-
Hindlimb components
- Bones:
- Sacrum, pelvis, femur, tibia & fibia, tarsal bones, metatarsal bones, phalanges
- joints:
- sacro-iliac, hip, stifle, tarsus/hock, metatarso-phalangeal, PIP, DIP
-
locomotion of hindlimb
- for propulsion (front limbs are weight bearing)
- sacro-iliac joint fused (transfer of forces from hindlimb to vertebral column)
- Hip-joint = pivotal point
-
Hindlimb terminology
- regions:
- gluteal (around hip), thigh (hip-stifle), crus (stifle-tarsus/hock), pes (tarsus-toes)
- directional:
- medial/lateral
- dorsal/palmer (past hock)
-
Evolution of hindlimb
- toes and stifle rotated cranially
- tibia & fibula don't rotate- remain parallel!
- flexor and extensor angles different to forelimb
-
pelvis (general)
- pelvic girdle/ossa coxae
- flat bones:
- margins = compact bone
- NO medullary cavity (centre = dipole) (spongy bone and marrow)
- wing of ilium- useful for bone marrow harvesting
- bilaterally summetrical
- 4 sections
-
4 sections of pelvis
- Ilium
- ischium
- pubis
- acetabular bone
-
Pelvis (ilium)
- cranial section of pelvis (boday and wing)
- wing: vertical orientation
- dorsal iliac spine
- ventral iliac spine
- gluteal surface (concave lateral surface)
- sacropelvic surface (medial surface)
- dog sacrum= 3 fused sacral vertebrae
-
Pelvis (sacro-iliac joint)
- sacrum (S1)- sacropelvic surface of ilium
- fibrous joint- fused
- supported by ligaments from lumbar and sacral vertebrae
- transmits forces from hindlimb during locomotion
-
Pelvis- pubis
- forms cranial aspect of pelvic floor
- iliopubic eminence (ilium meets pubis)
- pecten (concavity at cranial aspect)
- prepubic tendon (fills pecten) (associated w/ body wall)
-
Pelvis- ischium
- forms caudal aspect pelvic floor
- table: flat reigon
- tuber ischium/ischiatic tuberosity
- ischiatic arch (muscle attachment for reproductive organs
- sacrotuberous ligament (sacrum (S3)- tuber ischium)/remnant/band
- sugery: provides anchorage for sutures during muscle repair
- **ligament absent in cats!**
-
Pelvis (symphysis)
- meets midline (symmetrical)
- pelvic symphysis:
- located between pubis and ischium
- cartilage joint
- visible on radiographs
- immobile
- pubic tubercle
- (does not turn to bone until much later in life if ever)
-
Pelvis (obturator foramen)
- boundaries formed by pubis and ischium
- bridged by membrane and muscles
- blood vessels and nerves pass through
- (**obturator nerve!)
-
pelvis- acetabulum
- located at boundary of ilium, pubis and ischium
- cup shaped
- articulates w/ head of femur = hip joint
- acetabular fossa: non-articular area, rough bone, attachment of ligament of head of femur/round/teres ligament (all the same)
- lunate surface (articular surface, crescent shapes, hyaline cartilage)
- acetabular notch (ventral deficit, filled by transverse ligament)
-
Pelvis- centres of ossification
- main centres:
- illium/ischium/pubis/acetabular bone
- (acetabular bone fuses before born, fuse together to form 2 halves, pelvic symphysis fuses last)
- secondary centres:
- dorsal iliac crests
- tuber ischium
- ischiatic arch
-
Radiography- pelvis
- positioning:
- obturator foramen symmentrical= straight
- dog:
- wings of ilium and ischium diverge
- cat:
- wings of ilium and ischium are parallel (boxy)
-
Femur (general)
- long bone
- straight
- head
- body condyles
-
Proximal femur
- head: almost spherical, articulates w/ acetabulum (hip joint), smooth surface
- fovea: depression, rough bone, attachment ligament of head of femur (round/teres ligament)
- neck: forms angle between head and body
- greater trochanter: lateral palpable feature for locating joint
- lesser trochanter: medial
-
distal femur
- caudal aspect:
- medial condyle
- lateral condyle (covered w/ smooth bone and carilage, articulate w/ tibia= stifle joint)
- intercondylar fossa (rough bone, non articular, attachment of ligaments)
- popliteal fossa (origin of gastronemius muscle)
- cranial aspect:
- medial trochlear ridge
- lateral trochlear ridge
- trochlear groove (smooth surface, hyaline cartilage, articulates w/ patella)
- extrensor fossa (lateral aspect, tendon of origin of long digital extensor muscle)
-
Centres of ossification of Femur
- Head
- greater trochanter
- body
- distal epihysis
- (total number = 4)
-
Sesamoid bones of hindlimb/femur
- patella (x1):
- pyramid shaped
- sits in trochlear groove
- smooth articular surface
- hyaline cart.
- proximal and distal glide
- embedded in quadriceps muscle tendon of insertion
- continues as patellar ligament
- inserts onto tibial tuberosity
- Fabellae (x2):
- popliteal fossa
- embedded in gastronemius muscle
- one in each tendon of origin
- Popliteal sesamoid (x1):
- embedded in politeus muscle
MAX TOTAL= 4 (dog), cats will vary
-
Cat sesamoids in hindlimb
- patella always present
- medial fabella often not ossified so not visible on radiographs
- lateral fabellae and popliteus usually present but not always
- max total = 4
-
Clinical considerations of distal femoral fx
- Rush pins:
- curved
- cross over
- increased traction to prevent movement of distal epiphysis
- less damage to growth plate if still open
- (doesn't stop growth b/c pins slip as bone grows)
-
clinical considerations for midshaft femoral fx
- stabilisation:
- intramedullary (IM) pin: straight shaft
- reverse pinning technique: b/c head offset to neck
- method:
- make incision at fracture site
- pass pin proximally through proximal segment, through intertrochanteric fossa and out through incision in skin
- remove pin and pass back down through proximan segment, reduce fx and push into distal segment
- push to distal end of femur
-
Hindlimb nerve supply
- spinal nerves: L5, L6, L7, S1, S2
- dorsal branches (dorsal structures)
- ventral branches (lumbosacral plexus)
- emerging peripheral nerves to hindlimb muscles:
- gluteals, obturator, femoral, sciatic (tibial, fibular/peroneal)
-
Hip joint (general)
coxo-femoral joint
- head of femur
- acetabulum of pelvis (lunate surface)
- acetabulum: extended by labrum, completed ventrally by transverse ligament
- joint capsule attachments: around labrum, around neck of femur
- typical sunovial joint except NO COLLATERAL LIGAMENTS
- stability: ligament of head of femur, teres ligamnet/round ligament (fovea to acetabular fossa), surrounding muscle mass
-
Palpation of hip joint
- Pelvis:
- dorsal iliac crest/wing of ilium, tuber ischium
- femur:
- greater trochanter (allows location of hip joint)
- 3 structures for triangle
- should be bilaterally symmetrical
- help ID: hip dislocation, and pelvic fractures
-
radiography of hip joint
- dorsal border
- ventral border
- cranial acetabular edge/rim
- caudal acetabular edge/rim
- location of dorsal border relative to head of femur
-
clinical considerations (luxation/dislocation of hip)
- usually traumatic
- subluxation/loose hips: hip dysplasia in young dogs
- DJD: older animals
- Tx options: femoral head excision, hip replacement
-
Clinical consideration (Sx approach to the hip)
- trochanteric osteotomy
- remove greater trochanter (muscles remain attached)
- perform sx
- replace w/ pin
- minimal muscle damage
-
Clinical considerations (blood supply and hip)
- vessels from periosteum
- vessels from medulla
- joint capsule attached round neck
- vessels run from neck-head
- vulnerable to damage
- significance:
- femoral neck fracture
- femoral head physeal separation
- avascular necrosis
-
Hindlimb movement
- extrinsic muscles:
- Axial- appendicular skeleton
- move limb relative to trunk
- sacro-iliac joint immovable
- pivitol point = hip
- pelvis functions as part of axial skeleton
- hindlimb extrinsic muscles originate axial skeleton and pelvis
- Protraction: hip flexion, located cranial to hip
- Retraction
: hip extension, located caudal to hip- Abduction
: located dorsal to hip- adduction
: located ventral to hip
-
Extrinsic muscles (Abductors)
- located DORSAL to hip
- Gluteal muscles: superficial, middle, and deep
- Origin: sacrum and pelvis, gluteal surface
- Insertion: greater trochanter, acts as lever
supplied by gluteal nerve!
-
Extrinsic muscles (adductors)
- located ventral to hip joint
- origin: ventral surface pelvis
- insertion: medial aspect limb
- "GAPE" muscles=
- Gracilis: Insertion tibia and calcaneous(tarsus) (via common calcanean tendon)
- Adductor
- Pectineus
: insertion on femur - External obturator: (very small)
Supplied by Obturator nerve!
-
Extrinsic muscles (limb protractors/hip flexors- Iliopsoas muscle/Tensor fascia latae))
- Iliopsoas muscle
- Origin: lumbar vertebrae and ilium
- insertion: lesser trochanter (femur)
- supplied by femoral nerve!
- Tensor fascia latae
- 2 heads
- origin: ilium
- insertion: fascia latae
-
Extrinsic muscles (limb protractors/hip flexors- sartorius and Quads)
- Sartorius
- 2 heads
- origin: ilium
- insertion(s): femur and tibial tuberosity (via patellar ligament)
- (**only 1 head in cats)
- Quadriceps muscle- rectus femoris4 heads
- origin: ilium
- insertion: tibial tuberosity (via patellar ligament)
- supplied by femoral nerve!!
-
Extrinsic muscles (limb retractors/hip extensors)
- Biceps femoris
- origin: tuber ishium
- insertion: fascia latae and calcaneus (tarsus) (via common calcanean tendon)
- supplied by sciatic nerve!
- Semitendinosus
- Origin: ishium
- Insertion: tibia and calcaneus (tarsus) (via common calcanean tendon)
- Semimembranosus
- insertion: femur and tibia
- Supplied by sciatic nerve
-
Femoral triangle
- Boundaries: caudal- pectineus (& adductor), cranial- sartorius
- Femoral VAN
- Palpable pulses
-
Tibia and Fibula (general)
- Crus/crural region
- long bones: paired, Parallel
- Tibia: weight bearing
- Fibula: much reduced but present, lateral aspect
- Proximal and distal fibrous joints
- interosseous space= 1/2 length
- no rotation
-
Tibia (proximal end)
- triangle in short axis
- tibial plateau/plate:
- medial condyle
- lateral condyle
- smooth bone surface
- articulate w/ medial and lateral condyles of femur
- Intercondylar ridge: non-articular rough bone surface for ligament attachment
- tibial crest
- tibial tuberosity: insertion of patellar ligament
-
Tibia (distal end)
- oval in short axis
- choclea: concave articular surface, articulates w/ hock/tarsus
- medial malleolus: medial prologation(tibia), attachment of medial collateral ligament of hock
- lateral malleolus: lateral prolongation (fibula), attachment of lateral collateral ligament of hock
-
Palpation of tibia/fibula
- tibial crest
- medial malleolus (tibia)
- lateral malleolus (fibula)
-
centres of ossification of tibia and fibula
- tibia: proximal end, tibial tuberosity, body, distal end (total = 4)
- fibula: total = 3
-
clinical consideration fx repair of tibia/fibula
- intramedullary pin: straight bone
- bone plate and screws: medial aspect b/c no muscle so good exposure
- fibula- not important
-
Sifle joint components:
- Femur-tibia
- femur-patella
- A/femoro-tibial components:
- lateral & medial: femoral condyles, tibial condyles (don't articulate well w/ eachother)
- Non-articular: intercondylar fossa, intercondylar eminence
- meniscus
-
Stifle joint (meniscus/menisci)
- lateral and medial
- c-shaped cartilages
- wedge shaped
- thicker abaxial border
- attached to tibial condyles
- functions:
- stabilze joint
- cushioning
- proprioception (contain nerve endings, painful if damaged)
-
Stifle joint (meniscal ligaments)
- minisco-tibial ligament:
- mensicus- intercondylar eminence (tibia)
- hold menisci onto tibia
- Transverse ligament:
- between cranial aspects of menisci
- stabilise menisci
- Menisco-femoral ligament:
- lateral meniscus-intercondylar fossa (femur)
- hold femur onto menisci
- (movement occurs between femur and menisci
-
Stifle joint (joint support)
- hold bones together
- resist rotation
- limit movement to flexion and extension
- Collateral ligaments:
- medial condyle femur- tibia
- lateral condyle femur - fibul and tibia
- (tendon of origin of long digital extensor muscle)
- interal to joint capsule
- attach to abaxial aspects of menisci (NO GAPS!)
-
Stifle joint (cruciate ligaments)
- named for attachment to tibia
- cranial cruciate ligament: intercondylar eminence, medial aspect lateral condyle
- caudal cruciate ligament: intercondylar eminence, intercondylar fossa
- function: maintain femur on mensici, resist rotation
- Cranial cruciate rupture: joint instability, "cranial draw" sign (tibia moves cranial relative to femur)
-
Stifle joint (femoro-patellar components)
- patella
- trochlear groove (femur)
- patellar ligament: insertion of quadricepts (& sartorius) on tibial tuberosity
- stifle movement: patella pulled proximally (produces extension), patella pulled distally (allows flextion)
- patella held in trochlear groove
- proximal and distal glide
- no lateral movement
- support: medial and lateral trochlear ridges, lateral & medial femoro-patellar ligaments (patela-fabellae), fascia/retinaclulum
-
Clinical consideration: patellar luxation
patella no in the trochlear groove- usally medially
-
Stifle joint support
- femoro-tibial components
- Femoro-patellar components
-
Stifle joint (synovial joint)
- 3 compartments:
- femoro-patellar
- medial femoro-tibial (incorporate fabella)
- lateral femoro-tibia (incorporate fabella, incorporates tendon or origin long digital extensor)
- **in dogs- compartments communicate**
-
Radiography (stifle joint)
- retropatellar fat pad (joint effusion)
- cat: pointed patella, medial fabella often not mineralized, lateral fabella and politeal sesamoid usually visible
-
Palpation of stifle joint
- patella (proximal)
- patellar ligament
- tibial crest
- joint space
-
Stifle joint muscles (extensors)
- insert onto tibial tuberosity via patella then patellar ligament
- FEMORAL NERVE
- sartorius:
- 2 heads
- origin- ilium
- insertion- tibial tuberosity
- (also hip flexion)
- quadriceps muscle:
- rectus femoris: origin- ilium (also hip flexor)
- vastus lateralis: O- lateral femur
- vastus medialis: O- medial femur
- vastus intermedius: O- cranial femur
- All Insertion- tibial tuberosity (via patellar ligament)
- Supplied by FEMORAL NERVE
-
Stifle joint muscles (stifle flexors)
- caudal to stifle joint
- Biceps femoris:
- O-ishium
- I-fascia latae and calcaneus (via common calcanean tendon)
- Semitendiosus:
- O- ishium
- I-tibia and calcaneus (via common calcanean tendon)
- Supplied by the Sciatic nerve
- Semimembranosus:
O- ischium - I- femur and tibia
- supplied by SCIATIC NERVE
- Gastrocnemius
- O-femur (2 tendons of origin- fabellae)
- I-Calcaneus (via common calcanean tendon)
- supplied by the tibial nerve (branch of sciatic)
-
Tarsus (general)
- Composed of tarsal bones (short bones)
- proximal row: talus & calcaneus
- Middle row: Central & IV
- distal row: I, II, III, & IV
- IV TB bridges middle and distal rows
- (dog and pig have all bones present)
-
Tarsus (Calcaneus and Talus)
- Calcaneus:
- lateral and plantar location
- calcanean tuberosity/ tuber calcis (projects proximally)
- sustentaculum: projects medially, passage for DDFT
- Talus:
- Dorsal & medial location
- trochlea: articular surface, 2 ridges and central groove
-
Tarsus (tarso-crural joint)
- Tarsus- crus
- Talus- tibia and fibula
- calcaneus- not articular
- proximal intertarsal joint: Talus and calcaneus, central & IV
- Distal intertarsal joint: central I, II, III
- Tarso-metatarsal joint: distal row and metatarsal bones
- (intratarsal joints)
-
Tarsus movement
- Large range of flexion:
- most movement at tarso-crural joint
- little movement at other joints
- Trochlea not vertical:
- allows slight rotation at hock, limb protracted/hock flexed- hindlimbs lateral to forelimbs
-
Palpation of tarsus and centres of ossification
- Calcanean tuberosity
- medial malleolus
- lateral malleolus
- Centres of ossification: all single centre except calcaneus = 2
-
Tarsus (synovial joints)
- typical features of synovial joint
- capsule: extensive, extends (proximally between tibia and fibula, distally between metatarsal bones)
- poor communications between compartments
-
Tarsus (joint support)
- collateral ligaments: long- lateral (fibula- 5th MT), medial (tibia-2nd MT), medial and lateral malleolus. Short- bridge bone- bone
- Plantar ligaments: calcaneus-metatarsal bones, counteracts pull on calcanean tuberosity by common calcanean tendon
- Fibrocartilagenour reinforcement of joint capsule: friction free surface for passage of tendons, passive maintenance of joint
- Retinaculum:
-
Pes
- same as manus
- no stopper/carpal pad
- Dew claw: variable in dog, less common than for leg, absent in cats
-
Hock Flexor muscles
- Standing position = extension
- hock flexion: muscles run cranial/dorsal to limb
- peroneal/fibular nerve (branch of sciatic)
- Cranial tibial muscle:
- O- lateral tibea
- I-metatarsal bones
- Peroneus longus/long fibular muscle
- (group of 3)
- O- lateral tibia & fibula
- I- plantar aspect tarsus
- Peroneus brevis/short fibular muscle
- O-tibia & fibula
- I- 5th metatarsal bone
- (peroneus tertius/third fibular- not present in dog and cat)
-
Hock flexor AND digital extensor muscles
- Long digital extensor
- O- extensor fossa (femur)
- tendon of origin: incorporated into stifle joint capsule, provides lateral collateral support to stifle
- I- all digits (4 branches), distal phalanx-extensor process
- (lateral digital extensor muscle)
- O- lateral aspect tibia
- I- fuses w/ lateral branches of long digital extensor
-
Hock Extensor Muscles
- **common calcanean tendon (achilles tendon)
- inserts calcanean tuberosity of calcaneus: acts as LEVER for distal limb
- 3 components:
- Calcanean tendon: Biceps femoris, semitendinosis, gracilis
- Gastrocnemius
- superficial digital flexor
-
Hock Extensor AND digital flexor muscles
- Superficial digital flexor muscleO- Lateral ppliteal fossa femur (assoc. w/ gastrocnemius)
- I- Calcaneus (common calcanean tendon) AND branches to ALL digits (middle phalanx)
- supplied by the tibial nerve! (branch of sciatic)
-
Digital Flexor muscles
- Deep digital flexor muscle (2 heads)O- tibia
- Lateral (flexor hallicus longus): runs over sustentaculum of calcaneus, fibrocartilage reinforcement of joint capsule, held by retinaculum, protected by tendon sheath
- Medial (flexor digitorum longus): runs over medial aspect of tarsus
- merge then divide into 4 branches
- I- ALL digits (distal phalanx)
- supplied by the tibial nerve (branch of sciatic)
-
Hindlimb nerve supply (review)
- Spinal nerves: L5, L6, L7, S1, S2
- dorsal branches- dorsal structures
- ventral branches- lumbosacral plexus
- emerging peripheral nerves to hindlimb muscles: (4 major)
- Gluteals, obturator, femoral, sciatic (tibial, fibular/peroneal)
-
Gluteal nerve
- MOTOR ONLY!
- runs over dorsal surface body of ILIUM
- supplies gluteal muscles only (hindlimb abductors)
-
Obturator Nerve
- MOTOR ONLY!
- passes through obturator foramen
- short route to medial thigh
- Adductors:
- Gracilis
- adductor
- pectineus
- external obtruator (very very small)
-
Femoral Nerve
- MIXED- motor and sensory
- motor: cranial thigh muscles- hip flexors/limb protractors, stifle extensors (iliopsoas, sartorius, quadriceps (all heads))
- Patellar reflex: quadriceps, extension of stifle
- Damage: cannot extend stifle, cannot bear weight (no compensation), loss of patellar reflex
- SENSORY:
- saphenous branch (femoral triangle)
- medial aspect of limb
-
Sciatic (ischiatic) nerve
- MIXED- motor and sensory
- runs over dorsal surface body of ilium
- passes caudal to hip (don't mistake for sacrotuberous ligament)
- runs deep to biceps femoris
- MOTOR:
- caudal thigh muscles (hip extensors/limb retractors, stifle flexors (biceps femoris, semitendionosus, semimembranosus)
-
Tibial Nerve
- Branch of sciatic
- MOTOR: caudal crural muscles, hock extensors, digital flexors (gastrocnemius, superficial digital flexor, deep digital flexor)
- SENSORTY: caudal/plantar aspect limb
-
Fibular/peroneal nerve
- Branch of sciatic
- MOTOR: cranial crural muscles, hock flexors, digital extensors (cranial tibial, peroneus group, long digital extensor, lateral digital extensor)
- SENSORY: cranial/dorsal aspect limb, lateral thigh
-
Sciatic Nerve DAMAGE
- hip trauma/Sx
- femoral fx
- Lose supply to: hip extensors/stifle flexors
- hock extensorys/digital flexors
- hock flexors/digital extensors
- lose sensation to all but medial aspect
- CAN STILL:
- abduct (gluteals)
- adduct (obturator)
- protract/flex hip (femoral)
- extend stifle
-
Blood supply to hind limb
- (follow flexor surfaces)
- external iliac: leaves aorta and becomes:
- Femoral artery (gives off saphenous A- superficial supply to paw) becomes:
- Popliteal Artery: becomes:
- cranial tibial artery: provides deep supply to paw
- SUPERFICIAL: common digital arteries (dorsal and plantar)
- DEEP: metatarsal arteries (dorsal and plantar)
- FUSE: Proper digital arteries (dorsal and plantar)
- Deep supply most importat
- Femoral Triangle:
- pulse- femoral artery
- intravascular catheters- femoral vein
- femoral nerve- saphenous branch
-
Venous drainage in hindlimb
- Deep and superficial supply
- superficial: lateral saphenous vein access to systemic circulation
- Medial saphenous vein more prominent in cats
-
Lymphatic drainage
- popliteal (caudal to stifle)
- enlarged in response to infection
- can use to differentiate between localised/generalised Dz
- important meat inspection
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