BMS Anatomy Lecture 11 Lower Limb Bones PDF

BMS Anatomy Lecture 11 Lower Limb Bones (In-Person Class) Presented By: Dr. K. Lumsden; [email protected] (Toronto Campus) Dr. M. Doroudi; [email protected] Boucher Campus) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph.D. FAAA (Autho...

BMS Anatomy Lecture 11 Lower Limb Bones (In-Person Class) Presented By: Dr. K. Lumsden; [email protected] (Toronto Campus) Dr. M. Doroudi; [email protected] Boucher Campus) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph.D. FAAA (Author), 9th ed. Upper Limb Chapter; Pages: 674 – 689 Regions and Bones of the Lower Limb Parts A. Gluteal B. Thigh (from hip to knee) Subdivisions Bones _ Hip bone _ 1. Femur 2. Patella Joints Hip joint Knee joint 1. Proximal C. Leg (crura) tibiofibular joint _ (from knee to 1. Tibia 2. Distal tibiofibular joint 2. Fibula ankle) 1. made up of 7 tarsal 1. Ankle joint 1. Tarsus (ankle) bones 2. Subtalar 2. Metatarsus 2. made up of 5 3. Tarsometatarsal 3. Five toes metatarsal bones 4. (digits) 3. 14 phalanges, two Metatarsophalang from medial to for the big toe, and eal D. Foot (pes) lateral side three for each toe 5. Proximal and (from heel to First: Big toe or distal toes) Halux interphalangeal Second, third, fourth Fifth= Digitus minimus 2 3 5 five rudimentary vertebrae Fused together to form a wedgeshaped bone Superior articulation with L5th Inferior articulation with coccyx Laterally articulation with the two hip bones –Sacroiliac joints (via auricular surfaces). Sacral canal Sacral hiatus Sacral crests Posterior sacral foramina. These foramina provide a passage for posterior rami of S1 – S4 nerves. 4 Consists of five rudimentary vertebrae fused together to form a wedge-shaped bone , which is concave anteriorly. The upper border , or base , of the bone articulates with the 5th lumbar vertebra. The narrow inferior border articulates with the coccyx. Laterally the sacrum articulates with the two hip bones to form the sacroiliac joints (in auricular surfaces). The vertebral foramina are present and form the sacral canal. The laminae of the 5th sacral vertebra fail to meet in the midline, forming the sacral hiatus. On the posterior surface of the sacrum, above the sacral hiatus there are prominent bony ridges, known as sacral crests that represents the remnants of spinous, articular, and transverse processes of the embryonic segments. There are 4 pairs of posterior sacral foramina. These foramina provide a passage for posterior rami of S1 – S4 nerves. 5 The anterior surface of the sacrum: – anterior foramina on each side for the passage of the anterior rami of the sacral nerves (S1 – S4). Sacral promontory. Sacral Ala. The anterior border of this surface contributes to the formation of pelvic inlet (Superior Aperture). 6 The anterior surface of the sacrum is concave and has four anterior foramina on each side for the passage of the anterior rami of the sacral nerves (S1 – S4). The anterior and upper margin of the first sacral vertebra bulges forward and is known as the sacral promontory. On the sides of the promontory, two triangular flat surfaces are seen. These are called sacral Ala. The anterior border of this surface contributes to the formation of pelvic inlet (Superior Aperture). 7 4 fused vertebral segments Coccygeal cornu. Coccyx r Coccyx The coccyx consists of four vertebrae fused together to form a small triangular bone, which articulates at its base with the lower end of the sacrum. There are two processes arising from the first coccygeal segment toward the sacrum. These are known as coccygeal cornu that articulate with the sacral cornu to form the sacrococcygeal joints. 10 Hip Bone / Os Coxa 11 Hip Bone / Os Coxa 12 Hip Bone (Os Coxae, innominate bone) Hip Bone (Ilium part) External Surface features: The iliac crest (24) iliac tubercle (tuberculum) (29) posterior gluteal line (35), anterior gluteal line (34) inferior gluteal line (33) Supra- acetabular groove (sulcus) (19) 13 Hip Bone (Os Coxae, innominate bone) Made of three parts: ilium, pubis and ischium. It is a flat twisted bone with two surfaces (medial & lateral) and five borders (Ant. Post. Sup. Inf. & Med.) Hip Bone (Ilium part) The external surface (gluteal surface (20) is crossed by three lines. The posterior gluteal line (35), the anterior gluteal line (34), and the inferior gluteal line (33) Supra- acetabular groove (sulcus) (19) that gives attachment to the reflected head of the rectus femoris muscle is located in this surface of ilium. 14 Hip Bone (Ilium part) Internal Surface features: Iliac crest iliac fossa (21). auricular surface (articular surface for sacrum) (23), iliac tuberosity (22), Arcuate line (13) iliopectineal (iliopubic) eminence(14), 15 Hip Bone (Ilium part) The internal surface has a large, smooth, concave surface, called the iliac fossa (21). Behind the iliac fossa, there is an articular surface, (the auricular surface) (23), that articulates with a similar surface on the side of the sacrum. Behind the auricular surface there is a rough surface, known as the iliac tuberosity (22), for the attachment of the posterior sacroiliac ligaments. The arcuate line (13) of the ilium is on the internal surface of the hip bone. The iliac crest (24) (superior border) is convex and ends in the anterior superior iliac spine (ASIS) (25) and posterior superior iliac spine (PSIS) (30). About 5 cm. behind the ASIS there is a prominent tubercle called iliac tubercle (tuberculum) (29) on the outer lip. 16 Hip Bone (Ilium part) Anterior superior iliac spine (25) Anterior inferior iliac spine (32). Posterior superior iliac spine (30) Posterior inferior iliac spine(31). Greater sciatic notch (39). 17 Hip Bone (Ilium part) The anterior border of the ilium presents two projections, separated by a notch, the anterior superior iliac spine (25) and the anterior inferior iliac spine (32). Medial to the anterior inferior iliac spine is a broad, shallow groove which is bounded medially by an eminence, the iliopectineal (iliopubic) eminence(14), which marks the point of union of the ilium and pubis. The posterior border of the ilium also presents two projections separated by a notch, the 18the posterior superior iliac spine (PSIS) (30)and the posterior inferior iliac spine(31). Below posterior inferior iliac spine is a deep notch, the greater sciatic notch (39). Hip Bone (Ischium part) The Body (36) Ischial spine (38). Greater sciatic notch (39). Lesser sciatic notch (40). Ischial tuberosity (41). The Ischium Ramus (37) inferior border (ischiopubic ramus) 19 The Ischium forms the lower and back part of the hip bone. It is divisible into a body and a ramus. The Body (36) constitutes the posterior part of the acetabulum. Its internal surface is part of the wall of the lesser pelvis; from its posterior border extends backward a thin and pointed triangular eminence, the ischial spine (38). Above the spine is a large notch, the greater sciatic notch (39). Below the spine is a smaller notch, the lesser sciatic notch (40). On the postero-inferior aspect of the body there is a large swelling called the ischial tuberosity (41). The Ischium Ramus (37) joins the inferior ramus of the pubis (8) to form the inferior border (ischiopubic ramus) of the hip bone. Hip Bone (Ischium part) 20 Hip Bone (Pubis part) body (9), superior ramus (7) Pectineal line (12) Iliopectineal eminence (14) inferior ramus (8). Ischiopubic ramus (37) obturator foramen (5 pubic symphysis (41) pubic crest (11) pubic tubercle (10). 21 Hip Bone (pubis part) The Pubis ,the anterior and inferior part of the hip bone, is divisible into a body (9), a superior ramus (7) and an inferior ramus (8). The Body articulates with the body of the pubic bone on the other side at the pubic symphysis. It has a rounded pubic crest (11) on its superior surface that ends laterally as the prominent pubic tubercle (10). The Superior Ramus (7) projects postero-laterally from the body and joins the ilium and ischium at its base. This ramus carries the pectineal line (12) (pubic pecten). The superior ramus units with the ilium superiorly at the iliopectineal eminence (14). The inferior surface forms the upper boundary of the obturator foramen (5). On this surface one can find the obturator groove (15) that will turn to obturator canal by the attachment of the obturator membrane to the margins of the obturator foramen (5). The Inferior Ramus (8) joins to the inferior ischial ramus to form the inferior border of hip bone (the ischiopubic ramus). 22 rim or margin The Acetabulum acetabular labrum acetabular notch acetabular fossa lunate surface acetabular labrum, 23 The Acetabulum —The acetabulum is a deep, cup-shaped, hemispherical depression on the lateral surface of the hip bone. It is formed by pubis (6) , ilium, and ischium. It is bounded by a rim or margin, that serves for the attachment of a fibrocartilage structure called the acetabular labrum, which contracts its orifice, and deepens the surface for articulation. It presents below a deep notch, the acetabular notch (4), which is continuous with a circular non-articular depression, the acetabular fossa (2), at the bottom of the cavity. The notch is converted into a foramen (acetabular foramen) by the transverse ligament (transverse acetabular ligament); through the foramen nutrient vessels and nerves enter the joint. The rest of the acetabulum is formed by a curved articular surface, the lunate surface (3), for articulation with the head of the femur. 24 Head (12) – fovea capitis femoris (fovea of the head) (13), – the trochanteric fossa (17) – quadrate tubercle. Femur neck (2) greater trochanter (16) lesser trochanter (18). intertrochanteric line (14) intertrochanteric crest (15) 25 Femur Femur, the longest and strongest bone in the skeleton, is divisible into a body (1) and two ends. The Upper end presents a head (12) , a neck (2), a greater trochanter (16) and a lesser trochanter (18). The Head (12) which is spherical and forms rather more than a hemisphere, is directed upward, medial ward, and a little forward. An ovoid depression, the fovea capitis femoris (fovea of the head) (13), is situated a little below and behind the center of the head, and gives attachment to the ligamentum teres femoris (round ligament of the femur). The Neck (2) Greater Trochanter (16) is a large quadrilateral eminence, situated at the junction of the neck with the upper part of the body. Its medial surface, presents at its base a deep depression, the trochanteric fossa (17) for the insertion of the tendon of the obturator externus muscle. Lesser Trochanter (18) is a conical eminence. The intertrochanteric line (14); is located between the trochanters on the anterior aspect of the proximal end of femur. The intertrochanteric crest (15) is located between the trochanters on the posterior aspect of the proximal end of femur, about the middle of which is the quadrate tubercle. 26 Femur The Body or Shaft, almost cylindrical in form and convex in front, is strengthened by a prominent longitudinal ridge, the linea aspera (6), which is prolonged superiorly by three ridges. The lateral ridge is the gluteal tuberosity (9). The intermediate ridge or pectineal line (11) and the medial ridge. Below, the linea aspera is prolonged into two ridges (supracondylar ridges), enclosing a triangular area, the popliteal surface (24). The linea aspera has two lips The Lower end consists of two eminences known as the condyles (19, 20). In front, the condyles are separated by a smooth, shallow articular depression called the patellar surface (21). Behind, the interval between them forms a deep fossa, the intercondylar fossa (notch) (22). The lateral condyle (20) is broader in its anteroposterior diameter, but the medial condyle (19) is larger. Above each condyle is an elevation, the medial epicondyle (25) and the lateral epicondyle (27). On top of the medial epicondyle is a tubercle called the adductor tubercle (26). 27 28 The Patella (Knee Cap) The patella is a flat, triangular bone, situated on the front of the knee joint. It is usually regarded as a sesamoid bone, developed in the tendon of the quadriceps femoris. It serves to protect the front of the joint and increases the leverage of the quadriceps femoris by making it act at a greater angle. It has an anterior and a posterior surface three borders, and an apex. Surfaces: The anterior surface is convex and marked by numerous rough, longitudinal striæ. This surface is covered by an expansion from the tendon of the quadriceps femoris, which is continuous below with the superficial fibers of the patellar ligament (tendon). It is separated from the skin by a bursa. The posterior surface presents above a smooth, oval, articular area, divided into two facets by a vertical ridge; the ridge corresponds to the groove on the patellar surface of the femur, and the facets to the medial and lateral parts of the same surface; the lateral facet is the broader and deeper. Below the articular surface is a rough, non-articular area, that gives attachment to the patellar ligament (tendon). Borders.—The base or superior border gives attachment to that portion of the quadriceps femoris tendon which is derived from the rectus femoris and vastus intermedius muscles. The medial and lateral borders give attachment to those portions of the quadriceps femoris which are derived from the vastus lateralis and vastus medialis muscles. Apex.—The apex is pointed, and gives attachment to the patellar ligament (tendon). Articulation.—The patella articulates with the femur. 29 Proximal end: medial condyle lateral (3) condyle Tibia – Fibular facet – – – – Three borders (Ant. Med. & Lat.) and three surfaces. (Ant, Med, Post) The posterior surface (15) soleal line (17). superior articular surface intercondylar eminence (4). tibial tuberosity (11). Gerdy's tubercle The Body or Shaft (1) The Distal end medial malleolus (19). lateral surface – fibular notch (21) inferior surface 30 Tibia Tibia is a long bone with two ends and a shaft (body). The Upper end is large, and expanded into two eminences, the medial (2) and lateral (3) condyles. The superior articular surface presents two smooth articular facets separated by the intercondylar eminence (4). This eminence consists of medial (5) and lateral (6) intercondylar tubercle. Anterior to the condyles there is a large elevation, the tibial tuberosity (11). The medial condyle presents posteriorly a deep transverse groove ( attachment of semimembranosus muscle). The lateral condyle presents posteriorly a flat articular facet (9), for articulation with the head of the fibula (fibular facet). Gerdy's tubercle is located on the lateral condyle where the iliotibial band (iliotibial tract) inserts. 31 Tibia The Body or Shaft (1) has three borders (Ant. Med. & Lat.) and three surfaces. The anterior border (10), the most prominent of the three, is subcutaneous. The interosseous or lateral border (14) gives attachment to the interosseous membrane. The medial surface (12) is smooth and subcutaneous. The posterior surface (15) presents, at its upper part, a prominent ridge, the soleal line (17). The Lower end presents five surfaces. It is prolonged downward on its medial side as a strong process, the medial malleolus (19). The lateral surface presents the fibular notch (21) (for the fibula), the inferior surface articulates with talus. 32 Fibula The Proximal end Head (1) apex (3) The Body or Shaft (4) presents three borders and three surfaces. medial border, or interosseous border (11) lateral surface (6) Posterior border The Distal end: Lateral Malleolus (13 malleolar fossa (15). 33 Fibula Fibula is placed on the lateral side of the tibia, with which it is articulated above and below. The Upper end or Head (1) contains an articular surface (2) that articulates with the lateral condyle of the tibia. The apex (3) projects upward from the head. The Body or Shaft (4) presents three borders and three surfaces. The medial border, or interosseous border (11) gives attachment to the interosseous membrane. The lateral surface (6) faces the lateral compartment of leg. The Lower end or Lateral Malleolus (13) descends to a lower level than the medial malleolus. Behind and beneath the articular surface of the lateral malleolus (on its medial surface) is a rough depression, which gives attachment to the posterior talofibular ligament called malleolar fossa (15). 34 35 36 ¯ Foot: Made up of three parts: tarsus, metatarsus and digits (toes). § Tarsus: Made up of 7 tarsal bones, arranged in 3 groups. ³ Proximal group: talus above and calcaneus below. ³ Intermediate group: navicular; articulates posteriorly with the head of the talus. ³ Distal group : consists of cuboid and three cuneiforms (medial, intermediate and lateral). 37 Talus: body, neck, head. Articular surfaces: Superior surface Inferior surface Anterior surface Inferior surface Superior surface 38 r Talus: consists of a body, a neck, and a head. Superior surface of the body presents a smooth trochlear surface, for articulation with the inferior surface of the distal end of the tibia. Inferior surface presents two articular areas, the posterior and middle calcaneal surfaces, separated from one another by a deep groove, the sulcus tali. In the articulated foot it lies above a similar groove upon the upper surface of the calcaneus, and forms, with it, a canal (sinus tarsi) filled up by the interosseous talocalcaneal ligament. Neck is directed forward and medially located between the body and the head. Head looks forward and medially; its anterior articular or navicular surface is oval, and convex. Inferior surface Superior surface 39 Medial surface Medial surface articulates with medial malleolus. Lateral surface articulates with lateral malleolus. Lateral surface 40 Calcaneus The Calcaneus is the largest of the tarsal bones. It is situated at the lower and back part of the foot, serving to transmit the weight of the body to the ground, and forming a strong lever for the muscles of the calf. It presents six surfaces. Superior surface has three articular facets for talus. On this surface there is a sulcus, the calcaneal sulcus. In the articulated foot this sulcus lies below a similar one on the under surface of the talus, and the two form a canal (sinus tarsi) for the lodgment of the interosseous talocalcaneal ligament. 41 The inferior or plantar surface is bounded posteriorly by calcaneal tuberosity, which is prolonged at either end into a process; the lateral process and medial process. On this surface there is a tubercle known as calcaneal tubercle that gives attachment to the ligaments. 42 Medial surface; at its upper and forepart is a horizontal eminence, the sustentaculum tali, below which there is a groove for the tendon of the Flexor hallucis longus. Anterior or cuboid articular surface articulates with the cuboid bone. Lateral surface presents two oblique grooves separated by an elevated ridge, the fibular (peroneal) tubercle or trochlea. 43 Navicular bone The navicular bone is situated at the medial side of the tarsus, between the talus behind and the cuneiform bones in front. The anterior surface articulates with the three cuneiform bones. The posterior surface articulates with the head of the talus. The medial surface presents a rounded tuberosity. 44 Cuboid The cuboid bone is placed on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones. 45 Cuneiforms Cuneiform Bones; There are three cuneiform bones, the medial cuneiform, the Intermediate cuneiform, and the lateral cuneiform. They are also numbered from medial to lateral, 1, 2, and 3. 46 §Metatarsus: Made up of 5 metatarsal bones, which are numbered from medial to lateral (side). Each metatarsal bone has a base, a shaft and a head. The fifth metatarsal bone is recognized by a rough eminence, the tuberosity, on the lateral side of its base. §The phalanges of the foot correspond, in number and general arrangement, with those of the hand; there are two in the great toe, and three in each of the other toes. Each phalanges has a base, a shaft and a head. The distal phalanges has a distal tuberosity. 47 Foot Axis The axis of foot passes through the 2nd toe and metatarsal bone. Therefore, abduction and adduction of the toes are considered relative to the 2nd toe. 48