General Information About Joints
Joints are functional connections that connect various bones of the skeleton. In the early stages of the embryo, adjacent bone stubs are connected to each other continuously by the embryonal connective tissue. During the third or lethal month of embryonic life, gaps appear in the mesenchyme that connects some of the bony stumps. These cavities become larger and larger and merge with each other, thus creating a narrow gap between the two bone bases. During this time, most of the mesenchyme connecting the two bony structures is lost. Only the outermost parts remain as a thin layer and then take the character of fibrous connective tissue and form the joint capsule. Formations called meniscus or discus appear in some joints in a part of the mesenchyme that connects some bone structures, or internal ligaments that connect the two joint surfaces, as in the knee and hip joints. The cartilage layer that covers the articular surfaces also consists of the intermediate mesenchyme that connects the bone structures.
The joints that we have just described, that is, formed by the formation of a gap between the bone templates, are the most suitable joints for the neighboring bones to move. Such joints are called diarthrosis or junctura synovialis.
In some parts of the body, there are no gaps between the bone stubs, and the stubs remain uninterruptedly connected to each other afterwards. Joints formed in this way have little or no movement. Such joints are called synarcosis. Although there is no joint space, the mesenchyme that connects the bone structures in these also does not always preserve the embryonal connective tissue character. In some joints, this intermediate tissue develops as fibrous connective tissue, sometimes cartilage and sometimes bone tissue. The development of the mesenchyme between the bone structures in various directions and forming various tissues begins in embryonal life and continues in the extrauterine life. If the intermediate mesenchyme develops in the form of fibrous connective tissue, the joints are called syndesmosis, if they are cartilaginous, they are called synchondrosis, and if they take the characteristics of bone, they are called synostosis.
As in all our organs, the formation of the joints in various parts of our body follows the function of these joints in the future. We see that the condition of the adjacent bones, the shape of the joint surfaces, and the properties of all the tissues involved in the structure of the joint are adjusted according to the task of the joint. All the joints in our body are more or less related to each other in terms of function and together they form a system that provides the normal shape, condition and movements of the whole body. Therefore, changes in the shape, condition and structure of a joint cause changes in the shape, condition and structure of other joints. In this respect, the role and importance of individual joints are not at the same level, and the location, shape, condition and structure of the joint vary according to its task depending on these features. Sometimes, the loss of the normal feature of a single joint may cause the normal state of many organs and even the whole body to change both morphologically and physiologically.
Joints are one of the most important elements of the movement system. Muscles make the active organs of the movement system. During the events in the cytoplasm of the muscle cells, the potential energy hidden in the nutrients is converted into kinetic energy, and the force that manifests during the contraction of the muscle fibers moves the skeletal parts to which the muscle adheres. However, in order for the skeleton parts to move, these parts must be connected to each other through one or more joints.
The structure and shape of some joints are less favorable for the mobility of neighboring bones. However, these joints also perform very important tasks in equal parts of our body. Such joints are mostly found between small bones. Small bones, which move little but are connected to each other by solid joints, come together to form strong and at the same time springy, elastic columns and arches with their joints. For example, the skeleton of the foot, here, is a dome supported by arches in various conditions, as many small bones are connected to each other by means of joints that do not move. On the one hand, the hardness and strength of the bones, on the other hand, the elasticity of the tissues that participate in the structure of the joints are very important for the foot skeleton, which carries the weight of our whole body and also has to adapt to the various conditions of the surface we step on.
Joints are the most exposed to various diseases among the organs of the movement system and play a very important role in medicine. The most important reason that makes it easier for the joints to get sick is that they are constantly and mostly under heavy mechanical effects while on duty. In addition, external effects are especially traumas and the susceptibility of the synovial membrane covering the inner surface of the joints to infections.
Diarthrosis (juncturae synoviales-Full mobile joint)
It allows our body to move and change the state of its various parts. joints are playing joints (toggles) called diarthros. In diarthroses, it is essential that the adjacent bones that articulate are separated from each other by a narrow gap. The surfaces of adjacent bones that face this gap are called the articular surfaces. Articular surfaces are found at the ends of long bones. In short and flat bones, the articular surfaces are adjusted according to the state of the adjacent bone, and they can be found in various parts and faces of the bone. Apart from the joint space and articular surfaces, all diarthroses have a joint capsule made of connective tissue that connects the adjacent bones and surrounds the entire joint from the outside. The joint capsule adheres to the adjacent bones outside the articular surfaces and thus engulfs all the articular surfaces and the joint space, forming a cavity (cavum articulare) that is completely closed on all sides. In addition, all joints have ligaments that strengthen the connection between adjacent bones and are adhered to the outer surface of the joint capsule and their directions are adjusted according to the function of the joint. In some joints, apart from the external ligaments, there are also internal ligaments in the joint cavity that attach to the articular surfaces and connect the articular bones to each other. Now, let’s review these formations seen in all diarthroses, namely joint surfaces, joint capsule, external and internal ligaments, separately in terms of shape, condition and structure.
Joint surfaces: In all joints, the most important element in terms of the type, direction and width of the movement is the joint surfaces. The shape, condition and structure of the joint surfaces play a very important role in terms of being suitable for the purpose of the movements and not disrupting the normal direction of the movements with the effect of the weight changing according to the various states of the body during the movement and the effect of any external force.
One of the articular surfaces becomes convex and the other concave in swivels that allow wide movements. In such joints, the bones make rotational movements around a certain axis. Rotational movements can be made around each axis in two opposite directions. The concave face is usually smaller than the convex face. In some joints, both faces show both convexity and concavity at the same time. In such cases, the direction of the concavity of the face is perpendicular to the direction of the convexity. For example, if the concavity of an articular surface that is both convex and concave at the same time is front to back, its convexity will be from the inside to the outside. The articular surface on the opposite side must be both concave and convex. Some joints have flat or nearly flat faces on both sides. In such joints, the bones cannot rotate around an axis and the joint surfaces can only slide on each other in different directions depending on the condition of the faces. Sliding movements are always very limited. For example, the joints between the articular processes of the vertebrae. They determine the shape and condition of the joint faces, as well as the number and direction of the joint axes.
In order for the movements to follow regularly and in accordance with the purpose, the joint surfaces must be in harmony with each other and always in contact with each other in terms of shape. The size of the contact surface is also important in terms of the distribution of the weight over the excess surface in some joints under high pressure. However, in many joints, it is seen that the joint surfaces of the adjacent bones differ from each other in terms of size, and sometimes even the degrees of concavity and convexity on the two joint surfaces are more or less different from each other. However, if we examine the articular faces in living things and cadavers, we see that these deficiencies seen in the bone faces are completed by other formations belonging to the joint. Among these formations, the articular cartilage covering all the articular surfaces comes in the foreground. In addition, there are formations made of cartilage or fibrous connective tissue called meniscus, discus and labrum articulare in some joints.
Articular cartilage, articular surfaces in contact with each other at all movable joints, 2-5 mm. covered with a thick layer of cartilage. This layer is mostly made of hyaline cartilage. Articular surfaces are covered with fibrous cartilage in joints where the joint space is divided into two by only one discus articularis.
The structure of hyaline cartilage is very suitable in terms of changing the shape and condition of this tissue according to various conditions. It is very convenient in terms of function that the state of the fibers, which are located in the intermediate substance and surround the cartilage cells from all sides on the one hand, and extend in certain directions between the cells on the other hand, can change.
When the fibers change their state, the cartilage cells in between are forced to change their state. In the meantime, the fibers that form a strong and elastic capsule around the cells ensure that the cells are not destroyed. Thanks to the fact that the fibers and cells constituting the structure of the articular cartilage can change their state in this way, the cartilage layer can change its thickness in various parts in various degrees depending on the degree of pressure and allows the articular surfaces to fit together more. With increased pressure on the joint, the articular cartilage becomes thinner, but also widens, thereby enlarging the articular surfaces in contact with each other. The increase in the contact faces, on the other hand, allows the pressure to be distributed more and its effect to decrease. If the force that changes the condition of the articular cartilages disappears, the cartilage tissue returns to its original state thanks to its elasticity.
If the size and shape differences between adjacent articular faces are large, there are formations called meniscis or discus, which allow the faces to fit each other more and are inserted between the two articular faces. These, in turn, consist of mesenchyme that connects the bony structures.
Articular meniscus are mostly crescent-shaped, made of elastic cartilage-like tissue containing collagen fibers and are found on the lateral parts of the concave articular surfaces. Meniscus, on the one hand, enlarge the articular surface, and on the other hand, due to the elasticity of their tissues and at the same time, since they are connected in a way that can change their place a little, they change their shape and state with the effect of pressure during movement, and in this way, they allow the articular surfaces to fit together more. The discus, on the other hand, divide the joint space into two parts in the form of a partition by attaching to the sides of the articular surface and also to the capsule surrounding the joint cavity. Since discuses are more than the others, discus can not only eliminate the differences in shape between the joint surfaces, but also enable various movements to occur by changing the shape of the face in the same joint.
Formations called labrum articulare, made of fibrous connective tissue, are in the form of a ring. They are adhered to the edges of the concave articular surfaces. These formations widen the articular surface and deepen the pit, but these rings, despite the deepening of the pit and the more wrapped articular surface on the opposite side, do not interfere with movements much like bone tissue thanks to the elasticity of their tissues,
Capsula articularis: Joint capsule, We have explained above that it consists of the outermost layer of the mesenchyme, which connects the bone structures in embryonic life continuously. In this way, the joint space is completely and airtightly surrounded on all sides by the joint capsule. This is very important for the relationship between the articular surfaces and the whole joint mechanism.
The joint capsule is made of two layers that differ from each other in terms of structure and mechanism. Membrane fibrosa; The outer layer, called the outer layer, is made of solid fibrous connective tissue. This layer performs tasks such as connecting neighboring bones, protecting the joint from external influences, and preventing excessive and unnecessary movements. The thickness of the fibrous layer is not the same everywhere and is adjusted according to the direction of mechanical effects. In some places, the capsule tissue thickens, the fibers become denser and in this way, they form solid bands made of fibrous connective tissue called joint ligaments. Apart from these ligaments, in some joints, apart from the capsule, there are detached joint ligaments extending between the bones participating in the joint. Where the fibrous layer of the joint capsule attaches to the bone, it extends with the periosteum covering the bone, and the fibers in the capsule tissue continue with the fibers in the periosteum tissue. However, in some joints, such as in the hip joint, the joint capsule adheres to the bone by including a part of the bone covered by the periosteum and quite far from the cartilage edge.
Some of the muscle fibers adhering near the joints are also distributed over the joint capsule, and the fibers extending from the beams join the capsule tissue. The beams formed in this way also form ligaments that strengthen the capsule in some joints, such as the posterior aspect of the knee joint.
Membrane synovialis; The synovial layer of the joint capsule is a thin and soft membrane made of connective tissue. This layer completely covers the inner surface of the joint capsule and terminates at the edge of the cartilage covering the articular surfaces on both sides. Since the synovial layer is adhered to the fibrous layer by very loose connective tissue, it can be displaced. In some parts of the capsule, this layer makes various extensions that contain abundant fat cells. These extensions are inserted into the joint space and fill the gaps that occur when the joint surfaces do not fit together completely.
The inner surface of the synovial layer facing the joint cavity is flat and shiny. But here, as in the peritoneum or pleura, there is no epithelial layer that completely covers the surface. This face is covered with flattened connective tissue cells and these cells ensure the flatness of the surface. The synovial layer is very rich in terms of vessels and nerves. Nerves form rich networks here. The hypersensitivity of the joints is due to the abundance of sensitive nerve endings in the synovial layer and especially in the synovial processes inserted into the joint space. The multitude of vessels here is related to the secretion of joint fluid by the synovial layer. The synovial layer also has the ability to rapidly absorb fluids. If we give a liquid that does not destroy the tissues with a syringe into the joint cavity, this liquid is quickly resorbed, as in the subcutaneous tissue. This ability of the synovial layer plays a very important role in the loss of fluids (exudate) collected in the joint cavity during trauma or various diseases.
The joint fluid we call Sinovia is a very thick and sticky fluid containing mucin. In synavia, there are sporadic cells, fat granules, and small fragments detached from synovial appendages. Sinovia, which fills the joint space, increases the lubricity of the joint surfaces like machine oil and reduces the friction of the faces to an inaudible level.
Relationship between articular faces; In order for the movements to be carried out in a desired and purposeful way, it is essential that the joint surfaces sliding on each other are in close contact during the movement and do not move away from each other. One of the factors that provide this situation is atmospheric pressure, and the other is the tension of the muscles. The pressure in the joint cavity is always relatively low to atmospheric pressure, although it changes during movement. Therefore, the air pressure from the outside pushes the bone pieces joining the joint towards the joint cavity, bringing the faces closer together. The same pressure naturally exists on all soft formations covering the joint capsule and joint from all sides. The air pressure on the large joints is not to be underestimated, for example, the pressure on the hip joint from all sides is 12 – 15 kg. and if the capsule is not ruptured, it is difficult to remove the femoral head from the acetabulum. If a hole is made in the capsule, there is no pressure separation between the joint cavity and the atmosphere, and it is much easier to move the bones away from each other.
The second factor that ensures tight contact of the joint surfaces is muscle strength. The force created by the muscle, which is attached to the adjacent bones joining the joint with its two ends, moves the bone on the one hand, and brings the joint surfaces closer together by pulling the moving bone towards the support point, on the other hand. brings faces closer together.
It is also very important that the joint surfaces do not move away from each other during movement or with the effect of an external force, and that the normal contacts of the faces are maintained. If this normal situation between the joint faces is disturbed, a condition called dislocation occurs. Sometimes, if the movement in the normal direction is done too widely, it can cause the joint surfaces to move away from each other. In order to prevent unnecessary and even harmful movements and protrusions, the existing formation is different according to the joints.
In some joints, the shapes of the bone ends that make the articular faces are only suitable for certain movements. For example, in the elbow joint (articulatio cubiti), when the olecranon is inserted into the fossa olecrani, it prevents the ulna from going too far back and at the same time preventing both bones from sliding sideways. Incisura. The crista in the middle of the trochlearis and its insertion into the groove in the trochlea humeri prevent both bones from sliding sideways. This shows us that the type and degree of movement in this joint is determined mainly by the shapes of the joint surfaces. However, although it is weaker on movement in this joint, muscles and ligaments also have an effect. In the ankle joint (articulatio talocruralis), the types and directions of movement are determined by the shape and condition of the bones that make the articular faces. has been done. Here, the articular surfaces of the tibia and fibula enclose the articular surfaces of the talus like a fork. This situation allows the talus to move in two opposite directions around only one axis. In such joints, the type, direction and degree of movement are determined by the shape of the bones that make the articular faces. If you have to make excessive or abnormal movements with the effect of too much force, that is, if the dislocation occurs, the bones that make the joint surfaces are also broken.
In some joints, the shapes of the joint faces are not in a position to brake the movement or give a certain direction. In such joints, more ligaments or muscles provide the movement in accordance with the purpose. At the same time, these formations prevent the occurrence of excessive and inappropriate movements and thus the separation of the joint faces from each other. For example, in the knee joint (articulatio genu), the most important factor that ensures the normal course of movements and prevents dislocations is the internal and external ligaments of this joint. In some joints, this task is performed by more muscles. For example, in the shoulder joint (articulatio humeri). Here, the strong muscles surrounding the joint from three sides ensure that the humeral head stays in place and its movements are regular in the normal situation, and they also brake the movements.
In addition, other muscles that make the movement in the opposite direction exert a restraining effect on a movement made in a certain direction. For example, after the leg is straightened, the flexor muscles at the back of the femur, which pull the leg back, prevent the tibia from making more extension movements, that is, moving forward more. This restraining effect of the muscles is very important in terms of maintaining the normal state of the body and balance, as well as preventing dislocations in many joints.
In anatomy, various movements of various body parts have been given various names according to the direction of the movements. Since we will use these names when describing the movements that occur in various joints from now on, let’s briefly explain these names here.
Extension stretch: The pulling action (extendo – to stretch, pull, spread). This movement is mostly done backwards. Only the knee and ankle joints are extended forward. The change in the situation in these joints is due to the fact that humans stand and walk on two legs, unlike animals. However, the forward and upward movement of the foot is also called dorsal flexion
Flexion- bending: It is the movement made for the purpose of bending (flecto – bending, bending). The flexion movement is performed forward, except for the movement in the knee and ankle joints.
Abduction-movement away from the midline (abduco¬-removal to take away, to miss).
Adduction-to bring it closer to the midline (adduco- to pull towards oneself, to bring it closer).
Rotation – rotation movement (roto – rotate) lateral rotation – outward rotation, medial rotation – inward rotation.
Circumduction – rotation around a point is the gradual combination of movements in various directions. (Circumduco – to spin something around).
Classification of Joints
The terms articulatio or junctura oseum are used in joints. Joints are divided into three main classes according to their structural features and mobility.
I. Synarthrose (fibrous, immovable) joints: In this type of joints, the bone faces are in direct contact. In between is connective tissue or hyaline cartilage. However, these are fused together. These joints cannot move. They are mostly found between the skull bones. There are three types of this joint:
A. Syndemosis: In this type, two bones are connected by the ligamentum interosseus. For example: art. tibio fibularis inferior.
B. Suturae: the articular surfaces of the bones continue with each other. In between is a thin layer of connective tissue. If the faces of the bones are locked together by a number of protrusions, it is called a true sutura (sutura vera). There are three types of this type
a. Sutura dentata: Bones are locked to each other with irregular teeth. For example, the sutura sagitalis.
b.Sutura serrata: The joint is locked as if the two combs go into each other.
c.Sutura limbosa: Although there is an interlocking with gears, the articulating bones have jumped on top of each other. If the faces of the bones meet in flat fields and articulate, this is called a false sutura (sutura notha). It has two types:
a. Sutura squamosa: Bones join, leaving a wide jumping edge. For example; sutura temporoparietalis.
b. Sutura plana: Here, more or less flat articular surfaces come into contact with each other. For example; sutura intermaxillaris. as.
If a bone lamina enters a cleft between two bone laminae, it is called schindylesis. For example; such as rostrum sphenoidale-ala vomer.
C. Gomphosis: This name is given when a conical protrusion is driven into a joint socket like a nail. It is present in the body only between tooth roots and alveoli. Mobility in fibrous joints is proportional to the length of the fibrous fibers connecting the bones. Mostly they don’t move at all.
II. Amphiartrose (semi-cartilaginous) joints: The bones that make the joint are united by a cartilage. There are two varieties.
1. Synchondroses: Hyaline cartilage is filled between the articulating bones. This type of joint is found between the diaphysis and the epiphysis in enchondral ossification. Discus epiphysialis, which increases the length of the bone in long bones, is a typical example of this. When the bone stops growing, all of the cartilage becomes ossified (synostosis).
There are also examples of permanent synchondrosis, such as the costal cartilages between the ribs and the sternum.
2. Symphyses: Articulating bone surfaces are covered with hyaline cartilage. However, these faces are joined by a disc of fibrous cartilage.
The symphysis is a very strong, little moving joint. For example: art.intervertebralis anteriores and symphysis pubis.
III. Synovial (diarthroses) movable joints: Most of the joints in the body belong to this group. In the synovial joint, the articular surfaces are individually covered with hyaline cartilage. The joint capsule surrounds the joint.
This joint has 4 common structural features.
1.Cavitas articularis (joint cavity): It is the space between the cartilage covered surfaces and the inner surface of the joint capsule. It is filled with synovial fluid.
2.Cartilago articularis (articular cartilage): It is the hyaline cartilage covering the articular surfaces of the bones forming the joint. Its surface is polished and slippery.
Articular cartilages do not have nerves and blood vessels.
3.Capsula articularis (joint capsule): It is the fibrous capsule that surrounds the joints like an envelope. It is composed of two layers, an outer stratum fibrosum and an inner stratum synoviale. The second layer can also be considered. The fibrous layer is attached to the margins of the articular surfaces. Sometimes it can also bend and enter the joint space.
Joint capsules are usually reinforced with fibrous bands. They are either a part of the capsule (intrinsic ligaments) or separate bands from the capsule (extrinsic ligaments), these ligaments prevent movement in unwanted directions.
Ligaments are composed of collagen fiber bundles. Collagen fibers are arranged parallel or mixed. They are white silver in color. It can be bent, but its length does not change. Some ligaments have yellow elastic fibers. League them. flava and lig. nuchae is an example.
4. Membrane synoviales: forms the inner layer of the capsule. The membrane constantly secretes an egg-white-like fluid called synovia into the joint space. This fluid minimizes the frictional effects of the joint surfaces due to its slipperiness. The membrane is not fully adhered to the inner surface of the fibrous layer. Folds composed of connective tissue, adipose tissue and vessels fill the unnecessary spaces in the joint. If there is a tendon passing through the joint, the synovial membrane wraps around this tendon like a sheath. Some synovial joints have separate features apart from the four common features. We can divide them into three groups
1.Discus articularis; They are fibrous cartilage discs that have functions such as holding the two bones together or adapting the articular surfaces.
2.Labrum articulare; They are special fibrous cartilage formations that serve to deepen the articular surfaces. For example; labrum glenoidale
3.İntraartiküler tendo; kapsülü delerek eklem içinden geçen kas tendolarıdır. For example; m. biceps brachii uzun başı.
Sinovyal Eklemlerin Çeşitleri
Bu eklemler hareketlerine göre çeşitlendirilirler. Eklem tek eksen etrafında hareket edebilir. İki eksen veya çok eksen etrafında hareket edebilir.
Tek eksenliler
a. Trochlear (ginglymus); eklem yüzleri aşağı yukarı makara şeklindedir. Tek eksen etrafında harekete izin verirler. Bu hareket fleksiyon-ekstensiyon tarzındadır. For example; art.interphalangea, art. humeroulnaris. Bu eklemlerin geniş olanları bir miktar kayma ve rotasyon hareketi de yapabilir. For example; genu eklemi.
b. Trochoid-pivot; hareket dik eksen üzerinde rotasyon şeklindedir. Bu tipte eklem yüzleri ve ligamentler daha çok bir yüzük şeklindedir. For example; art. radioulnaris proksimalis, art. atlanto-axialis.
Çift eksenliler
a. Art. condyloid (elipsoid); burada condil şeklinde bir eklem çıkıntısı oval bir çukurun içine alınır. Bu eklem ekstensiyon-fleksiyon ve adduksiyon-abduksiyon hareketlerine izin verir. Cirkumdiksiyon hareketi de olabilir, ancak rotasyon olamaz. For example; el bileği eklemi.
b. Art. cellaris; eklem yüzleri eyer biçimindedir. Yukardaki eklemle aynı hareketlere izin verir. For example; art.carpometacarpea pollicis gibi
Çok eksenli eklemlere ise bir tek örnek vardır. Art. spheroidea-enarthrosis. Burada küre şeklinde bir yuvaya küre şeklinde bir eklem çıkıntısı girmiştir. Her türlü hareketi yapabilir. For example; omuz ve kalça eklemleri.
Art. plana; eklem yüzleri düzdür. Yalnızca kayma hareketleri yapabilir. Hareketleri ligamentlerle sınırlandırılmıştır. For example; intervertebral eklemler.
Eklemlerin Sinir ve Damarları
Sinir uçarı eklem kapsülü ve sinovial zarda sonlanır. Sinirler eklemin yüzeyindeki deri ve eklemi hareket ettiren kasların sinirlerinin dallarıdır. Buna Hilton Kanunu denir. Bu sinir uçları eklemi hareket ettiren kasların reflekslerini düzenleyen, proprioception ve ağrı duyuları taşırlar.
Kan ve lenf damarları eklemlerin etrafında anastomozlar yaparlar.
Klinik Önemi
1. Erişkin hayatın başlangıcından, yaşla birlikte gittikçe ve çok yavaş ilerleyerek eklem kıkırdaklarının yaşlanması olgusu ortaya çıkar. Bu olgu vertebral kolon, kalça, diz ve el eklemlerinde belirlidir. Bu geriye dönmez dejeneratif değişmeler kıkırdakların basıncı absorbe etme ve yağlama yeteneklerini azaltır. Bazı olgularda bu durum hiçbir önemli semptom vermediği halde, bazılarında devamlı ağrı yakınmalarına neden olur.
2. Athiritis (artrit) terimi bize eklemin enfeksiyonunu tanımlar. Osteoartrit, osteoartroz ve dejeneratif artrit gibi eklem hastalıkları buna örnektir. Ağırlık taşıyan eklemlerde şişmanlık bu hastalıkların ilerlemesini kolaylaştırır.
3. Snovyal sıvının akışkanlığı ısı ile değişir. Düşük ısılarda sıvı daha az akışkan duruma geçer. Bu olgu eklemlerin soğuk havalardan etkilenmesini kısmen açıklayabilir.
4. Sinovyal zar içindeki zengin kapiller ve lenfatik pleksuslar eklem boşluğundan güçlü bir absorbsiyon sağlar. Bu nedenle eklemin travmatik enfeksiyonlerı septisemi (enfeksiyon etkeninin kana karışması) ile sonuçlanabilir. Bunun tersine kan içindeki normal ve patolojik maddeler kolaylıkla eklem içine girebilir
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Sağlıklı günler dileği ile…
Uzman Dr.Ali AYYILDIZ – Veteriner Hekim – İnsan Anatomisi Uzmanı Dr. (Ph.D.)
