Soriano Notes~Chapter 8~Anatomy & Physiology

Front 1

Joints (Articulations)

Back 1

~Weakest parts of skeleton
~Articulation –Site where 2 or more bones meet
~Functions of joints:
a)Give skeleton mobility
b)Hold skeleton together

Front 2

*Structural classification of joints

Back 2

~Focuses on material binding bones together & whether or not a joint cavity is present

~3 structural classifications are:
1)Fibrous
2)Cartilaginous
3)Synovial

Front 3

*Functional classification

Back 3

~Based on amount of movement allowed by joint

~3 functional classes of joints are:
1)Synarthroses – immovable
2)Amphiarthroses – slightly movable
3)Diarthroses – freely movable

Front 4

Fibrous Structural Joints

Back 4

~Bones are joined by fibrous tissues

~There is no joint cavity

~Most are immovable

~3 types:
1)Sutures
2)Syndesmoses
3)Gomphoses

Front 5

Fibrous Structural Joints: Sutures

Back 5

~Occur between bones of skull

~Comprised of interlocking jxs completely filled w connective tissue fibers

~Bind bones tightly together but allow for growth during youth

~In middle age, skull bones fuse & are called synostoses

Front 6

Fibrous Structural Joints: Syndesmoses

Back 6

~Bones are connected by a fibrous tissue ligament

~Movement varies from immovable to slightly variable

~Ex:
1)Connection between tibia & fibula
2)1)Connection between radius & ulna

Front 7

Fibrous Structural Joints: Gomphoses

Back 7

~Peg-in-socket fibrous joint between a tooth 1)Connection between its alveolar socket

~Fibrous connection is periodontal ligament

Front 8

Cartilaginous Joints

Back 8

~Articulating bones are united by cartilage

~Lack a joint cavity

~2 types
1)synchondroses
2)symphyses

Front 9

Cartilaginous Joints: Synchondroses

Back 9

~A bar or plate of hyaline cartilage unites bones

~All synchondroses are synarthrotic

~Ex:
a)Epiphyseal plates of children
b)Joint between costal cartilage of first rib & sternum

Front 10

Cartilaginous Joints: Symphyses

Back 10

~Hyaline cartilage covers articulating surface of bone & is fused to an intervening pad of fibrocartilage

~Amphiarthrotic joints designed for strength & flexibility

~Examples include:
1)intervertebral joints
2)pubic symphysis of pelvis

Front 11

Synovial Joints

Back 11

~Those joints in which articulating bones are separated by a fluid-containing joint cavity

~All are freely movable diarthroses

~Examples:
1)all limb joints
2)most joints of body

Front 12

*Synovial Joints: General Structure

Back 12

~Synovial joints all have following:
1)Articular cartilage
2)Joint (synovial) cavity
3)Articular capsule
4)Synovial fluid
5)Reinforcing ligaments

Front 13

*Synovial Joints: Friction-Reducing Structures

Back 13

~Bursae –Flattened, fibrous sacs lined w synovial membranes & containing synovial fluid

~Common where ligaments, muscles, skin, tendons or bones rub together

~Tendon sheath – elongated bursa that wraps completely around a tendon

Front 14

*Synovial Joints: Stability

Back 14

~Stability is determined by:
a)Articular surfaces –Shape determines what movements are possible
b)Ligaments –Unite bones & prevent excessive or undesirable motion

~Muscle tone is accomplished by:
a)Muscle tendons across joints acting as stabilizing factors
b)Tendons that are kept tight at all times by muscle tone

Front 15

*Synovial Joints: Movement

Back 15

~2 muscle attachments across a joint are:
1)Origin –Attachment to immovable bone
2)Insertion –Attachment to movable bone

~Described as movement along transverse, frontal or sagittal planes

Front 16

Synovial Joints: Range of Motion

Back 16

1~Nonaxial –Slipping movements only

2~Uniaxial –Movement in 1 plane

3~Biaxial –Movement in 2 planes

4~Multiaxial –Movement in or around all 3 planes

Front 17

Gliding Movements

Back 17

~1 flat bone surface glides or slips over another similar surface

~Ex
1)Intercarpal
2)Intertarsal joints
3)Between flat articular processes of vertebrae

Front 18

Angular Movement

Back 18

1~Flexion —Bending movement that decreases angle of joint

2~Extension —Reverse of flexion; joint angle is increased

3~Dorsiflexion & plantar flexion —Up & down movement of foot

4~Abduction —Movement away from midline

5~Adduction —Movement toward midline

6~Circumduction —Movement describes a cone in space

Front 19

Rotation

Back 19

~The turning of a bone around its own long axis

~Examples:
1)Between first 2 vertebrae
2)Hip & shoulder joints

Front 20

Special Movements

Back 20

1~Supination & pronation

2~Inversion & eversion

3~Protraction & retraction

4~Elevation & depression

Front 21

Plane Joint

Back 21

~Articular surfaces are essentially flat

~Allow only slipping or gliding movements

~Only ex of nonaxial joints

Front 22

*Types of Synovial Joints:
Hinge Joints

Back 22

~Cylindrical projections of 1 bone fits into a trough-shaped surface on another

~Motion is along a single plane

~Uniaxial joints permit flexion & extension only

~Ex:
1)Elbow
2)Interphalangeal joints

Front 23

*Types of Synovial Joints:
Pivot Joints

Back 23

~Rounded end of 1 bone protrudes into a “sleeve” or ring, composed of bone (& possibly ligaments) of another

~Only uniaxial movement allowed

~Ex:
1)Joint between axis & dens
2)Proximal radioulnar joint

Front 24

*Types of Synovial Joints:
Condyloid or Ellipsoidal Joints

Back 24

~Oval articular surface of 1 bone fits into a complementary depression in another

~Both articular surfaces are oval

~Biaxial joints permit all angular motions

~Ex:
1)Radiocarpal (wrist) joints
2)Metacarpophalangeal (knuckle) joints

Front 25

*Types of Synovial Joints
Saddle Joints

Back 25

~Similar to condyloid joints but allow greater movement

~Each articular surface has both a concave & a convex surface

~Ex:
1)Carpometacarpal joint of thumb

Front 26

*Types of Synovial Joints:
Ball-and-Socket Joints

Back 26

~A spherical or hemispherical head of 1 bone articulates w a cuplike socket of another

~Multiaxial joints permit most freely moving synovial joints

~Ex:
1)Shoulder
2)Hip joints

Front 27

*Synovial Joints: Knee

Back 27

~Largest & most complex joint of body

~Allows flexion, extension & some rotation

~3 joints in 1 surrounded by a single joint cavity:
1)Femoropatellar joint
2)Lateral & medial tibiofemoral joints

Front 28

*Synovial Joints: Knee Ligaments & Tendons – Anterior View

Back 28

~Tendon of quadriceps femoris muscle
~Lateral & medial patellar retinacula
~Fibular & tibial collateral ligaments
~Patellar ligament

Front 29

*Synovial Joints: Knee –
Other Supporting Structures

Back 29

~Anterior cruciate ligament
~Posterior cruciate ligament
~Medial meniscus (semilunar cartilage)
~Lateral meniscus

Front 30

*Synovial Joints: Knee –
Posterior Superficial View

Back 30

~Adductor magnus tendon
~Articular capsule
~Oblique popliteal ligament
~Arcuate popliteal ligament
~Semimembranosus tendon

Front 31

*Synovial Joints: Shoulder (Glenohumeral)

Back 31

(Glenohumeral)

~Ball-&-socket joint in which stability is sacrificed to obtain greater freedom of movement

~Head of humerus articulates w glenoid fossa of scapula

Front 32

*Synovial Joints: Elbow

Back 32

~Hinge joint that allows flexion & extension only

~Radius & ulna articulate w humerus

~Annular ligament
~Ulnar collateral ligament
~Radial collateral ligament

Front 33

*Synovial Joints: Shoulder Stability

Back 33

~Weak stability is maintained by:
a)Thin, loose joint capsule
b)4 ligaments – Coracohumeral, and 3 glenohumeral
c)Tendon of long head of biceps, which travels through intertubercular groove & secures humerus to glenoid cavity
d)Rotator cuff (4 tendons) that encircles shoulder joint & blends w articular capsule

Front 34

*Synovial Joints: Hip (Coxal) Joint

Back 34

~Ball-&-socket joint

~Head of femur articulates w acetabulum

~Good range of motion but limited by deep socket & strong ligaments

Front 35

*Synovial Joints: Hip Stability

Back 35

~Acetabular labrum
~Iliofemoral ligament
~Pubofemoral ligament
~Ischiofemoral ligament
~Ligamentum teres

Front 36

Temporomandibular Joint (TMJ)

Back 36

~Mandibular condyle articulate w temporal bone
~2 types of movement
1)Hinge –Depression & elevation of mandible
2)Side to side – (lateral excursion) grinding of teeth

Front 37

*Sprains

Back 37

~Ligaments reinforcing a joint are stretched or torn

~Partially torn ligaments slowly repair themselves

~Completely torn ligaments require prompt surgical repair

Front 38

*Cartilage Injuries

Back 38

~Snap & pop of overstressed cartilage

~Common aerobics injury

~Repaired w arthroscopic surgery

Front 39

*Dislocations

Back 39

~Occur when bones are forced out of alignment

~Usually accompanied by sprains, inflammation & joint immobilization

~Caused by serious falls & are common sports injuries

~Subluxation –Partial dislocation of a joint

Front 40

Inflammatory & Degenerative Conditions

Back 40

1~Bursitis
a)An inflammation of a bursa, usually caused by a blow or friction
b)Symptoms are pain & swelling
c)Treated w anti-inflammatory drugs; excessive fluid may be aspirated

2~Tendonitis
a)Inflammation of tendon sheaths typically caused by overuse
b)Symptoms & treatment are similar to bursitis

Front 41

*Arthritis

Back 41

~More than 100 different types of inflammatory or degenerative diseases that damage joints

~Most widespread crippling disease in U.S.

~Symptoms –Pain, stiffness & swelling of a joint

~Acute forms are caused by bacteria & are treated w antibiotics

~Chronic forms include:
1)Osteoarthritis 2)Rheumatoid arthritis 3)Gouty arthritis

Front 42

*Osteoarthritis (OA)

Back 42

~Most common chronic arthritis; often called “wear-&-tear” arthritis

~Affects women more than men

~85% of all Americans develop OA

~More prevalent in aged & is probably related to normal aging process

Front 43

Osteoarthritis: Course

Back 43

~OA reflects years of abrasion & compression causing increased production of metalloproteinase enzymes that break down cartilage

~As one ages, cartilage is destroyed more quickly than it is replaced

~exposed bone ends thicken, enlarge, form bone spurs & restrict movement

~Joints most affected are cervical & lumbar spine, fingers, knuckles, knees & hips

Front 44

Osteoarthritis: Treatments

Back 44

~OA is slow & irreversible

~Treatments include:
1)Mild pain relievers, along w moderate activity
2)Magnetic therapy
3)Glucosamine sulfate decreases pain & inflammation

Front 45

*Rheumatoid Arthritis (RA)

Back 45

~Chronic, inflammatory, autoimmune disease of unknown cause, w an insidious onset

~Usually arises between ages of 40-50, but may occur at any age

~Signs & symptoms include joint tenderness, anemia, osteoporosis, muscle atrophy & cardiovascular problems

~Course of RA is marked w exacerbations & remissions

Front 46

Rheumatoid Arthritis: Course(6)

Back 46

1~RA begins w synovitis of affected joint
2~Inflammatory chemicals are inappropriately released
3~Inflammatory blood cells migrate to joint, causing swelling
4~Inflamed synovial membrane thickens into a pannus
5~Pannus erodes cartilage, scar tissue forms, articulating bone ends connect
6~End result, ankylosis, produces bent, deformed fingers

Front 47

Rheumatoid Arthritis: Treatment

Back 47

~Conservative therapy –Aspirin, long-term use of antibiotics & physical therapy

~Progressive treatment –Anti-inflammatory drugs or immunosuppressants

~Drug Enbrel, a biological response modifier, neutralizes harmful properties of inflammatory chemicals

Front 48

*Gouty Arthritis

Back 48

~Deposition of uric acid crystals in join soft tissues, followed by an inflammation response

~Typically, gouty arthritis affects joint at base of great toe

~In untreated gouty arthritis, bone ends fuse & immobilize joint

~Treatment –Colchicine, nonsteroidal anti-inflammatory drugs & glucocorticoids

Front 49

Developmental Aspects of Joints

Back 49

~By embryonic week 8, synovial joints resemble adult joints

~Few problems occur until late middle age

~Advancing years take their toll on joints:
1)Ligaments & tendons shorten & weaken
2)Intervertebral discs become more likely to herniate
3)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