Classification of joints:

1. Structural: according to the type of material binding the bones together and whether or not a
joint cavity is present
Fibrous- in general immovable
Cartilaginous- in general both
Synovial- in general freely movable
2. Functional: based on the amount of movements allowed at the joint and the type of movement
Synarthroses: immovable (axial)
Amphiarthroses: slightly moveable (axial)
Diarthroses: freely moveable (appendicular)
Articulation is the point of contact between two bones or between cartilage and bones.
1. The tighter the fit, the more restricted the movement and vice versa
2. The type of movement is determined by the type of the CT that binds the bones and the
position of the ligaments, muscles, and tendons.
Fibrous:

Joined by fibrous tissue- Dense Fibrous CT

No joint cavity is present
Movement depends on the length of the CT fibers uniting the bones
Very, very little or no movement at all
3 Types:
Sutures: Synarthroses
o Only occur between bones of the skull
o Bones interlock, and the junction is completely filled with very short CT fibers
o Still allow the brain to expand during youth
o During middle age, fibrous tissue ossifies and skull bones fuse into a single unit.
The closed sutures are called synostoses
Syndesmoses: Amphiarthrotic
o Bones connected exclusively by ligaments or fibrous tissue
o Connected by longer CT fibers than those of sutures
o Allows little movement but still better described as give
o Ex: ligament connecting distal ends of the tibia and fibula,
Gomphosis: Synarthrotic
o Peg-in-socket fibrous joint
o Ex: articulation of a tooth with its bony alveolar socket
o Very short collage fibers (periodontal ligament), fibrous connection for tooth

Cartilaginous:

Articulating bones are united by cartilage

Lack a joint cavity
Allow little or no movement
Two Types:
Synchondrosis: Synarthrotic
o Hyaline cartilage unites the bones
o Ex. Epiphyseal plates in long bones of children.
o Ex. Joint between costal cartilage of the 1st rib and the manubrium of the
sternum
o Both are temporary and will ossify, eventually become synostoses
Symphysis: Amphiarthrotic
o Articular surface of the bones are covered with articular (hyaline) cartilage,
which in turn is fused to fibrocartilage-main connecting material
o Fibrocartilage is compressible and resilient and acts as a shock absorber,
allowing limited amount of movement
o Ex. Intervertebral joints and the pubic Symphysis of the pelvis

Synovial:

Articulating bones are separated by a fluid-containing joint cavity-allowing substantial freedom

of movement
All synovial joints are freely movable diarthroses
Nearly all joints of the limbs-most joints of the body (appendicular skeleton)
Movement of synovial joints is determined by ligaments, muscles, tendons, and adjoining bones
Six distinguishing features:
1. Articular Cartilage:
Articular surface of bones are covered with hyaline cartilage (does not bind bones
together)
Absorb compression placed on the joint
2. Joint (synovial) cavity:
Joint cavity is really just a potential space that contains small amount of synovial
fluid
Functions as a cushion between two articular surfaces of the bones
3. Articular capsule:
Joint cavity is enclosed by a two layered articular capsule (joint capsule),
uniting/holding articulating bones
Two layers:
Fibrous layer (outer layer)
o Tough fibrous capsule, composed of dense irregular CT that is continuous
with the periosteum of articulating bones

o Strengthens the joint so that the bones are not pulled apart
Synovial membrane (inner layer)
o Composed of loose CT and elastic fibers and variable amount of fat
o Functions in secretion of synovial fluid, which lubricates the joint and
provides nourishment for articular cartilage
o Contains phagocytes
o Covers all internal joint surfaces that are not hyaline cartilage
4. Synovial fluid:
Fluid derived largely by filtration from blood flowing through the capillaries in the
synovial membrane, occupies all free spaces within joint capsule
Has a viscous, egg-white consistency due to hyaluronic acid, also contains nutrients
and phagocytes
Also found within articular cartilages, provides a slippery weight-bearing film that
reduces friction between cartilages. Without this friction rubbing would wear away
joint surfaces and friction would destroy joint tissue
Synovial fluid is forced from cartilages when a joint is compressed; then as pressure
on the joint is relieved, synovial fluid seeps back into the articular cartilages like
water into a sponge- Weeping lubrication
Weeping lubrication: lubricates free surfaces of the cartilages and nourishes their
cells
5. Reinforcing ligaments: (synovial joint is strengthened by several ligaments)
Synovial joints are reinforced and strengthened by a number of ligaments, most
often, capsular or intrinsic ligaments=thickened parts of fibrous capsule
o Arranged in parallel bundles, blending with the fibers within the joint
capsule
o Resist unidirectional recurrent strait
Extracapsular ligaments:
o Attaches to articulating bones holding bones together outside of capsule
o Ex. Lateral/collateral ligament of the knee
Intracapsular ligaments:
o Deep to the fibrous capsule (between fibrous layer and synovial membrane)
o Covered by synovial membrane, and do not actually lie within the joint
cavity
6. Nerves and blood vessels:
Richly supplied with sensory nerve fibers that innervate the capsule
Fibers detect pain, most monitor joint position and stretch and maintaining muscle
tone
Also richly supplied with blood vessels, which supply the synovial membrane. There,
capillary beds produce blood filtrate that is the basis of synovial fluid

 Miscellaneous features: menisci/articular discs

Hip and knee joints have cushioning fatty pads between fibrouscapsule and
synovial membrane
Articular discs, or menisci, extend inward from the articular capsule and partially
divide the synovial cavity in two
Articular discs improve the fit between articulating bone ends, making the joint
more stable and minimizing wear and tear on joint surface
Articular discs occur in the knees and jaw, sternoclavicular joint
Bursae:

Flattened fibrous sacs lined with synovial membrane and containing a thin film of synovial fluid
Occur where ligaments, muscles, skin, tendons or bones rub together
Main function is to reduce friction between adjacent structures during joint activity

Tendon sheath:

An elongated bursa that wraps completely around a tendon subjected to friction

Common where several tendons are crowded together
Ex. Wrist
Sheaths are cylindrical, fluid-filled, double-walled cushion

Tendon:

Dense regular CT (with fibrous cord) attaching muscle to bone

Factors Influencing Stability of Synovial Joints

1. Articular Surface:
Shapes of articular surfaces determine what movements are possible at a joint
Play a minor role in joint stability
The fit can contribute to much of the stability of a joint (hip joint-extremely stable by
the shape of its articular surface)
2. Ligaments:
The more ligaments a joint has the stronger it is
Prevent excessive or undesirable motion
Ligaments can stretch, when other stabilizing factors are inadequate. Stretched
ligaments stay stretched, and can stretch only about 6% of its length before it snaps.
Joint is not very stable if only ligaments are bracing a joint
3. Muscle Tone:
Most important stabilizing factor
Tendons are kept taut at all times by the tone of the muscles
Ex. Shoulder joints, pectoralis major and minor

Types of Synovial Joints

All synovial joints are similar in structure, but vary in shape of articular surface
Articular shape aids in determining its movements
1. Nonaxial (transitional) joints
Plane joints and gliding joints:
Slides against each other in all directions (back-and-forth and side-to-side)
Articular surfaces are essentially flat
Ex. Intercarpal, intertarsals, rib heads
2. Uniaxial joints (2 types)
Hinge or ginglymus joint
Convex surface (cylindrical outward) fits into concave surface (cylindrical
inward) with movement along one plane
Ex. Elbow and knee joints
Pivot or trochoid joint:
A pointed or conical surface of one bone articulates within a ring formed partly
by bone and ligament, which allows for rotation within the ring
One bone around its own long axis
Moving head side to side to indicate NO
Ex. Proximal radioulnar joint and atlantoaxial joint
3. Biaxial Joints (2 types)
Ellipsoidal or condyloid joint:
An oval shaped condyle of one bone fits into elliptical elongated cavity
(depression) of another
All angular movements (flexion, extension, abduction, adduction,
circumduction)
Ex. Wrist, radius,
Saddle or sellar joint
Both concave and convex articular surface (modified condyloid joint essentially)
Gives this joint greater movement than ellipsoidal
Ex. Thumb/trapezium, and metacarpals
4. Multiaxial joints
Ball and socket or spheroid joint:
Ball-like surface of one bone fits into a cup-like depression of another bone
Universal movement (movement on all axis)
Hip, shoulder
Angular Movements

Increase or decrease the angle between two bones

Movements may occur in any plane of the body and include flexion, extension, hyperextension,
abduction, adduction, and circumduction.

Flexion:

Decrease the angle of the joint and brings the two bones closer together, usually along the
sagittal plane

Extension:

Increase the angle of the joint and brings the two bones farther apart, usually along the sagittal
plane

Abduction:

Movement of the limb away from the midline or median plane of the body along the
frontal/coronal plane

Adduction:

Movement of limb toward the midline or median plane of the body along the frontal/coronal
plane

Circumduction:

The distal end of a limb moves in a circle while the joint remains stable

Rotation:

Turning movement of a bone around its own long axis

Common Joint Injuries: Sprain, strains, dislocations, and some cartilage injuries (traumas)
1. Sprain:
Ligaments reinforcing a joint are stretched or torn
Forcible wrenching or twisting of a joint with stretching or partial rupture of ligament
S/S: painful, the joint cannot be moved, swelling, hemorrhaging and brusing
2. Strain:
Overstretching of a muscle
3. Dislocation:
Bones forced out of alignment
Dislocations must be reduced-the bone ends must be returned to their proper
positions by a physician
Inflammation, redness, heat, pain
Ex. Fingers, shoulders, thumbs, jaw
4. Herniated disc (slipped)
Nucleus pulposa extrude out through the annulus fibrosus

Bursitis:

Inflammation of a bursa and is usually caused by a blow or friction, increased stress, trauma
Ex. Water on the knee, prolonged leaning on ones elbows

Tendonitis:

Inflammation of tendon sheaths

Ex. Synovial sheath as tenosynovitis
S/S: pain, swelling

Arthritis:

There are over 100 different types of inflammatory diseases that damage the joints
Leading cause of disability in US; 1 out of 3 Americans (70,000,000)
S/S: pain, stiffness, and swelling of the joint
Synovial membrane thickens and fluid production decreases, causing increased friction and pain
Cause of most is still unknown
Flare-ups and remissions are common in most types
Chronic forms include: osteoarthritis, rheumatoid arthritis, gouty arthritis

Osteoarthritis (Degenerative Joint Disease)

Most common chronic arthritis

Often called wear-and-tear arthritis
Most prevalent in older people
More women than men are affected
Its course is unilaterally, slow in progression and irreversible
Irritation, wear (aberrant) and abrasion, traumatic incidents
Deterioration of articular cartilage, mostly in the larger joints (knees, shoulders, hips,
intervertebral)
Formation of new bone, usually spurring (hypertrophic changes in subchondral areas and at the
margins at the epiphysis
More cartilage is destroyed than replaced

Rheumatoid arthritis (RA): (Chronic inflammatory disorder)

Onset: 30-50 years; 3:1 females to males

It is a systemic disease affects the entire body (other S/S: anemia, osteoporosis, muscle atrophy,
cardiovascular problems, fatigue, joint tenderness and stiffness) loss of appetite, fever, loss of
energy, anemia, rheumatoid nodules (lumps of tissue under the skin)
Affects joints, causes inflammation of the synovial membrane, (inflammatory cells release
enzymes that digest bone and cartilage deterioration of articular cartilage), causing pain,
stiffness, warmth, and redness

Seen mostly in smaller joints (fingers, feet and wrist); sometimes it can affect larger joints
(shoulders, neck, hips...)
Effects the body symmetrically and effects can be irreversible
RA is an autoimmune disease in which the body destroys its own tissues. May be genetically
predisposed, cause still unknown
Etiology:
Synovial membrane produces pannus (abnormal tissue), which adheres to the surface of
the articular cartilage and can/will eredoes the cartilage completely
Fibrous tissue joins exposed bone ends; ankylosing (ossification) takes place and the
bone ends fuse together
Not all will ossify but all be greatly inhibited by sever inflammation and swelling
Stills Disease: RA in children
S/S :most of the above and including leukocytosis, which leads to enlarged spleen and
lymph nodes

Gouty Arthritis (gout):

Mostly male, any age (mostly over 40)

Due to hyperuricemia (excessive amount of uric acid)
Due to inability to excrete uric acid normally by kidneys
Normal excretion but overproduction of uric acid (causing build-up)
May be caused by genetics; environment factors (stress and climate), and diet; uric acid is a
waste product of purine metabolism (from nucleoproteins of food [decreased meats, cheese,
red wine]-> nucleic acid, and is usually eliminated in the urine [gives urine its name]
The extra blood borne uric acid crystals are deposited in soft tissue (kidneys, cartilage of the ear
and joints)
Crystals irritate the cartilage and cause sudden severe attacks of extreme pain and tenderness,
redness, warmth and swelling; usually affects one joint (big toe)
Treatable: usually medicine that try to prevent uric acid formation without interfering with
nucleic acid synthesis