Intra-articular fibrocartilages
Intra-articular fibrocartilages are complete or incomplete plates of fibrocartilage that are attached to the joint capsule (the investing ligament) and that stretch across the joint cavity between a pair of conarticular surfaces. When complete they are called disks; when incomplete they are called menisci. Disks are found in the temporomandibular joint of the lower jaw, the sternoclavicular (breastbone and collarbone) joint, and the ulnocarpal (inner forearm bone and wrist) joint. A pair of menisci is found in each knee joint, one between each femoral condyle and its female tibial counterpart. A small meniscus is found in the upper part of the acromioclavicular joint at the top of the shoulder. These fibrocartilages are really parts of the fibrous layer of the diarthrosis in which they occur, and they effect a complete or partial division of the articular bursa into two parts, depending upon whether they are disks or menisci, respectively. When the division is complete, there are really two synovial joints—e.g., the sternodiskal and the discoclavicular.
A disk or meniscus is mostly fibrocartilage, the chondrification being slight and the fibrous element predominating, especially in the part nearest to the investing ligament. Both animal experiments and surgical experience have shown that a meniscus of the knee can regrow if removed. The function of these intra-articular plates is to assist the gliding movements of the bones at the joints that contain them.
The synovial layer
The inner layer of the articular joint capsule is called the synovial layer (stratum synoviale) because it is in contact with the synovial fluid. Unlike the fibrous layer, it is incomplete and does not extend over the articulating parts of the articular cartilages and the central parts of articular disks and menisci.
The layer, commonly called the synovial membrane, is itself divisible into two strata, the intima and the subintima. The intima is smooth and moist on its free (synovial) surface. It could be described as an elastic plastic in which cells are embedded. Its elasticity allows it to stretch when one of the articulating bones either spins or swings to the opposite side and to return to its original size when the movement of the bone is reversed.
The cells of a synovial membrane can be divided into two classes: synovial lining cells and protective cells. The synovial lining cells are responsible for the generation and maintenance of the matrix. Their form depends upon their location. They are flattened and rounded at or near the internal surface of the membrane, more elongated and spindle-shaped elsewhere. They appear to be quite mobile and able to make their way to the free surface of the membrane. Excepting the regions in which the synovial membrane passes from the investing ligament (fibrous capsule) to the synovial periostea, these cells are scattered and do not form a continuous surface layer as do, for example, the cells lining the inner surface of the gut or of a blood vessel. In this respect they resemble the cells of other connective tissues, such as bone and cartilage. Apart from the generation and maintenance of the matrix of the membrane, they also can ingest foreign material and thus have a phagocytic function. They seem to be the only cells capable of secreting hyaluronic acid, the characteristic component of synovial fluid.
The protective cells are scattered through the depths of the membrane. They are of two kinds: mast cells and phagocytes. The mast cells secrete heparin and play the same part in synovial membrane as they do elsewhere—for example, in the skin and the gums. The phagocytes ingest unwanted particles, even such large ones as those of injected India ink; they are, in short, scavengers here as elsewhere.
The subintima is the connective tissue base on which the intima lies; it may be fibrous, fatty, or areolar (loose). In it are found the blood vessels and nerves that have penetrated the fibrous layer. Both the blood vessels and the nerves form plexuses, to be described later. The areolar subintima forms folds (synovial fringes) or minute fingerlike projections (villi) that project into the synovial fluid. The villi become more abundant in middle and old age. The fatty parts of the subintima may be quite thin, but in all joints there are places where they project into the bursal cavity as fatty pads (plicae adiposae); these are wedge-shaped in section, like a meniscus, with the base of the wedge against the fibrous capsule. The fatty pads are large in the elbow, knee, and ankle joints.
The function of fatty pads depends upon the fact that fat is liquid in a living body and that, therefore, a mass of fat cells is easily deformable. When a joint is moved, the synovial fluid is thrown into motion because it is adhesive to the articular cartilages, the motion of the fluid being in the direction of motion of the moving part. The fatty pads project into those parts of the synovial space in which there would be a likelihood of an eddying (vortical) motion of the fluid if those parts were filled with fluid. In short, the pads contribute to the “internal streamlining” of the joint cavity. Their deformability enables them to do this effectively. Of equal importance is the fact that the fatty pads by their very presence keep the synovial fluid between the immediately neighbouring parts of the male and female surfaces sufficiently thin, with proper elasticity as well as viscosity, to lubricate the joint.
Fatty pads are well provided with elastic fibres that bring about recovery from the deformation caused by pressure across a moving joint and that prevent the pads from being squeezed between two conarticular surfaces at rest. Such squeezing can happen, however, as the result of an accident and is very painful because of the large number of pain nerve fibres in these pads.
The synovial fluid
The main features of synovial fluid are: (1) Chemically, it is a dialyzate (a material subjected to dialysis) of blood plasma—that is, the portion of the plasma that has filtered through a membrane—but it contains a larger amount of hyaluronic acid than other plasma dialyzates. (2) Physically, it is a markedly thixotropic fluid—that is, one that is both viscous and elastic. Its viscosity decreases with an increase in the speed of the fluid when it is in motion. Its elasticity, on the other hand, increases with an increase in the speed of the fluid. Its thixotropy is due to the hyaluronic acid in it. (3) Functionally, it has two parts to play: nutrition and lubrication. It has been established that synovial fluid alone, by virtue of its being a blood-plasma dialyzate, can nourish the articulating parts of the articular cartilages. Its thixotropic properties make it suitable for forming what are called elastohydrodynamic lubricant films between the moving and the fixed conarticular surfaces of any mating pair. The motion of the synovial fluid, referred to earlier in connection with the fatty pads, assists its nutritional function by distributing it over the articular surfaces, from which it slowly passes into the interior of the cartilage. The source of the hyaluronic acid is the synovial lining cells.
Types of synovial joints
Recognition of the bursal nature of synovial joints makes it possible to describe them simply in terms of the bursal wall and to group together a number of types of structures. There are seven types of synovial joints: plane, hinge, pivot, sellar, ellipsoid, spheroidal (ball-and-socket), and bicondylar (two articulating surfaces). This classification is based on the anatomical form of the articular surfaces.
Plane joint
The plane, or arthrodial, joint has mating surfaces that are slightly curved and may be either ovoid or sellar. Only a small amount of gliding movement is found. Examples are the joints between the metacarpal bones of the hand and those between the cuneiform bones of the foot.
Hinge joint
The hinge, or ginglymus, joint is a modified sellar joint with each mating surface ovoid on its right and left sides. This modification reduces movement to a backward-forward swing like that allowed by the hinge of a box or a door. The swing of the joint, however, differs from that of a hinge in that it is accompanied by a slight spin (rotation) of the moving bone around its long axis. This brings the joint either into or out of its close-packed position, which is always that of extension. The joints between the bones of the fingers (phalanges) and that between the ulna (inner bone of the forearm) and the humerus at the elbow are classic examples.
Pivot joint
The pivot, or trochoid, joints are of two forms: in one a pivot rotates within a ring; in the other a ring moves around a pivot. In each case the ring is composed of fibrous tissue, part of which is converted into cartilage to form a female surface; the remainder may be ossified. Similarly, only part of the pivot is covered by a male articular cartilage. Pivot joints are always of the ovoid class; from a functional aspect, they are the ovoid counterparts of hinge joints. The joint between the atlas and the axis (first and second cervical vertebrae), directly under the skull, allows for turning of the head from side to side. Pivot joints also provide for the twisting movement of the bones of the forearm (radius and ulna) against the upper arm, a movement used, for instance, in unscrewing the lid of a jar.
Sellar joint
The sellar joint has already been described in the section Articular cartilage. It has two types of movement, both swings: flexion-extension and abduction-adduction. In addition to these it allows movements combining these two—that is, swings accompanied by rotation of the moving bone. An example of a sellar joint is the carpometacarpal joint of the thumb. The thumb can be swung from side to side or from behind forward, but the most frequent movement is that in which the thumb swings so that it comes “face to face” with one or another of the fingers, as in grasping a needle or a ball. This movement is called opposition (i.e., of thumb to fingers). During opposition the thumb is rotated around its long axis; it has been said that human civilization depends upon the opposition of the thumb.
Ellipsoid joint
The ellipsoid joint also has two types of movement but allows opposition movement only to a small degree. Its surfaces are ovoid and vary in both length and curvature as they are traced from front to back or from side to side, just as the diameter and curvature of an ellipse vary in directions at right angles to each other (hence the name). The joint between the second metacarpal and the first phalanx of the second finger is a good example. It allows the finger to flex and extend, to swing toward or away from its neighbouring finger, and to swing forward with a slight amount of rotation.
Ball-and-socket joint
The ball-and-socket joint, also known as a spheroidal joint, is the only one with three types of movement. It is an ovoid joint the male element of which could be described as a portion of a slightly deformed sphere. The rounded surface of the bone moves within a depression on another bone, thus allowing greater freedom of movement than any other kind of joint. It is most highly developed in the large hip and shoulder joints of mammals, including humans, in which it provides swing for the arms and legs in various directions and also spin of those limbs upon the more stationary bones.
