JOINTS

By
DR M KAMRAN AMEER
 The Classification of Joints | General
Anatomy
• Broadly speaking, a joint or articulation is a
connection between two or more bones.
• Long bones articulate by their ends,
• Flat bones articulate by margins
• Short or irregular bones surfaces are articular.
 The Classification of Joints | General
Anatomy
Classification of Joints (functional):
• Two basic types: synarthroses and diarthroses.
Synarthroses Diarthroses
solid joints without any cavity synovial joints
Subdivided into: which possess joint cavity
filled with synovial fluid
(i) Fibrous joints and permit free
where no movement is permissible movements.

(ii) Cartilaginous joints

where restricted movements may take place.
 Fibrous Joints
• In these joints bones are united by the fibrous
tissue
Three types

Sutures: (1) Serrate suture (2) Denticulate suture

(3) Squamous suture (4) Plane suture
(5) Wedge and Groove suture (Schindylesis)

Syndesmoses: It is a type of fibrous joint where the surfaces of bones are united by
interosseous ligaments, and the bones concerned lie some distance apart.
Such ligaments persist throughout life and slight amount of movement is
possible. Examples-lnferior tibio-fibular joint, interosseous membranes of
the fore – arm and leg, ligamenta flava.

Gomphosis (Peg Here the roots of the teeth fit in the sockets of the jaw, and are united by
and Socket Joint) fibrous tissue
Syndesmoses:
 Sutures
• Most of the joints of the skull belong to this
group.
• Sutural joints appear between those bones which
ossify in membranes.
• The superficial fibres of periosteum of both
bones, however, cross the middle zone of the
sutual membrane and unite the bones.
• Ossification in sutural membrane goes on till the
late twenties, when the membrane is replaced by
bones resulting in synostosis.
 Types of sutures
(1) Serrate suture
• The edges of the bones present saw-tooth appearance.
• Example—Sagittal suture of the skull.
(2) Denticulate suture
• The margins present teeth, with the tips being broader than the roots.
• Example- Lamdoid suture.
(3) Squamous suture
• Here the edges of bones are united by over­lapping.
• Example-Between parietal bone and squamous part of temporal bone.
(4) Plane suture
• The borders are plane and united by sutural liga­ments.
• Example-Articulations between palatine processes of two maxillae.
(5) Wedge and Groove suture (Schindylesis):
• The edge of one bone fits in the groove of the other bone.
• Example between the rostrum of sphenoid and the upper margin of vomer
 Cartilaginous Joints
• Synchondroses (Primary Cartilaginous Joint):
• Symphyses (Secondary Cartilaginous Joint):
Synchondroses (Primary Cartilaginous Joint)

• The bones are united by a plate of hyaline cartilage, which

is temporary and is replaced completely by bone
(synostosis).
• No movement is possible at this joint
• It is primarily designed for bone growth.

Example:
(i) Junction between epiphysis and diaphysis of a growing
long bone
(ii) Articulation between basi-occiput and basi-sphenoid;
(iii) The first chondro-sternal joint
Symphyses (Secondary Cartilaginous Joint)

• Articular surface of the bones are covered with

hyaline cartilage and are united by a plate of fibro-
cartilage.
• All secondary cartilaginous joints persist through-
out life and occupy median plane of the body.
• A limited movement is possible
Examples-
(i) Intervertebral discs between the vertebral bodies
(ii) Symphysis pubis
(iii) Sterno-manubrial joint
 Classification of Synovial Joints
• (A) According to the number of articulating bones-the
joints may be simple, compound and complex.
1. Simple joint occurs when only two bones enter in the
articulation. Example-Interphalangeal joints of the
fingers and toes.
2. In a compound joint, more than two articular bones
are involved sharing a common articular capsule.
Ankle and radiocarpal joints are examples of this type.
3. When a joint is divided into two compart­ments by a
articular disc or meniscus, it is known as complex joint.
Examples- knee joint, sternoclavicular joint, etc.
 Classification of Synovial Joints
(B) According to the axis of movements and the shape of articular sufaces-the joints
may be uniaxial, biaxial, polyaxial and plane.
1. Uniaxial Joint:
• It has one degree freedom of movement and is subdivided into three types:
• (a) Hinge or Ginglymus joint
• (b) Pivot or Trochoid joint:
• (c) Condylar joint
2. Bi-Axial Joints:
• These joints have two degree freedom of movements, and present two varieties.
• (a) Ellipsoid joint
• (b) Saddle joint
3. Poly-Axial Joints:
They possess three degree freedom of movement
• ball and-socket or spheroidal joints
4. Plane Joints:
• The artcular surfaces are flat and produce gliding movements in various directions
 Classification of Synovial Joints
(a) Hinge or Ginglymus joint
• It moves around a transverse axis. One articular surface is convex like a cylin­der and the other surface
is reciprocally curved. The bones are united by strong collateral ligaments.
• Example- Interphalangeal joints of the fingers and toes, elbow and ankle joints.
(b) Pivot or Trochoid joint:
• The movement takes place on a vertical axis. One bone acts as a pivot which is encircled by an osseo-
ligamentous ring.
• Examples- Atlanto-axial joint; here pivot formed by the dens of the axis is fixed, and the ring formed
by the anterior arch of at­las and transverse ligament of atlas ro­tates.
• Radio-ulnar joint. In this case, pivot formed by the head of the radius rotates and the ring formed by
annular ligament and ulna is fixed.
(c) Condylar joint
• It moves mainly on a transverse axis, and partly on a vertical axis. Hence, it is a modi­fied hinge joint.
• In a condylar joint, each bone consists of two distinct articular surfaces, each is known as a condyle.
• Examples-Knee joint and temporo-mandibular joint.
(a) Ellipsoid joint
• One articular surface is convex and elliptical in outline. The other articular surface is concave and
reciprocally curved. The movements take place around transverse and anteroposterior axes,
• Examples-Radio-carpal, metacarpo -phalangeal, metatarsophalangeal, and atlanto-occipital joints
 Classification of Synovial Joints
(b) Saddle joint
• The opposing articular surfaces are concavo-convex in reciprocal manner.
• These permit move­ments similar to ellipsoid joint. Some rotation is also associated with the aforesaid
movements; this is known as conjunct rotation.
Examples—Carpo-metacarpal joint of thumb, and sterno-clavicular joint.
Ball and socket joint
• They possess three degree freedom of movement and mor­phologically are known as ball and-socket or
spheroidal joints . In this type of joint, the spheroidal articular surface of the distal bone moves within a
socket of the other bone, around three independent axes (trans­verse, antero-posterior and vertical) which
have one common centre. Movements permissible at these joints are flexion, extension, adduc­tion,
abduction, rotation and circumduction
Examples-
• (i) Shoulder and hip joints (typical)
• (ii) Talo-calcaneo-navicular joint; arti­culation between incus and stapes (Re­stricted ball and- socket joints.)
Plane Joints:
• The artcular surfaces are flat and produce gliding movements in various di­rections.
Examples—
• (i) Inter-carpal and inter-tarsal joints.
• (ii) Articulations between articular proc­esses of the vertebrae. (Facet joints.)
 Characteristics of synovial joints
1. Articular surfaces of the bones are covered with articular
cartilage.
2. The joint presents a cavity which is filled with viscous
synovial fluid.
3. The joint cavity is enveloped by a complete articular capsule,
which consists of outer fibrous capsule and inner synovial
membrane.
4. The articulating bones are connected by a number of
ligaments which are additional to the fibrous capsule.
5. Sometimes, the joint cavity is divided completely or
incompletely by articular disc or meniscus, which is
composed of fibrocartilage
• Description of the Component Parts of Synovial Joints
• Articular Cartilage:
• The articular cartilage of most joints is hya­line in structure, except in those bones which are ossified in membrane where it is composed of fibro-cartilage. Hyaline articular cartilage is avascular, non- nervous and elastic. On the convex articular surface (male) the cartilage is thickest in the centre and thinnest at the periphery.
• On the concave surface (female), however, it is thin­nest in the centre and thickest at the periphery. The articular cartilage, once damaged, cannot be replaced by hyaline tissue. Replacement is done by fibrous tissue; hence, articular carti­lage is indispensable.
• Functions:
• (a) It provides a smooth gliding surface and reduces forces of compression during weight-bearing or muscle action. The co-efficient of friction is equal to ‘ice on ice’. The surface of the cartilage is not perfectly smooth, and shows fine undulations which are filled with syno­vial fluid. In fact, the articular cartilage is extremely porous and absorbs synovial fluid in the resting condition. When the joint is compressed, the fluid is squeezed out of the cartilage.
• (b) It regulates the growth of epiphysis.
• Structure (Fig. 6-36):
• The articular cartilage consists of cells and an interlacement of collagen fibres. The sur­face is cell free and composed essentially of a net work of fine fibres. The cells are arranged in three layers, from superficial to deep;
• (i) Superficial layer-It consists of flattened cells, placed parallel with the articular surface.
• (ii) Intermediate layer-The cartilage cells are rounded and arranged in longitudi­nal rows.
• (iii) Deep layer-It consists of calcified ma­trix. Here cartilage cells die and are re­placed by bones.
• During growth the cartilage cells of inter­mediate layer proliferate by mitosis and grow away from the advancing bones. Once growth is over, the number of cells in articular carti­lage slowly decreases throughout life in rela­tion to the amount of intercellular substance.
• Changes in articular cartilage with age:
• A combination of degenerative and prolif­erative changes may be observed in advanced age. Degenerative changes occur in the central part of articular cartilage. The collagen fibres are unmasked forming fibrillation of the carti­lage.
• Proliferative changes occur around the edges of articular cartilage. The cartilage cells pro­liferate in these regions, and are replaced by bones which are known as osteophytes. The latter form lips around the joints.
• Nutrition of articular cartilage:
• Nutrition is derived from three sources:
• (a) From synovial fluid;
• (b) By diffusion from capillaries at the pe­riphery of the articular cartilage;
• (c) By diffusion from the adjacent epiphy­seal blood vessels.
• Synovial Fluid:
• It is a viscous and glairy fluid, which fills up the joint cavity. The synovial fluid is a dia- lysate of blood plasma into which hyaluronic acid is added from the synovial membrane. The hyaluronic acid is a high polymer of mucopoly­saccharide, and is secreted by the synovial cells and probably by the mast cells of synovial membrane. The viscosity of the fluid depends on the concentration of hyaluronic acid. More acid makes the fluid more viscous.
• Cellular contents of the fluid are monocytes, lymphocytes, macrophages, synovial cells, and a few leucocytes. Proteins in traces are present in the fluid, some as free macromolecules and some combined with hyaluronate. Synovial fluid is slightly alkaline.
• Substances passing in and out of synovial fluid-
• 1. Crystalloids diffuse readily in both di­rections.
• 2. Colloids leave the synovial fluid by lymphatics.
• 3. Particulate matters are removed by phagocytic activities of macrophages, and by synovial cells.
• Functions of the fluid:
• (a) It maintains nutrition of the articular cartilage.
• (b) It provides lubrication of the joint cav­ity to prevent wear and tear. Lubrica­tion is helped by the following factors:
• i. The articular surfaces of the bones are not perfectly congruous. This provides a space for flushing of the fluid. The synovial fluid spreads as an elastic ‘fluid film ’over the moving articular surfaces. During weight bearing the fluid is squeezed out from the interstices of the porous articular surfaces and exerts a sort of ‘weeping’ lubrication’. En­trapped synovial fluid in the articular sponge is enriched with the secretion of hyaluronic acid from the cartilage cells. This helps in boostering effect of lubrication by increasing viscosity.
• ii. Viscosity of the fluid maintains lubri­cation. In cold temperature viscosity increases, and this accounts for the stiff­ness of the joints in cold countries.
• iii. More movements of the joint encour­age more lubrication. Sometime a per­son experience difficulty in starting movements during morning hours. But when movements are continued, stiff­ness of the joints lessens.
• Joint Cracks:
• A noise in the joint is produced by the de­velopment of certain vacuum within the joint, due to forcible separation of articular surfaces. The vacuum is filled with water vapour and blood gas.
• Articular Capsule:
• It consists of outer fibrous capsule and in­ner synovial membrane.
• The fibrous capsule completely invests the joint, and is attached by continuous lines to the bones forming the joints close to their articu­lar cartilages. The capsule is formed by bun­dles of collagen fibres, which are arranged in irregular spirals and are sensitive to the changes of position of the joints. It is pierced by blood vessels and nerves. Sometimes the capsule presents opening through which synovial mem­brane comes out to act as bursa for the tendon of neighbouring muscle.
• Functions of the fibrous capsule:
• 1. It binds the articulating bones together.
• 2. It supports the synovial membrane on the inner surface.
• 3. Numerous sensory nerve endings ramify on the capsule. These nerves when stimulated produce contraction of the muscles by reflexes and thereby protect the joints. This is known as ‘watch dog’ action of the capsule.
• Synovial Membrane:
• It is a highly vascular and cellular connec­tive tissue membrane, which lines the inner aspects of the fibrous capsule and the bones lying within the capsule, but ceases at the pe­riphery of the articular cartilage, articular disc or meniscus.
• Structure of synovial membrane:
• The cells of the membrane are arranged in two zones, inner and outer. Inner zone (intima) is lined by discontinuous synovial cells. Ultra- structurally, the synovial cells consist of two types-A and B. Type A cells are more numer­ous, present filopodia at the free surface, and contain pinocytic vesicles and Golgi appara­tus.
• They resemble the macrophage cells and are derived from bone-marrow. Type В cells are rich in endoplasmic reticulum and resem­ble the fibroblasts. А-cells secrete hyaluronic acid, and phagocytose the particulate matters and other debris. В-cells secrete proteins in the synovial fluid. Outer zone (subintima) consists of a network of reticular fibres and contains connective tissue cells which are mostly fibroblasts, histiocytes and mast cells.
• Functions:
• (i) The membrane secretes synovial fluid which provides nutrition to the articu­lar cartilage.
• (ii) It liberates hyaluronic acid which main­tains viscosity of the fluid.
• (iii) It removes particulate matters and worm-out cartilage cells by the phago­cytic cativity.
• Types of Synovial Membrane:
• The membrane presents three types- fibrous, areolar and adipose (Fig. 6-37)
• Fibrous type is found where the synovial lin­i ng is adherent to the fibrous capsule and is subjected to pressure. The surface cells are widely separated from one another.
• Areolar type is present where the membrane moves freely over the fibrous capsule. The sur­face cells are close together in 3 or 4 rows.
• Adipose type covers intra-articular pad of fat; the surface cells are arranged in a single layer.
• Ligaments:
• The ligaments of synovial joints may be true or accessory. True ligaments are produced by the thickening of collagen fibres of the fibrous capsule. Accessory ligaments form additional bonds of union between the bones. They may be intra-capsular or extra-capsular. Some liga­ments may be produced by the degeneration of tendons of muscles, showing remnants of phylogeny.
• Functions:
• (i) The ligaments permit desirable move­ments and prevent the undesirable one.
• (ii) They maintain the stability of the joint.
• Articular Disc or Meniscus:
• Sometimes the joint cavity is divided com­pletely or incompletely by an articular disc or meniscus, which is attached at the periphery to the fibrous capsule. Structurally, an articu­lar disc is fibro-cartilaginous, the fibrous tis­sue being predominant.
• Articular disc divides the joint completely into two compartments [Fig. 6-35(b)]. In foe­tal life both surfaces of the disc are covered with synovial membrane which disappears later by wear and tear.
• Example-Теmporo-mandibu­lar, sternoclavicular and inferior radio-ulnar joints.
• Articular meniscus divides the joint incom­pletely into two compartments. In foetal life, it is covered with synovial membrane which dis­appears after birth. Examples-knee and acromio-clavicular joint.
• Functions of the disc or meniscus:
• 1. It helps in lubrication of the joint by maintaining an interval between the ar­ticular surfaces.
• 2. A disc or meniscus appears in those joints where gliding movement is asso­ciated with angular movement.
• 3. It prevents wear and tear of the articu­lar cartilage.
• Movements and Mechanism of Synovial Joints
• Active Movements:
• In a joint where movement is free, the more movable bone possesses larger articular sur­face. When movement is limited, the opposing articular surfaces are roughly equal in area.
• Types of movements in synovial joints are gliding, angular, circumduction and rotation.
• GLIDING movements take place in plane joints, where one bone slips over the other in a particular direction and the motion is limited. Such a series of gliding movements in the small joints of hand, foot and vertebral column act as efficient buffer against force.
• ANGULAR movements may be of two kinds (Fig. 6-44):
• (A) Flexion and Extension:
• Flexion means bending, and extension signifies straightening. These movements occur around a transverse axis, and in flexion the two morphologically oriented ven­tral surfaces are usually approximated.
• These principles, however, are not per­fectly applicable in the carpometacarpal joint of thumb, in shoulder, hip and ankle joints. In the case of thumb, it lies in a plane at right angles to the plane of the other fingers. As a result, flexion and extension at the carpometacarpal joint of the thumb take place parallel to the plane of the palm around an antero-pos­terior axis.
• (B) Adduction and Abduction:
• In adduction, the part moves towards the median plane, whereas in abduction it deviates away from the middle line. In the fingers of the hand these movements are mentioned with reference to the middle finger which represents the axis of hand. In the toes, however, these movements are described with refer­ence to the second toe, which is axis of the foot.
• Adduction and abduction take place around an antero-posterior axis, except in the carpo-metacarpal joint of thumb where the axis is transverse.
• Circumduction:
• It is a combination of four angular movements in successive orders describing a cone. The base of the cone is formed by the distal end of the moving bone. Circumduction occurs in biaxial and polyaxial joints.
• Rotation:
• This movement occurs around a vertical axis. The axis of rotation in shoulder joint passes through the long axis of humerus . In atlanto-axial joint the axis passes through the dens of the second cervical vertebra around which the atlas rotates.
• Truly speaking, movements of joints con­sist of two types- translation (gliding) and ro­tation. Rotation around a longitudinal axis is known as rotation proper, which may be ad­junct or conjunct. Adjunct rotation takes place actively by some muscles, whereas conjunct rotation occurs passively due to configuration of articular surface or tension of some liga­ments.
• Rotations at hip, shoulder and atlanto­axial joints are examples of adjunct rotation; rotations of knee joint during locking and un­locking qualify conjunct rotation. Rotatory movements around a transverse axis produce flexion and extension and around an antero­posterior axis produce adduction and abduc­tion.
• Passive and accessory movements:
• Sometimes the structure of the joint permits some movements by passive manipulation. Head of the humerus can be separated from the scapula by traction, provided the muscles are relaxed.
• Certain accessory movements can be per­formed actively in a joint, when resistance is encountered during the movement. A soild object, when grasped by the hand, produces rotation of the fingers at the metacarpo phalan­geal joints.
• The assessment of passive and accessory movements is of diagnostic value in muscle and joint disorders.