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Home , Ankle, Hip, Lateral meniscus

Hip, and joints

Musculoskeletal block- -lecture 18

Editing file Color guide : Only in boys’ slides in Green Only in girls’ slides in Purple Objectives Important in Red Doctor’s notes in Blue Extra information in Grey ✓ List the type & articular surfaces of , knee joint and ankle joint. ✓ Describe the of hip joints and ankle joint. ✓ Describe movements of hip joint, knee joint and ankle joint. ✓ Describe the capsule of knee joint, its extra- & intra-capsular ligaments. ✓ List important bursae in relation to knee joint. ✓ Apply Hilton’s law about nerve supply of knee joints. ● Type: a synovial, ball & socket joint The Hip Joint ● Articular surfaces: - of hip (pelvic bone) Ligaments: -head of the

Intracapsular Extracapsular

Transverse Iliofemoral Pubofemoral Ischiofemoral acetabular of femoral ligament ligament ligament ligament head

-Fibro-cartilaginous Converts Carries -Y shaped - Antero- inferior -Posterior to collar acetabular notch vessels to -Anterior to to joint joint -Attached to margins into foramen head of joint of acetabulum → (acetabular foramen) femur -Limits -Limits -Limits medial increases its depth through which the extension abduction and rotation for better retaining acetabular vessels lateral rotation of head of femur pass

Pictures in the following slide Intracapsular Extracapsular Movements Hip Dislocations Congenital

• More common in girls and Medial Lateral associated with inability to adduct Flexion Extension Abduction Adduction rotation rotation the (so the lower is abducted) • The upper of the acetabulum Gluteus Gluteus fails to develop adequately (main flexor) medius maximus Gluteus • The head of the femur rides up (main Adductors medius extensor) out of the acetabulum onto the Gluteus Quadratus Sartorius gluteal surface of the ileum minimus femoris Traumatic Pectineus Piriformis Gluteus Obturator Sartorius Gracilis • Common in motor vehicle Rectus (Powerful minimus externus and femoris extensor) internus (2 accidents when the thigh is flexed muscles) and adducted • The dislocated head is displaced posteriorly to lie on the posterior surface of the ileum • In posterior dislocation the sciatic nerve is liable to be injured

Girls slide only Knee joint Capsule Knee joint is formed of: The capsule is deficient anteriorly Three bones. & is replaced by: Three articulations. 1. quadriceps femoris tendon 2. patella Femoro-tibial Femoro-patellar 3. ligamentum patellae. articulations: articulations: The capsule also possesses 2 between the 2 femoral between posterior surface openings: & upper surfaces of patella & patellar

of the 2 tibial condyles. surface of femur. one for popliteus tendon & one for Type: Synovial, modified Type: Synovial, plane. communication with hinge suprapatellar bursa.

Nerve supply of the knee joint:

HILTON’S LAW: which dictates that: “The joint is supplied by branches from the same nerves supplying muscles acting on it, and also the skin over that joint” EXTRA-CAPSULAR LIGAMENTS

Ligamentum patellae (patellar from patella to tibial tuberosity. ligament)

Medial (tibial) collateral ligament from medial epicondyle of femur to upper part of medial surface of (firmly attached to medial ).

Lateral (fibular) collateral from lateral epicondyle of femur to head of ligament (separated from by popliteus tendon).

Oblique popliteal ligament extension of semimembranosus tendon. INTRA-CAPSULAR LIGAMENTS

Mensci

ATTACHMENTS Each meniscus is attached by : anterior & posterior horns into upper surface of tibia. The outer surface of is also attached to capsule & medial collateral ligament: medial meniscus is less mobile & more liable to be injured. They are 2 C-shaped plates of : FUNCTIONS: They deepen articular surfaces of - The medial meniscus is large tibial condyles. & oval. They serve as cushions between tibia - The lateral meniscus is small & femur. & circular. INTRA-CAPSULAR LIGAMENTS

Anterior cruciate Posterior cruciate

ATTACHMENTS: from anterior part of from posterior part of of intercondylar area of tibia to tibia to posterior part of anterior part of medial lateral of femur. condyle of femur.

FUNCTIONS: prevents posterior prevents anterior displacement of femur on displacement of femur on tibia. tibia. Important bursae in relation to knee joint (5 bursae):

1- Suprapatellar between femur & quadriceps bursa tendon, communicates with What is its clinical synovial membrane of knee joint importance? Subcutaneous This bursa infrapatellar bursa commonly gets 2- Prepatellar bursa between patella & skin. inflamed and Deep leads to infrapatella r bursa suprapatellar 3- Deep infrapatellar between tibia & ligamentum bursitis. Popliteal bursa bursa patella.

4- Subcutaneous between tibial tuberosity & skin. infrapatellar bursa

5- Popliteal bursa between popliteus tendon & capsule, communicates with synovial membrane of knee joint. Movement of knee joint

Active rotation (Performed When Knee is flexed) Flexion Extension

- Mainly by: A- medial rotation: B- lateral rotation: muscles; biceps femoris, semitendinosus & - Mainly by: semitendinosus & Biceps femoris. Quadriceps semimembranosus. semimembranosus. For extra femoris. explanation: - Assisted by: sartorius, - Assisted by: sartorius & A normal hinge gracilis & popliteus. gracilis. joint can only do flexion and extension but since the knee joint can also do some degree of rotation it is considered as a modified Movement of knee joint:

Inactive (dependent) rotation:

A- Locking of knee: B- Unlocking of knee:

- Slight Lateral rotation of tibia (or Medial rotation of tibia (lateral medial rotation of femur due to rotation of femur), at the the shape of condyles), at the end beginning of flexion. of extension. Performed by Popliteus to relax → Results mainly by tension of ligaments & allow easy flexion anterior cruciate ligament. - In a locked knee, all ligaments become tight. Ankle Joint Ankle Joint Ligaments

Medial () Lateral Ligament Type Synovial, hinge joint.

Strong triangular ligament Composed of 3 separate ligaments: Articular 1. UPPER: 1) Anterior talofibular ligament Surfaces A socket formed by the lower Apex: 2) end of tibia, medial & attached to medial malleolus 3) Posterior talofibular ligament lateral malleolus. 2. LOWER: Base: subdivided into 4 parts: Body of talus. 1) Anterior tibiotalar part 2) Tibionavicular part Pictures 3) Tibiocalcaneal part

4) Posterior tibiotalar part N.B. Inversion and Eversion movements occur Ankle Joint at the talo-calcaneo-navicular joint. Movements

DORSIFLEXION PLANTAR FLEXION Muscles that Muscles that perform inversion perform eversion Performed by muscles of -Initiated by: soleus 1) Tibialis anterior 1) anterior compartment of : -Maintained by: gastrocnemius 2) Tibialis posterior 2) -Assisted by other muscles 3) in posterior compartment of leg: 1- Tibialis anterior 2- Extensor hallucis longus 1- Tibialis posterior 3- Extensor digitorum longus 2-Flexor digitorum longus 4- Peroneus tertius 3- Flexor hallucis longus

-Also the muscles of the lateral compartment of the leg: 1- Peroneus longus 2- Peroneus brevis Question 5: An example of extra capsular ligament is: MCQs A. medial collateral ligament B. meniscus Question 1: The hip joint consists of the articulation of the acetabulum and …? C. anterior cruciate ligament A. Head of femur D. posterior cruciate ligament B. Head of tibia Question 6: The medial meniscus is: C. Head of fibula A. more mobile Question 2: Which muscle initiates plantar flexion? B. less mobile A. Peroneus longus C. less liable to be injured B. Peroneus brevis D. loosely attached to knee capsule C. Soleus Question 7: Bursa between femur and quadriceps tendon D. Gastrocnemius A. Deep Infrapatellar bursa. Question 3: What is the lateral ligament of the ankle joint? B. Suprapatellar bursa. A. Tibionavicular C. Prepatellar bursa. B. Anterior talofibular D. Subcutaneous Infrapatellar bursa. C. Tibiocalcaneal D. Posterior tibiotalar SAQ Question 4: What is the joint type in the femoro-tibial articulation? Question 1: Name 3 important bursae related to knee joint: A. saddle joint Answer: B. synovial, modified hinge Suprapatellar, prepatellar, deep infrapatellar , subcutaneous infrapatellar, C. synovial, plane popliteal D. ball and socket Question 2: What is Hilton’s law?

The joint is supplied by branches from nerves supplying muscles acting on it. Answers: Q1.A- Q2.C -Q3.B -Q4.B- Q5.A- Q6.B-Q7.B Team members

Girls’ team: Boys’ team: ● Ajeed Al Rashoud ● Khalid AL-Dossari ● Taif Alotaibi ● Naif Al-Dossari ● Noura Al Turki ● Faisal Alqifari ● Amirah Al-Zahrani ● Salman Alagla ● Alhanouf Al-haluli Special thank for ● Ziyad Al-jofan ● Sara Al-Abdulkarem ● Suhail Basuhail ● Rawan Al Zayed Anatomy team 436 ● Ali Aldawood ● Reema Al Masoud ● Khalid Nagshabandi ● Renad Al Haqbani ● Mohammed Al-huqbani ● Nouf Al Humaidhi ● Jehad Alorainy ● Fay Al Buqami ● Khalid AlKhani ● Jude Al Khalifah ● Omar Alammari ● Nouf Al Hussaini ● Alwateen Al Balawi ● Rahaf Al Shabri ● Danah Al Halees ● Haifa Al Waily Team leaders ● Rema Al Mutawa ● Amirah Al Dakhilallah Good luck ● Abdulrahman Shadid ● Maha Al Nahdi ● ● Ateen Almutairi Renad Al Mutawa Give us your feedback: ● Ghaida Al Braithen ● Reham Yousef =This lecture done by