1 ANATOMY OF JOINTS, GENERAL CONSIDERATIONS, AND PRINCIPLES OF JOINT EXAMINATION
Applied Anatomy
TYPES OF JOINTS
Synovial joints or diarthroses are freely movable joints. The bony surfaces are coated with hyaline cartilage and united by a fibrous articular capsule. The synovial membrane lines the inner surface of the capsule but does not cover the articular cartilage (Figure 1-1). The capsule is strengthened by collateral ligaments. Synovial joints comprise most of the joints of the extremities and are the most accessible joints to direct inspection and palpation. Synovial joints share important structural components: subchondral bone, hyaline cartilage, a joint cavity, synovial lining, articular capsule, and supporting ligaments.
FIGURE 1-1 A, Structure of the synovial joint. B, An example of a synovial joint in sagittal section.
STRUCTURE OF SYNOVIAL JOINTS AND SUPPORTING TISSUES
The synovial membrane provides an unobtrusive, flexible, low-friction, well-lubricated lining for diarthrodial joints, tendon sheaths, and bursae. Histologically the synovium consists of two layers: an intimal or synovial lining cell layer—made up of one to three layers of cells or synoviocytes—and a subintimal or subsynovial layer of loose, vascular, fibro-fatty connective tissue. Synovium has important phagocytic functions and produces synovial fluid. Table 1-1 shows different types of synovial effusions.
Joint capsules, ligaments, and tendons are dense fibrous tissues with a major role in musculoskeletal function. Collectively they allow and guide joint motion while resisting high tensile loads without deformation. Laxity or adaptive shortening of these structures affects joint motion and may lead to injury (see Figure 1-1).
Joint capsules attach around articular surfaces to form a continuous envelope for the joint. Capsular cells are predominantly fibroblasts with a dense fibrous matrix surrounding them. The capsule is lined with synovium that provides lubrication for the joint. Ligaments attach bone to bone and function to stabilize adjacent bones by restricting abnormal movements. Ligaments may be intracapsular, capsular, or extracapsular, and they share similar cell and matrix characteristics with the joint capsule and tendon tissues.
General Considerations and History
CATEGORIES OF MUSCULOSKELETAL PROBLEMS
Musculoskeletal problems and rheumatic diseases can be practically classified into five major categories, defined by the tissues predominantly affected: periarticular, articular, bone, nerve, and extraarticular.