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

7. SUTURE
Restricted to skull
Synostosis on completion of
growth.

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 .

36. OSTEOARTHRITIS

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.

38. RHEUMATOID ARTHRITIS

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