Bones and Joints of the Lower Limb Flashcards
What are the four ares of the bones of the lower limb?
Pelvic girdle Thigh (Patella) Leg Foot
What bones make up the pelvic girdle?
Hip bone, sacrum, coccyx
What bones make up the thigh?
Femur
Patella
What bones make up the leg?
Tibia (medially)
Fibula (laterally)
What bones make up the foot?
Tarsal bones Metatarsal bones (x5) Phalanges (x14)
What are the tarsal bones?
Talus, calcaneus, navicular, cuboid,
medial, intermediate and lateral cuneiforms
What forms the hip bone?
Ilium, Ischium and Pubic bones are fused to form the Hip bone
What is found between the 3 parts of the hip bone?
Tri-radiate cartilage between the 3 parts of the hip bone. The cartilage is visible radiologically, but ossifies by late teens
Where do the hip bones articulate with each other?
the pubic symphysis
Go look at some netters flashcards or something, we gotta know some of the spines, tuberosities and surfaces of the hip
Iliac tuberosity
Auricular surface
- Up top medially, surface articulates w spine I think
Ischal spine and Ischal tuberosity
- Down low medially
Symphysial surface
- Guess
Where does the head of the femur articulate with the hip?
Acetabulum
What makes up the acetabulum?
Articular (lunate) surface
Acetabular fossa
What is the purpose of the pelvic girdle?
− attaches the Lower Limb to the axial skeleton − Transfers the body weight to the lower limbs − provides an almost rigid, complete ring for weight bearing and child birth − supports the pelvic organs − provides muscle attachment for limb movement
What is the neuromuscular role of the pelvic girdle?
Provides “Gateways” for neurovascular structures to pass to and from the limbs
What is the evolutionary role of the pelvic girdle?
Well suited for stability during standing, walking, and running
What is a handy way to identify two of the important structures on the pelvic girdle?
Anterior superior iliac spine is on the same coronal plane as the pubic tubercle and pubic crest
The highest point of the iliac crest is at the level of L4
What are the pelvic joints?
Pubic symphysis
Sacro-iliac joint
What is the pubic symphysis?
Is a secondary cartilaginous (or fibrocartilage) joint
Supported by superior and arcuate ligaments
Disc between articular surfaces
What is the sarco-iliac joint?
Synovial anteriorly, fibrous posteriorly
Supported by the Anterior and Posterior sacro-iliac and Interosseous ligaments
Extremely limited movement
What neurovascular landmark is formed from the Sacrospinous and Sacrotuberous ligaments?
The ligaments also convert the sciatic notches into Greater and Lesser sciatic foramina for the passage of nerves and vessels
What movement does body weight cause on the pelvic girdle?
Body weight wants to rotate S1 downwards and S4 upwards
What prevents rotation of S1 downwards and S4 upwards?
The Sacrospinous and Sacrotuberous ligaments prevent the sacrum tilting forwards
• support the sacro-iliac joint
What are the 4 neurovascular gateways of the pelvic girdle?
The greater and lesser sciatic foramen
The gap between inguinal ligament and pelvic bone
Obturator canal
What passes through the greater sciatic foramen?
Sciatic Nerve and Gluteal Neurovascular Bundle
What passes through the lesser sciatic foramen?
Internal Pudendal Neurovascular Bundle
What passes through the gap between inguinal ligament and pelvic bone?
Femoral Neurovascular Bundle
What passes through the Obturator canal?
Obturator Neurovascular Bundle
What are the basic similarities and differences of the hip joint to the shoulder joint?
Ball and socket type synovial joint
stable but limited mobility
What are the major landmarks of the area of femur articulation on the hip?
Acetabular rim
Lunate surface
Acetabular fossa
Acetabular notch
What are the major landmarks of the proximal area of the femur?
- Head of femur
- Fovea of head of femur
- Neck of femur
- Greater trochanter
- Lesser trochanter
- Intertrochanteric crest (Quadrate tubercle)
- Intertrochanteric line
Describe the acetabulum
Deep socket, weight bearing, stable.
The rim is raised by the acetabular labrum (it may tear and cause pain)
Labrum bridges across the acetabular notch as the Transverse acetabular ligament
What covers the head of femur?
covered by hyaline cartilage all except for the fovea of head of femur
Describe the joint capsule go the hip joint
Attached to the acetabular rim, transverse acetabular ligament, intertrochanteric line and neck of the femur
Synovial membrane covers everything except the articular cartilage and forms a sleeve around the ligament of the head of femur.
The synovial layers of the capsule sends retinacular fibres medially along the femoral neck towards the head.
Describe the ligament around the hip joint
All capsular ligaments of the hip joint spiral around the joint and attach to femur so that they are taut in extension.
- Prevent overextension
- Stabilize the joint
- Save energy during standing
Some deep fibres of the fibrous capsule wind circularly around the neck and form Zona orbicularis
What are the capsular ligaments of the hip joint?
Iliofemoral - strongest
Pubofemoral
Ischiofemoral – weakest
What are the purposes of the iliofemoral and pubofemoral capsular ligamnets?
Iliofemoral - strongest
Prevents hyperextension of hip joint during standing
Pubofemoral
Prevents overabduction of hip joint; tightens during abduction and extension of hip
What makes the knee weight bearing?
- free movement in one plane only+ joint stability weight- bearing
Is the knee complex?
Yeah
What are the characteristics of the knee joint?
Showsthecommoncharacteristics of all hinge joints.
− The articular surfaces are
reciprocally shaped
− They have strong collateral
ligaments
− The muscles are grouped at the
sides of the joint where they do not interfere with movement
What structures should one look out for in the distal femur?
- Medial condyle and epicondyle
- Lateral condyle and epicondyle
- Patellar surface
- Popliteal surface
- Intercondylar fossa
What structures should one look out for in the patella?
- Base of patella
- Lateral articular surface
- Apex of patella
What structures should one look out for in the proximal tibia and fibula?
- Lateral condyle
- Medial condyle
- Intercondylar tubercles (eminence)
- Tibial tuberosity
- Anterior intercondylar region
- Posterior intercondylar region
- Medial and lateral tibial plateaus
- Intercondylar eminence
Describe the fibrous capsule of the knee joint
The fibrous capsule
− attaches to the articular margins − incomplete
− lined by synovial membrane
Describe the anterior aspect of the joint capsule of the knee joint
Anteriorly, the fibrous capsule is replaced by the quadriceps tendon (patellar ligament), the patella and fat pads on either side of patellar ligament
Augmented by the iliotibial tract and patellar retinacula from quadriceps
Describe the posterior aspect of the joint capsule of the knee joint
Posteriorly, the fibrous capsule is augmented by the:
- oblique popliteal ligament
- —• expansion of the semimembranosus muscle
- arcuate popliteal ligament
There is an opening in the capsule for the tendon of popliteus
What is the oblique popliteal ligament an expansion of?
the semimembranosus muscle
There is an opening in the capsule of the knee joint, what is it for?
the tendon of popliteus
Describe the bursae of the knee joint
There are numerous bursae around the knee joint because most tendons run parallel to the bones and pull lengthwise across the joint during knee movements
Some of these bursae communicate with the articular cavity of the knee joint
What are het bursae that communicate wit hth particular cavity of the knee joint?
- Suprapatellar bursa
- popliteus bursa
- anserine bursa (pes bursa)
- gastrocnemius bursa
What are the collateral ligaments of the knee joint?
Lateral (Fibular)
Medial (Tibial)
Not so bad
Describe the lateral (Fibular) collateral ligament of the knee
strong cord from Lateral femoral epicondyle to Head of fibula
- Prevents adduction of leg - Tendon of popliteus is
between this ligament &capsule
Describe the medial (Tibial) collateral ligament of the knee
broad, flat band from Medial femoral epicondyle to Tibial condyle
- Fused to joint capsule and medial meniscus
- Prevents abduction of leg
Which collateral ligament of the knee joint is injured more often?
Injuries to the medial collateral ligament and Medial meniscus are more common than the lateral equivalents
What are the menisci of the knee joint?
Two crescent-shaped fibrocartilage
- Medial meniscus
- Lateral meniscus
What is then purpose of ht menisci of the knee joint?
Increase the congruence of articular surfaces
Dissipate the forces/stress on articular cartilage
Absorb shock
Decrease friction
Participate in locking of knees
Proprioception
Describe the connecting anatomy of the menisci of the knee joint
The horns of the menisci are attached to the intercondylar areas of the tibial plateau
The menisci are interconnected anteriorly by the transverse ligament of the knee
They move antero-posteriorly during flexion/extension of knee
What is the vascular distribution of the menisci of the knee joint?
Inner 2/3 is avascular, outer 1/3 partially vascular
Where is the medial meniscus of the knee joint attached?
is attached round its margin to the joint capsule AND to the medial collateral ligament
Where is the lateral meniscus of the knee joint attached?
- is attached to the joint capsule but NOT to the lateral collateral ligament
- tendon of the popliteus muscle attach to lateral meniscus
What ligaments extend from the lateral meniscus of the knee joint?
Meniscofemoral ligaments extend from the posterior horn of lateral meniscus to medial condyle of femur
What do the cruciate ligaments in the knee joint do?
Anterior cruciate ligament
- Prevents anterior movement of
tibia and hyperextension
Posterior cruciate ligament
- Prevents posterior movement of
tibia (walking downhill)
They also act as a pivot for rotatory movements between the bones
Where do the cruciate ligaments attach?
They are named according to their tibial attachment soooo femur -> tibia
What is the collodiaphysial angle?
The angle between the long axes of the neck and shaft of the femur
Wider in children
What is the Q-angle?
A great name for a supervillains plan and also:
The angle between the anatomical axis of the femur and that of the tibia
What is the normal ranges of the collodiaphysial angle?
120-135 degrees
What are the abnormal ranges of the collodiaphysial angle?
Coxa vara = <120 degrees
(head looks hunchback)
Coxa valga >135 degrees
(head looks stretched up)
What structures are there to look out for on the distal tibia?
- Fibular notch
- Medial malleolus
- Inferior articular facet
- Groove for flexor hallucis longus
- Groove for tibialis posterior
What structures are there to look out for on the distal fibula?
Lateral malleolus
Malleolar fossa
Articular surface
What structures should you know on the talus?
- Head of talus
- Neck of talus
- Body of talus
- Lateral malleolar surface
- Medial malleolar surface
Describe the capsule and ligaments of the ankle joint?
Loose fibrous capsule
Synovial folds within capsule
(collateral) Ligaments of ankle all originate at malleoli and fan out to tarsal bones
What are the collateral ligaments of the ankle?
- Medial (deltoid) ligament: Resists dislocation during eversion of the foot
- Lateral ligament: Resists over- inversion
What does the medial (deltoid) ligament of the ankle joint do?
Resists dislocation during eversion of the foot
What does the lateral ligament of the ankle joint do?
Resists over- inversion
What are the movements of the ankle joint?
talocrural articulation - hinge joint that is weight bearing so movement gonna be limited:
Extension (dorsiflexion)
[Plantar] Flexion (more unstable because of narrow trochlea)
What are the proximal tarsal bones?
Talus at joint,
Calcaneus out back
What are the distal tarsal bones?
(M -> L) medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid
What tarsal bone is found between the proximal and distal rows of tarsal bones?
Navicular
What is the only bone of the foot to link with the leg?
Talus
What areas are the foot broken into?
Forefoot, midfoot, hindfoot
What are the joints of the foot?
Distal Tibiofibular: Syndesmose Ankle: hinge joint Intertarsal: Plane joints Intermetatarsal & Tarsometatarsal: Plane joints Metatarsophalangeal: Condyloid joints Interphalangeal: Hinge joints
What kind of joint is the distal tibiofibular and what are its movements?
Syndesmose
No movement, helps to stabilise ankle and foot
What kind of joint is the ankle and what are its movements?
Hinge joint
Plantar flexion and dorsiflexion
What kind of joint are the intertarsal and what are their movements?
Plane joints
inversion and eversion
What are the intertarsal joints?
- Subtalar (Talocalcaneal)
- Talo-calcaneo-navicular
- Calcaneo-cuboid
The latter two make up the transverse tarsal joint
What joints make up the transverse tarsal joint?
The talo-calcaneo-navicular and calcaneo-cuboid intertarsal joints
What kind of joint are the intermetatarsal & tarsometatarsal and what are their movements?
Plane joints
Gliding movements
What kind of joint is the metatarsophalangeal and what are its movements?
Condyloid joints
Flexion, extension, Abduction, adduction
What kind of joint is the interphalangeal and what are its movements?
Hinge joints
Flexion and extension
Describe the transverse tarsal joint
TalonavicularpartofTCN+CC
Enclosedbyjointcapsule
Two important ligaments support the joints and plantar arches
Assists in inversion/eversion
What are the two important ligaments that support the joints and plantar arches?
Long plantar ligament
Spring ligament: supports head of talus, and much of the body weight
Where does surgical amputation of the foot take place
Transverse tarsal joint is site for surgical amputation of foot.
Describe the plantar arches?
Arches between the points of contact
Absorb and distribute downward forces from
the body during standing and moving
Medial longitudinal arch: Calcaneus, talus, navicular, all cuneiforms and medial 3 metatarsals
Lateral longitudinal arch: Calcaneus, cuboid and 4th-5th metatarsals
Transverse arch: Cuneiforms and cuboid
What are the two plantar arches?
Medial longitudinal arch
Lateral longitudinal arch
What makes up the medial longitudinal plantar arch?
Calcaneus, talus, navicular, all cuneiforms and medial 3 metatarsals
What makes up the lateral longitudinal plantar arch?
Calcaneus, cuboid and 4th-5th metatarsals
