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Bones & Joints of the Lower Limb

Bones & Joints of the Lower Limb. The Dance Hal l by Vincent van Gogh ,1888. Kaan Yücel M.D., Ph.D. 16.November.2012 Friday. 2 functional components: Pelvic girdle & bones of the free lower limb Body weight is transferred Vertebral column ( Sacroiliac joints)

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Bones & Joints of the Lower Limb

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  1. Bones & Jointsof theLower Limb The Dance Hall byVincent van Gogh ,1888 Kaan Yücel M.D., Ph.D • 16.November.2012 Friday

  2. 2 functional components: Pelvic girdle & bones of the free lower limb Body weight is transferred Vertebral column (Sacroiliac joints) Pelvic girdle (Hip joints) Femurs (L. femora) Skeleton of thelowerlimb (inferiorappendicularskeleton)

  3. FEMUR longest and heaviest bone Transmits body weight from the hip bone to the tibia. Superior / Proximal end Shaft (Body) Inferior/ Distal end

  4. Proximalend of femur Superior (proximal) end of the femur • Head • Neck • 2 trochanters • Greater& Lesser • intertrochantericline • intertrochantericcrest • quadratetubercle • fovea capitisforlig.teres

  5. Shaft of femur Superior (proximal) end of the femur Gluteal tuberosity Linea aspera Medial and lateral lips of lineaaspera Medial and lateral supracondylar lines Pectineal line

  6. Superior (proximal) end of the femur Distalend of femur Adductor tubercle Intercondylar fossa Medial and lateral condyles Medial and lateral epicondyles Medial and lateral femoral condyles Patellar surface

  7. TIBIA Located on the anteromedial side of the leg Second largest bone in the body Flaresoutward at both ends to provide an increased area forarticulation and weight transfer.

  8. Proximalend of tibia widensto form medial& lateralcondyles (1,2) flatsuperiorarticularsurfacetibialplateau (3) articularsurfacesseparatedby intercondylareminence (4) formedby 2 intercondylartubercles medialandlateral (5,6) flankedbyrelativelyrough anteriorandposteriorintercondylarareas (7,8) • 1 • 4 • 5 • 6 2 Anterolateralview of lefttibia

  9. Shaft of tibia

  10. medialmalleolus Interosseous membrane unites the two leg bones. Inferiorly, the sharp border is replaced by fibular notch. Distalend of tibia

  11. PATELLA (Kneecap) • Largestsesamoid bone (a bone formed within the tendon of a muscle) in the body and is formed within the tendon of the quadriceps femoris muscle as it crosses anterior to the knee joint to insert on the tibia. • The patella is triangular: • Apex is pointed inferiorly for attachment to the patellar ligament, which connects the patella to the tibia. • Base is broad and thick for the attachment of the quadriceps femoris muscle from above. • Posterior surface articulates with the femur and has medial and lateral facets, lateral facet is larger than the medial facet for articulation with the larger corresponding surface on the lateral condyle of the femur.

  12. FIBULA Slender, lies posterolateral to the tibia No function in weight-bearing. Serves mainly for muscle attachment

  13. Proximalend & shaft of fibula Head (& a pointed apex) Articulates with the fibular facet on the posterolateral, inferior aspect of the lateral tibial condyle. Neck Like the shaft of the tibia, 3 borders (anterior, interosseous, & posterior) 3 surfaces (medial, posterior, and lateral)

  14. Distalend of fibula Distalendenlarges, projectslaterally & inferiorlylateralmalleolus moreprominentandposteriorthanthemedialmalleolus extendsapproximately 1 cm moredistally.

  15. BONES OF FOOT Tarsus (n=7) Metatarsus (n=5) Phalanges (n=14)

  16. "flat surface, especially for drying," Posterior foot/Proximal foot/Hindfoot TARSUS 7 bones Talus Calcaneus Cuboid Navicular Three cuneiforms Only one bone, the talus, articulates with the leg bones.

  17. TALUS • (L., ankle bone) Head Neck Body Superior surface trochlea of the talus is gripped by the two malleoli and receives the weight of the body from the tibia.

  18. Talus transmits weight in turn, dividing it between the calcaneus, on which the body of talus rests, and the forefoot, via an osseoligamentous “hammock” Hammock (Spring ligament;Calcenonavicular ligament) Across a gap between sustentaculum tali and navicular bone, lies anteriorly.

  19. Calcaneus (L., heel bone) Largest and strongest bone in the foot Lateral surface of the calcaneus has fibular trochlea Sustentaculum tali shelf-like support of the head of the talus

  20. Navicular (L., little ship) Flattened, boat-shaped bone Between head of the talus posteriorly & 3 cuneiforms anteriorly Medial surface projects inferiorly to form, navicular tuberosity Most lateral bone in the distal row of the tarsus Cuboid

  21. Three cuneiform bones (L. cuneus, wedge shaped) Medial(1st) Intermediate(2nd) Lateral(3rd) Each cuneiform articulates with navicular posteriorly & base of its appropriate metatarsal anteriorly. Lateral cuneiform also articulates with the cuboid.

  22. METATARSUS (Anterior foot/distal foot) 5 metatarsals numbered from the medial side of the foot Metatarsals and phalanges located in anterior half (forefoot) Tarsals in the posterior half (hindfoot) • 14 phalanges • 1st digit (great toe) • 2 phalanges • (proximal and distal) • Other four digits • 3 phalanges • (proximal, middle, and distal)

  23. 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

  24. 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

  25. 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 ligament posteriorly Ligament of the head of the femur

  26. MOVEMENTS OF HIP JOINT • Flexion-extension • Abduction-adduction • Medial-lateral rotation • Circumduction

  27. 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

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

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

  30. 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.

  31. 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

  32. 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.

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

  34. 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 • Anterior talofibular ligament • Posterior talofibular ligament • Calcaneofibular ligament • Medial ligament of the ankle(deltoid ligament)

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

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

  37. 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

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