The Dance Hall by Vincent van Gogh ,1888

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

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

Transverse acetabular ligament continuation of acetabular labrum

3 intrinsic ligaments

1)Iliofemoral ligament anteriorly and superiorly , strongest ligament of the body 2)Pubofemoral ligament anteriorly and inferiorly 3)Ischiofemoral ligament posteriorly –weakest of the 3

Ligament of the head of the femur

Ligaments

Iliofemoral ligament Y-shaped From Ant. Inf. Iliac Spine &Acetabular rim To Intertrochanteric line prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum

Pubofemoral ligament obturator crest of pubic bone blends with the medial part of the iliofemoral ligament tightens during both extension and abduction prevents overabduction of the hip joint

Ligaments

Ischiofemoral ligament

Ligaments

from the ischial part of the acetabular rim spirals around the femoral neck, medial to the base of the greater trochanter.

Ligaments

The ligaments and periarticular muscles (the medial and lateral rotators of the thigh) play a vital role in maintaining the structural integrity of the joint.

Ligaments

Ligament of the head of the femur primarily a synovial fold conducting a blood vessel weak and of little importance in strengthening the hip joint.

wide end attaches to the margins of the acetabular notch and the transverse acetabular ligament narrow end attaches to the fovea for the ligament of the head.

Flexion-extension Abduction-adduction Medial-lateral rotation Circumduction

MOVEMENTS OF HIP JOINT

MOVEMENTS OF HIP JOINT

During extension of the hip joint, the fibrous layer of the joint capsule, especially the iliofemoral ligament, is tense. The hip can usually be extended only slightly beyond the vertical except by movement of the bony pelvis (flexion of lumbar vertebrae).

MOVEMENTS OF HIP JOINT

From the anatomical position, the range of abduction of the hip joint is usually greater than for adduction. About 60° of abduction is possible when the thigh is extended, and more when it is flexed. Lateral rotation is much more powerful than medial rotation.

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 knee joint

Extracapsular ligaments 1) Patellar ligament

2) Fibular (Lateral) collateral ligament

3) Tibial (Medial) collateral ligament

4) Oblique popliteal ligament

5) Arcuate popliteal ligament

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

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23 Start: Posterior intercondylar area of tibia End: Lateral surface of the medial condyle of femur

Start: anterior intercondylar area of tibia just posterior to the attachment of the medial meniscus

End: Medial side of the lateral condyle of the femurr

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Limits posterior rolling (turning and traveling) of the femoral condyles on the tibial plateau during flexion. Prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint.

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Llimits anterior rolling of the femur on the tibial plateau during extension. Prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps prevent hyperflexion of the knee joint.

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In the weight-bearing flexed knee, Posterior Cruciate Ligament the main stabilizing factor for the femur (e.g., when walking downhill).

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Menisci of the knee joint are crescentic plates of fibrocartilage on the articular surface of the tibia that deepen the surface and play a role in shock absorption.

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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

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.

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(Superior) Tibiofibular joint

Syndesmosis (inferior tibiofibular) joint

In addition, an interosseous membrane joins the shafts of the two bones.

(Superior) Tibiofibular joint

Syndesmosis (inferior tibiofibular) joint

In addition, an interosseous membrane joins the shafts of the two bones.

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Syndesmosis (inferior tibiofibular) joint

stability of the ankle joint keeps the lateral malleolus firmly against the lateral surface of the talus

interosseous tibiofibular ligament anterior and posterior tibiofibular ligaments

ANKLE JOINT Talocrural joint

Distal ends of the tibia & fibula & superior parts of the talus Synovial Joint Type: Hinge

LIGAMENTS OF ANKLE JOINT 1) Lateral ligament of the ankle 2) Medial ligament of the ankle (deltoid ligament)

Lateral ligament of the ankle

anterior talofibular ligament flat, weak band

extends from lateral malleolus to neck of talus

posterior talofibular ligament

calcaneofibular ligament round cord

passes from tip of lateral malleolus to lateral surface of

calcaneus

thick, strong band

runs posteriorly from malleolar fossa to lateral tubercle

of talus

ANKLE JOINT

Medial (Deltoid) ligament of the ankle

strong and triangular in shape

apex attached above to medial malleolus broad base attached below to a line extends from the tuberosity of the navicular bone in front to medial tubercle of talus behind.

ANKLE JOINT

Medial (Deltoid) ligament of the ankle

strong and triangular in shape

1. tibionavicular part 2. tibiocalcaneal part 3. posterior tibiotalar part 4. anterior tibiotalar part

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The major joints at which movements occur Subtalar Talocalcaneonavicular Calcaneocuboid joints

Intertarsal joints between the cuneiforms and between the cuneiforms and the navicular allow only limited movement.

Transverse tarsal joint

Subtalar (talocalcaneal) joint Transverse tarsal joint (calcaneocuboid and talonavicular joints)

Inversion and eversion of the foot are the main movements

between posterior calcaneal facet on inferior surface of talus corresponding posterior talar facet on superior surface of calcaneus

allows gliding and rotation, involved in inversion and eversion of the foot.

Lateral, medial, posterior, and interosseous talocalcaneal ligaments stabilize the joint. Interosseous talocalcaneal ligament Lies within the tarsal sinus. Separates the subtalar and

talocalcaneonavicular joints. Especially strong.

The subtalar joint (by either definition) is where the majority of inversion and eversion occurs, around an axis that is oblique.

Orthopedic surgeons

anatomical subtalar joint + talocalcaneal part of talocalcaneonavicular joint

compound joint formed by two separate joints aligned transversely: Talocalcaneonavicular Calcaneocuboid joints

At this joint, the midfoot and forefoot rotate as a unit on the hindfoot around a longitudinal (AP) axis, augmenting the inversion and eversion movements occurring at the clinical subtalar joint.

Transection across the transverse tarsal joint

a standard method for surgical amputation of the foot

complex joint

head of the talus articulates with calcaneus plantar calcaneonavicular ligament (spring ligament) below navicular in front.

allows gliding and rotation movements, which together with similar movements of the subtalar joint are involved with inversion and eversion of the foot.

Capsule reinforced posteriorly by interosseous talocalcaneal ligament superiorly by talonavicular ligament inferiorly by plantar calcaneonavicular ligament (spring ligament)

Lateral part reinforced calcaneonavicular part of the bifurcate ligament

a Y-shaped ligament superior to the joint Base attached to anterior aspect of superior surface of calcaneus Arms attached to: dorsomedial surface of the cuboid (calcaneocuboid ligament) dorsolateral part of the navicular (calcaneonavicular ligament).

synovial joint between: facet on the anterior surface of the calcaneus corresponding facet on the posterior surface of the cuboid.

allows sliding and rotating movements involved with inversion and eversion of the foot. reinforced by bifurcate ligament long plantar ligament plantar calcaneocuboid ligament (short plantar ligament).

Short plantar ligament plantar calcaneocuboid ligament

Short, wide, and very strong Connects calcaneal tubercle to the inferior surface of the cuboid. Supports the calcaneocuboid joint Assists the long plantar ligament in resisting depression of the lateral arch of the foot

Long plantar ligament Longest ligament in the sole of the foot. Lies inferior to the plantar calcaneocuboid ligament. Between calcaneus and cuboid bone (inferior surfaces) More superficial fibers extend to the bases of the metatarsal bones. Supports the calcaneocuboid joint. Strongest ligament, resisting depression of lateral arch of the foot.

Ellipsoid synovial joints between heads of metatarsals and bases of proximal phalanges. Allow extension and flexion, and limited abduction, adduction, rotation, and circumduction. Four deep transverse metatarsal ligaments link heads of metatarsals together and enable the metatarsals to act as a single unified structure.

Hinge joints Reinforced by medial and lateral collateral ligaments and by plantar ligaments.

between metatarsal bones and adjacent tarsal bones plane joints limited sliding movements.

The range of movement of tarsometatarsal joint between metatarsal of great toe and medial cuneiform greater than that of other tarsometatarsal joints allows flexion, extension, and rotation.

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MAJOR LIGAMENTS OF FOOT Plantar calcaneonavicular ligament (spring ligament)

Long plantar ligament

Plantar calcaneocuboid ligament (short plantar ligament)

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MAJOR LIGAMENTS OF FOOT

Plantar calcaneonavicular

ligament (spring ligament)

Long plantar ligament

Plantar calcaneocuboid

ligament (short plantar

ligament)

In the foot, flexion and extension occur in the forefoot at the metatarsophalangeal and interphalangeal joints. Inversion is augmented by flexion of the toes (especially the great and 2nd toes), and eversion by their extension (especially of the lateral toes).

ARCHES OF FOOT Spreading the weight

ARCHES OF FOOT Spreading the weight

Longitudinal arch of the foot Medial longitudinal arch Calcaneus, talus, navicular, 3 cuneiforms & 3 metatarsals. higher and more important than the lateral longitudinal arch. talar head keystone of the medial longitudinal arch.

Lateral longitudinal arch

much flatter, rests on ground during standing. Calcaneus, cuboid, and lateral two metatarsals.

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ARCHES OF FOOT Spreading the weight

Transverse arch of the foot Runs from side to side Formed by cuboid, cuneiforms & bases of metatarsals