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StatPearls . Endowment Island (FL): StatPearls Publishing; 2021 Jan-.


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Introduction

A hinge joint is a kind of synovial joint the exists in the body and serves to permit motion primarily in one plane.<1> The hinge share is consisted of of two or an ext bones with articular surface that space covered by hyaline cartilage and lubricated through synovial fluid.<2> Stabilization of every hinge share is by muscles, ligaments, and also other connective tissues, such together the share capsule.<3><4> The hinge joints that the body incorporate the elbow, knee, interphalangeal (IP) joints that the hand and also foot and also the tibiotalar share of the ankle.


Structure and also Function

Hinge joints role by allowing flexion and extension in one plane with little degrees of movement in various other planes.<4> The hinge joint is an important component of the complex biomechanics that the human being body.<1> The knee, elbow, and ankle deserve to support huge amounts of force and assist in the performance of work. Interphalangeal joints room smaller and also contribute primarily to dexterity.<5> A hinge share is much more stable 보다 a ball and also socket joint yet offers much less mobility.


Embryology

Hinge joints start to construct as body buds roughly week 4 the embryogenesis.<6> In the adhering to weeks, the body buds proceed to grow, and mesenchyme creates into hyaline cartilage, which develops models that the limb bones.<2> Synovial joints type from one area dubbed the share interzone within the cartilaginous models. Dead cells within the interzone form the joint cavity, and the neighboring mesenchyme creates the share capsule and ligaments. Approximately the twelfth mainly of development, the process of endochondral ossification begins to transform many of the cartilaginous model into bone. At birth, hyaline cartilage continues to be on the articular surface of joints and also as the epiphyseal plate, which allows for the growth of bones.<7><2>


Blood Supply and Lymphatics

Elbow 

The structures of the elbow receive lot of their blood it is provided from branches that the brachial, radial, and ulnar arteries that form a series of anastomosis around the joint. Most of the elbow lymphatics follow the vasculature and flow to the axillary, clavicular, and cervical lymph nodes. Several of the lymphatics indigenous the forearm and also hand flow through the cubital nodes.<8><5><3>

Knee

The frameworks of the knee receive much of their blood it is provided from a plexus of arteries v branches indigenous the popliteal artery and also femoral artery. The genicular arteries and tibial recurrent arteries room the key contributing branches. Much of the lymphatic drainage native the knee complies with vasculature and also travels to the popliteal and also inguinal lymph nodes.<4><8>

IP Hand

The IP joints the the hand obtain blood supply from branches the the radial and also ulnar arteries. The major contributing branches space the superficial and deep palmar arches. Lymphatics travel superiorly follow me the upper extremity come the cubital, axillary, cervical, and also clavicular lymph nodes.<8><5>

IP Foot

The IP joints of the foot receive blood it is provided from branches of the anterior and also posterior tibial arteries. The major contributing branches room the dorsal and plantar metatarsal arteries. Lymphatics flow superiorly increase the reduced limb v the popliteal and also inguinal lymph nodes.<9><8>

Ankle

The frameworks of the ankle receive lot of their blood it is provided from anastomosis between branches that the anterior and posterior tibial and fibular arteries. Lymphatics flow superiorly increase the reduced limb through the popliteal and inguinal lymph nodes.<9><8>


Nerves

Elbow

The materials of the elbow receive innervation indigenous branches that the median, radial, ulnar, and also musculocutaneous nerves.<5><3><10>

Knee

The components of the knee obtain innervation from branches of the femoral nerve (L1, L2, L3) and also the sciatic nerve (L4, L5, S1, S2, S3), i m sorry branches into the tibial nerve and also common peroneal nerve.<4> 

IP

The IP joints of the hand obtain innervation indigenous branches of the radial, median, and ulnar nerves. The IP joints that the foot obtain innervation indigenous branches of the tibial, sural, and fibular nerves.<5><10><11>

Ankle

The contents of the ankle receive innervation indigenous branches of the tibial, sural, fibular, and also saphenous nerves.<12>


Muscles

Elbow

Flexion is generally the duty of the brachialis, biceps brachii, and also brachioradialis muscles, which originate ~ above various places of the humerus and scapula and also insert on portions of the radius and ulna. Extension is primarily completed by the triceps brachii and also anconeus muscles, which originate indigenous various places on the humerus and also scapula and insert on parts of the ulna.<5><3>

Knee

Flexion is do possible, primarily, through the articularis genus, rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. These muscles originate indigenous various locations on the femur and also anterior worse iliac spine. The vastus lateralis, vastus intermedius, and also vastus medialis conjoin to type the patellar tendon, which crosses the knee anteriorly and inserts ~ above the patella and also tibial tuberosity. Extension is predominately the duty of the biceps femoris, semitendinosus, semimembranosus, gastrocnemius, plantaris, gracilis, and popliteus.<13><14> These muscles originate native the ischial tuberosity, worse pubic ramus, and also different places on the femur. They insert on various locations of the tibia, fibula, and calcaneus.<4>

IP hand

Flexion of the hand IP joints generally occurs with the features of the flexor digitorum profundus, flexor pollicis longus, and flexor digitorum superficialis. Castle originate from various areas of the radius, ulna, interosseous membrane, and medial epicondyle, and also insert on portions of the phalanges. Expansion of the hand IP joints is noted by the extensor pollicis longus, extensor pollicis brevis, extensor digitorum, extensor indicis, and also extensor digiti minimi. Lock originate from various places of the radius, ulna, interosseous membrane, and lateral epicondyle, and insert on parts of the phalanges.<5><15>

IP foot

Flexion that the foot IP joints an outcome from the action of the flexor digitorum longus and also brevis, flexor hallucis longus and also brevis, quadratus plantae, and flexor digiti minimi brevis. Castle originate from various locations of the tibia, fibula, and calcaneus, and also insert on sections of the phalanges. Extension of the foot IP joints is mostly the duty of the extensor digitorum longus and also brevis, lumbricals, and also extensor hallucis longus muscles, i beg your pardon originate top top the tibia, calcaneus, flexor tendons, and also fibula, and also insert on parts of the phalanges.<12><16>

Ankle

Plantarflexion and also inversion an outcome from the plot of the gastrocnemius, plantaris, soleus, tibialis posterior, and also anterior. They originate from various places of the femur, tibia, and also fibula, and also insert on portions of the calcaneus, navicular, medial cuneiform, and metatarsal bones. Dorsiflexion and also eversion happen as features of the tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus brevis, and longus. Castle originate from various places on the tibia and fibula and insert on sections of the phalanges, metatarsals, and medial cuneiform bones.<16><17>


Physiologic Variants

During the pathologic process of IP joint osteoarthritis (OA), the proximal interphalangeal joint (PIP) establishes Bouchard’s nodes, and the distal interphalangeal joint (DIP) establishes Heberden’s nodes. These nodes room bony and also gelatinous outgrowths that the share articular cartilage. Rheumatoid arthritis (RA) is another condition that can cause deformities of the PIP and DIP joints.<18> The inflammatory IP share degeneration that RA deserve to lead to swan neck deformity which entails hyperextension that the proximal interphalangeal joint and flexion at the emboldened joint. Every one of these deformities to decrease motion and functionality.

Rickets is a an illness consisting of weak bones the most regularly occurs due to vitamin D deficiency in children. This an illness can greatly affect the knee joint as a dilute bone of the femur and also tibia permit for the advancement of varus bowing in the reduced extremities that transforms the biomechanics of the knee hinge joint.<1><19>


Surgical Considerations

All fractures that involve any surface of a hinge share are considered for surgery to maintain functional integrity and to assist prevent OA.<20> Injuries that compromise particular surrounding muscles, tendons, and also ligaments can be thought about for surgical procedure as well, to keep stability and also functionality.<21><17> Arthroscopy is mainly used to treat ligamentous and also meniscal injuries of the knee. End-stage OA the the knee can be treated with a knee replacement that involves reshaping the distal finish of the femur and proximal end of the tibia to it is in fitted v prosthetics, v a spacer placed between the two prosthetics. The knee continues to role primarily as a hinge joint.


Clinical Significance

The hinge joints, as with most joints of the body have the right to undergo degeneration the articular cartilage and also develop OA, specifically the knee and also IP joints that the hands and also feet. Trauma, task level, weight, lifestyle, and genetics all play a function in the advance of OA. Therapy centers around activity modification, physics therapy, NSAIDs, steroids, and also replacement.<20>

Dislocation of any hinge joint is also possible but wake up most often in the IP joints. Treatment of IP dislocations usually involves reduction and also splinting together opposed come elbow, knee, and ankle dislocations that regularly require surgical procedure to repair bordering structures.<5>

All hinge joints come to be less secure as ligaments become compromised. The ligaments that the ankle are frequently injured when one sustains one ankle sprain. The lateral collateral ligaments that the ankle are injured most commonly with the majority of ankle sprains being short grade and also managed through conservative treatment.<17> The knee has a variety of ligaments favor the medial collateral ligament and also anterior cruciate ligament the are commonly injured in sporting events. These injuries are treated conservatively or surgically relying on the period and task level the the individual.<21><22> The ulnar collateral ligament (UCL) of the elbow deserve to be hurt in overhead cram athletes. Some collegiate and also professional athletes, many notably baseball players, can undergo UCL reconstruction to keep high level of athletic performance.

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Other Issues

The degeneration that articular cartilage ~ above the surface of hinge joints is the source of much pain and dysfunction. This has sustained research in the area the cartilage replacement and also regeneration. Adipose-derived stem cell are currently being injected right into joints to aid decrease inflammation and promote renewal of cartilage. Hyaluronic acid is a glycosaminoglycan the occurs naturally throughout the body and also specifically in synovial fluid. That is currently synthetically produced and injected right into joints together viscosupplementation to help decrease friction and pain in between articular surfaces. The instrument behind these treatment modalities space not completely understood, and both lack an extensive studies, and an ext research is needed.<20>