Joints - Chiropractor Manhattan | Chiropractor New Yor City
Download
Report
Transcript Joints - Chiropractor Manhattan | Chiropractor New Yor City
JOINTS
JOINT
A joint is the junction or pivot point between two
or more bones.
Movement of the body as a whole results from the
rotation of bones about individual joints.
Joints transfer and dissipate forces produced by
gravity and muscle activation.
Dr. Michael P. Gillespie
2
ARTHROLOGY
Arthrology is the study of the classification,
structure, and function of joints.
Aging, long-term immobilization, trauma, and
disease all affect the structure and ultimate
function of joints.
These factors influence the quality and quantity
of human movement.
Dr. Michael P. Gillespie
3
CLASSIFICATION OF JOINTS
Structural Classification
Presence or absence of a space (synovial cavity)
Type of Connective Tissue
Dr. Michael P. Gillespie
Functional Classification
Relates to the degree of movement they permit.
4
CLASSIFICATION OF JOINTS BASED
ON MOVEMENT POTENTIAL
Two major types of joints exist within the body:
Synarthroses
Diarthroses
Dr. Michael P. Gillespie
5
JOINTS OF THE BODY
Dr. Michael P. Gillespie
6
SYNARTHROSES
A synarthrosis is a junction between two bones
that allows slight to essentially no movement.
Synarthroidial joints can be classified as either
fibrous or cartilaginous based upon the dominant
type of connective tissue.
Dr. Michael P. Gillespie
7
TYPES OF SYNARTHROSES
Fibrous joints
Dense connective tissue (high concentration of
collagen)
Sutures of the skull
Joints reinforced by an interosseous membrane
(distal tibiofibular joint).
Dr. Michael P. Gillespie
Cartilaginous joints
Flexible cartilage or hyaline cartilage
Symphysis pubis
Interbody joints of the spine
Manubriosternal joint
8
DIARTHROSES (SYNOVIAL JOINTS)
A diarthrosis is an articulation that allows
moderate to extensive motion.
Possess a synovial fluid-filled cavity.
Compose the majority of the joints within the
musculoskeletal system.
Dr. Michael P. Gillespie
9
SEVEN ELEMENTS OF
DIARTHRODIAL JOINTS
Articular cartilage – covers the ends and other
articular surfaces of bones
Joint capsule (articular capsule) – peripheral
curtain of connective tissue
Synovial membrane – dcxf vcdx d cxdfv cxfefdsex
Synovial fluid
Ligaments
Dr. Michael P. Gillespie
Capsular ligaments
Extracapsular ligaments
Blood vessels
Sensory nerves
10
ELEMENTS OF SYNOVIAL JOINTS
Dr. Michael P. Gillespie
11
INTRA-ARTICULAR DISCS (MENISCI)
Intra-articular discs (meninsci) – pads of
fibrocartilage imposed between articular
surfaces.
These pads increase congruency and improve
force dispersion.
Examples of intra-articular discs
Tibiofemoral (knee)
Distal radio-ulnar
Sternoclavicular
Acromioclavicular
Temporomandibular
Apophyseal (variable)
Dr. Michael P. Gillespie
12
PERIPHERAL LABRUM
A peripheral labrum of fibrocartilage extends
from the body rims of the glenoid fossa to the
shoulder and the acetabulum of the hip.
These structures deepen the concave surface of
the joint.
These structures support and thicken the
attachment of the joint capsule.
Dr. Michael P. Gillespie
13
FAT PADS
Fat pads thicken the joint capsule, causing the
inner surface of the capsule to fill nonarticulating
joint spaces formed by incongruent bony
contours.
They are prominent in the elbow and knee joints.
Enlarged and inflamed fat pads can adversely
affect the biomechanics of the joint.
Dr. Michael P. Gillespie
14
BURSAE
A bursa is an extension or outpouching of the
synovial membrane of a diarthroidial joint.
Bursae are filled with synovial fluid and exists in
areas of potential stress.
Bursae help to absorb force and protect
periarticular connective tissues, including bone.
Dr. Michael P. Gillespie
15
SYNOVIAL PLICA
Synovial plicae (synovial folds, synovial
redundancies, or synovial fringes) are slack,
overlapped pleats of tissue composed of the
innermost layers of the joint capsule.
They are found in joints with large capsular
surface area such as the knee and elbow.
They increase the synovial surface area and
allow full joint motion without undue tension on
the synovial lining.
Folds that are thickened or adhered due to
inflammation can alter the joint biomechanics.
Dr. Michael P. Gillespie
16
STRUCTURAL CLASSIFICATION OF JOINTS
Fibrous
Fibrous CT
Lack a synovial cavity
Cartilaginous
Joints
Cartilage
Lack a synovial cavity
Synovial
Dr. Michael P. Gillespie
Joints
Joints
Have a synovial cavity
Dense irregular CT
Often associated with accessory ligaments
17
FUNCTIONAL CLASSIFICATION OF JOINTS
Synarthrosis (syn = together)
Amphiarthrosis (amphi = on both sides)
A slightly moveable joint
Diarthrosis (moveable joint)
A freely moveable joint
Synovial joints
Dr. Michael P. Gillespie
Immovable joint
18
FIBROUS JOINTS
Lacks a synovial cavity
Little or no movement
Dr. Michael P. Gillespie
19
FIBROUS JOINTS
Sutures
Immovable
Synostosis – suture that is replaced by bone in
the adult
Syndesmoses
Slightly moveable (amphiarthrosis)
Ligament
Interosseous membrane
Dr. Michael P. Gillespie
Gomphoses
Dentoalveolar joint
20
CARTILAGINOUS JOINTS
Lacks a synovial cavity
Allows little or no movement
Synchondroses
Epiphyseal plate
Symphyses
Pubic symphisis
Intervertebral discs
Dr. Michael P. Gillespie
21
SYNOVIAL JOINTS
Synovial (Joint) Cavity – space btwn. Bones
Freely moveable
The bones are covered by hyaline cartilage
Contains the following:
Articular capsule
Synovial fluid
Accsessory ligaments and articular discs
Dr. Michael P. Gillespie
22
CLASSIFICATION OF SYNOVIAL JOINTS
BASED ON MECHANICAL ANALOGY
Hinge joint
Pivot joint
Ellipsoid joint
Ball-and-socket joint
Plane joint
Saddle joint
Condyloid joint
Dr. Michael P. Gillespie
23
HINGE JOINT
Primary Angular Motions
Mechanical Analogy
Door hinge
Anatomic Examples
Humero-ulnar joint
Interphalangeal joint
Dr. Michael P. Gillespie
Flexion and extension only
24
HINGE JOINT
Dr. Michael P. Gillespie
25
PIVOT JOINT
Primary Angular Motions
Mechanical Analogy
Doorknob
Anatomic Examples
Dr. Michael P. Gillespie
Spinning of one member around a single axis of
rotation
Humeroradial joint
Atlanto-axial joint
26
PIVOT JOINT
Dr. Michael P. Gillespie
27
ELLIPSOID JOINT
Primary Angular Motions
Mechanical Analogy
Flattened convex ellipsoid paired with a concave
trough
Dr. Michael P. Gillespie
Biplanar motion (flexion-extension and abductionadduction)
Anatomic Examples
Radiocarpal joint
28
ELLIPSOID JOINT
Dr. Michael P. Gillespie
29
BALL-AND-SOCKET JOINT
Primary Angular Motions
Mechanical Analogy
Spheric convex surface paired with a concave cup
Anatomic Examples
Dr. Michael P. Gillespie
Triplanar motion (flexion-extension, abductionadduction, and internal-external rotation)
Glenohumeral joint
Coxofemoral (hip) joint
30
BALL-AND-SOCKET JOINT
Dr. Michael P. Gillespie
31
PLANE JOINT
Primary Angular Motions
Mechanical Analogy
Relatively flat surfaces apposing each other, like a
book on a table
Anatomic Examples
Dr. Michael P. Gillespie
Slide (translation) or combined slide and rotation
Carpometacarpal joints (digits II to IV)
Intercarpal joints
Intertarsal joints
32
PLANE JOINT
Dr. Michael P. Gillespie
33
SADDLE JOINT
Primary Angular Motions
Biplanar motion
Spin between bones is possible, but may be limited by
interlocking nature of joint
Mechanical Analogy
Each member has a reciprocally curved concave and
convex surface oriented at right angles to the other,
like a horse rider and a saddle
Dr. Michael P. Gillespie
Anatomic Examples
Carpometarcarpal joint of the thumb
Sternoclavicular joint
34
SADDLE JOINT
Dr. Michael P. Gillespie
35
CONDYLOID JOINT
Primary Angular Motions
Biplanar motion
Either flexion-extension and abduction-adduction, or
flexion-extension and axial rotation (internalexternal rotation)
Mechanical Analogy
Dr. Michael P. Gillespie
Mostly spheric convex surface that is enlarged in one
dimension like a knuckle; paired with a shallow
concave cup
Anatomic Examples
Metacarpophalangeal joint
Tibiofemoral (knee) joint
36
CONDYLOID JOINT
Dr. Michael P. Gillespie
37
SIMPLIFYING THE CLASSIFICATION
OF SYNOVIAL JOINTS
Two articular forms based upon true movement
of the joint.
Essentially all synovial joints of the body with
the notable exception of planar joints can be
categorized under this scheme.
Dr. Michael P. Gillespie
Ovoid joint
Saddle joint
38
OVOID JOINT
An ovoid joint has paired mating surfaces that
are imperfectly spheric, or egg-shaped, with
adjacent parts possessing a changing surface
curvature.
The articular surface of one bone is convex and of
the other is concave.
Most joints of the body are of this variety.
Dr. Michael P. Gillespie
39
SADDLE JOINT
A saddle joint consists of paired convex and
concave surfaces oriented at approximately 90
degrees to each other.
Each member has a reciprocally curved concave
and convex surface oriented at right angles to the
other, like a horse rider and a saddle.
Dr. Michael P. Gillespie
40
BASIC SHAPES OF JOINT SURFACES
Dr. Michael P. Gillespie
41
Dr. Michael P. Gillespie
42
BIOLOGICAL MATERIALS OF
PERIARTICULAR CONNECTIVE
TISSUES
Fibrous Proteins
Ground Substance
Glycosaminoglycans
Water
Solutes
Dr. Michael P. Gillespie
Collagen (type I and II)
Cells
Fibroblasts
Chondrocytes
43
TYPES OF COLLAGEN IN
PERIARTICULAR CONNECTIVE
TISSUES
Type I
Thick, rugged fibers that elongate when stretched
Present in ligaments, tendons, fascia, and fibrous
joint capsules
Type II
Thinner fibers than type I
Provide a framework for maintaining the general
shape and consistency of structures, such as hyaline
cartilage
Dr. Michael P. Gillespie
44
TYPES OF MOVEMENTS AT SYNOVIAL
JOINTS
Gliding
Simple back and forth movement, limited in
range, planar joints
Angular
Movements
Increase or decrease in the angle btwn. bones
Dr. Michael P. Gillespie
Rotation
Bone revolves around a longitudinal axis
Special
Movements
45
ANGULAR MOVEMENTS
Flexion, extension, lateral flexion,
hyperextension
Abduction, adduction, and circumduction
Dr. Michael P. Gillespie
46
ROTATION
Medial (internal) rotation
Lateral (external) rotation
Dr. Michael P. Gillespie
47
SPECIAL MOVEMENTS
Elevation
Depression
Protraction
Retraction
Inversion
Dr. Michael P. Gillespie
48
SPECIAL MOVEMENTS
Eversion
Dorsiflexion
Plantar flexion
Supination
Pronation
Opposition
Dr. Michael P. Gillespie
49
DISLOCATION
Luxation – displacement of a bone from a joint
Subluxation
Incomplete dislocation
Dr. Michael P. Gillespie
Causes tearing or ligaments, tendons, and articular
capsules
50
ARTHROSCOPY
Observaion of the interior of a joint
Utilizes a lighted, pencil-thin instrument
Assists in surgery and assessment of the joint
space
Dr. Michael P. Gillespie
51
SPRAIN & STRAIN
The ankle joint is the most often sprained.
The lumbar spine is another prominent location of
sprain.
Dr. Michael P. Gillespie
Sprain – a forcible wrenching or twisting of the
joint that stretches or tears its ligaments, but
does not dislocate the bones.
Strain – a stretched or partially torn muscle.
52
BURSAE & TENDON SHEATHS
Bursae
Tendon sheaths
Tubelike bursae that wrap around tendons
Occurs where tendons pass through synovial cavities
Reduce friction
Dr. Michael P. Gillespie
Saclike structures
Reduce friction in some synovial joints
53
BURSITIS
An
Dr. Michael P. Gillespie
acute or chronic inflammation of a
bursa
Caused by trauma or infection
Repeated excessive exertion
Symptoms
Pain, swelling, inflammation & limited
movement
Treatment
Oral anti-inflammatory agents (herbal, O.T.C.
And prescription), corticosteroid injections
54
Dr. Michael P. Gillespie
55
Dr. Michael P. Gillespie
56
Dr. Michael P. Gillespie
57
Dr. Michael P. Gillespie
58
Dr. Michael P. Gillespie
59
Dr. Michael P. Gillespie
60
ROTATOR CUFF INJURY
Supraspinatous
Infraspinatous
Teres Minor
Subscapularis
Common injury among pitchers and volleyball
players due to excessive circumduction
Dr. Michael P. Gillespie
61
SEPARATED SHOULDER
Injury of the acromioclavicular joint
Due to forceful trauma such as when the
shoulder strikes the ground in a fall
Dr. Michael P. Gillespie
62
TENNIS ELBOW
Lateral epicondylitis
Little-league elbow
Dr. Michael P. Gillespie
63
GOLFER’S ELBOW
Medial Epicondylitis
Dr. Michael P. Gillespie
64
DISLOCATION OF THE RADIAL HEAD
The most common upper limb dislocation in
children
Occurs with a strong pull to the forearm while it
is extended and supinated
Swinging a child around with outstretched arms
Dr. Michael P. Gillespie
65
SWOLLEN KNEE
Immediate swelling is due to blood loss
Delayed swelling is due to excessive production of
synovial fluid “water on the knee”
Dr. Michael P. Gillespie
66
DISLOCATED KNEE
Displacement of the tibia relative to the femur
Most commonly dislocates anteriorly
Dr. Michael P. Gillespie
67
RHEUMATISM
Dr. Michael P. Gillespie
Any painful disorder of the supporting structures
of the body – bones, ligaments, tendons, or
muscles – that is not caused by infection or
injury.
68
ARTHRITIS
A form of rheumatism in which the joints are
swollen, stiff, and painful.
Dr. Michael P. Gillespie
69
TYPES OF ARTHRITIS
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Degenerative joint disease
Gouty arthritis
A person with gout produces excessive uric acid or is
unable to excrete it properly
Dr. Michael P. Gillespie
Autoimmune disease – the body attacks its own
tissues
70
LYME DISEASE
First reported in Lyme, CT
Bacteria transported by deer ticks
The rash often resembles a bull’s eye target,
although some people never develop a rash
Symptoms
Joint stiffness, fever, chills, headache, stiff neck,
nausea
Dr. Michael P. Gillespie
71
TERMINOLOGY
Arthralgia – pain in a joint
Bursectomy – removal of a bursa
Chondritis – inflammation of cartilage
Synovitis – inflammation of a synovial membrane
in a joint
Dr. Michael P. Gillespie
72