lower limb joints

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Lower Limb Joints Done by: Mohammed A Qazzaz

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A joint is the location at which bones connect. They are constructed to allow movement (except for skull bones) and provide mechanical support, and are classified structurally and functionally

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Structural classification : fibrous joint cartilaginous joint synovial joint

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Functional classification: Synarthrosis Amphiarthrosis diarthrosis

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Bones of the lower limb: Hip bone Patella Femur Tibia & Fibula The Foot

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the hip bone: At birth 3 separate bones that fuse at puberty. Ilium Ischium Pubis Ischium Ilium Pubis Acetabulum Acetabular Notch

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The Femur (ant. view) Head Neck Greater & Lesser Trochanters Intertrochanteric Line

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The Femur (post. view) 1. Intertrochanteric Crest 2. Quadrate Tubercle 3. Gluteal Tuberosity 4. Pectineal Line

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Approx. 125 o The angle of inclination is measured in the frontal plane and typically ranges from 115 to 140 degrees.

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Coxa Vara An angle between femoral neck and shaft less than 115°; increases stress on femoral neck. This: 1. shortens the limb; 2. decreases the effectiveness of the abductors; 3. increases the load on the femoral neck; 4. reduces the load on the femoral head.

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Coxa Valga An angle between femoral neck and shaft greater than 140°; increases pressure into the joint This: 1. lengthens the limb; mimics contracture of the hip abductors; reduces the load on the femoral neck; increases the load on the femoral head.

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The hip joint

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Type: Synovial Ball-and-Socket Joint

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Articular Surfaces : Femoral head and Acetabulum The femoral head and acetabulum have large amounts of spongy, trabecular bone to help attenuate forces applied to joint . Approx. 70% of the femoral head articulates with the acetabulum

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only horseshoe shaped lunate artic. surface is covered by articular cartilage.

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Fibrous Capsule: Proximally - 5-6 mm. Medial to acetabulum Distally – Ant . Intertrochanteric line; Post . Halfway along femoral neck

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Transverse Acetabular Lig . Ligament of the Head of the Femur ( Lig . Teres )

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Ligament Name Location Main Function* Iliofemoral “Y” Ant. Surf. Capsule Prevents hyperextension during standing Pubofemoral Ant. & Inf. Surf. Cap. Limits abduction and extension Ischiofemoral Posterior Surf. Capsule Prevents hyperextension Lig. of Head Intracapsular - betw. fem. head and acetab. notch Weak, contains artery, may limit adduction Transverse Acetab. Continuation of acetab. labrum over notch Helps hold head in acetabular fossa *note: no ligaments limit hip flexion

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(psoas bursa).

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Hip Joint Innervationbones Proprioception, Pain and Vasomotor fibers by nerves supplying PRIME MOVERS of joint. Ant - Femoral n. and Obturator n. Post – Small branches from sacral plexus (N. to Quad. Femoris ; Sup. Gluteal n.)

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Blood Supply Med. & Lat. Fem. Circumflex a. Acetabular a.

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Acetabular pierce capsule at femoral attachment and proceed along femoral neck toward head beneath synovial membrane.

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Motion of the Hip Joint Extension Hyperextension Flexion Abduction Adduction

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Motion of the Hip Joint cont. Medial Rotation Lateral Rotation

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The knee joint

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- The Knee Joint is the largest & most complicated joint in the body . - It consists of 3 Joints within a single synovial cavity : Medial Condylar Joint : Between the medial condyle “of the femur” & the medial condyle “of the tibia” . Latral Condylar Joint : Between the lateral condyle “of the femur” & the lateral condyle “of the tibia” . Patellofemoral Joint : Between the patella & the patellar surface of the femur . - The fibula is NOT directly involved in the joint .

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1 Capsule : Surrounds the sides & posterior aspect of the joint… On the frontal side , the capsule is absent .

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On each side of the patella , the capsule is strengthened by the tendons of Vastus Lateralis & Vastus Medialis .

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communicates with : - suprapatellar bursa , - popliteus bursa, - semimembranosus burse, - gastrocnemius bursa.

Bursae related to the knee joint:: 

Bursae related to the knee joint: 1- Anterior to the knee: 1. supra-patellar bursa 2. prepatellar bursa 3. superficial infra-patellar bursa 4. deep infrapatellar bursa 2- Posterior to the knee: 1. popliteus bursa 2. semimembrenosus bursa 3. semitendinosus bursa 4. gastrocnemius bursa 5. gracilis bursa 6. biceps bursa 7. sartorius bursa

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2) Ligaments : Extracapsular Ligaments : - Ligamentum Patellea ((a continuation of the Quariceps Femoris muscle )) - Lateral Collateral Lig . - Medial Collateral Lig . - Oblique Popliteal Lig (( derived from the Semimembranosus muscle )).

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Structures inside the knee joint: The medial and lateral menisci are 2 C-shaped sheets of fibrocartilage between the tibial & femoral condyles - Their peripheral border is thick & attached to the capsule , their inner border is thin & forms a free edge . Each meniscus is attached to the upper surface of the tibia by anterior & posterior horns .

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Intracapsular Ligaments : Cruciate Ligaments : 2 strong ligaments that cross each other within the joint cavity .

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Anterior Cruciate Ligament (ACL) : Attached to the anterior intercondylar area of the tibia , passes upward , backward & laterally to get attached to the lateral femoral condyle . Prevents posterior displacement of the femur (( With the knee joint flexed , the ACL prevents the tibia from being pulled anteriorly )) .

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Posterior Cruciate Ligament (PCL) : Attached to the posterior intercondylar area of the tibia , passes upward , forward , & medially to get attached to the medial femoral condyle . Prevents anterior displacement of the femur (( With the knee joint flexed , the PCL prevents the tibia from being pulled posteriorly )) .

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Anatomy of patella Thick, circular-triangular bone which articulates with the femur and covers and protects the anterior articular surface of the knee joint. It is the largest  sesamoid bone .

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Anterior surface It can be divided into three parts : The upper third is coarse, flattened, and rough; it serves for the attachment of the tendon of the quadriceps and often has  exostoses . The middle third has numerous vascular  canaliculi . The lower third includes the distal apex which serves as the origin of the patellar ligament.

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Posterior surface The upper three-quarters articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape.

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It is attached to the tendon of the quadriceps  femoris muscle, which contracts to extend/straighten the knee. The vastus intermedialis muscle is attached to the base of patella. The vastus lateralis and vastus medialis  are attached to lateral and medial borders of patella respectively. gliding joint, between the patella and the patellar surface of the femur the fibula is not directly involved in the joint.

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Popliteal Fossa diamond-shaped intermuscular space situated at the back of the knee.The fossa contains the popliteal vessels , the small saphenous vein, the common peroneal and tibial nerves, the posterior cutaneous nerve of the thigh, the genicular branch of the obturator nerve, connective tissue, and lymph nodes .

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Boundaries Laterally: The biceps femoris above and the lateral head of the gastrocnemius and plantaris below Medially : The semimembranosus and semitendinosus above and the medial head of the gastrocnemius below

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Proximal Tibiofibular Joint Articulation is between the lateral condyle of the tibia and the head of the fibula.The articular surfaces are flattened and covered by hyaline cartilage . This is a synovial, plane, gliding joint. Ligaments Anterior and posterior ligaments strengthen the capsule. The interosseous membrane Capsule and Synovial Membrane attached to the line of the articular surface. The common peroneal nerve supplies the joint. Movements A small amount of gliding movement takes place during movements at the ankle joint.

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Distal Tibiofibular Joint Articulation Articulation is between the fibular notch at the lower end of the tibia and the lower end of the fibula. Type The distal tibiofibular joint is a fibrous joint. Capsule There is no capsule

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Ankle Joint

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Ankle Joint The ankle joint consists of a deep socket formed by the lower ends of the tibia and fibula, into which is fitted the upper part of the body of the talus. Articulation Articulation is between the lower end of the tibia, the two malleoli, and the body of the talus.

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Type The ankle is a synovial hinge joint . Capsule The capsule encloses the joint and is attached to the bones near their articular margins.

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Ligaments The medial, or deltoid, ligament The lateral ligament is weaker than the medial ligament and consists of three bands. The anterior talofibular ligament The calcaneofibular ligament The posterior talofibular ligament

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Synovial Membrane The synovial membrane lines the capsule. Nerve Supply Deep peroneal and tibial nerves supply the ankle joint.

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Synovial Membrane The synovial membrane lines the capsule. Nerve Supply Deep peroneal and tibial nerves supply the ankle joint.

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Movements Dorsiflexion (toes pointing upward) and plantar flexion (toes pointing downward) are possible. The movements of inversion and eversion take place at the tarsal joints and not at the ankle joint.