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Joints of the Lower Limb
Dr. Asma’ Hassan
Department of Anatomy
Pusat Pengajian Sains Perubatan
Universiti Sains Malaysia
Features of a Synovial Joint
Synovial Joint
• Synovial cavity
• Articular cartilage
• Synovial membrane + fluid
• Articular capsule / fibrous capsule
Joint stability
• Articular surfaces
• Ligaments
• Muscle tone
Additional features
• Articular discs
• Labrum
• A tendon
HILTON’S LAW
A nerve supplying a joint also supplies the
muscles moving the joint and the skin
over the distal attachments of these muscles
Hip Joint
• ball and socket type
• strongest joint in the body
• bony parts
– head of femur + acetabulum
• Capsule of the joint
– proximal attachment: rim of
acetabular labrum
– distal attachment:
• anterior – intertrochanteric
line
• posterior – middle of neck of
femur
– fibres of capsule are reflected
back along neck of femur:
Retinacula fibres
– contain nutrient arteries to head
and neck of femur
Hip Joint
• Strengthened by 3 ligaments
which spiral around the femoral
neck
• Anterior part of capsule:
– Iliofemoral
– Pubofemoral
• Posterior part of capsule:
– Ischiofemoral
• Ligament of the head of femur
(Ligamentum teres)
– From pit of head of femur to
transverse ligament
Iliofemoral
ligament
Pubofemoral
ligament
Ischiofemoral
ligament
Hip Joint
• Acetabular labrum
– Attached to circumference of
acetabulum
– Serves to deepen the
acetabular cavity
• Transverse ligament
– Extend across acetabular notch
– Create an acetabular foramen:
allow nerve and vessels
• Synovial membrane
– Form a tube surrounding
ligamentum teres
– Covers the acetabular fat pad
(in acetabular fossa)
Arteries and Nerves to Hip Joint
Cruciate anastomosis
• Main source of blood for head of femur
– Inferior gluteal a - internal iliac
artery
– 1st perforating artery
deep femoral a
– Lateral circumflex femoral a
(femoral a - external iliac a)
– Medial circumflex femoral a
• Branches pass along femoral neck
beneath the reticular fibres of capsule
Nerve supply:
• Femoral nerve
• Obturator nerve
– same nerves that supply knee joint;
“referred pain to the knee”
Movements of Hip Joint
• Flexion - Iliopsoas muscle
Sartorius
Rectus femoris
Pectineus
• Extension – Gluteus maximus
Gracilis
• Adduction – Adductors muscles
Gracilis
• Abduction – Gluteus medius
Gluteus minimus
Movements of Hip Joint
• Rotation
• Lateral / External
– Gluteus maximus
– Quadratus femoris, Piriformis
– Obturator internus and externus
– Gemelli
• Medial / Internal
– anterior part of Gluteus minimus
– Gluteus medius
– Tensor fasciae latae
Knee Joint
• Largest joint, hinge type
• Bony parts: consist of 2 joints
– Tibiofemoral joint
– Patellofemoral joint
(fibula is excluded from knee joint)
Capsule of the joint
• Loose and thin
• Tibia – margin of tibial condyles
• Femur – lies above the articular surfaces of bone
• Patella – attached to medial and lateral margins
• Nerve supply: sciatic, femoral, obturator nerves
Knee Joint
External Ligaments
• Quadriceps muscle tendons
- contribute significantly to the stability
of knee joint
• Ligamentum patellae - anterior
• Oblique ligament - posterior
• Medial & lateral collateral ligaments – each side
• Medial & lateral patellar retinacula – each side of patella
Knee Joint
Internal structures
• Cruciate ligaments
• Semilunar cartilages
• Transverse ligament
Synovial membrane
• Largest synovial cavity
• Lines inner aspect of
articular capsule
• Communicate superiorly
with suprapatellar bursa
Knee Joint - cruciate ligaments
• Intracapsular but extrasynovial
1. Anterior cruciate ligament
• Origin: anterior intercondylar
area of tibia
• Insertion: lateral condyle of
femur
• Prevents hyperextension
2. Posterior cruciate ligament
• Origin: posterior intercondylar
area of tibia
• Insertion: medial condyle of
femur
• Prevents hyperflexion
Knee Joint - Semilunar cartilages
• Fx: create more receptive
articular surfaces for femur and
tibia
1. Medial meniscus
- larger, less curved than lateral
- attachment: in front and
behind intercondylar eminence
*Medial: attached to medial
collateral ligament
2. Lateral meniscus
- smaller, more freely mobile
- separated from lateral
collateral ligament by popliteus
tendon
Movements of Knee Joint
Flexion
• hamstring muscles
• Sartorius, gracilis
• gastrocnemius
Extension
• Quadriceps femoris
Locks knee into full extension
• Tensor fasciae latae
• Gluteus maximus - by way of the
iliotibial tract
Unlocks full extension and start
flexion
• Popliteus muscle
this muscle pulls on the lateral
condyle of the femur causing it to
rotate laterally
Ankle Joint
• Hinge joint
• Between tibia & fibula and talus
• Movements: Dorsiflexion / Plantarflexion
Articular capsule:
• Thin anterior and posterior
• Strong collateral ligaments on each side
Lateral ligaments Medial Ligaments
Anterior talofibular Tibionavicular
Posterior talofibular Tibiotalar (ant & post)
Calcaneofibular Tibiocalcaneal
Foot Joints
• Talocrural joint
– Dorsiflexion
– Plantarflexion
• 1-Transverse tarsal joint (TT)
– Talocalcaneonavicular joint
– Calcaneocuboid joint
• 2-Subtalar joint (ST)
Inversion
Eversion
T T
ST
1
2
Lymphatic drainage of Lower limb
1. Superficial lymphatic vessels
accompany saphenous veins
• lymphatic vessels accompany
great saphenous veins end in
superficial inguinal nodes
• lymphatic vessels accompany
small saphenous veins end in
popliteal lymph nodes
2. Deep lymphatic vessels
accompany deep veins
• both pass to external iliac nodes
Superficial inguinal nodes
1. Vertical group: lower limb
2. Horizontal group:
a) Superolateral group
: buttock, flank, back below
waist
b) Superomedial group
: below umbilicus
: perineum
- lower part of anal canal
- urethra
- external genitalia of both
sexes (exclude testes)
vertical
horizontal

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Joints of Lower Limb_ BSC 2013.pptx

  • 1. Joints of the Lower Limb Dr. Asma’ Hassan Department of Anatomy Pusat Pengajian Sains Perubatan Universiti Sains Malaysia
  • 2. Features of a Synovial Joint Synovial Joint • Synovial cavity • Articular cartilage • Synovial membrane + fluid • Articular capsule / fibrous capsule Joint stability • Articular surfaces • Ligaments • Muscle tone Additional features • Articular discs • Labrum • A tendon
  • 3. HILTON’S LAW A nerve supplying a joint also supplies the muscles moving the joint and the skin over the distal attachments of these muscles
  • 4. Hip Joint • ball and socket type • strongest joint in the body • bony parts – head of femur + acetabulum • Capsule of the joint – proximal attachment: rim of acetabular labrum – distal attachment: • anterior – intertrochanteric line • posterior – middle of neck of femur – fibres of capsule are reflected back along neck of femur: Retinacula fibres – contain nutrient arteries to head and neck of femur
  • 5. Hip Joint • Strengthened by 3 ligaments which spiral around the femoral neck • Anterior part of capsule: – Iliofemoral – Pubofemoral • Posterior part of capsule: – Ischiofemoral • Ligament of the head of femur (Ligamentum teres) – From pit of head of femur to transverse ligament Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament
  • 6. Hip Joint • Acetabular labrum – Attached to circumference of acetabulum – Serves to deepen the acetabular cavity • Transverse ligament – Extend across acetabular notch – Create an acetabular foramen: allow nerve and vessels • Synovial membrane – Form a tube surrounding ligamentum teres – Covers the acetabular fat pad (in acetabular fossa)
  • 7. Arteries and Nerves to Hip Joint Cruciate anastomosis • Main source of blood for head of femur – Inferior gluteal a - internal iliac artery – 1st perforating artery deep femoral a – Lateral circumflex femoral a (femoral a - external iliac a) – Medial circumflex femoral a • Branches pass along femoral neck beneath the reticular fibres of capsule Nerve supply: • Femoral nerve • Obturator nerve – same nerves that supply knee joint; “referred pain to the knee”
  • 8. Movements of Hip Joint • Flexion - Iliopsoas muscle Sartorius Rectus femoris Pectineus • Extension – Gluteus maximus Gracilis • Adduction – Adductors muscles Gracilis • Abduction – Gluteus medius Gluteus minimus
  • 9. Movements of Hip Joint • Rotation • Lateral / External – Gluteus maximus – Quadratus femoris, Piriformis – Obturator internus and externus – Gemelli • Medial / Internal – anterior part of Gluteus minimus – Gluteus medius – Tensor fasciae latae
  • 10. Knee Joint • Largest joint, hinge type • Bony parts: consist of 2 joints – Tibiofemoral joint – Patellofemoral joint (fibula is excluded from knee joint) Capsule of the joint • Loose and thin • Tibia – margin of tibial condyles • Femur – lies above the articular surfaces of bone • Patella – attached to medial and lateral margins • Nerve supply: sciatic, femoral, obturator nerves
  • 11. Knee Joint External Ligaments • Quadriceps muscle tendons - contribute significantly to the stability of knee joint • Ligamentum patellae - anterior • Oblique ligament - posterior • Medial & lateral collateral ligaments – each side • Medial & lateral patellar retinacula – each side of patella
  • 12. Knee Joint Internal structures • Cruciate ligaments • Semilunar cartilages • Transverse ligament Synovial membrane • Largest synovial cavity • Lines inner aspect of articular capsule • Communicate superiorly with suprapatellar bursa
  • 13. Knee Joint - cruciate ligaments • Intracapsular but extrasynovial 1. Anterior cruciate ligament • Origin: anterior intercondylar area of tibia • Insertion: lateral condyle of femur • Prevents hyperextension 2. Posterior cruciate ligament • Origin: posterior intercondylar area of tibia • Insertion: medial condyle of femur • Prevents hyperflexion
  • 14. Knee Joint - Semilunar cartilages • Fx: create more receptive articular surfaces for femur and tibia 1. Medial meniscus - larger, less curved than lateral - attachment: in front and behind intercondylar eminence *Medial: attached to medial collateral ligament 2. Lateral meniscus - smaller, more freely mobile - separated from lateral collateral ligament by popliteus tendon
  • 15. Movements of Knee Joint Flexion • hamstring muscles • Sartorius, gracilis • gastrocnemius Extension • Quadriceps femoris Locks knee into full extension • Tensor fasciae latae • Gluteus maximus - by way of the iliotibial tract Unlocks full extension and start flexion • Popliteus muscle this muscle pulls on the lateral condyle of the femur causing it to rotate laterally
  • 16.
  • 17. Ankle Joint • Hinge joint • Between tibia & fibula and talus • Movements: Dorsiflexion / Plantarflexion Articular capsule: • Thin anterior and posterior • Strong collateral ligaments on each side Lateral ligaments Medial Ligaments Anterior talofibular Tibionavicular Posterior talofibular Tibiotalar (ant & post) Calcaneofibular Tibiocalcaneal
  • 18.
  • 19. Foot Joints • Talocrural joint – Dorsiflexion – Plantarflexion • 1-Transverse tarsal joint (TT) – Talocalcaneonavicular joint – Calcaneocuboid joint • 2-Subtalar joint (ST) Inversion Eversion T T ST 1 2
  • 20. Lymphatic drainage of Lower limb 1. Superficial lymphatic vessels accompany saphenous veins • lymphatic vessels accompany great saphenous veins end in superficial inguinal nodes • lymphatic vessels accompany small saphenous veins end in popliteal lymph nodes 2. Deep lymphatic vessels accompany deep veins • both pass to external iliac nodes
  • 21. Superficial inguinal nodes 1. Vertical group: lower limb 2. Horizontal group: a) Superolateral group : buttock, flank, back below waist b) Superomedial group : below umbilicus : perineum - lower part of anal canal - urethra - external genitalia of both sexes (exclude testes) vertical horizontal