Articulations: Selected Articulations in Depth
Elbow
An extremely stable joint because: the articular capsule is fairly thick and is usually effective in protecting the articulations, the bony surfaces of the humerus and ulna interlock very well and provide solid bony support, multiple strong ligaments help reinforce the articular capsule.
Musculotendinous cuff
Another term for the "rotator cuff"
Radiocarpal articulation
Another term for the carpus
Hyperabduction
Another term for valgus deviation
Hyperadduction
Another term for varus deviation
Luxate
Another word for "dislocate"
Subluxation
Another word for "partially dislocated"
Carpus
Another word for the radiocarpal articulation
Water
As persons age, ___ is gradually lost from the nucleus pulposus and it becomes less effective as a cushion. This leads to greater chance of vertebral injury.
Articular disc
As the ___ of the TMJ is forced out of its normal position, a clicking or popping noise may be heard as the person opens or closes the mouth.
Locking the knee
At full extension of the knee joing, the tibia rotates laterally so as to tighten the ACL and squeeze the meniscus between the tibia and femur, enabling a person to stand for prolonged periods without using or tiring the muscles of the leg.
Avoid activities that cause jaw fatigue and to follow a soft diet, and/or use a bite appliance at night (surgery is a last resort)
Patients with TMJ disorders are advised to ___.
Glenohumeral joint
Permits the greatest range of motion of any joint in the body, and so it is also the most unstable joint in the body and the one most frequently dislocated.
Anular ligament
Surrounds the head of the radius and binds the proximal head of the radius to the ulna. This ligament helps to hold the head of the radius in place.
chew gum or grind or clench their teeth.
TMJ disorders are often seen in people who habitually _____.
Medial meniscus
The MCL is attached to the ___ of the knee joint as well, so an injury to the MCL usually affects the ___ as well.
Articular disc
The TMJ contains an ___, which is a thick pad of fibrocartilage separating the articulating bones and extending horizontally to divide the synovial cavity into two separate chambers.
Depression/elevation, protraction/retraction, side-to-side lateral movements
The TMJ exhibits a variety of movements:
ligaments that secure the joint, causing progressive internal displacement of the articular disc
The most common TMJ disorder occurs as a result of alteration in the _____.
Infraspinatus, subscapularis, teres minor
The muscles of the rotator cuff
Retinacular fibers
The name for the ligamentous fibers of the articular capsule of the acetabulofemoral joint. They reflect around the neck of the femur and provide additional stability to the capsule.
Valgus deviation
The part distal to the joint is abnormally angulated away from the midline of the body
Varus deviation
The part distal to the joint is abnormally angulated towards the midline of the body.
Distal and proximal radioulnar joints
The radiocarpal joint does NOT permit rotational movements. Pronation and supination occurs at the ___.
Condyloid
The radiocarpal joint is a ___ articulation
flexion, extension, adduction, abduction, circumduction (but no rotation)
The radiocarpal joint is a condyloid articulation that permits:
coracoid and acromion processes, clavicle
The shoulder joint is protected from above by an arch formed by the ___, and by the ___.
Anterior talofibular ligament, posterior talofibular ligament, calcaneofibular (lateral) ligament
The three lateral ligaments of the talocrural joint
Anulus fibrosus
The tough outer layer of fibrocartilage that covers each intervertebral disc and binds the disc to the bodies of adjacent vertebrae.
Humeroulnar joint, humeroradial
The two articulations of the elbow joint
Gliding joints
The type of synovial joints created from the articulation of adjacent superior and inferior articular processes
Ligaments
There are numerous ___ that stabilize the vertebral column.
Bursa
There are several ___ associated with the glenohumeral joint that help decrease friction where both tendons and large muscles extend across the joint capsule.
Ligaments
There are several ___ that support the TMJ.
Symphyses, gliding joints
There are two different types of articulations found in the vertebral column
Temporomandibular joint
This small, complex articulation located just anterior to the opening of the ear is the only movable joint between skull bones
Glenohumeral ligaments
Three thickenings of the anterior portion of the glenohumeral articular capsule that may or may not be present and provide only minimal support
Retinacular arteries
Travel through the retinacular fibers of the articular capsule of the acetabulofemoral joint. Branches of the deep femoral artery. Supplies almost all of the blood to the head and neck of the femur.
Arthritic changes as we age, pathologic changes
Two reasons the TMJ is subject to various disorders
Articular capsule of the acetabulofemoral joint
Very dense and strong, extends from the acetabulum to the trochanters of the femur, enclosing both femoral head and neck. Prevents the head from moving away from the acetabulum.
Ligamentum nuchae
Very thick and sturdy, and helps stabilize the skull on the cervical vertebrae
Gliding joint
What kind of joint is the acromioclavicular joint?
Poorly classified (Andy's opinion is gliding joint)
What kind of joint is the humeroradial joint?
Hinge joint
What kind of joint is the humeroulnar joint?
(highly modified) hinge joint
What kind of joint is the talocrural joint?
Hinge joints
What kind of joints are the interphalangeal joints
Hinge joints
What kind of joints are the interphalangeal joints?
Planar (gliding) joints
What kind of joints are the intertarsal joints?
Condyloid joints
What kind of joints are the metacarpophalangeal joints?
Condyloid
What kind of joints are the metatarsophalangeal joints? (allows abduction, adduction, flexion, and extension)
Three proximal carpal bones, distal articular surface of the radius
What makes up the radiocarpal articulation?
Excessive inversion (of the sole of the foot)
What movement causes an ankle sprain and the partial or complete tearing of the anterior talofibular ligament and the calcaneofibular ligament?
Quadriceps femoris muscle tendon
What tendon is the patella embedded in?
Autograft
When the ACL is replaced with a portion of the patient's own patellar ligament or with portions of their own hamstring tendons.
Allograft
When the ACL is replaced with iliotibial tract tissue from a cadaver
Intertarsal joints
Where does inversion and eversion of the foot occur?
Humeroradial joint
Where the capitulum of the humerus articulates with the head of the radius
Humeroulnar joint
Where the trochlear notch of the ulna articulates with the trochlea of the humerus
Fibrocartilage articular disc
A ___ lies within the joint cavity between the acromion and the clavicle
Joint capsule, slight/restricted
A ___ surrounds these gliding joints (the joints between the adjacent superior and inferior articular processes), and ___ movement is possible
Glenohumeral joint
A ball-and-socket joint formed by the articulation of the head of the humerus and the glenoid cavity of the scapula
Acetabular labrum
A fibrocartilage ___ runs along the rim of the acetabulum and rings the head of the femur as it articulates with the acetabulum.
Talocrural joint
A highly modified hinge joint that permits dorsiflexion and plantar flexion, and includes two articulations within one joint capsule.
Ligamentum nuchae
A ligement of note that extends between C7 and the base of the skull
Articular capsule
A loose ____ surrounds the TMJ and promotes an extensive range of motion.
Transverse humeral ligament
A narrow sheet that extends between the greater and lesser tubercles of the humerus
Surgical neck
A relatively loose articular capsule attachees to the ___ of the humerus
Arthroscope
A specialized flexible endoscope that is inserted into the joint capsule to diagnose disease of the joints.
Radial (lateral) collateral ligament
A supporting ligament of the elbow joint that is responsible for stabilizing the joint at its lateral surface
Ulnar (medial) collateral ligament
A supporting ligament of the elbow joint that stabilizes the medial side of the joint.
Coracohumeral ligament
A thickening of the superior part of the glenohumeral joint capsule and it runs from the coracoid process to the humeral head.
Ligamentum teres
A tiny ligament which originates along the acetabulum and attaches at the center of the head of the femur. Does not provide much strength to the joint, but it does typically contain a small artery that supplies some of the blood to the head of the femur.
adjacent superior and inferior articular processes
A type of intervertebral articulation occurs at the synovial joints between ____.
Elevation, depression, circumduction
A wide range of movements is possible, from the sternoclavicular joint, such as:
Articular disc
A(n) ___ partitions the sternoclavicular joint into two parts and creates two separate synovial joint cavities.
Intercarpal articulations (which are planar joints that permit gliding movements between the individual carpal bones)
Additional movements in the carpus region are made possible by ___.
Symphyses
All of the vertebral bodies between the axis (C2) and the sacrum are separated by intervertebral discs, creating ___.
Intervertebral discs
All of the vertebral bodies between the axis (C2) and the sacrum are separated by pads of fibrocartilage called ___.
two synovial joints (one between the temporal bone the and the articular disc, and a second between the articular disc and the mandible)
Because of the articular disc in the TMJ, the TMJ is really ___.
stabilized (and thus a forceful anterior or lateral blow to the mandible can result in partial or complete dislocation of the lower jaw)
Because of the loose articular capsule surrounding the TMJ that gives it so much motion, the TMJ is poorly ___
Tibiofemoral joint
Between the condyles of the femur and the condyles of the tibia
Patellofemoral joint
Between the patella and the patellar surface of the anterior distal femur.
Lateral and medial meniscus
C-shaped fibrocartilage pads located on the condyles of the tibia.
Knee joint
The largest and most complex diarthrosis of the body.
Nucleus pulposus
Composed of water with some supportive fibers. Functions as a shock absorber and provides resilience to the intervertebral disc
Sternoclavicular joint
Considered by my authors to be a saddle joint. Andy has researched this a lot, and some other sources say it is a gliding joint. Andy is currently undecided.
Hinge joint
Depression and elevation of the lower jaw is possible because the TMJ acts as a ___.
Anulus fibrosus, nucleus pulposus
Each intervertebral disc consists of two components:
Deltoid ligament
Extends from the medial malleolus of the tibia to the talus, calcaneus, and another tarsal bone. Prevents overeversion of the foot. Incredibly strong and rarely tears.
Patella ligament
Extends inferiorly to the patella and attaches on the anterior surface of the tibia (at tibial tuberosity)
Two
How many different types of articulations are found in the vertebral column?
Coracoclavicular ligament
If this ligmament is torn, the acromion and clavicle no longer align properly (A-C separation)
epiphyseal growth plate
In children who fall on their outstretched hand there might be a fracture through the ___ at the distal end of the humerus
Anular
Latin for "ring-shaped"
Osteoarthritis
Moderate exercise is good for the joints. Excessive exercise isn't, and can lead to ___ (like Nolan Ryan the baseball player and Dorothy Hamill the Olympic figure skater)
Rotator cuff
Most of the glenohumeral joint's strength is due to the ___ muscles surrounding it.
headaches, sinus pressure, pain in the paranasal sinuses, tympanic membrane, oral cavity, eyes, and teeth.
Other symptoms (other than clicking or popping) of the most common TMJ disorder
Gliding joint
Protraction and retraction of the lower jaw is possible because the TMJ acts as a ___.
Posterior cruciate ligament (PCL)
Runs from the ateriorinferior femur to the posterior side of the tibia. Prevents hyperflexion of the knee joint, and also prevenst the tibia from moving too far posteriorly of the femur.
Lateral (fibular) collateral ligament
Runs from the femur to the fibula. Reinforces the lateral surface of the knee joint and prevents varus deviation or hyper-adduction.
Medial (tibial) collateral ligament
Runs from the femur to the tibia. Reinforces the medial surface of the knee joint and prevents valgus deviation, or hyperabduction.
Anterior cruciate ligament (ACL)
Runs from the posterior femur to the anterior side of the tibia. Prevents hyperextension of the knee joint, and also prevents the tibia from moving too far anteriorly of the femur.
Gliding joint
Side-to-side lateral movements to grind food between the teeth is possible because the TMJ acts as a ___.
Tibiofemoral joint, patellofemoral joint
Structurally, the knee is composed of two separate articulations:
Articular capsule, reinforcing ligaments
Support and stability of the sternoclavicular joint are provided by the fibers of the ___ and by ___.
Coracoclavicular ligament
The ___ binds the clavicle to the coracoid process.
Tendons
The ___ of the rotator cuff muscles encircle the glenohumeral joint (except for the inferior portion) and fuse with the joint capsule
More
The acetabulofemoral joint is ___ (more or less?) stable than the glenohumeral joint (the shoulder).
Sternoclavicular joint
The articulation between the clavicle and the manubrium of the sternum
Temporomandibular joint
The articulation formed at the point where the mandibular condyle of the lower jaw articulates with the mandibular fossa of the temporal bone.
Fall on an outstretched hand
The center of the trochlear notch may be broken when you ___.
Indirectly prevents the clavicle from losing contact with the acromion
The coracoclavicular ligament is responsible for most of the stability of the acromioclavicular joint because it ___.
Acetabulofemoral joint
The coxal (hip) joint's name.
Stable
The elbow is an extremely ___ joint for several reasons.
Pulling stresses
The elbow may also be dislocated by ____, such as those experienced by gymnasts.
tough connective tissue capsule, ligaments
The entire wrist capsule is ensheathed by a ___ that has reinforcing broad ___ to support and stabilize the carpal bone positions.
Glenoid labrum
The fibrocartilaginous ___ encircles and covers the surface of the glenoid cavity
Acromioclavicular ligament
The fibrous joint capsule of the acromioclavicular joint is strengthened superiorly by the ___.
Deepen the concavity
The glenoid labrum helps to ___ of the glenoid cavity to help stabilize the head of the humerus in the glenohumeral joint
The head of the radius is pulled back and forcefully collides with the capitulum
The head of the radius and the capitulum can be damaged in young pitchers because immediately after throwing the ball, ___. A cause of "Little League elbow."
A single articular capsule, olecranon bursa
The humeroulnar joint and humeroradial joint are enclosed within ___, and there is also a large ___.
Nucleus pulposus
The inner gelatinous core of the intervertebral disc.
Hinge
The knee joint is primarily a ___ joint, but when it is flexed, it is also capable of slight rotation and lateral gliding movements.
Inferior portion
Which portion of the glenohumeral joint is the most likely site for injury?
Posterior
Which side of the interphalangeal joint doesn't have supporting ligaments (also the direction the finger moves if it is jammed)?
Sternoclavicular joint
While dislocation of this joint is possible, typically when a person falls on an outstretched hand, the clavicle fractures before the joint dislocates.
Flexing, extension, lateral flexion, and some rotation
While the movement between a single set of vertebrae is limited, when you add the movements of ALL the intervertebral joints, _____ is possible.
All of those structures (including the muscle and jaw) are innervated by numerous sensory fibers of the trigeminal nerve.
Why do so many areas of the head hurt when one has a TMJ disorder?
A fibrocartilaginous articular disc separates the relatively small head of the ulna from the radiocarpal joint
Why isn't the ulna considered part of the radiocarpal joint?
Loss of water from the nucleus pulposus
Why the vertebral column shortens with advancing age
Rotator cuff muscles
Work as a group to hold the head of the humerus in the glenoid cavity
Ligamentum nuchae
You can palpate this thick ligament along the posterior midline of your neck.
Support and stability
___ of the sternoclavicular joint are provided by the fibers of the articular capsule and by reinforcing ligaments.