Lower Limb Flashcards
Hip Bone
- Ilium = superior
- Ischium = postero-inferior
- Pubis = anteroinferior
Structure;
From most superior from an anterior perspective:
- Iliac crest (superior border)
- Ala (superior/anterior surface of ilium)
- Anterior Superior Iliac Spine ASIS (where iliac crest ends)
- Anterior Inferior Iliac Spine AIIS
- Body (inferior part of ilium)
Medial perspective:
1. Sacro-pelvic surface (where hip bone articulates with sacrum)
- Sacro-iliac Joint: compound joint made of synovial part (made of auricular surface of ilium) and fibrous syndesmosis (made of iliac tuberosity)
- Iliac fossa
- Greater Sciatic Notch
- Body of Ischium
- Ischial Spine
- Lesser ischial notch
- Ischial Tuberosity
- Body of Pubis
- Ischio-pubic Ramus
- Symphysial surface
Lateral Perspective:
- Ala
- Posterior Superior Iliac Spine (PSIS)
- PIIS
- Articular/Lunate Surface
- Acetabulum (socket where the 3 parts converge)
- Ischial Spine
- Ischial Tuberosity
- Obturator Foramen
Femur and Patella
Structure from proximal to distal:
- Head
- Neck
- Greater Trochanter
- Lesser trochanter
- Linea Aspera
- Patella
- Patella Surface
- Lateral epicondyle
- Medial condyle
- Medial epicondyle
- Adductor Tubercule
Tibia and Fibula
Tibia:
- Lateral and medial Tibial Plateau
- Soleal Line
- Tibial tuberosity
- Fibular notch of tibia
- Tibial articular surface
- Medial malleolus
Fibula:
- Head of Fibula
- Lateral malleolus
Tarsals, Metatarsals, Phalanges
7 Tarsal Bones:
- Calcaneus (‘heel’)
- Talus (articulate w tibia and fibula at ankle joint)
- Navicular (b/w talus and 3 cuneiform)
- Cuboid bone and 3 cuneiforms (articulate with metatarsals)
Sacroiliac Joint
compound joint with synovial part and fibrous syndesmosis
- auricular surface of sacrum articulates with the auricular surface of ilium
Function: To transmit the weight of the body through hip bones and to long bones
- limited movement
Pubic Symphysis
secondary cartilaginous joint b/w pubic bones
Hip Joint
Head of Femur articulates with Acetabulum of hip
Movements:
- flex/ext
- circumduction
- int/ext rotation
- abd/add
Lunate Artiular Carterliage doesn’t line whole acetabulum surface = INCONGRUENT surface so that not all surfaces of joint are touching at once and force and be focused in smaller points of impact and absorbed better by body
Why is the femur head and neck angled?
Important for bipedal distribution of weight through lower limbs
–> angle of femur head and neck slightly = give wider range of motion at hip joint
- -> diverts femur laterally at hip –> femur angles MEDIALLY to allow knees to be directly under pelvis to direct force directly through leg and foot
- —-> medial structures > lateral due to this asymmetry to support it
———> Lateral musculature of thigh = more dominant as it is more closely orientated to direction of thigh = more efficient
LATERAL MUSCLE BIAS, MEDIAL LOADING
Ligaments of Hip Joint
Ilio, Pubo and Ischio-Fermoral Ligaments
–> all ‘out of phase’/twisted as they all need to be able to bear weight and perform complex movements
Advantage: ligaments will always be tense = stability
Disadvantage: corkscrew has a gap in front where there is no tension –> fully flexed lower joint = LEAST STABLE
as limb flexes, ligaments unwind = increase mobility to anterior but decreased stability
Fully extended = highest stability
Knee Joint
Modified Hinge joint b/w DISTAL end of FEMUR and TIBIAL PLATEAU of tibia (no fibula)
- PATELLA articulates anteriorly
Structure:
- Lateral condyle > medial condyle of femur to prevent patella from laterally dislocating due to bias towards lateral muscle strength from femur angle
- PATELLAR TENDON: joins patella –> tibial tuberosity
- –> the main attachment of the quadriceps femoris muscles
- MEDIAL MENISCUS: wedge of fibrocartilage to accommodate curved femoral condyles on flat tibial plateau
- LATERAL MENISCUS: wedge of fibrocartilage providing increase congruence for femoral condyles to fit into
- KNEE JOINT CAPSULE: extends all the way to suprapatellar bursa
Ligaments:
- CRUCIATE: forms a cross inside knee to prevent anterior displacement of knee
- Anterior cruciate ligament (ACL) attaches to:
- ->TIBIA anteriorly
- -> FEMUR posteriorly
- Posterior Cruciate Ligament (PC) attaches toL
- –> FEMUR anteriorly
- –> TIBIA posteriorly
- COLLATERAL: prevents abduction/adduction or medial/lateral displacement of tibia
- LATERAL collateral ligament (LCL) = thinner, lax and weaker because its under less load due to femur angle = less likely to get damaged
- MEDIAL: thicker and taught because more likely to be damaged due to femur angle
Attaches: - to joint capsule
- medial meniscus
Ankle Joint
Distal tibia and fibula bound together by a syndesmosis and trochlea of talus
Trochlea of talus = slightly wedge shape (wider anteriorly)
Movements:
- PLANTARFLEXION = less stalbe
- wobble –> inversion/eversion - DORSIFLEXION = more stable
- posterior of trochlea = narrower and medial and lateral malleoli of tibia wrap tightly around wider anterior talus during dorsiflexion.
Ligaments involved:
- LATERAL ligaments: most commonly damaged due to shape of trochlea of talus and plantarflexed foot position when standing (less stable)
- ANTERIOR and POSTERIOR TALOFIBULAR ligaments
- CALCANEOFIBULAR ligament - MEDIAL: made up of:
- TIBIONAVICULAR part
- TIBIOCALCANEAL part
- ANT. AND POST. TIBIOTALAR parts - Elastic Spring Ligament:
- what the sustentaculum tali of talus dips into, therefore stretching ligament
- ligament absorbs energy/weight and springs back out
Structure:
- Sustentaculum Tali:
- part of medial calcaneus
- JOB = sustain position of talus and keep it supported when body weight is on talus
- is a site of attachment for the deltoid ligament - Tendon Fibularis
- runs behind lateral malleolus
- attaches to base of 5th metatarsal
- easy to cause bone avulsion (breakage)
Joints of Foot
Hindfoot = calcaneus + talus Midfoot = cuboid, navicular and cuneiform bones Forefoot = metatarsals + phalanges
Transverse Tarsal Joint: b/w hind and midfoot
Intertarsal Joint: b/w tarsals
Tarsometatarsal Joints: b/w midfoot and metatarsals
Metatarsal Phalangeal Joints: b/w metatarsals and proximal phalanges
- can flex/ext. add/abd
Interphalangeal Joints - b/w phalanges
- flex/ext.
Anterior Thigh Muscles - Hip Flexors
- PECTINEUS:
- adducts, flexes, rotates thigh
- attaches: from superior pubis ramus –> femur - ILIOPSAS:
- major hip flexor
- formed from: psoas major, iliacus, psoas minor
- attaches: distally to lesser trochanter of femur - SARTORIUS:
- flexes, abducts and laterally rotates thigh at hip joint
- flexes knee
Anterior Thigh - Knee Extensors (quads)
- OBLIQUUS GENU OF VASTUS MEDIALIS:
- only part that directly attaches to patella
- only muscle pulling knee medially to prevent LATERAL PATELLA DISLOCATION (due to angled femur and strong vastus lateralis) - RECTOR FEMORIS:
- crosses hip joint
- attaches to anterior inferior iliac spine (AIIS) - VASTUS LATERALIS, MEDIALIS, INTERMEDIALIS
- all attach to the greater trochanter of femur - QUADRICEPS TENDON:
- point of attachment for all 4 parts
- attaches to patellar ligament and tibial tuberosity
Posterior Thigh - Knee Flexors (hamstrings)
ISCHIAL TUBEROSITY OF HIP = where long head of biceps femoris, semimembranosus and semitendinosus attach
TIBIA = site of medial attachment for semimembranosus and semitendinosus
- BICEPS FEMORIS:
- lateral
- 2 heads
- short head attaches to posterior femur proximally
- both heads attach to lateral head of fibula distally - SEMITENDINOSUS
- SEMIMEMBRANOSUS
