Ch 8 - Joints

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KellyM
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Ch 8 - Joints
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2013-02-26 22:27:07
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  1. articulations

    -definition
    -function
    - classification
    • 1) Definition = the site where two or more bones meet (joint)
    • 2) Function = give skeleton mobility; hold skeleton together
    • 3) Classifications = functional and structural
  2. Functional classification of joints
    based on the amount of movement the joint allows they are classified into:

    • synarthroses - immovable joints (skull)
    • amphiarthroses - slightly movable joints (ribcage; sternum)
    • diarthroses - freely movable joints (elbow, fingers, wrists...)
  3. structural classification of joints
    based on the material binding the bones together and presence/absence of joint cavity.

    classified as:

    • fibrous joints
    • cartilaginous joints
    • synovial joints
  4. fibrous joints - definition; 1 example; 3 types
    • bones joined by dense fibrous connective tissue
    • no joint cavity
    • most are synarthrotic (immovable)
    • example: periodontal ligament

    • 3 types:
    • sutures
    • syndesmoses
    • gomphoses
  5. fibrous joints: Sutures
    • "seams"
    • immovable fibrous joint for protection of brain
    • rigid, interlocking joints
    • contain short connective tissue fibers
    • allow for growth during youth
    • in middle age, the sutures ossify and fuse (close) -- process called synostoses
  6. fibrous joints: Syndesmoses
    • bones connected by ligaments
    • fiber length varies so movement varies (if fibers are short, little to no movement or "give"; if fibers are long, a large amount of movement is possible)
  7. fibrous joints: Gomphoses
    • peg-in socket joints of teeth in alveolar sockets
    • fibrous connection is the periodontal ligament

    gompho = bolt or nail
  8. Cartilaginous joints - definition; 1 example; 2 types
    • bones united by cartilage
    • no joint cavity
    • not highly movable
    • example: pubic symphysis; intervertebral disc

    • Two types:
    • Synchondroses
    • Symphyses
  9. cartilaginous joints: Synchondroses
    • bar/plate of hyaline cartilage unites bones
    • all are synarthrotic (immovable)

    • Example:
    • temporary epiphyseal plate joints before becoming a synostoses after plate closure; cartilage of 1st rib w/manubrim - immovable
  10. cartilaginous joints: Symphyses
    • fibrocartilage unites bone
    • strong, flexible amphiarthroses (slightly movable)
  11. synovial joints
    • bones separated by a fluid filled joint cavity
    • all are diarthrotic (freely movable)
    • includes: all limb joints; most movable joints of body
  12. Synovial joints - 6 distinguishing features
    • 1) Articular cartilage (hyaline cartilage)
    • - prevents crushing of bone ends
    • 2) Synovial (joint) cavity
    • - small, fluid-filled potential space
    • 3) Articular (joint) capsule - consisting of 2 layers
    • - external fibrous layer (dense irregular tissue)
    • - inner synovial membrane (loose connective tissue that produces synovial fluid)
    • 4) Synovial fluid
    • - viscous, slippery fluid that lubricates and nourishes articular cartilage
    • 5) different types of reinforcing ligaments
    • - capsular (thickened part of fibrous layer)
    • -extracapsular (outside of capsule)
    • - intracapsular (deep to capsule, covered by synovial membrane)
    • 6) nerves and blood vessels
    • - nerve fibers monitor joint position, stretch, and pain
    • - capillary beds supply filtrate for synovial fluid
  13. Three stabilizing factors at synovial joints
    • 1) shapes of articular surfaces (minor role)
    • 2) ligament number and location (limited role)
    • 3) muscle tendons that cross joint (most important)
    • - muscle tone keeps tendons taut -- extremely important in reinforcing shoulder and knee joints and arches of foot
  14. Three general types of movements at synovial joints
    • 1) Gliding
    • - one flat bone surface glides or slips over another similar surface (intercarpal/tarsal joint; b/w articular processes of vertebrae)
    • 2) Angular movements
    • - increase or decrease angle b/w two bones; movement along sagittal plane (flexion, extension, hypertension; adduction, abduction; circumduction)
    • 3) Rotation
    • - turning of bone around its own long axis (medial and lateral rotation ~ turn head; toward midline or away from it ~ rotation of humerus and femur)
  15. special movements at synovial joints
    • 1) supination (radius and ulna parallel) and pronation (radius rotates over ulna) of radius and ulna
    • 2) dorsiflexion and plantar flexion of foot
    • 3) inversion (toes toward midline) and eversion (toes away from midline) of foot
    • 4) protraction (mandible forward) and retraction (mandible pushed back)
    • 5) elevation (closed) and depression (open) of mandible
    • 6) opposition of thumb and mandible (fingers touching?)
  16. Types of synovial joints:  six types based on shape of articular surfaces
    • 1) plane: intercarpal joints
    • 2) hinge: elbow
    • 3) pivot: proximal radioulnar joints
    • 4) condylar: metacarpophalengeal joints (knuckle); wrist joints
    • 5) saddle: carpometacarpal joints of the thumbs
    • 6) ball and socket: shoulder joints and hip joints.
  17. Common joint injuries: 3 types
    • cartilage tears
    • sprains
    • dislocations (luxations)
  18. common joint injuries: cartilage tears
    • due to compression and stress
    • fragments may cause joint to lock or bind
    • cartilage rarely repairs itself
    • repaired with arthroscopic surgery (ligaments repaired; cartilage fragments removed w/minimal tissue damage)
    • partial meisci removal renders joint less stable but still mobile; complete removal leads to osteoarthritis
    • meniscal transplant in younger patients
    • perhaps meniscus grown from own stem cells in future
  19. common joint injuries: sprains
    • reinforcing ligaments stretched or torn
    • partial tears slowly repair heal (poor vascularization)

    • 3 options if torn completely:
    • 1) ends sewn together
    • 2) replaced with grafts
    • 3) time and immobilization
  20. common joint injuries: dislocations (luxations)
    • bones forced out of alignment
    • accompanied by sprains, inflammation, and difficulty moving joint
    • caused by serious falls or contact sports
    • must be reduced to treat
  21. arthritis
    • >100 different types of inflammatory or degenerative diseases that damage joints
    • most widespread crippling disease in the US
    • symptoms: pain, stiffness, and swelling of joint
    • acute forms: caused by bacteria, treated w/antibiotics
    • chronic forms: osteoarthritis, rheumatoid arthritis, and gouty arthritis
  22. osteoarthritis (OA)
    • common, irreversible, degenerative ("wear and tear") arthritis
    • more cartilage is destroyed than replaced
    • may reflect excessive release of enzymes that break down articular cartilage
    • exposed bone ends thicken, enlarge, form bone spurs, and restrict movement
    • treatment: moderate activity, mild pain relievers, capsaicin creams
    • by age 85, half of Americans develop OA, more women than men
    • probably related to normal aging process
  23. rheumatoid arthritis (RA)
    • chronic, inflammatory, autoimmune disease (immune system attacks own cells)
    • usually arises b/w ages 40-50; 3x as many women than men
    • symptoms: joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems
    • RA begins with synovitis (inflammation) of affected joint ---- immune cells migrate to joint and release inflammatory chemicals that destroy tissues; synovial fluid accumulates; joint swelling occurs; inflamed synovial membrane which thickens
    • treatment: disrupt destruction of joints by immune system; steroidal and nonsteroidal anti-inflammatory drugs decreases pain and inflammation; immune suppressants slow autoimmune reaction; some agents target inflammatory mediators to block action of inflammatory chemicals; can replace joint with prosthesis
  24. know the difference between RA and OA

    -who gets it
    -symptoms
    -causes
    -treatment
    RA  and  OA

    • 1) who gets it?
    • 3x as many women that men, arises b/w ages 40-50
    • more women than men; half Americans by age 85
    • 2) symptoms?
    • joint pain and swelling (usually bilateral), anemia, osteoporosis, muscle weakness, and cardiovascular problems
    • exposed bone ends thicken, enlarge, form bone spurs, and restrict movement
    • 3) causes?
    • chronic, inflammatory autoimmune disease.  bone erosion and swollen inflamed synovial membrane.
    • common, irreversible, degenerative arthritis, most likely related to normal aging.  more cartilage is destroyed than replaced - bone ends rub together, thinned cartilage
    • 4) treatment?
    • disrupt destruction of joints by immune system; steroidal and nonsteroidal anti-inflammatory drugs decreases pain and inflammation; immune suppressants slow autoimmune reaction; some agents target inflammatory mediators to block action of inflammatory chemicals; can replace joint with prosthesis
    • moderate activity; mild pain relievers; capsaicin creams (Glucosamine, chondroitin sulfate, and nutritional supplements not effective)

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