ARTICULAR NEUROPHYSIOLOGY

Presented By – Yogesh Vyas

 Innerveation of the joint
 The majority of sensory innerveation of
the joint is found in the joint capsule.
 Two classes of the sensory neurons make up
the sensory innerveation
1) Neurons with large diameter myelinated
group 2 axons.
2) Neurons with small diameter
unmylinated or thinly myelinated group
3 & 4 axons also called as C – fiber afferents.
Group 1 axons innerveate only muscle
sensors & thus are not found in joints.
Group 2 neurons innerveate large multi-cellular end-
organs structures that are located in the capsule.
These sensory units are mechanoreceptors i.e. they are
mechanically sensitive.

The small diameter group 3 & 4 neurons have free nerve

endings as terminals
They have high threshold for mechanical activation
Intense, forceful, indentational or rotational stimuli are
required to activate them & it is generally accepted that
they are pain sensors.
 Nerve endings with group 2 axons
 There are two types of end organs innerveated by group 2 axons
1) Ruffini endings
2) Lamellated endings
 Ruffini endings
Morphology-The parent axons enters the joint capsule &
divides into multiple branches to form spray like ending
making large number of contacts with collagen
Distribution- Ruffini type endings are located in capsule on
the flexion side of joints i.e. side that is stretched upon
extension of the joint.
In the knee joint they are found in the posterior capsule.
Mechanical Sensitivty- Ruffini endings are stretch sensors.
The sensory contributions made by ruffini afferent neurons
are almost entirely confined to extensional rotations when
the joint is in limit of extension
 Golgi Tendon Organ
Morphology- The parent axon terminates
in an elongated, thinly capsulated structure
with a lamellar interior that in some ways
resembles a pacinian corpuscle.
Disribution- Lamellated endings are
found occasionally in the posterior side of
capsule, but mainly in the anterior parts
of knee joint
They are located in the subcapsular fibro
adipose tissue rather than in fibrous capsule
itself.
Mechanical sensitivty- These neurons
play no role in propriception in the knee,
but they appear to be responsible for the
sensations of compression that result from
applying external forces to the knee or from
effusions of the knee.
.
Afferent Neurons With Group 3 & 4 Axons
Morphology- Group 3 axons are small in diameter &
thinly myelinated, Gr. 4 axons are unmylinated.
Terminal process of both, however is a fine unmylinated axon
that branches & ends in fine tips having lumpy appearance.
Distribution – Sensory afferents with small diameter axons
terminate in free nerve endings that are located in soft
tissues of joint, including the capsule, collateral ligament &
patellar tendon.
Mechanical Sensitivty- fine afferents in joints responded
to very intense mechanical stimuli in the form of both
indentations & joint rotations.
 Neurogenic inflammation
When a joint is inflamed sensory neurons contribute
to generation and maintenance of inflammatory
process.
The process by which sensory neurons participate in
generating and maintaining inflammation is termed
“Neurogenic inflammation”.
 Joint afferents in proprioception
Proprioception-Complex senses of position & movement of a
joint
When a synovial joint is in its midrange position the senses of
movement & poisition arise from activity in muscle afferent
neurons
Tensing muscle which increases the discharge of muscle receptors
increases the sensitivty for detecting changes in joint position
Joint afferents appear to play no role in proprioception when joint
is in midrange of its position
Studies of joint afferents in animals show that joint afferents do
not provide signals to CNS useful in determing its position
CNS uses the signals from ruffini afferents only to recognize
that knee is in proximity to its limit of rotation in extension i.e.
serve as limit sensors in extension rotations
Lamellated endings
Lamellated endings- Poor candidates for role in
proprioception
They are sensitive to compression & not to rotational
stimuli
Fine afferents detect nociceptive stimulus irrespective
of joint position.
 Reflex connections made by joint afferent neurons
It is generally agreed that signals originating in peripheral
sensors as muscle spindles play a role in limb stabilization &
joint neurons do not play a major role in joint stabilization
Reflex affects that are mediated by Gr. 2 afferent do not have any
important role in stabilizing joints or in movement control
 No effect of neurectomy was found in the dogs motor behavior
by O'Connor et al.
The reflex effects that are contributed by fine nociceptor
afferents are difficult to evaluate .
The reflex effect made by fine afferents are consistent with the
“flexor reflex”. In flexor reflex stimuli that are intense enough to
excite nociceptor cause the stimulated limb to be withdrawn, so
the function of this reflex would be to flex the knee thus
protecting it by unloading it.
 The role of Joint Afferents in an Unstable Joint
Joint afferents have no role in regulation of joint
movement & only minimal role in proprioception
They protect the unstable joint from injury
In an experiment cutting the nerve to an unstable
joint increased the degree of cartilage injury
Reflex afferents are activated when the joint is
approaching the limit of its movement in extension,
fine afferents signal that the joint has been rotated in
“noxious position”.
If the joint can be repositioned, it would protect the
joint
 Mechanoreceptors in ligament
Sensory nerve endings have been described in ligaments , notably
the ACL.
Joint ligaments are deformed during rotations & it is known that
there are Gr. 2,3 & 4 sensory nerve endings in ligament.
Ruffini affernts respond to local tensile stresses or strain energy they
would be activated by stimuli that cause stress in the ACL
Ligament afferents do not play important role in proprioception
because
a) possing of nerve endings in ligaments are less compared
to joint capsule
b) ligament afferent serve as nonspecific limit sensors.
Since ligament tension can be caused by a number of different
types of rotations, the mechanoreceptors in them ar e poor
candidate to serve proprioceptive sensations of movements in
specific directions.
 Summary
Low threshold mechanoreceptors play a very small sensory role in
proprioception.
Ruffini afferents provide a limit of motion signal, that the joint is at or near
a limit of its movement.
Lamellated endings provide a sense of deep pressure.
The role of Low threshold mechanoreceptors is strictly sensory, when
activated they do not mediate significant motor reflex actions.
Joint nociceptors are activated by intense pressure stimuli or by forceful
rotations, both of which can be considered to be noxious.
They are sensitized by inflammation , they subserve sensations of pain
originating from joints.
The principal functional role for the sensory innervation of the joint is to
protect it in the event that it becomes unstable, by allowing the adaptations
of movement strategies that avoid damaging the unstable joint
Nociceptor in & around inflamed tissue can be activated
antidromically in Dorsal root reflexes.
THANK YOU