Joints

Dr. Shumaila Naz

DBS-NUMS
26-04-2021
 Joints: Structural and
functional classification

Structure of a typical synovial

joint
Learning outcomes
Types of synovial joints

Terms for descriptions of

movements
 • A joint is the site at which any two or
more bones articulate or come together.
Joints allow flexibility and movement of
the skeleton and allow attachment
between bones

Joints • General Function of Joints:

- Hold the skeleton together
- Allow for increased mobility and
flexibility of skeleton
 Types of joints
Fibrous joints
The bones forming these joints are linked with tough,
fibrous material. Such an arrangement often permits no movement.
For example, the joints between the skull bones, the sutures, are
completely immovable, and the healthy tooth is cemented into the
mandible by the periodontal ligament.
Cartilaginous joints
These joints are formed by a pad of tough fibrocartilage that acts as a
shock absorber. The joint may be immovable, as in the cartilaginous
epiphyseal plates, which in the growing child links the diaphysis of a
long bone to the epiphysis.
Some cartilaginous joints permit limited movement, as between the
vertebrae, which are separated by the intervertebral discs or at the
symphysis pubis which is softened by circulating hormones during
pregnancy to allow for expansion during childbirth
Synovial joints
Synovial joints are characterized by the presence of a space or capsule
between the articulating bones. The ends of the bones are held close
together by a sleeve of fibrous tissue and lubricated with a small amount of
fluid. Synovial joints are the most moveable of the body.
Types of joints
 Characteristics of a synovial joint
• Articular or hyaline cartilage
The parts of the bones in contact with each other are coated
with hyaline cartilage.
• This provides a smooth articular surface, reduces friction and
is strong enough to absorb compression forces and bear the
weight of the body.
• The cartilage lining, which is up to 7 mm thick in young people,
becomes thinner and less compressible with age. This leads to
increasing stress on other structures in the joint.
• Cartilage has no blood supply and receives its nourishment
from synovial fluid
 Characteristics of a synovial joint
• Synovial membrane
This epithelial layer lines the capsule and covers all non-weight-bearing surfaces inside
the joint. It secretes synovial fluid.

Synovial fluid
This is a thick sticky fluid, of egg-white consistency, which fills the synovial cavity. It:
• nourishes the structures within the joint cavity
• contains phagocytes, which remove microbes and cellular debris
• acts as a lubricant
• maintains joint stability
• prevents the ends of the bones from being separated, as does a little water between two
glass surfaces

Little sacs of synovial fluid or bursae are present in some joints, e.g. the knee. They act as
cushions to prevent friction between a bone and a ligament or tendon, or skin
where a bone in a joint is near the surface.
 Characteristics of a synovial joint
• Capsule or capsular ligament
The joint is surrounded and enclosed by a sleeve of fibrous tissue which holds
the bones together. It is sufficiently loose to allow freedom of movement but
strong enough to protect it from injury
• Other intracapsular structures
Some joints have structures within the capsule to pad and stabilize the joint, e.g.
fat pads and menisci in the knee joint. If these structures do not bear weight they
are covered by synovial membrane.
• Extracapsular structures
• Ligaments that blend with the capsule stabilize the joint.
• Muscles or their tendons also provide stability and stretch across the joints they
move. When the muscle contracts it shortens, pulling one bone towards the
other.
• Nerve and blood supply
Nerves and blood vessels crossing a joint usually supply the capsule and the
muscles that move it.
Main synovial joints of the limbs
Shoulder joint
This ball and socket joint is the most mobile in the body, and consequently
is the least stable and prone to dislocation, especially in children. It is
formed by the glenoid cavity of the scapula and the head of the humerus
and is well padded with protective bursae.
The capsular ligament is very loose inferiorly to allow for the free
movement normally possible at this joint. The glenoid cavity is
deepened by a rim of fibrocartilage, the glenoidal labrum, which provides
additional stability without limiting movement.
The tendon of the long head of the biceps muscle is held in the
intertubercular (bicipital) groove of the humerus by the transverse
humeral ligament. It extends through the joint cavity and attaches to the
upper rim of the glenoid cavity.
Synovial membrane forms a sleeve round the part of the tendon of the long
head of the biceps muscles within the capsular ligament and covers the
glenoidal labrum.

The joint is stabilized partly by a number of ligaments but mainly by the

muscles (and their tendons) present in the shoulder. Some of these muscles
collectively are called the rotator cuff, and rotator cuff injury is a common
cause of shoulder pain. The stability of the joint may be reduced if these
structures, together with the tendon of the biceps muscle, are stretched by
repeated dislocations of the joint.
 The latissimus dorsi is the largest muscle in the
upper body. The latissimus dorsi is responsible
for extension, adduction, transverse extension
also known as horizontal abduction (or
horizontal extension), flexion from an
extended position, and (medial) internal
rotation of the shoulder joint.

The teres major is a thick muscle of

the shoulder joint
Coracobrachialis muscle is the
smallest of the three muscles that
attach to the coracoid process of the
scapula.
The pectoralis major (from Latin
pectus 'breast') is a thick, fan-
shaped muscle, situated at the
chest of the human body.
The deltoid muscle is the muscle
forming the rounded contour of the
human shoulder
Teres minor is a posterior muscle of
the shoulder that extends between
the scapula and the head of
humerus
Main synovial joints of the limbs
Elbow joint
• This hinge joint is formed by the trochlea
and the capitulum of the humerus, and the
trochlear notch of the ulna and the head of
the radius. It is an extremely stable joint
because the humeral and ulnar surfaces
interlock, and the capsule is very strong.
• Extracapsular structures consist of anterior,
posterior, medial and lateral strengthening
ligaments, which contribute to joint
stability
Muscles and movements
Because of the structure of the elbow joint, the
only two movements it allows are flexion and
extension. The biceps is the main flexor of the
forearm, aided by the brachialis; the triceps
extends it
 Main synovial joints of the limbs
• Proximal and distal radioulnar joints
The proximal radioulnar joint is a pivot joint formed by the rim of
the head of the radius rotating in the radial notch of the ulna,
and is in the same capsule as the elbow joint.

The annular ligament is a strong extracapsular ligament that

encircles the head of the radius and keeps it in contact with the
radial notch of the ulna

The distal radioulnar joint is a pivot joint between the distal end
of the radius and the head of the ulna

Muscles and movements

The forearm may be pronated (turned palm down) or supinated
(turned palm up). Pronation is caused by the action of the
pronator teres and supination by the supinator and biceps
muscles
https://www.youtube.com/watch?v=Cph0LTG_Mss
 Main synovial joints of the limbs
Wrist joint
• This is a condyloid joint between the distal end of the
radius and the proximal ends of the scaphoid, lunate and
triquetrum.
• A disc of white fibrocartilage separates the ulna from
the joint cavity and articulates with the carpal bones. It
also separates the inferior radioulnar joint from the wrist
joint.
• Extracapsular structures consist of medial and lateral
ligaments and anterior and posterior radiocarpal
ligaments.

Muscles and movements

The wrist can be flexed, extended, abducted and adducted.
 flexor carpi radialis is a muscle of the human forearm that acts
to flex and (radially) abduct the hand.

Flexor carpi ulnaris is a fusiform muscle located in the anterior

compartment of the forearm
Main synovial joints of the limbs
Joints of the hands and fingers
There are synovial joints between the carpal bones,
between the carpal and metacarpal bones, between the
metacarpal bones and proximal phalanges and between
the phalanges.
Movement at the hand and finger joints is controlled by
muscles in the forearm and smaller muscles within the
hand.
There are no muscles in the fingers; finger movements are
produced by tendons extending from muscles in the
forearm and the hand.
The joint at the base of the thumb is a saddle joint, unlike
the corresponding joints of the other fingers, which are
condyloid. This means that the thumb is more mobile
than the fingers and the thumb can be flexed, extended,
circumducted, abducted and adducted.
In addition, the thumb can be moved across the palm to
touch the tips of each of the fingers on the same hand
 Main synovial joints of the limbs
The joints between the metacarpals and finger bones allow
movement of the fingers. The fingers may be flexed, extended,
adducted, abducted and circumducted, with the first finger
more flexible than the others.
The finger joints are hinge joints, and allow only flexion and
extension.
The flexor retinaculum is a strong fibrous band that stretches
across the front of the carpal bones, forming the carpal tunnel.
The tendons of flexor muscles of the wrist joint and the fingers
and the median nerve pass through the carpal tunnel, the
retinaculum holding them close to the bones.
Synovial membrane forms sleeves around these tendons in the
carpal tunnel and extends some way into the palm of the hand.
Synovial sheaths also enclose the tendons on the flexor surfaces
of the fingers. Their synovial fluid prevents friction that might
damage the tendons as they move over the bones.
The extensor retinaculum is a strong fibrous band that extends
across the back of the wrist. Tendons of muscles that extend the
wrist and finger joints are encased in synovial membrane under
the retinaculum. The synovial fluid secreted prevents friction
 Main synovial joints of the limbs
• Hip joint
• This ball and socket joint is formed by the cup-shaped
acetabulum of the innominate (hip) bone and the almost
spherical head of the femur.
• The capsular ligament encloses the head and most of the neck
of the femur. The cavity is deepened by the acetabular labrum, a
ring of fibrocartilage attached to the rim of the acetabulum,
which stabilises the joint without limiting its range of
movement.
• The hip joint is necessarily a sturdy and powerful joint, since it
bears all body weight when standing. It is stabilised by its
surrounding musculature, but its ligaments are also important.
• The three main external ligaments are the iliofemoral,
pubofemoral and ischiofemoral ligaments
• Within the joint, the ligament of the head of the femur
(ligamentum teres) attaches the femoral head to the acetabulum
Main synovial joints of the limbs
• Muscles and
movements
The lower limb can
be extended,
flexed, abducted,
adducted, rotated
and circumducted
at the hip joint
 Main synovial joints of the limbs
• Knee joint
•
This is the body’s largest and most complex joint. It is a
hinge joint formed by the condyles of the femur, the
condyles of the tibia and the posterior surface of the
patella.
• The anterior part of the capsule is formed by the tendon of
the quadriceps femoris muscle, which also supports the
patella (knee cap)
• Intracapsular structures include two cruciate ligaments that
cross each other, extending from the intercondylar notch of
the femur to the intercondylar eminence of the tibia. They
help to stabilize the joint.
• Semilunar cartilages or menisci are incomplete discs of white
fibrocartilage lying on top of the articular condyles of the
tibia. They are wedge shaped, being thicker at their outer
edges, and provide stability. They prevent lateral
displacement of the bones, and cushion the moving joint
by shifting within the joint space according to the relative
positions of the articulating bones.
 Main synovial joints of the limbs
• Bursae and pads of fat are numerous. They prevent friction
between a bone and a ligament or tendon and between the skin
and the patella. Synovial membrane covers the cruciate
ligaments and the pads of fat. The menisci are not covered
with synovial membrane because they are weight bearing.
• External ligaments provide further support, making it a hard
joint to dislocate. The main ligaments are the patellar ligament,
an extension of the quadriceps tendon, the popliteal ligaments
at the back of the knee and the collateral ligaments to each side.
• Muscles and movements
Possible movements at this joint are flexion, extension and a rotatory
movement that ‘locks’ the joint when it is fully extended. When the
joint is locked, it is possible to stand upright for long periods of time
without tiring the knee extensors.
Main synovial joints of the limbs
• Ankle joint
This hinge joint is formed by
the distal end of the tibia and
its malleolus (medial
malleolus), the distal end of
the fibula (lateral malleolus)
and the talus. Four important
ligaments strengthen this
joint: the deltoid and the
anterior, posterior, medial and
lateral ligaments.
 Main synovial joints of the limbs
• Muscles and movements
The movements of inversion and eversion
occur between
the tarsal bones and not at the ankle joint.

https://www.youtube.com/watch?v=XrVxxET3jAo

The Tibialis anterior (Tibialis anticus) is situated on the lateral

side of the tibia; it is thick and fleshy above, tendinous below
Main synovial joints of the limbs
Joints of the feet and toes

• There are a number of synovial joints between the tarsal bones, between the tarsal and metatarsal
bones, between the metatarsals and proximal phalanges and between the phalanges.
• Movements are produced by muscles in the leg with long tendons that cross the ankle joint, and by
muscles of the foot.
• The tendons crossing the ankle joint are wrapped in synovial sheaths and held close to the bones
by strong transverse ligaments.
• They move smoothly within their sheaths as the joints move. In addition to moving the joints of the
foot, these muscles support the arches of the foot and help to maintain balance