Joints of the Lower Limb

HIP JOINT, KNEE JOINT and ANKLE JOINT Type Articulation Capsule Ligaments Movements

Hip Joint The hip joint forms the connection between the lower limb and the pelvic girdle

HIP JOINT TYPE: ARTICULATIONS : BALL & SOCKET TYPE Cup shaped acetabulum & Hemispherical head of femur Acetebular surface is horseshoe shaped Cavity is deepened by – fibro cartilagenous rim called “ Acetabular labrum”

MOVEMENTS: FLEXION: EXTENSION: ABDUCTION: ADDUCTION: LATERAL ROTATION: MEDIAL ROTATION: CIRCUMDUCTION:

Blood Supply of the Hip Joint The medial and lateral circumflex femoral arteries The artery to the head of the femur

Avascular Necrosis of head More common >60 years In female for osteoporosis Supplied mainly by Medial circumflex femoral artery by its retinacular branches Blood supplied through round ligament of femur(br. Of Obturator) is grossly inadequate.

Hip Joint Replacement A metal prosthesis anchored to femur by bone cement A plastic socket is cemented to acetabulum

Dislocation of hip joint Posterior dislocation Posterior tearing of joint capsule Dislocated femoral head lies on posterior surface of ischium Occurs in head-on collision Complications Sciatic nerve may be damaged.

Relatively Rare phenomena POSTERIOR DISLOCATION of hip joint can lead to sciatic nerve injury. Most common manifestation is foot drop due to damage to common fibular part Relatively Rare phenomena

KNEE JOINT TYPE : Femoro-Tibial joint – Synovial joint of Hinge variety Patello-Femoral joint – Synovial joint of gliding variety . ARTICULATIONS : 1. Femoro-Tibial joint : Above – Femoral condyles Below – Tibial condyles & their Cartilaginous menisci 2. Patello-Femoral joint : Above – Posterior surface of patella Below – Patellar surface of lower end of femur The articular surfaces are lined with Hyaline cartilage

LIGAMENTS I. EXTRACAPSULAR LIGAMENTS: 1. Ligamentum patellae:- Attachments Above – Lower border of patella Below – Tibial tuberosity It is a continuation of the central portion of common tendon of Quadriceps femoris 2. Lateral collateral ligament: cord like above – Lateral condyle of femur below – Head of fibula

3. Medial collateral ligament: I. EXTRACAPSULAR LIGAMENTS: 3. Medial collateral ligament: is flat band like above – Medial condyle of femur below – medial surface of shaft of tibia It is firmly attached to the edge of the medial meniscus

II.INTRACAPSULAR LIGAMENTS: CRUCIATE LIGAMENTS: * Main ligaments bound between femur & tibia throughout joint range. 1.A.C.L. Attachments: below – Anterior intercondylar area of tibia above – posterior part of medial surface of lateral femoral condyle It prevents forward displacement of Tibia under the femur

2.P.C.L.:- Attachments: below – posterior inter condylar area of tibia above – anterior part of lateral surface of medial femoral condyle It prevents posterior pulling of tibia under the femur

3.Medial Meniscus and 4.Lateral Meniscus “C” shaped fibro cartilaginous sheets Peripheral border is thick & attached to capsule Inner border is thin, concave & free Upper surface – in contact with femoral condyles Lower surface – in contacts with tibial condyles Function : Shock absorbing cushion between two bones

MOVEMENTS: FLEXION EXTENSION MEDIAL ROTATION LATERAL ROTATION

Unhappy triad(MCL,MEDIAL MENISCUS AND ACL) It occurs from a blow to the lateral aspect of the knee with the foot on the ground

Knee Joint Injuries Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur. It occurs when the ACL is damaged.

Posterior drawer sign: PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.

Bursitis in the Knee Region 1. Prepatellar bursitis: Prepatellar bursitis is caused by friction between the skin and the patella. This condition has been called housemaid's knee.

Subcutaneous infrapatellar bursitis caused by excessive friction between the skin and the tibial tuberosity.

Baker's Cyst Posterior herniation of synovial membrane through joint capsule into popliteal fossa Usually asymptomatic but Large swellings may interfere with knee movements

Bones of the Foot

Bones of the Foot

Bones of the Foot

ANKLE JOINT TYPE : – Synovial joint of Hinge variety ARTICULATIONS : Above – Lower end of tibia and fibula Below – Body of talus The articular surfaces are lined with Hyaline cartilage

MOVEMENTS of the Ankle Joint 1. Dorsiflexion of the ankle 2. Plantarflexion of the ankle The movements of inversion and eversion take place at the tarsal joints and not at the ankle joint.

Clinical Anatomy

Pott fracture(dislocation of the ankle) Occurs when the foot is forcibly everted. Trimalleolar fracture: The combined fracture of the medial malleolus, lateral malleolus, and the posterior margin of the distal end of the tibia is known as a "trimalleolar fracture

Arches of the Foot The bones of the foot do not lie in a horizontal plane. Instead, they form longitudinal and transverse arches relative to the ground. The arches distribute weight over the pedal platform (foot), acting not only as shock absorbers but also as springboards for propelling it during walking, running, and jumping.

Longitudinal arch The longitudinal arch of the foot is formed between the posterior end of the calcaneus and the heads of the metatarsals. It is highest on the medial side where it forms the medial part of the longitudinal arch and lowest on the lateral side where it forms the lateral part.

Arches of the foot.

Transverse arch The transverse arch of the foot runs from side to side It is formed by the cuboid, cuneiforms, and bases of the metatarsals. The medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch.

Major Ligaments of the Foot 1. Plantar calcaneonavicular ligament (spring ligament): The spring ligament supports the head of the talus and plays important roles in the transfer of weight from the talus and in maintaining the longitudinal arch of the foot, of which it is the keystone (superior most element). 2. Long plantar ligament 3. Plantar calcaneocuboid ligament (short plantar ligament).

Support for arches of the foot

Clinical Anatomy 1.Hallux Valgus: Hallux valgus is a foot deformity caused by pressure from footwear and degenerative joint disease; it is characterized by lateral deviation of the great toe

Flatfeet Flatfeet can either be flexible (flat, lacking a medial arch, when weight bearing but normal in appearance when not bearing weight ) or rigid (flat even when not bearing weight).

The Q- angle The femur is diagonally placed within the thigh, whereas the tibia is almost vertical within the leg, creating an angle at the knee between the long axes of the bones. The angle formed between the two bones is called the Q- angle. The Q- angle is assessed by drawing a line from the ASIS to the middle of the patella and extrapolating a second line passing through the middle of patella and tibial tuberosity. It is wider in females than males.

The Q-angle

Genu varum When the leg is medially angulated in relation to the thigh, the femur becomes abnormally vertical, making the Q- angle small. The line of weight bearing falls medial to the center of the knee, excess pressure is placed on the medial aspect of the knee and the Medial meniscus becomes destroyed. The fibular collateral ligament ( lateral Collateral ligament) is overstressed.

Genu varum It is also called bow- leggedness); a physical  deformity marked by (outward bowing) of the leg in relation to the thigh, giving the appearance of an archer's bow.

Genu Varum and Genu Valgum

Genu Valgum When the leg is laterally angulated in relation to the thigh, Genu Valgum results ( Knock- knee). The weight- bearing line falls lateral to the center of the knee. The Tibial collateral ligament ( Medial Collateral Ligament) subsequently becomes over stretched , lateral meniscus becomes overstressed.

Genu Varum and Genu Valgum

Genu valgum It is commonly called "knock- knees", is a condition where the knees touch one another when the legs are straightened.

References Clinnically Oriented Anatomy by Keith L. Moore, Arthur F. Daley, Anne M. Agur 6th Edition. Google Images