Shoulder and Hip Joints
Anterior Cruciate Ligament
Anterior part of tibia to posterior lateral condyle of femur. Prevents anterior displacement of tibia. Prevetns hyperextension of knee.
Spinal Centers for Elbow Joint Movement
Flexion- C5, C6 Extension C6, C7 Supination of forearm: C6 Pronation of forearm: C7, C8
Spinal Centers for Hip Joint Movements
Flexion/Adduction: L2, L3 Extension/Abduction: L4, L5
Anterior Cruciate Ligament Injury
Hyperextension. *Anterior Drawer Sign- tibia can be pulled anteriorly suggesting a torn ACL.
Posterior Cruciate Ligament Injury
Hyperflexion. *Posterior Drawer Sign- tibia can be pulled posteriorly suggesting a torn PCL.
Ligaments of Hip Joint Capsule
Illiofemoral Ligament: Anterior Pubofemoral Ligament: Anterior Inferior Ischiofemoral Ligament: Posterior
Spinal Centers for Intertarsal Joint Movement
Inversion of Foot: L4, L5 Eversion of Foot: L5, S1
Shoulder Joint
*most unstable and mobile joint Sternoclavicular joint Acromioclavicular joint Glenohumoral joint
Lateral Ligament
Attaches to lateral malleolus and talus and calcaneus.
Hip Joint
Ball and socket synovial joint: Head of femur and acetablum of os coxa. Innervation: Femoral, obturator, sciatic, and superior gluteal n.
Glenohumeral Joint
Ball and socket synovial joint: head of humerous and glenoid cavity of scapula. Innervation: axillary, musculocutaneous, etc. *stability from rotator cuff. Often dislocated inferiorly.
Close Pack and Loose Pack
Close Pack: Greates stability Loose Pack: Least stability
Close and Loose pack of the Talocrural Joint
Close: Dorsiflexion Loose:Plantarflexion
Close and Loose Pack of the Elbow Joint
Close: Extension Loose: Flexion
Close and Loose Pack of the Knee Joint
Close: Extension Loose: Flexion
Close and Loose Pack of Hip Joint
Close: extension Loose: flexion
Close and Loose Pack of the Radiocarpal Joint
Close: extension Loose: flexion
Scaphoid Fractures
Commonly occur from falling on outstretched hand. Wrist pain, especially in anatomical snuff box. Avascular necrosis can occur.
Dislocation of Knee
Complete dislocations are uncommon.
Wrist (Radiocarpal) Joint
Condyloid synovial joint: radius, fibrocartilage, scaphoid, lunate, and triquetal. Intercarpal joints provide full range of movement. NO ROTATION OCCURS AT THE WRIST! Innervation: Medial, ulnar, radial
Patellar Ligament
Continuation of quadricepts ligament, attahes to patella
Talocrural Joint Capsule Components
Deltoid ligament Lateral ligament
Shoulder Seperation
Dislocation of acromioclavicular joint. Causes pain during abduction of shoulder, edema, tenderness, deformity. 1= sprain 2= subluxation 3= complete dislocation and tear coracoclavicular lig.
Ligament and Artery to Head of the Femur
Do not provide strenght or significant vascularization to the joint.
Spinal Centers for Talocrural Joint Movement
Dorsiflexion: L4, L5 Plantar Flexion: S1, S2
Fracture and Dislocations of the Ankle Joint
Due to forced overinversion or overeversion. Distal tibia or fibula is fractured.
Spinal Centers for Wrist Joint Movement
Extension: C6, C7 Flexion: C6, C7
Spinal Centers for Joint Movements of Knee
Extension: L3, L4 Flexion: L5, S1
Bursa
Flattened sac containing synovial fluid. Located where tendon rubs against bone, ligament, or other tendons.
Spinal Centers for Glenohumoral Joint Flexion Extension Lateral Rotation Medial Rotation Abduction Adduction
Flexion- C5 Extension- C6, C7, C8 Lateral Rotation- C5 Medial Rotation- C6, C7, C8 Abduction- C5 Adduction- C6, C7, C8
Tibial (Medial) Collateral Ligament Injury
Lateral blow to knee.
Fibular Collateral Ligament
Lateral epicondyle of femur to head of fibula. DOES NOT attach to lateral meniscus. Prevents hyperADDuction.
Dislocation of Hip Joint
Limb medially rotated and appears shorter. Congenital: Inadequate development of acetablum or femoral head. Acquired: Commonly occurs in car acidents. Femoral head dislocates posteriorly. *Sciatic nerve likely to be damaged.
Fractures of the Femoral Neck
Lower limb appears laterally rotated and shorter. Interochanteric: Fracture distal to joint capsule. Intracapsular: Fracture within the joint capsule. *Avascular Necrosis: Common in intracapsular fractures because retinacular aa. cut off and artery to head of femur is inadequate.
Fibular (Lateral) Collateral Ligament Injury
Medial blow to knee; uncommon.
Tibial Collateral Ligament
Median epicondyle of femur to median epicondyle of tibia. Attaches to medial meniscus. Pervents hyperABduction.
Medial and Lateral Menisci
Meial Meniscus: On medial condyle of tibia; connected to tibial collateral ligament. Lateral Meniscus: On lateral condyle of tibia.
Subluxation of Head of Radius
Occurs from sudden pull of radius distally. Tears annular ligament.
Shoulder Joint Dislocation
Occurs when humerous is abducted. Head of humerous pushed inferior, tears through inferior capsule, flexor and adductors pull humerous upward. Axillary nerve and posterior circumflex a.v. can be damaged.
Pott Fracture
Overeversion which pulls deltoid ligament and breaks off medial malleolus. Talus moves lateral and breaks off the lateral malleolus of tibia and fractures the distal part of fibula.
Retinacula of Femur
Part of capsule which extends from acetablum to neck of the femur. Contains retinacular aa. (br. of circumflex aa.)
Dislocation of Elbow
Posterior dislocation most common when falling on outstretched hand (radius and ulnar driven posteriorly). Ulnar nerve most likely to be damaged; median and brachial if severe enough.
Posterior Cruciate Ligament
Posterior tibia to anterior medial condyle of femur. Prevents posterior displacement of tibia. Prevents hyperflexion of knee (almost never happens).
Why are children more prone to radial head subluxations?
Radial heads are immature and slip out of the annular ligament.
Deltoid Ligament
Supports medial talocrural joint and prevents overeversion of the foot. If foot is overeverted the medial maleolus will break off before the ligament tears.
Ankle (Talocrural) Joint
Synovial hinge joint: Talus, tibia, fibula Dorsiflexion and plantar flexion. EVERSION AND INVERSION DO NOT OCCUR HERE! Innervation: Tibial, superficial fibular, deep fibular.
Knee Joint
Synovial hinge joint: femure, tibia, patella Joint capsule provides strenght medial, lateral, and posterior. Patellar ligament provides support anterior. Innervation: femoral, obturator, sciatic nerves
Elbow joint
Synovial hinge joint: humerus, radius, and ulna Stable in adults, not in children. Innervation: radial, musculocutaneous, median and ulnar (passes behind median epicondyle).
Acromioclavicular Joint
Synovial joint: acromion and lateral end of clavicle Innervation: Suprascapular, axillary, lateral pectoral nn. *strengthened superiorly by acromioclavicular lig. *anchored to coracoid process by coracoclavicular lig.
Sternoclavicular Joint
Synovial joint: clavical and manubrium Innervation: (medial) supraclavicular and sublavius nn. *clavicle will fracture before joint dislocates
Sprains of the Talocrural Joint
Tearing ligaments without fractrue or dislocation. Almost always an inversion injury damaging the lateral ligament. *Eversion sprains are rare due to strength of deltoid ligament.
Unhappy Triad of Injuries
Tibial collateral ligament, medial meniscus (attached to the tibial collateral ligament), and anterior cruciate ligament (typically). All three commonly injured in lateral blow to the knee.
What structures may be damaged in a knee dislocation?
Tibial nerve, popliteal a.v., and small saphenous v.
Ligaments of Elbow Joint
Ulnar collateral ligament Radial collateral ligament Annular ligament- In children the radial heads are immature and easy to subluxate from this joint.