Joints!

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Joints!

• 3 types of joints if we classify by function
  (i.e., by the degree of movement possible)
• Diarthroses (Synovial)
• Freely moveable joints
• Shoulder, knee, hip, elbow, interphalangeal,
  tarsal, and carpal joints
• Amphiarthroses (Cartilaginous) Amphi-slightly
• Slightly moveable joints
• Intervertebral discs, costosternal joints, pubic
  symphysis
• Synarthroses (Fibrous) Syn--together
• Joints with little or no movement
• Skull sutures, teeth in sockets, 1st costosternal
  joint.

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Joint Classification

• We can also classify joints by structure
• Synovial joints
• Bones separated by a joint cavity lubricated by
  synovial fluid enclosed in a fibrous joint
  capsule.
• Shoulder, hip, elbow, knee, carpal,
  interphalangeal

How would we classify these joints functionally?
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Joint Classification

• Fibrous joints
• Bones held together by collagenous fibers
  extending from the matrix of one bone into the
  matrix of the next.
• No joint cavity
• Little or no movement occurs between bones
• Skull sutures, teeth joints, distal radioulnar
  joints tibiofibular joints

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Types of Fibrous Joints

• There are three types of fibrous joint
• Suturesvery tight articulations between adjacent
  bones. Only found in the skull.
• Syndesmosisthe bones are held together by
  strong, fibrous connective tissue. Bones may be
  held together by ligaments or interosseous
  membranes. Very little movement is possible.
• Gomphosisa unique peg-and-socket joint at which
  no movement occurs. Only found between the
  permanent teeth and the maxilla.

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Joint Classifications

• Cartilaginous joints
• Bones held together by cartilage no joint cavity
• Epiphyseal plates of long bones, costosternal
  joints, pubic symphysis, intervertebral discs

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Types of Cartilaginous Joints

• There are two types of cartilalaginous joints
• 1. SymphysisExamples include the intervertebral
  discs and the symphysis pubis.
• 2. SynchondrosisExamples include the epiphyseal
  growth plate in a long bone.

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Herniated Disc

• Disc Surgery Herniated - Learn about Herniated
  Disc Surgery
• YouTube - Back Surgery for Disc Herniation

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Structure and Function

• Joints are designed for their function.
• Lets look at sutures as our 1st example
• What function do you suppose sutures are designed
  for?

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Structure and Function

• Lets look at some symphyses.
• What kind of joint is a symphysis? What kind of
  movement is possible?
• Name a symphysis! (an obvious one is in the
  picture)
• What connects the bones in these joints?

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Structure and Function

• Now lets talk about synovial joints.
• How do they differ from the previous 2?
• 5 main structural characteristics
• Articular cartilage
• What kind of cartilage is it? (H _ _ _ _ _ _ )
• Where do we find it?
• What does it do?

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Structure and Function

• Articular capsule
• 2 layered. Surrounds both articular cartilages
  and the space btwn them.
• External layer is made of dense irregular CT is
  continuous w/ the perisoteum.
• Inner layer is a synovial membrane made of loose
  connective tissue.
• It covers all internal joint surfaces except for
  those areas covered by the articular cartilage.

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Structure and Function

• Joint (Synovial) Cavity
• The potential space within the joint capsule and
  articular cartilage
• Synovial Fluid
• A small amount of slippery fluid occupying all
  free space w/i the joint capsule
• Formed by filtration of blood flowing through
  capillaries in the synovial membrane
• Synovial fluid becomes less viscous as joint
  activity increases.

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Structure and Function

• Reinforcing Ligaments
• What kind of tissue are they?
• What do you suppose their function is?
• Double-jointed-ness results from extra-stretchy
  ligaments and joint capsules. Is this
  necessarily a good thing?

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Other Synovial Structures

• The knee and hip joints have cushioning fatty
  pads btwn the fibrous capsule and the synovial
  membrane or bone.
• Discs of fibrocartilage (i.e., menisci) which
  improve the fit btwn bone ends, thus stabilizing
  the joint.
• Found in the knee, jaw, and sternoclavicular
  joint.
• Bursae are basically bags of lubricant - fibrous
  membrane bags filled w/ synovial fluid. Often
  found where bones, muscles, tendons, or ligaments
  rub together.

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Synovial Joints

• YouTube - Types of Synovial Joints

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Types of Synovial Joints

• Plane joints
• Articular surfaces are flat and allow short
  slipping or gliding movements.
• Intercarpal and intertarsal joints
• Hinge joints
• A cylindrical projection of one bone fits into a
  trough-shaped surface on another (like a hotdog
  in a bun)
• Movement resembles a door hinge.
• Elbow joint ulna and humerus Interphalangeal
  joints

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Type of Synovial Joints

• Pivot joints
• Rounded end of one bone protrudes into a ring
  formed by another bone or by ligaments of that
  bone.
• Proximal radioulnar joint
• Atlas-axial joint
• Condyloid joints
• Oval articular surface of one bone fits into a
  complementary depression on another.
• Radiocarpal joints
• Metacarpophalangeal joints

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Types of Synovial Joints

• Saddle joints
• Each articular surface has convex and concave
  areas. Each articular surface is saddle-shaped.
• Carpometacarpal joints of the thumbs.
• Ball-and-Socket joints
• Spherical or semi-spherical head of one bone
  articulates with the cuplike socket of another.
• Allow for much freedom of motion.
• Shoulder and hip joints.

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The Knee

• Largest and most complex diarthrosis in the body.
• Primarily a hinge joint, but when the knee is
  flexed, it is also capable of slight rotation and
  lateral gliding.
• Actually consists of 3 joints
• Patellofemoral joint
• Medial and lateral tibiofemoral joints
• The joint cavity is only partially enclosed by a
  capsule on the medial, lateral, and posterior
  sides.

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The Knee

• The lateral and medial condyles of the femur
  articulate with the lateral and medial condyles
  of the tibia.
• Between these structures, we have the lateral and
  medial menisci.
• Anteriorly, the patellar ligament binds the tibia
  to the inferior portion of the patella. The
  superior portion of the patella is then connected
  to the quadriceps femoris muscle

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The Knee

• At least a dozen bursae are associated with the
  knee.
• Multiple ligaments are present.
• The fibular collateral ligament extends from the
  lateral epicondyle of the femur to the head of
  the fibula.
• The tibial collateral ligament connects medial
  epicondyle of the femur to the medial condyle of
  the tibial shaft and is also fused to the medial
  meniscus.
• Both of these ligaments prevent excessive rotation

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The Knee

• The anterior and posterior cruciate ligaments are
  also very important.
• ACL connects the anterior intercondylar area of
  the tibia to the medial side of the lateral
  femoral condyle.
• Prevents forward sliding of the tibia and
  hyperextension of the knee.
• PCL connects the posterior intercondylar area of
  the tibia to the lateral side of the medial
  femoral condyle.
• Prevents backward displacement of the tibia or
  forward sliding of the femur.

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Clinical Conditions

• Arthritis describes about 100 different types of
  inflammatory or degenerative joint diseases.
• Osteoarthritis
• Most common arthritis.
• Normal joint use prompts the release of
  cartilage-damaging enzymes. If cartilage
  destruction exceeds cartilage replacement, were
  left with roughened, cracked, eroded cartilages.

• Eventually bone tissue thickens and forms spurs
  that can restrict movement.
• Most common in C and L spine, fingers, knuckles,
  knees, and hips.

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Clinical Conditions

• Rheumatoid arthritis
• Chronic inflammatory disorder
• Marked by flare-ups
• Autoimmune disease.
• Body creates antibodies which attack the joint
  surfaces
• The synovial membrane can inflame and eventually
  thicken into a pannus an abnormal tissue that
  clings to the articular cartilage.
• The pannus erodes the cartilage and eventually
  scar tissue forms and connects the 2 bone ends.
  This scar tissue can later ossify, fusing the
  bones together. This is known as ankylosis.

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Clinical Conditions

• Gouty arthritis
• When nucleic acids are metabolized uric acid is
  produced. Normally uric acid is excreted in the
  urine.
• If blood uric acid rises due to decreased
  excretion or increased production, it may begin
  to form needle-shaped crystals in the soft
  tissues of joints.
• Inflammation ensues causing painful arthritis.

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Gout Risk Factors
Risk factors for developing gout include obesity,
excessive weight gain, especially in youth,
moderate to heavy alcohol intake, high blood
pressure, and abnormal kidney function. Certain
drugs, such as thiazide diuretics
(hydrochlorothiazide Dyazide), low-dose
aspirin, niacin, cyclosporine, tuberculosis
medications (pyrazinamide and ethambutol), and
others can also cause elevated uric-acid levels
in the blood and lead to gout. Furthermore,
certain diseases lead to excessive production of
uric acid in the body. Examples of these diseases
include leukemias, lymphomas, and hemoglobin
disorders.
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Bursitis
Bursitis is the painful inflammation or
irritation of the bursa. The bursa is a soft,
fluid-filled sac that covers and cushions the
movement between the bones, tendons and muscles
near the joints.
Bursitis usually occurs under the shoulder
muscles, at the elbows (called epitrochlear
bursitis or "tennis elbow"), the hip sockets
(called trochanteric bursitis), heel bones
(called retrocalcaneal bursitis) or the kneecaps
(called infrapatellar bursitis or "housemaid's
knee"). It can also occur in the buttocks (called
ischiogluteal bursitis) or the thigh (called
trochanteric bursitis).
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Buristis

• http//www.livestrong.com/video/1662-bursitis-heal
  th-byte/

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Causes of Bursitis
Most commonly, bursitis is caused by trauma,
infection, and crystal deposits. Some specific
factors include Overuse or injury to the joint
areas from playing or working Incorrect posture
at work or rest, or poor conditioning before
exercise or playing sports An abnormal or
poorly positioned joint or bone (such as leg
length differences or arthritis in a particular
joint) that stresses soft tissue structures.
Sometimes in association with other diseases or
conditions, such as rheumatoid arthritis, gout,
tuberculosis or psoriatic arthritis
Staphylococcal or other (bacterial) infection
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Symptoms of Bursitis
Symptoms of bursitis may include Pain that
increases with movement of joint Tenderness of
joint Limited movement in the affected areas
Swelling and redness in affected areas
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Treatments of Bursitis
Treatment for bursitis includes applying the
R.I.C.E therapy, protecting the area, and
anti-inflammatory drugs.
It can help to protect bursae close to the skin,
such as the ankles and knees, with padding.
Additionally, deep-heat therapy (diathermy) can
also relieve the discomfort and inflammation of
bursitis. Anti-inflammatory medications, such
as aspirin or over-the-counter nonsteroidal drugs
(NSAIDs), such as ibuprofen, naproxen, or
indomethacin can often be helpful. If the cause
of the bursitis is bacterial, antibiotics will be
administered. If the inflammation does not
respond to the R.I.C.E. therapy and medications,
surgical drainage (aspiration) of fluid from the
bursa and the injection of corticosteroids into
the bursa is an alternative treatment. Surgical
removal of the bursa is a possibility for chronic
bursitis. With adherence to treatment, bursitis
usually subside in seven to 14 days.