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Joints and Movement
Organisation of the Body
| Question | Answer |
|---|---|
| What is a joint | A site where two or more bones meet |
| Factors determining stability of a joint | Shape and size of the articular surfaces Thickness of the joint capsule surrounding the joint ]Ligaments associated with the joint Tone of skeletal muscles and tendons passing across the joint |
| Ligaments | Connects bones to bones at joints Provide strength and restrict excessive movement Mainly composed of collagen fibres arranged in parallel, variable amounts of elastin (controls elastic properties) |
| Solid joints | Skeletal elements are held together by connective tissue. Provides stable, restricted movement Two main types: Fibrous Cartilaginous |
| Solid fibrous joints | Suture (between flat bones) e.g. skull Syndesmosis (between long bones) e.g. interosseous membranes Gomphosis (between teeth and bone) |
| Solid cartilaginous joints | Synchondrosis (primary) e.g. growth plates Symphysis (secondary) e.g. fibrocartilage in pelvis |
| Synovial joints | Skeletal elements separated by a cavity Hyaline cartilage covers articulating surfaces Enclosed in a fibrous joint capsule Lined with a synovial membrane composed of secretory cells that produce synovial fluid Ligaments present arise from periosteum |
| Types of synovial joint | Uniaxial - hinge e.g elbow and pivot e.g. radio-ulnar joint Biaxial - saddle e.g. joints in the hand and ellipsoid e.g. wrist Multiaxial - ball and socket e.g. hip and plane synovial joint e.g. in the foot |
| Shoulder girdle - Scapular | Posterior border of the shoulder girdle Connects axial to appendicular skeleton Assists optimal movement of the glenohumeral joint Site of attachment for 17 muscles which function across multiple joints |
| Shoulder girdle - clavicle | Sternoclavicular joint (saddle) Acromio-clavicular joint (plane) Attached to coracoid process by coraco-clavicular ligament (conoid ligament medially and trapezoid ligament laterally) Attached to 1st costal cartilage (costo-clavicular ligament) |
| Glenohumeral (shoulder) joint | Multiaxial ball and socket joint Connects shoulder girdle to upper limb Most mobile joint in the body allowing vast movement of the arm and hand. Allows fine manipulation of objects. |
| Structure of glenohumeral joint | Humeral head articulates with glenoid fossa (25-30% of head articulates) this is a key contributor to joint mobility along with scapular movement. Glenoid labrum - fibrocartilaginous structure inside joint capsule to provide stability |
| Glenohumeral joint capsule | Attaches to the circumference of the glenoid cavity and inserts into the anatomical neck of the humerus. The synovial membrane wraps around the tendon of the long head of biceps brachii, which passes within the intertubercular sulcus |
| Stabilising structures of the shoulder | Static - glenohumeral and coracohumeral ligament Dynamic - rotator cuff muscles which pull humeral head medially into the glenoid fossa during movement. |
| Rotator cuff muscles | Supraspinatus - assists with inital arm abduction Infraspinatus - lateral shoulder rotation Teres Minor - Lateral shoulder rotation These insert in greater tubercle Subscapularis - Medial shoulder rotation (inserts in lesser tubercle) |
| Shoulder dislocation | Anterior - most frequent direction of displacement Complications: axillary nerve and axillary artery damage More common than hip dislocation Head of humerus stops articulating with the glenoid fossa |
| Elbow joint | A compound hinge synovial joint Radiohumeral - capitullum of humerus with radial head Ulnohumeral - trochlea of humerus with trochlear notch of the ulna (separate olecranon and coronoid process articular facets) |
| Capsule of the elbow joint | Common with proximal radio-ulnar joint Attaches proximally to the olecranon fossa and coronoid fossa of the humerus Attaches distally to the proximal radioulnar joint and to the anular ligament |
| Ligaments of the elbow joint | Medially - ulnar collateral ligament Laterally - radial collateral ligament |
| What gives the elbow joint stability | Shape of articular surfaces Strong collateral ligaments Surrounding cuff of muscles (triceps brachii, brachialis and biceps brachii) Maximum stability at 90 degrees in position of mid pronation-supination |
| Radio-ulnar joints | Synovial pivot joints Proximal joint - head of radius and the radial notch of ulna. Annular ligament reinforces the joint Distal joint - ulnar notch of the radius with ulnar head. Articular disc binds them and separates from wrist |
| Interosseous membrane | A fibrous syndesmosis joint along the length of the shafts |
| Wrist joint | Synovial ellipsoid joint Formed by articulation between: distal end of radius and articular disc of the radioulnar joint with proximal row of carpal bones except pisiform. Radial and ulnar collateral ligaments strengthen laterally and medially |
| Capsule of the wrist joint | Attached to the distal ends of the radius and ulna and inserts into the dorsal and palmar aspects of the proximal row of carpal bones |
| Joints of the hand | Distal interphalangeal joint - hinge Proximal interphalangeal - hinge Metacarpo-phalangeal joint - ellypsoid 1st metacarpal joint (thumb) - saddle 2nd to 5th metacarpal joints - plane so restricted movement |
| Hip joint | Synovial ball and socket Acetabulum of the hip bone articulates with the head of femur Transmission of weight when standing and moving Strength and stability at expense of mobility |
| Acetabulum | Fusion of the ilium, ischium and pubis Articular part - covered with hyaline cartilage, deep central non-articular part =acetabular fossa Rim is deficient inferiorly=acetabular notch, close by transverse acetabular ligament Acetabular labrum deepens it |
| Head of the femur | Forms two thirds of a sphere, covered by hyaline cartilage (except where it is attached to the ligament of the head of the femur = fovea capitis) |
| Capsule of the hip joint | Very strong, forms a sleeve around the neck of the femur and the hip joint Additional support added by ligaments and muscles |
| Ligaments of the hip joint | 3 ligaments reinforce the external surface of the fibrous membrane and stabilise the joint: Iliofemoral Pubofemoral Ischiofemoral |
| Hip dislocation | Rare - deep acetabulum, acetabular labrum, strong capsule and hip joint ligaments Posterior dislocation is most common-when the hip is flexed ligaments are laxed, so seated people in high speed road accidents are prone. Complications:avascular necrosis |
| Knee joint | Largest synovial joint in the body Modified hinge joint Articulation between femur and tibia for weight bearing Articular surfaces are two femoral condyles and adjacent surfaces of superior aspect of tibial condyles |
| Articulation between patella and femur | Allows the pull of quadriceps femoris muscle to be directed anteriorly over the knee to the tibia without tendon wear Articular surfaces: V shaped trench on anterior surface of distal femur where two condyles join and adjacent surfaces on the patella |
| Capsule of the knee joint | Thin but strong. Strengthening bands from tendons Gaps: anteriorly- patella; lateroposteriorly; passage of tendon of popliteus muscle Forms fluid filled pouches = bursa |
| Lateral ligaments in the knee joint | Stabilisation Medial (tibial)collateral ligament - from the medial epicondyle of the femur to medial condyle and shaft of tibia Lateral (fibular) collateral ligament - rounded cord attaches from the lateral epicondyle of femur to the head of the fibular |
| Cruciate ligaments in the knee joint | Maintain anteroposterior stability Anterior cruciate ligament - prevents excessive anterior movement of the tibia Posterior cruciate ligament - prevent excessive posterior movement of the tibia Internal to the joint capsule but external to joint cavity |
| Menisci of the knee joint | Interconnected anteriorly by transverse ligament of the knee. Medial meniscus - attached around its margin to the capsule and tibial collateral ligament Lateral meniscus - unattached to the capsule connected to popliteus muscle tendon. |
| Tibio-fibular joints | Allow no active movement but permits a small range of gliding movement to accommodate ankle movement Proximal-plane synovial joint lateral tibial condyle and head of femur Distal - fibrous syndesmosis joint distal end of femur and fibular notch of tibia |
| Ligaments of the tibio-fibular joints | Proximal - anterior and posterior ligament of fibular head Distal - anterior, interosseous, posterior and transverse tibiofibular ligaments |
| Ankle joint | Distal ends of tibia and fibula form a tight mortise which clasps the talus Hinge joint - plantarflexion and dorsiflexion Capsule is weak and thin posteriorly and anteriorly to accommodate movement - lined by a loose synovial membrane |
| Subtalar joint and midtarsal joint | Between talus and calcaneus Movement of the ankle combined with movement at these joints Important for inversion and eversion of the foot Allows foot to be placed firmly on irregular surfaces providing a firm base |
| Medial Ankle ligaments | Tibiocalcaneal part Tibionavicular part Anterior tibiotalar part Posterior tibiotalar part Prevent excessive eversion |
| Lateral ankle ligaments | Posterior talofibular ligament Anterior talofibular ligament (most commonly injured) Calcaneofibular ligament Prevent excessive inversion |
| Arches of the foot | Medial longitudinal arch - calcaneus, talus, navicular, 3 cuneiforms, 1-3 metatarsals Lateral longitudinal arch - calcaneus, cuboid, 4-5 metatarsals Transverse arch - 3 cuneiforms, cuboid, 5 metatarsal bases |
| Ligaments of the arches of the foot | Plantar calcaneonavicular ligament - calcaneus to navicular Short plantar ligament - calcaneus to cuboid Long plantar ligament - calcaneus to bases 2-4 metatarsals |
| Function of the arches of the foot | Efficient in weight bearing Stabilising and supporting the foot |
| What is an arthrogram | When dye is injected into a joint to increase contrast before a scan is taken of the joint e.g. X-ray, MR or CT Used to diagnose labral/tendon/ligament/menisci tears, offer pain relief or in surgical planning |
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