gomphoses – between the teeth, where the tooth fits into the alveolar process, like a peg in a hole

gomphoses – between the teeth, where the tooth fits into the alveolar process, like a peg in a hole.

2. 
   Cartilaginous Joint – 2 ends of bone are joined by either hyaline cart., fibrocartilage, or both. { bone-cartilage-bone}
   

1. Primary Cartilaginous Joint - synchondrosis – no movement

• 
  synostosis – often temporary
  

• 
  costochondral articulations – between the ribs and the sternum – costal cartilage
  

• 
  symphysis pubis – between the pubic bones – Elastin is a hormone of pregnancy that relaxes this joint for partition so that the 2 pubic bones can spread to deliver the baby
  

• 
  intervertebral joint –between 2 vertebral bodies
  

There is no joint in the body with just fibrocartilage

1. 
   Joint capsule – outer lining stratum fibrosum made of dense CT attached to the periosteum. This has poor blood supply but is well innervated (pain, motion, tension, vibration )
   
2. 
   Synovial membrane or stratum synovium – inner lining, very vascular, but poorly innervated
   
3. 
   Synovial fluid – is very slick to lubricate the joint. It contains synoviocytes which secrete this synovial fluid.
   
4. 
   Articular cartilage – The articular ends of the bone are not covered with periosteum, but hyaline cartilage. All joints (except one ) are lined with hyaline cartilage!
   

2. 
   Anatomic shape of the articular surfaces
   
3. 
   Joint capsule – how tight and how strong it is
   
4. 
   Presence of adjacent structures
   

1. 
   Uniaxial - one plane - flexion /extension
   

1. 
   Hinge
   
2. 
   Pivot
   

2. 
   Biaxial - two planes - capable of flexion/extension and adduction/abduction.
   

1. 
   Condyloid
   
2. 
   Saddle
   

3. 
   Multiaxial or polyaxial or triaxial - three planes capable of flexion/extension, adduction/abduction, int/ext. rotation
   

1. 
   Ball and Socket
   
2. 
   Plane
   

1. 
   Ligaments – CT structure that connects bone to bone , “bandage”
   

• 
  Intrinsic – inside the joint w/I the joint capsule, cruciate ligament of the knee
  
• 
  Extrinsic – found associated w/ a joint capsule, just a thickening of the joint capsule, lateral collateral ligament of the knee
  

2. 
   Bursae – flat sac of synovial fluid membrane filled with synovial fluid, located usually where there is a tendon or muscle across a joint. Its function is to decrease friction, subdeltoid.
   
3. 
   Tendon sheath – modified bursa that surrounds a tendon and lubricates it when it moves back and forth. Shin splints –inflammation of the anterior tibial tendon sheath.
   

1. 
   “Hinge” - ginglymus – capable of flexion /extension
   

• 
  Humero-ulnar or cubital joint – AKA elbow joint
  
• 
  Distal interphalangeal joint
  
• 
  Knee joint – EXCEPTION – this is really a modified hinge joint, since the knee joint is biaxial.
  

• 
  Proximal radioulnar joint
  
• 
  Atlantoaxial joint – anterior arch of the Atlas with the dens of the Axis (Epistropheus)
  

1. 
   Condyloid - ellipsoidal joint – oval convex articular surface of one bone into the concave depression of another bone – capable of flexion/extension and adduction/abduction.
   

• 
  Radiocarpal joint
  
• 
  Metacarpophalangeal joint
  
• 
  Atlantooccipital joint – occipital condyles and superior articular facets of the atlas. EXCEPTION: this is only a hinge joint, but is named condyloid because of the shape of its components.
  

2. 
   Saddle - sellar joint – looks like 2 saddles – both bones of the joint are convex in one plane, concave in the other.
   

• 
  carpometacarpal joint of the thumb
  
• 
  trapezium and first metacarpal bone
  
• 
  articulation between the malleus and the incus
  

1. 
   Gliding Joints - plane – the articular surfaces are mostly flat and they glide on top of each other.
   

• 
  Zygapophyseal joints
  
• 
  Intercarpal and intertarsal joints
  
• 
  Sternoclavicular joint
  
• 
  Sternocostal joints - planar
  
• 
  Sacroiliac joint - planar – auricular surface of the sacrum and the ilium
  

2. 
   Ball and socket joints - spheroid - one bone contributes the ball, the other the socket of the joint
   

• 
  hip - coxofemoral joint -
  
• 
  shoulder joint – glenohumeral joint
  

Circumduction is only a combination of flexion/extension and adduction/abduction (not internal/external rotation)

• 
  Synovial, diarthrodial - freely movable
  
• 
  Ginglymus and condyloid – (movement and shape ) the condyles of the occiput rest on the superior articular facets of the atlas (condyloid portion); the condyles converge anteriorly and allow motion in only one plane (flexion and extension - hinge portion)
  
• 
  Anterior atlantooccipital membrane /ligament- anterior arch of atlas to anterior margin of foramen magnum, direct continuation of the anterior longitudinal ligament
  
• 
  Posterior atlantooccipital membrane - posterior arch of atlas to posterior margin of foramen magnum
  
• 
  Lateral Atlanto-occipital membrane - (Anterior Oblique Ligament), these two ligaments connect Transverse Process of atlas to jugular process of occiput.
  
• 
  Articular Capsule (capsular ligament) - these ligaments enclose the articular surfaces and are lined with a synovial membrane
  

• 
  the axis is NOT in direct articulation with the occiput so it is called a complex NOT a joint
  
• 
  Ligaments attach the axis to the occiput
  
• 
  Membrana-tectoria - occipito-axial ligament, tectorial membrane – superior continuation of the posterior longitudinal ligament; attaches on the occipital bone medial to the hypoglossal canal; closely adherent to the cranial dura once inside the cranial vault.
  
• 
  Alar Ligament - check ligament, odontoid ligament; one on each side, apex of dens to medial surface of occipital condyles, serve to limit or check the degree of rotation of the axis. ( Prevents turning your head like an owl or Linda Blair in the exorcist!) BOARD QUESTION!
  
• 
  Apical ligament (suspensory ligament) - single ligament, tip of dens to anterior margin of foramen magnum; may be remains of embryonic notochord as there is no disc here.
  
• 
  Cruciate ligament - 3 components N 15
  

1. 
   transverse ligament of the atlas - lateral mass over posterior aspect of dens to lateral mass – can be torn by whiplash.
   
2. 
   cranial crus - attaches central portion of the transverse ligament to ant. margin of foramen magnum
   
3. 
   caudal crus - attaches central portion of the transverse ligament to posterior body of axis
   

• 
  2 joints here: both are Synovial, diarthrodial
  

2. articulation between dens and anterior arch of the atlas and the dens and the transverse ligament of the atlas - trochoid, pivot joint

• 
  Ligaments associated with the Atlanto-axial joint N 14,15,16
  

1. 
   Anterior atlanto-axial ligament - anterior surface of body of axis to anterior arch of atlas
   
2. 
   Posterior atlanto-axial ligament - from the laminae of the axis to the posterior arch of the atlas
   
3. 
   Accessory Ligaments - runs from the medial surface of the lateral masses of atlas down to the posterior surface of the body at the base of dens
   
4. 
   Transverse Ligament of the Atlas - runs from lateral mass across the neural ring over the posterior aspect of the dens to hold the dens firmly against the fovea dentalis of the atlas, does not attach to the dens, small synovial pocket between the two. Articular facet = fovea dentalis
   

1. 
   Diarthrosis, synovial , gliding, planar
   
2. 
   Between the uncinate processes and a small indentation found on the inferior surface of the vertebra it articulates with.
   
3. 
   typically undergo degeneration with resulting bony outgrowth ( osteophytes ) which may encroach on neighboring structures such as the vertebral artery and the exiting spinal nerves.
   
4. 
   DO NOT COUNT THE ARTICULATIONS FOR THIS JOINT AS EXTRA ARTICULATIONS FOR THE VERTEBRAE.
   

1. 
   Secondary cartilaginous, symphysis, amphiarthrotic
   
2. 
   Intervertebral Disc – truly classified as a ligament
   

1. 
   23 total in the adult: the most superior one between C2 and C3, the most inferior one between L5 and S1
   
2. 
   25% of the height of the vertebral column is due to IVD’s
   
3. 
   lordotic curve areas - disks are thicker on the anterior side than posterior
   
4. 
   adherent to a thin layer of hyaline cartilage which covers the surfaces of the vertebral bodies
   
5. 
   attach to the anterior and posterior longitudinal ligaments and the heads of the ribs 2-9.
   

1. 
   Annulus fibrosus - peripheral portion, fibrocartilage
   
2. 
   Nucleus pulposus ( fibrocartilage in gelatinous matrix ) - 88% H2O at birth, 70% at age 70  this causes disc collapse  shrinking in age.
   

Located between the adjacent inferior articular facets of the superior vertebra and the superior articular facets of the inferior vertebra.

1. 
   Synovial
   
2. 
   Diarthrodial
   
3. 
   Plane
   
4. 
   Gliding
   
5. 
   Multiaxial
   

1. 
   Syndesmosis of the spine (“held together by ligament “) N 146
   

1. 
   Interspinous ligament - between spinous processes
   
2. 
   Supraspinous ligament - connects tips of spinous processes from C7 - S1 (first sacral tubercle)
   
3. 
   Ligamentum nuchae - direct continuation of the supraspinous ligament, from EOP and median nuchal crest to C7 – touches the tips of all transverse processes
   
4. 
   what about the ligamentum flavum, Anterior longitudinal ligament and the Posterior longitudinal ligament of the spine? ( ligamentum flavum is the only truly elastic ligament in the body.) These are syndesmosis as well
   

1. 
   Synovial, diarthrodial, hinge, ( but also: ) gliding ( due to the intra-articular disc ), multiaxial
   
2. 
   Components - articular disc fibrocartilage
   
3. 
   Articular surfaces lined with fibrocartilage ( NOT HYALINE CARTILAGE )
   
4. 
   Movement -
   

• 
  depression and elevation - hinge
  
• 
  protraction and retraction - gliding
  
• 
  lateral rotation
  

• 
  lateral ligament - prevents posterior displacement
  
• 
  stylomandibular - styloid process to ramus of mandible
  
• 
  sphenomandibular ligament - sphenoid bone to lingula/ramus of mandible
  

1. 
   Synovial, diarthrodial, gliding, multiaxial
   
2. 
   There is an articular disc made of fibrocartilage
   
3. 
   Ligaments ( not on test? )
   

• 
  Anterior sternoclavicular ligament - covers anterior aspect of the joint
  
• 
  Posterior sternoclavicular ligament - covers posterior aspect of the joint
  
• 
  Interclavicular ligament - attaches the two sternal ends
  
• 
  Costoclavicular ligament - costal cartilage of the first rib to the costal tubercle