Joints - Dr. Jerry Cronindrjerrycronin.weebly.com › uploads › 5 › 9 › 7 › 4 › 5974564 › ch_08_lec… · •Consists of three joints surrounded by single cavity 1. Femoropatellar

PowerPoint® Lecture Slides

prepared by

Karen Dunbar Kareiva

Ivy Tech Community College© Annie Leibovitz/Contact Press Images

Chapter 8 Part B

Joints

© 2017 Pearson Education, Inc.

8.5 Selected Synovial Joints

• Synovial joints are diverse

• All have general features, but some also have

unique structural features, abilities, and

weaknesses

• Five main synovial joints

– Knee

– Shoulder

– Elbow

– Hip

– Jaw


Knee Joint

• Largest, most complex joint of body

• Consists of three joints surrounded by single cavity

1. Femoropatellar joint

• Plane joint

• Allows gliding motion during knee flexion

2. Lateral joint and 3. Medial joint

• Lateral and medial joints together are called

tibiofemoral joint

• Joint between femoral condyles and lateral and

medial menisci of tibia

• Hinge joint that allows flexion, extension, and some

rotation when knee partly flexed© 2017 Pearson Education, Inc.

Figure 8.7a The knee joint.

Femur

Articularcapsule

Posterior

cruciate

ligament

Lateral meniscus

Anterior

cruciate

ligament

Tibia

Tendon ofquadricepsfemoris

Suprapatellarbursa

Patella

Subcutaneous

prepatellar bursa

Synovial cavity

Lateral meniscus

Infrapatellar fat pad

Deep infrapatellarbursa

Patellar ligament

Sagittal section through the right knee joint


Figure 8.7b The knee joint.

Anterior

Anterior

cruciate

ligament

Articularcartilageon medialtibialcondyle

Medial

meniscus

Posterior

cruciate ligament

Superior view of the right tibia in the knee joint,

showing the menisci and cruciate ligaments

Articularcartilage onlateral tibialcondyle

Lateral

meniscus


A&P Flix™: Knee


Knee Joint (cont.)

• Joint capsule is thin and absent anteriorly

• Anteriorly, quadriceps tendon gives rise to three

broad ligaments that run from patella to tibia

– Medial and lateral patellar retinacula that flank

the patellar ligament

• Doctors tap patellar ligament to test knee-jerk reflex

• At least 12 bursae associated with knee joint


Figure 8.7c The knee joint.

Quadricepsfemoris muscle

Tendon ofquadricepsfemoris muscle

Patella

Lateral

patellar

retinaculum

Fibular

collateral

ligament

Fibula

Medial patellar

retinaculum

Tibial collateral

ligament

Patellar

ligament

Tibia

Anterior view of right knee


Knee Joint (cont.)

• Capsular, extracapsular, or intracapsular

ligaments act to stabilize knee joint

• Capsular and extracapsular ligaments help

prevent hyperextension of knee

– Fibular and tibial collateral ligaments: prevent

rotation when knee is extended

– Oblique popliteal ligament: stabilizes posterior

knee joint

– Arcuate popliteal ligament: reinforces joint

capsule posteriorly


Figure 8.7d The knee joint.

Tendon ofadductormagnus

Medial head ofgastrocnemiusmuscle

Popliteusmuscle (cut)

Tibial

collateral

ligament

Tendon ofsemimembranosusmuscle

Femur

Articular capsule

Oblique popliteal

ligament

Lateral head ofgastrocnemiusmuscle

Bursa

Fibular collateral

ligament

Arcuate popliteal

ligament

Tibia

Posterior view of the joint capsule, including ligaments


Knee Joint (cont.)

• Intracapsular ligaments reside within capsule,

but outside synovial cavity

• Help to prevent anterior-posterior displacement

– Anterior cruciate ligament (ACL)

• Attaches to anterior tibia

• Prevents forward sliding of tibia and stops

hyperextension of knee

– Posterior cruciate ligament

• Attaches to posterior tibia

• Prevents backward sliding of tibia and forward sliding

of femur


Figure 8.7e The knee joint.

Posterior

cruciate

ligament

Fibular

collateral

ligament

Medial

condyle

Tibial

collateral

ligament

Anterior

cruciate

ligament

Medialmeniscus

Patellarligament

Patella

Quadricepstendon

Lateralcondyleof femur

Lateralmeniscus

Tibia

Fibula

Anterior view of flexed knee, showing the

cruciate ligaments (articular capsule

removed, and quadriceps tendon cut and

reflected distally)


Animation: Rotating Knee


Figure 8.7f The knee joint.

Medial femoral

condyle

Anterior cruciate

ligament

Medial meniscus

on medial tibial

condyle

Patella

Photograph of an opened knee joint;

view similar to (e)


Clinical – Homeostatic Imbalance 8.1

• Knee absorbs great amount of vertical force;

however, it is vulnerable to horizontal blows

– Common knee injuries involved the 3 C’s:

• Collateral ligaments

• Cruciate ligaments

• Cartilages (menisci)

– Lateral blows to extended knee can result in

tears in tibial collateral ligament, medial

meniscus, and anterior cruciate ligament

– Injuries affecting just ACL are common in

runners who change direction, twisting ACL

– Surgery usually needed for repairs© 2017 Pearson Education, Inc.

Figure 8.8 The “unhappy triad:” ruptured ACL, ruptured tibial collateral ligament, and torn meniscus.

Lateral

Hockey puckPatella

(outline)

Medial

Tibial

collateral

ligament

(torn)

Medial

meniscus

(torn)

Anterior

cruciate

ligament

(torn)


Shoulder (Glenohumeral) Joint

• Most freely moving joint in body

• Stability is sacrificed for freedom of movement

• Ball-and-socket joint

– Large, hemispherical head of humerus fits in

small, shallow glenoid cavity of scapula

• Like a golf ball on a tee

• Articular capsule enclosing cavity is also thin

and loose

– Contributes to freedom of movement


Figure 8.9a The shoulder joint.

Acromion of scapula

Coracoacromial ligament

Subacromial bursa

Fibrous layer ofarticular capsule

Tendon sheath

Tendon of long headof biceps brachii muscle

Synovial cavity ofthe glenoid cavitycontaining synovialfluid

Articular cartilage

Synovial membrane


Humerus

Frontal section through right shoulder joint


Animation: Rotating Shoulder Joint


Figure 8.9b The shoulder joint.

Synovial cavityof the glenoidcavity containingsynovial fluid

Articular cartilage


Humerus

Cadaver photo corresponding to (a)


Shoulder (Glenohumeral) Joint (cont.)

• Glenoid labrum: fibrocartilaginous rim around

glenoid cavity

– Helps to add depth to shallow cavity

– Cavity still only holds one-third of head of

humerus

• Reinforcing ligaments

– Primarily on anterior aspect

– Coracohumeral ligament

• Helps support weight of upper limb

– Three glenohumeral ligaments

• Strengthen anterior capsule, but are weak support© 2017 Pearson Education, Inc.

Figure 8.9c The shoulder joint.

Acromion


Subacromial bursa

Coracohumeral

ligament

Transverse humeralligament

Tendon sheath

Tendon of long headof biceps brachiimuscle

Coracoid process

Articular capsulereinforced byglenohumeral

ligaments

Subscapularbursa

Tendon of thesubscapularismuscle

Scapula

Anterior view of right shoulder joint capsule


Figure 8.9d The shoulder joint.

Acromion

Coracoid process

Articular capsule

Glenoid cavity

Glenoid labrum


Glenohumeral ligaments

Tendon of thesubscapularis muscle

ScapulaPosterior Anterior

Lateral view of socket of right shoulder joint,

humerus removed


Shoulder (Glenohumeral) Joint (cont.)

• Reinforcing muscle tendons contribute most to

joint stability

– Tendon of long head of biceps brachii muscle is

“superstabilizer”• Travels through intertubercular sulcus

• Secures humerus to glenoid cavity

– Four rotator cuff tendons encircle the shoulder

joint

• Subscapularis

• Supraspinatus

• Infraspinatus

• Teres minor© 2017 Pearson Education, Inc.

A&P Flix™: Rotator Cuff Muscles:

Overview (a)


A&P Flix™: Rotator Cuff Muscles:

Overview (b)


Figure 8.9c The shoulder joint.

Acromion


Subacromial bursa

Coracohumeral

ligament

Transverse humeralligament

Tendon sheath

Tendon of long headof biceps brachiimuscle

Coracoid process

Articular capsulereinforced byglenohumeral

ligaments

Subscapularbursa

Tendon of thesubscapularismuscle

Scapula

Anterior view of right shoulder joint capsule


Figure 8.9d The shoulder joint.

Acromion

Coracoid process

Articular capsule

Glenoid cavity

Glenoid labrum


Glenohumeral ligaments

Tendon of thesubscapularis muscle

ScapulaPosterior Anterior

Lateral view of socket of right shoulder joint,

humerus removed


Figure 8.9e The shoulder joint.

Acromion (cut)

Glenoid cavity

of scapula

Glenoid labrum

Rotator cuffmuscles(cut)

Capsule ofshoulder joint(opened)

Head of humerus

Posterior view of an opened right shoulder joint


A&P Flix™: Movement at Glenohumeral Joint:

An Overview


A&P Flix™: Movement at Glenohumeral

Joint (a)


A&P Flix™: Movement at Glenohumeral

Joint (b)


Elbow Joint

• Humerus articulates with radius and ulna

• Hinge joint formed primarily from trochlear notch

of ulna articulating with trochlea of humerus

– Allows for flexion and extension only

• Anular ligament surrounds head of radius

• Two capsular ligaments restrict side-to-side

movement

– Ulnar collateral ligament

– Radial collateral ligament


A&P Flix™: Movement of Elbow Joint (b)


Figure 8.10a The elbow joint.

Articularcapsule

Synovialmembrane

Humerus

Fat pad

Tendon oftriceps muscle

Bursa

Trochlea

Articular cartilageof the trochlearnotch

Median sagittal section through right elbow

(lateral view)

Synovial cavity

Articular cartilage

Coronoid process

Tendon ofbrachialis muscle

Ulna


Figure 8.10b The elbow joint.

Humerus

Anular

ligament

Lateralepicondyle

Articularcapsule

Radial

collateral

ligament

Olecranon

Ulna

Lateral view of right elbow joint

Radius


Figure 8.10c The elbow joint.

Humerus

Anular

ligament

Medialepicondyle

Radius

Articularcapsule

Coronoidprocessof ulna

Ulna

Ulnar

collateral

ligament

Cadaver photo of medial view of right elbow


Animation: Rotating Elbow


Figure 8.10d The elbow joint.

Articularcapsule

Anular

ligament

Coronoidprocess

Medialepicondyle

Ulnar

collateral

ligament

Humerus

Radius

Ulna

Medial view of right elbow


A&P Flix™: The Elbow Joint and Forearm:

An Overview


Hip (Coxal) Joint

• Ball-and-socket joint

• Large, spherical head of the femur articulates

with deep cup-shaped acetabulum

• Good range of motion, but limited by the deep

socket

– Acetabular labrum: rim of fibrocartilage that

enhances depth of socket (hip dislocations are

rare)


Figure 8.11a The hip joint.

Articular

cartilage

Acetabular

labrum

Femur

Hip (coxal) bone

Ligament of the

head of the femur

(ligamentum teres)

Synovial cavity

Articular capsule

Frontal section through the right hip joint


A&P Flix™: Movement at Hip Joint: Overview


Figure 8.11b The hip joint.

Acetabular

labrum

Synovial

membrane

Ligament of the

head of the femur

(ligamentum teres)

Head of femur

Articular capsule

(cut)

Photo of the interior of the hip joint, lateral view


Hip (Coxal) Joint (cont.)

• Reinforcing ligaments include:

– Iliofemoral ligament

– Pubofemoral ligament

– Ischiofemoral ligament

– Ligament of head of femur (ligamentum teres)

• Slack during most hip movements, so not important in

stabilizing

• Does contain artery that supplies head of femur

• Greatest stability comes from deep ball-and-

socket joint


Figure 8.11c The hip joint.

Ischium

Iliofemoral

ligament

Ischiofemoral

ligament

Greater

trochanter

of femur

Posterior view of right hip joint,

capsule in place


Figure 8.11d The hip joint.

Anterior

inferior iliac

spine

Greater

trochanter

Iliofemoral

ligament

Pubofemoral

ligament

Anterior view of right hip joint, capsule in place


Animation: Rotatable Hip


Temporomandibular Joint (TMJ)

• Jaw joint is a modified hinge joint

• Mandibular condyle articulates with temporal

bone

– Posterior temporal bone forms mandibular

fossa, while anterior portion forms articular

tubercle

• Articular capsule thickens into strong lateral

ligament


Temporomandibular Joint (TMJ) (cont.)

• Two types of movement

– Hinge: depression and elevation of mandible

– Gliding: side-to-side (lateral excursion) grinding

of teeth

• Most easily dislocated joint in the body


Figure 8.12a The temporomandibular (jaw) joint.

Mandibular fossaArticular tubercleZygomatic process

Infratemporal fossa

Externalacousticmeatus

Articularcapsule

Ramus ofmandible

Lateralligament

Location of the joint in the skull


Figure 8.12b The temporomandibular (jaw) joint.

Articular disc

Mandibularfossa

Articular tubercle

Superior jointcavity

Articularcapsule

Synovialmembranes

Condylarprocess ofmandible

Ramus ofmandible

Inferior jointcavity

Enlargement of a sagittal section through the joint


Figure 8.12c The temporomandibular (jaw) joint.

Superior view

Outline ofthe mandibularfossa

Lateral excursion: lateral (side-to-side) movements of the mandible



• Dislocation of TMJ is most common because of

shallow socket of joint

• Almost always dislocates anteriorly, causing

mouth to remain open

– To realign, physician must push mandible back

into place



• Symptoms: ear and face pain, tender muscles,

popping sounds when opening mouth, joint

stiffness

• Usually caused by grinding teeth, but can also

be due to jaw trauma or poor occlusion of teeth

– Treatment for grinding teeth includes bite plate

– Relaxing jaw muscles helps


8.6 Disorders of Joints

Common Joint Injuries

• Cartilage tears

– Due to compression and shear stress

– Fragments may cause joint to lock or bind

– Cartilage rarely repairs itself

– Repaired with arthroscopic surgery

– Partial menisci removal renders joint less stable but

mobile; complete removal leads to osteoarthritis

– Meniscal transplant possible in younger patients

– Perhaps meniscus grown from own stem cells in

future


Figure 8.13 Arthroscopic photograph of a torn medial meniscus.

Femur

Meniscus

Tear inmeniscus

Tibia


Common Joint Injuries (cont.)

• Sprains

– Reinforcing ligaments are stretched or torn

– Common sites are ankle, knee, and lumbar

region of back

– Partial tears repair very slowly because of poor

vascularization

– Three options if torn completely

• Ends of ligaments can be sewn together

• Replaced with grafts

• Just allow time and immobilization for healing


Common Joint Injuries (cont.)

• Dislocations (luxations)

– Bones forced out of alignment

– Accompanied by sprains, inflammation, and

difficulty moving joint

– Caused by serious falls or contact sports

– Must be reduced to treat

• Subluxation: partial dislocation of a joint


Inflammatory and Degenerative Conditions

• Bursitis

– Inflammation of bursa, usually caused by blow or

friction

– Treated with rest and ice and, if severe, anti-

inflammatory drugs

• Tendonitis

– Inflammation of tendon sheaths, typically caused

by overuse

– Symptoms and treatment similar to those of

bursitis



(cont.)

• Arthritis

– >100 different types of inflammatory or

degenerative diseases that damage joints

– Most widespread crippling disease in the U.S.

– Symptoms: pain, stiffness, and swelling of joint

– Acute forms: caused by bacteria, treated with

antibiotics

– Chronic forms: osteoarthritis, rheumatoid

arthritis, and gouty arthritis



(cont.)

• Osteoarthritis (OA)

– Most common type of arthritis

– Irreversible, degenerative (“wear-and-tear”)

arthritis

– May reflect excessive release of enzymes that

break down articular cartilage

• Cartilage is broken down faster than it is replaced

• Bone spurs (osteophytes) may form from thickened

ends of bones

– By age 85, half of Americans develop OA, more

women than men



(cont.)

• Osteoarthritis (OA) (cont.)

– OA is usually part of normal aging process

– Joints may be stiff and make crunching noise

referred to as crepitus, especially upon rising

– Treatment: moderate activity, mild pain relievers,

capsaicin creams

• Glucosamine, chondroitin sulfate, and nutritional

supplements not effective



(cont.)

• Rheumatoid arthritis (RA)

– Chronic, inflammatory, autoimmune disease of

unknown cause

• Immune system attacks own cells

– Usually arises between ages 40 and 50, but may

occur at any age; affects three times as many

women as men

– Signs and symptoms include joint pain and

swelling (usually bilateral), anemia, osteoporosis,

muscle weakness, and cardiovascular problems



(cont.)

• Rheumatoid arthritis (RA) (cont.)

– RA begins with inflammation of synovial

membrane (synovitis) of affected joint

– Inflammatory blood cells migrate to joint, release

inflammatory chemicals that destroy tissues

– Synovial fluid accumulates, causing joint swelling

– Inflamed synovial membrane thickens into

abnormal pannus tissue that clings to articular

cartilage

– Pannus erodes cartilage, scar tissue forms and

connects articulating bone ends (ankylosis)



(cont.)

• Rheumatoid arthritis (RA) (cont.)

– Treatment includes steroidal and nonsteroidal

anti-inflammatory drugs to decrease pain and

inflammation

– Disruption of destruction of joints by immune

system

• Immune suppressants slow autoimmune reaction

• Some agents target tumor necrosis factor to block

action of inflammatory chemicals

– Can replace joint with prosthesis


Figure 8.14 A hand deformed by rheumatoid arthritis.



(cont.)

• Gouty arthritis

– Deposition of uric acid crystals in joints and soft

tissues, followed by inflammation

– More common in men

– Typically affects joint at base of great toe

– In untreated gouty arthritis, bone ends fuse and

immobilize joint

– Treatment: drugs, plenty of water, avoidance of

alcohol and foods high in purines, such as liver,

kidneys, and sardines



(cont.)

• Lyme disease

– Caused by bacteria transmitted by tick bites

– Symptoms: skin rash, flu-like symptoms, and

foggy thinking

– May lead to joint pain and arthritis

– Treatment

• Long course of antibiotics


Documents

Joints - Dr. Jerry Cronindrjerrycronin.weebly.com › uploads › 5 › 9 › 7 › 4 › 5974564 › ch_08_lec… · •Consists of three joints surrounded by single cavity 1. Femoropatellar