Rhodes Study Material Part 3

Hip and Pelvis, Knee, Ankle and Foot

hip joint

most proximal of the lower extremity joints, important in weight bearing and walking, stable joint

triaxial,enarthrodial joint, convex femoral head and concave acetabulum

the hip joint is a

joint capsule

ligamentous sleeve, attaches from lip of acetabulum to the neck of the femur

acetabular labrum 

fibrocartilage located around the rim of the acetabulum, assists in holding the head into the acetabulum 

illiofemoral

resembles an inverted y, restricts hyperextension, supports 3 ½ times body’s weight, use this ligament with paraplegics 

pubofemoral

limits hyperextension, abduction, and lateral rotation

ishiofemoral

limits hyperextension and medial rotation

transverse acetabular ligement

ligament that covers the acetabular notch

round ligament (ligamentum teres)

runs from fovea capitis to acetabulum

inguinal ligament 

no function at the hip, attaches from ASIS to the pubic tubercle 

pes anserine

combination of the sartorius, gracilis, semitendinosous

inguinal ligament

superior border of femoral triangle

adductor longus

medial border of femoral triangle

sartorius

lateral border of femoral triangle

femoral vein, artery, nerve

femoral triangle contents

illipsoas

iliacus and psoas major

iliacus

origin: iliac crest

insertion: lesser tubercle

action: hip flexion

nerve: femoral

psoas major

origin: transverse processes of T12-L5

insertion: lesser tubercle

action: hip flexion

nerve: femoral 

rectus femoris

origin: AIIS

insertion: tibial tuberosity 

action: hip flexion, knee extension 

nerve: femoral 

pectineus

action: hip flexion

nerve: femoral

adductor longus

origin: anterior pubis

insertion: pectineal line of the femur 

action: hip adduction 

nerve: obturator 

adductor brevis

action: hip adduction

nerve: obturator 

adductor magnus

origin: inferior ramus of the pubis

insertion: linea aspera and adductor tubercle 

action: hip adduction 

nerve: obturator  

gracilis 

action: hip adduction 

nerve: obturator 

gluteus maximus 

origin: posterior sacrum,coccyx, ilium 

insertion: distal to greater trochanter/ IT band 

action: hip extension and lateral rotation 

nerve: inferior gluteal 

gluteus med/min

origin: lateral ilium

insertion: greater trochanter

action: hip abduction and medial rotation 

nerve: superior gluteal 

tensor fascia latae (TFL)

action: hip flexion and hip abduction

nerve: superior gluteal 

sartorius

insertion: pes anserine

action: hip flexion, hip lateral rotation hip abduction 

nerve: femoral

piriformis, gemelus superior, obturator externus, gemelus inferior, obturator internus, quadratus femoris

deep rotators include

deep rotators

action: hip external rotation

sciatic nerve

the piriformis can compress the

hip dysplasia

hip joint doesn’t form correctly, ball and socket is unstable

congenital hip dislocation

birth defect where hip doesn’t develop properly, ball of thigh is unstable or completely out of socket

legg calve perthes disease

congenetal or developmental condition where blood supply to femoral head, disrupted in children

osteoarthritis 

degeneration or articular cartilage, age releated 

hip fractures

break in upper part of thigh bone

IT Band syndrome

IT band gets irrated or swollen, pain to outside of knee

trochanteric bursitis

inflammation of bursa, pain on outside of hip

hip pointer

brusing to iliac crest due to direct trauma

joints of the pelvis 

sacroiliac, lumbosacral, pubic symphysis

sacroiliac

where sacrum meets ilium, nutation (sacral flexion), counternutation (sacral extension)

lumbosacral

where L5 and S1 meet, flexion/extension, lateral bending, rotation

pubic symphysis

fibrous, amphiarthrodial (very little movement)

pelvis as a while will do 

anterior pelvic tilit, posterior pelvic tilt 

innominate bone

ischium, pubis, and ilium fused together

patellofemoral joint 

plane joint (glide) 

patellar surface of the femur is concave, patella is convex

tibiofemoral joint

modified ginglymus (hinge)

flexion/extension (and rotation) 

proximal = condyles of the femur convex

distal = condyles of tibia are concave 

patella

helps increase the leverage and power of the quadriceps muscles for knee extension, allowing us to straighten our legs with greater force and efficiency 

serves as bony shield to protect the delicate knee joint 

biomechanical rotation 

not measured, ability of tibial to rotate laterally in non-weight bearing, ability of femur to rotate medially on the tibia in weight bearing 

menisci

wedge shaped fibrocartilage, within joint capsule, designed to absorb shock, distributes stresses evenly within the joint, helps increase stability of the joint

anterior cruciate ligament (ACL)

prevents hyperextension of the knee

posterior cruciate ligement (PCL)

prevents hyperflexion of the knee

intracapsular ligaments

ACL and PCL

extracapsular ligaments 

LCL and MCL, oblique popliteal ligament, arcuate popliteal ligament, patellar ligament, coronary ligament 

lateral collateral ligament (LCL)

lateral epicondyle of femur to head of fibula, no attachment to meniscus, restricts excessive adduction of the tibia on the femur 

medial collateral ligament (MCL)

medial femoral epicondyle to medial tibial condyle, directly attaches to medial meniscus, restricts excessive abduction of tibia on femur

oblique popliteal ligament and arcuate popliteal ligament

prevent hyperextension, posterior side of the knee

patellar ligament

reinforces the patella

coronary ligament

attach menisci to the tibia

terrible tirad (unholy triad)

tear of the ACL, MCL, and medial meniscus, lateral direct force to the knee

popliteal space

lateral superior border: biceps femoris

lateral inferior border: lateral head of gastrocnemius 

medial superior border: semimembranosus & semitendinosus 

medial inferior border: medial head of gastrocnemius 

superior tibiofibular joint

articulation between head of fibula and lateral proximal tibia, plane joint (glides only), dissipates torsional stresses applied to ankle, encompassed by ligaments - superior anterior and posterior tibiofibular 

quadriceps

prime movers of knee extension

hamstrings

prime movers of knee flexion

rectus femoris

origin: ASIS

insertion: tibial tuberosity 

action: knee extension, hip flexion 

nerve: femoral 

vastus lateralis

origin: posterior/lateral femur

insertion: tibial tuberosity 

action: knee extension

nerve: femoral 

vastus medialis

origin: posterior/ medial femur

insertion: tibial tuberosity 

action: knee extension 

nerve: femoral 

vastus intermedialis

origin: anterior femur (deepest)

insertion: tibial tuberosity 

action: knee extension

nerve: femoral 

muscles of the quads

rectus femoris, vastus lateralis, vastus medialis, vastus intermedialis

muscles of the hamstrings

semitendinosis, semimembranosis, biceps femoris

semitendinosis

origin: ischial tuberosity

insertion: pes anserine

action: knee flexion and hip extension 

nerve: tibial 

semimembranosis

origin: ischial tuberosity

insertion: medial tibial condyle 

action: knee flexion and hip extension 

nerve: tibial 

biceps femoris (short and long head)

origin: short head - linea aspera, long head - ischial tuberosity

insertion: head of fibula 

action: knee flexion and hip extension 

nerve: short head - common fibular, long head - tibial

joints of the ankle and foot

talotibial, talocalcaneal, mid tarsal, tarsometatarsals, MTP, DIP and PIP

talotibial (talocrural, true ankle joint) 

ginglymus/ hinge - plantarflexion, dorsifelxion 

articulations: distal tibia and fibula - concave, talus - conves 

Mortis and tenon joint 

subtalar joint (talocalcaneal)

plane joint - inversion and eversion

articulations: distal talus and superior calcaneus 

transverse tarsal joint

plane (gliding) - pronation and supination

articulating surfaces: talus and navicular and calcaneus and cuboid 

need this joint to be able to walk on uneven surfaces 

intertarsals and tarsometatarsal joint

plane joint, glide only

help to walk on uneven surfaces 

metatarsophalangeal joints (MTP)

condyloid - flexion/extension, abduction/adduction

articulating surfaces - metatarsal, proximal phalanx 

interphalangeal joints of digits 2-5

PIP - between proximal and middle phalanx, ginglymus/hinge joint, flex/ext

DIP- between middle and distal phalanx, ginglymus/hinge joint, flex/ext 

interphalangeal joint of the great toe (IP)

between proximal and distal phalanx of great toe

ginglymus joint - flex/ext 

lateral ligaments of foot/ankle

anterior talofibular, posterior talofibular, calcaneofibular

anterior talofibular (ATFL)

most commonly sprained

medial ligaments of foot and ankle

tibionavicular, tibiocalcaneal, anterior tibiotalar, posterior tibiotalar

ligaments of the foot

long plantar, short plantar, spring ligament

helps maintain arches

arches of the foot

medial longitudinal, lateral longitudinal, transverse longitudinal

supports by ligaments and fascia 

lateral longitudinal 

flattens with weight bearing

transverse ligament

flattens with weight bearing

pes planus

flat foot

pes cavus

high arch

hallucis 

great toe 

brevis

short

plantar fascia (aponeurosis)

thick band of connective tissue, supports arches, increases stability of the foot and arches during weight bearing

plantarfascitis

inflammation of the plantar fascia, espically at its attachment to the calcaneous

supination is a combination of 

inversion, adduction, plantarflexion 

pronation is a combination of

eversion, abduction, dorsiflexion

anterior tibialis

origin: prox/lat tibia

insertion: first cuneiform / metatarsal 

action: dorsiflexion, inversion

nerve: deep fibular 

extensor hallucis longus

origin: deep to anterior tib

insertion: distal phalanx of great toe

action: extends great toe, dorsiflexion, inversion 

nerve: deep fibular 

extensor digitorum longus

origin: deep and lateral to anterior tib

insertion: distal phalanx of 4 lesser toes 

action: extends digits 2-5 dorsiflexion 

nerve: deep fibular 

anterior compartment

anterior tibialis, extensor hallucis longus, extensor digitorum