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Joints of the Lower Limb

Joints of the Lower Limb. The Dance Hal l by Vincent van Gogh ,1888. 5.February.2014 Wednesday. Kaan Yücel M.D., Ph.D. Articulations of the pelvic girdle Lumbosacral joints , sacroiliac joints & pubic symphysis The remaining joints of the lower limb Hip joint Knee joint

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Joints of the Lower Limb

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  1. Jointsof theLower Limb The Dance Hall byVincent van Gogh ,1888 • 5.February.2014 Wednesday Kaan Yücel M.D., Ph.D

  2. Articulations of the pelvic girdle Lumbosacral joints, sacroiliac joints & pubic symphysis The remaining joints of the lower limb Hip joint Knee joint Tibiofibular joints Ankle joint Foot joints JOINTS OF LOWER LIMB

  3. Feature 1: Connection between lower limb & pelvic girdle Feature 2: 2nd most movable after the shoulder joint Synovial Joint Type: Ball and socket (Head of the femur & acetabulum) Weight transfer: To the heads and necks of the femurs

  4. Ligaments Transverse acetabular ligamentcontinuation of acetabular labrum 3 intrinsic ligaments Iliofemoral ligamentanteriorly and superiorly , strongest ligament of the body Pubofemoral ligament anteriorly and inferiorly Ischiofemoral ligamentposteriorly –weakest of the 3 Ligament of the head of the femur

  5. Ligaments IliofemoralligamentY-shaped From Ant. Inf. IliacSpine &AcetabularrimToIntertrochantericline prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum Pubofemoralligamentobturatorcrest of pubic bone blends with the medial part of the iliofemoral ligament tightens during both extension and abduction prevents overabduction of thehipjoint

  6. Ligaments Ischiofemoralligament from the ischial part of the acetabularrim spirals around the femoral neck, medial to the base of the greater trochanter.

  7. Ligaments The ligaments and periarticular muscles (the medial and lateral rotators of the thigh) play a vital role in maintaining the structural integrity of the joint.

  8. Ligaments Ligament of the head of the femur primarily a synovial fold conducting a blood vessel weak and of little importance in strengthening the hip joint. wide end attaches to the margins of the acetabular notch and the transverse acetabularligament narrow end attaches to the fovea for the ligament of the head.

  9. MOVEMENTS OF HIP JOINT • Flexion-extension • Abduction-adduction • Medial-lateral rotation • Circumduction

  10. MOVEMENTS OF HIP JOINT During extension of the hip joint, the fibrous layer of the joint capsule, especially the iliofemoral ligament, is tense. The hip can usually be extended only slightly beyond the vertical except by movement of the bony pelvis (flexion of lumbar vertebrae).

  11. MOVEMENTS OF HIP JOINT From the anatomical position, the range of abduction of the hip joint is usually greater than for adduction. About 60° of abduction is possible when the thigh is extended, and more when it is flexed. Lateral rotation is much more powerful than medial rotation.

  12. KNEE JOINT • Feature 1: Largest & most superficial joint • Feature 2: Hinge movements (Ext/Flex) combined with gliding & rotation • Synovial Joint Type: Hinge • 2 femorotibial articulations (lateral and medial) • between lateral & medial femoral and tibial condyles • 1 intermediate femoropatellar articulation • between patella & femur • No fibula involvment in the kneejoint

  13. Extracapsularligaments Patellar ligament Fibular (Lateral) collateral ligament Tibial (Medial) collateral ligament Oblique popliteal ligament Arcuate popliteal ligament

  14. INTRA-ARTICULAR LIGAMENTS Cruciate ligaments & menisci Anterior cruciate ligament(ACL) Posterior cruciate ligament(PCL)

  15. Start: anterior intercondylar area of tibia just posterior to the attachment of the medial meniscus End: Medialside of the lateral condyle of the femurr Start: Posteriorintercondylararea of tibia End: Lateralsurface of the medial condyle of femur

  16. Limitsposterior rolling (turning and traveling) of the femoral condyles on the tibial plateau during flexion. Preventsposterior displacement of the femur on the tibia and hyperextension of the knee joint.

  17. Llimits anterior rolling of the femur on the tibial plateau during extension. Preventsanterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint.

  18. In the weight-bearing flexed knee, PosteriorCruciateLigament the main stabilizing factor for the femur (e.g., when walking downhill).

  19. Menisci of the knee jointare crescentic plates of fibrocartilage on the articular surface of the tibia that deepen the surface and play a role in shock absorption.

  20. MOVEMENTS OF KNEE JOINT Flexion and extension are the main knee movements; some rotation occurs when the knee is flexed. When the knee is fully extended with the foot on the ground, the knee passively “locks” because of medial rotation of the femoral condyles on the tibial plateau (the “screw-home mechanism”). This position makes the lower limb a solid column and more adapted for weight-bearing. http://www.pt.ntu.edu.tw/hmchai/kinesiology/KINlower/Knee.files/KneeKinematics.htm

  21. BURSAE AROUND KNEE JOINT There are at least 12 bursae around the knee joint because most tendons run parallel to the bones and pull lengthwise across the joint during knee movements. The subcutaneous prepatellar and infrapatellar bursae are located at the convex surface of the joint, allowing the skin to be able to move freely during movements of the knee. The large suprapatellar bursa is especially important because an infection in it may spread to the knee joint cavity.

  22. TIBIOFIBULAR JOINTS (Superior) Tibiofibular joint Syndesmosis (inferior tibiofibular) joint In addition, an interosseous membrane joins the shafts of the two bones.

  23. TIBIOFIBULAR JOINTS (Superior) Tibiofibular joint Syndesmosis (inferior tibiofibular) joint In addition, an interosseous membrane joins the shafts of the two bones.

  24. TIBIOFIBULAR JOINTS Syndesmosis(inferior tibiofibular) joint stability of the ankle joint keeps the lateral malleolus firmly against the lateral surface of the talus interosseoustibiofibularligament anteriorandposteriortibiofibularligaments

  25. ANKLE JOINT • Talocrural joint • Distal ends of the tibia & fibula & superior parts of the talus • Synovial Joint Type: Hinge • LIGAMENTS OF ANKLE JOINT • Lateral ligament of the ankle • Medialligament of the ankle(deltoid ligament)

  26. Lateralligament of theankle • anterior talofibularligament • flat, weak band • extends from lateral malleolus to neck of talus • posterior talofibularligament • calcaneofibular ligament • round cord • passes from tip of lateral malleolus to lateral surface of calcaneus thick, strong band runs posteriorly from malleolarfossa to lateral tubercle of talus

  27. ANKLE JOINT • Medial (Deltoid) ligament of theankle strong and triangular in shape apex attached above to medial malleolus broad base attached below to a line extends from the tuberosity of the navicular bone in front to medial tubercle of talus behind.

  28. ANKLE JOINT • Medial (Deltoid) ligament of theankle strong and triangular in shape tibionavicularpart tibiocalcanealpart posterior tibiotalar part anterior tibiotalarpart

  29. FOOT JOINTS The major joints at which movements occur Subtalar Talocalcaneonavicular Calcaneocuboid joints Intertarsaljoints between the cuneiforms and between the cuneiforms and the navicular allow only limited movement. Transversetarsal joint

  30. FOOT JOINTS Subtalar (talocalcaneal) joint Transverse tarsal joint (calcaneocuboid and talonavicular joints) Inversion and eversion of the foot are the main movements

  31. SUBTALAR JOINT between posterior calcaneal facet on inferior surface of talus corresponding posterior talar facet on superior surface of calcaneus

  32. SUBTALAR JOINT allows gliding and rotation, involved in inversion and eversion of the foot.

  33. SUBTALAR JOINT • Lateral, medial, posterior, and interosseoustalocalcaneal ligaments stabilize the joint. • Interosseoustalocalcanealligament • Lieswithin the tarsal sinus. • Separatesthe subtalar and talocalcaneonavicularjoints. • Especially strong.

  34. SUBTALAR JOINT Orthopedic surgeons anatomical subtalar joint + talocalcanealpart of talocalcaneonavicularjoint The subtalar joint (by either definition) is where the majority of inversion and eversion occurs, around an axis that is oblique.

  35. TRANSVERSE TARSAL JOINT compound joint formed by two separate joints aligned transversely: Talocalcaneonavicular Calcaneocuboid joints

  36. TRANSVERSE TARSAL JOINT At this joint, the midfoot and forefoot rotate as a unit on the hindfoot around a longitudinal (AP) axis, augmenting the inversion and eversion movements occurring at the clinical subtalar joint. Transection across the transverse tarsal joint a standard method for surgical amputation of the foot

  37. TALOCALCANEONAVICULAR JOINT • complex joint • head of the talus articulates with • calcaneus • plantar calcaneonavicular ligament • (spring ligament) below • navicularin front.

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