Joint

Ajointis the location at which two or

morebonesmake contact.[1]They are
constructed to allow movement (except
for skull bones) and provide mechanical
support, and are classified structurally
and functionally

Classification
Joints are mainly classified structurally and
functionally. Structural classification is
determined by how the bones connect to
each other, while functional classification is
determined by the degree of movement
between the articulating bones. In practice,
there is significant overlap between the two
types of classifications.
Terms ending in thesuffix-sis are singular
and refer to just one joint, while -ses is the
suffix for pluralization.

Structural classification
Structural classification names and divides joints
according to how the bones are connected to each
other.[3]There are three structural classifications of
joints:
fibrous joint- joined by dense irregular connective
tissue that is rich in collagen fibers [4]
cartilaginous joint- joined bycartilage
synovial joint- not directly joined - the bones have a
synovial cavity and are united by the dense irregular
connective tissue that forms the articular capsule
that is normally associated with accessory
ligaments.[4]

Functional classification
Joints can also be classified functionally, by the
degree of mobility they allow:
synarthrosis- permits little or no mobility. Most
synarthrosis joints arefibrous joints(e.g., skull
sutures).
amphiarthrosis- permits slight mobility. Most
amphiarthrosis joints arecartilaginous joints(e.g.,
vertebrae).
diarthrosis- permits a variety of movements. All
diarthrosis joints aresynovial joints(e.g., shoulder,
hip, elbow, knee, etc.), and the terms "diarthrosis"
and "synovial joint" are considered equivalent by
Terminologia Anatomica.[6]

Biomechanical classification
Joints can also be classified based on their
anatomy or on their biomechanical properties.
According to the anatomic classification, joints
are subdivided intosimpleandcompound,
depending on the number of bones involved, and
intocomplexandcombinationjoints:[7]
Simple Joint: 2 articulation surfaces (e.g.
shoulder joint,hip joint)
Compound Joint: 3 or more articulation surfaces
(e.g.radiocarpal joint)
Complex Joint: 2 or more articulation surfaces and
anarticular discormeniscus(e.g.knee joint)

Anatomical
The joints may be classified anatomically into the following
groups:
Articulations of hand
Elbow joints
Wrist joints
Axillary articulations
Sternoclavicular joints
Vertebral articulations
Temporomandibular joints
Sacroiliac joints
Hip joints
Knee joints
Articulations of foot

Joint stability
The capacity of a joint to return to it's "normal"
position, remaining consistent and steady. Joints remain
stable due to the resting tension of the deep (shunt)
muscles that act to hold one bone against the next. As
each joint has specific motions that it is designed to do,
these deep shunt muscles are also important in guiding
the joint through the proper ranges of motion. One
common example of a joint stability issue occurs in a
whiplash injury. The high degree of force imparted on
the neck can damage these deep muscles and prohibit
them from doing their job. As a result of their failure,
the neck joints become unstable allowing the joints to
move in an unnatural way potentially causing further
discomfort.

Joint disorders
A joint disorder is termed anarthropathy, and when involvinginflammation
of one or more joints the disorder is called anarthritis. Most joint disorders
involve arthritis, but joint damage by externalphysical traumais typically
not termed arthritis.
Arthropathies are calledpolyarticularwhen involving many joints
andmonoarticularwhen involving only one single joint.
Arthritis is the leading cause of disability in people over the age of 55.
There are many different forms of arthritis, each of which has a different
cause. The most common form of arthritis,osteoarthritis(also known as
degenerative joint disease) occurs following trauma to the joint, following
an infection of the joint or simply as a result of aging. Furthermore, there is
emerging evidence that abnormal anatomy may contribute to early
development of osteoarthritis. Other forms of arthritis are
rheumatoid arthritis andpsoriatic arthritis , which areautoimmune diseases
in which the body is attacking itself.Septic arthritisis caused by joint
infection.Gouty arthritisis caused by deposition ofuric acidcrystals in the
joint that results in subsequent inflammation. Additionally, there is a less
common form of gout that is caused by the formation of rhomboidal shaped
crystals of calcium pyrophosphate. This form of gout is known as
pseudogout.

Nerve supply of joints

The sources of nerve fibres to a joint conform well to
Hiltons lawthe nerves to the muscles acting on a
joint give branches to that joint as well as to the
skin over the area of action of these muscles. Thus,
thekneejoint is supplied by branches from the
femoral, sciatic, and obturator nerves, which among
them supply the various muscles moving the joint.
Some of these nerves go to the fibrous capsule and
ligaments; others innervate this capsule and reach
the synovial membrane. Some of these nerves are
sensory; others give both motor and sensory fibres
to the arteries that accompany them.

Articular blood and lymph vessels

The joints are surrounded by a rich network of arteries and veins.
Thearteriesin the vicinity of a synovial joint give off subdivisions
that join (anastomose) freely on its outer surface. From the
network of vessels so formed, branches lead to the fibrous capsule
and ligaments and to the synovial membrane. Blood vessels to
the synovial membrane are accompanied by nerves, and, when
these vessels reach the subsynovial membrane, they proliferate to
form another anastomotic network from whichcapillariesgo to all
parts of the membrane. These subsynovial arteries also ramify to
the fatty pads and the nonarticulating parts of the articular
cartilage, disks, and menisci. None, however, go to the
articulating part of an articular cartilage, which therefore depends
upon the synovial fluid for its nourishment.
Veinsalign with the arteries. In addition, a joint has a welldeveloped set of lymphatic vessels, the ultimate channels of
which join those of the neighbouring parts of the limb or body
wall.

ligaments

 Inanatomy, aligamentis the

fibroustissuethat connectsbonesto
other bones and is also known
asarticular ligament,articular larua,
[1]
fibrous ligament, ortrue ligament.

 Ligamentcan also refer to:

Peritoneal ligament: a fold of
peritoneumor other membranes.
Fetal remnant ligament: the
remnants of a tubular structure from
thefetalperiod of life.

 The study of ligaments is known as

desmology(fromGreek
,desmos, "bond"; and,-logia)
Ligaments are similar totendons
andfasciaeas they are all made of
collagen except that ligaments join
one bone to another bone, tendons
join muscle to bone and fasciae
connect muscles to other muscles.

Articular ligaments
"Ligament" most commonly refers to
a band of tough, fibrous dense
regularconnective tissuecomprising
attenuatedcollagenousfibers.
Ligaments connect bones to other
bones to form ajoint. They do not
connectmusclesto bones; that is the
job oftendons. Some ligaments limit
the mobility of articulations, or
prevent certain movements

 Capsular ligaments are part of the

articular capsule that surrounds
synovial joints. They act as
mechanical reinforcements. Extracapsular ligaments join together and
provide joint stability. Intra-capsular
ligaments, which are much less
common,also provide stability but
permit a far larger range of motion.
Cruciate ligamentsoccur in pairs.

 Ligaments areviscoelastic. They gradually lengthen

when under tension, and return to their original
shape when the tension is removed. However, they
cannot retain their original shape when stretched
past a certain point or for a prolonged period of
time. This is one reason whydislocatedjoints must
be set as quickly as possible: if the ligaments
lengthen too much, then the joint will be weakened,
becoming prone to future dislocations.Athletes,
gymnasts, dancers, and martial artists perform
stretching exercises to lengthen their ligaments,
making their joints more supple.

 The term "double-jointed" refers to

people with more-elastic ligaments,
allowing their joints to stretch and
contort further. Such as a gymnast.
The medical term for describing such
double-jointed persons ishyperlaxity.

 The consequence of a broken ligament can be

instability of the joint. Not all broken
ligaments need surgery, but, if surgery is
needed to stabilise the joint, the broken
ligament can be repaired.Scar tissuemay
prevent this. If it is not possible to fix the
broken ligament, other procedures such as
theBrunelli procedurecan correct the
instability. Instability of a joint can over time
lead to wear of the cartilage and eventually
toosteoarthritis.

BURSAE
1a fibrous sac between certain tendons
and the bones beneath them. Lined with
a synovial membrane that secretes
synovial fluid, the bursa acts as a small
cushion that allows the tendon to move
over the bone as it contracts and relaxes.
bursa of Achilles,prepatellar bursa.
2a sac or closed cavity. See omental
bursa,pharyngeal bursa.

SYNOVIAL SHEAT
The membrane lining the cavity of
bone through which a tendon moves.
The American Heritage Medical
Dictionary
synovial sheath,any one of the
membranous sacs enclosing a
tendon of a muscle and facilitating
the gliding of a tendon through a
fibrous or a bony tunnel, such as that
under the flexor retinaculum of the

blood vessels
Theblood vesselsare the part of the
circulatory systemthat transportsblood
throughout thebody. There are three
major types of blood vessels: thearteries,
which carry the blood away from the
heart; thecapillaries, which enable the
actual exchange of water and chemicals
between the blood and thetissues; and
theveins, which carry blood from the
capillaries back toward the heart.

 The arteries and veins have different structures, veins having

two layers and arteries having three:
Tunica intima(the thinnest layer): a single layer of simple
squamousendothelial cellsglued by apolysaccharide
intercellular matrix, surrounded by a thin layer of
subendothelialconnective tissueinterlaced with a number of
circularly arranged elastic bands called the
internal elastic lamina.
Tunica media(the thickest layer): circularly arranged elastic
fiber, connective tissue, polysaccharide substances, the
second and third layer are separated by another thick elastic
band called external elastic lamina. The tunica media may
(especially in arteries) be rich invascular smooth muscle,
which controls the caliber of the vessel.
Tunica adventitia: entirely made of connective tissue. It also
containsnervesthat supply the vessel as well as nutrient
capillaries (vasa vasorum) in the larger blood vessels.

 Capillariesconsist of little more than

a layer of endothelium and
occasional connective tissue.
When blood vessels connect to form
a region of diffuse vascular supply it
is called ananastomosis(pl.
anastomoses). Anastomoses provide
critical alternative routes for blood to
flow in case of blockages.

Types
There are various kinds of blood vessels:
Arteries
Aorta(the largest artery, carries blood out of the
heart)
Branches of the aorta, such as thecarotid artery,
thesubclavian artery, theceliac trunk, the
mesenteric arteries, therenal arteryand the
iliac artery.

Arterioles
Capillaries(the smallest blood vessels)
Venules
Veins

Lymphatic system
The lymphatic system parallels the
cardiovascular system . The
lymphatic system is unique, in that it
is a 1-way system that returns lymph
fluid via vessels to the cardiovascular
system for eventual elimination of
toxic byproducts by end organs, such
as thekidney,liver,colon,skin, and
lungs.

 The lymphatic system consists of the

following:
Fluid, known as lymph
Vessels that transport lymph
Organs that contain lymphoid tissue
(eg, lymph nodes, spleen, and
thymus)

Organ

Function

Lymph

Contains nutrients, oxygen, hormones, and fatty

acids, as well as toxins and cellular waste
products, that are transported to and from
cellular tissues

Lymphatic vessels

Transport lymph from peripheral tissues to the

veins of the cardiovascular system

Lymph nodes

Monitors the composition of lymph, the location

of pathogen engulfment and eradication, the
immunologic response, and the regulation site

Spleen

Monitors the composition of blood components,

the location of pathogen engulfment and
eradication, the immunologic response, and the
regulation site

Thymus

Serves as the site of T-lymphocyte maturation,

development, and control

The lymphatic systems main

functions are as follows:
Restoration of excess interstitial fluid
and proteins to the blood
Absorption of fats and fat-soluble
vitamins from the digestive system
and transport of these elements to
the venous circulation
Defense against invading organisms.

The nervous system

Thenervous systemis an
organ systemcontaining anetwork
of specialized cells calledneurons
that coordinate the actions of a
humanand transmit signals between
different parts of its body.
the nervous system consists of two
parts, central and peripheral.

 Thecentral nervous system contains thebrain

,spinal cord, andretina. The
peripheral nervous systemconsists of sensory
neurons, clusters of neurons calledganglia,
andnervesconnecting them to each other and
to the central nervous system. These regions
are all interconnected by means of complex
neural pathways. Theenteric nervous system,
a subsystem of the peripheral nervous system,
has the capacity, even when severed from the
rest of the nervous system through its primary
connection by thevagus nerve, to function
independently in controlling the
gastrointestinal system.

 Neurons send signals to other cells as

electrochemical waves travelling along thin fibers
calledaxons, which cause chemicals called
neurotransmittersto be released at junctions called
synapses. A cell that receives a synaptic signal may
be excited, inhibited, or otherwise modulated.
Sensory neurons are activated by physical stimuli
impinging on them, and send signals that inform the
central nervous system of the state of the body and
the external environment. Motor neurons, situated
either in the central nervous system or in peripheral
ganglia, connect the nervous system to muscles or
othereffector organs.

 Central neurons, which in vertebrates

greatly outnumber the other types, make all
of their input and output connections with
other neurons. The interactions of all these
types of neurons form neural circuits that
generate an organism's perception of the
world and determine its behavior. Along with
neurons, the nervous system contains other
specialized cells calledglial cells(or simply
glia), which provide structural and metabolic
support.

autonomic nervous system

The autonomic nervous system (ANS) is a
very complex, multifaceted neural network
that maintains internal physiologic
homeostasis. This network includes
cardiovascular, thermoregulatory,
gastrointestinal (GI), genitourinary (GU),
and ophthalmologic (pupillary) systems .
Given the complex nature of this system, a
stepwise approach to autonomic disorders
is required for proper understanding.

Gross Anatomy
Central integration
The central autonomic network is a complex
network in the central nervous system (CNS)
that integrates and regulates autonomic
function. The network involves the cerebral
cortex (the insular and medial prefrontal
regions), amygdala, stria terminalis,
hypothalamus, and brainstem centers
(periaqueductal gray, parabrachial pons,
nucleus of the tractus solitarius, and
intermediate reticular zone of the medulla).

Afferent pathways
The afferent pathways have
receptors residing in the viscera and
are sensitive to mechanical,
chemical, or thermal stimuli. They
conduct along somatic and
autonomic nerves and enter the
spinal cord through the dorsal roots
or the brainstem through cranial
nerves. Impulses initiate local,
segmental, or rostral reflexes.

Efferent pathways
The autonomic nervous system (ANS)
consists of the sympathetic and
parasympathetic nervous system. The
sympathetic nervous system (SNS)
descends to the intermediolateral and
intermediomedial cells in the thoracolumbar
regions of the spine, extending from TI to L2.
Preganglionic axons exiting the spinal cord
enter the white rami communicantes to join
a network of prevertebral and paravertebral
ganglia.

Mucous membrane
Themucous membranes(ormucosae;
singularmucosa) are linings of mostlyendodermalorigin,
covered inepithelium, which are involved inabsorptionand
secretion. They line cavities that are exposed to the
external environment and internalorgans. They are at
several places contiguous withskin: at thenostrils, the
mouth, thelips, theeyelids, theears, thegenital area, and
theanus. The sticky, thick fluid secreted by the mucous
membranes andglandsis termedmucus. The termmucous
membranerefers to where they are found in thebodyand
not every mucous membrane secretes mucus.
Theglans clitoridis,glans penis(head of thepenis), along
with the inside of theforeskinand theclitoral hood, are
mucous membranes. Theurethra is also a mucous
membrane. The secreted mucus traps the pathogens in the
body, preventing any further activities of diseases.

Serous membrane
Inanatomy,serous membrane(orserosa) is a
smoothmembraneconsisting of a thin layer ofcells,
which secreteserous fluid, and a thin connective
tissue layer. Serous membranes line and enclose
several body cavities, known as serous cavities, where
they secrete a lubricating fluid which reduces friction
from muscle movement. Serosa is not to be confused
withadventitia, a connective tissue layer which binds
together structures rather than reducing friction
between them. The serous membrane covering the
heart and lining the mediastinum is referred to as the
pericardium, the serous membrane lining the thoracic
cavity and surrounding the lungs is referred to as the
pleura, and that lining the abdominopelvic cavity and
the viscera is referred to as the peritoneum

bones
Anatomists talk about both bone and bones. The
former is a type of connective tissue made up of
cells suspended in a matrix: the collagenous
matrix in bone just happens to be heavily
impregnated with minerals. You will learn about
bone cells elsewhere, but here is a picture of a
cast of one, just to prove they exist . This
osteocyte has characteristic long processes which
run through the bone putting it in touch both with
other cells and with blood vessels and nerves.
Bones are discrete organs made up of bone
tissue, plus a few other things.

 The main misconception about bones then,

is that they are made up of dead tissue.
This is not true, they have cells, nerves,
blood vessels and pain receptors. Bone
constituents, organic and inorganic matrix
and cells all turn over at a fairly rapid rate.
If we treat a bone with various solvents we
can remove the inorganic matrix and leave
the flexible collagen. Or we can burn a
bone and leave a hard brittle residue.

 The true structure of bone lies somewhere

between these images. In tensile strength bone
is rather like cast iron, although around 1/3 of the
weight, in bending stress it behaves like steel,
although only half as strong and in compression
it can withstand the forces exerted by a running
man (equivalent to a dead weight of 270kg).
Even in standing the compressive force on the
hip joint, which you might expect to be half the
bodyweight on each side, is multiplied by a factor
of around six by muscular pull, since we are not
in equilibrium when standing

Determination of shape
The shape and structure of bones is governed by many
factors, genetic, metabolic and mechanical. Genetic
determination of primary shape can be demonstrated
by organ culture of bone rudiments, which
subsequently grow into recognisable bones, i.e.
roughly the finished shape in all major respects. Fine
tuning is by muscular action. The muscles are active in
utero, although it is difficult to isolate their effect at
this stage. After birth, however, and up to adolescence
there is a correlation between activity and growth. this
is seen in reverse if we look at people who are
bedridden, or who have paralyses (such as
poliomyelitis)

 Metabolic factors are also important:

calcium, phosphorous, vitamins A,C and D
and the secretions of the pituitary, thyroid,
parathyroid adrenals and gonads are all
involved. Dwarves and giants are controlled
by aberrant hormones, but there is much
variation in normal height. Absence of
adequate supplies of vitamin D may lead to
rickets, and absence of calcium in the diet to
week bone liable to fracture.

Function
1-As a lever. The bones of the upper and lower
limbs pull and push, with the help of muscles.
2-As a calcium store. 97% of the body's
calcium is stored in bone. Here it is easily
available and turns over fast. In pregnancy
the demands of the fetus for calcium require a
suitable diet and after menopause hormonal
control of calcium levels may be impaired:
calcium leaches out leaving brittle
osteoporotic bones.

 3-Protective? This is often quoted in books: in fact

protection against outside forces is rarely needed, and
if it is we usually wear a cycling helmet, or a crash hat,
or a hard hat. Or sit in a very strong structure like a
formula 1 carbon fibre tub or a Volvo. So the bone
can't be that good. In practice these are exceeded by
the almost continuous large forces exerted by our own
muscles. Respiratory movements need ribs. If a thigh
bone or a humerus fractures the pull exerted by the
muscles, even though not in active use, will be enough
to overlap or otherwise displace the broken ends and
we need considerable force, traction, to reduce the
fracture i.e. to un-overlap the bits so that they can be
lined up. The force exerted by the masticatory muscles
is sufficient to support the bodyweight.

 4-As a marrow holder. This is

secondary to production of maximum
strength for minimum weight: the
cavities produced in unstressed
areas (like the holes in the tubes of a
bicycle frame) are used for marrow,
or in some places (mastoid) just for
air storage. Occurrence of bone in
two main forms, compact and
cancellous. Both can be seen in our
old lady's vertebra.

Classification of bones
The skeleton is made up of many
bones which change in proportion
between man and his close relatives
but are easily recognisable. The
easiest way to classify bones is by
shape.

Long bones
Typical of limbs, and a good place to start.
They consist of a central, usually hollow,
tubular region, the diaphysis linked to
specialised ends (epiphysis) by a junctional
region (metaphysis). Look at the shaft first.
Tubular, a bit like a bicycle frame tube.
Galileo was the first to write sensibly about
this, noting that a hollow tube was stronger,
weight for weight than a solid rod, and that
the dimensions had to be related to body
weight rather than area:

Short bones
Short bones are found in the wrist
and ankle, carpals and tarsals
respectively. They have no shaft, as
they do not increase dramatically in
size in one dimension during growth,
and tend to be cuboidal in shape.
They are rather like a Malteser in
construction, with cancellous bone in
the centre and a hard outer shell of
compact bone.

Flat bones
Flat bones like those of the cranium
or the scapula are sandwiches of
spongy bone between two layers of
compact bone. They are usually
curved, so we can refer to an inner
and outer table with diploe between
them. These diploe, especially in the
skull, may become pneumatised, i.e.
filled with air. A ring of facial sinuses
around the nose may become

Irregular bones
Any bones which don't fit these
arbitrary categories (bones of the
face, vertebrae) are referred to as
irregular.

Sesamoid
Sesamoid bones are interesting
because they occur in tendon,
especially where a tendon turns a
corner, and is thus exposed to
friction. We shall come across these
again when we talk about muscles.

adulthuman skeleton
consists of 206 bones. Individuals
may have more or fewer bones than
this owing to anatomical variations.
The most common variations include
additional (i.e. supernumerary)
cervical ribsorlumbar vertebra.
Sesamoid bonenumber can also vary
between individuals.

Cranial(8)

frontal bone
parietal bone(2)
temporal bone(2)
occipital bone
sphenoid bone
ethmoid bone

Facial bones (14)

mandible
maxilla(2)
palatine bone(2)
zygomatic bone(2)
nasal bone(2)
lacrimal bone(2)
inferior nasal conchae(2)
vomer

In themiddle ears(6):
malleus(2)
incus(2)
stapes(2)

In thethroat(1)
hyoid bone

In theshouldergirdle (4):
scapulaor shoulder blade (2)
clavicleor collarbone (2)

In thethorax(25):
sternumor breastbone, comprising
thebody of sternum(gladiolus),
manubrium, andxiphoid process(1)
ribs(2 x 12)

In thevertebral column
(24):
cervical vertebrae(7)
thoracic vertebrae(12)
lumbar vertebrae(5)

In thearms(2):
Humerus(2)

In theforearms(4):
radius(2)
ulna(2)

In thehandsexcludingsesamoid
bones(54):
Carpal(wrist) bones:
scaphoid bone(2)
lunate bone(2)
triquetrum bone(2)
pisiform bone(2)
trapezium(2)
trapezoid bone(2)
capitate bone(2)
hamate bone(2)

Metacarpus(palm) bones:
metacarpal bones(5 2)

Digits of the hands (finger bones or phalanges):

proximal phalanges(5 2)
intermediate phalanges(4 2)
distal phalanges(5 2)

In thepelvis(4):
sacrum[1]
coccyxor tailbone [1]
os coxaeor hipbone, comprising the
fusedilium,ischium, andpubis(2)

In thethighs(2):
Femur(2)

In thelegs(6):
patella(2)
tibia(2)
fibula(2)

In the feet excludingsesamoid

bones(52):
Tarsal(ankle) bones:
calcaneusor heel bone (2)
talus(2)
navicular bone(2)
medial cuneiform bone(2)
intermediate cuneiform bone(2)
lateral cuneiform bone(2)
cuboid bone(2)

Metatarsusbones:
metatarsal bone(5 2)

Digits of the feet (toe bones or phalanges):

proximal phalanges(5 2)
intermediate phalanges(4 2)
distal phalanges(5 2)

Cells that constitute the bone

marrow stroma are:

fibroblasts(reticular connective tissue)

macrophages
adipocytes
osteoblasts
osteoclasts
endothelial cells, which form thesinusoids. These
derive fromendothelial stem cells, which are also
present in the bone marrow.[3]
Macrophages contribute especially to
red blood cellproduction, as they deliverironfor
hemoglobinproduction.

cartilage
Cartilage is a type of connective tissue
composed of special cells known as
chondrocytes along with collagen or
yellow elastic fibers. The fibers and the
cells are embedded in a firm gel like
matrix rich in mucopolysaccharides.
Cartilage is not as hard and rigid as
bone. It is much more flexible and
elastic.

Types of cartilage:

There are three types of cartilage;

Hyaline cartilage
Fibrous cartilage
Elastic cartilage

Hyaline cartilage:
This type of cartilage has very thin
fibers having same refractive index
as the matrix of the cartilage and
thus these fibers are not seen.
Hyaline cartilage is the articular
cartilage of long bones, sternum, ribs
etc. Its color is bluish white and it is
flexible.

Fibrous cartilage:
This type of cartilage has numerous
white fibers. It is present in the
symphysis pubis, and
sternoclavicular joint etc. Its color is
glistening white and the appearance
is opaque.

Elastic cartilage:
This type of cartilage has numerous
yellow elastic fibers. It is present in the
ear pinna, external auditory meatus,
Eustachian tubes, and epiglottis etc.
Its color is yellowish and the
appearance is opaque.

Radiographic anatomy