Lecture Notes - Joints of the Lower Limb

The computer presentation used by Dr. Burkel in lecture is available on the web (password protected). You can also download the PowerPoint presentation to print or review.

  1. HIP JOINT: Multiaxial- ball and socket - designed for stability as well as free motion
    1. Osteology:
      1. Hip bone--os coxae - 3 embryological parts - ilium, ischium, pubis; Parts: Acetabulum, acetabular notch, acetabular fossa
      2. Femur: Parts related to joint: Head, neck, fovea capitis, intertrochanteric line and crest
    2. Movements: Adduction, abduction,Extension, flexion, Medial and lateral rotation, Circumduction
    3. Joint components:
      1. Cartilages: articular, acetabular labrum
      2. Synovial membrane
      3. Ligaments:
        1. Capsular: iliofemoral, ischiofemoral, pubofemoral
        2. intracapsular: ligamentum capitis femoris
        3. other: transverse acetabular ligament, zona orbicularis
      4. Bursae: iliopectineal, and synovial bursa associated with ischiofemoral ligament
      5. Vessels and Nerves:
        1. Medial and lateral circumflex femoral and obturator vessels
        2. Nerves: femoral, obturator, superior gluteal, n. to quad. fem.
    4. Injuries: Arthritic, dislocations, fractures, avascular necrosis
  2. KNEE JOINT: Primarily a hinge joint, with gliding and a small amount of rotation; GENU = Knee
    1. Osteology:
      1. Femur: medial and lateral condyles and epicondyles, patellar surface, intercondylar fossa,
      2. Patella: articular surfaces, attachments for quadraceps femoris and patellar lig.
      3. Tibia: med. and lat. condyles, intercondylar eminence, intercondylar tubercles
    2. Movements: Extension, flexion, Medial and lateral rotation
    3. Joint components:
      1. Cartilage: articular; medial and lateral menisci - bear weight in standing position
      2. Synovial membrane, synovial fat pad
      3. Ligaments:
        1. Capsular: medial (tibial) collateral (MCL), patellar, patellar retiniculae
        2. Intracapsular: anterior (ACL) a nd posterior (PCL) cruciate
        3. Extracapsular: fibular collateral (LCL) note- it is not attached to the capsule or lat. meniscus
        4. Dynamic: muscles crossing joint-intregrity of the joint is highly dependent on muscles
      4. Bursae: Supra and infrapatellar, subcutaneous prepatellar
      5. Muscles: intracapsular portion of popliteus
      6. Vessels and Nerves:
        1. Genicular anastomosis vessels:
        2. Femoral, obturator, tibial, common fibular nerves
    4. Injuries: Arthritic, dislocations, sprains, fractures, tears of ligaments and cartilages. "Terrible triad," "Drawer sign" and testing, "3 C's (collaterals, cruciates, and cartilages).
  3. TIBIOFIBULAR JOINTS: Proximal and distal synovial joints and interosseous syndesmosis - little movement.
    1. Osteology: articular surfaces and interosseous crests of tibia and fibula.
    2. Cartilages: articular
    3. Ligaments: anterior and posterior tibiofibular capsular ligs. transverse tibiofibular, interosseous mem.
  4. ANKLE JOINT: Talocrural Joint: A hinge joint, A mortise and tenon joint by shape
    1. Osteology: Malleoli of tibia and fibula, trochlea of talus
    2. Cartilages: Articular
    3. Ligaments:
      1. Medial: deltoid lig. (ant. and post. tibiotalar, tibiocalcaneal, tibionavicular)
      2. Lateral: anterior and posterior talofibular, calcaneofibular
    4. Vessels and nerves: those in area
    5. Injuries: Sprains, most common, especially involving lateral ligaments because of freedom of inversion; Pott's fracture: avulsion of distal tibia and fracture of fibula, tearing of associated ligaments
  5. INTERTARSAL JOINTS:
    1. Subtalar joint: note tarsal sinus and interosseous talocalcaneal ligament
    2. Transverse tarsal joint: Primarily responsible for inversion and eversion ,allows foot to
    accomodate irrregular surfaces, although all tarsal and the ankle joints also contribute.
  6. INTERMETATARSAL, METATARSOPHALANGEAL, AND INTERPHALANGEAL LIGAMENTS - bind adjacent bones together
  7. ARCHES OF THE FOOT: Transverse and Longitudinal arches supported by plantar aponeurosis, calcaneometatarsal ligament, long and short plantar ligaments, spring ligament