Lecture - MSK - Lower Limb and Back Flashcards
Lower Limb (pelvis to distal ends of toes)
- What are the two main functions?
- What are the 8 types of bones in the lower limb?
- Locomotion (walking, running, propulsion) annnnd weight-bearing (standing, control advance of the body over the foot aka stop us falling over our foot sorta)
- PELVIC BONE (made up of three bones - illium, ischium and pubis)
- FEMUR (called thigh region aka between the pelvis and the knee)
- PATELLA (sesamoid bone)- part of knee joint
- TIBIA (in the leg region aka between knee to ankle)
- FIBULA (also in leg region but this bone has no weight bearing - just there for muscle attachments)
- FOOT (so 7 tarsal bones, 5 metatarsals and 14 phalanges)
With the phalanges, you have 2 in big toe and 3 in the small toes
How does he lower limb minimise the energy expenditure when standing and walking?
The knee locks in place so like, the muscles don’t need to work
Centre of gravity pases post to hip, ant to knee and anterior to ankle
this keeps us upright and muscles on posterior aspect much bigger that counteract the gravity so we stay upright
Pelvic girdle
- How is the upper girdle different to this lower limb one?
- What two things are in the pelvic girdle?
- What does it connect? (aka it’s function)
- The upper one is completed with muscles but this lower one is fully completed with bone
- Two hip bones and one sacrum
- It connects the lower limb to the vertebral column.
Pelvic orientation
- How is it tilted? Like what do you see?
- Where does the highest point of iliac crest level up to>
- The pubic tubercles and the anterior superior iliac spines should be in the same plane (coronal plane) and that’s what its orientation is.
- Highest point of illiac crest and if we draw a line from here to vertebrate column, it goes to L4 (supracrystal plane - dw about this)
- Just remember the highest point reaches L4 vertebrate
Important landmarks of the hip bone (lateral view)
Where is the……on slide 9:
- Anterior superior iliac spine (spine = pointy bits)
- Anterior inferior iliac spine
- Pubic tubercule
- Acetabulum (These three bones (illium, isch and pubis that become ossified by 18-20 years) form the acetabulon for the hip joint. Was cartilage in kids)
- Obturator canal (obturator vessels and nerves - go through gap (canal) in the membrane since they can’t go through the actual ligaments etc)
- Obturator membrane
- Ischial tuberosity
- Lesser diatic notch
- Ischial spine
- Greater diabetic notch
- Gluteal surface
- Tell me whereabouts the pubis bone, ischium and allium are
- Why does it appear that there are cracks in kid legs?
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Label on slide where the following are:
- Illiac crest
- Inguinal ligament
- Ligament from anterior superior illiac spine to pubic tubercle = inguinal ligament - extension from anterior abdominal wall (imp gateway for strcutures leaving trunk to go to lower limb) - Where is the ischiopubic ramus?
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Joints of pelvis:
- Tell me about the sacroiliac joint
- What sort of joint is pubic symphysis?
- What hormone leads to the joints around pelvis soften in later stages of pregnancy?
- It is synovial anteriorly and then posteriorly it is fibrous (because support for the posterior needed)
- Fibrocartilage (allows some movement)
- Relaxin
What us symphysiotomy?
Symphysiotomy is a surgical procedure in which the cartilage of the pubic symphysis is divided to widen the pelvis allowing childbirth when there is a mechanical problem.
If baby’s head got stuck then they used to make a cut in pubic symphysis so creates 2-3cm gap so baby’s hip can go through but dont need to do that anymore bc healing it is very hard
Ligaments of the pelvis:
- Where is the anterior ligament
- Interosseous ligament (not the membrane bc interosseous membrane is bw tibia and fibula)
- What ligament forms the greater siatic foramen?
- What ligament forms the lesser siatic foramen?
- Where is the obturator membrane?
- In front of the sacroiliac joint sorta
- In between the sacrum and the allium
- Sacrospinous ligament (since it goes from sacrum to ischial spine)
- Sacrotuberous (since it goes from sacrum to ischial tuberosity)
- It covers the obturator foramen
What are the gateways to the lower limb?
Ligaments form formina so structures can go through
Well, there is underneath the inguinal ligament you have things that go from pelvis to the anterior part of the thigh
Then you have via the obturator canal
-Obturator strcutes go to medial side of thigh through the canal
Then via the greater and lesser sciatic foramen
- Sciatic nerve goes through the greater sciatic foramen
- The lesser siatic foramen also has strcutures leaving from pelvis into perineum (the region below pelvis) - that hole in pelvis bottom has musscles and that pelvic floor muscle (below this is the perineum)
Jointsssss
- What are the three types of joints?
- What are the types for each of these:
- sacroilliac
- symphysis pubis
- hip
- knee
- ankle
- intertarsal
- tarsometatarsal
- metatarsophalangeal
- interphalangeal
- Fibrous (most stable aka no movement really)
- Cartilaginous (has some movement)
- Synovial (real mobile and you classify this according to the shape) - Sacroilliac = fibrous and synovial both
Symphysis pubis = cartilaginous
Hip = synovial (ball and socket)
Knee = synovial (condylar)
Ankle = synovial (hinge)
Intertarsal = synovial (plane)
Tarsometatarsal = synovial (plane)
Metatarsophalangeal = synovial (ellipsoid = lexion, extension, add and abd)
Interphalangeal = synovial (hinge)
General features of the hip joint:
- What sort of synovial joint is it?
- Is it stable? Why?
- Does it have a wider range of movement than the shoulder joint?
- Where is the greater trochanter?
- Where is the lesser trochanter?
- Which side (ant or post) do you see the intertrochanteric line and which side the intertrochanteric crest?
- What is the area between the head and the neck called?
- What is the fovea and what is attached there?
- Ball and socket
- Yes, bc good fit since good bony and strong liga and capsule (capsule is a dynamic ligament in synovial joints)
- Shoulder has bigger range bc hip wants to be stable so compensated by less movement
- Like the bump on the lateral side of the femur top
- The bump on the medial side
- Line is anterior (from greater to lesser) and crest is posterior
- Subcapital area (since capital is head)
- It’s a little dip in the head of the femur for the ligament of the femoral head to attach
Hip joint: acetabulum + head of femur
Where is:
- Acetabular fossa
- it’s filled with fat - Acetabular foramen
- Transverse acetabular ligament - what does this do?
- Lunate surface and acetabular labrum
- On the lunar surface is a fibrocartilagious structure called labrum - it deepens socket a little bit more and bc it’s fibrocartilage, it cushions the socket. - What can you tell me about the arteries?
- Was the acetabular notch but in living, the gap (notch) filled with acetabular ligament and that completes this socket as a cicle
- In the first seven years of life, before ossifiction, this portion of femur head was fed by branches of obturator artery that came via this ligament.
For the hip bone, where are the capsule attachments?
What are the three here ligaments? When are they taught?
On the hip bone, the capsule is attached to the edges of the acetabulum, around the labrum and transverse ligament
On the femur, it attaches anteriorly to the intertrochanteric line and posteriorly it attaches into the next, proximal the the intertrochanteric crest (so not on the crest but before it on the neck)
There is the pubofemoral, illiofemoral (has the two parts) and the ischiofemoral (posterior sorta) ligaments and they’re taught when extension of hip
Name the arteries involved in the blood supply of the hip joint
Side 21
