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Joints:

Fibrous

Cartilagenous

Synovial
Fibrous: intervening layers of fibrous tissue or cartilage hold the bones together, almost direct contact (e.g. sutures of skull)

Cartilaginous: Slightly moveable joints separated by fibrocartilaginous discs. Nucleus pulposus is at the center of each disc (e.g. vertebrae, symphysis pubis)

Synovial: Bones don't touch and joints freely moveable. Bones covered by articular cartilage and separated by a synovial cavity. The synovial membrane lines the synovial cavity and secretes a small amount of synovial fluid. Fibrous joint capsule surrounds synovial membrane which is strengthened by ligaments (e.g. knee, shoulder)
Articular structures

Nonarticular structures

Ligaments

Tendons

Bursae
Articular structures: joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligaments, juxta-articular bone.

Nonarticular structures: periarticular ligaments, tendons, ursae, muscle, fascia, bone, nerve and overlying skin

Ligaments: ropelike bundles of collagen fibrils connecting bone to bone. White tissue at most synovial joints

Tendons: collagen fibers connecting muscle to bone. muscle to periosteum

Bursae: pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures. Lie between skin and the convex surface of a bone or joint or in area where tendons or muscles rub against bone, ligaments or other tendons or muscle.
3 main types of synovial joints (with subtypes)
Spheroidal: permit movement around three or more axes and in three or more planes
Ball and socket: Most moveable, ball-shaped head of one bone fits into a concave depression on another. Most moveable synovial joint.
Gliding: relatively flat articulating surfaces. Least amount of movement of synovial joints. (e.g. vertebrae)

Hinge: flat, planar or slightly curved, allowing only a gliding motion in a single plane, as in flexion and extension of the digits.
Hinge: Flexion and extension only (e.g. knee, elbow, digits)
Pivot: Projection of one bone articulates with a ring or notch of another bone (e.g. ring-shaped portion of C1 with dens of C2; head of radius articulating with radial notch of ulna)

Condylar: diarthroses that permit movement in 2 planes. The articulating surfaces are convex or concave, termed condyles.
Saddle: articulating ends of bones resemble reciprocally shaped miniature saddles (2 thumb joints only). Allows opposable thumb.
Condyloid (ellipsoidal): A condyle fits into an elliptical socket (e.g. condyles of the occipital bone into elliptical depressions of the atlas; distal end of radius fitting into depressions of the carpal bones).
Active and passive ROM

indications for performing each type of exam
ROM patient is capable of alone and ROM that provier can apply.

???
TM joint
Condylar synovial joint. Most used.

Condyle of mandible and capsule of temporal bobe cushioned by fibrocartilagenous disc.

Muscles involved in opening are external pterygoids. Closing is done by masseter (bottom post. of mandible), temporalis (side of head) and internal pterygoids (medial to masseter)
SITS muscles of the shoulder joint
The Scapulohumeral Group (rotator cuff)

Supraspinatus: above glenohumeral joint, inserts on the greater tubercle. Abducts humerus.

Infraspinatus and teres minor: cross glenohumeral joint posteriorly; insert on greater tubercle. Rotate forearm laterally (prepare for pistol)

Subscapularis: Crosses glenohumeral joint anteriorly; runs from ant. surface of scapula to lesser tubercle. Rotates forearm medially. (pistol)

Their function is to rotate the shoulder laterally. They also depress and rotate the head of the humerus.

Disfunction produces a positive "drop test"
Bony components shoulder joint
Humerus, clavicle and scapula.

Acromion is process just lateral to acromioclavicular joint.

Greater tubercle of humerus is medial to acromion.

Coracoid process of scapula is medial to greater tubercle and slightly medial and inferior to acromion
Bony structures of elbow joint
Lateral and medial epicondyle of humerus.

Olecranon process of the ulna.

Median nerve just medial to brachial artery.
Bony structures of the wrist and hand
Wrist includes distal radius and ulna and 8 small carpal bones. These connect to the metacarpals and then the phalanges (proximal, middle and distal).
Snuffbox
hollowed depression just distal to the radial styloid process. Floor produced by schaphoid. Near distal portion of radius.
Bony structures of hip
Iliac crest at upper margin, level with L4.

Iliac tubercle, marks the widest point of the crest.

Anterior superior iliac spine follows anterior and inferior to iliac tubercle.

inferior to iliac tubercle is the greater trochanter of the femur.

Medial and at the same level is pubic symphysis

Posterior superior iliac crest
directly underneath dimples above buttocks. The line between them crosses at S2.

Ischial tuberosity is medial to greater trochanter and under gluteal fold.
Bony structures of knee
Adductor tubercle is most superior and medial of bony structures.

Medial
and lateral epicondyles of femur are where their names suggest.

Tibial tuberosity is at top of medially flat section of chin.

Medial condyle of tibia is medial and somewhat higher than the tibial tuberosity.

Lateral condyle of tibia is lateral and slightly superior to tibial tuberosity.

Head of fibula is just inferior to lateral condyle of tibia.
Bony structures of ankle and foot
Ankle is hinge joint formed by tibia, fibula and talus.

Medial malleolus is the bony prominence at the distal end of the tibia.

Lateral malleolus is at the distal end of the fibula.

Calcaneus is under the talus and jutting posteriorly (the heel).

Longitudinal arch is arch.

Heads of the metatarsals is the ball of the foot
Anterior and posterior cruciate ligaments' fxn
ACL: crosses obliquely from lateral femoral condyle to medial tibia. Prevents tiia from sliding forward on the femur.

PCL: crosses from lateral tibia and lateral miniscus to medial femoral condyle. Prevents the tbia from slipping backward on the femur.
Medial collateral and Lateral collateral ligaments of knee fxn
They provide medial and lateral stability to the knee.
Fxn of:

Deltoid

Anterior talofibular

Posterior talofibular

Calcaneofibular
Deltoid: On the medial side of the ankle it protects from eversion (ankle bows inward)

Anterior & posterior talofibular and calcaneofibular protect from inversion (ankle bows outward) because they're on the lateral side.
Important questions to ask about joint pain?
localized, diffuse, systemic? mechanism of injury? chronic or acute? inflammatory or noninflammatory? Timing?
Phalen's

Tinnel's

McMurray's

Drawer

Bulge

Ballottement

Straight leg raising

Hyperextension test
Phalen's: Hold wrists in acute flexion for 60 seconds (opposite of prayer). A (+) result happens with numbness and tingling on palmar surface of thumb, index, middle and part of ring finger. Suggests median nerve carpal tunnel syndrome.

Tinnel's: percuss lightly over the course of the median nerve in the carpal tunnel. Numbness and tingling are (+) carpal tunnel syndrome.

McMurray's: pt supine. Grasp heel and flex the knee. Cup other hand over knee feeling joint line and move the knee laterally while rotating the knee internally and externally. Positive with pops, clicks and assoc. pain. (done for meniscus tears)

Drawer: Either anterior slide or posterior depending on ACL or PCL involvement.

Bulge: milk fluid from top to bottom. Apply medial pressure. Tap lateral side and look for fluid wave. Tests for minor effusions of knee.

Ballottement: Compress the suprapatellar pouch, then push the patella sharply against the femur and look for fluid returning to pouch. Test for larger effusions of the knee.

Straight leg raising: Supine. Raise patient's relaxed and straightened leg until pain occurs. Then dorsiflex the foot. Record the elevation at which pain occurs, the quailty and dist. of pain and the effects of dorsiflexion. Pain in affected leg when opposite leg is raised strongly confirms radicular pain and constitutes a (+) straight leg-raising sign.

Hyperextension test:
Signs of carpal tunnel
pain and numbness on ventral surface of first three digits (but not in palm) especially at night.

weak abduction of the thumb.

(+) Tinnel's

(+) Phalen's

Thenar atrophy (muscles at base of thumb)
clinical signs in joint inflammation
Swelling, warmth, tenderness and redness
Kyphosis

Scoliosis

Lordosis
Kyphosis: "hunchback" is abnormally increased roundness of thoracic curvature. Osteoporosis or chronic arthritis, neuromuscular diseases or individuals with compression fractures.

Lordosis: Lumbar curve of spine abnormally accentuated. Commonly seen in pregnancy, poor posture or disease.

Scoliosis: abnormal side to side curvature.
Crepitus
abnormal cracking noises. Inflammatory and could be break down of cartilage.
Measuring leg length
From anterior superior iliac spine to medial malleolus. Tape should cross knee on medial side.
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