Articulations

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Articulations

• Articulation joint point of contact between
  bones

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Joint Classification
Functional Name Structural Name Movement Example Description
Synarthroses Fibrous Immovable Syndesmoses ligaments
Sutures skull
Gomphoses Teeth to jaw
Amphiarthroses Cartilaginous (hyaline, fibrocartilage) Slightly movable Synchondrosis Ribs, epiphyseal plate
Symphyses Pubis, vertebral discs
Diarthroses Synovial Freely movable Uniaxial Hinge, pivot
Biaxial Saddle, ellipsoidal
Multiaxial Ball and socket, gliding
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SynarthrosesFibrous Joints
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AmphiarthosesCartilaginous
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DiarthrosesSynovial

• Most numerous
• Most complex
• Structures
• joint capsule
• sleevelike encasing around bone ends to bind them
  together
• synovial membrane
• membrane lining capsule to secrete synovial fluid
• bursae
• cushions joints and helps tendons move
• joint cavity
• small space between bones
• articular cartilage
• hyaline cartilage covering bone ends
• menisci
• pads of fibrocartilage between bones
• Ligaments
• strong, dense, white fibrous tissue that hold
  bones firmly together

bursae
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Knee Joint
(Hyaline cartilage)
(fibrocartilage)
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Ankle Joint
Anterior interior tibiofibular ligament
Achilles tendon (cut)
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Types of Joints
ellipsoidal
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Uniaxial Joints permits movement around one axis
and one plane

• projection of one bone articulating with a
  ring/notch of another bone
• examples - between vertebrate

• allows only flexion and extension
• examples elbow, knee
• knee joint
• largest joint, most complex, most frequently
  injured

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Biaxial Jointspermits movement around two
perpendicular axes and planes

• Example
• thumb
• only saddle joint in the body

• condyle fits into an elliptical socket
• Example
• between radius and carpals

ellipsoidal
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Multiaxial Joints permits movement around three
or more axes and planes

• most moveable joints
• ball shaped head fits into concave depression
• example - shoulder, hip
• humeroscapular joint
• most mobile joint
• sacroiliac joint
• hip joint

• relatively flat articulating surface that allows
  gliding movement
• example
• between carpals
• between tarsals
• between vertebrate

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Multiaxial Ball and socket
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Multiaxial Ball and socket
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Multiaxial Gliding
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Uniaxial Hinge
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ROM(Range of Motion)

• Goniometer
• Used to determine extent of injury and progress
  of rehabilitation
• measures range of motion (degree of angle)

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Angular ROM

• flexion decreases angle, movement towards body
• extension increase angle, movement away from
  body
• hyperextension stretching or extending beyond
  anatomical position
• plantar flexion increase angle between top of
  foot and front of leg (point down)
• dorsiflexion decrease angle between top of foot
  and front of leg (point up)
• ABduction move AWAY from medial plane
• ADduction move TOWARDS medial plane

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Circular ROM

• rotation pivoting a bone on its axis
• circumduction distal end of a body part moves
  in a circle
• supination hand palm side up
• pronation hand palm side down

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Special Movements

• inversion turn sole inward
• eversion turn sole outward
• protraction move part forward
• retraction move part backward
• elevation move part up
• depression move part down

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Joint Disorders

• Inflammatory (IJD)
• Rheumatoid arthritis
• Gouty Arthritis
• Noninflammatory (NIJD)
• Osteoarthritis
• Tramatic Injuries
• Dislocation
• Meniscus tear
• Sprain
• Ligament tear
• Herniated disc

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Joint Disorders

• Rheumatoid arthritis
• Chronic and systemic
• Inflammation of synovial membrane
• Cartilage destroyed, bone erosion
• Progressive crippling and deformity
• Pain, inflammation, decreased mobility, aching,
  stiffness
• Treat with corticosteroid drugs and NSAIDS

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Joint Disorders

• Gouty arthritis
• Also referred to as just Gout
• Excessive uric acid in blood
• Crystals get deposited in synovial fluid
• Chronic inflammation and tissue damage
• Swelling, tenderness
• Pin in wrists, fingers, ankles, knees, elbows
• Treat with Allopurinol (inhibits uric acid
  synthesis) and Uloric (new med)

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Joint Disorders
NIJDC
Osteoarthritis
IJD
IJD
Gout
Rheumatoid arthritis
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Joint Disorders

• Osteoarthritis
• Most common NIJD
• Wear and tear deterioration
• Atrophy of articular cartilage
• Formation of new bone at joint surface
• Most common in weight-bearing joints
• Stiffness, pain, limited movement
• Treat symptoms with NSAIDS

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Joint Disorders

• Dislocation
• Articular surfaces not in proper contact
• Tear vessels, nerves, ligaments, muscles
• Pain and swelling
• Treat with realignment (reduction)
• sometimes surgery

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Joint Disorders

• Sprain
• Stretching of ligaments surrounding joint
• Due to twisting motion
• Hematoma, limited motion
• Treatment R.I.C.E.
• Rest
• Ice
• compression
• elevation

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Degree of Sprains

•  1st degree ankle sprain 
• Some stretching or perhaps tearing may have
  occurred
• No loss of function
• Mild pain, little bruising
• Little or no swelling
• Some joint stiffness or difficulty walking
• 2nd degree ankle sprain
• Difficulty walking
• Moderate to severe pain
• Swelling and tenderness in the ankle joint
• Bruising may start after 3 to 4 days
• 3rd degree ankle sprain
• most serious
• Total rupture of a ligament
• Walking may not be possible
• Severe pain initially and substantial swelling
• May require surgery

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Joint Disorders

• Ligament Tears (3rd degree Sprain)
• Bruising, pain, swelling, instability
• Physical therapy
• Partial tear vs. complete tear
• Partial Tear boot/brace, crutches
• Complete Tear - Surgery after most swelling
  subsides

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Joint Disorders - Knee

• Meniscus Tear
• One of most common athletic injuries
• Swelling, pain, instability, limited motion
• Treat with arthroscopic surgery

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Meniscus
Normal
Tear of medial meniscus
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Joint Disorders - Knee

• ACL tear
• Women more likely than men
• Will hear a popping sound
• Usually due to twisting motion
• Get hit very hard on the side of your knee, such
  as during a football tackle
• Overextend the knee joint
• Quickly stop moving and change direction while
  running, landing from a jump, or turning
• Repair by grafting (not sew back together)
• Patellar tendon autograft (autograft comes from
  the patient)
• Hamstring tendon autograft
• Quadriceps tendon autograft
• Allograft (taken from a cadaver) patellar tendon,
  Achilles tendon, semitendinosus, gracilis, or
  posterior tibialis tendon

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ACL, MCL, PCL tears
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Arthroscopic surgery

• 3-4 very small incisions ¼ in.
• fiber-optic light source
• video camera
• terile saline solution is continuously pumped
  through the knee via a cannula

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Vertebral Disc Disorders
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Herniated disc Treatment

• Steroid epidural
• Use long needle to inject steroid into epidural
  space in order to shrink the herniation
  (cartilage)
• Surgery
• Microdiscectomy
• Fusion

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Steroid Epidural
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Knee Arthroscopic Surgery

• http//www.youtube.com/watch?vnAj2_pgTkEA
• http//www.youtube.com/watch?vkpW2MOOI5yw
• Knee Replacement
• http//www.youtube.com/watch?vH3xkj_1dZQ0

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Hip Replacement

• http//www.youtube.com/watch?vDosqbEy8ecY
• http//www.webmd.com/pain-management/video/hip-res
  toration
• http//www.youtube.com/watch?vlh2UX8gQnBM
• http//www.youtube.com/watch?vvJL8n_82ITM

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• Ankle Arthroscopy
• http//www.youtube.com/watch?vA22lTyPnguY
• Herniated disc epidural
• http//www.youtube.com/watch?v97m4VICMJoU
• Herniated disc microdisectomy
• http//www.youtube.com/watch?vrU8YYESYXzcfeature
  related
• Spinal Fusion
• https//www.youtube.com/watch?vHXtKKB6zEhM
• https//www.youtube.com/watch?vOkiHb-ECBVA

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