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Enarthrodial Joint

(joynt) [Fr. jointe, fr. L. junctio, a joining] The place where two or more bones meet. Some joints are fixed or immobile attachments of bones; other joints allow the bones to move along each other. A joint usually has a thin, smooth articular cartilage on each bony surface and is enclosed by a joint capsule of fibrous connective tissue. A joint is classified as immovable (synarthrodial), slightly movable (amphiarthrodial), or freely movable (diarthrodial). A synarthrodial joint is one in which the two bones are separated only by an intervening membrane, such as the cranial sutures. An amphiarthrodial joint is one having a fibrocartilaginous disk between the bony surfaces (symphysis), such as the symphysis pubis; or one with a ligament uniting the two bones (syndesmosis), such as the tibiofibular articulation. A diarthrodial joint is one in which the adjoining bone ends are covered with a thin cartilaginous sheet and joined by a joint capsule lined by a synovial membrane, which secretes synovial fluid. SYN: SEE: arthrosis (1)TYPES OF JOINTS MOVEMENTJoints are also grouped according to their motion: ball-and-socket (enarthrodial); hinge (ginglymoid); condyloid; pivot (trochoid); gliding (arthrodial); and saddle.Joints can move in four ways: gliding, in which one bony surface glides on another without angular or rotatory movement; angulation, occurring only between long bones, increasing or decreasing the angle between the bones; circumduction, occurring in joints composed of the head of a bone and an articular cavity, the long bone describing a series of circles, the whole forming a cone; and rotation, in which a bone moves about a central axis without moving from this axis. Angular movement, if it occurs forward, is called flexion; if backward, extension; if away from the body, abduction; and toward the median plane of the body, adduction.Because of their location and constant use, joints are prone to stress, injury, and inflammation. The main diseases affecting the joints are rheumatic fever, rheumatoid arthritis, osteoarthritis, and gout. Injuries comprise contusions, sprains, dislocations, and penetrating wounds.

enarthrodial joint

A joint that permits rotation of a bone, the joint being formed by a pivot-like process that turns within a ring, or by a ringlike structure that turns on a pivot. SYN: SEE: rotary joint; SEE: trochoid joint

Either of the encapsulated double synovial joints between the condylar processes of the mandible and the temporal bones of the cranium. These joints are separated by an articular disk and function as an upper gliding joint and a lower modified hinge or ginglymoid joint.

Schematic showing similarities between an idealized diarthrodial join and an intervertebral disc. The diarthrodial joint comprises a thin layer of cartilage that covers both the articulating bone surfaces, and an innervated but relatively avascular fibrous joint capsule. The inner surface of the capsule is lined by a synovial membrane that secretes the synovial fluid. The intervertebral disc has two articulating cartilaginous surfaces, the endplate cartilages that are separated by a second proteoglycan rich tissue the nucleus pulposus. Nucleus pulposus cells secrete and organize a complex extracellular matrix. The gel-like nucleus pulposus is surrounded circumferentially by a fibrocartilagenous annulus fibrosus. Sharpey fibers of the annulus are inserted into the end plate cartilages and the vertebral bone.

Intervertebral disc (A, B) and knee joint (C, D) from newborn mice were analyzed by in situ hybridization with isotope-labeled RNA probes for lubricin (B, D). It is evident that lubricin is expressed by the annulus fibrosus (af) and superficial zone chondrocytes of the articular cartilage. af, annulus fibrosus; np, nucleus pulposus; ep, endplate cartilage; fe, femur; ti, tibia, me, meniscus. Scale bars: 85 mm for A, B; 150 mm for C, D.

Plane joints permit sliding movements in the plane of articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement limited by their tight joint capsules. Plane joints are numerous and are nearly always small, such as the acromioclavicular joint between the acromion of the scapula and the clavicle. Typically, they are found in the wrists, ankles, the 2nd through 7th sternocostal joints, vertebral transverse and spinous processes.[1]

The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She was suffering from chronic pain and limited mobility of the shoulder joint due to adhesive shoulder capsulitis. She was treated with a multimodality approach with the goals of increasing shoulder range of motion and decreasing her pain. This did not provide significant improvement. The suprascapular nerve supplies motor and sensory innervation to the shoulder, and can be easily accessible in the supraspinatus fossa. A suprascapular nerve block dramatically decreased her pain. This clinical observation along with confirmatory nerve block play an important role during the decision-making process for a trial period of electrical neuromodulation. She was followed for 3 months after the permanent implantation of a suprascapular nerve stimulator. Her pain and shoulder range of motion in all planes improved dramatically. Peripheral nerve stimulation (PNS) of the suprascapular nerve, in addition to multimodality pain management, is one approach to the difficult task of treating adhesive capsulitis with accompanying pain and the inability to move the shoulder. We conducted a literature review on PubMed and found no case describing a similar patient to our knowledge.

In fibrous joints (synarthrodial joint) the bones are joined by fibrous tissue, namely dense fibrous connective tissue, and no joint cavity is present. The amount of movement allowed depends on the length of the connective tissue fibers uniting the bones. Although a few are slightly movable, most fibrous joints are immovable.

Cartilaginous joints are a type of joint where the bones are entirely joined by cartilage, either hyaline cartilage or fibrocartilage. These joints generally allow more movement than fibrous joints but less movement than synovial joints.

The primary purpose of the synovial joint is to prevent friction between the articulating bones of the joint cavity. While all synovial joints are diarthroses, the extent of movement varies among different subtypes and is often limited by the ligaments that connect the bones. Nearly all joints of the limbs and most joints of the body fall into this class.

A key structural characteristic for a synovial joint that is not seen at fibrous or cartilaginous joints is the presence of a joint cavity. The joint cavity contains synovial fluid, secreted by the synovial membrane (synovium), which lines the articular capsule. This fluid-filled space is the site at which the articulating surfaces of the bones contact each other. Hyaline cartilage forms the articular cartilage, covering the entire articulating surface of each bone. The articular cartilage and the synovial membrane are continuous. A few synovial joints of the body have a fibrocartilage structure located between the articulating bones. This is called an articular disc, which is generally small and oval-shaped, or a meniscus, which is larger and C-shaped.[1]

The bones entering into its formation are the hemispherical head of the humerus and the shallow glenoid cavity of the scapula, an arrangement which permits of very considerable movement, while the joint itself is protected against displacement by the tendons which surround it.

The ligaments do not maintain the joint surfaces in apposition, because when they alone remain the humerus can be separated to a considerable extent from the glenoid cavity; their use, therefore, is to limit the amount of movement.

The articular capsule completely encircles the joint, being attached, above, to the circumference of the glenoid cavity beyond the glenoidal labrum; below, to the anatomical neck of the humerus, approaching nearer to the articular cartilage above than in the rest of its extent. It is thicker above and below than elsewhere, and is so remarkably loose and lax, that it has no action in keeping the bones in contact, but allows them to be separated from each other more than 2.5 cm., an evident provision for that extreme freedom of movement which is peculiar to this articulation. It is strengthened, above, by the Supraspinatus; below, by the long head of the Triceps brachii; behind, by the tendons of the Infraspinatus and Teres minor; and in front, by the tendon of the Subscapularis. There are usually three openings in the capsule. One anteriorly, below the coracoid process, establishes a communication between the joint and a bursa beneath the tendon of the Subscapularis. The second, which is not constant, is at the posterior part, where an opening sometimes exists between the joint and a bursal sac under the tendon of the Infraspinatus. The third is between the tubercles of the humerus, for the passage of the long tendon of the Biceps brachii. 041b061a72


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