The hip joint is a multiaxial synovial ball-and-socket joint between the head of the femur and the acetabulum of the

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1 NfW Hip Joint The hip joint is a multiaxial synovial ball-and-socket joint between the head of the femur and the acetabulum of the pelvic bone. Unlike the ball-and-socket shoulder joint, the hip joint is designed for stability and support at the expense of some mobility. Similar to the shoulder joint, the acetabulum is rimmed by a fibrocartilaginous "lip" called the acetabular labrum that deepens the socket. The features of the hip joint are summarized in the table below. The primary hip joint ligaments include three major ligaments that surround the hip joint and one intemal ligament to the head of femur. LIGAMENT ATTACHMENT COMMENT Hip (Multiaxial Synovial Ball-and-Socket) Joint Capsular Iliofemoral Acetabular margin to femoral neck Iliac spine and acetabulum to intertrochanteric line Encloses femoral head and part of neck; acts in flexion, extension, abduction, adduction, circumduction Is strongest ligament; forms inverted Y (of Bigelow); limits hyperextension and lateral rotation Ischiofemoral Acetabulum to femoral neck Limits extension and medial rotation; is weaker ligament posteriorly Pubofemoral Pubic ramus to lower femoral neck Limits extension and abduction Labrum Acetabulum Fibrocartilage, deepens socket Transverse Acetabular notch interiorly Cups acetabulum to form a socket for femoral head acetabular Ligament of head of femur Acetabular notch and transverse ligament to femoral head Artery to femoral head runs in ligament COLOR the following ligaments of the hip joint, using a different color for each ligament or feature: 1. Iliofemoral ligament (Y ligament of Bigelow): positioned anteriorly 2. Pubofemoral ligament positioned anteriorly and inferiorly 3. Ischiofemoral ligament positioned posteriorly 4. Acetabular labrum: fibrocartilage around the rim of the socket 5. Articular cartilage on the head of the femur 6. Ligament of the head of the femur: attaches to the acetabular notch and transverse acetabular ligament Clinical Note,"< Figure 2-17 Hip fractures are common injuries. In the young, the fracture often results from trauma, whereas in the elderly the cause is often related to osteoporosis and associated with a fall. The neck of the femur is a common site for such fractures. Printed from STLDENT CONSULT: Netter's Anatomy Coloring Book (on 04 January 2013) 2013 Elsevier

2 IW1P C. luinl» )cncd: Itlcttl view I). Com»l tcction Hansen: Netter's Anatomy Coloring Soak, 1st Edition. Copyright 2009 by Saunders, an imprint of Elsevier, Inc. All rights reserved. j"n" Printed from: Netier's Anatomy Coloring Book (on 04 January 2013} 2013 Elsevier Til \ a ffn

3 NRM> Shoulder Joint The shoulder, or glenohumeral joint, is a muitiaxiai synovial ball-and-socket joint that allows tremendous mobility of the upper limb. Because of the shallow nature of this ball-and-socket joint and its relatively loose capsule, the shoulder joint is one of the most commonly dislocated joints in the body. The acromioclavicular joint is a plane synovial joint that permits some gliding movement when the arm is raised and the scapula rotates. The shoulder joint is reinforced by four rotator cuff muscles, whose tendons help stabilize the joint (also see Plate 3-17 on rotator cuff muscles): Supraspinatus Infraspinatus Teres minor Subscapularis Bursae help to reduce friction by separating the muscle tendons from the fibrous capsule of the glenohumeral joint. Additionally, although the glenoid cavity of the scapula is shallow, a rim of fibrocartilage, called the glenoid labrum flip"), lines the peripheral margin of the cavity like a collar and deepens the "socket." Note also that the tendon of the long head of the biceps muscle passes deep to the joint capsule to insert on the supraglenoid tubercle of the scapula. Features of the shoulder joint ligaments and bursae are summarized in the table below. LIGAMENT OR BURSA ATTACHMENT COMMENT Acromioclavicular (Synovial Plane) Joint Capsule and articular disc Acromioclavicular Coracoclavicular (conoid and trapezoid ligaments) Surrounds joint Acromion to clavicle Clavicle to coracoid process Allows gliding movement as arm is raised and scapula rotates Reinforces the joint Glenohumeral (Muitiaxiai Synovial Ball-and-Socket) Joint Capsule Coracohumeral Glenohumeral Transverse humeral Glenoid labrum Surrounds joint Coracoid process to greater tubercle of humerus Supraglenoid tubercle to lesser tubercle of humerus Spans greater and lesser tubercles of humerus Margin of glenoid cavity of scapula Permits flexion, extension, abduction, adduction, circumduction; most frequently dislocated joint Composed of superior, middle, and inferior thickenings Holds long head of biceps tendon in intertubercular groove Is fibrocartilaginous ligament that deepens glenoid cavity Bursae Subacromial Between coracoacromial arch and suprascapular muscle Subdeltoid Between deltoid muscle and capsule Subscapular Between subscapularis tendon and scapular neck COLOR the following ligaments and bursae (color these blue, parts C and D) associated with the shoulder joint, using a different color for each ligament: 1. Supraspinatus tendon 2. Subscapularis tendon 3. Biceps brachii tendon 4. Capsular ligaments of the shoulder no

4 5. Infraspinatus tendon 6. Teres minor tendon Clinical Note Movement at the shoulder joint, or almost any joint, can lead to inflammation of the tendons surrounding that joint and secondary inflammation of the bursa that cushions the joint from the overlying muscle or tendon. At the shoulder, the supraspinatus muscle tendon is especially vulnerable because it can become pinched by the greater tubercle of the humerus, the acromion, and the coracoacromial ligament. i t - Figure 2-12 About 95% of shoulder joint dislocations occur in an anterior direction. Often this can happen with a throwing motion, which places stress on the capsule and anterior elements of the rotator cuff (especially the subscapulans tendon). Printed from STUDENT CONSULT: Netter's Anatomy Coloring Book (on 04 January 2013) 2013 Bsevier QD

5 ffpuf A. Anlrrior ti AirnniHn.l.m(.uLlf Atn Clavicle i nimi.il livit ubr t. )uin[ opened: blrr.il \icvk D. Coruiul set lion Ihrnu^h joint Hansen: Welter's Anatomy Coioring Book, 1st Edition. Copyright 2009 by Saunders, an imprint of Elswier, inc. Ail rights reserved. Printed from: Netter's Anatomy Coloring Book (on 04 January 2013) 2013Bsevier i alapa SOtt \» 6>rp_k amjottctmka -

6 Knee Joint The knee is a biaxial condylar synovial joint and is the most sophisticated joint in the body. It participates in flexion, extension, and some gliding and medial rotation when it is flexed. When in full extension, the femur rotates medially on the tibia, and the ligaments tighten to "lock" the knee. Features of this joint are summarized in the table below. LIGAMENT ATTACHMENT COMMENT Knee (Biaxial Condylar Synovial) Joint Capsule Surrounds femoral and tibial condyles, and patella Is fibrous, weak (offers little support); flexion, extension, some gliding, and medial rotation Extra capsular Ligaments Tibial collateral Medial femoral epicondyle to Limits extension and abduction of leg; attached to medial tibial condyle medial meniscus Fibular collateral Patellar Lateral femoral epicondyle to fibular head Patella to tibial tuberosity Limits extension and adduction of leg; overlies popliteus tendon Acts in extension of quadriceps tendon Arcuate popliteal Fibular head to capsule Passes over popliteus muscle Oblique popliteal Semimembranosus tendon to posterior knee Limits hyperextension and lateral rotation Intracapsular Ligaments Medial meniscus Interarticular area of tibia, lies Is semicircular (C-shaped); acts as cushion; often over medial facet, attached to torn tibial collateral Lateral meniscus Interarticular area of tibia, lies Is more circular and smaller than medial meniscus; over lateral facet acts as cushion Anterior cruciate Posterior cruciate Transverse Anterior intercondylar tibia to lateral femoral condyle Posterior intercondylar tibia to medial femoral condyle Anterior aspect of menisci Prevents posterior slipping of femur on tibia; torn in hyperextension Prevents anterior slipping of femur on tibia; shorter and stronger than anterior cruciate Binds and stabilizes menisci Posterior Posterior lateral meniscus to Is strong meniscofemoral medial femoral condyle (ligament of Wrisberg) Patellofemoral (Biaxial Synovial Saddle) Joint Quadriceps tendon Patellar Muscles to superior patella Patella to tibial tuberosity Is part of extension mechanism Acts in extension of quadriceps tendon; patella stabilized by medial and lateral ligament (retinaculum) attachment to tibia and femur COLOR the following extracapsular and intracapsular ligaments of the knee joint, using a different color for each ligament: 1. Medial meniscus: fibrocartilage disc on the tibia that deepens the articular surface and acts as a shock absorber or cushion 2. Tibial (medial) collateral ligament 3. Posterior cruciate ligament 4. Anterior cruciate ligament 5. Lateral meniscus: similar disc of fibrocartilage on the lateral side of the tibia 6. Fibular (lateral) collateral ligament

7 Clinical Note Figure 2-19 knel w^irth!z iffi?hmc'ate "f!tent (ACL) is a C mmon athletic "*"* usual y related «twisting of the knee while the foot is firmly on the ground. Because the ACL prevents hyperextension of the knee movement of the tibia forward on the femur while keeping the foot stable (anterior drawer sign) is used to asalhtttz? Often ACL mjunes also are accompanied by a tear of the tibial collateral ligament or the medial menfecus TheSf meniscus attaches to the tibial collateral ligament. The combination of these three lir^ collateral ligament, and medial meniscus-is known as the "unhappy triad." Printed from STUDENT CONSULT: Natter's Anatomy Coloring Book (on 04 January 2013) 2013Elsevier

8 IPJf r A. In c-tlrmion: pottwigf»i (I. In tlriiim: Jnlrfiiir view I' nun Qwadrioupi k-n* itfv li'<hii hi Sills Ut.lllnruv I'.iii ll.it l<i;.itihiil I-in;' iriu.li t il p.il Wit Deep inlmimlelljn hutv» l.ill-l.ll IIMtUUII^ illllllij 11,1111.ll l.llil C Sa*ilUl MCtioffi ihrti\ I" mijiinp uf knnr 1). Intrrin f Hansen; Nettej*s Anatomy Coioring Book, 1st Edition. Copyright 2009 by Saunders, an imprint of Etsevier, Inc. All rights reserved. Add to My Slides I Go to My Slides Print this page Printed from: Netter's Anatomy Coloring Book (on 04 January 2013) 2013Elsevier rn \s