Factors Affecting Contact

and Range of Motion

at Synovial Joints
OBJECTIVE

Describe six factors that influence the type of movement

and range of motion possible at a synovial joint.

The articular surfaces of synovial joints contact one another

and determine the type and possible range of motion. Range of
motion (ROM) refers to the range, measured in degrees of a
circle, through which the bones of a joint can be moved. The following
factors contribute to keeping the articular surfaces in contact
and affect range of motion:
1. Structure or shape of the articulating bones. The structure or
shape of the articulating bones determines how closely they
can fit together. The articular surfaces of some bones have a
complementary relationship. This spatial relationship is very
obvious at the hip joint, where the head of the femur articulates
with the acetabulum of the hip bone. An interlocking fit
allows rotational movement.
2. Strength and tension (tautness) of the joint ligaments. The
different components of a fibrous capsule are tense or taut only
when the joint is in certain positions. Tense ligaments not only
restrict the range of motion but also direct the movement of the
articulating bones with respect to each other. In the knee joint,
for example, the anterior cruciate ligament is taut and the posterior
cruciate ligament is loose when the knee is straightened,
and the reverse occurs when the knee is bent. In the hip joint,
certain ligaments become taut when standing and more firmly
attach the head of the femur to the acetabulum of the hip bone.
3. Arrangement and tension of the muscles. Muscle tension reinforces
the restraint placed on a joint by its ligaments, and
thus restricts movement. A good example of the effect of
muscle tension on a joint is seen at the hip joint. When the
thigh is flexed with the knee extended, the flexion of the hip
joint is restricted by the tension of the hamstring muscles on
the posterior surface of the thigh, so most of us cant raise a
straightened leg more than a 90-degree angle from the floor.
But if the knee is also flexed, the tension on the hamstring
muscles is lessened, and the thigh can be raised farther, allowing
you to raise your thigh to touch your chest.
4. Contact of soft parts. The point at which one body surface
contacts another may limit mobility. For example, if you bend
your arm at the elbow, it can move no farther after the anterior
surface of the forearm meets with and presses against the
biceps brachii muscle of the arm. Joint movement may also be
restricted by the presence of adipose tissue.
5. Hormones. Joint flexibility may also be affected by hormones.
For example, relaxin, a hormone produced by the placenta and
ovaries, increases the flexibility of the fibrocartilage of the
pubic symphysis and loosens the ligaments between the
sacrum, hip bone, and coccyx toward the end of pregnancy.
These changes permit expansion of the pelvic outlet, which
assists in delivery of the baby.
6. Disuse. Movement at a joint may be restricted if a joint has not

been used for an extended period. For example, if an elbow

joint is immobilized by a cast, range of motion at the joint may
be limited for a time after the cast is removed. Disuse may also
result in decreased amounts of synovial fluid, diminished
flexibility of ligaments and tendons, and muscular atrophy, a
reduction in size or wasting of a muscle.
CHECKPOINT

11. How do the strength and tension of ligaments

determine range of motion?

9.8 Selected Joints of the Body

OBJECTIVE

Identify the major joints of the body by location,

classification, and movements.

In Chapters 7 and 8, we discussed the major bones and their markings.

In this chapter we have examined how joints are classified
according to their structure and function, and we have introduced
the movements that occur at joints. Table 9.3 (selected joints of
the axial skeleton) and Table 9.4 (selected joints of the appendicular
skeleton) will help you integrate the information you have
learned in all three chapters. These tables list some of the major
joints of the body according to their articular components (the
bones that enter into their formation), their structural and functional
classification, and the type(s) of movement that occur(s) at
each joint.
Next we examine in detail several selected joints of the body in
a series of exhibits. Each exhibit considers a specific synovial
joint and contains (1) a definitiona description of the type
of joint and the bones that form the joint; (2) the anatomical
componentsa description of the major connecting ligaments,
articular disc (if present), articular capsule, and other distinguishing
features of the joint; and (3) the joints possible movements.
Each exhibit also refers you to a figure that illustrates the joint.
The joints described are the temporomandibular joint (TMJ),
shoulder (humeroscapular or glenohumeral) joint, elbow joint,
hip (coxal) joint, and knee (tibiofemoral) joint. Because these
joints are described in Exhibits 9.A9.E (Figures 9.119.15), they
are not included in Tables 9.3 and 9.4.

Temporomandibular Joint
Defi nition
The temporomandibular joint (TMJ) (tem_-po-ro-man-DIB-ular) is a combined hinge and plane joint formed by the condylar
process of the mandible and the mandibular fossa and articular
tubercle of the temporal bone. The temporomandibular joint is the
only freely movable joint between skull bones (with the exception
of the ear ossicles); all other skull joints are sutures and therefore
immovable or slightly movable.

Anatomical Components

1. Articular disc (meniscus). Fibrocartilage disc that separates

the synovial cavity into superior and inferior compartments,

each with a synovial membrane (Figure 9.11c).
2. Articular capsule. Thin, fairly loose envelope around the circumference
of the joint (Figure 9.11a, b).
3. Lateral ligament. Two short bands on the lateral surface of
the articular capsule that extend inferiorly and posteriorly
from the inferior border and tubercle of the zygomatic process
of the temporal bone to the lateral and posterior aspect of
the neck of the mandible. The lateral ligament is covered by
the parotid gland and helps strengthen the joint laterally and
prevent displacement of the mandible (Figure 9.11a).
4. Sphenomandibular ligament (sfe-no-man-DIB-u-lar). Thin
band that extends inferiorly and anteriorly from the spine of the
sphenoid bone to the ramus of the mandible (Figure 9.11b). It
does not contribute significantly to the strength of the joint.
5. Stylomandibular ligament (st-lo-man-DIB-u-lar). Thickened
band of deep cervical fascia that extends from the styloid
process of the temporal bone to the inferior and posterior
border of the ramus of the mandible. This ligament separates
the parotid gland from the submandibular gland and limits
movement of the mandible at the TMJ (Figure 9.11a, b).

Movements

In the temporomandibular joint, only the mandible moves because

the temporal bone is firmly anchored to other bones of the skull by
sutures. Accordingly, the mandible may function in depression
(jaw opening) and elevation (jaw closing), which occurs in the inferior
compartment, and protraction, retraction, lateral displacement,
and slight rotation, which occur in the superior compartment
(see Figure 9.9ad).

Shoulder Joint
Definition
The shoulder joint is a ball-and-socket joint formed by the head of
the humerus and the glenoid cavity of the scapula. It is also referred
to as the humeroscapular or glenohumeral joint (gle-no-HU-mer-al).

Anatomical Components
1. Articular capsule. Thin, loose sac that completely envelops
the joint and extends from the glenoid cavity to the anatomical
neck of the humerus. The inferior part of the capsule is its
weakest area (Figure 9.12).
2. Coracohumeral ligament (kor_-a-ko-HU -mer-al). Strong, broad
ligament that strengthens the superior part of the articular capsule
and extends from the coracoid process of the scapula to
the greater tubercle of the humerus (Figure 9.12a, b). The
ligament strengthens the superior part of the articular capsule
and reinforces the anterior aspect of the articular capsule.
3. Glenohumeral ligaments. Three thickenings of the articular
capsule over the anterior surface of the joint that extend
from the glenoid cavity to the lesser tubercle and anatomical

neck of the humerus. These ligaments are often indistinct or

absent and provide only minimal strength (Figure 9.12a, b).
They play a role in joint stabilization when the humerus approaches
or exceeds its limits of motion.
4. Transverse humeral ligament. Narrow sheet extending from
the greater tubercle to the lesser tubercle of the humerus
(Figure 9.12a). The ligament functions as a retinaculum
(retaining band of connective tissue) to hold the long head of
the biceps brachii muscle.
5. Glenoid labrum. Narrow rim of fibrocartilage around the edge
of the glenoid cavity that slightly deepens and enlarges the
glenoid cavity (Figure 9.12b, c).
6. Bursae. Four bursae (see Section 9.4) are associated with the
shoulder joint. They are the subscapular bursa (Figure 9.12a),
subdeltoid bursa, subacromial bursa (Figure 9.12ac), and
subcoracoid bursa.

Movements
The shoulder joint allows flexion, extension, hyperextension,
abduction, adduction, medial rotation, lateral rotation, and circumduction
of the arm (see Figures 9.59.8). It has more freedom
of movement than any other joint of the body. This freedom
results from the looseness of the articular capsule and the
shallowness of the glenoid cavity in relation to the large size of
the head of the humerus.
Although the ligaments of the shoulder joint strengthen it to
some extent, most of the strength results from the muscles that
surround the joint, especially the rotator cuff muscles. These
muscles (supraspinatus, infraspinatus, teres minor, and subscapularis)
anchor the humerus to the scapula (see also Figure 11.15).
The tendons of the rotator cuff muscles encircle the joint (except
for the inferior portion) and intimately surround the articular
capsule. The rotator cuff muscles work as a group to hold the
head of the humerus in the glenoid cavity.

Elbow Joint
The elbow joint is a hinge joint formed by the trochlea and capitulum
of the humerus, the trochlear notch of the ulna, and the
head of the radius.

Anatomical Components

1. Articular capsule. The anterior part of the articular capsule covers

the anterior part of the elbow joint, from the radial and coronoid
fossae of the humerus to the coronoid process of the ulna and
the anular ligament of the radius. The posterior part extends from
the capitulum, olecranon fossa, and lateral epicondyle of the humerus
to the anular ligament of the radius, the olecranon of the
ulna, and the ulna posterior to the radial notch (Figure 9.13a, b).
2. Ulnar collateral ligament. Thick, triangular ligament that extends
from the medial epicondyle of the humerus to the coronoid
process and olecranon of the ulna (Figure 9.13a). Part of this
ligament deepens the socket for the trochlea of the humerus.
3. Radial collateral ligament. Strong, triangular ligament that

extends from the lateral epicondyle of the humerus to the anular

ligament of the radius and the radial notch of the ulna
(Figure 9.13b).
4. Anular ligament of the radius. Strong band that encircles the
head of the radius. It holds the head of the radius in the radial
notch of the ulna (Figure 9.13a, b).

Movements
The elbow joint allows flexion and extension of the forearm (see
Figure 9.5c).

Hip Joint
Defi nition
The hip joint (coxal joint) is a ball-and-socket joint formed by
the head of the femur and the acetabulum of the hip bone.

Anatomical Components
1. Articular capsule. Very dense and strong capsule that extends
from the rim of the acetabulum to the neck of the femur
(Figure 9.14c). With its accessory ligaments, this is one of the
strongest structures of the body. The articular capsule consists
of circular and longitudinal fibers. The circular fibers, called
the zona orbicularis, form a collar around the neck of the femur.
Accessory ligaments known as the iliofemoral ligament,
pubofemoral ligament, and ischiofemoral ligament reinforce
the longitudinal fibers of the articular capsule.
2. Iliofemoral ligament (il_-e-o-FEM-o-ral). Thickened portion
of the articular capsule that extends from the anterior inferior
iliac spine of the hip bone to the intertrochanteric line of the
femur (Figure 9.14a, b). This ligament is said to be the bodys
strongest and prevents hyperextension of the femur at the hip
joint during standing.
3. Pubofemoral ligament (pu_-bo-FEM-o-ral). Thickened portion
of the articular capsule that extends from the pubic part of
the rim of the acetabulum to the neck of the femur
(Figure 9.14a). This ligament prevents overabduction of the
femur at the hip joint and strengthens the articular capsule.
4. Ischiofemoral ligament (is_-ke-o-FEM-o-ral). Thickened portion
of the articular capsule that extends from the ischial wall
bordering the acetabulum to the neck of the femur (Figure
9.14b). This ligament slackens during adduction, tenses during
abduction, and strengthens the articular capsule.
5. Ligament of the head of the femur. Flat, triangular band (primarily
a synovial fold) that extends from the fossa of the acetabulum
to the fovea capitis of the head of the femur (Figure 9.14c).
The ligament usually contains a small artery that supplies the
head of the femur.
6. Acetabular labrum (as-e-TAB-u-lar LA -brum). Fibrocartilage
rim attached to the margin of the acetabulum that enhances the
depth of the acetabulum (Figure 9.14c). As a result, dislocation
of the femur is rare.

7. Transverse ligament of the acetabulum. Strong ligament that

crosses over the acetabular notch. It supports part of the acetabular
labrum and is connected with the ligament of the head
of the femur and the articular capsule (Figure 9.14c).

Movements
The hip joint allows flexion, extension, abduction, adduction,
lateral rotation medial rotation, and circumduction of the thigh
(see Figures 9.59.8). The extreme stability of the hip joint is
related to the very strong articular capsule and its accessory ligaments,
the manner in which the femur fits into the acetabulum,
and the muscles surrounding the joint. Although the shoulder and
hip joints are both ball-and-socket joints, the hip joints do not
have as wide a range of motion. Flexion is limited by the anterior
surface of the thigh coming into contact with the anterior abdominal
wall when the knee is flexed and by tension of the hamstring
muscles when the knee is extended. Extension is limited
by tension of the iliofemoral, pubofemoral, and ischiofemoral
ligaments. Abduction is limited by the tension of the pubofemoral
ligament, and adduction is limited by contact with the opposite
limb and tension in the ligament of the head of the femur.
Medial rotation is limited by the tension in the ischiofemoral
ligament, and lateral rotation is limited by tension in the iliofemoral
and pubofemoral ligaments.

Knee Joint
BJECTIVE

Describe the main anatomical components of the knee joint

and explain the movements that can occur at this joint.

Defi nition
The knee joint (tibiofemoral joint) is the largest and most complex
joint of the body (Figure 9.15). It is a modified hinge joint
(because its primary movement is a uniaxial hinge movement)
that consists of three joints within a single synovial cavity:
1. Laterally is a tibiofemoral joint, between the lateral condyle of
the femur, lateral meniscus, and lateral condyle of the tibia,
which is the weight-bearing bone of the leg.
2. Medially is another tibiofemoral joint, between the medial condyle
of the femur, medial meniscus, and medial condyle of the tibia.
3. An intermediate patellofemoral joint is between the patella
and the patellar surface of the femur.

Anatomical Components
1. Articular capsule. No complete, independent capsule unites the
bones of the knee joint. The ligamentous sheath surrounding the
joint consists mostly of muscle tendons or their expansions
(Figure 9.15eg). There are, however, some capsular fibers connecting
the articulating bones.
2. Medial and lateral patellar retinacula (ret_-i-NAK-u-la).
Fused tendons of insertion of the quadriceps femoris muscle
and the fascia lata (fascia of thigh) that strengthen the anterior
surface of the joint (Figure 9.15e).
3. Patellar ligament. Continuation of common tendon of insertion
of quadriceps femoris muscle that extends from the patella
to the tibial tuberosity. Also strengthens the anterior surface

of the joint. Posterior surface of the ligament is separated

from the synovial membrane of the joint by an infrapatellar fat
pad (Figure 9.15ce).
4. Oblique popliteal ligament (pop-LIT-e-al). Broad, flat ligament
that extends from the intercondylar fossa and lateral
condyle of the femur to the head and medial condyle of the
tibia (Figure 9.15f, h). The ligament strengthens the posterior
surface of the joint.
5. Arcuate popliteal ligament. Extends from lateral condyle of
femur to styloid process of the head of the fibula. Strengthens
the lower lateral part of the posterior surface of the joint
(Figure 9.15f).
6. Tibial collateral ligament. Broad, flat ligament on the medial
surface of the joint that extends from the medial condyle of the
femur to the medial condyle of the tibia (Figure 9.15a, eh).
Tendons of the sartorius, gracilis, and semitendinosus muscles,
all of which strengthen the medial aspect of the joint, cross the
ligament. The tibial collateral ligament is firmly attached to the
medial meniscus.
7. Fibular collateral ligament. Strong, rounded ligament on the
lateral surface of the joint that extends from the lateral condyle of
the femur to the lateral side of the head of the fibula (Figure 9.15a,
eh). It strengthens the lateral aspect of the joint. The ligament is
covered by the tendon of the biceps femoris muscle. The tendon
of the popliteal muscle is deep to the ligament.
8. Intracapsular ligaments (in_-tra-KAP-su-lar). Ligaments
within capsule connecting tibia and femur. The anterior and
posterior cruciate ligaments (KROO-she-at _ like a cross)
are named based on their origins relative to the intercondylar
area of the tibia. From their origins, they cross on their way to
their destinations on the femur.
a. Anterior cruciate ligament (ACL). Extends posteriorly and
laterally from a point anterior to the intercondylar area of
the tibia to the posterior part of the medial surface of the
lateral condyle of the femur (Figure 9.15a, b, h). The ACL
limits hyperextension of the knee (which normally does not
occur at this joint) and prevents the anterior sliding of the
tibia on the femur. This ligament is stretched or torn in
about 70% of all serious knee injuries.
ACL injuries are much more common in females than
males, perhaps as much as 3 to 6 times. The reasons are unclear
but may be related to less space between the femoral
condyle in females so that the space for ACL movement is
limited; the wider pelvis of females that creates a greater angle
between the femur and tibia and increases the risk for an
ACL tear; female hormones that allow for greater flexibility
of ligaments, muscles, and tendons but which do not permit
them to absorb the stresses put on them, thus transferring the
stresses to the ACL; and females lesser muscle strength causing
them to rely more on the ACL to hold the knee in place.
b. Posterior cruciate ligament (PCL). Extends anteriorly and
medially from a depression on the posterior intercondylar
area of the tibia and lateral meniscus to the anterior part of
the lateral surface of the medial condyle of the femur
(Figure 9.15a, b, h). The PCL prevents the posterior sliding
of the tibia (and anterior sliding of the femur) when the knee

is flexed. This is very important when walking down stairs

or a steep incline.
9. Articular discs (menisci). Two fibrocartilage discs between
the tibial and femoral condyles help compensate for the irregular
shapes of the bones and circulate synovial fluid.
a. Medial meniscus. Semicircular piece of fibrocartilage
(C-shaped). Its anterior end is attached to the anterior intercondylar
fossa of the tibia, anterior to the anterior cruciate ligament.
Its posterior end is attached to the posterior intercondylar
fossa of the tibia between the attachments of the posterior
cruciate ligament and lateral meniscus (Figure 9.15a, b, d, h).
b. Lateral meniscus. Nearly circular piece of fibrocartilage
(approaches an incomplete O in shape) (Figure 9.15a, b, d, h).
Its anterior end is attached anteriorly to the intercondylar
eminence of the tibia, and laterally and posteriorly to the
anterior cruciate ligament. Its posterior end is attached
posteriorly to the intercondylar eminence of the tibia, and
anteriorly to the posterior end of the medial meniscus. The
anterior surfaces of the medial and lateral menisci are connected
to each other by the transverse ligament of the knee
(Figure 9.15a) and to the margins of the head of the tibia by
the coronary ligaments (not illustrated).
10. The more important bursae of the knee include the following:
a. Prepatellar bursa between the patella and skin (Figure
9.15c, d).
b. Infrapatellar bursa between superior part of tibia and patellar
ligament (Figure 9.15ce).
c. Suprapatellar bursa between inferior part of femur and deep
surface of quadriceps femoris muscle (Figure 9.15ce).

Movements
The knee joint allows flexion, extension, slight medial rotation,
and lateral rotation of the leg in the flexed position (see Figures
9.5f and 9.8c).

Aging and Joints

OBJECTIVE

Explain the effects of aging on joints.

Aging usually results in decreased production of synovial fluid in

joints. In addition, the articular cartilage becomes thinner with
age, and ligaments shorten and lose some of their flexibility. The
effects of aging on joints are influenced by genetic factors and by
wear and tear, and vary considerably from one person to another.
Although degenerative changes in joints may begin as early as age
20, most changes do not occur until much later. By age 80, almost
everyone develops some type of degeneration in the knees, elbows,
hips, and shoulders. It is also common for elderly individuals to
develop degenerative changes in the vertebral column, resulting in
a hunched-over posture and pressure on nerve roots. One type of
arthritis, called osteoarthritis (see Disorders: Homeostatic Imbalances
at the end of this chapter), is at least partially age-related.
Nearly everyone over age 70 has evidence of some osteoarthritic
changes. Stretching and aerobic exercises that attempt to maintain
full range of motion are helpful in minimizing the effects of aging.
They help to maintain the effective functioning of ligaments, tendons,

muscles, synovial fluid, and articular cartilage.

CHECKPOINT

18. Which joints show evidence of degeneration in nearly

all individuals as aging progresses?

9.10 Arthroplasty
OBJECTIVE

Explain the procedures involved in arthroplasty, and

describe how a total hip replacement is performed.

Joints that have been severely damaged by diseases such as arthritis,

or by injury, may be replaced surgically with artificial joints in
a procedure referred to as arthroplasty (AR-thro-plas_-te; arthr- _
joint; -plasty _ plastic repair of). Although most joints in the
body can be repaired by arthroplasty, the ones most commonly
replaced are the hips, knees, and shoulders. About 400,000 hip
replacements and about 300,000 knee replacements are performed
annually in the United States. During the procedure, the ends of
the damaged bones are removed and metal, ceramic, or plastic
components are fixed in place. The goals of arthroplasty are to
relieve pain and increase range of motion.

Hip Replacements
Partial hip replacements involve only the femur. Total hip replacements
involve both the acetabulum and head of the femur
(Figure 9.16ac). The damaged portions of the acetabulum and the
head of the femur are replaced by prefabricated prostheses (artificial
devices). The acetabulum is shaped to accept the new socket, the
head of the femur is removed, and the center of the femur is shaped
to fit the femoral component. The acetabular component consists of
a plastic such as polyethylene, and the femoral component is composed
of a metal such as cobalt-chrome, titanium alloys, or stainless
steel. These materials are designed to withstand a high degree of
stress and to prevent a response by the immune system. Once the
appropriate acetabular and femoral components are selected, they
are attached to the healthy portion of bone with acrylic cement,
which forms an interlocking mechanical bond.

Knee Replacements
Knee replacements are actually a resurfacing of cartilage and,
like hip replacements, may be partial or total. In a total knee replacement,
the damaged cartilage is removed from the distal end
of the femur, the proximal end of the tibia, and the back surface of
the patella (if the back surface of the patella is not badly damaged,
it may be left intact) (Figure 9.16df). The femur is reshaped and
fitted with a metal femoral component and cemented in place.
The tibia is reshaped and fitted with a plastic tibial component
that is cemented in place. If the back surface of the patella is badly
damaged, it is replaced with a plastic patellar implant.
In a partial knee replacement, also called a unicompartmental
knee replacement, only one side of the knee joint is replaced.
Once the damaged cartilage is removed from the distal end of the
femur, the femur is reshaped and a metal femoral component is
cemented in place. Then the damaged cartilage from the proximal
end of the tibia is removed, along with the meniscus. The tibia is
reshaped and fitted with a plastic tibial component that is cemented
into place. If the back surface of the patella is badly damaged, it
is replaced with a plastic patellar component.
Researchers are continually seeking to improve the strength of

the cement and devise ways to stimulate bone growth around the
implanted area. Potential complications of arthroplasty include
infection, blood clots, loosening or dislocation of the replacement
components, and nerve injury. With increasing sensitivity of metal detectors at airports and
other public areas, it is possible that metal joint replacements may
activate metal detectors.