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Musclespull on bones to make them
move, but movement would not be
possible without joints between the
bones. Humanswould resemble statues
were itnot for the joints between bones
thatallow bones to move once the muscles
have provided the pull. Machine partsmost
likelyto wear out are those that rub together and
theyrequire the most maintenance. Movable joints are
placesin the body where the bones rub together, yet we tend to pay little atten-
tion to them. Fortunatelyour joints are self-maintaining, but damage to or dis-
ease ofa joint can make movement very difficult. We realize then how important
the movable jointsare for normal function.
Anar ticulation, or joint, isa place where two bones come together. We
usuallythink of joints as being movable, but that’s not always the case. Many
joints allow onlylimited movement, and others allow no apparent movement.
The structure ofa given joint is directly correlated with its degree of movement.
Fibrousjoints have much less movement than joints containing fluid and having
smooth articulating surfaces.
Jointsdevelop between adjacent bones or areas ofossification, and move-
mentis important in determining the type of joint that develops. If movement is
restricted_even in a highlymovable joint_at any time during an individual’s
life, the jointmay be transformed into a nonmovable joint.
Thischapter presents a scheme for naming joints (242) and an explanation
ofclasses of joints (242), and types of movement (248). It then presents a descrip-
tion of selected joints(253) and summarizesthe effects of aging on the joints (263).
Articulations
and
Movement
Colorized SEM of a chondrocyte within a lacuna
surrounded bycartilage matrix.
CHAPTER
8
Part 2 Supportand Movement
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Part2 Supportand Movement242
Naming Joints
Objective
■ Describe how joints are named.
Joints are commonly named according to the bones or por-
tions of bones that are united at the joint, such as the temporo-
mandibular joint between the temporal bone and the mandible.
PREDICT
Whatis the name of the joint between the metacarpalsand the
phalanges?
Some joints are given the name ofonly one of the articulat-
ing bones, such as the humeral (shoulder) joint between the
humerus and scapula.Still other joints are simply given the Greek
or Latin equivalent of the common name,such as cubital (ku¯⬘bi-
ta˘l)joint for the elbow joint.
1. What criteria are used to name joints?
Classes ofJoints
Objectives
■ Define and describe fibrous and cartilagenous joints.
■ Describe the general features of a synovial joint, and
explain theirfunction.
■ List and give examples of six types of synovial joints.
The three major kinds of joints are classified structurally as
fibrous, cartilaginous, and synovial.In this classification scheme,
joints are categorized according to the major connective tissue type
that binds the bones together,and whether or not a fluid-filled
joint capsule is present.Joints may also be classified according to
their function.This classification is based on the degree of motion
at each joint and includes the terms synarthrosis (nonmovable
joint), amphiarthrosis (slightly movable joint), and diarthrosis
(freely movable joint).This functional classification is somewhat
limited and is not used in this text. The structural classification
scheme with its various subclasses allows for a more precise classi-
fication and is the scheme we use.
FibrousJoints
Fibrous jointsconsist of two bones that are united by fibrous con-
nective tissue,have no joint cavity, and exhibit little or no move-
ment. Joints in this group are classified further as sutures,
syndesmoses,or gomphoses (table 8.1) based on their structure.
Sutures
Sutures (soo´choorz) are seams between the bones of the skull
(figure 8.1).Some sutures may become completely immovable in
older adults.Sutures are seldom smooth, and the opposing bones
often interdigitate (have interlocking fingerlike processes).This in-
terdigitation adds considerable stability to sutures.The tissue be-
tween the two bones is dense, regular collagenous connective
tissue,and the periosteum on the inner and outer surfaces of the
adjacent bones continues over the joint.The two layers of perios-
teum plus the dense fibrous connective tissue in between form a
sutural ligament.
In a newborn,membr anous areas called fontanels(fon⬘ta˘-
nelz⬘) are present within some of the sutures.The fontanels make
the skull flexible during the birth process and allow for growth of
the head after birth (figure 8.2).
Table 8.1
Class and Bones or
Example of Structures
Joint Joined Movement
Fibrous and Cartilaginous Joints
Fibrous Joints
Sutures
Coronal Frontal and parietal None
Lambdoid Occipital and parietal None
Sagittal The two parietal None
bones
Squamous Parietal and temporal Slight
Syndesmoses
Radioulnar Ulna and radius Slight
(interosseous
membrane)
Stylohyoid Styloid process and Slight
hyoid bone
Stylomandibular Styloid process and Slight
mandible
Tibiofibular Tibia and fibula Slight
(interosseous
membrane)
Gomphoses
Dentoalveolar Tooth and alveolar Slight
process
Cartilaginous Joints
Synchrondroses
Epiphyseal plate The diaphysis None
and epiphysis of a
long bone
Sternocostal Anterior cartilaginous Slight
part of first rib;
between rib and
sternum
Sphenooccipital Sphenoid and None
occipital
Symphyses
Intervertebral Bodies of adjacent Slight
vertebrae
Manubriosternal Manubrium and None
body of sternum
Symphysis pubis The two coxae None except
during
childbirth
Xiphisternal Xiphoid process and None
body of sternum
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Chapter 8 Articulations and Movement 243
The margins of bones within sutures are sites of continuous
intramembranous bone growth, and many sutures eventually be-
come ossified.For example, ossification of the suture between the
two frontal bones occurs shortly after birth so that they usually
form a single frontal bone in the adult skull.In most normal adults,
the coronal,sagittal, and lambdoid sutures are not fused. In some
very old adults,however,even these sutures may become ossified. A
synostosis (sin-os-to¯⬘sis) results when two bones grow together
across a joint to form a single bone.
PREDICT
Predictthe result of a sutural synostosis thatoccurs prematurely in a
child’sskull before the brain has reached itsfull size.
Syndesmoses
A syndesmosis (sin⬘dez-mo¯⬘sis;to fasten or bind) is a fibrous
joint in which the bones are farther apart than in a suture and
are joined by ligaments. Some movement may occur at syn-
desmoses because of flexibility of the ligaments, such as in the
radioulnar syndesmosis, which binds the radius and ulna to-
gether (figure 8.3).
Gomphoses
Gomphoses(gom-fo¯⬘se¯z) are specialized joints consisting ofpegs
that fit into sockets and that are held in place by fine bundles of
regular collagenous connective tissue.The joints between the teeth
and the sockets (alveoli) of the mandible and maxillae are gom-
phoses (figure 8.4). The connective tissue bundles between the
teeth and their sockets are called periodontal (per⬘e¯-o¯-don⬘ta˘l)
ligaments and allow a slight amount of “give” to the teeth
duringmastication.
Gingivitis
The gingiva, or gums, are the softtissues covering the alveolar process.
Neglectof the teeth can result in gingivitis, an inflammation of the
gingiva, often resulting from bacterialinfection. Left untreated, gingivitis
mayspread to the tooth socket, resulting in periodontal disease, the
leading cause oftooth loss in the United States. Periodontaldisease
involvesan accumulation of plaque and bacteria, and the resulting
inflammation, which graduallydestroys the periodontal ligamentsand
the bone. Asa result, teeth may become so loose that they come out of
their sockets. Proper brushing, flossing, and professionalcleaning to
remove plaque can usuallyprevent gingivitis and periodontal disease.
Frontal
bone
Parietal
bone
Occipital
bone
Coronal
suture
Sagittal
suture
Lambdoid
suture
Figure 8.1
Sutures
Parietal
bone
Occipital
bone
Mastoid (posterolateral)
fontanel
Frontal
bone
Sphenoidal
(anterolateral)
fontanel
Temporal bone
Squamous
suture
Lambdoid
suture
Coronal
suture
Figure 8.2
FetalSkull Showing Fontanels and Sutures
(a) Lateralview. (b) Superior view.
(b)
(a)
Frontal bones
(not yet fused
into a single
bone)
Frontal
(anterior)
fontanel
Parietal
bone
Occipital
(posterior)
fontanel
Occipital
bone
Sagittal
suture
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2. Define the term fibrous joint, describe three different types,
and give an example of each. Whatis a synostosis? Where
are periodontal ligamentsfound?
Cartilaginous Joints
Cartilaginous joints unite two bones by means of either hyaline
cartilage or fibrocartilage (table 8.1).Joints containing hyaline car-
tilage are called synchondroses;joints containing fibrocartilage are
called symphyses.
Synchondroses
A synchondrosis (sin⬘kon-dro¯⬘sis; union through cartilage) con-
sists of two bones joined by hyaline cartilage where little or no
movement occurs (figure 8.5a).The epiphyseal plates of growing
bones are synchondroses (figure 8.5b). Most synchondroses are
temporary,with bone eventually replacing them to form synostoses.
On the other hand, some synchondroses persist throughout life.
An example is the sternocostal synchondrosis between the first rib
and the sternum by way ofthe first costal cartilage (figure 8.5c). All
the costal cartilages begin as synchondroses, but because of the
movement that occurs between them and the sternum,all but the
first usually develop synovial joints at those junctions.As a result,
even though the costochondral joints (between the ribs and the
costal cartilages) are retained, most costal cartilages no longer
qualify as synchondroses because one end ofthe cartilage attaches
to bone (the sternum) by a synovial joint.
Symphyses
Asymphysis (sim⬘fi-sis; a growing together) consists of fibrocarti-
lage uniting two bones. Symphyses include the junction between
the manubrium and body ofthe sternum (figure 8.5c), the symph-
ysis pubis (figure 8.6),and the intervertebral disks (see figures 7.15
and 7.17).Some of these joints are slightly movable because of the
somewhat flexible nature offibrocartilage.
JointChanges During Pregnancy
During pregnancycertain hormones, such as estrogen, progesterone,
and relaxin, acton the connective tissue of joints, such asthe symphysis
pubis, causing them to become more stretchable and allowing the joints
to loosen. Thischange allows the pelvicopening to enlarge at the time of
delivery. After delivery, the connective tissue ofthe symphysis pubis
returnsto its original condition. The enlarged pelvicopening, however,
maynot return completely to its original size and the woman mayhave
slightlywider hips after the birth of the child.
These same hormonesmay act on the connective tissue of other
jointsin the body, such as the archesof the feet, causing them to relax,
which mayresult in fallen arches(see section on “Arch Problems,”
p.262). They may also act on some of the baby’s joints, such asthe hip,
causing the jointsto become more mobile than normal. Increased
mobilityof the hip can result in congenital (appearing at birth)
subluxation, or congenitaldislocation, of the hip. Congenitalhip
dislocation occursapproximately once in every 670 births.
3. Define cartilaginous joints, describe two different types,
and give an example of each. Whyare costochondral joints
unique?
SynovialJoints
Synovial(si-no¯⬘ve¯-a˘l; joint fluid; syn, coming together, ovia,re-
sembling egg albumin) joints contain synovial fluid and allow
considerable movement between articulating bones (figure 8.7).
These joints are anatomically more complex than fibrous and
cartilaginous joints. Most joints that unite the bones of the ap-
pendicular skeleton are synovial joints,reflecting the far greater
Part2 Supportand Movement244
Annular ligament
Head of radius
Biceps brachii tendon
Radius
Radioulnar syndesmosis
(interosseous membrane)
Ulna
Figure 8.3
RightRadioulnar Syndesmosis
The interosseousmembrane between the ulna and radius.
Crown
of tooth
Gingiva
(gum)
Root
of tooth
Gomphosis
Periodontal
ligaments
Alveolar bone
Figure 8.4
GomphosisBetween a Tooth and Alveolar Bone
ofthe Mandible
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Chapter 8 Articulations and Movement 245
mobility ofthe appendicular skeleton compared to that of the ax-
ial skeleton.
The articular surfaces of bones within synovial joints are
covered with a thin layer ofhyaline cartilage called articular carti-
lage,which provides a smooth surface where the bones meet. Ad-
ditional fibrocartilage articular disks are associated with several
synovial joints,such as the knee and the temporomandibular joint.
Articular disks provide extra strength and support to the joint and
increase the depth ofthe joint cavity.
The articular surfaces of the bones that meet at a synovial
joint are enclosed within a synovial joint cavity, which is sur-
rounded by a joint capsule.This capsule helps to hold the bones
together while allowing for movement.The joint capsule consists
of two layers: an outer fibrous capsule and an inner synovial
Figure 8.5
Synchondroses
(a) Synchondroses(epiphyseal plates) between the developing bonesof the coxa. (b) Epiphyseal plates. (c) Sternocostal synchondroses.
(a) (b)
(c)
Ilium
Sacrum
Pubis
Ischium
Symphysis
pubis
Figure 8.6
SymphysisPubis
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membrane (see figure 8.7). The fibrous capsule consists of dense
irregular connective tissue and is continuous with the fibrous layer
of the periosteum that covers the bones united at the joint. Por-
tions of the fibrous capsule may thicken to form ligaments.In ad-
dition,ligaments and tendons may be present outside the fibrous
capsule, thereby contributing to the strength and stability of the
joint while limiting movement in some directions.
The synovial membrane lines the joint cavity,except over the
articular cartilage. It is a thin, delicate membrane consisting of a
collection of modified connective tissue cells either intermixed
with part of the fibrous capsule or separated from it by a layer of
areolar tissue or adipose tissue.The membrane produces synovial
fluid,which consists of a serum (blood fluid) filtrate and secretions
from the synovial cells.Synovial fluid is a complex mixture of poly-
saccharides, proteins, fat,and cells. The major polysaccharide is
hyaluronic acid,which provides much of the slippery consistency
and lubricating qualities of synovial fluid. Synovial fluid forms an
important thin lubricating film that covers the surfaces ofa joint.
PREDICT
Whatwould happen if a synovial membrane covered the articular
cartilage?
In certain synovial joints,the synovial membrane may extend
as a pocket, or sac,called a bursa (ber⬘sa˘; pocket) for a distance
away from the rest ofthe joint cavity (see figure 8.7). Bursae contain
synovial fluid and provide a fluid-filled cushion between structures
that otherwise would rub against each other,such as tendons rub-
bing on bones or other tendons. Some bursae are not associated
with joints,such as those located between the skin and underlying
bony prominences,where friction could damage the tissues. Other
bursae extend along tendons for some distance, forming tendon
sheaths.Bursitis (ber-sı¯⬘tis) is an inflammation ofa bursa and may
cause considerable pain around the joint and restrict movement.
At the peripheral margin ofthe articular cartilage, blood vessels
form a vascular circle that supplies the cartilage with nourishment,but
no blood vessels penetrate the cartilage or enter the joint cavity.Addi-
tional nourishment to the articular cartilage comes from the underly-
ing cancellous bone and from the synovial fluid covering the articular
cartilage.Sensory ner ves enter the fibrous capsule and,to a lesser ex-
tent,the synovial membrane. They not only supply information to the
brain about pain in the joint but also furnish constant information to
the brain about the position of the joint and its degree of movement
(see chapter 14).Nerves do not enter the cartilage or joint cavity.
Typesof Synovial Joints
Synovial joints are classified according to the shape ofthe adjoining
articular surfaces.The six types of synovial joints are the plane, sad-
dle,hinge, pivot, ball-and-socket, and ellipsoid. These joints are il-
lustrated in figures 8.8 to 8.13 and are listed in table 8.2.Movements
at synovial joints are described as monoaxial (occurring around
one axis),biaxial (occurring around two axes situated at right an-
gles to each other),or multiaxial (occurring around several axes).
Part2 Supportand Movement246
Figure 8.7
Structure ofa Synovial Joint
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Chapter 8 Articulations and Movement 247
Table 8.2
Class and Example of Joint Structures Joined Movement
Plane Acromioclavicular Acromion process of scapula and clavicle Slight
Carpometacarpal Carpals and metacarpals 2–5 Multiple axes as a group
Costovertebral Ribs and vertebrae Slight
Intercarpal Between carpals Slight
Intertarsal Between tarsals Slight
Intervertebral Between articular processes of adjacent vertebrae Slight
Sacroiliac Between sacrum and coxa (complex joint with several Slight
planes and synchondroses)
Tarsometatarsal Tarsals and metatarsals Slight
Saddle Carpometacarpal pollicis Carpal and metacarpal of thumb Two axes
Intercarpal Between carpals Slight
Sternoclavicular Manubrium of sternum and clavicle Slight
Hinge Cubital (elbow) Humerus, ulna, and radius One axis
Genu (knee) Femur and tibia One axis
Interphalangeal Between phalanges One axis
Talocrural (ankle) Talus, tibia and fibula Multiple axes, one predominates
Pivot Atlantoaxial Atlasand axis Rotation
Proximal radioulnar Radius and ulna Rotation
Distal radioulnar Radius and ulna Rotation
Ball-and-Socket Coxal (hip) Coxa and femur Multiple axes
Glenohumeral (shoulder) Scapula and humerus Multiple axes
Ellipsoid Atlantooccipital Atlas and occipital bone Two axes
Metacarpophalangeal (knuckles) Metatarsals and phalanges Mostly one axis
Metatarsophalangeal Metatarsals and phalanges Mostly one axis
Radiocarpal (wrist) Radius and carpals Multiple axes
Temporomandibular Mandible and temporal bone Multiple axes, one predominates
Types of Joints
Figure 8.8
Plane Joint
Figure 8.9
Saddle Joint
Plane,or gliding, joints consist of two opposed flat surfaces
ofabout equal size in which a slight amount of g liding motion can
occur between the bones (figure 8.8).These joints are considered
monoaxial because some rotation is also possible but is limited by
ligaments and adjacent bone.Examples are the articular processes
between vertebrae.
Saddle joints consist of two saddle-shaped articulating
surfaces oriented at right angles to each other so that comple-
mentary surfaces articulate with each other (figure 8.9). Saddle
joints are biaxial joints.The carpometacarpal joint of the thumb
is an example.
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4. Describe the structure of a synovial joint. Howdo the
differentparts of the joint function to permit joint movement?
Whatare articular disks and where are they found?
5. Define the terms bursa and tendon sheath. What is their
function?
6. On what basis are synovial joints classified? Describe the
differenttypes of synovial joints, and give examples of
each. Whatmovements does each type of joint allow?
Typesof Movement
Objectives
■ Define and give examples of various types of movements in
the body.
■ Describe the factors that influence range of motion.
A joint’s structure relates to the movements that occur at that
joint.Some joints are limited to only one type of movement; others
can move in several directions.With few exceptions,movement is best
described in relation to the anatomic position: (1) movement away
from the anatomic position and (2) movement returning a structure
toward the anatomic position.Most movements are accompanied by
movements in the opposite direction and therefore are listed in pairs.
Gliding Movements
Gliding movements are the simplest of all the types of movement.
These movements occur in plane joints between two flat or nearly flat
surfaces where the surfaces slide or glide over each other.These joints
often give only slight movement,such as between carpal bones.
Angular Movements
Angular movements are those in which one part ofa linear structure,
such as the body as a whole or a limb,is bent relative to another part
of the structure,thereby changing the angle between the two parts.
Angular movements also involve the movement ofa solid rod, such
as a limb,that’s attached at one end to the body,so that the angle at
which it meets the body is changed. The most common angular
movements are flexion and extension and abduction and adduction.
Part2 Supportand Movement248
Figure 8.12
Ball-and-SocketJoint
Figure 8.13
Ellipsoid Joint
Figure 8.10
Hinge Joint
Figure 8.11
PivotJoint
Hinge jointsare monoaxial joints (figure 8.10). They consist
ofa convex cylinder in one bone applied to a corresponding concav-
ity in the other bone.Examples include the elbow and knee joints.
Pivot joints are monoaxial joints that restrict movement to
rotation around a single axis (figure 8.11).A pivot joint consists of a
relatively cylindrical bony process that rotates within a ring com-
posed partly of bone and partly of ligament. The articulation be-
tween the head ofthe radius and the proximal end of the ulna is an
example.The ar ticulation between the dens,a process on the axis
(see chapter 7),and the atlas is another example.
Ball-and-socket jointsconsist of a ball (head) at the end of
one bone and a socket in an adjacent bone into which a portion of
the ball fits (figure 8.12).This type of joint is multiaxial, allowing a
wide range ofmovement in almost any direction. Examples are the
shoulder and hip joints.
Ellipsoid joints(or condyloid joints) are modified ball-and-
socket joints (figure 8.13). The articular surfaces are ellipsoid in
shape rather than spherical as in regular ball-and-socket joints.El-
lipsoid joints are biaxial, because the shape of the joint limits its
range of movement almost to a hinge motion in two axes and re-
stricts rotation.The atlantooccipital joint is an example.
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Chapter 8 Articulations and Movement 249
Flexion and Extension
Flexion and extension can be defined in a number of ways,but in
each case exceptions to the definition exist.The literal definition is to
bend and straighten, respectively.This bending and straightening
can easily be seen in the elbow (figure 8.14).We have chosen to use a
definition with more utility and fewer exceptions.Flexion moves a
part of the body in the anterior or ventral direction. Extension
moves a part in a posterior or dorsal direction (figure 8.15).The ex-
ception to defining flexion and extension according to the coronal
plane is the knee,in which flexion moves the leg in a posterior direc-
tion and extension moves it in an anterior direction (figure 8.16).
Flexion
Extension
Figure 8.14
Flexion and Extension ofthe Elbow
Figure 8.15
Flexion and Extension Defined According to the
CoronalPlane
Flexion and extension of(a) the shoulder, (b) the neck, (c) the trunk.
Anterior to
coronal plane
Posterior to
coronal plane
Flexion
Extension
Coronal plane
Anterior to
coronal plane
Posterior to
coronal plane
Flexion Extension
Coronal plane
Flexion
Extension
Anterior to
coronal plane
Posterior to
coronal plane
Coronal plane
(a)
(c)
(b)
Figure 8.16
Flexion and Extension ofthe Knee
Flexion
Extension
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Movement of the foot toward the plantar surface,such as
when standing on the toes, is commonly called plantar flexion;
and movement ofthe foot toward the shin, such as when walking
on the heels,is called dorsiflexion (figure 8.17).
Hyperextension
Hyperextensionis usuallydefined as an abnormal, forced extension of a
jointbeyond its normal range of motion. For example, ifa person falls and
attemptsto break the fall byputting out a hand, the force of the fall directed
into the hand and wristmay cause hyperextension ofthe wrist, which may
resultin sprained joints or broken bones. Some health professionals,
however, define hyperextension asthe normal movementof structures,
exceptthe leg, into the space posterior to the anatomic position.
Abduction and Adduction
Abduction (meaning to take away) is movement away from the
midline;adduction (meaning to bring together) is movement to-
ward the midline (figure 8.18a). Moving the upper limbs away
from the body such as in the outward and then upward portion of
doing “jumping jacks”is abduction, and bringing the upper limbs
back toward the body is adduction.Abduction of the fingers in-
volves spreading the fingers apart,away from the midline of the
hand,and adduction is bringing them back together (figure 8.18b).
Abduction ofthe wrist, which is sometimes called radial deviation,
is movement ofthe hand away from the midline of the body, and
adduction ofthe w rist,which is sometimes called ulnar dev iation,
results in movement ofthe hand toward the midline of the body.
Abduction of the head is tilting the head to one side or the other
and is sometimes called lateral flexion of the neck.Bending at the
waist to one side or the other is usually called lateral flexionof the
vertebral column,rather than abduction.
Circular Movements
Circular movements involve the rotation ofa structure around an
axis or movement ofthe structure in an arc.
Rotation
Rotationis the turning of a structure around its long axis, such as
rotation ofthe head, the humerus, or the entire body (figure 8.19).
Medial rotation ofthe humerus with the forearm flexed brings the
hand toward the body.Rotation of the humerus so that the hand
moves away from the body is lateral rotation.
Part2 Supportand Movement250
Figure 8.17
Dorsiflexion and Plantar Flexion ofthe Foot
Plantar flexion
Dorsiflexion
Abduction
Adduction
Figure 8.18
Abduction and Adduction
Abduction and adduction of(a) the upper limb and (b) the fingers.
Abduction
Adduction
(a)
(b)
Lateral rotation
Medial rotation
Figure 8.19
Medialand Lateral Rotation of the Arm
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Pronation and Supination
Pronation (pro¯-na¯⬘shu˘n) and supination (soo⬘pi-na¯⬘shu˘n) refer
to the unique rotation ofthe forearm (figure 8.20). The word prone
means lying facedown;the word supine means lying faceup. Prona-
tion is rotation ofthe forearm so that the palm faces posteriorly in
relation to the anatomic position.The palm of the hand faces infe-
riorly ifthe elbow is flexed to 90°. Supination is rotation of the fore-
arm so that the palm faces anteriorly in relation to the anatomic
position.The palm of the hand faces superiorly if the elbow is flexed
to 90°.In pronation the radius and ulna cross; in supination they are
in a parallel position.The head of the radius rotates against the ra-
dial notch ofthe ulna during supination and pronation.
Circumduction
Circumductionis a combination of flexion, extension, abduction,
and adduction (figure 8.21).It occurs at freely movable joints such
as the shoulder.In circumduction, the arm moves so that it de-
scribes a cone with the shoulder joint at the apex.
Pronation
Supination
Figure 8.20
Pronation and Supination ofthe Hand
Circumduction
Figure 8.21
Circumduction
SpecialMovements
Special movements are those movements unique to only one or
two joints;they don’t fit neatly into one of the other categories.
Elevation and Depression
Elevationmoves a structure superiorly; depression moves it infe-
riorly (figure 8.22). The scapulae and mandible are primary ex-
amples. Shrugging the shoulders is an example of scapular
elevation.Depression of the mandible opens the mouth, and ele-
vation closes it.
Elevation
Depression
Figure 8.22
Elevation and Depression ofthe Scapula
Protraction and Retraction
Protractionconsists of moving a structure in a gliding motion in
an anterior direction (figure 8.23). Retraction moves the struc-
ture back to the anatomic position or even more posteriorly.As
with elevation and depression,the mandible and scapulae are pri-
mary examples. Pulling the scapulae back toward the vertebral
column is retraction.
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Part2 Supportand Movement252
Protraction
Retraction
Figure 8.23
Protraction and Retraction ofthe Mandible
Lateral excursion
to the right
Lateral excursion
to the left
Figure 8.24
Excursion ofthe Mandible
Opposition
Reposition
Figure 8.25
Opposition and Reposition ofthe Thumb and
Little Finger
Excursion
Lateral excursionrefers to moving the mandible to either the right or
left ofthe midline (figure 8.24), such as in grinding the teeth or chew-
ing.Medial excursion returns the mandible to the neutral position.
Opposition and Reposition
Opposition is a unique movement of the thumb and little finger
(figure 8.25).It occurs when these two digits are brought toward
each other across the palm ofthe hand. The thumb can also oppose
the other digits.Reposition is the movement returning the thumb
and little finger to the neutral,anatomic position.
Inversion and Eversion
Inversionconsists of turning the ankle so that the plantar surface
of the foot faces medially, toward the opposite foot.Eversion is
turning the ankle so that the plantar surface faces laterally (figure
8.26). Inversion of the foot is sometimes called supination, and
eversion is called pronation.
Eversion Inversion
Figure 8.26
Inversion and Eversion ofthe Foot
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Chapter 8 Articulations and Movement 253
Combination Movements
Most movements that occur in the course ofnormal activities are
combinations of the movements named previously and are de-
scribed by naming the individual movements involved in the com-
bined movement.For example, if a person raises a hand from the
anatomic position out to the side and then brings it in front so that
it is at shoulder height,that movement could be considered a com-
bination ofabduction and flexion.
7. Define the terms flexion and extension. How are they
differentfor the upper and lower limbs? What is
hyperextension?
8. Contrast abduction and adduction. Describe these
movementsfor the head, upper limbs, wrist, fingers, lower
limbs, and toes. Forwhat part of the body is the term lateral
flexion used?
9. Distinguish among rotation, circumduction, pronation, and
supination. Give an example of each.
10. Define the following jaw movements: protraction,
retraction, lateral excursion, medial excursion, elevation
and depression.
11. Define the terms opposition and reposition.
12. What terms are used for flexion and extension of the foot?
Forturning the side of the foot medially or laterally?
PREDICT
Whatcombination of movements is required at the shoulder and
elbow jointsfor a person to move the right upper limb from the
anatomicposition to touch the right side of the head with the
fingertips?
Range ofMotion
Range ofmotion is an expression of the amount of mobility that
can be demonstrated in a given joint.The active range of motion
is the amount of movement that can be accomplished by contrac-
tion of the muscles that normally act across a joint. The passive
range of motion is the amount of movement that can be accom-
plished at a joint when the structures that meet at the joint are
moved by some outside force,such as when a therapist holds onto
the forearm of a patient and moves it toward the patient’s arm,
flexing the joint.The active and passive range of motion for normal
joints is usually about equal.
The range of motion for a given joint is influenced by a
number of factors,including the shape of the articular surfaces
of the bones forming the joint, the amount and shape of carti-
lage covering those articular surfaces,the strength and location
of ligaments and tendons surrounding the joint, the strength
and location of the muscles associated with the joint, the
amount of fluid in and around the joint,the amount of pain in
and around the joint,and the amount of use or disuse the joint
has received over time.Abnormalities in the range of motion can
occur when any of those components changes. For example,
damage to a ligament associated with a given joint may increase
the range ofmotion of that joint.A torn piece of cartilage within
a joint can limit its range of motion. If the nerve supply to a
muscle is damaged so that the muscle is weakened, the active
range ofmotion for the joint acted upon by that muscle may de-
crease,but the passive range of motion for the joint should re-
main unchanged.Fluid buildup and/or pain in or around a joint
can severely limit both the active and passive range ofmotion for
that joint.With disuse, both the active and passive range of mo-
tion for a given joint decrease.
13. Define range of motion. Contrast active range of motion
with passive range of motion. Whatfactors influence range
of motion?
Description of Selected Joints
Objectives
■ Describe the temporomandibular, shoulder, elbow, hip,
knee, and ankle joints. Include the type of movementsand
special featuresof each.
■ Discuss the most common injuries of the shoulder, elbow,
hip, knee, ankle, and footarches.
It’s impossible in a limited space to describe all the joints of
the body;therefore, we describe only selected joints in this chapter,
and they have been chosen because of their representative struc-
ture,important function, or clinical significance.
Temporomandibular Joint
The mandible articulates with the temporal bone to form the tem-
poromandibular joint (TMJ). The mandibular condyle fits into
the mandibular fossa of the temporal bone. A fibrocartilage
articular disk is located between the mandible and the temporal
bone, dividing the joint into superior and inferior cavities
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(figure 8.27). The joint is surrounded by a fibrous capsule to
which the articular disk is attached at its margin,and is strength-
ened by lateral and accessory ligaments.
The temporomandibular joint is a combination plane and
ellipsoid joint,with the ellipsoid por tion predominating.Depres-
sion of the mandible to open the mouth involves an anterior glid-
ing motion ofthe mandibular condyle and articular disk relative to
the temporal bone,which is about the same motion that occurs in
protraction of the mandible; it is followed by a hinge motion that
occurs between the articular disk and the mandibular head. The
mandibular condyle is also capable of slight mediolateral move-
ment,allowing excursion of the mandible.
TMJ Disorders
TMJ disordersare a group of conditions that cause mostchronic
orofacialpain. The conditions include joint noise; pain in the muscle,
joint, or face; headache; and reduction in the range ofjointmovement.
TMJ pain isoften felt as referred pain in the ear. Patients maygo to a
physician complaining ofan earache and are then referred to a dentist.
Asmany as 65%–75% of people between ages 20 and 40 experience
some ofthese symptoms. Symptoms appear to affect men and women
aboutequally, but only about 10% of the symptoms are severe enough
to cause people to seekmedical attention. Women experience severe
pain eighttimes more often than do men.
TMJ disordersare classified as those involving the joint, with or
withoutpain; those involving only muscle pain; or those involving both the
jointdisorder and muscle pain. TMJ disorders are also classified asacute
or chronic. Acute casesare usually self-limiting and have an identifiable
cause. Chroniccases are not self-limiting, maybe permanent, and often
have no apparentcause. Chronic TMJ disorders are not easilytreated, and
chronicTMJ pain has much in common with other typesof chronic pain.
Whereassome people learn to live with the pain, others may experience
psychologicproblems, such asa sense of helplessness and hopelessness,
high tension, and lossof sleep and appetite. Drug dependency may occur
ifstrong drugs are used to control the pain; and relationships, lifestyle,
vocation, and socialinteractions may be disrupted. Manyof these
problemsmay make the pain worse through positive feedback. Treatment
includesteaching the patient to reduce jaw movementsthat aggravate the
problem and to reduce stressand anxiety. Physicaltherapy may help to
relaxthe muscles and restore function. Analgesic and antiinflammatory
drugsmay be used, and oral splints may be helpful, especiallyat night.
Part2 Supportand Movement254
Figure 8.27
RightTemporomandibular Joint, LateralView
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Chapter 8 Articulations and Movement 255
Shoulder Joint
The shoulder, or glenohumeral, joint is a ball-and-socket joint
(figure 8.28) in which stability is reduced and mobility is increased
compared to the other ball-and-socket joint,the hip. Flexion, ex-
tension,abduction, adduction, rotation,and circumduction can all
occur at the shoulder joint.The rounded head of the humerus ar-
ticulates with the shallow glenoid cavity of the scapula.The rim of
the glenoid cavity is built up slightly by a fibrocartilage ring, the
glenoid labrum, to which the joint capsule is attached. A sub-
scapular bursa (not shown in the figure) and a subacromial
bursaopen into the joint cavity.
The stability ofthe joint is maintained primarily by three sets
of ligaments and four muscles. The ligaments of the shoulder are
listed in table 8.3.The four muscles, referred to collectively as the
Figure 8.28
RightShoulder Joint
(a) Anterior view. (b) Frontalsection.
(a)
(b)
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rotator cuff, pull the humeral head superiorly and medially to-
ward the glenoid cavity.These muscles are discussed in more detail
in chapter 10.The head of the humerus is also suppor ted against
the glenoid cavity by the tendon from the biceps brachii muscle in
the anterior part ofthe arm. This tendon is unusual in that it passes
through the articular capsule of the shoulder joint before crossing
the head ofthe humerus and attaching to the scapula at the supra-
glenoid tubercle (see figure 7.29a).
Shoulder Disorders
The mostcommon traumatic shoulder disorders are dislocation and
muscle or tendon tears.The shoulder is the most commonly dislocated
jointin the body. The major ligaments crossthe superior par tof the
shoulder joint, and no major ligamentsor muscles are associated with
the inferior side. Asa result, dislocation of the humerus is most likely to
occur inferiorlyinto the axilla. Because the axilla containsvery important
nervesand arteries, severe and permanent damage may result from
attemptsto relocate a dislocated shoulder using inappropriate
techniques(see chapter 12). Chronic shoulder disorders include
tendonitis(inflammation of tendons), bursitis (inflammation of bursae),
and arthritis(inflammation of joints). Bursitis of the subacromial bursa
can become verypainful when the large shoulder muscle, called the
deltoid muscle, compressesthe bursa during shoulder movement.
Part2 Supportand Movement256
Table 8.3
Ligament Description
Ligaments of the Shoulder Joint
(see figure 8.28)
Glenohumeral Three slightly thickened longitudinal sets of
(superior, middle, fibers on the anterior side of the
and inferior) capsule; extend from the humerus to
the margin of the glenoid cavity
Transverse humeral Lateral, transverse fibrous thickening of the
joint capsule; crosses between the
greater and lesser tubercles and holds
down the tendon from the long head of
the biceps muscle
Coracohumeral Crosses from the root of the coracoid
process to the humeral neck
Coracoacromial Crosses above the joint between the
coracoid process and the acromion
process; an accessory ligament
PREDICT
Separation ofthe shoulder consists of stretching or tearing the
ligamentsof the acromioclavicular joint (acromioclavicular, or AC,
separation). Using figure 8.28aand your knowledge of the articulated
skeleton for assistance, explain the nature ofa shoulder separation,
and predictthe problems that may follow a separation.
Elbow Joint
Theelbow joint (figure 8.29) is a compound hinge joint consisting
ofthe humeroulnar joint, between the humerus and ulna, and the
humeroradial joint,between the humerus and radius. The proxi-
mal radioulnar joint is also closely related. The shape of the
trochlear notch and its association with the trochlea of the
humerus (figure 8.29a) limit movement at the elbow joint to flex-
ion and extension.The rounded radial head, however,rotates in the
radial notch ofthe ulna and against the capitulum of the humerus
(figure 8.29b),allowing pronation and supination of the hand.
The elbow joint is surrounded by a joint capsule. The
humeroulnar joint is reinforced by the ulnar collateral ligament
(figure 8.29c). The humeroradial and proximal radioulnar joints
are reinforced by the radial collateral ligamentand radial annu-
lar ligament(figure 8.29d). A subcutaneous olecranon bursa cov-
ers the proximal and posterior surfaces ofthe olecranon process.
Elbow Problems
Olecranon bursitisis an inflammation of the olecranon bursa. This
inflammation can be caused byexcessive rubbing ofthe elbow against a
hard surface and issometimes referred to as student’s elbow.The radial
head can become subluxated (partialjoint separation) from the annular
ligamentof the radius. This condition iscalled nursemaid’s elbow. If a
child islifted by one hand, the action may subluxate the radialhead.
Hip Joint
The femoral head articulates with the relatively deep,concave ac-
etabulum ofthe coxa to form the coxal, or hip joint (figure 8.30).
The head of the femur is more nearly a complete ball than the ar-
ticulating surface ofany other bone of the body. The acetabulum is
deepened and strengthened by a lip offibrocartilage called the ac-
etabular labrum, which is incomplete inferiorly,and by a trans-
verse acetabular ligament,which crosses the acetabular notch on
the inferior edge of the acetabulum. The hip is capable of a wide
range of movement, including flexion, extension,abduction, ad-
duction,rotation, and circumduction.
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Chapter 8 Articulations and Movement 257
Hip Dislocation
Dislocationof the hip may occur when the hip is flexed and the femur is
driven posteriorly, such aswhen a person sitting in an automobile is
involved in an accident. The head ofthe femur usually dislocates
posterior to the acetabulum, tearing the acetabular labrum, the fibrous
capsule, and the ligaments. Fracture ofthe femur and the coxa often
accompanyhip dislocation.
An extremely strong joint capsule,reinforced by several liga-
ments,extends from the rim of the acetabulum to the neck of the fe-
mur (table 8.4).The iliofemoral ligament is especially strong. When
standing,most people tend to thrust the hips anteriorly.This position
is relaxing because the iliofemoral ligament supports much of the
body’s weight.The ligamentum teres, which is the ligament of the
head ofthe femur, is located inside the hip joint between the femoral
head and the acetabulum.This ligament does not contribute much
Biceps brachii
tendon
Radius
Interosseus
membrane
Ulna
Humerus
Radial annular
ligament
Medial
epicondyle
Joint capsule
Ulnar collateral
ligament
Olecranon
process
Olecranon
bursa
Biceps
brachii
tendon (cut)
Radius
Interosseus
membrane
Ulna
Humerus
Radial annular
ligament
Lateral
epicondyle
Radial collateral
ligament
Olecranon
process
Olecranon
bursa
Joint capsule
Humerus
Fat pad
Olecranon bursa
Trochlea
Articular cartilage
of the trochlear notch
Joint capsule
Joint cavity
Synovial membrane
Articular cartilage
Coronoid
process
Ulna
Biceps
brachii
tendon (cut)
Radius
Interosseus
membrane
Ulna
Humerus
Radial annular
ligament (cut)
Lateral
epicondyle
Radial collateral
ligament (cut)
Olecranon
process
Olecranon
bursa
Joint
capsule
Elbow
Figure 8.29
RightElbow Joint
(a) Sagittalsection showing the relation between the ulna and humerus. (b)
Lateralside with ligaments cut to show the relation between the radial head,
ulna, and humerus. (c) Medialside. (d) Lateral side.
(a)
(b)
(c)
(d)
Table 8.4
Ligament Description
Ligaments of the Hip Joint
(see figure 8.30)
Transverse Bridges gap in the inferior margin of the
acetabular fibrocartilage acetabular labrum
Iliofemoral Strong, thick band between the anterior inferior
iliac spine and the inertrochanteric line of the
femur
Pubofemoral Extends from the pubic portion of the acetabular
rim to the inferior portion of the femoral neck
Ischiofemoral Bridges the ischial acetabular rim and the superior
portion of the femoral neck; less well defined
Ligamentum teres Weak, flat band from the margin of the acetabular
notch and the transverse ligament to a fovea in
the center of the femoral head
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toward strengthening the hip joint;however,it does carr y a small nu-
trient artery to the head ofthe femur in about 80% of the population.
The acetabular labrum,ligaments of the hip, and the surrounding
muscles make the hip joint much more stable but less mobile than
the shoulder joint.
Knee Joint
Theknee joint traditionally is classified as a modified hinge joint
located between the femur and the tibia (figure 8.31).Actually, it’s
a complex ellipsoid joint that allows flexion,extension, and a small
amount ofrotation of the leg.The distal end of the femur has two
large ellipsoid surfaces and a deep fossa between them.The femur
articulates with the proximal end of the tibia, which is flattened
and smooth laterally,w ith a crest called the intercondylar emi-
nence in the center (see figure 7.40).The margins of the tibia are
built up by thick fibrocartilage articular disks, called menisci
(me˘-nis⬘sı¯;crescent-shaped; figure 8.31b and d), that deepen the
Part2 Supportand Movement258
Pubofemoral
ligament
Lesser
trochanter
Tendon of rectus
femoris muscle (cut)
Iliofemoral
ligaments (cut)
Greater
trochanter
Femur
Pelvic bone
Articular cartilage
Joint cavity
Ligamentum teres
Head of femur
Neck of femur
Transverse
acetabular
ligament
Acetabular
labrum
Joint capsule
Greater
trochanter
Lesser
trochanter
Femur
Hip
Figure 8.30
RightHip Joint
(a) Anterior view. (b) Frontalsection.
(a)
(b)
articular surface.The fibula does not articulate with the femur but
articulates only with the lateral side of the tibia.
Two cruciate (kroo⬘she¯-a¯t; crossed) ligaments extend be-
tween the intercondylar eminence ofthe tibia and the fossa of the
femur (see figure 8.31b, d, and e). The anterior cruciate ligament
prevents anterior displacement of the tibia relative to the femur,
and the posterior cruciate ligament prevents posterior displace-
ment of the tibia.The joint is also strengthened by collateral and
popliteal ligaments and by the tendons of the thigh muscles,
which extend around the knee (table 8.5).
A number of bursae surround the knee (see figure 8.31f).
The largest is the suprapatellar bursa,which is a superior exten-
sion of the joint capsule and allows for movement of the anterior
thigh muscles over the distal end of the femur.Other knee bursae
include the subcutaneous prepatellar bursa and the deep infra-
patellar bursa, as well as the popliteal bursa, the gastrocnemius
bursa,and the subcutaneous infrapatellar bursa (not illustrated).
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Chapter 8 Articulations and Movement 259
Figure 8.31
RightKnee Joint
(a) Anterior superficialview. (b) Anterior deep view (knee flexed). (c) Posterior superficial view. (d) Posterior deep view.
(a)
(b)
(c)
(d)
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Part2 Supportand Movement260
Figure 8.31
(continued)
(e) Photograph ofanterior deep view. (f ) Sagittal section.
(e)
(f)
Table 8.5
Ligament Description
Ligaments of the Knee Joint (see figure 8.31)
Patellar Thick, heavy, fibrous band between the
patella and the tibial tuberosity; actually
part of the quadriceps femoris tendon
Patellar retinaculum Thin band from the margins of the patella to
the sides of the tibial condyles
Oblique popliteal Thickening of the posterior capsule;
extension of the semimembranous
tendon
Arcuate popliteal Extends from the posterior fibular head to
the posterior fibrous capsule
Tibial collateral Thickening of the lateral capsule from the
medial epicondyle of the femur to the
medial surface of the tibia; also called the
tibial collateral ligament
Fibular collateral Round ligament extending from the lateral
femoral epicondyle to the head of the
fibula; also called the fibular collateral
ligament
Ligament Description
Anterior cruciate Extends obliquely, superiorly, and posteriorly
from the anterior intercondylar eminence
of the tibia to the medial side of the
lateral femoral condyle
Posterior cruciate Extends superiorly and anteriorly from the
posterior intercondylar eminence to the
lateral side of the medial condyle
Coronary (medial Attaches the menisci to the tibial condyles
and lateral) (not illustrated)
Transverse Connects the anterior portions of the medial
and lateral menisci
Meniscofemoral Joins the posterior part of the lateral menisci
(anterior and to the medial condyle of the femur,
posterior) passing anterior and posterior to the
posterior cruciate ligament (not
illustrated)
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Clinical Focus Knee Injuries and Disorders
Injuries to the medialside of the knee are
much more common than injuriesto the lat-
eralside. The fibular (lateral) collateral liga-
ment strengthens the joint laterallyand is
stronger than the tibial (medial) collateral
ligament. Damage to the collateral liga-
mentsoccurs as a result of blows to the op-
posite side ofthe knee. Severe blows to the
medialside of the knee, which would dam-
age the fibular collateralligament, are far
lesscommon than blows to the lateral side
ofthe knee. In addition, the medial menis-
cusis fairly tightly attached to the tibial col-
lateral ligament and isdamaged 20 times
more often in a knee injurythan the lateral
meniscus, which is thinner and more
loosely attached. A torn meniscusmay re-
sultin a “clicking” sound during extension
ofthe leg; or, if the damage is more severe,
the torn piece of cartilage may move be-
tween the articulating surfacesof the tibia
and femur, causing the knee to “lock” in a
partially flexed position. If the knee is
driven anteriorly or if it is hyperextended,
the anterior cruciate ligamentmay be torn,
which causesthe knee joint to be very un-
stable. Ifthe knee is driven posteriorly, the
posterior cruciate ligament may be torn.
Surgicalreplacement of a cruciate ligament
with a transplanted or artificialligament is a
technique used to repair the damage.
A common type of football injury re-
sults from a blockor tackle to the lateral
side ofthe knee, which can cause the knee
to bend inward, opening the medialside of
the joint and tearing the medial collateral
ligament. The medialmeniscus often is torn
as well. Because thisligament is strongly
attached to the medialmeniscus, in severe
injuries, the anterior cruciate ligament,
which isattached to the medial meniscus,
isalso damaged (figure A).
Bursitisin the subcutaneous prepatellar
bursa (see figure 8.31f), commonly called
“housemaid’s knee,” may result from pro-
longed work performed while on the hands
and knees. Another bursitis, “clergyman’s
knee,” results from excessive kneeling and
affectsthe subcutaneous infrapatellar bursa
(notillustrated). This type of bursitis is com-
mon in carpetlayers and roofers.
Other common knee problems include
chondromalacia, or softening ofthe cartilage,
which results from abnormal movementof
the patella within the patellar groove, and the
“fatpad syndrome,” which consists of an ac-
cumulation offluid in the fat pad posterior to
the patella. An acutelyswollen knee appear-
ing immediately after an injury is usuallya
sign of blood accumulation within the joint
cavityand is called a hemarthrosis. A slower
accumulation offluid, “water on the knee,”
maybe caused by bursitis.
Anterior cruciate
ligament
Medial
meniscus
Tibial
collateral
ligament
MedialLateral
Blow
Figure A
Injuryto the Right Knee
Chapter 8 Articulations and Movement 261
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Part2 Supportand Movement262
Table 8.6
Ligament Description
Ligaments of the Ankle and Arch
(see figure 8.32)
Medial Thickening of the medial fibrous capsule
that attaches the medial malleolus to
the calcaneus, navicular, and talus; also
called the deltoid ligament
Calcaneofibular Extends from the lateral malleolus to
the lateral surface of the calcaneus;
separate from the capsule
Anterior talofibular Extends from the lateral malleolus to the
neck of the talus; fused with the joint
capsule
Long plantar Extends from the calcaneus to the cuboid
and bases of metatarsals 2–5
Plantar calcaneocuboid Extends from the calcaneus to the cuboid
Plantar calcaneonavicular Extends from the calcaneus to the navicular
(short plantar)
Ankle
Calcaneal
tendon (cut)
Plantar
calcaneonavicular
ligament
Medial ligament
Tibia
(medial malleolus)
Plantar calcaneo-
cuboid
ligament
Talus
Long
plantar
ligament
Calcaneus
Tibia
Long
plantar
ligament
Posterior
tibiofibular
ligament
Calcaneal
tendon (cut)
Calcaneus
Anterior tibiofibular ligament
Anterior talofibular ligament
Tendon of
fibularis
longus
muscle
Tendon of
fibularis
brevis
muscle
Fibula
(lateral malleolus)
Calcaneofibular
ligament
Figure 8.32
Ligamentsof the Right Ankle Joint
(a) Medialview. (b) Lateral view.
(a)
(b)
Ankle Jointand Arches of the Foot
The distal tibia and fibula form a highly modified hinge joint with
the talus called the ankle,or talocrural (ta¯⬘lo¯-kroo⬘ra˘l),joint (fig-
ure 8.32).The medial and lateral malleoli of the tibia and fibula,
which form the medial and lateral margins of the ankle,are rather
extensive,whereas the anterior and posterior margins are almost
nonexistent.As a result, a hinge joint is created from a modified
ball-and-socket arrangement. A fibrous capsule surrounds the
joint, with the medial and lateral parts thickened to form liga-
ments. Other ligaments also help stabilize the joint (table 8.6).
Dorsiflexion, plantar flexion, and limited inversion and eversion
can occur at this joint.
Ankle Injury
The ankle isthe most frequently injured major joint in the body. The
mostcommon ankle injuries result from forceful inversion of the foot. A
sprained ankleresults when the ligaments of the ankle are torn partially
or completely. The calcaneofibular ligamenttearsmost often, followed in
frequencyby the anterior talofibular ligament. A fibular fracture can
occur with severe inversion because the taluscan slide againstthe
lateralmalleolus and break it.
The ligaments of the arch serve two major functions: to
hold the bones in their proper relationship as segments of the
arch and to provide ties across the arch somewhat like a bow-
string.As weight is transferred through the arch system, some of
the ligaments are stretched,g iving the foot more flexibility and
allowing it to adjust to uneven surfaces.When weight is removed
from the foot,the ligaments recoil and restore the arches to their
unstressed shape.
Arch Problems
The archesof the foot normally form early in fetal life. Failure to form
resultsin congenital flat feet, or fallen arches, a condition in which the
arches, primarilythe medial longitudinal arch, are depressed or
collapsed (see figure 7.44). Thiscondition isnot always painful. Flat
feetmay also occur when the muscles and ligaments supporting the
arch fatigue and allow the arch, usuallythe medial longitudinal arch, to
collapse. During prolonged standing, the plantar calcaneonavicular
ligamentmay stretch, flattening the medial longitudinal arch. The
transverse arch mayalso become flattened. The strained ligaments can
become painful.
The plantar fascia isthe deep connective tissue superficial to the
ligamentsin the central plantar surface of the foot and the thinner
fascia on the medialand lateral sides of the plantar surface (see figure
8.32).Plantar fasciitis, which is an inflammation of the plantar fascia,
can be a problem for distance runnersas a result of continuous
stretching.
14. For each of the following joints, name the bones of the joint,
the specificpart of the bones that form the joint, the type of
joint, and the possible movement(s) atthe joint:
temporomandibular, shoulder, elbow, hip, knee, and ankle.
15. Describe dislocations of the shoulder and hip. What
conditionsare most likely to cause each type?
Seeley−Stephens−Tate:
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16. List the most common knee injuries, and tell which part of
the knee ismost often damaged in each type.
17. Define the term sprain, and describe which portions of the
ankle jointare most commonly damaged when it is
sprained.
Effects of Aging on the Joints
Objective
■ List the factors that contribute to the aging of synovial joints.
A number of changes occur within many joints as a person
ages.Those that occur in synovial joints have the greatest impact
and often present major problems for elderly people.In general, as
a person ages,the tissues of the body become less flexible and less
elastic as protein cross-linking,especially in fibrous connective tis-
sue,increases. The most important proteins related to tissue flexi-
bility are elastin and collagen. Tissue repair slows as cell
proliferation rates decline and the rate of new blood vessel devel-
opment decreases. These general changes can significantly affect
synovial joints.With use, the cartilage covering articular surfaces
can wear down.When a person is young, production of new, re-
silient matrix compensates for the wear.As a person ages, the rate
of replacement declines and the matrix becomes more rigid, thus
adding to its rate of wear.The production rate of lubricating syn-
ovial fluid also declines with age,further contributing to the wear
of the articular cartilage. In addition, the ligaments and tendons
surrounding a joint shorten and become less flexible with age,re-
sulting in a decrease in the range ofmotion of the joint.With age,
muscles,which strengthen the joints, tend to weaken.Older people
often experience a general decrease in activity,which causes the
joints to become less flexible and their range ofmotion to decrease.
18. List the age-related factors that contribute to cartilage wear
in synovial joints. Listthe age-related factors that cause a
lossof flexibility and loss of range of motion in synovial
joints.
Chapter 8 Articulations and Movement 263
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Anatomy and Physiology,
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II. Support and Movement 8. Articulations and
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Clinical Focus Joint Disorders
Arthritis
Arthritis, an inflammation of any joint, is
the most common and best known of the
jointdisorders, affecting 10% of the world’s
population. More than 100 different types
of arthritis exist. Classification is often
based on the cause and progress of the
arthritis. Causesinclude infectious agents,
metabolic disorders, trauma, and immune
disorders. Mild exercise retardsjointdegen-
eration and enhances mobility. Swimming
and walking are recommended for people
with arthritis; butrunning, tennis, and aero-
bics are not recommended. Therapy de-
pends on the type of arthritis but usually
includesthe use of antiinflammatory drugs.
Currentresearch is focusing on the possible
developmentof antibodies against the cells
that initiate the inflammatory response in
the jointsor against cell surface markers on
those cells.
Osteoarthritis (OA) is the most com-
mon type ofarthritis, affecting 10% of peo-
ple in the United States(85% of those over
age 70). OA maybegin as a molecular ab-
normalityin articular cartilage, with hered-
ity and normal wear-and-tear of the joint
important contributing factors. Slowed
metabolic rates with increased age also
seem to contribute to OA. Inflammation is
usuallysecondary in this disorder. It tends
to occur in the weight-bearing jointssuch as
the knees and is more common in over-
weightindividuals.
The first line of treatment for os-
teoarthritis is to change the lifestyle to re-
duce stress on affected joints. Synovial
jointsrequire movement to remain healthy.
Long periodsof inactivity may cause joints
to stiffen. Moderate exercise helpsreduce
pain and increase flexibility. Exercising also
helps people reduce excessweight, which
can place stress on joints of the lower
limbs. Older people should avoid high-
impactsports, such as jogging, tennis, and
racquetball, which place stress on the
joints. Cycling or walking are recom-
mended, butswimming is the best for peo-
ple with osteoarthritis, as it exercises the
muscles and joints without stressing the
joints. Wearing shock-absorbing shoescan
help. Splints or braces worn over an af-
fected jointmay sometimes be necessary to
properly align the joint and distribute
weightaround it.
Applying heat, such aswith hot soaks,
warm paraffin application, heating pads,
low-power infrared light, or diathermy(mild
electriccurrents that produce heat), directly
over the jointmay be helpful. Moving to a
warmer climate, however, doesn’tseem to
make much difference.
The American GeriatricsSociety has re-
leased guidelines for managing chronic
pain in elderlypatients with osteoarthritis.
They recommend acetaminophen (Tylenol)
or other nonsteroidal antiinflammatory
drugs(NSAIDs), such as aspirin and ibupro-
fen (Advil), for mild to moderate pain. Cap-
saicin, a component of hot red peppers,
may help relieve pain when applied as a
skin cream (Zostrix). Capsaicin seemsto re-
duce levels of a chemical known as
substance P thatcontributesboth to inflam-
mation ofthe joint and to the conduction of
pain sensations to the brain. If pain be-
comes a major problem and over-the-
counter pain relievers appear ineffective,
physicians may inject corticosteroids
directlyinto the affected joint.
Synviscand Hyalgan are two drugs de-
rived from hyaluronic acid, a naturalsub-
stance thatlubricates joints. They may be
administered by injection into the joint
when standard medication and exercise
programsfail to relieve pain. Glucosamine
and chondroitin sulfate are also natural
substancesassociated with joints. If taken
orally or by injection they may help af-
fected joints. However, glucosamine may
also raise blood sugar levels, so people
with diabetesshouldn’t use it without con-
sulting their physician. Injectionsof genet-
ically treated cells from synovial fluid,
which are able to blockthe immune factors
thought to cause the breakdown of joint
cartilage, are currently under investiga-
tion. An immune system protein called
transforming growth factor beta (TGF-␤),
introduced by gene therapy, is showing
some promise in repairing cartilage dam-
aged byosteoarthritis.
Ifother treatments fail, surgical proce-
duresmay be employed to relieve pain and
increase function in osteoarthritispatients.
Using arthroscopy, a surgeon can examine
the joint and clean outbone and cartilage
fragments that stimulate pain and inflam-
mation. In osteotomy, the bonesof joint are
reshaped to better align the joint. In a pro-
cedure called chondroplasty, a small
amountof healthy cartilage is removed and
grown in the laboratory. The newlygrown
cartilage is then implanted into the joint,
where itmay stimulate the regeneration of
damaged tissue.
Joint replacement isdiscussed at the
end of this Clinical Focus. Ifthe affected
jointcannot be replaced, surgeons mayper-
form a procedure called arthrodesis, in
which the bones meeting at the joint are
fused together. Thisprocedure is intended
to eliminate the pain, butthe joint is elimi-
nated and movementat that point becomes
impossible.
Rheumatoid arthritis (RA) is the sec-
ond most common type of arthritis. It af-
fectsabout 3% of all women and about 1%
ofall men in the United States. It is a gen-
eralconnective tissue disorder that affects
the skin, vessels, lungs, and other organs,
butit is most pronounced in the joints. It is
severelydisabling and most commonly de-
stroys small joints, such as those in the
handsand feet (figure B). The initial cause
isunknown but may involve a transient in-
fection or an autoimmune disease (an im-
mune reaction to one’s own tissues; see
chapter 22) thatdevelops against collagen.
A genetic predisposition may also exist.
Whatever the cause, the ultimate course
appears to be immunologic. People with
classicRA have a protein, rheumatoid fac-
tor, in their blood. In RA the synovial fluid
and associated connective tissue cellspro-
liferate, forming a pannus(clothlike layer),
which causesthe joint capsule to become
thickened and which destroysthe articular
cartilage. In advanced stages, opposing
joint surfaces can become fused. Juvenile
rheumatoid arthritis is similar to the adult
type in manyways, but no rheumatoid fac-
tor isfound in the serum.
Part2 Supportand Movement264
Seeley−Stephens−Tate:
Anatomy and Physiology,
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II. Support and Movement 8. Articulations and
Movement
© The McGraw−Hill
Companies, 2004
Hemophilic arthritis may result from
bleeding into the jointcavity caused by he-
mophilia, a hereditarydisease characterized
by a deficient clotting mechanism in the
blood. Some evidence existsthat the iron in
the blood istoxic to the chondrocytes, result-
ing in degeneration ofthe articular cartilage.
JointInfections
Lyme diseaseis the result of a bacterial in-
fection (Borrelia burgdorferi) transmitted to
humansby a tick vector (usually Ixodes sp.)
that affects the brain, nerves, eyes, heart,
and joints. The chronicarthritis and central
nervous system dysfunction thatare symp-
toms of the disease are severelydisabling
butrarely fatal. The disease is named for an
epidemicof childhood arthritis occurring in
Lyme, Connecticut, in 1975. Ithas probably
existed in Europe for many years and in
North America before the firstEuropean col-
onization but was unrecognized. Humans
and domestic animals are only incidental
hoststo the ticks, which normally infectwild
mammals and birds. Deer are of particular
concern. The northeastern United States
was greatly deforested during the eigh-
teenth and nineteenth centuries, and deer
and other wildlife populationsdeclined dra-
matically. The more recent abandonment
and reforestation of farms in New England
haslead to an increase in the deer and tick
populations, with a resurgence ofthe asso-
ciated joint and nervous system disease.
Over 100,000 cases of Lyme disease have
been reported in the United States since
1982. Although the disease is most com-
mon in the northeastern United States,
caseshave been reported in the north cen-
tralstates, along the West Coast, and scat-
tered throughout the eastern and central
states. Early manifestations ofthe disease
include flulike symptoms, with localized
skin rash. If untreated, the bacterium can
spread to the nervous system, heart, and
jointswithin a few weeks to months. A hu-
man vaccine againstLyme disease is cur-
rentlybeing used for high-risk individuals.
Suppurative (pus-forming) arthritis
may result from a number of infectious
agents. These jointinfections may be trans-
ferred from some other infected site in the
body or may be systemic(i.e., throughout
the body). Usually onlyone joint, normally
one ofthe larger joints, is affected, and the
course of suppurative arthritis, if treated
early, istransitory. With prolonged infection,
however, the articular surfacesmay degen-
erate. Tuberculous arthritis can occur as a
secondary infection from pulmonary tuber-
culosis and ismore damaging than typical
suppurative arthritis. It usually affects the
spine or large jointsand causes ulceration
ofthe ar ticular cartilagesand even erosion
ofthe underlying bone. Transient arthritis of
multiple joints is a common symptom of
rheumaticfever, but permanent damage sel-
dom occursin joints with this disorder.
Gout
Gout is a group of metabolic disorders in-
volving joints. These disordersare largely
idiopathic (of unknown cause), although
some casesof gout seem to be familial (oc-
cur in families and therefore are probably
genetic). Gout is more common in males
than in females. The ultimate problem in
goutpatients is an increase in uric acid in
the blood because oftoo much synthesis or
decreased removal through the kidneys.
The limited solubilityof uric acid salts in the
body results in precipitation of monoso-
dium urate crystals in various tissues, in-
cluding the kidneysand joint capsules.
The earliest symptom of gout is tran-
sientarthritis resulting from urate crystal ac-
cumulation in a jointcausing irritation of the
synovial membrane. Thisirritation can ulti-
matelylead to an inflammatory response in
the joints, and both the crystal deposition
and inflammation can become chronic. Nor-
mallyonly one or two joints are affected. The
mostcommonly affected joints (85% of the
cases) are the base ofthe greattoe and other
Chapter 8 Articulations and Movement 265
Figure B
Rheumatoid Arthritis
(a) Photograph ofhands with rheumatoid arthritis. (b) Radiographs of the same handsshown in (a).
Continued
(a) (b)
Seeley−Stephens−Tate:
Anatomy and Physiology,
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II. Support and Movement 8. Articulations and
Movement
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foot and leg joints to a lesser extent. Any
joint mayultimately be involved, and dam-
age to the kidneysfrom crystal formation oc-
curs in almost all advanced cases. Kidney
failure may occur in untreated cases. With
modern medications, these complications
seldom occur. Weightcontrol and reduced
alcoholconsumption can help prevent gout.
Pseudogout is a disorder that causes
pain and swelling similar to that seen in
gout, butit is characterized by calcium hy-
pophosphate crystaldeposits in joints.
HalluxValgus and Bunion
In people who wear pointed shoes, the
great toe can be deformed and displaced
laterally, a condition called halluxvalgus.
Bunions are often associated with hallux
valgus. A bunionis a bursitis that develops
over the firstmetatarsophalangeal joint be-
cause ofpressure and rubbing by shoes.
JointReplacement
As a result of recentadvancements in bio-
medicaltechnology, many joints ofthe body
can now be replaced byartificial joints. Joint
replacement, called arthroplasty,was first
developed in the late 1950s. One ofthe ma-
jor reasonsfor its use is to eliminate unbear-
able pain in patientsnear ages 55 to 60 with
jointdisorders. Osteoarthritis is the leading
disease requiring jointreplacement and ac-
counts for two-thirds of the patients.
Rheumatoid arthritisaccounts for more than
halfof the remaining cases.
The major objectivesin the design of
joint prostheses (artificial replacements)
include the development of stable articu-
lations, low friction, solid fixation to the
bone, and normal range of motion. New
syntheticreplacement materials are being
designed by biomedical engineers to ac-
complish these objectives. Prosthetic
jointsusually are composed of metal, such
as stainless steel, titanium alloys, or
cobalt–chrome alloys, in combination with
modern plastics, such as high-density
polyethylene, silastic, or elastomer. The
bone of the articular area is removed on
one side (a procedure called hemireplace-
ment) or both sides(total replacement) of
the joint, and the artificial articular areas
are glued to the bone with a syntheticad-
hesive, such as methylmethacrylate. The
smooth metalsurface rubbing against the
smooth plastic surface provides a low-
friction contactwith a range of movement
thatdepends on the design.
The successof joint replacement de-
pendson the joint being replaced, the age
and condition ofthe patient, and the state
ofthe technology. Most reports are based
on examination ofpatients 2–10 years af-
ter joint replacement. The technology is
improving constantly, so currentrepor ts
do notadequately reflect the effect of the
most recent improvements. Still, reports
indicate a success rate of 80%–90% in
hip replacementsand 60% or more in an-
kle and elbow replacements. The major
reason for failure of prosthetic joints is
loosening of the artificial joint from the
bone to which itis attached. New prosthe-
seswith porous surfaces help to overcome
thisproblem.
Part2 Supportand Movement266
An articulation,or joint, is a place where two bones come together.
Naming Joints
(p. 242)
Joints are named according to the bones or parts ofbones involved.
Classesof Joints
(p. 242)
Joints can be classified according to function or according to the type of
connective tissue that binds them together and whether fluid is present be-
tween the bones.
FibrousJoints
1. Fibrous joints are those in which bones are connected by fibrous
tissue with no joint cavity.They are capable of little or no
movement.
2. Sutures involve interdigitating bones held together by dense fibrous
connective tissue.They occur between most skull bones.
3. Syndesmoses are joints consisting offibrous ligaments.
4. Gomphoses are joints in which pegs fit into sockets and are held in
place by periodontal ligaments (teeth in the jaws).
5. Some sutures and other joints can become ossified (synostosis).
CartilaginousJoints
1. Synchondroses are immovable joints in which bones are joined by
hyaline cartilage.Epiphyseal plates are examples.
2. Symphyses are slightly movable joints made offibrocartilage.
SynovialJoints
1. Synovial joints are capable of considerable movement.They consist
ofthe following:
• Articular cartilage on the ends of bones, which provides a smooth
surface for articulation.Articular disks can provide additional
support.
• A joint cavity surrounded by a joint capsule of fibrous connective
tissue,which holds the bones together while permitting flexibility,
and a synovial membrane,which produces synovial fluid that
lubricates the joint.
2. Bursae are extensions ofsynovial joints that protect skin, tendons,
or bone from structures that could rub against them.
3. Synovial joints are classified according to the shape ofthe adjoining
articular surfaces:plane (two flat surfaces), saddle (two saddle-shaped
surfaces),hinge (concave and convex surfaces),pivot (cylindrical
projection inside a ring),ball-and-socket (rounded surface into a
socket),and ellipsoid (ellipsoid concave and convex surfaces).
SUMMARY
Continued
Seeley−Stephens−Tate:
Anatomy and Physiology,
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II. Support and Movement 8. Articulations and
Movement
© The McGraw−Hill
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Chapter 8 Articulations and Movement 267
1. Which ofthese is commonly used for classifying joints in the body?
a. the connective tissue that binds the bones together
b. the degree ofmotion at each joint
c. the number of bones that articulate with each other
d. the embryonic tissue that formed the joint
e. both a and b
2. Given these types of joints:
1. gomphosis
2. suture
3. symphysis
4. synchondrosis
5. syndesmosis
Choose the types that are held together by fibrous connective tissue.
a. 1,2,3
b. 1,2,5
c. 2,3,5
d. 3,4,5
e. 1,2,3,4,5
3. Given these types of joints:
1. gomphosis
2. suture
3. symphysis
4. synchondrosis
5. syndesmosis
Choose the types that are held together by cartilage.
a. 1,2
b. 1,4
c. 2,3
d. 3,4
e. 3,5
4. Which ofthese joints is not matched with the correct joint ty pe?
a. parietal bone to occipital bone—suture
b. between the coxae—symphysis
c. humerus and scapula—synovial
d. shafts ofthe radius and ulna—synchondrosis
e. teeth in alveolar process—gomphosis
5. The epiphyseal plate can be described as a type of joint. Choose the
term that describes the joint before growth in the length ofthe bone
has ended.
a. synchondrosis
b. synostosis
c. syndesmosis
d. symphysis
e. synovial
6. Which ofthese t ypes of joints are often temporary,with bone
replacing them?
a. syndesmoses
b. synovial
c. symphyses
d. gomphoses
e. synchondroses
7. Which ofthese joints are the most movable?
a. sutures
b. syndesmoses
c. symphyses
d. synovial
e. gomphoses
REVIEW AND COMPREHENSION
Typesof Movement
(p. 248)
1. Gliding movements occur when two flat surfaces glide over one
another.
2. Angular movements include flexion and extension,plantar and
dorsiflexion,abduction and adduction.
3. Circular movements include rotation,pronation and supination,
and circumduction.
4. Special movements include elevation and depression,protraction
and retraction,excursion, opposition and reposition, and inversion
and eversion.
5. Combination movements involve two or more ofthe above-
mentioned movements.
6. Range of motion is the amount of movement,active or passive, that
can occur at a joint.
Description ofSelected Joints
(p. 253)
1. The temporomandibular joint is a complex hinge and gliding joint
between the temporal and mandibular bones.It is capable of
elevation and depression,protraction and retraction, and lateral and
medial excursion movements.
2. The shoulder joint is a ball-and-socket joint between the head ofthe
humerus and the glenoid cavity ofthe scapula that permits a w ide
range ofmovements. It is strengthened by ligaments and the
muscles ofthe rotator cuff. The tendon of the biceps brachii passes
through the joint capsule.The shoulder joint is capable of flexion
and extension,abduction and adduction, rotation, and
circumduction.
3. The elbow joint is a compound hinge joint between the humerus,
ulna,and radius. Movement at this joint is limited to flexion and
extension.
4. The hip joint is a ball-and-socket joint between the head ofthe
femur and the acetabulum ofthe coxa. It is greatly strengthened by
ligaments and that is capable ofa wide range of movements,
including flexion,extension, abduction, adduction, rotation,and
circumduction.
5. The knee joint is a complex ellipsoid joint between the femur and
the tibia that is supported by many ligaments.The joint allows
flexion and extension and slight rotation ofthe leg.
6. The ankle joint is a special hinge joint of the tibia,fibula, and talus
that allows dorsiflexion and plantar flexion and inversion and
eversion.
7. Ligaments of the foot arches hold the bones in an arch and transfer
weight in the foot.
Effectsof Aging on the Joints
(p. 263)
With age,connective tissue of the joints becomes less flexible and less elas-
tic.The resulting joint rigidity increases the rate of ware in the articulating
surfaces.The change in connective tissue also reduces the range of motion.
Seeley−Stephens−Tate:
Anatomy and Physiology,
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II. Support and Movement 8. Articulations and
Movement
© The McGraw−Hill
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8. In which of these joints are periodontal ligaments found?
a. sutures
b. syndesmoses
c. symphyses
d. synovial
e. gomphoses
9. The intervertebral disks are an example of
a. sutures.
b. syndesmoses.
c. symphyses.
d. synovial joints.
e. gomphoses.
10. Joints containing hyaline cartilage are called , and
joints containing fibrocartilage are called .
a. sutures;synchondroses
b. syndesmoses;symphyses
c. symphyses; syndesmoses
d. synchondroses;symphyses
e. gomphoses; synchondroses
11. The inability to produce the fluid that keeps most joints moist
would likely be caused by a disorder ofthe
a. cruciate ligaments.
b. synovial membrane.
c. articular cartilage.
d. bursae.
e. tendon sheath.
12. Which ofthese is not associated w ith synovial joints?
a. perichondrium on surface of articular cartilage
b. fibrous capsule
c. synovial membrane
d. synovial fluid
e. bursae
13. All of the costochondral joints,except for the first, usually develop into
a. bursae.
b. synovial joints.
c. syndesmoses.
d. synostoses.
e. symphyses.
14. Assume that a sharp object penetrated a synovial joint.From this list
ofstructures:
1. tendon or muscle
2. ligament
3. articular cartilage
4. fibrous capsule (ofjoint capsule)
5. skin
6. synovial membrane (of joint capsule)
Choose the order in which they would most likely be penetrated.
a. 5,1,2,6,4,3
b. 5,2,1,4,3,6
c. 5,1,2,6,3,4
d. 5,1,2,4,3,6
e. 5,1,2,4,6,3
15. Which ofthese do hinge joints and saddle joints have in common?
a. Both are synovial joints.
b. Both have concave surfaces that articulate with a convex surface.
c. Both are monoaxial joints.
d. Both a and b.
e. All of the above.
Part2 Supportand Movement268
16. Which ofthese joints is correctly matched with the ty pe of joint?
a. atlas to occipital condyle—pivot
b. tarsals to metatarsals—saddle
c. femur to coxa—ellipsoid
d. tibia to talus—hinge
e. scapula to humerus—plane
17. Once a doorknob is grasped,what movement of the forearm is
necessary to unlatch the door,that is, turn the knob in a clockwise
direction? (Assume using the right hand.)
a. pronation
b. rotation
c. supination
d. flexion
e. extension
18. After the door is unlatched,what movement of the elbow is
necessary to open it? (Assume the door opens in,and you are on the
inside.)
a. pronation
b. rotation
c. supination
d. flexion
e. extension
19. After the door is unlatched,what movement of the shoulder is
necessary to open it? (Assume the door opens in,and you are on the
inside.)
a. pronation
b. rotation
c. supination
d. flexion
e. extension
20. When grasping a doorknob,the thumb and little finger undergo
a. opposition.
b. reposition.
c. lateral excursion.
d. medial excursion.
e. dorsiflexion.
21. Tilting the head to the side is
a. rotation.
b. depression.
c. abduction (lateral flexion).
d. lateral excursion.
e. flexion.
22. A runner notices that the lateral side of her right shoe is wearing
much more than the lateral side ofher left shoe. This could mean
that her right foot undergoes more than her left
foot.
a. eversion
b. inversion
c. plantar flexion
d. dorsiflexion
e. lateral excursion
23. For a ballet dancer to stand on her toes,her feet must
a. evert.
b. invert.
c. plantar flex.
d. dorsiflex.
e. abduct.
Seeley−Stephens−Tate:
Anatomy and Physiology,
Sixth Edition
II. Support and Movement 8. Articulations and
Movement
© The McGraw−Hill
Companies, 2004
Chapter 8 Articulations and Movement 269
24. An articular disk is found in the
a. shoulder joint.
b. elbow joint.
c. hip joint.
d. knee joint.
e. ankle joint.
25. A lip (labrum) of fibrocartilage deepens the joint cavity of the
a. temporomandibular joint.
b. shoulder joint.
c. elbow joint.
d. knee joint.
e. ankle joint.
26. Which ofthese joints has a tendon inside the joint cavity?
a. temporomandibular joint
b. shoulder joint
c. elbow joint
d. knee joint
e. ankle joint
27. Which ofthese str uctures help to stabilize the shoulder joint?
a. rotator cuff muscles
b. cruciate ligaments
c. medial and collateral ligaments
d. articular disk
e. all of the above
28. Bursitis of the subacromial bursa could result from
a. flexing the wrist.
b. kneeling.
c. overuse of the shoulder joint.
d. running a long distance.
e. extending the elbow.
29. Which ofthese does not occur w ith the aging of joints?
a. decrease in production of new cartilage matrix
b. decline in synovial fluid production
c. ligaments and tendons stretch and increase range of motion
d. weakening ofmuscles
e. increase in protein cross-linking in tissues
Answers in Appendix F
1. What would be the result ifthe sternal synchondroses and the
sternocostal synchondrosis ofthe first rib were to become
synostoses?
2. Using an articulated skeleton,examine the following list of joints.
Describe the type ofjoint and the movement(s) possible.
a. the joint between the zygomatic bone and the maxilla
b. the ligamentous connection between the coccyx and the sacrum
c. the elbow joint
3. For each ofthe following muscles, describe the motion(s) produced
when the muscle contracts.It may be helpful to use an articulated
skeleton.
a. The biceps brachii muscle attaches to the coracoid process of
the scapula (one head) and the radial tuberosity ofthe radius.
Name two movements that the muscle accomplishes in the
forearm.
b. The rectus femoris muscle attaches to the anterior superior iliac
spine and the tibial tuberosity.How does contraction move the
thigh? The leg?
c. The supraspinatus muscle is located in and attached to the
supraspinatus fossa ofthe scapula. Its tendon runs over the head
ofthe humerus to the greater tubercle. When it contracts, what
movement occurs at the glenohumeral (shoulder) joint?
d. The gastrocnemius muscle attaches to the medial and lateral
condyles ofthe femur and to the calcaneus. What movement of
the leg results when this muscle contracts? Ofthe foot?
4. Crash McBang hurt his knee in an auto accident by ramming it
into the dashboard.The doctor tested the knee for ligament
damage by having Crash sit on the edge ofa table with his leg
flexed at a 90-degree angle.The doctor attempted to pull the tibia
in an anterior direction (the anterior drawer test) and then tried
to push the tibia in a posterior direction (the posterior drawer
test).No unusual movement of the tibia occurred in the anterior
drawer test but did occur during the posterior drawer test.
Explain the purpose ofeach test, and tell Crash which ligament he
has damaged.
Answers in Appendix G
CRITICAL THINKING
1. The joint between the metacarpals and the phalanges is the
metacarpophalangeal joint.
2. Premature sutural synostosis can result in abnormal skull shape,
interfere with normal brain growth,and result in brain damage if
not corrected.Such an abnormality is usually corrected surgically by
removing some ofthe bone around the suture and creating an
artificial fontanel,which then undergoes normal synostosis.
3. The synovial membrane is very thin and delicate.A considerable
amount ofpressure is exerted on the articular cartilages within a
joint,and the articular cartilage is very tough, yet flexible, to
withstand the pressure.If the synovial membrane covered the
articular cartilage,it would be easily damaged during movement.
ANSWERS TO PREDICT QUESTIONS
Seeley−Stephens−Tate:
Anatomy and Physiology,
Sixth Edition
II. Support and Movement 8. Articulations and
Movement
© The McGraw−Hill
Companies, 2004
4. The movements required are abduction ofthe arm and flexion of
the forearm,or flexion of the arm and forearm and slight pronation
ofthe hand.
Part2 Supportand Movement270
5. A shoulder separation involves stretching or tearing ofthe
acromioclavicular ligament and may involve tearing ofthe
coracoclavicular ligament as well.Because the only bony attachment
ofthe upper limb to the body is from the scapula through the
clavicle to the sternum,separation of the acromioclavicular joint
greatly reduces the stability ofthe shoulder. The scapula and
humerus tend to be displaced inferiorly,and the proximal pivot
point for the upper limb is destabilized.
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