Joints (general) Joints of the upper limb Joints of the lower limb

1. Joints (general) • Joints of the upper limb • Joints of the lower limb Chapter 9 of Tortora Human anatomy Lecturer: Dr. M. Samsam University of Central Florida, Orlando, Pictures from Platzer atlas and textbook of human anatomy and K. Moore anatomy

2. Types of Joints: 1- Continuous (synarthroses) 2- Discontinuous (diarthroses) Continuous Joints: 1- Fibrous (syndesmosis) 2- Cartilaginous (synchondrosis) 1- Fibrous joints: examples: Interosseous memb. Ligamentum Flavum Sutures of the skull Gomphosis 2- Cartilaginous: Primary:Hyaline cartilage between the bones, e.g.:Epiphysial disk. eg: between the epiphysis and the diaphysis, or the joints between the 3 parts of the hip bone. Secondary: Symphysis

3. DiscontinuousJoints: (Diarthroses or Synovial joints) 1- Articular surfaces: Hyaline or Fibrocartilage 2- Articular capsule: composed of Synovial and Fibrous membranes 3- Joint cavity: Synovial fluid *Angle of excursion

4. Synovial joints: Additional features:(Possibly) Ligaments Intercalated disks-menisci Articular lip Bursa Restricting features: Ligaments Bones Soft tissue Factors keeping Contact between the articular surfaces: Muscles Capsular ligaments Surface adhesion Atmospheric pressure *Pathology: Degeneration of cartilage Ankylosis

5. *Classification of synovial joints: 1-Axes 2-degree of freedom 3-number of articular surfaces 4-shape: 1- Plane joints 2- Hinge (ginglymus) joints 3- pivot (trochoid) joints 4- Ellipsoidal joints: 5- Saddle (Sellar) joints: 6- Ball-and-Socket joints: Fixed joints: (Amphiarthrosis)

6. Sternoclavicular joint: synovial *Saddle type but acts as Ball and socket joint Articular surfaces: Sternal end of clavicle and the manubrium. Articular disk (9). anterior (10) and posterior sternoclavicular and interclavicularligaments (11). Costoclavicular ligament (8) also supporting the joint. *3 degrees of freedom. Clavicle moves at about 60o by arm elevation. *Movements: elevation and depression of shoulder protraction, retraction and circumduction. Acromioclavicular joint: synovial Plane joint, Articular surfaces: Acromial surface of clavicle and Acromion process of scapula acromioclavicular lig.(13) It moves in combination with sternoclavicular Joint.

7. *Shoulder joint: Ball and socket Between head of the humerus (ball) and glenoid cavity (socket) Hyaline cartilage covering the surfaces The cavity is enlarged by articular lip. No strong ligaments Muscles strengthen the joint (rotator cuff muscles) Axillary recess (6) Long head of biceps brachii muscle passes through bicipital groove and actually originates from supraglenoid tubercle. The capsule is supported by: Coracohumaral Ligament superiorly (7) and 3 weak glenohumeral ligaments (sup, middle, inf). A few bursae are associated with joint: subcoracoid. Coracoacromial ligament (10) restricts the movement Movements: 3 degrees, multi-axial , Abduction, adduction anteversion (flexion), retroversion (extension), lateral and medial rotation and circumduction Dislocation is common: anterior dislocation: Injury to the axillary nerve.

8. *Elbow joint: Is a compound joint, composed of : Humeroradial, humeroulnar and proximal radioulnar Joints. 1- joint capsule, is lax and strengthened by brachialis and triceps muscles. 2- humeral epicondyles (outside the capsule) 3- Synovial membrane, 4- Fibrous membrane 5- Fatty tissue, 8- Annular ligament of the radius 9- Superior recessus sacciformis 10- Ulnar collateral ligament 11- anterior fibers, 12- posterior fibers, 13- oblique F. 14- Radial collateral ligament Quadrate ligament: connects the neck of radius to The radial notch of ulna Movements: Flexion, extension, supination and pronation Ulnar (medial) collateral ligament injury sprain: Leads to abnormal abduction of the forearm. Radial (lateral) collateral ligament injury sprain: Adduction of forearm is disturbed. *Pulled elbow: subluxation of the head of the radius Reduction: pressing radial head posteriorly (elbow flexed), then extend and supinate the forearm

9. Elbow joint, continued Humeroradial joint: Is a ball and socket like joint but doesn’t function so. Humeroulnar is a hinge joint *Joints between radius and ulna: A- Proximal radioulnar joint is a pivot joint B- Inerosseous membrane between radius and ulna (continuous fibrous joint) C- Distal Radioulnar joint: Pivot joint Between head of Ulna and ulnar notch of Radius 7- Inferior recessus sacciformis Proximal and distal radioulnar joints are necessarily combined joints to permit pronation and supination

10. Wrist (radiocarpal) joint: synovial Ellipsoid type, Surfaces: Proximally by Radius and articular disk, and distally by proximal row of carpal bones. Movements: Abduction (radial deviation) Adduction (ulnar deviation), Flexion and Dorsiflexion (extension) and circumduction Ligaments: ulnar collateral ligament (8) Radial collateral ligament (9) Palmar radiocarpal lig (10), dorsal radiocarpal lig (11) Palmar ulnocarpal lig (12) And many other ligaments The joint between carpal bones (midcarpal) is S shape. There is a little movement between the bones of first row but almost no movement between the 2nd row and between these and the metacarpals.

11. Carpometacarpal joint of the thumb: Saddle joint (synovial) Movements: Abduction, adduction, opposition, reposition and circumduction Carpometacarpal joints: Are Amphiarthroses (synovial joints) (almost no movement) Metacarpophalangeal joints: synovial Are ball and socket in shape but restricted movements due to collateral ligaments. Passive rotation of 50o might be possible Interphalangeal joints: synovial Hinge joints: Collateral and palmar ligaments Movements: flexion and extension

12. Hip joint: Ball and socket type *Articular surfaces *Joint movements: *Innervation: Sciatic N., Femoral N. and Obturator N. * The joint has five ligaments: *Four of them are extracapsular: Ilio-femoral ligament (10): Lateral part: prevents lateral rotation and adduction of femur Medial part: prevents medial rotation of femur Ischio-femoral ligament (12): prevents medial rotation of femur Pubo-femoral lig (13): prevents femur abduction Orbicular zone (11): Maintain contact between the head and the socket. Ligament of the head of the femur (6): Intracapsular, contains the Acetabular artery coming from Obturator artery.

13. Weight bearing line

14. Knee joint: Largest joint Supporting body weight *Side supporting ligaments: Collateral ligaments: The medial (tibial) collateral ligament (9) and The lateral collateral ligament (15) and the Iliotibial tract External ligaments: Collateral ligaments (9 and 15) Lateral + medial pathelar retinaculum (5,6) Patellar ligament (2) Oblique popliteal ligament (18) Arcuate popliteal ligament (19) 14- tendon of semimembranous M. 21- poplital M. 24-25) med and lat heads of gastrocnemius

15. Knee joint: Synovial membrane Innervation Only look 1- synovial membrane 2- fibrous membrane 5- suprapateller bursa 6- reflexion of the synovial membrane 15- infrapatellar fat pad 16- patella 17- infrapatellar synovial fold 18- alar folds 19- infrapatellar bursa 20- patellar ligament

16. Knee joint, intrinsic Ligaments, Menisci: Ligaments: *Ant cruciate lig: Prevents backward sliding of femur, produces medial rotation, Locks the knee in extension *Post cruciate lig: prevents femur from forward sliding. *Popliteus M.: Flexes the knee, unlocks the knee, and laterally rotates the femur on tibia. Meniscofemoral ligaments (ant and post) *Tears of the Menisci: Longitudinal and transverse During partial flexion and lateral Rotation (mostly). Medial meniscus 20 times more than the lateral one. *Pathology: Unhappy Triad During skiing (caught-edge fall) In football (clipping)

17. Knee joint: Movements: Flexion and extension: (140o) Femur rolls and glides on menisci Rotation: Femur and menisci move over tibia Phases of knee extension: 1- Initial phase: Rotation in suprameniscal compartment 2- intermediate phase: Femur glides forward in inframeniscal compartment 3- Terminal phase: (screwed home) medial rotation, tight collateral ligaments Obligatory terminal rotation of about 5o. Flexion: during flexion, fibular collateral ligament is completely relaxed as well as medial collateral ligament and both ACL and PCL are taut. Pathology: *Drawer phenomenon *Wobbly joint

18. *Ankle (talocrural) Joint: Articular surfaces: Tibia, fibula, talus Type: Hinge joint Monoaxial: transverse axis from medial malleolus to lateral malleolus. Movements: plantar flexion 25o and dorsiflexion 35o. *Ligaments: Deltoid lig (3,4,5,6) (crossed by TP and FDL) posterior and anterior Talofibular (10) Calcaneofibular lig (11) *Sprains: mostly Inversion sprains *Tretment: RICE 11 16 1-malleolar mortise 2-joint capsule 3-Deltoid lig: 4-tibionavicular part 5-tibiocalcaneal part 6-tibiotalar part 8-navicular bone 9-sustentaculum tali 10-ant. Talofibular lig 11-calcaneofibular lig 12-ant. Tibiofibular lig 13- Talus 14- Calcaneus 15- Cuboid 16- Biforcate lig 17- 2nd matatarsal Red: Chopart’s joint line (transverse tarsal joint) Blue: Lisfranc’s joint line 18-plantar calca-cuboid lig 19-long plantar lig 20-medial cuneiform 21-intermediate cuneiform 22-lateral cuneiform 23-medial tubercle of post process of talus 24-plantar calc-navicul lig

19. Subtalar and Talocalcaneonavicular J. *Subtalar Joint: (posterior) Articular surfaces: Talus (the post calcaneal) Calcaneus Ligaments: Med and lat talocalcaneal And interosseous T-C. *Talocalcaneonavicular Joint (anterior): Articular surfacse: 1-talus 2-calcaneus 3-navicular 4-plantar calcaneonavicular lig. Type: Ball and Socket Movement: Rotation (inversion and eversion) *Walking on slope mediated by movements over Subtalar+Transverse tarsal joint: (talocalcaneonavicular and calcaneocuboid) joints 1- subtalar joint 2- talocalcaneonavicular J. 3-Talus 4-Calcaneus 5-lat talocalcaneal lig 6-Navicular 7-plantar calcaneonavicular lig (Spring ligament) 8-tense biforcate lig 9-Cuboid 10-interosseuos talo-calc lig 11-calcaneocuboid joint 12-dorsal calc-cuboid lig 13-dorsal cuboido-navicul lig 14-talonavicular lig 15-dorsal tarso-metatars lig 16-dorsal metatarsal ligs 17-long plantar lig 18-plantar metatarsal ligs 19-tendon Peroneus longus 20-tendon tibialis ant 21-tendon tibialis post 22-tedon peroneus brevis 23-plantar calc-cuboid lig 24-plantar cuboideo-navic ligament.

20. Movements of the foot, The axis of Henke (rotation occurs over this axis) Only look

21. Metatarsophalageal J. Type: Ball and socket joints but, restricted mobility due to collateral ligaments. Interphalangeal J. Type: Hinge joints

22. Ligaments of the foot: Not important Longitudinal arches:

23. Plantar arches

24. Shapes of the foot: Arch pathology:

25. **Disorder of joints: Injuries: Sprains: when ligaments reinforcing a joint are stretched or torn, very painful. Complete rupture of the ligaments needs surgical repair or removal. Dislocation (luxation): when bones of the joint are forced out of alignment Subluxation: partial or incomplete dislocation of the joint. Torn cartilage: mainly in the knee joint. Surgical repair and removal of the torn parts (loose body) through arthroscopic surgery. Autologous cartilage implantation: used to heal damaged joint cartilage. Inflammatory and degenerative joint diseases: Bursitis and tendinitis: inflammation of the bursa or tendon. Housemaid’s knee: prepatellar bursitis Student’s elbow or Olecranon bursitis Arthritis: inflammation or degeneration of the joints accompanied by pain, swelling and stiffness. Rheumatoid arthritis: autoimmune disease, sever inflammation of the joints. Ankylosing spondylitis: kind of rheumatoid arthritis affecting sacroiliac joints and vertebrae (mainly in males). Osteoarthritis: degenerative condition involving articular cartilages mainly in weight-bearing joints. Gouty arthritis: Inflammation caused by high blood levels of uric acid and deposition of urate salts in the synovial membranes. Lyme disease: arthritis caused by bacteria transmitted by tick bites.