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Upper and Lower Limbs

Dr. Estrada || August 9, 2016


Lecture Outline:
I. Upper Limb
A. Pectoral Girdle
B. Humerus
C. Radius and Ulna
D. Carpals
E. Metacarpals
F. Phalanges
G. Joints
H. Radiographs
II. Lower Limb
A. Innominate bone
B. Femur
C. Patella
D. Tibia and Fibula
E. Tarsals
F. Metatarsals
G. Phalanges
H. Joints
I. Plantar Arches
J. Radiographs
K. Abnormalities

UPPER LIMB
Multijointed lever that is freely movable on the trunk at
the soulder joint.
Divided into the bones of the shoulder, arm, elbow,
forearm, wrist and hand

PECTORAL GIRDLE

Composed of the clavicle and the scapula


a. Clavicle
- long, slender bone that lies horizontally
across the root of the neck
- acts as strut that holds arm away from trunk
- Transmits forces from upper limb to the axial
skeleton
- Provides attachment for muscles
- Articulations:
1. Medially: with sternum and first costal
cartilage
2. Laterally: Acromion process of the
scapula
Medial two thirds convex forward
Lateral third: concave forward
PARTS:
1. Conoid tubercle bony prominence on
the inferior surface of the lateral third of
the clavicle; marks insertion of the
conoid ligament
2. Sternal facet articulating part with the
manubrium of the sternum and first
costal cartilage
3. Subclavian groove site of attachment
of the subclavius muscle
4. Shaft/body of the clavicle double
curve in a horizontal plane
5. Deltoid tubercle lateral 1/3 of clavicle;
origin of deltoid bundle

Trans # 3 [Ace, Lace, James, Jovi, Chelsy]

6.
7.
8.

b.

Trapezoid line where trapezoid


ligament attaches; the lateral part of the
coracoclavicular ligament
Acromial facet articulates with the
acromion
Impression of costoclavicular
ligament inferiorly, at the median
aspect, slightly posterior

Scapula
- flat triangular bone that lies on the
posterior chest wall between the 2nd and
7th ribs
- together with clavicle and head of the
humerus forms the shoulder girdle
PARTS
1. Coracoid process projects upward
and forward above glenoid cavity; site of
attachment
2. S u p e r o l a t e r a l a n g l e f o r m s
pearshaped glenoid cavity; articulates
with head of humerus
3. Inferior angle can be palpated easily;
at level of 7th rib, spine of 7th thoracic
vertebra
4. Suprascapular notch medial to the
base of the coracoid process
5. Subscapular fossa anterior surface;
concave and shallow; anterior landmark
6. Spine of scapula posterior landmark
7. Supraspinous/suprascapular fossa
origin of supraspinatus muscle
8. Acromion process forms the
subcutaneous point of the shoulder and
articulates with the acromial end of the
clavicle
9. Glenoid fossa articulates with head of
humerus
10. Medial border of scapula
11. Lateral border of scapula
12. Neck of scapula
13. Superior border of scapula
14. Superior angle

HUMERUS

bone of the arm

articulates with scapula at shoulder joint

articulates with radius and ulna at elbow joint

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Upper and Lower Limbs

PARTS:
a) Head of radius (flat surface)
small, circular; concave upper part
articulates with capitulum and radial notch
of ulna
b) Neck underneath head
c) Radial/Bicipital tuberosity distal to neck;
insertion of biceps; anterior
d) Interosseus border medial; lies along
interosseus space which is covered by
interosseus membrane; bind radius and ulna
together
e) Ulnar notch medial surface; articulates
with round head of ulna
f) Styloid process distal end of radius;
projects distally from its lateral margin
B. Ulna
- medial bone of forearm
- Articulations:
4. Proximal end: with humerus at the elbow
joint and with head of radius at radioulnar
joint
5. Distal end: radius at the distal radioulnar joint
- Excluded from wrist joint by articular disc

Figure 1. Humerus (w/ zoomed distal end)


PARTS:
a) Head of humerus proximal part; articulates
with glenoid cavity of the scapula
b) Anatomic neck immediately below head and
separates it from greater and lesser tubercles
c) Greater and lesser tuberosities below
antomic neck; separated from each other by
bicipital groove
d) Surgical neck where upper end of humerus
joins shaft
e) Deltoid tuberosity roughened elevation at
the lateral aspect halfway down the shaft
f) Spiral groove behind and below deltoid
tuberosity; accommodates radial nerve
g) Medial and lateral epicondyles at lower end
of humerus; attachment of muscles and
ligaments
h) Capitulum rounded; for articulation with
head of radius
i) Trochlea pulley-shaped for articulation with
trochlear notch of ulna
j) Radial fossa above the capitulum; receives
head of radius
k) Coronoid fossa above trochlea anteriorly;
receives coronoid process of ulna
l) Olecranon fossa above trochlea posteriorly;
receives olecranon process of ulna
m) Lateral supracondylar ridge
n) Medial supracondylar ridge
RADIUS AND ULNA

Bones of the forearm


A. Radius
- lateral bone of the forearm
- shorter than ulna
- Articulations:
1. Proximal end with humerus at elbow joint
2. Ulna at proximal radioulnar joint
3. Distal end with scaphoid and lunate

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PARTS:
1) Olecranon process large, proximal end;
forms prominence of elbow
2) Trochlear notch
notch of olecranon process at the anterior
surface
articulates with trochlea of humerus
3) Coronoid process triangular; below
trochlear notch
4) Radial notch on lateral surface of coronoid
process; articulation for radius
5) Interosseus border
6) Head distal, rounded
7) Styloid process projectin on its medial
aspect

Figure 2. Radius and Ulna Anterior (Left) and Posterior


(Right) Views

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Upper and Lower Limbs

CARPALS

Bones of the wrist

2 rows: proximal and distal rows

4 bones each row


Proximal Row

Distal row

Scaphoid

Trapezium

Lunate

Trapezoid

Triquetral

Capitate

Pisiform

Hamate

Flexor retinaculum tissue that covers the


anterior surface, forming a roof
Carpal tunnel formed by carpal bones at the
floor; where median nerve passes

Figure 4. Metacarpals and Phalanges


JOINTS
1. Sternoclavicular Joint

Morphological Classification: Synovial joint

Functional Classification: Saddle joint

Articulation: Sternal end of clavicle and the


manubrium sterni and the first costal cartilage

Ligaments: Costoclavicular ligament is a strong


ligament that runs from the junction of the first rib with
the first costal cartilage covering the articular surfaces

Movements: Forward (anterior) and backward


(posterior) movement of the clavicle (medial
compartment) and Elevation and depression of the
clavicle in the lateral compartment

Figure 3. Carpal bones


METACARPALS
10 bones all in all
Numbered from 1-5 from thumb to little finger (lateral to
medial)
First metacarpal bone of the thumb is the shortest and
most mobile.
Attached to the carpal bones
PARTS:
a. Base: articulates with the distal row of the carpal
bones
b. Shaft: slightly concave forward and is triangular in
transverse section. Its surfaces are posterior, lateral,
and medial.
c. Head: form the knuckles; articulate with the proximal
phalanges
PHALANGES

28 bones

Each finger has three phalanges, except for the


thumb (1st) which has only two.

Parts of the 2nd-5th phalanges: Proximal, Middle, and


Distal

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!
Figure 5. Sternoclavicular Joint
2.

Acromioclavicular Joint

Morphological Classification: Synovial joint

Functional Classification: Plane joint

Articulation: Lateral End of Clavicle ad Acromion of


Scapula

Ligaments: Superior and inferior acromioclavicular


ligament, Coracoclavicular ligament (accessory)

Movements: Gliding movement (when the scapula


rotates or when the clavicle is elevated or depressed)

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Upper and Lower Limbs

Figure 6. Acromioclavicular Joint


3.

Shoulder Joint/ Glenohumeral Joint

Morphological Classification: Synovial joint

Functional Classification: Ball and Socket joint

Articulation: Rounded head of the humerus and the


glenoid fossa

Ligaments: Glenohumeral ligaments


a. Transverse humeral ligament - strengthens the
capsule and bridges the gap between the 2
tuberosities)
b. Coracohumeral ligament - strengthens the
capsule above and stretches from the root of the
coracoid process to the greater tuberosity of the
humerus)
c. Coracoacromial ligament (accessory) - extends
between the coracoid process and the acromion.
Its function is to protect the superior aspect of the
joint
a. Movements: Flexion, Extension, Abduction, and
Adduction, Lateral rotation, Medial rotation &
circumduction

o
Lateral ligament - triangular and attached by
its apex to the lateral epicondyle of the humerus and
by its base to upper margin of the annular ligament
o
Medial ligament- triangular and consists
primarily of 3 strong bands:
o
Anterior band - passes from the medial
epicondyle of the humerus to the medial margin of the
coronoid process
o
Posterior band - passes from the medial
epicondyle of the humerus to the medial side of the
olecranon
o
Transverse band - passes between the ulnar
attachments of the 2 preceding bands
Movements: Flexion and Extension (one axis)

5. Wrist Joint

Morphological Classification: Synovial joint

Functional Classification: Ellipsoid joint

Articulation: Distal end of the radius and the articular


disc above Scaphoid, Lunate and Triquetral bones
Ligaments:
o
Anterior and posterior ligaments (strengthen
the capsule)
o
Medial ligaments (attached to the styloid
process of the ulna and the triquetral bone) lateral
ligaments (attached to the styloid process of the
radius and to the scaphoid bone)
Flexion, extension,
Movements:
abduction, adduction, circumduction
6. Intercarpal Joint

Morphological Classification: Synovial joint

Functional Classification: Plane joint

Articulation: Carpal Bones

Movements: Gliding and Sliding

Figure 9. Intercarpal Joint


!

Figure 7. Glenohumeral Joint


4. Elbow Joint

Morphological Classification: Synovial joint

Functional Classification: Hinge joint

Articulation: Humerus (trochlea &capitulum) with Ulna

(trochlear notch) and Radius (head) Ligaments:

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RADIOGRAPHS
a. Shoulder region - Anteroposterior view

The view shows the outer two thirds of the clavicle,


separated from the acromion of the scapula by a gap that
represents the acromioclavicular joint.

The acromion is seen above the head of the humerus


and is continuous with spine of the scapula.

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Upper and Lower Limbs

The coracoid process of the scapula is seen


projecting upward and forward.

The glenoid fossa is not seen in complete profile and


is overlapped to a variable extent by the head of the
humerus.

The greater part of the scapula is projected behind the


upper part of the thoracic cage.

The proximal third of the humerus is well visualized


Greater tuberosity projects laterally.

Lesser tuberosity seen face on

Bicipital groove cannot be seen

Surgical neck well seen

Medial and lateral supracondylar ridges superimposed


Medial and lateral epicondyles of the humerus
superimposed; may be recognized by tracing the long
axis of the radius superiorly
The olecranon and coronoid process of the ulna
may be seen
The greater part of the head may be visualized

!
d.

b.

Elbow region - Anteroposterior view

Lateral and occipital epicondyles of the humerus


clearly seen

Olecranon and coronoid fossa of the humerus


produce an area of transradiancy

A parallel translucent gap extends across the joint


between the rounded capitulum and the upper surface of
the radius and between the trochlea and coronoid process.

The head, neck and bicipital tuberosity of the radius


clearly seen

The olecranon and coronoid processes of the ulna are


seen

Proximal radioulnar joint can be visualized

!
e.
!
c.

Elbow Region - Lateral view

Elbow joint flexed to 90 degrees

Shoulder joint adbucted to a right angle

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Wrist and hand - Posteroanterior view

The distal ends of the radius and ulna, with their


styloid process

seen to extend farther distally than that of


ulna

The proximal row of carpal bones is seen with the


pisiform bone superimposed on the triquetral bone.

The distal row of carpal bones is also seen

Hook of the hamate small oval area of increased


density

Carpus cartilaginous at birth

Capitate begins to ossify during the first year

Metacarpal bones and phalanges may be seen

Sesamoid bones of the abductor pollicis brevis, flexor


pollicis brevis tendons, tendons of the adductor
pollicis, first palmar interosseous muscles can be
recognized

Sesamoid bones overlap the first


metacarpophalangeal joint

Wrist and hand - Lateral view

The articulation of the radius and the lunate well


shown

The concave distal surface of the lunate articulating


with the capitate seen

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Upper and Lower Limbs

Pisiform bone visualized anteriorly and may overlap


the scaphoid bone

1.

LOWER LIMB
The primary function of the lower limb is to support
the weight of the body and to provide a stable
foundation in standing, walking and running
become specialize for locomotion
The lower limbs are divided into the hip girdle, the
thigh, the knee, the leg, the ankle and the foot.

Table 1. The bones of the lower extremity

PARTS:

Ilium
supports the flank
superior broad and expanded portion which extends
upward from the acetabulum
a)

b)
c)
d)
e)
f)
g)

!
INNOMINATE BONE

a large, flattened, irregularly shaped bone, constricted


in the center and expanded above and below.

It meets its fellow on the opposite side in the middle


line in front, and together they form the sides and
anterior wall of the pelvic cavity.

Consists of three parts: the ilium, ischium, and


pubis, which are distinct from each other in the
young, but are fused in the adult; the union of the
three parts takes place in and around a large cup
shaped articular cavity, the acetabulum, which is
situated near the middle of the outer surface of the
bone.

Hip bones articulate with the sacrum at the sacroiliac


joints and form the anterolateral walls of the pelvis;
they articulate with one another anteriorly at the
symphysis pubis.
Figure 10. The innominate bone

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h)
i)

j)

Iliac crest a long curved ridge along the border


of the ilium, which is the uppermost and largest
bone in the pelvis; convex in its general outline
but is sinuously curved, being concave inward in
front, concave outward behind; palpable
Anterior Superior Iliac spine - uppermost,
situated at the junction of the crest and anterior
border; more prominent in women
Anterior Inferior Iliac spine below a notch
(where Sartorius takes origin) and ends in the
upper lip of the acetabulum
Posterior Superior Iliac spine - serves for the
attachment of the oblique portion of the posterior
sacroiliac ligaments and the multifidus
Posterior Inferior Iliac spine - corresponds with
the posterior extremity of the auricular surface
Iliac fossa- a large, smooth, concave surface,
which gives origin to the Iliacus and is perforated
at its inner part by a nutrient canal
Arcuate line - below the iliac fossa is a smooth,
rounded border which runs downward, forward,
and medialward
Greater Sciatic notch above and behind the
acetabulum, below the posterior inferior spine
Iliac tubercle - elevated and rough, for the
attachment of the posterior sacroiliac ligaments
and for the origins of the Sacrospinalis and
Multifidus; 4 cm. from superior iliac spine.
Gluteal lines attachment for muscles
o Posterior Gluteal line
the shortest
begins at the crest, about 5 cm in front of its
posterior extremity
distinctly marked at first, but becomes less
distinct, and is often altogether lost as it
passes downward to the upper part of the
greater sciatic notch, where it ends, it
o Anterior Gluteal line
the longest

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Upper and Lower Limbs


begins at the crest, about 4 cm behind its
anterior extremity
ends at the upper part of the greater sciatic
notch
the space between the anterior and
posterior gluteal lines and the crest is
concave, and gives origin to the Gluteus
medius; also called middle gluteal line
o Inferior Gluteal line
the least distinct
begins in front at the notch on the anterior
border
ends near the middle of the greater sciatic
notch

3.

PARTS:
a) Body - forms one-fifth of the acetabulum, contributing
by its external surface both to the lunate surface and
the acetabular fossa
b) Superior ramus - extends from the body to the
median plane where it articulates with its fellow of the
opposite side. It is conveniently described in two
portions, viz., a medial flattened part and a narrow
lateral prismoid portion
c) Inferior ramus - is thin and flattened. It passes
lateralward and downward from the medial end of the
superior ramus; it becomes narrower as it descends
and joins with the inferior ramus of the ischium below
the obturator foramen
d) Pubic crest forms the upper body of the pubis;
medial to the pubic tubercle, it extends from this
process to the medial end of the bone
e) Pubic tubercle - projects forward; the inferior crus of
the subcutaneous inguinal ring (external abdominal
ring), and the inguinal ligament (Pouparts ligament)
are attached to it; prominence on the body
f) Pecten (pectinial line, pectin pubis) - the
continuation on the superior ramus pubis of the linea
terminalis, forming a sharp ridge
g) Obturator crest medial, sharp margin, forming part
of the circumference of the obturator foramen, and
giving attachment to the obturator membrane

Figure 11. Ilium, Ischium and Pubis


2.

PARTS:

Pubis
forms the front of the pelvis and supports the
external organs of generation
extends medial ward and downward from the
acetabulum and articulates in the middle line with
the bone of the opposite side

Ischium
the lowest and strongest portion
it proceeds downward from the acetabulum,
expands into a large tuberosity, and then, curving
forward, forms, with the pubis, a large aperture, the
obturator foramen
a)

b)
c)

d)

Ischial tuberosity forms the posterior aspect of


the lower part of the body of the bone;
prominence in the body, surface detaches in
sitting position
Ischial spine projects from the posterior border
of the ischium and intervenes between the
greater and lesser sciatic notches
Ischial ramus - the superior ramus projects
downward and backward from the body and
presents for examination three surfaces: external,
internal, and posterior. The inferior ramus is the
thin, flattened part of the ischium, which ascends
from the superior ramus, and joins the inferior
ramus of the pubisthe junction being indicated
in the adult by a raised line
Lesser Sciatic notch - is smooth, coated in the
recent state with cartilage, the surface of which
presents two or three ridges corresponding to the
subdivisions of the tendon of the Obturator
internus, which winds over it

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Figure 12. Innominate bone (Lateral view)


4.

Acetabulum
Point of attachment of the head of femur
Deep, cup-shaped, hemispherical depression,
directed downward, laterally, and forward

5.

Obturator Foramen
A large aperture, situated between the ischium and
pubis

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15

Upper and Lower Limbs


In the male it is large and of an oval form, its
longest diameter slanting obliquely from before
backward
In the female it is smaller, and more triangular
bounded by a thin, uneven margin, to which a
strong membrane is attached, and presents,
superiorly, a deep groove, the obturator groove,
which runs from the pelvis obliquely medially and
downward
FEMUR

Thigh bone

Articulates with the acetabulum to form the hip joint.

Articulates below with tibia and the patella to form the


knee joint.
PARTS:
Head
Forms about two-thirds of a sphere
Articulates with the acetabulum of the hip bone to
form the hip joint
b) Fovea Capitis
A small depression along the center of the head
serves as an attachment for the ligament of the head
part of the blood supply to the head of the femur from
the obturator artery is conveyed along this ligament
and enters the bone at fovea
c) Neck
Connects the head to the shaft
Passes downward, backward and laterally
Makes an angle of about 125 (slightly less in female)
with the long axis of the shaft
o Size of the angle can be altered by disease
o Common site of fractures especially in the elderly
d) Greater and Lesser trochanter
Large eminences situated at the junction of the neck
and the shaft
e) Intertrochanteric Line
Connects the two trochanters anteriorly where the
iliofemoral ligamentis attached
f) Intertrochanteric Crest
A prominence that posteriorly joins the two
trochanters on which an elevation is found, quadrate
tubercle
a)

Figure 13. Femur and Patella


Gluteal Tuberosity
On the posterior surface of the shaft below the greater
trochanter
Site of attachment of the gluteus maximus muscle
h) Shaft
Smooth and rounded on its anterior surface
Posteriorly, it has a ridge called Linea aspera to
which are muscles attached
i) Lower Part of the Femur
The medial margin continues below as the medial
supracondylar ridge to the adductor tubercle (small
prominence on medial epicondyle) on the medial
condyle.
The lateral margin continues below with the lateral
supracondylar ridge.
j) Lateral and Medial Epicondyles
Found immediately below the two epicondyles
Separated posteriorly by the intercondylar notch /
intercondylar fossa.
Anterior surface is joined by an articular surface for
patella, patellar surface.
Takes part in the formation of the knee joint.
k) Popliteal Surface
A flat, triangular area on its posterior surface between
the two epicondyles
g)

PATELLA

Largest sesamoid bone

Triangular in shape

Separated from skin by subcutaneous bursa

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Upper and Lower Limbs

2.
!

Figure 14. Patella


TIBIA AND FIBULA
1. Tibia

The large weight-bearing medial bone of the legs.

Articulates with the condyles of the femur and the


head of the fibula above and with the talus and the
distal end of the fibula below.

Has an expanded upper end, a smaller lower end,


and a shaft.

Anterior and posterior intercondylar areas


Separates the upper articular surfaces of the tibial
condyles
Lies between these areas is the intercondylar
eminence
Articulates with the condyles of the femur and the
head of the fibula above and with the talus and the
distal end of the fibula below.

c)

Shaft
Triangular in cross section, presenting 3 borders and
3 surfaces
Anterior border forms the shin.
Becomes rounded below, where it becomes
continuous with the medial malleolus

d)

Tuberosity
Located at the junction of the anterior border with the
upper end of the tibia
Receives the attachment of the ligamentum patellae

e)

Lateral/Interosseous border
Gives attachment to the interosseous membrane

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Soleal line
An oblique line located at the posterior surface of the
shaft
For the attachment of the soleus muscle
The lower end of the tibia is slightly expanded and
on its inferior aspect shows a saddle-shaped
articular surface for the talus

g)

Medial malleolus
Lateral surface articulates with the talus

Fibula

A slender lateral bone of the leg

Takes no part in the articulation at the knee joint

Below: forms the lateral malleolus of the ankle joints

Takes no part in the transmission of body weight

Provides attachment for muscles

PARTS:
a) Head
The upper end
Surmounted by a styloid process
Possesses an articular surface for articulation with
the lateral condyle of the tibia

PARTS:
a) Lateral and medial condyles located at the upper
end
aka lateral and medial tibial plateaus
Articulate with the lateral and medial condyles of the
femur and the lateral and medial menisci intervening
o Lateral condyle
Possesses on its lateral aspect a small circular
articular facet for the head of the fibula
o Medial condyle
Has on its posterior aspect the insertion of the
semimembranosus muscle
b)

f)

b)

Shaft
Long and slender
Has 4 borders and 4 surfaces
Medial/Interosseous border
Gives attachment to the interosseous
membrane

c)

Lower end of the femur


Forms the triangular lateral malleolus

d)

Articular facet
Located on the medial surface of the lateral
malleolus
For articulation with the lateral aspect of the talus

e)

Malleolar fossa
Depression below and behind the articular facet

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Upper and Lower Limbs


Figure 15. Tibia and Fibula
TARSALS

Calcaneum, Talus, Navicular, Cuboid, Cuneiform (3)


bones

Only the talus articulates with the tibia and the fibula
at the ankle joint

o
o

Calcaneum

largest bone of the foot and forms the prominence of


the heel

articulates above with the talus and in front with the


cuboid.

It has six surfaces:


o Anterior surface - small and forms the
articular facet that articulates with the cuboid
bone
o Posterior surface- forms the prominence of
the heel and gives attachment to the tendo
calcaneus (Achilles tendon)
o Superior surface- dominated by two
articular facets for the talus, separated by a
roughened groove, the sulcus calcanei
o Inferior surface- has an anterior tubercle in
the midline and a large medial and a smaller
lateral tubercle at the junction of the inferior
and posterior surfaces
o Medial surface- possesses a large, shelflike
process, termed the sustentaculum tali,
which assists in the support of the talus.
o Lateral surface- almost flat; the peroneal
tubercle (small elevation on its anterior part)
separates the tendons of the peroneus
longus and brevis muscles

Talus

articulates above at the ankle joint with the tibia and


fibula, below with the calcaneum, and in front with the
navicular bone
possesses a head, a neck, and a body
Head
o directed distally and has an oval convex
articular surface for articulation with the
navicular bone
o articular surface is continued on its inferior
surface, where it rests on the sustentaculum
tali behind and the calcaneonavicular
ligament in front.
Neck
o lies posterior to the head and is slightly
narrowed
o upper surface is roughened and gives
attachment to ligaments, and its lower surface
shows a deep groove, the sulcus tali.
o The sulcus tali and the sulcus calcanei in the
articulated foot form a tunnel, the sinus tarsi,
which is occupied by the strong interosseous
talocalcaneal ligament
Body
o Cuboidal
o superior surface articulates with the distal
end of the tibia; convex from before backward
and slightly concave from side to side.

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lateral surface presents a triangular articular


facet for articulation with the lateral malleolus
of the fibula
medial surface has a small, comma-shaped
articular facet for articulation with the medial
malleolus of the tibia
posterior surface is marked by two small
tubercles, separated by a groove for the flexor
hallucis longus tendon.

Navicular Bone

tuberosity can be seen and felt on the medial border


of the foot 1 in. (2.5 cm) in front of and below the
medial malleolus

it gives attachment to the main part of the tibialis


posterior tendon
Cuboid Bone

deep groove on the inferior aspect of the cuboid bone

lodges the tendon of the peroneus longus muscle


Cuneiform Bones

Composed of three small, wedge-shaped bones

articulate proximally with the navicular bone and


distally with the first three metatarsal bones

wedge shape contributes greatly to the formation and


maintenance of the transverse arch of the foot

Figure 16. Calcaneum, Talus, Navicular, and Cuboid bones


METATARSALS AND PHALANGES

resemble the metacarpals and phalanges of the hand

each possesses a head distally, a shaft, and a base


proximally

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The five metatarsals are numbered from the medial to
the lateral side
First metatarsal bone
large and strong ; plays an important role in
supporting the weight of the body
head is grooved on its inferior aspect by the medial
and lateral sesamoid bones in the tendons of the
flexor halluces brevis
Fifth metatarsal
has a prominent tubercle on its base that can be
easily palpated along the lateral border of the foot
The tubercle gives attachment to the peroneus
brevis tendon

Each toe has three phalanges except the big toe,


which possesses only two

Figure 18. Pelvic girdle with Lumbosacral joint (encircled)


2.

Figure 17. Tarsals, metatarsals, phalanges (superior view)


JOINTS OF THE LOWER LIMBS
1. Sacroiliac joint
Classification

Symphisis pubis

Classification

Cartilaginous

Articulating bones

Pubis ! Pubis

Ligaments

Superior and inferior


pubic ligament

Movements

Almost no movement

Synovial on the anterior


Syndesmosis on the
posterior

Articulating bones

Sacrum ! 2 Ilium

Ligaments

a. Posterior and
interosseous sacroiliac
ligament
b. Anterior sacroiliac
ligament
Iliolumbar ligament

Movements

Limited
!

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Figure 19. Pelvic girdle with pubic symphysis (encircled)
3. Acetabulofemoral joint (Hip joint)
Classification

Synovial, Ball and Socket


Multiaxial

Articulating bones

Head of femur !
Acetabulum (ilium, ischium,
pubis)

Ligaments

a. Iliofemoral ligament
b. Pubofemoral ligament
c. Ischiofemoral ligament
d. Transverse acetabular
e. Ligament head of femur

Movements

a. Flexion-extension
b. Abduction-adduction
c. Lateral rotation
d. Medial rotation
e. circumduction

Movements

a. Flexion-extension
b. Rotation (medial and lateral)

Figure 21. Knee Joint


5.

Talocrural joint (Ankle joint)

Classification

Synovial, Hinge

A r t i c u l a t i n g Medial malleolus ! medial surface


bones
of talus
Ligaments

a. Anterior talofibular ligament


b. Posterior talofibular ligament
c. Calcaneofibular ligament
d. Medial ligament of ankle

Movements

a. Dorsiflexion
b. Plantarflexion

!
Figure 20. Acetabulofemoral joint
4.

Knee Joint

Classification

Synovial, Hinge

A r t i c u l a t i n g a. Medial and lateral condyles of


bones
femur ! condyles of tibia
b. femur ! patella
Ligaments

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a. Ligamentum patellae
b. Lateral collateral ligament
c. Medial collateral ligament
d. Oblique popliteal ligament
e. Anterior and posterior cruciate
ligaments

Figure 22. Talocrural Joint


6.

Subtalar/Talocalcareal joint

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Classification

Synovial, Plane

RADIOGRAPHS
1. Pelvis

A r t i c u l a t i n g Inferior surface
bones
of body of talus
(posterior calcaneal
Articular facet) articulates
with superior surface
(posterior talar articular surface) of
calcaneus
Ligaments

Capsule support:
a. Medial, Lateral, Posterior
talocalcaneal ligaments
Binds bones together:
Interosseous talocalcaneal ligament

Movements

Inversion
Eversion
!

2.

Sacrum and coccyx obscured by pubic symphysis

Hip Joint

Figure 23. Talocalcareal joint


PLANTAR ARCHES

Supports the body on an erected posture by:


a) Distribution of weight
b) Acting as shock absorber
c) Adapting to changes in surface contour
Parts:
Medial Longitudinal Arch:
1. Calcaneum
2. Talus
3. Navicular bone
4. 3 cuneiform bones
5. First 3 metatarsals
Lateral Longitudinal Arch:
1. Calcaneum
2. Cuboid
3. 4th and 5th metatarsal
Transverse Arch
1. Bases of metatarsal
2. Cuboid
3. 3 cuneiform

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3.

Shentonss Line - continuous curve formed by the


upper margin of the obturator foramen and Inferior
margin of the neck of the femur

Knee Joint

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ABNORMALITIES IN THE LOWER LIMBS


1. Genu Valgus (Knock Knee)
Distal tibia directed towards median sagittal
plane
2. Genu Varus (Bow-legged)
Medial angulation of leg in relation to thigh
Outward curvature of femur and tibia

!
4.

Ankle

Figure 24. (L-R) Genu valgum, Normal knees, Genu varum


3.

Clubfoot
Foot twisted out of shape
The foot is inverted
the ankle is plantarflexed
the forefoot is adducted

!
5.

Feet

Figure 25. Clubfeet


4.

Flatfoot
Flexible: result from loose or degenerated
intrinsic ligaments
Rigid: bone deformity (such as a fusion of
adjacent tarsal bones)
Acquired: due to trauma, degeneration with
age
Head of the talus displaces inferomedially
and becomes prominent

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Figure 26. Normal foot (left) vs Flatfoot (right)

REFERENCES:
1.
2.

Clinical Anatomy by Regions 9th Ed. (Snell)


PPT

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