2-5-5. Synovial JointsLearning Objectives
Synovial joints are the most common type of joint in the body (Figure 1). A key structural characteristic for a synovial joint that is not seen at fibrous or cartilaginous joints is the presence of a joint cavity. This fluid-filled space is the site at which the articulating surfaces of the bones contact each other. Also unlike fibrous or cartilaginous joints, the articulating bone surfaces at a synovial joint are not directly connected to each other with fibrous connective tissue or cartilage. This gives the bones of a synovial joint the ability to move smoothly against each other, allowing for increased joint mobility.
Synovial Joints
Structural Features of Synovial JointsSynovial joints are characterized by the presence of a joint cavity. The walls of this space are formed by the Friction between the bones at a synovial joint is prevented by the presence of the Outside of their articulating surfaces, the bones are connected together by ligaments, which are strong bands of fibrous connective tissue. These strengthen and support the joint by anchoring the bones together and preventing their separation. Ligaments allow for normal movements at a joint, but limit the range of these motions, thus preventing excessive or abnormal joint movements. Ligaments are classified based on their relationship to the fibrous articular capsule. An At many synovial joints, additional support is provided by the muscles and their tendons that act across the joint. A Additional Structures Associated with Synovial JointsA few synovial joints of the body have a fibrocartilage structure located between the articulating bones. This is called an Additional structures located outside of a synovial joint serve to prevent friction between the bones of the joint and the overlying muscle tendons or skin. A
Bursae
A Homeostatic ImbalancesBursitisBursitis is the inflammation of a bursa near a joint. This will cause pain, swelling, or tenderness of the bursa and surrounding area, and may also result in joint stiffness. Bursitis is most commonly associated with the bursae found at or near the shoulder, hip, knee, or elbow joints. At the shoulder, subacromial bursitis may occur in the bursa that separates the acromion of the scapula from the tendon of a shoulder muscle as it passes deep to the acromion. In the hip region, trochanteric bursitis can occur in the bursa that overlies the greater trochanter of the femur, just below the lateral side of the hip. Ischial bursitis occurs in the bursa that separates the skin from the ischial tuberosity of the pelvis, the bony structure that is weight bearing when sitting. At the knee, inflammation and swelling of the bursa located between the skin and patella bone is prepatellar bursitis (“housemaid’s knee”), a condition more commonly seen today in roofers or floor and carpet installers who do not use knee pads. At the elbow, olecranon bursitis is inflammation of the bursa between the skin and olecranon process of the ulna. The olecranon forms the bony tip of the elbow, and bursitis here is also known as “student’s elbow.” Bursitis can be either acute (lasting only a few days) or chronic. It can arise from muscle overuse, trauma, excessive or prolonged pressure on the skin, rheumatoid arthritis, gout, or infection of the joint. Repeated acute episodes of bursitis can result in a chronic condition. Treatments for the disorder include antibiotics if the bursitis is caused by an infection, or anti-inflammatory agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids if the bursitis is due to trauma or overuse. Chronic bursitis may require that fluid be drained, but additional surgery is usually not required. Types of Synovial JointsSynovial joints are subdivided based on the shapes of the articulating surfaces of the bones that form each joint. The six types of synovial joints are pivot, hinge, condyloid, saddle, plane, and ball-and socket-joints (Figure 3). Pivot JointAt a Hinge JointIn a Condyloid JointAt a Saddle JointAt a Plane JointAt a Ball-and-Socket JointThe joint with the greatest range of motion is the Ball-and-socket joints are classified functionally as multiaxial joints. The femur and the humerus are able to move in both anterior-posterior and medial-lateral directions and they can also rotate around their long axis. The shallow socket formed by the glenoid cavity allows the shoulder joint an extensive range of motion. In contrast, the deep socket of the acetabulum and the strong supporting ligaments of the hip joint serve to constrain movements of the femur, reflecting the need for stability and weight-bearing ability at the hip.
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Watch this video to see an animation of synovial joints in action. Synovial joints are places where bones articulate with each other inside of a joint cavity. The different types of synovial joints are the ball-and-socket joint (shoulder joint), hinge joint (knee), pivot joint (atlantoaxial joint, between C1 and C2 vertebrae of the neck), condyloid joint (radiocarpal joint of the wrist), saddle joint (first carpometacarpal joint, between the trapezium carpal bone and the first metacarpal bone, at the base of the thumb), and plane joint (facet joints of vertebral column, between superior and inferior articular processes). Which type of synovial joint allows for the widest range of motion? Aging and the…JointsArthritis is a common disorder of synovial joints that involves inflammation of the joint. This often results in significant joint pain, along with swelling, stiffness, and reduced joint mobility. There are more than 100 different forms of arthritis. Arthritis may arise from aging, damage to the articular cartilage, autoimmune diseases, bacterial or viral infections, or unknown (probably genetic) causes. The most common type of arthritis is osteoarthritis, which is associated with aging and “wear and tear” of the articular cartilage (Figure 4). Risk factors that may lead to osteoarthritis later in life include injury to a joint; jobs that involve physical labor; sports with running, twisting, or throwing actions; and being overweight. These factors put stress on the articular cartilage that covers the surfaces of bones at synovial joints, causing the cartilage to gradually become thinner. As the articular cartilage layer wears down, more pressure is placed on the bones. The joint responds by increasing production of the lubricating synovial fluid, but this can lead to swelling of the joint cavity, causing pain and joint stiffness as the articular capsule is stretched. The bone tissue underlying the damaged articular cartilage also responds by thickening, producing irregularities and causing the articulating surface of the bone to become rough or bumpy. Joint movement then results in pain and inflammation. In its early stages, symptoms of osteoarthritis may be reduced by mild activity that “warms up” the joint, but the symptoms may worsen following exercise. In individuals with more advanced osteoarthritis, the affected joints can become more painful and therefore are difficult to use effectively, resulting in increased immobility. There is no cure for osteoarthritis, but several treatments can help alleviate the pain. Treatments may include lifestyle changes, such as weight loss and low-impact exercise, and over-the-counter or prescription medications that help to alleviate the pain and inflammation. For severe cases, joint replacement surgery (arthroplasty) may be required. Joint replacement is a very invasive procedure, so other treatments are always tried before surgery. However arthroplasty can provide relief from chronic pain and can enhance mobility within a few months following the surgery. This type of surgery involves replacing the articular surfaces of the bones with prosthesis (artificial components). For example, in hip arthroplasty, the worn or damaged parts of the hip joint, including the head and neck of the femur and the acetabulum of the pelvis, are removed and replaced with artificial joint components. The replacement head for the femur consists of a rounded ball attached to the end of a shaft that is inserted inside the diaphysis of the femur. The acetabulum of the pelvis is reshaped and a replacement socket is fitted into its place. The parts, which are always built in advance of the surgery, are sometimes custom made to produce the best possible fit for a patient. Gout is a form of arthritis that results from the deposition of uric acid crystals within a body joint. Usually only one or a few joints are affected, such as the big toe, knee, or ankle. The attack may only last a few days, but may return to the same or another joint. Gout occurs when the body makes too much uric acid or the kidneys do not properly excrete it. A diet with excessive fructose has been implicated in raising the chances of a susceptible individual developing gout. Other forms of arthritis are associated with various autoimmune diseases, bacterial infections of the joint, or unknown genetic causes. Autoimmune diseases, including rheumatoid arthritis, scleroderma, or systemic lupus erythematosus, produce arthritis because the immune system of the body attacks the body joints. In rheumatoid arthritis, the joint capsule and synovial membrane become inflamed. As the disease progresses, the articular cartilage is severely damaged or destroyed, resulting in joint deformation, loss of movement, and severe disability. The most commonly involved joints are the hands, feet, and cervical spine, with corresponding joints on both sides of the body usually affected, though not always to the same extent. Rheumatoid arthritis is also associated with lung fibrosis, vasculitis (inflammation of blood vessels), coronary heart disease, and premature mortality. With no known cure, treatments are aimed at alleviating symptoms. Exercise, anti-inflammatory and pain medications, various specific disease-modifying anti-rheumatic drugs, or surgery are used to treat rheumatoid arthritis.
Osteoarthritis
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Visit this website to learn about a patient who arrives at the hospital with joint pain and weakness in his legs. What caused this patient’s weakness?
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Watch this animation to observe hip replacement surgery (total hip arthroplasty), which can be used to alleviate the pain and loss of joint mobility associated with osteoarthritis of the hip joint. What is the most common cause of hip disability?
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Watch this video to learn about the symptoms and treatments for rheumatoid arthritis. Which system of the body malfunctions in rheumatoid arthritis and what does this cause? Chapter ReviewSynovial joints are the most common type of joints in the body. They are characterized by the presence of a joint cavity, inside of which the bones of the joint articulate with each other. The articulating surfaces of the bones at a synovial joint are not directly connected to each other by connective tissue or cartilage, which allows the bones to move freely against each other. The walls of the joint cavity are formed by the articular capsule. Friction between the bones is reduced by a thin layer of articular cartilage covering the surfaces of the bones, and by a lubricating synovial fluid, which is secreted by the synovial membrane. Synovial joints are strengthened by the presence of ligaments, which hold the bones together and resist excessive or abnormal movements of the joint. Ligaments are classified as extrinsic ligaments if they are located outside of the articular capsule, intrinsic ligaments if they are fused to the wall of the articular capsule, or intracapsular ligaments if they are located inside the articular capsule. Some synovial joints also have an articular disc (meniscus), which can provide padding between the bones, smooth their movements, or strongly join the bones together to strengthen the joint. Muscles and their tendons acting across a joint can also increase their contractile strength when needed, thus providing indirect support for the joint. Bursae contain a lubricating fluid that serves to reduce friction between structures. Subcutaneous bursae prevent friction between the skin and an underlying bone, submuscular bursae protect muscles from rubbing against a bone or another muscle, and a subtendinous bursa prevents friction between bone and a muscle tendon. Tendon sheaths contain a lubricating fluid and surround tendons to allow for smooth movement of the tendon as it crosses a joint. Based on the shape of the articulating bone surfaces and the types of movement allowed, synovial joints are classified into six types. At a pivot joint, one bone is held within a ring by a ligament and its articulation with a second bone. Pivot joints only allow for rotation around a single axis. These are found at the articulation between the C1 (atlas) and the dens of the C2 (axis) vertebrae, which provides the side-to-side rotation of the head, or at the proximal radioulnar joint between the head of the radius and the radial notch of the ulna, which allows for rotation of the radius during forearm movements. Hinge joints, such as at the elbow, knee, ankle, or interphalangeal joints between phalanx bones of the fingers and toes, allow only for bending and straightening of the joint. Pivot and hinge joints are functionally classified as uniaxial joints. Condyloid joints are found where the shallow depression of one bone receives a rounded bony area formed by one or two bones. Condyloid joints are found at the base of the fingers (metacarpophalangeal joints) and at the wrist (radiocarpal joint). At a saddle joint, the articulating bones fit together like a rider and a saddle. An example is the first carpometacarpal joint located at the base of the thumb. Both condyloid and saddle joints are functionally classified as biaxial joints. Plane joints are formed between the small, flattened surfaces of adjacent bones. These joints allow the bones to slide or rotate against each other, but the range of motion is usually slight and tightly limited by ligaments or surrounding bones. This type of joint is found between the articular processes of adjacent vertebrae, at the acromioclavicular joint, or at the intercarpal joints of the hand and intertarsal joints of the foot. Ball-and-socket joints, in which the rounded head of a bone fits into a large depression or socket, are found at the shoulder and hip joints. Both plane and ball-and-sockets joints are classified functionally as multiaxial joints. However, ball-and-socket joints allow for large movements, while the motions between bones at a plane joint are small. Interactive Link QuestionsExercise 1Watch this video to see an animation of synovial joints in action. Synovial joints are places where bones articulate with each other inside of a joint cavity. The different types of synovial joints are the ball-and-socket joint (shoulder joint), hinge joint (knee), pivot joint (atlantoaxial joint, between C1 and C2 vertebrae of the neck), condyloid joint (radiocarpal joint of the wrist), saddle joint (first carpometacarpal joint, between the trapezium carpal bone and the first metacarpal bone, at the base of the thumb), and plane joint (facet joints of vertebral column, between superior and inferior articular processes). Which type of synovial joint allows for the widest ranges of motion? Show/Hide Solution Ball-and-socket joint. Exercise 2Visit this website to read about a patient who arrives at the hospital with joint pain and weakness in his legs. What caused this patient’s weakness? Show/Hide Solution Gout is due to the accumulation of uric acid crystals in the body. Usually these accumulate within joints, causing joint pain. This patient also had crystals that accumulated in the space next to his spinal cord, thus compressing the spinal cord and causing muscle weakness. Exercise 3Watch this animation to observe hip replacement surgery (total hip arthroplasty), which can be used to alleviate the pain and loss of joint mobility associated with osteoarthritis of the hip joint. What is the most common cause of hip disability? Show/Hide Solution The most common cause of hip disability is osteoarthritis, a chronic disease in which the articular cartilage of the joint wears away, resulting in severe hip pain and stiffness. Exercise 4Watch this video to learn about the symptoms and treatments for rheumatoid arthritis. Which system of the body malfunctions in rheumatoid arthritis and what does this cause? Show/Hide Solution The immune system malfunctions and attacks healthy cells in the lining of your joints. This causes inflammation and pain in the joints and surrounding tissues. Review QuestionsExercise 5Which type of joint provides the greatest range of motion?
Show/Hide Solution A Exercise 6Which type of joint allows for only uniaxial movement?
Show/Hide Solution B Exercise 7Which of the following is a type of synovial joint?
Show/Hide Solution C Exercise 8A bursa ________.
Show/Hide Solution C Exercise 9At synovial joints, ________.
Show/Hide Solution D Exercise 10At a synovial joint, the synovial membrane ________.
Show/Hide Solution D Exercise 11Condyloid joints ________.
Show/Hide Solution B Exercise 12A meniscus is ________.
Show/Hide Solution A Critical Thinking QuestionsExercise 13Describe the characteristic structures found at all synovial joints. Show/Hide Solution All synovial joints have a joint cavity filled with synovial fluid that is the site at which the bones of the joint articulate with each other. The articulating surfaces of the bones are covered by articular cartilage, a thin layer of hyaline cartilage. The walls of the joint cavity are formed by the connective tissue of the articular capsule. The synovial membrane lines the interior surface of the joint cavity and secretes the synovial fluid. Synovial joints are directly supported by ligaments, which span between the bones of the joint. These may be located outside of the articular capsule (extrinsic ligaments), incorporated or fused to the wall of the articular capsule (intrinsic ligaments), or found inside of the articular capsule (intracapsular ligaments). Ligaments hold the bones together and also serve to resist or prevent excessive or abnormal movements of the joint. Exercise 14Describe the structures that provide direct and indirect support for a synovial joint. Show/Hide Solution Direct support for a synovial joint is provided by ligaments that strongly unite the bones of the joint and serve to resist excessive or abnormal movements. Some joints, such as the sternoclavicular joint, have an articular disc that is attached to both bones, where it provides direct support by holding the bones together. Indirect joint support is provided by the muscles and their tendons that act across a joint. Muscles will increase their contractile force to help support the joint by resisting forces acting on it. Glossaryarticular capsule articular cartilage articular disc ball-and-socket joint bursa condyloid joint extrinsic ligament hinge joint intracapsular ligament intrinsic ligament meniscus pivot joint plane joint proximal radioulnar joint saddle joint subcutaneous bursa submuscular bursa subtendinous bursa synovial fluid synovial membrane tendon tendon sheath
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