
It begins to close after 2 month after birth but does not
completely close up to 12 months. JNVU PHARMACY, JODHPUR

Movement at Synovial Joints
Synovial joints allow for many types of movement
including gliding, angular, rotational, and special
movements.
Movement at Synovial Joints
The range of movement allowed by synovial joints is
fairly wide. These movements can be classified as:
gliding, angular, rotational, or special movement.
Gliding Movement
Gliding movements occur as relatively flat bone surfaces
move past each other. They produce very little rotation or
angular movement of the bones. The joints of the carpal
and tarsal bones are examples of joints that produce
gliding movements..

Angular Movement
Angular movements are produced by changing the angle
between the bones of a joint. There are several different
types of angular movements, including flexion, extension,
hyperextension, abduction, adduction, and circumduction.
Flexion, or bending, occurs when the angle between the
bones decreases. Moving the forearm upward at the
elbow or moving the wrist to move the hand toward the
forearm are examples of flexion. In extension, the
opposite of flexion, the angle between the bones of a
joint increases. Straightening a limb after flexion is an
example of extension. Extension past the normal
anatomical position is referred to as hyperextension. This
includes moving the neck back to look upward or bending
the wrist so that the hand moves away from the forearm

Abduction occurs when a bone moves away from the
midline of the body. Examples of abduction include
moving the arms or legs laterally to lift them straight out
to the side. Adduction is the movement of a bone toward
the midline of the body. Movement of the limbs inward
after abduction is an example of adduction.
Circumduction is the movement of a limb in a circular
motion, as in swinging an arm around.

Rotational Movement
Rotational movement is the movement of a bone as it
rotates around its longitudinal axis. Rotation can be
toward the midline of the body, which is referred to as
medial rotation, or away from the midline of the body,
which is referred to as lateral rotation. Movement of the
head from side to side is an example of rotation.
Special Movements
Some movements that cannot be classified as gliding,
angular, or rotational are called special movements.
Inversion involves moving the soles of the feet inward,
toward the midline of the body. Eversion, the opposite of
inversion, involves moving of the sole of the foot
outward, away from the midline of the body. Protraction
is the anterior movement of a bone in the horizontal
plane. Retraction occurs as a joint moves back into
position after protraction.

Protraction and retraction can be seen in the movement
of the mandible as the jaw is thrust outwards and then
back inwards. Elevation is the movement of a bone
upward, such as shrugging the shoulders, lifting the
scapulae. Depression is the opposite of elevation and
involves moving the bone downward, such as after the
shoulders are shrugged and the scapulae return to their
normal position from an elevated position. Dorsiflexion is
a bending at the ankle such that the toes are lifted
toward the knee. Plantarflexion is a bending at the ankle
when the heel is lifted, such as when standing on the
toes. Supination is the movement of the radius and ulna
bones of the forearm so that the palm faces forward or
up. Pronation is the opposite movement, in which the
palm faces backward or down. Opposition is the
movement of the thumb toward the fingers of the same
hand, making it possible to grasp and hold objects.

Osteoarthritis. The most common type, osteoarthritis
is the "wear-and-tear" form that increases with age.
Cartilage that normally cushions the joint breaks down
over time, leading to stiffness and pain, especially with
movement. With hip arthritis and knee arthritis, walking
becomes more difficult as pain builds and flexibility
decreases. Adults in their 50s and older are more likely to
develop this chronic, progressive disease, and women are
more vulnerable.
Rheumatoid arthritis. Rheumatoid arthritis is an
autoimmune condition affect the lining of the joints. Cells
of the immune system that normally don't belong in the
joints accumulate there in large numbers, Fox says. As
the immune cells interact with the local joint cells, he
explains, it causes ever-increasing inflammation, with
eventual damage and destruction of cartilage and bone.

Spondyloarthritis. Also known as spondylitis, this
umbrella term covers certain other rheumatoid diseases.
Axial spondylitis involves inflammation in the spine and
can eventually lead to spinal fusion, or ankylosing
spondylitis. Enteropathic arthritis is a possible
complication of inflammatory bowel diseases like
ulcerative colitis. Psoriatic arthritis, which is associated
with the skin condition psoriasis, tends to affect the joints
of the hands and feet.
Juvenile idiopathic arthritis. Also known as juvenile
rheumatoid arthritis, JIA is the most common chronic
joint condition in kids. In this autoimmune condition, the
child's immune system attacks the body's own healthy
tissue. It's called "idiopathic" because the cause is
unknown. Inflammation from JIA may affect the muscles,
joints, ligaments, internal organs and even the eyes. An
added concern is that JIA can alter children's normal
growth.

Lupus. This autoimmune condition affects various parts
of the body, including the skin, internal organs, blood,
brain, bones and joints. Inflammation caused by lupus
can trigger arthritis, particularly in the hands, elbows,
shoulders, knees and feet.
Gout. This type of arthritis most often affects the joint
connecting the big toe to the rest of the foot. In gout,
excess uric acid – a waste product in the blood – forms
crystals in the joints. Gout flare-ups, which are extremely
painful, frequently strike in the middle of the night. Men
are more likely to have gout, although women become
more vulnerable after menopause.
Bursitis. Bursitis involves inflammation of the small,
fluid-filled sacs called bursae that cushion the joints and
surrounding tendons, muscles and bone. With bursitis,
overuse or sudden injury of joints such as the hip, elbow
and shoulder can lead to flare-ups. Bacterial infections
can sometimes cause bursitis.

THE ROLE OF RHEUMATOLOGISTS
Rheumatologists are medical doctors who specialize in
the diagnosis and treatment of disorders of the joints,
muscles, and bones. They diagnose and treat diseases
such as arthritis, musculoskeletal disorders, osteoporosis,
and autoimmune diseases such as ankylosing spondylitis
and rheumatoid arthritis.
Rheumatoid arthritis (RA) is an inflammatory disorder
that primarily affects the synovial joints of the hands,
feet, and cervical spine. Affected joints become swollen,
stiff, and painful. Although it is known that RA is an
autoimmune disease in which the body’s immune system
mistakenly attacks healthy tissue, the cause of RA
remains unknown. Immune cells from the blood enter
joints and the synovium, causing cartilage breakdown,
swelling, and inflammation of the joint lining. Breakdown
of cartilage results in bones rubbing against each other,
causing pain. JNVU PHARMACY, JODHPUR

RA is more common in women than men; the age of
onset is usually 40–50 years of age.
Rheumatologists diagnose RA on the basis of symptoms
(joint inflammation and pain), X-ray and MRI imaging,
and blood tests.
Arthrography, a type of medical imaging of joints, uses
a contrast agent, such as a dye, that is opaque to X-rays.
This allows the soft tissue structures of joints, such as
cartilage, tendons, and ligaments, to be visualized. An
arthrogram differs from a regular X-ray by showing the
surface of soft tissues lining the joint in addition to joint
bones.
An arthrogram allows early degenerative changes in
joint cartilage to be detected before bones become
affected.

There is currently no cure for RA; however,
rheumatologists have a number of treatment options
available. Early stages can be treated by resting the
affected joints, using a cane or joint splints, to minimize
inflammation.
When inflammation has decreased, exercise can be
used to strengthen the muscles that surround the joint in
order to maintain joint flexibility. If joint damage is more
extensive, medications can be used to relieve pain and
decrease inflammation.
Anti-inflammatory drugs such as aspirin, topical pain
relievers, and corticosteroid injections may be used.
Surgery may be required in cases in which joint damage
is severe.

JOINTS

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JOINTS