Fundamentals
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
Cartilaginous joints are those in which the articulating bones are connected by cartilage. They do not have a joint cavity. The amount of movement possible at cartilaginous joints varies from immovable to highly movable, with synchondroses being immovable and symphyses being slightly or highly movable. A synchondrosis is a joint where the bones are firmly connected by hyaline cartilage (see articulating surfaces). Examples include the epiphyseal (growth) plates in the long bones of the extremities and sternocostal synchondroses between the sternum (breastbone) and the anterior end of the ribs in the thoracic cage (see thoracic region – joints). The second type of cartilaginous joint is a symphysis, in which the bones are connected by fibrocartilage. In these joints, hyaline cartilage is present on the articulating parts of the bone. These joints are somewhat movable and include the intervertebral joints. The fibrocartilaginous intervertebral disc connects the vertebral bodies and acts as a shock absorber within the vertebral column (see thoracic region – joints). Another example is the pubic symphysis on the anterior aspect of the pelvis (see lumbar spine and pelvis – bones). This joint becomes quite flexible prior to childbirth to enable the infant to pass more easily through the birth canal.
Skeletal System
David Sturgeon in Introduction to Anatomy and Physiology for Healthcare Students, 2018
The final type of cartilage, fibrocartilage, is extremely tough and is found at sites where high pressure is applied such as the meniscus (crescent-shaped pad) of the knee. Its spongy formation makes it an excellent shock absorber and it is also located between the vertebral disks of the spine and the pubic symphysis of the pelvis. The pubic symphysis is also an example of a secondary cartilaginous joint (symphysis) where cartilage connects bone directly to bone. These joints are permanent and allow a small degree of flexible movement. Other examples include the intervertebral joints of the spine and manubrio-sternal joint of the breastbone. Primary cartilaginous joints (synchondrosis), on the other hand, are temporary joints which are only present during bone growth. For example, the epiphyseal plates of long bones form temporary joints until ossification occurs following the pubertal growth spurt. There are two other types of joint present in the human body: fibrous joints and synovial joints. Fibrous joints are typically immovable (or allow only a small degree of movement) and are divided into three categories: sutures, gomphoses and syndesmoses.
Mandibular Condyle Fractures
Jeffrey R. Marcus, Detlev Erdmann, Eduardo D. Rodriguez in Essentials of CRANIOMAXILLOFACIAL TRAUMA, 2014
Fractures of the mandibular condyle can occur in isolation or in combination with other fractures. Isolated unilateral condyle fractures most frequently result from low- or moderate-energy impacts directly to the side of the face. Bilateral condyle fractures occur more commonly from higher-energy impacts to the chin or anterior mandible. Energy is transmitted through the buttresses of the ascending rami to the condylar necks and condylar heads, which are relatively weaker. Fracture of the symphysis can be seen in this combination as well. Another common pattern is unilateral condyle fracture in combination with contralateral fracture of the parasymphyseal, body, or angle regions. In these moderate-to-high-energy impacts, force is transmitted to the condyle after an initial impact on the contralateral side. By understanding these patterns and by being alert to possible combinations, it is more likely that all injuries will be identified.
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
Moreover, there is no unified diagnostic standard and expert consensus for pubic symphysis separation currently. Clinically, it is mainly differentiated according to the symptoms, signs, physical examination and imaging examination of parturient, which mainly includes: (1) the parturient can experience the severe pain and inflammation at the pubic symphysis during and after the delivery. The pain can radiate to the waist and thigh area, and the symptoms will aggravate when moving and weight-bearing; (2) it is difficult to walk or stand unsteadily, the physical examination can show that the symphysis is red or swollen, and the pelvic compression or separation test is positive; (3) partial parturient may have the sacroiliitis, and the Trendelenburg test and ‘4’ sign test are positive; (4) pelvic X-ray examination shows that the separation distance of pubic symphysis is > 10 mm (Scriven et al. 1995; Valsky et al. 2006). For this current patient, the preoperative imaging examination revealed the separation distance was 82.75 mm, which was far beyond the usual standard.
Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report
Published in European Journal of Physiotherapy, 2018
Kingsley S. R. Dhinakar, Anjanette Cantoria Lacaste
A 25-year female elite hockey athlete presenting with a left groin pain, just above the pubic symphysis area, with onset of 6 months consulted for a second opinion. The patient is 165 cm in height and weight is 58 kg with right leg dominance. Prior to consultation, patient had already undertaken a period of physiotherapy treatment from which she was given a diagnosis of pubic symphysitis. The patient reported that she received conservative management that included a period of rest following initial onset, strength and conditioning training and soft tissue techniques. Painkillers were also commenced with the clinical reasoning that the pain may have been due to central sensitisation; however, they were ineffective. The patient had a corticosteroid injection to the symphysis after 3 months of onset. An acupuncturist was consulted who said that there were several trigger points in the abdominal muscles and due to chronicity, surgical options were also considered.
Minimal-contact physical interventions for pregnant women with musculoskeletal disorders: a systematic review of randomised and non-randomised clinical trials
Published in Journal of Obstetrics and Gynaecology, 2022
Chukwuebuka P. Onyekere, Grace N. Emmanuel, Benjamin C. Ozumba, Chinonso N. Igwesi-Chidobe
For pubic symphysis pain, Flack et al. (2015) reported that flexible neoprene belt reduced pain intensity more than rigid nylon belt. However, pain preceding 24 hours decreased in the flexible belt group compared to the rigid belt group while combining the two groups, pain intensity preceding week also decreased overall. Depledge et al. (2005) reported that verbal and written education about the anatomy and pathology of symphysis pubis dysfunction and self-help management, multimodal home-based exercise plus rigid/non-rigid belt reduced pain intensity. However, on group comparison, there was significant reduction in pain intensity for the exercise-only group and the group receiving exercise plus a rigid belt but not for the group receiving exercise plus a non-rigid belt (evidence: high).
Related Knowledge Centers
- Fibrocartilage
- Pubic Symphysis
- Synchondrosis
- Vertebra
- Sternum
- Intervertebral Disc
- Cartilaginous Joint
- Amphiarthrosis
- Sacrococcygeal Symphysis
- Mandibular Symphysis