Learning objective 1: Explain how joints can be classified according to the type of tissue that binds the bones together



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CHAPTER 8

JOINTS OF THE SKELETAL SYSTEM

LEARNING OBJECTIVE 1: Explain how joints can be classified according to the type of tissue that binds the bones together.

Lecture Suggestions and Guidelines


  1. Discuss the concept that joints can be classified by the type of tissue that binds the bones together at each junction.

  2. Describe a fibrous joint, in which fibrous connective tissue holds together bones; a cartilaginous joint, in which hyaline cartilage or fibrocartilage connects the bones together; and a synovial joint, which contains articular cartilage, a joint capsule, and a synovial membrane.

  3. Provide an example of each major classification of joint.

Application Question(s)


  1. Develop a variety of index cards, each containing the name of a joint, its location, and type of movement. Ask students to determine whether the joint is classified as fibrous, cartilaginous, or synovial.

Answer: N/A

Critical Thinking Issue(s)


  1. Ask students to prepare a short report on osteoarthritis. Share their findings with the class.

Answer: Osteoarthritis is a chronic degenerative arthritis. It presents a progressive wear of joints with age. Erosion of articular cartilage is common. Previous damage to a joint may also be a causal factor. Bone spurs (spicules of new bone) may form on exposed bone. Treatment may consist of a combination of rest and special exercise, anti-inflammatory or steroid medication, heat application, or surgical replacement of the damaged joint.

LEARNING OBJECTIVE 2: Describe how bones of fibrous joints are held together.

Lecture Suggestions and Guidelines


  1. Describe syndesmosis in terms of amphiarthrotic movement.

  2. Describe sutures in terms of synarthrotic movement.

  3. Describe gomphosis in terms of synarthrotic movement.

Application Question(s)


  1. Ask students to discuss examples of three types of fibrous joints. Give an example of each.

Answer: a) Syndesmosis-an amphiarthrotic joint. Bones are bound together by long fibers of connective tissue. Example: tibiofibular articulation; b) Suture-adjacent bones grow together and united via a sutural ligament. Sutures are synarthrotic. Example: sutures of the flat bones of the skull; c) Gomphosis-a synarthrotic joint formed by the union of a cone-shaped bony process in a bony socket. Example: a tooth fastened to the jawbone via the periodontal ligament.

Critical Thinking Issue(s)


  1. The fetal skull contains small regions of hyaline cartilage called fontanels. Why is it important that these “soft” areas are delayed in being converted to bone?

Answer: These areas allow: a) the skull shape to change slightly during childbirth; and b) flexibility in skull structure which aids brain growth during early infancy. In time, the fontanels close and are replaced by sutures.

LEARNING OBJECTIVE 3: Describe how bones of cartilaginous joints are held together.

Lecture Suggestions and Guidelines


  1. Compare and contrast two type of cartilaginous joints: 1) synchondrosis, in which bands of hyaline cartilage unite the bones; and 2) symphysis, in which hyaline cartilage is attached to a pad of fibrocartilage.

  2. Provide examples of synchondrosis in the human body, for instance, between the manubrium and first rib.

  3. Provide examples of symphysis in the human body, for instance, the symphysis pubis in the pelvis.

Application Question(s)


  1. Ask students to discuss examples of the two types of cartilaginous joints: synchondrosis and symphysis.

Answer: Synchondrosis-connection of epiphysis with diaphysis via hyaline cartilage in a developing long bone. Also, the junction of the manubrium and the first rib. Symphysis-symphysis pubis in the pelvis and the joint formed by two adjacent vertebrae via a cartilaginous disk.

Critical Thinking Issue(s)


  1. A patient has complained about a dull, relentless pain in the lower back, which extends laterally to the hip and into the right leg toward the knee. He does a great deal of lifting on the job and felt his back “go” recently while loading stores. X-rays revealed a herniation of the L3 and L4 vertebral disks. What is a herniated disk and what is the prognosis for returning it to homeostasis?

Answer: A herniated disk is the result of a rupture or bulging of a disk of fibrous cartilage, which rests between two adjacent vertebrae. Excess pressure placed upon the disk (as by lifting heavy objects) may cause the nucleus pulposus to bulge out, placing pressure on a spinal nerve. Prognosis for a return to homeostasis is good if the damage is minimal, however, in more serious cases, surgery may be required to relieve the pain and return normal nerve functioning.

LEARNING OBJECTIVE 4: Describe the general structure of a synovial joint.


and

LEARNING OBJECTIVE 5: List six types of synovial joints, and name an example of each type.

Lecture Suggestions and Guidelines


  1. Describe the joint capsule and its reinforcing ligaments.

  2. Lecture on the synovial membrane and the secretion of synovial fluid.

  3. Discuss the location and function of bursae.

  4. Introduce six types of synovial joints, including ball-and-socket joints, condyloid joints, gliding joints, hinge joints, pivot joints, and saddle joints.

  5. Discuss the anatomy and range of motion of each of 6 synovial joint types, and give an example of each in the human body.

Application Question(s)


  1. Reinforce the understanding of the six major types of synovial joints by asking students to name each type of synovial joint and demonstrate a movement, which illustrates each of them.

Answer: The six major types of synovial joints with an example of each are: a) ball-and-socket-shoulder, hip; b) condyloid-joints between metacarpals and phalanges; c) gliding-joints in the wrist and ankle; d) hinge-elbow; e) pivot-proximal ends of radius and ulna; and f) saddle-joint between carpal and metacarpal of the thumb.

Critical Thinking Issue(s)


  1. One form of chronic arthritis is sometimes referred to as synovioarthritis. Why would this term more appropriately describe the nature of this form of arthritis?

Answer: The synovial membrane of many joints is affected by swelling, formation of pulpy masses, and eventual destruction of the articular cartilage. The joint surfaces may fuse causing stiffness and immobility.

LEARNING OBJECTIVE 6: Explain how skeletal muscles produce movements at joints, and identify several types of joint movements.

Lecture Suggestions and Guidelines


  1. Discuss skeletal muscle action and movement at synovial joints. Include an introduction to origin and insertion.

  2. Introduce a minimum of 15 common types of body movements. Define each term and demonstrate the movements to the class.

Application Question(s)


  1. Ask students to apply their knowledge of various types of body movements by demonstrating them to the class. The student should name the body movement, define it, give an example of the movement, and then physically demonstrate it.

Answer: Possible examples are almost limitless, but at least one demonstration should be provided for each of the following body movements: flexion, extension, hyperextension, dorsiflexion, plantar flexion, abduction, adduction, rotation, circumduction, supination, pronation, eversion, inversion, protraction, retraction, elevation, and depression.

Critical Thinking Issue(s)


  1. One cold, misty evening, a softball player was rounding third base toward home plate when he felt something “pull” and he heard a slight “pop” in his hamstring region. Would the injury most likely be a sprain, strain, or dislocation?

Answer: Strains are commonly referred to as “pulled muscles” caused by excessive use or stretching. Sprains, on the other hand, are usually the result of a twisting or wrenching of a joint, and dislocations occur when a bone is forcibly displaced from its joint. In the case of this softball player, a combination of weather conditions and ineffective warm-up exercises contributed to a “pulled” hamstring, a very common kind of strain.

LEARNING OBJECTIVE 7: Describe the shoulder joint, and explain how its articulating parts are held together.

Lecture Suggestions and Guidelines


  1. Introduce the shoulder joint as a ball-and-socket joint. Define the cylindrical joint capsule.

  2. Describe the role of ligaments and bursae in the construction of the shoulder joint.

  3. Demonstrate the shoulder joint’s range of motion.

Application Question(s)


  1. What causes bursitis?

Answer: Bursitis is a very painful inflammation of the bursae, small fluid filled sacs located near joints. Shoulder joint bursae are the most frequently affected, resulting in pain, inflammation, and movement limitations. Rest, moist heat application, anti-inflammatory medication, and steroids comprise the treatment regimen.

Critical Thinking Issue(s)


  1. Explain why the shoulder joint is relatively easily dislocated.

Answer: The glenoid cavity is a shallow socket that receives the head of the humerus at the shoulder. The shoulder joint is articulated primarily with muscles instead of bony structures and ligaments, increasing the likelihood of a dislocation.

LEARNING OBJECTIVE 8: Describe the elbow, hip, and knee joints, and explain how their articulating parts are held together.

Lecture Suggestions and Guidelines


  1. Introduce the elbow joint as a hinge joint, the hip joint as a ball-and-socket joint, and the knee joint as two condyloid joints.

  2. Describe the anatomy of the elbow, hip, and knee joints and compare/contrast their structures.

  3. Relate the anatomy of the elbow, hip, and knee joints to their physiology. Demonstrate the range of motion of each.

Application Question(s)


  1. Football careers are frequently ended as a result of damage to the ACL. What is the ACL, and what does the damage involve?

Answer: ACL is an abbreviation for anterior cruciate ligament. It originates from the anterior intercondylar area of the tibia and extends to the lateral condyle of the femur. Damage to the ACL results in pain, swelling, inflammation, and bleeding within the joint. The ACL’s ability to help prevent displacement of articulating surfaces is greatly comprised.

Critical Thinking Issue(s)


  1. What is “tennis elbow?”

Answer: Activities, which require forearm rotation or wrist extension (not necessarily tennis) may cause a tendon tear, resulting in upper forearm pain and inflammation near the elbow.

LEARNING OBJECTIVE 9: Describe the life-span changes in joints.

Lecture Suggestions and Guidelines


  1. Describe joint stiffness as one of the earliest life-span changes.

  2. Discuss the effects of aging on symphysis joints.

  3. Identify the loss of function in various fibrous joints and synovial joints.

Application Question(s)


  1. Ask students to identify various joints on an articulated human skeleton and describe the severity and timing of changes in these joints that occur in a lifetime.

Answer: Responses should include identification and discussion of several fibrous joints, synchondroses, symphysis joints, and synovial joints.

Critical Thinking Issue(s)


  1. Compare and contrast various types of arthritis, in terms of age of onset, symptoms, treatments, and prognoses.

Answer: Responses should include a discussion of osteoarthritis, rheumatoid arthritis, spondyloarthropathies, gout, juvenile rheumatoid arthritis, scleroderma, systemic lupus erythematosus, Kawasaki disease, streptococcus A infection, and Lyme arthritis.

RELATED DISEASES OF HOMEOSTATIC INSTABILITY


  1. Rheumatoid Arthritis—Pain in joints characterized by severe inflammation, degeneration of articular cartilage, and ankylosis. It may be systemic and chronic, with periods of exacerbation and remission.

  2. Ankylosing Spondylitis—May be a variation of rheumatoid arthritis. A stiffening of vertebral joints. If is more common in men. Bone fusion occurs with calcification of the intervertebral discs.

  3. Osteoarthritis—A degenerative arthritis resulting from progressive wear of joints with age. There may be erosion of articular cartilage and bone spurs. Treatment includes a combination of rest and special exercises, anti-inflammatory medication, heat applications, or surgery.

SUGGESTIONS FOR ADDITIONAL READING


Flieger, Ken. March 1995. Getting to know gout. FDA Consumer. This painful joint disorder has several causes.

Foley, Kathleen M. September 1996. Controlling the Pain of Cancer. Scientific American.

Kearney, Jay T. June 1996. Training the Olympic Athlete. Scientific American.

Lewis, Ricki. July/August 1991. Arthritis: Modern treatments for that old pain in the joints. FDA Consumer. New hope for the many people who suffer from the inflamed joints of arthritis.








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