Joints of the Lower Limb - PowerPoint PPT Presentation

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Joints of the Lower Limb

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  1. Jointsof theLower Limb The Dance Hall byVincent van Gogh ,1888 • 03.March.2014 Monday 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 prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum Pubofemoralligamentobturatorcrest of pubic bone 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. MOVEMENTS OF HIP JOINT • Flexion-extension • Abduction-adduction • Medial-lateral rotation • Circumduction

  9. 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.

  10. 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

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

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

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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.

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

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

  21. 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

  22. 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)

  23. 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

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

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

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

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

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

  29. CALCANEOCUBOID JOINT synovial joint between: facet on the anterior surface of the calcaneus corresponding facet on the posterior surface of the cuboid.

  30. 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).

  31. 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

  32. 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.

  33. 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.

  34. 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.

  35. MAJOR LIGAMENTS OF FOOT • Plantar calcaneonavicular ligament (spring ligament) • Long plantar ligament • Plantar calcaneocuboid ligament (short plantar ligament)

  36. MAJOR LIGAMENTS OF FOOT • Plantar calcaneonavicular ligament (spring ligament) • Long plantar ligament • Plantar calcaneocuboid ligament (short plantar ligament)

  37. 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).

  38. ARCHES OF FOOT Spreading the weight

  39. 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

  40. ARCHES OF FOOT Spreading the weight Transverse arch of the foot Runs from side to side Formed by cuboid, cuneiforms & bases of metatarsals