Joints of the Lower Limb II

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Transcription:

Joints of the Lower Limb II

Lecture Objectives Describe the components of the knee and ankle joint. List the ligaments associated with these joints and their attachments. List the muscles acting on these joints according to the type and movement they perform. Describe the bursas in relation to these joints. Describe the stability of these joints. Describe the major palpable bony prominences of these joints.

Knee Joint Condyles of femur and condyles of tibia Hinge joint Plane joint between femur and patella Flexion and extension and slight rotation Nerve supply: femoral, obturator, common peroneal, and tibial nerves

Attachment Capsule is missing anteriorly Patella & tendons Gap posteriorly Popliteus m. tendon Knee Joint: Fibrous Capsule

Knee Joint: Ligaments Extracapsular ligaments Ligamentum patellae Lateral collateral ligament Medial collateral ligament Oblique popliteal ligament Expansion from the semimembranosus tendon

Fibular Collateral Ligament Lateral collateral ligament Attachments. Popliteus tendon separates it from lateral meniscus

Tibial Collateral Ligament Medial collateral ligament Deep fibers attach to the medial meniscus Attachments.

Knee Joint: Ligaments Intracapsular ligament Cruciate ligaments Anterior cruciate ligament Posterior cruciate ligament

Anterior Cruciate Ligament Attachments Orientation Prevents: Posterior displacement of femur Anterior displacement of tibia Hyperextension

Posterior Cruciate Ligament Stronger Attachments Orientation Prevents: Anterior displacement of femur Posterior displacement of tibia Hyperflexion

Cruciate Ligaments: Injury ACL injury is common PCL injury is rare Test of injury

Knee Joint: Menisci Medial & lateral menisci Type of tissue. Shape.. Edges.. Functions.

Knee Joint: Medial Meniscus Attachments Horns TCL mobility injury

Knee Joint: Lateral Meniscus Attachments Horns Popliteus tendon mobility injury

Knee Joint: Synovial Membrane Lines fibrous capsule Excludes ligaments, menisci, & infrapatellar fat pad Synovial membrane folds Infrapatellar fold Alar folds

Knee Joint: Bursae Anterior bursae Suprapatellar bursa Continuous with synovial membrane Attached superiorly by articularis genus (from vastus intermedius) Elevate bursa on extention Prepatellar bursa Superficial infrapatellar bursa Deep infrapatellar bursa

Knee Joint: Bursae Posterior bursae Popliteal bursa* Semimembranosus bursa* Four bursae related to muscles tendons Biceps femoris Sartorius and gracilis Medial head of gastrocnemius Lateral head of gastrocnemius * Continuous with synovial membrane

Knee Movements Flexion Extension.. Rotation Mostly at flexion Medial rotation Sartorius, gracilis, & semitendinosus 5 to 10 Lateral rotation Biceps femoris 30

Proximal Tibiofibular Joint Lateral condyle of the tibia and head of fibula Plane joint Ligaments Anterior and posterior ligaments The interosseous membrane Nerve supply: common peroneal nerve

Distal Tibiofibular Joint Fibular notch and fibula Fibrous joint Ligaments Interosseous ligaments Interosseous membrane Anterior and posterior ligaments Inferior transverse ligament Nerve supply: deep peroneal and tibial nerves

Ankle Joint Distal end of tibia and fibula and the body of the talus Hinge joint Nerve supply: deep peroneal and tibial nerves

Ankle Joint: Ligaments Medial (deltoid) ligament Stronger Lateral ligament Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament

Ankle Joint: Movements Dorsiflexion Anterior compartment mm. Planter flexion Lateral and posterior compartments mm.

Ankle Joint: Injuries Ankle injury > other major joint in the body Ankle sprain Mostly inversion injury Lateral lig. sprain Weaker Mostly anterior talofibular lig.

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