four types of motion occur at sovial joints gliding angular rotational and then special movements which are Mo motions that occur only at specific joints I will talk about angular rotational in the special movements first and finish up with gliding movements on this slide you're seeing some examples of angular motion angular motion either increases or decreases the angle between two bones these movements may occur at many of the synovial joints they include the following specific types flexion and extension hyperextension lateral flexion abduction and adduction and circumduction flexion is movement in an anterior posterior plane of the body that decreases the angle between the articulating bones bones are brought closer together as the angle between them decreases examples include bending your fingers toward your palm to make a fist bending your forearm toward your arm at the elbow flexion at the shoulder when you raise an arm anteriorly and flexion of the neck when you bend your head anteriorly to look down at your feet the opposite of flexion is extension which is movement in an anterior post posterior plane that increases the angle between the articulating bones extension is a straightening action that usually occurs in the sagittal plane of the body straightening your arm and forearm until the Upper Limb projects directly away from the anterior side of your body or straightening your fingers after making a clenched fist are examples of extension flexion and extension of various body parts is Illustrated in your textbook hyper extension is the extension of a joint Beyond 180° for example if you extend your arm and hand with a palm facing inferiorly and then raise the back of your hand as if admiring a new ring on your finger the wrist is hyperextended if you glance up at the ceiling while standing your neck is hyper extended lateral flexion occurs when the trunk of the body moves in a coronal plane a coronal I should say coronal coronal plane laterally away from the body this type of movement occurs primarily between the vertebrae in the cervical and Lumbar regions of the vertebral column abduction will be considered on the next slide abduction means to move away it is a lateral movement of a body part away from the midline abduction occurs when either the arm or the thigh is moved laterally away from the body midline Abduction of either the fingers or the toes means that you spread them apart away from the longest digit which is acting as the midline abducting the wrist also known as radial deviation involves pointing the hand and fingers laterally away from the body the opposite of abduction is adduction which means to move toward and is the medial movement of a body part toward the body midline I think of abduction as a child that's being abducted taken away from its family an adduction its name tells you to add things together bring them together adduction occurs when you bring your raised arm or thigh back toward the body midline or in the case of the digits toward the midline of the hand an example of both abduction and adduction would be you doing jumping jacks when you take your legs apart and your arms swing out to the side and over your head that's abduction and when you bring your jump back in and the legs come in together and your hands go down by your side that's adduction so now you can do your jumping jacks by saying abduction adduction abduction adduction adducting the wrist also known as ner deviation involves pointing the hand and fingers medially towards the body abduction and adduction of various body parts are shown in your textbook circumduction is a sequence of movements in which the proximal end of an appendage remains relatively stationary while the distal end makes a circular motion the resulting movement makes an imaginary cone shape for example when you draw a circle on the Blackboard your shoulder remains stationary while your hand moves the tip of the imaginary cone is the stationary shoulder while the rounded base of the cone is the circle the hand makes circumduction is a complex movement that occurs as a result of a continuous sequence of flexion abduction extension and adduction rotation is a pivoting motion in which a bone turns on its own longitudinal axis rotational movement occurs at the atlanto axial joint which pivots when you rotate your head to gesture no car no some limb rotations are described as either away from the median plane or toward it for example lateral rotation or external rotation turns the anterior surface of the femur or humoris laterally whereas medial rotation or internal rotation turns the anterior surface of the femur or humorous internally I like to think of this like a ballerina who's doing their toe points and they toe point out which is lateral rotation toe point in which is medial or if you're not a dancer hey when you're driving and you press on the gas you are doing lateral rotation of your femur and when you step on the brake you're doing medial rotation pronation is the medial rotation of the forearm so that the palm of the hand is directed posteriorly or inferiorly the radius andna are crossed to form an X supination occurs when the forearm rotates laterally so that the Palm faces anteriorly or superiorly if the person is laying down and the radius is parallel with the olna in superation the person would be in anatomic position the forearm must be supinated to be in anatomic position some motions occur only at specific joints and do not readily fit into any of the functional categories previously discussed like rotational motion angular motion and soon I'll talk about gliding motion these special movements include depression and elevation dorsa flexion and plantar flexion inversion and ersion protraction and retraction and opposition a special consideration is Excursion there's medial and lateral and some textbooks actually put this as a gliding rotation or a gliding motion which is technically true but when we speak of Excursion we are specifically speaking of a joint in the mouth that allows you to chew more on this to come depression is the inferior movement of a part of the body examples of depression and I don't mean being sad I mean movement include the movement of the mandible while opening your mouth to chew food and the movement of your shoulders in an inferior Direction elevation is the superior movement of a body part examples of elevation include the superior movement of the mandible while closing your mouth at the temporal mandibular joint and at the movement of the shoulders in a superior Direction like you were shrugging your shoulders dorsa flexion and planter flexion are limited to the ankle joint dorsa flexion occurs when the Tallow cural or ankle joint is bent such that the superior surface of the foot and Toes moves toward the leg this movement occurs when you dig in your heels and it prevents your toes from scraping the ground when you take a step meaning walking on your heels in plantar flexion movement at the ankle joint permits extension of the foot so that the toes Point inferiorly like when a ballerina is standing on her tiptoes she is in full plantar flexion I remember plantar flexion as your toys your toys your toes are pointed toward the plants in the ground Point downward inversion and ersion are movements that occur at the inter tarsal joints of the foot only an inversion turning inward the sole of the foot turns medially that would be like you walking on your lateral malis in ersion the soul turns to face laterally that would be like you walking on your medial malis some orthopedists and runners use the terms pronation and superation when describing foot movements instead of using inversion and ersion inversion is foot supination whereas eversion is foot pronation for you Runners out there protraction is the anterior movement of a body part from an anatomic position as when moving your jaw anteriorly at the temporal mandibular joint shown here on the screen he's jutting his jaw outward or hunching Your Shoulders anteriorly by crossing your arms I like to think of as a a a pubescent teenager pubescent female she often times has protraction because she is worried about her breast development she doesn't want people to see her little mosquito bites growing into developing breast tissue as I like to say but as soon as she learns what boobs can do for her in her life she will no longer protract but instead she's going to retract and throw her shoulders back and stick her breasts out because that will get her noticed right so with retraction it is a posterior directed movement from the anatomic position again think of it as pulling the shoulders back to thrust out the chest at the carpo metacarpal joint the thumb moves toward the Palmer tips of the fingers as it crosses the palm of the hand this movement is called opposition it enables the hand to grasp objects and is the most distinctive digital movement in humans the opposite movement is called reposition again a special consideration is Excursion if you were to move your mandible from side to side that is called medial and lateral Excursion and it helps to let you chew this is considered to be a gliding motion and more on this in the next slide this table summarizes the kinds of movements at sovial joints again they're broken down into four main categories gliding angular rotational and then the special movements one of the special movements I told you about was medial and lateral Excursion that sort of of like you swinging your jaw side to side that is technically considered to be a gliding motion of your jaw in which case two opposing articular surfaces in this case the temporal mandibular joint the bones are sliding past each other in a certain amount of Direction like side to side to side in this case and the amount of movement is actually relatively slight this slide is not officially taken from a section in your textbook it is basically just to reiterate some factors that can influence joint stability whether or not they actually do influence a joint's stability is dependent on the kind of joint that we're talking about and the picture in this slide is reiterating again the idea of this inverse relationship between mobility and stability the more stable a joint is the less mobile it is so what can influence joint stability it can certainly be the articular surfaces though seldom do they actually play a major role in joint stability however there are some classic examples where clearly the articular surfaces do play a role for example the elbow um the knee and particularly the hip if we think about the big head of the femur resting in the acetabulum the indented region of the OC coxy that clearly is a very deep ball in socket so the articular surfaces do help in the joint stability there the shapes of the joint determine the type of movement possible um hinge joint in the case of the elbow and the knee versus ball and socket for the hip ligaments certainly reinforce Force The Joint stability the more ligaments there are the stronger the joint is however if the ligaments are stretched in the case of when a joint is dislocated this can lead to the deterioration of the joint stability muscle tone there are some classic examples where the muscle tone is actually very important for joint stability and a classic example of that is actually the musculature that surrounds the glenohumeral joint or shoulder joint the muscle tone can keep tension and keep a joint intact and additionally proprioceptors these are stretch receptors in the muscle tone can um send information up to the brain where you feel your muscles are being stretched and this actually signals you to stop whatever motion you're doing before you compromise The Joint that these muscles are acting around now I would like to talk about some special case uh joints um ones that are particularly clinically relevant I'd like to start with a shoulder or glenohumeral joint it is common commonly referred to as I just said as a shoulder joint it is a ball and socket joint formed by the articulation of the head of the humoris and the glenoid cavity of the scapula it permits the greatest range of motion and is as you saw from the previous slide then the greatest range of motion means you have the least stability so it's the greatest range of motion of any joint in the body and so it is also the most unstable joint in the body and the one most frequently dislocated however frequently dislocated most the versus the most easily dislocated um that's where textbooks tend to blur the line so according to most of my studies the TMJ or temporal mandibular joint is the most easily dislocated but not necessarily the most frequently dislocated so in this case the shoulder joint is the most frequently dislocated the fibrocartilaginous glenoid laum encircles and covers the surface of the glenoid cavity and the purpose of this is to actually deepen that cavity and make it a slightly deeper ball and socket uh joint a relatively loose articular capsule attaches to the surgical neck of the humoris The glenohumeral Joint has several major ligaments just to name a few and I for my students I don't ask you to identify them or name them for your lecture exam but in lab we do have a shoulder joint model where you can see some of these ligaments for example the chora the Coro Acom i al joint um its name again or ligament I should say um its name tells you what bone or structure of a bone the ligament attaches to so it attaches to the choid process of the scapula and the acromial process of the scapula the chooral ligament is a thickening of the Superior part of the joint capsule and it runs from the corid process to the humeral head there are glenohumeral ligaments and these are thickenings of the anterior portion of the articular scap or capsule sorry and these ligaments are often indistinct or absent and provide only minimal support and we can continue on with a transverse humeral ligament Etc now in addition the tendon of the long head the bicep brachi travels within the articular capsule and helps stabilize the humoral head in the joint very important joint stabilizer that tendon of the long head of the biceps brachi ligaments of the glenohumeral joint strengthen the joint only minimum most of the joint strength as I said before is due to the muscles surrounding it in this case the muscles that surround it are called or referred to as the rotator cuff muscles these muscles include the supraspinatus infraspinatus teres minor and the subscapularis and they work as a group to hold the head of the humoris in the glenoid cavity the tendons of these muscles encircle The Joint except for the inferior portion and fuse with the articular capsule because the inferior portion of the joint lacks rotator cuff muscles this area is weak and is the most likely sight of injury now what's a Bersa a Bersa is a fibrous sack like structure that contains sovial fluid and is lined by a sovial membrane bery plural occur around most sovial joints and also where bones ligaments muscle skin or tendons overly each other and rub together bie may be either connected to the Joint cavity or completely separate from it they are designated to alleviate the friction resulting from the various body movements such as a tendon or ligament rubbing up against a bone an elongated Bersa called a tendon sheath wraps around tendons where they may be ex where there may be excessive friction tendon sheets are commonly are especially common in the confined spaces of the wrist and Ankle but we do find a Bersa a sack of sovial membrane now this sack of synovial membrane is shown here in blue in my picture you see several Bersy there's even one around the tendon of the long head of the biceps brachi a Bersa is not a synovial joint okay it doesn't have all the seven classic parts of a synovial joint it is basically a sack of sovial membrane and in the case of the shoulder joint like I said shown in in this picture in blue we see several bie and their purpose is basically to decrease the friction the specific places on the shoulder where both tendons and large muscles extend across the articular capsule so there again a large number of bery in the shoulder joint let's take a clinical view on shoulder joint dislocations like I said it shoulder joint is the most frequently dislocated but according to my studies the second most e easily dislocated it might be that you think I'm splitting hairs but it's a shallow joint and it has the greatest Mobility but that comes at a price lack of stability dislocation means a joint that has that's out of place apart from its its its Lo um articulation between bones a joint injury dislocation in which the articulating bones like I said have separated and it's very common in the shoulder although these injuries can occur at any of the three shoulder joints described in the chapter um the shoulder joint is a very complex joint they are more common at the acromio clavicular joint or the glenohumeral joint the term shoulder separation refers to a dislocation of the acromioclavicular joint this injury often results from a hard blow to the Joint as when a hockey player is slammed into the boards for those of you who play hockey or one Falls onto the shoulder symptoms include tenderness and edema which means swelling in the area of the joint and pain when the arm is abducted more than 90° because in this position significant movement occurs between the separated bone surfaces Additionally the acroman will appear very prominent and pointed treatment can range from rest to surgery depending on the severity of the dislocation so again you get kind of a pointed um appearance to the shoulder The glenohumeral Joint dislocations are very common because this joint is very mobile and yet unstable these dislocations usually occur when a fully abducted humorous struck hard for example when a quarterback is hit as he is about to release a football or when when a person falls on an outstretched hand the initial blow pushes the humoris into the inferior part of the articular capsule where it's weakest and tears it as the humorus dislocates now again that gleno humoral joint is weakest inferiorly as well as anteriorly once the humoral head is no longer held in place by the capsule the anterior thorax or chest muscles pull superiorly and medially on the humoral head causing it to lie just inferior to the coracoid process the result is that the shoulder appears flattened and squared off because the humoral head is dislocated anteriorly and inferiorly to the glenohumeral Joint capsule again where it's weakest that joint is weakest anteriorly and inferiorly some glenohumeral dislocations can be repaired by popping the humorous back into the Glen cavity and I described what this meant in lab and I told you about how this happened to my husband and how the nurse had to hold my husband's arm outward abducted and then the physician came in at him with his knee on the aner side and just used his knee to thrust my husband's um humoral head back into the glenoid cavity more severe dislocations may need surgical repair and once you dis loate your shoulder in this fashion the ligaments get stretched they get weakened and you are more likely to dislocate your shoulder in the future the knee joint is the largest and most complex di diarthrosis or very mobile joint of the body it primarily functions as a hinge joint but when the knee is flexed it is also capable of slight rotation and lateral gliding structurally the knee is composed of two separate articulations the tibiofemoral joint is between the condil of the femur and the condil of the tibia and two the patellofemoral joint is between the patella and the patellar surface of the femur the knee joint has an articular capsule that enclos encloses only the medial lateral and posterior regions of the knee joint the articular capsu does not cover the anterior surface of the knee joint rather the quadriceps femoris muscle tendon passes over the anterior surface the patella is embedded within this tendon and the patellar ligament extends beyond the patella and continues to its attachment on the tibial tuberosity of the tibia thus there is no single unified capsule in the knee nor is there a common joint C cavity posteriorly the capsule is strengthened by several pole ligaments on either side of the joint are two collateral ligaments that become taut on extension and provide additional stability to the Joint the fibular collateral ligament also called the lateral collateral ligament reinforces the lateral surface of the joint this ligament runs from the femur to the fibula and prevents hyper abduction to of the leg at the knee in other words it prevents the leg from moving too far medially relative to the thigh the tibial collateral ligament or medial collateral ligament reinforces the medial surface of the knee joint this ligament runs from the femur to the tibia and prevents hyper Abduction of the leg at the knee in other words it prevents the leg from moving too far laterally relative to the thigh this ligament is attached to the medial meniscus of the knee joint as well so an injury to the tibial collateral ligament usually affects the medial meniscus deep to the articular capsule and within the knee joint itself are a pair of c-shaped fiber cartilage pads located on the condil of the tibia these pads called the medial meniscus and the lateral meniscus partially stabilize The Joint medially and laterally act as cushions between the Artic surfaces and continuously change shape to conform to the articulating surfaces as the femur moves again these are fibrocartilage also deep to the articular capsule of the knee of the knee joint are two cruet ligaments which limit the anterior and posterior movement of the femur on the tibia these ligaments cross each other in the form of an X hence the name cruet which means cross the anterior cruet ligament or ACL runs from the posterior F femur to the anterior side of the tibia when the knee is extended the ACL is pulled tight and prevents hyper extension the ACL prevents the tibia from moving too far Anor ly on the femur the posterior cruet ligament or PCL runs from the anterio inferior femur to the posterior side of the tibia the PCL becomes taught on flexion and so it prevents hyper flexion of the knee and the PCL also prevents posterior displacement of the tibia on the femur let's talk about some clinically relevant knee injuries although the knee is capable of bearing much weight and has numerous strong supporting ligaments it is highly V vulnerable to injury especially among athletes because the knee is reinforced by tendons and ligaments only ligamentous injuries to the knee are very common the tibial collateral ligament is frequently injured when the leg is forcibly abducted at the knee such as when a person knee is hit on the lateral side because the tibial collateral ligament is attached to the medial meniscus the medial meniscus may be injured as well injury to the fibular collateral ligament can occur if the medial side of the knee is struck resulting in hyper adduction of the leg at the knee this type of injury is fairly rare in part because the fibular collateral ligament is very strong and also because medial blows to the knee are not common let's admit it How likely is someone to get in between your legs to knock you on the mid side or medial side of your knee the antor Cru ligament ACL can be injured when the leg is hyperextended for example if a runner's foot hits a hole I've done that so many times because the ACL is rather weak compared to the other knee ligaments it is especially prone to to injury to test for ACL injury a physician asks a person to sit on the table their knees are bent and the physician will gently tug anteriorly on the tibia in other words The Physician will grab the lower leg and on with the other hand um brace the him or herself with the thigh and see if they can wiggle anteriorly the ant the tibia forward and this is called the anterior drawer test like pulling a drawer forward too much forward movement indicates an ACL tear conversely a PCL tear may occur if the leg is if the leg is hyperflexed or if the tibia is driven posteriorly on the femur PCL injury occurs rarely because this ligament is rather strong and the physician will do a posterior drawer test which means again the patient's sitting down knees are bent over over the table and if the physician can push the tibia posteriorly like pushing a drawer closed that's indicative of a pcal tear the minisi Also may be prone to injury tears in the meniscus may occur due to blows to the knee or due to the general overuse of the joint because the minisi are composed of fiber cartilage they cannot regenerate and often must be surgically treated the quote unhappy triad injuries refers to a triple injury of the tibial collateral ligament medial meniscus and antier cruet ligament this is the most common type of football injury it occurs when a player is illegally clipped by a lateral blow to the knee and the leg is forcibly abducted and laterally rotated if the blow is severe enough the tibial collateral ligament tears followed by tearing of the medial meniscus as these two structures are connected the force that tears the tibial collateral ligament and the medial meniscus is thus transferred to the ACL because the ACL is relatively weak it tears as well by the way it's not just football players but soccer players are very commonly illegally clipped we call this an in an illegal slide tackle and they often times have the unhappy as well the treatment of ligamentous knee injuries depends on the severity and type of injury conservative treatment involves immobilizing the knee for a period of time surgical treatment can include repairing the torn ligaments or replacing the ligaments with a graph from another tendon or ligament many knee surgeries now may be performed with arthoscopy arthoscopy is is a type of conservative surgical treatment where a very small incision is made in the knee and an arthroscope an instrument with a camera and light source iser is inserted in the knee allowing the surgeon to clearly see the surgical area without having to make large incisions the temperomandibular joint or TMJ is formed by the articulation of the head of the mandible with the articular tubc of the temporal bone anteriorly and the mandibular fossa posteriorly this small complex articulation is the only mobile joint between skull bones the TMJ has several unique anatomic features a loose articular capsule surrounds the joint and promotes an extensive range of motion the TMJ is poorly stabilized and thus a forceful anterior or lateral movement of the m can result in partial or complete dislocation of the mandible it is the most easily dislocated joint it contains an articular disc which is a thick pad of fibrocartilage separating the articulating bones and extends horizontally to divide the joint cavity into two separate chamber Chambers as a result the TMJ is really two cobio joints one between the temporal bone and the articular disc and a second between the articular disc and the mandible the TMJ exhibits hinge gliding and some pivot joint movements it's function it functions like a hinge during jaw depression and elevation while chewing it Glides slightly forward during protraction of the jaw for biting and Glides slight from side to side that would be medial and lateral Excursion to grind food between the teeth during chewing the elbow joint is a hinge joint composed primarily of two articulations one the humo olner joint where the trolear notch of the enna articulates with the troa of the humorus and two the humoro radial joint where the capitulum of the humoris articulates with the head of the radius these joints are enclosed within a single single articular capsule excuse me and this joint can be dislocated it is considered to be the third commonly dislocated joint in some textbooks say it's the third EAS most easily dislocated joint even though some textbooks say it's a very stable joint let's review some clinical aspects for the elbow the term subluxation refers to an incomplete dislocation in which the contact between the Bony joint surfaces is altered but they are still in partial contact in subluxation of the head of the radius the head is pulled out of the angular ligament or Ann sorry not angular annular ligament the layman's terms for this injury includ pulled elbow or as I learned in anatomy nurs mides elbow or slipped elbow this injury occurs commonly in almost exclusively in children typically those younger than age five because a child's annular ligament is thin and the head of the radius is not fully formed after age5 both the ligament and the radial head are more fully formed so the risk of this type of injury lessens dramatically however it may occur if an individual p suddenly on a child's pronated forearm luckily treatment is very simple the pediatrician applies posteriorly placed pressure to the head of the radius while slowly pivoting the the child's forearm supinating it and this basically screws the radial head back in the annular ligament I should tell you that nurse maid's elbow in a child younger than five raises eyebrows and is suspicious of child abuse like a parent yanking on the child's arm come here follow me come over here and pulling them the hip joint also called The coxal Joint is the articulation between the head of the femur and the relatively deep concave acetabulum of the OS coxy a fibrocartilagenous acetabular labrum further deepens the socket it's very similar to the glenoid Le the hip joints more extensive bony architecture is therefore much stronger and more stable than that of the glenohumeral joint conversely the hips joints increased stability means that it is less mobile than the glenohumeral joint the hip joint must be more stable and thus Less Mobile because it supports the body weight however the hip joint can be weakened when the hip is slightly flexed and laterally rotated that would be the femur slightly flexed and laterally rotated like when a person is driving and they're pressing on the gas if you were to be um hit in a in front end collision that impact with your foot on the gas pedal that's enough to knock the head of the femur out of the acetabulum I'd like to finish up our lecture with some clinical perspectives on joint disorders some of these words I've been using throughout the lecture for example like a dislocation of a joint or luxation but what is a sprain a sprain is a stretching or tearing of ligaments without fracture or dislocation of the joint for example like an ankle sprain results when the foot is twisted almost always due to over inversion what about other types of joint disorders how about a dis a discussion on arthritis it is a group of inflammatory or degenerative diseases of joints that occur in various forms each form presents the same symptoms swelling the joint pain and stiffness it is the most prevalent crippling disease in the United States some common forms of arthritis are gouty arthritis osteoarthritis and rheumatoid arthritis gouty arthritis is typically seen in middle-aged and older individuals and is more common in males often C often called gout this disease occurs as a result of an increased level of uric acid a normal cellular waste product from metabolism of nucleotides DNA this abnormal level causes urate crystals to accumula in the blood sovial fluid and sovial membranes the body's inflammatory respon response to the urate crystals results in joint pain gout usually begins with an attack on a single joint often in the great toe of all places and later progresses to other joints eventually gudy arthritis May immobilize joints by causing Fusion between the articular surfaces of the bones often nonsteroidal anti-inflammatory drugs or nids are used to alleviate symptoms and reduce the inflammation osteoarthritis is the most common type of arthritis this chronic degenerative joint condition is termed wear and tear quote unquote arthritis because of its prevalence in weightbearing joints and its association with older adults the entire joint is affected but the articular articular cartilage appears to break down first eventually bone rubs against bone causing abrasions on the Bony surfaces or Uber eation sorry about that without the protective articular cartilage movements at the joints become stiff and painful weightbearing joints most affected by osteoarthritis are those of the hips knees feet and cervical and Lumbar regions of the spine other joints commonly affected include the shoulders and interial Joints Osteo arthritis is typically seen in older individuals although more and more athletes are experiencing AR arthritis at an earlier age due to the repetive repetitive stresses placed on their joints nids are used to alleviate the symptoms of osteoarthritis rheumatoid arthritis is typically seen in younger and middle-aged adults and is much more prevalent in women it presents with pain and swelling of the joints mus weakness osteoporosis and assorted problems with both the heart and the blood vessels rheumatoid arthritis is an autoimmune disorder in which the body's immune system targets its own tissues for attack although the cause of this reaction is unknown it often follows infection by certain bacteria and viruses that have surface molecules similar to molecules normally present in the joints when the body's immune system is stimulated to to attack the foreign molecules it also destroys its own joint tissue thus initiating the autoimmune disorder rheumatoid arthritis starts with synovial membrane inflammation and I show that here in the picture not the sovial membrane inflammation but this rheumatoid arthritis joint disfiguration in the top right picture fluid and white blood cells leak from the small blood vessels into the joint cavity causing it increase in synovial fluid volume as a consequence The Joint swells and the inflamed synovial membrane thickens eventually the articular cartilage and often the underlying bone become eroded Scar Tissue later forms and oif and Bone ends fused together a process called ankis that immobilizes the joint two types of medication are often prescribed to treat rheumatoid arthritis and I discussed this very very early on in my physiology Class A the faster acting firstline medications include Neds non-steroidal anti-inflammatory drugs and corticosteroids like cortisol or the prescription term pricone they are often used to relieve joint pain slower but longer acting second line medications such as meth Methotrexate and hydroxychloroquine or Quin help put the disease into remission and slow down the distraction of the joints again the pictures here show a woman with rheumatoid arthritis Lyme disease is a particularly interesting clinical correlation because the Spyro uh Spyro are basically Anor robic organisms they are kind of an eccentric category of bacteria um because of their unusual cellular morphology and distinctive mechanism of motility so they look like a a spiral cork screw basically but anyway these spirro can cause um what's called relapsed fever and this is one of the um symptoms for limes disease where basically the person um in limes disease actually does not require an intermediate and you can actually get Lim's disease this particular spyroy can be spread from person to person by direct contact you don't need to be bitten by lice or ticks um one of the side effects of lime disease is inflammation of joints and therefore the Pres the person presents with arthritis you know inflammation of the joint interestingly the organism that actually causes Lyme disease just so you know can cause what's called relapsing fever and the reason why they can do this is because they can alter surface antigens during the disease course to avoid immunologic detection so the person's immune system detects this spirro launches an immune resp response abates the fever Etc and the organism is basically curtailed and then it changes its surface antigen to to become antigenic and pathogenic again and then it takes time for the person to detect that pathogen and elicit another immune response and this was actually something that they were trying to rule out in me personally just last January January 2014 when I had relapsed ing fever every um four to 5 days sometimes seven days I would be fever free and then I would have a severe debilitating fever that would last anywhere from hours to days and one of the things that they were worried about was that I had been bitten by a tick or had contracted Lyme disease and they were never able to grow up the pathogen they were NE never able to conclusively prove Pro that I had Lyme disease had no bites I had no you know Bullseye presentation it was all a big mystery regarding btis and tendonitis anytime you read the suffix itis it basically means an inflammatory response so an inflamed Bersa or inflamed tendon it basically is an in inflammation response there's a lot of irritation and with NSAIDs the inflammation can be curtailed with torn cartilage I told you about arthroscopic uh surgery to go in and clip off the torn edges of the cartilage particularly of the torn minuscula sorry minuscula torn minisi there's also the last bullet here artificial joints or arthoplasty surgical joint replacement is also referred to as arthroplasty and it may be performed after failure of other nonsurgical approaches like the NSAID therapy before surgery is considered treatment regimens include activity modification use of braces um even encouraging certain types of exercise medications such as the nids that I told you about the nonsteroidal anti-inflammatory drugs NS Aid DS or nids as they're called and or they can use corticosterone um supplements or injections like the pricone that I was telling you about um into the joint and surgery involves removing the damaged cartilage and Joint surface modifying the bone architecture to align the joint properly and then a metal or plastic prosthetic is implanted to replace the joint surface the options available materials used and recovery time are are dependent upon the joint being replaced for instance hip replacement usually incurs includes complete replacement of the head and the neck of the femur and shoulder replacement includes the articular surfaces the recovery time for total knee replacement surgery is the shortest between six and 8 weeks with full recovery expected within 6 months total shoulder replacement incurs the longest recovery time because the joint is immobilized between six and eight weeks before extensive Physical Therapy can begin as materials and methods Advance the longevity of the replace joint has lengthened so that between 75% and 95% are still functional after 15 years I have to tell you I have a very young cousin well at this point he's 40 almost 40 and when he was in his young 20s he was in a very severe car accident with his sister and his sister also my cousin her name was terara she was tragically killed in this this accident horrific and her brother my cousin who is still alive he had a severely fractured quote hip which we know now in this class to be really the the head of the femur was fractured he actually had some of the bones of his OS coxy fractured as well I mean it just crushed his hip so he's had to have hip replacement similar to what you see in this picture he has a lot of rods and screws and he's he's just he's a mess right there and he will likely have to have a couple of quote hip replacements throughout his lifespan because they last only so long before the screws and the bolts that are anchored in the bone well those are deemed foreign and your immune system will attack those and kind of you know like a like a screw that you might go into drywall and you need kind of an anchor if you don't do that if you just put a screw and drywall it gets loose right it won't hold a picture frame or even a nail in drywall so very similar in joints if it it's screwed in or nailed in eventually the bone degrades and that that anchor gets loose like a nail gets loose and drywall and so you have to replace them and you use new screws and Bolts Etc and you drill them into different places of the bone where it's a tighter fit but again these typically last about 15 to 20 years so my cousin sadly is looking at a lifetime of at least a couple of hip replacements that concludes our discussion on chapter nine joints goodbye