Amphiarthrosis Two contiguous surfaces united by fibrocartilaginous disks No cavity between the bones Strong ligamentus support Small amount of rocking and sliding motion Subtypes: hyaline, fibrocartilage Hyaline - synchondroses - cartilage United the bones at the unction of cartilage - permits light bending during early life - temporary Union in long bone growth (epiphyseal plate) Fibrocartilage - symphyses - cartilage fuses into a pad of fibrocartilage that is compressible and allows some movement - center of each pad/disc is the nucleous pulposus (cushion/shock absorber)

Joint Mechanics Flashcards by Mary Kaar

Cartilaginous Joint

Amphiarthrosis
Two contiguous surfaces united by fibrocartilaginous disks
No cavity between the bones
Strong ligamentus support
Small amount of rocking and sliding motion
Subtypes: hyaline, fibrocartilage

Hyaline

synchondroses
cartilage United the bones at the unction of cartilage
permits light bending during early life
temporary Union in long bone growth (epiphyseal plate)

Fibrocartilage

symphyses
cartilage fuses into a pad of fibrocartilage that is compressible and allows some movement
center of each pad/disc is the nucleous pulposus (cushion/shock absorber)

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Synovial Joint

Diarthrosis
Most common joint
Articulating bones do not touch
Separated by a fluid-containing joint cavity
Freely mobile
Some contain fibrocartilage discs or meniscus
Articular surface covered with hyaline cartilage
Enclosed by a fibrous joint capsule creates a closed joint cavity
Synovial membrane lines the joint capsule secreting a viscous fluid nourishing and lubricating the hyaline cartilage

Types:

plane
hinge (ginglymus)
saddle
condyloid
ball and socket (ellipsoid, condylar)
pivot

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Plane Synovial Joint

Two flat surfaces
Motion limited to minimal sliding
Ex: triquetreum-pisiform

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Ginglymus Synovial Joint

Hinge
Allows for large degree of freedom of motion in one plane
Ex: elbow

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Spherical Synovial Joint

Ball and socket
Round convex head that articulates with a concave surface
Allows greatest degree of motion

Modified ball and socket:
- condylar: partial flattering of both articular surfaces; limits motion; ex: metacarpal-phalangeal

ellipsoid: head is ellipsoid; greater motion than condylar less than spheroid; ex: radiocarpal

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Trochoid Synovial Joint

Composed of a ball shape that is surrounded by a circle composed of bone and ligament
Primary motion is rotation
Ex: atlas and axis

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Sellar Synovial Joint

Composed of one concave and one convex bone
Allows for greater motion in all planes
Ex: thumb

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Synovial Articular Discs (Meniscus)

Vascular and nerve supply at the periphery
Buffer and maintains normal joint relationship
Limit joint motion in undesirable direction

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Synovial Fibrocartilaginous (Labrum)

Deepens the articular surface

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Synovial Tendons

Within the capsule of the joint

Can become contiguous with fibrocartilaginous labrum

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Hilton’s Law

Nerves supplying a joint also supply the muscles moving the joint and the skin covering the attachments of these muscles

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Joint play, a small but precise amount of movement, which is independent of the action of voluntary muscle function is best assessed in:
A. Active exam
B. Passive exam
C. Postmortem exam
D. Practical exam

B. Passive exam

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This type of joint has primarily a small amount of rocking and/or sliding motion.

A. Cartilaginous
B. Synovial
C. Fibrous
D. Colorado Gold

A. Cartilaginous

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Common elements of a synovial joint include all of the following except:

A. Fibrous capsule
B. Hyaline cartilage
C. Ligamentous reinforcement
D. Synchondrosis
E. Synovial membrane

D. Synchondrosis

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A synovial joint that acts as a hinge is known as this type of joint:

A. Plane
B. Ginglymus
C. Saddle
D. Condyloid
E. Ellipsoid

B. Ginglymus

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The nerve endings within a joint are primarily found within this part of the joint:

A. Hyaline Cartilage
B. Fibrocartilage
C. Articular Capsule
D. Vascular Anastomosis
E. Tendons

C. Articular capsule

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Wolff’s Law

Bone is increased where needed and reabsorbed where it is not
Increased density/hypertrophy related to increased stresses
Decreased - condition of disuse,aging
Can lead to altered stress/strain properties of the bone

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Remodeling and Adaptation: Cartilage

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Trauma or abnormal wear leads to structural disruption of matrix
Loses elasticity therefore increases stiffness
Limited capacity to regenerate or repair
With repeated high stresses can lead to development or degenerative joint disease

Remodeling and Adaptation: Ligaments and Tendons

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Become stronger and stiffer with increased stress
Number and quality of collagen cross-links increase
Become weaker and less stiff with a reduction of stress
Loss of collagen, loser deformation to fail: immobilization, aging

Inflammatory Arthritis

Rheumatoid Arthritis

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Most common inflammatory arthritis
75% women between 30-60 yo
Joint swelling
Immune system mistakenly attacks the synovial and cartilage of the joint
Cartilage wears away, cushioning fluid (synovium) becomes inflamed => chemicals to be released that damage the cartilage and bone of affected joint

Osteoarthritis

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Most common type (16 million in the US)
Usually middle-aged and older people
Joint disease that gets worse over time
Does not cause swelling in joints (not inflammatory)
Cartilage starts to erode, allows bones to grid or rub together => pain

Traumatic Arthritis

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People who have experienced an injury or fracture
Leads to a conduction called avascular necrosis: blood supply to bone is cut off
Lack of blood supply causes surrounding cartilage to deteriorate and bones grind or rub together => pain

Joint Degeneration: Fibrillation

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Early degenerative change of articular cartilage due to loss of proteoglycans
Unmasks collagen fibers and increases water content in chondrocytes
Affected cartilage becomes dull with yellowish discoloration

GROUND CLASS APPEARANCE

Joint Degeneration: Ebrunation

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Complete loss (ulceration) of articular cartilage
Thickening of subchondral bone - osteosclerosis
Permanent lesion
Pain on weight bearing

IVORY LIKE APPEARANCE

Joint Degeneration: Joint Mice

Osteochondromatosis Fragments of cartilage and/or bone floating free in synovial fluid Pieces of degenerating cartilage detach from subchondral bone Catching and locking of joint Commonly seen in degenerative joint diseases: osteochondrosis dissecans (OCD)

Plain Films

X-ray | Evaluates structure, relationship

CT Scan

Evaluates osseous structures, blood

MRI

Evaluates soft tissue best

Contrast

Interarticular - CT scan - joint: look for what's not there Intravenous - MRI - blood flow

Blood Work

Biomarkers - normal function Inflammation markers - abnormal function Immunological studies - abnormal function - autoimmune

Electromyography

Innervation function

Vascular Studies

Structural integrity

42 year old female presents to the office complaining that, on occasion, her left knee locks and catches. She has noticed particularly while playing golf. After a minute or less it stops and she is able to have a full range of motion again. PE: negative findings: - McMurray - Valgus/Varus Stress - Anterior/Posterior Drawer - Pivot Shift/Lachmans - No swelling or joint fluid on observation or Palpation What test would you want to order next? ``` A. Blood work B. X-ray C. EMG D. Vascular study E. None of the above ```

B. X-ray

42 year old female presents to the office complaining that, on occasion, her left knee locks and catches. She has noticed particularly while playing golf. After a minute or less it stops and she is able to have a full range of motion again. PE: negative findings: - McMurray - Valgus/Varus Stress - Anterior/Posterior Drawer - Pivot Shift/Lachmans - No swelling or joint fluid on observation or palpation What intervention would you do next? ``` A. OMT B. Physical Therapy C. Injection D. Surgery E. Non-steroidal ```

D. Surgery

``` 61 year old male presents to the office with 16 months of low back pain causing him to limp which is getting worse. Pain at it's worse 9/10, Tylenol used to help but not anymore. Increases as the day goes on, keeps him from doing his activities of daily living. Has been to Chiro, his back pops, pain better for an hour or so then all comes back. PE: Flattening of lumbar spine - TART changes throughout - Decreased ROM Lumbar Spine - Positive log roll - Short leg on the right - neuro vascular exam normal ``` What test would you want to order? ``` A. Blood work B. X-Ray C. EMG D. Vascular study E. None of the above ```

B. X-Ray

``` 61 year old male presents to the office with 16 months of low back pain causing him to limp which is getting worse. Pain at it's worse 9/10, Tylenol used to help but not anymore. Increases as the day goes on, keeps him from doing his activities of daily living. Has been to Chiro, his back pops, pain better for an hour or so then all comes back. PE: Flattening of lumbar spine - TART changes throughout - Decreased ROM Lumbar Spine - Positive log roll - Short leg on the right - neuro vascular exam normal ``` What inner action would you do next? ``` A. OMT B. Physical Therapy C. Injection D. Surgery E. Non-steroidal ```

D. Surgery

B. X-Ray

A. OMT

``` 24 year old male presents to clinic with CC low back pain. Notices with lifting or running. Plays pro-indoor soccer works on loading dock in off season. Pain between a 2-6/10, constant, radiates into groin, notices worse when extends leg or turns quickly. Has not taken anything for the pain. PE: normal curvature of lumbar spine - TART changes on the right L5-S1 area - Decreased flexion of Lumbar Spine - Negative Log Roll - Short leg on the right - neuro vascular exam normal ``` Same athlete gets taken down from behind during a match. Has immediate pain in his right ankle and is unable to bear weight without significant pain. PE: effusion of the ankle joint - TTP on anterior Tamar dome - Pain with passive flexion and extension - Pain with tilt, anterior drawer, and squeeze tests What test would you want to order next? ``` A. Blood work B. X-Ray C. EMG D. Vascular study E. None of the above ```

B. X-Ray

``` 24 year old male presents to clinic with CC low back pain. Notices with lifting or running. Plays pro-indoor soccer works on loading dock in off season. Pain between a 2-6/10, constant, radiates into groin, notices worse when extends leg or turns quickly. Has not taken anything for the pain. PE: normal curvature of lumbar spine - TART changes on the right L5-S1 area - Decreased flexion of Lumbar Spine - Negative Log Roll - Short leg on the right - neuro vascular exam normal ``` Same athlete gets taken down from behind during a match. Has immediate pain in his right ankle and is unable to bear weight without significant pain. PE: effusion of the ankle joint - TTP on anterior Tamar dome - Pain with passive flexion and extension - Pain with tilt, anterior drawer, and squeeze tests What intervention would you do next? ``` A. OMT B. Physical Therapy C. Injection D. Surgery E. Non-steroidal ```

D. Surgery

A 43 year old male has recurrent anterior shoulder pain and reports he dislocated that same shoulder several times while playing collegiate soccer. An MRI confirms a suspicion that he has torn his labral cartilage. What type of synovial joint has been injured? ``` A. Condyloid B. Ginglymus C. Plane D. Saddle E. Spheroidal ```

E. Spheroidal

57 year old UPS driver presents to the office complaining of medial knee pain bilaterally. It has progressively been getting worse over the last two years. He is in the office because recently his left knee has been locking in flexion. You order a plain film x-Ray of the knee and observe medial joint space narrowing, some osteophylic lipping of the joint lines, what appears to be a couple of loose bodies, and a hard-polished appearance of the end plate of the medial femur and tibia. You would diagnosis this patient with Osteoarthritis and know that locking of the joint to be due to: ``` A. Eburnation B. Gout C. Osteochromatosis D. Osteoporosis E. Osteophytes ```

C. Osteophromatosis

Fibrous Joint

Synarthrosis Connected by dense fibrous tissue - fills the space Motion greatly limited Suture edges types: squamous - overlapping edges; serrated - interlocking edges Examples: - cranial articulations - sydesmosis: joint united by a ligament ours fibrous sheet - gomphosis: a conical process fitting into a socket in an immovable joint

Joint Mechanics Flashcards

(43 cards)