hello everyone and welcome to my online human anatomy lecture and in this lecture we will be talking about joints and fractures I am dr. D let's go ahead and get started okay so let's get some terms out of the way first if you've probably heard of this term before this is dislocation and that is when a joint is not aligned properly so a joint is a location is an area between two bones okay so two bones connect and there's an error in the middle that's a joint so when those two don't align properly this called a dislocation a look sation is a dislocation which the articulating services of a joint are forced entirely out of position we'll see that momentarily a subluxation is a dislocation where a joint is slightly out of its normal position and an ankylosis here is stiffness stiffness here in the joint due to bones fusing together probably due to an injury or a disease now a surgeon repairing a damaged joint must be certain to maintain the shape of the articulating surfaces because in correctly opposed articulating surfaces might develop abnormal ankylosis so you've probably heard this abnormal and closest most joints have surfaces that do match if an injury occurs and the joint services no longer match bone spurs may form so bone spurs are when you have two pieces of bone so say for example you have one bone here and here's a joint and then you have another bone right over here this is okay but say that you have that same bone here and the joints somehow got something something happened and then now the bones connect like this well you see here this area where the two bones connect that will cause additional mineral deposits in this particular area making these bones a little bit stronger but the problem here is that the more force that and that's being placed in that region the more bone that it's going to be deposit in that and then so eventually it's gonna end up habita the more pressure you put on it it will start to form bone spurs these little spikes that kind of stick up from there and that's no good okay that would be a bone spur this is very painful okay the joints and can no longer alter its shape in order to adapt to that particular joint okay all right so here's an example of a dislocation or a luxation of the talus you can see right here this gentleman was playing basketball and then probably tricked out right here tripped and then therefore had the dislocation of that talus bone okay if you need to review on what the talus bone is go ahead and get to the lecture where we talked about the bones okay here is an example of the subluxation of the vertebra you can see here this is a normal vertebra all the nerves are coming out just fine there's room enough for them to come out but as soon as there is a subluxation on the vertebra so each one of these bones here is called a vertebra and you can see that the second one here kind of got pushed inward a little bit we don't know why but that was enough for the bone to crush this nerve and also to crush the intervertebral discs that cushion that's underneath there to help provide that nice bounce cushion so the bones don't can tap one another and cause those bones first so that would be a subluxation of the vertebra remember that ankylosis is the fusion of the spine and you can see here we get this bony bridge this is the vertebra this is also the vertebra down here and then we have the intervertebral discs or IVD I'm just gonna call it that this would be that bone spur okay that performed across that okay we can classify fractures based on a number of different things first we can describe them as simple or closed fractures this is a type of fracture like a crack in the bone or break in the bone where the skin isn't broken into okay so if you were to look at my arm if I break my arm I'm never gonna if my arm bone were to break and then the bones kind of snap like this okay so here's two pencils if they break and they snap like this okay as long as it doesn't pierce through the skin so let's just try this again so imagine this this little round tape is in this areas inside of your arm okay so we have your the bone we've got here the bone sorry there's the joint no problem now if it breaks like this it hasn't punctured through the skin so that's a closed fracture but as soon as it right out from the skin that would be a compound or open fracture okay now for a closed fracture simple fracture this may require a cast and you've probably seen a number of these in your an elementary school you know all the boys were playing basketball or some rough sport and then they break a bone and they have to come into class with the cast the girls can't you've seen it - probably mmm now compound are open here that's when the bone has broken straight through the skin and unfortunately as you've probably heard the theme that I've talked to in previous lectures the air is full of microbes and pathogens and things that are that aren't supposed to go inside of our body but because the bone is broken straight through the skin that becomes a yummy yum for microbes to want to feast on and that will increase the chance of an infection there which can be life-threatening if not treated right away and this would require surgery for sure hospitalization and even IV antibiotics now another type of way we can classify them is describing fractures as incomplete fracture that is when only one side of the bone is broken but it's still kind of hanging on there so imagine we have one bone like this okay and all a sudden break the bone snaps so the bone ends up looking at something like this but it's kind of attached by this little piece that would be an incomplete fracture because the bone has it completely broken into two separate pieces it's still kind of hanging on there it's just like a like an asparagus or celery when you try to break it but it's still the fibers are still kind of hanging the two side the 2p together that's an incomplete fracture another one here would be a complete fracture again that's when the it's completely broken through you have two separate and distinct pieces two separate pieces okay pieces now we can describe complete fractures as displaced which is when the bone fragments don't line up so you broke this bone there in pieces but when you try to put them back together again it's just not quite puzzling themselves back together that would be a displaced fracture displaced complete fracture and a non-displaced one is when you get lucky and all the bones line up the way that they're supposed to you were able to put Humpty Dumpty back together again you were able to put those bone puzzles back together again and that's what it means to be non-displaced complete bone fracture okay now once you have described if the fracture is open or closed complete or incomplete then you can describe it based upon its shape so we can describe them here as a stress or hairline fracture greenstick epiphysial transverse oblique spiral commuted avulsion impact compression and even depression fracture okay many different ways we can describe all right um you can go ahead and visit these links here on your own I can't play these videos in my online youtube lecture because then YouTube would flag it and so go ahead and visit those links and check it out okay all right let's run down that list that we described earlier here excuse me let's go ahead and talk about the first of those fractures here so we can remember this list it's go ahead and talk about the stress fracture now this is the least serious type these stress fractures it is a tiny almost invisible break on the surface of a bone and usually due to Maine putting a little too much force on that bone okay so if you're you're holding a weight in your hand and it's a little too heavy you know say that you're lifting weights and you decided to you know like say do a shoulder press okay you're pressing this weight up again up for shoulder okay and it a little too heavy so what ends up happening here is you start to get cracks in your bone and they're very minutely little cracks that would be a stress fracture there was extra stress added onto the bone that the bone could not handle now muscles build up faster than bones six weeks into military basic training camp for example you get many stress fractures from too much new running because the body has adapted to it that's why they always say in a workout when you start working out to kind of gradually get yourself into the heavy weights gradually get yourself into that tough routine and not to not just jump in cold turkey because you risk getting these stress fractures because your body hasn't adapted and adjusted to this new way this new lifestyle that you're placing on it so now unfortunately you can't see stress fractures in an x-ray up until around the third week when a bone callus begins to form and this needs to be diagnosed right away the patient thinks there is no fracture and they continue to run it can unfortunately break all the way through and how do they diagnose it well they diagnose this by placing a tuning fork on the bone but not at the area of tenderness the vibration ends up traveling down and eventually that broken part will start to vibrate and their nerve endings that are kind of dangling out there because there are nerves neurons and nerves that run straight through these bones okay that's why it's very painful when you break a bone because the nerves are sending a signal down okay and so when you have this vibration moving down that bone room or like this and then the nerves are gonna get agitated and it's gonna send it to your brain and tell you hey it's painful okay you can see here very subtly you can barely see that stress fracture let's zoom in a little bit right in here you can see you can barely see that very light stress fracture line or the next type of fracture would be a greenstick fracture and no it's not because a fracture it looks like a green stick it is the most common type of fracture in children it's like breaking a green twig and that's where it where the or name originates from but it's not completely broken and it breaks on one side but kind of bends on the other bones and children are are not fully mineralized in here and this is what causes these greenstick fractures more often again the bones haven't fully matured they haven't fully mineralized with calcium and any sort of minerals that keep that give it its bone strength here's another one you can see here an incomplete fracture we have pieces of a kind of hanging out hanging on to one another I've never broken a bone by the way that not to my memory so I wouldn't know what it feels like okay epiphyseal fracture here the growth plate in the bone of a child is called an epiphyseal plate and that area is made up of cartilage which is weaker than bone so the whole thing can be broken during an injury and this is very serious because this epiphysial fracture here on a bone okay you have this epiphysial plate this epiphyseal plate here contains stem cells contains cartilage that during puberty will make the bone grow upwards and downwards okay make it grow longer it will elongate longer and it has to be untouched well not really it has to be pretty much untouched because as soon as you get this epiphyseal plate out of alignment so say that I were to blow up the bone up here a little bit more say that goes out of alignment due to say you broke your bone that means that when this bone is undergoing puberty and growth when you're undergoing puberty and the bone is growing that means it will grow and at different rate so it would just kind of look awkward so let me move this aside here and what ends up happening is one side of the bone ends up looking just a little awkward there okay because we had that extra this unaligned epiphysial plate okay and this is no good it just looks way awkward instead of growing evenly okay and you may need repeated surgery to strengthen us straighten out the bone as it grows here's an example of a epiphysial fracture as you can see here the fracture has broken straight through the epiphyseal line here is the epiphyseal line right here and you can see it broke straight through and so it's very difficult to realign them back perfectly together so alright a transverse fracture here the bone breaks completely through so this is a complete fracture okay right to the left in the transverse plane remember the transverse plane is wax on wax off right okay so it broke straight through now an oblique fracture here is when the bone breaks completely through but from the upper down to the lower in the oblique plane you can see here he is breaking straight through a spiral fracture here is when the bone was twisted such as in skiing or rollerblading and prop it cracks okay a twisted crack you can see here okay and here's another image showing you that twist at a spiral fracture here again due to twisting action and it causes it to fracture and this is a very common sports fracture again due to twisting forces excessive twisting forces or the next one here is a comminuted bone a fracture now this is when the bone shatters into three or more pieces most of us if we break a bone it probably broke into two pieces but anywhere three or more it's a comminuted fracture a bone graft might be needed to hold those three pieces together okay and then this is the most serious type of closed fracture okay still within the skin it hasn't pierced straight through the skin now obviously open fractures if you have to compare them with close open fractures are much more serious again because not only they have to deal with trying to heal itself back together but since the bone broke straight through the skin now they've got a second problem which is dealing with microbes that are in the air dealing with microbes that land onto the bone and want to feast upon your in your tissues that are sticking out there your insides in your bone okay and you can see here excuse me again this breaks into three or more pieces here's one piece here's a second piece and then of course here's a third piece right up there okay all right again another example of a comminuted fracture here at the hip we've got one piece two piece three pieces here down here is a 1-2-3 pretty bad due to a hip fall okay all right and this is what they are again this was a fracture here near the pubic the pubis region of the of the bone you can see here they have to use a bracer to realign these bones back another one here you can see just to try to get them back okay they have to nail it screw it and put a graft there all right you can pause this and read it on your own okay avulsion fractures when a piece of the bone is broken off by the sudden strong contraction of the muscle again another type of common sports injury and it's often seen with groin muscle injury and inversion ankle sprains at the fifth metatarsal styloid process okay so you can see right around here it's a fracture in there the person twisted their ankle and attendant pulled off and ripped a piece of the bone out so you have it if you want to zoom in and take a look you can see it there okay all right you can watch this on your own okay just a nice fun comic or an impacted fracture here this is when pressure was exerted on both ends of the same bone and then that resulted in the bone being crushed okay now often seen in the femur after falling from a height again this is a bone in the leg and if you need to review on those you can watch the bone lecture okay a person fell from a height and the head of the femur smashed and jammed into the acetabulum of the hip so and that can cause this weaker region here to crush okay now speaking of the femoral bone the femoral stress via the femoral neck supports 50% of your body's weight this neck region right over here in the anatomical neck there is a region of spongy tissue unfortunately and that is where it is weaker it's if it were compact bone that's different we know that compact bone is very strong and very dense but spongy bone is more porous and so therefore any sort of extra excessive force and pressure will cause it to break in that zone of weakness right over here where you have a whole bunch of spongy tissue okay and this may be a factor in hip fractures as well okay zone a weakness right here and here's a nice picture showing you the difference between spongy and compact bone very dense here in the compact bone versus in the spongy give a whole bunch of holes in it so it makes it a weak point if there's excessive amount of force being placed on that tissue all right next up we've got the pathological fracture and that's when the bone breaks first due to osteoporosis then the patient falls and this is especially common in the hip bone next up we've got compression fracture this is when two bones are forcing a third bone to fracture and if resulting in the middle bone being crushed an example would be three vertebrae being crushed together from a fall the middle vertebra is ones being crushed people with osteoporosis who due to loss of bone minerals often get this type of fracture spontaneously so let's look at the next slide that will show you that compression you can see the bone on above and the bone below there's a lot of weight being pressed against that Center bone and eventually that leads to it being crushed okay this can also result I've heard stories and even cases where weight lifters in the gym when they are say doing their squats okay they put the barbell squat they put the barbell back here and then they squat down and some people get a little bit overzealous about how much they can squat and then that leads to that leads to them getting this type of compression compression fracture okay because they were overzealous they didn't recognize their limitations and so therefore wanted their either ego got in the way and this could result okay so you got to be very careful all right a depression fracture this is when the bone is press inward often seen in skull fractures due to a blunt object so right here you can see this is an example of maybe someone you know maybe for this cartoon individual someone got the butt of say a soda can and boof hit it so hard to the point where it just made up impression inside of the skull and depressed the skull inward you can see here in this the outer part of the skull is right here found inside it's supposed to be out here but a blunt object was jammed or hit into that region the skull therefore causing it to go downward okay and here's an example of a cartoon describing depression fractures there so you can pause and read this on your own all right colles fracture this fracture is a fry the distal radius in the forearm with the dorsal displacement of the wrist and the hand or posterior displacement the fracture is sometimes referred to as a dinner fork or bayonet deformity due to the shape of the resultant forearm often occurs when a runner falls on their outstretched hands you can see here we've got a lot of crushed bones okay and and a lot of displacement going on in here so we zoom in okay here as well all right the pisiform fracture now this this is the most the most commonly most commonly the fizzy form is injured in a fall on an outstretched hand with the wrist and extension or if the heal the hand is used like a hammer the bow may need to be removed surgically and being an anchor for several ligaments and muscles when one fractures the fizzy form there is a 50% chance of additional fractures in the rady distal radius or another carpal bone okay and you can see right over here let me do that fracture now a scaphoid fracture let me move myself a little bit make it a little smaller all right now a scaphoid fracture here is amongst the most common type of injuries and they frequently occur again following following a fall on an outstretched hand x-rays taken soon after the injury may not reveal a fracture but diagnosis may quickly prevent death of that bone and one of the reasons why is because the blood supply reaches this bone last there are you know you would think that in my hand blood would come from my heart out here and then eventually make its way and spread out to my hand but there are a few vessels that will few blood vessels that will wrap that will go around my hand and the ue back you turn back and then the scaphoid bone is one of those bones that where the blood vessel has to make a loop around and then come back to feed it all right the anatomical snuffbox here this is a triangular deepening on the radial dorsal aspect of the hand at the level of the carpal bone specifically the scaphoid and trapezium bones forming the floor the name originates from the use of the surface for placing and then sniffing powder tobacco or snuff so let me see if I can do that with my hand alright let me so I can do this with my hands so you can see here let me see if I can do it my hand ah there is okay so it's not working here so Ruiz take a look here right my right hand is better okay oh man right here okay there is a triangle right here that you probably can't see if I flex it enough but right here right here right here ah that's not working forget it just look at the picture I'm not going to this is this is not working for me so you can see here the anatomical snuffbox if it's in a certain Flex position it will pre this like dip in a depression in there and a lot of times in the older days Elden days they would put powdered stuff inside of this you know just kind of as like a little mini spoon you know but your body comes within just like that okay so now in the event of a fall onto an outstretched hand this is the area through which the brunt of the force will focus and this results in a scaffold bone being the most often fractured bone of the wrist the scaffold is a small oddly shaped bone whose purpose is to facilitate mobility rather than stability of the wrist so it is often the weakest link interestingly the scaphoid fracture is one of the most frequent cases of medical legal issues okay now an interesting anatomical anomaly in the vascular supply to the scaffold is that the blood enters the scalp or dislike' I said okay the scaphoid bones run here it the blood comes up around and then comes back to the scaphoid in the event of a fracture the proximal segment of the skyfall will be devoid of the vascular supply and avascular necrosis will results and that's death of the tissue from the lack of blood supply that's necrosis when a bone dies from the lack of blood supply the condition is called osteochondritis dissecans okay also contreras dissecans and due to the small size of the scaphoid and its shape it is difficult to determine early on whether or not the scaphoid is indeed fractured with an x-ray pain in the anatomical snuffbox is a presumptive diagnosis of a fracture here okay and the patient would then be sent to get an MRI you can watch this video on fracture surgery and it's for the same reasons why I can't show it here do - um being flagged okay all right let's go ahead and talk about joints and articulations now a joint or articulation is any point at which two bones will meet okay regardless of whether or not they move okay so there are multiple bones in our skull but it doesn't mean that they flap like my wrists us okay but there are joints there that hold them together the science of joint structure function and dysfunction is called Arthur ology with an a are th not anthology no not anthropology no okay it's Arthur ology okay and the study of the musculoskeletal movement is called kinesiology and so many individuals out there a number of students that love to study kinesiology and that is a study of human movement okay which is our next slide that's what it means kinesiology is a scientific study of human movement and it addresses physiological mechanical and psychological mechanisms now applications to this includes biomechanics orthopedics strength and conditioning sports psychology rehabilitation such as physical and occupational therapy as well as sport and exercise a number of personal trainers I know have gone into kinesiology in case you study individuals who have earned degrees in this field can work in research the fitness industry clinical settings and an industrial environments kinesiology is a branch of biomechanics which deals with a broad range of motions and mechanical processes in the body alright some boat cab terms here tendons you've probably heard me mention this in a previous lecture tendons here bind muscle to bone okay ligaments bone to bone okay so tendons is muscle to bone ligaments is bone to bone okay tmb LBB whatever works for you both are made up of dense irregular connective tissue all right now when discussing muscles there is a point of origin the point where it inserts into and the action so pretty much what it's saying okay okay so say that I have a bone here okay whatever you get the idea here's another bone cool that's pretty bad anyway and here's a muscle okay and what so what's good and there's a joint so this is a muscle so muscles always have an origin point where they start and then where they insert into and since this is the bone that moves now therefore this site would be called the insertion site not this phone so whatever ball moves due to this muscle contracting wherever that tendon touches on that bone that's called the insertion point guys okay origin doesn't move the insertion moves okay so and the muscles have an action what do they do what's their purpose when they contract what do they help what do they what what angle is what two bones are being flexed what two bones are being extended for example all right classification of joins you can do so in one of two ways you can describe them based upon the type of movement okay and we have three types no movement limited movement and free movement and you're gonna need to know the vocab terms for these you can also describe them based upon what tissues joins the bones so for example we've got fibrous joints made up of fibrous connective tissue which is the type of dense regular connective tissue and examples of these includes sutures teeth and ligaments and you also have cartilaginous joints okay and this is fibrocartilage examples of this would be found in the intervertebral discs and the pubic symphysis and also the hyaline cartilage which contains no capsule around it basically the epiphyseal plate and the costal cartilages now we also can describe them based upon synovial tissue which is contains a Highland cartilage with a capsule and we'll describe these a little bit later all right let's talk about the type of movement this first one here okay so the ones that are a moveable are described as sin are throught ik limited amphi freely die are throught ik and you need to know these like the back of your hand okay no I'm like the back of your hand and be very careful with antiarthritic and die are thought because a lot of people they when they hear the word amphi they think of like ambidextrous when you're when you can use both hands the same and so they think that oh if you are flexible to use both hands that must mean you have a hole it's like really flexible so they would describe amphi as being freely movable okay and that's not it and die here di they would think that oh well if it's only limited movement then it would be die because amphi is more than die but that's not it so be very careful not to flip-flop MPR throught ik and die Arthur okay all right move on next up we got the we can describe them here based upon their the tissue that joins in let's talk about the fibrous joints next now the fibrous joints a fibrous joint is two bones joined together by connective tissue more specifically fibrous and again that's a type of dense irregular connective tissue and this one doesn't have a joint cavity and some fibrous joints are moveable and that those include sutures and gum fuzzies which we'll see momentarily and some are slightly movable and these are managed by regular ligaments okay now a joint with the regular length ligament is called a sin des Moses okay so if we were to describe them based upon whether they move or not sutures would be sin or throught ik because they don't move golf o'seas is the same and syndesmosis would be MV orthotic because they allow for some slight movement you're probably wondering what is a suture here it is a suture is a joint okay and gum Fuzzy's the this is where you you have two bones or coming together and in between you have a joint and the joint doesn't allow for any movement in here okay so this is typically found in the skull and you see a whole bunch of fibers here that are holding these two pieces together and they're so strong and tight that it makes it feel like it's one piece and it allows no movement whatsoever alright craniosynostosis here this is a condition in which one or more of the fibrous sutures in the infant's skull prematurely fuses by turning into bone so when tissue turned into bone the technical medical term for that is ossification okay thereby changing the growth pattern of the skull and it may result in increased intracranial pressure leading to possibly a visual impairment sleeping impairment eating difficulties or an impairment of mental development combined with a significant reduction in IQ so what this is saying here is your skull when your baby is small when you grow up it's supposed to get larger and accommodate for your growing brain but if as a child those joints fuse and they become full-out bone so if you can imagine going back to a previous slide here imagine these sutures becoming bone now they're no longer ligaments they're no longer joints they're just what there's solid bone that means that when this young boy here is growing up and his skull is supposed to expand to accommodate larger brain it doesn't because it stays small because it's all bone there's nothing to allow it to grow and so therefore the brain continues to grow but the skull does not and so as a brain is growing and growing growing it's getting tighter in there and so therefore you know the brain is gonna want to expand out the point where there is no resistance it can't expand upward this way because the skull is in the way so it's gonna expand downward and guess what's down there your optic nerve and you have um your the optic nerve your nose your mouth it's all down here and that's why there are complications when you have a patient with craniosynostosis now a gum Phocis here you'll find these in teeth so the tooth sits like a peg in a socket and the periodontal ligament holds it in place okay down here there you have periodontal ligaments that hold them in place okay and these are movable now just select you guys know the region above the gum line is called the crown and the region below the gum line is called the root now a syndesmosis here a syndesmosis is a joint in which the two bones are connected by a regular length ligament and the ligament fibers are longer than a suture organ Phocis okay and these joints are slightly movable therefore we can describe them as being an fie orthotic so you want to be able to write this slide out I know the Latin word for each type of movement and know what type of movement each of those joints have let's move on to the next one here describing cartilaginous joints okay a cartilaginous joint is when you have two bones that are joined by cartilage and the cartilage is either fibrocartilage or hyaline cartilage now fire broke cartilaginous joints here our sympathies are amphi our throttle or slightly movable examples are intervertebral discs and the pubic symphysis okay now the Highland cartilage joints here they don't have capsules so we describe them as sitting on drowsies and these are syn orthotic or immovable and examples here include the epiphyseal plate and the costal cartilage in between your ribs can your ribs between your ribs and your sternum therefore one type of cartilaginous joint is slightly movable and that would be the fibrocartilage and another type is immovable and that will be the hyaline cartilage all right so in a synthesis two bones are joined by fibrocartilage and this would be MV r throught ik which means slightly movable and that makes sense here okay these these are made up of fibrocartilage slightly immovable and you you can bend down and pick up a pencil okay so when you bend down your spine has to help you curve your back so you can bend downward and you know it does have some slight movement so that's why it's described as an TR throught ik alright a synchondrosis here is a joint in which the bones are bound by heiling cartilage and it contains no capsule a synchondrosis is Cinar throught ik and not moveable okay okay all right let's talk about those intervertebral discs okay the function is to absorb shock okay so you have a vertebrae vertebrae and intervertebral discs that cushion in between it be very careful because the bone is called vertebrae and in between here's the cushioning is called intervertebral discs because they both have something that sounds like vertebrae a lot of people tend to use these two words interchangeably a lot of people they call the vertebra an intervertebral disc because when you look at it looks like a disc so be very careful you want to get those vocab terms sorted out the bones themselves are called the vertebrae and then the cushioning here is called an intervertebral disc okay and those discs have little movement and they are made up of an outer ring of fibrocartilage and this is called the annulus fibrosus and in the middle section you have elastic cartilage called the nucleus pulposus which provides that nice cushioning between those two balls now why do you need an annular Fibrosis ring okay and that fibrosis ring here is on the next slide can see here this inner portion is a nucleus pulposus and then the ring on the outside here is called the annulus fibrosus so the question is why do we have that ring well the nucleus proposes is like a rubber ball and when you compress it it can be flattened and the ring keeps it from compressing all the way down okay so this would be that intervertebral disk once again this is the vertebra the bone itself and what's in blue here is the intervertebral disk so again here's a nucleus pulposus okay nucleus pulposus just like you saw in the earlier slide and then we have annulus fibrosus here on the outside if too much pressure is placed on this intervertebral disk sometimes it can smoosh and crack a nut crack but pretty much bust open and you can see here in the right side we have a busted open intervertebral disk and then the center portion here will ooze out and then press against this nerve okay the yeah will press against that nerve just like okay and causes severe back pain okay a herniated disc care a herniated intervertebral disc that's not to be confused with the picture that we saw earlier okay earlier let me see here earlier I showed you a picture of this in the beginning of lecture this is not a herniated intervertebral disc this is you know a subluxation okay so don't confuse that with the herniated intervertebral disc where are we here okay now this Ernie happens hernia is anything that sticks out like a pouch that got that got busted out so if I were to have a sack of like tissue on my wrist my wrist if I were to have a sack of tea that's called a hernia if I have a blood vessel that's kind of poking out through say the rectal wall that's that's a hernia okay in green all hernias say that you have the your intestines okay especially popular especially common in men okay your intestine you're doing squats and the muscles and the intestines are pressing against this particular wall and then it pierces through into another chamber that's another hernia okay they're more particularly inguinal hernia if it Pierce's into the groin into the scrotum okay we'll talk more about that in the male reproductive system okay men have issues too okay so when you bend forward the disc compresses in the front okay so we see on the next slide if you were to bend forward say this is this is the anterior this is the posterior here if you were to bend forward it's gonna place pressure on that annular that outer ring okay now if there's a weakness in the posterior region the annulus fibrosus will tear and then the nucleus proposes herniates out and pokes out posterior lis okay now here's what's happening if you bend over and you can see the anterior portion of the vertebra is pressing against this one of two things can happen now the a this one crushes and then the inside start oozing out anteriorly which is very unlikely or B since the posterior portion is the weaker portion it starts popping out this way that's when you get that posterior herniated disc and you can see this is what's going on as soon as the insides press outward it will press against those nerves against the spinal cord and it causes a lot of pain and can lead to some paralysis because the nerves aren't sending their signal over so you end up not being a little to move so improper lifting and pushing with the back can cause this and one treatment is to put a metal rod in between the bodies of the vertebra to help them maintain their distance between the so that the hernia doesn't press against those nerve and another one is a laminectomy and that's where the lamina is removed from the vertebra to make more room for the herniation of the nerves aren't getting pinched okay we've already seen this light we're gonna move on okay next on a journey let's talk about synovial joints now the most familiar type of joint and the most common type are the synovial joints and it allows a wide range of motion so it is functionally classified as a diuretic joint which is a Dyer throw C's and examples include the elbow the me knuckles the joints between the risk and the ankle bones now synovial joints are the most structurally complex type of joint having a joint cavity nerves blood vessels ligaments and are the most likely to develop uncomfortable and crippling dysfunctions some characteristics here it hasn't enclosed chamber there's a flexible fibrous capsule made up of dense irregular connective tissue we have synovial fluid within there cavity synovial cavity the inner membrane which is its Nova membrane that produces the lubricating fluid which is a synovial fluid that helps your joints move smoothly on the articulating cartilage covers the ends of the bones you have reinforcing ligaments to stabilize them and you have and they are innervated where the nerves go to the joint and are vascular all right now in synovial joints the facing surfaces of the two bones are covered with articular cartilage okay and that is a layer of Highland College around two millimeters thick okay you have the articular cartilage right over here okay on both sides now these surfaces are separated by a narrow space and the joint articular cavity contain a slipper lubricant called synovial fluid and this is rich in a protein called albumin okay and also a high hyaluronic acid which is an oil that makes it pretty slippery also I've heard that very important in 404 skin okay now which gives its viscous its viscosity thickness and slippery texture it nourishes the articular cartilages removes their ways and makes movements at the synovial joints almost friction free now the synovial membrane here lines the inside of the capsule and is what makes that signal real fluid speaking of synovial fluid okay now it lubricates the joints we know that it allows for smooth movement we know that but it also nourishes the articular cartilage like I said but in order to do so you have to apply pressure onto the joints to feed the cartilage so that the nourishment gets diffused and forced diffuses into those tissues and there is an online video on YouTube I can't show it here because I'll get flagged look for Ellen DeGeneres cornstarch cornstarch experiment or something like that okay look for that Ellen DeGeneres cornstarch experiment and then you will see you'll see it's really cool okay oh and the Ellen the cornstalks so what you're gonna see is you're gonna see a lady run across this really thick dense solution of cornstarch and water and it's so dense that it becomes a sort of unique fluid if you add more weight onto the fluid it actually helps prop the person up but if you just stand there's a quicksand you'll just sink straight on down so you really want to see that joint Snowville fluid is just like that all right so the capsule is a kinetic is connected tissue which is made of articular capsule which encloses the cavity and retains a fluid and it does have an outer fibrous layer which acts like a sleeve it is continuous with the periosteum of the adjoining bones and the inner layer called the cellular synovial membrane okay you have an inner portion there between the articular cartilage okay and the articular disc you have that synovial membrane all right now in several synovial joints fibrocartilage grows inward from the joint capsule and forms a pad between the articulating bones when the pad crosses the entire joint capsule it is called an articular disk or meniscus these guys here are meniscus okay some joints such as a knee will use these men inside this is the plural this is singular to act as a guide for movement of the bones to prevent unwanted movements such as lateral movement of the knee okay you can see here that the the condyles the lateral the medial condyle of the bones here will sit on top of these medial meniscal and it will help guide their movement okay and it also prevents them from from pew this way or breaking that way all right let's talk ligaments now the joint capsule alone is not strong enough okay those men si are not strong enough here you can see so you do have reinforcing ligaments which provides most of the strength of holding the bones together bone to bone and they are made up of dense regular connective tissue and in your knee you have collateral ligaments in there and these are the main ligaments that keep the knee from moving medially and laterally okay now ligaments take a long time to heal if they are torn the reason blood vessels are too far away okay they already have enough fibroblasts which makes the collagen so they eventually will heal it might be better to break a bone because again bones are networked with blood vessels that contain oxygen and nutrients ligaments are farther away so it takes them longer okay now you've probably heard this word sprain and strain now a sprain with the letter P here is a tear in the ligament and these are pretty serious when the ligament is sprained it can take six months to heal once again blood supply is too far away and even with the partial tear you have to be very careful because the joints will become unstable and can easily be re injured now a strain here is a tear in the muscle and is not as bad because it has good circulation and heals faster if you can walk on it and it heals in a couple days it's a strain okay and here's some examples of ligaments found in the ankle all over here you can pause the video and take a look at this yourself you have the deltoid ligament and you can see here all those three are involved take a look at the name tbo Tyler we have the tibia and he had the talus okay bone right here so look at the name tibial navicular there's a navicular bone right here tibial calcaneal right here calcaneus so look at the names okay okay let's talk about a bursa or bursae a bursa is a sac of synovial fluid that is involved in lubrication by serving as a cushion between the muscle and ligament or tendon and bone it does not need to be attached to any bone and acts like a pillow between the muscle and the bone okay pillow bursae cushions muscles helps tendon slide more easy lower joints and sometimes enhances a mechanical effect of a muscle by modifying the direction in which the tendon pulls it's very similar to when you're sleeping in bed and you have that lower back pain and then you end up saying you know I'm gonna get a pillow put it in between my legs so that it helps neutralize my spine or you put the pillow underneath your knee to prop your leg up so it neutralizes that spine that's similar here the bursae access like that pillow okay to neutralize or to help make it easier for those tendons the inside of a bursa is lined by a synovial membrane which makes the synovial fluid inside the bursa and this fluid can be produced in excess during overuse causing the bursa to swell and pinch the nerves in that area and what's an inflamed Bursa call is called bursitis crackling sounds in the joints such as cracking your knuckles or back are from the release of nitrogen gas bubbles and then it synovial fluid but it does not lead to arthritis it's an old it's an old out-of-date saying people think they have a crack their knuckles that they're gonna get like these massive bubble joints and no and here it is there's that Bursa sitting on underneath act like acting like a pillow underneath these tendons okay now a synovial again bursitis is the information the bursa due to over exertion of a joint and tendinitis here is a form of bursitis in which a tendon sheath is inflamed so say that you commonly if you went to the gym and you haven't lifted weights and say a month or two months and you go into the gym and you start lifting the weights that you did when you were at your peak point yeah you're probably gonna get tendinitis because those tendons aren't prepared to go back to the weight that you used to lift before or it's a it's your first time working out and then you have an ego going on and you see your friend lifting so much weight and you're kind of like oh shoot and then you start trying to lift their weight yeah you're probably gonna get tendinitis if not you are going to injure yourself because you have not given your body time to grow and and and become familiar and get used to the high weights okay now there's six types of synovial joints characterized by the motion allowed by the shape of their bones we've got plane hinge pivot condyloid saddle ball and socket here is the plane joint you can see here it's movement and only one plane which is the transverse or the frontal plane and examples of this includes the carpal or the tarsal bones superior and inferior articular processes between the vertebrae those would be examples of plane joints you can see here right there in the wrist this is the wrist not the palm guys it's in it's there okay a hinge joint here is movement only in the sagittal plane and examples here be your elbow your knee and the interphalangeal joints in your fingers and toes now remember that it is in the sagittal plane remember we're looking at the patient in its standard anatomical position and if you don't remember that I would strongly recommend going back to the introductory a lecture that I gave online and you can see here the joint moves backwards and forwards it doesn't move side-to-side or doesn't rotate that much next up we've got the pivot joints and this allows only rotational movement and is only in one plane which is the transverse plane examples would be your axis and your Atlas vertebrae in your neck the proximal radioulnar joint where the annular ligament on the ulna encircles the head of the radius that's another one okay and you can see here here's that pivot joint we have the condyloid joint okay this is when one bone is shaped like a rounded flask and the others like a cup and it allows for movement in two planes which is described to us by AXA and the example here is a metacarpal phalangeal joints and these are biaxial condyloid joints here found in your fingers okay a saddle joint is just like when a person is saddle on a horse right you got movement in two planes and each joint surface is both convex in one plane and concave in another and they fit together like a rider in a saddle and examples are at the base of the thumb between the trapezium and the metacarpal the first metacarpal the saddle joints are biaxial joints in primate Anatomy that allows for your opposable thumb so you can see here okay a saddle joint right there at your thumb you've got here the ball and socket joint say this allows your movement in all three planes your shoulder and hip joints our ball and socket and this type of joint is multi axial allows from a lot of movement okay and all three okay so the importance of novio joins here include the tempo mandibular joint knee joint hip joint and shoulder joint so here we have it here is the temporal mandibular joint to me here okay this particular region right over here okay in the jaw and speaking of jaw there is an awesome video that I cannot show here it is the America's Got Talent circus sideshow well just type in YouTube I can't show the video here I'll get flagged but type in America's Got Talent circus sideshow or circus freaks okay and it will show you an example of a individual getting that locked jaw okay so check that video it's really cool I can't show it here unfortunately I normally will show it in my on-campus games but no all right common causes of elbow pain here fractures ligament sprains and muscle and tendon tears are common causes of elbow pain dislocation usually due to a fall and children may dislocate the head of the radius from being pulled on by the arm that's called the nursemaids elbow there's also tennis elbow which is technically called lateral epicondylitis and this is due to frostfall exertion of the wrist and the wrist extension is painful and it's diagnosed by resisting extension of the third finger creating pain in the lateral epicondyle golfer's elbow here is medial epicondylitis from repeatedly flexing wrist or clenching your fingers in the old crane and okra ninh bursitis here's information of a small sack of fluid the olecranon versa on the tip of your elbow now treatment of elbow and wrist pain here includes splinting forearm support bands tapping ultrasound oral anti-inflammatory meds and cortisone steroid injections okay again here's an example of elbow and wrist splints here you can see the splint is in place now the knee joined here the largest and most complex diarthrosis of the body and the hinge joint but has movable movements of gliding rolling and rotations there are three articulations here we've got the lateral the medial condyles of the femur and the tibia and the patella and femur these are those three articulations now notice is that the fibula does not articulate with the femur only the tibia does okay extra capsule ligaments of the knee we've got the patellar ligament which is also known as a patellar tendon the medial collateral ligament and the lateral collateral ligament so here it is we've got the patellar ligament okay here's the patella we've got the tibial collateral ligament because it is connected to the tibia and then we have the fibular collateral ligament because it is connected to the fibula that's where the first word implies okay now these two ligaments prevent the knee from rotating when the joint is being extended so when you're using that joint it prevents it from being extended from rotating when being extended oh my gosh it is three o'clock in the morning okay intracapsular ligaments of the knee here there are two ligaments that lie inside the joint capsule and they are deep within the joint cavity but they are not inside the fluid-filled synovial cavity and these ligaments cross each other to form an X and we've got the anterior cruciate ligament and the posterior cruciate ligament now the anterior cruciate ligament here is the weaker of the two and it is slack when the knee is flexed out when it is fully extended and prevents posterior displacement of the femur and hyperextension of the knee joint now the posterior cruciate ligament here revered as PCL this is toute during flexi on and prevents anterior displacement the femur on the tibia and is the main stabilizing factor when weight-bearing during flexed knee positions like walking downhill here it is there's a posterior cruciate ligament on the inside the anterior cruciate ligament there as well okay and more about this when you get to the knee okay there is a separate in the lab but there is a separate online video for that you'll definitely see it in there okay we mentioned this moments ago the men inside of the knee you have the medial and the lateral now the crescent C shaped plates on the fibrocartilage located over the meter and the lateral tibial condyles and they attach to the intercondylar eminence on the top of the tibia and they act like shock absorbers and they are thicker on the lateral men inside here and taper to thin on the medial side on the unattached edges at the interior of the joint okay so here's a lateral and the medial meniscus you can see the laterals much thicker compared to the medial in the knee the two Pharmacology extends inward from the left and right but do not entirely cross a joint in each again are called meniscus and they absorb the shock of the body weight on the knee and prevent the femur from rocking from side to side on the tibia here's another image this has a really good view of the anterior and posterior cruciate ligaments okay you can see we this is looking at the anterior view okay and you can see the anterior cruciate ligament in the front post here is kind of sitting in the back same here here's anterior cruciate ligament the post tears in the back okay comic you can read this on your own okay the hip joint here the main factor responsible for stabilizing the hip joint is not the ligament at the fovea capitis inside particular capsule nope it is not stabilized by the deep socket it's the ligaments around the head of the femur that help give it its stability okay these ligaments right over here okay there's a posterior view of the hip joint okay you can see all those ligaments help give it that stability and this is just the head of the femur okay okay finger and toe joint abbreviations here mpj stands for metacarpal phalangeal joints ipj stands for interphalangeal joints okay they also stands for mpg it also stands for metatarsal phalangeal joints now they're for the eye PJ's or the interphalangeal ders there are two types of them we've got the distal and the proximal so di PJ means distal interphalangeal joints P I PJ stands for proximal interphalangeal joints the thumb or the Pollack's and the big toe or the hallux knuckle is just called the interphalangeal joint but the knuckles of the other digits are identified as either distal or proximal okay let's talk about arthritis here there are several types of osteoarthritis rheumatoid arthritis and gouty arthritis osteoarthritis here is more common the older you get the articular cartilage begins to break down and the bone spurs start to grow and that's not good because when bones first start to grow then it starts to add some friction so if you look here at the hip joint for example and here is the head of the femur and here is the acetabulum of the hip imagine if the the cartilage was gone in here if it breaks down and then eventually the bone hits to hit the bone here hits this bump and it starts to form spikes Spurs in there and imagine trying to move the femur okay and the leg that would be very painful it's just like having little needles in that bone scratching against that socket and just really really painful okay and that's what causes that creaking sound okay this the surfaces aren't smooth anymore this is also known as wear and tear arthritis and this is the most common disorder of joints and that can be mild to severe needing joint replacement and these people can actually predict the weather since it's an oval fluid is under pressure okay and as air pressure changes the fluid expands and it begins to press against these bone spurs okay and then it hits a nerve somewhere nearby and it will cause pain now rain right be right before rain the pressure builds up and it hurts more but as soon as it starts raining because the water has not precipitated earlier the oxygen molecules in the air had to compete with the water vapor gas that's in the air so there's not a lot of room but as soon as water condenses into a liquid water rain and it starts dropping down then all those water vapors are now on the ground as a liquid so there's more room up there for those oxygen molecules and because there's more room there's not a lot of pressure being placed on these joints okay and so the pressure goes down as soon as it rains but as the rain is building up okay that's when it really is her painful and here's an example of what a hippo would look like my voice professor had total hip replacement I remember my music voice professor she would be walking around trying to demonstrate good posture but then what ended up happening was that she had severe back pain because it was called referred pain okay so it's actually pain that originates in the hip but it's being felt somewhere else so that's referred pain and she didn't know why and that ended up being because she had bone spurs growing in her hips she had to get total hip replacement and was out for many months and she had her hip replacement on December 24th so anyway Rema Toit arthritis here this is not a disease of old age it's an autoimmune disease where the body attacks and destroys the cartilage attacks and destroys the cartilage in the synovial joints and it can start in childhood and that's called juvenile rheumatoid arthritis and it is not known for spur formation unlike osteoarthritis it is degenerative in nature the knuckles swell and become unusable causing gnarled hands and feet usually at the mem PJ's and usually needs joint replacements but artificial joints only last every 15 years for 15 years so if you have adult rheumatoid arthritis and you get their first hip replacement age 60 that's okay because the next ones at 75 and then by you know and then 90 so it should be okay but if they have it the juvenile form and they have their first hip replaced age 32 the next ones 45 and 60 and eventually the bones that they're working with start to degrade and then they may no longer be able to take the stem of the implant and in the stem of the implant will break through the shaft of the bone here's an example gnarled fingers here okay next up is gouty arthritis or gout and this is caused by a genetic error in the metabolism of something called uric acid and a gaudy episode is triggered by eating too much red meat or protein and it was more than common years ago when people ate nothing but meat and the breakdown of protein is urea which leads to uric acid crystals build up in cooler areas of the body especially at the MPGs or the metatarsal phalangeal joints of the base of the big toes the crystals poke the cartilage like needles and cause a joint to swell up gout is not known for spur formation unlike osteoarthritis you can visit this link down here to get a more information about gouty arthritis and gout prevention diets other bone disorders here include osteomalacia which are malformed bones this is a genetic malformation of the bones the epiphyseal plates are particularly affected in this case and another one here's rickets which is a type of australasia that is not genetic it is caused by lack of vitamin D now like all types of Awesome aleisea rickets also particularly affects the epiphyseal plates okay here are some images of those awesome aleisea here you can see that the legs are curved and rickets okay same same signs okay but one is genetic the other is not genetic here's osteomyelitis that is an infection of the bone you can see here and this oh my goodness I mean what happened here you know oh well should trim okay a condo plays a here is a genetic condition where the bones don't develop properly and that leads to dwarfism okay and that is especially in the epiphyseal place where you have that complication so they end up having a condition called dwarfism okay who's your favorite adore from who's your favorite drawer from a Song of Ice and Fire Game of Thrones who's your who's your favorite drawer from Game of Thrones right okay if you guys have seen Game of Thrones I always call a song of ice and fire Co that's actually the title of the series but Game of Thrones is the first book of the series and I never watched the I have not watched thee the series actually as of today I have not watched the series I've probably seen clips here and there by never watch I did read the first book so okay chondromalacia patella here means a problem in the cartilage of the patella and chondromalacia patella here is a condition in which the patella rubs on the femur in the knee joint and it becomes scratch or deform causing pain and don't get this confused with achondroplasia which is Dorf ism okay and you can see here it's crashing against the bone causing tremendous complications giggle these okay I don't want to say Paget's disease here is more common to older individuals and it may be related to a viral infection of this characterized by excessive bone deposit you can see here in this gentleman's forehead there's just mineral deposits being formed and formed and formed and so it starts to form a mound of bone there okay you can see them in x-rays for sure the more mineral deposits the darker it looks under x-ray you can see here this patient's left leg hip and right arm full of mineral deposits okay in this x-ray the more white it is the more bone deposits you have you can see here at the patella of this patients knee and on the outskirts here you have more bone deposits okay now ankylosing spondylitis here Ras this is a disorder in which the vertebra binds strongly together to limit the flexibility of the spine here is this gentleman who I'm sure when he found out that he had this condition was you know was a little sad but you know especially when they're calling him in to take pictures due to this particular reason you know 1947 we have her very young healthy gentleman and then 10 years later 57 67 and it finally Steen 72 of the year that he probably passed away can you imagine being this gentleman here um anyway knowing that you have a condition they're taking pictures of you every 10 years so okay psoriatic arthritis are developed in 30% of people who have chronic skin condition known as psoriasis and the diagnostic feature here is the pencil in the cup look at this here's the pencil and there's a cup okay and it will appear in on an x-ray and it often often accompanied by surah psoriatic nails which look like fungus but aren't actually not fungal infections okay now other joint disorders here includes synovitis which is inflammation of the synovial - and you may need steroid cortisone injections arthroplasty here is a surgical procedure to repair or remodel a damaged joints such as hammer toe and Lyme disease is an inflammatory arthritis of the knee joint caused by a bacterial infection after a tick bite okay okay polydactyly in the name poly means many digits this is when you have an extra finger or digit on the hand or the foot and it's usually due to a soft piece of tissue oops a small piece of soft tissue that acts like a finger occasionally it might contain a bone maybe no joints maybe bone and joint and it's rarely a function of complete functioning digit so our fingers and toes the word to describe them all is digits now when it comes to the hand will more commonly see the extra digit on the pinkie side okay and that will be known as the ulnar side not as common on the thumb side which is the radial side and definitely rare in between okay now these are respectfully known as post axial pre axial which is on the thumb post Axios on the pinky and central which is anywhere in between now it can occur by itself as an autosomal dominant mutation in a single gene but it is usually one feature of a syndrome of congenital anomalies by the way congenital means you're born with it okay and it happens one out of every five hundred births here are some images of polydactyly oops you can see here mm-hmm okay here's another one not a completely functioning digit but it's in there some tissue here right right here as well this patient here was born with two thumbs okay here you can see two thumbs and no these are not fingers these are grapes okay careful these are grapes okay here's here's what it looks like after surgery okay that's a finger all right now syndactyly here are fused digits then in fetal development syndactyly is actually normal okay not polydactyly syndactyly they've been fused at about 16 weeks of gestation and pregnancy an enzyme dissolves the tissue between the fingers and toes and the webbing disappears so while we're in our mother's room our fingers look like duck feet okay we got webs in between each of those fingers and then as we mature out in the mother's womb the enzyme like it says on this slide will activate and will start eating away at those webs carving out our individual fingers but every now and then in some fetuses this process doesn't finish and then so therefore when they're born they're left with some residual webbing um simple syndactyly can be full or partial and is present at birth and patients born with it now this is due to an abnormal gene on chromosome 2 6 and 7 okay depending on which fingers are fused and it can be simple or complex now in simple syndactyly the adjacent fingers or toes are joined by soft tissue and complex then you have bones that are fused on top of that okay now it can be complete or incomplete a complete syndactyly the skin is joined all the way from bottom to top tip a finger straight on down all the way in complete is where the skin is only joined up parts of it not the whole thing so if we look at the next slide okay this would be partial syndactyly partial syndactyly now if this skin on this person's foot goes all the way up here they connect all the way up here straight on down then that's complete syndactyly but this is not complete syndactyly this is partial syndactyly incomplete syndactyly okay and i have to say the these are very clean feet whoever's foot this is very clean it looks like mine not my foot but anyway complex and actally occurs as part of a syndrome such as a pert syndrome and typically involves more day it's an appart syndrome is Cindy actually with malformations of the skull caused by an abnormal gene on chromosome 10 so here it is this patient here has a pert syndrome so alright fenestrated syndactyly means that the skin is joined for most of the digit but in a proximal area there is a gap in the syndactyly with normal skin and this type of syndactyly is found in amniotic band syndrome and what is amniotic band syndrome that is a congenital disorder caused by an entrapment of fetal parts usually a limb or digits in fibrous amniotic bands while in utero some other examples of poly syndactyly here you can see that right here okay here I'm sure this patient here has another finger back there but didn't show it so all right now this man here fell off of a 50-foot cliff while rock climbing so another one here another one here okay you can see we have graphs and screws and bolts trying to help this patient heal another one here okay another one all right okay and that concludes our lecture the rest of these slides are not on my end in one of my exams but you are welcome to pause the slide and welcome to pause the slide and read for your information so we'll let the animation finish here okay okay and you can pause the video and read a proper ergonomics and that's it alright that is truly it okay thank you all for hanging in there with this lecture okay I hope that you found this lecture informative and very helpful for you if you have any questions for me and you're enrolled in one of my classes you know how to get a hold of me otherwise go out there aced that test a stack quiz and until our next online lecture this is dr. D signing out