S1M2

Your hip

• Ball and socket joint allows several axis of movement
• Knee and Ankle

• Plane joints permit gliding or sliding movements
• Example is your Superior Tibiofibular Joint

• It is the 2nd most moveable joint. It is a ball and socket joint.
• While standing the wt. of the upper body is transmitted through the hip bones to the heads and necks of the femurs.

• One of three ligaments of the hip joint!
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• 2 of the 3 ligaments of your hip (the other is the Ischiofemoral
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It increases the depth of your acetabulum

• Lateral circumflex femoral
• Medial circumflex femoral artery
• Acetabular branch-->the artery going to the head of the femur, in the ligament)
• Retinacular arteries (which are in the synovial folds !!! STARRED--know the retinacular arteries
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Basically says the nerves supply the muscules extending directly across and action at a given joint also innervate that joint (provide sensory innervation)

• The anterior aspect of the hip joint
• Because femoral nerve innervates the Rectus Femoris and the Pectineus muscles, so it supplies sensory info over the hip joint

To the inferior aspect of the hip joint because it innervates Obturator Externus (hilton's law)

• Posterior Aspect: Nerve to the Quadratus Femoris (motor innerv by quadratus femoris)
• Superior Aspect: Superior Gluteal Nerve (motor innerv of the abductors of the thigh like glut med and min)

• Generally occurs in women 60 years and older
• Shortened and laterally rotated limb (due to lateral rotators of the leg and the hamstrings, rectus femoris and adductors that shorten that pull superiorly)
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Medial Circumflex femoral artery!

• Due to severe impact trama when the thigh is flexed, adducted and medially rotated. (sitting in a car)
• The joint capsule tears posteriorly and inferiorly
• The femoral head moves posterior to the acetabulum (fx to the acetabulum and labrum)
• Pt presents with shortening and medial rotation of the limb

• Fx of the acetabulum
• Tear of the acetabulum labrum (gives the acetabulum depth)
• Injury to the SCIATIC NERVE! (paralysis of hamstrings, think all those muscles are innevated by Sciatic n. branches)
• Sensory deficit on the posterior lateral leg and foot as well

When you are skiing and your tips of your skis get stuck in the snow! You can tear the acetabulum anterior instead of posteriorly!

• A total hip replacement is shown on the right, a resurfacing on the left hip
• A hip replacement is the standard for arthritis, has a limited shelf life (about 20 years), doesn't spare the bone when being inserted, and pts are typically older and aren't going to be running around (they will die before it needs replaced again)

A hip resurfacing is perfect for younger patients because it preserves the bone, and also the head of the femur is larger after a resurfacing which prevents subsequent disslocation. Eventually resurfacing results in a hip replacement.

Flexion and Extension!

• (2) femorotibial (one medial and one lateral)
• (1) femoropatellar

EASY!

Quadraceps femoris (mostly) and vastus medialis/lateralis

• Describes as the "quadriceps-pull" angle
• The angle between the ASIS to the patella and from the midpoint of the tibia through the patella
• Normal Q-angle centers the mid-knee under the head of the femur-->aids in wt. bearing

• Genu valgum ("knock-knee")- increase in Q angle:
• the lateral angle of the tibia is abnormally diagonal
• The weight bearing line falls laterally placing excessive stress on the lateral knee.
• This can cause stress on the TCL (tibial collateral ligament)
• Lateral Articular Cartilage and Lateral miniscus affected
• Abnormal femoropatellar joint due to excessive lateral pull

• Genu varum (bow leg) smaller q-angle: abnormal medial angle of tibia
• Weight bearing falls medially, placing excess stress on medial artic. cartilage, medial meniscus, the FCL

• LATERALLY- due to quadraceps femoris pull
• Vastus medialis and the higher lateral lip of the femur helps to prevent this lateral dislocation

• Pain deep to the patella medial to the knee, especially after downhill running.
• Due to repetitive microtrauma due to abnormal alignment of the patella on the femur

Strengthing of the Vastus Medialis

• Fibular colateral ligament (FCL/LCL)--in picture
• Popliteus
• Patellar Ligaments--in picture
• Tibial colateral ligaments (TCL/MCL)

• The Oblique popliteal ligament (expansion of semimembranous, and it stengthens the posterior joint capsule)
• The Arcuate Popliteal ligament

• HYPEREXTENSION at the KNEE!
• (think of the gymnastics video)
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HYPERFLEXION at the Knee.

• If the ACL is injured, the tibia will slide anteriorly under a fixed femur
• A postive drawer sign (90 degree flexed)
• A positive Lachman's test
• + result if there is more than a 5 mm movement

• Falling onto the tibial tuberosity with a flexed knee
• Shows a posterior drawer sign--> tibia slids posteriorly under a fixed femur

Always compare this with an unaffected limb!

• The medial meniscus (Cshaped, less mobile, attached to TCL/MCL) and the
• lateral meniscus (smaller and circular, more mobile than medial meniscus)
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Ligament sprains!

• Tear to the ACL, TCL (tibial collateral ligament) & medial meniscus
• Caused by a foot being fixed combined with a twisting motion
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• Prepatellar bursitis (inflammation of the SQ prepatellar ligament)
• Caused by repetative weight bearing on the patella (cleaning the floor)

• Infrapatella bursitis (inflammation of SQ infrapatellar bursa)
• Think of kneeling in the Catholic church, its inferior to the patella!!

Because if there is a cut and bacteria gets into this bursa it can spread into the knee, it will eventually end up in the popliteal lymph nodes!

Superior Tibiofibular Joint (synovial, fibrous joint which allows slight movement) Where is it? between fibular head and lateral condyle. Innervated by Common fibular, Tibial nerves. Blood supply: inferior lateral genicular and anterior tibial recurrent artery

• Inferior Tibiofibular: between interosseous membrane, very limited movement, innervated by deep fibular, tibial, and saphenous nerves. Blood supply from fibular and ant/post tibial arteries.
• THIS JT is SO IMPT for ankle JOINT STABILITY!!!! DON'T FORGET!