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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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slide1

Jointsof theLower Limb

The Dance Hall byVincent van Gogh ,1888

  • 5.February.2014 Wednesday

Kaan Yücel M.D., Ph.D

slide2

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

slide3

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

slide4

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

slide5

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

slide6

Ligaments

Ischiofemoralligament

from the ischial part of the acetabularrim

spirals around the femoral neck, medial to the base of the greater trochanter.

slide7

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.

slide8

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.

slide9

MOVEMENTS OF HIP JOINT

  • Flexion-extension
  • Abduction-adduction
  • Medial-lateral rotation
  • Circumduction
slide10

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).

slide11

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.

slide12

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
slide13

Extracapsularligaments

Patellar ligament

Fibular (Lateral) collateral ligament

Tibial (Medial) collateral ligament

Oblique popliteal ligament

Arcuate popliteal ligament

slide21

INTRA-ARTICULAR LIGAMENTS

Cruciate ligaments & menisci

Anterior cruciate ligament(ACL)

Posterior cruciate ligament(PCL)

slide23

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

slide24

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.

slide25

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.

slide26

In the weight-bearing flexed knee, PosteriorCruciateLigament

the main stabilizing factor for the femur (e.g., when walking downhill).

slide28

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.

slide30

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

slide31

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.

slide33

TIBIOFIBULAR JOINTS

(Superior) Tibiofibular joint

Syndesmosis (inferior tibiofibular) joint

In addition, an interosseous membrane joins the shafts of the two bones.

slide34

TIBIOFIBULAR JOINTS

(Superior) Tibiofibular joint

Syndesmosis (inferior tibiofibular) joint

In addition, an interosseous membrane joins the shafts of the two bones.

slide36

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

slide37

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)
slide38

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

slide39

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.

slide40

ANKLE JOINT

  • Medial (Deltoid) ligament of theankle

strong and triangular in shape

tibionavicularpart

tibiocalcanealpart

posterior tibiotalar part

anterior tibiotalarpart

slide42

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

slide43

FOOT JOINTS

Subtalar (talocalcaneal) joint

Transverse tarsal joint (calcaneocuboid and talonavicular joints)

Inversion and eversion of the foot are the main movements

slide44

SUBTALAR JOINT

between

posterior calcaneal facet on inferior surface of talus

corresponding posterior talar facet on superior surface of calcaneus

slide45

SUBTALAR JOINT

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

slide46

SUBTALAR JOINT

  • Lateral, medial, posterior, and interosseoustalocalcaneal ligaments stabilize the joint.
  • Interosseoustalocalcanealligament
  • Lieswithin the tarsal sinus.
  • Separatesthe subtalar and talocalcaneonavicularjoints.
  • Especially strong.
slide47

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.

slide48

TRANSVERSE TARSAL JOINT

compound joint formed by two separate joints aligned transversely:

Talocalcaneonavicular

Calcaneocuboid joints

slide49

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

slide50

TALOCALCANEONAVICULAR JOINT

  • complex joint
  • head of the talus articulates with
  • calcaneus
  • plantar calcaneonavicular ligament
  • (spring ligament) below
  • navicularin front.
slide51

TALOCALCANEONAVICULAR JOINT

allows gliding and rotation movements, which together with similar movements of the subtalar joint are involved with inversion and eversion of the foot.

slide52

TALOCALCANEONAVICULAR JOINT

Capsulereinforced

posteriorly by interosseoustalocalcanealligament

superiorly by talonavicular ligament

inferiorly by plantar calcaneonavicular ligament (spring ligament)

slide53

TALOCALCANEONAVICULAR JOINT

Lateralpartreinforced

calcaneonavicular part of the bifurcate ligament

a Y-shaped ligament superior to the joint

Base attached to anterior aspect of superior surface of calcaneus

Arms attached to:

dorsomedialsurface of the cuboid (calcaneocuboidligament)

dorsolateral part of the navicular (calcaneonavicular ligament).

slide54

CALCANEOCUBOID JOINT

synovial joint between:

facet on the anterior surface of the calcaneus

corresponding facet on the posterior surface of the cuboid.

slide55

CALCANEOCUBOID JOINT

  • allows sliding and rotating movements involved with inversion and eversion of the foot.
  • reinforced by
  • bifurcate ligament
  • long plantar ligament
  • plantar calcaneocuboid ligament (short plantar ligament).
slide56

Shortplantar ligament

  • plantar calcaneocuboid ligament
  • Short, wide, and very strong
  • Connects calcaneal tubercle to the inferior surface of the cuboid.
  • Supportsthe calcaneocuboidjoint
  • Assiststhe long plantar ligament in resisting depression of the lateral arch of the foot
slide57

Long plantar ligament

Longestligament in the sole of the foot.

Liesinferior to the plantar calcaneocuboidligament.

Betweencalcaneusandcuboid bone (inferiorsurfaces)

More superficial fibers extend to the bases of the metatarsal bones.

Supportsthe calcaneocuboidjoint.

Strongestligament, resisting depression of lateral arch of the foot.

slide58

Metatarsophalangealjoints

Ellipsoidsynovial joints between heads of metatarsals and bases of proximal phalanges.

Allowextension and flexion, and limited abduction, adduction, rotation, and circumduction.

Four deep transverse metatarsal ligaments link heads of metatarsals together and enable the metatarsals to act as a single unified structure.

Interphalangealjoints

Hingejoints

Reinforcedby medial and lateral collateral ligaments and by plantar ligaments.

slide59

Tarsometatarsaljoints

between metatarsal bones and adjacent tarsal bones

plane joints

limited sliding movements.

The range of movement of tarsometatarsaljoint between metatarsal of great toe and medial cuneiform

greater than that of other tarsometatarsal joints

allows flexion, extension, and rotation.

slide60

MAJOR LIGAMENTS OF FOOT

  • Plantar calcaneonavicular ligament (spring ligament)
  • Long plantar ligament
  • Plantar calcaneocuboid ligament (short plantar ligament)
slide61

MAJOR LIGAMENTS OF FOOT

  • Plantar calcaneonavicular ligament (spring ligament)
  • Long plantar ligament
  • Plantar calcaneocuboid ligament (short plantar ligament)
slide62

FOOT JOINTS

In the foot, flexion and extension occur in the forefoot at the metatarsophalangeal and interphalangeal joints. Inversion is augmented by flexion of the toes (especially the great and 2nd toes), and eversion by their extension (especially of the lateral toes).

slide63

ARCHES OF FOOT

Spreading the weight

slide64

ARCHES OF FOOT

Spreading the weight

Longitudinal arch of the foot

Medial longitudinal arch

Calcaneus, talus, navicular, 3 cuneiforms & 3 metatarsals.

higherand more important than the lateral longitudinal arch.

talar headkeystoneof the medial longitudinal arch.

Lateral longitudinal arch

much flatter, rests on ground during standing. Calcaneus, cuboid, and lateral two metatarsals.

2

3

slide65

ARCHES OF FOOT

Spreading the weight

Transverse arch of the foot

Runs from side to side

Formed by cuboid, cuneiforms & bases of metatarsals