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JOINTS

BY DR SIKANDER KHAN dr.sikander05@gmail.com

Allah has bestowed human beings with a wide variety of joints.

`A'ishah (R.A) narrated that the Prophet (S.A.W) said: "Everyone has been created with three hundred and sixty joints.

DEFINITION

The point where two or more bones meet is called a joint. The other name of joints is arthroses.

Different joints in body

FUNCTIONS
Give the skeleton mobility. Hold the skeleton together.

Classification of joints
1) On the basis of structure 2) On the basis of function 3) On the basis of movement

1)Classification on the basis of structure:

I. II.

Solid joints: the joints without a cavity . Synovial joints: the joints with a cavity between them.

Types of solid joints

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I.
1)

Solid joints

Fibrous joints: the bones are held together by fibrous connective tissue that is rich in collagen fibers. No synovial cavity

a.

Sutures
Skull only Bony fusion Bound by dense fibrous connective tissue TYPES: Serrate edges are saw-like Denticulate: tooth like processes Squamous suture: bone margins overlap Plane suture: apposition of flat surfaces

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Fibrous jointscontinued
b.Gomphosis
Teeth to gums Peg and socket joint

c.Syndesmoses
bones connected by ligaments

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Types of solid joints....continued


2)Cartilaginous joints:
The bones are held together by cartilage.

a.

Synchondroses/primary cartilaginous joints


On completion of growth hyaline cartilage is replaced by bone

e.g epiphyseal cartilage of long bones between vertebrosternal ribs and sternum

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Types of cartilagenous jointscontinued


b. Symphyses/ secondary cartilaginous joints
bones separated by fibro cartilage Mostly permanent pubic symphysis Intervertebral discs Some joints e.g. between sacrum and coccyx undergo partial or complete synostosis
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e.g.

II. Synovial joints


more movement within articular capsules
lined with synovial membrane where synovial fluid is found

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Accessory structures of synovial jointcontinued


Articular/Hyaline Cartilage
Smooth cartilage at the end of bones at joint

Two-Layered Joint Capsule


Outer Layer Tough fibrous capsule Inner Layer Synovial Membrane

Synovial Fluid
Slippery fluid in joint capsule

Ligament
A band of strong fibrous tissue
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Accessory structures of synovial jointcontinued


Articular/Hyaline Cartilage Prevent friction between articulating bones Two-Layered Joint Capsule Outer Layer Strengthen joint Inner Layer To secrete synovial fluid Synovial Fluid Reduce friction between articular cartilages Nourish articular cartilage Ligament To connect one bone to another

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Strong connective tissue that attaches muscle to bone. Connect muscle to muscle.

Accessory structures of synovial jointcontinued Tendons

Bursa Fluid filled sacs Cushion the joint and act as shock absorbers

Meniscus

White fibrocartilage Improves the fit between bone ends Increases joint stability Reduces wear and tear at joint
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SYNOVIAL JOINT

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Types of synovial joints

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Types of synovial jointscontinued


Plane joints :the articulating surfaces are flat or slightly curved. e.g are intercarpal joints, intertarsal joints, sternoclavicular joints, acromioclavicular joints, sternocostal joints, vertebrocostal joints.etc.
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Examples of plane joint

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Types of synovial jointscontinued


Hinge Joints-the convex surface of one fits into the concave surface of another. e.g. elbow joint, ankle joint, interphalangeal joints,etc.
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Types of synovial jointscontinued


Pivot Joints-here the rounded or pointed surface of one bone articulates with a ring formed partly by another bone and partly by a ligament. e.g atlanto-axial joint, radioulnar joint etc.

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Types of synovial jointscontinued


Condyloid Jointsalso called ellipsoidal joint. The convex oval-shaped projection of one fits into the oval-shaped depression of another e.g metacarpophalangeal joints.

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Types of synovial jointscontinued


Saddle Joints-here the articular surface of one bone is saddle-shaped and the articular surface of the other fits into the saddle. e.g. Carpometacarpal joint.

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Types of synovial jointscontinued


Ball-and-Socket Joints- this consists of the ball-like surface of one bone fitting into a cuplike depression of another bone e.g Shoulder and hip joints.
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2)Classification on the basis of function


Functionally, joints are classified as one of the following:
Synarthrosis: an immovable joint. Amphiarthrosis: a slightly movable joint. Most amphiarthrosis joints are cartilaginous. Diarthrosis: a freely movable joint. All diarthroses are synovial joints.

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3)CLASSIFICATION ON THE BASIS OF MOVEMENT


Uniaxial joints e.g. the elbow joint

Biaxial joints e.g. the wrist joint


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CLASSIFICATION ON THE BASIS OF MOVEMENTcontinued


Multiaxial joints: e.g. shoulder joint

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Factors affecting at Synovial Joints


Structure or shape of the articulating bones Strength and tension of ligaments. Arrangement and tension of muscles Apposition of soft parts Hormones use
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Vasculature of joints
Articular arteries from vessels around joints Often these arteries form anastamoses around joints Articular veins accompany arteries Articular veins like articular arteries, are located inside a joint capsule, mostly in the synovial membranes

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Innervation
Rich nerve supply Most articular nerves are branches of cutaneous nerves supplying the muscles that cross and move the joint( obey Hiltons law) In distal parts of limbs( hands and feet) articular nerves are branches of cutaneous nerves supplying the overlying skin
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Innervation continued
Joints transmit a sensation called proprioception Synovial membrane is relatively insensitive Pain fibers are numerous in fibrous layer and associated ligaments causing pain when joints are injured Sensory nerve endings respond to twisting and stretching that occur during sport activities
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Joints of new born


The bones of the calvarium (skullcap) of a new born infant do not make full contact with each other At these sites, the sutures form wide areas of fibrous tissue called fontanelles
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DEGENERATIVE JOINT DISEASES


Risk factors include age ,heredity, injury and obesity Particularly those of hip, knee, vertebral column and hands Some destruction is inevitable during such activities as jogging, which wears away the articular cartilages and sometimes erodes the underlying articular surfaces Trauma to a joint may be followed by arthritis ,inflammation of joint and septicemia
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Degenerative joint diseases..continued


Most common is osteoarthritis, which is often accompanied by stiffness, discomfort and pain.

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Degenerative joint diseases..continued


Rheumatoid arthritis
Chronic inflammatory disorder Marked by flareups Autoimmune disease.

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Degenerative joint diseases..continued

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Examination of joint
1. Clinical examination 2. Imaging( MRI/CT) 3. Arthroscopy A cannula and arthroscope is inserted in joint cavity For abnormalities such as torn articular discs
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