Intro/Synovial Joints LS1/15

[Animation (2-3 seconds): Same recs as in Knee Joint Overview. Screen should open with just text and one blue image of synovial joint. (still or *super brief* animation).]

Old text...Have you ever wondered how your knee supports your weight as it freely moves? How do the bones of our knees resist the forces of weight and gravity that might easily cause them to crunch and rub together? What prevents the knee from easily rotating or sliding when it is engaged in dynamic, weight bearing activity? (Depending on other changes, Lucie/anatomists will revise Begin text for this unit.)

You'll learn the answers to these questions as you progress through this unit on synovial joints.

By the end of this unit, you should be able to:

- Define and describe 5 characteristics of synovial joint.
- Distinguish between synovial and non-synovial joints.
- Identify and list other synovial joints in the body.
- Apply your synovial joint knowledge to a case study.

Synv1.0

Note: there are subtle text and IAA scripting changes throughout this revised design plan. Read edits carefully.
Black screen

Animation plays as soon as screen is opened. Once it has ended, final image from animation remains.

Bullet icon (small dot?) to go in front of learning objectives (instead of number)

In this and future units, light blue text links to curriculum glossary.

Intro/Synovial Joints LS1/15

As you learned in the previous unit, the knee is structurally classified as a synovial joint. It is comprised of structures that protect the integrity of the joint while simultaneously promoting a tremendous range of movement as shown in this video.

[Begin video button: Move video that currently opens unit to here.]

Synv1.1

Black screen

Video is played when students click on begin video button. Before that, it appears as still image.

Intro/Synovial Joints LS1/15

Most of the joints located in the upper and lower limbs are synovial joints.. Synovial joints have five distinguishing features:

a) articular capsule: a double-layered capsule surrounding the articulating bones which consists of an outer fibrous layer and an inner synovial membrane;

b) joint or synovial cavity: a fluid filled space that separates the articulating bones;

c) synovial fluid: afiltrate of plasma contained within the synovial cavity;

d) articular cartilage: hyaline cartilage covering the surfaces of the articulating bones; and

e) reinforcing ligaments: ligaments contained within or outside the articular capsule that stabilize the joint.

Explore the anatomy of the synovial joint structures and the related coronal image (below). Note how the synovial membrane is shaped by the bones of the knee joint.

[Graphic: Explore the anatomy button]

[Graphic: Coronal section of knee joint that highlights synovial joint structures. (The structures are same colors as they are in corresponding IAA.)

Synv2.0

IAA: Articular capsule presented and rotated 360. Idealized synovial membrane filled with fluid is presented along with capsule (looking like a "balloon"). The bones of the knee come together from top and bottom of screen, squishing the balloon which is pushed out to the sides with a small cavity remaining (synovial cavity;) image rotates 360. Articular cartilage is added, then the ligaments; image rotates 360.

The highLIghted structures in IAA should be in colors that match the structure names in the text

Intro/Synovial Joints LS1/15

Apply your knowledge of the general features of synovial articulations to the glenohumeral joint of the shoulder.

Explore the anatomy of the shoulder joint (and related coronal view below) and match each structure of the synovial joint with its correct anatomical name.

Reinforcing ligaments A) B) C) D)

Articular capsule A) B) C) D)

Synovial fluid in the synovial cavity A) B) C) D)

Articular cartilage A) B) C) D)

[Graphic: Explore the anatomy button]

[Graphic: Coronal slice of shoulder joint presenting synovial joint structures. Pointers and ABCD’s on structures but no labels.

[Graphic: Clear responses.]

[Graphic: Submit responses.]

You have correctly identified the xxx and the yyy structures. Please try again to identify all the correct structures.

[Graphic: Clear responses.]

[Graphic: Submit responses.]

Synv3.0

First IAA: presenting the best views possible to see and find synovial joint characteristics in the shoulder joint. Pointers and ABCD’s on structures but no labels.

2nd IAA: Modify the first IAA so that it identifies structures by color as in the knee IAA and matches color to text for structure names.

Submitted response is evaluated for correct matches and these are presented to students. Last text section appears only after initial responses have been evaluated.

2nd IAA appears after students have submitted second responses (or after initial responses if they are all correct.)

Intro/Synovial Joints LS1/15

Explore the knee structures presented. Rotate the anatomy and view it from various angles; examine it closely to get a sense of the different textures. Can you identify the articular capsule and the synovial membrane?

[Graphic: Explore the anatomy button]

The double layered sleeve-like structure that you see here (that envelops the articulating bones) is the articular capsule.

The outer layer is composed of a tough but flexible dense connective tissue, which is continuous with the periosteum of each bone in the joint. This outer layer provides the strength necessary to hold the bones together but also allows for flexibility during joint movement.

The inner layer is composed of a thin membrane called the synovial membrane. This membrane covers all surfaces within the joint that are not covered with articular cartilage.

[Graphic: Explore the anatomy button]

Synv4.0

IAA's: Modify existing IAA and add an additional IAA.

First IAA is same as what you have only it begins with bones and LIgaments in place; then these are removed, moving into the IAA that’s there now.

Second IAA is same as what you have (no bones), only with structures highLIghted in different colors. Structure names in text should match colors in IAA. Highlight first highlights entire capsule in one color, then this disappears and outer and inner layers are identified by separate highlight colors.

For text that is highlighted in corresponding IAA's, structure name in text matches structure color in IAA.

If students click on structure in IAA, structure is highlighted and specific structure name appears in text field.

Intro/Synovial Joints LS1/15

Again, examine the knee structures presented.

The synovial membrane forms a closed fluid-filled sac called the synovial or joint cavity. Capillary beds within the synovial membrane secrete a viscous filtrate of blood plasma. The fluid has a slippery feel that is similar to uncooked egg white. Synovial fluid fills the synovial cavity and lubricates the surfaces of cartilage and bone, reducing friction within the moving joint.

[Graphic: Explore the anatomy button]

Notice that the surfaces of the articulating bones are covered with a glassy smooth substance called articular cartilage. This is composed of hyaline cartilage. Articular cartilage helps decrease friction and serves to cushion and absorb compressive and shearing forces. The presence of healthy intact cartilage is crucial to the proper function of synovial joints. Damage or excessive wear may result in the development of osteoarthritis.

[Graphic: Explore the anatomy button]

Synv4.1

Create 2 IAAs.

First IAA highLIghts synovial cavity and simulates synovial fluid filLIng cavity.

2^nd IAA should highLIght articular cartilage.

Again, structure names in text should match structure colors in IAA.

Intro/Synovial Joints LS1/15

Based on your knowledge of synovial joints examine the following joints and determine which of them possess the anatomical characteristics of a synovial joint.

[Graphic: coronal view of hip; good views of synovial joint structures]

Hip--synovial joint/nonsynovial

[Graphic: parasagittal view of temporal mandibular; good views of synovial joint structures]

Temporal mandibular--synovial joint/nonsynovial

[Graphic: coronal view of cranial suture; good views of synovial joint structures]

Cranial suture--synovial joint/nonsynovial

[Graphic: coronal view of elbow; good views of synovial joint structures]

Elbow--synovial joint/nonsynovial

[Graphic: coronal view of pubic symphysis; good views of synovial joint structures]Pubic symphysis--synovial joint/nonsynovial

[Graphic: Clear responses.]

[Graphic: Submit responses.]

Synv5.0

Students are provided with click boxes for each response. Once they are ready to submit responses, they click on Submit responses graphic which records response. Instructors can then later track participation of each student. Clear responses button clears responses if students want to change mind before submitting.

Intro/Synovial Joints LS1/15

The following list includes joints of the appendicular and axial skeletons. Determine whether they are synovial or non-synovial joints.

Click on the correct classification in the boxes provided.

(Hint: Given that synovial joints are freely movable joints, you might use your own body to assist you in categorizing the joints.)

List?

[Graphic: Clear response.]

[Graphic: Submit response.]

Synv6.0

Intro/Synovial Joints LS1/26

As you have seen, the anatomical features of a synovial joint allow a tremendous range of motion. This freedom of movement sometimes comes at a price.

Overuse and age can damage the articular cartilage of the synovial joint. And extended wear and tear can degrade the cartilage resulting in painful bone on bone contact.

Apply your knowledge of synovial joint structures as you explore the following case study. First, you will review the case study profile. You'll then be directed to perform a virtual physical examination of the case's anatomy, comparing to your knowledge of the norms. And finally, you'll respond to related analytical questions about the case.

Proceed to the synovial joint case study.

Synv7.0

Case study text links to following case study info

Intro/Synovial Joints LS1/26

Case study profile:

Ben is a 45-year-old longshoreman who presents with a swollen and painful knee. He is an enthusiastic weekend athlete, and participates in several sports including baseball and basketball.

Ben reports extreme pain after several hours of work and during exercise, especially while shooting hoops. The pain is relieved with rest.

Labs and xrays:

Blood tests--

• normal uric acid levels
• normal hematocrit
• absence of rheumatoid factor

Synovial fluid sample--

• viscous, yellow and transparent
• elevated white blood cell (WBC) count
• presence of cartilage fragments
• absence of crystals or rheumatoid factor

Xray--

[Graphic: x-ray of osteoarthritis case.]

• Note the narrowing of the joint space
• Note the presence of bone spurs (called osteophytes)

Synv8.0

Appears as black screen initially.

First IAA:

IAA that simulates an osteoarthritis case. Exterior view only.

Second IAA:

IAA that simulates an osteoarthritis case. Knee flexes and extends 2x. Simluate grinding, catching as in osteoarthritis case. Exterior view?

Third IAA:

IAA that simulates an osteoarthritis case. Internal view that allows students to explore all synovial joint structures listed in text. (Anatomists to specifically define views.)

Note: purple text links in analysis text open still images of the norm for students to compare/contrast to the case study. Ideally, they will open in the bottom R hand corner of screen.

Though text is long, it needs to all appear on the same screen for students to be successful with the activity.

Purple links in analysis text open still images of the norm (bottom R hand corner of screen would be ideal).

For the multiple choice activity at the end, same functionality as described in previous multiple choice activity--presented with click boxes for response.

Intro/Synovial Joints LS1/26

The correct diagnosis for Ben is osteoarthritis. This disease is most commonly found in joints that undergo repetitive use. It is marked by the sorts of gross and arthroscopic changes you witnessed in the examination of Ben’s knee.

Knowing this, you can probably easiliy distinguish between the normal and pathological arthroscopies of the knee.

[Graphic: View Arthroscopy 1 button]

[Graphic: View Arthroscopy 2 button]

You now possess an elementary understanding of the functional and structural characteristics of the knee joint. Proceed to the next unit and investigate the unique features of the bones of the knee.

For further learning on osteoarthritis, participate in the extension activities for this unit:

Review extensive website that details the proceedure for knee examinations and answer related questions.

Read overview article on osteoarthritis and answer related questions.

Review article that summarizes treatment for osteoarthritis and answer related questions.

Or, for further discussion or questions related to your learning on synovial joints and their disorders, go to Ask the Anatomist.

Synv8.1

View Arthroscopy buttons activate short video clips of normal and pathological arthroscopies of knee.

Intro/Synovial Joints LS1/26

For students interested in learning more about a thorough knee exam, visit the following website. Once you have reviewed the site, apply your learning to this case by answering the questions below.

<http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/mo56_knee_joint/knee_joint.shtml>

It is likely that laxity would be a symptom of oesteoarthritis? Why or why not?

[short answer text box]

Using the method described on the website, what might you expect to find as you examined the knee for an effusion in this case?

[short answer text box]

How about if you were to perform the patellar grind test, as described on the website?

[short answer text box]

[Graphic: Clear responses.]

[Graphic: Submit responses.]

Synv8.2

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Short answer response box feilds are provided after each question. Once all responses have been submitted, response screen appears (8.3)

Intro/Synovial Joints LS1/26

Response text for questions on previous page. Anatomists to write.

Synv8.3

Appears as black screen.

Intro/Synovial Joints LS1/26

Intro/Synovial/Osteoarthritis Overview Extension Activity
Osteoarthritis Overview:

Review the overview article on oesteoarthritis and answer the questions below.

Related Website:

Overview article

<http://health.excite.com/content/article/1680.50480>

Focus questions:

What is the incidence of osteoarthritis, as compared to the other forms of arthritis?

A. It is the least common form of arthritis.

B. It is the most common form of arthritis.

What is the prevalence of osteoarthritis in seniors?

A. 20%

B. 30%

C. 50%

Can osteoarthritis be prevented?

A. Yes

B. No

[Graphic: Clear responses.]

[Graphic: Submit responses.]

Synv8.4

Appears as black screen.

Multiple choice click boxes are provided for each question. Once all responses have been submitted, response screen appears (8.3)

Intro/Synovial Joints LS1/26

Osteoarthritis is by far the most common form of arthritis, effecting 15.8 million people.

Nearly 50% of people over 65 year of age have osteoarthritis.

Osteoarthritis can not be prevented, though limiting stress on joints may help.

Synv8.5

Appears as black screen.

Intro/Synovial Joints LS1/26

To further extend you learning about oesteoarthritis, review the following treatment summary article. When you have finished, return to this site to respond to the questions below.

<http://health.excite.com/content/article/1680.50483>

List two reasons why exercise might be beneficial for someone with oesteoarthritis. [short answer text box]

Why is Tylenol recommended over Advil for osteoarthritis? [short answer text box]

List two other treatments for oesteoarthritis. [short answer text box]

[Graphic: Clear responses.]

[Graphic: Submit responses.]

Synv8.6

Black screen

Short answer response box feilds are provided after each question. Once all responses have been submitted, response screen appears (8.7)

Intro/Synovial Joints LS1/26

Weight loss, reduction of pain and stiffness, increase in flexibility, muscle strength, endurance and sense of well being are all benefits of exercise for the osteoarthritis patient.

Tylenol is recommended over Advil (an anti-inflammatory drug) for osteoarthritis mainly because inflammation is not the primary cause for the disorder, as it is with rheumatoid arthritis.

There are many forms of treatment for osteoarthritis, ranging from mild to extreme, in terms of their level of intrusiveness. These include: heat, mechanical aids, alternative remedies, cognitive behavioral therapy, drug treatments, surgery.

Synv8.7

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Intro/Synovial Joints LS1/26

Screen #

Frame to be used to display related IAA's/Vis Human images

Engineers to create a format for simple threaded discussion. This format should allow students/instructors to view previous discussion topics (View Library Topics), to submit their own responses to existing topics (Submit Related Question/ Response), to create new topics to add to library (Submit New Topic) or to do a word search of the library database (Search Library Database),. I'd like to date comments and identify whether its a student or instructor (anatomist) comment.

This may mean that the regular text frame becomes 2 frames, instead of 1 (allowing for viewing and submitting). We would also like the potential to include IAA's/still images of Vis Human data as part of discussion, where appropriate.

Intro/Synovial Joints LS1/26

Screen #

Frame to be used to display related IAA's/Vis Human images

For this Ask the Anatomist screen and all future Ask the Anatomist screens, when initial screen opens, students see only View Library Topics (with skeletal list displayed below), Submit Related Question/Response,Submit New Topic, and Search Library database,.

Clicking on Synovial joints or on the specific discussions below opens the actual student/anatomist questions/responses.

Clicking on Submit Related Question/Response opens window where one can enter student or instructor #, date, and comment/question. These are automatically filed into existing discussions.

Submit New Topic opens similar window, with added ability to give the topic a title; new topics are automatically placedas new heading on Topic list. We would also like for instructors have power to rearrange list or rename topic titles, according to their needs.

Intro/Synovial Joints LS1/26

Screen #

Frame to be used to display related IAA's/Vis Human images--

Ruth/Nora/Ann:

how about recommending a simple IAA or images that would support this disuccsion?