Transcript Chapter 9-articulationsx

Chapter 9
Articulations
Part 1, 9.1-9.4
1
What are articulations?
• Any place of contact between bones
• Place of articulation is called a joint
– arthrology = study of joints (arthro = joint)
2
Fig. 9.1
• The tradeoff
– stability vs mobility
Mobility
Most mobile
Glenohumeral
Hip joint
joint
(shoulder)
Very unstable
Immobile
Elbow joint
Intervertebral
joints
Suture
Stability
Most stable
Joint classifications — Structural
• Fibrous
– bones held together by dense regular connective tissue
• Cartilaginous
– bones joined by cartilage
• Synovial
– has fluid-filled cavity
– fluid separates cartilage-covered bone surfaces
– bone surfaces enclosed in cavity, joined by ligaments
4
Joint classifications — Functional
• Synarthrosis
– immobile
• Amphiarthrosis
– slightly mobile
• Diarthrosis
– freely mobile
5
Types of Fibrous Joints
(9.2a) Gomphosis
Root of tooth
Gomphosis
• “peg in a socket”
• In human body, only gomphoses (pl.) are
roots of teeth with mandible and maxillae
• tooth held by periodontal membrane
• Functional classification: synarthrosis
Periodontal
membranes
Alveolar
process of
mandible
6
Types of Fibrous Joints
Suture
• Only in skull
• Distinct, interlocking, irregular edges
– increase strength and decrease fractures
Suture
• Permit growth of skull during childhood
• Become ossified in adulthood
• When completely fused, called synostoses (pl.)
7
Types of Fibrous Joints
Ulna
Radius
Syndesmosis
(interosseous
membrane)
Syndesmoses
– syndesmos = fastening
– syn = with; desmos = band, ligament
– Bones joined by long strands of dense regular
connective tissue only
• interosseous membrane
– Ex. radius and ulna, tibia and fibula
– Functional classification: amphiarthroses
Types of Cartilaginous Joints
Synchondrosis
• syn = with
• chondro = cartilage
• Bones joined by hyaline
cartilage
• Functional classification:
synarthroses
Epiphyseal plate
Costochondral
joints
Joint between
first rib and
sternum
(9.3a Synchondroses)
NOT these joints
9
Types of Cartilaginous Joints
Symphysis
Intervertebral joint Intervertebral disc
• Bones joined by pad of fibrocartilage
• Resists compression and stress
• Functional classification:
amphiarthroses
Pubic symphysis
Body of vertebra
(9.3b Symphyses)
Synovial Joints
Periosteum
Yellow bone marrow
Basic features
• articular capsule
– two layers thick
• joint cavity with synovial fluid
– synovial fluid secreted by
synovial membrane
Articular cartilage
Fibrous layer
Synovial
membrane
Articular
capsule
Joint cavity
(containing synovial
fluid)
Ligament
9.4 Typical synovial joint
Synovial Joints
Periosteum
Basic features
• articular cartilage
• ligaments
• nerves and blood vessels (not
shown)
• Functional classification:
diarthrosis
Ligament
Yellow bone marrow
Fibrous layer
Synovial
membrane
Articular
capsule
Joint cavity
(containing synovial
fluid)
Articular cartilage
9.4 Typical synovial joint
Ligaments
• Dense regular connective tissue
• Connect bone to bone
• Two types:
– Extrinsic ligaments are outside
the articular capsule
– Intrinsic ligaments are
thickening of articular capsule
itself
• include extracapsular
ligaments and intracapsular
ligaments
13
Accessory structures
• Bursa
– fibrous, saclike structure filled
with synovial fluid
– may be connected to or outside
joint cavity
– alleviate friction
– tendon sheath is an elongated
bursal wrapped around a
tendon
14
Tendon sheath
(opened)
Fig. 9.5
(b) Tendon sheaths
of wrist and hand,
anterior view
Tendon of flexor
digitorum profundus
Tendon of flexor
digitorum
superficialis
Digital tendon
sheaths
Tendon sheath around
flexor pollicis longus
tendon
Tendon of flexor carpi radialis
Tendon of flexor pollicis longus
Common flexor
tendon sheath
Tendons of flexor
digitorum superficialis
and flexor digitorum
profundus
Fig. 9.5
Femur
Bursa deep to gastrocnemius
muscle
Articular capsule
Articular cartilage
Meniscus
Joint cavity filled
with synovial fluid
Suprapatellar bursa
Synovial membrane
Patella
Prepatellar bursa
Fat pad
Infrapatellar bursae
Patellar ligament
Tibia
(a) Bursae of the knee joint, sagittal section
Hinge joint (uniaxial)
Fig. 9.6
Synovial Joints
Humerus
Radius
Ulna
• Hinge Joint
– Convex surface of one
bone fits in concave surface
of another
– Moves along one axis only
Fig. 9.6
Synovial Joints
Plane joint (uniaxial)
Triquetrum
Hamate bone
• Plane Joint
–
–
–
–
AKA planar or gliding joing
least mobile diarthrosis
only side-to-side movement
between carpals and
between tarsals
Fig. 9.6
Synovial Joints
Trapezium
First metacarpal
bone
Saddle joint
(biaxial)
• Saddle Joint
– surfaces of both bones
have convex and concave
surfaces (like a saddle)
– Enables movement in more
than one direction
Fig. 9.6
Synovial Joints
Metacarpal
bone
Proximal
phalanx
• Condylar Joint
Condylar joint
(biaxial)
– AKA condyloid or ellipsoid joints
– oval, convex surface on one
bone, concave surface on other
– move back and forth and sideto-side
• Pivot Joint
– Turn around an axis
– Protrusion of one bone articulates
with concave surface and ligament of
another
– neck joint; proximal radioulnar joint
Dens of axis
Atlas
Axis
Pivot joint
(uniaxial)
Fig. 9.6
Synovial Joints
Ball-and-socket
joint (multiaxial)
• Ball-and-socket Joint
– multiaxial; most freely mobile
– spherical head of one bone fits into
cuplike socket of another bone
– shoulder and hip joints
Ilium
Head of
femur
Extension
Hyperextension
Hyperextension
Flexion
Extension
Flexion
Flexion
Extension
• Angular motion
– Flexion: decreases angle between bones
– Extension: straightening action, increases
angle
– Hyperextension: extension beyond 180º
• Angular motion
– Lateral Flexion: trunk of
body moves on coronal
plane
Lateral
flexion
• Angular motion
– Adduction: movement of body
part toward central plane
– Abduction: movement of body
part away from central plane
Abduction
Adduction
Abduction
Adduction
Abduction
Adduction
• Angular motion
– Circumduction: circular movement
of distal end of appendage
Circumduction
Circumduction
Lateral rotation
Rotation
Medial rotation
• Rotational motion
– Rotation: Pivoting around a longitudinal axis
– Lateral rotation: turning away from the midsaggital
plane
– Medial rotation: turning toward the midsaggital plane
Lateral
rotation
Medial
rotation
• Depression: Inferior
movement
• Elevation: superior movement
Depression
Elevation
Dorsiflexion
Plantar
flexion
• Dorsiflexion: bending foot up;
talocrural joint bends, raising superior
surface of foot
• Plantar flexion: pointing toes;
extension of foot so toes point inferiorly
• Inversion: sole of foot turns medially
• Eversion: sole of foot turns laterally
Inversion
Eversion
Protraction
Retraction
• Protraction: anteriorly directed movement of body part
• Retraction: posteriorly directed movement of body part
• Opposition: thumb moves across
palm of hand
• Reposition: movement back to
anatomical position
• pronation: rotation of
forearm or foot so that
anatomical position of
palm or sole of foot is
facing posteriorly
• supination: rotation of
forearm or foot so that
anatomical position of
palm or sole of foot is
facing anteriorly
• pronation: rotation of forearm or
foot so that anatomical position of
palm or sole of foot is facing
posteriorly
• supination: rotation of forearm or
foot so that anatomical position of
palm or sole of foot is facing
anteriorly
Fig. 9.12
Temporomandibular joint (TMJ)
• head of mandible with articular tubercle of
temporal bone and mandibular fossa
• only mobile joint in skull
• surrounded by loose articular capsule
Hinge joint
Gliding joint
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Fig. 9.12
Temporomandibular ligament
Articular capsule
External acoustic meatus
Styloid process
Stylomandibular ligament
Sphenomandibular ligament
Coronoid process of mandible
Articular surface
of mandibular fossa
Fig. 9.12
Temporomandibular joint
Articular disc
Articular capsule
Head of mandible
Styloid process
Articular tubercle
Fig. 9.13
Intervertebral articulations
Facet of superior
articular process
• only C1-C2 lacks disc
• disc is anulus fibrosus around nucleus
pulposus
• articulations between
– bodies of vertebrae
– superior and inferior articular processes
• articulations between superior and
inferior articular processes are plane
joints
– prevent gliding movements
– surrounded by articular capsule
Anulus
fibrosus
Nucleus
pulposus
Intervertebral
disc
Inferior articular
process
Superior articular
process
Fig. 9.14
Interclavicular
ligament
Sternoclavicular
Clavicle
ligament
Sternoclavicular
Joint
• saddle joint between
First rib
manubrium and
sternal end of clavicle Costoclavicular
• contains articular disc
• enables elevation,
depression, and
circumduction
Articular disc
Articular capsule
ligament
(a) Anterior view with upper
limbs in anatomic position
Fig. 9.15
Acromioclavicular ligament
Acromion
• Acromioclavicular Joint
– between acromion and acromial
end of clavicle
– has articular disc
– helps provide range of movement
in shoulder
Clavicle
Coracoclavicular ligament
Coracoid process
(a) Right shoulder region, anterior view
Fig. 9.15
Glenohumeral Joint
Acromion
Subacromial bursa
Coracohumeral ligament
Coracoacromial ligament
Coracoid process
Subdeltoid bursa
Glenohumeral ligaments
Tendon sheath
Tendon of long head
of biceps brachii
Humerus
(a) Right shoulder region,
anterior view
Fig. 9.16
Humerus
Elbow Joint
Lateral epicondyle
• humeroulnar joint and
Articular capsule
humeroradial joint
• thick articular capsule Radial collateral ligament
Anular ligament
• many strong ligaments
Medial epicondyle
Ulnar collateral
ligament
Tendon of biceps
brachii (cut)
Radius
Ulna
Flexion
Extension
(a) Right elbow, anterior view
Fig. 9.16
Humerus
Elbow Joint
Lateral epicondyle
• radial collateral ligament
Articular capsule
(aka lateral collateral
ligament) stabilizes Radial collateral ligament
Anular ligament
lateral surface
– extends around head of
radius between anular
ligament and lateral
epicondyle of humerus
Medial epicondyle
Ulnar collateral
ligament
Tendon of biceps
brachii (cut)
Radius
Ulna
(a) Right elbow, anterior view
Fig. 9.16
Humerus
Elbow Joint
• ulnar collateral
ligament (aka medial
collateral ligament)
stabilizes medial
surface
– extends from medial
epicondyle of humerus
to coronoid process of
ulna, posteriorly to
olecranon
Lateral epicondyle
Medial epicondyle
Articular capsule
Radial collateral ligament
Ulnar collateral
ligament
Anular ligament
Tendon of biceps
brachii (cut)
Radius
Ulna
(a) Right elbow, anterior view
Fig. 9.16
Humerus
Elbow Joint
• anular ligament
surrounds neck of
radius, holds radius
in place
Lateral epicondyle
Medial epicondyle
Articular capsule
Radial collateral ligament
Ulnar collateral
ligament
Anular ligament
Tendon of biceps
brachii (cut)
Radius
Ulna
(a) Right elbow, anterior view
Fig. 9.16
Elbow Joint
Anular
ligament
Humerus
Articular
capsule
Tendon of biceps
brachii (cut)
Lateral epicondyle
Radius
Radial collateral ligament
Ulna
(b) Right elbow, lateral view
Fig. 9.16
Elbow Joint
Tendon of
biceps brachii
(cut)
Articular
capsule
Anular
ligament
Radius
Humerus
Medial epicondyle
Ulnar collateral ligament
Ulna
(c) Right elbow, medial view
Fig. 9.16
Elbow Joint
Trochlea
Articular capsule
Humerus
Coronoid process
Radius
Articular cartilage
Ulna
Olecranon
Trochlear notch
(d) Right elbow, medial sagittal section
Dislocated shoulder
Dislocated head
of humerus
Clavicle
“Squared-off”
shoulder
Acromioclavicular
separation
Glenoid
cavity
Displaced head
of humerus
Dislocated glenohumeral joint.
Radiograph of acromioclavicular and
glenohumeral dislocations.
Fig. 9.17
Radiocarpal Joint
• scaphoid, lunate, and triquetrum
Radiocarpal
(carpals) and distal radius, and
joint
articular disc
Radial collateral ligament
• disc separates ulna from
radiocarpal joint
Scaphoid
Intercarpal joints
Distal
radioulnar joint
Articular disc
Ulnar
collateral
ligament
Triquetrum
Carpometacarpal
joint of thumb
Right radiocarpal joint, coronal section
Fig. 9.17
Radiocarpal Joint
• articular capsule covers
Radiocarpal
entire wrist joint
joint
• ligaments support and
Radial collateral ligament
stabilize carpal bone
positions
Scaphoid
• flexion, extension, adduction,
Intercarpal joints
abduction, and circumduction
(not rotation)
Carpometacarpal
• plane joints between carpals
joint of thumb
are intercarpal articulations
Distal
radioulnar joint
Articular disc
Ulnar
collateral
ligament
Triquetrum
Right radiocarpal joint, coronal section
Fig. 9.18
Hip Joint
(c) Right hip, coronal section
Acetabular labrum
Acetabulum
Greater trochanter
• AKA coxal joint
• Acetabular labrum is
fibrocartilage ring around
acetabulum
– strengthens and stabilizes joint
Ischium
(d) Right hip, anterior view,
internal aspect of joint
Acetabular labrum
Fig. 9.18
Hip Joint
(c) Right hip, coronal section
• ligament of head of
femur
– AKA ligamentum teres
– originates along
acetabulum
– attaches to center of head of femur
– contains artery that supplies blood to
head of femur
Ligament of
head of
femur
(d) Right hip, anterior view,
internal aspect of joint
Fig. 9.18
Hip Joint
(c) Right hip, coronal section
• Articular capsule
surrounds joint
– very strong capsule
– extends from acetabulum
to trochanters of femur
Articular
capsule
(d) Right hip, anterior view,
internal aspect of joint
Fig. 9.18
• 3 spiraling ligaments
reinforce capsule
Hip Joint
– iliofemoral ligament
• Y-shaped
• supports anterior capsule
Iliofemoral ligament
– pubofemoral ligament
Greater trochanter
• triangular shape
• from capsule’s inferior region
Pubofemoral ligament
Lesser trochanter
(a) Right hip, anterior view
Fig. 9.18
Hip Joint
Iliofemoral ligament
Ischiofemoral ligament
Greater trochanter
• 3 spiraling ligaments
reinforce capsule
Lesser trochanter
– ischiofemoral ligament
• located posteriorly
• supports posterior capsule
Ischial tuberosity
• Together, ligaments strengthen
joint, especially when extended
(b) Right hip, posterior view
Fig. 9.18
Hip Joint
Iliofemoral ligament
Iliofemoral ligament
Ischiofemoral ligament
Greater trochanter
Greater trochanter
Pubofemoral ligament
Lesser trochanter
Lesser trochanter
Ischial tuberosity
(a) Right hip, anterior view
(b) Right hip, posterior view
Knee Joint
•
•
•
•
•
•
Largest diarthrosis
Most complex diarthrosis
Primarily hinge joint
When flexed, capable of slight rotation and lateral gliding
Very strong, often injured
2 articulations
– Tibiofemoral joint between condyles of femur and condyles of tibia
– Patellofemoral joint between petella nd patellar surface of femur
• Articular capsule encloses the medial, lateral, and posterior regions of joint
Fig. 9.19b
Femur
Lateral
condyle
Fibula
Femur
Articular cartilage
Medial
condyle
Tibia
(d) Right knee, anterior deep view
Medial
condyle
Tibia
Lateral
condyle
Fibula
(e) Right knee, posterior deep view
Fig. 9.19b
Lateral
condyle
Lateral condyle
Medial condyle
Fibular
collateral
ligament
AKA lateral
collateral
ligament
Fibula
Femur
Articular cartilage
Tibia
Tibial collateral
ligament
AKA medial
collateral ligament
(d) Right knee, anterior deep view
Fibular
collateral
ligament
Tibia
Fibula
(e) Right knee, posterior deep view
Fig. 9.19b
Anterior
cruciate
ligament
Fibular
collateral
ligament
Posterior cruciate
ligament
Anterior cruciate
ligament
Fibular
collateral
ligament
Medial meniscus
Lateral
meniscus
Tibial collateral ligament
• Anterior cruciate ligament (ACL) connects posterior femur to anterior tibia
– prevents hyperextension of knee
• Posterior cruciate ligament (PCL) connects anterior femur to posterior tibia
– prevents hyperflexion of knee, posterior displacement of tibia on femur
• Cross in middle of joint, making X shape (hence, “cruciate”)
Posterior
cruciate
ligament
Fig. 9.19b
Femur
Medial condyle
Lateral
meniscus
Lateral
meniscus
Medial meniscus
Tibial collateral ligament
Fibula
Tibia
(d) Right knee, anterior deep view
Tibia
Fibula
(e) Right knee, posterior deep view
• Meniscus is C-shaped pad of fibrocartilage on tibial condyle
– cushion and stabilize joint
– change shape to conform to surface of femur as it moves
Fig. 9.19a
Quadriceps femoris muscle
Flexion
Quadriceps femoris tendon
Extension
(a) Right knee,
anterior
superficial view
Fibular collateral
ligament
Patella within
quadriceps tendon
Fibula
Tibial collateral ligament
Patellar ligament
Tibia
Fig. 9.19a
(b) Right knee,
posterior
superficial
view
Gastrocnemius
muscle heads (cut)
Femur
Articular capsule
Oblique popliteal
ligament
Fibular collateral ligament
Tibial collateral ligament
Arcuate popliteal ligament
Popliteus
muscle (cut)
Fibula
Tibia
Fig. 9.19a
Femur
(c) Right knee, sagittal section
Quadriceps femoris tendon
Suprapatellar bursa
Articular capsule
Menisci
Anterior cruciate
ligament
Patella
Prepatellar bursa
Infrapatellar fat pad
Patellar ligament
Infrapatellar bursae
Tibial tuberosity
Tibia
Page 277
Arthroscopic
view of knee
joint, showing
torn meniscus
“Unhappy triad” of
injuries to the right
knee.
Lateral blow to knee
Torn tibial collateral ligament
Torn anterior
cruciate ligament
Torn medial meniscus
Fig. 9.20
Ankle Joint
• AKA talocrural joint
• Two articulations in
Posterior
one capsule
tibiofibular
Plantar flexion
Dorsiflexion
Fibula
Fibula
Tibia
Anterior tibiofibular
ligament
Talus
Lateral ligament
– distal end of tibia ligament
with talus
Calcaneus
– distal end of fibula
Metatarsal V
and lateral aspect (a) Right foot, lateral view
of talus
– capsule covers distal tibia,
Deltoid ligament
Navicular bone
malleoli, and talus
Tibia
Talus
Lateral
ligament
Calcaneus
Metatarsal V
(b) Right foot, anterolateral view
Tibia
Talus
Deltoid
ligament
Talus
Calcaneus
Calcaneus
Metatarsal I
Tibia
Metatarsal I
(c) Right foot, medial view
Navicular bone
Fig. 9.20
Ankle Joint
• Medial and lateral malleoli prevent side-to-side movement
• deltoid ligament binds tibia to medial foot
– prevents overeversion
Deltoid ligament
Navicular bone
Tibia
Talus
Deltoid
ligament
Talus
Calcaneus
Calcaneus
Metatarsal I
Tibia
Metatarsal I
(c) Right foot, medial view
Navicular bone
Fig. 9.20
• Lateral ligament binds fibula to lateral foot
Ankle Joint
Fibula
– prevents overinversion
– prone to sprains and tears
Tibia
Fibula
Tibia
Talus
Talus
Lateral ligament
Lateral
ligament
Calcaneus
Calcaneus
Metatarsal V
(a) Right foot, lateral view
Metatarsal V
(b) Right foot, anterolateral view
Fig. 9.20
Plantar flexion
Ankle Joint
• Anterior and posterior
tibiofibular ligaments
attach tibia to fibula at
distal end
Dorsiflexion
Fibula
Tibia
Anterior tibiofibular
ligament
Talus
Posterior
tibiofibular
ligament
Lateral ligament
Calcaneus
Metatarsal V
(a) Right foot, lateral view
Fig. 9.21
Right foot, superior view
Foot Joints
• Four synovial joints
• Intertarsal joints
– enable inversion and eversion of foot
I
• Tarsometatarsal joints
– plane articulations
– permit twisting and some side-to-side
movement
III
II
Tarsometatarsal joints
Cuneiform bones
Intertarsal joints
Navicular bone
Talus
Calcaneus
V
IV
Cuboid
bone
Interphalangeal
(IP) joints
Fig. 9.21
Foot Joints
• Metatarsophalangeal (MP) joints
Metatarsophalangeal
(MP) joints
– between metatarsals and phalanges
– condylar joints
– permit adduction and abduction of toes, flexion
and extension
I
II III
IV
V
• Interphalangeal (IP) joints
Cuneiform bones
– between phalanges
– permits flexion and extension only (curling toes)
Navicular bone
Cuboid
bone
Talus
Calcaneus
Right foot, superior vie
Aging of the Joints
• Size, flexibility and shape of joints affected and modified by use
– active joints have larger and thicker capsules
– active joints have larger ligaments and bones
• Age or injury can cause calcification or synostosis of joint
• Arthritis involves damage to articular cartilage
– osteoarthritis (degenerative arthritis) usually results from wear and tear
– exercise compresses articular cartilages, synovial fluid squeezed out and pulled back
in, providing nutrients to joints
– exercise strengthens muscles supporting joints
– extreme exercise may aggravate joint problems, leading to osteoarthritis
Other forms of arthritis
• Gouty arthritis (gout) results from uric acid buildup in blood
– often seen in middle age and older, especially in males
– urate crystals accumulate in blood, synovial fluid, and synovial membranes
– causes joint pain
• Rheumatoid arthritis (RA) is autoimmune disease
– usually develops in young or middle-aged people
– causes pain and swelling of joints, muscle weakness, osteoporosis
– may lead to blindness