physiology of joints

8/10/2019 Physiology of Joints

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V O L . 45 -A , N O . 5 . JU L Y 19 63

1061

P h ysio log y o f Jo in ts

B Y E R N E S T D . G A R D N E R , M .D .t, D E T R O IT , M IC H IG A N

n Ins tru ctio na l C o urse L ec ture T he m e rica n cad em y o f O rth opa ed ic Su rge on s

T h is accou n t o f th e p hys io log y of jo in ts is d raw n la rge ly from prev iously

p ub lish ed accoun ts tha t a re the basis o f th is Ins truc tion al C o urse 5 , 6 , 7 { 1 4 9 } I t seem s ad-

v isab le to bring the m ater ia l

up -to -da te and to in clu de ce rta in re lativ ely recen t

f ind ings. N ew stu d ie s w hich have n o t been ve rif ied o r w hich a re con tro ve rsia l u sua lly

h av e been om itted . O n ly a few re fe ren ces a re g iven ; each , h ow ev er , ha s an ex tensiv e

b ib liog raph y (see pa rticu la r ly the recen t bo ok by B arne tt, D av ie s, and M acC ona ill

and the p ape r by P u tscha r).

Jo in ts h ave ce rta in co m m o n stru c tu ra l featu re s and fun ctio ns. O n th e basis o f

the m ost cha rac te ris tic struc tu ra l featu re s , jo in ts m ay be c lass ified in to th ree m ain

types: f ib rous , ca r tilag inou s, and syn ov ia l.

F ib rou s Jo in ts

In a fib ro us jo in t, so m e tim es called a sy na rth ros is , th e bo nes are u n ited by

fib ro us tissu e. T h e tw o ch ie f types o f fib ro us jo in ts a re su tu re s an d synd esm oses. A

g om p hosis , the jo in t b etw een a too th and th e bon e o f its socke t, is som e tim es c lassed

as a th ird typ e.

C artilag inous Jo in ts

T h e b on cs o f car tilag ino us jo in ts a re un ited e ithe r by h ya line cartilage o r by

fib rocart i lage.

H ya line C ar tila ge Jo in ts

H ya line cartilage jo in ts are som e tim es ca lled p rim ary ca rtilag in ous jo in ts and

som etim es syncho ndroses. T he h ya lin e car tilage is a pers isten t part o f th e em bry on ic

ca rtilag inou s ske le ton , and it se rv es a s a g ro w th zo ne fo r one or b o th o f the bo nes

tha t it jo in s. A n ep iph ysea l p la te is an exam p le o f th is ty pe of jo in t. M o st h ya line

ca rtilag e jo in ts a re o b lite ra ted , tha t is , rep laced by bo ne , w hen gro w th ceases .

F ibrocartila g ino us Jo in ts

F ib ro ca rtilag inou s jo in ts a re som e tim es ca lled second ary cartilag ino us jo in ts

an d som e tim es am p h ia rth ro se s. T he te rm sym p hys is is a lso app lied to it. T he bo nes

a re u n ited by fib roca rtilage d uring so m e phase o f the ir ex isten ce ; the f ib rocartilage

is separa ted f rom

the b ones by th in p la tes o f hy alin e cartilage . In te rve rteb ra l d isc s

and th e pub ic sym p hysis a re ex am ples o f fib roca rtilag in ous jo in ts .

In th e in te rv erteb ra l d is c, th in , h ya line ca rtilage p late s sep ara te the u pp er an d

lo w er a sp e cts of th e d isc fro m the ad jacen t v erteb ra l bo d ie s . D urin g the pe riod of

* T he pe rson al in vestiga tio ns reported o n in th is paper w ere supp orted by resea rch gran ts

from the M ich igan C hap ter o f the A rth r itis and R h eu m atism F ounda tion and fr om th e N a tio n a l

Ins titu tes o f H ea lth , U n ited S ta tes P ub lic H ealth Serv ice , A -5 32 .

t I )epa rtm en t o f A na tom y , C o llege o f M ed icine , W ayne S ta te U niversity , 1 401 R ivard ,

De tr oit 7 , M ic hig an .


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1062 A .A .O .S . IN S T R U C T IO N A L C O U R S E L E C T U R E

g row th each p la te p ro v ides on e of the tw o zones from w hich th e ve rteb ra l bo dy gro w s

in h eig h t. In a you ng adu lt, the ann u lus fib rosus con sists o f a se rie s o f lam e llae o f

co llageno us b und les tha t a re anchored , abov e and be low , to the m arg ins o f the

h ya line p late s an d to the rin g ep iph yses. T h e inne rm os t lam e llae con ta in fib ro -

car t i lage.

T h e n uc leu s pu lposu s is w h ite , g lis ten in g , and sem ig e latin ous. It co nsis ts o f

fine strand s o f co llagenou s fibe rs , co nn ec tive - tissue ce lls , c a rtilage ce lls , an d am o r-

pho us g roun d substance . A t b irth , it is m uco id an d co n ta ins n o tocho rd al ce lls . I t

also con ta in s fib rou s and cartilag inous e lem en ts tha t g rad ua lly rep lace th e no to -

ch orda l e lem en ts . W ith ad vanc ing ag e , th e en tire d is c ten ds to becom e ca rtilag inou s

and the d ifferences b e tw een the nuc leus pu lp osu s an d the ann u lus a re o ften lost.

Few , if any , n erve end ings a re p resen t in the d isc

excep t o n its su rface o r pe rh ap s

in its ou te rm ost lam ellae . V asom otor an d sen sory f ib ers from sp ina l nerves and

sym p ath etic tru nks sup p ly th e an te rio r long itud in al lig am en t. S im ila r fibe rs from

sym p a th e tic tru n k s and sinuv e rteb ral (recu rren t m en ingea l) ne rv es sup p ly th e

po ste rio r lo ng itu d ina l ligam en t.

Synov ia l Jo in ts

In sy nov ial jo in ts , a lso te rm ed d ia rth ro d ia l jo in ts , th e bon es are un ited by a

fib rous capsu le and by ligam en ts , bu t a re o th erw ise sep ara ted by a cav ity . T h e in ne r

a spec t o f th e capsu le is lin ed by syn ov ia l m em b rane , w h ich p rod uces the syno v ia l

f lu id th a t fills th e jo in t cav ity and lub rica te s the jo in t.

T he re m ay be in tra -ar ticu la r ligam en ts o r ten don s w hich a re u sua lly cove red by

syno v ia l m em b rane . T he jo in t cav ity is so m e tim es pa rtia lly o r com ple tely su b-

d iv ided by fib ro us o r f ib rocartilag ino us d iscs o r m en isci ; the se a re n o t cove red b y

syno v ia l m em bran e excep t to a ce rtain ex ten t a t th eir p e riph ery . T he a rticu lar

su rfaces o f the b ones a re cove red w ith cartilage , w h ich is u sua lly hya line .

T y pes o f S yn oi ia l Jo in ts

S yn ov ia l jo in ts m ay b e c la ssified as s im p le o r com p oun d acco rd ing to th e num -

her o f a rticu la ting surfaces. A sim ple jo in t has o ne pa ir o f a rticu la ting surfaces,

fo r exam p le, an in terph alang ea l jo in t. A com p oun d jo in t, su ch as the e lbow , has

m ore than on e pa ir o f a rticu la ting su rfaces.

S yno v ia l jo in ts m ay b e cla ssif ied acco rd ing to ax is o f m ovem en t. A jo in t m ay

have o n ly on e ax is o f ro ta tion , fo r in stance , a h in ge jo in t, w h ich can o n ly b e flexed

an d ex tended . Jo in ts w ith tw o axes o f m ovem en t, such as sadd le an d e llip so id jo in ts ,

can b e flexed , ex ten ded , abdu c ted , and ad duc ted bu t canno t b e ro ta ted . In jo in ts

w ith a t least th ree ax es, su ch as a ba ll-an d -socke t jo in t, a ll m ov em en ts can take

p lace.

F ina lly , syno v ia l jo in ts m ay be c la ssified acco rd ing to th e shapes o f the ir a rticu -

lar su rfaces. T he m ore com m on ty pes are p lane , h inge , and cond y la r jo in ts . B a ll-

an d -socke t, ellip so ida l, p iv o t, an d sadd le jo in ts a re le ss co m m o n .

Movemen t s a t Syno via l Jo in ts

M ovem ents a t syno v ia l jo in ts inc lude ac tive , pass ive , and accesso ry m ov e-

m en t s .

T h ree ty pes o f activ e m ov em en ts occu r a t syno v ia l jo in ts : (1 ) g lid in g o r s lip p in g

m ov em en ts , (2 ) angu lar m ov em en ts abo u t a horizon ta l ax is (flex ion and ex ten sion )

o r ab ou t an an terop oste rio r ax is (abd uc tion an d ad du ctio n )

,

and (3 ) ro ta to ry m ov e-

m e n t s

ab ou t a lo ng itu d ina l ax is (m ed ia l and late ral) .

Passive m ov em en ts a re those p roduced by an ex te rna l fo rce , such as grav ity

or an ex am ine r.

T H E J O U R N A L O F B O N E A N D J O IN T S U R G E R Y


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E . D . G A R D N E R : P H Y S IO L O G Y O F J O IN T S 1063

A ccesso ry m ov em en ts (o f ten c las sified as passiv e) a re those tha t can be p ro -

d uced on ly by the m an ipu latio n o f an ex am ine r. F o r exam p le , by m an ip u la ting the

w rist jo in t o f a sub jec t, on e can bring abou t a certa in am oun t o f g lid ing an d ro ta tio n ,

bu t th e m usc le arran gem en ts are such th at th e su b ject cann o t activ ely ca rry o u t

th e se m ovem en ts .

Stru ctu re and F unc tion

S y nov ial jo in ts a re sp ec ia lized fo r m ore o r le ss free m ov em en t. T h e e ffec ts o f

fr ic tion a re m in im ized by th e lu b rica tion m ech an ism s of these jo in ts . E ffec tive

lu b rica tion depends on a nu m ber o f fac to rs , pa rticu la r ly a v iscous lub ricatin g flu id

(syn ov ia l flu id ) and incon gruou s bearing surfaces (a rticu la r ca rtilage).

S yn ov ia l M em bra ne a nd Syno via l F lu id

S y nov ial m em brane is a v ascu la r co nnec tive tissu e th at line s the inn er su rface o f

the jo in t capsu le. Its m o st cha rac ter is tic m o rph o log ica l featu re is a cap illa ry n etw ork

ad jacen t to th e jo in t cav ity . S yno v ia l m em brane a lso con ta ins ly m ph atic vesse ls

an d a few nerve fibe rs .

T he con nectiv e -tissu e ce lls o f syno v ia l m em bran e fo rm a re lativ ely sm oo th

su rface from w hich a va riab le n um b er o f v illi, fo lds, an d fa t pads p ro jec t. T he sub-

su rface tissue va ries in th ickn es s and m ay be fib ro us, a reo lar , o r fatty .

S y nov ial m em brane is re spo nsib le fo r the fo rm atio n o f syno v ia l flu id (syn ov ia ) ,

w h ich is a h igh ly v iscous flu id tha t lu b rica te s the jo in t an d a ids in the n u tr ition o f

ar ticu la r car tilage . Its v iscosity is d ue alm ost en tire ly to the p re sen ce of h ya lu ron ic

ac id , som e tim es te rm ed m uc in , w h ich is p ro duced by ce lls o f th e syn ov ia l m em b rane

th roug h ene rg y-requ ir ing reac tions , ju st a s are the m ucop o lysaccha rides in the

g ro und sub stance o f o the r con nectiv e tissues. S o lu tion s o f hya lu ron ic ac id o f m ore

th an 1 pe r cen t fo rm g e ls . T he v iscosity o f syno v ia l flu id d rops to tha t o f w a te r if

th e hy a lu ro n ic ac id is rem ov ed (b y acid p rec ip ita tion , b y enzym atic hy dro lysis , o r

by en zy m atic depo lym eriza tion )

.

T h e v iscosity a lso v arie s w ith tem p era tu re, b ein g

greate r a t low er tem p era tu re.

T he o th er cons titu en ts o f syn ov ia l flu id are d erived ch ie f ly by d ia ly sis from

bloo d p lasm a . H ow eve r, a nu m ber o f p ro tein s a re p re sen t in con cen tra tions such

tha t facto rs o f m olecu la r shape and ch arge seem im portan t, as w e ll a s m olecu la r

w e i g h t { 1 7 6 } .

S yn ov ia l flu id a lso no rm ally co n ta ins a few ce lls , m ostly m on onu clea r, de -

r ived from the lin ing tissue .

A rticu la r C a rtilage

A rticu la r car tilage is usua lly hy a line , the m a tr ix o f w h ich cons is ts ch ie f ly o f

cho ndro itin su lph ate A and C . T he p a rt im m ed ia te ly ad jacen t to bo ne is usu ally

ca lc ified . D uring grow th , a r ticu lar ca r tilag e p ro v ides the g row th zone fo r endo -

chon dral ossif icatio n in th e ep iph ysis . T h e cartilage can a lso reg en era te and repa ir

defects .

W h en grow th ceases, ar ticu la r ca r tilag e lose s m uch of its po w er o f g row th and

repa ir. H ow ev er , so m e g ro w th is still po ssib le and thu s ca rtilage tha t is lo st d u ring

n orm a l use can be rep laced

F urth e rm o re , g row th of ca rtilage is d irectly invo lved

in the rem o de ling o f adu lt jo in ts tha t m ay resu lt from m ech an ica l o r pa tho lo g ical

s t ress 8,9

C artilage is a re silien t and e la stic tissue tha t has the sp ong elik e p ro pe rty o f

be ing ab le to abso rb sy nov ia l flu id w hich d iffuses th rou gh th e ca rtilag e m atr ix .

T hese q ua litie s a re im portan t fac to rs in e ffec tive lub rica tion . T he d iffu sion of flu id

is th e m echan ism by w hich nu tr itive m a te r ials reach th e cartilag e cells . T h ese m a-

V O L . 4 5-A , N O . 5 , JU L Y 196 3


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1064 A .A .O .S . IN S T R U C T IO N A L C O U R S E L E C T U R E

te rials are derived from syn ov ia l flu id , from ep iphy sea l v esse ls , and from cap illar ie s

in

th e a r ter ia l circ le at the pe rip he ry o f the jo in t.

Lubrica tio n M echa n ism s

Jo in t lu b rica tion is ex trem ely e ffectiv e, so e ffectiv e th at the co effic ien t o f fric tion

is m uch lo w er than tha t o f ice slid ing o n ice . Jo in t lub r ica tion is genera lly co nside red

to b e an exam ple o f hyd rod ynam ic o r flu id -f ilm lubrica tion . T he es sen tia l cond ition

is the p re sence o f incong ru ous bea rin g su rfaces (a rticu la r su rfaces do no t fit p erfec tly

th ro ugh ou t th e w h o le ran ge of m ov em en t). T he incon gru ity p erm its the estab lish -

m en t o f w edg e -sh ap ed sp aces occup ied by sy nov ial f lu id .

D u rin g m o vem en t, syno v ia l flu id m o ves th rou gh these spaces, and a p re ssu re

d ev elo ps tha t is su ff icien t to k eep the m o v ing su rfaces sepa ra ted b y a film of flu id .

T h is film tak es u p the e ffec ts o f fric tio n . M en isc i, in tra -a r ticu lar d isc s , fa t p ad s, and

syn ov ia l fo lds aid in sp read ing syn ov ial f lu id th ro ugh ou t the jo in t and a re th ere fo re

o f so m e im portance in jo in t lu b rica tion . R ecen tly , ex pe rim en ts an d a rg um en ts h av e

been p re sen ted to th e e ffect th at jo in t lub rica tio n is an exam p le o f bou nda ry lu b rica -

tion , pe rhaps w ith a con tr ibu tio n of qu asihyd ro dyn am ic lub ricatio n . In bou nda ry

lub rica tion , th e na tu re o f th e slid ing su rfaces and th e q ua lity o f the lub rican t a re

o f p rim e im po rtance

T h e sh ap e of the su rfaces and th e v iscosity o f th e lu b rican t a re un im portan t,

and the coe ffic ien t o f fr ictio n is indepen den t o f the ve loc ity o f m ov em en t. T he

m o ving su rfaces are sep ara ted by lub rican t on ly a few m olecu le s th ick , the lu b rican t

b ein g adh eren t to , o r inco rpo ra ted in to , the su rfaces. B o und ary lu b rica tion w o u ld

seem p articu la rly w e ll adap ted fo r slo w -m o v ing , heav ily lo aded , rec ip ro catin g jo in ts ,

su ch as sy nov ia l jo in ts .

H o w ev er , s till o th er stud ies lend su ppo rt to th e hy drody nam ic theo ry and in -

d ica te tha t syn ov ia l jo in ts have a sp ec ia l k in d of flu id -film lub rica tio n te rm ed w eep-

ing lu b rica tion (oo zin g of syno v ia l flu id from th e a rticu la r car tilage ) 2 T his is

sup p lem en ted by flo atin g lub rica tion , th a t is , the c la ssic , flu id -f ilm typ e. B o und -

a ry lub rica tion m ay occu r u nde r ce r tain cond itions.

A ny m ech an ical sy stem w ears w ith tim e , an d sy nov ial jo in ts are n o ex cep tio n .

S om e w ear-an d-tea r (a lso ca lled use-destruc tion o r a ttr itio n ) is inev itab le , ev en w ith

normal act iv ity ,

a ltho ugh e ff ic ien t lu b rica tion g rea tly m in im izes it. T he m ost com -

m o n resu lt is the w ea rin g aw ay of ar ticu la r ca rtilage to va ry ing d eg rees, occas iona lly

to the ex ten t o f exp osin g , e rod in g , and po lish ing the un de rly ing bon e. W ear-and -

tear m ay be exagge rated by facto rs su ch as trau m a , d is ea se , an d b iochem ica l p ro c -

e sse s tha t ch an ge articu la r geom e try , a lter syn ov ia l f lu id , an d in te rfere w ith ca rtilag e

m e t ab o l i sm .

Absorp tio n from Jo in t C av ity

D iffu sion in eith er d irec tion tak es p lace read ily be tw een the b loo d and lym -

ph atic cap illa rie s o f the syno v ia l m em bran e on th e o ne h and and th e jo in t cav ity on

the o the r. T rue so lu tio ns tha t are in jected in to the jo in t cav ity d iffuse rap id ly in to

cap illar ie s . W h en co llo id al so lu tion s o r f ine S usp ension s a re in jected , th e ra te o f

en tran ce in to the syn ov ia l m em bran e is inv erse ly p rop ortio na l to th e size o f the

pa rticle s . S m all co llo ida l pa rtic le s en te r bo th types o f cap illa rie s . W hen the pa rtic le s

a re o f a ce rta in c ritic a l s ize , p ro bab ly abou t tha t o f the g lob u lin m olecu le , rem o va l

by d iffu sion in to vesse ls s tops, excep t fo r sm a ll q uan titie s tha t en te r lym p ha tic

cap illa rie s . L arge r pa rticle s rem ain in th e sy nov ial tissue .

T h e rate o f d iffu sion and abso rp tion o f so lu tions is inc rea sed if th e in tra -

a rticu la r p re ssu re is inc rea sed , e ithe r b y m ov em en t o r b y in jec tion u nd er h igh pre s-

su re.

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E . I). G A R D N E R : P H Y S IO L O G Y O F J O IN T S 1065

B loo d S up p ly

T he arte rie s tha t su pp ly th e jo in t and the ad jacen t b one arise m o re o r le ss in

c o m m o n . M ost o f those tha t su pp ly th e bon e en te r the b one a t o r nea r th e line o f

capsu la r attachm en t and fo rm a p ro m inen t ne tw ork arou nd th e jo in t.

T he a rte rie s th at supp ly the jo in t u ltim ate ly fo rm a cap illary ne tw ork tha t is

m ost p ro m in en t in the ce llu la r and areo la r a rea s o f the syno v ia l m em brane . A rte rio -

veno us an astom o ses are a lso p re sen t in jo in ts in po sitions tha t w ou ld enab le them

to shun t b lood pas t the cap illa ry n etw orks . H o w ever, the ir sp ec ific fun ctions are

unk now n. R e la tive ly little is kno w n abo u t the con tro l o f b lood flo w in jo in ts .

N erve Su pp ly

S ynov ia l jo in ts a re su pp lied b y bran ch es of the nerv es tha t supp ly the o ver-

ly in g sk in an d th e m usc le s tha t m ov e the jo in t. T he m ann er in w h ich ne rves reach

jo in ts is va ried bo th in th e nu m ber o f b ranches fro m sp ec if ic ne rves and in th e

p re sence o r absen ce of specif ic b ran ch es . E ach m ajo r a r ticu la r n erve sup p lie s a w ide -

sp read bu t nev er th eless re la tive ly cons tan t reg ion o f a jo in t. E ach m ajo r reg ion of a

jo in t is su pp lied by a t lea st tw o m ajo r b ran ch es. T he jo in ts o f th e v erteb ral co lum n

and the p rox im a l pa rts o f th e lim bs also rece ive sym p ath e tic fib ers tha t ru n w ith

b lo od v es sels to the jo in t. P o ssib ly , th is pe riv ascu lar rou te is a lso ava ilab le fo r

senso ry fibe rs from these jo in ts.

S ec tion of a sin g le a rticu la r n erve fo r re lief o f a rth ritic pa ili w ill n o t dene rva te

a jo in t

and m ay fail to re liev e th e pa in . M an y of the f ibe rs in ar ticu la r ne rv es fo rm

p ain end ings. T hese en d ing s a re m o st num erou s in jo in t capsu le s and lig am en ts ,

th e tw isting or stretch in g o f w hich can he v e ry pa in fu l. S tud ies o f hu m an jo in ts

opened under loca l anes thesia ind ica te tha t th e f ib rous cap su le is h igh ly sensitiv e,

w he reas the syno v ia l m em bran e is re lativ ely in sen sitive . S om e o f the n e rve fibers

th at accom p an y arte rie s in to bo ne fo rm pa in end in gs in th e adv en titia o f th ese

v essels . H ence , som e jo in t pa in m ay a rise

in

su bcho ndra l cance llous bo ne o r m arro w .

T he fo llo w in g po in ts a re e sp ec ia lly p ertinen t to jo in t p ain : it. is u sua lly d iffu se

and p oorly lo ca lized , especia lly in the back 1 It of ten le ads to re f lex con tractio ns

or to sp asm s o f m u scle s. S p a sm in tu r n m ay le ad to re flex a trop hy of an tago n istic

m usc les if the p a in is o f lon g dura tion . Jo in t p ain m ay be re fe rred , jus t as pa in f rom

an y deep or v isce ra l s truc tu re m ay be . W h en the pa in is s ev ere and sudd en in o nse t.,

th er e m ay be ,

in

a d d itio n to r efle x m u scle sp asm , reflex v iscer a l an d c ircu la tor y

re sp onses, inc lud in g tem pora ry slow ing of the pu lse an d fall o f b lood pres su re.

M a n y of th e f ibe rs in jo in t ne rv es are pos tgang lio n ic sym p ath etic fibe rs fo r the

supp ly o f the sm o o th m usc le in th e a r ticu lar b loo d v es sels . S om e senso ry fibe rs form

en d ing s (m ostly p ain ) in the adv en titia o f the b lood vessels , inc lud in g th ose

in the

syn ov ia l m em b ran e.

T he la rg er fib ers

in jo in t n e rv es form p ro p r ioc ep t ive e n d in g s,

ch ief ly R uffin i

end ings and pac in ifo rm corpu sc les, in the jo in t capsu le an d ligam en ts . T h ese end -

ings are sen sitive to th e stre tch in duced by m o vem en t. W h en a jo in t is m oved ,

cer ta in recep to rs f ire o ff , rap id ly at f irs t, an d th en a t a ra te tha t depends o n th e

speed an d ex ten t o f m ovem en t. A fte r the jo in t has m ov ed a certa in d istance, o the r

recep to rs a re stim u la ted , and then still o the rs . T hu s, fo r a g iven po sition and fo r a

cer ta in ran ge of m o vem en t, c erta in rec ep tors a re m or e sen sit ive than o the rs . S o m e

rec ep tor s a p p ear to be ac tive th rou gh the w ho le ran ge of m ov em en t. M a n y recep -

tor s a d ap t slo w ly ; they con tin ue to d ischa rge afte r m ov em en t has stop ped .

T he propriocep tive end in gs in jo in ts are accu rat.e ind ica to rs o f po sition and of

m ov em en t and a re th e ch ief p eriph era l co n trib u to rs to the k in esth etic sense . T h is

sense , a lso k now n as m uscle sense o r m u sc le- jo in t-tend on sen se, rece ives little , if

ally,

co n tr ibu tio n fro m senso ry end in gs

i ii m u sc le s.

T he prop rio cep tiv e end ings and

VO 4 5 -A , N O . 5 , J U L Y 1 9 6 3


6/6

1066

A .A .O .S . IN S T R U C T IO N A L C O U R S E L E C T U R E

the ir cen tra l con nec tions a lso ap pea r to b e con cerned in th e re f lex regu la tion of

m ov em en t an d p ostu re .

D enerva tio n of a jo in t usua lly does no t lead to a neurop a th ic a rth ropa thy

un less the re is a lso a w idespread denerv ation of a lim b , a ffec ting sk in , bon es , and

muscles, as ve ll as jo in ts, so

th at ex cessiv e m ov em ein t.

and d am ag e to a jo in t resu lt..

D eve lopm en t o f Jo in ts

M ost s tud ies o f the d eve lopm en t o f jo in ts hav e b een conce rn ed w ith th e

syn ov ia l jo in ts o f th e lim bs . S hortly a f ter lim b bud s ap pea r in the em b ry o , the

m esenchy m al ce lls o f the bu ds pro life ra te and fo rm an ax ia l m ass term ed a b lastem a .

C ho ndrifica tion in th is b la stem a resu lts in the fo rm a tion o f ca rtilage m ode ls o f the

fu tu r e h o n e s.

T he b la st.em a th at rem a ins be tw een th e ch ond rify in g sk ele ta l e lem en ts

fo rm s a rea s term ed in te rzo n es . T h e m esenchy m e im m edia te ly ad jacen t to th e in te r-

zon es becom es v ascu la r ized and m ost in tra-a rticu la r stru ctu re s , such as ligam en ts ,

m enisc i, an d sy nov ia l m em b rane , d iffe ren tiate from it.

B y the end of the em bryon ic pe riod , the d ev elo p ing jo in ts c lose ly re sem b le

adu lt jo in ts in fo rm an d a rrangem en t. T he change from a gene ra lized cellu lar

h lastem a to jo in ts hav ing a fo rm and arran gem ent s im ila r to tho se in the ad u lt

occurs du rin g the pe rio d of ab ou t fo u r and a ha lf to seven w eeks afte r fer tiliz atio n .

T he re is n o recap itu la tion in the sense th at stru c tu re s cha rac ter is tic o f ad u lt low er

fo rm s ap pear as an in te rm ed ia te phase . A rticu la r struc tu res such as ligam en ts

develop

in situ

and und ergo no m igra tion hav in g phy logene tic sign ificance.

D urin g the la tte r pa rt o f the em bryo n ic p eriod , o r ea rly in th e fe tal pe rio d ,

m in u te spaces app ear in th e in te rzon es o f the m a jo r jo in ts an d in th e ad jacen t

m esen chym e. T hese sp aces coa le sce and fo rm a jo in t cav ity . T he pro cess o f cav ita -

tio n is p rob ab ly enzym atic .

R e fe r e nc e s

1 . B A R N E T T , C . H ., an d

C oB B oL D , A .

F .: L u b rica tio n w ith in L iv in g J oin ts. J . B o lle an d Jo in t

Su rg ., 44 -B : 662 -674 , A ug . 1 962 .

2. B A R N E T T , C . H .;

1 ) A V I E S ,

1) . V .; and M A C C O N A I L L , M . A .

S yn ov ial Jo in ts. L on do n , C low es

and S ons , 1 961 .

3.

C A L A N D R U C I O ,

I I. A ., a n d

G I L M E R ,

W . S ., JR . : P ro l ife ration , R ege neration , an d R epa ir o f

A rticu la r C artilage of Im m ature

Anilnals.

J. B on e an d

Jo in t S u rg . ,

4 4-A : 4 31-45 5 , A pr. 1 962 .

4 . C H A R N L E Y , J O H N : T h e L u b ricat ion o f A n im a l Jo in ts

in R ela tio n to S urg ica l R econs truc tio n

b y A rt .h ro pl as ty . A n n . R h e u m at. l )is . , 19 : 10-19 , 1 960 .

5. G A R D N E R , E R N E S T :

Physio logy

of M ovab le Jo in ts. P hys io l. R ev ., 30 : 127 -176 , 1 950 .

6. G A R D N E R , E R N E S T : P hy sio log ica l M ech an ism s in M ovab le Jo in ts .

In

lin s true tio ln a l C ourse

L e c t u re s , T h e A m er ica n A c ad em y of O rth op ae d ic S u rge on s. V ol. 10 , p p . 2 51 -26 1 . A n n A rb or ,

\r.

E dw ard s, 1 953 .

7. G A R D N E R , E R N E S T :

T h e N e rve S u p p ly of M u scles, J o iin ts an d O th er D eep S tru ctu re s. B u ll.

H o sp . Jo in t I)is., 2 1 : 15 3-1 61 , 1 96 0 .

8. J O H N S O N ,

L . C .: K in etic s of O steo arth rit is . L ab . In ve st., 8 : 122 3-1 23 8 , 19 59 .

9.

M O F F E T T , B . C . :

T he T em porom and ibu la r Jo in t. In C o m plete I)en tu re P ros thodon tics .

E dite d by J. J. S h arry . N ew Y ork , B lak is ton , 196 2 .

10 .

N E U H A U S ,

0 . W .: T h e P r ote in s of S yn ov ia l F lu id . J . M ich ig an S ta te M ed . S o c., 6 1 : 45 8-4 63 ,

1 9 6 2 .

11 .

P E D E R S E N ,

H . E .;

B L U N C K ,

C . F . J .; an d

G A R D N E R , E R N E S T :

T h e A natom y of L um bosacra l

P oste rio r R a m i and M cn ing eal B ran che s of S p ina l N erves (S in u-V er teb ral N erv es).

J . B on e

an d Jo in t Su rg ., 3 8 -A : 37 7-391 , A pr. 1 956 .

12 .

P U T S C H A R ,

\\ 0. J .: G en era l P ath ology of th e M u scu lo-sk e leta l S y ste m . In H andbuch der

A lige m e in e n P a th o log ie . E d ite d b y F . B {252 }c h n e r, E . L e tte rer , an d F . R o u le t. V ol. 3 , p a rt 2 ,

pp .

359-488 .

B er lin , S p rin ge r, 196 0 .

T H E J O U R N A L O F H O N E A N D J O IN T S U R G E R Y

physiology of joints

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