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Musculoskeletal Physiopathology > Joint Structure > Flashcards

Joint Structure Flashcards

1
Q

What are the classifications of joints?

A
  • Diarthrosis (synovial/mobile joint)
  • Synarthrosis (immobile joint)
  • Amphiarthrosis (between)
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2
Q

What are the subclassifications of diarthrosis/synovial joints based on movement?

A
  • Uniaxial
  • Biaxial
  • Polyaxial
  • Plane
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3
Q

What type of joints are the ulnohumeral joint, and proximal and distal radioulnar joints?

A

Uniaxial diarthoses

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4
Q

What type of joint is the radiocarpal joint?

A

Biaxial diarthrosis

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5
Q

What type of joints are the shoulder and hip?

A

Polyaxial diarthsosis

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6
Q

What type of joints are zygapophyseal joints, patellofemoral joint, and carpal/tarsal joints?

A

Plane (flat joint) diarthrosis

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7
Q

What are five types of synarthroses?

A
  • Symphysis
  • Suture
  • Synchondrosis
  • Syndesmosis
  • Synostosis
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8
Q

What type of joints are the pubic symphysis and intervertebral discs?

A

Symphysis synarthrosis (technically amphiarthrosis)

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9
Q

What is found within symphysis synarthrosis joints?

A

Fibrocartilage and ligaments

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10
Q

What is found within suture synarthrosis joints?

A

Interdigitating bones with ligamentous connections

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11
Q

Where can suture synarthrosis joints be found?

A

Skull

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12
Q

What type of joint are manubriosternal and costochondral joints?

A

Synchondrosis synarthrosis

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13
Q

What is found within synchondrosis synarthrosis joints?

A

Structures with cartilage ends, but no synovium

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14
Q

What type of joint are interosseous membranes are tibiofibular and radioulnar joints?

A

Syndesmosis synarthrosis

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15
Q

What is found within syndesmosis synarthrosis joints?

A

Fibrous connections between bones without cartilage

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16
Q

What is a normal variant of synostosis synarthrosis?

A

5th toe synphalangism

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17
Q

What is a pathological fusion of bones classified as synostosis synarthosis?

A

SI ankylosis in ankylosing spondylitis

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18
Q

What is a unit load?

A

Compressive force expressed as kg/cm3

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19
Q

What is the unit load threshold for cartilage injury?

A

20-26kg/cm3

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20
Q

Excessive unit loads lead to…

A

damage of articular cartilage

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21
Q

What protects the joint cartilage from exceeding unit load?

A
  • M/C adjacent muscles, tendons
  • Extra-articular ligaments
  • Joint and bone deformation
  • Intra-articular structures (ligaments and menisci)
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22
Q

What are the external support structures of the knee?

A

Tendons: biceps femoris, patellar
Ligaments: medial and lateral collateral ligaments
Muscles: quadriceps

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23
Q

What are the three types of articular cartilage?

A
  • Hyaline cartilage
  • Fibrocartilage
  • Elastic cartilage
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24
Q

What type of collagen is found in hyaline cartilage?

A

Type 2 collagen (resists compressive forces)

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25
Q

What type of collagen is found in fibrocartilage?

A

Type 1 collagen (resists tensile forces)

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26
Q

What type of collagen is found in elastic cartilage?

A

Type 2 collagen (and elastin)

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27
Q

What is the weakest type of cartilage?

A

Hyaline cartilage (susceptible to chondral fractures from tensile forces)

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28
Q

What type of cartilage is found in synovial joints and ribs?

A

Hyaline cartilage

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29
Q

What type of cartilage is found in the following?

  • Menisci
  • Triangular cartilage (wrist)
  • Labrum (shoulder and hip)
A

Fibrocartilage

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30
Q

What is the strongest type of cartilage?

A

Fibrocartilage

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31
Q
A
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32
Q

What type of cartilage is found in the pinna of the ear, nose, Eustachian tube, and epiglottis?

A

Elastic cartilage

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33
Q

What is the makeup of extracellular matrix of hyaline cartilage?

A

70-80% water
20-30% type II collagen and proteoglycans

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34
Q

How does hyaline cartilage appear?

A

Smooth and white, generally no thicker than 6mm

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35
Q

What is the function of hyaline cartilage?

A
  • Shock absorption
  • Low coefficient friction
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36
Q

What are the six zones of joint histology?

A
  • Tangential zone
  • Transitional zone
  • Radial zone
  • Tidal zone
  • Calcified zone
  • Subchondral bone plate
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37
Q

joint histology

What is found in the tangential zone?

A

Flat chondrocytes, lots of type II collagen, aka skin of cartilage/armor plate

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38
Q

joint histology

What is found in the transitional zone?

A

Round chondrocytes, lots of matrix

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39
Q

joint histology

What is found in the radial zone?

A

Columns of chondrocytes like in articular cartilage

40
Q

joint histology

What is found in the tidal zone?

A

Separation of vascular from avascular regions; base line for normal chondrocyte reproduction

41
Q

joint histology

What is found in the calcified zone?

A

Small chondrocytes, heavy calcification of matrix; chondrocyte reproduction in disease states (ie. acromegaly)

42
Q

Layers of collagen have opposing grain directions
What does this allow for?

A

Resistance to forces from different directions

43
Q

joint histology

What is the interface between mineralized and unmineralized cartilage?

A

Tide mark or blue line

44
Q

joint histology

What does the tide mark or blue line divide?

A

Nutritional source for chondrocytes:

  • Articular side of line is diffusion
  • Osseous side of the line is epiphyseal blood vessels
45
Q

joint histology

Above the tide mark or blue line, how do chondrocytes behave?

A

Replicate and migrate up towards surface above the line

46
Q

joint histology

Below the tide mark or blue line, how do chondrocytes behave?

A

Divide only if there is the appropriate chemical stimulus (ie. acromegaly)

47
Q

Is articular cartilage vascularized?

A

No, avascular

48
Q

Which part of the joint capsule is highly vascularized and innervated?

A

Fibrous layer of tissue

49
Q

The internal portion of the joint capsule is lined by ___

A

synovial membrane

50
Q

The synovial membrane is comprised of 2-3 layers of ___

A

synoviocytes

51
Q

synoviocytes

What are type A cells?

A

Macrophages with lysosomal enzymes

52
Q

synoviocytes

What are type B cells?

A

Fibroblast like cells

53
Q

Which synoviocytes produce synovial fluid components such as hyaluronate, collagens, fibronectin, and glycoproteins?

A

Type B cells

54
Q

Synovial tissue is arranged in ___ and ___

A

villi and microvilli

55
Q

What are four functions of synovium?

A
  1. Diffusion of nutrients and waste products
  2. Ingestion of joint debris
  3. Secretion of hyaluronate, immunoglobulins, lysosomal enzymes
  4. Lubrication by secreting glycoproteins
56
Q

Synovium provides lubrication by secreting ___

A

glycoproteins

57
Q

Synovium secretes…

A

hyaluronate, immunoglobulins, and lysosomal enzymes

58
Q

How much synovial fluid is found in a joint?

A

1-4ml

59
Q

How does synovial fluid act as a molecular sieve?

A

Hyaluronate molecules are large negatively charged molecules with high affinity for water

60
Q

How is synovial fluid non-clotting?

A

No thromboplastin or fibrinogen

61
Q

When interposed between hyaline cartilage surfaces, synovial fluid creates a coefficient of friction near ___

A

zero

62
Q

When interposed between hyaline cartilage surfaces, ___ creates a coefficient of friction near zero

A

synovial fluid

63
Q

___ is essential for joint development and maintenance

A

Movement

64
Q

Synovium and other vascularized structures require ___ to maintain optimal funciton

A

regular activity

65
Q

How does moderate exercise affect articular cartilage?

A

Decreases fibrillation and chondrocyte necrosis

66
Q

How does immobilization affect articular cartilage?

A

Decreases proteoglycans and increases atrophy

67
Q

___ helps maintain optimal diffusion of nutrients and wastes in articular cartilage

A

Activity

68
Q

What is arthrogryposis?

A
  • Multiple congenital joint contractures
  • Abnormal connective tissue deposited around joints
69
Q

If there are multiple congenital joint contractures and lack of joint mobility in utero, what condition is present?

A

Arthrogryposis

70
Q

What are some consequences of abnormal connective tissue deposited around joints by arthrogryposis?

A
  • Stiffness
  • Muscle weakness due to underdeveloped muscles and tendons
  • Joint surface may become flattened and incongruent
71
Q

What is the following law?

Every peripheral nerve supplying a muscle sends a branch to the joint moved by the muscle and to the skin overlying the joint

A

Hiltons’ law

72
Q

What are the four types of nerve endings in a joint?

A
  1. Encapsulated endings
  2. Pacinian corpuscles
  3. Golgi tendon organs
  4. Free nerve endings
73
Q

What is the function of encapsulated nerve endings in a joint?

A

Respond to mechanical stimuli such as pressure and stretch

74
Q

What is the function of pacinian corpuscles in a joint?

A

Respond to initiation and cessation of movement

75
Q

What is the function of golgi tendon organs in a joint?

A

A stretch receptor responding to the tension generated at the musculotendinous junction

76
Q

What is the function of free nerve endings in a joint?

A

Mediate pain

77
Q

What is the function of bursae?

A

Cushion and lubricate

78
Q

What are bursae?

A

Connective tissue sacs lined with synovium

79
Q

When do deep lying bursae develop?

A

Before birth

80
Q

What can create new bursae (adventitial bursae)?

A

Excess friction

81
Q

What is tendinitis?
How long is healing?

A

Acute tearing of the fibers creating an inflammatory reaction
Healing generally takes 6 weeks

82
Q

What is tendinosis?
How long is healing?

A

Chronic overuse creates collagen degenerative microtears without inflammation
Healing takes 6 weeks to 6 months

83
Q

Which tendons can have tenosynovitis?

A

Only those with tendon sheathes

84
Q

Can the Achilles tendon have tenosynovitis?

A

No, it doesn’t have a tendon sheath

85
Q

What are tendon sheaths?

A

Tubes surrounding the tendons lined with synovium and filled with synovial fluid

86
Q

What are the two layers of tendon sheaths?

A

Visceral and parietal with synovial fluid between

87
Q

What is tenosynovitis?

A

Inflammation of tendon sheath synovium

88
Q

Is tenosynovitis infectious or non-infectious?

A

Either

89
Q

What are some causes of non-infectious tenosynovitis?

A
  • Overuse (repetitive strain injuries)
  • Autoimmune disease (rheumatoid arthritis, psoriatic arthritis)
  • Idiopathic
90
Q

Inflammation from tenosynovitis leads to increased…

A

increased fibrin thickening of synovial fluid and increasing friction

91
Q

What pieces of evidence are present with an infectious case of tenosynovitis?

A
  • Purulent exudate
  • Necrosis of tendon sheath, tendon, and other structures
92
Q

What are some clinical manifestations of tenosynovitis?

A
  • Stiffness
  • Pain
  • Swelling, redness, warmth
  • Decreased range of motion
  • Increased symptoms with activity
  • Decreased symptoms with rest
93
Q

Which tendon is inflamed in De Quervain’s tenosynovitis?

A

Abductor pollicis longus

94
Q

Treatment of tendinosis and tenosynovitis depends upon ___

A

cause

95
Q

Infectious tendinosis/tenosynovitis can be treated with:

A

antibiotics

96
Q

Which structure helps prevent excessive unit loads in joints?

A

Synovial villi

97
Q

In synovial joints, what are the articulating ends of bone usually covered by?

A

Hyaline cartilage

Musculoskeletal Physiopathology (15 decks)

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