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Joint Stuff Flashcards

1
Q

anatomically simple joint

A

2 bones (surfaces) + 1 capsule

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2
Q

anatomically compound joint

A

more than 2 joint surfaces

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3
Q

complex joint

A

has meniscus

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4
Q

mechanically simple joint

A

moves 3 axes at 90 degree angles to eachother

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5
Q

mechanically compound joint

A

not right angles to eachother but more oblique axes

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6
Q

unmodified ovoid joint

A

ball and socket joint
sphere shape
3 axes and 3 degrees of freedom
(hip and shoulder)

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7
Q

modified ovoid

A

ellipse shape
2 axes, 2 degrees of freedom
(MCP joint)

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8
Q

unmodified sellar joint

A

saddle joint
2 axes, 2 degrees of freedom
(thumb)

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9
Q

modified sellar joint

A

hinge joint
1 axis, 1 degree of freedom
(IP, elbow)

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10
Q

fibrous cartilage joint

A

all move and are not fused

-synarthose

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11
Q

synarthroses

A

no genuine joint space, no fluid (synovium), divided by tissue in between

fibrous joint is also called a synarthrosis or synarthrodial joint is a point at which adjacent bones are bound by collagen fibers that emerge from one bone, cross the space between them, and penetrate into the other

  • syndesmosis (ankle tib and fib)
  • synchondrosis (costochondral)
  • synostosis (sutures in skull)
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12
Q

syndesmosis

A

fibrous tissue in between (ankle: tib and fib)

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13
Q

synchondrosis

A

cartilage in between (costochondral)

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14
Q

synostosis

A

bony tissue in between (sutures in skull)

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15
Q

diarthrosis

A

A freely movable joint between bones; all such joints are synovial joints in terms of their structure.

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16
Q

symphyses

A

half joints, connecting tissue partially fills the joint (pubic symphyses)

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17
Q

synoviales

A

movable joints

amphiarthrosis: less than 10 degrees of movement
articulations: more than 10 degrees of movement

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18
Q

osteokinematics

A

movement of the bones

spin and swing

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19
Q

osteokinematics spin

A

pure rotation around a mechanical axis (IR/ER of long bone)

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20
Q

swing

A

any movement other than pure spin
cardinal swing-pure swing
arcuate swing-impure swing

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21
Q

cardinal swing

A

pure swing

the shortest route between two points

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22
Q

arcuate swing

A

simultaneous with rotation: swing + spin

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23
Q

arthrokinematics

A

movements within a joint capsule

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24
Q

arthrokinematics spin

A

rotation around a stationary axis

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25
Q

gliding or sliding

A

one point on moving surface comes into contact with-new points on a stationary surface

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26
Q

rolling

A

both surfaces move: new points on one surface come into contact with new points on another moving surface

27
Q

gliding or translation

A

one surface (arc surface) slides over another surface without adding another component

28
Q

angulation

A

increase or decrease in angle formed between two adjacent joints (knee)

29
Q

Hip Joint: Coxo femoral joint:

mechanically:
joint type:
axes:
DF`

A
  • mechanically simple (moves 3 axes at 90 degree angles to each other)
  • ball and socket joint (Unmodified ovoid: ball and socket joint: a sphere, 3 axes and 3 degrees of freedom (shoulder, hip))
  • 3 axes with 3 degrees of freedom (triaxial):
  1. transverse axis: flexion and extension (X axis)
  2. anteroposterior axis: adduction and abduction (Z axis)
  3. vertical axis: internal and external rotation (Y axis)
30
Q

Hip Joint Characteristics:

A

i. Stability: much more limited in ROM than shoulder
ii. ROM partially compensated for by lumbar spine (extra movement in the back)
iii. Most difficult joint in body to dislocate (more likely to fx femur) (knee into dashboard and dislocate head of femur from acetabulum)
iv. Major functions: support body weight and locomotion (antalgic gait pattern if hip affected)

31
Q

Angle of anteversion

A

(15 degrees) Acute angle is formed between the frontal plane and the femur:

32
Q

Angle of Torsion:

A

15 degrees

rotation of the distal part of the femur relative to the proximal part. The distal part of the femur (femoral condyles) is internally rotated relative to the proximal part (femoral head and neck)

Normally head and neck projects superiorly and anteriorly

Femoral condyles are internally rotated relative to neck and head of femur

33
Q

Anteversion

A

Angle is greater than 15 degrees. Excess internal torsion of the femoral condyles relative to the head and neck. [toe in]

  1. So to centralize the femoral head in the acetabulum the person has to internally rotate
  2. too much internal rotation of the femur, head and neck too much anterior, need to do more internal/medial rotation
34
Q

Retroversion

A

angle is less than 15 degrees

  1. Doesn’t have enough internal rotation in the femur shaft—more external rotation
  2. The head and neck don’t project anteriorly enough (medial and slightly posterior)
  3. To centralize the femoral head, need to do more external/lateral rotation
35
Q

TOE IN

A

iii. If increase angle of anteversion, larger angle from frontal plane, have a toe in because need to turn femur in so the femoral head match into the acetabulum –stretching the patient will not help. This is different than a toe in from tight hip rotators in which case you can stretch those.

36
Q

Angle of inclination:

A

125 degrees a line through the shaft of the femur and a line through the head/neck of femur

Coxa vara: angle less than 125 degrees

i. More susceptible to femoral neck fracture due to more torsion: rotary force/torque is greater as you approach a right angle
ii. Sometimes people with hip fx, fx before the fall

Coxa valga: angle greater than 125 degrees

i. In newborn see this
ii. Head projects superiorly and medially, less of a medial projection in coxa valga

37
Q

Coxa vara:

A

angle less than 125 degrees

i. More susceptible to femoral neck fracture due to more torsion: rotary force/torque is greater as you approach a right angle
ii. Sometimes people with hip fx, fx before the fall

38
Q

Coxa valga:

A

angle greater than 125 degrees

i. In newborn see this
ii. Head projects superiorly and medially, less of a medial projection in coxa valga

39
Q

Acetabulum is hemispherical:

  1. The acetabulum is _____ compared to femoral head
  2. Surrounded by ______, adds depth to acetabulum, more coverage for head of the femur
  3. Acetabulum is where _________merge together
  4. The acetabulum is directed _______
A

directed laterally, anteriorly, and inferiorly

  1. The acetabulum is shallow compared to femoral head
  2. Surrounded by acetabular labrum-stability of hip, adds depth to acetabulum, more coverage for head of the femur
  3. Acetabulum is where ischium, ilium, pubis merge together
  4. The acetabulum is directed laterally and anteriorly (femur is also directed anteriorly) and inferiorly
40
Q

Articular cartilage

A
  1. The cartilage on the head has a hole in the middle called the fovea for a ligament to attach
  2. The ligament there is the ligament of the head of the femur = ligamentum teres
41
Q

Acetabular labrum

  1. shape
  2. ligament there
  3. will it repair?
A
  1. It is a horse shoe shaped structure and does not completely surround the entire acetabulum, in this way the vessels can get into the hip joint
  2. The transverse acetabular ligament crosses that gap
  3. It is fibrocartilage, will not repair itself
42
Q

Ligamentum teres:

  • what is it
    1. length
    2. Embedded in _____
    3. It is a ____ structure, does not do a lot, trivial mechanical role
    4. Vascularization?
A

ligament of the head of the femur, the round ligament

  1. Short: 3.5cm
  2. Embedded in protective adipose tissue
  3. It is a vestigial structure, does not do a lot, trivial mechanical role
  4. Vascularization of some extent
43
Q

Transverse acetabular ligament:

-what it connects

A

connects the two pieces of the horseshoe labrum, creating a full circumference

44
Q

Head of femur gets vascular supply from:

A

Head of femur gets vascular supply from the circumflex artery from the neck of the femur, if fx neck, get avascular necrosis of the head—need to do a hemi arthroplasty (new head)

45
Q

acetabullar capsule

i. Cylindrical sleeve from ______ to the upper end of the _______
1. Relationship with _____
2. On medial aspect of the capsule have some leeway: synovial folds that look like an accordion called the ____ that are designed to allow you to increase amount of abduction

A

i. Cylindrical sleeve from iliac bone to the upper end of the femur
1. Relationship with rectus femoris, attach onto acetabullar rim, transverse acetabular ligament, and periphery of the labrum, comes down along trochanteric line at the lateral and middle third of the femoral neck –covers entire joint
2. On medial aspect of the capsule have some leeway: synovial folds that look like an accordion called the Frenulum that are designed to allow you to increase amount of abduction

46
Q

Four sets of fibers: give strength to capsule

A

Four sets of fibers: give strength

  1. Longitudinal
  2. Oblique
  3. Arcuate
  4. Circular
47
Q

Zona obicularis:

adds stability _______

A

adds stability to the head of the femur: as pull on head to displace it, not only total labrum coverage and transverse acetabular ligament but the zona obicularis holds the head in the acetabulum
1. [wiki: annular ligament is a ligament on the neck of the femur formed by the circular fibers of the articular capsule of the hip joint. It is also known as the orbicular zone, ring ligament, and zonular band]

48
Q

Illiofemoral Ligament

  • where
  • situated
  • relationship with
A

“Y” ligament (ligament of berlin)
1. Fan shaped, strongest ligament of the joint

  1. Apex attached to lower AIIS inserted into entire length of tronchanteric line
  2. 2 portions:
    • Superior portion-iliotrochanteric band: IT band: more horizontal
  • Central part is weak
  • Inferior portion: iliofemoral ligament: inserted into lower trochanteric line: more oblique
  1. Has an attachment to AIIS by the rectus femoris
  2. Prevents hyperextension of the hip
  3. Key ligament for SCI patient population for ambulation (stand on the Y ligaments to allow them to ambulate)
49
Q

Pubofemoral ligament:

  • where
  • situated
  • relationship with
A
  1. Medially to anterior aspect of the illiopubic eminance, superior ramus of pubic bone, and obterator crest
  2. Inserts laterally into the anterior surface of the trochanteric fossa
  3. Blends with pectinius
  4. If put with the illiofemoral ligament it makes a Z
  5. Anteriorly situated
  6. Relationship with illiopsoas bursa
50
Q

Ischiofemoral ligament:

  • where
  • situated
  • relationship with
A
  1. Posterior surface of the acetabular rim and labrum
  2. Fibers run superiorly and laterally, insert into inner surface of the greater trochanteric anterior to the trochanteric fossa
  3. Relationship with obterator externus
51
Q

ligaments under moderate tension, the way they coil around the joint, maximized for most stability when ____

why?

what helps stand

A

In erect position all ligaments under moderate tension, the way they coil around the joint, maximized for most stability in standing even though do not have bony congruence

ii. As man evolved from quadriped and pelvis rotated posteriorly, all ligaments became coiled around the neck of the femur in the same direction, clockwise from the hip of the femur.
iii. Extension winds the ligaments, flexion unwinds them
iv. If we stand with COG behind hip, the Y ligaments keep us up (important for patients with weak/flaccid muscles behind hip joint)

52
Q

hip ligaments

-Flexion and Extension

A
  1. flexion everything gets relaxed because we have maximum bone congruency
  2. extension: all taut
53
Q

hip ligaments

IR/ER

A
  1. Lateral rotation: ligaments on anterior surface taut, ligaments on posterior surface become slack
  2. Medial Rotation: ischialfemoral ligament taut, pubofemural and illiofemoral ligaments that are anterior become slack
54
Q

hip ligaments

abduction/adduction

A
  1. Abduction: pubofemoral ligament becomes tight (Ischiofemoral ligament becomes tight) while the illiotrochanteric band becomes slack
  2. Adduction: illiotrochanteric band becomes tight, pubofemoral ligament becomes loose. Ischiofemoral ligament becomes slack.
55
Q

HIP arthrokinematics

Flexion and extension from neutral is ______

Flexion and extension from another position is __________

–In the long bone: ______ (osteokinematic)

–In the joint: ____

Abduction and adduction is ______

Medial and lateral rotation is _______

A

Flexion and extension from neutral is pure spin

Flexion and extension from another position is a mix of spin and glide
–In the long bone: spin with swing = arcuate swing (osteokinematic)

–In the joint: spin with glide

Abduction and adduction is a combination of spin and glide

Medial and lateral rotation is a combination of spin and glide

56
Q

Zero Starting Position: the anatomical position:

A

i. Thigh in frontal plane
ii. Line between ASISs
iii. Line between ASIS and patella are at right angles to each other

57
Q

Resting Position

A

maximal laxity of the joint (it is somewhere in the midrange). This is the position where we assess joint mobility, it is optimal because everything around the joint is maximally relaxed. It is also the ideal position to start treatment on a tight joint after the assessment.

i. Hip flexed 30 degrees
ii. Hip abducted 30 degrees
iii. Hip slight external rotation

58
Q

Closed Packed Position:

A

diametrically opposed to the resting position and it is where everything is taut and too restrictive for assessing and treating. (only treat approaching it)

i. Maximal extension from 0 degrees
ii. Maximal Internal Rotation
iii. Maximal Abduction

59
Q

Capsular Pattern:

A

unique to each joint, but the same to that type of joint across people. It is a series of proportional limitations and not a particular number value but a proportional value.

  • –IR (this is the most limited motion for the hip capsular pattern)
  • –Extension from 0 degrees
  • –Abduction
  • –Flexion
  • –ER (least limited of all these motions, and even more so, adduction is rarely ever limited)

vi. If patient has OA, they will often have 0 degrees of IR, wont do medial rotation at all (also worse in morning, with a lot of walking, with stairs..), or they lose some of it, and also some of the other motions.

60
Q

HIP ROM

A

iii. Flexion: 110-120 degrees
iv. Extension: 10-15 degrees
v. Abduction: 30-50 degrees
vi. Adduction: 30 degrees
vii. ER: 40-60 degrees
viii. IR: 30-40 degrees

61
Q

Type 1 Receptors:

A

in fibrous capsule in superficial layers between collagen fibers:

a. Small, play a role in postural and kinesthetic awareness
b. More proximal (cervical spine, shoulder, hip)
c. Static and dynamic mechanoreceptors
d. Low threshold, slow adapting, continue to be activated for a minute
e. Are active at the beginning of the range
f. They are not active in the middle of the range

62
Q

Type 2 Receptors

A

in deep fibrous capsule and in the fat pads in the joint

a. More distally like lumbar, foot, hand
b. Dynamic mechanoreceptors
c. Low threshold
d. Rapidly adapting

63
Q

Type 3 receptors:

A

GTO: golgi tendon organ:

a. create reflex inhibition of muscle tone: respond to stretch at end of range, they are found in ligaments and considered to be dynamic mechanical receptors.
b. Have a high threshold and adapt slowly.
c. Respond to stretch at the end of the ROM to protect you so you don’t overstretch the muscle or joint.

64
Q

Type 4 receptors

A

nociceptors:

a. Found in ligaments, walls of blood vessels, in fibrous capsule, and places like the anterior dura, long ligaments in the spine, spinous ligament
b. Small, unmyelenated fibers
c. Create tonic reflexive effects
d. Create inflammatory response

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