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.