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III. Syndesmology

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2. Development of the Joints
The mesoderm from which the different parts of the skeleton are formed shows at first no differentiation into masses corresponding with the individual bones. Thus continuous cores of mesoderm form the axes of the limb-buds and a continuous column of mesoderm the future vertebral column. The first indications of the bones and joints are circumscribed condensations of the mesoderm; these condensed parts become chondrified and finally ossified to form the bones of the skeleton. The intervening non-condensed portions consist at first of undifferentiated mesoderm, which may develop in one of three directions. It may be converted into fibrous tissue as in the case of the skull bones, a synarthrodial joint being the result, or it may become partly cartilaginous, in which case an amphiarthrodial joint is formed. Again, it may become looser in texture and a cavity ultimately appear in its midst; the cells lining the sides of this cavity form a synovial membrane and thus a diarthrodial joint is developed.	1
The tissue surrounding the original mesodermal core forms fibrous sheaths for the developing bones, i. e., periosteum and perichondrium, which are continued between the ends of the bones over the synovial membrane as the capsules of the joints. These capsules are not of uniform thickness, so that in them may be recognized especially strengthened bands which are described as ligaments. This, however, is not the only method of formation of ligaments. In some cases by modification of, or derivations from, the tendons surrounding the joint, additional ligamentous bands are provided to further strengthen the articulations.	2
In several of the movable joints the mesoderm which originally existed between the ends of the bones does not become completely absorbed—a portion of it persists and forms an articular disk. These disks may be intimately associated in their development with the muscles surrounding the joint, e. g., the menisci of the knee-joint, or with cartilaginous elements, representatives of skeletal structures, which are vestigial in human anatomy, e. g., the articular disk of the sternoclavicular joint.	3

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The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.

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