Human joints: types and structural features. Structure of the human joint Basic structure of the joint

Joint is a movable articulation of two or more skeletal bones.

Joints unite the bones of the skeleton into a single whole. More than 180 different joints help a person move. Together with bones and ligaments, they are classified as the passive part of the musculoskeletal system. Joints can be compared to hinges, the task of which is to ensure smooth sliding of bones relative to each other. In their absence, the bones will simply rub against each other, gradually collapsing, which is a very painful and dangerous process. In the human body, joints play a triple role: they help maintain body position, participate in the movement of body parts relative to each other, and are organs of locomotion (movement) of the body in space.

The main elements that are present in all so-called true joints are:

• articular surfaces (ends) of connecting bones;
• joint capsule;
• joint cavity.

The joint cavity is filled with synovial fluid, which is a kind of lubricant and promotes free movement of the articular ends.

Based on the number of articular surfaces, they are distinguished:

• a simple joint having only 2 articular surfaces, for example interphalangeal joints;
• a complex joint having more than two articulating surfaces, such as the elbow joint. A complex joint consists of several simple joints in which movements can be performed separately;
• a complex joint containing intra-articular cartilage that divides the joint into 2 chambers (bicameral joint).

Classification of joints is carried out according to the following principles:

• by the number of articular surfaces;
• according to the shape of the articular surfaces;
• by function.

The articular surface of the bone is formed by hyaline (less often fibrous) articular cartilage. Articular cartilage is tissue filled with fluid. The surface of the cartilage is smooth, strong and elastic, capable of absorbing and releasing liquid well. The thickness of articular cartilage is on average 0.2-0.5 millimeters.

The joint capsule is formed by connective tissue. It surrounds the articulating ends of the bones and on the articular surfaces passes into the periosteum. The capsule has a thick outer fibrous fibrinous membrane and an inner thin synovial membrane, which secretes synovial fluid into the joint cavity. The ligaments and tendons of the muscles strengthen the capsule and promote movement of the joint in certain directions.

The auxiliary formations of the joint include intra-articular cartilage, discs, menisci, lips and intracapsular ligaments. The blood supply to the joint comes from a widely anastomosing (branched) articular arterial network formed by 3-8 arteries. The innervation (supply of nerves) of the joint is carried out by a nervous network formed by sympathetic and spinal nerves. All articular elements, except hyaline cartilage, have innervation. They contain significant amounts of nerve endings that carry out pain perception, as a result of which they can become a source of pain.

Joints are usually divided into 3 groups:

1. synarthrosis - motionless (fixed);
2. amphiarthrosis (half-joints) - partially mobile;
3. diarthrosis (true joints) - mobile. Most joints are movable joints.

According to the World Health Organization, every 7th person on the planet suffers from joint pain. Between the ages of 40 and 70 years, joint diseases are observed in 50% of people and in 90% of people over 70 years of age.

A synovial joint is a joint in which the ends of the bones meet in the articular capsule. These include most human joints, including the load-bearing ones - the knee and pelvis hip joint s.

Joints are divided into simple and complex. Simple bones are formed by 2 bones, while complex bones are formed by more than 2 bones. If several independent joints are involved in the movement, as in the lower jaw when chewing, such joints are called combined. A combined joint is a combination of several joints isolated from each other, located separately, but functioning together. These are, for example, both temporomandibular joints, proximal and distal radioulnar joints, and others.

In shape, the articular surfaces resemble segments of the surfaces of geometric bodies: a cylinder, an ellipse, a ball. Depending on this, cylindrical, ellipsoidal and spherical joints are distinguished.

The shape of the articular surfaces determines the volume and direction of movements around 3 axes: sagittal (runs from front to back), frontal (runs parallel to the plane of support) and vertical (perpendicular to the plane of support).

Circular motion is a sequential movement around all axes. In this case, one end of the bone describes a circle, and the entire bone - a cone shape. Sliding movements of the articular surfaces are also possible, as well as moving them away from each other, as is, for example, observed when stretching the fingers. The function of a joint is determined by the number of axes around which movements occur.

The following main types of joint movements are distinguished:

• movement around the frontal axis - flexion and extension;
• movements around the sagittal axis - adduction and abduction movements around the vertical axis, that is, rotation: inward (pronation) and outward (supination).

The human hand contains: 27 bones, 29 joints, 123 ligaments, 48 ​​nerves and 30 named arteries. We move our fingers millions of times throughout our lives. The movement of the hand and fingers is provided by 34 muscles; only when moving the thumb, 9 different muscles are involved.

It is the most mobile in humans and is formed by the head of the humerus and the articular cavity of the scapula.

The articular surface of the scapula is surrounded by a ring of fibrocartilage - the so-called articular lip. The tendon of the long head of the biceps brachii muscle passes through the joint cavity. Shoulder joint strengthens the powerful coracohumeral ligament and surrounding muscles - deltoid, subscapularis, supra- and infraspinatus, teres major and minor. The pectoralis major and latissimus dorsi muscles also take part in shoulder movements.

The synovial membrane of the thin articular capsule forms 2 extra-articular inversions - the tendons of the biceps brachii and subscapularis. The anterior and posterior arteries that envelop the humerus and the thoracoacromial artery take part in the blood supply to this joint; the venous outflow is carried out into the axillary vein. The outflow of lymph occurs in the lymph nodes of the axillary region. The shoulder joint is innervated by branches of the axillary nerve.

1. brachial bone;
2. shoulder blade;
3. collarbone;
4. joint capsule;
5. folds of the joint capsule;
6. acromioclavicular joint.

The shoulder joint is capable of movement around 3 axes. Flexion is limited by the acromion and coracoid processes of the scapula, as well as the coracobrachial ligament, extension by the acromion, coracobrachial ligament and joint capsule. Abduction in the joint is possible up to 90°, and with the participation of the upper limb belt (when the sternoclavicular joint is included) - up to 180°. Abduction stops when the greater tuberosity of the humerus rests on the coracoacromial ligament. The spherical shape of the articular surface allows a person to raise his arm, move it back, and rotate the shoulder along with the forearm and hand in and out. This variety of hand movements was a decisive step in the process of human evolution. The shoulder girdle and shoulder joint in most cases function as a single functional formation.

It is the most powerful and heavily loaded joint in the human body and is formed by the acetabulum of the pelvic bone and the head of the femur. Hip joint strengthened by the intraarticular ligament of the head of the femur, as well as the transverse ligament of the acetabulum, covering the neck of the femur. From the outside, the powerful iliofemoral, pubofemoral and ischiofemoral ligaments are woven into the capsule.

The blood supply to this joint is through the circumflex femoral arteries, branches of the obturator and (variably) branches of the superior perforating, gluteal and internal pudendal arteries. The outflow of blood occurs through the veins surrounding the femur, in femoral vein and through the obturator veins into the iliac vein. Lymphatic drainage occurs in the lymph nodes located around the external and internal iliac vessels. The hip joint is innervated by the femoral, obturator, sciatic, superior and inferior gluteal and pudendal nerves.
The hip joint is a type of ball-and-socket joint. It allows movements around the frontal axis (flexion and extension), around the sagittal axis (abduction and adduction) and around the vertical axis (external and internal rotation).

This joint experiences a lot of stress, so it is not surprising that its lesions take first place in general pathology articular apparatus.

One of the largest and most complex human joints. It is formed by 3 bones: the femur, tibia and fibula. Stability of the knee joint is provided by intra- and extra-articular ligaments. The extra-articular ligaments of the joint are the fibular and tibial collateral ligaments, the oblique and arcuate popliteal ligaments, the patellar ligament, and the medial and lateral suspensory ligaments of the patella. The intra-articular ligaments include the anterior and posterior cruciate ligaments.

The joint has many auxiliary elements, such as menisci, intra-articular ligaments, synovial folds, and bursae. Each knee joint has 2 menisci - external and internal. The menisci look like crescents and play a shock-absorbing role. The auxiliary elements of this joint include synovial folds, which are formed by the synovial membrane of the capsule. The knee joint also has several synovial bursae, some of which communicate with the joint cavity.

Everyone had to admire the performances of artistic gymnasts and circus performers. People who are able to climb into small boxes and bend unnaturally are said to have gutta-percha joints. Of course, this is not true. The authors of The Oxford Handbook of Body Organs assure readers that “such people have phenomenally flexible joints” - in medicine this is called joint hypermobility syndrome.

1. femur
2. tibia
3. synovial fluid
4. internal and external menisci
5. medial ligament
6. lateral ligament
7. cruciate ligament
8. patella

The shape of the joint is a condylar joint. It allows movements around 2 axes: frontal and vertical (with a bent position in the joint). Flexion and extension occur around the frontal axis, and rotation occurs around the vertical axis.

The knee joint is very important for human movement. With each step, by bending, it allows the foot to step forward without hitting the ground. Otherwise, the leg would be carried forward by raising the hip.

The bones in the skeleton are connected in various ways. The simplest type of connection, the most ancient in phylogenetic terms, can be considered connection through fibrous connective tissue. In this way, for example, parts of the exoskeleton in invertebrates are connected. A more complex form of connection between parts of the skeleton is connection through cartilage tissue, for example, in the skeleton of fish. The most developed form of bone connection in animals living on land was articulation through joints, which made it possible to produce a variety of movements. As a result of a long evolutionary process, humans have preserved all 3 types of connections.

DEVELOPMENT OF BONE JOINTS

Bone joints develop in close relationship with the development of the bones themselves. In humans, continuous connections are first formed as simpler ones - in the 6th week of the intrauterine period. In the embryo, in the cartilaginous anlages of the bones, where connections should be formed, a concentration of mesenchyme and a convergence of the connecting cartilaginous bone models are observed. At the same time, the mesenchymal layer between them turns into either cartilage or fibrous tissue.

With the development of synovial joints or joints in the 8-9th week, the embryo experiences a rarefaction of mesenchyme on the epiphyses, which leads to the formation of a joint space. By this time, osteoblasts penetrate into the diaphyses of cartilaginous bone models and form bone tissue. The epiphyses remain cartilaginous, and the mesenchyme covering the future articular surfaces turns into hyaline articular cartilage several millimeters thick. At the same time, the articular capsule begins to form, in which 2 layers can be distinguished: the outer fibrous layer, consisting of fibrous

connective tissue, and internal epithelial - synovial membrane. The joint ligaments are formed from the mesenchyme adjacent to the joint, which forms the capsule.

In the second half of the embryonic period, intra-articular components are formed: discs, menisci, intracapsular ligaments due to the mesenchyme, which is retracted in the form of an elastic cushion between the cartilaginous epiphyses of the tubular bones. The formation of the articular cavity occurs not only in the embryonic period, but also in the postnatal period. In different joints, the formation of the intra-articular cavity is completed at different times.

GENERAL ARTHROLOGY

Bones can connect to one another using a continuous connection when there is no gap between them. This connection is called synarthrosis(synarthrosis). A discontinuous connection in which a cavity is located between the articulating bones and forms joint(articulatio), called diarthrosis, or synovial junction(juncturae synovialis).

Continuous connections of bones - synarthrosis

Continuous bone connections (Fig. 32), depending on the type of tissue connecting the bones, are divided into 3 groups: fibrous joints (juncturae fibrosae), cartilaginous joints (juncturae cartilagina) and connections through bone tissue - synostoses (synostoses).

To fibrous joints include syndesmosis, interosseous membrane and suture.

Syndesmosis(syndesmosis)- This is a fibrous connection through ligaments.

Ligaments(ligamenta) serve to strengthen bone joints. They can be very short, for example interspinous and intertransverse ligaments (ligg. interspinalia et intertransversaria), or, conversely, long, like the supraspinous and nuchal ligaments (ligg. supraspinale et nuchae). Ligaments are strong fibrous cords consisting of longitudinal, oblique and overlapping bundles of collagen and a small amount of elastic fibers. They can withstand high tensile loads. A special type of ligament is the yellow ligament (ligg.flava), formed by elastic fibers. They are durable and

Rice. 32. Continuous connections:

a - syndesmosis; b - synchondrosis; c - symphysis; d, e, f - impacting (dental-alveolar junction); g - serrated seam; h - scaly suture; and - flat (harmonious) seam; k - interosseous membrane; l - ligaments

strength of fibrous syndesmoses, at the same time they are characterized by great extensibility and flexibility. These ligaments are located between the vertebral arches.

A special type of syndesmosis includes dentoalveolar syndesmosis or inclusion(gomphosis)- connection of the roots of the teeth with the dental alveoli of the jaws. It is carried out by fibrous bundles of periodontium, running in different directions depending on the direction of the load on a given tooth.

Interosseous membranes: radioulnar syndesmosis (syndesmosis radioulnaris) and tibiofibular (syndesmosis tibiofibularis). These are connections between adjacent bones through interosseous membranes - respectively, the interosseous membrane of the forearm and interosseous membrane of the leg (membrane interossea cruris). Syndesmoses also close openings in the bones: for example, the obturator foramen is closed by the obturator membrane (membrana obturatoria), there are atlanto-occipital membranes - anterior and posterior (membrana atlantooccipitalis anterior et posterior). Interosseous membranes close the openings in the bones and increase the surface area for muscle attachment. The membranes are formed by bundles of collagen fibers, are inactive, and have openings for blood vessels and nerves.

The seam(sutura) is a joint in which the edges of the bones are firmly articulated by a small layer of connective tissue. Sutures occur only on the skull. Depending on the shape of the edges of the skull bones, the following sutures are distinguished:

Serrated (sut. serrata)- the edge of one bone has teeth that fit into the depressions between the teeth of another bone: for example, when connecting the frontal bone with the parietal bone;

Scaly (sut. squamosa) formed by placing obliquely cut bones on top of each other: for example, when connecting scales temporal bone with parietal;

Flat (sut. plana)- the smooth edge of one bone is adjacent to the same edge of the other, characteristic of the bones of the facial skull;

Schindylosis (splitting; schindylesis)- the sharp edge of one bone fits between the split edges of another: for example, the connection of the vomer with the beak of the sphenoid bone.

In cartilaginous joints(juncturae cartilaginea) The bones are held together by layers of cartilage. Such compounds include synchondrosis And symphysis

Synchondrosis(synchondrosis) formed by continuous layers of cartilage. This is a strong and elastic connection with slight mobility, which depends on the thickness of the cartilage layer: the thicker the cartilage, the greater the mobility, and vice versa. Synchondroses are characterized by spring functions. An example of synchondrosis is a layer of hyaline cartilage at the border of the epiphyses and metaphyses in long tubular bones - the so-called epiphyseal cartilage, as well as the costal cartilages that connect the ribs to the sternum. Synchondrosis can be temporary or permanent. The former exist until a certain age, for example epiphyseal cartilages. Permanent synchondrosis remains throughout a person’s life, for example, between the pyramid of the temporal bone and the neighboring bones - the sphenoid and occipital.

Symphyses(symphyses) They differ from synchondrosis in that there is a small cavity inside the cartilage connecting the bones. The bones are also fixed by ligaments. Symphyses were previously called semi-joints. There are the symphysis of the manubrium of the sternum, the intervertebral symphysis and the pubic symphysis.

If a temporary continuous connection (fibrous or cartilage) is replaced bone tissue, then it is called synostosis(synostosis). An example of synostosis in an adult is the connections between the bodies of the occipital and sphenoid bones, between the sacral vertebrae, and the halves of the lower jaw.

Discontinuous bone connections - diarthrosis

Discontinuous bone connections - joints(juncturae synovialis), or synovial joints, diarthrosis,- formed from continuous connections and are the most progressive form of bone connection. Each joint has the following components: articular surfaces, covered with articular cartilage; joint capsule, covering the articular ends of the bones and strengthened by ligaments; joint cavity, located between the articulating surfaces of the bones and surrounded by the articular capsule, and articular ligaments that strengthen the joint (Fig. 33).

Articular surfaces(facies articularis) covered with articular cartilage (cartilago articularis). Typically, one of the articulating articular surfaces is convex, the other concave. The structure of cartilage can be hyaline or, less commonly, fibrous. The free surface of the cartilage, facing the joint cavity, is smooth, which facilitates movement

Rice. 33. Joint structure diagram:

1 - synovial membrane; synovial layer; 2 - fibrous membrane; fibrous layer; 3 - fat cells; 4 - articular capsule; 5 - hyaline articular cartilage; 6 - mineralized cartilage matrix; 7 - bone; 8 - blood vessels; 9 - articular cavity

bones relative to each other. Inner surface cartilage is firmly connected to the bone through which it receives nutrition. The elasticity of hyaline cartilage softens shocks. In addition, cartilage smoothes out all the roughness of the articulating bones, giving them the appropriate shape and increasing the congruence (coincidence) of the articular surfaces.

Joint capsule(capsula articularis) covers the articular surfaces of the bones and forms a hermetically closed articular cavity. The capsule consists of two layers: the outer layer - a fibrous membrane (membrana fibrosa) and internal - synovial membrane (membrana synovialis). The fibrous membrane is formed by fibrous connective tissue. In joints that perform extensive movements, the capsule is thinner than in inactive ones.

The synovial membrane consists of loose connective tissue, which is covered with a layer of epithelial cells. The synovial membrane forms special outgrowths - synovial villi (villi synoviales), involved in the production of synovial fluid (synovia). The latter moisturizes the articular surfaces, reducing their friction. In addition to villi, the synovial membrane has synovial folds (plicae synoviales), protruding into the joint cavity. Fat can be deposited in them, and then they are called fat folds (plicae adiposae). If the synovial membrane bulges outward, synovial bursae (bb. synoviales). They are located in areas of greatest friction, under muscles or tendons. In addition, in large joints the synovial membrane can form more or less closed cavities - inversions of the synovial membrane (recessus synoviales). Such inversions, for example, are found in the articular capsule of the knee joint.

Articular cavity(cavitas articularis) It is a slit-like space limited by the articular surfaces of the bones and the articular capsule. It is filled with a small amount of synovial fluid. The shape and size of the articular cavity depend on the size of the articular surfaces and the attachment sites of the capsule.

In addition to the considered main components present in each joint, additional formations are observed: the articular lip, articular discs, menisci, ligaments and sesamoid bones.

Articular labrum (labrum articulare) comprises fibrous fabric, attached along the edge of the glenoid cavity. It increases the area of ​​contact between the articular surfaces. For example, the labrum is present in the shoulder and hip joints.

Articular disc (discus articularis) and articular meniscus (meniscus articularis) They are fibrous cartilage located in the joint cavity. If the cartilage divides the joint cavity completely into 2 floors, which is observed, for example, in the temporomandibular joint, then they speak of a disc. If the division of the joint cavity is incomplete, then they speak of menisci: for example, menisci in the knee joint. Articular cartilage promotes congruence of articulating surfaces and reduces the impact of shocks.

Intracapsular ligaments (ligg. intracapsularia) They are made of fibrous tissue and connect one bone to another. On the side of the joint cavity they are covered with the synovial membrane of the joint capsule,

which separates the ligament from the joint cavity: for example, the ligament of the femoral head in the hip joint. The ligaments that strengthen the articular capsule and lie in its thickness are called capsular. (ligg. capsularia), and those located outside the capsule are extracapsular (ligg. extracapsularia).

Sesamoid bones (ossa sesamoidea) located in the joint capsule or in the thickness of the tendon. Their inner surface, facing the joint cavity, is covered with hyaline cartilage, the outer surface is fused with the fibrous layer of the capsule. An example of a sesamoid bone located in the capsule of the knee joint is the patella.

Types of joints

Joints are divided depending on the shape and number of articulating surfaces or functions (the number of axes around which movements are made in the joint). The following forms of joint movements are distinguished:

Movement around the frontal axis: decreasing the angle between the articulating bones - bending(flexio), increasing the angle between them - extension(extension);

Movement around the sagittal axis: approaching the median plane - casting(adductio), distance from her - lead(abductio);

Movement around the vertical axis: outward rotation(supinatio);inward rotation(pronatio);circular rotation(circumductio), in which the rotating limb segment describes a cone.

The range of motion in the joints is determined by the shape of the articulating bone surfaces. If one surface is small and the other is large, then the range of motion in such a joint is large. In joints with articular surfaces almost equal in area, the range of motion is much less. In addition, the range of motion in the joint depends on the degree of its fixation by ligaments and muscles.

The shape of the articular surfaces is conventionally compared with geometric bodies (sphere, ellipse, cylinder). They are classified by shape and distinguish between spherical, flat, ellipsoidal, saddle-shaped, trochlear and other joints. Based on the number of axes, multiaxial, biaxial, and uniaxial joints are distinguished. The shape of the articular surfaces also determines the functional mobility of the joints and, therefore,

number of axes. Based on the shape and number of axes, we can distinguish: uniaxial joints - block-shaped, cylindrical; biaxial joints - ellipsoidal, condylar, saddle-shaped; multiaxial joints - spherical, flat. Movements in the joint are determined by the shape of its articular surfaces (Fig. 34).

Uniaxial joints. IN cylindrical joint(articulatio cylindrica) the articular surface of one bone is shaped like a cylinder, and the articular surface of the other bone is shaped like a cavity. In the radioulnar joint, movements occur inward and outward - pronation and supination. The cylindrical joint is the articulation of the atlas with the axial vertebra. Another form of uniaxial joints is block-shaped(ginglymus). In this joint, one of the articulating surfaces is convex with a groove in the middle, the other articular surface is concave and has a ridge in the middle. The groove and ridge prevent lateral slip. An example of a trochlear joint is the interphalangeal joints of the fingers, which provide flexion and extension. Type of trochlear joint - helical joint(articulatio cochlearis), in which the groove on the articulated surface is located somewhat obliquely with respect to the plane perpendicular to the axis of rotation. As this groove continues, a screw is formed. These joints are the ankle and the humeral-ulnar.

Biaxial joints.Elliptical joint(articulatio ellipsoidea) the shape of the articular surfaces approaches an ellipse. In this joint, movements around two axes are possible: frontal - flexion and extension, and sagittal - abduction and adduction. In biaxial joints, circular rotation is possible. Examples of biaxial joints are the wrist and atlanto-occipital. Biaxial also includes saddle joint(articulatio sellaris), the articulated surfaces of which resemble a saddle in shape. The movements in this joint are the same as in the elliptical joint. An example of such a joint is the carpometacarpal joint of the thumb. Condylar joint(articulatio bicondylaris) refers to biaxial (the shape of the articular surfaces is close to elliptical). In such a joint, movements around two axes are possible. An example is the knee joint.

Multiaxial (triaxial) joints.Ball and socket joint(articulatio sphenoidea) has the greatest freedom of movement. It is possible

Rice. 34.1.Synovial joints (joints). Types of joints according to shape and number of axes of rotation:

a - uniaxial joints: 1, 2 - trochlear joints; 3 - cylindrical joint; b - biaxial joints: 1 - elliptical joint; 2 - condylar joint; 3 - saddle joint;

c - triaxial joints: 1 - spherical joint; 2 - cup-shaped joint; 3 - flat joint

Rice. 34.2.Patterns of joint movements:

a - triaxial (multiaxial) joints: 1 - spherical joint; 2 - flat joint; b - biaxial joints: 1 - elliptical joint; 2 - saddle joint; c - uniaxial joints: 1 - cylindrical joint; 2 - trochlear joint

movements around three mutually perpendicular axes: frontal, sagittal and vertical. Around the first axis flexion and extension occur, around the second - abduction and adduction, around the third - outward and inward rotation. An example is the shoulder joint. If glenoid cavity deep, as in the hip joint, where the head of the femur is deeply covered by it, then such a joint is called cup-shaped(articulatio cotylica). Multiaxial joints include flat joint(articulatio plana), the articular surfaces of which are slightly curved and represent segments of a circle of large radius. These are, for example, the joints between the articular processes of the vertebrae.

If 2 bones take part in the formation of a joint, then the joint is called simple(articulatio simplex), if 3 or more - complex(articulatio composita). An example of a simple joint is the shoulder, and a complex joint is the elbow. Combined joints- a set of several joints in which movements are performed simultaneously. For example, movement in one temporomandibular joint is impossible without movement in the other.

A number of factors are important in fixing joints: adhesion of articular surfaces, their strengthening by the capsular-ligamentous apparatus, traction of muscles and tendons attached to the circumference of the joints.

The joints have pronounced individual, age and gender characteristics. Mobility in bone joints depends on the individual structural features of these joints. It is not the same for people of different ages, genders and fitness levels.

Blood supply and innervation of joints

The joints are supplied with blood by the branches of the main arterial trunks, which pass nearby. Sometimes a vascular network of several arteries is formed on the surface of the joint, for example the arterial networks of the elbow and knee joints. The outflow of venous blood occurs into the venous vessels that accompany the arteries of the same name. The joints are innervated by nearby nerves. They send nerve branches into the articular capsule, forming a number of branches and terminal nerve apparatus (receptors) in it. Lymph drainage occurs to nearby regional lymph nodes.

CONNECTION OF BONES OF THE TORSO

Spinal column connection

The vertebral bodies are connected by intervertebral symphysis(symphysis intervertebralis); located between the vertebral bodies intervertebral discs(disci intervertebrals). The intervertebral disc is a fibrocartilaginous formation. On the outside it is formed by a fibrous ring (anulus fibrosus), the fibers of which run in an oblique direction to adjacent vertebrae. The nucleus pulposus is located in the center of the disc (nucl. pulposus), which is a remnant of the dorsal string (chord). Due to the elasticity of the disc, the spinal column absorbs the shocks that the body experiences when walking and running. The height of all intervertebral discs is 1/4 of the entire length of the spinal column. The thickness of the discs is not the same everywhere: the greatest in the lumbar region, the smallest in the thoracic region.

There are 2 longitudinal ligaments running along the vertebral bodies - anterior and posterior (Fig. 35). Anterior longitudinal ligament(lig. longitudinale a nterius) located on the anterior surface of the vertebral bodies. It starts from the anterior tubercle of the arch of the atlas and stretches to the first sacral vertebra. This ligament prevents excessive extension of the spine. Posterior longitudinal ligament(lig. longitudinale posterius) runs inside the spinal canal from the body of the second cervical vertebra to the first sacral vertebra. It prevents excessive flexion of the spine.

The connections between the arches and processes are referred to as syndesmoses. So, between the arches of the vertebrae there are strong yellow ligaments(ligg.flava), between the spinous processes of the vertebrae - interspinous ligaments(ligg. interspinalia), which at the tips of the processes turn into supraspinous ligaments(ligg. supraspinalia), running in the form of a round longitudinal cord along the entire length of the spinal column. In the cervical region, the ligaments above the VII vertebra thicken in the sagittal plane, extend beyond the spinous processes and attach to the external occipital protrusion and crest, forming nuchal ligament(lig. nuchae). Between the transverse processes of the vertebrae are located intertransverse ligaments(ligg. intertransversaria).

Rice. 35. Connections of the spinal column: a - side view (the left half of the vertebrae has been partially removed): 1 - vertebral body; 2 - intervertebral disc; 3 - posterior longitudinal ligament; 4 - anterior longitudinal ligament; 5 - facet joint (opened); 6 - interspinous ligament; 7 - yellow ligament; 8 - supraspinous ligament; 9 - intervertebral foramen;

b - rear view from the spinal canal (vertebral arches removed): 1 - posterior longitudinal ligament; 2 - intervertebral disc; c - view from the side of the spinal canal at the vertebral arches: 1 - vertebral arch; 2 - yellow ligament

Facet joints

The lower articular processes of the vertebra articulate with the upper articular processes of the underlying vertebra using facet joints(articulationes zygapophysiales). According to the shape of the articular surfaces, they are considered flat, and in the lumbar spine - cylindrical.

Lumbosacral joint(articulatio lumbosacralis) between the sacrum and the fifth lumbar vertebra has the same structure as the articulations of the vertebrae with each other.

Sacrococcygeal joint(articulatio sacrococcygeal) has some features due to the loss of the coccyx's characteristic structure for the vertebrae. Between the bodies of the V sacral and I coccygeal vertebrae there is an intervertebral disc, as in true vertebral joints, but inside it, instead of the nucleus pulposus, there is a small cavity. Runs along the anterior surface of the coccyx ventral sacrococcygeal ligament(lig. sacrococcygeum ventrale), which is a continuation of the anterior longitudinal ligament. Along the posterior surface of the bodies of the sacral vertebrae and coccyx there is deep dorsal sacrococcygeal ligament(lig. sacrococcygeum dorsale profundum)- continuation posterior longitudinal ligament(lig. longitudinals posterius). The inferior sacral foramen is closed superficial posterior sacrococcygeal ligament(lig. sacrococcygeum posterius superficialis), running from the dorsal surface of the sacrum down to the posterior surface of the coccyx. It corresponds to the supraspinous and yellow ligaments. Lateral sacrococcygeal ligament(lig. sacrococcygeum laterale) runs along the lateral surface of the sacrum and coccyx.

CONNECTION OF THE I AND II CERVICAL VERTEBRES BETWEEN THEM AND WITH THE SKULL

The connections of the condyle in the occipital bone with the superior articular fossae of the atlas form a combined ellipsoid atlanto-occipital joint(articulatio atlantooccipitalis). Movements around the sagittal axis are possible in the joint - tilting the head to the sides and around the frontal axis - flexion and extension. The connection of the atlas and the axial vertebra forms 3 joints: paired combined flat lateral atlantoaxial joint(articulatio atlantoaxial lateralis), located between the lower articular surfaces of the atlas and the upper articular surfaces of the axial vertebra; unpaired cylindrical median atlantoaxial joint(articulatio atlantoaxialis medialis), between the tooth of the axial vertebra and the articular fossa of the atlas. The joints are strengthened by strong ligaments. Between the anterior and posterior arches of the atlas and the edge of the foramen magnum are stretched anterior and posterior atlanto-occipital membranes(membranae atlantooccipitales anterior et posterior)(Fig. 36). Atlas spreads between the lateral masses transverse ligament of the atlas(lig. trasversum atlantis). From the upper free edge of the transverse ligament passes the fibrous

Rice. 36. Connection of the cervical vertebrae to each other and to the skull: a - cervical spine, view from right side: 1 - interspinous ligament; 2 - yellow ligaments; 3 - nuchal ligament; 4 - posterior atlanto-occipital membrane; 5 - anterior atlanto-occipital membrane; 6 - anterior longitudinal ligament;

b - upper part of the spinal canal, rear view. Vertebral arches removed

and spinous processes: 1 - lateral atlantoaxial joint; 2 - atlanto-occipital joint; 3 - occipital bone; 4 - cover membrane; 5 - posterior longitudinal ligament; c - in comparison with the previous figure, the integumentary membrane has been removed: 1 - transverse ligament of the atlas; 2 - pterygoid ligaments; 3 - cruciate ligament of the atlas; d - in comparison with the previous figure, the cruciate ligament of the atlas was removed:

1- ligament of the apex of the tooth; 2 - pterygoid ligament; 3 - atlanto-occipital joint; 4 - lateral atlantoaxial joint;

e - median atlantoaxial joint, top view: 1 - transverse atlas ligament;

2-pterygoid ligament

cord to the anterior semicircle of the foramen magnum. A fibrous bundle runs from the lower edge of the same ligament down to the body of the axial vertebra. The upper and lower bundles of fibers together with the transverse ligament form cruciate ligament of the atlas(lig. cruciforme atlantis). From the upper part of the lateral surfaces of the odontoid process there are two pterygoid ligaments(ligg. alaria), heading to the condyles of the occipital bone.

SPINAL COLUMN AS A WHOLE

Spinal column(columna vertebralis) consists of 24 true vertebrae, sacrum, coccyx, intervertebral discs, articular and ligamentous apparatus. The functional importance of the spine is enormous. It is the receptacle for the spinal cord, which lies in the spinal canal (canalis vertebralis); serves as a support for the body, participates in the formation of the chest and abdominal walls.

There are intervertebral foramina between the vertebrae above and below (forr. intervertebralia), where the spinal nodes lie, blood vessels and nerves pass through. The intervertebral foramina are formed by the inferior notch of the overlying vertebra and the superior notch of the underlying vertebra.

The human spine has curves in the sagittal plane (see Fig. 18.1). In the cervical and lumbar regions, the spine forms curves with the convexity directed anteriorly - lordosis(lordosis), and in the thoracic and sacral regions - bends directed posteriorly - kyphosis(kyphosis). The bends of the spinal column give it spring properties. Curves are formed in the postnatal period. At the 3rd month of life, the child begins to raise his head, and cervical lordosis appears. When the child begins to sit, it forms thoracic kyphosis(6 months). When moving to a vertical position, lumbar lordosis occurs (8-9 months). The final formation of bends ends by the age of 18. Lateral curves of the spine in the frontal plane - scoliosis- represent pathological curvatures. In old age, the spine loses its physiological curves; as a result of loss of elasticity, a large thoracic curve, the so-called senile hump, is formed. In addition, the length of the spine may decrease by 6-7 cm. Movements in the spinal column are possible around 3 axes: frontal - flexion and extension, sagittal - tilt to the right and left, vertical - rotational movements.

X-ray anatomy of the spinal column

To study the structure of the spinal column, radiography is used in frontal and lateral projections.

On radiographs in lateral projections, the vertebral bodies and intervertebral spaces corresponding to the intervertebral discs, vertebral arches, spinous and articular processes, joint spaces, and intervertebral foramina are visible. The shadows of the transverse processes are superimposed on the shadows of the vertebral bodies. X-rays of the spinal column make it possible to study its bends and structural features of each section.

Radiographs in direct projections also show details of the structure of the vertebrae and intervertebral spaces, and the transverse processes in the cervical and lumbar spine are free from overlap, and in the thoracic spine they are aligned with the posterior ends of the ribs. The spinous processes overlap the vertebral bodies. Radiographs of the sacrum and coccyx show the sacral foramen, lumbosacral and sacroiliac joints.

JOINTS OF THE CHEST

Connection of the ribs to the sternum and spine

The seven true ribs are connected to the sternum by means of the costal cartilages, and the cartilage of the first rib is connected by synchondrosis to the manubrium of the sternum. The remaining 6 costal cartilages (II-VII) form flat sternocostal joints(articulationes sternocostales). Between the cartilages of the VI-VIII ribs there are joints called intercartilaginous(articulationes interchondrales).

The ribs are connected to the vertebrae by costovertebral joints(articulationes costovertebral), consisting of two joints. One of them is the head joint (articulatio capitis costae), the other is the costotransverse joint (articulatio costotransversaria) between the costal tubercle and the transverse process of the vertebra (Fig. 37).

CHEST IN GENERAL

Rib cage(compages thoracis) formed by 12 pairs of ribs with cartilage, 12 thoracic vertebrae, sternum and articular-ligamentous apparatus. The chest is involved in protecting organs located

Rice. 37. Connection of the ribs to the sternum and spine:

a - connection with the sternum: 1 - costal cartilages; 2 - radiate sternocostal ligament; 3 - collarbone; 4 - interclavicular ligament; 5 - articular disc of the sternoclavicular joint; 6 - costoclavicular ligament; 7 - cavities of the sternocostal joints; 8 - intercartilaginous joints;

b - with the spine: 1 - anterior longitudinal ligament; 2 - costal fossa on the vertebral body; 3 - costal fossa on the transverse process of the vertebra; 4 - rib; 5 - joint of the rib head, strengthened by the radiate ligament

in the chest cavity. The chest has 2 openings (apertures) - upper and lower.

Superior thoracic outlet (apertura thoracis superior) bounded posteriorly by the body of the first thoracic vertebra, laterally by the first rib, and anteriorly by the sternum. Inferior thoracic outlet (apertura thoracis inferior) limited posteriorly by the body of the XII thoracic vertebra, laterally and anteriorly by the XI and XII ribs, costal arches and the xiphoid process. Right and left costal arches (arcus costales), formed by the last of the ribs connecting to the sternum (X), forming the substernal angle (angulus infrasternalis), the dimensions of which are determined by the shape of the chest. The spaces between adjacent ribs are called intercostal (spatium intercostale).

The shape of the chest varies and depends on body type, age and gender. There are two extreme forms of the chest: narrow and

long, with low ribs and a sharp substernal angle; wide and short, with a greatly expanded lower aperture and a large substernal angle. A woman's chest is more rounded, steeper and narrower in the lower section. In men, its shape is close to a cone; all its dimensions are larger.

X-ray anatomy of the chest

A chest x-ray in the anteroposterior projection shows the dorsal segments of the ribs, which are directed laterally and downward, and the anterior segments of the ribs, which are directed in the opposite direction. The costal cartilages do not produce shadows. The sternoclavicular joints, sternum, and intercostal spaces are clearly visible.

Questions for self-control

1.List the types of connections. Give their characteristics.

2.What are the types of joints based on shape and number of axes? Describe each type of connection.

3.Name the continuous connections of bones.

4.What additional formations do you know in the joint? What function do they perform?

5.How are the vertebral bodies connected to each other?

6. How are the 1st and 2nd cervical vertebrae connected to each other and to the skull?

7.What shapes of the chest are found depending on body type, age and gender?

CONNECTION OF LIMB BONES

Joints of the upper limb

Joints of the upper limb belt

AC joint(articulatio acromioclavicularis) formed by the acromial end of the clavicle and the acromion of the scapula. The articular surface is flat. Movements in the joint are possible around all 3 axes, but their amplitude is very small. Inside the articular cavity there is articular disc(discus articularis). The joint is strengthened by the following ligaments: coracoclavicular (lig. coracoclaviculare), going from the coracoid process of the scapula to the lower surface of the clavicle, as well as

acromioclavicular (lig. acromioclaviculare), located between the clavicle and acromion.

In the girdle of the upper limb, the coracoacromial ligament is also distinguished (lig. coracoacromiale) in the form of a triangular plate located between the acromion of the scapula and the coracoid process. This ligament is the arch of the shoulder joint and limits the upward abduction of the arm.

Sternoclavicular joint(articulatio sternoclavicularis)(Fig. 38) is formed by the clavicular notch of the sternum and the sternal end of the clavicle. To increase the conformity of the articular surfaces, there is an articular disc inside the joint cavity, dividing the joint cavity into 2 sections. The shape of the articulated surfaces of the bones is saddle-shaped. In terms of range of motion due to the disc, the joint approaches spherical. Movements around the sagittal axis up and down, around the vertical axis forward and backward, as well as rotation of the clavicle around the frontal axis and a slight circular movement are possible. The joint is strengthened by the following ligaments: costoclavicular (lig. costoclavicular), going from the cartilage of the first rib to the lower surface of the clavicle; anterior and posterior sternoclavicular (ligg. sternoclaviculares anterius et posterius), passing in front and behind due to the joint disc; interclavicular ligament (lig. interclaviculare), which connects both sternal ends of the clavicle above the jugular notch.

Rice. 38.Sternoclavicular joint, front view. The right joint is opened with a frontal incision:

1 - articular disc; 2 - interclavicular ligament; 3 - anterior sternoclavicular ligament; 4 - collarbone; 5 - costoclavicular ligament; 6 -I rib; 7 - manubrium of the sternum

Joints of the free upper limb Shoulder joint

Shoulder joint(articulatio humeri)(Fig. 39) is formed by the head of the humerus and the glenoid cavity of the scapula. There is a discrepancy between the articulated surfaces of the bones; to increase congruence, a labrum is formed along the edge of the glenoid cavity (labrum glenoidale). The articular capsule is thin, free, starts from the edge of the articular labrum and is attached to the anatomical neck of the humerus. The tendon of the long head of the biceps brachii muscle passes through the joint cavity. It lies in the intertubercular groove of the humerus and is surrounded by a synovial membrane. The joint is strengthened by the coracobrachial ligament (lig. coracohumerale), starting from the coracoid process of the scapula and intertwining with the joint capsule. The shoulder joint is surrounded by muscles on the outside. Muscle tendons, surrounding

Rice. 39. Shoulder joint, right, front view (capsule and ligaments of the joint): 1 - coracobrachial ligament; 2 - coracoacromial ligament; 3 - coracoid process; 4 - blade; 5 - articular capsule; 6 - humerus; 7 - tendon of the long head of the biceps brachii muscle; 8 - tendon of the subscapularis muscle; 9 - acromion

compressing the joint, not only strengthen it, but also, when moving in the joint, pull back the joint capsule, preventing it from being pinched. According to the shape of the articulated surfaces, the joint belongs to spherical. Movements in the joint are possible around three mutually perpendicular axes: sagittal - abduction and adduction, vertical - pronation and supination, frontal - flexion and extension. Circular rotations are possible in the joint.

Elbow joint

Elbow joint(articulatio cubiti) is complex and consists of 3 joints: humeroulnar, humeroradial and proximal radioulnar. They have a common cavity and are covered with one capsule (Fig. 40).

Ab

Rice. 40.Elbow joint, front view:

a - external view: 1 - radius; 2 - tendon of the biceps brachii; 3 - annular ligament of the radius; 4 - radial collateral ligament; 5 - joint capsule; 6 - humerus; 7 - ulnar collateral ligament; 8 - ulna; b - joint capsule removed: 1 - articular cartilage; 2 - adipose tissue; 3 - synovial membrane

Shoulder-ulnar joint(articulatio humeroulnaris) formed by the trochlea of ​​the humerus and the trochlear notch ulna. The joint is trochlear, with a helical deviation from the midline of the trochlea.

Humeral joint(articulatio humeroradial)- this is the articulation of the head of the humerus and the fossa on the head of the radius, the shape of the joint is spherical.

Proximal radioulnar joint(articulatio radioulnaris proximalis) formed by the radial notch of the ulna and the articular circumference of the radius. The shape of the joint is cylindrical. Movements in the elbow joint are possible around two mutually perpendicular axes: the frontal one - flexion and extension, and the vertical one, passing through the shoulder-elbow joint - pronation and supination.

The elbow joint contains the following ligaments: annular ligament of the radius (lig. annulare radii) in the form of a ring covers the head of the humerus; radial collateral ligament (lig. collaterale radiale) comes from the lateral epicondyle and passes into the annular ligament; ulnar collateral ligament (lig. collaterale ulnare) passes from the medial epicondyle to the medial edge of the coronoid and ulnar processes of the ulna.

Forearm joints

The bones of the forearm in their proximal and distal sections are connected by a combined joint. The proximal radioulnar joint is discussed above.

Distal radioulnar joint(articulatio radioulnaris distalis) formed by the head of the ulna and the ulnar notch of the radius. An additional formation in the joint is the articular disc. The shape of the joint is cylindrical. Movements in the joint - pronation and supination - are possible around a vertical axis passing through the head of the radius and ulna. A tendinous interosseous membrane is stretched between the interosseous ridges of the radius and ulna. (membrana interossea antebrachii) with openings for the passage of blood vessels and nerves.

Between both bones of the forearm there is a continuous connection in the form of an interosseous membrane.

Joints of the hand

Wrist joint(articulatio radiocarpea) is complex (Fig. 41). The shape of the articular surfaces is elliptical. His

Rice. 41. Joints and ligaments of the hand: a - front view: 1 - distal radioulnar joint; 2 - ulnar collateral ligament of the wrist; 3 - pisiform-hook ligament; 4 - pisiform-metacarpal ligament; 5 - hook of the hamate; 6 - palmar carpometacarpal ligaments; 7 - palmar metacarpal ligaments; 8 - deep transverse metacarpal ligaments; 9 - metacarpophalangeal joint (opened); 10 - fibrous sheath of the third finger of the hand (opened); 11 - interphalangeal joints (opened); 12 - tendon of the muscle - deep flexor of the fingers; 13 - tendon of the muscle - superficial flexor of the fingers; 14 - collateral ligaments; 15 - carpometacarpal joint of the thumb (opened); 16 - capitate bone; 17 - radiate ligament of the wrist; 18 - radial collateral ligament of the wrist;

19 - palmar radiocarpal ligament;

20 - lunate bone; 21 - radius; 22 - interosseous membrane of the forearm; 23 - ulna

form the articular surface of the radius, the articular disc and the proximal row of carpal bones (scaphoid, lunate, triquetrum). An articular disc separates the distal radioulnar joint from the radiocarpal joint. Movements around the frontal axis - flexion and extension, and around the sagittal axis - abduction and adduction are possible.

Wrist joints, intercarpal joints(articulationes intercarpales) connect the bones of the wrist. These joints are strengthened by interosseous and intercarpal ligaments (ligg. interossea et intercarpea), palmar and dorsal intercarpal (ligg. intercarpea palmaria et dorsalia).

Rice. 41. Continuation: b - frontal cut of the left wrist joint and joints of the wrist bones), front view: 1 - radius bone; 2 - wrist joint; 3 - radial collateral ligament of the wrist; 4 - midcarpal joint; 5 - intercarpal joint; 6 - carpometacarpal joint; 7 - intermetacarpal joint; 8 - intercarpal ligament; 9 - collateral ulnar ligament of the wrist; 10 - articular disc;

11- distal radioulnar joint;

Pisiform joint(articulatio ossis pisiformis)- This is the joint between the pisiform bone, located in the tendon of the extensor carpi ulnaris, and the triquetrum bone.

Carpometacarpal joints(articulationes carpometacarpals) complex. They articulate the second row of carpal bones with the bases of the metacarpal bones. II-IV carpometacarpal joints belong to flat joints. They are strengthened by palmar and dorsal ligaments.

Carpometacarpal joint of the thumb(articulatio carpometacarpea pollicis) formed by the trapezium bone and the base of the first metacarpal bone; This is the saddle joint. Movements in the joint are carried out around two axes: frontal - opposition (opposition) and reverse movement (reposition) and sagittal - abduction and adduction.

Intermetacarpal joints(articulationes intermetacarpals) located between the bases of the II-V metacarpal bones.

Metacarpophalangeal joints(articulationes metacarpophalangeae) formed by the heads of the metacarpal bones and the fossae of the bases of the proximal

phalanges of fingers. The metacarpophalangeal joints of the II-V fingers have a spherical shape. The joints are strengthened by ligaments. Movements in them are possible around the frontal axis - flexion and extension, the sagittal axis - abduction and adduction; Rotational movements are also possible, and in the first metacarpophalangeal joint - only flexion and extension.

Interphalangeal joints of the hand(articulationes interphalangeae manus) formed by the heads and bases of the middle phalanges, the heads of the middle and the bases of the distal phalanges. These are block-shaped joints in shape. Ligaments run along the lateral surfaces of the joint. Movements in the joint are possible around the frontal axis - flexion and extension.

Differences in the structure and function of the joints of the upper limb

Differences in the shape of the joints are due to the functional characteristics of the upper limb. Thus, the structure of the joints of the upper limb girdle depends on individual characteristics. In people engaged in heavy physical labor, a costoclavicular joint appears between the first rib and the collarbone at the site of the ligament of the same name. In individuals with highly developed muscles, full extension of the elbow joint is impossible, which is associated with excessive development of the olecranon process and functional hypertrophy of the forearm flexors. With insufficiently developed muscles, not only full extension is possible, but also hyperextension in the joint, usually in women. Joint mobility in women is slightly greater than in men. The amplitude of movements is especially large in small joints brush and fingers.

X-ray anatomy of the joints of the upper limb

On x-rays (see Fig. 28) of the upper limb, the joints are identified as gaps between the bones due to the fact that articular cartilage transmits x-rays better than bone tissue. The capsule and ligaments, as well as the cartilage, are usually not visible.

Joints of the lower limb

Joints of the lower limb girdle

Articulations of the pelvic bones can be discontinuous or continuous. The pelvic bones have a complex ligamentous apparatus. The sacrotuberous ligament runs from the lateral edge of the sacrum and coccyx to the ischial tuberosity (lig. sacrotuberale). Sacrospinous ligament (lig. sacrospinale),

starting in the same place as the previous one, crossing with it and attaching to the ischial spine. Both ligaments transform the greater and lesser sciatic notches into foramina of the same name. (for. ischiadica majus et minus), through which muscles, blood vessels and nerves pass. The obturator foramen is closed by the fibrous obturator membrane (membrana obturatoria), excluding the superolateral edge, where there remains a small opening that continues into the obturator canal (canalis o bturatorius), through which the vessels and nerves of the same name pass.

Pubic symphysis(symphysis pubica) refers to a special type of synchondrosis and is located in the sagittal plane. Between the facing surfaces of the pubic bones, covered with hyaline cartilage, there is an interpubic disc (discus interpubicus), having a small cavity.

Sacroiliac joint(articulatio sacroiliac) formed by the ear-shaped articular surfaces of the sacrum and ilium. According to the shape of the articular surfaces, the joint is considered flat. The articular surfaces are covered with fibrous cartilage. The joint is strengthened by strong ligaments, which almost completely eliminates movement in it.

Pelvis as a whole

In education pelvis(pelvis)(Fig. 42) the pelvic bones, sacrum with coccyx, ligamentous apparatus. The pelvis is divided into big(pelvis major) And small(pelvis minor). They are separated by a border line (lipea terminalis), running from the promontory of the sacrum to the arcuate line of the iliac bones, then along the crests of the pubic bones and ending at the upper edge of the symphysis.

The small pelvis has two openings - apertures: upper (apertura pelvis superior), limited by the border line, and lower (apertura pelvis inferior).

The structure of the pelvis has pronounced gender differences: the female pelvis is wider and shorter, the male pelvis is higher and narrower. The wings of the iliac bones of the pelvis of women are more deployed, the entrance to the pelvic cavity is larger. The pelvic cavity in women resembles a cylinder, in men it resembles a funnel. Cape (promontorium) on the pelvis of men it is more pronounced and protrudes forward. The sacrum in women is wide, flat and short, in men it is narrow, high and curved. The ischial tuberosities in women are more turned to the sides, the junction of the pubic bones forms an arc, and the lower branches of the ischial and pubic bones form a right angle. In the male pelvis, the pubic branches unite to form an acute angle.

For physiological birth, size is of great importance female pelvis. Direct size of the inlet to the pelvis - true, or gynecological, conjugate(conjugata vera, sen conjugata gynecologica) is the distance from the promontory of the sacrum to the most prominent point on the posterior surface of the pubic symphysis and is equal to 11 cm. Transverse diameter(diameter transversa) the entrance to the pelvis is 12 cm. This is the distance between the most distant points of the border line. Oblique diameter(diameter obliqua)- the distance between the sacroiliac joint on one side and the crests of the pubic bones on the other. The distance from the lower edge of the symphysis to the coccyx is called the direct size of the pelvic outlet and is equal to 9 cm. During childbirth, it increases to 11-12 cm.

Joints of the free lower limb

Hip joint

Hip joint(articulatio coxae)(Fig. 43) is formed by the acetabulum of the pelvic bone and the head of the femur. According to the shape of the articular surfaces, the hip joint is a spherical joint of a limited type - a cup-shaped joint. Movements in it are less extensive and are possible around three mutually perpendicular axes: frontal - bending And extension, vertical - supination And pronation, sagittal - lead And casting In addition, circular rotation is possible. The depth of the glenoid cavity increases due to the cartilaginous acetabular labrum (labrum acetabuli), bordering the edge of the acetabulum. Above the acetabular notch

Rice. 42. Connections of the bones of the lower limb girdle:

a - front view: 1 - anterior longitudinal ligament; 2 - cape; 3 - iliopsoas ligament; 4 - anterior sacroiliac ligament; 5 - inguinal ligament; 6 - iliopectineal arch; 7 - sacrospinous ligament; 8 - fossa of the acetabulum; 9 - transverse acetabular ligament; 10 - obturator membrane; 11 - medial leg; 12 - arcuate ligament of the pubis; 13 - pubic symphysis; 14 - superior pubic ligament; 15 - obturator canal; 16 - lacunar ligament; 17 - superior anterior iliac spine;

b - rear view: 1 - superior articular process of the sacrum; 2 - iliopsoas ligament; 3 - posterior sacroiliac ligament; 4 - supraspinous ligament; 5 - posterior sacroiliac ligament; 6 - greater sciatic foramen; 7 - superficial posterior sacrococcygeal ligament; 8 - sacrospinous ligament; 9 - small sciatic foramen; 10 - sacrotuberous ligament; 11 - obturator foramen; 12 - deep posterior sacrococcygeal ligament; 13 - pubic symphysis; 14 - ischial tuberosity; 15 - ischial spine; 16 - superior posterior iliac spine

Rice. 43. Hip joint, right:

a - the cavity of the hip joint was opened by a frontal cut: 1 - pelvic bone; 2 - articular cartilage; 3 - joint cavity; 4 - ligament of the femoral head; 5 - acetabular lip; 6 - transverse acetabular ligament; 7 - ligament - circular zone; 8 - greater trochanter; 9 - head of the femur; b - joint ligaments, front view: 1 - lower anterior iliac spine; 2 - iliofemoral ligament; 3 - articular capsule; 4 - pubofemoral ligament; 5 - obturator canal; 6 - obturator membrane; 7 - lesser trochanter; 8 - femur; 9 - large skewer

the strong transverse ligament of the acetabulum is thrown over (lig. transversum acetabuli). Inside the joint there is an intraarticular ligament of the femoral head (lig. capitis femoris).

The capsule of the hip joint starts from the edges of the acetabulum and is attached on the epiphysis of the femur in front to the intertrochanteric line in the back, not reaching the intertrochanteric crest. Fibrous fibers of the capsule form a circular zone around the femoral neck (zona orbicularis). The joint capsule is strengthened by extra-articular ligaments: the iliofemoral ligament (lig. iliofemorale) starts from the inferior anterior iliac spine and attaches to the intertrochanteric line; ischiofemoral ligament (lig. ischiofemoral) goes from the body and tubercle of the ischium to the capsule; pubofemoral ligament (lig. pubofemorale) runs from the superior ramus of the pubis to the lesser trochanter.

Knee-joint

Knee-joint(articulatio genus)(Fig. 44) has the largest articular surfaces; This is a complex joint. The condyles of the femur and tibia and the patella take part in its formation. According to the shape of the articulating surfaces, the knee joint is condylar (articulatio bicondylaris). Movements occur around two axes: frontal - bending And extension and vertical (with a bent knee) - pronation And supination. Inside the joint cavity are the medial and lateral menisci (meniscus medialis et lateralis), consisting of fibrous cartilage. Both menisci are connected anteriorly by the transverse knee ligament (lig. transversum genus). The anterior and posterior cruciate ligaments lie within the fibrous capsule of the joint. (lig. cruciatum anterius et posterius). The anterior one starts from the lateral condyle, goes down and inward, and attaches to the anterior intercondylar field. The posterior cruciate ligament extends outward from the medial condyle of the femur and attaches to the posterior condylar field of the tibia. The joint capsule is strengthened by ligaments: fibular collateral ligament (lig. collaterale fibulare) goes from the lateral condyle of the femur to the head of the fibula; tibial collateral ligament (lig. collaterale tibiale) passes from the internal condyle of the femur to the condyle of the tibia; oblique popliteal ligament (lig. popliteum obliquum) comes from the internal tibial condyle

Rice. 44. Knee joint: a - front view: 1 and 4 - lateral and medial suspensory ligaments of the patella; 2 - quadriceps tendon; 3 - patella;

5- patellar ligament;

b - after opening the joint cavity: 1 - pterygoid fold; 2 - lateral meniscus; 3 - fibrous membrane of the joint capsule; 4 - synovial membrane; 5 - suprapatellar bursa; 6 - posterior and 7 - anterior cruciate ligaments; 8 - infrapatellar synovial fold; 9 - medial meniscus; 10 - patella;

c - sagittal section of the joint in the sagittal plane: 1 - meniscus; 2 - synovial bursa under the posterior thigh muscles; 3 - suprapatellar bursa; 4 - prepatellar bursa (subcutaneous); 5 - patella; 6 - infrapatellar fat body (anterior continuation of the pterygoid folds); 7 - patellar ligament; 8 - subpatellar subcutaneous bursa; 9 - deep subpatellar bursa

bones superior and lateral to the joint capsule; arcuate popliteal ligament (lig. popliteum a rcuatum) starts from the lateral condyle of the femur and is part of the oblique ligament. Patellar ligament (lig.patellae) comes from the top of the patella and attaches to the tibial tuberosity. On the sides of this ligament are the medial and lateral suspensory ligaments of the patella. (retinaculi patellae mediate et laterale).

The synovial membrane of the knee joint covers the cruciate ligaments, forming folds with layers of fatty tissue. The most strongly developed pterygoid folds (plicae alares). The synovial membrane contains villi.

The membrane itself forms 9 inversions: an unpaired anterosuperior median and 8 paired ones - 4 each in front and behind: anterosuperior and anterioinferior, posterosuperior and posteroinferior (medial and lateral). In the knee joint there are a number of mucous bursae (Fig. 45): subcutaneous prepatellar (b. subcutaneaprepatellaris), subfascial prepatellar (b. subfascialis prepatellaris), subtendinous prepatellar (b. subtendinea prepatellaris), deep under-

Rice. 45. Synovial (mucous) bursae of the knee joint filled with dye (photo from the specimen): 1 - fragments of the joint capsule; 2 - suprapatellar bursa; 3 - quadriceps tendon; 4 - patella; 5 - patellar ligament; 6 - joint cavity surrounded by a synovial membrane; 7 - medial meniscus; 8 - tibial collateral ligament; 9 - tendon of one of the posterior thigh muscles; 10 and 11 - bags under the posterior muscles of the thigh and lower leg

patellar (b. infrapatellaris profunda), communicating with the joint cavity. On the back surface of the joint, the bags are located under the muscle tendons.

Shin joints

Both bones of the leg in the proximal region form an articulation - tibiofibular joint(articulatio tibiofibularis), having a flat shape.

Foot joints

Ankle joint(articulatio talocruralis) formed by the articular surfaces of the distal ends of the tibia and the block of the talus (Fig. 46). The joint is block-shaped in shape, movements in it are possible around the frontal axis - flexion and extension. The joint capsule is attached along the edge of the articular surfaces of the bones. The capsule is strengthened on the sides by ligaments: medial (deltoid) (lig. collaterale mediale; lig. deltoideum), anterior and posterior talofibular (ligg. talofibulares anterius et posterius) and calcaneofibular (lig. calcaneofibulare).

Intertarsal joints(articulationes intertarsae) formed between adjacent tarsal bones. These include talocaleonavicular joint(articulatio talocalcaneonavicularis),transverse tarsal joint(articulatio tarsi transversa),calcaneocuboid joint(articulatio calcaneocuboidea),sphenodvicular joint(articulatio cuneonavicularis).

Tarsometatarsal joints(articulationes tarsometatarsales) formed by the bones of the tarsus and metatarsus. They are flat and include the following joints: between the medial cuneiform and first metatarsal bones, between the intermediate and lateral cuneiform bones and the II-III metatarsal bones, between the cuboid bone and the IV-V metatarsal bones. The joints are strengthened by strong plantar and dorsal ligaments.

Intermetatarsal joints(articulationes intermetatarsales) located between the lateral surfaces of the four metatarsal bones facing each other; According to the shape of the articulating surfaces, these are flat joints.

Metatarsophalangeal joints(articulationes metatarsophalangeae) formed by the heads of the metatarsal bones and the bases of the I-V phalanges. Based on the shape of the articular surfaces, these joints are classified as spherical, but mobility in them is limited.

Rice. 46. Foot joints:

a - top view of the foot: 1 - interphalangeal joints; 2 - metatarsophalangeal joints; 3 - wedge-shaped bones of the tarsus; 4 - cuboid bone; 5 - calcaneus;

6- talus with trochlea - the articular surface of the ankle joint;

7- transverse tarsal joint; 8 - scaphoid bone; 9 - tarsometatarsal joints;

b - view of the foot from the medial side: 1 - dorsal tarsometatarsal ligaments; 2 - ligaments between the bones of the tarsus (sphenoid-scaphoid); 3 - collateral medial ligament (deltoid); 4 - long plantar ligament; 5 - calcaneonavicular ligament

Interphalangeal joints of the foot(articulationes interphalangeae pedis) located between the individual phalanges of the fingers and have a block-like shape.

Movements in the joint occur around the frontal axis - flexion and extension.

Differences in the structure and function of the joints of the lower limb

The joints of the lower limb vary significantly in the size and shape of the articular surfaces, as well as in the strength of the ligamentous apparatus. In adults, the ankle joint has greater mobility towards the sole, and in children - towards the rear. The child's foot is more supinated. When a child begins to walk, he does not rest on the entire foot, but on its outer edge. The shape of the foot may depend on the profession. People engaged in heavy physical labor have wide and short feet; for people not engaged in hard work, it is narrow and long. The foot has a vaulted structure, performing supporting and spring functions. There are 2 foot shapes: arched and flat. The arched structure of the foot provides a springing effect when walking and is supported by ligaments of the sole, in particular the long plantar ligament (see Fig. 46, b). The flat shape causes the development of a pathological condition called flat feet.

X-ray anatomy of the joints of the bones of the lower limb

Radiographs of the joints of the lower limb reveal the bony articular surfaces delimited by the joint space. The thickness and transparency of the latter, depending on the condition of the cartilage, may change with age.

Questions for self-control

1.With what joints does the clavicle connect to the bones of the upper limb? Describe these joints.

2.What movements are possible in the shoulder joint?

3.How is the elbow joint structured? Give a description of each of the joints that make it up.

4.How is the wrist joint structured? What movements are possible in this joint?

5.What is the carpometacarpal joint of the thumb formed by? What movements occur in this joint?

6.What types of joints are there in the joints of the pelvic bones? Describe these compounds.

7.List the dimensions of the female pelvis. What is the significance of these sizes for women?

8.List the extracapsular and intracapsular ligaments of the knee joint. How do these ligaments affect joint movement?

9.How is the ankle joint built? What movements are possible in this joint? Name the ligaments that strengthen it.

10. List the intertarsal joints.

SKULL CONNECTIONS

The bones of the skull are articulated in different ways: the bones that form the vault are articulated through fibrous joints - sutures, and the base of the skull is articulated through cartilaginous joints, the synchondrosis of the skull.

Lower jaw attaches to the temporal bones through the temporomandibular joints.

Skull as a whole

As mentioned above, the skull is divided into cerebral and facial. In the first, the arch and the base are distinguished. On the arch, on the side, on each side there is temporal fossa, serving as a place of fixation of the temporal muscle, and in front of the eminence - frontal tubercle

At the base of the skull, which looks like a thick plate with complex relief, there are outer base of skull(basis cranii externa), facing down towards the neck, and inner base of skull(basis cranii interna), which, together with the cranial vault, forms cranial cavity(cavitas cranii)- seat of the brain.

Both the external and internal bases of the skull are penetrated by a large number of holes, channels, and crevices in which vessels and nerves are located that connect the brain with the body as a whole.

At the border of the base of the skull with the facial skull there are pits that are important in practical terms: infratemporal, located immediately below the temporal fossa of the vault, and pterygopalatine- continuation of the infratemporal deep, in the medial direction.

The bones of the facial skull, together with some bones of the base of the skull, form eye socket(orbita) And bony nasal cavity(cavitas nasalis ossea)- the location, respectively, of the eye and associated structures and the olfactory organ. Bones of the facial skull: upper and lower jaws, palatine bones are involved in the formation oral cavity(cavitas oris).

Chest joints

Synovial joints of the skull

Joints of the upper limb

Joints of the lower limb

Joints or synovial joints (articulations synoviales) are presented in the form of discontinuous connections of bones. They are among the most common types of articulation of human bones and are necessary to create all the necessary conditions for high mobility of the body. A simple joint (articulation simplex) is such if two bones were involved in its formation. A complex joint (articulation composita) is such if it is formed from three or more bones.

Each joint consists of mandatory structural elements and auxiliary formations. Basic elements allow joints to relate specifically to a number of joints. These include articular cartilage and surfaces, joint capsules and cavities. Accessory structures allow joints to have certain functional and structural differences.

Articular cartilage (cartilage articulares) consists of hyaline cartilage, but sometimes it can be constructed of fibrocartilage. It is necessary to cover bones that articulate and face each other. One surface of such a joint is fused with the surface of the bone, and the second part is freely located in the joint.

The articular capsule (capsula articularis) is presented in the form of a closed case and is necessary for the articulation of bones facing each other. It consists of fibrous connective tissue and has two layers - two membranes. The outer membrane also consists of fibrous tissue and is intended to perform a mechanical role. Inside, the first membrane passes into the second - the synovial membrane. Here it forms synovial folds (stratum synoviale), secretes synovium or synovial fluid into the joint, which nourishes the articular cartilage itself, as well as the surfaces of the bones, plays the role of a shock absorber and significantly changes the mobility of the joint. All this is ensured by the viscosity of the synovial fluid (synovia). Moreover, it is precisely due to the synovial folds and villi (vilii synoviales), which face the articular cavity, that the working surface of the membrane increases significantly.

The articular cavity (cavitas articularis) is a narrow closed gap, which is limited by articulating bones and a fluid-filled capsule. This cavity does not have the ability to communicate with the atmosphere.

The auxiliary parts and formations of the joints are quite diverse. These include ligaments, articular discs, menisci, and labrums. Each of the above entities should be described in more detail.

Joint ligaments (ligamenta) are presented in the form of bundles of dense connective fibrous tissue. They are necessary to strengthen the joint capsule and limit the guiding movements of bones in the joints. There are capsular, extracapsular ligaments and intracapsular ligaments. The first type of ligaments (capsularia) is located in the thickness of the capsule itself, namely between the fibrous and synovial membrane. Extracapsular ligaments are located on the outside of the composite capsule. They are harmoniously woven into the outer part of the fibrous layer. And the intracapsular ligaments are located precisely inside the joint, but are separated from its cavity by the synovial membrane. In general, almost all joints in our body have such ligaments.

Articular discs (disci articulares) are layers of fibrous or hyaline cartilage that are wedged between the articular surfaces. They are attached to the joint capsule and divide it into two floors. Thus, the discs increase the conformity of surfaces, volume and variety of movements. Therefore, the articular discs play the role of shock absorbers and significantly reduce shocks and shocks that occur during movement.

Articular menisci (menisci articulares) are presented in the form of crescent-shaped formations of fibrous cartilage. They are necessary to absorb a variety of movements. For example, in each knee joint there are two menisci, which are attached to the capsule located to the tibia, and the other sharper end is freely located in the joint cavity.

The labrum (labra articularia) is a dense formation of fibrous connective tissue. It is located at the edge of the glenoid cavity and is necessary to deepen it and increase the conformity of the surfaces. The labrum goes directly into the cavity of the joint itself.

Joints can also vary in shape and degree of mobility. According to their shape, we can distinguish spherical or cup-shaped joints, flat, ellipsoidal and saddle-shaped, ovoid and cylindrical, as well as trochlear and condylar joints.

It is important to note that the nature of possible movements in the joint depends on the shape. For example, spherical and flat joints have a generatrix in the form of a segment of a circle, so they allow movement around three axes perpendicular to each other (frontal, sagittal and vertical). Therefore, the shoulder joint, which has a spherical shape (articulations spheroideae), allows flexion and extension relative to the frontal axis, as well as combining this action with the sagittal axis or abducting and adducting the action relative to the frontal plane. Also around the frontal axis, rotation can be carried out relative to the horizontal axis with turns inward or outward. In flat joints, movements are quite limited, because the flat surface looks like a small segment of a circle with a large diameter. Ball-shaped joints allow you to perform actions with a fairly large amplitude of rotation, as well as with the addition of leading actions in a circle. In the latter case, the center of rotation will be the ball-and-socket joint, and the moving bone will describe the so-called cone surface.

Biaxial joints are those joints that can only move around two axes at the same time. These include the wrist joints in the form of ellipsoid joints, as well as the carpometacarpal joint of the first finger of the hand in the form of a saddle joint.

Uniaxial joints include cylindrical (articulations trochoideae) and block-shaped (ginglymus) types of joints. In the first case, the movement occurs parallel to the axis of rotation. For example, the atlantoaxial median joint with a vertical axis of rotation, which passes through the tooth of the second cervical vertebra and the proximal radioulnar joint. In the second case, the generatrix of the joint is knee or beveled relative to the axis of rotation. An example of this type of joint is the interphalangeal or ulnohumeral joint.

Condylar joints (articulations bicondylares) are slightly modified elliptical joints (articulations ellipsoideae).

In general, there are cases when movements can only be realized with simultaneous movement of adjacent joints. They are anatomically isolated, but share a common function. This combination should be taken into account when studying the structure of the human skeleton and when analyzing the structure of movements.

Joint- the place where human bones are connected. Joints are essential for the mobility of bone joints and they also provide mechanical support.

Joints are formed by the articular surfaces of the epiphyses of bones, which are covered with hyaline cartilage, an articular cavity that contains a large number of synovial fluid, as well as the joint capsule and synovial membrane. In addition, the knee joint contains menisci, which are cartilage formations that have a shock-absorbing effect.

The articular surfaces have a covering consisting of hyaline or fibrous articular cartilage, the thickness of which ranges from 0.2 to 0.5 mm. Smoothness is achieved through constant friction, with the cartilage acting as a shock absorber.

The joint capsule (articular capsule) is covered with an outer fibrous membrane and an inner synovial membrane and has a connection with the connecting bones at the edges of the articular surfaces, while it tightly closes the articular cavity, thereby protecting it from external influences. The outer layer of the joint capsule is much stronger than the inner one, as it consists of dense fibrous connective tissue, the fibers of which are located longitudinally. In some cases, the joint capsule is connected by ligaments. The inner layer of the joint capsule consists of a synovial membrane, the villi of which produce synovial fluid, which provides hydration to the joint, reduces friction and nourishes the joint. This part of the joint has the most nerves.

Joints are surrounded by periarticular tissues, which include muscles, ligaments, tendons, blood vessels and nerves.

Joint ligaments They are made of dense tissue, they are necessary to control the range of motion of the joints and are located on the outside of the joint capsule, with the exception of the knee and hip joints, where the connections are also located inside, providing additional strength.

Blood supply to joints occurs along the articular arterial network, which includes from 3 to 8 arteries. The innervation of the joints is provided by the spinal and sympathetic nerves. All elements of the joint are innervated, with the exception of hyaline cartilage.

Joints are classified functionally and structurally.

The structural classification of joints divides joints according to the type of bone connections, and the functional classification of joints divides joints according to the methods of motor functions.

The structural classification of joints divides them according to the type of connective tissue.

There are three types of joints according to structural classification:

• Fibrous joints- have dense regular connective tissue rich in collagen fibers.
• Cartilaginous joints- connections are formed by cartilage tissue.
• Synovial joints- the bones in this type of joint have cavities and are connected by dense irregular connective tissue, forming an articular capsule, which usually has additional ligaments.

The functional classification of joints divides joints into the following types:

• Synarthrotic joints- joints that are almost completely devoid of mobility. Most synarthrotic joints are fibrous joints. For example, they connect the bones of the skull.
• Amphiarthrotic joints- joints that provide moderate mobility of the skeleton. Such joints include, for example, intervertebral discs. These joints are cartilaginous joints.


• Diarthrotic joints- joints that allow free movement of joints. These joints include the shoulder joint, hip joint, elbow joint and others. These joints have a synovial joint. In this case, diarthrosis joints are divided into six subgroups depending on the type of movement: ball-and-socket joints, nut-shaped (cup-shaped) joints, block-shaped (hinged) joints, rotary joints, condylar joints, joints connecting by mutual reception.

Joints are also divided according to the number of axes of motion: monoaxial joints, biaxial joints And multi-axis joints. Joints are also divided into one, two and three degrees of freedom. Joints are also divided according to the type of articular surfaces: flat, convex and concave.

There is a division of joints according to their anatomical structure or biomechanical properties. In this case, joints are divided into simple and complex, it all depends on the number of bones that participate in the structure of the joint.

• Simple joint- has two movable surfaces. Simple joints include the shoulder joint and the hip joint.
• Complex joint- a joint that has three or more movable surfaces. This joint includes the wrist joint.
• Compound joint- this joint has two or more movable surfaces, as well as an articular disc or meniscus. Such a joint may include the knee joint.

Anatomically, joints are divided into the following groups:

• Hand joints
• Wrist joints
• Elbow joints
• Axillary joints
• Sternoclavicular joints
• Vertebral joints
• Temporomandibular joints
• Sacroiliac joints
• Hip joints
• Knee joints
• Foot joints

Joint diseases

Joint diseases are called arthropathy. When a joint disorder is accompanied by inflammation of one or more joints it is called arthritis. Moreover, when in inflammatory process several joints become involved, the disease is called polyarthritis, and when one joint becomes inflamed it’s called monoarthritis.

The main cause of disability in people over 55 years of age is arthritis. Arthritis comes in several forms, each caused by different causes. The most common form of arthritis is osteoarthritis or degenerative joint disease that occurs as a result of joint injury, infection, or old age. Also, according to research, it has become known that improper anatomical development is also a cause of early development of osteoarthritis.

Other forms of arthritis such as rheumatoid arthritis t and psoriatic arthritis are the result of autoimmune diseases.

Septic arthritis caused by a joint infection.

Gouty arthritis is caused by the deposition of uric acid crystals in the joint, which causes subsequent inflammation of the joint.

Pseudogout characterized by the formation and deposition of diamond-shaped crystals of calcium pyrophosphate in the joint. This form of arthritis is less common.

There is also such a pathology as hypermobility joints. This disorder is observed most often in young women and is characterized by increased joint mobility as a result of sprained articular ligaments. In this case, the movement of the joint can fluctuate beyond its anatomical limits. This disorder is associated with a structural change in collagen. It loses strength and becomes more elastic, which leads to partial deformation. This disorder is believed to be hereditary.

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Types of human joints

They can be classified by functionality:

A joint that does not allow movement is known as synarthrosis. Skull sutures and gomphos (the connection of the teeth to the skull) are examples of synarthrosis. The connections between bones are called syndesmoses, between cartilages - synchordroses, and bone tissue - synthososes. Synarthrosis is formed using connective tissue.

Amphyarthrosis allows slight movement of the connected bones. Examples of amphiarthrosis are intervertebral discs and the pubic symphysis.

The third functional class is free-moving diarthrosis. They have the highest range of motion. Examples: elbows, knees, shoulders and wrists. Almost always these are synovial joints.

The joints of the human skeleton can also be classified according to their structure (according to the material from which they are composed):

Fibrous joints are made of tough collagen fibers. These include the sutures of the skull and the joint that connects the ulna and radius bones of the forearm together.

Human cartilaginous joints consist of a group of cartilages that connect the bones together. Examples of such joints would be the joints between the ribs and costal cartilage, and between the intervertebral discs.

The most common type, a synovial joint, is a fluid-filled space between the ends of the connected bones. It is surrounded by a capsule of tough, dense connective tissue covered with a synovial membrane. The synovial membrane that makes up the capsule produces an oily synovial fluid whose function is to lubricate the joint, reducing friction and wear.

There are several classes of synovial joints, such as ellipsoidal, trochlear, saddle and socket joints.

Ellipsoidal joints connect smooth bones together and allow them to slide past each other in any direction.

Locking joints, such as the human elbow and knee, limit movement in only one direction so that the angle between the bones can be increased or decreased. Restricted movement in the trochlear joints provides more strength and strength to the bones, muscles and ligaments.

Saddle joints, such as those between the first metacarpal bone and the trapezium bone, allow the bones to rotate 360 ​​degrees.

The human shoulder and hip joint are the only ball-and-socket joints in the body. They have the freest range of motion and are the only ones that can turn on their own axis. However, the disadvantage of ball and socket joints is that their free range of motion makes them more susceptible to dislocation than less mobile human joints. Fractures are more common in these places.

Some synovial types of human joints need to be considered separately.

Trochlear joint

Trochlear joints are a class of synovial joints. These are the human ankles, knee and elbow joints. Typically, a trochlear joint is a ligament of two or more bones where they can only move in one axis to bend or straighten.

The simplest trochlear joints in the body are the interphalangeal joints, located between the phalanges of the fingers and toes.

Because they bear little body weight and mechanical force, they are composed of simple synovial material with tiny additional ligaments for reinforcement. Each bone is covered with a thin layer of smooth hyaline cartilage, designed to reduce friction at the joints. The bones are also surrounded by a capsule of tough fibrous connective tissue covered by a synovial membrane.

The structure of a person's joint is always different. For example, the elbow joint is more complex, formed between the humerus, radius and ulna bones of the forearm. The elbow is subjected to more heavy loads than the joints of the fingers and toes, so it contains several strong accessory ligaments and unique bone structures that strengthen its structure.

The ulnar and radial accessory ligaments help support the ulna and radius bones and strengthen the joints. The human legs also consist of several large block-like joints.

Similar to the elbow, the ankle joint is located between the tibia and fibula in the tibia and the talus in the leg. The branches of the tibia fibula form a bony socket around the talus to limit the movement of the leg along one axis. Four additional ligaments, including the deltoid, hold the bones together and strengthen the joint to support the body's weight.

Located between the thigh of the leg and the tibia and fibula of the leg, the knee joint is the largest and most complex trochlear joint in the human body.

The elbow joint and ankle joint, which have similar anatomy, are most often susceptible to osteoarthritis.

Ellipsoidal joint

The ellipsoid joint, also known as the planus joint, is the most common form of synovial joint. They are formed near bones that have a smooth or almost smooth surface. These joints allow the bones to slide in any direction - up and down, left and right, diagonally.

Due to their structure, ellipsoidal joints are flexible, while their movement is limited (to prevent injury). Elliptical joints are covered by a synoval membrane, which produces fluid that lubricates the joint.

Most ellipsoidal joints are located in the appendicular skeleton between the carpal bones of the wrist, between the carpal joints and metacarpal bones of the hand, and between the bones of the ankle.

Another group of ellipsoidal joints is located between the faces of twenty-six vertebrae in the intervertebral joints. These joints allow us to flex, extend, and rotate our torso while maintaining the strength of the spine, which supports the body's weight and protects the spinal cord.

Condylar joints

There is a separate type of ellipsoidal joint - the condylar joint. It can be considered a transitional form from a block-shaped joint to an ellipsoidal one. The condylar joint differs from the trochlear joint by a large difference in the shape and size of the articulating surfaces, as a result of which movement around two axes is possible. The condylar joint differs from the ellipsoidal joint only in the number of articular heads.

Saddle joint

The saddle joint is a type of synovial joint where one of the bones is formed like a saddle and the other bone rests on it, like a rider on a horse.

Saddle joints are more flexible than ball and saddle joints.

The best example of a saddle joint in the body is the carpometacarpal joint of the thumb, which is formed between the trapezius bone and the first metacarpal bone. In this example, the trapezium forms a rounded saddle on which the first metacarpal bone sits. The carpometacarpal joint allows a person's thumb to easily cooperate with the other four fingers of the hand. The thumb is, of course, extremely important to us, as it is what allows our hand to firmly grasp objects and use many tools.

Ball and socket joint

Ball and socket joints are a special class of synovial joints that have the highest freedom of movement in the body due to their unique structure. The human hip joint and shoulder joint are the only ball-and-socket joints in the human body.

The two main components of a ball and socket joint are the ball-and-socket bone and the cup-shaped bone. Consider the shoulder joint. Human anatomy is designed in such a way that the spherical head of the humerus (upper arm bone) fits into the glenoid cavity of the scapula. The glenoid cavity is a small, shallow notch that gives the shoulder joint the greatest range of motion in the human body. It is surrounded by a ring of hyaline cartilage, which acts as a flexible reinforcement to the bone, while muscles called the rotator cuff hold the humerus inside the socket.

The hip joint is slightly less mobile than the shoulder, but is a stronger and more stable joint. Additional stability of the hip joint is needed to support a person's body weight on the legs while performing activities such as walking, running, etc.

At the hip joint, the rounded, almost spherical head of the femur (femur) fits snugly into the acetabulum, a deep depression in the pelvic bone. A fairly large number of tough ligaments and strong muscles hold the head of the femur in place and resist the most severe stresses in the body. The acetabulum also prevents hip dislocation by limiting the movement of the bone within it.

Based on all of the above, you can create a small table. We will not include the structure of the human joint. So, the first column of the table indicates the type of joint, the second and third - examples and their location, respectively.

Human joints: table

Joint type	Examples of joints	Where are they located?
Block-shaped	Knee, elbow, ankle joint. The anatomy of some of them is shown below.	Knee - between the femur, tibia and patella; ulna - between the humerus, ulna and radius; ankle - between the lower leg and foot.
Ellipsoidal	Intervertebral joints; joints between the phalanges of the fingers.	Between the edges of the vertebrae; between the phalanges of the toes and hands.
Globular	Hip and shoulder joint. Human anatomy pays special attention to this type of joint.	Between the femur and pelvic bone; between the humerus and scapula.
Saddle	Carpometacarpal.	Between the trapezium bone and the first metacarpal bone.

To make it clearer what human joints are, we will describe some of them in more detail.

Elbow joint

Human elbow joints, the anatomy of which has already been mentioned, require special attention.

The elbow joint is one of the most complex joints in the human body. It is formed between the distal end of the humerus (more precisely, its articular surfaces - the trochlea and condyle), the radial and trochlear notches of the ulna, as well as the head of the radius and its articular circumference. It consists of three joints at once: the humeroradial, humeroulnar and proximal radioulnar.

The glenohumeral joint is located between the trochlear notch of the ulna and the trochlea (articular surface) of the humerus. This joint is a trochlear joint and is uniaxial.

The humeroradial joint is formed between the condyle of the humerus and the head of the humerus. Movements in the joint occur around two axes.

The promaximal radioulnar connects the radial notch of the ulna and the articular circumference of the head of the radius. It is also single-axis.

There is no lateral movement in the elbow joint. In general, it is considered a trochlear joint with a helical sliding pattern.

The largest joints in the upper body are the elbow joints. Human legs also consist of joints that simply cannot be ignored.

Hip joint

This joint is located between the acetabulum on the pelvic bone and the femur (its head).

This head is covered with hyaline cartilage almost throughout its entire length, except for the fossa. The acetabulum is also covered with cartilage, but only near the semilunar surface; the rest of it is covered with a synoval membrane.

The hip joint includes the following ligaments: the ischiofemoral, iliofemoral, pubofemoral, orbicularis, and the ligament of the femoral head.

The iliofemoral ligament originates at the inferior anterior ilium and ends at the intertrochanteric line. This ligament is involved in maintaining the body in an upright position.

The next ligament, the ischiofemoral ligament, begins at the ischium and is woven into the capsule of the hip joint itself.

A little higher, at the top of the pubic bone, the pubofemoral ligament begins, which goes down to the capsule of the hip joint.

Inside the joint itself is a ligament of the head of the femur. It begins at the transverse ligament of the acetabulum and ends at the fossa of the femoral head.

The circular zone is made in the form of a loop: it is attached to the lower anterior ilium and surrounds the neck of the femur.

The hip and shoulder joints are the only ball-and-socket joints in the human body.

Knee-joint

This joint is formed by three bones: the patella, the distal end of the femur and the proximal end of the tibia.

The knee joint capsule is attached to the edges of the tibia, femur and patella. It is attached to the femur under the epicondyles. On the tibia it is fixed along the edge of the articular surface, and the capsule is attached to the patella in such a way that its entire anterior surface is outside the joint.

The ligaments of this joint can be divided into two groups: extracapsular and intracapsular. There are also two lateral ligaments in the joint - the tibial and fibular collateral ligaments.

Ankle joint

It is formed by the articular surface of the talus and the articular surfaces of the distal ends of the fibula and tibia.

The articular capsule is attached to the edge of the articular cartilage almost along its entire length and departs from it only on the anterior surface of the talus. On the lateral surfaces of the joint there are its ligaments.

The deltoid, or medial ligament, consists of several parts:

- posterior tibiotalar, located between the posterior edge of the medial malleolus and the posterior medial parts of the talus;

- anterior tibiotalus, located between the anterior edge of the medial malleolus and the posteromedial surface of the talus;

- tibiocalcaneal part, extends from the medial malleolus to the support of the talus;

- tibial-scaphoid part, originates from the medial malleolus and ends at the dorsum of the scaphoid bone.

The next ligament, the calcaneofibular ligament, extends from the outer surface of the lateral malleolus to the lateral surface of the neck of the talus.

Not far from the previous one is the anterior talofibular ligament - between the anterior edge of the lateral malleolus and the lateral surface of the neck of the talus.

And the last, posterior talofibular ligament originates at the posterior edge of the lateral malleolus and ends at the lateral tubercle of the process of the talus.

In general, the ankle joint is an example of a trochlear joint with a helical motion.

So, now we have an exact idea of ​​what human joints are. Joint anatomy is more complex than it seems, as you can see for yourself.

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Shoulder joint

It is the most mobile in humans and is formed by the head of the humerus and the articular cavity of the scapula.

The articular surface of the scapula is surrounded by a ring of fibrocartilage - the so-called articular lip. The tendon of the long head of the biceps brachii muscle passes through the joint cavity. The shoulder joint is strengthened by the powerful coracohumeral ligament and surrounding muscles - deltoid, subscapularis, supra- and infraspinatus, teres major and minor. The pectoralis major and latissimus dorsi muscles also take part in shoulder movements.

The synovial membrane of the thin joint capsule forms 2 extra-articular inversions - the tendons of the biceps brachii and subscapularis. The anterior and posterior arteries that envelop the humerus and the thoracoacromial artery take part in the blood supply to this joint; the venous outflow is carried out into the axillary vein. The outflow of lymph occurs in the lymph nodes of the axillary region. The shoulder joint is innervated by branches of the axillary nerve.

The shoulder joint is capable of movement around 3 axes. Flexion is limited by the acromion and coracoid processes of the scapula, as well as the coracobrachial ligament, extension by the acromion, coracobrachial ligament and joint capsule. Abduction in the joint is possible up to 90°, and with the participation of the upper limb belt (when the sternoclavicular joint is included) - up to 180°. Abduction stops when the greater tuberosity of the humerus rests on the coracoacromial ligament. The spherical shape of the articular surface allows a person to raise his arm, move it back, and rotate the shoulder along with the forearm and hand in and out. This variety of hand movements was a decisive step in the process of human evolution. The shoulder girdle and shoulder joint in most cases function as a single functional formation.

Hip joint

It is the most powerful and heavily loaded joint in the human body and is formed by the acetabulum of the pelvic bone and the head of the femur. The hip joint is strengthened by the intraarticular ligament of the femoral head, as well as the transverse ligament acetabulum, which surrounds the neck of the femur. From the outside, the powerful iliofemoral, pubofemoral and ischiofemoral ligaments are woven into the capsule.

The blood supply to this joint is through the circumflex femoral arteries, branches of the obturator and (variably) branches of the superior perforating, gluteal and internal pudendal arteries. The outflow of blood occurs through the veins surrounding the femur into the femoral vein and through the obturator veins into the iliac vein. Lymphatic drainage occurs in the lymph nodes located around the external and internal iliac vessels. The hip joint is innervated by the femoral, obturator, sciatic, superior and inferior gluteal and pudendal nerves.
The hip joint is a type of ball-and-socket joint. It allows movements around the frontal axis (flexion and extension), around the sagittal axis (abduction and adduction) and around the vertical axis (external and internal rotation).

This joint experiences a lot of stress, so it is not surprising that its lesions occupy first place in the general pathology of the articular apparatus.

Knee-joint

One of the largest and most complex human joints. It is formed by 3 bones: the femur, tibia and fibula. Stability of the knee joint is provided by intra- and extra-articular ligaments. The extra-articular ligaments of the joint are the fibular and tibial collateral ligaments, the oblique and arcuate popliteal ligaments, the patellar ligament, and the medial and lateral suspensory ligaments of the patella. The intra-articular ligaments include the anterior and posterior cruciate ligaments.

The joint has many auxiliary elements, such as menisci, intra-articular ligaments, synovial folds, and bursae. Each knee joint has 2 menisci - the outer and the inner. The menisci look like crescents and play a shock-absorbing role. The auxiliary elements of this joint include synovial folds, which are formed by the synovial membrane of the capsule. The knee joint also has several synovial bursae, some of which communicate with the joint cavity.

Everyone had to admire the performances of artistic gymnasts and circus performers. People who are able to climb into small boxes and bend unnaturally are said to have gutta-percha joints. Of course, this is not true. The authors of The Oxford Handbook of Body Organs assure readers that “their joints are phenomenally flexible”—medically known as joint hypermobility syndrome.

The shape of the joint is a condylar joint. It allows movements around 2 axes: frontal and vertical (with a bent position in the joint). Flexion and extension occur around the frontal axis, and rotation occurs around the vertical axis.

The knee joint is very important for human movement. With each step, by bending, it allows the foot to step forward without hitting the ground. Otherwise, the leg would be carried forward by raising the hip.

According to the World Health Organization, every 7th person on the planet suffers from joint pain. Between the ages of 40 and 70 years, joint diseases are observed in 50% of people and in 90% of people over 70 years of age.
Based on materials from www.rusmedserver.ru, meddoc.com.ua

See also:

7 Early Signs of Arthritis

8 Ways to Destroy Your Knees

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General subtleties

In general, the joint is formed by two articulations: the first, the main one, is the femorotibial articulation, the second is formed by the femur and the patella. The joint is complex; it is condylar in type. The joint moves in three mutually perpendicular planes, the first, which is also the most important, is sagittal, in which flexion and extension occur, which is carried out in the range from 140 to 145 degrees.

Abduction and adduction occur in the frontal plane; it is insignificant, amounting to only 5 degrees. IN horizontal plane Rotation occurs internally, externally, and slight movements are possible in a bent position. From a normal or neutral, bent position, rotation is possible no more than 15-20 degrees.
Additionally, there are two more types of movements, which are represented by sliding, rolling of the articular surfaces of the condyles of the tibia in relation to the femur, occurring in front, back, and vice versa.

Biomechanics

Joint anatomy is impossible without understanding biomechanics; treatment is based on this. It is complex, its essence lies in simultaneous movement in several planes. If a person tries to straighten the leg from 90 to 180 degrees, then due to the ligaments there is a rotation, displacement in front or to the other side of any part of the tibial plateau.

The structure is such that the condyles of both bones are not ideal in relation to each other, so the range of movements increases significantly. Stabilization occurs due to the presence of many ligaments, complemented by adjacent muscles.
There are menisci inside the cavity; strengthening occurs due to the capsular-ligamentous apparatus, which is covered on top by the muscle-tendon complex.

Soft tissue structures

This is a complex of soft tissues that, performing a specific function, provide range of motion. These include a large number of formations that have their own structure. In general, children's and adult joints do not differ in their structure.

Menisci

These formations consist of connective tissue cartilage; roughly speaking, it is a lining located between the smooth surfaces of the femoral condyles and tibia. Their anatomy is such that they help eliminate incongruity. In addition, their structure involves depreciation, redistributing the load over the entire surface of the bones. Due to all of the above, the human knee is stabilized, the synovial fluid moves evenly throughout the joint.

Along their periphery, the menisci are tightly connected to the capsule using ligaments. They are distinguished by their strength, because the periphery bears the maximum load.
During movement, the meniscus moves along the surface of the plateau of the tibia; when there is a rupture, this process does not occur, so treatment is required. The menisci are strengthened with the help of collateral cruciate ligaments.

The free edge of the menisci faces the center; a child’s joint, unlike an adult’s, contains blood vessels. The menisci of an adult have them only along the periphery, which is no more than 1/4. Everything is surrounded by a capsule, which has folds and bags, in which liquid is produced. It is nutrition and lubricant for cartilage, the total amount does not exceed a teaspoon. The folds replace the cavities of the knee and create additional shock absorption.

Ligamentous apparatus

In the cavity of the knee joint there are formations - cruciate, paired ligaments. They are separated from the cavity using the synovial membrane. Thickness 10 mm, length 35 mm. The anatomy of the human anterior cruciate ligaments is such that they begin with a wide base on the inner or medial surface of the outwardly located femoral condyle. Further, their structure differs in that they go from top to bottom inwards, attaching to the anterior surface of the intercondylar eminence on the tibia.

The structure of the ligaments is based on a large number of fibers, which, when combined, form two main bundles. During movement, each individual bundle of ligaments experiences stress. Thus, not only the muscles are involved in strengthening the joint, preventing bone dislocation. Normally, the anterior cruciate ligament, by its tension, prevents even minimal subluxation of the lateral condyle, the plateau of the tibia, when the joint is in its most vulnerable position.

The thickness of the posterior cruciate ligament is 15 mm, its length is up to 30 mm. It originates in the anterior part of the internal femoral condyle, moving downward, outward, and is attached to the posterior surface of the intercondylar eminence behind the tuberosity. The structure of the posterior ligament involves the weaving of some fibers into the joint capsule.

The posterior cruciate ligament prevents the tibia from moving posteriorly and from hyperextension. When a ligament ruptures in a person, this kind of movement becomes possible, and treatment is determined based on the degree of the rupture. The ligament also includes two bundles of fibers.

Extra-articular ligaments

On the inside, the knee is strengthened not only by the muscles, but also by the internal collateral ligament. It contains two portions - superficial and deep. The first portion plays the role of a joint stabilizer; it consists of long fibers that fan out from the inner femoral condyle and gradually pass to the tibia. The second portion is formed by short fibers, partially woven into the area of ​​the menisci of the human joint. If the ligament is completely torn, treatment is reduced to surgery.

Along the outer surface, the human joint is strengthened by external or lateral collateral ligaments. Part of the fibers of this ligament extend to the posterior surface, where they participate in additional strengthening. A child's joint contains more elastic fibers in the joint ligaments.

Muscles

Dynamically, in addition to ligaments, muscles are involved in stabilizing the joint. They surround the joint on both sides, complicating its structure. In case of partial rupture, the muscles of the knee in a person help to further stabilize it. All muscles have their own strength. But the most powerful is the quadriceps, which is involved in the formation of the patellar ligaments.

With pathology, the muscles, especially the quadriceps, begin to atrophy and strength decreases. During the rehabilitation period, treatment is aimed at restoring its function, which is the most important.

When it is necessary to restore posterior knee instability, the main treatment is to strengthen the joint after injury to any part of the posterior cruciate ligament. The posterior muscle group includes the semimembranosus, semitendinosus, and tender, which are located on the inside of a person; the biceps is located on the outer surface of the thigh.

Normal and pathological knee

Understanding the processes occurring in the joint optimizes treatment, making it more effective. It is not enough to know the structure of a human joint; what matters is how it functions. The adult and children's joints have articular surfaces that are covered with highly differentiated hyaline cartilage. It consists of chondrocytes, collagen fibers, ground substance, and germ layer.
The load that falls on the cartilage is evenly distributed between all components. A structure based on this principle allows it to withstand pressure or shear loads.

An injury can have a significant impact on the structure of the knee, the mechanism of which largely determines the treatment. Cartilage can be damaged as a result of excessive impact during sudden braking during rotation. When the ligaments are damaged, instability of the joint occurs and it begins to move to the sides. An additional factor complicating treatment may be hemarthrosis, in which blood accumulates in the cavity of the knee joint. The dead cells lead to the release of large amounts of lysosomal enzymes, which ultimately leads to the destruction of joint structures.

Basically, the cartilage in the joint is damaged as a result of external causes. The degree of damage depends on the strength and duration of the damaging factor. Cracks appear, which are the gateway to further destruction of collagen fibers. Vessels sprout from any part of the bone, leading to a decrease in regenerative ability. The bone is also subject to destruction processes.

The joint has a complex macroscopic and microscopic structure and function, understanding which helps to treat it correctly.

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Anatomy and movement of joints

Every movement in a person's life is regulated by the central nervous system, then the signal is transmitted to the required muscle group. In turn, it sets the desired bone in motion. Depending on the freedom of movement of the joint axis, the action is performed in one direction or another. The cartilage of the articular surfaces increases the diversity of movement functions.

A significant role is played by muscle groups that contribute to the movement of joints. The structure of the ligaments consists of dense tissue, they provide additional strength and shape. The blood supply passes through the large main vessels of the arterial network. Large arteries branch into arterioles and capillaries, bringing nutrients and oxygen into the joint and periarticular tissues. Outflow occurs through the venous vascular system.

There are three main directions of movement, they determine the functions of the joints:

1. Sagittal axis: performs the function of abduction - adduction;
2. Vertical axis: performs the function of supination - pronation;
3. Frontal axis: performs the function of flexion - extension.

The structure and shape of joints in medicine are usually divided into classes in a simple way. Classification of joints:

• Uniaxial. Block type (finger phalanges), cylindrical joint (radio-ulnar joint).
• Biaxial. Saddle joint (carpometacarpal), elliptical type (radiocarpal).
• Multi-axis. Ball-and-socket joint (hip, shoulder), flat type (sternoclavicular).

Types of joints

For convenience, all joints of the human body are usually divided into types and types. The most popular division is based on the structure of human joints; it can often be found in the form of a table. The classification of individual types of human joints is presented below:

• Rotary (cylindrical type). The functional basis of movement in the joints is supination and pronation around one vertical axis.
• Saddle type. An articulation refers to a type of joint where the ends of the bone surfaces sit on top of each other. The volume of movement occurs along the axis along its ends. Such joints are often found at the base of the upper and lower limbs.
• Ball-shaped type. The structure of the joint is represented by a convex shape of the head on one bone and a depression on the other. This joint is a multi-axis joint. The movements in them are the most mobile of all, and are also the freest. It is represented in the human torso by the hip and shoulder joints.
• Complex joint: In humans, this is a very complex joint, forming a body complex of two or more simple joints. Between them, an articular layer (meniscus or disc) is placed on ligaments. They hold the bone one next to the other, preventing lateral movements. Types of joints: kneecap.
• Combined joint. This connection consists of a combination of several joints that are different in shape and are isolated from one another, performing joint functions.
• Amphiarthrotic, or tight joint. It contains a group of strong joints. The articular surfaces sharply limit movement in the joints for greater density, there is practically no movement. They are present in the human body where movements are not needed, but strength is needed for protective functions. For example, the sacral joints of the vertebrae.
• Flat type. This form of joints in humans is represented by smooth, perpendicularly located joint surfaces in the articular capsule. Axes of rotation are possible around all planes, which is explained by the slight dimensional difference of the articulating surfaces. These are the bones of the wrist, for example.
• Condylar type. Joints whose anatomy has at its base a head (condyle), similar in structure to an ellipse. This is a kind of transitional form between the block-shaped and ellipsoidal types of joint structure.
• Block type. The articulation here is a cylindrical process located against the underlying cavity on the bone and is surrounded by an articular capsule. It has a better connection, but less axial mobility than the spherical type of connection.

The classification of joints is quite complex, because there are a lot of joints in the body and they have a variety of shapes and perform specific functions and tasks.

Connection of cranial bones

The human skull has 8 paired and 7 unpaired bones. They are connected to each other by dense fibrous sutures, except for the bones of the lower jaws. The development of the skull occurs as the body grows. In newborns, the bones of the skull roof are represented by cartilaginous tissue, and the sutures still bear little resemblance to a joint. With age, they become stronger, gradually turning into hard bone tissue.

The bones of the facial part fit smoothly to each other and are connected by even sutures. In contrast, the bones of the medulla are connected by scaly or serrated sutures. The mandible is attached to the base of the skull by a complex ellipse-shaped complex biaxial joint. Which allows jaw movements along all three types of axes. This is due to the daily process of eating.

Spinal joints

The spine consists of vertebrae, which form articulations with each other with their bodies. The atlas (first vertebra) is attached to the base of the skull using condyles. It is similar in structure to the second vertebra, which is called epistopheus. Together they create a unique mechanism that is unique to humans. It promotes tilting and turning of the head.

The classification of the joints of the thoracic region is represented by twelve vertebrae, which, with the help of the spinous processes, are attached to each other and to the ribs. The articular processes are directed frontally, for better articulation with the ribs.

The lumbar region consists of 5 large vertebral bodies, which have a great variety of ligaments and joints. Most often occur in this department intervertebral hernia, due to improper loads and poor muscle development in this area.

Next comes the coccygeal and sacral sections. In the prenatal state, they are cartilaginous tissue, divided into a large number of parts. By the eighth week they merge, and by the ninth they begin to ossify. At the age of 5–6 years, the coccygeal region begins to ossify.

The spine in the sacral region is fully formed by the age of 28. At this time, the separate vertebrae fuse into one section.

The structure of the joints of the lower extremity belt

Human legs consist of many joints, both large and small. They are surrounded by a large number of muscles and ligaments, have a developed network of blood vessels and lymphatic vessels. Structure of the lower limb:

1. The legs have many ligaments and joints, of which the ball-shaped hip joint is the most mobile. It is this that, in childhood, little gymnasts and gymnasts begin to confidently develop. The largest ligament here is the femoral head. IN childhood it stretches unusually, and this determines the early age at which gymnasts compete. At the early level of pelvic formation, the ilium, pubis and ischium are formed. They are initially connected by the joints of the lower extremity belt into a bone ring. Only by the age of 16–18 do they ossify and fuse into a single pelvic bone.
2. In medicine, the most complex and heaviest structure is the knee. It consists of three bones, which are located in a deep interweaving of joints and ligaments. The knee joint capsule itself forms a series of synovial bursae, which are located along the entire length of adjacent muscles and tendons that do not communicate with the cavity of the joint itself. The ligaments located here are divided into those that enter the joint cavity and those that do not. At its core, the knee is a condylar type of joint. When it acquires an extended position, it already works as a block-shaped type. When the ankle bends, rotational movements occur in it. The knee joint claims to be the most complex joint. At the same time, you need to carefully take care of it, and not overdo it with overloads on your legs, because restoring it is very, very difficult, and at a certain stage it is even impossible.
3. Regarding the ankle joint, it is necessary to keep in mind that the ligaments lie on its lateral surfaces. It connects a large number of large and small bones. The ankle joint is a block-type joint in which screw motion is possible. If we talk about the foot itself, then it is divided into several parts and does not represent any complex articular joints. In its composition, it has typical block-like connections located between the bases of the phalanges of the fingers. The articular capsules themselves are free and are located along the edges of the articular cartilage.
4. The foot is subject to everyday stress in human life, and also has an important shock-absorbing effect. It consists of many small joints.

The structure of the joints of the upper limb belt

The hand includes many joints and ligaments that are capable of very finely regulating the actions and motor skills of the smallest movements. One of the most complex joints here is the shoulder. It has many fastenings and interweavings of ligaments, which are difficult to adjust one to one. The main three large ligaments are responsible for abduction, adduction, raising the arms to the sides, anteriorly and upward.

Raising the arm above the shoulder introduces movement to the muscles and ligaments of the scapula. The shoulder is connected to the scapula by a powerful fibrous ligament, which allows a person to perform various complex and difficult activities with heavy weights.

The classification of the elbow joint is very similar in structure to the structure of the knee joint. It includes three joints surrounded by one base. The heads at the base of the bones in the elbow joint are covered with hyaline cartilage, which improves gliding. In the cavity of a single joint, there is a blocking of complete movement. Due to the fact that the elbow joint involves the humerus and ulna bones in movement, lateral movements are not fully performed. They are inhibited by collateral ligaments. The interosseous membrane of the forearm also takes part in the movement of this joint. The underlying nerves and blood vessels pass through it to the end of the arm.

The muscles of the wrist and metacarpus begin to attach near the wrist joint. Many thin ligaments regulate motor movement both on the back of the hand and on the sides.

Humans inherited the thumb joint from monkeys. Human anatomy is similar to the structure of our ancient relatives precisely in this joint. Anatomically, it is determined by grasping reflexes. This bone articulation helps interact with many objects in the environment.

Joint diseases

In humans, joints are perhaps the most susceptible to disease. Among the main pathologies, it is necessary to highlight hypermobility. This is a process where there is increased activity of bone joints that goes beyond the permissible axes. Undesirable stretching of the ligaments occurs, allowing the joint to make deep movement, which has an extremely bad effect on the tissues adjacent to the heads of the bones. After some time, such movements lead to deformation of the joint surfaces. This disease is inherited, how this remains to be determined by doctors and scientists.

Hypermobility is often detected in young girls and is genetically determined. It leads to deformation of connective tissues and especially bone joints.

With this type of illness, it is highly not recommended to choose a job in which you have to be in the same position for a long time. In addition, it is necessary to exercise carefully, as there is a risk of even more hyperextension of the ligaments. Which, in turn, ends with varicose veins or arthrosis.

The most common localization of diseases:

1. Shoulder girdle diseases often occur in people in old age, especially in those who are accustomed to making a living through hard physical labor. People who go to the gym very often are also in the critical zone. Subsequently, old age is accompanied by pain in the shoulders (shoulder arthritis) and osteochondrosis of the cervical spine. Doctors often find osteoarthritis or arthritis of the shoulder joint in people in this category.
2. Elbow diseases also often plague athletes (epicondylitis). As people age, their joints experience discomfort and limited mobility. They are caused by deforming osteoarthritis, arthritis and inflammation of the arm muscles. Therefore, it is necessary to remember the correct technique and time of practice.
3. The joints of the arms, fingers and hands become inflamed in rheumatoid arthritis. The disease manifests itself as “tight glove” syndrome. Its peculiarity is that both hands are affected. Cases of arthrosis with acute damage to tendons occur in professions associated with fine motor skills: for musicians, jewelers, as well as those who type texts on the keyboard for a long time every day.
4. In the hip area, coxarthrosis is most often identified. A typical disease in older people is osteoporosis (softening of the femur structure). Bursitis and tendinitis of the hip joint occur in runners and football players.
5. Diseases in the knee are detected in people of all age groups, since it is a very complex complex. Restoring it in 90% of cases is impossible without surgical intervention, which, in turn, does not guarantee a complete cure for this connection.
6. The ankle is characterized by arthrosis and subluxation. Pathologies are classified as professional in dancers and women who often use high heels. Osteoarthritis affects people who are obese.

Healthy joints are a luxury nowadays, which is difficult to notice until a person is faced with their problem. When every movement in a certain joint is made with pain, then a person is able to give a lot to restore health.

It would be difficult to imagine a person’s life without precise and confident movements. Regarding any profession where a person’s physical skills are involved, one must pay tribute to the help of joints and ligaments. They are activated reflexively, and we almost never notice how the slightest movements decide our fate, from driving a car to complex surgical operations. In all this, we are helped by joints, which can turn life the way you want.

Human leg joints

Continuous connections

Depending on the type of tissue located between the bones, three types of continuous connections are distinguished: fibrous, cartilaginous and bone.

1. Fibrous connections , With indesmoses , syndesmosis, is a type of continuous connection where there is connective tissue between the bones. Syndesmoses include: ligaments, interosseous membranes, sutures, fontanelles, dento-alveolar impactions.

Ligaments, ligamenta, are fibrous bundles of connective tissue. In most cases they are educated fibrous tissue. Between the vertebral arches, the ligaments consist of elastic connective tissue (synelastosis), these are the yellow ligaments, ligament flava.

interosseous membranes, membrana interossea, fills large gaps between bones, for example, between the bones of the forearm and lower leg.

Seams, suturae, are a layer of connective tissue located between the bones of the skull.

Based on the shape of the connecting bone edges, the following sutures are distinguished:

a) serrated, sutura serrata (between the frontal and parietal bones, parietal and occipital bones);

b) scaly, sutura squamosa (between the temporal and parietal bones);

c) flat, sutura plana (between the bones of the facial skull).

fontanelles, fonticuli, are non-ossified connective tissue areas of the cranial vault of a newborn.

Dento-alveolar impaction, gomfosis, is the connection of the tooth with the bone tissue of the dental alveolus through a system of ligaments.

2. Cartilaginous connections , synchondrosis, synchondrosis, these are continuous connections of bones through cartilage tissue. Synchondrosis can be temporary or permanent.

Temporary synchondroses include epiphyseal cartilages connecting the diaphyses and epiphyses of tubular bones; cartilage between the sacral vertebrae. Temporary synchondroses persist in childhood and are then replaced by a bone connection - synostosis.

Permanent synchondrosis is present between the first rib and the manubrium of the sternum.

3. Connections using bone tissue , synostosis, synostosis, is formed as a result of the replacement of temporary cartilage with bone tissue or at the site of syndesmosis, for example, during ossification of the sutures between the bones of the skull in old age. In some diseases, permanent synchondrosis, syndesmoses, and joints are subject to synostosis.

Intermittent, connections

These include joints, articulatio. These connections have a more complex structure and, unlike sedentary or completely motionless continuous connections, make possible various movements of parts of the human body.

Joints are divided into main and auxiliary elements.

Basic elements of a joint

1. Articular surfaces, facies articularis, are located on the bones at the places of their articulation with each other. In most joints, one of the articulating surfaces is convex (the articular head) and the other is concave (the glenoid cavity). The articular surfaces are covered by articular cartilage, cartilage articularis. Most articular surfaces are covered with hyaline cartilage, and only some joints, such as the temporomandibular and sternoclavicular joints, have fibrocartilage. Thanks to its elasticity, articular cartilage protects the ends of bones from damage during shocks and shocks.

2. The articular capsule, capsula articularis, surrounds the parts of the bones that articulate with each other and hermetically closes the joint. In the articular capsule there are: a) an outer fibrous membrane, built of dense fibrous connective tissue; b) the internal synovial membrane, which produces intra-articular fluid - synovium.

3. Articular cavity, cavitas articularis, a slit-like space between the articular surfaces, which contains synovium.

4. Synovia is a viscous liquid that is located in the articular cavity. Synovia moistens the articular surfaces, reducing friction during joint movements, provides nutrition to the articular cartilage and metabolism in the joint.

Auxiliary elements of the joint

1. Articular disc, discus articularis, a cartilaginous plate located between the articular surfaces and dividing the articular cavity into two chambers.

2. Articular menisci, menisci articularis, curved cartilaginous plates located in the cavity of the knee joint between the condyles of the femur and tibia.

Articular discs and menisci increase the contact area of ​​the articular surfaces and act as shock absorbers and also play a role in movement.

3. The labrum, labrum articulare, is a cartilaginous rim attached to the edge of the articular cavity and increases its area and, consequently, the contact area of ​​the articular surfaces.

4. Ligaments, ligamenta, form the ligamentous apparatus of the joint, apparatus ligamentosus. Ligaments strengthen the joint, inhibit movement, and can also guide movement.

There are: a) extracapsular ligaments, separated from the articular capsule by connective tissue; b) capsular ligaments woven into the joint capsule; c) intracapsular ligaments located in the joint cavity and covered with a synovial membrane.

Classification of joints

The joints of the human body are very diverse in their structure and function.

I. Based on the number of articular surfaces located in one capsule, simple and complex joints are distinguished:

1. A simple joint, articulatio simplex, is formed by two bones (interphalangeal joints).

2. A complex joint, articulatio composita, is formed by 3 or more bones (elbow, ankle).

II. According to their simultaneous joint function, joints are divided into combined and non-combined.

1. Combined joints, articulatio combinata, is a combination of several joints isolated from each other, but functioning together (temporomandibular joints, proximal and distal radioulnar joints).

2. A non-combined joint, articulatio acombinata, functions independently.

III. Based on the presence of auxiliary elements, joints can be complex.

A complex joint, articulatio complexa, is a joint in the cavity of which there are discs or menisci (knee joint, sternoclavicular joint).

IV. Depending on the shape of the articular surfaces, joints can perform movements around one, two or three axes: uniaxial, biaxial and multiaxial.

1. Uniaxial joints are joints in which movement occurs only around one axis. Block-shaped and cylindrical joints are uniaxial in shape. In the trochlear joint, movements occur around the frontal axis (flexion and extension). In a cylindrical joint - around a vertical axis (rotation).

2. Biaxial joints - movements occur around two axes. The ellipsoidal, condylar and saddle joints are biaxial in shape. Movements in them occur around the frontal axis (flexion and extension) and around the sagittal axis (adduction and abduction).

3. Multi-axis joints - movements occur around three axes. According to the shape of the articular surfaces, multiaxial joints are spherical, cup-shaped and flat. A typical ball-and-socket joint is the shoulder joint, in which movements are possible around 3 axes - frontal (flexion and extension), sagittal (abduction and adduction) and vertical (outward and inward rotation). The hip joint has a cup-shaped shape - it differs from the ball-and-socket joint in its deeper articular cavity. IN flat joints sliding movements in different directions.

Circumduction, circumductio, circular motion, transition from one axis to another.

It should be noted that the range of motion in the joint is determined by a number of factors:

1. Congruence of articular surfaces - the smaller it is, the greater the range of movements.

2. Combination of joints - in combination joints, movements are determined by the joint that has the smallest number of axes of movement.

3. Auxiliary elements of joints - can either increase or decrease the range of motion. Thus, due to the intra-articular disc, an additional axis of movement appears; the articular labrum, which increases the congruence of the articular surfaces, reduces the range of movements; intraarticular ligaments direct and limit movements in the joint.

4. The structure of the articular capsule - in joints that have enough thin capsule, the range of movements is greater.

5. Condition of extra-articular ligaments - a well-developed ligamentous apparatus limits joint movements.

6. The muscles surrounding the joint - with their tone they bring together and hold the articulating surfaces.

7. Synovial fluid – has an adhesive effect. If its secretion is impaired, the range of motion in the joint decreases and pain and crunching appear.

Symphyses

Symphyses (half-joints) are an intermediate type of joint between intermittent and continuous joints. Symphyses are cartilage located between two bones, in which there is a small cavity. The walls of this cavity do not have a synovial lining, and the cavity itself is not filled with synovial fluid (pubic symphysis).

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PRIVATE ARTHROLOGY

Connection of skull bones

The bones of the skull are connected to each other using continuous and intermittent connections.

Continuous connections between the bones of the skull are represented mainly by fibrous connections, syndesmosis, in the form of sutures in adults and interosseous membranes in newborns. At the base of the skull there are cartilaginous connections, synchondroses.

The bones of the roof of the skull are connected by serrated and scaly sutures. The sagittal edges of the parietal bones are connected by a serrated sagittal suture, sutura sagittalis, and the frontal and parietal bones are connected by a serrated lambdoid suture, sutura lambdoidea. The scales of the temporal bone are connected to the parietal bone and the greater wing of the sphenoid bone by a scaly suture, sutura squamosa. The bones of the facial skull are connected by flat sutures, sutura plana.

The cartilaginous connections at the base of the skull are the connections between the body of the sphenoid bone and the basilar part of the occipital bone, sphenooccipital synchondrosis, synchondrosis sphenooccipitalis, between the petrous part of the temporal bone and the basilar part of the occipital bone, petrooccipital synchondrosis, synchondrosis petrooccipitalis.

Rice. 1. Connection of the skull bones

1 – anterior fontanel (fonticulus anterior); 2 – posterior fontanel (fonticulus posterior).

Rice. 2. Newborn skull

Rice. 3. Temporomandibular joint

· Blood supply: a. auricularis profunda from a. maxillaris.

· Venous drainage: vv. articulares in v. retromandibularis.

· Innervation: n. auriculotemporalis from n. mandibularis from n. trigeminus.

· Lymph drainage: n. lymphoidei parotidei.

Connections between vertebrae

The vertebral bodies are connected by:

1. Intervertebral disc, discus intervertebralis, which consists of a fibrous ring, annulus fibrosus, and a pulposus, nucleus pulposus. Each disc is a fibrocartilaginous plate. Between the bodies of the cervical and thoracic vertebrae there is constant synchondrosis. Between the bodies of the lumbar vertebrae is the symphysis, since there is a gap inside the nucleus pulposus. Between the bodies of the sacral vertebrae there is temporary synchondrosis, which is replaced by bone tissue with age.

2. Anterior and posterior longitudinal ligaments, lig. longitudinale anterius et posterius, which run along the anterior and posterior surfaces of the vertebral bodies - synarthrosis, syndesmosis.

Rice. 4. Connection of vertebrae

The vertebral arches are connected by the yellow ligaments, ligg.flava, - synarthrosis, syndesmosis.

The transverse processes are connected using intertransverse ligaments, ligg.intertransversaria, - synarthrosis, syndesmosis.

The spinous processes are connected by the interspinous ligaments, ligg.interspinalia and the supraspinous ligament, lig.supraspinale. In the cervical spine, the continuation of the supraspinous ligament is the nuchal ligament, lig.nuchae.

The articular processes articulate with the help of the facet joints, art. zygapophysiales. These joints articulate the lower articular surfaces, facies articularis inferiores, of the overlying vertebra and the upper articular surfaces, facies articularis superiores, of the underlying vertebra.

In structure, the facet joints are simple, combined, in shape - flat, in function - inactive.

The sacrum and coccyx are connected by the sacrococcygeal joint, articulatio sacrococcygea.

· Blood supply: a. vertebralis (cervical region); aa. intercostales posteriores (thoracic region); aa. lumbales ( lumbar region); rr. sacrales laterales (sacral section).

· Venous drainage: plexus venosus vertebralis internus et externus in v. columnae vertebralis; vv. intercostales posteriores in vv. lumbales, in v. iliaca interna.

· Innervation: rr. dorsales nn. spinales.

· Lymph drainage: n. lymphoidei occipitales, cervicales laterales profundi, n. lymphoidei intercostales, lumbales, sacrales.

Rice. 5. Connections between the I and II cervical vertebrae

Lateral atlantoaxial joint, art. atlantoaxialis lateralis, paired, formed by the lower articular fossae of the first cervical vertebra, fovea articulares superiors, and the upper surfaces of the second cervical vertebra, facies articulares superiores. The joint is combined in structure, flat in shape, uniaxial in function, movements are combined with the middle atlanto-axial joint.

Ligaments that strengthen the joint: a) ligament of the apex of the tooth, lig.apicis dentis; b) pterygoid ligaments. ligg.alaria, these ligaments go from the tooth to the occipital bone; c) cruciate ligament. lig. cruciforme atlantis; d) the integumentary membrane, membrane tectoria, covers the joints and ligaments from the side of the spinal canal.

· Blood supply: a. vertebralis from a. subclavia.

· Venous drainage: plexus venosus vertebralis internus et externus in v. columnae vertebralis.

· Innervation: rr. dorsales nn. spinales.

· Lymph drainage: n. lymphoidei occipitales, cervicales laterales profundi.

Spinal column

The spinal column is S-shaped. Several curves are distinguished in it: lordosis, lordosis, cervical and lumbar - a bend of the spinal column with a convexity forward; kyphosis, kyphosis, sacral and thoracic - bending of the spinal column with a convexity backwards.

Scoliosis is a curvature of the spinal column to the right or left.

The curves of the spinal column in humans are formed in connection with upright posture and soften shocks when walking.

The movements of the spinal column are the sum of the movements between all the vertebrae. In the spinal column, movements around 3 axes are possible: 1) around the frontal axis - flexion and extension; 2) around the sagittal axis – abduction, adduction (tilts to the side); 4) around a vertical axis – rotation. Circular movement, circum ductio, is also possible, in which a transition is made from one axis to another.

Connection of ribs

The ribs, articulating with the vertebrae, form 2 joints: the rib head joint and the costotransverse joint.

1. Joint of the rib head, art.capitis costae. Formed by the articular surfaces of the rib head, facies articularis capitis costae, and costal fossae, fovea costales, on the bodies of 2 adjacent vertebrae or a fossa on the body of one vertebra (for the I, XI, XII ribs). Therefore, the joints of the 1st, 11th and 12th ribs are simple, and all the rest are complex. The joints are combined in structure with costotransverse joints (movements occur simultaneously), spherical in shape, and uniaxial in function.

Ligaments that strengthen the joint: a) II-X ribs, the radiate ligament of the rib head, lig.capitis costae radiatum, goes from the rib head to the bodies of two adjacent vertebrae; b) intra-articular ligament of the rib head, lig. capitis costae intraarticulare. This ligament runs from the crest of the rib head to the intervertebral disc (in the joints of the II-X ribs). This ligament is not present in the joints of the 1st, 11th and 12th ribs, since the head of these ribs articulates with the entire fossa of one vertebra.

2. Costotransverse joint, art.costotransversaria. Formed by the tubercle of the rib, tuberculum costae, and the costal fossa, fovea costalis, of the transverse process of the vertebra. The XI and XII ribs do not form costotransverse joints. The joint is combined with the joint of the rib head, cylindrical in shape, uniaxial in function.

Movements occur simultaneously in 2 joints: the costotransverse joint and in the joint of the rib head - rotation around the longitudinal axis of the rib neck. In this case, the front ends of the ribs, together with the sternum, rise (when inhaling) and fall (when exhaling), and the middle parts of the ribs diverge to the sides.

Ligament that strengthens the joint: costotransverse ligament, lig. costotransversarium.

· Blood supply: aa. intercostales posteriores from the thoracic aorta.

· Venous drainage: vv. intercostales posteriores in v. azygos, hemiazygos.

· Innervation: rr. dorsales nn. spinales.

· Lymph drainage: n. lymphoidei intercostales.

Connection of ribs to sternum

The I-VII ribs (true ribs, costae verae) connect to the sternum. The first rib connects to the sternum through cartilaginous tissue, synarthrosis, synchondrosis.

The II-VII ribs form the sternocostal joints, art. Sternocostales. The joints are formed by the costal cartilage of the rib, cartilago costalis, and the costal notch of the sternum, incisura costalis. The joints are simple in structure, flat in shape, and inactive in function, since gliding of several degrees is possible.

Ligaments that strengthen the joint: a) radiate sternocostal ligament, lig.sternocostale radiatum; b) intra-articular sternocostal ligament, lig. sternocostale intraarticulare - this ligament is well expressed only in the joint of the 2nd rib. c) on the anterior surface of the sternum, the radiate sternocostal ligaments fuse with the periosteum and form the sternum membrane, membrana sterni.

VIII, IX and X ribs (false ribs, costae spuriae) are connected to the overlying ribs through a layer of connective tissue, synarthrosis, syndesmosis. Intercartilaginous joints may form between the false ribs. The XI, XII ribs are located with their anterior ends in the thickness of the muscles of the abdominal wall (oscillating ribs, costae fluctuantes).

· Blood supply:

· Venous drainage: vv. thoracicae internae in v. brachiocephalica.

· Innervation: nn. intercostales.

· Lymph drainage:

Rib cage

The chest is formed by 12 thoracic vertebrae, 12 pairs of ribs and the sternum. The rib cage limits the chest cavity. There are 4 walls in the chest: anterior, posterior and 2 lateral; 2 openings - the upper and lower apertures of the chest. The upper aperture of the chest, apertura thoracis superior, is limited by the 1st thoracic vertebra, 1st ribs, and manubrium of the sternum. The trachea, esophagus, vessels, and nerves pass through the upper aperture. The lower aperture of the chest, apertura thoracis inferior, is limited by the XII thoracic vertebra, the lower ribs and the xiphoid process of the sternum. The VII-X ribs, connected to each other by costal cartilages, form the costal arch, arcus costalis. The right and left costal arches limit the substernal angle, angulus infrasternalis.

The inferior aperture is closed by a diaphragm, which has openings for the passage of the aorta, esophagus and inferior vena cava. Depending on the body type, there are three shapes of the chest: flat, cylindrical and conical. In people of brachymorphic body type, the chest has a conical shape, the substernal angle is greater than 90 0. In people with a dolichomorphic body type, the chest is flat, the substernal angle is less than 90 0. In people of mesomorphic body type, the chest has a cylindrical shape, the substernal angle is 90 0.

Rice. 6. Sternoclavicular joint

Ligaments that strengthen the joint: a) interclavicular ligament, lig.interclaviculare; b) anterior and posterior sternoclavicular ligaments, lig.sternoclaviculare anterius et posterius; c) costoclavicular ligament, lig.costoclaviculare.

· Blood supply: a. thoracica interna from the first section of a. subclavia.

· Venous drainage: vv. thoracicae internae in vv. brachiocephalica.

· Innervation: nn. intercostales I-II.

· Lymph drainage: n. lymphoidei parasternales, cervicales laterales profundi.

Rice. 7. Own ligaments of the scapula

Ligaments that strengthen the joint: a) acromioclavicular ligament, lig.acromioclaviculare; b) coracoclavicular ligament, lig.coracoclaviculare.

Own ligaments of the scapula: a) superior transverse ligament of the scapula, lig.transversum scapulae superius; b) lower transverse ligament of the scapula, lig.transversum scapulae inferius; c) coracoacrominal ligament, lig. coracoacromialis - shoulder arch.

· Blood supply: ramus acromialis from a. thoracoacromialis from a. axillaris.

· Venous drainage: v. thoracoacromialis in v. axillaris.

· Innervation:

· Lymph drainage: n. lymphoidei axillares.

Rice. 8. Shoulder joint

· Blood supply: a. thoracoacromialis, a. circumflexae humeri anterior et posterior from a. axillaris.

· Venous drainage: v. thoracoacromialis, vv. circumflexae humeri anterior et posterior in v. axillaris.

· Innervation: n. suprascapularis, n. axillaris from plexus brachialis.

· Lymph drainage: n. lymphoidei axillares.

Elbow joint, art. cubiti

The joint is complex, formed by the articular surfaces of the humerus, ulna and radius bones, between which 3 joints are formed:

1. Shoulder-elbow joint, art.humeroulnaris. Formed by the trochlea of ​​the humerus, trochlea humeri, and the trochlear notch of the ulna, incisura throchlearis. The joint is block-shaped in shape and uniaxial in function.

Movements: around the frontal axis - flexion and extension with a helical stroke (simultaneously with the humeral-radial joint).

2. Shoulder-radial joint, art.humeroradialis. Formed by the head of the condyle of the humerus, capitulum humeri, and the head of the radius, caput radii. The joint is spherical, but biaxial in function.

Movements: around the frontal axis - flexion and extension (simultaneously with the shoulder-elbow); around the vertical axis – rotation (simultaneously with the proximal and distal radioulnar joints).

3. Proximal radioulnar joint, art. radioulnaris proximalis. Formed by the radial notch of the ulna, incisura radialis, and the articular circle on the head of the radius, circumferentia articularis. The joint is cylindrical, uniaxial.

Movements: around a vertical axis - rotation (combined with distal radioulnar).

Ligaments that strengthen the elbow joint: a) radial collateral ligament, lig. collateral radiale; b) ulnar collateral ligament, lig. collaterale ulnare; c) annular ligament of the radius, lig. anulare radii.

In general, movements in the elbow joint are carried out along 2 axes: frontal and vertical.

· Blood supply: aa. collateralis ulnaris superior et inferior from a. brachialis; aa. collateralis media et radialis from a. profunda brachii; a. recurrens radialis from a. radialis; a. interossea recurrens from a. interossea posterior from a. interossea communis from a. ulnaris; a. recurrens ulnaris from a. ulnaris.

· Venous drainage: vv. radiales, vv. ulnares, vv. brachiales

· Innervation:

· Lymph drainage: n. lymphoidei cubitales.

CONNECTION OF THE BONES OF THE HAND

Rice. 10. Carpal joint, connection of the bones of the hand

Ligaments that strengthen the joint: a) radial collateral ligament of the wrist, lig. collaterale carpi radiale; b) ulnar collateral ligament of the wrist, lig. collaterale carpi ulnare; c) palmar radiocarpal ligament, lig. radiocarpale palmare; d) dorsal radiocarpal ligament, lig. radiocarpale dorsale.

Movements: around the frontal axis - flexion and extension; around the sagittal axis – adduction and abduction. Circumduction is possible.

· Blood supply: rete carpi dorsale (r. carpalis dorsalis from aa. radialis et ulnaris, a. interosseae anterior et posterior from a. interossea communis from a. ulnaris), rete carpale palmare (r. carpeus palmaris from a. ulnaris et radialis, a. interossea anterior from A. interossea communis from A. ulnaris).

· Venous drainage: vv. ulnares, vv. radiales, vv. interosseae.

· Innervation: n. ulnaris, n. radialis, n. medianus from plexus brachialis.

· Lymph drainage: n. lymphoidei cubitales.

Rice. 11. Sacroiliac joint, pubic symphysis

The pelvic bones are also connected to the sacrum using ligaments:

a) sacrotuberous ligament, lig.sacrotuberale.

b) sacrospinous ligament, lig.sacrospinale.

These ligaments transform the greater and lesser sciatic notches into the greater and lesser sciatic foramina, foramen ischiadicum majus et minus.

· Blood supply: ramus pubicus from a. obturatoria from a. iliaca interna; ramus obturatorius from a. epigastrica inferior from a. iliaca externa.

· Venous drainage: v. epigastrica inferior, vv. obturatoriae, v. iliaca communis, v. cava inferior.

· Innervation: n. obturatorius from plexus lumbalis.

· Lymph drainage: nodi lymphoidei inguinales profundi.

The pelvic bones and sacrum unite to form the pelvis. The pelvis is divided into 2 sections: a) large pelvis, pelvis major; b) small pelvis, pelvis minor. The border between them is the boundary line running along the promontory of the sacrum, the arcuate line of the iliac bones, the crest of the pubic bones and the upper edge of the pubic symphysis.

In the pelvis there are:

a) entrance – the upper aperture of the pelvis, aperture pelvis superior.

b) pelvic cavity, cavitas pelvis.

c) exit – the lower aperture of the pelvis, aperture pelvis inferior.

Rice. 12. Own pelvic ligaments

When measuring a large pelvis, 3 transverse dimensions and an outer direct dimension are determined:

1) the distance between the two most distant points of the iliac

ridges (25-27 cm);

2) the distance between the two anterosuperior iliac spines (28-29 cm);

3) the distance between the two greater trochanters (30-32 cm);

4) external direct size (anatomical conjugate, conjugate natomica) – 5) distance from the symphysis to the recess between the last lumbar and first sacral vertebrae (20.0-21.0 cm).

Rice. 13. Sex differences in the pelvis

To determine the true direct size of the pelvis, conjugata vera, subtract 9.5-10.0 cm from the external direct size.

When measuring the pelvis, determine:

1) cross dimension entrance to the small pelvis (13.5-15.0 cm) is determined by subtracting 14.0-15.0 cm from the intercrestal diameter;

2) the transverse size of the pelvic outlet is the distance between the two ischial tuberosities (11.0 cm);

3) the direct size of the outlet from the pelvis (9.0-11.0 cm) is the distance between the apex of the coccyx and the lower edge of the pubic symphysis.

Rice. 14. Hip joint

Knee joint, art. genus

Formed by the medial, condylus medialis, and lateral, condylus lateralis, condyles of the femur, the upper articular surface of the tibia, facies articularis superior, and the patella, patella.

Rice. 15. Knee joint

The structure of the joint is complex, since the auxiliary elements of the meniscus are located in the joint cavity.

The joint is condylar in shape of the articulating surfaces and biaxial in function.

Auxiliary elements located in the joint cavity: 1) medial and lateral menisci, meniscus medialis et lateralis. The menisci of the knee joint increase the congruence of the articulating surfaces, increase the range of motion and perform a shock-absorbing function; 2) transverse ligament of the knee, lig. transversum genus, connects the anterior parts of the menisci; 3) anterior cruciate ligament, lig. cruciatum anterius, goes from the lateral condyle of the femur to the anterior intercondylar field; 4) posterior cruciate ligament, lig. cruciatum posterius, goes from the medial femoral condyle to the posterior intercondylar field (cruciate ligaments direct movements in the knee joint); 5) the synovial membrane forms a series of protrusions, which are called synovial bursae: a) the patellar bursa, bursa suprapatellaris, is located under the tendons of the quadriceps femoris muscle; b) subpatellar bursa, bursa infrapatellaris, which is located under the patellar ligament.

Movements: around the frontal axis - flexion and extension, around the vertical axis - rotation in a bent knee.

Ligaments that strengthen the joint: 1) tibial collateral ligament, lig. collateral tibiale; 2) fibular collateral ligament, lig. collateral fibulare; 3) oblique patellar ligament, lig. popliteum obliguum; 4) arcuate patellar ligament, lig. popliteum arcuatum; 5) patellar ligament, lig. patellae, formed by tendon fibers of the quadriceps femoris muscle.

· Blood supply: a. descendens genus from a. femoralis; aa. genus superiores lateralis et medialis; aa. genus inferiores lateralis et medialis; a. genus media (all listed arteries are from a. poplitea); a. recurrens tibiales anterior et posterior from a. tibialis anterior.

· Venous drainage: v. poplitea, v. femoralis.

· Innervation: n. tibialis, n. fibularis communis from plexus sacralis.

· Lymph drainage: nodi lymphoidei poplitei.

Joints of the leg bones

The bones of the lower leg (tibia and fibula) are connected by the tibiofibular joint, the tibiofibular syndesmosis and the interosseous membrane of the tibia.

Rice. 16. Connection of the shin bones

1. Interfibular joint, art. tibiofibularis. Formed by the fibular articular surface, facies articularis fibularis, the tibia and the articular surface of the head of the fibula, facies articularis capitis fibulae.

The structure of the joint is simple, the shape of the articulating surfaces is flat, the function is inactive, only slight gliding is possible in it.

2. Interfibular syndesmosis, syndesmosis tibiofibularis. Formed by the fibular notch, incisura fibularis, tibia and lateral malleolus, malleolus lateralis, fibula, which are connected by fibrous connective tissue, synarthrosis, syndesmosis.

3. Interosseous membrane of the leg, membrana interossea cruris, syndesmosis, connects the interosseous edges of the tibia and fibula. The fixed connection of the bones of the lower leg is associated with the supporting function of the lower limb.

CONNECTIONS OF THE BONES OF THE FOOT

Rice. 17. Bones of the leg and foot

Ligaments that strengthen the joint: a) talocalcaneal interosseous ligament, lig. talocalcaneum interosseum, located in the sinus between the talus and calcaneus. b) plantar calcaneonavicular ligament, lig. calcaneonaviculare plantare.

Movements: around the sagittal axis (common with the axis of the subtalar joint) - supination simultaneously with adduction and pronation simultaneously with abduction.

Movements in the subtalar and talocaleonavicular joints are usually combined with movements in the ankle joint. When the foot flexes, it supination and adduction occurs, and when the foot extends, it pronates and abducts.

Rice. 18. Ankle joint, connection of the bones of the foot

Head movements

Movements of the head are usually combined with movements of the cervical part of the spinal column, but can be performed in isolation in the atlanto-occipital and atlanto-axial joints.

Flexion: longus capitis, rectus capitis anterior, supraglottic and infrahyoid muscles.

Extension: the head parts of the autochthonous muscles of the back, the sternocleidomastoid muscles, the upper bundles of the trapezius muscle, the posterior rectus capitis muscles.

Bends to the side: suboccipital muscles of one side, especially the lateral rectus muscle, sternocleidomastoid muscle of the same side.

Head rotation: rectus major posterior, inferior oblique capitis, sternocleidomastoid on the opposite side.

Strong movements of the head are produced by muscles acting on the cervical part of the spinal column.

Rib cage

Raising the ribs with inhalation: external interpersonal, scalene, superior posterior serratus muscles. With a fixed shoulder girdle, inhalation is increased by the major and minor pectoral and anterior serratus muscle, and with the head thrown back - the sternocleidomastoid muscles.

The lowering of the ribs during a calm exhalation occurs without the participation of muscles due to the elasticity of the costal cartilages and costovertebral joints. When you exhale deeply, the internal intercostal and subcostal muscles, the transverse thoracic muscle, the serratus inferior muscles, and the abdominal muscles contract.

During abdominal breathing (in infants) and mixed breathing, the diaphragm plays an important role. Chest breathing without significant contractions of the diaphragm is observed in pregnant women.

Movements of the chest are combined with movements of the spinal column: when inhaling, the spine extends, and when exhaling, it bends.

Movements of the shoulder girdle.

Movements of the shoulder girdle are carried out in the sternoclavicular and acromioclavicular joints and are usually combined with movements in the shoulder joint.

The scapula is pressed against the chest by the combined action of the rhomboid and serratus anterior muscles.

Shoulder girdle levator: levator scapulae and upper trapezius muscles.

Shoulder girdle descent: lower trapezius, minor pectoral muscle.

The movement of the scapula forward and laterally (from the spinal column) is produced by the serratus anterior muscle: backward and medially (towards the spinal column) – middle part trapezius and rhomboid muscles.

Scapular rotation: superior and inferior trapezius and serratus anterior. In this case, the glenoid cavity of the scapula turns upward and the arm can be raised above the horizontal level.

Shoulder joint

Flexion (raising the arm forward): anterior bundles of the deltoid muscle, biceps brachii muscle, coraco- brachialis muscle, pectoralis major muscle (its clavicular and sternocostal parts).

Extension: posterior deltoid, teres major, latissimus dorsi; long head triceps brachii (with arm raised).

Abduction: deltoid and supraspinatus muscles, long head of biceps brachii.

Adduction: pectoralis major, teres major, latissimus, long head of triceps brachii.

Internal rotation: subscapularis and pectoralis major, teres major, biceps brachii, as well as latissimus dorsi and anterior deltoid.

External rotation: infraspinatus and teres minor, posterior deltoid.

With fixed arms, the pectoralis major and latissimus dorsi muscles pull up the torso.

Elbow joint

Flexion: biceps brachii and brachialis. In this case, the brachioradialis muscle and pronator teres perform a supporting function.

Extension: triceps brachii. At the same time, the elbow muscle protects the joint capsule from pinching.

The rotational moment of the elbow extensors is about 2/3 of the rotational moment of its flexors. Torque is the product of muscle thrust and the shoulder of application of this force.

Radioulnar joints

Supination: supinator muscle, biceps brachii.

Pronation: Pronator teres, pronator quadratus, and flexor carpi radialis.