Joints (1+2) Flashcards
What are the 4 types of joints?
Fibrous, primary cartilaginous, secondary cartilaginous and synovial.
Classify the 4 joints by movability.
Fibrous and primary cartilaginous are immovable, secondary cartilaginous is slightly movable and synovial is movable.
Define fibrous joints (synostosis).
Fibrous joints (synostosis) occur when bone is linked to bone by fibrous tissue.
Define primary cartilaginous joints (synchondrosis).
Primary cartilaginous joints (synchondrosis) occur when bone is linked to bone by hyaline cartilage.
Define secondary cartilaginous joints (symphysis).
Secondary cartilaginous joints (symphysis) occur when the sequence of adjoined structures is as follows: bone, hyaline cartilaginous plate, fibrocartilaginous disc, hyaline cartilaginous plate, bone.
Define synovial joints, differentiate between typical and atypical synovial joints.
A typical synovial joint has articular surfaces of two bone ends enclosed in a fibrous capsule, the articular surfaces are connected by hyaline cartilage. An atypical synovial joint has the articular surfaces of the bone ends linked by fibrocartilage
What are the different types of synovial joints?
Hinge, modified hinge, condyloid, saddle condyloid, pivot, plane, ball and socket.
Sternoclavicular joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-none
8-Blood supply and nerve supply
9-Clinical problems
1-saddle synovial joint, 3 degrees of freedom
2-sternal head of clavicle and manubrium of sternum
3-medial clavicle, clavicular notch of sternum and 1st costal cartilage
4-A fibrocartilaginous articular disc is present.
5-Intrinsic-anterior and posterior sternoclavicular ligaments. Extrinsic-costoclavicular and interclavicular ligaments
6-all muscles that have insertions on the scapula act on the joint as well as the sternocleidomastoid
7-none
8-Nerves-nerve to subclavius(C5), medial pectoral nerve (C8,T1) and supraclavicular nerves. Blood-internal thoracic artery, thoracoacromial artery, subclavian artery.
9-costoclavicular syndrome in which the neurovascular bundle is compressed as it passes from clavicle to 1st rib, symptoms include pain, numbness and tingling sensation in hands.
Acromioclavicular joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-none
8-Blood supply and nerve supply
9-Clinical problems
1-plane synovial joint, 3 degrees of freedom
2-acromion, lateral clavicle
3-acromion, lateral clavicle
4-fibrocartilaginous disc is present
5-Intrinsic-acromioclavicular ligament. Extrinsic-conoid and trapezoid ligament (forming the coracoclavicular ligament) and the coracoacromial ligament.
6-muscles that attach to the scapula or clavicle have influence over this joint
7-none
8-Nerves-suprascapular nerve and lateral pectoral nerve. Blood - thoracoacromial and suprascapular artery.
9-acromioclavicular joint separation resulting in dislocation
Glenohumeral joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-none
8-Blood supply and nerve supply
9-CLINICAL PROBLEMS!!!
1-ball and socket synovial joint, 3 degrees of freedom
2-glenoid cavity, head of humerus
3-glenoid labrum and anatomical neck
4-glenoid labrum and the tendons of the 4 rotator cuff muscles
5-Intrinsic-superior, middle and inferior glenoid ligaments. Extrinsic-coracohumeral ligament.
6-rotator cuff muscles, any muscle with attachments on the humerus
7-none
8-Nerves-axillary, suprascapular and long thoracic nerves. Blood-anterior circumflex humeral, posterior circumflex humeral and axillary arteries.
9-Shoulder dislocation, mostly anterior dislocation. This type of dislocation is more likely when the arm is forcefully abducted and externally rotated.
Elbow joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial hinge joint, consisting of 3 joints; humeroulnar (1DOF), humeroradial (2DOF) and proximal radioulnar joints (1DOF)
2-In the humeroulnar joint, the trochlea articulates with the trochlear notch in the ulna. In the humeroradial joint, the capitulum articulates with the head of the radius. In the proximal radioulnar joint, the head of the radius articulates with the radial notch of the ulna.
3-at the humerus, above the coronoid and radial fossae but below the olecranon fossa and at the ulna, along the coronoid process and the olecranon and to the annular ligament.
4-synovial membrane and fat pads within the fossae.
5-Intrinsic-ulnar collateral ligament and radial collateral ligament. Extrinsic-annular ligament
6-upper limb muscles as well as anconeus, pronator teres, pronator quadratus and supinator muscle.
7-Nerves-median, ulnar, radial and musculocutaneous nerves. Blood-brachial, radial and ulnar arteries.
8-medial epicondylitis(Golfer’s elbow), inflammation of tendons attached to the namesake. Lateral epicondylitis(Tennis elbow), overuse of forearm muscles.
Distal radioulnar joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial pivot joint with 1 degree of freedom
2-ulnar head, ulnar notch
3-capsule attaches to distal radius and ulnar head
4-triangular fibrocartilage complex
5-extrinsic-anterior and posterior distal radioulnar ligaments
6-pronation, supination of forearm, pronator teres, pronator quadratus, supinator, biceps brachii
7-nerve-median and radial nerves. Blood-anterior and posterior interosseous artery
8-TFCC injury as a result of trauma/chronic wear, causing pain on ulnar wrist and loss of grip strength
Radiocarpal joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial condyloid joint with 2 degrees of freedom
2-distal radius, proximal scaphoid lunate and triquetrum
3-capsule attached to articular margins thickened as radial and ulnar collateral ligament
4-triangular fibrocartilaginous disc
5-Intrinsic-scapholunate, lunotriquetral and intercarpal ligaments. Extrinsic-radial/ulnar collateral ligaments, dorsal/palmar radiocarpal ligaments and palmar ulnocarpal ligament
6-flexion/extension, pronation/supination, deviation, all muscles connecting forearm and wrist
7-Nerve-median, ulnar, radial nerves. Blood-radial and ulnar arteries, anterior/posterior interosseous arteries.
8-distal radius fracture causes Colles, resulting in dinner fork deformity. Smith’s fracture is of the radius but it shifts inwards. Scaphoid fracture causes avascular necrosis because of the bone’s retrograde blood supply.
Carpal joints; state:
1-Type(s)
2-Articular surfaces
3-Movements of the joint
4-Blood supply and nerve supply
5-Clinical problems
1-plane synovial with 1 degree of freedom. Consists of 7 joints. The proximal/distal intercarpal joints are between adjacent bones and the midcarpal joint connects the proximal and distal row. Pisotriquetral joint connects the 2 bones.
2-individual joints are planar. Composite joints are condyloid.
3-gliding movements increase the range of motion of the wrist especially in flexion and radial deviation.
4-Nerves-anterior and posterior interosseous nerves from median and radial nerves respectively. Blood-radial artery,
ulnar artery, anterior and posterior interosseous artery.
5-Kienbok’s disease, avascular necrosis of the lunate due to fractures.
Carpometacarpal joints; state:
1-Type(s)
2-Articular surfaces
3-Movements of the joint
4-Blood supply and nerve supply
5-Clinical problems
1-saddle/plane synovial joint with 1/2 degree/s of freedom
2-distal facets of carpus and proximal surface of metacarpals
3-1st cmc (saddle) joint allows flexion, extension, abduction, adduction, opposition and reposition. 2nd and 3rd are rigid. 4th and 5th allow for some extension/flexion.
4-Nerves-anterior and posterior interosseous nerves from median and radial nerves respectively. Blood-radial artery,
ulnar artery, anterior and posterior interosseous artery.
5-boxer’s fracture in the 5th metacarpal can lead to malunion, reducing functionality.
Metacarpophalangeal joints; state:
1-Type(s)
2-Articular surfaces
3-Movements of the joint
4-Blood supply and nerve supply
1-condyloid synovial joints with 2 degrees of freedom
2-cupped bases of phalanges and rounded heads of metacarpals, consists of a fibrocartilage pad on palm
3-flexion, extension, ulnar/radial deviation
4-Nerve-median, radial and ulnar. Blood-superficial and deep palmar arch
Interphalangeal joints; state:
1-Type(s)
2-Articular surfaces
3-Intrinsic and extrinsic ligaments
4-Movements of the joint
5-Blood supply and nerve supply
1-synovial hinge joints with 1 degree of freedom
2-phalangeal heads and bases
3-Intrinsic-medial/lateral collateral ligaments, palmar ligament (thick and fibrocartilaginous). Extrinsic-flexor and extensor tendons.
4-flexion and extension
5-Nerve-median, radial and ulnar. Blood-superficial and deep palmar arch
Atlanto-occipital joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial condyloid joint with 2 degrees of freedom
2-occipital condyles of the skull and superior articular facets of C1. Respective convexity and concavity is involved.
3-loose joint capsule for ROM
4-no discs or tendons
5-intrinsic ligaments-anterior and posterior atlanto-occipital membranes (a continuation of ligamentum flavum). Extrinsic-alar, tectorial membrane and apical ligament of the dens.
6-flexion, extension, lateral flexion (slight). Longus capitis, rectus capitis anterior/major/minor/lateralis, splenius capitis, semispinalis capitis, sternocleidomastoid.
7-Nerves-suboccipital (C1). Blood-vertebral and occipital arteries.
8-occipital neuralgia-compression of the occipital nerve leading to pain in upper neck, back of head and back of eyes
Atlanto-axial joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements and muscles acting on the joint
7-Blood supply and nerve supply
8-Clinical problems
1-(median) pivot joint, (laterals) plane synovial joint with 1 degree of freedom
2-median atlanto-axial joint-dens and anterior arch of C1. Lateral atlanto-axial joints-inferior articular surfaces of the atlas and the superior articular surfaces of the axis.
3-joint capsule
4-hyaline cartilage
5-intrinsic-transverse ligament of the atlas. Extrinsic-alar, apical ligament of the dens and the tectorial membrane.
6-rotation
7-Nerves-suboccipital (C1) and second cervical nerve (C2). Blood-vertebral and ascending pharyngeal artery.
8-odontoid fracture, torticollis-tight muscles; limited ROM, transverse ligament rupture-dens may press against the spinal cord.
Facet joints; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-facet joints (zygapophyseal) are plane synovial joints with 1 degree of freedom.
2-superior articular process of the lower vertebrae and the inferior articular process of the upper vertebrae
3-thin joint capsule in the C vertebrae which grows thicker in the L vertebrae.
4-no discs or tendons
5-intrinsic-ligamentum flavum connects adjacent laminae. Extrinsic-supraspinous, interspinous and intertransverse ligaments.
6-C region-flexion, extension, lateral flexion and rotation. T region-limited(lateral flexion and extension). L region-flexion and extension.
7-Nerve-medial branches of the dorsal rami of the spinal nerves. Blood-posterior intercostal arteries (T) and lumbar arteries (L).
8-facet joint syndrome-degeneration/inflammation of facet joints causing localised pain and stiffness. Facet joint hypertrophy-enlargement of the facet joints due to osteoarthritis, which leads to spinal stenosis and nerve compression.
Intervertebral joints; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-cartilaginous joint (symphysis) with 3 degree of freedom
2-superior and inferior surfaces of the vertebral bodies
3-no capsule, annulus fibrosus is an outer ring that connects adjacent vertebrae
4-intervertebral disc found in joints from C2/3 to L5/S1. Annulus fibrosus is the outer layer of concentric collagen fibers. Nucleus pulposus-gel-like centre core allowing for shock absorption.
5-intrinsic-anterior and posterior longitudinal ligaments (ALL/PLL). Extrinsic-ligamentum flavum, interspinous, supraspinous and intertransverse ligaments.
6-flexion, extension, lateral flexion, rotation
7-Nerves-sinuvertebral nerves. Blood-vertebral arteries (C), posterior intercostal arteries (T), lumbar arteries (L).
8-degenerative disc disease-age related wear and tear, loss of height, decreased ROM, nerve impingement. Spinal stenosis-narrowing of the spinal canal due to disc degeneration. Spondylolisthesis-one vertebra slips forward. Osteophytes-bony outgrowths from the vertebral body.
Costovertebral joint; state:
1-Type
2-Articular surfaces
3-Intrinsic and extrinsic ligaments
4-Movements of the joint
5-Blood supply and nerve supply
6-Clinical problems
Costotransverse joint; state:
1-Type
2-Articular surfaces
3-Intrinsic and extrinsic ligaments
4-Movements of the joint
5-Blood supply and nerve supply
6-Clinical problems
Sacroiliac joint; state:
1-Type
2-Articular surfaces
3-Intrinsic and extrinsic ligaments
4-Movements of the joint
5-Blood supply and nerve supply
6-Clinical problems
1-plane synovial joint with 1 degree of freedom (diarthroidal)
2-auricular surface of sacrum (concave) and the auricular surface of ilium (convex)
3-intrinsic-anterior/posterior sacroiliac ligaments. Extrinsic-interosseous sacroiliac, sacrotuberous, sacrospinous and iliolumbar ligaments.
4-nutation (forward tilt) and counternutation
5-Nerves-sacral plexus and lumbar plexus, dorsal and ventral rami of sacral nerves. Blood-superior gluteal artery, iliolumbar artery and lateral sacral artery.
6-ankylosing spondylitis-inflammatory arthritis that causes SI joint fusion. Sacroiliitis-inflammation of the SI joint.
Hip joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-ball and socket synovial joint with 3 degrees of freedom
2-head of femur and acetabulum of pelvis
3-acetabulum to femoral neck
4-ligamentum teres (containing the acetabular branch of the obturator artery, important blood vessel for children) and acetabulum labrum, deepening the socket, providing additional stability, thicker on superior crest.
5-intrinsic-iliofemoral, pubofemoral and ischiofemoral. Extrinsic-zona obicularis (around femoral neck)
6-flexion, extension, abduction, adduction, internal and external rotation (circumduction).
7-Nerves-femoral, obturator and superior gluteal nerves and nerve to quadratus femoris. Blood-medial/lateral circumflex femoral arteries, superior/inferior gluteal arteries and obturator artery.
8-femeroacetabular impingement (FAI)-abnormal contact leading to pain and damage. Hip dysplasia- congenital malformation of hip joint.
State Wolff’s law.
Wolff’s law states that in healthy animals, bone will adapt to the loads under which it is placed.
Pubic symphysis; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-secondary cartilaginous (symphysis)
2-symphyseal surfaces of right and left pubic bones
3-blends with the periosteum of the pubic bones
4-fibrocartilaginous interpubic disc
5-intrinsic-superior pubic ligament. Extrinsic-anterior and posterior pubic ligaments.
6-very limited, increased flexibility is seen during pregnancy.
7-nerves-ilioinguinal, genitofemoral and obturator nerves. Blood-inferior epigastric, obturator and inferior pudendal arteries.
8-osteitis pubis is seen in athletes, it is inflammation of the joint. Symphyseal diastasis is separation of the joint due to childbirth or other trauma.
Knee joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial condyloid joint with 2 degrees of freedom. But 6 degrees of freedom clinically. Includes patellofemoral joint.
2-distal end of femur, distal tibial plateau, femoral patellar surface
3-blends with the tibial collateral ligament and attaches to edge of patella
4-medial and lateral menisci (fibrocartilage), tendon of popliteus, Hoffa’s fat pad (infrapatellar, behind patellar tendon but in front of the femoral condyles)
5-Intrinsic-ACL, PCL and transverse ligament of the knee. Extrinsic-medial and lateral collateral ligaments, patellar ligament, oblique and arcuate popliteal ligaments.
6-flexion/extension, internal/external rotation, gliding and rolling
7-Nerves-femoral, tibial, common peroneal nerve. Blood-genicular anastomosis.
8-ligament tears. Meniscal tears. Lateral patellar dislocations.
Superior tibiofibular joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-synovial plane joint with 1 degree of freedom
2-oval facet on fibular head and oval facet on lateral condyle of tibia
3-none
4-none
5-Intrinsic-anterior and posterior ligaments of the head of the fibula. Extrinsic-interosseous membrane*
6-gliding
7-Nerves-common peroneal nerve and nerve to popliteus. Blood-inferior lateral genicular artery and anterior tibial artery.
8-injury to common peroneal nerve affects dorsiflexion and eversion of foot
Inferior tibiofibular joint; state:
1-Type
2-Articular surfaces
3-Capsular attachments
4-Intracapsular structures (discs/tendons)
5-Intrinsic and extrinsic ligaments
6-Movements of the joint
7-Blood supply and nerve supply
8-Clinical problems
1-fibrous joint (syndesmosis) with 1 degree of freedom
2-fibular notch on tibia and triangular area on medial fibula
3-no capsule
4-none; fibrous joint
5-Intrinsic-anterior and posterior inferior tibiofibular ligament (AITFL/PITFL). Extrinsic-interosseous tibiofibular ligament (strong) and transverse tibiofibular ligament
6-gliding, widening of mortise
7-Nerves-deep peroneal, tibial, saphenous nerves. Blood-branches from fibular and A/P tibial arteries.
8-high ankle sprain-caused by excessive dorsiflexion or external rotation of foot. Effusion of the popliteal fossa. Baker’s cyst, swelling at the posterior knee, synovial extrusion through the posterior knee joint capsule, causing pressure on vascular structures. Tests for ACL tears: Lachman’s test-move tibia anteriorly relative to femur. Pivot shit test-internally rotate an elevated and extended leg, apply valgus (medial) stress, flex the knee in this manner. Produces a disconcerting feeling.
State Hilton’s law.
The nerve supplying a muscle that acts on a joint also supplies the joint and the skin over the joint.
What is hemarthrosis?
Hemarthrosis is bleeding within a joint
What is effusion? State causes, symptoms, diagnosis and treatment.
Effusion is excessive synovial fluid within a joint; swelling.
Causes: trauma to ligaments (ACL), meniscal tears, osteoarthritis, Baker’s cyst rupture.
Symptoms: knee swelling, pain, reduced ROM, tight sensation
Diagnosis: patellar tap (squeeze from both sides, palpate patella, see if it is floating), bulge sign (in medial knee), MRI, X-ray, etc…
Treatment: RICE, arthrocentesis
State tests for ACL tears.
Lachman’s test-move tibia anteriorly relative to femur.
Pivot shit test-internally rotate an elevated and extended leg, apply valgus (medial) stress, flex the knee in this manner. Produces a disconcerting feeling.
Anterior drawer test-flex knee, sit on foot, push posteriorly and pull anteriorly, ensuring a firm end point.
What is synovitis?
Synovitis refers to the inflammation of the synovial membrane, which lines the joint capsule and produces synovial fluid to lubricate and nourish the joint. It often leads to knee effusion.
What is the Baker’s cyst?
A Baker’s cyst is a fluid-filled swelling at the back of the knee due to excess synovial fluid in the popliteal bursa.
What are problems faced by women at the knee joint due to their anatomical variations?
Patellofemoral pain syndrome: the larger Q-angle in females leads to altered patellar tracking and anterior knee pain.
A higher Q-angle, hormonal influences, and joint laxity contribute to increased rates of knee osteoarthritis in women.
Iliotibal band syndrome: women are more prone due to wider hips, which increase tension on the IT band, leading to lateral knee pain.
State the joint type of the intervertebral joints.
Secondary cartilaginous (symphysis)
State the joint type of the costovertebral and costotransverse joints.
Synovial plane joint, the 2 joints act simultaneously
State the joint type of the costochondral joints.
Primary cartilaginous joint (hyaline)
State the joint type of the interchondral joints.
Synovial plane joint, ribs 7-10
State the joint type of the sternocostal joints.
Primary cartilaginous joint (1)
Synovial plane joint (2 to 7)
State the joint type of the sternoclavicular joint.
Saddle type synovial
State the joint type of the manubriosternal joint.
Secondary cartilaginous (symphysis)
State the joint type of the xiphisternal joint.
Primary cartilaginous (synchondrosis)
