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Poonam Singh
Poonam Singh

Joints are regions where two or more bones meet. They can be classified based on structure and function. The main types are fibrous, cartilaginous, and synovial joints. Synovial joints are the most advanced and include hinge, pivot, ball and socket, and others. They have articular cartilage, a fibrous capsule, synovial membrane and fluid, and allow various movements. Common joint diseases are osteoarthritis and rheumatoid arthritis. Joint replacement surgery can help treat severe joint damage from diseases like arthritis.

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CAPT POONAM SINGH PG RESIDENT JOINTS
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.
A. Sutures 1. Plane 2. Squamous 3. Serrate 4. Dentate 5. Schindylesis B. Gomphosis C. Syndesmosis A. 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
CLASSIFICATION 1. 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.
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
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
SUTURE Restricted to skull Synostosis on completion of growth.
TYPES OF SUTURES (median palatine suture) (sagittal suture) (lambdoid suture) (between temporal & parietal bone)
SYNDESMOSIS • Fibrous connection between bones • Represented by  Interosseous ligament  Slender fibrous cord  Dense Aponeurotic membrane Eg. Inf tibiofibular jt, post part of sacroiliac jt.
GOMPHOSIS • Peg & socket joints between tooth & its socket
CARTILAGINOUS JOINT 1. Primary Cartilaginous Joint Also called as synchondrosis
CARTILAGINOUS JOINT 2. Secondary Cartilaginous Joints Also called as symphysis
SYNOVIAL JOINT • Most evolved joint. • Freely movable joint. • Possess a joint cavity that consists of synovial fluid.
CHARACTERISTICS OF SYNOVIAL JOINTS 1. 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.
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.
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
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
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.
BLOOD SUPPLY • Periarticular arterial plexuses– circulus articularis vasculosus • Articular cartilage: avascular • Fibrous capsule & ligaments: poor blood supply • Synovial membrane: rich blood supply
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.
TYPES OF SYNOVIAL JOINT 1. Based on shape of articular surface Articulating surface- Flat Gliding or Sliding Movements Eg. Intercarpal & Intertarsal Intermetacarpal Intermetatarsal Zygapophyseal
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
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
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.
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
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
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.
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.
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.
MOVEMENTS OF SYNOVIAL JOINTS 1. TRANSLATION: gliding or sliding movements 2. ANGULATION: change in the angle betn the topographical axes of the articulating bones. 4 types a). Flexion b). Extension c). Abduction d). Adduction 3. ROTARY / CIRCULAR MOVEMENTS a). Axial rotation b). Circumduction
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
DEVELOPMENT OF JOINTS  Their subsequent development varies acc. to type of joint 1.Fibrous joint 2.Cartilaginous joint 3.Synovial joint
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.
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
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 .
OSTEOARTHRITIS
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.
RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS • T/t: - physical therapy -nutritional therapy -analgesia/ anti-inflammatory (NSAIDS) -steroids -DMARDS (disease- modifying anti - rheumatic drugs)
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
JOINT REPLACEMENT SURGERY • Complications: 1. Mal positioning of the components 2. Loss of ROM, dislocation 3. # of the adjacent bone 4. Damage to b.vs & nerves 5. Infection, persistent pain 6. Weakness 7. Loosening of the components
• 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
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  • 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 A. 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 1. 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
  • 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 1. 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 1. TRANSLATION: gliding or sliding movements 2. ANGULATION: change in the angle betn the topographical axes of the articulating bones. 4 types a). Flexion b). Extension c). Abduction d). Adduction 3. 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 .
  • 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.
  • 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: 1. Mal positioning of the components 2. Loss of ROM, dislocation 3. # of the adjacent bone 4. Damage to b.vs & nerves 5. Infection, persistent pain 6. Weakness 7. 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

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