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MSS > MSS02 Lower Limb Bones And Joints > Flashcards

MSS02 Lower Limb Bones And Joints Flashcards

1
Q

Lower limb regions

A
  1. Gluteal
  2. Thigh
  3. Leg (crus)
  4. Foot (pes)

Anterior:

  1. Knee (genu)
  2. Foot dorsum
  3. Big toe (hallux)

Posterior:

  1. Popliteal fossa
  2. Ankle (tarsus)
  3. Sole (plantar)
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2
Q

Lower limb bones

A
  1. Hip bone
  2. Femur
  3. Patella
  4. Fibula
  5. Tibia
  6. Foot bones
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3
Q

Hip bone

A

3 parts:

  1. Ilium (upper)
  2. Pubis (lower anterior)
  3. Ischium (lower posterior)

Ilium:

  1. ASIA (Anterior superior iliac spine)
  2. PSIS
  3. Iliac crest
  4. Iliac fossa
  5. Auricular surface (medial side) (connect to sacrum)
  6. Greater sciatic notch

Pubis:
1. Pubic tubercle

Ischium:

  1. Ischial spine
  2. Ischial tuberosity
  3. Lesser sciatic notch
Pubis + Ischium:
Obturator foramen (acetabulum下面)

Ilium + Pubis + Ischium:
Acetabulum (femur socket)

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4
Q

Femur

A
  1. Head
  2. Neck
  3. Greater trochanter (***anterior)
  4. Lesser trochanter (***posterior)
  5. Intertrochanteric line (anterior)
  6. Intertrochanteric crest (posterior)
  7. Quadrate tubercle (posterior)
  8. Gluteal tuberosity (posterior)
    * **9. Linea aspera (posterior)
  9. Medial / Lateral epicondyle
  10. Medial / Lateral condyle
  11. Intercondylar fossa

Condyle: more central than Epicondyle

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5
Q

Femoral neck

A

Angle of inclination: 125o

Angle of anteversion (頭向前) / femoral torsion: 12o

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6
Q

Patella

A

link to:

  1. Quadriceps tendon (to quadriceps)
  2. Ligamentum patellae (to tibia)

Largest sesamoid bone

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7
Q

Tibia and Fibula

A

Tibia (無head, neck, epicondyle):

  1. Medial + Lateral condyle
  2. Tibial tuberosity (anterior)
    * **3. Soleal line (posterior)
    * **4. Medial malleolus (distal ankle bone)

Fibula:

  1. Head
  2. Neck
    * **3. Lateral malleolus (distal ankle bone)
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8
Q

Foot bones

A
  1. Large Tarsal bone (x2)
    - Calcaneus (lateral)
    - Talus (medial)
  2. Small Tarsal bone (x5)
    - Cuboid (lateral)
    - Navicular (posteromedial)
    - Cuneiform (anteromedial) —> lateral / medial / intermediate
  3. Metatarsal (x5)
  4. Phalanges (x2: Big toe, x3: other digits)
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9
Q

Tarsal bones

A

Large Tarsal (後–>前):

  1. Calcaneus
  2. Talus

Small Tarsal (lateral–>medial):

  1. Cuboid
  2. Navicular
  3. Cuneiform (lateral, intermediate, medial)
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10
Q

Transference of weight

A

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
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11
Q

Sacroiliac joint

A

***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)

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12
Q

Hip joint

A

***Synovial ball-and-socket joint

4 ligaments:

  1. 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:
  1. Iliofemoral (anterior, strongest)
  2. Pubofemoral (anterior)
  3. 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)
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13
Q

Dislocation of hip joint

A
  • Mostly posterior (femur head posterior and superior to acetabulum)

Damage:

  1. ***Sciatic nerve
  2. ***Ligamentum teres
  3. Artery of ligamentum teres –> Avascular necrosis of femoral head (children)
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14
Q

Hip fracture

A
  • Elderly women common
  • Osteoporosis
  • Fracture of neck
  • -> tear ***Retinacular vessels (within femoral neck region)
  • -> Avascular necrosis of femoral head

3 types:

  1. Intracapsular (neck)
  2. Intertrochanteric (trochanters)
  3. Subtrochanteric (femur body fracture)
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15
Q

***Blood supply to femur head

A
  1. 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
  2. Artery of ligamentum teres
    - branch of **Obturator artery
    - **    more important in children
    - small contribution to blood supply in adults
  3. Nutrient arteries
    - small contribution
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16
Q

***Knee joint

A

***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
  1. 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
17
Q

Tibiofibular joints

A

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

18
Q

Ankle joint

A

***Synovial hinge joint

Lateral, Medial Malleoli + lower articular surface of Tibia
+
Talus
(Mortise + Tenon 入榫)

***Collateral Ligament:

Medial:
1. Deltoid ligament

Lateral:

  1. Anterior talofibular ligament
  2. Posterior talofibular ligament
  3. 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
19
Q

Foot joint

A
  1. Transverse tarsal joints (Synovial plane joints)
    - Calcaneocuboid joint
    - Talonavicular joint (TN)
  2. Tarsometatarsal joints (Synovial plane joints)
  3. Metatarsophalangeal joints (Synovial ellipsoid / condylar joints)
  4. Interphalangeal joints (Synovial hinge joints)
  5. Subtalar joint (Talus to Calcaneus) + Transverse tarsal / mid-tarsal joint
    —> STTN complex (Synovial plane joints)
    —> Inversion / Eversion take place

Ligaments:

  1. ***Plantar ligaments (strong –> support foot arches (act as ties))
    - Long plantar
    - Short plantar
    - Spring
  2. Interosseous ligaments (strong –> support foot arches (act as ties))
    - ***Talocalcaneal interosseous ligament
  3. Dorsal ligaments (weak)
20
Q

Foot arches

A
  • 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)
21
Q

Mechanism of arch support

A
  1. Ties pulling from above
    - Tibialis anterior (muscle)
  2. Slings (扯向上)
    - Peroneus longus (muscle)
  3. Ties near concavity
    - Interosseous ligaments
  4. Ties in concavity
    - Plantar ligaments
    - short muscles
  5. Ties between bases
    - Plantar aponeurosis
22
Q

Types of joint

A

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

23
Q

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A

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