JOINTS OF THE LOWER EXTREMITY •Pelvis as a whole: •By connection of os coxae with os sacrum through sacroiliac joint and symphysis in the front, it is created a solid circle. • •Articulatio sacroiliaca •Type: tough joint- amphiarthrosis •Articular surfaces: •facies auricularis ossis sacri •facies auricularis ossis ilii Articular capsule: short, tough Ligaments: •lig. sacroiliacum ventrale •lig. sacroiliacum dorsale •lig. sacroiliacum interosseum •lig. iliolumbale from L4-5 to dorsal side of crista iliaca •Movements: minimal •Articulationes cinguli Symphysis pubica Type: tough, cartilaginous connection discus interpubicus- at the back eminentia retropubica (palpable), there is sometimes a cleft inside Articular surfaces: facies symphysiales (os pubis) Ligaments: lig. pubicum inferius= lig. arcuatum pubis – from below, it holds even when the pelvic bones are spread out lig. pubicum superius • • • •Ligaments of pelvis •lig. inguinale • •lig. sacrospinale •foramen ischiadicum majus (it is divided by the course of m. piriformis into foramen suprapiriforme et infrapiriforme) •lig. sacrotuberale •foramen ischiadicum minus • •lig. sacrococcygeum anterius •lig. sacrococcygeum posterius • •membrana obturatoria •canalis obturatorius •Pelvis as a whole: •Linea terminalis separates the large and small pelvis from each other. •Pelvis major is a part of abdominal cavity •Pelvis minor contains a part of organs of genital and urinary systems. •The small pelvis in the woman presents important birth canal. In connection with this function, there are significant gender differences on the pelvis. •Male pelvis is higher and narrower •Female pelvis is lower and wider • •Gender differences of pelvis •Female pelvis: •sacrum wider and shorter, •promontorium protrudes less into the entrance- oval shaped, •coccyx shorter and more movable, •alla ossis illii- in the frontal plane •arcus pubicus •foramen obturatum lower – triangular shape •tubera ischiadica- further from each other •symphysis pubica- lower • Dimensions of the pelvis •The largest dimension of newborn skull- the length - 11,5 cm must be consistent with dimensions of single pelvic planes •The newborn head rotates during the birth so, that its largest dimension passes through the largest dimension of appropriate plane: • •aditus pelvis •amplitudo pelvis •angustia pelvis •exitus pelvis • • •External pelvis dimensions •Distantia bispinalis 26cm •Distantia bicristalis 29cm •Distantia bitrochanterica 31cm •Conjugata externa- upper edge of symphysis to the spinous proces of L5: 18 - 20cm •Articulatio coxae • Type: spherical, restricted – enarthrosis Articular head: caput femoris Articular pit: facies lunata acetabuli, enlarged by labrum acetabuli, pulvinar acetabuli Articular capsule: From margins of acetabulum ventrally to linea intertrochanterica dorsally to collum femoris •Ligaments: •lig. transversum acetabuli •lig. iliofemorale • •lig. pubofemorale •lig. ischiofemorale •lig. capitis femoris •zona orbicularis • •Movements: •flexion, extension •abduction, adduction •rotation • •Articulatio genus • Type: composed joint, trochlear Tibio-femoral part: Articular head: condyli femoris Articular pit: facies articulares superiores tibiae, meniscus medialis, meniscus lateralis Patello-femoral part: Articular head: facies articulares patellae Articular pit: facies patellaris femoris Articular capsule: fibrous and synovial layers •Ligaments: •a) intraarticular •lig. cruciatum anterius •lig. cruciatum posterius •lig. transversum genus • • • • •b) extraarticular •Tendon of m. quadriceps femoris - lig. patellae •retinaculum patellae mediale •retinaculum patellae laterale •lig. collaterale fibulare •lig. collaterale tibiale •lig. popliteum obliquum •Synovial layer: •plica synovialis patellaris •plicae alares •corpus adiposum infrapatellare • •Bursae: •b. suprapatellaris •b. profunda infrapatelaris •b. prepatelaris subcutanea •b. infrapatellaris subcutanea •b. prepatellaris subtendinea •b. anserina • • • • • •Movements: • • • • • • •Flexion/extension - 4 phases: •1. Initial rotation •2. Rolling movement •3. Slide movement •4. Final rotation • • • • Connections of tibia and fibula •Articulatio tibiofibularis • Type: plane joint Articular surfaces: facies articularis tibiae facies articularis capitis fibulae Articular capsule: short, tough Ligaments: •lig. capitis fibulae anterius •lig. capitis fibulae posterius Movements: sliding, minimal •Membrana interossea cruris •Fibrous membrane between margo interosseus of tibia and margo interosseus of fibula. • •Syndesmosis tibiofibularis •Type: fibrous connection Surfaces: incisura fibularis tibiae, distal end of fibula Ligaments: •lig. tibiofibulare anterius •lig. tibiofibulare posterius •Movements: minimal •Articulatio talocruralis •Type: composed, trochlear joint Articular head: trochlea tali Articular pit: facies articularis malleoli lateralis, facies articularis inferior tibiae et facies articularis malleoli medialis - tibiofibular fork Articular capsule: it is attached to margins of articular surfaces •Movements: •plantar and dorsal flexion •Ligaments: •lig. collaterale mediale = lig. deltoideum •pars tibionavicularis •pars tibiotalaris anterior •pars tibiocalcanearis •pars tibiotalaris posterior • •lig. collaterale laterale •lig. talofibulare anterius •lig. calcaneofibulare •lig. talofibulare posterius • • • • •Articulatio subtalaris (talocalcanea) •Typ: cylindrical joint Articular head: facies articularis talaris posterior calcanei Articular pit: facies articularis calcanearis posterior tali Ligaments: •lig. talocalcaneum laterale •lig. talocalcaneum mediale •lig. talocalcaneum posterius •lig. talocalcaneum interosseum •(within sinus tarsi) • •Articulatio talocalcaneonavicularis •Type: spherical joint Articular head: caput tali, facies articularis calcanea media et anterior tali Articular pit: os naviculare, •facies articularis talaris media •et anterior calcanei, •fibrocartilago navicularis • •Ligaments: •lig. calcaneonaviculare plantare- fibrocartilago navicularis • •lig. talonaviculare dorsale • •Movements: combined inversion - plantar flexion, adduction and supination eversion - dorsal flexion, abduction and pronation •Articulatio calcaneocuboidea •Type: amphiarthrosis •Articular surfaces: facies articularis cuboidea calcanei, os cuboideum • • •Ligaments: •lig. calcaneocuboideum plantare •lig. plantare longum •Chopart´s joint= art. tarsi transversa • articular line:art. talonavicularis et calcaneocuboidea • •Ligaments: dorsal side: •lig. talonaviculare •lig. bifurcatum: • lig. calcaneonaviculare • lig. calcaneocuboideum • •Plantar side: •lig. calcaneonaviculare plantare •lig. calcaneocuboideum plantare •Articulatio cuneonavicularis •Type: composed, tough joint •Connection of three ossa cuneiformia with os naviculare, ossa cuneiformia between each other and os cuneiforme laterale with os cuboideum Ligaments: •ligg. cuneonavicularia dorsalia et plantaria •ligg. intercuneiformia dorsalia, plantaria et interossea •ligg. cuneocuboideum dorsale, plantare et interosseum •Movements: minimal •Lisfranck´s joint= functional unit: • •Articulationes tarsometatarsales •Distal row of tarsal bones and bases of metatarsal bones A. os cuneiforme mediale - os metatarsale I B. os cuneiforme intermedium et laterale - os metatarsale II et III C. os cuboideum - os metatarsale IV et V • •Articulationes intermetatarsales •Connections between bases of adjacent metatarsal bones. •Ligaments: • • • • • • •Plantar side: •ligg. metatarsalia plantaria • •Dorsal side: •ligg. metatarsalia dorsalia •et interossea •ligg. tarsometatarsalia dorsalia •ligg. tarsometatarsalia plantaria •Articulationes metatarsophalangeae •Type: transition between cylindrical and spherical joints Articular head: caput ossis metatarsalis Articular pit: basis phalangis proximalis Ligaments: •ligg. collateralia •ligg. plantaria - fibrocartilagines plantares •lig. metatarsale transversum profundum • •Movements: flexion and extension in small range - abduction and adduction •Articulationes interphalangeae pedis •Type: trochlear joint Articular head: caput phalangis Articular pit: basis phalangis Ligaments: •ligg. plantaria - fibrocartilagines plantares •ligg. collateralia • •Movements: flexion and extension in restricted range •Foot vault •- It prevents compression of soft tissues in the foot •- It allows flexibility of the foot during walking •transversal – it is given by arch of ossa cuneiformia, it is held by interosseous ligaments, m. peroneus longus, m. tibialis anterior, m. adductor hallucis •longitudinal – top is talus, aponeurosa, lig. plantare longum, m. tibialis ant. et post., m. flexor hallucis longus, m. flexor digitorum longus, short muscles of foot