JOINTS

By Dr.Lakshmi kantha.B.M
Associate professor
Department of Anatomy
DMWIMS, Wayanad,Kerala
 JOINTS
• CLINICAL CASE SINERIO
• DEFINITION
• CLASSIFICATION
• SYNOVIAL JOINTS
• BLOOD SUPPLY
• NERVE SUPPLY
• KINESIOLOGY
• APPLIED ASPECTS
CLINICAL CASE SINERIO

• 30 year old male came

with history of fall from
motorbike followed by
which he was not able to
abduct his right shoulder.
• On examination there
was loss of deltoid
prominence on right side
with restricted range of
movement of right
shoulder joint.
 DEFINITION
• Joints means a place where
two things are joined
together.
• “It is the connection
between two or more
bones”.

ARTHROLOGY:-
• “It is the science which
deals with the study of
joints”
 CLASSIFICATION
DEPENDING ON
STRUCTURE

Fibrous joints Cartilaginous Synovial joints

joints

DEPENDING ON
FUNCTION

Synarthroses Amphiarthroses Diarthroses freely

immovable restricted mobility movable
 SYNARTHROSES

Articular surface are joined by tough fibrous

tissue.

Fibrous joints

Sutures Syndesmoses Gomphosis

 SUTURES
• Most of the Joints of the
skull
• Appear between the
bones which ossify in
membranes
• Suture membranes
(Ligaments) present
between opposed
margins.
 SUTURES
• They binds periosteum
and promote bone
growth.
• Completely ossify by
twenty years, then
resulting in synostosis.
 SERRATE SUTURE
• Edges of the bones
present saw toothed
appearance
• E.g.: sagittal suture
 DENTICULATE SUTURE
• The margins looks like
teeth, with the tips being
broader than roots.
• E.g.: Lambdoid suture
 SQUAMOUS SUTURE
• Edges of bones are united
by overlapping
• E.g.: suture b/w parietal
bone and squamous part
of temporal bone
 PLANE SUTURE
• Margins of bone are
plane and united by
sutural ligament
• E.g.: articulation b/w
palatine process of two
maxillae
 WEDGE OR GROOVE
(Schindylesis)
• The edge of one bone fits
in the groove of the other
bone
• E.g.: b/w rostrum of
sphenoid and the upper
margin of Vomer.
 SYNDESMOSES
• Here surfaces of bones
are united by
interosseous ligaments
and bones lie some
distance apart.
E.g.
1. Inferior tibio-fibular joint
2. Interosseous
membranes of the
forearm and leg
3. Ligamentum flava
 GOMPHOSIS

• Here roots of the teeth fit

in the sockets of the jaw
and are united by fibrous
tissue.
 AMPHIARTHROSES
(CARTILAGINOUS JOINTS)
• Bones are joined by cartilage.
• Fibrous capsule will hold the joint in place.
• Restricted movements are possible
Types

Synchondroses Symphyses
(Primary cartilaginous joints) (Secondary cartilaginous joint)
 SYNCHONDROSES
• Here bones are united by Examples:
a plate of hyaline 1. Junction between
cartilage-temporarily – epiphysis and diaphysis
later completely replaced 2. Articulation between
by bone ( synostosis ) basi-occiput and base-
• No movement possible sphenoid
• Primarily designed for the 3. First chondro-sternal
bone growth joint
Junction between epiphysis and
diaphysis
 Articulation b/w basi-occiput and
basi-sphenoid
• Synostosis at 25 years
• Early Synostosis before
eruption of permanent
teeth leads to dental
mal-occlusion
First chondro-sternal joint
 SYMPHYSES
• Articular surface covered by hyaline cartilage and are
united by a plate of fibrocartilage.
• Some times the joints are enveloped by incomplete
fibrous capsule
• They persists through out life and are in median plane of
the body
• Limited movement is possible due to compression of
fibro cartilage.
• Thickness of fibrocartilage is related to range of
movement.
 1. Intervertebral discs
Structure
• Annulus fibrosus-
concentric layer of fibers.
• Nucleus pulposus-
gelatinous- water
• cartilage cells,
multinucleated
notochordal cells
• Functions: shock-
absorber, resistance to
compression
 2.Symphysis pubis
• Present in anterior arch of
pelvis in between body of
two pubic bone.
• When medial thrusts of
femoral head are
transmitted through the
anterior arch-interpubic
disc resists the force by
acting as a shock
absorber.
 3. Manubrio-sternal joint

• Pump handle movement

responsible for increase in
antero-posterior diameter.
• After 60 years partly or
completely replaced by bone
 DIARTHROSES
(SYNOVIAL JOINTS)
Most evolved and most movable
CHARACTERSTICS:-
1. Articular cartilage
2. Cavity with viscous Synovial
fluid
3. Complete articular capsule
with outer fibrous capsule
and inner Synovial
membrane
4. Ligaments
5. Articular disc or meniscus.
6. Bursa.
 ARTICULAR CARTILAGE
• Hyaline cartilage
• Avascular. Non-nervous,
elastic.
• Damaged- cannot be
replaced by hyaline
cartilage but by fibrous
tissue - indispensable.
• On convex articular
surface.
• On concave articular
surface.
 Cont..
Functions:
• Smooth gliding surface and reduce the
force of compression or muscle action.
• Coefficient of friction is equal to ice on ice.
• The surface shows undulations - filled with
Synovial fluid - i.e...., it is extremely porous
and absorbs Synovial fluid in resting
condition – on compression fluid is
squeezed out.
• Regulates the epiphysial growth.
Structure:
• Consists of cells with an
interlacement of collagen
fibers
1. Superficial - flattened
cells-parallel to articular
surface
2. Intermediate- rounded
cells- longitudinal rows
3. Deep layer- calcified
matrix-cells die and
replaced by bone.
 cont…
Changes with age
• Degenerative
Occurs in the central part
of the cartilage.
• Proliferative
Occurs in the peripheral
part of the
cartilage.(osteophyte)
 Cont..
Nutrition:
1. From Synovial fluid
2. By diffusion from the capillaries at the
periphery of the articular cartilage
3. By diffusion from the adjacent epiphysial
blood vessels.
 SYNOVIAL MEMBRANE

Highly vascular & cellular connective

tissue- lines inner aspects of fibrous capsule
& bones lying within the joint- but cease at
the periphery of the articular capsule,
articular disc or meniscus.
 Structure
• Cells arranged in two • Type-B cells- resemble
zones. fibroblast-secretes
• Inner zone proteins in the Synovial
fluid.
• Outer zone
• Outer zone- network of
• Inner zone- two types
reticular fibers +
of cells- type A and B
connective tissue cells
• Type-A resembles like fibroblast, histiocyte
macrophages- secretes and mast cells.
hyaluronic acid and
phagocytic.
 Functions
• Secretes Synovial fluid-
gives nutrition to
articular cartilage.
• Liberates hyaluronic
acid- maintains
viscosity of synovial
fluid.
• Phagocytic activity-
particulate matter and
worn out cartilage cells.
 Cont..
Types:
1. Fibrous: Synovial
lining adherent to the
fibrous capsule
2.Areolar: where
Synovial membrane
freely moves over the
fibrous capsule
3.Adipose: covers intra
articular pad of fat.
 SYNOVIAL FLUID
• Viscous, glary fluid
• It is dialysate of blood
plasma into which
hyaluronic acid is added.
• Hyaluronic acid is a high
polymer of
mucopolysacharide and
secreted by the Synovial
cells and mast cells of
Synovial membrane.
• Viscosity depends on
concentration of
hyaluronic acid.
 Cont..
Alkaline
Cellular contents:
• Monocytes,
lymphocytes,
macrophages,
Synovial cells and
few leucocytes.
• Proteins traces.
 Cont..
Functions:
1.Nutrition to articular capsule
2.Lubrication of joint cavity to prevent wear and
tear:- this is helped by,
A) Incongruous articular surfaces- this provides
space for the flushing of fluid- Synovial fluid
spread as an elastic fluid film over moving
articular surface.
B) Viscosity of fluid maintains the lubrication,
depands on concentration of hyaluronic acid.
C) More movements of the joint increase the
lubrication.
Joint cracks
 ARTICULAR CAPSULE
• Outer- fibrous capsule
• Inner- Synovial
membrane.
FIBROUS CAPSULE-
• Completely invests joint
• Attached on the bones
close to articular cartilage
continuously.
• Formed by bundles of
collagen fibers-irregular
spirals-
• Sensitive to changes of
position of joint.
 Cont.
Functions:
1.Binds articulating bones
together.
2.Supports Synovial
membrane
3.Watch dog action-
sensory nerve endings
ramify on the capsule-
when stimulated-
contraction of muscles
by reflex- protect the
joint from over
stretching.
 LIGAMENTS
• Holds the bones in position.
Types- True and False
• True – Thickening of
collagen of the fibrous
capsule.
• False- form additional bonds
of union b/w the bones.
Functions-
• Permit desirable movement
and prevent undesirable
movement.
• Stability of joints.
 ARTICULAR DISC
( MENISCUS )

• Fibro-cartilaginous
disc, attached at the
periphery of capsule.
• Divides joint
completely/
incompletely.
 Cont..
• Articular disc- divides joint completely.
• E.g.- TM joint, sternoclavicular joint,
inferior radio ulnar joint
 Cont..
• Articular meniscus- divides joint
incompletely
• E.g.- knee joint, acromio-clavicular joint
 Cont..
Functions:-
1. Helps in lubrication of joints
2. Smoothens gliding and angular
movements.
3. Prevents wear and tear of the
articular cartilage.
 Bursa
• Sometimes the capsule opening through
which synovial membrane comes out to
act as bursa.
• It is a device to reduce friction between
two mobile but tightly opposed surfaces,
permitting complete freedom of movement
within the limited range.
• Types : Subcutaneous, subtendinous,
sub muscular, subfacial, inter ligamentous,
communicating.
 CLASSIFICATION--- SYNOVIAL JOINTS

According to no. of articulating bones

1. Simple joints.
2. Compound joints.
3. Complex joints.
 Simple joints

When 2 bones enters in

the articulation.
Example:
Interphalangeal joints of
fingers and toes.
 Compound joints
More than 2 articular
bones sharing a
common articular
capsule.
Example:
1. Ankle joint.
2. Radio-carpal joint.
 Complex joints

Joints containing articular discs or meniscus

Example:
1. Knee joint.
2. Sternoclavicular joint.
 Acc. To axis of movement/shape
of articular surface
Uniaxial Biaxial Polyaxial Plane

1 degree 2 degree 3 degree Articular

freedom of freedom of freedom of surface flat
movement movement movement

1.Hinge 1.Ellipsoid 1.Ball &

socket
2.Pivot 2.Saddle

3.Condylar
 UNIAXIAL JOINTS

HINGE (Ginglymus)-
• Moves around
Transverse axis
• Articular surface-
convex
• Other reciprocally
curved.
• E.g.- elbow, ankle
interphalangial joints
of fingers and toes
UNIAXIAL JOINTS cont..
Pivot type: ( Trochoid)
Vertical axis movement
One bone acts as pivot
and is encircled by
osseo-ligamentous
ring
E.g.1. Atlanto axial joint
2. Superior & inferior
radioulnar joints.
UNIAXIAL JOINTS cont..
• Condylar joint
Movement takes place
mainly on transverse axis
and partly on vertical
axis.
Modified hinge joint.
Each bone has two articular
surfaces called condyles
enveloped in same.
capsule.
e.g., Knee and jaw joints
 BIAXIAL JOINTS
• Presents two degree
of movements.
• Two types
• 1.Ellipsoid joint
• 2. Saddle joint
BIAXIAL JOINTS cont..
• Ellipsoid joint
• Here oval convex male
surface fitting into
elliptically concave
female surface.
• Movements- transverse &
anteroposterior axis-
flexion, extension,
adduction, abduction &
Circumduction but no
rotation on vertical axis.
• Example: Radio carpal
joint, Atlanto-occipital
joint.
BIAXIAL JOINTS cont..
Saddle joint
Opposing articular
surfaces are concavo
convex in reciprocal
manner.
Movements are similar to
ellipsoid joint but rotation
is present- conjunct
rotation.
e.g., Carpometacarpal
joint of thumb, sterno-
Clavicular joint.
 POLYAXIAL JOINTS
• Three degree freedom of movement.
• Ball & socket / spheroidal joints.
• Example: Shoulder & hip joints, talo-calcaneo-
navicular joint, inco-stapedial joint ( restricted
ball & socket joint)
•Spheroidal articular surface of one bone moves
within the socket of other bone.
•Around three independent axis with one
common centre - transverse, vertical and
antero - posterior
 PLANE JOINTS
• Articular surfaces are
flat, produce gliding
movements.
• E.g., Intercarpal
joints, Inter-tarsal
joints, Articulation b/w
articular process of
vertebrae
Cont..
 MOVEMENTS
TYPES
1.Gliding
2.Angular
3.Circumduction
4.Rotation
GLIDING:
• Occurs in Plane joints
• Limited motion
possible
• One bone slips over
the other in a particular
direction
• Example: Joints of
hand, foot and
vertebral column
 Cont..
ANGULAR:
Types:
1.Flexion & Extension
2.Adduction & Abduction.
 Cont..
Flexion- bending
Extension-
straightening
• Occurs around
transverse axis
• How ever this
principle not
applicable in carpo-
metacarpal joint of
thumb, shoulder, hip
and ankle joints
 Cont..
• Adduction &
Abduction
• Adduction-
movements towards
the median plane
• Abduction-
movements away
from the median
plane
• Axis- AP axis except
C-M joint of thumb,
here axis is
transverse
 Cont..
CIRCUMDUCTION-
• Combination of 4
angular movements in
successive orders
describing a cone
• Base of the cone
formed by distal end
of the moving bone.
• Occurs in biaxial and
polyaxial joints.
 Cont..
ROTATION-
• around vertical axis
• E.g.- shoulder joint-
axis along the
humerus
• Atlanto-axial joint-
axis along the dens
 Factors limiting the range of
movements

1.Shape of articulating bones

2.Tension of the ligaments
3.Tension of the antagonistic muscles
4.Approximation of soft parts.
 Cont..
1.Shape of articulating
bones
• When opposing
articular surfaces are
disproportionate,
bone with larger
surface gets more
freedom of movement
 Cont..
2.Tension of the
ligaments.
• E.g.- the extension of
hip joint is limited by
the tension of ilio-
femoral ligament
 Cont..
3.Tension of the
antagonistic muscles
• Hip flexion with extended
knee- movement stop
early due to tension of
Hamstring muscles
• Hip flexion with flexion of
knee-movement more
prolonged & thigh come
till anterior abdominal
wall
 Cont..
4.Approximation of
soft parts.
• Approximation of arm
and fore arm in full
flexion at elbow limits
the range of
movement.
Factors maintaining the stability of
joints

• Bony configuration
• Ligaments
• Muscles
• Atmospheric pressure and force of
cohesion.
Cont..
1.Bony configuration
• Important in hip and ankle
joint.
• In hip joint head of the
femur is completely
received by the
acetabular socket
• In ankle- trochlear
surface of the talus is
embraced by tibio-fibular
mortise.
 Cont..
2.Ligaments
• Permit desirable
movements-restrict
undesirable
movement.
• Can with stand the
short duration stress
as they are made up of
collagen which are
once stretched cannot
be reversed.
 Cont..
3.Muscles
• Tone of the muscle
maintain the stability
of joint.
• E.g.- short muscles of
scapula- maintains
stability of shoulder
joint.
 Blood supply
• Epiphyseal vessels- Enter the long bone at or
near the attachment of the fibrous capsule- give
articular branches- form rich capillary plexus in
Synovial membrane- circulus vasculosus
• These end around the articular margin in a
fringe of looped anastomosis.
 Nerve supply
• Articular capsule and ligaments have rich nerve
supply.
1.Sensory 2.Autonomic ( vasomotor)
• Sensory- form Ruffini endings and paccinian
corpuscles- convey proprioceptive sensation-
concerned with control of posture, locomotion
and perception of position and movement.
• Some sensory fibers form free nerve endings-
pain sensation.
 Cont..
Hiltons law- says that,
• Nerves which supply the joint also give
branches to the muscles regulating the
movements of the joint and skin over the
joint.
• Irritation of the nerve in joint disease-
reflex spasm of the muscles and fix the
joint in the position of comfort and the pain
referred to the skin.
 Cont..
Gardner's observation- says that
• The part of the capsule which is rendered taut by
the contraction of a group of muscles, is
supplied by a nerve which innervates their
antagonistic muscles.
• E.g.- Inferomedial part of the capsule of hip joint
is stretched during abduction- this part of the
capsule is supplied by the Obturator nerve which
also supplies the adductors of the hip joint- this
establish the local reflex arcs- helpful for the
stability of the joint.
• LAST’S FORMULATION ( R.J LAST)
1.Four contiguous spinal segments regulate
movements of a particular joint : upper two
segments control one movement, lower
two segments regulate opposite
movement.
2.For a joint one segment more distal in the
limb, the Centers lie en block, one
segment lower in the cord.
 Lower limb

• Hip centre - L2 L3 L4 L5 Knee joint-

• Knee centre- L3 L4 L5 S1 • Extension—L3L4
• Ankle centre- L4 L5 S1S2 • Flexion—L5S1
Hip joint – Ankle joint
• Flexion—L2L3 • Dorsi-flexion—L4L5
• Extension—L4L5 • Plantar flexion—S1S2
• Adduction—L2L3 Mid-tarsal joint-
• Abduction—L4L5 • Inversion—L4
• Medial rotation—L2L3 • Eversion—L5S1
• Lateral rotation—L4L5
 DEVELOPMENT
5th wk of IUL - Early limb bud develops at the lateral
part of the trunk covered with surface ectoderm
and filled with undifferentiated mesenchyme
Paraxial blastema (cellular condensation of
mesoderm) develops within the long axis of the limb.
6th wk of IUL - paraxial blastema chondrified in the
regions of future bones- in the cranio caudal
direction.
Cellular interzone appears b/w adjacent cartilage
models and has 3 layers– 2 chondrogenic layers
covering the ends of the cartilage modal & an
intermediate layer of loose mesenchyme
 Cont..
8th wk of IUL– ossification begins in the cartilage
model and replaced by the bone except at their
ends where cartilage cells persists as articular
cartilage.
The mesenchyme at the periphery of the
interzone is vascularised and converted into the
joint capsule and intra-capsular structures.
In the intermediate layer of the interzone– cleft
like spaces develop and are filled with Synovial
fluid produced by mesenchymal cells.
4th month of fetal life —all the clefts coalesce
and form single joint cavity
Synovial membrane is differentiated from inner
layer of joint capsule, with this quickening starts.
KINESIOLOGY
DEFINITION
Kinesiology is a branch of the
Biomechanics and it is a science of
movements.
PRE REQUISITS
1.Geometric configuration of the articular
surface.
2.Mechanical axis of the bone
3.Movements executed by the bone
4.The movements permitted by the joints.
 Cont..
Articular surfaces—
1.Ovoid– convex or concave
2.Sellar ( saddle shaped )– are concave in
one plane and convex at right angles to
the concave plane.
 Cont..
• Chord– if two points
on an ovoid surface
are joined by the
shortest possible line.
• Arc– the longer line
joining the points
 Cont..
• Triangle– when three
points at different
positions over the
ovoid surface are
connected to one
another by three
chords, the area is
called as Triangle.
• Trigone– if one of the
chords connecting
these points is
replaced by an arc is
called as Trigone.
 Cont..
• When the sum of the
three angles of such
triangle is > 180
degrees– surface is
convex
• When the sum of the
three angles is < 180
degrees—surface is
concave
 Cont..
• Evolute of profile:- an ovoid convex surface
condylar joint is viewed in profile view, it
accommodates the arcs of a number of circles
with variable radii, when the centers of these
circles are joined, the line formed is known as
Evolute of profile.
• During movement of such condylar surface the
axis changes from moment to moment along the
Evolute.
 Cont..
• At a particular phase of
movement the convex
articular surface is
perfectly congruent with
the reciprocal concave
surface of the other bone-
CLOSE PACKED
condition of joint.
• Here no space is
available to flush the
Synovial fluid and
articular capsule is
maximally stretched.
 Cont..
• In other phase of
movement- articular
capsule is loose and joint
space is sufficient for
providing nutrition and
lubrication by Synovial
fluid– known as LOOSE
PACKED condition of the
joint.
• If joints are immobilized in
this position while
treatment, the functional
efficacy is improved.
 Cont..
• Mechanical axis: it is
a line which passes
perpendicularly
through the centre of
the articular surface.
• In a symmetrical long
bone the mechanical
axis passes through
the centre of the
bony model.
• In asymmetrical bone-
axis passes oblique
to the bone.
 Cont..
• SPIN– movement of a bone at terminal
joint around the fixed mechanical axis.
• SWING--- when mechanical axis itself
moves at a joint.
• CARDINAL SWING– when the
mechanical axis describes a chordal path
b/w two points of the joint surface.
• ARCUATE SWING---- axis moves along
an arc with some spin.
 Basic components of movements
by Synovial joints
1.Spin
2.Slide
3.Roll

• Spin– occurs around a fixed mechanical

axis.
 Cont..
• Sliding movement–
mechanical axis and
both ends of a moving
bone move in the
same direction.
• Rolling movement–
when one end and
mechanical axis
moves in one
direction and other
end moves in
opposite direction.
 APPLIED ASPECT
• ARTHRITIS
• ARTHRALGIA
• OSTEOARTHRITIS
• DISLOCATION
• INTRA ARTICULAR FRACTURE
• LIGAMENT TEARS
• SYNOVIAL CYST
• JOINT ASPIRATION
• INTRA ARTICULAR INJECTIONS
• JOINT REPLACEMENT
• ARTHROSCOPY
Arthritis
Arthritis cont..
Osteo arthritis
Dislocation
Intra articular fracture
Sprain(Ligament Tear)
Synovial cyst
Joint aspiration
Intra-articular injections
Joint Replacement
Arthroscopy