B5 - gait/lower limb 4 Flashcards
what type of joint is the hip joint?
ball and socket synovial joint
the hip joint consists of an articulation between what?
the acetabulum of pelvis and head of femur
what deepens the acetabulum (increases the size of the articular area of the acetabulum)?
the acetabular labrum (a fibrocartilagnious collar)
what are the acetabulum and head of femur covered in?
articular cartilage
where is the articular cartilage of the acetabulum and head of femur thicker?
at the places of weight bearing
what are the attachments of the capsule of the hip joint?
- proximally: edge of acetabulum
- distally : intertrochanteric line anteriorly and the femoral neck posteriorly
what do the ligaments of the hip act to do?
increase stability
what is the only intracapsular ligament of the hip joint?
the ligament of head of femur
where does the ligament of head of femur run?
from acetabular fossa to the fovea of femur
what does the ligament of head of femur enclose?
a branch of the obturator artery = artery to head of femur (a minor source of arterial supply to hip joint)
what are the 3 main extracapsular ligaments of the hip joint, continuous with the outer surface of the hip joint capsule?
- iliofemoral ligament
- pubofemoral
- ischiofemoral
describe the iliofemoral ligament
- arises from anterior inferior iliac spine and then bifurcates before inserting into the intertrochanteric line of the femur
- has a ‘Y shaped” appearance
what does the iliofemoral ligament prevent?
hyperextension of the hip joint
what is the strongest of the 3 extracapsular hip ligaments?
iliofemoral ligament
describe the pubofemoral ligament
- spans between the superior pubic rami and the intertrochanteric line of the femur
- reinforces the capsule anteriorly and inferiorly
- has a triangular shape
what does the pubofemoral ligament prevent?
excessive abduction and extension
describe the ischiofemoral ligament
- spans between the body of the ischium and the greater trochanter of the femur
- reinforces the capsule posteriorly
- has a spiral orientation
what does the ischiofemoral ligament prevent and do?
- prevents hyper extension
- holds the femoral head in the acetabulum
the arterial supply to the hip joint?
- mainly: medial and lateral circumflex femoral arteries = branches of the profunda femoris artery
- they anastomose at the base of the femoral neck to form a ring, from which smaller arteries arise to supply the hip joint itself
- also artery of head of the femur = branch of obturator
what artery is responsible for the majority of the arterial supply to the hip joint and why?
medial circumflex femoral because the lateral circumflex femoral has to penetrate through the thick iliofemoral ligament
what can damage to the medial circumflex femoral artery result in?
avascular necrosis of the femoral head
what type of cartilage covers the articulating surfaces of the hip joint?
hyaline
the articular cartilage that covers the acetabular rim forms 3/4 of a circle. what is the name given to the area where the cartilage is missing?
acetabular notch
what is the main blood supply to the femoral head supplied by?
retinacular vessels of the medial and lateral circumflex femoral arteries
describe the transverse acetabular ligament
this is a continuation of the acetabular labrum and bridges the acetabular notch
what movements can occur at the hip joint?
- flexion
- extension
- abduction
- adduction
- lateral rotation
- medial rotation
The degree to which flexion at the hip can occur depends on whether the ____ is _____ – this ______ the hamstring muscles, and increases the range of flexion.
The degree to which flexion at the hip can occur depends on whether the knee is flexed – this relaxes the hamstring muscles, and increases the range of flexion.
Extension at the hip joint is limited by the joint capsule and the __________. These structures become _____ during extension to limit further movement.
Extension at the hip joint is limited by the joint capsule and the iliofemoral ligament. These structures become taut during extension to limit further movement.
what type of joint is the knee joint?
a hinge type synovial joint
what are the 2 articulations of the knee joint?
tibiofemoral and patellofemoral
what kind of cartilage covers the joint surfaces of the knee joint?
hyaline cartilage
knee joint is enclosed within a single joint cavity
describe the tibiofemoral articulation
- medial and lateral condyles of the femur articulate with the tibial condyles
- it is the weight-bearing component of the knee joint
describe the patellofemoral articulation
- anterior aspect of the distal femur articulates with the patella
- it allows the tendon of the quadriceps femoris (knee extensor) to be inserted directly over the knee — increasing the efficiency of the muscle
blood supply to knee joint?
through genicular anastomoses around the knee, which are supplied by the genicular branches of the femoral and popliteal arteries
The nerve supply to the knee joint, according to Hilton’s law, is by the nerves which supply the muscles which cross the joint. These are the _____, _______ and ________ nerves.
femoral, tibial and common fibular nerves
the medial and lateral menisci are fibrocartilage structures in the knee that serve what 2 functions?
- to deepen the articular surface of the tibia, this increasing stability of the joint
- to act as shock absorbers by increasing SA to further dissipate forces
> they separates the tibia and femur to decrease the contact area between the bones and serves as a shock absorber
they also reduces friction between the 2 bones
describe the medial meniscus
- attached to the intercondylar fossa of the tibia and is fixed to the tibial collateral ligament and joint capsule
what does damage to the tibial collateral ligament usually result in?
a medial meniscal tear
describe the lateral meniscus
- smaller than medial meniscus
- attaches to intercondylar area of tibia
- fairly mobile
superior surface of tibia
what is a bursa?
- a synovial fluid filled sac found between moving structures in a joint
- reduce wear and tear on the structures in the joint
- also represent weak points
what 4 bursae are found in the knee joint?
- suprapatellar bursa
- prepatellar bursa
- infrapatellar bursa
- semimembranosus bursa
what separates the lateral meniscus from the lateral collateral ligament?
popliteal tendon
describe the suprapatellar bursa
an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur
describe the prepatellar bursa
found between the apex of the patella and the skin
describe the infrapatellar bursa
split into deep and superficial
- the deep bursa lies between the tibia and the patella ligament
- the superficial lies between the patella ligament and the skin
describe the semimembranosus bursa
located posteriorly in the knee joint, between the semimembranosus muscle and the medial head of the gastrocnemius
describe the patellar ligament
a continuation of the quadriceps femoris tendon distal to the patella.
attaches to the tibial tuberosity
what 2 collateral knee ligaments are there?
- tibial (medial) collateral ligament
- fibular (lateral) collateral ligament
describe the tibial (medial) collateral ligament
- wide and flat
- found on the medial side of the knee joint
- proximally it attaches to the medial epicondyle of the femur
- distally it attaches to the medial condyle of the tibia
describe the fibular (lateral) collateral ligament
- thinner and rounder than the tibial collateral
- attaches proximally to the lateral epicondyle of the femur
- attaches distally to a depression on the lateral surface of the fibular head
what do the collateral ligaments of the knee do?
act to stabilise the hinge motion of the knee, preventing excessive medial or lateral movement
what cruciate ligaments are there in the knee?
- anterior cruciate ligament (ACL)
- posterior cruciate ligament (PCL)
what do the cruciate ligaments connect?
the femur and the tibia
describe the ACL
- attaches to the anterior intercondylar region of the tibia where it blends with the medial meniscus
- it ascends posteriorly to attach to the femur in the intercondylar fossa
- it prevents anterior dislocation of the tibia onto the femur
describe the PCL
- attaches to the psoterior intercondylar region of the tibia and ascends anteriorly to attach to the anteriormedial femoral condyle
- it prevents posterior dislocation of the tibia onto the femur
what are the 4 main movements of the knee joint?
- extension
- flexion
- lateral rotation
- medial rotation
what type of joint is the proximal tibiofibular joint?
plane type synovial joint
what is the articulation in the proximal tibiofibular joint?
between the head of the fibula and the lateral condyle of the tibia
what are the articular surfaces of the proximal tibiofibular joint lined with?
hyaline cartilage
the proximal tibiofibular joint is contained within a joint capsule. what additional support does the capsule receive?
- anterior and posterior superior tibiofibular ligaments
- lateral collateral ligament of the knee joint
- biceps femoris — provides reinforcement as it inserts onto the fibular head
what do the anterior and posterior superior tibiofibular ligaments span between?
the fibular head and the lateral tibial condyle
describe the neurovascular supply of the proximal tibiofibular joint
- arterial supply is via the inferior genicular arteries and the anterior tibial recurrent arteries
- the joint is innervated by branches of the common fibular nerve and the nerve to the popliteus (a branch of the tibial nerve)
what kind of joint is the distal tibiofibular joint?
fibrous joint (where the joint surfaces are bound by tough, fibrous tissue)
what articulates in the distal tibiofibular joint?
the fibular notch of the distal tibia and the fibula
what are the supporting structures of the distal tibiofibular joint?
- interosseous membrnae
- anterior and posterior inferior tibiofibular ligaments
- inferior transverse tibiofibular ligament = a continuation of the posterior inferior tibiofibular ligament
does the distal tibiofibular joint have a joint capsule?
NO, it is a fibrous joint
only synovial joints have a joint capsule
neurovascular supply of the distal tibiofibular joint
- arterial supply via branches of the fibular artery and the anterior and posterior tibial arteries
- innervation derived from the deep peroneal and tibial nerves
what type of joint is the ankle/talocrural joint?
synovial hinge joint
what are the tibia and fibula bound together by?
strong tibiofibular ligaments
the ankle/talocrural joint exists between the distal ends of the ____ and ____ and the upper part of the body of the _____. this ______ forms a hinge joint that allows ____ and _____
- tibia and fibula
- talus
- mortice
- dorsiflexion and plantarflexion
what is the medial/deltoid ligament?
- attached to the medial malleous
- stronger than the lateral ligament
- strengthens the capsule of the ankle joint medially
what is the lateral ligament?
-originates from the lateral malleolus
- resists over-inversion of the foot
- made of 3 parts — anterior talofibular, posterior talofibular, calcaneofibular
- strengthens the ankle joint capsule laterally
what kind of joint is the subtalar joint?
plane synovial
what are the articulating surfaces of the subtalar joint?
inferior surface of body of talus with superior surface of calcaneus (posterior talar articular surface with posterior calcaneal articular facet)
as is typical for a synovial joint, the surfaces of the subtalar joint are covered by ________
articular cartilage
the capsule of the subtalar joint is supported by what?
- posterior talocalcaneal ligament
- medial talocalcaneal ligament
- lateral talocalcaneal ligament
what ligament acts to bind the talus and the calcaneus together?
interosseous talocalcaneal ligament
the interosseous talcocalcaneal ligament leis within the _________ and is particularly strong, providing the majority of the ligament outs stability to the subtalar joint
sinus tarsi = a small cavity between the talus and calcaneus
what movements does the subtalar joint allow?
eversion and inversion
neurovascular supply of the subtalar joint
- posterior tibial and fibular arteries
- innervation to plantar aspect by medial or lateral plantar nerve
- innervation to dorsal aspect by deep fibular nerve
