GENERAL ARTHROLOGY RNDr. Michaela Racanska, Ph.D. Lecture 7 - DENTISTRY Skeletal junctions Juncturae seu Systema articulare Two main types of connections: 1. Synathrosis /fibrous joint, fluent connection/ - union by some kind of the connective tissue (fibrous tissue, cartilage, bone) fjffir iJT"* WTW __ Articular cartilagi 2. Diarthrosis /synovial joint, connection by touch/ - union by touch (by articular surfaces and another additional features) Source of the pictures: http://www.wikiskripta.eu/index.php/Spojen%C3%AD_kost%C3%AD Fibrous joint (synarthrosis) >Continuous connections by a layer of connective tissue between bones nearly immobile >The articular surfaces are missing! > Differentiation according to the type of connective tissue 1) Syndesmosis - articulatio fibrosa, bones are joined by fibrous tissue 2) Synchondrosis - articulatio cartilaginea, bones are joined by cartilage 3) Synostosis - articulatio ossea, bones are joined by bone tissue Syndesmosis (art. fibrosa) 1) connective tissue (ligaments), band of collagen fibrous tissue, (like a rope, ribbon or flat membrane) sutura scrrata Ulna SYNDESMOSES 2) wedging (gomphosis): fixation of tooth to the alveolus Tooth Gomphosis joint Mandible Source: http://medical-dictionary.thefreedictionary.com/gompriosis 3) sutures between flat skull bones (suturae). The main types of sutures: ■serrated suture (sutura serrata) ■squamous suture (sutura squamosa), ■flat suture (sutura plana) sutura squamosa sutura plana Source: anatomie Cihák Synchondrosis (art. cartilaginea) bones are joined by cartilage >Connection using hyaline cartilage (connection of ribs and sternum, between bones of the skull base- in child) Obtu-mlw cttnal >connection using fibrous cartilage (SYMPHYSIS) (intervertebral discs, pubic symphysis (symphysis pubica) between both pelvic bones w ^ Source:http://www.wikiskripta.eu/index.php/Soubor:Gray394.png Synostosis (art. ossea) >bones are joined by bone tissue, for example synostosis sphenooccipitalis Connection of the bones using the bone tissue, the result is growing of two or more bones DIARTHROSIS (junctura synovialis, articulatlo) Articulation (joint) is movable union of two or more bones by touch of contact articular surfaces covered by the articular cartilage. General features of a joint Synovial Joint > Articular surfaces=/oc/es articulares particular fossa=/osso articularis, articular head=caput articulare) > Joint capsu\e=capsula articularis (stratum fibrosum and stratum synoviale) > Joint cavity=coi//tos articularis articular fissure filled by synovial fluid {synovia) Synovial fluid (synovia) - nourishes an articular cartilage, increases adhesion and decreases friction of contact surfaces (plicae) or (villi) - are folds of the synovial layer of the articular capsule and increase inner surface of articular capsule (capsula articularis) > Articular network (rete articulare) - plentiful supplying of joint by arteries, veins and nerves > Special joint apparatus Synovial membrane Articular cartilage Fibrous joint capsule Joint cavity filied with synovial fluid Ligaments Additional features of the joints a) labrum articulare - fibrocartilaginous ring - broadening of a shallow articular fossa by a strip of cartilage b) articular discs and meniscs (disci and menisci articulares) - plates of cartilage, which serves as elastic pads, discs divid the articular cavity into two parts, menisci only partly c) ligaments (ligamenta) are present in the most joints as extracapsular, capsular or intracapsular ligaments d) articular muscles [musculi articulares) - prevent of a strangulation of articular capsules e) bursae and synovial pockets [bursae synoviales) - are small cavities close to the joint. They are constructed by synovial membrane and synovial fluid. Usually may communicate with the joint cavity. Movements in joints >Possible according to the shape of articulation surfaces and on position of muscles attachments around the joints >Joints monoaxial, biaxial, multiaxial Basic position of the joint - basic anatomical position Middle position of the joint - most relaxed joint capsule Movements in joints Plantar newon [Illustrations : A. Micheau - MD] (a) Supination (S) and pronation (P) Copyright G&2001 Benjamin Curmnirigs. an imprint or Addison Wesley Longman, inc. Types of joints Joints may be classified from various points of view. According to a number of articular surfaces: a) Simple joints >only two bones are in contact b) Compound joints >more than two bones are in contact >two bones and between them is located or >disk [discus) or menisk [meniscus articularis). Classification of joints according to the shape of articular surfaces: spheroidal joint (ball-and-socket joint) (articulatio spheroidea) - head has shape like a sphere or its part), free spheroid joint (arthrodia) spheroid joint with restricted movements (enarthrosis) > ellipsoidal (condyloid) joint (articulatio ellipsoidea) > cylindrical joint: pivot joint (trochoid) (articulatio trochoidea), wheel joint - the axe of movement is parallel with the longitudinal axe of bone hinge joint (articulatio trochlearis); ginglymus - the axe of movement is in the right angle to the longitudinal axe of bone > saddle joint (sellar) (articulatio sellaris) >plane joint (articulatio plana) > amphiartrosis ART. PLANA AMPHIARTROSIS (a) Planar joint between the navicular and second and third cuneiforms of the tarsus in the foot BALL AND SOCKET ARTH RODIA t Ball and socket |olnt CYLINDRICAL JOINT: HINGE JOINT ENARTHROSIS - Acetabulum of hip bone Head of —^ jß, femur (f) Ball-and-socket joint between head of the femur and acetabulum of the hip bone PIVOT JOINT : Hinge joint Pivot joint ART. ELLIPSOIDEA (CONDYLOID) 2^ m f No rotation! Movements according to the long axis Radius Scaphoid- -Ulna f— Lunate - I CT (d) Condyloid joint between radius and scaphoid and lunate bones of the carpus (wrist) SADDLE JOINT Radius Trapezium Metacarpal of thumb (e) Saddle joint between trapezium of carpus (wrist) and metacarpal of thumb Saddle joJnt Classification of joints according to the level of moveability and number of axis of movements: _Allas (CI) Joints with minimal movement: With irregular surfaces - amphiarthrosis Joints with sliding movements: -Flat joints - articulatio plana Joints with rotational movements: -Joint surfaces allow rotation along one to three axis One-axis joints (art. cylindroidea and art. trochlearis) Two-axis joints (art. ellipsoidea and art. sellaris) Triaxial joints (art. sphaeroidea) Axis (C2) Pivot In pivot joints (uniaxial), a rounded process of bone fits into a bony ligamentous socket, permitting rotation. Plane Plane joints (usually uniaxial) permit gliding or sliding movements Hinge Hinge joints (uniaxial) permit flexion and extension only. Ball and socket In ball and socket joints (multiaxial). a rounded head fits into a concavity, permitting movement on several axes. Saddle In saddle joints (biaxial), saddle-shaped heads permit movement in two different planes Condyloid Condyloid joints (biaxial) permit flexion and extension, abduction and adduction, and circumduction How to describe joints Obvious are theoretical knowledges of the general arthrology, the knowledges of the special osteology is obvious. We are following this outline : 1. Name of the joint, 2. Names of the articular surfaces, 3. Characteristic of the joint capsule 4. Joint auxiliary equipmnet, 5. Type of the joint, 6. Movements in the joint. An integral part is the description of the joints at the plain x-rays in sagittal and lateral projection Special arthrology Connections of the skull (juncturae cranii) Junctions of the skull > craniovetebral junctions > syndesmoses > synchondroses > temporomandibular joint > hyoid junctions Craniovertebral iunctiones > Connection of the skull with the CI and C2 1. Articulatio atlantooccipitalis Paired joint AS: condyli occipitales and foveae articulares superiores of atlas AS: Is attached to the margins of the articular surfaces Special apparatus: membrána atlantooccipitalis anterior and posterior (between arches of atlas and occipital bone) membrána tectoria (cranial continuation of lig. longitudinale posterius, it reaches to clivus) Type of joint: elipsoidal with possibility of flexion and extension of the head and there are also possible smaller movements sideways Membrana uiLmtii.itiv posterior I y mtcrvpin.ik Litt. \upm>pst*lc ;inlt.inli>-oťt:i|>i[;ili\ .interior Mcmbr.m.i ilLtnlo-nct -., ■■ jntcrmr Ali» -Čapnuli arlKuliimnis aiLinio-axiiütN. Uer.ilh. AnkubtKi />|capophvvCjlr% t«CKpi J I > ig tongiludvuk anlcnuv Caput Li artKublio /ygapophy\ca1i> -Vertebra pmmmen\ DKj\iLtrt> o\m\ iKCipil.iliv Lig. i! ..-"i .■ allantts I +* longitudmak posienuv cmbrana ailanto occipital* posterior Membrana alLinto occipilatrt anlemr L« allanio-occipitalis anterior I ii1 ip . . tlcniiN Areu* anicnor atüniri Arttculilk) alLinln-avialn mcduna (ftbtpM i) ( apsub articular*! Lig longitudinale anicrius tec toru Lig !ran%vcrvum alLintb L*t,cnjulorme alLinits Lig flavum Tora men -■UervcMebrak Lig inicrsprn.tk 11 2. Articulatio atlantoaxialis a) articulatio atlantoaxialis lateralis •Paired joint AS: facies articulares inferiores of atlas fades articulares superiores of axis b) articulatio atlantoaxialis mediana •Unpaired joint AS: facies articularis anterior on frontal side of dens axis with fovea dentis of atlas and facies articularis posterior on dorsal side of dens axis with lig. transversum atlantis AC: is common and is attached to the margins of the articular surfaces Cavwn .irticuijfc Dens .< v in At1ii.ul.iIio .ill.inuv-.i\il.ihs mediana lie iransversum allanlis Membrana lectoria Lig longiludinalc posterius Special apparatus: lig. apicis dentis, ligg. alaria, lig. cruciforme atlantis, formed by lig. transversum atlantis and fasciculi longitudinales ("vertical fibrous bands going from axis to occipital bone) Type of joint: both joints form one mechanical unit, atlas is rotating along dens axis in range of 60° Pars ivi-.ii.it :■. own (vcpialb C'anatn hvpogtuwÜH C'ap\ub BfticuUm-(.itl.inti* -»hi ipd.iIrO I v .»Lire I cruofnrmc .tl Units Mcmbniu (ccii>rvi (I ivotiktm i inn) Ovum articulare Dens a\i\ Arliculalio allantn-axilalis mediana I.ig iransversum atl.iniis Articublio .ilLuil4iMKv U'll.ilr. (HCKpUl ) Skull syndesmoses Skull synchondroses Present sutures (suturge), between the margins of the bones, there is a layer of fibrous tissue s- sphenopetrosa s. petrooccipitalis s.lnteroccipitalis - anterior et posterior Temporomandibular joint (articulatio temporomandibularis) AS: caput mandibulae connects with fossa mandibularis and tuberculum articulare of temporal bone AC: is attached to the margins of the articular surfaces, its medial part is very strong, it rows together with discus orticuloris Type of joint: gynglimus (hinge) Elevation - closing of the mouth Depresion - opening of the mouth Protraction - shifting od the chin forwards Retraction - shifting od the chin backwards Special apparatus: discus articularis (fibrous cartilage): > its middle part is thiner and the margins are thicker, > it grows together with articular capsule, > It reduce sliding friction > allow the mouth open and close > it divides articular cavity into: > upper compartment: pars discotemporalis -between the condyle and disc (1,2ml) > lower compartment - discomandibularis -between the disc and mand. fossa (0,9ml) Ligaments - extraarticular on lateral side: lig. laterale around the joint: lig. sphenomandibulore (runs from the styloid process -> the posterior edge of the angle of the mandible) lig. stylomandibulore (runs from the styloid process -> the posterio edge of the angle of the mandible) Movements at the TMJ Hinge movement ■type of rotation takes place in the lower compartment between the stationary disc and the moving condyle Gliding movement ■takes place in the upper compartment between the superior surface of the disc, which is moving, and mandibular fossa Depression - the opening ■with simple rotation at the joint can be achieved 15 - 20mm intericisor distance ■during translation, the disc and condyle move under the articular eminence Elevation - the closing ■translation - the condyles move backward and upward along the articular eminence ■rotation upward to attain final position Protrusion ■slide the mandible forward ■maximal protrusion results in the lower incisors being a few mm anterior to the maxillary incisors Hvoid junctions The skull and hyoid bone connects using muscle and lig. stylohyoideum X-ray picture of skull of Maxmilián the 2nd with good visible processus styloideus elongatus, 7 cm long Connections of the spine and thorax Junctions of the spine Spine (columna vertebralis) We can observe all types of junctiones on the spine Synartroses and diarthroses as well Synarthrosis - syndesmosis- ligaments - synchondrosis- disci intervertebrales - synchondrosis sacrococcygea - synostosis- os sacrum, os coccygis Diarthrosis- articulationes interverteb rales Joints of the Vertebral Bodies > disci intervertebrales: altogether 23,1/3 of the height of the spine > cartilaginous (symphysis) connection, discus > (anulus fibrosus - hyaline and fibrous cartilage - Concentric layers of fibrocartilaginous fibers, nucleus pulposus-fibrous tissue) Junctions of vertebral arches - elastic ligaments - ligamenta flava (interarcualia) Superior articular process Transverse process and transverse costal facet Zygapophysial joint cavity Pedicle of vertebral arch (cut) Intervertebral foramen Lamina of vertebral arch Vertebral body Anterior -longitudinal ligament blending with anulus fibers of IV disc Intervertebral • disc Inferior articular process Ligamentum llavum Posterior longitudinal ligament I Anterior longitudinal ligament covering vertebral body - Foramina for blood vessels entering.' exiting vertebral bodies Anterior view Junctions of articular processes of vertebrae •articulationes intervertebrales between the superior and inferior articular processes of adjacent vertebrae - zygapophysial/facet joints sliding movements angulations of the articular facets determine types of movements - short ligaments: - ligg. intertransversaria - ligg. interspinalia - lig. supraspinale (cervical area) - as _ sagitally oriented ligamentum nuchae which is going to the occipital bone External occpital protuberance Posterior atianto-ocapital -umUriiriu Nuchal ligament Ligamenta flava Interspinous ligaments Spoous process of C7 vertebra Supraspinous ligament Intervertebral disc Posterior longitudinal ligament Pechcle (cut> » Anterior longitudinal / ligament Intertransverse ligament Transverse process Articular capsule of zygapophysial joints Lateral costotransverse ligament Interspinous ligament Supraspinous ligament (A) Right lateral view (B) Right posterior oblique view Junctions common for all vertebrae a) lig. longitudinale anterius b) lig. longitudinale posterius • They continue also to the sacral and coccygeal bone Ligamentum Flavum Facet Capsular/ Ligament Interspino Ligament Supraspinous Ligament itertransverse Ligament Posterior Longitudinal \~Ligament Anterior ongitudinal Ligament S5 Co1 - Co5 Synostosis • Conection using the bone tissue •Sacral bone: fusion of five sacral vertebrae • Coccygeal bone: fusion of 3 - 5 coccygeal vertebrae Curvature of vertebral column 1. In the sagittal plane - double S-shaped: lordosis: curvature forwards, cervical C4-5 and lumbar L3-4 kyphosis: curvature backwards, thoracic Th6-7 and sacral 2. Curvature in the frontal plane - Skoliosis, mild skoliosis is physiological and it is present in all people - in most mild right, in some mild left (if you are right or left-handed) SHAPE AND MOVEMENTS OF THE SPINE - 35% of body height Movements • anteflexion, retroflexion, 90° cervical, 23° lumbar, most stressed and vulnerable is part of the lower cervical vertebrae, Thll-12, L4-S1 • lateroflexion, 30° cervical, 35° lumbar • Rotation and torsion, 60-70° cervical, 25-35° thoracic • Springing movements Mobility of the vertebral column - depends on the size of intervertebral disc -the mobility is rectricted by: ligaments, articular capsules and muscles ■ the cervical vertebrae allow a range of flexion, lateroflexion and rotation coupled with laterof lexion the thoracic should be particularly mobile in rotation (is limited by the attachment of ribs) in the lumbar region - anteflexion, retroflexion, lateral flexion Lateral Junctions of the thorax costovertebral joints art. capitis costae art. costotransversarium ■ costochondral joints and interchondral joints artt. interchondrales (6th-9th) membrana intercostalis externa, interna - sternocostal joints artt. sternocostales (2nd-5th) synchondrosis (1st, 6th, 7th) Costovertebral Joints Articulationes capitis costae ■ AF: head of the rib articulates with the inferior and superior costal facets of two adjacent thoracic vertebral bodies and the intervening intervertebral disc ■ AC: firm and it is attached to the margins of AF ■ special apparatus: lig. capitis costae radiatum, at 2nd - 10th rib capitis costae intraarticulare ■j movements: along axis parallel with the neck of the rib ■ allow elevation and depression of the ribs Articulationes costotransversariae AF: foveae costales transversales and art. surface on tuberculum costae AC: margins of the articular surfaces special apparatus: lig. costotransversaria, between collum costae and transversal proccess of the vertebra Movements: along axis which is parallel with collum costae \v, t ^ Articulatio intervertebralis ) Processus articularls inferior vertebrae VII | Processus arlicularis superior vertebrae VIII Processus transversus Lig. tuberculi costae laterale Lig. tuberculi costae I laterale Articulatio--- costotransversaria (BCKpur) ^O'R Lig. costotransversarium--- urn Articulatio capitis costae (hck costae um Juncturae sternocostales • Connections between costal cartilages and sternum 1. Synchondrosis sternocostal is: cartilaginous connection with incisura costalis sterni, regularly at 1st often at 6th and 7th rib 2. Artt. sternocostales: between 2nd to 5th rib and sternum AS: sternal end of costal cartilage, incisura costalis sterni AC: to the margins of the articular surfaces Special apparatus: ligg. sternocostalia radiata - they form membrana sterni externa and interna Junctions of adjacent ribs 1. Articulationes interchondrales joint connection between costal cartilages of 5th to 9th rib, covered by short articular capsule 2. Membranae intercostales - fibrous membranes connecting adjacent ribs Membrana intercostalis externa Chest cage shape and movements • Shape of truncated cone • base (apertura thoracis inferior)_ • apex (apertura thoracis superior) • walls-frontal, dorsal, lateral cavitas thoracis spatia intercostalia a reus costarum angulus infrasternalis V Movements • in costovertebral connections, axis runs parallel with collum costae • Upward rotation - inspirium downward rotation- exspirium Movements of the thoracic wall during inspiration produce increases in the intrathoracic volume and diameters of the thorax Right lateral views Right lateral view Anterior view H-H -«4 Forced inspiration Forced expiration Illustrations were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993) Netter: Interactive Atlas of Human Anatomy. Windows Version 2.0 Čihák R: Anatomie 2 (Splanchnologia). Avicenum, zdravotnické nakladatelství, Praha, 1988. Drake et al: Gray's Anatomy for Students. 2010 Archiv of the lecturer