Apps to Functional Anatomy Lecture 6

Lower Limb Functional Anatomy

Part A
Hip Anatomy, DOF & Injuries

Lower Limb Overview

ž Primary support and locomotion mechanism
ž Humans heavily dependent due to bipedalism
ž Human upper and lower limb discrepancies pronounced compared to primates
ž Lower limb comprised of largest muscles and bones in the body
ž Structured to undergo the largest forces
regularly encountered by the body

Lower Limb Segment Masses

Large force producing structures proximal;
Femur size
Thigh muscle PCSA and pennation angle

Smaller passive shock absorbing tendinous distal;

Foot arches
Achilles tendon
Force dissipation
Proprioception

Pelvis
ž Link between the lower limb and the trunk
ž Cradles the internal organs of the torso
ž Females wider pelvis to allow child birth
ž Large articular surfaces for hip and trunk muscles
ž Often referred to as centre of mass point in body
Pelvic Bones

Anatomical Structure – Pelvic Girdle

ž Pelvic girdle
— Ilium (upper)
— Provides points of origin for muscles involved in hip abduction (Gmed, Gmin)
— Ischium (posterior)
— Origin for muscles involved in hip extension (Gmax, BF, Semiten., Seminmen.)
— Pubis (anterior)
— Origin for muscles involved in hip flexion (RF, Sar)
— Sacrum
— Left and right pelvic bones joined together posteriorly

Functional Anatomy of the pelvic girdle

Pubic Symphasis
ž Connects left and right anterior part of the pelvis
ž Weak cartilaginous joint supported by a pubic ligament (linked with tendonitis –
osteitis pubis)

Sacroiliac (two – left and right)

ž Runs posteriorly and is the strongest joint held by powerful ligament support
(strongest in the whole human body)
ž Transmits body weight to the hip and subjected to lumbar loading. Also absorbs
shear forces during gait
ž Males have stronger joints, and thus are less flexible than females in pelvis ROM

Femoral (hip joint)

ž Stable, yet mobile – similar to glenohumeral joint, although reduced sub/dislocation
– strong musculature
ž 70% of femoral head articulates with the acetabulum, compared with only 25% of
the humeral head with the glenoid cavity.
 ž Synovial (ball & socket) joint between the femoral head and acetabulum /
acetabulum labrum (similar to glenoid fossa / labrum) at the glenohumeral joint.

Hip Joint
ž Ball and socket joint; spherical femoral head (ball) and convex acetabulum (socket)
ž Highly mobile yet stable joint due to architecture, ligamenture and musculature
ž Three DOF;
— flex/ext; ~120°/~15°
— add/abd; ~25°/~45°
— int/ext rot; ~40°/~40°

“Hip & Shoulder” joint similarities

ž Shoulder girdle.
— Acromioclavicular
— Scapulothoracic
— Sternoclavicular
ž Pelvic girdle
— Sacroilliac
— Pubic symphasis

ž Shoulder joint
— Glenohumeral
ž Hip joint
— Femoral

Movements of the Pelvis

Hip and Pelvis Synergistic Movement
ž Enables large ROM of thigh
ž Realistically lumbar spine ROM

Primary Movements of the Pelvis

Hip Joint Musculature

ž Complex due to multiple DOF and ROM
ž Important for both stability and movement
 ž A range of pennation angles and muscle structures – multiple jobs
Short tendons, large CSA

Hip Related Injury

Hamstring Tears
ž Usually occurs during gait swing phase, when muscle is lengthening;
Hip flexion and knee extension
ž Eccentric contraction from both joints

Hip Joint Fracture

ž Fracture at the femoral neck
ž Generally impact related, i.e. falls
ž Decrease in bone mineral density in the elderly
ž Hip fracture significantly decreases quality and life expectancy in older population

Part B
Knee Anatomy, DOF & Injuries

Femur
ž Largest bone in the body
ž Articulates with hip and knee joint
ž Muscles capable of creating largest torques in body
ž Obtuse angle of head allows foot (base of support) under body (centre of mass)
ž Females larger pelvis
= larger femoral angle
or q angle (frontal plane)

Functional Anatomy of the knee joint

ž Consists of THREE articulations that control flexion / extension with small amounts of
lateral flexion and rotation.

Tibiofemoral (the knee joint)

ž Articulation between the body’s two longest bones (femur and tibia)
ž The soft tissue (ligaments) around this joint help to support and maintain correct
joint position (discussed later)
 Patellofemoral
ž The patella (knee cap) fits along the trochlear groove on the femur.
ž The patella’s primary role is to produce mechanical advantage of the
quadriceps.
Tibiofibular
ž Not as significant as the other two joints, although 16% of loading on the
lower leg is transmitted through this joint. Primarily acts to dissipate forces
and torsional stress.

ž Soft tissue of the tibiofemoral joint

ž FOUR important ligaments act to support and maintain joint position
— Medial & lateral collateral ligaments protect against medial forces and lateral
forces, and prevents over rotation of the joint. Both lie within the joint
— Anterior & Posterior cruciate ligaments offer support in anterior and posterior
directions of the knee. The ACL is 40% longer and is more commonly injured
(stability loss)

Patella
ž Largest seasmoid bone in the body
ž Function
— Transmits the muscle force of the quadriceps to the tibia
ž Advantages
— Increases surface area contact
of quadriceps tendon in knee
flexion
— Improves the leverage of the
quadriceps on the tibia

Knee Joint Movement

Primarily a single degree of freedom joint
Flexion/Extension
- Swing phase walking
- Weight acceptance stance phase
- Limited ROM in hyperextension

Flexion involves:
internal rotation of the tibia
Medial condyle greater movement on tibia

Knee Musculature
Quadriceps group
ž Primary knee flexors
ž Large PCSA pennate muscles
ž Converge on patella
ž Multi pennation stabilises flexor torque

Hamstrings group
ž Primary knee flexors
ž Quadriceps antagonist
ž More fusiform and tendinous than quadriceps – longer, <F, >ROM
ž Two joint muscles have greater ROM to act through
ž Hamstrings to quadriceps torque generation ratio; ~50% at low speeds; ~80% at high
speeds

Valgus / varus knee

ž Genu Varum (bowed) and genu valgum (knocked) are conditions based on Q-angle.
Valgus knees are more common in western society, linked with obesity and a wide
pelvis

Knee Joint Injuries

ž Incorrect loading / mal-alignment
ž Big loads; Body mass & ground forces
ž Big levers; Tibia length & femur length
=Big forces
Collateral ligament sprain/rupture
ž Knee – very limited add/abd
ž Acute injury
ž Knee forced into greater add/abduction than ROM
ž Either trauma from opposition or overload due to gait error

Thigh Injuries
Osteoarthritis
ž Degeneration of the articular cartilage
ž Constant loading across the lifespan OR acute meniscal tear
ž Cartilage degrades at a faster rate than the body can repair
ž Results in direct femoral/tibial bone contact

Part C
Lower Leg Anatomy, DOF & Injuries
Lower Leg Musculature
ž Elongated tendinous muscles
ž Generally small cross sectional area
ž Therefore function in dynamic stretch shorten capacities over large ROM
ž Must stabilise the mobile ankle/subtalar complex under high mechanical demand
landing and gait
ž Achilles tendon plantar flexors largest PCSA & 1st and 2nd class lever
ž Surprisingly simply represented in prosthetics

Compartments (syndrome?)
Anterior
Dorsi- flexors but also inversion and eversion
Phalange extensors
Lateral
Primary evertors; Peroneal group
Posterior
Plantar flexion; greatest PCSA most common and highest mechanical demand
Deep Posterior
Additional plantar flexors, invertors and evertors
Phalange flexors

The Foot
Function
Support (heel) and propulsion (ball)
Foot Bones
“Elastic Arched Structure”
Flattened when loaded during locomotion for shock absorption
n Longitudinal arch:
n Heel to heads of five metatarsals.
n Supported by the plantar fascia.
n Transverse arch:
n Side-to-side concavity.
n Anterior tarsal bones & metatarsals.

Subtalar Joint
Talus – Keystone of the foot arch, transfers load
n Gliding joint between underside of talus and upper & anterior aspects of calcaneus.
n Plantar calcaneonavicular “spring ligament” helps support talus.

Movements
Supination
-Combination of inversion (plantar foot surface faces ‘in’ towards midline)
and adduction (foot rotates in toward midline)
Pronation
-Combination of eversion and abduction
Dorsi flexion
and
Plantar flexion

Structure of the Ankle Joint

n Hinge joint
n Articulation of talus with malleoli of tibia & fibula.
n Dorsi and Plantar Flexion only.
n Bound together by ligaments

Foot Injuries
Metatarsal Stress fractures
Plantar Fasciitis
ž Exposure to very high forces
— Gymnastic landings 14x BW
ž Relatively small structures

Lower Leg Stress Injury – similar to compartment syn.

ž Tissue structure and repair capacity below load exposure
ž “Shin Splints” – Can mean stress fracture, muscle or fascia tears, compartmental
pressure
Ankle Sprain
ž Ankle inversion beyond normal ROM
ž Damage to lateral ligaments
ž Performance error, insufficient stabilisation