JOINTS

CAPT POONAM SINGH

PG
RESIDENT
 INTRODUCTION
• Joints are the regions of the skeleton where
- 2 or more bones
- bones with cartilage articulate
- 2 or more cartilage

• Supported by variety of soft tissue structures

• Functions:
i) to facilitate growth
ii) to transmit forces between bones.
 Classification of
Joints

Fibrous Cartilaginous Synovial

Fixed Slightly movable Freely movable
(Synarthrosis) (Amphiarthrosis)
(Diarthrosis)

A. Sutures
1. Plane A. Pri. Cart. joints 1. Plane
2. Squamous 2. Hinge
3. Serrate (Synchondrosis) 3. Pivot
4. Dentate 4. Bicondylar
5. Schindylesis 5. Ellipsoid
6. Saddle
B. Gomphosis B. Sec.cart. Joints 7. Ball and socket
(Symphysis)
C. Syndesmosis
 CLASSIFICATION
1. Functional classification

 Immovable (synarthrosis)

Cranial sutures in adult

Pri cartilaginous jt. in children

 Slightly movable (amphiarthrosis)

Secondary cartilaginous jts

Syndesmosis

 Freely movable (diarthrosis)

Synovial jt.
 CLASSIFICATION
2. Structural classification

Depends on the nature of intervening soft

tissue, presence or absence of joint cavity
a) Fibrous joint
b) Cartilaginous joint
c) Synovial joint
 FIBROUS JOINT

• Lacks intervening cart. between 2 bones

• United by fibrous CT
• Articulation :-Fixed (ROM restricted/ slight)
• Lacks joint cavity
• 3 types:- a) Sutures
b) Syndesmosis
c) Gomphosis
SUTURE

Restricted to skull

Synostosis on completion of
growth.
 TYPES OF SUTURES

(median palatine suture)

(sagittal suture) (between temporal & parietal bone)

(lambdoid suture)
 SYNDESMOSIS
• Fibrous connection between bones

• Represented by

 Interosseous ligament
 Slender fibrous cord
 Dense Aponeurotic membrane

Eg. Inf tibiofibular jt,

post part of sacroiliac jt.
 GOMPHOSIS
• Peg & socket joints between tooth & its socket
 CARTILAGINOUS JOINT

1. Primary Cartilaginous Joint

 Also called as
synchondrosis
 CARTILAGINOUS JOINT

2. Secondary Cartilaginous
Joints

 Also called as
symphysis
 SYNOVIAL JOINT
• Most evolved
joint.

• Freely
movable joint.

• Possess a joint
cavity that
consists of
synovial
fluid.
 CHARACTERISTICS OF SYNOVIAL JOINTS
1. Articular cartilage
 Articular surfaces are covered
by thin plates of hyaline cartilage
Exceptions:- acromioclavicular
sternoclavicular
TM joints
( atypical synovial joints)

 Provides smooth friction-free

movements & resists
compression forces.
 2. Fibrous capsule

 Longitudinal & interlacing

bundles of parallel fibers of
white collagen.

 Completely encloses a jt
except where it is interrupted
by synovial membrane.

 Stabilizes the jt in such a way

that it permits movements but
resists dislocation.
3. Synovial membrane

 Thin highly vascular memb of CT.

 Pink, smooth and shiny.
 Lines capsule, covers exposed osseous
surfaces ,tendon sheaths, bursa
 but doesn't cover the articular
cartilage, intra-articular disc / menisci.
 Function: produces synovial fluid
Histology of synovial membrane

2-3 layers of synovial lining cells, elliptical & have numerous cytoplasmic processes

Beneath them are localized capillaries

Fat tissue of subintima

4. Synovial fluid
 Clear or pale yellow, viscous, slightly
alkaline at rest.
 Fluid vol :- < 0.5ml in large jt (knee)
 Composition: Hyaluronic acid, Lubricin,
Proteinase and Collagenase.
 Fxn :- reduce friction, shock absorption,
nutrient and waste transportation.

5. Intra-articular menisci, disc and fat pads

 fibrocartilage, not covered by synovial
membrane.
 BLOOD SUPPLY
• Periarticular arterial plexuses–
circulus articularis vasculosus
• Articular cartilage: avascular
• Fibrous capsule & ligaments:
poor blood supply
• Synovial membrane: rich
blood supply
 NERVE SUPPLY
• HILTON’S LAW

The nerves supplying

the joint capsule also
supply the muscles
regulating the
movement of the jt &
skin over the joint.
 TYPES OF SYNOVIAL JOINT
1. Based on shape of articular surface

Articulating surface- Flat

Gliding or Sliding Movements

Eg. Intercarpal & Intertarsal

Intermetacarpal
Intermetatarsal
Zygapophyseal
TYPES OF SYNOVIAL JOINT

Uniaxial

Resemble hinge of door

Articular surface- pulley shaped

Eg. Humero-ulnar Jt.

Interphalangeal Jt.
Knee & Ankle Jt

2. HINGE JOINT
 TYPES OF SYNOVIAL JOINT
Biaxial

Elliptical convex surface of one bone

articulates with elliptical concave
surface of other bone

Eg. Radio-Carpal Joint

Atlanto Occipital Joint
Meta-tarso phalangeal Joint
Meta-carpophalangeal Joint

3. ELLIPSOIDAL JOINTS
 TYPES OF SYNOVIAL JOINT
Uniaxial Joint Eg. Superior Radio-ulnar Jt.
Median Atlanto-axial Articular surface of
one bone
is rounded & fits into the
concavity of another bone.

Further rounded part

surrounded by a
Ligamentous ring.

4.PIVOT JOINT
 TYPES OF SYNOVIAL JOINT

5.BICONDYLAR JOINT
Biaxial

Round articular surface of one bone fits into socket type articular
surface of another bone.

Eg. Knee Joint, Temporo-mandibular Joint

 TYPES OF SYNOVIAL JOINT

Bi-axial

Articular surfaces are reciprocally

saddle shaped i.e Concavo-convex.

Eg. Carpo-metacarpal joint of thumb,

Calcaneo-cuboid Joint
Sterno-clavicular Joint
Incudo malleolar Joint

6.SADDLE JOINT
 TYPES OF SYNOVIAL JOINT

7. BALL AND SOCKET JOINT

Multi-axial

Rounded convex surface of one bone fits into the cup-like

socket of another bone.

Eg Hip Joint, Shoulder Joint, Incudo-stapedial Joint.

 2. Based on plane of movements

I Uniaxial joint : Hinge, Pivot joint

II Biaxial joint: Condylar, Ellipsoid, Saddle joint

III Multiaxial joint: Ball and socket joint.

 3. Based on no. of articulating bone

I Simple joint: only 2 bones take part in formation

of a joint.

II Compound joint: > 2 bones take part in

formation of a joint.

III Complex joint: joint cavity is divided into 2 by

the intra-articular disc or meniscus, eg. TM joint,
knee joint.
 MOVEMENTS OF SYNOVIAL JOINTS
1. TRANSLATION: gliding or sliding movements

2. ANGULATION: change in the angle betn the topographical axes of the

articulating bones.
4 types a). Flexion
b). Extension
c). Abduction
d). Adduction

3. ROTARY / CIRCULAR MOVEMENTS

a). Axial rotation
b). Circumduction
 DEVELOPMENT OF JOINTS
• Mainly mesoderm in origin with some neural crest
contribution.


Regions of developing cartilage consist of widely
spaced cells surrounded by matrix.


Condensation of somatopleuric mesenchymal cells
develop between developing skeletal elements to
form plates of interzonal mesenchyme
 DEVELOPMENT OF JOINTS


Their subsequent development
varies acc. to type of joint

1.Fibrous joint
2.Cartilaginous joint
3.Synovial joint
 Cracking joint
• When the two bones of a joint are pulled
away from each other, the synovial membrane
expands, but the fluid volume does not. In
order to fill the empty space, gases dissolved
in the fluid are pulled out, and when they fill
this new empty space, a popping sound is
made.
 ARTHRITIS

• Inflammation of one or more joints, synovial

membrane.
• > 100 different forms of arthritis.

• Symptoms: swollen jt, tender, warm, stiffness

limits the movements.

• Main complaint: jt pain ( due to inflammation

that occurs around the jt, damage to the jt from
disease, daily wear and tear of the jt, muscle
strains caused by forceful movement)

• Most common: osteoarthritis

 OSTEOARTHRITIS
• Most common form of arthritis
• degenerative joint disease 
• Cause: mechanical stress, overweight, hereditary,
developmental deficits
• Symptoms: jt pain, tenderness, stiffness, locking and
sometimes an effusion.
• T/t : -exercise
- lifestyle modification
- analgesics
- jt replacement surgery used to improve
quality of life .
OSTEOARTHRITIS
 RHEUMATOID ARTHRITIS
• Is an autoimmune disease that results in a chronic, systemic
inflammatory disorder that may affect many tissues ,organs and jts.
• Women 2-3 times more affected than men.
• Onset is frequent during middle age.
• Pathology: destruction of articular cartilage and ankylosis of the
joints.
• Commonly involved parts: hands, feet and cervical spine but larger jt
can also be involved.
• Symptoms: -pain ( lasts for more than 1 hour)
-stiffness mainly occurs in the morning
-disabling & painful condition can lead to loss of
function.
RHEUMATOID ARTHRITIS
 RHEUMATOID ARTHRITIS
• T/t: - physical therapy
-nutritional therapy
-analgesia/ anti-inflammatory (NSAIDS)
-steroids
-DMARDS (disease- modifying anti -
rheumatic drugs)
 JOINT REPLACEMENT SURGERY
• Is a procedure of orthopedic surgery in which
the arthritic or dysfunctional joint surface is
replaced with an orthopedic prosthesis.
• Indication: severe joint pain or dysfunction,
not alleviated by less-invasive therapies.
• Most common: knee and hip replacement
 JOINT REPLACEMENT SURGERY
• Complications:
1. Mal positioning of the
components
2. Loss of ROM, dislocation
3. # of the adjacent bone
4. Damage to b.vs & nerves
5. Infection, persistent pain
6. Weakness
7. Loosening of the
components
• Sgt Jerrod fields , US
army.. Won a gold
medal in 100m with a
time of 12.5 secs at the
endeavor games in
Edmond,Okla, on June
13-2009