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Gross Anatomy - Lower Extremity > Joints and Ligaments of the Lower Extremity and Back > Flashcards

Joints and Ligaments of the Lower Extremity and Back Flashcards

1
Q

Sacroiliac Joint

General Characteristics
Articulations
Ligaments (List)
Movements

A

General Characteristics:
Stable synovial joint where weight is transferred between the lower limb and the trunk

Articulations:
The auricular surface of the Ilium articulates with the auricular surface of the sacrum. Ridges above the auricular surfaces of both bones interlock with each other

Ligaments:

  1. Posterior Sacroiliac
  2. Anterior Sacroiliac
  3. Interosseous Sacroiliac
  4. Sacrotuberous
  5. Sacrospinous

Movements:
Limited to slight gliding and rotation

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2
Q

Ligaments of the Sacroiliac Joint: Attachments and Function

Posterior Sacroiliac Ligament

A

Thick Broad Band

Runs from the posterior surface of the sacrum to the Iliac Tuberosity

Reinforces the posterior aspect of the joint

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3
Q

Ligaments of the Sacroiliac Joint: Attachments and Function

Anterior Sacroiliac Ligament

A

Thin band; thinner than posterior iliac ligament

Runs from the Ventral Surface of the Sacrum to the medial part of the iliac fossa

Reinforces the joint anteriorly

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4
Q

Ligaments of the Sacroiliac Joint: Attachments and Function

Interosseous Sacroiliac Ligament

A

Between the Ilium and the Sacrum

holds the bones together on the irregular surface above the auricular surface of the Iluim

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5
Q

Ligaments of the Sacroiliac Joint: Attachments and Function

Sacrotuberous Ligament

A

Large band running from the posterior and lateral surfaces of the sacrum and coccyx to the Ischial tuberosity

Works with the Sacrospinous ligament to:
Creates the greater and lesser sciatic foramen

Prevent upward movement of the inferior end of the sacrum due to the downward force of the body weight coming down through the spinal column

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6
Q

Ligaments of the Sacroiliac Joint: Attachments and Function

Sacrospinous Ligament

A

Runs from the Anterolateral surface of the sacrum to the ischial spine

Works with the Sacrotuberous ligament to:
Creates the greater and lesser sciatic foramen

Prevent upward movement of the inferior end of the sacrum due to the downward force of the body weight coming down through the spinal column

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7
Q

Pubic Symphysis

General Characteristics
Articulations
Ligaments (List)
Movements

A

General Characteristics:
Fibrocartilaginous, symphyseal joint

Articulation:
Articulation between adjacent symphysial surfaces of pubis bones

There is a fibrocartilaginous disc between the bones

Ligaments:

  1. Superior Pubic Ligament
  2. Inferior Pubic Ligament

Movement:
None

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8
Q

Ligaments of the Pubic Symphysis: Attachments and Function

Superior Pubic Ligament

A

Superior to the Joint

Extends between the pubic crests

Strengthens the joint superiorly

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9
Q

Ligaments of the Pubic Symphysis: Attachments and Function

Inferior Pubic Ligament

A

Inferior to the Joint and to the disc

Extends between the pubic rami

Strengthens the joint inferiorly

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10
Q

Hip Joint

General Characteristics
Articulation
Articular Capsule
Ligaments (List)
Movements
Blood Supply
A

General Characteristics:
Ball and socket type synovial joint
Mobility is sacrificed for stability

Articulation:
Head of the femur articulates with the acetabulum of the hip bone, which is enlarged by a ring of fibrocartilage called the acetabular labrum

Articular Capsule;
Outer fibrous and inner synovial layers

Outer capsule loosely surrounds the joint to allow for greater mobility.

It runs from the acetabulum and acetabular ligament to the intertrochanteric line of the femur anteriorly and the base of the neck of the femur posteriorly
A portion of the synovial membrane protrudes inward forming a bursa.

Ligaments:

  1. Ligament of the Head of the Femur
  2. Transverse Acetabular Ligament
  3. Iliofemoral Ligament
  4. Pubofemoral Ligament
  5. Ischiofemoral Ligament

Movements:
Flexion/Extension, Abduction/Adduction, IR/ER, Circumduction

Blood Supply:
Medial and Lateral Circumflex Femoral Arteries
Artery of the head of the Femur

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11
Q

Ligaments of the Hip Joint: Attachments and Function

Ligament of the Head of the Femur

A

Runs from the acetabulum into the head of the femur

Not very strong

Carries the artery of the head of the femur to the femur - not really for joint support

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12
Q

Ligaments of the Hip Joint: Attachments and Function

Transverse Acetabular Ligament

A

Runs across the inferior part of the acetabulum where it is deficient.

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13
Q

Ligaments of the Hip Joint: Attachments and Function

Iliofemoral Ligament

A

Runs from the AIIS to the intertrochanteric line of the femur (superior/anterior aspect of the joint

Shaped like an Inverted Y

Runs a spiral course so that when it gets taught (with extension), it screws the head of the femur into the acetabulum

Limits Hyperextension

Provides major static restraint against gravitational force in quiet standing

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14
Q

Ligaments of the Hip Joint: Attachments and Function

Pubofemoral Ligament

A

Runs from the Pubis to the fibrous capsule of the hip joint

Blends with the Iliofemoral Ligament - also has a spiral course and contributes to screwing the head of the femur into the acetabulum as the hip goes into extension and the ligaments get taught

Reinforces the capsule inferiorly and anteriorly

Limits hyper abduction

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15
Q

Ligaments of the Hip Joint: Attachments and Function

Ischiofemoral Ligament

A

Winds around the joint from anterior to posterior, running from the ischial part of the acetabular rim to the neck of the femur posteriorly.

Blends with the joint capsule and runs a spiral course, allowing it to help screw the head of the femur into the acetabulum with extension. This prevents hyperextension at the hip.

Reinforces the posterior aspect of the joint

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16
Q

Knee Joint: General Characteristics

A

Synovial joint

Modified Hinge

Incongruent shape of articular surfaces leads it to be mechanically weak

Stability of the knee is due largely to surrounding muscles, soft tissue, tendons, and ligaments

The joint has the most congruency with the knee is in extension

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17
Q

Knee Joint: Articulations

A

The knee is primarily the articulation of the tibia and the femur and is called the tibiofemoral joint.

It can be subdivided into:
Lateral Tibiofemoral - lateral femoral condyle articulates with lateral tibial condyle
Medial Tibiofemoral - medial femoral condyle articulates with medial tibial condyle

The Patella also articulates with the patellar surface of the femur at the patellofemoral joint

The fibula IS NOT involved in the articulation at the knee and is not weight bearing

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18
Q

Knee Joint: Articular Capsule

A

The fibrous external layer:
Thin, incomplete sleeve.
It attaches to the medial meniscus but not to the lateral meniscus
It has an opening posteriorly for the tendon of popliteus to pass through and attach to the tibia

The Inner synovial membrane:
Lines the fibrous capsule and lines all of the surfaces not covered by the outer fibrous layer

Attaches to the superior and inferior outer margins of the menisci

Centrally, it becomes separated from the fibrous layer

From the posterior aspect of the joint, the synovial layer reflects inwardly making a loop around the cruciate ligaments so that they are excluded from the joint capsule

The cruciate ligaments are not enclosed in the synovial layer

It forms 2 Bursae (pouches) that provide low friction surfaces for tendons:

  1. Suprapatellar bursa - located superiorly between the distal end of the femur and the quadriceps femoris tendon; continuous with the synovial membrane; muscle slips from vastus intermedius (articular muscle of the knee) attach to it and pull it out of the way so that it doesn’t get impinged when the knee is extended.
  2. Subpopliteal recess - located posterolaterally; lies betweel the lateral meniscus and the popliteus tendon.
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19
Q

Knee Joint: Structures Reinforcing the Joint Capsule

A 
Anteriorly: 
Patella
Patella Ligament
Quadriceps Tendon
Medial and Lateral Retinacula (extensions of the insertions of vastus lateralis and medialis)

Posteriorly:

  1. Arcuate ligament - inserts on the joint capsule and covers the popliteus wehre it runs between the FCL and the knee joint
  2. Oblique Popliteal ligament - extension of semimembranosus tendon

Medial:
TCL
Pes Anserine Tendons

Lateral:
FCL
Iliotibial Tract

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20
Q

Knee Joint: Ligaments

Patella Ligament

A

Extracapsular

Thick fibrous band that extends from the base of the patella to the tibial tuberosity

Blends with the Medial and Lateral patellar retinacula

Continuation of the central portion of the quadriceps tendon

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21
Q

Knee Joint: Ligaments

Arcuate Ligament

A

Extracapsular Ligament

Arises posterior to the fibular head and passes over the tendon of popliteus, the spreads over the posterior aspect of the joint, blending with the capsule.

Supports the knee posteriorly.

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22
Q

Knee Joint: Ligaments

Oblique Popliteal

A

Extracapsular Ligament

Recurrent expansion of the tendon of semimembranosus posteriorly

Arises posterior to the medial condyle and passes superolaterally toward the lateral femoral condyle

Blends with the central part of the posterior aspect of the joint capsule

Spans the intracondylar fossa of the femur

Reinforces the posterior aspect of the joint

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23
Q

Knee Joint: Ligaments

TCL

A

Extracapsular Ligament

TCL = Tibial collateral ligament

Flat band that extends from the medial femoral condyle to the medial condyle and surface of the tibia

At the midpoint, its deep fibers attach to the medial meniscus

Reinforces the medial aspect of the joint

Resists valgus forces (lateral to medial); Genu valgum will put stress on TCL

WEAKER than FCL

24
Q

Knee Joint: Ligaments

FCL

A

Extracapsular Ligament

FCL = Fibular Collateral Ligament

Cord-like structure that extends from the lateral femoral condyle to the lateral surface of the fibular head

Tendon of Popliteus passes deep to it, separating it from the lateral meniscus.

Reinforces the lateral aspect of the knee joint

Taut in full extension

Varus forces will place stress on FCL (forces going medial to lateral) therefore having genu varus stresses FCL

25
Q

Knee Joint: Ligaments

Cruciate Ligaments (Overview)

A

Located within the joint capsule but outside of the synovial cavity

Primary rotary stabilizers of the knee

Both ligaments have an anteromedial and a posterolateral part so both are taut regardless of where you move the knee

Named for where they attach on the tibia

26
Q

Knee Joint: Ligaments

ACL

A

Intracapsular Ligament

Extends from the anterior intercondylar area of the tibia to the posterior part of the medial side of the lateral femoral condyle

Resists posterior displacement of the femur on the tibia (and anterior displacement of the tibia on the femur) as well as knee hyper extension.

It is slack in flexion and taut in extension, thogh it is always at least partially taught

It is the weaker of the 2 cruciate ligaments and has weaker blood supply.

27
Q

Knee Joint: Ligaments

PCL

A

Intracapsular Ligament

PCL = Posterior Cruciate ligament

Extends from the posterior intercondylar area of the tibia and passes superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur

Resists anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur (like in walking downhill) and resists knee hyper extension

Taut in flexion and slack in extension

Stronger of the 2 cruciate ligaments

28
Q

Knee Joint: Menisci

Overview

A

Wafers of fibrocartilage on the articular surface of the tibia

Aid in lubrication, nutrition, shock absorption, and joint congruency; reduce friction during movement

the inner 2/3 are avascular and the outer 1/3 is vascualrized

They cary 40 - 70 percent of the load across the knee

When you squat down (as you flex your knees) the menisci move posteriorly; the lateral one moves more than the medial one

29
Q

Knee Joint: Menisci

Medial Meniscus

A

C shaped

On the medial articular surface of the tibia (tibial plateau)

Larger and less mobile of the 2 menisci

It is thicker posteriorly than anteriorly

Anterior and Posterior horns attach to the anterior and posterior intercondylar areas respectively

It is firmly adhered to the deep fibers of MCL

30
Q

Knee Joint: Menisci

Lateral Meniscus

A

O shaped

On the lateral tibial plateau

Smaller and more mobile

More equal in thickness throughout

Its horns attache to the intercondylar areas of the tibia (the are closer together

It is separated from the FCL by the popliteus tendon and is therefore more mobile and less likely to be injured

31
Q

Knee Joint: Ligaments

Posterior Meniscofemoral Ligament

A

Intracapsular ligament

Joins the lateral meniscus to the PCL and the medial condyle of the femur

only found in about 70% of knees

32
Q

Knee Joint: Ligaments

Coronary Ligament

A

Portion of the joint capsule extending from the margins of the menisci to the periphery of the tibial condyles.

They help hold the menisci in place

33
Q

Knee Joint: Ligaments

Transverse Ligament of the Knee

A

Runs between the anterior horns of the lateral and medial menisci, crossing the anterior intercondylar area

Tethers the menisci together during movement, and helps prevent the anterior horns of the menisci form moving forward when the knee is being extended.

Only found in about 58% of knees.

34
Q

Knee Joint: Movements

Primary Movement
Screw Home Mechanism

A

Primary movement it flexion/extension

Because the lateral femoral articular surface is smaller than the medial articular surface, the lateral part comes in to full extension first, and some rotation is required to bring the medial side of the knee into full extension.

Screw home mechanism:
To lock the knee in a CKC, as the knee comes into extension, the femur passively rotates medially to bring the medial side of the knee into full extension; no help from muscles is required.

To unlock the knee in a CKC, the popliteus muscle contracts to rotate the femur laterally on the tibia about 5 degrees.

To lock the knee in an OKC, the tibia passively rotates laterally on the femur.

To unlock the knee in an OKC, the popliteus contracts to actively rotate the tibia medially on the femur

35
Q

Knee Joint: Arteries

A

Descending Genicular branch of femoral artery
Descending branch of lateral circumflex femoral artery
Popliteal artery (gives off genicular branches)
Superior Medial and Lateral Genicular Arteries
Middle Genicular Artery
Inferior Medial and Lateral Genicular Arteries
Reccurrent branches of Anteiror Tibial, Posterior Tibial, and Circumflex Fibular arteries

36
Q

Knee Joint: Bursae

Bursae of the Anterior Knee

A

Suprapatellar Bursa:
Continuous with the synovial membrane; lies between the quadriceps tendon and the anterior femur

Subcuatneous Prepatellar:
Between the skin and the patella bone

Subcutaneous Infrapatellar:
Between the skin and the patellar ligament

Deep Infrapatellar:
Lies between the patellar ligament and the tibia

37
Q

Knee Joint: Bursae

Bursae of the Posterior Knee

A

Popliteus Bursa:
Continuous with the synovial membrane; lies between the popliteus tendon and the lateral condyle of the tibia

Semimembranosus Bursa:
Lies between the semimembranosus tendon and the medial head of gastrocnemius

Gastrocnemius Bursa:
deep to the proximal attachment of the tendon of the medial head of gastrocnemius

Anserine Bursa:
Separates the 3 tendons that attach at the pes anserine from the medial tibia and the TCL

38
Q

Proximal Tibiofibular Joint

Joint Type
Articulation
Ligaments and Capsule
Movement

A

Type: Plane type synovial

Articulation: between the head of the fibula and the lateral condyle of the tibia

Ligaments and capsule: has an articular capsule that is strengthened by anterior and posterior ligaments

Movements: Slight upward movement of the fibula occurs with ankle plantarflexion as the wider anterior part of the talus moves up into the mortise of the ankle at the distal tibiofibular joint. We feel this movement more at the proximal than at the distal joint because the integrity of the mortise must be maintained.

39
Q

Distal Tibiofibular Joint

Joint Type
Articulation
Ligaments and Capsule
Movement

A

Type: Fibrous Joint (syndesmosis)

Articulation: fibular notch of the tibia with the medial surface of the distal fibula

Ligaments:

  1. Interosseous Ligament (continuous with interosseous membrane)
  2. Anterior and posterior ligaments (posterior ligament has a transverse part that runs between the malleoli forming part of the posterior wall of the mortise of the ankle)
40
Q

Ankle (Talocrural) Joint

General Characteristics
Articulations
Ligaments (list)
Movements

A

General Characteristics: Hinge type synovial joint

Joint is formed by the medial malleolus of the tibia, the lateral malleolus of the fibula, and the pulley shaped trochlea of the talus. the fibula is NOT WEIGHT BEARING

The malleoli, along with the inferior transverse part of the posterior tibiofibular ligament form a socket (mortise) into which the trochlea of the talus fits

Articulations:
Between the distal ends of the tibia and fibula (malleoli) and the superior part of the talus

Medial surface of the lateral malleolus articulates with the lateral surface of the talus

Lateral Surface of the medial malleolus articulates with the medial surface of the talus

Ligaments:
LCL of the ankle, composed of
1. Anterior talofibular
2. Posterior Talofibular
3. Calcaneofibular
**Fibula is a smaller bone so it comes last in the name

MCL of the ankle (aka deltoid ligament) composed of:

  1. Tibionavicular
  2. Tibiocalcaneal
  3. Posterior Tibiotalar
  4. Anterior Tibiotalar
    * *tibia is a larger bone and it forms the malleolus on this side so it comes first in the name

Movements: Dorsiflexion and Plantarflexion (joint is most stable in Dorsiflexion b/c the wider part of the talus is in the mortise)

41
Q

Important Intertarsal Joints (2)

A

Subtalar:
Articulation of the inferior surface of the talus with the sustentaculum tali of the calcaneus

Transverse tarsal:
Made up of adjacent talonavicular and calcaneocuboid joints

42
Q

Ligaments of the Intertarsal Joints: MCL and LCL of the ankle

A

Anchor the talus onto the calcaneus and the navicular

43
Q

Ligaments of the Intertarsal Joints: Talocalcaneal Interosseous Ligament

A

Anchors the talus to the Calcaneus

44
Q

Ligaments of the Intertarsal Joints: Spring Ligament

A

Aka Plantar calcaneonavicular ligament

Deep to Tibialis Posterior Tendon

Supports the head of the talus, which is the keystone of the medial longitudinal arch; holds the talus in place

Prevents downward displacement of the talus between the calcaneus and the navicular

45
Q

Ligaments of the Intertarsal Joints: Long Plantar Ligament

A

On the lateral side of the foot

supports the calcaneocuboid joint

46
Q

Ligaments of the Intertarsal Joints: Short Plantar ligament

A

comes out medially just deep to the long plantar ligament

also supports the calcaneocuboid joint

47
Q

Movements of the Intertarsal Joints

A

Inversion:
Occurs primarily at the subtalar joint, and is associated with forefoot supination and adduction at the transverse tarsal joint

Eversion:
Occurs primarily at the subtalar joint and is associated with abduction and forefoot pronation at the transverse tarsal joint

48
Q

Tarsometatarsal Joints

Articulation
Movement

A

Articulation of the cuboid and 3 cuneiforms with the bases of the metatarsals

Ligaments are Dorsal , Plantar, and Interosseous

Very little movement; slight gliding

49
Q

Intermetatarsal Joints

Articulation
Movement

A

Articulations between adjacent metatarsals

Ligaments are Dorsal , Plantar, and Interosseous

Little individual movement

50
Q

Metatarsophalangeal Joint

A

Between heads of metatarsals and bases of proximal phalanges

Have collateral ligaments and strong reinforcing plantar ligaments

Movement:
Flexion/Extension
Abduction/Adduction

51
Q

Interphalangeal Joints

A

heads of proximal phalanges articulate with bases of distal phalanges

Have collateral and plantar ligaments

Do flexion/extension

52
Q

Arches of the Foot: Overview

A

Act as shock absorbers for supporting the weight of the body and propelling it forward

Make the foot adaptable to changes in surfaces and weight

They resist movement in the opposite direction of force

They are maintained by the shape of the bones, the plantar ligaments, the plantar aponeurosis, and the action of the muscles

53
Q

Arches of the Foot: Medial Longitudinal Arch

A

Underneath the tendon of Tibialis Posterior

Composed of the Calcaneus, Talus (keystone of the arch supported by spring ligament), navicular, cuneiforms, and metatarsals (medial 3)

supported by the tendons of tibalis anterior, tibialis posteiror, and fibularis longus

54
Q

Arches of the Foot: Lateral Longitudinal Arch

A

Much lower than the medial longitudinal arch

Composed of Calcaneus, Cuboid, and lateral 2 metatarsals

55
Q

Arches of the Foot: Transverse arch

A

composed of the cuboid (laterally), cuneiforms, and metatarsals

supported by the fibularis longus tendon

Gross Anatomy - Lower Extremity (11 decks)

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