Download Joints of the lower limb

Joints of the lower limb
Hip joint
Knee joint
Ankle joint
Hip joint
• it is a synovial joint of ball and socket type, the
joint formed between the head of the femur and
the acetabulum the articular surface of which is
horseshoe shaped and is deficient inferiorly at
the acetabular notch.
• The cavity of the acetabulum is deepened
by the presence of a fibrocartilaginous rim
called the acetabular labrum, the labrum is
bridges across the acetabular notch by the
transverse acetabular ligament.
• The strength and stability of the joint
depend on :
• 1-
Depth
of
the
acetabulum
which
increased by the labrum acetabulae.
• 2-The strength of the ligaments and the
surrounding muscles.
• The fibrous capsule which surrounds the joint
attached to the margin of the acetabulum and
transverse ligament proximally. Distally attached
to the intertrochantric line and greater trochanter
anteriorly and intertrochantric crest posteriorly.
The fibrous capsule is lined by the synovial
membrane.
Ligaments of the joint
• 1- Iliofemoral ligament is a strong ligament lie in
the front of the joint. it is inverted Y shaped.
• 2- Pubofemoral ligament it is triangular ligament
lie in the lower anterior part of the capsule.
• 3- Ischiofemoral ligament it is spiral in shape lie
posteriorly.
iliofemoral ligament
Ischiofemoral ligament
• 4- The transverse acetabular ligament it
converts the notch into a tunnel through
which the blood vessels and nerves enter
the joint.
• 5- Ligaments of the head of the femur it is
flat attached to the pit on the head of the
femur and by its base to the transverse
acetabular ligament.
Movement of the joint
• 1- flexion which is very free.
• 2- Extension is extremely restricted by the iliofemoral
ligament.
• 3- Abduction is restricted by the pubofemoral ligament.
• 4- Adduction is restricted by the lateral portion of the
iliofemoral ligament.
• 5- Medial rotation tightens the ischiofemorall ligament.
• 6- Lateral rotation is limited by the pubofemoral
ligament and the lateral part of the iliofemoral ligament.
• Blood supply of the joint
• 1- Ascending branches of lateral and medial
circumflex femoral artery.
• 2- Acetabular branches of the obturator and
medial circumflex arteries.
• 3- Branches of the superior and inferior gluteal
artery.
• Nerves of the joint
• 1- Nerve to quadratus femoris.
• 2- The femoral nerve through nerve to
rectus femoris.
• 3- Anterior division of the obturator nerve.
The knee joint
It is a synovial joint of the hinge type, it is
unstable joint but this overcome by certain
mechanism:
• 1- expansion of the upper end of the tibia and
lower end of the femur.
• 2- Presence of the strong collateral ligament and
tendons.
• 3- Strong capsule.
• 4- Presence of the intra-articular ligaments.
• The articular surface of the femur is the condyles
while the articular surface of the tibia is the tibial
condyles which is deepen by the mensci. On the
front of the joint the capsule is absent permitting
the
synovial
membrane
to
pouch
upward
beneath the quadriceps tendon forming the
suprapatellar bursa.
•
• The capsule of the joint attached to the
condyles of the femur superiorly and to the
tibial condyles and the margin of the
mensci inferiorly.
Ligaments of the joint
• 1- lateral and medial patellar retinacula these are
extensions from the tendons of the lateral and medial
vasti ms. which run along the sides of the pattela.
• 2- Iliotibial tract attached laterally to the oblique line in
the lateral condyle of the tibia and to the head of the
fibula.
• 3- The ligamentum patellae which is a continuation of
the quadriceps femoris tendon run on the patella to
reach the tibial tuberosity.
• 4- Oblique popliteal ligament it is the posterior
reinforcement of the capsule of the joint and it is
extension
from
the
tendon
of
the
semimembrenosus m.
• 5- Arcuate popliteal ligament arise from the
back of the head of the fibula and runs medially
over the popliteus m.
6- Collateral ligament they are tibial and
fibular collateral ligaments. They are very strong
ligaments.
• Tibial collateral ligament: extends from the
medial epicondyle of the femur to the medial
condyle of the tibia.
• Fibular collateral ligament: it is cord like ligament
extends from the lateral epicondyle of the femur
to the head of the fibula.
cruciate ligaments
• 7- these are two ligaments lie inside the joint
cross each other.
•
Anterior cruciate ligament extends from in
front of condylar eminence of tibia to the
posterior part of the lateral condyle of the femur
it passes upward and backwards.
•
• Posterior
cruciate
ligament
passes
upwards and forwards from the posterior
part of the tibial intercondylar area to the
lateral surface of the medial condyle of the
femur. It prevents anterior displacement of
the femur on the tibia.
Mensci
• These are a C shaped plates of fibrocartilage
which deepen the articular surface of the tibial
condyles, they are medial and lateral they
attached to :
• 1- intercondylar area by their horns.
• 2- The margins of the tibial condyles.
• The two mensci linked together anteriorly
by transverse ligaments of the knee.
• The lateral meniscus is circular to keep the
spherical lateral condyle of the femur.
•
The medial meniscus is elongated
anteroposteriorly to keep the shape and
movement of the medial condyle of the
femur.
Synovial membrane
• It lines all the structures which forms the
wall of the cavity of the knee joint except
the articular surfaces of the bones, mensci
and the posterior part of the fibrous
capsule where the synovial membrane
turns forwards to enclose the cruciate
ligaments.
Anastomosis around the knee joint
Formed by 8 arteries these are:
• 1- 2 lateral and 2 medial genicular arteries from the
popliteal artery.
• 2- Descending genicular artery from the femoral artery.
• 3- Anterior and posterior tibilal recurrent arteries.
• 4- Genicular artery from the lateral circumflex artery.
• The middle genicular artery play a little part since it
supply the structures within the capsule of the joint.
Nerves of the joint
• 1- femoral nerve through nerve of vasti
muscles.
• 2- Common peroneal nerve through
superior and inferior lateral genicular
nerves.
• 3- Tibial nerve through superior and
inferior medial genicular nerves.
• 4- Obturator nerve.
Movement of the joint
Flexion through biceps, semitendinosus and
semimembranosus; assisted by the sartorius,
gracilis and popliteus.
• Extension by quadriceps femoris m.
• Rotation: medial rotation by sartorius, gracilis
and semitendinosus. Lateral rotation by biceps
femoris m.
Ankle joint
This is a hinge type of joint between the trochlea
of the talus with the distal end of the tibia and
medial malleolus medially and the lateral surface
of the body of the talus with the lateral malleolus
laterally.
• It is strong and stable joint by:
• 1- The powerful ligament and tendons.
• 2- The insertion o the trochlea into the
deep socket between medial and lateral
malleoli.
Ligaments of the joint
• 1- medial (Deltoid) ligament. It is a very strong
ligament radiates from the distal border of the
medial malleolus to the medial side of the talus,
to the medial surface of the calcaneus, to the
navicular bone and to the neck of the talus.
Deltoid ligament
• 2- Lateral ligament consists of 3 bands, the
anterior and posterior are thickenings of the
fibrous capsule, the anterior one is the anterior
talofibular ligament and the posterior is the
posterior
talofibular
ligament.
And
the
calcaneofibular ligament extend from the distal
end of the lateral malleolus to the lateral surface
of the calcaneus.
Lateral ligament
Anastomois around the ankle joint
• 1- on the lateral side the lateral malleolar
branch of the anterior tibial artery and the lateral
tarsal branch of the dorsalis pedis artery
anastomosed with the perforating branch and
terminal branches of the peroneal artery.
• 2- On the medial side the medial malleolar
artery
anastomosed
with
the
medial
calcanean branch of the posterior tibial
artery. The posterior tibial artery itself also
anastomosed with the peroneal artery
posterior to the ankle joint.
• Nerve supply of the joint from the tibial nerve and the
lateral branch of the deep peroneal nerve.
• Movements of the joint are the dorsiflexion and
planterflexion.
• Dorxiflexion is through the muscles of the anterior
compartment of the leg; while the planteflexion through
the muscles of the superficial compartment of the back
of the leg.
• The maximum stability of the joint is achieved in
dorxiflexion.