Exam 2 Ligaments, Tendons, and structures

Tibiofibular Joint Proximal

• Synovial, gliding 

• Ligamentous support: Anterior proximal tibiofibular ligament and Posterior proximal tibiofibular ligament

Tibiofibular Joint Distal

• Gliding joint, synovial 

• Ligamentous support: Anterior distal tibiofibular ligament, Posterior distal tibiofibular ligament, and Interosseous (tibiofibular) ligament

Middle Tibiofibular Joint

• Fibrous Joint

• Crural Interosseous Membrane

• Attachments: Connects the interossous borders of the tibia and fibula

• Functions: Separates the anterior compartment from the posterior compartment, serves as sites for muscular attachments

Ankle Joint

Talocrural

Bones: Tibia, Fibula, Talus (trochlear surface)

Synovial - Hinge 

Ankle Joint Movement

Sagittal Plane: dorsiflexion and plantarflexion

Dorsiflexion

Anterior angle decreasing or less than 90 degrees (toes pointed up)

Plantarflexion

Anterior angle increasing or greater than 90 degrees (toes pointed down)

Intertarsal Joints 

Synovial - gliding

Composed of 7 Tarsal Bones: talus (trochlea), calcneus, navicular, cuboid, medial (#1) cuneiform, intermediate (#2) cuneiform, lateral (#3) cuneiform

Intertarsal Movement

Frontal Plane (mostly)

Inversion = supination, adduction, varus 

Eversion = pronation, abduction, valgus 

Intertarsal Joints - Rearfoot motion 

Most movement occurs at the subtalar joint (talocalcaneo ligament) and talonavicular joint 

Lateral Ankle and Intertarsal ligaments

Anterior talofibular, Calcaneofibular, and Posterior talofibular 

Prevents: Excessive Inversion (or lateral ankle sprain)

Medial Ankle Ligaments

Deltoid Ligaments, Anterior talotibial, Tibionavicular, Calcaneotibial, Posterior talotibia

Prevents excessive eversion 

Tarsometatrsal Joints 

Cuneiforms, cuboid and bases of metatarsals

Synovial - gliding 

Metatarsophalangea Joints (MP)

Heads of metatarsals and base of proximal phalanages

Synovial condyloid 

Movements: sagittal and transverse (3rd toe is midline)

Interphalangeal Joints (IP) (9)

Synovial - condyloid, but function as hinge joint due to tight lateral ligaments

PIP = Proximal IP joints

DIP = Distal IP joints

Movements: Sagittal

Sagittal Movement

Flexion, extension, hyperextension

Transverse Movement 

Abduction and Adduction

Medial Longitudinal Arch 

Bones: calcaneus, talus, navicular, cuneiforms, 1st three metatarsals

Flexible 

Important in shock absorption upon contact with ground 

Transverse arch in mid-foot 

Bones: Cuboid, cuneiforms, metatarsals (base)

Transverse arch in forefoot

Bones: Metatarsals (head)

Ligaments that support arches

Plantar aponeurosis, Long plantar, Spring

Classification of Hip Joint

Synovial, Ball and socket, multiaxial, complex, stable

Extensor Retinaculum Superior 

Characteristics: Proximal to the talocrural joint

Attachments: Laterally to the distal anterior border of the fibula, Medially to the distal anterior border of the tibia

Extensor Retinaculum Inferior

Characteristics: Anterior to the talocrural joint, Y shaped  

Attachments: Stem (lateral part): attaches to the upper surface of the calcaneus, Proximal Band: reaches the medial malleolus, Distal Band: extends infermedially to the plantar aponeurosis 

Holds: TA, EHL, EDL, PT

Flexor Retinaculum

Characteristics: Medial to the talocrural joint 

Attachments: Anteriorly to the tip of the medial malleolus, Continues posteriorly to the medial calcaneal process and plantar aponeurosis 

Holds: TP, FDL, & FHL

Notes: Tendinous synovial sheaths and bursae

Peroneal Retinaculum Superior

Characteristics: Lateral to the talocrural joint 

Attachments: Back of the lateral malleolus, To the lateral calcaneal surface 

Holds PL, PB

Peroneal Retinaculum Inferior

Characteristics: Lateral to the talocural joint

Attachments: Continues anteriorly with the inferior extensor retinaculum, To lateral calcaneal surface

Hip Joint Movement

Sagittal: flexion, exension, hyperextension

Frontal pane: abduction, adduction

Transverse: external rotation, internal rotation, horizontal abduction, horizontal adduction

Circumduction: all three planes

Angle of inclination

Normal = 125 degrees, Coxa valga = >125 degrees, Coxa varum = <125 degrees

Coxa Valga

Coxa valga, genu varum, structurally long leg

Coxa Vara

Coxa vara, genu valga, pes planus (eversion), structurally short leg 

Iliofemoral Ligament

Proximal Attachment: Below AIIS, Ilial rim of acetabulum 

Distal Attachment: Intertrochanteric Line

Extrinsic

Function: Checks Hip hyperEXT, Check hip ABD

Pubofemoral Ligament

PA: Pubic rim of acetabulum 

DA: Blends with iliofemoral Ligament at intertrochanteric line 

Capsular

Function: Checks Hip hyperEXT and ABD

Ischiofemoral Ligament

PA: Ischial rim of acetabulum

DA: Intertrochanteric crest and medial surface of GT

Capsular 

Posteriorly located 

Function: Oblique Fibers check hip hyperEXT and Int. Rot.

Transverse Acetabular Ligament

Extrinsic 

Attaches adjacent inferior end of the acetabular notch 

Function: Completes round articular surface, Protects neurovascular supply of the head of the femur

Ligamentum Teres

Intrinsic 

PA: Around the margins of acetabular notch 

DA: Fovea capitis of femur

Pelvic Girdle Joints

Sarcoiliac: Synovial gliding, Tight ligaments

Pubic Symphysis: Cartilaginous, Fibrocartilage

Pelvic Girdle Movement

Sagittal Plane: Anterior tilt: forward, Posterior tilt: backward (like doing a crunch) (ASIS movement)

Frontal Plane: Lateral tilt right, Lateral tilt left (lowest side)

Transverse Plane: Rotation right, Rotation left

Closed kinetic chain(CKC) vs. open kinetic chain (OKC)

Closed: proximal end moves

Open: distal end moved

Same movement but did the pelvis or femur move? Hip flexion and anterior tilt look the same, Hip flexors anteriorly tilt the pelvis

Lateral tilt muscles (hip abductors) when standing on LEFT leg with lateral tilt LEFT

Gluteus medius 

Gluteus minimis 

Tensor Fascia Latae

Lateral tilt muscles (hip adductors) when standing on LEFT leg with lateral tilt RIGHT 

Adductor longus 

Adductor brevis 

Adductor magnus 

Pectineus 

Gracilis

Hip lateral rotators when standing on LEFT leg with rotation RIGHT

Gluetus Maximus 

Six lateral rotators: Piriformis, Gemelli (2), Obtorators (2), Quadratus femoris

Adductor muscle

Hip medial rotators when standing on LEFT leg with Rotation LEFT

Gluetus medius 

Gluteus minimis 

TFL