Joints of the Lower Limb

1. Joints of the Lower Limb

2. HIP JOINT, KNEE JOINT and ANKLE JOINT • Type • Articulation • Capsule • Ligaments • Movements • Blood Supply • Nerve Supply

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

4. HIP JOINT • TYPE: BOLL & SOCKET TYPE • ARTICULATIONS : Cup shaped acetabulum & Hemi spherical head of femur Acetebular surface is horseshoe shaped Cavity is deepended by – fibro cartilagenous rim called “ Acetabular labrum”

5. CAPSULE : • Medially – acetabullar labrum • Laterally – Inter trochantric line of femur

6. 5 IN NO. • ILIO-FEMORAL LIGAMENT: • - Strong, inverted “y” shaped Lig. • - Base is above – from AIIS • - 2 limbs are below from – • upper & lower parts of Inter – • trochanteric line • 2. PUBO - FEMORAL LIGAMENT: • - Triangular in shape • Base – superior ramusof pubis • Apex – Lower part of Inter trochanteric line • Limits – extension & abduction LIGAMENTS

8. 3. ISCHIOFEMORAL LIGAMENT: - Spiral shaped ligament - Acetabular margin of Ischium & greater trochanter - limits extension 4. TRANSVERS ACETABULAR LIGAMENT: - formed between the acetabular labrum ends - Bridges the acetabular notch 5. Lig. OF HEAD OF FEMUR: - Flat, triangular ligament - apex – pit on the head of femur - base – transversLig. & acetabular margins

10. MOVEMENTS: • FLEXION: • EXTENSION: • ABDUCTION: • ADDUCTION: • LATERAL ROTATION: • MEDIAL ROTATION: • CIRCUMDUCTION:

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

13. Avscular 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.

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

15. Nerve Supply of the Hip Joint • Hilton's law states that the nerves supplying the muscles extending directly across and acting at a given joint also innervate the joint.

16. Dislocation of hip joint • Posterior dislocation • Posterior tearing of joint capsule • Dislocated femoral headlies on posterior surface of ischium • Occurs in head-on collision • Complications • Sciatic nerve may damage.

17. POSTEIOR 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

18. 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 – Tibialcondyles & 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

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

20. 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

21. II.INTRACAPSULAR LIGAMENTS: CRUCIATE LIGAMENTS: * Main lig.’s 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 Tibialcondyles

22. 2.P.C.L.:- Attachments: below – posterior inter condylar area of tibia above – anterior part of lateral surface of medial femoral condyle It prevents backward displacement of tibialcondyles andanterior displacement of femur on the tibia It prevents posterior pulling of tibia when the knee is flexed

24. 3.Medial Meniscus and4.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 tibialcondyles • Function : Shock absorbing cushion between two bones

26. MOVEMENTS: • FLEXION • EXTENSION • MEDIAL ROTATION • LATERAL ROTATION

27. Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)

28. Knee Joint Injuries • Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.

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

30. BURSAE: • ANTERIOR SIDE: 1. SUPRA PATELLAR BURSA 2. PRE - PATELLAR BURSA 3. INFRA PATELLAR BURSA i). Superficial ii). Deep • POSTERIOR SIDE: 1. POPLITEAL BURSA 2. SEMIMEMBRANOSUS BURSA

32. Four bursae communicate with synovial cavity of knee • Suprapatellar • Popliteus • Anserine • Gastrocnemiusbursae

34. 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.

35. Subcutaneous infrapatellar bursitis • caused by excessive friction between the skin and the tibialtuberosity.

36. Baker's Cyst • Posterior herniation of synovial membrane through joint capsule into poplitealfossa • Usually asymptomatic but Large swellings may interfere with knee movements

38. Anastomoses of arteries around the knee. • Genicular branches of the femoral and popliteal arteries . • Recurrent branches from anterior and posterior tibial arteries

39. Nerve Supply • Hilton's law • The femoral, obturator, common peroneal, and tibial nerves supply the knee joint

40. Knee joint replacement • Plastic and metal components are cemented to the femoral and tibial bone ends after removing defective bone areas • Used in Osteoarthritis- most commonly

41. 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

43. LIGAMENTS Medial or Deltoid ligament: • 1.Posterior tibiotalar • 2.Anterior tibiotalar • 3.Tibionavicular • 4. Tibiocalcaneal 3 4 5

44. Medial ligament of the ankle joint (Deltoid ligament)

45. Lateral ligament of the ankle joint • 1.Posterior talofibularthick strong lig. (malle.fossa to lat.tubercle of talus) • 2.Anterior talofibularweak • 3.calcaneofibular ligament round cord (lat. Mall to Lat.surface of calcaneus)

46. Lateral ligament of the ankle joint.

47. 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.

48. Clinical Anatomy

49. Ankle Injuries • The lateral ligament is injured because it is much weaker than the medial ligament. • The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.

50. 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