MSS02 Lower Limb Bones And Joints Flashcards
Lower limb regions
- Gluteal
- Thigh
- Leg (crus)
- Foot (pes)
Anterior:
- Knee (genu)
- Foot dorsum
- Big toe (hallux)
Posterior:
- Popliteal fossa
- Ankle (tarsus)
- Sole (plantar)
Lower limb bones
- Hip bone
- Femur
- Patella
- Fibula
- Tibia
- Foot bones
Hip bone
3 parts:
- Ilium (upper)
- Pubis (lower anterior)
- Ischium (lower posterior)
Ilium:
- ASIA (Anterior superior iliac spine)
- PSIS
- Iliac crest
- Iliac fossa
- Auricular surface (medial side) (connect to sacrum)
- Greater sciatic notch
Pubis:
1. Pubic tubercle
Ischium:
- Ischial spine
- Ischial tuberosity
- Lesser sciatic notch
Pubis + Ischium: Obturator foramen (acetabulum下面)
Ilium + Pubis + Ischium:
Acetabulum (femur socket)
Femur
- Head
- Neck
- Greater trochanter (***anterior)
- Lesser trochanter (***posterior)
- Intertrochanteric line (anterior)
- Intertrochanteric crest (posterior)
- Quadrate tubercle (posterior)
- Gluteal tuberosity (posterior)
* **9. Linea aspera (posterior) - Medial / Lateral epicondyle
- Medial / Lateral condyle
- Intercondylar fossa
Condyle: more central than Epicondyle
Femoral neck
Angle of inclination: 125o
Angle of anteversion (頭向前) / femoral torsion: 12o
Patella
link to:
- Quadriceps tendon (to quadriceps)
- Ligamentum patellae (to tibia)
Largest sesamoid bone
Tibia and Fibula
Tibia (無head, neck, epicondyle):
- Medial + Lateral condyle
- Tibial tuberosity (anterior)
* **3. Soleal line (posterior)
* **4. Medial malleolus (distal ankle bone)
Fibula:
- Head
- Neck
* **3. Lateral malleolus (distal ankle bone)
Foot bones
- Large Tarsal bone (x2)
- Calcaneus (lateral)
- Talus (medial) - Small Tarsal bone (x5)
- Cuboid (lateral)
- Navicular (posteromedial)
- Cuneiform (anteromedial) —> lateral / medial / intermediate - Metatarsal (x5)
- Phalanges (x2: Big toe, x3: other digits)
Tarsal bones
Large Tarsal (後–>前):
- Calcaneus
- Talus
Small Tarsal (lateral–>medial):
- Cuboid
- Navicular
- Cuneiform (lateral, intermediate, medial)
Transference of weight
Body weight –> Femur –> **Tibia –> **Talus –> ***Foot arches –> other Tarsal + Metatarsal bones
- **Weight-bearing points:
1. Calcaneus (後腳㬹)
2. Heads of metatarsals (ball of foot)
Normal standing: weight equally divided between Calcaneus and ball of foot
Longitudinal and Transverse arches:
- -> Weight distribution
- -> Springiness of foot
Sacroiliac joint
***Synovial plane joint
Ilium Auricular surface + Sacrum corresponding surface
Stabilized by ligaments:
(1. Interosseous sacroiliac ligaments (transverse)
2. Posterior sacroiliac ligaments
3. Sacrospinous ligament
4. Sacrotuberous ligament)
Hip joint
***Synovial ball-and-socket joint
4 ligaments:
- Ligamentum teres (ligament of femur head, attach to Fovea capitis of femur head) (=/ ligamentum teres / round ligament of liver!!!)
Capsule fibres:
- ***Spiral arrangement
- thickened to form 3 ligaments:
- Iliofemoral (anterior, strongest)
- Pubofemoral (anterior)
- Ischiofemoral (posterior)
Very stable:
- due to shape of articular surface + 3 ligaments
Most stable position:
- Slightly Hyperextended
- -> Standing (ligaments wind up and force the articular surfaces closer together)
Most unstable position:
- Hip Flexed and Adducted
- -> Sitting + Cross legs (ligaments slack)
Dislocation of hip joint
- Mostly posterior (femur head posterior and superior to acetabulum)
Damage:
- ***Sciatic nerve
- ***Ligamentum teres
- Artery of ligamentum teres –> Avascular necrosis of femoral head (children)
Hip fracture
- Elderly women common
- Osteoporosis
- Fracture of neck
- -> tear ***Retinacular vessels (within femoral neck region)
- -> Avascular necrosis of femoral head
3 types:
- Intracapsular (neck)
- Intertrochanteric (trochanters)
- Subtrochanteric (femur body fracture)
***Blood supply to femur head
- Retinacular arteries
- branches of Medial and Lateral **Circumflex Femoral arteries (from **Deep Femoral artery)
- pierce joint capsule (出面穿入去), run beneath synovial membrane along femoral neck, enter femoral head through small holes - Artery of ligamentum teres
- branch of **Obturator artery
- **more important in children
- small contribution to blood supply in adults - Nutrient arteries
- small contribution
***Knee joint
***Synovial condyloid / modified hinge joint:
Femur + Tibia
***Synovial plane joint:
Femur + Patella
Articular disks of the knee-joint: Menisci (lateral + medial)
Movement:
- Flexion / Extension
- **- some Rotation when joint flexed
- -> Medial rotation of femur: during last phase of extension (stand up)
- -> Lateral rotation of femur: unlock the knee (begin knee flexion) by ***Popliteus muscle
Synovial cavity:
- Extensive synovial cavity with a number of Bursae
1. Suprapatellar bursa
2. **Prepatellar bursa
3. Deep infrapatellar bursa
4. **Subcutaneous infrapatellar bursa - -> joint effusion can extend to Bursae
- -> Bursitis: **Prepatellar (anterior to patella), **Subcutaneous infrapatellar (anterior to ligamentum patellae)
- **Ligaments:
1. Cruciate ligament - ACL: connect to anterior tibia
- PCL: connect to posterior tibia
- Anteroposterior stability
- Collateral ligament
- Tibial CL (MCL)
- Fibular CL (LCL)
- Transverse stability
- Both: Rotational stability
Injury:
- Very unstable joint due to incongruous (不一致的) articular surface
- ***Medial side prone to injuries e.g. torn ligament/capsule, sprain, torn meniscus
- **Twisting of hyperextended knee: **ACL tear
- ***Most stable position: full extension
- -> femur rotates medially on the tibia during full extension
- -> all ligaments taut, knee in “screwing-home” position
- Muscle tone of ***Quadriceps Femoris is the most important stabilizing factor
Tibiofibular joints
Very little movement
Superior/ Proximal tibiofibular joint:
***Synovial plane joint
Inferior / Distal tibiofibular joint:
***Syndesmosis (fibrous joint held together by ligaments —> Anterior + Posterior tibiofibular ligament)
Interosseous membrane binds the shafts of tibia and fibula together
Ankle joint
***Synovial hinge joint
Lateral, Medial Malleoli + lower articular surface of Tibia
+
Talus
(Mortise + Tenon 入榫)
***Collateral Ligament:
Medial:
1. Deltoid ligament
Lateral:
- Anterior talofibular ligament
- Posterior talofibular ligament
- Calcaneofibular ligament
Stability:
- Strong collateral ligament (esp. Deltoid ligament) –> prevent ad/abduction
- **Stable esp. **Dorsiflexed (trochlea of talus is wider anteriorly: Tibia, Fibula夾實Talus)
- Most **unstable in **Plantar flexed –> dislocation
Injury:
- Forced inversion-adduction / eversion-abduction
- -> Rupture of collateral ligaments
- -> Fractures of malleoli
Inversion (外翻/正常拗柴):
- -> Avulsion of lateral malleolus
- -> Push fracture of medial malleolus
Eversion (內翻拗柴):
- -> Avulsion of medial malleolus
- -> Push fracture of lateral malleolus
Foot joint
- Transverse tarsal joints (Synovial plane joints)
- Calcaneocuboid joint
- Talonavicular joint (TN) - Tarsometatarsal joints (Synovial plane joints)
- Metatarsophalangeal joints (Synovial ellipsoid / condylar joints)
- Interphalangeal joints (Synovial hinge joints)
- Subtalar joint (Talus to Calcaneus) + Transverse tarsal / mid-tarsal joint
—> STTN complex (Synovial plane joints)
—> Inversion / Eversion take place
Ligaments:
- ***Plantar ligaments (strong –> support foot arches (act as ties))
- Long plantar
- Short plantar
- Spring - Interosseous ligaments (strong –> support foot arches (act as ties))
- ***Talocalcaneal interosseous ligament - Dorsal ligaments (weak)
Foot arches
- Longitudinal arches x2 (medial higher than lateral)
- Anterior transverse arch x1
—> 形成一個三角形 - formed by shape of bones
- supported by:
1. **Plantar ligaments
2. **Interosseous ligaments
3. **Plantar aponeurosis
4. Muscles
5. Tonic contraction of extrinsic and intrinsic muscles (act as **slings / ties)
Mechanism of arch support
- Ties pulling from above
- Tibialis anterior (muscle) - Slings (扯向上)
- Peroneus longus (muscle) - Ties near concavity
- Interosseous ligaments - Ties in concavity
- Plantar ligaments
- short muscles - Ties between bases
- Plantar aponeurosis
Types of joint
Plane joint:
- Sacroiliac joint
- Knee (Femur + Patella)
- Superior/ Proximal tibiofibular joint
- Transverse tarsal joints
- Tarsometatarsal joints
- Subtalar joint + Transverse tarsal joint (STTN complex)
Ball-and-socket:
- Hip joint
Condyloid / modified hinge joint:
- Knee (Femur + Tibia)
Syndesmosis:
- Inferior / Distal tibiofibular joint
Hinge:
- Ankle joint
- Interphalangeal joints
Ellipsoid / Condylar:
- Metatarsophalangeal joint
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