Bone, Joint, Cartilage & LigamentOT 5762January 2016

1. Describe the five classifications of bones and examples for each classification2. Define general purpose and types of bone markings/formations3. Describe the two methods of bone development and compare/contrast4. Describe the elementary principles of joint design and 2 categories of joints5. Define arthrokinematics and osteokinematics and discriminate between the two6. Describe the structure and function of the six major types of synovial joints7. Describe the degrees of freedom for different synovial joints and usual planes/axes of movement for these joint types8. Describe the structures that contribute to joint stability and mobility.9. Describe the role of ligaments and brainstorm positions that stretch ligaments in the body (for example flexing the spine stretches the posterior longitudinal ligament)10. Describe the role of cartilage and the types of cartilage in the body11. Compare a closed kinematic chain with an open kinematic chain and give examples of each12. Define and compare closed and loose-packed positions of a joint13. Describe how joints are innervated; Hiltons Law14. Describe Wolffs law and how bones can change based upon these principles15. Describe the pathology and cause of osteoarthritis (degenerative joint disease)

ReadingsMoore text: pgs. 2-16Levangie text: pgs. 64-83, 88-104

Planes and AxesPlanes/axes: http://www.physical-solutions.co.uk/articles/Understanding%20Planes%20and%20Axes%20of%20Movement.pdf

Planes and AxesPicture source: http://www.physical-solutions.co.uk/articles/Understanding%20Planes%20and%20Axes%20of%20Movement.pdf

Planes and AxesWatch this video about planes and axes

https://www.youtube.com/watch?v=WzM256oL3y8

Tissues of the Human BodyEpithelial tissue - very little extracellular material between the cells (line the outer and inner surfaces of the body such as skin, blood vessel lining, pericardium)Muscular tissue contractile cellsNervous tissue conductible cells Connective tissue - extra-cellular material between the cells (bone, tendons, ligaments, fat, blood)

Types of Connective Tissues(including but not limited to):BoneLigamentCartilageTendonSkinFatBloodFascia

Connective TissueAll connective tissue is made ofCellular components Chondroblast, fibroblast, osteoblasts, tenocytes, etc.Extracellular componentsCollagenElastinWaterDifferent types of connective tissue vary in:-Types of cellular components-Proportion of extracellular components

Forces applied to connective tissueTension: distractive force (pull on connective tissue)carry a bucket, stretch a muscleCompression: compressing force (push together connective tissue)weight bearing, gravity, fall on hand, jumpingShear: forces in opposite directions at right angles to the connective tissuebend over, hit from the side

Different types of forces

BoneHardest connective tissue in the bodyMore collagen than elastin60% waterWithstands greater compression (being pushed on) than tension (being pulled on)Living organ that Hurts when injured nerve supplyBleeds when fractured blood supplyRemodels in response to stressChanges with age

Bone LayersPeriosteum - outside cover (except articulating surfaces)Compact bone - (cortex) hard outer layer within periosteumSpongy/cancellous bone - inner bone Medullary cavity - filled with bone marrowYellow marrow stores fatRed marrow creates blood cellsBlood supply - (Haversian system)

Bone DevelopmentIntramembranous ossification (membranous bone formation)embryonic connective tissue (mesenchyme) begins ossification during the fetal periodi.e., skull Endochondral ossification (cartilaginous bone formation)embryonic connective tissue (mesenchyme) form cartilage modelsbone replaces the cartilagei.e., most bones

Bone DevelopmentWatch this video about the two types of bone development

https://www.youtube.com/watch?v=p-3PuLXp9Wg

Endochondral ossification inlong bones

Classification of BonesLong bonesTubular (humerus and phalanges)Short bonesCuboidal (carpals and tarsals)Flat bonesProtective (sternum and skull)Irregular bonesOther types of bones (vertebra)Sesamoid bonesDevelops within a tendon (patella)

Classification of bones

Bone Markings & Formationscondylecrestepicondylefacetforamenfossagroovelinemalleolusnotchprotuberancespinespinous processtrochantertubercletuberosityServe as attachments for muscles, grooves to protect tendons/nerves/vessels, facilitate articulations between bones

Bone Markings & FormationWatch this video describing different bone markings and formations

https://www.youtube.com/watch?v=WZ_JF2yKWWg

Bone Markings & FormationBone markings flashcards http://quizlet.com/3792064/bone-marking-types-flash-cards/

These flashcards are for your reference. It is not necessary that you know these definitions for this class, but they may be used to help you review the material.

Bone Markings & Formation

Bone RemodelingBone has the ability to remodel, alter its size, shape and structure to meet the mechanical demands placed on itGains or loses cancellous and/or cortical bone in response to the level of stress Wolffs law states the remodeling of bone is influenced by mechanical stresses

Wolffs Law

Wolffs LawWatch this video explanation of bone remodeling and Wolffs Law

https://www.youtube.com/watch?v=yENNqRJ2mu0

CartilageFlexible connective tissue that forms a model for bony growth, makes up certain body parts, covers the end of bones & buffers between joints3 typeswhite fibrocartilage-intervertebral discs, labrumyellow elastic cartilage-ears, epiglottishyaline articular cartilage-articular cartilageCellular component: chondroblasts/cytesExtracellular components: vary by typeUp to 85% waterNo blood supply or nerves, limited healing

Types of cartilageFibrocartilageBonding cement in joints with little motionIV discs, labrum, menisciOnly type I collagenElastic cartilageIn ears and epiglottisContains mostly elastinHas elastic recoilHyaline cartilageSmooth covering on bone ends in synovial jointsContains more glycoproteins than other cartilages

LigamentsBind bones together at joints20% cellular component: fibroblasts80% extracellular component: more collagen than elastin; yet varies in ligament70% waterResists forces in more than 1 directionWithstand compression, tension, and shear forces

TendonsConnect muscle to boneSmall cellular component: fibroblastsLarge extracellular component: collagen and elastin proportions varyResists high unidirectional tensile forces75% waterWithstands greater tension than shear Most vulnerable at the ends

MusclesProvides mobility and stability at the jointsConsist of muscle tissue (contractile tissue) wrapped in connective tissue and connected to the bones by connective tissuetendons, tracts, aponeurosisVary by type, size, fiber content, etc

More about muscles in future classes

Connective tissue changesConnective tissue changes structure and function in response to internal and external forces applied to the tissueViscoelasticityelastic: ability of material to return to original state following deformation of shape/lengthviscosity: ability of material to dampen shearing forces

ViscoelasticityConnective tissue will return to previous shape after deforming force unless force is:applied for a long durationa high magnitude force gradually increased in intensityapplied to a higher-temperature tissue

Response to ForceElastic regiondeformation only temporary, returns to normal shape after force removedPlastic regiondeformation permanent after load removedUltimate failureload continues in plastic range and the tissue ruptures, avulses or fractures

JointsUnion of 2 or more bonesCan be simple or complex depending on functionStability - ends of bones fit together and are braced with capsules, ligaments, tendons (i.e., knee)Mobility- ends of bones fit together and capsules are filled with synovial fluid, occasionally cartilage wedges are present (i.e., shoulder)Need some stability in order to have mobility

Two Joint CategoriesSynarthrosesbones are directly joined by connective tissue - no to minimal movement 1. Fibrous joints fibrous tissue unites the bones 2.Cartilaginous joints fibrocartilage connects the bonesDiarthrosesbones are indirectly joined by a capsule with - moderate to maximal movementAlso called synovial

JointsWatch this video about types of synarthrotic joints/ joint structure: https://www.youtube.com/watch?v=FknWsN9EVJA

Fibrous Joints (synarthrosis)SutureEnds of bones interlock and are united by a thin layer of dense fibrous tissue

Sutures between skull bonesGomphosisBones adapted to each other and united by fibrous tissue

Tooth into mandible or maxillaSyndemosisBones joined directly by a ligament, cord or aponeurotic membrane

Interosseous membrane between fibula and tibia

Suture joint

Gomphosis joint

Syndemosis joint

Cartilaginous Joints (synarthrosis)SymphysisBones joined by fibrocartilaginous discs or plates

Pubic symphysis, IV discs

SynchondrosisParts of the bone are joined by hyaline growth cartilage

Epiphyseal plate in long bones, 1st sternocostal joint

Symphysis joint

Synchondrosis joint

Synovial Joint Construction (diarthrosis)Joint capsule formed of fibrous tissueJoint cavity contains synovial fluidSynovial membrane lining inner surface of the capsuleSynovial fluid forms a film over the joint surfacesHyaline cartilage covers the joint surfaces

Synovial Joint

Types of Synovial JointsUniaxialHingePivotBiaxialCondyloidSaddleTriaxialPlaneBall and socket

Synovial Joints - uniaxialHingeJoint surfaces designed to allow motion in a sagittal plane only Flexion and extensionJoint capsule is thin and laxBones are joined by strong collateral ligaments

Interphalangeal joints of fingers, elbow joint

Hinge joint

Synovial Joints - UniaxialPivot1 surface shaped like a ring and other shaped to rotate within the ringMovement occurs in the horizontal plane only around vertical axisLigaments surround the socket

Dens of C1- atlas around C2 - axis vertebrae

Pivot joint

Synovial Joints - biaxial CondyloidConcave surface of 1 bone slides over convex surface of other Sagittal (flex/ext) & Frontal planes (abd/add)Metacarpal-phalangeal joint of the fingers

Condyloid joint

Synovial Joints - biaxial SaddleEach joint surface is convex in 1 plane and concave in other - like a rider in a saddle Motions in 2 planes (flex/ext) & (abd/add)Carpometacarpal joint of the thumb

Saddle joint

Synovial Joints - triaxialPlaneAdjacent joint surfaces glide or rotate on each otherSmall joints with minimal movement in all planes Carpal joints in the wrist

Plane joint

Synovial Joints - triaxialBall-and-socketBall-like convex surface fits into a concave socketLarge joints with maximal movement permitted in all planes Gleno-humeral joint of the shoulder; hip joint

Ball-and-socket joint

Summary of Synovial Joints in the Body

Synovial JointsWatch this video describing the six different kinds of synovial joints

http://study.com/academy/lesson/the-six-types-of-synovial-joints-examples-definition.html

Hiltons LawStates that the nerves supplying a joint also supply the muscles moving the joint or the skin covering their attachments

Hiltons LawFor example: Musculocutaneous nerve supplies innervation to muscles that move the elbow, as well as, pain and proprioception

Kinematic chainLinkage of a series of joint in such a way that motion at one of the joints in the series is accompanied by motion at an adjacent joint2 typesOpenClosed

Kinematic chainsClosed chaindistal end of the joint linkage (limb) is fixedmotion occurs in a predictable fashionjoints are interdependentOpen chaindistal end of the joint linkage (limb) is freemotion occurs in various fashionsjoints may function independently or in unison

FixedFree

Osteokinematics(osteo = bone; kinematics = movement)Movement of the bonesFlexion/extenstionAbduction/adductionMovement that is measured in ROMDetermined by shape of the joint surfaces, joint capsule, ligaments, muscle bulk, tendons, and bonesROM is normal, hypermobile, or hypomobile dependent on bony and soft tissue

Arthrokinematics(arthro = joint; kinematics = movement)Movement of 1 joint surface in relation to another with 1 surface a more stable baseType of movement which occurs at a joint depends on the shape of the articular surfaceMotion can be roll, slide, or spinA combination of these motions keep opposing joint surfaces in contact and increases ROM

Convex surface is moving on fixed concave surfaceConvex articulating surface moves in a direction opposite the direction traveled by the shaft of the bone

Concave surface is moving on a fixed convex surfaceConcave articulating surface moves in the same direction as the remaining portion of the bony leverFixed bony lever

If humerus did not both roll and slide, it would roll out of glenoid fossa

ArthrokinematicsClosed pack position - joint surfaces are maximally congruent and ligaments and joint capsule are maximally taut, so joint is most stable Usually at extreme end of ROMLittle to no joint playElbow, knee, and IP extension

ArthrokinematicsLoose pack position - joint surfaces are relatively free to move in relation to the other, so structures are more lax Any position other than closed-packMP extension

Joint PlayJoint play is the non-voluntary movement of one articular surface on anotherAssessed by therapists movement of jointToo lax = instabilityToo tight = restricted movement

OsteoarthritisDegenerative joint diseaseLeads to degradation of jointCartilage becomes less effective as shock absorber and lubricating surfaceArticulation between bones becomes vulnerable to frictionMay cause pain, stiffness, discomfort, inactivity

Osteoarthritis

***Interfibrillar protein network previously referred to as ground substance

Fibrillar component previously referred to as fibrous tissue

2 fibrillar proteins are collagen and elastinCollagen is strong as steel, nonelasticElastin is white fibrous tissue, elastic so deforms and returns to previous position

Is always more collagen than elastin in the fibrillar component, but amounts vary between connective tissue type

No need to know details of the interfibrillar components that the Levangie text goes into, such as the types of collagen**Bone is highly calcified*The artic surfaces are covered with hyaline cartilage

Cancellous bone is the same as spongy bonesTrabeculae are thin plates of calcified tissue in spongy bone**Intermembranous - mesenchyme replaced by bone forming osteoblast cellsThe anterior fontinels in the brain is an example of the areas of the skull still membranous at birth, not bone until 2 yrs. Old

Endochondral - 3 events:1. Bony collar forms at center and begins laying down bone through oppositional growth2.Cartilage cells at center grown through interstitial growth3. Artery invades middle of the bone

Interstitial growth continues from these epiphysis near the ends of the bones. The epiphyseal plate is cartilage that is growing until a certain age (up to 20 yrs)

If damaged at this area until bone growth complete, growth will hault*Figure 1.11 p.20Endochondral ossification in long bones1. Mesenchymal cells condense and differentiate into chondroblasts to form a cartilaginous bone model2. In the midregion the cartilage calcifies and periosteal caplillaries grown into the calcified cartilage to supply its interior3. The vessles and osteogenic cells (bone-forming cells) form a periosteal bud4. The capillaries initiate the primary ossification center, where bone replaces cartilage in the main body of the bone The body of a bone ossified from the primary ossification center is the diaphysis5. Secondary ossification centers develop after birth and the parts of the bone ossifed from these centers are epiphyses6. Epiphyseal arteries grow into the developing cavietiesMetaphysis is the flared part of the diaphysis nearest the epiphysis7. The bone formed in the primary center in diaphysis does not fuse with bone frrom secondary centers in the epiphyses until the bone reaches its adult size8. These epiphyseal plates are eventually replaces by bone so the diphyses and epiphyses fuse.9. A seam at this region remains that can be seen on xrays, the epiphyseal line***Condyle-rounded articular area (lat femoral condyle)crest-ridge of bone (iliac crest)epicondyle-eminence superior to condyle (lat epicond)facet-flat area where bones articulate (vertebrae/rib)foramen-passage thru bone (obturator foramenfossa-hollow or depressed area (infraspinous fossa of scapula)groove-elongated depression or furrow (bicupital groove in humerus)line-linear elevation (tibia)malleolus-rounded process (lat malleolus of fibula)protuberance-projection of bone (ext occupital protuberance)spine-thornlike process (spine of scapula)spinous process-projecting spinelike parttrochanter-large blunt elevation (greater trochanter of femur)tubercle-small raised eminence (greater tubercle of humerus)tuberosity large rounded elevation (ischial tuberosity)*Picture of bone markings and formation p19*Yellow cartilage is more elastic than whiteHyaline cartilage is the thin covering on the end of most bones at joints which provides a smooth articular surface

Since no blood supply relies on the flow of fluids in and out for nutrition

Compression and movement allow for this flow of fluids, but prolonged heavy compression can prevent this nutritional flow and lead to changes in the cartilage

Changes in the cartilage also occur with normal aging and arthritic changes.

They can occur with long term immobilization of the joint also as the joint lacks the nutrition, can have degenerative changes

*Resists forces in more than 1 direction due to the varied arrangement of collagen fibers, so is very strong*Resists unidirectional tensile forces as a parallel arrangement of collagen fibers

Some tendons are covered by a sheath in areas where high amount of friction is generated with movement, as in the wrist. The tendon sheath is called tenosynovium

spot where tendon and muscle connect is called the myotendinous junction*Design of a jt is determined by its function

jts that serve multiple functions are more complex in design*Suture is an example of a fibrous jt, which is a synarthrosis

**Syndesmosis is an example of a fibrous jt which is a synarthrosis*Other type of synarthrosis is cartilaginous jtsSymphysis is an example of a cartilaginous synarthrosis jt**Synchondrosis is an example of a cartilaginous synarthrosis *Joint capsule - 2 layersouter - dense fibrous tissue completely encircles ends of bones and is reinforced by ligaments and tendons that cross the jointis poorly vascularized but richly innervated by joint receptors that detect rate and direction of movement, compression and tension, vibration and paininfo is sent to the CNS to act upon - will learn about next semesterinner layer is highly vascularized but poorly innervatedinsensitive to pain but dilates/constricts in response to heat or cold this layer manufactures synovial fluid and collagen and removes waste Synovial fluid- a clear pale yellow viscous fluid that lubricates the joint to reduce friction between the bone and nourishes the cartilage (has no blood supply of its own)Viscosity of fluid varies with movement speed (thinner if rapid mvmt) and temperature (thinner if hot temperaturea0*Diarthrosis synovial jt diagram*Pivot motion is rotation***CMC also opposes, but this is a composite plane, so call only diarthrode**CMC also opposes, but this is a composite plane, so call only diarthrode*Moore/Dalley textbook states that plane joints move in only 1 plane; however Norkin/Levange says 3 planesAlthough slight movement only, we will call triaxial in this course*Moore/Dalley textbook states that plane joints move in only 1 plane; however Norkin/Levange says 3 planesAlthough slight movement only, we will call triaxia in this coursel*******Roll - rolling of 1 joint surface on another, as in a tire rolling on the road (femoral condyles rolling on tibia)Sliding - gliding of 1 component over another, as when a braked wheel skids (prox phalanx on metacarpal)Spin - rotation of the movable component, as when a top spins, a pure rotatory motion (radius on humerus in pron/sup)*Abd of humerus is accompanied by inferior sliding of the head of the humerus in the glenoid fossa

add of humerus is accompanied by superior sliding of the head of the humerus

if didnt both roll and slide the humerus would roll out of the glenoid fossa**