Lecture 12 Flashcards
synovial joint
- bones separated by fluid-filld joint cavity
- are diarthrotic
- synovial joints are very mobile so they have less stability…. so we need ligaments
what are the 6 features of the synovial joints?
- articular cartliage
- caps at the end of the bone… smooth cap to make smooth movement
- synovial caivty
- space between the two bone that make the join
- synovial fluid
- made by the synovial membrane
- jont capsule
- fibrous layer (external)
- synovial membrane (inner, makes synovial fluid)
- reinforcing ligaments (extra ligments)
- nerves and blood vessles (nevers ging throgh)
picture of the 6 features
other features of synovial joints
fatty pads
articular discs (menisci)
bursae
tendon sheaths
- protection for bones… we don’t want bones to hit bones
fatty pads
cusing between fibrous layer and synovial membrane or bone
sorrounding places where bone come into contact with each other….extra adipose for cushioning
articular discs (menisci)
fibrocartilage separates articular surface to improve “fit” of bone ends, stabilize joint and reduce wear and tear
menisci only in knee joint for the femur to have nice snug fit….makes a nice cushion to reduce wear and tear
bursae
sace lined with synovial membrane (contain synovial fluid)…any place where we’ll have some tension
reduce friction where ligaments, muscles, skin, tendons, or bones rub together
tendon sheaths
elongated bursa wrapped completely around tendon subjected to frictions
arm and the synovial joint pic
knee and synovial joint pic
what are the six types of synovial joints
- plane
- hinge
- pivot
- condylar
- saddle
- ball and socket
plane joint
- 2 flat structures that slide across one another
- found in
- intercarpals joints
- intertarsal joints
- joints between vertebral articular surfaces
- non axial so allows for micromovements
Hinge Joints
- like a door frame
- uniaxial== flexion and extension is the only movement
- Found in :
- elbow
- knee
- interphalangeal joint (joint within the finger itself)
pivot joint
- used for pivot motions
- found in
- proximal radioulna joints
- atlantoaxial joints (neck)
- allows the radius to spin around the ulna
- uniaxial beacuse only moving in one place, spinning on the long axis of the bone
Condylar joint
- has concave and convex surface
- biaxial… move in both sagitall and coronal place…
- allows flexion and extension and abduct and adduction
- found in:
- metacarpophalangeal (knuckle) joints
- wrist joins
saddle joint
- only found in carpometacarpal joints of the thumbs
- concave and convex … aloows for the same movement as the condyler ( flexion&extension and abduction&adduction)
- Thumb attachment to wrist
*
Ball and Socket Joint
- most mobile and least stable..
- found in
- head of humorous sit it socket by scapula (glenoid fossa)
- head of femur sit in socket by ilium and ishium (acetabelum)
- multiaxial..
- flexion and tension
- adduction and abduction
- rotation
summary of joints
describe the lower limb
anchored to the axial skeletron by the acroiliac jont and ligaments
divided into: gluteal region, thigh, leg and foot
nerves
Branches of the lumbosacral plexus associated with the lower limb – first 1
Ilio-inguinal
spinal segment: L1
Motor: none in the lower limb (innervates muscles of abdominal wall)
sensory: skin over anteromedial thigh and adjacent perinum
genitofemoral nerve
spinal segment: L1 -:2
motor: none in lower limb (genital branch innervates cremaster)
sensory: skin on anterior central thigh, genital branch innervates skin on anterior perineum
femoral nerve
spinal segment: L2- L4
motor: muscles in the anterior compartment of thigh, branches supply iliacus and pectineus
sensory: skin over anterior thing, anteromedial knee, medial leg and medial foot
obturator nerve
spinal segment: L2- L4
motor: muscles in the medial compartment of thigh (except pectineus and part of adductor magnus), obturator externus
sensory: skin over upper medial thigh
branches of the lumbosacral plexus associated with the lower limb – part 2
sciatic
spinal segment: L4 -S3
motor: muscle in posterial thigh, part of adductor magnus (ischium), muscles in the leg and foot
sensory: skin over lateral leg and foot, sole and dorsal surface of foot
superior gluteal
spinal segment: L4- S1
motor: gluteus medius, gluteus minimus, tensor fascia lata
sensory: none
inferior gluteal
spinal segment: L5 -S2
motor: gluteus maxims
sensory: on
lateral cutaneous nerve of the thigh
spinal segment: L2- L3
motor: none
sensory: parietal peritoneum in iliac fossa, skin over anterolateral thigh
posterior cutaneous nerve of the thigh
Spinal segment: S1-S3
motor: none
sensory: skin over upper medial aspect of thigh and adjacent perineum, post thigh and upper post leg
nerve to quadratus femoris
spinal segment: L4-S1
motor: quadratus femoris and inferor gemellus
sensory: none
nerve to obturator internus
spinal segment: L5- S2
motor: obturator internus and superior gemellus
sensory: none
perforating cutaneous nerve
spinal segment: S2- S3
motor: none
sensory: skin over medial gluteal fold
Muscles of the gluteal region
superfical group of larger muscles which abducg and extend the hip
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae
- gluteus minimus is the deepest, medius is the middle, tensor fascia latae*
- ….insers into the IT band*
IT band
Ilotibia tract … thick fascia along the later aspect of the thigh
Gluteus minimus
origin: posterior ilium btween anterior and inferior gluteal lines
insertion: greater trochanter
innervation: superior gluteal nerve
action: abduct femur- stabiliaztion of pelvis during single leg stance
gluteus medius
origin: posterior ilum between anterior and posterior gluteal lines
inserton: greater trochanter
innervation: superior gluteal nerve
action: abduct femur-stabilization of pelvis during single leg stance
* important for stabilization of pelvis… keep hip stable, and prevent hip from dropping every step*
gluteus maximus
origin: fascia covering gluteus medius, posterior ilium, fascia or erector spinae, dorsal surface of sacrum, coccyx, sacrotuberous ligament (originates on the ileum and sacrus and to coccyx, fibers run diagonal)
Insertion: posterior ilotibila tract and gluteal tuberosity
innervation: inferiro gluteal nerve
action: extension, lateral rotaton, abduction of hip
* passes over the posterior aspect of hip and allows for extension of hip….diagonial nature of fiber allows it to pass over the lateral aspect of hip to cause abduction and a little rotation*
tensor fascia lata
origin: lateral cest of ilium between ASIS and tubercle of crest
insertion: Iliotiila tract of fascia lata
innervation: superior gluteal nerve
action: stabilizes knee in extension
what are the deep group of small muscle which externally rotate the femur?
piriformis
obturator internus
superior gemellus
inferior gemellus
quadratus femmoris
Piriformis
origin: anterior surface of sacrum
insertion: greater trochanter
innervation: branches S1-S2
action: laterally rotate extneded hip; abduct flexed femur
obturator internus
origin: anterolateral wall of true pelvis, obturator membrane
insertion: greater trochanter
innervation: nerve to obturator internus
action: laterally rotate extended hip; abduct flexed femur
superior gemellus
origin: external surface of ischial spine
innertion: superiro surface of obturator internus tendon and greater trochanter
innervation: nerve to obturator internus
action: laterally rotate extended hip, abduct flexed femus
Inferior gemellus
origin: upper aspect of ischial tuberosity
insertion: inferior surface of obturator internus tendon and greater trochanter
innervation: nerve to quadratus femoris
action: laterally rotate extended hip, abduct flexed femus
quadratus femoris
origin: lateral aspect of ischium anterior to ischial tuberosity
insertion: quadrate tubercule on intertrochanteric crest
innervation: nerve to quadratus femoris
action: laterally rotate femur
picture
muscles the externally rotate the femur chart
gluteus chart
branches of the lumbosacral plexus associated with the lower limb part 1 chart
branches of the lumbosacral plexus associated with the lower limb
part 2 chart
Trendelenburg Sign
happens in people with weak or paralyzed abductors….
when patient stand on leg, the pelvis drops on the lifted leg side ….seen in patients with superior gluteal nerve damage
gait is abnormal… weakened abductor muscles allow pelvis to tilt, patient compensates by tiliting the trunk the other way to maintain levle of the trunk during gait
superior gluteal nerve
passes through greater sciatic foramen above piriformis
travels between the gluteus medius and minimus
supplies gluteus medius and minimus
sciatic nerve
passes through greater sciatic foramen below pififormis
descends between superfical and deep gluteal muscles, enters posterior thigh
innervates all of the muscles of the posterior compartment of thigh and muscles that move ankle and foot
ingerior gluteal nerve
passes through greater sciatic foramen below pififormis
innervates gluteus maximus
Quadratus Femoris
passes through greater sciatic foramen below pififormis and deep to sciatic
innerverates quadrtus femoris and inferior gemellus
obturator internus
passes through treater sciatic foramen below pififormis between post cutaneous and pudendal
innervates obstrurator internus and superior gemellus
posterior cutaneous nerve of the thigh
passes through greater sciatic foramen below piriformis and medial to sciatic
innervates skin over gluteal fold, posterior thigh and parts of perineum
pudendal nerve
passes through greater sciatic foramen below piriformsis and medial to sciatic
somatic innervation of perineum
no gluteal innervation
perforating cutaneous nerve
exits the pelvic cavity by piercing the sacrotuberous ligament
innervates skin over medial gluteus maximus
Intramuscular injections
injection in the upper outer quadrant … to avoid sciated nerve and superior gluteal vessels and nerve
must be careful not to damage neurovascular structures
inject into gluteus medius anterosupeiror to gluteus maximus
Inferor gluteal artery
originates from anterior trunk of internal iliac artery
exits greater sciatic foramen below pififormis with nerve
supplies surrounding muscles and descends into posterior thing where it anastomoses with branches of femoral artery
superior gluteal artery
originates from posterior trunk of internal iliac artery
exits greater sciatic foramen above piriformis with nerve
divides in gluteal region…
superifical branch==passes onto deep surface of gluteus maximsu
deep branch== passes between gluteus medius and minimus
veins
travel with the same named arteries
(inferior gluteal veins and superior gluteal veins)
lymphatics
deep vessels accompany gluteal blood vessels into the pelvic cavity and drain into internal iliac nodes
superficial drain into superficial inguinal nodes
