joints

1. CAPT POONAM SINGH PG RESIDENT JOINTS

2. 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.

3. A. Sutures 1. Plane 2. Squamous 3. Serrate 4. Dentate 5. Schindylesis B. Gomphosis C. Syndesmosis Pri. Cart. joints ( Synchondrosis ) B. Sec.cart. Joints ( Symphysis ) 1 . Plane 2. Hinge 3. Pivot 4. Bicondylar 5. Ellipsoid 6. Saddle 7. Ball and socket Synovial Freely movable ( Diarthrosis ) Cartilaginous Slightly movable ( Amphiarthrosis ) Fibrous Fixed ( Synarthrosis ) Classification of Joints

4. CLASSIFICATION 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.

5. 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

6. 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

7. SUTURE Restricted to skull Synostosis on completion of growth.

8. TYPES OF SUTURES (median palatine suture) ( sagittal suture) ( lambdoid suture) (between temporal & parietal bone)

9. SYNDESMOSIS Fibrous connection between bones Represented by Interosseous ligament Slender fibrous cord Dense Aponeurotic membrane Eg . Inf tibiofibular jt , post part of sacroiliac jt .

10. GOMPHOSIS Peg & socket joints between tooth & its socket

11. CARTILAGINOUS JOINT 1. Primary Cartilaginous Joint Also called as synchondrosis

12. CARTILAGINOUS JOINT 2. Secondary Cartilaginous Joints Also called as symphysis

13. SYNOVIAL JOINT Most evolved joint. Freely movable joint. Possess a joint cavity that consists of synovial fluid.

14. CHARACTERISTICS OF SYNOVIAL JOINTS 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.

15. 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.

16. 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

17. 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

18. 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.

19. BLOOD SUPPLY Periarticular arterial plexuses– circulus articularis vasculosus Articular cartilage: avascular Fibrous capsule & ligaments: poor blood supply Synovial membrane: rich blood supply

20. 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.

21. TYPES OF SYNOVIAL JOINT 1. Based on shape of articular surface Articulating surface- Flat Gliding or Sliding Movements Eg. Intercarpal & Intertarsal Intermetacarpal Intermetatarsal Zygapophyseal

22. 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

23. TYPES OF SYNOVIAL JOINT 3. ELLIPSOIDAL JOINTS 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

24. 4.PIVOT JOINT 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.

25. 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

26. TYPES OF SYNOVIAL JOINT 6.SADDLE 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

27. 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.

28. 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.

29. 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.

30. MOVEMENTS OF SYNOVIAL JOINTS TRANSLATION: gliding or sliding movements ANGULATION: change in the angle betn the topographical axes of the articulating bones. 4 types a ). Flexion b ). Extension c ). Abduction d). Adduction ROTARY / CIRCULAR MOVEMENTS a). Axial rotation b). Circumduction

31. 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

32. DEVELOPMENT OF JOINTS Their subsequent development varies acc. to type of joint 1.Fibrous joint 2.Cartilaginous joint 3.Synovial joint

33. 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.

34. 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

35. 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 .

36. OSTEOARTHRITIS

37. 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.

38. RHEUMATOID ARTHRITIS

39. RHEUMATOID ARTHRITIS T/t: - physical therapy -nutritional therapy -analgesia/ anti-inflammatory (NSAIDS) -steroids -DMARDS (disease- modifying anti - rheumatic drugs)

40. 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

41. JOINT REPLACEMENT SURGERY Complications: Mal positioning of the components Loss of ROM, dislocation # of the adjacent bone Damage to b.vs & nerves Infection, persistent pain Weakness Loosening of the components

42. 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