Exam 4D Flashcards
hip joint type
synovial
ball and socket
hip joint articular surfaces
head of femur
lunate surface (articular surface of acetabulum): deficient inferiorly (acetabular notch, bridged by transverse acetabular ligament)
acetabulum is deepened by a fibrocartilaginous rim (acetabular labrum), attaches to margins of acetabulum
hip joint ligaments
iliofemoral (of Bigelow) pubofemoral ischiofemoral orbicular zone ligament of head of femur
iliofemoral, pubofemoral and ischiofemoral ligaments wind around hip joint in a spiral fashion; provide for a “screw-home” effect in full extension of joint, as thigh is extended, ligaments are twisted, get tight and head of femur is guided like a screw into its socket; close-packed position of hip joint, or position of greatest bony congruence and stability, is full extension
iliofemoral ligament
strengthens joint anteriorly, strong, inverted Y-shaped ligament, stem attaches to lower part of AIIS, 2 limbs of Y attach to intertrochanteric line, limits extension
pubofemoral ligament
strengthens joint inferiorly, attaches proximally to superior ramus of pubis and pubic part of acetabular rim, blends distally with lower part of iliofemoral ligament, limits extension and abduction
ischiofemoral ligament
strengthens joint posteriorly, attaches proximally to ischial part of acetabular rim, fibers pass superiorly and laterally, attach distally to upper surface of neck of femur, medial to base of greater trochanter, limits extension
orbicular zone
consists of deeply located, circularly arranged fibers, that form collar around femoral neck, helps to hold head of femur in acetabulum
ligament of head of femur
located inside joint and covered by synovial membrane, extends from transverse acetabular ligament and margins of acetabular notch to fovea of head of femur, not very important mechanically (may limit adduction), contains artery of ligament of head of femur (branch of obturator artery) which makes a small contribution to blood supply of femoral head
hip joint nerve supply
femoral nerve, obturator nerve, superior gluteal nerve and nerve to quadratus femoris
hip joint movements
hip joint has wide range of motion, but less than shoulder joint
range of motion has been sacrificed to provide strength and stability
allows flexion/extension, abduction/adduction, medial and lateral rotation and circumduction
hip joint problems
in posterior dislocation of the hip joint, affected limb is shorter and medially rotated
in fracture of neck of femur, affected limb is shorter and laterally rotated
knee joint
largest and most complex synovial joint of body
consists of 2 articulations closely integrated:
tibiofemoral joint: between tibial and femoral condyles
patellofemoral joint: between articular surface of patella and patellar surface of femur
fibula does not participate in knee joint
functions as modified hinge joint, allows primarily flexion/extension + some medial and lateral rotation
menisci
medial meniscus is more open than lateral meniscus
menisci are attached by their anterior and posterior ends (horns) to anterior and posterior intercondylar areas of tibia
posterior part of lateral meniscus is also attached to medial condyle of femur via posterior meniscofemoral ligament (sometimes there is an anterior meniscofemoral ligament, too)
transverse ligament of knee
connects anterior aspects of medial and lateral menisci
patellar ligament
extends from lower part of patella to tibial tuberosity (downward continuation of tendon of quadriceps femoris)
articular capsule is reinforced on each side of patella and patellar ligament by tendinous fibers derived from medial and lateral vasti, medial and lateral patellar retinacula
oblique popliteal ligament
fibrous expansion of tendon of semimembranosus muscle; strengthens posterior aspect of joint capsule
arcuate popliteal ligament
originates from head of fibula and arches over popliteus muscle, as muscle exits knee joint; strengthens articular capsule posteriorly
fibular (lateral) collateral ligament
cord-like, extends from lateral epicondyle of femur to head of fibula; does not attach to lateral meniscus; tendon of popliteus muscle intervenes between fibular collateral ligament and lateral meniscus; prevents hyperextension and adduction of leg
tibial (medial) collateral ligament
broad, flat band, extends from medial epicondyle of femur to medial condyle and upper part of medial surface of shaft of tibia, firmly attached to medial meniscus (makes medial meniscus more fixed in position), prevents hyperextension and abduction of leg
cruciate ligaments
two strong intracapsular ligaments; constitute main bond between femur and tibia; named anterior and posterior according to their tibial attachments
anterior cruciate ligament:
extends from anterior intercondylar area of tibia to medial surface of lateral condyle of femur prevents anterior displacement of tibia on femur (posterior displacement of femur on tibia)
posterior cruciate ligament
extends from posterior intercondylar area of tibia to lateral surface of medial condyle of femur prevents posterior displacement of tibia on femur (anterior displacement of femur on tibia)
suprapatellar bursa
out-pouching of synovial membrane of knee joint extends superiorly, deep to quadriceps femoris communicates with joint cavity
subcutaneous prepatellar bursa
located in subcutaneous tissue between patella and skin (its inflammation is called housemaid’s knee)
subcutaneous infrapatellar bursa
located in subcutaneous tissue between patellar ligament and skin (its inflammation is called clergyman’s knee)
deep (subtendinous) infrapatellar bursa
located between patellar ligament and tibia
there are also bursae associated with popliteus, insertion of semimembranosus, insertion of pes anserinus, insertion of biceps femoris, origins of medial and lateral heads of gastrocnemius, iliotibial tract and fibular collateral ligament
knee joint innervation
femoral nerve, obturator nerve, common fibular nerve and tibial nerve
knee joint movements
flexion/extension
medial and lateral rotations (with knee flexed)
at the end of full extension, there is lateral rotation of tibia, if foot is off ground, or medial rotation of femur, if foot is on ground supporting body weight this causes tightening of major ligaments of joint knee is said to be in “locked” position
at beginning of flexion, knee is “unlocked” by popliteus (causes medial rotation of tibia if foot is off ground, or lateral rotation of femur if foot is on ground)
proximal tibiofibular joint
synovial joint (plane type) between head of fibula and articular surface on posterolateral aspect of lateral condyle of tibia articular capsule is strengthen by anterior and posterior ligaments of fibular head allows small amount of movement during movements of ankle joint
interosseous membrane:
fibrous membrane connecting interosseous borders of tibia and fibula binds tibia and fibula together and provides attachment for muscles
distal tibiofibular joint (syndesmosis)
fibrous joint between lower ends of tibia and fibula consists of anterior, posterior and interosseous tibiofibular ligaments (interosseous ligament is an inferior continuation of interosseous membrane) allows small amount of movement during movements of ankle joint
ankle joint type
synovial joint, hinge type
ankle joint articular surfaces
consists of a deep socket (formed by inferior and malleolar articular surfaces of tibia and malleolar articular surface of fibula) that embraces upper part of body of talus (trochlea consists of superior articular surface and medial and lateral malleolar articular surfaces)
medial (deltoid) ligament
strong, triangular in shape its apex is attached to medial malleolus, its base is attached to navicular, talus and calcaneus parts: tibionavicular, tibiocalcaneal and anterior and posterior tibiotalar ligaments
lateral ligament
weaker than medial ligament, consists of 3 bands:
anterior talofibular ligament
posterior talofibular ligament
calcaneofibular ligament
anterior talofibular ligament
from anterior margin of lateral malleolus to lateral aspect of neck of talus most commonly torn in ankle sprains
posterior talofibular ligament
from malleolar fossa to lateral tubercle of posterior process of talus
calcaneofibular ligament
from tip of lateral malleolus to lateral surface of calcaneus
ankle joint innervation
tibial and deep fibular nerves
ankle joint movements
dorsiflexion and plantar flexion of foot
subtalar joint (talocalcaneal)
synovial joint between posterior calcaneal articular surface (on inferior surface of body of talus) and posterior talar articular surface (on superior surface of calcaneus)
subtalar ligaments
medial, lateral and posterior talocalcaneal ligaments
interosseous talocalcaneal ligament: located anterior to joint, within tarsal sinus main bond between talus and calcaneus
support is also provided by some ligaments of ankle joint which, passing from tibia and fibula to calcaneus, span talus
talocalcaneonavicular joint
synovial joint (medial part of transverse tarsal joint)
proximal articular surface formed by talus consists of navicular articular surface and anterior and middle calcaneal articular surfaces
distal articular surface formed by talar articular surface of navicular (on posterior aspect of navicular) and anterior and middle talar articular surfaces of calcaneus (middle talar articular surface lies on superior aspect of sustentaculum tali)
distal articular surface is completed by the strong plantar calcaneonavicular (spring) ligament extends from anterior margin of sustentaculum tali to inferior surface of navicular superior surface of ligament covered with cartilage supports head of talus
joint is also strengthen superiorly by dorsal talonavicular ligament, laterally by calcaneonavicular part of bifurcate ligament and posteriorly by interosseous talocalcaneal ligament
calcaneocuboid joint
synovial joint, saddle type (lateral part of transverse tarsal joint) established between articular surfaces on anterior surface of calcaneus and posterior surface of cuboid
calcaneocuboid joint ligaments
bifurcate
long plantar
short plantar
bifurcate ligament
located on superior surface of joint Y-shaped stem of “Y” attaches to calcaneus and its limbs attach to cuboid and navicular
long plantar ligament
strong ligament on inferior surface of joint attaches posteriorly to calcaneus, just anterior to its tuberosity, and anteriorly to cuboid and bases of 2nd to 4th (or 2nd to 5th) metatarsals passes under sulcus for fibularis longus tendon and transforms sulcus into an osteofibrous tunnel
short plantar (plantar calcaneocuboid) ligament
located deep (superior) to long plantar ligament extends from inferior surface of calcaneus (calcaneal tubercle) to inferior surface of cuboid
other tarsal joints
cuneonavicular joint: synovial joint between navicular and 3 cuneiforms
cuboideonavicular joint: joint between navicular and cuboid (usually a fibrous joint, but occasionally a synovial joint)
intercuneiform and cuneocuboid joints: synovial joints established between adjacent cuneiforms and between lateral cuneiform and cuboid, respectively
movements occurring at these joints: slight gliding and rotation during inversion and eversion of foot
tarso/internetatarsal joints
synovial joints, plane type
tarsometatarsal joints: between 3 cuneiforms and cuboid (proximally) and bases of metatarsals (distally)
intermetatarsal joints: between bases of adjacent metatarsals (2nd to 5th)
allow limited gliding movements
1st tarsometatarsal joint (between medial cuneiform and base of 1st metatarsal) has greater range of motion than remaining tarsometatarsal joints
metatarsophalangeal joints
similar to metacarpophalangeal joints of hand
Type: synovial joints, ellipsoid (condylar) type
Articular surfaces: heads of metatarsals and bases of proximal phalanges
Movements: flexion/extension (minimal abduction/adduction)
MTP ligaments
plantar ligaments (plates): fibrocartilaginous thickenings of inferior surface of joint capsules deep transverse metatarsal ligaments: connect heads of adjacent metatarsals (from 1st to 5th) collateral ligaments: fibrous cords on each side of joints
interphalangeal joints
similar to interphalangeal joints of hand
there are proximal (PIP) and distal (DIP) interphalangeal joints in all toes, except great toe (has only one IP joint)
Type: synovial joints, hinge type
Articular surfaces: head of one phalanx and base of phalanx immediately distal
Ligaments: plantar and collateral ligaments (similar to MTP joints)
Movements: flexion/extension
foot as a functional unit
main functions of foot:
supports body weight
serves as lever to propel body in walking and running
foot is a segmented lever with multiple joints pliable, can adapt to uneven surfaces
arches of foot
each foot is arched in such a way (from anterior to posterior and from side to side) that it approximates a half-dome when medial borders of 2 feet are placed together, a complete dome is formed
3 arches are described: medial longitudinal, lateral longitudinal and transverse
medial longitudinal arch
higher than lateral longitudinal arch
consists of calcaneus, talus, navicular, 3 cuneiforms and 1st, 2nd and 3rd metatarsals
lateral longitudinal arch
consists of calcaneus, cuboid and 4th and 5th metatarsals
transverse arch
consists of bases of all metatarsals, cuboid and 3 cuneiforms
arches are maintained by
shape of bones
strong ligaments that bind bones together (especially on plantar aspect) short and long plantar ligaments, plantar calcaneonavicular (spring) ligament and plantar aponeurosis
tone of muscles in sole of foot and muscles of leg that insert into foot bones and suspend arches from above
shape of bones and ligaments are responsible for maintaining arches in relaxed foot and in weight-bearing static foot (passive support)
in active foot muscles are recruited (dynamic support)
pes planus
flat foot
condition in which medial longitudinal arch is depressed or collapsed
pes cavus
claw foot
condition in which medial longitudinal arch is abnormally high most cases are caused by muscle imbalance, in many instances resulting from poliomyelitis
