Articulations Articulation joint point of contact between bones

Articulations Articulation = joint = point of contact between bones

Joint Classification Functional Name Synarthroses Amphiarthroses Diarthroses Structural Name Fibrous Cartilaginous (hyaline, fibrocartilage) Synovial Movement Immovable Slightly movable Freely movable Example Description Syndesmoses ligaments Sutures skull Gomphoses Teeth to jaw Synchondrosis Ribs, epiphyseal plate Symphyses Pubis, vertebral discs Uniaxial Hinge, pivot Biaxial Saddle, ellipsoidal Multiaxial Ball and socket, gliding

Synarthroses Fibrous Joints

Amphiarthoses Cartilaginous

Diarthroses Synovial • • • Most numerous Most complex Structures – joint capsule • sleevelike encasing around bone ends to bind them together – synovial membrane • bursae membrane lining capsule to secrete synovial fluid – bursae • cushions joints and helps tendons move – joint cavity • small space between bones – articular cartilage • hyaline cartilage covering bone ends – menisci • pads of fibrocartilage between bones – Ligaments • strong, dense, white fibrous tissue that hold bones firmly together

Knee Joint (Hyaline cartilage) (fibrocartilage)

Ankle Joint Anterior interior tibiofibular ligament Achilles tendon (cut)

Types of Joints ellipsoidal

Uniaxial Joints permits movement around one axis and one plane • projection of one bone articulating with a ring/notch of another bone – examples - between vertebrate • allows only flexion and extension – examples – elbow, knee • knee joint – largest joint, most complex, most frequently injured

Biaxial Joints permits movement around two perpendicular axes and planes • Example – thumb • only saddle joint in the body • condyle fits into an elliptical socket • Example – between radius and carpals ellipsoidal

Multiaxial Joints permits movement around three or more axes and planes • most moveable joints • ball shaped head fits into concave depression • example - shoulder, hip – humeroscapular joint • most mobile joint – sacroiliac joint • hip joint • relatively flat articulating surface that allows gliding movement • example – between carpals – between tarsals – between vertebrate

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ROM (Range of Motion) • Goniometer – Used to determine extent of injury and progress of rehabilitation – measures range of motion (degree of angle)

Angular ROM • • flexion – decreases angle, movement towards body extension – increase angle, movement away from body hyperextension – stretching or extending beyond anatomical position plantar flexion – increase angle between top of foot and front of leg (point down) dorsiflexion – decrease angle between top of foot and front of leg (point up) ABduction – move AWAY from medial plane ADduction – move TOWARDS medial plane

Circular ROM • rotation – pivoting a bone on its axis • circumduction – distal end of a body part moves in a circle • supination – hand palm side up • pronation – hand palm side down

Special Movements • • • inversion – turn sole inward eversion – turn sole outward protraction – move part forward retraction – move part backward elevation – move part up depression – move part down

Joint Disorders • Inflammatory (IJD) – Rheumatoid arthritis – Gouty Arthritis • Noninflammatory (NIJD) – Osteoarthritis – Tramatic Injuries • • • Dislocation Meniscus tear Sprain Ligament tear Herniated disc

Joint Disorders • Rheumatoid arthritis – Chronic and systemic – Inflammation of synovial membrane – Cartilage destroyed, bone erosion – Progressive crippling and deformity – Pain, inflammation, decreased mobility, aching, stiffness – Treat with corticosteroid drugs and NSAIDS

Joint Disorders • Gouty arthritis – Also referred to as just Gout – Excessive uric acid in blood – Crystals get deposited in synovial fluid – Chronic inflammation and tissue damage – Swelling, tenderness – Pin in wrists, fingers, ankles, knees, elbows – Treat with Allopurinol (inhibits uric acid synthesis) and Uloric (new med)

Joint Disorders NIJDC Osteoarthritis IJD Rheumatoid arthritis IJD Gout

Joint Disorders • Osteoarthritis – Most common NIJD – Wear and tear deterioration – Atrophy of articular cartilage – Formation of new bone at joint surface – Most common in weight-bearing joints – Stiffness, pain, limited movement – Treat symptoms with NSAIDS

Joint Disorders • Dislocation – – Articular surfaces not in proper contact Tear vessels, nerves, ligaments, muscles Pain and swelling Treat with realignment (reduction); sometimes surgery

Joint Disorders • Sprain – Stretching of ligaments surrounding joint – Due to twisting motion – Hematoma, limited motion – Treatment: R. I. C. E. • • Rest Ice compression elevation

Degree of Sprains • 1 st degree ankle sprain – – – • 2 nd degree ankle sprain – – • Some stretching or perhaps tearing may have occurred No loss of function Mild pain, little bruising Little or no swelling Some joint stiffness or difficulty walking Difficulty walking Moderate to severe pain Swelling and tenderness in the ankle joint Bruising may start after 3 to 4 days 3 rd degree ankle sprain – – – most serious Total rupture of a ligament Walking may not be possible Severe pain initially and substantial swelling May require surgery

Joint Disorders • Ligament Tears (3 rd degree Sprain) • Bruising, pain, swelling, instability • Physical therapy • Partial tear vs. complete tear – Partial Tear – boot/brace, crutches – Complete Tear - Surgery after most swelling subsides

Joint Disorders - Knee • Meniscus Tear – One of most common athletic injuries – Swelling, pain, instability, limited motion – Treat with arthroscopic surgery

Meniscus Normal Tear of medial meniscus

Joint Disorders - Knee • ACL tear – Women more likely than men – Will hear a popping sound – Usually due to twisting motion • Get hit very hard on the side of your knee, such as during a football tackle • Overextend the knee joint • Quickly stop moving and change direction while running, landing from a jump, or turning – Repair by grafting (not sew back together) • Patellar tendon autograft (autograft comes from the patient) • Hamstring tendon autograft • Quadriceps tendon autograft • Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon

ACL, MCL, PCL tears

Arthroscopic surgery • 3 -4 very small incisions ¼ in. – fiber-optic light source – video camera – terile saline solution is continuously pumped through the knee via a cannula

Vertebral Disc Disorders

Herniated disc Treatment • Steroid epidural – Use long needle to inject steroid into epidural space in order to shrink the herniation (cartilage) • Surgery • Microdiscectomy • Fusion

Steroid Epidural

Knee Arthroscopic Surgery • http: //www. youtube. com/watch? v=n. Aj 2_pg Tk. EA • http: //www. youtube. com/watch? v=kp. W 2 M OOI 5 yw Knee Replacement • http: //www. youtube. com/watch? v=H 3 xkj_1 d. ZQ 0

Hip Replacement • http: //www. youtube. com/watch? v=Dosqb. E y 8 ec. Y • http: //www. webmd. com/painmanagement/video/hip-restoration • http: //www. youtube. com/watch? v=lh 2 UX 8 g. Qn. BM • http: //www. youtube. com/watch? v=v. JL 8 n_ 82 ITM

Ankle Arthroscopy http: //www. youtube. com/watch? v=A 22 l. Ty. Pngu. Y Herniated disc epidural http: //www. youtube. com/watch? v=97 m 4 VICMJo. U Herniated disc microdisectomy http: //www. youtube. com/watch? v=r. U 8 YYESYXzc&feature= related Spinal Fusion https: //www. youtube. com/watch? v=HXt. KKB 6 z. Eh. M https: //www. youtube. com/watch? v=Oki. Hb-ECBVA