CAPT POONAM SINGH PG RESIDENT

JOINTS

INTRODUCTION• Joints are the regions of the skeleton where - 2 or more bones

- bones with cartilage articulate - 2 or more cartilage

• Supported by variety of soft tissue structures

• Functions: i) to facilitate growth ii) to transmit forces between bones.

A. Sutures1. Plane2. Squamous3. Serrate4. Dentate 5. Schindylesis

B. Gomphosis C. Syndesmosis

A. Pri. Cart. joints

(Synchondrosis)

B. Sec.cart. Joints (Symphysis)

1. Plane2. Hinge3. Pivot 4. Bicondylar5. Ellipsoid6. Saddle7. Ball and socket

SynovialFreely movable

(Diarthrosis)

CartilaginousSlightly movable(Amphiarthrosis)

FibrousFixed

(Synarthrosis)

Classification of Joints

CLASSIFICATION1. Functional classification Immovable (synarthrosis)

Cranial sutures in adult Pri cartilaginous jt. in children

Slightly movable (amphiarthrosis)

Secondary cartilaginous jts Syndesmosis

Freely movable (diarthrosis)

Synovial jt.

CLASSIFICATION

2. Structural classification

Depends on the nature of intervening soft tissue, presence or absence of joint cavity

a) Fibrous joint b) Cartilaginous joint c) Synovial joint

FIBROUS JOINT

• Lacks intervening cart. between 2 bones• United by fibrous CT• Articulation :-Fixed (ROM restricted/ slight)• Lacks joint cavity• 3 types:- a) Sutures b) Syndesmosis c) Gomphosis

SUTURE

Restricted to skull

Synostosis on completion of growth.

TYPES OF SUTURES

(median palatine suture)

(sagittal suture)

(lambdoid suture)

(between temporal & parietal bone)

SYNDESMOSIS• Fibrous connection between bones

• Represented by

Interosseous ligament Slender fibrous cord Dense Aponeurotic membrane

Eg. Inf tibiofibular jt, post part of sacroiliac jt.

GOMPHOSIS

• Peg & socket joints between tooth & its socket

CARTILAGINOUS JOINT

1. Primary Cartilaginous Joint

Also called as synchondrosis

CARTILAGINOUS JOINT

2. Secondary Cartilaginous Joints

Also called as symphysis

SYNOVIAL JOINT

• Most evolved joint.

• Freely movable joint.

• Possess a joint cavity that consists of synovial

fluid.

CHARACTERISTICS OF SYNOVIAL JOINTS

1. Articular cartilage Articular surfaces are covered by

thin plates of hyaline cartilage Exceptions:- acromioclavicular

sternoclavicular TM joints

( atypical synovial joints)

Provides smooth friction-free movements & resists compression forces.

2. Fibrous capsule

Longitudinal & interlacing bundles of parallel fibers of white collagen.

Completely encloses a jt except where it is interrupted by synovial membrane.

Stabilizes the jt in such a way that it permits movements but resists dislocation.

3. Synovial membrane

Thin highly vascular memb of CT.Pink, smooth and shiny.Lines capsule, covers exposed osseous

surfaces ,tendon sheaths, bursa but doesn't cover the articular

cartilage, intra-articular disc / menisci.Function: produces synovial fluid

Histology of synovial membrane

2-3 layers of synovial lining cells, elliptical & have numerous cytoplasmic processes

Beneath them are localized capillaries

Fat tissue of subintima

4. Synovial fluid Clear or pale yellow, viscous, slightly

alkaline at rest. Fluid vol :- < 0.5ml in large jt (knee) Composition: Hyaluronic acid, Lubricin,

Proteinase and Collagenase. Fxn :- reduce friction, shock absorption,

nutrient and waste transportation.

5. Intra-articular menisci, disc and fat pads fibrocartilage, not covered by synovial

membrane.

BLOOD SUPPLY• Periarticular arterial plexuses–

circulus articularis vasculosus• Articular cartilage: avascular• Fibrous capsule & ligaments:

poor blood supply• Synovial membrane: rich

blood supply

NERVE SUPPLY

• HILTON’S LAW

The nerves supplying the joint capsule also supply the muscles regulating themovement of the jt & skin over the joint.

TYPES OF SYNOVIAL JOINT1. Based on shape of articular surface

Articulating surface- Flat

Gliding or Sliding Movements

Eg. Intercarpal & Intertarsal Intermetacarpal Intermetatarsal Zygapophyseal

Uniaxial

Resemble hinge of door

Articular surface- pulley shaped

Eg. Humero-ulnar Jt. Interphalangeal Jt. Knee & Ankle Jt

2. HINGE JOINT

TYPES OF SYNOVIAL JOINT

TYPES OF SYNOVIAL JOINT

3. ELLIPSOIDAL JOINTS

Biaxial

Elliptical convex surface of one bone articulates with elliptical concave surface of other bone

Eg. Radio-Carpal Joint Atlanto Occipital Joint Meta-tarso phalangeal Joint Meta-carpophalangeal Joint

4.PIVOT JOINT

TYPES OF SYNOVIAL JOINTUniaxial Joint Eg. Superior Radio-ulnar Jt. Median Atlanto-axial Articular surface of one bone is rounded & fits into the concavity of another bone.

Further rounded partsurrounded by a Ligamentous ring.

TYPES OF SYNOVIAL JOINT

5.BICONDYLAR JOINTBiaxial

Round articular surface of one bone fits into socket type articular surface of another bone.

Eg. Knee Joint, Temporo-mandibular Joint

TYPES OF SYNOVIAL JOINT

6.SADDLE JOINT

Bi-axial

Articular surfaces are reciprocally saddle shaped i.e Concavo-convex.

Eg. Carpo-metacarpal joint of thumb, Calcaneo-cuboid Joint Sterno-clavicular Joint Incudo malleolar Joint

TYPES OF SYNOVIAL JOINT

7. BALL AND SOCKET JOINT

Multi-axial

Rounded convex surface of one bone fits into the cup-like socket of another bone.

Eg Hip Joint, Shoulder Joint, Incudo-stapedial Joint.

2. Based on plane of movements

I Uniaxial joint : Hinge, Pivot joint

II Biaxial joint: Condylar, Ellipsoid, Saddle joint

III Multiaxial joint: Ball and socket joint.

3. Based on no. of articulating bone

I Simple joint: only 2 bones take part in formation of a joint.

II Compound joint: > 2 bones take part in formation of a joint.

III Complex joint: joint cavity is divided into 2 by the intra-articular disc or meniscus, eg. TM joint, knee joint.

MOVEMENTS OF SYNOVIAL JOINTS

1. TRANSLATION: gliding or sliding movements

2. ANGULATION: change in the angle betn the topographical axes of the articulating bones.

4 types a). Flexion b). Extension c). Abduction d). Adduction

3. ROTARY / CIRCULAR MOVEMENTS a). Axial rotation b). Circumduction

DEVELOPMENT OF JOINTS

• Mainly mesoderm in origin with some neural crest contribution.

Regions of developing cartilage consist of widely spaced cells surrounded by matrix.

Condensation of somatopleuric mesenchymal cells develop between developing skeletal elements to form plates of interzonal mesenchyme

DEVELOPMENT OF JOINTS

Their subsequent development varies acc. to type of joint

1.Fibrous joint2.Cartilaginous joint3.Synovial joint

Cracking joint

• When the two bones of a joint are pulled away from each other, the synovial membrane expands, but the fluid volume does not. In order to fill the empty space, gases dissolved in the fluid are pulled out, and when they fill this new empty space, a popping sound is made.

ARTHRITIS

• Inflammation of one or more joints, synovial membrane.

• > 100 different forms of arthritis.

• Symptoms: swollen jt, tender, warm, stiffness limits the movements.

• Main complaint: jt pain ( due to inflammation that occurs around the jt, damage to the jt from disease, daily wear and tear of the jt, muscle strains caused by forceful movement)

• Most common: osteoarthritis

OSTEOARTHRITIS

• Most common form of arthritis• degenerative joint disease • Cause: mechanical stress, overweight, hereditary,

developmental deficits• Symptoms: jt pain, tenderness, stiffness, locking and

sometimes an effusion.• T/t : -exercise - lifestyle modification - analgesics - jt replacement surgery used to improve

quality of life .

OSTEOARTHRITIS

RHEUMATOID ARTHRITIS• Is an autoimmune disease that results in a chronic, systemic

inflammatory disorder that may affect many tissues ,organs and jts.• Women 2-3 times more affected than men.• Onset is frequent during middle age.• Pathology: destruction of articular cartilage and ankylosis of the

joints.• Commonly involved parts: hands, feet and cervical spine but larger

jt can also be involved.• Symptoms: -pain ( lasts for more than 1 hour) -stiffness mainly occurs in the morning -disabling & painful condition can lead to loss of

function.

RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS

• T/t: - physical therapy -nutritional therapy -analgesia/ anti-inflammatory (NSAIDS) -steroids

-DMARDS (disease- modifying anti - rheumatic drugs)

JOINT REPLACEMENT SURGERY

• Is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis.

• Indication: severe joint pain or dysfunction, not alleviated by less-invasive therapies.

• Most common: knee and hip replacement

JOINT REPLACEMENT SURGERY

• Complications:1. Mal positioning of the components2. Loss of ROM, dislocation3. # of the adjacent bone4. Damage to b.vs & nerves5. Infection, persistent pain6. Weakness7. Loosening of the components

• Sgt Jerrod fields , US army.. Won a gold medal in 100m with a time of 12.5 secs at the endeavor games in Edmond,Okla, on June 13-2009