Knee & Ankle Joints PDF

C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ Prof. Mujahid Khan ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0 C o ll e g e o f List the type and articular surfaces of each joint M Describe the capsule and ligaments of each joint e d...

C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ Prof. Mujahid Khan ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0 C o ll e g e o f List the type and articular surfaces of each joint M Describe the capsule and ligaments of each joint e d List important bursae (if any) in relation to each joint ic i List important relations of each joint n e Describe movements of each joint – ‫ك‬ Apply Hilton’s law about nerve supply of joints ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The knee joint is the largest and most complicated joint in the body It consists of two condylar joints between the medial dicine – ‫كلية الطب‬ Loading… and lateral condyles of the femur and the corresponding condyles of the tibia A gliding joint, between the patella and the patellar surface of the femur Fibula is not directly involved in the joint C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f Above are the rounded condyles of the femur M e d ic Below are the condyles of the tibia and their cartilaginous menisci Loading… i n e – ‫ك‬ In front is the articulation between the lower end of the femur ‫ل‬ and the patella ‫ية‬ ‫ا‬ ‫ ل‬ The articular surfaces of the femur, tibia and patella are ‫ط‬ covered with hyaline cartilage ‫ب‬ dicine – ‫كلية الطب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The joint between the femur and tibia is a synovial joint of the hinge variety dicine – ‫كلية الطب‬ Some degree of rotatory movement is possible The joint between the patella and femur is a synovial joint of the plane gliding variety C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f M The capsule is attached to the margins of the articular e d surfaces and surrounds the sides and posterior aspect of ic i the joint n e – The capsule is absent on the front of the joint permitting ‫ك‬ ‫ل‬ the synovial membrane to pouch upward beneath the ‫ية‬ quadriceps tendon, forming the suprapatellar bursa ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  On each side of the patella, the capsule is strengthened by expansions from the tendons of vastus lateralis and medialis dicine – ‫كلية الطب‬ Behind the joint, the capsule is strengthened by an expansion of the semimembranosus muscle called the oblique popliteal ligament An opening in the capsule behind the lateral tibial condyle permits the tendon of the popliteus to emerge dicine – ‫كلية الطب‬ Loading… C o ll e g e o f The ligamentum patellae (patellar ligament) is attached above M e to the lower border of the patella and below to the tuberosity d of the tibia ic i n e It is a continuation of the central portion of the common – tendon of the quadriceps femoris muscle ‫ك‬ ‫ل‬ ‫ ية‬ The lateral collateral ligament is cordlike and is attached above ‫ا‬ to the lateral condyle of the femur and below to the head of the ‫ل‬ ‫ط‬ fibula ‫ب‬ C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The medial collateral ligament is a flat band and is attached above to the medial condyle of the femur and below to the medial surface of the shaft of the tibia dicine – ‫الطب‬ ‫ كلية‬and is firmly attached to the edge of the medial meniscus The oblique popliteal ligament is a tendinous expansion derived from the semimembranosus muscle. It strengthens the posterior aspect of the capsule ‫كلية الطب – ‪dicine‬‬ C o ll e g e o f M The cruciate ligaments are two strong intracapsular d e ligaments that cross each other within the joint cavity ic i n They are named anterior and posterior, according to e – their tibial attachments ‫ك‬ ‫ل‬ ‫ ية‬ These important ligaments are the main bond between ‫ا‬ ‫ل‬ the femur and the tibia throughout the joint's range of ‫ط‬ movement ‫ب‬  The anterior cruciate ligament is attached to the anterior intercondylar area of the tibia and passes upward, backward, and laterally, to be attached to the posterior part of the medial surface of the lateral femoral condyle dicine – ‫كلية الطب‬ It prevents posterior displacement of the femur on the tibia C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f M Posterior cruciate ligament is attached to the posterior e intercondylar area of the tibia and passes upward, forward, and d ic medially to be attached to the anterior part of the lateral i surface of the medial femoral condyle n e – ‫ ك‬ It prevents anterior displacement of the femur on the tibia ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  The menisci are C-shaped sheets of fibrocartilage The peripheral border is thick and attached to the capsule, and the inner border is thin and concave and forms a free edge dicine – ‫كلية الطب‬ The upper surfaces are in contact with the femoral condyles and the lower surfaces are in contact with the tibial condyles Their function is to deepen the articular surfaces of the tibial condyles to receive the convex femoral condyles They also serve as cushions between the two bones ‫كلية الطب – ‪dicine‬‬ C o ll e g e o f M The suprapatellar bursa lies beneath the quadriceps muscle and e communicates with the joint cavity d ic i The prepatellar bursa lies in the subcutaneous tissue between the skin and n the front of the lower half of the patella and the upper part of the e ligamentum patellae – ‫ك‬ ‫ ل‬ The superficial infrapatellar bursa lies in the subcutaneous tissue between ‫ية‬ the skin and the front of the lower part of the ligamentum patellae ‫ا‬ ‫ ل‬ The deep infrapatellar bursa lies between the ligamentum patellae and the ‫ط‬ tibia ‫ب‬  The popliteal bursa is found in association with the tendon of the popliteus and communicates with the joint cavity dicine – ‫كلية الطب‬ The semimembranosus bursa is found related to the insertion of the semimembranosus muscle and may communicate with the joint cavity C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f M e The femoral, obturator, common peroneal, and tibial d nerves supply the knee joint ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  Flexion Extension dicine – ‫كلية الطب‬ Medial rotation Lateral rotation ‫كلية الطب – ‪dicine‬‬ C o ll e g e o The ankle joint consists of a deep socket formed by the lower f M ends of the tibia and fibula e d Upper part of the body of the talus fits into the socket ic i n Talus is able to move on a transverse axis in a hinge like e – manner ‫ك‬ ‫ ل‬ Shape of the bones and the strength of the ligaments and the ‫ية‬ surrounding tendons make this joint strong and stable ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ dicine – ‫كلية الطب‬ Loading…  Articulation is between the lower end of the tibia, the two malleoli and the body of the talus The inferior transverse tibiofibular ligament, which runs between dicine – ‫الطب‬ ‫كلية‬ the lateral malleolus and the posterior border of the lower end of the tibia It deepens the socket into which the body of the talus fits The articular surfaces are covered with hyaline cartilage C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f M e The ankle is a synovial hinge joint d ic i n The capsule encloses the joint and is attached to the e bones near their articular margins – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  The medial or deltoid ligament is strong and is attached by its apex to the tip of the medial malleolus Below the deep fibers are attached to the nonarticular dicine – ‫كلية الطب‬ area on the medial surface of the body of the talus Superficial fibers are attached to the medial side of the talus, the sustentaculum tali, the plantar calcaneonavicular ligament and the tuberosity of the navicular bone ‫كلية الطب – ‪dicine‬‬ C o ll e g e o f M e The lateral ligament is weaker than the medial d ic ligament and consists of three bands i n e – The anterior talofibular ligament runs from the lateral ‫ك‬ malleolus to the lateral surface of the talus ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  The calcaneofibular ligament runs from the tip of the lateral malleolus downward and backward to the lateral surface of the calcaneum dicine – ‫كلية الطب‬ The posterior talofibular ligament runs from the lateral malleolus to the posterior tubercle of the talus C o ll e g e o f M e d ic i n Deep peroneal and tibial nerves supply the ankle joint e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  Dorsiflexion and plantar flexion are possible Movements of inversion and eversion take place at dicine – ‫كلية الطب‬ the tarsal joints and not at the ankle joint C o ll e g e o f M e Anteriorly: Tibialis anterior, extensor hallucis longus, d anterior tibial vessels, deep peroneal nerve, extensor ic i digitorum longus, and peroneus tertius n e – Posteriorly: The tendo calcaneus and plantaris ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬  Posterolaterally (behind the lateral malleolus): The peroneus longus and brevis dicine – ‫كلية الطب‬ Posteromedially (behind the medial malleolus): Tibialis posterior, flexor digitorum longus, posterior tibial vessels, tibial nerve and flexor hallucis longus C o ll e g e o f The capsule and ligaments receive an abundant sensory M nerve supply e d ic i A sensory nerve supplying a joint also supplies the n e muscles moving the joint and the skin overlying the – insertions of these muscles ‫ك‬ ‫ل‬ ‫ ية‬ This fact is known as Hilton’s law ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Gray's Anatomy for Students, 4th edition Snell Clinical Anatomy, 9th edition dicine – Clinically ‫كلية الطب‬ Oriented Anatomy , Keith L. Moore- 7th edition Netter’s Atlas of Human Anatomy, 7th edition 0 C o ll e g e o f M e d ic i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬